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Diagenetic History of the Ordovician Chongson Limestone in the Chongson Area, Kangwon Province, Korea (강원도 정선 지역 오르도비스기 정선석회암의 속성 역사)

  • Bong, Lyon-Sik;Chung, Gong-Soo
    • Journal of the Korean earth science society
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    • v.21 no.4
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    • pp.449-468
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    • 2000
  • The Ordovician Chongson Limestone deposited in the carbonate ramp to the rimmed shelf shows diverse diagenetic features. The marine diagenetic feature appears as isopachous cements surrounding ooids and peloids. Meteoric diagenetic features are recrystallized finely and coarsely crystalline calcite, evaporite casts filled with calcite, and isopachous sparry calcite surrounding ooid grains. Shallow burial diagenetic features include wispy seam, microstylolite, and dissolution seam whereas deep burial features include stylolite, burial cements. blocky calcite with twin lamellae, and poikilotopic calcite. Dolomites consist of very finely to finely crystalline mosaic dolomite formed as supratidal dolomite, disseminated dolomite of diverse origin, patchy dolomite formed from bioturbated mottles, and saddle dolomite of burial origin. Silicified features include calcite-replacing quartz and fracture-filling megaquartz. Burial cements characterized by poikilotopic texture show ${\delta}^{18}$O value of -10.4 %$_o$ PDB, ${\delta}^{13}$C value of -1.0%$_o$ PDB and 504ppm Sr, 3643ppm Fe, and 152ppm Mn concentrations. Finely and coarsely crystalline limestones show similar ${\delta}^{18}$O and ${\delta}^{13}$C value to those of burial cements; however, they show lower Sr and higher Fe and Mn concentrations than burial cements. This suggests that very finely and coarsely crystalline limestones were recrystallized in freshwater and then they were readjusted geochemically in the burial setting whereas the burial cements were formed in relatively high temperature and low water/rock ratio conditions. Very finely and finely crystalline mosaic dolomites with ${\delta}^{18}$O value of -8.2%$_o$ PDB, ${\delta}^{13}$C value of -1.9 %$_o$ PDB, and 213ppm Sr, 3654ppm Fe, and 114ppm Mn concentrations, respectively are interpreted to have been formed penecontemporaneously in supratidal flat and then recrystallized in the low water/rock ratio burial environment. Geochemical data suggest that the low water/rock ratio burial environment was the dominant diagenetic setting in the Chongson Limestone. The Chongson Limestone has experienced marine and meteoric diagenesis during early diagenesis. With deposition of Haengmae and Hoedongri formations part of the Chongson Limestone was buried beneath these formations and it experienced shallow burial diagenesis. During the Devonian the Chongson Limestone was tectonically deformed and subaerially exposed. During the Carboniferous to the Permian about 3.3km thick Pyongan Supergroup was deposited on the Chongson Limestone and the Chongson Limestone was in deep burial depths and stylolite, burial cements, blocky calcite and saddle dolomite were formed. After this burial event the Chongson Limestone was subaerially exposed during the Mesozoic and Cenozoic by three periods of tectonic disturbance including Songnim, Daebo and Bulguksa disturbance. Since the Bulguksa disturbance during Cretaceous and early Tertiary the Chongson Limestone has been subaerially exposed.

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A THREE-DIMENSIONAL FEM COMPARISON STUDY ABOUT THE FORCE, DISPLACEMENT AND INITIAL STRESS DISTRIBUTION ON THE MAXILLARY FIRST MOLARS BY THE APPLICATION OF VAR10US ASYMMETRIC HEAD-GEAR (비대칭 헤드기어의 적용시 상악제 1 대구치에 나타나는힘과 변위 및 초기 응력분포에 관한 3차원 유한요소법적 연구)

