The Effect of Different Counselors on Treatment Outcome of Tinnitus Retraining Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus retraining therapy (TRT) is one of the most effective treatment modalities of tinnitus based on the neurophysiological model proposed by Jastreboff and Hazell. This study was performed to evaluate the effect of counselor factor on treatment outcomes of TRT. SUBJECTS AND METHOD: The total of 78 patients who had TRT from three different counselors in a tinnitus clinic of tertiary referral center from Jan 2015 to Dec 2015 were included in this study. Their medical records were retrospectively reviewed to evaluate the therapeutic response to TRT. RESULTS: Among 78 patients who were followed-up for more than 6 months, 47, 20, and 11 patients were treated by counselors A, B, C (all ENT specialists), respectively. Counselor A had 15-year-experience of TRT counseling, whereas counselor B and C were well trained but beginners of TRT counseling. Initial clinical characteristics including Tinnitus Handicap Inventory (THI) and tinnitus Visual Analogue Scale (VAS) scores of the patients among three groups were not significantly different. Treatment responses evaluated via THI and most of the tinnitus VAS scores after at least 6 months after TRT were significantly improved in all three groups (p<0.05) with no significant difference between the senior (A) and junior (B, C) group. CONCLUSION: TRT seems to be an effective treatment modality of tinnitus even in this short term follow-up study. Treatment outcomes of TRT may not depend on the counselors once they are well trained and follow the same protocol.

The Best-Matched Pure Tone Average and Speech Recognition Threshold for Different Audiometric Configurations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The agreement between pure-tone average (PTA) and speech recognition threshold (SRT) has become more important with the increasing demands for medical certification. The purpose of this study was to explore the relationships between the SRT and several variations of PTA, and to determine which PTA formula would provide the best agreement with SRT for different audiometric configurations. SUBJECTS AND METHOD: Audiological data on 783 ears were retrospectively collected. The air-conduction PTAs were calculated using five different formulas: three-frequency average (3FA), weighted three-frequency average (W3FA), four-frequency average (4FA), weighted four-frequency average (W4FA), and six-frequency average (6FA). The audiometric configuration was classified into five categories. The PTA-SRT relationships were analyzed using correlation and simple linear regression for each audiometric configuration. RESULTS: Highest correlation was observed between the SRT and W3FA for all audiometric configurations with the correlation coefficient of 0.964 as a whole. The SRT and 3FA were best-matched in the linear regression models for overall/flat/high frequency gently sloping/low frequency ascending; the SRT and W3FA were best-matched for high frequency steeply sloping (HFSS); the SRT and 4FA were best-matched for miscellaneous audiograms. CONCLUSION: The most stable PTA variations that make the best-matched pairs with SRT for any audiogram are the conventional 3FA and W3FA doubling 1 kHz threshold. The addition of frequencies higher than 2 kHz to a PTA formula seems to have impeded the PTA-SRT agreement, especially for HFSS audiograms. W3FA should be the method of choice in predicting SRT from PTA for HFSS audiograms.

A Case of Lupus Pneumonitis Therapy in a Patient with Acute Systemic Lupus Erythematosus / 대한내과학회지

Systemic lupus erythematosus is a connective tissue disease with multiple organ involvement due to atypical creation of an antibody to an intracellular component. Although it can directly invade respiratory organs, such as the pleura, pulmonary parenchyma, trachea, pulmonary vessels, and pulmonary muscle, pulmonary involvement is mostly secondary to infection after immunosuppressant use, and pulmonary parenchyma invasion due to an immune response is relatively rare. This is a case report of acute lupus pneumonitis in a patient with systemic lupus erythematosus who was successfully treated with steroid therapy.

