Recent advances in bronchoscopy have led to changes in clinical diagnostics and therapeutics in pulmonary medicine. In diagnostic bronchoscopy, there have also been new developments in endobronchial ultrasound technology which may be incorporated into clinical practice in the near future. Functional bronchoscopy, which evaluates information such as airway pressure, airflow, or gas exchange, suggests promising clinical advances in the near future. In therapeutic bronchoscopy, bronchoscopic volume reduction is a novel approach for the treatment of severe emphysema. In this review, seven recently published articles representing current advances in bronchoscopy are summarized and discussed.
Bronchoscopy ; Emphysema ; Pulmonary Medicine ; Pulmonary Surgical Procedures

Passive smoking is an important risk factor for lung cancer and its impact might be more significant than generally appreciated in Korea. We reviewed the literatures that support the biologic plausibility of Environmental Tobacco Smoke (ETS) causing lung cancer and summarized epidemiological evidences. Because ETS exposure is a preventable risk factor, more social efforts should be directed to reduce ETS exposure.
Korea ; Lung Neoplasms* ; Lung* ; Risk Factors ; Smoke ; Tobacco ; Tobacco Smoke Pollution*

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is becoming a standard method for invasive mediastinal staging and for the diagnosis of paratracheal and peribronchial lesions. It is essential to understand the technical aspects of EBUS-TBNA to ensure safe and efficient procedures. In this review, we discuss the practical aspects to be considered during EBUS-TBNA, including anesthesia, manipulation of equipment, understanding mediastinal ultrasound images, target selection, number of aspirations needed per target, sample handling, and complications.
Anesthesia ; Aspirations (Psychology) ; Bronchoscopy ; Handling (Psychology) ; Lung Neoplasms ; Needles* ; Ultrasonography

BACKGROUND: Pulmonary tuberculosis(TB) is still prevalent and remains a significant clinical problem for the elderly. However, the disease presents in many ways, and there are frequent adverse drug reactions that may prevent the early diagnosis and treatment of elderly TB patients compared to the young. The purpose of this study was to determine whether or not there are any differences in the clinical feature of pulmonary tuberculosis(TB) in both the diagnosis and treatment between the young (less than 64 years) and the elderly (65 years and more). METHODS: The medical records of 125 young and 70 elderly pulmonary TB patients, who were diagnosed with and treated for pulmonary TB at the Seoul Municipal Boramae Hospital from November 1991 to January 1997, were analyzed retrospectively. RESULTS: Anorexia(12% vs. 31.4%), general weakness (20.0% vs. 54.3%), dyspnea(21.6% vs. 37.1%) and an abnormal mentality (0.8% vs. 15.7%) were more frequent presenting symptoms in elderly TB patients, whereas hemoptysis (32.8% vs. 10.0%) and fever (BT>37℃ 58.4% vs. 35.7%) were more frequent in the young. The elderly had a higher number of cardiovascular and chronic obstructive pulmonary diseases as underlying illnesses. In chest PA, there were no differences in the location of the TB lesion, but the appearances were initially diagnosed more frequently as pneumonia or lung cancer (8.8% vs. 30.0%, p<0.05) in the elderly. There was no difference in the detection rate of acid fast bacilli(AFB) in the sputum between the two groups. There were no differences in the treatment response and follow-up loss. However, adverse drug reactions (13.6% vs. 45.7%, p<0.05), and changes in medication (4.9% vs. 25.7%, p<0.05) during treatment occurred more frequently in the elderly. One among the 125 young patients died from tuberculosis whereas 6 among the 70 elderly patients died from the disease. CONCLUSION: Because the clinical and radiological presentations were more atypical, a sputum AFB smear and culture should be done immediately in the elderly who are TB. The elderly experienced more frequent adverse drug reactions and mortality during treatment, but the response to treatment was good and rapid.
Aged* ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Early Diagnosis ; Fever ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung Diseases, Obstructive ; Lung Neoplasms ; Medical Records ; Mortality ; Pneumonia ; Retrospective Studies ; Seoul ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Sarcoidosis is an inflammatory disease involving multiple-organs with an unknown cause. The new onset of sarcoidosis associated with therapeutic agents has been observed in 3 clinical settings; tumor necrosis factor antagonists in autoimmune rheumatologic diseases, interferon alpha with or without ribavirin in patients with chronic hepatitis C or melanoma, and antineoplastic agent-associated sarcoidosis in patients with hematologic malignancies. Here, we report a female patient who developed sarcoidosis after capecitabine treatment as an adjuvant chemotherapy for sigmoid colon cancer. To our knowledge, this is the first report of a capecitabine-induced sarcoidosis.
Chemotherapy, Adjuvant ; Deoxycytidine ; Female ; Fluorouracil ; Hematologic Neoplasms ; Hepatitis C, Chronic ; Humans ; Interferon-alpha ; Melanoma ; Ribavirin ; Sarcoidosis ; Sigmoid Neoplasms ; Tumor Necrosis Factor-alpha ; Capecitabine

