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Background: Neuron specific enolase (NSE) is a neuronal form of the glycolytic enzyme enolase which was first found in extracts of brain tissue, and later in a variety of APUD cells and neurons of the diffuse endocrine system. SCLC shares many APUD properties with normal neuroendocrine cells. NSE immunostaining and serum NSE measurement may be a useful marker of neuroendocrine differentiation in lung tumors and diagnosis of small cell carcinoma. Methods: NSE immunohistochemical staining was done and at the same time serum NSE levels were measured in 22 small cell lung cancer and 21 non small cell lung cancer which were confirmed histologically. Results: 1) NSE immunoreactivity was detected in 9 of the 18 (50%) small cell lung cancer, in 5 of the 16 non small cell lung cancer. 2) Whereas the mean value in non-small cell lung cancer group was , the mean level of serum NSE in small cell lung cancer increased up to . In small cell lung cancer patients, mean value of limited disease group was , while mean value of extended disease group was showing statistically significant difference. If serum levels above 20 ng/ml were tentatively defined as positive, 16 of 22 (73%) patients with SCLC had positive serum NSE level, but only one patient with NSCLC did. There was no correlation between serum NSE level and immunoreactivity of NSE. Conclusion: These studies indicate that serum NSE measurement may be a useful marker for the diagnosis and disease extent and NSE immunostaining can be used to demonstrate the neuroendocrine components of lung tumor.

연구배경 : 호흡곤란은 호흡기질환 환자의 가장 흔한 주소이나 이를 감지하는 정확한 기전은 아직 잘 알려져 있지 않다. 폐질환에서 호흡곤란의 심한 정도와 치료에 대한 반응을 측정하는 데 있어 객관적인 폐기능을 이용하여 왔으나 호흡곤란은 폐 환기능 뿐 아니라 심장, 폐질환, 심인적 요인 등을 반영한 복합적인 증상이므로 주관적으로 측정하는 호흡곤란지수(dyspnea index)를 사용하여 이러한 증상의 정도를 양적으로 측정하는 것도 유용할 것으로 생각된다. 방법 : 증상이 기관지천식 환자를 대상으로 Visual Analogue Scale(VAS) 및 Borg Scale Dyspnea Index (BSDI)와 Spirometry를 검사전 휴식상태, methacholine 유발검사에서 양성을 나타내었을 때, 기관지확장제 투여후 각각 측정하였다. 결과 : 1) 기저상태와 Methacholine 및 기관지확장제 투여후 시행한 폐기능검사 결과와 VAS 및 BSDI 간 상관관계는 없었다. 2) FEV1, FVC 및 MMFR 변화량과 VAS 및 BSDI 변화량 간에도 상관관계는 없었다. 3) 천식의 증상호소가 경미한 환자군이 증상호소가 심한 환자군 보다 methacholine 및 기관지확장제 투여 후의 VAS 및 BSDI의 변화가 더 컸다. 4) 호흡곤란지수중 VAS이 BSDI 보다 조금 큰 수치 및 변화량을 보였으며 두 지수 간의 상관관계를 볼 수 있었다(R=0.82). 결론 : 기관지천식 환자에서 기저상태 및 Methacholine 유발검사시에 객관적인 폐기능 검사 수치의 유의한 차이가 없음에도 불구하고 주관적인 호흡곤란지수는 변화하는 경향을 보였으며, 이는 경중 천식군에서 더욱 뚜렷하였다. 호흡곤란지수는 환자 간의 비교척도로는 사용될 수 없으나 한 환자에서 경과관찰이나 치료효과를 판정하는데에 spirometry와 함께 중요한 지표가 될 것으로 생각된다. 【Background: Despite dyspnea is a predominant complaint of patients with respiratory disease, the mechanisms contributing to the sensation of breathlessness are poorly understood. Traditionally, physicians have measured objective pulmonary function to assess severity of dyspnea. But it will be also useful to measure subjective dyspnea index because dyspnea probably depends on a complex interplay of mechanical, experimental, emotional and other factors. Method: We measured breathlessness at rest, after Methacholine challenge and then bronchodilator inhalation using a Visual Analogue Scale (VAS) and Borg Scale Dyspnea Index (BSDI) in stable asthmatic patients. Spirometry was performed concomittently. Results: There was no correlation between dyspnea index and FEV1. There was also no correlation between the change in dyspnea index and change in FEV1. The change in dyspnea index after methacholine and bronchodilator was greater in clinically mild asthmatic patients than clinically severe symptomatic group. Conclusion: In asthmatic patients, there was a wide variation in sensory response for any given FEV1, and the change in perception of dyspnea was greater in those with clinically mild symptoms. The measurement of dyspnea index may yield information complementary to that obtained by spirometry.】

Background: As well as fiberoptic bronchoscopy, chest computerized tomographic scan can now differentiate the benign from malignant causes and the obstructive from non-obstructive causes of lung collapse. This study was designed to evaluate the usefulness of chest CT scan and fiberoptic bronchoscopy in the diagnosis of middle lobe syndrome. Method: We reviewed the clinical features, roentgenographic changes, pathologic findings and bronchoscopic findings in 16 patients with middle lobe syndrome who were admitted to Severance Hospital during period of January, 1987 through January, 1992. Results: The male to female ratio was 1:1. The most common symptoms were cough and sputums. Crackle was the most common physical finding. Underlying disease was lung cancer, pulmonary tuberculosis and endobronchial tuberculosis in 3 each other, benign stenosis in 2, lung abscess, broncholithiasis, bronchial chondroma, pneumonia and nonspecific inflammation in 1 each other. Conclusion: We conclude that the combination of chest computerized tomogram and fiberoptic bronchoscopy was most desirable for the diagnosis of middle lobe syndrome.

Tuberculous tracheobronchitis is defined as a specific inflammation of the trachea or major bronchi caused by the tubercle bacillus and recognized as one of the most common and serious complication of pulmonary tuberculosis. It had been a diagnostic challenge in prebronchoscopic era and since 1968, fiberoptic bronchoscopy has been accepted as a safe and valuable diagnostic procedure of tuberculous tracheobronchitis. Now, it remains a troublesome therapeutic problem due to its sequelae such as bronchostenosis, bronchiectasis and bronchial deformity. The authors analyzed the clinical features, radiological findings and bronchoscopic findings with pathologic and bacteriologic study on 61 cases of tuberculous tracheobronchitis and following results were obtained. 1) The peak incidence was in the fourth decade and male to female ratio was 1:3.4. 2) The most common symptom was cough (86.9%) and followed by sputum (49.2%), dyspnea (27.9%), fever (19.8%), weight loss (11.5%), hemoptysis (6.6%), hoarseness (6.6%) and chest discomfort (3.3%) and localized wheezing was heard in 18%. 3) In chest X-ray, consolidation with collapse was observed in 70.5%, and followed by consolidation only (18.0%), mediastinal node enlargement (8.2%), cavitary lesion (6.6%), suspicious hilar mass (3.3%) and miliary lesion (1.6%) and there was no abnormal findings in 4.9%. 4) Bronchoscopy showed hyperplastic lesion in 67.2%, mucosal lesion (18.0%), ulcerative lesion (9.8%) and stenotic lesion (4.9%). The most common site of bronchial lesion was right upper bronchus (36.1%) and followed by right main bronchus (34.4%), left main bronchus (29.5%), left upper bronchus (16.4%), right middle bronchus (8.2%), right lower bronchus (6.6%) and left lower bronchus (3.3%). 5) Chronic granulomatous inflammation with or without caseation necrosis on microscopic examination was confirmed in 69.7%, bronchial washing AFB stain was positive in 34.1%, prebronchoscopic sputum AFB stain was positive in 88.1% and postbronchoscopic sputum AFB stain was positive in 30.1%.

