The clinical investigation for determining the etiology of bronchial anthracofibrosis / 대한내과학회지

BACKGROUND: The bronchial anthracofibrosis has been thought to be a unique clinical syndrome caused by a fibrotic response to active or old tuberculous infection, but recent studies suggest that long-term exposure to woodsmoke may be the cause of the development of bronchial anthracofibrosis and the tuberculosis is thought to be a disease frequently associated with bronchial anthrocofibrosis, not the main etiology. The purpose of this study was to elucidate the relationship between the bronchial anthracofibrosis and the long-term exposure to woodsmoke and tuberculosis through analyses of the clinical features of patients with bronchial anthracofibrosis. METHODS: 166 patients having bronchial anthracofibrosis confirmed by bronchoscopy were included in this study. They were 23 males and 143 females, having mean sge 72.4 years, ranging from 56 to 91. The epidemiologic features, distinctive clinical features, physiologic findings, radiologic findings and bronchoscopic findings were analyzed retrospectively. RESULTS: All the patients living in rural area (129 of 166) had experienced long-term exposure to woodsmoke. The history of tuberculosis was obtained in 52 patients without history of occupational exposure to dust. The predominant chest CT findings were atelectasis, bronchial stenosis and calcified or noncalcified lymph node enlargements. The most common abnormality of pulmonary function was obstructive pattern, observed in 47.8%. The bronchoscopic examination disclosed multifocal anthracotic plaques mostly at the bifurcation of lobar or segmental bronchi, particularly in upper lobe. The bronchial stenosis was frequently observed in right middle and upper lobe. The associated diseases were obstructive airway disease in 56, obstructive pneumonia in 40, active tuberculosis in 36, and lung cancer in 11 patients. CONCLUSION: The bronchial anthracofibrosis, in the patient who has long-term experience to woodsmoke inhalation without any history of environmental exposure to dust, is one of the manifestation of lung disease related to woodsmoke inhalation, and is frequently associated with various pulmonary diseases, including tuberculosis.

The Continuous Monitoring of Oxygen Saturation During Fiberoptic Bronchoscopy / 결핵

BACKGROUND: Flexible fiberoptic bronchoscopy(FFB) has become a widely performed technique for diagnosing and managing pulmonary disease because of its low complication and mortality rate. Since the use of FFB in p atients with severely depressed cardiorespiratory function is increasing and hypoxemia during the FFB can induce significant cardiac arrhythmias, the early detection and adequate management of hypoxemia during FFB is clinically important. METHODS: To evaluate the necessity of the continuous monitoring of the oxygen saturation(SaO2) during the FFB, the SaO2 was continuously monitored from the finger tip using pulse oximetry before, during and after the FFB in 379 patiets. The patients were then divided into two groups, those with and without hypoxemia (SaO2<90%). The baseline pulmonary function data and the clinical characteristics of the two groups were compared. RESULTS: The mean baseline SaO2 was 96.9+/-2.85%. An SaO2<90% was recorded at some point in 62(16.4%) out of 379 patients, with 12 out of 62 experiencing this prior to the FFB, in 37 out of 62 during the FFB, and in 13 out of 62 after the FFB. No differences were observed in the smoking and sex distribution between those with and without hypoxemia. The mean age was older in those with hypoxemia than those without. Significant differences were observed in the mean baseline SaO2 and the mean time for the procedure between the two groups. The FEV1 was significantly lower in those with hypoxemia, and both the FVC and FEV1/FVC also tended to decrease in this group. Managing hypoxemia included deep breathing in 20 patients, a supplemental oxygen supply in 39 patients, and the abortion of the procedure in 3 patients. CONCLUSIONS: These results suggest that the continuous monitoring of th oxygen saturation is necessary during fiberoptic bronchoscopy, and it should be performed in patients with a depressed pulmonay function in order for the early detection and adequate management of hypoxemia.

A Case of Mycoplasma Pneumoniae Pneumonia Accompanying High Adenosine Deaminase Activity in Pleural Effusion / 결핵

Mycoplasma pneumioniae has a unique genomic composition, cellular biology, and a fastidious nature as the smallest cell-free living oranism that lacks a cell wall. Previous studies have suggested that a clinical manifesta tion of a M. pneumoniae infection is a consequence of a host immune response, particularly involving cellular immunity. Adenosine deaminase (ADA) is the main T-lymphocyte enzyme, and its activity is high in diseases where cellular immunity is stimulated. Therefore, its activity is useful for diagnosing a tuberculous pleural effusion. A pleural effusion is found in 5-20% of Mycoplasma pneumonia patients. However, there are few reports of high ADA activity in a mycoplasmal pleural effusion. Here we report a case of Mycoplasma pneumoniae infection established by a polymerase chain reaction and serologic tests, accompanying high ADA activity in a pleural effusion.