The levels of expressions and catalytic activities of cytochrome P450 (CYP1A1) and glutathione-S-transferase class mu (GSTM1) enzymes in lungs and their metabolic balance may be an important determinant host factor underlying lung cancer. Genetic differences in metabolism, MspI restriction sites, Ile-Val polymorphism of CYP1A1 gene, and the null genotype of GSTM1 have been reported to be associated with susceptibility to lung cancer. The present studies were undertaken to establish frequencies of the polymorphic genotypes of CYP1A1 and GSTM1 in Koreans, and to evaluate linkage disequilibrium of the genotypes associated with higher lung cancer risks among Koreans. GSTM1(-) genotype was found in 52% of control subjects, whereas it was found in 55% of lung cancer patients. The allelic variants in CYP1A1 were distributed differently in lung cancer patients and controls. The heterozygous genotype frequency of the MspI site in lung cancer patients (53%) was higher than in controls (49%). The frequency of Ile/Val genotype of CYP1A1 was low in lung cancer patients, which are mostly squamous cell carcinoma.
Adenocarcinoma/genetics ; Carcinoma, Small Cell/genetics ; Carcinoma, Squamous Cell/genetics ; Cytochrome P-450 CYP1A1/genetics* ; Gene Frequency ; Genotype ; Glutathione Transferase/genetics* ; Human ; Korea ; Linkage Disequilibrium ; Lung Neoplasms/genetics* ; Mutation ; Polymorphism (Genetics)*

To study the relationship between the urinary hippuric acid and subjective symptoms in toluene exposed workers, urinary hippuric acid was measured and subjective symptoms questionnarire was surveyed in 93 toluene exposed male workers and 96 non-exposed office male workers. The results are as follows: 1. Mean concentration of urinary hippuric acid, which is significantly higher in exposed group than in non-exposed group, was 1.3 g/l, 1.2(GM, GSD respectively) in exposed group and 0.6 g/l, 1.2(GM, GSD respectively) in non-exposed group. 2. Mean concentration of toluene in the air in the workplace, which is significantly higher in the department of coater than in the department of mixing, was 23.4 ppm, 6.2(GM, GSD respectively) in the department of mixing and 59.8 ppm, 3.4(GM, GSD respectively) in the department of coater. 3. Complained rates of subjective symptoms were significantly higher in exposed group than in non exposed group in all items. 4. In exposed group, complained rate of CNS related symptoms was higher than that of irritation related symptoms in the first part but there was no significant difference and complained rate of irritation related symptoms in the second part was significantly higher than that of CNS related symptoms. 5. In exposed group, complained rates of subjective symptoms were not compatible with dose-response relationship by the concentration of urinary hippuric acid, duration of work, department of work, and age group retrospectively.
Humans ; Male ; Retrospective Studies ; Toluene*

To obtain the useful information for the status of working environment and health management of workers in manufacturing industries, comparision of results on the status of working environmental and health management of workers for 32 manufacturing industries in Chunam area from 1988 to 1989 was carried out. The results were as follows: 1. The rate of over-PEL(Permissible Exposure Limit) to for hazardous factors decreased significantly 23.5% in 1988, 18.3% in 1989 (p<0.05) and, the highest rate of over-PEL was the stone and sand handling industry, the highest rate of over-PEL was the dusty worplace as 38.5% in 1988, 35.2% in 1989. 2. The rate of workers exposed to hazardous factors in 1988 and in 1989 was 22.4% respectively, the rate of workers checked up special health examination was 40.1% in 1988, 75.3% in 1989. In stone and sand handling an dmedicochemical industries, none of workers exposed to hazardous factors was subjected to special health examination in 1988, but 75% of workers exposed to hazardous factors had checked up in 1989. 3. The 6 industries appointed as part-time factory physician among 17 industries which were supposed to have factory physician according to the Safety and Healthy Act of Korea, 6 out of 24 industries only appointed industrial hygienist, furthermore 4 out of 6 hygienists had another duty in addition to occupational hygiene itself.
Hygiene ; Korea ; Silicon Dioxide

