A Septic embolism is a type of embolism infected with bacteria containing pus. These may become dangerous if dislodged from their original location. Embolisms of this type in the azygos vein are potentially fatal. The diagnosis of septic azygos vein embolism is difficult, so rapid diagnosis and treatment is important to avoid complications. Generally, treatment is enough for appropriate antibiotic therapy without anticoagulant therapy. We report a case of staphylococcal septic embolism in the azygos vein, which was discovered in a 51-year-old man exhibiting chest pain, dyspnea and fever. The patient was treated with antibiotic therapy alone without the use of anticoagulants.
Anticoagulants ; Azygos Vein ; Bacteremia ; Bacteria ; Chest Pain ; Dyspnea ; Embolism ; Fever ; Humans ; Middle Aged ; Pulmonary Embolism ; Sepsis ; Staphylococcus ; Staphylococcus aureus ; Suppuration

5-Aminosalicylate agents are the main therapeutic agents for ulcerative colitis. Balsalazide is a prodrug of 5-aminosalicylate and has fewer side effects than the other 5-aminosalicylate agents. Pulmonary complications resembling granulomatosis with polyangiitis in ulcerative colitis are extremely rare. Here, we report a patient with ulcerative colitis on balsalazide presenting respiratory symptoms and multiple pulmonary nodules from a chest radiography that was pathologically diagnosed with a limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant. To our knowledge, this is the first report of a balsalazide-induced limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant.
Bronchiolitis ; Bronchiolitis Obliterans ; Colitis, Ulcerative ; Humans ; Mesalamine ; Multiple Pulmonary Nodules ; Phenylhydrazines ; Thorax ; Ulcer ; Wegener Granulomatosis

Patients with acromegaly have high incidence of benign or malignant neoplasia than general population. Around fifteen percent of the deaths reported in acromegaly are attributable to malignancy of cancer. On the whole, mortality in acromegaly has been shown to be correlated with the degree of growth hormone (GH) control. Especially, the levels of insulin like growth factor-1 (IGF-1) may be higher in neoplasm, but there is no clear evidence to prove that tumor development is triggered by IGF-1 in acromegaly. Henceforth, we report a case of acromegaly associated with lung and gastric cancer in a 58-year-old man, suggesting the possible carcinogenic role of IGF-1.
Acromegaly* ; Growth Hormone ; Humans ; Incidence ; Insulin ; Insulin-Like Growth Factor I ; Lung Neoplasms ; Lung* ; Middle Aged ; Mortality ; Stomach Neoplasms*

The 64-year-old female patient with cough and intermittent hemoptysis of six months duration visited our hospital. On chest computed tomography, a small, ovoid, 1.3cm sized and well enhanced lesion was detected on the distal trachea. Two multiple lobulated lesions on the sigmoid and transverse colon were revealed on the colonoscopy. The histological findings showed small and medium sized lymphocytes infiltration, CD20 and CD79a positive staining and multiple lymphoepithelial lesions on the distal trachea and colon tissues. Herein, a case of primary MALT lymphoma, with involvement of the trachea and colon, which was treated with rituximab (CD20 anti-monoclonal antibody), cyclophosphamide, adriamycin, vincristine and prednisolone (CHOP regimen), is reported.
Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Cough ; Cyclophosphamide ; Doxorubicin ; Female ; Hemoptysis ; Humans ; Lymphocytes ; Lymphoma, B-Cell, Marginal Zone* ; Middle Aged ; Prednisolone ; Thorax ; Trachea* ; Vincristine ; Rituximab

