PURPOSE: An anthracofibrosis(AF), dark multiple anthracotic pigmentations combined with narrowing and obstruction of bronchi, was reported to be strongly related with past and active pulmonary tuberculosis. This study was performed to determine whether anti-tuberculous regiemens would be helpful in patients with anthracofibrosis who failed to demonstrate the evidences of pulmonary tuberculosis. METHODS: Twenty-two patients with multiple anthracotic pigmentations in bronchia mucosa with luminal narrowing were enrolled in this study. The bacteriological and histological findings for Mycobacterium tuberculosis was reviwed in each patients. They are composed of 8 males and 14 females ranging from 55 to 85 years old in age. RESULTS: The most common symptoms were coughing(73%, 16/22), followed by sputum(41%, 9/22), dyspnea on exertion (32%, 7/22), and hemoptysis(27%, 6/22). The evidence of pulmonary tuberculosis, defined by positive AFB smear or culture of Mycobacterium tuberculosis from sputum or bronchial washing fluid or histological findings of granuloma with caseous necrosis, were found in eleven patients(50%) and the others has showed no evidences. Among 11 patients without pulmonary tuberculosis, only one patient showed the evidences of pulmonary tuberculosis after 16 months, and the 8 patients still showed no evidence of pulmonary tuberculosis during follow-up periods of ranging from 8 months to 60 months. CONCLUSION: Beause the authracofibrosis is closely related to tuberculosis, it needs to find out extensively the evidences of tuberculosis in patient with authracofibrosis. Chemotherapy for tuberculosis should be administrated only with confirmation of tuberculosis on bacteriologic study.
Bronchi ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies ; Granuloma ; Humans ; Male ; Mucous Membrane ; Mycobacterium tuberculosis ; Necrosis ; Phenobarbital ; Pigmentation ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the clinical efficacy of DCE-MDCT in OGIB patients. METHODS: We retrospectively analyzed the medical records of 362 patients who underwent DCE-MDCT between March 2009 and January 2014. A total of 45 patients diagnosed with OGIB were included in this study. Their baseline characteristics and treatment procedure were analyzed retrospectively. The positive rates of DCE-MDCT for the detection of bleeding and associated factors were assessed. RESULTS: The mean age of the patients was 59 years, and males represented 51.1%. Melena was the most common symptom (44.4%). Positive rate of DCE-MDCT findings was 20.0% (9/45). Among these patients, intraluminal contrast extravasation was found in 5 patients (55.6%) and intraluminal hematoma or mass lesions were found in 2 patients each (22.2%). Thirty nine patients (86.7%) underwent conservative management, and 6 patients (13.3%) underwent specific treatment, such as endoscopic treatment, embolization, or surgery. Patients who showed positivity in DCE-MDCT more frequently received specific treatment compared with those who were negative (44.4% vs. 5.6%, p=0.010). CONCLUSIONS: Although DCE-MDCT showed a low positive rate (20.0%), positive findings of DCE-MDCT could lead to specific treatment. Positive DCE-MDCT findings play a useful role in the management of patients with OGIB.
Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging ; Humans ; Male ; Melena/etiology ; Middle Aged ; *Multidetector Computed Tomography ; Recurrence ; Retrospective Studies

