Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retoperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic solerosing mediastinitis with orbital fibrous dysplasia of unknown cause, which was confirmed by open lung biopsy, so reported it with a review of literature.
Biopsy ; Cholangitis, Sclerosing ; Eating ; Fibrosis* ; Hemorrhage ; Humans ; Inflammation ; Lung ; Mediastinitis ; Orbit ; Retroperitoneal Fibrosis ; Steroids ; Thyroid Gland

OBJECTIVES: Organophosphates make their clinical effects after absorbed through gastrointestinal tract, lungs and skin. We commonly see the gastrointestinal tract and lung as routes of organophosphates (OP) intoxication, but there have been few reports that said the skin as a route OP intoxication. We have experienced many patients that showed OP intoxication symptoms during or after the control of pine gall midge. So we analyzed the clinical characteristics of the patients and evaluated the route of OP intoxication. METHODS: We analyzed retrospectively 26 cases who were diagnosed as 'OP intoxication after control of pine gall midge' from June 1 1995 to July 31 1996. RESULTS: 1) The mean age of the cases, mean duration of work and mean initial cholinesterase level were 52 years, 11.9 days, 318.2U/L respectively. And the over all ratio of male to female was 11:15. 2) All cases were engaged in drug injection and 7 cases (32%) weared mask. Face and upper body were excluded from protective clothings. 3) The cardinal symptoms were diarrhea and dizziness followed by nausea, vomiting, headache, anorexia, paralysis in order of frequency. 4 Directly contributing factors to symptom onset were rain, excessive sweating due to hot weather and direct contact. 5) Most of cases (92%) were recovered completely. 2 cases died during hospitalization due to acute respiratory failure and sepsis. Mechanical ventilation were applied in 4 cases for mean 12 days. In 2 cases, there were neurobehavioral changes as delayed neurologic sequelae. CONCLUSION: We have concluded that the route of organophosporus intoxication after the control of pine gall midge was skin (transdermal absorption). Sufficient education and protective measures should be done for preventing organophosporus intoxication in the control of pine gall midge.
Anorexia ; Cholinesterases ; Clothing ; Diarrhea ; Dizziness ; Education ; Female ; Gastrointestinal Tract ; Headache ; Hospitalization ; Humans ; Lung ; Male ; Masks ; Nausea ; Organophosphates ; Paralysis ; Rain ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Sepsis ; Skin ; Sweat ; Sweating ; Vomiting ; Weather

BACKGROUND: ADA is an enzyme found in most cells, and is involved in purine metabolism, but its chief role concerns the proliferation and differentiation of lymphocytes, especially T-lymphocytes. For that reason ADA has been looked on as a marker of cell-mediate immunity, which is th key mechanism of the tuberculous pleural effusion. Thus, the pleural fluid ADA activity is increased in the tuberculous pleural effusion.Age associated immune deline is characterized by decreases in both B and T-lymphocyte function and the former may be largely a result of the latter. Therefore, the epleural fluid ADA activity would be lower in old rather than in young, patients with tuberculous pleural effusion. We studied the relationship between age, and pleural fluid ADA activity, in patients with tuberculous pleural effusion. METHODS: In the 46 patients with tuberculous pleural effusion enroll in this study, the pleural fluid ADA activities were measured by means of an automated kinetic method. RESULTS: The mean age of the patients was 53.0+/-22.0 years, with a male to female ratio of 30 : 16. The patients were divided into two groups, young patients, regarded as <65 and old regarded as >or=65 years with 28 and 18 patients, respectively. The pleural fluid ADA activity in both groups show significant differences : 99.4+/- 22.6 IU/L(young patients) Vs. 75.8+/-30.9 IU/L(old patients)(p<0.05), but a negative correlation with age (r=-0.311, p<0.05). CONCLUSION: Although pleural fluid ADA activity was not adequately increase, tuberculous pleural effusion, in older patients, would have to be considered clinically suspicious tuberculous pleural effusion.
Adenosine Deaminase* ; Adenosine* ; Female ; Humans ; Lymphocytes ; Male ; Metabolism ; Pleural Effusion* ; T-Lymphocytes

