• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.295-303
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• 2003

Backgroung : The incidence of penicillin-resistant streptococcus pneumoniae(PRSP) accounts for almost 70% of all pneumococcal pneumonia cases in Korea. It is still unclear as to whether the efficacy of penicillin or equally active beta-lactam agents is compromised in PRSP pneumonia. This study investigated the prevalence of PRSP in community-acquired pneumonia and its clinical course. Methods : A total of 42 patients with community-acquired pneumococcal pneumonia were evaluated from July 1999 to May 2001. The cultured strains of Streptococcus pneumoniae were divided into susceptible, intermediately resistant, and resistant strains by an E-test, and the effect of the clinical course was investigated. Results : From a total of 42 patients, 22 (52.4%) patients had an intermediate resistance (MIC $0.1-1{\mu}g/m{\ell}$) and six (14.3%) showed a high resistance ($MIC{\geq}2.0{\mu}g/m{\ell}$) with current penicillin susceptibility categories. However, according to the classification of the DRSPTWG (Drug Resistant Streptococcus pneumoniae Therapeutic Working Group), there were 11 cases (26.2%) of intermediate resistance and no case of high resistance. Under empirical antimicrobial treatment, there was no difference in the clinical outcome between the penicillin susceptible and resistant group. Conclusion : The clinical outcome of PRSP pneumonia with empirical therapy was acceptable. These results suggest that the current MIC breakpoint for penicillin resistance in Streptococcus pneumoniae has been set at a very low level and penicillin resistance according to the NCCLS classification does not significantly influence the outcome of the empirical treatment for pneumococcal pneumonia.

• Tuberculosis and Respiratory Diseases
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• v.66 no.6
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• pp.437-443
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• 2009

Background: The aim of this study was to consider the significance of pleural fluid adenosine deaminase (ADA) activity combined with lymphocyte/neutrophil (L/N) ratio in the diagnosis of tuberculous pleurisy (TBpl) in a region of intermediate prevalence of tuberculosis (TB). Methods: We collected data from 388 patients with exudative pleural effusions. The final diagnoses were compared to the results from our diagnostic method using pleural fluid ADA and L/N ratio. Results: 108 patients had a final diagnosis of TBpl; 102 cases had high levels of ADA ($\geq$40 IU/L). When we considered ADA $\geq$40 IU/L as a diagnostic criterion, the sensitivity was 94.4%, specificity 87.5%, and posttest posttest probability 74.5%. However, when we considered ADA $\geq$40 IU/L combined with the L/N ratio $\geq$0.75 as a diagnostic criterion, the specificity and post-test probability were rose to 97.5% and 93%, respectively. The other causes of high ADA and L/N ratios were lymphoma and metastatic carcinoma, but mass-like lesions were found on the chest radiographs or CT scans. Conclusion: To evaluate the causes of exudative pleural effusions in a region of intermediate prevalence of tuberculosis, we recommend measuring the pleural fluid ADA and L/N ratio first. If the result is high and malignancies are not suspected, it may be diagnostic of TBpl.

• Tuberculosis and Respiratory Diseases
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• v.57 no.6
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• pp.535-542
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• 2004

Background : Despite the clinical clues of bronchial asthma, some chronic coughers fail to be diagnosed due to negative test results. This study was aimed at evaluating the diagnostic performance of routine objective tests and identifying a cost-effective approach for asthmatics with a chronic cough. Methods : Patients with a chronic cough of more than 3 weeks duration, and showing normal chest radiograph and spirometry were enrolled. On the first visit, objective tests, composed of serum total IgE, peripheral blood eosinophil count, spontaneous sputum eosinophil count, methacholine bronchial provocation test (MBPT) and paranasal sinus radiograph, were performed, with the simultaneous administration of oral prednisolone (0.5mg/kg) for one week. The final diagnoses were made on the basis of the test results, and the patients grouped according to their steroid responsiveness. The role of the etiologic diagnosis tests was evaluated, and the medical costs of the final management plan simulated with respect to three assumed models. Results : Sixty chronic coughers were finally analyzed. The final diagnoses were as follows: bronchial asthma 21.7%, eosinophilic bronchitis 6.7%, paranasal sinusitis 18.3%, presumptive allergy 8.3% and non-diagnostic case 45.0%. Ninety percent were steroid responder. With the bronchial asthma cases, the positive rate of MBPT was 38.5%, with sputum eosinophil count in 84.6%, serum total IgE in 38.5%, and a peripheral blood eosinophil count rate of 30.8%. When the test results and steroid responsiveness data were applied to the 3 models, the chest radiograph, spirometry, sputum eosinophil count and paranasal sinus radiograph test results, and simultaneous short term steroid treatment seemed to have acceptable diagnostic performances, which could be used as a further guide to cost-effective planning. Conclusion : Objective tests, composed of chest radiograph, spirometry, paranasal sinus radiograph and sputum eosinophil count, with simultaneous short term steroid treatment, are suggested as cost-effective approaches for asthmatics with a chronic cough.

