• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.488-497
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• 1999

Background : Identification of the histologic cell type of lung cancer is important because it is related to the treatment modality and prognosis. Currently, many diagnostic methods are used to determine the cell type. We have studied to evaluate the histologic accuracy of each diagnostic methods in lung cancer. Method : 168 cases were analysed retrospectively, who underwent curative thoracotomy for lung cancer in Seoul National University Hospital from January, 1994 to February, 1997. Sputum cytology, percutaneous needle aspiration(PCNA), percutaneous needle biopsy(PCNB), bronchial washing cytology and flexible bronchoscopic biopsy were evaluated respectively. The k coefficient was applied to evaluate the degree of concordance between the histologic diagnosis obtained by each methods and the one derived from thoracotomy. Results : The k value in sputum cytology was 0.86. In the 34 cases with squamous cell carcinoma(SQ), 32 cases were finally diagnosed as having such by thoracotomy. 7 of the 8 cases with adenocarcinoma(AD) turned out to have the same. The k value in PCNA was 0.51. In the 31 cases with SQ, only 14 cases were finally diagnosed as having such. All of the 3 cases with small cell carcinoma(SC) turned out to have the same. The k value in PCNB was 0.77. The diagnosis was correct in 13 of the 16 patients with SQ and in 30 of the 32 cases with AD. The k value in bronchial washing cytology was 1.0. In all of the 29 cases with SQ and all of the 7 cases with AD, the diagnosis was correct. The k value in flexible bronchoscopic biopsy was 0.77. The diagnosis was correct in 51 of the 52 cases with SQ and in 1 of the 2 cases with SC. Conclusion : The concordance rate with the final histologic diagnosis in sputum cytology, PCNB, bronchial washing cytology and flexible bronchoscopic biopsy were excellent ($k{\geq}0.75$), while that in PCNA was fair (k=0.53). Because PCNA showed lower concordance rate than other diagnostic methods, PCNA is recommended to perform with PCNB.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.768-774
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• 1999

Background: It is well known that rifampin decreases the hypoprothrombinemic effect of warfarin by induction of cytochrome P-450 enzyme in healthy volunteer. However, in patients the dosage schedule of warfarin during rifampin therapy is not established. Therefore, patients taking both rifampin and warfarin were reviewed to find out the adequate dosage schedule of warfarin in addition to side effects by interaction of two drugs. Method: Patients taking both rifampin and warfarin were retrieved from patients who were admitted due to heart disease and tuberculosis at Boochun Sejong Hospital from January of 1995 to August of 1999. To decide the adequate dosage of warfarin, the dosage of warfarin before, during, and after rifampin was evaluated in patients who kept adequate hypoprothrombinemic effect of warfarin during rifampin. To decide the adequate dosage schedule of warfarin, the time interval from the beginning of rifampin to normalization of prothrombin time(INR$\geq$1.1) was evaluated. And, the side effects by interaction of two drugs were reviewed. Results: All 12 patients taking both rifampin and warfarin were retrieved. Among them only 6 kept adequate hypoprothrombinemic effect of warfarin during rifampin. The dosage of warfarin during rifampin was $2.4{\pm}0.6$(mean$\pm$standard deviation) times as much as that before rifampin but the dosage after rifampin was the same as that before rifampin. The time interval from the beginning of rifampin to normalization of prothrombin time was $5.8{\pm}2.9$(mean${\pm}$standard deviation) days. 2 out of 12 had complication related to the interaction of rifampin and warfarin, one cerebral embolism just after the beginning of rifampin and the other cerebral hemorrhage just after the discontinuation of rifampin. Conclusion: When both rifampin and warfarin are prescribed, it would be a possible method to be confirmed by prospective study that warfarin be gradually increased about 2 times more than that without rifampin over 1 week or so after the beginning of rifampin and be tapered to the same dosage as that before rifampin when rifampin is discontinued. And, it would be prudent that prothrombin time be monitored frequently during rifampin and warfarin therapy, especially the beginning or discontinuation of rifampin.

