ABSTRACT
Primary thymic adenocarcinoma is a very rare malignancy of the anterior mediastinum with no standardized treatment. A 36-year-old male patient presented with hoarseness over the past 3 months. A chest computed tomography (CT) scan showed an infiltrative mass to the proximal vessels and aortic arch in left upper mediastinum (4.1x3.1x5.4 cm). Brain magnetic resonance imaging (MRI) showed focal lesions, suggesting metastasis in the left frontal lobe. A thoracoscopic biopsy of the mediastinal mass confirmed a primary thymic adenocarcinoma forming a glandular structure with atypia of tumor cells. The patient received four cycles of systemic chemotherapy, consisting of etoposide and cisplatin, with concurrent radiotherapy (6,000 cGy/30 fractions) to the mediastinal lesion and the metastatic brain lesion (4,200 cGy/12 fractions). A follow-up chest CT scan and brain MRI showed a decrease in the size of the left upper mediastinal mass and brain lesion. We report a rare case of the primary thymic adenocarcinoma with a literature review.
Subject(s)
Adult , Humans , Male , Adenocarcinoma , Aorta, Thoracic , Biopsy , Brain , Chemoradiotherapy , Cisplatin , Drug Therapy , Etoposide , Follow-Up Studies , Frontal Lobe , Hoarseness , Magnetic Resonance Imaging , Mediastinum , Neoplasm Metastasis , Radiotherapy , Small Cell Lung Carcinoma , Thorax , Thymus Gland , Tomography, X-Ray ComputedABSTRACT
No abstract available.
Subject(s)
Cerebral Cortex , Magnetic Resonance Imaging , Wernicke EncephalopathyABSTRACT
BACKGROUND: Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation. METHODS: We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress. RESULTS: Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consistency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p< 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997-3.582, p = 0.051). CONCLUSIONS: Shorter hospital stay (within 9 days of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.
Subject(s)
Female , Humans , Bronchoscopy , Colon , Intensive Care Units , Length of Stay , Pneumonia , Respiration, Artificial , Retrospective Studies , Risk Factors , TracheostomyABSTRACT
Although Taxol(R) is one of the most successful drugs in current cancer chemotherapy against solid tumors, a major problem is hypersensitivity reactions that arises as a consequence of activation of the complement (C) system, "C activation-related pseudo-allergy". Most severe hypersenstivity reactions occur within the first few minutes of Taxol(R) administration, usually after the first or second dose. Here we report a case of a severe hypersensitivity reaction in a 72-year-old man undergoing Genexol-PM(R) infusion. Hypotension and polymorphic pruritic skin rash appeared 2 hours after the start of Genexol-PM(R) infusion (with an appropriate premedication). Treating with methylprednisolone, epinephrine and inotropic agents, reduced the hypotension and the skin rash disappeared. We report this case with a review of the literature.
Subject(s)
Aged , Humans , Anaphylaxis , Complement System Proteins , Epinephrine , Exanthema , Hypersensitivity , Hypersensitivity, Delayed , Hypotension , Methylprednisolone , Paclitaxel , PurpuraABSTRACT
Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.
Subject(s)
Humans , Male , Bronchial Fistula , Carcinoma, Non-Small-Cell Lung , Fistula , Lung Neoplasms , Lymph Nodes , Lymphatic Diseases , Pneumonia , Thoracic Cavity , Thorax , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.
Subject(s)
Humans , Arrhythmias, Cardiac , Breath Holding , Carcinoma, Non-Small-Cell Lung , Central Nervous System , Chlorpromazine , Contracts , Deglutition , Dehydration , Diaphragm , Glottis , Hiccup , Intercostal Muscles , Lung Neoplasms , Malnutrition , Phrenic Nerve , Reflex , Sleep Initiation and Maintenance Disorders , WaterABSTRACT
Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.
Subject(s)
Adult , Female , Humans , Arthritis, Rheumatoid , Aspergillosis , Aspergillus , Biopsy , Deglutition Disorders , Environmental Exposure , Etanercept , Esophagitis , Immunocompromised Host , Immunosuppressive Agents , Itraconazole , Mortality , Prednisolone , Respiratory SystemABSTRACT
Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.
