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A Case of Pulmonary Alveolar Proteinosis Associated with Pulmonary Tuberculosis (폐결핵과 병발된 폐포단백증 1예)

  • Park, Min Sik;Jung, Sung Chang;Jin, Myoung In;Lee, Jin Bae;Lim, Sang Hyuk;Park, Sung Hun;Chung, Seung Hie;Shin, Tae Rim;Hyun, Dae Sung;Lee, Sang Chae;Yun, Kil Suk;Kwon, Kun Young
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.4
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    • pp.411-418
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    • 2002
  • 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 intra-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 middled lobes, and a portion of right lower lobe. Optical microscopy of the lung tissue obtained by and open lung biopsy revealed 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. Thereafter she showed improvement in her symptoms and a partial improvement in the chest X-ray and HRCT findings. We present a case of PAP associated with pulmonary tuberculosis.

Clinical Characteristics and Prognostic Factors in Patients with Pulmonary Tuberculosis Admitted to Intensive Care Units (중환자실로 입원한 폐결핵 환자의 임상 양상과 예후 인자)

  • Kang, Ji-Young;Kim, Myung-Sook;Kim, Ju-Sang;Kang, Hyeon-Hui;Kim, Seung-Soo;Kim, Yong-Hyun;Kim, Jin-Woo;Lee, Sang-Haak;Kim, Seok-Chan;Moon, Hwa-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.68 no.5
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    • pp.259-266
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    • 2010
  • Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.

Normalization of Elevated CA 19-9 Level after Treatment in a Patient with the Nodular Bronchiectatic Form of Mycobacterium abscessus Lung Disease

  • Chang, Boksoon;Han, Seo Goo;Kim, Wooyoul;Ko, Yousang;Song, Junwhi;Hong, Goohyeon;Eom, Jung Seop;Lee, Ji Hyun;Jhun, Byung Woo;Koh, Won-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.75 no.1
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    • pp.25-27
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    • 2013
  • Carbohydrate antigen 19-9 (CA 19-9) is a widely-used tumor marker in patients with pancreatic cancer. However, some patients with respiratory disease also exhibit elevated serum CA 19-9 levels. We report a case of normalization of elevated serum CA 19-9 levels after treatment of the nodular bronchiectatic form of Mycobacterium abscessus lung disease. A 40-year-old man visited our hospital because of chronic cough and sputum. A computed tomography scan revealed severe bronchiectasis in the right upper and right middle lobes. Nontuberculous mycobacteria were repeatedly isolated and identified as M. abscessus. The serum CA 19-9 level was elevated to 142.35 U/mL (normal range, <37 U/mL). Surgical resection was performed because of failure of sputum conversion after antibiotic treatment. The serum CA 19-9 level returned to the normal range after surgery. This case suggested that serum CA 19-9 levels could be elevated in patients with the nodular bronchiectatic form of M. abscessus lung disease.

Effects of Sleep Habits on EEG Sensory Motor Rhythm in Female College Students (여자 대학생의 수면습관이 감각운동리듬 뇌파에 미치는 영향)

  • Lee, Won-Joon;Choi, Hyun-Ju
    • Journal of Life Science
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    • v.22 no.5
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    • pp.613-620
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    • 2012
  • To evaluate the effects of sleep habits on the powers of beta waves and the sensory motor rhythm of the electroencephalogram (EEG), female college student subjects were divided into four groups, according to their sleep habits, as follows: GSHG (Good Sleep Habit Group), CSHG (Common Sleep Habit Group: late bedtime), CSDG (Cognitive Sleep Disorder-Delayed Sleep Phase Syndrome Group), and NSDG (Non-cognitive Sleep Disorder-Delayed Sleep Phase Syndrome Group). Brain function was stimulated by reading a book for 3 min in the morning (9~12 am) and the EEG was measured. According to the results, the powers of the beta waves and sensory motor rhythm were not different during the resting period among the four groups. However, during the reading stimulation period, the powers of beta waves and the sensory motor rhythm in the GSHG were significantly greater than in the other groups ($p$ <0.05). Beta powers during stimulation also increased in all brain areas in the GSHG ($p$ <0.05). Interestingly, these were decreased in the frontal and temporal lobes in the CSHG by the reading stimulation ($p$ <0.05). On the other hand, sensory motor rhythm, which represents focusing efficacy, only improved in the GSHG. These results indicate that the brain's focusing function during the reading stimulation was not properly operating in the morning in the female college students who had a delayed bedtime and bad sleep habits.

