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Nontuberculous Mycobacterial pulmonary Infection in Immunocompetent Patients (면역적격자에서 비결핵마이코박테리아의 폐감염)

  • Lee, Hyo-Won;Kim, Mi-Na;Shim, Tae-Sun;Bai, Gill-Han;Pai, Chik-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.2
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    • pp.173-182
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    • 2002
  • Background : Nontuberculous mycobacteria (NTM) have usually been considered to be contaminants of colonizers when isolated from respiratory specimens in Korea, where there is a high prevalence of tuberculosis and a low rate of HIV infections. Therefore, there has been few studies on the clinical significance of NTM species in immunocompetent patients were investigated. Methods : Thirty-five NTM isolates, for which species identification was requested by the treating physicians during 1999 at the Asan Medical Center, were retrospectively analyzed. They were identified to the species level by mycolic acid analysis using high-performance liquid chromatography. The medical records of the patients with the NTM isolates were reviewed to identify those patients who met the American Thoracic Society (ATS)'s criteria for mycobacterial pulmonary infection. Their antimicrobial susceptibility data were compared with the clinical outcomes. Results : The NTM were identified as M. intracellulare (6 isolates), M. avium (5), M. abscessus (5), M. gordonae (5), M. terrae complex (4), M. szulgai (2), M. kansasii (2), M. fortuitum (2), M. peregrinum (1), M. mucogenicum (1), M. celatum (1), and M. chelonae (1). All 35 patients showed clinical symptoms and signs of chronic lung disease, but none had a HIV infections; 16 (45.7%) patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria, 5 and 4 cases were affected with M. intracellulare and M. abscessus, respectively; 8 patients had a history of pulmonary tuberculosis. 13 patients received antimycobacterial therapy for an average of 21 months and 9 patients were treated with second-line drugs. Only 4 patients had improved radiologically. Conclusion : A NTM should be considered a potential pathogen of pulmonary infections in immunocompetent patients with chronic pulmonary diseases. Most NTM infections were left untreated for a prolonged period and showed a poor outcome as a result, M. intracellulare and M. abscessus were the two most frequent causes of NTM pulmonary infections in this study. Species identification and antimycobacterial susceptibility tests based on the species are needed for the optimum management of a NTM pulmonary infection in patients.

Detection of Mycobacterium Tuberculosis in Bronchial Specimens Using a Polymerase Chain Reaction in Patients with Bronchial Anthracofibrosis (기관지 탄분 섬유화증 환자의 기관지내시경 검체에서 PCR을 이용한 결핵균의 검출)

  • Na, Joo-Ock;Lim, Chae-Man;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Shim, Tae-Sun
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.2
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    • pp.161-172
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    • 2002
  • Background : To Investigate the association between bronchial anthracofibrosis (AF) and tuberculosis (TB), and the clinical utility of a polymerase chain reaction (PCR) on bronchial specimens for rapid diagno-sis of active pulmonary TB in patients with bronchial AF. Method : Thirty patients (25 women and 5 men ranging in age from 53 to 88), who were diagnosed with bronchial AF by a bronchoscopic exami-nation, were enrolled in this study. PCR targeting the IS6110 segment of Mycobacterium tuberculosis was performed on the bronchial wash fluid and anthracofibrotic bronchial tissue. The PCR results were compared with the bacteriological, histological, and clinical findings. Results : Eighteen of the 30 patients (60%) were associated with TB, nine of whom were confirmed as having active TB. The remaining 9 had a past history of TB. The sputum or bronchial aspirate AFB smear, culture, and histological findings were positive in 4 (13%), 9 (30%), and 5 (17%) patients, respectively. PCR of the AF tissue and bronchial wash fluid was positive in 5 (17%) and 11 (37%) of the 30 patients, respectively. PCR was more sensitive than the AFB smears for diagnosing pulmonary TB (22 % us 89 %, respectively, p<0.05). All 5 patients with positive AF tissue PCR results also had both histological findings and positive bronchial wash fluid PCR results. Of the 3 patients with positive PCR but negative bacteriological or histological results, 2 of these patients appeared to have active tuberculosis on a clinical basis. Conclusion: Although TB-PCR did not reveal an increased association between bronchial AF and TB compared with traditional methods, PCR on the bronchial wash fluid appears to be useful for the rapid diagnosis of pulmonary TB in patients with bronchial AF. TB-PCR on AF bronchial tissue itself did not yield additional benefits for diagnosing TB, which suggests that an AF lesion itself may not be an active or original site of the infection, but a secondary change of TB.

