• Tuberculosis and Respiratory Diseases
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• v.40 no.2
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• pp.104-111
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• 1993

Background: Gram-negative bacterial endotoxin induced septicemia is known to be a leading cause in the development of adult respiratory distress syndrome(ARDS). The mechanism of endotoxin induced lung injury is mainly due to the activated neutrophils which injure the capillary endothelial cells by releasing oxidant radical and resulted in pulmonary edema. We studied the change of antioxidant enzyme in the case of large or small, intermittant dose of endotoxin infused rat lungs. Methods: Endotoxin was given to the rat through the peritoneal cavity in the dose of 7 mg/kg body weight in the large dose group and 1 mg/kg for 10 days in the small dose group. Bronchoalveolar lavage (BAL) was done and rats were killed at 6, 12, 24 hours after single endotoxin injection in the large dose group and 3, 7, 10 days after daily endotoxin injection for 10 days in the small dose group. The lungs were perfused with normal saline through the pulmonary artery to remove the blood and were homogenized in 5 volume of 50 mM potassium phosphate buffer containing 0.1 mM EDTA. After centrifuging at 100,000 g for 60 minute, the supernatent was removed and stored at $-70^{\circ}C$ until measuring for superoxide dismutase (SOD), catalase, glutathione peroxidase (GSH-Px) and protein. Results: We observed the following results. 1) The lung wet/dry weight ratio and albumin concentration in the BAL fluids were increased to peak at 12 hours and neutrophil number in the BAL fluids were peak at 6 hours after endotoxin injection in the large dose group. 2) Cu, Zn SOD (IU/mg protein) was significantly decreased after 6, 12 hours after endotoxin injection in the large dose group. 3) There were no singnificant change in the level of Mn SOD, catalase, GSH-Px after endotoxin injection in both groups. Conclusion: Endotoxin in the large dose group produced the acute pulmonary edema and decreased the Cu, Zn SOD in the lung tissue after injecting endotoxin at 6 and 12 hours. These phenomenon may be due to the cell membrane damage by endotoxin. Further research would be necessary whther giving SOD by intratracheal route or method to increase the synthesis of SOD may lessen the acute lung injury by endotoxin.

• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.221-227
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• 1996

Background : Measurement of pleural fluid constituents are of value in the diagnosis of pleural effusions and in the seperation of exudates from transudates. The position of the patient(sitting or lying) prior to thoracentesis may result in difference in the measurement of these constituents. The purpose of this study is to determine whether postural differences in pleural fluid constituents exist, and if so, whether they are of any clinical significance. Method : 41 patients with pleural effusions on chest roentgenography were prospectively studied. The fluid cell counts, partial gas tension, and concentrations of chemical constituents were compared in the supine and upright positions. Results : 1) A total of 10 patients were found to have an transudative effusion. In the transudates there was no significant difference in pleural fluid constituents according to posture change. 2) A total of 31 patients were found to have an exudative effusion. Statistically significant postural changes were noted in pH, WBC counts, protein, and LDH concentrations in the exudates. It may be due to postural sedimentary effect in the pleural space. 3) The PCO2 measurements and glucose concentration were not affected by changes in position in exudates or transudates. Conclusion : Postural sedimentary effect occurs in the pleural space with reference to the measurement of certain pleural fluid constituents when an inflammatory process is present. Therefore it is recommended that thoracentesis after 30 minutes in the sitting position should be performed.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1366-1381
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• 1997

