Unusual Presentation of Miliary Tuberculosis / 결핵및호흡기질환

No abstract available.

The Meaning of Polysomnographic Indexes in Patients with Obstructive Sleep Apnea and Erectile Dysfunction / 대한남성과학회지

PURPOSE: The purpose of this study was to correlate erectile function with polysomnographic indexes of obstructive sleep apnea(OSA) and other associated factors. MATERIALS AND METHODS: Among the 42 patients who visited our sleep clinic, we enrolled 32 patients who scored lower than 22 on the IIEF-5(International Index of Erectile Function-5). Polysomnography(PSG) was performed for OSA evaluation. Apnea-hypopnea index(AHI), AHI during REM sleep, AHI during non-REM sleep, arousal index(AI), and sleep efficacy(SE) were used as PSG indexes. Obesity was quantified by body mass index(BMI). The patients were divided into 2 groups according to AHI: group A 10(n=19). BMI and erectile function scores were compared between the 2 groups. The correlations among erectile function scores, PSG indexes, and BMI were analyzed. RESULTS: IIEF-5 score was negatively correlated with AHI(r=-0.372, p <0.05) and AI(r=-0.472, p <0.05), and there was a positive correlation with SE(r=0.372, p <0.05) of PSG. Between the 2 AIH groups, the low AHI group had a statistically higher mean erectile function score, especially in the EF domain and in the total IIEF score compared to the high AHI group. CONCLUSIONS: Indexes for penile rigidity were negatively correlated with AHI and AI. These findings suggest that AHI, AI, and SE of PSG are meaningful indexes of erectile function and support the hypothesis that hypoxia induced by sleep apnea plays a role in poor rigidity. Further studies in larger groups, including analysis of PSG indexes and erectile function changes before and after the treatment of sleep apnea, would be necessary to confirm this hypothesis.

Two Cases of Pharyngeal Tuberculosis Secondary to Pulmonary Tuberculosis / 감염과화학요법

Pharyngeal involvement of tuberculosis is rare and is seen only in massive sputum positive patients with cavitating pulmonary tuberculosis. The pharyngeal lesions are secondary to aspiration of heavily infected sputum from lung and consist of painful shallow ulcers in pharynx. Chronic sore throat and unexplained dysphagia should alert the clinician to possibility of tuberculosis, especially in the countries where tuberculosis is endemic. We report two cases of pharyngeal tuberculosis with pulmonary tuberculosis, one of which has concurrent laryngeal and intestinal tuberculosis. Histological and bacteriological examinations established the diagnosis of pharyngeal tuberculosis associated with pulmonary focus.

Pulmonary Leptospirosis complicated by Acute Respiratory Distress Syndrome without Hemoptysis / 감염과화학요법

Leptospirosis is an acute febrile illness that is endemic in many tropical areas and considered the most common zoonosis worldwide. It is caused by the spirochete Leptospira interrogans. The clinical manifestations may be extremely variable, ranging from flu-like symptoms with mild constitutional complains like fever, headache, myalgias, and gastrointestinal complaints to a severe presentation with the complete Weil's syndrome and sometimes with acute respiratory distress syndrome (ARDS). In Korea, the more common clinical finding is pulmonary manifestation such as cough, hemoptysis and dyspnea. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary hemorrhage and/or acute respiratory distress syndrome (ARDS). A 67-year-old farmer was referred to the hospital with a history of fever, dyspnea, and confusion. She was found to have severe arterial hypoxemia but, denied blood-tinged sputum. Radiography showed widespread infiltrations over both lung fields, and hemodynamic features were consistent with ARDS. The patient recovered completely without mechanical ventilation.

Two Cases of Pharyngeal Tuberculosis Secondary to Pulmonary Tuberculosis / 감염과화학요법

Pharyngeal involvement of tuberculosis is rare and is seen only in massive sputum positive patients with cavitating pulmonary tuberculosis. The pharyngeal lesions are secondary to aspiration of heavily infected sputum from lung and consist of painful shallow ulcers in pharynx. Chronic sore throat and unexplained dysphagia should alert the clinician to possibility of tuberculosis, especially in the countries where tuberculosis is endemic. We report two cases of pharyngeal tuberculosis with pulmonary tuberculosis, one of which has concurrent laryngeal and intestinal tuberculosis. Histological and bacteriological examinations established the diagnosis of pharyngeal tuberculosis associated with pulmonary focus.

Pulmonary Leptospirosis complicated by Acute Respiratory Distress Syndrome without Hemoptysis / 감염과화학요법

Leptospirosis is an acute febrile illness that is endemic in many tropical areas and considered the most common zoonosis worldwide. It is caused by the spirochete Leptospira interrogans. The clinical manifestations may be extremely variable, ranging from flu-like symptoms with mild constitutional complains like fever, headache, myalgias, and gastrointestinal complaints to a severe presentation with the complete Weil's syndrome and sometimes with acute respiratory distress syndrome (ARDS). In Korea, the more common clinical finding is pulmonary manifestation such as cough, hemoptysis and dyspnea. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary hemorrhage and/or acute respiratory distress syndrome (ARDS). A 67-year-old farmer was referred to the hospital with a history of fever, dyspnea, and confusion. She was found to have severe arterial hypoxemia but, denied blood-tinged sputum. Radiography showed widespread infiltrations over both lung fields, and hemodynamic features were consistent with ARDS. The patient recovered completely without mechanical ventilation.

