• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.19-24
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• 1995

Background: Although pulmonary tuberculosis is effectively controlled with 6 months or 9 months short course standard regimens, comparable numbers of treatment failures ensued because of inadequate treatment mainly due to patient's poor compliance. Indequate treatment with standard regimens during initial treatment may cause emergence of drug resistance and prolong the duration of chemotherapy. Also it may make the patient lesser compliant and finally increase the morbidity and the mortality. Methods: A clinical study was done to evaluate clinical and bacteriological characteristics of 94 patients who were retreated for pulmonary tuberculosis. Results: 1) 62 of the 94 patients were male and 32 patients were female. Mean age is 51 years old in male and 45 years old in female. 2) The extent of the disease on the chest radiograph was minimal in 10(11.1%) patients, moderate in 31(33.3%) patients, and far advanced in 52(55.6%) patients. 3) On sputum bacteriologic examination, 73(77.7%) patients were positive in sputum AFB smear and/or culture for Mycobacterium tuberculosis. 4) Results of drug sensitivity test performed in 42 patients showed that the resistance to one drug is in 9(20.5%) patients, two drugs in 18(40.8%) patients, and more than three drugs in 14(31.8%) patients. 5) Poor patient's compliance was the leading cause of the retreatment of pulmonary tuberculosis(43.6%) 6) Only 24(25.5%) patients of the 94 retreatment patients were successfully treated and 39(41.6%) patients were dropped out during follow-up. Conclusion: We concluded that poor patient's compliance was the most important cause of treatment failure not only in primary treatment patients but also in retreatment patients. Primary treatment of pulmonary tuberculosis should be completed under strict monitoring of the patient because significant number of retreatment patients had multiple drug resistance and poor outcome.

• Tuberculosis and Respiratory Diseases
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• v.76 no.3
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• pp.114-119
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• 2014

Background: Epigallocatechin-3-gallate (EGCG), a major biologically active component of green tea, has anti-cancer activity in human and animal models. We investigated the schedule-dependent effect of EGCG and paclitaxel on growth of NCI-H460 non-small cell lung cancer cells. Methods: To investigate the combined effect of EGCG (E) and paclitaxel (P), combination indices (CIs) were calculated, and cell cycle analysis was performed. For the effect on cell apoptosis, western blot analysis was also performed. Results: CI analysis demonstrated that both concurrent and sequential E ${\rightarrow}$ P treatments had antagonistic effects (CIs >1.0), but sequential P ${\rightarrow}$ E had synergistic effects (CIs <1.0), on the growth inhibition of NCI-H460 cells. In the cell cycle analysis, although paclitaxel induced $G_2/M$ cell cycle arrest and increased the sub-G1 fraction, concurrent EGCG and paclitaxel treatments did not have any additive or synergistic effects compared with the paclitaxel treatment alone. However, western blot analysis demonstrated that sequential P ${\rightarrow}$ E treatment decreased the expression of Bcl-2 and procaspase-3 and increased poly(ADP-ribose) polymerase (PARP) cleavage; while minimal effects were seen with concurrent or sequential E ${\rightarrow}$ P treatments. Conclusion: Concurrent or sequential E ${\rightarrow}$ P treatment had opposite effects to P ${\rightarrow}$ E treatment, where P ${\rightarrow}$ E treatment showed a synergistic effect on growth inhibition of NCI-H460 cells by inducing apoptosis. Thus, the efficacy of EGCG and paclitaxel combination treatment seems to be schedule-dependent.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.913-922
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• 1995

