Annual Change of Peak Expiratory Flow Rate in Asthma and COPD / 결핵및호흡기질환

BACKGROUND: Measurement of peak expiratory flow rate (PEFR) in a follow-up examination for a chronic airway disease is useful because it has the advantages of being a simple measurement and can be repeated during examination. The aim of this study was to examine the annual decrease of PEFR in asthma and chronic obstructive pulmonary disease (COPD) patients and to confirm the factors which influence this decrease. METHODS: From May, 2003 to September, 2010, the annual decrease of PEFR was obtained from asthma and COPD patients attending an outpatient pulmonary clinic. PEFR was measured using a Mini-Wright peak flow meter (Clement Clarke International Ltd. UK), and we conducted an analysis of factors that influence the change of PEFR and its average values. RESULTS: The results showed an annual decrease of 1.70+/-12.86 L/min the asthmatic patients and an annual decrease of 10.3+/-7.32 L/min in the COPD patients. Age and FEV1 were the predictive factors influencing change in asthma, and FEV1 and smoking were the predictive factors influencing change in COPD. CONCLUSION: We confirmed the annual decreasing PEFR in patients with chronic airway disease and identified factors that work in conjunction with FEV1 to influence the change.

Usefulness of Vibration Response Imaging (VRI) for Pneumonia Patients / 결핵및호흡기질환

BACKGROUND: Pneumonia is commonly seen in outpatient clinics. it is widely known as the most common cause of death from infectious disease. Pneumonia has been diagnosed by its typical symptoms, chest X-ray and blood tests. However, both chest X-rays and blood tests have limitations in diagnosis. Thus primary care clinicians usually have been constrained due to a lack of adequate diagnostic tools. Vibration response imaging (VRI) is a newly emerging diagnostic modality, and its procedure is non-invasive, radiation-free, and easy to handle. This study was designed to evaluate the diagnostic usefulness of the VRI test among pneumonia patients and to consider its correlation with other conventional tests such as Chest X-ray, laboratory tests and clinical symptoms. METHODS: VRI was performed in 46 patients diagnosed with pneumonia in Konkuk University Medical Center. VRI was assessed in a private and quiet room twice: before and after the treatment. Sensors for VRI were placed on a patient's back at regular intervals; they detected pulmonary vibration energy produced when respiration occurred and presented as specific images. Any modifications either in chest X-ray, C-reactive protein (CRP), white blood cell count (WBC) or body temperature were compared with changes in VRI image during a given time course. RESULTS: VRI, chest X-ray and CRP scores were significantly improved after treatment. Correlation between VRI and other tests was not clearly indicated among all patients. But relatively severe pneumonia patients showed correlations between VRI and chest X-ray, as well as between VRI and CRP. CONCLUSION: This study demonstrates that VRI can be safely applied to patients with pneumonia.

A case of eosinophilic cellulitis associated with angioedema and eosinophilia / 천식및알레르기

Eosinophilic cellulitis was first described by Wells, which is characterized by cellulitis like skin lesion, eosinophilic infiltration of dermis and subcutaneous fat with characteristic flame figure appearance of chollagen bundles. Peripheral eosinophilia is not necessary for the diagnosis of eosinophilic cellulitis, but association with hypereosinophilic syndrome was reported. Episodic angioedema associated with eosinophilia was first described by Gleich et al. as recurrent attack of angioedema; peripheral eosinophilia; and body weight gain; they described this as separate disease entity rather than variant of the hypereosinophilic syndrome. Both angioedema associated with eosinophilia and eosinophilic cellulitis were reportedly associated with hypereosinophilic syndrome, and we believe both diseases are variants of idiopathic hypereosinophilic syndrome. We experienced a patient with eosinophilic cellulitis who has expressed skin lesion resembling angioedema associated with eosinophilia, and who also has involvement of pleura and gastrointestinal tract. We speculate that this patient represents an overlap syndrome of idiopathic hypereosinophilic syndrome, eosinophilic cellulitis and angioedema associated with eosinophilia.

Occupational asthma induced by cephalosporin precursor / 천식및알레르기

A 41-year-old male pharmaceutical worker developed dyspnea and wheezing 10 years after beginning the work. He had handled powder of cephalosporin precursor, 7-aminocephalosporanic acid (7-ACA). He had suffered from dyspnea, chest tightness and wheezing in the workplace for the last three years. Recently, these symptoms were aggravated. His pulmonary function test showed severe obstructive pattern and PC(20) was 0.06 mg/ml on MBPT(methacholine bronchial provocation test). Skin prick test and intradermal test showed positive reactions to ceftriaxone, cefazolin, etc. During the skin test, he suffered from an asthmatic attack and anaphylactic shock. Bronchial provocation test with cefotiam elicited a dual asthmatic reaction. We presumed that IgE-mediated mechanism may be mainly involved in the pathogenesis of cephalosporin induced occupational asthma, in addition to other immunologic or non-immunologic mechanisms. Further studies will be necessary to investigate the pathogenesis of this disease.