Background : Uvulopalatopharyngoplasty(UPPP) has become the most common surgical treatment for obstructive sleep apnea syndrome(OSAS). However, the results of this therapeutic modality have been quite variable with successful results by several authors and poor results by others. Until recently, in Korea, there is only a few reports about the clinical efficacy of UPPP. A prospective study was undertaken to evaluate the effectiveness and complications of UPPP. Method : Twenty-six OSAS patients who had undergone UPPP with preoperative and postoperative polysomnographic studies were included in this study. Two definitions of surgical success were used. The responder was defined, using a conventional criteria, as a 50% or more reduction in apnea index(AI) or apneahypopnea index(AHI) after UPPP, or a postoperative AI of <10 or AHI of <20. The initial cure was defined, using our own criteria, as a postoperative AI of <5 or AHI of <10. Complications were categorized in two groups : early(disorders during the first 10 postoperative days) and late. Results : Eighteen patients(69.2%) were responders, and ten patients(38.5%) were considered as initial cure. On the other hand, in five patients (19.2%), postoperative polysomnographic data demonstrated deterioration compared with preoperative data. Reduction rate of AI or AHI following UPPP was not significantly related to the preoperative body mass index, AI or AHI. There was no significant change of sleep architecture before and after UPPP in responder and initial cure groups. Early complications such as pain, dyspnea, bleeding, nasal reflux, dysphagia or wound disruption were observed in all patients. Late complications such as nasal reflux, voice change, dysphagia, loss of taste, pharyngeal dryness or foreign body sensation were discovered in 22 patients (84.6%). However, all early and late complications were of minor importance. Conclusion : The response to UPPP was favorable in approximately 70% of OSAS patient. However, the initial Cure rate of UPPP was relatively low. We suggest that selection of more appropriate surgical candidates and adequate surgical protocol is necessary to obtain a more successful result with UPPP.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.953-961
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• 1998

Background : In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatment, progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors influencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. Methods: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline: (a) compliants; (b) patients who initially complied but gave up of themselves midway during the course of treatment; (c) noncompliants who refused the treatment. Results: The overall compliance rate was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sex, marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage I and II, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. Conclusion: To enhance the compliance, special care including education programs about therapy including complication and prognosis are necessary, especially for educationally and economically disadvantaged patients.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.493-504
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• 1997

Background : Non-small cell lung cancer is one of the most frequent cause of death due to cancer in men, and its incidence among women is rapidly increasing. Although there has been a recent surge of interest in combined modality therapy for stageIII non-small cell lung cancer(NSCLC), the optimal treatment is still not well established. Thoracic irradiation has long been the gold standard for locally advanced unresectable NSCLC. However, although conventional radiotherapy(XRT) can palliate symptom and improve local control of disease, it has at most only a modest effect on survival. Recently, cisplatin(cis-diamminedichloroplatinum) has been reported to enhance the cell-killing effect of radiation For patients with unresectable NSCLC, cisplatin-based concurrent chemoradiotherapy(CCRT) had the advantage of therapeutic response over XRT alone and therapeutic side effect more commonly occurred in CCRT group in EORTC(European Organization for Research and Treatment of Cancer) and other trials. Objectives : We compared therapeutic response, compliance, and side effects between CCRT and XRT in patients with advanced NSCLC. Patients and Method : Thirty patients with biopsy-proven inoperable NSCLC were randomized to one of two treatment arms. Arm A consisted of XRT, radiotherapy for 4~6 weeks(1.8 Gy given 20~33 times, in five fractions a week), and arm B consisted of CCRT, radiotherapy for 2 weeks(3 Gy given to times, in five fractions a week), followed by 3 week rest period and then radiotherapy 2 more weeks(2.5 Gy given 10 times, in five fractions a week), combined with 6mg cisplatin per square meter, given daily before radiotherapy. We evaluate therapeutic response, compliance, change of performance status, side effects, and radiation pneumonitis by using the author's made scoring system. Results : There was no significant difference in therapeutic response and compliance. But there was a significantly lower laboratory complication and radiation pneumonitis in CCRT group (p < 0.05). There's significant negative correlation between stage and therapeutic response score in both groups(R=0.353, p < 0.05) In both groups, patients with squamous cell carcinoma had a tendency to higher therapeutic response score than those with adenocarcinoma. Conclusion : There was no difference between CCRT and XRT in respect to therapeutic response and compliance. But CCRT had a advantage of decreased side effects.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.311-321
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• 1998

