Seizure Occurring 4 Days after Discontinuation of Long-term High-dose Zolpidem

Zolpidem is widely used for insomnia and is known to have relatively few side effects. There have been several reports of side effects, but only a few for withdrawal symptoms. A 41-year-old woman developed convulsions 4 days after discontinuing zolpidem. She was taking more than 10 times the standard dosage. After electroencephalography monitoring without antiseizure medications, she showed no more seizures. This case highlights the danger of zolpidem withdrawal and warns about the easy accessibility of zolpidem for individuals.

Isolated Complete Tongue Paralysis as a Manifestation of Focal Cortical Infarction

Although isolated contralateral tongue deviation following unilateral cortical infarction was occasionally reported, the unilateral lesion usually produces no significant deficit of tongue motility considering bilateral supranuclear innervation of the hypoglossal nerve. We observed a patient with obvious tongue paralysis, including intrinsic muscles, caused by ischemic stroke involving the motor area of the tongue in the primary motor cortex.

Weight change in patients with differentiated thyroid carcinoma after total thyroidectomy versus lobectomy

Purpose@#Thyroid hormone is an important hormone in maintaining metabolism and homeostasis in the body. There exists a common perception among patients that thyroid surgery will cause weight gain. Prevention of any undesired weight gain could be important for the maintenance of well-being in most patients. Our study compares changes in body mass index (BMI) and weight after total thyroidectomy or lobectomy in thyroid cancer patients. @*Methods@#A total of 967 patients with differentiated thyroid carcinoma were enrolled in the study, from March 2011 to July 2016 at Chung-Ang University Hospital. Exclusion criteria were less than lobectomy, modified radical neck dissection, recurred operation, and combined operation for other causes. Primary endpoints were change in body weight and BMI at 2 years after surgery. A subgroup analysis was performed for patients with significant weight change. @*Results@#There were no differences between both groups in BMI after 2 years of thyroid operation. Thyroid stimulating hormone (TSH) levels were not significantly different. Fifteen percent of patients showed significant change in body weight after 2 years of operation. The subgroup analysis of these patients showed no significant differences in gender, age, or extent of operation between those who had gained weight compared to those who had lost weight. There were also no differences in postoperative TSH levels, levothyroxine supplementation, or radioactive iodine treatment. @*Conclusion@#There was a minimal postoperative increase in mean BMI over the years in patients undergoing thyroidectomy for differentiated thyroid cancer. However, weight change did not differ in those undergoing thyroid lobectomy or total thyroidectomy.

Weight change in patients with differentiated thyroid carcinoma after total thyroidectomy versus lobectomy

Purpose@#Thyroid hormone is an important hormone in maintaining metabolism and homeostasis in the body. There exists a common perception among patients that thyroid surgery will cause weight gain. Prevention of any undesired weight gain could be important for the maintenance of well-being in most patients. Our study compares changes in body mass index (BMI) and weight after total thyroidectomy or lobectomy in thyroid cancer patients. @*Methods@#A total of 967 patients with differentiated thyroid carcinoma were enrolled in the study, from March 2011 to July 2016 at Chung-Ang University Hospital. Exclusion criteria were less than lobectomy, modified radical neck dissection, recurred operation, and combined operation for other causes. Primary endpoints were change in body weight and BMI at 2 years after surgery. A subgroup analysis was performed for patients with significant weight change. @*Results@#There were no differences between both groups in BMI after 2 years of thyroid operation. Thyroid stimulating hormone (TSH) levels were not significantly different. Fifteen percent of patients showed significant change in body weight after 2 years of operation. The subgroup analysis of these patients showed no significant differences in gender, age, or extent of operation between those who had gained weight compared to those who had lost weight. There were also no differences in postoperative TSH levels, levothyroxine supplementation, or radioactive iodine treatment. @*Conclusion@#There was a minimal postoperative increase in mean BMI over the years in patients undergoing thyroidectomy for differentiated thyroid cancer. However, weight change did not differ in those undergoing thyroid lobectomy or total thyroidectomy.

