• Tuberculosis and Respiratory Diseases
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• v.73 no.5
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• pp.273-277
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• 2012

Paraneoplastic limbic encephalitis (PLE) is a rare syndrome characterized by memory impairment, affective and behavioral disturbances and seizures. Among many different neoplasms known to cause PLE, small cell lung cancer (SCLC) is the most frequently reported. The pathogenesis is not fully understood but is believed to be autoimmune-related. We experienced a patient with typical clinical features of PLE. A 67-year-old man presented with seizure and disorientation. Brain magnetic resonance imaging demonstrated high signal intensity in the bilateral amygdala and hippocampus in flair and T2-weighted images suggestive of limbic encephalitis. Cerebrospinal fluid tapping revealed no evidence of malignant cells or infection. Positron emission tomography/computed tomography showed a lung mass with pleural effusion and a consequent biopsy confirmed the diagnosis of PLE associated with SCLC. The patient was subsequently treated with chemotherapy and neurologic symptoms gradually improved.

• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.664-669
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• 2004

Extramedullary plasmacytoma(EMP) comprises 5% of all plasma cell neoplasms and commonly occurs in the upper airway or digestive tract. However, it rarely develops in the lungs. We present a case of primary pulmonary plasmacyotma in a 45 year old man, who presented as an endobronchial mass with a pleural effusion, but without evidence of multiple myeloma. The treatment options for EMP include surgery, surgery and radiotherapy, surgery and chemotherapy or chemotherapy alone. Surgery and radiation therapy appeared to be equally effective forms of treatment. The local recurrence rate was reported to be 30%, with 48% progressing to multiple myeloma, and median survival was reported to be 63-101 months. Our patient was initially treated with melphalan and prednisolone. However the disease progressed, and radiotherapy was combined with chemotherapy. In addition, the chemotherapy regimen was also changed to thalidomide and dexamethasone. The patient did not respond to this treatment regimen and finally died.

• Tuberculosis and Respiratory Diseases
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• v.61 no.3
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• pp.294-298
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• 2006

Lymphocytic interstitial pneumonia(LIP) is an uncommon condition in which the alveolar septa and extra-alveolar interstitial space are markedly expanded by small lymphocytes, plasma cells and histiocytes. Chest radiographs generally show nonspecific patterns with the most common pattern showing bibasilar reticular or reticulonodular infiltrates. Hilar or mediastinal lymphadenopathy and pleural effusions are usually absent. We encountered a 42-year-old female patient who was admitted to hospital because of exertional dyspnea and palpitation. The chest X-ray showed an enlarged bilateral hilar shadow and diffusely increased bronchovascular markings in both lung fields. The chest CT showed diffuse nodular infiltrations with mild septal thickening and combined patchy ground glass opacity in both lungs, and conglomerated mediastinal and bilateral hilar lymphadenopathy. A diagnosis of LIP was made from the tissue pathology taken by a thoracoscopic lung biopsy. The patient showed clinical and radiographic improvement after 3 months of treatment with prednisolone. We report a case of LIP presenting as diffuse nodular interstitial infiltrations with multiple mediastinal and bilateral hilar lymphadenopathy.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.237-240
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• 2007

Pulmonary choriocarcinoma is a very rare tumor in men. Herrein, the case of a pulmonary choriocarcinoma in 39-year-old man, and whether it had a primary nature, is reported. He denied any prior medical illness, but was admitted to our hospital with a history of a cough, and progressive dyspnea and hemoptysis 2 and 1 week duration, respectively. Chest radiographs on admission revealed a huge lung mass, 10 cm in diameter, in the left upper lung field, with left pleural effusion. Although biopsies using several diagnostic methods for the pathological confirmation were attempted, the pathology was not confirmed. Finally, the patient died after 2 months of regression. An autopsy of the lung was then performed.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.48-51
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• 2008