Immunohistochemical Study on the Cerebral Ganglion of African giant Snail, Achatina fulica (아프리카 왕달팽이(Achatina fulica) 뇌신경절의 면역조직화학적 구조)

  • 장남섭;한종민
    • The Korean Journal of Malacology
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    • v.15 no.1
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    • pp.1-11
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    • 1999
  • An immunohisochemical study on the cerebral ganglion of the African giant snail, Achatina fulica. was conducted by applying the AB/AY staining and the avidin-bovine-peroxidase complex staining methods. The followings are the results obtained throughout the study. The cerebral ganglion of Achatina fulica is an ellipsoidal body of 2 x 1 mm in size, which is connected by the cerebral commissure of 1 mm in diameter. The cross-section through the cerebral ganglion, shaped like a butterfly, is divided into the medio-dorsal parts, the latero-dorsal parts, the caudo-dorsal parts, and the lateral lobes. In the medio-dorsal and latero-dorsal parts, the LG cells and the DG cells are found mixed, although the LG cells are dominant. In lateral lobe, however, the Y cells are quite dominant, while the LG cells and the DG cells are seldom found. The LG cells are 20-70 $\mu\textrm{m}$ in sizes and circular or ellipsoidal in shapes. They are stained light green with the AB/AY. 1 - 3 nucleoli are found in karyolymph, where granular chromantins are evenly distributed. In cytoplasm, it is found that the secretory granules are evenly developed.

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Molecular phylogeny of Astilbe: Implications for phylogeography and morphological evolution (노루오줌속(Astilbe)의 분자 계통: 계통지리 및 형질 진화에 대한 고찰)

  • Kim, Sang-Yong;Kim, Sung-Hee;Shin, Hyunchur;Kim, Young-Dong
    • Korean Journal of Plant Taxonomy
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    • v.39 no.1
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    • pp.35-41
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    • 2009
  • Astilbe (Saxifragaceae) is a genus well known for its disjunctive distribution in Asia and eastern North America. In this study, we reconstructed a molecular phylogeny of the genus using the sequences of ITS regions of nuclear ribosomal DNA. A total of 17 species representing major lineage of Astilbe and closely related taxa were included in the phylogenetic analyses. We obtained a Bayesian phylogenetic tree in which Saxifragopsis was positioned as a sister group to Astilbe. The Japanese endemic species, A.platyphylla was the most basal lineage within the genus. This species is well known for its distinct morphological features such as unisexual flowers, apetaly, and calyx with 7-11 lobes. Two species, A. biternata, a New World representative of the genus, and A. rivularis widely distributed in S. Asia, branched off early in the evolution of Astilbe. The remaining species formed a strongly supported core clade, which diverged into two robust geographical lineages: the first ("Japonica" clade) of species distributed in Japan, Taiwan, and Philippines and the other ("Rubra" clade), of taxa in China and Korea. The ITS phylogeny indicates that the Bering land bridges were the major route for the origin and dispersal of A. biternata. The two Taiwanese taxa and A. philippinensis were found to derive from the Japanese member, as the genus advanced southwards. The ITS phylogeny suggests that apetaly originated independently at least two times within the genus. Our results do not support Engler's classification system of the genus based on the leaf type (simple vs. compound), but reaffirm Hara's taxonomic idea which primarily considered the features of calyx.

Bloom-forming dinoflagellate Akashiwo sanguinea(Dinophyceae) in Jangmok Harbour of Geoje Island, Korea: Morphology, phylogeny and effects of temperature and salinity on growth (거제도 장목항에서 적조원인생물 Akashiwo sanguinea(Dinophyceae): 형태, 분자계통학적 특성 및 온도와 염분에 따른 성장 특성)

  • Han, Kyong Ha;Li, Zhun;Youn, Joo Yeon;Kang, Byeong Jun;Kim, Hyun Jung;Seo, Min Ho;Soh, Ho Young;Shin, Hyeon Ho
    • Korean Journal of Environmental Biology
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    • v.37 no.2
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    • pp.119-128
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    • 2019
  • The morphological characteristics of the bloom-forming dinoflagellate Akashiwo sanguinea isolated from Jangmok Harbour, Geoje in Korea was examined using light and scanning electron microscope (SEM), and its large subunit (LSU) rDNA was sequenced. Additionally, investigation was done on the effects of temperature and salinity on the growth of A. sanguinea. The cells were dorso-ventrally compressed up to 54.7-70.3 ㎛ long and 31.5-48.5 ㎛ wide. The epicone was conical while the hypocone was separated into two lobes. The nucleus was positioned at the center of the cell. The yellow-brown chloroplasts radiated close to the cell center. SEM observation indicated that A. sanguinea has an e-shaped apical groove. Molecular phylogeny based on LSU rDNA gene sequences revealed that the A. sanguinea strains isolated from Jangmok Harbor were classified in the clade of ribotype A. The maximum growth rate (0.50 day-1) was observed at 20℃ and 20 psu, while the maximum cell density (1,372 cells mL-1) was observed at 25℃ and 30 psu. This indicates that the blooms of A. sanguinea ribotype A in Korean coastal area are affected by water temperature, rather than the salinity.