Clinical Characteristics and Prognosis of Elderly Patients Receiving Prolonged Mechanical Ventilation in the Medical Intensive Care Unit at a University Hospital (한 대학병원 내과계 중환자실에서 장기간 기계환기를 받은 노인 환자들의 특징 및 예후)

  • Han, Min Soo;Moon, Kyoung Min;Lee, Yang Deok;Cho, Yongseon;Na, Dong Jib
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.6
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    • pp.445-450
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    • 2008
  • Background: As the number of older-aged people increases, the number of elderly patients who receive critical care services is expected to increase substantially. The objective of this study was to examine the clinical characteristics and outcomes of elderly patients who receive mechanical ventilation for more than 30 days in the medical intensive care unit (MICU) at a university hospital. Methods: We retrospectively examined forty-one elderly patients (${\geq}65$ years old) who were receiving mechanical ventilation, from April 2004 to March 2007, for periods exceeding 30 days at the MICU at Eulji University Hospital. Results: The MICU and hospitalmortality rate were 60.9% and 65.9%, respectively. The mean length of the ICU stay was 57.5 days and the mean duration of mechanical ventilation was 49.3 days. The most common reason for MICU admission was acute respiratory failure (73.2%), followed by sepsis (12.2%), neurological problems (9.8%), and gastrointestinal bleeding (4.9%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher for the nonsurvivors than for the survivors (28.0 vs. 25.0, respectively, p=0.03). The nonsurvivors received more red blood cell (RBC) transfusions during their ICU stay than did the survivors (84.0% vs. 43.8%, respectively p=0.007). The factors associated with hospital death were the APACHE II score and if the patient had received a RBC transfusion. Conclusion: The APACHE II score and a RBC transfusion were predictors of increased hospital mortality for the elderly patients who were on prolonged mechanical ventilation. These predictors may assist physicians to make clinical decisions for this patient population.

Comparative study of acupuncture and invasive laser acupuncture therapy at $SI_3$.$BL_{40}$ on the tibial, sural nerve injury and L5 spinal nerve ligation model in rats (백서(白鼠)의 신경병리성(神經病理性) 동통(疼痛)에 대한 후계(後谿).위중(委中) 혈위(穴位) 호침료법(毫鍼療法)과 레이저 침습조사(侵襲照射) 침료법(鍼療法)과의 비교(比較) 연구(硏究))

  • Wei, Tung-Sheun;Youn, Dae-Hwan;Youn, Yeo-Chung;Na, Chang-Su
    • Korean Journal of Acupuncture
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    • v.22 no.2
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    • pp.9-24
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    • 2005
  • Objective: We have studied the effects of acupuncture and low level He-Ne laser therapy(LLLT) at $SI_3$, $BL_{40}$ on the tibial, sural nerve injury due to sports-damage or traffic accident and L5 spinal nerve ligature model like general herniation of nucleus pulposus(HNP) in a rat of neuopathic pain. Methods: A model of neuropathic pain was made by injuring tibial nerve and sural nerve while common peroneal nerve was maintained. Also, it was made by isolating left 5th lumbar spinal nerve. Three weeks after the neuropathic surgery, acupuncture and LLLT was injected at $SI_3$,$BL_{40}$ one time a day for one week. LLLT was divided three groups, that is LLLT-1(5mW), LLLT-2(10mW) and LLLT-3(30mW). After that, we examined the withdrawal response of neuropathic rats' legs by Von frey filament and acetone stimulation. And also we examined c-Fos, Nocieptin and KOR-3 in the midbrain central gray of neuropathic rats. Results: As we have observed the effect of mechanical allodynia, LLLT-3 group were diminished on 4 day, 5 day, 6 day and 7 day in the resection model compared with control model, LLLT-1 group were diminished on 5 day, LLLT-2 group were diminished on 3 day and 6 day, LLLT-3 group were diminished on 3 day, 4 day, 5 day, 6 day and 7 day in connected model compared with control group. As we have observed the effect of cold allodynia, LLLT-3 group were diminished on 7 day in the resection model compared with control model, LLLT-1 group were diminished on 6 day, 7 day, LLLT-3 group were diminished on 7 day in connected model compared with control group. As we have observed the effect of activity of c-Fos in the central gray part, LLLT-3 were diminished in resection model compared with control group, LLLT-1 group were diminished in connected model compared with control group. As we have observed the effect of activity of Nociceptin in the central gray part, resection model were not increased compared with control group, LLLT-1 group and LLLT-3 group were increased in connected model compared with control model. As we have observed the effect of activity of KOR-3 in the central gray part, resection model were not increased compared with control group, LLLT-3 group were increased in connected model compared with control model. Conclusions: We have noticed that LLLT-1 and LLLT-3 group have more controllable effect than acupuncture group. This study can be used in clinical therapy for neuropathic pain. But it is not reliability that Nociceptin and KOR-3 have effectively to control pain. Therefore We have to follow up about that.

