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Clinical Characteristics of Miliary Tuberculosis (속립성 폐결핵의 임상적 특성)

  • Kim, Jin-Ho;Moon, Doo-Seop;Lee, Dong-Suck;Park, Ik-Soo;Yoon, Ho-Joo;Shin, Dong-Ho;Kim, Tae-Wha;Park, Sung-Soo;Lee, Jung-Hee
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.2
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    • pp.144-151
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    • 1994
  • Background: Miliary tuberculosis almost always results from the discharge of infected caseous material into the blood stream, usually from a well hidden lymph node in the presentation of this disease in the past four decades, and although it is seen less frequent1y today than previously, its presentation and manifestation may require greater suspicion and diligence by the physician. We investigated the clinical characteristics, predisposing factors and accompanying diseases of miliary tuberculosis and tried to acquire the early diagnosis and treatment of this disease. Methods: A retrospective clinical study was done on 40 cases of miliary tuberculosis admitted to Hanyang University Hospital from Mar. 1989 to Dec.1992. The study investigated age and sex distribution, seasonal distribution, duration of symptoms before admission, pre-disposing factors, clinical symptoms, biochemical findings, chest X-ray findings, extrapulmonary tuberculosis associated with miliary tuberculosis, prognosis and mortality rate. Results: 1) The patients were most common in the age group between 20 and 29(23%) and the ratio of male to female was 1.4:1(male 23 : female 17). 2) Sputum smears for tubercle bacilli were positive in 5 cases(13%). 3) The most common clinical symptoms were fever with chilling(47.5%), coughing(47.5%), second most common symptom was dyspnea(32.5%), and the physical findings on admission were tachycardia(30%), weight loss(27.5%), meningeal signs(17.5%) in order. 4) The predisposing factors were heavy alcohol drinking(6 cases), steroid use(3 cases), pregnancy(2 cases) etc. 5) The chest X-ray findings on admission were miliary shadow only(40%), in addition pneumonic infiltration, pleurisy, and calcification in order. 6) The extrapulmonary tuberculosis associated with miliary tuberculosis were tuberculous meningitis(30%), bone and joint tuberculosis(17.5%), intestinal tuberculosis(15%) in order. 7) Biochemical findings were increased SGOT/SGPT(32.5%), increased alkaline phosphatase(32.5%), hypoalbuminemia(15%), hyponatremia(15%) etc. 8) About 4-6 weeks later after treatment(INH, RFP, PZA, EMB), 26 cases(65%) were improved on clinical symptoms or chest X-ray, 12 cases(30%) were stationary or aggravated, and 2 cases(5%) were died. Conclusion: For the early diagnosis and treatment of miliary tuberculosis, we must see its presentation and manifestation with greater interest and suspicion and investigate its predisposing factors and accompanying diseases.

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Identification of Mycobacterium Tuberculosis in Pleural Effusion by Polymerase Chain Reaction (PCR) (흉막삼출액에서 Polymerase Chain Reaction (PCR)을 이용한 결핵균의 검출에 관한 연구)

  • Kim, Ho-Joong;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo;Kim, Keun-Youl;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.5
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    • pp.509-518
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    • 1993
  • Background: By amplifying small amount of DNA, polymerase chain reaction (PCR) can be used for the detection of very small amount of microbial agent, and may be especially useful in certain cases which are difficult to be diagnosed microbiologically or serologically. Tuberculous pleurisy is a disease that can be diagnosed in only 70% of cases by conventional diagnostic tools, and PCR would be a very rapid, easy, and sensitive diagnostic method. Method: The specificity and sensitivity of PCR to detect Mycobacterium tuberculosis DNA were evaluated using various strains of Mycobacteria. To evaluate the diagnostic usefulness of PCR in tuberculous pleurisy, we used PCR to detect Mycobacterium tuberculosis DNA in pleural fluid. The amplification target was 123 base pair DNA, a part of IS6110 fragment, 10~16 copies of which are known to exist per genome. The diagnostic yield of PCR was compared with conventional methods, including pleural fluid adenosine deaminase (ADA) activity. Also, the significance of PCR in undiagnosed pleural effusion was evaluated prospectively with antituberculosis treatment. Results: 1) Using cultured Mycobacterium tuberculosis and other strains, PCR could detect upto 1 fg DNA and specific for only Mycobacterium tuberculosis and Mycobacterium bovis. 2) Using pleural effusions of proven tuberculosis cases, the sensitivity of PCR was 80.0% (16/20), and the specificity 95.0% (19/20). 3) Among 13 undiagnosed, but suspected tuberculous effusion, the positive rate was 60% in 10 improved cases after antituberculosis medications, and 0% in 3 cases of proven malignancy later. 4) Adenosine deaminase level of proven and clinically diagnosed tuberculous pleurisy patients was significantly higher than that of excluded patients, and correlated well with PCR results. Conclusion: We can conclude that PCR detection of Mycobacterium tuberculosis in pleural effusion has acceptable sensitivity and specificity, and could be an additional diagnostic tool for the diagnosis of tuberculous pleurisy.

