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Nodal Status of the Head and Neck Cancer Patients (두경부 암 환자의 경부 림프절 전이 분석)

  • Yang, Dae-Sik;Choi, Myung-Sun;Choi, Jong-Ouck
    • Radiation Oncology Journal
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    • v.15 no.4
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    • pp.321-329
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    • 1997
  • Purpose : It is well known that the risk of lymph nodes metastases to head and neck cancers are influenced by the location and size of the Primary tumor. as well as the degree and types of histological differentiation. However, data on the statistical analyses of lymph node metastases from the head and neck cancers among Korean Population are not available at present. In order to obtain current status of such data, we have analyzed cancer patients at the department of radiation oncology, korea universityhospital for radiation treatment. Materials and Methods : We have evaluated nine-hundred and ninetyseven (997) head and neck cancer Patients who visited to the Department of radiation oncology, between November 1981 to December 1995. After careful physical examinations and CAT scan, Patients were divided into two groups, those with positive lymph node metastases and with negative lymph node metastases. The nodal status were classified according to the TNM system of American Joint Committee on Cancer (AJCC) Besults : Four-hundred and sixteen Patients out of the 997 patients were lymph node positive $(42\%)$ and 581 patients were lymph node negative $(58\%)$ when they were first presented at the department of radiation oncelogy. According to the AJCC classification, the distribution of positive lymph node is as follow: Nl:106 $(25.5\%),\;N2a:100\;(24\%),\;N2b:68\;(16.4\%),\;N2c:69\;(16.6\%),\;3:73\;(15\%).$ respectively. The frequency of lymph node metastases according to the primary sites is as follow : larynx 283 $(28.5\%)$, paranasal sinuses: 182 $(18\%),\;oropharynx:144\;(14.5\%)\;nasopharynx:122(12\%),\;oral\;cavity\;92\;(9\%),\;hypopharynx:71\;(7\%),\;falivary\;gland:58\;(6\%)$ unknown primary:31 $(3\%),\;skin:\;14(2\%)$,. The most frequent Primary site for the positive Iymph node metastases was nasopharynx $(71\%)$ followed by hypopharynx $(69\%),\;oropharynx\;(64\%),\;oral\;cavity\;(39\%)$ The most common histologic type was squamous cell carcinoma (652/997: $65.4\%$). followed by malignant lymphoma $(109/997:11\%)$. Conclusion : Statistical results of lymph node metastases from head and neck cancer at our department were very similar to those obtained from other countries. It is concluded that the location of Primary cancer influences sites of metastases on head and neck, and stage of the primary cancer also influences the development of metastatic lesions. Since the present study is limited on the data collected from one institute. further statistical analyses on Korean cancer Patients are warrented.

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An Analysis of the Study Tendency on Rheumatoid Arthritis -Focusing on Domestic Theses for a Degree and Journal Since 2004- (류마토이드 관절염의 연구동향에 대한 소고(小考) -2004년 이후의 국내 학위논문 및 학회지 논문을 중심으로-)

