BACKGROUND: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope. METHODS: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope. RESULTS: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications. CONCLUSION: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.
Adult ; Alligators and Crocodiles ; Biopsy ; Bronchoscopes ; Chest Pain ; Cough ; Dyspnea ; Eating ; Fever ; Foreign Bodies ; Hemoptysis ; Humans ; Jaw ; Medical Records ; Pneumonia ; Pulmonary Atelectasis ; Respiratory Sounds ; Retrospective Studies ; Surgical Instruments ; Thorax ; Tooth

Wegener's granulomatosis is a systemic vasculitis of the medium and small arteries, as well as of the venules, arterioles, and occasionally large arteries, and primarily involves the upper and lower respiratory tracts and the kidneys. Renal symptoms of Wegener's granulomatosis are indistinguishable from those of vasculitis such as Henoch-Schonlein purpura and microscopic polyangiitis. This case, though initially diagnosed as Henoch-Schonlein purpura, was confirmed as Wegener's granulomatosis from a lung biopsy fifteen years after the initial diagnosis. We report this case with a review of the literature.
Arteries ; Arterioles ; Biopsy ; Delayed Diagnosis* ; Diagnosis ; Kidney ; Lung ; Microscopic Polyangiitis ; Purpura, Schoenlein-Henoch* ; Respiratory System ; Systemic Vasculitis ; Vasculitis ; Venules ; Wegener Granulomatosis*

Wegener's granulomatosis is a systemic vasculitis of the medium and small arteries, as well as of the venules, arterioles, and occasionally large arteries, and primarily involves the upper and lower respiratory tracts and the kidneys. Renal symptoms of Wegener's granulomatosis are indistinguishable from those of vasculitis such as Henoch-Schonlein purpura and microscopic polyangiitis. This case, though initially diagnosed as Henoch-Schonlein purpura, was confirmed as Wegener's granulomatosis from a lung biopsy fifteen years after the initial diagnosis. We report this case with a review of the literature.
Arteries ; Arterioles ; Biopsy ; Delayed Diagnosis* ; Diagnosis ; Kidney ; Lung ; Microscopic Polyangiitis ; Purpura, Schoenlein-Henoch* ; Respiratory System ; Systemic Vasculitis ; Vasculitis ; Venules ; Wegener Granulomatosis*

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia. Mycoplasma pneumonia causes upper and lower respiratory tract symptoms in all age groups, with the highest attack rates in subjects 5 to 20 years old. In patients with mycoplasma pneumonia, the most common radiographic findings may be reticulonodular or interstitial infiltration, which have a predilection for the lower lobes. Findings that show lung collapse on a chest X-ray are very rare. We report a case of mycoplasma pneumonia that showed right upper lobe collapse.
Humans ; Mycoplasma pneumoniae ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Pulmonary Atelectasis ; Respiratory System ; Thorax ; Young Adult

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia. Mycoplasma pneumonia causes upper and lower respiratory tract symptoms in all age groups, with the highest attack rates in subjects 5 to 20 years old. In patients with mycoplasma pneumonia, the most common radiographic findings may be reticulonodular or interstitial infiltration, which have a predilection for the lower lobes. Findings that show lung collapse on a chest X-ray are very rare. We report a case of mycoplasma pneumonia that showed right upper lobe collapse.
Humans ; Mycoplasma pneumoniae ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Pulmonary Atelectasis ; Respiratory System ; Thorax ; Young Adult

Pulmonary aspergillosis may present with three different features, according to the immune status of the host. These forms are invasive aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma. Bronchial involvement is an uncommon type of invasive pulmonary aspergillosis. We encountered an unusual case of an endobronchial aspergillosis that completely obstructed the left upper lobe, which was initially thought to be lung cancer. We report this case along with a review of the relevant literature.
Aspergillosis* ; Aspergillosis, Allergic Bronchopulmonary ; Bronchi* ; Invasive Pulmonary Aspergillosis ; Lung Neoplasms ; Pulmonary Aspergillosis

The necrotizing fascitis, that develops after a Cesarean section, is acknowledged as a rare complication due to the development of antibiotics. Having a very high mortality rate, the only way to prevent the septic shock and the impairment of the cardiopulomary function is the use of adequate antibiotics, the infusion of IV fluids, a radical section of the necrotized fascia and a through cleansing. We have an experience in treating a primipara who had a necrotic fascitis after Cesarean section, and therefore, report this case with the review of articles enclosed.
Anti-Bacterial Agents ; Cesarean Section* ; Fascia ; Fasciitis ; Fasciitis, Necrotizing* ; Female ; Mortality ; Pregnancy ; Shock, Septic