BACKGROUND: Diagnosis of tuberculous pleurisy is sometimes difficult using conventional diagnostic methods. We have investigated the utility of pleural fluid cell IFN-gamma production assay in the diagnosis of tuberculous pleurisy. METHODS: We prospectively performed pleural fluid cell IFN-gamma production assay in 39 patients with tuberculous pleural effusions (TPE) and in 26 patients with nontuberculous pleural effusions (NTPE) (13 malignant pleural effusions and 13 parapneumonic effusions). Pleural fluid cells were cultured in DMEM media and stimulated with purified protein derivatives (PPD), and phytohemagglutinin (PHA) for 24 hr. The amount of IFN-gamma released in the culture supernatant was quantitated by IFN-gamma ELISA assay. We have also measured adenosine deaminase (ADA) activities and IFN-gamma concentrations in the pleural fluid. RESULTS: 1) The pleural fluid levels of ADA activity and IFN-gamma concentrations were significantly higher in TPE than NTPE (p<0.01). 2) IFN-gamma production in TPE cells stimulated by PPD (755,266+/-886,636 pg/ml) was significantly higher than NTPE cells (3,509+/-6,980 pg/ml) (p<0.01). By considering the fact that IFN-gamma concentrations over 10,000 pg/ml is a criteria for the diagnosis of TBE, sensitivity and specificity of the test were 97.4 and 92.3%, respectively. 3) The ratios of IFN-gamma production by the stimulation with PPD and PHA (PPD/PHA) were significantly higher in TPE cells (59+/-85) than NTPE cells (5+/-18)(p<0.01). Considering the criteria for the diagnosis of TBE as PPD/PHA ratio over 5, sensitivity and specificity of the test were 76.9 and 92.3%, respectively. CONCLUSION: Pleural fluid cell IFN-gamma production assay may be useful for the diagnosis of tuberculous pleurisy.
Adenosine Deaminase ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Prospective Studies ; Tuberculosis ; Tuberculosis, Pleural*

BACKGROUND: To evaluate the clinical efficacy of pulmonary resection combined with first-line antituberculous drug therapy in patients with well-localized, cavities-containing pulmonary multidrug-resistant tuberculosis (MDR-TB). METHOD: From February 1998, seventeen patients with well-localized, cavities-containing pulmonary MDR-TB were enrolled and followed prospectively up to December 2004. After radical pulmonary resection, the patients were treated with antituberculous drugs comprising of isoniazid (H), rifampin (R), pyrazinamide (Z), ethambutol (E), and streptomycin (S) (3HERZS/3HERS/6HER). RESULTS: All recovered isolates of M. tuberculosis were resistant to both isoniazid and rifampin, and to a mean of 4.8 antituberculous drugs (range, 2 to 7 drugs). Surgical procedures included lobectomy (13 patients), lobectomy plus segmentectomy (3 patients), and pneumonectomy (1 patient). The median time for postoperative sputum smear and culture conversion was 2 days (range, 1 to 23 days). Fifteen (94%) patients had durable cures (mean follow-up period, 39.0 months). One patient failed to convert her sputum and was successfully switched to second-line therapy; one patient developed active disease again almost 7 years later, likely due to re-infection with a new M tuberculosis strain. CONCLUSION: Radical resection combined with administration of first-line antituberculous agents was effective in patients with well-localized, cavities-containing pulmonary MDR-TB.
Drug Therapy* ; Ethambutol ; Follow-Up Studies ; Humans ; Isoniazid ; Mastectomy, Segmental ; Pneumonectomy ; Prospective Studies ; Pyrazinamide ; Rifampin ; Sputum ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant* ; Tuberculosis, Pulmonary

