BACKGROUND: The intrapleural hypofibrinolysis is caused by mainly excessive concentration of pleural plasminogen ogen activator inhibitor-1 antigen(PAI-1 Ag), which binds tissue type plasminogen activator. In pleural inflammation induced by sclerosing agents for pleurodesis, levels of pleural PAI-1 antigen increase in relation to decreing D-dimer levels. It has been known that the pleural mexothelial cells have the capability of secreting PAI-1 Ag in response to inflammation in vivo. Therefore, we estimated whether pleural inflammation changes the balance between fibrinolytic and coagulative properties in exudative pleural effusions. METHOD: The thirty cases was included in our study. We determined the pleural levels of glucose, lactic dehy-drogenase(LDH), pH and the counts of white blood cell(WBC), polymorpho leukocyte(PMN), lymphocyte as the parameters of pleural inflammation and cellular components of pleural fluid. The plasma level of fibrinogen in fluid and the neutrophil count in blood were determined. The levels of D-dimer, PAI-1 Ag and thrombin-antithrombin lll complex(TAT) were determined by ELISA(Behring, Marburg, Germany). RESULTS: The causes of pleural effusion were as following : tuberculous in 14 cases, malignant in 10 cases and parapneumonic in 6 cases. The levels of pleural D-dimer, PAI-1 Ag and TAT was significantly higher than that of plasma(p<0.001). The severity of pleural inflammation did not correlated with pleural D-dimer, PAI-1 Ag, TAT and their plaxma levels. But the level of pleural TAT correlated with pleural WBC and lymphocyte count. CONCLUSION: We found the the severity of pleural inflammations did not correlated with pleural D-dimer, PAI-1 Ag, TAT and the possibility of local production of PAI-1 antigen is present.
Fibrinogen ; Fibrinolysis* ; Glucose ; Hydrogen-Ion Concentration ; Inflammation ; Lymphocyte Count ; Lymphocytes ; Neutrophils ; Plasma ; Plasminogen ; Plasminogen Activator Inhibitor 1 ; Pleural Effusion ; Pleurodesis ; Sclerosing Solutions ; Tissue Plasminogen Activator

Eosinophilia accompanied by eosinophilic invasion and organ dysfunction may develope idiopathic hypereosinophilic syndrome. Any organ can be involved including bone marrow, lung, skin, heart, gastrointestinal tract and nervous system. Cough, dyspnea, pleural effusion or chest pain are common pulmonary manifestation, and they may be attributed to parenchymal infiltration, pulmonary embolism or heart failure. We report a 43-year-old woman with idiopathic hypereosinophilic syndrome involving bone marrow, skin, and lung. The patient developed acute dyspnea and chest pain. High resolution CT demonstrated multiple wedge-shaped segmental involvement with pleural effusion thought to be a pulmonary infarction or heart failure. Echocardiography could not find any abnormality. Lung biopsy showed interstitial eosinophilic infiltration with increased eosinophils in BAL fluid. She was treated with high dose corticosteroid and hydroxyurea. Within few days, most of her symptoms disappeared and chest radiography nearly cleared up.
Adult ; Biopsy ; Bone Marrow ; Chest Pain ; Cough ; Dyspnea ; Echocardiography ; Eosinophilia ; Eosinophils ; Female ; Gastrointestinal Tract ; Heart ; Heart Failure ; Humans ; Hydroxyurea ; Hypereosinophilic Syndrome* ; Lung ; Nervous System ; Pleural Effusion ; Pulmonary Embolism ; Pulmonary Infarction ; Radiography ; Skin ; Thorax

BACKGROUND: Surgical intervention is known as the principle management for hemoptysis of significant amount But surgical procedure is applicable 13 only small number of patients because of increased mortality in emergency surgery and various functional and structural problems after lung resection. Bronchial artery embolization(BAE) has been used as an alternative interventional technique for immediate control of patients with increased risk for surgery due 19 recurrent or massive hemoptysis. BAE also has limitations such as recurrent bleeding after procedure and its role for the application to small amount of hemoptysis is still not established. METHOD: To evaluate immediate and long term effectiveness of BAE, we analysed 65 patients with hemoptysis according to therapeutic modalities they received ; BAE versus conservative management. RESULTS: The success rate for immediate control of hemoptysis was significantly higher in BAE group with 43 cases(100%) among 43 cases compared with 17 cases(77%) among 22 cases in conservative group (p<0.001). The disease control duration was 19.5α8.06 months in BAE group and 18.8α6.06 months in conservative group(p>0.05). The therapeutic response in BAE group was 82%(36/43 cases) and 95%(21/22 cases) in conservative group(p>0.05). According to the amount of hemoptysis, the therapeutic response were seen in 91%(29/32 cases) in less than 100ml and 85%(28/33 cases) in 100~400ml (p>0.05). According to the manifestation of hemoptysis, the therapeutic response in groups of recurrent and nonrecurent were 87%(20/23 cases) and 88%(37/42 cases)(p>0.05). CONCLUSION: The difference of therapeutic response between BAE and conservative group in patients with small amounts of hemoptysis was not found except for immediate control of hemoptysis.
Bronchial Arteries* ; Emergencies ; Hemoptysis* ; Hemorrhage ; Humans ; Lung ; Mortality

