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The Nagoya Protocol on access to genetic resources and fair and equitable sharing of benefits arising from their utilization in the convention on biological diversity entered into force on October 12, 2014. Accordingly, attention toward securing the sovereignty and discovering the utilization value of biological resources has been increasing to secure national competitiveness. We are developing a freshwater biodiversity information platform for the systematic conservation and industrialization of freshwater biodiversity in South Korea. The platform comprises an integrated management system of freshwater bioresources for systematic registration and management of freshwater biodiversity information based on databases; a management system of storage for managing freshwater biological specimen; a utilization information system that manages efficacy, experimental method, and activity produced by the Nakdonggang National Institute of Biological Resources and external big data such as literature and patent; and a freshwater bioresources culture collection for preservation, ordering and deposition of biological resources. These systems are connected organically. Text mining, one of the big data technologies, helps to determine the utility of biological resources through comprehensive analysis. We tried to establish utilization foundations by predicting the usability of biological resources through systematic collection, processing, and analyzing external data, such as abstract, in order to support industrialization of national freshwater bioresources. Through text mining, we constructed a literature-based corpus and preprocessed the corpus with lowercase conversion and removal of stop word. Then, a word cloud was created and statistical analysis was performed. As a result, genes and diseases associated with specific biological resources have been identified. In this study, through a comprehensive analysis of species, genes, and disease information using text mining, we were able to determine the utilization value of biological resources. This study will help the freshwater biodiversity researchers by adding a function for utilization analysis in the utilization information system of the platform in the future.

The role of disseminated intravascular coagulation (DIC) has not been extensively studied in patients with sepsis. A prospective study was performed in a single university hospital. The incidences of DIC at day 1 (

BACKGROUND: We evaluated the clinical characteristics and factors associated with mortality in very elderly patients ≥ 90 y of age admitted to the ICU. METHODS: We evaluated age-specific rates of admission and mortality in 16,935 subjects ≥ 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects ≥ 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward. RESULTS: The mortality rate of ICU subjects ≥ 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose ( P = .006), poor nutrition ( P = .001), high Simplified Acute Physiology Scoring II scores ( P < .001), DNR order ( P = .002), and vasopressor treatment ( P = .03) were independent predictive factors of mortality in subjects ≥ 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died. CONCLUSIONS: The very elderly subjects (≥ 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.

Purpose A recent study demonstrated that exertional desaturation is a predictor of rapid decline in lung function in patients with chronic obstructive pulmonary disease (COPD); however, the study was limited by its method used to detect exertional desaturation. The main purpose of this study was to explore whether exertional desaturation assessed using nadir oxygen saturation (SpO2) during the 6-minute walk test (6MWT) can predict rapid lung function decline in patients with COPD. Materials and Methods A retrospective analysis was performed on 57 patients with moderate to very severe COPD who underwent the 6MWT. Exertional desaturation was defined as a nadir SpO2 of

Horseshoe crabs (order Xiphosura) are often referred to as an ancient order of marine chelicerates and have been considered as keystone taxa for the understanding of chelicerate evolution. However, the mitochondrial genome of this order is only available from a single species, Limulus polyphemus. In the present study, we analyzed the complete mitochondrial genomes from two Asian horseshoe crabs, Carcinoscorpius rotundicauda and Tachypleus tridentatus to offer novel data for the evolutionary relationship within Xiphosura and their position in the chelicerate phylogeny. The mitochondrial genomes of C. rotundicauda (15,033 bp) and T. tridentatus (15,006 bp) encode 13 protein-coding genes, two ribosomal RNA (rRNA) genes, and 22 transfer RNA (tRNA) genes. Overall sequences and genome structure of two Asian species were highly similar to that of Limulus polyphemus, though clear differences among three were found in the stem-loop structure of the putative control region. In the phylogenetic analysis with complete mitochondrial genomes of 43 chelicerate species, C. rotundicauda and T. tridentatus were recovered as a monophyly, while L. polyphemus solely formed an independent clade. Xiphosuran species were placed at the basal root of the tree, and major other chelicerate taxa were clustered in a single monophyly, clearly confirming that horseshoe crabs composed an ancestral taxon among chelicerates. By contrast, the phylogenetic tree without the information of Asian horseshoe crabs did not support monophyletic clustering of other chelicerates. In conclusion, our analyses may provide more robust and reliable perspective on the study of evolutionary history for chelicerates than earlier analyses with a single Atlantic species.

