A Case of Endobronchial Carcinoid Tumor Treated by Flexible Bronchoscopic Resection / 결핵및호흡기질환

Bronchial carcinoid tumor accounts for less than 5% of all primary lung tumors in adults. Although surgical resection is the treatment of choice, here we report a case of bronchial carcinoid tumor treated with flexible bronchoscopic resection. A 19-year-old-man presented with a history of wheezing with dyspnea for six months. A simple chest x-ray showed no abnormal findings, but a pulmonary function test showed a moderate obstructive lung disease pattern without a bronchodilator response. A computed tomogram of the thorax revealed an enhanced 15x12 mm nodule in the left main bronchus. Bronchoscopic examination showed a polypoid mass with a stalk in the left main bronchus, which almost completely occluded the left main bronchus. Histopathology of the resected specimen revealed a bronchial carcinoid tumor. We treated the carcinoid tumor with a flexible bronchoscopic resection. During the follow up period of 6 months, the previous tumor didn't relapse. Initial bronchoscopic resection should be considered when bronchial carcinoid tumor can be approached by bronchoscopy.

Effects of esomeprazole premedication on gastric pH during laparoscopic surgery / 대한마취과학회지

BACKGROUND: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS: In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.

Usefulness of Small Caliber Catheter Insertion for a Spontaneous Pneumothorax / 결핵및호흡기질환

BACKGROUND: The large caliber catheter used in the treatment of pneumothorax causes great damage to the chest wall and organs. The purpose of this study was to prove that the use of a smaller caliber catheter is effective in treating pneumothorax with decreasing admission period and that the recurrence rate of spontaneous pneumothorax is low. METHODS: Patients who had been admitted for treatment of first time occurrence of pneumothorax between May, 2004 and December, 2008 were included in the study. The caliber of catheter used this study is 18 Guage (1.2 mm). The efficacy of treatment, admission period and recurrence rate of treating pneumothorax with small caliber catheter were compared to the control group using a tube thoracostomy for treatment. RESULTS: The admission period for primary spontaneous pneumothorax was 10.8+/-3.6 days for the group (n=68) using tube thoracostomy compared to 4.5+/-1.3 days for the group (n=31) using the small caliber catheter (p<0.05). There was no statistically significant difference in recurrence rate between the two groups. CONCLUSION: The use of a smaller caliber catheter for the treatment of pneumothorax reduces the admission period without a significant increase in recurrence rates.

Usefulness of 5-aminolevulinic acid-photodynamic for diagnosing lung cancer / 대한내과학회지

BACKGROUNDS/AIMS: Photodynamic diagnosis (PDD) is a modern method for fluorescence imaging of a bronchogenic malignancy. Adverse effects and high costs, partly related to the general application of photosensitizers, are important limitations of the method. However, local application of a photosensitizer could help minimize these problems. 5-Aminolevulinic acid (ALA)-induced fluorescence promotes tumor selective accumulation of protoporphyrin, so tumors can be distinguished from healthy tissue. We compared white light bronchoscopy (WLB) with PDD for the early detection and exact staging of lung cancer. METHODS: We examined 56 stage I and II lung cancer patients (age 65 years; range, 44.83) by photodynamic bronchoscopy (D-Light/AFsystem; Karl Storz GmBH, Tuttlingen, Germany) who had symptoms of cough, sputum, and hemoptysis with atypical cells in sputum cytology. Biopsies were taken from suspected lung cancer by both methods, and 181 lesions were analyzed. RESULTS: The diagnostic accuracy of WLB, using histopathologic results as the standard, was 48.6%, whereas the accuracy using ALA-PDD was 73.5%. The sensitivity of WLB for detecting dysplasia or cancer was 57.1%, and the specificity was 85.6%. When the results from ALA-PDD were considered, these values were 90.5% and 79.1%, respectively. Of 2 patients with carcinoma in situ, only ALA-PDD revealed the lesions. Three patients with initial stage I or II became stage IIIB or IV after ALA-PDD. CONCLUSIONS: Early detection and exact staging of lung cancer can be facilitated using a combination of ALA-PDD and WLB.

