BACKGROUND: The costimulatory molecule 4-1BB, a member of nerve growth factor receptor/tumor necrosis factor (NGFR/TNFR) super family, is involved in cell survival and death. METHODS: In this study, female C57BL/6 (H-2(b)) mice were used as a recipient, and DBA/2 (H-2(d)) as a donor to assess a mixed lymphocyte reaction (MLR) and CTL response in vitro, and skin graft survival. IL-2, IFN level was measured by ELISA. RESULTS: Mixed lymphocyte reaction (MLR) analysis showed that 4-1BB- deficient responder cells showed enhanced cellular proliferation over littermate controls. In contrast, IL-2 production was diminished only in 4-1BB knockout cultures. The IFN expression, on the other hand, was comparable between the groups. When female C57BL/6 (H-2(b)) mice were grafted with the trunk skin of DBA/2 (H-2d) mice, the in vivo tissue destruction of 4-1BB-deficient mice was not distinct from the normal littermates. CONCLUSION: These data suggest that 4-1BB is critical for the induction of alloreactive responses in vitro but 4-1BB alone could not change the course of skin rejection in vivo.
Allografts* ; Animals ; Cell Proliferation ; Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Female ; Graft Survival ; Hand ; Humans ; Interleukin-2 ; Lymphocyte Culture Test, Mixed ; Mice* ; Necrosis ; Nerve Growth Factor ; Skin* ; Tissue Donors ; Transplants

BACKGROUND: The costimulatory molecule 4-1BB, a member of nerve growth factor receptor/tumor necrosis factor (NGFR/TNFR) super family, is involved in cell survival and death. METHODS: In this study, female C57BL/6 (H-2(b)) mice were used as a recipient, and DBA/2 (H-2(d)) as a donor to assess a mixed lymphocyte reaction (MLR) and CTL response in vitro, and skin graft survival. IL-2, IFN level was measured by ELISA. RESULTS: Mixed lymphocyte reaction (MLR) analysis showed that 4-1BB- deficient responder cells showed enhanced cellular proliferation over littermate controls. In contrast, IL-2 production was diminished only in 4-1BB knockout cultures. The IFN expression, on the other hand, was comparable between the groups. When female C57BL/6 (H-2(b)) mice were grafted with the trunk skin of DBA/2 (H-2d) mice, the in vivo tissue destruction of 4-1BB-deficient mice was not distinct from the normal littermates. CONCLUSION: These data suggest that 4-1BB is critical for the induction of alloreactive responses in vitro but 4-1BB alone could not change the course of skin rejection in vivo.
Allografts* ; Animals ; Cell Proliferation ; Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Female ; Graft Survival ; Hand ; Humans ; Interleukin-2 ; Lymphocyte Culture Test, Mixed ; Mice* ; Necrosis ; Nerve Growth Factor ; Skin* ; Tissue Donors ; Transplants

BACKGROUND: Sarcoidosis, uncommon in Korea, has variable clinical course, ranging from benign self-limited recovery to life-long disability regardless of corticosteroid therapy. The purpose of this st udy is to observe the clinical course of untreated sarcoidosis. METHODS: Twenty four patients who were confirmed as sarcoidosis by tissue diagnosis were included. For average 12month follow-up periods, subjective symptoms, radiologic findings, and parameters of pulmonary function test(FVC, FEV1, DLco) were evaluated every 3months compared between corticosteroid treated (n=5) and non-treated (n=19) patients. 'Deterioration' was defined if patients met more than one of followings (1) decrement in any parameters of pulmonary function test (2) worsening in the degree of dyspnea (3) increase in radiologic extents, and (4) newly developed extrapulmonary sarcoidosis. 'Stable' was defined as no significant interval changes in every parameters. 'Improvement' was defined as decrement of extension of the radiologic lesions without deterioration. RESULTS: Among 19 untreated sarcoidosis patient, one deteriorated, 14 improved (13 of them showed complete resolution in radiology), and 4 were remained stable. On the other hand, five corticosteroid treated patients, uveitis was developed in one, 2 improved, and 2 remained stable. CONCLUSION: These findings suggest that patient with sarcoidosis, especially those without serious extrapulmonary disease, has stable clinical course and would not need corticosteroid therapy.
Diagnosis ; Dyspnea ; Follow-Up Studies ; Hand ; Humans ; Korea ; Respiratory Function Tests ; Sarcoidosis* ; Uveitis

BACKGROUND: The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infilrate in immunocompromised hosts. METHOD: All cases presenting as a new pulmonary infilrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. RESULTS: In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy (10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematogic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules (6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. CONCLUSION: When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.
Abscess ; Amphotericin B ; Aspergillosis ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Fungi ; Glass ; Hematologic Neoplasms ; Humans ; Immunocompromised Host* ; Itraconazole ; Lung ; Mucormycosis ; Mycoses* ; Needles ; Prognosis ; Retrospective Studies ; Risk Factors ; Thoracic Surgery, Video-Assisted ; Thorax ; Transplantation ; Transplants

