A Case of Pulmonary Infarction Probably Related with Henoch-Schönlein Purpura

We report a case of pulmonary infarction probably related with Henoch-Schönlein purpura, which presented with purpura on both lower extremities in a 27-year-old woman. The purpura had developed 4 days previously and it had no itching or tend'erness. She complained of mild fatigue, chest tightness, but no dyspnea or hemoptysis. On routine examination, chest radiography showed a poorly defined nodular opacity on the left lung field, and it was diagnosed by a follow up chest CT as a pulmonary infarction secondary to pulmonary vasculitis.

Mono-therapy versus dual-therapy as transcellualr K shifting agents for acute therapy of hyperkalemia on maintenance hemodialysis / 대한내과학회지

OBJECTIVES: We evaluate the efficacy of transcellualr K-lowering effect at 1 hour following mono-therapy compared to that of dual-therapy , and aimed to find the sage and rapid method for acute therapy of hyperkalemia before dialysis in 10 ESRD patients with maintenance hemodialysis. METHOD: For ten patients of end stage renal failure with body weight between 55 and 65 Kg and a predialysis plasma potassium greater than 5.5 mEq/L, we studied in three separated phases separated from one another by at least 1 week. After 1 hour following mono-therapy (2mEq/Kg of NaHCO3 in interavenous infusion, 10 units of regular insulin with 50ml of 50% glucose in i.v. push, or 15mg of salbutamol in nebulizer) or dual therapy(NaHCO3 + Insulin with glucose, NaHCO3 + salbutamol, or salbutamol + insulin with glucose) for hyperkalemia, we compared the efficacy and safety of each transcellular K shifting methods. RESULTS: Bicarbonate infusion induced a signigicant raise in plasma bicarbonate and pH from baseline values in both mono-therapy and dual-therapy without any significant difference each other. Among mono-therapeutic regimens, bicarbonate alone failed to lower plasme K from baseline levels (-0.1+/-0.15 mEq/L, P=NS) whereas two other regimens effectively lowered plasma K (-0.62+/-0.06 mEq/L in insulin with glucose, -0.57+/-0.04 mEq/L in salbutamol, P vs. basal <0.05 in both). The K-lowering effects in the three combined regimeds of dual therapy were more prominent as compared to that of three regimens of monotherapy (-0.96+/-0.08 mEq/L in NaHCO3 + salbutamol, -1.20+/-0.6 mEq/L in NaHCO3 + insulin with glucose, and -1.20+/-0.10 mEq/L in salbutamol + insulin with glucose, respectively)(P<0.05). Two patients in monotherapy with salbutamol alone were resistant to the hypokalemic effect, however in dual therapy with simultaneous administration of salbutamol and bicarbonate resolved it. Also, hypoglycemia (<60mg/dL of fasting glucose) was noted in 4 patients in mon-therapy of insuli with glucose alone, 2 in dual-therapy of insulin with glucose + NaHCO3, but none in insulin with glucose + salbutamol. CONCLUSION: Dudal-therapeutic regimens lowered plasma potassium more effectively than mono-therapeutic regimens, and among them, the combination of insulin with glucose plus salbutamol could be recommended as an efficacious and safe modality in the acute therapy of hyperkalimia in ESRD patients.

Chest X-ray Findings and Acid-base Disturbances in the Early Phase of Leptospirosis / 대한내과학회지

