Expressions of Laminin-1 in Lung Alveolar Septa after CS gas Exposure in Rats / 결핵및호흡기질환

BACKGROUND: Laminin-1 is known to have regular functions in the development and course of differentiation of the lungs. The morphogenesis and distribution of laminin-1 still remains as a mystery and its distribution and changes in the molecular structure of laminin-1 in the pathogenesis of the lung still is a subject of great controversy. In this study, experiments were done to delineate the distribution and changes in the amount of laminin-1 after inducing inflammation of the lungs by exposing experimental animals to CS gas and especially, to find compositions of laminin-1 within type II pneumocytes. MATERIALS AND METHODS: The experimental subjects of study were newborn rats and the extracted tissue from the experimental rats were viewed under light microscope and electron microscope after the sections were treated with immunohistochemical methods and immunogold reaction methods using bounded gold particles. RESULTS: 1) Lymphocytes and mononuclear phagocytes invaded the alveolar septa in the 2 day group rats after CS gas exposure and intense interstitial inflammation was seen in the 3 day group. 2) Laminin immunoreactions decreased to a moderate degree in the 2 and 3 day group rats after CS gas exposure and strong laminin immunoreactions were seen again in the 5 and 7 day group rats. 3) Gold particles in basal lamina of the lung blood-air barrier decreased and in the type I pneumocytes decreased in the 2 and 3 day group rats after CS gas exposure. 4) Gold particles were seen only on the surface of the cell membranes of type II pneumocytes of the 1 and 2 day group rats after CS gas exposure. 5) Few gold particles around the lamellar bodies and cytoplasm of type II pneumocytes in the control rat group and at 12 hours after CS gas exposure. Gold particles are seen only on the surface of type II pneumocytes of the 1 and 2 day group rats after CS gas exposure and are evenly distributed in small amounts in the cells of the 3 day group after CS gas exposure. CONCLUSION: CS gas exposure in the rats caused inflammation of lung alveolar septa and also induced a decrease in laminin-1 in basal lamina and loss of laminin-1 in the cytoplasm of type II pneumonocytes. As the inflammatory cells disappeared, an increase in the distribution of laminin-1 occurred. This reflects tissue regeneration functions of laminin-1 in the pneumocytes of rats and the distribution of laminin-1 in type II pneumocytes can be seen through the electron microscope using immunogold methods.

Cerebral Infarction as a Complication of Nephrotic Syndrome: A Case Report with a Review of the Literature

Arterial thrombosis is relatively rare compared with venous thrombosis in nephrotic syndrome. However, the assessment of its pathogenesis and risk factors in individual patient with nephrotic syndrome is necessary to allow appropriate prophylactic management because it is a potentially serious problem. Hereby, with review of the literature, we report a case of a 53 yr-old man with cerebral infarction associated with nephrotic syndrome due to focal segmental glomerulosclerosis during the course of treatments with diuretics and steroid. It reveals that the hypercoagulable state in nephrotic syndrome can be associated with cerebral infarction in adults. Prophylactic anticoagulants can be considered to reduce the risk of serious cerebral infarction in nephrotic patients with risk factors such as severe hypoalbuminemia and on diuretics or steroid treatment, even in young patients regardless of types of underlying glomerular diseases.

Clinical Analysis of the Operative Results of the Type A Aortic Dissection according to the Location of the Intimal Tear / 대한흉부외과학회지

