PURPOSE: To determine the CT factors which predict positive results of bronchoscopic biopsy in cases of lung cancer with CT-bronchus sign. MATERIALS AND METHODS: In 30 patients who on CT showed a lung mass with CT-bronchus sign and who had undergone bronchoscopic biopsy, lung cancer was confirmed histopathologically and/or clinically. The CT findings were evaluated for the location, nature and size of the mass, and the type of CT-bronchus sign, and the diagnostic rate of bronchoscopic biopsy and of CT findings was compared. RESULTS: Seventeen of 30 patients (56.7%) were diagnosed by bronchoscopic biopsy and their diagnostic rates according to the location were as follows: 100% (10/10) in cases involving the lobar bronchus; 60% (6/10) in cases involving the proximal segmental bronchus and 10% (1/10) in cases involving the distal segmental bronchus. In 20 cases of peripheral lung cancer, 16.7% (1/6) of masses with less than 3cm in diameter, 44.4% (4/9) of masses with more than 3cm and less than 6cm, and 40.0% (2/5) of masses with more than 6cm were diagnosed bronchoscopically. In addition, 57.1% (4/7) of cases with abrupt bronchial obstruction, 33.3% (3/9) with a patent bronchus within the mass, 0% (0/3) with bronchial displacement or a marginally located bronchus and 0% (0/1) with tapered bronchial obstruction were diagnosed on bronchoscopic biopsy. One of two cases with perilesional lymphangitic spread and two of four cases with a large cavity were diagnosed bronchoscopically. CONCLUSION: In cases of lung cancer, bronchoscopic biopsy is a useful initial diagnostic method where the mass is located in 1cm proximal to segmental bronchial bifurcation and is more than 3cm in diameter, there is CT-bronchus sign with abrupt bronchial obstruction or a patent bronchus within the mass, and associated perilesional lymphangitic spread or large air-cavity. In most cases where there is peripheral lung mass less than 3cm in diameter, however, bronchoscopic biopsy alone is not adequate, and the use of a further diagnostic modality is required.
Biopsy* ; Bronchi ; Humans ; Lung Neoplasms* ; Lung*

Tolosa-Hunt syndrome is a rare self-limiting disease characterized by a painful, unilateral ophthalmoplegia caused by an idiopathic granulomatous inflammation in cavernous sinus, the superior orbital fissure or the orbital apex. We report a case of a 51-year-old man who presented at the emergency department with periocular pain and diplopia. Physical examination, and radiological and laboratory testing performed at that time were diagnostically inconclusive. After hospitalization, the patient was diagnosed with Tolosa-Hunt syndrome. Treatment with high dose steroid was started; by 2 days later, the periocular pain was relieved and other symptoms had improved. The rarity of Tolosa-Hunt syndrome calls for knowledge of the disease and attention by an emergency physician. The case report includes as summary of the syndrome, its' diagnosis and treatment.
Cavernous Sinus ; Diplopia ; Emergencies ; Hospitalization ; Humans ; Inflammation ; Male ; Middle Aged ; Ophthalmoplegia ; Orbit ; Physical Examination ; Tolosa-Hunt Syndrome

PURPOSE: The aim of this study was to compare the accuracy of the conventional method and Bayesian analysisin estimating the probability of malignancy in solitary pulmonary nodules. MATERIALS AND METHODS: The studyinvolved 83 pathologically proven cases of solitary pulmon ary nodules, 44 of which were malignant, and 39,benign. To estimate the probability of malignancy in solitary pulmonary nodules, chest radiographs and CT scans ofthe 83 patients were interpreted by a team of six ; three of the six used the conventional method of subjectiveinterpretation and the others. Bayesian analysis. The smoking history of 59 of the patients was obtained, and itwas decided whether this would help determine the probability of malignancy. RESULTS: On average, those using theconventional method correctly interpreted 34.7(78.9%) of 44 cases of malignant nodules and 27.7(71%) of 39 benignnodules, while those using Bayesian analysis correctly classified 32.3 cases of malignant nodules(73.4%) and 25.3cases of benign nodules(64.9%). Between the two teams, there was no statistically significant difference in theaccuracy of qualitative assessment(P>.05). In ROC analysis conventional interpretation and Bayesian analysisshowed an accuracy of Az=80.8 and Az=76.7, respectively. Among 59 patients known to have smoked, the conventionalmethod showed an accuracy of Az=79.0 without this knowledge and Az=80.2 with the knowledge for Bayesian analysis,the corresponding figures were Az=77.2 and Az=72.5, respectively. Information relating to smoking history thus didnot significantly improve the accuracy of prediction(p>.05). CONCLUSION: For estimating the probability ofmalignancy in solitary pulmonary nodules, the accuacy of the conventional method of interpretation is notsignificantly different from that of Bayesian analysis; information relating to smoking history significantlyimprove the accuracy of neither method.
Bayes Theorem* ; Humans ; Radiography, Thoracic ; ROC Curve ; Smoke ; Smoking ; Solitary Pulmonary Nodule* ; Tomography, X-Ray Computed

