Effects of Add-On Therapy with NDC-052, an Extract from Magnoliae Flos, in Adult Asthmatic Patients Receiving Inhaled Corticosteroids

BACKGROUND/AIMS: There is a need for new anti-asthmatic medications with fewer side effects. NDC-052, an extract of the medicinal herb Magnoliae flos, which has a long history of clinical use, was recently found to have anti-inflammatory effects. Herein, we evaluated the effects of NDC-052 as an add-on therapy in patients with mild to moderate asthma using inhaled corticosteroids (ICS). METHODS: In a non-comparative, multi-center trial, 148 patients taking ICS received NDC-052 for eight weeks. We evaluated their forced expiratory volume in one second (FEV1), morning and evening peak expiratory flow rate (AM and PM PEFR), AM/PM asthma symptom scores, visual analogue symptom (VAS) scores, night-time wakening, frequency of short-acting beta2-agonist usage, and adverse events. RESULTS: After eight weeks, both AM and PM PEFRs were significantly improved. Asthma symptom scores, VAS scores, the frequency of nights without awakening, and the frequency of beta2-agonist use were also reduced. Most of the adverse drug reactions were mild and resolved spontaneously. CONCLUSIONS: The addition of NDC-052 to ICS had a beneficial effect on asthma control in patients with mild to moderate asthma, with good tolerability and fewer side effects. Further studies are necessary to evaluate the effects of NDC-052 in patients with severe and/or refractory asthma.

Issues on Safety of Long-Acting Muscarinic Antagonist / 결핵및호흡기질환

The prevention of and the controlling of symptoms, reductions in the frequency of exacerbations, and disease severity are central to the pharmacologic therapy of chronic obstructive pulmonary disease (COPD). COPD patients are inclined to be older, have more comorbidities, and use polypharmacy as a result. Long-acting inhaled muscarinic antagonists (LAMAs) is a preferred treatment modality. However, the cardiovascular (CV) safety of anti-cholinergics, including LAMA, has been an issue. In contrast, the results of the UPLIFT trial and a pooled analysis of data from 30 trials of tiotropium illustrates the association of tiotropium with reductions in the risk of all cause mortality, CV mortality and CV events. And, the UPLIFT trial provides clues regarding the additive advantages of tiotropium in COPD patients who already are using long-acting inhaled beta2 agonists and inhaled corticosteroids. Following the contribution of tiotropium as a first LAMA, new LAMAs such as aclidinium and glycopyrrolate (NVA-237) seem to be emerging.

A Case of Isoniazid Induced Gynecomastia / 결핵및호흡기질환

No abstract available.

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.

Clinical Characteristics and Prognosis of Elderly Patients Receiving Prolonged Mechanical Ventilation in the Medical Intensive Care Unit at a University Hospital / 결핵및호흡기질환

BACKGROUND: As the number of older-aged people increases, the number of elderly patients who receive critical care services is expected to increase substantially. The objective of this study was to examine the clinical characteristics and outcomes of elderly patients who receive mechanical ventilation for more than 30 days in the medical intensive care unit (MICU) at a university hospital. METHODS: We retrospectively examined forty-one elderly patients (> or =65 years old) who were receiving mechanical ventilation, from April 2004 to March 2007, for periods exceeding 30 days at the MICU at Eulji University Hospital. RESULTS: The MICU and hospitalmortality rate were 60.9% and 65.9%, respectively. The mean length of the ICU stay was 57.5 days and the mean duration of mechanical ventilation was 49.3 days. The most common reason for MICU admission was acute respiratory failure (73.2%), followed by sepsis (12.2%), neurological problems (9.8%), and gastrointestinal bleeding (4.9%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher for the nonsurvivors than for the survivors (28.0 vs. 25.0, respectively, p=0.03). The nonsurvivors received more red blood cell (RBC) transfusions during their ICU stay than did the survivors (84.0% vs. 43.8%, respectively p=0.007). The factors associated with hospital death were the APACHE II score and if the patient had received a RBC transfusion. CONCLUSION: The APACHE II score and a RBC transfusion were predictors of increased hospital mortality for the elderly patients who were on prolonged mechanical ventilation. These predictors may assist physicians to make clinical decisions for this patient population.