It is very rare for an exocervical adenocarcinoma to metastasize to the lung parenchyma and pleura. A 54-year-old woman was admitted with dyspnea and left pleural effusion on chest X-ray. She had a history of exocervical adenocarcinoma 3 years previously and was treated with hysterectomy, chemotherapy, and radiation therapy. Last year, she was diagnosed with a left vestibular schwannoma and underwent subtotal mass removal surgery. After admission, metastatic adenocarcinoma of the pleura was diagnosed by video-assisted thoracic surgery biopsy. We herein report the rare case of exocervical adenocarcinoma that presented as a metastatic lesion to the pleura 3 years after the initial diagnosis.
Adenocarcinoma ; Biopsy ; Dyspnea ; Female ; Humans ; Hysterectomy ; Lung ; Middle Aged ; Neoplasm Metastasis ; Neuroma, Acoustic ; Pleura ; Pleural Effusion ; Pleural Neoplasms ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thorax

Langerhans cell histiocytosis (LCH) is a proliferative disease that shares phenotypic characteristics with Langerhans cells (LCs) and involves multiple organs. Here, we report a case of LCH in a 36-year-old male simultaneously involving the lungs and thoracic spine. Chest computed tomography (CT) showed multifocal thin-walled cysts and ill-defined nodular opacities primarily in the bilateral upper and middle lung lobes that fluctuated with smoking. Despite improvement of pulmonary lesions after smoking cessation, osteolytic lesion of thoracic vertebra was aggravated. Symptoms were not improved after nerve block, suggesting vertebral instability that necessitated surgical mass removal and posterior fusion. Microscopically diffuse proliferation of immature, rounded LCs and inflammatory cell infiltration was noted. Although pulmonary LCH in an adult is a benign disease that is usually resolved spontaneously after smoking cessation, surgical treatment should be considered in a case of spinal LCH.
Adult ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Langerhans Cells ; Lung ; Male ; Nerve Block ; Smoke ; Smoking ; Smoking Cessation ; Spine ; Thorax

PURPOSE: In order to investigate the role of Fas on the chemosensitivity of cancer cells in regards to chemotherapeutic agents, the Fas/FasL signaling pathway of apoptosis was explored in human hepatoma cells. MATERIALS AND METHODS: Fas expression of hepatoma cells including Chang, Huh7, HepG2, and Hep3B cells, was determined by RT-PCR and flow cytometry analysis. Cell viability was measured by MTT assay and apoptosis was assessed by DNA fragmentation assay. The catalytic activity of the caspase-family proteases including caspase-3, 6, 8, and 9 proteases, was tested using fluorogenic biosubstrates. The expression of apoptotic mediators including cytochrome c, PARP, and Bcl2 family proteins were measured from cytosolic and mitochondrial compartments. Mitochondrial membrane potential was measured by fluorescence staining with JC-1, rhodamine 123. RESULTS: Fas mRNA was constitutively expressed in Chang and HepG2 as defined as Fas (+) cells, but not in Huh7 and Hep3B cells, defined as Fas (-) cells. Fas (+) cells were markedly sensitive to 5-FU whereas Fas (-) cells were resistant and able to survive. 5-FU increased Fas expression of Fas (+) HepG2 cells and simultaneously resulted in apoptotic death, characterized by the ladder-pattern fragmentation of genomic DNA. Moreover, it increased the catalytic activity of caspase-8 protease, which eventually cleaved the Bid into truncated Bid which translocated into mitochondria only in Fas (+) cells. It also increased the caspase-9 protease activity with Bax expression, cytosolic release of cytochrome c, and mytochondrial dysfunction only in Fas (+) HepG2 cells. Furthermore, 5-FU increased the enzymatic activity of caspase-3 protease with PARP digestion in HepG2 cells. CONCLUSION: 5-FU exerted cytotoxicity against hepatoma cells via activation of Fas-mediated apoptotic signaling including caspase cascades and mytochondrial dysfunction. Our data suggests that Fas may be an important modulator of the chemosensitivity of cancer cells vis- -vis anticancer chemotherapeutic agents.
Apoptosis* ; Carcinoma, Hepatocellular ; Caspase 3 ; Caspase 8 ; Caspase 9 ; Cell Survival ; Cytochromes c ; Cytosol ; Digestion ; DNA ; DNA Fragmentation ; Flow Cytometry ; Fluorescence ; Fluorouracil* ; Hep G2 Cells* ; Humans ; Membrane Potential, Mitochondrial ; Mitochondria* ; Peptide Hydrolases ; Rhodamine 123 ; RNA, Messenger