Recalcitrant Low Back Pain Diagnosed as Hypophosphatemic Osteomalacia Induced by Antiviral Medication

We report a rare case of anti-viral agent induced hypophosphatemic osteomalacia presented with localized and radicular pain. A 51-year-old man, who had been taking adefovir for chronic hepatitis, had experienced low back pain radiating to his right thigh for 2 years. With impression of lumbar disc herniation, he underwent magnetic resonance imaging and found multi-level disc herniation with facet joint synovial cysts. He received transforaminal epidural steroid injections, however, symptoms did not improve. To find other possible causes, additional tests were performed. Blood tests revealed hypophosphatemia and increased serum alkaline phosphatase, and osteoporosis was noted in dual-energy X-ray absorptiometry with multiple hot uptakes in bone scan. After replacement of adefovir to entecavir and supplement of phosphate and vitamin D, phosphate level and the clinical symptoms were improved. This is the first to report the presentation of osteomalacia due to anti-viral agent as radicular low back pain with facet synovial cysts.

Differences of Diagnostic Rate According to Technique of Bronchial Brush in the Diagnosis of Lung Cancer / 대한암학회지

PURPOSE: Brush cytology is one of useful methods for establishing a diagnosis of lung cancer. There are two methods of retrieving the specimen of brush cytology. One is to withdraw the brush through the working channel of the bronchoscope (withdrawn brush) and the other is to withdraw the brush and bronchoscope as a unit, with brush remaining protruded through the distal tip of the bronchoscope (nonwithdrawn brush). We tried to compare two methods in the cellularity of the specimen and the diagnosis of lung cancer. MATERIALS AND METHODS: Thirty-one patients with suspected lung cancer were studied prospectively. The sequence of sampling (withdrawn or nonwithdrawn brush) was assigned randomly. The specimens were interpreted by two cytopathologists about cellularity (1-4) and presence of recognizable malignant cells. RESULTS: Cellularity was significantly greater for nonwithdrawn brush (p<0.05). There was no significant difference of diagnostic rate between both methods in the diagnosis of lung cancer. CONCLUSION: Withdrawing the brush through the bronchoscope decreases the cellularity, but it does not affect the diagnostic rate for lung cancer.

Lung Volumes and Diffusing Capacity in Bronchiectasis : Correlation with the Findings of High Resolutional CT / 결핵

BACKGROUND: The patient with bronchiectasis may have obstructive ventilatory impairment combined with mild restrictive ventilatory impairment due to fibrosis of surrounding lung parenchyme and pleural adhesions caused by chronic recurrent pulmonary infections. Since hyperinflation or emphysematous change can be occured in bronchiectasis, pulmonary functions such as lung volumes and diffusing capacity may also vary with associated emphysema. METHODS: For the evaluation of lung volumes and diffusing capacity in bronchiectasis with respect to the anatomic types and severity of bronchiectasis, a total of 40 cases comprising 24 cases of tubular, and 16 cystic type of bronchiectasis were analyzed retrospectively. Correlation between lung functions and extent of bronchiectasis or associated emphysema detected in HRCT were also evaluated. RESULTS: Vital capacity(VC) tended to decrease in cystic type than in tubular type. As the severity of bronchiectasis became serious, the VC were significantly reduced, whereas the total lung capacity(TLC), residual volume(RV) and its ratio to the total lung capacity(RV/TLC) had no significant difference. Lung clearance index(LCI) was significantly increased in cystic type than in tubular type, whereas the slope of phase III in single breath nitrogen curve(deltaN2/L) was not significantly changed regard to the type and severity of bronchiectasis. DLCO and DLCO/VA reflecting diffusing capacity were significantly decreased in cystic type and also as the severity of bronchiectasis became serious. The correlation coefficient of VC, DLCO and LCI with the extent of bronchiectasis were -0.322, -0.339 and 0.487, respectively, whereas other parameters were not significantly correlated with the extent of bronchiectasis. VC and DLCO correlated negatively with the extent of emphysema while RV, RV/TLC, LCI and deltaN2/L correlated positively. CONCLUSION: These findings suggest that the reduction of VC and diffusing capacity or uneven distribution of inspired gas in bronchiectasis are related to both the extent of bronchiectasis and associated emphysema while increased residual volume be related to the extent of associated emphysema alone.