Clinical Effectiveness of High-Flow Nasal Cannula in Hypoxaemic Patients during Bronchoscopic Procedures / 결핵및호흡기질환

BACKGROUND: Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure. METHODS: We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017. RESULTS: Ten patients (44–75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation (SpO2) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air SpO2 pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases. CONCLUSION: This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.

The Clinical Efficacy and Safety of Four-Weekly Docetaxel as First-Line Therapy in Elderly Lung Cancer Patients with Squamous Cell Carcinoma / 결핵

BACKGROUND: Docetaxel is one of the standard treatments for advanced non-small cell lung cancer. Docetaxel is usually administered in a 3-week schedule, but there is significant toxicity. In this phase II clinical study, we investigated the efficacy and safety of a 4-weekly schedule of docetaxel monotherapy, as first-line chemotherapy for advanced squamous cell carcinoma in elderly lung cancer patients. METHODS: Patients with stage IIIB/ IV lung squamous-cell carcinoma age 70 or older, that had not undergone cytotoxic chemotherapy were enrolled. Patients received docetaxel 25 mg/m2 on days 1, 8, and 15, every 4 weeks. Primary endpoint was the objective response rate (ORR). Secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity profiles. RESULTS: A total of 19 patients were enrolled. Among 19 patients, 17 were for evaluated efficacy and safety. In the intent-to-treat population, ORR and disease control rate (DCR) were 11.8% and 47.1%, respectively. In the response evaluable population, ORR was 16.7% and DCR was 66.7%. Median PFS and OS were 3.1 months and 3.3 months, respectively. There were three adverse grade 3/4 events. Grade 1 neutropenia was reported in one patient. CONCLUSION: Our data failed to demonstrate efficacy of a 4-weekly docetaxel regimen, in elderly patients with a poor performance status. However, incidence of side effects, including neutropenia, was lower than with a 3-week docetaxel regimen, as previously reported.

Bacterial and Viral Identification Rate in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Korea

PURPOSE: The most common cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is respiratory infection. Most studies of bacterial or viral cause in AECOPD have been conducted in Western countries. We investigated bacterial and viral identification rates in AECOPD in Korea. MATERIALS AND METHODS: We reviewed and analyzed medical records of 736 cases of AECOPD at the Korea University Guro Hospital. We analyzed bacterial and viral identification rates and classified infections according to epidemiological factors, such as Global Initiative for Chronic Obstructive Lung Disease stage, mortality, and seasonal variation. RESULTS: The numbers of AECOPD events involving only bacterial identification, only viral identification, bacterial-viral co-identification, and no identification were 200 (27.2%), 159 (21.6%), 107 (14.5%), and 270 (36.7%), respectively. The most common infectious bacteria identified were Pseudomonas aeruginosa (13.0%), Streptococcus pneumoniae (11.4%), and Haemophilus influenzae (5.3%); the most common viruses identified were influenza virus (12.4%), rhinovirus (9.4%), parainfluenza virus (5.2%), and metapneumovirus (4.9%). The bacterial identification rate tended to be higher at more advanced stages of chronic obstructive pulmonary disease (p=0.020 overall, p=0.011 for P. aeruginosa, p=0.048 for S. pneumoniae). Staphylococcus aureus and Klebsiella pneumoniae were identified more in mortality group (p=0.003 for S. aureus, p=0.009 for K. pneumoniae). All viruses were seasonal (i.e., greater prevalence in a particular season; p < 0.050). Influenza virus and rhinovirus were mainly identified in the winter, parainfluenza virus in the summer, and metapneumovirus in the spring. CONCLUSION: This information on the epidemiology of respiratory infections in AECOPD will improve the management of AECOPD using antibiotics and other treatments in Korea.