Background Although platinum-based doublet chemotherapy is considered as standard of care for patients with advanced non-small cell lung cancer (NSCLC), most of them are eventually supposed to experience disease progression. Pemetrexed, docetaxel, erlotinib, and gefitinib have been shown to be active as monotherapy for pretreated patients. In this study, the efficacy of pemetrexed and carboplatin as a salvage therapy for patients with advanced NSCLC is evaluated. Patients and methods From March 2007 to February 2009, 32 patients who were diagnosed with inoperable NSCLC and treated with one or more prior cisplatin-based chemotherapies were enrolled. Treatment consisted of pemetrexed 500mg/m 2 over a 10-min intravenous infusion and carboplatin at an AUC 5mg/mL/min over a 30-min intravenous infusion on Day 1 of a 21-day cycle. All patients were supplemented with folic acid and vitamin B12 to reduce the hematological toxicity of pemetrexed. Results There were one (3.1%) complete response and five partial (15.6%) responses. The overall response rate was 18.8% and the median response duration was 4.4 months. Among the responders, four patients had adenocarcinoma and two had squamous cell carcinoma. Nine patients had stable disease, and the disease control rate was 46.9%. With a median follow up duration of 9.4 months, the median time to progression was 2.3 months and the median OS was 9.4 months. Seven patients (21.9%) experienced grade 3 and 4 hematologic toxicities; one anemia (3.1%), six neutropenia (18.8%), and six thrombocytopenia (18.8%). Two patients experienced grade 4 febrile neutropenia with infection. Four patients (12.5%) experienced grade 3 non-hematologic toxicities; four asthenia (12.5%), two anorexia (6.3%), and one stomatitis (3.1%). Grade 1–2 peripheral neuropathy developed in 13 patients (40.6%). Conclusion The combination of pemetrexed and carboplatin showed favorable toxicity profiles and activity in the pretreated patients with advanced NSCLC. It is suggested that this regimen can be a good chemotherapeutic option as a salvage therapy for patients with NSCLC.

Since the Nagoya Protocol on Access to genetic resources and Benefit Sharing (ABS) came into force in 2014, the conservation and assurance of national biodiversity has been internationally stressed. The Government of South Korea is exercising significant efforts to integrate and manage the information pertaining to biological resources in line with this global trend. However, connecting and sharing biodiversity data has certain challenges because the existing databases and information systems are being operated using different standards. In the present study, we established an integrated management system for freshwater biodiversity information, the Freshwater Biodiversity Platform (FBP), to support the conservation and sustainable use of biodiversity. This platform allows the management of various types of biodiversity data, such as occurrences, habitats and genetics, for freshwater species inhabiting South Korea. The data fields are based on a global biodiversity data standard, Darwin Core, and national biodiversity standards of South Korea in order to share our data more efficiently, both nationally and internationally. It is important to note that the platform deals with information related to the utilization of biological resources as well as information representing the national biodiversity. We have collected bibliographical data, such as papers and patents, from databases, including information on the use of biological resources. The data have been refined by applying a national species list of South Korea and ontology terms in (MeSH) to compile valuable information for biological industries. Furthermore, our platform is open source and is compatible with multiple language packs to facilitate the availability of biodiversity data for other countries and institutions. Currently, the Freshwater Biodiversity Platform is being used to collect and standardize various types of existing freshwater biodiversity data to build foundations for data management. Based on these data, we will improve the platform by adding new systems that can analyze and release data for public access. This platform will provide integrated information on freshwater species from the Korean Peninsula to the world and contribute to the conservation and sustainable use of biological resources.

