Screening Clinic for Coronavirus Disease 2019 to Prevent Intrahospital Spread in Daegu, Korea: a Single-Center Report

There is still a paucity of studies on real-world outcome of screening clinic for hospital protection from coronavirus disease 2019 (COVID-19). As the number of COVID-19 cases was growing rapidly in Daegu, Korea, we started operating an active screening clinic outside the hospital premises. Over two weeks, 2,087 patients were screened using real-time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2, with 42 confirmed cases. Before the screening clinic period, an average of 36 beds (maximum 67 beds) per day were closed due to unrecognized COVID-19 patients entering the hospital. In contrast, after the screening clinic operated well, only one event of closing emergency room (25 beds) occurred due to a confirmed COVID-19 case of asymptomatic patient. We report the operational process of screening clinic for COVID-19 and its effectiveness in maintaining the function of tertiary hospitals.

Interstitial Lung Disease and Lung Cancer Development: A 5-Year Nationwide Population-Based Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In this nationwide 5-year longitudinal population-based study, we aimed at investigating the incidence of lung cancer among patients with interstitial lung disease. MATERIALS AND METHODS: Data was collected from the Korean National Health Insurance Research Database from 49,773,195 Korean residents in 2009. Thirteen thousand six hundred and sixty-six patients with interstitial lung disease diagnosed January-December 2009. The end of follow-up was June 30, 2014. Up to four matching chronic obstructive pulmonary disease controls were selected to compare the lung cancer high-risk group based on age, sex, diagnosis date (within 30 days), and hospital size. The number of patients with newly developed lung cancer was determined. RESULTS: The incidences of lung cancer were 126.98, 156.62, and 370.38 cases per 10,000 person-years (2,732, 809, and 967 cases of cancer, respectively) in the chronic obstructive pulmonary disease, interstitial lung disease, and chronic obstructive pulmonary disease with interstitial lung disease groups, respectively. Of the 879 patients with idiopathic pulmonary fibrosis, 112 developed lung cancer (incidence, 381.00 cases per 10,000 person-years). CONCLUSION: Incidence of lung cancer among patients with interstitial lung disease was high. Interstitial lung diseases have a high potential for developing into lung cancer, even when concurrent with chronic obstructive pulmonary disease.

Rhabdomyolysis with Acute Kidney Injury Successfully Treated with External Cooling / 계명의대학술지

Hyperthermia can cause severe complications such as rhabdomyolysis, which can induce acute kidney injury. Normal thermoregulation can be disturbed by high fever, and maintenance of a normal body temperature by external cooling can reduce oxygen consumption, and increase vascular tone. Several studies have been conducted to determine the effectiveness of external cooling in treat rhabdomyolysis or renal failure. We report a case of rhabdomyolysis leading to multiple organ dysfunction, including renal failure. The use of an external cooling device achieved fever control and successfully treated rhabdomyolysis and renal failure.

A prospective cohort study of latent tuberculosis in adult close contacts of active pulmonary tuberculosis patients in Korea

BACKGROUND/AIMS: The objective of this prospective study was to evaluate the diagnosis and treatment of latent tuberculosis infection (LTBI) in adult close contacts of active pulmonary tuberculosis (TB) patients in Korea. METHODS: Adult close contacts of active pulmonary TB patients were recruited at a regional tertiary hospital in Korea. The participants were tested for LTBI using the tuberculin skin test (TST) and/or QuantiFERON-TB Gold (QFT-G) test. LTBI patients, who consented to treatment, were randomly assigned to receive isoniazid for 9 months (9INH) or rifampin for 4 months (4RIF). RESULTS: We examined 189 adult close contacts (> 18 years) of 107 active pulmonary TB patients. The TST and QFT-G were positive (≥ 10 mm) in 75/183 (39.7%) and 45/118 (38.1%) tested participants, respectively. Among 88 TST or QFT-G positive LTBI participants, 45 participants were randomly assigned to receive 4RIF (n = 21) or 9INH (n = 24), respectively. The average treatment duration for the 4RIF and 9INH groups was 3.3 ± 1.3 and 6.1 ± 2.7 months, respectively. Treatment was completed in 25 participants (4RIF, n = 16; 9INH, n = 9). LTBI participants who accepted treatment were more likely to be women and have more cavitary lesions on the chest radiographs of index cases and positive TST and QFT-G results compared to those who refused treatment. CONCLUSIONS: About 40% of adult close contacts of active pulmonary TB patients had LTBI; about 50% of these LTBI participants agreed to treatment.

