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Analysis of Mediatinal Lymph Nodes with Internal Low Density on Contrast Enhanced CT Scan.

Young Hoon RYU ; Kyu Ok CHOE ; Yong Kook HONG ; Sung Kyu KIM ; Joon CHANG ; Won Young LEE

Tuberculosis and Respiratory Diseases.1997;44(2):264-279. doi:10.4046/trd.1997.44.2.264

BACKGROUND: To analyze the morphologic characteristics of low density lymph node in etiologic differentiation of lymphadenopathy, emphasizing the different features between tuberculosis and lung cancer, on contrast enhanced CT scan,. METHOD: A total of 64 patients who showed low density lymph nodes on chest CT scan were analyzed. Primary causes were tuberculosis (n=28), lung cancer (n=27), malignant lymphoma (n=5) and metastasis from extrathoracic malignancies (n = 4). CT scan was performed with 10mm slice thickness and 7 characteristic features were evaluated: location,size, presence or absence of the nonnecrotic lymph node, calcification, perinodal fat obliteration, thickness and evenness of the enhancing rim. RESULTS: In patients with tuberculous lymphadenopathy, lymph nodes with uneven (68.0%) and thick (62.1%) enhancing rim were more common than lung cancer (p<0.05). Low density lymph nodes with less than 1cm in size were found only in tuberculous lymphadenopathy(n=10). In 48.2% of patients with lung cancer, more than 1 nonnecrotic enlarged lymph node were coexisted, whereas 21.4% in patients with tuberculous lymphadenopathy(p=0.06). However, the size, location and calcification were not statistically significant between tuberculous lymphadenopathy and lung cancer. CONCLUSION: Tuberculous lymphadenopathy is strongly suggested when enhancing rim of enlarged lymph nodes is uneven and thick, when the coexisting nonnecrotic lymph nodes are few in number and when central low density is encountered in normal sized lymph nodes.
Humans ; Inflammation ; Lung Neoplasms ; Lymph Nodes* ; Lymphatic Diseases ; Lymphoma ; Neoplasm Metastasis ; Tomography, X-Ray Computed* ; Tuberculosis

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Analysis of rpoB Gene in Rifampin-Resistant M. Tuberculosis by Direct Sequencing and Line Probe Assay.

Min Ki LEE ; Yun Seong KIM ; Hyo Jin LEE ; Du Su CHEON ; Sang Myung YUN ; Sam Seok PARK ; Cheol Min KIM ; Soon Kew PARK

Tuberculosis and Respiratory Diseases.1997;44(2):251-263. doi:10.4046/trd.1997.44.2.251

BACKGROUND: The emergence of multidrug-resistant strains of Mycobacterium tuberculosis presents a significant challange to the treatment and control of tuberculosis, and there is an urgent need to understand the mechanisms by which strains acquire multidrug resistance. Recent advances in molecular methods for the detection of M. tuberculosis genetic targets have approached the sensitivity of culture Furthermore the prospect of determining resistance in mycobacteria at the nucleic acid level particulary to first-line drugs like rifampin, isoniazid has provided a glimps of the next generation of sensitivity test for M. tuberculosis. Previous studies in RMP resistant M. tuberculosis have shown that mutation in beta subunit of RNA polymerase is main mechanism of resistance. METHOD: In this study, rpoB gene for the ~3 subunit of RNA polymerase from M. tuberculosis of 42 cultured samples (32 were RMP resistant and 10 were sensitive cases) were isolated and characterised the mutations. Direct sequencing data were compared with the results of INNO-LiPA Line Probe Assay (LiPA, Innogenetics, Belgium), commercial RMP resistance detecting kit using reverse hybridization method. RESULTS: All of the RMP resistant samples were revealed the presence of mutation by LiPA. In 22 samples (68.8%) out of 32 RMP resistant cases, the mutation types were confirmed by the positive signal at one of 4 mutation bands in the strip. The most frequent type was R5 (S53 IL) which were 17 cases (77.3%). Results of direct sequencing were identified the exact characteristics of 8 mutations which were not comfirmed by LiPA. S522W type point mutation and 9 base pair deletion at codon 513-515 were new identified mutations for the first time. CONCLUSION: Mutations in rpoB gene is the main mechanism of RMP resistance in M. tuberculosis and LiPA is a very useful diagnostic tool for the early diagnosis of RMP resistance in M. tuberculosis.
Base Pairing ; Codon ; DNA-Directed RNA Polymerases ; Drug Resistance, Multiple ; Early Diagnosis ; Isoniazid ; Mycobacterium tuberculosis ; Point Mutation ; Rifampin ; RNA Polymerase I ; Tuberculosis*

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Clinical Study of Pulmonary Tuberculosis for Admitted Patients at National Masan Tuberculosis Hospital.