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare but significantly imperative in inducing chronic pulmonary hypertension. Clinically, it is difficult to distinguish between IPAH and CTEPH. However, the treatment of pulmonary hypertension is different depending on the disease. The present study was performed to analyze the similarities and differences in clinical features between IPAH and CTEPH. METHODS: During a nine-year period, thirty-three patients with IPAH and twenty-two patients with CTEPH were enrolled. Symptoms, physical findings, chest radiograph, electrocardiograph, pulmonary function test, echocardiograph, perfusion lung scan, right heart catheterization results were analyzed between both the groups. RESULTS: The median age of IPAH group was 33 (6~70) years that was lower than that (52(27~80) years) of CTEPH group. Amongst the IPAH patients, there was female predominance (76 %) and there was no sex difference between the patients with CTEPH. Both the groups exhibited similarity in the results of chest radiograph, electrocardiograph, pulmonary function test, and echocardiograph. In the perfusion lung scan, all IPAH patients exhibited findings with normal (28%) or low probability (72%) of pulmonary embolism and all CTEPH patients exhibited findings with high probability of pulmonary embolism. CONCLUSION: Although IPAH and CTEPH bear similarities in terms of symptoms, physical signs and general investigation results, there were differences in age distribution, sex predominance and results of perfusion lung scan.
Age Distribution ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis, Differential ; Electrocardiography ; Female ; Humans ; Hypertension* ; Hypertension, Pulmonary* ; Lung ; Perfusion ; Pulmonary Embolism ; Radiography, Thoracic ; Respiratory Function Tests ; Sex Characteristics

BACKGROUND: The role of combination therapy of inhaled corticosteroid (ICS) plus long-acting beta2-agonist (LABA) in asthma is well established, but nor much is known about this treatment in COPD. Recent studies have revealed that combining therapy is associated with fewer acute exacerbations in COPD, but in most of the studies, high-dose combination therapies have been employed. The current study assessed the effect of moderate or high-dose combination therapy of ICS plus LABA on the frequency of acute exacerbations in COPD. METHODS: Between January 1, 2001 and August 31, 2004, 46 patients with COPD (moderate, severe, very severe) were enrolled who received either fluticasone/salmeterol (flu/sal) 250 microgram/50 microgram twice a day (group A) or flu/sal 500 microgram/50 microgram twice a day (group B) for more than a year. We divided them into two groups depending on the dosage of ICS plus LABA. Effect of drugs was compared based on the factors such as symptom aggravation, number of admission, and time to first exacerbation during a year after use. RESULTS: Eleven of twenty-six patients in group A (42.3%) experienced acute exacerbation and eleven of twenty patients in group B (55%) experienced acute exacerbation during 1 year. Mean exacerbation rate of Group A was 0.96 and Group B was 1.05. Mean admission rate was 0.15 and 0.30, respectively. There was no statistically significant difference of aggravation rate, number of administration and time to first exacerbation between the two treatment groups. CONCLUSION: There was no significant difference between moderate and high dose combined inhaler therapy to reduce acute exacerbation in COPD patients (moderate, severe, very severe). Hence, the effective dose of combination therapy needs further study in patients with COPD.
Adrenal Cortex Hormones* ; Asthma ; Humans ; Nebulizers and Vaporizers ; Pulmonary Disease, Chronic Obstructive*

No abstract available.
Lung Neoplasms* ; Lung* ; Peroxidase*

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in hospital-acquired infection, and is prevalent in intensive care units (ICU). The MRSA colonization rates of the nares and throat were examined in both the ICU and general ward. This study was performed to investigate the MRSA rate and necessity for MRSA screening cultures in patients admitted to ICU. METHODS: Between June and September 2004, those patients admitted to both the medical ICU and general ward participated in this study. Bacterial cultures were performed on swabs of the nares and throat taken within 24 hours of admission. Clinical data were also collected. RESULTS: One hundred and twenty one patients and 84 patients, admitted to the medical ICU and medical general ward, respectively, were investigated. The numbers of nasal MRSA colonization in the ICU and general ward were 3 (2.5%) and 3 (3.6%), respectively. There were 2 (1.7%) cases of throat MRSA colonization in the ICU, but none in the general ward. The MRSA colonization rates of the nares and throat were no different between the ICU and general ward. There were no significant differences in the previous admission, operation history and admission route between the ICU and general ward groups. CONCLUSION: The MRSA colonization rates of the nares and throat were 3.3 and 3.6% in the ICU and the general ward, respectively. The MRSA screening test does not appear to be required in all patients admitted to the ICU, but further studies, including high-risk patients, are recommended.
Colon ; Humans ; Intensive Care Units* ; Critical Care* ; Mass Screening ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pharynx* ; Staphylococcus aureus* ; Staphylococcus*