• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.15-21
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• 2003

Background : There are many risk factors for osteoporosis in patients with chronic obstructive pulmonary disease(COPD). These include smoking, a low body mass index, insufficient exercise, and the use of glucocortcoids. However, there is lack of data on the incidence of osteoporosis according to the different glucocorticoid administration methods in patients with COPD. This study compared the incidence of osteoporosis according to the different administration methods of glucocorticoid. Methods : A matched case-controlled study (gender, age, cumulative steroid dose and pack-years of smoking) was conducted. Forty-five patients with documented COPD for at least a 3 year duration and a cumulative glucocorticoid dose above 1,000 mg were enrolled in study. The patients were classified into the following three groups. First, fifteen patients received continuous inhaled glucocorticoid with intermittent oral steroids but had no admission history due to an acute exacerbation(Group I). Secondly, fifteen patients received a multiple course of oral steroids with additional inhaled glucocorticoid but had no admission history due to their acute exacerbation(Group II). Lastly, fifteen patients received intermittent oral or inhaled glucocorticoids and had an admission history due to the acute exacerbation with intravenous steroid treatment for at least 2 weeks per year(Group III). The enrolled patients had apulmonary function test and bone densitometry performed at the lumbar spine and femoral neck. Results : The patients from Group III had significantly high incidence of osteoporosis in the lumbar and femoral neck compared to Group I and Group II (p<0.01). Conclusion : The incidence of osteoporosis in patients with COPD appears to be strongly affected by the method of steroid administration. This result suggests that intravenous steroid administration is strongly associated with the risk of osteoporosis.

• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.104-113
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• 2003

Background : Rhinovirus(RV) infections frequently trigger dyspnea and paroxysmal cough in adult patients with asthma and are the most prevalent cause of the common cold. However, the mechanisms of a RV-induced airway inflammation is unclear. Since the RV does not directly destroy the airway epithelium, it is presumed that the immune response to the RV contributes to the pathogenesis of the respiratory symptoms. In order to test this hypothesis, this study characterized the time-sequenced alterations in interleukin(IL)-8 elaboration from the human bronchial epithelial cells and evaluated the role of NF(nuclear factor)-${\kappa}B$ in the RV-induced IL-8 production by pretreating the inhibitors of NF-${\kappa}B$ activation. Methods : The ability of RV-infected human bronchial epithelial cells and BEAS-2B cells to produce the IL-8 was compared with the controls. This study infected BEAS-2B cells with the RV14 obtained from the American Type Culture Collection. The supernatants were harvested from the RV infected BEAS-2B cells and the controls at 2hr, 4hr, 6hr, 12hr, 24hr, 48hr from the inoculation time. This study measured the IL-8 concentration using the ELISA kits. In order to elucidate the role of NF-${\kappa}B$ in the RV-induced IL-8 production, the effect of the NF-${\kappa}B$ inhibitors was evaluated on RV-induced IL-8 production. Results: The BEAS-2B cells produced small amounts of IL-8 that accumulated slowly with time in the culture. The RV was a potent stimulator of the IL-8 proteins production by BEAS-2B human bronchial epithelial cells. Antioxidants, N-acetyl-L-cysteine(NAC),\ and pyrrolidine dithiocarbamate(PDTC), blocked the IL-8 elaboration by the RV-infected BEAS-2B cells, which was dose-dependent, but N-Tosyl-L-phenylalanine chloromethyl ketone(TPCK) did not. Conclusion: Some antioxidants inhibited the RV-induced IL-8 production by blocking the NF-${\kappa}B$, which may have a therapeutic potential in asthma.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.746-753
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• 1998

