• Tuberculosis and Respiratory Diseases
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• v.53 no.5
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• pp.542-549
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• 2002

Purpose : The purpose of our study was to assess the usefulness of the Tl-201 SPECT for the detection of the postoperative tumor recurrence on chest wall. Methods: 28 patients including 14 with suspected recurrence of tumor in the chest wall on postoperative chest cr scan, 10 with postoperative pleural effusion which proved benign on radiologic, cytologic and laboratory findings, and 4 with chronic tuberculous empyema as control group were included. All patients underwent SPECT 30 minutes and 4 hours after intravenous injection of 111MBq of Tl-201. Tumor uptake was visually graded by two interpreters and scored as follows : no uptake:0, similar to contralateral lung: 1, higher than contralateral lung but less than heart:2 and similar to heart:3. Results : Markedly increased (grade 3 or 2) Tl-201 uptake was noted in patients with suspected recurrence of tumor in the chest wall (13/14) whereas no (8/10) or minimal (2/10) uptake along the collapsed lung in patients with postoperative benign pleural effusion. In two patients, Tl-201 SPECT revealed additional recurrent tumor mass lesions that were barely perceptible on chest cr scan. Patients with chronic tuberculous empyema showed relatively smoothly marginated increased uptake along the chest wall 4/4), but lesser in degree (grade 1 or 2), when compared to recurrent tumor uptake. Conclusion : Tl-201 lung SPECT seems to be useful to detect postoperative tumor recurrence on chest wall and to differentiate malignant from benign pleural effusion and may provide additional information to the morphologic data obtained by CT.

• Tuberculosis and Respiratory Diseases
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• v.66 no.1
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• pp.13-19
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• 2009

Background: The interferon-gamma assay is reported to have high sensitivity and specificity for making the diagnosis of latent tuberculosis infection. The clinical usefulness of this essay for detecting active tuberculosis has not fully defined. We evaluated the diagnostic value of the commercial interferon-gamma assay kit (QuantiFERONTB GOLD) for patients with suspected tuberculosis. Methods: From January to August 2007, we recruited 52 patients with suspected tuberculosis infection. We performed chest X-ray, sputum smear, culture, PCR and the QuantiFERON-TB GOLD test. Pleural fluid analysis and pleural biopsy were also done for the patients with pleural effusion. Results: Of the 52 patients we studied, 30 patients had a positive QuantiFERON-TB GOLD test result. 35 patients were finally diagnosed with active tuberculosis: twenty-five with a positive QuantiFERON-TB GOLD test and 10 with a negative QuantiFERON-TB GOLD test. The sensitivity of the QuantiFERON-TB GOLD test was 71.4% and the specificity was 64.7%. The positive predictive value was 0.83 and the negative predictive value was 0.50. There was no significant difference of any of the clinical and laboratory characteristics between the two groups of patients except the C-reactive protein (CRP) level. The CRP level was 29.2${\pm}$27.3 mg/dL in the pulmonary tuberculosis patients with a positive QuantiFERON-TB GOLD test and 72.9${\pm}$67.9 mg/dL in the patients with a negative QuantiFERON-TB GOLD test (p<0.05). Conclusion: The sensitivity and specificity of the QuantiFERON-TB GOLD test were inadequate for making the diagnosis of active tuberculosis. We suggest that the QuantiFERON-TB GOLD test should not be used by itself to exclude the diagnosis of active tuberculosis. The relationship of the QuantiFERON-TB GOLD test and the CRP level in patients with TB would be further investigated.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.534-538
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• 2005

Purpose : Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology. Many complications other than cardiovascular involvement have been recognized in KD. However, there have been few reports published concerning involvement of the lungs in this disease. The purpose of this study was to examine the relationship between serum TNF-${\alpha}$, the degree of coronary artery dilatation and chest X-ray(CXR) findings. In addition, we have investigated serum anti-Mycoplasma antibody(AMA) titers in patients with KD who have abnormal CXR findings. Methods : Eighty four patients with KD were included in this study(group I; 41 patients with normal CXR fndings, group II; 43 patients with abnormal CXR findings). Serum levels of TNF-${\alpha}$ and AMA titer were measured. Results : We reviewed the CXR findings and clinical courses of 84 patients with Kawasaki disease and found abnormal CXR findings in 43 patients(51.2 percent). Peribronchial cuffing was the most frequent abnormality(22.4 percent). In the group with abnormal CXR findings(group II), a statistical difference was not noted in age, sex, duration of fever, hemoglobin, WBC, platelet, ESR, and CRP levels and incidence of coronary arterial lesions as compared with the group having normal CXR findings(group I). No difference was noted in serum TNF-${\alpha}$ level between group I and group II. 2 patients(12.5 percent) of 16 KD patients with abnormal CXR findings have positive AMA titer(above 1 : 320). Conclusion : Most of the abnormal CXR findings in KD patients were peribronchial cuffing. The abnormal CXR findings in KD patients did not mean severe inflammations. It is difficult to consider that CXR abnormalities are related to coronary arterial lesions. In addition, further study on the relationship between Mycoplasma infection and Kawasaki disease is needed.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.969-975
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• 2005