The purpose of this study was to investigate the anti-hyperlipidemic effect of soy bean extract solution fermented by Bacillus subtilis MORI (BTD-1E) in obese db/db mice. Eight-week-old male db/db mice were administered 33.3 mg/kg BTD-1E solution orally once a day for four weeks. The BTD-1E group showed significantly lower body weight compared with the db control group (P<0.05). The BTD-1E group showed significantly lower serum total cholesterol and LDL cholesterol levels compared with the db control group, respectively (P<0.05, P<0.01). The BTD-1E group showed significantly decreased liver weight relative to final body weight compared with the db control group (P<0.01). After four weeks of BTD-1E administration, lipid droplets in the liver were apparently decreased in the BTD-1E group compared to the db control group. In summary, our results suggest that BTD-1E has an anti-hyperlipidemic effect in the obese mouse model.
1-Deoxynojirimycin ; Animals ; Bacillus ; Bacillus subtilis ; Body Weight ; Cholesterol ; Cholesterol, LDL ; Humans ; Liver ; Male ; Mice ; Mice, Obese ; Soybeans

BACKGROUND: It has been reported that heat shock protein 70 (HSP70) and interleukin-8 (IL-8) play an important role in cells during the wound healing process. However, there has been no report on the effect of HSP70 and IL-8 on the blisters of burn patients. OBJECTIVE: This study aimed to evaluate the serial quantitative changes of HSP70 and IL-8 in burn blisters. METHODS: Twenty-five burn patients were included, for a total of 36 cases: twenty cases on the first day, six cases on the second, five cases on the third, three cases on the fourth, and two cases on the fifth. A correlation analysis was performed to determine the relationship between the concentration of HSP70 and IL-8 and the length of the treatment period. RESULTS: The HSP70 concentration was the highest on the first day, after which it decreased down to near zero. Most HSP70 was generated during the first 12 hours after the burn accident. There was no correlation between the concentration of HSP70 on the first day and the length of the treatment period. No measurable concentration of IL-8 was detected before 5 hours, but the concentration started to increase after 11 hours. The peak value was measured on the fourth day. CONCLUSION: While HSP70 increased in the first few hours and decreased afterwards, IL-8 was produced after 11 hours and increased afterward in burn blister fluid. These findings provide new evidence on serial changes of inflammatory mediators in burn blister fluid.
Blister* ; Burns* ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Humans ; Interleukin-8 ; Wound Healing ; Wounds and Injuries

BACKGROUND AND AIMS: Zinc is an essential, mostly intracellular, trace element which participates in many oxidative or deoxidative reactions and in a protective action on liver cell activity. Plasma zinc levels are known to decrease in patients with liver disease including chronic viral hepatitis. The aim of this study was to reveal whether hepatic zinc concentrations have a correlation with grades of necroinflammation or stages of fibrosis in the patients with chronic viral hepatitis. METHODS: This study consisted of 50 subjects (43 chronic hepatitis B, 4 chronic hapatitis C, and 3 cirrhosis). Each specimen of liver tissue was classified with the grade of lobular inflammation, portal/periportal inflammation, and stage of fibrosis according to Scheuer's method. Hepatic zinc concentration was determined by ICP-Atomic Emission Spectrometry. RESULTS: The mean hepatic zinc concentration in the 50 chronic viral hepatitis patients was 233.66 g/g dry weight of liver tissue. The hepatic zinc levels were significantly correlated with the grades of portal/periportal inflammation (rs=-0.385, p=0.006), and grades of lobular inflammation(rs=-0.342, p=0.015). The stages of fibrosis were also negatively related (rs=-0.423, p=0.002). The zinc concentrations differed significantly among grades of lobular inflammation (p=0.013) and among stages of fibrosis (p=0.044). CONCLUSIONS: Hepatic zinc concentrations showed negative correlation with grades of portal/periportal inflammation, lobular inflammation, and stage of fibrosis in the patients of chronic viral hepatitis. These results suggest that decreased hepatic zinc concentration might be associated with severe hepatic injury and reflect decreased protective activity on liver cell injury.
Fibrosis ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Inflammation ; Liver ; Liver Diseases ; Plasma ; Spectrum Analysis ; Zinc*