• Tuberculosis and Respiratory Diseases
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• v.66 no.4
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• pp.295-299
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• 2009

Background: There are various etiologies causing bronchiectasis, but the cases without definite causes account for a quite high proportion. It is also uncertain that immunoglobulin G subclass deficiency (IgGSD) is associated with bronchiectasis. Therefore, we tried to measure the frequency of IgGSD in patients with bronchiectasis of unclear etiology, and to observe the clinical features of those patients with bronchiectasis and IgGSD. Methods: For the outpatients of a university hospital who were diagnosed as bronchiectasis by chest CT, we produced comprehensive history taking and physical examinations, and finally selected 31 patients with bronchiectasis of unclear etiology. Results: Two patients had total immunoglobulin G deficiency. The frequency of IgGSD was comparatively high (n=14). When we compared IgGSD group to normal immunoglobulin G subclass group, there were no significant differences in sex, age, and the frequency of sinusitis, bronchial asthma, and the abnormal lung function. Conclusion: In cases of bronchiectasis without definite causes, it can be considered to measure the level of immunoglobulin G subclass. It is also probably worthwhile to further evaluate the relationship between IgGSD and bronchiectasis.

• Tuberculosis and Respiratory Diseases
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• v.62 no.6
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• pp.506-515
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• 2007

Background: Nosocomial pneumonia in an intensive care unit (ICU) is associated with a high mortality rate. Diagnosing a respiratory tract infection in critically ill patients is still difficult but detailed information for the pathogens is needed to establish an adequate antimicrobial treatment. This study examined the causative organisms and their antimicrobial resistance using bronchoalveolar lavage (BAL) from patients suspected of having pneumonia in the ICU. Methods: From January 2004 to June 2006, ICU patients with diffuse lung infiltration were prospectively enrolled. The BAL was used to diagnose the respiratory infection, with 104 > or = organisms considered a positive result. The most common organisms and their antimicrobial resistances were analyzed from the quantitative BAL cultures in the burn ICU and non-burn ICU. Results: A total 72 patients were included, 35 (M 29, F 6) in the burn ICU and 37 (M 26, F 11) in the non-burn ICU. 27 patients (77.1%) in the burn ICU and 22 patients (59.5%) in the non-burn ICU met the criteria for a positive BAL culture. The major pathogens were Staphylococcus aureus, Acinetobacter species and Pseudomonas aeruginosa. All strains (100%) of Staphylococcus aureus isolated from BAL (9 cases) were methicillin-resistant (MRSA) in the burn ICU, but 5 strains (71.4%, 7 cases) were MRSA in the non-burn ICU. Regarding Pseudomonas aeruginosa, the rate of resistance to amikacin, ciprofloxacin, cefepime, imipenem, ceftazidime, piperacillin/tazobactam in the burn and non-burn ICU ranged from 45.5% to 90% and 25% to 50%, respectively. In addition, the rate of resistance of Acinetobacter species to the above drugs in the burn and non-burn ICU ranged from 81.8% to 100% and 62.5% to 100%, respectively. Conclusions: These results are expected to provide useful guidelines for choosing the effective empirical antimicrobial therapy in patients with lung infiltrations in the burn and non-burn ICU.

• Journal of Korean Tunnelling and Underground Space Association
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• v.19 no.4
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• pp.669-683
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• 2017

The objective of this study is to propose a modification of the previously proposed drainage system for catching the partial leakage of underground concrete structures. Two techniques were proposed for applying the drainage system only to the leaking parts. One was for conveying leaking groundwater to the collection point in the drainage system and the other was for conveying the collected groundwater to the primary drainage system of the underground concrete structure. Four waterproofing materials for conveying leaking groundwater to the catchment point of the drainage system, Durkflex made of porous rubber material, KE-45 silicone adhesive with super strong adhesion, Hotty-gel made of polymeric materials and general silicone adhesive were evaluated for waterproofing performance. Hotty-gel only showed perfect waterproof performance and the other three waterproof materials leaked. The modified drainage system with Hotty-gel and drainage pipe with fixed saddle to convey the leaking groundwater from the catchment point to the primary drainage system were tested on the concrete retaining wall. The waterproof performance and the drainage performance were evaluated by injecting 1,000 ml of water in the back of the modified drainage system at the 7-day, 14-day, 21-day, 28-day, 2-month and 3-month. There was no problem in waterproof performance and drainage performance of the modified drainage system during 3 months. In order to evaluate the construction period and construction cost of the modified drainage system, it was compared with the existing leaching repair method in surface cleaning stage, leakage treatment stage, and protective barrier stage. Total construction period and construction cost were compared in considering the contents of work, repair material, construction equipment, working time, and total number of workers. As a result of comparing and analyzing in each construction stage, it was concluded that the modified drainage system could save construction period and construction cost compared to the existing leaching repair method.