Background: When we define the pressure of pulmonary vasculature in which a recruitment of blood flow occurs as $P_I$ and the proportion of change in pulmonary artery to that in cardiac output as IR and then we compare PI and IR with pulmonary vascular resistance, we would find some problems in pulmonary vascular resistance. In other words, it is the theory that, IR should be increased mainly in pulmonary embolism in which decreases the cross sectional area of pulmonary vasculature. But there are many contradictory reports resulted from various researches and the fact is known widely that any difference exists between PVR and PI, IR. For this reason, the purpose of this study is to observe how PI and IR change at the time of the outbreak and during treatment of the pulmonary embolism, and to find out the meaning of these new indicators and the difference from the pulmonary vascular resistance used generally when we subdivide the pulmonary vascular resistance into PI and IR. Method: After making AV fistula in experimental dog, we controlled cardiac output at the intervals of 15 minute in case of three kinds(all AV fistula are obstructed, only one of fistula is open and all of fistula is open), and after evoking massive pulmonary embolism with radioactive autologous blood clots, we measured the mean pulmonary artery pressure, and calculated PI and IR. We observed the pattern of change in PI and IR, without giving the control group any specific treatment and with injecting intravenously rtPA in the Group 1 and Group 2 at the dose of 1mg per kg, for 15 minutes fot the former and 3 hours for the latter. Result: 1) Pulmonary vascular resistance showed a change similar to that of pulmonary artery pressure and in all three group, PVR increased significantly, but group 1 and group 2 showed tendency that PVR keeps on decreasing after treatment, and the rate of decrease in group 1 is more rapid than group 2 significantly. 2) Both intersection(PI) and degree(IR) are proved statistically significant, in view of the straight line relationship between cardiac output and pulmonary artery pressure, calculated by minimal regression method. 3) PI changed similarly to pulmonary vascular resistance, while in the IR which is theoretically more similar to PVR, there was no significant difference or change after rtPA infusion. Conclusion: In the pulmonary embolism, Both change in IR which means real resistance of pulmonary vasculature and PI which was developed due to secondary vasoconstriction by pulmonary embolism are reflected same time.

• Tuberculosis and Respiratory Diseases
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• v.57 no.6
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• pp.567-572
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• 2004

Background : The effect of PEEP(ed note: Define PEEP.) on the lung volume in patients with auto-PEEP during mechanical ventilation is not even. In patients with an expiratory limitation such as COPD, a PEEP of 85% from an auto-PEEP can be used with minimal increase in the lung volume. However, the application of PEEP to patients without an expiratory flow limitation can result in progressive lung. This study was carried out to evaluate the different PEEP effects on the lung volume according to the different pulmonary diseases. Methods : Sixteen patients who presented with auto-PEEP during mechanical ventilation were enrolled in this study. These patients were divided into 3 groups: asthma, COPD and tuberculosis sequela (patients with severe cicatrical fibrosis as a result of previous tuberculosis and compensatory emphysema). A PEEP of 25, 50, 75 and 100% of the auto-PEEP was applied, and the lung volume increments were estimated using the trapped lung volume. Results : In the asthma group, the trapped lung volume was not increased at a PEEP of 25 and 50% of the auto-PEEP. This group showed a significant lung volume increment from a 75% PEEP. In the COPD group, the lung volume was increased only at 100% PEEP. In the tuberculosis sequela group, the lung volume was increased progressively from low PEEP levels. However, a significant increment of the lung volume was noted only at 100% PEEP. Conclusion : The effects of the applied PEEP on the lung volume were different depending on the underlying lung pathology. The level of the applied PEEP >50% of the auto-PEEP might increase the trapped lung volume in patients with asthma.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.349-354
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• 1977

Mediastinoscopy is a surgical endoscopic technique used mainly for examination and biopsy of lesions of the superior and posterior middle mediastinum. It is particularly concerned with diseases that primarily or secondary involve the paratracheal and parabronchial lymphatics. A total of 18 cases of mediastinoscopy are presented with a detailed analysis of indications and results. Of these mediastinoscopy was positive in i0 [56%] and negative in 8 [44%]. The 10 positive mediastinoscopies were diagnostic in 4 patients with malignant lymphoma, 5 patients with carcinoma of the lung, one patient with active pulmonary tuberculosis. Of 8 negative mediastinoscopies, one was inoperable due to recurrent laryngeal nerve involvement, 7 patients were subjected to radical resection. Complications of mediastinoscopy were developed in 2 cases, one was minimal degree of subcutaneous emphysema on anterior chest wall, and the other was widening of right mediastinal border due to hematoma. Two complications were completely absorbed after 7 days.

