Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability.
Abdominal Pain ; Cardiomyopathies ; Catecholamines ; Female ; Hemodynamics ; Hemoptysis ; Hemorrhage ; Humans ; Hypertension ; Pheochromocytoma ; Pneumonia ; Pulmonary Edema

BACKGROUND: Single nucleotide polymorphisms (SNPs), which consist of a substitution of a single nucleotide pair, are the most abundant form of genetic variations occurring with a frequency of approximately 1 per 1000 base pairs. SNPs by themselves do not cause disease but can predispose humans to disease, modify the extent or severity of the disease or influence the drug response and treatment efficacy. Single nucleotide polymorphisms (SNPs), particularly those within the regulatory regions of the genes often influence the expression levels and can modify the disease. Studies examining the associations between SNP and the disease outcome have provided valuable insight into the disease etiology and potential therapeutic intervention. Traditionally, the genotyping of SNPs has been carried out using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP), which is a low throughput technique not amenable for use in large-scale SNP studies. Recently, TaqMan real-time PCR chemistry was adapted for use in allelic discrimination assays. This study validated the accuracy and utility of real-time PCR technology for SNPs genotyping METHODS: The SNPs in promoter sequence (-37 and -524) of lung cancer suppressor gene, RRM1 (ribonucleotide reductase M1 subunit) with the genomic DNA samples of 89 subjects were genotyped using both real-time PCR and PCR-RFLP. RESULTS: The discordance rates were 2.2% (2 mismatches) in -37 and 16.3% (15 mismatches) in -524. Auto-direct sequencing of all the mismatched samples(17 cases) were in accord with the genotypes read by real-time PCR. In addition, 138 genomic DNAs were genotyped using real-time PCR in a duplicate manner (two separated assays). Ninety-eight percent of the samples showed concordance between the two assays. CONCLUSION: Real-time PCR allelic discrimination assays are amenable to high-throughput genotyping and overcome many of the problematic features associated with PCR-RFLP.
Base Pairing ; Chemistry ; Discrimination (Psychology) ; DNA ; Genes, Suppressor* ; Genetic Variation ; Genotype ; Humans ; Lung Neoplasms* ; Lung* ; Oxidoreductases ; Polymorphism, Single Nucleotide* ; Real-Time Polymerase Chain Reaction* ; Regulatory Sequences, Nucleic Acid ; Treatment Outcome

Wegener's granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules. We report a case of Wegener's granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener's granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia.
Arthralgia ; Cough ; Cyclophosphamide ; Dyspnea ; Humans ; Immunocompromised Host ; Kidney ; Lung Neoplasms ; Lung* ; Male ; Nasal Obstruction ; Opportunistic Infections ; Pneumonia ; Prednisolone ; Radiography, Thoracic ; Respiratory Insufficiency ; Respiratory System ; Tuberculosis ; Vasculitis ; Wegener Granulomatosis*

Recently, intra-Muscular Stimulation (IMS) therapy is being increasingly used for musculoskeletal pain. This procedure is generally regarded as a safe procedure for the general public. Some cases of iatrogenic pneumothorax caused by acupuncture have been reported in the medical literature. However, a case of an IMS therapy associated pneumothorax has not reported. We experienced two cases of iatrogenic pneumothorax after IMS therapy. A 62 year-old man received IMS therapy on the right shoulder due to posterior neck pain. After IMS therapy, acute dyspnea and chest discomfort developed. The other patient was a 74 year-old woman who also received IMS therapy. This patient experienced a nonproductive cough and acute dyspnea after the treatment. As the popularity of this form of alternative medicine increases, we might expect to see more cases of iatrogenic pneumothorax. Physicians should be aware of the adverse events associated with IMS therapy.
Acupuncture ; Aged ; Complementary Therapies ; Cough ; Dyspnea ; Female ; Humans ; Middle Aged ; Musculoskeletal Pain ; Neck Pain ; Pneumothorax* ; Shoulder ; Thorax

Lung cancer patients have increased risk of thromboembolism (TE) due to various factors such as by hypercoagulability, tumor thrombosis, decrease of ambulation, and chemotherapy etc. Among these factors, chemotherapy associated TEs have been reported, although the causes and pathomechanisms of TEs were not clear. Recently, reports proposed the potential role of platelets in endothelial damage by the chemotherapeutic agents. We have experienced a case of pulmonary TE after systemic chemotherapy with gemcitabine and cisplatin. The patient complained aggravated exertional dyspnea after chemotherapy and diagnosed as pulmonary TE by computerized tomogram. After anticoagulation and interruption of the chemotherapy, improvement of exertional dyspnea and resolution of the pulmonary TE were observed
Cisplatin* ; Drug Therapy* ; Dyspnea ; Humans ; Lung Neoplasms* ; Lung* ; Pulmonary Embolism* ; Thromboembolism ; Thrombophilia ; Thrombosis ; Walking