Chronic expanding hematoma of the thorax is a specific subtype of the chronic empyema. It presents as a slowly expanding intrathoracic mass which result in dyspnea or recurrent hemoptysis. The symptoms develop months or years after tuberculous pleurisy, trauma or surgery. Usually, it shows three common findings: a giant mass lesion in the thorax, some surrounding calcifications, the absence of signs or symptoms of infection. We report a case of chronic expanding hematoma of the thorax, initially presenting as massive hemoptysis through bronchopleural fistula which resulted in radiologic findings of new air-fluid level within the previous pleural lesion filled with unknown materials.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.33-38
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• 2008

Alcaligenes xylosoxidans is a catalase and oxidase positive, motile, nonfermentative and gram-negative rod bacterium. A. xylosoxidans infection is a rare cause of pulmonary infection and little information concerning treatment is available. The majority of patients that develop A. xylosoxidans infection belong to a high-risk group due to an immunocompromised condition or due to pulmonary cystic fibrosis. We report two rare cases of immunocompentent patients that developed a pulmonary infection due to A. xylosoxidans. A 77-year-old man was admitted with a lung abscess. The patient denied having any prior medical illness. A culture of bronchial washing fluid showed the presence of A. xylosoxidans. Despite appropriate antibiotic treatment, the patient died from acute respiratory distress syndrome (ARDS). Another patient, a 61-year-old man without an underlying disease, was admitted with empyema. Under the condition of a closed thoracostomy, a high fever persisted and the empyema was also aggravated. A. xylosoxidans was detected from a culture of pleural fluid. Susceptible antibiotic treatment was provided and surgical intervention was performed. We report these cases with a review of the literature.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.56-65
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• 2002

A pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor with a vascular origin. A PEH can arise in many organ systems, such as the lung, liver, bone and soft tissues. It is a borderline malignancy but the clinical course is usually benign. In this report, we describe three cases of PEH. Case 1, a 61-year-old man, had nonspecific chest discomfort and the chest X-ray showed a solitary lung nodule. This nodule was diagnosed by an open lung biopsy. The pathologic findings including abundant necrosis, mitosis and hyperchromatic and pleomorphic nuclei, indicated a malignancy. The electron microscopic study showed Weibel-Palade bodies and the immunohistochemical stain for CD31 showed a positive reaction in the tumor cells, and linear staining along the vascular lumina. Case 2, a 34-year-old man, was admitted for an evaluation of multiple small nodules, incidentally detected a screening chest X-ray. The nodules were diagnosed by a immunohistochemical stain for the factor VIII-related antigen. Case 3, a 34-year-old woman, complained of left pleuritic chest pain. A simple chest film and the chest CT scan revealed multiple bilateral nodules and a left pleural effusion. An immunohistochemical stain for the factor VIII-related antigen was used to diagnose the nodules. Forth-one months after the diagnosis, she died of pulmonary insufficiency.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1180-1190
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• 1990

96 patients underwent cardiac valve replacement for valvular heart diseases consecutively between February 1986 to February 1990 in the Department of Thoracic and Cardiovascular Surgery of Yeungnam University Hospital. The follow up period was between 6 months and 4.5 years postoperatively[mean 23.4$\pm$13.1 months]. 75 cases got mitral valve replacement, 6 cases, aortic valve replacement, 15 cases, double valve replacement. 30[31.2%] patients were male and 66[68.8%] were female and the age ranged from 14 to 66 years old. Early hospital death within 30 days postoperation were 5 patients[5.2%], consisting of by low cardiac output in 2, infective endocarditis in 1, multiple organ failure with sepsis in 1 patient. There was no late postoperative death. Most common early postoperative complication was wound disruption [8.7%] and then low cardiac output, pneumothorax, pleural effusion in order. Most common late postoperative complications were minor bleeding episodes[8.7%] related to anticoagulant therapy which were consisted of frequent epistaxis in 3, gum bleeding in 2, hemorrhagic gastritis in 1, hypermenorrhea in 1, hematoma in right arm in 1 patient. Valve-related complications included valve thrombosis [1.6%/ patient-year], valve failure due to pannus formation[1.1% /patient-year], prosthetic valve endocarditis[1, 1%o/patient-year] and minor anticoagulant hemorrhage[4.4% /patient-year]. 5 cases of reoperations were performed in 4 patients due to valve failure and all of them were in the mitral positions[2.7% /patient-year]. Cardiothoracic ratios in the chest X-ray decreased at the 6th month and 1st year postoperation in all patients. But in New York Heart Association[NYHA] functional class IV, no change in cardiothoracic ratio was found between 6 months and 1 year postoperation. In the echocardiogram, the size of the cardiac chambers decreased, but ejection fraction increased postoperatively in each functional class. In the electrocardiogram, decreases were found in the incidence of atrial fibrillation, left atrial enlargement, left ventricular hypertrophy with right bundle branch block increasing postoperatively in each functional class. The actuarial survival rate was 98.4% for all patients, 98.7% for mitral valve replacement, 83.8% for aortic valve replacement, and 80% for double valve replacement at the end of a 4.5 year follow up period. Meanwhile the actuarial freedom rate was 91.5% for prosthetic valve endocarditis, 91.6% for thromboembolism, 89.0% for prosthetic valve failure and 83.7% for minor anticoagulant hemorrhage. Preoperative NYHA class III and IV were 75% of all patients, but 95% of all patients were up graded to NYHA class I and II postoperatively.

