• Title/Summary/Keyword: Clinical evaluation

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Clinical Evaluation of Surgical Resection of Pulmonary Tuberculosis (폐결핵에 대한 외과적 치험)

  • Park, Seung-Kyu;Shon, Mal-Hyun;Han, Dong-Gi;Ha, Hyun-Chul;Jin, Young-Ho;Song, Sun-Dae
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.474-480
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    • 1995
  • Background: In spite of initial intensive and long-term chemotherapy for pulmonary tuberculosis, many problems remain in the treatment of the residual lesion. The role of surgical intervention for pulmonary tuberculosis is getting rid of such residual lesion of pulmonary tuberculosis to support the healing process and to induce bacteriologically negative conversion in the end. Method: We experienced 30 cases of pulmonary resection for pulmonary tuberculosis from Aug. 1994 through Apr. 1995 in National Masan Tuberculosis Hospital. We conducted retrospective study to analyze several variables for the cases. Results: 1) The ratio between male and female was 4:1(male 24, female 6) and the age of peak incidence was in 3rd and 4th decades. 2) Indications for pulmonary resection in the radiographic findings were cavitary lesions of 19 cases(63.3%), destroyed one side of 8 cases(26.7%) and destroyed one lobe of 3 cases(10%). 3) 16 of 20 cases with unilateral lesions and all of 10 cases with bilateral lesions on chest X-ray films showed AFB positive on preoperative sputum smears. 14 cases(87.5%) of unilateral lesions and 9 cases(90%) of bilateral ones were converted into AFB negative postoperatively. Negative conversion rates of pneumonectomy and lobectomy cases were 100% and 85.7%, respectively. 4) Preoperative combined disease was 3 cases(10%) of DM and postoperative complications were 2 cases(6.7%) of dead space and no death. Conclusion: Chemotherapy only has some limitation in treatment of all tuberculosis. So, surgical intervention for pulmonary tuberculosis is an effective method as partner of chemotherapy.

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The Usefulness in an Automated Kinetic Method in Determining of ADA Activity in Pleural Fluid (자동화학분석기를 이용한 흉막액내 ADA 활성치 측정의 유용성에 관한 연구)

  • Ryu, Jeong-Seon;Yong, Suk-Joong;Song, Kwang-Seon;Shin, Kye-Chul;Lee, Won-Sik;Kang, Shin-Ku;Uh, Young;Yoon, Kap-Jun
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.838-845
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    • 1995
  • The determination of ADA(adenosine deaminase) activity in pleural fluid is useful in differental diagnosis of pleural effusion. The conventional method of determining ADA activity used by Giusti was influenced by contamination of ammonia. Additionally, because Giusti's method was mannual method a determining the ADA activities in sample, was not easily automated. In 1993, Oosthuizen HM with collegues developed simple kinetic method for determining ADA activity. It was reliable and suiable method for automation. In this study, we have measured ADA activity in 162 patients with various pleural effusion by Hitachi 747 autoanalyser using the Oosthuizen kinetic method for the purpuse of determination of new diagnostic cut-off value for the tuberculous effusion and evaluation of the correlation between the conventional method and new automated method. This new method of an enzymatic reaction involves 2, 6-dichlorophenolindophenol dye(DICP), adenosine, xanthine oxidase(XO), and nucleoside phosphorylase(NP). The results were as follows: 1) The mean pleural ADA activity of the tuberculous effusion was $52.53{\pm}16.43\;U/L$ and significantly higher than that of other groups(p<0.001). If the diagnostic cut-off value of pleural ADA activity for tuberculous effusion is above 30 U/L, the sensitivity is 96% and the specificity is 90%. 2) The mean pleural to serum ADA activity ratio of the tuberculous effusion was $2.29{\pm}0.96$ and it was also significantly higher than that of other pleural groups(p<0.001). If the diagnostic cut-off value of pleural to serum ADA activity ratio is 1.5, the sensitivity is 80% and the specificity is 88% in the diagnosis of tuberculous pleural effusion. 3) The new kinetic method is correlates well to Giuisti's conventional method(r=0.971). In conclusion, the new kinetic method described is easily automated and seems to be suitable for the routine determination of ADA activity.