  • Kim, Jong-Soo;Cha, Dyung-Suk;Ju, Jin-Won;Lee, Jin-Woo
    • The korean journal of orthodontics
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    • v.31 no.1 s.84
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    • pp.25-38
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    • 2001
  • The purpose of this study was to compare the force, the displacement and the stress distribution on the maxillary first molars altered by the application of various asymmetric head-gear. For this study, the finite element models of unilateral Cl II maxillary dental arch was made. Also, the finite element models of asymmetric face-bow was made. Three types of asymmetric face-bow were made : each of the right side 15mm, 25mm and 35mm shorter than the left side. We compared the forces, the displacement and the distribution of stress that were generated by application of various asymmetric head-gear, The results were as follows. 1. The total forces that both maxillary first molars received were similar in all groups. But the forces that mesially positioned tooth received were increased as the length of the outer-bow shortened, and the forces that normally positioned tooth received were decreased as the length of the outer-bow shortened. 2. In lateral force comparison, the buccal forces that normally positioned tooth received were increased as the length of the outer-bow shortened, and the buccal fortes that mesially positioned tooth received were decreased as the length of the outer-bow shortened. Though the net lateral force moved to the buccal side of normally positioned tooth as the length of the outer-bow shortened, both maxillary first molars received the buccal force. That showed 'Avchiai Expansion Effect' 3. The distal forces, the extrusion forces and the magnitudes of the crown distal tipping that mesially positioned tooth received were increased as the length of the outer-bow shortened, and the forces that normally positioned tooth received were decreased as the length of the outer-bow was shortened. 4. The magnitude of the distal-in rotation that normally positioned tooth received were increased as the length of the outer-bow was shortened. But, mesially positioned tooth show two different results. For the outer-bow 15mm shortened, mesially positioned tooth showed the distal-in rotation, hut for the outer-bow 25mm and 35mn shortened, mesially positioned tooth showed the distal-out rotation. Thus, the turning point exists between 15mm and 25mm. 5. This study of the initial stress distribution of the periodontal ligament at slightly inferior of the furcation area revealed that the compressive stress in the distobuccal root of the normally positioned tooth moved from the palatal side to the distal side and the buccal side successively as the length of the outer-bow shortened. 6. This study of the initial stress distribution of the periodontal ligament at slightly inferior of the furcation area revealed that the magnitudes of stress were altered but the total stress distributions were not altered in the mesiobuccal root and the palatal root of normally positioned tooth, and also three roots of mesially positioned tooth as the length of the outer-bow shortened.

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The Analysis of the Current Status of Medical Accidents and Disputes Researched in the Korean Web Sites (인터넷 사이트를 통해 살펴본 의료사고 및 의료분쟁의 현황에 관한 분석)

  • Cha, Yu-Rim;Kwon, Jeong-Seung;Choi, Jong-Hoon;Kim, Chong-Youl
    • Journal of Oral Medicine and Pain
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    • v.31 no.4
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    • pp.297-316
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    • 2006
  • The increasing tendency of medical disputes is one of the remarkable social phenomena. Especially we must not overlook the phenomenon that production and circulation of information related to medical accidents is increasing rapidly through the internet. In this research, we evaluated the web sites which provide the information related to medical accidents using the keyword "medical accidents" in March 2006, and classified the 28 web sites according to the kinds of establishers. We also analyzed the contents of the sites, and checked and compared the current status of the web sites and problems that have to be improved. Finally, we suggested the possible solutions to prevent medical accidents. The detailed results were listed below. 1. Medical practitioners, general public, and lawyers were all familiar with and prefer the term "medical accidents" mainly. 2. In the number of sites searched by the keyword "medical accidents", lawyer had the most sites and medical practitioners had the least ones. 3. Many sites by general public and lawyers had their own medical record analysts but there was little professional analysts for dentistry. 4. General public were more interested in the prevention of medical accidents but the lawyers were more interested in the process after medical accidents. The sites by medical practitioners dealt with the least remedies of medical accidents, compared with other sites. 5. General public wanted the third party such as government intervention into the disputes including the medical dispute arbitration law or/and the establishment of independent medical dispute judgment institution. 6. In the comparison among the establishers of web sites, medical practitioners dealt with the least examples of medical accidents. 7. The suggestion of cases in counseling articles related to dental accidents were considered less importantly than the reality. 8. Whereas there were many articles about domestic cases related to the bloody dental treatment, in the open counseling articles the number of dental treatment regarding to non insurance treatment was large. 9. In comparing offered information of medical accidents based on the establishers, general public offered vocabularies, lawyers offered related laws and medical practitioners offered medical knowledge relatively. 10. They all cited the news pressed by the media to offer the current status of domestic medical accidents. Especially among the web sites by general public, NGOs provided the plentiful statistical data related to medical accidents. 11. The web sites that collect the medical accidents were only two. As a result of our research, we found out that, in the flood of information, medical disputes can be occurred by the wrong information from third party, and the medical practitioners have the most passive attitudes on the medical accidents. Thus, it is crucial to have the mutual interchange and exchange of information between lawyer, patients and medical practitioners, so that based on clear mutual comprehension we can solve the accidents and disputes more positively and actively.

