Comparing Inhaler Use Technique Based on Inhaler Type in Elderly Patients with Respiratory Disease / 결핵및호흡기질환

Background@#The aim of this study was to investigate inhaler device handling in elderly patients. Inhaler devices with respect to misuse and error correction were also compared. @*Methods@#Inhaler use technique was assessed using standardized checklists at the first visit and 3-month follow-up visit after retraining. The primary outcome was difference in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction, the most common step of misuse, and factors affecting the accuracy of inhaler use. @*Results@#A total of 251 patients (mean age, 76.4 years) were included. The handling of 320 devices was assessed in the study. All patients had been trained before. However, only 24.7% of them used inhalers correctly. Proportions of acceptable use for Evohaler, Respimat, Turbuhaler, Ellipta, and Breezhaler/Handihaler were 38.7%, 50.0%, 61.4%, 60.8%, and 43.2%, respectively (p=0.026). At the second visit, the acceptable use ratio had increased. There were no significant differences among inhaler types (Evohaler, 63.9%; Respimat, 86.1%; Turbuhaler, 74.3%; Ellipta, 64.6%; and Breezhaler/Handihaler, 65.3% [p=0.129]). In multivariate analysis, body mass index, Turbuhaler, and Ellipta showed positive correlations with acceptable use of inhalers, whereas Chronic Obstructive Pulmonary Disease Assessment Test score showed a negative correlation. @*Conclusion@#Although new inhalers have been developed, the accuracy of inhaler use remains low. Elderly patients showed more errors when using pressurized metered-dose inhalers than using dry powder inhalers and soft-mist inhalers. However, there were no significant differences in misuse among inhaler devices after individual training. Results of this study suggests that repeat training is more important than inhaler type.

Treatment Response and Long Term Follow-up Results of Nonspecific Interstitial Pneumonia

The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse.

Risk Factors of Postoperative Pneumonia after Lung Cancer Surgery

The purpose of this study was to investigate risk factors of postoperative pneumonia (POP) after lung cancer surgery. The 417 lung cancer patients who underwent surgical resection in a tertiary referral hospital were included. Clinical, radiological and laboratory data were reviewed retrospectively. Male and female ratio was 267:150 (median age, 65 yr). The incidence of POP was 6.2% (26 of 417) and in-hospital mortality was 27% among those patients. By univariate analysis, age > or = 70 yr (P or = 4.2 hr (P = 0.043), intraoperative red blood cells (RBC) transfusion (P = 0.004), presence of postoperative complications other than pneumonia (P = 0.020), forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) or = 0.15 mg/dL (P = 0.001) were related with risk of POP. Multivariate analysis showed that age > or = 70 yr (OR = 3.563, P = 0.014), intraoperative RBC transfusion (OR = 4.669, P = 0.033), the presence of postoperative complications other than pneumonia (OR = 3.032, P = 0.046), and FEV1/FVC < 70% (OR = 3.898, P = 0.011) were independent risk factors of POP. In conclusion, patients with advanced age, intraoperative RBC transfusion, postoperative complications other than pneumonia and a decreased FEV1/FVC ratio have a higher risk for pneumonia after lung cancer surgery.

Diffuse Alveolar Hemorrhage Subsequently Developed after Recovery from Severe Acute Lung Injury Caused by H1N1 Influenza Infection: A Case Report / 대한구급학회지

Severe acute lung injury (ALI), leading to respiratory failure caused by H1N1 infection, developed in a 34-year-old man during a work-up for non-small cell lung cancer. Although he fully recovered through instant treatment with oseltamivir, mechanical ventilation was required again, 7 days later, due to subsequent diffuse alveolar hemorrhage (DAH). Finally, his condition improved and he was able to move out of the intensive care unit. However, multiple pulmonary metastatic nodules appeared over a period of one month, suggesting the aggressive nature of lung cancer. Although he was discharged after chemotherapy, his prognosis seemed poor, considering the rapidity of growth of the lung cancer. It is important to recognize that DAH can occur after acute lung injury caused by influenza virus.

