Segmental bile duct leakage after hepatic resection managed with percutaneous ablation by N-butyl cyanoacrylate

A biloma is a rare abnormal accumulation of intrahepatic or extrahepatic bile caused by a traumatic or spontaneous rupture of the biliary tree. The reported incidence of postoperative biloma ranges from 4.8% to 7.6%. Biliary drainage is usually important and necessary for the treatment of biloma, but sometimes bile leakage fails to improve despite prolonged conservative drainage. We report a case of postoperative refractory biliary leakage managed with percutaneous ablation by N-butyl cyanoacrylate.

Tuberculin Skin Test and QuantiFERON-TB Gold Assay before and after Treatment for Latent Tuberculosis Infection among Health Care Workers in Local Tertiary Hospital / 결핵및호흡기질환

BACKGROUND: The QuantiFERON-TB Gold assay and tuberculin skin test (TST) have been useful test for diagnosing latent tuberculosis infections (LTBI). However, there are few reports on the efficacy of the QuantiFERON-TB Gold assay and TST in evaluating the response after the treatment of LTBI. This study examined the changes in the TST and QuantiFERON-TB Gold assay before and after a treatment for latent tuberculosis in health care workers (HCWs) at a local tertiary hospital. METHODS: A cohort of volunteers working as nurses and doctors who underwent a TST and QuantiFERON-TB Gold assay was established. The volunteers positive for the QuantiFERON-TB Gold assay had been treated with 3 months of isoniazid (INH) and rifampin (RFP). After completing treatment, the TST and QuantiFERON-TB Gold assay were repeated. RESULTS: Of the 48 participants (14 doctors, 34 nurses, M: F=11:37, mean age=29.9+/-5.5 years, mean employment period=74.9+/-64.3 months), 19 (39.6%) tested positive to the TST (mean induration=19.1+/-9.7 mm) and 8 (16.7%) were QuantiFERON-TB Gold assay. Among them, one had active pulmonary tuberculosis. Seven volunteers were consistently positive to both the TST and QuantiFERON-TB Gold assay after being medicated with INH and RFP for 3 months. CONCLUSION: TST and QuantiFERON-TB Gold assay are unsuitable for evaluating the treatment response of LTBI because they were consistently positive both before and after the anti-tuberculosis medication.

A Case of Lung Cancer Obscured by Endobronchial Aspergilloma / 결핵및호흡기질환

A 70-year-old man was referred to the department of pulmonology due to blood tinged sputum and an abnormal chest X-ray. The chest X-ray and CT scans revealed a lobulated contour mass-like lesion in the left upper lung field. The bronchoscopic examination showed a whitish and polypoid mass occluding the left upper lobe bronchus. A biopsy specimen from the lesion revealed many aspergillus hyphae. Intravenous and oral itraconozole were administered over a 4 weeks period. Several months later, the size of the mass on chest X-ray increased and a percutaneous lung biopsy revealed a sarcomatoid carcinoma. We reported a case of lung cancer that was obscured by an endobronchial aspergilloma with a review of the relevant literature.

Relationship between Systemic Inflammatory Marker, Oxidative Stress and Body Mass Index in Stable COPD Patient / 결핵및호흡기질환

BACKGROUND: The main factors associated with weight loss in patients with COPD are not well known. Since chronic inflammation and oxidative stress play a major pathogenic role in COPD, these factors may be responsible for the patients' weight loss. Therefore, this study measured the body mass index (BMI) in COPD patients and evaluated the variables, such as systemic inflammatory marker, oxidative stress and lung function, that correlate with the BMI. METHOD: The stable COPD patients (M:F=49:4, mean age=68.25+/-6.32) were divided into the lower (25) BMI group. The severity of the airway obstruction was evaluated by measuring the FEV1. The serum IL-6 and TNF-alpha levels were measured to determine the degree of systemic inflammation, and the carbonyl protein and 8-iso-prostaglandin F2alpha level was measured to determine the level of oxidative stress. Each value in the COPD patients and normal control was compared with the BMI. RESULTS: 1) Serum 8-iso-prostaglandin F2alpha in COPD patients was significantly higher (456.08+/-574.12 pg/ml) than that in normal control (264.74+/-143.15 pg/ml) (p<0.05). However, there were no significant differences in the serum IL-6, TNF-alpha, carbonyl protein between the COPD patients and normal controls. 2). In the COPD patients, the FEV1 of the lower BMI group was significantly lower (0.93+/-0.25L) than that of the normal BMI (1.34+/-0.52L) and higher BMI groups (1.72+/-0.41L) (p<0.05). The lower FEV1 was significantly associated with a lower BMI in COPD patients (p=0.002, r=0.42). The BMI of very severe COPD patients was significantly lower (19.8+/-2.57) than that of the patients with moderate COPD (22.6+/-3.14) (p<0.05). 3). There were no significant differences in the serum IL-6, TNF-alpha, carbonyl protein and 8-iso-prostaglandin F2alpha according to the BMI in the COPD patients. CONCLUSION: The severity of the airway obstruction, not the systemic inflammatory markers and oxidative stress, might be associated with the BMI in stable COPD patients. Further study will be needed to determine the factors associated with the decrease in the BMI of COPD patients.

