A Case of Tracheal Hamartoma Treated with Endoscopic Mucosal Resection / 계명의대학술지

A 77-year-old male patient was hospitalized due to dyspnea and cough. At chest auscultation, Rhonchi was heard from both lung fields. The chest computed tomography (CT) observed nodular lesions within mid-trachea. Bronchoscope observed salient mass from the membranous portion in the mid-trachea, and after taking a biopsy, it was diagnosed as hamartoma. Tracheal hamartoma is a rare benign tumor of lung. Similar way to the endoscopic mucosal resection (EMR), we did endoscopic resection of tracheal hamartoma. We report a case of tracheal hamartoma treated with Endoscopic mucosal resection via flexible bronchoscopy.

The Nephrometry Score: Is It Effective for Predicting Perioperative Outcome During Robot-Assisted Partial Nephrectomy?

PURPOSE: Robot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012 at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluated to predict perioperative outcomes. RESULTS: Of the 113 patients, 81 were men and 32 were women. The patients' mean age was 53.5 years, and their mean body mass index was 22.3 kg/m2. Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that a distance between the tumor and the collecting system of 4 cm were associated with adverse profiles of complications, WIT, and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.3.9.7; p=0.016). A distance between the tumor and the collecting system of < or =4 mm was associated with increased risk of WIT exceeding 20 minutes (OR, 2.8; 95% CI, 1.3.6.3; p=0.012). CONCLUSIONS: Tumor size and proximity of the mass to the collecting system showed significant associations with EBL and WIT, respectively, during RPN. The R.E.N.A.L and PADUA nephrometry scoring systems did not predict perioperative outcomes.

Chronic Lower Urinary Tract Symptoms in Young Men Without Symptoms of Chronic Prostatitis: Urodynamic Analyses in 308 Men Aged 50 Years or Younger

PURPOSE: We investigated the etiologies of lower urinary tract symptoms (LUTS) and compared urodynamic characteristics between different diagnostic groups in young men with chronic LUTS. MATERIALS AND METHODS: We reviewed the medical records of 308 men aged 18 to 50 years who had undergone a urodynamic study for chronic LUTS (> or =6 months) without symptoms suggestive of chronic prostatitis. RESULTS: The men's mean age was 40.4 (+/-10.1) years and their mean duration of symptoms was 38.8 (+/-49.2) months. Urodynamic evaluation demonstrated voiding phase dysfunction in 62.1% of cases (primary bladder neck dysfunction [PBND] in 26.0%, dysfunctional voiding [DV] in 23.4%, and detrusor underactivity [DU]/acontractile detrusor [AD] in 12.7%) and a single storage phase dysfunction in 36.4% of cases (detrusor overactivity [DO] in 13.3%, small cystometric capacity in 17.9%, and reduced bladder sensation in 5.2%). Most of the demographic characteristics and clinical symptoms did not differ between these diagnostic groups. Whereas 53.9% of patients with voiding dysfunction had concomitant storage dysfunction, 69.6% of those with storage dysfunction had concomitant voiding dysfunction. Men with DV or DU/AD exhibited lower maximum cystometric capacity than did those with normal urodynamics. Low bladder compliance was most frequent among patients with PBND (10.0%, p=0.025). In storage dysfunctions, men with DO exhibited higher detrusor pressure during voiding than did those with other storage dysfunctions (p<0.01). CONCLUSIONS: Because clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment.

Reference Equations for the Six-Minute Walk Distance in Healthy Korean Adults, Aged 22-59 Years / 결핵및호흡기질환

BACKGROUND: The six-minute walk test has been widely used in people with chronic cardiopulmonary disorders as an outcome assessment with regards to therapeutic or prognostic determinants. This study was undertaken to determine the six-minute walk distance (6MWD) in a sample of healthy Koreans and to create a reference equation. We also compared the 6MWD of our cohort with previously published equations. METHODS: Two hundred fifty-nine healthy subjects (95 males) aged 22-59 years performed two walking tests using a standardized protocol. 6MWD was defined as the greatest distance achieved from the two tests. The effect of anthropometrics on the 6MWD was also investigated. RESULTS: The average 6MWD was 598.5+/-57.92 m, with significantly longer distances by males (628.9+/-59.51 m) than females (580.9+/-47.80 m) (p<0.001). Age, height, weight, and body mass index were significantly correlated with 6MWD in univariate analysis. Stepwise multiple regression showed height to be single independent predictor of 6MWD (r2=0.205, p<0.001). The reference equations derived in Caucasian and North African populations tend to overestimate the distance walked by Korean subjects, while Asian equations underestimate it. CONCLUSION: The average 6MWD in these Korean populations was 600 m. The regression equation revealed that individual's height was the most significant predictor of distance, explaining 20.5% of the distance variance.

Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation

BACKGROUND: Hyperleukocytosis caused by acute lymphoblastic leukemia (ALL) is associated with early morbidity and mortality due to hyperviscosity arising from the excessive number of leukocytes.This study was designed to assess the incidence of hyperleukocytosis, survival outcomes, and adverse features among pediatric ALL patients with hyperleukocytosis. METHODS: Between January 2001 and December 2010, 104 children with previously untreated ALL were enrolled at the Pusan National University Hospital. All of them were initially stratified based on the National Cancer Institute (NCI) risk; 48 (46.2%) were diagnosed with high-risk ALL. The medical charts of these patients were retrospectively reviewed. RESULTS: Twenty (19.2%) of the 104 children with ALL had initial leukocyte counts of >100x10(9)/L, and 11 patients had a leukocyte count of >200x10(9)/L. Male gender, T-cell phenotype, and massive splenomegaly were positively associated with hyperleukocytosis. Common early complications during induction therapy included renal dysfunction, and central nervous system hemorrhage. The complete remission (CR) rate for the pediatric ALL patients with hyperleukocytosis (94.1%) was similar to the overall CR rate (95.6%). The estimated 3-year event free survival (EFS) and overall survival of ALL children with hyperleukocytosis were 75.0% and 81.2%, respectively. However, patients with initial leukocyte counts >200x10(9)/L had a lower EFS than those with initial leukocyte counts 100-200x109/L (63.6% vs. 100%; P=0.046). CONCLUSION: The outcome of pediatric ALL cases with an initial leukocyte count >200x10(9)/L was very poor, probably due to early toxicity-related death during induction therapy.

Relationship between bronchial anthracofibrosis and endobronchial tuberculosis

BACKGROUND/AIMS: Various pulmonary diseases may be associated with bronchial anthracofibrosis (BAF). Our aim was to identify a relationship between BAF and endobronchial tuberculosis (EBTB). METHODS: In total, 156 patients, diagnosed with EBTB using bronchoscopy, between June 1999 and May 2008, were included. Clinical and bronchoscopic findings between patients with BAF (n = 72, BAF group) and without BAF (n = 84, non-BAF) were analyzed retrospectively. RESULTS: The crude odds ratio (OR) of BAF for EBTB was 8.88 (95% confidence interval, 6.37 to 12.37). On multivariate analysis, adjusting for age, history of biomass smoke exposure, and comorbidities, the most significant independent factor for EBTB was a history of biomass smoke exposure (adjusted OR, 17.471; adjusted p < 0.001). EBTB was more frequent in the right lung, particularly the right middle lobar bronchus, in the BAF group. Actively caseating, edematous-hyperemic, and ulcerative were the major types, with 77 (49%), 33 (21%), and 31 cases (20%), respectively. The BAF group had more ulcerative type, while the non-BAF group had more actively caseating type. The duration of EBTB treatment was similar between the groups. No significant difference was observed in the development of complications during treatment and posttreatment bronchostenosis between the groups. CONCLUSIONS: These findings suggest that BAF may be a risk factor for EBTB and affect the location and morphological type at the time of EBTB development.

Primary Undifferentiated Penile Sarcoma in Adolescence

We report a case of primary penile undifferentiated sarcoma. A 16-year-old adolescent man visited Pusan National University Hospital complaining of a painless mass on his penis that was increasing in size. Magnetic resonance images revealed a 5x5-cm mass and pathological examinations revealed small round cell sarcomas with neuroendocrine differentiation. The tumor, which had metastatic pulmonary nodules, was treated by tumorectomy and systemic chemotherapy. Thirty-four months after the initial diagnosis, the patient was still alive without evidence of local recurrence or metastatic disease. This is our second case of an undifferentiated penile sarcoma.

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.

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women

PURPOSE: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) < or =12 ml/s combined with a detrusor pressure at Qmax < or =10 cmH2O for men and women, respectively. RESULTS: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU. CONCLUSIONS: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.