Effect of Photodynamic Therapy in Lung Cancer / 결핵및호흡기질환

BACKGROUND: Photodynamic therapy (PDT) involves the use of photosensitizing agents for treatment of malignant disease. PDT is approved by the U.S. Food and Drug Administration for the endobronchial microinvasive nonsmall cell lung cancer and for palliation in patients with obstructing tumors. We report our experience and results of PDT in lung cancer. METHOD:Ten patients with lung cancer who were diagnosed in Chosun university hospital by histologic confirm through bronchoscopy were included between August 2002 and May 2003. The photosensitizer (Photogem(R), Lomonosov institute of Fine Chemical, Russia/ dose 2.0 mg/kg body weight) was injected 48 hours prior to the PDT session. For PDT with the photosensitizer (Photogem(R)), Diode LASER system (Biolitec Inc., Germany, wavelength; 633nm) were used. PDTs were done at 48-72 hours after photogem injection. Follow up bronchoscopy and chest X-ray or thorax computerized tomography were done for evaluate PDT response. RESULTS: 9 of 10 patients with endobronchial obstruction showed partial remission with bronchus opening after PDT. Direct reaction of the tumor to PDT was similar in despite of its localization. It was as follows; edema, hyperemia, in-situ bleeding, fibrin film occurrence. Any other complications such as sunburns of skin, inflammation within the PDT zone were not occurred by the end of the fourth week. CONCLUSION: In the advanced endobronchial disease, PDT has been shown to be useful in treating endobronchial tumors that are causing clinically significant dyspnea or are likely to progress and lead to further clinical complications, such as postobstructive pneumonia.

Immunoreactivity of Iron-Repressible Cell Wall Proteins and Exoproteins of Staphylococcus aureus

In the present study, we tried to investigate immunoreactivity of iron-repressible cell wall proteins and exoproteins of Staphylococcus aureus when the convalescent serum obtained from the patient with septicemia was applied. On SDS-PAGE and western blot analysis, several iron-repressible cell wall proteins expressed in iron-deficient BHI showed strong immunoreactivity, whereas no or relatively weak immunoreactivity was shown in iron-sufficient BHI. Several exoproteins were expressed only in iron-deficient BHI and these exoproteins showed strong immunoreactivity. These results indicate that several iron-repressible cell wall proteins and exoproteins are expressed and are immunogenic in vivo. Since in vivo state is an relatively iron-restricted condition, we recommend the use of iron-deficient media for studies concerning pathogenicity of staphylococcal in human.

Immunoreactivity of Iron-Repressible Cell Wall Proteins and Exoproteins of Staphylococcus aureus

In the present study, we tried to investigate immunoreactivity of iron-repressible cell wall proteins and exoproteins of Staphylococcus aureus when the convalescent serum obtained from the patient with septicemia was applied. On SDS-PAGE and western blot analysis, several iron-repressible cell wall proteins expressed in iron-deficient BHI showed strong immunoreactivity, whereas no or relatively weak immunoreactivity was shown in iron-sufficient BHI. Several exoproteins were expressed only in iron-deficient BHI and these exoproteins showed strong immunoreactivity. These results indicate that several iron-repressible cell wall proteins and exoproteins are expressed and are immunogenic in vivo. Since in vivo state is an relatively iron-restricted condition, we recommend the use of iron-deficient media for studies concerning pathogenicity of staphylococcal in human.

A case of diffuse alveolar hemorrhage following administration of artecoll / 대한내과학회지

Diffuse alveolar hemorrhage (DAH) is a relatively uncommon disorder that most often occurs in patients with systemic autoimmune or idiopathic disease. DAH may result from coagulation disorders, inhaled toxins, or infection. The principal histopathologic features of pulmonary capillaritis include capillary wall necrosis with infiltration by neutrophils, interstitial erythrocytes, and/or hemosiderin, and interalveolar septal capillary occlusion by fibrin thrombi. New inert materials such as polymerized silicones, artecoll is used as injectable aesthetic microimplants. They are still able to stimulate a clinically evident granulomatous reaction. The rate of allergic reaction is very low. We report the case of diffuse alveolar hemorrhage following administration of artecoll.

