Nonepisodic angioedema with eosinophilia: A case report of a Korean patient

Nonepisodic angioedema with eosinophilia (NEAE) is a rare disease characterized by nonrecurrent angioedema with eosinophilia and normal serum IgM levels occurring predominantly in an East Asian female population. A 49-year-old male patient visited our clinic due to swelling of both the scrotums and the lower extremities, and fever. He had history of nasal polyp, cephalosporin allergy, and asthma. He was diagnosed as having NEAE and was treated with systemic corticosteroid, then he was symptom-free for more than 8 months. He had been administered omalizumab for 3 months due to uncontrolled asthma prior to the onset of angioedema which had helped taper the oral corticosteroid, and this may be associated with presentation of NEAE. Here, we report a case of NEAE in a male patient which presented with constitutional symptoms such as fever and scrotal edema

YI Kwang Su's Love and history records of modern hospital under the japanese colonial period / 의사학

This article aims to evaluate and analyze the description of the modern hospital as history record, which appeared in YI Kwang Su's novel Love. This novel has mentioned in detail western style clinic, Bukgando Catholic hospital, tuberculosis sanitarium as its main space. Modern hospitals are depicted in the novel has a great significance in historical aspect as well as in literary aspect. The most data on modern hospital is laws, statistics and newspaper archives. These materials are a great help to understand the history and status of the modern hospital. Literary description here is important materials, that specific to reconstruct the appearance of the modern hospital at that time. Literary representations infuse life into the history record. In this regard, Love has special meaning in the history of Korean modern literature. Before anything else, doctor AN Bin's clinic as a first space of the novel vividly shows the reality of the Western style clinic and a general practitioner under the colonial period. The establishment of the hospital was based on ⌜Rules on private hospital⌟ declared by the Japanese Government General of Korea in 1919. According to this Rules, a private clinic's founder had to submit the documents to the director of police affairs, in which all the details were written. It included name of hospital, site location and size, floor plan of a nearby building, each size of patient's rooms, number of steps and emergency exit, bath, toilet, disinfecting room. AN Bin's clinic was a private hospital with the requirements in the rules. The descriptions of this clinic re-created real situation of private hospitals, specifically scale of hospital, interior space, conditions of patient's room at the time. The second modern hospital in the novel is Bukgando Catholic hospital. There is a lot more materials on medical activity and hospital of protestant churches than we thought. But we do not have a lot of information on catholic church's medical activities and hospital. In this respect, Bukgando Catholic hospital in Love has a great value as historical material. The medical activity of catholic churches was weak than protestant's one under the japanese colonial period. But there were catholic church's medical activities and hospitals. The catholic church's professional medical activities are mainly deployed since the 1930s in earnest, especially Bukgando Catholic hospital played an important role. The catholic hospital in this novel is valuable material to understand medical activities of catholic church. Third form of the modern hospital described in the Love is tuberculosis sanitarium. WADA Tomomi maintained that the model of Bukhan sanitarium was Kyeongseong sanitarium, that was established by the seventh-day adventist in 1936. She thinks, that the adventist church's treatment is similar to Bukhan sanitarium's. The therapy of the adventist church, however, was common from tuberculosis treatment at the time and AN Bin was not adventist. And WADA Tomomi said that ‘ozone’ therapy of Bukhan sanitarium came from Kyeongseong sanitarium. But we can find this therapy in Haeju sanitarium. In this respect, AN Bin's sanitarium is similar to Haeju sanitarium. YI Kwang Su had not modeled his Bukhan sanitarium on certain sanitarium. He had integrated the materials on sanitarium and envisioned Bukhan sanitarium. Here Haeju sanitarium played important role than Kyeongseong sanitarium. In conclusion, Love has a special meaning as an important historical material, that restore and understand the history of the modern hospital. Literature is worth as a record of the society. In particular, novel infuses human breath into the history record, as if we can see the motion picture.

