OBJECTIVES: The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan. METHODS: We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center. RESULTS: The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient). CONCLUSIONS: Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.
Abscess ; Bacillus ; Candida albicans ; Catheters ; Cellulitis ; Chest Pain ; Drainage ; Female ; Hip ; Humans ; Klebsiella ; Male ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Pulmonary Embolism ; Retrospective Studies ; Sensation ; Sepsis ; Tertiary Healthcare ; Thorax

BACKGROUND: It is well-known that cell-free nucleic acids rise in patients with many types of malignancies. Several recent experimental studies using cancer cell lines have shown that changes in cell-free RNA are predictive of the response to chemotherapy. The objective of this study was to determine whether quantification of free RNA can be used as a biomarker for clinical responses to chemotherapy in patients with lung cancer. METHODS: Thirty-two patients with lung cancer (non-small cell lung cancer, n=24; small cell lung cancer, n=8) were divided into 2 groups according to their responses to chemotherapy (response group, n=19; non-response group, n=13). Blood samples were collected before and after two cycles of chemotherapy. Real-time quantitative RT-PCR was used for transcript quantification of the glyceraldehyde-3-phosphate dehydrogenase gene. RESULTS: The pre chemotherapy values (Response group 41.36+/-1.72 vs. Non-response group 41.33+/-1.54, p=0.78) and post chemotherapy values (Response group 39.92+/-1.81 vs. Non-response group 40.41+/-1.47, p=0.40) for cell free RNA concentrations, expressed as Ct GAPDH (threshold cycle glyceraldehyde-3-phosphate dehydrogenase gene) levels, was not different between the two groups. There was no significant relationship between changes in the cell free RNA level clinical responses after chemotherapy (p=0.43). CONCLUSION: We did not find a correlation between quantification of serum cell free RNA levels and clinical responses to chemotherapy in patients with lung cancer. Further investigations are needed to determine whether the cell free RNA level is a useful predictor of responses to chemotherapy in patients with lung cancer.
Biomarkers ; Cell Line ; Humans ; Lung ; Lung Neoplasms ; Nucleic Acids ; Oxidoreductases ; Pilot Projects ; RNA ; Small Cell Lung Carcinoma

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.
Adult ; Allopurinol ; Anti-Inflammatory Agents, Non-Steroidal ; Anticonvulsants ; Blood Urea Nitrogen ; Creatinine ; Diuretics ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Eosinophilia ; Eosinophils ; Exanthema ; Fever ; Fluid Therapy ; Humans ; Hypersensitivity ; Liver ; Nephritis, Interstitial* ; Oliguria ; Prostatitis ; Proteinuria ; Renal Dialysis ; Renal Insufficiency ; Ultrasonography

A 53-year-old male was admitted to our hospital for evaluation of the second kidney transplant. A Iliopsoas Bursitis was detected on diagnostic abdominopelvic computed tomography. He had undergone a coronary angiography (CAG) due to chest pain 1 month prior to his visit. At that time, he had experienced pain on his right back and flank for some time. We found no other causes or predisposing factors associated with that problem. Thus, we report on a case of iliopsoas bursitis after CAG.
Bursitis* ; Causality ; Chest Pain ; Coronary Angiography* ; Humans ; Kidney ; Kidney Transplantation ; Male ; Middle Aged

Common clinical manifestations in patients with IgG subclass deficiency include recurrent respiratory tract infection, recurrent otitis media and sinopulmonary infection by virus or bacteria. The administration of intravenous immunoglobulin (IVIG) has been regarded as the most effective therapy in these patients. We experienced a 22-year-old patient with IgG3 subclass deficiency and recurrent fungal infection of oral cavity and lips. IVIG was given at 0.2g/kg/dose twice a month for 6 months. After treatment with IVIG, the patient improved clinically.
Bacteria ; Humans ; Immunoglobulin G* ; Immunoglobulins ; Immunoglobulins, Intravenous ; Lip ; Mouth* ; Otitis Media ; Respiratory Tract Infections ; Young Adult

BACKGROUND: Fascin is an actin-bundling protein that plays an important role in cellular motility. Fascin is normally expressed in the neuronal and mesenchymal cells and its expression is low or absent in the epithelia. However, an overexpression of fascin has been linked to the invasive behavior of some neoplasms such as breast, stomach and ovarian tumors. In this study, we evaluated the expression of fascin and its prognostic significance in stage I non-small cell lung cancer (NSCLC). METHODS: Immunohistochemical staining for fascin was performed on the paraffin-embeded tissue sections of 81 cases of resected NSCLC. Staining of more than 5% of the tumor cells was recorded as positive immunoreactivity. RESULTS: Fascin expression was seen in 73% (59/81) of the cases and this was more frequently seen in squamous cell carcinoma than in adenocarcinoma (93% vs 42%). There were no significant correlations of fascin immunoreactivity with tumor recurrence and overall survival. CONCLUSION: The expression rate of fascin was relatively high in NSCLC, but this was without prognostic significance. The exact clinical role of fascin should be defined through further investigations.
Adenocarcinoma ; Breast ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Carrier Proteins ; Lung Neoplasms ; Microfilament Proteins ; Neurons ; Prognosis ; Recurrence ; Stomach

