• Tuberculosis and Respiratory Diseases
• /
• v.59 no.4
• /
• pp.356-360
• /
• 2005

Background : This study examined the clinical utility of using indirect chest radiography during a physical examination of new conscripts for determine the presence of pulmonary tuberculosis. Methods : Over an eight-month period, this study examined 25386 people who underwent a physical examination after conscription. The abnormal findings on mass miniature radiography were followed-up using direct chest radiography. The positive predictive value of mass miniature radiography and direct chest radiography was compared. The incidence, degree of infiltration and clinical outcome of active pulmonary tuberculosis were also evaluated during a follow-up examination. Results : The positive rate of mass miniature radiography was 1.19% (n=302). Various lesions were identified: Parenchymal lesions (n=109), mediastinal lesions (n=6), cardiovascular lesions (n=45), pleural lesions (n=49), bony lesions (n=90) and miscellaneous lesions (n=7). The incidence of active pulmonary tuberculosis by mass miniature radiography was 0.26% (n=67). The first diagnosis was made in 50 people; active pulmonary tuberculosis (n=42), pneumonia (n=1), a mediastinal mass (n=1), a rib fracture (n=2) and a pneumothorax (n=4). Most cases of active pulmonary tuberculosis were mildly infiltrated and either improved or were cured by the follow-up examination. Conclusion : Although mass miniature radiography in a physical examination after conscription has limitations, but it is a useful means for detecting the presence of early disease, particularly in active pulmonary tuberculosis.

• 한국노년학
• /
• v.38 no.1
• /
• pp.169-185
• /
• 2018

The purpose of this study examined the feasibility and efficacy of a senior center-based diabetes self-management program applying action research approach. The cyclical action research method was applied for this study: plan, act, evaluate, and reflect in delivering three waves of the intervention program. Three waves of a 12 weeks-length small group diabetes self-management program were offered during the period of 15 months in a senior center in Seoul. Planning of $2^{nd}$ and $3^{rd}$ wave program were based on reflection of $1^{st}$ and $2^{nd}$ program evaluation respectively. Among the 46 participants, 93.48% (N=43) completed the program. The quantitative evaluation showed statistically significant improvement in HbA1C(p<.001), fasting plasma glucose(p<.001), BMI(p=.016), waist circumference(p=.001), systolic blood pressure(p=.036), diabetes self-management behavior(p<.001) and health knowledge(p=.008). Qualitative data revealed that individual management was very helpful in empowering and adhering for own diabetes care for the participants. Participants reported high satisfaction towards the program with mean satisfaction score of 65.12. Application of the Diabetes Self-management program with action study strategy was successful in community setting for improving participants' subjective and objective outcomes. Action research method guides the practitioner to tailor the program to respond for the participants and field needs.

• The Journal of the Korean bone and joint tumor society
• /
• v.11 no.1
• /
• pp.54-61
• /
• 2005

Purpose: The granulocytic sarcoma which developed in leukemic patients are quite rare and it will have bad prognosis, but it's tumor pathogenesis and also their treatment are not yet established. Through this study we have tried to know their clinical course, prognosis and their end result of recent treatment. Material and Methods: Total 20 patients of granulocytic sarcoma which were developed in total 2,197 leukemic patients from April, 1998 to September, 2004 were treated at the leukemic center and the orthopaedic department of St. Mary's hospital, Catholic University of Korea, and followed them for 1~78 months(average 18 months). Results: Total 20 cases of granulocytic sarcoma was found in 14 cases of total 1,331 acute myelocytic leukemic patients(AML), 4 cases of total 744 of chronic myelocytic leukemic patients(CML), and only one case in total 122 of acute biphenotype of leukemia. And so their occurrence rate in leukmic patients are actually 0.91%, total 20 cases of granulocytic sarcoma in total 2,197 leukemic patients at same period. Their ages are average 28.3 years(4~52 years), and male are predominant(13 cases) than female(7 cases). Single involvement was found in 11 cases but multiple lesions are in 9 cases, and spine, brain, extremities, chest, and pelvic bone are involved in frequency. The granulocytic sarcoma was developed in various stages of the leukemia, ie, 8 cases in complete remission of leukemia, and 12 cases in the treatment process of AML. The pathohistologic evaluation of granulocytic sarcoma was done in 6 cases which was developed in their extremities, and confirmed numerous immature myeloblasts and lymphocytes mixed. The treatment of these granulocytic sarcoma was mainly limited for the treatment of leukemia by Glivac and massive steroid therapy(19cases) and also combined with the bone marrow transplantation(13 cases), but radiation therapy with average 3,500 rads in 15 cases out of total 20 sarcomas was also done, and followed them for average 17.5 months after development of granulocytic sarcomas. Finally their prognosis was so bad that 12 patients(60%) out of total 20 granulocytic sarcoma were dead in 6.5 months after sarcoma developed and we found the granulocytic sarcoma was more fatal if they are developed during the process of CML(mortality: 100%(4/4cases). Conclusion: The prognosis of granulocytic sarcomas in leukemic patients are quite fatal, and much more studies for their pathogenesis and ways of treatment should be performed continuously.