A Case of Lupus Pneumonitis Therapy in a Patient with Acute Systemic Lupus Erythematosus / 대한내과학회지

Systemic lupus erythematosus is a connective tissue disease with multiple organ involvement due to atypical creation of an antibody to an intracellular component. Although it can directly invade respiratory organs, such as the pleura, pulmonary parenchyma, trachea, pulmonary vessels, and pulmonary muscle, pulmonary involvement is mostly secondary to infection after immunosuppressant use, and pulmonary parenchyma invasion due to an immune response is relatively rare. This is a case report of acute lupus pneumonitis in a patient with systemic lupus erythematosus who was successfully treated with steroid therapy.

Mycobacterium avium lung disease combined with a bronchogenic cyst in an immunocompetent young adult

We report a very rare case of a bronchogenic cyst combined with nontuberculous mycobacterial pulmonary disease in an immunocompetent patient. A 21-year-old male was referred to our institution because of a cough, fever, and worsening of abnormalities on his chest radiograph, despite anti-tuberculosis treatment. Computed tomography of the chest showed a large multi-cystic mass over the right-upper lobe. Pathological examination of the excised lobe showed a bronchogenic cyst combined with a destructive cavitary lesion with granulomatous inflammation. Microbiological culture of sputum and lung tissue yielded Mycobacterium avium. The patient was administered anti-mycobacterial treatment that included clarithromycin.

A Case of Pleural Hydatid Cyst Mimicking Malignancy in a Non-Endemic Country / 결핵및호흡기질환

Hydatid disease is caused by the larval stage of taenia Echinococcus, which endemic in the Mediterranean region. Recently, the prevalence of the disease has increased worldwide due to an increase in the frequency of travel and immigration. As the infested larvae migrate through the bloodstream, the final destination is most commonly the liver or lungs; direct pleural invasion is very rare. A 50-year-old diabetic Korean man presented with an incidentally noted 2 cm right pleural nodule. On follow up imaging after three months, its size had increased. To confirm the diagnosis of the lesion, surgical excision was performed. Histopathological examination showed the diagnosis of a hydatid cyst. The patient had no history of overseas travel, but lives in an urban area where many foreign workers from endemic countries reside. This is the first reported case of primary pleural hydatid disease in a non-endemic country.

Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals / 결핵및호흡기질환

BACKGROUND: The increasing rate of drug-resistant tuberculosis (TB) is a threat to the public health and TB control. In Korea, about 75~80% of TB patients are treated in private hospitals and the rate has been continuously increasing since 2000. METHODS: On a retrospective basis, we enrolled 170 newly diagnosed with or retreated for multidrug-resistant TB (MDR-TB) in 2004 from 21 private hospitals. We extracted the following demographics and treatment history from patient medical records: initial treatment outcomes, cumulative survival rates, treatment outcomes, and prognostic factors. RESULTS: Of the 170 patients, the majority were male (64.1%), the mean age was 44.5 years old, and mean body-mass-index was 20.2 kg/m2. None of the patients tested positive for HIV. Eleven (6.5%) were confirmed to have extensively drug-resistant TB (XDR-TB) at treatment initiation. Treatment success rates were not different between XDR-TB (36.4%, 4/11) and non-XDR MDR-TB (51.6%, 82/159). Default rate was high, 21.8% (37/170). Far advanced disease on X-ray was a significant negative predictor of treatment success; advanced disease and low BMI were risk factors for all-cause mortality. CONCLUSION: In private hospitals in Korea, the proportion of XDR-TB in MDR-TB was comparable to previous data. The treatment success rate of MDR-/XDR-TB remains poor and the failure rate was quite high. Adequate TB control policies should be strengthened to prevent the further development and spread of MDR-/XDR-TB in Korea.

Intralobar Pulmonary Sequestration Receiving Its Blood Supply from the Celiac Artery / 결핵및호흡기질환

Intralobar pulmonary sequestration is a rare congenital lung anomaly. It is defined as a portion of nonfunctioning lung parenchyma that receives its blood supply from an anomalous systemic artery. Patients often present with chronic or recurrent pneumonia. A chest radiograph may show a cystic lesion with air-fluid levels in the lung base. A high index of suspicion is needed for a diagnosis. Surgical removal of a symptomatic intralobar pulmonary sequestration is generally the treatment of choice. Identifying the aberrant artery is a difficult problem when resecting a pulmonary sequestration. The thoracic and abdominal aortas are the most common origins for the abnormal blood supply. However, arterial supply from the celiac artery is quite rare. We present a case of intralobar pulmonary sequestration with the blood supply originating from the celiac artery.

