Cicatricial Fibromatosis Diagnosis after Suspected Local Recurrence at the Bronchial Stump Following Lobectomy for Lung Cancer

A mass excision surrounding the bronchial stump was performed to exclude malignancy in a 42-year-old man who had undergone a right lower lobectomy for lung cancer. The mass was identified as a cicatricial fibroma. Cicatricial fibromatosis, which is desmoid fibromatosis that arises in a surgical scar, is a well-known clinical condition. It consists of histologically benign neoplasms. Their occurrence after thoracic surgery is extremely rare. Biopsy or excision of suspicious lesions is very important for diagnosis. R0 resection remains the principal outcome for intra-thoracic desmoid fibromatosis. We report that a cicatricial fibromatosis in the subcarinal space was removed after suspicion of local recurrence at the bronchial stump follwing lobectomy for lung cancer.

Primary Pulmonary Biphasic Synovial Sarcoma Confirmed by Molecular Detection of a SYT-SSX2 Fusion Gene: Report of 1 Case

We experienced a case of primary pulmonary biphasic synovial sarcoma, which was confirmed by immunohistochemistry and molecular testing of SYT-SSX2 fusion transcripts. The patient was a 61-year-old man who presented with a well-defined mass in the left upper lung field on chest radiography. Left upper lobectomy with lymph node dissection was performed. Histological and immunophenotypic features were consistent with biphasic synovial sarcoma. Reverse transcriptase polymerase chain reaction, performed using RNA extracted from frozen tumor samples for the detection of SYT-SSX fusion gene, amplified a single 331-bp fragment that was characteristic of the SYT-SSX2 fusion transcripts. We report a case of primary pulmonary biphasic synovial sarcoma, which was confirmed by SYT-SSX2 fusion transcripts, and present a brief review of the literature on Korean cases.

Factors Associated with Early Death in Patients with Community-Acquired Pneumonia / 결핵및호흡기질환

BACKGROUND: Early death is an important problem associated with the management of community-acquired pneumonia. However, there is little information on the risk factors associated with it. The aim of this study was to identify the factors associated with early death in community-acquired pneumonia patients. METHODS: From January 1999 to July 2004, 1,487 adult patients with community-acquired pneumonia who were admitted to the pulmonary department via emergency center were examined. Early death was defined as those who died within 2 days of hospitalization. The clinical and laboratory aspects of the patients who died early (n=30) were compared with those of an age and gender matched control population (n=60) . RESULTS: In the early death group, respiratory rate, heart rate, and blood urea nitrogen (BUN) were significant higher (p<0.05 for all), while the arterial pH, systolic pressure, and PaO2 were significant lower (p<0.05 for all) than the control. The independent factor significantly associated with early death was tachypnea (OR, 7.049). CONCLUSION: The importance of an early clinical assessment in emergency center with community-acquired pneumonia needs to be emphasized in order to recognize patients at risk of early death.

Validity of peak expiratory flow for assessing the presence of airflow obstruction / 대한내과학회지

BACKGROUND: Since there has been strong correlation between peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1), assessing the presence of airflow obstruction by PEF measurements would be useful in general practice, but its usefulness has not been well investigated. We hypothesize that PEF would be practicable for assessing the presence of airflow obstruction. METHODS: PEF measurements were performed mini-Wright peak flow meter in 106 patients (aged 19-82) with a history of asthma or chronic obstructive lung disease. The change in PEF (% predicted value) was compared with the change in FEV1 and forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC). Airflow obstruction was analyzed according to European Community for Coal and Steel criteria. When defined as an FEV1 and FEV1/FVC ratio both below the 90% confidence interval of predicted values before bronchodilator. RESULTS: Airflow obstruction was observed in 76.4% (81) of patients. Relative operating characteristic analysis showed that an below in PEF of 60% of predicted value gave optimal discrimination between patients with no airflow obstruction and airflow obstruction (the sensitivity and specificity of below 60% of predicted value in detecting FEV1 and FEV1/FVC ratio both below the 90% confidence interval of predicted values were 86.4% and 83.0% respectively, with a positive predictive value of 94.5%) CONCLUSION: Percentage of predicted value in PEF could be used to diagnose airflow obstruction.

Change of Lung Volumes in Chronic Obstructive Pulmonary Disease Patients with Improvement of Airflow Limitation after Treatment / 결핵및호흡기질환

BACKGROUND: It is important to predict the exercise capacity and dyspnea, as measurements of lung volume, in patients with COPD. However, lung volume changes in response to an improvement in airflow limitation have not been explored in detail. In the present study, it is hypothesized that lung volume responses might not be accurately predicted by flow responses in patients with moderate to severe airflow limitations. METHODS: To evaluate lung volume responses, baseline and follow up, flow and lung volumes were measured in moderate to severe COPD patients. The flow response was defined by an improvement in the FEV1 of more than 12.3%; lung volume changes were analyzed in 17 patients for the flow response. RESULTS: The mean age of the subjects was 66 years; 76% were men. The mean baseline FEV1, FEV1/FVC and RV were 0.98L (44.2% predicted), 47.5% and 4.65 L (241.5%), respectively. The mean follow up duration was 80 days. The mean differences in the FEV1, FVC, TLC and RV were 0.27 L, 0.39 L, -0.69 L and -1.04 L, respectively, during the follow up periods. There was no correlation between the delta FEV1 and delta RV values(r=0.072, p=0.738). CONCLUSION: To appropriately evaluate the lung function in patients with moderate to severe airflow limitations; serial lung volume measurements would be helpful.