Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitive disease showing various radiographic and clinical manifestations. Its clinical course has not been fully understood. Here I describe a case of a 23-year-old immunocompetent man with frequently relapsing ABPA. He was asthmatic. He visited our hospital because of a chronic cough. Laboratory examination showed eosinophilia with increased total and Aspergillus-specific IgE as well as positive skin reaction to Aspergillus fumigatus. Radiologic feature was a dense consolidation. Histology showed organizing pneumonia with eosinophilic infiltration. On the diagnosis of ABPA, he was treated with systemic steroid and itraconazole. Although treatment response was excellent, he suffered from recurrent ABPA three times thereafter in the form of fleeting mass-like consolidation.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Cough ; Diagnosis ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Itraconazole ; Lung ; Pneumonia ; Recurrence ; Skin ; Young Adult

No abstract available.
Eosinophils

BACKGROUND: In chronic obstructive pulmonary disease (COPD) patients, the serum levels of C-reactive protein (CRP) are elevated and an increase of CRP is more exaggerated in the acute exacerbation form of COPD (AECOPD) than in stable COPD. Pulmonary arterial hypertension is a common complication of COPD. An increased level of CRP is known to be associated with the risk of systemic cardio-vascular disorders. However, few findings are available on the potential role of CRP in pulmonary arterial hypertension due to COPD. METHODS: This study was performed prospectively and the study population was composed of 72 patients that were hospitalized due to AECOPD. After receiving acute management for AECOPD, serum CRP levels were evaluated, arterial oxygen pressure (PaO2), was measured, and the existence of pulmonary arterial hypertension under room air inhalation was determined in the patients. RESULTS: The number of patients with pulmonary arterial hypertension was 47 (65.3%)., There was an increased prevalence of pulmonary arterial hypertension and an increase of serum CRP levels in patients with the higher stages of COPD (e.g., patients with stage 3 and stage 4 disease; P<0.05). The mean serum CRP levels of patients with pulmonary arterial hypertension and without pulmonary arterial hypertension were 37.6+/-7.4 mg/L and 19.9 +/-6.6 mg/L, respectively (P<0.05). However, there was no significant difference of the mean values of PaO2 between patients with pulmonary arterial hypertension and without pulmonary arterial hypertension statistically (77.8+/-3.6 mmHg versus 87.2+/-6.0 mmHg). CONCLUSION: We conclude that higher serum levels of CRP can be a sign for pulmonary arterial hypertension in AECOPD patients.
C-Reactive Protein ; Humans ; Hypertension ; Hypertension, Pulmonary ; Inhalation ; Oxygen ; Prevalence ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive

The majority of patients with an advanced-stage ovarian cancer relapse within approximately 18 months after completion of the first-line therapy. Recurrent ovarian cancer commonly presents as peritoneal seeding, while other distant sites are anywhere including the pleura, liver, lung, central nervous system, spleen, skin, bone, and breast. As pulmonary metastases usually occur through hematogenous or lymphangitic routes, the pattern of the metastases of ovarian cancer is multiple and scattered diffusely. The solitary pulmonary metastasis of ovarian cancer is an extremely rare condition, thus it can be misdiagnosed as a primary lung cancer, unless physician has a clinical suspicion. Herein, we introduce a case of solitary pulmonary metastasis of ovarian cancer which occurred 9 years after the curative surgery and chemotherapy.
Breast ; Central Nervous System ; Drug Therapy ; Humans ; Liver ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis ; Ovarian Neoplasms* ; Pleura ; Recurrence* ; Skin ; Spleen ; Thoracic Surgical Procedures

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder induced by Aspergillus fumigatus that occurs generally in patients with underlying chronic airway disorders. However, the development of ABPA associated with lung malignancy remains unknown. An 80-year-old woman was admitted for evaluation of chronic cough. Her radiologic finding was a mass like opacity with mucoid impaction, showing finger-in-glove sign, one of the typical radiologic findings for ABPA. In addition, laboratory tests revealed that her data satisfied the diagnostic criteria for ABPA. Interestingly, final pathologic examination showed that the mass lesion was small cell lung cancer. Here, we describe a case of delayed diagnosis of small cell lung cancer with ABPA, suggesting that a possibility of accompanying lung malignancy such as small cell lung cancer should be considered in patients with ABPA. This case let us realize the importance of clinical suspicion that different entities of diseases can be occurred simultaneously for the correct diagnosis without delay.
Aged, 80 and over ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Cough ; Delayed Diagnosis* ; Diagnosis ; Female ; Humans ; Hypersensitivity ; Linear Energy Transfer ; Lung ; Small Cell Lung Carcinoma*

