Magnetic Resonance Imaging (MRI) is one of the most advanced imaging techniques in clinical and research medicine. However, clinical application of MRI to the lung or thorax has been limited due to various drawbacks. Low signal intensity of the lung and cardiac and respiratory movements are the most serious problems with MRI in thorax. Nevertheless, MRI is superior to CT in some selected patients with thoracic diseases. The role of clinical MRI in thoracic disease has been widened with improvement of MR equipments and development of new pulse sequences. Otherwise, functional assessment of lung by MRI has been studied for the last decade. These include perfusion MRI with or without contrast enhancement and ventilation MRI with oxygen-enhancement or hyperpolarized noble gas, 3He and 129Xe.(Tuberculosis and Respiratory Diseases 2004, 56:571-592)
Background:The plasma B-type natriuretic peptide(BNP) concentration increases with the degree of pulmonary hypertension in patients with chronic respiratory disease. The aim of this study was to examine the prognostic role of BNP in the acute exacerbation of chronic obstructive lung disease (COPD). Method:We selected 67 patients who were admitted our hospital because of an acute exacerbation of COPD. Their BNP levels were checked on admission at the Emergency Department. Their medical records were analyzed retrospectively. The patients were divided into two groups according to their in-hospital mortality. The patients’ medical history, comobidity, exacerbation type, blood gas analysis, pulmonary function, APACHE II severity score and plasma BNP level were compared.Results:Multiple logistic regression analysis identified three independent predictors of mortality: FEV1, APACHE II score and plasma BNP level. The decedents group showed a lower FEV1(28±7 vs. 37±15%, p=0.005), a higher APACHE II score(22.4±6.1 vs. 15.8±4.7, p=0.000) and a higher BNP level (201±116 vs. 77±80pg/mL, p=0.000) than the sSurvivors group. When the BNP cut-off level was set to 88pg/mL using the receiver operating characteristic curve, the sensitivity was 90% and the specificity was 75% in differentiating between the survivors and decedents. On Fisher’s exact test, the odds ratio for mortality was 21.2 (95% CI 2.49 to 180.4) in the patients with a BNP level > 88pg/mL.Conclusion:The plasma BNP level might be a predictor of mortality in an acute exacerbation of COPD as well as the FEV1 and APACHE II score.(Tuberculosis and Respiratory Diseases 2004, 56:600-610)
Background:Corticosteroids in combination with cytotoxic drugs are the mainstays of therapy for idiopathic pulmonary fibrosis (IPF). However, there has been no regimen showing any survival benefit. The aim of this study was to describe a short-term clinical experience on interferon gamma-1b (IFN-γ1b) therapy for IPF, as an antifibrotic agent.Methods:Medical records of 27 patients who were treated with IFN-γ1b (2 million IU, 3 times a week, subcutaneous injection) were retrospectively reviewed. Treatment response was assessed using ATS/ERS criteria in 17 patients who received IFN-γ1b for more than 6 months. In addition, we compared the efficacy of IFN-γ1b therapy with that of cyclophosphamide±prednisolone therapy (n=26).Results:The median age of IFN-γ treated group (M:F=19:8) was 59 years (44-74 years). Compared to the patients who showed a stable response at 6 months (n=12), the deteriorated group (n=5) had worse baseline lung function (FVC, 55.4±11.3% vs. 70.7±10.9%, p=0.019; DLco, 50.3±7.3% vs. 76.9±19.6%, p=0.014). Lower baseline PaO2 on room air breathing was observed in the deteriorated group (68.6±7.8mmHg vs. 91.4±6.6mmHg p=0.001). Subcutaneous IFN-γ1b did not show better efficacy than prednisolone. Five patients discontinued IFN-γ because of severe side effects. ARDS developed in one patient, who eventually died. Conclusion:The administration of IFN-γ1b is not desirable for patients diagnosed with IPF with poor lung function. Long-term and large-scaled clinical studies are needed for its efficacy in IPF.(Tuberculosis and Respiratory Diseases 2004, 56:619-627)
Background:Percutaneous needle aspiration biopsy(PNAB) of the lung is a safe procedure for diagnosis of various pulmonary diseases but complications such as pneumothorax can occasionally develop. We reviewed the complications arising after PNAB and analysed the risk factors of pneumothorax.Method:We collected data by reviewing medical records and radiographic studies of 403 patients who underwent PNAB of the lung between 1988 and 2002 and analyzed the risk factors of pneumothorax.Result : The incidence of complication was 12.9%, 48 patients with pneumothorax and 4 patients with mild hemoptysis. Among the 48 pneumothorax patients, 35 patients showed mild(<20%) and was treated by only oxygen supply, 11 patients had severe pneumothorax(>50%) and chest tube insertion was done and 2 patients were treated by needle aspiration. As the results of multivariate analysis, size and location of lesion, location of approach, diagnosis of lesion showed no significant relationship, while age and gender of patients(p<0.05) and the depth of approach(p<0.001) were significantly related to pneumothorax. Smoking amount(p<0.001) as well as the smoking history(p<0.005) were also significantly related and the examiner displaying various incidence of pneumothorax from 4.0% to 23.1% among individuals also was a significant independent risk factor(p<0.05). While the average depth of approach for 13 patients treated by chest tube insertion or needle aspiration was 8.2±1.2cm, 35 patiens treated only by oxygen supply was 6.7±1.6cm suggesting that the depth of approach was lead to a severe pneumothorax.Conclusion:The independent risk factors of pneumothorax, the most common complication after PNAB, are age and gender of patients, depth of approach, examiner of procedure, smoking history and smoking amount.(Tuberculosis and Respiratory Diseases 2004, 56:628-637)
