Lack of the Association between Microsatellite Polymorphism in Toll-like Receptor 2 Gene and Development of COPD / 결핵및호흡기질환

BACKGROUND: The fact that only 10-20% of chronic cigarette smokers develop chronic obstructive pulmonary disease (COPD) reflects the presence of genetic factors associated with the susceptibility to COPD. Recently, it was reported that the surfactant protein A increases the secretion of matrix metalloprotease 9, which degrades extracellular matrices of the lung, through a Toll-like receptor 2 (TLR2). In this context, possible role of TLR2 in the pathogenesis of COPD was postulated, and a functional dinucleotide repeat polymorphism in intron II of TLR2 was evaluated for any association with COPD. METHOD: Male patients with COPD and male smokers with a normal pulmonary function were enrolled in this study. The number of Guanine-Thymine repeats in intron II of the TLR2 gene were counted. Because the distributions of the repeats were trimodal, the alleles were classified into three subclasses, 12-16 repeats: short (S) alleles; 17-22 repeats: medium length (M) alleles; and 23-27 repeats: long (L) alleles. RESULT: 125 male patients with COPD and 144 age- and gender-matched blood donors with a normal lung function were enrolled. There were no differences in the distribution of each allele subclass (S, M and L) between the COPD and control group (p=0.75). The frequencies of the genotypes with and without each allele subclass in the COPD and control group were similar. CONCLUSION: A microsatellite polymorphism in intron II of TLR2 gene was not associated with the development of COPD in Koreans.

Clinical Characteristics and Prognosis of Lymphocyte Dominant Exudative Pleural Effusion with Low ADA, Low CEA, Negative Cytology and Negative AFB Smear / 결핵및호흡기질환

BACKGROUND: A pleural effusion is a common medical problem. Despite several diagnostic tests, 15-20% of pleural effusions go undiagnosed. The aim of this study was to evaluate the clinical characteristics and prognosis of a lymphocyte dominant exudative pleural effusion with a low adenosine deaminase (ADA), low carcinoembryonic antigen (CEA), negative cytology and negative acid fast bacilli (AFB) smear. METHOD: From Jan 2000 to Aug 2001, 43 patients with lymphocyte dominant exudative pleural effusions whose AFB smear and cytologic exam were negative, their pleural fluid ADA level was < 40 IU/L, and their CEA level was < 10 ng/mL were enrolled in this study. A retrospective analysis of the patients' medical records was carried out. RESULT: Among 31 of the 43 cases (72%), probable underlying diseases causing the pleural effusion were identified: 21cases of malignant diseases, 4 cases of liver cirrhosis, 2 cases of pulmonary tuberculosis, 1 case of end stage renal disease, 1 case of a chylothorax, 1 case of a post?CABG (coronary artery bypass graft) state, 1 case of a pulmonary embolism. No clinically suspected etiology was identified in the remaining 12 cases (28%). Of these 12 pleural effusions, 7 cases spontaneously resolved, 2 effusions resolved with antibiotics, and the other 2 cases were persistent. CONCLUSION: Lymphocyte dominant exudative pleural effusions with a low ADA, low CEA, negative cytological exam, and negative AFB smear, but without a definite cause might have a benign course and clinicians can observe them with attention.

Effect Of Vpp/Cav Alternating Chemotherapy Versus Carboplatin/Etoposide(Ce) Chemotherapy For Extensive Stage Small Cell Lung Cancer / 결핵

BACKGROUND: To compare the efficacies and side effects of etoposide, cisplatin/cyclophosphamide, adriamycin, vincristine(VPP/CAV) with that those of carboplatin etoposide(CE) in extensive stage small cell lung cancer patients. METHOD: Patients with extensive stage small cell lung cancer who has measurable disease were eligible. VPP/CAV group(n=22) was treated with cisplatin(60mg/m2 iv. D1) etoposide(100mg/m2 iv. D1-3),after and 3 weeks later cyclophosphamide(1000mg/m2 iv. D1), adriamycin(40mg/m2 iv. D1), and vincristine(1.4mg/m2 iv. D1), were administered alternatively. CE group (n=22) was treated with carboplatin (325mg/m2 iv. D1) and etoposide (100mg/m2 iv. D1-3)(;) repeated treatment was performed every 3 weeks. RESULT: Forty four patients were eligible for the study. Overall The overall response rate was 61.4% (complete remission rate 0%, partial response rate 61.4%, stable disease rate 25%, progressive disease rate 13.6%), and median survival was 10.8 months. In VPP/CAV group, response rate was 54.5%(complete remission rate 0%, partial response rate 54.4%, stable disease rate 27.3%, progressive disease rate 18.2%), and, in carboplatin/etoposide group, the response rate was 68.2%(complete remission rate 0%, partial response rate 68.2%, stable disease rate 22.7%, progressive disease rate 9.1%). The median survival time was 9.5 months in the VPP/CAV group and 11 months in CE group. The toxicity of both group was moderate, and anemia was more frequent in the CE group. CONCLUSION: VPP/CAV regimen and CE regimen produced similar response rate and survival time rates and survival times in extensive stage small cell lung cancer patients. We may suggest that CE regimen are effective may be effective as part of the initial therapy of for extensive stage small cell lung cancer.

