Detecting eggs from feces and/or sputum is probably closely associated with many factors such as degree or intensity of infection, physiological status of the host(age, eating habit and duration of residence in the area), the duration of infection for the parasite (age and reproductive activity of flukes), and methods of collecting specimens and technique of examination. Neverthless, it is difficult to determine which factor plays the most inportant role in detecting eggs except comparison of factual result obtained by standardized techniques. The purpose of the study was to find out which method would give better result for detection of eggs, and to estimate what proportion of patients would be missed when the method selected is used. On a single examination of both specimens, stool and sputum, collected from the same person, sputum examination was found to be superior to stool examination for detection of eggs; 37 of 40 egg positives had eggs in sputum whereas only 21 of 40 in stool. Repeated sputum examination on the same subject in spaced time gave higher overall egg detection rate; in the first examination for all skin reaction positives, the detection rate was 36.8%, in the second examination on those who had negative results in the first examination, it was 11.6% among 602 persons examined, and 5.3 percent of 95 persons who were negative in previous two examinations. Thus, repeated sputum examinations (three times) increased the overall detection rate to 48.5% from 36.8%. According to the result obtained through this study, it would be worthwhile to recommend repeated sputum examinations at least three times on the same subject even if collecting second and third sputum is quite difficult problem in mass survey; about 12% of total patients who can be detected as positive by three times repeated examinations shall be missed if only a single sputum examination is done.
parasitology-trematode-Paragonimus westermani ; diagnosis ; sputum examination ; stool examination skin test

Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3 5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Antifungal Agents ; Fever ; Humans ; Korea ; Neutropenia ; Neutrophils ; Physical Examination ; Sputum

Primary malignant melanoma occurring in the lung is very rare and only few cases have been reported in the literatures. We have experienced one case of primary malignant melanoma of the right middle lobe. The patient was a 65-year-old male who had cough with blood tinged sputum for one month. Chest computed tomography showed about 4.5x3 cm sized mass at the right middle lobe encasing the bronchus. Percutaneous needle biopsy was performed and confirmed to malignant melanoma. Physical examination and additional clinical history showed that the mass had not metastasized to other possible primary sites. The patient underwent thoracotomy with right middle lobe lobectomy. Histologically, the tumor showed sheets of tumor cells that have nuclear atypia and melanin pigment Postoperative course was uneventful and the patient has been followed up for 24 months with no recurrence.
Aged ; Biopsy, Needle ; Bronchi ; Cough ; Humans ; Lung Neoplasms ; Lung* ; Male ; Melanins ; Melanoma* ; Physical Examination ; Recurrence ; Sputum ; Thoracotomy ; Thorax ; Tolnaftate

This study was conducted to evaluate the health hazards and to develop diagnostic methods of glass fiber workers. We examined 40 male glass fiber workers (exposure group) and 57 male non-glass fiber workers (reference group) with a questionnaire, physical examination, chest x-ray and pathological examination in Mar, 1997. Also we examined 65 male glass fiber workers (exposure group) and 42 male non-glass fiber workers (reference group) with the same methods also we did some energy-dispersive x-ray analyses with a scanning electron microscopic examination in Sep. 1997. Most of the clinical symptoms were significantly more frequent among the exposure group than the reference group. Coughing (32.5%), itching of the nose (30.0%), irritation of eyes (27.5%), irritation of the nose (25.0%) and sputum (22.5%) were the major symptoms among the exposure group in Mar. 1997. Only itching of the nose was significantly more frequent in Sep. 1997. No cases of pneumoconiosis were observed among the groups and there were no differences in chest abnormalities between the exposure group with the reference group on both examinations. The prevalence of dermatosis among the exposure group was 20.0% (8 cases) and the cumulative prevalence was 72.5% (29 cases) in Mar. 1997. The prevalence of dermatosis among the exposure group was 23.1% (15 cases) and the cumulative prevalence was 58.5% (38 cases) in Sep. 1997. Onset of dermatosis among the exposure group was most frequent within one month after handling. The frequent sites of skin lesions were the hands and arms on both examinations. Glass fiber induced skin lesions can be diagnosed by the scotch tape method or KOH mount and then can be examined under the light, polarizing and phase-contrast microcopies. Glass fibers can be identified by some energy-dispersive x-ray analyses with a scanning electron microscopic examination.
Arm ; Cough ; Glass* ; Hand ; Humans ; Male ; Nose ; Physical Examination ; Pneumoconiosis ; Prevalence ; Pruritus ; Questionnaires ; Skin ; Skin Diseases ; Sputum ; Thorax

