• Tuberculosis and Respiratory Diseases
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• v.58 no.2
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• pp.160-166
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• 2005

Background : Although home oxygen therapy in hypoxemic patients with chronic lung disease has been increasing over the decade in Korea, the present state has not been known well. This study was done to know the situation of home oxygen therapy in a Korean university hospital. Methods : Between January 1, 2000 and August 31, 2003, 86 patients prescribed home oxygen therapy by the pulmonary physicians of Asan Medical Center were investigated using their medical record and questionnaire. Results : Patients (52 men, mean age of 61 years) with home oxygen therapy were increasing by every year. Underlying diseases were COPD (n=29), tuberculous destroyed lung (n=18), bronchiectasis (n=15), ILD (n=12), and others. Baseline $FEV_1/FVC$, FVC, and $FEV_1$ of patients were $58.4{\pm}25.2%$, $54.5{\pm}17.1%$ of predicted, and $41.7{\pm}20.6%$ of pred. Mean oxygen flow was 1.5 L/min and mean duration per day was 14.5 hours. During therapy, mean $PaO_2$ values have increased from 51.2 to 77.7 mm Hg and $PaCO_2$ values have increased from 47.5 to 49.6 mm Hg. Only 16.5% of the subjects were monitored by visiting nurses or pulse oximeter. Three year survival rate was 56.6% and hypercapnic patients showed better prognosis. Conclusion : The patients with home oxygen therapy were increasing yearly and a part of them were monitored. The hypercapnea respiratory failure patients would have better prognosis.

• Tuberculosis and Respiratory Diseases
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• v.59 no.2
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• pp.170-178
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• 2005

Background : Idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare but significantly imperative in inducing chronic pulmonary hypertension. Clinically, it is difficult to distinguish between IPAH and CTEPH. However, the treatment of pulmonary hypertension is different depending on the disease. The present study was performed to analyze the similarities and differences in clinical features between IPAH and CTEPH. Methods : During a nine-year period, thirty-three patients with IPAH and twenty-two patients with CTEPH were enrolled. Symptoms, physical findings, chest radiograph, electrocardiograph, pulmonary function test, echocardiograph, perfusion lung scan, right heart catheterization results were analyzed between both the groups. Results : The median age of IPAH group was 33 (6~70) years that was lower than that (52(27~80) years) of CTEPH group. Amongst the IPAH patients, there was female predominance (76 %) and there was no sex difference between the patients with CTEPH. Both the groups exhibited similarity in the results of chest radiograph, electrocardiograph, pulmonary function test, and echocardiograph. In the perfusion lung scan, all IPAH patients exhibited findings with normal (28%) or low probability (72%) of pulmonary embolism and all CTEPH patients exhibited findings with high probability of pulmonary embolism. Conclusion : Although IPAH and CTEPH bear similarities in terms of symptoms, physical signs and general investigation results, there were differences in age distribution, sex predominance and results of perfusion lung scan.

• Tuberculosis and Respiratory Diseases
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• v.60 no.5
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• pp.510-515
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• 2006

Background : Although 17% of Korean adults over the age of 45 years have chronic obstructive pulmonary disease (COPD), there is only limited data on the cause of death in COPD patients in Korea. Therefore, this retrospective study was performed to examine the cause of death in COPD patients at a referral hospital in Korea. Methods : The medical records of 28 deceased patients diagnosed as COPD in Asan Medical Center from January to December 2003 were reviewed patients had died in Asan Medical Center and 16 patients had died outside the hospital. The Korean National Statistical Office confirmed 88 deceased patients out of 1,078 patients diagnosed as COPD in Asan Medical Center in 2003. After excluding those with tuberculous destroyed lung, bronchiectasis, and lung cancer, 28 COPD patients were evaluated. Results : The causes of death were pulmonary disease including pneumonia in 16 patients (57%), cardiac disease in 5 patients (18%), sudden death in 3 patients (11%), and other causes in 4 patients (14%). The cause of death was pulmonary disease in 83% (10 out of 12 patients) and 38% (6 out of 16 patients) of patients who died in Asan Medical Center and outside the center, respectively (P=0.05). The cause of death was pulmonary disease in 43% of patients with $FEV_1$ more than 50 % of the predicted value and in 55% of patients with $FEV_1$ less than 50 % of the predicted value (P=0.89). Conclusion : Pulmonary disease is the leading cause of death in COPD patients in Korea.

