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Outcomes of Combined Mitral Valve Repair and Aortic Valve Replacement (대동맥판막 치환술과 동반시행한 승모판막 성형술 결과)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Se;Kim, Woong-Han;Whang, Sung-Wook;Lee, Cheol;Chang, Yun-Hee;Jo, Won-Min;Kim, Jae-Hyun;Seo, Hong-Ju;Kim, Soo-Cheol;Lim, Cheong;Kim, Wook-Sung;Lee, Young-Tak;Choi, Hyun-Seok;Moon, Hyun-Soo;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.463-471
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    • 2003
  • The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.

Effect of Garlic Stalk Silage on Performance and Carcass Characteristics of Hanwoo Steers (마늘대 사일리지 급여가 한우거세우의 성장 및 도체특성에 미치는 영향)

  • Chu, G.M.;Lee, H.J.;Park, J.S.;Cho, H.W.;Ahn, B.H.
    • Journal of Animal Science and Technology
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    • v.45 no.6
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    • pp.1007-1018
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    • 2003
  • This study was conducted to investigate the effect of feeding of garlic stalk silage on performance and carcass characteristics of Hanwoo steers. Feeding trial was conducted with 27 heads of Hanwoo steers and these animals were divided into two groups of control(rice straw) and garlic stalk silage. Animals consuming rice straw were fed concentrates and rice straw for 22 months from the 5 months of age and animals consuming garlic stalk silage were fed concentrates, rice straw and garlic stalk silage for 22 months from the 5 months of age. Animals fed rice straw and garlic stalk silage were fed 1.34 and 1.47, 1.69 and 1.74, 1.65 and 1.66% concentrates to body weight for the growing period, fattening period and finishing period, respectively. Animals fed rice straw and garlic stalk silage as roughage sources were fed 1.37 and 1.38, 0.65 and 0.63, 0.43 and 0.43% roughages to body weight for the growing period, fattening period and finishing period, respectively. Also, animals fed garlic stalk silage were offered 0.22 and 0.33% garlic stalk silage to body weight for the fattening and finishing period, respectively. Animals fed rice straw and garlic stalk silage as a roughage sources did not differ in average daily gain during the whole feeding periods. Animals of control group consumed less concentrates and roughage than those fed garlic stalk silage during the whole feeding periods. However, feed efficiency was not significantly different between both treatments. Beef yield including backfat thickness, eye muscle area and carcass weight was slightly lower in the animals fed garlic stalk silage than in the animals fed rice straw even though there were no differences between both treatments. However, beef quality including beef color, fat color, texture, maturity and marbling score was slightly higher in the garlic stalk silage-fed animals than in the animals fed rice straw although there were not statistically different between both treatments. Animals consuming garlic stalk silage was significantly(p<0.05) lower in shear value than those fed rice straw. Amino acid composition including essential amino acid and non-essential amino acid was not different between animals fed rice straw and garlic stalk silage. Eye muscle area of animals fed garlic stalk silage contained slightly higher oleic acid, less linoleic acid and arachidonic acid and more linolenic acid than that of animals fed rice straw only as a roughage sources. So eye muscle area of animals fed garlic stalk silage contained more mono-unsaturated fatty acid than that of animals fed rice straw and $\omega$6/$\omega$3 ratio was narrower in the animals fed garlic stalk silage than in the animals fed rice straw. Economic income was higher by 20% in the animals fed garlic stalk silage than in the animals fed rice straw. Therefore, It may be concluded that feeding of garlic stalk silage as a roughage sources to steers during the fattening period seems to improve meat quality, fatty acid composition and economic income.

Cardio-pulmonary Adaptation to Physical Training (운동훈련(運動訓練)에 대(對)한 심폐기능(心肺機能)의 적응(適應)에 관(關)한 연구(硏究))

