One Case of Video-Assisted Thoracoscopic Removal of Acupuncture Needle in Lung Parenchyma / 결핵및호흡기질환

We report the case of a 32-year-old woman presenting with intermittent chest pain resulted from a migratory acupuncture needle. The patient received acupuncture treatment approximately 3 years prior to this presentation, for the treatment of chronic left shoulder and lumbar pain after delivery. Chest radiography revealed a retained needle in the lingular segmental area. Video-assisted thoracoscopy was then used to remove the migratory acupuncture needle attached between the lingular segmental lobe and the pericardial fat. The patient recovered without complications and was discharged home.

Association between the Human Surfactant Protein-A(SP-A) Gene Locus and Chronic Obstructive Pulmonary Disease in Korean Population / 결핵및호흡기질환

BACKGROUNDS: This study investigated whether or not a polymorphism in the gene encoding the surfactant protein A(SP-A) has any bearing on the individual susceptibility to the development of chronic obstructive pulmonary disease(COPD) in a genetically homogenous Korean population. METHODS: The genotypes of 19 COPD patients and 20 healthy neonates as controls were tested using a polymerase chain reaction followed by restriction fragment length polymorphism analysis for the SP-A gene. RESULTS: The specific frequencies of the 6A2 and 6A18 alleles of SP-A1 and the 1A2 allele of SP-A2 were much higher in the COPD group than control group (p<0.05). However, the frequencies of the 6A3 and 6A4 alleles of SP-A1 and the 1A0 allele of SP-A2 in the COPD group were significantly lower than the control group. In the COPD group, the frequencies of the +50 locus genotypes GG of SP-A1 and the +9 locus genotypes CC of SP-A2 were 85.0% and 60.6%, respectively, and 19.7% and 24.8% in the control group, respectively. The frequencies of the polymorphic genotypes or alleles showed a statistically significant difference between the COPD group and the control group (P<0.05). CONCLUSION: A genetic polymorphism in SP-A is associated with the development of COPD in the Korean population.

1 Case of Bronchial Leiomyoma with Intralobar Pulmonary Sequestration / 결핵및호흡기질환

Both bronchial leiomyoma and pulmonary sequestration are rare conditions, and to the best of our knowledge there are no reports of the two conditions coexisting. We report a female patient with bronchial leiomyoma with acquired pulmonary sequestration who presented with dyspnea, cough and purulent sputum. The patient had been treated for pneumonia at a local medical clinic. but was transferred to our clinic beacausr there was no clinical improvement. A 3-D computed tomography scan revealed a 1.5 cm sized mass near the distal portion of the left main bronchus and an anomalous artery arising from the aorta. The patient showed clinical improvement after a left lower lobectomy and a ligation of the anomalous artery.

Idiopathic Fibrosing Mediastinitis Causing Pulmonary Hypertension with Improvement by Steroid Treatment / 결핵및호흡기질환

Idiopathic fibrosing mediastinitis is, an uncommon cause of pulmonary hypertension this is characterized by excessive fibrosis of the mediastinum with an unknown etiology. Steroid therapy has been suggested for individuals with progressive symptoms, bu there is littlet data demonstrating the efficacy of such therapy are lacking. We present a case of pulmonary hypertension secondary to a compression of a main pulmonary artery by fibrosing mediastinitis which was confirmed by a biopsy with a thoracotomy. The chest CT scan and 2D echocardiography performed before and after a trial of steroid therapy demonstrated improvement after steroid therapy.

A Case of Epithelioid Hemangioendothelioma Involving the Lung, Pleura and Liver / 결핵및호흡기질환

Epithelioid hemangioendothelioma (EH) is a rare borderline malignant tumor which originating from vascular endothelial cells and occurs in many organs such as soft tissues, lung, liver and bone. But, pulmonary EH which simultaneously involves pleura and liver is very rare. In the present report, we describe an uncommon case of EH involving the lung, pleura and liver in a 26-year-old woman. Chest CT showed single nodule in right upper lobe with large amount of pleural effusion at ipsilateral side and abdominal CT multiple round low densities in liver. The EH was confirmed by microscopic analysis and immunohistochemical staining of CD34+ from open lung biopsy specimen.

Comparison of Clinical Features between Idiopathic Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension / 결핵및호흡기질환

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare but significantly imperative in inducing chronic pulmonary hypertension. Clinically, it is difficult to distinguish between IPAH and CTEPH. However, the treatment of pulmonary hypertension is different depending on the disease. The present study was performed to analyze the similarities and differences in clinical features between IPAH and CTEPH. METHODS: During a nine-year period, thirty-three patients with IPAH and twenty-two patients with CTEPH were enrolled. Symptoms, physical findings, chest radiograph, electrocardiograph, pulmonary function test, echocardiograph, perfusion lung scan, right heart catheterization results were analyzed between both the groups. RESULTS: The median age of IPAH group was 33 (6~70) years that was lower than that (52(27~80) years) of CTEPH group. Amongst the IPAH patients, there was female predominance (76 %) and there was no sex difference between the patients with CTEPH. Both the groups exhibited similarity in the results of chest radiograph, electrocardiograph, pulmonary function test, and echocardiograph. In the perfusion lung scan, all IPAH patients exhibited findings with normal (28%) or low probability (72%) of pulmonary embolism and all CTEPH patients exhibited findings with high probability of pulmonary embolism. CONCLUSION: Although IPAH and CTEPH bear similarities in terms of symptoms, physical signs and general investigation results, there were differences in age distribution, sex predominance and results of perfusion lung scan.