Bronchioloalveolar cell carcinoma accounts for less than 6% of all primary lung cancer but has distinct clinical and radiological features and unusual pathologic appearance. The characteristic features are its peripheral location and tendency of rapid progression to diffuse type via aeroginous and lymphatic route without surgical intervention. Among them, mucin secretory type bronchioloalveolar cell carcinoma is the rarest and most distinctive. We experienced a case of mucin secretory type bronchioloalveolar cell carcinoma in a 47 year old female with roentgenographic findings of chronic progressive pulmonary consolidation with muliple cavities.

Bronchoalveolar lavage had been done as the treatment of some diseases such as alveolar proteinsois, bronchiectasis, and severe asthma to remove excessive secretion or mucus. But in the recent decade it has been done as a diagnostic method and a tool to understand and evaluate the pathophysiology of diffuse interstitial lung diseases such as sarcoidosis, pneumoconiosis and hypersensitivity pneumonitis. To analyse the bronchoalveolar fluid, it might be useful to have a standard reference (especially cell counts and differetial count of the cells from bronchoalveolar lavage fluid) of normal person. But it is difficult to study the normal volunteers. We investgated the bronchoalveolar lavage fluid of 48 patients (28 nonsmokers, 20 smokers) who visited Severance Hospital because of minor pulmonary symptoms such as cough and sputum. They did neither complain of dyspnea nor cyanosis, and had normal or unilateral minor lesion on physical examination and chest X-ray. We analysed the recovery rate, viability, total cell count and differential count of the cells in fluid obtained by bronchoalveolar lavage. The following results were obtained: 1) Age ranged from 17 to 72 years-old with the mean age of 36.7; there was no difference of age between the nonsmoker and the smoker gorup. Male to female ratio was 2.43:1 for total group, 1.15:1 for nonsmokers, and 19:1 for smokers. 2) The diagnoses of the patients were undetermined in 41.9%, healed pulmonary tuberculosis in 37.5%, laryngitis or pharyngitis in 10.4% and others in 10.4%. 3) Total cell number of the recovered fluid by bronchoalveolar lavage was significantly higher in male[] than in female[](p vs ]. 4) The differential count of the cells from bronchoalveolar lavage fluid had no difference between the nonsmokers and the smokers. 5) There was no correlation between the total cell count and smoking or age. 6) In the smoker group, there was no correlation between the amount of smoking and the total cell count of the bronchoalveolar fluid. In conclusion, it should be careful to regard the patients with symptoms or minor radiologic abnormalities as a control group in bronchoalveolar lavage study and further study of cell analysis in bronchoalveolar lavage will be needed between smoker and nonsmoker in the male and female healthy people.

Adenosine deaminase (ADA) is an enzyme which is essential for the differentiation of lymphoid cells, especially T-cells and ADA plays a role in the maturation of monocyte to macrophage. Therefore ADA levels are related to stimulation of cellular immunity. We have investigated the measurement of ADA activity in bronchoalveolar lavage fluid of the patients with active and inactive pulmonary tuberculosis and control group. The results obtained are as follows: 1) The ADA activity and corrected ADA activity from the BAL fluid in active tuberculosis group (Total Lavage ADA; , Total Lavage ADA/Albumin; ) were increased when compared with those in inactive tuberculosis (TL-ADA; , TL-ADA/Alb; ) and control (TL-ADA; , TL-ADA/Alb; ) groups. 2) The ADA activity and lavage ADA/serum ADA activity ratio in BAL fluid from the lesion site (TL-ADA; , L-ADA/S-ADA; ) were increased when compared with those from the non-lesion site (TL-ADA; , L-ADA/S-ADA; )and normal side (TL-ADA; , L-ADA/S-ADA; ) in active tuberculosis group. 3) The ADA activity in BAL fluid from far advanced group (TL-ADA; ) was increased when compared with those from the mild group (TL-ADA; ) and moderate advanced group (TL-ADA; ) in active tuberculosis. 4) The albumin level from the BAL fluid was correlated with the ADA activity (R=0.89). 5) The ADA activity recovered from the BAL fluid was correlated with the recovered lymphocyte percentage (R=0.60). In conclusion, the ADA activity from the BAL fluid in active tuberculosis group was increased when compared with that in inactive tuberculosis and control groups, especially from the lesion site. To evaluated the specificity of ADA determination for diagnosis of active tuberculosis, BAL must be done at lesion site of the diseased lung and the proper correcting material other than albumin must be chosen to correct the dilution factor of lavage fluid.

Sarcoidosis, a multisystemic granulomatous disorder of unknown causes, which presents with bilateral hilar adenopathy, pulmonary infiltration, and cutaneous, ocular, bones, and nervous and reticuloendothelial systems involvement, commonly involves young adults of both sexes. Herein, the case of a 70-year-old male, with progressive hoarseness of two weeks’ duration and mild dyspnea, is reported. A fiberoptic bronchoscopy, performed to investigate the hoarseness, revealed paralysis of the left vocal cord, but with no other local abnormality. Two nodules, as pathologic findings, showed noncaseating epithelioid cell granulomas. We note a rare case of sarcoidosis, with vocal cord palsy, in Korea. (Tuberc Respir Dis 2005; 59: 209-212)

Exudative pleural effusion can arise from pneumonia, tuberculosis, cancer, etc. Early drainage is needed for prevention of complications such as pleural fibrosis, thickening, bronchopleural fistulae and decline of lung function. Intrapleural Instillation of fibrinolytic enzymes has been used for 50years as an adjunct in the removal of fibrous material, hematoma and pus from the thoracic cavity. By the local fibrinolytic effect on fibrinous exudates within the pleural space, fibrinolytic agent has improved results of chest tube or pig tail drainage. But there were no controlled randomized studies, so significant controversy exists concerning the efficacy of this therpy, especially tuberculous pleurisy. Furthermore about complication, severe spontaneous bleeding has not been reported with intrapleural urokinase. Intrapleural fibrinolytic enzymes has shows no systemic complication. When it is administrated intravenously, not into intrpleural space, major bleeding is reported about 1-3% of patient, especially they had systemic disease, such as coagulation abnormalities. This case report presents a patient who suffered major hemothorax induced hypovolemic shock following the administration of 100,000 units of urokinase intrapleurally. He was 25-year old male with tuberculosis pleurisy without systemic illness demonstraion. (Tuberc Respir Dis 2004; 57:465-469)

Internal myiasis is a rare disease, which has not been reported in Korea, yet. This case report describes a patient with pneumonia associated with internal myiasis. She was 84-year old female who was admitted to the emergency department, Konyang University Hospital as a result of dyspnea and fever and a drowsy mental state. Approximately twenty fly maggots continuously crawled out from the nose at the third hospital day in the intensive care unit. These maggots were almost 7.2mm long and were identified as the genus lucilia belonging to the family Calliphoridae. In addition, a bronchial washing study showed eggs of the dipterous larvae. A lesion of this myiasis case might have been located in the respiratory system of patient. This case is the first internal myiasis of the respiratory system reported in Korea. This cases is discussed with a review of the relevant literature.

Pleural effusion due to hepatic cirrhosis with ascites is well known, although hepatic hydrothorax in the absence of ascites is a rare condition, the pathogenesis of which is still unknown. We report a case of hepatic hydrothorax without ascites confirmed by the intraperitoneal injection of Tc-99m mecroaggregated serum albumin (Tc-99m MAA) that demonstrated the passage of Tc-99m MAA into the right pleural cavity.