Subcutaneous nodule developed after needle biopsy for lung cancer / 대한내과학회지

No abstract available.

The number of resident physicians and the mortality rate in a medical intensive care unit / 대한내과학회지

BACKGROUND/AIMS: The treatment outcome of patients hospitalized in intensive care units (ICUs) can be influenced by physician factors, including both intensivists and resident physicians. We evaluated the association between the number of residents who are exclusively responsible for the ICU and the mortality rate in a medical ICU. METHODS: The data obtained from an open medical ICU in a teaching hospital from Jan. 2005 to Dec. 2009 were analyzed retrospectively. We evaluated the associations between the ICU mortality rate and both the number of resident physicians and the number of patient-days per resident physician using multivariate Poisson regression analysis adjusted for year and month. RESULTS: The months with fewer than two residents tended to have a higher ICU mortality rate, although this difference was not significant in the univariate analyses. Multivariate Poisson regression analysis showed that months with fewer than two residents had a significantly higher ICU mortality rate compared with months with two residents (incidence risk ratio (IRR) 1.59, 95% confidence interval (CI) 1.05-2.41; p=0.029). The number of ICU patient-days per resident physician was not associated with the ICU mortality rate (IRR; 1.00, 95% CI, 0.99-1.01; p=0.649). CONCLUSIONS: The presence of fewer than two residents exclusively responsible for the medical ICU was an independent risk factor of a higher ICU mortality rate. However, no association was found between the number of ICU patient-days per resident physician and the ICU mortality rate.

Relations between serum gamma-glutamyltransferase and prevalence of diabetes mellitus / 대한내과학회지

BACKGROUND: Gamma-glutamyltransferase (GGT), which is an intracellular antioxidant due to maintain intracellular concentrations of glutathione, may be a marker of oxidative stress. In the present study, oxidative stress was thought to be a cause of diabetes mellitus. So, We performed a cross sectional study about the relations between GGT and prevalence of diabetes mellitus. METHODS: In total 5049 healthy men who had visited the Yonsei Wonju Christian Hospital for health care from 1st January 2002 to 31st December 2002, we measured BMI, blood pressure, GGT, total cholesterol, ALT and fasting blood sugar levels. RESULTS: There were strong relations between serum GGT concentrations and age, BMI, total cholesterol, systolic blood pressure, diastolic blood pressure and ALT level. GGT level had positive correlations with the prevalence of diabetes mellitus and impaired glucose tolerance when divided into four classes, 0~19 IU/L, 20~39 IU/L, 40~59 IU/L and over 60 IU/L. We got the same results after adjustment with BMI, total cholesterol, blood pressure and ALT level. CONCLUSION: There was a positive correlation between GGT level and the prevalence of diabetes mellitus, and that was definite especially when BMI, total cholesterol, blood pressure and ALT levels were in normal range. We suggest that serum GGT level would be an important marker in the development of diabetes mellitus.

Inhibition of Viability and Genetic Change in Hypoxia-treated Lung Pericytes / 결핵및호흡기질환

BACKGROUND: Lung pericytes are important constituent cells of blood-air barrier in pulmonary microvasculature. These cells take part in the control of vascular contractility and permeability. In this study, it was hypothesized that change of lung pericytes might be attributable to pathologic change in microvasculature in acute lung injury. The purpose of this study was how hypoxia change proliferation and genetic expression in lung pericytes. METHODS: From the lungs of several Sprague-Dawley rats, performed the primary culture of lung pericytes and subculture. Characteristics of lung pericytes were confirmed with stellate shape in light microscopy and immunocytochemistry. 2% concentration of oxygen and 200muM CoCl2 were treated to cells. Tryphan blue method and reverse transcription-polymerase chain reaction were done. RESULTS: 1. We established methodology for primary culture of lung pericytes. 2. Hypoxia inhibited cellular proliferation in pericytes. 3. Hypoxia could markedly induce vascular endothelial growth factor(VEGF) and smad-2. 4. Hypoxia-inducible factor-1alpha (HIF-1alpha)was also induced by 2% oxygen. CONCLUSION: Viability of lung pericytes are inhibited by hypoxia. Hypoxia can stimulate expression of hypoxia-responsive genes. Pericytic change may be contributed to dysfunction of alveolar-capillary barrier in various pulmonary disorders.