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous infalmmation, which was compatible with tuberculosis. Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin. In patients with severe diarrhea receining anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.
Aged ; Anti-Bacterial Agents ; Biopsy ; Chest Pain ; Clostridium difficile ; Diarrhea ; Dyspnea ; Enterocolitis, Pseudomembranous* ; Ethambutol ; Gastrointestinal Tract ; Humans ; Isoniazid ; Lung ; Metronidazole ; Mucous Membrane ; Physical Examination ; Pleural Effusion ; Respiratory Sounds ; Rifampin* ; Sigmoidoscopy ; Sputum ; Thorax ; Tuberculosis ; Vancomycin

Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually resent with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.
Diabetes Mellitus ; Humans ; Leukemia ; Lymphoma ; Mucormycosis* ; Opportunistic Infections ; Pneumonectomy

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. METHODS: A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveloar lavage or lung biopsy. RESULTS: Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD (3.27±3.15 mg/dl vs. 1.19±0.94 md/dl, p=0.030). The corresponding drop in hemoglobin level was 2.69±1.26 g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by 1.38±4.22 days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). CONCLUSION: The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.
Anemia ; Biopsy ; Collagen ; Cough ; Creatinine ; Diagnosis ; Dyspnea ; Female ; Fever ; Hemoptysis ; Hemorrhage* ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Mortality ; Prognosis ; Radiography, Thoracic ; Retrospective Studies* ; Therapeutic Irrigation ; Thorax ; Vascular Diseases

OBJECTIVES: In order to investigate the level and the association between bone lead and blood lead levels of non-occupationally, lead-exposed Koreans, the authors studied the lead biomarkers of 137 middle aged Koreans (86 males and 51 females) older than whose age were above 40 years. METHODS: The tibia lead level was selected as the bone lead indicator of cortical bone, and the blood lead level was also measured. The tibia lead level was measured by K-shell XRF with 30-minute measurement of each subjects. The blood lead level was analyzed by AAS method. RESULTS: The mean (SD) of the tibia lead level of the 137 study subjects was 3.49 (4.99) microgram/g, and tended to be higher. The mean (SD) of tibia lead level in male subjects (was 3.90 (4.88) microgram/g) and larger than in that of female subjects (2.80 (5.14) microgram/g), but without no statistical significance was observed. The mean (SD) of blood lead level of all total subjects was 3.70 (1.35)microgram/dl, and tended to be higher. The mean (SD) of blood lead level in male subjects (was 3.93 (1.25) microgram/dl) and larger than in that of female subjects (3.30 (1.42) microgram/dl), but without no statistical significance was observed. In multiple regression analysis of blood lead levels after adjusting for covariates, age was a significant independent variable. A weak association of age with tibia lead in female subjects was also observed in multiple regression analysis. CONCLUSION: The mean (SD) of tibia and blood lead levels of middle aged Koreans whose ages were over 40 years old were 3.49 (4.99) microgram/g and 3.70 (1.35) microgram/dl, respectively. Age and sex were positive predictors of blood lead level in multiple regression analysis after controlling for the covariates. However, in multiple regression analysis whereas age was weakly association with tibia lead level only in female subjects in multiple regression analysis.
Adult ; Biological Markers ; Female ; Humans ; Male ; Middle Aged* ; Occupations* ; Tibia

Catamenial hemoptysis is a rare condition caused by thoracic endometriosis that presents as tracheobronchial or pulmonary endometriosis. While hormonal treatment may cause virilization and sterility, due to the antiestrogenic effect, its surgical removal via thoracotomy is a particularly invasive procedure and is not recommended as the first choice treatment in young woman. Successful surgical removal by video-assisted thoracoscopic surgery (VATS) has recently been reported, and may be indicated for young patients who at some stage would like to become pregnant. Herein, a case of a 25-year-old unmarried woman with catamenial hemoptysis, cured by VATS, is reported.
Adult ; Endometriosis* ; Estrogen Receptor Modulators ; Female ; Hemoptysis ; Humans ; Infertility ; Single Person ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy ; Virilism