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The Role of Bronchoscopy in Determining the Etiology of Pleural Effusion (흉막유출증의 원인규명에 기관지내시경의 역할)

  • Kim, Chang-Ho;Son, Ji-Woong;Kim, Gwan-Young;Kim, Jeong-Seok;Chae, Sang-Chull;Won, Jun-Hee;Kim, Yeon-Jae;Park, Jae-Yong;Jung, Tae-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.2
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    • pp.397-403
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    • 1998
  • Background: Little information is available concerning the value of bronchoscopy in patients with a lymphocytic exudative pleural effusion in which percutaneous pleural biopsy have been regarded as cornerstone in investigating the etiology. Recently, a few reports suggest that bronchoscopy may be more effective diagnostic method in patients with unexplained pleural effusion accompanied by hemoptysis or other roentgenographic abnormalities, such as mass, infiltrate, atelectasis. Method: Mter initial examinations of sputum and pleural fluid through thoracentesis in 112 patients(male 75 cases, female 37 cases, mean age 53.2 years) who were admitted for evaluation of the cause of pleural effusion, we performed bronchoscopy and closed pleural biology in most patients with undiagnosed lymphocytic exudate and compared the diagnostic yield of both invasive methods according to hemoptysis or other roentgenographic abnormalities, and investigated the sole diagnostic contribution of bronchoscopy. Results: Tuberculosis(57 cases, 51%) was the most common cause of pleural effusion. Percutaneous pleural biopsy showed more diagnostic yield than bronchoscopy regardless of presence or absence of other clinical or radiologic abnormalities. In 25 cases with unknown etiology after pleural biopsy, additional diagnostic yield by bronchoscopy was 36 % (4/11) in patients with associated features and only 7 % (1/14) with lone effusion, and, as the sole mean for diagnsosis in all patients with pleural effusion, was only 4.5%(5/12). Conclusion : In a region of high prevalence of tuberculosis as a cause of pleural effusion, percutaneous pleural biospy is more effective method when invasive method is required for confirmative diagnosis of unexplained lymphocytic exudative pleural effusion, and bronchoscopy is unlikely to aid in the diagnosis of lone pleural effusion.

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Detection of Point Mutations in the rpoB Gene Related to Drug Susceptibility in Mycobacterium Tuberculosis using an Oligonucleotide Chip (올리고뉴클레오티드 칩(Oligonucleotide Chip)을 이용한 항결핵제 감수성과 관련된 Mycobacterium tuberculosis rpoB 유전자의 점돌연변이 판별 방법)

  • Kim, Hyun-Jung;Kim, Seong-Keun;Shim, Tae-Sun;Park, Yong-Doo;Park, Mi-Sun
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.1
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    • pp.29-41
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    • 2001
  • Background : The appearance of multiple-drug-resistant Mycobacterium tuberculosis strains has been seriously compromising successful control of tuberculosis. Rifampin-resistance, caused by mutations in the rpoB gene, can be indicative of multiple-drug-resistance, and its detection is of great importance. The present study aimed to develop an oligonucleotide chip for accurate and convenient screening of drug-resistance. Methods : In order to detect point mutations in the rpoB gene, an oligonucleotide chip was prepared by immobilizing specific probe DNA to a microscopic slide glass by a chemical reaction. The probe DNA that was selected from the 81 bp core region of the rpoB gene was designed to have mutation sites at the center. A total of 17 mutant probes related to rifampin-resistance including 8 rifabutin-sensitive mutant probes were used in this study. For accurate determination, wild type probes were prepared for each mutation position with an equal length, which enabled a direct comparison of the hybridization intensities between the mutant and wild type. Results : Mycobacterial genomic DNA from clinical samples was tested with the oligonucleotide chip and the results were compared with those of the drug-susceptibility test in addition to sequencing and INNO-LiPA Rif. TB kit test in some cases. Out of 15 samples, the oligonucleotide chip results of 13 samples showed good agreement with the rifabutin-sensitivity results. The two samples with conflicting result also showed a discrepancy between the other tests, suggesting such possibilities as existence of mixed strains and difference in drug-sensitivity. Further verification of these samples in addition to more case studies are required before the final evaluation of the oligonucleotide chip can be made. Conlcusion : An oligonucleotide chip was developed for the detection of rpoB gene mutations related to drugsusceptibility. The results to date show the potential for using the oligonucleotide chip for accurate and convenient screening of drug-resistance to provide useful information in antituberculosis drug therapy.

