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Pharmacokinetics of ofloxacin in Patients with Multidrug-Resistant Tuberculosis (다제내성결핵 환자에서 ofloxacin의 약동학적 분석)

  • Park, Seung-Kyu;Yoon, Young-Ran;Lee, Woo-Chul;Jun, Hyung-Min;Shon, Ji-Hong;Kim, Kyoung-Ah;Park, Ji-Young;Shin, Jae-Gook
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.128-136
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    • 2002
  • Background: There are few studies that have reported on the pharmacokinetic(PK) disposition of fluoroquinolones in patients with multi-drug resistant tuberculosis(MDR-Tb), even though fluoroquinolones are frequently co-prescribed to those patients. In this study, the PK disposition of ofloxacin, a fluoroquinolone, was evaluated in patients with MD R -Tb. Methods: Twenty patients with MDR-Tb were given 2nd line Tb drugs including ofloxacin (300mg twice a day), prothionamide, cycloserine, para-aminosalicylic acid, kanamycin, and streptomycin. The patients were grouped according to their body mass index(BMI) as an index of emaciation (group A : 18.5$\leq$BMI <23, group B : BMI < 18.5). Blood samples were serially drawn and urine samples were collected upto 24 hours after the last dose of those drugs at steady state (over 1 month). The ofloxacin concentrations were determined using HPLC (High Performance Liquid Chromatography). Results: The AUC of ofloxacin in group B was greater than that in group A ($31.4{\pm}8.9{\mu}g/ml{\cdot}h$ vs. $24.1{\pm}6.2{\mu}g/ml{\cdot}h$)(Check the symbols), (p<0.05). The total clearance(Cl/F) of ofloxacin was $0.16{\pm}0.03$ L/h/kg in group A, and $0.14{\pm}0.03$ L/h/kg in group B. The half-lives of ofloxacin in two groups were similar (group A : $5.3{\pm}0.8$ hours, group B : $5.7{\pm}0.9$ hours). In addition, the other PK parameters in two groups were also similar. Conclusions: The pharmacokinetics of ofloxacin in patients with MDR-Tb appears to be comparable with those of normal subjects, and the extent of emaciation appears to have an influence on the pharmacokinetics of ofloxaicn in chronic debilitated MDR-Tb patients.

The Clinical Characteristics of Diffuse Alveolar Hemorrhage : A Retrospective Study of 21cases (미만성 폐포 출혈의 임상 양상과 예후)

  • Ham, Hyoung-Suk;Roh, Gil-Hwan;Kang, Eun-Hae;Kang, Soo-Jung;An, Chang-Hyeok;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.5
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    • pp.614-623
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    • 2000
  • Background : Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. Method : A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveolar lavage or lung biopsy. Results : Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD ($3.27{\pm}3.15$ mg/dl vs. $1.19{\pm}0.94$ mg/dl, p=0.030). The corresponding drop in hemoglobin level was $2.69{\pm}1.26$ g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by $1.38{\pm}4.22$ days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). Conclusion : The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.

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Primary Surgical Closure Should Be Considered in Premature Neonates with Large Patent Ductus Arteriosus

  • Ko, Seong-Min;Yoon, Young Chul;Cho, Kwang-Hyun;Lee, Yang-Haeng;Han, Il-Yong;Park, Kyung-Taek;Hwang, Yoon Ho;Jun, Hee Jae
    • Journal of Chest Surgery
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    • v.46 no.3
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    • pp.178-184
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    • 2013
  • Background: Treatment for patent ductus arteriosus (PDA) in premature infants can consist of medical or surgical approaches. The appropriate therapeutic regimen remains contentious. This study evaluated the role of surgery in improving the survival of premature neonates weighing less than 1,500 g with PDA. Materials and Methods: From January 2008 to June 2011, 68 patients weighing less than 1,500 g with PDA were enrolled. The patients were divided into three groups: a group managed only by medical treatment (group I), a group requiring surgery after medical treatment (group II), and a group requiring primary surgical treatment (group III). Results: The rate of conversion to surgical methods due to failed medical treatment was 67.6% (25/37) in the patients with large PDA (${\geq}2$ mm in diameter). The number of patients who could be managed with medical treatment was nine which was only 20.5% (9/44) of the patients with large PDA. There was no surgery-related mortality. Group III displayed a statistically significantly low rate of development of bronchopulmonary dysplasia (BPD) (p=0.008). The mechanical ventilation time was significantly longer in group II (p=0.002). Conclusion: Medical treatment has a high failure rate in infants weighing less than 1,500 g with PDA exceeding 2.0 mm. Surgical closure following medical treatment requires a longer mechanical ventilation time and increases the incidence of BPD. Primary surgical closure of PDA exceeding 2.0 mm in the infants weighing less than 1,500 g should be considered to reduce mortality and long-term morbidity events including BPD.

