As the prevalence of tuberculosis declines, the proportion of nontuberculous mycobacterial (NTM) lung disease is increasing in Korea. The combined use of liquid and solid media increases the sensitivity of mycobacterial culture and shortens culture time. Because NTMs are ubiquitous in the environment, NTM lung disease requires strict diagnostic criteria to prevent over-diagnosis of NTM lung disease. Mycobacterium avium complex is the most common pathogen of NTM lung disease in Korea and present in two forms: upper lobe cavitary and nodular bronchiectatic form. Decision of treatment of NTM lung disease depends on the infecting species and overall condition of the patient. Because medical therapy requires the use of multiple drugs over 18 to 24 months, surgery for localized disease may be useful for those species refractory to medical therapy.
Background: Pre-B-cell colony enhancing factor (PBEF) has been suggested as a novel biomarker in sepsis and acute lung injury. We measured the PBEF in bronchoalveolar lavage (BAL) fluid of acute critically ill patients with lung infiltrates in order to evaluate the clinical utility of measuring PBEF in BAL fluid. Methods: BAL fluid was collected by bronchoscope from 185 adult patients with lung infiltrates. An enzyme-linked immunosorbent assay was then performed on the collected fluids to measure the PBEF. Results: Mean patient age was 59.9±14.5 years and 63.8% of patients were males. The mean concentration of PBEF in BAL fluid was 17.5±88.3 ng/mL, and patients with more than 9 ng/mL of PBEF concentration (n=26, 14.1%) had higher Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ and Sequential Organ Failure Assessment (SOFA) scores on the BAL exam day. However, there were no significant differences in clinical characteristics between survivors and non-survivors. In patients with leukocytosis (n=93) seen on the BAL exam day, the linear regression analysis revealed a significant, positive relationship between PBEF and APACHE Ⅱ (r2=0.06), SOFA score (r2=0.08), Clinical Pulmonary Infection Score (r2=0.05), and plateau pressure in patients on ventilators (r2=0.07) (p＜0.05, respectively). In addition, multivariate regression analysis with PBEF as a dependent variable showed that the plateau pressure (r2=0.177, p＜0.05) was correlated positively with PBEF. Conclusion: The PBEF level in the BAL fluid may be a useful, new biomarker for predicting the severity of illness and ventilator-induced lung injury in critically ill patients with lung infiltates and leukocytosis.
Background: Several large outbreaks have demonstrated the threat of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in close-contact environments, such as occurs during training and quartering of military recruits training. In South Korea, which is a hospital or healthcare-associated MRSA prevalent area, military service is compulsory for all healthy young men. We surveyed and determined the extent of CA-MRSA colonization in the upper respiratory tracts of Korean military recruits. Methods: The Korean military recruits who were enrolled in a military training facility from November 2004 to March 2005 were eligible for this study. Sputum or nasopharyngeal swap was obtained from randomly selected subjects who displayed upper respiratory tract symptoms. Results: Of the 181 participants, 32 participants (17.7%) were colonized with S. aureus, and 12 participants (6.6%) were colonized with MRSA. Among the cases that were colonized with S. aureus, 37.5% (12/32) were colonized with MRSA. Antimicrobial susceptibility testing showed resistant patterns that were suggestive of the CA-MRSA strains for all of the MRSA isolates. Conclusion: This study of Korean military recruits found a great deal of showed MRSA colonization in them, and the antimicrobial resistant profile that was suggestive of a CA-MRSA strain. Further efforts to prevent the spread of MRSA infections and careful monitoring for CA-MRSA outbreaks are warranted, especially in a high risk group such as military recruits.