The Clinical study of Lung Cancer in Patients Younger than 40 Years of Age / 결핵

BACKGROUND: Bronchogenic carcinoma is generally considered as a disease that predominantly affects middle-aged and elderly men. A small percentage of patients with lung cancer are diagnosed in the third or fourth decade of life or earlier. The current study was performed to review the clinical characteristics of bronchogenic carcinoma in patients younger than 40 years of age at Chungnam National University Hospital. METHOD: To determine the clinicopathologic characteristics including survival rates of lung cancer patients younger than 40 years of age and to compare them with those of patients older than 40 years of age at diagnosis, data of 905 patients diagnosed as lung cancer from January 1990 to March 1997 were analyzed. RESULT: Twenty-three of 805 patients(2.5%) belonged to the young age group (less than 40 years). Male to female ratios of young age group and control group were 2.8 : 1 and 5.3 : 1, respectively. The mean duration of symptoms from onset to the definite diagnosis was 3.2 months in the young age group. The most common initial symptoms in the young age group were cough(52.2%) and dyspnea(43.5%). Adenocarcinoma(43.5%) was more frequent in the young age group than in the control group(20.1%). Stage III and IV(70%) tumors were more frequent in the young age group than in the control group(52.3%). Distant metastasis rae of the young age group(56.6%) was higher than that of the control group(22.3%). CONCLUSION: The predominance of adenocarcinoma, the lower male-female ratio, and the high incidence of advanced stage tumor at diagnosis are the characteristics of lung cancer in patients younger than 40 years of age.

Prophylactic cranial irradiation in limited small-cell lung cancer: incidence of brain metastasis and survival and clinical aspects / 결핵

PURPOSE: Brain metastases are present in approximately 10-16% of small cell lung cancer patients at diagnosis. Brain metastasis is an important clinical problem associated with increasing the survival rate, with a cumulative incidence of up to 80% in patients surviving 2 years. Prophylactic cranial irradiation(PCI reduces the incidence of brain matastasis and may prolong survival in patients with limited small-cell lung cancer who achieved complete remission. This study was performed to analyze the incidence of brain metastasis, survival and clinical aspects after PCI in patients with limited small-cell lung cancer who achieved complete remission. METHODS: Between 1989 and 1999, forty-two patients with limited small-cell lung cancer who achived achieved complete remission after therapy were enrolled into this study retrospectively. All patients received etoposide and cisplatin(VPP) alternating with cytoxan, adriamycin, and vincristine(CAV) every 3 weeks for at least 6 cycles initially. All patients received thoracic radiotherapy:concurrent(38.1%) and sequentia(61.9%). All patients received late PCI. RESULTS: Most patients(88.1%) were men, and the median age was 58 years. The median follow-up duration was 18.1 months. During the follow-up period, 57.1% of the patients developed relapse. The most frequent site of relapse was chest(35.7%), followed by brain(14.3%), liver(11.9%), adrenal gland(4.4%), and bone(2.2%). With the Kaplan-Meier method, the average disease-free interval was 1,090 days(median 305 days). The average time to development of brain relapse after PCI and other sites relapse(except brain) were 2,548 days and 1,395 days(median 460 days), respectively. The average overall survival was 1,233 days(median 634 days, 21.1 months), and 2-year survival rates was 41.7%. The average overall survival in the relapse group was 642 days(median 489 days) and in the no relapse group was 2,622 days(p<0.001). The average overall survival in the brain relapse guoup was 928 days(median 822 days) and in the no brain relapse group was 1,308 days(median 634 days)(p=0.772). In most patients(85.7%), relepse(expect brain) or systemic disease was the usual cause of death. Brain matastasis was the cause of death in 14.3% of the cases. CONCLUSIONS: We may conclude that PCI reduces and delays brain metastasis in patients with limited small-cell lung cancer who achieved complete remission. We found decreased survival in relapse group but, no significant survival difference was noted according to brain matastasis. And relapse(except brain) or systemic disease was the usual cause of death. In order to increase survival, new treatment strategies for control methods for relapse and systemic disease are required.