Lung Volumes and Diffusing Capacity in Bronchiectasis : Correlation with the Findings of High Resolutional CT / 결핵

BACKGROUND: The patient with bronchiectasis may have obstructive ventilatory impairment combined with mild restrictive ventilatory impairment due to fibrosis of surrounding lung parenchyme and pleural adhesions caused by chronic recurrent pulmonary infections. Since hyperinflation or emphysematous change can be occured in bronchiectasis, pulmonary functions such as lung volumes and diffusing capacity may also vary with associated emphysema. METHODS: For the evaluation of lung volumes and diffusing capacity in bronchiectasis with respect to the anatomic types and severity of bronchiectasis, a total of 40 cases comprising 24 cases of tubular, and 16 cystic type of bronchiectasis were analyzed retrospectively. Correlation between lung functions and extent of bronchiectasis or associated emphysema detected in HRCT were also evaluated. RESULTS: Vital capacity(VC) tended to decrease in cystic type than in tubular type. As the severity of bronchiectasis became serious, the VC were significantly reduced, whereas the total lung capacity(TLC), residual volume(RV) and its ratio to the total lung capacity(RV/TLC) had no significant difference. Lung clearance index(LCI) was significantly increased in cystic type than in tubular type, whereas the slope of phase III in single breath nitrogen curve(deltaN2/L) was not significantly changed regard to the type and severity of bronchiectasis. DLCO and DLCO/VA reflecting diffusing capacity were significantly decreased in cystic type and also as the severity of bronchiectasis became serious. The correlation coefficient of VC, DLCO and LCI with the extent of bronchiectasis were -0.322, -0.339 and 0.487, respectively, whereas other parameters were not significantly correlated with the extent of bronchiectasis. VC and DLCO correlated negatively with the extent of emphysema while RV, RV/TLC, LCI and deltaN2/L correlated positively. CONCLUSION: These findings suggest that the reduction of VC and diffusing capacity or uneven distribution of inspired gas in bronchiectasis are related to both the extent of bronchiectasis and associated emphysema while increased residual volume be related to the extent of associated emphysema alone.

Is Premedication necessary for Outpatient Fiberoptic Bronchoscopy / 결핵

No abstract available.

The Role of Bronchoscopy in Determining the Etiology of Pleural Effusion / 결핵

BACKGROUND: Little information is available concerning the value of bronchoscopy in patients with a lymphocytic exudative pleural effusion in which percutaneous pleural biopsy have been regarded as cornerstone in investigating the etiology. Recenfly, a few reports suggest that bronchoscopy may be more effective diagnostic method in patients with unexplained pleural effusion accompanied by hemoptysis or other roentgenographic abnormalities, such as mass, infiltrate, atelectasis. METHOD: After initial examinations of sputum and pleural fluid through thoracentesis in 112 patients(male 75 cases, female 37 cases, mean age 53.2 years) who were admitted for evaluation of the cause of pleural effusion, we performed bronchoscopy and closed pleural biopsy in most patients with undiagnosed lymphocytic exudate and compared the diagnostic yield of both invasive methods according to hemoptysis or other roentgenographic abnormalities, and investigated the sole diagnostic contribution of bronchoscopy. RESULTS: Tuberculosis(57 cases, 51%) was the most common cause of pleural effusion Percutaneous pleural biopsy showed more diagnostic yield than bronchoscopy regardless of presence or absence of other clinical or radiologic abnormalities. In 25 cases with unknown etiology after pleural biopsy, additional diagnostic yield by bronchoscopy was 36% (4/11) in patients with associated features and only 7% (1/14) with lone effusion, and, as the sole mean for diagnsosis in all patients with pleural effusion, was only 4.5% (5/12) Condusion: In a region of high prevalence of tuberculosis as a cause of pleural effusion, percutaneous pleural biospy is more effective method when invasive method is required for confirmative diagnosis of unexplained lymphocytic exudative pleural effusion, and bronchoscopy is unlikely to aid in the diagnosis of lone pleural effusion.

