To determine overall detection rates of lung cancer by low-dose CT (LDCT) screening and to compare histopathologic and imaging differences of detected cancers between high- and low-risk groups, this study included 6,406 asymptomatic Korean adults with >or=45 yr of age who underwent LDCT for lung cancer screening. All were classified into high- (>or=20 pack-year smoking; 3,353) and low-risk (3,053; <20 pack-yr smoking and non-smokers) groups. We compared CT findings of detected cancers and detection rates between high- and low-risk. At initial CT, 35% (2,255 of 6,406) had at least one or more non-calcified nodule. Lung cancer detection rates were 0.36% (23 of 6,406). Twenty-one non-small cell lung cancers appeared as solid (n=14) or ground-glass opacity (GGO) (n=7) nodules. Cancer likelihood was higher in GGO nodules than in solid nodules (p<0.01). Fifteen of 23 cancers occurred in high-risk group and 8 in low-risk group (p=0.215). Therefore, LDCT screening help detect early stage of lung cancer in asymptomatic Korean population with detection rate of 0.36% on a population basis and may be useful for discovering early lung cancer in low-risk group as well as in high-risk group.
Adenocarcinoma/diagnosis ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/diagnosis ; Carcinoma, Squamous Cell/diagnosis ; Comparative Study ; Female ; Humans ; Korea ; Lung Neoplasms/*diagnosis ; Male ; Mass Screening/*methods ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed/*methods

BACKGROUND: Solitary pulmonary nodule (SPN) may show different pre- sentation in tuberculosis (TB)-endemic countries. The aim of this study was to identify clinical and radiological predictors favoring benign or malignant SPN in TB-endemic region. METHODS: Two hundred one SPNs in 201 consecutive Korean patients were included (< 3 cm in diameter, all confirmed by pathology or bacteriology, 93 benign and 108 malignant diseases). For clinical parameters, age, sex, smoking status and amount, and past history of pulmonary tuberculosis and diabetes mellitus were investigated retrospectively. For radiological parameters, size, location, margin characteristics, presence of calcification, pleural tag, surrounding satellite nodule, cavitation, internal low attenuation, open bronchus sign, surrounding ground-glass opacity, enhancement pattern of the SPNs and mediastinal lymph node (LN) enlargement were analyzed on chest CT scans. RESULTS: Patients with a older age (60.7+/-9.6 vs 56.2+/-13.1, p=0.008) and more than 40-pack years smoking (27.8% vs 14.0%, p=0.017) were more frequently related with malignant than benign SPN. On chest CT scans, spiculated margin, contrast enhancement more than 20 Hounsfield unit and presence of pleural tag and mediastinal LN enlargement were more frequently observed in malignant than benign SPNs. In contrast to previous studies, satellite lesions (21.5% vs 1.9%, p < 0.001) and cavitation (20.4% vs 5.6%, p=0.001) were more frequently seen in benign than malignant SPN. Positive predictive values of benignity were 90.9% and 76.0%, respectively, when satellite lesions and cavitation were found in cases of SPN. CONCLUSION: Satellite lesions and cavitation on chest CT scan could be useful predictors for benign SPN in TB-endemic areas.
Adult ; Age Factors ; Carcinoma/pathology/radiography ; Coin Lesion, Pulmonary/*pathology/*radiography ; Female ; Human ; Korea ; Lung Neoplasms/pathology/radiography ; Male ; Middle Age ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*pathology/*radiography

BACKGROUND: The evaluation of candidates for successful lung resection is important. We studied to Our study was conducted to determine the preoperative predictors of postoperative mortality and morbidity in lung cancer patients with impaired lung function. METHOD: Between October 1, 1995 to August 31, 1997, 36 lung resection candidates with FEV1 of less than 2L or 60% predicted due to lung cancer were included prospectively. Age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness were considered as systemic potential predictors for a successful lung resection. Smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test were also included for the analysis. In addition, predicted postoperative(ppo)pulmonary factors such as ppo-FEV1, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-FEV1% x ppo-DLco% and ppo-maximal O2 uptake(VO2max) were also measured. RESULTS: There were 31 men and 5 women with the median age of 65 years (range 44 to 82) and a mean FEV1 of 1.78 +/-0.06L. Pneumonectomy was performed in 14 patients, bilobectomy in 8, lobectomy in 14. Pulmonary complications developed in 10 patients, cardiac complications in 3, other complications (empyema, air leak, bleeding) in 4. Twelve patients were managed in the intensive care unit for more than 48 hours. Two patients died within 30 days after operation. The ppo-VO2max was less than 10 mg/kg/min in these two patients. MVV was the only predictor for the pulmonary complications. However, there was no predictors for the post operative death in this study.
Blood Gas Analysis ; Dyspnea ; Electrocardiography ; Female ; Hematocrit ; Humans ; Intensive Care Units ; Lung Neoplasms* ; Lung* ; Male ; Mortality* ; Pneumonectomy ; Pneumonia ; Prospective Studies ; Respiration ; Respiratory Function Tests ; Serum Albumin ; Smoke ; Smoking ; Weight Loss

