• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.455-464
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• 1995

Background: Considering that both humoral and cell mediated immunities play an important role for human tuberculosis infection, enzyme-linked immunosorbent assay(ELISA) measurement of immunoglobulin G (IgG) antibody to mycobacterial antigens can be used for the serologic diagnosis of tuberculous pleural effusion. Method: We measured absorbance values of IgG antibodies to purified-protein-derivative (PPD) and lipoarabinomannan-B (LAM-B) in the pleural fluid (PF) and the serum in 40 tuberculous (TPE) and 19 nontuberculous pleural effusions (NTPE). Results: 1) The IgG antibodies to PPD and LAM-B were significantly (P<0.0005) higher in the PF and the serum of TPE compared to NTPE. 2) The IgG antibodies to PPD and LAM-B in the serum were higher than that in PF. 3) Significant correlations were found between pleural and serum IgG antibodies to PPD and LAM-B. 4) With a cutoff value for IgG antibody to PPD in the PF of 0.091, sensitivity was 55.0% and specificity 94.7% in the diagnosis of TPE. 5) With a cutoff value for IgG antibody to LAM-B in the PF of 0.337, sensitivity was 50.0% and specificity 94.7% in the diagnosis of TPE. 6) The seropositive rates in TPE were not related to PPD skin test status, the amount of PF and coexisting active pulmonary tuberculosis. Conclusion: The assay of IgG antibodies to PPD and LAM-B might be useful for the diagnosis of TPE. Our study suggests the mechanism of passive transfer of IgG antibodies to PPD and LAM-B from the serum to the PF through pleural tissue.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.685-696
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• 1999

Background : Idiopathic pulmonary fibrosis (IPF) is a diffuse inflammatory and fibrosing process that occurs within the interstitium and alveolus of the lung with invariably poor prognosis. The major problem in management of IPF results from the variable rate of disease progression and the difficulties in predicting the response to therapy. The purpose of this retrospective study was to evaluate the short-term efficacy of steroid and immunosuppressive therapy for IPF and to identify the pre-treatment determinants of favorable response. Method : Twenty patients of IPF were included. Diagnosis of IPF was proven by thoracoscopic lung biopsy and they were presumed to have active progressive disease. The baseline evaluation in these patients included clinical history, pulmonary function test, bronchoalveolar lavage (BAL), and chest high resolution computed tomography (HRCT). Fourteen patients received oral prednisolone treatment with initial dose of 1mg/kg/day for 8 to 12 weeks and then tapering to low-dose prednisolone (0.25mg/kg/day). Six patients who previously had experienced significant side effects to steroid received 2mg/kg/day of oral cyclophosphamide with or without low-dose prednisolone. Follow-up evaluation was performed after 6 months of therapy. If patients met more than one of followings, they were considered to be responders : (1) improvement of more than one grade in dyspnea index, (2) improvement in FVC or TLC more than 10% or improvement in DLco more than 20% (3) decreased extent of disease in chest HRCT findings. Result : One patient died of extrapulmonary cause after 3 month of therapy, and another patient gave up any further medical therapy due to side effect of steroid. Eventually medical records of 18 patients were analyzed. Nine of 18 patients were classified into responders and the other nine patients into nonresponders. The histopathologic diagnosis of the responders were all nonspecific interstitial pneumonia (NSIP) and that of nonresponders were all usual interstitial pneumonia (UIP) (p<0.001). The other significant differences between the two groups were female predominance (p<0.01), smoking history (p<0.001), severe grade of dyspnea (p<0.05), lymphocytosis in BAL fluid ($23.8{\pm}16.3%$ vs $7.8{\pm}3.6%$, p<0.05), and less honeycombing in chest HRCT findings (0% vs $9.2{\pm}2.3%$, p<0.001). Conclusion : Our results suggest that patients with histopathologic diagnosis of NSIP or lymphocytosis in BAL fluid are more likely to respond to steroid or immunosuppressive therapy. Clinical results in large numbers of IPF patients will be required to identify the independent variables.