Invasive pulmonary aspergillosis is a disease occuring predominantly in patients with defects in immunity such as neutropenia, hematologic malignancies or with defects in cell-mediated immunity. The isolation of Aspergillus from respiratory tract of normal host usually signifies tracheobronchial colonization, making this diagnosis difficult. There are isolated case reports occuring in normal hosts but most of them were diagnosed postmortem at autopsies indicating that early diagnosis of invasive aspergillosis in normal host is difficult. We describe here a case of invasive aspergillosis in a immunocompetent host diagnosed by lung biopsy which was successfully treated with Amphotericin-B. Invasive pulmonary aspergillosis should be included as one of the differential diagnosis if a patient with pneumonic consolidation does not respond to usual therapy, even if the patient does not have any defect in immunity.
Aspergillosis ; Aspergillus ; Autopsy ; Biopsy ; Colon ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Hematologic Neoplasms ; Humans ; Immunity, Cellular ; Invasive Pulmonary Aspergillosis* ; Lung ; Neutropenia ; Respiratory System

BACKGROUND: With variable symptoms and nonspecific radiographic appearances, pulmonary embolism (PE) is a frequent and often undiagnosed cause of mortality and morbidity. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study suggested that the majority of patients undergoing ventilation-perfusion (V-Q) scan would require additional studies to establish or to exclude the diagnosis of PE. Pulmonary angiography has been regarded as gold standard for diagnosis of PE. However, it is an invasive procedure that may be associated with significant notable mo rbidity and mortality. Thus, availability of an accurate, noninvasive screening examination is highly desirable. METHOD: From October 1994 to February 1997, twenty patients (male 13, female 7, range 23-91 years, median 58 years) who were suspected as pulmonary embolism on the basis of clinical evidence and underwent the spiral volumetric computed tomography (spiral CT), were studied retrospectively to evaluate the effectiveness of spiral CT as a diagnostic tool in PE. RESULTS: PE could be excluded with spiral CT in 4 patients; diagnoses of these patients were lung cancer, pneumonia with lung abscess, bilateral pleural effusion due to congestive heart failure, nonspecific pulmonary abnormality retrospectively. One patient who disclosed high probability in V/Q scan, could be diagnosed as pneumonia with lung abscess and underlying emphysema with spiral CT. Among 4 patients who showed intermediate and low probability in V/Q scan, 3 patients could be confirmed as PE with spiral CT. Spiral CT were helpful in 3 patients, in whom V/Q scan could not be performed due to other reasons (e.g. night time, mechanical ventilation) to confirm the diagnosis of PE. Spiral CT could demonstrate embolus above lobar artery level in 11 patients, and up to segmental artery level in 5 patients. CONCLUSION: This study demonstrated that spiral CT could allow accurate demonstration of thrombotic clots in centrally localized embolism. Spiral CT could be effective, specific, noninvasive and useful diagnostic screening modality for the diagnosis of pulmonary embolism.
Angiography ; Arteries ; Cone-Beam Computed Tomography ; Diagnosis ; Embolism ; Emphysema ; Female ; Heart Failure ; Humans ; Lung Abscess ; Lung Neoplasms ; Mass Screening ; Mortality ; Pleural Effusion ; Pneumonia ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, Spiral Computed*

BACKGROUND: With variable symptoms and nonspecific radiographic appearances, pulmonary embolism (PE) is a frequent and often undiagnosed cause of mortality and morbidity. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study suggested that the majority of patients undergoing ventilation-perfusion (V-Q) scan would require additional studies to establish or to exclude the diagnosis of PE. Pulmonary angiography has been regarded as gold standard for diagnosis of PE. However, it is an invasive procedure that may be associated with significant notable mo rbidity and mortality. Thus, availability of an accurate, noninvasive screening examination is highly desirable. METHOD: From October 1994 to February 1997, twenty patients (male 13, female 7, range 23-91 years, median 58 years) who were suspected as pulmonary embolism on the basis of clinical evidence and underwent the spiral volumetric computed tomography (spiral CT), were studied retrospectively to evaluate the effectiveness of spiral CT as a diagnostic tool in PE. RESULTS: PE could be excluded with spiral CT in 4 patients; diagnoses of these patients were lung cancer, pneumonia with lung abscess, bilateral pleural effusion due to congestive heart failure, nonspecific pulmonary abnormality retrospectively. One patient who disclosed high probability in V/Q scan, could be diagnosed as pneumonia with lung abscess and underlying emphysema with spiral CT. Among 4 patients who showed intermediate and low probability in V/Q scan, 3 patients could be confirmed as PE with spiral CT. Spiral CT were helpful in 3 patients, in whom V/Q scan could not be performed due to other reasons (e.g. night time, mechanical ventilation) to confirm the diagnosis of PE. Spiral CT could demonstrate embolus above lobar artery level in 11 patients, and up to segmental artery level in 5 patients. CONCLUSION: This study demonstrated that spiral CT could allow accurate demonstration of thrombotic clots in centrally localized embolism. Spiral CT could be effective, specific, noninvasive and useful diagnostic screening modality for the diagnosis of pulmonary embolism.
Angiography ; Arteries ; Cone-Beam Computed Tomography ; Diagnosis ; Embolism ; Emphysema ; Female ; Heart Failure ; Humans ; Lung Abscess ; Lung Neoplasms ; Mass Screening ; Mortality ; Pleural Effusion ; Pneumonia ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, Spiral Computed*

