• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.265-270
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• 2002

Vocal cord dysfunction (VCD) is respiratory disorder characterized by paradoxical closure of the vocal cord during the respiratory cycle leading to obstructive airway symptoms. The clinical presentation of VCD is often dramatic and its misdiagnosis as asthma or exercise-induced brochospasm(EIB) has led to inappropriate treatment including high dose corticosteroids, intubation, and tracheostomy. Many VCD patients are asymptomatic at rest and require exercise challenge to elicit symptoms and vocal cord abnormalities. The "gold standard" for the diagnosis of VCD remains laryngoscopy or bronchoscopy with direct visualization of paradoxical adduction of the vocal cords. We report a case of exercise-induced Vocal cord masqueraded as exercise-induced asthma unresponsive to corticosteroids. And bronchodilator confirmed by typical bronchoscopic findings with paradoxial adduction of the vocal cords.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.390-394
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• 2001

Lymphocytic interstitial pneumonia(LIP) is characterized by a massive infiltration of the interstitium of the lung by mature lymphocytes, plasma cells and reticuloendothelial cells. LIP may be associated with autoimmune diseases including Sj$\check{o}$grens syndrome, SLE, myasthenia gravis, pernicious anemia, autoimmune hemolytic anemia, and HIV or an EB virus infection. There is a possibility of LIP progressing to a pulmonary or systemic lymphoma. The therapeutic response to corticosteroids and/or immunosuppressive drugs varies. Here we report a case of LIP that was diagnosed by an open lung biopsy and clonality study. The patient was a 36 year-old man without autoimmune disease or HIV infection. He was admitted as a result of severe hypoxemia showing $PaO_2$ of 48.3mmHg. The patient was treated with corticosteroids after the diagnosis and had fully recovered without a sequalae or relapse.

• Clinical and Experimental Pediatrics
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• v.54 no.8
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• pp.322-328
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• 2011

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

• Tuberculosis and Respiratory Diseases
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• v.78 no.1
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• pp.27-30
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• 2015

The drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a severe adverse drug-induced reaction which includes a severe skin eruption, fever, hematologic abnormalities (eosinophilia or atypical lymphocytes) and internal organ involvement. The most frequently reported drug was anticonvulsants. The diagnosis of DRESS syndrome is challenging because the pattern of cutaneous eruption and the types of organs involved are various. The treatments for DRESS syndrome are culprit drug withdrawal and corticosteroids. Here we report a 71-year-old man with skin eruption with eosinophilia and hepatic and renal involvement that appeared 4 weeks after he had taken anti-tuberculosis drugs (isoniazid, ethambutol, rifampicin, and pyrazinamide), and resolved after stopping anti-tuberculosis drugs and the administration of systemic corticosteroids. DRESS recurred after re-challenging isoniazid, we identified isoniazid was causative drug.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.175-186
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• 2022

This study aimed to systematically review the effectiveness of methylene blue (MB) photosensitizers in the management of symptomatic oral lichen planus (OLP). Electronic online databases and manual searches were performed for randomized controlled trials (RCTs) published in English between January 2010 and February 2022. RCTs comparing photodynamic therapy (PDT) and corticosteroid therapy at baseline and follow-up period were identified. The Cochrane risk of bias tool was used to assess the quality of the included studies. A meta-analysis was performed regarding visual analog scale (VAS) scores, Thongprasom sign scores, lesion size, response to treatment, and exacerbation of lesions after therapy. The clinical severity was analyzed qualitatively. Five RCTs consisting of 180 samples fulfilled the inclusion and exclusion criteria. All parameters of VAS score, Thongprasom sign score, lesion size, and response to treatment were statistically non-significant. Our results indicate that both MB-PDT and corticosteroid therapy are effective for the management of OLP. Moreover, MB-PDT is an effective alternative treatment option for OLP when corticosteroids are contraindicated. However, conclusive evidence cannot be ascertained owing to the heterogeneity among the studies.

• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.130-135
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• 2024

The effectiveness of corticosteroids in preventing immune reconstitution inflammatory syndrome in non-human immunodeficiency viruses Pneumocystis carinii pneumonia (PCP) patients, such as severe combined immunodeficiency (SCID) patients, is controversial. We experienced a paradoxical reaction during severe PCP treatment in a SCID infant, which responded well to adjuvant corticosteroids.