Background:Uteroglobin is a protein produced by the normal bronchial epithelium and its expression level is lower in non-small cell lung cancer tissues and cell lines. It mainly functions as an anti-inflammatory, and when it is overexpressed in cancer cells, the neoplastic phenotype is antagonized. cPLA2 and COX-2, which are also associated with inflammation, were reported to be related to cancer. The relationship between cPLA2, COX-2 and uteroglobin is unclear. The relationship between uteroglobin and ERK, which is related to cell growth, is also not unclear. This study investigated the changes in the cPLA2 and COX-2 expression levels and the ERK activities after the overexpression of uteroglobin in non-small cell lung cancer cell lines.Methods:The A549 and NCI-H460 cell lines were infected by adenovirus-null and adenovirus- uteroglobin. The cChange in the cPLA2, COX-2 expression level and ERK activity after uteroglobin overexpression was measured by Western blot. The change in MMP activity was measured by zymography.Results:Western blot revealed decreased expression levels of cPLA2, and COX-2, and increased pERK levels in nonsmall cell lung cancer cells after uteroglobin overexpression. Zymography revealed no changes in the MMP-2 activity and lower MMP-9 activity. U0126, which is a specific inhibitor of ERK-activating kinase MEK-1/-2, prevented the decrease in the MMP-9 activityConclusions: A decrease in cPLA2 expression, COX-2 expression, MMP-9 activity and a increase in ERK activity may be related to the anticancer effects of uteroglobin in nonsmall cell lung cancer cells.(Tuberculosis and Respiratory Diseases 2004, 56:638-645)
Background:The aim of this study was to elucidate the mediastinal lymphatic drainage of non- small-cell lung cancer (NSCLC). Methods : We retrospectively analyzed the frequency of enlarged mediastinal lymph node (LN) in 256 NSCLC patients with N2 or N3 diseases on CT scan, especially with respect to the location of primary tumor. Results : In 57 patients with right upper lobe (RUL) tumors, right lower paratracheal LN (89.5%) was the most commonly enlarged, followed by subcarinal LN (54.4%). In 61 patients with left upper lobe (LUL) tumors, left lower paratracheal (70.5%) and subaortic LNs (52.5%) were commonly enlarged. Subcarinal LN enlargement without ipsilateral superior mediastinal LN enlargement was rarely found in both upper lobe tumors; RUL 8.8%, LUL 6.6%. In patients with right or left lower lobe (RLL or LLL) tumors, the most commonly enlarged LN was subcarinal; 88.2%, 65.7%, respectively. In RLL tumors with both subcarinal and superior mediastinal LN enlargements, the frequency of ipsilateral superior mediastinal LN involvement was similar to that of bilateral superior mediastinal involvement. In LLL tumors with both subcarinal and superior mediastinal LN enlargements, bilateral superior mediastinal involvement was more frequent than ipsilateral superior mediastinal involvement. Conclusion : The results of this study suggest that both upper lobe tumors are mainly drained directly to ipsilateral superior mediastinal LNs, and that both lower lobe lesions are drained to superior mediastinal LN via subcarinal LNs.(Tuberculosis and Respiratory Diseases 2004, 56:646-656)
As a chronic multisystemic inflammatory disorder, Behet's disease may manifest vascular, cardiac, neurological and gastrointestinal abnormalities. However, involvement of large veins, such as thrombosis of the superior or inferior vena cava, is a very rare complication. Herein, a case of superior vena cava syndrome, due to the thrombotic obstructions of the subclavian and brachiocephalic vein, is reported in a 27-year old woman with chronic Behet's disease.(Tuberculosis and Respiratory Diseases 2004, 56:657-663)
Extramedullary plasmacytoma(EMP) comprises 5% of all plasma cell neoplasms and commonly occurs in the upper airway or digestive tract. However, it rarely develops in the lungs. We present a case of primary pulmonary plasmacyotma in a 45 year old man, who presented as an endobronchial mass with a pleural effusion, but without evidence of multiple myeloma. The treatment options for EMP include surgery, surgery and radiotherapy, surgery and chemotherapy or chemotherapy alone. Surgery and radiation therapy appeared to be equally effective forms of treatment. The local recurrence rate was reported to be 30%, with 48% progressing to multiple myeloma, and median survival was reported to be 63-101 months. Our patient was initially treated with melphalan and prednisolone. However the disease progressed, and radiotherapy was combined with chemotherapy. In addition, the chemotherapy regimen was also changed to thalidomide and dexamethasone. The patient did not respond to this treatment regimen and finally died.(Tuberculosis and Respiratory Diseases 2004, 56:664-669)