BACKGROUND: Clinical syndrome of leptospirosis in Korea which accompanied by hemoptysis, pulmonary hemorrhage, respiratory failure was quite different from that of typical Weil's disease. The death rate in the early stage of disease has relationship with chest X-ray findings and acid-base disturbances resulted from hypoxia and asphyxia. We've come to consider chest X-ray findings and arterial blood gas findings as factors influencing the prognosis of the disease. METHODS: Forty one cases of leptospirosis diagnosed by acute febrille illness symptoms and serologic tests were graded for chest X-ray findings and grouped according to acid-base abnormalities. Retrospectively, we attempted to correlate the acid-base disturbances and chest X-ray findings with morbidity and mortality of the disease. RESULTS: The result were as follows. 1) Abnormal chest X-ray findings were observed in 30 cases(73%). Mortalities according to the chest X-ray findings were 0(0%), 2(17%), 3(0%), 4(0%), 5(33%), 6(50%) and chest X-ray findings influenced the mortality with statistical significance(p<0.05). 2) Acid-base abnormalities were observed in 39 cases(95%) and the types were divided to six groups . Respiratory alkalosis was the most common acid-base disturbance(44%). Five cases were died. Two of five were respiratory alkalosis, two cases were mixed respiratory metabolic acidosis and another case was mixed respiratory-metabolic alkalosis. As shown, acid-base abnormality influenced the mortality and mixed acid-base disturbances were showed high mortality with statistical significance (p<0.05). 3) Total mortality was 12%(five of forty-one). The chest X-ray score, morbidity, pH, pCO2, pO2, and HCO3 were 5.0 +/- 0.8, 3.4 +/- 1,3, 7.16 +/- 0.17, 32.5 +/- 1.1, 43.3 +/- 13.4 and 17.6 +/- 3.1 in died group, 2.4 +/- 0.4, 12.7 +/- 1.0, 7.46 +/- 0.01, 48.8 +/- 13.4, 65.4 +/- 3.7 and 23.4 +/- 0.9 in recovery group, respectively. There was difference between two groups with statistical significance. CONCLUSION: In this study, we concluded that chest X-ray findings and acid-base abnormalities influenced the mortality of leptospirosis. The factors above mentioned make us consider chest X-ray and blood gas analysis are essential to the patient hospitalized for the suspicion of leptospirosis. Especially, these factors pointed out the patient having chest X-ray abnormalities and mixed acid-base disturbances needed intensive care in the early stage of leptospirosis.

Analysis of p53 and Retinoblasoma(Rb) Gene Polymorphisms in Relation to Lung Cancer in Koreans / 결핵

BACKGROUND: The p53 and retinoblastoma(Rb) tumor suppressor genes are associated with the pathogenesis of several types of human cancer. Substantial. proportion of the primary lung cancers or cell lines have been reported to have the p53 and/or the Rb gene mutations. But so far there is no report on the analysis of the Rb gene polymorphism as one of the genetic susceptibility marker. This study was undertaken to establish the gene frequencies of the polymorphic genotypes of the p53 and Rb genes in Koreans to evaluate the possible involvement of these genotypes as a risk factor of lung cancer. METHODS: In this study 145 controls without previous and present tumor history and 128 lung cancer patients were subjected to analysis The two intragenic polymorphisms of the p53 gene(exon 4/AccII, intron 6/MspI) and one intron 17/XbaI polymorphism of the Rb gene were analysed by the method of polymersae chain react lion-restriction fragment length polymorphisms(PCR-RFLPS). The genotype of the intron 3/16 bp repeat polymorphism of p53 was determined by PCR and direct gel electrophoresis. RESULTS: There were no significant differences in the genotype distributions of the p53 gene between lung cart cert patients and controls. But heterozygotes(Arg/Pro) of the exon 4/AcclII polymorphisms were slightly over-represented than controls, especially in the Kreyberg type I cancer, which was known 13 be associated with smoking. The intron 3/16 bp duplication and the intron 6/MspI polymorphisms were in complete linkage disequilibrium. About 95% of the individuals were homozygotes of the common alleles both in the 16 duplication and MspI polymorphisms, and no differences were deteced in the genotype distributions between lung cancer patients and controls. Overall genotype distributions of the Rb gene polymorphisms between lung cancer patients and controls were not significantly different However, the genotype distributions in the Kreyberg type I cancer were significantly different from those of controls(p=0.0297) or adenocarcinomas(p=0.0008). It was noticeable that 73.4% of the patients with adenocarcinomas were heterozygotes(r1/r2) whereas 39.2% of the Kreyberg type I cancer were heterozygous at this polymorphisms. In the lung cancer patients, significant differences were a]so noted between the high dose smokers and low dose smokers including non-smokers(p=0.0258). The relative risk to Kreyberg type I cancer was significantly reduced in the individuals with the genotype of r1/r2(odds ratio=0.46, 95%C.I.=0.25-0.86, p=0.0124). The combined genotype distribution of the exon 4/AccII of the p53 and the intron 17 Rb gene polymorphisms in Kreyberg type I cancers were significantly different from dose of controls or adenocarcinomas. The highest odds ratio were observed in the individuals with the genotypes of Arg/pro and r2/r2(odds ratio=1.97, 95%C.I.=0.84-4.59) and lowest one was in the patients with Arg/Arg, r1/r2 genotype(odds ratio=0.54, 95%C.I.=0.25-1.14). CONCLUSION: The p53 and the Rb gene polymorphisms modulate the risk of smoking induced lung cancer development in Koreans. However, the exact mechanism of risk modulation by these polymorphism remains to be determined. For more discrete clarification of associations between specific genotypes and lung cancer risk, the evaluations of these polymorphisms in other ethnics and more number of patients will be needed.