Subject(s)
Adult , Female , Humans , Arthritis, Rheumatoid , Aspergillosis , Aspergillus , Biopsy , Deglutition Disorders , Environmental Exposure , Etanercept , Esophagitis , Immunocompromised Host , Immunosuppressive Agents , Itraconazole , Mortality , Prednisolone , Respiratory SystemABSTRACT
Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures.
Subject(s)
Humans , Pregnancy , Young Adult , Antibodies, Anticardiolipin , Antiphospholipid Syndrome , Diagnosis , Fever , Hypertension, Pulmonary , Lupus Coagulation Inhibitor , Mortality , Pulmonary Embolism , Respiratory Distress Syndrome , Sputum , Thorax , ThrombosisABSTRACT
BACKGROUND: Height is essential variable for assessing nutritional status, estimating glomerular filtration rate, and drug dosage besides in epidemiologic study. In old age, spinal deformity and thinning of the intervertebral discs may produce a spurious decrease in height. In the nonambulants, standard methods of height measurement may be impractical. The present study has been designed to predict the height using regression analysis by long bone measurement. METHODS: One hundred twelve persons in one elderly welfare facility were studied. Standing height was measured. Total arm length, upper arm length, forearm length, tibial length in erect and supine position were measured. A nomogram has been prepared from these data to predict height. RESULTS: Multiple regression analysis was used to measure relationship between measured height, age, sex, and each of the measured parameters. Among the parameters in the erect position, height was best predicted by erect tibial length(ETL)(p<0.01). Among the parameters in the supine position, height was best predicted by supine total arm length(STAL)(p<0.05). Estimation of height was calculated by linear regression analysis. Estimation of height(cm)=93.036+2.383 x ETL(cm)-0.233 x age-5.747 x sex(R2=.815). Estimation of height(cm)=87.985 + 1.775 x STAL(cm)-0.151 age-6.787 x sex(R2=.803). CONCLUSION: In the present study it has been shown that erect tibial length and supine total arm length may be a good predictor of total height. The nomogram may provide the prediction of height in the nonambulant elderly.
Subject(s)
Aged , Humans , Arm , Body Height , Congenital Abnormalities , Epidemiologic Studies , Forearm , Glomerular Filtration Rate , Intervertebral Disc , Linear Models , Nomograms , Nutritional Status , Supine PositionABSTRACT
OBJECTIVES: To evaluate objectively the effect and utility of voice therapy which uses acoustic analysis and aerodynamic assessment, in addition to psychoacoustic analysis, as an initial treatment for patients with vocal nodules. MATERIALS AND METHODS: Eighteen females and 14 males with vocal nodules were treated by voice therapy. The results of pre-treatment and post-treatment were compared with each other after the following analyses: acoustic analysis by measuring relative average pertubation (RAP) and shimmer; aerodynamic assessments by measuring S to Z ratio and maximum phonation time, and psychoacoustic analysis by using the GRBAS scales. RESULTS: All measurements of post-treatment improved significantly. The post-treatment results of children showed better improvement in shimmer, relative average pertubation and MPT, compared to those of adult patients. No significant difference in improvement could be found between male and female patients. CONCLUSION: Voice therapy may serve as one primary treatment modality in vocal nodule patients.
Subject(s)
Adult , Child , Female , Humans , Male , Acoustics , Phonation , Psychoacoustics , Voice , Weights and MeasuresABSTRACT
BACKGROUND: Stomach cancer is the most malignant neoplasm among Koreans. There ane a number of epidemiological studies on dietary factors of stomach cancer in many countries. However, analytical studies on Korean dietary factors are very scarce. SUBJECTS AND METHODS: A case-control study was conducted at the Korea Cancer Center Hospital in Seoul between April and September in 1996. One hundred twenty-six stomach cancer patients confirmed by the histological diagnosis were compared with 234 control subjects matched by age, sex, and admission date. A food frequency questionnaire asking the consumption frequency of 85 selected food items was used to gather the information from all subjects via a face-to-face interview. Multiple logistic regression models were used to estimate relative risks when controlling simultaneously for covariates. RESULTS: An increased risk of stomach cancer was noted among those with low economic status, fast eating rate, high eating out, hot-temperature soup preference, salt preference, cucumber Kimchi intake, use of pickled fish in Kimchi. Intake of garlic, green onion, tofu, mung bean pancake, acorn-starch paste, starch vermicelli with mixed vegetables, total fruits, citrus fruits, cabbage, green peppers, spinach, mushrooms and total meat appeared to be protective. Stomach cancer risk was not associated with intake of rice, dairy product, fishes, condiments, coffee, tea, and the cooking methods. These data suggested that the high intake of salt and smoked or pickled food may be associated with a hig risk of stomach cancer, and this association could be due to a intragastric formation of nitrosamines. The negative association with fruits and some vegetable consumption may be due to the inhibition of nitrosation process. CONCLUSION: Our findings indicated that dietary factors contributed to stomach cancer occurrence in Korea, and this may offer clues for further ethnical and prevention research.
