OBJECTIVES: Since Mountain proposed the new staging system of non-small cell lung cancer in 1986, the indications for operation of NSCLC have been extended. However, operative mortality is from 3 to 6%. Therefore it is important to reduce unnecessary operation and to evaluate unresectability of tumor correctly, preoperatively The purpose of this study is to find out the causes of unresectability in patients who were initially thought to be resectable preoperatively. METHODS: By retrospective analysis, 64 patients out of 291 NSCLC patients who were undergone operation for curative resection in Seoul National University Hospital from Jan. of 1987 to Dec. of 1991, ware found to be unresectable at operating roost were selected for this study. Out of 64 patients,42 were evaluable. The analysis was focused on the change of pre- & post-operative staging and the causes of unresectability of tumors. RESULTS: Among B2 patients with unresectable tumor who could be evaluated, preoperative CT finding showed resectable tumors in 55% (23 patients) and suspicious for unresectable tumors in 45% (19 patients). The causes of unresectability were technically unresectable T3 lesions in 7% (3 patients), T4 lesions in 62% (26 patients), N2 lesions in 17% (7 patients) and N3 lesions in 14% (6 patients). CONCLUSION: The major causes of unresectability of NSCLC were pulmonary artery invasions. It is suggested that careful evaluation of mediastinal structure, especially great vessels by additional imaging technique other than CT (like MRI) is indicated in selected NSCLC cases.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Mortality ; Pulmonary Artery ; Retrospective Studies ; Seoul

BACKGROUND: Since tumor necrosis factor was discovered in 1975, TNF has been well known about its cytotoxic effect on tumor cells in vivo and in vitro. According to the recent improvement of molecular biological techinques, it is possible that exogenous TNF gene is transferred to tumor cells and is expressed in theirs. By virtue of TNF gene transfer, we have expected that TNF expressed in TNF-gene-transferred tumor cells would kill tumor cells in vivo without systemic side effect. The expected mechanisms in which antitumor effects of TNF expressed in TNF-gene-transferred tumor cells are working would be as followings. In the first mechanism, TNF expressed in TNF-gene-transferred tumor cells would kill tumor cells around (like homicide). In the second mechanism, TNF expressed in TNF-gene-transferred tumor cells would kill themselves (like suicide). In the third mechanism, TNF expressed in TNF-gene-transferred tumor cells would recruit immune effector cells and kill tumor cells indirectly. In the last mechanism, TNF expressed in TNF-gene-transferred tumor cells would augment cytokine such as interferon-γ to kill tumor cells. Among these four mechanisms of antitumor effect, only the second mechanism has not been established yet. Therefore, to elucidate the second mechanism, We performed this study. METHOD: We transferred TNF-α gene to NCI-H2058, a human mesothelioma cell line and WEHI164, a murine fibrosarcoma cell line by using retroviral vector(pLT12SNTNF). And, We determined by using MTT assay whether TNF expressed in TNF-gene-transferred tumor cell lines would kill themselves like suicide or not. Then, if TNF-gene-transferred tumor cell lines would not suicide themselves, 1 would know more about the TNF sensitivity of TNF-gene-transferred tumor cell lines to exogenous TNF also by MTT assay. RESULT: NCI-H2058 and WEHI164 which were sensitive to TNF, became far less sensitive to endogenous and exogenous TNF after being transferred TNF-α gene to. CONCLUSION: TNF-gene-transfer to NCI-H2058 and WEHI164 gaffe them resistance to TNF.
Cell Line ; Cell Line, Tumor* ; Fibrosarcoma ; Humans ; Mesothelioma ; Necrosis* ; Retroviridae* ; Suicide ; Tumor Necrosis Factor-alpha ; Virtues ; Zidovudine

Evaluation of postpneumonectomy space (PPS) by CT in patients with lung cancer for operation-related complication or tumor recurrence is critical, but often difficult. We retrospectively analysed CT scans of 38 patients who underwent pneumonectomy for lung cancer. CT scans were obtained on 7-10th post-operative day for baseline image and at varying intervals of 2 to 24 months thereafter. Usual postoperative findings in patients without complication included mediastinal shifting, changes in subpleural space, changes in parietal pleura, and herniation of contralateral lung. Four patients had postoperative complications including empyema(n=3) and bronchopleural fistula(n=2). Twelve patients showed findings of tumor recurrence such as lymph node metastasis, local recurrence, and pericardial and contralateral pleural effusion. By comparing follow-up CT with baseline CT, we were able to detect early cancer recurrence and postoperative complications. Our results indicate that serial chest CT play an important role in the evaluation of the patients who underwent pneumonectomy for lung cancer.
Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Neoplasm Metastasis ; Pleura ; Pleural Effusion ; Pneumonectomy* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed*

