No abstract available.
Splenomegaly*

Pulmonary Embolism can develop in variable conditions, and presents with nonspecific symptoms and signs. If diagnosis is delayed, it can be resulted in catastrophic results. Therefore, early diagnosis and adequate treatment is crucial in Pulmonary Embolism. Lung Perfusion Scan is useful screening test. Negative result can exclude pulmonary embolism, But, perfusion defects don't always mean pulmonary embolism. To find the better methods of interpretation of king perfusion scan and To evaluate the clinical course and outcomes of the patients, in whom pulmonary embolism was suspected by lung perfusion scan, we reviewed the clinical records of 49 cases suspected by lung perfusion scan at Seoul National University Hospital during the period of January, 1995 to July, 1996. The results are as follows. First impression of cases in which PE was present at time of admission were pulmonary embolism (63%), heart diseases (26%), and pneumonia (11%) in orders. Underlying diseases of cases in which PE developed during admission were malignancy (36.5%), 10-I (22.7%), sepsis (13.7%), and SLE (9.1%) in orders. The predisposing factors were operation (20%), cancer (16%), immobility (16%), connective tissue disease (16%), heart dis. (10%), old age (10%), and preg/pelvic dis. (8%) The results of lung perfusion scan were HPPE 40cases(26.8%), IPPE 21 cases(14.1%), LPPE 88 cases(59.l %) and cases(%) of treatment in these cases were HPPE 34 cases(85%), IPPE 9 cases(42,9%), IPPE 0 case(0.0%). Treatments were heparin and warfarin (69.5%), heparin alone (8.2%), warfarin alone (2.0%), embolectomy(4.1%), thrombolytics (20%), IVC filter (2.0%), and no treatment (12.2%) In 34 cases (694%), follow up could be done, and 5 cases were recurred (10.2%). The causes of recurrence was incomplete anticoagulant therapy (3 cases) 2rnd recurrence of predisposing factor (2 cases). Expired case due to pulmonary embolism was one who was expired just before trial of thrombolytie therapy. CONCLUSION: Efforts should be made to shorten the interval from onset of Sx to Dx, ie, high index of suspision.
Causality ; Connective Tissue Diseases ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Heart ; Heart Diseases ; Heparin ; Humans ; Lung* ; Mass Screening ; Perfusion* ; Pneumonia ; Pulmonary Embolism* ; Recurrence ; Seoul ; Sepsis ; Warfarin

BACKGROUND: Endotoxin, the component of outermembrane of gram negative organism, plays an important role in the initiation and amplification of inflammatory reaction by its effects on inflammatory cells. Until recently, there have been continuing efforts to delinate the mechanisms of the signal trasduction pathway of endotoxin stimuli on inflammatory cells. By uncovering the mechanisms of signal transduction pathway of endotoxin stimuli, we can expect to have tools to control the excessive inflammatory responses which sometimes may be fatal to the involved host. It was generally accepted that endotoxin exerts its inflammatory effects through inflammatory cytokines that are produced by endotoxin-stimulated inflammatory cells and there were some reports on the importance of protein kinase C and protein tyrosine kinase activation in the production of inflammatory cytokines by endotoxin. So we evaluated the effect of pretreatment of protein kinase C inhibitors (H7, Staurosporin) and protein tyrosine kinase inhibitors(Herbimycin, Genistein) on the endotoxin-stimulated cytokines(IL-8 & TNF-alpha) mRNA expression. METHOD: Peripheral blood monocytes were isolated from healthy volunteers by Ficoll-Hypaque density gradient method and purified by adhesion to 60mm Petri dishes. Endotoxin(LPS 100ng/ml) was added to each dishes except one control dish, and each endotoxin-stimulated dishes was preincubated with H7, Staurosporin(protein kinase C inhibitor), Herbimycin or Genistein(protein tyrosine kinase inhibitor) respectively except one dish. Four hours later the endotoxin stimulation, total RNA was extracted and Northern blot analysis for IL-8 mRNA and TNF-alpha mRNA was done. RESULT: Endotoxin stimulation increased the expression of IL-8 mRNA and TNF-alpha mRNA expression in human peripheral blood monocyte as expected and the stimulatory effect of endotoxin on TNF-alpha mRNA expression was inhibited by protein kinase C inhibitors(H7, Staurosporin) and protein tyrosine kinase inhibitors (Herbimycin, Genistein). The inhibitory effect of each drugs was increased with increasing concentration. The stimulatory effect of endotoxin on IL-8 mRNA was also inhibited by H7 and protein tyrosine kinase inhibitors (Herbimycin, Genistein) dose-dependently but not by Staurosporin. CONCLUSION: Protein kinase C and protein tyrosine kinase are involved in the endotoxin induced signal transduction pathway in human peripheral blood monocyte.
Blotting, Northern ; Cytokines ; Healthy Volunteers ; Humans ; Interleukin-8 ; Monocytes* ; Phosphotransferases ; Protein Kinase C* ; Protein Kinases* ; Protein-Tyrosine Kinases* ; RNA ; RNA, Messenger ; Signal Transduction* ; Tumor Necrosis Factor-alpha