Serum Lmmunoglobulin G and M Level after Xenograft Valve or Valved Conduit Implantation (이종 조직판막 도관 혹은 판막 이식술 직후 면역 글로불린 항체 G, M의 혈중 농도 변화)

  • Kwak, Jae-Gun;Yoo, Jae-Suk;Yoon, Sun-Hee;Kim, Woong-Han;Kim, Kyung-Hwan;Kim, Yong-Jin
    • Journal of Chest Surgery
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    • v.41 no.2
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    • pp.223-228
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    • 2008
  • Background: The aim of this study is to confirm that peripheral blood sampling for measuring of serum immunoglobulin can predict immunological changes after xenograft implantation. Material and Method: Between March 2006 and January 2007, 19 patients were enrolled (10 xenograft implantation group, 9 control group). Through 3 peripheral blood samples, we measured changes in serum immunoglobulin G and M levels preoperatively, and 2 and 10 days postoperatively. Result: In both groups, serum immunoglobulin levels showed similar changes-they decreased 2 days postoperatively, then increased up to the baseline levels 10 days postoperatively. However, this postoperative change of immunoglobulin G and M was not significantly different in absolute value or pattern between the 2 groups (Ig G; p-value=0.393, Ig M; p-value=0.193). Conclusion: We could not predict immunological changes after xenograft implantation by measuring serum immunoglobulin levels by simple blood sampling. Direct checking of ${\alpha}$-Galactose antibody may confirm an immunological reaction after xenograft implantation.

A Study on the Body Type of Hanwoo(Korean Cattle) Steer by Using Principal Components Analysis (주성분 분석을 이용한 거세한우의 체형분류에 관한 연구)

  • Ha, D.W.;Kim, H.C.;Kim, B.W.;Lee, M.Y.;Lee, J.H.;Shin, C.K.;Do, C.H.;Lee, J.G.
    • Journal of Animal Science and Technology
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    • v.44 no.6
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    • pp.643-652
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    • 2002
  • Data were consisted of the ten body measurements (withers height, rump height, body length, chest depth, chest width, rump width, rump length, thurls width, hipbone width and chest girth) of 642 steers (Korean cattle), which was entered in the National Beef Quality Contest hosted by the Korea Animal Improvement Association from 1997 to 2001. A principal components analysis was used to classify the body types of the steers, and estimate the correlations between carcass traits and principal components for the body measurements of the first, second, third and fourth period, respectively. The first principal component of body measurements at the first, second, third and fourth period accounted for 76.0%, 83.0%, 72.7% and 57.4% of the total variance, respectively. The sum of first, second and third principal component at each period accounted for 86.69%, 90.49%, 84.62% and 77.26% of the total variance, respectively. At each period, all the first principal component of the body measurements were positive and it generally showed large framed body shape. The size of body was influenced mostly by chest depth(0.328${\sim}$0.339) and rump length(0.325${\sim}$0.341). The second, third and fourth principal component at the each period were various. There were positive correlations between principal components index of each period and carcass traits such as carcass weight(0.539${\sim}$0.755), average daily gain(0.256${\sim}$0.564), backfat thickness(0.227${\sim}$0.280), and eye muscle area(0.187${\sim}$0.344). The correlation with yield grade index(-0.246${\sim}$-0.110), however, was negative. The correlation with marbling score(0.066${\sim}$0.099) was low or statistically insignificant. According to principal component indexes of the second, third, and fourth components, the correlations with the carcass traits were various. There were no large differences between the correlations of the single body measurement trait with the carcass traits and the correlations of the first principal component indexes with the carcass traits.