Itraconazole Prophylaxis for Invasive Aspergillosis in Severe Neutropenic Patients / 대한혈액학회지

BACKGROUND: Invasive aspergillosis is an important cause of morbidity and mortality in neutropenic patients after chemotherapy in hematologic malignancies. HEPA filtration was known as an effective preventive measure for invasive aspergillosis, but the role of chemoprophylaxis has not been established yet. Itraconazole has been considered to be an effective antifungal agent for invasive aspergillosis. We evaluated the effect of itraconazole chemoprophylaxis in the prevention of invasive aspergillosis for neutropenic patients after chemotherapy in hematologic malignancies, who were treated in general ward without HEPA filtration. METHODS: A total of 89 patients with hematologic malignancies were enrolled in the two groups between January, 1995 and December, 1997 at Samsung medical center. Itraconazole, 200 mg po twice daily, was given to the patients as their neutrophil count decreased below 1,000/microliter following chemotherapy, and continued until it recovered over 1,000/microliter. Incidence of invasive aspergillosis was prospectively compared between the itraconazole prophylaxis group and the control group. RESULTS: Itraconazole prophyaxis was done in 34 patients on a total 59 episodes of severe neutropenia (absolute neutrophil count <500/microliter) after chemotherapy. Two out of 34 patients were histologically diagnosed as invasive aspergillosis. Control group included 55 patients with 103 episodes of severe neutropenia. Five out of 55 patients were diagnosed as invasive aspergillosis. No statistically significant differences were observed between two groups, because 2 of 59 (3.4%) and 5 of 103 (4.9%) were found to have invasive aspergillosis proven histologically (P=1.00). CONCLUSION: Itraconazole chemoprophylaxis for invasive aspergillosis was not effective, and the prognosis was closely related to the recovery of neutrophils. But we cannot exclude thepossibility that the drug has been failed in achieving effective plasma concentration by oral administration, as reported in several studies. Randomized prospective study, including measurement of plasma drug concentration, is warranted to evaluate the efficacy of itraconazole for the prevention of invasive aspergillosis.

Plasma total homocysteine and folate concentration in patients with chronic renal failure and renal transplant recipients / 대한내과학회지

BACKGROUND: A few articles reported that the plasma total homocysteine(tHcy) concentration of renal transplant recipients(RTR) was higher than that of normal controls, but lower than that of patients with chronic renal failure. But renal function of the RTR was variable, and plasma tHcy concentration of RTR with normal renal function was unknown. We compared plasma tHcy concentration of RTR with normal renal function to normal controls and evaluated the relation between folate concentration, the independent factor of plasma tHcy concentration, and plasma tHcy in patients with chronic renal failure in predialysis, hemodialysis(HD) and continuous ambulatory peritoneal dialysis(CAPD). METHODS: We measured fasting plasma level of total homocysteine by high-performance liquid chromatography and folate concentration in 36 predialysis CRF patients(Ccr<25mL/min), 37 HD patients, 28 CAPD patients, 41 RTR(serum creatinine< or =1.4mg/dL) and 37 healthy controls. RESULTS: 1)Mean(+/-SD) tHcy concentration in predialysis CRF(21.93+/-14.33micromol/L), HD(18.24+/-8.73micromol /L) and CAPD(17.16+/-7.8micromol/L) patients was significantly higher than that in controls (8.91+/-4.11micromol/L, P<0.05) but tHcy concentration of RTR group(8.99+/-3.99micromol/L)had no difference from that of normal controls 2)In predialysis patients, CAPD patients, and HD patients showed a significant negative correlation between serum folate and plasma tHcy concentrations (r=-0.18, p<0.05). 3)In predialysis, HD and CAPD patients, mean plasma folate concentration in patients with 1mg/ day-folate supplementation(20.41+/-15.65ng/mL) was higher than patients without 1mg/day-folate supplementation (10.20+/-8.24ng/mL)(p<0.05) and mean plasma tHcy concentration in patients with 1mg/day-folate supplementation (17.87+/- 7.94micromol/L) was lower than patients without 1mg/day-folate supplementation(21.87+/-13.35micromol/L)(p<0.05). CONCLUSION: Plasma tHcy concentration in RTR with normal renal function had no difference with that in normal controls. In predialysis, HD, and CAPD patients, plasma tHcy had negative correlation with plasma folate concentration and plasma tHcy in patients with 1mg folate supplementation, usual dose in chronic renal failure, was higher than that in patients without folate supplementation and lower than that in normal controls.