Circadian Rhythm of Surfactant Protein A, B and C mRNA in Rats

BACKGROUND: All organisms have developed an internal timing system capable of reacting to and anticipating environmental stimuli with a program of appropriately timed metabolic, physiologic and behavioral events. The alveolar epithelial type II cell of the mammalian lung synthesizes, stores, and secretes a lipoprotein pulmonary surfactant, which functions to stabilize alveoli at low lung volumes. METHODS: The authors investigated the diurnal variation of surfactant protein A, B and C mRNA accumulation. The diurnal variation on gene expression of surfactant protein A, B and C was analysed using filter hybridization at 9 a.m., 4 p.m. and 11 p.m. Lung SP-A protein content was determined by double sandwich ELISA assay using a polyclonal antiserum raised in rabbits against purified rat SP-A. RESULTS: 1. The accumulation of SP-A mRNA at 4 p.m. was significantly decreased by 23.5% compared to the value at 9 a.m. (p< 0.05). 2. The accumulation of SP-B mRNA at 4 p.m. and 11 p.m. was decreased by 15.1% and 5.7%, respectively, compared to the value at 9 a.m. (p=0.07, p=0.69). 3. The accumulation of SP-C mRNA at 4 p.m. and 11 p.m. was decreased by 6.8% and 7.7%, respectively, compared to the value at 9 a.m. (p=0.38, p=0.57). 4. Total lung SP-A content at 4 p.m. and 11 p.m. was increased by 5.3% and 15.9%, respectively, compared to the value at 9 a.m. (p=0.64, p=0.47). CONCLUSION: These findings represent the diurnal variation of surfactant proteins mRNA expression in vivo. These results indicated that the diurnal variation of significant gene expression is observed in hydrophilic surfactant protein rather than in hydrophobic surfactant proteins.

Circadian rhythm of surfactant protein A, B and C mRNA in rats / 대한내과학회지

BACKGROUND: All organisms have developed an internal timing system capable of reacting to and anticipating environmental stimuli with a program of appropriately timed metabolic, physiologic, and behavioral events. The alveolar epithelial type II cell of mammalian lung synthesizes, stores, and secretes a lipoprotein pulmonary surfactant, which functions to stabilize alveoli at low lung volumes. METHODS: The authors investigated the diurnal variation of surfactant protein A, B and C mRNA accumulation. The diurnal variation on gene expression of surfactant protein A, B and C were analysed using filter hybridization at 9 AM, 4 PM and 11 PM. Lung SP-A protein content was determined by double sandwich ELISA assay using a polyclonal antiserum raised in rabbits against purified rat SP-A. RESULTS: 1. The accumulation of SP-A mRNA at 4 PM was significantly decreased 23.5% compared to the value at 9 AM (p<0.05). 2. The accumulation of SP-B mRNA at 4 PM and 11 PM was decreased by 15.1% and 5.7%, respectively, compared to the value at 9 AM (p=0.07, p=0.69). 3. The accumulation of SP-C mRNA at 4 PM and 11 PM was decreased by 6.8% and 7.7%, respectively, compared to the value at 9 AM (p=0.38, p=0.57). 4. Total lung SP-A content at 4 PM and 11 PM was increased by 5.3% and 15.9%, respectively, compared to the value at 9 AM (p=0.64, p=0.47). CONCLUSION: These findings represent diurnal variation of surfactant proteins mRNA expression in vivo. This results suggested the diurnal variation of hydrophilic surfactant protein rather than hydrophobic surfactant proteins.

Effects of Intracavitary Urokinase Instillation in Complicated Pleural Effusion / 결핵

BACKGROUND: Complicated exudative pleural fluid collections have traditionally been treated by either closed tube thoracostomy drainage or open surgical drainage. Complete drainage is important in order to control pleural sepsis, restore pulmonary function, and entrapment. Recently intracavitary fibrinolytic therapy has been advocated as a method to facillitate drainage of complicated exudative pleural effusion and to allow enzymatic debridemant of the restrictive fibrinous sheets covering the pleural surface. The purpose of this study is to prospectively evaluate the effects of image-guided catheter drainage with high dose urokinase(UK) instillation in the treatment of complicated pleural effusions. PATIENTS: Twenty complicated pleural effusion patients that poorly respond to image-guided drainage were allocated to receive UK. There were 8 pneumonia and 12 tuberculosis. METHODS: Drugs were diluted in 250 mL normal saline and were infused intrapleurally through the chest tube or pig-tail catheter in a daily dose of 250,000 IU of UK. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasound and/or computed tomography. RESULTS: The mean UK instillation time was 1.63+/-0.10 The mean volume drained UK instillation was 381.3+/-314.4 mL, and post-UK was 321.6+/-489.5 mL. The follow up duration after UK therapy was mean 212.9+/-194.5 days. We had successful results in 19 cases (95.0%). There were 12 pleural thickenings (60.0%), 2 markedly decreased effusions (10.0%) and 5 cases of no thickening or effusion. In only one patient (5%)with complicated pleural effusion due to tuberculosis, there was recurrence after treatment. CONCLUSIONS: Image-guided drainage with high dose UK instillation (250,000 U/day) in complicated pleural effusion is a safe and more effective method than closed thoracostomy drainage. And this management, in turn, can obviate surgery in most cases.