The Clinical Efficacy and Safety of Four-Weekly Docetaxel as First-Line Therapy in Elderly Lung Cancer Patients with Squamous Cell Carcinoma / 결핵및호흡기질환

BACKGROUND@#Docetaxel is one of the standard treatments for advanced non-small cell lung cancer. Docetaxel is usually administered in a 3-week schedule, but there is significant toxicity. In this phase II clinical study, we investigated the efficacy and safety of a 4-weekly schedule of docetaxel monotherapy, as first-line chemotherapy for advanced squamous cell carcinoma in elderly lung cancer patients.@*METHODS@#Patients with stage IIIB/ IV lung squamous-cell carcinoma age 70 or older, that had not undergone cytotoxic chemotherapy were enrolled. Patients received docetaxel 25 mg/m2 on days 1, 8, and 15, every 4 weeks. Primary endpoint was the objective response rate (ORR). Secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity profiles.@*RESULTS@#A total of 19 patients were enrolled. Among 19 patients, 17 were for evaluated efficacy and safety. In the intent-to-treat population, ORR and disease control rate (DCR) were 11.8% and 47.1%, respectively. In the response evaluable population, ORR was 16.7% and DCR was 66.7%. Median PFS and OS were 3.1 months and 3.3 months, respectively. There were three adverse grade 3/4 events. Grade 1 neutropenia was reported in one patient.@*CONCLUSION@#Our data failed to demonstrate efficacy of a 4-weekly docetaxel regimen, in elderly patients with a poor performance status. However, incidence of side effects, including neutropenia, was lower than with a 3-week docetaxel regimen, as previously reported.

Clinical and molecular characteristics of pulmonary sarcomatoid carcinoma

BACKGROUND/AIMS: Pulmonary sarcomatoid carcinoma (PSC) is a poorly differentiated non-small cell lung cancer (NSCLC) that contains components of spindle or giant cells. Owing to its low prevalence, there are insufficient data regarding its clinical features, therapeutic strategies and prognosis. METHODS: The medical records of 26 patients diagnosed with PSC from January 2009 to June 2015 were reviewed and analyzed for clinicopathological characteristics, treatment modality, and outcomes. RESULTS: The median age was 69.5 years. Twenty-three patients (88%) were male. Twenty-four patients (92%) were smokers. The median time from symptom onset to diagnosis was one month. Eighteen patients (69%) were diagnosed at an advanced stage. Pleomorphic carcinoma was the most common subtype, and epidermal growth factor receptor (EGFR) mutation was positive in two of 11 patients. Among 13 patients tested for programmed death ligand 1 (PD-L1) immunohistochemistry assay, eight showed high expression of PD-L1. The median overall survival (OS) of all patients was 9.5 months. In total, 12 patients were treated with chemotherapy: nine with platinum-based doublet therapy, two with tyrosine kinase inhibitor, and one with docetaxel. Seven patients showed partial response or stable disease. The median OS and progression-free survival of patients who received chemotherapy were 8.7 and 2.8 months, respectively. CONCLUSIONS: PSC was more common in males, smokers, and the elderly, with worse prognosis than ordinary NSCLC; chemotherapy response was favorable, and EGFR mutation status and PD-L1 expression may offer more therapeutic options.

Safety of medial dissection of the thyroid gland along the trachea based on anatomic constancy of the laryngeal entry point of the recurrent laryngeal nerve

PURPOSE: The purpose of this study was to determine the extent of safety of medial dissection of the thyroid gland along the trachea. Medial to lateral dissection of the thyroid gland along the trachea after early division of the isthmus has been known to be a useful technique in thyroid surgery, especially for difficult cases, but the risk of injury of the recurrent laryngeal nerve (RLN) has constrained thyroid surgeons from utilizing this technique to its full extent. METHODS: Distances of the laryngeal entry point (LEP) of 134 RLNs of 71 patients from the midline of the trachea, and some other anatomical distances, were measured intraoperatively. The relationships of the intraoperatively measured data with circumferences of the cartilaginous portion of the trachea (CCT) around LEP measured preoperatively by CT scan were evaluated. RESULTS: LEP was always located within 2 mm vertically from the horizontally extended line of the inferior border of the cricoid cartilage and was the closest point from the midline in the whole course of the RLN. The distance between LEP and the midline was very closely correlated with CCT measured on preoperative CT scan, and it can be accurately calculated with a regression equation; Distance between LEP and the midline = (0.42 × CCT) + (1.2 × sex) + 3.2 (mm) (sex: female=0, male=1; R2 = 0.85). CONCLUSION: Early division of the isthmus and dissecting the thyroid off the trachea to the calculated extent is a safe and effective procedure.

