Background: Pulmonary hypertension in COPD patients is the result of a direct effect of tobacco smoke on the intrapulmonary vessels with the abnormal production of the mediators that control vasoconstriction, vasodilatation, and vascular cell proliferation, which ultimately lead to aberrant vascular remodeling and physiology. COPD patients are prone to the developmint of an acute and chronic thromboembolism with an elevation of the plasma procoagulant and fibrinolytic markers However, the roles of the coagulation and fibrinolysis system on the right ventricular dysfunction in COPD patients are not well defined. We examined the alteration of the coagulation and fibrinolysis system in COPD patients according to the right ventricular function measured using cardiac multidetector computed tomography (MDCT).Methods: The right ventricular ejection fraction (RVEF) was measured using cardiac MDCT in 26 patients who were diagnosed with COPD according to the definition of the GOLD guideline. The plasma level of thrombin antithrombin (TAT) and plasminogen activator inhibitor (PAI)-1 were measured using an enzyme linked immunoassay.Results: The plasma TAT was markedly elevated in COPD patients (10.5±19.8μg/L) compared with those of the control (3.4±2.5 μg/L) (p<0.01). However, the plasma PAI-1 in COPD patients (29.6±20.7 ng/mL) was similar to that in the controls. The plasma TAT showed a significant inverse relationship with the RVEF measured by the cardiac MDCT in COPD patients (r=-0.645, p<0.01). However, the plasma PAI-1 did not show a relationship with the RVEF (r=0.022, p=0.92).Conclusion: These results suggest that the coagulation system in COPD patients is markedly activated, and that the plasma level of TAT might be a marker of a right ventricular dysfunction in COPD patients. (Tuberc Respir Dis 2006; 60: 625-630)
Background: Patients with COPD generally complain of very different degrees of dyspnea regardless of their pulmonary function. The study, we assessed the right ventricular ejection fraction in relation to dyspnea in COPD patient.Methods: The pulmonary function including the diffusion capacity was measured. The right ventricle ejection fraction (RVEF) was measured using a first-pass radionuclide scan by multigated acquisition (MUGA). Forty patients with chronic obstructive pulmonary disease (COPD) were stratified for dyspnea according to the Medical Research Council (MRC) scale. Moderate dyspnea and severe dyspnea is defined as MRC 2/3 (n = 16) and MRC 4/5 (n = 24) respectively. Results: The baseline pulmonary function tests including DLCO and the resting arterial blood gas were similar in the moderate and severe dyspnea group, with the exception of the residual volume (% predicted) (moderate 160 ± 27, severe 210 ± 87, p < 0.03). The right ventricle ejection fraction was significantly (p < 0.001) lower in the severe dyspnea group (25 ± 8) than in the moderate group (35 ± 6). The independent factor assessed by multiple logistic regression revealed only the severity of dyspnea to be significantly associated with RVEF (p < 0.02).Conclusion: This study showed that the right ventricle ejection fraction would contributes to severity of dyspnea in patients with a similar pulmonary function (Tuberc Respir Dis 2006; 60: 631-637)
Backgrounds: This study investigated whether or not a polymorphism in the gene encoding the surfactant protein A(SP-A) has any bearing on the individual susceptibility to the development of chronic obstructive pulmonary disease(COPD) in a genetically homogenous Korean population.Methods: The genotypes of 19 COPD patients and 20 healthy neonates as controls were tested using a polymerase chain reaction followed by restriction fragment length polymorphism analysis for the SP-A gene.Results: The specific frequencies of the 6A2 and 6A18 alleles of SP-A1 and the 1A2 allele of SP-A2 were much higher in the COPD group than control group (p<0.05). However, the frequencies of the 6A3 and 6A4 alleles of SP-A1 and the 1A0 allele of SP-A2 in the COPD group were significantly lower than the control group. In the COPD group, the frequencies of the +50 locus genotypes GG of SP-A1 and the +9 locus genotypes CC of SP-A2 were 85.0% and 60.6%, respectively, and 19.7% and 24.8% in the control group, respectively. The frequencies of the polymorphic genotypes or alleles showed a statistically significant difference between the COPD group and the control group (P<0.05).Conclusion: A genetic polymorphism in SP-A is associated with the development of COPD in the Korean population.(Tuberc Respir Dis 2006; 60: 638-644)