BACKGROUND: Five year survival rate of postoperative stage I non-small lung cancer(NSCLC) reaches to 66%. In the remaining one third of patients, however, cancer recurs and overall survival of NSCLC remains dismal. To evaluate clinical and pathologic characteristics of recurred NSCLC, we studied patterns and factors for postoperative recurrence in patients with staged I, II NSCLC. METHOD: A retrospective analysis was performed in 234 patients who underwent radical resection for pathologic stage I, II NSCLC. All patients followed for at least one year were included in this study. RESULTS: 1) There were 177 men and 57 women. The median age was 63. The median duration of follow up was 732 days (range 365~1,695 days). The overall recurrence rate was 26.5% and the recurrence occurred at 358.8 +/- 239.8 days after operation. 2) The age of recurred NSCLC patients were higher (63.2 +/- 8.8 years) than that of non-recurred patients (60.3 +/- 9.8 years)(p=0.043). The recurrence rate was higher in stage II (46.9%) than in stage I (18.8%, p<0.001) NSCLC. The size of primary lung mass was larger in recurred (5.45 +/- 3.22 cm) than that of non-recurred NSCLC (3.74 +/- 1.75 cm, p<0.001). Interestingly, there were no recurrent cases when the resected primary tumors were less than 2cm. 3) Distant recurrence was more frequent than locoregional recurrence (66.1% vs. 33.9%). Distant recurrence rate was more frequent in female and adenocarcinoma. Brain metastasis was more frequent in patients with adenocarcinoma than squamous cell carcinoma (p=0.024). CONCLUSION: The tumor size and stage were two important factors for recurrence. Considering that distant brain metastasis was more frequent in patients with adenocarinoma, prospective study should follow to evaluate the effectiveness of preoperative brain imaging.
Adenocarcinoma ; Brain ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Female ; Follow-Up Studies ; Humans ; Lung ; Male ; Neoplasm Metastasis ; Neuroimaging ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous infalmmation, which was compatible with tuberculosis. Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin. In patients with severe diarrhea receining anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.
Aged ; Anti-Bacterial Agents ; Biopsy ; Chest Pain ; Clostridium difficile ; Diarrhea ; Dyspnea ; Enterocolitis, Pseudomembranous* ; Ethambutol ; Gastrointestinal Tract ; Humans ; Isoniazid ; Lung ; Metronidazole ; Mucous Membrane ; Physical Examination ; Pleural Effusion ; Respiratory Sounds ; Rifampin* ; Sigmoidoscopy ; Sputum ; Thorax ; Tuberculosis ; Vancomycin

Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually resent with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.
Diabetes Mellitus ; Humans ; Leukemia ; Lymphoma ; Mucormycosis* ; Opportunistic Infections ; Pneumonectomy

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. METHODS: A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveloar lavage or lung biopsy. RESULTS: Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD (3.27±3.15 mg/dl vs. 1.19±0.94 md/dl, p=0.030). The corresponding drop in hemoglobin level was 2.69±1.26 g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by 1.38±4.22 days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). CONCLUSION: The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.
Anemia ; Biopsy ; Collagen ; Cough ; Creatinine ; Diagnosis ; Dyspnea ; Female ; Fever ; Hemoptysis ; Hemorrhage* ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Mortality ; Prognosis ; Radiography, Thoracic ; Retrospective Studies* ; Therapeutic Irrigation ; Thorax ; Vascular Diseases

BACKGROUND: Surgery may have a role when medical treatment alone is not successful in patients with multi-drug resistant (MDR) pulmonary tuberculosis (PTB). To document the role of resection in MDR PTB, we analyzed 4 years of our experience. METHODS: A retrospective review was performed on thirteen patients that underwent pulmonary resection for MDR PTB between May 1996 and February 2000. All patients had organisms resistant to many of the first-line drugs including isoniazid (INH) and rifampicin (RFP). RESULTS: The thirteen patients were 37.5±12.4 years old (mean±S.D.)(M:F=5:8), and their sputum was culture positive even with adequate medication for prolonged periods (109.7±132.0 months), resistant to 2-8 drugs including isoniazid and rifampin. All patients had localized lesion(s) and most (92.3%) had cavities. At least 3 sensitive anti-TB medications were started before surgery in all patients according to the drug sensitivity test. The preoperative FE1 was 2.37±0.83 L. Lobectomy was performed in 11 patients and pleuropneumonectomy in two. Postoperative mortality did not occur, but pneumonia occurred as a complication in one (7.7%). After 41.5±58.9 days (range 1~150 days) follow up, negative conversion of sputum culture was achieved in all patients within 5 months. Only one patient (7.7%) recurred 32 months after lung resection. CONCLUSION: When medical treatment alone is not successful, surgical resection can be a good treatment option in patients with localized MDR PTB.
Follow-Up Studies ; Humans ; Isoniazid ; Lung ; Mortality ; Pneumonia ; Retrospective Studies ; Rifampin ; Sputum ; Tuberculosis, Pulmonary*