Background Acute pulmonary thromboembolism (APTE) remains an important cause of morbidity and mortality in Western countries. In Korea, both the incidence and the mortality rate of APTE were thought to be low compared to Western countries. We performed the present study to investigate the current status of APTE in Korea. Methods Eight hundred and eight registry patients with APTE were analyzed with respect to clinical symptoms and signs, the presence of underlying diseases or predisposing factors, diagnostic methods, treatment and clinical course. Results The most common risk factors were prolonged immobilization (22.9%), deep venous thrombosis (22.0%), a recent operation (19.2%), and cancer (15.8%). The most common symptoms were dyspnea (78.6%), and chest pain (26.9%). The most common abnormality on chest radiography was effusion. The overall mortality rate at 3 months was 11.0%. Multivariate logistic regression analysis demonstrated that increased mortality risk was independently associated with the following baseline factors: onset in hospital (OR 1.88; 95% CI 1.03–3.42; p =0.03), lung cancer (OR 9.20; 95% CI 1.96–43.27; p =0.005), tachycardia (OR 3.50; 95% CI 1.86–6.60; p =0.0001), cardiogenic shock (OR 6.74; 95% CI 2.73–16.64; p =0.0001), and cyanosis (OR 3.45; 95% CI 1.27–9.44; p =0.01). Conclusions Some differences did exist for the risk factors, symptoms, chest X-ray findings, mortality rate and prognostic factors as compared with those for Western patients. These results can prove especially helpful in the diagnosis as well as for the treatment of patients with APTE.

Background Early detection of drug-resistant Mycobacterium tuberculosis is important for the control and prevention of disease transmission. However, conventional drug susceptibility tests for drug-resistant M tuberculosis take at least 3 to 8 weeks. Here, we report the clinical efficacy of direct DNA sequencing analysis for detecting drug-resistant TB on sputum specimens in a clinical setting. Methods A total of 113 sputum specimens from 111 patients, who were suspected of having drug-resistant TB by clinicians, were used for DNA sequencing of katG, rpoB, embB , and pncA genes for isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) resistance, respectively, and the results were compared with drug susceptibility tests. The optimization of antituberculosis drugs according to the results of DNA sequencing and the treatment outcomes of the patients were also analyzed. Results Turnaround time of the direct DNA sequencing analysis was 3.8 ± 1.8 days. We found mutations related to drug resistance in 30 clinical specimens for katG , 39 for rpoB , 13 for embB , and 24 for pncA . The sensitivity and specificity of the assay were 63.6% and 94.6% for INH, 96.2 and 93.9% for RIF, 69.2% and 97.5% for EMB, and 100% and 92.6% for PZA, respectively. Of the patients with RIF resistance, including multidrug-resistant TB by the assay, 92.5% of the patients with initial first-line antituberculosis drugs were changed to second-line antituberculosis drugs, and treatment was successful in 61.9% of these cases. Conclusion Direct DNA sequencing analysis of clinical sputum specimens is a rapid and useful method for the detection and treatment of drug-resistant TB.

Purpose: Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. However, its relationships are not always consistent. Gender difference has been reported to influence asthma severity and asthma control. We investigated the contribution of obesity to airway hyperresponsiveness (AHR) and lung function before and after treatment in adult asthmatics. Methods: The medical records of a total of 323 adult asthmatics were analyzed retrospectively. Asthma was diagnosed based on the positive result of methacholine bronchial provocation test (PC20≤25 mg/mL) or bronchodilator test (≥12% and 200-mL improvement in forced expiratory volume in 1 second after inhalation of a bronchodilator). Follow-up spirometry was performed in 113 patients after at least 3 months of asthma treatment with controller medication. Percent change between spirometry before and after treatment was defined as {[(value after treatment.value before treatment)/value before treatment]×100}. Body mass index (BMI, weight [kg]/height [m2]) was categorized into underweight ( 30) according to the world health organization classification. Results: BMI did not show any significant correlation with PC20 value of methacholine provocation test and each lung function parameter before and after treatment. When we divided the study subjects according to gender and age, BMI was negatively correlated with PC20 value only in female adult asthmatics under 65 years old (r=.0.024, P=0.036). Conclusion: Obesity is positively correlated with the intensity of AHR in female adult asthmatics. Gender seems to differentially contribute to the relationship between BMI and AHR. (Allergy Asthma Respir Dis 2014;2:16-22)