Background: PM10(Particulate matter with a diameter < 10㎛), which is characterized by different environmental conditions, is a complex mixture of organic and inorganic compounds. The Asian dust event caused by meteorological phenomena can also produce unique particulate matter in affected areas. This study investigated the cytokine produced by A549 epithelial cells exposed to particles collected during both the Asian dust pfenomenon and ambient air particles in a non-dusty period.Method: Air samples were collected using a high volume air sampler(Sibata Model HV500F) with an air flow at 500ℓ/min for at least 6 hours. The cytokine messenger RNA(mRNA) was measured using a reverse transcriptase polymerase chain reaction(RT-PCR). The A549 cells were exposed to 10 to 500㎍/㎖ of a suspension containing PM10 for 24 hours. Each was compared with those in the non-exposed control cells.Result: The mRNA levels of interleukin(IL)-1α, IL-Iβ , IL-8, and the granulocyte macrophage colony stimulating factor(GM-CSF) increased after veing exposed to PM10 in the ambient air particles, compared with those in the non-exposed control cells. The increase in IL-1α and IL-8 were dose dependent at a PM10 concentration between 100㎍/㎖ and 500㎍/㎖. The mRNA level of IL-8 in the A549 epithelial cells was higher during the in the Asian dust period(500㎍/㎖) than during the non dust period.Conclusion: A549 cells exposed to the PM10 collected during the Asian dust period produce more proinflammatory cytokine than during non-dusty period. This cytokine enhances the local inflammatory response in the airways and can also contribute to the systemic component of this inflammatory process. (Tuberc Respir Dis 2006; 60: 663-672)
Most malignant mesenchymal tumors of the lung are metastases of a primary tumor from elsewhere in the body. A primary pulmonary synovial sarcoma is a very rare neoplasm that accounts for approximately 10% of soft tissue sarcomas and makes up only 0.5% of all primary lung malignancies. We report a case of a primary pulmonary synovial sarcoma in a 60-year old woman. In this case, a lung metastasis was excluded using 18F-FDG PET /CT imaging.(Tuberc Respir Dis 2006; 60: 673-677)
Both bronchial leiomyoma and pulmonary sequestration are rare conditions, and to the best of our knowledge there are no reports of the two conditions coexisting. We report a female patient with bronchial leiomyoma with acquired pulmonary sequestration who presented with dyspnea, cough and purulent sputum. The patient had been treated for pneumonia at a local medical clinic. but was transferred to our clinic beacausr there was no clinical improvement. A 3-D computed tomography scan revealed a 1.5 cm sized mass near the distal portion of the left main bronchus and an anomalous artery arising from the aorta. The patient showed clinical improvement after a left lower lobectomy and a ligation of the anomalous artery. (Tuberc Respir Dis 2006; 60: 678-683)
Uterine cervical cancer is the 5th most common malignancy in Korean women. With the development of new diagnostic and therapeutic modalities, earlier stage cancers are being diagnosed with longer survival rates being anticipated. Accordingly, recurrent cancers are being encountered more often in clinical practice. Most recurrent uterine cervical cancer patients, have intra-pelvic lesions and adjacent lymph node involvement, while a distant metastasis alone is extremely rare. A mediastinal recurrence of uterine cervical cancer is not common with most manifesting as small lymph node enlargements. We report a case of a 46-year-old woman with recurrent uterine cervical cancer presenting only as a huge mediastinal mass without a local recurrence. (Tuberc Respir Dis 2006; 60: 684-689)
Central venous catheterization is used to provide a large amount of fluid, total parenteral nutrition and to administer antitumor agents with few complications reported. We report an uncommon case of pleural effusion that occurred after central venous catheterization. In many cases, the mechanism for the pleural effusion after central venous catheterization occurs through an injury to the superior vena cava by the continuous mechanical force of the catheter tip, the flow of large amount of fluid and an osmotic injury to the wall of the vein. This case is somewhat different in that the central catheter was placed in an aberrant vessel resulting in the pleural effusion. A post-placement chest roentgenogram and the correct approach of catheterization are important for preventing this complication.(Tuberc Respir Dis 2006; 60: 690-693)