Clinical Features and Response to UDCA Treatment of Primary Biliary Cirrhosis / 이화의대지

OBJECTIVES: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease that may progress to end stage liver cirrhosis. Benefits of ursodeoxycholic acid (UDCA) treatment has been investigated through large clinical studies. However, most of the studies were done in western countries and recent increase in prevalence of this relatively uncommon chronic liver disease draws attention in Korea. As early UDCA treatment effectively prevent the grave consequences of PBC progression, early diagnosis and lifelong management with UDCA is important. This study was designed to investigate the clinical features of PBC and response rates of UDCA treatments in Ewha Womans University Medical Center. METHODS: Clinical data of PBC patients diagnosed between 2001 and 2014 at Ewha Womans University Medical Center were analyzed retrospectively. RESULTS: A total of 35 patients with mean follow-up duration of 42 months were enrolled. At the diagnosis, 72.7% of the patients were asymptomatic, 5.7% had decompensated liver cirrhosis. The mean serum alkaline phosphate (ALP) level was 2.65 times upper limit of normal. UDCA was prescribed in 91.4% of the patients (n=32), among which 77.4% exhibited biochemical responses defined as serum ALP less than 2 upper limit of normal at 6 months (Mayo criteria). CONCLUSION: Most PBC patients were asymptomatic at the time of diagnosis and the average biochemical responses rate to UDCA treatment were ranged from 60.0% to 78.9% according to various response criteria. To elucidate the clinical features and courses of Korean PBC patients in detail, larger scale investigations and longer clinical follow up studies are warranted.

Blood Stream Infections in Patients in the Burn Intensive Care Unit / 감염과화학요법

BACKGROUND: The study on bacteremia helps empirically select the proper antibiotics before the results of culture test about causative pathogen. The purpose of this study is to investigate causative pathogen in bloodstream infection, changing aspects based on elapsed time after burn, relationship with other sites and resistance of important causative pathogen against antibiotics through analysis on bacteria isolated from blood culture of patients hospitalized in burn intensive care unit (BICU). MATERIALS AND METHODS: A retrospective study was conducted targeting patients hospitalized in BICU from January 2007 to June 2011. Changes of causative pathogen in bloodstream infection based on elapsed time after injury were analyzed. We would like to examine the relationship between bloodstream infection and infection on other body parts by comparing results of cultures in burn wound site, sputum, urine and catheter tip. Antibiotics resistance patterns of Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus species, and Klebsiella pneumoniae were studied. RESULTS: A total of 2,337 burn patients were hospitalized in BICU for 54 months. Causative pathogen was cultured in blood cultures from 397 patients (17.0%). P. aeruginosa (169, 30.1%) was the most cultured and A. baumannii (107, 19.0%) and S. aureus (81, 14.4%) were followed. It was confirmed that the relative frequency of A. baumannii tended to get lower as the period got longer after injury, but the relative frequency of K. pneumoniae got higher as the period got longer after injury. With comparison without bacteremia, P. aeruginosa bacteremia showed high probability in which the same bacteria were cultured in wound site, sputum and cathether tip, and A. baumannii bacteremia and candida bacteremia had high probability in sputum, and urine and catheter tip, respectively. 95.9% of P. aeruginosa and 95.3% of A. baumannii showed the resistance against carbapenem. 96.3% of S. aureus was methicillin resistant and 36.2% of Enterococcus species were vancomycin resistant. 75.0% of K. pneumonia were extended-spectrum beta-lactamase (ESBL)-producing bacteria. CONCLUSIONS: Since the highly antibiotic resistant microorganisms were isolated from the patients hospitalized in BICU during early phase, the empirical selection of antibiotics targeting these pathogens should be considered before the results of microbiologic culture test. In addition, use of empirical antifungal agent after 1 week of injury can be considered for patients who have risk factor of fungal infection.

