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Usefulness of Photodynamic Therapy in the Management of Early Central Lung Cancer: A Report of Three Cases.

Jong Hoo LEE ; Kyeongman JEON ; Won Jung KOH ; Gee Young SUH ; Man Pyo CHUNG ; Hojoong KIM ; O Jung KWON ; Joungho HAN ; Sang Won UM

Tuberculosis and Respiratory Diseases.2009;67(4):338-344. doi:10.4046/trd.2009.67.4.338

In photodynamic therapy, a chemical photosensitizer is activated by light of a specific wavelength., Photodynamic therapy has been combined with bronchoscopy in patients who are ineligible for surgical resection in order to treat patients with early central lung cancer. Here, we describe 3 patients with early central lung cancer who were treated effectively using photodynamic therapy. Our experience shows that this approach is a useful modality in the therapy of these types of tumors.
Bronchoscopy ; Humans ; Light ; Lung ; Lung Neoplasms ; Photochemotherapy

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The Usefulness of Whole-blood Interferon-gamma Release Assay for the Diagnosis of Extra-pulmonary Tuberculosis.

Hye Min LEE ; Sung Gun CHO ; Hyung Koo KANG ; Sung Woon PARK ; Byung Ook LEE ; Jae Hee LEE ; Eun Ju JEON ; Jae Chol CHOI

Tuberculosis and Respiratory Diseases.2009;67(4):331-337. doi:10.4046/trd.2009.67.4.331

BACKGROUND: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). METHODS: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. RESULTS: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. CONCLUSION: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.
Hand ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Lymphadenitis ; Mycobacterium tuberculosis ; Pleurisy ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

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The Influence of Adverse Drug Reactions on First-line Anti-tuberculosis Chemotherapy in the Elderly Patients.

Jeong Ihm JEONG ; Bock Hyun JUNG ; Mi Hye KIM ; Jae Min LIM ; Dong Cheon HA ; Sung Won CHO ; Dae Sik RHUI

Tuberculosis and Respiratory Diseases.2009;67(4):325-330. doi:10.4046/trd.2009.67.4.325

BACKGROUND: Pulmonary tuberculosis (TB) is still common disease among the elderly patients in Korea where the overall incidence of TB is decreasing. Adverse drug reactions (ADR) associated with anti-TB drugs occurs frequently. Especially the aged tends to have more frequent ADRs than younger ones. These ADRs can cause significant morbidity, compromise therapeutic effects of drugs and even induce drug resistance. Therefore we evaluated the effect of ADRs on the first-line anti-TB drugs in elderly patients with active pulmonary TB. METHODS: We retrospectively reviewed the charts and radiological findings of the patients with 65 and older who were bacteriologically confirmed as active TB and treated with standard anti-TB drugs for at least 6 months. Major ADR was defined with temporary or continuous stop of any first-line drugs intake. RESULTS: An ADR was noted in 54% of all patients. The incidence of major ADR was 32% in all elderly patients. Dermatologic ADR (9%) was the most common among the major ADRs. GI trouble (8%), arthralgia (6%), visual change (6%), hepatotoxicity (4%), and fever (1%) were also noted. The drugs responsible for major ADR were ethambutol (62%), pyrazinamide (35%), rifampin (18%) and isoniazid (9%). Major ADRs were associated with higher ESR level at the initiation of anti-TB drugs. CONCLUSION: First-line anti-TB drugs in elderly patients frequently caused the major ADRs. Therefore the elderly patients receiving anti-TB drugs should be closely monitored and better tolerable therapy should be considered as part of a TB research agenda.
Aged ; Arthralgia ; Drug Resistance ; Drug Toxicity ; Ethambutol ; Fever ; Humans ; Incidence ; Isoniazid ; Korea ; Pyrazinamide ; Retrospective Studies ; Rifampin ; Tuberculosis, Pulmonary

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Chest Wall Tuberculosis: Clinical Features and Treatment Outcomes.

Young Joo KIM ; Hee Jung JEON ; Chang Ho KIM ; Jae Yong PARK ; Tae Hoon JUNG ; Eung Bae LEE ; Tae In PARK ; Kyung Nyeo JEON ; Chi Young JUNG ; Seung Ick CHA

Tuberculosis and Respiratory Diseases.2009;67(4):318-324. doi:10.4046/trd.2009.67.4.318