3-D Finite element stress analysis in screw-type, cement-type, and combined-type implant fixed partial denture designs (임플란트 상부보철물의 유지형태에 따른 3차원 유한요소 응력분석)

  • Lee, Sung-Chun;Kim, Seok-Gyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.4
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    • pp.365-375
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    • 2009
  • Statement of problems: Stress analysis on implant components of the combined screw- and cement-retained implant prosthesis has not investigated yet. Purpose: The purpose of this study was to assess the load distribution characteristics of implant prostheses with the different prosthodontic retention types, such as cement-type, screw-type and combined type by using 3-dimensional finite element analysis. Material and methods: A 3-dimensional finite element model was created in which two SS II implants (Osstem Co. Ltd.) were placed in the areas of the first premolar and the first molar in the mandible, and three-unit fixed partial dentures with four different retention types were fabricated on the two SS II implants. Model 1 was a cement-retained implant restoration made on two cement-retained type abutments (Comocta abutment; Osstem Co. Ltd.), and Model 2 was a screw-retained implant restoration made on the screw-retained type abutments (Octa abutment; Osstem Co. Ltd.). Model 3 was a combined type implant restoration made on the cement-retained type abutment (Comocta abutment) for the first molar and the screw-retained type abutment (Octa abutment) for the first premolar. Lastly, Model 4 was a combined type implant restoration made on the screw-retained type abutment (Octa abutment) for the first molar and the cement-retained type abutment (Comocta abutment) for the first premolar. Average masticatory force was applied on the central fossa in a vertical direction, and on the buccal cusp in a vertical and oblique direction for each model. Von-Mises stress patterns on alveolar bone, implant body, abutment, abutment screw, and prosthetic screw around implant prostheses were evaluated through 3-dimensional finite element analysis. Results: Model 2 showed the lowest von Mises stress. In all models, the von Mises stress distribution of cortical bone, cancellous bone and implant body showed the similar pattern. Regardless of loading conditions and type of abutment system, the stress of bone was concentrated on the cortical bone. The von-Mises stress on abutment, abutment screw, and prosthetic screw showed the lower values for the screw-retained type abutment than for the cement-retained type abutment regardless of the model type. There was little reciprocal effect of the abutment system between the molar and the premolar position. For all models, buccal cusp oblique loading caused the largest stress, followed by buccal cusp vertical loading and center vertical loading. Conclusion: Within the limitation of the FEA study, the combined type implant prosthesis did not demonstrate more stress around implant components than the cement type implant prosthesis. Under the assumption of ideal passive fit, the screw-type implant prosthesis showed the east stress around implant components.

Methylenetetrahydrofolate Reductase C677T Polymorphism in Gastric Cancer (위암에서 Methylenetetrahydrofolate Reductase C677T의 유전자 다형성)

