Risk Factors for Depression of Patients with Tuberculosis in Tuberculosis Specialty Hospital / 정신신체의학

OBJECTIVES: This study aimed to investigate the risk factors of depression for patients with tuberculosis(TB). METHODS: A total of 57 patients with TB were recruited. All participants completed the Becks Depression Inventory-II for evaluating depressive symptoms. The risk factor for depression was analyzed by binary logistic regression analysis. Nomogram was performed for probability of depression. RESULTS: Low body mass index(BMI, OR 0.801, 95% CI 0.65, 0.98), interruption of treatment for TB(OR 5.908, 95% CI 1.19, 29.41), past history of depression(OR 24.653, 95% CI 1.99, 308.44) were associated with increased risk for depression. The calibration curve for predicting probability of survival showed a good agreement between the nomogram and actual observation(Original C-index=0.789, bias corrected C-index=0.754). CONCLUSIONS: The result of the present study indicate that low BMI, interruption of treatment for TB, and past history of depression were risk factors for depression in patients with TB. The psychiatric intervention may be needed to prevent depression if the patients with TB have risk factor during treatment for TB.

Clinical Manifestations of Persistent Smear Positive and Culture Negative Sputum Tests 5 Months after First-line Anti-Tuberculous Chemotherapy / 결핵및호흡기질환

BACKGROUND: It is not known with certainty whether patients with persistently positive sputum smear results who have also had negative sputum culture results require prolongation of treatment for tuberculosis in order to avoid an increased risk of eventual relapse. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the appropriate duration of treatment in these patients. METHODS: Sixty of 69 patients with sputum smear positive and culture negative tests at 5 months after first line anti-tuberculous chemotherapy from 2002 to 2003 were retrospectively analyzed. Exclusion criteria included incomplete treatment or resistance to rifampicin or two additional antibiotics, as determined by a drug susceptibility test (DST). RESULTS: Smear conversion of the study subjects was observed after 8.3+/-2.3 months treatment, and the patients were culture negative after 2.0+/-0.8 months. The relapse rates of the study subjects were 3.8, 10.0, and 25.8% after 1, 2, and 5 years of anti-tuberculosis chemotherapy, respectively. The relapse rates were not significantly affected by a series of risk factors such as age, sex, presence of diabetes, a sputum culture examination after 2 months treatment, previous treatment history, chest radiograph, and duration of the treatment (p>0.05). CONCLUSION: Regimen change is not required for patients with persistent smear positive but culture negative tests in the fifth month for first line antituberculous treatment. However, a further study will be needed to clarify the high relapse rate in this specific group of patients.

Effects of Tobacco-Specific Carcinogen on Protein Kinase C Isoforms / 대한흉부외과학회지

BACKGROUND: Cigarette smoking is the leading cause of the lung cancer. However, mechanism of action underlying the carcinogenesis in the lung still remains to be elucidated. The present study attempted to look into the carcinogenic potential of tobacco-specific nitrosamine, NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone) and the effects of protein kinase C (PKC) isoforms in an immortalized human epithelial cell model. MATERIAL AND METHOD: Immortalized human epithelial cells were exposed with NNK and examined for its carcinogenic potential as measured by saturation density, soft-agar colony formation, and cell aggregation assay. The specific isoform of PKCs involved in the cellular transformation was analysed through western blot with monoclonal antibody and measured separately in cytosolic fraction and membrane fraction. RESULT: Human epithelial cells exposed with NNK showed prominent carcinogenic potential in saturation density, soft agar colony formation, and cell aggregation assay. PKC isoform analysis results are as follows: PKC-alpha showed significant translocation of protein levels from cytosolic fraction to membrane fraction, as analyzed by immunoblot. PKC-epsilon showed a dose-dependent increase of translocation. PKC-lambda was not affected by NNK treatment. CONCLUSION: The study demonstrated that there was a certain specificity in the patterns of isoform induction following chemical carcinogen exposure. Thus, it is suggested that identification of specific isoform be a clue to find target molecules in the carcinogenesis.

Intrapleural Perfusion Hyperthermic-Chemotherapy for Pleural Seeding of Lung Cancer / 대한흉부외과학회지

Lung cancer with pleural seeding has poor prognosis and is generally treated by intravenous anticancer chemotherapy only. We performed intrapleural perfusion hyperthermic-chemotherapy in two lung cancer patients with pleural seeding. Herein, we report our outcome with literature review.

