Yang Keun Rhee

Serum levels of interleukins (IL)-4, IL-5, IL-13, and interferon-γ in acute asthma

T-cell activation and alteration of cytokine levels are involved in the pathogenesis of bronchial asthma. However, the profile of circulating T-lymphocyte subsets and related cytokines during acute asthmatic attacks is still unclear. We hypothesized that serum levels of interleukin (IL)-4, IL-5, and IL-13 would be increased, whereas IFN-γ would be decreased in acute asthma. The subjects enrolled in this study included 58 acute asthmatics, 22 asymptomatic asthmatics, and 10 healthy controls. Serum levels of IL-4, IL-5, IL-13, and IFN-γ were measured using a sandwich enzyme-linked immunosorbent assay. We correlated serum levels of IL-4, IL-5, IL-13, and IFN-γ with initial forced expiratory volume in 1 sec (FEV1). Compared with control subjects, acute asthmatics had significantly increased levels of circulating IL-4 (p < 0.001), IL-5 (p < 0.001), and IL-13 (p < 0.001), although the differences were of borderline significance in serum IFN-γ (p = 0.069). There were also significant differences in the circulating levels of IL-4, IL-5, and IL-13 between acute asthmatics and asymptomatic asthmatics. There was no significant association between initial FEV1 and serum levels of IL-4 or IL-13, however, among acute asthmatics, a lower initial FEV1 was associated with higher IL-5 and/or lower IFN-γ levels. Our results suggest that serum levels of IL-4, IL-5, and IL-13 may be elevated in acute asthma, and that higher levels of IL-5 and/or lower levels of IFN-γ are associated with severe airway obstruction.

Spontaneous Pneumomediastinum and Hemopneumothoraces Secondary to Cystic Lung Metastasis

We report a case of a cystic metastasis to the lung from an angiosarcoma of the scalp in a 75-year-old man who complained of hemoptysis. A chest CT scan showed multiple thin-walled pulmonary cysts, bilateral pneumothoraces, small nodules and pneumomediastinum. Histologic examination revealed pleural infiltration of angiosarcoma cells. One month later, a high-resolution CT scan showed that the cysts had rapidly developed into large lesions.

Two Cases of Broncholith Removal under the Guidance of Flexible Bronchoscopy

Most broncholiths are related to infection with fungus or tuberculosis and they involve the lymph nodes; those cases that are caused by silicosis are rarely seen. Broncholith might lead complication such as bronchial rupture into the mediastinum, which can result in hemoptysis, cough, repeated pneumonia and so on. Flexible bronchoscopy plays an important part in the diagnosis of broncholithiasis, but its therapeutic application in the clinical setting is controversial. We report here on two cases of broncholith removal without complication with the use of a balloon catheter and tripod forceps using flexible bronchoscopy.

Intrathoracic malignant peripheral nerve sheath tumor in von Recklinghausen's disease.

Malignant peripheral nerve sheath tumor (MPNST) is defined as any malignant tumor arising from or differentiating toward the cells of the peripheral nerve sheath. MPNST accounts for about 5–10% of all soft tissue tumors and is often associated with neurofibromatosis type I (NF-1, von Recklinghausen’s disease). It is one of the malignant tumors associated with von Recklinghausen’s disease. Its common site is the lower and upper extremities, trunk, head and neck. But intrathoracic manifestations are very rare. We report a case of a 40 year-old man with multiple neurofibromatosis who was presented with an intrathoracic malignant peripheral nerve sheath tumor.

508 Antioxidants Attenuate Airway Remodeling by Regulating NF-EB, NRF2, and HIF in a Murine Model of Chronic Asthma.

Background Reactive oxygen species (ROS) play a crucial role in the pathogenesis of acute and chronic respiratory diseases. Antioxidants have been found to ameliorate airway inflammation and hyperresponsiveness in animal models employing short-term exposure to allergen. However, little data are available on the effect of antioxidants on airway remodeling and signaling pathways in chronic asthma. Methods In the present study, we used a long-term exposure murine model of allergic airway disease to evaluate the influence of an antioxidant, L-2-oxothiazolidine-4-carboxylic acid (OTC) or &agr;-lipoic acid (LA) on airway remodeling and to explore possible transcription factors and kinases involved in this effect. Results Long-term challenge of ovalbumin (OVA) increased ROS production, airway inflammation, and airway hyperresponsiveness, and developed features of airway remodeling such as excessive mucus secretion, subepithelial fibrosis, and thickening of the peribronchial smooth muscle layer. Administration of OTC or LA reduced these features of asthma including airway remodeling, which was accompanied by suppression of transforming growth factor-&bgr;1, vascular endothelial growth factor, and T-helper 2 cytokines. In addition, OVA-induced activation of nuclear factor-&kgr;B (NF-&kgr;B), nuclear factor erythroid 2p45-related factor-2 (Nrf2), hypoxia-inducible factor (HIF)-1&agr;, and HIF-2&agr; was reduced by OTC or LA. Our results also showed that OTC or LA down-regulated phosphoinositide 3-kinase activity and decreased phosphorylation of p38 mitogen-activated protein kinase but not extracellular signal-regulated kinase 1/2 or c-Jun N-terminal kinase. Conclusions These findings demonstrate that OTC and LA can inhibit activation of NF-&kgr;B, Nrf2, and HIF and thus attenuate allergen-induced airway remodeling, suggesting that antioxidants may provide therapeutic benefit in chronic asthma and other airway disorders.

