A Case of Endobronchial Aspergilloma Associated with Foreign Body in Immunocompetent Patient without Underlying Lung Disease / 결핵및호흡기질환

Aspergillus causes a variety of clinical syndromes in the lung including tracheobronchial aspergillosis, invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, and aspergilloma. Aspergilloma usually results from ingrowths of colonized Aspergillus in damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. There are a few reports on endobronchial aspergilloma without underlying pulmonary lesion. We have experienced a case of endobronchial aspergilloma associated with foreign body developed in an immunocompetent patient without underlying lung diseases. A 59-year-old man is being hospitalized with recurring hemoptysis for 5 months. X-ray and computed tomography scans of chest showed a nodular opacity in superior segment of left lower lobe. Fiberoptic bronchoscopy revealed an irregular, mass-like, brownish material which totally obstructed the sub-segmental bronchus and a foreign body in superior segmental bronchus of the lower left lobe. Histopathologic examinations of biopsy specimen revealed fungal hyphae, characteristic of Aspergillus species.

Plasma C-Reactive Protein and Endothelin-1 Level in Patients with Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension

Pulmonary hypertension is a frequent complication of chronic obstructive pulmonary disease (COPD) and associated with a worse survival and increased risk of hospitalization for exacerbation of COPD. However, little information exists regarding the potential role of systemic inflammation in pulmonary hypertension of COPD. The purpose of the present study was to investigate the degree of C-reactive protein (CRP) and endothelin-1 (ET-1) levels in COPD patient with and without pulmonary hypertension. The levels of CRP and ET-1 were investigated in 58 COPD patient with pulmonary hypertension and 50 patients without pulmonary hypertension. Pulmonary hypertension was defined as a systolic pulmonary artery pressure (Ppa) > or =35 mmHg assessed by Doppler echocardiography. Plasma CRP and ET-1 levels were significantly higher in patients with pulmonary hypertension than in patients without hypertension. There were significant positive correlations between the plasma ET-1 level and CRP level in the whole study groups. For COPD patients, systolic Ppa correlated significantly with plasma CRP levels and plasma ET-1 levels. These findings support a possibility that CRP and ET-1 correlate to pulmonary hypertension in COPD patients.

A Case of Ischemic Colitis Associated with Paclitaxel Loaded Polymeric Micelle (Genexol-PM(R)) Chemotherapy / 결핵및호흡기질환

Paclitaxel has been widely used for treating many solid tumors. Although colonic toxicity is an unusual complication of paclitaxel-based chemotherapy, the reported toxicities include pseudomembranous colitis, neutropenic enterocolitis and on rare occasions ischemic colitis. Genexol-PM(R), which is a recently developed cremophor-free, polymeric micelle-formulated paclitaxel, has shown a more potent antitumor effect because it can increase the usual dose of paclitaxel due to that Genexol-PM(R) does not include the toxic cremophor compound. We report here on a case of a 57-year-old man with advanced non-small cell lung cancer and who developed ischemic colitis after chemotherapy with Genexol-PM(R) and cisplatin. He complained of hematochezia with abdominal pain on the left lower quadrant. Colonoscopy revealed diffuse mucosal hemorrhage and edema from the sigmoid colon to the splenic flexure. After bowel rest, he recovered from his symptoms and the follow-up colonoscopic findings showed that the mucosa was healing. Since then, he was treated with pemetrexed monotherapy instead of a paclitaxel compound and platinum.

A Case of Pulmonary Paragonimiasis with Recurrent Pleural Effusion and Cured by Four Cycles of Chemotherapy / 결핵및호흡기질환

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae, which occurs as a result of eating raw or undercooked freshwater crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection. Human paragonimiasis occurs sporadically. We experienced a case of pulmonary paragonimiasis in a 35-year-old woman with left lower chest pain. The patient had hypereosinophilia and a pleural effusion. The diagnosis was confirmed by positive ELISA (Enzyme-linked immunosorbent assay) that detected Paragonimiasis westermani antibody in the serum. We treated the patient with praziquantel for two days at a daily dosage of 75 mg/kg. Left pleuritic pain and pleural effusion improved after treatment. However, similar symptoms and pleural effusion developed recurrently for the first 3 courses of treatment with praziquantel. Upon the fourth round of treatment, the patient made a full recovery.

A Case of Tracheal Carcinoma Diagnosed by Rigid Bronchoscopy in Lidocaine Anaphylaxis Patient / 결핵및호흡기질환

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

Matrix Metalloproteinase-1 and Tissue Inhibitor of Metalloproteinase-1 levels in Exudative Pleural Effusions / 결핵및호흡기질환

BACKGROUND: The balances of the proteinases and antiproteinases system have been implicated in the pathogenesis of various exudative pleural effusions. The aim of this study was to examine the matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in exudative pleural effusions. METHODS: The study included 33 tuberculous effusions, 17 malignant, and 5 transudates. The pleural levels of MMP-1 and TIMP-1 were determined using a commercially available ELISA assay. RESULTS: The group of tuberculous effusions showed higher pleural MMP-1 levels than the malignant and transudates. The pleural TIMP-1 levels of the tuberculous and malignant effusions were higher than the transudates. CONCLUSION: Elevated pleural MMP-1 and TIMP-1 levels were found in tuberculous effusions.

A Case of Adenocarcinoma Presenting a Solitary Pulmonary Nodule That Showed No Growth Over 4 Years / 결핵및호흡기질환

A case of 51-year-old woman with a malignant solitary pulmonary nodule (SPN) that exhibited no growth over a period of 4 years is reported. Surgical wedge resection revealed an adenocarcinoma upon intra-operative frozen ex-amination. The operation was completed with a right upper lobectomy and complete lymphadenectomy. The authors recommend an early surgical procedure for any SPNs due to risk factors for developing lung cancer.

A Case of Acute Acalculous Cholecystitis Complicating Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

Endoscopic retrograde cholangiopancreatography (ERCP) has gained wide acceptance as a valuable tool for the diagnosis and management of disease of the pancreas and biliary tract. Complications associated with ERCP include bleeding, perforation, pancreatitis, and cholangitis, and the incidence is about 5~10%. Acute acalculous cholecystitis can be developed rarely after ERCP. It tends to have more complicated course, resulting in higher morbidity and mortality. We report a case of acute acalculous cholecystitis complicating therapeutic ERCP in a 52-year-old man with primary common bile duct stone. He underwent open cholecystectomy because of uncontrolled infection and rapid progression to septic shock. Although acute acalculous cholecystitis is one of rare complications developed after ERCP, it should be considered as one of the differential diagnosis in patients who complain of abdominal pain after ERCP because of high mortality rate and the need for prompt surgical management.

A Case of Recurrent Peritonitis Associated with Colon Cancer in a Continuous Ambulatory Peritoneal Dialysis Patient / 대한신장학회잡지

Recurrent peritonitis is the major complication of continuous ambulatory peritoneal dialysis (CAPD) and a common reason for discontinuation of this form of therapy. Polymicrobial peritonitis by gram- negative organisms suggests intraabdominal pathology not directly associated with CAPD, necessitating early removal of catheter and/or abdominal exploration. The source of infection may still be gastrointestinal, especially in light of the polymicrobial gram-negative peritonitis and rarely be gastrointestinal malignancy. We recently experienced a case of 64-year-old woman with recurrent CAPD peritonitis by polymicrobial gram-negative organisms, originated from colon cancer. Colon cancer was confirmed by barium enema, abdominal CT and colonoscopic biopsy. She underwent right hemicolectomy and removal of catheter simultaneously. The biopsy revealed a moderately to poorly differentiated adenocarcinoma with abundant mucin production.