Multiple primary cancer is a state of disease that developed more than two cancers in an individual, independently. Multiple primary malignant cancer is divided to synchronous and metachronous type depending on the interval between their diagnoses. Synchronous multiple cancer is diagnosed within an interval of six months and metachronous multiple cancer more than six months interval. As further advance in diagnostic techniques and treatment method bring about progressive increase in the number of individuals living in the 'cancer age' group. So, the population of patients with subsequent primary cancer will increase and after all the incidence of multiple primary cancer will be increased, gradually. Herein, we experienced a case of a 83-year-old male patient with metachronous triple primary cancer composed of gastric cancer, bladder cancer and lung cancer. We found the adenocarcinoma of stomach, transitional cell cancer of bladder and squamous cell carcinoma of lung. For its great rarity, we report this case with review of literatures about the history, criteria, incidence, site relationship and so on.
Adenocarcinoma ; Aged, 80 and over ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Incidence ; Lung Neoplasms ; Lung* ; Male ; Stomach Neoplasms ; Stomach* ; Urinary Bladder Neoplasms ; Urinary Bladder*

OBJECTIVES: Endobronchial anthracofibrotic pigmentation, which presents as dark black or brown pigmentation mucosal changes of multiple bronchi combined with bronchial fibrosis and obstruction, is not a rare finding when performing diagnostic bronchoscopy for Koreans. This study was performed to define the clinical characteristics and to determine the association of these finding with the Korean life style and such other diseases as coal workers, pneumoconiosis or tuberculosis in the patients with anthracofibrotic pigmentation. METHODS: This retrospective analysis was conducted on 70 (5.2%) patients with endobronchial anthracofibrotic pigmentation, among a total of 1340 patients who underwent bronchoscopy. The distinctive clinical features, the personal life style, the past medical history, the histology and microbiology, the radiologic finding and the natures of the bronchoscopic lesions were analyzed. RESULTS: This mean age of the patients with anthracofibrotic pigmentation was 60.6+/-9.2 year old and the male to female ratio was 1:1.7. The common respiratory symptoms of these patients were coughing and sputum (81%, 57/70), and this was followed in order by dyspnea and hemoptysisir. The symptoms were not related with smoking and an occupational history such as being a coal worker and so on. Pneumonia was most common finding on the radiologic studies. On bronchoscopy, the right middle lobe bronchus was most commonly involved. The most common associated disease was tuberculosis, and 40 cases (57.1%) were diagnosed by AFB staining, TB PCR, bronchoscopic guided tissue biopsy and a past history of tuberculosis. Other diseases related with anthracotic pigmentation were hypertension, diabetes, COPD, lung cancer, pneumoconiosis and asthma. CONCLUSION: These results suggest that endobronchial anthracofibrotic pigmentation was mostly related with pulmonary tuberculosis rather than with coal- related disease. Endobronchial anthracofibrotic pigmentation was more prevalent in older age females in Korea.
Asthma ; Biopsy ; Bronchi ; Bronchoscopy ; Coal ; Cough ; Dyspnea ; Female ; Fibrosis ; Humans ; Hypertension ; Korea ; Life Style ; Lung Neoplasms ; Male ; Pigmentation* ; Pneumoconiosis ; Pneumonia ; Polymerase Chain Reaction ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Smoke ; Smoking ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

Foreign body aspiration occurs rarely in adults. Aspiration of foreign bodies into tracheobronchial tree commonly occurs by accident, and in most cases they get removed without delay. Sometimes, however, small foreign bodies that lodge in the peripheral airway are often asymptomatic initially and become symptomatic several years later. In these cases, unless a clear history of an aspiration event is obtained, it is difficult to even consider the aspiration as a cause of pneumonia. Foreign bodies were most frequently located in right lower lobe and usually aspirated unilaterally. A review of recent literature reveals only a few case reports of unilaterally aspirated foreign body in adults. We are reporting an adult case of obstructive pneumonia due to foreign bodies (fish vertebrae) aspirated into both bronchi at least 5 month prior to his hospitalization into our institute. Removal of the endobronchial foreign bodies was successfully accomplished by flexible bronchoscopy. The patient did not experience any complication and the pneumonia was completely resolved after removal of foreign bodies.
Adult ; Bronchi* ; Bronchoscopy ; Foreign Bodies ; Hospitalization ; Humans ; Pneumonia* ; Spine*