BACKGROUND: Abnormalities of the peripheral blood are frequent and varied in patients with miliary tuberculosis. Anemia,leukopenia, thrombocytopenia, pancytopenia, monocytosis, basophilia, eosinophilia and leukemoid reactions have been reported. These abnormalities are more frequent in patients with positive bone marrow study. In this report, we evaluated clinical, hematological and immunological features in patients with miliary tuberculosis in order to know whether difference is existed between "bone marrow biopsy positive group(pathologically proven to miliary tuberculosis)" and "negative group". METHOD: Clinical evaluation, serum ADA, sIL-2R, and T-lymphocyte subsets were measured in 40 patients with miliary tuberculosis who received bone marrow biopsy. RESULTS: 1) The average age of patients was 39 year-old. There were 23 male and 17 female patients. Associated extrapulmonary tuberculosis are 9 CNS tuberculosis, 6 joint tuberculosis, and 2 tuberculous pleurisy. 2) Sixteen of the 40 patients were positive bone marrow biopsy(60%). 3) Sixteen of the 40 patients(60%) had anemia(ll positive patients: 13 negative patients). Leukopenia occurred in 12 per cent(4:l). Thrombocytopenia was noted in 10%(3:1). 4) The mean value of serum ADA was 83 U/L(90 U/L: 70.6 U/L, p=0.23). 5) The mean activity of Soluble IL-2 receptor was 4,643 pmol/L(6840+/-7446 pmol/L: 1,897 +/- 1,663 pmol/L, p=0.06). 6) In the T lymphocyte subsets, the percent of T-lymphocytes was 64%(62%:73%, p=0.2). In some patients(9), T4 and T8 ratio in BAL fluid(1.97+/-1.2) was higher than that in the peripheral blood(1.16+/-0.5). CONCLUSION: Bone marrow examination are diagnostic in 60% of cases of miliary tuberculosis. Percents of the total T lymphocyte and helper T cell in BAL are more elevated than in peripheral blood. There was no significant difference in peripheral blood abnormalities and marker of T lymphocyte activation between the bone marrow biopsy positive and negative group.
Biopsy ; Bone Marrow Examination ; Bone Marrow* ; Eosinophilia ; Female ; Humans ; Leukemoid Reaction ; Leukopenia ; Lymphocyte Activation ; Lymphocytes ; Male ; Pancytopenia ; Receptors, Interleukin-2 ; T-Lymphocyte Subsets ; T-Lymphocytes ; Thrombocytopenia ; Tuberculosis ; Tuberculosis, Miliary* ; Tuberculosis, Osteoarticular ; Tuberculosis, Pleural

Malignant pleural effusions (MPEs) are an important clinical problem in patients with neoplastic disease. They can occur as the initial presentation of cancer, a delayed complication in patients with previously diagnosed malignancies, or the first manifestation of cancer recurrence after therapy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, and ovaries. However, almost all tumor types have been reported to cause MPEs. Regardless of the etiology, the median survival from clinical recognition is 4 months. New imaging modalities assist the evaluation of patients with a suspected MPE. However cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Management of an MPE remains palliative. Managements are directed toward removing pleural fluids and when appropriate, performing pleurodesis or initiating long-term drainage to prevent fluid reaccumulation. Talc pleurodesis is still the choice of treatment although concerns about its safety remain. Several factors such as performance status, expected survival, lung re-expansion following pleural fluid drainage and co-morbidities should be considered before the treatment.
Breast ; Drainage ; Female ; Humans ; Lung ; Lymphoma ; Mesothelioma ; Ovary ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurodesis ; Recurrence ; Talc

PURPOSE: Circumcision is widely practiced in Korea, but the general principles of circumcision are not established. To date, several studies on the public's attitude regarding circumcision have been reported, but there have been few studies on doctor's opinions. This study was designed to evaluate the difference of clinical opinion regarding circumcision between the doctors in South Korea. MATERIALS AND METHODS: A questionnaire was sent to the doctors working in university hospitals and primary clinics. The items of the questionnaire were for and against circumcision, the actual clinical practice of circumcision, the recommendation of circumcision, the reasons for it and the difficulties in practicing circumcision. RESULTS: Of the 1,000 questionnaires we sent out, 725 were returned. Of 233 urologists, 211 (91%) agreed with performing circumcision and of the 420 doctor of other department, 319 (76%) agreed with performing circumcision. A total of 530 doctors (81%) agreed with performing circumcision. Both the urologists and the doctors practicing in other departments selected hygiene as the reason for practicing circumcision, 155 (73%) and 254 (86%), respectively. The responses to the questionnaire revealed corresponding opinions regarding circumcision between the urologists and doctors of other departments. CONCLUSIONS: Most Korean men were found to be circumcised and they were very much satisfied with the results. In other countries, there was a difference in clinical opinions between doctors concerning circumcision; however, Korean doctors revealed a corresponding opinion regarding circumcision.
Circumcision, Male* ; Female ; Hospitals, University ; Humans ; Hygiene ; Korea ; Male ; Surveys and Questionnaires

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

No abstract available.
Lung Neoplasms* ; Lung* ; Radon*

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