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APICAL FITNESS OF NON-STANDARDIZED GUTTA-PERCHA CONES IN SIMULATED ROOT CANALS PREPARED WITH ROTARY ROOT CANAL INSTRUMENTS (전동화일로 형성된 근관에서 비표준화 Gutta-percha Cone의 적합성)

  • Kwon, O-Sang;Kim, Sung-Kyo
    • Restorative Dentistry and Endodontics
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    • v.25 no.3
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    • pp.390-398
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    • 2000
  • The purpose of this study was to evaluate the apical fitness of non-standardized gutta-percha cones in root canals prepared with rotary Ni-Ti root canal instruments of various tapers and apical tip sizes. Simulated sixty curved root canals of plastic blocks were prepared with crown-down technique using rotary root canal instruments of Maillefer ProFile$^{(R)}$ .04 and .06 taper (Maillefer Instrument SA, Switzerland). Specimens were divided into six groups and prepared as follows: Group 1, prepared up to size 25 of .04 taper ; Group 2, prepared up to size 30 of .04 taper ; Group 3, prepared up to size 35 of .04 taper ; Group 4, prepared up to size 25 of .06 taper ; Group 5, prepared up to size 30 of .06 taper ; Group 6 ; prepared up to size 35 of .06 taper. After cutting off the coronal portion of plastic, blocks perpendicular to the long axis of the canal with the use of a diamond saw, apical 5mm of canal space was analyzed. Prepared apical canal spaces were duplicated using rubber base impression material to evaluate two dimensional total area of apical canal space. Various sized gutta-percha cones were applied in the 5mm-apical canal space, which were size 25, size 30 and size 35 standardized gutta-percha cone, Diadent Dia-Pro ISO-.04$^{TM}$ and .06$^{TM}$(Diadent, Korea), and medium-fine (MF), fine (F), fine-medium (FM) and medium (M) sized non-standardized gutta-percha cones (Diadent, Korea). Coronal excess gutta-percha were cut off with a sharp blade. Photographs of impressed apical canal spaces and gutta-percha cones were taken with a CCD camera under a stereomicroscope and stored in a computer. Areas of the total canal space and gutta-percha cones were calculated using a digitalized image analysing program, CompuScope (Sungjin Multimedia Co., Korea). Ratio of apical fitness was obtained by calculating the area of gutta-percha cone to the total area of the canal space. The data were analysed statistically using One-way Analysis of Variance and Duncan's Multiple Range Test. The results were as follows: 1. In canals prepared up to size 25 ProFile$^{(R)}$ of .04 taper, non-standardized MF and F cones occupied significantly more canal space than Dia-Pro ISO-.04$^{TM}$ or size 25 standardized ones (p<0.05). 2. In canals prepared up to size 30 ProFile$^{(R)}$ of .04 taper, non-standardized F cones occupied significantly more canal space than Dia-Pro ISO-.04$^{TM}$ or size 30 standardized ones (p<0.05), and non-standardized MF cones occupied more canal space than size 30 standardized ones (p<0.05). 3. In canals prepared up to size 35 ProFile$^{(R)}$ of .04 taper, there was no significant difference in canal space occupation among non-standardized MF and F, size 35 standardized, and Dia-Pro ISO-.04$^{TM}$ cones (p>0.05). 4. In canals prepared up to size 25 ProFile$^{(R)}$ of .06 taper, non-standardized MF and F cones occupied significantly more canal space than Dia-Pro ISO-.06$^{TM}$, or size 25 standardized ones (p<0.05), and Dia-Pro ISO-.06$^{TM}$, cones occupied significantly more space than size 25 standardized ones (p<0.05). 5. In canals prepared up to size 30 ProFile$^{(R)}$ of .06 taper, non-standardized FM cones occupied significantly more canal space than Dia-Pro ISO-.06$^{TM}$ or size 30 standardized ones (p<0.05), and non-standardized F cones occupied significantly more canal space than size 30 standardized ones (p<0.05). 6. In canals prepared up to size 35 ProFile$^{(R)}$ of .06 taper, non-standardized M and FM, Dia-Pro ISO-.06$^{TM}$ occupied significantly more canal space than size 35 standardized ones (p<0.05). In summary, in both canals prepared with .04 or .06 taper ProFile$^{(R)}$, non-standardized cones showed better fitness than Dia-Pro ISO$^{TM}$ or standardized ones, which was more characteristic in smaller canals.

