A 61-year-old woman with a history of asthma and pulmonary tuberculosis was presented with purulent bloody sputum. She was treated as having lung abscess initially, but her signs and symptoms did not improve with traditional therapy. Finally, in the clinical course and laboratory data during hospitalization, she was diagnosed as ABPA with coexistent aspergilloma. Thereafter she was treated with itraconazole for aspergilloma, and corticosteroid for ABPA. The symptoms of hemoptysis and dyspnea were improved. A case of ABPA with coexistent aspergilloma and a brief review of the literature were presented.
Aspergillosis, Allergic Bronchopulmonary* ; Asthma ; Dyspnea ; Female ; Hemoptysis ; Hospitalization ; Humans ; Itraconazole ; Lung Abscess ; Middle Aged ; Sputum ; Tuberculosis, Pulmonary

BACKGROUND: Pulmonary tuberculosis is frequently accompanied with complications such as bronchiectasis, cavities, fibrosis and a deterioration of the lung function. However, there is little information available on the pathogenesis of these complications in pulmonary tuberculosis. Among the many factors involving in tissue remodeling, transforming growth factor-beta1 (TGF-beta1) is a potent stimulus of the extracellular matrix fomation and a mediator of potential relevance for airway wall remodeling. Therefore, this study examined the relationship between the radiological changes and the TGF-beta1 level in patients with pulmonary tuberculosis. METHODS: Serum and bronchoalveolar lavage fluid (BALF) were collected from total of 35 patients before treating them for active pulmonary tuberculosis, and the TGF-beta1 levels were measured using an enzyme-linked immunosorbent assay (ELISA). The BALF levels were recalculated as the epithelial lining fluid (ELF) levels using the albumin method. pulmonary function test (PFT) and high resolution computed tomography (HRCT) were performed before and after treatment. RESULTS: There was a strong correlation between the serum TGF-beta1 level and the presence of cavities (r=0.404, p=0.006), even though the BAL TGF-beta1 level showed a weak correlation with complications. In addition, there was no correlation between the TGF-beta1 levels before treatment and the changes in the PFT and HRCT during treatment. CONCLUSION: There is a correlation between the serum TGF-beta1 level and cavity formation in pulmonary tuberculosis before treatment. However, further study will be needed to confirm this.
Bronchiectasis ; Bronchoalveolar Lavage Fluid ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fibrosis ; Humans ; Lung ; Respiratory Function Tests ; Transforming Growth Factor beta1 ; Tuberculosis, Pulmonary*

BACKGROUND: The most widely used pulmonary function test is spirometry. It is a relatively simple and noninvasive test that measures the volume of air expelled from fully inflated lungs. However, spirometry is an effort-dependent test that requires careful instruction and the full cooperation of the test subject. Because the old patients have relatively longer expiration time than the young patients, it is difficult for both old age and technician to fulfill the end of test criteria for forced vital capacity (FVC) maneuver. In the present study, we aimed to investigate whether forced expiratory volume in six seconds (FEV6) could be utilized in place of FVC in the detection of airway obstruction for the old age. METHODS: Total 353 old age (> or =65years) were enrolled in this study and performed spirometry. Subjects were divided into two groups by FEV1/FVC as the gold standard for diagnosing obstructive airway disease; Group I: 132 patients with FEV1/FVC> or =70% , Group II: 221 patients with FEV1/FVC<70% The relationship between FVC and FEV6 values were analyzed in both groups and differences between the groups were investigated. RESULTS: The mean difference of FVC and FEV6 values (FVC-FEV6) was 138.4+/-23.0 mL (5.06+/-2.86%). This difference was found to be higher in group II (189.4+/-162.5 mL, 7.0+/-5.4%) than group I (52.9+/-47.3 mL, 1.9+/-1.5%). When FEV1/FVC is taken as the gold standard, FEV1/FEV6 had negative predictive value of 87.4% and a sensitivity of 91.4% in the detection of obstructive airway disease. Conclusion: FEV6 was a relative good candidate for parameter in the detection of airway obstruction in the old age for whom it is difficult to fulfill acceptable FVC maneuver. However, additional researches are needed to determine the usefulness of FEV6 in detecting obstructive airway disease of old age.
Airway Obstruction ; Diagnosis* ; Forced Expiratory Volume ; Humans ; Lung ; Respiratory Function Tests ; Spirometry ; Vital Capacity

Spontaneous pneumomediastinum is defined as a clinical syndrome thatos characterized by the presence of air in the mediastinal space, which is not due to an old previous injury or surgery. The condition is caused by a sustained increase in the intraalveolar and intrabronchial pressure with extravasated air dissecting along the perivascular spaces of the mediastinum. This is an uncommon complication of sports activity. The most common symptom is chest pain. This diagnosis should be considered for younger people who present with pleuritic chest pain or dyspnea and a characteristic crackling feel (known as subcutaneous crepitation) when touching of the skin covering the chest wall or neck, and they look otherwise well with normal vital signs. Usually no treatment is required, but the mediastinal air will be absorbed faster if the patient inspires high concentrations of oxygen. We present here a case of spontaneous pneumomediastinum that occurred during a Taekwondo match, along with a review of the relevant literature.
Chest Pain ; Dyspnea ; Humans ; Mediastinal Emphysema ; Mediastinum ; Neck ; Oxygen ; Skin ; Sports ; Thoracic Wall ; Vital Signs