  • Seo Won;Park Won Cheol;Lee Jeong Kyun;Kim Jeong Jung
    • Journal of Gastric Cancer
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    • v.5 no.1
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    • pp.10-15
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    • 2005
  • Purpose: Recently the role of vitamins, folate in particular, has been emphasized in the maintenance of health. Folate deficiency is known to give rise to developmental delay, immature vascular disease, neural tube defect, acute leukemia, atherosclerotic vascular disease, delivery defects, breast cancer, and particularly gastrointestinal neoplasia. Methylenetetrahydrofolate reductase (MTHFR) is an essential enzyme in folate metaboism, and influences DNA synthesis and DNA methylation. Generally, folate deficiency is associated with gastrointestinal neoplasms. The amino-acid- changing and enzyme-activity-reducing nucleotide polymorphism (766C$\rightarrow$T/ Ala222Val) has been described in the MTHFR polymorphism and leads to low enzyme activity that may reduce the capacity of DNA methylation and possibly uracil mis-incorporation into DNA. These processes may be critical in the oncogenic transformation of human cells, especially in colorectal carcinomas. We investigated the relationship between the MTHFR polymorphism in gastric cancer and the tumor site, the smoking history, and the alcoholic history. Materials and Methods: Ninety-six (96) individuals with gastric cancer and 287 healthy persons were analyzed. Blood sampling was performed, PCR-RFLP was analyzed, and MTHFR polymorphism genotypes of C/C, C/T, and T/T were obtained and analyzed statistically for their correlation. Results: In the gastric cancer group there were 69 ($72\%$) males and 27 ($28\%$) females. There were also 58 cases ($60\%$) involving the gastric lower body, 20 cases ($21\%$) the gastric mid-body, and 18 cases ($19\%$) the gastric upper body. In the control group there were 169 ($59\%$) males and 118 ($41\%$) females. Among the gastric cancer, 56 ($61\%$) smoking patients, 40 ($39\%$) non-smoking patients, 45($47\%$) alcoholic patients, 51 ($53\%$) non-alcoholic patients. In the gastric cancer group, MTHER polymorphisms were C/C in 18 ($19\%$) cases, C/T in 59 ($61\%$) cases, T/T in 19 ($20\%$) cases. In the control group polymorphisms were C/C 116 ($40\%$) cases, C/T 103 ($36\%$) cases, and T/T 68 ($24\%$) cases (P=0.045). In cases of lower gastric body cancer, polymorphisms were C/C in 16 ($24\%$) C/C in 16 ($24\%$) cases and C/T or T/T in 42 ($72\%$) cases. In cases of upper and mid-body cancer, polymorphisms were C/C in 2 ($5\%$) cases and C/T or T/T 36 ($95\%$) cases (P=0.006). In the non-smoking patient group, polymorphisms were C/C in 5 (12%) cases and C/T or T/T in 35 ($88\%$) cases. In the smoking patient group, C/C in 13 ($23\%$) cases and C/T or T/T in 43 ($77\%$) cases (P=0.189). In the non-alcoholic patient group, polymorphisms were C/C in 6 ($12\%$) cases and C/T or T/T in 45 ($88\%$) cases. In the alcoholic patient group, polymorphisms were C/C in 12 ($26\%$) cases and C/T or T/T in 33 ($74\%$) cases (P=0.063) Conclusion: MTHFR polymorphisms are associated with gastric cancer and tumor site, but not with smoking and alcohol drinking.

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The Early Experience with a Totally Laparoscopic Distal Gastrectomy (전(全)복강경하 원위부 위절제술의 초기 경험)

  • Kim Jin Jo;Song Gyo Young;Chin Hyung Min;Kim Wook;Jeon Hae Myoung;Park Cho Hyun;Park Seung Man;Lim Keun Woo;Park Woo Bae;Kim Seung Nam
    • Journal of Gastric Cancer
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    • v.5 no.1
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    • pp.16-22
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    • 2005
  • Purpose: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been increasing lately. Although minimally invasive surgery is more beneficial, no reported case of a totally laparoscopic distal gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experiences, to determine the feasibility of a totally laparoscopic distal gastrectomy using an intracorporeal gastroduodenostomy in treating early gastric carcinoma. Materials and Methods: We investigated surgical results and clinicopatholgic characteristics of eight(8) patients with an early gastric carcinoma who underwent a totally laparoscopic distal gastrectomy at the Department of Surgery, Our Lady of Mercy Hospital, The Catholic University of Korea, between June 2004 and September 2004. The intracorporeal gastroduodenostomy was performed with a delta-shaped ananstomosis by using only laparoscopic linear staplers (Endocutter 45mm; Ethicon Endosurgery, OH, USA). Results: The operative time was $369.4\pm62.5$ minutes (range $275\∼465$ minutes), and the anastomotic time was 45.1\pm14.4$ minutes (range $32\∼70$ minutes). The anastomotic time was shortened as surgical experience was gained. The number of laparoscopic linear staplers for an operation was $7.1\pm0.6$. The number of lymph nodes harvested was $31.9\pm13.1$. There was 1 case of transfusion and no case of conversion to an open procedure. The time to the first flatus was 2.8$\pm$0.5 days, and the time to the first food intake was $4.1\pm0.8$ days. There were no early postoperative complications, and the postoperative hospital stay was $10.0\pm3.9$ days. Conclusion: A totally laparoscopic distal gastrectomy using an intracorporeal gastroduodenostomy with a delta-shaped anastomosis is technically feasible and can maximize the benefit of laparoscopic surgery for early gastric cancer.