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Determination of Short Term Prognosis Among Chronic Obstructive Lung Disease with Acute Respiratory Failure According to Simplified Acute Physiology Score (만성 폐쇄성 폐질환에서 급성 호흡부전 발생시 Simplifed Acute Physiology Score에 따른 단기예후의 평가)

  • Lee, Sang-Pyo;Sung, Yun-Up;Kim, Sang-Hoon;Kim, Bong-Sik;Kim, Young-Jun;Park, In-Won;Choi, Byung-Whui;Hue, Sung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.5
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    • pp.532-539
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    • 1993
  • Background: Physician's estimates of patient survival often influence clinical decisions, especially those near the end of life. In addition. clinical decisions frequently reflect trade-offs between morbidity and length of survival. As a result, accurate estimates of survival can be extremely useful in clinical decision. When the episode of acute respiratory failure in chronic obstructive lung disease, evaluation of the severity of the condition and short term prognosis is difficulit based on the available clinical or paraclinical data at the time of admission. Method: In this study, we performed a retrospective study in Chung Ang University Hospital, 74 patients (51 males, 23 females), who were hospitalized with chronic obstructive lung disease with acute respiratory failure from 1980 to 1992. We evaluated these patients to determine lung prognostic factors at time of admission in the Intensive Care Unit (ICU) that predict short term survival, and to determine the possible application of the Simplified Acute Phsiology Score (SAPS) to this population, All patients were treated with similar regimen during the hospitalization. Results: The results were as follows: 1) Hospital mortality was 34%(25/74 patients) and surival rate was 66%(49/74 patients) in COPD with acute respiratory failure. The prognosis of the older age was much poorer than those of the young age. 2) There was no difference in mortality according to the results of basal pulmonary test and arterial blood gas analysis. 3) The SAPS at admission was higher in those patients who expired(10.8) than the survived(6.5), and there was positive correlation between SAPS and mortality (r=0.91, p<0.05). 4) Prognostic factors in acute respiratory failure complicating COPD which were identifiable at time of admission to the ICU were as follows: cachexia, encephalopathy, serum creatinine and phosphate. Conclusion: In conclusion, the SAPS might have a good prognostic value for determination of short term survival among chronic obstructive lung disease with acute respiratory failure.

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Quality and Affecting Factor of Care for Patients Hospitalized with Pneumonia (폐렴 입원환자 진료과정의 질적 수준과 이에 영향을 미치는 요인: 임상질지표를 중심으로)

  • Moon, Sangjun;Lee, Jin-Seok;Kim, Yoon;You, Sun-Ju;Choi, Yun-Kyoung;Suh, Soo Kyung;Kim, Yong-Ik
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.4
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    • pp.300-308
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    • 2009
  • Background: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. Methods: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months' August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. Results: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. Conclusion: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.