• Tuberculosis and Respiratory Diseases
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• v.48 no.6
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• pp.956-963
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• 2000

Backgrounds : Obstructive sleep apnea syndrome(OSA) can divided into two groups, positional(PP) and non-positional(NPP) obstructive sleep apnea syndrome, according to the body position while sleeping. In this study, we evaluated the differences of anthropometric data and polysomnographic recordings between the two types of sleep apnea syndrome. Materials : Fifty patients with OSA were divided two groups by Cartwright's criteria. The supine respiratory disturbance index (RDI) was at least two times higher than the lateral RDI in the PP group, and the supine RDI was less than twice the lateral RDI in the NPP group. This patients underwent standardized polysomnographic recordings. The anthropometric data and polysomnographic data were analyzed, statistically. Results : Of all 50 patients, 30% were found to be positional OSA. BMI was significantly higher in the PP group(p<0.05). Total sleep time was significantly longer in the PP group (350.6$\pm$28.2min, 333.3$\pm$46.0min, (p<0.05). Sleep efficiency was high in the PP group(89.6$\pm$6.4%, 85.6$\pm$9.9%, p<0.05). Deep sleep was significantly higher and light sleep was lower in the PP group than in the NPP group but no difference was observed in REM sleep between the two groups. Apnea index(AI) and RDI were significantly lower( 17.0$\pm$10.6, 28.5$\pm$13.3, p<0.05) and mean arterial oxygen saturation was higher in the PP group(92.7$\pm$1.8%. p<0.05) than in the NPP group. Conclusion : Body position during sleep has a profound effect on the frequency and severity of breathing abnormalities in OSA patients. A polysomnographic evaluation for suspected OSA patients must include monitoring of the body position. Breathing function in OSA patients can be improved by controlling their obesity and through postural therapy.

• Tuberculosis and Respiratory Diseases
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• v.57 no.1
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• pp.19-24
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• 2004

Background : It is difficult to differentiate between tuberculous pneumonia and Community Acquired Pneumonia, so the diagnosis and treatment of tuberculous pneumonia can be delayed frequently. In this study, we attempted to retrospectively evaluate the clinical and radiologic characteristics of tuberculous pneumonia. Methods : We conducted a retrospective analysis of clinical characteristics of 58 patients diagnosed with tuberculous pneumonia from Nov. 1997 to May 2001 at Korea university kuro hospital. Result : The male to female ratio was 1:1 and the mean age at diagnosis was $54.5{\pm}18.6$ years. Fifty five patients were confirmed microbiologically and three patients pathologically. There were 20 patients(34.5%) who had diabetes mellitus(8cases), chronic obstructive pulmonary disease(3cases), malignancy(3cases), bronchiectasis(2cases), chronic renal failure(1cases) or long term history of corticosteroid treatment(3cases). Many patients had multilobar infiltration in chest X-ray, dominantly in the lower lobe. thirty two patients(55.2%) had infiltration in more than 2 lobes and 5 patients in more than 4 lobes. The significant correlation between the diabetes mellitus and the infiltrated Rt lower lobe(RLL) was found on the borders of confidence limit.(P=0.07<0.1). There was significant correlation between woman and infiltrated lobe(RML, RLL, LLL) excluding the both upper lobe(P=0.029). Conclusion : We must consider tuberculous pneumonia when lobar pneumonia with consolidation resistant to antibiotics, especially in the patients who have diabetes mellitus, chronic obstructive pulmonary disease, malignancy, bronchiectsis, chronic renal failure or long term history of corticosteroid treatment.

• Journal of the Korean Society of Food Science and Nutrition
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• v.25 no.5
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• pp.855-864
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• 1996

The purpose of this study is to evaluate nutritional status of tube feeding patients, and to investigate the effects of giving enteral nutritional support to them. 83 in-patients have been examined for their nutritional status. The mean caloric density was 0.77kca1/m1. 36.1% to 75.9% of them were malnourished in terms of biochemical assessment. The energy intake showed the significant and positive correlation in all biochemical parameters. And the protein intake showed the significant and positive correlation in total protein, serum albumin, serum iron, hemoglobin, hematocrit and TLC. But age was correlated negatively to serum albumin and transferrin. The amount of energy and protein intake has been significantly increased as the tube feeding duration became longer. Also the effect of enteral nutritional support for 6 weeks has been investigated. Case group(n=8) was administered 250kca1 of polymeric formula in addition to their usual diet, while control group(n=8) kept the amount of their original intake. When comparing the biochemical changes of the case group and those of control group at week 0 and week 6 respectively, it showed significant differences in total protein, serum transferrin and TLC. This study suggests that the malnourished status of tube feeding patients can be improved and even prevented if nutritional support is properly administered.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.1
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• pp.41-48
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• 2010