Superoxide Dismutase Gene (SOD1, SOD2, and SOD3) Polymorphisms and Antituberculosis Drug-induced Hepatitis

PURPOSE: Drug-induced liver injury (DILI) is a serious issue often leading to discontinuation of the proper regimen of antituberculosis drugs (ATD). Previous studies have suggested that antioxidant enzymes play an important role in DILI. METHODS: We explored whether polymorphisms in superoxide dismutase genes, including Cu/Zn superoxide dismutase (SOD1), manganese superoxide dismutase (SOD2) and extracellular superoxide dismutase (SOD3) are associated with ATD-induced hepatitis. Genotype distributions of four single nucleotide polymorphisms (SNPs) in three genes (rs2070424, SOD1; rs4880, SOD2; rs2536512, and rs1799895, SOD3) were compared between 84 patients with ATD-induced hepatitis and 237 patients tolerant to ATD. RESULTS: Intron SNP rs2070424 of SOD1 showed a significant association with ATD-induced hepatitis. The frequency of genotypes carrying minor alleles (GA or GG) was significantly higher in the case group than that of controls (P=0.019, OR=2.26, 95% CI 1.14-4.49). For the other SNPs of SOD2 and SOD3, there were no differences in genotype frequencies between ATD-induced hepatitis and ATD-tolerant controls. CONCLUSIONS: These findings suggest that rs2070424 of SOD1 is significantly associated with ATD-induced hepatitis. This genetic variant may be a risk factor for ATD-induced hepatitis in individuals from Korea.

A Case of Anaphylaxis Induced by Contact with Young Radish (Raphanus sativus L)

Young radish (Raphanus sativus L), a member of the mustard family (Cruciferae), is a common ingredient of Kimchi. Although few reports have described anaphylaxis to cruciferous vegetables, we report the case of anaphylaxis induced by contact with young radish. A 46-year-old female with a history of contact allergy to metal presented to our emergency room (ER) with dizziness, generalized eruption and gastrointestinal upset. Her symptoms developed after re-exposure to young radish while chopping it. Hypotensive blood pressures were noted. Three days prior, the patient had experienced generalized urticaria with pruritus immediately after chopping the fresh young radish, which resolved spontaneously. In the ER, her symptoms improved by the administration of epinephrine (0.3 mL), antihistamine (chlorpheniramine) and isotonic saline hydration. A skin prick test with young radish extract showed positive reactivity. The same skin test was negative in five adult controls. IgE-mediated hypersensitivity could be an important immunologic mechanism in the development of young radish-induced anaphylaxis.

Massive Hemoptysis due to Acute Mitral Regurgitation with Sporadic Primary Mitral Valve Prolapse / 대한구급학회지

The most common cardiac cause of massive hemoptysis is mitral stenosis. Mitral regurgitation is rarely complicated by massive hemoptysis. A 48-year-old man with no significant medical history was admitted to our hospital with hemoptysis and production of 500 mL of blood within 24 hours. A pan-systolic murmur was found on chest examination. A chest computed tomography showed airspace consolidation in the right upper and middle lobes, with faint bilateral ground glass opacity. Echocardiography revealed mitral valve prolapse and grade IV mitral regurgitation. The patient was diagnosed with sporadic primary mitral valve prolapse. After mitral valve repair surgery, the patient recovered fully.

Massive Hemoptysis due to Acute Mitral Regurgitation with Sporadic Primary Mitral Valve Prolapse / 대한중환자의학회지

The most common cardiac cause of massive hemoptysis is mitral stenosis. Mitral regurgitation is rarely complicated by massive hemoptysis. A 48-year-old man with no significant medical history was admitted to our hospital with hemoptysis and production of 500 mL of blood within 24 hours. A pan-systolic murmur was found on chest examination. A chest computed tomography showed airspace consolidation in the right upper and middle lobes, with faint bilateral ground glass opacity. Echocardiography revealed mitral valve prolapse and grade IV mitral regurgitation. The patient was diagnosed with sporadic primary mitral valve prolapse. After mitral valve repair surgery, the patient recovered fully.

Acute lung injury after bee sting acupuncture

Bee stings can cause severe adverse reactions. There have been no cases of acute lung injury induced by bee sting acupuncture. We report a case of a 52-year-old male who required high flow oxygen therapy because of acute lung injury by bee sting acupuncture. The patient had been treated with live bee sting acupuncture by himself for knee pain. After self-injections of live bee sting, he immediately presented with generalized urticaria that remitted within 3 hours after taking an oral antihistamine. Ten days later, he visited our emergency department due to dyspnea and dizziness. He was diagnosed with acute lung injury by bee sting acupuncture based upon a history of symptom onset after exposure to the allergen and clinical test results. This case emphasizes that practitioners should consider potential risks of delayed-onset adverse reactions induced by bee sting acupuncture.

Erratum: The Effects of Bronchiectasis on Asthma Exacerbation / 결핵및호흡기질환

In the reference list, reference 16 should be omitted. Reference numbers in the text and in the reference list must be changed accordingly.

