A Case of Bronchonodal Fistula by Endobronchial Tuberculosis / 계명의대학술지

The Bronchial fistula is caused by infection, malignancy, trauma, inflammatory disease and foreign body. The bronchonodal fistula by endobronchial tuberculois is very rare complication. The authors present a 70-year-old man presented with hoarseness and sore throat. This patient diagnosed with endobronchial tuberculosis, which was complicated by bronchonodal fistula by sputum acid fast bacilli stain, bronchoscopy, and chest computed tomography. The patient was treated with antituberculosis therapy for 1 year, and follow up bronchoscopy and radiologic study showed regression of bronchonodal fistula.

Patient's Perception of Symptoms Related to Morning Activity in Chronic Obstructive Pulmonary Disease: The SYMBOL Study

BACKGROUND/AIMS: Patients with chronic obstructive pulmonary disease (COPD) experience more problematic respiratory symptoms and have more trouble performing daily activities in the morning. The aim of this study was to assess the perception of COPD symptoms related to morning activities in patients with severe airflow limitation. METHODS: Data of 133 patients with severe airflow limitation were analyzed in a prospective, non-interventional study. A clinical symptom questionnaire was completed by patients at baseline. In patients having morning symptoms, defined by at least one or more prominent or aggravating symptom during morning activities, a morning activity questionnaire was also completed at baseline and following 2 months of COPD treatment. RESULTS: The most frequently reported COPD symptom was breathlessness (90.8%). Morning symptoms were reported in 76 (57%) patients; these had more frequent and severe clinical COPD symptoms. The most frequently reported morning activity was getting out of bed (82.9%). The long acting muscarinic antagonist (odds ratio [OR], 6.971; 95% confidence interval [CI], 1.317 to 11.905) and chest tightness (OR, 0.075; 95% CI, 0.011 to 0.518) were identified as significantly related to absence of morning symptoms. There was no significant correlation between the degree of forced expiratory volume in 1 second improvement and severity score differences of all items of morning activity after 2-month treatment. CONCLUSIONS: Fifty-seven percent of COPD patients with severe airflow limitation have morning symptoms that limit their morning activities. These patients also have more prevalent and severe COPD symptoms. The results of this study therefore provide valuable information for the development of patient-reported outcomes in COPD.

A Case of Poncet's Disease in a Patient with Pulmonary Tuberculosis Accompanying Erythema Nodosum / 결핵및호흡기질환

Poncet's disease is an aseptic polyarthritis developing in the presence of active Tuberculosis occurring elsewhere, and is not due to direct involvement of joints but to an immunological reaction to tuberculoprotein. We experienced a case of Poncet's disease accompanying erythema nodosum in a 55-year-old female patient with pulmonary tuberculosis. She had multiple tender erythematous nodules on both lower limbs for 3 months and a cough and sputum from one month ago. She felt severe pain in both knees and ankles with swelling one week before admission. Her chest X-ray, computed tomography (CT) scan and positive sputum AFB stain results revealed that she had active pulmonary tuberculosis accompanying erythema nodosum and aseptic polyarthritis. Her arthritis and erythema nodosum were dramatically improved within four weeks after anti-tuberculosis therapy. We report a case of Poncet's disease in pulmonary tuberculosis accompanying erythema nodosum.

A Comparison of Tiotropium 18microgram, Once Daily and Ipratropium 40microgram, 4 Times Daily in a Double-Blind, Double-Dummy, Efficacy and Safety Study in Adults with Chronic Obstructive Pulmonary Disease / 결핵및호흡기질환

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.

Effect of Uteroglobin on cPLA2, COX-2 Expression and ERK Activation in NSCLC Cells / 결핵

BACKGROUND: Uteroglobin is a protein produced by the normal bronchial epithelium and its expression level is lower in non-small cell lung cancer tissues and cell lines. It mainly functions as an anti-inflammatory, and when it is overexpressed in cancer cells, the neoplastic phenotype is antagonized. cPLA2 and COX-2, which are also associated with inflammation, were reported to be related to cancer. The relationship between cPLA2, COX-2 and uteroglobin is unclear. The relationship between uteroglobin and ERK, which is related to cell growth, is also not unclear. This study investigated the changes in the cPLA2 and COX-2 expression levels and the ERK activities after the overexpression of uteroglobin in non-small cell lung cancer cell lines. METHODS: The A549 and NCI-H460 cell lines were infected by adenovirus-null and adenovirus- uteroglobin. The cChange in the cPLA2, COX-2 expression level and ERK activity after uteroglobin overexpression was measured by Western blot. The change in MMP activity was measured by zymography. RESULTS: Western blot revealed decreased expression levels of cPLA2, and COX-2, and increased pERK levels in nonsmall cell lung cancer cells after uteroglobin overexpression. Zymography revealed no changes in the MMP-2 activity and lower MMP-9 activity. U0126, which is a specific inhibitor of ERK-activating kinase MEK-1/-2, prevented the decrease in the MMP-9 activity CONCLUSIONS: A decrease in cPLA2 expression, COX-2 expression, MMP-9 activity and a increase in ERK activity may be related to the anticancer effects of uteroglobin in nonsmall cell lung cancer cells.

A Case of Mucormycosis Found in the Breast of a Hemodialysis Patient for Diabetic Nephropathy / 대한신장학회잡지

Mucormycosis, caused by Zygomycetes fungi of the order Mucorales, is a rare opportunistic infection which usually develops in immunosuppressed patients, especially in patients with diabetic acidosis. This infection, associated with the presence of broad, nonseparate hyphae in tissue, originates usually in the perinasal sinuses and nose, orbit, central nervous system, lung, skin, soft tissue, or gastrointestinal tract, but is occasionally disseminated from the primary location to other areas. Recently we experienced a case of Mucormycosis found in the breast of a 70-year old woman undergoing hemodialysis for diabetic nephropathy. The patients was very poor in her systemic condition. On physical examination, we found the subcutaneous mass in the left breast. Breast ultrasonography showed a mass with a relatively clear boundary in subcutaneous fatty layer and excisional biopsy confirmed infiltration of breast tissue by fungal hyphae. With improvement of patient's malnutrition via an aggressive hemodialysis, control of blood glucose and total parentral nutrition, the mass was slightly reduced in size and maintained without causing any notable symptom. Since Mucormycosis found in the breast tissue has not been reported in the literature yet, we report its case observed in a hemodialysis patient for diabetic nephropathy with the review of the literatures.

A Case of Pulmonary Cryptococcosis in Healthy Person / 결핵

Cryptococcosis is a systemic fungal infection caused by Cryptococcus neoformans. This mycosis is best known for meningeal involvement, yet, this disease rarely can be limited to the lungs. The usual portal of entry is respiratory tract. The recently rising incidence of the disease can be attributable to wide use of steroid, immunosuppressive agents and advent of AIDS. We experienced one case of pulmonary cryptococcosis in healthy person, who was admitted to the our hospital because of cough. Cryptococcus neoformans was isolated in the sputum, and lung tissue obtained by CT guide needle aspiration biopsy. Clinical improvement was noted after 6weeks of medical therapy with fluconazole.