• Pediatric Infection and Vaccine
• /
• v.18 no.1
• /
• pp.91-96
• /
• 2011

Bacille Calmette-Gu$\acute{e}$rin (BCG) vaccine is a live attenuated vaccine derived from Mycobacterium bovis. Frequent complications after BCG vaccination are localized ulcer formation and regional lymphadenitis, but there could be rarely severe systemic reactions to BCG vaccine such as osteomyelitis and disseminated BCG infection. Although disseminated BCG infection can be complicated in infants with underlying immunodeficiency after BCG vaccination, it is very unlikely to develop in immunocompetent infants or children. We report a 13-month-old infant who presented with fever, skin nodules, and multiple enlarged lymph nodes 5 months following BCG vaccination. She was diagnosed with disseminated BCG infection by PCRconfirmed M. bovis BCG infection at ${\geq}$2 anatomical sites beyond the region of vaccination. The patient showed no obvious evidence of immunodeficiency as judged on the basis of previous disease history, plasma immunoglobulin levels, B and T lymphocytes counts in peripheral blood, DHR (dihydrorhodamine 123 fluorescence) test and HIV test. She started antituberculous treatment with isoniazid and rifampin, and now, apparently her symptoms have been improved.

• YAKHAK HOEJI
• /
• v.31 no.4
• /
• pp.204-212
• /
• 1987

Rifampicin is an indispensable drug along with isoniazid for the control of tuberculosis and is usually prescribed as the combination of rifampicin and isoniazid. This paper is attemtped to investigate the interaction of rifampicin and isoniazid. Isoniazid was administered orally at a dose of 30mg/kg of rabbits pretreated with rifampicin 7.5mg/kg, 15mg/kg, and 30mg/kg, respectively twice daily for 9 days. The results are as follows: The blood level and relative bioavailability of isoniazid were decreased significantly (p<0.05) by rifampicin at a dose of 15mg/kg and 30mg/kg. The renal clearance of total isoniazid and ratio of its metabolites to isoniazid were increased significantly (p<0.05) by rifampicin at a dose of 15mg/kg and 30mg/kg. It seemed to be due to enzyme induction by rifampicin. Elimination rate constant ($\beta$) of isoniazid was increased and half life ($t_{1/2$\beta}$) was decreased by rifampicin pretreatment. Dosage regimen of isoniazid after long term administration of rifampicin should be adjusted carefully.

• The Korean Chronic Disease News
• /
• no.310
• /
• pp.1-18
• /
• 2006

강원도 인제군 보건소 권장원 소장/‘만성질환관리사업지원단’설치.운영/경기도립노인전문병원 2008년 건립/전통 한의약 세계적 브랜드로 육성/인터넷 이용 결핵환자 원격판독/“간호조무사 대체 법적 근거 마련”/건보-자보 일원화 추진 논란/“아시아 당뇨 대란 심각하다”/2010년 세계뇌졸중학회 서울 유치/“성분명처방, 시간 필요하다”/생동성 관련 품목허가취소 가처분 수용/KGMP“ 의약품 품목별로 평가한다”/식약청, 11번째 국산 신약 시판 허가/내년부터 의약품 설명서 알기 쉽게 교체/군부대장병 금연환경조성을 위한 이동금연클리닉 사업/외래환자 1위는‘서울아산병원’/‘대한네트워크병의원협회’발족/뇌혈관질환 50대 이후 사망원인 1위 차지/건강한 생활습관이 심혈관질환 예방의 첩경/

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.1
• /
• pp.30-37
• /
• 1996

Background: The extraction methods of DNA from clinical samples are the major obstacle to use the PCR(polymerase Chain Reaction) in routine labortary for early detection of M. tuberculosis. We tried to improve the extraction method of DNA from sputum for establishment of the PCR in routine labortary by reducing the possibility of cross contamination and performing it easily and safely. Methods: We used the $InstaGene^{TM}$ DNA extraction kit(BioRad Co.) using Chelex 100 ion exchange resin for preparation of DNA. We compared InstaGene method in 100 cases of sputum from proteinase K method which is known as the most commonly used method for DNA purification(Experiment 1). And we compared InstaGene method in 98 cases of sputum from Microwave method developed by a company in Korea(Experiment 2). In experiment 1,245bps of IS6110 were amplified and then 188bps were amplified by nested PCR. In experiment 2,536bps in primary PCR and 276bps in nested PCR were amplified and analysed by agarose gel electrophoresis and EtBr staining. Results: When we chose AFB smear, culture, or AFB smear and culture as a standard test, PCR had low specificity and positive predictive value in both experiments. The InstaGene method has higher value in sensitivity and negative predictive value significantly than proteinase K method. The InstaGene method and the Microwave methods were similar in sensitivity, specificity, positive predictive value and negative predictive value. Conclusion: Even though both methods had lower possibility of cross contamination, shorter time requirement, simplicity, and economic advantages than Proteinase K method, the InstaGene method was a little simpler than the Microwave method. Therefore, in terms of usefulness in clinical application, the Instagene method seems to be the most useful method in DNA extraction for detection of M. tuberculosis using PCR. The reliability of this method will be clarified by further studies with enough clinical samples.

