Meanings and Indications of pretreatment assessment of esophageal carcinoma with bronchoscopy / 대한내과학회지

OBJECTIVES: To determine the yield of bronchoscopy for evaluating tracheobronchial spread in esophageal carcinoma and to identify the conditions for bronchoscopy in patients with newly diagnosed esophageal carcinoma, who planned to be operated. METHODS: From March 1989 to June 1997, 115 patients with esophageal carcinoma had received bronchoscopy. Bronchoscopic findings were classified into three types: Type I: no definitive endobronchial lesion, Type II: indirect effects(hyperemia and compression), Type III: invasion. CT findings were classified into three classes: Class A: tumor separated from tracheobronchial tree, Class B: abutting tree, Class C: compressing tree. We investigated the correlations of clinical presentation and non-invasive tests (including esophagogram) with bronchoscopic findings. RESULTS: 1) Among 115 patients, bronchoscopic findings were Type I in 67(58.3%), Type II in 34(29.6%), Type III in 14(12.2%). 2) Abnormal bronchoscopic findings are related with length of lesion by esophagogram.(p < 0.05) 3) Class C lesion by chest CT scan were closely correlated with abnormal bronchoscopic findings. 4) Chest symptoms were frequently associated with type III lesion of bronchoscopy CONCLUSION: We could recommend preoperative bronchoscopy in recently diagnosed as esophageal carcinoma who got more than 2 of 3 variables listed below: 1) patients who had chest symptoms, such as cough with sputum, hemoptysis, and dyspnea 2) length of tumor is long in esophagogram(above 5 cm in length), 3) tracheobronchial compressed lesion by chest CT scan. Bronchoscopy is not needed in cases with no chest symptom, short lesion length(below 5 cm) and normal chest CT finding for preoperative evaluation of esophageal carcinoma.

The usefulness of dyspnea rating in evaluation for pulmonary impairment/disability in patients with chronic pulmonary disease / 결핵

BACKGROUND: Resting pulmonary function tests(PFTs) are routinely used in the evaluation of pulmonary impairment/disability. But the significance of the cardiopulmonary exercise test(CPX) in the evaluation of pulmonary impairment is controvertible. Many experts believe that dyspnea, though a necessary part of the assessment, is not a reliable predictor of impairment. Nevertheless, oxygen requirements of an organis m at rest are different from at activity or exercising, and a clear relationship between resting PFTs and exercise tolerance has not been established in patients with chronic pulmonary disease. As well, the relationship between resting PFTs and dyspnea is complex. To investigate the relationship of dyspnea, Resting PFTs, and CPX, we evaluated the patients of stabilized chronic pulmonary disease with clinical dyspnea rating(baseline dyspnea index, BDI), resting PFTs, and CPX. METHOD: The 50 patients were divided into two groups: non-severe and severe group on basis of results of resting PFTs(by criteria of ATS), CPX(by criteria of ATS or Ortega), and dyspnea rating(by focal score of BDI). Groups were compared with respect to pulmonary function, indices of CPX, and dyspnea rating. RESULTS: 1) According to the criteria of pulmonary impairment with resting PFTs, VO2 max, and focal score of BDI were significantly low in the severe group(p0.05). According to focal score(

A Case of Primary Unknown Squamous Cell Carcinoma Incidentally Found in the Thrombus After Pulmonary Embolectomy / 결핵

A thromboembolic event in patients later given a diagnosis of cancer is the result rather than the cause of the cancer. The risk of hidden cancer is significantly higher for patients with recurrent idiopathic thromboembolism compared to those with secondary deep vein thrombosis. Microemboli from hepatic or adrenal metastases and large-sized emboli from the great veins invaded by the tumor are the sources of tumor embolization. The intraarterial tumor emboli less likely invade the arterial wall. Thrombus formation and organization may be capable of destroying tumor cells within pulmonary blood vessels. Therefore, all tumor emboli are not true metastases. The treatment of deep vein thrombosis and pulmonary embolism in patients with cancer consists of anticoagulation with heparin and warfarin, venacaval filters, appropriate anti-neoplastic agents, and surgical methods(embolectomy, thromboendarterectomy). However, considerable literatures suggest that oral anticoagulant such as warfarin is ineffective in the treatment of those. We report a case of primary unknown squamous cell carcinoma incidentally found in the thrombus after pulmonary embolectomy.

Urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion before and during cisplatin chemotherapy in patients with intrathoracic malignancy / 결핵

BACKGROUND: Nausea and vomiting associated with chemotherapy are common side effects which remain difficult to control. Acute phase nausea and vomiting (0-24 hours after induction of chemotherapy) parallels plasma serotonin release, which explains the effectiveness of 5-HT3 receptor antagonists. Serotonin released from gastrointestinal enterochromaffin cells may mediate chemotherapy-induced emesis. In this study, we analyzed urinary excretion of 5-HIAA, the main metabolite of serotonin. METHODS: Eight men and four women were studied in their cisplatin chemotherapy cycle. Urinary 5-hydroxyindoleacetic aicd (HIAA) levels were determined before and during a 24-hour period under ondansetron prophylaxis. RESULTS: Urinary 5-HIAA excretion for a 24-hour period was increased in all patients after induction of cisplatin (P=0.002). CONCLUSION: Cisplatin chemotherapy is associated with serotonin release in the acute phase. Our finding provides evidence for a relationship between emesis and serotonin following cisplatin chemotherapy.

Diagnostic Significance of the Serologic Test Using Antigen of Mycobacterium Tuberculosis for Antibody Detection by ELISA / 결핵

BACKGROUND: Diagnosis by direct microscopy and/or by culture of the Mycobacterium tuberculosis from body fluids or biopsy specimens is "Gold standard". However, the sensitivity of direct microscopy after Ziehl-Neelsen staining is relatively low and culture of mycobacteria is time consuming. Detection of mycobacterial DNA in clinical samples by the polymerase chain reaction is highly sensitive but laborious and expensive. Therefore, rapid, sensitive and readily applicable new tests need to be developed. So we had evaluated the clinical significance of serologic detection of antibody to 38 kDa antigen, which is known as the most specific to the M. tuberculosis complex, and culture filtrate antigen by ELISA in sputum AFB smear negative patients. METHOD: In this study, culture tests for acid fast bacilli with sputa or bronchial washing fluids of 183 consecutive patients who were negative of sputum AFB smear were performed. Simultaneously serum antibodies to 38 kDa antigen and unheated culture filtrate of M. tuberculosis were detected by an ELISA method. RESULTS: The optical densities of ELISA test with 38 kDa and culture filtrate antigen were significantly higher in active pulmonary tuberculosis cases than in non tuberculous pulmonary diseases (pO.05). In the smear-negative active pulmonary tuberculosis patients, the sensitivity of the ELISA using 38 kDa antigen and culture filtrate was 20.0% and 31.4%, respectively. The specificity was 95.3% and 93.9%, respectively. CONCLUSION: In active pulmonary tuberculosis but smear negative, the serologic detection of antibody to 38 kDa antigen and culture filtrate by ELISA cannot substitute traditional diagnostic tests and does not have clinically significant role to differenciate the patient with active pulmonary tuberculosis from other with non-tuberculous pulmonary diseases.

Correlation of Gross Appearance or RBCs Numbers with Pleural Histocytology and Pleural Fluid Carcinoembryonic Antigen Values in Malignancy Associated Pleural Effusions / 결핵

BACKGROUND: Most of malignant pleural effusions are serous but 8-33% of them are bloody. We wanted to evaluate the relationships between gross appearance and pleural CEA level or results of histocytology in malignancy associated pleural effusions. We also tried to reevaluate the meaning of CEA measurement in histocylogically proved or unproved malignancy associated pleural effusions. METHODS: We studied 98 cases of malignancy associated pleural effusions, 50 cases of histocylologically proven malignant effusions and 48 cases of histologically unproven paramalignant effusions. We had observed gross appearance and conventional laboratory values and CEA levees for pleural effusions. RESULTS: 44.9% of malignancy associated effusions were bloody(63.6% of bloody effusions were histstocytologically proven malignant effusion). 65.0% of malignancy associated pleural effusions which have RBCs numbers over 100,000/mm3 were cytologically proven malignant effusions. 72.7% of cytologically proven malignant effusions had increased pleural fluid CEA level over 10 ng/ml. 58.2% of cases with pleural CEA over 10ng/ml had positive results in pleural histocytology. There was no definable relationships between pleural fluid CEA elevation and RBCs numbers and results of pleural fluid cytology. CONCLUSION: About half of the cases with malignancy associated pleural effusions were bloody. Histocytologically proven malignant effusions were more common in bloody effusion than non-bloody effusion (63.6% Vs 38.9%). But increased red blood cell numbers was not associated with positivity of pleural histocytology. Pleural fluid CEA elevation(over 10 ng/ml) was not correlated with positive pleural histocytology. But pleural fluid CEA elevation was rare In nonmalignant pleural effusions, and than pleural CEA measurement in uncertain pleural effusions maybe helpful to distinguishes its origin.

