Symptom Questionnaire and Laboratory Findings in Subjects with Airflow Limitation: a Nation-wide Survey / 결핵및호흡기질환

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. COPD has systemic effects, such as skeletal muscle dysfunction and abnormal weight loss. It also has been suggested that COPD is related to other chronic disease, such as cardiovascular disease, osteoporosis, and anemia. The aim of this study was to evaluate a symptom questionnaire and laboratory findings in subjects with air flow limitation. METHODS: We evaluated a symptom questionnaire and laboratory findings in subjects with airflow limitation detected by spirometry in conjunction with the Second Korean National Health and Nutrition Examination Survey. A total of 9,243 adults over the age of 18 were recruited. Among the adults, we finally analyzed 2,217 subjects who met the acceptability and repeatability criteria of spirometry, showed normal findings on chest radiography, and were older than 40 years of age. RESULTS: There were 288 subjects with airflow limitation as determined by spirometry. The frequency of respiratory symptoms such as cough, sputum and wheezing were significantly higher in subjects with airflow limitation (p<0.01). Hemoglobin and hematocrit levels were higher in subjects with airflow limitation (hemoglobin level 13.98 mg/dL vs. 13.62 mg/dL, hematocrit 42.10% vs. 40.89%; p<0.01). The HDL cholesterol level was lower in subjects with airflow limitation (44.95 mg/dL vs. 45.60 mg/dL; p<0.01). There was no significant difference in the total cholesterol, triglyceride, blood urea nitrogen, creatinine, and fasting glucose levels. CONCLUSION: In subjects with airflow limitation, prevalence of respiratory symptoms was higher than in normal spirometry subjects and the levels of hemoglobin and the hematocrit were higher. The HDL cholesterol level was lower in subjects with airflow limitation.

A Case of Endobronchial Tuberculosis with Repeated Expectoration of Nodular Tissues / 결핵및호흡기질환

Herein, we report a case of tumorous endobronchial tuberculosis with successful recovery of atelectasis without any significant bronchial stricture, after repeated expectorations of nodular tissues. A 24-year-old male patient was presented with persistent cough. The patient was diagnosed to be suffering from tuberculous lymphadenitis on right axillar and mediastinum of lung, and was subsequently treated with antituberculosis agents. After two months, clinical deteriorations and atelectasis were observed on right upper lobe of lung. Multiple endobronchial tumorous lesions, which obstructed the right main bronchus, were revealed on bronchoscopy, and based on the endobronchial biopsy findings we confirmed that the patient was suffering from endobronchial tuberculosis. We decided to administer antituberculosis agents without any additional procedure. After few weeks, the patient spontaneously expectorated nodular tissues with vigorous coughing. Later on, the symptoms and atelectasis disappeared and the patient was completely recovered. This case shows that in patients suffering from tumorous endobronchial tuberculosis, endobronchial mass can be expectorated spontaneously without sequelae of significant bronchial stenosis.

Two cases of anaphylaxis to diclofenac with aspirin tolerance / 대한내과학회지

Anaphylaxis is an acute life-threatening reaction, usually mediated by immunologic and non- immunologic mechanisms. Non-steroidal anti-inflammatory drugs (NSAIDs) can produce anaphylactic reactions by different pathogenic mechanisms. The most of these reactions are elicited by different NSAIDs depending on the potency of the cyclooxygenase inhibition, but other reactions provoked by IgE-dependent mechanism. The NSAIDs most often involved in these kinds of reactions are pyrazolones and aspirin. Diclofenac is a widely used NSAID derivative of phenylacetic acid. Anaphylaxis to diclofenac with aspirin tolerance has been rarely described. Here we report two cases of selective anaphylaxis to diclofenac with good tolerance to aspirin. It may be suggested by IgE-dependent reaction, not by cyclooxygenase inhibition.

A case of anaphylactoid reaction to nonionic contrast agent, Iodixanol (Visipaque(R)) during coronary angiography / 대한내과학회지

Radiocontrast agent infusion is the most common cause of non-IgE mediated anaphylactoid reaction in the modern medical procedures. The newer lower-osmolar nonionic contrast agents cause significantly lower adverse reactions than the high-osmolar ones. However, anaphylactoid reaction to nonionic contrast agent can cause life-threatening events and even death has been rarely reported. Iodixanol (Visipaque(R)) is a nonionic, dimeric contrast agent, which is currently used in cardiac catheterization. Here we report a case of anaphylactoid reaction to Iodixanol, a nonionic radiocontrast agent, during cardiac catheterization. A 45-year-old male patient underwent cardiac catheterization for evaluation of substernal pain during exercise. Five minutes after this contrast injection to the left coronary artery, he complained itching and dizziness. Subsequently, generalized urticaria, cyanosis and hypotension were developed. His coronary angiogram showed normal findings. He was treated with intravenous fluids, intravenous diphenhydramine, sucutaneous epinephrine and sympathomimetics and one hour later he recovered. This case suggests that anaphylactoid reaction to a radiocontrast media, iodixanol, should be considered in the list of differential diagnoses for cardiopulmonary arrest during cardiac catheterization.

