• 대한핵의학회지
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• 제1권2호
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• pp.1-25
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• 1967

In 20 normal cases and 39 pulmonary tuberculosis cases, regional pulmonary arterial blood flow measurements and lung perfusion scans by $^{131}I$-Macroaggregated albumin, lung inhalation scans by colloidal $^{198}Au$ and spirometries by respirometer were done at the Radiological Research Institute. The measured lung function tests were compared and the results were as the following: 1. The normal distribution of pulmonary blood flow was found to be $54.5{\pm}2.82%$ to the right lung and $45.5{\pm}2.39%$ to the left lung. The difference between the right and left pulmonary arterial blood flow was significant statistically (p<0.01). In the minimal pulmonary tuberculosis, the average distribution of pulmonary arterial blood flow was found to be $52.5{\pm}5.3%$ to the right lung and $47.5{\pm}1.0%$ to the left lung when the tuberculous lesion was in the right lung, and $56.2{\pm}4.4%$ to the right lung and $43.8{\pm}3.1%$ to the left lung when the tuberculous lesion was in the left lung. The difference of pulmonary arterial blood flow between the right and left lung was statistically not significant compared with the normal distribution. In the moderately advanced pulmonary tuberculosis, the average distripution of pulmonary arterial blood flow was found to be $26.9{\pm}13.9%$ to the right lung and $73.1{\pm}13.9%$ to the left lung when the tuberculous lesion was more severe in the right lung, and $79.6{\pm}12.8%$ to the right lung and $20.4{\pm}13.0%$ to the left lung when the tuberculous lesion was more severe in the left lung. These were found to be highly significant statistically compared with the normal distribution of pulmonary arterial blood flow (p<0.01). When both lungs were evenly involved, the average distribution of pulmonary arterial blood flow was found to be $49.5{\pm}8.01%$ to the right lung and $50.5{\pm}8.01%$ to the left lung. In the far advanced pulmonary tuberculosis, the average distribution of pulmonary arterial blood flow was found to be $18.5{\pm}11.6%$ to the right lung and $81.5{\pm}9.9%$ to the left lung when the tuberculous lesion was more severe in the right lung, and $78.2{\pm}8.9%$ to the right lung and $21.8{\pm}10.5%$ to the left lung when the tuberculous lesion was more severe in the left lung. These were found to be highly significant statistically compared with the normal distribution of pulmonary arterial blood flow (p<0.01). When both lungs were evenly involved the average distribution of pulmonary arterial blood flow was found to be $56.0{\pm}3.6%$ to the right lung and $44.0{\pm}3.2%$ to the left lung. 2. Lung perfusion scan by $^{131}I$-MAA in patients with pulmonary tuberculosis was as follows: a) In the pretreated minimal pulmonary tuberculosis, the decreased area of pulmonary arterial blood flow was corresponding to the chest roentgenogram, but the decrease of pulmonary arterial blood flow was more extensive than had been expected from the chest roentgenogram in the apparently healed minimal pulmonary tuberculosis. b) In the pretreated moderately advanced pulmonary tuberculosis, the decrease of pulmonary arterial blood flow to the diseased area was corresponding to the chest roentgenogram, but the decrease of pulmonary arterial blood flow was more extensive in the treated moderately advanced pulmonary tuberculosis as in the treated minimal pulmonary tuberculosis. c) Pulmonary arterial blood flow in the patients with far advanced pulmonary tuberculosis both before and after chemotherapy were almost similar to the chest roentgenogram. Especially the decrease of pulmonary arterial blood flow to the cavity was usually greater than had been expected from the chest roentgenogram. 3. Lung inhalation scan by colloidal $^{198}Au$ in patients with pulmonary tuberculosis was as follows: a) In the minimal pulmonary tuberculosis, lung inhalation scan showed almost similar decrease of radioactivity corresponding to the chest roentgenogram. b) In the moderately advanced pulmonary tuberculosis the decrease of radioactivity in the diseased area was partly corresponding to the chest roentgenogram in one hand and on the other hand the radioactivity was found to be normally distributed in stead of tuberculous lesion in the chest roentgenogram. c) In the far advanced pulmonary tuberculosis, lung inhalation scan showed almost similar decrease of radioactivity corresponding to the chest roentgenogram as in the minimal pulmonary tuberculosis. 4. From all these results, it was found that the characteristic finding in pulmonary tuberculosis was a decrease in pulmonary arterial blood flow to the diseased area and in general decrease of pulmonary arterial blood flow to the diseased area was more extensive than had been expected from the chest roentgenogram, especially in the treated group. Lung inhalation scan showed almost similar distribution of radioactivity corresponding to the chest roentgenogram in minimal and far advanced pulmonary tuberculosis, but there was a variability in the moderately advanced pulmonary tuberculosis. The measured values obtained from spirometry were parallel to the tuberculous lesion in chest roentgenogram.