The Effects of Bronchiectasis on Asthma Exacerbation / 결핵및호흡기질환

BACKGROUND: Bronchiectasis and asthma are different in many respects, but some patients have both conditions. Studies assessing the effect of bronchiectasis on asthma exacerbation are rare. The aim of this study is to investigate the effect of bronchiectasis on asthma exacerbation. METHODS: We enrolled 2,270 asthma patients who were followed up in our hospital. Fifty patients had bronchiectasis and asthma. We selected fifty age- and sex-matched controls from the 2,220 asthma patients without bronchiectasis, and assessed asthma exacerbation and its severity based on the annual incidence of total asthma exacerbation, annual prevalence of steroid use, and frequency of emergency room visits and hospitalizations due to asthma exacerbation in each group. RESULTS: Fifty patients (2.2%) had bronchiectasis and asthma. The annual incidence of asthma exacerbation was higher in patients with asthma and bronchiectasis than in patients with asthma alone (1.08+/-1.68 vs. 0.35+/-0.42, p=0.004). The annual prevalence of steroid use (0.9+/-1.54 vs. 0.26+/-0.36, p=0.006) and the frequency of emergency room visits (0.46+/-0.84 vs. 0.02+/-0.13, p=0.001) due to asthma exacerbation were also higher in patients with asthma and bronchiectasis than in patients with asthma alone. CONCLUSION: Bronchiectasis is associated with difficult asthma control.

Suppression of Heme Oxygenase-1 by Prostaglandin E2-Protein Kinase A-A-Kinase Anchoring Protein Signaling Is Central for Augmented Cyclooxygenase-2 Expression in Lipopolysaccharide-Stimulated RAW 264.7 Macrophages

PURPOSE: Prostaglandin (PG) E2 is an immunomodulatory lipid mediator generated mainly via the cyclooxygenase-2 (COX-2) pathway from arachidonic acid at sites of infection and inflammation. A positive feedback loop of PGE2 on COX-2 expression is critical for homeostasis during toll-like receptor (TLR)-mediated inflammatory processes. The mechanism of PGE2-regulated COX-2 expression remains poorly understood. The low-molecular-weight stress protein heme oxygenase-1 (HO-1) contributes to the anti-inflammatory, anti-oxidant and anti-apoptotic response against environmental stress. METHODS: We explored the involvement of HO-1 on PGE2 regulation of LPS-induced COX-2 expression in RAW 264.7 macrophages. RESULTS: LPS-induced COX-2 expression in RAW 264.7 macrophages was enhanced by exogenous PGE2 or cyclic AMP (cAMP) analogue and was suppressed by a COX inhibitor (indomethacin), a protein kinase A (PKA) inhibitor (KT5720), and A kinase anchoring protein (AKAP) disruptors (Ht31 and RIAD). This result suggests that the stimulatory effects of endogenous and exogenous PGE2 on COX-2 expression are mediated by a cAMP-PKA-AKAP-dependent pathway. The induction of HO-1 was observed in LPS-stimulated RAW 264.7 macrophages. This induction was suppressed by exogenous PGE2 and enhanced by blockage of the endogenous PGE2 effect by the PKA inhibitor or AKAP disruptors. In addition, HO-1 induction by the HO activator copper protoporphyrin suppressed LPS-induced COX-2 expression, which was restored by the addition of exogenous PGE2. The induction of HO-1 inhibited LPS-induced NF-kappaB p-65 nuclear expression and translocation. CONCLUSIONS: AKAP plays an important role in PGE2 regulation of COX-2 expression, and the suppression of HO-1 by PGE2-cAMP-PKA-AKAP signaling helps potentiate the LPS-induced COX-2 expression through a positive feedback loop in RAW 264.7 macrophages.

Unilateral Thrombosis of a Deep Cerebral Vein Associated with Transient Unilateral Thalamic Edema

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.