A Study on the Difference of Scattered Rays with or Without Gonadal Shielding During Chest Computed Tomography (흉부 전산화 단층 촬영 검사 시 발생하는 생식선 차폐 유무에 따른 산란 선량 차이에 관한 연구)

  • Kwak, Jong Hyeok;Kim, Gyeong Rip;Sung, Hyun Chul;Kim, Seung Won;Song, Geun Sung;Choi, Min Gyeong;Lee, Sang Weon
    • Journal of the Korean Society of Radiology
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    • v.15 no.2
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    • pp.109-115
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    • 2021
  • This study is a study on the difference in dose according to the presence or absence of gonadal shielding of scattered rays generated during chest computed tomography examination, and the scattered dose of the examination site was measured by placing the RadEye G-10 device in the center of the phantom. When the gonads are not shielded, the scattering lines of the whole, both sides, posterior and gonads are measured and Xenolite nolead Apron (0.35 mm PB), Xenolite nolead Apron (front 0.35 mm PB Mix back 0.25 mm PB, Skirt overlap), Half Apron After shielding with (0.5 mm PB), each scattered dose was measured. During chest computed tomography, the scattered dose of the test site was measured at 272 μSv, and when not shielded with Apron, the average total was 43 μSv, left 81 μSv, right part 82 μSv, posterior part 38.8 μSv, and Gonad part 16 μSv. Became. Xenolite nolead Apron shielded only the upper part and measured all 11.2 μSv, left part 43.1 μSv, right part 45.3 μSv, posterior part 12 μSv and Gonad part 5.2 μSv. Xenolite nolead Apron (Skirt overlap) covered the Pelvis area 360° and the dose was measured to be 5.6 μSv in the whole, 22.4 μSv in the left, 15.7 μSv in the right side, 6 μSv in the posterior part, and 3.2 μSv in the Gonad part. Xenolite nolead Apron (Skirt overlap) covered the Pelvis area 360° and the dose was measured to be 5.6 μSv in the whole, 22.4 μSv in the left, 15.7 μSv in the right side, 6 μSv in the posterior part, and 3.2 μSv in the Gonad part. When measuring only the upper part with Half Apron, the total measurement was 10.7 μSv, the left part 42.6 μSv, the right part 40.6 μSv, the posterior part 11.3 μSv, and the Gonad part 4.7 μSv. The method of 360° shielding of the pelvic area showed a dose reduction of more than 80%, and a dose reduction effect of more than 70% was shown when all shielding was performed. In all computerized tomography examinations, research to reduce the exposure dose and various shielding devices were used. It is believed that continuous research on the technique is needed.

Development of Calcification-Resistant Bovine Pericardium with $PEO-SO_3$ (I) - An implantation study of bovine pericardium at aorta and pulmonary artery in canine model - ($PEO-SO_3$를 이용한 항석회화 조직첨포의 개발 (I) - 잡견을 이용한 대동맥과 폐동맥 이식 실험연구 -)

  • Kim, Hyoung-Mook;Baek, Man-Jong;Sun, Kyung;Kim, Kwang-Taik;Lee, In-Sung;Kim, Hark-Jei;Lee, Won-Kyu;Park, Ki-Dong
    • Journal of Chest Surgery
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    • v.31 no.10
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    • pp.919-923
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    • 1998
  • Background: Calcific degeneration is unavoidable in either homo- or heterografts implanted in the human body. We have developed a calcification-resistant cardiovascular tissue patch using a novel technique of anticalcification. Materials and methods: Fresh bovine pericardium was harvested at the slaughter house and transfered to the laboratory in Hank's solution. After trimming and fixing the pericardium, it was embedded in 4$^{\circ}C$ 0.65% glutaraldehyde for a week and then washed by phosphate-buffered saline(PBS) of pH 7.4. This prepared pericardium was then stored in 2.5% sulphonated polyethyleneoxide(PEO-SO3) solution for 2 days at room temperature and reversed by 4$^{\circ}C$ NaBH4 solution for 16 hours. To evaluate the calcification-resistance of surface modified bovine pericardium with PEO-SO3, either glutaraldehyde- treated(GA group, n=4) or PEO-SO3-treated pericardial patch(PEO-SO3 group, n=4) was implanted into adult mongrel dog to reconstruct the main pulmonary artery and the descending aorta using a partial clamp technique. After 1 month follow-up, the implanted patches were retrieved to evaluate the pathologic findings and the content of calcium and phosphorous. Results: The PEO-SO3 group showed substantially less retraction and significantly less calcium deposition than the GA group in both aortic(7.10$\pm$1.05 vs. 13.81$\pm$2.33 mg/g of dried tissue) and pulmonary positions(1.55$\pm$0.29 vs. 6.72$\pm$0.70 mg/g)(p<0.01). Phosphorous contents were also less in the PEO-SO3 group than the GA group significantly, 8.11$\pm$1.07 mg/g vs. 19.33$\pm$4.31 mg/g in the aortic and 2.58$\pm$0.40 vs. 12.60$\pm$3.40 mg/g in thepulmonary position(p<0.01). Conclusions: These findings suggest that PEO-SO3 modified bovine pericardium is highly calcification-resistant but further study is needed to evaluate the long-term biological safety and compatibility of the prosthesis.