• Tuberculosis and Respiratory Diseases
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• 제48권6호
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• pp.870-878
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• 2000

목적 : 초진시 흉부 X-선 소견상 경증의 폐결핵 병변을 보이면서 활동성 미정으로 판독되었을 때, 객담 검사장 결핵균이 검출되지 않은 경우가 많아 그러한 환자군에서 결핵의 활동성 평가를 위한 $^{67}Ga$ 평면영상의 가치를 확인하고, 일반적으로 평면영상보다 민감도와 정확도가 높다고 알려진 SPECT과의 비교 분석을 통해 두 검사간의 유용성올 평가하고자 하였다. 대상 및 방법 : 1996년 6월부터 1999년 12월까지 본원 내과에 내원 한 환자 중 최초 흉부 X-선 소견상 경증의 폐결핵 병변을 보이면서 활동성 미정으로 판독된 69예를 대상으로 $^{67}Ga$ 평면영상과 SPECT를 동시에 시행하였다. 결과 : 전체 대상환자 69예 중 최종 활동성 폐결핵으로 판정된 37예 중 객담 결핵균 도말 검사에서 8예(22%), 객담 배양검사에서 8예(22%)가 균양성 이었으며，임상적으로 항결핵제를 투약하여 6개월 지나 추적 검사한 흉부 X-선에서 호전을 보인 경우가 21예 (57%)였다. 최종 활동성으로 판정된 37예 중 $^{67}Ga$ 평면영상에서 섭취 소견이 보인 경우는 24예(65%), 섭취소견이 보이지 않은 경우가 13예(35%)였으며, SPECT에서 섭취 소견이 보인 경우는 25예(68%), 섭취소견이 보이지 않은 경우가 12예(32%)였다(Table 2). 최종 비활동성 폐결핵으로 판정된 32예 중 $^{67}Ga$ 평면영상에서는 모든 예에서 섭취 소견이 보이지 않았고, SPECT에서 섭취 소견이 보이지 않은 경우가 31예(97%), 섭취 소견이 보인 경우가 1예(3%)였다. 결론 : X-선 소견상 경증의 폐결핵 병변을 보이면서 활동성 미정인 폐결핵 환자의 활동성 판정에 있어서 $^{67}Ga$ 평면영상은 민감도가 65%, 특이도가 100%, 음성 예측율이 71.1%이고, SPECT은 민감도가 68%, 특이도가 97%, 음성 예측율이 72.1%로 나타났다. 흉부 X-선 소견에서 초진시 활동성 미정으로 판독된 경증 폐결핵 환자에서 $^{67}Ga$ 평면영상과 SPECT은 초진시 활동성 여부 판정에 모두 유용한 것으로 사료되며 $^{67}Ga$ 평면영상과 SPECT의 비교분석에서 민감도와 특이도, 음성예측율에서도 통계학적으로 유의한 차이는 발견하지 못하였다.

