• Tuberculosis and Respiratory Diseases
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• v.42 no.3
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• pp.277-294
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• 1995

Background: The prevalence of tuberculosis in Korea decreased remarkably for the past 30 years, while the incidence of disease caused by mycobacteria other than tuberculosis is unknown. Korean Academy of Tuberculosis and Respiratory Diseases performed national survey to estimate the incidence of mycobacterial diseases other than tuberculosis in Korea. We analyzed the clinical data of confirmed cases for the practice of primary care physicians and pulmonary specialists. Methods: The period of study was from January 1981 to October 1994. We collected the data retrospectively by correspondence with physicians in the hospitals that referred the specimens to Korean Institute of Tuberculosis, The Korean National Tuberculosis Association for the detection of mycobacteria other than tuberculosis. In confirmed cases, we obtained the records for clinical, laboratory and radiological findings in detail using protocols. Results: 1) Mycobacterial diseases other than tuberculosis were confirmed that 1 case was in 1981, 2 cases in 1982, 4 cases in 1983, 2 cases in 1984, 5 cases in 1985, 1 case in 1986, 3 cases in 1987, 1 case in 1988, 6 cases in 1989, 9 cases in 1990, 14 cases in 1990, 10 cases in 1992, 4 cases in 1993, and 96 cases in 1994. Cases since 1990 were 133 cases(84.2%) of a total. 2) Fifty seven percent of patients were in the age group of over 60 years. The ratio of male to female patients was 2.6:1. 3) The distribution of hospitals in Korea showed that 61 cases(38.6%) were referred from Double Cross Clinic, 42 cases(26.6%) from health centers, 21 cases(13.3%) from tertiary referral hospitals, 15 cases(9.5%) from secondary referral hospitals, and 10 cases(6.3%) from primary care hospitals. The area distribution in Korea revealed that 98 cases(62%) were in Seoul, 17 cases(10.8%) in Gyeongsangbuk-do, 12 cases(7.6%) in Kyongki-do, 8 cases(5.1%) in Chungchongnam-do, each 5 cases(3.2%) in Gyeongsangnam-do and Chungchongbuk-do, 6 cases(3.8%) in other areas. 4) In the species of isolated mycobacteria other than tuberculosis, M. avium-intracellulare was found in 104 cases(65.2%), M. fortuitum in 20 cases(12.7%), M. chelonae in 15 cases(9.5%), M. gordonae in 7 cases(4.4%), M. terrae in 5 cases(3.2%), M. scrofulaceum in 3 cases(1.9%), M. kansasii and M. szulgai in each 2 cases(1.3%), and M. avium-intracellulare coexisting with M. terrae in 1 case(0.6%). 5) In pre-existing pulmonary diseases, pulmonary tuberculosis was 113 cases(71.5%), bronchiectasis 6 cases(3.8%), chronic bronchitis 10 cases(6.3%), and pulmonary fibrosis 6 cases(3.8%). The timing of diagnosis as having pulmonary tuberculosis was within 1 year in 7 cases(6.2%), 2~5 years ago in 32 cases(28.3%), 6~10 years ago in 29 cases(25.7%), 11~15 years ago in 16 cases(14.2%), 16~20 years ago in 15 cases (13.3%), and 20 years ago in 14 cases(12.4%). Duration of anti-tuberculous treatment was within 3 months in 6 cases(5.3%), 4~6 months in 17 cases(15%), 7~9 months in 16 cases(14.2%), 10~12 months in 11 cases(9.7%), 1~2 years in 21 cases(18.6%), and over 2 years in 8 cases(7.1%). The results of treatment were cure in 44 cases(27.9%) and failure in 25 cases(15.8%). 6) Associated extra-pulmonary diseases were chronic liver disease coexisting with chronic renal failure in 1 case(0.6%), diabetes mellitus in 9 cases(5.7%), cardiovascular diseases in 2 cases(1.3%), long-term therapy with steroid in 2 cases(1.3%) and chronic liver disease, chronic renal failure, colitis and pneumoconiosis in each 1 case(0.6%). 7) The clinical presentations of mycobacterial diseases other than tuberculosis were 86 cases (54.4%) of chronic pulmonary infections, 1 case(0.6%) of cervical or other site lymphadenitis, 3 cases(1.9%) of endobronchial tuberculosis, and 1 case(0.6%) of intestinal tuberculosis. 8) The symptoms of patients were cough(62%), sputum(61.4%), dyspnea(30.4%), hemoptysis or blood-tinged sputum(20.9%), weight loss(13.3%), fever(6.3%), and others(4.4%). 9) Smear negative with culture negative cases were 24 cases(15.2%) in first examination, 27 cases(17.1%) in second one, 22 cases(13.9%) in third one, and 17 cases(10.8%) in fourth one. Smear negative with culture positive cases were 59 cases(37.3%) in first examination, 36 cases (22.8%) in second one, 24 cases(15.2%) in third one, and 23 cases(14.6%) in fourth one. Smear positive with culture negative cases were 1 case(0.6%) in first examination, 4 cases(2.5%) in second one, 1 case (0.6%) in third one, and 2 cases(1.3%) in fourth one. Smear positive with culture positive cases were 48 cases(30.4%) in first examination, 34 cases(21.5%) in second one, 34 cases(21.5%) in third one, and 22 cases(13.9%) in fourth one. 10) The specimens isolated mycobacteria other than tuberculosis were sputum in 143 cases (90.5%), sputum and bronchial washing in 4 cases(2.5%), bronchial washing in 1 case(0.6%). 11) Drug resistance against all species of mycobacteria other than tuberculosis were that INH was 62%, EMB 55.7%, RMP 52.5%, PZA 34.8%, OFX 29.1%, SM 36.7%, KM 27.2%, TUM 24.1%, CS 23.4%, TH 34.2%, and PAS 44.9%. Drug resistance against M. avium-intracellulare were that INH was 62.5%, EMB 59.6%, RMP 51.9%, PZA 29.8%, OFX 33.7%, SM 30.8%, KM 20.2%, TUM 17.3%, CS 14.4%, TH 31.7%, and PAS 38.5%. Drug resistance against M. chelonae were that INH was 66.7%, EMB 66.7%, RMP 66.7%, PZA 40%, OFX 26.7%, SM 66.7%, KM 53.3%, TUM 53.3%, CS 60%, TH 53.3%, and PAS 66.7%. Drug resistance against M. fortuitum were that INH was 65%, EMB 55%, RMP 65%, PZA 50%, OFX 25%, SM 55%, KM 45%, TUM 55%, CS 65%, TH 45%, and PAS 60%. 