We experienced a 59-year-old immunocompetent female patient who complained progressive cough. A bronchoscopic examination revealed an endobronchial mass protruding from the left lower lobe and occluding anterior-basal segment bronchus. Bronchial biopsy and endobronchial ultrasound guided transbronchial needle aspiration were consistent with cryptococcal infection. However, the response of medical therapy was an unsuccessful. Finally, the patient underwent left lower lobectomy with lymph node dissection. We report a case of pulmonary cryptococcosis mimicking bronchogenic lung cancer, and surgical therapy with antifungal treatment resulted in successful resolution of the pneumonia.
Biopsy ; Bronchi ; Bronchial Neoplasms ; Bronchoscopy ; Cough ; Cryptococcosis* ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Node Excision ; Middle Aged ; Mycoses ; Needles ; Pneumonia ; Ultrasonography

BACKGROUND/AIMS: It is not clear which tests are indicative of the activity and severity of tuberculosis (TB). This study aimed to investigate the predictive value of neuron-specific enolase (NSE) and to determine the origin of NSE in TB patients. METHODS: A single-center retrospective analysis was conducted on newly diagnosed TB patients between January and December 2010. Patients were categorized into one of two disease groups (focal segmental or extensive) based on chest X-ray. Pre- and post-treatment NSE concentrations were evaluated. To determine the origin of serum NSE concentration, NSE staining was compared with macrophage-specific CD68 staining in lung tissues and with a tissue microarray using immunohistochemistry and immunofluorescence. RESULTS: A total of 60 newly diagnosed TB patients were analyzed. In TB patients, NSE serum concentration was significantly increased and NSE level decreased after treatment (p < 0.001). In proportion to serum high-sensitivity C-reactive protein concentration, the mean serum concentration of NSE in the extensive group (25.12 ng/mL) was significantly higher than that in the focal segmental group (20.23 ng/mL, p = 0.04). Immunohistochemical staining revealed a large number of macrophages that stained positively for both NSE and CD68 in TB tissues. In addition, NSE signals mostly co-localized with CD68 signals in the tissue microarray of TB patients. CONCLUSIONS: Our results suggest that NSE may be a practical parameter that can be used to monitor TB activity and treatment response. Elevated serum NSE level originates, at least in part, from macrophages in granulomatous lesions.
C-Reactive Protein ; Diagnosis ; Fluorescent Antibody Technique ; Humans ; Immunohistochemistry ; Lung ; Macrophages ; Phosphopyruvate Hydratase* ; Retrospective Studies ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

OBJECTIVES: The purpose of this study is to investigate the factors related to long-term hospitalization of schizophrenia. METHODS: The subjects were inpatients with schizophrenia who were constantly hospitalized for more than 12 months and their caregivers. They were compared with schizophrenia with no previous experience of sustained hospitalization for more than 12 months and their caregivers. Demographic and clinical data, Korea version of the Positive and Negative Symptom Scale, functional disability and family burden scale were analyzed. RESULTS: In this study long-term hospitalization of schizophrenia was influenced by the following measures. First, primary caregivers variables such as parents/non-parents and cohabitation with patients, second, negative symptom severity of passive/apathetic social withdrawal and lack of spontaneity and flow of conversation, and third, functional disability of go to hospital/take a dose regularly and using public transportation/facilities were associated with long-term hospitalization. And they were significant in logistic regression analysis. CONCLUSION: The above results suggest that long-term hospitalization of schizophrenic patients in Korea might be affected by caregiver's factor, negative symptoms, and functional disability.
Caregivers ; Hospitalization* ; Humans ; Inpatients ; Korea ; Logistic Models ; Schizophrenia*