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The Abuse and Invention of Tradition from Maintenance Process of Historic Site No.135 Buyeo Gungnamji Pond (사적 제135호 부여 궁남지의 정비과정으로 살펴본 전통의 남용과 발명)

  • Jung, Woo-Jin
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.35 no.2
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    • pp.26-44
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    • 2017
  • Regarded as Korea's traditional pond, Gungnamj Pond was surmised to be "Gungnamji" due to its geological positioning in the south of Hwajisan (花枝山) and relics of the Gwanbuk-ri (官北里) suspected of being components to the historical records of Muwang (武王)'s pond of The Chronicles of the Three States [三國史記] and Sabi Palace, respectively, yet was subjected to a restoration following a designation to national historic site. This study is focused on the distortion of authenticity identified in the course of the "Gungnamji Pond" restoration and the invention of tradition, whose summarized conclusions are as follows. 1. Once called Maraebangjuk (마래방죽), or Macheonji (馬川池) Pond, Gungnamji Pond was existent in the form of a low-level swamp of vast area encompassing 30,000 pyeong during the Japanese colonial period. Hong, Sa-jun, who played a leading role in the restoration of "Gungnamji Pond," said that even during the 1940s, the remains of the island and stone facilities suspected of being the relics of Gungnamji Pond of the Baekje period were found, and that the traces of forming a royal palace and garden were discovered on top of them. Hong, Sa-jun also expressed an opinion of establishing a parallel between "Gungnamji Pond" and "Maraebangjuk" in connection with a 'tale of Seodong [薯童說話]' in the aftermath of the detached palace of Hwajisan, which ultimately operated as a theoretical ground for the restoration of Gungnamj Pond. Assessing through Hong, Sa-jun's sketch, the form and scale of Maraebangjuk were visible, of which the form was in close proximity to that photographed during the Japanese colonial period. 2. The minimized restoration of Gungnamji Pond faced deterrence for the land redevelopment project implemented in the 1960s, and the remainder of the land size is an attestment. The fundamental problem manifest in the restoration of Gungnamji Pond numerously attempted from 1964 through 1967 was the failure of basing the restorative work in the archaeological facts yet in the perspective of the latest generations, ultimately yielding a replication of Hyangwonji Pond of Gyeongbok Palace. More specifically, the methodologies employed in setting an island and a pavilion within a pond, or bridging an island with a land evidenced as to how Gungnamji Pond was modeled after Hyangwonji Pond of Gyeongbok Palace. Furthermore, Chihyanggyo (醉香橋) Bridge referenced in the designing of the bridge was hardly conceived as a form indigenous to the Joseon Dynasty, whose motivation and idea of the misguided restoration design at the time all the more devaluated Gungnamji Pond. Such an utterly pure replication of the design widely known as an ingredient for the traditional landscape was purposive towards the aesthetic symbolism and preference retained by Gyeongbok Palace, which was intended to entitle Gungnamji Pond to a physical status of the value in par with that of Gyeongbok Palace. 3. For its detachment to the authenticity as a historical site since its origin, Gungnamji Pond represented distortions of the landscape beauty and tradition even through the restorative process. The restorative process for such a historical monument, devoid of constructive use and certain of distortion, maintains extreme intimacy with the nationalistic cultural policy promoted by the Park, Jeong-hee regime through the 1960s and 1970s. In the context of the "manipulated discussions of tradition," the Park's cultural policy transformed the citizens' recollection into an idealized form of the past, further magnifying it at best. Consequently, many of the historical sites emerged as fancy and grand as they possibly could beyond their status quo across the nation, and "Gungnamji Pond" was a victim to this monopolistic government-led cultural policy incrementally sweeping away with new buildings and structures instituted regardless of their original space, and hence, their value.

