• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.389-400
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• 2002

Background : The rapid diagnostic tests for tuberculosis are needed to facilitate early treatment of tuberculosis and prevention of Mycobacterium tuberculosis transmission. The Xeniss Rapid TB kit is a rapid, card-based immunochromatographic test for the detection of antibodies directed against M. tuberculosis antigens including antigen 5(38-kDa antigen). The objective of this study was to evaluate the performance of the Xeniss Rapid TB kit for the diagnosis of active tuberculosis with serums from patients, asymptomatic healthy and close contact controls. Methods : 188 patients with active tuberculosis were tested; 177 with pulmonary tuberculosis(18 with combined pleurisy), and 11 with extrapulmonary tuberculosis. The control groups were composed of 82 close contacts and 57 healthy adults. Study subject were drawn from one national tuberculosis hospital for patients and close contacts, and another private hospital for healthy adults in Masan city, Korea. The Xeniss Rapid TB kit(Xeniss Life Science Co., Ltd., Seoul, Korea) was evaluated by using serum samples according to the instructions of the manufacturer by an investigator masked to the clinical and microbiological status of the study subjects. Results : The diagnostic sensitivity of the Xeniss Rapid TB kit was 73.9% in patients and specificities were 73.2% and 93.0% in close contact and healthy adults respectively. The positive predictive value in patients was 84.2% and the negative predictive value in controls was 85.8%. Conclusion : This study shows that the Xeniss Rapid TB test is a simple and fast method to diagnose active TB. The results of the sensitivity and specificites suggest that serodiagnosis using this point of care testing(POCT) device would be valuable and advantageous for screening tuberculosis in the clinical field.

• Tuberculosis and Respiratory Diseases
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• v.47 no.5
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• pp.586-597
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• 1999

Background: Many diagnostic tests have developed to diagnose tuberculosis and other mycobacterial diseases but the diagnosis of tuberculosis relies largely on radiological findings and acid-fast staining of sputum and/or culture. Recently, new serologic diagnostic methods, which are safe and easy to use have been introduced into Korea. In this study, the usefulness of serologic diagnosis for tuberculosis and the disease pattern induced variation of the test were evaluated. Methods: Serological assay was performed upon 108 patients with two test kits, the ICT tuberculosis and the BioSign$^{TM}$TB, which are based upon a rapid immunochromatographic assay technique, capable of being interpreted within 15 minutes. The case groups consisted of 61 patients with active pulmonary tuberculosis(36 patients), extrapulmonary tuberculosis(3 patients), or both(22 patients). Control groups consisted of 47 patients with inactive old pulmonary tuberculosis(17 patients), nontuberculous pulmonary disease(16 patients) and nonpulmonary cardiac disease(14 patients). Results : The diagnostic sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of the ICT tuberculosis were 64.3%, 91.5%, 90.0% and 68.3% respectively. The diagnostic sensitivity, specificity, PPV and NPV of the BioSign$^{TM}$TB were 76.5%, 95.3%, 94.1 % and 78.8% respectively. Differences in sensitivity were not significant between patients with previous history of tuberculosis or patients without prior history of tuberculosis. The ICT tuberculosis test showed higher sensitivity in pulmonary tuberculosis patients(76.5%) than extrapulmonary tuberculosis patients(33.3%). There was no difference in sensitivity between patients with or without cavitary lesion by chest X-ray. Conclusion: Considering high specificity and PPV, serologic diagnosis using a rapid immunochromatographic assay device is another helpful diagnostic method in the diagnosis of tuberculosis, when combined with previous diagnostic methods such as chest X-ray, microbiologic study but it has limitation in terms of confirming the diagnosis for tuberculosis as the only diagnostic method because of relatively low sensitivity and NPV.

• Tuberculosis and Respiratory Diseases
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• v.79 no.1
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• pp.14-21
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• 2016

Cough is one of the most common symptom of many respiratory diseases. The Korean Academy of Tuberculosis and Respiratory Diseases organized cough guideline committee and cough guideline was developed by this committee. The purpose of this guideline is to help clinicians to diagnose correctly and treat efficiently patients with cough. In this article, we have stated recommendation and summary of Korean cough guideline. We also provided algorithm for acute, subacute, and chronic cough. For chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered. If UACS is suspicious, first generation anti-histamine and nasal decongestant can be used empirically. In CVA, inhaled corticosteroid is recommended in order to improve cough. In GERD, proton pump inhibitor is recommended in order to improve cough. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, angiotensin converting enzyme inhibitor, habit, psychogenic cough, interstitial lung disease, environmental and occupational factor, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and idiopathic cough can be also considered as cause of chronic cough. Level of evidence for treatment is mostly low. Thus, in this guideline, many recommendations are based on expert opinion. Further study regarding treatment for cough is mandatory.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.1007-1015
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• 2002

