PURPOSE: Smoking elicits airway inflammation and airflow obstruction in patients with asthma, even after smoking cessation. The aim of this study was to examine the effects of smoking cessation on lung function and quality of life (QOL) in asthmatic patients. METHODS: Thirty-two patients with asthma who were active smokers were recruited. After education on the effects of smoking on asthma, 22 patients continued to smoke, and 10 quit smoking. All patients were treated with inhaled fluticasone propionate (1 mg/day) for 3 months. We compared forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow between 25 and 75% FVC (FEF(25-75%)), and scores on a QOL questionnaire at baseline, 1, 2, and 3 months. RESULTS: Quitters showed a greater percent change in FEV1 (19.1+/-6.3 vs. 7.9+/-2.4%, P=0.024) and FEV1/FVC (6.5+/-4.14 vs. 3.5+/-1.5%, P=0.05) than smokers. Both quitters and smokers showed improved QOL scores after 1, 2, and 3 months of fluticasone treatment. CONCLUSIONS: Patients with asthma who quit smoking showed less airway obstruction, suggesting that smoking cessation is crucial in the management of asthma.
Airway Obstruction ; Androstadienes ; Asthma ; Diethylpropion ; Forced Expiratory Volume ; Humans ; Inflammation ; Lung ; Quality of Life ; Smoke ; Smoking ; Smoking Cessation ; Vital Capacity ; Fluticasone ; Surveys and Questionnaires

The airway management for patients with critical airway problems continues to be a challenge to the anesthesiologist. In general cases, conventional ventilation techniques have been used successfully. These include fiberoptic bronchoscope guided intubation, supraglottic airway, endotracheal or endobronchial intubation at operative field, high frequency jet ventilation, etc. However, patients with near-fatal airway obstruction or severely depressed pulmonary function that is refractory to conventional ventilation methods also present. In these cases, cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO) can be used. Although these situations are uncommon indications for ECMO, ECMO can be a potential option for these life threatening conditions. Especially, venovenous (VV) ECMO can be used for pure pulmonary support. We describe three cases of airway surgery requiring ECMO. VV ECMO was established in all cases. ECMO provided adequate temporary pulmonary support and all patients weaned from ECMO successfully without any complication.
Airway Management ; Airway Obstruction ; Anesthesia ; Bronchoscopes ; Cardiopulmonary Bypass ; Extracorporeal Membrane Oxygenation ; High-Frequency Jet Ventilation ; Humans ; Intubation ; Membranes ; Ventilation

BACKGROUND: Uteroglobin (UG) is a secretary protein that has strong immunomodulatory properties, and which is synthesized in most epithelia including lung tissue. Overexpression of UG is associated with decreased expression of cyclooxygenase (COX)-2 and suppression of cancer cell growth. Indoleamine 2,3-dioxygenase (IDO) catalyzes tryptophan along the kynurenine pathway, and both the reduction in local tryptophan and the production of tryptophan metabolites contribute to the immunosuppressive effects of IDO. METHODS: In this study, we investigated the pattern of expression of COX-2 and IDO, and the effect of UG transduction in the expression of COX-2 and IDO in several non-small cell lung cancer cell lines, especially A549. RESULTS: Both COX-2 and IDO were constitutionally expressed in A549 and H460 cells, and was reduced by UG transduction. In A549 cells, the slightly increased expression of COX-2 and IDO with the instillation of interferon-gamma (IFN-gamma) was reduced by UG transduction. However, the reduced expression of COX-2 and IDO by UG transduction was not increased with IFN-gamma instillation in A549 cells. In both the A549 COX-2 sense and the A549 COX-2 anti-sense small interfering RNA (siRNA)-transfected cells, IDO was expressed; expression was reduced by UG transduction, irrespective of the expression of COX-2. CONCLUSION: The results suggest that the anti-proliferative function of UG may be associated with the immune tolerance pathway of IDO, which is independent of the COX-2 pathway.
Carcinoma, Non-Small-Cell Lung ; Cell Line ; Constitution and Bylaws ; Cyclooxygenase 2 ; Immune Tolerance ; Indoleamine-Pyrrole 2,3,-Dioxygenase ; Interferon-gamma ; Kynurenine ; Lung ; Prostaglandin-Endoperoxide Synthases ; RNA, Small Interfering ; Tryptophan ; Uteroglobin

