The vermilion border of the lips has a modifed epithelium, which is much more likely to develop allergic contact sensitivity reactions than oral mucosa. Allergens in contact with both the oral mucosa and the lips oftens produce only cheilitis. Allergic contact cheilitis may result from topical medicaments, dentifrices, cosmetics, foods, plants or metals. We present six cases of allergic contact cheilitis confirmed by patch test. The toot4paste was incriminated in 2 cases, the lipstick in 3 cases and the bubble gum in one rase as producing chelitis respectively.
Allergens ; Cheilitis* ; Dentifrices ; Dermatitis, Contact ; Epithelium ; Gingiva ; Lip ; Metals ; Mouth Mucosa ; Patch Tests

A 42 year-old male with a history of multidrug-resistant pulmonary tuberculosis suddenly developed massive hemoptysis. Embolization of a bronchial artery branch and the collateral systemic arteries did not resolve the recurrent bleeding. Spiral computerized tomography(spiral CT) of the chest showed contrast enhanced nodules within a large cavity at the left lower lobe in the arterial phase suggesting a Rasmussen aneurysm. A pulmonary angiogram showed abnormal vascular nodules at that site. Coils were deployed at both the proximal and distal vessels of this aneurysmal sac for embolization. Transcatheter arterial embolization is a safe and effective means of controlling bleeding from this pulmonary arterial pseudoaneurysm. Here we report a case of a Rasmussen aneurysm diagnosed by spiral CT, which was successfully treated by pulmonary arterial embolization with a coil.
Aneurysm* ; Aneurysm, False ; Arteries ; Bronchial Arteries ; Embolization, Therapeutic ; Hemoptysis ; Hemorrhage ; Humans ; Male ; Respiratory Insufficiency ; Thorax ; Tomography, Spiral Computed ; Tuberculosis, Pulmonary

We report a case of type V hyperlipoproteinemia and xanthoma eruptivum associated with diabetes mellitus in a 12-year-old female. She had diffuse erythematous yellowish papules on the extremities and trunk with itching. The laboratory findings showed increased serum blood glucose, cholesterol and triglyceride, increasing pre- and chylomicron bands on electrophoresis of lipoprotein. The biopsy specimen of an erythematous yellowish colored papule on the trunk showed characteristic findings of xanthoma.
Biopsy ; Blood Glucose ; Child ; Cholesterol ; Diabetes Mellitus* ; Electrophoresis ; Extremities ; Female ; Humans ; Hyperlipoproteinemia Type V* ; Lipoproteins ; Pruritus ; Triglycerides ; Xanthomatosis*