Diffuse Pulmonary Alveolar Hemorrhage and Interstitial Pneumonitis after Subcutaneous Injection of Atelocollagen for Cosmetic Purpose: Two Case Reports / 결핵

Atelocollagen have been used recently in skin and other soft tissue defect regions more than silicone fluid because of the low incidence of an immune reaction and complications. Several cases of acute pneumonitis after a subcutaneous injection of silicone have been reported. The symptoms were dyspnea, fever, chest pain and hemoptysis. Previous reports have explained the pathophysiology of acute pneumonitis to a pulmonary microembolism and cellular inflammation. We experienced two cases of an acute interstitial pneumonitis and pulmonary hemorrhage after a subcutaneous injection of atelocollagen. They were all healthy young women and complained of dyspnea, fever and blood tinged sputum. The chest radiography and computerized tomography showed a bilateral ground glass opacity in both lung fields. One case recovered completely with conservative treatment but the clinical course of the other case was aggravated to the degree that invasive positive pressure ventilation therapy was required. We report a rare case of a diffuse pulmonary alveolar hemorrhage and an interstitial pneumonitis after the subcutaneous injection of atelocollagen for cosmetic purposes.

Response of Hyperhomocysteinemia to Folic Acid Supplementation in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Hyperhomocysteinemia is a common finding in patients with end-stage renal disease and has been recognized as an independent risk factor for atherosclerotic disease in the coronary, cerebral, and peripheral vasculature. Although treatment with folic acid is known to be effective method for decreasing plasma homocysteine of hemodialysis patients in many studies, there are no controlled data for long term treatment. The present study is aimed to assess clinical response of folic acid administration for 12 weeks. METHODS: 38 patients undergoing hemodilaysis were supplemented with 5 mg folic acid daily for 12 weeks and were observed for next 12 weeks after stopping folic acid. We measured plasma homocysteine and folic acid concentration every 2 weeks during treatment and every 4 week for next 12 weeks after stopping folic acid. RESULTS: Baseline Plasma homocysteine concentration in hemodialysis patients was higher than normal control. In hemodialysis paient with folic acid administrtion(5 mg/day), significant decrease in plasma homocysteine concentration was noted after 2 week(27.8%, p<0.005) and normalization of plasma homocysteine concentration was noted in 14 of 38 patient(37%) at 12 weeks. After stopping folic acid, plasma homocycteine concentration increased to baseline concentration at 8 weeks. There were no significant complications except mild nausea, vomiting during treatment. CONCLUSION: These result indicate that relatively long term treatment of 5 mg daily folic acid in hemodialysis patient cause a more normalization of plasma homocysteine concentration than other short term studies.

A case of recurrent postpartum hemolytic uremic syndrome / 대한내과학회지

The hemolytic uremic syndrome (HUS) is characterized by triad of microangiopathic hemolytic anemia, thrombocytopenia, and azotemia. The major causes of this syndrome are infectious diseases, drugs, cancer, connective tissue diseases and pregnancy. The association of pregnancy with HUS is an unusual but well described event occurring typically in the postpartum period. Postpartum HUS is also a cause of acute renal failure in pregnancy. Some cases of recurrent HUS due to drugs or infection were reported. We experienced a 33-year-old woman with recurrent postpartum HUS. She had postpartum HUS 5 years ago and was recovered completely with one month treatment including hemodialysis. On this admission, she presented with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We carried out hemodialysis, plasmapheresis and other conservative management for 2 months. However, the patient's renal function was not recovered, and maintenance hemodialysis was required.

