Clinical Study of Primary Carcinoma of The Lung(III) / 결핵

BACKGROUND: Lung cancer continues to increase worldwide. Also, the proportion of female patients incease and adenocarcinoma is the predominant histological type among lung cancer in many western countries. So, we studied these current trends of lung cancer by clinical approach of recent patients from our department. METHOD: We conducted a retrospective analysis on 212 subjects who were diagnosed with lung cancer at the department of chest medicine in National Medical Center between January 1990 and July 1996. The contents of analysis were patient's profile, clinical manifestation, smoking habits, accuracy of diagnostic methods, histological cell type, staging and treatment, etc. RESULTS: The results were as follows. 1) The ratio of male to female was 5.2:1. The peak incidence of age was 7th decade(35.4 %). 2) Chief complaints were cough, dyspnea and chest pain, etc. The most common duration of symptoms before the first admission was less than 3 months(57.7%). On the other side, duration more than 1 year represented 6.5%. The early diagnosed patients has been increased from the 1980s. 3) Smokers among the total patients were 77.2%. The proportion of smokers in sqamous cell carcinoma, small cell carcinoma and adenocarcinoma were 88.4%, 85.7% and 55.7%, respectively. Smoking history and histological cell type were correlated in squamous and small cell carcinoma. 4) Squamous cell carcinoma is still the predominant histological type(44.8%), but, adenocarcinoma increased more than the previous study(30.7%). The other histological types were small cell carcinoma(17.0%) and large cell carcinoma(3.8%) in order of their proportions. 5) The accuracy of diagnostic methods were as follows : sputum cytology 75.3%, bronchoscopic biopsy 65.7%, lymph node aspiration cytology 95.8%, percutaneous lung aspiration cytology 94.6% and open lung biopsy 100%. The general accuracies of diagnostic methods were improved than previous studies. 6) Performance status scales on admission were relatively good. After diagnosis, chemotherapy and/or radiotherapy were undertaken in 69.3% of the patients, and only 7.5% of the patients were operated. CONCLUSION: In our study, squamous cell carcinoma is still the predominant histological cell type, but, adenocarcinoma continues to increase. Because adenocarcinoma is less correlated with smoking habits, further evaluation of other carcinogens than smoking is requested. Screening and early diagnosis of lung cancer is important for good performance status scales in spite of advanced stages. But, we think that the prevention, for example, stop smokings is more important as because of no perfect treatment for lung cancer.

Clinical Investigation of Cervical Tuberculous Lymphadenitis / 결핵

BACKGROUND: Cervical tuberculous lymphadenitis(CTL) is one of the most common extra-pulmonary tuberculosis. Recently overall incidence of pulmonary tuberculosis has decreased, but the incidence of tuberculous lymphadenitis has not decreased. Its duration of treatment is still controversial and the pathogenesis, prognosis and relationship with other site tuberculous are poorly published. So we did a retrograde study of 120 cases of confirmed CTL about its clinical manifestations. METHODS: All patients were applied fine needle aspiration(FNA) of palpable enlarged cervical lymph nodes and 114 patients were examined for AFB smear and 34 patients for TB culture with aspirated fluid. 57 patients were examined Mantoux test(5TU with PPD-S). With above methods, a total of 120 patients was diagnosed as having CTL RESULTS: 1) CTL is most prevalent in young women between the age of 20 30 years and the incidence of CTL in female is 2.5 times higher than that of male. It is located most commonly in the posterior cervical area. The most common presenting symptom is painless palpable enlarged cervical lymph nodes. 2) With FNA of enlarged cervical lymph nodes, the percentage of histopathological positivity is 82.3%. The percentage of AFB smear positivity is 38.6%, and that of TB culture positivity is 17.6% (p<0.001). 3) Pulmonary tuberculosis is noted in 79 cases(65.8%). And 42 cases(53.5%) of them had minimal pulmonary tuberculosis. In 14 cases(11.7%),other extrapulmonary tuberculosis coexsisted and pleural tuberculosis was most common in the order. 4) CTL was treated with anti-tuberculous medication(first line drug) and median treatment duration was 18.5months. During treatment, the size of involved lymph nodes decreased gradually in 62 cases(75.8%), newly developed lymph nodes were found in 25 cases(30.4%),fluctuation formation in 22 cases(26.8%) and fistula formation in 14 cases(17.0%). CONCLUISON: CTL is prevalent in women between the age of 20 ~ 40 years and it involves posterior cervical area most commonly. CTL is treated with long-term anti-tuberculous chemotherapy. We think it is one manifestation of systemic disease and frequently coexisting with pulmonary tuberculosis. Despite anti-tuberculous chemotherapy, the size of involved lymph nodes was increased, new lymph nodes were developed or fluctuation and fistula formed in involved lymph nodes. After sufficient medication, when the patient felt pressure discomfort from enlarged lymph node or fistula was formed, we recommended total excision of involved lymph nodes.