BACKGROUND/AIMS: Non-resolving or slow-resolving pneumonia refers to the persistence of pulmonary infiltrates for >30 days after an initial pneumonia-like illness. Organizing pneumonia (OP) can be found on a lung biopsy in association with a number of diseases. The object of this study was to elucidate the clinical characteristics of the non-resolving pneumonia with the pathology of an OP and suggest the proper diagnostic and therapeutic approaches for the reduction of unnecessary procedures. METHODS: We retrospectively analyzed 70 patients diagnosed with an OP by percutaneous transthoracic needle biopsy and that met the inclusion criteria. Their pulmonary lesions were reviewed for disease resolution. Patients were divided into either a radiologically benign group (group I, n=57) or a malignancy group (group II, n=13) based on the computed tomography (CT) findings. RESULTS: All patients in group I and 8 patients in group II improved and had a complete resolution by 81.70+/-45.36 days. The microbiology findings showed that many infectious pathogens can lead to an OP despite antibiotic therapy. Three cases in group II were ultimately diagnosed as malignancies. CONCLUSIONS: Our data suggest that non-resolving or slow-resolving lesions were strongly suspicious for a malignancy on the CT scans, despite appearing to be benign OP pathologically; such cases should be considered for re-biopsy. In cased with pathology consistent with OP and benign CT findings, careful observation for 3 months is recommended to allow for the complete radiological resolution of the benign OP associated with infection.
Biopsy ; Biopsy, Needle ; Humans ; Lung ; Pneumonia ; Retrospective Studies ; Tomography, Spiral Computed

BACKGROUND: Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit. METHODS: Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging. RESULTS: The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II. CONCLUSIONS: Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.
Arm ; Elbow ; Humans ; Humeral Head ; Joint Instability ; Magnetic Resonance Imaging ; Prospective Studies ; Range of Motion, Articular ; Recurrence ; Shoulder Dislocation ; Shoulder* ; Surgeons

Reactive oxygen species (ROS) play an important role in the pathogenesis of airway inflammation and hyperresponsiveness. Recent studies have demonstrated that antioxidants are able to reduce airway inflammation and hyperreactivity in animal models of allergic airway disease. A newly developed antioxidant, small molecular weight thiol compound, N-acetylcysteine amide (AD4) has been shown to increase cellular levels of glutathione and to attenuate oxidative stress related disorders such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis. However, the effects of AD4 on allergic airway disease such as asthma are unknown. We used ovalbumin (OVA)-inhaled mice to evaluate the role of AD4 in allergic airway disease. In this study with OVA-inhaled mice, the increased ROS generation, the increased levels of Th2 cytokines and VEGF, the increased vascular permeability, the increased mucus production, and the increased airway resistance in the lungs were significantly reduced by the administration of AD4. We also found that the administration of AD4 decreased the increases of the NF-kappaB and hypoxia-inducible factor-1alpha (HIF-1alpha) levels in nuclear protein extracts of lung tissues after OVA inhalation. These results suggest that AD4 attenuates airway inflammation and hyperresponsiveness by regulating activation of NF-kappaB and HIF-1alpha as well as reducing ROS generation in allergic airway disease.
Acetylcysteine/*analogs & derivatives/therapeutic use ; Animals ; Asthma/drug therapy/*immunology/pathology ; Bronchial Hyperreactivity/*drug therapy/metabolism ; Hypoxia-Inducible Factor 1, alpha Subunit/*metabolism ; Mice ; NF-kappa B/*metabolism ; Ovalbumin/immunology ; Reactive Oxygen Species/*metabolism ; Vascular Endothelial Growth Factor A/metabolism

Neurilemmomas are relatively uncommon, slowly growing tumors which originate from Schwann cells. Intrathoracic neurilemmomas often occur in the chest wall and posterior mediastinum, but endobronchial neurilemmomas are exceedingly rare. These tumors in trachea or bronchus are usually detected by radiologic examinations, mostly computed tomography scan of chest. An 88-year-old man was admitted for management of pneumonia in left lower lobe and parapneumonic effusion. On bronchoscopic examination, there was a small polypoid nodule less than 1 cm in diameter mimicking an endobronchial inflammatory polyp at the bifurcation of the right anterior segmental bronchus and lateral segmental bronchus and under auto-fluorescence imaging, the nodule showed reddish brown area with defined margin. The bronchoscopic biopsy revealed that the bronchial nodule was endobronchial neurilemmoma. This is an interesting case of endobronchial neurilemmoma mimicking a bronchial polyp that is detected incidentally via bronchoscopy.
Aged, 80 and over ; Biopsy ; Bronchi ; Bronchoscopy ; Humans ; Mediastinum ; Neurilemmoma* ; Optical Imaging ; Pneumonia ; Polyps* ; Schwann Cells ; Thoracic Wall ; Thorax ; Trachea