• Title/Summary/Keyword: 중심

Search Result 77,830, Processing Time 0.097 seconds

Dietary Habits and Foodservice Attitudes of Students Attending American International Schools in Seoul and Gyeonggi Area (서울.경기지역 외국인 학교 학생들의 식습관 및 급식만족도 -미국계 외국인 학교를 중심으로-)

  • Kim, Ok-Sun;Lee, Young-Eun
    • Journal of the East Asian Society of Dietary Life
    • /
    • v.22 no.6
    • /
    • pp.744-757
    • /
    • 2012
  • This study was designed to obtain basic data for the globalization of Korean food and the expansion of food exports through contract foodservices. A survey of dietary habits and attitudes toward school foodservices was given to students in three American international schools served by a domestic contract foodservice management company located in Seoul and Gyeonggi area. The results showed an average of three meals taken daily 3.39 times for male students and 2.95 times for female students and the time required for a meal was about 24~26 minutes. The average breakfast frequency was 5.10 times(4.59 times for male students and 5.35 times for female students) and many students reported skipping breakfast due to a lack of time. The average weekly frequency of dining out was 1.78 times(2.15 times for male students and 1.60 times for female students). In all schools, irrespective of gender and grade, students responded that a desire for snacking was 'why they want to have cookies', and snacking hours were frequently listed as 'between noon and evening'. Many also responded that an unbalanced diet is the reason some snacks are 'not to their taste'. Overall, students were highly satisfied with the foodservice menu, although there was a significant difference in what was considered proper food temperature, proper food seasoning, suitable amounts of food, and freshness of food. Male and female students were specifically highly satisfied with the 'freshness of food materials' and 'variety of menu' respectively. Overall, all students were highly satisfied with the foodservice, including the 'cleanliness of tables and trays'.

Two Anhydrous Zeolite X Crystal Structures, $Ca_{18}Tl_{56}Si_{100}Al_{92}O_{384}\;and\;Ca_{32}Tl_{28}Si_{100}Al_{92}O_{384}$ (제올라이트 X의 두 개의 무수물 $Ca_{18}Tl_{56}Si_{100}Al_{92}O_{384}$$Ca_{32}Tl_{28}Si_{100}Al_{92}O_{384}$의 결정구조)

  • Choi, Eun Young;Kim, Yang
    • Journal of the Korean Chemical Society
    • /
    • v.43 no.4
    • /
    • pp.384-385
    • /
    • 1999
  • Two anhydrous crystal structures of fully dehydrated, $Ca^{2+}$- and $Tl^+$-exchanged zeolite X, TEX>$Ca_{18}Tl_{56}Si_{100}Al_{92}O_{384}($Ca_{18}Tl_{56}$-X;\alpha=24.883(4)\AA)$ and TEX>$Ca_{32}Tl_{28}Si_{100}Al_{92}O_{384}($Ca_{32}Tl_{28}$-X;\alpha=24.973(4)\AA)$ per unit cell, have been determined by single-crystal X-ray diffraction techniques in the cubic space group Fd3 at $21(1)^{\circ}C.$ $Ca_{18}Tl_{56}-X$ was prepared by ion exchange in a flowing stream of 0.045 M aqueous $Ca(NO_3)_2$ and 0.005 M $TlNO_3$. $Ca_{32}Tl_{28}-X$ was prepared similarly using a mixed solution of 0.0495 M $Ca(NO_3)_2$ and 0.0005M $TlNO_3$. Each crystal was then dehydrated at 360 $^{\circ}C$ and $2{\times}10^{-6}$ Torr for 2 days. Their structures were refined to the final error indices, $R_1=0.039\;and\;R_2=0.036$ with 382 reflections for $Ca_{18}Tl_{56}-X$ , and $R_1=0.046\;and\;R_2=0.045$ with 472 reflections for $Ca_{32}Tl_{28}$-X for which $/>3\sigma(I).$ In the structures of dehydrated $Ca_{18}Tl_{56^-}X\;and\;Ca_{32}Tl_{28}$-X, $Ca^{2+}\;and\;Tl^+$ ions are located at six crystallographic sites. Sixteen $Ca^{2+}$ ions fill the octahedral sites I at the centers of double six rings ($Ca_{18}Tl_{56}$-X:Ca-O=2.42(1) and O-Ca-O=93.06(4)$^{\circ}$; $Ca_{32}Tl_{28}$-X Ca-O=2.40(1) $\AA$ and O-Ca-O=93.08(3)$^{\circ}$). In the structure of $Ca_{18}Tl_{56}$-X, another two $Ca^{2+}$ ions occupy site II (Ca-O=2.35(2) $\AA$ and O-Ca-O=111.69(2)$^{\circ}$) and twenty six $Tl^+$ ions occupy site II opposite single six-rings in the supercage; each is 1.493 $\AA$ from the plane of three oxygens $(Tl-O=2.70(8)\AA$ and O-Tl-O=92.33(4)$^{\circ}$). About four $Tl^+$ ions are found at site II',1.695 $\AA$ into sodalite cavity from their three oxygen plane (Tl-O=2.81 (1) and O-Tl-O=87.48(3)). The remaining twenty six $Tl^+$ ions are distributed over site III'(Tl-O=2.82 (1) $\AA$ and Tl-O=2.88(3)$^{\circ}$). In the structure of $Ca_{32}Tl_{28}$-X, sixteen $Ca^{2+}$ ions and fifteen $Tl^+$ ions occupy site III' (Ca-O=2.26(1) $\AA$ and O-Ca-O=119.14(4)$^{\circ}$; Tl-O=2.70(1) $\AA$ and O-Tl-O=92.38$^{\circ}$) and one $Tl^+$ ion occupies site II'. The remaining twelve $Tl^+$ ions are distributed over site III'. It appears that $Ca^{2+}$ ions prefer sites I and II in that order and $Tl^+$ ions occupy the remaining sites.