이 증례는 만성 호흡부전으로 기관절개 상태로 가정에서 인공환기기 유지 중인 환자에서 기관벽 약화와 기관식도루를 진단한 경우이다. 의학의 발전으로 가정에서 인공환기기를 유지하는 환자가 늘고 있다. 이러한 환자에서 호흡곤란이 발생하였을 때 기저질환 악화나 폐렴 등의 발생 외에도 기관절개관의 합병증도 고려되어야 하며 평소에 가정에서 인공환기기의 사용법뿐만 아니라 기관절개관과 경비위관의 관리도 철저한 주의가 필요하겠다.

Thymoma is a rare neoplasm associated with a number of autoimmune disorders and tumors. Organizing pneumonia is a reaction of the lung to various injuries. A feature of organizing pneumonia is plugs of granulation tissue within the lumens of small airways, or alveoli. Causes of organizing pneumonia include various disorders and conditions; however, thymoma with organizing pneumonia located in both lungs is very rare. We report a case of resolving organizing pneumonia after thymoma resection. Our case is the first to demonstrate that resolving organizing pneumonia can occur after thymoma resection, as has been speculated by many researchers. (Korean J Med 2013;85:92-95)

Background Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

Purpose: A new spirometric reference equation was recently developed from the first national chronic obstructive pulmonary disease (COPD) survey in Korea. How ever, Morris’ equation has been preferred for evaluating spirometric values instead. The objective of this study was to evaluate changes in severity staging in Korean COPD patients by adopting the newly developed Korean equation. Materials and Methods: We evaluated the spirometric data of 441 COPD patients. The presence of airflow limitation was defined as an observed post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) less than 0.7, and the severity of airflow limitation was assessed according to GOLD stages. Spirometric values were reassessed using the new Korean equation, Morris’ equation and other reference equations. Results: The severity of airflow limitation was differently graded in 143 (32.4%) patients after application of the new Korean equation when compared with Morris’ equation. All 143 patients were reallocated into more severe stages (49 at mild stage, 65 at moderate stage, and 29 at severe stage were changed to moderate, severe and very severe stages, respectively). Stages according to other reference equations were changed in 18.6-49.4% of the patients. Conclusion: These results indicate that equations from different ethnic groups do not sufficiently reflect the air flow limitation of Korean COPD patients. The Korean reference equation should be used for Korean COPD patients in order to administer proper treatment.

Background: Persistent cough has recently been found to be associated with Chlamydia pneumoniae infection. We aimed to investigate the infection rate of C. pneumonia in adult patients with chronic cough. Methods: We recruited 68 patients with persistent cough lasting in excess of 3 weeks, who visited Kangdong Sacred Heart Hospital from January 2005 to August 2005. On the first visit, chest and paranasal sinuses radiography, skin prick test of common allergens, and induced sputum samples for C. pneumoniae were performed in all of patients. Further evaluation for diagnosis included a methacholine provocation test and eosinophil counts in induced sputum. Results: The most common cause of chronic cough was upper airway cough syndrome (UACS) (26.5%), followed by eosinophilic bronchitis (20.6%) and cough variant asthma (16.2%). Idiopathic chronic cough was the cause in 33.8% of patients. The mean duration of cough was 11.7 months. C. pneumoniae was isolated by polymerase chain reaction (PCR) from one patient who had upper respiratory air way syndrome. Conclusion: Chlamydia pneumoniae appears to have a minor role as a cause of chronic cough in patients.