• 대한미생물학회지
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• 제20권1호
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• pp.79-89
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• 1985

It is important to discriminate between tuberculosis and tuberculosis-like disease by Mycobacteria other than tuberculosis in the serodiagnosis of tuberculosis. But because common antigens share among Mycobacteria, their antigenicities to human are similar. Therefore degree of cross-reactivity of antibody in the sera of patients with tuberculosis between M. tuberculosis and Mycobacteria other than tuberculosis should be checked to increase the specificity in the serodiagnosis of tuberculosis. The activity levels of IgG antibody in the sera of 106 patients confirmed as active pulmonary tuberculosis and 30 normal healthy control person to the pressate extract antigen (TE, BE, AE, and FE antigen) from M. tuberculosis, M. bovis, M. avium, and M. fortuitum were measured by enzyme-linked immunosorbent assay and the crossreactivity of IgG antibody with mycobacterial species was analysed. The results were as follows; 1. The activity level(O.D. at 492nm) of IgG to TE antigen in sera of patients with pulmonary tuberculosis was $0.228{\pm}0.167$ in minimal tuberculosis; moderately advanced, $0.556{\pm}0.616$; far advanced, $1.116{\pm}0.651$ and $0.315{\pm}0.245$ in miliary tuberculosis. 2. The activity level (O.D. at 492nm) of IgG to BE antigen in sera of patients with pulmonary tuberculosis was $0.190{\pm}0.162$ in minimal tuberculosis; moderately advanced, $0.337{\pm}0.361$; far advanced, $0.713[\pm}0.460$ and $0.204{\pm}0.162$ in miliary tuberculosis. 3. The activity level (O.D. at 492nm) of IgG to AE antigen in sera of patients with pulmonary tuberculosis was $0.165{\pm}0.114$ in minimal tuberculosis; moderately advanced, $0.392{\pm}0.494$; far advenced, $0.751{\pm}0.512$ and $0.233{\pm}0.191$ in miliary tuberculosis. 4. The activity level (O.D. at 492nm) of IgG to FE antigen in sera of patients with pulmonary tuberculosis was $0.280{\pm}0.227$ in minimal tuberculosis; moderately advanced, $0.460{\pm}0.564$ ; far advanced, $0.845{\pm}0.573$ and $0.257{\pm}0.103$ in miliary tuberculosis. 5. The activity level (O.D. at 492nm) of IgG in sera of healthy control person was $0.126{\pm}0.084$ to TE antigen. $0.105{\pm}0.041$ to BE antigen, $0.103{\pm}0.052$ to AE antigen, and $0.095{\pm}0.061$ to FE antigen. 6. Degree of correlation(r) in activity level of IgG between TE antigen and BE antigen was 0.905 ; between TE antigen and AE antigen, 0.760; between TE antigen and FE antigen, 0.790, and between AE antigen and FE antigen, 0.945. 7. As O.D. above 0.200 was determined positive for the serodiagnosis of pulmonary tuberculosis, the sensitivity and specificity in ELISA using TE antigen were 80% and 87% respectively, whereas in the case of using BE antigen, 66% and 100%; in the case of using AE antigen, 62% and 100%, and in the case of using FE antigen, 72% and 93%, respecitively.

• Tuberculosis and Respiratory Diseases
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• 제39권3호
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• pp.255-260
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• 1992

A pulmonary actinomycosis is a chronic suppurative disease which leads to abscess formation and fibrosis it was caused by aspiration of contaminated material from to mouth or oropharynx. Recently pulmonary actinomycosis is very rare by widespread use of antibiotics. Clinically, patients with pulmonary actinomycosis initially experience nonproductive coughing and low grade fever, but pulmonary complaints can be minimal. We report a case of pulmonary actinomycosis associated with hemoptysis which was confirmed by lobectomy with a review of literature.

• Tuberculosis and Respiratory Diseases
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• 제38권3호
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• pp.245-249
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• 1991