Neutrophil Apoptosis and H2O2 Release by LPS in Diabetics / 결핵및호흡기질환

BACKGROUND: Bacterial infections in diabetic patients are an important cause of increased morbidity and mortality. It has been reported that bacterial infections in diabetics showed more impaired PMN functions such as reduced PMN respiratory burst and decreased microbicidal activity in inflammed tissues. Also, apoptosis(programmed cell death) is postulated to be a key mechanism for neutrophil elimination. It is very important that PMN apoptosis keeps the balance from an area of inflammation. Actuallly, as little was known about PMN apoptosis and respiratory burst in diabetes, we investigated PMN apoptosis and hydrogen peroxide production after endotoxin exposure. METHODS: Peripheral venous blood samples were collected by routine venipuncture from healthy volunteers and diabetics to harvest neutrophils. We respectively measured the PMN apoptosis, the production of hydrogen peroxide, and the cell viability. RESULTS: Normal neutrophils showed a tendency to decreased apoptosis after endotoxin treatment. In patients with diabetes, PMN apoptosis was significantly decreased compared with healthy controls. In addition, the LPS-induced neutrophils in diabetics demonstrated more decreased apoptosis. However, the production of hydrogen peroxide was not different between groups. CONCLUSION: These observations suggest that the decreased PMN apoptosis in diabetics with endotoxin exposure may also affect the increased susceptibility and severity of infections.

A case of primary synovial sarcoma of the pleura / 대한내과학회지

Synovial sarcoma is a malignant soft tissue tumor originated from primitive mesenchymal cell and displays epithelial differentiation. Synovial sarcoma most commonly occurs in the peri-articular regions of the extremities in adolescents and young adults. But primary synovial sarcoma of the pleura is extremely rare. The present report describes a case of primary synovial sarcoma of the pleura in a 35-year-old male who showed unilateral spontaneous hemothorax as initial manifestation. The tumor mass was removed by open thoracotomy. The tumor was composed of oval to spindle cells with abundant vascular structures. Some of the spindle-shaped tumor cells express cytokeratin. A diagnosis of monophasic fibrous synovial sarcoma was made by histologic and immunologic features. The patient received chemotherapy postoperatively and showed no evidence of recurrence or tumor at other sites 1 year after surgery.

Detection of Mycobacterium Tuberculosis in Bronchial Specimens Using a Polymerase Chain Reaction in Patients with Bronchial Anthracofibrosis / 결핵

No abstract availalbe.

The Effect of Heat Co-treatment on Acute Lung Injury of the Rat Induced by Intratracheal Lipopolysaccharide / 결핵

BACKGROUND: The heat shock protein (HSP) 70 families are known to protect cells against the irreversible tissue injury induced by stress and to induce the recovery of cell function during stress. Heat pretreatment was reported to decrease the acute lung injury(ALI) of rats induced by lipopolysaccharide (LPS). However the role of heat shock with LPS co-treatmenton ALI is unclear. The purpose of this study was to investigate the effect of heat treatment, which was given immediately after the beginning of ALI induced by LPS intratracheally administered in rats. METHODS: Either saline (saline group) or LPS was intratracheally instilled without heat treatment (LPS group). In addition, heat was conducted 18 hours prior to the instillation of LPS (pre-treatment group) and conducted immediately after instillation of LPS (co-treatment group). Six hours after the LPS or saline treatment, blood, bronchoalveolar lavage (BAL) fluid and lung tissue samples were obtained. The myeloperoxidase (MPO) activity and the heat shock protein expression in the lung tissue, the differential counts of the polymorphonuclear leukocytes (PMN) in the BAL fluids, and the LDH, protein, IL-1beta, TNF-alpha and IL-10 levels in BAL fluid and serum were measured. RESULTS: 1)The MPO activity, the differential PMN counts in the BAL fluid, BAL fluid and serum cytokines were higher in the LPS, the heat pre-treatment and co-treatment group than those of the saline group (p value <0.05). 2)The MPO activity and the protein level in the BAL fluid from the heat co-treatment group were similar to those of the LPS group. 3) The serum TNF-alpha level of the heat co-treatment group was significantly higher than that of the LPS group (p=0.01) . CONCLUSIONS: Heat shock response administered immediately after a LPS instillation did not attenuate the ALI in this model.