OBJECTIVES: Smoking is one of the most important leading causes of lung cancer. Smoking habit is recognized as nicotine dependence, which consists of physical and psychosocial dependence. To evaluate social nicotine dependence, the Kano Test for Social Nicotine Dependence (KTSND) working group developed a new questionnaire. We examined the social nicotine dependence among high school students, university students and patients with lung cancer. METHODS: We applied Korean version of KTSND(KTSND-K) questionnaire to high school students, university students and patients with lung cancer. Complete data obtained from the 1333 responders were analyzed. RESULTS: Among the responders, current smokers, past-smokers, and never-smokers were 17.3%, 16.4%, and 66.3% respectively. According to smoking status, the total KTSND-K scores of current smokers were significantly higher than those of past-smokers, and of never-smokers (17.7+/-6.6 versus 13.7+/-5.7, and 10.9+/-5.15, P<0.001). The total KTSND-K scores of males were higher than those of females, suggesting that males have a propensity for depending nicotine socially much more than females (13.2+/-6.2 and 11.7+/-5.7 respectively, P<0.05). And the total KTSND scores of the patients with lung cancer, medical students, nursing students, and high school students were 11.2+/-3.8, 14.9+/-4.8, 14.6+/-5.8 and 15.6+/-5.9 respectively. The scores of patients with lung cancer were significantly lower than non-cancer people(P<0.01). Our study suggested that the KTSND-K questionnaire could be a useful method to evaluate psychosocial aspects of smoking in patients with lung cancer and non-cancer people.
Female ; Humans ; Lung Neoplasms* ; Male ; Nicotine ; Surveys and Questionnaires* ; Smoke ; Smoking ; Students, Medical ; Students, Nursing ; Tobacco Use Disorder*

OBJECTIVES: Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy. METHODS: This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80degrees C, and the bronchoscope was removed with the probe after crystal formation on the contacted area. RESULTS: The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic,silicon,and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure. CONCLUSIONS: The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.
Anesthesia, Local ; Arrhythmias, Cardiac ; Bronchi ; Bronchoscopes ; Bronchoscopy* ; Emergencies ; Female ; Foreign Bodies* ; Hemorrhage ; Humans ; Male ; Retrospective Studies ; Surgical Instruments

We report the case of a 53-year-old man who presented with obstructive pneumonitis and broncholithiasis. We attempted to remove the broncholith with forceps through a flexible endoscope, but the potential for bleeding due to partial synechia did not allow this. We succeeded in removing it with cryotherapy. The histopathological diagnosis was thoracic actinomycosis associated with broncholithiasis. Endobronchial actinomycosis with a broncholith is very rare. We successfully treated a patient with endobronchial actinomycosis with a broncholith by administering short-term antibiotics after broncholithectomy via cryotherapy through a flexible bronchoscope.
Actinomycosis* ; Anti-Bacterial Agents ; Bronchoscopes* ; Bronchoscopy ; Cryotherapy* ; Diagnosis ; Endoscopes ; Hemorrhage ; Humans ; Middle Aged ; Pneumonia ; Surgical Instruments

No abstract available.

PURPOSE: To evaluate the prognostic value of metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) on initial positron emission tomography-computed tomography (PET-CT) and investigate the clinical value of SUVmax for early detection of locoregional recurrent disease after postoperative radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: A total of 100 patients with locally advanced HNSCC received primary tumor excision and neck dissection followed by adjuvant radiotherapy with or without chemotherapy. The MTV and SUVmax were measured from primary sites and neck nodes. The prognostic value of MTV and SUVmax were assessed using initial staging PET/CT (study A). Follow-up PET/CT scan available after postoperative concurrent chemoradiotherapy or radiotherapy were evaluated for the SUVmax value and correlated with locoregional recurrence (study B). A receiver operating characteristic (ROC) curve analysis was used to define a threshold value of SUVmax with the highest accuracy for recurrent disease assessment. RESULTS: High MTV (>41 mL) is negative prognostic factor for disease free survival (p = 0.041). Postradiation SUVmax was significantly correlated with locoregional recurrence (hazard ratio, 1.812; 95% confidence interval, 1.361 to 2.413; p < 0.001). A cut-off value of 5.38 from follow-up PET/CT was identified as having maximal accuracy for detecting locoregional recurrence by ROC analysis. CONCLUSION: MTV at staging work-up was significantly associated with disease free survival. The SUVmax value from follow-up PET/CT showed high diagnostic accuracy for the detection of locoregional recurrence in postoperatively irradiated HNSCC.
Carcinoma, Squamous Cell ; Chemoradiotherapy ; Disease-Free Survival ; Electrons ; Follow-Up Studies ; Head ; Head and Neck Neoplasms ; Humans ; Neck ; Neck Dissection ; Positron-Emission Tomography ; Radiotherapy, Adjuvant ; Recurrence ; ROC Curve ; Tumor Burden

