A Comparative Study of Community-acquired Klebsiella pneumoniae Bacteremia and Escherichia coli Bacteremia / 감염

BACKGROUND: Klebsiella pneumoniae is the second most common causative pathogen only next to Escherichia coli among the facultative Gram-negative rods causing both community-acquired and nosocomial bacteremia. METHODS: We have reviewed the clinical and laboratory data from all patients with community-acquired K. pneumoniae bacteremia and compared it with randomly selected community-acquired E. coli bacteremia in the patients who were admitted to Ajou University hospital between the period from 1997 to 1998. RESULTS: The incidence of K. pneumoniae bacteremia was 1.8/1,000 patient discharge. Of 51 patients with K. pneumoniae bacteremia, 27 were male and 24 were female. The mean age was 58.4 years. The primary foci of K. pneumoniae bacteremia were hepatobiliary tract (35%), urinary tract (22%), respiratory tract (16%) and 20% of patients had no primary focus identified. The attributable mortality of K. pneumoniae bacteremia was 20%. Patients with K. pneumoniae and E. coli bacteremia had common clinical features, but K. pneumoniae bacteremia had high incidence of diabetes mellitus as an underlying illness and there was a tendency to form abscess and neutropenia more frequently than in E. coli bacteremia. E. coli was found to be more resistant to antibiotics (ampicillin/ sulbactam, ciprofloxacin, gentamicin, cephalothin, co-trimoxazole, tetracycline and tobramycin) than K. pneumoniae. CONCLUSION: K. pneumoniae bacteremia occurred more frequently in diabetes mellitus and the major primary focus was hepatobiliary tract. K. pneumoniae bacteremia had a higher incidence of abscess formation and neutropenia than E. coli.

Spontaneous Bacterial Empyema in a Patient with Liver Cirrhosis / 감염

Spontaneous bacterial empyema (SBEM), a relatively rare complication of liver cirrhosis, is characterized by a bacterial infection of the transudative pleural fluid without obvious infection focus within the thoracic cavity. The analysis of pleural fluid shows characteristic 'infected transudate' with occasional identification of causative organism as in spontaneous bacterial peritonitis. The outcome is relatively favorable with early identification of the disease and subsequent proper an-tibiotic therapy alone. Closed horacotomy is not nece- ssary in most cases and may be even more hazardous. We report a case of SBEM in a 37-year old male patient with hepatitis B-virus associated liver cirrhosis, who recovered with antibiotic therapy alone.

Increased Expression of Phospholipase C-gamma1 Activator Protein, AHNAK in Human Lung Cancer Tissues / 결핵

BACKGROUND: Phospholipase C(PLC) plays a central role in cellular signal transduction and is important in cellular growth, differentiation and transformation. There are currently ten known mammalian isozymes of PLC reported to this date. Hydrolysis of phosphatidylinositol 4,5-bisphosphate(PIP2) by PLC produces two important second messengers, inositol 1,4,5-trisphosphate(IP3) and diacylglycerol. PLC-gamma1, previously, was known to be activated mainly through growth factor receptor tyrosine kinase. Other mechanisms of activating PLC-gamma1 have been reported such as activation through tau protein in the presence of arachidonic acid in bovine brain and activation by IP3, phosphatidic acid, etc. Very recently, another PLC-gamma1 activator protein such as tau has been found in bovine lung tissue, which now is considered to be AHNAK protein. But there has been no report concerning AHNAK and its associated disease to this date. In this study, we examined the expression of the PLC-gamma1 activator, AHNAK, in lung cancer specimens and their paired normal. METHODS: From surgically resected human lung cancer tissues taken from twenty-eight patients and their paired normal counterparts, we evaluated expression level of AHNAK protein using immunoblot analysis of total tissue extract. Immunohistochemical stain was performed with primary antibody against AHNAK protein. RESULTS: Twenty-two among twenty-eight lung cancer tissues showed over expression of AHNAK protein(eight of fourteen squamous cell lung cancers, all of fourteen adenocarcinomal). the resulting bands were multiple ranging from 70 to 200 kDa in molecular weight and each band was indistinct and formed a smear, reflecting mobility shift mainly due to proteolysis during extraction process. On immunohistochemistry, lung cancer tissues showed a very heavy, dense staining with anti-AHNAK protein antibody as compared to the surrounding normal lung tissue, coresponding well with the results of the western blot. CONCLUSION: The overexpression of PLC-gamma1 activator protein, AHNAK in lung cancer may provide evidence that the AHNAK protein and PLC-gamma1 act in concerted manner in carcinogenesis.