BACKGROUND: The importance of pro-inflammatory cytokines, especially tumor necrosis factor α(TNF-α) and interleukin-1β(IL-1β), have been extensively documented in the generation of inflammatory lung disease. Lung epithelial cells are also actively involved in initiating and maintaining inflammation by producing pro-inflammatory mediators. Understanding the mechanism of pro-inflammatory cytokine expression in lung epithelial cells is crucial to the development of new therapeutic modalities for inflammatory lung disease. Transcription of most pro-inflammatory cytokines is dependent on the actiation of NF-κB. However, the relationship between pro-inflammatory cytokine expression and NF-κB/IκB pathway in lung epithelial cells is not clear. METHODS: BEAS-2B, A549, NCI-H719 cells were stimulated with IL-1β or TNF-α at various times, and then IL-8 and TNF-αmRNA expressions were assayed by Northern blot analysis. IL-1β or TNF-α-induced NF-κB activation was assessed by the nuclear translocation of p65 NF-κB subunit. The degradation of IκBα and IκBβ by IL-1βor TNF-α stimulation was assayed by Western blot analysis. The phosphorylation of IκBαwas evaluated by Western blot analysis after pre-treating cells with proteasome inhibitor followed by IL-1β or TNF-α stimulation. The basal level of IKKα expression was evaluated by Western blot analysis. RESULTS: IκBαand IκBβ was repidly degraded after 5 minutes of incubation with IL-1β or TNF-α in BEAS-2B, A549, and NCI-H157 cells. The activation of NF-κB and the induction of IL-8 and TNF-α mRNA expressions were observed by IL-1β or TNF-α stimulation in these cells. In contrast, neither the changes in NF-κB/IκB pathway nor IL-8 and TNF-α mRNA expression was induces by IL-1β or TNF-α stimulation in NCI-H719 cell. IL-1β and TNF-α-induced IκB phoshorylation was observed in BEAS-2B, A549, and NCI-H157 cells, but not in NCI-H719 cells. The basal level of IKKα expression was not different between cells. CONCLUSION: NF-κB/IκB pathway plays an important role in the ixpression of pro-inflammatory cytokine in most lung epithelial cells. The absence of the effect on NF-κB/IκB pathway in NCI-H719 cells seems to be due to the defect in the intracellular signal transduction pathway upstream to IKK.
Blotting, Northern ; Blotting, Western ; Cytokines ; Epithelial Cells* ; Inflammation ; Interleukin-8 ; Lung Diseases ; Lung* ; Phosphorylation ; Proteasome Inhibitors ; RNA, Messenger ; Signal Transduction ; Tumor Necrosis Factor-alpha

In 2005, a group of mycolic acid-containing bacteria was characterized as belonging to a novel genus, Segniliparus with species Segniliparus rugosus and S. rotundus. We report a case of the S. rugosus isolated from a 54-year-old woman with radiologic features mimicking that of non-tuberculous mycobacteriosis (NTM). When the patient first visited our hospital, an acid-fast bacteria (AFB) smear tested positive and Mycobacterium tuberculosis polymerase chain reaction (TB PCR) was negative in the bronchoalveolar lavage sample. After 2 months, the growing colonies were reported as NTM, but could not be identified because they had died. One year after the initial visit, induced sputum samples showed the same results, positive AFB smear and negative TB PCR. At this point, the growing colonies were identified as S. rugosus. Therefore, we should consider Segniliparus genus as a differential diagnosis for AFB in respiratory specimens in addition to the genus Mycobacterium.
Actinomycetales ; Bacteria ; Bronchoalveolar Lavage ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Mycobacterium ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Sputum