A Case of Bronchogenic Squamous Cell Carcinoma in Patient with Swyer-James Syndrome

Swyer-James syndrome is a rare disease with patients presenting with unilateral hyperlucent lungs due to hypoplasia of the pulmonary artery and bronchiolitis obliterans. A unilateral hyperlucent lung generally develops after a lower respiratory tract infection during early childhood. In extremely rare cases, an association of bronchogenic carcinoma with Swyer-James syndrome has been reported. Here we report a case of bronchogenic squamous cell carcinoma associated with Swyer-James syndrome with a relevant literature review.

Comparisons of 12-Hour and 24-Hour Sustained-Release Theophyllines in the Management of Asthma

Background : Sustained-release theophylline, which is generally prescribed as a twice-daily equal-dose regimen, is one of the more common asthma treatments. The development of a sustained-release drug delivery technology that enables improved control of the theophylline blood levels represents a significant advancement in both the efficacy and safety of dosing. Method : A crossover study was conducted with 25 adult chronic asthmatic patients requiring daily bronchodilator therapy. The study group included thirteen males and twelve females with ages ranging from 19 to 71 years. The overall approach was to place the patients first on the twice-daily preparation() for 28 days at 8 AM and 8 PM, and measure the pulmonary function and theophylline level on the 28th day. The patients were subsequently switched to the once-daily preparation() in the same daily dose at 8 PM on the 29th day and the same parameters were measured on the 56th day. Results : The mean serum levels of theophylline were in the -treated period and in the -treated period. ln addition, the showed percent in the -treated and percent in the -treated period. Thus there were no significant differences between the once-daily and twice-daily preparation. Conclusion : The results indicated little clinical differences between the two medications. The two drugs are equally effective in controlling asthma over the four weeks of treatment.

Vascular Endothelial Growth Factor and Matrix Metalloproteinase-9 in Acute Asthma

Background : Bronchial asthma is an inflammatory disease of the airways that is associated with airway remodeling. The vascular endothelial growth factor (VEGF) is a potent, multifunctional cytokine that contributes to angiogenesis and inflammation. Matrix metalloproteinase-9 (MMP-9) is a major proteolytic enzyme that in duces bronchial remodeling in asthma. However, there is no data available on the possible role of the VEGF or on the potential relationship between the VEGF and MMP-9 in acute asthma. Therefore, the VEGF was studied to determine whether or not it participates in airway inflammation during acute asthma. An additional aim of this study was to determine whether or not the VEGF levels correlated with the MMP-9 levels in the sputum of acute asthma patients. Methods: Both the VEGF and MMP-9 levels were measured by an enzyme immunoassay and zymographic analysis in the sputum of patients with either stable asthma or with acute asthma. The VEGF and MMP-9 levels were also evaluated during a spontaneous asthma attack. Results : The VEGF levels were significantly higher in the sputum of acute asthmatic patients than in either the stable patients the control subjects. The VEGF levels in the sputum during asthma exacerbation were significantly higher than those on the remission days, and those levels decreased after asthma therapy. In acute asthmatic patients, the VEGF levels in the sputum correlated with the number of neutrophils and eosinophils. In addition, a significant correlation was established between the VEGF and MMP-9 levels in the sputum. Conclusion : These results suggest that VEGF overproduction is associated with airway inflammation during acute asthma and is related to the MMP-9 function.

Pulmonary mucormycosis with an appearance of consolidation

The mucormycosis is a group of serious opportunistic infections caused by fungi of the class Zygomycetes and order Mucorales. Pulmonary mucormycosis is a relatively rare disease but typically manifested by a rapidly progressive, often fatal pneumonia in patients with diabetes mellitus, hematologic malignant neoplasms, or organ transplants. The radiologic manifestations of pulmonary mucormycosis are nonspecific and include progressive lobar or multilobar consolidations, pulmonary masses and pulmonary nodules. Recently, we experienced a pulmonary mucormycosis in 32-year-old man with uncontrolled diabetes. He complained of cough, left pleuritic chest pain and generalized weakness. Initial chest X-ray finding was the consolidation on the lower lobe of the left lung. On the sixth hospital day, bronchoscopic examination with lung biopsy revealed broad, non-septate hyphae with right-angle branching, diagnostic of mucormycosis, and consequently amphotericin B therapy was started. We performed a lobectomy of the left lower lobe of the lung on 29th hospital day.

A Case of Multiple Pulmonary Arteriovenous Malformation Treated with Coil Embolization

Pulmonary arteriovenous malformation(PAVM) is an uncommon congenital anomaly. As pulmonary arteriovenous malformation is a direct communication between the branches of pulmonary artery and vein which originated from the malformation of capillary development, major disturbances in gas exchange can result. This malformation results in the several symptoms such as dyspnea, hemopyssis, cyanosis, and severe neurologic complaints. However, the most of patients are usually asymptomatic. Selective pulmonary angiography is well known the helpful diagnostic method. Recently, therapeutic embolization has been advocated as the treatment of choice for pulmonary arteriovenous malformations. We report a case of multiple pulmonary arteriovenous malformation, which was detected on the simple chest X-ray and successfully treated with coil embolization in a 19-year-old asymptomatic woman.