BACKGROUND: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. METHODS: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately -89degrees C, and the icing time was 5~20 seconds. RESULTS: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications-one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. CONCLUSION: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.
Airway Obstruction ; Anoxia ; Argon Plasma Coagulation ; Bronchoscopes ; Cryotherapy ; Dyspnea ; Electrocoagulation ; Extreme Cold ; Hemoptysis ; Humans ; Korea ; Lung ; Lung Neoplasms ; Mediastinal Emphysema ; Nitrous Oxide ; Photochemotherapy

BACKGROUND: Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea. METHODS: We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records. RESULTS: Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor (kappa coefficient=0.06). CONCLUSION: In the present study, the two prediction rules had a different predictive accuracy for pulmonary embolisms. Applying the revised Geneva rules to inpatients and emergency ward patients suspected of having PE may allow a more effective diagnostic process than the use of the Wells rules.
Angiography ; Emergencies ; Europe ; Humans ; Inpatients ; Korea ; North America ; Prevalence ; Pulmonary Embolism ; Retrospective Studies ; ROC Curve

BACKGROUND: Patients with diabetes mellitus are highly sensitive to infections, including tuberculosis, and the longer the duration of DM, the greater is the prevalance of tuberculosis. We studied the difference of the clinical manifestations, radiologic findings, resistance and others factors of patients with diabetic and non-diabetic pulmonary tuberculosis. METHODS: The patients we enrolled in this study were newly diagnosed with pulmonary tuberculosis from January 2003 to December 2005. RESULTS: 159 patients were enrolled in this study. There were 30 pulmonary tuberculosis patients with diabetic mellitus (DMTB) and 129 pulmonary tuberculosis patients without diabetic mellitus (non-DMTB). There was no difference in the basic characteristics and clinical manifestation between both the groups. For the chest X-ray findings, the moderately advanced tuberculosis patients were the most common (43.3% in the DMTB group and 49.6% in the non-DMTB group). There was no relation between the severity of tuberculosis activity on chest x-ray and the presence of diabetes. The prevalence of cavitory lesions in the DMTB group was significantly higher than that in the non-DMTB group, but the prevalence of atelectasis was higher in the non-DMTB group (p<0.05). There was no difference in the incidence of lower lung involvement, the number of involved lobes, the number of treatment days and the radiological sequelae in both groups. CONCLUSION: The DMTB patients had a higher incidence of cavitory lesions and a higher incidence of atelectasis than the non-DMTB patients.
Diabetes Mellitus ; Humans ; Incidence ; Lung ; Prevalence ; Pulmonary Atelectasis ; Retrospective Studies ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

Malignant mesothelioma (MM) is the aggressive tumor of serosal surfaces. There are crude pathogenetic results regarding the biology of MM. Coordinated upregulations of p53 gene expression are shown in malignancies. We believed that there are changes in the p53 expression with transformation from reactive hyperplasia to MM. A 65-year-old male was admitted the hospital because of left pleuritic chest pains in 2004. Chest computed tomography (CT) results showed left pleural effusions with loculation and pleural thickening. Pathologic findings revealed reactive mesothelial hyperplasia. In 2008, the patient again felt left pleuritic chest pains. Chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of his left pleura. He was diagnosed with well-differentiated papillary mesothelioma. Serial change was analyzed by immunohistochemical staining for p53 of pleural tissues. There were no remarkable changes in p53 expressions during the transformation to MM.
Aged ; Biology ; Chest Pain ; Diagnosis ; Follow-Up Studies* ; Genes, p53 ; Humans ; Hyperplasia ; Male ; Mesothelioma* ; Pleura ; Pleural Effusion ; Thorax ; Tomography, X-Ray Computed ; Tumor Suppressor Protein p53

BACKGROUND: We aimed to investigate the role of the physician in practice and the factors that influence the success rate of smoking cessation. METHODS: This study retrospectively analyzed 126 adult smokers who had visited the outpatient department of pulmonology, and received motivational interviewing with or without supplement drugs. The findings include continuous smoking abstinence rate, which was evaluated at 6, 12 and 24 weeks, and the factors associated with continuous abstinence for 6 months or longer. RESULTS: The patients with only motivational interviewing accounted for 57.9%, while the nicotine patch therapy was applied to 30.2%; and varenicline was prescribed to 11.9%. The smoking cessation success rates of at 6, 12, and 24 weeks were 55.6%, 47.6%, and 33.3%, respectively. However, even in the failure group at six months, tobacco consumption was decreased under 10 cigarettes per day in 42.1% (53/126). In multivariate logistic regression analysis, degree of Fagerstom Test for Nicotine Dependence (p=0.034; odds ratio, 3.607; 95% confidence interval [CI], 1.102-1.807), the absence of smoking-related lung disease (p=0.008; odds ratio, 4.693; 95% CI, 1.497-14.707), and education level (p=0.001; odds ratio, 181.420; 95% CI, 8.414-3,911.502) were the predictors of successful smoking cessation. CONCLUSION: An improved continuous smoking abstinence rate can be obtained by motivational interviewing, regardless of the association with pharmacotherapy.
Adult ; Drug Therapy ; Education ; Humans ; Logistic Models ; Lung Diseases ; Motivational Interviewing* ; Odds Ratio ; Outpatients ; Pulmonary Medicine ; Retrospective Studies ; Smoke ; Smoking ; Smoking Cessation* ; Tobacco Products ; Tobacco Use ; Tobacco Use Cessation Products ; Tobacco Use Disorder ; Varenicline