The Global Initiative of Chronic Obstructive Lung Disease (GOLD) guidelines define chronic obstructive pulmonary disease (COPD) in subjects with FEV(1)/FVC0.7. However, the use of this fixed ratio may result in over-diagnosis of COPD in the elderly, especially with mild degree of COPD. The lower limit of normal (LLN) can be used to minimize the potential misclassification. The aim of this study was to evaluate the impact of different definitions of airflow obstruction (LLN or fixed ratio of FEV(1)/FVC) on the estimated prevalence of COPD in a population-based sample. We compared the prevalence of COPD and its difference diagnosed by different methods using either fixed ratio (FEV(1)/FVC0.7) or LLN criterion (FEV(1)/FVC below LLN). Among the 4,816 subjects who had performed spirometry, 2,728 subjects met new ATS/ERS spirometry criteria for acceptability and repeatability. The prevalence of COPD was 10.9% (14.7% in men, 7.2% in women) by LLN criterion and 15.5% (21.8% in men, 9.1% in women) by fixed ratio of FEV(1)/FVC among subjects older than 45 yr. The difference of prevalence between LLN and fixed ratio of FEV(1)/FVC was even higher among subjects with age/=65, 14.9% and 31.1%, respectively. In conclusion, the prevalence of COPD by LLN criterion was significantly lower in elderly compared to fixed ratio of FEV(1)/FVC. Implementing LLN criterion instead of fixed ratio of FEV(1)/FVC may reduce the risk of over-diagnosis of COPD in elderly people.

Background: Solitary pulmonary nodules (SPN) are encountered incidentally in 0.2% of patients who undergo chest X-ray or chest CT. Although SPN has malignant potential, it cannot be treated surgically by biopsy in all patients. The first stage is to determine if patients with SPN require periodic observation and biopsy or resection. An important early step in the management of patients with SPN is to estimate the clinical pretest probability of a malignancy. In every patient with SPN, it is recommended that clinicians estimate the pretest probability of a malignancy either qualitatively using clinical judgment or quantitatively using a validated model. This study examined whether Bayesian analysis or multiple logistic regression analysis is more predictive of the probability of a malignancy in SPN. Methods: From January 2005 to December 2008, this study enrolled 63 participants with SPN at the Kangnam Sacred Hospital. The accuracy of Bayesian analysis and Bayesian analysis with a FDG-PET scan, and Multiple logistic regression analysis was compared retrospectively. The accurate probability of a malignancy in a patient was compared by taking the chest CT and pathology of SPN patients with ＜30 mm at CXR incidentally. Results: From those participated in study, 27 people (42.9%) were classified as having a malignancy, and 36 people were benign. The result of the malignant estimation by Bayesian analysis was 0.779 (95% confidence interval [CI], 0.657 to 0.874). Using Multiple logistic regression analysis, the result was 0.684 (95% CI, 0.555 to 0.796). This suggests that Bayesian analysis provides a more accurate examination than multiple logistic regression analysis. Conclusion: Bayesian analysis is better than multiple logistic regression analysis in predicting the probability of a malignancy in solitary pulmonary nodules but the difference was not statistically significant.

basis. Bronchoalveolar lavage (BAL) fluid for the purpose of quantitative cultures (≥10 4 cfu/mL) was obtained from all patients. Serum procalcitonin levels determined by PCT -Q kit were measured on BAL day and classified as follows; ＜0.5 ng/mL, 0.5∼2.0 ng/mL, 2.0∼ 10.0 ng/mL and ＞10.0 ng/mL. We analyzed the patient’s characteristics according to outcome; favorable or unfavorable, defined as death. Results: Patients from the following categories were included: medical 17 (47.2%), surgical 9 (25%), and burned 10 (27.8%). APACHE II scores on admission to intensive care unit were 11.5±6.89 and 11 (30.6%) had unfavorable outcomes. A procalcitonin level ≥0.5 ng/mL was in 17 (47.2%) of all. On univariate analysis, the frequencies of burn injury, mechanical ventilation, multiple organ failure, and a procalcitonin level ≥0.5 ng/mL were more often increased in patients with unfavorable outcomes than in those with favorable outcomes (p＜.05). Also, a higher procalcitonin range and ventilator-associated pneumonia (VAP) were more closely associated with an unfavorable outcome (p＜.05). However in multivariate analysis, a strong predictor of unfavorable outcome was burn injury (p＜.05). A procalcitonin level ≥0.5 ng/mL was more sensitive in predicting VAP than unfavorable outcome. Conclusion: A higher procalcitonin level seems to be associated with VAP, but further study is required to know that procalcitonin would be a prognostic marker in critically ill patients with respiratory infections.