Leiomyoma of the bronchus is a very rare benign tumor of the lung. Most endobronchial leiomyomas occur as secondary foci of primary uterine leiomyoma. We herein report a case with endobronchial tumor that had a different pathology from a primary resected uterine leiomyoma and was therefor considered a primary endobronchial leiomyoma. A 51-year-old woman with a history of uterine myoma presented with productive cough and fever. Bronchoscopy revealed a lightly yellow colored mass lesion that totally obstructed the orifice of the left lower lobe of the lung. The diagnosis of leiomyoma was made by histological examination of the obtained specimen. We considered the possibility of a benign metastasizing pulmonary leiomyoma. For treatment and differential diagnosis, a left lower lobe lobectomy of the lung and total hysterectomy with bilateral salphingooopherectomy were performed. The differences between lung and uterine lesions were confirmed by morphologic finding and immunohistochemical staining. The pathological diagnosis was primary endobronchial leiomyoma combined with uterine myoma.
Bronchi ; Bronchoscopy ; Cough ; Diagnosis ; Diagnosis, Differential ; Female ; Fever ; Humans ; Hysterectomy ; Leiomyoma* ; Lung ; Middle Aged ; Pathology

BACKGROUND: Lung cancer has been the leading cause of cancer death in South Korea since 2000. This study examined the clinical characteristics of lung cancer patients diagnosed in a community hospital from the year 2000 to 2005, and compared these results with previously reported statistical data. METHOD: The lung cancer data in a form of an electronic medical record was downloaded from the hospital medical information system. The clinical characteristics of the 1,509 patients with lung cancer were analyzed retrospectively. RESULT: The mean age of the patients was 63.7 years. 82.5% and 74.5% of the patients were men and smokers, respectively. Squamous cell carcinoma (41.6%) was the most common pathology type followed by adenocarcinoma(32.3%) and small cell carcinoma(13.9%). When 604 patients who were diagnosed from 2000 to 2003 were compared with 905 patients diagnosed from 2004 to 2005, the age of patients increased significantly (61.5 years vs. 65.1 years; p<0.001) and the proportion of adenocarcinomas was significantly higher(29.3% vs. 34.4%; p=0.046). CONCLUSION: Among the major histology types of lung cancer, the incidence of adenocarcinoma has been increasing recently. The age of the lung cancer patients at diagnosis is getting older. This is despite the fact that the distributions of the initial anatomic stages have not changed significantly.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Diagnosis ; Electronic Health Records ; Hospitals, Community ; Humans ; Incidence ; Information Systems ; Jeollanam-do* ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Pathology ; Retrospective Studies

BACKGROUND: LOH11A is a region with frequent allele loss (>75%) in lung cancer that is located on the centromeric part of chromosome 11p15.5. Clinical and cell biological studies suggest that this region contains a gene associated with metastatic tumor spread. RRM1 encoding the M1 subunit of ribonucleotide reductase, which is an enzyme that catalyses the rate-limiting step in deoxyribonucleotide synthesis, is located in the LOH11A region. METHODS: Polymorphisms were found at nucleotide position (-)37 (C/A) and (-)524 (C/T) from the beginning of exon 1 of the RRM1 gene that might regulate the expression of RRM1. We studied the polymorphisms in 127 Korean individuals (66 lung cancer and 61 normal controls) and compared with those of 140 American patients with lung cancer. RESULTS: CC, AC and AA were found at the (-)37 position in 64(50.4%), 55(43.3%), and 8(6.3%) out of 127 Korean individuals (66 cancer, 61 non-cancer patients), respectively. There was a similar frequency of allele A at (-)37 in the American(27.9%) and Korean population(28.0%). CC, CT and TT was found at the (-)524 position in 24(18.9%), 44(34.6%), and 59(46.5%) out of the 127 Korean individuals, respectively. There was a similar frequency of allele C at (-)524 in the American(34.6%) and Korean population(36.2%).There was no difference in the frequency of the (-)37 and (-)524 genotypes between the cancer and non-cancer group. However there was a significant correlation of the genotypes between (-)37 and (-)524 (p<0.001), which suggests the possible coordination of these polymorphisms in the regulation of the promoter activity of the RRM1 gene. CONCLUSION: RRM1 promoter polymorphisms were not found to be significant risk factors for lung cancer. However, a further study of the promoter activity and expression of the RRM1 gene according to the pattern of the polymorphism will be needed.
Alleles ; Catalysis ; Exons ; Genes, vif ; Genotype ; Humans ; Lung Neoplasms* ; Lung* ; Ribonucleotide Reductases ; Risk Factors

OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.
Dermatology ; Diabetes Mellitus ; Diabetic Foot ; Diagnosis ; Endocrinology ; Female ; Foot Deformities ; Foot Diseases ; Foot Ulcer ; Foot* ; Humans ; Male ; Mortality ; Nails ; Odds Ratio ; Onychomycosis ; Outpatients ; Physical Examination ; Prevalence* ; Risk Factors ; Skin ; Tinea Pedis ; Ulcer*

The Holt-Oram syndrome or cardiomelic syndrome is characterized by the association of upper limb and heart malformations. Most frequently, abnormalities of the thumb and secundum atrial septal defects are associated with the disease. The mode of inheritance is autosomal dominant. The etiology of this disease is unknown but is most likely of multifactorial origin. Here we report a case Holt-Oram syndrome with affected mother which was diagnosed at 18th gestational weeks by prenatal ultrasonograpy. Fetal ultrasonography revealed abnormalities of upper limbs, and heart. The upper limbs were shorter than normal, syndactyly of both hands were seen and both wrists were markedly angulated. Ventricular septal defect was suspicious. After genetic counselling her pregnancy was terminated at 22nd gestational week.
Hand ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Mothers* ; Pregnancy ; Syndactyly ; Thumb ; Ultrasonography* ; Ultrasonography, Prenatal ; Upper Extremity ; Wills ; Wrist