Background : Tuberculous pleurisy treatments improve symptoms such as fever, chest pain, cough, and prevents the progression to active pulmonary tuberculosis and the development of residual pleural thickening that decrease diaphragm and rib cage movement This study investigated how the degree of residual pleural thickening affects the pulmonary function. Methods : Fifty seven patients who were initially diagnosed as having tuberculous pleurisy, were treated with anti-tuberculous medication for 6 months and had residual pleural thickening between May 1998 and January 2000 at the Eulji university hospital were reviewed. A chest X-ray and pulmonary function test(PFT, Sensormedics 2200) were performed. The predicted value(%) of the forced vital capacity(FVC), forced inspiratory vital capacity(FNC) and total lung capacity(TLC) were measured. The residual pleural thickening was defined the average of the summation in the lateral chest at the level of the imaginary line intersecting from the cardiophrenic angle to the diaphragmatic dome and the lowest part of the costophrenic angle between them. The results were sorted into three grades according to pleural thickness

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/, was 42.5 mm Hg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ARDS by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of A TRA. And so, we present this case with a review of related literatures.

Background: Genomic instability, which is manifested by the replication error(RER) phenotype, has been proposed for the promotion of genetic alterations necessary for carcinogenesis. Merlo et al. reported frequent microsatellite instability in primary small cell lung cancers. However, Kim et al. found that instability occurred in only 1% of the loci tested and did not resemble the replication error-positive phenotype. The significance of microsatellite instability in the tumorigenesis of small cell lung cancer as well as the relationship between microsatellite instability and its clinical prognosis was investigated in our study. Methods: Fifteen primary small cell lung cancers were chosen for this study. The DNAs extracted from paraffin-embedded tissue blocks with primary tumor and corresponding control tissue were investigated. Forty microsatellite markers on chromosome 1p, 2p, 3p, 5q, 6p, 6q, 9p, 9q, 13q, and 17p were used in the microsatellite analysis. Results: Thirteen(86.7%) of 15 tumors exhibited LOH in at least one of the tested microsatellite markers. Three of 13 tumors exhibiting LOH lost a larger area in chromosome 9p. LOH was shown in 72.7% on chromosome 2p, 40% on 3p, 50% on 5q, 46.7% on 9p, 69.2% on 13q, and 66.7% on 17p(Table 1). Nine(60%) of 15 tumors exhibited shifted bands in at least one of the tested microsatellite markers. Nine cases exhibiting shifted bands showed altered loci ranging 2.5~52.5%(mean )(Table 2). Shifted bands occurred in 5.7% (34 of 600) of the loci tested(Table 2). Nine cases with shifted bands exhibited LOH ranging between 0~83.3%, and the median survival duration of those cases was 35 weeks. Six cases without shifted bands exhibited LOH ranging between 0~83.3%, and the median survival duration of those cases was 73 weeks. There was no significant difference between median survival durations of the two groups(p=0.4712). Conclusion: Microsatellite instability as well as the inactivation of several tumor suppressor genes may play important roles in the development and progression process of tumors. However, the relationship between microsatellite instability and its clinical prognosis in primary small cell lung cancer could not be established.

A thromboembolic event in patients later given a diagnosis of cancer is the result rather than the cause of the cancer. The risk of hidden cancer is significantly higher for patients with recurrent idiopathic thromboembolism compared to those with secondary deep vein thrombosis. Microemboli from hepatic or adrenal metastases and large-sized emboli from the great veins invaded by the tumor are the sources of tumor embolization The intraarterial tumor emboli less likely invade the arterial wall. Thrombus formation and organization may be capable of destroying tumor cells within pulmorlary blood vessels. Therefore, all tumor emboli are not true metastases. The treatment of deep vein thrombosis and pulmonary embolism in patients with cancer consists of anticoagulation with heparin and warfarin, venacaval filters, appropriate anti-neoplastic agents, and surgical methods(embolectomy, thromboendarterectomy). However, considerable literatures suggest that oral anticoagulant such as warfarin is ineffective in the treatment of those. We report a case of primary unknown squamous cell carcinoma incidentally found in the thrombus after pulmonary embolectomy.

Cytomegaloviruses (CMVs) are ubiquitous but highly species-specific agents which commonly infect many animals, including humans. Cytomegalovirus (CMV) pneumonia has been one of the most important opportunistic infections in the immunocompromised host for those who have acquired immunodeficiency syndrome (AIDS) or who have received kidney, bone marrow or other organs. Cytomegalovirus infection has been known to be associated with congenital, infantile and adult nephrotic syndrome. We report a rare case of CMV pneumonia with nephrotic syndrome in a 62-year-old female who recovered fully with ganciclovir.

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABP A initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABP A include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.

Background : Tuberculous mediastinal lymphadenitis (TML) is a relatively commonly encountered in Korea. However, there were no datas available on TML without other combined tuberculous infections in Korea. We retrospectively analyzed clinical manifestations, radiologic findings, Chest CT scan findings, the duration of treatment, and follow up Chest CT scan findings of 23 cases who had only TML. Method : 23 cases from 1991 to 1997 with TML confirmed by biopsy and had no other combined tuberculous infections were studied retrospectively. Results : Of the 23 cases, 7 cases were male and 16 female. The male to female ratio was 1 : 2.4. Mean age was 31 years and the most prevalent age group was the 3rd decade(43%). The most common presenting symptoms were fever(39%) followed by no symptom, cough, swallowing difficulty, and chest discomfort. On simple chest X-ray, mediastinal enlargement were noted in 20 cases(90%). The most frequently involved site was the paratracheal node in 11 cases with the right to left side involvement ratio being 4.6 : 1. On chest CT scan, the most commonly enlarged node was the paratracheal node(33%) followed by the subcarinal(20%), hilar(13%), tracheobronchial (8%), subaortic(8%), supraclavicular(8%) and anterior. mediastinal nodes. 6 cases were dropt out due to incomplete follow up. Thirteen cases were treated with HERZ regimen and the mean duration of treatment was 14 months. Three cases were treated with second line drug regimens(Tarivid, Pyrazinamide, Streptomycin plus Ethambutol or Para-aminosalicylic acid) for 18 months. In HERZ groups, one case was recurred after 10 months later and retreatment was done by same HERZ regimen during 12 months. Follow up chest CT scan after completion of treatment were done in 13 cases and that revealed more than a 50% decrease in size in 77% of the cases and no interval change in 23% of the cases. Conclusion : In cases of TML without other combined tuberculous infection, the minimal duration of treatment was required 12 months by HERZ regimen and 18 months by a 2nd line regimen or more. Further studies will be needed to confirm the treatment duration for TML without other combined tuberculous infections.

Background: Coal-worker's pneumoconiosis(CWP) is radiologically divided into two major groups: simple pneumoconiosis (SP), in which small, rounded or irregular opacities smaller than 1cm are observed, and progressive massive fibrosis(PMF), which is characterized by opacities larger than 1cm. SP has a life expectancy equivalent to miners with no radiographic evidence of CWP, but PMF is associated with more obvious impairments of ventilatory capacity and premature death. But only minority of workers develop PMF when exposed to dust concentrations similar to those experienced by workers who develop only SP. In this study, immune status in patients with CWP were evaluated by measurement of the serum immunoglobulin levels between control, SP and PMF groups. Method: Coal workers selected for this study were emplyees of the Tae-Baek and Dong-Hae Hospital. All the patients were men of 45-76 years old and the mean duration of exposure to coal dust were 23.2 years. By X-ray examination, 51 patients were classified in SP, 59 in PMF category. The normal controls examined were 58 men of 26-70 years old. Serum Ig levels were estimated by using Nephelometer(Behring Nephelometer : Germany) and serum were collected 51 in SP, 49 in PMF and 57 cases in control group. Results: The levels of IgG were increased but the levels of IgM were decreased with increasing age in control groups. There were no statistical difference of immunoglobulin levels between smokers and nonsmokers in control groups. There were no statistical difference of immunoglobulin levels between Control, SP and PMF groups. Multiple regression analysis were undertaken to determine the statistical significance of the apparent trends and estimate the effects associated with age, smoking habit and radiological category of CWP. According to this analysis, the levels of IgG were decreased significantly in SP group and had decreasing tendancy, but not statistically significant in PMF group. Conclusion : From the observations described, CWP patients had decreased IgG concentration compared to control gorup. Therefore, there was some relation between CWP and immunoglobulin concentration.

