• Tuberculosis and Respiratory Diseases
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• v.54 no.2
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• pp.219-229
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• 2003

Background : The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. Materials and Methods : 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. Results : Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated, were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion($9.4{\pm}5.25days$ vs. $19.2{\pm}9.42days$, p<0.05) and the duration of hospital admission after catheter insertion($15.9{\pm}10.45days$ vs. $38.6{\pm}11.46days$, p<0.01) of the patients with only PCD treated were more longer than those of the patients treated with surgical procedure after PCD. They were same between the patients treated with urokinase after PCD and the patients treated with surgical procedure after PCD($11.1{\pm}7.35days$ vs. $19.2{\pm}9.42days$, p<0.05, $17.5{\pm}9.17days$ vs. $38.6{\pm}11.46days$, p<0.01). In 16 patients(44.4%) with only PCD treated or PCD and urokinase treated, the amount of effusion at the time of catheter removal was decreased more than 75% and in 17 patients(47.2%) effusion decreased 50~75%. .In one patient effusion decreased 25~50%, in two patients effusion decreased less than 25%. One month after catheter removal, in 35 patients(97.2%, four patients were cast off), the amount of pleural effusion was successfully decreased more than 50%. There were no complications related to pigtail catheter insertion. Conclusion : In this study, PCD seemed to be an early efficacious procedure in treating the patients with complicated parapneumonic effusion or empyema without any serious procedure related complication.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.674-684
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• 1999

Background : It has been generally known that the incidence of lung cancer is higher in the patients with idopathic pumonary fibrosis (IPF) than those in general population. The reported incidence was variable from 4.8 to 43.2%. There were controversies on the most frequent cell type (squamous cell carcinoma vs. adenocarcinoma) and no study was done about the real concordance of cancer and the fibrotic lesion. And the pulmonary fibrosis may influence not only the development of cancer but also the treatment and prognosis of the cancer, but there was no report on that point. Method : Total 63 patients ($66.8{\pm}7.8$ year, M : F=61 : 2) were diagnosed as IPF combined with lung cancer (IFF-CA) at Asan Medical Center. A retrospective analysis was done about the risk factors of the lung cancer, pulmonary function test, the site of cancer(especially the relationship of the cancer with the fibrotic lesion), the histologic types, and the stage of cancer. The histologic types were compared with those of 2,660 patients with lung cancer who were diagnosed at the same institute for the same period. The effect of IPF on the treatment of the cancer was evaluated with the survival time after the detection of lung cancer. Results : The lung cancer was found in 63(22.9%) out of 281 patients with IPF. But in most of them(45 patients), lung cancer was detected at the same time with IPF and only in 18 patients, the cancer was diagnosed during the follow-up($25.2{\pm}17.7$ months) of IPF. So in our study, 6.7% of patients with IPF developed lung cancer during the course of the disease. The age ($66.8{\pm}7.84$ vs. $63.4{\pm}11.1$ years), percentage of smoker (88.9 vs. 67.2%), and the male gender (96.8 vs. 67.6%) were significantly higher in IPF-CA compared with lone IPF (p<0.05). The odds ratio of smoking was 4.7 compared with non smoking IPF controls. The lung cancer was located more frequently in the upper lobe and 55.5% was in the periphery of lung. The cancer was developed in the fibrotic lesion in 23 patients (35.9%), and in the majority of the patients, the cancer was separated from the fibrosis. The cell type of the lung cancer in IPF-CA was squamous cell carcinoma 34.9%, adenocarcinoma 30.2%, small cell carcinoma 19.0%, large cell undifferenciated carcinoma 6.3%, and others 9.5%. No significant difference in the distribution of histologic type of the lung cancer was found between IPF-CA and lone lung cancer. There was no significant difference in demographic features, cell types, location and the stage of the cancer between the group with concurrent IPF-CA and the group with cancer diagnosed during the follow up of IPF. There was a tendency (but statistically not significant : p=0.081) of higher incidence of adenocarcinoma among the cancers developed in the fibrotic area(43.5%) (F-CA) than in the cancers in non-fibrotic area (22.5%) (NF-CA). The prognosis of the patients with F-CA was poor (median survival : 4 months) compared with the patients with NF-CA (7 months, p=0.013), partly because the prevalence of severe IPF (the extent of fibrosis in HRCT 50%) was higher in F-CA group. Conclusion : These data suggest that the lung cancer in the patients with IPF has similar features to the ordinary lung cancer.