Clinical effects of neoafjuvant chemotherapy in stage IIIA non-small cell lung cancer / 대한내과학회지

BACKGROUND: Surgical therapy remains the only curative treatment of localized non-small cell lung cancer(NSCLC). But the efficacy of surgery for patients with NSCLC is limited, although recent studies suggest that neoadjuvant chemotherapy may improve survival. Many studies also demonstrated benefit for neoadjuvant therapy. However very few studies about neoadjuvant chemotherapy were reported in Korea. We conducted this study to examine the possible benefit of neoadjuvant chemotherapy in patients with operable stage IIIA NSCLC. METHODS: Twenty seven patients(25 men and 2 women) with clinical stage IIIA NSCLC were analyzed. The patients received 2 to 4 courses of cisplatin based chemotherapy and followed by surgery. To compare the resection rate and survival, 12 patients(10 men, 2 women) with clinical stage IIIA and initially treated operation were also anayzed. RESULTS: The radiologically assessed response rate to the neoadjuvant therapy was 59.3%. Twelve seven patients underwent gross tumor resection with 24(88.9%) having complete resection and 21(77.8%) having postaperative stage I ar II. Pathologically defined response in nodal staging was more higher(85.2%). There was no difference of relapse free interval in recurred patients between two groups. But in patients treated with neoadjuvant therapy, distant recurrence is less higher than local recurrence. The median period of survival was 42 months in the patients treated with neoadjuvant therapy, and 27 months in the patients initially treated with surgery(p=0.287). CONCLUSION: The neoadjuvant chemotherapy improves local tumor control and lowers the distant recurrence. There was a possible trend improving median survival. So neoadjuvant chemotherapy might be considered as a standard therapy in stage IIIA NSCLC.

The Clinical significance of STAT-PAT-PAK ULTRA FAST(R) and ICT Tuberculosis for Serologic Diagnosis of Tuberculosis / 결핵

BACKGROUND: In recent years, tuberculosis has re-emerged as a major health problem in both industrialized and developing countries. Recent advances in identifying and purifying antigens secreted in active tuberculosis infection have lead to the development of serological assays based on a number of immunodominant antigens. To date, the most sensitive and specific of these antigens has been the 38-kDa antigen. METHOD: Two rapid membrane-based serologic assays using antigen(38-kDa) from mycobacterium tuberculosis for the diagnosis of tuberculosis were evaluated in 22 patients with smear-positive pulmonary tuberculosis, 14 patients with inactive pulmonary tuberculosis, and 9 patients with non-tuberculous lung disease. RESULT: The evaluation of validity(sensitivity, specificity, positive predictive value, negative predictive value, false positivity and false negativity) of STAT-PAK ULTRA FAST(R) were 77.3%, 28.6%, 63.0%, 44.4%, 71.4%, and 22.7% for differential diagnosis of active pulmonary tuberculosis and inactive pulmonary tuberculosis, respectively. The evaluation of validity of STAT-PAK ULTRA FAST(R) were 77.3%, 33.3%, 73.9%, 37.5%, 66.7%, and 22.7% for differential diagnosis of active pulmonary tuberculosis and non-tuberculosis. The evaluation of validity of ICT Tuberculosis were 54.5%, 57%, 66.7%, 44.4%, 42.9%, and 45.5% for differential diagnosis of active pulmonary tuberculosis and inactive pulmonary tuberculosis. The evaluation of validity of ICT Tuberculosis were 54.5%, 100%, 100%, 47.4%, 0%, and 45.4% for differential diagnosis of active pulmonary tuberculosis and non-tuberculosis. CONCLUSION: We concluded no effectiveness of STAT-PAK ULTRA FAST(R) and ICT tuberculosis on serologic diagnosis of pulmonary tuberculosis. In the future, further large-scale study should be needed for serologic diagnosis of pulmonary tuberculosis.

Two cases of Pulmonary Alveolar Proteinosis Improved by Whole Lung Lavage / 결핵

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipid, is deposited on alveoli and bronchioles. Several cases were reported since 1986, and the numbers of patients is increasing in Korea. Although the pathogenesis and causative treatment of PAP is not well known, whole lung lavage is the only consistently successful treatment. We report 2 cases of PAP which were confirmed by open lung biopsy with electron microscopy and clinically improved by whole lung lavage with a review of literature.

Delayed Diagnosis of Primary Lung Cancer / 결핵

BACKGROUND: Lung cancer is an important public health problem because of rapidly increasing malignancy in both sexes in relation with high smoking rate in Korea. Despite advances in therapeutic modalities and supportive cares, 5-year survival rate has improved only marginally during the past 2 decades. Therefore, the early detection of lung cancer is strongly needed for batter prognosis and we conducted this study to review the clinical factors resulting in delayed diagnosis of lung cancer. METHOD: The clinical data such as presenting symptoms duration for diagnosis disease entities causing misdiagnosis or delayed diagnosis, were analyzed retrospectively in 154 patients with primary lung cancer diagnosed at Chungnam National university hospital from January to December in 1995. RESULTS: 63 patients(40.9%) out of 154 patients were delayed diagnosed with the duration of 6.3 months compared with 3.6 months in patients diagnosed without delay. In delayed diagnosed group, Cough & sputum and dyspnea as presenting symptom were more critical than hemoptysis and chest pain, and doctor's delay was more critical than patient's delay. Tuberculosis(30/63) was most frequent disease entity causing delayed diagnosis, followed by pneumonia(9/63), COPD(6/63), heart diseases(5/63), etc.. CONCLUISON: It should be emphasized that any respiratory symptom be checked with chest X-ray to differentiate lung cancer and periodic check of chest X-ray be also needed for the longterm patients with any disease, especially with high risk group.