  • Cho, Kang-Ha
    • The Korean Journal of Physiology
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    • v.1 no.1
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    • pp.103-120
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    • 1967
  • As pointed out by many previous investigators, the cardio-pulmonary system of well trained athletes is so adapted that they can perform a given physical exercise more efficiently as compared to non-trained persons. However, the time course of the development of these cardio-pulmonary adaptations has not been extensively studied in the past. Although the development of these training effects is undoubtedly related to the magnitude of an exercise load which is repeatedly given, it would be practical if one could maintain a good physical fitness with a minimal daily exercise. Hence, the present investigation was undertaken to study the time course of the development of cardio-pulmonary adaptations while a group of non-athletes was subjected to a daily 6 to 10 minutes running exercise for a period of 4 weeks. Six healthy male medical students (22 to 24 years old) were randomly selected as experimental subjects, and were equally divided into two groups (A and B). Both groups were subjected to the same daily running exercise (approximately 1,000 kg-m). 6 days a week for 4 weeks, but the rate of exercise was such that the group A ran on treadmill with 8.6% grade for 10 min daily at a speed of 127 m/min while the group B ran for 6 min at a speed of 200 m/min. In order to assess the effects of these physical trainings on the cardio-pulmonary system, the minute volume, the $O_2$ consumption, the $CO_2$ output and the heart rate were determined weekly while the subject was engaged in a given running exercise on treadmill (8.6% grade and 127 m/min) for a period of 5 min. In addition, the arterial blood pressure, the cardiac output, the acid-base state of arterial blood and the gas composition of arterial blood were also determined every other week in 4 subjects (2 from each group) while they were engaged in exercise on a bicycle ergometer at a rate of approximately 900 kg m/min until exhaustion. The maximal work capacity was also determined by asking the subject to engage in exercise on treadmill and ergometer until exhaustion. For the measurement of minute volume, the expired gas was collected in a Douglas bag. The $O_2$ consumption and the $CO_2$ output were subsequently computed by analysing the expired gas with a Scholander micro gas analyzer. The heart rate was calculated from the R-R interval of ECG tracings recorded by an Offner RS Dynograph. A 19 gauge Cournand needle was inserted into a brachial artery, through which arterial blood samples were taken. A Statham $P_{23}AA$ pressure transducer and a PR-7 Research Recorder were used for recording instantaneous arterial pressure. The cardiac output was measured by indicator (Cardiogreen) dilution method. The results may be summarized as follows: (1) The maximal running time on treadmill increased linearly during the 4 week training period at the end of which it increased by 2.8 to 4.6 times. In general, an increase in the maximal running time was greater when the speed was fixed at a level at which the subject was trained. The mammal exercise time on bicycle ergometer also increased linearly during the training period. (2) In carrying out a given running exercise on treadmill (8.6%grade, 127 m/min), the following changes in cardio·pulmonary functions were observed during the training period: (a) The minute volume as well as the $O_2$ consumption during steady state exercise tended to decrease progressively and showed significant reductions after 3 weeks of training. (b) The $CO_2$ production during steady state exercise showed a significant reduction within 1 week of training. (c) The heart rate during steady state exercise tended to decrease progressively and showed a significant reduction after 2 weeks of training. The reduction of heart rate following a given exercise tended to become faster by training and showed a significant change after 3 weeks. Although the resting heart rate also tended to decrease by training, no significant change was observed. (3) In rallying out a given exercise (900 kg-m/min) on a bicycle ergometer, the following change in cardio-vascular functions were observed during the training period: (3) The systolic blood pressure during steady state exercise was not affected while the diastolic blood Pressure was significantly lowered after 4 weeks of training. The resting diastolic pressure was also significantly lowered by the end of 4 weeks. (b) The cardiac output and the stroke volume during steady state exercise increased maximally within 2 weeks of training. However, the resting cardiac output was not altered while the resting stroke volume tended to increase somewhat by training. (c) The total peripheral resistance during steady state exercise was greatly lowered within 2 weeks of training. The mean circulation time during exorcise was also considerably shortened while the left heart work output during exercise increased significantly within 2 weeks. However, these functions_at rest were not altered by training. (d) Although both pH, $P_{co2}\;and\;(HCO_3-)$ of arterial plasma decreased during exercise, the magnitude of reductions became less by training. On the other hand, the $O_2$ content of arterial blood decreased during exercise before training while it tended to increase slightly after training. There was no significant alteration in these values at rest. These results indicate that cardio-pulmonary adaptations to physical training can be acquired by subjecting non-athletes to brief daily exercise routine for certain period of time. Although the time of appearance of various adaptive phenomena is not identical, it may be stated that one has to engage in daily exercise routine for at least 2 weeks for the development of significant adaptive changes.