A Case of Idiopathic Pulmonary Alveolar Proteinosis Treated with Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) after Partial Response to Whole Lung Lavage / 결핵및호흡기질환

Idiopathic pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by surfactant component accumulation in the alveolar space. Idiopathic PAP has recently been recognized as a autoimmune disease of impaired alveolar macrophage function caused by autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF). While whole lung lavage has been the standard treatment, not every patient shows a complete response. Subcutaneous injection or inhalation of GM-CSF is another promising treatment option for PAP. A 45-year-old patient visited our hospital for dyspnea, he was diagnosed as PAP and underwent whole lung lavage. Eighteen months later, the patient had not achieved complete remission in despite of initial response. After then he was administered with GM-CSF (5 microgram/kg/day, subcutaneous injection) for fivetimes a week during 2 months. Nine months later, the abnormal shadows in high-resolution computed tomography (HRCT) decreased and the patient fully recovered in forced vital capacity. After 60 months, the HRCT scan showed complete remission of PAP.

Bone formation of newly developed biphasic calcium phosphate in rabbit calvarial defect model: A pilot study / 대한치주과학회지

PURPOSE: Biphasic calcium phosphates have been of great interest recently. Mixing adequate ratios of hydroxyapatite(HA) and beta-tricalcium phosphate(beta-TCP) allowed to control the resorption rate without distorting its osteoconductive property. This study evaluated the bone formation effect of newly developed biphasic calcium phosphate(BCP) in calvarial defect of rabbits. MATERIALS AND METHODS: 6 male New Zealand rabbits were used. Four defects with 8mm in diameter were created on each animal. BCP with HA/beta-TCP ratio of 7:3 and particle size of 0.5~1.0 mm was used as the test group and bovine bone with 0.25~1.0 mm particle size, as the control group. Both test and control group materials were randomly implanted in the calvarial defects and were covered witha polymer membrane. The animals were sacrificed after 12, 24, and 48 weeks of implantation under general euthanasia. Resin blocks were obtained and were stained by masson's trichrome for histological observation. RESULTS: Overall results were uneventful without any defect exposure or inflammation. The amount of new bone formation and bone maturity increased with increase in healing period at both groups. New bone in test group was mostly formed along the material particle surrounded by osteoblasts, and observation of osteoblastic stream was also present. Bone maturity increased as it was closer to thedefect margins. Under the same healing period, the test group showed more bone formation than the control group with more stable bovine bone particles remaining even after 48 weeks, whereas considerable resorption took place in BCP. Almost total defect closure was observed in test group with new bone formation in the central part of the defect. However, limited new bone formation was observed in the control group. CONCLUSION: Within the limits of the study, the present study reveals the newly developed BCP to be a good osteoconductive material. However, further studies are needed to be conducted in a different study model with a larger sample size.

