Change in management and outcome of mechanical ventilation in Korea: a prospective observational study

Background/Aims@#There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. @*Methods@#International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. @*Results@#Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. @*Conclusions@#There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.

Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019

Background/Aims@#The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients. @*Methods@#This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up. @*Results@#Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients. @*Conclusions@#Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.

Utility of Radial Probe Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Diffuse Lung Lesions / 결핵

BACKGROUND: Radial probe endobronchial ultrasound (R-EBUS) is widely used for diagnosing peripheral pulmonary lesions. However, the utility of R-EBUS-guided transbronchial lung biopsy (TBLB) for diffuse lung lesions (DLLs) remains unknown. We designed this study to evaluate the utility of R-EBUS-guided TBLB in DLLs. METHODS: This retrospective study enrolled patients admitted from January 2016 to November 2017 who underwent TBLB for DLLs. The R-EBUS-guided TBLB and blind TBLB groups were compared. DLL was defined as any lung disorder that involved more than one segment of the lung. In both the groups, fluoroscopy and guided sheath were not used during TBLB. RESULTS: A total of 127 patients underwent TBLB for DLLs (67 patients in the R-EBUS-guided TBLB group and 60 in the blind TBLB group). There were no differences in age, sex, and comorbid illnesses between the two groups. Furthermore, there was no difference in the TBLB diagnostic yield of the two groups (p=0.660) although more samples were collected from the R-EBUS-guided TBLB group (p=0.003). Procedure time was significantly longer in the R-EBUS-guided TBLB group than in the blind TBLB group (p<0.001). Thus, incidence of pneumothorax was significantly lower in the R-EBUS-guided TBLB group than in the blind TBLB group (p=0.032). CONCLUSION: Diagnostic yield in DLLs did not differ between the R-EBUS-guided TBLB and blind TBLB groups. Findings show that R-EBUS-guided TBLB in DLLs may reduce risk of pneumothorax.

Utility of Radial Probe Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Diffuse Lung Lesions / 결핵및호흡기질환

BACKGROUND@#Radial probe endobronchial ultrasound (R-EBUS) is widely used for diagnosing peripheral pulmonary lesions. However, the utility of R-EBUS-guided transbronchial lung biopsy (TBLB) for diffuse lung lesions (DLLs) remains unknown. We designed this study to evaluate the utility of R-EBUS-guided TBLB in DLLs.@*METHODS@#This retrospective study enrolled patients admitted from January 2016 to November 2017 who underwent TBLB for DLLs. The R-EBUS-guided TBLB and blind TBLB groups were compared. DLL was defined as any lung disorder that involved more than one segment of the lung. In both the groups, fluoroscopy and guided sheath were not used during TBLB.@*RESULTS@#A total of 127 patients underwent TBLB for DLLs (67 patients in the R-EBUS-guided TBLB group and 60 in the blind TBLB group). There were no differences in age, sex, and comorbid illnesses between the two groups. Furthermore, there was no difference in the TBLB diagnostic yield of the two groups (p=0.660) although more samples were collected from the R-EBUS-guided TBLB group (p=0.003). Procedure time was significantly longer in the R-EBUS-guided TBLB group than in the blind TBLB group (p<0.001). Thus, incidence of pneumothorax was significantly lower in the R-EBUS-guided TBLB group than in the blind TBLB group (p=0.032).@*CONCLUSION@#Diagnostic yield in DLLs did not differ between the R-EBUS-guided TBLB and blind TBLB groups. Findings show that R-EBUS-guided TBLB in DLLs may reduce risk of pneumothorax.