BACKGROUND: Silent myocardial ischemia is often found in old diabetics. Many diagnostic tools are used for diagnosis of angina. But these tools are difficult to use in primary care. Therefore we have planned to investigate the change of electrocardiography in old diabetics, using resting electrocardiogram which is available for primary care. METHOD: 67 patients with ST-T change group and 262 patients with control group were included in this study. Patients with chest pain or heart problem were excluded. The resting electrocardigraphy is examined by standard 12 lead electrocardiogram. RESULTS: There are differences of diabetes, HDL-cholesterol between ST-T change group and control group. Diabetes and HDL- cholesterol are significant factors that change ST-T wave in the resting electrocardigraphy. CONCLUSION: ST-T change of old diabetics without chest pain is more frequent than non diabetics. That means myocardial ischemia and requires treatment at secondary or third medical center. In conclusion, regular electrocardigraphy monitoring at primary care should be required in old diabetics.
Chest Pain* ; Cholesterol ; Diabetes Mellitus ; Diagnosis ; Electrocardiography ; Heart ; Humans ; Myocardial Ischemia ; Primary Health Care ; Thorax*

While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.
Abdominal Abscess ; Biopsy ; Brain ; Brain Abscess ; Drainage ; Humans ; Laparotomy ; Male ; Middle Aged ; Neurologic Manifestations ; Peritonitis ; Peritonitis, Tuberculous ; Pleurisy ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: Epstein-Barr virus (EBV) is involved in the pathogenesis of angioimmunoblastic T-cell lymphoma (AILT), but its precise role and prognostic impact are not clear. This study aimed to evaluate the incidence of EBV-postitivity in the tumor and bone marrow (BM) samples from AILT patients, and their correlations with the clinical variables and patient survival. METHODS: Seventy AILT cases were identified over a period of 8 years. Twenty seven cases were investigated for their EBV tumor status, and 10 BM samples of these patients were investigated for their EBV status with using in situ hybridization (ISH). EBV PCR was performed for the BM mononuclear cells in 8 cases. RESULTS: Among the 27 tumor specimens, ten (37%) were EBV-positive. Only CD20-negativity in tumor correlated with the EBV-positivity (p=0.035). In 13 (48%) patients, gross tumor involvement was recognized by hematoxylin-eosin staining at the time of diagnosis. Among the 10 patients who had additional BM slides available, there were 3 with BM involvement, and none showed EBV positive results on ISH. EBV PCR of the BM mononuclear cells revealed one-positive case among 8 patients. This patient was negative for both BM involvement and EBV ISH. The median overall survival of the 25 treated patients was 48.9 months (95% CI: 18.6~79.2 months). Neither overall survival nor progression-free survival was related with EBV-positivity of the tumor. CONCLUSIONS: EBV-positivity of tumor had no impact on the prognosis of AILT patients.
Adolescent ; Adult ; Aged ; Bone Marrow/virology ; DNA, Viral/isolation & purification ; Female ; Herpesvirus 4, Human/*isolation & purification ; Humans ; Immunoblastic Lymphadenopathy/mortality/*virology ; In Situ Hybridization ; Lymphoma, T-Cell/mortality/*virology ; Male ; Middle Aged ; Polymerase Chain Reaction ; Prognosis ; Survival Analysis

OBJECTIVE: To elucidate risk factors for coronary heart diseases among Korean males. METHODS: A nested case control study was conducted among a Korea Medical Insurance Cooperation(KMIC) cohort composed of 108,802 males. The cases included 246 male patients who were admitted to hospital due to coronary heart diseases from 1993 to 1997 (I20-25 by ICD) and whose diagnosis was confirmed by the protocol by WHO MONICA Project(1994). The control group was composed of 483 patients selected by frequency matching considering age and resident area from an inpatient care group without coronary heart disease during the same period. For study cases and the controls, the results of a health check-up in 1990 and a questionnaire on life style in 1992 were received through the KMIC. Some additional information was collected by telephone interviews during October 1999. RESULTS: Multiple logistic regression analysis showed that the odds ratio(OR) of coronary heart diseases among past smokers and current smokers as compared to non-smokers were 1.94(95% CI : 1.14-3.31) and 2.20(95% CI : 1.35-3.59), respectively. The OR among persons who drank 4 cups or more of caffeinated beverages such as coffee or tea daily as compared to persons who drank one cup for 2-3 days was 2.56(95% CI : 1.07-6.12). The OR among persons with high normal BP and stage 3 hypertension against normotension were 2.51(95% CI : 1.44-4.37) and 5.08(95% CI : 2.38-10.84). The OR among persons whose blood cholesterol were 240 mg/dL or more against lower than 200mg/dL was 2.24(95% CI : 1.43-3.49). CONCLUSION: Smoking, drinking of excessive caffeinated beverages, hypertension and high blood cholesterol were proven to be significant risk factors for coronary heart diseases among Korean males.
Beverages ; Case-Control Studies* ; Cholesterol ; Coffee ; Cohort Studies ; Coronary Disease* ; Diagnosis ; Drinking ; Humans ; Hypertension ; Inpatients ; Insurance ; Interviews as Topic ; Korea ; Life Style ; Logistic Models ; Male ; Questionnaires ; Risk Factors* ; Smoke ; Smoking ; Tea