Primary Adenoid Cystic carcinoma Arising in the Bronchus / 결핵

BACKGROUND: Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease that is histologically and ultrastructurally identical to the salivary gland tumor of the same name and regarded as a slow growing low-grade malignancy. We examined its clinkcal characteristics. METHODS: We collected 13 Korean cases of primary adenoid cystic carcinoma arising in the bronchus including 5 cases of our own and 8 cases from the literature. RESULT: The patients ages ranged from 20 to 74. Men numbered 9 and women 4. The presenting symptoms were cough, dyspnea, and hemoptysis. The fiberoptic bronchoscopic findings were primarily hypervascular polypoid mass with a smooth surface that obstructed airway totally or near totall. There were three inoperable cases including two cases with distant metastasis to bone or cervica lymph node and one case with mediastinal invasion. The remaining 10 patients underwent surgical resection. Among them, two patients received postoperative radiotherapy. The median survival was 21 months in the 8 surgical and evaluable cases. One paient lived 13 years without recurrence. The prognosis was relatively favorable in operable cases. CONCLUSION: It was not common for primary adenoid cystic carcinoma arising in the bronchus to have distant metastasis or invasion to the mediastinum on presentation. The prognosis was relatively favorable in operable cases. It would be important to perform flexible bronchoscopy for early diagnosis and to do surgical treatment if possible

A Case of Eyeball Metastasis of Lung Adenocarcinoma Confirmed by Enucleation / 결핵

Metastatic tumors to the eyes are probably the most common type of intraocular malignancies. The most common metastatic tumor is the breast cancer overall and lung cancer in men. An eyeball metastasis from lung cancer has a poor prognosis. Differentiating an eyeball metastasis from the primary malignant melanoma is important. Eyeball metastasis of a lung adenocarcinoma confirmed by pathology has not report in Korea. Here we reoprt a case of a metastatic lung adenocarcinoma to the eyeball confirmed by enucleation and a transbronchial lung biopsy with a review of the relevant literature.

Differential Diagnosis By Analysis of Pleural Effusion / 결핵

BACKGROUND: Pleural effusion is one of most common clinical mainifestations associated with a variety of pulmonary disease such as malignancy, tuberculosis, and pneumonia. However, there are no useful laboratory tests to determine the specific cause of pleural effusion. Therefore, an attempt was made to analyze the various types of pleural effusion and search for useful laboratory tests for pleural effusion in order to differentiate between the disease, especially between a malignant pleural effusion and a non-malignant pleural effusion. METHODS: 93 patients with a pleural effusion, who visited the Severance hospital from January 1998 to August 1999, were enrolled in this study. Ultrasound-guided thoracentesis was done and a confirmational diagnosis was made by a gram stain, bacterial culture, Ziehl-Neelsen stain, a mycobacterial culture, a pleural biopsy and cytology. RESULTS: The male to female ratio was 56:37 and the average age was 47.1±21.8 years. There were 16 cases with a malignant effusion, 12 cases with a para-malignant effusion, 36 cases with tuberculosis, 22 cases with a para-pneumonic effusion, and 7 cases with transudate. The LDH2 fraction was significantly higher in the para-malignant effusion group compared to the para-pneumonic effusion group [30.6±64.% and 20.2±7.5%, respectively (p<0.05)] and both the LDH and LDH2 fraction was significantly in the para-malignant effusion group compared to those with tuberculosis [16.4±7.2% vs. 7.6±4.7%, and 30.6±6.4% vs. 17.6±6.3% respectively (p<0.05)]. The pleural effusion/serum LDH4 fraction ratio was significantly lower in the malignant effusion group compared to those with tuberculosis [1.5±0.8 vs. 2.1±0.6, respectively (p<0.05)]. The LDH4 fraction and the pleural effusion/serum LDH4 fraction ratio was significantly lower in the para-malignant effusion group compared to those with tuberculosis [17.0±5.8% vs. 23.5±4.6% and 1.3±0.4 vs. 2.1±0.6, respectively(p<0.05)]. CONCLUSION: These results suggest that the LDH isoenzyme was the only useful biochemical test for a differential diagnosis of the various disease. In particular, the most useful test was the pleural effusion/serum LDH4 fraction ratio to distinguish between a para-malignant effusion and a tuberculous effusion.

A Case of the Hepatic Hydrothorax in the Absence of Ascites Confirmed by Tc-99m Macroaggregated Serum Albumin Scan / 결핵

Pleural effusion due to hepatic cirrhosis with ascites is well known, although hepatic hydrothorax in the absence of ascites is a rare condition, the pathogenesis of which is still unknown. We report a case of hepatic hydrothorax without ascites confirmed by the intraperitoneal injection of Tc-99m macroaggregated serum albumin (Tc-99m MAA) that demonstrated the passage of Tc-99m MAA into the right pleural cavity.