Effectiveness and Safety of High-Flow Nasal Cannula Oxygen Delivery during Bronchoalveolar Lavage in Acute Respiratory Failure Patients / 결핵및호흡기질환

BACKGROUND: Bronchoalveolar lavage (BAL) is a necessary procedure for diagnosis of various lung diseases. High-flow nasal cannula (HFNC) oxygen delivery was recently introduced. This study aimed to investigate the safety and effectiveness of HFNC oxygen supply during BAL procedure in patients with acute respiratory failure (ARF). METHODS: Patients who underwent BAL while using HFNC at a partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2; PF) ratio of 300 or below among patients who had been admitted from March 2013 to May 2017 were retrospectively investigated. RESULTS: Thirty-three BAL procedures were confirmed. Their baseline PF ratio was 166.1±46.7. FiO2 values before, during, and after BAL were 0.45±0.12, 0.74±0.19, and 0.57±0.14, respectively. Flow (L/min) values before, during, and after BAL were 26.5±20.3, 49.0±7.2, and 40.8±14.2, respectively. Both FiO2 and flow during and after the procedure were significantly different from those before the procedure (both p < 0.001). Oxygen saturation levels before, during, and after BAL measured by pulse oximeter were 94.8±2.9, 94.6±3.5, and 95.2±2.8%, respectively. There were no significant differences in oxygen saturation among the three groups. Complications of BAL procedure included transient hypoxemia, hypotension, and fever. However, there was no endotracheal intubation within 24 hours. Baseline PF ratio in “without HFNC” group was significantly higher than that in “with HFNC” group. There were no differences in complications between the two groups. CONCLUSION: The use of HFNC during BAL procedure in ARF patients was effective and safe. However, there were no significant differences in oxygen saturation level and complications comparing “without HFNC” group in mild ARF. More studies are needed for moderate to severe ARF patients.

Chemical Pneumonitis after Inhalation of Waterproofing Spray: A Case Report / 계명의대학술지

Waterproofing spray is commonly used to waterproof textile, tents, boots, etc. Chemical pneumonitis caused by inhalation of waterproofing spray has often been reported. Most waterproofing sprays contain a fluoropolymer in combination with hydrocarbons. However, chemical pneumonitis caused by waterproofing spray not containing fluoropolymer is uncommon. The authors are reporting a case of chemical pneumonitis caused by waterproofing spray, which contained hydrocarbon only. A 35-year-old man presented with dyspnea. The patient used a waterproofing spray on a tent for 30 minutes in a closed room. One hour and a half after spraying, the patient developed dyspnea, and his dyspnea had gotten worse. The patient's respiratory rate was fast, and the patient's arterial blood gas analysis showed hypoxemia. The chest X-ray and high resolution computed tomography showed bilateral ground-glass opacities and areas of consolidation in both lower lung fields. The patient was diagnosed with chemical pneumonitis caused by inhalation of waterproofing spray. Oxygen was given to the patient, and the patient was started on methylprednisolone intravenously. The patient's symptom improved after one day. After one week, most of symptoms of the patient improved and his chest X-ray showed improvement, so the patient was discharged. After discharge, oral prednisolone was prescribed instead of methylprednisolone, and was gradually tapered off. One month later, the patient's chest X-ray showed complete resolution.

Treatment of Endobronchial Hemorrhage Using Balloon Tamponade and Bronchial Artery Embolization / 계명의대학술지

Endobronchial hemorrhage is common complication of bronchoscopic biopsy. There are several hemostatic methods including cold saline irrigation, topical vasoactive substance instillation, tranexamic acid treatment, and balloon tamponade. Insertion of balloon catheter into bronchoscopic working channel is relatively simple and useful method for the selective hemostasis. Here, we report a case of 75-year-old female patient who had hemorrhage during endobronchial biopsy with flexible bronchoscopy. Since primary treatments such as cold saline irrigation and epinephrine instillation had been failed to stop hemorrhage, balloon catheter was immediately inserted into the bleeding site for temporal hemostasis. And then, bronchial artery embolization was followed for the additional treatment of hemorrhage. We suggest to use balloon catheter as a bridge therapy before bronchial artery embolization.

