Usefulness of impulse oscillometry in patients with asymptomatic bronchial asthma / 천식및알레르기

BACKGROUND: Impulse oscillometry (IOS) is a valuable method for evaluating respiratory func- tion in a patient with bronchial asthma. There have been no reports on compliance assessment of the remodeled airway by estimation of the relationship between resistance and breathing volume in asymptomatic asthma using IOS. OBJECTIVE: This study was performed to evaluate whether IOS could distinguish asymptomatic asthma from healthy control and detect altered physiology of the airway due to airway remodeling in asymptomatic asthmatic patients with normal pulmonary function. METHOD: 16 healthy and 16 asymptomatic patients with bronchial asthma were asked to breathe with the usual tidal volume (Vt) and with twice the amount of Vt. Using IOS, impedance, resistance for frequency at 5Hz and 20 Hz, reactance, and resonant frequency were measured. RESULTS: Resonant frequency was significantly higher in asymptomatic asthma than in healthy control for breathing with both usual Vt and twice the amount of Vt (mean+/-S.E.M. 16.35+/-1.44 Hz vs 13.34+/-0.66 Hz, 16.27+/-0.72 Hz vs 13.68+/-0.66 Hz, p<0.05 respectively), but the discriminant power of resonant frequency for distinguishing asymptomatic asthma from healthy control was low. There were no significant differences of other IOS parameters between asthma and control groups. Compared with control group, asymptomatic asthma group showed no significant change of IOS parameters according to breathing volume change. CONCLUSION: In this study, we could not find any IOS parameters sensitive enough to detect altered physiology of the remodeled airway in patients with asymptomatic bronchial asthma. Further studies are recommended to improve sensitivity of IOS method for investigating airway physiology in bronchial asthma.

A Case of Insulinoma Localized by Percutaneous Tracshepatic Portal Catheterization with Insulin Hormone Assay / 대한내분비학회지

The diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.

The detection of collapsible airways contributing to airflow limitation / 결핵

BACKGROUND: The detection of collapsible airways has important therapeutic implications in chronic airway disease and bronchial asthma. The distinction of a purely collapsible airways disease from that of asthma is important because the treatment of the former may include the use of pursed lip breathing or nasal positive pressure ventilation whereas in the latter, pharmacologic approaches are used. One form of irreversible airflow limitation is collapsible airways, which has been shown to be a component of asthma or to emphysema, it can be assessed by the volume difference between what exits the lung as determined by a spirometer and the volume compressed as measured by the plethysmography. METHOD: To investigate whether volume difference between slow and forced vital capacity(SVC-FVC) by spirometry may be used as a surrogate index of airway collapse, we examined pulmonary function parameters before and after bronchodilator agent inhalation by spirometry and body plethysmography in 20 cases of patients with evidence of airflow limitation(chronic obstructive pulmonary disease 12 cases, stable bronchial asthma 7 cases, combined chronic obstructive pulmonary disease with asthma 1 case) and 20 cases of normal subjects without evidence of airflow limitation referred to the Pusan National University Hospital pulmonary function laboratory from January 1995 to July 1995 prospectively. RESULTS: 1) Average and standard deviation of age, height, weight of patients with airflow limitation was 58.3+/-7.24(yr), 166+/-8.0(cm), 59.0+/-9.9(kg) and those of normal subjects was 56.3+/-12.47(yr), 165.9+/-6.9(cm), 64.4+/-10.4(kg), respectively. The differences of physical characteristics of both group were not significant statistically and male to female ratio was 14:6 in both groups. 2) The difference between slow vital capacity and forced vital capacity was 395+/-317ml in patients group and 154+/-176ml in normal group and there was statistically significance between two groups(p0.05). CONCLUSION: The difference between slow vital capacity and forced vital capacity by spirometry may be useful for the detection of collapsible airway and may help decision making of therapeutic plans.

A Case of Granular Cell Myoblastoma of the Orbit

The authors experienced a case of orbital granular cell myoblastoma in a 22 year old female, which is extreamely rare. The tumor mass had grown since 6 years ago in her right orbit. On ocular examination, the right eye was proptosed and displaced out and upward. Extraocular movements showed slight limitation of adduction of the right eye. The computed tomographic scanning revealed well defined hypervascular mass density in the right orbit. The mass was removed by modifiedkronlein approach and histopathologic examination revealed it to have features typical of granular cell myoblastoma.

Two Cases of Leber's Hereditary Optic Atrophy Occurred in Mother and Son

Leber's hereditary optic atrophy is characterized by sudden loss of central vision occuringin the second and third decade of life and nondirect transmission with male preponderance, Leber disease affecting both eyes in different degree and not simultaneouly, showing in its. early stage hyperemia of optic disc followes by a secondary atrophy, which involves a serious permanent impairment of central vision. Recently, the auther have been experienced Leber hereditary optic atrophy in 30 years old mother and 12 years old son, with severe impaiarment of visual acuity and central scotoma in both eyes and had pallor on the discs. Clinical ophthalmoscopic, perimetric, color vision test and neurologic examination were performed in two persons.