To investigate the imbalance of the cytokine production profile of T cells from atopic asthmatics, we measured concentrations of IL-4, IL-5 and IFN-y by ELISA method in the culture supernatants of peripheral blood mononuclear cells(PBMCs) and Derrnato-phagoides pteronyssinus(Der p) J-stimulated PBMCs from Der p-sensitized atopic asthmatics, Der p-sensitized healthy atopits, non-atopic asthmatics and healthy non-atopics. The suppressive effect of IFN-y on cytokine production of Der p J-stimulated PBMCs was also examined. The PBMCs from atopics showed higher IL-4 and IL-5 production in response to PHA +TPA and higher IFN-gamma production in response to Der p Jq compared with non-atopits. The Der p J-stimulated PBMCs from atopics showed a tendency of increased IL-5 production in response to Der p J and higher IL-4 and IL-5 production in response to PHA+TPA compared with non-atopics. IL-5 production of Der p J-stimulated PBMCs from atopics was suppressed by IFN It is suggested that an imbalance in IL-4, IL-5 and IFN-y production is a feature of the atopic state. The TH2 characteristics of allergen-stimulated PBMCs could be regulated by IFN-y.
Enzyme-Linked Immunosorbent Assay ; Interleukin-4 ; Interleukin-5 ; T-Lymphocytes

BACKGROUND: Pulmonary tuberculosis(TB) is still prevalent and remains a significant clinical problem for the elderly. However, the disease presents in many ways, and there are frequent adverse drug reactions that may prevent the early diagnosis and treatment of elderly TB patients compared to the young. The purpose of this study was to determine whether or not there are any differences in the clinical feature of pulmonary tuberculosis(TB) in both the diagnosis and treatment between the young (less than 64 years) and the elderly (65 years and more). METHODS: The medical records of 125 young and 70 elderly pulmonary TB patients, who were diagnosed with and treated for pulmonary TB at the Seoul Municipal Boramae Hospital from November 1991 to January 1997, were analyzed retrospectively. RESULTS: Anorexia(12% vs. 31.4%), general weakness (20.0% vs. 54.3%), dyspnea(21.6% vs. 37.1%) and an abnormal mentality (0.8% vs. 15.7%) were more frequent presenting symptoms in elderly TB patients, whereas hemoptysis (32.8% vs. 10.0%) and fever (BT>37℃ 58.4% vs. 35.7%) were more frequent in the young. The elderly had a higher number of cardiovascular and chronic obstructive pulmonary diseases as underlying illnesses. In chest PA, there were no differences in the location of the TB lesion, but the appearances were initially diagnosed more frequently as pneumonia or lung cancer (8.8% vs. 30.0%, p<0.05) in the elderly. There was no difference in the detection rate of acid fast bacilli(AFB) in the sputum between the two groups. There were no differences in the treatment response and follow-up loss. However, adverse drug reactions (13.6% vs. 45.7%, p<0.05), and changes in medication (4.9% vs. 25.7%, p<0.05) during treatment occurred more frequently in the elderly. One among the 125 young patients died from tuberculosis whereas 6 among the 70 elderly patients died from the disease. CONCLUSION: Because the clinical and radiological presentations were more atypical, a sputum AFB smear and culture should be done immediately in the elderly who are TB. The elderly experienced more frequent adverse drug reactions and mortality during treatment, but the response to treatment was good and rapid.
Aged* ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Early Diagnosis ; Fever ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung Diseases, Obstructive ; Lung Neoplasms ; Medical Records ; Mortality ; Pneumonia ; Retrospective Studies ; Seoul ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Background: Perioperative hyperglycemia can occur in surgical patients and may increase postoperative morbidity and mortality, especially in patients with diabetes. Therefore, we conducted the present study to evaluate whether the administration of 6% hydroxyethyl starch (HES)-130/0.4 increases blood glucose levels in patients with diabetes. Methods: Forty patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into two groups according to the fluids administered 20 min before spinal anesthesia (Group L, lactated Ringer’s solution; Group H, 6% HES-130/0.4). Patient characteristics, intraoperative variables, blood glucose levels, mean blood pressure (MBP), and heart rate (HR) were recorded at five time-points (0, 20, 60, 120, and 240 min). Results: A total of 39 patients were analyzed (Group L, n = 20; Group H, n = 19). The amount of intraoperative fluid was significantly higher in Group L than in Group H (718.2 ml vs. 530.0 ml, P = 0.010). There were no significant differences in the changes in blood glucose levels, HR, or MBP between the two groups (P = 0.737, P = 0.896, and P = 0.141, respectively). Serial changes in mean blood glucose levels from baseline also showed no significant differences between the groups (P = 0.764). Conclusions There were no significant changes in blood glucose levels when lactated Ringer’s solution or 6% HES-130 was used. When compared to the lactated Ringer’s solution, no evidence that 6% HES-130/0.4 produces hyperglycemia in diabetic patients could be found. Further evaluation of larger populations is needed.