A Study on the Morphological Structure of Sasul-Sijo (사설시조의 형태구조 연구)

  • Won, Yong-Moon
    • Sijohaknonchong
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    • v.23
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    • pp.161-188
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    • 2005
  • The purpose of this study was to delve into the morphological types of Sijo in an effort to determine the morphological structure of Sasul-sijo, and it's also attempted to present standard about how to discriminate Pyong-si, Eos-sijo and Sasul-sijo from one another from a morphological standpoint. It's suggested that Si with tee Jangs, six verses and 12 stanzas or more, with three Jangs, seven verses and 14 stanzas or more, and with three Jangs, eight verses and 16 stanzas or more should respectively be called Pyong-sijo, Eos-sijo and Sasul-sijo. After what Sijo was and what's not were discussed, how to distinguish Eos-sijo from Sasul-sijo was described, and finally, the structure of Sasul-sijo was presented. As for Sijo and non-Sijo, the types of works that consisted of tee Jangs, like Sijo, yet didn't suit its framework and Yuljo and were written in Chinese characters were regarded as non-Sijo. Concerning discrimination between Eos-si and Sasul-sijo, the type of Sijo that included one more or higher number of verse(s) and two more or higher number of stanzas in one of three Jangs was defined as Eos-sijo, and the type of Sijo that involved two more or higher number of verses and four more or higher number of stanzas in one of three Jangs was called Sasul-sijo. In other words, Eos-sijo contained one more verse in one of tee Jangs, and Sasul-sijo included one more Jang in one tee Jangs. The sort of Sijo that contained one more Jang in one of three Jangs could be viewed as Sasul-sijo. Regarding the structure of Sasul-si, there should be three Jangs, eight verses and 16 stanzas in one piece of Sasul-sijo. Any type of Sijo that contained two more or higher number of verses and four more or higher number of stanzas could be called Sasul-sijo. Such an addition of verse and stanza could done in various ways. The examples were (1) adding stanzas the first Jang, 2) adding stanzas to the second Jang, (3) adding stanzas to the final Jang, (4) adding stanzas to both the first and Second Jangs, (5) adding stanzas to th the second and final Jangs, and (6) adding stanzas to all the first, second and third Jangs at the same time. Besides, there was an extremely broad gap between the numbers of verse and stanza in Sasul-sijo, which ranged from a low of eight stanzas to a high of 87 ones in one of three Jangs.

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Factors Related with the Compliance and Treatment in Patients with Pulmonary Tuberculosis in Urban and Suburb Area (도시와 농촌지역의 폐결핵 환자 순응도 및 치료에 관련된 요인)

  • Kim, Sang-Soon;Kim, Yoon-Ock
    • Research in Community and Public Health Nursing
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    • v.7 no.1
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    • pp.69-79
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    • 1996
  • To investigate the factors related with the compliance and the treatment of the patients with pulmonary tuberculosis in urban and suburb area, we followed up all the 755 registered patients(at urban Public Health Office 544, at suburb 210) as follow from January 1,1992 to December 31, 1993. We describe the general characteristics and the characteristics related with the disease of the patients according to the area as follow. 150 patients(27.5%) were at their age of 20 to 29 years in the urban area, whereas 45 patients (21.4%) were 60 to 69 years and another 45 patients(21.4%) were 70 to 79 years in the suburb area. According to the first chest X -ray examination, 54.5% of all cases were proved to be mild in the urban area. But in the suburb area, moderate cases (44.3%) were more than mild cases(p<0.01). Follow-up X-ray's were performed more properly(p<0.05) in the urban area(94.3%) than in the suburb area(90.0%). Most cases were found in the chest X -ray examination performed by Public Health Office (p<0.01) : payable chest X-ray in the urban area (56.7%) and free chest X-ray in the suburb area(35.2%). More patients were cured in the urban area(90.8%) than in the suburb area(87.1%). The presence of supporting family member were significantly higher(p<0.05) in the urban area(79.1%) than in the suburb area(88.1%). In the analysis of the treatment efficacy, more cure ate were found in the patients cytologically confirmed to be culture (+). In the urban area, 201 culture (+) patients (93.5%) 294 culture (-) patients (89.1%) were cured. In the suburb area, 99 culture (+) patients(91.7%) and 84 culture (-) patients(82.4%) were cured. Age, the presence of supporting family member, and the socioeconomic status of the patient had significant association with the prescription compliance related with the general characteristics of the patients. Whereas, X-ray finding and AFB culture finding were the significant factors associated with the prescription compliance related with pulmonary tuberculosis (p<0.05). The cumulative compliance in the survival analysis was 92.5% in the urban area and 88.1% in suburb area, at sixth month of follow-up. Failure rate for regular drug receipt was highest at second month in the urban area(3.75%) and at fourth month in the suburb area(4.15%). In logistic regression of the factors related with the tratment result, first X-ray examination and prescription compliance were significantly associated in the urban area(p<0.05). However, there is no factor significantly associated with the treatment result in the suburb area. It could be explained by too small size of the sample. In logistic regression of the factors related with the prescription compliance, first chest X-ray, sputum culture outcome and the presence of supporting family member were significant variables in the urban area(p<0.05). Most patients with family member were proved to be compliant with the prescription. This shows that it is important for the patients with long-lasting ilnesses to have supporting family member. Therefore, to improve prescription compliance we should strengthen the health education before the initiation of treatment and take special interest in the patients without supporting family member.

