Treatment of Pulmonary Tumor Embolism from Choriocarcinoma: Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors’ hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.

Case of Mycobacterium Massiliense Infection Presenting as Recurrent Pneumonia in Sjogren's Syndrome / 대한내과학회지

Mycobacterium massiliense is an emerging pathogen that is increasingly reported as a causative agent occurring during medical procedures, at surgical sites, and intramuscularly [1]. Although previously classified as part of M. abscessus, M. massiliense has recently been identified as a new species of rapidly growing nontuberculous mycobacteria [1,3] via a comparative sequence analysis of rpoB and hsp65 [3,5]. However, the clinical manifestations of M. massiliense have not been well characterized. We report here in a case of recurrent pneumonia for 3 years that improved with antibiotic treatment for M. massiliense in a 37-year-old woman with Sjogren's syndrome. The patient showed a substantial response to treatment with a combination of antimicrobial therapies comprising clarithromycin and amikacin without cefoxitin for 6 months. This is the first report of pulmonary infection of M. massiliense with Sjogren's syndrome in Korea.

A Case of Prostatic Abscess due to Burkholderia pseudomallei / 대한내과학회지

Melioidosis is an infectious disease caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia and northern Australia, where B. pseudomallei is a soil saprophyte and invades the host through inoculation, inhalation or ingestion. It infects mostly adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ, presenting with either cough or fever resulting from a primary spread. Also, seeding and abscess formation can arise in any organ. However, prostatic abscess due to melioidosis is uncommon. We report a case of pneumonia, and prostate and scrotal abscesses due to Burkholderia pseudomallei, in a 48-year-old man with diabetes mellitus who had a history of working in Malaysia. This is the first report of genitourinary infection of melioidosis in Korea.

Bronchoscopic Electrocautery with Electroprobe and Diathermic Snare in Patients with Malignant Airway Obstruction / 결핵및호흡기질환

BACKGROUND: Endobronchial tumors cause?life-threatening dyspnea and can lower the quality of life due to central airway obstruction.?In those cases with an intraluminal tumor, various bronchoscopic techniques are available for tumor debulking. The therapeutic effect of bronchoscopic electrocautery for palliation in patients with a symptomatic tumor obstruction was studied. METHOD: Nineteen patients with bronchogenic carcinomas (n=15) and metastatic tumors affecting the bronchi (n=4), between March 2002 and March 2005, were enrolled in this study. Electrocautery was performed under local anesthesia using an electroprobe and diathermic snare. Using flexible bronchoscopy, a follow-up bronchoscopic examination was performed 3-4 days later. Symptom improvement was evaluated by FEV1, FVC and dyspnea score (Modified Borg Category Scale (0~10)), both before and after the electrocautery. RESULTS: The success rate of electrocautery on the follow up examination was 84%. Patients with endoluminal airway lesions had a mean overall decrease in the size of the obstruction to 47.8+/-15.7%. The mean Improvement in the dyspnea score immediately after the endobronchial tumor debulking was 2.78+/-1.42.The average improvements in the FEV1 and FVC after electrocautery were 0.32+/-0.19L and 0.5+/-0.22L, respectively. There were 2 cases of complications related with electrocautery (one each of pneumothorax and pneumonia). CONCLUSION: Electrocautery using an electroprobe and diathermic snare was an effective and safe palliative treatment for a symptomatic endoluminal airway obstruction in lung cancer.

Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer / 결핵

BACKGROUND: Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancers. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improve the survival rate by using the proper therapeutic methods. MATERIAL AND METHOD: The clinical data from 394 patients, who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. RESULT: There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 71 days, 211 days, and 419 days, respectively (p<0.001). The data emphasizes the importance of anticancer treatment for improving the survival time for patients. The group of concurrent chemoradiotherapy regimens (30 patients) showed a significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of the laboratory study were groups of leukocytes =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic sites. However, the median survival time of the patients with an ipsilateral pleural effusion was longer than the patients with other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). CONCLUSION: Disease stage and 5% body weight loss for the recent 3 months at the diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prolonged in recent years. It was suggested that the use of the EP (etoposide and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer / 결핵

BACKGROUND: Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancers. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improve the survival rate by using the proper therapeutic methods. MATERIAL AND METHOD: The clinical data from 394 patients, who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. RESULT: There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 71 days, 211 days, and 419 days, respectively (p<0.001). The data emphasizes the importance of anticancer treatment for improving the survival time for patients. The group of concurrent chemoradiotherapy regimens (30 patients) showed a significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of the laboratory study were groups of leukocytes =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic sites. However, the median survival time of the patients with an ipsilateral pleural effusion was longer than the patients with other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). CONCLUSION: Disease stage and 5% body weight loss for the recent 3 months at the diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prolonged in recent years. It was suggested that the use of the EP (etoposide and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

