• Title/Summary/Keyword: Failure Criteria

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Female Gender is a Poor Predictive Factor of Functional Dyspepsia Resolution after Helicobacter pylori Eradication: A Prospective, Multi-center Korean Trial (기능성 소화불량증 환자에서 헬리코박터 파일로리 제균 치료 효과 및 관련 요인: 국내 전향적, 다기관 연구)

  • Kim, Sung Eun;Kim, Nayoung;Park, Seon Mee;Kim, Won Hee;Baik, Gwang Ho;Jo, Yunju;Park, Kyung Sik;Lee, Ju Yup;Shim, Ki-Nam;Kim, Gwang Ha;Lee, Bong Eun;Hong, Su Jin;Park, Seon-Young;Choi, Suck Chei;Oh, Jung Hwan;Kim, Hyun Jin
    • The Korean Journal of Gastroenterology
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    • v.72 no.6
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    • pp.286-294
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    • 2018
  • Background/Aims: The predictive factors of functional dyspepsia (FD) remain controversial. Therefore, we sought to investigate symptom responses in FD patients after Helicobacter pylori (H. pylori) eradication and used predictive factor analysis to identify significant factors of FD resolution at one-year after commencing eradication therapy. Methods: This prospective, multi-center clinical trial was performed on 65 FD patients that met Rome III criteria and had H. pylori infection. Symptom responses and factors that predicted poor response were determined by analysis one year after commencing H. pylori eradication therapy. Results: A total of 63 patients completed the one-year follow-up. When an eradication success group (n=60) and an eradication failure group (n=3) were compared with respect to FD response rate at one year, results were as follows; complete response 73.3% and 0.0%, satisfactory response 1.7% and 0.0%, partial response 10.0% and 33.3%, and refractory response 15.0% and 66.7%, respectively (p=0.013). Univariate analysis showed persistent H. pylori infection (p=0.021), female gender (p=0.025), and medication for FD during the study period (p=0.013) were associated with poor FD response at one year. However, age, smoking, alcohol consumption, and underlying disease were not found to affect response. Finally, multivariate analysis showed that female gender (OR, 4.70; 95% CI, 1.17-18.88) was the sole independent risk factor of poor FD response at one year after commencing H. pylori eradication therapy. Conclusions: Female gender was found to predict poor response in FD patients despite H. pylori eradication. Furthermore, successful H. pylori eradication appears to be associated with FD improvement, but the number of non-eradicated patients was too small to conclude.

Empirical Analysis of Accelerator Investment Determinants Based on Business Model Innovation Framework (비즈니스 모델 혁신 프레임워크 기반의 액셀러레이터 투자결정요인 실증 분석)

  • Jung, Mun-Su;Kim, Eun-Hee
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.1
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    • pp.253-270
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    • 2023
  • Research on investment determinants of accelerators, which are attracting attention by greatly improving the survival rate of startups by providing professional incubation and investment to startups at the same time, is gradually expanding. However, previous studies do not have a theoretical basis in developing investment determinants in the early stages, and they use factors of angel investors or venture capital, which are similar investors, and are still in the stage of analyzing importance and priority through empirical research. Therefore, this study verified for the first time in Korea the discrimination and effectiveness of investment determinants using accelerator investment determinants developed based on the business model innovation framework in previous studies. To this end, we first set the criteria for success and failure of startup investment based on scale-up theory and conducted a survey of 22 investment experts from 14 accelerators in Korea, and secured valid data on a total of 97 startups, including 52 successful scale-up startups and 45 failed scale-up startups, were obtained and an independent sample t-test was conducted to verify the mean difference between these two groups by accelerator investment determinants. As a result of the analysis, it was confirmed that the investment determinants of accelerators based on business model innovation framework have considerable discrimination in finding successful startups and making investment decisions. In addition, as a result of analyzing manufacturing-related startups and service-related startups considering the characteristics of innovation by industry, manufacturing-related startups differed in business model, strategy, and dynamic capability factors, while service-related startups differed in dynamic capabilities. This study has great academic implications in that it verified the practical effectiveness of accelerator investment determinants derived based on business model innovation framework for the first time in Korea, and it has high practical value in that it can make effective investments by providing theoretical grounds and detailed information for investment decisions.