• Tuberculosis and Respiratory Diseases
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• v.60 no.5
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• pp.548-553
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• 2006

Background : Alcoholic ketoacidosis(AKA) is a metabolic disturbance that is caused by prolonged and excessive alcohol consumption. Though the prognosis is reportedly good, its outcome is unclear in some cases that are combined with multi-organ failure. There are few reports of an analysis of cases admitted to an intensive care unit(ICU) Method: Cases of AKA admitted to the ICU over the last 5 years were retrospectively analyzed. Severe AKA was characterized by multi-organ failure that required treatment in an ICU Results : All patients were males with a history of excessive alcohol consumption. Five of them (50%) mainly complained of gastrointestinal symptoms (nausea, vomiting, diarrhea), showing metabolic acidosis with an increased asmolar and anion gap. Rhabdomyolysis with acute renal failure was the most common combined organ failure. Mechanical ventilation was performed in 80%. Six patients died and 4 patients survived. In the surviving patients, the arterial blood gas analysis(ABGA) was normalized within 12 hours after admission. Conclusion : In severe AKA patients, rhabdomyolysis with acute renal failure was the most common complication. The mortality rate was high and death from shock occurred within 3 days.

• Tuberculosis and Respiratory Diseases
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• v.61 no.3
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• pp.218-226
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• 2006

Background: The lung volume and diffusing capacity are influenced by ethnicity. However, there are no equations for predicting the normal lung volume in the adult Korean population, and there is only one equation for diffusing capacity. The aim of this study is to select the most suitable reference equation for the Korean population. Method: 30 men and 33 women at Hanyang University Guri Hospital, and 27 men and 34 women at Asan Medical Center in healthy nonsmoking adults were enrolled in this study. The subject's age, gender, height, weight, lung volume by plethysmography, and diffusing capacity by a single breathing method were obtained. The most suitable equation with the lowest sum of residuals between the observed and predicted values for lung volume and diffusing capacity was selected. Result: At Hanyang University Guri Hospital, the equations with the lowest sum of residuals in the total lung capacity were ECSC's equation in males (sum of residual: 0.04 L) and Crapo/Morris's equation (-1.04) in women. At the Asan Medical Center, the equations with the lowest sum of residuals in the total lung capacity were Goldman/Becklake's equation in males (sum of residual: -2.35) and the ECSC's equation -4.49) in women. The equations with the lowest sum of residuals in the Diffusing capacity were Roca's equation in males (sum of residual: -13.66 ml/min/mmHg) and Park's in women (25.08) in Hanyang University Guri hospital and Park's equation in all cases in the Asan Medical Center (male: -1.65, female: -6.46). Conclusions: Until a reference equstion can be made for healthy Koreans by sampling, ECSC's equation can be used for estimating the lung volume and Park's can be used for estimating the diffusing capacity.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.398-405
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• 2007

Background: There is little data on the 3 year prognosis and quality of life of patients on long-term (>72 hour) mechanical ventilation in a medical intensive care unit (MICU). Methods: Patients with long-term mechanical ventilation from May 2003 through July 2003 in MICU of Asan Medical Center, Seoul were enrolled in this studay. The survival rates were observed prospectively at 1, 3, 6, 12, 24, 36 months, and the quality of life of survivor was measured at 12 months by using Short Form 36 (SF-36). Results: The survival rate at 1, 3, 6, 12, 24 and 36 months was 54.8% (40/73), 39.7% (29/73), 30.1% (22/73), 20.5% (15/73), 18.3% (13/71) and 16.9% (12/71), respectively. There was a similar survival rate regardless of the diseases that required mechanical ventilation. A neoplasm or chronic liver disease had a worse survival rate than chronic lung or kidney disease (p<0.05). Each SF-36 domain except for the Role-emotional was inferior to the general population. Conclusions: The survival rate of patients with mechanical ventilation more than 72 hours is decreases continuously until 12 months but is relatively constant from 12 to 36 months. In these patients quality of life is also decrased.

• Tuberculosis and Respiratory Diseases
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• v.63 no.4
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• pp.331-336
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• 2007

Background: Although pulmonary tuberculosis (TB) is a respiratory disease, the presence of Mycobacterium tuberculosis (Mtb) DNA or Mtb itself has been reported in the peripheral blood (PB) of several patients with pulmonary TB. Additionally, it was recently announced that active pulmonary TB patients donated PB, and that this blood was then transfused to other individuals in Korea. Methods: Sixty-nine patients with bacteriologically-confirmed pulmonary TB (35), non-tuberculous mycobacterial (NTM) lung disease (6), and other lung diseases (28) were enrolled in this study, which was conducted to determine if Mtb DNA could be detected in the PB by PCR. In addition, 10 pulmonary TB patients with high-burden bacilli were also enrolled in this study for the culture of Mtb in PB. Results: PCR detected the presence of Mtb in 22.8% (8/35) of the pulmonary TB patients, in 16.7% (1/6) of the patients with NTM lung disease, and in none of the patients with other diseases (0%). In addition, no Mtb was cultured from the PB of the 10 pulmonary TB patients. Conclusion: Although Mtb DNA was detected in the PB of some patients with pulmonary TB, viable Mtb was not isolated from the PB of those patients, which indicates that patients that viable Mth may not be transmitted via trasfusion of blood of pulmonary TB patients.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.35-41
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• 1992