Lower Lung Field Tuberculosis / 결핵

BACKGROUND: Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung ahscess. Thus the correct diagnosis may be sometimes delayed for a long time. METHODS: We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. RESULTS: Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1:1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the S0patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%), collapse(16%), cavitary lesion(l0%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of S0patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. CONCLUSION: When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.

The Influence of Nonselective Beta-Adrenergic Blockade (carteolol) and ACE Inhibitor (captopril) in Plasma Potassium on Maintenance hemodialysis / 대한내과학회지

OBJECTIVES: The degree of hyperkalemia and effects of potassium removal by hemodialysis on the plasma potassium concentration to see the influence of nonselective beta-adrenergic blockade(carteolol) and ACE inhibitor(captopril) on patients in maintenance hemodialysis were evaluated. METHODS: This study was done on 16 patients with end-stage renal disease undergoing maintenance hemodialysis. These patients were classified two groups; group 1-patients with carteolol or captopril(9 patients) and group 2-patients without medication(7 patients). Measurement of plasma potassium and arterial blood gas analyses were performed at pre-dialysis and during hemodialysis(4 hours). To analysis the distribution of potassium kinetics during hemodialysis, dialysis potassium clearance rate was introduced in this study. RESULTS: 1) Among 16 patients studied, the mean age was 43 years old and the ratio of male to female was 2: 1 and the mean duration of hemodialysis was 17.9 months. The underlying cause of end-stage renal disease was chronic glomerulonephritis in the most patients. 2) The mean predialysis plasma potassium concentration of all patients, group 1 on medication, and group 2 without medication was 5.13 +/- 1.04mEq/L, 5.67 +/- 1.01mEq/L and 4.410.55mEq/L, with high significance(p<0.001) between groups 1 and 2. 3) The mean postdialysis plasma potassium concentration of group 1 on medication and group 2 without medication was 348 +/- 0.40mEq/L and 3.39 +/- 0.56mEq/L with insignificance between groups 1 and 2. 4) The pre- and post-dialysis concentration of plasma sodium, pH and bicarbonate between group 1 and group 2 was similar except glucose. 5) Despite the fall in absolute plasma concentration in group 1 more than twice than in group 2, the difference in dialysis potassium clearance rate measured at 1 hour of hemodialysis in group 1 compared to that of group 2 was only 12M. CONCLUSION: These data are consistent with at least a two-compartment distribution of plasma potassium rather than single pool in addition to frequent hyperkalemia on maintenance hemodialysis on nonselective beta-adrenergic blocker or ACE inhibitor contributed to partial impairment of extrarenal transcellular shifts of potassium during inter- and intra-dialytic phase.

A Case of Thymic Carcinoid Tumor / 결핵

Until 1972, many carcinoid tumors of the thymus were not recognized as distinct lesions and were mistakenly labeled as variants of thymomas. Thymic carcinoid tumors are unusual neoplasms that show different morphological, functional, and behavioral characteristics than those of thymomas. We report a case of a 65-year-old woman with thymic carcinoid tumor. The cinicopathological findings are discussed with a review of the literature.