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M-mode Ultrasound Assessment of Diaphragmatic Excursions in Chronic Obstructive Pulmonary Disease : Relation to Pulmonary Function Test and Mouth Pressure (만성폐쇄성 폐질환 환자에서 M-mode 초음파로 측정한 횡격막 운동)

  • Lim, Sung-Chul;Jang, Il-Gweon;Park, Hyeong-Kwan;Hwang, Jun-Hwa;Kang, Yu-Ho;Kim, Young-Chul;Park, Kyung-Ok
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.736-745
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    • 1998
  • Background: Respiratory muscle interaction is further profoundly affected by a number of pathologic conditions. Hyperinflation may be particularly severe in chronic obstructive pulmonary disease(COPD) patients, in whom the functional residual capacity(FRC) often exceeds predicted total lung capacity(TLC). Hyperinflation reduces the diaphragmatic effectiveness as a pressure generator and reduces diaphragmatic contribution to chest wall motion. Ultrasonography has recently been shown to be a sensitive and reproducible method of assessing diaphragmatic excursion. This study was performed to evaluate how differences of diaphragmatic excursion measured by ultrasonography associate with normal subjects and COPD patients. Methods: We measured diaphragmatic excursions with ultrasonography on 28 healthy subjects(l6 medical students, 12 age-matched control) and 17 COPD patients. Ultrasonographic measurements were performed during tidal breathing and maximal respiratory efforts approximating vital capacity breathing using Aloka KEC-620 with 3.5 MHz transducer. Measurements were taken in the supine posture. The ultrasonographic probe was positioned transversely in the midclavicular line below the right subcostal margin. After detecting the right hemidiaphragm in the B-mode the ultrasound beam was then positioned so that it was approximately parallel to the movement of middle or posterior third of right diaphragm. Recordings in the M-mode at this position were made throughout the test. Measurements of diaphragmatic excursion on M-mode tracing were calculated by the average gap in 3 times-respiration cycle. Pulmonary function test(SensorMedics 2800), maximal inspiratory(PImax) and expiratory mouth pressure(PEmax, Vitalopower KH-101, Chest) were measured in the seated posture. Results: During the tidal breathing, diaphragmatic excursions were recorded $1.5{\pm}0.5cm$, $1.7{\pm}0.5cm$ and $1.5{\pm}0.6cm$ in medical students, age-matched control group and COPD patients, respectively. Diaphragm excursions during maximal respiratory efforts were significantly decreased in COPD patients ($3.7{\pm}1.3cm$) when compared with medical students, age-matched control group($6.7{\pm}1.3cm$, $5.8{\pm}1.2cm$, p< 0.05}. During maximal respiratory efforts in control subjects, diaphragm excursions were correlated with $FEV_1$, FEVl/FVC, PEF, PIF, and height. In COPD patients, diaphragm excursions during maximal respiratory efforts were correlated with PEmax(maximal expiratory pressure), age, and %FVC. In multiple regression analysis, the combination of PEmax and age was an independent marker of diaphragm excursions during maximal respiratory efforts with COPD patients. Conclusion: COPD subjects had smaller diaphragmatic excursions during maximal respiratory efforts than control subjects. During maximal respiratory efforts in COPD patients, diaphragm excursions were well correlated with PEmax. These results suggest that diaphragm excursions during maximal respiratory efforts with COPD patients may be valuable at predicting the pulmonary function.

