Coccidioidomycosis is a common infectious disease in southwestern North America, which is caused by the soil fungus, Coccidioides immitis. Due to the mobility of the modern population, increasing numbers of cases are being diagnosed outside the endemic areas. Moreover, diagnosis in non-endenmic areas may be delayed or confused due to its rarity. Here we report a case of pulmonary coccidioidomycisis in an immigrant. The patient presented with unexplained pulmonary symptoms. A history of recent travel to or immigration from an endemic area may suggest coccidioidomycosis. In addition an early tissue biopsy is helpful in establishing this diagnosis.
Bacterial Infections and Mycoses ; Biopsy ; Coccidioides ; Coccidioidomycosis* ; Communicable Diseases ; Diagnosis ; Emigrants and Immigrants* ; Emigration and Immigration ; Fungi ; Humans ; Mycoses ; North America ; Soil

Two different types, called “Yin-Yang Wu Tai” and “Yin-Yang Er Shi Wu Ren,” respectively, are described in the Huang Di Nei Jing, Ling Shu section. Each type can be divided into four closely interrelated sub-items: character, physique, constitution and therapy. These relations can be explained with the concept of the “unity of the physical and spiritual,” which is based on a holistic perspective with physical referring to the body and spiritual referring to mental activity.
If we regard these types as psychologic, we can compare them with present western psychological types. E. Kretschimer and L. Corman discussed this in relation to “character and physique” or “character and countenance.” Kampo examination of the physique and countenance are anthroposcopic. In contrast, the examination of character includes both anthroposcopy and medical interviews. Applying this knowledge, it may be possible to improve diagnostic techniques in Kampo medicine.

PURPOSE: To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. RESULTS: Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. CONCLUSION: Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle* ; Bronchi ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Tubes ; Diagnosis ; Drainage ; Hemoptysis ; Humans ; Lymph Nodes ; Needles ; Neoplasm Metastasis ; Pneumothorax ; Spine ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

Objective: To isolate phenyl propanoides from the barks of Syringa dilate, identify their structures, and determine the contents by reliable HPLC. Methods: Phenyl propanoides were extracted with methanol, and isolated by silica gel chromatography. The structures were elucidated by spectroscopic analysis including NMR, MS, UV, and IR. Shimpack CLC C18 (150 mm × 6 mm, 5 μm) column chromatography was employed with gradient elute of 1% acetic acid and methanol, and the column temperature was set at 30℃. The flow rate was 1.0 mL/min and the detection wavelength was set at 267 nm. Results: Two phenyl propanoides were isolated from the barks of S. dilata grown in DPR of Korea and identified as syringin (1) and coniferin (2). The linear range of syringin was 0.2-6.0 mg/mL, the correlation co-efficient was 0.999 8, and the average recoveries were 99.8%, 100.6%, and 100.9%. The results showed that the content in the barks was 8 folds of inner parts. There was no difference in locations and the content of syringin increased in winter, while decreased in summer. Conclusion: The elucidation of phenyl propanoides existence in S. dilata could be a fundamental for the search of new herbal materials. The method is simple, rapid, and reliable. It can be used to determine the content of syringin in herbal medicines.

No abstract available.
Otitis Media* ; Otitis* ; Tympanoplasty*

No abstract available.
Mycobacterium tuberculosis* ; Mycobacterium* ; Pleural Effusion*

No abstract available.
Diagnosis* ; Tuberculosis*

No abstract available.
Lung Neoplasms* ; Lung* ; Mass Screening* ; Seoul*

No abstract available.
Acute Lung Injury* ; Capillaries* ; Oxygen*

BACKGROUND: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant causes of cirrhosis. It is uncertain that tie same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia. METHOD: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. RESULTS: The hypoxemia of PaO2 less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). Hut there was no patient with significant hypoxemia of PaO2 less than 60 mmHg. PaO2 was significantly decreased in the patients with spider angioma than the patients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of 11.4+/-4.1% than normoxemic group of 4.1+/-2.0% (p<0.05). CONCLUSIONS: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to play a major role in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.
Alcoholics ; Anoxia* ; Ascites ; Blood Gas Analysis ; Dilatation ; Esophageal and Gastric Varices ; Fibrosis ; Hemangioma ; Hepatic Encephalopathy ; Humans ; Incidence ; Korea ; Liver Cirrhosis* ; Liver Cirrhosis, Biliary ; Liver Function Tests ; Liver* ; Lung Diseases ; Renal Circulation ; Respiratory Function Tests ; Skin ; Spiders ; Technetium Tc 99m Aggregated Albumin* ; Whole Body Imaging*