Transcatheter Arterial Embolization for Hemoptysis / 결핵

BACKGROUND: Transcather arterial embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function such as postpneumonectomy patients and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization and analysed the correlation of the clinical and angiographic characteristics and investigated the clinical course and outcome after arterial embolization in the patients with significant hemoptysis. METHOD: 58 patients with massive or recurrent hemoptysis underwent transcatheter arterial embolization for the treatment of hemoptysis from April 1992 to Sept. 1993. RESULTS: Most common cause of hemoptysis was pulmonary tuberculosis(34 cases, 58.3%). Embolized vessels responsible for hemoptysis were 56 bronchial arteries and 32 nonbronchial systemic arteries. Initial most common angiographic findings were hypervascularity and shunt. Initial success rate of hemoptysis control revealed 81.1%. However, 15 of 58 patients(25.9%) showed recurrence of hemoptysis after transcatheter arterial embolization. The complications(18 cases, 31%) such as chest pain, fever, voiding difficulty, atelectasis, paralytic ileus and unwanted embolization were occured. CONCLUSION: Transcatheter arterial embolization is useful and relatively safe treatment modality for immediate bleeding control of patients with massive hemoptysis or inoperable cases. The further evaluation of the long term results according to the embolized material and underlying pulmonary disease will be required.

A Case Report of Mediastinal Leiomyosarcoma / 결핵

The leiomyosarcoma is uncommom tumor that consists of 10% of all sarcoma incidence and commonly arise from retroperitomeum or mesentery. But leiomyosarcoma arose from mediastinum is very rare and only incidental case report is present. Mediastial leiomyosarcoma may originate from superior vene cava, pulmonary artery, small vessels of alveoli, esophagus and cardiac muscle. Common symptoms that are related with leimoyosarcoma of mediastinum are cough and dydpnea but dysphagia, chest pain and hemoptysis can be produced. Although long term survival after complete resection of tumor was reported in localized disease, there wes no effective therapy that prolong the survival in patients who had disseminated disease of huge tumor mass. We report the case of posterior mediastinal leiomyosarcoma confirmed by aspiration cytology and immunohistochemical staining, along with a review of literature.

A Case of Pulmonary Histiocytosis-X Associated with Bilateral, Recurrent, and Spontaneous Pneumothorax / 결핵

Histiocytosis-X is a term used to define three diseases with similar morphologic characteristics : Letterer-Siwe diseae, Hand-Schuller-Christian disease and Eosinophilic granuloma. In general, they differ in terms of their age of onset, severity of clinical course and site of involvement. Eosinophilic granuloma typically is seen in young adults. Eosinophilic granuloma is diagnosed in the presense of diffuse pulmonary infiltrate, bony involvement. However, the Pulmonary radiologic findings of eosinophilic granuloma are variable accordinary to stage of disease. therefore pathologic diagnosis of involving site is essential for confirmative diagnosis of eosinophilic grananuloma. Pathologically. the three disease are characterized by granulomatous infiltration of alveolar septa and bronchial walls and often involvement of bone. The hallmark of this disease is proliferation of the Langerhans' cell. The identifying feature is the X-body or Birbeck granule that is present in Langerhans' cells and histiocytic cells found in the lung of EG patient. We report a case of bilateral, recurrent and spontaneous pneumothoraces in a 21 year old man with pulmonary histiocytosis-X which is confined by eosinophilc granuloma in bone marrow biopsy and ultrastructural examination in cells obtained from BAL.

Obstructive pneumonitis of right lower lung field / 결핵

No abstract available.

A case of subacute necrotizing lymphadenitis with pancytopenia / 대한혈액학회지

No abstract available.