The Relationship between Hospital Departments and Risk of Developing Tuberculosis among Nurses Working at a University Hospitalin Korea: Retrospective Cohort Study / 대한산업의학회지

OBJECTIVES: To investigate the occurring characteristics of pulmonary tuberculosis (TB) among nurses working at a university hospital in Korea. METHODS: A retrospective cohort study was conducted using medical records from a university hospital. A total of 351 nurses without any pulmonary disease were enrolled during 2000~2007, and were followed up until October 2010. To compare with the incidence of TB between occupational subgroups, workplaces were divided into high and low TB-exposure risk departments. For statistical analysis, the relative risks for TB incidences between departments were estimated using Cox proportional hazards models and mean incidences were estimated with person-time years. RESULTS: Seven cases of TB were observed during 2001 person-years. Five and two cases were observed in the high and low TB-exposure risk departments, respectively. The relative risk of TB infection in the high TB-exposure risk departments were 6.52 (95% CI, 1.26~33.60) compared to that in the low TB-exposure risk department. The mean incidence of TB in the total nurses was 0.350% per person-year. CONCLUSIONS: According to the concept of occupational and environmental medicine, high TB-exposure risk departments were more likely to be at increased risk of tuberculosis.

Unusual Endoscopic Retrograde Cholangiographic Finding in a Case of Xanthogranulomatous Cholecystitis / 대한소화기내시경학회지

Xanthogranulomatous cholecystitis is a rare form of chronic gallbladder inflammation that is characterized by a severe proliferative fibrosis and has rarely been described in the radiologic literature. Like xanthogranulomatous pyelonephritis, it is an entirely benign but unusual expression of a reactive process and may be confused with a malignant neoplasm. Histologically, foamy histiocytes, multinucleated giant cells, other inflammatory cells, fibrous reaction with spindle cells, cholesterol cleft and noncaseating granuloma were found. Treatment of this benign inflammatory condition requires cholecystectomy to remove the focus of inflammation, control subsequent infection and relieve symptoms A case of xanthogranulomatous cholecystitis mimiking carcinoma of the gallbladder on abdominal USG, abdominal CT, and ERCP examination is presented with brief review of the literature.

Time Course Change of Phagocytes and Proinflammatory activities in BALF in Endotoxin-induced Acute Lung Injury / 결핵

BACKGROUND: Severe acute lung injury(ALI), also known as the adult respiratory distress syndrome(ARDS), is a heterogenous nature of dynamic and explosive clinical synrome that exacts a mortality of approximately 50%. Endotoxin(ETX) is an abundant component of the outer membrane of gram-negative bacteria capable of inducing severe lung injury in gram-negative sepsis and gram-negative bacterial pneumonia, which are among the most common predisposing causes of ARDS. The influx of PMNs into airway tissue is a pathological hallmark of LPS-induced lung injury. And th3re is a substantial evidence suggesting that cytokines are important mediators of lung injury in gram-negative sepsis. However, the kinetics of phagocytes and cytokines by an exact time sequence and their respective pathogenic importance remain to be elucidated. This study was performed to investigate the role of phagocytes and proinflammatory cytokines in ETX-induced ALl through a time course of changes in the concentration of protein, TNFa and IL-6, and counts of total and its differential cells in BALF. The consecutive histologic findings were also evaluated. METHOD: The experimental animals, healthy male Sprague-Dawley, weighted 200+/-50g, were divided into controland ALI-group. ALI was induced by an intravenous administration of ETX, 5mg/kg. Above mentioned all parameters were examined at 0(control), 3, 6, 24, 72 h after administration of ETX. TNFa and IL-6 conc. in BALE were measured by a bioassay. RESULTS: The protein concentration and total leukocyte count(TC) in BALF was significantly increased at 3h compared to controls(p<0.05). The protein conc. was significantly elavated during observation period, but TC was significantly decreased at 72h(p<0.05 vs. 24h). There was a close relationship between TC and protein cone. in BALF(r = 0.65, p <0.001). The PMN and monocyte count was well correlated with TC in BALF, and the correlation of PMN(r=0.97, p<0.001) appeared to be more meaningful than that of monoeyte(r = 0.61, p<0.001). There was also a significant correlation between protein cone. and PMN or monocyte count in BALF(PMN vs. monocyte r = 0.55, p<0.005 vs. r = 0.64, p<0.001). The count of monocyte was significantly elavated during observation period though a meaningful reduction of PMN count in BALF at 72h, this observation suggested that monocyte may, at least, partipate in the process of lung injury steadly. In this sudy, there was no relationship between IL-6 and TNFt conc., and TNFa but not IL-6 was correlated with TC(r 0.61, p <0.05) and monocyte(r = 0.67, p<0.05) in BALF only at 3, 6h after ETX introduced. In particular, the IL-6 cone. increased earlier and rapidly peaked than TNFz cone. in BALF. In histologic findings, the cell counts of lung slices were increased from 3 to 72h(p<0.001 vs. NC). Alveolar wallthickness was increased from 6 to 24h(p<0.001 vs. NC). There was a significant correlation between the cell counts of lung slices and alveolar wall-thickness(r= 0.61, p<0.001). This result suggested that the cellular infiltrations might be followed by the alterations of interstitium, and the edematous change of alveolar wall might be most rapidly recovered to its normal condition in the process of repair. CONCLUSION: We concluded that although the role of PMIN is partly certain in ETX-induced ALI, it is somewhat inadequate to its known major impact on ALL Alveolar macrophage and/or non-immune cells such as pulmonary endothelial or epithelial cells, may be more importantly contributed to the initiation and perpetual progression of ETX-induced ALI. The IL-6 in ETX-induced ALI was independent to TNFa, measured by a bioassay in BALF. The early rise in IL-6 in BALF implies multiple origins of the IL-6.