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The Outcome of Cardiac Surgery in Low Birth Weight Infants (저체중 출생아의 심기형 수술의 성적)

  • 성시찬;김시호;이영석
    • Journal of Chest Surgery
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    • v.35 no.6
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    • pp.430-438
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    • 2002
  • It is known that low birth weight is a risk factor for poor outcome in cardiac surgery for many cardiac defects. We reviewed our recent surgical experiences on congenital heart defect (other than patent ductus arteriosus) in low birth weight babies. Material and Method: From September 1994 to February 2001, 31 consecutive infants weighing 2500 g or less underwent cardiac surgery with (OHS group n=12) or without cardiopulmonary bypass (CHS group n=19). A retrospective study was carried out to evaluate short-and intermediate-term outcome. Mean gestational age and age at operation were 36.9 weeks(range, 32.3-42weeks) and 32.1days (range, 0-87days) respectively. Mean body weight at birth and operation were 1972g (range, 1100-2500g) and 2105g (range, 1450-2500 g) respectively. There was no difference between the two groups in age and body weight. Defects included ventricular septal defect (VSD) (n=3), VSD with arch anomaly (n=2), total anomalous pulmonary venous return (n=2), transposition of the great arteries (TGA) (n=2), truncus arteriosus (n=2), and univentricular heart with cor triatriatum (n=1) in OHS group, and coarctation of aorta (n=7), tetralogy of Fallot (TOF) (n=3), TOF with pulmonary atresia (n=3), multiple muscular VSDs (n=1), double outlet right ventricle (n=1), pulmonary atresia with intact ventricular septum (n=2), tricuspid atresia (n=1), and TGA with multiple VSD (n=1) in CHS group. 13 patients (41.9%) were intubated pre-operatively. Result: There were 4 early deaths(<30 days); 1 (8.3%) in OHS group and 3 (15.8%) in non-OHS group. All these early deaths were related to the pulmonary artery banding(PAB). There was no operative mortality in infants undergoing complete repair and palliative operations other than PAB. Delayed sternal closure was required in 3 patients. Prolonged postoperative mechanical ventilation (>7 days) was required in 7 patients(58.3%) in OHS and 7(38.8%) in CHS group. Late mortality occurred in 3 patients, two of which were non-cardiac. A patient in OHS group was documented to have neurologic sequelae. All the survivors except two are in NYHA class 1. Conclusion: Complete repair and palliative operations other than PAB can be performed in low birth weight infants with low operative mortality and an acceptable intermediate-term result. However, about a half of the patients required long-term postoperative mechanical ventilation.

A Survey of Nutritional Status on Pre-School Children in Korea (학영기전아동(學齡期前兒童)의 영양실태조사(營養實態調査))

