Background: Pulmonary nodules manifest as pure or mixed ground glass opacities (GGOs), or solid nodules. Methods: We retrospectively surveyed 317 cases with pulmonary nodules to observe the proportion and predictive factors of transient lesions in patients with pulmonary nodules. Results: At the initial computed tomography scan, 63.7% showed solid nodules, while 20.2% had mixed GGOs and 16.1% of cases manifested as pure GGOs. Nodules from 114 cases (36%) disappeared or decreased in size during follow up, while in 203 cases (64%), they did not change or became enlarged. During follow up, more than half of the GGOs resolved (66.7% in pure GGOs, 54.7% in mixed GGOs), while only 22.3% of solid nodules resolved. Between transient and persistent pulmonary nodules, significant differences were observed in age, gender, smoking history, presence of eosinophilia, size, and radiologic attenuation of nodules (solid or GGO). In multivariate analysis, age (Յ55 years), size of nodules (>15 mm), eosinophilia, and GGO were significant independent predictors of transient nodules. The main causes of transient nodules were pneumonia or eosinophilic pulmonary infiltrates. Conclusion: Thirty-six percent of pulmonary nodules resolved spontaneously or with medical treatment. Transient nodules showed different clinical and radiological characteristics from persistent nodules.

Purpose Most patients with pleuropulmonary paragonimiasis can be cured by the initial single set of Praziquantel (PZQ) treatment. However, several cases have been reported to have unsatisfactory responses to the initial PZQ treatment. The objective of this study was to evaluate the clinical findings of patients with pleuropulmonary paragonimiasis who needed additional PZQ treatment after the 1st set chemotherapy. Patients and Methods Thirty-two patients who were diagnosed with pleuropulmonary paragonimiasis at our institution between 2003 and 2008 were retrospectively reviewed. Results All patients were treated initially with PZQ for 3 days (1st set chemotherapy). Twenty-four patients (75.0%) showed improvement in respiratory symptoms and pulmonary involvements. However, eight patients (25.0%) suffered from relapsed respiratory symptoms and pleural effusion. For these patients, an additional 2nd set PZQ treatment resulted in the resolution of the symptoms and pulmonary involvements. The characteristics of patients who needed multi-set treatments were as follows; longer duration of respiratory symptoms (single vs multi-set treatment group; 6.67 ± 8.08 vs 17.86 ± 11.84 weeks, p=0.009), higher IgG titer (optical density, O.D.) for Pargonimus westermani (ELISA O.D. for PW, 0.54 ± 0.19 vs 0.88 ± 0.16 O.D., p=0.001) and higher frequency of multiple pulmonary lesions (% of patients with multiple lesions; 16.7% vs 50.0%, p=0.059). Conclusion The patients who had a longer duration of respiratory symptoms, higher ELISA titer for PW and/or multiple pulmonary lesions needed an additional PZQ treatment after the 1st set of chemotherapy. Close follow-up after the initial treatment is necessary especially for such patients.

Background: In 2007, the American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) published new diagnostic guidelines for nontuberculous mycobacterial (NTM) disease. Bacteriological criteria have become simpler compared to the 1997 ATS diagnostic criteria. Objective: For assessing the impact of the 2007 ATS/IDSA diagnostic criteria, we compared the diagnosis rate and time to diagnosis of NTM lung disease using the 1997 and 2007 ATS guidelines. Methods: Sixty-four patients who had excreted Mycobacterium intracellulare, M. avium, M. abscessus or M. kansasii at least one time in their respiratory specimens at Chonnam National University Hospital were reviewed. The 1997 ATS and 2007 ATS/IDSA guidelines were applied to these patients. Results: Thirty-seven of 64 patients (57.8%) were diagnosed with NTM lung disease by the 1997 ATS criteria. When the 2007 ATS/IDSA criteria were applied, 6 patients were newly diagnosed with NTM lung disease. The diagnosis rate significantly increased from 57.8 to 67.2% (p < 0.001). The time to diagnosis in the 1997 ATS and 2007 ATS/IDSA guidelines was 46.4 ± 53.0 and 36.2 ± 38.5 days, respectively (p = 0.002). Conclusion: These data suggest that we can shorten the time to diagnose NTM lung disease and diagnose more simply by using the 2007 ATS/IDSA guidelines. Further study will be needed to assess that these changes affect the management of NTM disease.

Temozolomide is an oral alkylating agent with clinical activity against glioblastoma multiforme (GM). It is generally well-tolerated and has few pulmonary side effects. We report a case of temozolomide-associated brochiolitis obliterans organizing pneumonia (BOOP) requiring very high-dose corticosteroid treatment. A 56-yr-old woman presented with a 2-week history of exertional dyspnea. For the treatment of GM diagnosed 4 months previously, she had undergone surgery followed by chemoradiotherapy, and then planned adjuvant chemotherapy with temozolomide. After the 1st cycle, progressive dyspnea was gradually developed. Chest radiograph showed diffuse patchy peribronchovascular ground-glass opacities in both lungs. Conventional dose of methylprednisolone (1 mg/kg/day) was begun for the possibility of BOOP. Although transbronchial lung biopsy findings were compatible with BOOP, the patient's clinical course was more aggravated until hospital day 5. After the dose of methylprednisolone was increased (500 mg/day for 5 days) radiologic findings were improved dramatically.

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