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From a Defecation Alert System to a Smart Bottle: Understanding Lean Startup Methodology from the Case of Startup "L" (배변알리미에서 스마트바틀 출시까지: 스타트업 L사 사례로 본 린 스타트업 실천방안)

  • Sunkyung Park;Ju-Young Park
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.5
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    • pp.91-107
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    • 2023
  • Lean startup is a concept that combines the words "lean," meaning an efficient way of running a business, and "startup," meaning a new business. It is often cited as a strategy for minimizing failure in early-stage businesses, especially in software-based startups. By scrutinizing the case of a startup L, this study suggests that lean startup methodology(LSM) can be useful for hardware and manufacturing companies and identifies ways for early startups to successfully implement LSM. To this end, the study explained the core of LSM including the concepts of hypothesis-driven approach, BML feedback loop, minimum viable product(MVP), and pivot. Five criteria to evaluate the successful implementation of LSM were derived from the core concepts and applied to evaluate the case of startup L . The early startup L pivoted its main business model from defecation alert system for patients with limited mobility to one for infants or toddlers, and finally to a smart bottle for infants. In developing the former two products, analyzed from LSM's perspective, company L neither established a specific customer value proposition for its startup idea and nor verified it through MVP experiment, thus failed to create a BML feedback loop. However, through two rounds of pivots, startup L discovered new target customers and customer needs, and was able to establish a successful business model by repeatedly experimenting with MVPs with minimal effort and time. In other words, Company L's case shows that it is essential to go through the customer-market validation stage at the beginning of the business, and that it should be done through an MVP method that does not waste the startup's time and resources. It also shows that it is necessary to abandon and pivot a product or service that customers do not want, even if it is technically superior and functionally complete. Lastly, the study proves that the lean startup methodology is not limited to the software industry, but can also be applied to technology-based hardware industry. The findings of this study can be used as guidelines and methodologies for early-stage companies to minimize failures and to accelerate the process of establishing a business model, scaling up, and going global.

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Shear strain behaviour due to twin tunnelling adjacent to pile group (군말뚝 기초 하부 병렬터널 굴착 시 전단변형 거동 특성)

  • Subin Kim;Young-Seok Oh;Yong-Joo Lee
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.26 no.1
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    • pp.59-78
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    • 2024
  • In tunnel construction, the stability is evaluated by the settlement of adjacent structures and ground, but the shear strain of the ground is the main factor that determines the failure mechanism of the ground due to the tunnel excavation and the change of the operating load, and can be used to review the stability of the tunnel excavation and to calculate the reinforcement area. In this study, a twin tunnel excavation was simulated on a soft ground in an urban area through a laboratory model test to analyze the behavior of the twin tunnel excavation on the adjacent pile grouped foundation and adjacent ground. Both the displacement and the shear strain of ground were obtained using a close-range photogrammetry during laboratory model test. In addition, two-dimensional finite element numerical analysis was performed based on the model test. The results of a back-analysis showed that the maximum shear strain rate tends to decrease as the horizontal distance between the pillars of the twin tunnel and the vertical distance between the toe of the pile group and the crown of the tunnel were decreased. The impact of the second tunnel on the first tunnel and pile group was decreased as the horizontal distance between the pillars of the twin tunnel was increased. In addition, the vertical distance between the toe of the pile group and the crown of the tunnel had a relatively greater impact on the shear strain results than the horizontal distance of the pillars between the twin tunnels. According to the results of the close-range photogrammetry and numerical analysis, the settlement of adjacent pile group and adjacent ground was measured within the design criteria, but the shear strain of the ground was judged to be outside the range of small strain in all cases and required reinforcement.

Analysis of the Radiation Therapy Outcomes and Prognostic Factors of Thymoma (흉선종에 대한 방사선치료 성적 및 예후인자분석)

  • Lee, Seok-Ho;Lee, Kyu-Chan;Choi, Jin-Ho;Lee, Jae-Ik;Sym, Sun-Jin;Cho, Eun-Kyung
    • Radiation Oncology Journal
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    • v.28 no.1
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    • pp.1-8
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    • 2010
  • Purpose: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. Materials and Methods: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4:3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. Results: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (${\geq}60$, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). Conclusion: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

The Prognostic Value of the First Day and Daily Updated Scores of the APACHE III System in Sepsis (패혈증환자에서 APACHE III Scoring System의 예후적 가치)