• Journal of Hospice and Palliative Care
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• v.12 no.4
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• pp.194-198
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• 2009

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea Purpose: Malignant bowel obstruction causes gastrointestinal symptoms and leads to diminished quality of life in patients with advanced cancer. Several studies have shown the efficacy of octreotide for the relief of malignant bowel obstruction-related symptoms. The aim of this study is to assess the efficacy and safety of octreotide in patients with malignant bowel obstruction. Methods: We retrospectively reviewed medical records of twenty nine patients who had suffered from malignant bowel obstruction without clinical improvement of conservative care and subsequently, received octreotide treatment. Initial dosage of octreotide was 0.1 mg/day, and dose was escalated depending on the clinical effect. For each patient, we assessed visual analogue scale (VAS) of pain, number of vomiting episode, and amount of nasogastric tube drainage. Results: Median dosage of octreotide was 0.2 mg/day (range 0.1~0.6), and median duration from initial medication to death was 20 days (range 2~103). VAS before and after octreotide treatment were 5.6$\pm$1.24, and 2.7$\pm$0.96, respectively. The numbers of vomiting episode before and after octreotide treatment were 3.6/day$\pm$2.5, and 0.4/day$\pm$0.8, respectively. The mean amounts of nasogastric tube drainage before and after octreotide treatment were 975$\pm$1,083 cc/day and 115$\pm$196 cc/day, respectively. Statistically significant reduction in VAS, the number of vomiting episode and the amount of nasogastric tube drainage were observed after octreotide treatment (P<0.05). Conclusion: Administration of octreotide in patients with malignant bowel obstruction, which is uncontrolled by other medication, was effective and safe. In such clinical situations, physicians should consider to add of octreotide for symptomatic control.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.409-414
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• 2001

Background : Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluate the etiological importance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. Method : The CAP patients over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age $63.8{\pm}15.3$) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. Result : The average Fine's PORT score was 99.7(${\pm}44.9$). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pnewnophila serogroup 1 were not detected. Conclusion : Legionella pnewnophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.

• Tuberculosis and Respiratory Diseases
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• v.50 no.2
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• pp.222-228
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• 2001

Backgrounds : Recent technological developments have introduced a new method to identifying M. tuberculosis complex DNA in clinical samples directly. The direct amplification test (DAT) is approved for identifying M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). When there is a discrepancy between the AFB smear and DAT, no information on their clinical utility is currently available. In this study, the diagnostic reliability of DAT was investigated in suspected pulmonary tuberculosis patients whose sputum AFB smear was negative. Methods : From June 1, 1998 through May 30, 1999, 909 patients with presumed active pulmonary tuberculosis were enrolled. A sputum AFB stain, culture, DAT and/or biopsy were performed. Using the criteria of clinical tuberculosis or confirmed tuberculosis, the positive predictive value of DAT in diagnosing pulmonary tuberculosis was investigated. Results : The positive predictive value of DAT was 82.1% by the clinically active tuberculosis criteria. However, it decreased to 61.5% when diagnosis was restricted to only to culture positive or biopsy proven cases. The false positive rate of DAT was 18.0%. Conclusion : The DAT is a valuable diagnostic method in suspected patients whose sputum AFB is was negative.

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.728-735
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• 1996

Background : Recognition and ingestion of opsonized microorganisms by neutrophils induces the burst of oxidative metabolic activity. Products of the respiratory burst activity provide powerful oxygen dependent killing mechanism. Measurement of respiratory burst activity has been a major indicator of the functional capacity of neutrophils. We determined the respiratory burst activity of neutrophils in patients with pneumonia and observed the changes during the clinical course of pneumonia. Methods: The EDTA blood was drawn from 24 normal controls and same numbers of pneumonia patients. The respiratory burst activity(with the production of $H_2O_2$ which changes nonfluorescent DCF-DA to green fluorescent DCF) in the non-stimulated state and the stimulated state with fMLP and PMA of neutrophils was measured by flowcytometry at day 1, 3, 5, 7 and 9 of admission. Results: The respiratory burst activity of neutrophils was mildly increased by stimulation with fMLP. But there was no statistical significance between normal control and patients with pneumonia. The respiratory burst activity of neutrophils was markedly increased by stimulation with PMA in both groups. There was a significant difference in response to PMA between normal control and patients with pneumonia. The production of hydrogen peroxide from neutrophils was decreased during early course of pneumonia and it was recuperated gradually to normal level in 9 days. Conclusion : Hydrogen peroxide production from neutrophils was suppressed during early course of pneumonia and restored after treatment. It is suggested that the production of oxygen radical in response to PMA stimulation from each neutrophils is decreased rather than increased during the early course of pneumonia.