Expression of MAGE and GAGE genes in the bronchogenic cancer tissues obtained by bronchoscopy / 대한내과학회지

BACKGROUND: There has been significant progress in the identification of tumor associated antigens. Among the tumor associated antigens, MAGE (melanoma antigen), BAGE, GAGE, PRAME, NY-ESO were named as cancer/testis specific antigens since they are only expressed in the testis or cancer cells. Because of their relative specificity, they have been considered as the appropriate targets for the specific immunotherapy, or the early diagnosis of several cancers. In bronchogenic cancer, these antigens would be useful as a promising candidate in the screening test or immunotherapy. This study was to investigate the expression of MAGE and GAGE genes in the bronchogenic cancer tissues obtained by bronchoscopy. METHODS: In five normal bronchial and 26 cancer tissues obtained by bronchoscopic biopsy from 26 bronchogenic cancer patients, total cellular mRNA was extracted. Then RT PCR was run in 35 cycles, with two different kinds of primers designed to detect the several subtypes of MAGE DNA simultaneously and the similar process to detect GAGE DNA was also done. Concurrently, DNA sequencing of the isolates was done in portion to prove the isolates are cloned MAGE and GAGE DNA. With probes confirmed by DNA sequencing, the isolates were reevaluated by Southern blotting. Then the expression of MAGE or GAGE in the bronchogenic cancer tissues was evaluated by the tissue types and clinical staging. RESULTS: In the five controls, MAGE or GAGE was not detected in any specimen and beta actin was not expressed in 4 cases, suggesting the specimen might be too small to detect beta actin by 35 cycles of PCR. In the 26 cancer tissues, the expression rate of MAGE and GAGE was 42.3% (11/26) and 42.3% (11/26) respectively and MAGE or GAGE were expressed in 17 cases (65.3%). Neither clinical staging nor tissue types were associated with the expression of MAGE or GAGE. Beta actin was not detected in 11 cases of cancer specimen, but MAGE or GAGE were expressed in 10 cases of them. CONCLUSION: Using these primers in detection of MAGE or GAGE genes in the bronchoscopicbiopsy tissues seems to be effective or complimentary method in screening of bronchogenic cancer patients, who would be the candidate for the possible immunotherapy.

Expression of MAGE in the Induced Sputum of Lung Cancer Patients / 결핵

BACKGROUND: Tumor associated antigens, which are produced specifically by tumor cells, are promising targets for the early diagnosis and immunotherapy. Among the tumor associated antigens, MAGE (a melanoma antigen), BAGE, GAGE, PRAME and NY-ESO were named as cancer/testis specific antigens since they are detected exclusively in the testis or cancer cells. If MAGE is easily detectable in the sputum, it would become a convenient method for diagnosing lung cancer. This study was undertaken to investigate MAGE expression in the induced sputum obtained from lung cancer patients. METHOD: In 14 control patients and 30 lung cancer patients, the induced sputum was collected after inhaling 3% saline(5 cc) delivered by nebulizer for approximately 5 minutes after a mouth rinse and bronchodilator inhalation. The induced sputum was placed in a conservative-mixed solution (guanidinium isothiocyanate, Triton X-100). The total cellular mRNA was extracted from the cells and RT PCR and nested PCR were run in 30 and 35 cycles respectively, with two different types of primers specially designed to detect six subtypes of MAGE DNA simultaneously. RESULTS: MAGE expression was not detected in the 14 controls, but in the 30 cancer patients, MAGE was found in 24 patients (80%, p=0.001). In the cancer patients, there were no differences in the expression level according to the tissue types (squamous cell cancer 13/17, adenocarcinoma 7/9, and small cell cancer 4/4, p=0.56). Among the 24 MAGE-positive patients, the tumor was not visible on a bronchoscopy in 11 patients (45.8%). CONCLUSION: A study of MAGE in induced sputum appears to be a useful and complementary method in the diagnosis of lung cancer. A further prospective study with more patients is recommended.

Peak Expiratory Flow(PEF) Measured by Peak Flow Meter and Correlation Between PEF and Other Ventilatory Parameters in Healthy Children / 결핵