  • Lim, Chae-Man;Lee, Jae-Kyun;Lee, Sung-Soon;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Park, Pyung-Hwan;Choi, Jong-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.871-877
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    • 1995
  • Background: The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis. Methods: In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1(D1), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the D1 score, and also in respect to the changes of the updated D2 and D3 scores. Results: 1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older($62.7{\pm}12.6$ vs $51.1{\pm}18.1$ yrs), presented with lower mean arterial pressure($56.9{\pm}26.2$ vs $67.7{\pm}14.2\;mmHg$) and showed greater number of multisystem organ failure($1.2{\pm}0.8$ vs $0.2{\pm}0.4$) than the survivors(p<0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The D1 score was lower in the survivors (n=21) than in the nonsurvivors ($44.1{\pm}14.6$, $78.5{\pm}18.6$, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (D1 vs D2, $44.1{\pm}14.6$ : $37.9{\pm}15.0$, p=0.035; D2 vs D3, $37.9{\pm}15.0$ : $30.1{\pm}9.3$, p=0.0001) but showed a tendency to increase in the nonsurvivors (D1 vs D2 (n=21), $78.5{\pm}18.6$ : $81.3{\pm}23.0$, p=0.1337; D2 vs D3 (n=11), $68.2{\pm}19.3$ : $75.3{\pm}18.8$, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, $53.8{\pm}10.0$ in the survivors, $55.3{\pm}10.3$ in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(D1 vs D2, $53.3{\pm}10.0$ : $43.6{\pm}16.4$, p=0.0278; D2 vs D3, $43.6{\pm}16.4$ : $31.2{\pm}10.3$, p=0.0005), but showed a tendency to increase in the nonsurvivors(D1 vs D2 (n=6), $55.3{\pm}10.3:66.7{\pm}13.9$, p=0.1562; D2 vs D3 (n=4), $64.0{\pm}16.4:74.3{\pm}18.6$, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors ($5.5{\pm}2.9$ vs $1.9{\pm}3.7$, p=0.046) in this group. Conclusion: In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.

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Construction and Application of Intelligent Decision Support System through Defense Ontology - Application example of Air Force Logistics Situation Management System (국방 온톨로지를 통한 지능형 의사결정지원시스템 구축 및 활용 - 공군 군수상황관리체계 적용 사례)

  • Jo, Wongi;Kim, Hak-Jin
    • Journal of Intelligence and Information Systems
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    • v.25 no.2
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    • pp.77-97
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    • 2019
  • The large amount of data that emerges from the initial connection environment of the Fourth Industrial Revolution is a major factor that distinguishes the Fourth Industrial Revolution from the existing production environment. This environment has two-sided features that allow it to produce data while using it. And the data produced so produces another value. Due to the massive scale of data, future information systems need to process more data in terms of quantities than existing information systems. In addition, in terms of quality, only a large amount of data, Ability is required. In a small-scale information system, it is possible for a person to accurately understand the system and obtain the necessary information, but in a variety of complex systems where it is difficult to understand the system accurately, it becomes increasingly difficult to acquire the desired information. In other words, more accurate processing of large amounts of data has become a basic condition for future information systems. This problem related to the efficient performance of the information system can be solved by building a semantic web which enables various information processing by expressing the collected data as an ontology that can be understood by not only people but also computers. For example, as in most other organizations, IT has been introduced in the military, and most of the work has been done through information systems. Currently, most of the work is done through information systems. As existing systems contain increasingly large amounts of data, efforts are needed to make the system easier to use through its data utilization. An ontology-based system has a large data semantic network through connection with other systems, and has a wide range of databases that can be utilized, and has the advantage of searching more precisely and quickly through relationships between predefined concepts. In this paper, we propose a defense ontology as a method for effective data management and decision support. In order to judge the applicability and effectiveness of the actual system, we reconstructed the existing air force munitions situation management system as an ontology based system. It is a system constructed to strengthen management and control of logistics situation of commanders and practitioners by providing real - time information on maintenance and distribution situation as it becomes difficult to use complicated logistics information system with large amount of data. Although it is a method to take pre-specified necessary information from the existing logistics system and display it as a web page, it is also difficult to confirm this system except for a few specified items in advance, and it is also time-consuming to extend the additional function if necessary And it is a system composed of category type without search function. Therefore, it has a disadvantage that it can be easily utilized only when the system is well known as in the existing system. The ontology-based logistics situation management system is designed to provide the intuitive visualization of the complex information of the existing logistics information system through the ontology. In order to construct the logistics situation management system through the ontology, And the useful functions such as performance - based logistics support contract management and component dictionary are further identified and included in the ontology. In order to confirm whether the constructed ontology can be used for decision support, it is necessary to implement a meaningful analysis function such as calculation of the utilization rate of the aircraft, inquiry about performance-based military contract. Especially, in contrast to building ontology database in ontology study in the past, in this study, time series data which change value according to time such as the state of aircraft by date are constructed by ontology, and through the constructed ontology, It is confirmed that it is possible to calculate the utilization rate based on various criteria as well as the computable utilization rate. In addition, the data related to performance-based logistics contracts introduced as a new maintenance method of aircraft and other munitions can be inquired into various contents, and it is easy to calculate performance indexes used in performance-based logistics contract through reasoning and functions. Of course, we propose a new performance index that complements the limitations of the currently applied performance indicators, and calculate it through the ontology, confirming the possibility of using the constructed ontology. Finally, it is possible to calculate the failure rate or reliability of each component, including MTBF data of the selected fault-tolerant item based on the actual part consumption performance. The reliability of the mission and the reliability of the system are calculated. In order to confirm the usability of the constructed ontology-based logistics situation management system, the proposed system through the Technology Acceptance Model (TAM), which is a representative model for measuring the acceptability of the technology, is more useful and convenient than the existing system.