  • Choi, Yong-Hun;Yoon, Il-Ji
    • Journal of Korean Medicine Rehabilitation
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    • v.19 no.2
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    • pp.125-156
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    • 2009
  • Objectives : To research the trend of studies related to rheumatoid arthritis and to indicate the hereafter direction for its study in oriental medicine and its treatment. Methods : I reviewed 75 domestic oriental medical journals, and 50 medical journals about rheumatoid arthritis published after 2004, and comparative analysis was made. And these theses were classified by college, year, field of study, subject. Results : The following are the results of this study. 1. Classified by oriental medical college, Dae-jeon college published the most theses, followed by Dong-guk, Kyung-hee, Se-myung and Dong-shin college. Han-yang college published the most theses among college of medicine. 2. Classified by type of thesis, experimental theses(70 pieces, 94%) showed higher rate than that of clinical theses(4 pieces, 5%) in oriental medical studies. However, in medical studies, clinical theses(34 pieces, 68%) showed higher rate than that of experimental theses(15 pieces, 30%). 3. Analyzed by subject, the most dealt subject in oriental medicine was herb medication, followed by herbal acupuncture, single herb, electroacupuncture, sasang & gene, acupuncture & moxibustion, complex accordingly. The most dealt subject in medical clinical journals was standards of diagnosis & prognosis, followed by medication, gene analysis, pathogenesis, clinical pattern, operative treatment and complication accordingly. 4. In theses related to herb medication, most of the subject was to evaluate anti-inflammatory and immunoregulatory effects of herb medication with geopungseup, jibitong, hwalhyeolgeoer function. The tendency of experimental methods was focusing on understanding anti-inflammatory and immunoregulatory mechanisms through molecular biologic methods by analyzing cytokine and gene. 5. Most of theses related to herbal acupuncture were experimental studies verifying ant-inflammatory and immnoregulatory effects through methods observing change of cytokine and immunoregulatory factors. Regarding remedies for herbal acupuncture, Ulmus davidiana Planch was most preferred, followed by bee venom. 6. In theses related to single herb, Boik-yak was most prefered, followed by Geopungseup-yak and Hwalhyeolgeoer-yak. Regarding methods of research, there were tendency of shifting from methods verifying travail, anti-inflammatory and anti-pyretic effects through a test of behavior, morphometry, serology and temperature measurement of the rectum and the skin into verifying anti-inflammatory and immunoregulatory effects through observing inflammatory cytokine in the joint and cells of spleen. 7. In theses related to electroacupuncture, ST36 and adjuvant were most preferred as acupoints and induced factor. The tendency of experimental methods was turning from verifying mechanism of travail effect to analyzing inflammation and pain inducing factors. 8. Diverse medical clinical studies were published. Subjects such as diagnosis and prognosis, medication, gene analysis, clinical pattern, operational treatment, complication and pathogenesis were published. Especially, studies about standards of early diagnosis, and research on possible parallel medications with methotrexate were actively inquired. 9. Most of theses related to medical experimental studies was about mediators and receptors related to inflammatory induction and osteoclasia mechanism. Also, it was presented blockage of them can be effective on rheumatoid arthritis. Conclusions : The oriental medicine studies have merit in its diversity of treatment, but it clinical studies is lacking compared to experimental studies. Also, more diversity of subjects is necessary. Therefore, complementary measures are needed. Hereafter, oriental medicine research about rheumatoid arthritis needs more clinical research verifying the effectiveness and safety in clinical field. Also, we require oriental medical standard of diagnosis and researches on pathological generation which would make early checkup and prognosis possible.

Experimental Study on the Thermodynamic Characteristics of Commercial Small-size Moxa Combustion (상용 소형 쑥뜸의 열역학적 특성에 대한 실험적 연구)

