Clinical Characteristics and Prognosis of Lung Cancer Patients Admitted to the Medical Intensive Care Unit at a University Hospital / 결핵및호흡기질환

BACKGROUND: The management of patients with lung cancer has improved recently, and many of them will require admission to the medical intensive care unit (MICU). The aim of this study was to examine the clinical characteristics and to identify risk factors for mortality in patients with lung cancer admitted to the MICU. METHODS: We conducted retrospective analysis on 88 patients with lung cancer admitted to the MICU between April 2004 and March 2008. RESULTS: Of the 88 patients (mean age, 66 years), 71 patients (80.7%) had non-small cell lung cancer and 17 patients (19.3%) had small cell lung cancer. Distant metastasis were present in 79 patients (89.8%). The main reasons for MICU admission were acute respiratory failure (77.3%), sepsis (11.4%), and central nervous system dysfunction (4.5%). Mechanical ventilation was used in 54 patients (61.4%). Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of MICU stay, need for mechanical ventilation, source of MICU admission were correlated with MICU mortality. The type of lung cancer and metastasis were not predictive factors of death in MICU. CONCLUSION: Most common reason for ICU admission was acute respiratory failure. Mortality rate of lung cancer patients admitted to the MICU was 65.9%. APACHE II score, length of ICU stay, need for mechanical ventilation, source of MICU admission were predicted factors of death in the MICU.

A Case of Isoniazid Induced Gynecomastia / 결핵및호흡기질환

No abstract available.

A Case of Spontaneous Pneumomediatsinum during Taekwondo / 결핵및호흡기질환

Spontaneous pneumomediastinum is defined as a clinical syndrome thatos characterized by the presence of air in the mediastinal space, which is not due to an old previous injury or surgery. The condition is caused by a sustained increase in the intraalveolar and intrabronchial pressure with extravasated air dissecting along the perivascular spaces of the mediastinum. This is an uncommon complication of sports activity. The most common symptom is chest pain. This diagnosis should be considered for younger people who present with pleuritic chest pain or dyspnea and a characteristic crackling feel (known as subcutaneous crepitation) when touching of the skin covering the chest wall or neck, and they look otherwise well with normal vital signs. Usually no treatment is required, but the mediastinal air will be absorbed faster if the patient inspires high concentrations of oxygen. We present here a case of spontaneous pneumomediastinum that occurred during a Taekwondo match, along with a review of the relevant literature.

A Case of Primary Leiomyosarcoma with Prominent Osteoclast-like Giant Cell of Lung with Cardiac Invasion / 결핵및호흡기질환

The incidence of a pulmonary leiomyosarcoma as a primary lung tumor is quite rare. We report a case of primary leiomyosarcoma with a cardiac invasion in a 76 year old man. He was admitted due to left anterior chest wall pain for one month. Chest computed tomography showed a 9x8x10cm sized , large round mass in the left upper and lower lobes, and an amorphous low density lesion within the left atrium. Chest magnetic resonance imaging showed a large round mass in the left upper and lower lobes with growth into the left atrium. A diagnosis of leiomyosarcoma with prominent osteoclast-like giant cells was made based on the microscopic and immunohistochemical findings of a permanent specimen by explothoracotomy. The pathologic features of the tumor showed round mononuclear hyperchromatic cells and multinucleated giant cells that resembled osteoclasts. The immunohistochemical staining showed that the giant cells are positive for CD68 but negative for the muscle markers while the round cells were positive for the muscle marker. The patient refused further treatment and died after two months.

Immediate Effect of Hemodialysis on Pulmonary Function and Bronchodilator Response in Patients with Chronic Renal Failure / 결핵

BACKGROUND: We hypothesized that there was a relationship between body weight change and bronchodilator response (BDR) in patients with chronic renal failure (CRF) on hemodialysis (HD). Several mechanisms such as pulmonary edema due to water retention or increased permeability of alveolar capillary may play a important role in pulmonary function impairment and bronchial hyperresponsiveness in patients with CRF on HD. But, no studies have been published concerning BDR in patients with CRF on HD. This study was aimed to know the immediate effect of hemodialysis on pulmonary function and BDR in patients with CRF on HD. METHODS: This study included 30 patients with CRF on HD. We collected data including age, sex, height, pretibial and pedal pitting edema, interdialysis weight gain, postdialysis weight loss , underlying diseases, duration of HD, FEV1, FVC, FEV1/FVC, and BDR before and after HD. RESULTS: Interdialysis weight gain of the patients was 3.4 +/- 1.0 kg, and postdialysis weight loss was 3.2 +/- 0.7 kg. Before HD, FEV1, FVC, and FEV1/FVC of the patients were 89 +/- 22%, 86 +/- 19% of predicted, and 87 +/- 10 %. After bronchodilator inhalation, these parameters were changed to 95 +/- 22%, 90 +/- 19% of predicted, and 88 +/- 9% respectively. BDR was positive in 15 patients. After HD, FEV1, FVC, and FEV1/FVC of the patients were 100 +/- 23%, 94 +/- 18% of predicted, and 88 +/- 11%. After bronchodilator inhalation, these parameters were changed to 102 +/- 23%, 96 +/- 18% of predicted, and 89 +/- 8% respectively. BDR was positive in 9 patients. CONCLUSION: First, HD increases FEV1, FVC, and FEV1/FVC but little affects BDR. Second, there is no correlation between postdialysis weight loss and increases in FEV1, FVC, and FEV1/FVC after HD. Third, there is also no correlation not only between interdialysis weight gain and BDR before HD but between postdialysis weight loss and BDR after HD.

A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis / 결핵및호흡기질환

A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis Pellagra is a disease caused by a deficiency of nicotinic acid or niacin. It is mostly found among people eating corn-based diets in parts of China, Africa and India. It is also induced by drugs, such as isoniazid or 5-fluorouracil. Isoniazid inhibits the conversion of tryptophan to niacin and may induce pellagra, particularly in poorly nourished patients. Pellagra should be suspected whenever tuberculous patients under the treatment with isoniazid develop mental, neurological or gastrointestinal symptoms, even in the absence of typical skin changes. Herein, our experienced of a case of pellagra induced by isoniazid during treatment of pulmonary tuberculosis is reported. The patient was referred due to a skin rash and drowsy mental status. Her skin lesion developed during treatment for pulmonary tuberculosis. Her symptoms were improved after discontinuation of antituberculous agents and on the administration of nicotinamide.