Twenty cases of diffuse alveolar hemorrhage: A single center retrospective study / 대한내과학회지

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is an uncommon pulmonary disease. It could be occurred by diverse causes with the different response to the treatment. However, the clinical features of DAH have not been well known in Korea. METHODS: Twenty cases identified as DAH between March of 1990 and July of 2000 at a university affiliated hospital were retrospectively reviewed. RESULTS: The median age was 45 yr (range: 18~73 yr) with 11 females. Diagnosis was made by clinical and radiologic findings including hemoptysis, newly developed anemia, and diffuse bilateral lung opacities with the continuous bloody lavage fluid or bloody bronchial aspirate on bronchoscopy. The mean APACHE III score was 50.8 (+/-26.7) points. Hemoptysis prior to admission was observed in 8 (40%) patients. Diffuse crackles were heard on the bilateral lung fields in 18 cases. On chest radiographs, diffuse ground glass appearance and/or confluent air space consolidation with ill defined irregular margin were mainly observed. In patients with DAH the hemoglobin level fell a mean of 2.0 (+/-0.8) g/dL. Fourteen (70%) patients received mechanical ventilation due to the respiratory failure. Six patients (30%) were dead during admission. Among these patients, 4 patients were dead due to refractory respiratory failure with continuous DAH. The bleeding tendency such as disseminated intravascular coagulation or low platelet count was higher in dead patients than the survivors (p=0.018). The survivors of DAH with noninfectious causes showed better responses to immunosuppressive drugs with/without plasmapheresis compared to nonsurvivors (p=0.003). CONCLUSION: DAH was prone to develop acute respiratory failure and needed mechanical ventilation frequently. However, DAH of non-infectious causes showing a good response to the immunosuppresive therapy would have a better prognosis. In addition, DAH would have a worse prognosis in cases of combined bleeding tendency.

Eight Cases of Mucin-hypersecreting Cholangiocarcinoma Similar to Intraductal Papillary Mucinous Tumor of the Pancreas / 대한소화기내시경학회지

BACKGROUND/AIMS: Mucin-hypersecreting cholangiocarcinoma is very similar to intraductal papillary mucinous tumor (IPMT) of the pancreas. But this disease is rare and its clinicopathologic features are not well known. The purposes of this study are to report our experience of eight patients with the tumor and to analyze the characteristics of its clinical, radiological and pathological finding. METHODS: Eight patients (3 men and 5 women, mean age 52 years) were diagnosed as having a mucin-hypersecreting cholangiocarcinoma among 4,570 cases of ERCP from 1995 to 1998. RESULTS: Recent or previous attacks of biliary pain or acute cholangitis were elicited in most of the patients. CT showed diffuse intra- and extra-hepatic duct dilatation in all patients and suspicious ill-defined mass shadow in 2 out of 8 patients. On cholangioscopic examination, a papillary mass or minute mucosal lesion was found in the dilated bile duct containing thick viscid mucin. Eight patients were recommended an operation and curative resection was performed in seven patients. Histologically, well-differentiated adenocarcinoma in the background of benign hyperplasia and adenoma was documented in all patients. CONCLUSIONS: Mucin- hypersecreting cholangiocarcinoma may be characterized by exceedingly similarity to IMPT of the pancreas in clinical, radiological and pathological features. Further investigation is needed for detailed information such as natural history and outcome.

The Usefulness of Noninvasive Positive Pressure Ventilation in Patients With Acute Respiratory Failure after Extubation / 결핵

BACKGROUND: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in paients who developed acute respiratory failure after extubation. METHOD: We retrospectively analyzed thirty one patients (eighteen males and thirteen females, mean ages 63+/-13.2 years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 cmH2O of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. RESULTS: 1) NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. 2) There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and PaO2/FiO2 between the success and the failure group. 3) Heart rate and respiration rate were significantly decreased with increase SaO2 after thirty minutes of NIPPV in both groups (p<0.05). Ho wever, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in SaO2 leading to endotracheal reintubation. 4) The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases (62% vs 39%) (p=0.007). 6) The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease (n=9), aggravation of undelying disease (n=5), mask intolerance (n=2), and retained airway secretion (n=1). CONCLUSION: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

The Predictable Factors for the Mortality of Fatal Asthma with Acute Respiratory Failure / 결핵

BACKGROUNDS: Previous reports have revealed a high morbidity and mortality in fatal asthma patients, especially those treated in the medical intensive care unit(MICU). But it has not been well known about the predictable factors for the mortality of fatal asthma(FA) with acute respiratory failure. In order to define the predictable factors for the mortality of FA at the admission to MICU, we analyzed the relationship between the clinical parameters and the prognosis of FA patients. METHODS: A retrospective analysis of all medical records of 59 patients who had admitted for FA to MICU at a tertiary care MICU from January 1992 to March 1997 was performed. RESULTS: Over all mortality rate was 32.2% and 43 patients were mechanically ventilated. In uni-variate analysis, the death group had significantly older age (66.2 +/- 10.5 vs. 51.0 +/- 18.8 year), lower FVC(59.2 +/- 21.1 vs. 77.6 +/- 23.3%) and lower FEV1(41.4 +/- 18.8 vs. 61.1 +/- 23.30%), and longer total ventilation time (255.0 +/- 236.3 vs. 98.1 +/- 120.4 hour)(por=40) and PaO2/FiO2 ratio (<200) on the second day of MICU, which might reflect the response of treatment, rather than initially presented clinical parameters would be more important predictable factors of mortality in patients with FA.