12) The activities of disease on chest roentgenogram showed that no active disease was 7 cases(4.4%), mild 20 cases(12.7%), moderate 67 cases(42.4%), and severe 47 cases(29.8%). Cavities were found in 43 cases(27.2%) and pleurisy in 18 cases(11.4%). 13) Treatment of mycobacterial diseases other than tuberculosis was done in 129 cases(81.7%). In cases treated with the first line anti-tuberculous drugs, combination chemotherapy including INH and RMP was done in 86 cases(66.7%), INH or RMP in 30 cases(23.3%), and not including INH and RMP in 9 cases(7%). In 65 cases treated with the second line anti-tuberculous drugs, combination chemotherapy including below 2 drugs were in 2 cases(3.1%), 3 drugs in 15 cases(23.1%), 4 drugs in 20 cases(30.8%), 5 drugs in 9 cases(13.8%), and over 6 drugs in 19 cases (29.2%). The results of treatment were improvement in 36 cases(27.9%), no interval changes in 65 cases(50.4%), aggravation in 4 cases(3.1%), and death in 4 cases(3.1%). In improved 36 cases, 34 cases(94.4%) attained negative conversion of mycobacteria other than tuberculosis on cultures. The timing in attaining negative conversion on cultures was within 1 month in 2 cases(1.3%), within 3 months in 11 cases(7%), within 6 months in 14 eases(8.9%), within 1 year in 2 cases(1.3%) and over 1 year in 1 case(0.6%). Conclusion: Clinical, laboratory and radiological findings of mycobacterial diseases other than tuberculosis were summarized. This collected datas will assist in the more detection of mycobacterial diseases other than tuberculosis in Korea in near future.

• Korean Journal of Head & Neck Oncology
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• v.5 no.1
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• pp.39-46
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• 1989

Kimura's Disease is a chronic inflammatory and proliferative condition producing subcutaneous masses especially in the head and neck area. This report of our experience with 5 patients with this disease is the first in the Korean surgical literature. Kimura's Disease is thought to be part of the larger spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). It is characterized pathologically by hyperplastic lymphoid follicles, eosinophilic infiltration, and vase 비 ar proliferation. It produces masses which are most common in the area of the parotid, submandibular gland and upper neck. These masses occupy the subcutaneous tissues but also extend into salivary tissue and into upper neck nodes. One of our patients had masses in the groin. The tumors are extremely vascular due to the presence of new proliferative vessels and sinusoids. The average age of our 5 patients was 35, but all but one case were younger than 38 years of age. The male: female ratio was 3 : 2, and the average duration of symptoms was 5,2years. All patients had peripheral blood eosinophilia. All had multiple masses, sometimes symmetrical. The management was surgery alone in one case, surgery and steroids in one case, surgery and radiotherapy in two cases, and all three modalities in one case. The relationship of this entity to ALHE and our experience in the management of this disease are presented. A clinicopathological discrepancy alerted us to the existence of Kimura's Disease. A nineteen-year old male presented with subcutaneous masses over both mastoid areas present for 3 years (Case III). When biopsy on each side was reported as 'eosinophilic granuloma' we submitted the slides to an internationally expert pathologist. Symmetrically occurring tumors in the peri-parotid subcutaneous areas did not fit any category of neoplasm or granuloma known to us. The diagnosis, made by Dr. Gist Fan at the Ochsner Clinic, was Kimura's Disease. We found two additional cases in a review of soft tissue eosinophilic granuloma previously reported at Presbyterian Medical Center, and since then have diagnosed two new cases. These five cases constitute the basis for this, the largest series to be reported in Korea. These vascular, tumor-like lesions of the skin, subcutaneous areas and subjacent structures of the head and neck have been a variety of names, such as angiolymphoid hyperplasia with eosinophilia, eosinophilic hyperplastic lymphogranuloma, angioblastic lymphoid hyperplasia with eosinophilia, histioid hemangioma, and epithelioid hemangioma. The history of this disease spectrum dates back to 1937 when Kimm and Szeto (1) reported 7 cases of 'eosinophilic hyperplastic lymphogranuloma' in the Proceedings of the Chinese Medical Journal. In 1948 Kimura and his associates(2) reported additional cases in Japan under the title 'On the unusual granulation combined with hyperplastic changes of lymphatic tissue.' From then until 1966 several hundred cases were reported in China and Japan. The first report from the West was by Wells and Whimster(3) in the British Journal of Dermatology, in 1969. These authors coined the term, angiolymphoid hyperplasia with eosinophilia (ALHE). Since that time a debate has ensued as to whether Kimura's Disease and ALHE are distinct entities, or whether Kimura's is part of the larger spectrum of ALHE, perhaps a later or advanced phase. From the clinical perspective, surgeons should be aware of the diagnosis of Kimura's Disease not only as part of the differential diagnosis of head and neck tumors but also because these lesions are indolent, and generally require conservative surgical removal as part of the management program. CASE I. A 37-year-old female company employee presented in August 1982 with submental swelling of 12 