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Radiographic evaluation of marginal bone resorption around two types of external hex implants : preliminary study (두 종의 external hex implant의 변연골 흡수에 관한 연구 : 예비연구 (preliminary study))

  • Lee, Ji-Eun;Heo, Seong-Joo;Koak, Jai-Young;Kim, Seong-Kyun;Han, Chong-Hyun
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.2
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    • pp.169-174
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    • 2008
  • Statement of problem: Changes of the marginal bone around dental implants have significance not only for the functional maintenance but also for the esthetic success of the implant. It was proposed that bone-retention elements such as microthreads at the coronal part of implant might help maintain the marginal bone level. Purpose: This study was designed to evaluate the effect of microthread configuration within the marginal coronal portion of the implant fixture at the marginal bone changes after loading around two different external hex implants. Material and methods: Twenty-four patients were included and randomly assigned to treatment with $Br{{\aa}}nemark$ system implants (Group 1, rough-surfaced implants, n=20) and Oneplant system implants (Group 2, rough-surfaced neck with microthreads, n=20). Clinical and radiographic examinations were conducted at baseline (implant loading) and 1 year postloading. Data analysis was performed by the SAS statistical package version 9.1.3 (SAS Institute, Cary, NC, USA) and the final model was calculated by the MIXED procedure (three-level ANCOVA) for marginal bone change of each test group at baseline and 1 year follow-up. Results: Comparing to baseline, significant differences were noted in marginal bone level changes for the 2 groups at 1 year follow-up (P<0.05). Group 1 had a mean crestal bone level changes of $0.83{\pm}0.31mm$; Group 2 had a mean crestal bone level changes of $0.44{\pm}0.36mm$. Rough-surfaced with microthreads implants showed significantly less marginal bone loss than rough surfaced neck without microthread implants. Conclusion: A rough surface with microthreads at the implant was beneficial design to maintain the marginal bone level against functional loading.

ORTHODONTIC TRACTION OF HORIZONTALLY ERUPTED LOWER LATERAL INCISOR ON THE LINGUAL SIDE (설측으로 수평 맹출한 하악 측절치의 교정적 견인)

  • Mah, Yon-Joo;Sohn, Hyung-Kyu;Choi, Byung-Jai;Lee, Jae-Ho;Kim, Seong-Oh
    • Journal of the korean academy of Pediatric Dentistry
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    • v.37 no.1
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    • pp.117-123
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    • 2010
  • Tooth eruption is the movement of the tooth from the developing place in the alveolar bone to the functional position in the oral cavity. The permanent incisors originate from the dental lamina on the lingual side of preceding deciduous tooth and erupt to the level of the occlusion through the well developed gubernacular cord. Ectopic eruption is a developmental disturbance in the eruption pattern of the permanent dentition. Most of the ectopically erupted lower incisor has been found in lingual side. The ectopically erupted tooth could be repositioned by orthodontic force in the early mixed dentition, which could help preventing the problems of loss of space and the lingual tilting of the lower anterior teeth. An eight-year-old girl visited the department of pediatric dentistry, Yonsei Dental University Hospital, for the evaluation and the treatment of the lower right lateral incisor, which was horizontally erupted in the lingual side, parallel to the mouth floor. Her tongue was placed on the labial side of that tooth. There was no previous dental history of dental caries or trauma on the pre-occupied primary incisor. Clinical and radiographic examinations including the computed tomography(CT), showed no evidence of dilacerations on root. Therefore, we decided to start active orthodontic traction of the lower right lateral incisor. We designed the fixed type of buccal arch wire and the lip bumper with hook for the traction. Button was attached to the lingual side of the ectopically positioned tooth. Elastic was used between the appliance and the button on that tooth. After the tooth become upright over the tongue level, appliance was change to the removable type and periodic check-up with occlusal guidance was followed to monitor the position of the tooth. In this case using the fixed appliance with modified form of lip bumper and hook embedded in acrylic part instead of extraction was very efficient up-righting the ectopically erupted tooth toward the occlusal plane.