The Role of Camera-Based Coincidence Positron Emission Tomography in Nodal Staging of Non-Small Cell Lung Cancer / 결핵

BACKGROUND: It is very important to determine an accurate staging of the non-small cell lung cancer(NSCLC) for an assessment of operability and it's prognosis. However, it is difficult to evaluate tumor involvement of mediastinal lymph nodes accurately utilizing noninvasive imaging modalities. PET is one of the sensitive and specific imaging modality. Unfortunately PET is limited use because of prohibitive cost involved with it's operation. Recently hybrid SPECT/PET (single photon emission computed tomography/positron emission tomography) camera based PET imaging was introduced with relatively low cost. We evaluated the usefulness of coincidence detection (CoDe) PET in the detection of metastasis to the mediastinal lymph nodes in patients with NSCLC. METHODS: Twenty one patients with NSCLC were evaluated by CT or MRI and they were considered operable. CoDe PET was performed in all 21 patients prior to surgery. Tomographic slices of axial, coronal and sagittal planes were visually analysed. At surgery, mediastinal lymph nodes were removed and histological diagnosis was performed. CoDe PET findings were correlated with histological findings. RESULTS: Twenty of 21 primary tumor masses were detected by the CoDe PET. Thirteen of 21 patients was correctly diagnosed mediastinal lymph node metastasis by the CoDe PET. Pathological NO was 14 cases and the specificity of NO of CoDe PET was 64.3%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N1 node was 83.3%, 73.3%, 55.6%, 91.7%, and 76.2% respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N2 node was 60.0%, 87.5%, 60.0%, 87.5%, and 90.0% respectively. There were 3 false negative cases but the size of the 3 nodes were less than 1cm. The size of true positive nodes were 1.1cm, 1.0cm, 0.5cm respectively. There were 1 false positive among the 12 lymph nodes which were larger than 1cm. False positive cases consisted of 1 tuberculosis case, 1 pneumoconiosis case and 1 anthracosis case. CONCLUSION: CoDe PET has relatively high negative predictive value in the enlarged lymph node in staging of mediastinal nodes in patients with NSCLC. Therefore CoDe PET is useful in ruling out metastasis of enlarged N3 nodes. However, further study is needed including more number of patients in the future.

The imbalance between coagulation and fibrinolysis is related to the severity of the illness and the prognosis in sepsis

OBJECTIVES: The coagulation and fibrinolytic system appears to be activated by the septic process independently, leading to the syndrome of disseminated intravascular coagulation (DIC). In this study, we investigated the changes within the hemostatic system related to the severity of the illness and the prognosis in patients with sepsis. METHODS: Plasma thrombin-antithrombin III (TAT) and plasmin-alpha 2-antiplasmin (PAP) complexes were measured using ELISA methods in 32 patients with sepsis and 20 controls and were analyzed according to the APACHE III scores and survival of the patients. RESULTS: Plasma TAT and PAP in patients with sepsis were significantly higher than controls. Nonsurvivors showed greater levels of TAT (21.7 +/- 22.3 ng/mL) and lower levels of PAP (628.4 +/- 378.1 ng/mL) than survivors (TAT: 11.1 +/- 11.2 ng/mL; PAP: 857.1 +/- 364.1 ng/mL). The imbalance between coagulation and fibrinolysis described as TAT/PAP ratio was closely related with APACHE III scores in patients with sepsis (r = 0.47) and the TAT/PAP ratio in nonsurvivors was significantly higher compared with survivors (34.4 +/- 21.4 vs. 14.4 +/- 13.8). CONCLUSION: In sepsis, both coagulation and the fibrinolysis system are activated and the imbalance between coagulation and fibrinolysis predisposes to the hypercoagulation state and is closely related to the severity of the disease and the prognosis.

