Diagnostic value of lysine-aspirin bronchoprovocation test for aspirin-sensitive asthma / 알레르기

Aspirin(ASA) and NSAIDs can induce bronchoconstriction in 10~20% of adult asthmatics patients. Inhalation of lysine-ASA(L-ASA) has been described as an alternative method for diagnosis of ASA-sensitive asthma. To further understand the characterlstics of ASA-sensitive asthmas. we studied 38 asthmatic patients with ASA -sensitivity (36 intrinsic and 2 extrinsic asthma) proven by L-ASA bronchoprovocation test (BPT). Most were female (male to female ratio was 27:73). Twenty (53%) of them had no previous history of adverse reactions when exposed to ASA. Twenty nine (79%) had rhino-sinusitis symptoms. Early asthmatic response was observed in 16 (42%) patients, late only response in 16(42%), and dual response in 6(16%) patients. The threshold of L-ASA to provoke a positive response ranged from 11.2 to 180 mg/ml and most (68.3%) had a positive response after the inhalation of 180 mg/ml. Concurrent sensitivity to sulfite was noted in 14 (36%) patients, followed by sensitivity to tartrazine in one (3%) patient. None showed a positive response to sodium benzoate. After the avoidance from ASA/ NSAIDs with administration of anti-asthmatic medications, symptom and medication scores reduced in 26(87%) patients among 30 followed patients. They were classified into the improved group: four (13%) patients belonged to the not-improved group. There were no significant differences in clinical characteristics between the improved and not- improved group (p>0.05). In conclusion, L-ASA BPT could be considered as a useful method to diagnose ASA -sensitive asthma and be used to screen the causative agent for asthmatic patients with intrinsic type, especially in female patients with rhino-sinusitis and/or nasal polyp, even though they do not have arty history of adverse reactions. Cessation of exposure and proper treatment may allow to reduce symptom and medication scores.

Acute Pulmonary Edema Caused by Inhalation of Nitrogen Dioxide / 결핵

A 68 year-old male was admitted with complaint of dyspnea and nonproductive cough which developed 6 hours after accidental inhalation of nitrogen dioxide. On admission, acute pulmonary edema and severe hypoxemia were found. With oxygen and bronchodilator therapy, diffuse alveolar consolitation and his dyspnea were improved from the following day. He was discharged at 8th hospital day with prednisolone 30mg daily for prevention of bronchiolitis obliteraus. During 6 weeks of follow up, there was no evidence of bronchiolitis obliterans.

Cobalt-induced occupational asthma associated with systemic illness

We report a case of occupational asthma caused by cobalt associated with systemic symptoms. He was a non-atopic, ex-smoker and had worked in a glassware factory for 14 months. A skin prick test with CoSO4 up to 100 mg/ml showed a negative result. A bronchoprovocation test with CoSO4 demonstrated an isolated asthmatic response with systemic symptoms such as fever, arthralgia and myalgia. Although an initial methacholine bronchial challenge test showed a negative result, the following methacholine bronchial challenge test which was done 24 hours after the challenge testing demonstrated an increased airway hyperresponsiveness at 2.5 mg/ml which recovered 7 days later. An intradermal skin test with 10 mg/ml and 100 mg/ml CoSO4 solution demonstrated positive responses respectively(13 x 12/40 x 32, 20 x 15/40 x 37 (mm), histamine 16 x 14/64 x 50). A patch test including cobalt showed a negative result. Bronchoalveolar lavage fluid after the cobalt inhalation testing and other laboratory findings showed no evidence of hypersensitivity pneumonitis. These results suggested that cobalt could induce occupational asthma with systemic illness in an exposed worker.

The Effect of Non-Ionic Contrast Media on Q-T Interval and ST-T Wave of ECG during Coronary Angiography

BACKGROUND: During coronary angiography, some electrocardiographic changes occured due to contrast media, which do life threatening influences. METHODS: We compared the electrocardiographic changes which were induced by injection of three radiopaque contrast media during selective coronary angiography in 49 patients with chest pain. One of the contrast media was high osmolar ionic(Urografin_76) and the another was low osmolar ionic(Hexabrix) and the last was non-ionic(Ioversol). Electrocardiograms were obtained before, during and after selective coronary angiography. RESULTS: The changes of S-T segment or T were decreased in non-ionic group rather than high osmolar or ionic group. And there was significant Q-Tc interval prolongation among all three groups except comparision of low osmolar ionic contrast dye and non-ionic contrast dye in left coronary angiography. CONCLUSION: Non-ionic low osmolar contrast media was safer than high osmolar or ionic contrast medial because of lesser change of Q-Tc interval during selective coronary angiography.

The study of 24-hour holter monitoring in patients with coronary artery disease

BACKGROUND: Patients with ischemic heart disease have many episodes of ischemic attack which is presented as ST-T change in electrocardiogram during ordinary daily life. The purpose of this study was to confirm the presence of a significant circardian variation in transient myocardial ischemia and the difference of the incidence of ischemia according to involved vessel. METHODS: Twenty two patients with angiographically significant coronary stenosis were evaluated. The ambulatory electrocardiography(Holter monitoring) was performed in each patients. RESULTS: One hundred twenty-eight episodes of ischemic ST-T changes occured in 18(82%) of 22 patients and 65(51%) episodes of ischemic ST-T changes occured between 6 A.M. and 12 noon(p<0.005). The mean frequency per patient according to involved vessel was 9 in double vessel disease, 4.5 in diffuse sclerosis with old myocardial infarction, 2.9 in single left anterior descending, 2.3 in single right coronary and 1 in single left main coronary artery disease. The only one episode of T wave change was observed in patients with lesion of left circumflex artery. The mean frequency of ST changes per patient according to type of angina was 4.8 in postinfartion angina, 3.5 in unstable angina and 2.1 in stable angina and the mean frequency of T change was 4.7 in stable angina, 2 in unstable angina and 0.3 in postinfarction angina. CONCLUSIONS: The significant circardian variation of ischemic activity was found in patients with ischemic heart disease. The mean frequency of ST change was higher in double vessel disease and diffuse sclerosis with old myocardial infarction than in other coronary artery lesion. And the episode of ST change was more frequent in postinfarction angina and unstable angina pectoris and the episodes of T change in stable angina pectoris. Also this study suggest 24-hour Holter monitoring has a low detectability of ischemic episodes in patient with lesion of left circumflex artery.