PURPOSE: To evaluate the efficacy and safety of vinorelbine and carboplatin in advanced non- small-cell lung cancer (NSCLC). MATERIALS AND METHODS: Between August 1998 and July 1999, 25 patients were enrolled. The median age was 68 (range, 46~77) years and male:female ratio was 23:2. Two patients had stage IIIa, 15 had stage IIIb and 8 had stage IV. Sixteen patients had ECOG performance status of 0 or 1 and 9 had 2 or 3. Sixteen patients had squamous cell carcinoma, 8 had adenocarcinoma and 1 had undifferentiated NSCLC. Treatment consists of intravenous carboplatin 400 mg/m2 on day 1 and vinorelbine 25 mg/m2 on days 1 and 8. The treatment was repeated every 28 days. RESULTS: Twenty-three of 25 patients were evaluable. Partial response were observed in 11 patients. The overall response rate was 48% (95% confidence interval: 27~69%) and the median response duration was 19 (range 7 ~44 ) weeks. The median survival of 25 patients was 52 (range 3~53 ) weeks. Toxicities were evaluated by WHO criteria. During a total of 108 cycles, granulocytopenia worse than WHO grade 3 occurred in 2%, thrombocytopenia in 4% and anemia in 10%, respectively. Treatment-related death occurred in 1 patient due to sepsis during cytopenic period. Non-hematologic toxicity was minor and easily controlled. CONCLUSION: A combination chemotherapy of intravenous vinorelbine and carboplatin has relatively high activity with acceptable toxicities in patients with advanced NSCLC.
Adenocarcinoma ; Agranulocytosis ; Anemia ; Carboplatin* ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Lung Neoplasms ; Sepsis ; Thrombocytopenia

BACKGROUND: In patients with chronic obstructive pulmonary disease(COPD), it is well known that hypoxemia increases the frequency of VPB, which is associated with the poor prognosis such as sudden death. The aim of this study is to evaluate the effect of short and long-term low flow oxygen therapy on the development of VPBs in patients with COPD by correcting the hypoxemia. METHOD: In 19 patients with COPD, oxygen saturation and VPB are monitored by pulse oxymeter and 24-hour Holter EKG, with room air and the 1st and the 8th day during oxygen therapy by nasal prong (2L/min). RESULTS: The arterial oxygen saturation was significantly higher on the 1st day of oxygen therapy compared with breathing room air, and also higher on the 8th day of oxygen therapy than on the 1st day. We found that there was significant correlation between the minimal value of the arterial oxygen saturation and the mean value of the arterial oxygen saturation. The number of VPBs per hour was significantly higher on the 1st day of oxygen therapy compared with breathing room air, and also higher on the 8th day of oxygen therapy than on the 1st day. There was no significant correlation between the decrease of the frequency of VPBs and the increase of the minimal arterial oxygen saturation. But, because of the low p value as 0.056, The correlation is highly suggested. CONCLUSION: With oxygen therapy, the arterial oxygen saturation was increased and the number of VPBs was decreased, and with long-term oxygen therapy more than 7days, the number of VPBs was more decreased in patients with COPD.
Anoxia ; Death, Sudden ; Electrocardiography ; Humans ; Oxygen* ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Respiration

Primary mediastinal nonseminomatous germ cell tumor associated with Klinefelter's syndrome is a rare disorder. We experienced a case of recurred primary mediastinal nonseminomatous germ cell tumor developed in a 24-year-old patient with Klinefelter's syndrome. The patient had been treated with surgery and combination chemotherapy under the diagnosis of primary mediastinal nonseminomatous germ cell tumor before. A round mass was found on the right lower lung field in the chest X-ray during follow up. The patient was diagnosed as recurred primary nonseminomatous germ cell tumor and Klinefelter's syndrome through tumor markers, peripheral blood karyotyping, and other tests including hormonal assay and was treated with combination chemotherapy and surgery again. When the patient is diagnosed as primary mediastinal nonseminomatous germ cell tumor, Klinefelter's syndrome and hematologic malignancies should be considered to be associated diseases and vice versa.
Diagnosis ; Drug Therapy, Combination ; Follow-Up Studies ; Germ Cells* ; Hematologic Neoplasms ; Humans ; Karyotyping ; Klinefelter Syndrome* ; Lung ; Neoplasms, Germ Cell and Embryonal* ; Thorax ; Biomarkers, Tumor ; Young Adult