Thioredoxin Peroxidase manifestation in Radiation-induced White rat Lung tissues / 결핵

BACKGROUND/AIMS: It is well recognized that all aerobic cells have the protective mechanisms in order to minimize the tissue damage induced by various reactive oxygen species(ROS). Thioredoxin peroxidase(TPX) which has been recently identified and characterized functions to convert peroxide to water. The protein is also found in various subtypes(TPX-A and B, MER5, HS22 and HORF-06) and is known to be ubiquitous in most human cells. Especially, ischemic brain injuries, partial hepatectomy and radiation induced DNA damages. In treating lung cancer, radiation therapy has a major place in the local control and the relief of symptoms, but radiation induced free radical injury and resulting pulmonary fibrosis has been the major drawback of the therapy. However, little is known about the protective mechanisms and biologic modulations against radiation induced tissue damages. METHODS: Eighteen mice were divided into six groups, 3 in each group, and fifteen had received 900cGy of radiation. The mice were sacrificed according to the pre determined time schedule; immediate, 1, 2, 3 and 6weeks after irradiation. Extracts were made from the lungs of each mice, Western blot analysis of various subtypes of TPX were done after SDS-PAGE. Examination of H and E stained slides from the same irradiated specimens and the control specimens were also performed. RESULTS: No difference in the intensity of the immunoreactive bands in the irradiated lung samples of the mice compared to the unirradiated control was observed regardless of the time intervals, although H and E examination of the sample specimens demonstrated progressive fibrotic changes of the irradiated lung samples. CONCLUSION: In conclusion, according to our data, it is suggested that various thioredoxin peroxidase subtypes and catalase which are known to be increased in many repair processes may not be involved in the repair of the radiation injury to the lung and subsequent fibrosis.

Pulmonary Toxicity Following High-Dose Chemotherapy With Peripheral Blood Stem Cell Transplantation / 결핵

BACKGROUND: High-dose chemotherapy is increasingly employed in many refractory malignant diseases. This therapy has been reported to increase response rate and survival benefits but it is also associated with higher treatment-related morbidity and mortality. We evaluated clinical characteristics and course of the pulmonary toxicity following high-dose chemotherapy with peripheral blood stem cell transplantation. METHODS: Ninety-seven patients who had received high-dose chemotherapy with peripheral blood stem cell transplantation were evaluated. Five patients who developed lung lesions which were not related to infection nor primary malignant disease underwent transbronchial lung biopsy. The patients' clinical characteristics, treatments, and prognosis were reviewed retrospectively. RESULTS: Five patients(5.1%) developed idiopathic pneumonia syndrome. The high dose chemotherapy regimens employed were cyclophosphamide, BCNU, and cisplatin in 3 cases, one case of BCNU, etoposide, Ara-C, cyclophosphamide combination, and a regimen consisting of BCNU, etoposide, Ara-C, and melphalan. The total dose of BCNU used was 300-400 mg/m2 and that of cyclophosphsmide was 6,000 mg/m2. All of 5 patients received radiation therapy before this treatment. After an average duration of 14 weeks (4-26 weeks) of high-dose chemotherapy, patients developed cough, dyspnea and fever. The chest X-rays showed bilateral diffuse infiltration in 3 cases and the focal infiltration in the other 2 cases. All the patients received corticosteroid therapy as a treatment for the lung lesions. Two of them progressed to acute respiratory distress syndrome and died. Three patients recovered without residual lung lesion but one of them died of dilated cardiomyopathy. CONCLUSION: High-dose chemotherapy with peripheral blood stem cell transplantation especially which containing BCNU regimen may develop idiopathic pneumonia syndrome related to pulmonary toxicity and corticosteroid therapy may be beneficial in some cases.

Pervalence of sensiticity to aspirin (ASA) and food additives in subjects diagnosed as having intrinsic asthma / 천식및알레르기

