[Show abstract][Hide abstract] ABSTRACT: Ankylosing spondylitis is a chronic inflammatory multisystem disease that primarily affects the axial joints. Pleuropulmonary involvement is an uncommon extra-articular manifestation of ankylosing spondylitis. There is a wide spectrum of pulmonary parenchymal changes in ankylosing spondylitis, beginning in the early stages of the disease and increasing over time. The lesions are usually asymptomatic, and not visible on chest radiographs in early stages. We reported a case of advanced ankylosing spondylitis in a 56-year-old man with progressive pulmonary bullous fibrocystic changes on both upper lobes that were misdiagnosed as tuberculosis in the early stages of the disease.
Tuberculosis and Respiratory Diseases 10/2015; 78(4):459-62. DOI:10.4046/trd.2015.78.4.459
[Show abstract][Hide abstract] ABSTRACT: There are few data about thoracic hyperkyphosis which focused on respiratory events and prognoses. We investigated the clinical features and outcomes of respiratory complications requiring hospitalization in patients with thoracic hyperkyphosis.
Following a retrospective review of the medical records between 2002 and 2011, we included 51 patients with thoracic hyperkyphosis who had visited the respiratory department due to respiratory symptoms.
Of total 51 patients, 35 patients were hospitalized due to respiratory events. Among 56 total hospitalized events, acute respiratory failure (ARF) (n = 18) and exacerbation of a chronic airway disorder (n = 18) were the most common causes. Respiratory events related mortality was 13.7 % (7/51). The median value of the thoracic kyphosis angle was 89.0°. The ratio of the measured kyphosis angle to the normal value according to age and sex showed the median value of 2.38 (interquartile range 1.61-2.87). This ratio was negatively correlated with both predicted forced vital capacity (γ = -0.647, p < 0.0001) and predicted forced expiratory volume for 1 s (γ = -0.518, p = 0.008). After adjustments for age and sex, hyperkyphosis (angle ≥90°) was not found to influence the development of ARF (hazard ratio 3.2; 95 % confidence interval, 0.86-12.14; p = 0.082).
Patients with thoracic hyperkyphosis presenting to a respiratory department with respiratory issues commonly experienced respiratory events requiring hospitalization and had a poor prognosis. In addition, the severity of the kyphosis angle was correlated with respiratory insufficiency although it was not a risk factor for the development of ARF.
Beiträge zur Klinik der Tuberkulose 08/2015; 193(6). DOI:10.1007/s00408-015-9795-6 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to assess the image quality and radiation dose reduction of ultra-low-dose CT using sinogram-affirmed iterative reconstruction (SAFIRE).
This prospective study enrolled 25 patients who underwent three consecutive unenhanced CT scans including low-dose CT (120 kVp and 30 mAs) and two ultra-low-dose CT protocols (protocol A, 100 kVp and 20 mAs; protocol B, 80 kVp and 30 mAs) with image reconstruction using SAFIRE. The image quality and radiation dose reduction were assessed.
The mean (± SD) effective radiation dose was 1.06 ± 0.11, 0.44 ± 0.05, and 0.31 ± 0.03 mSv for low-dose CT, ultra-low-dose CT protocol A, and ultra-low-dose CT protocol B, respectively. Overall image quality was determined as diagnostic in 100% of low-dose CT scans, 96% of ultra-low-dose CT protocol A scans, and 88% of ultra-low-dose CT protocol B scans. All patients with nondiagnostic quality images had a body mass index (weight in kilograms divided by the square of height in meters) greater than 25. There was no statistically significant difference in detection frequencies of 14 lesion types among the three CT protocols, but pulmonary emphysema was detected in fewer patients (3/25) in ultra-low-dose CT protocol B scans compared with ultra-low-dose CT protocol A scans (5/25) or low-dose CT scans (6/25). We measured the longest dimensions of 33 small solid nodules (3.8-12.4 mm in long diameter) and found no statistically significant difference in the values afforded by the three CT protocols (p = 0.135).