  • Lee Geon-Mok;Hwang Yoo-Jin;Lee Gun-Hyee
    • Journal of Acupuncture Research
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    • v.18 no.6
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    • pp.171-187
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    • 2001
  • Objective : Moxibustion has been proved efficacious for many diseases, but isn't widespread in the clinics due to a danger of skin burning, the smoke produced while burning a moxa combustion and so on. Therefore, another type of moxa that can be resolved these troubles is required. To improve the effect of moxibustion and develop the new thermal stimulating treatment, the performance of commercial moxibustion widely used are studied systematically and found out quantitatively. Methods : We have selected two types (small-size moxa A(sMA), small-size moxa B (sMB)) among small-size moxaes used widely in the clinic. We examined combustion time, various temperatures, temperature gradient in each period during a combustion of moxa. Results : 1. The combustion time in the preheating period appeared somewhat longer in sMA than in sMB. 2, The combustion time in the heating period appeared longer in sMA by 26% than in sMB. 3. The average temperature in the heating period was $37.6{\sim}37.8^{\circ}C\;in\;sMA\;and\;36.2{\sim}36.8^{\circ}C$ in sMB and the maximum temperature measured at a center of contact surface in sMA was $48.6^{\circ}C$, higher by over $2.8^{\circ}C$ than that of sMB moxibustion. 4. The average ascending temperature gradient in the heating period was $0.08{\sim}0.1^{\circ}C/sec$ in both moxaes, and the average ascending temperature gradient of heating period in sMB appeared larger. The maximum ascending temperature gradient appeared higher in sMB, and the time reaching maximum ascending temperature gradient appeared much earlier in sMA than in sMB. 5. The combustion time in the retaining period was around 100 sec in sMA and around 275 sec in sMB. 6. The average temperature in the retaining period was $42.2{\sim}46.0^{\circ}C\;in\;sMA\;and\;39.3{\sim}41.4^{\circ}C/sec$ in sMB. The minimum temperature in the retaining period was over $38.80^{\circ}C$ in sMA but just $34.7^{\circ}C$ in sMB. 7. The average descending temperature gradient in sMA was $-0.050{\sim}0.067^{\circ}C/sec$ and in sMB was $-0.030{\sim}0.037^{\circ}C/sec$ 8. The combustion time in the cooling period appeared longer over two times in sMA than in sMB, and the time which the cooling period (minimum temperature) finished at appeared later in sMB by 55 sec. 9. We classified the combustion process that the measured temperature rose over body heat($37^{\circ}C$) into the effective combustion period. The effective combustion time was 233.3 sec in sMA and 300.4 sec in sMB respectively, and was longer by about 29% in sMB. The average temperature and maximum temperature in the effective combustion time appeared higher in sMA. The time taken until the maximum temperature was reached was 225.1 sec in sMA and 244.5 sec in sMB, faster by about 20 sec in sMA. The maximum ascending temperature gradient during the effective combustion period appeared larger about 1.4 times in sMB, but the time when the maximum ascending temperature gradient happened was faster in sMA. Conclusion : It appears that sMB, compared with sMA, is proper if necessary to apply the long time and weak stimulus, because of the gentle stimulus during the relatively longer time. In contrast, sMA that the symmetrical combustion happened is proper if necessary to apply the short time and strong stimulus.

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Recent Progress in Air-Conditioning and Refrigeration Research : A Review of Papers Published in the Korean Journal of Air-Conditioning and Refrigeration Engineering in 2012 (설비공학 분야의 최근 연구 동향 : 2012년 학회지 논문에 대한 종합적 고찰)