Localized Pulmonary Edema in Patient with Severe Mitral Regurgitation / 결핵및호흡기질환

An 82-year-old female non-smoker with a history of hypertension presented with increasing dyspnea, cough and some purulent sputum without fever. Upon admission, the patient was in a distressed condition. Auscultation revealed diminished breath sounds with no rales over the right lung. An examination of the heart revealed a regular rhythm and a systolic murmur radiating from the apex of the heart. There was no pitting edema in the lower extremities. The blood tests showed mild leukocytosis and an increased C-reactive protein level. The O2 saturation was 98 % whilst breathing room air. The electrocardiogram demonstrated sinus tachycardia. The chest radiograph showed a moderate cardiomegaly, right lobe infiltrates, and blunting of the both costophrenic sulcus suggesting a small pleural effusion. Three days after admission, the symptoms became slightly aggravated despite being treated with empirical antibiotics for presumed community-acquired pneumonia. Transthoracic color Doppler echocardiography indicated an ejection fraction of 48 %, mild left ventricular enlargement, and moderate left atrial enlargement resulting in severe mitral regurgitation. The clinical symptoms and right pulmonary edema resolved quickly with intravenous furosemide treatment.

Expression of Hypoxia-inducible Factor-1alpha and Vascular Endothelial Growth Factor in Corpus Cavernosum of the Type 2 Diabetes Mellitus Rat / 대한남성과학회지

PURPOSE: The expression of hypoxia-inducible factor-1alpha(HIF-1alpha) and vascular endothelial growth factor(VEGF) has been known as important factor of vascular complications in diabetes mellitus. The penile tumescence has variable degree according to vascularity. The aims of this study were to investigate erectile function and cavernosal expression of HIF-1alpha and VEGF in Otsuka Long-Evans Tokushima Fatty(OLETF) rats, which develop NIDDM naturally. MATERIALS AND METHODS: Ten male OLETF rats and ten control male Long-Evans Tokushima Fatty(LETO) rats were included in this study. The development of diabetes mellitus for OLETF were defined by glucose tolerance test at 26 weeks. After 72 weeks, OLETF rats, LETO rats and ten twenty-week male Sprague-Dawley rats were studied. Intracavernosal pressure were measured after cavernous nerve stimulation. Immunohistochemical stain and Western blot analysis were done for HIF-1alpha and VEGF in corpus cavernosum. RESULTS: Cavernous nerve stimulation-induced mean intracavernosal pressure(mmHg) was significantly decreased in the OLETF group(21.6+/-6.7 mmHg) compared to LETO(32.8+/-16.0 mmHg) group and in the LETO group compared to Sprague-Dawley group(47.2+/-11.7 mmHg)(p <0.05). With Western blot analysis, HIF-1alpha and VEGF expressions were higher in the OLETF group compared to other groups. With immunohistochemical stain, HIF-1alpha and VEGF were mainly expressed in corpus cavernosum and endothelium. CONCLUSIONS: We propose that increased HIF-1alpha and VEGF expressions in OLETF rat penile tissue can be found at microvascular injury in corpus cavernosum and are presumed to be associated with vasculogenic erectile dysfunction.

Unresolving Pneumonia / 결핵및호흡기질환

A 47-year-old-man was admitted to the emergency department with dyspnea, right pleuritic pain, and high fevers for 3 days. He had a nonproductive cough that exacerbated the chest pain. A clinical examination revealed distressed and slightly tachypneic patient, with blood pressure of 110/90 mmHg, temperature of 39degrees C, pulse of 90 beats/min, respiratory rate of 24 breaths/min. A chest examination showed significantly diminished breath sounds in the right lung with dullness to percussion. Laboratory investigation demonstrated leukocytosis and a raised C-reactive protein. The results of arterial blood gas analysis revealed moderate hypoxemia. A radiograph and a CT scan of the chest showed extensive consolidation with multifocal low densities, and pleural effusion in the right lung. A diagnostic thoracentesis revealed straw-colored fluid, which was found to be a neutrophil-predominant exudate. At 7 days after admission, the clinical symptoms had not improved and the temperature was still 39degrees C despite the aggressive therapy of community- acquired pneumonia. After comprehensive history taking, we realized then that he accidentally aspirated kerosene while siphoning from fuel tank to put into the boiler 3 days ago. Bronchoscopy with bronchial washings could be successful in establishing the diagnosis of hydrocarbon pneumonitis by demonstration of a high lipid-laden macrophage index. Thereafter, the symptoms and radiographic opacities gradually improved, and he was discharged several days later.