A Case of Bronchial Mucoepidermoid Carcinoma Associated with Adeonocarcinoma / 결핵

Mucoepidermoid carcinoma was initially recognized as occurring only in the salivary gland and only later was it appreciated that it occurred in the bronchus and trachea as well. Mucoepidermoid carcinoma of bronchial gland origin is extremely rare, and little is known about their natural history. This carcinoma is derived from the minor salivary gland of the proximal tracheobronchial tree and it is divided into low-grade and high-grade by gross, histologic, and ultrastructural criteria. Also Its clinical and biologic behaviors are closely related with histologic grade of carcinoma. We have experienced a rare case of bronchial mucoepidermoid carcinoma associated with adenocarinoma which obstructed the left main bronchus and was successfully removed by the pneumonectomy.

The effect of percutaneous pig-tail catheter drainage in the management of lung abscess and empyema / 결핵

BACKGROUND: Lung abscess is an accumulation of pus within a destroyed portion of the lung. Antibiotic therapy and postural drainge has proven to be an effective method of treatment for the majority of patients with pyogenic lung abscess. When medical therapy fails, thoracotomy and pulmonary resection are the current therapies. Empyema is pus in the pleural space, and this term is reserved for effusions on which the Gram stain of the pleural fluid is positive. Initially, such collection may be drained via chest tube. Recently, in patients who are judged to be unsuitable for surgery and are in poor condition, percutaneous drainage using pig-tail catheter has been performed. We report our experience with 10 cases of lung abscess and 23 cases of empyema who were treated by percutaneous pig-tail catheter drainage. SUBJECTS AND METHODS: Our study included 10 patients with lung abscess and 23 patients with empyema who were treated by percutaneous pig-tail catheter drainage, from January, 1990, to May, 1996, at Hanyang University then a pig-tail catheter was inserted into the abscess or the site of empyema under fluoroscopic and ultrasonograpic guidance. Following aspiration, the catheter was sutured into the skin, and connected to the suction tip. Catheter drainage was discontinued when the abscess or empyema was resolved in radiologically and clinically. RESULTS: There were 2 cases of lung abscess caused by Staphylococcus aureus and Klebsiella pneumoniae and 14 cases of empyema caused by M. tuberculosis. The others were unknown. The duration of drainage was 1-2 weeks in 7 cases of lung abscess and 14 cases of empyema. In the 29 of 33 patients, percutaneous drainage were carried out successfully. 20 of the 29 cases rapidly improved. CONCLUSION: Percutaneous drainge is effective and relatively safe for management of lung abscess or empyema refractory to medical therapy or poor candidates for surgical treatment.

The Clinical Features of Endobronchial Tuberculosis: A Retrospective Study on 201 Patients for 6 years / 결핵