Study on the Availability of Repeated Flexible Bronchoscopy (RFB) / 결핵

BACKGROUND: Ever since Flexible Fiberoptic Bronchoscopy was introduced into clinical practice, it has played an important role in both diagnosis and therapy of respiratory diseases. Performance of repeated bronchoscopic examinations is not so uncommon. This study was designed prospectively to assess the clinical availability of the Repeated Flexible Bronchoscopy (RFB). METHODS: Pre-established indications were as follows; 1) To confirm diagnosis or the cell type in proven malignancy, 2) For diagnosis or location of hemoptysis, 3) For follow-up or confirming recurrence, 4) For therapeutic purposes. We performed RFB and analysed the data in 156 patients during 28-month period. RESULTS: The frequency of RFB was 23.0%. The indication for diagnosis or cell type of malignancy was 25 cases, in which 2 cases were confirmed by the third bronchoscopic examination and 3 cases by surgical procedures. Localization of bleeding site was confirmed in 53.8%. RFB for small cell lung cancer yielded more information on residual or recurred lesion not apparent even with the CT scan in 30%. Previous cases of bronchostenosis due to endo-bronchial tuberculosis was shown to have worsened in 66.7%. Therapeutic manipulations were done in 126 cases and bronchial suction was most common. Complications showed decreasing tendency with repeated examinations. CONCLUSION: The RFB for diagnosis or cell type of malignancy was useful in that comfirmation of diagnosis was possible in 85.7% of malignancy. More aggressive procedures should be employed including TBLB or TBNA. The RFB showed the possibility of usefulness in the follow-up of patients with small cell lung cancer. For the patients with hemoptysis or endobronchial tuberculosis, the RFB did not showed the significance because its results did not influence the diagnosis, therapy or clinical course.

A Case of Bronchial Mucoepidermoid Carcinoma Associated with Adeonocarcinoma / 결핵

Mucoepidermoid carcinoma was initially recognized as occurring only in the salivary gland and only later was it appreciated that it occurred in the bronchus and trachea as well. Mucoepidermoid carcinoma of bronchial gland origin is extremely rare, and little is known about their natural history. This carcinoma is derived from the minor salivary gland of the proximal tracheobronchial tree and it is divided into low-grade and high-grade by gross, histologic, and ultrastructural criteria. Also Its clinical and biologic behaviors are closely related with histologic grade of carcinoma. We have experienced a rare case of bronchial mucoepidermoid carcinoma associated with adenocarinoma which obstructed the left main bronchus and was successfully removed by the pneumonectomy.

The Establishment of Sperm Penetration Assay Using Cryopreserved Hamster Oocyte / 대한비뇨기과학회지

To establish sperm penetrating assay (SPA) with using cryopreserved hamster oocyte, we performed the stepwise SPA with 1) fresh hamster oocyte and hamster sperm, 2) cryopreserved hamster oocyte and hamster sperm, 3) fresh hamster oocyte and human sperm, and 4) cryopreserved hamster oocyte and human sperm, in 4 cases of male hamster and 12 cases of fertile human. In SPA of hamster sperm with fresh hamster oocyte, the oocyte penetration rate (PR) were 100+0%, and the penetration index(mean penetration per oocyte, PI) was 22.4 +/- 1.8. In SPA of hamster sperm with cryopreserved hamster oocyte, the PR were 100 +/- 0%, and the Pl was 14.1 +/- 2.9 (p<0.01). When the oocytes were examined at 1, 2, 3, and 6 hour post insemination, hamster sperm penetration was 1 hour slower in cryopreserved oocytes than in fresh ones. In SPA of human sperm with fresh hamster oocyte, the PR was 79.5 +/- 10%, and the Pl was 2.78 +/- 2.6. In SPA of hamster sperm with cryopreserved hamster oocyte, the PR was 73.9+/- 16%, and the PI was 2.82 +/- 2.7. There`s no significant difference in SPA using human sperm. These results suggest that them may be some functional damages on cryopreserved oocyte, because Pl of fresh oocytes is higher than that of cryopreserved oocytes. However in sperm of human, it dose not make significant difference in Pl between fresh and cryopreserved oocytes. The SPA using cryopreserved hamster oocyte would appear to have wide application of the evaluation of infertility, the assessment of the treatment of infertility and the experiment in infertility field.

