BACKGROUND: Exposure to cigarette smoking (CS) is a major risk factor for the development of lung cancer. CS is known to cause oxidative DNA damage and mutation of tumor-related genes, and these factors are involved in carcinogenesis. 8-Hydroxydeoxyguanosine (8-OHdG) is considered to be a reliable biomarker for oxidative DNA damage. Increased levels of 8-OHdG are associated with a number of pathological conditions, including cancer. There are no reports on the expression of 8-OHdG by immunohistochemistry in non-small cell lung cancer (NSCLC). METHODS: We investigated the expression of 8-OHdG and p53 in 203 NSCLC tissues using immunohistochemistry and correlated it with clinicopathological features including smoking. RESULTS: The expression of 8-OHdG was observed in 83.3% of NSCLC. It was significantly correlated with a low T category, negative lymph node status, never-smoker, and longer overall survival (p < .05) by univariate analysis. But multivariate analysis revealed that 8-OHdG was not an independent prognostic factor for overall survival in NSCLC patients. The aberrant expression of p53 significantly correlated with smoking, male, squamous cell carcinoma, and Ki-67 positivity (p < .05). CONCLUSIONS: The expression of 8-OHdG was associated with good prognostic factors. It was positively correlated with never-smokers in NSCLC, suggesting that oxidative damage of DNA cannot be explained by smoking alone and may depend on complex control mechanisms.
Carcinogenesis ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; DNA ; DNA Damage ; Humans ; Immunohistochemistry ; Lung Neoplasms ; Lymph Nodes ; Male ; Multivariate Analysis ; Risk Factors ; Smoke ; Smoking ; Tobacco Products

Staphylococcus lugdunensis is a member of coagulase-negative staphylococci (CoNS), an uncommon microbial culture isolate with virulent potency. Although CoNS are common skin commensals, and often regarded as contaminants or colonizers when isolated from clinical specimen cultures, the clinical course and microbiological characteristics of Staphylococcus lugdunensis may resemble those of Staphylococcus aureus rather than other CoNS. Invasive infectious diseases such as infective endocarditis, peritonitis, skin and soft tissue infection, vascular prosthetic infection, septicemia, and osteomyelitis have been found to be associated with Staphylococcus lugdunensis. Here we report the first case of psoas abscess caused by methicillin-sensitive Staphylococcus lugdunensis in Korea.
Colon ; Communicable Diseases ; Endocarditis ; Korea ; Osteomyelitis ; Peritonitis ; Psoas Abscess* ; Sepsis ; Skin ; Soft Tissue Infections ; Staphylococcus aureus ; Staphylococcus lugdunensis* ; Staphylococcus*

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.
Acute Kidney Injury ; Anoxia ; Antimalarials/*administration & dosage ; Extracorporeal Membrane Oxygenation ; Humans ; Lung/radiography ; Malaria, Vivax/*complications/diagnosis/radiography/therapy ; Male ; Middle Aged ; Multiple Organ Failure ; Plasmodium vivax/*isolation & purification ; Republic of Korea ; Respiratory Distress Syndrome, Adult/*complications/radiography/therapy ; Treatment Outcome

At the time of diagnosis, about 20% of patients with gastric cancer have stage IV disease involving the liver, lung, and bone. Brain metastasis from gastric cancer is exceedingly rare, with an incidence of <1% of clinical cases. A 59-year-old man was admitted with hearing loss in the left ear and left facial palsy for 1 month. A magnetic resonance imaging scan revealed a tumor in the cerebellopontine angle that extended to the inner auditory canal and that was clinically diagnosed as acoustic neuroma. After complete resection, histological examination showed metastatic poorly differentiated carcinoma. Further investigation revealed advanced gastric cancer involving the antrum with no evidence of the involvement of other sites except the brain parenchyma. Palliative total gastrectomy was performed and the surgical specimen revealed a poorly cohesive carcinoma that was histopathologically identical to that of the resected brain tumor. Here we report this rare case of gastric cancer that initially presented as a solitary brain metastasis mimicking acoustic neuroma.
Acoustics ; Brain Neoplasms ; Brain ; Cerebellopontine Angle ; Diagnosis ; Ear ; Facial Paralysis ; Gastrectomy ; Hearing Loss ; Humans ; Incidence ; Liver ; Lung ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis ; Neuroma, Acoustic ; Stomach Neoplasms