Background : Cigarette smoking is closely related to both lung cancer and chronic obstructive pulmonary disease. The incidence of lung cancer is higher in patients with obstructive ventilatory impairment than in patients without obstructive ventilatory impairment regardless of smoking. So, obstructive ventilatory impairment is suspected as an independent risk factor of lung cancer. Methods: For the evaluation of the role of obstructive ventilatory impairment as a risk factor of lung cancer, a total of 73 cases comprising 47 cases of malignant and 26 benign solitary pulmonary nodule were analyzed retrospectively. A comparative study of analysis of forced expiratory volume curves and frequencies of obstructive ventilatory impairment were made between cases with malignant and benign nodules. Results: In comparison of vital capacity and parameters derived from forced expiratory volume curve between two groups. VC, FVC and $FEV_1$ were not significantly different. whereas $FEV_1/FVC%$ and FEF 25-75% showed a significant decrease in the cases with malignant nodule. The frequency of obstructive ventilatory impairment determined by pulmonary function test was significantly higher in the cases with malignant nodule(23.4%) than in benign nodule(3.8%). When the risk for lung cancer was examined by the presence or absence of obstructive ventilatory impairment using the logistic regression analysis, the unadjusted relative risk for the lung cancer of obstructive ventilatory impairment was 17.17. When the effect of smoking and age were considered, the relative risk was to 8.13. Conclusion: These findings suggest that an obstructive ventilatory impairment is a risk factor of lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.309-320
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• 1997

Background : There are many suggested methods for the indirect determination of anaerobic threshold(AT) using the changes of ventilatory parameters in response to ventilatory load accompanying the increase of blood lactic acid level during exercise and the threshold derived from them is called ventilatory threshold(VT). They include ventilatory equivalent method(VEM), End-tidal $PO_2$ method($PETO_2$). V-slope method(VSM), and respiratory quotient method(RQ). But in the patients with chronic airway obstruction(CAO), the AT determined by ventilatory methods may not reflect true AT because the patients with CAO show inadequate ventilatory response to the increase of blood lactic acid level during excercise. Methods : For the investigation of detection rate and reliability of above four VT determination methods in the patients with CAO, we performed the symptom-limited and maximal incremental exercise test in 17 patients with CAO and 12 normal controls. The incremental workload was 10 W /min in CAO group and 25 W/min in control group. The reliability of VT in each group was investigated by the calculation of Spearman correlation coefficient. Results : The detection rates of VT were 100% by RQ, 91.7% by both VEM and $POETO_2$, and 83.3% by VSM in normal control group, while 94.1% by RQ, 64.7% by VEM and $PETO_2$, and 83.3% by VSM in CAO group. Good correlations were noted among VEM, $POETO_2$, and VSM except RQ in normal control group. But there was no significant correlation except between VEM and $PETO_2$ in CAO group. Conclusions : RQ is very sensitive but crude and VEM is near similar to $PETO_2$. The clinical usefulness of VT determined by ventilatory method might be limited in patients with severe CAO.

• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.338-349
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• 1999

Polymorphonuclear leukocytes(PMN) are the predominant inflammatory cells recruited in acute lung injury such as adult respiratory distress syndrome, pneumonia and also chronic lung disease such as idiopathic pulmonary fibrosis and pulmonary emphysema. Interleukin-8(IL-8) is an 8,000 D protein produced by many cells and has potent neutrophil chemoattractant and activating properties. The GRO, also called melanoma growth-stimulatory activity(MGSA), referring to a peptide of 73 amino acids, was reported to be mitogenic for cultured human melanoma cells. Mature GRO/MGSA has marked sequence similarity to IL-8. In view of the structural similarities to IL-8, it was of particular interest to test GRO for neutrophil activating and chemotactic properties. We found a significant release of IL-8 and GRO/MGSA from the cultured human umbilical vein endothelial cell(HUVEC) which was stimulated either with TNF$\alpha$ or IL-1$\beta$ and also found the expression of IL-8 and GRO/MGSA mRNA. Neutrophil chemotactic activity was enhanced in accordance with the increased IL-8 and GRO/MGSA. Our study also suggest that the IL-8 is more important in the increased neutrophil chemotactic activity than GRO/MGSA when endothelial cell is stimulated with TNF$\alpha$ or IL-1$\beta$ in vitro.