Extraction of Endobronchial Tooth by Flexible Bronchoscopy Using Fishnet Basket in Patients of Intensive Care Unit with Artificial Airway / 대한구급학회지

Foreign body aspiration into the tracheobronchial tree can cause serious problems. Tooth aspiration can occur during emergency endotracheal intubation. However, removal of a tooth from the airway is difficult because of the round shape and smooth surface of the tooth. Here, I report extraction of a tooth from the airway by flexible bronchoscopy using fishnet basket in intensive care patients. The procedure was performed in six patients. All patients were critically ill with an artificial airway (n = 4; endotracheal tube, n = 2; tracheostomy tube). The tooth location was right bronchial tree in three patients and left bronchial tree in three patients. Tooth extraction failed in two patients because the teeth were impacted in the distal bronchus during bronchoscopy. There was no complication such as life threatening arrhythmia or hypoxemia during the procedure. Using flexible bronchoscopy with a fishnet basket, we were able to extract aspirated teeth from patients with an artificial airway.

Clinical Demographics and Outcomes in Mechanically Ventilated Patients in Korean Intensive Care Units

Knowledge of clinical demographics and outcomes of mechanically ventilated patients is important but there are few prospectively collected data in Korea. The objective of the present study was to describe the current status of mechanically ventilated patients in Korea as of 2010. We analyzed the data of Korean patients (275 patients in 12 Korean intensive care units [ICU]) participating in a multinational prospective cohort study on mechanical ventilation. The most common indication for mechanical ventilation was pneumonia (23%). Pressure-limited ventilation modes were preferred over volume-cycled ventilation modes. Non-invasive positive pressure ventilation was used in only seven (2%) patients as the initial ventilatory support. Median duration of mechanical ventilation was 7 days and ICU mortality was 36%. The multiple logistic regression model revealed that the Simplified Acute Physiology Score II (SAPS II) score at ICU admission (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.001-1.036; P=0.033), peak pressure (OR, 1.054; 95% CI, 1.016-1.095; P=0.006), and the number of failed organs (OR, 2.132; 95% CI, 1.634-2.781; P<0.001) were independently associated with ICU mortality. This study provides a snapshot of current practice of mechanical ventilation in Korea.

Reversal of Cisplatin Resistance by Epigallocatechin Gallate Is Mediated by Downregulation of Axl and Tyro 3 Expression in Human Lung Cancer Cells

Lung cancer is still the number one cause of death from cancer worldwide. The clinical effect of platinum-based chemotherapy for non-small cell lung cancer is constrained by the resistance to drug. To overcome chemo-resistance, various modified treatment including combination therapy has been used, but overall survival has not been improved yet. In this study, chemo-resistant lung cancer cells, A549/Cis and H460/Cis, were developed by long-term exposure of cells to cisplatin and the proliferative capability of these resistant cells was verified to be reduced. We found cytotoxic effect of epigallocatechin gallate (EGCG), a major catechin derived from green tea, on both the parental lung cancer cells, A549 and H460, and their cisplatin resistant cells, A549/Cis and H460/Cis. ELISA and Western blot analysis revealed that EGCG was able to increase interlukine-6 (IL-6) production per cell, whereas its downstream effector Signal transducers and activators of transcription 3 (STAT3) phosphorylation was not changed by EGCG, indicating that IL-6/STAT3 axis is not the critical signaling to be inhibited by EGCG. We next found that EGCG suppresses the expression of both Axl and Tyro 3 receptor tyrosine kinases at mRNA and protein level, explaining the cytotoxic effect of EGCG on lung cancer cells, especially, regardless of cisplatin resistance. Taken together, these data suggest that EGCG impedes proliferation of lung cancer cells including their chemo-resistant variants through downregulation of Axl and Tyro 3 expression.

