BACKGROUND: A few reports of transudative malignant effusion on a small number of patients have suggested the need to perform routine cytologic examination in all cases of transudative pleural effusion, whether encountered for malignancy or not. The purpose of this study was to investigate whether cytologic examination should be performed in all cases of transudative pleural effusion for the diagnosis of malignancy. METHODS: We performed a retrospective study of 229 consecutive patients with malignant pleural effusion, proven either cytologically or with biopsy. In patients with transudative pleural effusion, we reviewed medical records, results of transthoracic echocardiography, fiberoptic bronchoscopy, chest X-ray, chest CT scan, and ultrasonogram of the abdomen. These data were examined with particular attention to identifying whether or not the malignancy was suggested on chest X-ray, examining the involvement of the superior vena cava, great vessels, and lymph nodes, determining the presence of pericardial effusion, and observing the endobronchial obstruction. RESULTS: Transudative malignant pleural effusion was observed in seven (3.1%) of the 229 patients, and was caused either by the malignancy itself (6 patients) or by coexisting cardiac diseases (1 patient). All the patients showed evidence suggesting the presence of malignancy at the time of initial thoracentesis, which facilitated the decision of most clinicians on whether to perform cytologic examination for the diagnosis of malignancy. CONCLUSION: Therefore, in all cases of transudative pleaural effusion, no clinical implications indicating malignancy were found on cytologic examination.
Biopsy ; Carcinoma/classification/*pathology/*secondary ; Exudates and Transudates ; Human ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Neoplasm Staging ; Neoplasms, Unknown Primary/*pathology ; Pleural Effusion, Malignant/metabolism/*pathology ; Retrospective Studies ; Support, Non-U.S. Gov't

PURPOSE: To evaluate the incidence of sacral insufficiency fracture in osteoporotic patients with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. MATERIALS AND METHODS: We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. RESULTS: Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (p = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (p=0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. CONCLUSION: About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral insufficiency fracture, which was not uncommon. These findings suggest the need to consider the possibility of pelvic sacral insufficiency fracture in cases of T/L spinal MRI for patients with osteoporotic compression fracture.
Bone Marrow ; Edema ; Female ; Fractures, Compression* ; Fractures, Stress* ; Hand ; Humans ; Incidence* ; Magnetic Resonance Imaging ; Male ; Osteoporosis ; Retrospective Studies ; Sacrum ; Spine*

BACKGROUND: Chronic cough is a common symptom that requires the systematic diagnostic approach for proper evaluation. Postnasal drip syndrome(PNDS), bronchial asthma, gastroesophageal reflux disease(GERD), and chronic bronchitis are among the common causes. This study was conducted to evaluate the spectrum and the frequency of the causes of chronic cough. METHODS: We prospectively evaluated 93 patients who had chronic cough despite normal chest radiographic finding. History and physical examination were done along with paranasal sinus radiograph, spirometry, bronchoprovocation test and 24-hours' ambulatory aesophageal pH monitoring as necessary. RESULTS: Forty-nine(52%) of the 93 patients had PNDS, 15 patients(16%) bronchitis, 10 patients(11%) asthma, 4 patients(4%) GERD, 7 patients(8%) both PNDS and asthma, 4 patients(4%) undiagnosed condition and 4 patients(4%) were taking ACE inhibitor. Sixty-nine percent of the patients with PNDS improved after follow up, 73% patients with bronchitis, 80% patients with asthma, 50% patients with GERD, 100% patients with both PNDS and asthma, and 100% patients with ACE inhibitor. CONCLUSION: PNDS was the most common causes of chronic cough. Bronchitis was the second and asthma the third in frequency. The etiology of chronic cough can be determined easily by history and physical examination, successful therapy initiated in most patients. The response to specific therapy also was important in evaluation of chronic cough.
Asthma ; Bronchitis ; Bronchitis, Chronic ; Cough* ; Diagnosis ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Physical Examination ; Prospective Studies ; Radiography, Thoracic ; Spirometry