A Case of Spontaneously Regressed Endobronchial Sarcoma after Obstructive Pneumonia / 결핵및호흡기질환

The spontaneous regression (SR) of cancer is defined as the complete disappearance of a malignant disease without adequate treatment. SR is a very rare biological event, particularly in a pulmonary sarcoma. We report the first documented case of an endobronchial sarcoma that regressed spontaneously in Korea. We encountered a rare case of a 72-year-old woman with an undiagnosed intrapelvic cystic mass, who presented with a smooth surfaced endobronchial tumor obstructing the orifice of the right lower lobe bronchus on a bronchoscopic examination. She had a prior history cervical cancer and adenocarcinoma in the right middle lobe lateral segment of her lung for which she had undergone radiation therapy. The tumor was diagnosed as an endobronchial sarcoma by the histopathology findings and immunohistochemistry. It was unclear if the tumor was a primary sarcoma of the lung or a metastatic lesion of an intrapelvic cystic mass because she refused a diagnostic exploratory laparotomy. Two months later, obstructive pneumonia of the right lower lobe with parapneumonic effusion developed with fever above 38.5degrees C for 10 days. After recovering from pneumonia, she was followed up regularly in the outpatient clinic without any specific treatment. One year later after treating the obstructive pneumonia, the follow-up bronchoscopy revealed complete SR of endobronchial sarcoma. It is believed that the obstructive pneumonia accompanied by fever above 38.5degrees C for 10 days might have played a role in this SR.

A Case of Primary Endobronchial Leiomyosarcoma Noticed by Massive Hemoptysis / 결핵및호흡기질환

A primary pulmonary leiomyosarcoma is a very rare pulmonary malignancy that arises from smooth muscle of either the bronchial or arterial walls. Common symptoms of the tumor are cough, dyspnea, chest pain and hemoptysis. The diagnosis of a primary pulmonary sarcoma can be established only after extensive clinical and radiologic examinations have failed to identify an alternative primary source. The only effective treatment for the tumor is a complete surgical resection when feasible. The type of resection is dictated by the local anatomic extent of the tumor. We report a case of a 21-year-old male with a primary endobronchial leiomyosarcoma who presented with massive hemoptysis. A necrotic ulcerative endobronchial lesion was observed in the orifice of left lower lobe bronchus on a bronchoscopic examination. He was treated with a complete sleeve resection of the left lower lobe. Three months later, local recurrence of the tumor was noticed on the follow up bronchoscopy and a then left pneumonectomy was then performed. Fifteen months later, the patient died from empyema with a bronchopleural fistula that was associated with tumor recurrence at the stump of the pneumonectomy.

A Case Of Primary Gastric Choriocarcinoma Associated With Adenocarcinoma / 대한내과학회지

Choriocarcinoma is a HCG-producing epithelial neoplasm derived from either trophoblastic or totipotential germ cells. It is a highly malignant tumor, which is rapidly invasive and widely metastatic, and in most cases develops within the uterus after a normal or abnormal gestation, including ectopic pregnancy. Non-gestational choriocarcinoma rarely occur as a primary neoplasm in the gonads or in the extragonadal midline locations such as mediastinum, retroperitoneum, and pineal gland. It also has been reported very rarely to arise in parenchymal organs such as the prostate, lung, breast, brain, liver, kidney, bladder, vagina, and gastrointestinal tract. A 58-year old man was admitted to our hospital with symptoms of tarry stool and epigastric discomfort. The endoscopic biopsy specimen initially revealed pooly differentiated carcinoma of stomach with regional lymph node metastasis. Patient underwent distal gastrectomy with Billroth II anastomosis. Choriocarcinoma of stomach with well differentiated tubular adenocarcinoma was diagnosed by the surgical biopsy specimen, and the serum level of beta-HCG was 2,775 mIU/mL.In three months after operation, the patient presented with pain on right upper quadrant abdomen, and the CT scan revealed multiple liver metastasis. Bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy were administered, but he died three months after the initial diagnosis.