  • Han, Hwataik;Lee, Dae-Young;Kim, Sa Ryang;Kim, Hyun-Jung;Choi, Jong Min;Park, Jun-Seok;Kim, Sumin
    • Korean Journal of Air-Conditioning and Refrigeration Engineering
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    • v.25 no.6
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    • pp.346-361
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    • 2013
  • This article reviews the papers published in the Korean Journal of Air-Conditioning and Refrigeration Engineering during 2012. It is intended to understand the status of current research in the areas of heating, cooling, ventilation, sanitation, and indoor environments of buildings and plant facilities. The conclusions are as follows : (1) The research works on thermal and fluid engineering have been reviewed as groups of fluid machinery, pipes and valves, fuel cells and power plants, ground-coupled heat pumps, and general heat and mass transfer systems. Research issues are mainly focused on new and renewable energy systems, such as fuel cells, ocean thermal energy conversion power plants, and ground-coupled heat pump systems. (2) Research works on the heat transfer area have been reviewed in the categories of heat transfer characteristics, pool boiling and condensing heat transfer, and industrial heat exchangers. Researches on heat transfer characteristics included the results for natural convection in a square enclosure with two hot circular cylinders, non-uniform grooved tube considering tube expansion, single-tube annular baffle system, broadcasting LED light with ion wind generator, mechanical property and microstructure of SA213 P92 boiler pipe steel, and flat plate using multiple tripping wires. In the area of pool boiling and condensing heat transfer, researches on the design of a micro-channel heat exchanger for a heat pump, numerical simulation of a heat pump evaporator considering the pressure drop in the distributor and capillary tubes, critical heat flux on a thermoexcel-E enhanced surface, and the performance of a fin-and-tube condenser with non-uniform air distribution and different tube types were actively carried out. In the area of industrial heat exchangers, researches on a plate heat exchanger type dehumidifier, fin-tube heat exchanger, an electric circuit transient analogy model in a vertical closed loop ground heat exchanger, heat transfer characteristics of a double skin window for plant factory, a regenerative heat exchanger depending on its porous structure, and various types of plate heat exchangers were performed. (3) In the field of refrigeration, various studies were executed to improve refrigeration system performance, and to evaluate the applicability of alternative refrigerants and new components. Various topics were presented in the area of refrigeration cycle. Research issues mainly focused on the enhancement of the system performance. In the alternative refrigerant area, studies on CO2, R32/R152a mixture, and R1234yf were performed. Studies on the design and performance analysis of various compressors and evaporator were executed. (4) In building mechanical system research fields, twenty-nine studies were conducted to achieve effective design of mechanical systems, and also to maximize the energy efficiency of buildings. The topics of the studies included heating and cooling, HVAC system, ventilation, renewable energy systems, and lighting systems in buildings. New designs and performance tests using numerical methods and experiments provide useful information and key data, which can improve the energy efficiency of buildings. (5) In the fields of the architectural environment, studies for various purposes, such as indoor environment, building energy, and renewable energy were performed. In particular, building energy-related researches and renewable energy systems have been mainly studied, reflecting interests in global climate change, and efforts to reduce building energy consumption by government and architectural specialists. In addition, many researches have been conducted regarding indoor environments.

The Effect of Photomodulation in Human Dermal Fibroblasts (피부 섬유아세포에서 광자극의 효과)

  • Kim, Mi Na;Kwak, Taek Jong;Kang, Nae Gyu;Lee, Sang Hwa;Park, Sun Gyoo;Lee, Cheon Koo
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.41 no.4
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    • pp.325-331
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    • 2015
  • Skin is exposed to sunlight or artificial indoor light on a daily. The reached solar light on the earth surface consist of 50% visible light and 45% infrared (IR) except for ultra violet (UV). The negative effects of UV including UVB and UVA have been steadily investigated within the last decades. However, little is known about the effects of visible or IR light. In this study, we irradiated human dermal fibroblasts using light emitting diode (LED) to investigate the optimal parameter for enhancing cell growth and collagen synthesis. We found that red of 630 nm and green of 520 nm enhance the cell proliferation, but irradiation with purple and blue light exerts toxic effects. To examine the response of irradiation time and light intensity on the fibroblasts, cells were exposed to red or green light with intensities from 0.05 to $0.75mW/cm^2$. Procollagen secretion was increased of 1.4 fold by 10 min irradiation, while 30 min treatment decreased the collagen synthesis of dermal fibroblasts. Treatment with red of $0.3mW/cm^2$ and green of 0.15 and $0.3mW/cm^2$ resulted in enhancement of collagen mRNA. Lastly, we investigated the combinatorial effect of red and green light on dermal fibroblasts. The sequential irradiation of red and green light is an efficient way for the purpose of the increase in the number of fibroblasts than single light treatment. On the other hand, the exposure of red light alone was more effective method for enhancing of collagen secretion. Our study showed that specific light parameters accelerated cell proliferation, gene expression and collagen secretion on human dermal fibroblasts. In conclusion, we demonstrate that light exposure with specific parameter has beneficial effects on the function of dermal fibroblasts, and suggests the possibility of its cosmetically and clinical application.

