Background: Lung cancer has been the leading cause of cancer death in South Korea since 2000. This study examined the clinical characteristics of lung cancer patients diagnosed in a community hospital from the year 2000 to 2005, and compared these results with previously reported statistical data. Method: The lung cancer data in a form of an electronic medical record was downloaded from the hospital medical information system. The clinical characteristics of the 1,509 patients with lung cancer were analyzed retrospectively. Result: The mean age of the patients was 63.7 years. 82.5% and 74.5% of the patients were men and smokers, respectively. Squamous cell carcinoma (41.6%) was the most common pathology type followed by adenocarcinoma(32.3%) and small cell carcinoma(13.9%). When 604 patients who were diagnosed from 2000 to 2003 were compared with 905 patients diagnosed from 2004 to 2005, the age of patients increased significantly (61.5 years vs. 65.1 years; p<0.001) and the proportion of adenocarcinomas was significantly higher(29.3% vs. 34.4%; p=0.046). Conclusion: Among the major histology types of lung cancer, the incidence of adenocarcinoma has been increasing recently. The age of the lung cancer patients at diagnosis is getting older. This is despite the fact that the distributions of the initial anatomic stages have not changed significantly. (Tuberc Respir Dis 2006; 61: 427-432)
연구배경: COPD 환자에서 천식을 동반한 환자들이 많이 있다고 보고 되어 있었고 기관지 과민성이 높은 비율로 보고되어 메타콜린 기관지유발검사가 이 두 질환을 감별에 어떤 의의가 있는지 알아보았고, 치료에 대한 도움을 얻고자 연구하였다. 방 법: 전북대학교병원에서 2004년 1월부터 2004년 12월까지 메타콜린 기관지유발검사를 시행한 환자를 대상으로 전향적으로 연구하였다. 65명의 천식환자 23명의 COPD환자, 대조군에서 메타콜린 기관지유발검사를 분석하였다.결 과: 각 군의 PC20의 평균값은 천식군, COPD군 및 대조군에서 각각 8.1±1.16, 16.9±2.21 과 22.0±1.47 mg/mL이고, 천식군, COPD군 및 대조군의 메타콜린 기관지유발검사의 양성율은 각각 65%, 30%와 9%였다. 메타콜린 기관지유발검사 양성 판정 기준을 PC20 16 mg/mL 이하로 가정할 때 천식군과 COPD군의 양성율은 80%와 30%이었고 민감도, 특이도, 양성예측률 및 음성예측률은 각각 80%, 75%, 78%와 78%였다.
Background: Although airway hyper-responsiveness is one of the characteristics of asthma. bronchial hyper-responsiveness has also been observed to some degree in patients with chronic obstructive pulmonary disease (COPD). Moreover, several reports have demonstrated that a number of patients have both COPD and asthma. The methacholine bronchial challenge test (MCT) is a widely used method for the detecting and quantifying the airway hyper- responsiveness, and is one of the diagnostic tools in asthma. However, the significance of MCT in differentiating asthma or COPD combined with asthma from pure COPD has not been defined. The aim of this study was to determine the role of MCT in differentiating asthma from pure COPD. Method: This study was performed prospectively and was composed of one hundred eleven patients who had undergone MCT at Chonbuk National University Hospital. Sixty-five asthma patients and 23 COPD patients were enrolled and their MCT data were analyzed and compared with the results of a control group. Result: The positive rates of MCT were 65%, 30%, and 9% in the asthma, COPD, and control groups, respectively. The mean PC20 values of the asthma, COPD, and control groups were 8.1±1.16 mg/mL, 16.9±2.21 mg/mL, and 22.0±1.47 mg/mL, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT for diagnosing asthma were 65%, 84%, 81%, and 69%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT (ed note: please check this as I believe that these values correspond to the one PC20 value. Please check my changes.) at the new cut-off points of PC20 ≤ 16 mg/ml, were 80%, 75%, 78%, and 78%, respectively. Conclusion: MCT using the new cut-off point can be used as a more precise and useful diagnostic tool for distinguishing asthma from pure COPD. (Tuberc Respir Dis 2006; 61: 433-439)