Tracheobronchial rupture is one of the less-common injuries associated with blunt chest trauma. The diagnosis of tracheobronchial rupture is not easy, but failure to diagnosis may lead to death or long-term disability. Early diagnosis and appropriate management can reduce the mortality and morbidity. Bronchoscopy is the diagnostic method of choice for patients with tracheobronchial rupture. We report a case of tracheal rupture after blunt chest trauma. A 40-year-old man was transferred to our hospital for dyspnea after blunt chest trauma. He was promptly diagnosed as tracheal rupture by fiberoptic bronchoscopy and chest computed tomogram. He was successfully managed by thoracotomy and primary repair.

Background : To assess the utility of HRCT in the evaluation of visceral pleural invasion and to determine whether visceral pleural invasion and bronchovascular bundle thickening on the same lobe could be related to the recurrence and survival in non-small cell lung cancer (NSCLC) Method: Eighty one patients, which were fulfilled long-term follow-up at least 18 months (maximum 103 months) among which 434 patients had underwent curative surgical resection for NSCLC from 1986 to 1995, were studied. They were analyzed to evaluate whether the prognostic factors such as the recurrence and survival depend on visceral pleural invasion and bronchovascular bundle thickening to the same lobe. Thirty two patients adjacent to a chest wall or a fissure were evaluated for visceral pleural invasion by HRCT. CT criteria included abutting pleura along the chest wall, abutting and/or compressing fissure, croosing fissure, and pleural tail. Results: The positive predictive value and the negative predictive value of crossing fissure were 100% and 100%, respectively. Two patients showing spiculated interface between a mass and abutting fissure were confirmed to have visceral pleural invasion at surgery. Visceral pleural invasion confirmed at surgery was significant to local recurrence and survival (p.05). Conclusion : Visceral pleural invasion and bronchovascular bundle thickening to the same lobe have a role in predicting prognosis such as recurrence and survival in NSCLC. Therefore, the analysis of visceral pleural invasion on CT scan and the pathological analysis of bronchovascular bundle thickening to the same lobe may be necessary to predict the prognosis in NSCLC.

Background: Reactive oxygen species are involved in multi-stage process of carcinogenesis. The moot of cancer cell lines and cancer cells in tumor tissue produce reactive oxygen species and on the other hand, the activities of catalase, Mn- and CuZn-superoxide dismutase in tumor cells are usually low. These persistent oxidative stress in tumor tissue facilitates tumor invasion and metastasis. 12-kDa thioredoxin, which regulates the intracellular redox potential with glutathione and glutaredoxin is involved in cell activation, proliferation, differentiation and redox-mediated apoptosis. It is also purified as 14-kDa and 10-kDa eooinophilic cytotoxic enhancing factor(ECEF) from human histiocytic cell(U937) and 10-kDa ECEF has more than 20 times eosinophilic stimulation activity than 14-kDa ECEF. It has been reported that adult T-cell leukemia, squamous cell carcinoma of uterine cervix, and hepatocellular carcinoma show increased amounts of human thioredoxin and thioredoxin mRNA is increased in lung cancer. In this study, we investigated the expression of conventional antioxidant enzymes such as catalase, CuZn-SOD, and glutathione peroxidase and thioredoxin in lung cancer tissue compared to adjacent normal lung tissue and the induction of thioredoxin in macrophage cells after treatment of oxidative stress and endotoxin Methods: We measured the amount of conventional antioxidant enzymes such as catalase, CuZn-SOD, and glutathione peroxidase and thioredoxin in lung cancer tissue compared to adjacent normal lung tissue by immunoblot analysis and the induction of thioredoxin in mouse monocyte-macrophage cells(RAW 264.7) by treatment of 5 menadione and 1 endotoxin Results: On immunoblot analysis, the expression of 12-kDa thioredoxin was increased in lung cancer tissue compared to paired normal lung tissue. but the expression of catalase and CuZn-SOD were decreased in lung cancer tissue compared to paired normal tissue and the expression of glutathione peroxidase in lung cancer was variable. The expression of truncated thioredoxin was also increased in lung cancer. When mouse monocyte-macrophage cells were treated with 5 menadione and 1 endotoxin, the expression of thioredoxin was peaked at 12 hrs and sustained to 48 hrs. Conclusion: In contrast with other conventional antioxidants, the expression of 12-kDa and truncated thioredoxin in lung cancer were increased and it is closely associated with persistent oxidative stress in tumor microenvironment. Considering especially the biological functions of truncated thioredoxin, the increased amount of truncated thioredoxin has significant role in tumor growth through cell proliferation.

Backgrounds: To investigate the role of CT as a screening tool and to compare the diagnostic accuracy with that of the fiberoptic bronchoscopy (FOB) in evaluating the causes of hemoptysis. Methods: The retrospective review of plain chest radiograph, CT and FOB was done in 72 patients with hemoptysis. The diagnosis were confirmed by histology (n=33), bacterial culture (n=6), cytology (n=3), serology (n=2), skin test (n= 1), clinical response (n=5), and airway disease mainly by HRCT (n=22). Results: The causes of hemoptysis were shown to be lung cancer (n=29), bronchiectasis (n=19), tuberculosis (n=12), aspergilloma (n=5), invasive aspergillosis (n=l), COPD (n=3) and others (n=3). The sensitivity was 100% and 91,7% by CT and FOB respectively. The diagnostic compatibility was 95.8% and 59.7% by CT and FOB respectively. The diagnostic compatibility in cases with central airway disease was 96.3% and 100 % in CT and FOB. In parenchymal disease, CT and FOB showed 91.3 % and 43.5 % of compatibility, respectively. airway disease, CT and FOB showed 100% and 31.8% compatibility, respectively. That is to say, CT has higher sensitivity and diagnostic compatibility than FOB for identifying the causes of hemoptysis, and is more helpful for patients with hemoptysis from parenchymal or airway disease. FOB had the advantage in obtaining histologic, cytologic and bacteriologic diagnosis with biopsy or washing Conclusion: CT should be used as the screening method before performing FOB for patients with hemoptysis who have normal or nonspecific findings or peripheral airway disease in plain chest radiograph.

Background: Resting pulmonary function tests(PFTs) are routinely used in the evaluation of pulmonary impairment/disability. But the significance of the cardiopulmonary exercise test(CPX) in the evaluation of pulmonary impairment is controvertible. Many experts believe that dyspnea, though a necessary part of the assessment, is not a reliable predictor of impairment. Nevertheless, oxygen requirements of an organism at rest are different from at activity or exercising, and a clear relationship between resting PFTs and exercise tolerance has not been established in patients with chronic pulmonary disease. As well, the relationship between resting PFTs and dyspnea is complex. To investigate the relationship of dyspnea, resting PFTs, and CPX, we evaluated the patients of stabilized chronic pulmonary disease with clinical dyspnea rating(baseline dyspnea index, BDI), resting PFTs, and CPX. Method: The 50 patients were divided into two groups: non-severe and severe group on basis of results of resting PFTs(by criteria of ATS), CPX(by criteria of ATS or Ortega), and dyspnea rating(by focal score of BDI). Groups were compared with respect to pulmonary function, indices of CPX, and dyspnea rating. Results: 1. According to the criteria of pulmonary impairment with resting PFTs, max, and focal score of BDI were significantly low in the severe group(pmax(ml/kg/min) and max(%), the parameters of resting PFTs, except were not significantly different between non-severe and severe(p>0.05). According to focal score((%), FVC(%), MW(%), , and max were significantly lower in the severe group(pmax(ml/kg/min) and max(%) were low(p(%) was correlated with max(%)(r=0.52;pmax and max WR. Therefore, if not contraindicated, CPX would be considered to evaluate the severity of pulmonary impairment in patients with chronic pulmonary diseases, including with severe resting PFTs. Current criteria used to evaluate the severity of impairment were insufficient in considering the degree of dyspnea, so new criteria, including the severity of dyspnea, may be necessary.

