No abstract available.
Physiology* ; Prognosis* ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency*

BACKGROUND: Endobronchial tuberculosis is one of the serious complications of pulmonary tuberculosis. Without early diagnosis and proper treatment of endobronchial tuberculosis, bronchostenosis can leave and lead to the collapse of distal lung parenchyme, bronchiectasis, and secondary pneumonia accompanied with moderate to severe dyspnea, cough, hemoptysis, and localized wheezing. Therefore steroid therapy has been tried to prevent bronchostenosis. But the effect of steroid therapy on the endobronchial tuberculosis is not definite at present. We tried to elucidate the effect of steroid on the treatment of endobronchial tuberculosis for prevention of bronchoste- nosis. METHODS: We observed the initial and sequential bronchoscopic findings, pulmonary function tests and simple chest roentgenograms in 58 patients diagnosed as endobronchial tuberculosis and admitted to Chung-Ang university hospital from 1988 to 1992. The patients in nonsteroid group (n=39) were treated with anti-tuberculosis chemotherapy only and steroid group(n=17) with combined steroid therapy. Sequential bronchoscopic findings, pulmonary function tests, and chest roentgenograms were comparatively analyzed between the two groups. RESULTS: 1) The endobronchial tuberculosis was highly prevalent in young females especially in third decade. 2) Both actively caseating type and the stenotic type without fibrosis was the most common in the bronchoscopic classification. 3) The sequential bronchoscopic findings in steroid group 2 months after treatment showed no significant improvements compared with nonsteroid group. 4) There was no significant difference between the two groups in the sequential bronchoscopic improvements according to bronchoscopic types. 5) We did not find any significant difference in improvements on follow-up pulmonary function tests and simple chest roentgenograms between the two groups 2 month after treatment. 6) There was no significant adverse effect of steroid during the treatment. CONCLUSION: Combined steroid therapy provably would not influence outcome of the treatment of endobronchial tuberculosis.
Bronchiectasis ; Classification ; Cough ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Female ; Fibrosis ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung ; Pneumonia ; Respiratory Function Tests ; Respiratory Sounds ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

OBJECTIVES: Microalbuminuria predicts cardiovascular mortality in patients with non-insulin-dependent diabetses mellitus (NIDDM). Microalbuminuria is frequently associated with high blood pressure, dyslipidemia, insulin resistance and central obesity, and has been suggested to be a feature of metabolic syndrome (syndrome X). Metabolic syndrome is also present in Cushings syndrome, which is characterized by primary hypercortisolism as well as profound visceral obesity. Considering common features of Cushings syndrome and metabolic syndrome, microalbuminuria could be a feature of Cushings syndrome. METHODS: We studied urinary albumin excretion (UAE) in 13 patients with Cushings syndrome. UAE was reexamined after the correction of hypercortisolemia in the patients with microalbuminuria or overt proteinuria. Kidney biopsy was performed in 3 patients with microalbuminuria. RESULTS: Eight out of 13 patients (61.5 %) had microalbuminuria. Kidney biopsy revealed apparently normal glomerular structures without evidence of diabetic or hypertensive nephropathy. Patients underwent successful removal of pituitary or adrenal tumors and were reevaluated 2 months after surgery. UAE declined profoundly in all of the patients with initial microalbuminuria. CONCLUSION: Our results demonstrate that more than 60% of patients with Cushings syndrome have microalbuminuria. This rate far exceeds the rate in NIDDM patients and hypertensive patients. Microalbuminuria nearly completely reversed after successful treatment of hypercortisolism.
Biopsy ; Cushing Syndrome ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Humans ; Hypertension ; Insulin Resistance ; Kidney ; Mortality ; Obesity, Abdominal ; Proteinuria