BACKGROUND: The location of intimal tear can vary in type A acute aortic dissection. The aim of this study was to assess the operative result according to the intimal tear site. MATERIAL AND METHOD: From January, 1995 to May, 2003, 18 patients underwent surgery for acute type A aortic dissection. The patients were classified according to the intimal tear site. In Group I (n=11), the intimal tear site was located within the ascending aorta, in Group II (n=7), the intimal tear site was located in the aortic arch, descending aorta, or intramural hematoma only. All clinical data were analyzed retrospectively. RESULT: In Group I, the operative time, cardiopulmonary bypass time, aorta cross clamp time and circulatory arrest time were 381.5+/-81.0 min, 223.5+/-42.5 min, 146.4+/-34.8 min and 36.5+/-17.4 min, respectively; and in group II, 461.7+/-54.0 min, 252.5+/-45.3 min, 162.5+/-45.3 min and 47.0+/-14.4 min respectively. All of those were greater in group II. The overall hospital mortality rate was 27.8% (5/18) and was significantly higher in Group II (57.1%)(p=0.003) compared to that in Group I (9.1%). The causes of death were hemorrhage (n=1) in group I and hemorrhage (n=2), multiple organ failure (n=1), and rupture of abdominal aorta (n=1) in group II. CONCLUSION: Surgical treatment of acute type A aortic dissection with intimal tear in the ascending aorta results in an acceptable mortality rate, but in patients with intimal tear in the aortic arch or descending aorta, the operative mortality still remains high when only ascending aorta replacement was performed. In these circumstances, in order to improve surgical results, efforts to include the intimal tear site in the operative procedure will be needed.

Resternotomy for Recurrent Aortic Aneurysm Adherent to the Sternum Under Deep Hypothermic Circulatory Arrest / 대한흉부외과학회지

Reoperation on the recurrent aortic aneurysm adjuvent to sternum remains a challenging problem in regard to the risk of the massive hemorrhage at the time of resternotomy resulting from inadvertent entry into the aneurysmal sac. The cardiopulmonary bypass technique of femoral cannulation and deep hypothermic circulatory arrest can provide a safe resternotomy. The left ventricle is likely to distend due to lack of contraction with ventricular fibrillation during core cooling. To prevent ventricular distention during core cooling, sufficient venous drainage is mandatory. We report a technique in which deep hypothermic circulatory arrest is achieved before resternotomy without left ventricular distention by active venous drainage using centrifugal pump.

Taussig-Bing Anomaly with Coarctation of Aorta / 대한흉부외과학회지

The patient was a 30-day-old female infant with symptoms of severe dyspnea and cyanosis, when she was admitted to the ER. The echocardiography revealed DORV with subpulmonary VSD, and the diagnosis of Taussig-Bing anomaly was made. Two days after admission, an urgent operation was performed. The operation consisted of intraventricular tunnel repair and arterial switch operation. She was discharged, and after checking her chest X-ray through OPD, there was no interval change of cardiomegaly. She was then re-admitted, and the angiography revealed coactation of aorta. We performed a resection and end-to-end anastomosis of aorta. She is currently in good condition 11 months postoperatively.

Bronchopleural Fistula after Pneumonectomy: Autosuture Versus Manual Suture / 대한흉부외과학회지

BACKGROUND: Staple closure of bronchial stump was compared with manual suture closure among 100 cases of pneumonectomy during the recent 5-year period. We have reviewed the incidence of bronchpleural fistula between autosutured group and manual sutured group. MATERIAL AND METHOD: During the recent 5-year period, 100 patients underwent pneumonectomy at Hanyang University Hospital. Staple closure of bronchial stump was performed in 65 patients and manual suture in 35 patients. There were 55 males and 10 females in the autosutured group, and 26 males and 9 females in manual sutured group, which showed no significant statistical difference between the two groups. The mean ages of patients for autosutured group and manual sutured group were 56.7+/-10.3 years and 61.4+/-9.2 years, respectively, which showed no significant statistical difference between the two groups. There were 38 cases of left pneumonectomy and 27 cases of right pneumonectomy in autosutured group, and 22 cases of left pneumonectomy and 13 cases of right pneumonectomy in manual sutured group. There were 53 cases of malignancy and 12 cases of benign imflammatory disease in autosutured group, and 27 cases of malignancy and 7 cases of benign imflammatory disease in manual sutured group. RESULT: The incidence of bronchopleural fistula was 6.1% in autosutured group and 5.7% in manual sutured group. The incidence of other postoperative complication between the two groups showed no significant statistical difference. CONCLUSION: The incidence of bronchopleural fistula between autosutured group and manual sutured group was not different stastically. Both method for closure of bronchial stump can be performed in pneumonectomy.