Surgical intervention for pumlmonary tuberculosis has been controverted for last several decades. Although it is widely held that the chemotherapy is the best modality for treatment of pulmonary tuberculosis, surgical intervention has still some roles in well elected circumstance. At the National Kongju Tuberculosis Hospital in Korea, we performed a retrospective case Cohort study through the regular follow-up of 463 cases, who underwent the surgical intervention for pulmonary tuberculosis between January 1986 and April 1990. The results were as follows: 1) The male to female ratio was 1.8:1 and 84.4% of the patients were between 20 and 49 years of age. 2) According to the NAT classification, 6 cases (1.3%) were minimal, 216 (46.7%) moderately advanced and 241 (52%) far advanced. 3) One hundred and thirty four cases (28.9%) had the treatment history of 5 to 10 years and 129 cases (27.9%) of 3 to 4 years. 4) As for the pathologic entities, 172 cases (37.1%) had the totally destroyed lung and 137 (29.6%) destroyed lobe or segment. 5) A total of 238 cases (51.4%) underwent pneumonectomy and 153 (33.0%) lobectomy. 6) As the post-operative complications, 21 cases (4.5%) had empyema and 11 (2.4%) bleeding. The rate of complication after pneumonectomy and lobectomy was 5.8% and 3.2%, respectively. 7) Six cases (1.3%) died post-operatively. 8) Out of 238 cases with pre-operative positivity for AFB, 212 achieved the negative conversion, its rate being 89.1%. It follows from these results that although it has a limit, surgical intervention may play an important role in treating some patients with pulmonary tuberculosis.

• Journal of Chest Surgery
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• 제26권10호
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• pp.775-780
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• 1993

Pulmonary aspergilloma resulting from colonization of Aspergillus fumigatus is potentially life-threatening disease due to massive hemoptysis. Between August 1990 and November 1993, twelve patients were operated for the treatment of pulmonary aspergilloma. The mean age was 38.8 years. All patients had underlying cavitary lung disease, and the tuberculosis is the most common cause. Ten patients have experienced hemoptysis, but the clinical presentation of hemoptysis at the time of operation was mostly intermittent and scanty. Operative procedures were segmentectomy in 1 patient, lobectomy in 8, pneumonectomy in 2, and pleuropneumonectomy in 1. There were three complications, bronchopleural fistula in one patient and prolonged air leak in 2. There was no postoperative death. Conclusively, our results suggest that established aspergilloma associated with tuberculosis or other cavitary lesions should undergo early elective pulmonary resection, even though it has only minimal hemoptysis.

• Tuberculosis and Respiratory Diseases
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• 제43권5호
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• pp.693-700
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• 1996

연구배경: 1980년대 들어서 폐결핵의 치료는 INH, RFP, EMB(또는 SM)의 6개월 표준 단기 요법이 정착되었고 치료 성적 또한 괄목한 만한 향상을 보여왔으나 초치료 실패 및 재치료 실패 환자에서는 약제 내성 및 약제 부작용으로 인한 치료 중단이 큰 문제가 되었다. 1980년대 개발된 Quinolone 계통의 항생제인 OFX은 감영성 호흡기 질환 치료제로서의 역할을 할 뿐만 아니라, 최근에는 결핵 치료제로 사용되고 있다. 이에 따라 저자들은 PTA, CS, PAS, OFX을 사용하여 폐결핵 환자들의 재치료 또는 재재치료의 임상효과를 알아보았다. 방법: 1993년 3월부터 1995년 8월까지 국립 공주 결핵병원에 입원하였던 객담내 결핵균 양성 환자중 초치료및 재치료에 실패한 환자로 추척이 가능한 66명을 대상으로하여 후향적 조사를 하였다. 결과: 1) 객담내 균음전 객담 도말 양성 환자 66명 중 42 명(64%)이 15개월내에 객담내 균음전되었다. 2) 흉부 X-선상의 호전은 경증에서는 3명(75%), 중등중에서는 23명(64%), 중증은 12명(46%)이었고, 전체적으로는 38명(58%)에서 호전되었다. 4) 질병 기간에 따른 균 음전율은 각100%(병력이 1년미만), 88%(1-3년), 80%(3-5년) 그리고 52%(5년이상)이었다. 5) 부작용 PTA의 부작용은 위장판 장애(소화불량, 구역, 구토, 복통등)와 경한 간기능 장애를 보여주었고, CS은 정신상태 이상(주로 불면과 감정장애)이 8명(12%)에서 있었으며, 경련은 없었다. PAS에 의한 위장 장애는 오심, 구토, 복부 불쾌감과 같은 위장장애가 대부분으로 41명(62%)에서 관찰되었다(Table 5). 결론: 폐결핵 치료 역시 다른 모든 질환과 마찬가지로 환자의 병력이 젊을수록, 흉부 X-선상의 병변이 적을수록 좋은 성적을 보였으며, 38명(58%)의 경우에는 X-선상의 호전을 보였으나 일부에서는 매우 제한적이고 더 이상의 호전을 기대하기가 어려울 것으로 생각되는 예도 있었다. 부작용으로는 위장장애(소화장애, 오심, 구토, 변비, 설사)가 주가 되었으며, 위장장애는 대부분의 경우에서는 규칙적인 증상 치료로 많은 호전을 가져 왔다. 또한 무엇보다도 전문가에 의한 적절한 치료약제의 결정과 지속적인 항결핵제 복용을 위한 정기적인 의사와의 면담 및 추후검사가 필요할 것으로 생각된다.