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The Bronchial Biopsies and Steroid Response in Unexplained Chronic Non-Productive Cough (원인을 알 수 없는 만성 기침의 기관지 생검소견과 경구 스테로이드의 효과)

  • Lee, Sang-Yeub;Jeong, Hye-Cheol;Kim, Kyung-Kyu;Kim, Je-Hyeong;Kwan, Young-Hwan;Lee, Sung-Yong;Lee, So-Ra;Cho, Hyun-Deuk;Lee, Sin-Hyung;Shim, Jae-Jeong;Cho, Jae-Yun;Kim, Han-Gyum;Kang, Kyung-Ho;Yoo, Se-Hwa;In, Kwang-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.3
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    • pp.372-385
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    • 1999
  • Background: The purpose of this study was to examine the causes and pathologic process of chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph by investigating clinicopathologic findings. Method: We studied 25 adults with chronic non-productive cough over a 3-week period with a normal chest radiograph and pulmonary function tests without any other symptoms. Clinical assessment, cough score, chest and sinus radiograph, pulmonary function tests, methacholine challenge, allergic skin prick test, and bronchoscopy for bronchial biopsies were performed. Subjects were then treated with prednesolone 20 to 30 mg/day for 1 to 2 weeks. Results: The experimental group was divided into two subgroups-those infiltrated with eosinophils, and those infiltrated with lymphocytes depending on eosinophil and lymphocyte counts, both of which were respectively higher than those of the control group. Eosinophils infiltrated group had mean numbers of eosinophil of 89.8 $cells/mm^3$ while control group's mean was 0.4 $cells/mm^2$(p=0.005). Lymphocyte infiltrated group was 4 patients whose mean was 84.3 $cells/mm^2$ with 28.4 $cells/mm^2$ of control group(P=0.026). In addition, the mean thickness of the basement membrane of experimental group was $14.20{\pm}5.20{\mu}m$ in contrast of control group whose mean was $3.50{\pm}1.37{\mu}m$(P=0.001). With the methacholine challenge test, 7 of the 21 eosinophil infiltrated subjects were diagnosed with cough variant asthma ; the other 14 with eosinophilic bronchitis. Three subjects with eosinophilic bronchitis were atopic positive (21.4%) with the skin prick test In the lymphocyte dominant group, all four subjects were diagnosed with lymphocytic bronchitis. Cough score was improved after steroid treatment in 22 of 25 subjects in the experimental group (88.0%). Conclusion: These results suggest chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph was associated with airway inflammation by eosinophil and lymphocyte infiltration. The causes for chronic non-productive cough were eosinophilic bronchitis, cough variant asthma, and lymphocytic bronchitis(written in frequency). They further suggest that therapeutic treatment with steroids can provide effective symptomatic relief.

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TNF-$\alpha$ TGF-$\beta$ and Fibrinolytic Parameters in Tuberculous and Malignant Pleural Effusions (결핵성 및 악성 흉막염에서 TNF-$\alpha$, TGF-$\beta$ 및 섬유소용해계의 역할)