  • Ju, Jin-Soon;Oh, Seoung-Ho
    • Journal of Nutrition and Health
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    • v.9 no.2
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    • pp.68-86
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    • 1976
  • The primary purpose of this study is to evaluate the correct nutritional status on pre-school children in Korea. Furthermore, it made an attempt to find and define nutrional problems, and assist in establishment on their nutritional improvement plan. For this, food intake and health condition (physical, clinical, biochemical and parasitological) survey on 109 Pre-school children in both sexes, randomly selected from Yang-Gu area in Gang-Won province and Rea-ju area in Kyong-gy Province, were conducted by means of three-day records, during the two periods of Spring and Fall season in 1975. The results obtained are summerized as follows: 1. The food intake; Average food intake of the subjects per day were $508{\sim}647g$ ($83{\sim}91%$ in vegetable foods and $5.5{\sim}11.7%$ in animal foods) in Yang-gu area, and $587{\sim}698g$ ($88{\sim}89%$ in vegetable foods and $6.3{\sim}7.6%$ in animal foods) in Rea-ju area. 2. The intake of energy and nutrients; a) Calory intake. Average energy intake of subjects per day in Yang-gu area$(1120{\sim}1415kcal)$ were all lower than the Korean Recommended Dietary Allowances (RDA) in either Spring and Fall survey, whereas the subjects in Rea-ju area were lower intake $(1213{\sim}1418kcal)$ than the RDA in the Spring but higher intake$(1516{\sim}1755kcal)$ than the RDA in the Fall, and the average intake were similar level with that of RDA. b) Protein intake. Average protein intake of the subjects per day in Yang-gu area $(33{\sim}43g)$ girl subjects in Rea-ju area $(35{\sim}39g)$ were lower than the RDA in either Spring and Fall survey, whereas the boy subjects in Rea-ju area$(36{\sim}38g)$ were lower in Spring and higher $(49{\sim}57g)$ in the Fall than that of the RDA, but the average $(43{\sim}47g)$ were similar level with the RDA. The protein intake from animal sources in all subjects were much lower $(5.5{\sim}11.7\;of\;total\;protein)$ than the RDA. c) Fat intake. Average fat intake were very lower in all subjects of both area $(14{\sim}24g\;in\;Yang-gu,\;10{\sim}12g\;in\;Rea-ju)$ than that of RDA which is recommended $12{\sim}14%$ of total energy to be supplied from fat. d) Calcium intake. Average calcium intake were very low in all subjects of both area $(264{\sim}355mg\;in\;Yang-gu\;and\;283{\sim}429mg\;in\;Rea-ju)$, especially, these in Spring were about a half level of the RDA, and it was much increased in the Fall due to increased intake of milk, but it was still not enough than the RDA. e) Vitamin A intake. Average intake of V.A ($703{\sim}1465\;IU$ in Ynag-gu and $750{\sim}1521\;IU$ in Rea-ju) were also lower than the RDA, moreover their V-A sources were mainly vegetable, so that the V-A supply might be critical one for the subjected. f) Riboflavin intake. Average riboflavin intake on all subjects in both area except boys in Rea-ju area in Fall, were very lower than the RDA. 3. The physical status; a) Average weight and height of boys aged 4 and 5 in Yang-gu area and girls of aged 5 in Rea-ju area were lower than those of Korean Standard of 1967 report, but those by age of girls in Yang-gu area and boys in Rea-ju area were a little heigher than the Korean Standard. It is, hower, present Korean standard of physical status might be somehow heigher than the 1967, since the socio-economical situation has been much improved during past a decade. So that, if one considered on this sense, the physical status of the subjects on this survey might be somehow lower than those of present Korean standard. b) Average upper arm circumference in both area were no difference each other, and their mean values of age 4, 5 and 6 in boy and girl were 15.6, 16.5, 16.4 and 15.5, 16.5, 16.4cm respectively. c) Average chest girth of boys were similar to those of Korean standard whereas the girls were smaller than the Korea standard. The average head circumference also showed similar tendency with the chest girth. 4. The clinical findings; The most popular clinical signs were angular stomatitis and dental caries, and boys had more heigher incidence then the girls. 5. The biochemical findings; a) Hemoglobin and anemia Average Hb value of boys and girls were 11.4 and 10.9g per 100 ml of blood respectively. The incidence of anemia (Hb value below 11 g/100 ml, by WHO) was increased by age, and girls had more heigher incidence than the boy (34% : 48%). The incidence of anemia in age of 4,5, and 6 in boys and girls were 28%, 41% 34%, and 33%, 50%, 49% respectively. The degree of the anemia was not severe, and the anemia of there subjects may be caused mainly low intake of better quality protein and low iron intake as well. b) Hematocrit. Average Ht value of whole subject were $39.9{\sim}41.6%$. c) Blood plasma protein. Average blood plasma protein contents of whole subjects were $6.6{\sim}7.4gm$ per 100 ml. The incidence of deficient range (<6.0g%, by ICNND) was only one girl of age 4 in yang Gu area. 6. Parasitological findgs; The most popular parasitism were asicris lumbicoides and trichocephalus trichiura, and about 2/3 of the whole subjects were suffering one or more of these parasitism.

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Medical Thoracoscopy in Pleural Disease: Experience from a One-Center Study

  • Kim, Soo Jung;Choi, Sun Mi;Lee, Jinwoo;Lee, Chang-Hoon;Lee, Sang-Min;Yim, Jae-Joon;Yoo, Chul-Gyu;Kim, Young Whan;Han, Sung Koo;Park, Young Sik
    • Tuberculosis and Respiratory Diseases
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    • v.80 no.2
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    • pp.194-200
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    • 2017
  • Background: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. Methods: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data. Results: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59-73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were $50{\mu}g$ and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT). Conclusion: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.