The comparision of Right anterolateral thoracotomy and Median sternotomy in the Atrial Septal Defect repair / 대한흉부외과학회지

BACKGROUND: Currently, atrial septal defect repair has been considered low risk operation due to the development of open heart surgery. Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. MATERIAL AND METHOD: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy (group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. RESULT: The mean weight of group A was 38.77+/-15.57kg and 38.21+/-21.82kg in group B. In group A, mean operation(OP) time was 197.6+/-61.40min, mean cardiopulmonary bypass(CPB) time was 48.66+/-13.02min and mean fibrillation time or aortic cross clamp (ACC) time was 30+/-11.64min. In group B, mean OP time was 212.33+/-31.95min, mean CPB time was 55+/-12.10min, and mean fibrillation or ACC time was 29.33+/-9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78+/-0.78 hours, mean postoperative ICU stay was 1.2+/-0.47 days and mean postoperative hospital stay was 10.20+/-1.08 days. In group B, mean mechanical ventilation time was 5.95+/-3.73 hours, mean post operative ICU stay was 1.41+/-0.61 days, and mean postoperative hospital stay was 12.20+/-3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33+/-90.54cc vs 352.33+/-239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block. CONCLUSION: Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument (p<0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.

Clinical Analysis of the Recent Results of Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: Previous reports present that the early results of coronary artery bypass grafting (CABG) has been improving with the accumulation of surgical experience. We conducted a retrospective analysis of the patients who received CABG to evaluate the recent results of CABG. MATERIAL AND METHOD: Between January 1996 and August 2001, 154 patients underwent CABG at Hanyang University Hospital. There were 47 patients(group I) who were operated between 1996 and 1998, and 107 patients(group II) who were operated thereafter. The preoperative diagnosis, operative procedure, mortality, and complications were analyzed retrospectively. RESULT: There were 35 males and 12 females in group I, and 78 males and 29 females in group II, which shows similar ratio of sexes between the two groups. The average age of patients for group I and group II was 55.9+/-6.2 years and 61.0+/-8.0 years, respectively, showing a significant increase in group II(p<0.05). The average left ventricular ejection fraction(LVEF) for group I and group II was 54.6+/-11.8% and 56.9+/-13.0%, respectively. The number of patients who had previous MI in group I and group II were 13 patients(27.7%) and 14 patients(13.1%), respectively, which shows a significant difference (p<0.05). All procedures were performed using the cardiopulmonary bypass(CPB) and moderate systemic hypothermia. Myocardial protection was achieved using intermittent hypothermic ischemia under ventricular fibrillation state or cold crystalloid cardioplegic solution for most of group I patients, whereas cold blood cardioplegic solution was used for group II patients. The mean CPB times for group I and group II were 149.2+/-48.7 minutes and 113.1+/-30.6 minutes, respectively. The mean aortic cross clamp times for group I and group II were 81.3+/-26.5 minutes 72.2+/-23.9 minutes, respectiely. These figures show that CPB and aortic cross clamp times were significantly reduced in group II(p<0.05). The use of the left internal thoracic artery(LITA) was increased from 42%(20/47) for group I to 81% (87/107) for group II. The mean number of grafts also significantly increased from 2.5+/-0.6 for group I to 3.0+/-1.1 for group II(p<0.05). Intra-aortic balloon pump(IABP) was applied in 7 cases in group I and 17 cases in group II. Of these, 28.6%(2/7) and 52.9%(9/17) were broadly applied preoperatively in patients with LVEF<40% or congestive heart failure. The operative mortalities for group I and II were 10.6%(5/47) and 0.9%(1/107), respectively, which shows significant decrease for group II(p<0.05). CONCLUSION: This report suggest that CABG using CPB can recently be performed more safely in virtue of the accumulation of surgical experience with reduction in CPB and aortic cross clamp times and improved surgical techniques and myocardial protection. And we think that the optimal treatment of patients with left ventricular dysfunction associated with congestive heart failure and the extended application of IABP, especially have contributed to the reduction of operative mortality and morbidity.

