A Case of Tracheal Leiomyoma / 대한내과학회지

Leiomyomas account for 2% of the benign tumors of the lower tracheobronchial tree. Tracheal leiomyomas most commonly occur in the fourth decade man. The most co mmon segment to be affected is the lower third of the trachea and the usual site of origin is the posterior mem branous portion. Symptoms are due to partial or com plete obstruction of the trachea. Intermittent or constant dyspnea and wheezing are the most common symptoms of tracheal leiomyoma and have been erroneously ascri bed to bronchial asthma. Clinical symptoms distinguished from bronchial asthma, chest CT scan and bronchoscopy can make diagnosis. The diagnosis of leiomyoma of the lower respiratory tract is by chest C-T scan and bronc hoscopy, which gives direct visualization and biopsy ma terial is sent for histologic examination. The treatment of leiomyoma is essentially conservative since there have been no reports of recurrence after limited resection. Intr atracheal leiomyomas have been dealt with in three ways: by bronchoscopic removal, by excision via a tra cheotomy, and by circumferential resection with primary end-to-end anastomosis. In recent years, successful mass removal with YAG laser and electrocautery technique were reported. We have experienced 36 year-old-male with hemopty sis, cough and sputum production. Tracheal leiomyoma was diagnosed by chest CT scan and bronchoscopy. Mass removal and tracheoplasty were done successfully. So we present this case with the review of literature.

Alexithymia in patients with bronchial asthma / 천식및알레르기

BACKGROUND: Alexithymia refers to a specific disturbance in psychic functioning characterized by difficulties in capacity to verbalize affect and to elaborate fantasies. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders. OBJECTIVE: The present study was to evaluate the relationship between the alexithymia and bronchial asthma, and to compare the results with finding from a group of acute infectious illness subjects. MATERIAL AND METHOD: Alexithymia was measured with on Korean translation of the TAS-20 (Toronto Alexithymic Scale-20 Korea version) and the Scored Archetypal 9 Test(SAT9). Thirty patients with bronchial asthma and thirty patients with acute infectious illness completed these tests. The SAT9 and the TAS-20K scores were compared in the both group, considering the age, gender, education level, and duration of illness. RESULT: Bronchial asthma patients had significantly higher score of on the TAS-20K and SAT9 compared with those with infectious illness(p<0.05). The two scales correlated in expected direction. Alexithymia was significantly related to education level(SAT9: r=0.335, TAS-20K: r=-0.376, p<0.01) and duration of illness(asthma group, SAT9: r=-0.383, TAS-20K: r=0.288, p<0.05). CONCLUSION: Bronchial asthma patients had significantly higher alexithymic scores. This finding suggests that psycliathic consultation may be considered for the management of asthmatic patients with alexithyria.

Changes of Souble ICAM-1 Levels in Patients with Tsutsugamushi Disease / 대한내과학회지

OBJECTIVES: ICAM-1 has been shown to be required for leukocyte migration into inflammed area and plays a significant role in inflammatory disease including bronchial asthma, and various infectious disease such as tuberculosis and malaria. Although, the significance of soluble ICAM-1(sICAM-1) in rickettial disease has not been recognized. The present investigation was designed to evaluate the sICAM-1 levels in patients with tsutsugamushi disease, and the correlation factors between sICAM-1 level and subject characteristics including clinical and laboratory indices. METHODS: Eight normal controls and thirteen patients with tsutsugamushi disease underwent serum sampling for sICAM-1 level, which was measured by using ELISA kit. RESULTS: 1) sICAM-1 level is significantly elevated in patients group. 2) sICAM-1 level is a significantly correlation with AST level, titer of anti-tsutsugamushi antiboby, and leukocyte counts, but other factors such as age, sex, differential fraction of leukocyte, ALT, duration of fever, and total hospital day etc, are not. CONCLUSION: These results show that sICAM-1 may be a role in the pathogenesis of tsutsugamushi disease.

A Case of Cyclic Hematopoiesis / 대한혈액학회지

Classical cyclic neutropenia is the most frequent of the cyclic hematopoietic disorders and a rare condition characterized by regular and predictable oscillations in the peripheral neutophil counts with the cycle length varying from 14 to 28 days and in many cases simultaneous fluctuation in the other blood cell line. The etiology of cyclic neutropenia is unknown, but has usually been considered as stem-cell disorder. We have observed a 17-year-old boy with a cyclic pancytopenia with a constant and predictable oscillation period of about 120 days. Serial bone marrow biopsies showed a similar fluctuating pattern and myelodysplatic change. We report this case and review the literature regarding this unusal long period cyclic neutropenia.

sICAM-1, sE-selectin, sVCAM-1 Concentration in Patients with Pulmonary Tuberculosis / 결핵

BACKGROUND: Leukocyte-endothelial adhesion molecules have been implicated in the pathogenesis of inflammatory disease. ICAM-1, VCAM-1 and E-selectin are cell surface adhesion molecule on vascular endothelial cells. They are up-regulated by inflammatory cytokines and regulate the adhesion and migration of leukocytes across the endothelium. Tuberculosis, a granulomatous disorder is an infection caused by Mycobacterium tuberculosis. The clinical manifestations of tuberculosis are dependent on the cellular immune response to tubercule bacilli. Circulating adhesion molecules are probably formed by cleavage and release into the circulation of the extracellular domain of the membrane bound form. The elevated levels of circulating adhesion molecules have been reported in numerous disease state. To evaluate their role as markers of disease activity in tuberculosis, we measured a sE-selectin, sVCAM-1 and sICAM-1 levels in the serum with seventies of mild, moderate and far advanced pulmonary tuberculosis. METHODS: The control and test groups were divided as follows. Group I: control(n=5), Group II: atients with mild pulmonary tuberculosis(n=12), Group III: patients with moderate pulmonary tuberculosis(n=20), Group IV patients with far advanced pulmonary tuberculosis(n=19). Serum sICAM-1, sVCAM-1 and sE-selectin were measured by ELISA kit. RESULTS: Serum soluble adhesion molecules are elevated in patients with pulmonary tuberculosis. Circulating ICAM-1 levels were significantly elevated in patients with moderate and far advanced pulmonary tuberculosis when compared with control group. When compared with control group, serum sVCAM-1 levels showed significant elevation in patients with mild, moderate and far advanced pulmonary tuberculosis. Serum sE-selectin levels were significantly elevated in patients with far advanced pulmonary tuberculosis when compared with control group. CONCLUISON: These results suggest that sICAM-1, sVCAM-1, and sE-selectin may be invloved lix the pathogenesis of tuberculosis. And, particularly, sICAM-1 and sVCAM-1 may be useful markers of the disease activity.