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Comparative evaluation of radiation exposure in radiation-related workers (방사선 작업종사자의 피폭선량 비교 평가)

  • Baek, Seong-Min;Jang, Eun-Sung
    • Journal of the Korean Society of Radiology
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    • v.5 no.4
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    • pp.195-200
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    • 2011
  • The purpose of this study is to investigate the dose of radiation exposure to radiation-related workers in a hospital setting, thus increasing awareness of the health risk to the radiation-related workers. The result of the analysis showed the average dose of radiation exposure to radiation-related workers in hospital K was $0.75{\pm}0.26mSv$ in 2008, $0.67{\pm}0.30mSv$ in 2009, and $0.92{\pm}0.33mSv$ in 2010. The average dose of radiation exposure in hospital P was $0.43{\pm}0.13mSv$ in 2008, $0.43{\pm}0.20mSv$ in 2009, and $0.33{\pm}0.85mSv$ in 2010. The average dose of radiation exposure in hospital K by age group was 13.39mSv for age 20 to 29, 8.37mSv for age 30 to 39, 1.19mSv for age 40 to 49, 0.28mSv for age 50 to 59, and 0.32mSv for age 60 to 69 The average dose of radiation exposure in hospital P by age group was 0.33mSv for age 20 to 29, 1.41mSv for age 30 to 39, 0.83mSv for age 40 to 49, 1.66mSv for age 50 to 59, and 1.12mSv for age 60 to 69. Moreover, the average radiation exposure to radiation-related workers over 3 year period by gender group in hospital K was $2.92{\pm}1.03mSv$ for male group and $0.94{\pm}0.93mSv$ for female group. The average radiation exposure over 3 year period by gender group in hospital P was $0.66{\pm}0.18mSv$ for male group and $1.80{\pm}0.60mSv$ for female group. Persons working in diagnostic radiology department received mean of $1.65{\pm}1.54mSv/year$, mean $1.17{\pm}0.82mSv/year$ in radiation oncology, mean $1.79{\pm}1.42mSv/year$ at nuclear medicine department and mean $0.99{\pm}0.51mSv/year$ at other departments. Radiation exposure was higher than that of other departments(p<0.05). Doctors and technologists received higher radiation exposure (mean $1.75{\pm}1.17mSv/year$, $1.60{\pm}1.39mSv/year$ each) than other workers(p<0.05). Measurement and evaluation of radiation exposure in radiation-related workers should be widely conducted accurately and consistently in the radiation-related occupational setting so that people in these occupational settings are more aware of the risk from radiation exposure, and thus give more attention and caution to decrease radiation exposure. It would be essential to minimize accumulated radiation dose in the radiation-related occupational setting in order to maintain and improve the health of radiation-related workers.

Optimum Management Plan for Soil Contamination Facilities (특정토양오염관리대상시설의 최적 관리방안에 관한 연구)

  • Park, Jae-Soo;Kim, Ki-Ho;Kim, Hae-Keum;Choi, Sang-Il
    • Korean Journal of Soil Science and Fertilizer
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    • v.45 no.2
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    • pp.293-300
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    • 2012
  • This study was to investigate the unsuitable rate of the storage facilities, the changes in corrosion process over time after installation according to the status, the time to install the facilities, years elapsed after facilities installation, inspection of methods and motivation, and so on, based on the results of the inspection at the petroleum storage facilities conducted by domestic soil-relate specialized agency to derive optimal management plans which meet the status of soil contamination facilities. The results showed that the facilities more than 5 years after the initial leak test at the time of the installation need to be inspected periodically by considering costs of leak test and remediation of polluted soil. The inspection period can be decided by cost and leak test methods showing discrepancies for the results obtained from individual test whether it was direct or indirect. To compensate these matters, we suggested that the direct inspection method on regular schedule is recommended. On the other hand, the inspection can be voluntarily completed to ease burden of the results by inspection or equivalent level to this inspection method. Also, it may need improved construction supervision and performance test system to minimize the occurrence of the nature defects in installing the facilities as well as the upgrade program for the facilities during intervals of inspection period.

