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Occupational lung disease (OLD) is a group of lung diseases caused and/or aggravated by organic and inorganic inhaled dust, fumes, and mist. OLD can develop under various occupational situations. Therefore, occupational history should be considered when evaluating respiratory symptoms. Once OLD is developed, it may not be treated and may even progress after exposure to the causative agents has stopped. The best ways to treat OLD are prevention and early detection by controlling the working environment and conducting regular surveillance of workers. Common OLDs in Korea are coal worker`s pneumoconiosis, asbestos-related diseases, and occupational asthma. Recent aspects of these common OLDs in Korea will be described based on recently published studies.
Interstitial lung disease (ILD) is a group of diseases characterized by pulmonary interstitial inflammation. Finally the inflammation results in pulmonary fibrosis and impairment of oxygen transportation. The causes of idiopathic interstitial pneumonia (IIP) are unknown. Diagnosis of IIP is not easy, especially distinguising between nonspecific interstitial pneumonia and usual interstitial pneumonia (UIP). First line treatments of IIP include corticosteroids and immune modulators, which have limited effect. Currently, several drugs are being researched to prevent and treat fibrosis. Newer drugs that may useful to treat pulmonary fibrosis include endothelin receptor antagonist, recombinant soluble TNF receptor antagonist, and cotrimoxazole. The causes of IIP are largely unknown, treatment is not specific, and prognosis is poor. Recent studies are underway to investigate the pathogenesis and treatment of IIP and pulmonary fibrosis. As the pathogenesis of IIP is elucidated, better treatments will emerge.
Critically ill patients requiring treatment in intensive care unit (ICU) are increasing recently. The patients treating in intensive care unit have various catheter, device, antibiotics treatment, and decreased immunity, and are prone to get complications from those. Some complications are clinically insignificant, but some complications may be fatal. The serious complications are including ventilator associated pneumonia that is one type of hospital acquired pneumonia, venous thromboembolism that is a major risk factor of pulmonary embolism, and stress related ulcer that make clinically significant gastrointestinal bleeding. Those complications prolong ICU stay period, increase morbidity and mortality, and cost. Therefore we should try to decrease incidence of those complications. The methods to decrease the complications in ICU are including education of facility staffs including physicians, nurses, students, and other staffs, and daily formal routine evaluation of patients in ICU. (Korean J Med 2011;80: 152-157)
Autoimmune progesterone dermatitis is a rare autoimmune response to endogenous progesterone that usually occurs in fertile females. Cutaneous or mucosal lesions develop cyclically during the luteal phase of the menstrual cycle when progesterone levels are elevated. Symptoms usually start 3–10 days before menstruation and resolve 1–2 days after menstruation ceases. We report the case of a 48-year-old woman with intermittent eczematous skin lesions of the legs, forearms, and buttocks. She was diagnosed with allergic contact dermatitis, and topical steroids were prescribed. Her skin eruptions waxed and waned for 6 years and were associated with her menstrual cycle. We performed an intradermal test using progesterone,which was positive, and prescribed gonadotropin-releasing hormone analogues monthly for 3 months. The patient’s skin lesions improved, confirming the diagnosis. Autoimmune progesterone dermatitis should be included in the differential diagnosis of recurrent eczema that is refractory to treatment in women of child-bearing age.
Levofloxacin, a fluoroquinolone and L-isomer of the racemate ofloxacin, has been approved for the treatment of acute and chronic bacterial infections. Gastrointestinal complaints are the most frequently reported adverse drug reactions to fluoroquinolones. Other adverse events include headache,dizziness, increased liver enzyme levels, photosensitivity, tachycardia, QT prolongation, and eruptions. Anaphylaxis has been documented as a rareadverse drug reaction to levofloxacin; however, diagnostic tests are needed to evaluate whether these reactions are the result of levofloxacin treatment. While the results of skin tests are considered unreliable due to false-positive responses, the oral provocation test is currently considered to bethe most reliable test. Tryptase, a neutral protease, is the dominant protein component of secretory granules in human mast cells, and an increasedserum concentration of tryptase is a highly sensitive indicator of anaphylaxis. Herein, we report a case of levofloxacin-induced anaphylaxis in whichthe patient exhibited elevated serum tryptase levels and a positive oral levofloxacin challenge test result. As anaphylaxis is potentially life-threatening,the administration of fluoroquinolones to patients who have experienced a prior reaction to this type of agent should be avoided.