BACKGROUND: A diagnosis and treatment of chest wall tuberculosis (CWTB) is both difficult and controversial. The aim of this study was to collect information on the optimal treatment for CWTB. METHODS: The clinical features, radiographic findings, and treatment outcomes of 26 patients, who underwent surgery and were diagnosed histopathologically, were retrospectively analyzed. RESULTS: The most common presenting symptom was a palpable mass found in 24 patients (92.3%). In all patients, CT revealed a soft tissue mass that was accompanied by a central low density, with or without peripheral rim enhancement. The sensitivity and specificity of the bone scintigram for bone involvement were 87.5% and 100%, respectively. CWTB was diagnosed preoperatively by aspiration cytology and smear for acid-fast bacilli in five out of 11 patients. Twenty-three patients (88.5%) underwent a radical excision and three underwent incision/drainage or an incisional biopsy. The duration of antituberculous medication was 7.5+/-3.98 months with a follow-up period of 28.2+/-26.74 months. Among the 20 patients who completed their treatment, nine received chemotherapy for six months or less and 11 received chemotherapy for nine months or more. Two patients had a recurrence four and seven months after starting their medication. CONCLUSION: A 6 month regimen may be appropriate for CWTB patients who have undergone a complete excision.
Biopsy ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies ; Thoracic Wall ; Thorax ; Tuberculosis

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Role of Methacholine PC20 in FEF(25-75%) for the Diagnosis of Bronchial Asthma.

Kyeong Min SON ; Seung Hun JANG ; Hye Ryun KANG ; Boram HAN ; Joo Hee KIM ; Hyun Sung KIM ; Sung Hoon PARK ; Yong Il HWANG ; Dong Gyu KIM ; Ki Suck JUNG

Tuberculosis and Respiratory Diseases.2009;67(4):311-317. doi:10.4046/trd.2009.67.4.311

BACKGROUND: The methacholine bronchial provocation test is a useful tool for evaluating asthma in patients with normal or near normal baseline lung function. However, the sensitivity of this test is 82~92% at most. The purpose of this study is to evaluate the clinical usefulness of FEF(25-75%) in identification of airway hyperresponsiveness in patients with suspected asthmatic symptoms. METHODS: One hundred twenty-five patients who experienced cough and wheezing within one week prior to their visiting the clinic were enrolled. RESULTS: Sixty-four subjects showed no significant reduction of FEV1 or FEF(25-75%) on the methacholine bronchial provocation test (Group I). In 24 patients, FEF(25-75%) fell more than 20% from baseline without a 20% fall of FEV1 during methacholine challenge (Group II). All patients who had more than 20% fall of FEV1 (n=37) also showed more than 20% of reduction in FEF(25-75%) (Group III). Baseline FEV1/FVC (%) and FEF(25-75%) (L) were higher in group II than group III (81.51+/-1.56% vs. 75.02+/-1.60%, p<0.001, 3.25+/-0.21 L vs. 2.45+/-0.21 L, p=0.013, respectively). Group II had greater reductions of both FEV1 and FEF(25-75%) than group I at 25 mg/mL of methacholine (p<0.001). The provocative concentration of methacholine causing a 20% fall in FEF(25-75%) in group II was about three-fold higher than that in group III. CONCLUSION: A 20% fall of FEF(25-75%) by methacholine provocation can be more sensitive indicator for detecting a milder form of airway hyperresponsiveness than FEV1 criteria.
Asthma ; Bronchial Provocation Tests ; Cough ; Humans ; Lung ; Methacholine Chloride ; Respiratory Sounds

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Relation between Cyclooxygenase-2 and Polo-like Kinase-1 in Non-Small Cell Lung Cancer.

Kyu Hwa LEE ; Seok Chul YANG

Tuberculosis and Respiratory Diseases.2009;67(4):303-310. doi:10.4046/trd.2009.67.4.303

BACKGROUND: Elevated expression of cyclooxygenase-2 (COX-2) and Polo-like kinase-1 (PLK-1) is observed in a wide variety of cancers. Augmented expression of COX-2 and enhanced production of prostaglandin E2 (PGE2) are associated with increased tumor cell survival and malignancy; COX-2 has been implicated in the control of human non-small cell lung carcinoma (NSCLC) cell growth. PLK-1 siRNA induced the cell death of lung cancer cells and the systemic administration of PLK-1 siRNA/atelocollagen complex inhibited the growth of lung cancer in a liver metastatic murine model. COX-2 and PLK-1 are involved in proliferation and in cell cycle regulation, and there is a significant correlation between their interaction in prostate carcinoma. METHODS: In this study, we investigated the pattern of COX-2 and PLK-1 expression in NSCLC, after treatment with IL-1beta, COX-2 inhibitor and PLK-1 siRNA. RESULTS: Expression of PLK-1 was decreased in A549 COX-2 sense cells, and was increased in A549 COX-2 anti-sense cells. Knock out of PLK-1 expression by PLK-1 siRNA augmented COX-2 expression in A549 and NCl-H157 cells. When A549 and NCI-H157 cells were treated with COX-2 inhibitor on a dose-dependent basis, PLK-1 and COX-2 were reduced. However, when the expression of COX-2 was induced by IL-1beta, the production of PLK-1 decreased. CONCLUSION: These results demonstrate that COX-2 and PLK-1 are regulated and inhibited by each other in NSCLC, and suggest that these proteins have a reverse relationship in NSCLC.
Carcinoma, Non-Small-Cell Lung ; Cell Cycle ; Cell Cycle Proteins ; Cell Death ; Cell Survival ; Cyclooxygenase 2 ; Dinoprostone ; Humans ; Liver ; Lung ; Lung Neoplasms ; Prostate ; Protein-Serine-Threonine Kinases ; Proteins ; Proto-Oncogene Proteins ; RNA, Small Interfering

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Treatment Guidelines for Community-acquired Pneumonia in Korea: An Evidence-based Approach to Appropriate Antimicrobial Therapy.