Subject(s)
Humans , Agaricales , Brassica , Capsicum , Case-Control Studies , Citrus , Coffee , Condiments , Cooking , Dairy Products , Diagnosis , Diet , Eating , Epidemiologic Studies , Fishes , Fruit , Garlic , Korea , Logistic Models , Meat , Nitrosamines , Nitrosation , Onions , Seoul , Smoke , Soy Foods , Spinacia oleracea , Starch , Stomach Neoplasms , Stomach , Tea , Vegetables , Surveys and QuestionnairesABSTRACT
BACKGROUND: Stomach cancer is the most malignant neoplasm among Koreans. There are some studies on risk factors for cancer prevention. SUBJECTS AND METHODS: A case-control study was conducted at the Korea Cancer Center Hospital in Seoul between April and September in 1996. One hundred twenty-six stomach cancer patients confirmed by the histological diagnosis were compared with 234 control subjects mached by age, sex, and admission date. The questionnaire included information on sociodemographic characteristics, smoking and drinking habits, height, weight, family history of cancer, nutrient supplements intake etc. Associations of stomach cancer with con-dietary factors were evaluated. Multiple logistic regression models were used to estimate relative risks when controlling simultaneously for covariates. RESULTS: Weight and body mass index(BMI, kg/m2) at diagnosis were significantly low in cases compared with controls. As non-dietary factors, smoking habits, alcoholic beverage, family gistory, physical activity, water supply, stress, vitamin suppliments and the use of functional foods were not associated with stomach cancer risk. CONCLUSION: Our findings indicated that non-dietary factors were not associated with stomach cancer risk.
Subject(s)
Humans , Alcoholic Beverages , Case-Control Studies , Diagnosis , Drinking , Functional Food , Korea , Logistic Models , Motor Activity , Risk Factors , Seoul , Smoke , Smoking , Stomach Neoplasms , Stomach , Vitamins , Water Supply , Surveys and QuestionnairesABSTRACT
PURPOSE: To assess MR findings of hydroxyapatite orbital implants and their usefulness for the evaluation of fibrovascular ingrowth. MATERIALS AND METHODS: MR images of 32 hydroxyapatite orbital implants were obtained six months after implantation surgery. We retrospectively analysed MR images for signal intensity and contrast enhancement in both central and peripheral zones of the implants. The degree of contrast enhancement in an implant was compared with that of the temporalis muscle on contrast enhanced fat suppressed T1 weighted images. RESULTS: On T1-weighted images, implants showed a higher signal intensity than that of the vitreous body in the opposite globe. All implants showed peripheral contrast enhancement, densely enhanced in 30 cases and faintly in two. Three implants showed dense central contrast enhancement, and in the remainder, enhancement was similar to that of gray matter. On T2 weighted images, bright signal intensity was noted in 29 implants, focally in 19 and diffusely in ten. In most cases, areas of peripheral iso- to low signal intensity on T2-weighted images corresponded well with the contrast-enhanced area on T1 weighted images. CONCLUSION: At six months ofter surgery, Gd-enhanced MR imaging was useful for the evaluation of fibrovascular ingrowth in hydroxyapatite orbital implants.
Subject(s)
Durapatite , Magnetic Resonance Imaging , Orbit , Orbital Implants , Retrospective Studies , Vitreous BodyABSTRACT
No abstract available.
ABSTRACT
No abstract available.