BACKGROUND: In diagnosis or monitor of the airway obstruction in bronchial asthma, the measurement of FEV1 in the standard method because of its reproducibility and accuracy. But the measurement of peak expiratory flow(PEF) by peak flow meter is much simpler and easier than that of FEV1 especially in children. Yet there have been still no data of the predicted normal values of PEF measured by peak flow meter in Korean children. This study was conducted to provide equations to predict the normal value of PEF and correlation between PEF and FEV1 in healthy children. METHOD: PEF was measured by MiniWright peak flow meter, and the forced expiratory volume and the maximum expiratory flow volume curves were measured by Microspiro HI 501(Chest Co.) in 346 healthy children (age:5-16 years, 194 boys and 152 girls) without any respiratory symptoms during 2 weeks before the study. The regression equations for various ventilatory parameters according to age and/or height, and the regression equations of FEV1 by PEF were derived. RESULTS: 1. The regression equation for PEF(L/min) was:12.6×age(year)+3.4×height(cm)-263(R2=0.85) in boys, and 6×age(year)+3.9×height(cm)-293(R2=0.82) in girls. 2. The value of FEFmax(L/sec) derived from the maximum expiratory flow volume curves was multiplied by 60 to compare with PEF(L/min), and PEF was faster by 125 L/min in boys and 118 L/min in girls, respectively. 3. The regression equation for FEV1(ml) by PEF(L/min) was:7×PEF-550(R2=0.82) in boys, and 5.8×PEF-146(R2=0.81) in girls, respectively. CONCLUSION: This study provides regression equations predicting the normal values of PEF by age and/or height in children. And the equations for FEV1, a gold standard of ventilatory function, was predicted by PEF. So, in taking care of children with airway obstruction, PEF measured by the peak flow meter can provide useful information.

A Case of Cytomegalovirus Pneumonia Associated with Nephrotic Syndrome / 결핵

No abstract available.

A Case of Cytomegalovirus Pneumonia Associated with Nephrotic Syndrome / 결핵

No abstract available.

The usefulness of dyspnea rating in evaluation for pulmonary impairment/disability in patients with chronic pulmonary disease / 결핵

BACKGROUND: Resting pulmonary function tests(PFTs) are routinely used in the evaluation of pulmonary impairment/disability. But the significance of the cardiopulmonary exercise test(CPX) in the evaluation of pulmonary impairment is controvertible. Many experts believe that dyspnea, though a necessary part of the assessment, is not a reliable predictor of impairment. Nevertheless, oxygen requirements of an organis m at rest are different from at activity or exercising, and a clear relationship between resting PFTs and exercise tolerance has not been established in patients with chronic pulmonary disease. As well, the relationship between resting PFTs and dyspnea is complex. To investigate the relationship of dyspnea, Resting PFTs, and CPX, we evaluated the patients of stabilized chronic pulmonary disease with clinical dyspnea rating(baseline dyspnea index, BDI), resting PFTs, and CPX. METHOD: The 50 patients were divided into two groups: non-severe and severe group on basis of results of resting PFTs(by criteria of ATS), CPX(by criteria of ATS or Ortega), and dyspnea rating(by focal score of BDI). Groups were compared with respect to pulmonary function, indices of CPX, and dyspnea rating. RESULTS: 1) According to the criteria of pulmonary impairment with resting PFTs, VO2 max, and focal score of BDI were significantly low in the severe group(p0.05). According to focal score(

A Clinical Review of Primary Tracheal Carcinoma / 결핵

BACKGROUND: Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 percent of all malignancies of the respiratory tract Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. METHODS: We Have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking arid respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. RESULTS: Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then strider or wheezing, cough, and sputum in order. The routine chest roentgenographic examinations wore not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with SCC and ACC were S months and 24.9 months respectively. We bad bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression CONCLUSION: We would like to perform more comprehensive diagnostic too]s(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumors(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax arid waning of dyspnea according to changes of position. 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

A Case of Wegener's granulomatosis with obstruction of both anterior tibial and peroneal arteries / 결핵

Wegener's granulomatosis is characterized by necrotizing granulomatous vasculitis affecting upper and lower respiratory tracts and kidneys. Vascular lesions commonly involve capillaries and small vessels but, less commonly larger vessels. We report a 46-year-old male patient of Wegener's granulomatosis associated with paranasal sinusitis, pulmonary consolidations, glomerulonephritis, skin lesions with obstruction of both anterior tibial and peroneal arteries. Several necrotic lesions of the toes had progressed to gangrene and both transmetatarsal amputations were done. The patient continued to receive cyclophosphamide and prednisolone.

A Case of Wegener's granulomatosis with obstruction of both anterior tibial and peroneal arteries / 결핵

Wegener's granulomatosis is characterized by necrotizing granulomatous vasculitis affecting upper and lower respiratory tracts and kidneys. Vascular lesions commonly involve capillaries and small vessels but, less commonly larger vessels. We report a 46-year-old male patient of Wegener's granulomatosis associated with paranasal sinusitis, pulmonary consolidations, glomerulonephritis, skin lesions with obstruction of both anterior tibial and peroneal arteries. Several necrotic lesions of the toes had progressed to gangrene and both transmetatarsal amputations were done. The patient continued to receive cyclophosphamide and prednisolone.