Effect of Iron-Uptake System on the Growth of Staphylococcus aureus according to the Iron Concentration and Oxygen Tension / 감염

BACKGROUND: We previously reported that activity of iron-uptake systems (IUS) influenced on the growth of Staphylococcus aureus in body fluids which are relatively iron-restrictive conditions. Iron and oxygen are closely related each other in several microbial metabolism. In the present study, we tried to investigate the effect of IUS on the growth of S. aureus according to the iron concentration and oxygen tension. METHODS: SR-1 strain, whose IUS are defective, was isolated from the standard strain, ATCC 6538. These two strains were cultured under the aerobic, microaerobic and anaerobic condition in the iron-sufficient BHI and iron-depleted BHI, respectively. Bacterial growth was measured by optical density. RESULTS: Growth of both strains was inhibited in the iron-depleted BHI. Growth of parental strain was more active in the iron-sufficient BHI as well as in the ion-depleted BHI than that of SR-1 strain. Growth of both strains was more active under the aerobic condition than under the microaerobic or anaerobic condition. In the iron-depleted BHI, parental strain showed a striking difference of growth according to the oxygen tension. In the iron-depleted BHI, growth of SR-1 strain was markedly inhibited regardless of oxygen tension. CONCLUSION: IUS influenced more on the growth of S. aureus in the iron-depleted environments than in the iron-sufficient environments, and under the aerobic condition than under the microaerobic or anaerobic condition in the iron-depleted environments. These results indicated the possibility that oxygen as well as iron regulate activity and expression of IUS.

A Case of Proptosis Associated with Orbital Panniculitis

PURPOSE: To report a case with proptosis associated with orbital panniculitis. METHODS: A 34-old-year man with unilateral proptosis for 1 month presented with diffuse swelling and redness in the eyelid and conjunctiva. His systemic symptoms were high fever, headache, nausea, diarrhea, dizziness, weight loss, malaise and hepatosplenomegaly. He had subcutaneous nodules on the inguinal region, the pubis, and the upper abdomen. Ophthalmic examinations, orbit magnetic resonance imaging(MRI), and biopsy from orbital tissue were performed. RESULTS: The right eye revealed proptosis(22/14/102, Hertel's exophthalmometer), but other ocular findings including the fundus were normal. Diffuse infilterative lesions and definite proptosis were shown on orbit MRI. Biopsy specimen of orbital tissue revealed histiocytes containing nuclei and nuclear debris, mononuclear cells infiltration, and the characteristic 'bean-bag' cell i.e., macrophage exhibiting hemophagocytosis, which is histopathological characteristic of cytophagic histiocytic panniculitis. Proptosis, swelling and redness of the eyelid improved gradually following systemic corticosteroid therapy to control the disease. CONCLUSION: This report describes a rare finding of proptosis as the manifesting sign of orbital panniculitis.

Cell Wall Proteins of Staphylococcus aureus Responsive to Oxygen Tension and Iron Concentration / 감염

BACKGROUND: We previously reported that activity of iron-uptake systems (IUS) influenced on the growth of Staphylococcus aureus in laboratory medium and body fluids according to the iron and oxygen concentrations, which they are closely related each other in several microbial metabolism. In the present study, we tried to investigate the profiles of cell wall proteins of S. aureus according to the change of iron and oxygen concentrations. METHODS: SR-1 strain, whose IUS are defective, was isolated from the standard strain ATCC 6538 by repeated exposure against streptonigrin. These two strains were cultured under the aerobic, microaerobic and anaerobic conditions in the iron-sufficient BHI and iron-depleted BHI, respectively. Cell wall proteins were visualized by Coomassie staining after SDS-PAGE. RESULTS: Cell wall proteins of the both strains were expressed more than under the aerobic condition than under the anaerobic condition in the iron-sufficient medium as well as in the iron-deficient medium. However, expression of cell wall proteins of SR-1 strain was markedly inhibited compared to that of parental ATCC 6538 strain, especially in the iron-deficient medium. Among the proteins more expressed under the aerobic culture condition in the iron-deficient medium, about 88, 55, 39, 36, 35 and 33 kDa of proteins were iron-repressible and oxygen-inducible, and corresponded to the iron-repressible proteins which other researchers reported. CONCLUSION: Expression of cell wall proteins of S. aureus was affected by simultaneous and respective change of iron and oxygen concentrations. Activity of IUS influenced more on the expression of cell wall proteins of S. aureus in the iron-deficient environment than in the iron-sufficient environment. These results suggest the possibility that the iron-repressible and oxygen-inducible proteins mimic those (antigens) found commonly in clinical infections.