Clinical Characteristics of Pulmonary Cryptococcosis / 결핵

BACKGROUND: So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases. METHODS: The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained. RESULTS: Cryptococcosis occured frequently over sixth decade and the male to female ratio was 3.6:1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnosis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture ,serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities. CONCLUSION: Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnostic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.

The Clinical Features of Endobronchial Tuberculosis: A Retrospective Study on 201 Patients for 6 years / 결핵

Background: Endobronchial tuberculosis is definded as tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence. Endobronchial tuberculosis has clinical significance due to its sequela of cicatrical stenosis which causes atelectasis, dyspnea and secondary pneumonia and may mimic bronchial asthma and pulmanary malignancy. Method: The authors carried out, retrospectively, a clinical study on 201 patients confirmed with endobronchial tuberculosis who visited the Department of Pulmonary Medicine at Hangyang University Hospital from January 1990 to April 1996. The following results were obtained. Results: 1) Total 201 patienls(19.5%) were confirmed as endobronchial tuberculosis among 1031 patients who had been undergone flexible bronchofiberscopic examination. The number of male patients were 55 and that of female patients were 146, and the male to female ratio was 1: 2.7. 2) The age distribution were as follows: there were 61(30.3%) cases in the third decade, 40 cases(19.9%) in the fourth decade, 27 cases(13.4%) in the sixth decade, 21 cases(10.4%) in the fifth decade, 19 cases(9.5%) in the age group between 15 and 19 years, 19 cases(9.5%) in the seventh decade, and 14 cases(7.0%) over 70 years, in decreasing order. 3) The most common symptom, in 192 cases, was cough 74.5%, followed by sputum 55.2%, dyspnea 28.6%, chest discomfort 19.8%, fever 17.2%, hemoptysis 11.5%, in decreasing order, and localized wheezing was heard in 15.6%. 4) In chest X-ray of 189 cases, consolidation was the most frequent finding in 67.7%, followed by collapse 43.9%, cavitary lesion 11.6%, pleural effusion 7.4%, in decreasing order, and there was no abnormal findings in 3.2%. 5) In the 76 pulmanary function tests, a normal pattern was found in 44.7%, restrictive pattern in 39.5%, obstructive pattern in 11.8%, and combined pattern in 3.9%. 6) Among total 201 patients, bronchoscopy showed caseous pseudomembrane in 70 cases(34.8%), mucosal erythema and edema in 54 cases(26.9%), hyperplastic lesion in 52 cases(25.9%), fibrous stenosis in 22 cases(10.9%), and erosion or ulcer in 3 cases(1.5%). 7) In total 201 cases, branchial washing AFB stain was positive in 103 cases(51.2%), bronchial washing culture for tuberculous bacilli in 55 cases(27.4%). In the 99 bronchoscopic biopsies, AFB stain positive in 36.4%, granuloma without AFB stain positive in 13.1%, chronic inflammation only in 36.4%, and non diagnostic biopsy finding in 14.1%. Conclusions: Young female patients, whose cough resistant to genenal antitussive agents, should be evaluated for endobronchial tuberculosis, even with clear chest roentgenogram and negative sputum AFB stain. Furthermore, we would like to emphasize that the bronchoscopic approach is a substantially useful means of making a differential diagnosis of atelectasis in older patients of cancer age. At this time we have to make a standard endoscopic classification of endobronchial tuberculosis, and well designed prospective studies are required to elucidate the effect of combination therapy using antituberculous chemotherapy with steroids on bronchial stenosis in patients with endobronchial tuberculosis.