BACKGROUND: Usual interstitial pneumonia (UIP) is a progressive fibrous lung disease with occasional fatal outcomes. However, the extent and rate of progression varies markedly from one patient to another. As a result, it is difficult to determine the time of the initial treatment and assess the disease activity and course. Fibroblast foci (FF) is well known to synthesize collagen actively by their myofibroblasts component. However, the prognostic value of the FF have not been evaluated in patients with UIP. Therefore this study was undertaken to determine how the number of fibroblastic foci can reflect the disease activity and progression. METHODS: Twenty patients with UIP(M:F=13:7), who were diagnosed by a surgical lung biopsy. The number of fibroblastic foci was analyzed in terms of its correlation with the clinical manifestations. pulmonary function test, arterial blood gas analysis, and a bronchoalveolar lavage(BAL). RESULTS: The number of fibroblastic foci did not correlate with the various lung function tests and the other clinical parameters. Intersetingly, the percentage of neutrophils in the bronchoalveolar lavage fluid did correlate with the quantity of the normalized Vv of FF(r=0.60, p<0.05). The patients were divided into 2 groups, group I and II, arbitratily, according to the value of the normalized Vv. The clinical parameters and the PFT results were not different between the two groups. In particular, the survival rate between the two groups according to the Kaplan-Meier analysis were not different. CONCLUSION: A large number of FF does not imply a bad prognosis in patients wit UIP.
Biopsy ; Blood Gas Analysis ; Bronchoalveolar Lavage Fluid ; Collagen ; Fatal Outcome ; Fibroblasts* ; Humans ; Idiopathic Pulmonary Fibrosis* ; Kaplan-Meier Estimate ; Lung ; Lung Diseases ; Myofibroblasts ; Neutrophils ; Prognosis ; Respiratory Function Tests ; Survival Rate

BACKGROUND: There are epidemiological clinical studies that describe the relationship of decreased serum cholesterol levels or their treatment with suicides, offensive actions and depression. METHODS: We studied 140 patients who were hospitalized at Asan Foundation Jeongup Hospital (in Korea) via emergency room after suicide attempts and whose serum cholesterol levels were acquired during 53 months (from Jan. 1. 1995 to May 31. 1999). They were evaluated with the use of t-test. The serum cholesterol levels were compared between the control group of 140 persons who underwent health check ups and 140 patients who were of similar age and sex ratios. RESULTS: Subjects showed significant decrease in serum cholesterol levels in comparison with the control group. Low serum cholesterol levels were related with the severity of suicidal attempts. 1) The subjects showed lower serum cholesterol levels than the control group(150.51+/-56.69mg/dl vs 185.61+/-31.94mg/dl; t= 6.382, df=278, P<0.001) (Table 3). 2) Those who killed themselves showed statistically significant decrease in serum cholesterol levels than those who survived after their suicidal attempts(169.13+/-49.29mg/dl vs 135.89+/-34.14; t=2.005, P<0.05) (Table 4). CONCLUSION: This study was carried out in farming and fishing villages of Korea. The result showed that the decrease in serum cholesterol levels increased the risk of suicide trials. This fact is similar to the results of the previous studies performed at other farming and fishing communities. In addition, those who killed themselves had lower serum cholesterol levels compared to those who survived suicide attempts. This relationship was associated with depression.
Cholesterol* ; Chungcheongnam-do ; Depression ; Emergency Service, Hospital ; Humans ; Korea ; Sex Ratio ; Suicide