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Analysis of the Movement of Surgical Clips Implanted in Tumor Bed during Normal Breathing for Breast Cancer Patients (유방암 환자의 정상 호흡에서 종양에 삽입된 외과적 클립의 움직임 분석)

  • Lee, Re-Na;Chung, Eun-Ah;Suh, Hyun-Suk;Lee, Kyung-Ja;Lee, Ji-Hye
    • Radiation Oncology Journal
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    • v.24 no.3
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    • pp.192-200
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    • 2006
  • [ $\underline{Purpose}$ ]: To evaluate the movement of surgical clips implanted in breast tumor bed during normal breathing. $\underline{Materials\;and\;Methods}$: Seven patients receiving breast post-operative radiotherapy were selected for this study. Each patient was simulated in a common treatment position. Fluoroscopic images were recorded every 0.033 s, 30 frames per 1 second, for 10 seconds in anterior to posterior (AP), lateral, and tangential direction except one patient's images which were recorded as a rate of 15 frames per second. The movement of surgical clips was recorded and measured, thereby calculated maximal displacement of each clip in AP, lateral, tangential, and superior to inferior (SI) direction. For the comparison, we also measured the movement of diaphragm in SI direction. $\underline{Results}$: From AP direction's images, average movement of surgical clips in lateral and SI direction was $0.8{\pm}0.5\;mm$ and $0.9{\pm}0.2\;mm$ and maximal movement was 1.9 mm and 1.2 mm. Surgical clips in lateral direction's images were averagely moved $1.3{\pm}0.7\;mm$ and $1.3{\pm}0.5\;mm$ in AP and SI direction with 2.6 mm and 2.6 mm maximal movement in each direction. In tangential direction's images, average movement of surgical clips and maximal movement was $1.2{\pm}0.5\;mm$ and 2.4 mm in tangential direction and $0.9{\pm}0.4\;mm$ and 1.7 mm in SI direction. Diaphragm was averagely moved $14.0{\pm}2.4\;mm$ and 18.8 mm maximally in SI direction. $\underline{Conclusion}$: The movement of clips caused by breathing was not as significant as the movement of diaphragm. And all surgical clip movements were within 3 mm in all directions. These results suggest that for breast radiotherapy, it may not necessary to use breath-holding technique or devices to control breath.

An Experimental Study on Development of the Opening Apparatus for Oil Boom (오일펜스 전개장치 개발에 관한 실험적 연구)

  • Jang Duck-Jong;Na Sun-Chol
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.9 no.1
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    • pp.45-54
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    • 2006
  • The study was to review methods by which a ship can unfold and tow an oil boom by attaching the opening apparatus to an oil boom through experiments. The shape and dimension of the opening apparatus were designed with the measurement value of the towing tension load of the oil boom and the dimension of winch drum of the oil boom installed in the ship considered. For the field experiment to identify the performance of the opening apparatus, opening apparatuses were prepared to have the dimension of $3.0m^2$ and $6.0m^2$ which is 91% and 75% of the calculation value for type B and C respectively. As a result, T(kg), the value of tension in type B oil boom according to the towing speed(v) change when two ships are towed together were proved to be $T=920v^{1.1}\;and\;T=500v^{0.9}$ in case the distance is 100 m and 50 m. Based on the result, the dimension of the opening apparatus for type B and C oil boom was calculated as $3.3m^2$ and $8.0m^2$ respectively. When unfolding and towing by attaching the opening apparatus and 200 m of towing line at both ends of type B and type C oil boom, the maximum width of the opening apparatus was shown as 114 m and 95 m in average(width of opening/total length of oil boom: 33% and 57%) in the towing speed of 1.5 kt. It was evaluated that the opening apparatus could concentrate the spilled oil in a good performance. However as far as the increase rate of oil boom opening width according to the length of the towing line is debatable, the increase rate is remarkably reduced when it is lengthened from 100 m to 150 m and to 200 m although it showed extreme increase of 31% and 40% when the length of the towing line was changed from 50 m to 100 m. Therefore, it is inferred that the towing line should be maintained more or less 100 m to get good spread efficiency of the opening apparatus. Additionally, if the towing speed is faster than 1.5 kt, the opening width was narrowed because of the reduced spread efficiency and the shape of the oil boom can be unstable because of the partial sinking of the oil boom, run over waves, or flap of skirt. Thus the reasonable towing speed can be within 1.5 kt for the operation of the opening apparatus.