  • PDF

Characteristics and Distribution Pattern of Carbonate Rock Resources in Kangwon Area: The Gabsan Formation around the Mt. Gachang Area, Chungbuk, Korea (강원 지역에 분포하는 석회석 자원의 특성과 부존환경: 충북 가창산 지역의 갑산층을 중심으로)

  • Park, Soo-In;Lee, Hee-Kwon;Lee, Sang-Hun
    • Journal of the Korean earth science society
    • /
    • v.21 no.4
    • /
    • pp.437-448
    • /
    • 2000
  • The Middle Carboniferous Gabsan Formation is distributed in the Cheongrim area of southern Yeongwol and the Mt. Gachang area of Chungbuk Province. This study was carried out to investigate the lithological characters and geochemical composition of the limestones and to find out controlling structures of the limestones of the formation. The limestones of the Gabsan Formation are characterized by the light gray to light brown in color and fine and dense textures. The limestone grains are composed of crinoid fragments, small foraminfers, fusulinids, gastropods, ostracods, etc. Due to the recrystallization, some limestones consist of fine crystalline calcites. The chemical analysis of limestones of the formation was conducted to find out the contents of CaO, MgO, Al$_2$O$_3$, Fe$_2$O$_3$ and SiO$_2$. The content of CaO ranges from 49.78-60.63% and the content of MgO ranges from 0.74 to 4.63% The contents of Al$_2$O$_3$ and Fe$_2$O$_3$ are 0.02-0.55% and 0.02${\sim}$0.84% , respectively. The content of SiO$_2$ varies from 1.55 to 4.80%, but some samples contain more than 6.0%. The limestones of the formation can be grouped into two according to the CaO content: One is a group of which CaO content ranges from 49.78 to 56.26% and the other is a group of which CaO content varies from 59.36 to 60.38%. In the first group, the contents of Al$_2$O$_3$, Fe$_2$O$_3$ and SiO$_2$ range very irregularly according to the CaO content. In the second group, the values of MgO, Al$_2$O$_3$, Fe$_2$O$_3$ and SiO$_2$ are nearly same. Detailed structural analysis of mesoscopic structures and microstructures indicates the five phase of deformation in the study area. The first phase of deformation(D$_1$) is characterized by regional scale isoclinal folds, and bedding parallel S$_1$ axial plane foliation which is locally developed in the mudstone and sandstone. Based on the observations of microstructures, S$_1$ foliations appear to be developed by grain preferred orientation accompanying pressure-solution. During second phase of deformation, outcrop scale E-W trending folds with associated foliations and lineations are developed. Microstructural observations indicate that crenulation foliations were formed by pressure-solution, grain boundary sliding and grain rotation. NNW and SSE trending outcrop scale folds, axial plane foliations, crenulation foliations, crenulation lineations, intersection lineations are developed during the third phase of deformation. On the microscale F$_3$ fold, axial plane foliations which are formed by pressure solution are well developed. Fourth phase of deformation is characterized by map scale NNW trending folds. The pre-existing planar and linear structures are reoriented by F$_4$ folds. Fifth phase of deformation developed joints and faults. The distribution pattern of the limestones is mostly controlled by F$_1$ and F$_4$ folds.