years' duration and with inguinal swelling of 7 years' duration. The submental mass measured 5x5cm. and the inguinal mass was 8x4cm. in size. Peripheral eosinophilia varying from 14% to 40% was found. On August 20, 1982, the submental mass was removed and a superficial groin dissection was done. In May 1983 an intraoral lesion of the palate was removed. The patient is free of disease. CASE II. A 23-year-old unemployed man visited this hospital for the first time in July, 1984, with swelling of the right cheek present for 6 years. The mass was soft and ill-defined but measured 10x20cm. and extended from the submandibular upper neck to the zygomatic arch, and from the mastoid to the cheek, over the parotid gland. Eosinophilia varying from 27% to 29% was noted in the peripheral blood. On March 21, 1986, the lesion was resected. The procedure comprised an extended superficial parotidectomy from the temporalis fascia to the upper neck. Post-operatively radiotherapy 3000 rad tissue dose was administered using the 6 MeV linear accelerator. The patient remains free of disease. CASE III. A 19-year-old student came to the clinic with masses over both mastoid areas, present 3 years. On the right there were two adjacent lesions, one over the mastoid, the other in the upper jugular level of the neck. On the left it was a single mass over the mastoid. Eosinophilia varied from 13 to 32% in the peripheral blood, and 11.6% in the bone marrow. Incisional biopsy revealed 'eosinophilic granuloma' and a trial of predisolone was employed. The mass increased in size so a small dose of radiation (600 rads) was used, with substantial regression,. The lesion on the left was excised and follwed by 1000 rads radiotherapy. Finally recurrent tumor on the right side was removed on November 5, 1985. The patient remains free of disease. CASE N. A 29-year-old local merchant had had swelling of both upper necks since childhood. At the time of his first visit on March 17, 1986, the right submandibular mass measured 5x3.5cm. and the ,right upper neck and parotid tail mass measured 2.5cm. On the left there were masses in the upper neck, the largest of which measured 2.5cm, and of the parotid tail, 2.0cm. in size.(See Fig. 1) Peripheral eosinophilia of 39% was recorded. Left side partial parotidectomy and resection of the upper neck and subdigstric mases was done on May 2, 1986. The mass involving the right parotid tail and upper neck nodes was removed on Angust 7,1986. Postoperatively the patient was placed on prednisolone 30 mg. per day. No definite masses are palpable. CASE V. A 66-year-old housewife informed us, at the time of her first visit in May, 1986, that she had had multiple neck masses since 10 years ago. On the right side there was a 2.5cm. subcutaneous mass of the upper neck, over the upper jugular chain. On the left there was a 9x4.5cm. mass involving the entire parotid, the post-auricular area and the upper neck. A third mass presented in the submental area and measured 3.5cm. (See Fig. 2) Eosinophilia of 51% was noted in the peripheral blood. partial excision of the left upper neck lesion and complete excision of the submental mass were performed on june 6, 1986. post-operatively she was placed on 20 mg. of prednisolone daily, but when the mass re-grew after two months she was referred to Radiation Therapy for a 2500 rad course of treatment. A barely palpable thickening remains.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.303-314
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• 2001

Background : Matrix metalioproteinase(MMP)-2 and MMP-9 have been known to play an important role in cell migration and the tissue remodeling process by type IV collagen lysis, a major component of the basement membrane. Intra-alveolar fibrosis, secondary to an injury to the basement membrane of the alveolar epithelial lining, is a major process in the pathogenesis of idiopathic pulmonary fibrosis(IPF). Therefore, MMP-2 and MMP-9 was hypothesized to play an important role in IPF pathogenesis. As a result, their level may reflect the activity or prognosis. Method : Forty one progressive IPF patients(age $59.82{\pm}1.73$ years, M:F=23:18), 16 patients with stable IPF for more than one year without therapy(age : $63.6{\pm}2.8$ years, M:F=13:3), and 7 normal controls were enrolled in this study. The MMP-2 and MMP-9 levels in the BAL fluid and alveolar macrophage conditioned media(AM-CM) were measured by zymography and the TIMP-1 level was measured by ELISA. Results : 1) The MMP-2 level in BALF was highest in the progressive IPF group ($1.36{\pm}0.28$) followed by the stable group ($0.46{\pm}0.13$) and the controls ($0.08{\pm}0.09$), which was statistically significant. The MMP-9 level of the IPF ($0.31{\pm}0.058$) and the stable group ($0.22{\pm}0.078$) were higher than that of the control group ($0.002{\pm}0.004$). In the AM-CM, only MMP-9 was detected, which was significantly higher in IPF group ($0.80{\pm}0.1O$) than in the control group($0.23{\pm}0.081$). The TIMP-1 level was also higher in both the IPF ($36.34{\pm}8.62\;{\mu}g/ml$) and stable group ($20.83{\pm}8.53\;{\mu}g/ml$) compared to the control group ($2.80{\pm}1.05\;{\mu}g/ml$) (p<0.05). 3) There was a correlation between the MMP-2 level in the BALF with the total cell number(r=0.298) and neutrophils(r=0.357) (p<0.05), and the MMP-9 level with the number of neutrophils (r=0.407) and lymphocytes (r=0.574)(p<0.05). The TIMP-1 level correlated with the total number of cell (r=0.338, p<0.05) and neutrophils(r=0.449, p=0.059). Conclusion : Both MMP and TIMP appear to play an important role in IPF pathogenesis, and their level may reflect the disease activity.