연구배경: 감염증의 발생여부는 장기이식환자의 예후에 중요한 영향을 미친다. 국내와 같이 결핵의 유병률이 높은 지역에서는 장기이식후 기회감염으로 결핵 발병의 위험성이 높을 것으로 추정되나 아직 간 또는 심장이식환자에서의 결핵의 발병률 및 임상양상에 대한 보고가 부족하거나 없다.방 법: 1992년 1월 부터 2004년 7월까지 서울아산병원에서 간 또는 심장이식을 받은 840명(간이식 730예, 심장이식 110예)을 대상으로 의무기록을 후향적으로 분석하였다.결 과: 국내의 한 대학병원에서 간이식 후 결핵의 발생률은 1.5% (추적 26.6±19.8개월), 심장이식은 2.7% (추적 59.7±33.3개월)였다. 이것은 과거 보고된 국내 신장이식 환자들에서의 결핵 유병률보다는 낮은 것으로 추정된다. 폐외결핵이 35% (속립성 결핵 14%)를 차지하여 기존의 보고들과 같이 폐외결핵의 발병률이 높았다.간이식 환자에서 결핵발병의 위험인자는 단변수 분석에서 이식 후 당뇨, 낮은 이식 전 백혈구 수치, 만성 거부반응이었고, HBeAg 양성은 경계수준의 유의성을 보였다. 대부분의 이식환자에서 결핵 예방 치료가 시행되지 않았고, 결핵이 발생한 대다수의 환자는 리팜핀을 포함한 1차 약제로 치료하였고, 항결핵치료와 연관된 급성 거부반응은 2예에서 관찰되었다.
Background: Post-transplant tuberculosis (TB) is a serious complication in solid organ transplant recipients worldwide, However there is little or no data on TB in liver or heart transplant recipients in Korea. Methods: The incidence and clinical characteristics of TB of 730 patients who had undergone a liver transplant in a university hospital in Korea between 1992 and 2004, and 110 heart transplant recipients in the same period, were reviewed retrospectively. Results: The incidence of TB was 1.5%(11/730) and 2.7%(3/110) in the liver and heart transplantation, respectively. The median time from the transplant to the development of TB was 8.4 months(1.0-30.8). and the mean time from the symptoms to the diagnosis of TB was 2.1±3.6 months(0.3-13.2). Nine patients (65%) had pulmonary TB and five (35%) had extrapulmonary TB. The leukopenia and positive HbeAg at the baseline, post-transplant diabetes mellitus, and chronic rejection were associated with the development of TB in the liver transplant recipients. Ten patients were treated with a 4-drug standard regimen for a mean duration of 7.8±3.5 months. One patients died of TB. Conclusion: The incidence of TB in liver or heart transplant recipients was similar to that reported in other countries with a similar TB-burden. (Tuberc Respir Dis 2006; 61: 440-446)
Background: MMPs and TIMPs are important factors for abnormal remodeling the pulmonary parenchyme in idiopathic interstitial pneumonia(IIP) This study evaluated the expression of MMPs and TIMPs in the tissue of IPF, NSIP and normal control subjects. Method: The MMP-2 and -9 activity in the lung tissue was studied by gelatin zymography, and the expression of MMP-1, -2 ,-9, TIMP-1 and -2 in the lung tissue was measured by immunohistochemistry. Thirty five patients, who were diagnosed with IIP (UIP ; 22, NSIP ; 13), were enrolled in the immunohistochemical study. Thirteen patients with IIP (UIP ; 9, NSIP ; 4) and five patients with lung cancer were enrolled in the zymographic assay. Results: (1) The immunohistochemistry for MMP-1,-2,-9, TIMP-1 and-2 ; MMP-1,-9 and TIMP-2 were stained stronger in the UIP subjects than NSIP and the normal control. TIMP-2 was strongly stained in the UIP tissue. particularly the fibroblasts in the fibroblastic foci. (2) Zymography for MMP-2 and MMP-9 revealed MMP-2 to have prominent expression in the UIP tissue than in the NSIP tissue. Conclusions: These results suggest that the overexpression of the TIMPs and gelatinases in UIP might be important factors in the irreversible fibrosis of the lung parenchyme (Tuberc Respir Dis 2006; 61: 447-455)
연구배경: 대량 흉수의 가장 흔한 원인은 악성으로 알려졌으나 이에 대한 보고가 많지 않고, 지역 및 시대에 따라 다른 분포를 보였다. 저자들은 결핵의 유병율이 높은 국내에서 대량 흉수의 원인 질환의 분포를 알아보고, 원인 질환 감별을 위한 흉수의 분석지표에 대해 알아보기 위해 연구를 시행하였다.방 법: 2002년 7월부터 2005년 7월까지 한양대학교 구리병원에 입원하여 흉수 천자를 시행하였던 298명 환자를 대상으로 후향적 조사를 시행하였다. 대량 흉수는 흉부단순촬영에서 일측 흉곽의 2/3 이상을 차지한 경우로 정의하였고 각 환자에서 혈청 생화학 검사, 흉수 천자 소견을 비교하였다.결 과: 전체 298명의 흉수 예 중 대량 흉수는 41예, 13.8% 이었다. 대량 흉수의 원인으로는 악성 흉수가 19예(46.3%)로 가장 많았고 결핵 15예(36.6%), 부폐렴성 흉막염 및 농흉 4예(9.8%), 여출성 흉수 3예(7.3%) 순이었다. 대량 흉수 중 악성 흉수(n=19)와 양성 흉수군(n=22)의 비교 시 악성 흉수에서 ADA가 낮고(30.5 vs 86.2;p=0.017), amylase 수치가 높았다(349.0 vs 39.2;p=0.031). 흉수 적혈구는 악성 흉수 군에서 높은 경향을 보였다(95,406 vs 22,105;p=0.052).