ABCC2 Haplotype is Associated With Antituberculosis Drug-Induced Maculopapular Eruption

Genetic variants in ATP-binding cassette (ABC) transporter genes are associated with increased susceptibility to adverse drug reactions. We hypothesized that genetic variant ABC transporters (ABCB1 and ABCC2) may be candidate markers for predicting maculopapular eruption (MPE) induced by antituberculosis therapy. We compared the genotype distributions of single nucleotide polymorphisms and haplotypes in the ABCB1 and ABCC2 genes between 62 antituberculosis drug (ATD)-induced MPE cases and 159 ATD-tolerant controls using multivariate logistic regression analysis. There was no significant association between genetic polymorphisms in ABCB1 and ATD-induced MPE (P>0.05). Among seven selected SNPs of ABCC2, IVS3-49C>T in intron and I1324I were associated with ATD-induced MPE (P=0.029 and 0.036, respectively). In an analysis of the ABCC2 haplotypes (ht; -1549G>A_-24C>T_IVS3-49C>T_V417I), ht1[G-C-C-G] was significantly associated with ATD-induced MPE (P=0.032, OR=0.35, 95% CI: 0.16-0.95). No significant association between the other haplotypes and ATD-induced MPE was observed. An ABCC2 haplotype is associated with the presence of ATD-induced MPE in patients with tuberculosis and may be a genetic risk factor for the development of MPE induced by ATD.

A Case of Bilateral Vocal Cord Paralysis Due to Subglottic Pressure Injury after Endotracheal Intubation: A Case Report / 대한구급학회지

Bilateral vocal cord paralysis may occur as a result of mechanical injury during neck surgery, nerve compression by endotracheal intubation or mass, trauma, and neuromuscular diseases. However, only a few cases of bilateral vocal cord paralysis have occurred following short-term endotracheal intubation. We report a case of bilateral vocal cord paralysis subsequent to extubation after endotracheal intubation and mechanical ventilation due to severe pneumonia for 2 days.

Prediction of Brobchodilator Response by Using FEF25~75% in Adult Patient with a Normal Spirometry Result / 결핵및호흡기질환

BACKGROUND: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity (FEF(25~75%)) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between FEF25~75% and BDR in patients with suspicious asthma and normal spirometry. METHODS: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] > or =70% & FEV1% predicted > or =80%) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of FEV1 after bronchodilator (DeltaFEV1%). RESULTS: Among the 440 patients with normal spirometry, FEF(25~75%)% predicted were negatively correlated with DeltaFEV1% (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of FEF(25~75%)% predicted were 64.0+/-14.5% in the BDR (+) group and 72.9+/-20.8% in the BDR (-) group (p<0.01). The negative correlation between FEF(25~75%)% predicted and DeltaFEV1% was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, FEF(25~75%) at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. CONCLUSION: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, FEF(25~75%)% predicted was well correlated with BDR.

A case of pneumatosis cystoides intestinalis complicated by pneumoperitoneum in a post-tuberculosis destroyed lung / 대한내과학회지

Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts within the bowel wall. It may be idiopathic or secondary to a variety of disorders. Associated conditions include chronic obstructive pulmonary disease, the use of non-steroidal anti-inflammatory drugs, collagen vascular disease, organ transplantation, and necrotizing enterocolitis. Approximately 15% of cases are idiopathic. We present a case of pneumatosis cystoides intestinalis complicated by pneumoperitoneum in chronic respiratory failure due to a post-tuberculosis destroyed lung. Successful palliation involved paracentesis of the peritoneal air and oxygen therapy.

Incidence of tuberculosis in Korean diabetics: Comparison with that in non-diabetic hypertensive subjects / 대한내과학회지

BACKGROUND/AIMS: Tuberculosis remains a major cause of mortality in South Korea, and the prevalence of diabetes is also increasing rapidly. Diabetes is a well known risk factor for tuberculosis. However, the risk varies according to race and regional prevalence. We assessed the potential impact of diabetes as a risk factor for tuberculosis in South Korea. METHODS: We performed a retrospective cohort study in a secondary referral hospital. The incidence of tuberculosis in a diabetic cohort was compared with that in a non-diabetic hypertensive cohort for 6 years. Diabetics who visited our diabetic clinic and non-diabetic hypertensive patients who visited our cardiology clinic from Jan 2004 to April 2004 were assigned to the diabetic cohort and the non-diabetic hypertensive cohort, respectively. Patients in each cohort had to receive medications to control their diseases. Patients with end-stage renal disease, malignancy, or HIV infection were excluded. Relative risk and tuberculosis-free survival rates of each cohort were calculated. RESULTS: The incidences of tuberculosis were 32 in the diabetic cohort (n=2491; mean age, 59.1+/-11.8 years; 44.5% male) and ten in the non-diabetic hypertensive cohort (n=1885; mean age, 59.9+/-12.8 years; 41.6% male). The estimated annual incidences per 100,000 persons were 282.8 and 112.9, respectively. The relative risk was 2.220 (p=0.028; 95% confidence interval, 1.090~4.523). However, no significant difference in cumulative tuberculosis-free survival rate was observed between the cohorts (p=0.075). CONCLUSIONS: A trend for a higher incidence of tuberculosis existed in diabetics, as compared to non-diabetic hypertensive patients, among a Korean population.