The Effects of Nuclear Factor-kappa B Decoy Oligodeoxynucleotide on Lipopolysaccharide-Induced Direct Acute Lung Injury / 결핵및호흡기질환

BACKGROUND: The pathophysiologic mechanisms of early acute lung injury (ALI) differ according to the type of primary insult. It is important to differentiate between direct and indirect pathophysiologic pathways, and this may influence the approach to treatment strategies. NF-kappa B decoy oligodeoxynucleotide (ODN) is a useful tool for the blockade of the expression of NF-kappa B-dependent proinflammatory mediators and has been reported to be effective in indirect ALI. The purpose of this study was to investigate the effect of NF-kappa B decoy ODN in the lipopolysaccharide (LPS)-induced direct ALI model. METHODS: Five-week-old specific pathogen-free male BALB/c mice were used for the experiment. In the preliminary studies, tumor necrosis factor (TNF)-alpha, interleukine (IL)-6 and NF-kappa B activity peaked at 6 hours after LPS administration. Myeloperoxidase (MPO) activity and ALI score were highest at 36 and 48 hours, respectively. Therefore, it was decided to measure each parameter at the time of its highest level. The study mice were randomly divided into three experimental groups: (1) control group which was administered 50 microliter of saline and treated with intratracheal administration of 200 microliter DW containing only hemagglutinating virus of Japan (HVJ) vector (n=24); (2) LPS group in which LPS-induced ALI mice were treated with intratracheal administration of 200 microliter DW containing only HVJ vector (n=24); (3) LPS+ODN group in which LPS-induced ALI mice were treated with intratracheal administration of 200 microliter DW containing 160 microgram of NF-kappa B decoy ODN and HVJ vector (n=24). Each group was subdivided into four experimental subgroups: (1) tissue subgroup for histopathological examination for ALI at 48 hours (n=6); (2) 6-hour bronchoalveolar lavage (BAL) subgroup for measurement of TNF-alpha and IL-6 in BAL fluid (BALF) (n=6); (3) 36-hour BAL subgroup for MPO activity assays in BALF (n=6); and (4) tissue homogenate subgroup for measurement of NF-kappa B activity in lung tissue homogenates at 6 hours (n=6). RESULTS: NF-kappa B decoy ODN treatment significantly decreased NF-kappa B activity in lung tissues. However, it failed to improve the parameters of LPS-induced direct ALI, including the concentrations of tumor necrosis factor-alpha and interleukin-6 in BALF, myeloperoxidase activity in BALF and histopathologic changes measured by the ALI score. CONCLUSION: NF-kappa B decoy ODN, which has been proven to be effective in indirect models, had no effect in the direct ALI model.

Clinical Characteristics of Smoking Asthmatics / 결핵및호흡기질환

BACKGROUND: The smoking prevalence in asthma patients are similar to those in the general population. Asthma and active cigarette smoking can interact to create more severe symptoms, an accelerated decline in lung function and impaired therapeutic responses. Accordingly, asthmatics with a history of smoking were examined to define the clinical characteristics and lung function of smoking asthmatics. METHODS: The medical records of 142 asthmatics with a known smoking history were reviewed. The patients were divided into three groups according to their smoking history - current smokers, former smokers and non-smokers. The clinical characteristics, lung function, and annual declines of the forced expiratory volume in one second (FEV1) were compared. RESULTS: Fifty-three of the 142 patients (37%) were current smokers, 24 were former smokers (17%) and 65 were non-smokers (45%). The patients with a hospital admission history during the previous year included 16 current smokers (30%), 4 former smokers (17%) and 7 non-smokers (11%) (p=0.02). The mean FEV1 (% predicted) was 76.8+/-19.8%, 71.6+/-21.1% and 87.9+/-18.7% for current smokers, former smokers and non-smokers, respectively (p<0.001). The FEV1/forced vital capacity (FVC) (ratio, %) values were 63.6+/-12.6%, 59.3+/-14.9% and 72.1+/-11.8% in current smokers, former smokers and non-smokers, respectively (p<0.001). The corresponding mean values for the individual FEV1 slopes were not significant (p=0.33). CONCLUSION: Asthmatic smokers demonstrated higher hospital admission rates and lower lung function. These findings suggest that the smoking history is an important predictor of a poor clinical outcome in asthma patients.