Improvement of Certification Criteria based on Analysis of On-site Investigation of Good Agricultural Practices(GAP) for Ginseng (인삼 GAP 인증기준의 현장실천평가결과 분석에 따른 인증기준 개선방안)

  • Yoon, Deok-Hoon;Nam, Ki-Woong;Oh, Soh-Young;Kim, Ga-Bin
    • Journal of Food Hygiene and Safety
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    • v.34 no.1
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    • pp.40-51
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    • 2019
  • Ginseng has a unique production system that is different from those used for other crops. It is subject to the Ginseng Industry Act., requires a long-term cultivation period of 4-6 years, involves complicated cultivation characteristics whereby ginseng is not produced in a single location, and many ginseng farmers engage in mixed-farming. Therefore, to bring the production of Ginseng in line with GAP standards, it is necessary to better understand the on-site practices of Ginseng farmers according to established control points, and to provide a proper action plan for improving efficiency. Among ginseng farmers in Korea who applied for GAP certification, 77.6% obtained it, which is lower than the 94.1% of farmers who obtained certification for other products. 13.7% of the applicants were judged to be unsuitable during document review due to their use of unregistered pesticides and soil heavy metals. Another 8.7% of applicants failed to obtain certification due to inadequate management results. This is a considerably higher rate of failure than the 5.3% incompatibility of document inspection and 0.6% incompatibility of on-site inspection, which suggests that it is relatively more difficult to obtain GAP certification for ginseng farming than for other crops. Ginseng farmers were given an average of 2.65 points out of 10 essential control points and a total 72 control points, which was slightly lower than the 2.81 points obtained for other crops. In particular, ginseng farmers were given an average of 1.96 points in the evaluation of compliance with the safe use standards for pesticides, which was much lower than the average of 2.95 points for other crops. Therefore, it is necessary to train ginseng farmers to comply with the safe use of pesticides. In the other essential control points, the ginseng farmers were rated at an average of 2.33 points, lower than the 2.58 points given for other crops. Several other areas of compliance in which the ginseng farmers also rated low in comparison to other crops were found. These inclued record keeping over 1 year, record of pesticide use, pesticide storages, posts harvest storage management, hand washing before and after work, hygiene related to work clothing, training of workers safety and hygiene, and written plan of hazard management. Also, among the total 72 control points, there are 12 control points (10 required, 2 recommended) that do not apply to ginseng. Therefore, it is considered inappropriate to conduct an effective evaluation of the ginseng production process based on the existing certification standards. In conclusion, differentiated certification standards are needed to expand GAP certification for ginseng farmers, and it is also necessary to develop programs that can be implemented in a more systematic and field-oriented manner to provide the farmers with proper GAP management education.