Background: Endobronchial tuberculosis is definded as tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence. Endobronchial tuberculosis has clinical significance due to its sequela of cicatrical stenosis which causes atelectasis, dyspnea and secondary pneumonia and may mimic bronchial asthma and pulmanary malignancy. Method: The authors carried out, retrospectively, a clinical study on 201 patients confirmed with endobronchial tuberculosis who visited the Department of Pulmonary Medicine at Hangyang University Hospital from January 1990 to April 1996. The following results were obtained. Results: 1) Total 201 patienls(19.5%) were confirmed as endobronchial tuberculosis among 1031 patients who had been undergone flexible bronchofiberscopic examination. The number of male patients were 55 and that of female patients were 146, and the male to female ratio was 1: 2.7. 2) The age distribution were as follows: there were 61(30.3%) cases in the third decade, 40 cases(19.9%) in the fourth decade, 27 cases(13.4%) in the sixth decade, 21 cases(10.4%) in the fifth decade, 19 cases(9.5%) in the age group between 15 and 19 years, 19 cases(9.5%) in the seventh decade, and 14 cases(7.0%) over 70 years, in decreasing order. 3) The most common symptom, in 192 cases, was cough 74.5%, followed by sputum 55.2%, dyspnea 28.6%, chest discomfort 19.8%, fever 17.2%, hemoptysis 11.5%, in decreasing order, and localized wheezing was heard in 15.6%. 4) In chest X-ray of 189 cases, consolidation was the most frequent finding in 67.7%, followed by collapse 43.9%, cavitary lesion 11.6%, pleural effusion 7.4%, in decreasing order, and there was no abnormal findings in 3.2%. 5) In the 76 pulmanary function tests, a normal pattern was found in 44.7%, restrictive pattern in 39.5%, obstructive pattern in 11.8%, and combined pattern in 3.9%. 6) Among total 201 patients, bronchoscopy showed caseous pseudomembrane in 70 cases(34.8%), mucosal erythema and edema in 54 cases(26.9%), hyperplastic lesion in 52 cases(25.9%), fibrous stenosis in 22 cases(10.9%), and erosion or ulcer in 3 cases(1.5%). 7) In total 201 cases, branchial washing AFB stain was positive in 103 cases(51.2%), bronchial washing culture for tuberculous bacilli in 55 cases(27.4%). In the 99 bronchoscopic biopsies, AFB stain positive in 36.4%, granuloma without AFB stain positive in 13.1%, chronic inflammation only in 36.4%, and non diagnostic biopsy finding in 14.1%. Conclusions: Young female patients, whose cough resistant to genenal antitussive agents, should be evaluated for endobronchial tuberculosis, even with clear chest roentgenogram and negative sputum AFB stain. Furthermore, we would like to emphasize that the bronchoscopic approach is a substantially useful means of making a differential diagnosis of atelectasis in older patients of cancer age. At this time we have to make a standard endoscopic classification of endobronchial tuberculosis, and well designed prospective studies are required to elucidate the effect of combination therapy using antituberculous chemotherapy with steroids on bronchial stenosis in patients with endobronchial tuberculosis.

A Case of Biphasic Pulmonary Blastoma / 결핵

Pulmonary blastoma is a primary lung tumor consisting of a mixture of immature embryonal-like mensenchymal and epithelial components and in some areas resemble embryonal lung tissue of up to 3-4 months gestational age. The tumor was first described in 1945 by Barrett and Barnard and again in 1952 by Barmard, who named it an embryoma of the lung which resembled fetal lung histologically, with glandular structures lined by non-ciliated epithelium and a surrounding stroma resembling mesenchyme. In 1961 Spencer renamed them Pulmonary blastoma as he believed they represented neoplasms similar in pathogenesis to nephroblastoma. The prognosis of these tumors is poor, and the clinical course is not readily predicted from histological appearance. Untill now, more than one hundred cases have been reported in the literature in the word and there is no report in Korea. We report a case of biphasic pulmonary blastoma, which ruptured spontaneously, in a 31-year-old young man who was presented as sharp pain under the right subscapular area.

A Case of Biphasic Pulmonary Blastoma / 결핵

Pulmonary blastoma is a primary lung tumor consisting of a mixture of immature embryonal-like mensenchymal and epithelial components and in some areas resemble embryonal lung tissue of up to 3-4 months gestational age. The tumor was first described in 1945 by Barrett and Barnard and again in 1952 by Barmard, who named it an embryoma of the lung which resembled fetal lung histologically, with glandular structures lined by non-ciliated epithelium and a surrounding stroma resembling mesenchyme. In 1961 Spencer renamed them Pulmonary blastoma as he believed they represented neoplasms similar in pathogenesis to nephroblastoma. The prognosis of these tumors is poor, and the clinical course is not readily predicted from histological appearance. Untill now, more than one hundred cases have been reported in the literature in the word and there is no report in Korea. We report a case of biphasic pulmonary blastoma, which ruptured spontaneously, in a 31-year-old young man who was presented as sharp pain under the right subscapular area.