Foreign body aspiration occurs rarely in adults. Aspiration of foreign bodies into tracheobronchial tree commonly occurs by accident, and in most cases they get removed without delay. Sometimes, however, small foreign bodies that lodge in the peripheral airway are often asymptomatic initially and become symptomatic several years later. In these cases, unless a clear history of an aspiration event is obtained, it is difficult to even consider the aspiration as a cause of pneumonia. Foreign bodies were most frequently located in right lower lobe and usually aspirated unilaterally. A review of recent literature reveals only a few case reports of unilaterally aspirated foreign body in adults. We are reporting an adult case of obstructive pneumonia due to foreign bodies (fish vertebrae) aspirated into both bronchi at least 5 month prior to his hospitalization into our institute. Removal of the endobronchial foreign bodies was successfully accomplished by flexible bronchoscopy. The patient did not experience any complication and the pneumonia was completely resolved after removal of foreign bodies.
Adult ; Bronchi* ; Bronchoscopy ; Foreign Bodies ; Hospitalization ; Humans ; Pneumonia* ; Spine*

Tsutstugamushi disease is a major febrile disease that generally occurs in the fall in Korea with hemorrhagic fever with renal syndrome and leptospirosis. This disease is often accompanied by interstitial pneumonia, acute renal failure and liver failure. The causative agent, namely Orientia tsutsugamushi, is transmitted to humans through the bite of a laval trombiculid mite, which is commonly known as a chigger. A 78 year old man was admitted in October 2004 with intractable fever and a drowsy mentality. Two weeks earlier, he visited a private clinic complaining of a simple skin rash. He was treated with antihistamine and steroid, but his symptoms were aggravated and he was referred to our hospital. His physical examination and laboratory findings showed a septic shock status. The maculopapular rash had spread over his face, chest, abdomen and extremities. Eschar was observed in lower back area but it was too difficult to distinguish it from other skin rashes. His chest X-ray appeared as diffuse nodular patchy consolidations in the bilateral lung parenchyme. He was treated with a mechanical ventilator and doxycycline under th suspicion of Tsutstugamushi disease. However, he suffered multiorgan failure accompanied by acute respiratory distress syndrome, acute renal failure and acute hepatitis. He was treated in the intensive care unit for approximately 12 weeks and his general condition was recovered.
Abdomen ; Acute Kidney Injury ; Aged ; Doxycycline ; Exanthema ; Extremities ; Fever ; Hemorrhagic Fever with Renal Syndrome ; Hepatitis ; Humans ; Intensive Care Units ; Korea ; Leptospirosis ; Liver Failure ; Lung ; Lung Diseases, Interstitial ; Orientia tsutsugamushi ; Physical Examination ; Respiratory Distress Syndrome, Adult ; Scrub Typhus ; Shock, Septic ; Thorax ; Trombiculidae ; Ventilators, Mechanical

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.
Aged ; Bronchoscopy ; Dyspnea ; Epithelioid Cells ; Granuloma ; Hoarseness ; Humans ; Korea ; Lymph Nodes* ; Male ; Mononuclear Phagocyte System ; Paralysis ; Sarcoidosis ; Vocal Cord Paralysis ; Vocal Cords ; Young Adult

The bronchopulmonary sequestration is a rare congenital malformation of the lung, concerning about the abnormal feeding systemic artery, needed for invasive angiography for definite diagnosis. This case report is described that patient diagnosed by multi-detectional computed tomography (MDCT) without angiography and combined with aspergillosis within an intralobar seqestration. He was 43-year old male patient with left submandibular mass. On chest PA, abnormal cystic lesion was shown in left lower lung field. There were multiple cysts with internal air-fluid level in left lower lobe on computed tomography. By useing MDCT, we could reconstruct internal structures and feeding artery, arising from thoracic aorta. We could confirm the intralobar bronchopulmonary sequestration. Lobectomy of the left lower lobe was done. On histologic finding, there was intralobar type pulmonary seqestration with chronic inflammation with hyphae of aspergillus species focally.
Adult ; Angiography ; Aorta, Thoracic ; Arteries ; Aspergillosis* ; Aspergillus ; Bronchopulmonary Sequestration* ; Diagnosis ; Humans ; Hyphae ; Inflammation ; Lung ; Male ; Thorax