Transcatheter Embolotherapy of Giant Pulmonary Arteriovenous Malformation Using Amplatzer(R) Vascular Plug / 결핵및호흡기질환

Pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly due to an abnormal communication between the pulmonary artery and vein. The most common presenting symptom is a dyspnea on exertion related to this right-to-left shunt. If left untreated, PAVM has been known to result in serious complications. Incomplete pulmonary capillary network can be the cause of cerebral abscesses and other non-infectious neurological complications, such as stroke and transient ischemic attacks due to paradoxic embolism Transcatheter embolotherapy, using coils or balloons, has replaced surgical resection as the treatment of choice for PAVM. However, the risk of device embolization has limited the use of coil embolotherapy, while the size of PAVM is huge. Recently, Amplatzer(R) Vascular Plug has been proposed as an alternative endovascular occlusion device for arteriovenous malformation. We report a case of 81-year-old male patient with a giant PAVM, which was successfully treated by transcatheter embolotherapy using the Amplatzer(R) Vascular Plug.

A case of Wegener's granulomatosis masquerading as a lung abscess / 대한내과학회지

Wegener's granulomatosis is a small vessel vasculitis characterized by necrotizing granulomatous inflammation of the upper and lower respiratory tracts and kidney. Early diagnosis and immediate treatment are very important for a better prognosis, but the nonspecific, variable clinical manifestations and radiologic findings make the diagnosis difficult. A positive proteinase 3-antineutrophil cytoplasmic antibody test is helpful for the diagnosis of Wegener's granulomatosis. Here, we report a case of Wegener's granulomatosis in 54-year-old man who initially presented with fever and multiple cavitary consolidations on the chest radiograph suggestive of a lung abscess. The final diagnosis of Wegener's granulomatosis was based on the medical history of otitis media, gradually developed microscopic hematuria, necrotizing granulomatous inflammation on lung histopathology, and a positive proteinase 3-antineutrophil cytoplasmic antibody test.

Identification and Diagnostic Utility of Serologic Reactive Antigens from Mycobacterium tuberculosis Sonic Extracts

It is important to identify and to test serologically active antigens, so as to devise a cocktail of the best antigens or peptides. We searched for antigens that have serodiagnostic utility using two-dimensional fractionation of sonic extracts from Mycobacterium tuberculosis and probing with pools of sera from healthy subjects and patients with tuberculosis (TB). Reactive protein spots with patient sera were identified by tandem mass spectrometry. Three proteins, Rv0652, Rv2626c, and Rv3418c, which have not previously been described as serologic targets, were identified. Rv0652 protein among them was expressed in Escherichia coli and serum IgG antibodies against this antigen were measured in 150 patients with pulmonary TB and in 115 healthy subjects. The sensitivity and specificity were 39% and 92%, respectively. These results suggest that a newly identified protein, Rv0652 may be a valuable candidate to be included in a cocktail test kit for TB diagnosis.