The Clinical Features of Endobronchial Tuberculosis: A Retrospective Study on 201 Patients for 6 years / 결핵

Background: Endobronchial tuberculosis is definded as tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence. Endobronchial tuberculosis has clinical significance due to its sequela of cicatrical stenosis which causes atelectasis, dyspnea and secondary pneumonia and may mimic bronchial asthma and pulmanary malignancy. Method: The authors carried out, retrospectively, a clinical study on 201 patients confirmed with endobronchial tuberculosis who visited the Department of Pulmonary Medicine at Hangyang University Hospital from January 1990 to April 1996. The following results were obtained. Results: 1) Total 201 patienls(19.5%) were confirmed as endobronchial tuberculosis among 1031 patients who had been undergone flexible bronchofiberscopic examination. The number of male patients were 55 and that of female patients were 146, and the male to female ratio was 1: 2.7. 2) The age distribution were as follows: there were 61(30.3%) cases in the third decade, 40 cases(19.9%) in the fourth decade, 27 cases(13.4%) in the sixth decade, 21 cases(10.4%) in the fifth decade, 19 cases(9.5%) in the age group between 15 and 19 years, 19 cases(9.5%) in the seventh decade, and 14 cases(7.0%) over 70 years, in decreasing order. 3) The most common symptom, in 192 cases, was cough 74.5%, followed by sputum 55.2%, dyspnea 28.6%, chest discomfort 19.8%, fever 17.2%, hemoptysis 11.5%, in decreasing order, and localized wheezing was heard in 15.6%. 4) In chest X-ray of 189 cases, consolidation was the most frequent finding in 67.7%, followed by collapse 43.9%, cavitary lesion 11.6%, pleural effusion 7.4%, in decreasing order, and there was no abnormal findings in 3.2%. 5) In the 76 pulmanary function tests, a normal pattern was found in 44.7%, restrictive pattern in 39.5%, obstructive pattern in 11.8%, and combined pattern in 3.9%. 6) Among total 201 patients, bronchoscopy showed caseous pseudomembrane in 70 cases(34.8%), mucosal erythema and edema in 54 cases(26.9%), hyperplastic lesion in 52 cases(25.9%), fibrous stenosis in 22 cases(10.9%), and erosion or ulcer in 3 cases(1.5%). 7) In total 201 cases, branchial washing AFB stain was positive in 103 cases(51.2%), bronchial washing culture for tuberculous bacilli in 55 cases(27.4%). In the 99 bronchoscopic biopsies, AFB stain positive in 36.4%, granuloma without AFB stain positive in 13.1%, chronic inflammation only in 36.4%, and non diagnostic biopsy finding in 14.1%. Conclusions: Young female patients, whose cough resistant to genenal antitussive agents, should be evaluated for endobronchial tuberculosis, even with clear chest roentgenogram and negative sputum AFB stain. Furthermore, we would like to emphasize that the bronchoscopic approach is a substantially useful means of making a differential diagnosis of atelectasis in older patients of cancer age. At this time we have to make a standard endoscopic classification of endobronchial tuberculosis, and well designed prospective studies are required to elucidate the effect of combination therapy using antituberculous chemotherapy with steroids on bronchial stenosis in patients with endobronchial tuberculosis.

Expression of Transforming Growth Factor-Beta in Patients with Interstitial Lung Diseases (ILD) / 결핵