No abstract available.
Pulmonary Embolism*

PURPOSE: To evaluate the CT and MR findings of bronchial anthracofibrosis. MATERIALS AND METHODS: Forty-one patients with ronchoscopically confirmed bronchial anthracofibrosis were included in this study. Thirty-six were female and five were male, and all were aged between 53 and 89 (mean, 70) years. The CT (n=41) and MR findings (n=5) were retrospectively analysed with regard to bron-chostenosis, atelectasis, air-space consolidation, lymph node enlargement, calcified lymph node, mass and bronchial wall thickening, as seen on CT, and signal intensity of the mass and lymph nodes, as seen on MR. RESULTS: CT scans revealed the presence of bronchostenosis (n=34, 83%), atelectasis (n=24, 59%), pneumonic consolidation (n=26, 63%), enlarged mediastinal lymph node (n=39, 95%), calcified lymph node (n=22, 54%), mass (n=4,10%), and thickening of bronchial wall (n=1, 2.4%). Multifocal involvement of bron-chostenosis, atelectasis, and air-space consolidation occurred in 61%, 50% and 30% of cases, retrospectively. MR imaging showed low signal intensity of mass (n=3) and lymph nodes (n=10) on T1WI and T2WI. but in one case, mass and lymph node showed central high signal intensity on T2WI. CONCLUSION: A multiplicity of bronchostenosis, atelectasis, air-space consolidation and enlarged mediastinal lymph nodes were characteristic CT findings of bronchial anthracofibrosis. Most MR findings included relatively low signal intensity of masses and lymph nodes on T2WI, possibly indicating the benign nature of the diseases
Female ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Pneumoconiosis ; Pulmonary Atelectasis ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Sepsis-induced acute lung injury (ALI) is caused by many cellular and humoral mediators induced by an endotoxin. Histamine, which is widely distributed in the lungs and has been considered as an importa nt mediator of sepsis. It increases P-selectin expression on the endothelial cell surfaces and induces IL-8 secretion. Therefore, an endotoxin-induced histamine may be related to neutrophil-mediated ALI by inducing the migration and activation of neutrophils in the lung tissue. However, the role of endogenous histamine in endotoxin-induced ALI had not been clarified. The purpose of this study was to investigate how endotoxin-induced ALI is influenced by endogenous histamine and to identify the possible mechanism of action. METHODS: The study consisted of 4 groups using Sprague-Dawley rats : 1) control group, where the rats were infused intratracheally by normal saline, 2) an endotoxin group, where lipopolysaccharide (LPS) was administered intratracheally 3) the H2 receptor antagonist-treated group (H2 group) and 4) the H1 receptor antagonist-treated group (H1 group), where H2 receptor blocker (ranitidine) and H1 receptor blocker (pyrilamine) were co-treated intravenously with the intratracheal administration of an endotoxin. The lung leak index using I125-BSA, the total protein and LDH concentration in the lung lavage fluid, myeloperoxidase (MPO) activity in the lung tissue, the pathologic score and the total number of neutrophils, TNF-alpha, IL-Ibeta and IL-10 in lung lavage (BAL) fluid were measured in each group as the indices of lung injury. RESULTS: Compared to the control group, the endotoxin group exhibited significant increasis in all lung injury indices. Significant reductions in the encotoxin-mediated increases in lung leak index (p<0.05) were observed in both the H1and H2 groups. In addition, the total protein (p<0.05) and LDH concentration (p<0.05) in the BAL fluid were also lower in the H2 group compared to the endotoxin group. However, there was no change in the MPO activity in the lung tissue, the pathologic score and the total number of neutrophils in the BAL fluid in both the H2and H1 groups compared to the endotoxin group. The increases in TNF-alpha, IL-Ibeta and IL-10 concentrations in the BAL fluid observed in the endotoxin group were not reduced in the H2and H1 groups. CONCLUSION: Antigistamine attenuated the enhanced alveolar-capillary permeability induced by the endotoxin via the H2 receptor. However the attenuation mechanism may not be related to the pathogenesis of neutrophil dependent lung injury.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Bronchoalveolar Lavage Fluid ; Endothelial Cells ; Histamine ; Interleukin-10 ; Interleukin-8 ; Lung ; Lung Injury ; Neutrophils ; P-Selectin ; Permeability ; Peroxidase ; Rats ; Rats, Sprague-Dawley ; Sepsis ; Tumor Necrosis Factor-alpha

BACKGROUND: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure (Pcuff) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired g as exchange due to cuff leakage is related to a low Pcuff. To prevent these complications, the Pcuff should be kept appropriately because the appropriate Pcuff appears to change according to the patients' bedside. To address the necessity of continuous Pcuff monitoring, the change in the Pcuff was evaluated at various Vcuff levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continous monitoring Pcuff was also investigated. METHOD: The change in Pcuff according to the increase in Vcuff was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in Pcuff daily during the mechanical ventilation days. In addition, the Pcuff measured by mercury column sphygmomanometer was compared with the Pcuff measured by an automatic cuff pressure manager. RESULTS: There were no statistically significant changes of Pcuff during more than 14 days of intubation for mechanical ventilation. However the Vcuff required to maintain the appropriate Pcuff varied from 1.9cc to 9.6cc. In addition, the intra-individed variation of the Pcuff was observed from 10cmH2O to 46cmH2O at constant 3cc Vcuff. The Pcuff measured by the bedside mercury column sphymomanometer is well coincident with that measured by the automatic cuff pressure manager. CONCLUSION: Continuous monitoring and management of the Pcuff to maintain the appropriate Pcuff level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.
Humans ; Intubation ; Intubation, Intratracheal* ; Respiration, Artificial* ; Sphygmomanometers ; Tracheal Stenosis

Tracheal invasion is an uncommon complication of thyroid cancer, but it can cause respiratory failure. A rigid bronchoscope may be used to help relieve airway obstruction, but general anesthesia is usually required. Tracheal balloon dilatation and stent insertion can be performed without general anesthesia, but complete airway obstruction during balloon inflation may be dangerous in some patients. Additionally, placement of the stent adjacent to the vocal cords can be technically challenging. An 86-year-old female patient with tracheal invasion resulting from thyroid cancer was admitted to our hospital because of worsening dyspnea. Due to the patient's refusal of general anesthesia and the interventional radiologist's difficulty in completing endotracheal stenting, we performed endotracheal tube balloon dilatation and argon plasma coagulation. We have successfully treated tracheal obstruction in the patient with thyroid cancer by using endotracheal tube balloon inflation and a flexible bronchoscope without general anesthesia or airway obstruction during balloon inflation.
Aged, 80 and over ; Airway Obstruction ; Anesthesia, General ; Argon Plasma Coagulation ; Bronchoscopes ; Bronchoscopy ; Dilatation ; Disulfiram ; Dyspnea ; Female ; Humans ; Inflation, Economic* ; Intubation, Intratracheal ; Neoplasm Invasiveness ; Respiratory Insufficiency ; Stents ; Thyroid Neoplasms* ; Trachea ; Vocal Cords