Background: Corticosteroid is most potent and effective anti-inflammatory medication currently available and inhaled form has been used in the long-tenn control of asthma. Fluticasone propionate(Flixotide/Flovent: FP) is highly potent and topically active inhaled corticosteroid and has at least twice the potency of beclomethasone dipropionate(BDP) in the control of asthma. The aim of this study was to compare the efficacy of FP and BDP in several aspects. Method: Fifty patients with asthma were treated in a randomized, parallel group study of 4 weeks duration. During 2-week run-in period -agonist was administered. After run-in period, FP was administered via Diskhaler or BDP via reservoir dry-power device. During the run-in and treatment period, morning and evening peak expiratory flow rate(PEFR) were measured daily. Daytime and nighttime asthma symptoms, daytime and night-time rescue bronchodilator use were checked daily. and FVC were measured biweekly in both groups. Results: Three patients treated with FP and seven patient treated with BDP were dropped out. Therefore forty patients completed the study. Morning and evening PEFR was increased and diurnal variation of PEFR decreased significantly in both groups. increased significantly in FP treatment group but not in BDP group. There were also improvements in daytime and night-time asthma symptoms, daytime and night-time rescue bronchodilator use in both groups after treatment There were no significant difference between groups in any of the efficacy parameters. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP. Conclusion: In this study, fluticasone propionate was as effective as beclomethasone dipropionate in the control of asthma. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP without adverse effect.

배 경 : 패혈증에서 과도한 활성산소종의 생성은 급성 폐손상의 병리 기전에 중요한 역할을 한다. Catalase 및 MnSOD 등의 항산화 단백은 패혈증 환자의 혈청내 증가하며 급성호흡곤란증후군의 발생 예측 인자 및 패혈증의 예후 인자로 알려져 있다. Peroxiredoxin(Prx) 는 최근 독특하고 중요한 세포내 항산화 단백으로 알려져 있다. 본 연구는 대식세포인 mouse monocyte-macrophages(RAW 264.7) 세포에 산화 스트레스 및 내독소 처리후 Prx I 및 Prx II의 발현 평가하고 패혈증 동물 모델에서 복강세척액 및 기관지폐포세척액내 Prx I, Prx II 및 Trx의 양을 측정하였다. 방 법 : Prx I, Prx II 및 Trx에 대한 특이 항체를 이용하여 immunoblot 분석으로 호중구, 대식세포 및 적혈구에 이들의 분포를 평가하였다. Mouse monocyte-macrophages 세포에 $5\;{\mu}M$ menadione 및 1 mg/ml lipopolysaccharide(LPS) 을 처치하여 Prx I 및 Prx II의 발현을 평가하였으며 6 mg/Kg LPS를 복강내 투여하여 유발한 복강내 패혈증 동물의 복강세척액내 Prx I, Prx II 및 Trx의 양을 측정하였으며 복강내 패혈증 동물 및 5 mg/Kg LPS를 정맥내 투여하여 유발한 정맥내 패혈증 동물에서 기관지폐포세척액내 Prx I, Prx II 및 Trx을 측정하였으며 폐장의 염증 정도와 비교하였다. 결 과 : Prx I 및 Prx II의 분포는 호중구, 폐포대식세포 및 적혈구에서 서로 다른 양상을 보였다. Mouse monocyte-macrophages 세포에 $5\;{\mu}M$ menadione 및 $1\;{\mu}g/ml$ lipopolysaccharide을 처치하였을 때 Prx I 발현은 증가하였으나 Prx II 발현은 변화하지 않았다. 복강내 패혈증 동물에서 복강세척액내 Prx I, Prx II 및 Trx의 양은 증가하였으나 복강내 패혈증 및 정맥내 패혈증 동물에서 기관지폐포세척액내 폐장 염증 정도와 관계없이 Prx I, Prx II 및 Trx의 양은 증가하지 않았다. 결 론 : 세포내 항산화 단백으로서 mouse monocyte-macrophages 세포에서 Prx I의 발현은 산화 스트레스 및 내독소 처치후 증가한다. Prx I, Prx II 및 Trx양은 패혈증 동물 모델에서 국소 염증 부위에서 증가하나 손상된 폐장에서는 증가하지 않는다. 【Background : In sepsis, excessive generation of reactive oxygen species plays key roles in the pathogenesis of acute lung injury. The serum antioxidants such as catalase and MnSOD are elevated in sepsis and considered as predictors of acute respiratory distress syndrome(ARDS) and prognostic factors of sepsis. Peroxiredoxin(Prx) has recently been known as an unique and major intracellular antioxidant. In this study, we evaluated the expression of Prx I and Prx II in mouse monocyte-macrophage cells(RAW 267.7) after treatment of oxidative stress and endotoxin and measured the amount of Prx I, Prx II and thioredoxin(Trx) in peritoneal and bronchoalveolar lavage fluid of septic animal model. Methods : Using immunoblot analysis with specific antibodies against Prx I, Prx II and Trx, we evaluated the distribution of Prx I and Prx II in human neutrophil, alveolar macrophage and red blood cell. We evaluated the expression of Prx I and Prx II in mouse monocyte-macrophage cells after treatment of $5\;{\mu}M$ menadione and $1\;{\mu}g/ml$ lipopolysaccharide(LPS) and measured the amount of Prx I, Prx II and Trx in peritoneal lavage fluid of intraperitoneal septic animals(septic animal model induced with intraperitoneal 6 mg/Kg LPS injection) and those in bronchoalveolar lavage fluid of intraperitoneal septic animals and intravenous septic animals(septic animal model induced with intravenous 5 mg/Kg LPS injection) and compared with the severity of lung inflammation. Results : The distribution of Prx I and Prx II were so different among human neutrophil, alveolar macrophage and red blood cell. The expression of Prx I in mouse monocyte-macrophage cells was increased after treatment of $5\;{\mu}M$ menadione and $1\;{\mu}g/ml$ lipopolysaccharide but that of Prx II was not increased. The amount of Prx I, Prx II and Trx were increased in peritoneal lavage fluid of intraperitoneal septic animals but were not increased in bronchoalveolar lavage fluid of intraperitoneal and intravenous septic animals regardless of the severity of lung inflammation. Conclusion : As intracellular antioxidant, the expression of Prx I is increased in mouse monocyte-macrophage cells after treatment of oxidative stress and endotoxin. The amount of Prx I, Prx II and Trx are increased in local inflammatory site but not increased in injured lung of septic animal model.】