BACKGROUND: Transforming growth factor-beta(TGF-beta) may play a role in a variety of fibroproliferative disorders including pulmonary fibrosis via the induction of extracellular matrix accumulation. TGF-beta not only stimulates extracellular matrix production, but also decreases matrix degradation. Interstial lung diseases have demonstrated marked expression of TGF-beta. METHODS: To evaluate the possible role of TGF-beta in human pulmonary fibrosis, by using neutralizing antibody of TGF-beta we investigated immunohistochemically the expression of TGF-beta in the formalin-fixed, paraffin-embedded tissue sections of the 5 normal cases for the control, and a couple of pieces of tissues taken out of 3 cases with idiopathic pulmonary fibrosis, 3 cases with ILD from bleomycin toxicity, 3 cases with ILD from sarcoidosis, and 3 cases with ILD from eosinophilic granuloma. RESULTS: In the 5 normal cases for the control, the TGF-beta was expressed in bronchial and alveolar epithelial cells. Up-regulation of the TGF-3 expression was showed in the interstitial fibroblast cells of alveolar septa in 5 pieces and proliferated alveolar pneumocytes in 1 piece among 6 pieces tissues taken out of 3 cases with idiopathic pulmonary fibrosis. Also up-regulation of the TGF-beta expression was showed in alveolar lining pneumocytes, intra-alveolar mononuclear cells, and epithelioid cells in most of cases of ILD from bleomycin toxicity, sarcoidosis and eosinophilic granuloma. CONCLUSION: These findings suggest that up-regulation of the TGF-beta are involved in pathogenesis of interstitial lung fibrosis from variety of causes.

A Case of Kartagener's Syndrome Presenting as Respiratory and Right Heart Failures / 결핵

Kartagener's syndrome, a congenital disease transmitted as an autosomal recessive illness with a prevalence of approximately 1:20,000 persons, is characterized by the triple association of situs inversus, bronchiectasis, and sinusitis. Affected persons have an incoordination of ciliary motility that leads to defective mucociliary transport, chronic bronchial infections. Kartagener's syndrome is a subset of the immotile cilia syndrome and therefore all patients with Kartagener's syndrome have immotile cilia with obvious ultrastructural defects in the ciliary axoneme. In the respiratory tract this inability presumably causes impaired clearance of mucus and inhaled particles and results in the chronic infections of the sinuses and bronchial trees that are characterized of the disease. The end-stage phenomenon in Kartagener's syndrome, respiratory or heart failure is a less common event and heart-lung transplantation is becoming an accepted therapy for patients with end-stage pulmonary disease in Kartagener's syndrome in many institutes. We report one case of Kartagener's syndrome in a 25-year-old young woman who was presented as respiratory and right heart failures, with review of literatures.

A Case of Takayasu's Arteritis with Multiple Occlusion of Pulmonary Arteries / 결핵

Takayasu's arteritis(aortoarteritis) is a chronic inflammatory disease involving the aorta, the arteries arising from the aorta, and the pulmonary arteries also may be involved. The inflammation leads to either stenosis and occlusion of the involved artery or formation of aneurysm or both. The arterial lesions can lead to secondary hypertension, retinopathy, cardiac involvement, cerebrovascular events, and premature death. The course and prognosis of patients with aortoarteritis show wide variation, and few authors have published systematic studies documenting the natural history of this disease. While the etiology of Takayasu's arteritis remains unknown, various modes of treatment including steroids, vascular surgery, and balloon angioplasty have been used for management of these patients. We experienced a case of Takayasu's arteritis with multiple occlusion of pulmonary arteries, which was confirmed by angiography and perfusion scan, so reported it with a review of literature.

Multiple Small Nodular Lung Lesions with Severe Dyspnea / 결핵

Diffuse panbronchiolitis is a chronic inflammatory lung disease of unknown etiology which is characterized by chronic airflow limitation and airway inflammation, predominantly localized in the respiratory bronchioles with infiltration of inflammatory cells, and has typical clinical, radiological and pathological features. Obstructive respiratory functional impairment, occasional symptoms of wheezing, and also cough and sputum resemble the feature of emphysema, bronchial asthma, or chronic bronchitis, respectively. We experienced a case of pathologically proven advanced diffuse panbronchiolitis in a 55-year-old man with productive cough and exertional dyspnea. The chest radiography showed multiple tiny nodular densities on whole lung fields. It was confirmed by thoracoscopy-guided lung biopsy and the patient was improved after initiation of treatment with low-dose erythromycin

The Utility of Immunological Markers and Pulmonary Function Test in the Early Diagnosis of Pulmonary Involvement in the Patients with Rheumatoid Arthritis / 결핵