• Proceedings of the Korean Society for Food Science of Animal Resources Conference
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• 1995.11a
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• pp.1-48
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• 1995

식생활은 인간 생활의 주체이고 먹는다는 것은 그 수단이다. 그중 중요한 하나의 명제는 인간이 놓여진 여러 환경에서 어떻게 건강을 유지하고 그 개체가 소유하고 있는 능력을 최대치까지 생리적으로 성장 발전시킴과 동시에 최대한 수명을 연장시키기 위한 식물 섭취방법을 마이크로 레벨까지 해명하는데 있다. 인간은 일생동안 엄청난 양의 음식물을 먹는다(70세 수명일 경우 200만 파운드 즉 체중의 1,400배). 그러나 먹기는 먹되 자신의 건강과 장수를 위하여 어떤 음식을 어떻게 선택하여 어떻게 먹어야 하는 문제가 매우 중요하다. 최근 우리나라도 국민 소득이 늘면서 식생활은 서구화 경향으로 기우는 듯하다. 공해를 비롯한 수입식품 등 여러 가지 문제점이 제기됨에 따라 자연식과 건강식을 주장하는 소리가 높이 일고 있다. 그중에는 축산 식품이 콜레스테롤 함량이 다른 식품에 비하여 높게 함유하고 있다는 것으로 심혈관질환의 주범인양 무차별 강조하는 나머지 육식공포 내지는 계란 등의 혐오감 마저 불러 일으키는 경향까지 있는 듯하다. 따라서 본논고에서는 축산식품중의 콜레스테롤 함량수준이 과연 성인병의 주범인지 아니면 다른 지방산과 관련해서 올바르게 평가하고 그 문제점과 대책을 개관해 보고 요약하면 다음과 같다. 1. 사람은 유사이래 본능적으로 주변의 식물이나 동물의 고기를 먹고 성장하여 자손을 증식시키고 어느 사이에 늙으면 죽음을 맞이 하는 싸이클을 반복하면서 기나긴 세월동안 진화를 하여 오늘날의 인간으로서의 자태를 이루었다. 유인원과 같은 인류의 선조들은 수렵을 통해 육식을 많이 하였을 것이므로 인간은 원래 육식동물이 아닐까? 구석기시대의 유물을 보면 많은 뼈가 출토되고 “얄타미라”나 “라스코” 동굴벽화가 선명하게 묘사되고 있다. 2. 우리나라 선조 승구족의 일파가 백두산을 비롯한 만주 송화강 유역에 유입되면서 수렵과 목축을 주요 식품획득의 수단으로 식품문화권을 형성하면서 남하하여 한반도 민족의 조상인 맥족(貊族)으로 맥적(貊炙)이라고 하는 요리(오늘날의 불고기)를 먹었다는 기록이 있다. 3. 인간의 수명을 1900년대로 거슬러 올라가서 뉴질랜드가 세계최장수국(호주는 2위)로서 평균수명은 남자 58세, 여자 69세인 반면 일본과 한국은 당시 남자 36세, 여자 37세이던 것이 일본은 1989년에 이르러 세계 최장수국으로 등장했으나 1990년 당시 뉴질랜드${\cdot}$호주 등은 목축 및 밀(小麥) 생산국가였기 때문이라는 것과 일본은 오늘날 합리적인 식생활 국가라는 것을 간과해서는 안된다. 4. 우리나라 10대 사망원인중 (1994년도) 뇌혈관질환이 1위, 교통사고 2위, 암이 3위 순위로서 연령별로는 10~30대의 불의의 사고(교통사고), 40~60대는 암, 70대 이상은 뇌혈관질환이 가장 많다. 구미${\cdot}$일 7개국 정상국가들은 심질환 사망이 가장 높다. 5. 식생활의 변화에 있어서 우리나라는 주식으로 섭취해 왔던 곡류는 70년 대비 94년에는 0.7배 감소된 반면 육류 5배, 계란 2.4배, 우유는 무려 29.3배 증가되었다. 식생활 패턴이 서구화 경향으로 바뀌는 것 같다. 6. 71년도 우리나라의 지질섭취량은 국민 1인당 1일 평균 13.1g에 섭취에너지의 5.7%수준이었으나 92년도에는 34.5g으로서 총에너지 섭취량의 16.6%에 달하고 총섭취 지방질중 동물성 섭취 비율은 47%를 차지 한다. 국민 평균 혈청콜레스테롤 농도는 80년에 비해 88년에는 11%가 증가되었고 80년에 210mg/dl 이상 되는 콜레스테롤 혈증인 사람의 비율이 5%에서 88년에는 23%로 크게 증가했다. 7. 세계 정상국가들의 단백질 즉 축산식품의 섭취는 우리나라보다 적게는 2배, 많게는 6~7배 더 섭취하고 90년도 우리나라의 지질섭취량은 일본의 1/3수준에 불과하다. 8. 콜레스테롤은 인체를 비롯한 모든 동물체에 필수적으로 분포하고 있는 것으로 체내 존재하고 있는 총량은 90~150g, 이중 혈청콜레스테롤은 4%(6g)를 차지하고 있음에도 불구하고 이 아주 적은 콜레스테롤에 일희일비(一喜一悲) 논쟁은 60~70년 끄러오고 있다. 9. 콜레스테롤의 생체내 기능으로서는 (1) 세포벽의 지지물질 (2) 신경세포 보호막물질 (3) 담즙산의 합성 (4) 비타민 D의 합성 (5) 임신시에 반듯이 필요한 분자 (6) 기타 여러 가지 기능을 수행하는 것으로 필수적인 물질이다. 10. 우리가 식이를 통해서 섭취 콜레스테롤을 550mg정도를 섭취한다고 하더라도 이 정도의 양은 배설 소모되는 양과 거의 맞먹는 양이다. 피부와 땀샘에서 소실되는 양만도 100~300mg에 달하기 때문에 미국농무성에서 섭취량을 300mg로 제한하는 것은 무의미하다. 