Once vs. Twice Daily Thoracic Irradiation in Limited Stage Small Cell Lung Cancer (국한성 병기 소세포폐암의 방사선치료시 분할 조사방식에 따른 치료성적)

  • Kim, Jun-Sang;Kim, Jae-Sung;Kim, Ju-Ock;Kim, Sun-Young;Cho, Moon-June
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.291-301
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    • 1998
  • Purpose : A retrospective study was conducted comparing single daily fraction (SDF) thoracic radiotherapy (TRT) with twice daily (BID) TRT to determine the potential benefit of BID TRT in limited-stage small cell lung cancer (SCLC). Endpoints of the study were response. survival, pattern of failure, and acute toxicity. Materials and Methods : Between November 1989 to December 1996, 78 patients with histologically proven limited-stage SCLC were treated at the Department of Therapeutic Radiology, Chungnam National University Hospital. Of these, 9 were irradiated for palliative intent, and 1 had recurrent disease. Remaining 68 patients were enrolled in this study. There were 26 patients with a median age of 58 years, and 22 (85$\%$) ECOG performance score of less than 1 in SDF TRT. There were 42 patients with a median age of 57 years, and 36 (86$\%$) ECOG performance score of less than 1 in BID TRT By radiation fractionation regimen, there were 26 in SDF TRT and 42 in BID TRT. SDF TRT consisted of 180 cGy, 5 days a week. BID TRT consisted of 150 cGy BID, 5 days a week in 13 of 42 and 120 cGy BID, in 29 of 42. And the twice daily fractions were separated by at least 4 hours. Total radiotherapy doses were between 5040 and 6940 cGy (median, 5040 cGy) in SDF TRT and was between 4320 and 5100 cGy (median, 4560 cGy) in BID TRT. Prophylactic cranial irradiation (PCI) was recommended for patients who achieved a CR. The recommended PCI dose was 2500 cGy/10 fractions. Chemotherapy consisted of CAV (cytoxan 1000 mg/$m^2$, adriamycin 40 mg/$m^2$, vincristine 1 mg/$m^2$) alternating with VPP (cisplatin 60 mg/$m^2$, etoposide 100 mg/$m^2$) every 3 weeks in 25 (96$\%$) of SDF TRT and in 40 (95$\%$) of BID TRT. Median cycle of chemotherapy was six in both group. Timing for chemotherapy was sequential in 23 of SDF TRT and in 3 BID TRT, and concurrent in 3 of SDF TRT and in 39 of BID TRT Follow-up ranged from 2 to 99 months (median, 14 months) in both groups. Results : Of the 26 SDF TRT, 9 (35$\%$) achieved a complete response (CR) and 14 (54$\%$) experienced a partial response (PR). Of the 42 BID TRT, 18 (43$\%$) achieved a CR and 23 (55$\%$) experienced a PR. There was no significant response difference between the two arms (p=0.119). Overall median and 2-year survival were 15 months and 26.8$\%$, respectively. The 2-year survivals were 26.9$\%$ and 28$\%$ in both arm, respectively (p=0.51). The 2-rear survivals were 35$\%$ in CR and 24.2$\%$ in PR, respectively. The grade 2 to 3 esophageal toxicities and grade 2 to 4 neutropenias were more common in BID TRT (p=0.028 0.003). There was no difference in locoregional and distant metastasis between the two arms (p=0 125 and 0.335, respectively). The most common site of distant metastasis was the brain. Conclusion : The median survival and 2-year survival were 17 months and 20.9$\%$ in SDF TRT with sequential chemotherapy, and 15 months and 28$\%$ in BID TRT with concurrent chemotherapy, respectively. We did not observe a substantial improvement of long-term survival in the BID TRT with concurrent chemotherapy compared with standard schedules of SDF TRT with sequential chemotherapy. The grade 2 to 3 esophageal toxicities and glade 2 to 4 neutropenias were more common in BID TRT with concurrent chemotherapy. Although the acute toxicities were more common in BID TRT with concurrent chemotherapy than SDF TRT with sequential chemotherapy, a concurrent chemotherapy and twice daily TRT was feasible. However further patient accrual and long-term follow up are needed to determine the potential benefits of BID TRT in limited-stage SCLC.

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Clinical Characteristics of Pulmonary Aspergilloma (폐국균종의 임상적 고찰)

  • Kang, Tae-Kyung;Kim, Chang-Ho;Park, Jae-Yong;Jung, Tae-Hoon;Sohn, Jeong-Ho;Lee, Jun-Ho;Han, Seong-Beom;Jeon, Young-Jun;Kim, Ki-Beom;Chung, Jin-Hong;Lee, Kwan-Ho;Lee, Hyun-Woo;Shin, Hyeon-Soo;Lee, Sang-Chae;Kweon, Sam
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1308-1317
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    • 1997
  • Background : Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergilloma. Method : During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria : 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagno-sis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). Results : 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7 : 1 (57 men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis (6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients (7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. Conclusion : During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.

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