Background: MicroRNAs (miRNAs) play an important role in the regulation of cell proliferation, apoptosis, development and differentiation. Several studies have shown that aberrant expression of miRNAs is involved in cancer development and progression by regulating the expression of proto-oncogenes or tumor suppressor genes. In this study, we investigated miRNA expression profiles in Korean patients with non-small cell lung cancer (NSCLC). Methods: We performed miRNA microarray analysis containing 60∼65 bp oligonucleotide probes representing human 318 miRNAs and validated the results of the microarray with Northern blot analysis or quantitative RT-PCR. Next, we examined the correlation between miRNA expression and the target gene transcriptional profile using a human whole-genome-expression microarray. Results: We showed that 35 miRNAs were expressed differentially in the NSCLCs and corresponding non-malignant lung tissues. We showed that 35 miRNAs were expressed differentially in the NSCLCs and corresponding nonmalignant lung tissues. Thirteen of the 35 differentially expressed miRNAs were newly identified in the present study. Of the 35 miRNAs, 2 (miR-371 and miR-210) were over-expressed in lung cancers, and 33 miRNAs, including miR-145, were under-expressed in lung cancers. miR-99b expression consistently showed a negative correlation with FGFR3 expression. Conclusion: Albeit a small number of patients were examined, these results suggest that miRNA expression profiles in Korean lung cancers may be somewhat different from the expression profiles reported on lung cancers in Western populations. The findings suggest that miR-99b might be a tumor suppressor through its up-regulation of FGFR3.
Background: The discomfort caused by chronic cough, that is persistent for more than 3 weeks, causes a number of patients to seek medical attention. However, the underlying disorder often remains undetermined despite thorough examinations, and is considered to be idiopathic. This study compared the efficacy of inhaled corticosteroid with conventional cough suppressants on chronic idiopathic cough. Methods: Eligible patients with chronic idiopathic cough were randomly assigned to either the inhaled fluticasone group or the codeine plus levodropropizine oral administration group. The subjects in each group took their planned medication for 2 weeks. After the trial, comparative analyses of outcomes were performed in terms of the remnant cough (%) at the end of treatment, drug compliance, and adverse drug events. Results: Seventy-seven patients were enrolled in this randomized trial; 38 to the inhaled fluticasone group and 39 to the codeine plus levodropropizine group. The remnant cough was 41.0±35.8% in the inhaled fluticasone group, and 32.4±32.0% in the codeine＋levodropropizine group (p=0.288). Drug compliance was 95.4±7.4% and 81.8±18.6% in the inhaled fluticasone and the codeine＋levodropropizine group, respectively (p＜0.001). Nine patients had adverse drug events in the codeine＋levodropropizine group compared to one in the inhaled fluticasone group (p＜0.001). Conclusion: Short-term inhaled corticosteroid is not inferior to conventional antitussive agents in controlling chronic idiopathic cough without significant adverse events.
Background: Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP. Methods: This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability. Results: Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032). Conclusion: In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.
Background: Micro computed tomography (CT) is rapidly developing as an imaging tool, especially for mice, which have become the experimental animal of choice for many pulmonary disease studies. We evaluated the usefulness of micro CT for evaluating lung fibrosis in the murine model of bleomycin-induced lung inflammation and fibrosis. Methods: The control mice (n=10) were treated with saline. The murine model of lung fibrosis (n=60) was established by administering bleomycin intra-tracheally. Among the 70 mice, only 20 mice had successful imaging analyses. We analyzed the micro CT and pathological findings and examined the correlation between imaging scoring in micro CT and histological scoring of pulmonary inflammation or fibrosis. Results: The control group showed normal findings on micro CT. The bnormal findings on micro CT performed at 3 weeks after the administration of bleomycin were ground-glass opacity (GGO) and consolidation. At 6 weeks after bleomycin administration, micro CT showed various patterns such as GGO, consolidation, bronchiectasis, small nodules, and reticular opacity. GGO (r=0.84) and consolidation (r=0.69) on micro CT were significantly correlated with histological scoring that reflected pulmonary inflammation (p＜0.05). In addition, bronchiectasis (r=0.63) and reticular opacity (r=0.83) on micro CT shown at 6 weeks after bleomycin administration correlated with histological scoring that reflected lung fibrosis (p＜0.05). Conclusion: These results suggest that micro CT findings from a murine model of bleomycin-induced lung fibrosis reflect pathologic findings, and micro CT may be useful for predicting bleomycin-induced lung inflammation and fibrosis in mice.