The stomach is a rare site for metastasis, with autopsy incidence rates of 0.2% to 1.7%. This low rate makes diagnosis of metastatic gastric cancer challenging for clinicians. The authors report a case of a 64-year-old man diagnosed with gastric metastasis of primary lung adenocarcinoma that was initially mistaken for primary gastric cancer, as well as a review of the medical literature.
Adenocarcinoma ; Autopsy ; Hematemesis ; Hemoptysis ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms

Diffuse pulmonary ossification is rare disease of unknown etiology. Since the first description by Luschka in 1856, about 140 cases have been reported worldwide, but no such case has been reported in Korea yet. We report 40-year-old woman who was diagnosed as diffuse nodular pulmonary ossification on open lung biopsy. She has no respiratory symptoms & physical findings and no previous disease history. She was incidentally found to have multiple pulmonary nodules on roentgenographic examination. Open lung biopsy was done for above lesion and S he was proven to have diffuse nodular pulmonary ossification. She was followed by roentgenographic examination and showed no progression.
Adult ; Biopsy ; Female ; Humans ; Korea ; Lung ; Multiple Pulmonary Nodules ; Rare Diseases

BACKGROUND: The NF-kappaB transcription factors control various biological processes including the immune response, acute phase reastion and cell cycle regulation. NF-kappaB complexes are retained in the cytoplasm in the basal state and various stimuli cause a translocation of the NF-kappaB complexes into the nucleus where they bind to the kappaB elements and regulate the transcription of the target genes. Recent reports also suggest that NF-kappaB proteins are involved in oncogenesis, tumor growth and metastasis. High expression of NF-kappaB expression was reported in many cancer cell lines and tissues. The constitutive activation of NF-kappaB was also reported in several cancer cell lines supporting its role in cancer development and survival. The anti-apoptotic action of NF-kappaB is important for cancer survival. NF-kappaB also controls the expression of several proteins that are important for cellular adhesion (ICAM-1, VCAM-1) suggesting a role in cancer metastasis. In lung cancer, high expression levels of the NF-kappaB subunit p50 and c-Rel were reported. In fact, high expression does not mean a high activity, and the activation pattern of NF-kappaB in lung cancer has not been reported. METHODS: In this study, the NF-kappaB nuclear binding activity in the basal and TNF-alpha stimulated states were examined in various lung cancer cell lines and compared with the normal bronchial epithelial cell line. Twleve lung cancer cell lines including the non-small cell and small cell lung cancer cell lines (A549, NCL-H358, NCI-H441, NCL-H522, NCL-H2009, NCI-H460, NCI-H1229, NCI-H1703, NCL-H157, NCL-H187, NCI-H417, NCI-H526) and BEAS-2B bronchial epithelial cell line were used. To evaluate the NF-kappaB expression amd DNA binding activity, western blot analysis and an electrophoretic mobility shift assay with the nuclear protein extracts. RESULTS: The basal expressions of the p50 subunits were observed in the BEAS-2B cell line and all lung cancer cell lines except for NCI-H358 and NCI-H460. The expression levels of p65 and p50 were increased 30 minutes after stimulation with TNF- alpha in BEAS-2B and in 10 lung cancer cell lines. In the NCI-H358 and NCI-H460 cell lines, p65 expression was not observed in the basal and stimulated states and the two p50 related protein levels were higher after stimulation with TNF-alpha. These new proteins were smaller than p50 and are thought to be variants of p50. In the basal state, NF-kappaB was nearly activated in the BEAS-2B and all lung cancer cell lines. The DNA binding activity of the NF-kappaB complexes was markedly higher after stimulation with TNF-alpha. In the BEAS-2B and all lung cancer cell lines except for NCI-H358 and NCI-H460, the activated NF-kappaB complex was a p65/p60 heterodimer. In the NCI-H358 and NCI-H460 lung cancer cell lines, the NF-kappaB complex was variant of a p50/p50 homodimer. CONCLUSION: The NF-kappaB activation pattern in the lung cancer cell lines and the normal bronchial epithelial cell lines was similar except for the activatio of a variant of the p50/p50 homodimer in some lung cancer cell lines.
Acute-Phase Reaction ; Biological Processes ; Blotting, Western ; Carcinogenesis ; Cell Cycle ; Cell Line* ; Cytoplasm ; DNA ; Electrophoretic Mobility Shift Assay ; Epithelial Cells ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis ; NF-kappa B* ; Nuclear Proteins ; Small Cell Lung Carcinoma ; Transcription Factors ; Tumor Necrosis Factor-alpha*