BACKGROUND: In the case of bilateral total knee replacement arthroplasty (TKA), surgery is performed either simultaneously or in a staged manner. We tried to investigate the differences of blood loss and transfusion practice between the use of simultaneous and staged operations. METHODS: We analyzed retrospectively the medical records of 20 patients undergoing simultaneous TKA (simultaneous group), who received autologous blood via a reinfusion system, and 20 patients undergoing staged TKA (staged group), of which the interval is about three weeks. We compared the amount of blood loss, and the number of transfusions and transfusion-related complications between the two groups of patients. RESULTS: Postoperative total blood loss was 2,174 +/- 460 ml in the simultaneous group and 1,850 +/- 461 ml in the staged group. There was no significant difference for transfusion (simultaneous group 3.5 +/- 1.1 units, staged group 3.9 +/- 1.4 units; P > 0.05). In the simultaneous group, the volume of autologous transfusion was 985 +/- 326 ml, corresponding to 2.5 +/- 0.8 units. The total number of transfused RBC units including autologous blood was 6.1 +/- 1.5 units in the simultaneous group and 3.9 +/- 1.4 units in the staged group. In the staged group, the amount of postoperative drained blood was significantly less in the second knee operation than that in the first knee operation (first knee surgery, 992 +/- 265 ml; second knee surgery, 868 +/- 260 ml: P < 0.05). CONCLUSIONS: Postoperative blood loss and total transfusion were less in the staged TKA group of patients as compared with the simultaneous TKA group of patients. Postoperative blood salvage and reinfusion appear to be safe and effective for patients undergoing simultaneous TKA.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Transfusion ; Costs and Cost Analysis ; Humans ; Knee ; Medical Records ; Operative Blood Salvage ; Postoperative Hemorrhage ; Retrospective Studies

PURPOSE: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. MATERIALS AND METHODS: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. RESULTS: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). CONCLUSION: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.
Gastrectomy* ; Humans ; Intestinal Obstruction ; Laparoscopy ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

BACKGROUND: Pulmonary Langerhans cell histiocytosis forms part of a spectrum of diseases that are characterized by a monoclonal proliferation and infiltration of organs by Langerhans cells. Several organ systems may be involved in Langerhans cell histiocytosis, including the lungs, bone, skin, pituitary gland, liver, lymph nodes and thyroid. Pulmonary histiocytosis X represents 2.8% of interstitial lung disease. Here we present the clinical, radiological, therapeutic aspects of pulmonary histiocytosis X. METHOD: Fourteen cases of biopsy-proven pulmonary histiocytosis X patients who were diagnosed in Seoul National University Hospital during the period from January 1990 to December 1998 were analyzed retrospectively. RESULT: There were 12 men and 2 women in this study. The initial presenting symptoms were dyspnea, cough, chest pain, which was associated with the pneumothorax, and chest radiography abnormalities. Only 8 patients (57%) were smokers. There were 5 patients with extra-pulmonary histiocytosis (pituitary, bone, skin). Eight patients had received the chemotherapy. There were no mortalities and only one patient experienced an aggravation of symptom during the follow-up period. CONCLUSION: In contrast to previous reports from other countries, the patients with pulmonary histiocytosis X in this study presented with several different clinical characteristics, such as a male predominance, relatively low smoker's rate, and a better prognosis.
Chest Pain ; Cough ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies ; Histiocytosis ; Histiocytosis, Langerhans-Cell* ; Humans ; Langerhans Cells ; Liver ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Mortality ; Pituitary Gland ; Pneumothorax ; Prognosis ; Radiography ; Retrospective Studies ; Seoul ; Skin ; Thorax ; Thyroid Gland