• Radiation Oncology Journal
• /
• v.12 no.2
• /
• pp.151-158
• /
• 1994

Since Jan. 1992, authors have conducted a pilot study to treat malignant glioma with multiple daily fractionated(MDF) radiation therapy and this paper presents the outcome compared MDF to conventional factionated(CF) radiation therapy Between Sep. 1989 and Jan. 1993, forty three patients with high grade glioma of brain except brain stem glioma were treated: nineteen patients were treated with CF radiation therapy and 24 patients were treated with MDF radiation therapy. In CF radiation therapy, total dose was 6300cGy/35fx in 7 weeks, which 5040cGy was delivered to the initial target volume and 1260cGy to reduced target volume. And in MDF radiation therapy, total dose was 6400cGy/40fx in 4 weeks, which 3200cGy was delivered to the initial target volume as 160cGy 2 times daily 6hr apart. All patients had histologically confirmed anaplastic astrocytoma(AA) of glioblastoma multiforme (GBM) with stereotactic biopsy or craniotomy for subtotal or gross tumor resection. The range of follow-up was 7 months to 4 years with a median follow-up of 9 months. The Median survival from surgery was 9 months for all patients. The median survival was 9 months and 10 months for MDF group and CF group and 10 months and 9.5 months for glioblastoma multiforme and anaplastic astrocytoma, respectively. In 36 patients with follow-up CT scan or MRI scan, disease status was evaluated according to treatment groups, Four patients(GBM:3, AA:1) of 21 patients in MDF group, were alive with no evidence of disease, while none of patient was alive with no evidence of disease in CF group. The progression of disease had occurred in 20 patients, 11 patients and 9 patients in MDF group and CF group, respectively All of these patients showed in-field progression of disease, Four of 11 patients($27\%$) in MDF group showed the new leasion outside of the treatment field, while 5 of 9 patients($56\%$) in CF group. In our study the prognosis was not influenced by age, KPS, grade, extent of surgery and different fractional scheduled radiation therapy. Authors concluded that MDF regimen was well tolerated and shortened the treatment period from 7 weeks to 4 weeks without compromising results. We believe that further follow-up is needed to assess the role of MDF.

• Tuberculosis and Respiratory Diseases
• /
• v.48 no.2
• /
• pp.236-245
• /
• 2000

Background: Transbronchial lung biopsy(TBLB) has known to yield useful information for pulmonary infiltrates of uncertain etiology, However, its safety and usefulness have not been conclusive in the critically ill patients with respiratory failure. Moreover, TBLB has not been recommended for patients with mechanical ventilation. This study was conducted to investigate the diagnostic values and risks of Will performed on critically ill patients at bedside to obtain information on the pulmonary infiltrate of unknown etiology. Methods: Twenty patients(21 admissions with 23 cases) with diffuse pulmonary infiltrates who were treated in a medical intensive care unit of a tertiary referral hospital from January 1994 to May 1998, were enrolled for the study. Their medical records were retrospectively reviewed. TBLB was opted when a noninvasive diagnostic work-up failed to reveal the cause for the pulmonary infiltrate. The procedure was performed at patients' bedside without assistance of fluoroscopy. Bronchial washing or bronchoalveolar lavage was performed on the same pulmonary segment before performing TBLB. Results: Adequate specimens were obtained in 18 cases(78%). TBLB provided a specific diagnosis in two cases. The results of TBLB suggested the underlying etiology in 9 cases; bacterial pneumonitis(4), hypersensitivity pneumonitis(1), polymyositis(1), radiation fibrosis(1), idiopathic pulmonary fibrosis(1), and BOOP(1). Therapeutic decisions were altered in 11 cases(47.8%) based on the TBLB results. Pneumocystis carinii was found in the BAL fluid of another case. Ten patients with a therapeutic change and ten patients without a management change had mortality rates of 40% and 80%, respectively. The APACHE III scores were significantly higher in patients with complications($72.8{\pm}21.8$) compared with those without complications ($48.3{\pm}18.9$)(p<0.05). The complication rates were higher in those with mechanical ventilation(50%) than in those without Mechanical ventilation(33%), but the difference was not statistically significant(p=0.3). Conclusions: TBLB may be a useful diagnostic option for critically ill patients with unknown cause of pulmonary infiltrates. However, it should be cautious be used with care for patients with mechanical ventilation or for severely ill patients.

