CT Densitometry of Lung Mass: The Effect of Reconstruction Algorithm

PURPOSE: To evaluate the effect of reconstruction algorithms on the CT measurement of mean lung mass density and normal thoracic structures. MATERIALS AND METHODS: Forty-six patients with a 2-9cm-sized lung mass underwent thoracic CT examinations with intravenous contrast enhancement and using a CT HiSpeed Advantage scanner (GE Medical Systems). In each examination, the axial image of the lung mass was reconstructed using soft, standard, detail, and bone algorithms. The mean value and standard deviation of mass density in Hounsfield Units (HU) were measured using ROIs of three different sizes (50 mm2, 200 mm2, and 350 mm2 or more), and the same method was used to measure the density of normal lung, muscle, bone, and vessels. In 21 patients, mass density was also measured on unenhanced and delayed enhanced images and the degree of enhancement was calculated. RESULTS: The average maximum difference in mean mass density in the images of the four different algorithms was less than 1 (range, 0.1 -1.9) HU (ROI size, 350 mm2 or more), 0 -4.2 HU (200 mm 2), and 0.1 -3.6 HU (50mm2). The average maximum difference in the degree of lung mass enhancement was 0.5 -1.2 (range, 0 -1.6 )HU (ROI size, 350 mm2 or more). The mean density of the four normal thoracic structures was highest in images reconstructed with the bone algorithm, though there was no significant difference between the four different algorithms (p = 1.000). CONCLUSION: The measured mean CT density of a lung mass larger than 2 cm does not significantly change according to the reconstruction algorithm used. When using a small ROI, however, the density difference may increase.

Thioredoxin Peroxidase manifestation in Radiation-induced White rat Lung tissues / 결핵

BACKGROUND/AIMS: It is well recognized that all aerobic cells have the protective mechanisms in order to minimize the tissue damage induced by various reactive oxygen species(ROS). Thioredoxin peroxidase(TPX) which has been recently identified and characterized functions to convert peroxide to water. The protein is also found in various subtypes(TPX-A and B, MER5, HS22 and HORF-06) and is known to be ubiquitous in most human cells. Especially, ischemic brain injuries, partial hepatectomy and radiation induced DNA damages. In treating lung cancer, radiation therapy has a major place in the local control and the relief of symptoms, but radiation induced free radical injury and resulting pulmonary fibrosis has been the major drawback of the therapy. However, little is known about the protective mechanisms and biologic modulations against radiation induced tissue damages. METHODS: Eighteen mice were divided into six groups, 3 in each group, and fifteen had received 900cGy of radiation. The mice were sacrificed according to the pre determined time schedule; immediate, 1, 2, 3 and 6weeks after irradiation. Extracts were made from the lungs of each mice, Western blot analysis of various subtypes of TPX were done after SDS-PAGE. Examination of H and E stained slides from the same irradiated specimens and the control specimens were also performed. RESULTS: No difference in the intensity of the immunoreactive bands in the irradiated lung samples of the mice compared to the unirradiated control was observed regardless of the time intervals, although H and E examination of the sample specimens demonstrated progressive fibrotic changes of the irradiated lung samples. CONCLUSION: In conclusion, according to our data, it is suggested that various thioredoxin peroxidase subtypes and catalase which are known to be increased in many repair processes may not be involved in the repair of the radiation injury to the lung and subsequent fibrosis.

Pulmonary Toxicity Following High-Dose Chemotherapy With Peripheral Blood Stem Cell Transplantation / 결핵

BACKGROUND: High-dose chemotherapy is increasingly employed in many refractory malignant diseases. This therapy has been reported to increase response rate and survival benefits but it is also associated with higher treatment-related morbidity and mortality. We evaluated clinical characteristics and course of the pulmonary toxicity following high-dose chemotherapy with peripheral blood stem cell transplantation. METHODS: Ninety-seven patients who had received high-dose chemotherapy with peripheral blood stem cell transplantation were evaluated. Five patients who developed lung lesions which were not related to infection nor primary malignant disease underwent transbronchial lung biopsy. The patients' clinical characteristics, treatments, and prognosis were reviewed retrospectively. RESULTS: Five patients(5.1%) developed idiopathic pneumonia syndrome. The high dose chemotherapy regimens employed were cyclophosphamide, BCNU, and cisplatin in 3 cases, one case of BCNU, etoposide, Ara-C, cyclophosphamide combination, and a regimen consisting of BCNU, etoposide, Ara-C, and melphalan. The total dose of BCNU used was 300-400 mg/m2 and that of cyclophosphsmide was 6,000 mg/m2. All of 5 patients received radiation therapy before this treatment. After an average duration of 14 weeks (4-26 weeks) of high-dose chemotherapy, patients developed cough, dyspnea and fever. The chest X-rays showed bilateral diffuse infiltration in 3 cases and the focal infiltration in the other 2 cases. All the patients received corticosteroid therapy as a treatment for the lung lesions. Two of them progressed to acute respiratory distress syndrome and died. Three patients recovered without residual lung lesion but one of them died of dilated cardiomyopathy. CONCLUSION: High-dose chemotherapy with peripheral blood stem cell transplantation especially which containing BCNU regimen may develop idiopathic pneumonia syndrome related to pulmonary toxicity and corticosteroid therapy may be beneficial in some cases.