연구배경 : NO는 생체내에서 생성되는 유리 반응기로서 혈관 긴장도외 완화, 혈소판 응집 저지, 혈관 내피세포에 대한 백혈구 유착 방해, 감염에 대한 숙주 방어 등에서 중요한 역할을 한다. NO는 전이 금속(transition metal), 산소, 기타 반응기 등과 쉽게 반응하므로 여러 생체내 반응에 관여하여 산화제 손상을 촉진시키거나 감소시킬 가능성이 제기되었다. 급성 폐손상 및 급성 호흡곤란 증후군에서는 폐혈관 내피세포 및 호중구의 상호작용 및 산화제 손상이 매우 중요한 병인으로 알려져 있으며, NO를 급성 호흡곤란 증후군에서 흡입하여 치료하는 것은 산화제에 의한 혈관 내피세포 손상에서 외부로부터 NO를 공급하는 상황이다. 본 연구에서는 외인성 NO의 공여나 내인성 NO 억제가 산화제에 의한 폐미세혈관 내피세포의 손상을 악화시키거나 완화시킬 수 있는지를 관찰하였다. 방 법 : 산화제에 의한 세포손상은 백서 폐미세혈관 내피세포에 과산화수소를 생성하는 glucose oxidase(GO)를 투여하여 야기시키고 이를 $^{51}Cr$ 방출 측정으로 평가하였다. 산화제에 의한 폐혈관 내피세포의 손상에 외인성 NO가 미치는 영향은 NO 공여물인 SNAP 혹은 SNP를 산화제와 동시에 투여하여 평가하였다. 산화제에 의한 폐혈관 내피세포의 손상에 내인성 NO 억제가 미치는 영향은 NOS 길항제인 L-NMMA을 추가로 투여하여 평가하였다. INF- $\gamma$ , TNF- $\alpha$ LPS 등으로 내인성 NO 생성을 자극한 후 L-NMMA의 효과도 관찰하였으며, NO 공여물이나 내피세포로 부터의 NO생성은 nitrite 측정으로 평가하였다. 결 과 : 백서 폐 미세혈관 내피세포에서 $^{51}Cr$ 방출이 GO 5mU/ml에서 $8.7{\pm}0.5%$ , 10 mU/ml에서 $14.4{\pm}2.9%$ , 15 mU/ml에서 $32.3{\pm}2.9%$ , 20 mU/ml에서 $55.5{\pm}0.3%$ . 30 mU/ml에서 $67.8{\pm}0.9%$ 로 GO 15 mU/ml 이상에서 대조군의 $9.6{\pm}0.7%$ 에 비하여 유의하게 증가하였으며 (P $\gamma$ 500 U/ml, TNF- $\alpha$ 150 U/ml, LPS 1 ${\mu}g/ml$ 을 배양액에 첨가하여 24시간 경과시 배양액 중 nitrite 농도가 $3.9{\pm}0.3\;{\mu}M$ 로 증가하였으며, 이에 L-NMMA 0.5 mM을 첨가하면 $0.2{\pm}0.l\;{\mu}M$ 로 유의하게 억제되었다(p $\gamma$ , TNF- $\alpha$ LPS 자극후 GO에 의한 $^{51}Cr$ 방출에 L-NMMA는 영향을 주지 않았다. GO 20 mU/ml에 의한 $^{51}Cr$ 방출이 SNAP 100 ${\mu}M$ 의 추가로 대조군 수준으로 현저히 억제되었으나, SNP, potassium ferrocyanide, potassium ferricyanide 등의 추가는 영향이 없었다. Hanks' balanced salt solution(HBSS) 중의 SNAP 100 ${\mu}M$ 로 부터 4 시간 동안 nitrite가 $23.0{\pm}1.0\;{\mu}M$ 농도로 축적되었으나, SNP는 1 mM에서도 nitrite가 검출되지 않았다. SNAP은 HBSS 중의 GO가 과산화수소를 시간 경과에 따라 생성하는데 영향이 없었다. 결 론 : 결론적으로 폐미세혈관 내피세포에서 GO에 의하여 생성되는 과산화수소로 산화제 손상을 야기하였으며, NO 공여물인 SNAP으로부터 제공된 외연성 NO가 산화제 손상을 방지하고 이 보호효과는 NO 방출 능력에 의할 가능성이 시사되었다. 따라서 생체내 환경에 따라 외인성 NO가 내피세포에 대한 산화제 손상에 보호 효과가 있을 수 있다고 추정된다. 【Background : Nitric oxide(NO) is an endogenously produced free radical that plays an important role in regulating vascular tone, inhibition of platelet aggregation and white blood cell adhesion to endothelial cells, and host defense against infection. The highly reactive nature of NO with oxygen radicals suggests that it may either promote or reduce oxidant-induced cell injury in several biological pathways. Oxidant injury and interactions between pulmonary vascular endothelium and leukocytes are important in the pathogenesis of acute lung injury, including acute respiratory distress syndrome(ARDS). In ARDS, therapeutic administration of NO is a clinical condition providing exogenous NO in oxidant-induced endothelial injury. The role of exogenous NO from NO donor or the suppression of endogenous NO production was evaluated in oxidant-induced endothelial injury. Method : The oxidant injury in cultured rat lung microvascular endothelial cells(RLMVC) was induced by hydrogen peroxide generated from glucose oxidase(GO). Cell injury was evaluated by $^{51}$ chromium( $^{51}Cr$ ) release technique. NO donor, such as S-nitroso-N-acetylpenicillamine(SNAP) or sodium nitroprusside(SNP), was added to the endothelial cells as a source of exogenous NO. Endogenous production of NO was suppressed with N-monomethyl-L-arginine(L-NMMA) which is an NO synthase inhibitor. L-NMMA was also used in increased endogenous NO production induced by combined stimulation with interferon- $\gamma$ (INF- $\gamma$ ), tumor necrosis factor- $\alpha$ (TNF- $\alpha$ ), and lipopolysaccharide(LPS). NO generation from NO donor or from the endothelial cells was evaluated by measuring nitrite concentration. Result : $^{51}Cr$ release was $8.7{\pm}0.5%$ in GO 5 mU/ml, $14.4{\pm}2.9%$ in GO 10 mU/ml, $32.3{\pm}2.9%$ in GO 15 mU/ml, $55.5{\pm}0.3%$ in GO 20 mU/ml and $67.8{\pm}0.9%$ in GO 30 mU/ml ; it was significantly increased in GO 15 mU/ml or higher concentrations when compared with $9.6{\pm}0.7%$ in control(p $^{51}Cr$ release by GO. Nitrite concentration was increased to $3.9{\pm}0.3\;{\mu}M$ in culture media of RLMVC treated with INF- $\gamma$ (500 U/ml), TNF- $\alpha$ (150 U/ml) and LPS( $1\;{\mu}g/ml$ ) for 24 hours ; it was significantly suppressed by the addition of L-NMMA. The presence of L-NMMA did not affect $^{51}Cr$ release induced by GO in RLMVC pretreated with INF- $\gamma$ , TNF- $\alpha$ and LPS. The increase of $^{51}Cr$ release with GO(20 mU/ml) was prevented completely by adding 100 ${\mu}M$ SNAP. But the add of SNP, potassium ferrocyanate or potassium ferricyanate did not protect the oxidant injury. Nitrite accumulation was $23{\pm}1.0\;{\mu}M$ from 100 ${\mu}M$ SNAP at 4 hours in phenol red free Hanks' balanced salt solution. But nitrite was not detectable from SNP upto 1 mM The presence of SNAP did not affect the time dependent generation of hydrogen peroxide by GO in phenol red free Hanks' balanced salt solution. Conclusion : Hydrogen peroxide generated by GO causes oxidant injury in RLMVC. Exogenous NO from NO donor prevents oxidant injury, and the protective effect may be related to the ability to release NO. These results suggest that the exogenous NO may be protective on oxidant injury to the endothelium.】

