Prevalence of Combined Bronchial Asthma with COPD in Patients with Moderate to Severe Air flow Limitation / 결핵

BACKGROUND: ATS(American Thoracic Society) defined new guidelines for COPD(chronic obstructive lung disease) in April 2001, following the results of the global initiative for chronic obstructive lung disease. The most important concept of COPD is an airflow limitation which is not fully reversible compared to bronchial asthma(BA). The criteria for COPD are postbronchodilator FEV1 less than 80% of the predicted value and an FEV1 per FVC ratio less than 70%. The global initiative for asthma(GINA) study defined asthma, which included immune-mediated chronic airway inflammatory airway disease, and found that airflow limitation was wide spread, variable and often completely reversible. Taken together COPD and BA may be combined in airflow limitation. This study was designed to evaluate the prevalence of BA in patients with COPD of moderate to severe airflow limitation. METHODS: COPD was diagnosed by symptoms and spirometry according to ATS guidelines. Enrolled subjects were examined for peak flow meters(PFM), sputum eosinophils and eosinophil cationic protein(ECP) levels, serum total IgE with allergy skin prick test, and methacholine bronchial provocation test(MBPT). RESULTS: About 27% of COPD patients with moderate to severe airflow limitation were combined with BA. There was significantly decreased response to PFM in severe COPD. However, there was no significant relationship between BA and COPD according to the degree of severity. The BA combined with COPD group showed significantly high eosinophil counts and ECP level in induced sputum. However, neutrophil counts in induced sputum showed significant elevation in the pure COPD group. CONCLUSION: Twenty-seven percent of COPD patients with moderate to severe ventilation disorder were combined with BA, but there were no significant differences according to the degree of severity.

A Case of Wegener's Granulomatosis with Thin Glomerular Basement Membrane Disease / 대한류마티스학회지

Wegener's granulomatosis is a necrotizing,granulomatous vasculitis that involves multiple organs including the upper and lower respiratory tract and the kidney.The kidney initially exhibits focal necrotizing glomerulonephritis,which progresses to crescentic glomerulonephritis in Wegener's granulomatosis.We experienced a case of Wegener's granulmatosis which was associated with a thin glomerular basement membrane disease.The patient suffered from nasal stuffiness,recurrent serous otitis media,and tinnitus.Despite antibiotic therapy and ventral tube insertion,symptoms did not improve and hearing difficulty was aggravated.Ulcerative,necrotizing granulomatous inflammations with multinucleated giant cells were seen on nasal biopsy.She had recurrent microscopic hematuria and the renal biopsy findings by light and immunofluorescent microscopy did not reveal any abnormalities but diffuse thinning of the glomerular basement membrane (226nm)was observed by electronmicroscopy. With the above clinical findings and biopsy results,we diagnosed Wegener's granulmatosis with thin glomerular basement membrane disease.Thin glomerular basement membrane disease,also called benign recurrent hematuria,is characterized by diffuse thinning of the glomerular basement membrane and hematuria. Weekly low-dose methotrexate together with prednisone was used as treatment regimen because nonglomerular microscopic hematuria may be the first sign of cyclophosphamide-induced renal toxicity.With the above combination therapy, she felt well-being sense and her hearing difficulty was also much improved. She has been treated as an outpatient with glucocorticoid.

Effect of Cisapride on ATP-sensitive K Channel of Ventricular Cell

BACKGROUND: It has been generally accepted that Cisapride (Prepulsid?or propulsid?), a widely used gastrointestinal prokinetic agent, is associated with Torsades de Points, a life-threatening arrhythmia. Recently, cisapride-induced APD (action potential duration)-prolongation was inhibited by glibenclamide, a KATP channel blocker. But the direct effect of cisapride on K(ATP) channels has not been studied until now. Therefore, we investigated cisapride's effects on KATP channels of isolated rat ventricular myocytes. METHODS: After the isolation of rat ventricular myocytes, we analysed the single channel current with patch pipettes. The method of analysis was the student t-test. RESULTS: 1) Cisapride (10(-6) M- 10(-4) M) inhibited KATP channel opening without changing channel conductance Ki was about 20micronM, and Hill coefficient was 0.75. 2) Cisapride inhibited pinacidil-induced KATP channel opening in the cell attached mode. CONCLUSIONS: These results suggest that cisapride-induced APD prolongation and arrythmic effects may be partly related to KATP channel inhibition.

Exercise Pulmonary Function Test in Preresection and Postresection of the Lung due to Malignancy - follow up after 4 weeks and 6 months / 대한내과학회지

OBJECTIVES: At present, the overall incidence of lung cancer is increasing, causing the age-adjusted lung cancer death rate to double every 15 years. Surgical resection of the tumor offers the best prospect of long-term survival in patients with lung cancer. Accurate prediction of postoperative ventilatory function should be helpful in determining in which patients the risk of surgery are acceptable. Exercise pulmonary function test has been widely applied to objective measure of work capacity, and can be extremely helpful for investigating exertional dyspnea. But no attempt is made to assess the contribution of the lung to be resected to performance, and it has been advocated as an additional predictor of postoperative complications. The present investigation was designed to evaluate the factors such as FEV1, FVC, VEmax, Vo2max, anaerobic threshold, heart rate reserve, breathing reserve and the corelation between FEV1 and VO2max at 4 weeks and 6months after resection in patients with lung cancer. METHODS: The eighteen of patients with lung cancer who considered surgically resectable underwent progre ssively incremental exercise test to symptom-limited stage before opera-tion, and also have done at surgical resection after 4 weeks, and 6 momths. Measurements were made of metabolic, cardiorespiratory, blood gases and symptoms during exercise test. RESULTS: 1) There were significant decreases in FEV1, FVC, VO2max, VE max in 4 weeks after operation and were more decreased in FEV1, FVC, VE max with significance, but fall in VO2max without significance in 6 month after operation. 2) There was a significant corre lation between the decrease of FEV1 and that of VO2max in 6 month after operation . Conclusions This result suggests that change of FEV1 is a relatively useful predictor of change in exercise performance after lung resection in 6 month after operation.

Acute Arterial Occlusion of the Left Lower Extremity during Prolonged Fasting

Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.