BACKGROUND: ADA is an enzyme found in most cells, and is involved in purine metabolism, but its chief role concerns the proliferation and differentiation of lymphocytes, especially T-lymphocytes. For that reason ADA has been looked on as a marker of cell-mediate immunity, which is th key mechanism of the tuberculous pleural effusion. Thus, the pleural fluid ADA activity is increased in the tuberculous pleural effusion.Age associated immune deline is characterized by decreases in both B and T-lymphocyte function and the former may be largely a result of the latter. Therefore, the epleural fluid ADA activity would be lower in old rather than in young, patients with tuberculous pleural effusion. We studied the relationship between age, and pleural fluid ADA activity, in patients with tuberculous pleural effusion. METHODS: In the 46 patients with tuberculous pleural effusion enroll in this study, the pleural fluid ADA activities were measured by means of an automated kinetic method. RESULTS: The mean age of the patients was 53.0+/-22.0 years, with a male to female ratio of 30 : 16. The patients were divided into two groups, young patients, regarded as <65 and old regarded as >or=65 years with 28 and 18 patients, respectively. The pleural fluid ADA activity in both groups show significant differences : 99.4+/- 22.6 IU/L(young patients) Vs. 75.8+/-30.9 IU/L(old patients)(p<0.05), but a negative correlation with age (r=-0.311, p<0.05). CONCLUSION: Although pleural fluid ADA activity was not adequately increase, tuberculous pleural effusion, in older patients, would have to be considered clinically suspicious tuberculous pleural effusion.
Adenosine Deaminase* ; Adenosine* ; Female ; Humans ; Lymphocytes ; Male ; Metabolism ; Pleural Effusion* ; T-Lymphocytes

PURPOSE: Except hormonal agents and biologic response modifier, the biologic effects of chemotherapy and radiotherapy as anti-cancer therapy have the mechanism of DNA injury. They cause not only cancer cell necrosis, but also infertility, bone marrow suppression, secondary malignancy, and individual death. There are many reports to human genome or chromosomal injuries by radiation but few by chemotherapy. Therefore this study is designed for systemic evaluation of the frequency of chromosomal damage by chemotherapy. MATERIALS AND METHODS: We performed evaluation of chromosomal aberration, sister chromatid exchange, and mitotic index were examined in 3 patient with NSCLC. Two of them were stage IIIb and the other one was stage IV. Venous blood was taken from patients before chemotherapy and one day after last administration of combination chemotherapy. Microscopic examination for chromosomal aberration, chromatid aberration, and SCEs was done after cell culture and FPG stain. RESULTS: The incidence of chromatid break was 3 before chemotherapy and 26 after chemotherapy. The incidence of SCEs was 9.85 1.93 before chemotherapy and 40.47 7.12 after chemotherapy. CONCLUSION: Incidence of chromatid break and SCEs increased after combination chemotherapy.
Bone Marrow ; Carcinoma, Non-Small-Cell Lung ; Cell Culture Techniques ; Chromatids ; Chromosome Aberrations* ; DNA Damage ; Drug Therapy ; Drug Therapy, Combination ; Genome, Human ; Humans ; Incidence ; Infertility ; Mitotic Index ; Necrosis ; Radiotherapy ; Sister Chromatid Exchange

PURPOSE: We checked the levels of serum 25-hydroxyvitmain D (25OHD) in the patients with chronic kidney disease (CKD) to survey the status of vitamin D levels, to see the seasonal variations of 25OHD, and to evaluate the relationships among the levels of intact PTH, corrected calcium, and phosphorus. METHODS: We defined vitamin D insufficiency and vitamin D deficiency as serum 25-hydroxyvitamin D levels between 20 and 30 ng/mL and below 20 ng/mL, respectively. 185 patients in a single center were enlisted who categorized into 3 groups, CKD2-3, CKD4, and CKD5 by eGFR using MDRD7 equation. To see the seasonal differences of the levels of 25OHD, we collected laboratory data two times per each patient during summer division (April to September) and winter division (October to March). RESULTS: Prevalences of hypovitaminosis D were 42.8% (CKD2-3), 66.1% (CKD4), 92.8% (CKD5) in summer division and 48.7% (CKD2-3), 73.1% (CKD4), 92.8% (CKD5) in winter division. Seasonal difference of the levels of 25OHD was evident only in CKD stage 2-3 (p=0.018). Negative correlations were recognized between 25OHD and intact PTH (r=-0.2048, p<0.001), phosphorus (r=-0.1711, p=0.0011). CONCLUSION: Hypovitaminosis D is prevalent even in patients with early stages of CKD. The levels of 25OHD decreased significantly in winter division in patients with CKD stages 2-3. The levels of 25OHD were inversely correlated with those of intact PTH, phosphorus, respectively.
25-Hydroxyvitamin D 2 ; Calcium ; Humans ; Phosphorus ; Prevalence ; Renal Insufficiency, Chronic ; Seasons ; Vitamin D ; Vitamin D Deficiency