Inquiry about Management of Non-Small Cell Lung Cancer / 대한암학회지

PURPOSE: In recent years there has been a considerable increase in the use of chemotherapy as an adjuvant to surgery, radical radiotherapy and in addition to best supportive care. However, the value of chemotherapy in improving survival is still unclear, despite more than 50 randomised trials addressing this question in the different stages of disease. This study was done to evaluate Korean doctors' personal management preference and their beliefs about prognosis in non-small celllung cancer(NSCLC). MATERIALS AND METHODS: A mail survey of Korean respirologists, thoracic surgeons, radiation oncologists, and medical oncologists was performed. Four cases of NSCLC were described and respondents were asked to give their treatment recommendations and to estimate the prognosis in each case. RESULTS: After a complete resection for stage II NSCLC, 27% recommended no adjuvant treatment, 36% recommended radiotherapy, 18% recommended chemotherapy, and 19% recommended both radiotherapy and chemotherapy. After a complete resection for stage IIIA(N2) NSCLC, the vast majority of respondents recommended adjuvant therapy. For an asymptomatic patient with stage IIIB NSCLC, 5% recommended supportive care, 24% recommended radiotherapy, 16% recommended chemotherapy, and 54% recommended chemotherapy combined with radiotherapy. For a patient with stage IV NSCLC, 76% recommended chemotherapy with or without palliative radiotherapy. Doctors' treatment preference was significantly different by their speciliaty in a case with stage II, IIIA(N2), or IV NSCLC. Most respondents believed that chemotherapy would increase survival in NSCLC. Doctors' beliefs about the efficacy of treatment were strongly associated with their treatment recommendations. CONCLUSION: Korean doctors generally preferred relatively aggressive management although their personal preferences varied widely. Team approach is important in deciding the treatment modality because doctors' treatment preference is different by their speciality.

Obstructive Ventilatory Impairment as a Risk Factor of Lung Cancer / 결핵

BACKGROUND: Cigarette smoking is closely related to both lung cancer and chronic obstructive pulmonary disease. The incidence of lung cancer is higher in patients with obstructive ventilatory impairment than in patients without obstructive ventilatory impairment regardless of smoking. So, obstructive ventilatory impairment is suspected as an independent risk factor of lung cancer. METHODS: For the evaluation of the role of obstructive ventilatory impairment as a risk factor of lung cancer, a total of 73 cases comprising 47 cases of malignant and 26 benign solitary pulmonary nodule were analyzed retrospectively. A comparative study of analysis of forced expiratory volume curves and frequencies of obstructive ventilatory impairment were made between cases with malignant and benign nodules. RESULTS: In comparison of vital capacity and parameters derived from forced expiratory volume curve between two groups, VC, FVC and FEV1 were not significantly different whereas FEV1/FVC% and FEF 25-75 % showed a significant decrease in the cases with malignant nodule. The frequency of obstructive ventilatory impairment determined by pulmonary function test was significantly higher in the cases with malignant nodule (23.4%) than in benign nodule(3.8%). When the risk for lung cancer was examined by the presence or absence of obstructive ventilatory impairment using the logistic regression analysis, the unadjusted relative risk for the lung cancer of obstructive ventilatory impairment was 17.17. When the effect of smoking and age were considered, the relative risk was to 8.13. CONCLUISON: These findings suggest that an obstructive ventilatory impairment is a risk factor of lung cancer.

A Clinical Experience of Tracheal Bronchus / 결핵

Tracheal bronchus is an uncommon anomaly of the airway in which an ectopic bronchus arises from the trachea superior to its bifurcation. It is usually asymptomatic and no intervention is needed. However in the cases complicated with recurrent pneumonia, bronchiectasis or abscess, surgical excision may be needed. We report 5 cases of tracheal bronchus with or without complication or combined anomaly.

Differences in Prediction Formulas for the MVV According to the Status of Ventilatory Function / 대한내과학회지

OBJECTIVES: The MVV reflects subjective dyspnea, exercise capacity, postoperative complication. But, the MVV embodies certain disadvantages and is dependent on coordination, endurance and motivation. A timed vital capacity for calculation of an indirect maximal voluntary ventilation is used. We evaluated differences in prediction formulas for the MUV according to the status of ventilatory function. METHODS: Forty-seven normal subjects, 68 patients with obstructive ventilatory impairment, and 23 patients with restrictive ventilatory impairment were studied. The relationships between the MVV and Flow or time parameters in forced expiratory volume and flow volume curves were compared among normal subjects and patients with obstructive or restrictive ventilatory impairment. RESULTS: 1) High correlation coefficients(R>or=0.87) were found between the FEV0.5, 0.75, 1 and the MVV in 47 normal subjects and 91 patients with ventilatory impairment. 2) The MVV can be conveniently estimated from the FEV1 values. The following regression formulas for the prediction of the MVV were obtained. Normal: MVV=44.01 X FEV1-21.09(r(2)=0.771, SEE=11.085) Obstructive ventilatory impairment: MVV=38.34 X FEV1-4.58(r(2)0.812, SEE=4.816) Restrictive ventilatory impairment: MVV=45.20 X FEV1-3.80(r(2)=0.899, SEE=6.929). 3) There were significant differences in prediction formulas for the MVV obtained by FEV1 between each group (P<0.05). CONCLUSION: These results suggest that different prediction formulas for the MVV, by multiplying the FEV1 by a constant, are respectively required in normal subjects and patients with obstructive or restrictive ventilatory impairment.