Purpose : The aim of this study is to find a method to diagnose and treat children who showed benign hemophagocytic histiocytes in bone marrow examination. Methods : We analyzed the clinical data of thirty patients retrospectively who showed benign hemophagocytic histiocytes in bone marrow examination from January 1995 to November 2001 at Keimyung University Dong-san Hospital. Bone marrow histiocytes were classified into a few, some, and many according to the number of histiocytes comparing with the white cells. Results : The age of thirty patients ranged from two months to 15 years. The median age was 5.6 years with male predominance(2.3 : 1). The most frequent clinical manifestation was fever; others were respiratory symptom, hepatosplenomegaly, lymphadenopathy and skin rash(in order of frequency). Common laboratory findings were leukopenia, thrombocytopenia, anemia and abnormal liver function test. Infection was present in 30 patients; causative organisms were documented in 15 patients, and bacterial infection was more common. Epstein Barr virus was the cause of infection in four patients. Bone marrow examination showed a few(20.0%), some(75.0%) and many(30.0%) hemophagocytic histiocytes. Combination immunochemotherapy including immunoglobulin, steroids and cyclosporine were helpful in 22 out of 30 patients. The mortality rate was high in young patients who showed some to many hemophagocytic histiocytes. Conclusion : Bone marrow examinations and early detection of histiocytes will be helpful in children who have fever, hepatosplenomegaly and abnormal liver function test. Immunochemotherapy were helpful and further investigation will be needed for the detection of the relationship between the bone marrow findings and prognosis.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.973-979
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• 2002

Purpose : Recently, a number of rapid antigen detection tests have been available to diagnose group A streptococcal pharyngotonsillitis. The purpose of this study was to determine the sensitivity, specificity and consistency of the two rapid antigen detection tests. Methods : Among the patients who visited our clinic from November 2001 to February 2002, 61 patients who had clinical findings of pharyngeal erythema or edema, pharyngeal exudates and soft palatine petechiae were enrolled in our study. A total of 61 patients were tested with rapid antigen detection tests and throat culture. BD $LINK2^{TM}$ Strep A(Becton, Dickinson & Company, U.S.A.) and $QuickVue^{(R)}$ $In-Line^{TM}$(Quidel Corporation, U.S.A.) were selected for rapid antigen detection tests. Results : Of the 61 patients tested, 22 patients were confirmed as group A streptococcal pharyngotonsillitis by throat culture. The BD $LINK2^{TM}$ Strep A had a sensitivity of 81.8% and a specificity 89.7%. The positive and negative predictive values were 81.8% and 89.7%, respectively. The $QuickVue^{(R)}$ $In-Line^{TM}$ had a sensitivity of 77.3% and a specificity of 100%. The positive and negative predictive values were 100% and 88.6%, respectively. The kappa values of BD $LINK2^{TM}$ Strep A and $QuickVue^{(R)}$ $In-Line^{TM}$ were 0.72 and 0.81, respectively. Conclusion : In addition to high sensitivity, specificity and consistency, both kits are easy to use and simple to interpret, and therefore have the potential to be used with backup throat culture for diagnosis of acute pharyngotonsillitis.

• The Journal of Internal Korean Medicine
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• v.19 no.2
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• pp.37-49
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• 1998

To make a objective diagnosis of the syndrome of cold-limbs, We investigated the 20 patients with cold limbs and GI trouble and 20 normal people as a control group. And we compared the thermal difference between Chon-jung(CV17) and Chung-wan(CV12 中脘), Chon-jung(CV17) and Ki-hae(氣海 CV6) and we compared the thermal differences of No-gung(PE8 勞宮) and Yong-chon(湧泉 KI1), too. The results were as follows. 1. All 20 patients had GI trouble and cold limbs. They had the symptom-Indigestion(16 cases-80%) with heart burn, tympanites, abdominal distention, hiccup, belching. Beside that symptom they also had constipation(6 cases-30%), diarrhea(3 cases-15%), headache & dizziness(6 cases-30%). And some had the menstrual syndrome, chronic fatigue, palpitation, insomnia, edema, arthralgia. 2. The thermal difference of the palms between the patients group and the control group were $25.70^{\circ}C,\;25.82^{\circ}C$, but they were not significant. 3. The thermal difference of the soles between the patients group and the control group were $23.58^{\circ}C,\;24.42^{\circ}C$ and the significancy was P=0.020 so it was significant(P<0.05). 4. The thermal difference of the palms and Chon-jung(CV17) between the patients group and the control group were $1.08^{\circ}C,\;0.76^{\circ}C$, but they were not significant. 5. The thermal difference of the sales and Chon-jung(CV17) between the patients group and the control group were $3.01^{\circ}C,\;1.90^{\circ}C$ and the significancy was P=0.003 so it was significant(P<0.05). 6. The thermal difference of Chon-jung(CV17) and Chung-wan(CV12 中脘) between the patients group and the control group was $0.30^{\circ}C,\;0.62^{\circ}C$ and the significancy was P=0.793 so it was significant(P<0.05). 7. The thermal difference of Chon-jung(CV17) and Ki-hae(CV6 氣海) between the patients group and the control group was $0.53^{\circ}C,\;0.68^{\circ}C$, but they were not significant. From the above, I could find the significance of D.I.T.I to diagnose the cold-feet not the cold-hands and the thermal difference between the trunk and limbs was more significant on cold-feet than on cold-hand, either.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.16-23
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• 2004