The Time Responses of Spirometric Values in Response to Single Doses of Inhaled Salbutamol / 결핵

BACKGROUND: An assessment of the presence and the degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. However, the time responses of spirometric parameters in response to bronchodilator have not been well investigated. METHODS: We studied 15 patients with asthma. Spirometric and mini-Wright peak expiratory flow measurements were performed at 15, 30, 45, and 60 minutes after using single dose(200 micro gram) of inhaled bronchodilator, salbutamol. RESULTS: The mean values of forced expiratory volume in one second(FEV1) and forced vital capicaty(FVC) were significantly increased at 60 minutes after using bronchodilator in comparison to 15 minutes. And peak expiratory flow rate measured by either mass flow sensor or mini-Wright peak flow meter were significantly increased at 45 minutes after using bronchodilator in comparison to 15 minutes. CONCLUSIONS: To appropriate evaluation of the bronchodilator response in patients with reversible airflow limitation, it would be useful measuring either FEV1 or PEF at the later time point 60 or 45 minutes in comparison to 15 minutes after using bronchodilator.

Diagnostic Utility of MAGE Expression in Exudative Pleural Effusion / 결핵

BACKGROUND: In recent years, numerous human tumor specific antigens such as melanoma antigen gene(MAGE) that is recognized by autologous cytotoxic T lymphocytes have been identified. MAGE is expressed in many human malignancies in various organs, such as lung, breast, stomach, esophagus and leukemia. Therefore MAGE has been studied widely for tumor diagnosis and immunotherapy. But, so far there were no clinical studies evaluating the role of MAGE in pleural effusion. We investigated the expression of MAGE in the patients with exudative pleural effusion for it's diagnostic utility and the RESULTS: were compared with those of cytologic examinations. METHODS: Diagnostic thoracentesis was performed in 44 consecutive patients with exudative pleural effusion during 6 months. We examined the expression of MAGE and cytology with the obtained pleural effusion. Expression of MAGE was interpreted by means of a commercial kit using RT-PCR method. Enrolled patients were divided into two groups such as malignant and benign and we analyzed its' sensitivity and specificity. RESULTS: There were no significant differences between two groups in age, sex, white blood cell counts in pleural fluid, pleural fluid/serum protein ratio and pleural fluid/serum LDH ratio. The sensitivity and specificity of MAGE were 72.2% and 96.2% respectively and the positive predictive value and negative predictive value of MAGE were also 92.9% and 83.3% respectively. The sensitivity and negative predictive value of cytologic examinations were 66.7% and 81.3% respectively. There were no significant differences between sensitivities of MAGE and cytologic examinations but false positive result of MAGE was found in 1 case of tuberculous pleurisy. CONCLUSION: MAGE is a sensitive and specific marker for the differential diagnosis between benign and malignant effusion in patients with exudative pleural effusion. And MAGE would provide the equal sensitivity compared with that of cytologic examination in patients with malignant pleural effusion if 5mL of the pleural fluid is examined.

The Characteristics of Unipolar and Bipolar Electrograms at the Origin of Ventricular Tachycardia

BACKGROUND AND OBJECTIVES: In radiofrequency catheter ablation (RFCA), it is an essential point to understand the characteristics of local electrograms at arrhythmic focus. However controversy exists as whether the unipolar or bipolar electrogram is superior in detecting arrhythmic focus. SUBJECTS AND METHODS: We evaluated the characteristics of unipolar and bipolar electrograms at ventricular tachycardia (VT) origin. Electroanatomical mapping and RFCA were performed in 6 patients with idiopathic VT. 22 sites were enrolled and 6 of them were successful sites. We analyzed the relationship between surface and local electrograms in accordance with success or failure. We also analyzed the morphology of local electrograms. RESULTS: At successful sites of RFCA, point of unipolar onset (22.86+/-10.82 msec vs 5.47+/-26.31 msec, p<0.05) and maximal negative slope (16.57+/-17.46 msec vs -4.00+/-22.77 msec, p<0.05) were recorded earlier than unsuccessful sites. R wave amplitude (0.11+/-0.19 mm vs 0.64+/-0.57 mm, p<0.05) and R/S ratio (0.02+/-0.30 vs 0.18+/-0.26, p<0.05) of unipolar electrograms were smaller at successful sites. R wave duration was shorter at successful sites (6.29+/-8.49 msec vs 11.33+/-6.26 msec) but there was no statistical significance. QRS duration of bipolar electrograms was longer at successful sites (66.14+/-17.93 msec vs 49.07+/-13.11 msec, p<0.05). CONCLUSION: In electranatomical mapping for VT, point of unipolar onset and maximal negative slope could predict local activation time more precisely Unipolar electrograms showed shorter R wave duration and smaller R/S ratio at successful sites of RFCA. We can estimate the focus of VT by using these chracteristics of unipolar and bipolar electrogram.