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Different Perceptions, Knowledge, and Attitudes of Elementary, Middle, and High School Students regarding Irradiated Food, Nuclear Power Generation, and Medical Radiation (초, 중, 고등학생의 방사선조사식품, 원자력발전, 의료방사선에 대한 인식, 지식, 태도 차이)

  • Han, Eun Ok;Kim, Jae Rok;Choi, Yoon Seok
    • Journal of Radiation Protection and Research
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    • v.39 no.2
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    • pp.118-126
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    • 2014
  • A survey was conducted on perceptions, knowledge, and attitudes of elementary, middle, and high school students, who will lead public opinion in the future, regarding irradiated food, nuclear power generation, and medical radiation. These topics urgently require general social acceptability among various fields in which radiation is used. Educational methods to enhance social acceptability were partially discovered. First, it is necessary to implement different strategies when designing courses for female and male students. Male students have higher levels of objective knowledge (p<0.039) of irradiated food, necessity (p<0.001) and objective knowledge (p<0.001) of nuclear power generation, approval of building a nuclear power plant in the nation (p<0.001), necessity (p<0.001) and objective knowledge (p<0.001) of medical radiation, and attitudes regarding using medical radiation (p<0.007, p<0.001). Second, the educational effect of explanations to help increase national understanding of the necessity and safety of nuclear power generation will increase if information on the necessity and safety of medical radiation is provided as well. Both male and female students perceived that medical radiation is the most necessary (p<0.001), medical radiation is the safest (p<0.001), and nuclear power generation is the least safe (p<0.013). Moreover, the correlation between medical radiation and nuclear power generation was the highest. Third, there is a need for different lectures between classes, since the patterns of perception vary according to the field of radiation use among elementary, middle, and high school students. Elementary school students had high interest in education on nuclear power generation (p<0.005), perceived that irradiated food is safe (p<0.001), and had the most positive attitude toward consuming irradiated food (p<0.001). Middle school students had high interest in education on nuclear power generation (p<0.018), perceived that nuclear power generation (p<0.001) and medical radiation (p<0.002) are safe, and had the most positive attitude toward using radiation for treatment (p<0.001). High school students had the highest level of objective knowledge on nuclear power generation (p<0.001) and medical radiation (p<0.001), and perceived that medical radiation is the most necessary (p<0.017); however, they perceived that nuclear power generation is the least safe (p<0.001). Attitudes toward irradiated food intake (p<0.001) and approving construction of a nuclear power plant in their neighborhood (p<0.001) were both low. Fourth, it is necessary to provide educational programs to change perceptions and improve attitudes rather than providing education focused on objective knowledge. There was no correlation between objective knowledge and necessity of irradiated food, objective knowledge and safety and interest in education on nuclear power generation, and objective knowledge and interest in education and information acquirement regarding medical radiation. In particular, high school students had the highest level of objective knowledge and yet had the least positive attitudes toward approving construction of nuclear power plants in their neighborhood and intake of irradiated food. Therefore, to increase the social acceptability of using nuclear energy and radiation in Korea, it is desirable to provide strategic educational programs to improve perceptions, knowledge, and attitudes regarding the necessity and safety of their use.