• Tuberculosis and Respiratory Diseases
• /
• v.59 no.1
• /
• pp.69-76
• /
• 2005

Background : Residual pleural thickening (RPT) is the most common complication of tuberculous pleurisy (TP), despite adequate anti-tuberculous chemotherapy. At the conclusion of treatment, 43-50% of patients present RPT, with its incidence varying according to the time of evaluation. To assess the spontaneous resolution of RPT, the RPT at the completion of treatment was compared with that at the final follow-up. The factors related to the development of RPT after the completion of treatment were also studied. Methods : The medical records of sixty four patients, diagnosed with TP between March 2001 and June 2003, were retrospectively. The RPT was measured at the completion of treatment and at the time of the final follow-up and the degree and frequency of RPT compared between the two measurements. Each time, the patients were divided into two groups: those with and without RPT. The clinical characteristics and the radiographic and pleural fluid findings of the two groups were compared. Results : Thirty six (56%) and 27 patients had RPT at the completion of treatment and at the time of the final follow-up, respectively (median follow up period: 8 months). Spontaneous resolution of the RPT was found in 9 patients (24%), and had decrease below 10mm in 15 (42%) during the follow-up period after treatment. The patients were initially divided into two groups: 36 and 27 patients with and without RPT, respectively. There was no predicting factor of RPT, with the exception of the presence of CRP, between the two groups. The patients were also separated into two groups at the time of final visit: 27 and 37 patients with and without RPT, respectively. The patients with RPT were found to have a lower total WBC count in pleural fluid. Conclusion : 57% of patients with RPT were found to have spontaneous resolution of the residual pleural thickening after completion of the chemotherapy. The time of evaluation for RPT and its predicting factors were decided after adequate follow-up, irrespective of the completion of treatment.

• Journal of Chest Surgery
• /
• v.31 no.6
• /
• pp.610-614
• /
• 1998

The first heart-lung transplantation in Korea was successfully performed. The recipient was a 11 year old girl with pulmonary atresia with intact ventricular septum. She had been catheterized at the ages of 4 months, 3 years, 7 years and 10 years, which revealed that neither Fontan nor biventricular repair was feasible. The donor was a traffic accident victim, a 9 year-old boy with the same blood type. The donor was pronounced dead according to the guidelines of the Korean Medical Association's Brain Death Committee. The operation was performed on April 20, 1997. The native heart-lung block was explanted segmentally and donor one was placed above the phrenic nerve using the Arizona technique. After the tracheal anastomosis with single continuous 4-0 prolene, both vena cavae were anastomosed, followed by aortic anastomosis. The graft ischemic time was 145 minutes. The postoperative course was complicated by fever and tracheal stenosis at the anastomosis site. The fever was controlled by anti-tuberculous medications and the tracheal stenosis was relieved by stent(Palmaz 8 mm, 30 mm in length) placement on POD #71. The patient is doing well and is very active in her 7th postoperative month.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.6
• /
• pp.725-729
• /
• 1993

A case of cavitary pulmonary tuberculosis with persistent positive bacilli due to resistant strain was treated successfully with artificial pneumothorax with antituberculosis chemotherapy. Negative conversion of Tubercle bacilli was noticed by four months on sputum smears and by 11 months on sputum cultures after the starting of artificial pneumothorax. The cavitary lesion was collapsed by 13 months. Artificial pneumothorax is one of the collapse therapies of pulmonary tuberculosis which had been used widely in the early 20th century before the era of antituberculosis chemotherapy. Nowadays, this method is almost neglected due to its inferiority in efficacy as compared to chemotherapy and complications. But we recommend considering this method when no other measure is likely to be useful in open cavitary lesion.