Clinical Study on Laryngo - Microscopic Surgery For Vocal Nodules and Polyps (후두결절 및 폴립의 후두미세 수술에 관한 임상연구)

  • 문영일
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1983.05a
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    • pp.11.2-11
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    • 1983
  • Vocal nodules and polyps are much more frequent in singers, public speakers, teachers and actors. Voice trauma and voice misuse, at times associated with mild inflammatory reaction, appear to be important in their etiology. It is generally agreed that vocal cord nodules and polyps are inflammatory in nature and they arise in the subepithelial layer of loose connective tissue of the vocal cord. Since the junction of anterior and middle thirds of the membranous cord and has the greatest amplitude of vibration. This is the site of predilection for vocal cord nodules. The author performed laryngomicrosurgery for 70 cases of vocal nodules and polyps at Ewha Womans University Hospital during the period of 5 years. The result obtained were as follows ; 1) Surgical excision is not necessarily the best approach because vocal nodules in the early stages will resolve with the simplest voice therapy. 2) In children, surgery is rarely indicated because most nodules in children regress during adolescence. 3) For patients who use their voices professionally, voice therapy is indicated for three months. 4) If after three month of conservative treatment the cord lesion does not improve and the patient it still dissatisfied with his voice, laryngomicrosurgery can then be considered. 5) The small cuffed endotracheal tube in the interarytenoid space helps to keep the cords immobile and in an abducted position. 6) Removal of the nodule shoule be started by gentle retraction posteriorly and as soon as a tear appears anterior to the nodule. 7) On occasion it is preferable to start the dissection with a siccle knife while the nodule is held on the stretch. 8) Voice rest should be maintained for a week following which the free edges of the cords are usually healed.

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Usefulness and Limitations of Fine Needle Aspiration Cytology in Adult Cervical Lymph Node Enlargement Patients: An analysis of 342 cases (성인 경부 림프절 비대 환자들에서 미세침 흡인 세포검사법의 유용성과 문제점: 342 증례의 분석)

  • Lee, Jaeho
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.1
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    • pp.18-28
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    • 2004
  • Background : Many diseases like lung cancer and tuberculosis can involve cervical lymph node. Fine needle aspiration cytology(FNAC) was known as a useful screening test for the evaluation of enlarged lymph node. But the usefulness and limitations of FNAC according to disease category or physical characteristics of lymph node were not yet fully established. Methods : Retrospective analysis of three hundred forty two adult patients who performed FNAC due to enlarged cervical lymph nodes at the Seoul Municipal Boramae Hospital during the period from January 1999 to December 2002 and final diagnosis could be made by surgical biopsy, microbiology or clinical observation. Results : Among the 342 cases, 176(51.5 %) were finally diagnosed as benign nature ncluding reactive hyperplasia, Kikuchi's disease and acute suppuration. Eighty eight(25.7 %) were diagnosed as tuberculous lymphadenitis, 66(19.3 %) as metastasis, and 12(3.5 %) as lymphoma. Tuberculosis, metastasis, and lymphoma all showed significantly larger diameter, longer duration of lymph node enlargement. There were higher frequency of supraclavicular involvement in the cases of tuberculosis and metastasis. The overall diagnostic sensitivity of FNAC was 88.0 %, and 88.6 % in benign nature lesion, 77.3 % in tuberculosis, 90.1% in metastasis and 58.3 % in lymphoma. The diagnosis of tuberculosis was made by FNAC in 68 cases (77.3 %) among 88 cases. Lung cancer(43.9 percent) was most frequent cause of cervical lymph node metastasis. Diagnostic sensitivity of FNAC was significantly lower in the supraclavicular than other cervical lymph node(80 % vs. 91.3 %) and not correlated with disease nature, node size or number. Conclusion : Though FNAC was a reliable screening test for enlarged cervical lymph node enlargement, the diagnostic sensitivity was low in the case of lymphoma or when the enlarged lymph node was located at the supraclavicular area.