Purpose: In this study, we tried to evaluate the clinical characteristics or circumstances that lead to unintentionally the delay in the diagnosis of intussusception or to the wrong direction that prevent the proper management early. Methods: All the patients of intussusception with delayed diagnosis in the department of pediatrics or emergency room at Gyeongsang National University Hospital from 1990 to 2003 were enrolled and reviewed retrospectively. Results: There were 8 boys and 6 girls and their median age was 8 months (range 2 months to 10 years). Their initial symptoms and signs were vomiting, seizure, diarrhea, lethargy, irritability, bloody stool, palpable abdominal mass, foul odor of urine and tachycardia. Clinical diagnosis or impressions at admission consisted of acute gastroenteritis, shigellosis and toxic encephalopathy, convulsive disorders, urinary tract infections, sepsis, abdominal mass and intestinal obstruction. Eight patients were luckily diagnosed due to the delayed manifestations of cyclic irritability or currant jelly stool. Six patients were not paid attentions for the possibilities of intussusception and diagnosed serendipitiously by the abdominal sonography or CT during the evaluation of the abdominal mass or distension. Only five of 14 cases (35.7%) were successfully managed by barium or air reductions. The other 9 cases needed surgical operations. Conclusion: Delayed diagnosis of intussusception arise when doctors initially diagnose the patients incorrectly due to the unusual presentations or when they overlook the newly arising symptoms or signs suggestive intussusception after the admission because they are ardently attached to the first impressions or initial clinical diagnosis.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.199-206
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• 2000

Purpose: Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise $^{99m}Tc$-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. Materials and Methods: We evaluated 301 patients (mean age $52{\pm}10$ years, 166 males and 135 females) with normal exercise $^{99m}Tc$-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subject were evaluated for cardiac events and followed for 8-55 months (mean $19{\pm}10$ months) after imaging. Results: During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patients with positive (n=27) and negative (n=235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Conclusion: Patients with normal exercise $^{99m}Tc$-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.207-221
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• 2000

Purpose: Cost-effectiveness of myocardial SPECT for the diagnosis of coronary artery disease was investigated considering the present and amended costs of myocardial SPECT and exercise ECG in Korea. Materials and Methods: Four diagnostic tactics such as 1) coronary angiography (CAG) after exercise ECG, 2) CAG after myocardial SPECT, 3) direct CAG, and 4) CAG after myocardial SPECT following exercise ECG were chosen. Costs were calculated using the present costs of various tests and effects represented by Quality Adjusted Life Year (QALY) were estimated. Difference of QALY (${\Delta}QALY$) was calculated by subtracting QALY of diagnosed/treated cases from QALY of undiagnosed cases. $Cost/{\Delta}QALY$ was calculated and compared between four different tactics according to pre-test probability. Results: When pre-test probability was equal to or larger than 0.6, direct CAG was the most cost-effective. When pre-test probability was between 0.2 and 0.6, CAG after myocardial SPECT following exercise ECG was the most cost-effective. CAG after myocardial SPECT was the second most cost-effective. Cost-effectiveness was similar when the costs of exercise ECG were doubled or quadrupled. CAG after exercise ECG was always the least cost-effective. Conclusion: Myocardial SPECT with or without preceding exercise ECG was the most cost-effective method to diagnose coronary artery disease in the present or expected amended cost system.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.17 no.3
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• pp.103-108
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• 2017

Kabuki syndrome is a rare congenital disorder that causes multiple birth defects and mental retardation. Mutation of the lysine methyltransferase 2D (KMT2D) gene is the primary cause of Kabuki syndrome. We report a 4-year-old Korean girl diagnosed with Kabuki syndrome based on distinctive facial features (eversion of the lower lateral eyelid, arched eyebrows, depressed nasal tip, prominent ears), skeletal anomalies, short stature, and molecular analysis, which revealed a novel frameshift mutation in the KMT2D gene. A 4-year-old patient had a past history of congenital cardiac malformations (coarctation of the aorta, ventricular septal defect, atrial septal defect, patent ductus arteriosus), subclinical hypothyroidism and dysmorphic features at birth including webbed neck, short fingers, high arched palate, micrognathia and horseshoe kidney. She showed unique facial features such as a long palpebral fissure, long eyelashes, arched eyebrows with sparseness of the lateral third, broad nasal root, anteverted ears, and small mouth. Her facial features suggested Kabuki syndrome, and genetic analysis discovered a novel heterozygous frameshift mutation (c.4379dup, p.Leu1461Thrfs*30) in exon 15 of the KMT2D gene. The diagnosis of our 4-year-old patient was made through thorough physical examination and history taking, and genetic testing. It is challenging to diagnose patients with Kabuki syndrome at birth, since the characteristic facial features are expressed gradually during growth. Clinical suspicion aroused by regular follow-ups may lead to earlier diagnosis and interventions.