Hydrogen Peroxide Modulates Phospholipase A2 Aactivity and Endogenous Oxidative Stress in the Free Radical Induced Acute Lung Injury / 대한흉부외과학회지

BACKGROUND: In an attempt to investigate the role of oxidants in the activation of phospholipase A2(PLA2) and endogenous oxidative stress in the lung, acute inflammatory lung injury was induced by the instillation of hydrogen peroxide into the trachea of Sprague-Dawley rats. MATERIAL AND METHOD: To prove the hypothesis that released oxidants from neutrophils activate the PLA2 retrogradely, activities of PLA2 and lysoplatelet activating factor acetyltransferase(lysoPAF AT) were assayed 5 hours after instillation of hydrogen peroxide. In addition, to confirm the impairing effects of the activation of PLA2 associated with endogenous oxidative stress, lung weight/body weight ratio(Lx10(-3)/B), protein contents(mg/two lungs) in bronchoalveolar lavage(BAL) were measured. As neutrophilic respiratory burst has been known to play a pivotal role in the genesis of endogenous oxidative stress associated with acute inflammatory lung injury, BAL neutrophils counts and level of lung myelperoxidase(MPO) were measured after hydrogen peroxide insult. Morphological and histochemical studies were also performed to identify the effect of the endogenous oxidative stress. RESULT: Five hours after hydrogen peroxide instillation, lungs showed marked infiltration of neutrophils and increased weight. Protein contents in BAL increased significantly compared to those of normal rats. PLA2 activity was enhanced in the hydrogen peroxide instilled group. Interestingly, the accelerated production of platelet activating factor(PAF) was confirmed by the increased activity of lysoPAF AT in the H2O2 employed lung. Morphologically, light microscopic findings of lungs after instillation of hydrogen peroxide showed atelectasis and infiltration of inflammatory cells, which was thought to be caused by lipid mediators produced by PLA2 activation. In cerium chloride cytochemical electron microscopy, dense deposits of cerrous perhydroxide were identified. In contrast, no deposit of cerrous perhydroxide was found in the normal lung. CONCLUSION: As all these findings were consistent with the lung injury caused by neutrophilic oxidative stress, it is suggested that the activation of PLA2 by oxidants might participate in the genesis of endogenous oxidative stress. Collectively, the positive feedback loop between oxidative stress and PLA2 activation may participate in the pathogenesis of Adult Respiratory Distress Syndrome(ARDS).

Critical Pathway for Management of Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: With the advances of video technology, thoracoscopic surgery has been applied to various areas of the thoracic surgical fields including major surgeries. Now a days, thoracoscopic surgery is performed as a procedure of choice for primary spontaneous pneumothorax. But the operative indication for the primary spontaneous pneumothorax has not been changed since the last few decades, although the procedure of choice was changed from open thoracotomy to thoracoscopy. Therefore, we thought new treatment strategy will be necessary for the management of primary spontaneous pneumothorax. MATERIAL AND METHOD: Between January 1998 and December 1999, 149 primary spontaneous pneumothorax patients were admitted to the Kyungpook National University Hospital. Result; Of these patients, 177 were first attack pneumothoraces and the number of total attacks were 250. CONCLUSION: Analyzing the amount of pneumothorax, methods of treatment, number of recurrences, recurrence rate and hospital stay, we propose a critical pathway for establishing new treatment strategy for the management of primary spontaneous pneumothorax.

Allergens Causing Atopic Diseases in Canine

Canine atopic skin disease is seasonal or sometimes non-seasonal immune-mediated skin disease which occurs commonly in Korea. The definite clinical sign is systemic pruritus, especially on periocular parts, external ear, interdigit spaces and lateral flank. For diagnosis of this dermatitis, complete history taking followed by intradermal skin test and serum in vitro IgE test needs to be performed. Allergen selection for the diagnosis and treatment of atopic dermatitis should be varied geographically. In this study, with intradermal skin test(IDST) the prevalence of atopic disease and what allergens are involved in are researched. Allergens used for IDST included 26 allergen extracts from six allergen groups: grasses, trees, weeds, molds, epidermal allergens and environmental allergens. The number of allergens was 42 in which the positive and negative controls are included. The most common positive allergen reaction was the house dust mites on IDST(22/35, 63%). The other positive allergen reactions were to flea(3/35, 9%), molds(1/35, 3%), house dusts(2/35, 6%), feathers (1/35, 3%), cedar/juniper(1/35, 3%), timothy grass(1/35, 3%) and dandelion(1/35, 3%). In this study, the most prevalent allergen causing atopic dermatitis in dogs in Korea was the house dust mites followed by the flea.