• Tuberculosis and Respiratory Diseases
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• v.61 no.3
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• pp.265-272
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• 2006

Background: Chest wall deformities such as kyphoscoliosis, thoracoplasty, and fibrothorax cause ventilatory insufficiency that can lead to chronic respiratory failure, with recurrent fatal acute respiratory failure(ARF). This study evaluated the frequency and outcome of ARF, the physiologic status, and the long-term prognosis of these patients. Methods: Twenty-nine patients with chest wall disorders, who experienced the first requirement of ventilatory support from ARF were examined. The mortality and recurrence rate of ARF, the pulmonary functions with arterial blood gas analysis, the efficacy of home oxygen therapy, and the long-term survival rate were investigated. Results: 1) The mortality of the first ARF was 24.1%. ARF recurred more than once in 72.7% of the remaining 22 patients, and overall rate of successful weaning was 73.2%. 2) Twenty-two patients who recovered from the first ARF showed a restrictive ventilatory impairment with a mean FVC and TLC of 37.2% and 62.4 % of predicted value, respectively, and a mean $PaCO_{2}$ of 57mmHg. Among the parameters of pulmonaty functions. the FVC(p=0.01) and VC(p=0.02) showed a significant correlation with the $PaCO_{2}$ level. 3) There were no significant differences between the patients treated with conservative medical treatment only and those with additional home oxygen therapy due to significant hypoxemia in the patients with recurrent ARF and the mortality. 4) The 1, 3, 5-year survival rates were 75%, 66%, and 57%, respectively, in the 20 patients who had recovered from the first ARF, excluding the two patients managed by non-invasive nocturnal ventilatory support. Conclusion: These results suggest that active ventilatory support should be provided to patients with ARF and chest wall disorders. However, considering recurrent ARF and weak effect of home oxygen therapy, non-invasive domiciliary ventilation is recommended in those patients with these conditions to achieve a better long-term prognosis.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.512-522
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• 1999

Background: Due to the paucity of suitable donor organs for lung allotransplantation, a number of techniques have been developed to improve the lung preservation. Ultrastructural studies of the morphologic changes of the flushing, preservation and reperfusion injury in donor lungs have rarely been reported. Methods: Adult dogs (n=46) were matched as donors and recipients for the single lung transplantation. The donor lungs were preserved after flushing with preservation solution and transplanted after 20-hours of preservation at $10^{\circ}C$. Ultrastructural features of the lung were examined after flushing, preservation and 2 hours after lung transplantation (reperfusion) respectively. Results: Electron microscopy after flushing showed focal alveolar collapse and mild swelling of type I epithelial cells. After preservation both type I epithelial cells and endothelial cells were swollen and destroyed focally. The endothelial cells showed protrusion of tactile-like structures into the lumina, blebs or vacuoles of the cytoplasm After reperfusion the lung tissue showed fibrin material in the alveoli, prominent type I epithelial cell swelling with fragmented cytoplasmic debris and marked endothelial cell swelling with vacuoles or tactile-like projections. The alveolar macrophages showed active phagocytosis. Scanning electron microscopic examination of the pulmonary parenchyma showed focally alveolar collapse and focal consolidation after the preservation and more prominent changes after the reperfusion procedure. The lungs preserved with low potassium dextran glucose solution, with additional prostaglandin $E_1(PGE_1)$ and verapamil(VP) showed relatively well preserved ultrastructures compared with those which were preserved with modified Euro-Collins or University of Wisconsin, and with additional $PGE_1$ and/or VP. Conclusion: The ultrastructural changes associated with flushing were mild in severity, the donor lungs were injured during the preservation, and further damage was occurred during the reperfusion. The reperfusion injury resulted in prominent pulmonary parenchymal alterations with a pattern of acute lung injury.

• Tuberculosis and Respiratory Diseases
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• v.48 no.5
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• pp.730-739
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• 2000