BACKGROUND: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. METHODS: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. RESULTS: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. CONCLUSION: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.
Drug Resistance ; Drug Resistance, Multiple ; Ethambutol ; Humans ; Isoniazid ; Logistic Models ; Mycobacterium ; Prevalence ; Recurrence ; Retrospective Studies ; Rifampin ; Risk Factors ; Streptomycin ; Tertiary Care Centers ; Treatment Failure ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary

BACKGROUND: A diagnosis of malignant pleural effusion is clinically important, as the prognosis of lung cancer patients with malignant pleural effusion is poor. The diagnosis will be difficult if a cytological test is negative. This study was performed to investigate whether the detection of hypermethylation of the p16 (CDKN2A) and retinoic acid receptor b2 (RARB2) genes in pleural fluid is useful for a diagnosis of malignant pleural effusion. METHODS: Pleural effusion was collected from 43 patients and was investigated for the aberrant promoter methylation of the RARB2 and CDKN2A genes by use of methylation-specific PCR. Results were compared with findings from a pleural biopsy and from pleural fluid cytology. RESULTS: Of 43 cases, 17 cases of pleural effusion were due to benign diseases, and 26 cases were from lung cancer patients with malignant pleural effusion. Hypermethylation of the RARB2 and CDKN2A genes was not detected in the case of benign diseases, independent of whether or not the patients had ever smoked. In 26 cases of malignant pleural effusion, hypermethylation of RARB2, CDKN2A or either of these genes was detected in 14, 5 and 15 cases, respectively. The sensitivities of a pleural biopsy, pleural fluid cytology, hypermethylation of RARB2, hypermethylation of CDKN2A, or hypermethylation of either of the genes were 73.1%, 53.8%, 53.8%, 19.2%, and 57.7%, respectively; negative predictive values were 70.8%, 58.6%, 58.6%, 44.7%, and 60.7%, respectively. If both genes are considered together, the sensitivity and negative predictive value was lower than that for a pleural biopsy, but higher than that for pleural fluid cytology. The sensitivity of hypermethylation of the RARB2 gene for malignant pleural effusion was lower in small cell lung cancers than in non-small cell lung cancers. CONCLUSION: These results demonstrate that detection of hypermethylation of the RARB2 and CDKN2A genes showed a high specificity, and sensitivity was higher than for pleural fluid cytology. With a better understanding of the pathogenesis of lung cancer according to histological types at the molecular level, and if appropriate genes are selected for hypermethylation testing, more precise results may be obtained.
Biopsy ; Genes, p16 ; Humans ; Lung Neoplasms ; Methylation ; Pleural Effusion ; Pleural Effusion, Malignant ; Polymerase Chain Reaction ; Prognosis ; Receptors, Retinoic Acid ; Smoke

Mantle cell lymphoma is relatively rare and generally difficult to differentiate from other types of lymphoma. The clinical course is very aggressive. We recently experienced a very rare patient with pleural mantle cell lymphoma associated with pleural tuberculosis. A 60-year-old female patient was admitted because of dyspnea. Chest films revealed pleural effusion. Analysis of pleural effusion was not diagnostic, but we started therapeutic trial for tuberculosis. After 2 months of anti-tuberculosis medication, the pleural effusion was not improved. We repeated pleural biopsy. Histologic finding was chronic inflammation but AFB culture was positive. After another 3 months of medications for tuberculosis, there was no improvement. We repeated pleural biopsy and thoracentesis. Repeated biopsy and the result of flow cytometry of pleural effusion were consistent with mantle cell lymphoma. We started chemotherapy for lymphoma. After three cycles of chemotherapy, pleural effusion was decreased, but she worsened and died of hepatic failure probably due to viral hepatitis.
Biopsy ; Drug Therapy ; Dyspnea ; Female ; Flow Cytometry ; Hepatitis ; Humans ; Inflammation ; Liver Failure ; Lymphoma ; Lymphoma, Mantle-Cell* ; Middle Aged ; Pleural Effusion ; Pleurisy ; Thorax ; Tuberculosis ; Tuberculosis, Pleural*

An elevated serum CA19-9 level is an indication of pancreatic and biliary tract cancer. However, it has recently become known that nonmalignant gastrointestinal diseases and a variety of nonmalignant respiratory diseases, such as idiopathic interstial pneumonia, collagen vascular disease associated lung diseases, diffuse panbronchiolitis and bronchiectasis, can also show an elevated serum CA19-9 level. We recently encountered a case of bronchiectasis with persistently elevated serum CA19-9, but without any evidence of malignant disease in endoscopic retrograde pancreatocholangiography, abdominal computed tomography, and positron emission tomography. After serial follow-up of 3 years and 10 months, there was still no evidence of cancer. It is believed that the elevated serum CA19-9 level was due to bronchiectasis. An elevated serum CA19-9 level should be interpreted carefully with the patients' clinical condition.
Biliary Tract Neoplasms ; Bronchiectasis ; Bronchiolitis ; Collagen ; Follow-Up Studies ; Gastrointestinal Diseases ; Haemophilus Infections ; Lung Diseases ; Pneumonia ; Positron-Emission Tomography ; Vascular Diseases