BACKGROUND: The tetralogy of Fallot (TOF) with pulmonary atresia (PA) and a ductus-dependent pulmonary circulation (no major aorto-pulmonary collateral arteries (MAPCAs)) has been treated with staged repair or primary repair depending on the preference of surgeons or institutions. We evaluated the 19-year outcome of staged repair for this anomaly to find out whether our surgical strategy should be changed. MATERIALS AND METHODS: Forty-four patients with TOF/PA with patent ductus arteriosus (PDA) who underwent staged repair from June 1991 to October 2010 were included in this retrospective study. The patients with MAPCAs were excluded. The average age at the first palliative shunt surgery was 40.8+/-67.5 days (range: 0~332 days). Thirty-one patients (31/44, 70%) were neonates. The average weight was 3.5+/-1.6 kg (range: 1.6~8.7 kg). A modified Blalock-Taussig (BT) shunt was performed in 38 patients, classic BT shunt in 4 patients, and central shunt in 2 patients. Six patients required concomitant procedures: pulmonary artery angioplasty was performed in 4 patients, pulmonary artery reconstruction in one patient, and re-implantation of the left pulmonary artery to the main pulmonary artery in one patient. Four patients required a second shunt operation before the definitive repair was performed. Thirty-three patients underwent definitive repair at 24.2+/-13.3 months (range: 7.3~68 months) after the first palliative operation. The average age at the time of definitive repair was 25.4+/-13.5 months (range: 7.6~68.6 months) and their average weight was 11.0+/-2.1 kg. For definitive repair, 3 types of right ventricular outflow procedures were used: extra-cardiac conduit was performed in 30 patients, trans-annular patch in 2 patients, and REV operation in 1 patient. One patient was lost to follow-up after hospital discharge. The mean follow-up duration for the rest of the patients was 72+/-37 months (range: 4~160 months). RESULTS: Ten patients (10/44, 22.7%) died before the definitive repair was performed. Four of them died during hospitalization after the shunt operation. Six deaths were thought to be shunt-related. The average time of shunt-related deaths after shunt procedures was 8.7 months (range: 2 days~25.3 months). There was no operative mortality after the definitive repair, but one patient died from dilated cardiomyopathy caused by myocarditis 8 years and 3 months after the definitive repair. Five-year and 10-year survival rates after the first palliative operation were 76.8% and 69.1%, respectively. CONCLUSION: There was a high overall mortality rate in staged repair for the patients with TOF/PA with PDA. Majority of deaths occurred before the definitive repair was performed. Therefore, primary repair or early second stage definitive repair should be considered to enhance the survival rate for patients with TOF/PA with PDA.
Angioplasty ; Arteries ; Cardiomyopathy, Dilated ; Ductus Arteriosus, Patent ; Follow-Up Studies ; Hospitalization ; Humans ; Infant, Newborn ; Lost to Follow-Up ; Myocarditis ; Pulmonary Artery ; Pulmonary Atresia ; Pulmonary Circulation ; Retrospective Studies ; Survival Rate ; Tetralogy of Fallot

OBJECTIVE: It was suggested that the cause of microalbuminuria is heterogeneous in NIDDM. However, only a few studies are available that investigated the renal pathology in NIDDM patients with microalbuminuria. This study was undertaken to evaluate renal pathology in Korean NIDDM patients with microalbuminuria. METHODS: Fifty NIDDM patients with microalbuminuria and without retinopathy were undertaken renal biopsy. Renal pathologic findings were classified as follows: group A, near-normal finding; group B, typical diabetic nephropathology; group C, atypical patterns of renal injury (mild glomerular change with disproportionally severe tubulointerstitial lesion, arteriolar hyalinosis or global glomerular sclerosis); group D, non-diabetic renal lesion. RESULTS: Seventeen patients were classified into group A, 19 into group B and 8 into group C. Six patients had non-diabetic renal lesions and they were all confirmed to be IgA nephropathy. Fasting blood sugar and GFR were significantly higher in group B than in group A and group C respectively, and systolic blood pressure was higher in group C than in group A. CONCLUSION: Renal pathology in microalbuminuric NIDDM patients without retinopathy was heterogeneous. This may explain heterogeneous clinical meaning of microalbuminuria in NIDDM.
Biopsy ; Blood Glucose ; Blood Pressure ; Diabetes Mellitus, Type 2* ; Fasting ; Glomerulonephritis, IGA ; Humans ; Pathology* ; Population Characteristics*

The purpose of this study was to examine the effect of stabilization of retinyl palmitate (RP) on its skin permeation and distribution profiles. Skin permeation and distribution study were performed using Franz diffusion cells along with rat dorsal skin, and the effect of drug concentration and the addition of pectin on skin deposition profiles of RP was observed. The skin distribution of RP increased in a concentration dependent manner and the formulations containing 0.5 and 1 mg of pectin demonstrated significantly increased RP distributions in the epidermis. Furthermore, it was found that skin distribution of RP could be further improved by combined use of pectin and ascorbyl palmitate (AP), due largely to their anti-oxidative effect. These results clearly demonstrate that the skin deposition properties of RP can be improved by stabilizing RP with pectin. Therefore, it is strongly suggested that pectin could be used in the pharmaceutical and cosmetic formulations as an efficient stabilizing agent and as skin penetration modulator.
Animals ; Diffusion ; Epidermis ; Rats ; Skin*

The purpose of this study was to examine the effect of stabilization of retinyl palmitate (RP) on its skin permeation and distribution profiles. Skin permeation and distribution study were performed using Franz diffusion cells along with rat dorsal skin, and the effect of drug concentration and the addition of pectin on skin deposition profiles of RP was observed. The skin distribution of RP increased in a concentration dependent manner and the formulations containing 0.5 and 1 mg of pectin demonstrated significantly increased RP distributions in the epidermis. Furthermore, it was found that skin distribution of RP could be further improved by combined use of pectin and ascorbyl palmitate (AP), due largely to their anti-oxidative effect. These results clearly demonstrate that the skin deposition properties of RP can be improved by stabilizing RP with pectin. Therefore, it is strongly suggested that pectin could be used in the pharmaceutical and cosmetic formulations as an efficient stabilizing agent and as skin penetration modulator.
Animals ; Diffusion ; Epidermis ; Rats ; Skin*