BACKGROUND: The importance of pro-inflammatory cytokines, especially tumor necrosis factor α(TNF-α) and interleukin-1β(IL-1β), have been extensively documented in the generation of inflammatory lung disease. Lung epithelial cells are also actively involved in initiating and maintaining inflammation by producing pro-inflammatory mediators. Understanding the mechanism of pro-inflammatory cytokine expression in lung epithelial cells is crucial to the development of new therapeutic modalities for inflammatory lung disease. Transcription of most pro-inflammatory cytokines is dependent on the actiation of NF-κB. However, the relationship between pro-inflammatory cytokine expression and NF-κB/IκB pathway in lung epithelial cells is not clear. METHODS: BEAS-2B, A549, NCI-H719 cells were stimulated with IL-1β or TNF-α at various times, and then IL-8 and TNF-αmRNA expressions were assayed by Northern blot analysis. IL-1β or TNF-α-induced NF-κB activation was assessed by the nuclear translocation of p65 NF-κB subunit. The degradation of IκBα and IκBβ by IL-1βor TNF-α stimulation was assayed by Western blot analysis. The phosphorylation of IκBαwas evaluated by Western blot analysis after pre-treating cells with proteasome inhibitor followed by IL-1β or TNF-α stimulation. The basal level of IKKα expression was evaluated by Western blot analysis. RESULTS: IκBαand IκBβ was repidly degraded after 5 minutes of incubation with IL-1β or TNF-α in BEAS-2B, A549, and NCI-H157 cells. The activation of NF-κB and the induction of IL-8 and TNF-α mRNA expressions were observed by IL-1β or TNF-α stimulation in these cells. In contrast, neither the changes in NF-κB/IκB pathway nor IL-8 and TNF-α mRNA expression was induces by IL-1β or TNF-α stimulation in NCI-H719 cell. IL-1β and TNF-α-induced IκB phoshorylation was observed in BEAS-2B, A549, and NCI-H157 cells, but not in NCI-H719 cells. The basal level of IKKα expression was not different between cells. CONCLUSION: NF-κB/IκB pathway plays an important role in the ixpression of pro-inflammatory cytokine in most lung epithelial cells. The absence of the effect on NF-κB/IκB pathway in NCI-H719 cells seems to be due to the defect in the intracellular signal transduction pathway upstream to IKK.
Blotting, Northern ; Blotting, Western ; Cytokines ; Epithelial Cells* ; Inflammation ; Interleukin-8 ; Lung Diseases ; Lung* ; Phosphorylation ; Proteasome Inhibitors ; RNA, Messenger ; Signal Transduction ; Tumor Necrosis Factor-alpha

BACKGROUND: Hydroxyethyl starch (HES), a commonly used resuscitation fluid, has the property to induce hyperglycemia as it contains large ethyl starch, which can be metabolized to produce glucose. We evaluated the effect of 6% HES-130 on the blood glucose levels in non-diabetic patients undergoing surgery under spinal anesthesia. METHODS: Patients scheduled to undergo elective lower limb surgery were enrolled. Fifty-eight patients were divided into two groups according to the type of the main intravascular fluid used before spinal anesthesia (Group LR: lactated Ringer's solution, n = 30 vs. Group HES: 6% hydroxyethyl starch 130/0.4, n = 28). Blood glucose levels were measured at the following time points: 0 (baseline), 20 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), and 6 h (T6). RESULTS: Mean blood glucose levels at T5 in the LR group and T4, T5 in the HES group, increased significantly compared to baseline. There were no significant changes in the serial differences of mean blood glucose levels from baseline between the two groups. CONCLUSIONS: Administration of 6% HES-130 increased blood glucose levels within the physiologic limits, but the degree of glucose increase was not greater than that caused by administration of lactated Ringer's solution. In conclusion, we did not find evidence that 6% HES-130 induces hyperglycemia in non-diabetic patients.
Anesthesia, Spinal ; Blood Glucose* ; Colloids ; Glucose ; Humans ; Hydroxyethyl Starch Derivatives ; Hyperglycemia ; Lower Extremity ; Resuscitation ; Starch*