Background: Mucoepidermoid carcinoma of the lung arises from submucosal gland of tracheobronchial tree. Histologically, the tumor is composed of mucin-secreting cells, squamous cells, and intermediated cells, which show no particular differentiating characteristics, in varying proportions. The tumor is divided into low grade and high grade depending on the proportion of cells, and the degree of the mitotic activity, cellular necrosis and nuclear pleomorphism. While favorable prognosis of low grade tumor, high grade tumor, which is very difficult to differentiate from adenosquamous carcinoma, has an aggressive clinical course. The tumor is rare, comprising 0.1 to 0.2% of primary lung cancers and 1 to 5% of bronchial adenomas. Method: A retrospective clinical study was done on 17 cases of mucoepidermoid carcinoma. The study investigated the clinical features, radiologic findings, bronchoscopic findings, histology and clinical courses. Results: Age ranged between second to seventh decade with a mean age of 42 years. Twelve out of 17 cases were male. Five out of 17 cases were smokers with a mean 11 pack-years. Common symptoms included dyspnea, cough, hemoptysis, and wheezing. Two out of 17 cases was asymptomatic. Atelectasis or mass was common radiologic finding. Plain chest radiography was normal in one patient whom the tumor was located in upper trachea. Bonchoscopy revealed exophytic mass in 12 cases and nodular infiltrations in 4 cases. One case having solitary pulmonary nodule in the right lower lung was normal on bronchoscopy. Histologically, ten out of 17 cases were low grade, and seven out of 17 cases were high grade. Among 10 patients with low grade tumor,9 patients were performed operation and have been alive without recurrence during a mean follow-up of 30 months. Two out of 7 patients with high grade tumor were performed pneumonectomy and have been alive during a follow-up of 3 and 8 months, respectively. Conclusion: Most of mucoepidermoid carcinoma is located at central airway and is presented symptoms by mucosal irirtation. Although atelectasis or mass is common radiologic finding. chest X -ray can be normal. The histologic grading and the extent of tumor are two most important factors for prognosis.

• Tuberculosis and Respiratory Diseases
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• v.52 no.2
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• pp.137-144
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• 2002

Background: Hemoptysis is an often alarming presenting symptom and VEGF is a major regulator of both normal and abnormal angiogenesis, including many inflarrunatory diseases. In this report the clinical significance of the serum VEGF level in patients with hemoptysis was investigated. Methods: Thirty-two patients with hemoptysis were evaluated. The estimated amount of hemoptysis, etiology and serum VEGF level was examined at admission and bronchial angiography was performed in 22 patients. In order to objectify the neovascularization status, one point for the presence of the A-V shunt, hypervascularity, vascular tortuosity was designated for a total of 0-3 points. Results: Mean quantity of hemoptysis was $172.4{\pm}270.4ml$. The mean angiographic neovascularization score was $1.23{\pm}0.75$. The serum VEGF level correlated with the quantity of hemoptysis(r=0.524, p=0.002) and with the angiographic neovascularization score(r=0.441, p=0.04). Using the standard diagnostic criterion for massive hemoptysis, the serum VEGF level of patients with massive hemoptysis($642.4{\pm}545.6$ pg/ml, n=13) was found to be higher than that of patients with non-massive hemoptysis($394.6{\pm}225.8$ pg/ml, n=19) (p=0.069). Conclusion: Regardless of the etiology, the serum VEGF may contribute to abnormal neovascularization in patients with hemoptysis. Therefore, it is suggested that serum VEGF measurements may help in predicting a massive hemoptysis.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.1047-1057
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• 1998

Background : Sarcoidosis is a systemic granulomatous disorder of unknown origin and characterized by accumulation of T cells and macrophages. Various cytokines may play crucial roles in the activation of T cells and macrophages, and thereby in the formation of granulomas. However, little is known about the balance between proinflammatory cytokines and antiinflammatory cytokines in the development of sarcoid granulomas and disease activities. In the present study, we measured IL-6, IL-8 and IL-10 in the bronchoalveolar lavage fluid(BALF) from patients with pulmonary sarcoidosis to find out whether there is an imbalance between proinflammatory cytokines and antiinflammatory cytokines in the lung. Methods: Fourteen subjects with the diagnosis of sarcoidosis and six healthy volunteers were included. BALF was concentrated ten-fold by pressure ultrafiltration and each cytokine levels were measured by EUSA method. Active sarcoidosis was defined by major organ involvement or clinically progressive diseases. Results: The mean IL-6 levels in the BALF of the active sarcoidosis group were significantly increased than in controls or inactive sarcoidosis group(p<0.05). Meanwhile, the IL-8 levels were increased and IL-10 levels were decreased in the active sarcoidosis group than in controls or inactive sarcoidosis group without significance(p>0.05). In active pulmonary sarcoidosis patients, the IL-6 levels in BALF correlated with the BALF CD4/CD8 ratio(r=0.768, p<0.05) and IL-8 levels(r=0.564, p<0.05). Conclusions : The data presented showed that pro-inflammatory cytokine IL-6 is important in the pathogenesis of sarcoidosis and decreased tendency of anti-inflammatory cytokine IL-10 might also be involved in the development of granulomatous inflammation in sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• v.49 no.6
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• pp.715-723
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• 2000