• Tuberculosis and Respiratory Diseases
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• v.51 no.6
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• pp.540-549
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• 2001

Background : Usual interstitial pneumonia (UIP) is a progressive fibrous lung disease with occasional fatal outcomes. However, the extent and rate of progression varies markedly from one patient to another. As a result, it is difficult to determine the time of the initial treatment and assess the disease activity and course. Fibroblast foci (FF) is well known to synthesize collagen actively by their myofibroblasts component. However, the prognostic value of the FF have not been evaluated in patients with VIP. Therefore this study was undertaken to determine how the number of fibroblastic foci can reflect the disease activity and progression. Methods: Twenty patients with UIP(M : F=13 : 7), who were diagnosed by a surgical lung biopsy. The number of fibroblastic foci was analyzed in terms of its correlation with the clinical manifostations, pulmonary function test, arterial blood gas analysis, and a bronchoalveolar lavage(BAL). Results : The number of fibroblastic foci did not correlate with the various lung function tests and the other clinical parameters. Interestingly, the percentage of neutrophils in the bronchoalveolar lavage fluid did correlate with the quantity of the normalized Vv of FF(r=0.60, p<0.05). The patients were divided into 2 groups, group I and II, arbitrarily, according to the value of the normalized Vv. The clinical parameters and the PIT results were not different between the two groups. In particular, the survival rate between the two groups according to the Kaplan-Meier analysis were not different. Conclusion : A large number of FF does not imply a bad prognosis in patients with UIP.

• Tuberculosis and Respiratory Diseases
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• v.55 no.4
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• pp.388-394
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• 2003

Background : Monoclonal antibodies directed against well-known epitopes on cytokeratin (CK) 8, 18 and 19 (Monototal) have been used in the development of a new diagnostic tool for lung cancer. In the mid-1990s, CK 19 fragments (Cyfra 21-1) became popular and widely used for such diagnosis. This is the first study specifically designed to compare these two markers. Method : The serum levels of CK 8, 18 and 19 were measured using two-site monoclonal/polyclonal immunoradiometric assay kit in 57 healthy adults and 289 patients who were admitted to Seoul National University Hospital from May to September, 2002. The lung cancer group comprised 129 primary lung cancer patients; 116 with non-small cell lung cancer(NSCLC) and 13 with small cell lung cancer (SCLC). The control group comprised 160 non-malignant pulmonary lung disease patients and 57 healthy adults. A total of 166 twin Monototal and Cyfra 21-1 serum assays were obtained; 76 with lung cancer, 70 with non-malignant pulmonary lung disease and 20 healthy adults. Results : The mean serum value of Monototal was $412.47{\pm}455.45U/L$ in NSCLC, $237.08{\pm}145.15U/L$ in SCLC, $126.54{\pm}95.72U/L$ in non-malignant pulmonary lung disease, and $63.68{\pm}31.66U/L$ in healthy adults. The serum values of the lung cancer groups were significantly higher than those of the control group (p<0.01). Using a cut off value of 188U/L, sensitivity and specificity was 66.4% and 81.9% in NSCLC, and 43.8% and 81.9% in SCLC, respectively. The serum levels of CK 8, 18 and 19 were higher in advanced NSCLC than in early stage disease. Conclusion : The serum levels of CK 8, 18 and 19 may be useful in the diagnosis of NSCLC.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.638-645
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• 1993

Objectives: The functional effects of pulmonary resection are dependent on the preexisting function of resected and remaining tissue as well as on the compensatory potential of the remaining tissue. Nowadays, large pulmonary resections are usually applied to lung cancer patients often already compromised by chronic lung disease. It is important to evaluate the pulmonary reserve after lung resection preoperatively in the decision of operability and extent of resection. The aim of this study was to evaluate the changes of pulmonary function after pulmonary resection. Methods: 8 lobectomized and 8 pneumonectomized patients were evaluated. The pulmonary function test was performed preoperatively and in immediate postoperative period and thereafter to 5 years at 3 months interval. Results: 1) The pulmonary function 1 week after operation was significantly low compared with predicted values in, lobectomy and pneumonectomy groups(p<0.05), and improved closely to their predicted values 3 months after operation. 2) The FVC was maintained above predicted value at 6-24 months and similar to predicted value thereafter in lobectomy group. In pneumonectomy group, the FVC maintained similar to predicted value at 6-36 months and improved above its predicted value thereafter. 3) The FEV1 was maintained similar to their predicted values from 6 months to 5 years after operation in both groups. 4) The FEV1/FVC did not change in the course of time in both groups. 5) The FEF25-75% was maintained similar to predicted value at 6-60 months after operation in lobectomy group, but it decreased under predicted value after 1 year in pneumonectomy group. 6) The MVV was maintained similar to predicted value at 6-24 months and decrease thereafter in lobectomy group. In pneumonectomy group, the MVV was maintained at 6-60 months after operation. 7) The differeces in the pulmonary function(FVC, FEV1, FEF25-75%, MVV) between two groups were seen only at 6 months after operation(p<0.05). Conclusion: The pulmonary function was markedly decreased immediately after operation, improved similar to predicted value at 1-3 months, highest at 6 months, and maintained similar to the predicted value to 5 years after pulmonary resection. The difference in the pulmonary function between two groups was the most at 6 months after operation.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.992-999
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• 1998