Erlotinib (TarcevaⓇ) has been considered to be a new, promising oral chemotherapy agent for local advanced or metastatic non-small cell lung cancer (NSCLC). Erlotinib is regarded as relatively safe, but interstitial lung disease (ILD) related to erlotinib has been reported on an infrequent basis in Asia. We report an histologically confirmed case of recurrent erlotinib-induced ILD. Although, the patient was highly responsive to the first erlotinib treatment, the therapy was discontinued due to erlotinib-induced ILD. After intravenous high dose methylpredinisolone treatment, ILD was improved rapidly by radiologic studies, but the particular lung cancer re-emerged. We restarted the patient erlotinib on low-dose oral methylpredinisolone, resulting in a recurrence of erlotinib-induced ILD. Our case suggests that re-administration of erlotinib should be performed on a limited basis in patients that have developed ILD on previous use, even if a therapeutic effect can be estimated.
Desmoid tumor (fibromatosis) is a histologically benign fibrous neoplasm showing locally infiltrating growth. This type of tumor commonly occurs in the abdomen, but intrathoracic desmoid tumor is uncommon. To date, 12 casesof intrathoracic desmoid tumor protruding into the pleural cavity, radiologically mimicking pleural masses, have been reported. Here, we report on a case of intrathoracic desmoid tumor protruding into the pleural cavity, andpartially covered by parietal pleura. The main preoperative differential diagnoses included pleural solitary fibrous tumor, inflammatory pseudotumor or malignant mesothelioma. A near-total mass excision was performed. Pathologically, the tumor was composed of a paucicellular arrangement of spindle-shaped cells with fibromyxoid stroma. The resection margin was partially involved with spindle cells present. On histochemical staining, the spindle cells were strongly positive for vimentin and negative for CD34, consistent with a desmoid tumor. The patient wasstable without further adjuvant treatment during 6-years of follow-up.
Infliximab, a TNF-α antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis,Crohn’s disease and Behcet’s disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet’s disease and uveitis. We report this case with a review of the relevant literature.
A pseudochylothorax, a chyliform pleural effusion, is a rare disease of pleural effusion that contains cholesterol crystals or high lipid content that is not the result of a disrupted thoracic duct. Most of the cases were found in patients with long-standing pleural effusion due to chronic inflammatory disease, such as old tuberculous pleurisy or chronic rheumatoid pleurisy. We experienced a case of pseudochylothorax in a 74-year-old man, who was being treated for pulmonary tuberculosis and pleurisy 10 years ago. The diagnosis was confirmed on pathological study of the pleural effusion, which contained cholesterol crystals having a diagnostic rhomboid appearance.
Malignant rhabdoid tumors arise primarily from the kidney. Extrarenal malignant rhabdoid tumors are rare, with the liver, central nervous system, and skin reported as the primary sites. Malignant rhabdoid tumors of the mediastinum are extremely rare among extrarenal malignant rhadoid tumors; only 3 cases have been reported to date, all characterized by aggressive clinical behavior. We experienced a 35-year-old woman diagnosed with malignant rhabdoid tumor in the anterior mediastinum with multiple metastases. The tumor was surgically unresectable, and treated with palliative radiation therapy. Three-month after radiation treatment, she died from dissemination of the malignant rabdoid tumor.
A traumatic pulmonary pseudocyst is a rare complication of blunt thoracic trauma. The clinical symptoms and signs are similar to other respiratory diseases, such as pulmonary tuberculosis. Therefore, a trauma history with the resulting radiologic and clinical findings is important for making a diagnosis. A 26-year-old male was admitted to our hospital due to cough for 3 days. The chest x-ray revealed diffuse infiltrations and a cavitary lesion at the left lung. His left chest had hit a tree as a result of motorcycle accident one day before admission. Initially, it was assumed that his symptoms and chest X-ray might be due to a tuberculosis infection. However, bronchoscopy revealed old blood clots at both lungs, particularly in the left lower lobe bronchus. A transbronchial lung biopsy showed alveolar hemorrhage. A traumatic pulmonary pseudocyst was diagnosed from his trauma history and these findings. Computed tomography of the chest performed 4 months later showed regression of the cavitary lesion.