Immunohistochemical Analysis for the Expression of DR5 TRAIL Receptor and p53 in Non-small Cell Lung Cancer (비소세포폐암에서 DR5 TRAIL 수용체와 p53에 관한 면역조직화학적 분석)

  • Lee, Kye-Young;Lee, Jung-Hyun;Kim, Sun-Jong;Yoo, Kwang-Ha
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.4
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    • pp.278-284
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    • 2008
  • Background: TRAIL is a promising anticancer agent which induces selective tumor cell death due to a unique receptor system that includes death receptors and decoy receptors. DR5 TRAIL receptor is an originally identified p53-regulated death receptor gene that was induced, by doxorubicine, only in cells with a wild-type p53 status. We investigated that focused on the correlation between the DR5 and p53 expressions in non-small cell lung cancer (NSCLC). Methods: Immunohistochemical analysis, with using avidin-biotinylated horseradish peroxidase complex, was carried out in 89 surgically resected NSCLC formalin-fixed paraffin-embedded tissue sections. As primary antibodies, we used anti-DR5 polyclonal antibody and anti-p53 monoclonal antibody. A negative control was processed with each slide. The positive tumor cells were quantified twice and these values were expressed as percentage of the total number of tumor cells, and the intensity of immunostaining was expressed. The analysis of the DR5 expression was done separately in tumor area and in a nearby region of normal tissue. Results: The DR5 expression was high in the bronchial epithelium (89% of cases) but this was almost absent in type I & II pneumocytes, lymphocytes and smooth muscle cells. High DR5 expression rate in tumor was seen in 28% (15/53) of squamous cell carcinomas, in 47% (15/32) of adenocarcinomas and, in 50% (2/4) of large cell carcinomas. The DR5 expression did not show any statistical significance relationship with the T stage, N stage, or survival. However, the DR5 expression showed significant inverse correlation with the p53 expression. (p< 0.01). Conclusion: We demonstrated that the DR5 expression in NSCLC via immunohistochemical analysis is relatively tumor-specific except for that in the normal bronchial epithelium and it is significantly dependent on the p53 status. This might be in vivo evidence for the significance of the DR5 gene as a p53 downstream gene.

The Association between Family Support, Activities of Daily Living and Depression among Hospitalized Older Patients with Chronic Diseases (만성질환 입원노인의 가족지지 및 일상생활 수행능력과 우울과의 관련성)

  • Kim, Jeong Yi;Ryu, So Yeon;Han, Mi Ah;Choi, Seong Woo
    • Journal of agricultural medicine and community health
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    • v.41 no.1
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    • pp.13-26
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    • 2016
  • Purpose: This study was performed to identify the association between family support, activities of daily living (ADL) and depression among hospitalized older patients with chronic diseases. Methods: This study subjects were 100 elderly patients with chronic diseases including chronic respiratory diseases, diabetes mellitus and et al. in a general hospital. The collected data were patient characteristics, family support, ADL, and depression by structured questionnaire and medical chart review. The used statistical analyses were t-test, analysis of variance, Pearson's correlational analysis and multiple regression analysis. Results: The mean scores of family support, ADL and depression were $49.95{\pm}8.68$, $8.65{\pm}2.65$, $6.66{\pm}3.78$, respectively. The prevalence rate of depression was 64.0%. In simple analysis, the statistically significant associated factors with depression were age, spouse, economic status, social activity, subjective health status, and number of pain. Depression had statistically a significant positive correlation with ADL and a negative correlation with family support. The final result of hierarchial multiple regression analysis (Model 3), the factors related to depression were family support (b=-.135, p<.001), subjective health status (b=2.510, p=.001). Conclusions: It is necessary to develop and apply the program for controlling the depression of elderly patients with health education, reinforcement of supportive systems in hospital. And, further multidisciplinary studies should be done.

A Survey on the Knowledge and Attitude of Workers Concerning Occupational Health (근로자의 산업보건 지식과 태도에 관한 조사연구)