A Case of acute respiratory distress syndrome induced by all-trans-retinoic acid / 결핵

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/mm3 PaO2 was 42.5 mmHg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ADRD by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of ATRA. And so, we present this case with a review of related literatures.

A case of endobronchial aspergilloma

Pulmonary aspergillosis may be classified under three categories, depending upon whether the host is atopic or immunocompromised: invasive aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma. However, it is not always possible to effectively categorize this disease. We experienced a case of endobronchial aspergilloma, which was difficult to categorize, in a healthy male patient. The chest X-ray and computed tomography showed an ill-defined nodule mimicking lung cancer. Fiberoptic bronchoscopy revealed an aspergilloma without cavity formation in the left lower laterobasal segmental bronchial orifice. The aspergilloma was removed and the patient's symptoms were relieved. We present this unusual case with a review of the literature.

Fluticasone Propionate and Beclomethasone Dipropionate in Asthmatic Patients / 결핵

BACKGROUND: Corticosteroid is most potent and effective anti-inflammatory medication currently available and inhaled form has been used in the long-term control of asthma. Fluticasone propionate(Flixotide/Flovent : FP) is highly potent and topically active inhaled corticosteroid and has at least twice the potency of beclomethasone dipropionate(BDP) in the control of asthma. The aim of this study was to compare the efficacy of FP and BDP in several aspects. METHOD: Fifty patients with asthma were treated in a randomized, parallel group study of 4 weeks duration. During 2-week run-in period beta2-agonist was administered. After run-in period, FP 500 micro gram/day was administered via Diskhaler or BDP 800 micro gram/day via reservoir dry-power device. During the run-in and treatment period, morning and evening peak expiratory flow rate(PEFR) were measured daily. Daytime and night-time asthma symptoms, daytime and night-time rescue bronchodilator use were checked daily. FEV1.0 and FVC were measured biweekly in both groups. RESULTS: Three patients treated with FP and seven patient treated with BDP were dropped out. Therefore forty patients completed the study. Morning and evening PEFR was increased and diurnal variation of PEFR decreased significantly in both groups. FEV1.0 increased significantly in FP treatment group but not in BDP group. There were also improvements in daytime and night-time asthma symptoms, daytime and night-time rescue bronchodilator use in both groups after treatment. there were no significant difference between groups in any of the efficacy parameters. Therapeutic effects were dimonstrated earlier in patient treated with FP than BDP. CONCLUSION: In this study, 500 micro gram/day fluticasone propionate was as effective as 800 micro gram/day beclomethasone dipropionate in the control of asthma. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP without adverse effect.

A Case of Primary Unknown Squamous Cell Carcinoma Incidentally Found in the Thrombus After Pulmonary Embolectomy / 결핵

A thromboembolic event in patients later given a diagnosis of cancer is the result rather than the cause of the cancer. The risk of hidden cancer is significantly higher for patients with recurrent idiopathic thromboembolism compared to those with secondary deep vein thrombosis. Microemboli from hepatic or adrenal metastases and large-sized emboli from the great veins invaded by the tumor are the sources of tumor embolization. The intraarterial tumor emboli less likely invade the arterial wall. Thrombus formation and organization may be capable of destroying tumor cells within pulmonary blood vessels. Therefore, all tumor emboli are not true metastases. The treatment of deep vein thrombosis and pulmonary embolism in patients with cancer consists of anticoagulation with heparin and warfarin, venacaval filters, appropriate anti-neoplastic agents, and surgical methods(embolectomy, thromboendarterectomy). However, considerable literatures suggest that oral anticoagulant such as warfarin is ineffective in the treatment of those. We report a case of primary unknown squamous cell carcinoma incidentally found in the thrombus after pulmonary embolectomy.

A case of allergic bronchopulmonary aspergillosis shown as bilateral pulmonary masses / 결핵

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABPA initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABPA include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.

A Case of Pleural Involvement in Patient with Waldenstr m's Macroglobulinemia / 대한혈액학회지

Waldenstr m's macroglobulinemia (WM) is a rare lymphoproliferative disorder characterized by lymphocytic tumor infiltration of the bone marrow and monoclonal IgM gammopathy. There had been anecdotal reports of pleural involvement in WM. We experienced a case of WM with pleural involvement and reported here for the first time in Korea with review of literature. A 73-year-old male patient was admitted to our hospital due to dizziness and general weakness. Serum protein electrophoresis showed M-peak in the gamma-globulin region, which was revealed as IgM kappa macroglobulin by serum and urine immunoelectrophoresis. He complained headache, visual disturbance and epistaxis associated with hyperviscosity syndrome and plasma filtration and combination chemotherapy was performed immediately. Symptoms and laboratory parameters such as serum IgM level and globulin fraction were markedly improved thereafter. But during the treatment, insidiously progressive exertional dyspnea was developed and the chest X-ray showed bilateral pleural effusion. The pleural fluid contained abundant plasmacytoid lymphocytes with reactive mesothelial cells. His dyspnea was completely resolved with clearing of the radiographic pleural effusion after continued steroid therapy.