BACKGROUND: Extubation failure was associated with poor prognosis and high hospital mortality. Cuff leak test (CLT) has been proposed as a relatively simple method for detecting laryngeal obstruction that predispose toward postextubation stridor (PES) and reintubation. We examined the risk factors of extubation failure and evaluated the usefulness and limitation of CLT for predicting PES and reintubation. METHODS: Thirty-four consecutive patients intubated more than 24 hours were examined. The subjects were evaluated daily for extubation readiness, and CLT was performed prior to extubation. Several parameters in the extubation success and failure group were compared. The accuracy and limitation of CLT were evaluated after choosing the thresholds values of the cuff leak volume (CLV) and percentage (CLP). RESULTS: Of the 34 patients studied, 6 (17.6%) developed extubation failure and 3 (8.8%) were accompanied by PES. The patients who had extubation failure were more likely to have a longer duration of intubation and more severe illness. The patients who developed PES had a smaller cuff leak than the others: according to the CLV (22.5+/-23.8 vs 233.3+/-147.1ml, p=0.020) or CLP (6.2+/-7.3 vs 44.3+/-24.7%, p=0.013). The best cut off values for the CLV and CLP were 50ml and 14.7%, respectively. The sensitivity, negative predictive value, and specificity of CLT were relatively high, but the positive predictive value was low. CONCLUSION: The likelihood of developing extubation failure increases with increasing severity of illness and duration of intubation. A low CLV or CLP (<50ml or 14.7%) is useful in identifying patients at risk of PES, but the CLT is not an absolute predictor and should not be used an indicator for delaying extubation.
Hospital Mortality ; Humans ; Intubation ; Prognosis ; Respiratory Sounds* ; Risk Factors*

This study was conducted to evaluate the effectiveness and safety of a practical protocol for titrating positive end-expiratory pressure (PEEP) involving recruitment maneuver (RM) and decremental PEEP. Seventeen consecutive patients with acute lung injury who underwent PEEP titration were included in the analysis. After baseline ventilation, RM (continuous positive airway pressure, 35 cm H2O for 45 sec) was performed and PEEP was increased to 20 cmH2O or the highest PEEP guaranteeing the minimal tidal volume of 5 mL/kg. Then PEEP was decreased every 20 min in 2 cmH2O decrements. The "optimal" PEEP was defined as the lowest PEEP attainable without causing a significant drop (>10%) in PaO2. The "optimal PEEP" was 14.5 +/- 3.8 cmH2O. PaO2 /FI O2 ratio was 154.8 +/- 63.3 mmHg at baseline and improved to 290.0 +/- 96.4 mmHg at highest PEEP and 302.7 +/- 94.2 mmHg at "optimal PEEP", both significantly higher than baseline (p<0.05). Static compliance was significantly higher at "optimal" PEEP (27.2 +/- 10.4 mL/ cmH2O) compared to highest PEEP (22.3 +/- 7.7 mL/cmH2O) (p<0.05). Three patients experienced transient hypotension and one patient experienced atrial premature contractions. No patient had gross barotrauma. PEEP titration protocol involving RM and PEEP decrement was effective in improving oxygenation and was generally welltolerated.
Adult ; Aged ; Aged, 80 and over ; Blood Pressure ; Female ; Heart Rate ; Human ; Male ; Middle Aged ; Oxygen/blood ; Pneumonia/therapy ; Positive-Pressure Respiration/adverse effects/*methods ; Pulmonary Gas Exchange ; Respiratory Distress Syndrome, Adult/*therapy ; Retrospective Studies