Psoas abscess is caused by primary or secondary and most commonly results from direct extension of intraabdominal infections. Staphylococcus aureus is the most common organism for psoas abscess secondary to vertebral osteomyelitis. Tuberculosis, malnutrition, alcoholism, diabetes mellitus, bone marrow failure, and steroid use are responsible for compromise in host defense and consequent increase in the relative risk of psoas abscess. We report here a case of bilateral poas abscess developed in a 58 year old patient with relapsed plasmacytoma in pelvic cavity during chemotherapy.
Abscess ; Alcoholism ; Bone Marrow ; Diabetes Mellitus ; Drug Therapy ; Humans ; Intraabdominal Infections ; Malnutrition ; Middle Aged ; Multiple Myeloma* ; Osteomyelitis ; Plasmacytoma ; Poa ; Psoas Abscess* ; Staphylococcus aureus ; Tuberculosis

Aspergillus peritonitis is a rare but serious cause of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We report 2 cases of peritonitis caused by Aspergillus niger in CAPD which were treated successfully with voriconazole and caspofungin, respectively, and catheter removal. Both patients initially received amphotericin B; however, they were not cured with the agent. We briefly discuss the proper selection of antifungal agent and the treatment duration. Previously reported cases of the CAPD peritonitis caused by A. Niger are also reviewed in this article.
Amphotericin B ; Aspergillus ; Aspergillus niger ; Catheters ; Echinocandins ; Humans ; Niger ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pyrimidines ; Triazoles

We report a case of a 25-year old man with chronic kidney disease with secondary hyperparathyroidism who had persistent elevation of serum parathyroid hormone level after the immediate total parathyroidectomy and autotransplantation. To localize supernumerary (ectopic) parathyroid gland, we checked Tc-99m MIBI scintigraphy, MDCT and PET-CT. Contrast-enhanced MDCT showed a small strong enhancing lesion over left bracheocephalic vein, and PET-CT showed multiple brown tumors. We removed the supernumerary parathyroid gland and got a rapid drop of parathyroid hormone level.
Hyperparathyroidism, Secondary ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Renal Insufficiency, Chronic ; Technetium Tc 99m Sestamibi ; Veins

OBJECTIVE: C-reactive protein (CRP), lipoprotein (a)[Lp(a)], and fibrinogen are associated with systemic inflammatory reactions. Statins have anti-inflammatory effects. However, the effect of statins on these parameters is inconsistent. We evaluated the effect of statins on inflammatory markers and variables related to changes in these markers. METHODS: A total of 390 hypercholesterolemic patients were enrolled. Atorvastatin (n=112), lovastatin (n=25), pitavastatin (n=49), rosuvastatin (n=20), and simvastatin (n=184) were administered. Lipids, CRP, Lp(a), and fibrinogen levels were measured before and after 2 months of the therapy. RESULTS: Statins reduced cholesterol, low density lipoprotein (LDL) cholesterol, and triglyceride levels by -28.9+/-9.1% (P=0.000), -41.4+/-12.4% (P=0.000), and -11.6+/-39.4% (P=0.000), respectively and increased high density lipoprotein (HDL) cholesterol level by 2.56+/-13.2% (P=0.014). CRP levels decreased from 1.23+/-1.30 to 1.14+/-1.29 mg/L (P=0.000). Lp(a) levels were not changed (P=0.91) and fibrinogen levels increased from 277.8+/-54.4 to 282.6+/-56.9 mg/dL (P=0.042). Changes in CRP levels were associated with baseline CRP levels (r=-0.56, P=0.000) and changes in HDL cholesterol levels (r=-0.14, P=0.005). Changes in Lp(a) levels were associated with changes in triglyceride (r=-0.24, P=0.000) and baseline aspartate aminotransferase level (r=0.12, P=0.015). Changes in fibrinogen levels were associated with baseline fibrinogen levels (r=-0.40, P=0.000), sex (r=0.18, P=0.001), and changes in HDL cholesterol levels (r=-0.15, P=0.003). CONCLUSION: Inflammatory markers showed different responses to statins and changes in these markers were associated with different parameters. This finding suggests that anti-inflammatory effect of statin is confined to a specific pathway of inflammation.
Aspartate Aminotransferases ; C-Reactive Protein ; Cholesterol ; Cholesterol, HDL ; Fibrinogen ; Fluorobenzenes ; Heptanoic Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Lipoprotein(a) ; Lipoproteins ; Lovastatin ; Pyrimidines ; Pyrroles ; Quinolines ; Simvastatin ; Sulfonamides ; Atorvastatin Calcium ; Rosuvastatin Calcium