BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

A lung cyst is an air-filled lucent structure surrounded by a thin wall. The presence of multiple intrapulmonary cysts is defined as cystic lung disease. Although cystic lung disease is rare, incidental detection has increased significantly in recent years by screening using computed tomography. There are many conditions that can mimic lung cysts and cause cystic lung disease. Clinical, radiographic, and histologic findings are all necessary for a proper diagnosis, and multidisciplinary approaches are frequently required. The aim of this report is to review the causes and characteristics of cystic lung disease to better understand and improve treatment.
Birt-Hogg-Dube Syndrome ; Histiocytosis, Langerhans-Cell ; Hydrazines ; Lung ; Lung Diseases ; Lymphangioleiomyomatosis ; Mass Screening

OBJECTIVES: This study was conducted to provide data for the establishment of a practical and the effective exercise program for managing the musculoskeletal symptoms of workers who are employed in small and medium sized enterprises. METHODS: The risk factors related to musculoskeletal disease management were chosen according to the relevant literatures, and were based on advise from experts on the Delphi method. Questionnaires on selected risk factors (with a 5-point Likert scale) were given to 785 subjects who worked in small and medium sized enterprises. The subjects were then classified in the risk group when they had the symptoms and recorded at least 3 points. From those subjects in the risk group, those who had both work-related factors and general characteristics factors (with an average of at least 3 points) were further classified as the high risk group. We performed a 12-week musculoskeletal exercise program for the low and high risk groups to analyze their changes in symptoms and complaints in order to estimate the effectiveness of the exercise program. RESULTS: Out of 785 subjects, 454(57.8%) were in the risk group of musculoskeletal diseases and 121(15.4%) were in the high risk group. According to multiple logistic regression analysis of the factors for the musculoskeletal symptoms in the low risk group, the significant risk factors were sex and personal disease related with musculoskeletal disease, while the risk factors in the high risk group were age, sex, and personal disease related with musculoskeletal disease. After the 12-week exercise program was performed by the low risk group, the number of musculoskeletal symptom complaints in the control group did not significantly changed, whereas for the intervention group, the number of musculoskeletal symptom complaints significantly declined for all parts of the body. After the 12-week exercise program performed by the high risk group, the number of musculoskeletal symptom complaints in the control group was significantly enhanced for the arm and elbow parts. In the intervention group, the complaint rate for musculoskeletal symptoms significantly declined only for the low back. CONCLUSION: The musculoskeletal symptoms were significantly improved by the exercise program in the low risk group, but not in the high risk group. It is suggested that control measures on administrative and/or work related factors, in addition to the exercise program should be considered simultaneously for the control of musculoskeletal symptoms in groups at high risk of musculoskeletal disease.
Arm ; Elbow ; Humans ; Logistic Models ; Musculoskeletal Diseases ; Questionnaires ; Risk Factors

BACKGROUND: Chronic obstructive pulmonary disease (COPD), is a chronic inflammatory disorder. We evaluated whether white blood cell (WBC) count, is associated with the severity of COPD, independent of other inflammatory conditions, such as metabolic syndrome. METHODS: The WBC counts were compared between 1227 COPD patients and 8679 non-COPD adults older than 40. The relationships between the WBC count, lung function, and symptoms score in COPD patients, were determined, using general linear regression analyses. RESULTS: The WBC count was negatively associated with forced vital capacity (FVC, L), FVC (% predicted), forced expiry volume in one second (FEV₁, L), and FEV₁ (% predicted) in COPD patients. Additionally, the WBC count was independently associated with the quality of life measure, by EQ5D-index score. However, this relationship between WBC count, and disease severity, was not significant in current smokers, because of the confounding effect of smoking, on the WBC count. CONCLUSION: The WBC count is associated with current smoking status and COPD severity, and a risk factor for poor lung function, and quality of life, especially in non-currently smoking COPD patients. The WBC count can be used, as an easily measurable COPD biomarker.
Adult ; Humans ; Leukocyte Count* ; Leukocytes* ; Linear Models ; Lung ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Respiratory Function Tests ; Risk Factors ; Smoke ; Smoking ; Vital Capacity

A 49-year-old Chinese woman presented to Ilsan Paik Hospital emergency department with fever and general weakness. Chest computed tomography revealed cavity and peribronchial nodules and consolidation in the right upper lobe. A diagnosis of suspected active tuberculosis was made. A review of the patient’s medication prescribed at another hospital indicated that she had been taking antituberculosis medication for several months. Initially, the patient had anemia and mild thrombocytopenia. In addition, she developed leukopenia and her thrombocytopenia worsened. After discontinuing the antituberculosis medication, her pancytopenia initially improved, but was aggravated again after starting on antituberculosis drugs. Despite discontinuing the antituberculosis medication again, her pancytopenia progressed. As she had a high anti-nuclear antibody titer, another systemic disease was suspected. She was diagnosed with systemic lupus erythematosus and her leukopenia and thrombocytopenia improved after initiation of treatment with systemic steroids and antimalarial drugs