Solitary Fibrous Tumor of the Diaphragmatic Pleura / 대한흉부외과학회지

We present a case of a 47-year-old woman with benign solitary fibrous tumor of the pleura originated in the diaphragm which was discovered incidentally on a chest radiograph. Chest radiograph, sonograph, computed tomographic scan and magnetic resonance image studies proved a well circumscribed and lobulated fibrous tumor of the pleura. During the subsequent right thoracotomy, the tumor was found to be encapsulated and consisted of firm mass. It was connected to the diaphragm with 5x4 cm area by pedicle. Most of the tumor was free of adhesion. It was excised completely together with attached diaphragm. The tumor measured 23.5x3.5x8.0 cm and the pathologic diagnosis was benign solitary fibrous tumor and the attached diaphragm was free of disease.

Gastropericardial Fistula as a Late Complication after Esophagectomy with Esophagogastrostomy: A case report / 대한흉부외과학회지

A 56 year-old man complaining of dry cough, dyspnea, chest pain, fever, and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy and subsequent radiotherapy because of an esophageal cancer. After the emergency echocardiography revealed a small amount of pericardial effusion and pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach and the pericardium, and an emergency operation was done under the diagnosis of gastropericardial fistula. The patient expired postoperative seven days later. Gastropericardial fistula caused by a peptic ulcer perforation after the esophagectomy and esophagogastrostomy operation is a very rare complication and brings forth a disastrous result. Early detection using the chest radiography, electrocardiogram, upper GI study, echocardiography and a review of physical examination, and an immediate treatment are therefore mandatory.

Analysis of Postpneumonectomy Complication without Balanced Chest Bottle / 대한흉부외과학회지

BACKGROUND: Pneumonectomy carries the possibility of numerous dangerous complications as well as the vast effect the operation itself has on the cardiopulmonary function. Most of operations are done with the insertion of the chest tubes upon completion, but because of the high incidence of pyothorax as its complications, we have tried to analyze and compare the cases without inserting the chest tubes. MATERIAL AND METHOD: During a 5 year period from January, 1996 to December 2000, 100 cases, which were operated at the Hanyang University Hospital, were selected using the patient's charts. The age, gender, indication of operation, associated diseases, and operation site(left or right) were classified accordingly and the postoperative complications and mortality were statistically analyzed using the X2-test. After resecting the lung, the intrathoracic pressure was set at -15~-20cm H2O using the nelaton catheter, and the thoracotomy site was then closed. The gradual collection of the fluid and blood in the thorax of the operated side, as well as the mediastinum location, were observed carefully for 4~5 days postoperatively with the aid of the simple chest x-rays. RESULT: Of the 100 cases, 16 cases of pulmonary tuberculosis(16%), 81 cases of lung tumor(81%), 2 cases of bronchiectasis(2%), and 1 case of aspergilloma associated bronchiectasis were noted. There were 8 mortality cases(8%), and of the 34 cases(34%), 44 complications were noted. The age, sex, and operation site(left or right) were not statistically significant with the complications. 7 of the 16 cases of pulmonary tuberculosis(44%) and 27 of the 81 cases of lung tumor(33%) had complications, but they were found not to bestatistically significant. The increase of the complication rate in the pulmonary tuberculosis patients was 3.86. The evidence of postoperative bleeding was observed in 6 cases with the 3 cases being the pulmonary tuberculosis patients and the 3 cases were others. This shows that the increase in postoperative bleeding in the pulmonary tuberculosis is statistically significant(p=0.019). Of the 100 cases, there were 8 mortality cases(8%), with 5 cases from the 81 cases of the lung tumor group(6.1%), 3 cases from the 16 cases of pulmonary tuberculosis group(18.7%). CONCLUSION: The mortality and complication rates of the pneumonectomy operation with or without the insertion of the chest tube were similar to the previous reports, and we can conclude that the pneumonectomy without the insertion of the chest tube is also a good method, and We expect that this method will decrease the infection rate. The high risk group of mortality and complications was the pulmonary tuberculosis patients.