Multi-loculated empyemas after acupuncture

There are several reported possible complications of acupuncture including hepatitis, pneumothorax, and cardiac tamponades, but the development of empyema is unusual. All the previously described cases of empyemas were due to acupuncture needles being inadvertently left in the thoracic cavities. We describe a thirty seven years old female patient who developed empyema after multiple acupuncture sessions whose disease course was unique because the empyema developed without an acupuncture needle being left in the thoracic cavity. This case demonstrates that an acupuncture needle being left in the thoracic cavity is not necessary for the development of empyema after acupuncture sessions as previously described.

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 scar sarcoidosis

Infiltration of sarcoid granuloma in old cutaneous scars is one of the uncommon cutaneous manifestations of sarcoidosis. Here, we report the case of a 47-year-old female who presented with swelling and irritation in 5 old scars. She had acquired these scars 9 years ago in a traffic accident. An incisional scar biopsy revealed noncaseating granulomas consistent with sarcoidosis. High-resolution CT (HRCT) revealed right paratracheal, both hilar, paraaortic, and subcarinal lymphadenopathy without any nodular densities in both lung fields. Successful regression of cutaneous inflammation was achieved using a short course of oral steroids.

A Case of Scrub Typhus Complicating Subdural Hematoma

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and manifested with fever, skin rash, myalgia, and hepatitis etc. Most of patients improve with antibiotics such as doxycycline. The spectrum of the clinical severity ranges from mild to severe with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. We report a case of a 72-year-old man with scrub typhus complicating subdural hematoma.

A Case of Scrub Typhus Complicating Subdural Hematoma

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and manifested with fever, skin rash, myalgia, and hepatitis etc. Most of patients improve with antibiotics such as doxycycline. The spectrum of the clinical severity ranges from mild to severe with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. We report a case of a 72-year-old man with scrub typhus complicating subdural hematoma.

A Case of Paragonimiasis that was Suspicious for a Lung Malignancy by PET/CT / 결핵및호흡기질환

Positron emission tomography/computed tomography (PET/CT) is valuable for the diagnosis of malignancies. However, PET/CT is unable to discriminate exactly between inflammation and a neoplasm. We report a case of a 50-year-old man with pulmonary paragonimiasis that was suspicious for lung cancer, as detected by PET/CT. The use of PET/CT revealed multilobulated consolidation on the right lung and patchy consolidation on the left lung, with increased fluorodeoxyglucose (FDG) uptake. In addition, the left paraaortic lymph node (LN) and peripancreatic LN showed enlargement with increased FDG uptake. Lung cancer with multiple lymph node metastases was suspected from the increased standardized uptake values (SUV >4.5) determined by PET/CT. We performed wedge resection via video-assisted thoracic surgery (VATS) and found Paragonimus westermani eggs in the involved tissues.

A Case of Paragonimiasis that was Suspicious for a Lung Malignancy by PET/CT / 결핵및호흡기질환

Positron emission tomography/computed tomography (PET/CT) is valuable for the diagnosis of malignancies. However, PET/CT is unable to discriminate exactly between inflammation and a neoplasm. We report a case of a 50-year-old man with pulmonary paragonimiasis that was suspicious for lung cancer, as detected by PET/CT. The use of PET/CT revealed multilobulated consolidation on the right lung and patchy consolidation on the left lung, with increased fluorodeoxyglucose (FDG) uptake. In addition, the left paraaortic lymph node (LN) and peripancreatic LN showed enlargement with increased FDG uptake. Lung cancer with multiple lymph node metastases was suspected from the increased standardized uptake values (SUV >4.5) determined by PET/CT. We performed wedge resection via video-assisted thoracic surgery (VATS) and found Paragonimus westermani eggs in the involved tissues.

A Case of Probable Community Acquired Acinetobacter baumannii Pneumonia / 결핵및호흡기질환

No abstract available.