  • Shim, Tae-Sun;Yang, Sung-Eun;Chi, Hyun-Sook;Kim, Mi-Jung;Chung, Hun;JeGal, Yang-Jin;Lim, Chae-Man;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.2
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    • pp.149-161
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    • 2000
  • Background : Residual pleural thickening (RPT) develops in about 50% of tuberculous pleurisy ($PL_{TB}$). Some reports have suggested that elevated TNF-$\alpha$ and impaired fibrinolysis could be the cause of RPT, but until now, the mechanism and predictors of RPT have not been well known. TGF-$\beta$ has been known to promote fibrogenesis and is increased in tuberculous pleural fluid (PF). $PL_{TB}$ and malignant pleurisy ($PL_{MAL}$) manifest lymphocyte-dominant exudative pleural effusion, and it has clinical implications in the differentiation of the two diseases based on the findings of pleural effusion. We performed this study to compare pleural fluid TNF-$\alpha$ TGF-$\beta$, and fibrinolytic parameters between $PL_{TB}$ and $PL_{MAL}$, and to find the predictors of RPT in $PL_{TB}$. Methods : Thirty-five $PL_{TB}$ and 14 $PL_{MAL}$ patients who were admitted to the Asan Medical Center from February 1997 to August 1999 were enrolled. All $PL_{TB}$ patients were prescribed a primary, short-course, anti-tuberculosis regimen. INF-$\alpha$ tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), plasminogen, $\alpha$2-antiplasmin, and D-dimer were measured in both PF and PB. TGF-$\beta$was measured only in PF. Clinical characteristics, TNF-$\alpha$ TGF-$\beta$ and fibrinolytic parameters were compared between patients with RPT less than 2 mm and patients with more than 2 mm of the thirty patients who completed the anti-tuberculosis treatment. Results : The levels of TNF-$\alpha$ tPA, PAI-1, plasminogen, $\alpha$2-antiplasmin, and D-dimer in PF were higher than those in peripheral blood (PB) in $PL_{TB}$, whereas only plasminogen, $\alpha$2-antiplasmin, and D-dimer were higher in PF than in PB in $PL_{MAL}$. Pleural fluid TNF-$\alpha$ TGF-$\beta$, PAI-1, plasminogen, $\alpha$2-antiplasmin were increased in $PL_{TB}$ compared with $PL_{MAL}$, but these factors did not show any further advantages over ADA in differentiation between $PL_{TB}$ and $PL_{MAL}$. TNF-$\alpha$ TGF-$\beta$ and fibrinolytic parameters did not show any differences between patients with RPT less than 2 mm and patients with RPT more than 2 mm. Conclusion : Our data suggest that TNF-$\alpha$, TGF-$\beta$ and fibrinolytic parameters may play some role for the development of RPT in $PL_{TB}$, but they failed to predict the occurrence of RPT in $PL_{TB}$. Also these parameters did not seem to have any advantages over ADA in differentiating between two diseases.

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Pulmonary Mycoses in Immunocompromised Hosts (면역기능저하 환자에서 폐진균증에 대한 임상적 고찰)

  • Suh, Gee-Young;Park, Sang-Joon;Kang, Kyeong-Woo;Koh, Young-Min;Kim, Tae-Sung;Chung, Man-Pyo;Kim, Ho-Joong;Han, Jong-Ho;Choi, Dong-Chull;Song, Jae-Hoon;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1199-1213
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    • 1998
  • Background : The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients is a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infiltrate in immunocompromised hosts. Method : All cases presenting as a new pulmonary infiltrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. Results : In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47 yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy(10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematologic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules(6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. Conclusion : When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.

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Chemokine Secretion From Alveolar Macrophages in Patients with Diffuse Interstitial Lung Diseases(DILD) (미만성 간질성 폐질환 환자들의 폐포대식세포의 chemokine(MIP-1, IL-8) 분비능에 관한 연구)

  • Kim, Dong Soon;Paik, Sang Hoon;Lim, Chae Man;Lee, Sang Do;Koh, Younsuck;Kim, Woo Sung;Kim, Won Dong
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.6
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    • pp.954-964
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    • 1996
  • Background : The type of the infiltrating cells in al veolitis may be determined by the chemokines in the lesion. MIP-1 ${\alpha}$, a C-C type chemokine, stimulates proliferation and cytokine secretion from macrophages and induces early neutrophilic and later monocytic inflammation in vi vo. IL-8, a C-X-C type chemokine is known to attract neutrophils and T-lymphocytes. This study is performed to find out the relative role of two different chemokines in diffuse interstitial lung disease. Subject and Method : We measured the secretion of MIP- 1 ${\alpha}$ and IL-8 from alveolar macrophages(AM), and their level in BAL fluid of 26 patients with DILD (10 IPF, 4 collagen disease, 10 sarcoidosis, and 2 hypersensitivity pneumonitis) and 7 normal control. Result: IL-8 secretion was significantly increased in patients with DILD ($8.15{\pm}4.58$ ng/ml) than in normal ($1.10{\pm}0.93$ ng/ml, p=0.0003). Significant correlation was found between IL-8 secretion and total cell number in BAL fluid (r=0.484, p=0.0068), %(r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte, and % of AM (r=-0.505, 0.0032). MIP- 1 ${\alpha}$ secretion was also increased in DILD ($2.41{\pm}1.45$ ng/ml) compared to control ($0.63{\pm}0.30$ ng/ml, p=0.0031), and showed a tendency of correlation with total cell number (r=0.368, p=0.0456) and No. of alveolar macrophages (r=0.356, p=0.0579) in BAL fluid. The concentration of IL-8 in BAL fluid was significantly increased in the patients with DILD ($40.4{\pm}34.5$ pg/ml) compared to control ($3.90{\pm}2.47$ pg/ml, p=0.0094) and it showed a significant correlation with the total cell number (r=0.484, p=0.0068), %(r=-0.505, p=0.0032) of AM, and % (r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte in BAL fluid. But there was a no significant difference in MIP- 1 ${\alpha}$ concentration in BAL fluid between normal control group and the patients with DILD. Conclusion : From the above results, we concluded that AM of DILD releases increased amount of both IL-8 and MIP- 1 ${\alpha}$ but IL-8 has better correlation with the type of alveolitis.