Myxoma of the Kidney

Renal myxomas are very rare neoplasms. We report herein, on a case of a myxoma in a 65-year-old woman, who presented with a left renal mass, following several symptomatic episodes of gross hematuria and abdominal pain in the left upper quadrant. The ultrasonographs and intravenous pyelographs showed mild hydronephrosis and a delayed excretory urogram of the left kidney. A computed tomographic scan of the abdomen revealed a mass at the upper portion of the pelvis in the left kidney. A left nephrectomy was performed. On the cut surface, a relatively well demarcated mass, measuring 3.0x2.0x2.0 cm, was identified at the upper pole of the left kidney. A microscopic examination revealed a myxoma of the kidney.

Three cases of Pulmonary Epithelioid Hemangioendothelioma / 결핵

A pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor with a vascular origin. A PEH can arise in many organ systems, such as the lung, liver, bone and soft tissues. It is a borderline malignancy but the clinical course is usually benign. In this report, we describe three cases of PEH. Case 1, a 61-year-old man, had nonspecific chest discomfort and the chest X-ray showed a solitary lung nodule. This nodule was diagnosed by an open lung biopsy. The pathologic findings including abundant necrosis, mitosis and hyperchromatic and pleomorphic nuclei, indicated a malignancy. The electron microscopic study showed Weibel-Palade bodies and the immunohistochemical stain for CD31 showed a positive reaction in the tumor cells, and linear staining along the vascular lumina. Case 2, a 34-year-old man, was admitted for an evaluation of multiple small nodules, incidentally detected a screening chest X-ray. The nodules were diagnosed by a immunohistochemical stain for the factor VIII-related antigen. Case 3, a 34-year-old woman, complained of left pleuritic chest pain. A simple chest film and the chest CT scan revealed multiple bilateral nodules and a left pleural effusion. An immunohistochemical stain for the factor VIII-related antigen was used to diagnose the nodules. Forth-one months after the diagnosis, she died of pulmonary insufficiency.

Aspartate and alanine aminotransferase in Fasciola hepatica

The activity and distribution of aspartate aminotransferase (EC 2.6.1.1) and alanine aminotransferase (EC 2.6.1.2) in adult Fasciola hepatica have been studied. Fasciola hepatica was fractionated by differential centrifugation into nuclear, mitochondrial and cytosolic fractions. The activity of GOT and GPT was measured by the method of Reitman and Frankel. Isozyme patterns of those enzyme were also examined by DEAE-cellulose column chromatography. The results obtained were as follows: The activity of aspartate and alanine aminotransferase was about 0.55 unit and 0.92 unit per 1 g of Fasciola hepatica, respectively. The activity of those enzymes was relatively low compared with those in mammalian tissues. The distribution of aspartate aminotransferase in the subcellular organelles showed that 71 percent of the activity was in cytosolic, 24 percent in mitochondrial and 5 percent was in nuclear fraction. About 22 percent of the total alanine aminotransferase activity was found in the mitochondrial fraction, about 66 percent in the cytosolic fraction. Aspartate aminotransferase from cytosolic fraction was separated into two types of isozymes, whereas alanine aminotransferase from cytosolic fraction gave only one active peak on DEAE-cellulose column chromatography.