BACKGROUND: Chronic cough is a common symptom that requires the systematic diagnostic approach for proper evaluation. Postnasal drip syndrome(PNDS), bronchial asthma, gastroesophageal reflux disease(GERD), and chronic bronchitis are among the common causes. This study was conducted to evaluate the spectrum and the frequency of the causes of chronic cough. METHODS: We prospectively evaluated 93 patients who had chronic cough despite normal chest radiographic finding. History and physical examination were done along with paranasal sinus radiograph, spirometry, bronchoprovocation test and 24-hours' ambulatory aesophageal pH monitoring as necessary. RESULTS: Forty-nine(52%) of the 93 patients had PNDS, 15 patients(16%) bronchitis, 10 patients(11%) asthma, 4 patients(4%) GERD, 7 patients(8%) both PNDS and asthma, 4 patients(4%) undiagnosed condition and 4 patients(4%) were taking ACE inhibitor. Sixty-nine percent of the patients with PNDS improved after follow up, 73% patients with bronchitis, 80% patients with asthma, 50% patients with GERD, 100% patients with both PNDS and asthma, and 100% patients with ACE inhibitor. CONCLUSION: PNDS was the most common causes of chronic cough. Bronchitis was the second and asthma the third in frequency. The etiology of chronic cough can be determined easily by history and physical examination, successful therapy initiated in most patients. The response to specific therapy also was important in evaluation of chronic cough.
Asthma ; Bronchitis ; Bronchitis, Chronic ; Cough* ; Diagnosis ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Physical Examination ; Prospective Studies ; Radiography, Thoracic ; Spirometry

Cutaneous papillomas or acrochorda usually appear after the 4th decade of life in areas with skin folds. Conventional methods of removal are associated with bleeding problems, pain and prolonged sequelae. Thus, acrochorda removal with lasers has gained attention. In this study, we compared the efficacy of two popular laser types with different wavelengths and pulse widths for removal of skin tags. A 60-year-old Korean male noticed skin tags on his neck bilaterally. All tags were treated in a single session, on one side with a picosecond (ps)-domain 532 nm Nd:YAG laser and on the contralateral side with a long-pulsed (LP) 755 nm alexandrite laser. The endpoint for the ps-532 laser was immediate whitening, while that for the LP and quasi-LP (QLP) 755 lasers were visible changes on the surface of the lesion. Antibiotic ointment was applied, dressing was done and clinical photographs were taken. Both lasers effectively removed the skin tags at all settings in a single session without bleeding and with minimal discomfort. Crust formation occurred on both sides with natural shedding within 1 to 2 weeks. Transient erythema lasted longer in the tags treated with the ps-532 laser. At the 5th month of follow-up, residual lesions were detected on the field treated with the ps-532 laser. No persistent side effects such as scarring or postinflammatory hyperpigmentation (PIH) were observed. In conclusion, both the ps-532 nm Nd:YAG and the 755 nm alexandrite lasers ensured safe and effective removal of skin tags in a single session without adverse sequelae.

Common variable immune deficiency (CVID) is the most common primary immune deficiency, which is manifested as chronic recurrent respiratory infections and hypoglobulinemia. CVID usually presents in the second or third decade of life. A 33-year-old woman was admitted with recurrent pneumococcal pneumonia with bacteremia and had very low levels of serum immunoglobulin G, M and A. This case emphasized a high index of suspiciousness for diagnosis of CVID in a mid-adulthood patient presenting with recurrent pneumonia with hypoglobulinemia.
Adult ; B-Lymphocytes ; Bacteremia ; Common Variable Immunodeficiency ; Female ; Humans ; Immunoglobulin G ; Pneumonia ; Pneumonia, Pneumococcal ; Respiratory Tract Infections