Background : Obstructive sleep apnea syndrome (OSAS) affects systemic blood pressure and cardiac function. The development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac rhythm, suggests that recurrent hypoxia and arousals from sleep may increase a sympathetic nervous system activity. Continuous positive airway pressure (CPAP) therapy has been found to be an effective treatment of OSAS. However, only a few studies have investigated the cardiovascular and sympathetic effects of CPAP therapy. We evaluated influences of nasal CPAP therapy on the cardiovascular system and the sympathetic activity in patients with OSAS. Methods : Thirteen patients with OSAS underwent CPAP therapy and were monitored using polysomnography, blood pressure, heart rate, presence of arrhythmia and the concentration of plasma catecholamines, before and with CPAP therapy. Results: The apnea-hypopnea index (AHI) was significant1y decreased (p<0.01) and the lowest arterial oxygen saturation level was elevated significantly after applying CPAP (p<0.01). Systolic blood pressure tended to decrease after CPAP but without statistical significance. Heart rates during sleep were not significantly different after CPAP. However, the frequency and number of types of arrhythmia decreased and sinus bradytachyarrhythmia disappeared after CPAP. Although there was no significant difference in the level of plasma epinephrine concentration, plasma norepinephrine concentration significantly decreased after CPAP (p<0.05). Conclusion : CPAP therapy decreased the apnea-hypopnea index, hypoxic episodes and plasma norepinephrine concentration. In addition, it decreased the incidence of arrhythmia and tended to decrease the systemic blood pressure. These results indicate that CPAP may play an important role in the prevention of cardiovascular complications in patients with OSAS.

• The Journal of Korean Academy of Prosthodontics
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• v.48 no.1
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• pp.16-27
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• 2010

Purpose: The aim of this experimental study is to observe the effect of platelet-rich plasma (PRP) on early bone regeneration of rats both in normal condition and in osteoporosis induced by ovariectomy. Material and methods: Total 40 Sprague-Dawley female rats were divided into 4 groups. A 8-mm-diameter calvarial critical-sized defect (CSD) was made by drilling with trephine at the center of calvaria in cranium of every rat. Every CSD was augmented with an osteoconductive synthetic alloplastic substitute ($MBCP^{TM}$) and PRP as follows. Group A; 10 non-ovariectomized rats grafted with only $MBCP^{TM}$. Group B; 10 non-ovariectomized rats grafted with $MBCP^{TM}$ and PRP. Group C; 10 ovariectomized rats grafted with only $MBCP^{TM}$. Group D; 10 ovariectomized rats grafted with $MBCP^{TM}$ and PRP. At 4 weeks after graft, every rat was sacrificed. And histomorphometric analysis was performed by measuring calcified area of new bone formation within the CSD. Results: Comparing four groups, results were obtained as follows. 1. In non-ovariectomized groups, PRP showed a positive effect somewhat but not significant (P > .05). 2. In ovariectomized groups, PRP showed a positive effect significantly (P < .05). 3. In PRP untreated groups, ovariectomy diminished bone regeneration significantly (P < .05). 4. In PRP treated groups, ovariectomy diminished bone regeneration somewhat but not significant (P > .05). Conclusion: Within the limitation of this study, it can be concluded that PRP in combination with an osteoconductive synthetic alloplastic substitute has an effect on bone regeneration more significantly in ovariectomized osteoporotic rats than in normal rats.