Effects of the Mutation of the p53 Tumor Suppressor Gene and the K-ras Gene on Clinical Manifestation in Non-small Cell Lung Cancer / 대한내과학회지

OBJECTIVE: A multistep process of gene alterations is required for tumor formation. p53 gene mutation is the most frequent and K-ras gene mutation places second in the gene abnormalities of non-small cell lung cancer (NSCLC). The effect by the mutations of the p53 and ras genes on clinical manifestation is still highly controversial. Little is known about the interaction between them in NSCLC. The present study was designed to investigate the effect by the mutations of the p53 tumor suppressor gene and K-ras oncogene on clinical manifestation, and the interaction between the mutations of two genes in the Korean NSCLC. METHODS: Fifty-eight patients were enrolled in this study who had been diagnosed as having NSCLC from stageI to stage III. They all had been alive for more than one month without any complication after curative resection. The paraffin-embedded lung tissues after resection were used to investigate the p53 expression by immunohistochemical staining, the mutations of the p53 and K-ras genes by polymerase chain reactionsingle strand conformation polymorphism (PCR-SSCP) and nucleotide sequencing. RESULTS: p53 protein was overexpressed in 25.9% by immunohistochemical staining. Overexpression was significantly more frequent in epidermoid carcinoma (p=0.01634). But there was no significant difference between the overexpression group and the negative expression group according to stage and survival. By PCR-SSCP analysis, the mobility shift of the p53 gene was found in 29.1%. There was no significant difference between the groups with and without mobility shift according to cell type, stage and survival. By nucleotide sequencing, p53 gene mutation was 37.9%. The locations of mutation were dispersed among numerous codons and the modes of mutation were also diverse. There was also no significant difference between the groups with and without mutation according to cell type, stage and survival. K-ras gene mutation was 24.1% and only in codon 12 by nucleotide sequencing. Although there was no significant difference between the groups with and without mutation according to cell type or stage, K-ras gene mutation carried a significantly worse prognosis in NSCLC (overall survival p=0.0391, disease-free survival p=0.0318). When the patients were divided into 4 groups according to p53 gene mutation and K-ras gene mutation, there was also no significant difference among any group according to cell type or stage. The prognosis became worse if K-ras gene mutation accompanied (overall survival p=0.0021, disease- free survival p=0.0166). Only the stage (p=0.0313) and K-ras gene mutation (p=0.0457) were significant prognostic factors by Cox regression test. An analysis in stage III showed the significantly shorter survival period in the patients with K-ras gene mutation. K-ras gene mutation, therefore, was confirmed as the independently significant prognostic factor separately from stage. CONCLUSION: p53 gene mutation had no clinical or prognostic significance because of scattered locations and diverse modes of mutation in contrast to K-ras gene mutation, which had a significantly negative effect on the prognosis of NSCLC. p53 and K-ras gene mutations were apparently independent genetic alterations which played different roles in the clinical manifestation and prognosis of NSCLC.

Catamenial Hemoptysis Caused by the Endometriosis of the Lung Parenchyme, Treated with Bisegmental Wedge Resection / 결핵

Catamenial hemoptysis is a term used to describe recurrent hemoptysis occuring at the time of menstruation and is caused by the presence of thoracic endometriosis. The diagnosis is almost always established on the clinical grounds and by exclusion of other causes of recurrent hemoptysis. The pathogenesis of the thoracic endometriosis is not clear but several hypothesis have been proposed, such as retrograde flow of the endometrial tissue through the diaphragmatic defects, microembolization through pelvic veins and differenciation into endometrial tissues. We report a case of a 35-year-old woman who presented with catamenial hemoptysis caused by the endometriosis of lung parenchyme. The lesion was localized to the right upper lobe posterior segment and right lower lobe superior segment by the computerized tomogram of the chest during the time of mensturation and treated effectively with bisegmental wedge resection.

Distribution of phospholipase C isozymes in normal human lung tissue and their immunohistochemical localization

Phospholipase C(PLC) plays a central role in signal transduction and it is important in cellular growth, differentiation and transformation. There are currently ten known mammalian isozymes of PLC identified and cloned. However, there are no report of PLC distribution in human lung tissue or their significances in pulmonary diseases. Presence of various PLC isozymes in normal human lung tissue was studied from surgical specimens. PLC isozymes in tissue extracts of the lung were partially purified by successive chromatographic steps on heparin-sepharose CL-6B conventional and TSKgel heparin-5PW HPLC columns and their activities were assayed. PLC activity peaks identified in the chromatography were immunoblotted with specific antibodies against ten known mammalian PLC isozymes(PLC-beta 1-4, -gamma 1-2, and -delta 1-4). In addition, immunohistochemical staining of the lung tissue was performed to determine subcellular and histological localization of PLC isozymes. The results indicate that normal human lungs contain beta 1, beta 3, gamma 1, and delta 1, isozymes of PLC. The order of amount present in the lung tissue was PLC-delta 1 > gamma 1 >beta 1 >> beta 3, in descending order. On immunohistochemistry, PLC-gamma 1 was most widely distributed and was present in bronchiolar epithelium, in type I and type II pneumocytes as well as in fibroblasts of the interstitial tissue. PLC-delta 1 was present in the cytoplasm of the bronchiolar epithelium whereas PLC-beta 1 was localized to the apical membranous portion of the same epithelium. PLC-beta 3 was seen in the nucleus of the respiratory and alveolar lining epithelium as well as in the nucleus of lung fibroblasts.

Pseudoepidemic of mycobacteria other tuberculosis(MOTT) due to contaminated bronchoscope / 결핵

No abstract available.