Presently talc is one of the agents most commonly used for producing a pleurodesis in patients with either a recurrent pleural effusion or a spontaneous pneumothorax. Talc can be instilled into the pleural space either as an aerosol (insufflation) or as a suspension (slurry) in saline. They are quite effective in producing a pleurodesis. However, they rarely have acute serious adverse effects including acute respiratory distress syndrome, and recently a discussion for using pleurodesis has been reported. We experienced a case of acute respiratory distressed syndrome after talc pleurodesis. A 64 year old man, who was diagnosed lung cancer with a malignant pleural effusion at the same side, was treated by pleurodesis using talc to control the effusion. After 3 days, he suffered fever, chill and breathlessness. The chest PA and CT revealed a bilateral infiltration in both lungs and the blood gas analysis confirmed hypoxemia, which required mechanical ventilation.
Anoxia ; Blood Gas Analysis ; Fever ; Humans ; Lung ; Lung Neoplasms ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurodesis* ; Pneumothorax ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Talc* ; Thorax

PURPOSE: As Korea is an aging society (WHO classification) and projected to be an aged society in 10 years, peripheral vascular diseases (PVD) in the elderly population has emerged as an important social and medical issue. But their prevalence was rarely reported in Korea. The purpose of this study is to define the prevalence of carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAOD) of lower limb in the Incheon area. METHODS: Elderly men (> or =65 years) were referred randomly from the Incheon Federation of Korean Senior Citizens' Association (from Nov 2008 to Sep 2009) to Inha Univeristy Hospital, Incheon, Korea for a PVD screening program. The subjects were screened for CAS and AAA by duplex. CAS was defined as > or =50% internal CAS and AAA as > or =3 cm aortic diameter in minor axis. PAOD of lower limb was screened by measurement of ankle brachial index (ABI); ABI of < or =0.9 was considered abnormal. RESULTS: 1150 subjects were screened including 103 octogenarians (9.0%). Mean age was 72.3+/-0.2 years. Combined conditions were hypertension (54.3%), diabetes mellitus (25.2%), coronary artery disease (15.6%), dyslipidemia (18.9%), obesity (31.1%) and smoking history (71.7%). CAS was detected in 7.7% (89/1,150) subjects. Thirty-three (2.9%) were diagnosed with AAA. PAOD was detected in 50 subjects (4.4%). CONCLUSION: Prevalence of PVD in Korea is not lower compared to that of western countries, especially the USA and the UK. A nationwide program for timely detection and treatment for PVD should be developed.
Aged ; Aged, 80 and over ; Aging ; Ankle Brachial Index ; Aortic Aneurysm, Abdominal ; Arterial Occlusive Diseases ; Axis, Cervical Vertebra ; Carotid Stenosis ; Coronary Artery Disease ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Korea ; Lower Extremity ; Male ; Mass Screening ; Obesity ; Peripheral Vascular Diseases ; Prevalence ; Smoke ; Smoking ; Vascular Diseases

We report here a case with hypereosinophilia and peripheral artery occlusion. A 32-yr-old Korean woman presented to us with lower extremity swelling and pain. Angiography revealed that multiple lower extremity arteries were occlusive. The biopsy specimen showed perivascular and periadnexal dense eosinophilic infiltration in dermis and subcutaneous adipose tissue. Laboratory investigations revealed a persistent hypereosinophilia. She was prescribed prednisolone 60 mg daily. Her skin lesion and pain were improved and the eosinophil count was dramatically decreased. After discharge, eosinophil count gradually increased again. Cyanosis and pain of her fingers recurred. She had been treated with cyclophosphamide pulse therapy. Her eosinophilia was decreased, but the cyanosis and tingling sense were progressive. The extremity arterial stenoses were slightly progressed. Skin biopsy showed perivascular eosinophilic infiltration in the dermis and CD40 ligand (CD40L) positive eosinophilic infiltration. The serum TNF-alpha was markedly increased. These results suggest that CD40L (a member of TNF-alpha superfamily) could play a role in the inflammatory processes when eosinophil infiltration and activation are observed. We prescribed prednisolone, cyclophosphamide, clopidogrel, cilostazol, beraprost and nifedipine, and she was discharged.
Adult ; Arterial Occlusive Diseases/*diagnosis/etiology ; CD40 Ligand/analysis ; Cyanosis/etiology ; Diagnosis, Differential ; Eosinophilia/*diagnosis/etiology ; Female ; Gangrene/etiology ; Humans ; Hypereosinophilic Syndrome/blood/complications/*diagnosis ; Immunohistochemistry ; Peripheral Vascular Diseases/*diagnosis/etiology ; Skin/chemistry/pathology ; Tumor Necrosis Factor-alpha/metabolism ; Vasculitis/*diagnosis/etiology