Seung Kyu PARK ; In Hwan CHOI ; Chul Min KIM ; Cheon Tae KIM ; Sun Dae SONG

Tuberculosis and Respiratory Diseases.1997;44(2):241-250. doi:10.4046/trd.1997.44.2.241

OBJECTIVE: Although the prevalence of pulmonary tuberculosis has decreased progressively after the national control program for tuberculosis began, nowadays the number of MDRTB is increasing seriously. MDRTB tends to be poor responsive to current antituberculosis regimens. It is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. The purpose of present study is to evaluate the clinical features of pulmonary tuberculosis patients admitted in one national tuberculosis hospital and to expose the problems pertaining to current remedies, to increase the treatment efficacy for pulmonary tuberculosis including MDRTB in the end. METHOD: Retrospective analysis of 336 pulmonary tuberculosis patients admitted in National Masan Tuberculosis Hospital was done. Contents of analysis were patients profile, the first diagnosed time and medical institutes, family history, residence, previous treatment history, chief complaints at the time of admission, lesion site on chest X-ray film, combined deseases, side reaction to antibuberculosis drugs, used drugs before admission and the results of drug sensitivity test. RESULTS: The ratio between male and female was 4:1. Age showed relatively even distribution from 3rd to 6 th decades. 64.6% of the patients was diagnosed at public health center. Weight loss was the most common complaint at admission. Bilateral lesions on chest X-ray films were 59.8%. 1 30patients had combined desease, of which DM was the most common(37.7%). 95patients had family history, of which parents were the most common(41.7%). According to the time of first diagnosis, 31 patients were diagnosed before 1980, and after then the number of patients was increased by degrees Residence overwhelmed in pusan and gyung-nam province. 258 patients got previous treatment history, of which 112 patients(43.4%) had more than 3 times and only 133 patients(51.6%) got regular medication. 97 patients used more than other 3 drugs in addition to INH, EMB, RFP and PZA before admission. 154 patients were informed with the results of drug sensitivity test. of which 77 patients had resistance to more than 5 drugs. Gastrointestinal problem was the most common in side reaction to drugs. CONCLUSION: In the case of weigt loss of unknown cause, tuberculosis should be suspected. In first treatment, sufficient and satisfactory explanation for tuberculosis is necessary and treatment period should not be stict to 6 month-short term therapy. In retreatment, new drugs should not be added to used drugs enen though drug sensitivity restlts show sensitivity to some of them. Proper time for surgical intervention should not be delayed.
Academies and Institutes ; Busan ; Compliance ; Diagnosis ; Drug Resistance ; Female ; Hospitals, Chronic Disease* ; Humans ; Male ; Parents ; Prevalence ; Public Health ; Retreatment ; Retrospective Studies ; Thorax ; Treatment Outcome ; Tuberculosis* ; Tuberculosis, Pulmonary* ; Weight Loss ; X-Ray Film

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Lower Lung Field Tuberculosis.

Doo Seop MOON ; Byung Sung LIM ; Yeon Soo KIM ; Seong Min KIM ; Jae Young LEE ; Dong Suck LEE ; Jang Won SOHN ; Kyung Sang LEE ; Suck Chul YANG ; Ho Joo YOON ; Dong Ho SHIN ; Sung Soo PARK ; Jung Hee LEE

Tuberculosis and Respiratory Diseases.1997;44(2):232-240. doi:10.4046/trd.1997.44.2.232

BACKGROUND: Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung ahscess. Thus the correct diagnosis may be sometimes delayed for a long time. METHODS: We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. RESULTS: Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1:1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the S0patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%), collapse(16%), cavitary lesion(l0%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of S0patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. CONCLUSION: When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.
Adult ; Age Distribution ; Anemia ; Anorexia Nervosa ; Biopsy ; Biopsy, Fine-Needle ; Bronchiectasis ; Bronchoscopy ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Lung Neoplasms ; Lung* ; Male ; Mycobacterium tuberculosis ; Pneumonia ; Pulmonary Medicine ; Retrospective Studies ; Sputum ; Stomach Neoplasms ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

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Clinical Features of Endobronchial Tuberculosis.