• Economic and Environmental Geology
• /
• v.38 no.5 s.174
• /
• pp.535-545
• /
• 2005

Environmental survey from some abandoned metal mine areas was undertaken on to assess the risk of adverse health effects on human exposure to arsenic influenced by past Au-Ag mining activities. Elevated levels of As were found in tailings from the studied mine areas. This high concentration may have a impact on soils and waters around the tailing piles. In order to perform the human risk assessment, chemical analysis data of soils, rice grains and waters fur As have been used. The HQ values fer As via the rice grain and groundwater consumption were significantly higher compared with other exposure pathways in all metal mine areas. However, there were minimal soil and water dermal contact risks. The resulting Hl values of As from the Dongil, Okdong and Hwacheon mine areas were higher than 5.0, and their toxic risk due to drinking water and rice grain was strong in these mine areas. The cancer risk of being exposed to As by the rice grain route from the Dongil, Okdong and Hwacheon mine areas was $5.2\times10^{-4},\;6.0\times10^{-4}\;and\;8.1\times10^{-4}$, respectively. The As cancer risk via the exposure pathway of drinking water from these mine areas exceeded the acceptable risk of 1 in 10,000 fer regulatory purposes. Thus, the daily intakes of groundwater and rice grain by the local residents from the Dongil, Okdong and Hwacheon mine areas can pose a potential health threat if exposed by long-term arsenic exposure.

• Pediatric Infection and Vaccine
• /
• v.6 no.1
• /
• pp.107-115
• /
• 1999

Purpose : Enterobiasis is probably one of the most common parasitic infection world-wide. Human is the only known host of Enterobius vermicularis. Children are more commonly infected with Enterobius vermicularis than adults and infections are commonly recurred. In Korea, there is a high prevalence. So, we performed this study to evaluate the present status of Enterobius vermicularis infection among children in the Masan, Changwon areas and to determine the efficacy of flubendazole against this parasitic nematode. Methods : From November to December, 1997, urban and rural elementary school children and urban preschool children were examined for the presence of Enterobius vermicularis egg. All the children were examined once by an adhesive cellotape anal swab technique in the early morning at home by their parents guided by specific instructions for the technique. Results : 1) A total of 644 adhesive cellotape anal swab specimens was collected from 205 urban elementary school children, 290 rural elementary school children and 145 urban preschool children. Among them, 114(17.7%) were positive for Enterobius vermicularis eggs. There was no significant differences in the rate with regard to sex. 2) In the preschool children, the egg detection rate was 42(29.0%) out of 145 children. This rate was significantly higher compared with 72(14.4%) of 499 school children. 3) The egg detection rates in the rural and urban school children were 15.2, 13.7% respectively. There was no significant difference in both groups. In the 3rd grade and below in elementary school children, there was a higher rate compared with above 4th grade group. 4) In day care center where egg detection rate was high as 41%, the children were given two doses of 100mg flubendazole every 3 weeks, including staffs and family members. After treatment, egg detection rate fatted as 6%. Conclusion : Our data demonstrated that there was high prevalence of Enterobius vermicularis infection. In the light of these results, it is necessary to examine and treat children as soon as possible.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.5
• /
• pp.683-692
• /
• 1996

Background: Although most of the patients with tuberculous pleural effusions completely reabsorbed their effusions and became asymptomatic within 2 to 4 months, later surgical procedures such as decortication is needed in some patients because of dyspnea caused by pleural loculations and thickening despite anti-tuberculous chemotherapy. It is obligatory to secure adequate drainage to prevent the development of complications. But, the best methods for treating loculated tuberculous pleural effusions remain debatable. Recent several reports revealed that intrapleural instillation of fibrinolytic agents is an effective adjunct in the management of complicated empyema and may reduce the need of surgery. Purpose : The effects of catheterization with intrapleural urokinase instillation were prospectively evaluated in the patients with septated tuberculous pleural effusion, and compared with other therapeutic effects of different modalities of therapy such as repeated thoracentesis and small-bored catheterization. Methods : Forty-eight patients diagnosed with tuberculous pleurisy were randomly separated into three groups; control group(n=13), catheter group(n=12), urokinase group(n=22). In urokinase group, dose of 100.000U urokinase was instilled into the pleural cavity via a percutaneous drainage catheter for complete drainage or total dose of 700,000U of urokinase. After two hours clamping, the catheter was opened and intermittently irrigated. The early and late effectiveness of therapies was assessed by radiographically and by measuring the volume of fluid drained from the catheter. Results : There was statistically significantly better result in the urokinase group in respect of frequency of catheterization, frequency of catheter obstruction and the duration of catheterization in early effectiveness(p < 0.05). There were no difference in radiologic improvement of follow-up in later phase chest X-ray between urokinase group and catheter group in later phase(p > 0.05). But there were more failure rates in control group especially honeycomb septa in pleural effusion sonographically than former two groups. And there were no complications of urokinase such as fever or hemorrhage. Conclusion : In the treatment of septated tuberculous pleurisy, there were better results in urokinase than those of catheterization alone in early effectiveness. And there was no difference in radiographic improvement between urokinase group and catheter group. Intrapleural instillation of urokinase is an effective and safe mode of treatment for septated tuberculous pleural effusions and alleviates the need for thoracotomy.