BACKGROUND: As the number of older-aged people increases, the number of elderly patients who receive critical care services is expected to increase substantially. The objective of this study was to examine the clinical characteristics and outcomes of elderly patients who receive mechanical ventilation for more than 30 days in the medical intensive care unit (MICU) at a university hospital. METHODS: We retrospectively examined forty-one elderly patients (> or =65 years old) who were receiving mechanical ventilation, from April 2004 to March 2007, for periods exceeding 30 days at the MICU at Eulji University Hospital. RESULTS: The MICU and hospitalmortality rate were 60.9% and 65.9%, respectively. The mean length of the ICU stay was 57.5 days and the mean duration of mechanical ventilation was 49.3 days. The most common reason for MICU admission was acute respiratory failure (73.2%), followed by sepsis (12.2%), neurological problems (9.8%), and gastrointestinal bleeding (4.9%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher for the nonsurvivors than for the survivors (28.0 vs. 25.0, respectively, p=0.03). The nonsurvivors received more red blood cell (RBC) transfusions during their ICU stay than did the survivors (84.0% vs. 43.8%, respectively p=0.007). The factors associated with hospital death were the APACHE II score and if the patient had received a RBC transfusion. CONCLUSION: The APACHE II score and a RBC transfusion were predictors of increased hospital mortality for the elderly patients who were on prolonged mechanical ventilation. These predictors may assist physicians to make clinical decisions for this patient population.
Aged ; APACHE ; Critical Care ; Erythrocytes ; Hemorrhage ; Hospital Mortality ; Humans ; Critical Care ; Intensive Care Units ; Prognosis ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Sepsis ; Survivors

No abstract available.
Clarithromycin ; Doxycycline ; Scrub Typhus*

No abstract available.
Tuberculosis, Miliary*

In Plasmodium vivax and Plasmodium ovale malaria, some of the liver stage parasites remain dormant. The activation of these dormant forms (called hypnozoite) can give rise to relapse weeks, months or years after the initial infection. To prevent relapses, a course of primaquine may be given as terminal prophylaxis to patients. Different strains of Plasmodium vivax vary in their sensitivity to primaquine and, recently, cases of relapse of Plasmodium vivax after this standard primaquine therapy were reported from various countries. We reported a case of primaquine resistant malaria which initially was thought to be relapsed caused by loss of terminal prophylaxis.
Animal ; Antimalarials/therapeutic use* ; Case Report ; Chloroquine/therapeutic use ; Drug Resistance ; Human ; Malaria, Vivax/parasitology ; Malaria, Vivax/drug therapy* ; Male ; Middle Age ; Plasmodium vivax/growth & development ; Plasmodium vivax/drug effects ; Primaquine/therapeutic use* ; Recurrence

Sulfone hypersensitivity syndrome, which is characterized by fever, skin rash, hemolytic anemia, atypical lymphocytosis, and acute hepatic injury, is a potentially fatal variant of dapsone hypersensitivity. A 62-year-old woman with a history of arthralgia developed sulfone syndrome while receiving dapsone 100 mg/day for 20 days. Fever, malaise, prominent rashes, hepatitis, eosinophilia and hemolytic anemia developed and she which required hospitalization. The patient's symptoms reversed following discontinuation of dapsone and administration of steroid (0.5 mg/kg). A case of sulfone syndrome and a brief review of the literature were presented.
Anemia, Hemolytic ; Arthralgia ; Dapsone* ; Eosinophilia ; Exanthema ; Female ; Fever ; Hepatitis ; Hospitalization ; Humans ; Hypersensitivity* ; Lymphocytosis ; Middle Aged

Fusobacteria are anaerobic gram-negative, non-spore forming bacilli found in normal flora of the oral cavity, urogenital tract, and gastrointestinal tract. Fusobacterium nucleatum has been seldom reported as a cause of liver abscess, particularly in immunocompetent hosts. A 55-year-old man with frequent periodontal disease visited our hospital with intermittent fever and headache for 2 months. Abdominal CT scan revealed an 8.2x6 cm mass in the right hepatic lobe with central low density. Abscess culture revealed F. nucleatum as the causative organism. Percutaneous abscess drainage and intravenous administration of antibiotics for 4 weeks improved symptoms and decreased the abscess size. We report a rare case of liver abscess due to F. nucleatum in an immunocompetent man with periodontal disease.
Ampicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Fusobacterium Infections/complications/*diagnosis/drug therapy ; Fusobacterium nucleatum/*isolation & purification ; Humans ; Injections, Intravenous ; Liver Abscess/*diagnosis/etiology/microbiology ; Male ; Middle Aged ; Periodontal Diseases/*diagnosis ; Sulbactam/therapeutic use