BACKGROUND: The six-minute walk test has been widely used in people with chronic cardiopulmonary disorders as an outcome assessment with regards to therapeutic or prognostic determinants. This study was undertaken to determine the six-minute walk distance (6MWD) in a sample of healthy Koreans and to create a reference equation. We also compared the 6MWD of our cohort with previously published equations. METHODS: Two hundred fifty-nine healthy subjects (95 males) aged 22-59 years performed two walking tests using a standardized protocol. 6MWD was defined as the greatest distance achieved from the two tests. The effect of anthropometrics on the 6MWD was also investigated. RESULTS: The average 6MWD was 598.5+/-57.92 m, with significantly longer distances by males (628.9+/-59.51 m) than females (580.9+/-47.80 m) (p<0.001). Age, height, weight, and body mass index were significantly correlated with 6MWD in univariate analysis. Stepwise multiple regression showed height to be single independent predictor of 6MWD (r2=0.205, p<0.001). The reference equations derived in Caucasian and North African populations tend to overestimate the distance walked by Korean subjects, while Asian equations underestimate it. CONCLUSION: The average 6MWD in these Korean populations was 600 m. The regression equation revealed that individual's height was the most significant predictor of distance, explaining 20.5% of the distance variance.
Adult* ; Asian Continental Ancestry Group ; Body Mass Index ; Cohort Studies ; Exercise Test ; Exercise Tolerance ; Female ; Healthy Volunteers ; Humans ; Male ; Physical Endurance ; Reference Values ; Walking

Patients with immune-mediated inflammatory diseases (IMIDs) are increasingly being treated with anti-tumor necrosis factor (TNF) agents and are at increased risk of developing tuberculosis (TB). Therefore, diagnosis and treatment of latent TB infection (LTBI) is recommended in these patients due to the initiation of anti-TNF therapy. Traditionally, LTBI has been diagnosed on the basis of clinical factors and a tuberculin skin test. Recently, interferon-gamma releasing assays (IGRAs) that can detect TB infection have become available. Considering the high-risk of developing TB in patients on anti-TNF therapy, the use of both a tuberculin skin test and an IGRA should be considered to detect and treat LTBI in patients with IMIDs. The traditional LTBI treatment regimen consisted of isoniazid monotherapy for 9 months. However, shorter regimens such as 4 months of rifampicin or 3 months of isoniazid/rifampicin are increasingly being used to improve treatment completion rates. In this review, the screening methods for diagnosing latent and active TB before anti-TNF therapy in patients with IMIDs will be briefly described, as well as the current LTBI treatment regimens, the recommendations for managing TB that develops during anti-TNF therapy, the necessity of regular monitoring to detect new TB infection, and the re-initiation of anti-TNF therapy in patients who develop TB.
Diagnosis* ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Isoniazid ; Latent Tuberculosis* ; Mass Screening ; Necrosis ; Rifampin ; Skin Tests ; Tuberculin ; Tuberculin Test ; Tuberculosis ; Tumor Necrosis Factor-alpha

Tuberculosis is a significant infectious problem in elderly patients with comorbidities in Korea. The age-associated diseases such as malignancy and diabetes mellitus may increase the risk of tuberculosis in this population. The medication treatments of tuberculosis in patients with comorbidities can cause adverse reactions to antituberculosis drugs and inadequate treatment responses. Thus, clinicians must carefully monitor the toxicity of antituberculosis therapy and the efficacy of treatment in patients with comorbidities.
Aged ; Comorbidity* ; Diabetes Mellitus ; Humans ; Korea ; Tuberculosis*

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.
Aged ; Biopsy ; Breast ; Carcinoma, Renal Cell* ; Cartilage ; Clavicle ; Dyspnea ; Humans ; Lung ; Neoplasm Metastasis* ; Pleura ; Ribs ; Sternum ; Thoracic Cavity ; Thoracic Wall* ; Thorax*

Endobronchial chondroma is a cartilaginous benign tumor,which arises from the bronchial cartilage. As a rare benign tumor, endobronchial chondroma differs from cartilaginous hamartoma in that it includes cartilage components only,but hamartoma contains lipomatous and lymphoid tissue.The clinical manifestations of endobronchial chondroma are associated with the extent of mechanical obstruction of bronchus.Symptoms of endobronchial chondroma are nonspecific,such as cough, sputum, fever, or dyspnea on exertion.Endobronchial chondroma is often misdiagnosed as other diseases,such as asthma, chronic obstructive pulmonary disease,or pulmonary tuberculosis. The treatment is usually surgical procedures,such as resection of lung segment or lobe by thoracostomy or resection of tumor by bronchoscopy.We report a case of the patient who was diagnosed to have endobronchial chondroma treated by bronchial resection and end to end anastomosis.
Asthma ; Cartilage ; Chondroma* ; Cough ; Dyspnea ; Fever ; Hamartoma ; Humans ; Lung ; Sputum ; Thoracostomy ; Tuberculosis, Pulmonary