• Sleep Medicine and Psychophysiology
• /
• v.8 no.2
• /
• pp.107-112
• /
• 2001

Introduction: Narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and cataplexy, is known to be closely associated with the human leukocyte antigen (HLA) DQB1*0602. Several studies have suggested that HLA-DQB1*0602 is strongly linked with narcolepsy-cataplexy. However, no studies have yet been made on whether HLA DQB1*0602 is associated with Korean patients with narcolepsy. This study was designed to investigate the frequency of HLA-DQB1*0602 of Korean patients with narcolepsy. Methods: Twenty patients were selected (mean age: $28.2{\pm}3.0$, 11 men and 9 women). The patients were confirmed to have narcolepsy by the overnight polysomnography and multiple sleep latency test (MSLT) in addition to their clinical history and symptoms at St. Vincent's Hospital and Korea University Hospital Sleep Disorders Clinic. Any subjects co-morbid with other hypersomnic sleep disorders such as sleep apnea or periodic limb movements during sleep were excluded. Clinical data was collected through a semi-structured interview for narcoleptic patients. All patients and 21 control did HLA typing for the presence of DQB1*0602. Results Obtained were as Follows: 1) Mean sleep latency was 2.4 (${\pm}2.0$ minutes) and mean frequency of sleep-onset REM period was 3.0 (${\pm}1.6$) by MSLT. 2) Characteristic symptoms of narcolepsy investigated were as follows: excessive daytime sleepiness (100%), cataplexy (100%), sleep paralysis (60%), hypnagogic hallucination (70%) and disrupted nocturnal sleep (75%). 3) Strong emotional expression such as laughing (80%) and joking (70%) triggered cataplexy which affects the knee and leg region (80%) and jaw region (30%). 4) HLA-DR2 was found in 90% of patients and 35% in controls. The frequency of HLA-DQB1*0602 in patients and controls was 90%, and 24%, respectively. Conclusions: These results, which exhibit high HLA-DQB1*0602 expression in Korean patients with narcolepsy, suggest that HLADQB1*0602 could be a strong genetic marker in narcolepsy.

• Journal of the Korean Society of Radiology
• /
• v.10 no.1
• /
• pp.29-37
• /
• 2016

This study aims to improve the satisfaction level of the patient who undergoes CT contrast examination by developing and applying pretreatment process system, which not only can reduce the side effects caused by the test but also can help carry out the test smoothly. The subjects were 214 patients who booked CT contrast examination from January 2014 to February 2014 but could not carry out their test on schedule. We analyzed the reasons for the delay and conducted follow-up survey on them. We analyzed the usefulness of pretreatment process system by contemplating and developing pretreatment process system and applying it to the patients for whom follow-up survey was conducted from January 2015 to February 2015. The number of outpatients who came to the hospital form January to February 2014 was 2,846 and the number of patients who could not undergo the test was 214, accounting for 7.52% of the total. The specific reason for the delay includes 214 cases of unknown creatinine 98 with 120 minutes of average delay time, 40 cases of creatinine over 1.3(19%) with 30minutes of average delay time, 34 cases of past contrast media side effect 6% with 40 minutes of average delay time and 25 cases of lack of pretreatment such as fasting, etc. 11% with 120minutes of average delay time. The number of CT scan has been increasing ever since the development of CT and the frequency of using the contrast media is expected to increase. If we can employ pretreatment process system in order to effectively control the side effect of contrast media and help the CT contrast examination to be smoothly conducted on schedule, I'm sure we could improve the quality of our medical service and increase our patients' satisfaction who come to our CT scan room.