A case of bronchomalacia due to endobronchial tuberculosis / 결핵

We report a case of localized bronchomalacia which was caused by endobronchial tuberculosis.

Effects of corticosteroid and chlorambucil on multiple pulmonary artery aneurysms in Behcet's syndrome: A case repor

A patient with Behcet's syndrome in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroid and chlorambucil is reported.

A Clinical Review of Broncholithiasis / 결핵

BACKGROUND: Broncholithiasis is uncommon but clinically important because it may cause a variety of nonspecific symptoms and signs prior to the onset of lithoptysis, and rarely massive hemoptysis. METHOD: A retrospective clinical study was done on 11 case of broncholithiasis diagnosed at Kyungpook National University Hospital from Jan. 1985 to Dec. 1993. The study investigated the clinical features, radiologic findings, bronchoscopic findings and management. RESULTS: 1) The common symptoms included cough, dyspnea, hemoptysis, fever and purulent sputum. Lithoptysis occurred in 3 patients. 2) The radiologic findings were variable and nonspecific. Hilar calcification and parenchymal calcification were the most common findings. 3) The bronchoscopy was performed in 10 patients and revealed broncholiths in 9 patients. 4) Chemical composition of broncholiths was analyzed in 2 patients. Calcium carbonate was main component. 5) In 6 out of 9 patients in whom broncholiths was revealed by bronchoscopy, broncholiths were successfully extracted through the flexible bronchoscope. 6) In 9 patients, broncholithiasis was related to tuberculosis and in 1 case, related to silicosis. CONCLUSION: Broncholithiasis shows a variable clinical spectrum. Tuberculosis is the most common cause of broncholithiasis. In the case of no accompanied complication, nonsurgical management such as bronchoscopic removal and conservative therapy is an effective measure.

The Prognosis following Radiation Therapy or Surgical Resection for Stage 1 Non-Small Cell Lung Cancer / 결핵

BACKGROUD: Surgical resection is the treatment of choice for localized, operable non-small cell carcinoma of the lung. Curative radiotherapy, however, is considered an alternative to surgery in patients with poor performance state, poor cardiopulmonary function, or who refuse surgery. However, the difference in prognosis after surgery and radiotherapy is not well established in the patients with stage I non-small cell lung cancer. METHOD: To evaluate the difference in progonsis between surgery and radiotherapy in stage I non-small cell lung cancer, a retrospective study was done with 15 patients treated with curative radiotherapy and 24 patients treated with curative surgery. RESULTS: The overall response rate was 80%, with 33% complete response, after radiotherapy. The median survival time of the patients with radiotherapy was 14.9 months, with 2-year and 5-year survival rates of 22% and 0%, respectively. The median survival time of the patients with surgery was 37.7months, with 2-year and 5-year survival rates of 65% and 41%, respectively. CONCLUSION: These results suggest that surgery is better than the radiotherpy in view of survival rate and it is necessary to recommend, more strongly, curative surgery to patients with stage I non-small cell lung cancer if the patients are able to receive operation. To compare, more accurately, the difference in prognosis by the modality of therapy, large multicenter study is needed.

A Case of Carcinoid-Type Tumorlets of The Lung / 결핵

Carcinoid-type tumorlets of the lung are nodular microscopic proliferation of round and spindle-shaped small cells which originated from bronchial or bronchiolar Kulchitsky-type neuroendocrine cells, which are usually encountered as an incidental finding during microscopic examination of the lungs at autopsy or surgically removed for bronchiectasis or other reasons. We report one case of carcinoid-type tumorlets in the lung which was surgically removed from a patient who had bronchiectasis, and the cells of tumorlets showed immunohistochemical reactivities for markers of epithelial and neuroendocrine differentiation.