The Clinical Features of Endobronchial Tuberculosis: A Retrospective Study on 201 Patients for 6 years / 결핵

Background: Endobronchial tuberculosis is definded as tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence. Endobronchial tuberculosis has clinical significance due to its sequela of cicatrical stenosis which causes atelectasis, dyspnea and secondary pneumonia and may mimic bronchial asthma and pulmanary malignancy. Method: The authors carried out, retrospectively, a clinical study on 201 patients confirmed with endobronchial tuberculosis who visited the Department of Pulmonary Medicine at Hangyang University Hospital from January 1990 to April 1996. The following results were obtained. Results: 1) Total 201 patienls(19.5%) were confirmed as endobronchial tuberculosis among 1031 patients who had been undergone flexible bronchofiberscopic examination. The number of male patients were 55 and that of female patients were 146, and the male to female ratio was 1: 2.7. 2) The age distribution were as follows: there were 61(30.3%) cases in the third decade, 40 cases(19.9%) in the fourth decade, 27 cases(13.4%) in the sixth decade, 21 cases(10.4%) in the fifth decade, 19 cases(9.5%) in the age group between 15 and 19 years, 19 cases(9.5%) in the seventh decade, and 14 cases(7.0%) over 70 years, in decreasing order. 3) The most common symptom, in 192 cases, was cough 74.5%, followed by sputum 55.2%, dyspnea 28.6%, chest discomfort 19.8%, fever 17.2%, hemoptysis 11.5%, in decreasing order, and localized wheezing was heard in 15.6%. 4) In chest X-ray of 189 cases, consolidation was the most frequent finding in 67.7%, followed by collapse 43.9%, cavitary lesion 11.6%, pleural effusion 7.4%, in decreasing order, and there was no abnormal findings in 3.2%. 5) In the 76 pulmanary function tests, a normal pattern was found in 44.7%, restrictive pattern in 39.5%, obstructive pattern in 11.8%, and combined pattern in 3.9%. 6) Among total 201 patients, bronchoscopy showed caseous pseudomembrane in 70 cases(34.8%), mucosal erythema and edema in 54 cases(26.9%), hyperplastic lesion in 52 cases(25.9%), fibrous stenosis in 22 cases(10.9%), and erosion or ulcer in 3 cases(1.5%). 7) In total 201 cases, branchial washing AFB stain was positive in 103 cases(51.2%), bronchial washing culture for tuberculous bacilli in 55 cases(27.4%). In the 99 bronchoscopic biopsies, AFB stain positive in 36.4%, granuloma without AFB stain positive in 13.1%, chronic inflammation only in 36.4%, and non diagnostic biopsy finding in 14.1%. Conclusions: Young female patients, whose cough resistant to genenal antitussive agents, should be evaluated for endobronchial tuberculosis, even with clear chest roentgenogram and negative sputum AFB stain. Furthermore, we would like to emphasize that the bronchoscopic approach is a substantially useful means of making a differential diagnosis of atelectasis in older patients of cancer age. At this time we have to make a standard endoscopic classification of endobronchial tuberculosis, and well designed prospective studies are required to elucidate the effect of combination therapy using antituberculous chemotherapy with steroids on bronchial stenosis in patients with endobronchial tuberculosis.

Effect of Freezing Method, Thawing Temperature and Post-thaw Dilution/Washing on Motility and Morphology Characteristics of High-quality Human Sperm / 대한비뇨기과학회지

Ten semen samples of high initial quality donated by fertile men were processed to compare the effect of two freezing methods, two thawing temperatures and the effect of dilution and washing on sperm motility (CASA) and morphologic characteristics (stricter criteria). Semen samples were divided in two equal parts and frozen either by fast vapour freezing or by slow computer-controlled freezing. For each freezing method, half of the straws were thawed at room temperature (22 degrees C), the other half were thawed at 37 degrees C. From each freeze-thawing treatment, one straw was evaluated immediately post-thawing; another straw was washed to remove the cryoprotectant solution. In this way, each semen sample was subjected to eight freeze-thawing treatment. The freezing and thawing of each semen sample was uniformly associated with a decrease in a sperm quality. The most commonly observed adverse effect was severe impairment of sperm motility. No effect of the freezing method and thawing temperature was observed on motility characteristics evaluated by computer-assisted semen analysis, nor on morphology parameters evaluated by stricter criteria. Only in regard to normal morphology was computer-controlled freezing slightly superior to fast vapour freezing. Post-thaw dilution and washing exerted a detrimental effect on sperm motility by reducing percentage motility by 30% - 40% compared to unwashed thawed specimens. Post-thaw dilution and washing obviously impaired normal morphology of spermatozoa by increasing percentage of small heads while linearity was increased significantly. Freezing-thawing was most effective when fast vapour freezing was followed by 37 degrees C thawing , and when slower computer-controlled freezing was combined with 22 degrees C thawing, causing linearity increased significantly Otherwise significant interactions between the freezing method and the thawing temperature were not observed. From these data, we think that vapour freezing is similar to computer-controlled freezing for high-quality semen in terms of recovery of morphologically normal with adequate progressive motility. For cryopreservation flow quality spermatozoa from patients, the effect of each freeze-thawing treatment is eligible for testing in another study.