Anaphylaxis Caused by Benzalkonium in a Nebulizer Solution

Benzalkonium chloride (BAC) is commonly used as a bactericidal preservative in nebulizer solutions, and can cause paradoxical onchoconstriction following nebulizing therapy in some asthmatics. We describe a case of anaphylactic shock in a 23-yr-old asthmatic woman following an intradermal skin test with a salbutamol solution containing BAC. Since she complained of cough and dyspnea after inhalation therapy with a nebulizer solution, we conducted an intradermal skin test using the same solution, which contained BAC. About 10 min later, the patient reported dizziness, palpitations, and dyspnea. On examination, tachycardia, tachypnea, and hypotension were found. She was resuscitated with a subcutaneous injection of epinephrine and an infusion of saline. One month later, we conducted a bronchial provocation test with BAC, and she showed a positive response.

A Case of Pulmonary Edema Due to the Severe Airway Obstruction by the Burglary Attack / 결핵

Acute fulminating pulmonary edema was developed in 20 year old female following an acute airway obstruction due to a burglary attack on neck with bare hands. The pathogenesis of pulmonary edema is related to the alveolar and capillary damage induced by the severe negative pressure generated by attempting to inspire against the closed upper airway. This female responded to fluid restriction and oxygen supply. To our knowledge, pulmonary edema caused by man has never been reported in the literature.

A Case of Behcet's Disease with Superior Vena Cava Syndrome / 결핵

As a chronic multisystemic inflammatory disorder, Behcet's disease may manifest vascular, cardiac, neurological and gastrointestinal abnormalities. However, involvement of large veins, such as thrombosis of the superior or inferior vena cava, is a very rare complication. Herein, a case of superior vena cava syndrome, due to the thrombotic obstructions of the subclavian and brachiocephalic vein, is reported in a 27-year old woman with chronic Behcet's disease.

A case of hypersensitivity associated with oral aloe agent / 천식및알레르기

Aloe has been widely used as folk medicine for centuries, especially for skin injury and burns. The aloes consisted of various substances including highly sensitizing agent, anthraquinone and there are few reports of hypersensitivity to aloe in the medical literatures. We report herein a case of hypersensitivity associated with oral aloe agent. A 36-year-old woman was referred for recurrent pruritic hives on various parts of her body 3 days ago. She had been admitted with acute urticaria and hepatitis in another hospital 20 days previously and discharged 1 week ago. On detailed medication history, she had been consuming oral aloe agent since 1 month ago and developed pruritic hives and athralgia following ingestion of oral aloe agent. Abnormalities of liver function were also shown. The patient underwent allergic skin test and showed positive response to aloe.

A case of anaphylactic reaction to oral cefaclor / 대한내과학회지

Antibiotics induced anaphylaxis is one of the most acute and potentially fatal drug-related adverse reactions. Cefaclor, an oral second-generation cephalosporin with a beta lactam ring, is used various infectious diseases of the respiratory tract. Few cases of cefaclor anaphylaxis have been rarely reported. Here we report a case of anaphylactic reaction to cefaclor in a 40-year-old female patient. She developed systemic reaction comprised of generalized hives with itching, vomiting, abdominal pain, and hypotension. She was treated on our ER with intravenous fluids, intravenous diphenhydramine and subcutaneous epinephrine. Since four month ago, she had developed generalized pruritic eruptions with flu-like symptoms. The rash resolved the same day after treated with intravenous diphenhydramine. On detailed history taking for medication, we had known that she received a same prescription containing a cefaclor at every episode. Subsequently we tested the patient with cefaclor and conducted an intradermal skin test and an ELISA to cefaclor-HSA conjugate. She showed a positive response. Cefaclor is widely used for common infections, physicians should anticipate the possibility of anaphylactic reaction treated with this agent, particularly in cases of multiple exposure.

A Case of Pulmonary Carcinosarcoma which Metastasize to Pelvic Cavity After Left Pneumonectomy / 결핵

Pulmonary carcinosarcoma(Sarcomatoid carcinoma of the lung) is a rare pulmonary malignancy, which is defined as having an admixtture of both carcinomatous and sarcomatous components. Pulmonary carcinosarcoma occurs most frequentlly in males between 50 and 80 years of age. It predominantly affects the upper lobe and/or the principal bronchi, and is associated with a history of smoking. Here, we report a case of pulmonary carcinosarcoma with a left lobe atelectasis due to an endobronchial mass in a 56-year-old male. After a left pneumonectomy, the pathologic stage was IIb (T3N0M0). Four months later, an abdominal mass was observed and exploratory laparotomy revealed metastases of the pulmonary carcinosarcoma to the pelvic cavity.