Intravascular Lipoma of the Right Subclavian Vein / 결핵및호흡기질환

Lipomas are common soft tissue tumors that are located in the body tissues containing adipose tissues. However, lipomas arising from the walls of a vein are very rare. Intravascular lipomas have been described most commonly in association with the inferior vena cava. Intravascualar lipomas involving the subclavian vein are rare. We are reporting a case of an asymptomatic lipoma of the right subclavian vein, growing into the right brachiocephalic vein.

Tracheal collapsibility measured using end-expiratory chest CT in chronic airway disease / 대한내과학회지

BACKGROUND/AIMS: Partial tracheal narrowing can occur during expiration in the normal population. It is not certain whether the trachea collapses more readily in chronic airway disease. We evaluated the tracheal narrowing at end-expiration using computed tomography (CT). METHODS: We investigated 45 patients and 22 normal subjects who underwent high-resolution CT and pulmonary function tests. In each subject, two CT images at the same level of the aortic arch were compared: one at end-inspiration and the other at end-expiration. The cross-sectional area and sagittal diameter of the trachea were measured using a hand-tracing method, using the in-program measuring tools of Medical Image Viewer, and the percentage changes of each value were calculated. RESULTS: Of the 45 patients with chronic airway disease, 21 had chronic obstructive pulmonary disease, 16 had bronchial asthma, and 8 had bronchiectasis. The mean change in the cross-sectional area was 13.3% in the patients and 9.0% in the normal subjects (p0.05). The decrease in tracheal cross-sectional area was greatest in bronchiectasis, while the greatest decrease in sagittal diameter was in bronchial asthma. There was no significant difference in tracheal collapsibility among the disease groups. The percent change in the tracheal cross-sectional area was correlated with the % predicted FVC (r=-0.033, p<0.05) and FEV1 (r= 0.277, p<0.05) in both the patients and normal controls. CONCLUSIONS: The decrease in tracheal cross-sectional area at end-expiration measured using chest CT was greater in chronic airway disease than in normal subjects, and was associated with ventilatory function.

A Case of Pseudochylothorax Developed from Chronic Pleural Effusion after Treatment of Tuberculous Pleurisy / 결핵및호흡기질환

A pseudochylothorax, a chyliform pleural effusion, is a rare disease of pleural effusion that contains cholesterol crystals or high lipid content that is not the result of a disrupted thoracic duct. Most of the cases were found in patients with long-standing pleural effusion due to chronic inflammatory disease, such as old tuberculous pleurisy or chronic rheumatoid pleurisy. We experienced a case of pseudochylothorax in a 74-year-old man, who was being treated for pulmonary tuberculosis and pleurisy 10 years ago. The diagnosis was confirmed on pathological study of the pleural effusion, which contained cholesterol crystals having a diagnostic rhomboid appearance.

The Role of Keratinocyte-derived Chemokine in Hemorrhage-induced Acute Lung Injury in Mice

Dominant inflammatory cytokines might be different depending on the underlying causes of acute lung injury (ALI). The role of kertinocyte-derived chemokine (KC), a potent chemoattractant for neutrophils, has not been clearly established in hemorrhage-induced ALI. In this study, lung injury and cytokine expressison were evaluated in LPS- or hemorrhage-induced ALI models of BALB/c mice. The myeloperoxidase activities at 4 hr after hemorrhage and LPS-injection were 47.4+/-13.0 and 56.5+/-16.4 U/g, respectively. NF-kappa B activity peaked at 4 hr after hemorrhage, which was suppressed to the control level by anti-high mobility group B1 (HMGB1) antibody. Lung expressions of TNF-alpha, MIP-2, and IL-1beta were increased by LPS injection. However, there was only a minimal increase in IL-1beta and no expressions of TNF-alpha or MIP-2 in hemorrhage-induced ALI. In contrast, lung KC increased significantly at 4 hr after hemorrhage compared to control levels (83.1+/-12.3 vs. 14.2+/-1.6 pg/mL/mg by ELISA) (P<0.05). By immunohistochemical staining, lung neutrophils stained positive for KC. Increased KC was also observed in bronchoalveolar lavage fluid and plasma. KC plays an important role in hemorrhage-induced ALI.