11. 콜레스테롤 운반체로서의 지단백질은 그 밀도가 낮은 것으로부터 킬로미크론(chylomicron), 초저밀도 지단백질(VLDL), 저밀도 지단백질(LDL) 및 고밀도 지단백질(HDL)으로 나누는데 LDL은 혈청콜레스테롤 중 약 70%, HDL은 약20%를 함유한다. 12. 혈중 콜레스테롤 수준에 영향을 미치는 요인을 열거하여 보면 다음과 같다. 1) 음식을 통해서 섭취되는 콜레스테롤 중 단지 10~40%정도가 흡수되고, 체내에서 합성되는 콜레스테롤이 증가할수록 식이콜레스테롤은 실제 혈청콜레스테롤 수준에 거의 영향을 미치지 않으므로 식이중함량에 대하여 공포를 느끼고 기피할 필요가 없다. 2) 고도불포화지방산, 단가불포화지방산, 포화지방산의 비 즉 P/M/S의 비가 균형되도록 권장한다. 3) 동맥경화를 비롯한 성인병의 원인이 되는 혈전증에는 EPA의 양을 높여줌으로서 성인병을 예방할 수 있다. 4) 오메가6지방산 아라키도닉산과 오메가3지방산인 EPA로 유도되는 에이코사에노이드 또는 프로스타노이드는 오메가6와 3지방산을 전구체로 하여 생합성되는 중요한 생리활성 물질이다. 5) 사람은 일반적으로 20세에서 60세까지 나이를 먹어감에 따라 혈중 콜레스테롤 수준이 증가하고 60세 이후부터는 일정한 수준을 유지하며 심장보호성 HDL-콜레스테롤은 감소하는 반면에 죽상경화성 LDL콜레스테롤은 증가한다. 6) 높은 HDL콜레스테롤 수준이 심장병 발생 위험요인을 감소시키는 기능을 갖고 있기 때문에 좋은 HDL이라 부르고, LDL은 나쁜 콜레스테롤이라 부르기도 하는데, 이것은 유전적 요인보다도 환경적 요인이 보다 큰 영향을 미친다. 7) 이것은 생활 형태와 영양섭취상태를 포함해서 개인적 생활패턴에 영향을 받는다. 8) 많은 실험에서 혈중 콜레스테롤 상승은 노년의 가령(加齡)에 적응하기 위한 자연적 또는 생리적인 세포의 생화학적이고 대사적인 기능을 위해 필수적일 수 있다는 것을 간과해서는 안될 것이다. 이 점으로 미루어 노년의 여성들을 위한 콜레스테롤 농도를 200mg/dl이 가장 알맞은 양이 아닌 듯하다. 9) 스트레스는 두가지 모양으로 유발되는데 해로은 스트레스(negative), 이로운 스트레스(positive)로서 긴장완화는 혈중 콜레스테롤 농도를 10% 떨어진다. 10) 자주 운동을 하는 사람들은 혈중 HDL콜레스테롤치가 운동을 하지 않는 사람보다 높다. 육체적인 운동의 정도와 혈중 HDL콜레스테롤 농도와는 정비례한다. 11) 흡연은 지방을 흡착시키므로 혈전증의 원이이 되며 혈관속의 HDL농도를 감소시킨다. 12) 에너지의 과잉섭취에 의한 체중 증가느 일반적으로 지단백질대사에 영향을 미치고, 간에서는 콜레스테롤 과잉 생산과 더불어 VLDL콜레스테롤의 LDL콜레스테롤 혈증을 나타냄으로 운동과 더불어 비만이 되지 않도록 하여야 한다. 13. 콜레스테롤 함량에 대한 조절기술 1) 식품의 우열을 평가할 때 단순히 동물성 또는 식물성 식품으로 분류해서 총괄적으로 논한다는 것은 지양되어야 한다. 이것은 그 식품에 함유하고 있는 지방산의 종류에 따라서 다르기 때문이다. 2) 인체의 원할한 기능 유지를 위해서는 P /M /S비율 뿐만 아니라 섭취 지방질의 오메가6 /오메가3계 지방산의 비율이 모두 적절한 범위에 있어야 하며 한두가지 지방산만이 과량일 때는 또 다른 불균형을 일으킬 수 있다는 점을 알아야 한다. 3) 닭고기는 오메가6지방산 함량을 높이기 위하여 사료중에 등푸른 생선이나 어분이나 어유를 첨가하여 닭고기는 첨가수준에 따라 증가됨을 알 수 있다. 4) 오늘날 계란내의 지방산 조성을 변화시켜 난황내의 오메가 3계열 지방산 함량을 증가시킨 계란의 개발이 활발해졌다. 14. 계란 콜레스테롤에 대한 소비자들의 부정적 인식을 불식시키고자 계란의 클레스테롤 함량을 낮추는 과제가 등장하면서 그 기술개발이 여러모로 시도되고 있으나 아직 실용 단계에 이르지 못했다. 15. 계란의 콜레스테롤 문제에 대한 대책으로서 난황의 크기를 감소시키는 방법에 대한 연구도 필요하다. 16. 계란 중 콜레스테롤 함량 분석치는 표현 방식에 따라서 소비자들을 혼란시킬 가능성이 있다. 또한 과거에는 비색법으로 분석했으나 오늘날은 효소법으로 분석하면 분석치에 상당한 차이가 있다. 17. 소비자의 요구를 만족시키고 버터 소비를 촉진시키기 위해 콜레스테롤을 감소시키는 물리적${\cdot}$생물학적 방식이 제안되어 있으나 현장적용이 가능한 것은 아직 없다. 18. 우리나라에서 이미 시판되고 있는 DHA우유가 선보였고 무콜레스테롤 버터의 경우 트란스(trans)형 지방산에 관해서는 논란의 여지가 많을 것이다. 끝으로 국가 목표의 하나는 복지사회 건설에 있고 복지국가 실현에는 국민 기본 욕망의 하나인 식생활 합리화가 선행되어야 한다. 소득이 늘고 국가가 발전해감에 따라 영양식${\cdot}$건강식 및 기호식을 추구하게 됨을 매우 당연한 추세라 하겠다. 우리의 식생활이 날로 향상되어 지난날의 당질 위주에서 점차 축산물쪽으로 질적 개선이 이루어진다는 것은 고무적임에 틀림없다. 이 축산물을 통한 풍요로운 식의 문화를 창출하면서 건강과 장수 그리고 후손에 이르기까지 번영하고 국가 경쟁력 강화에 심혈을 기우려야 할 때이다.