  • PDF

The Jurisdictional Precedent Analysis of Medical Dispute in Dental Field (치과임상영역에서 발생된 의료분쟁의 판례분석)

  • Kwon, Byung-Ki;Ahn, Hyoung-Joon;Kang, Jin-Kyu;Kim, Chong-Youl;Choi, Jong-Hoon
    • Journal of Oral Medicine and Pain
    • /
    • v.31 no.4
    • /
    • pp.283-296
    • /
    • 2006
  • Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.

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
    • /
    • v.47 no.4
    • /
    • pp.365-375
    • /
    • 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.

Protective Effects of Chemical Drugs on the Course of Uranium-induced Acute Renal Failure (우라늄오염에 의한 신부전증에 미치는 제염제의 방호효과)

  • Kim, Tae-Hwan;Chung, In-Yong;Kim, Sung-Ho;Kim, Kyeng-Jung;Bang, Hyo-Chang;Yoo, Seong-Yul;Chin, Soo-Yil
    • Journal of Radiation Protection and Research
    • /
    • v.15 no.2
    • /
    • pp.27-39
    • /
    • 1990
  • Appreciable radiation exposures certainly were occurred in the reactor burn-up, the nuelear fall-out and the surroundings of nuclear installations with radioactive effluents. Therefore, radioactive nuclides is not only potentially hazardous to workers of nuclear power plants and related industrials, but also the wokers who handle radioactive nuclides in biochemical research and nuclear medicine diagnostics. And in the case of occurring the nuclear accidents, the early medical treatment of radiation injury should be necessary but little is established medical procedures to decontaminate the victims of internal contamination of radioactive nuclides in korea. Accordingly, to achieve the basic data for protective roles and medical treatment of radiation injury, the present studies were carrid out to evaluate the decontamination of uranium by the chemical drugs. The results observed were summarized as follows: 1. The combined treatmet group of sodium bicarbonate and saline with uranyl nitrate injection simultaneously and the dithiothreitol group that was administered 30 minutes after uranyl nitrate injection were increased significantly in the change of body weight than uranyl nitrate-only group (P<0.005). 2. All the experimental groups were increased the fluid intake and urine volume on the uranyl nitrate-induced acute renal failure. but the combined treatment group of sodium bicarbonate and saline with uranyl nitrate injection simultaneously and the dithiothreitol group that was administered 30 minutes after uranyl nitrate injection have the higher increment of fluid intake and urine volume (P<0.05). 3. When sodium bicarbonate and saline was treated with uranyl nitrate injection simultaneously. and dithiothreitol was administered 30 minutes after uranyl nitrate injection. there was significantly reduced in BUN concentration (P<0.01). 4. When dithiothreitol was administered 30 minutes after uranyl nitrate injection. there was reduced more significantly on the increment of serum creatinine concentration than that observed in uranyl nitrate-only group(P<0.01). but when the combined treatment of sodium bicarbonate and saline with uranyl nitrate simultaneously, there was still. albeit much less marked. decrease in serum creatinine concentration. 5. The sodium bicarbonate and saline was treated with uranyl nitrate simultaneously and dithiothreitol was administered at 30 minutes after uranyl nitrate were excreted markedly higher urine creatinine concentration than the uranyl nitrate-only group. 6. Uranyl nitrate has been used in experimental animals to produce hydropic degeneration and swelling of proximal tubules, disappearance of microvilli and brush border or necrosis in the kidney and centrilobular necrosis, congestion, and telangiectasia of the liver. When the sodium bicarbonate and saline was treated with uranyl nitrate simultaneously, and dithiothreitol was administered. 30 minutes after uranyl nitrate, there was more marked the protective effect than uranyl nitrate-only group. Finally, if the sodium bicarbonate and saline may administered as quickly as possible each time that some risk for internal contamination, with uranium, and dithiothreitol is administered 30 minutes after uranium contamination, there ameliorates the course of uranyl nitrate-induced acute renal failure.and this effect is assocciated with prevention of uranium (heavy metal)-induced alterations in BUN, serum creatinine, urine creatinine, fluid intake, urine volume and body weight.