PURPOSE: This study was conducted to evaluate the patterns of disease progression following either resection or palliative management of hilar cholangiocarcinoma and to clarify the polarity of the resection margin. METHODS: The medical records of 78 hilar cholangiocarcinoma patients who were admitted to the Inha University Hospital between June of 1996 and May of 2006 were retrospectively reviewed. The patterns of recurrence were compared between the margin positive, margin negative and palliative management groups, and factors influencing recurrence and survival were then analyzed using the Cox proportional hazard model. RESULTS: The hilar cholangiocarcinoma recurred or progressed in 56 patients (71.8%) following the initial treatment, and the median progression free survival (PFS) time was 10.1 months. The 3-yr estimates of overall relapse and the median PFS were 90.7% and 17 months, respectively, in the resection group (n=32) and 100% and 7 months, respectively, in the palliative group (n=46) (p=0.045). There was no significant difference observed in the 3-yr estimates of overall disease progression or the median PFS according to the margin positivity or resection methods. When the disease progression pattern was analyzed, there was no significant difference observed between the groups, however, the survival analysis showed that survival was greater in the group that underwent resection with curative intent than in the palliative management group (p=0.001). Adjuvant chemotherapy or radiotherapy had no effect on recurrence or survival, and poor differentiation was the only significant prognostic factor for survival identified when the Cox proportional hazard model was used. CONCLUSION: Because no difference in the pattern of disease progression existed, aggressive surgical resection should be attempted to prevent recurrence and to increase survival, even in cases in which a suspicious positive resection margin is present.
Chemotherapy, Adjuvant ; Cholangiocarcinoma* ; Disease Progression ; Disease-Free Survival ; Humans ; Medical Records ; Proportional Hazards Models ; Radiotherapy ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: The point mutations in 23S rRNA gene accounts for the majority of the clarithromycin resistance of Helicobacter pylori. This study aimed to investigate the association between the clarithromycin-resistance of H. pylori and the failure of primary H. pylori eradication therapy in Jeju Island. METHODS: Between April 2011 and October 2012, 6,937 patients underwent endoscopy, and H. pylori infection was evaluated in 2,287 patients (33.0%). Total of 110 patients with H. pylori infection were treated with proton pump inhibitor (PPI)-based triple therapy. The result of eradication was evaluated with urea breath test, histology and PCR which were conducted 4 weeks from the last dose of medicine. RESULTS: The patients who had point mutations were 33 (26.0%). A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%). Among 110 patients treated with PPI-based triple therapy, the success rate of the eradication therapy was 52.7% (58/110) and 70.7% (58/82) by intention-to-treat and per-protocol analysis, respectively. Fifteen of the 24 patients who failed the eradication therapy showed point mutations; 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. Patients with A2143G mutation H. pylori showed higher failure rate of 87.5%. Patients with A2142G mutation H. pylori showed similar failure rate compared to those of the patients with wild type H. pylori. CONCLUSIONS: In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with other regions of Korea (15.8-31.3%). A2143G mutation is associated with the failure of H. pylori eradication.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Clarithromycin/*therapeutic use ; DNA, Bacterial/analysis ; Drug Resistance, Bacterial ; Female ; Gastroscopy ; Helicobacter Infections/*drug therapy ; Helicobacter pylori/drug effects/*genetics ; Humans ; Islands ; Male ; Middle Aged ; Point Mutation ; Polymerase Chain Reaction ; Proton Pump Inhibitors/therapeutic use ; RNA, Ribosomal, 23S/*genetics ; Republic of Korea ; Young Adult

PURPOSE: Identification of tolerable alternative analgesics is crucial for management in nonsteroidal anti-inflammatory drug (NSAID)-sensitive patients. We investigated cross-reactivity of acetaminophen and celecoxib according to the type of aspirin/NSAID hypersensitivity and aimed to determine the risk factors for cross-intolerance. METHODS: We retrospectively reviewed the medical records of patients intolerant to aspirin and NSAIDs who had undergone an acetaminophen and/or celecoxib oral provocation test. Aspirin/NSAID hypersensitivity was classified into 4 types according to a recently proposed classification: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated chronic urticaria (AECU), aspirin-induced acute urticaria/angioedema (AIAU), and NSAID-induced blended reaction (NIRD). RESULTS: A total of 180 patients with hypersensitivity to aspirin and NSAIDs were enrolled; 149 acetaminophen provocation test results and 145 celecoxib provocation test results were analyzed. The overall cross-reaction rates to acetaminophen and celecoxib were 24.8% and 10.3%, respectively. There was a significant difference in the cross-reactivity to acetaminophen according to the type of NSAID hypersensitivity. Cross-reactivity to acetaminophen was highest in the AECU group (43.9%), followed by the AERD (33.3%), NIBR (16.7%), and AIAU (12.5%) groups. Underlying chronic urticaria was more prevalent in patients with cross-intolerance to both acetaminophen (P=0.001) and celecoxib (P=0.033). Intolerance to acetaminophen was associated with intolerance to celecoxib (P<0.001). CONCLUSIONS: Acetaminophen and celecoxib may induce adverse reactions in a non-negligible portion of aspirin/NSAID-sensitive patients. Physicians should be aware of the possible cross-reactions of these alternative drugs and consider an oral challenge test to confirm their tolerability.
Acetaminophen* ; Analgesics ; Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Classification ; Cross Reactions ; Drug Hypersensitivity* ; Humans ; Hypersensitivity ; Medical Records ; Methods ; Retrospective Studies ; Risk Factors ; Urticaria ; Celecoxib