• Tuberculosis and Respiratory Diseases
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• v.54 no.4
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• pp.367-377
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• 2003

Background : It is well known that only 10% of those infected with Mycobacterium tuberculosis actually develop clinical disease, indicating the existence of host genetic factors regulating disease expression. In this study, we investigated HLA-DRB1 and -DQB1 gene polymorphisms in Korean patients with pulmonary tuberculosis (PTB). Methods : HLA-DRB1 and -DQB1 gene polymorphisms were investigated in 67 PTB patients without previous treatment history, 38 drug-sensitive (DS) and 29 multidrug-resistant (MDR) cases, and 200 healthy controls. HLA-DRB1 typing was done using reverse SSO (sequence specific oligonucleotide) and PCR-SSCP (single strand conformational polymorphism) methods and DQB1 typing was done using PCR-RFLP (restriction fragment length polymorphism), PCR-SSCP and PCR-SSP (sequence specific primer) methods. Results : Among the PTB patients, MDR-TB cases showed frequencies of DRB1*0701 and *08032 increased by about two-fold compared to those of normal controls, and likewise for their associated DQB1 alleles, DQB1*0202 and *0601 (15.5% vs. 34.5%, p=0.01). The frequency of HLA-DQB1*0609 was significantly increased in PTB patients (4.0% vs. 14.9%, p=0.004), showing similar increases in both DS and MDR cases. There was also an association of HLA alleles with the clinical severity of the disease according to the extent of lung lesion. Significantly increased frequencies of DRB1*08032 (4.2% vs. 32.6%, p=0.007) and DQB1*0601 (12.5% vs. 34.9%, p=0.047) were observed in more advanced (moderately & far advanced/DS and far advanced/MDR), compared with less advanced (minimal/DS and moderately advanced/MDR) lung lesions. Although DRB1*0701, DQB1*0202 and DQB1*0609 showed significant increases in different subsets of the disease, these HLA alleles did not show consistent association with disease severity. Conclusion : HLA-DRB1*08032 and DQB1*0601 alleles were associated with genetic susceptibility to MDR-TB in Korean patients, and also with disease severity and progression of PTB.

• Tuberculosis and Respiratory Diseases
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• v.60 no.2
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• pp.221-227
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• 2006

Background : Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short- term effects of inhaled corticosteroid on chronic cough Methods : Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler $800{\mu}g/day$ for ten days. The primary outcome measure was a decrease in the cough score after treatment. Results : Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment. Conclusion : Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.

• Journal of Nutrition and Health
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• v.6 no.1
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• pp.53-69
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• 1973

For the purpose of ascertaining the status of physical growth and development of the University students, an intensive survey was conducted by the authors towards a total of 2,197 (male: 1,694, female: 503) who passed the written enterance examination at the Korea University in 1972. The items included the measurements on physical growth, various physical indices, status of visual distourbance and pulmonary infiltration. The findings and results can be summarized as follows. 1. Physical growth: The average of body height by sex were 167.2 cm in male and 156.0cm in female, body weight 59.3kg and 51.9kg, chest-girth 86.7cm and 81.2cm, sitting height 91.7cm and 85.8cm, respectively. 2. Various indices about physical growth & development; Relative body weight by sex were 35.47 and 33.27, relative chest girth 51.85 and 52.05, relative sitting height 54.84 and 55.00, respectively. $R{\ddot{a}}here$ index was 1,269 in males and 1,367 in females, Kaup index 2,121 and 2,133, Verveck index 87.32 and 85.32, respectively. 3. Status of visual distaurbance: The vision of the students under 0.9 with Han's testing chart was 52.83% and 55.27% in left eye and 53.60% and 54.87% in right eye, respectively. 4. Pulmonary infiltration Among the total 58 students were diagncsed as pulmonary infiltration (tuberculosis), of whom 43 were minimal case, 12 were moderately advanced cases and 3 were far advanced cases.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.380-387
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• 1998