Osteoporosis in Patients with Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome / 결핵

BACKGROUND: Osteoporosis is a common disease that occurs comorbidly in patients with chronic inflammatory airway diseases, including asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap syndrome (ACOS). However, the prevalence of osteoporosis in patients with ACOS has not widely been evaluated. Therefore, we investigated the prevalence of osteoporosis and its relationship with the clinical parameters of patients with asthma, COPD, and ACOS. METHODS: This was a retrospective, cross-sectional study. Bone mineral density (BMD), lung function tests, and disease status evaluations were conducted. RESULTS: A total of 321 patients were enrolled: 138 with asthma, 46 with ACOS, and 137 with COPD. One hundred and ninety-three patients (60.1%) were diagnosed with osteoporosis (53.6% of asthma, 65.2% of ACOS, and 65.0% of COPD). Patients with ACOS showed a significantly lower BMD and T-score than did those with asthma. In addition to age, sex, and body mass index (BMI), which were previously reported to be associated with BMD, BMD also had a negative correlation with the diagnosis of ACOS, as compared to a diagnosis of asthma, after adjusting for age, sex, BMI, smoking, and inhaled corticosteroid use (p=0.001). Among those patients with COPD and ACOS, BMD was negatively associated with the COPD Assessment Test (CAT) after adjustment (p < 0.001). Inhaled corticosteroid was not associated with the prevalence of osteoporosis and BMD. CONCLUSION: Patients with ACOS, particularly aged and lean women, should be more carefully monitored for osteoporosis as compared to patients with asthma.

Anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease

Hypereosinophilia, defined as an absolute eosinophil count of >1,500/μL, can be caused by a number of allergic, infectious, paraneoplastic and neoplastic disorders. In cases of hypereosinophilia with lymphoid proliferation, pathological confirmation is essential to exclude either myeloid or lymphoid malignancy. A 38-year-old woman with both cervical lymphadenopathies and peripheral blood eosinophilia visited our clinic. She had already performed core biopsy of lymph nodes and diagnosed as Kimura disease at a regional hospital. At the time of our clinic visit, there were no palpable cervical lymph nodes. The blood test showed hypereosinophilia with a high total IgE level. There was no evidence of tissue infiltration of eosinophils except for duodenitis with eosinophilic infiltration. Based on these findings, she was diagnosed as Kimura disease. She treated with high-dose systemic corticosteroid (1 mg/kg) and additional immunosuppressants sequentially used cyclophosphamide and cyclosporine. However, her eosinophilia waxed and waned, and a left inguinal mass was newly found. Excisional biopsy findings showed large atypical lymphoid cells with numerous eosinophilis, and immunohistochemistry showed CD3+, CD20−, CD30+ and anaplastic lymphoma kinase (ALK). The final diagnosis was ALK-negative anaplastic large cell lymphoma. We report a case of anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease. In the case of hypereosinophilia with lymphadenopathy, it is necessary to differentiate hematologic diseases through immunochemical staining.

Osteoporosis in Patients with Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome / 결핵및호흡기질환