Clinical Manifestations and Treatment Outcomes of Pulmonary Aspergilloma

BACKGROUND: Pulmonary aspergilloma usually results from the ingrowth of colonized Aspergillus from a damaged bronchial tree, a pulmonary cyst, or from the cavities of patients with underlying lung diseases. In the present study, we analyzed the clinical features, diagnostic methods, and managements of 36 patients with pulmonary aspergilloma. METHODS: Thirty-six patients were diagnosed as having pulmonary aspergilloma at Chung-Ang University Hospital between February 1988 and February 2000. Their medical records were reviewed retrospectively. RESULTS: The age of patients (median +/- SD) was 53.3 +/- 11.8 years, the male to female ratio was 2.36: 1, and the most frequent symptom was hemoptysis, which occurred in 24 patients (65%). The most common underlying disease was pulmonary tuberculosis (81%), and the upper lobes of both lungs were the most frequently involved sites. Nine patients received a chest CT in the prone position and seven of these showed a movable fungus ball. Eleven patients were positive for the precipitin antibody to A. fumigatus. Twenty patients underwent surgical resection, and post-operative complications were reported in seven cases. The post-operative mortality was 5.6% (2/36). CONCLUSION: Pulmonary aspergilloma usually develops in the patients with underlying lung diseases. Resectional lung surgery is considered the mainstay of therapy for pulmonary aspergilloma. However, this operation is associated with significant complications and death in some cases. Therefore, it is necessary to develop reasonable criteria for selection of candidates for such surgery.

A Case of Bronchial Foreign Body Misdiagnosed as Bronchial Asthma / 결핵및호흡기질환

In adults, aspiration of foreign bodies into tracheobronchus is sometimes presented atypically, mimicking chronic pulmonary diseases such as bronchial asthma, pneumonia, or empyema, especially without notice of aspiration or choking. In such cases, diagnosis and adequate treatments are often delayed. Suspicion of foreign body aspiration and computed tomography and bronchoscopic examination make correct diagnosis more early. We report a case of bronchial foreign body, which had been misdiagnosed as bronchial asthma with wheezing in the whole lung filed, and reversible airway obstruction in the spirometry

Clinical Expriences of Circumferential Stapled Hemorrhoidectomy

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.

Clinical Expriences of Circumferential Stapled Hemorrhoidectomy

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.

Evaluation of Tuberculosis Activity in Patients with Anthracofibrosis by Use of Serum Levels of IL-2 sRalpha, IFN-gamma and TBGL(Tuberculous Glycolipid) Antibody / 결핵

BACKGROUND: Anthracofibrosis, a descriptive term for multiple black pigmentation with fibrosis on bronchoscopic examination, has a close relationship with active tuberculosis (TB). However, TB activity is determined in the later stage by the TB culture results in some cases of anthracofibrosis. Therefore, it is necessary to identify early markers of TB activity in anthracofibrosis. There have been several reports investigating the serum levels of IL-2 sRalpha, IFN-gamma and TBGL antibody for the evaluation of TB activity. In the present study, we tried to measure the above mentioned serologic markers for the evaluation of TB activity in patients with anthracofibrosis. METHODS: Anthracofibrosis was defined when there was deep pigmentation (in more than two lobar bronchi) and fibrotic stenosis of the bronchi on bronchoscopic examination. The serum of patients with anthracofibrosis was collected and stored under refrigeration before the start of anti-TB medication. The serum of healthy volunteers (N=16), patients with active TB prior to (N=22), and after (N=13), 6 month-medication was also collected and stored. Serum IL-2 sRalpha and IFN-gamma were measured with ELISA kit (R&D system, USA) and serum TBGL antibody was measured with TBGL EIA kit (Kyowa Inc, Japan). RESULTS: Serum levels of IL-2 sRalpha in healthy volunteers, active TB patients before and after medication, and patients with anthracofibrosis were 640+/-174, 1,611+/-2,423, 953+/-562, and 863+/-401 pg/ml, respectively. The serum IFN-gamma levels were 0, 8.16+/-17.34, 0.70+/-2.53, and 2.33+/-6.67 pg/ml, and TBGL antibody levels were 0.83+/-0.80, 5.91+/-6.71, 6.86+/-6.85, and 3.22+/-2.59 U/ml, respectively. The serum level of TBGL antibody was lower than that of other groups (p<0.05). There was no significant difference of serum IL-2 sRalpha and IFN-gamma levels among the four groups. CONCLUSION: The serum levels of IL-2 sRalpha, IFN-gamma and TBGL antibody were not useful in the evaluation of TB activity in patients with anthracofibrosis. More useful ways need to be developed for the differentiation of active TB in patients with anthracofibrosis.