Iterative reconstruction allows ultra-low-dose CT and affords acceptable image quality, allowing size measurements of solid pulmonary nodules to be made.
American Journal of Roentgenology 06/2015; 204(6):1197-1202. DOI:10.2214/AJR.14.13629 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to characterize the prognosis and identify factors that contribute to rebleeding after bronchial artery embolization (BAE) in patients with active or inactive pulmonary tuberculosis (PTB).
Following a retrospective review, 190 patients had hemoptysis requiring BAE due to PTB in one hospital between 2006 and 2013.
The median age at the time of diagnosis of PTB was 37 years and 54 years at the time of first episode of hemoptysis. Among 47 patients (24.7 %) who experienced rebleeding after BAE during the median follow-up period of 13.9 months [interquartile range (IQR) 2.3-36.0 months], bleeding recurred in 12 patients (6.3 %) within 1 month and in 15 patients (7.9 %) after 1 year. The median non-recurrence time was 8.6 months (IQR 1.2-27.6 months). Independent predictors of rebleeding after BAE were tuberculous-destroyed lung [hazard ratio (HR) 3.0; 95 % confidence interval (CI) 1.5-6.2; p = 0.003], the use of anticoagulant agents and/or antiplatelet agents (HR 2.6; 95 % CI 1.1-5.8; p = 0.022), underlying chronic liver disease (HR 2.7; 95 % CI 1.1-4-6.9; p = 0.033), elevated pre-BAE C-reactive protein (CRP) (mg/dL) (HR 2.4; 95 % CI 1.0-5.5; p = 0.048), and the existence of fungal ball (HR 2.1; 95 % CI 1.0-4.3; p = 0.050).
The risk of rebleeding after BAE in active or inactive PTB was high, particularly in patients with tuberculous-destroyed lung, chronic liver disease, the use of anticoagulant agents and/or antiplatelet agents, elevated pre-BAE CRP, and the existence of fungal ball.
Beiträge zur Klinik der Tuberkulose 04/2015; 193(4). DOI:10.1007/s00408-015-9728-4 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) patients include those who have never smoked. However, risk factors other than smoking in never-smokers have not been elucidated sufficiently. This study investigated the risk factors for COPD among never-smokers in Korea using population-based data.
The data were retrieved from the Korean National Health and Nutrition Survey IV conducted from 2007 to 2009. Among subjects aged 40 years or older who underwent appropriate pulmonary function tests, never-smokers not diagnosed with asthma and not showing a restrictive pattern on pulmonary function tests were enrolled. Risk factors of COPD in never-smokers were analyzed using logistic regression models.
Among 24,871 participants in the representative Korean cohort, 3,473 never-smokers were enrolled. COPD patients accounted for 7.6% of the never-smokers. In the logistic regression analysis, low education status (odds ratio [OR]: 2.0; 95% confidence interval [CI]: 1.2-3.2), occupational exposure (OR: 2.6; 95% CI: 1.3-5.3), a history of tuberculosis (OR: 4.5; 95% CI: 2.3-8.7), bronchiectasis (OR: 6.0; 95% CI: 1.4-25.4), male sex (OR: 4.2; 95% CI: 2.6-6.7), advanced age (60-69 years vs 40-49 years; OR: 3.8; 95% CI: 2.0-7.0), and being underweight (body mass index <18.5 vs 18.0-24.9 kg/m(2); OR: 3.1; 95% CI: 1.0-9.4) were associated with the development of COPD.
Low education status, manual labor, a history of tuberculosis and bronchiectasis, as well as male sex, advanced age and being underweight were risk factors for COPD in Korean never-smokers.
International Journal of COPD 03/2015; 10:497-506. DOI:10.2147/COPD.S77662 · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting.
Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response.
Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%.
Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.