Background: To correlate the emphysema score for quantification of the overall extent of emphysema in both lungs by CT with physiologic fingings and to get more objective and simple method to assess the extent of emphysema. Method: Thin-section CT and pulmonary function test(PFT) were performed in 17 patients with emphysema (all males, mean age, 62 years). Emphysema score was obtained as percentage of emphysematous lung area, dividing the total area of the emphysema(voxels with attenuation value less than -880, -900, -920HU, respectively) by the overall area of both lungs(voxels with attenuation value less than -400HU) with highlighting voxels using "Density mask" program. Emphysema score was calculated from whole lung(ESV) and 5 representative scans(ESR) using "Density mask", Visual emphysema score(ESV) was obtained by visual assessment from 5 representative scans. Correlation of these emphysema scores(ESW, ESR, ESV) and physiologic findings were performed, comparing the ESW with ESR and ESV. Results: ESW had correlation with DLCO(r=0.53-0.64) and $FEV_1/FVC$(r=0.42-0.57) among PFT parameters. ESR had good correlation with ESW and with PFT parameters as well. ESV did not correlate with PFT parameters except DLCO. Conclusion: CT quantification of emphysema using "density mask" correlated well with physiologic findings. To assess the severity of emphysema, both ESW and ESR are more reliable than ESV, and ESR is recommended in routine practice as it is objective, simple and reliable.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.574-582
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• 1997

Background : Normal humans meet the increased ventilatory need during exercise initially by the increase of tidal volume (TV) and later by the increase of respiratory frequency (Rf). And the inspiratory duty cycle (Ti/Ttot) is also increased more than 50% for the compensation of the decrease of respiratory cycle provoked by the increase of respiratory frequency. The patients with chronic airflow obstruction show rapid and shallow breathing pattern during exercise because of the decreased ventilatory capacity and the increased dead space ventilation. However, the studies about the change of inspiratory duty cycle are only a few and there is no literature about the relationship between the change of inspiratory duty cycle and the degree of airflow obstruction. Methods : The subjects were the twelve patients with chronic airflow obstruction (CAO) and ten normal people. The incremental exercise test was done. The increase of work load was 10 W in CAO group and 25 W in normal control group. The analysis of the results was done by the comparison of the parameters such as minute ventilation (VE), TV, Rf, physiologic dead space (Vd/Vt), and inspiratory duty cycle between the two groups. Each parameters were compared after transformation into % control duration base that means dividing the total exercise time into five fractions and % control duration data were obtained at rest, 20%, 40%, 60%, 80%, and max. Statistical analysis was done by repeated measure ANOVA using SAS program. Results : The changes of VE and TV were significantly different between two groups while the change of Rf was not significant. The decrease of Vd/Vt was significantly low in CAO group. Ti/Ttot was markedly increased from 38.4 + 3.0% at rest to 48.6 + 4.5% at max in normal control group while Ti/Ttot showed little change from 40.5 + 2.2% at rest to 42.6 + 3.5% at max. And the change of inspiratory duty cycle showed highly good correlation with the degree of airflow obstruction (FEV1%). (r=0.8151, p < 0.05). Conclusions : The increase of Ti/Ttot during exercise observed in normal humans is absent in the patients with CAO and the change of Ti/Ttot is well correlated with the degree of airflow obstruction.