Prevalence and Clinical Outcome of Penicillin-resistant Pneumococcal Pneumonia / 결핵

BACKGROUND: The incidence of penicillin-resistant streptococcus pneumoniae(PRSP) accounts for almost 70% of all pneumococcal pneumonia cases in Korea. It is still unclear as to whether the efficacy of penicillin or equally active beta-lactam agents is compromised in PRSP pneumonia. This study investigated the prevalence of PRSP in community-acquired pneumonia and its clinical course. METHODS: A total of 42 patients with community-acquired pneumococcal pneumonia were evaluated from July 1999 to May 2001. The cultured strains of Streptococcus pneumoniae were divided into susceptible, intermediately resistant, and resistant strains by an E-test, and the effect of the clinical course was investigated. RESULTS: From a total of 42 patients, 22 (52.4%) patients had an intermediate resistance (MIC 0.1-1 microgram/ml) and six (14.3%) showed a high resistance (MIC> or =2.0 microgram/ml) with current penicillin susceptibility categories. However, according to the classification of the DRSPTWG (Drug Resistant Streptococcus pneumoniae Therapeutic Working Group), there were 11 cases (26.2%) of intermediate resistance and no case of high resistance. Under empirical antimicrobial treatment, there was no difference in the clinical outcome between the penicillin susceptible and resistant group. CONCLUSION: The clinical outcome of PRSP pneumonia with empirical therapy was acceptable. These results suggest that the current MIC breakpoint for penicillin resistance in Streptococcus pneumoniae has been set at a very low level and penicillin resistance according to the NCCLS classification does not significantly influence the outcome of the empirical treatment for pneumococcal pneumonia.

Treatment of Diffuse Tracheobronchial Amyloidosis by Repeated Electrocautry Under Fiberoptic Bronchoscopy / 결핵

Diffuse tracheobronchial amyloidosis is an uncommon form of pulmonary involvement, and causes prolonged cough, dyspnea, wheezing and repeated development of pneumonia. We report a case of diffuse tracheobronchial amyloidosis in 58-year-old woman that was traeted by repeated electrocautry under flexible fiberoptic bronchoscopy. The patient had a long-standing history of dyspnea and was admitted due to resting dyspnea, which was aggravated to impending respiratory failure after diagnostic procedures. We applied repeated electrocautry to the endobronchial amyloid tumors and successfully reduced bronchial stenosis and the pateint didn\'t feel dyspnea. We suppose that, in certain cases of tracheobronchial amyloidosis patients, endobronchial electrocautry would be a helpful procedure.

Two Cases of Tracheopathia Osteoplastica / 결핵

Tracheopathia osteoplastica is a rare disease of unknown cause and characterized by cartilaginous or bony projection into the tracheobronchial lumen, usually not involved posterior membranous portion of tracheobronchial tree. In the past, most of the cases were diagnosed incidentally at autopsy. But after the introduction of bronchoscopy and computed tomography, antemortem diagnosis was reported. Because of initial presenting symptoms were indolent and non-specific, misdiagnosis was reported frequently and correct diagnosis was delayed usually. We report two cases of tracheopathia osteoplastica diagnosed by fiberoptic bronchoscopic biopsy.

Diagnosis of Tuberculous Cervical Lymphadenitis Using Polymerase Chain Reaction / 결핵

BACKGROUND: Tuberculous cervical lymphadenitis can be diagnosed by clinical findings, chest X-ray, Mantoux test, but confirmed only by excisional biopsy. The polymerase chain reaction(PCR) is now widely applied to test very small amount of pathogen and would be used to detect Mycobacterium tuberculosis in biopsied tissues and fine needle aspirates. METHOD: We carried out the PCR using IS-1 and IS-2 primers in 16 samples from tuberculous cervical lymphadenitis patients, and 13 samples from non-tuberculous cervical lymphadenopathy patients. Acid fast staining and culture for Mycobacterium were all negative. RESULTS: All of 8 pathologically confirmed tuberculous cervical lymphadenitis samples showed positive PCR results, and of 5/8 clinically diagnosed samples were positive. None of 6 pathologically excluded samples were positive, and among 7 clinically undiagnosed samples 2 showed positive PCR results. CONCLUSION: In patients with suspected tuberculous cervical lymphadenitis, PCR could be used to detect Mycobacterium tuberculosis using biopsied tissues and even fine needle aspirates with good sensitivity and specificity.

Two cases of silicone- induced pulmonary embolism / 결핵

No abstract available.

Chronic mercury vapor poisoning of the lung plain radiograph and high resolution CT

Authors analyzed the findings of findings of chest radiographs and high-resolution CT(HRCT) of chronic mercury vapor poisoning in 12 patients who were diagnosed by previous working history for mercury-thermometer and high level of mercury in blood and urine. The purpose of this paper is to introduce the HRCT findings of chronic mercury vapor poisoning. Duration of mercury exposure was ranged from 10 to 41 months(mean, 21.8 months). Estimated value of serum mercury was ranged from 3.6 to 8.7µg/dl(mean, 5.3 µg/dl: normal value is less than 0.5µg/dl). Estimated value of mercury in urine was ranged from 104 to 482µg/1(mean, 291.4µg/1: normal value is less than 20µg/1). Chest radiographs showed positive findings such as ground-glass opacities and peribronchial cuffings in only 2 out of 12 patients, but HRCT showed positive findings such as ground-glass opacities in 8 patients, peribronchial cuffings in 7 patients, centrilobular abnormalities in 5 patients, interface sign in 4 patients, interlobular septal thickening with intralobular lines in 2 patients and lobular consolidation in one patient. In conclusion, chest HRCT is superior to chest radiograph to show the pulmonary manifestation of chronic mercury vapor poisoning. In patients with chronic mercury vapor poisoning, HRCT findings of centrilobular distributed ground-glass opacities and peribronchial cuffinges are characteristic.