Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014 / 결핵및호흡기질환

Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma.

Extended Sleeve Lobectomy for Tuberculous Bronchial Stenosis: A case report / 대한흉부외과학회지

Tuberculosis involving the central airway occasionally results in diffuse stenosis in the distal trachea and main bronchus. When the stenosis is more limited to the main bronchus, sleeve resection can be performed with high likelihood of a good result. Bronchial stenosis limited to 2 cm is considered favorable for bronchial sleeve resection. However, a longsegment stenosis may make sleeve resection difficult or impossible, and pneumonectomy or therapeutic bronchoscopy may be performed. An extended sleeve lobectomy is a procedure to remove more than one lobe using a bronchoplasty technique and its applications to the patients with locally advanced lung cancer were reported. We performed an extended sleeve lobectomy in a patient with tuberculous bronchial stenosis involving the right main bronchus, bronchus intermedius, right middle lobar bronchus and right lower lobar bronchus, and report this case with review of literatures.

A Case of Addison' s Disease / 대한피부과학회지

Addison's disease is a rare disorder resulted from a chronic deficiency of the adreanl cortical hormone. The clinical manifestations are general weakness, weight loss, hyperpigmentation, hypovolemia with hyponatremia and hyperkalemia. We report a case of Addison's disease in a 60-year-old woman who has experienced slowly progressive weakness, weight loss and generalized cutaneous pigmentation, especially sun exposed area, extensor surface and nail bed for the last, 2 years. On a hormonal assay of the adrenal glands, basal plasma cortisol level was decreased and basal plasma ACTH level was markedly elevated. A chest X-ray showed streaky tuberculous infiltration in left, upper lobe field and adrenal CT scan showed calcific densities of both adrenal glands with nodular enlargement of right adrenal gland. There was a clinical improvement with steroid replacement therapy and anti-tuber- culosis chemotherapy. A nearly normal appearance was obtained after 5 months' treatment.

A Cavitary Lesion Changed to Pulmonary Nodule / 결핵

We have experienced a case of pulmonary adenocarcinoma looked like cavitary lesion of pulmonary tuberculosis in 49-year-old male patient. He has taken antituberculous medication for 5 months under the impression of pulmonary tuberculosis with cavity at local hospital. The cavitary lesion was changed nodular mass on follow-up chest X-ray. Transthoracic fine needle aspiration was done and cytologic specimen suggested squamous cell carcinoma. Right middle lobectomy was performed. The nodular mass, which was confirmed as adenocarcinoma on microscopic examination, had central cavity filled with hemorrhage.

A Case of Primary Leiomyosarcoma of the Lung / 결핵

Primary leiomyosarcoma of the lung is very uncommon, and fewer than 50 cases now have been reported. Primary leiomyosarcoma of the lung resembles bronchogenic carcinoma in its clinical presentation and radiologic appearance. However, the former has some differences; younger onset than bronchogenic carcinoma, polypoid endobronchial growth, few positive cytologic examination of sputum and unusual lymph node metastasis. We experienced a case of primary leiomyosarcoma of the lung.