An intrathoracic malignant peripheral nerve sheath tumor in a neurofibromatosis type 1 patient / 대한내과학회지

A malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue tumor defined as any malignant tumor arising from or differentiating toward the cells of the peripheral nerve sheath. It is one of the malignant tumors associated with neurofibromatosis type 1 (von Recklinghausen's disease). They occur most commonly on the lower and upper extremities, trunk, head, and neck, while intrathoracic tumors are very rare. We report an intrathoracic MPNST in a 66-year-old female with neurofibromatosis type 1.

A case of bronchiolitis obliterans with bronchiectasis / 대한내과학회지

Bronchiolitis obliterans (BO) is a non-specific inflammatory injury that affects the small airways, resulting in progressive dyspnea and airflow limitation. The inflammatory process is characterized by granulation tissue filling the lumen of the terminal and respiratory bronchioles, extending into the distal air spaces. BO is usually described in association with bone marrow, heart-lung, or lung transplantation. Outside transplantation, it is rare. We report a 66-year-old female patient who presented with dyspnea that resulted in a diagnosis of BO with bronchiectasis.

The Spectrum of Various Intracranial Manifestations in Leukemic Patients: A Pictorial Review

The recent therapeutic advances for treating hematologic neoplasm have improved patients' survival, but these treatments have increased the frequency of neurologic complications and toxic effects. Most of the neurological features of leukemia are divided into three main categories: the primary effects of the disease, the treatment-related side effects and the infectious complications. The purpose of this pictorial assay is to document the radiologic abnormalities seen in the intracranial structures during and after the treatment of leukemia, and to aid in the clinical management of patients.

A Case of Pleural Lipoma Treated with Video-assisted Thoracic Surgery (VATS) / 결핵및호흡기질환

No abstract available.

Effect of the Antigenic Differences of Neuroblastoma on the Maturation and Immunoactivity in Dendritic Cells / 대한소아혈액종양학회지

PURPOSE: Most of neuroblastoma (NB) patients present with advanced disease, and the survival of patients with advanced stage disease remains poor, despite of aggressive therapy such as high dose chemotherapy and autologouse stem cell transplantation. It is necessary to control of minimal residual disease in NB patients in order to reduce relapse rate. Dendritic cells (DC) are crucial for induction of antitumor immunity. Recent studies suggest that tumors avoid immune surveillence by inhibiting DC function. We investigated the effect of NB cells about maturation and/or function of dendritic cells using peripheral blood monocytes as dendritic cell source. METHODS: DCs were generated in the presence of GM-CSF (granulocyte and marcrophage colony-stimulating factor) and IL (interleukin) -4 from peripheral blood of healthy donors. DCs were exposed to human some kinds of NB cells or NB lysate. And the maturation of DC was induced by adding TNF (tumor necrosis factor) -alpha, IL-1beta, IL-6 and prostaglandin E2 for 2 days. DCs were analyzed by flow cytometry and mixed lymphocyte reactions. RESULTS: DCs exposed to NB cells didn't upregulate the expression of CD83, HLA-DR, CD80 and CD86, and DCs exposed to NB lysate didn't upregulate the expression of CD83 and HLA-DR. DCs exposed to NB cells and NB lysate inhibited the proliferation of allogenic T cells in mixed lymphocyte reactions. CONCLUSION: NB cells induced impaired maturation and immune function of DCs. These findings have significant implications for DC-based immunotherapy in the treatment NB and suggested that it was necessary to develop a new method of priming antigen to dendritic cells at NB immunotherapy.

A Comparison of Clinical Efficacy of Weaning Method Between the Mode of Intermittent Mandatory Ventilation and Intermittent Mandatory Ventilation Plus Pressure Support / 결핵

BACKGROUND: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiratory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by ah endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object : The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation (IMV) in facilitating weaning process compared to IMV mode alone. METHOD: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant through the weaning period. For the patients who required mechanical ventilation for less than 72hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning retrial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. RESULTS: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. CONCLUSION: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm H2O did not induce significant physiologic changes during weaning process.