BACKGROUND: It is reported that frequency of pulmonary involvement in the patients with rheumatoid arthritis reaches 10 to 50% and pulmonary involvement is a principal cause of death. As immunology and radiology has developed, interest for the early diagnosis of pulmonary involvement is increasing. METHOD: Among the patients at Hanyang University Hospital from March, 1990 to July, 1995, we compared the 29 patients having pulmonary involvement with the 18 patients controls in clinical and chest high resolution computed tomography(HRCT) findings by immunological markers and findings of pulmonary function test. We sought useful markers for early diagnosis of pulmonary involvement with noninvasive investigations. RESULTS: The ratio of males to females was 14: 15 in the group of pulmonary involvement, and all of the 18 patients were females in the control group. Smoking history was 31%(9/29) in the former group and none in the latter group. Rheumatoid factor(RF) was positive in 96.5%(28/29) of the pulmonary involvement group and in 100%(18/18) of the control group(p=0.12). Antiperinuclear factor(APF) showed a significant difference: 86.9%(20/23, average value: 2.0) was positive in the pulmonary involvement group and 50%(8/16, average value: 1.1) in the control group(p=0.04). Antinuclear antibody(ANA) was positive in 60.7%(17/28) of the pulmonary involvement group and in 72.2%(13/18) of the control group(p=0.33). Cryoglobulin, also showed a significant difference: 72%(18/25) in the pulmonary involvement group was positive and 56.2% (9/16) in the control group was positive(p=0.02). Bony erosion was positive in 61.5%(16/26) of the pulmonary involvement group and in 77.7%(14/18) of the control group(p=0.8). On the pulmonary function test, the average value of alveolar volume corrected diffusion capacity and residual volume in the pulmonary involvement group and in the control group were 1.07mmol/min/KPa(predicted value: 64.2%), 1.32L(predicted value: 70%)and 1.44mmol/min/KPa, 3.75L(predicted value: 86.6%), respectively(p=0.003, p=0.004), showing a significant difference. CONCLUSION: APF or cryoglobulin on the serological test, the measurement of residual volume and alveolar volume corrected diffusion capacity may be used as effective markers in the diagnosis of pulmonary involvement of the patients with rheumatoid arthritis.

Transthoracic Fine Needle Aspiration Biopsy in Localized Pulmonary Lesions: Diagnostic Accuracy and Complications / 결핵

INTRODUCTION: Transthoracic fine needle aspiration biopsy(TNAB) has shown to be a resonably safe, simple, and accurate procedure in diagnosis of intrathoracic lung lesions. We reviewed the results of 1,005 TNAB of chest lesions performed on 930 patients with 20 or 22-gauze needles over a period of 10 years. METHODS: From November 1983 to June 1995, 1,005 cases in 930 patients with an undiagnosed lung lesion underwent TNAB at the Hanyang University Hospital: 66% were men and 34% were women. Most of the patients were 40~60 years old and the youngest patient was 3 years of age. RESULT: 540 patients had various malignant chest lesions and 322 patients had benign pulmonary lesions. The diagnostic accuracy of TNAB was 96.1 percent in malignant diseases with one false positive result and 90.1% in benign diseases. A definitive diagnosis was not obtained in the remaining 68 patients. The most common diagnoses among 519 malignancy chest lesions with TNAB were the following: squamous cell lung carcinoma, 31.7%; adenocarcinoma, 24.7%; small cell lung carcinoma, 16.7%; metastatic cancer, 14.2%; large cell lung carcinoma, 6.2% and so on. Complications included pneumothorax in 12.3% necessitating chest tube drainage in 0.6%. Minor hemoptysis occurred in 3.6%. There was no death directly attributable to the procedure. CONCLUSION: We concluded that TNAB permits a direct approach to all kinds of localized lung lesions with a high degree of accuracy and without major complications.

The measurement of gastric emptying time in chronic renal failure patients with dysfunctional upper gastrointestinal symptoms and the effect of cisapride / 대한신장학회잡지

No abstract available.