BACKGROUND AND OBJECTIVE: In patients with aspirin-sensitive asthma, anti-inflammatory treatment is a common problem in clinical practice. Nimesulide has been chosen due to weak inhibitory action on cyclooxygenase in ASA-sensitive asthma patients. In this study, we evaluated the safety of nimesulide in patients with ASA-sensitive asthma. METHODS: We performed lysine-aspirin bronchoprovocation test to confirm ASA-sensitive asthma, and nimesulide oral provocation test (up to 200 mg) to screen nimesulide sensitivity in 17 cases of bronchial asthma patients. RESULTS: Fifteen (88.2%) of 17 subjects showed positive responses to lysine-aspirin bronchoprovocation test. Six (35.3%) patients reacted to nimesulide oral provocation test. Of the six patients who reacted to nimesulide, three experienced bronchospasm, two urticaria, and one anaphylaxis. All positive reactions occurred within the 200 mg dose. One of 6 subjects showed a positive response to nimesulide oral provocation test without ASA-sensitivity. CONCLUSION: The prevalence of nimesulide sensitivity among aspirin-sensitive asthma was 33.3%, which was higher than in the previous reports. Screening oral provocation test is essential before prescribing relative COX-2 inhibitors for ASA-sensitive asthmatic patients. A case of nimesulide-sensitive asthma without ASA-sensitivity was also noted.
Anaphylaxis ; Asthma* ; Bronchial Spasm ; Cyclooxygenase 2 Inhibitors ; Humans ; Mass Screening ; Prevalence* ; Prostaglandin-Endoperoxide Synthases ; Urticaria

This investigation was designed to confirm IL-8 production from human bronchial epithelial cells with toluene diisocyanate (TDI) exposure and to examine the effects of pro-inflammatory cytokine and dexamethasone. We cultured Beas-2B, a bronchial epithelial cell line with TDI-HSA conjugate and compared with those without conjugate. IL-8 in the supernatant was measured by ELISA. To evaluate the effect of proinflammatory cytokines, peripheral blood mononuclear cells (PBMC) were collected from TDI- and non-TDI asthma patients, and were added to the epithelial cell culture. Dexamethasone or antibodies to TNF-alpha and IL-1beta were pre-incubated with PBMC supernatant. There was a significant production of IL-8 from bronchial epithelial cells with addition of TDI-HSA conjugate in a dose-dependent manner, which was significantly augmented with addition of PBMC supernatant. Higher production of IL-8 was noted with addition of PBMC supernatant from TDI-asthma patients than in those from non-TDI asthma patients. IL-1beta and IL-1beta/TFNalpha antibodies were able to suppress the IL-8 productions. Pre-treatment of dexamethasone induced dose-dependent inhibition of the IL-8 production. These results suggest that the IL-8 production from bronchial epithelial cells contribute to neutrophil recruitment occurring in TDIinduced airway inflammation. IL-1beta released from PBMC of TDI-induced asthma patients may be one of the pro-inflammatory cytokines to enhance IL-8 production.
Asthma/immunology ; Bronchi/*cytology/metabolism ; Cell Line ; Dexamethasone/pharmacology ; Epithelial Cells/cytology/*drug effects/*metabolism ; Glucocorticoids/pharmacology ; Human ; Interleukin-8/*metabolism ; Leukocytes, Mononuclear/cytology/metabolism ; Support, Non-U.S. Gov't ; Toluene 2,4-Diisocyanate/*toxicity

We report a case of hypersensitivity pneumonitis in a 30-yr-old female housewife caused by Penicillium species found in her home environment. The patient was diagnosed according to history, chest radiograph, spirometry, high-resolution chest CT, and transbronchial lung biopsy. To identify the causative agent, cultured aeromolds were collected by the open-plate method. From the main fungi cultured, fungal antigens were prepared, and immunoblot analysis with the patient's serum and each fungal antigen was performed. A fungal colonies were isolated from the patient's home. Immunoblotting analysis with the patient's sera demonstrated a IgG-binding fractions to Penicillium species extract, while binding was not noted with control subject. This study indicates that the patient had hypersensitivity pneumonitis on exposure to Penicillium species in her home environment.
Adult ; Alveolitis, Extrinsic Allergic/*etiology/immunology/*microbiology ; Antibodies, Fungal/blood ; Antigens, Fungal ; Environmental Microbiology ; Female ; Housing ; Humans ; Immunoglobulin G/blood ; Korea ; Penicillium/*immunology/isolation and purification/*pathogenicity