Clinical Features of Brain Abscesses in Neonates and Children: A Single Center Experience from 1997 to 2006 (단일기관에서 조사한 소아 뇌농양의 임상양상(1997-2006))

  • Lee, Teak Jin;Chu, Jin-Kyong;Kim, Ki Hwan;Kim, Khi Joo;Kim, Dong Soo
    • Pediatric Infection and Vaccine
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    • v.15 no.1
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    • pp.30-35
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    • 2008
  • Purpose : We evaluated clinical presentations of brain abscesses, including predisposing factors, causative organisms, and mortality rate in neonates and children. Methods : We retrospectively reviewed the medical charts of neonates and children with brain abscesses treated at Severance Hospital from January 1997 through December 2006. Results : Among 27 neonates and children with brain abscesses, overall mortality was 22 % and 38% of survivors developed neurologic sequelae. The mortality rate was 38% in 8 infants with brain abscesses. The most common location of brain abscesses were frontal and parietal lobes, followed by temporal lobe. There were 7 cases with multiple brain abscesses. Streptococci (33%), Staphylococci (27%), and Gram-negative enterics (20%) were commonly isolated. The common predisposing conditions were neurosurgical procedure (30 %), cyanotic congenital heart disease (15%), and sinusitis/otitis (7%). Fever (74%), headache (37%), nausea/vomiting (33%), and altered mental status (33%) occurred commonly. Compared with children older than 1 year of age, infants were associated with multiple brain abscesses (63%, P=0.011) and high rates of death or neurologic sequelae (88%, P= 0.033). Conclusion : We should have a high index of suspicion in order to recognize the condition as early as possible, especially in infancy with brain abscesses who presents vague or nonspecific symptoms and signs.

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Improving the Accuracy of Early Diagnosis of Thyroid Nodule Type Based on the SCAD Method

  • Shahraki, Hadi Raeisi;Pourahmad, Saeedeh;Paydar, Shahram;Azad, Mohsen
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.1861-1864
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    • 2016
  • Although early diagnosis of thyroid nodule type is very important, the diagnostic accuracy of standard tests is a challenging issue. We here aimed to find an optimal combination of factors to improve diagnostic accuracy for distinguishing malignant from benign thyroid nodules before surgery. In a prospective study from 2008 to 2012, 345 patients referred for thyroidectomy were enrolled. The sample size was split into a training set and testing set as a ratio of 7:3. The former was used for estimation and variable selection and obtaining a linear combination of factors. We utilized smoothly clipped absolute deviation (SCAD) logistic regression to achieve the sparse optimal combination of factors. To evaluate the performance of the estimated model in the testing set, a receiver operating characteristic (ROC) curve was utilized. The mean age of the examined patients (66 male and 279 female) was $40.9{\pm}13.4years$ (range 15- 90 years). Some 54.8% of the patients (24.3% male and 75.7% female) had benign and 45.2% (14% male and 86% female) malignant thyroid nodules. In addition to maximum diameters of nodules and lobes, their volumes were considered as related factors for malignancy prediction (a total of 16 factors). However, the SCAD method estimated the coefficients of 8 factors to be zero and eliminated them from the model. Hence a sparse model which combined the effects of 8 factors to distinguish malignant from benign thyroid nodules was generated. An optimal cut off point of the ROC curve for our estimated model was obtained (p=0.44) and the area under the curve (AUC) was equal to 77% (95% CI: 68%-85%). Sensitivity, specificity, positive predictive value and negative predictive values for this model were 70%, 72%, 71% and 76%, respectively. An increase of 10 percent and a greater accuracy rate in early diagnosis of thyroid nodule type by statistical methods (SCAD and ANN methods) compared with the results of FNA testing revealed that the statistical modeling methods are helpful in disease diagnosis. In addition, the factor ranking offered by these methods is valuable in the clinical context.

A case of megalencephalic leukoencephalopathy with subcortical cysts (피질하 낭종을 동반한 거대뇌성 백질뇌병증 1예)

  • Park, Eun Young;Kim, Young Ok;Kim, Ji Youn;Yeo, Chae Young;Baek, Hee Jo;Kim, Chan Jong;Kim, Eun Young;Woo, Young Jong
    • Clinical and Experimental Pediatrics
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    • v.51 no.12
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    • pp.1342-1345
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    • 2008
  • Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare white matter disorder, first described in the early 1990s. The brain in patients with MLC appears swollen on MRI, with diffuse white matter abnormalities; in addition, there is an invariable presence of subcortical cysts, primarily in the anterior temporal region sparing the deep white matter, basal ganglia, thalami, and cerebellum. Patients with MLC present with macrocephaly and neurological abnormalities such as motor deterioration, ataxia, spasticity, and cognitive deficits. We report a twenty-month-old boy who presented with seizures and macrocephaly, delay in development, and abnormal brain MRI findings compatible with the diagnosis of MLC. The brain MRI revealed bilateral hypersignal intense subcortical white matter regions in the frontal, temporal, and parietal lobes on T2-weighted images, which were not yet associated with cystic changes. During follow-up, the frequency of seizures decreased after anticonvulsant medication was started, but the head circumference remained above the 97th percentile, and the patient continued to have developmental delay.