Superficial Spreading Stomach Cancer: Report of One Case / 대한소화기내시경학회지

Superficial spreading stomach cancer, as first described by Stout in 1942, is superficially spreading cancer confined to mucosa and submucosa, and measuring up to 10 cm in diameter. Clinical manifestation is peptic ulcer like symptom with a long duration, and a gross appearance is characterized by reddening, irregular and slight nodular thickening of the involved mucosa. We should be careful to differentiate chronic atrophie gastritis or multiple superficial gastric erosions from superficial spreading stomach cancer. It is classified to a subtype of early gastric cancer type Ilc(IIc'') and the prognosis is as good as early gastric cancer. A 60-yearold woman was admitted to our hospital because of epigastric pain for 2 years. She was confirmed to have superficial spreading stomach cancer by gastroduodenoscopy, endoseopic ultrasonography, and operation. We report a case of superficial spreading stomach cancer with a review of relevant literatures.

A case of occupational asthma induced by 7-Aminocephalosporanic acid (7-ACA) / 알레르기

Occupational asthma has been defined airway inflammation, hyperresponsiveness, and reversible airway obstruction related to exposure in workplace. Several drugs can cause asthma by inhalation during the manufacture. We report a case of cephalosporin induced occupational asthma which had not been reported in Korea yet. A 28 year-old male, an laboratorian, developed paroxysmal cough, dyspnea and chest tightness for four months. He has handled powder of cephalosporins and its precursors for thirty months. His symptoms used to be worsened during and shortly after his work and subsided several hours after work. When he visited our hospital, he denied such symptoms and revealed no abnormality on physical examinations. Skin prick test revealed positive result for ceftriaxone, ACT and 7-ACA, but negative for the other antibiotics. Bronchial provocation with 7-aminocephalosporanic acid elicited a single early response. In this case, the patient showed a positive bronchial provocation test to 7-aminocephalosporanic acid and a positive skin prick test to 7-ACA, aminocephalosporanic thiazine, ceftriaxone. We presumed that pathogenic mechanism of cephalosporin-induced asthma may be an IgE-mediated allergic reaction by the strong positive reaction in skin test. But further studies will be necessary to evaluate exact pathogenesis of cephalosporin-induced asthma.

Airway hyperresponsiveness and etiology in patients with chronic cough / 결핵

BACKGROUND:Chronic cough is commomly defined as a persistent or recurrent cough exceeding 3 week's duration. The prevalence of chroinc cough is reported to range from 14% to 23% for nonsmoking adults. The post nasal drip syndrome has been determined to be the most common cause of chronic cough, followed by asthma, chronic bronchitis, gastroesophageal reflux and bronchiectasis. Cough can be the only manifestation of asthma.. Bronchial provocation tests are useful in diagnosing cough variant asthma. We investigated the clinical or laboratory findings and the incidence of airway hyperresponsiveness and evaluated the etiology in patients with chronic cough. METHOD: We evaluated 46 patients with chronic cough. Methacholine challenge test were done. RESULTS: The results were as follows : 1) Thirty - five percent(16/46) of the chronic cough patients and 44% of the post nasal drip syndrom(7/16) showed the positive responses to methacholine challenge test. 2) The underlying causes of chronic cough were post nasal drip syndrome in 35%, bronchitis in 21.7%, cough-variant asthma in 17.4%, and unknown condition in 25.9%. 3) Airway hyperresponsiveness in chronic cough was not related to respiratory symptom, nasal symptom, post nasal drip, smoking, derangement of ventilatory function, atopy, or sinusitis. CONCLUSION: Airway hyperresponsivenss in patients with chronic cough increased in frequency when compaired with normal control, allergic rhinitis. Cough-variant asthma account for 17.4% of patients with chronic cough.

Inflammatory cells and T lymphocytes in bronchoalveolar lavage fluid from asthmatic patients: Relationship with development of asthmatic symptoms and therapeutic responese / 알레르기

OBJECTIVES: Chronic asthma has a number of characteristic feature; the increased airway responsiveness and bronchial inflammation. Although these mechanisms are not clear, activated T-cell has had an important role in migration and activation of inflammatory cells. In order to evaluate the role of T-lymphocyte and T-cell subsets in the development of asthmatic symptoms and the posibility for predicting the therapeutic response, we performed bronchoalveolar lavage from asymptomatic and symptomatic asthmatic subjects and inflammatory cell count, T-cell subset, activated T-lymphocyte were analysed and they were compared with healthy controls. METHOD: 76 bronchial asthmatics and 54 healthy controls were enrolled in this study. Asthmatic patients were classified into symptomatic and asymptomatic group according to symptom severity. Symptomatic group was divided into two groups according to therapeutic response ; early responder(ER) and late responder(LR). Lymphocytes(T-lymphocytes subsets and activation marker) in bronchoalveolar lavage(BAL) cells were analyzed using a flow-cytometry. RESULTS: The counts of eosinophil and neutrophil in BAL fluid were significantly higher in both asymptomatic and symptomatic asthmatic patient than those of healthy controls (p0.05), the numbers of T3 and T4 lymphocyte subsets were significantly higher in LR than in healthy controls, and the number of T3-IL2R+, T4-IL2R+ lymphocytes were significantly higher in ER than in healthy controls(p<0.05). CONCLUSION: We could conclude that the infiltration and activation of T-lymphocytes might be associated with the development of asthmatic symptoms and responsiveness to therapy.