BACKGROUND/AIMS: Viral suppression of the hepatitis B virus (HBV) can be induced by lamivudine, but the relapse seen in many patients after cessation of lamivudine therapy is troublesome. We thought that the host immune response is important to prevent viral relapse. We compared the frequency of HBV-specific CD8+ T cells in the peripheral blood and their expansion capacity after exposure to viral antigen between the patients showing sustained HBeAg seroconversion after use of lamivudine and those patients without sustained response. METHODS: We analyzed HBV-specific CD8+ T cells that were isolated from the blood of 14 patients with HLA-A2 who showed lamivudine induced HBeAg seroconversion (HBV DNA < 0.5 pg/mL, and the cells were negative for HBeAg) at the end of lamivudine therapy. The purified T cells were directly stained ex vivo, after they had been stimulate with synthetic peptide, using the HBV core 18-27-specific HLA tetramer (Tc 18-27) and monoclonal antibody to CD8. The HBV viral load was quantified by the Amplicor HBV Monitor assay. RESULTS: In patients with a sustained HBeAg response (the sustained group) for a duration of 15.5 months of follow-up, the median number of Tc 18-27 cells out of the 5 X 10(4) CD8+ T cells was 49.5 (15-135). On the contrary, in patients who experienced relapse (the relapsed group) during a median of 7.5 months of follow-up, the median number of Tc 18-27 cells out of the 5 X 10(4) CD8+ T cells was 13.5 (0-95). Especially, among patients with a viral load of HBV DNA < 1 X 10(3) copies at the end of treatment, the median number of Tc 18-27 cells out of 5 X 10(4) CD8+ T cells was 87 (45-135) in sustained group compared to 12 (6-50) in the relapsed group. All patients in the sustained group demonstrated a vigorous expansion of the core 18-27-specific CD8+ T cells after stimulation with viral peptide, in contrast to only 3 out of 8 patients in the relapsed group. CONCLUSIONS: This study demonstrates that the frequency and functional responsiveness of the circulating HBV-specific CD8+ T cells may be important for obtaining a sustained HBeAg response to lamivudine.
Adult ; Antiviral Agents/*therapeutic use ; CD8-Positive T-Lymphocytes/*immunology ; English Abstract ; Female ; Hepatitis B/drug therapy/*immunology/virology ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/*immunology ; Humans ; Lamivudine/*therapeutic use ; Male ; Recurrence ; Viral Load

BACKGROUND AND OBJECTIVES: Congestive heart failure is one of the most frequent problems in cardiovascular patients. However, very little data concerning this syndrome in Korea was available. The objectives of this study were to evaluate the demographic and clinical characteristics of hospitalized Korean patients with congestive heart failure. SUBJECTS AND METHODS: Six university hospitals that fulfilled the protocol for clinical information of the patients with heart failure, were prospectively engaged in this study. Six hundred and ninety patients, admitted between Jan. 1. 1998 and Dec. 31. 1999, were enrolled. RESULTS: Ischemic heart disease was the most frequent underlying disease (33.2%), with the other causes of heart failure being cardiomyopathy (23%), hypertensive heart disease (22%) and valvular heart disease (12.7%). Compared with ischemic cardiomyopathy, the patients with idiopathic dilated cardiomyopathy were younger (61.1+/-16.6 vs. 66.9+/-10.3, p<0.05), had less incidence of diabetes (16.8% vs. 32.2%) and smoked less (13.5+/-21.5 vs. 20.4+/-26.0 pack-year). The common aggravating factors were arrhythmia (22%), myocardial ischemia (21.7%) and infection (18.7%). Thirty nine (5.7%) patients died during the one year follow up period. Ischemic heart disease was the main underlying disease in the fatal cases (46.2%). CONCLUSION: Ischemic heart disease was the major cause of heart failure, and the leading cause of death in Korean patients with congestive heart failure.
Arrhythmias, Cardiac ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cause of Death ; Coronary Disease ; Epidemiology ; Estrogens, Conjugated (USP)* ; Follow-Up Studies ; Heart Diseases ; Heart Failure* ; Heart Valve Diseases ; Hospitals, University ; Humans ; Incidence ; Korea* ; Myocardial Ischemia ; Prospective Studies ; Smoke