A Survey of Korean Consumers' Awareness on Animal Welfare of Laying Hens (산란계 동물복지에 대한 국내 소비자의 인지도 조사)

  • Hong, Eui-Chul;Kang, Hwan-Ku;Park, Ki-Tae;Jeon, Jin-Joo;Kim, Hyun-Soo;Kim, Chan-Ho;Kim, Sang-Ho
    • Korean Journal of Poultry Science
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    • v.45 no.3
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    • pp.219-228
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    • 2018
  • This study was conducted twice to investigate egg purchase behavior and perception on animal welfare of Korean consumers. This study included women, who were the main decision makers and caretakers in the household, and men with one-person household. This survey was conducted with by the Computer Assisted Web Interview and Gang Survey methods. On the key considerations factor, the highest response rate was considered to be 'price', and the response rate of considering 'packing date' increased in the second survey. At a reasonable price based on 10 eggs, the response rate was the highest at 53.8% and 42.9% in both the first and second surveys and the appropriate price averages were 2,482 won and 2,132 won, respectively. The highest rate of purchase of egg consumers from 'Large Mart' followed by 'Medium sized supermarket' and 'Chain supermarket'. As for the awareness about animal welfare, the recognition ratio (73.5%) was higher in the result of the second survey than the first. The cognitive period of animal welfare was 59.0% before the insecticide egg crisis and 41.0% thereafter. Regarding whether or not they have ever seen an animal welfare certification mark and an animal welfare animal farm certification mark, 59.6% of respondents said that they saw it for the first time and 37.6% answered that they knew the animal welfare certification mark. On the animal welfare system, the 'free-range' response rate was the highest at 85.8%. The 'free-range' fit response decreased by 34.2%p, while the 'barn' and 'European type' fit response increased by 13.2%p and 24.1%p, respectively. The number of 'I have never seen' and 'I have ever eaten' responses to the recognition and eating experience of animal welfare certified eggs decreased while the number of those who answered 'Have ever seen' and 'Have eaten' increased. The answer of purchasing animal welfare certified eggs at department stores, organic farming cooperatives, and internet shopping malls was higher than that of buying conventional eggs. Of the total respondents, 92.0% were willing to purchase an animal welfare egg before the price was offered, but after offering the prices of animal welfare eggs, the intention to purchase was 62.7%, which was about 30%p lower than before. The reason for purchasing an animal welfare certified egg was the highest score of 71.0% for 'I think it is likely to be high in food safety', and 38.1% for 'I think the price is high' for lack of intention to purchase. In the sensory evaluation of animal welfare eggs, egg color and skin texture of conventional eggs were significantly higher than those of certified welfare eggs (P<0.05), and boiled eggs showed that egg whites of animal welfare certified eggs were more (P<0.05). As a result, the results of this study will contribute to the activation of the animal welfare certification system for laying hens by providing basic data on consumer awareness to animal welfare certified farmers.

Clinicopathologic features of Acute Interstitial Pneumonia (급성 간질성 폐렴의 임상적 고찰)