Repair of Morgagni Hernia through the Abdominal Approach: A case report / 대한흉부외과학회지

Morgagni's hernia constitutes about 3% of all the congenital diaphragm hernias. It is usually asymptomatic and it is frequently found coincidentally during routine diagnostic testing in adulthood. It is usually diagnosed by simple chest X-ray, but when this condition is without intestinal herniation, then chest CT or other modalities are necessary. Operative repair is desirable when there is the risk of strangulation of the intestine. The trans-thoracic or trans-abdominal approaches are possible to treat this malady. We report here on one case for which we successfully used a laparoscopic approach to treat this problem.

Unusual Presentation of Miliary Tuberculosis / 결핵및호흡기질환

No abstract available.

A Case of Possible Doxycycline-Resistant Scrub Typhus / 결핵및호흡기질환

No abstract available.

Two Cases of Pharyngeal Tuberculosis Secondary to Pulmonary Tuberculosis

Pharyngeal involvement of tuberculosis is rare and is seen only in massive sputum positive patients with cavitating pulmonary tuberculosis. The pharyngeal lesions are secondary to aspiration of heavily infected sputum from lung and consist of painful shallow ulcers in pharynx. Chronic sore throat and unexplained dysphagia should alert the clinician to possibility of tuberculosis, especially in the countries where tuberculosis is endemic. We report two cases of pharyngeal tuberculosis with pulmonary tuberculosis, one of which has concurrent laryngeal and intestinal tuberculosis. Histological and bacteriological examinations established the diagnosis of pharyngeal tuberculosis associated with pulmonary focus.

Pulmonary Leptospirosis complicated by Acute Respiratory Distress Syndrome without Hemoptysis

Leptospirosis is an acute febrile illness that is endemic in many tropical areas and considered the most common zoonosis worldwide. It is caused by the spirochete Leptospira interrogans. The clinical manifestations may be extremely variable, ranging from flu-like symptoms with mild constitutional complains like fever, headache, myalgias, and gastrointestinal complaints to a severe presentation with the complete Weil's syndrome and sometimes with acute respiratory distress syndrome (ARDS). In Korea, the more common clinical finding is pulmonary manifestation such as cough, hemoptysis and dyspnea. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary hemorrhage and/or acute respiratory distress syndrome (ARDS). A 67-year-old farmer was referred to the hospital with a history of fever, dyspnea, and confusion. She was found to have severe arterial hypoxemia but, denied blood-tinged sputum. Radiography showed widespread infiltrations over both lung fields, and hemodynamic features were consistent with ARDS. The patient recovered completely without mechanical ventilation.

Two Cases of Pharyngeal Tuberculosis Secondary to Pulmonary Tuberculosis

Pharyngeal involvement of tuberculosis is rare and is seen only in massive sputum positive patients with cavitating pulmonary tuberculosis. The pharyngeal lesions are secondary to aspiration of heavily infected sputum from lung and consist of painful shallow ulcers in pharynx. Chronic sore throat and unexplained dysphagia should alert the clinician to possibility of tuberculosis, especially in the countries where tuberculosis is endemic. We report two cases of pharyngeal tuberculosis with pulmonary tuberculosis, one of which has concurrent laryngeal and intestinal tuberculosis. Histological and bacteriological examinations established the diagnosis of pharyngeal tuberculosis associated with pulmonary focus.

Pulmonary Leptospirosis complicated by Acute Respiratory Distress Syndrome without Hemoptysis

Leptospirosis is an acute febrile illness that is endemic in many tropical areas and considered the most common zoonosis worldwide. It is caused by the spirochete Leptospira interrogans. The clinical manifestations may be extremely variable, ranging from flu-like symptoms with mild constitutional complains like fever, headache, myalgias, and gastrointestinal complaints to a severe presentation with the complete Weil's syndrome and sometimes with acute respiratory distress syndrome (ARDS). In Korea, the more common clinical finding is pulmonary manifestation such as cough, hemoptysis and dyspnea. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary hemorrhage and/or acute respiratory distress syndrome (ARDS). A 67-year-old farmer was referred to the hospital with a history of fever, dyspnea, and confusion. She was found to have severe arterial hypoxemia but, denied blood-tinged sputum. Radiography showed widespread infiltrations over both lung fields, and hemodynamic features were consistent with ARDS. The patient recovered completely without mechanical ventilation.