• Tuberculosis and Respiratory Diseases
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• v.61 no.4
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• pp.356-365
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• 2006

Background: Corticosteroids are known to be significant prognostic parameters in sepsis. Recently, an absolute and relative insufficiency of the corticosteroids system has often been reported to often develop particularly in severe sepsis. Degree of such an adrenal insufficiency not only has prognostic implications but also can be used to guide corticosteroids replacement therapy. The 24-hour urinary cortisol levels as well as serum cortisol concentrations were measured to assess the clinical significance and their relationship with the other parameters of sepsis, and also evaluated the clinical implications of the relative adrenal insufficiency. Methods: 26 consecutive patients with sepsis were enrolled. The basal random serum cortisol, ACTH, ADH, lactate levels and 24-hour urinary free cortisol amount were measured. The rapid ACTH ($250{\mu}g$) stimulation test was also performed. Results: Basal serum cortisol levels were higher in the non-survivors than in the survivors. The 24-hour urinary free cortisol levels were higher in the patients with severe sepsis than in those without. The serum cortisol levels strongly correlated with the serum ADH and lactate levels. The 24-hour urinary free cortisol levels strongly correlated with the serum cortisol and lactate levels. The fractional changes in the cortisol levels after the rapid ACTH stimulation tests correlated with the serum cortisol, ADH, and lactate levels. Conclusion: Both the serum cortisol and 24-hour urinary cortisol were found to be significant prognostic factors in sepsis, and showed a strong correlation with the other parameters. The relative adrenal insufficiency might also be an important clinical parameter.

• Tuberculosis and Respiratory Diseases
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• v.83 no.1
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• pp.42-50
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• 2020

Background: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients. Methods: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified. Results: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40-6.29) and 4.24 (95% CI, 1.37-13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level. Conclusion: Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

• Clinical and Experimental Pediatrics
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• v.58 no.12
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• pp.472-477
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• 2015

Purpose: Adherence to treatment with inhaled corticosteroids (ICS) is a critical determinant of asthma control. The objective of this study was to assess factors that determine adherence to ICS therapy in children with asthma. Methods: Fifty-eight children with asthma, aged 5 to 16 years, used ICS with or without a spacer for 3 months. Adherence rates as measured from questionnaires and canisters, asthma symptom scores, and inhalation technique scores were assessed every 30 days. The degree of supervision by caregivers was assessed at day 30. Results: Adherence rates measured using canisters were lower at day 60 than at day 30 (P=0.044) and did not change thereafter ($74.4%{\pm}17.4%$ at day 30, $66.5%{\pm}18.4%$ at day 60, and $67.4%{\pm}22.2%$ at day 90). Adherence rates at days 60 and 90 and during the total study period were significantly different when measured by using questionnaires versus canisters (P<0.001, P=0.022, and P =0.001, respectively). In the comparison of adherence rates repeatedly measured at days 30, 60, and 90 and adherence rates during the total study period among the 3 groups, adherence rates in the high-degree supervision group were significantly higher than those in the low-degree supervision group ($82.0{\pm}16.0$ vs. $66.1{\pm}14.5$, $75.4{\pm}14.4$ vs. $56.2{\pm}18.4$, $75.0{\pm}18.3$ vs. $55.0{\pm}19.7$ [P=0.027]; $77.9{\pm}12.2$ vs. $59.1{\pm}11.4$ [P=0.021]) after adjustment for sex and age. Conclusion: The level of caregiver supervision is an important factor affecting adherence to ICS therapy in children with asthma. Therefore, a high degree of supervision may be required to increase adherence to ICS therapy in children with asthma.

• Tuberculosis and Respiratory Diseases
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• v.62 no.4
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• pp.308-313
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• 2007

Background: The nitric oxide (NO) released by inducible NO synthase (iNOS) plays an important role in the pathophysiology of sepsis. Corticosteroids also play a role in the hemodynamic and inflammatory reactions in sepsis. Both have been shown to have a relationship theoretically, but their correlation and clinical impacts have rarely been evaluated. Methods: 26 patients with sepsis and 14 healthy controls were enrolled in this study. The initial random plasma total NO and the serum cortisol levels were measured. The same measurements were serially carried out on the $3^{rd}$, $5^{th}$, and $7^{th}$ days. Results: The initial total plasma levels of NO and cortisol were higher in the patients with sepsis than in the healthy controls. The total NO levels were higher in patients with severe sepsis than in the those with mild sepsis. There was a correlation between the total NO and cortisol level throughout the study. Conclusion: In patients with sepsis, the levels of plasma NO and cortisol were well correlated during the first week of sepsis, which suggests an interrelationship. However, the clinical and pathogenetic implications await further evaluation.