Purpose : We performed a study of clinical findings of Mycoplasma Pneumonia in children, to know differences between recent clinical manifestations of Mycoplasma pneumonia and previous studies. Methods : The subjects of this study were 393 children who were diagnosed as Mycoplasma pneumonia with high titers of Mycoplasma antibody(${\geq}1$ : 160) or fourfold rises of Mycoplasma antibody at Chung Ang University Hospital from January 1998 to December 2003. We practiced a retrospective study on the clinical manifestations of Mycoplasma pneumonia based on their medical records. Results : Male to female ratio was 1.06 to 1 and mean age was $4.32{\pm}2.94years$. The highest incidence was in the age of 2 to 3 years(18.6 percent). Most frequent months were October, and November in 2000, April in 2002, and October and, December in 2003. Twenty six point seven percent showed allergic diseases. Second degree relatives of 10.7 percent patients had allergic diseases. Forty three point three percent were admitted before this admission for pneumonia. Allergic tests were positive in 65.7 percent. Cough, and sputum were the most common symptoms and abdominal pain, and vomiting were the most frequent extrapulmonary symptoms. Atelectasis and pleural effusion were seen in 2.5 percent and 1.8 percent. Infiltrations were more common on the right side. Titers of each simultaneous test for cold agglutinin and mycoplasma antibody were not in proportion to each other (P=0.163). Conclusion : The onset age of mycoplasma pneumonia was found to be lower than it used to be. More patients had a past medical history or a family history of allergic disease, and more wheezing was heard and associated with recurrent pneumonia.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.432-440
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• 2000

Background : The prevalence of pulmonary tuberculosis among the elderly is increasing in Korea and in the developed countries due to the increased elderly population and their predispositions to chronic disease, poverty and decreased immunity. To define the characteristics of pulmonary tuberculosis in the elderly, we evaluated the clinical spectrum of pulmonary tuberculosis. Method : We analyzed 92 patients retrospectively that were diagnosed as active pulmonary tuberculosis over the age of 65. The analysis involved patient's profiles, clinical manifestations, coexisting diseases, diagnostic methods, anti-TB medications and their side effects, and treatment outcomes. Results : The results were as follows : - 1) The ratio of male to female was 2.1:1(62:30 cases) 2) Chief complaints were a cough (47.8%), dyspnea (40.2%), sputum (38.0%), chest pain (12.0%), anorexia (10.9%), and fever (9.8%). 3) 38 (41.3%) of cases had a past history of pulmonary tuberculosis. 4) The coexisting diseases were : -COPD, 25 cases (27.2%); pneumonia, 17 cases (18.5%); DM. 13 cases (14.1%); and malignancy, 10 cases (10.9%). 5) The positivity of Mantoux test (5 TU, PPD-S) was 82.7%. 6) Pulmonary tuberculosis was diagnosed using the following methods : sputum AFB (Acid Fast Bacillus) smear 42.4%, sputum TB (M. Tuberculosis) culture 15.2%, sputum TB PCR (Polymerase Chain Reaction) 10.9%, bronchial washing AFB smear 2.1%, chest radiology only 25.0%. 7) Locations of radiologic lesions were RULF, 50 cases; RLLF, 50 cases, mostly, then LLLF ; 26 cases were leastly involved. 8) The coexisting tuberculosis were endobronchial TB(8.7%), TB pleurisy(7.6%) miliary TB(5.4%), intestinal TB(2.2%), renal TB(1.1%) 9) The proportion of treatment regimen with 1st line drug and 2nd line drug were 92.3% and 7.6%, respectively. 10) The outcome of treatment were as follows : cured 31.5%, expired 13.0%, no return 47.8%, follow-up now 7.6%. Conclusion : The pulmonary tuberculosis in the elderly has atypical patterns with chronic coexisting diseases. Therefore, the possibility of pulmonary tuberculosis should be considered in elderly patients with pulmonary symptoms.

• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.101-111
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• 2004

Purpose : This study was performed to observe the epidemiological pattern of M. pneumoniae pneumonia during the period from 1993 to 2002 and also to see some clinical characteristics of M. pneumoniae pneumonia during recent five years. Methods : We had performed a retrospective analysis of epidemiological pattern of occurrence in 682 patients with M. pneumoniae pneumonia admitted to Department of Pediatrics of Han-il General Hospital from January, 1993 to December, 2002. Results : The annual ratio of M. pneumoniae pneumonia was compared with the total numbers of respiratory tract infection patients. The ratios were 19.1% in 1993, 13.0% in 1994, 5.6% in 1995, 12.8% in 1996, 18.6% in 1997, 22.6% in 1998, 1.1% in 1999, 13.3% in 2000, 9.1% in 2001, 6.0% in 2002, and 19.9% in 2003. The epidemics have occurred in 1993, 1997, 1998, 2000, and 2003 years showing 3~4 year intervals. The peak incidence of age was four to six years old(286 cases; 41.9%) and male-to-female ratio was 1 : 1.1. Monthly distribution showed a high frequency from August to December and the major outbreak occurred in November(119 cases; 17.4%), in October(106 cases; 15.5%), and in December(96 cases; 14.1%) in order of frequency. The most common symptoms were cough (660 cases; 96.8%), fever(569 cases; 83.4%), and sputum(522 cases; 76.5%) in that order. Leukocytosis was observed in 31.2% of patients based on a normal range according to the adjusted age. Increased ESR(${\geq}20mm/hr$) was noted in 42.5% of cases and CRP was positive in 37.8% of cases. On the chest X-ray examination, pulmonary infiltration was noted in 557 cases(81.7%), and the patterns of pneumonic infiltration were bronchopneumonia(78.0%), lobar(35.5%), lobular(19.2%), and interstitial pneumonia(28.7%). Complications were paranasal sinusitis(41 cases), acute otitis media(23 cases), pleural effusion(19 cases). cervical lymphadenitis(18 cases), and glomerulonephritis(1 case). Conclusion : The pattern of M. pneumoniae pneumonia from 1997 to 2003 noted 3~4 year interval with peak monthly distribution of October and November compared with 3 year interval and peak incidence of summer period before 1996.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.559-565
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• 2003

By improving the flow pattern in Fontan circuit, total cavopulmonary connection (TCPC) could result in a better outcome than atriopulmonary connection Fontan operation. For the patients with impaired hemodynamics after atriopulmonary Fontan connection, conversion to TCPC can be expected to bring hemodynamic and functional improvement. We studied the results of the revision of the previous Fontan connection to TCPC in patients with failed Fontan circulation. Material and method: From October1979 to June 2002, eight patients who had failed Fontan circulation, underwent revision of previous Fontan operation to TCPC at Yonsei University Hospital. Intracardiac anomalies of the patients were tricuspid atresia (n=4) and other functional single ventricles (n=4). Mean age at TCPC conversion was 14.0$\pm$7.0 years (range, 4.6~26.2 years) and median interval between initial Fontan operation and TCPC was 7.5 years (range, 2.4~14.3 years). All patients had various degree of symptoms and signs of right heart failure. NYHA functional class was 111 or IV in six patients. Paroxysmal atrial fibrillation (n:f), cyanosis (n=2), intraatrial thrombi (n=2), and protein losing enteropathy (PLE) (n=3) were also combined. The previous Fontan operation was revised to extracardiac conduit placement (n=7) and intraatrial lateral tunnel (n=1). Result: There was no operative death. Major morbidities included deep sternal infection (n=1), prolonged pleural effusion over two weeks (n=1), and temporary junctional lachyarrhythrnia (n=1). Postoperative central venous Pressure was lower than the preoperative value (17.9$\pm$3.5 vs. 14.9$\pm$1.0, p=0.049). Follow-up was complete in all patients and extended to 50,1 months (mean, 30.3$\pm$ 12.8 months). There was no late death. All patients were in NYHA class 1 or 11. Paroxysmal supraventricular tachycardia developed in a patient who underwent conversion to intraatrial lateral tunnel procedure, PLE was recurred in two patients among three patients who had had PLE before the convertsion. There was no newly developed PLE. Conclusion: Hemodynamic and functional improvement could be expected for the patients with Fontan circulatory failure after atriopulmonary connection by revision of their previous circulation to TCPC. The conversion could be performed with low risk of morbidity and mortality.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.281-288
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• 2006