Seizures in Children Receiving Cancer Treatment / 임상소아혈액종양

BACKGROUND: The neurological complications of childhood patients with cancer are caused by brain metastasis, chemotherapy, and infection. Seizure is one of the most important neurological complications of pediatric patients receiving chemotherapy. This study was designed to identify the causes, clinical manifestations, and prognosis of seizures in children receiving cancer treatment.METHODS: We retrospectively reviewed the medical records of pediatric cancer patients with seizures at Pusan National University Hospital from January 2005 to December 2010.RESULTS: Among 271 patients, 31 experienced seizures (19 males and 12 females), and the mean age at the first seizure was 8.6 years (1.7-18.0 years). Seizures frequently occurred in patients with brain tumors (27.8%), and the types of seizures were generalized seizure in 15 patients (48.4%) and partial in 16 cases (51.6%). Eighteen (62.0%) of 29 patients who underwent a brain magnetic resonance imaging study and 21 (75.0%) of 28 cases who received an electroencephalogram recorded abnormal findings. The causes of seizures were drugs, CNS infections, and brain metastasis each in five cases (16.2%). Drugs were the most common cause in patients with a hematological malignancy (16.2%), whereas brain metastasis was the most common cause in patients with solid tumors (12.9%). Eight (40.0%) of 20 patients who survived received anticonvulsants. Eleven patients (35.5%) expired, and the most common cause of death was progression of the malignancy.CONCLUSION: Drugs, CNS infection, and brain metastasis of tumors were the most common causes of seizure in children with malignancy.

Seizures in Children Receiving Cancer Treatment / 임상소아혈액종양

BACKGROUND: The neurological complications of childhood patients with cancer are caused by brain metastasis, chemotherapy, and infection. Seizure is one of the most important neurological complications of pediatric patients receiving chemotherapy. This study was designed to identify the causes, clinical manifestations, and prognosis of seizures in children receiving cancer treatment. METHODS: We retrospectively reviewed the medical records of pediatric cancer patients with seizures at Pusan National University Hospital from January 2005 to December 2010. RESULTS: Among 271 patients, 31 experienced seizures (19 males and 12 females), and the mean age at the first seizure was 8.6 years (1.7-18.0 years). Seizures frequently occurred in patients with brain tumors (27.8%), and the types of seizures were generalized seizure in 15 patients (48.4%) and partial in 16 cases (51.6%). Eighteen (62.0%) of 29 patients who underwent a brain magnetic resonance imaging study and 21 (75.0%) of 28 cases who received an electroencephalogram recorded abnormal findings. The causes of seizures were drugs, CNS infections, and brain metastasis each in five cases (16.2%). Drugs were the most common cause in patients with a hematological malignancy (16.2%), whereas brain metastasis was the most common cause in patients with solid tumors (12.9%). Eight (40.0%) of 20 patients who survived received anticonvulsants. Eleven patients (35.5%) expired, and the most common cause of death was progression of the malignancy. CONCLUSION: Drugs, CNS infection, and brain metastasis of tumors were the most common causes of seizure in children with malignancy.

Bronchiolitis Obliterans in Children: A Single Institution Experience / 소아알레르기및호흡기학회지

PURPOSE: Although bronchiolitis obliterans (BO) most often occurs after infection, the incidence of post-transplant BO has recently increased due to the increase of organ and bone marrow transplantation. However, there is limited data on the responses to treatment using measurements of pulmonary function in patients with BO. This study aimed to describe clinical characteristics and pulmonary function in children with BO from a single institute and to compare the responses according to treatment modalities in children with post-infectious BO. METHODS: This study was conducted on 22 children who were diagnosed with BO from January 2005 to December 2010. Based on the medical chart, treatment courses and prognosis of the patients were examined retrospectively. The severity of clinical symptoms was determined by the Denver symptom score, basal pulmonary function, and responses to bronchodilators; all parameters were measured and compared between the time of diagnoses and follow-up six months later. RESULTS: The mean age of the patients when diagnosed with BO was 8.3+/-6.6 years; of those patients, sixteen were boys and six were girls. Nineteen cases of BO were associated with acute infection, and the most common cause of those cases was adenovirus. Three cases of BO occurred following allogeneic bone marrow transplantation for acute myelogenous leukemia. The Denver symptom scores at the time of diagnosis were averaged to 3.95+/-0.63, and the average symptom score after follow-up of six months was 2.15+/-0.73. The averages of the % forced vital capacity (FVC), % forced expiratory volume in 1 second (FEV1), and % forced expiratory flow, midexpiratory phase (FEF25-75%) at the time of diagnosis were 69+/-13%, 40.5+/-12.7%, and 17.6+/-7.8%, respectively, and FEV1/FVC was 56.7+/-10.9%. The averages of %FVC, % FEV1, and %FEF25-75% six months after diagnosis were 78+/-17.3%, 62.5+/-16.5%, and 35.6+/-9.5%, respectively, and FEV1/FVC was improved to 70.7+/-18.9%. Symptom scores of the group treated with high dose systemic steroids decreased significantly compared to those of the group treated with inhaled corticosteroids (P<0.05). Likewise, improvement of FEV1/FVC after treatment was greater in the group treated with high dose systemic steroids than in the group treated with inhaled corticosteroids (P<0.05). CONCLUSION: Infections are the more frequent causes of BO in our institute, and adenovirus ismost common. Six-month follow-up study results suggest high dose systemic steroids could lead to better improvement of clinical symptoms and pulmonary function in children with post-infectious BO.