Evaluation of Error Factors in Quantitative Analysis of Lymphoscintigraphy (Lymphoscintigraphy의 정량분석 시 오류 요인에 관한 평가)

  • Yeon, Joon-Ho;Kim, Soo-Yung;Choi, Sung-Ook;Seok, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.15 no.2
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    • pp.76-82
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    • 2011
  • Purpose: Lymphoscintigraphy is absolutely being used standard examination in lymphatic diagnosis, evaluation after treatment, and it is useful for lymphedema to plan therapy. In case of lymphoscintigraphy of lower-extremity lymphedema, it had an effect on results if patients had not pose same position on the examination of 1 min, 1 hour and 2 hours after injection. So we'll study the methods to improve confidence with minimized quantitative analysis errors by influence factors. Materials and Methods: Being used the Infinia of GE Co. we injected $^{99m}Tc$-phytate 37 MBq (1.0 mCi) 4 sylinges into 40 people's feet hypodermically from June to August 2010 in Samsung Medical Center. After we acquired images of fixed and unfixed condition, we confirmed the count values change by attenuation of soft tissue and bone according to different feet position. And we estimated 5 times increasing 2 cm of distance between $^{99m}Tc$ point source and detector each time to check counts difference according to distance change by different feet position. Finally, we compared 1 and 6 min lymphoscintigraphy images with same position to check the effect of quantitative analysis results owing to difference of amounts of movement of the $^{99m}Tc$-phytate in the lymphatic duct. Results: Percentage difference regarding error values showed minimum 2.7% and maximum 25.8% when comparing fixed and unfixed feet position of lymphoscintigraphy examination at 1 min after injection. And count values according to distance were 173,661 (2 cm), 172,095 (4 cm), 170,996 (6 cm), 167,677 (8 cm), 169,208 counts (10 cm) which distance was increased interval of 2 cm and basal value was mean 176,587 counts, and percentage difference values were not over 2.5% such as 1.27, 1.79, 2.04, 2.42, 2.35%. Also, Assessment results about amounts of movement in lymphatic duct within 6 min until scanning after injection showed minimum 0.15%, and maximum 2.3% which were amounts of movement. We can recognize that error values represent over 20% due to only attenuation of soft tissue and bone except for distance difference (2.42%) and amounts of movement in lymphatic duct (2.3%). Conclusion: It was show that if same patients posed different feet position on the examination of 1 min, 1 hour and 2 hours after injection in the lymphoscintigraphy which is evaluating lymphatic flow of patients with lymphedema and analyzing amount of intake by lymphatic system, maximum error value represented 25.8% due to attenuation of soft tissue and bone, and PASW (Predictive Analytics Software) showed that fixed and unfixed feet position was different each other. And difference of distance between detector and feet and change of count values by difference of examination beginning time after injection influence on quantitative analysis results partially. Therefore, we'll make an effort to fix feet position and make the most of fixing board in lymphoscintigraphy with quantitative analysis.

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Evaluation of the Image Quality According to the Pre-set Method in PET/CT Image (PET/CT 영상 획득 시 사전설정법 차이에 따른 영상 질 평가)

  • Park, Sun-Myung;Lee, Hyuk;Hong, Gun-Chul;Chung, Eun-Kyung;Choi, Choon-Ki;Seok, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.15 no.2
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    • pp.41-46
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    • 2011
  • Purpose: The result of exam using an imaging device is very closely related with the image quality. Moreover, this image quality can be changed according to the condition of image acquisition and evaluation method. In this study, we evaluated the image quality according to the difference of pre-set method in PET/CT image. Materials & Methods: PET/CT Discovery STe16 (GE Healthcare, Milwaukee, USA), Chest PET phantom (Experiment 1) and 94 NEMA phantom (Experiment 2) were used. Phantom were filled with $^{18}F$-FDG maintaining hot sphere and background ratio to 4:1. In the case of experiment 1, we set the radio activity concentration on 3.5, 6.0, 8.6 kBq/mL. In the case of experiment 2, we set the radio activity concentration on 3.3, 5.5, 7.7, 9.9, 12.1, 16.5 kBq/mL. All experiments were performed with the time-set method for 2 minutes 30 seconds per frame and the count-set method with one hundred million counts in 3D mode after CT transmission scan. For the evaluation of the image quality, we compared each results by using the NECR and SNR. Results: In the experiment 1, both the NECR and SNR were increased as radioactivity concentration getting increased. The NECR was shown as 53.7, 66.9, 91.4. and SNR was shown as 7.9, 10.0, 11.7. Both the NECR and SNR were increased in time-set method. But the count-set method's pattern was not similar with the time-set method. The NECR was shown as 53.8, 69.1, 97.8, and SNR was shown as 14.1, 14.7 14.4. The SNR was not increased in count-set method. In experiment 2, results of both the NECR and SNR were shown as 45.1, 70.6, 95.3, 115.6, 134.6, 162.2 and 7.1, 8.8, 10.6, 11.5, 12.7, 14.0. These results were shown similar patten with the experiment 1. Moreover, when the count-set method was applied, the NECR was shown as 42.1, 67.3, 92.1, 112.2, 130.7, 158.7, and SNR was shown as 15.2, 15.9, 15.6, 15.4, 15.5, 14.9. The NECR was increased but SNR was not shown same pattern. Conclusion: Increment of administered radioactivity improves the quality of image unconcerned with the pre-set method. However, NECR was not influenced by increment of total acquisition counts through simple increasing scan duration without increment of administered activity. In case of count-set method, the SNR was shown similar value despite of increment of radioactivity. So, the administered activity is more important than the scan duration. And we have to consider that evaluation of image quality using only SNR may not be appropriate.