• Radiation Oncology Journal
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• v.25 no.2
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• pp.79-92
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• 2007

[ $\underline{Purpose}$ ]: For the first time, a nationwide survey in the Republic of Korea was conducted to determine the basic parameters for the treatment of esophageal cancer and to offer a solid cooperative system for the Korean Pattern of Care Study database. $\underline{Materials\;and\;Methods}$: During $1998{\sim}1999$, biopsy-confirmed 246 esophageal cancer patients that received radiotherapy were enrolled from 23 different institutions in South Korea. Random sampling was based on power allocation method. Patient parameters and specific information regarding tumor characteristics and treatment methods were collected and registered through the web based PCS system. The data was analyzed by the use of the Chi-squared test. $\underline{Results}$: The median age of the collected patients was 62 years. The male to female ratio was about 91 to 9 with an absolute male predominance. The performance status ranged from ECOG 0 to 1 in 82.5% of the patients. Diagnostic procedures included an esophagogram (228 patients, 92.7%), endoscopy (226 patients, 91.9%), and a chest CT scan (238 patients, 96.7%). Squamous cell carcinoma was diagnosed in 96.3% of the patients; mid-thoracic esophageal cancer was most prevalent (110 patients, 44.7%) and 135 patients presented with clinical stage III disease. Fifty seven patients received radiotherapy alone and 37 patients received surgery with adjuvant postoperative radiotherapy. Half of the patients (123 patients) received chemotherapy together with RT and 70 patients (56.9%) received it as concurrent chemoradiotherapy. The most frequently used chemotherapeutic agent was a combination of cisplatin and 5-FU. Most patients received radiotherapy either with 6 MV (116 patients, 47.2%) or with 10 MV photons (87 patients, 35.4%). Radiotherapy was delivered through a conventional AP-PA field for 206 patients (83.7%) without using a CT plan and the median delivered dose was 3,600 cGy. The median total dose of postoperative radiotherapy was 5,040 cGy while for the non-operative patients the median total dose was 5,970 cGy. Thirty-four patients received intraluminal brachytherapy with high dose rate Iridium-192. Brachytherapy was delivered with a median dose of 300 cGy in each fraction and was typically delivered $3{\sim}4\;times$. The most frequently encountered complication during the radiotherapy treatment was esophagitis in 155 patients (63.0%). $\underline{Conclusion}$: For the evaluation and treatment of esophageal cancer patients at radiation facilities in Korea, this study will provide guidelines and benchmark data for the solid cooperative systems of the Korean PCS. Although some differences were noted between institutions, there was no major difference in the treatment modalities and RT techniques.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.291-301
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• 1998

Purpose : A retrospective study was conducted comparing single daily fraction (SDF) thoracic radiotherapy (TRT) with twice daily (BID) TRT to determine the potential benefit of BID TRT in limited-stage small cell lung cancer (SCLC). Endpoints of the study were response. survival, pattern of failure, and acute toxicity. Materials and Methods : Between November 1989 to December 1996, 78 patients with histologically proven limited-stage SCLC were treated at the Department of Therapeutic Radiology, Chungnam National University Hospital. Of these, 9 were irradiated for palliative intent, and 1 had recurrent disease. Remaining 68 patients were enrolled in this study. There were 26 patients with a median age of 58 years, and 22 (85$\%$) ECOG performance score of less than 1 in SDF TRT. There were 42 patients with a median age of 57 years, and 36 (86$\%$) ECOG performance score of less than 1 in BID TRT By radiation fractionation regimen, there were 26 in SDF TRT and 42 in BID TRT. SDF TRT consisted of 180 cGy, 5 days a week. BID TRT consisted of 150 cGy BID, 5 days a week in 13 of 42 and 120 cGy BID, in 29 of 42. And the twice daily fractions were separated by at least 4 hours. Total radiotherapy doses were between 5040 and 6940 cGy (median, 5040 cGy) in SDF TRT and was between 4320 and 5100 cGy (median, 4560 cGy) in BID TRT. Prophylactic cranial irradiation (PCI) was recommended for patients who achieved a CR. The recommended PCI dose was 2500 cGy/10 fractions. Chemotherapy consisted of CAV (cytoxan 1000 mg/$m^2$, adriamycin 40 mg/$m^2$, vincristine 1 mg/$m^2$) alternating with VPP (cisplatin 60 mg/$m^2$, etoposide 100 mg/$m^2$) every 3 weeks in 25 (96$\%$) of SDF TRT and in 40 (95$\%$) of BID TRT. Median cycle of chemotherapy was six in both group. Timing for chemotherapy was sequential in 23 of SDF TRT and in 3 BID TRT, and concurrent in 3 of SDF TRT and in 39 of BID TRT Follow-up ranged from 2 to 99 months (median, 14 months) in both groups. Results : Of the 26 SDF TRT, 9 (35$\%$) achieved a complete response (CR) and 14 (54$\%$) experienced a partial response (PR). Of the 42 BID TRT, 18 (43$\%$) achieved a CR and 23 (55$\%$) experienced a PR. There was no significant response difference between the two arms (p=0.119). Overall median and 2-year survival were 15 months and 26.8$\%$, respectively. The 2-year survivals were 26.9$\%$ and 28$\%$ in both arm, respectively (p=0.51). The 2-rear survivals were 35$\%$ in CR and 24.2$\%$ in PR, respectively. The grade 2 to 3 esophageal toxicities and grade 2 to 4 neutropenias were more common in BID TRT (p=0.028 0.003). There was