Phylogenetic Relationships and co-evolution Between Hantaan Virus and Rodent Host , Striped-field Mice ( Apodemus agrarius ) by Mitochondrial DNA Sequences

Hantaviruses, members of the family Bunyaviridae, are causative agents of hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Hantaan (HTN) virus, the etiologic agent of clinically severe HFRS in Far East Asia, Russia and the Balkans, was first isolated in 1976 from lung tissues of striped-field mice (Apodemus agrarius) captured in Songnae-ri, Kyungki-do, Korea. Mitochondrial DNA (mtDNA) in vertebrates evolve very rapidly, and hence it can provide a high resolution for distinguishing between closely related organism and species. To clarify the phylogenetic relationship of HTN viruses with their natural rodent host, a part of M segment of HTN virus and 424-nucleotide region of cytochrome b gene of mtDNA were amplified and sequenced from tissues of striped-field mice by reverse transcription-polymerase chain reaction (RT-PCR) and PCR, respectively. A 324-nucleotide region of G2 glycoprotein-encoding M segment of HTN virus was amplified from lung tissues of A. agrarius mice, revealed 84-86% sequence similarity with Apodemus-borne HTN virus strains from China. The co-speciation of Apodemus-borne hantaviruses with its natural reservoir rodents, A. agrarius and A. flavicollis, be found. A. agrarius rodent population from South Korea had almost same genetic background irrespective of their geographic origin. HTN virus strains from South Korea shared a common ancestry and were evolutionarily distinct from HTN viruses kom China. We have found no evidence for the presence of phylogenetic relationship of A. agrarius-borne Korean HTN virus strains with the genetic diversity of their rodent host captured in Korea based on cytochrome b gene of mtDNA.

Transbronchial Needle Aspiration in the Diagnosis of Submucosal and Peribronchial Bronchogenic Carcinoma / 결핵

Although exophytic endobronchial lesions can readily be diagnosed by routine forceps biopsy through the fiberoptic bronchoscope, submucosal or peribronchial tumor can be difficult to diagnose. So we evaluated the diagnostic utility of transbronchial needle aspiration (TBNA) through the fiberoptic bronchoscope in patients presenting with endoscopic abnormalities suggestive of submucosal or peribronchial tumor. PATIENTS AND METHODS: Retrospective review of 120 lung cancer patients who were found to have the lesions suggestive of peribronchial and submucosal tumor during fiberoptic bronchoscopy was performed from Jan. 1994 to Dec. 2002 at Severance Hospital, Yonsei University College of Medicine. METHODS: Forcep biopsy was positive in 63 cases (52.5%) and TBNA in 91 (75.8%), which was significantly better than forcep biopsy (p=0.001). The combination of forceps biopsy and TBNA was positive in 106 cases (88.3%), which was significantly better than forceps biopsy alone (p=0.0001). The difference of TBNA yield according to cell type or bronchoscopic appearance of lesion was not significant, but it showed the relatively better result in small cell carcinoma. CONCLUSIONS: We concluded that TBNA significantly increase the yield over forcep biopsy alone in the detection of submucosal or peribronchial bronchogenic carcinoma.

Comparison of Imposed Work of Breathing Between Pressure-Triggered and Flow-Triggered Ventilation During Mechanical Ventilation / 결핵