BACKGROUND: The total and differential cell count of bronchoalveolar lavage(BAL) fluid are useful assessing activity, prognosis and response to therapy in diffuse interstitial lung disease. But controversy exist as to the appropriate method in processing BAL fluid. Therefore we investigated the effect of gauze filtration, centrifugation and different storage time of BAL fluid on the total and differential cell count. METHOD: We obtained BAL fluid from 6 persons with no active lung lesion and divided pooled BAL fluid into several siliconized glass tubes and filtered through 0,1, 2, 4 folds of cotton guaze(pore size:lmm), and compared total cell count using hemocytometer after trypan blue staining and differential cell count after Wright-Giemsa staining of cytocentrifuged preparations. And we also counted total and differential cell count after centrifugation(400g for 30 mm) and various storage time(2hr, 24hr, and 48hr). RESULTS: There was no difference in total and differential cell count according to folds of gauze filtraion. But without gauze filtration, mucus threads that hampered total and differential cell count were found in 2 cases (33%). Centrifugation resulted in loss of total cell count(24+/-18%) without change in differential cell count. There was no change in total cell count after 21w storage but significant cell loss was found after 241w storage time(24hr : 28+/-21%, 48hr: 41+/-24%). However there was no change in differential cell count with 48hr storage time. CONCLUSION: Total and differential cell count of BAL fluid may be best performed after cotton gauze filtration without centrifugation and within 2 hours.
Bronchoalveolar Lavage ; Cell Count ; Centrifugation ; Filtration ; Glass ; Humans ; Lung ; Lung Diseases, Interstitial ; Mucus ; Prognosis ; Silicones ; Therapeutic Irrigation* ; Trypan Blue

BACKGROUND: IFN-gamma is known to activate mononuclear phagocytes and to mediate host defense mechanism against some intracellular microorganisms, but litfle is known about anti-mycobacterial activity and mechanism of IFN-gamma in human. In this study, we investigated the role of IFN-gamma in the pathogenesis of tuberculosis by observing the effect of IFN-gamma on the phagocytosis of M.tuberculosis(MTB) and on the production of TNF-alpha by human pulmonary alveolar macrophage. METHOD: Pulmonary alveolar macrophage(PAM) were prepared with adhesion purification method from bronchoalveolar lavage fluid obtained from 8 persons without active lung lesion and cultured(1 x 106cells/ml) with MTB(3 x 107 bacteria/ml) with or without IFN-gamma(300U/ml), LPS(0.5ug/ml) and autologous serum(10%). After 2 hours, the percentage of PAM-phagocytosed MTh was counted after AFB staining(modified Kynion method). TNF-alpha production by PAM stimulated by IFN-gamma(300U/ml), MTB(1 x l06bacteria/ml) and LPS(0.5ug/ml) for 24hours was measured in culture supernatant using ELISA method. The degree of phagocytosis of MTh by PAM stimulated with IFN-gamma(300U/ml) and LPS(0.5ug/ml) for 24hours was also investigated. RESULTS: IFN-gamma did not influence the phagocytosis of MTB by PAM(percentage of PAM-phagocytosed MTB: control: 22.1+/- 4.9, IFN-gamma: 20.3+/- 5.3) and did not increase TNF-alpha production by PAM(controfl 21+/-38pg/ml, IFN-gamma : 87+/-106pg/ml), and the degree of phagocytosis of MTh by PAM pre-stimulated with IFN-gamma for 24 hours, was not increased (controL 24.5+/-9.5, IFN-gamma : 23.4+/-10.1). CONCLUSION: IFN-gamma does not influence on the phagocytosis of MTB and TNF-alpha production by PAM.
Bronchoalveolar Lavage Fluid ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Lung ; Macrophages, Alveolar* ; Mycobacterium tuberculosis ; Phagocytes ; Phagocytosis* ; Tuberculosis* ; Tumor Necrosis Factor-alpha

PURPOSE: To evaluate the efficacy and safety of gemcitabine and carboplatin (GC) in the treatment of advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: Between November 1999 and April 2001, 34 patients were enrolled in this study. The median age was 66 (range: 52-74) years old and all were male. Sixteen patients demonstrated stage IIIB, 15 stage IV, and 3 recurrence of disease after surgery. Twenty-two patients showed a ECOG performance status of 0 or 1 and 12 had 2. Twenty patients presented with squamous cell carcinoma, 11 adenocarcinoma and 3 unclassified NSCLC. The treatment regimen consisted of intravenous carboplatin AUC of 6 on day 1 and gemcitabine 1,250 mg/m2 on day 1 and 8. The treatment was repeated every 28 days. Toxicities were evaluated according to WHO toxicity criteria. RESULTS: All thirty-four patients were evaluable. Partia responses were observed in 15 patients. The overall response rate was 44% (95% confidence interval: 27-61%) and the median response duration was 26 (range 8-60 ) weeks. The median survival of all patients was 50 (range 8-70 ) weeks. During a total of 144 cycles, granulocytopenia greater than WHO grade 2 occurred in 2%, thrombocytopenia in 2%, and anemia in 3%, respectively. Non- hematologic toxicities were minor and easily controlled. CONCLUSION: A combination chemotherapy of intravenous gemcitabine and carboplatin has a relatively high activity with acceptable toxicities in patients with advanced NSCLC.
Adenocarcinoma ; Agranulocytosis ; Anemia ; Area Under Curve ; Carboplatin* ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Drug Therapy, Combination ; Humans ; Lung Neoplasms ; Male ; Recurrence ; Thrombocytopenia