Jae Hoon SONG ; Ki Suck JUNG ; Moon Won KANG ; Do Jin KIM ; Hyunjoo PAI ; Gee Young SUH ; Tae Sun SHIM ; Joong Hyun AHN ; Chul Min AHN ; Jun Hee WOO ; Nam Yong LEE ; Dong Gun LEE ; Mi Suk LEE ; Sang Moo LEE ; Yeong Seon LEE ; Hyukmin LEE ; Doo Ryeon CHUNG

Tuberculosis and Respiratory Diseases.2009;67(4):281-302. doi:10.4046/trd.2009.67.4.281

The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.
Adult ; Anti-Bacterial Agents ; Communicable Diseases ; Humans ; Joints ; Korea ; Pneumonia ; Tuberculosis

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Clinical Year in Review of Interstitial Lung Diseases: Focused on Idiopathic Interstitial Pneumonia.

Won Yeon LEE

Tuberculosis and Respiratory Diseases.2009;67(4):275-280. doi:10.4046/trd.2009.67.4.275

Interstitial lung disease (ILD) is a group of diseases characterized by pulmonary interstitial inflammation. Finally the inflammation results in pulmonary fibrosis and impairment of oxygen transportation. The causes of idiopathic interstitial pneumonia (IIP) are unknown. Diagnosis of IIP is not easy, especially distinguising between nonspecific interstitial pneumonia and usual interstitial pneumonia (UIP). First line treatments of IIP include corticosteroids and immune modulators, which have limited effect. Currently, several drugs are being researched to prevent and treat fibrosis. Newer drugs that may useful to treat pulmonary fibrosis include endothelin receptor antagonist, recombinant soluble TNF receptor antagonist, and cotrimoxazole. The causes of IIP are largely unknown, treatment is not specific, and prognosis is poor. Recent studies are underway to investigate the pathogenesis and treatment of IIP and pulmonary fibrosis. As the pathogenesis of IIP is elucidated, better treatments will emerge.
Adrenal Cortex Hormones ; Fibrosis ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis ; Inflammation ; Lung ; Lung Diseases, Interstitial ; Oxygen ; Prognosis ; Pulmonary Fibrosis ; Receptors, Endothelin ; Receptors, Tumor Necrosis Factor ; Transportation ; Trimethoprim, Sulfamethoxazole Drug Combination

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A Case of Different Response of Miliary Lung and Intracranial Nodules to Antituberculous Therapy.

Kwang Young PARK ; Ho Jin LEE ; Jae Wook JUNG ; Yoon Hee CHOI ; Seung Bum NAM ; Se Han AHN ; Cheol Hyeon KIM ; Jae Cheol LEE

Tuberculosis and Respiratory Diseases.2008;64(2):153-157. doi:10.4046/trd.2008.64.2.153

Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the miliary lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later.
Adult ; Biopsy ; Female ; Humans ; Lung ; Treatment Failure ; Tuberculoma ; Tuberculoma, Intracranial ; Tuberculosis

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A Case of Pseudoalveolar Sarcoidosis with Unilateral Pulmonary Infiltration.

Hee Kyung KIM ; Hee Jung BAN ; Su Young CHI ; Dong Ryeol CHAE ; Gye Jung CHO ; Jung Hwan LIM ; Jin Yung JU ; Yong Soo KWON ; In Jae OH ; Kyu Sik KIM ; Yu Il KIM ; Sung Chul LIM ; Young Chul KIM

Tuberculosis and Respiratory Diseases.2008;64(2):149-152. doi:10.4046/trd.2008.64.2.149

A sarcoidosis is a multisystemic granulomatous disorder that has a predilection for pulmonary involvement, and the common radiological findings for the disease are bilateral nodular or reticulonodular patterns. Pseudoalveolar sarcoidosis is a rare presentation of sarcoidosis. The radiological finding is an alveolar pattern that involves or compresses the alveoli by clustered interstitial granuloma. A 58-year-old man was admitted due to incidental findings of a unilateral consolidative lesion as seen on chest radiography. A chest computed tomography (CT) examination showed multiple bronchoalveolar consolidations that were suspicious of a malignancy. However, a percutaneous needle biopsy revealed non-caseating granuloma with an asteroid body that was compatible with sarcoidosis. After one month, the consolidative lesions improved without any treatment.
Biopsy, Needle ; Granuloma ; Humans ; Incidental Findings ; Middle Aged ; Sarcoidosis ; Thorax

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