A Case of Nonclassifiable Interstitial Pneumonia after Allogeneic Hematopoietic Stem Cell Transplantation / 결핵및호흡기질환

Despite the improvements in supportive care, early and late hematopoietic stem cell transplantation-related complications still remain a significant cause of morbidity and mortality. Pulmonary complications occur in 40~60% of patients who undergo allogeneic hematopoietic stem cell transplantation. Late-onset noninfectious pulmonary complications can occur months and even years after transplantation. Interstital lung disease has also been reported to be a late post-transplant complication. Exposure to cytotoxic drugs and/or irradiation has been implicated as a cause of pulmonary toxicity including pulmonary fibrosis. We report a case of an 18-year-old female with non-classifiable interstitial pneumonia that manifested eight and a half years after allogeneic hematopoietic stem cell transplantation. The condition worsened rapidly and the patient eventually died.

The Diagnosis of Old Gravel Aspiration in Adults by MDCT: A Case Report

We report a case of old gravel aspiration in a 57-year-old man who had been accidentally buried in a field of construction for ten hours, three years prior. A chest radiograph showed peribronchial pneumonic infiltrates in the right lower lobe, with a proximal ovoid radiopaque endobronchial density at the trunchus basalis. These findings were more clearly visualized on the 64-channel multidetector CT (MDCT). Moreover, the patient recovered from his condition, following a bronchoscopic retrieval. However, the patient had persistent bronchiectasis of the right lower lobe on a subsequent follow-up chest radiograph, one month later.

A Case of Pulmonary Paragonimiasis Presented as Solitary Pulmonary Nodule and Suspected as Lung Cancer on (18)F-Fluorodeoxyglucose Positron Emission Tomography / 결핵및호흡기질환

Pulmonary paragonimiasis continues to be a diagnostically challenging parasitic disease, despite a drastically decreased prevalence in South Korea during the past decade. Pulmonary paragonimiasis is characterized by fever, chest pain, and chronic cough with hemoptysis. Numerous radiographic and computed tomographic findings including the presence of pneumothorax, pleural effusion, and parenchymal lesions such as nodular or infiltrative opacities have been reported. The clinical and radiological manifestations of paragonimiasis can resemble those of lung cancer, tuberculosis or a metastatic malignancy. Furthermore, this disease can mimic lung cancer as seen on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). We report a case of pulmonary paragonimiasis in a 48-year old man that presented with a solitary pulmonary nodule and was suspected as a lung cancer based on FDG-PET imaging.

Two Cases of Chemical Pneumonitis Caused by Hydrogen Sulfide / 결핵및호흡기질환

Chemical pneumonitis is an occupational lung disease that's caused by the inhalation of chemical substances. Its severity depends on the characteristics of the substances, the exposure time and the susceptibility of the patients. Hydrogen sulfide is not only emitted naturally, but it also frequently found in industrial settings where it is either used as a reactant or it is a by-product of manufacturing or industrial processes. Inhalation of hydrogen sulfide causes various respiratory reactions from cough to acute respiratory failure, depending on the severity. Two pharmaceutical factory workers were admitted after being rescued from a waste water disposal site that contained hydrogen sulfide. In spite that they recovered their consciousness, they had excessive cough and mild dyspnea. The simple chest radiographs and high resolution computed tomography showed diffuse interstitial infiltrates, and hypoxemia was present. They were diagnosed as suffering from chemical pneumonitis caused by hydrogen sulfide. After conservative management that included oxygen therapy, their symptoms, hypoxemia and radiographic abnormalities were improved.

A Case of Papillary Thyroid Cancer Presenting as Pleural Effusion / 결핵및호흡기질환

No abstract available.

Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction / 결핵및호흡기질환

BACKGROUND: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. METHODS: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately -89degrees C, and the icing time was 5~20 seconds. RESULTS: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications-one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. CONCLUSION: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

Bilateral Pulmonary Infiltrate with Milky BAL Fluid / 결핵및호흡기질환

Exogenous lipoid pneumonia is an uncommon disease that's caused by aspirating lipid formulations. Squalene, obtained from shark liver oil, is one of the causative agent and this is commonly used by some Koreans as a health promoting medication. We report here on a case of exogenous lipoid pneumonia that developed after ingestion of squalene capsules. The case showed milky BAL fluid and multiple pulmonary consolidations.