BACKGROUND: This study evaluated the accuracy of smoking habit from the data obtained from the medical records of lung cancer patients against the data obtained form face-to-face interview questionnaires METHODS: The smoking habits of 225 lung cancer patients were categorized into never smoked, ex-smoker and current smoker in face-to-face interview questionnaire and medical record taken at the time of admission for a diagnosis. The overall agreement between two sources was evaluated. The factors affecting the disagreement between two sources and the level of data omission of the smoking habits in medical records were analyzed suing multiple logistic regression. RESULTS: The smoking habit between two sources showed moderate overall agreement(Kappa (kappa)=0.60). The lowest agreement was observed in the ex-smokers(kappa=0.49). Multivariate analysis revealed an age of 65 or older to be a statistically significant factor associated with the increasing disagreement risk compared with those 64 or younger (OR 3.02; 95% CI 1.58-5.80). The omission rate of smoking habits in the medical records was 18.2%. Adenocarcinoma was shown to be a statistically significant factor of associated with an increasing omission rate compared with squamous cell carcinoma (OR 3.00; 95% CI 1.19-7.59). CONCLUSION: The smoking habits obtained from medical record moderately reflect their true behavior. However, the smoking habit data from medical record should be used with caution when being used in a clinical study or cohort study of lung cancer.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cohort Studies ; Diagnosis ; Humans ; Logistic Models ; Lung Neoplasms* ; Lung* ; Medical Records* ; Multivariate Analysis ; Questionnaires* ; Smoke* ; Smoking*

A 38-year-old woman presented with massive hemoptysis ( 200 mL/ 24 hours) occurring abruptly after generalized tonic clonic seizure. She experienced similar episodes of hemoptysis on three later occasions. Although the coexistence of hemoptysis and seizure has been reported, albeit rarely, as a clinical manifestation of postictal neurogenic pulmonary edema, massive hemoptysis after seizure is an extremely rare event with no recurrent cases of such episodes having ever been reported. The coexistence of hemoptysis and seizure increases the difficulty in diagnosis for the clinician. We describe the differential diagnosis among the diseases capable of causing seizure and hemoptysis.
Adult ; Case Report ; Diagnosis, Differential ; Epilepsy, Tonic-Clonic/*complications ; Female ; Hemoptysis/*diagnosis/etiology ; Human ; Pulmonary Alveoli ; Pulmonary Edema/complications ; Recurrence ; *Respiration, Artificial

BACKGROUND: Perfusion scans are accurate predictors of postoperative lung function. There are few previous studies aimed at predicting the postoperative exercise capacity using the perfusion scanning and those that did reported contradictory results. METHOD: We prospectively studied the preoperative spirometric, exercise tests and perfusion scans from in 49 consecutive patients who were admitted to Inha University Hospital with surgically resectable lung cancer from Jan. 1998 to Jun. 1999 29 patients who had any condition affecting the lung function and exercise capacity, or refused a surgical resection or a follow-up study were excluded. Spirometric and exercise tests were performed 6 months after operation in 20 patients. RESULTS: The predicted postoperative FEV1, FVC and TLC correlated well with the following corresponding postoperative values : γs and p value, 0.809 and 0.000 for the FEV1 ; 0.895 and 0.000 for the FVC ; 0.741 and 0.006 for the TLC, respectively. The measured postoperative exercise values were slightly higher than the postoperative exercise values predicted, VO(2max) and Wr(max), were as 112% of VO(2max) predicted and 119% of WR(max) predicted. The change in FEV1, FVC and TLC had a weak correlation with the change in VO(2max) and WR(max). CONCLUSION: The perfusion scan was a useful tool for predicting the postoperative exercise capacity. However, they had a tendency to underestimate the exercise capacity, especially in the patients who had a pneumonectomy. A weak correlation between the change in lung function and exercise capacity was obseved.
Exercise Test ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Perfusion* ; Pneumonectomy ; Prospective Studies