A previously healthy 59-year old male patient was admitted due to cough and abnormal chest x-ray. Cough started 5 months ago and persisted. Two months before admission, abnormality in chest PA was detected. He had no symptom other than cough. He was nonsmoker and physical examination revealed no abnormal finding. His chest X-ray showed ill-defined 2x1 cm ovoid infiltration in left middle lung field. On chest computed tomography, it was located in the subpleural region of posterobasal segment of left lower lobe. Mediastinal lymphadenopathy was absent. Blood test and sputum examination were not diagnostic. Fluoroscopy-guided percutaneous needle biopsy revealed pulmonary cryptococcosis. After central nervous system involvement was excluded by spinal tap, oral ketoconazole therapy was started. The lesion decreased in size after 8 weeks of therapy and almost disappeared on follow-up chest X-ray 4 months later.
Biopsy, Needle ; Central Nervous System ; Cough ; Cryptococcosis* ; Follow-Up Studies ; Hematologic Tests ; Humans ; Ketoconazole ; Lung ; Lymphatic Diseases ; Male ; Physical Examination ; Spinal Puncture ; Sputum ; Thorax

In most cases of amyotrophic lateral sclerosis (ALS), respiratory muscle involvement is a late complication. Only 2.7% of ALS patients presenting with their first clinical symptoms in the extremities also experience respiratory symptoms. We report a case of an 81-year-old man with ALS, diagnosed by an unexplained failure to wean from mechanical ventilation. The patient was presented with acute respiratory failure, tachypnea and respiratory acidosis. Computed tomography of the chest showed large amounts of sputum in the trachea. An endotracheal tube was inserted, and the patient was placed on volume-controlled ventilation. However, in the course of recovery, he could not be weaned from mechanical ventilation, despite the absence of cardiopulmonary impairment. Having considered other causes of respiratory failure, wediagnosed ALS after a physical and neurologic examination and electrodiagnostic testing.
Acidosis, Respiratory ; Aged, 80 and over ; Amyotrophic Lateral Sclerosis ; Extremities ; Humans ; Neurologic Examination ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Muscles ; Sputum ; Tachypnea ; Thorax ; Trachea ; Ventilation

The tests for sputum acid fast bacilli and sputum cytology for malignancy were negative. The PC20 of bronchial methacholine challenge test was 20.2 mg/ml. Transbronchial lung biopsy showed bronchial inflammatory change with infiltration of eosinophils and the existence of fungal hypae. Antibody index for serum IgE-Af and IgG-Af was 10.2 and 2.1 respectively, comparing with Af-sensitive asthma patients. Recently we experienced an allergic bron-chopulmonary aspergillosis with atypical respiratory symptoms. Forty-seven years old female was admitted to our hospital because of cough, sputum, right pleuritic pain for 2 weeks. She had experienced pneumonia several times, but had been not confirmed any causative organism. On physical examination, breathing sound was decreased over right upper lung, but wheezing and crackle were not heard over both lungs. The chest X-ray showed segmental consolidation in right upper lobe, and HRCT showed tubular bronchiectasis and obstruction of right upper lobal bronchus due to mucoid impaction. Allergic skin prick test against Aspergillus fumigatus(Af) and serum preeipitin were negative, but intrader mal skin test was positive for Af. Specific IgE for Af was positive with class I. Total eosinophil count was 650/mm3, total IgE level was more than 3000 IU/ml, ESR was 62mm/hr, and eosinophils in induced sputum was 35%. The test for sputum acid fast bacilli and spu-Tum cytology for malignancy were negative. The PC20 of bronchial methacholine challenge-Test was 20.2 mg/ml. Transbronchial lung bi-Opsy showed bronchial inflammatory change With infiltration of eosinophils and the exis-Serum lgE-Af and lgG-Af was 10.2 and 2.1 Respectively, comparing with Af-sensitive Asthma patients.
Aspergillosis ; Aspergillus ; Asthma* ; Biopsy ; Bronchi ; Bronchiectasis ; Cough ; Eosinophils ; Female ; Humans ; Immunoglobulin E ; Lung ; Methacholine Chloride ; Physical Examination ; Pneumonia ; Respiratory Sounds ; Skin ; Skin Tests ; Sputum ; Thorax