Comparison of the Tuberculin Skin Test and the Interferon-gamma Release Assay for the Diagnosis of Cervical Tuberculous Lymphadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To compare the tuberculin skin test (TST) and the interferon gamma release assay (IGRA) for the diagnosis of cervical tuberculous lymphadenitis (TL). SUBJECTS AND METHOD: A prospective comparison between the TST and the IGRA was performed in subjects who met the inclusion criteria for suspicious cervical TL. TL was confirmed by culture results and clinical diagnosis of TL was also made by histology, polymerase chain reaction and treatment response of the anti-tuberculosis drug. RESULTS: Of the 43 subjects enrolled, 11 subjects were confirmed as TL, nine subjects as clinical TL and 23 subjects as non-TL. The TST and the IGRA were all positive in TL. The agreement between the TST and IGRA was kappa=0.40 in both clinical TL and non-TL. The sensitivity and specificity of the TST were 95.0% [95% confidence interval (CI), 92.1-97.9] and 39.1% (95% CI, 32.6-45.6), respectively. By comparison, the sensitivity and specificity of the IGRA were 85.0% (95% CI, 80.3-89.8) and 52.2% (95% CI, 45.5-58.8), respectively. CONCLUSION: The IGRA was more specific than the TST, while the TST was more sensitive than the IGRA. The higher specificity of IGRA could make IGRA play a useful adjunct role in the diagnosis for cervical TL.

ANCA-Associated Vasculitic Neuropathy with Concurrent Pulmonary Tuberculosis

Antineutrophil cytoplasmic antibodies (ANCA) are closely linked to primary systemic vasculitis, and ANCA detection has became an important diagnostic hallmark of ANCA-associated vasculitis (AAV). However, it has been reported that tuberculosis is associated with positivity for ANCA and it is difficult to differentiate clinically between tuberculosis and AAV. We report a patient with the concomitant appearance of AAV and pulmonary tuberculosis. Positivity for ANCA should be carefully interpreted as indicative of AAV, especially in countries with a high prevalence of tuberculosis.

Patient's Perception of Symptoms Related to Morning Activity in Chronic Obstructive Pulmonary Disease: The SYMBOL Study

BACKGROUND/AIMS: Patients with chronic obstructive pulmonary disease (COPD) experience more problematic respiratory symptoms and have more trouble performing daily activities in the morning. The aim of this study was to assess the perception of COPD symptoms related to morning activities in patients with severe airflow limitation. METHODS: Data of 133 patients with severe airflow limitation were analyzed in a prospective, non-interventional study. A clinical symptom questionnaire was completed by patients at baseline. In patients having morning symptoms, defined by at least one or more prominent or aggravating symptom during morning activities, a morning activity questionnaire was also completed at baseline and following 2 months of COPD treatment. RESULTS: The most frequently reported COPD symptom was breathlessness (90.8%). Morning symptoms were reported in 76 (57%) patients; these had more frequent and severe clinical COPD symptoms. The most frequently reported morning activity was getting out of bed (82.9%). The long acting muscarinic antagonist (odds ratio [OR], 6.971; 95% confidence interval [CI], 1.317 to 11.905) and chest tightness (OR, 0.075; 95% CI, 0.011 to 0.518) were identified as significantly related to absence of morning symptoms. There was no significant correlation between the degree of forced expiratory volume in 1 second improvement and severity score differences of all items of morning activity after 2-month treatment. CONCLUSIONS: Fifty-seven percent of COPD patients with severe airflow limitation have morning symptoms that limit their morning activities. These patients also have more prevalent and severe COPD symptoms. The results of this study therefore provide valuable information for the development of patient-reported outcomes in COPD.

A Case of Multiple Symmetrical Lipomatosis Causing Upper Airway Obstruction / 결핵및호흡기질환

Multiple symmetrical lipomatosis (MSL), also called Madelung's disease, is a rare disorder of unknown etiology and characterized by abnormal accumulation of large subcutaneous fatty masses in neck, shoulder, and upper trunk. MSL has known to predominantly affect middle-aged men with a history of alcoholism. Although the clinical course of MSL is considered to be slowly progressive, in advanced stage, fatty masses in the neck may compress the upper aerodigestive tract, resulting in dyspnea and dysphagia. The treatment of MSL is surgical resection, but radical excision is very difficult and recurrence after surgery is frequent. We report the case of 55-year-old man with long lasting MSL, which caused severe airway obstruction. This patient was admitted with progressive dyspnea and massive accumulation of fat around the vocal cord that was detected on a neck CT scan. This abnormal fatty infiltration in supraglottic region caused upper airway obstruction.