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the important features. The main reason for underdiagnosis is thought to be a low frequency in complaining of symptoms due to the reduction of intellectual recognition and physical activity. Among the various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreased complaints for wheezing are also noted in elderly asthmatics. The objective of this study is to determine if less complaints of wheezing in elderly asthmatic is due to a decrease in the development of wheezing. METHODS: 61 young (20-39 years old), 68 middle-aged (40-59 years old) and 65 elderly (older than 60 years old) stable asthmatic subjects were studied (each group shall be called, hereafter, Young Group, Middle-aged Group and Old Group, respectively). During the methacholine induced airway narrowing, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted in 194 asthmatics. RESULTS: One hundred and sixty-nine patients (87%) developed wheezing during the methacholine induced airway obstruction. The frequency of wheezing during the methacholine challenge was found to be comparable among the groups. The methacholine concentration, % fall in FEV1, and FEV1 levels of the initial detection of wheezing were not different among the groups. Among the patients who developed wheezing, 47 patients (77%), 42 patients (61.8 %) and 26 patients (40%) complained of wheezing in Young, Middle and Old Group, respectively. CONCLUSION: In conclusion, the decreased perception of wheezing is a main factor for the low frequency of complaints of wheezing in elderly asthmatics.
Adult ; Age Factors ; Aged ; Analysis of Variance ; Asthma/*complications/diagnosis ; Chi-Square Distribution ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Perception ; Respiratory Sounds/*etiology

Allergic bronchopulmonary aspergillosis(ABPA) is a syndrome seen in patients with asthma and cystic fibrosis. It is characterized by chronic cololinization of the airways with a ubiquitous fungus, Aspergillus fumigatus. Clinically, it is a syndrome characterized by recurrent episodes of wheezing, mucus production, pulmonary infiltrates, and elevated levels of serum IgE. ABPA patients are also accompanied with bronchiectasis in 89% and observed in 10% of cystic fibrosis that show the features of end-stage lung pattern. There are few reports of ABPA associated with bullae. We will report here a case of ABPA developing in an old cicartrical and bullous lesion of a lung.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Asthma ; Blister ; Bronchiectasis ; Cystic Fibrosis ; Fungi ; Humans ; Immunoglobulin E ; Lung* ; Mucus ; Respiratory Sounds

BACKGROUND: Some chemotherapeutic drugs induce NF-κB activation by degrading the IκBα protein in cancer cells which contributes to anticancer drug resistance. We hypothesized that inhibiting IκBα degradation would block NF-κB activation and result in increased tumor cell mortality in response to chemotherapy. METHODS: The "superrepressor" form of the NF-κB inhibitor was transferred by an adenoviral vector (Ad-IκBα-SR) to the human lung cancer cell lines (NCI H157 and NCI H460). With a MTT assay, the level of sensitization to cisplatin and paclitaxel were measured. To confirm the mechanism, an EMSA and Annexin V assay were performed. RESULTS: EMSA showed that IκBα-SR effectively blocked the NF-κB activation induced by cisplatin. Transduction with Ad-IκBα-SR resulted in an increased sensitivity of the lung cancer cell lines to cisplatin and paclitaxel by a factor of 2~3 in terms of IC50. Annexin-V analysis suggests that this increment in chemosensitivity to cisplatin probably occurs through the induction of apoptosis. CONCLUSION: The blockade of chemotherapeutics induced NF-κB activation by inducing Ad-IκBα-SR, increased apoptosis and increasing the chemosensitivity of the lung cancer cell lines tested, subsequently. Gene transfer of IκBα-SR appears to be a new therapeutic strategy of chemosensitization in lung cancer.
Adenoviridae ; Annexin A5 ; Apoptosis ; Cell Line* ; Cisplatin ; Drug Resistance ; Drug Therapy ; Humans* ; Inhibitory Concentration 50 ; Lung Neoplasms* ; Lung* ; Mortality ; Paclitaxel*

An anomalous systemic arterial supply to the normal basal segments of the left lower lobe without sequestration is a rare congenital anomaly. It differs from classical bronchopulmonary sequestration in that the involver lung retains a normal connection to the bronchial tree, although some place this entity exists within the broad framework of pulmonary sequestration. We experienced a case of a woman who presented with a nodular lesion on a chest X-ray. Contrast-enhanced CT diagnosed her as having an anomalous systemic arterial supply to the normal basal segments of the left lower lobe. This case is reported with a brief literature review.
Bronchopulmonary Sequestration ; Female ; Humans ; Lung* ; Thorax ; Tomography, X-Ray Computed ; Trees