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Can high serum anti-M${\ddot{u}}$llerian hormone levels predict the phenotypes of polycystic ovary syndrome (PCOS) and metabolic disturbances in PCOS patients?

  • Hwang, Yu Im;Sung, Na Young;Koo, Hwa Seon;Cha, Sun Hwa;Park, Chan Woo;Kim, Jin Yeong;Yang, Kwang Moon;Song, In Ok;Koong, Mi Kyoung;Kang, Inn Soo;Kim, Hye Ok
    • Clinical and Experimental Reproductive Medicine
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    • v.40 no.3
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    • pp.135-140
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    • 2013
  • Objective: To evaluate correlations between serum anti-M${\ddot{u}}$llerian hormone (AMH) levels, phenotypes of polycystic ovary syndrome (PCOS), obesity, and metabolic parameters in patients with PCOS. Methods: A total of 175 patients with PCOS were diagnosed according to the Rotterdam Consensus were included. Exclusion criteria were age over 40, FSH>25 mIU/mL, and 17a-OHP>1.5 ng/mL. The Phenotypes of PCOS were divided into a severe form (oligo-anovulation, ANOV/hyperandrogenism/polycystic ovary morphology [PCOM]; n=59) and a mild form without HA (ANOV/PCOM, n=105). The serum AMH levels were classified into 3 groups (<5 vs. 5-10 vs. >10 ng/mL). Obesity was defined as body mass index (BMI) ${\geq}25kg/m^2$ (n=34). Results: The mean age was $25.9{\pm}5.7$ year and mean AMH level was $10.1{\pm}5.4$ ng/mL. The BMI ($kg/m^2$) was higher in group 1 ($24.2{\pm}6.3$) than in group 2 ($21.9{\pm}4.3$, p=0.046) or group 3 ($21.6{\pm}3.3$, p=0.019). There was no difference among the three groups in age, menstrual interval, antral follicle counts, androgens, or other metabolic parameters. The obesity group showed significantly lower AMH ($7.7{\pm}3.9$ ng/mL vs. $10.7{\pm}5.6$ ng/mL), p=0.004) and low-density lipoprotein levels ($93.1{\pm}21.2$ mg/dL vs. $107.5{\pm}39.3$ mg/dL, p=0.031), and showed higher total T ($0.74{\pm}0.59$ L vs. $0.47{\pm}0.36$ ng/mL, p=0.001), free T ($2.01{\pm}1.9$ vs. $1.04{\pm}0.8$ pg/mL, p=0.0001), and free androgen index ($6.2{\pm}7.9$ vs. $3.5{\pm}3.0$, p=0.003). After controlling for age factors and BMI, the serum AMH levles did not show any significant correlations with other hormonal or metabolic parmeters. Conclusion: For PCOS patients under the age 40, serum AMH is not negatively correlated with age. High serum AMH levels can not predict the phenotype of PCOS and metabolic disturbances in PCOS patients in the non-obese group. Further study might be needed to define the relation more clearly.

A Survey on Treatment of Breast Cancer Patients with Korean Medicine: Preliminary Research for Clinical Practice Guidelines (한의표준임상진료지침 개발을 위한 유방암 보완치료 실태조사)