Background : The aim of this study was to analyze the clinical manifestations and efficacy of treatment regimens in order to determine the adequate combination of anti-tuberculotic agents and duration of treatment for tuberculous lymphadenitis. Methods : We made a review of 373 patients with tuberculous lymphadenitis, who were admitted to four medical college hospitals in Taegu Korea from 1989 to 1998, and their diagnoses were confirmed histologically and bacteriologically. Results : The incidence of tuberculous lymphadenitis was 71.3% in women and 57.7% were between the ages of 20 and 39 years. The most common symptom was painless swelling. The most commonly involved lymph nodes were unilateral superficial cervical lymph node groups. Tuberculous lymphadenitis was accompanied with active pulmonary tuberculosis, commonly. The sensitivity of fine needle aspiration(FNA) in tuberculous lymphadenitis was 79.6%, and 92.2% of the patients had a strong positive reaction to the tuberculin skin test. The most commonly prescribed anti-tuberculotic regimen was the combination of INH, RMP, EMB, and PZA(62.6 %). Eighty percent of patient were treated for 9-12 months. There was no significantly difference in the recurrence rate of tuberculous lymphadenitis between the combinations of anti-tuberculotic agent, including INH and RMP, and between the durations of treatment, for a period of 6 months of more. Conclusion : The combination of FNA cytologic examination and tuberculin skin test may be helpful in the diagnosis of tuberculous lymphadenitis. We propose that the combination of anti-tuberculotic agents, INH, RMP, EMB, and PZA, be prescribed to patients for 6 to 9 months.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.861-869
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• 1998

Backgrounds: The injury of a tissue results in the infalmmation, and the imflammed tissue is replaced by the normal parenchymal cells during the process of repair. But, constitutional or repetitive damage of a tissue causes the deposition of collagen resulting in the loss of its function. These lesions are found in the lung of patients with idiopathic pulmonary fibrosis, complicated fibrosis after diffuse alveolar damage (DAD) and inorganic dust-induced lung fibrosis. The tissue from lungs of patients undergoing episodes of active and/or end-stage pulmonary fibrosis shows the accumulation of inflammatory cells, such as mononuclear cells, neutrophils, mast cells and eosinophils, and fibroblast hyperplasia. In this regard, it appears that the inflammation triggers fibroblast activation and proliferation with enhanced matrix synthesis, stimulated by inflammatory mediators such as interleukin-1 (IL-1) and/or tumor necrosis factor (TNF). It has been well known that TGF-$\beta$ enhance the proliferation of fibroblasts and the production of collagen and fibronectin, and inhibit the degradation of collagen. In this regard, It is likely that TGF-$\beta$ undergoes important roles in the pathogenesis of pulmonary fibrosis. Nevertheless, this single cytokine is not the sole regulator of the pulmonary fibrotic response. It is likely that the balance of many cytokines including TGF-$\beta$, IL-1, IL-6 and TNF-$\alpha$ regulates the pathogenesis of pulmonary fibrosis. In this study, we investigate the interaction of TGF-$\beta$, IL-1$\beta$, IL-6 and TNF-$\alpha$ and their effect on the proliferation of fibroblasts. Methods: We used a human fibroblast cell line, MRC-5 (ATCC). The culture of MRC-5 was confirmed by immunofluorecent staining. First, we determined the concentration of serum in cuture medium, in which the proliferation of MRC-5 is supressed but the survival of MRC-5 is retained. Second, we measured optical density after staining the cytokine-stimulated cells with 0.5% naphthol blue black in order to detect the effect of cytokines on the proliferation of MRC-5. Result: In the medium containing 0.5% fetal calf serum, the proliferation of MRC-5 increased by 50%, and it was maintained for 6 days. IL-1$\beta$, TNF-$\alpha$ and IL-6 induced the proliferation of MRC-5 by 45%, 160% and 120%, respectively. IL-1$\beta$ and TNF-$\alpha$ enhanced TGF-$\beta$-induced proliferation of MRC-5 by 64% and 159%, but IL-6 did not affect the TGF-$\beta$-induced proliferation. And lNF-$\alpha$-induced proliferation of MRC-5 was reduced by IL-1$\beta$ in 50%. TGF-$\beta$, TNF-$\alpha$ and both induced the proliferation of MRC-5 to 89%, 135% and 222%, respectively. Conclusions: TNF-$\alpha$, TGF-$\beta$ and IL-1$\beta$, in the order of the effectiveness, showed the induction of MRC-5 proliferation of MRC-5. TNF-$\alpha$ and IL-1$\beta$ enhance the TGF-$\beta$-induced proliferation of MRC-5, but IL-6 did not have any effect TNF-$\alpha$-induced proliferation of MRC-5 is diminished by IL-1, and TNF-$\alpha$ and TGF-$\beta$ showed a additive effect.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1063-1071
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• 1997