BACKGROUND: The Mega Acer Kit(R) (MAK) is a newly designed heated and humidified breathing circuit that warms fluid passing through the circuit lumen. In this study, we investigated the system's efficacy for the perioperative prevention of hypothermia and fluid warming. METHODS: Ninety patients undergoing spinal surgery were enrolled in this study and randomly assigned to 3 groups based on the fluid warming device used: no fluid warming system (Group C, n = 30), via a Standard Ranger (Group R, n = 30), or via the MAK (Group M, n = 30). Distal esophageal temperatures (Teso) and infusion fluid temperature (TF) were recorded at 15 min intervals for duration of 180 min during surgery. If Teso was < 35.0degrees C, a forced-air convective warming device was used. RESULTS: Final Teso values were 34.8 +/- 0.3degrees C, 35.1 +/- 0.1degrees C, and 35.8 +/- 0.3degrees C in groups C, R, and M, respectively (P < 0.01). Teso was significantly higher in group M when compared with that in groups C and R throughout the study period (P < 0.05). The number of patients requiring a forced-air convective warming device was significantly lower in group M (n = 0) when compared with that in groups R (n = 17) and C (n = 30) (P < 0.05). The final infusion fluid temperature was higher in group M when compared with that in groups C and R throughout the study period (35.4 +/- 1.0 vs. 23.0 +/- 0.3 and 32.8 +/- 0.6degrees C; P < 0.01). CONCLUSIONS: The MAK is more effective for preventing hypothermia and for warming fluid than the Standard Ranger.
Acer ; Esophagus ; Hot Temperature ; Humans ; Hypothermia* ; Respiration

BACKGROUND: From 1987 to 1997, a total of 500 patients underwent surgery for esophageal cancer in our department. To determine the lon g-term results, recurrence patterns and prognostic factors, we reviewed the 11 y ears experiences. MATERIAL AND METHOD: Double pr imary tumors, cancers of the pharyngoesophageal and esophagogastric junction, pa lliative bypass surgery or esophageal prosthesis and exploration only were exclu ded in this study. Resection was usually performed through right thoracotomy(Ivo r Lewis operation) and anastomosis was made with staplers. Extended lymph node d issection was performed from August 1994 but not before. The stomach was used as a substitute for the esophagus in 96.8%. All reconstruction was done through po steromediastinal route except cervical reconstruction. RESULT: 474(94.8%) had confirm ed squamous cell carcinoma. Most(58.2%) of the tumors were located in the middle third of the esophagus, 47.4% of patients had operative pathologic stage III di sease, and 25% had stage IIA disease. Of the resections, 392 were classified as curative and 74 palliative, blunt dissection(transhiatal esophagectomy) and jeju nal free graft(34) were excluded in these classifications. The overall morbidity rate was 38.4%. The operative mortality rate was 5.8%, mainly due to respirator y complications and anastomosis leakages. The follow-up rate of these patients w as 99.8%. Overall actuarial 1, 2, and 5-year survival rates were 63.5%, 38.9%, a nd 19.4% including operative mortality. In standard lymph node dissection group, the actuarial 1, 2, and 5-year survival rates were 60.7%, 35.9%, and 16.9%(oper ative mortality rate: 4.3%), but in extended lymph node dissection group, the ac tuarial 1, 2, and 4-year survival rates were 70.2%, 46.5% and 30.9%(operative mo rtality rate: 6.5%), respectively. In curative resection group, the actuarial 1, 2, and 5-year survival rates were 69.4%, 43.9%, and 21.9%, but in palliative re section group, these were 37.8%, 17.6%, and 7.3%, respectively. The 4-year survi val rate was 35.6% in curative resection with extended lymph node dissection gro up. Postoperative recurrence was found in 226 patients. Site of recurrence were mainly lymph nodes(69%; neck, paratracheal and abdominal) and other systemic rec urrence was detected at liver, lung, bone, brain etc. CONCLUSION: We think that cura tive resection with extensive lymph node dissection is necessary for long term s urvival, but adequate postoperative care is a prerequisite. In advanced esophage al cancer, more effective multimodal adjuvant regimens remain to be established.
Brain ; Carcinoma, Squamous Cell ; Classification ; Ear ; Esophageal Neoplasms* ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neck ; Oceans and Seas ; Postoperative Care ; Prostheses and Implants ; Recurrence ; Stomach ; Survival Rate ; Ventilators, Mechanical

Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and Alzheimer disease. Diffusion tensor imaging (DTI) can estimate the microstructural integrity of white matter tracts in MCI. We evaluated the microstructural changes in the white matter of MCI patients with DTI. We recruited 11 patients with MCI who met the working criteria of MCI and 11 elderly normal controls. The mean diffusivity (MD) and fractional anisotropy (FA) were measured in 26 regions of the brain with the regions of interest (ROIs) method. In the MCI patients, FA values were significantly decreased in the hippocampus, the posterior limb of the internal capsule, the splenium of corpus callosum, and in the superior and inferior longitudinal fasciculus compared to the control group. MD values were significantly increased in the hippocampus, the anterior and posterior limbs of the internal capsules, the splenium of the corpus callosum, the right frontal lobe, and in the superior and the inferior longitudinal fasciculus. Microstructural changes of several corticocortical tracts associated with cognition were identified in patients with MCI. FA and MD values of DTI may be used as novel biomarkers for the evaluation of neurodegenerative disorders.
Aged ; Aged, 80 and over ; Aging/*pathology ; Anisotropy ; Biological Markers ; Cerebral Cortex/*pathology ; Cognition Disorders/*pathology ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Male ; Middle Aged ; Neural Pathways/*pathology ; Severity of Illness Index