Most sharp force fatalities are attributed to homicide or suicide, with only a few accidental cases reported to date. Broken glass accounts for most of these accidental fatalities. We herein report an unusual accidental death caused by a broken glass cup. A 21-year-old woman was found dead on the floor of her studio apartment. The studio was a duplex consisting of one room and a bathroom, with a stepped drawer leading to the second floor. She was lying face down with her legs spread apart in a large pool of blood, surrounded by many pieces of broken glass. There was an oblique cut measuring 9 cm in length in the right sternocleidomastoid region just above the right clavicle. The surface of the cut wound showed irregular edges and the internal jugular vein was severed in the depth of the wound. She appeared to have fallen down the steps onto the ground floor and been fatally injured in the neck by a piece of broken glass.
Clavicle ; Deception ; Female ; Glass ; Homicide ; Humans ; Jugular Veins ; Leg ; Neck ; Neck Injuries ; Suicide ; Wounds and Injuries ; Young Adult

BACKGROUND: Since open Wiltse approach allows limited visualization for foraminal stenosis leading to an incomplete decompression, we report the short-term clinical and radiological results of unilateral biportal endoscopic foraminal decompression using 0° or 30° endoscopy with better visualization. METHODS: We examined 31 patients that underwent surgery for neurological symptoms due to lumbar foraminal stenosis which was refractory to 6 weeks of conservative treatment. All 31 patients underwent unilateral biportal endoscopic far-lateral decompression (UBEFLD). One portal was used for viewing purpose, and the other was for surgical instruments. Unilateral foraminotomy was performed under guidance of 0° or 30° endoscopy. Clinical outcomes were analyzed using the modified Macnab criteria, Oswestry disability index, and visual analogue scale. Plain radiographs obtained preoperatively and 1 year postoperatively were compared to analyze the intervertebral angle (IVA), dynamic IVA, percentage of slip, dynamic percentage of slip (gap between the percentage of slip on flexion and extension views), slip angle, disc height index (DHI), and foraminal height index (FHI). RESULTS: The IVA significantly increased from 6.24°± 4.27° to 6.96°± 3.58° at 1 year postoperatively (p = 0.306). The dynamic IVA slightly decreased from 6.27°± 3.12° to 6.04°± 2.41°, but the difference was not statistically significant (p = 0.375). The percentage of slip was 3.41% ± 5.24% preoperatively and 6.01% ± 1.43% at 1-year follow-up (p = 0.227), showing no significant difference. The preoperative dynamic percentage of slip was 2.90% ± 3.37%; at 1 year postoperatively, it was 3.13% ± 4.11% (p = 0.720), showing no significant difference. The DHI changed from 34.78% ± 9.54% preoperatively to 35.05% ± 8.83% postoperatively, which was not statistically significant (p = 0.837). In addition, the FHI slightly decreased from 55.15% ± 9.45% preoperatively to 54.56% ± 9.86% postoperatively, but the results were not statistically significant (p = 0.705). CONCLUSIONS: UBEFLD using endoscopy showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability. It could be a feasible alternative to conventional open decompression or fusion surgery for lumbar foraminal stenosis.
Constriction, Pathologic* ; Decompression* ; Endoscopy ; Follow-Up Studies ; Foraminotomy ; Humans ; Minimally Invasive Surgical Procedures ; Spinal Stenosis ; Spine* ; Surgical Instruments

Most sharp force fatalities are attributed to homicide or suicide, with only a few accidental cases reported to date. Broken glass accounts for most of these accidental fatalities. We herein report an unusual accidental death caused by a broken glass cup. A 21-year-old woman was found dead on the floor of her studio apartment. The studio was a duplex consisting of one room and a bathroom, with a stepped drawer leading to the second floor. She was lying face down with her legs spread apart in a large pool of blood, surrounded by many pieces of broken glass. There was an oblique cut measuring 9 cm in length in the right sternocleidomastoid region just above the right clavicle. The surface of the cut wound showed irregular edges and the internal jugular vein was severed in the depth of the wound. She appeared to have fallen down the steps onto the ground floor and been fatally injured in the neck by a piece of broken glass.