Background: Extracardiac pericardial-flap lateral tunnel Fontan operation has theoretical advantage of growth potentiality of the extracardiac tunnels. The mid-term results of this technique and morphologic change of the lateral tunnel were studied. Material and Method: Clinical data was reviewed in 42 patients who underwent extracardiac pericardial-flap lateral tunnel Fontan operation between November 1993 and December 2004. The age was $2.8{\pm}1.5$ years and the body weight was $12.3{\pm}3.2$ kg. Extracardiac tunnel was constructed using the pedicled pericardium with the base undetached. By reviewing the follow-up cardiac angiograms, the diameter and the cross-sectional area of the lateral tunnel was compared to those of inferior vena cava. Result: There were four operative mortality cases (9.8%) and the causes of death were low cardiac output for all four cases. Postoperatively, five patients had prolonged pleural effusion longer than two weeks and one patient required a permanent pacemaker due to complete heart block. Follow-up was possible in 37 patients and the follow up duration was $3.8{\pm}2.2$ years. During that period, one patient died, of upper gastrointestional bleeding combined with heart failure and one patient died a sudden death of unknown cause. Two patients required reoperation due to subaortic stenosis and anastomosis site stenosis between inferior vena cava and lateral tunnel. In one patient, bradyarrhythmia was anew but there was no thromboembolic complication. The lateral tunnel showed growth in proportion to the size of the inferior vena cava. Conclusion: Extracardiac pericardial-flap lateral tunnel Fontan operation is relatively simple and safe. The mid-term result was favorable and the extracardiac tunnel showed potential for growth.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.194-203
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• 1999

Purpose: Childhood pancreatitis has more various and somewhat different etiology than adult. Until now the analysis of severity in childhood pancreatitis were not well-known, although several studies have been made. Therefore, we studied the etiology and complications in childhood pancreatitis and analyzed whether Ranson and CT criteria could be applicated to evaluate the severity of childhood pancreatitis patients. Methods: The records of 30 patients with pancreatitis under 15 years of ages who were diagnosed in Asan medical center were reviewed. Age, sex, history, etiology, clinical features and treatment was reviewed in all patients but complications, Ranson and CT criteria were available in only 12 patients. Correlation between the number of complications and both Ranson and CT criteria were calculated with Spearman correlation coefficient. Results: 1. Median age at diagnosis was 7.3 years of age. 28 cases were acute pancreatitis and 2 cases were chronic pancreatitis. 2. Etiology: choledochal cyst(8 cases), drug (7 cases), trauma (4 cases), infection (3 cases), biliary stone or bile sludge (3 cases), idiopathic (2 cases) Hemolytic uremic syndrome, pancreatic duct obstruction, iatrogenic (1 case). 3. Local complications were ascites (5 cases), pseudocyts (4 cases) and systemic complications were hyperglycemia (4 cases), hypocalcemia (3 cases), pleural effusion (3 cases), etc. 4. Positive correlation was found between the number of complication and Ranson creteria (r=0.78, P=0.0016) and between the number of complication and CT criteria (r=0.65, P=0.015) in 13 cases. Conclusion: A trial to search the biliary duct anomaly may help to find the causes of childhood idiopathic pancreatitis, and both Ranson and CT criteria can be applicated to pediatric patients to evaluate the severity of childhood pancreatitis.

• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.37-45
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• 2024

Purpose: This study aimed to examine the clinical features and determinants of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMP) and to assess the differences in the time to fever resolution between doxycycline (DXC), tosufloxacin (TFX) and corticosteroid (CST) as second-line treatment. Methods: We retrospectively analyzed the medical records of patients under the age of 18 who were admitted to Nowon Eulji University Hospital between July 2018 and February 2020, diagnosed with mycoplasma pneumonia. Macrolide resistance was confirmed by detecting point mutations in the 23S rRNA gene. MUMP was clinically defined by persistent fever (≥38.0℃) lasting for 72 hours or more after the initiation of macrolide treatment. In cases of MUMP, patients were treated with an addition of CST, or the initial macrolide was replaced either DXC or TFX. Results: Out of 157 cases of mycoplasma pneumonia, 83 cases (52.9%) did not respond to macrolides. Patients with MUMP exhibited significantly higher C-reactive protein (CRP) levels (3.2±3.0 vs. 2.4±2.2 mg/dL, P=0.047), more frequent lobar/segmental infiltrations or pleural effusions (56.6% vs. 27.0%, P<0.001; 6.0% vs. 0.0%, P=0.032), and a higher prevalence of 23S rRNA gene mutations (96.4% vs. 64.6%, P<0.001) when compared to those with macrolide-susceptible M. pneumoniae pneumonia. In terms of second-line treatment, 15 patients (18.1%) responded to CST, 30 (36.1%) to DXC, and 38 (45.8%) to TFX. The time to defervescence (TTD) after initiation second-line treatment was significantly shorter in the CST group compared to the DXC (10.3±12.7 vs. 19.4±17.2 hours, P=0.003) and TFX groups (10.3±12.7 vs. 25.0±20.1 hours, P=0.043), with no significant difference observed between the DXC and TFX groups (19.4±17.2 vs. 25.0±20.1 hours, P=0.262). Conclusions: High CRP levels, the presence of positive 23S rRNA gene mutation, lobar or segmental lung infiltration, and pleural effusion observed in chest X-ray findings were significant factors associated with macrolide unresponsiveness. In this study, CST demonstrated a shorter TTD compared to DXC or TFX. Further, larger-scale prospective studies are needed to determine the optimal second-line treatment for MUMP.