Background: Minimal pressure support(PSmin) is a level of pressure support which offset the imposed work of breathing(WOBimp) developed by endotracheal tube and ventilator circuits in pressure support ventilation While the lower applied level of pressure support compared to PSmin could induce respiratory muscle fatigue, the higher level than PSmin could keep respiratory muscle rest resulting in prolongation of weaning period during weaning from mechanical ventilation PSmin has been usually applied in the level of 5~10 cm$H_2O$, but the accurate level of PSmin is difficult to be determinated in individual cases. PSmin is known to be calculated by using the equation of "PSmin = peak inspiratory flow rate during spontaneus ventilation$\times$total ventilatory system resistance", but correlation of calculated PSmin and measured PSmin has not been known. The objects of this study were firstly to assess whether customarily applied pressure support level of 5~10 cm$H_2O$ would be appropriate to offset the imposed work of breathing among the patients under weaning process, and secondly to estimate the correlation between the measured PSmin and calculated PSmin. Method : 1) Measurement of PSmin : Intratracheal pressure changes were measured through Hi-Lo jet tracheal tube (8mm in diameter, Mallinckroft, USA) by using pulmonary monitor(CP-100 pulmonary monitor, Bicore, USA), and then pressure support level of mechanical ventilator were increased until WOBimp was reached to 0.01 J/L or less. Measured PSmin was defined as the lowest pressure to make WOBimp 0.01 J/L or less. 2) Calculation of PSmin : Peak airway pressure(Ppeak), plateau airway pressure(Pplat) and mean inspiratory flow rate of the subjects were measured on volume control mode of mechanical ventilation after sedation. Spontaneous peak inspiratory flow rates were measured on CPAP mode(O cm$H_2O$). Thereafter PSmin was calculated by using the equation "PSmin = peak inspiratory flow rate$\times$R, R = (Ppeak-Pplat)/mean inspiratory flow rate during volume control mode on mechanical ventilation". Results: Sixteen patients who were considered as the candidate for weaning from mechanical ventilation were included in the study. Mean age was 64(${\pm}14$) years, and the mean of total ventilation times was 9(${\pm}4$) days. All patients except one were males. The measured PSmin of the subjects ranged 4.0~12.5cm$H_2O$ in 14 patients. The mean level of PSmin was 7.6(${\pm}2.5\;cmH_2O$) in measured PSmin, 8.6 (${\pm}3.25\;cmH_2O$) in calculated PSmin Correlation between the measured PSmin and the calculated PSmin is significantly high(n=9, r=0.88, p=0.002). The calculated PSmin show a tendancy to be higher than the corresponding measured PSmin in 8 out of 9 subjects(p=0.09). The ratio of measured PSmin/calculated PSmin was 0.81(${\pm}0.05$). Conclusion: Minimal pressure support levels were different in individual cases in the range from 4 to 12.5 cm$H_2O$. Because the equation-driven calculated PSmin showed a good correlation with measured PSmin, the application of equation-driven PSmin would be then appropriate compared with conventional application of 5~10 cm$H_2O$ in patients under difficult weaning process with pressure support ventilation.

• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.71-79
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• 2003

Background : A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. Methods : Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia ($PaO_2/FIO_2$ ratio ${\leq}200$ on oxygen 10 L/min via mask with reservoir bag) were enrolled. The CPAP 5-6 $cmH_2O(F_IO_2\;1.0)$ was delivered through an inflatable face mask using a conventional mechanical ventilator. The CPAP began 10 min before starting the BAL and continued for 30 min after the procedure was completed. A bronchoscope was passed through a T-adapter and advanced through the mouth. BAL was performed using the conventional method. The vital signs, pulse oxymetry values, and arterial blood gases were monitored during the study. Results : (1) Median age was 56 years(male:female=4:3). (2) The baseline $PaO_2$ was $78{\pm}16mmHg$, which increased significantly to $269{\pm}116mmHg$(p=0.018) with CPAP. After the BAL, the $PaO_2$ did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The $SpO_2$ showed a similar trend with the $PaO_2$ and did not decrease to below 90 % during the duration of the study. (3) The $PaCO_2$ increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases. Conclusion : In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.