Backgroung : The efficacy of oral corticosteroids in the treatment of chronic asthma is undisputed, but their long-term use is associated with adverse side-effects, including supression of the hypothalamic-pituitary adrenal axis function, osteoporosis, weight gain, hypertension and impaired glucose tolerance. The introduction of inhaled corticosteroids in the early 1970's represented a significant therapeutic advance in the management of asthma, since these compounds combined high topical potency with low systemic activity. Fluticasone propionate is a new topically active synthetic glucocorticosteroid that combinds a high degree of efficacy with negligible systemic bioavailability. This study was perfomed to determine the effect of inhaled fluticasone propionate on the adreocortical supression in patients with bronchial asthma or chronic obstructive pulmonary disease. Method : The adrenocortical function was assessed by measurement of plasma cortisol concentration at 8 o'clock in morning and free cortisol in 24 hour urine collection at interval. Absolutely, no steroid was taken during pretreatment period of 10days. There after each subject inhaled fluticasone aerosol, in daily doses of 500 or 1000micrograms for 12days. The dose was delivered by metered dose inhaler(MDI). Results : The serum cortisol and 24hour urinary free cortisol were not decreased during the treatment period in patients with inhaled fluticasone propionate in daily doses of 500 micrograms. In contrast, serum cortisol was significantly decreased on 9th and 12th day(p less than 0.05). And, 24hour urinary free cortisol was also significantly decreased on 3rd and 12th day of treatement period(p less than 0.05) in patients with inhaled fluticasone in daily doses of 1000 micrograms. Conclusion : These results suggested that endogenous cortisol secretion was not supressed after short-term inhalation of fluticasone in daily dose of 500 micrograms, but in daily dose of 1000 micrograms, the endogenous cortisol secretion was supressed.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.388-393
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• 1999

Background: Correct preoperative staging of esophageal cancer is a prerequisite for adequate treatment. We prospectively compared the accuracy of positron emission tomography (PET) with [fluorine-18]FDG in the staging of esophageal cancer to that of computed tomography (CT). Material and Method: The findings of FDG PET and of chest CT including lower neck and the upper abdomen of 20 biopsy-proven squamous cell carcinoma patients (male, 19; female, 1; mean age, 61) were compared with the pathologic findings obtained from a curative esophagectomy with lymph node dissection. Result: The sensitivities of FDG PET and CT for diagnosis of primary tumor were the same, 90.0% (18/20). Both FDG PET and CT failed to show the primary tumor in 2 of 20 patients; one had a 1cm sized carcinoma in situ and the other had T1 stage cancer. By using the results of the pathologic examinations of 193 removed lymph node groups, we calculated the diagnostic sensitivities, specificities and accuracies of PET and CT (*$\chi$2 p < 0.005). Sensitivity** Specificity Accuracy* PET 55.6%(30/54) 97.1%(135/139) 85.5%(165/193) CT 13.0%(7/54) 98.6%(137/139) 74.6%(144/193) One of four patients with a false-positive for PEThad had active pulmonary tuberculosis. Among the 24 tumor involved lymph node groups, PET failed to show tumor metastasis in 5 lymph node groups abutting the tumor and in 14 lymph node groups located where the decay correction was not performed. Conclusion: Based on the above findings, it is suggested that [F-18]FDG-PET is superior to CT in the detection of nodal metastases and in the staging of patients with esophageal cancer.

• Journal of Korean Academy of Nursing
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• v.24 no.1
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• pp.58-69
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• 1994