Background: There are various etiologies causing bronchiectasis, but the cases without definite causes account for a quite high proportion. It is also uncertain that immunoglobulin G subclass deficiency (IgGSD) is associated with bronchiectasis. Therefore, we tried to measure the frequency of IgGSD in patients with bronchiectasis of unclear etiology, and to observe the clinical features of those patients with bronchiectasis and IgGSD. Methods: For the outpatients of a university hospital who were diagnosed as bronchiectasis by chest CT, we produced comprehensive history taking and physical examinations, and finally selected 31 patients with bronchiectasis of unclear etiology. Results: Two patients had total immunoglobulin G deficiency. The frequency of IgGSD was comparatively high (n=14). When we compared IgGSD group to normal immunoglobulin G subclass group, there were no significant differences in sex, age, and the frequency of sinusitis, bronchial asthma, and the abnormal lung function. Conclusion: In cases of bronchiectasis without definite causes, it can be considered to measure the level of immunoglobulin G subclass. It is also probably worthwhile to further evaluate the relationship between IgGSD and bronchiectasis.

Spontaneous regression is extremely rare in lung cancer and this in spite of its global high incidence. So far, less than 30 such cases have been reported in the literature. We report here on the case of a 68-year-old man who had the diagnosis of adenocarcinoma and in absence of any medical therapy, he had a partial spontaneous regression of tumor.

□ 이달의 X선 □Tracheostomy is one of the oldest surgical procedures in medica l history. The indications for a tracheostomy include the relief of an upper airway obstruction, long-term mechanical ventilation, and decreased airway resistance to help wean the patient from mechanical ventilator support. Unfortunately, tracheostomy is also associated with a number of problems including, bleeding, infection, pneumothorax, and trac heal stenosis. A pneumothorax is an uncommon complication of a tracheostomy, and can result from direct inju ry to the pleura or positive pressure ventilation through a dislocation of the tracheostomy tube. We report an uncommon c ase of a tracheostomy-induced bilateral tension pneumothorax with a review of the literature. (Tuberc Respir Dis 2007; 62: 437-440)Key word: Tracheostomy, Tension pneumothorax.Address for Correspondence: Sang Myeon Park, M.DDivision of Pulmonology Kangnam Sacred Heart Hospital, Hallym University 948-1, Daelim-1 dong, Youngdungpo-gu, Seoul, 150-950, KoreaPhone: 82-2-829-5118, Fax: 82-2-846-4669E-mail: thoraxmd@hallym.or.krReceived: Mar. 26. 2007Accepted: May. 4. 2007

The patient is a 62-year-old man with known diabetes mellitus who presented with a two-weeks-history of dyspnea, cough, and fever. He was diagnosed with a lung abscess in the right upper lobe and was treated with intravenous antibiotics. The patient's clinical and radiological findings improved within seven days after medical treatment. However, newly developed ground-glass opacity and infiltrations were obs erved in the right lower lung. Fourteen days after admission, the patient's symptoms and imaging finding became aggravated despite trestment with susceptible antibiotics for lung abscess. Trans-bronchial lung biopsy (TBLB) was performed in the lateral basal segment of the right lower lobe of the lung. A histologic photomicrograph showed organizing pneumonia, also called bronchiolitis obliterans with organizing pneumonia(BOOP), that became more definite as the terminal bronchioles and alveoli became occluded with masses of inflammatory cells and fibrotic tissue. The clinical symptoms and radiograph findings resolved quickly with prednisone treatment. We report a case of secondary organizing pneumonia diagnosed after TBLB following lung abscess treatment and provide a review of the literature. (Tuberc Respir Dis 2007; 62: 540-544)

Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial ratio and COHb were and . Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