The Requirement and Effect of the Document of Carriage in Respect of the International Carriage of Cargo by Air (국제항공화물운송에 관한 운송증서의 요건 및 효력)

  • Lee, Kang-Bin
    • The Korean Journal of Air & Space Law and Policy
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    • v.23 no.2
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    • pp.67-92
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    • 2008
  • The purpose of this paper is to research the requirements and effect of the document of carriage in respect of the carriage of cargo by air under the Montreal Convention of 1999, IATA Conditions of Carriage for Cargo, and the judicial precedents of Korea and foreign countries. Under the Article 4 of Montreal Convention, in respect of the carriage of cargo, an air waybill shall be delivered. If any other means which preserves a record of the carriage are used, the carrier shall, if so requested by the consignor, deliver to the consignor a cargo receipt. Under the Article 7 of Montreal convention, the air waybill shall be made out by the consignor. If, at the request of the consignor, the carrier makes it out, the carrier shall be deemed to have done so on behalf of the consignor. The air waybill shall be made out in three original parts. The first part shall be marked "for the carrier", and shall be signed by the consignor. The second part shall be marked "for the consignee", and shall be signed by the consignor and by the carrier. The third part shall be signed by the carrier who shall hand it to the consignor after the goods have been accepted. Under the Article 5 of Montreal Convention, the air waybill or the cargo receipt shall include (a) an indication of the places of departure and destination, (b) an indication of at least one agreed stopping place, (c) an indication of the weight of the consignment. Under the Article 10 of Montreal Convention, the consignor shall indemnify the carrier against all damages suffered by the carrier or any other person to whom the carrier is liable, by reason of the irregularity, incorrectness or incompleteness of the particulars and statement furnished by the consignor or on its behalf. Under the Article 9 of Montreal Convention, non-compliance with the Article 4 to 8 of Montreal Convention shall not affect the existence of the validity of the contract, which shall be subject to the rules of Montreal Convention including those relating to limitation of liability. The air waybill is not a document of title or negotiable instrument. Under the Article 11 of Montreal Convention, the air waybill or cargo receipt is prima facie evidence of the conclusion of the contract, of the acceptance of the cargo and of the conditions of carriage. Under the Article 12 of Montreal Convention, if the carrier carries out the instructions of the consignor for the disposition of the cargo without requiring the production of the part of the air waybill or the cargo receipt, the carrier will be liable, for any damage which may be accused thereby to any person who is lawfully in possession of that part of the air waybill or the cargo receipt. According to the precedent of Korea Supreme Court sentenced on 22 July 2004, the freight forwarder as carrier was not liable for the illegal delivery of cargo to the notify party (actual importer) on the air waybill by the operator of the bonded warehouse because the freighter did not designate the boned warehouse and did not hold the position of employer to the operator of the bonded warehouse. In conclusion, as the Korea Customs Authorities will drive the e-Freight project for the carriage of cargo by air, the carrier and freight forwarder should pay attention to the requirements and legal effect of the electronic documentation of the carriage of cargo by air.

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Clinical Differential Diagnosis of Usual Interstitial Pneumonia from Nonspecific Interstitial Pneumonia (통상성 간질성 폐렴과 비특이성 간질성 폐렴의 임상적 감별 진단)