Objective and METHOD: In order to identify the aggravating agents for intrinsic asthma, we performed ASA- and food additive-challenge tests on 182 subjects diagnosed as having intrinsic asthma. The following tests were performed: Lysine-aspirin bronchoprovocation test to confirm aspirin-sensitivity, sodium bi-sulfite (40-200mg) oral provocation test for sulfite sensitivity, tartrazine oral provocation test (50mg) for tartrazine sensitivity, and sodium benzoate (400mg) oral provocation test for sodium benzoate sensitivity. Positive reaction was defined as decrease in FEV, by more than 20% from the baseline value after the provocation. RESULT: Seventy-five (41.2%) of 182 subjects showed positive responses to more than one agent among the aspirin and three food additives challenged. The prevalence of aspirin-sensitivity was the highest (22.5%), followed by sulfite-sensitivity (8.8%), and then concurrent sensitivity to both aspirin and sulfite (6.0% ), to both aspirin and tartrazine (1.6% ), to aspirin, sulfite and tartrazine (1.1%) and to aspirin, sulfite and sodium benzoate (0.5%). Rhino-sinusitis was noted in 62.5% of aspirin-sensitive asthmatic subjects, 60% of sulfite-sensitive ones, and 80% of tartrazine-sensitive ones. Urticaria was noted in 21.4% of aspirin-sensitive asthmatic subjects, 16.6% of sulfite-sensitive ones and 6.3% of tartrazine-sensitive ones. Thirty-seven to 83% of positive responders had no adverse reaction history. CONCLUSION: These findings suggest that ASA and food additive challenge tests should be considered as a screening test to evaluate any aggravating factors in subjects with intrinsic asthma, even though they may not have experienced any adverse reactions.

NK and LAK activities of mononuclear cells from peripheral blood and regional lymph node in patients with primary lung cancer / 대한내과학회지

BACKGROUND: Several lymphocytic populations, such as natural killer(NK) cells and lymphokine-activated killer (LAK) cells, are involved in immunosurveillance against tumors. Whereas the biological significance of the regional lymph node as a tumor barrier remains unclear, the clinical prognostic relevance of the neoplastic infiltration of these nodes is accepted. It appears that lymph node metastasis are more frequent in lung cancer than in other cancers because of impaired defensive mechanisms in the regional lymph nodes. However little is known about the immunologic function of regional lymph node lymphocytes in patients with lung cancer. Although there is general agreement that the NK and LAK activities of peripheral blood mononuclear cells(PBMC) decreases in patients with various solid and leukemic tumors, this decrease remains unclear with regard to the NK and LAK activities of their regional lymph node mononuclear cells(LNMC). We performed this study to determine the NK and LAK acti vities of regional lymph node, and to compare with those of peripheral blood in patients with lung cancer. METHODS: We measured the NK and LAK activities of PBMC and LNMC that were extirpated at lung cancer operations in 17 patients with lung cancer by 4 hour 51Cr-release assay using K562, Raji cell and allogenous lung cancer cell line(NCIH1092) as a target cell. E:T ratio were 12.5:1, 25:1, and 50:1. RESULTS: 1. Recombinant interleukin-2 induced strong cytotoxic activities against various target cells in PBMC and LNMC. 2. In patients with lung cancer, NK and LAK activities against K562 and allogenous lung cancer cell line(NCIH 1092) were lower than those of PBMC. 3. Against Raji cell, NK activities were not signifi cantly different between PBMC and LNMC, but LAK activities were significantly lower than those of PBMC. 4. NK activities against K562, Raji, and NCIH1092 cell were not significantly different between in patients with early stage and advanced stage lung cancer. 5. LAK activities of PBMC and LNMC against K562, Raji, and NCIH1092 cell were significantly lower in pa tients with advanced stage than those in patients with early stage lung cancer. CONCLUSION: NK and LAK activities of LNMC in patients with lung cancer were lower than those of PBMC, but the cytotoxicity was markedly increased after culture with rIL-2.

A Case of Amylase Producing Small Cell Lung Cancer / 결핵

The majority of lung cancers associated with hyperamylasemia are adenocarcinomas. Here we report an unusual case of a 54-year-old male patient who complained of dyspnea, anterior chest wall discomfort and facial edema for one month, presenting with a huge mediastinal mass and hyperamylasemia complicated by pericardial effusion Histological evaluation of mediastinal mass revealed small cell carcinoma and pericardium showed nonspecific inflammation with fibrosis. The serum amylase had an electrophoretic mobility similar to that of salivary gland enzyme. There were no evidence of a salivary or pancreatic causes of hyperamylasemia. After chemotherapy, parenchymal lung lesions improved and hyperamylasemia disappeared. For the mannagement of peracardial effusion a pericardial window was forms(i. We concluded that the striking increase in serum amylase was due to the ectopic production of this enzyme by the tumor.