A Case of Multiple Symmetrical Lipomatosis Causing Upper Airway Obstruction / 결핵및호흡기질환

Multiple symmetrical lipomatosis (MSL), also called Madelung's disease, is a rare disorder of unknown etiology and characterized by abnormal accumulation of large subcutaneous fatty masses in neck, shoulder, and upper trunk. MSL has known to predominantly affect middle-aged men with a history of alcoholism. Although the clinical course of MSL is considered to be slowly progressive, in advanced stage, fatty masses in the neck may compress the upper aerodigestive tract, resulting in dyspnea and dysphagia. The treatment of MSL is surgical resection, but radical excision is very difficult and recurrence after surgery is frequent. We report the case of 55-year-old man with long lasting MSL, which caused severe airway obstruction. This patient was admitted with progressive dyspnea and massive accumulation of fat around the vocal cord that was detected on a neck CT scan. This abnormal fatty infiltration in supraglottic region caused upper airway obstruction.

Curcumin Induces Downregulation of E2F4 Expression and Apoptotic Cell Death in HCT116 Human Colon Cancer Cells; Involvement of Reactive Oxygen Species

E2F transcription factors and their target genes have been known to play an important role in cell growth control. We found that curcumin, a polyphenolic phytochemical isolated from the plant Curcuma longa, markedly suppressed E2F4 expression in HCT116 colon cancer cells. Hydrogen peroxide was also found to decrease E2F4 protein level, indicating the involvement of reactive oxygen species (ROS) in curucmin-induced downregulation of E2F4 expression. Involvement of ROS in E2F4 downregulation in response to curcumin was confirmed by the result that pretreatment of cells with N-acetylcystein (NAC) before exposure of curcumin almost completely blocked the reduction of E2F4 expression at the protein as well as mRNA level. Anti-proliferative effect of curcumin was also suppressed by NAC which is consistent to previous reports showing curcumin-superoxide production and induction of poly (ADP-ribose) polymerase (PARP) cleavage as well as apoptosis. Expression of several genes, cyclin A, p21, and p27, which has been shown to be regulated in E2F4-dependent manner and involved in the cell cycle progression was also affected by curcumin. Moreover, decreased (cyclin A) and increased (p21 and p27) expression of these E2F4 downstream genes by curcumin was restored by pretreatment of cells with NAC and E2F4 overexpression which is induced by doxycycline. In addition, E2F4 overexpression was observed to partially ameliorate curcumin-induced growth inhibition by cell viability assay. Taken together, we found curcumin-induced ROS down-regulation of E2F4 expression and modulation of E2F4 target genes which finally lead to the apoptotic cell death in HCT116 colon cancer cells, suggesting that E2F4 appears to be a novel determinant of curcumin-induced cytotoxicity.

Bullous Eosinophilic Cellulitis (Wells' Syndrome) in a Patient with Churg-Strauss Syndrome: A Case Report and Review of Literatures / 대한류마티스학회지

Wells' syndrome is an inflammatory dermatosis with associated aberrant eosinophil responses caused by unknown factors. Its histology is characterized by erythematous plaques with "flame figures" in the dermis, which is potentially diagnostic but not pathognomic. Cases of Wells' syndrome in patients with Churg-Strauss syndrome (CSS), which is characterized by antineutrophil cytoplasmic antibody-related necrotizing vasculitis, marked peripheral eosinophilia, and eosinophil tissue infiltrates, have rarely been reported, and the pathogenic association between these two diseases remains undetermined. Differences of clinical and histopathologic features of these two diseases suggest that they are distinct disease entities, even though, in part, they share pathogenic mechanisms. Here we present a new case with Wells' syndrome in a patient with CSS, treated with systemic steroid.