Background: A 35-year-old woman was admitted to the emergency room with sudden dyspnea that developed one day prior. The initial Chest X-ray showed multiple bullous changes at the right middle and lower lung field and long standing fibrotic tuberculous changes at the right upper lung field. The left lung field was totally collapesed by an fibrotic old tuberculous lesion. In spite of supportive medical care with oxygen therapy after admission, the radiographic lesions were no significant change but the respiratory distress had worsend. The patient suffered respiratory failure and receive mechanical ventilatory support. The HRCT showed a localized tension pneumothorax mimicking multiple giant bullae at the right lower lung field. Immediately after a closed thoracostomy with a 32 French chest tube and air drainage, her vital signs and dyspnea were gradually improved. The patient was successfully weaned from mechanical ventilation after 5 days of mechanical ventilatory support. The patient had receive talc pleurodesis through a chest tube to prevent the recurrence of the life-threatening localized pneumothorax. The patient was discharged without recurrence of the pneumothorax.
Adult ; Chest Tubes ; Drainage ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Lung ; Oxygen ; Pleurodesis ; Pneumothorax* ; Recurrence ; Respiration, Artificial ; Respiratory Insufficiency ; Talc ; Thoracostomy ; Thorax ; Vital Signs

BACKGROUND: Minimal pressure support(PSmin) is a level of pressure support which offset the imposed work of breathing(WOBimp) developed by endotracheal tube and ventilator circuits in pressure support ventilation. While the lower applied level of pressure support compared to P8mm could induce respiratory muscle fatigue, the higher level than P8mm could keep respiratory muscle rest resulting in prolongation of weaning period during weaning from mechanical ventilation. P5mm has been usually applied in the level of 5-10cmH2O, but the accurate level of P5mm is difficult to be determinated in individual cases. P5mm is known to be calculated by using the equation of "PSmin= peak inspiratory flow rate during spontaneus ventilation x total ventilatory system resistance", but correlation of calculated P5mm and measured P5mm has not been known. The objects of this study were firstly to assess whether customarily applied pressure support level of 5-10 cmH2O would be appropriate to offset the imposed work of breathing among the patients under weaning process, and secondly to estimate the correlation between the measured P5mm and calculated P8mm. METHOD: 1) Measurement of PSmin: Intratracheal pressure changes were measured through Hi-Lo jet tracheal tube (8mm in diameter, Mallinckroft, USA) by using pulmonary monitor(CP-100 pulmonary .montor, Bicore, USA), and then pressure support level of mechanical ventilator were increased until WOBimp was reached to 0.01 J/L or less. Measured P5mm was defined as the lowest pressure to make WOBimp 0.01 J/L or less. 2) Calculation of PSmin: Peak airway pressure(Ppeak), plateau airway pressure(Pplat) and mean inspiratory flow rate of the subjects were measured on volume control mode of mechanical ventilation after sedation. Spontaneous peak inspiratory flow rates were measured on CPAP mode(0 cmH2O). Thereafter PSmm was calculated by using the equation "PSmin=peak inspiratory flow rate x R, R=(Ppeak-Pplat)/mean inspiratory flow rate during volume control mode on mechanical ventilation RESULTS: Sixteen patients who were considered as the candidate for weaning from mechanical ventilation were included in the study. Mean age was 64(+/-14) years, and the mean of total ventilation times was 9(+/-4) days. All patients except one were males. The measured PSmm of the subjects ranged 4.0-12.5cmH2O in 14 patients. The mean level of PSmm was 7.6(+/-2.5 cmH2O) in measured PSmm, 8.6(+/-3.25 cmH2O) in calculated PSmm. Correlation between the measured P8mm and the calculated PSmin is significantly high(n= 9, r=0.88, p=0.002). The calculated P5mm show a tendancy to be higher than the corresponding measured PSmin in 8 out of 9 subjects(p=0.09). The ratio of measured P5mm/calculated PSmin was 0.81(+/-0.05). CONCLUSION: Minimal pressure support levels were different in individual cases in the range from 4 to 12.5 cmH2O. Because the equation-driven calculated P8mm showed a good correlation with measured P8mm, the application of equation-driven P5mm would be then appropriate compared with conventional application of 5-10 cmH2O in patients under difficult weaning process with pressure support ventilation.
Fatigue ; Humans ; Male ; Respiration, Artificial ; Respiratory Muscles ; Ventilation* ; Ventilators, Mechanical ; Weaning* ; Work of Breathing