Background: Differential diagnosis is very important in patients with pleural effusions. A few studies on the etiologies of massive pleural effusions have been reported, but these were conducted in different decades and locations. In the present study, the etiologic spectrum of massive pleural effusions in Korea, were evaluated through an investigation at one university hospital. Methods: Retrospective chart reviews were performed in patients having undergone thoracentesis between July 2002 and July 2005. Pleural effusions were deemed to be massive if they occurred in two thirds or more of one hemithorax. The etiologies of massive pleural effusions, pleural fluid findings, serum laboratory findings, and sputum and pleural fluid cytologies were compared. Results: Of 298 pleural effusions cases, 41 (13.8%) had massive pleural effusions. The most frequent causes of massive pleural effusions were malignancy (19; 46.3%) followed by tuberculosis (15; 36.6%), parapneumonic effusion (4; 9.8%) and transudate (3; 7.3%). Compared with massive benign effusions, patients with massive malignant pleural effusions were more likely to have lower adenosine deaminase (ADA) activity, a higher amylase level and higher RBC count in their pleural fluids. Also, compared with non-tuberculosis effusions, patients with massive tuberculous pleural effusions were more likely to have lower RBC and neutrophil counts, but a higher lymphocyte count, adenosine deaminase (ADA) activity and protein level. Conclusion: The most common etiologies of massive pleural effusions in Korea are malignancy and tuberculosis. A high ADA content favors a tuberculous condition, while bloody effusions with a relatively lower ADA content. favors malignancy. The proportion of tuberculosis in massive pleural effusions was higher than in previous reports. (Tuberc Respir Dis 2006; 61: 456-462)
저자들은 폐암 및 항암치료에 의한 만성 질환으로 유발된 중등도의 빈혈이 있어 농축적혈구의 수혈치료 후 발생한 호흡곤란 및 발열 호소하여 다른 원인 감별 후 수혈에 의해 유발된 급성 폐 손상 진단하에 대증치료후 환자의 증상은 호전되었다. 이러한 수혈에 의해 유발된 급성 폐 손상은 그간 국내에서 보고 된 적이 없었던 증례로 이를 문헌 고찰과 함께 보고하는 바이다.
Transfusion related acute lung injury (TRALI) is a serious, potentially life-threatening complication of transfusion therapy that is sometimes under diagnosed and under reported. Patients with TRALI present with dyspnea/respiratory distress and fever. The symptoms, signs and chest radiological findings in TRALI are similar to transfusion associated circulatory overload, which makes it is difficult to distinguish it from circulatory overload. Although the mortality rate in cases of TRALI is relatively low, TRALI is the third most common cause of fatal transfusion reactions next to ABO blood type incompatibility and hepatitis. Mild-to-moderate cases of TRALI may be misdiagnosed as volume overload. Recently, we encountered two cases where the patients suffered from dyspnea and fever after a transfusion. and review of the relevant literature. (Tuberc Respir Dis 2006; 61: 473-478)
급성 섬유소성 기질화 폐렴 (AFOP)은 임상적으로 급성 간질성 폐렴과 유사하지만 세기관지내 섬유소 축적을 보이며 유리질막이 존재하지 않는 조직학적 특성을 갖는 간질성 폐렴의 한 형태이다. 일부 보고나 본 증례에 따르면 임상경과는 급성 간질성 폐렴보다 비교적 양호한 것으로 기대된다. 그러므로 급격히 진행하는 호흡곤란을 호소하는 환자에게 거친 호흡음과 함께 수포음이 들리고, 방사선 검사상 양측 폐 전반에 걸쳐 현저한 간유리 음영이 있을 경우 조직소견을 바탕으로 급성 간질성 폐렴이나 다른 간질성 폐질환을 감별진단하고 치료방법을 결정하고 병의 경과 및 예후를 예측할 수 있다.
Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD. (Tuberc Respir Dis 2006; 61: 479-483)
원발성 기관지내 평활근육종은 폐에 원발하는 매우 드문 악성 종양으로 통상적인 생검방법으로는 육종의 진단이 쉽지 않고 수술적 폐생검이 필요한 경우가 많으며 치료는 근치적 절제술로 완치를 기대할 수 있다. 저자들은 대량객혈을 주소로 내원한 21세 남자에서 좌폐하엽 기관지에서 발생한 원발성 기관지내 평활근육종을 진단하고 좌하엽 수상절제술을 시행하였으나 3개월 후에 국소 재발하였다. 1차 수술 후 4개월 째 좌측 전폐절제술을 시행하였으나 2차 수술 후 11개월 째 다시 국소재발과 기관지흉막루가 발생하였고 이와 관련된 농흉과 패혈증으로 사망하였던 환자를 경험하여 이를 보고하는 바이다.
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. (Tuberc Respir Dis 2006; 61: 484-489)
자궁근종의 병력을 가진 51세 여자가 기침, 가래, 발열을 주소로 내원하였다. 기관지내시경하 조직 생검상 평활근종이 발견되었고 환자의 자궁근종의 병력을 고려했을 때 양성 전이성 폐평활근종과의 감별이 필요하였다. 좌하엽 절제술과 동시에 자궁 절제술을 시행하였고 두 병변의 조직학적 소견을 비교해 보았을 때 폐의 병변은 자궁근종과는 무관한 원발성 기관지 평활근종으로 확진되었으며 이후 증상의 호전을 보여 현재 경과관찰 중이다.
Leiomyoma of the bronchus is a very rare benign tumor of the lung. Most endobronchial leiomyomas occur as secondary foci of primary uterine leiomyoma. We herein report a case with endobronchial tumor that had a different pathology from a primary resected uterine leiomyoma and was therefor considered a primary endobronchial leiomyoma. A 51-year-old woman with a history of uterine myoma presented with productive cough and fever. Bronchoscopy revealed a lightly yellow colored mass lesion that totally obstructed the orifice of the left lower lobe of the lung. The diagnosis of leiomyoma was made by histological examination of the obtained specimen. We considered the possibility of a benign metastasizing pulmonary leiomyoma. For treatment and differential diagnosis, a left lower lobe lobectomy of the lung and total hysterectomy with bilateral salphingooopherectomy were performed. The differences between lung and uterine lesions were confirmed by morphologic finding and immunohistochemical staining. The pathological diagnosis was primary endobronchial leiomyoma combined with uterine myoma. (Tuberc Respir Dis 2006; 61: 490-495)
신세포암은 원발 부위의 수술적 절제를 하더라도 전이를 자주하는 질환으로 이에 따라 5년간의 추적조사가 권장되고 있다. 본 증례에서는 신세포암으로 신적출술 이후 통상적인 5년간의 추적조사기간동안 전이가 발견되지 않았으나, 7년후 폐렴으로 내원하여 조사중에 발견한 신세포암의 기관지내 전이를 수술적인 방법으로 제거하여서 보고하는 바이다
A distant metastasis from a renal cell carcinoma is quite common after a radical nephrectomy. For this reason, a5 year scheduled follow up is recommended. However, a distant metastasis 5 years after the resection is quite rare. We encountered an endobronchial metastasis from a renal cell carcinoma that was discovered 7 years after the radical nephrectomy, and did not present during the 5 year scheduled follow up regimen. We report this case with a review of the literatures. (Tuberc Respir Dis 2006; 61: 496-500)