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Diagnostic Efficacy of FDG-PET Imaging in Solitary Pulmonary Nodule (고립성폐결절의 진단시 FDG-PET의 임상적 유용성에 관한 연구)

  • Cheon, Eun Mee;Kim, Byung-Tae;Kwon, O. Jung;Kim, Hojoong;Chung, Man Pyo;Rhee, Chong H.;Han, Yong Chol;Lee, Kyung Soo;Shim, Young Mog;Kim, Jhingook;Han, Jungho
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.6
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    • pp.882-893
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    • 1996
  • Background : Over one-third of solitary pulmonary nodules are malignant, but most malignant SPNs are in the early stages at diagnosis and can be cured by surgical removal. Therefore, early diagnosis of malignant SPN is essential for the lifesaving of the patient. The incidence of pulmonary tuberculosis in Korea is somewhat higher than those of other countries and a large number of SPNs are found to be tuberculoma. Most primary physicians tend to regard newly detected solitary pulmonary nodule as tuberculoma with only noninvasive imaging such as CT and they prefer clinical observation if the findings suggest benignancy without further invasive procedures. Many kinds of noninvasive procedures for confirmatory diagnosis have been introduced to differentiate malignant SPNs from benign ones, but none of them has been satisfactory. FOG-PET is a unique tool for imaging and quantifying the status of glucose metabolism. On the basis that glucose metabolism is increased in the malignant transfomled cells compared with normal cells, FDG-PET is considered to be the satisfactory noninvasive procedure which can differentiate malignant SPNs from benign SPNs. So we performed FOG-PET in patients with solitary pulmonary nodule and evaluated the diagnostic accuracy in the diagnosis of malignant SPNs. Method : 34 patients with a solitary pulmonary nodule less than 6 cm of irs diameter who visited Samsung Medical Center from Semptember, 1994 to Semptember, 1995 were evaluated prospectively. Simple chest roentgenography, chest computer tomography, FOG-PET scan were performed for all patients. The results of FOG-PET were evaluated comparing with the results of final diagnosis confirmed by sputum study, PCNA, fiberoptic bronchoscopy, or thoracotomy. Results : (I) There was no significant difference in nodule size between malignant (3.1 1.5cm) and benign nodule(2.81.0cm)(p>0.05). (2) Peal SUV(standardized uptake value) of malignant nodules (6.93.7) was significantly higher than peak SUV of benign nodules(2.71.7) and time-activity curves showed continuous increase in malignant nodules. (3) Three false negative cases were found among eighteen malignant nodule by the FDG-PET imaging study and all three cases were nonmucinous bronchioloalveolar carcinoma less than 2 em diameter. (4) FOG-PET imaging resulted in 83% sensitivity, 100% specificity, 100% positive predictive value and 84% negative predictive value. Conclusion: FOG-PET imaging is a new noninvasive diagnostic method of solitary pulmonary nodule thai has a high accuracy of differential diagnosis between malignant and benign nodule. FDG-PET imaging could be used for the differential diagnosis of SPN which is not properly diagnosed with conventional methods before thoracotomy. Considering the high accuracy of FDG-PET imaging, this procedure may play an important role in making the dicision to perform thoracotomy in diffcult cases.

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