Clinical investigation of pulmonary aspergilloma / 대한내과학회지

BACKGROUND: Pulmonary aspergilloma usually results from the ingrowth of the colonized Aspergillus in the damaged bronchial tree, pulmonary cyst, or cavities of patients with underlying lung diseases. We analyzed the clinical features, diagnostic methods, and managements of 36 patients with pulmonary aspergilloma. METHODS: From February 1988 to February 2000, medical records of 36 patients who were diagnosed as pulmonary aspergilloma at Chung Ang university hospital were reviewed retrospectively. RESULTS: The mean age (mean+/-SD) was 53.3+/-11.8 years, The male to female ratio was 2.36:1. The most frequent symptom was hemoptysis which occured in 24 patients (65%). The most common underlying disease was pulmonary tuberculosis (81%). The upper lobe was most commonly involved area. In 9 patients, chest CT was taken with prone position and 7 of them showed movability of the fungus ball. Eleven patients showed positive test for precipitin antibody of Aspergillus species. As for the treatment, 20 patients underwent surgical resection. Post-operative complications were reported in 7 cases. The post-operative mortality was 5.6% (2/36). CONCLUSION: Pulmonary aspergillomas usually develop in patients with underlying respiratory diseases. Resectional lung surgery is considered to be the mainstay of therapy for pulmonary aspergilloma. However, operation is associated with significant complication rate and even deaths. Therefore, it is necessary to develop a reasonable criteria for the selection of suitable candidates with aspergilloma for the surgery.

The Effects of Surfactant on Neutrophil Apoptosis in Lipopolysaccharide Induced Acute Lung Injury in Rat / 결핵