A Case of Intrathoracic Malignant Peripheral Nerve Sheath Tumor in Neurofibromatosis Type I

Malignant peripheral nerve sheath tumor (MPNST) is a rare neoplasm and the main cause of the mortality in neurofibromatosis type 1 (NF 1). MPNSTs have been found mostly in the head and neck and the upper or lower extremities with intrathoracic MPNSTs being uncommon. PET has been a useful diagnostic modality of MPNSTs in NF 1. We present a 17-year-old girl patient with NF 1. She was admitted with chronic cough and shortness of breath caused by a huge mediastinal mass. An 18FDG-PET study revealed intense uptake at the mediastinal mass. She underwent surgery to lessen respiratory symptoms, and the mass was histologically diagnosed as an intrathoracic MPNST.

Ureteroscopic Surgery for a Large Upper Ureteral Stone in an Infant with Bilateral Vesicoureteral Reflux

Pediatric urolithiasis is a relatively rare disease that can have lifelong consequences. The management of pediatric urolithiasis should be individualized with careful consideration of the patients' small body sizes, delicate tissues, needs for general anesthesia with every procedure, and risks of long-term complications. Miniaturization of urological instruments has made the treatment of distal ureteral stones by ureteroscopy in children more common, but there are few reports of the ureteroscopic removal of large upper ureteral stones in infants. We present a case of a 10-month-old female who simultaneously underwent ureteroscopic surgery and endoscopic Deflux(R) injection for treatment of a 22x10 mm unilateral upper ureteral stone and bilateral vesicoureteral reflux. We also review the current treatment options for pediatric urolithiasis.

Is a 22 cm Ureteric Stent Appropriate for Korean Patients Smaller than 175 cm in Height?

PURPOSE: Determining the ideal length of a ureteric stent is important to avoid complications associated with stent placement. Clinically, most urologists usually choose the length of a ureteric stent according to the patient's height. On the basis of a Chinese population study, a 22 cm ureteric stent has been recommended for patients smaller than 175 cm. We evaluated the appropriateness of this recommendation in Korean patients. MATERIALS AND METHODS: A total of 70 patients who were smaller than 175 cm and who underwent ureteroscopic lithotripsy and ureteric stent insertion were studied. The appropriateness of the stent length was determined on the basis of plain film findings. Patient discomfort was measured by use of a visual analogue scale (VAS) before the removal of the ureteric stent. RESULTS: In 29 patients with a 22 cm ureteric stent, 21 patients (72.4%) had an appropriate ureteric stent length and the mean VAS was 4.1. In 36 patients with a 24 cm ureteric stent, 20 patients (55.6%) had an appropriate ureteric stent length and the mean VAS was 4.0. Among 5 patients with a 26 cm ureteric stent, 1 patient (20%) had an appropriate ureteric stent length and the mean VAS was 5.4. CONCLUSIONS: In Korean patients smaller than 175 cm in height, a 22 cm ureteric stent was an appropriate length.

A Case of Pulmonary and Endobronchial Mycobacterium avium Infection Presenting as an Acute Pneumonia in an Immunocompetent Patient / 결핵및호흡기질환

The global number of Mycobacterium avium complex (MAC) pulmonary infection is increasing. Patients with preexisting lung disease or who are immunodeficient are at the greatest risk for developing MAC infection. Endobronchial lesions with MAC infection are rare in the immunocompetent host. However, there have been an increasing number of reports of an immunocompetent host being afflicted with various manifestations of MAC infection. We report a case of pulmonary and endobronchial MAC infection presenting as an acute pneumonia in a 59-year-old female without preexisting lung disease or immunodeficiency.