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Effect of Nutrient Solution Strength on Growth, Fruit Quality and Yield of Strawberry 'Ssanta' in Hydroponics (배양액의 농도가 딸기 '싼타'의 생육, 수량 및 과실의 품질에 미치는 영향)

  • Jun, Ha Joon;Byun, Mi Soon;Liu, Shi Sheng;Jeon, Eui Hwan;Park, So Deuk;Chae, Jang Hee
    • Journal of Bio-Environment Control
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    • v.21 no.3
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    • pp.192-198
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    • 2012
  • Experiments were conducted to investigate the optimum concentration of nutrient solution in hydroponics for strawberry 'Ssanta' bred at Gyongsangbuk-do Agricultural Research & Extension Services. Nutrient solutions for strawberry, which made by Yamazaki, were supplied EC (Electrical Conductivity) 0.6, 0.8, 1.2, and $1.8dS{\cdot}m^{-1}$ after planting on cocopeat medium during experiment period. Growth of shoot of strawberries did not show statistical differences among treatments. Fruit length showed the longest in EC $0.8dS{\cdot}m^{-1}$ in all clusters. In the second flower cluster, fruit length showed longer in EC 0.8 and $1.2dS{\cdot}m^{-1}$ than EC 0.6 and $1.8dS{\cdot}m^{-1}$. In the third flower cluster, it showed the longest in EC 0.8 and $1.2dS{\cdot}m^{-1}$, followed by 0.6 and $1.8dS{\cdot}m^{-1}$. The longest was in EC $0.8dS{\cdot}m^{-1}$ and the shortest in EC $1.8dS{\cdot}m^{-1}$ in the fourth flower cluster. Fruit diameter did not show significant differences among treatments, but longest in EC 0.8 and $1.2dS{\cdot}m^{-1}$ in all clusters. The heaviest mean fruit weight appeared in EC $0.8dS{\cdot}m^{-1}$ in all flower clusters. And heavier in EC $1.2dS{\cdot}m^{-1}$ in the second and third clusters. Also the weight was significantly light in plants grown in EC 0.6 and $1.8dS{\cdot}m^{-1}$ in the second and third cluster. Soluble solids of fruit was the highest in EC $0.6dS{\cdot}m^{-1}$ in all clusters. As the results, we came to the conclusion that the optimum EC for strawberry 'Ssanta' was EC $0.8{\sim}1.2dS{\cdot}m^{-1}$ in this experiment.

Usefulness of LIFE in diagnosis of bronchogenic carcinoma (기관지 암의 진단에서 형광기관지 내시경검사의 유용성)