  • PDF

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
    • /
    • v.23 no.2
    • /
    • pp.67-92
    • /
    • 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.

  • PDF

An Appreciation of Functional Role of Macrophage in the Acute Lung Injury in the Neutropenic Rat. (호중구 감소증을 보이는 백서의 급성폐손상에서 대식세포의 기능적 역할)

  • Kim, Yong-Hoon;Ki, Sin-Young;Im, Keon-Il;Moon, Seung-Hyug;Cheong, Seung-Whan;Kim, Hyeon-Tae;Uh, Soo-Taek;Park, Choon-Sik;Jin, Byung-Won
    • Tuberculosis and Respiratory Diseases
    • /
    • v.44 no.2
    • /
    • pp.379-390
    • /
    • 1997
  • Background : It has long been suggested that neutrophils and their products are implicated as the central mediators of the acute lung injuries. Contrary to the dominant role of neutrophils in ARDS, many cases of ARDS has occurred in the setting of severe neutropenia without pulmonary neutrophil infiltration. Therefore it is certain that effector cell(s) other than neutrophil play an important role in the pathogenesis of ARDS. This experiment was performed to define the mechanism of ARDS in the setting of neutropenia, 1) by comparing the severity of endotoxin-induced lung injury, 2) by measurement of hydrogen peroxide production and cytokine concentration in the bronchoalveolar lavage cells and fluids obtained from different rats with and without cyclophosphamide-pretreatment. Method : The male Sprague-Dawleys were divided into the normal control (NC)-, endotoxin (ETX)-, and cyclophosphamide (CPA)-group in which neutropenia was induced by injecting cyclophosphamide intraperitoneally. Acute lung injury was evoked by injecting lipopolysaccharide (LPS) into a tail vein. The bronchoalveolar lavage (BAL) was performed at 3 and 6 hour after administration of LPS to measure the change of cell counts and concentrations of protein and cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). Hydrogen peroxide (HPO) production from BAL cells was measured at 6 hour after LPS administration by phenol red microassay with and without zymosan stimulation. Results : The results were as follows. A change of leukocyte counts in the peripheral blood after treatment with CPA : More than 95% of total leukocytes and neutrophils were reduced after CPA administration, resulting in severe neutropenia. A change of BAL cells : In the ETX-group, the number of total cells (p < 0.01) and of macrophage and neutrophil (p < 0.05) were increased at 3 and 6 hour after LPS administration compared to those of NC-group. In the CPA-group, the number of total leukocyte and macrophage were not changed after LPS administration, but neutrophil counts were significantly reduced and it took part in less than 0.1% of total BAL cells (p < 0.01 vs NC-group). BAL cells in this group were almost all macrophages (99.7%). A change of protein concentration in the BALF : In the ETX-group, protein concentration was increased at 3 hour and was more increased at 6 hour after LPS administration (p < 0.05 and < 0.01 vs NC-group, respectively). In the CPA-group, it was also significantly elevated at 3 hour after LPS administration (p < 0.05 vs NC-group), but the value was statistically not different from that of ETX-group. The value measured at 6 hour after LPS administration in the CPA-group became lower than that of ETX-group (p < 0.05), but showed still a higher value compared to that of NC-group (p < 0.05). A change of cytokine concentration in the BALF : TNF -alpha and IL-6 were elevated in the ETX - and CPA-group compared to those of NC-group at both time intervals. There was no statistical difference in the values of both cytokines between the ETX- and CPA-groups. Measurement of hydrogen peroxide production from BAL cells : There was no intergroup difference of HPO production from resting cells. HPO production after incubation with opsonized zymosan was significantly elevated in all groups. The percent increment of HPO production was highest in the ETX-group (89.0%, p < 0.0008 vs NC-group), and was 42.85 in the CPA-group (p = 0.003 vs NC-group ). Conclusion : Acute lung injury in the setting of neutropenia might be caused by functional activation of resident alveolar macrophages.