Tuberculosis and Respiratory Diseases 01/2015; 78(1):1-7. DOI:10.4046/trd.2015.78.1.1
[Show abstract][Hide abstract] ABSTRACT: Gastric sarcoidosis is a rare disease accounting for 0.1~0.9% of all sarcoidosis cases. It presents either as a systemic disease or as an isolated finding. Diagnosis is established with biopsy of a lesion. It is important to distinguish between sarcoidosis and a sarcoid-like reaction, which can be caused by Crohn's disease, foreign body reaction, fungal infection, tuberculosis, or malignancy. We report a 60-year-old woman with both gastric and pulmonary sarcoidosis.
[Show abstract][Hide abstract] ABSTRACT: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery.
[Show abstract][Hide abstract] ABSTRACT: Objectives
To investigate the association between self-reported sleep duration and serum vitamin D level in elderly Korean adults.DesignCross-sectional data analysis.SettingKorean National Health and Nutrition Examination Survey 2010.ParticipantsNoninstitutionalized adults aged 60 to 80 (N = 1,614).MeasurementsThe confounding variables were serum 25-hydroxy vitamin D level, age, sex, body mass index, smoking history, alcohol consumption, and self-reported daily sun exposure and sleep duration. Self-reported daily sleep duration was divided into four groups: Q1 (≤4 hours), Q2 (5–6 hours), Q3 (7–8 hours), and Q4 (≥9 hours).ResultsMean serum vitamin D levels of subjects in the Q1, Q2, Q3, and Q4 groups were 44.18, 48.08, 48.83, and 51.78 nmol/L, respectively. On multivariate linear regression analysis, subjects in the Q2 (B = 3.80, 95% confidence interval (CI) = 0.42–7.19), Q3 (B = 4.89, 95% CI = 1.54–8.24), and Q4 (B = 5.18, 95% CI = 0.78–9.58) groups had significantly higher serum vitamin D levels than subjects in the Q1 group.Conclusion
Serum vitamin D level is positively associated with self-reported daily sleep duration in elderly Korean individuals. These results suggest that inadequate sleep duration may be associated with lower vitamin D levels in elderly adults.
Journal of the American Geriatrics Society 12/2014; 62(12). DOI:10.1111/jgs.13148 · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and objective
Overlap syndrome shares features of both asthma and chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate characteristics of overlap syndrome and their effect on self-rated health (SRH).
We analyzed data from the Fourth Korea National Health and Nutrition Examination Survey of 2007–2009. Subjects with acceptable spirometry and available wheezing history were included. Subjects were classified into four groups based on forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) results and the presence or absence of self-reported wheezing for the previous 12 months: 1) COPD group, defined as having FEV1/FVC <0.7 without self-reported wheezing history; 2) asthma group, defined as having self-reported wheezing history without FEV1/FVC <0.7; 3) overlap syndrome group, having both FEV1/FVC <0.7 and wheezing history; and 4) non-obstructive disease (NOD) group, having neither FEV1/FVC <0.7 nor self-reported wheezing. SRH was categorized as better or lower based on responses to a questionnaire.
From a total 9,104 subjects, 700 were assigned to the COPD group, 560 to the asthma group, 210 to the overlap syndrome group, and 7,634 to the NOD group. Compared to the other groups, subjects in the overlap syndrome group were more likely to have low lung function, a high proportion of smokers, low socioeconomic status, short education duration, lower SRH, and past diagnosis of pulmonary tuberculosis or bronchiectasis. Multiple logistic regression analysis revealed that both overlap syndrome and asthma groups were independently associated with lower SRH after adjustment for age, sex, socioeconomic status, education level, smoking status, comorbidities, and lung function. Female, old age, low education level, low economic status, smoker and other comorbidities were also associated with lower SRH.
Overlap syndrome was accompanied by high morbidity and was associated with lower SRH, which needs more appropriate care.
International Journal of COPD 07/2014; 9:795-804. DOI:10.2147/COPD.S61093 · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Aims
Gastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients.