• Journal of Preventive Medicine and Public Health
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• 제29권1호
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• pp.67-78
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• 1996

The purpose of this study was examine the general characteristics of relapsed pulmonary tuberculous patients (i.e. age, sex, weight, occupation, previous forms of treatment, drug sensitivity, and the frequency of relapse) in order to improve future treatments of tuberculosis as well as to perpetuate health education. The data was obtained from the medical records of 186 relapsed pulmonary tuberculosis patients who were registered for treatment at various public health offices in Seoul during the year of 1994. The major findings obtained from the study were as follows; 1) The male to female ratio of relapsed pulmonary tuberculous patients was about 7:3, more specifically 23.7% of the men and 30.9% of the women were between 20 and 29 years of age. 2) Comparing initial less aggravated states to relapsed states, patients with minimal X-ray findings later proved moderately advanced X-ray findings. Furthermore, patients with negative sputum AFB findings later proved positive sputum AFB findings. 3) Of the 186 patients studied, 91.9% suffered, relapse and 8.1% suffered 2 or more relapses. Of the patients who suffered at least 1 relapse, 54.8% received short-term treatment, 26.9% received long-term treatment, and 18.3% received treatment of an unknown during their initial tuberculosis treatment periods. 4) fifty five point four percent of the patients had no reaction to the drug treatment(not available), 25.9% of the patients had sensitive reaction to the drug treatment, 18.7% of the patients had resistant reaction to the- drug treatment. Drug resistance was higher in patients that exhibited positive X-ray findings as well as in patients that exhibited positive sputum AFB findings. furthermore, patients receiving treatment of an unknown nature(35.5%) exhibited higher drug resistance than those receiving short-term treatment(13.6%) and long-term treatment(17.0%). 5) Of the 160 patients who suffered relapses, 8.8% suffered a relapse within 1 year after treatment and 91.2% suffered a relapse at least 1 year after treatment. Furthermore, our study showed that women, under 30, who received short-term treatment and encounterd complications during their primary treatment suffered relapses faster than any other groups studied. In addition, minimal X-ray findings and sputum AFB findings were not correlated to the time relapse occured. Therefore, the seater efforts are needed to prevent relapsed pulmonary tuberculosis.

• Tuberculosis and Respiratory Diseases
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• 제41권1호
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• pp.42-46
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• 1994

저자들은 반복적인 객혈이 있는 폐국균종 환자에서 경피적 공동내 Amphotericin B의 주입에 의해 객혈에 대한 효과적인 치료 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권9호
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• pp.808-811
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• 1994

We reported a successful right pneumonectomy using video assisted thoracoscopy for endobronchial tuberculosis. Thoracoscopic surgery has many advantages in spite of its technical difficulties. These advantages include good cosmetic effects, short hospital stay, decreased postoperative morbidity, and good postoperative pulmonary function.The patient was young unmarried female, and her right lung was nearly total obstructed by endobronchial tuberculous dissemination and secondary pulmonary infection. The procedure was a little complicated by inadequate placements of the thoracoscopic ports and 5cm length utility thoracotomy incision. Minimal pain killer was needed only two days after operation and scar of operative wound was very satisfying. Postoperative course was unusual and the patient was discharged 7 days after operation.