BACKGROUND: Nonspecific interstitial pneumonitis (NSIP) is most likely to be confused with usual interstitial pneumonitis (UIP). Unlike patients with UIP, the majority of patients with NSIP have a good prognosis, with most patients improving after treatment with corticosteroids. Therefore it is clinically important to differentiate NSIP from UIP. UP to now, the only means of differentiating these two diseases was by means of surgical lung biopsy. American Thoracic Society (ATS) proposed a clinical diagnostic criterial for UIP to provide assistance to clinicians in its diagnosis without surgical lung biopsy. This study is aimed to investigate whether there were clinical and radiological differences between NSIP and UIP, and the usefulness of ATS clinical diagnostic criteria for UIP in Korea. METHODS: we studied 60 patients with UIP and NSIP confirmed by surgical lung biopsy. Clinical manifestations, pulmonary function test, arterial blood gas analysis, bronchoalveolar lavage (BAL), and high resolution computed tomography (HRCT) were evaluated and analyzed by Chi-square test or t-test. The clinical criteria for UIP proposed by ATS were applied to all patients with idiopathic interstitial pneumonia. RESULTS: Forty-two patients with UIP and 18 with NSIP were pathologically identified. Among the 18 patients with NSIP (M : F = 1 : 17), the mean age was 55.2± 8.4 (44~73)yr. Among the 42 patients with UIP (M : F = 33 : 9), the mean age was 59.5±7.1 (45~74) yr (p=0.0460. Fever was more frequent in NSIP (39%) (p=0.034), but clubbing was frequently observed in UIP (33%) (p=0.023). BAL lymphocytosis was more frequent (23%) (p=0.0001) and CD4/CD8 ratio was lower in NSIP (p=0.045). On HRCT, UIP frequently showed honeycomb appearance (36 of 42 patients) through not in NSIP (p=0.0001). Six of 42 UIP patients (14.3%) met the ATS clinical criteria for IPF, and 3 of 16 NSIP patients (18.8%) met the diagnostic criteria. CONCLUSION: Being a relatively young female and having short duration of illness, fever, BAL lymphocytosis, low CD4/CD8 ratio with the absence of clubbing and honeycomb appearance in HRCT increase the likelihood of the illness being NSIP. The usefulness of ATS clinical diagnostic criteria for UIP may be low in Korea.
Adrenal Cortex Hormones ; Biopsy ; Blood Gas Analysis ; Bronchoalveolar Lavage ; Diagnosis ; Diagnosis, Differential* ; Female ; Fever ; Humans ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis* ; Korea ; Lung ; Lung Diseases, Interstitial* ; Lymphocytosis ; Prognosis ; Pulmonary Fibrosis ; Respiratory Function Tests

BACKGROUND: Nonspecific interstitial pneumonia (NSIP) has been reported recently to show much better response to medical treatment and better prognosis compared with idiopathic UIP. However, clinical characteristics of idiopathic NSIP discriminating from UIP have not been defined clearly. METHOD: Among 120 patients with biopsy-proven diffuse interstitial lung diseases between July 1996 and March 2000 at Samsung Medical Center, 18 patients with idiopathic NSIP were included in this study. Retrospective chart review and radiographic analysis were performed. RESULTS: 1) At diagnosis, 17 patients were female and average age was 55.2 +/-8.4 years (44~73 years). The average duration from development of respiratory symptom to surgical lung biopsy was 9.9+/-17.1 months. Increase in bronchoalveolar lavage fluid lymphocytes (23.0 +/-13.1%) was noted. On HRCT, ground glass and irregular linear opacity were seen but honeycombing was absent in all patients. 2) Corticosteroids were initially given to 13 patients of whom medication was stopped in 3 patients due to severe side effects. Further medical therapy was impossible in 1 patient who experienced streroid-induced psychosis. Herpes zoster (n=3), tuberculosis (n=1), avascu lar necrosis of hip (n=1), cataract (n=2) and diabetes mellitus (n=1) developed during prolonged corticosteroid administration. Of 7 patients receiving oral cyclophosphamide therapy, hemorrhagic cystitis hindered one patient from continuous medication. 3) After medical treatment, 14 of 17 patients improved and 3 patients remained stable (mean w-up ; 24.1+/-11.2 months). FVC increased by 20.2 +/-11.2% of predicted value and the extent of ground glass opacity on HRCT decreased significantly (15.7+/-14.7%). 4) Of 14 patients who had stopped medication, 5 showed recurrence of NSIP and 2 aggravated during steroid tapering. All patients with recurrence showed deterioration within one year after completion of initial treatment. CONCLUSION: Since idiopathic NSIP has unique clinical profiles and shows a good prognosis, differential diagnosis from UIP and aggressive medical treatment are needed.
Adrenal Cortex Hormones ; Biopsy ; Bronchoalveolar Lavage Fluid ; Cataract ; Cyclophosphamide ; Cystitis ; Diabetes Mellitus ; Diagnosis ; Diagnosis, Differential ; Female ; Glass ; Herpes Zoster ; Hip ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases, Interstitial* ; Lymphocytes ; Necrosis ; Prognosis ; Psychotic Disorders ; Recurrence ; Retrospective Studies ; Tuberculosis