From our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD.
In total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients.
The prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.
The Korean Journal of Internal Medicine 07/2014; 29(4):466-73. DOI:10.3904/kjim.2014.29.4.466 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
The development of other primary cancers in patients with lung cancer is unfortunate and uncommon, although the frequency is increasing. The aim of this study was to determine the clinical features and prognosis in patients with multiple primary cancers (MPC) involving lung cancer.Methods
After a retrospective review of 1644 patients who were newly diagnosed with primary lung cancer between 1998 and August 2012 at a tertiary hospital, 105 patients were included.ResultsThe median age at the time of lung cancer diagnosis was 67 years, and 68 patients were male. Synchronous primary cancers occurred in 47% of the study population (49/105). Among those with metachronous cancer (56/105), the median interval between the diagnosis of lung cancer and another malignancy was 47.1 months, and 21 patients were diagnosed with lung cancer as the first primary tumor. The most frequent type of other malignancy was urogenital (30%), followed by gastrointestinal (30%) and thyroid malignancies (16%). Advanced stage of lung cancer (hazard ratio (HR), 3.2; 95% confidence interval (CI), 1.8-5.7; P<0.001), supportive care only as treatment for lung cancer (HR, 2.8; 95% CI, 1.3-6.0; P=0.006), and head and neck cancer as another malignancy (HR, 3.9; 95% CI, 1.4-10.8; P=0.010) were independent predictors of shorter survival from the time of diagnosis of the second primary cancer.Conclusion
Advanced lung cancer stage, symptomatic supportive care only without antitumor therapy for lung cancer, and head and neck cancer as another primary malignancy were poor prognostic factors in patients with MPC involving primary lung cancer.
Thoracic Cancer 07/2014; 6(2). DOI:10.1111/1759-7714.12158 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
This study analyzed the negative prognostic factors in patients who received second-line chemotherapy for advanced inoperable non-small cell lung cancer (NSCLC).
We retrospectively reviewed the records of 137 patients with inoperable stage III-IV NSCLC who received second-line chemotherapy. The effects of clinical parameters on survival were analyzed and the hazard ratios (HR) for mortality were identified by a Cox regression analysis.
Sex, age older than 65 years, smoking history, cell type, T-stage, best response to first-line chemotherapy and first-line chemotherapy regimen were significant negative predictors in univariate analysis. The multivariate analysis showed that patients older than 65 years (HR, 1.530; 95% confidence interval [CI], 1.020-2.297), advanced T stage (T4 vs. T1; HR, 2.273; 95% CI, 1.010-5.114) and non-responders who showed progression with first-line chemotherapy (HR, 1.530; 95% CI, 1.063-2.203) had higher HR for death.
The age factor, T stage and responsiveness to first-line chemotherapy were important factors in predicting the outcome of patients with advanced NSCLC who received second-line chemotherapy. The results may help to predict outcomes for these patients in the future.
Tuberculosis and Respiratory Diseases 07/2014; 77(1):13-7. DOI:10.4046/trd.2014.77.1.13
[Show abstract][Hide abstract] ABSTRACT: Tuberculosis is an important cause of morbidity and mortality world-wide. We report the case of a 52-year-old man who presented with a two month history of sore throat without other general or respiratory symptoms. Oral ex- amination revealed ulcerative and granulomatous lesions on the soft palate and tonsils. Histological examination of the lesions showed granulomatous tissue with caseaous necrosis consistent with tuberculosis. A chest x-ray and computed to- mography of the chest showed miliary tuberculosis of both lungs. The oral lesions improved with antituberculous medication by one month. Tuberculosis should be considered in the differential diagnosis of oral lesions which do not respond to appropriate antibiotic therapy. Pulmonary tuberculosis should also be considered in patients with oral tuberculosis even if they do not have respiratory symptoms.