Colobronchial Fistula as a Late Complication of Esophagocologastrostomy / 대한흉부외과학회지

We report a case of colobronchial fistula, which is an extremely rare complication of esophagocologastrostomy. A 53-year-old man developed recurrent respiratory symptoms 30 months after colon interposition for corrosive esophageal and gastric strictures. Chest radiographs and computed tomography showed an aspiration pneumonia and total atelectasis of the left lower lobe(LLL). Esophagoscopy and barium esophagogram revealed fistula between the colon just below the esophagocolostomy and superior segment of the LLL. The colobronchial fistulectomy and left lower lobe lobectomy were performed. This rare complication should be considered in patients who develop recurrent productive cough whenever they drink or eat something after esophagocologastrostomy.

Colobronchial Fistula as a Late Complication of Esophagocologastrostomy / 대한흉부외과학회지

We report a case of colobronchial fistula, which is an extremely rare complication of esophagocologastrostomy. A 53-year-old man developed recurrent respiratory symptoms 30 months after colon interposition for corrosive esophageal and gastric strictures. Chest radiographs and computed tomography showed an aspiration pneumonia and total atelectasis of the left lower lobe(LLL). Esophagoscopy and barium esophagogram revealed fistula between the colon just below the esophagocolostomy and superior segment of the LLL. The colobronchial fistulectomy and left lower lobe lobectomy were performed. This rare complication should be considered in patients who develop recurrent productive cough whenever they drink or eat something after esophagocologastrostomy.

Congenital Cardiac Anomaly Combined with the VATER Association: A case report / 대한흉부외과학회지

VATER is a complex anomaly of multiple organs and often combined with cardiac anomalies. However, it can be cured with active surgical intervention. We achieved successful result with aggressive surgery in the patient with VATER and report it with references.

Aortoenteric Fistula: one case report / 대한흉부외과학회지

Secondary aortoenteric fistula is a rare but fatal complication of reconstructive aortoiliac surgery. This disease entity could be divided into true aortoenteric fistula and paraprosthetic enteric fistula. The prevention, diagnosis and treatment of this complication remains a challenging problem. We report a 39 year old man who was diagnosed as paraprosthetic enteric fistula in endoscopy and operated 41 months after reconstructive aortoiliac surgery due to the infected pseudoaneurysm.

Langerhans' Cell Histiocytosis in Chest Wall / 대한흉부외과학회지

Langerhans' Cell Histiocytosis(LCH) is a disease of unknown origin, characterized by abnormal proliferation of Langerhans' cells. Previously, it has been called histiocytosis X, which included eosinophilic granuloma, Hand-Sch ller-Christian's disease, and Letterer-Siwe disease. Any organs or tissues such as skin, lymph nodes, bone and bone marrow can be involved. However, LCH of chest wall is rarely reported in our country. We experienced a 18 month old male child, who had osteolytic lesion involving the rib with axillary lymph node metastasis. The tumor was confirmed as LCH after surgery.

Thromboendarterectomy of Chronic Pulmonary Thromboembolism: A Case Report / 대한흉부외과학회지

Chronic pulmonary artery thromboembolism is a relatively rare phenomenon causing hypoxia and pulmonary hypertension that eventually leads to respiratory failure and right heart failure. Patients with acute pulmonary artery thromboembolism are generally treated with antithrombotics and thrombolytics. However, in cases with chronic pulmonary artery thromboembolism the fibrinized thrombus is so strongly adhered to the pulmonary artery wall that medical treatment becomes ineffective and surgical treatment must then be considered. We report a 47year old patient, with a history of repeated admission due to unresolved chronic obstructive pulmonary disease and chronic pulmonary artery thromboembolism at a local hospital, who underwent a successful endarterectomy of pulmonary artery thromboemboli using intermittent total circulatory arrest.

Surgical Management of Critical Pulmonary Stenosis: A case report / 대한흉부외과학회지

Although pulmonary valvular stenosis with intact ventricular septum is a common congenital abnormality, critical pulmonary stenosis of its severe form in the neonate is rare and highly fatal. With the development of percutaneous balloon valvuloplasty, surgical treatment is even more rare. This report is on a 2 day old male neonate with a critical pulmonary stenosis with intact ventricular septum who suffered from severe cyanosis and hypoxemia. Oxygen was inhalated and Prostaglandin E1 was infused initially and then arterial PO2 was increased from 19 mmHg to 54 mmHg. Percutaneous balloon valvuloplasty was attemped; however, the guidewire could not pass through the stenotic pulmonary valve, and during the procedure right ventricular perforation was suspected due to the presence of dye in the pericardial space. Emergency transarterial pulmonary valvotomy was performed using normothermic cardiopulmonary bypass. Postoperatively, the patient was in fair condition in the ICU and presently is in good condition at 6 months postoperative follow up.