Objectives: The aim of this study was to assess appropriate time to convert intramuscular progesterone support to oral administration for luteal phase support in in vitro fertilization (IVF). Methods: Seventy-six cycles of IVF in which fetal heart beat was identified after treatment were included. Patients underwent controlled ovarian hyperstimulation with GnRH agonist long protocol (n=7) or GnRH antagonist protocol (n=66). Cryopreserved embryo transfer was performed in three cycles. Luteal support was initiated by daily intramuscular injection of progesterone, and after confirmation of fetal heart beat, converted to oral micronized progesterone (Utrogestan, Laboratoires Besins International, France) 300 mg daily before or after 8 gestational weeks. The oral progesterone was continued for 11 weeks. Results: Overall clinical abortion rate was 3.9% (3/76) and mean time to conversion was $8^{+4}$ gestational weeks ($46{\pm}5.8$ days after oocytes retrieval). The abortion rate was 5.6% (1/17) and 3.4% (2/59) in patients with conversion before 7 weeks and after 8 weeks, respectively, which were not statistically significant (p=0.678). The miscarriages were occurred at $9^{+4}$ weeks, $11^{+3}$ weeks and $11^{+4}$ weeks. Conclusion: Sequential luteal support using intramuscular and oral progesterone yields a relatively low clinical abortion rate. If fetal heart beat confirmed, sequential regimen appears to be safe and convenient method to reduce patients' discomfort induced by multiple injections.

• Journal of Oral Medicine and Pain
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• v.30 no.1
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• pp.57-67
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• 2005

The aim of this study was to evaluate bone scan(SUR) and SPECT(hot spot) in patients with TMJ osteoarthritis. 99mTc-MDP bone scan and SPECT were done in 27 patients, total 54 temporomandibular joints were examined with clinical examination, plain radiography. 42 TMJs were osteoarthritis and 12 TMJs were normal case, clinically diagnosed. We compared osteoarthritis group and control group of bone scan(SUR) and SPECT(hot spot). thus we compared before and after treatment of bone scan(SUR) and bone SPECT(hot spot) according to history, contributing factor, symptom degree, treatment, treatment period. The obtained results were as follows. 1. Bone scan(SUR) and SPECT(hot spot) activity of osteoarthritis group were higher than control group(P<0.05, P<0.01). 2. Bone scan(SUR) and SPECT(hot spot) activity were decreased after treatment at TMJ with osteoarthritis(P<0.01). 3. Bone scan(SUR) and SPECT(hot spot) activity were decreased at treatment group with splint(P<0.01, P<0.05). 4. Bone scan(SUR) and SPECT(hot spot) activity were decreased at Chronic group(P<0.01, P<0.05). 5. Bone scan(SUR) and SPECT(hot spot) activity were decreased at low noise NAS(<6) group(P<0.01,P<0.05). 6. Bone scan(SUR) and SPECT(hot spot) activity were decreased at TMD patient with parafunctional habit and without trauma history, psychosocial factor. 7. Bone scan(SUR) and SPECT(hot spot) activity were higher at before treatment required more treatment period.

• Journal of dental hygiene science
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• v.2 no.2
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• pp.95-103
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• 2002

This study was carried out to investigate recognition level and practical application status of oral hygiene devices through making a survey of Seoul inhabitants. And survey was implemented in order to propose oral hygiene device for household health care activities. The following results were obtained by analyzing personal interviews of 347 commuting patients at two university hospitals and seven dental clinics. 1) The average length of toothbrush head was estimated as 22.3 mm and average changing cycle was 2.3 months. The user ratio of flat-headed brush was estimated as 51.9% and 46.7% were using fluoridated toothpaste. 2) Generally the ratio of toothpick users was higher than other device users. But the user ratio of dental floss was higher than toothpick in case of patients under orthodontic treatment. 3) The patients under orthodontic treatment were not familiar with handling orthodontic toothbrush. Though 45.8% among orthodontic patients recognized this type of toothbrush, only 25.4% of them knew how exactly to use it. 4) It was shown very low user ratio of oral hygiene devices that the patients who had periodontal problem, hypersensitive trouble, halitosis, implant or denture 5) The patients who had halitosis showed the highest user ratio of toothpick. The patients who had separation of teeth showed the highest user ratio of dental floss. The patients who're under orthodontic treatment showed the highest user ratio of interproximal brush and motorized brush. 6) In response to the most interesting dental disease, it's surveyed as follows; 60.3% of dental caries, 24.0% of periodontal disease, 14.8% of false occlusion and 0.9% of oral cancer. 7) Regarding the motivation of using those oral hygiene devices, 45% responded that it was because of recommendation by dental clinics. Among the negative answers, 38.6% responded that it was because of no selection guidance. 31.3% answered that they didn't use hygiene device because it's inconvenient. 12.0% answered that it's difficult to buy and expensive. 7.8% responded that they didn't feel significant improvement. 4.8% answered that dental hospitals and clinics didn't even introduce those hygiene devices. Therefore efficient campaign for those hygiene devices over all Korea nation should be developed and education program must be prepared for each case of patients in every dental hospitals and clinics.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.10 no.2
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• pp.212-219
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• 1999