The Southeast Asian journal of tropical medicine and public health 07/2014; 45(4):869-73. · 0.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute eosinophilic pneumonia (AEP) is a disease characterized by an acute febrile onset, eosinophilia in bronchoalveolar lavage fluid, and a dramatic response to corticosteroids. Although many studies have reported a close relationship between direct cigarette smoking and AEP, few studies have identified an association between passive smoking and AEP. Here, we report a case of AEP in a 19-year-old female with cough, fever, and dyspnea after 4 weeks of intense exposure to secondhand smoke for 6 to 8 hours a day in an enclosed area.
Tuberculosis and Respiratory Diseases 04/2014; 76(4):188-91. DOI:10.4046/trd.2014.76.4.188
[Show abstract][Hide abstract] ABSTRACT: Nontuberculous mycobacteria (NTM) are pathogens that cause chronic respiratory disease, even in immunocompetent patients. We hypothesized that low subcutaneous fat is a predisposing factor for NTM lung disease.
Following a retrospective review of medical records from between 2005 and 2012, a total of 148 patients with NTM lung disease and 142 age- and sex-matched controls were enrolled. We evaluated subcutaneous fat using chest computed tomography (CT) scans at the midpole level of the left kidney.
The median age of the patients was 62 years and 60.8 % were female. Approximately 71 % were classified into a nodular bronchiectatic group. The patient group had significantly less subcutaneous fat than the control group (39.3 vs. 53.0 cm(2), p = 0.001). Patients with both localized disease (43.5 vs. 53.0 cm(2), p = 0.042) and extensive disease (35.9 vs. 53.0 cm(2), p < 0.0001) had less subcutaneous fat compared with the control group. No difference in subcutaneous fat was observed with respect to the increasing bacterial load in sputum (p = 0.246). In 20 patients with prominent disease progression during the follow-up period, no significant difference was observed between subcutaneous fat at the initial diagnosis and that at the follow-up CT (36.2 vs. 42.0 cm(2), p = 0.47).
Our results suggest that lower subcutaneous fat may contribute to host susceptibility to NTM lung disease.
Beiträge zur Klinik der Tuberkulose 02/2014; 192(3). DOI:10.1007/s00408-014-9565-x · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the image quality of ultra-low-dose computed tomography (ULDCT) using sinogram-affirmed iterative reconstruction (SAFIRE) compared to reduced dose CT (RDCT).
Eighty-one consecutive patients underwent non-enhanced ULDCT using 80 kVp and 30 mAs and contrast-enhanced RDCT using automated tube potential selection and tube current modulation. CT images were reconstructed with SAFIRE. Image noise and subjective image quality of normal structures and various pulmonary lesions were assessed.
The mean effective doses were 0.29 ± 0.03 and 2.88 ± 1.11 mSv for ULDCT and RDCT, respectively. ULDCT had significantly higher noise (p < 0.001). Image quality of five normal structures was diagnostic in 91.1 % of ULDCT and 100 % of RDCT. With ULDCT, the frequencies of non-diagnostic image quality were 2.0 (1/50), 4.6 (13/280), 25.5 (14/55), and 40.0 (8/20)% for BMIs of < 20, 20-25, 25-30, and >30. In the assessment of pulmonary lesions, non-diagnostic image quality was observed for 11.2 % of all lesions, 60.9 % of decreased attenuation (significantly more frequent for upper lung lesions), and 23.5 % of ground-glass nodules.
ULDCT generates diagnostic images in patients with a BMI ≤25, but is of limited use for lesions with decreased attenuation, ground-glass nodules, or those located in the upper lobe.
• Iterative reconstruction enables ultra-low-dose CT (ULDCT) with very low radiation doses. • Image quality of ULDCT depends on the patient body mass index (BMI). • Selection of kVp and mAs depends on both BMI and lesion type. • Diagnosis of pulmonary emphysema or ground-glass nodules requires higher radiation doses.
European Radiology 01/2014; 24(4). DOI:10.1007/s00330-013-3090-9 · 4.01 Impact Factor