BACKGROUND: The level of imposed work of breathing (WOB) is important for patient-ventilator synchrony and during weaning from mechanical ventilation. Triggering methods and the sensitivity of demand system are important determining factors of the imposed WOB. Flow triggering method is available on several modem ventilator and is believed to impose less work to a patient-triggered breath than pressure triggering method. We intended to compare the level of imposed WOB on two different methods of triggering and also at different levels of sensitivities on each triggering method (0.7 L/min vs 2.0 L/min on flow triggering ; -1 cmH2O vs -2 cm H2O on pressure triggering). METHODS: The subjects were 12 patients (64.8α4.2 yrs) on mechanical ventilation and were stable in respiratory pattern on CPAP 3 cmH2O. Four different triggering sensitivities were applied at random order. For determination of imposed WOB, tracheal end pressure was measured through the monitoring lumen of Hi-Lo Jet tracheal tube (Mallincrodt, New York, USA) using pneumotachograph/pressure transducer (CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Other data of respiratory mechanics wert also obtained by CP-100 pulmonary monitor. RESULTS: The imposed WOB was decreased by 37.5% during 0.7 L/min on flow triggering compared to -2 cmH2O on pressure triggering and also decreased by 14% during -1 cmH2O compared to -2 cmH2O on pressure triggering (p<0.05 in each). The PTP(Pressure Time Product) was also decreased significantly during 0.7 L/min on flow triggering and -I cmH2O on pressure triggering compared to -2 cmH2O on pressure triggering(p<0.05 in each). The proportions of imposed WOB in total WOB were ranged from 37% to 85% and no significant changes among different methods and sensitivities. The physiologic WOB showed no significant changes among different triggering methods and sensitivities. CONCLUSION: To reduce the imposed WOB, flow triggering with sensitivity of 0.7 L/min would be better method than pressure triggering with sensitivity of -2 cm H2O.

Plasma Activity of Lysosomal Enzymes in Active Pulmonary Tuberculosis / 결핵

BACKGROUND: The confirmative diagnosis of pulmonary tuberculosis(Tb) can be made by the isolation of Mycobacterium Tuberculosis(MTb) in the culture of the sputum, respiratory secretions or tissues of the patients, but positive result could not always be obtained in pulmonary Tb cases. Although there are many indirect ways of the diagnosis of Tb, clinicians still experience the difficulty in the diagnosis of Tb because each method has its own limitation. Therefore development of a new diagnostic tool is clinically urgent. It was reported that silica cause some lysosomal enzymes to be released from macrophages in vitro and one of these enzymes is elevated in workers exposed to silica dust and in silicotic subjects. In pulmonary Tb, alveolar macrophages are known to be activated after ingestion of MTb. Activated macrophages can kill MTb through oxygen free radical species and digestive enzymes of lysosome. But if macrophages allow the bacilli to grow intracellularly, the macrophages will die finally and local lesion will enlarge. Then it is assumed that the lysosomal enzymes would be released from the dead macrophages. The goal of this investigation was to determine if there are differences in the plasma activities of lysosomal enzymes, beta-glucuronidase(GLU) and beta-N- acetyl glucosaminidase(NAG), among the groups of active and inactive pulmonary Tb and healthy control, and to see if there is any possibility that the plasma activity of GLU and NAG can be used as diagnostic indicies of active pulmonary Tb. METHODS: The plasma were obtained from 20 patients with bacteriologically proven active pulmonary Tb, 15 persons with inactive Tb and 20 normal controls. In 10 patients with active pulmonary Tb, serial samples after 2 months of anti-Tb medications were obtained. Plasma GLU and NAG activities were measured by the fluorometric methods using 4-methylumbelliferyl sub- strates. All data are expressed as the mean +/-the standard error of the mean. RESULTS: The activites of GLU and NAG in plasma of the patients with active Tb were 21.52 +/-3.01 and 325.4+/-23.37(nmol product/h/ ml of plasma), respectively. Those of inactive pulmonary Tb were 24.87+/-3.78, 362.36+/-33.92 and those of healthy control were 25.45 +/-4.05, 324.44+/-28.66 (nmol product/ h/ml of plasma), respectively. There were no significant differences in the plasma activities of both enzymes among 3 groups. The plasma activities of GLU at 2 months after anti-Tb medications were increased(42.18+/-5.94 nmol product/h/ ml of plasma) in the patients with active pulmonary Tb compared with that at the diagnosis of Tb(P-value <0.05). CONCLUSION: The results of the present investigation suggest that the measurement of the plasma activities of GLU and NAG in the patients with active pulmonary Tb could not be a useful method for the diagnosis of active Tb. Further investigation is necessary to define the reasons why the plasma activities of the GLU was increased in the patients with active pulmonary Tb after Tb therapy.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites / 감염과화학요법

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites / 감염과화학요법

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.