  • PDF

Postoperative Clinical Courses According to the Length of Preoperative Drug Therapy in Pulmonary Tuberculosis (폐결핵 환자의 수술전 항결핵제 투여기간에 따른 수술후 임상경과)

  • Kwon, Eun-Su;Kim, Dae-Yun;Park, Seung-Kyu
    • Tuberculosis and Respiratory Diseases
    • /
    • v.47 no.6
    • /
    • pp.775-785
    • /
    • 1999
  • Background : Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to find out the ideal timing of operation. Method: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by $x^2$-test. Results: Eighty one point two percent were men and 18.8 % women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.l(range, 0 to 9). Patients were treated preoperatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group. Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. Conclusion: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.

  • PDF

Pulmonary Resection in the Treatment of Multidrug-Resistant Tuberculosis (다제 내성 폐결핵환자의 폐절제술에 관한 연구)

  • Kwon, Eun-Soo;Ha, Hyun-Cheol;Hwang, Su-Hee;Lee, Hung-Yol;Park, Seung-Kyu;Song, Sun-Dae
    • Tuberculosis and Respiratory Diseases
    • /
    • v.45 no.6
    • /
    • pp.1143-1153
    • /
    • 1998
  • Background : Recent outbreaks of pulmonary disease due to drug-resistant strains of Mycobacterium Tuberculosis have resulted in significant morbidity and mortality in patients worldwide. We reviewed our experience to evaluate the effects of pulmonary resection on the management of multidrug-resistant tuberculosis. Method : A retrospective review was performed of 41 patients undergoing pulmonary resection for multidrug-resistant tuberculosis between January 1993 and December 1997. We divided these into 3 groups according to the radiologic findings : (1) patients who have reasonably localized lesion (Localized Lesion Group ; LLG) (2) patients who have cavitary lesions after pulmonary resection on chest roentgenogram (Remained Cavity Group : RCG) (3) patients who have Remained infiltrative lesions postoperatively (Remained infiltrative group : RIG). We evaluated the negative conversion rate after resection and overall response rate of the groups. Then they were compared with the results of the chemotherapy on the multi drug-resistant tuberculosis which has been outcome by Goble et al. Goble et al reported that negative conversion rate was 65% and overall response rate, 56% over a mean period of 5.1 months. Results : Seventy five point six percent were men and 24.4% women with a median age of 31 years (range, 16 to 60 years). Although the patients were treated preoperatively with multidrug regimens in an effort to reduce the mycobacterial burden, 22 of 41 were still sputum culture positive at the time of surgery. 20 of 22 patients(90.9%, p<0.01) responded which is defined as negative sputum cultures within 2 months postoperative. Of 26 patients with the sufficient follow up data, 19 have Remained sputum culture negative for a mean duration of 25.7 months (73.1%, p<0.05). The bulk of the disease was manifest in one lung, but lesser amounts of contralateral disease were demonstrated in 15, consisted of 8 in RIG and 7 in RCG, of 41. 12 of 12 patients (100%, p<0.01) who were sputum positive at the time of surgery in LLG converted successfully. 14 of 15 patients (93.3%, p<0.05) with the follow up have completed treatment and not relapsed for a mean period of 25. 7 months. The mean length of postoperative drug therapy of LLG was 12.2 months. In RIG, postoperative negative conversion rate was 83.3% which was not significant statistically. There was a statistical significance in overall response rate (100%, p<0.05) of RIG for a mean period of 24.4 months with a mean length of postoperative chemotherapy, 11.8 months. In RCG a statistically lower overall response rate (14.3%, p<0.01) has been revealed for a mean duration of follow up, 24.2 months. A negative conversion rate of RCG was 75% which was not significant statistically. Conclusion : Surgery plays an important role in the management of patients with multidrug-resistant Mycobacterium tuberculosis infection. Aggressive pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection to avoid treatment failure or relapse. Especially all cavitary lesions on preoperative chest roentgenogram should be resected completely. If all of them could not be resected perfectly, you should not open the thorax.

  • PDF