Sung Soo PARK ; Jung Hee LEE

Tuberculosis and Respiratory Diseases.1997;44(2):223-231. doi:10.4046/trd.1997.44.2.223

A total of 322 patients with endobronchial tuberculosis (8.1%) out of 3,982 subjects who had a flexible fiberoptic bronchoscopic examination at the Department of Pulmonary Medicine of Hanyang University Hospital between the beginning of March 1982 and the end of Apr11 1996 were included in this study. The peak incidence occurred in the second decade, and the male to female was 1 : 3.0. The barking cough with variable amounts of sputum was the most common chief complaint in 56.9% of the 313 patients. Other complaints included dyspnea, chest pain, fever, hemoptysis, and generalized weakness. Localized wheeze was heard over the chest in 16.9% of the 313 patients. Infiltration/consolidation was the most common roentgenographic finding of the chest in 64.2%. Bronchoscopically, hypertrophy with luminal narrowing was the most common findings in 32.3% of the 322 patients and left main bronchus was the most frequently involved in 24.0%. Using fiberoptic bronchoscopy allows not only substantial meaningful assessment of endobronchial tuberculosis but also makes a differential diagnosis of lung cancer in older patients. We need further evaluations of standard bronchoscopic classification of endobronchial tuberculosis, diagnostic accuracy of endobronchial tuberculosis by PCR, a large prospective study of effects of corticosteroids in endobronchial tuberculosis patients, and appropriate treatment of atelectasis by endobronchial tuberculosis.
Adrenal Cortex Hormones ; Bronchi ; Bronchoscopy ; Chest Pain ; Classification ; Cough ; Diagnosis, Differential ; Dyspnea ; Female ; Fever ; Hemoptysis ; Humans ; Hypertrophy ; Incidence ; Lung Neoplasms ; Male ; Phenobarbital ; Polymerase Chain Reaction ; Pulmonary Atelectasis ; Pulmonary Medicine ; Sputum ; Thorax ; Tuberculosis*

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A case of pulmonary disease with unilateral hyperlucent lung.

Joon Sang OHN ; Jee Young SEO ; Mi Ran PARK ; Nam Soo RHEU ; Dong ill CHO

Tuberculosis and Respiratory Diseases.1996;43(6):1042-1047. doi:10.4046/trd.1996.43.6.1042

The Swyer-James syndrome is a relatively uncommon disease entity presented with unilateral hyperlucent lung due to hypoplasia of a pulmonary artery and bronchiectasis of the affected lung. The main finding is a hyperlucent lung with small hilar shadows on the chest X-ray. Pulmonary angiography is the standard method for diagnosis. We report a case of the Swyer-James syndrome with a brief review of literature.
Angiography ; Bronchiectasis ; Diagnosis ; Lung ; Lung Diseases* ; Lung, Hyperlucent* ; Pulmonary Artery ; Thorax

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A Case of Primary Mediastinal Germ Cell Tumor Associated with Klinefelter's Syndrome.

Yong Jo KIM ; Gyo Seon KWUN ; Young Wo LEE ; Kyung Tae KIM ; Yeon Hee PARK ; Baek Yeol RYOO ; Tae You KIM ; Young Hyuck IM ; Choon Taek LEE ; Yoon Koo KANG ; Kyung Ja CHO ; Jhin Oh LEE ; Tae Woong KANG

Tuberculosis and Respiratory Diseases.1996;43(6):1035-1041. doi:10.4046/trd.1996.43.6.1035

Klinefelter's syndrome is characterized by small testes, azoospermia, gynecomastia, and elevated levels of plasma gonadotropins in men with two or more X chromosomes. Previous investigators reported that patients with Klinefelter's syndrome are predisposed to the development of a non-seminomatous germ cell tumor in the mediastinum. It is suggested that this linkage may be due to the hormonal imbalance in Klinefelter's syndrome and consequently, the formation of dysgenetic germ cell and/or abnomal migration of germ cell. We report here a case of Klinefelter's syndrome in a 24-years-old man who was presented with anterior mediastinal mass. The clinical and laborarotory findings were compatible with Klinefelter's syndrome and he was found to have 47 XXY karyotype. Pathological findings for mediastinal mass revealed mixed germ cell tumor composed of mature cystic teratoma and endodermal sinus tumor. He was treated with cis-platin containing chemotherapy and followed up in partial remission.
Azoospermia ; Drug Therapy ; Endodermal Sinus Tumor ; Germ Cells* ; Gonadotropins ; Gynecomastia ; Humans ; Karyotype ; Klinefelter Syndrome* ; Male ; Mediastinum ; Neoplasms, Germ Cell and Embryonal* ; Plasma ; Research Personnel ; Teratoma ; Testis ; X Chromosome

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Two cases of bronchial leiomyoma resectedby Nd-YAG laser under flexible bronchoscopy.