Comparison of flexural strength according to thickness between CAD/CAM denture base resins and conventional denture base resins (CAD/CAM 의치상 레진과 열중합 의치상 레진의 두께에 따른 굴곡 강도 비교)

  • Lee, Dong-Hyung;Lee, Joon-Seok
    • Journal of Dental Rehabilitation and Applied Science
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    • v.36 no.3
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    • pp.183-195
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    • 2020
  • Purpose: The purpose of this study is to compare the flexural strength of CAD/CAM denture base resins with conventional denture base resins based on their thicknesses. Materials and Methods: For the conventional denture base resins, Lucitone 199® (C-LC) was used. DIOnavi - Denture (P-DO) and DENTCA Denture Base II (P-DC) were taken for the 3D printing denture base resins. For the prepolymerized PMMA resins, Vipi Block Gum (M-VP) and M-IVoBase® CAD (M-IV) were used. The final dimensions of the specimens were 65.0 mm x 12.7 mm x 1.6 mm / 2.0 mm / 2.5 mm. The 3-point bend test was implemented to measure the flexural strength and flexural modulus. Microscopic evaluation of surface of fractured specimen was conducted by using a scanning electron microscope (SEM). After testing the normality of the data, one-way ANOVA was adopted to evaluate the differences among sample groups with a significance level of P = 0.05. The Tukey HSD test was performed for post hoc analysis. Results: Under the same thicknesses, there are significant differences in flexural strength between CAD/CAM denture base resins and conventional denture base resins except for P-DO and C-LC. M-VP showed higher flexural strength than conventional denture base resins, P-DC and M-IV displayed lower flexural strength than conventional denture base resins. Flexural modulus was highest in M-VP, followed by C-LC, P-DO, P-DC, M-IV, significant differences were found between all materials. In the comparison of flexural strength according to thickness, flexural strength of 2.5 mm was significantly higher than that of 1.6 mm in C-LC. Flexural strength of 2.5 mm and 2.0 mm was significantly higher than that of 1.6 mm in P-DC and M-VP. In M-IV, as the thickness increases, significant increase in flexural strength appeared. SEM analysis illustrates different fracture surfaces of the specimens. Conclusion: The flexural strength of different CAD/CAM denture base resins used in this study varied according to the composition and properties of each material. The flexural strength of CAD/CAM denture base resins was higher than the standard suggested by ISO 20795-1:2013 at a thickness of 1.6 mm or more though the thickness decreased. However, for clinical use of dentures with lower thickness, further researches should be done regarding other properties at lower thickness of denture base resins.

The Role of the Endometrium and Embryo in Human Implantation (인간 착상 과정에 자궁내막과 배아의 역할)

  • Jee, Byung-Chul
    • Development and Reproduction
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    • v.13 no.1
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    • pp.1-11
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    • 2009
  • Implantation itself is governed by an array of endocrine, paracrine and autocrine modulators, of embryonic and maternal origin. Window of implantation is the unique temporal and spatial expression of factors allows the embryo to implant via signaling, appositioning, attachment, and invasion in a specific time frame of $2{\sim}4$ days. When the embryo has arrived in the uterine cavity, a preprogrammed sequence of events occurs, which involves the production and secretion of a multitude of biochemical factors such as cytokines, growth factors, and adhesion molecules by the endometrium and the embryo, thus leading to the formation of a receptive endometrium. Cytokines such as LIF, CSF-1, and IL-1 have all been shown to play important roles in the cascade of events that leads to implantation. Integrin, L-selectin ligands, glycodelin, mucin-1, HB-EGF and pinopodes are involved in appositioning and attachment. The embryo also produces cytokines and growth factors (ILs, VEGF) and receptors for endometrial signals such as LIF, CSF-1, IGF and HB-EGF. The immune system and angiogenesis play an important role. The usefulness of these factors to assess endometrial receptivity and to estimate the prognosis for pregnancy in natural and artificial cycles remains to be proven. Integrins, pinopodes, glycodelin and LIF (from biopsies) are promising candidates; from uterine flushings, glycodelin and LIF are also candidates. The ideal serum marker is not available, but VEGF, glycodelin and CSF have some clinical implications. Further evaluation that includes larger groups of infertile women and fertile controls are needed to elucidate whether their presence in plasma, flushing fluid, or endometrial samples can be used as some kind of a screening tool to assess endometrial function and prognosis for pregnancy before and after artificial reproductive therapy. A better understanding of their function in human implantation may lead to therapeutic intervention, thereby improving the success rate in reproduction treatment. New molecular techniques are becoming available for measuring both embryonic and endometrial changes prior to and during implantation. The use of predictive sets of markers may prove to be more reliable than a single marker. Ultimately, the aim is to use these tools to increase implantation in artificial cycles and consequently improve live-birth rates.

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