BACKGROUND: Renal dysfunction occurs in up to 75% of patients with liver cirrhosis and is a major cause for mortality and morbidity. Hyperbilirubinemia, hepatic encephalopathy, spontaneous bacterial peritonitis and underlying renal insufficiency have been reported as risk factors for renal dysfunction in patients with liver cirrhosis, but further evaluations are still being required. METHODS: We retrospectively analized 91 liver cirrhosis patients hospitalized at Severance Hospital between Jan 1, 1996 and Dec 31, 2001 who had normal renal function at admission. RESULTS: Forty-four patients were enrolled in renal dysfunction group and forty-seven patients in control group. There were no significant differences between two groups in age, cause for liver cirrhosis, presence of diabetes mellitus, history of aminoglycoside treatment, serum albumin level, and prothrombin time. The incidence of ascites (95% vs. 47%), hepatic encephalopathy (66% vs. 17%), bacteremia (38% vs. 4%), urinary tract infection (16% vs. 2%), spontaneous bacterial peritonitis (30% vs. 6%), and upper gastrointestinal bleeding (25% vs. 9%) were significantly high in renal dysfunction group, compared to control group (p<0.05). In renal dysfunction group, the level of total bilirubin (9.1+/-8.3 mg/dL vs. 3.5+/-6.2 mg/dL) was also much higher than control group. Multiple logistic regression analysis showed ascites, hepatic encephalopathy, and bacteremia as independent risk factors for renal dysfunction. CONCLUSION: Ascites, hepatic encephalopathy, and bacteremia are postulated to be risk factors for renal dysfunction in liver cirrhosis patients. Renal function and urine output should be cautiously monitored in liver cirrhosis patients with these risk factors.
Ascites ; Bacteremia ; Bilirubin ; Diabetes Mellitus ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Hyperbilirubinemia ; Incidence ; Liver Cirrhosis* ; Liver* ; Logistic Models ; Mortality ; Peritonitis ; Prothrombin Time ; Renal Insufficiency ; Retrospective Studies ; Risk Factors* ; Serum Albumin ; Urinary Tract Infections

BACKGROUNDS/AIMS: Hepatitis B virus(HBV) specific cytotoxic T lymphocyte (CTL) response is believed to play a major role in virus control and liver damage in chronic hepatitis B(CHB). We performed this study to evaluate whether HBV specific CTL could be visualized directly by tetrameric HLA-A2/core 18-27 complex(T c18-27) in the peripheral blood and liver of patients with CHB. On the basis of our results we clarified patients intrahepatic compartmentalization and correlation with HBV specific CTL and viral replication or liver damage. METHODS: We stained peripheral blood mononuclear cells of 33 HLA-A2 + and 8 HLA-A2 patients with CHB with cychrome conjugated anti-CD8 mAb and phycoerythrin conjugated T c18-27. Among these we analysed intrahepatic lymphocyte of 11 HLA-A2 + patients. We compared the frequency of T c18-27 specific CD8+ cells with serum HBV-DNA levels or alanine aminotransferase(ALT) levels. RESULTS: The frequency of circulating T c18-27 specific CD8+ cell was higher(9-101 cells per 50,000 CD8+ cells) than background level in 14 among 33 patients. The frequency of intrahepatic T c18-27 specific CD8+ cells was 12-2100 cells per 50,000 CD8+ cells in 8 out of 11 patients whose liver was obtained This was 17.4-150 times higher than circulating T c18-27 specific CD8+ cells. The frequency of circulating T c18-27 specific CD8+ cells was increased in 10 out of 18 patients with serum HBV DNA level <0.5 pg/mL and ALT < 40 IU/L. It was increased in just 4 out of 15 patients with HBV DNA level > 800 pg/mL and ALT >70 IU/L. The frequency of intrahepatic T c18-27 CTL tended to be lower in high levels of serum HBV DNA and was not correlated with liver inflammation. CONCLUSION: This study provess that if HBV-specific CTLs are barely detectable in the peripheral blood of CHB, much more HBV-specific CTLs are in the liver and most HBV-specific CTLs are infiltrated in the liver. Also, in the presence of an effective HBV specific CD8 response the inhibition of viral replication can be independent of liver damage.
CD8-Positive T-Lymphocytes/immunology ; DNA, Viral/analysis ; English Abstract ; HLA-A2 Antigen/analysis/*immunology ; Hepatitis B Virus/genetics/*immunology ; Hepatitis B, Chronic/*immunology/virology ; Human ; T-Lymphocytes, Cytotoxic/*immunology ; Viral Core Proteins/*immunology