Improvement of Pulmonary Function after Administration of Azithromycin in a Patient with Bronchiolitis Obliterans: a Case Report / 결핵및호흡기질환

Bronchiolitis obliterans (BO) is a serious noninfectious complication following an allogeneic bone marrow transplant (BMT). A 21-year-old female received an allogeneic BMT as a treatment for myelodyplastic syndrome. Four months after the BMT, progressive dyspnea developed and BO was also diagnosed by a lung biopsy. The patient was administered steroid and immunosuppressive agents for 1 year but there was no improvement in pulmonary function. Azithromycin was prescribed (500 mg q.d. for 3 days followed by 250 mg three time a week) because macrolides might decrease the inflammatory reaction leading to BO. The patient's pulmonary function improved after administration of azithromycin for 1 year. The forced expiratory volume in a one second (FEV1) increase was 220 mL (28.2%) and the forced vital capacity (FVC) increase was 460 mL (25.7%). We report the improvement in the pulmonary function after the administration of azithromycin for 1 year in a patient with BO after a BMT.

The Clinical Characteristics and Prognosis of Elderly Patients with Lung Cancer Diagnosed in Daegu and Gyeongsangbukdo / 결핵및호흡기질환

BACKGROUND: Lung cancer is the leading cause of cancer death in South Korea since the year 2000 and it is more common in elderly patients, with a peak incidence at around 70~80 years of age. However, these elderly patients receive treatment less often than do the younger patients because of organ dysfunction related to their age and their comorbidities, and they show poor tolerance to chemotherapy. The aims of this study were to analyze the clinical characteristics and treatment-related survival of elderly patients with lung cancer. METHODS: In this retrospective study, we analyzed the clinical data of 706 lung cancer patients who were diagnosed at hospitals in Daegu and Gyeongsangbukdo from January 2005 to December 2005. We compared the clinical characteristics and outcomes of the patients who were aged 70 years and older (elderly patients) with those clinical characteristics and outcomes of the younger individuals. RESULTS: The median age of the patients was 68 years (from 29 to 93) and the elderly patients were 38.7% (n=273) of all the study's patients. Squamous cell carcinoma was the most common type of lung cancer in both the elderly and younger patient groups. Elderly patients had more symptoms of dyspnea and chronic obstructive pulmonary disease (COPD) than the younger patients (p<0.001 and p<0.001, respectively). A good performance status (ECOG 0-1) was less common for the elderly patients (p<0.001). The median survival of the non-small cell lung cancer (NSCLC) patients was significantly higher in the younger patient group than in the elderly patient group (962 days vs 298 days, respectively, p=0.001). However, the median survival of the NSCLC patients who received any treatment showed no significant difference between the younger patient group and the elderly patient group (1,109 days vs 708 days, respectively, p=0.14). CONCLUSION: Our data showed that appropriate treatment for selected elderly patients improved the survival of patients with NSCLC. Therefore, elderly NSCLC patients with a good performance status should be encouraged to receive appropriate treatment.

A Case of Tenosynovitis Due to Mycobacterium intracellulare in a Patient with Rheumatoid Arthritis

Nontuberculous mycobacteria are ubiquitous organisms that are frequently present in the water, soil and animal reservoirs. Nontuberculous mycobacterial infections of the musculoskeletal system are rare and usually associated with predisposing factors, such as prior joint disease, trauma, use of intraarticular or oral corticosteroids, or an immunocompromised state. A sixty five-year-old patient with rheumatoid arthritis was hospitalized due to swelling on the left wrist. M. intracellulare was cultured from the aspirated joint fluid. The patient was successfully treated with clarithromycin, ethambutol, and rifampin. We report this case with review, emphasizing high suspicion for nontuberculous mycobacterial infection in patients with predisposing risk factors.