Forty eight patients with adenoid cystic carcinoma (ACC) in the head and neck treated between 1979 and 1990 were reviewed according to treatment modalities and clinical courses. The common site of origin was minor salivary gland ($69\%$), mostly hard palate and maxillary sinus. 11 patients received radiation therapy (RT) alone and 37 patients received combined surgery and radiation therapy. The follow-up period of the survivors ranged from 4 to 118 months (median 49.5 months). The 5 year local control rate was $69.3\%$, $67.3\%$ and 83.9$\%$ in RT alone, conservative operation (OP)+RT and radical OP+RT group, respectively (p>0.05). The control of local disease was best achieved with radical OP+RT. In postoperative RT, high dose ($\ge$60 Gy) and generous field size($\ge$64 cm$^2$) yielded a better local control rate. Actuarial overall survival rate was $79.0\%$, at 5 years and $19.2\%$ at 10 years. Distant metastases (DM) developed in $40\%$ of patients, mostly in the lung. Disease-free (NED) survival rate was $45.8\%$ at 5 years and significant differences did not exist according to primary sites and treatment options. Survival rate after the onset of DM was $19.5\%$ at 5 years. Occurrence of DM tends to lower survival significantly. In an effort to find the role of RT in the treatment of ACC, our data suggest that a well-planned postoperative RT employing a high dose and generous field size can produce high local control rate and remaining urgent problem of distant metastasis demands more effective chemotherapy for the purpose of improving survival of ACC patients.

• Radiation Oncology Journal
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• v.13 no.1
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• pp.69-78
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• 1995

Seventy four patients with soft tissue sarcomas treated by postoperative radiotherapy in the Department of Therapeutic Radiology, Seoul National University Hospital between August 1979 and September 1990 were analyzed. The follow-up Period ranged from 3 to 145 months with a median of 51 months. Liposarcoma and malignant fibrous histiocytoma(MFH) constituted $54\%$ of the cases and the histologic grades of tumors are as follows: grade I, 23 cases; grade II, 17 cases; grade III, 24 cases: unknown grade, 10 cases. The patients were treated by marginal(17 cases), wide(55 cases) or compartmental(2 cases) excision followed by Postoperative radiotherapy. The total radiation doses were 4200-8820 cGy (median 6000 cGy), 180-200 cGy daily. 5 times per week. Of 74 Patients, 35 ultimately failed. The local control was $62.2\%$ at 5 years and cumulative risk of distant metastasis was $22,3\%$ at 5 years. The overall survival and disease free survival were $72.3\%$, and $53.3\%$ at 5 years, respectively. Survival after appearance of metastasis was $15.1\%$ at 3 years. Patients with liposarcoma experienced better local control than those with other histologic type and tumor grade and surgical resection margin significantly correlated with local recurrence, distant metastasis and overall survival on univariate analysis. In conclusion, re-excision is needed for patients with positive surgical resection margin to improve local control and further therapeutic measures using effective chemotherapy should be explored in the hope of improving overall survival.

• Journal of Radiation Protection and Research
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• v.39 no.3
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• pp.142-149
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• 2014

Korea conducts a national health screening program to improve and check-up on public health and in recent years, the screening usage has been increased. Given the increased screening usage for radiographic exams, this study predicts the frequency of using radiographic exams and the exposure dose. This study estimates the usage of radiographic exams by isolating radiographic exams from the 2011 analysis of the national health insurance corporation, and estimates the public exposure dose by applying each procedure's dose table from UNSCEAR 2008. As a result of the analysis, in the 2011 National Health Screening, the average exposure dose per person is assumed to be 0.57 mSv, and depending on the type of screening program from the radiographic exam, an examinee could be exposed to between 0.2 mSv and 11.081 mSv. The frequency of using radiographic exposure was found to be 16,005,914 and the exposure dose was 6,311.76 person-Sv. The most frequent exam is the Chest X-ray, which was performed 1,070,567 (69.17%), and the UGI has the highest exposure dose at 5,217.94 person-Sv (82.67%). The outcome is categorized based on gender and age, excluding those under 39 years old. In all age groups, the screening usage and exposure dose are higher in females than in males. In particular, females between 50 and 54 years old have the highest screening usage (1,674,787, 10.5%) and exposure dose (701.59 person-Sv, 11.1%). As UGI accounts for 82.76% of procedures, except when done for medical purposes, if the government supports a voluntary UGI exam (which includes the UGI exam in the National Screening Program) or abolishes it completely, as seen overseas, the cost-effectiveness and validity of the UGI exam, as well as the exposure dose from the National Screening Program will all decrease significantly.