BACKGROUND/AIMS: The protective role of HBV-specific CD8+ cells is dependent on their ability to efficiently migrate to the infected liver, where they may exert an effector function. The migratory behavior of CD8+ cells is influenced by their expression of different chemokine receptors. This study was intended to analyse the pattern of chemokine receptor expression of HBV specific CD 8+ cells in chronic B viral infection. METHODS: We analysed the CCR5 and CCR3 profile of HBV-specific CD8+ cells isolated from the blood and liver of patients with different patterns of HBV infection. Purified T cells were stained directly ex vivo, or after antigen-specific stimulation, using HBV peptide-specific HLA tetramers and monoclonal antibodies to CD8, CCR5 and CCR3, with analysis by flow cytometry. RESULTS: In patients with chronic hepatitis B characterised by low levels of virus (serum HBV DNA <0.5pg/mL) and minimal liver inflammation, analysis of circulating and intrahepatic CD8+ cells demonstrated that liver infiltrating Tc18-27-specific cells were preferentially CCR5+ (up to 80% of HBV-specific CD8+ cells), in contrast to cells of the same specificity within the circulating compartment (up to 35% of HBV-specific CD8+ cells). Furthermore, CCR3 was expressed by about 10% of Tc18-27+ cells infiltrating the liver, but was absent from circulating cells. Following HBV-specific stimulation in vitro the CCR5 expression of circulating Tc18-27-specific cells was up-regulated, to levels found in liver infiltrating cells, whereas CCR3 expression was unchanged. CONCLUSIONS: The chemokine receptor profile of HBV-specific CD8+ cells is influenced by the anatomical site of these cells, and the clinical pattern of disease. The ability of circulating HBV-specific CD8+ cells of patients with low replicating virus to upregulate CCR5 suggests that these cells may respond to increases in virus replication by efficiently migrating into the infected liver.
CD8-Positive T-Lymphocytes/immunology/*metabolism ; English Abstract ; Hepatitis B Virus/immunology ; Hepatitis B, Chronic/*immunology/pathology ; Human ; Liver/pathology ; Receptors, CCR5/metabolism ; Receptors, Chemokine/*metabolism ; T-Cell Antigen Receptor Specificity

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipids, is deposited in the alveoli and bronchioles. The deficiency in the clearance and degradation of the i ntra-alveolar phospholipoproteinaceous material in PAP most likely represents a dysfunction of the type II pneumocytes. Although the pathogenesis and causative treatment of PAP is unclear a whole lung bronchopulmonary lavage is a relatively safe and effective treatment. Here we experienced a case of pulmonary alveolar proteinosis in a 62 year old female patient who had pulmonary tuberculosis approximately 20 years ago. She complained of aggravated dyspnea and chronic cough, and presented fine inspiratory crackles at both lung fields. diffuse ground glass opacity with some area of consolidation and smooth interlobular septal thickenings in both upper, right middle lobes, and a portion of right lower lobe. Optical microscopy of the lung tissue obtained by an open lung biopsy many granulomas containing acid-fast smear positive bacilli and diffuse homogeneous PAS-positive fluid in the alveolar space. Immunohistochemical stain showed surfactant A in the alveolar space. Antituberculosis drugs with bronchoalveolar lavage were used to treat the disease. There after she showed improvement in her symptoms and a partial improvement in the chest X-ray and HRCT findings. We present a case of PAT associated with pulmonary tuberculosis.
Biopsy ; Bronchioles ; Bronchoalveolar Lavage ; Cough ; Dyspnea ; Female ; Glass ; Granuloma ; Humans ; Lung ; Microscopy ; Middle Aged ; Phospholipids ; Pneumocytes ; Pulmonary Alveolar Proteinosis* ; Respiratory Sounds ; Thorax ; Tuberculosis, Pulmonary*