Iron-uptake System of Staphylococcus aureus According to the Antibiotic Susceptibility / 감염

OBJECTIVE: It was reported that a few antimicrobial agents influenced on the activity of bacterial iron- uptake system (IUS). In the present study, we tried to investigate the relatedness between the resistance of antibiotics and the activity of the two high-affinity IUS, siderophore-mediated IUS and transferrin-binding protein (SA-tbp)-mediated IUS, of Staphylococcus aureus clinical isolates. METHODS: Total 71 strains including the standard ATCC 6538 strain were used. Seventy strains were isolated from the second or third line general hospitals from 1998 to 1999. Antimicrobial susceptibility test was performed by disk diffusion method. CAS agar diffusion assay was used for the measurement of staphylococcal siderophore. To visualize the expression of SA-tbp, Western blotting using human transferrin conjugated with horseradish peroxidase was performed. RESULTS: Among the nine antimicrobial agents, only the susceptible strains to oxacillin produced more siderophore compared to the resistant strains (P0.05). There were no antibiotics related to the expression of SA-tbp (P>0.05). CONCLUSION: These results indicate that only oxacillin (OXAC) influences on the production of staphylococcal siderophore and the further consecutive study about the action mechanism of OXAC is necessary.

Radiofrequency Ablation of Lung Cancer: Preliminary Report

PURPOSE: Radiofrequency ablation (RFA) of lung cancer in animals and humans has been described in previously published reports. The aim of this study was to present our preliminary experience of treatment of lung cancer involving this approach. MATERIALS AND METHODS: Eight patients with lung malignancies [stage IIIB or IV bronchogenic adenocarcinoma (n=6), metastatic squamous cell carcinoma (n=1), metastatic hepatocellular carcinoma (n=1)] underwent RFA treatment. In all cases LeVeen-type electrodes were employed and CT was used to monitor the procedure. One-day and one-month follow-up CT scans were obtained and analyzed. RESULTS: Prior to treatment, tumor diameter ranged from 2.5 to 5 cm; afterwards, low attenuation consistent with coagulative necrosis was observed. Complications included a small amount of pneumothorax (n=4), pleural effusion (n=8), and subcutaneous emphysema (n=1). Tumor size decreased in five patients, was unchanged in two, and increased in one. CONCLUSION: Radiofrequency ablation of lung cancer is safe and may result in a reduced tumor burden.

A Case of Sjogren's Syndrome with Interstitial Lung Disease and Multiple Cystic Lung Disease / 결핵

A 47-years-old woman presented with a 2-month history of a dry mouth and dry cough. The patient had been taking medication for Sjogren's syndrome for approximately 7 years. The chest radiography showed multiple cystic lesions and a hazy density in both lower lung fields. The HRCT showed a diffuse ground glass like appearance and multiple variable sized cystic lesions in both lung fields. After medication, the symptoms were aggravated. Bronchoscopy was preformed with a transbronchial lung biopsy. The biopsies showed an infiltration of lymphocytes, neutrophils, monocytes and histiocytes through the interstitial space of the alveola and a widening of the alveolar septa. However, the histological findings of the cysts were not obtained. Sjogren's syndrome is a slowly progressive inflammatory autoimmune disease, which is characterized by lymphocyte mediated destruction of the exocrine glands, with pulmonary involvement in approximately 19-65%, High-resolution CT is a sensitive technique for assessing the pulmonary involvement in patients with Sjogren's syndrome. Although a lung biopsy is not always necessary for establishing a diagnosis of an interstitial lung disease in Sjogren's syndrome. A lung biopsy may reveal a wide spectrum of changes ranging from a mild inflammatory response to end stage fibrosis with honeycombing. Because of the predominantly peribronchiolar inflammatory infiltration and inspissated secretions the cysts were suspected to have been formed by the ballvalve phenomenon. However, no definite evidence was obtained.