A Clinical Evaluation of Esophageal Perforation / 대한흉부외과학회지

BACKGROUND: Esophageal perforation is an extremely lethal injury that requires careful management for survival. MATERIAL AND METHOD: We performed a retrospective clinical review of 14 patients treated for esophageal perforation at the Department of Thoracic and Cardiovascular Surgery hanyang University Hospital between July 1986 and August 1998. Cardiovascular Surgery Hanyang University Hospital between July 1986 and August 1998. RESULT: The ration between male and female patients was 12:2 and their ages ranged from 9 to 68 years( average: 446 years). Iatrogenic perforations were found in 6 patients(42.9%) spontaneous perforations in 3 patients(21.4%) traumatic perforations in 2 patients(14.3%) and caustic perforations foreign body origin and esophagel cancer in 1 patient (7.1%) each. Four of the patients(28.6%) had esophageal ruptures located cancer in 1 patient (7.1%) each. Four of the patients (28.6%) had esophageal ruptures located in the cervical esophagus and 10 patients (71.4%) in the thoracic esophagus, The most frequent location was in the mid third portion of the esophagus (35.7%) there were also 2 patients(14.3%) in the upper third portion and 3 patients(21.4%) in the lower third portion. Complications encountered included mediastinitis empyema or pleural effusion mediastinal or lung abscess sepsis and aspiration pneumonia. The most frequent complication that occurred was mediastinitis in 9 cases (57%) Three patients underwent conservative treatment. Among the patients who underwent surgical treatment 5 patients underwent primary closure 6 patients underwent open drainage and 2 patients underwent reconstrumction (1 patients had an initial primary closure and 1 patient had an initial open drainage procedure). The mortality rates for those with conservative and surgical treatment were 66.7% (2cases) and 9.1% (1 cases) respectively. CONCLUSIONS: Perforation of the esophagus although very rare has a high mortality rate and thus aggressive operative therapy is necessary.

Clinical Evaluation of Risk Factors Affection Postoperative Morbidity and Mortality in the Surgical Treatment of Tuberculous Destroyed Lung / 대한흉부외과학회지

BACKGROUND: This retrospective study tries to identify specific risk factors that may increase complication rates after the surgical treatment of tuberculous destroyed lung. MATERIAL AND METHOD: A retrospective study was performed on forty-seven patients, who received surgical treatment for tuberculous destroyed lung in the Department of Thoracic and Cardiovascular Surgery at Hanyang University Hospital from 1988 to 1998, to identify specific preoperative risk factors related to postoperative complications. Fisher's exact test was used to identify the correlations between the complications and right pneumonectomy, preoperative FEV1, predicted postoperative FEV1, massive hemoptysis, postoperative persistent empyema. RESULT: Hospital mortality and morbidity rates of the patients who received surgical treatment for tuberculous destroyed lung were 6.4% and 29.7%, respectively. In view of the hospital mortality and morbidity rates as a whole, predicted postoperative FEV1 less than 0.8L(p<0.005), preoperative FEV1 less than 1.8L(p=0.01), massive hemoptysis(p<0.005), postoperative persistent positive sputum cultures(p<0.0005), and the presence of multi drug resistant tuberculosis(p<0.05) presented statistically significant correlations. Among the postoperative complications, bronchopleural fistula, the most common complication, was found to have statistically significant corrleations with the preoperative empyema(p<0.05) and postoperative persistent positive sputum cultures(p<0.05). CONCLUSIONS: Although mortality and morbidity rates after surgical treatment of tuberculous destroyed lung were relatively low, when predicted postoperative FEV1 was less than 0.8L, when preoperative FEV1 was less than 1.8L, when massive hemoptysis was present, when postoperative sputum cultures were persistently positive, and when multi drug resistant tuberculosis was present, the rates were significantly higher.