Background : Radiation pneumonitis(RP) is the major serious complication of thoracic irradiation treatment. In this study, we attempted to retrospectively evaluate the long-term prognosis of patients who experienced acute RP and to identify factor that might allow prediction of RP.Methods : Of the 114 lung cancer patients who underwent thoracic radiotherapy between December 2000 and December 2002, We performed analysis using a database of 90 patients who were capable of being evaluated.Results : Of the 44 patients(48.9%) who experienced clinical RP in this study, the RP was mild in 33(36.6%) and severe in 11(12.3%). All of severe RP were treated with corticosteroids. The median starting corticosteroids dose was 34 mg(30∼40) and median treatment duration was 68 days(8∼97). The median survival time of the 11 patients who experienced severe RP was significantly poorer than the mild RP group. (p=0.046) The higher total radiation dose( 60 Gy) was significantly associated with developing in RP.(p=0.001) The incidence of RP did not correlate with any of the ECOG performance, pulmonary function test, age, cell type, history of smoking, radiotherapy combined with chemotherapy,once-daily radiotherapy dose fraction. Also, serum albumin level, uric acid level at onset of RP did not influence the risk of severe RP in our study.Conclusion : Only the higher total radiation dose( 60 Gy) was a significant risk factor predictive of RP. Also severe RP was an adverse prognostic factor. (Tuberculosis and Respiratory Diseases 2004, 56:40-50)
Background : Pulmonary hypertension is a poor prognostic factor in patients with chronic respiratory disease. However, diagnosing pulmonary hypertension is a difficult procedure which often requires an invasive test. Thus new alternative biochemical markers would be useful in clinical field and are in search. We sought to assess the role of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with pulmonary hypertension.Method : We measured plasma NT-proBNP level in twenty nine patients suspected for pulmonary hypertension. Pulmonary hypertension was defined as being right ventricular systolic pressure more than 35 mm Hg estimated by Doppler echocardiography. Plasma NT-proBNP level was measured by electrochemiluminescence sandwich immunoassay.Results : The log-transformed values for plasma NT-proBNP levels showed a linear correlation (correlation coefficiency: 0.783, p-value <0.001) with right ventricular systolic pressure. PlasmaNT-proBNP levels closely correlated with right ventricular systolic pressure, right ventricular hypertrophy, interventricular septal flattening and right ventricular dilatation.Conclusion : Our results suggest that the measurement of plasma NT-proBNP level is an useful marker of the presence of pulmonary hypertension. (Tuberculosis and Respiratory Diseases 2004, 56:67-76)
Background : We hypothesized that there was a relationship between body weight change and bronchodilator response (BDR) in patients with chronic renal failure (CRF) on hemodialysis (HD). Several mechanisms such as pulmonary edema due to water retention or increased permeability of alveolar capillary may play a important role in pulmonary function impairment and bronchial hyperresponsiveness in patients with CRF on HD. But, no studies have been published concerning BDR in patients with CRF on HD. This study was aimed to know the immediate effect of hemodialysis on pulmonary function and BDR in patients with CRF on HD.Methods : This study included 30 patients with CRF on HD. We collected data including age, sex, height, pretibial and pedal pitting edema, interdialysis weight gain, postdialysis weight loss , underlying diseases, duration of HD, FEV1, FVC, FEV1/FVC, and BDR before and after HD.Results : Interdialysis weight gain of the patients was 3.4 1.0 kg, and postdialysis weight loss was 3.2 0.7 kg. Before HD, FEV1, FVC, and FEV1/FVC of the patients were 89 22%, 86 19% of predicted, and 87 10 %. After bronchodilator inhalation, these parameters were changed to 95 22%, 90 19% of predicted, and 88 9% respectively. BDR was positive in 15 patients. After HD, FEV1, FVC, and FEV1/FVC of the patients were 100 23%, 94 18% of predicted, and 88 11%. After bronchodilator inhalation, these parameters were changed to 102 23%, 96 18% of predicted, and 89 8% respectively. BDR was positive in 9 patients.Conclusion : First, HD increases FEV1, FVC, and FEV1/FVC but little affects BDR. Second, there is no correlation between postdialysis weight loss and increases in FEV1, FVC, and FEV1/FVC after HD. Third, there is also no correlation not only between interdialysis weight gain and BDR before HD but between postdialysis weight loss and BDR after HD. (Tuberculosis and Respiratory Diseases 2004, 56:77-84)
A 69 year-old female was admitted to the hospital due to intermittent hemoptysis for 1 month. Emergent bronchoscopy revealed mass-like lesion almost completely obstructing right intermediate bronchus with multiple hemorrhagic spots. Bronchial arterial angiography was performed but failed to find out actively bleeding vessel. Spiral computerized tomography of the chest showed contrast enhanced bulging of the posterior portion of right main bronchus into the lumen of right intermediate bronchus suggesting Rasmussen aneurysm. The AFB smear of bronchial washing fluid was positive.Pulmonary arterial angiography and embolization were not performed due to improvement of clinical course with medical conservative care. Here we report a case of endobronchial mass-like Rasmussen aneurysm grossly suspected by bronchoscopy and diagnosed by spiral CT, which successfully managed by medical conservative care with antituberculous agents.(Tuberculosis and Respiratory Diseases 2004, 56:85-90)
Primary lung cancer frequently metastasizes to distant organs. But breast is a very rare site of metastasis. So, accurate diagnosis is essential to rule out primary breast cancer. A 62-year old woman who had complained of cough was diagnosed as small cell lung carcinoma of the right lower lobe. She had a 2.5cm sized lobular mass in left upper mid portion of breast.Sonoguided breast biopsy revealed small cell carcinoma consistent with metastatis from primary lung cancer. She also had bone metastses to the scapula and the vertebrae.We report the case of metastatic breast cancer from small cell lung carcinoma. (Tuberculosis and Respiratory Diseases 2004, 56:91-96)
Anomalous systemic arterial supply to the lung is a rare congenital anomaly. The lung supplied by the anomalus systemic artery has a normal bronchial tree, which is usually in the basal segment of the lung, especially in the left lung. Most of patients are asymptomatic, but the main clinical symptoms of this disease are hemoptysis and exertional dyspnea. CT is useful for the diagnosis and showed a retrocardiac nodular shadow connected to the descending aorta branching into the basal segments of the relatively normal lower lobe. Surgery is indicated for all patients. Here we report a case of anomalous systemic arterial supply to normal basal segments of left lower lobe in a patient with hemoptysis with a review of the relevant literature. (Tuberculosis and Respiratory Diseases 2004, 56:97-102)
Thymolipoma is rare benign tumor of the thymic gland and mostly occurs at anterior mediastinum. Thymolipoma comprises 2∼9% of thymic tumor and less than 1% of mediastinal mass.Therefore, thymolipoma should be differentiated from anterior mediastinal tumor such as thymoma, germ cell tumor and lymphoma. These tumors resemble cardiomegaly, pleural effusion, basal atelectasis, pericardial tumor and cyst, pleural tumor, lung cancer and pulmonary sequestration, and differentiated from above mentioned diseases.Though most cases are asymptomatic, there can be dyspnea with compression of adjacent organ by mass effect, and myasthenia gravis. We experienced a thymolipoma simulating cardiomegaly and report the case with the review of literatures. (Tuberculosis and Respiratory Diseases 2004, 56:103-108)