Objective：This study is designed to get clinical guidelines for management of children with TBI by examining neuropsychiatric sequelae of TBI, determining whether the severity of TBI, type of treatment, and enviornmental factors are related to those sequelae, and defining the adequacy of public psychological tests as evaluating tools for them. Method：This is chart review of 47 children, aged 5 to 14 years, referred to a psychiatric outpatient clinic for neuropsychiatric evaluation at least 6 months after TBI. Data on the initial GCS score, associated injury, treatment type, and duration of hospital stay are obtained from medical records. EEG, MRI, intelligent test, and several psychological tests are administrated at the point of assessment. Results：1) Cognitive symptoms outnumber externalizing behavioral, emotional, and somatic symptoms, with no significant differences of frequencies of those 4 categorical symptoms between mild injury group and moderate to severe group. 2) Children treated with non-surgical method(p<0.01) complain more cognitive symptoms than the others. 3) Behavioral symptoms are related to younger age(p<0.05), and to anticonvulsant medication(p<0.05). 4) Children with associated injury complain emotional symptoms more frequently(p<0.05). 5) More somatic symptoms are presented by children with no medication(p<0.05), and with higher I.Q(p<0.05). 6) Low I.Q is correlated to low GCS score (p<0.05). Cognitive impairment is confirmed in 25 in 42 children complaining cognitive symptoms though I.Q test and BGT, whose hospital stay is longer than the others(p<0.05). 7) emotional disturbance is confirmed in 22 in 25 children showing emotional problems through psychological tests, who complain cognitive symptoms more frequently(p<0.05). Conclusion：This findings suggest that even mild TBI children need to be followed-up and treated as complaining neuropsychiatric symptoms over 6 months after injury, and shorter hospital stay is recommended for cognitive and emotional status of children, and for better evaluation of neuropsychiatric sequelae of TBI, more specific tests should be included in neuropsychological test tools.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.621-628
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• 1997

Background : As the pleural inflammation progresses, exudative pleural fluid becomes loculated rapidly with pleural thickening. Complete drainage is important to prevent pleural fibrosis, entrapment and depression of lung function. Intrapleural urokinase instillation therapy has been advocated as a method to facilitate drainage of gelatinous pleural fluid and to allow enzymatic debriment of pleural surface. This study was designed to investigate the predictors of effectiveness of intrapleural urokinase in the treatment of loculated pleural effusion. Method : Thirty-five patients received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French. Twenty-two patients had tuberculous pleural effusions, and 13 had non-tuberculous postpneumonic empyemas. A total of 240,000 units of urokinase was dissolved in 240 ml of normal saline and the aliquots of 80mL was instilled into the pleural cavity via pig-tail catheter per every 8hr. Effectiveness of intrapleural urokinase instillation therapy was assessed by biochemical markers, ultrasonography, and technical details. A greater than 50% improvement on follow-up chest radiographs was defined as success group. Result : Twenty-seven of 35 (77.1%) patients had successful outcome to urokinase instillation therapy. Duration of symptoms before admission was shorter in success group ($11.8{\pm}6.9day$) than in failure group ($26.62{\pm}16.5day$) (P<0.05). Amount of drained fluid during urokinase therapy was larger in success group ($917.1{\pm}392.7ml$) than in failure group ($613.8{\pm}259.7ml$) (P<0.05). Pleural fluid glucose was higher in success group ($89.7{\pm}35.9mg/dl$) than in failure group ($41.2{\pm}47.1mg/dl$) (P<0.05). Pleural fluid LDH was lower in success group ($878.4{\pm}654.3IU/L$) than in failure group ($2711.1{\pm}973.1IU/L$) (P<0.05). Honeycomb septated pattern on chest ultrasonography was observed in six of eight failure group, but none of success group (P<0.05). Conclusion : Longer duration of symptoms before admission, smaller amount of drained fluid during urokinase therapy, lower glucose value, higher LDH value in pleural fluid examination, and honeycomb septation pattern on chest ultrasonograph were predictors for failure group of intrapleural urokinase instillation therapy.