A 49-year-old Chinese woman presented to Ilsan Paik Hospital emergency department with fever and general weakness. Chest computed tomography revealed cavity and peribronchial nodules and consolidation in the right upper lobe. A diagnosis of suspected active tuberculosis was made. A review of the patient’s medication prescribed at another hospital indicated that she had been taking antituberculosis medication for several months. Initially, the patient had anemia and mild thrombocytopenia. In addition, she developed leukopenia and her thrombocytopenia worsened. After discontinuing the antituberculosis medication, her pancytopenia initially improved, but was aggravated again after starting on antituberculosis drugs. Despite discontinuing the antituberculosis medication again, her pancytopenia progressed. As she had a high anti-nuclear antibody titer, another systemic disease was suspected. She was diagnosed with systemic lupus erythematosus and her leukopenia and thrombocytopenia improved after initiation of treatment with systemic steroids and antimalarial drugs

OBJECTIVES: We evaluated changes in mammographic density (MMGD) after hormone therapy (HT) using levonorgestrel (LNG) in Korean postmenopausal women. METHODS: In this retrospective study, 58 healthy postmenopausal women with no history of prior HT were included. Twenty-three women were given a cyclic regimen of estradiol valerate (E) 2 mg/day + LNG 0.075 mg/day and 25 untreated women served as a negative control and 10 women treated with continuous combined regimen of conjugated equine estrogen (CEE) 0.625 mg/day + medroxyprogesterone acetate (MPA) 2.5 mg/day as a positive control. Mammography was obtained at baseline and 1 year later, and MMGD was assessed. In addition, the change in the proportion of the dense area after HT was assessed using the J-image program. Data were analyzed with analysis of variance and chi-square or Fisher's exact test. RESULTS: There were no significant differences in baseline characteristics among three groups. After 1 year of HT, increase of BI-RADS grade in CEE + MPA group (7/9, 77.8%) was higher than in E + LNG group (2/16, 12.5%; P = 0.001). But there was no difference between untreated group (1/19, 5.3%) and E + LNG group (2/16, 12.5%; P = 0.446). In subgroup analysis of women with BI-RADS grade 3 at baseline, no significant difference. Changes in the proportion of dense areas assessed by the J-image program showed similar results. Regression analysis revealed that there was no correlation between baseline dense area and changes after HT in E + LNG group. CONCLUSION: HT using LNG did not influence MMGD in Korean postmenopausal women. Further study on breast cancer risk may be needed.
Breast Neoplasms ; Estradiol ; Estrogens ; Female ; Humans ; Levonorgestrel ; Mammary Glands, Human ; Mammography ; Medroxyprogesterone Acetate ; Retrospective Studies

OBJECTIVES: We evaluated changes in mammographic density (MMGD) after hormone therapy (HT) using levonorgestrel (LNG) in Korean postmenopausal women. METHODS: In this retrospective study, 58 healthy postmenopausal women with no history of prior HT were included. Twenty-three women were given a cyclic regimen of estradiol valerate (E) 2 mg/day + LNG 0.075 mg/day and 25 untreated women served as a negative control and 10 women treated with continuous combined regimen of conjugated equine estrogen (CEE) 0.625 mg/day + medroxyprogesterone acetate (MPA) 2.5 mg/day as a positive control. Mammography was obtained at baseline and 1 year later, and MMGD was assessed. In addition, the change in the proportion of the dense area after HT was assessed using the J-image program. Data were analyzed with analysis of variance and chi-square or Fisher's exact test. RESULTS: There were no significant differences in baseline characteristics among three groups. After 1 year of HT, increase of BI-RADS grade in CEE + MPA group (7/9, 77.8%) was higher than in E + LNG group (2/16, 12.5%; P = 0.001). But there was no difference between untreated group (1/19, 5.3%) and E + LNG group (2/16, 12.5%; P = 0.446). In subgroup analysis of women with BI-RADS grade 3 at baseline, no significant difference. Changes in the proportion of dense areas assessed by the J-image program showed similar results. Regression analysis revealed that there was no correlation between baseline dense area and changes after HT in E + LNG group. CONCLUSION: HT using LNG did not influence MMGD in Korean postmenopausal women. Further study on breast cancer risk may be needed.
Breast Neoplasms ; Estradiol ; Estrogens ; Female ; Humans ; Levonorgestrel ; Mammary Glands, Human ; Mammography ; Medroxyprogesterone Acetate ; Retrospective Studies

The etiology of acute pericarditis is often thought to be autoimmune, and Graves' disease has been reported in a few series to manifest as acute pericarditis. Since the etiology of recurrent pericarditis is known to be more associated with autoimmune causes, recurrent acute pericarditis may be a potential cardiovascular complication of Graves' disease. We report a case of recurrent acute pericarditis that was presumed to be associated with Graves' disease which was controlled after management of the problem of the thyroid.
Graves Disease ; Pericarditis ; Thyroid Gland

Rhinovirus infection is typically associated with the common cold and has rarely been reported as a cause of severe pneumonia in immunocompetent adults. A 55-year-old previous healthy woman, who consumed half a bottle of alcohol daily, presented with respiratory failure after one week of upper respiratory infection symptoms. Radiography revealed bilateral, diffuse ground glass opacity with patchy consolidation in the whole lung field; bronchoalveolar lavage fluid analysis indicated that rhinovirus was the causative organism. After five days of conservative support, the symptoms and radiographic findings began to improve. We report this rare case of rhinovirus pneumonia in an otherwise healthy host along with a review of references.
Adult* ; Alcohol Drinking ; Bronchoalveolar Lavage Fluid ; Common Cold ; Female ; Glass ; Humans ; Lung ; Middle Aged ; Pneumonia ; Radiography ; Respiratory Insufficiency* ; Rhinovirus*