A Case of lymphangitic carcinomatosis of lung presented as rapidly exacerbating reticulonodular infiltrates / 결핵

A 52-year-old woman was presented with 2-week history of increasing dyspnea and dry cough. The chest radiograph revealed bilateral reticular infiltrates. Radiographic infiltrates were rapidly progressed and symptoms from hypoxemia were aggravated. The patient was intubated and bronchoscopy with transbronchial lung biopsies was performed. Biopsies revealed lymphatic vessels plugged by nests of metastatic adenocarcinoma. She died 11 days after admission despite of intensive ventilatory support. We had difficulties in the diagnosis of lymphangitic lung carcinomatosis at initial presentation of her illness because the progression was unusually rapid. Lymphangitic lung carcinomatosis should be included in the differential diagnosis of patients showing rapidly progressive interstitial radiographic findings. Also, transbronchial lung biopsy may be a useful tool to confirm the diagnosis.

Effect of Bronchial Artery Embolization(BAE) in Management of Massive Hemoptysis / 결핵

BACKGROUND: Massive and untreated hemoptysis is associated with a mortality of greater than 50 percent. Since the bleeding is from a bronchial arterial source in the vast majority of patients, embolization of the bronchial arteries(BAE) has become an accepted treatment in the management of massive hemoptysis because it achieves immediate control of bleeding in 75 to 90 percent of the patients. METHODS: Between 1990 and 1996, we treated 146 patients with hemoptysis by bronchial artery embolization. Catheters(4, 5, or 7F) and gelfoam, ivalon, and / or microcoil were used for embolization. RESULTS: Pulmonary tuberculosis and related disorders were the most common underlying disease of hemoptysis(72.6%). Immediate success rate to control bleeding within 24hours was 95%, and recurrence rate was 24.7%. The recurrence rate occured within 6 months after embolization was 63.9%. Initial angiographic findings such as bilaterality, systemic-pulmonary artery shunt, neovascularity, aneurysm were not statistically correlated with rebleeding tendency(P>0.05). Among Initial radiographic findings,only pleural lesions were significantly correlated with rebleeding tendency(P<0.05). At additional bronchial artery angiograpy done due to rebleeding, recanalization of previous embolized arteries were 63.9%, and the presence of new feeding arteries were 16.7%, and 19.4% of patients with rebleeding showed both. The complications such as fever, chest pain, headache, nausea and vomiting, arrhythmia, paralylytic ileus, transient sensory loss(lower extremities), hypotension, urination difficulty were noticed at 40 patients(27.4%). CONCLUSION: We conclude that bronchial artery embolization is relatively safe method achieving immediate control of massive hemoptysis. At initial angiographic findings, we could not find any predictive factors for subsequent rebleeding. It may warrant further study whether patients with pleural disease have definetely increased rebleeding tendency.

The Relationship between ST-T Electrical Alternans on EKG and Ventricular Arrhythmia

In order to observe the development of ventricular arrhythmia during regional myocardial ischemia and reperfusion, especially under the presence or absence of ST-T electrical alternans on epicardial EKG. The proximal left descending coronary artery(LAD) was ligated for 20 minutes and then reperfused suddenly in twenty-three cats. Standard lead EKG(Lead??, chest lead EKG and epicardial lead EKG were recorded simultaneously during the occlusion and reperfusion respectively. During the ligation of LAD, STEA was observed in thirteen cats(56.5%). In occlusion period, the incidence of ventricular tachycardia in STEA positive group was significantly higher than in the negative group(p<0.01) and arrhythmic score was significantly higher(p<0.005) also In the reperfusion period the incidence of vefntricular fibrillation in STEA positive group was significantly higher than in the negative group(p<0.025). But there was the tendency to be higher in arrhythmic score of STEA positive group. There were no differences in heart rate, systolic left ventricular pressure, ST elevation and ST width in both groups. Most forms of ST-T of sinus rhythm before and after development of ventricular premature beat was low form(L). It was concluded that at the presence of STEA on EKG, the incidence of ventricular arrhythmia was more prevalent. So, STEA can be available as a marker of ventricular arrhythmia and prognostic factor.