Immunogenicity and Safety of Recombinant Hepatitis B Vaccine(Engerix B) / 감염

BACKGROUND: Several studies on the efficacy and safety of the hepatitis B vaccine have shown variable immunogenicity. In this study we reexamined the immunogenicity and safety of recombinant hepatitis B vaccine, Engerix B which have currently been administered to the children in Korea. METHODS: Serum samples were collected from 126 children and 111 adults who were immunized according to the 0, 1, 2-month and 0, 1, 6-month vaccination schedule. Anti-HBs antibody titers were measured by ELISA in sera obtained after each immunization, and compared by immunization schedules. RESULTS: In 62 children with 0, 1, 2-month immunization schedule seroconversion rate was 83.9% after 1st vaccination, 96.8% after 2nd, and 98.4% after 3rd. In 64 children with 0, 1, 6-month immunization schedule seroconversion rates was 78.1% after 1st vaccination, 87.5% after 2nd and 100% after 3rd. In 50 adults immunized with 0, 1, 2-month schedule seroconversionrates was 48.0% after 1st vaccination, 74.0% after 2nd and 90.0% after 3rd. In 61 adults immunized with 0, 1, 6-month schedule seroconversion rate was 44.3% after 1st vaccination, 65.6% after 2nd and 93.4% after 3rd. Seroconversion rate after 0, 1, 2- month vaccination schedule were 98.4% in children and 90.0% in adults. Seroconversion rate after 0, 1, 6-month schedule were 100% in children and 93.4% in adults. There were no significant local and systemic untoward reactions among vaccinees. CONCLUSION: The recombinant Engerix B is excellent in immunogenicity with 93.4% and 100% seroconversion rates in adults and children, respectively. There is no significant difference in seroconversion rate between two vaccination schedule. The vaccine is safe.

A case report of anti-neutrophil cytoplasmin autoantibody positive polyarteritis nodosa / 대한내과학회지

No abstract available.

A Case of Anaphylaxis Induced by Rifampin / 대한내과학회지

Rifampin, when given in usual doses, is well tolerated with less than 4% of patients having significant adverse reactions. The patient had did not have any adverse reaction to rifampin in the first place. After 10 years, however, the patient was presented with hypotension, shortness of breath, wheezing and deterioration of consciousness in 10 minutes after taking rifampin. All abnormal symptoms and signs of anaphylaxis were normalized in 24 hours after administration of normal saline, glucocorticosteroid, and antihistamine. Skin prick test with rifampin showed positive reaction to gradual concentration of rifampin in dose dependent manner. The wheals by rifampin developed in 30 minutes and maximized in 2 hours, while normal saline and histamine controls showed expected negative and positive response in 10 minutes, respectively. Recently we expererienced a rare case of anaphylaxis after single oral administration of rifampin (450mg), who had been treated with antituberculous drug including rifampin, ca 10 years ago.

The Usefulness of Quantitative Culture of Bronchoalveolar Lavage Fluid in the Diagnosis of Bacterial Pneumonia / 대한내과학회지

BACKGROUND: The aim of this study is to evaluate the usefulness of quantitative culture of bronchoalveolar lavage(BAL) fluid for the diagnosis of bacterial pneumonia and identification of causative agents. METHODS: Study group consisted of 30 episodes in 28 patients, enrolled from January 1995 through June 1996. Inclusion criteria were 1) presence of respiratory symptoms such as cough, sputum or dyspnea 2) increased peripheral blood leukocyte count(> or =11,000/mm3) 3) Fever(> or =38.3 degrees C) 4) purulent sputum 5) new or progressive infiltrate on chest radiography. For the diagnosis of pneumonia and its causative agents, sputum smear and culture, blood culture and BAL fluid studies were performed. BAL fluid studies included differential count of white blood cell, BAL fluid smear and culture, detection of elastin fibers and presence of intracellular organisms(ICO). Quantitative culture of BAL fluid was considered positive if colony-forming units was more than 1.0 x 104/ml. Positive criteria for ICO was presence of microorganism in more than five per 100 of phagocytes. RESULT: Recruited were 22 males and 6 females. The mean age was 57.5+/-13.5 years(range 25-84). Of 30 episodes underwent BAL fluid studies, 19 cases were diagnosed to be bacterial pneumonia. S. aureus(7 cases) was the most common causative agent and was followed by P. aeruginosa(4), E. cloacae(2), A. baumanii(1), H. influenzae(1) and -hemolytic Streptococcus(1). Sensitivity of quantitative culture of BAL fluid for the diagnosis of bacterial pneumonia was 68.4% and its specificity was 63.6%. Elastin fibers were detected in 5 cases(31%) and ICO over 5% in 3 cases(15.7%). When criteria of quantitative culture of BAL fluid, detection of ICO and elastin fibers were applied together, diagnostic rate of pneumonia was 84.2%(16/19). CONCLUSON: Quantitative culture of BAL fluid was more sensive and specific compared to sputum and blood culture for the diagnosis of bacterial pneumonia. It was suggested that detection of ICO and elastic fibers in BAL fluid could raise the diagnostic rate of bacterial pneumonia.