Initial Experience with Concomitant Prolift(TM) System and Tension-Free Vaginal Tape Procedures in Patients with Stress Urinary Incontinence and Cystocele / 대한배뇨장애요실금학회지

PURPOSE: The objective of this study is to report our initial experience about the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (Prolift(TM)) and concomitant tension-free vaginal tape (TVT) as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI). MATERIALS AND METHODS: We reviewed the charts of patients who underwent Prolift(TM) and TVT between April 2009 and March 2010. All patients had a physical examination and staging of cystocele. According to the International Continence Society system 2, 5 and 3 women had stage grade II, III and IV respectively. All the patients underwent pelvic examination 1, 3, 6 month and 1 year after operation and anatomical and functional outcomes were recorded. An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher on the last physical examination. RESULTS: The mean follow-up was 7.1 (1-11) months. Overall success rate of cystocele repair was 90%. The anatomical cure rate of cystocele was 50%. The cystocele repair improved 4 patients, but failed in 1. SUI was cured in all patients. No significant complications including bladder or vessel injury and mesh related erosion occurred. The postoperative complication was transient voiding difficulty (2 cases). CONCLUSIONS: These preliminary results suggest that Prolift(TM) and TVT offer a safe and effective treatment for female anterior vaginal wall prolapse and SUI. However, a long-term follow up is necessary in order to support the good result maintenance.

The Experience of Cystocele Repair with Monofilament polypropylene Mesh

PURPOSE: The use of synthetic mesh to reinforce the anterior vaginal wall support for cystocele repair has been proposed to prevent recurrence. We evaluated the efficacy and safety of cystocele repair using monofilament polypropylene mesh (Gynemesh PS(TM)). MATERIALS AND METHODS: This study was performed in 53 patents who underwent cystocele repair using monofilament polypropylene mesh between January 2006 and January 2009. According to the ICS (International Continence Society) stage classification, 33, 17 and 3 women had stage II, III and IV cystocele. The operation were performed through the vaginal approach. Patients were followed up for 9 to 36 months. We defined the cure of cystocele as stage 0, improvement as stage I, and failed as stage II or greater RESULTS: The mean follow-up was 23.8 months. At follow-up, 41 women were anatomically cured (77.4%), 12 women were improved as stage I (22.6%) and no one was failed. Six cases were previously ICS stage II, 5 cases were stage III and 1 case was stage IV in improved group. No significant intraoperative complications occurred. The postoperative complications were de novo urgency (4 cases, 7.6%), erosion of mesh (2 cases, 3.8%) and anterior vaginal wall hematoma (1 case, 1.9%). CONCLUSION: The use of polypropylene mesh for correction of cystocele by transvaginal route with tension free technique seems to be a safe and effective procedure.

Recovery Rate of Nontuberculous Mycobacteria and the Clinical Course of Nontuberculous Mycobacterial Pulmonary Disease at a Secondary Hospital / 결핵및호흡기질환

BACKGROUND: To examine the recovery rate of nontuberculous mycobacteria (NTM) from respiratory specimens and the clinical course of NTM pulmonary disease at a 700-bed secondary hospital. METHODS: This study analyzed the results of 843 acid-fast bacilli (AFB) culture-positive respiratory specimens from 650 subjects collected between May 2003 and April 2008. In addition, the clinical course of NTM pulmonary disease, diagnosed using criteria established by the American Thoracic Society, was examined. RESULTS: There were 67 (7.9%) NTM isolates recovered from 52 (8.0%) subjects. Among the 535 AFB smear-positive specimens, 34 (6.3%) NTM isolates were recovered. There were 33 (10.7%) NTM isolates were recovered from 308 AFB smear-negative specimens. Of 52 subjects with isolated NTM, M. intracellulare was the most common species at 73.1% (n=33), followed by M. kansassi (n=7), M. abscessus (n=2), M. fortuitum (n=2), and M. avium (n=1). Sixteen (30.8%) patients had NTM pulmonary disease and the most common causative organism was M. intracellulare (n=14, 87.5%). Of these, 6 cases attained negative conversion in culture, 4 cases failed to attain negative conversion because of poor cooperation or expiration from complicated underlying lung disease, and 5 cases were transferred to a higher-grade hospital. CONCLUSION: The recovery rate of NTM from respiratory specimens was relatively low and the most common species was M. intracellulare. Patients with NTM pulmonary disease showed variable clinical outcomes.

A Case of Exogenous Lipoid Pneumonia after Ingestion of Squalene in Patients with Achalasia / 결핵및호흡기질환

Exogenous lipoid pneumonia (ELP) is a chronic inflammatory reaction of the lungs resulting from the aspiration of vegetable, animal or mineral oils. Squalene, is a derivative of shark liver oil that is taken as a traditional remedy in some Asian countries, and is used widely also in cosmetics. Similar to the symptoms in most cases of oil aspiration, the symptoms of squalene-induced lipoid pneumonia are either absent or nonspecific. Hence, the disease is generally detected incidentally. Although many cases with predisposing factors have been reported, ELP with achalasia is quite rare. We report a 47-year old woman with achalasia who developed ELP after ingesting squalene. The patient was treated successfully by supportive care and surgical treatment of the achalasia.