Hojoong KIM ; Woo Heon KANG ; Soo Jung KANG ; Man Pyo CHUNG ; Dong Chull CHOI ; O Jung KWON ; Chong H. RHEE ; Yong Choi HAN

Tuberculosis and Respiratory Diseases.1996;43(6):1028-1034. doi:10.4046/trd.1996.43.6.1028

The leiomyoma of the bronchus is a very rare benign tumor in the lower respiratory tract. Though classical treatment of the branchial leiomyoma is surgical resection, bronchoscopic tumor resection has been recently applied to selected cases. We experienced two cases of bronchial leiomyomas which were successfully resected under flexible bronchoscopy using Nd-YAG laser and bronchial snare. We speculated that bronchoscopic resection of the bronchial leiomyoma would be an effective and safe way of treatment, and more technical developments should follow.
Bronchi ; Bronchoscopy* ; Lasers, Solid-State* ; Leiomyoma* ; Respiratory System ; SNARE Proteins

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A case report of the Pulmonary Malignant Lymphomaof the mucosa-associated lymphoid tissue(MALT).

Joon sang OHN ; Hyung dae SON ; Chang seon KIM ; Young sil LEE ; Sang won YOON ; Nam soo RHEU ; Dong ill CHO

Tuberculosis and Respiratory Diseases.1996;43(6):1019-1027. doi:10.4046/trd.1996.43.6.1019

The pulmonary lymphomas were thought to originate in specialized lymphoid tissue that is associated with bronchial mucosa(bronchus-associated lymphoid tissue(BALT)), and they were categorized as mucosa-associated lymphoid tissue(MALT) lymphoma. MALT lymphoma consists of a monoclonal population of cell, in contrast to reactive lymphoid proliferation, which consists of polyclonal cells. Lymphoma arising from MALT(=MALToma) represents a distinct clinicopathologic features. It is usually localized to their original site for a long time and shows much more favorable prognosis than lymphoma at other site. Some MALT lymphoma could arise simultaneously or successively in different organ or that cells from MALT lymphoma might circulate and give rise to another lymphoma by homing in the MALT of another organ, such as breast, salivary gland, stomach etc, and can be multifocally disseminated or recurred. We report a case of low-grade B-cell lymphoma of the mucosa-associated lymphoid tissue(MALT) of the lung, which was confirmed by open lung biopsy, immunohistochemistry and PCR assay.
B-Lymphocytes ; Biopsy ; Breast ; Immunohistochemistry ; Lung ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Polymerase Chain Reaction ; Prognosis ; Salivary Glands ; Stomach

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Three cases of primary mediastinal Nonseminomatous germ cell tumors.

Soon II LEE ; Suk Joong YONG ; Kwang Seon SONG ; Kye Chul SHIN ; Kyung Moo YANG ; Mee Yon CHO ; Hyung Rae LIM ; Kwang Ha YOO ; Hwa Sang CHO ; Jong Kil YOO ; Jong Oh SONG

Tuberculosis and Respiratory Diseases.1996;43(6):1008-1018. doi:10.4046/trd.1996.43.6.1008

Primary mediastinal nonseminomatous germ cell tumor is extremely rare. Apart from rarity and large size, mediastinal germ cell tumors show striking similarity to testicular tumors in age, incidence, and tumor type. The symptoms associated with these tumors are related mainly to size, invasion of neighboring structures, and distant metastases. Tissue diagnosis is obtained by biopsy of the primary lesion or by biopsy of metastatic sites. Tumors often present with advanced bulky disease, which are unresectable. So these tumors require an aggressive multidisciplinary approach to management. Optimal management includes aggressive surgical debulking and early use of cisplatin-bleomycin-based combination chemotherapy. Serial biomarker measurements permit early recognition of recurrence and improved timing of surgical intervention. The prognosis for mediastinal germ cell tumors is poor, not only because they are far advanced at the time of diagnosis but also because some of the tumors-such as embryonal carcinomas, choriocarcinomas, and endodermal sinus tumors-are very aggressive. In these cases, we present three young male patients with large mass on anterior mediastinum. Tissue diagnosis was obtained by primary lesion biopsy. All patients received surgical debulking and combination chemotherapy and experienced a brief response and eventually had relapses. We report these cases with a review of literatures.
Biopsy ; Carcinoma, Embryonal ; Choriocarcinoma ; Diagnosis ; Drug Therapy, Combination ; Endoderm ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Incidence ; Male ; Mediastinum ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal* ; Pregnancy ; Prognosis ; Recurrence ; Strikes, Employee ; Testicular Neoplasms

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