• Tuberculosis and Respiratory Diseases
• /
• v.50 no.3
• /
• pp.334-342
• /
• 2001

Background : RpoB gene mutations have been found in about 96-98% of rifampicin (RMP)-resistant Mycobacterium tuberculosis. Recent reports confirm that the in laboratory settings a rpoB gene mutation can be used as a surrogate marker for multi-drug resistant tuberculosis. However, its usefulness in clinical applications has not been evaluated. This study was performed to confirm whether mutation analysis of the rpoB gene of M. tuberculosis is useful in clinical settings. Methods : The medical records of 33 patients in whom rpoB gene analysis was conducted using an INNOLiPA Rif. TB assay (LiPA) from June, 1998, to July, 2000, at the Asan Medical Center were retrospectively reviewed in 33 patients. The clinical characteristics in addition to the drug susceptibility and LiPA results were analyzed. The drug susceptibility test was considered as a gold standard method for M. tuberculosis susceptibility and these results were compared with those of the rpoB gene study and sequencing analysis. Sequencing analysis of the rpoB gene was done in cases where there was a discrepancy between the results of the drug susceptibility an d rpoB gene study. Results : The mean age and sex ratio was $42{\pm}18$, and 24:9 (M:F), respectively. There were 19 RMP susceptible (58%) and 14 RMP-resistant cases (42%) according to the rpoB gene study. The mean time from the request to reporting the results of the rpoB gene study was $5.2{\pm}2.6$ days. The mean gap from reporting the rpoB gene study to reporting the susceptibility was $56{\pm}35$ days. Twenty-eight cases (85%) showed identical results compared with the drug susceptibility results, whereas five cases (15%) showed contradictory results. When compared with the sequencing analysis, of the five cases that showed contradictory results, two had LiP A analysis errors and the remaining three were identical to the sequencing results. The rpoB gene study was of assistance in choosing the appropriate drugs in 28 cases (85%). Conclusions : An rpoB gene study using an LiP A assay was useful in rapidly diagnosing RMP-resistant tuberculosis, which enabled a proper choice of the appropriate drugs in clinical practices. However, an LiPA assay always should be performed in conjunction with microscopy, culture, and susceptibility tests.

• Tuberculosis and Respiratory Diseases
• /
• v.59 no.6
• /
• pp.684-689
• /
• 2005

Silicosis is a chronic fibrosing lung disease that is initiated by prolonged and extensive exposure to respirable free crystalline silica. Accelerated silicosis is rare and is clinically identical to the classic form of silicosis with the exception that the time from initial exposure to the onset of the disease is shorter and the rate of disease progression is dramatically faster. We describe a case of accelerated silicosis, which mimicked miliary pulmonary tuberculosis. The patient had worked in a mine coal for a period of 9 years. Subsequently, he worked in construction dealing with cement and sand for 14 years until he visited this clinic. The clinical course was notable for the rapid progression of the radiological features of silicosis over a period of 2 months. Polarizing light microscopic studies of the biopsied specimens by a transbronchial lung biopsy showed polarizing particles, which were typical of silica. To the best of our knowledge, this is the first case report of accelerated silicosis in Korea.

• Journal of Chest Surgery
• /
• v.35 no.4
• /
• pp.290-295
• /
• 2002

Backgroud: Pneumonectomy carries the possibility of numerous dangerous complications as well as the vast effect the operation itself has on the cardiopulmonary function. Most of operations are done with the insertion of the chest tubes upon completion, but because of the high incidence of pyothorax as its complications, we have tried to analyze and compare the cases without inserting the chest tubes. Material and Method: During a 5 year period from January, 1996 to December 2000, 100 cases, which were operated at the Hanyang University Hospital, were selected using the patient's charts. The age, gender, indication of operation, associated diseases, and operation site(left or right) were classified accordingly and the postoperative complications and mortality were statistically analyzed using the $\chi$ 2-test. After resecting the lung, the intrathoracic pressure was set at -15 ~ -20cm $H_2O$ using the nelaton catheter, and the thoracotomy site was then closed. The gradual collection of the fluid and blood in the thorax of the operated side, as well as the mediastinum location, were observed carefully for 4~5 days postoperatively with the aid of the simple chest x-rays. Result: Of the 100 cases, 16 cases of pulmonary tuberculosis(16%), 81 cases of lung tumor(81%), 2 cases of bronchiectasis(2%), and 1 case of aspergilloma associated bronchiectasis were noted. There were 8 mortality cases(8%), and of the 34 cases(34%), 44 complications were noted. The age, sex, and operation site(left or right) were not statistically significant with the complications. 7 of the 16 cases of pulmonary tuberculosis(44%) and 27 of the 81 cases of lung tumor(33%) had complications, but they were found not to be statistically significant. The increase of the complication rate in the pulmonary tuberculosis patients was 3.86. The evidence of postoperative bleeding was observed in 6 cases with the 3 cases being the pulmonary tuberculosis patients and the 3 cases were others. This shows that the increase in postoperative bleeding in the pulmonary tuberculosis is statistically significant(p=0.019). Of the 100 cases, there were 8 mortality cases(8%), with 5 cases from the 81 cases of the lung tumor group(6.1%), 3 cases from the 16 cases of pulmonary tuberculoses group(18.7%).