Giant cell interstitial pneumonia, a synonym of (for) hard metal pneumoconiosis, is a unique form of pulmonary fibrosis resulting from an exposure to hard metal dust. A case of biopsy-proved giant cell interstitial pneumonia in the absence of appropriate history of exposure to hard metal dust is reported. The patient presented with clinical features of chronic interstitial lung disease or idiopathic pulmonary fibrosis. He worked in a chemical laboratory at a fertilizer plant(,)where he had been exposed to various chemicals such as benzene and toluene. He denied having any other hobby in his house or job at work which may have exposed him hard metal dust(.) High-resolution CT scan revealed multi-lobar distribution of ground glass opacity with peripheral and basal lung predominance. The retrieved fluid of bronchoalveolar lavage contained asbestos fiber and showed neutrophil predominance. Surgical lung biopsy was performed for a definite diagnosis. Lung specimen showed alveolar infiltration of numerous multinucleated giant cells with mild interstitial fibrosis. Upon detailed examination of the lung tissue, one asbestos body was found. An analysis for mineral contents in lung tissue was performed. Compared to with the control specimen, the amount of cobalt and several hard metal components in the lung tissue of this patient was ten times higher. We speculated that the inconsistency between occupational history and the findings of pathologic and mineralogical analyses could be explained by the difference in individual immunologic reactivity to hard metal dust despite the relatively small amount of unrecognized environmental exposure (ED: It's hard to understand what this phrase is trying to say).
Asbestos ; Benzene ; Biopsy ; Bronchoalveolar Lavage ; Cobalt ; Diagnosis ; Dust ; Environmental Exposure ; Fibrosis ; Giant Cells* ; Glass ; Hobbies ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases, Interstitial* ; Neutrophils ; Pneumoconiosis ; Pulmonary Fibrosis ; Toluene ; Tomography, X-Ray Computed

BACKGROUND: Solitary pulmonary nodule (SPN) may show different pre- sentation in tuberculosis (TB)-endemic countries. The aim of this study was to identify clinical and radiological predictors favoring benign or malignant SPN in TB-endemic region. METHODS: Two hundred one SPNs in 201 consecutive Korean patients were included (< 3 cm in diameter, all confirmed by pathology or bacteriology, 93 benign and 108 malignant diseases). For clinical parameters, age, sex, smoking status and amount, and past history of pulmonary tuberculosis and diabetes mellitus were investigated retrospectively. For radiological parameters, size, location, margin characteristics, presence of calcification, pleural tag, surrounding satellite nodule, cavitation, internal low attenuation, open bronchus sign, surrounding ground-glass opacity, enhancement pattern of the SPNs and mediastinal lymph node (LN) enlargement were analyzed on chest CT scans. RESULTS: Patients with a older age (60.7+/-9.6 vs 56.2+/-13.1, p=0.008) and more than 40-pack years smoking (27.8% vs 14.0%, p=0.017) were more frequently related with malignant than benign SPN. On chest CT scans, spiculated margin, contrast enhancement more than 20 Hounsfield unit and presence of pleural tag and mediastinal LN enlargement were more frequently observed in malignant than benign SPNs. In contrast to previous studies, satellite lesions (21.5% vs 1.9%, p < 0.001) and cavitation (20.4% vs 5.6%, p=0.001) were more frequently seen in benign than malignant SPN. Positive predictive values of benignity were 90.9% and 76.0%, respectively, when satellite lesions and cavitation were found in cases of SPN. CONCLUSION: Satellite lesions and cavitation on chest CT scan could be useful predictors for benign SPN in TB-endemic areas.
Adult ; Age Factors ; Carcinoma/pathology/radiography ; Coin Lesion, Pulmonary/*pathology/*radiography ; Female ; Human ; Korea ; Lung Neoplasms/pathology/radiography ; Male ; Middle Age ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*pathology/*radiography

No abstract available.
Drug Therapy* ; Multiple Myeloma* ; Stem Cell Transplantation* ; Stem Cells*