The primary mucosa-associated lymphoid tissue(MALT) lymphoma of the lung is a rare low grade B cell lymphoma arising from bronchus-associated lymphoid tissue(BALT) which had been regarded as pseudolymphoma. It has the characteristic histologic with monoclonal B cells of centrocyte-like lymphoid cells and a lymphoepithelial lesion. Clinically it shows an indolent clinical course course and much more favorable prognosis than lymphoma of other site. We report 3 cases of the pulmonary malignant lymphoma of BALT, which was confirmed by lung biopsy, immunohistochemistry and PCR assay.
B-Lymphocytes ; Biopsy ; Immunohistochemistry ; Lung ; Lymphocytes ; Lymphoid Tissue* ; Lymphoma* ; Lymphoma, B-Cell ; Polymerase Chain Reaction ; Prognosis ; Pseudolymphoma

BACKGROUND: The NF-kappaB transcription factors control various biological processes including the immune response, acute phase reastion and cell cycle regulation. NF-kappaB complexes are retained in the cytoplasm in the basal state and various stimuli cause a translocation of the NF-kappaB complexes into the nucleus where they bind to the kappaB elements and regulate the transcription of the target genes. Recent reports also suggest that NF-kappaB proteins are involved in oncogenesis, tumor growth and metastasis. High expression of NF-kappaB expression was reported in many cancer cell lines and tissues. The constitutive activation of NF-kappaB was also reported in several cancer cell lines supporting its role in cancer development and survival. The anti-apoptotic action of NF-kappaB is important for cancer survival. NF-kappaB also controls the expression of several proteins that are important for cellular adhesion (ICAM-1, VCAM-1) suggesting a role in cancer metastasis. In lung cancer, high expression levels of the NF-kappaB subunit p50 and c-Rel were reported. In fact, high expression does not mean a high activity, and the activation pattern of NF-kappaB in lung cancer has not been reported. METHODS: In this study, the NF-kappaB nuclear binding activity in the basal and TNF-alpha stimulated states were examined in various lung cancer cell lines and compared with the normal bronchial epithelial cell line. Twleve lung cancer cell lines including the non-small cell and small cell lung cancer cell lines (A549, NCL-H358, NCI-H441, NCL-H522, NCL-H2009, NCI-H460, NCI-H1229, NCI-H1703, NCL-H157, NCL-H187, NCI-H417, NCI-H526) and BEAS-2B bronchial epithelial cell line were used. To evaluate the NF-kappaB expression amd DNA binding activity, western blot analysis and an electrophoretic mobility shift assay with the nuclear protein extracts. RESULTS: The basal expressions of the p50 subunits were observed in the BEAS-2B cell line and all lung cancer cell lines except for NCI-H358 and NCI-H460. The expression levels of p65 and p50 were increased 30 minutes after stimulation with TNF- alpha in BEAS-2B and in 10 lung cancer cell lines. In the NCI-H358 and NCI-H460 cell lines, p65 expression was not observed in the basal and stimulated states and the two p50 related protein levels were higher after stimulation with TNF-alpha. These new proteins were smaller than p50 and are thought to be variants of p50. In the basal state, NF-kappaB was nearly activated in the BEAS-2B and all lung cancer cell lines. The DNA binding activity of the NF-kappaB complexes was markedly higher after stimulation with TNF-alpha. In the BEAS-2B and all lung cancer cell lines except for NCI-H358 and NCI-H460, the activated NF-kappaB complex was a p65/p60 heterodimer. In the NCI-H358 and NCI-H460 lung cancer cell lines, the NF-kappaB complex was variant of a p50/p50 homodimer. CONCLUSION: The NF-kappaB activation pattern in the lung cancer cell lines and the normal bronchial epithelial cell lines was similar except for the activatio of a variant of the p50/p50 homodimer in some lung cancer cell lines.
Acute-Phase Reaction ; Biological Processes ; Blotting, Western ; Carcinogenesis ; Cell Cycle ; Cell Line* ; Cytoplasm ; DNA ; Electrophoretic Mobility Shift Assay ; Epithelial Cells ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis ; NF-kappa B* ; Nuclear Proteins ; Small Cell Lung Carcinoma ; Transcription Factors ; Tumor Necrosis Factor-alpha*