Lambert Eaton myasthenic syndrome(LEMS) is a paraneoplastic syndrome caused by defects in the secretion of acetylcholine from the presynaptic membrane of nerve terminals and is strongly associated with small cell lung carcinoma. The pathogenesis of LEMS is the destruction of voltage gated calcium channels by an autoimmune process resulting in clinical manifestations consisting of lower extremity weakness. decreased deep tendon reflexes and autonomic dysfunctions. The diagnosis can be confirmed by the characteristic clinical features and repetitive nerve stimulation. The neurological symptoms and signs of LEMS may manifest themselves months before the clinical manifestation of the underlying malignancy. Therefore early diagnosis and treatment of the primary malignancy may become possible through the diagnosis of this rare paraneoplastic syndrome. We report a case of a patient diagnosed with LEMS who upon further evaluation for an underlying malignancy was found to have a 0.2 cm sized nodular and infiltrative mass lesion at the bifurcation of the left apicoposterior segmental and anterior segmental bronchi by bronchoscopy. Although repeated bronchoscopic biopsies of the lesion was not able to disclose malignancy, under strong clinical suspicion left upper lobectomy was performed and subsequently the diagnosis of small cell carcinoma of the lung was confirmed. Muscle weakness began to improve starting from a week after the surgery, then reached a plateau 2 weeks later. Muscle weakness improved further after the trial of anticancer chemotherapy.

연구배경: 결핵의 유병률은 감소하는 추세이나 노인, 항암약물요법, HIV 감염 풍에 의해 면역기능이 약화된 환자에 있어서 결핵의 발생이 문제가 되고 있으며, 특히 다제내성균주의 출현은 큰 문제이다. 결핵진단법 중 체액에서 도말검사나 배양검사를 통해서 Myco-bacterium tuberculosis를 검출하는 것이 표준진단법이나, 도말검사는 상대적으로 민감도가 낮고 배양검사는 오랜시간이 소요된다. 중함연쇄반응을 이용하여 결핵균의 DNA를 검출하는 방법은 매우 민감하나 비용이 많이 소요된다. ELISA(enzyme linked immunosorbent assay)를 이용하여 혈청에서 결핵균 특이항원에 대한 항체를 검출하는 방법이 객담도말음성인 활동성 폐결핵환자를 다른 비결핵성 폐질환으로부터 감별하는데 유용한지를 확인하고자 하였다. 방 법: 연세대학교 세브란스 병원에 입원한 183명의 객담도 말음성인 폐질환환자에서 항산균에 대한 객담도말 및 배양검사와 결핵균 특이 항원인 recombinant 38 kilo-dalton 항원과 culture filtrate항원을 이용한 ELISA 검사를 시행하였다. 결 과: 35명의 활동성 폐결핵환자 중 18명에서 배양검사상 Mycobacterium tuberculosis를 검출할 수 있었다. 38 kDa와 culture filtrate에 대한 흡광도는 활동성 폐결핵환자들에서 비결핵성 폐질환자들보다 유의하게 높았다 (p 0.05) 객담도말음성인 환자에 있어서 38 kDa과 culture filtrate의 민감도는 각각 20.0%와 31.4%였고 특이도는 각각 95.3%와 93.9%였다. 결 론: 객답도말검사 음성인 활동성 폐결핵환자에 있어서 ELISA를 이용한 38 kDa과 culture filtrate 항원에 대한 혈청항체검사법은 기존진단방법보다 낮은 민감도를 보여, 비결핵성 폐질환으로부터 활동성 폐결핵을 감별진단하는데 크게 도움이 되지 않을 것으로 여겨진다. 【Background: Diagnosis by direct microscopy and/or by culture of the Mycobacterium tuberculosis from body fluids or biopsy specimens is "Gold standard". However, the sensitivity of direct microscopy after Ziehl-Neelsen staining is relatively low and culture of mycobacteria is time consuming. Detection of mycobacterial DNA in clinical samples by the polymerase chain reaction is highly sensitive but laborious and expensive. Therefore, rapid, sensitive and readily applicable new tests need to be developed. So we had evaluated the clinical significance of serologic detection of antibody to 38 kDa antigen, which is known as the most specific to the M. tuberculosis complex, and culture filtrate antigen by ELISA in sputum AFB smear negative patients. Method: In this study, culture tests for acid fast bacilli with sputa or bronchial washing fluids of 183 consecutive patients who were negative of sputum AFB smear were performed. Simultaneously serum antibodies to 38 kDa antigen and unheated culture filtrate of M. tuberculosis were detected by an ELISA method. Results: The optical densities of ELISA test with 38 kDa and culture filtrate antigen were significantly higher in active pulmonary tuberculosis cases than in non tuberculous pulmonary diseases (p 0.05). In the smear-negative active pulmonary tuberculosis patients, the sensitivity of the ELISA using 38 kDa antigen and culture filtrate was 20.0% and 31.4%. respectively. The specificity was 95.3% and 93.9%. respectively. Conclusion : In active pulmonary tuberculosis but smear negative, the serologic detection of antibody to 38 kDa antigen and culture filtrate by ELISA cannot substitute traditional diagnostic tests and does not have clinically significant role to differenciate the patient with active pulmonary tuberculosis from other with non-tuberculous pulmonary diseases.】

Background: Most of malignant pleural effusions are serous but 8-33% of them are bloody. We wanted to evaluate the relationships between gross appearance and pleural CEA level or results of histocytology in malignancy associated pleural effusions. We also tried to reevaluate the meaning of CEA measurement in histocytologically proved or unproved malignancy associated pleural effusions. Methods: We studied 98 cases of malignancy associated pleural effusions, 50 cases of histocytologically proven malignant effusions and 48 cases of histocytologically unproven paramalignant effusions. We had observed gross appearance and conventional laboratory values and CEA levels for pleural effusions. Results: 44.9% of malignancy associated effusions were bloody(63.6% of bloody effusions were histocytologically proven malignant effusion). 65.0% of malignancy associated pleural effusions which have RBCs numbers over were cytologically proven malignant effusions. 72.7% of cytologically proven malignant effusions had increased pleural fluid CEA level over 10 ng/ml. 58.2% of cases with pleural CEA over 10 ng/ml had positive results in pleural bistocytology. There was no definable relationships between pleural fluid CEA elevation and RBCs numbers and results of pleural fluid cytology. Conclusion: About half of the cases with malignancy associated pleural effusions were bloody. Histocytologically proven malignant effusions were more common in bloody effusion than non-bloody effusion(63.6% Vs 38.9%). But increased red blood cell numbers was not associated with positivity of pleural histocytology. Pleural fluid CEA elevation(over 10 ng/ml) was not correlated with positive pleural histocytology. But pleural fluid CEA elevation was rare in nonmalignant pleural effusions, and than pleural CEA measurement in uncertain pleural effusions maybe helpful to distinguishes its origin.

Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

Background : To analyze the morphologic characteristics of low density lymph node in etiologic differentiation of lymphadenopathy, emphasizing the different features between tuberculosis and lung cancer, on contrast enhanced CT scan. Method : A total of 64 patients who showed low density lymph nodes on chest CT scan were analyzed. Primary causes were tuberculosis (n=28), lung cancer (n=27), malignant lymphoma (n=5) and metastasis from extrathoracic malignancies (n=4). CT scan was performed with 10mm slice thickness and 7 characteristic features were evaluated : location, size, presence or absence of the nonnecrotic lymph node, calcification, perinodal fat obliteration, thickness and evenness of the enhancing rim. Results : In patients with tuberculous lymphadenopathy, lymph nodes with uneven (68.0%) and thick (62.1%) enhancing rim were more common than lung cancer (p

Epithelioid Hemangioendothelioma(EH) is a rare vascular tumor, originating from endothelial cells. The principal locations are lung, soft tissue, bone and liver. This tumor is of borderline malignancy, relatively benign course. In the lung, the tumor is often multifocal, bilateral and frequently lead to the mistaken diagnosis of metastatic carcinoma. Although EH of the lung is relatively slow growing tumor, extensive pulmonary involvement, systemic metastasis, mainly to the liver have been documented. A 26-year-old man with EH involving the lung and liver was reported. Chest X-ray and chest CT showed multiple nodules in both lung fields and Abdominal CT multiple round low densities in liver. Transbronchial lung biopsy was performed. The patient diagnosed as EH by light microscopic finding and immunohistochemical study for Factor VIII-related antigen.