BACKGROUND: Induced sputum analyses are widely utilized to evaluate airway inflammation in asthmatics. However, the values have not been examined in Korean adults. OBJECTIVE: The purpose of this study is to determine reference ranges for induced sputum eosinophils and their influencing factors in Korean adults. METHODS: A total of 208 healthy nonasthmatic adults were recruited. Sputum induction and processing followed the international standard protocols. RESULTS: Adequate sputum samples were successfully collected from 81 subjects (38.9%). The upper 90 percentile for sputum eosinophil was calculated as 3.5%. The median value of eosinophil count percentage was significantly higher in subjects with atopy than those without atopy (median, 1.6%; range, 0-11.0% vs. median, 0%; range 0-3.6%, p=0.030). However, no significant correlations were found with age, gender, body mass index, smoking status, blood eosinophil, or fractional exhaled nitric oxide levels. CONCLUSION: Current study was the first attempt to determine the reference ranges of induced sputum eosinophils in Korean adults. The cutoff value for sputum eosinophilia was 3.5%, and was significantly associated with atopy.
Adult ; Body Mass Index ; Eosinophilia ; Eosinophils ; Healthy Volunteers ; Humans ; Inflammation ; Nitric Oxide ; Reference Values ; Smoke ; Smoking ; Sputum

The characteristic features of Churg-Strauss syndrome are vasculitis, both intra- and extravascular granuloma formation with eosinophilic tissue infiltration, and strong association with asthma and peripheral eosinophilia. Churg-Strauss syndrome with pleural effusion is relatively common and only a few cases have previously been reported in Korea. We report a case of Churg-Strauss syndrome with pleural effusion confirmed by VATS.
Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Eosinophils ; Granuloma ; Korea ; Pleural Effusion ; Thoracic Surgery, Video-Assisted ; Vasculitis

PURPOSE: Sensitization to specific allergens may be important in the development of allergic airway inflammation and airway hyperresponsiveness (AHR). We evaluated the effect of specific aeroallergen sensitization on eosinophilic airway inflammation and AHR. METHODS: We reviewed retrospectively the clinical data of subjects who underwent skin prick tests to aeroallergens, induced sputum analysis, and methacholine bronchial provocation tests to evaluate lower airway symptoms as well as analyzed the associations between the pattern of aeroallergen sensitization and sputum eosinophilia or AHR. RESULTS: Of the 1,202 subjects be enrolled, 534 (44.4%) were sensitized to at least one aeroallergen in skin tests. AHR was demonstrated in 23.5% and sputum eosinophilia in 38.8%. Sputum eosinophilia was significantly associated with sensitization to perennial allergens (OR, 1.9; 95% CI, 1.4-2.5), house dust mite (OR, 1.7; 95% CI, 1.3-2.3), dog (OR, 1.9; 95% CI, 1.1-3.3), and cat (OR, 2.1; 95% CI, 1.4-3.4). AHR was associated with sensitization to perennial allergens (OR, 2.7; 95% CI, 2.0-3.7), house dust mite (OR, 2.2; 95% CI, 1.6 3.2), Alternaria (OR, 2.3; 95% CI, 1.2-4.7), and cat (OR, 2.7; 95% CI, 1.7-4.3). Sensitization to more perennial allergens increased the risk for sputum eosinophilia and AHR. There was no relationship with individual seasonal allergens. CONCLUSION: The development of airway eosinophilic inflammation and AHR in an adult Korean population was associated with sensitization to perennial allergens rather than seasonal allergens.
Adult ; Allergens ; Alternaria ; Animals ; Bronchial Provocation Tests ; Cats ; Dogs ; Eosinophilia ; Eosinophils* ; Humans ; Inflammation* ; Methacholine Chloride ; Pyroglyphidae ; Retrospective Studies ; Seasons ; Skin ; Skin Tests ; Sputum