Use of Protected Specimen Brush for the Diagnosis of Pulmonary Infection / 대한내과학회지

OBJECTIVES: Culture of sputum is apt to be contaminated through oral cavity and proximal airway. Therefore, identification of true etiologic agents by sputum culture is not always reliable. In order to differentiate the pulmonary infection from non-infectious disease and to identify the true etiologic agent of acute pulmonary infection, we used PSB(Protected Specimen Brushing) and evaluated the efficacy of PSB. METHODS: In 168 patients with acute febrile illness with pulmonary infiltrations(male 106, female: 61, mean age: 49.5+/-17.6), we performed PSB via a bronchoscope and compared the results along with blood culture and sputum culture. Protected specimen brush was introduced through biopsy channel of bronchoscope and was rotated within the purulent secretions. Tip of the brush was severed with aseptic technique and was immersed in 1cc of Ringer's lactate solution and vigorously mixed for 1 minute. The specimen was submitted for quantitative culture within 15 minutes and was regarded positive culture if colony forming units were above 10(3)/ml. RESULTS: Using PSB for the diagnosis of pulmonary infection, sensitivity was 71.1% and specificity was 84.296. PSB was helpful in identifing true etiologic agent among several potentially pathogenic organisms. Using PSB for the diagnosis of UAP (ventilator associated pneumonia), sensitivity was 72.4% and specificity was 100%. CONCLUSION: Use of PSB can be a helpful method for the diagnosis of pulmonary infection and identification of its etiologic agents.

The effect of trypsin and chymotrypsinon the chemotaxis and activation of eosinophil / 결핵

BACKGROUND: Eosinophilic leukocytes are prominent cellular participants in the pathogenesis of allergic disease and asthma. Chemotaxis is still a very useful method in evaluating the response of human eosinophil to novel modulators. Degranulated mast cells and activated T lymphocytes are responsible for the pathophysiology of asthma and tryptase is one of most important proteases released after activation of mast cells. The purpose of this study was to investigate the actions of trypsin and chymotrypsin on eosinophils in terms of chemotaxis and activation. METHOD: Eosinophils were isolated by negative immunoselection from the peripheral blood of atopic donors. Chemotaxis was studied by using micro-Boyden chambers and ECP release was assayed by fluoroimmunoassay. RESULTS: Eosinophil showed a chemotactic response to trypsin. Maximal chemotactic response was with 1000microg/ml trypsin (56.52 +/- 14.50/HPF) which was comparable to PAF. But chymotrypsin showed no significant chemotactic response to eosinophils. Trypsin at the concentration of 10, 100,1000microg/ml induced secretion of ECP, which at the concentration of 10microg/ml represented about 2.7 times of the spontaneous rate of release. Soybean protease inhibitor reduced trypsin induced ECP release. CONCLUSION: Trypsin can induce chemotactic response to eosinophils and activation of eosinophils that can induce secretion of ECP. On the contrary, chymotrypsin showed no direct effect on eosinophils. We propose a role of trypsin on the chemotaxis and activation of eosinophils.