no difference in locoregional and distant metastasis between the two arms (p=0 125 and 0.335, respectively). The most common site of distant metastasis was the brain. Conclusion : The median survival and 2-year survival were 17 months and 20.9$\%$ in SDF TRT with sequential chemotherapy, and 15 months and 28$\%$ in BID TRT with concurrent chemotherapy, respectively. We did not observe a substantial improvement of long-term survival in the BID TRT with concurrent chemotherapy compared with standard schedules of SDF TRT with sequential chemotherapy. The grade 2 to 3 esophageal toxicities and glade 2 to 4 neutropenias were more common in BID TRT with concurrent chemotherapy. Although the acute toxicities were more common in BID TRT with concurrent chemotherapy than SDF TRT with sequential chemotherapy, a concurrent chemotherapy and twice daily TRT was feasible. However further patient accrual and long-term follow up are needed to determine the potential benefits of BID TRT in limited-stage SCLC.

• Tuberculosis and Respiratory Diseases
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• v.39 no.6
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• pp.453-473
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• 1992

Background: National survey was performed to estimate the incidence of sarcoidosis in Korea. The clinical data of confirmed cases were analysed for the practice of primary care physicians and pulmonary specialists. Methods: The period of study was from January 1991 to December 1992. Data were retrospectively collected by correspondence with physicians in departments of internal medicine, dermatology, ophthalmology and neurology of the hospitals having more than 100 beds using returning postcards. In confirmed and suspicious cases of sardoidosis, case record chart for clinical and laboratory findings were obtained in detail. Results: 1) Postcards were sent to 523 departments in 213 hospitals. Internal medicine composed 41%, dermatology 20%, ophthalmology 20% and neurology 19%. 2) Postcards were returned from 241 departments (replying rates was 48%). 3) There were 113 confirmed cases from 50 departments and 10 cases. The cases were composed from internal medicine (81%), dermatology (13%), ophthalmology (3%) and neurology (3%). 78 confirmed cases were analysed, which were composed from department of internal medicine (92%), dermatology (5%), and neurology (3%). 4) The time span for analysed cases was 1980 to 1992. one case was analysed in 1980 and the number gradually increased to 18 cases in 1991. 5) The majority of patients (84.4%) were in the age group of 20 to 49 years. 6) The ratio of male to female was 1 : 1.5. 7) The most common chief complains were respiratory symptoms, dermatologic symptoms, generalized discomforts, visual changes, arthralgia, abdominal pains, and swallowing difficulties in order. 16% of the patients were asymptomatic. 8) Mean duration between symptom onset and diagnosis was 2 months. 9) The most common symptoms were respiratory, general, dermatologic, ophthalmologic, neurologic and cardiac origin in order. 10) Hemoglobin, hematocrits and platelet were in normal range. 58% of the patients had lymphopenia measuring less than 30% of white cell count. The ratio of CD4 to CD8 lymphocytes was $1.73{\pm}1.16$ with range of 0.43 to 4.62. ESR was elevated in 43% of the cases. 11) Blood chemistry was normal in most cases. Serum angiotensin converting enzyme (S-ACE) was $66.8{\pm}58.6\;U/L$ with the range of 8.79 to 265 U /L. Proteinuria of more than 150 mg was found in 42. 9% of the patients. 12) Serum IgG was elevated in 43.5%, IgA in 45.5%, IgM in 59.1% and IgE in 46.7%. The levels of complement C3 and C4 were in the normal range. Anti-nuclear antibody was detected in 11% of the cases. Kweim test was performed in 3 cases, and in all cases the result was positive. 13) FVC was decreased in 17.3%, FEV1 in 11.5%, FEV1/FVC in 10%, TLC in 15.2%, and DLco in 64.7%. 14) PaO2 was decreased below 90 mmHg in 48.6% and PaCO2 was increased above 45 mmHg in 5.7%. 15) The percentage of macrophages in BAL fluid was $51.4{\pm}19.2%$, lymphocytes $44.4{\pm}21.1%$, and the ratio of CD4 to CD8 lymphocytes was $3.41{\pm}2.07$. 16) There was no difference in laboratory findings between male and female. 17) Hilar enlargement on chest PA was present in 87.9% (bilaterally in 78.8% and unilaterally in 9.1%). 18) According to Siltzbach's classification, stage 0 was 5%, stage 158.3%, stage 228.3%, and stage 38.3%. 19) Hilart enlargement on chest CT was present in 92.6% (bilaterally 76.4% and unilaterally in 16.2%). 20) HRCT was done in 16 cases. The most common findings were nodules, interlobular thickening, focal patchy infiltrations in order. Two cases was normal finding. 21) Other radiologic examinations showed bone change in one case and splenomegaly in two cases. 22) Gallium scan was done in 12 cases. Radioactivity was increased in hilar and mediastinal lymph nodes in 8 cases and in parenchyme in 2 cases. 23) The pathologic diagnosis was commonly performed by transbrochial lung biopsy (TBLB, 47.3%), skin and mediastinal lymph nodes biopsy (34.5%), peripheral lymph nodes biopsy (23.6%), open lung biopsy (18.2%) and bronchial biopsy in order. 24) The most common findings in pathology were non·caseating granuloma (100%), multi-nucleated giant cell (47.3%), hyalinized acellular scar (34.5%), reticulin fibrin network (20%), inclusion body (10.9%), necrosis (9.1%), and lymphangitic distribution of granuloma (1.8%) in order. Conclusion: Clinical, laboratory, radiologic and pathologic findings were summarized. This collected data will assist in finding a test for detection and staging of sarcoidosis in Korea in near future.