  • Lee, Sang Hwa;Shim, Jae Jeong;Lee, So Ra;Lee, Sang Youb;Suh, Jung Kyung;Cho, Jae Yun;Kim, Han Gyum;In, Kwang Ho;Choi, Young Ho;Kim, Hark Jei;Yoo, Se Hwa;Kang, Kyung Ho
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.69-84
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    • 1997
  • Background : Although the overall prognosis of patients with lung cancer is poor, highly effective treatment exists for the small subset of patients with early lung cancer(carcinoma in situ/micro- invasive cancer). But very few patients have benefit from them because these lesions are difficult to detect and localize with conventional white-light bronchoscopy. To overcome this problem, a Lung Imaging Fluorescence Endoscopic device(LIFE) was developed to detect and clearly delineate the exact location and extent of premalignant and early lung cancer lesions using differences in tissue autofluorescence. Purpose : The purpose of this study was to determine the difference of sensitivity and specificity in detecting dysplasia and carcinoma between fluorescence imaging and conventional white light bronchoscopy. Material and Methods : 35 patients (16 with abnormal chest X-ray, 2 with positive sputum study, 2 with undiagnosed pleural effusion, 15 with respiratory symptom) have been examined by LIFE imaging system. After a white light bronchoscopy, the patients were submitted to fluorescence bronchoscopy and the findings of both examinations have been classified in 3 categories(class I, II, III). From of all class n and III sites, 79 biopsy specimens have been collected for histologic examination: a comparison between histologic results and white light or fluorescence bronchoscopy has been performed for assessing sensitivity and specificity of the two methods. Results : 1) Total 79 sires in 35 patients were examined. Histology demonstrated 8 normal mucosa, 21 hyperplasia, 23 dysplasia, and 27 microinvasive and invasive carcinoma. 2) The sensitivity of white light or fluorescence bronchoscopy in detecting dysplasia was 60.9% and 82.6%, respectively. 3) The results of this study showed 70.3 % sensitivity for microinvasive or invasive carcinoma with LIFE system, versus 100% sensitivity for white light in 27 cases of carcinoma. The false negative study of LIFE system was 8 cases(3 adenocarcinoma and 5 small cell carcinoma), which were infiltrated in submucosal area and had normal epithelium. Conclusion : To improve the ability 10 diagnose and stage more accurately, fluorescence imaging may become an important adjunct to conventional bronchoscopic examination because of its high detection rate of premalignant and malignant epithelial lesion. But. it has limitation to detect in submucosal infiltrating carcinoma.

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Diffuse Panbronchiolitis : Clinical Significance of High-resolution CT and Radioaerosol Scan Manifestations (미만성 범세기관지염에서 흉부 고해상도 전산화 단층촬영의 임상적의의 및 폐환기주사 소견)

  • Song, So Hyang;Kim, Hui Jung;Kim, Young Kyoon;Moon, Hwa Sik;Song, Jeong Sup;Park, Sung Hak;Kim, Hak Hee;Chung, Soo Kyo
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.124-135
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    • 1997
  • Background : Diffuse panbronchiolitis(DPB) is a disease characterized clinically by chronic cough, expectoration and dyspnea; and histologically by chronic inflammation localized mainly in the region of the respiratory bronchiole. It is prevalent in Japanese, but is known to be rare in Americans and Europians. Only a few cases in Chinese, Italians, North Americans and Koreans have been reported. It is diagnosed by characteristic clinical, radiological and pathologic features. High-resolution CT(HRCT) is known to be valuable in the study of the disease process and response to therapy in DPB. To our knowledge, there has been no correlation of its appearance on HRCT with the severity of the disease process, and radioaerosol scan(RAS) of the lung has not previously been used for the diagnosis of DPB. Method : During recent two years we have found 12 cases of DPB in Kangnam St. Mary's Hospital, Catholic University Medical College. We analysed the clinical characteristics, compared HRCT classifications with clinical stages of DPB, and determined characteristic RAS manifestations of DPB. Results : 1. The ages ranged from 31 to 83 years old(mean 54.5 years old), and male female ratio was 4:8. 75%(9/12) of patients had paranasal sinusitis, and only one patient was a smoker. 2. The patients were assigned to one of three clinical stages of DPB on the basis of clinical findings, sputum bacterology and arterial blood gas analysis. of 12 cases, 5 were in the first stage, 4 were in the second stage, and 3 were in the third stage. In most of the patients, pulmonary function tests showed marked obstructive and slight restrictive impairments. Sputum culture yielded P.aeruginosa in 3 cases of our 12 cases, K.pneumoniae in 2 cases, H.influenzae in 2 cases, and S.aureus in 2 cases. 3. Of 12 patients, none had stage I characteristics as classified on HRCT scans, 4 had slage II findings, 5 had stage III findings, and 3 had stage IV characteristics. 4. We peformed RAS in 7 of 12 patients With DPB. In 71.4% (5/7) of the patients, RAS showed mottled aerosol deposits characteristically in the transitional and intermediary airways with peripheral airspace defects, which contrasted sharply with central aerosol deposition of COPD. 5. There were significant correlations between HRCT stages and clinical stages(r= 0.614, P < 0.05), between HRCT types and Pa02(r= -0.614, P < 0.05), and between HRCT types and ESR(r= 0.618, P < 0.01). Conclusion : The HRCT classifications correspond well to the clinical stage. Therfore in the examination of patients with DPB, HRCT is useful in the evaluation of both the location and severity of the lesions. Also, RAS apears to be a convenient, noninvasive and useful diagnostic method of DPB.

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