A Case of Thrombocytopenia and Purpura Induced by Rifamnpin, Pyrazinamide, and Ciprofloxacin / 결핵

Drug-induced thrombocytopenia and purpura have boon developed by many various agents. Rifampin and Pyrazinamide have been known as bactericidal antituberculous drugs, but, the above side effects have been a problem. Especially, hematologic side effects art fatal to patients occasionally. Rifampin-induced thrombocytopenia and purpura have been well known, also, pyrazinamide-induced thrombocytopenia have been reported. A new quilonone agent Ciprofloxacin, has been commonly used in clinics now, but it's side effects are not known well. So, we report a case of a 23-year-old female with thrombocytopenia and purpura after taking Rifampin, Pyrazinamide, and Ciprofloxacin as antituberculous agents.

Balloon dilatation for bronchial stenosis in Endobronchial Tuberculosis / 결핵

BACKGROUND: To evaluate the effect of the balloon dilatation in tuberculous bronchial stenosis, we performed balloon dilatation in 13 cases which had airway obstruction in main bronchus with the impairment of pulmonary function. MATERIAL AND METHODS: Thirteen women with tuberculous bronchial stenosis(9cases: left main bronchus, 4 cases: right main bronchus) underwent fluoroscopically guided balloon dilatation under the local anesthesia. Among the these patient, 9 cases were active endobronchial tuberculosis, and 4 cases were inactive. Immediate and long term follow-up(average 15.6months) assessments were done focused on change on PFT. The increase of FVC or FEV1 more than 15% after the procedure was considered effective. Complications after dilatation were evaluated in all patients. RESULT: 1) There were an decrease of self-audible wheezing in 75%(6/8), improvement of dyspnea in 62.5%(5/8), improvement of cough and expectoration in 50%(3/6), and improvement of chest discomfort in 50%(l/2). 2) Significant improvement of PFT was noted in 42.9%(3/7) of which respiratory symptoms duration was below 6 months. But, significant improvement of PFT was noted in only 25% (1/4) of which respiratory symptoms duration was above 12 months. 3) Active stage was 69.2%(9/13) and inactive was 30.8%(4/13). There was an significant improvement of PFT in 44.4%(4/9) of active stage, but, only 25%(l/4) of inactive stage was improved. 4) In 61.5%(8/13), FVC and FEV1 were increased to 35.5%, and 22.2% at post-dilatation 7 days. After 1 month later, FVC and FEV1 were increased to 54.7%, and 31.8% in 5 cases(38.5%). 4 cases in which long-term follow-up(average 19.8months) was possible the improvement of FVC, and FEV1 were 30.5%, and 10.1%. . 5) Just after balloon dilatation therapy, transient leukocytosis or fever was noted in 30.8%(4/13), and blood-tinged sputum was noted in 30.8%(4/13). However, serious complication, such as pneumothorax, pneumomediastinum or mediastinitis, was not noted. CONCLUSION: We conclude that tuberculous bronchial stenosis, which is on active stage, and short dulation of respiratory symptoms was more effective on balloon dilatation than inactive stage or long duration of respiratory symptoms. Furthermore, balloon dilatation is easier, much less invasive and expensive than open surgery, and cryotherapy or photoresection. Because of these advantage, we think that balloon dilatation could be the first choice for treating bronchial stenosis and could be done at first in early stage if unresponsiveness with steroid therapy is observed.

