Relationship of airway remodeling with clinical characteristics in bronchial asthma / 천식및알레르기

BACKGROUND: We observed airway remodeling, which is the thickness of the susepithelial layer, in asthmatic patients and inhealthy subjects in order to determine its relationship with severity of disease, such as symptom, bronchial hyperresponsiveness, and degree of acute exacerbation. Moreover, for evaluation of factors contributing to airway remodeling, we analyzed the age, sex, presence of atopy, length of asthmatic history and degree of airway inflammation. METHODS: Thirty-six patients with asthma and ten healthy controls were recruited for the study. The degree of asthma symptom severity was assessed using NIH criteria. Bronchial responsiveness to methacholine was expressed as provocative concentration of methacholine causing a 20% fall in FEV1. The degree of acute exacerbation was assessed by PaCO2 during acute exacerbation. Bronchoscopy, bronchoalveolar lavage(BAL), and bronchial biopsy were performed for all subjects; the total cell counts, differential cell counts and levels of ECP were measured in BAL fluid, and the basement membrane thickness and degree of epithelial shedding were measured in biopsy samples under light microscopy. RESULTS: The mean values of basement membrane thickness were 7.8+/-0.6 micrometer in asthmatics, and 4.1+/-0.5 micrometer in healthy subjects (p or =7.5 micrometer) compared to those with base- ment membrane less than 7.5micrometer (0.26+/-0.13 mg/ml vs. 0.74+/-0.16 mg/ml, p<0.05). No difference was found between the degree of thickening in patients with different degree of acute exacerbation with age, sex, atopy and lengths of asthmatic history. The degree of thickening was positively correlated to degree of epithelial shedding (r=0.393, p<0.05), but not to the degree of total cell counts, differential cell percentage nor ECP in BAL fluid. CONCLUSION: We confirmed that thickening of the basement membrane is a characteristic finding of asthma. We also demonstrated that it affects symptom severity and bronchial hyperresponsiveness, and is related to degree of epithelial damage rather than duration of asthma history.

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.

The Influences of Obstructive Apneas on Changes of Cardiovascular Function in Anesthetized Dogs with alpha-chloralose / 결핵

BACKGROUND: Patients with obstructive sleep apnea syndrome are known to have high long-term mortality compared to healthy subjects because of their cardiovascular dysfunction. The observation of hemodynamic changes by obstructive apneas is helpful to understand when attempting to understand the pathophysiological mechanism of the development of cardiovascular dysfunction in those patients. Therefore, we studied the changes of in cardiovascular function with the an animal model and tried to obtain the basic data for an ideal experimental model (this phrase is unclear), which is required a requirement for the a more advanced study. METHODS: In 16 Sixteen anesthetized dogs with alpha-chloralose, experimental subjects (delete) were divided into two groups : 8 dogs of room air breathing group and 8 dogs of oxygen breathing group. We measured PaO2, PaCO2, heart rate, cardiac output, mean femoral artery pressure, and mean pulmonary artery pressure at specified times during the apnea-breathing cycle : before endotracheal tube occlusion (baseline), 25 seconds after endotracheal tube occlusion (apneic period), 10 seconds (early phase of postapneic period, EPA) and 25 seconds (late phase of postapneic period, LPA) after spontaneous breathing. RESULTS: In room air breathing group, the heart rate significantly decreased significantly decreased at during the apneic period compared to that at baseline (P<0.01) and increased at EPA and LPA compared to that during the apneic period (P<0.01). But, the heart rate showed no significant changes during apneic and postapneic periods in the oxygen breathing group. Cardiac output tended to decrease at during apneic period compared to that at baseline, but did not show statistical significance was statistically significant. Cardiac output significantly decreased at LPA compared to at baseline (P<0.01). Mean femoral artery pressure was significantly decreased at during apneic period compared to that at baseline (P<0.05). CONCLUSION: Through this experiment, we were partially able to understand the changes of cardiovascular function indirectly, but it is suggested that the (delete) new experimental animal model displaying physiological mechanism close to sleep in nature might natural sleep should be established (,)and the advanced study of in the changes of cardiovascular function and its cause their causes should be continued.

A Case of Variant Angina Associated with Hyperthyroidism

While angina pectoris is not uncommonly seen in hyperthyroidism, only rare case reports have proved that the myocardial ischemia was induced by coronary artery spasm. A 62 year-old man with a prior diagnosis of hyperthyroidism presented with repeated episodes of syncope and chest pain. The coronary angiogram showed normal coronary arteries. Severe diffuse spasm of both coronary was spontaneously induced and normalized after intracoronary nitroglycerin injection during the procedure of coronary angiography. For one year, he was on simultaneous antianginal and antithyroidal medicines with accomplishment of euthyroid state. He did not experience and anginal symptom for the last six months. The followup coronary angiogram performed 1 year later revealed a newly developed atherosclerotic lesion (about 50% stenosis in diameter) at the proximal left anterior descending artery. However provocative challenge test with intracoronary acetylcholine infusion failed to induce coronary spasm at the lesion. We report a case of coronary artery spasm associated with hyperthyroidism with a review of literatures.

Pelvic Pain Syndrome - Successful Treatment by Ovarian Vein

Pelvic pain syndrome or pelvic congestion syndrome, with no apparent organic cause, is a common gynecologicaldisorder. Ovarian varix, one of the causes of this syndrome, presents a difficult diagnostic and therapeuticproblem, though surgical ligation of the ovarian vein is an effective method of treatment. Although ovarian veinembolization has been recently developed as a useful alternative, no previous reports have described thisprocedure in Korea. We report a case of pelvic pain syndrome successully treated by ovarian vein embolization.

Abdominal Wall Leakage in CAPD Patient Confirmed by CT Peritoneography / 대한신장학회잡지

Abdominal wall leakage of dialysate in continuous ambulatory peritoneal dialysis (CAPD) patients is uncommon complication. We experienced one case of abdominal wall leakage in CAPD patient confirmed by CT peritoneography. She complained weight gain, decreased ultrafiltration volume, and localized abdominal wall edema without clinical evidence of hernia. CT peritoneography of the abdomen showed leakage of contrast dye from the site of insertion of the CAPD catheter into the anterior abdominal wall. The dialysate was completely drained and CAPD was discontinued. She was switched temporally to hemodialysis and abdominal wall edema disappeared. When CAPD was restarted seven days later, the edema appeared. After CAPD catheter was removed and reinserted at the opposite site, she returned to CAPD without leakage.