  • Kim, Nam-Hoon;Kang, Na-Hoon;Yoo, Eun-Sil;Park, Nam-Chun;Lee, Jin-Wook;Park, Kyoung-Sun;Lee, Jin-Moo;Lee, Chang-Hoon;Jang, Jun-Bock;Jang, Bo-Hyoung;Hwang, Deok-Sang
    • The Journal of Korean Obstetrics and Gynecology
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    • v.31 no.4
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    • pp.165-178
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    • 2018
  • Objectives: To determine the current status of the treatment of breast cancer patients by Korean Medicine doctors (KMDs) and to examine the need for clinical practice guidelines (CPGs) for the supportive care of these patients. Methods: This cross-sectional study used a self-administered questionnaire. Participants were asked about their experience in treating breast cancer patients; the number of breast cancer patients they currently treat; the main complaints expressed by, diagnoses of, and treatments used for such patients; and their opinions about Korean Medicine (KM) as the basis for providing supportive care for breast cancer. Results: The data for this study were collected from 322 respondents. 84 of whom reported having ever treated patients with breast cancer. Most breast cancer patients who visited the KM clinic were classified as stage I or II, and their major complaints were fatigue, general weakness and musculoskeletal pain. The major diagnostic strategies were syndrome differentiation and pulse diagnosis. The major treatments administered were herbal medicine, acupuncture, and moxibustion. KMDs cited a need for medical information, such as CPGs, as their most important concern with regard to the treatment of breast cancer patients. Conclusions: This survey determined the prevalence of the use of KM for Korean breast cancer patients. Our results underscore the need for clinical practice guidelines for using of KM as the basis of supportive care for breast cancer and for informing clinicians and patients about this approach.

Effect of Noise in Human Body (소음이 인체에 미치는 영향)

  • 이영노
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1972.03a
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    • pp.7-8
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    • 1972
  • The effects of noise exposure are of two types: Nonauditory effects and auditory effects. Nonauditory effects of noise exposure are interference with communication by speech, sleeping and emotional behavior. The noise will cause the high blood pressure and rapid pulse, also that decrease the salivation and gastric juice. in experimentaly showed that the Corticoid hormon: Gonatotropic hormone were decrease and Thyrotropic hormoone is increase. Auditory effect of noise exposure. when the normal ear is exposed to noise at noise at hamful intensities (above 90㏈) for sufficiently long periods of time, a temoral depression of hearing results, disappearing after minutes or hours of rest. When the exposure longer or intesity greater is reached the Permanent threshold shift called noise-induced hearing loss. Hearing loss resulting from noise exposure presents legal as well as medical problems. The otologist who examines and evaluates the industrial hearing loss cases must be properly informed, not only concerning the otologic but also about the physical and legal aspects of the problems. The measurement of hearing ability is the most important part of a hearing conservation, both preplacement and periodic follow-up tests of hearing. The ideal hearing conservation program would be able to reduce or eliminate the hazardous noise at its source or by acoustic isolation of noisy working area and two ear protections (plugs and muff type) were developed for personal protection.

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The Differences in Efficacy and Effect of Herbal Extracts by the Part and Solvent Extraction from the Medical Plants (약용식물의 부위별 및 추출용매에 따른 효능효과의 차이)

  • Kim, Kyung-Dong;Na, Min-Kyun;Kim, Sang-Jin
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.32 no.2 s.57
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    • pp.105-110
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    • 2006
  • This study was to describe the differences in efficacy and effect of herbal extracts by the part and solvent extraction from the medical plants used as materials of oriental herbs cosmetics. And, this study was to apply to the test method of efficacy and effect related to the antioxidation as herbal extracts, complex of actual ingredient, not existing analytical methods of single ingredient. After screening the medical plants with the antioxidative activity primarily and selecting 11 sorts of medical plants to be used by the part in the literature, this study was to confirm the differences through the well-known test methods like DPPH radical scavenging activity test and hydroxyl radical scavenging activity test. For examples, in case of Trachelospermum asiaticum, compared with the aerial part and fruit, the value of DPPH radical scavenging activity test had $25.2 {\pm} 0.2$ and $62.4 {\pm}1.6$ each. It has shown that the value of fruit had 2.4 times higher effect than the one of aerial part. In case of hydroxyl scavenging activity test, it was effective in the fruit, but it has shown that there was no effect on the aerial part. It showed the same phenomena in some other plants. From the result above, this researcher could understand that it needed to consider extracting the medical plants or plants with the active principle by the part. Also, this study was to confirm the differences in effect according to the solvent as it changed the solvent extraction after selecting a plant (Lithospermum erythrorhizon) widely used for medicine and dye. As a result of measuring the actual value of superoxide scavenging activity test, this study was to consider that there were differences by the part or solvent extraction in extracting and using the medical plants as it has shown that the effect differences produced $10{\sim}80%$ according to the solvent. When it was applied to the products, this study has shown that it needed to decrease the possible errors.