Balloon dilatation for bronchial stenosis in Endobronchial Tuberculosis / 결핵

BACKGROUND: To evaluate the effect of the balloon dilatation in tuberculous bronchial stenosis, we performed balloon dilatation in 13 cases which had airway obstruction in main bronchus with the impairment of pulmonary function. MATERIAL AND METHODS: Thirteen women with tuberculous bronchial stenosis(9cases: left main bronchus, 4 cases: right main bronchus) underwent fluoroscopically guided balloon dilatation under the local anesthesia. Among the these patient, 9 cases were active endobronchial tuberculosis, and 4 cases were inactive. Immediate and long term follow-up(average 15.6months) assessments were done focused on change on PFT. The increase of FVC or FEV1 more than 15% after the procedure was considered effective. Complications after dilatation were evaluated in all patients. RESULT: 1) There were an decrease of self-audible wheezing in 75%(6/8), improvement of dyspnea in 62.5%(5/8), improvement of cough and expectoration in 50%(3/6), and improvement of chest discomfort in 50%(l/2). 2) Significant improvement of PFT was noted in 42.9%(3/7) of which respiratory symptoms duration was below 6 months. But, significant improvement of PFT was noted in only 25% (1/4) of which respiratory symptoms duration was above 12 months. 3) Active stage was 69.2%(9/13) and inactive was 30.8%(4/13). There was an significant improvement of PFT in 44.4%(4/9) of active stage, but, only 25%(l/4) of inactive stage was improved. 4) In 61.5%(8/13), FVC and FEV1 were increased to 35.5%, and 22.2% at post-dilatation 7 days. After 1 month later, FVC and FEV1 were increased to 54.7%, and 31.8% in 5 cases(38.5%). 4 cases in which long-term follow-up(average 19.8months) was possible the improvement of FVC, and FEV1 were 30.5%, and 10.1%. . 5) Just after balloon dilatation therapy, transient leukocytosis or fever was noted in 30.8%(4/13), and blood-tinged sputum was noted in 30.8%(4/13). However, serious complication, such as pneumothorax, pneumomediastinum or mediastinitis, was not noted. CONCLUSION: We conclude that tuberculous bronchial stenosis, which is on active stage, and short dulation of respiratory symptoms was more effective on balloon dilatation than inactive stage or long duration of respiratory symptoms. Furthermore, balloon dilatation is easier, much less invasive and expensive than open surgery, and cryotherapy or photoresection. Because of these advantage, we think that balloon dilatation could be the first choice for treating bronchial stenosis and could be done at first in early stage if unresponsiveness with steroid therapy is observed.

A case report of the Pulmonary Malignant Lymphomaof the mucosa-associated lymphoid tissue(MALT) / 결핵

The pulmonary lymphomas were thought to originate in specialized lymphoid tissue that is associated with bronchial mucosa(bronchus-associated lymphoid tissue(BALT)), and they were categorized as mucosa-associated lymphoid tissue(MALT) lymphoma. MALT lymphoma consists of a monoclonal population of cell, in contrast to reactive lymphoid proliferation, which consists of polyclonal cells. Lymphoma arising from MALT(=MALToma) represents a distinct clinicopathologic features. It is usually localized to their original site for a long time and shows much more favorable prognosis than lymphoma at other site. Some MALT lymphoma could arise simultaneously or successively in different organ or that cells from MALT lymphoma might circulate and give rise to another lymphoma by homing in the MALT of another organ, such as breast, salivary gland, stomach etc, and can be multifocally disseminated or recurred. We report a case of low-grade B-cell lymphoma of the mucosa-associated lymphoid tissue(MALT) of the lung, which was confirmed by open lung biopsy, immunohistochemistry and PCR assay.