BACKGROUND: The therapeutic effects of surfactant on acute lung injury derive not only from its recruiting action on collapsed alveoli but also from its anti-inflammatory effects. Pro-apoptotic action on alveolar neutrophils represents one of the important anti-inflammatory mechanisms of surfactant. In the present study, we evaluated the effects of surfactant on the apoptosis of human peripheral and rat alveolar neutrophils. METHODS: In the (Ed- the article is not definitely needed but it helps to separate the two prepositions 'in') in vitro study, human neutrophils were collected from healthy volunteers. An equal number of neutrophils (1X10(6)) (Ed-confirm) was treated with LPS (10, 100, 1000ng/ml), surfactant (10, 100, 1000micro gram/ml), or a combination of LPS (1000ng/ml) and surfactant (10, 100, 1000micro gram/ml). After incubation for 24 hours, the apoptosis of neutrophils was evaluated by Annexin V method. In the in vivo study, induction of acute lung injury in SD rats by intra-tracheal instillation of LPS (5mg/kg) was followed by intra-tracheal administration of either surfactant (30mg/kg) or normal saline (5ml/kg). Twenty-four hours after LPS instillation, alveolar neutrophils were collected and the apoptotic rate was evaluated by Annexin V method. In addition, changes of the respiratory mechanics of rats (respiratory rate, tidal volume, and airway resistance) were evaluated with one chamber body plethysmography before, and 23 hours after, LPS instillation. RESULTS: In the in vitro study, LPS treatment decreased the apoptosis of human peripheral blood neutrophils (control; 47.4+/-5.0%, LPS 10ng/ml; 30.6+/-10.8%, LPS 100ng/ml; 27.5+/-9.5%, LPS 1000ng/ml; 24.4+/-7.7%). The combination of low to moderate doses of surfactant with LPS promoted apoptosis (LPS 1000ng/ml + Surf 10micro gram/ml; 36.6+/-11.3%, LPS 1000ng/ml + Surf 100micro gram/ml; 41.3+/-11.2%). The high dose of surfactant (1000micro gram/ml) decreased apoptosis (24.4+/-7.7%) and augmented the anti-apoptotic effect of LPS (LPS 1000ng/ml + Surf 1000micro gram/ml; 19.8+/-5.4%). In the in vivo study, the apoptotic rate of alveolar neutrophils of surfactant-treated rats was higher than that of normal saline-treated rats (6.03+/-3.36% vs. 2.95+/-0.58%). The airway resistance (represented by Penh) of surfactant-treated rats was lower than that of normal saline-treated rats at 23 hours after LPS injury (2.64+/-0.69 vs. 4.51+/-2.24, p<0.05). CONCLUSIONS: Surfactant promotes the apoptosis of human peripheral blood and rat alveolar neutrophils. Pro-apoptotic action on neutrophils represents one of the important anti-inflammatory mechanisms of surfactant.

The Relationship Between the NF-kappa B Activity and Anti-inflammatory Action of Surfactant in the Acute Lung Injury of Rats / 결핵

BACKGROUND: The therapeutic effects of surfactants on acute lung injury derive not only from their recruiting action on collapsed alveoli but also from their anti-inflammatory action in the alveolar space. This study evaluated the anti-inflammatory action of a surfactant in an acute lung injury model of rats by measuring the WBC count, IL-1beta and IL-6 level of bronchoalveolar lavage(BAL) fluid. In addition, neutrophils were recollected from the BAL fluid and the NF-kappa B activity of the neutrophilic nuclear protein was evaluated. METHODS: Male Sprague-Dawley rats weighing approximately 300 gram were divided into 3 groups, which consisted of 6 rats respectively. In the control group, normal saline(3ml/kg) was instilled into the trachea twice with 30 minute interval. In two other groups, acute lung injury was induced by the intra-tracheal instillation of LPS(5mg/kg). Thirty minutes later, either a surfactant(ST group; 30mg/kg) or normal saline(NT group: 3ml/kg) was instilled via the trachea. Twenty-four hours after the LPS instillation, the BAL fluid was retrieved to measure the WBC count and cytokine(IL-1beta and IL-6) levels. The neutrophils were isolated from the BAL fluid and the nuclear protein was extracted to evaluate the NF-kappa Bactivity using a eletrophoretic mobility shift assay(EMSA). RESULTS: The WBC count of the BAL fluid of the ST group(3,221+/-1,914 X 10(3)/micro liter) was higher than that of the control group(356+/-275X10(3)/micro liter)(p<0.05) and lower than that of the NT group(5,561+/-1,757 X 10(3)/micro liter)(p<0.05)). The BAL fluid level of IL-1beta from the NT group(2,064+/-1,082pg/ml) was higher than those of the ST group(360+/-234pg/ml)(p<0.05) and the control group(0pg/ml)(p<0.05). The BAL fluid concentration of IL-6 from the NT group(3,621+/-567pg/ml) was also higher than those of the ST group(1,754+/-1,340pg/ml)(p<0.05) and control group(49+/-62pg/ml)(p<0.05). The NF-kappa B activity of the neutrophilic nuclear protein in the ST group and NT group was similar. CONCLUSIONS: The surfactant attenuates the alveolar inflammation in the acute lung injury of rats model. However, its anti-inflammatory action does no't appear to be mediated by the inhibition of NF-kappa B activity.

Treatment of tetanus:a case report

No abstract available.

Treatment of tetanus:a case report

No abstract available.