• Journal of Korean Society of Forest Science
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• v.34 no.1
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• pp.31-46
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• 1977

The study was made to give some helpful information for policy-making on ornamental tree cultivation by doing a survey on general situations, management analysis, and future prospects of the ornamental tree growing. The study was carried out through literature studies related to the subject, questionaire surveys, and on-the-spot investigation. The questionaire surveys could be divided into two parts: pre-questionaire survey and main-questionaire survey. In the pre-questionaire survey, the researchers intended to identify the total number of ornamental tree growers, cultivation areas in size and their locations. The questionaires were sent to each town and county administration authorities, forest cooperatives, and related organizations through-out the nation. The main-questionaires were prepared for detailed study and the questionaires were sent to 200 tree growers selected by option by taking considerations of the number of tree growers and the size of cultivating areas in regions. The main findings and some information obtained in the survey were as follows: 1. The total land for ornamental tree growing was amounted to 1,873.02 hectares and the number of cultivators was totaled to 2,717. 2. The main occupations of the ornamental tree growers were found in horticulture (41.9%), agronomy (25.9%), officialdom (11.3%), animal husbandry (6.5%), business circle(4.8%), and forestry (3.2%) in sequence. 3. The ornamental trees were cultivated mostly upperland (54.8), forest land (19.4%), rice paddy (11.3%) and others. 4. The educational training of the tree growers seemed quite high. The results of the survey indicated that a large number of tree growers was occupied by college graduates (38.7%), and then high school graduates (34.7%), middle school graduates (12.9%) in order. 5. The tree farming was undertaken as a side-job (41.9%) rather than main-job (23.4%), but a few of respondents rated as subsidiary-job (18.6%). 6. The management status classified by the rate of hired labors used was likely to belong to three categories: independant enterprise management (41.9%); half independant management (31.5%); and self-management (32.4%). 7. The majority of the tree growers sold their products to the consumers through middle-man channel (48.4%), or directly to the house-holder and detailers (13.7%), but a few of the respondents answered that they disposed of their products by bidding (11.2%) or by direct selling to the contractors (4.8%). 8. The channel cf marketing seemed somewhat complicated. The results of the survey were as: (1) producers ${\rightarrow}$consumers (22.6%) (2) producers ${\rightarrow}$field middle-men${\rightarrow}$consumers (33.1%) (3) producers ${\rightarrow}$field middle-men${\rightarrow}$first stage brokers${\rightarrow}$consumers (15.3%) (4) producers ${\rightarrow}$field middle-men${\rightarrow}$second stage middle-men${\rightarrow}$brokers${\rightarrow}$consumers (5.7%) (5) producers${\rightarrow}$field middle-men${\rightarrow}$third stage middle-men${\rightarrow}$second stage middlemen${\rightarrow}$brokers${\rightarrow}$consumers (4.8%) 9. It was responded that the margin for each stage of middle-men or brokers was assumed to be 30-50%(33.1%), 20-30%(32.3%), 50-100%(9.7%), and 100-200%(2.4%) in sequence. 10. The difference between the delivery price of consumers and field selling price of the producers seemed quite large. Majority of producers responded that they received half a price compared to the consumer's prices. 11. About two thirds of the respondents opposed to the measure of "Law on Preservation and Utilization of Agricultural Land" in which says that all the ornamental trees grown on flat agricultural lands less than 8 degrees in slope must be transplanted within three years to other places more than 8 degrees in slope. 12. The tree growers said that they have paid rather high land taxes than they ought to pay (38.7%), but come responded that land tax seemed to be appropriate (15.3%), and half of the respondents answered "not known". 13. The measures for the standardization of ornamental trees by size were backed up by a large number of respondents (57.3%), but one third of the respondents showed negative answer (29.8%). 14. About half of the respondents favored the systematic marketing through organization such as forest cooperatives (54%), but quite a few respondents opposed to organizing the systematic marketing channel (36.3%). 15. The necessary measures for permission in ornamental tree cultivation was rejected by a large number of respondents (49.2%) than those of favored (43.6%).