BACKGROUND@#Osteoporosis is a common disease that occurs comorbidly in patients with chronic inflammatory airway diseases, including asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap syndrome (ACOS). However, the prevalence of osteoporosis in patients with ACOS has not widely been evaluated. Therefore, we investigated the prevalence of osteoporosis and its relationship with the clinical parameters of patients with asthma, COPD, and ACOS.@*METHODS@#This was a retrospective, cross-sectional study. Bone mineral density (BMD), lung function tests, and disease status evaluations were conducted.@*RESULTS@#A total of 321 patients were enrolled: 138 with asthma, 46 with ACOS, and 137 with COPD. One hundred and ninety-three patients (60.1%) were diagnosed with osteoporosis (53.6% of asthma, 65.2% of ACOS, and 65.0% of COPD). Patients with ACOS showed a significantly lower BMD and T-score than did those with asthma. In addition to age, sex, and body mass index (BMI), which were previously reported to be associated with BMD, BMD also had a negative correlation with the diagnosis of ACOS, as compared to a diagnosis of asthma, after adjusting for age, sex, BMI, smoking, and inhaled corticosteroid use (p=0.001). Among those patients with COPD and ACOS, BMD was negatively associated with the COPD Assessment Test (CAT) after adjustment (p < 0.001). Inhaled corticosteroid was not associated with the prevalence of osteoporosis and BMD.@*CONCLUSION@#Patients with ACOS, particularly aged and lean women, should be more carefully monitored for osteoporosis as compared to patients with asthma.

Reactive Oxygen Species Modulator 1 (Romo1) Predicts Poor Outcomes in Advanced Non-small Cell Lung Cancer Patients Treated with Platinum-Based Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Reactive oxygen species modulator 1 (Romo1) is a key mediator of intracellular reactive oxygen species production. However, examination of the clinical usefulness of Romo1 in cancers has been limited. We evaluated the association of Romo1 expression with clinical outcomes in advanced non-small cell lung cancer (NSCLC) patients treated with platinum-based chemotherapy. MATERIALS AND METHODS: Romo1 expression in tumor tissue was examined by immunohistochemistry and evaluated by histological score. Survival analyses were performed according to Romo1 expression and the association between Romo1 expression and clinical parameters was evaluated. RESULTS: A total of 88 tumor specimens were analyzed. Significantly shorter median progression-free survival (PFS) was observed in the high Romo1 group compared with the low Romo1 group (4.5 months vs. 9.8 months, p < 0.001), and the median overall survival (OS) of the high Romo1 group was also significantly shorter than that of the low Romo1 group (8.4 months vs. 15.5 months, p < 0.001). Results of multivariate analyses showed significant association of high Romo1 expression with both poor PFS (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.71 to 4.44) and poor OS (HR, 3.99; 95% CI, 2.36 to 6.74). Results of the subgroup analysis showed a similar association regardless of tumor histology. Romo1 expression showed no association with any clinical parameter including age, sex, smoking status, stage, differentiation, or tumor histology. CONCLUSION: Romo1 overexpression was associated with poor response to treatment and shorter survival in advanced NSCLC patients treated with platinum-based chemotherapy. Romo1 could be a potential adverse predictive marker in this setting.

Pulmonary Sarcoidosis Induced by Adalimumab: A Case Report and Literature Review

No abstract available.

An IgE-Mediated Allergic Reaction Caused by Mulberry Fruit

Mulberry (Morus spp.) is a widespread deciduous tree and its fruit is commonly eaten in Korea and eastern Asia. Some reports demonstrate that mulberry fruit is a food allergen in the Mediterranean area. However, there has been no report of systemic allergic reactions after ingesting mulberry fruit in Korea. An 18-year-old boy with a mulberry fruit allergy visited our allergy clinic. He had experienced generalized urticaria, chest tightness, breathing difficulty, and abdominal cramping after ingesting mulberry fruit. The patient had a positive skin reaction to mulberry fruit extract (mean wheal size, 5 mm). We performed an ELISA to detect specific IgE antibody (Ab) to mulberry fruit extract in the patient's serum compared to those of non-atopic healthy controls and birch-sensitized individuals. Specific IgE Ab to mulberry fruit extract was detected in the patient's serum, as compared to non-atopic healthy controls. Another subject, who was strongly sensitized to birch pollen, also had a positive serum-specific IgE Ab to mulberry fruit. We performed IgE immunoblot analysis using the patient's and the other subject's sera, who had serum-specific IgE to mulberry fruit, to identify the IgE-binding component. An identical IgE-binding component to mulberry extract was detected in the two subjects at around 17 kDa, and which might be PR 10 of Bet v 1. In conclusion, mulberry fruit could induce a systemic allergic reaction through an IgE-mediated mechanism, and cross-reactivity might occur between mulberry fruit and birch pollen.