The Comparison of Induced Astigmatism and Clinical Results after Cataract Surgery using Different Clear Corneal Incisions

PURPOSE: To compare the induced astigmatism and clinical results after cataract surgery using different clear corneal incisions. METHODS: This prospective, nonrandomized study comprised 60 eyes (48 patients) scheduled for cataract surgery between October 2000 and March 2001; 20 eyes received 1-plane stab clear corneal incisions(Group 1), 20 eyes, 2-plane stab clear corneal incisions(Group 2) and 20 eyes, 2-plane hinge incisions(Group 3). Preoperative corneal astigmatism, surgically induced corneal astigmatism and changes of visual acuity were analyzed at 1 day, 1 and 2 weeks, 1 and 2 months postoperatively using ARK-700(NIDEK) and visual acuity chart projector. Data and group comparisons were evaluated by ANOVA, Chi-Square test, Repeated measures ANOVA, Kruskal-Wallis test, Analysis of CoVariance(ANCOVA). RESULTS: The surgically induced astigmatism in all groups showed no difference in WTR change and uncorrected visual acuity also showed no different results in all groups. Mean keratometric astigmatisms were 0.23+/-1.05 D (ATR) preoperatively, 0.03+/-1.31 D (WTR) at 1 day, 0.14+/-1.13 D at 1 week, 0.16+/-1.11 D at 2 weeks, 0.13+/-1.07 D at 1 month, 0.11+/-1.04 D (WTR) at 2 months. Mean surgically induced keratometric astigmatisms were 0.75+/-0.65 at 1 day, 0.65+/-0.43 D at 1 week, 0.54+/-0.48 D at 2 weeks, 0.53+/-0.45 D at 1 month and 0.45+/-0.46D (WTR) at 2 months after operation. CONCLUSIONS: There were no significant differences in postoperative visual acuity and surgically induced astigmatism at 2 months postoperatively among these three groups and all incisions offered satisfactory short-term astigmatic results and rapid visual rehabilitation. A longer study of a larger series should be done to confirm the findings.

A case of isolated posterior capsule rupture and traumatic cataract caused by blunt ocular trauma

An isolated rupture of the posterior capsule that is caused by a blunt ocular trauma has been rarely reported and is usually detected incidentally during surgery for a complicated cataract. We found an isolated posterior capsule rupture on the third day after trauma in a 25-year-old man who was admitted for the treatment of traumatic hyphema and we performed a phacoemusification and anterior vitrectomy with PC-IOL, implantation because of the traumatic cataract which had progressed after the injury. The PC-IOL was implanted safely into the capsular bag without severe enlargement of the posterior capsular rupture. The break seems to function as a capsulotomy which provides a clear visual axis. We report this case with a review of the literatures.

Patterns of Iron Utilization According to the Growth of Staphylococcus aureus

To elucidate iron utilization patterns of Staphylococcus aureus according to the growth, we checked the residual iron concentration and the production of siderophores at the indicated times while culturing S. aureus ATCC 6538 and 25923 strains in brain heart infusion broth. By using streptonigrin susceptibility test and investigating growth curves in three culture media of which iron concentration is 0.2, 20, 45 uM, respectively, we found out that iron metabolism of 6538 strain was more active than that of 25923 strain. In point of tendency of iron consumption, 6538 strain steeply consumed iron just before the onset of stationary phase, but 25923 strain did gradually iron throughout the growth phase. Nevertheless, total amount of iron consumed by each strain during the growth was almost no difference between the strains. CAS diffusion assay in detecting siderophores showed that siderophore production followed iron consumption. These results suggest that the siderophores play significant role in iron utilization in vitro.