  • Shim, Jae-Jeong;Park, Sang-Muyn;Lee, Sang-Hwa;Lee, Jin-Gu;Cho, Jae-Yun;Song, Gwan-Gyu;In, Kwang-Ho;Yoo, Se-Hwa;Kang, Kyung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.58-66
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    • 1995
  • Background: Acute interstitial pneumonia is a relatively rare form of interstitial pneumonia, since the vast majority of interstitial pneumonia have a more chronic course. It corresponds to the lesion described by Hamman and Rich, as Hamman-Rich disease in 1944. Another name in the clinical literature is accelerated interstitial pneumonia, idiopathic acute respiratory distress syndrome (idiopathic ARDS), and the organizing stage of diffuse alveolar damage. Acute interstitial pneumonia differs from chronic interstitial pneumonia by clinical and pathologic features. Clinically, this disease is characterized by a sudden onset and a rapid course, and reversible disease. Method and Purpose: Five cases of pathologically proven acute interstitial pneumonia were retrospectively studied to define the clinical, radiologic, and pathologic features. Results: 1) The five cases ranged in age from 31 to 77 years old. The onset of illness was acute in all patients, it began with viral-like prodrome 6~40 days prior to shortness of breath, and respiratory failure eventually developed in all patients. In 2 cases, generalized skin rash was accompanied with flu-like symptoms. Etiologic agent could not be identified in any case. 2) All patients had leukocytosis and severe hypoxemia. Pulmonary function test of 3 available cases shows restrictive ventilatory defect, and one survived patient(case 5) has a complete improvement of pulmonary function after dismissal. 3) Diffuse bilateral chest infiltrates were present radiologically. Theses were the ground-glass, consolidation, and reticular densities without honeycomb fibrosis in all patients. The pathologic abnormalities were the presence of increased numbers of macrophages and the formation of hyaline membranes within alveolar spaces. There was also interstitial thickening with edema, proliferation of immature fibroblast, and hyperplasia of type II pneumocyte. In the survived patient(case5), pathologic findings were relatively early stage of acute interstitial pneumonia, such as hyaline membrane with mild interstitial fibrosis. 4) Of the 5 patients, four patients died of respiratory failure 14~90 days after onset of first symptom, and one survived and recovered in symptoms, chest X ray, and pulmonary function test Conclusion: These results emphasize that acute interstitial pneumonia is clinically, radiologically, and pathologically distinct form of interstitial pneumonia and should be separated from the group of chronic interstitial pneumonia. Further studies will be needed to evaluate the pathogenesis and the treatment of acute interstitial pneumonia.

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A Survey on Physical Complaints Related with Farmers' Syndrome of Vinylhouse and Non-vinylhouse Farmers (비닐하우스 재배농민과 일반농민의 농부증 관련 신체증상 호소율 조사)

  • Lee, Ju-Young;Park, Jung-Han;Kim, Doo-Hie
    • Journal of Preventive Medicine and Public Health
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    • v.27 no.2 s.46
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    • pp.258-273
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    • 1994
  • To compare the physical complaints of vinylhouse farmers with those of non-vinylhouse farmers, a personal interviews on 250 vinylhouse and 142 non-vinylhouse farmers were conducted in Sungjoo county in Kyungpook province selected by a random sampling from July 5 to July 10, 1993. Blood pressure of the subjects was also measured. Vinylhouse farmers had a higher average age, larger family size, shorter experience of farming, more working hours per day and working days per year and higher annual income than the non-vinylhouse farmers. The frequency of pesticide spray of the vinylhouse farmers was 3.4 times on the average in June 1993 as compared with 2.0 times of non-vinylhouse farmers, and 16.7 times for the vinylhouse farmers during the last one year while it was 8.3 times for the non-vinylhouse farmers in the same period. While 39.6% of vinylhouse farmers experienced pesticide intoxication symptoms such as headache, nausea, vomiting, dizziness, itching, and skin irritation, etc. during the month of June, 25.4% of non-vinylhouse farmers experienced such symptoms. The most frequent symptoms among eight symptoms that constitute the farmers' syndrome were lumbago, numbness of hand or foot, shoulder pain and dizziness regardless of sex and type of farming. Prevalence of the farmers' syndrome in male and female among vinylhouse farmers were 22.1%, 43.4%, respectively, and the prevalence in non-vinylhouse farmers was 23.2% for male and 50.7% for female. There was no statistically significant difference in the prevalence of farmers' syndrome between vinylhouse and non-vinylhouse farmers. However, the prevalence in female was about 2 times higher than that of male. When the effects of other factors were adjusted by multiple logistic regression for farmers' syndrome, the prevalence in female was 3.0 times higher than that of male. The prevalence of farmers' syndrome was increased as the age of farmers increased in both vinylhouse and non-vinylhouse farmers, and adjusted odds ratio of farmers' syndrome increased by 3% as the age increased by 1 year. Adjusted odds ratio for Farmers' syndrome in farmers who experienced pesticide intoxication during the month of June was 3.1 times higher than that of farmers who did not have such experience. While the prevalence of hypertension in male and female non-vinylhouse farmers were 22.4%, 13.7%, respectively, the prevalence in vinylhouse farmers were 13.5% for male and 12.0% for female. However, there was no association between farmers' syndrome and hypertension. It was found in this study that the vinylhouse farmers are at a high risk of pesticide intoxication, which is associated with tile common physical complaints. To reduce such risk it is necessary to develop farming methods which do not require the pesticide or may use less pesticide, a safer method of pesticide spraying, and the protective equipments which can be worn at a high temperature and have a better protective effect. Also education of farmers for the correct methods of ventilation after pesticide spraying in the vinylhouse and wearing the protective equipments may be considered as a supportive method. Since inappropriate posture at work and intensive labor may cause farmers' syndrome, it is recommended to develop farming tools which reduce physical burden and take a rest and exercise periodically during work. It is necessary to strengthen the hypertension management program of the Kyungpook province, because the prevalence of hypertension was as high as about 15%.