A Case of Cytomegalovirus Pneumonia Associated with Nephrotic Syndrome / 결핵

No abstract available.

A Case of Cytomegalovirus Pneumonia Associated with Nephrotic Syndrome / 결핵

No abstract available.

One Case of Tracheal Rupture after Blunt Chest Trauma Diagnosed Early by Fiberoptic Bronchoscopy / 결핵

Tracheobronchial rupture is one of the less-common injuries associated with blunt chest trauma. The diagnosis of tracheobronchial rupture is not easy, but failure to diagnosis may lead to death or long-term disability. Early diagnosis and appropriate management can reduce the mortality and morbidity. Bronchoscopy is the diagnostic method of choice for patients with tracheobronchial rupture. We report a case of tracheal rupture after blunt chest trauma. A 40-year-old man was transferred to our hospital for dyspnea after blunt chest trauma. He was promptly diagnosed as tracheal rupture by fiberoptic bronchoscopy and chest computed tomogram. He was successfully managed by thoracotomy and primary repair.

One Case of Tracheal Rupture after Blunt Chest Trauma Diagnosed Early by Fiberoptic Bronchoscopy / 결핵

Tracheobronchial rupture is one of the less-common injuries associated with blunt chest trauma. The diagnosis of tracheobronchial rupture is not easy, but failure to diagnosis may lead to death or long-term disability. Early diagnosis and appropriate management can reduce the mortality and morbidity. Bronchoscopy is the diagnostic method of choice for patients with tracheobronchial rupture. We report a case of tracheal rupture after blunt chest trauma. A 40-year-old man was transferred to our hospital for dyspnea after blunt chest trauma. He was promptly diagnosed as tracheal rupture by fiberoptic bronchoscopy and chest computed tomogram. He was successfully managed by thoracotomy and primary repair.

A case of angioedema associated with eosinophilia / 천식및알레르기

Episodic angioedema with eosinophilia was described by Gleich, et al. as a distinct entity characterized by recurrent angioedema, urticaria, leukocytoeis with remarkable eosinophilia, fever and periadically increased body weight. Since then, several cases of this disorder have been reported in the United States, Europe and Japan. We present a Korean patient whose clinical, histopathologic, and laboratory findings are consistent with the syndrome of episodic angioedema with eosinophilia. This case supports the previous study that revealed some differences between Asian and Caucasian patients.

A Case of Acute Pancreatitis in Systemic Lupus Erythematosus / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is a multisystemic disease that can involve the gastrointestinal tract, liver, and biliary system. Symptomatic pancreatic involvement, however, has rarely been reported. It may be part of the primary disease process, such as vasculitic or autoimmune etiology, or associated with drug therapy, in particular corticosteroid. We report here a lupus patient who developed severe pancreatitis within 30 hours of initiation of corticosteroid therapy; we also discuss the relation between pancreatitis and systemic lupus erythematosus.

A Case of Toxoplasma Lymphadenitis / 감염

Toxoplasma lymphadenitis is the most common clinical manifestation of toxoplasmosis in an immunocompetent host. In foreign countries, it is a relatively common etiology of reactive hyperplasia of lymph nodes, but it is still rare in Korea. The cervical lymph nodes are the most commonly involved, whereas systemic manifestations are rare. We are reporting a case of toxoplasma lymphadenitis in an immunocompetent host. A 31-year-old man was admitted to the hospital because of submandibular lymph node enlargement for 3 months. Toxoplasma lymphadenitis was diagnosed by positive IgG and IgM toxoplasma antibody titer and specific pathologic findings of submandibular lymph node, such as reactive follicular hyperplasia, epitheioid histiocytes in the interfollicular area, and infiltrations of subcapsular monocytoid B lymphocytes. In Korea, travels to and from other countries and contacts with foreigners are increasing, possibly increasing the incidence of toxoplasma lymphadenitis, which should be considered in the differential diagnosis of lymphadenitis.

A Case of Optic Neuritis in Systemic Lupus Erythematosus / 대한내과학회지

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Optic neuritis in SLE is very rare and the prevalence can be estimated to be approximately 1% of the patients of SLE. The main pathogenesis of optic neuritis with SLE is that of a vaso-occlusive disease in small vessels and the histopathologic appearance has varied from demyelination to definite vascular disease with axonal necrosis. The visual outcome of optic neuritis in SLE has often been poor. The treatments of optic neuritis in SLE are intravenous methylprednisolone, immunosuppressive agents and plasmapheresis. The authors experienced a case of lupus nephritis and CNS lupus which was complicated by optic neuritis in 18-year-old female patient who complained of sudden visual disturbance of the both eyes After treatment with plasmapheresis and systemic corticosteroid, her visual deficit was gradually recovered.