Background : The Sequential Organ Failure Assessment (SOFA) score can help to assess organ failure over time and is useful to evaluate morbidity. The aim of this study is to evaluate the performance of SOFA score as a descriptor of multiple organ failure in critically ill patients in a local unit hospital, and to compare with APACHE III scoring system. Methods : This study was carried out prospectively. A total of ninety one patients were included who admitted to the medical intensive care unit (ICU) in Chuncheon Sacred Heart Hospital from May 1 through June 30, 2000. We excluded patients with a length of stay in the ICU less than 2 days following scheduled procedure, admissions for ECG monitoring, other department and patients transferred to other hospital. The SOFA score and APACHE III score were calculated on admission and then consecutively every 24 hours until ICU discharge. Results : The ICU mortality rate was 20%. The non-survivors had a higher SOFA score within 24 hours after admission. The number of organ failure was associated with increased mortality. The evaluation of a subgroup of 74 patients who stayed in the ICU for at least 48 hours showed that survivors and non-survivors followed a different course. In this subgroup, the total SOFA score increased in 81% of the non-survivors but in only 21% of the survivors. Conversely, the total SOFA score decreased in 48% of the survivors compared with 6% of the non-survivors. The non-survivors also had a higher APACHE III score within 24 hours and there was a correlation between SOFA score and APACHE III score. Conclusion : The SOFA score is a simple, but effective method to assess organ failure and to predict mortality in critically ill patients. Regular and repeated scoring enables patient's condition and clinical course to be monitored and better understood. The SOFA score well correlates with APACHE III score. (Tuberc Respir Dis 2004; 57:329-335)

Background : Recurrent pneumonia in adults is not uncommon. However, there is no domestic data about recurrent pneumonia in adults. Therefore, we investigated the associated diseases and clinical findings of recurrent pneumonia in adults. Methods : Among 5513 patients who were treated in five teaching hospitals of Hallym medical center?over a 5-year period, we retrospectively reviewed the medical records of the 58 who were compatible with diagnostic criteria of recurrent pneumonia. Results : The number of patients with recurrent pneumonia was 58 (1.05%, 58/5513) during the 5 years. Thirtyseven patients were male and 21 were female. Mean age was 66.4 (±14.9) years. Median interval between each pneumonic episode was 18.5 months. Associated diseases were 25 cases of respiratory diseases, 13 of heart diseases, 13 of diabetes mellitus, 7 of lung malignancies, 11 of malignan cies other than lung, 7 of neurologic disease, and 8 of miscellaneous diseases. Three cases had no underlying illness. Of the 8 cases with 2 or more times of recurrence, 4 were associated with respiratory diseases, 2 with aspiration pneumonia due to neurologic diseases, 1 with heart disease and 1 with no underlying illness. Recurrent pneumonic episodes affecting the same location were 30 of the total recurrent pneumonic episodes (30/67, 47.8%) and common associated diseases were respiratory diseases including lung malignancies. The etiology of recurrent pneumonia was Streptococcus pneumoniae, methicillinresistant Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, atypical organisms, etc. Conclusion : Recurrent pneumonia in adults had a low incidence rate compared with children, but most cases had associated illness. Respiratory diseases including lung cancer were the most common associated illness of recurrent pneumonia. (Tuberc Respir Dis 2004; 57:47-54)

Background: Diffuse panbronchiolitis(DPB) is a chronic inflammatory lung disease that presents as coughing, copious sputum, exertional dyspnea, which progresses to bronchiectasis. The pathogenesis of bronchiectasis is controlled by inflammatory mediators, which are closely related to mucus hypersecretion, goblet cell dysplasia. In recent studies, the epidermal growth factor receptor(EGFR) system was reported to be associated with this process. It was hypothesized that a relationship exists between goblet cell dysplasia, EGFR expression, and inflammatory mediators produced by neutrophil. Method: Alcian blue/periodic acid -Schiff(AB/PAS) stain, MUC5AC, EGFR, CD16 immunohistochemical stain were examined to investigate a role for the EGFR system in a mucus hypersecretion in DPB using the lung biopsy specimens from 13 DPB patients and 6 controls. Results : In the DPB group, the AB/PAS and MUC5AC -stained areas were , , respectively. In the control group, the AB/PAS- and MUC5AC-stained areas were , , which was significantly larger than in the DPB group (each comparison, p in the DPB group, but zero in of the control group. The extent of neutrophilic infiltration was /5HPF in the DPB group and /5HPF in the control group, which was statistically significant(p=0.002). Conclusion: The EGFR system is highly related to goblet cell dysplasia, mucus hypersecretion and neutrophilic inflammation in DPB.