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Study for Treatment Effects and Prognostic Factors of Bronchial Asthma -Follow Up Over 2 Years- (2년 이상 관찰중인 성안 기관지 천식환자의 치료 효과 및 예후인자에 관한 연구)

  • Choung, Bo-Young;Park, Jung-Won;Kim, Sung-Kyu;Hong, Chein-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.3
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    • pp.559-573
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    • 1997
  • Background : Asthma causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough. These symptoms are usually associated with widespread but variable airflow limitation that is partly reversible either spontaneously or with treatment. The inflammation also causes an associated increase in airway responsiveness to a variety of stimuli. Method : Of the 403 adult bronchial asthma patients enrolled from March 1992 to March 1994 in Allergy Clinics of Severance Hospital in Yonsei University, this study reviewed the 97 cases to evaluate the treatment effects and to analyse prognostic factors. The patients were classified to five groups according to treatment responses ; group 1 (non control group) : patients who were not controlled during following up, group 2 (high step treatment group) : patients who were controlled longer than 3 months by step 3 or 4 treatment of "Global initiative for asthma, Global strategy for asthma management and prevention" (NHLBI/WHO) with PFR(%) larger than 80%, group 3 (short term control group) : patients who were controlled less than 1 year by step 1 or 2 treatment of NHLBI/WHO, group 4 (intermediate term control group) : patients who were controlled for more than 1 year but less than 2 years by step 1 or 2 treatment of NHLBI/WHO, group 5 (long term control group) : patients who were controlled for more than 2 years by step 1 or 2 treatment of NHLBI/WHO. Especially the patients who were controlled more than 1 year with negatively converted methacholine test and no eosinophil in sputum were classified to methacholine negative conversion group. We reviewed patients' history, atopy score, total IgE, specific IgE, methacholine PC20 and peripheral blood eosinophil count, pulmonary function test, steroid doses and aggrevation numbers after treatment. Results : On analysis of 98 patients, 20 cases(20.6%) were classified to group 1, 26 cases(26.8%) to group 2, 23 cases(23.7%) to group 3, 15 cases(15.5%) to group 4, and 13 cases(13.4%) to groups 5. There were no differences of sex, asthma type, family history, smoking history, allergic rhinitis and aspirin allergy among the groups. In long term control group, asthma onset age was younger, symptom duration was shorter, and initial pulmonary function was better. The long term control group required lower amounts of oral steroid. had less aggrevation during first 3months after starting treatment and shorter duration from enrollment to control Atopy, allergic skin test, sputum and blood eosinophil, total IgE, nonspecific bronchial responsiveness was not significantly different among the groups. Seven out of 28 patients who were controlled more than 1 years showed negatively converted methachloine test and no eosinophils in the sputum. The mean control duration was $20.3{\pm}9.7$ months and relapse did not occur. Conclusion : Patients who had asthma of onset age younger, shorter symptom duration, better PFT, lower treatment initial steps, lower amounts of steroid needs and less aggravation numbers after starting treatment were classified in the long term control groups compared to the others.