  • 박영식;조수열;남철현
    • Journal of Environmental Health Sciences
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    • v.18 no.2
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    • pp.3-18
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    • 1992
  • This research was carried out on 1,017 production workers for four months from May to August, 1991, to search more effective management method of their health by grasping their knowledge and attitude on industrial health. The results of this study can be summarized as follows: 1. As for general characteristics, 74.2% were male and 25.8% were female among the 1,017 workers. The two largest age groups were 30~39, 38.7%. As for education level, graduation from high school was 58.6%, 61.2% were married, 35.9% owned their house, and workers who worked more than 1 year less than 5 years was 52.9%, workers who worked 8 hours a day was 46.7%, the largest group income level was 60~69 thousand won 21.2%, and the degree of satisfaction with work was ordinary, 45.6%. 2. The degree of recognition concerning occupational diseases was 92.5% at a very high rate. Causes of occupational diseases under the present work field were in order of noise, dust, heavy metal. The largest group of the counterplan for prevention was an improvement of working environment, 62.0%. 3. The major cause that threatens worker's health was poor working environment, 31.4%. As the best method for workers' health management, working environment management was pointed. 4. As for health examination result, the response that it is of use to health management was 53.8%. As for examination method and result, 42.7% responded that they are formal. The practice period was more than once every six months as the largest group, and the highest desire for improvement was that they wants an exact information of the result. 5. 49.3% of the respondents know about the measurement of working environment an the response that the measurement is necessary to improve working environment was 57.9%, and that the results from the measurement were reflected on improvement an management 57.5%. Appropriate period to take a measurement was more than once per six months, 40.2% and per three months, 29.1%. 6. As for safety and halth instruction, 34.5% were educated for both, 38.2% for only safety education and just 4.6% for only health education. 51.9% responded that they had never been educated out of work place. The period of its practice was more than once a month, 39.5% and every three months, 21.3%. 7. The importance of safety and health showed that the one is equal to the other, 59.8%, that the one is more important, 29.6%, and that other is more important, 7.6%. 67.7% said the necessity of a safety and health manager. 8. In spite of more or less health obstacle of work environment, 14.9% of the respondents wanted to overwork to gain an allowance for over-time work, 39.9% didn't, and 40.2% according to condition and state. 9. As the most important cause of industrial accident, 40.2% indicated unsafe behavior. As for the individual protective instrument, 66.1% of all the respondents said they have worn it to protect industrial diseases. 10. As for the degree of understanding of the contents in Industrial Safety and Health Law and Industrial Law of Accident Insurance, an affirmative response was respectively 49.3% and 50.8% and the sources of safety-health information were televisions and radios, 28.0%. Therefore, it is necessary that we do positive working environmental improvement, continuous management and health education's inforcement to increase their health and prevent occupational diseases.

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Oral health status and treatment need of institutionalized elderly patients (노인요양시설에 있는 노인환자의 구강실태 및 치료수요도)

  • Yang, Soon-Bong;Moon, Hong-Suk;Han, Dong-Hoo;Lee, Ho-Yong;Chung, Moon-Kyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.5
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    • pp.455-469
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    • 2008
  • Statement of problems: In the area of dental care, the institutionalized elderly have placed the most vulnerable state, and we cannot find their subjective need of dental treatment because of the physical and mental disabilities, But we have no basic investigation of their oral health conditions. Purpose: The aims of the current study were to investigate the oral health status of institutionalized elderly patients who are in the least benefited side of dental service, and to analyze their dental treatment needs. Material and methods: The survey of the oral status was carried out on 758 institutionalized elderly, and 212 elderly who was more than 65 years old from D dental office, and it was based on the Guidelines of Oral Health Research of year 2000 in Republic of Korea. Results and conclusion: The DMFT index of the institutionalized elderly appeared higher than that of the same ages in control group, and it increased with age. The number of residual teeth of the institutionalized elderly appeared lower than that of the same ages in control group, and it decreased with age (P < .05). The number of fixed partial denture in institutionalized elderly was lower than that of the same ages in control group (P < .05). The percentage wearing removable partial denture was not significant between the elderly in institutions and the control group, and was not different according to age between the two groups. The percentage of institutionalized elderly wearing complete denture appeared lower than that of the same ages in control group, and it increased with age. The percentage of institutionalized elderly needing complete denture was higher than that of control group, and the percentage of elderly needing complete denture on the maxilla was higher than that of the mandible. 16.35% of the institutionalized elderly was living without denture in spite of their fully edentulous state. The need for complete denture increased rapidly with age. The number of valued teeth and dental prostheses in shortened dental arch concept and number of occluding pairs of teeth of institutionalized elderly were lower than that of the control group (P < .05). In institutionalized elderly, the number of residual teeth, the number of fixed partial dentures, and the percentage wearing removable partial dentures were higher in the mandible, and the percentage wearing complete dentures was higher in the maxilla (P < .05). The rate of institutionalized elderly needing prosthodontic treatment appeared to be 67.82%, where the number of occluding pairs of teeth was less than 10. When it is difficult to evaluate the subjective need of dental treatment as with the institutionalized elderly, estimation using the number of occluding pairs of teeth can be a useful indicator that can project treatment needs. For the oral health care of institutionalized elderly, it is essential to increase the awareness of nurses and caregivers who take care of them, about the importance of the oral health. Since the average life span and number of residual teeth are increasing gradually, the welfare policy should be changed to implementing regular dental examinations, preservative treatment forms and oral health control of dentulous patients where the traveling-treatment system and visit system are supplemented. And principles should be set that the present denture project of edentulous patients should be done by specialists who'll also be responsible for postmanagement. Through this research of institutionalized elderly, the oral health status which is worsened by aging could be confirmed. And the interest and positive participation of dental society on the elderly should come first in order to solve the rising treatment needs of the elderly patients.