• (The) Research of the performance art and culture
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• no.18
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• pp.413-444
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• 2009

This paper is an analysis of stage and performance elements for the ceremonial procedures and dance featured in bongsudang-jinchan, a feast celebrating the 60th birthday of Hyegyeong-gung Hongssi (Crown Princess Hong of Hyegyeonggung), the mother of King Jeongjo, which took place in Hwaseong haegung palace in 1795. The primary sources used are data on bongsudangjinchan recorded in Wonhaeng-eulmyojeongriuigwe, Jeongjo-sillok, Hongjae-jeonseo, pictorial sources such as Folding Screens of Hwaseong-neunghaeng and Hwaseong Ilgi, which is a journal in Korean by Yi Hui-pyeong. A court ceremony to offer music, dance, flowers, and food, as well as wine and poetry which express the sentiments of chung (fidelity) and hyo (filial piety) was considered a national ceremony and has constituted a unique musical culture during the 500 years of Joseon dynasty. However, after the fall of Joseon dynasty, ceremonial music and dance, which have been organically linked within the overall symbolic system of ye (courtesy), became scattered to become independent 'pieces.' As a result, all of their philosophy, principles, and the time-space interpretation of court music and dance became greatly reduced, leaving only the artistic expression and formal structure of the music and dance to become emphasized. Since the 1990s, there has been many research and events aiming to re-create the court ceremonial tradition, resulting in the increase of the related performance activities. This is especially true with bongsudang-jinchan, which is now being performed on modern stage in various forms. However there are still many problems to be solved, such as the issue of re-creating and restoring the original, and the question of artistic value found in the traditional pieces. Until now, much focus has been paid to the outer re-construction of uiju document as recorded in Wonhaeng-eulmyo-jeongriuigwe. On the other hand, there lacked an in-depth study which analyzes the stage situation and performance elements. Therefore in this paper, after focusing on the stage structure and performance elements, it is concluded that bongsudang-jinchan, the only court feast to be held in Haeng gung, not only consists of the fundamental aspects of court performance principle as 'governing through ye and ak (music),' but also served as an important occasion to bring together the sovereign and the subject. Bongsudang-jinchan had features of both naeyeon (feast for ladies) and oeyeon (feast for gentlemen). It minimized the use of screens and allowed every guest to enjoy food, music, and dance together, but provided a separate tent for foreign guests, maintaining the ideal balance between equality and distinction among different gender and social status. A screen symbolizing the venue for the feast is placed for all of the government officials. The king then pronounces the beginning of the banquet in which the ideal of gunsin-dongyeon (king and officials dining together) is realized. This indicates that bongsudang-jinchan, compared to other court ceremonies that emphasize the principle of yeak (courtesy and music), focuses more on the spirit of harmony and rapprochement. The king played a more active role in bongsudang-jinchan than in any other royal feasts. Examples as recorded in uiju documents are; Jeongjo's conversation with his retainers after the 7th wine, king's bestowing of food and flowers to the officials, writing his own majesty's poems with regard to the festival, and asking the retainers to write replying poems. All these played an important part in making the occasion more rich, extensive, and meaningful. Moreover, as analysis of the structure of orchestral music and court dance featured in bongsudang-jinchan shows, it was like any other court banquet in that it employed minimal use of extravagance in movements and conversation. However, the colors and tonal texture used in the music and dance were more brilliant in this case. Compared to other banquets that took place before king Jeongjo, the dance style was more diverse, which included some of the latest additions. There were past performances arranged anew. Noteworthy are; the incorporation of "Seonyurak (Boat Dance)" and "Geommu (Sword Dance)," traditionally used for local officials and civilians feast, to suit the court taste; and the use of saenghwang (mouth organ), which was a rising instrument in pungnyubang (literati's private salon), for "Hakmu (Cranes Dance)." This especially indicates the nature of the 'open structure' pursued by the court banquets at the time, which strove to break away from the traditional rules and customs and accept something new.