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The Three Types of Clinical Manifestation of Cow's Milk Allergy with Predominantly Intestinal Symptoms (위장관 증세 위주로 발현하는 영유아기 우유 알레르기 질환의 3가지 임상 유형에 관한 고찰)

  • Lee, Jeong-Jin;Lee, Eun-Joo;Kim, Hyun-Hee;Choi, Eun-Jin;Hwang, Jin-Bok;Han, Chang-Ho;Chung, Hai-Lee;Kwon, Young-Dae;Kim, Yong-Jin
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.3 no.1
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    • pp.30-40
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    • 2000
  • Purpose: During the first year of life, cow's milk protein is the major offender causing food allergy. Cow's milk allergy (CMA) affects 2~7% of infants, of which approximately one-half show predominantly gastrointestinal symptoms. We studied the clinical types of cow's milk allergy with predominantly gastrointestinal symptoms (CMA-GI) of childhood. Methods: The retrospective study was performed on 30 (male 22, female 8) patients who had diagnosed as CMA-GI during 2 years and 3 months from March 1995 to June 1997. Results: 1) Children with CMA-GI presented in the three types of clinical manifestation on the basis of time to reaction to milk ingestion: Quick (Q) onset (5 cases), Slow (S) onset (20 cases), Quick & Slow (Q&S) (5 cases). 2) Age on admission of the three groups was significantly different (p<0.05): (Q onset: $81.4{\pm}67.1$ days, S onset: $31.9{\pm}12.7$ days, Q&S: $366.0{\pm}65.0$ days). Although the body weight at birth was 10~95 percentile in all patients, body weight on admission was different: (Q onset: 10~50 percentile, S onset: below 10 percentile, Q&S: 10~25 percentile). S onset group was significantly different compared with other groups (p<0.05) and 90% of this one was failure to thrive below 3 percentile. 3) Peripheral leukocyte counts were as followings: (Q onset: $5,700{\sim}12,300/mm^3$, S onset: $10,000{\sim}33,400/mm^3$, Q&S: $5,200{\sim}14,900/mm^3$). Slow onset group was significantly different compared with other groups (p<0.05). Serum albumin levels on admission were as followings: (Q onset: $4.2{\pm}0.4\;g/dl$, S onset: $3.0{\pm}0.3\;g/dl$, Q&S: $4.0{\pm}0.3\;g/dl$). S onset group was significantly different compared with other groups (p<0.05) and 85% of this one was below 3.5 g/dl. 4) Although morphometrical analysis on small intestinal mucosa did not show enteropathy in Q onset and Q&S groups, all cases of S onset revealed enteropathy: 45% of this one showed subtotal villous atrophy, 55 % showed partial villous atrophy. 5) Allergic reaction test to other foods was not performed in S onset group because of ethical problem and high risk in general condition. In Q onset group, allergic reaction to one or two other foods: soy formula, weaning formula and eggs. Q&S goup revealed allergic reactions to several foods or to most of all foods except protein hydrolysate formula: eggs, potatos, some kinds of sea food, apples, carrots, beef and chicken. 6) Serum IgE level, peripheral eosinophil counts, milk RAST, soy RAST, skin test were not significantly different among groups. Conclusion: CMA-GI may present in three clinical ways on the basis of time to reaction to milk ingestion, typical clinical findings and morphologic changes in the small bowel mucosal biopsy specimens. This clinical subdivision might be helpful in diagnostic and therapeutic approaches in CMA-GI. Early suspicion is mandatory especially in S onset type because of high risks with malnutrition and enteropathy.

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