• Tuberculosis and Respiratory Diseases
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• v.60 no.2
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• pp.205-214
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• 2006

Background : Acute exacerbations form a major component of the socioeconomic burden of COPD. As yet, little information is available about the long-term outcome of patients who have been hospitalized with acute exacerbations, although high mortality rates have been reported. The aim of this study was to determine predictors of long-term mortality after hospitalization for acute exacerbation of COPD. Methods : We performed a retrospective cohort study of consecutive patients admitted to the hospital for COPD exacerbation between 2000 through 2004. Patients who had died in hospital or within 6-months after discharge, had tuberculosis scar, pleural thickening or bronchiectasis by chest radiography or had been diagnosed with malignancy during follow-up periods were excluded. Results : Mean age of patients was 69.5 years, mean follow-up duration was 49 months, and mean $FEV_1$ was 1.00L (46% of predicted). Mortality was 35% (17/48). In the multivariate Cox regression analysis, heart rate of 100/min or more (p=0.003; relative risk [RR], 11.99; 95% confidence interval [CI], 2.34-61.44) and right ventricular systolic pressure (RVSP) of 35mmHg or more (p=0.019; RR, 6.85; 95% CI, 1.38-34.02) were independent predictors of mortality. Conclusion : Heart rate and RVSP in stable state may be useful in predicting long-term mortality for COPD patients admitted to hospital with acute exacerbation.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.196-202
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• 2015

Background: Viridans streptococci (VS) are a large group of streptococcal bacteria that are causative agents of community-acquired respiratory tract infection. However, data regarding their clinical characteristics are limited. The purpose of the present study was to investigate the clinical and radiologic features of community-acquired pneumonia (CAP) with or without parapneumonic effusion caused by VS. Methods: Of 455 consecutive CAP patients with or without parapneumonic effusion, VS were isolated from the blood or pleural fluid in 27 (VS group, 5.9%) patients. Streptococcus pneumoniae was identified as a single etiologic agent in 70 (control group) patients. We compared various clinical parameters between the VS group and the control group. Results: In univariate analysis, the VS group was characterized by more frequent complicated parapneumonic effusion or empyema and bed-ridden status, lower incidences of productive cough, elevated procalcitonin (>0.5 ng/mL), lower age-adjusted Charlson comorbidity index score, and more frequent ground glass opacity (GGO) or consolidation on computed tomography (CT) scans. Multivariate analysis demonstrated that complicated parapneumonic effusion or empyema, productive cough, bed-ridden status, and GGO or consolidation on CT scans were independent predictors of community-acquired respiratory tract infection caused by VS. Conclusion: CAP caused by VS commonly presents as complicated parapneumonic effusion or empyema. It is characterized by less frequent productive cough, more frequent bed-ridden status, and less common CT pulmonary parenchymal lesions. However, its treatment outcome and clinical course are similar to those of pneumococcal pneumonia.