In order to see the development of Nursing related research activities in Korea over the last three decades, abstracts of almost all of the Master and Ph.D theses that appeared from 1961 up to August 1991 were collected. The number of theses was 2354, from which an index of key words has been constructed. Key words were defined as those terms in each thesis title that convey major objectives of the given thesis study and the important nursing concepts dealt with in the thesis. Although all the key words were picked from the thesis title only, full use was made of the abstracts in deciding the principal objectives and essential contents of the thesis studies and their important concepts as well. In total, 539 kinds of key words were identified from the 2354 titles, and the identified words were all found to be in the International Nursing Index. On an average each title has two key words. Which key words were most frequently used, how they have changed with time, what kind of concept is preferably dealt with by each graduate school, and the concepts to which a given key word is likely to be connected were examined. The results are summerized below : 1) For each decade the theses numbers were as follows : 54(2.3%) from the 60’s, 413(17.5%) from the 70’s, 1523(64.7%) from the 80’s, and 364(15.5%) from the 90’s. Master’s thesis contributed 96% (2252) of the papers and Ph. D’s theses filled the remaining 4%(102). 2) A total of 539 key words were used, averaging about 2 for each thesis. The most frequently used key words were ‘Nurse’, ‘Anxiety’, ‘Knowledge / Attitude /Practice’, ‘Stress /Stressor’, ‘Attitude’, ‘Job-Satisfaction’, ‘Mental Disorder’, ‘Operation’, ‘Elderly’, ‘Nursing Role’. 3) Each decades key words can be classified as : the 60’s : ‘Nursing Education’, ‘Pulmonary Tuberculosis’, ‘Mother-Child Health’, ‘Growth & Development’, ‘Public Facilities’, ‘Mental Disorder’ : the 70’s : ‘Nurse’, ‘Family Planning’, ‘Attitude’ / ‘Knowledge, Attitude / Practice’, ‘Curriculum in Nursing Education’, ‘Clinical Practice in Nursing’, ‘Analysis of the Work of the Nurse’, ‘Health Education of School’, : the 80’s : ‘Nurse’, ‘Anxiety’, ‘Stress /Stressor’, ‘Operation’, ‘Nursing Role’, ‘Job Satisfaction’ : the 90’s : ‘Nurse’, ‘Elderly’, ‘Family-Support’, ‘Stress /Stressor’, ‘Home Care’. Key word ‘Nurse’ appears continuously and most frequently through the years, which indicates that there has been active study of the characteristics of nurses and related fields. The concept ‘Anxiety’ has been studied steadly from the 80’s and it shows that interest in health and disease are increasing Which comes as a result of society changing to an industrial and informational community. 4) Looking into each graduate school’s study area key words ‘Anxiety’, ‘Nurse’, ‘Mental Disorder’, ‘Stress /Stressor’, ‘Operation’, ‘Attitude’, ‘Hemo-dialysis’, were studied in the regular graduate school : ‘Family Planning /Contraception’, ‘Knowledge / Attitude /Practice’, ‘Physical Health-State /Physical Health Examination’, ‘Nurse’, ‘Using Clinical Facilities’, ‘Health Education of School’, were studied in the Graduate School of Public Health’ ; ‘Nurse’, ‘Anxiety’, ‘Stress / Stressor’, ‘Job-Satisfaction’, ‘Clinical Practice Education’, ‘Nursing Education’, were studied in the Graduate School of Education : ‘Nurse’, ‘Job Satisfaction’, ‘Nursing Role’, ‘Administration - Employment /Employment Management’, ‘Leadership’, ‘Personnel Profile’, ‘Nursing Manpower / Changing Working Place’, were studied in the Graduate School of Public Administration. 5) The Connection between key words were : ‘Nurse Job Satisfaction’, ‘Stress / Stressor ⇔ Coping / Ajustment’, ‘Nurse ⇔ Nursing Role’, ‘Anxiety ⇔ Giving Information’, ‘Nurse ⇔ Stress / Stressor’, ‘Anxiety ⇔ Operation’, ‘Nurse ⇔ Burnout’, ‘Knowledge, Attitude, Practice ⇔ Family Planning’, ‘Nurse Administration ⇔ Employment’, ‘Anxiety Muscle ⇔ Relaxation Technic’, ‘Anxiety ⇔ Mental Disorder’. From the above it can be noted that many nursing concepts were handled in the thesis titles. But there were more than enough papers on the characteristics of the nurse. It is suggested that in depth research be made on ‘Nursing Accidents’, t-‘Ethics’, ‘Nurse - Patient Interactions’, ‘Spritual Care’, ‘Dying’, ‘Hospice’, ‘Resident Helper’ and that there should be in depth research relating to the physical and mental development of youth and in particular physical concepts like ‘Drug - Abuse’, ‘Child -Abuse and Teaching’.