Background : Surgical intervention is known as the principle management for hemoptysis of significant amount. But surgical procedure is applicable to only small number of patients because of increased mortality in emergency surgery and various functional and structural problems after lung resection. Bronchial artery embolization(BAE) has been used as an alternative interventional technique for immediate control of patients with increased risk for surgery due to recurrent or massive hemoptysis. BAE also has limitations such as recurrent bleeding after procedure and its role for the application to small amount of hemoptysis is still not established. Method : To evaluate immediate and long term effectiveness of BAE, we analysed 65 patients with hemoptysis according to therapeutic modalities they received ; BAE versus conservative management. Results : The success rate for immediate control of hemoptysis was significantly higher in BAE group with 43 cases(100%) among 43 cases compared with 17 cases(77%) among 22 cases in conservative group (p months in BAE group and months in conservative group(p > 0.05). The therapeutic response in BAE group was 82%(36/43 cases) and 95%(21/22 cases) in conservative group (p > 0.05). According to the amount of hemoptysis, the therapeutic response were seen in 91%(29/32 cases) in less than 100ml and 85%(28/33 cases) in 100~400ml (p > 0.05). According to the manifestation of hemoptysis, the therapeutic response in groups of recurrent and nonrecurent were 87%(20/23 cases) and 88%(37/42 cases)(p > 0.05). Conclusion : The difference of therapeutic response between BAE and conservative group in patients with small amounts of hemoptysis was not found except for immediate control of hemoptysis.

Background : Cancer invasion and metastasis require the dissolution of the extracellular matrix in which several proteolytic enzymes are involved. One of these enzymes is the urokinase-type plasminogen activator(u-PA), and plasminogen activator inhibitors(PAI-1, PAI-2) also have a possible role in cancer invasion and metastasis by protection of cancer itself from proteolysis by u-PA. It has been reported that the levels of u-PA and plasminogen activator inhibitors in various cancer tissues are significantly higher than those in normal tissues and have significant correlations with tumor size and lymph node involvement. Here, we measured the concentration of plasma u-PA and PAI-1 antigens in the patients with lung cancer and compared the concentration of them with histologic types and staging parameters. Methods : We measured the concentration of plasma u-PA and PAI-1 antigens using commercial ELISA kit in 37 lung cancer patients, 21 benign lung disease patients and 24 age-matched healthy controls, and we compared the concentration of them with histologic types and staging parameters in lung cancer patients. Results : The concentration of u-PA was in controls, in benign lung disease patients and in lung cancer patients. The concentration of PAI-1 was in controls, in benign lung disease patients, and in lung cancer patients. The concentration of PAI-1 in lung cancer patients was higher than those of benign lung disease patients and controls. The concentration of u-PA was in squamous cell carcinoma, in adenocarcinoma, 0.9ng/mL in large cell carcinoma, and in small cell carcinoma. The concentration of PAI-1 was in squamous cell carcinoma, in adenocarcinoma, 42 ng/mL in large cell carcinoma, and in small cell carcinoma. The concentration of u-PA was 0.74ng/mL in stage I, in stage II, in stage IIIA, in stage IIIB, and in stage IV. The concentration of PAI-1 was 21.8ng/mL in stage I, in stage II, in stage IIIA, in stage IIIB, and in stage IV. When we divided T stage into T1-3 and T4, the concentration of u-PA was in T1-3 and in T4, and the concentration of PAI-1 was in T1-3 and in T4. The concentration of PAI-1 in T4 was significantly higher than that in T1-3. The concentration of u-PA was in M0 and in M1, and the concentration of PAI-1 was in M0 and in M1. Conclusions : The plasma levels of PAI-1 in lung cancer were higher than benign lung disease and controls, and the plasma levels of PAI-1 in T4 were significantly higher than T1-3. These findings suggest involvement of PAI-1 with local invasion of lung cancer, but it should be confirmed by the data on comparison with pathological staging and tissue level in lung cancer.

Cryptococcosis is a systemic infection caused by the yeast-like fungus Cryptococcus neoformans. Respiratory tract is the usual portal of infection but relatively few cases of pulmonary cryptococcosis have been reported. Recently the incidence of the disease are increasing because the perception to seek the disease is increasing and immunocompromised hosts are more widespread with introduction of immune-suppressants, steroids and advent of AIDS. Because of nonspecific pattern of clinical manifestation, radiologic findings, differentiating the other diseases is essential and it needs fungal culture and biopsy. We describe a patient in the state of bilateral adrenalectomy due to bilateral ACTH-independent macronodular hyperplasia who developed pulmonary cryptococcosis and was later infected with pulmonary tuberculosis.

Lymphangioleiomyomatosis is a rare disease which afflicts young women of childbearing age. We experienced a 32-year-old female who was admitted because of worsening exertional dyspnea after hormonal therapy with Clomifen for five months and intermittent hemoptysis. Chest PA showed diffuse ground glass appearance with some reticular infiltrations. High resolution CT scan showed multiple small thin walled cysts distributed homogeneously throughout the entire lung. Pulmonary function test showed characteristic obstructive pattern despite the restrictive interstitial pattern of chest radiography. Thoracoscopic lung biopsy specimen showed abnormal proliferation of smooth muscle cells in the walls of lymphatic vessels, bronchioles, and pulmonary vessels typical of pulmonary lymphangioleiomyomatosis. Hormonal therapy with medroxyprogesterone was initiated.

The association between hypercoagulability and malignant disease was first described by Armand Trousseau in 1865. According to Trousseau, the thrombophlebitis was usually/migratory and recurrent and involved both venous and arterial system. Thrombosis remains the hallmark of Trousseau's syndrome, although a wide variety of coagulation disorders including disseminated intravascular coagulation(DIC), pulmonary embolism, thrombotic endocarditis, and bleeding have been associated with the syndrome. Since then, abnormalities of the coagulation system have been repeatedly demonstrated in patients with cancer. Pancreatic carcinoma is thought to carry the highest risk of Trousseau's syndrome although the number of cases of Trousseau's syndrome is actually higher in patients with lung cancer because of the greater prevalence of this tumor. We report a thirty-five year old male patient with Trousseau's syndrome associated with lung cancer initially presenting deep vein thrombosis.

Background: Parathyroid hormone-related protein(PTHrp) was first identified as the cause of hypercalcemia in malignancy. Hypercalcemia can be found in malignancy, especially in the epidermoid carcinoma of the lung, even without extensive metastases to the bones. The application of sensitive assays for PTHrp may help in the early diagnosis of lung cancer, in the monitoring of treatment and in the detection of recurrence. Method: Serum PTHrp was measured by radioimmunoassay detecting the N-terminal 1~34 peptide of human PTHrp(PTHrp 1-34) in 63 histologically confirmed lung cancer patients and 22 healthy controls. Result: Serum PTHrp(meanS.E.) was in 63 lung cancer patients and in 22 controls(p>0.05). PTHrp was in 34 epidermoid carcinoma patients, in 15 adenocarcinoma patients and in 9 small cell carcinoma patients. In epidermoid carcinoma patients, PTHrp was in stage II(n=3; p in stage IIIa(n=9), in stage IIIb(n=12) and in stage IV(n=9; p; p