PURPOSE: To evaluate treatment outcomes and prognostic factors in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiation. MATERIALS AND METHODS: From January 2005 to June 2009, 51 patients were treated with concurrent chemoradiation for 3 different aims: locally advanced stage III, locally recurrent disease, and postoperative gross residual NSCLC. Median age was 63 years. Distribution of stages by the 6th edition of American Joint Committee on Cancer (AJCC) was as follows: IIIA (37.3%), IIIB (56.9%). Chemotherapy was administered every week concurrently with radiation using one of the following regimens: paclitaxel (60 mg/m2), docetaxel+cisplatin (20 mg/m2+20 mg/m2), cisplatin (30 mg/m2). Total radiation dose was 16-66.4 Gy (median, 59.4 Gy). RESULTS: Median follow-up duration was 40.8 months. The overall response rate was 84.3% with 23 complete responses. The median survival duration for the overall patient group was 17.6 months. The 3-year survival rate was 17.8%. A total of 21 patients had recurrent disease at the following sites: loco-regional sites (23.6%), distant organs (27.5%). In the multivariate analysis of the overall patient group, a clinical tumor response (p=0.002) was the only significant prognostic factor for overall survival (OS). In the multivariate analysis of the definitive chemoradiation arm, the use of consolidation chemotherapy (p=0.022), biologically equivalent dose (BED)10 (p=0.007), and a clinical tumor response (p=0.030) were the significant prognostic factors for OS.The median survival duration of the locally recurrent group and the postoperative gross residual group were 26.4 and 23.9 months, respectively. CONCLUSION: Our study demonstrated that clinical tumor response was significantly associated with OS in the overall patient group. Further investigations regarding the optimal radiation dose in the definitive chemoradiation and the optimal treatment scheme in locally recurrent NSCLC would be required.
Arm ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Consolidation Chemotherapy ; Follow-Up Studies ; Humans ; Joints ; Multivariate Analysis ; Paclitaxel ; Survival Rate

PURPOSE: To evaluate treatment outcomes and prognostic factors in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiation. MATERIALS AND METHODS: From January 2005 to June 2009, 51 patients were treated with concurrent chemoradiation for 3 different aims: locally advanced stage III, locally recurrent disease, and postoperative gross residual NSCLC. Median age was 63 years. Distribution of stages by the 6th edition of American Joint Committee on Cancer (AJCC) was as follows: IIIA (37.3%), IIIB (56.9%). Chemotherapy was administered every week concurrently with radiation using one of the following regimens: paclitaxel (60 mg/m2), docetaxel+cisplatin (20 mg/m2+20 mg/m2), cisplatin (30 mg/m2). Total radiation dose was 16-66.4 Gy (median, 59.4 Gy). RESULTS: Median follow-up duration was 40.8 months. The overall response rate was 84.3% with 23 complete responses. The median survival duration for the overall patient group was 17.6 months. The 3-year survival rate was 17.8%. A total of 21 patients had recurrent disease at the following sites: loco-regional sites (23.6%), distant organs (27.5%). In the multivariate analysis of the overall patient group, a clinical tumor response (p=0.002) was the only significant prognostic factor for overall survival (OS). In the multivariate analysis of the definitive chemoradiation arm, the use of consolidation chemotherapy (p=0.022), biologically equivalent dose (BED)10 (p=0.007), and a clinical tumor response (p=0.030) were the significant prognostic factors for OS.The median survival duration of the locally recurrent group and the postoperative gross residual group were 26.4 and 23.9 months, respectively. CONCLUSION: Our study demonstrated that clinical tumor response was significantly associated with OS in the overall patient group. Further investigations regarding the optimal radiation dose in the definitive chemoradiation and the optimal treatment scheme in locally recurrent NSCLC would be required.
Arm ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Consolidation Chemotherapy ; Follow-Up Studies ; Humans ; Joints ; Multivariate Analysis ; Paclitaxel ; Survival Rate