Image analysis of Specialized Vocational high school recognized by middle school student (중학생이 인식하는 특성화 고등학교 이미지 분석)

  • Kim, Yeong-Hun;Kim, Tae-Hoon
    • 대한공업교육학회지
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    • v.38 no.2
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    • pp.114-135
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    • 2013
  • The purpose of this study is to provide base line data for right concept and identity establishment of Specialized Vocational high school, to identify recognition of Specialized Vocational high school, to analyze image of Specialized Vocational high school recognized by middle school student. The population was all middle school third year students in Korea. Using random sampling technique, 50 classes of 61 schools were sampled for the study. A survey questionnaire used Semantic Differential(SD) suggested by Osgood(1957). SD consisted of a number of adjective pairs, finally, this study used 11 adjective pairs to have validity. 1,198 out of 1,441 questionnaire were returned (a return rate of 83.14%), among which 935 were used for the analysis after data cleaning. An alpha level of 0.05 was established a prior for determining significance. All data analysis was accomplished using the SPSS 20.0 Win. Based on the finding of the study, the major results of the this study were as follows : 1. Higher average is female students' image of Specialized Vocational high school than male students' that, but, The difference between the two samples was not statistically significant. 2. It was only 20% that receive career education of Vocational high school. It is necessary to accomplish and expand career education of Specialized Vocational high school for proper career education from middle school, to realize career exploration and decide one's career path based on one's specialty. 3. They have positive images who hope for going on to the Specialized Vocational high school of education than the others. 4. It is necessary to accomplish and expand career education of Specialized Vocational high school for proper career education from middle school, to realize career exploration and decide one's career path based on one's specialty, because the result was statistically significant. 5. They have the more possitive image of Specialized Vocational high school, the more know it, totally.

Factors Affecting Problematic Drinking by University Students in Chuncheon Area (춘천지역 대학생의 문제음주에 영향을 미치는 요인)

  • Kim, Yoon-Sun;Kim, Bok-Ran
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.6
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    • pp.934-942
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    • 2014
  • The purpose of this study was to investigate factors affecting problematic drinking by university students in the Chuncheon area. Lifelong drinking rate of subjects was 98.1%. Problematic drinking rates according to AUDIT (alcohol use disorders identification test) were as follows: 21.3% 'no problem', 58.0% 'at-risk drinking', 10.0% 'alcohol abuse' and 10.7% 'alcohol dependence'. Research has shown that problematic drinking is more prevalent among freshmen, early drinkers, those with hypochondria, and students who are less satisfied with their campus life or whose own parents are frequent drinkers. It has been shown that more serious problematic drinking is associated with higher 'positive alcohol outcome expectancies' and 'coping motives for drinking', and 'recognition level of drinking cultures' is considered less desirable. Multiple regression analysis revealed that 'coping motives for drinking' was the most significant variable affecting the problematic drinking of university students. Developing and fostering various alcohol-reducing programs that largely focus on 'coping motives for drinking' will greatly contribute to solving problematic drinking.