Immunohistochemical Detection of p53, erbB-2 and CEA Oncoprotein in Lung Cancer Clinical Correlations / 결핵

BACKGROUND: The prognosis of patients with lung cancer is still poor. Lung cancer exhibits a variable clinical outcome, even in those patients with same stage Numerous reports suggest that oncogene expression night play a role in explaining the variability of response and survival But many of these reports are still under debete. So we studied the clinical relevance of oncogene expression in Korean lung cancer patients. lmmunohistochemistry of p53, erbB-2, CEA expression was performed. METHOD: From March, 1992 until March, 1997, 120 patients with lung cancer were reviewed. p53, erbB-2, and CEA expression were detected on paraffin-embedded tumor blocks with the use of monoclonal antibodies. The survival arid response has correlated with the expressibility of p53, erbE-2, arid CEA oncoprotein. RESULTS: Overall, the expression rates of p53 erbB-2, and CEA were 33.7%, 59.3%, and 32.6% respectively. Expression rates were not con-elated to cell type or stage. Compared with response to chemotherapy, no correlation was found. The expression of p53, erbB-2, or CEA was not correlated with 2-year survival. With simultaneous applications of p53. erbB-2, and CEA, patients with 2 or more expressions also did not show poor response to chemotherapy. CONCLUISON: We conclude the p53, erbB-2, and CEA expression are clinically less useful in predicting response to chemotherapy or survival.

A Clinical Study on Tuberculous Cervical Lymphadenitis / 대한내과학회지

OBJECTIVES: Tuberculous cervical lymphadenitis is one of the common cause of cervical mass in young adult in Korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous treatment. To clarify the duration of medical treatment and to define the cause of prolonged treatment duration METHODS: we analyzed the clinical data of 62 patients with tuberculous cervical lymphadenitis diagnosed at the Chungnam National University Hospital from Jan. 1994 to July 1996 and all patients were divided into two groups (standard and prolonged) by treatment duration. RESULTS: The most prevalent age group was 20 to 39 years old (67%) and male to female ratio was 1:2.6. The most common physical finding was painless swelling on neck, standard group was 52%, prolonged group was 42%. The average size of lymph node was 2.7cm and 3.2cm, respectively (p<0.05). In prolonged group, incidence of associated pulmonary tuberculosis and previous antituberculous treatment history were higher than that in standard group (27%, 35% respectively). The most common affected site was right side of neck , whereas 19% of prolonged regimen group were involved in both side of neck. Bacteriological study from node aspirates showed relatively higher positivity in prolonged group (27%) than in standarded group (5%). The causes of prolonged treatment were increased mass(27%) or remnant mass(23%) and the develoment of new node formation and existing nodes after completion of treatment were found in both groups(10% of standard group , 19% of prolonged group). CONCLUSION: A new, prospective trial for proper regimens or duration of antituberculosis treatment is strongly needed.

Prospective Study for Treatment Method of Cervical Tuberculous Lymphadenitis / 결핵

BACKGROUND: Tuberculous cervical lymphadenitis is one of the common causes of cervical mass in adult (espe cially in woman) in korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous chemotherapy. METHOD: To clarify the proper duration and/or combination of regimens, we analyzed the clinical data of 31 patient with cervical lymphadenitis diagnosed at Chungnam National University Hospital from March 1996 to December 1996 and all patients were prospectively randomized into two groups(2HREZ/4HRE and 6HREZ) by treatment method. RESULT: Prevalent age, male to female ratio, association with pulmonary tuberculosis and history of previous antituberculous medication were not statiscally different between two groups. The average size of the largest lymph node before teatment was 2.43+/-0.98cm and 3.15+/-1.74cm, respectively and was 0.63cm and 0.6cm after treatment, respectively. In both groups, 2 patients have engrowing node or not changed node during tratment and no recurrence was found during follow up period upto 12 months. In both groups, no significant side reaction resulting in discotinuation or changing the regimens was noticed. CONCLUSION: Short course antituberculosis therapy(2HREZ/4HRE) could be recommanded as effective standard therapy for superficial lymph node tuberculosis. Longterm follow up at least 36 months to observe recurrence might be needed to confirm this conclusion.