The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo-breast approach thyroidectomy: a prospective, randomized, double-blind, placebo-controlled study

PURPOSE: The aim of this study was to evaluate the effects of preoperative ropivacaine infiltration in patients undergoing robotic thyroidectomy using the bilateral axillary breast approach method. METHODS: Using a randomized, double-blind study design, 34 consecutive female patients who underwent robotic thyroidectomy were randomly assigned to receive local infiltration to the skin flap site using either only 0.9% saline solution, 3 mL/kg (group C, n = 17) or 0.1% ropivacaine with saline, 3 mg/kg (group L, n = 17). Local anesthetic was administered prior to skin incision after the induction of general anesthesia. Postoperative pain was rated at 2, 6, 18, 30, 42, and 66 hours postoperatively by visual analogue scale (VAS) score. The bottom hit counts (BHC) from patient controlled analgesia and fentanyl consumption were evaluated. CRP levels, mean blood pressure (BP), and heart rate (HR) were also evaluated. RESULTS: VAS pain scores were significantly lower in group L than in group C from 2 to 42 hours (P < 0.05). Fentanyl use for analgesia and BHC were also significantly lower in group L compared with group C during the first postoperative 6 and 2 hours, respectively (P < 0.05). The total consumption of fentanyl was significantly lower in group L than in group C (P = 0.009). No significant differences were noted for baseline, postoperative mean BP, or HR. CONCLUSION: Preoperative infiltration using ropivacaine with saline to all flap sites is a safe and effective method for reducing postoperative pain and postoperative fentanyl consumption in patients with robotic thyroidectomy.

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy / 결핵및호흡기질환

Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

Effects of Transglutaminase 2 Inhibition on Ventilator-Induced Lung Injury

This study was performed to examine the role of transglutaminase 2 (TG2) in ventilator-induced lung injury (VILI). C57BL/6 mice were divided into six experimental groups: 1) control group; 2) lipopolysaccharide (LPS) group; 3) lung protective ventilation (LPV) group; 4) VILI group; 5) VILI with cystamine, a TG2 inhibitor, pretreatment (Cyst+VILI) group; and 6) LPV with cystamine pretreatment (Cyst+LPV) group. Acute lung injury (ALI) score, TG2 activity and gene expression, inflammatory cytokines, and nuclear factor-kappaB (NF-kappaB) activity were measured. TG2 activity and gene expression were significantly increased in the VILI group (P < 0.05). Cystamine pretreatment significantly decreased TG2 activity and gene expression in the Cyst+VILI group (P < 0.05). Inflammatory cytokines were higher in the VILI group than in the LPS and LPV groups (P < 0.05), and significantly lower in the Cyst+VILI group than the VILI group (P < 0.05). NF-kappaB activity was increased in the VILI group compared with the LPS and LPV groups (P < 0.05), and significantly decreased in the Cyst+VILI group compared to the VILI group (P = 0.029). The ALI score of the Cyst+VILI group was lower than the VILI group, but the difference was not statistically significant (P = 0.105). These results suggest potential roles of TG2 in the pathogenesis of VILI.

A Case of IgG4-Related Disease Presenting as Massive Pleural Effusion and Thrombophlebitis / 결핵및호흡기질환

Immunoglobulin (Ig) G4-related disease is a recently recognized systemic fibroinflammatory condition characterized by a lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells with elevated circulating levels of IgG4. The disease can either be localized to one or two organs, or present as diffuse multi-organ disease. Furthermore, lesions in different organs can present simultaneously or metachronously. In the pulmonary manefestations, lesions associated with IgG4-related disease have been described in the lung parenchyma, airways and pleura, as well as the mediastinum. We report a case of IgG4-related disease presenting as massive pleural effusion and thrombophlebitis.