  • An, Chang-Hyeok;Koh, Young-Min;Chung, Man-Pyo;Suh, Gee-Young;Kang, Soo-Jung;Kang, Kyeong-Woo;Ahn, Jong-Woon;Lim, Si-Young;Kim, Ho-Joong;Han, Jeung-Ho;Lee, Kyung-Soo;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.6
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    • pp.932-943
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    • 2000
  • Background : Nonspecific interstitial pneumonitis (NSIP) is most likely to be confused with usual interstitial pneumonitis (UIP). Unlike patients witþ UIP, the majority of patients with NSIP have a good prognosis, with most patients improving after treatment with corticosteroids. Therefore it is clinically important to differentiate NSIP from UIP. Up to now, the only means of differentiating these two diseases was by means of surgical lung biopsy. American Thoracic Society (ATS) proposed a clinical diagnostic criteria for UIP to provide assistance to clinicians in its diagnosis without surgical lung biopsy. This study is aimed to investigate whether there were clinical and radiological differences between NSIP and UIP, and the usefulness of ATS clinical diagnostic criteria for UIP in Korea. Methods : We studied 60 patients with UIP and NSIP confirmed by surgical lung biopsy. Clinical manifestations, pulmonary function test, arterial blood gas analysis, bronchoalveolar lavage (BAL), and high resolution computed tomography (HRCT) were evaluated and analyzed by Chi-square test or t-test. The clinical criteria for UIP proposed by ATS were applied to all patients with idiopathic interstitial pneumonia. Results : Forty-two patients with UIP and 18 with NSIP were pathologically identified. Among the 18 patients with NSIP (M : F=1 : 17), the mean age was 55.2$\pm$8.4 (44~73) yr. Among the 42 patients with UIP (M : F=33 : 9), the mean age was 59.5$\pm$7.1 (45~74) yr (p=0.046). Fever was more frequent in NSIP (39%) (p=0.034), but clubbing was frequently observed in UIP (33%) (p=0.023). BAL lymphocytosis was more frequent (23%) (p=0.0001) and CD4/CD8 ratio was lower in NSIP (p=0.045). On HRCT, UIP frequently showed honeycomb appearance (36 of 42 patients) though not in NSIP (p=0.0001). Six of 42 UIP patients (14.3%) met the ATS clinical criteria for IPF, and 3 of 16 NSIP patients (18.8%) met the diagnostic criteria. Conclusion : Being a relatively young female and having short duration of illness, fever, BAL lymphocytosis, low CD4/CD8 ratio with the absence of clubbing and honeycomb appearance in HRCT increase the likelihood of the illness being NSIP. The usefulness of ATS clinical diagnostic criteria for UIP may be low in Korea.

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The Characteristics of Bronchioloalveolar Carcinoma Presenting with Solitary Pulmonary Nodule (고립성 폐결절로 나타난 기관지폐포암의 임상적 고찰)

  • Kim, Ho-Cheol;Cheon, Eun-Mee;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Rhee, Chong-H.;Han, Yong-Chol;Lee, Kyoung-Soo;Han, Jung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.280-289
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    • 1997
  • Background : Bronchioloalveolar carcinoma (BAC) has been reported to diveres spectrum of chinical presentations and radiologic patterns. The three representative radiologic patterns are followings ; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. While, the localized consolidation and solitary nodular patterns has favorable prognosis, the multicentric of diffuse pattern has worse prognosis regardless of treatment. BAC presenting as a solitary pulmonary nodule is often misdiagnosed as other benign disease such as tuberculoma. Therefore it is very important to make proper diagnosis of BAC with solitary nodular pattern, since this pattern of BAC is usually curable with a surgical resection. Methods : We reviewed the clinical and radiologic features of patients with pathologically-proven BAC with solitary nodular pattern from January 1995 to September 1996 at Samsung Medical Center. Results : Total 11 patients were identified. 6 were men and 5 were women. Age ranged from 37 to 69. Median age was 60. Most patients with BAC with solitary nodular pattern were asymptomatic and were detected by incidental radiologic abnormality. The chest radiograph showed poorly defined opacity or nodule and computed tomography showed consolidation, ground glass appearance, internal bubble-like lucencies, air bronchogram, open bronchus sign, spiculated margin or pleural tag in most patients. The initial diagnosis on chest X-ray were pulmonary tuberculosis in 4 patients, benign nodule in 2 patients and malignant nodule in 5 patients. The FDG-positron emission tomogram was performed in eight patients. The FDG-PET revealed suggestive findings of malignancy in only 3 patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in 1 patient, by CT guided percutaneous needle aspiration in 2 patients, and by lung biopsy via video-assited thoracocopy in 8 patients. Lobectomy was performed in all patients and postoperative pathologic staging were $T_1N_0N_0$ in 8 patients and $T_2N_0M_0$ in 3 patients. Conclusion : Patients of BAC presenting with solitary nodular pattern were most often asymptomatic and incidentally detected by radiologic abnormality. The chest X-ray showed poorly defined nodule or opacity and these findings were often regarded as benign lesion. If poorly nodule or opacity does not disappear on follow up chest X-ray, computed tomography should be performed. If consolidation, ground glass appearance, open bronchus sign, air bronchogram, internal bubble like lucency, pleural tag or spiculated margin are found on computed tomography, further diagnostic procedures, including open thoracotomy, should be performed to exclude the possiblity of BAC with solitary nodular pattern.

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