BACKGROUND: Known as a kind of complication or a specific form of pulmonary tuberculosis, endobronchial tuberculosis caused several kinds of problems in diagnosis and managements. But the frequency of this disease are is widely variable, generally reported from as low as 10 - 20% to as high as 40 - 50%. We prospectively performed bronchoscopy in patients diagnosed as pulmonary tuberculosis to evaluate the frequency of endobronchial tuberculosis and its related findings. METHOD: From March, 1995 to February, 1996, we prospectively performed bronchoscopy in patients newly diagnosed as pulmonary tuberculosis and evaluated the frequency of endobronchial tuberculosis, its clinical features and laboratory findings including raiologic, microbiologic and physiologic aspects. RESULTS: Number of patients diagnosed as pulmonary tuberculosis was 103 and 55 patients(53.4%) were found to have endobronchial tuberculosis. But the frequency were 43.8% in male and 76.7% in female, respectively. Frequently noted symtoms were nonspecific including cough, sputum, fever, weight loss in the order of frequency but cough was more frequent than in pulmonary tuberculosis. Physical examination showed rale,decreased breathing sound and wheezing and wheezing was more frequent than in pulmonary tuberculosis. All 7 subtypes were noted bronchoscopically and edema-hyperemia (stenotic without fibrosis) type was most frequently(32.7%) noted, and followed by chronic nonspecific bronchitis type stenotic with fibrosis type and actively caseating type in the order of frequency. The relationship between subtypes of endobronchial tuberculosis and radiologic findings was insignificant. Right lung was involved more frequently than left lung and left upper lobe was most commonly involved site, and followed by right upper lobe and trachea. Acid-fast bacilli(AFB) positivity in sputum and / or bronchial washing fluid was 73% and suggested high risk of infectivity. CONCLUSION: The frequency of endobronchial tuberculosis in patients with pulmonary tuberculosis was higher than known and also suggested bronchoscopic examination to detect endobronchial involvement should be recommanded and careful management is also needed to prevent complications.
Bronchitis ; Bronchoscopy ; Cough ; Diagnosis ; Female ; Fever ; Fibrosis ; Humans ; Lung ; Male ; Physical Examination ; Prospective Studies ; Respiratory Sounds ; Sputum ; Trachea ; Tuberculosis* ; Tuberculosis, Pulmonary* ; Weight Loss

Congenital cystic adenomatoid malformation (CCAM) is an uncommon, nonhereditary anomaly caused by arrest of lung. Patients with CCAM may present with respiratory distress as newborns, or may remain asymptomatic until later in life. CCAM type I is rarely found in association with bronchial atresia (BA) in adults; we present such a case. Case: A 54-year-old female presented with chronic cough and blood-tinged sputum. Physical examination and laboratory tests were unremarkable. Chest radiographs and a CT scan of the chest showed multiple large air-filled cysts consistent with a CCAM in the right lower lobe, and an oval-shaped opacity in the distal right middle lobal bronchus. Based on the radiologic findings, right middle lobectomy and a medial basal segmentectomy of the right lower lobe were performed via a thoracotomy. These lesions were consistent with Stocker's Type I CCAM and BA in the different lobes.
Aged ; Bronchi ; Cough ; Cystic Adenomatoid Malformation of Lung, Congenital ; Female ; Humans ; Infant, Newborn ; Lung ; Mastectomy, Segmental ; Middle Aged ; Physical Examination ; Sputum ; Thoracotomy ; Thorax

Chronic obstructive pulmonary disease (COPD) and bronchial asthma are considered to be two distinct respiratory symptoms that share a functional abnormality, namely, airflow limitation. The new diagnosis of both syndromes relies on the measurement of expiratory flow, in particular, the forced expiratory volume measured after first-second forced expiration (FEV1) from forced vital capacity (FVC). COPD is characterized by poorly reversible or irreversible airflow limitation, wheareas asthma is characterized by reversible airflow obstruction, but the definitions of the COPD and asthma overlap each other, and 10-30% of COPD patients are combined with asthma. COPD and asthma should be considered separately, given the increasing divergence in the overall approach to treatment. COPD is largely "irreversible" - in constrast to asthma - and not substantially improved by inhaled anti-inflammatory treatment. In most cases, the clinical presentations of COPD and asthma are relatively easy to distinguish and the key in differentiating between them is history taking, physical examination, sputum and bronchoalveolar lavage fluid (BALF) examination, bronchial provocation and bronchodilator response test, HRCT, and biopsy. However, in some cases, it is very difficult to distinguish between pure COPD and COPD combined with asthma. I suggest, in these cases, peak expiratory flow rate (PEFR) is very valuable to evaluate the diurnal and seasonal variations of lung function needed for differential diagnosis.
Asthma* ; Biopsy ; Bronchoalveolar Lavage Fluid ; Diagnosis ; Diagnosis, Differential ; Forced Expiratory Volume ; Humans ; Lung ; Peak Expiratory Flow Rate ; Physical Examination ; Pulmonary Disease, Chronic Obstructive* ; Seasons ; Sputum ; Vital Capacity