BACKGROUND AND OBJECTIVES: Immunoglobulin G (IgG) subclass deficiency has been reported in patients with bronchial asthma and is associated with recurrent respiratory tract infections. Aspirin-sensitive asthma (ASA) which affects 10% of adult asthmatics, asthma runs a chronic course with frequent asthma exacerbations, often related to respiratory infections. We performed this study to identify the prevalence of IgG subclass deficiency and evaluate the association between recurrent asthma exacerbations and IgG subclass deficiency in ASA. SUBJECTS AND METHODS: We measured serum levels of IgG and IgG subclass in 26 aspirin- sensitive asthmatic patients (15 steroid used and 11 steroid not used) and 55 healthy controls using nephelometry. Reference values of each IgG subclass was defined as cumulative percentile between 2.5% to 97.5% of controls. RESULTS: Total IgG, IgG1, IgG2 and IgG3 of aspirin-sensitvie asthmatics, were significantly lower than for those of controls (p<0.05, respectively). However, there were no significant differences in total IgG and IgG subclass concentrations, between steroid-not-used asthma group and controls (p>0.05, respectively). CONCLUSION: Lowered levels of IgG, IgG1, IgG2 and IgG3 were noted in ASA sensitive asthma patients, which might be associated with use of steroid. Further studies will be needed to evaluate their clinical significance.
Adult ; Asthma* ; Humans ; Immunoglobulin G* ; Nephelometry and Turbidimetry ; Prevalence ; Reference Values ; Respiratory Tract Infections

BACKGROUND: An appreciable number of patients with toluene diisocyanate (TDI)-induced asthma have high serum levels of specific IgE (sIgE) antibody to TDI-human serum albumin conjugate (HSA). A recent investigation suggested a role of specific IgG (sIgG) in the development of TDI asthma. METHODS: We observed the changes in the levels of specific IgE and IgG antibodies to TDIHSA conjugate in TDI-induced asthmatic patients during seven years avoidance. RESULTS: Six subjects with high sIgE and five with high sIgG were enrolled. All of them had taken anti-asthmatic medications with complete avoidance. Serum levels of sIgE and sIgG to TDI-HSA conjugate were detected by ELISA. The level of sIgE continued to decline up to 7 years and the mean half-life was 3.9 years. The mean half-life of sIgG was 4.5 yrs. CONCLUSION: These findings suggest that both sIgE and sIgG to TDI-HSA conjugate may persist for several years after the last exposure to TDI.
Adult ; Asthma/*chemically induced/immunology ; Biological Markers/blood ; Human ; Immunoglobulin E/blood/*immunology ; Immunoglobulin G/blood/*immunology ; Longitudinal Studies ; Male ; Middle Aged ; Serum Albumin/*immunology ; Support, Non-U.S. Gov't ; Toluene 2,4-Diisocyanate/adverse effects/*immunology

Appreciable numbers of aspirin-sensitive asthmatic patients have chronic severe asthmatic symptoms. We report two cases of aspirin-sensitive asthmatics with mild asthmatic symptoms, whose methacholine PC20 levels were 9.07 and 7.06 mg/ml at first visit. The aspirin sensitivity was confirmed by lysine-aspirin bronchoprovocation at initial diagnosis. After anti-asthmatic medications and avoidance of salicylate-containing agents, respiratory symptoms, airway hyperrespon-siveness, and aspirin sensitivity disappeared after 33 and 45 months. These results suggest that early detection and careful avoidance of salicylate-containing agents may have beneficial effects resulting in resolution of airway hyperresponsiveness and aspirin sensitivity in aspirin-sensitive asthmatic patients.
Aspirin ; Asthma* ; Diagnosis ; Humans ; Methacholine Chloride

Background and objectives: Mugwort pollen is one of the major causative allergens in this country. There have been a few reports suggesting a significant association between mugwort pollen and food allergens. The aim of this study was to evaluate the allergenic relationship between mugwort pollen and food allergens based upon skin prick tests. Material and method: Of 2,909 allergy patients who had been skin tested to identify causative allergens at the Allergy Clinic of Ajou University Hospital, 471 patients sensitized to mugwort, ragweed, or Hop Japanese pollens on skin prick test (2+ of A/H ratio) were enrolled for this study. Positive rates to common inhalant or food allergens and their allergenic relationships with other pollens or food allergens were analyzed based upon skin prick test results. RESULTS: The positive rates (2+ of A/H) to nettle, rye grass, Bermuda grass, birch, and alder pollens were significantly higher in those sensitized to mugwort pollen than in those of negative responders (p<0.05, respectively). In regard to food allergens, positive rates to celery (15.3%) and carrot (14.5%) were significantly higher in patients sensitized to mugwort pollen (p<0.05, respectively). Significant association was noted between mugwort pollen and celery allergen (p< 0.05). CONCLUSION: Positive response to mugwort pollen can be associated with celery and carrot sensitivity on skin prick tests.
Allergens* ; Alnus ; Ambrosia ; Apium graveolens* ; Artemisia* ; Asian Continental Ancestry Group ; Betula ; Cynodon ; Daucus carota* ; Humans ; Humulus ; Hypersensitivity* ; Lolium ; Pollen* ; Skin Tests ; Skin*