Measuring Serum Procalcitonin in Patients with Fever in the ICU to Differentiate Infectious Causes from Non-Infectious Causes / 결핵및호흡기질환

BACKGROUND: Although fever is one of the most common and challenging problem in intensive care medicine(ICU), it is difficult to distinguish between infectious and non-infectious causes. Procalcitonin(PCT) has recently been reported to be an indicator of various infectious diseases. This study examined whether or not measuring the serum PCT level in patients with fever in the ICU can help distinguish fevers with infectious causes from those with non-infectious causes. METHODS: ICU patients with fever at 38degrees C or over from March to August 2005 were prospectively enrolled. The cause of the fever was identified by the culture results and clinical course. The leukocytes, CRP, PCT, IL-6, and TNF-alpha in the fever patients with infectious and non-infectious causes were compared, and the PCT level in the patients with fever in the ICU were compared with those without fever. RESULTS: 1) 42 patients were enrolled and 46 cases of fever were analyzed. 26 cases were considered to be infectious, while 13 cases were considered to be non-infectious. 7 cases were found to have no clear causes. 2) There were no significant differences in the degree of fever, leukocytes count, CRP, IL-6, and TNF-alpha levels in the patiemts with infectious and non-infectious causes. 3) The serum PCT level was higher in those with infectious causes than in those with non-infectious causes (15.1+/-32.57ng/mL vs 2 .68+/-3.63ng/mL) but there was no statistical significance (p=0.06). 4) The serum PCT level of the ICU patients with fever was significantly higher than in those without fever (10.94+/- 27.15ng/mL vs 0.45+/-0.49ng/mL) (p=0.02). CONCLUSION: The serum PCT cannot be used to distinguish the fever in ICU patients with infectious causes from that with non-infectious causes.

The Diagnostic Usefulness of Pleural Fluid Adenosine deaminase with Lymphocyte/Neutrophil Ratio in Tuberculous Pleural Effusion / 결핵및호흡기질환

BACKGROUND: The measurement of adenosine deaminase(ADA) level in pleural fluid is useful in the diagnosis of tuberculous(TB) pleural effusion. However, ADA is also elevated in other diseases such as malignancy, bacterial infections, empyema, and collagen vascular disease, ADA alone has limited value. The object of this study is to determine diagnostic usefulness of the combined use of ADA value with lymphocyte/neutrophil ratio(L/N ratio) rather than the use of ADA alone. METHOD: We evaluated 198 patients(age=55.9+/-12.9, M/F=2.7:1) with pleural effusion who had admitted in Gyeong-sang National University Hospital from Jan. 1999 to Dec. 2001. retrospectively. Patients were divided into four diagnostic groups: TB pleural effusion(n=91), parapneumonic effusion(n=65), malignant effusion(n=21), and transudative effusion(n=13). The ADA level, differential cell count, biochemistry, cytology, and microbiology of each diagnostic groups were evaluated. The sensitivity, specificity, negative predictive value(npv), positive predictive value(ppv) and efficiency were calculated at each ADA values and combined ADA value with various L/N ratios. RESULT: The ADA level in TB pleural effusion was significantly higher than that of parapneumonic effusion, malignant pleural effusion, and transudative effusion(por=50 IU/L in the diagnosis of TB pleural effusion were 89.0%, 82.2%, 81.0%, 89.8% and 85.5% respectively. When ADA>or=50 IU/L was combined with lymphocyte/neutrophil ratio>or=0.75, sensitivity, specificity, ppv, npv, and efficiency were 83.5%, 96.3%, 95.0%, 87.9% and 90.5% respectively. Specificity, ppv and efficiency were increased with combination of ADA value and L/N ratio. CONCLUSION: Combination of ADA value and L/N ratio in pleural effusion is more useful than ADA value alone in the diagnosis of TB pleural effusion.