• Tuberculosis and Respiratory Diseases
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• v.58 no.3
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• pp.257-266
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• 2005

Background : The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. Patients and Methods : From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. Results : The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>0.05). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce phalosporin had been infused. Conclusion : Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

• Tuberculosis and Respiratory Diseases
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• v.58 no.3
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• pp.230-242
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• 2005

Background : Spirometry should be compared with the normal predictive values obtained from the same population using the same procedures, because different ethnicity and different procedures are known to influence the spirometry results. This study was performed to obtain the normal predictive values of the Forced Vital Capacity(FVC), Forced Expiratory Volume in 1 Second($FEV_1$), Forced Expiratory Volume in 6 Seconds($FEV_6$), and $FEV_1/FVC$ for a representative Korean population. Methods : Based on the 2000 Population Census of the National Statistical Office of Korea, stratified random sampling was carried out to obtain representative samples of the Korean population. This study was performed as a part of the National Health and Nutrition Survey of Korea in 2001. The lung function was measured using the standardized methods and protocols recommended by the American Thoracic Society. Among those 4,816 subjects who had performed spirometry performed, there was a total of 1,212 nonsmokers (206 males and 1,006 females) with no significant history of respiratory diseases and symptoms, with clear chest X-rays, and with no significant exposure to respiratory hazards subjects. Their residence and age distribution was representative of the whole nation. Mixed effect models were examined based on the Akaike's information criteria in statistical analysis, and those variables common to both genders were analyzed by regression analysis to obtain the final equations. Results : The variables affecting the normal predicted values of the FVC and $FEV_6$ for males and females were $age^2$, height, and weight. The variables affecting the normal predicted values of the $FEV_1$ for males and females were $age^2$, and height. The variables affecting the normal predicted values of the $FEV_1/FVC$ for male and female were age and height. Conclusion : The predicted values of the FVC and $FEV_1$ was higher in this study than in other Korean or foreign studies, even though the difference was < 10%. When compared with those predicted values for Caucasian populations, the study results were actually comparable or higher, which might be due to the stricter criteria of the normal population and the systemic quality controls applied to the whole study procedures together with the rapid physical growth of the younger generations in Korea.

• Progress in Medical Physics
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• v.20 no.4
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• pp.308-316
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• 2009

To achieve the accurate evaluation of given absorbed dose from output dose of linear accelerator photon beam through investigate the characteristics of LiF:Mg,Cu,P TLD powder. This experimental TL phosphor is performed with a commercial LiF:Mg,Cu,P powder (Supplied by PTW) and TL reader (LTM, France). The TLD was exposed to 6 MV X rays of linear accelerator photon beam with range 15 to 800 cGy in blind dose at two hospitals. The dose evaluation of TLD was through the experimental algorithms which were dose dependency, dose rate dependency, fading and powder weight dependency. The glow curve has shown the three peaks which are 110, 183 and 232 degrees of heating temperature and the main dosimetric peak showed highest TL response at 232 high temperature. In this experiments, the LiF:Mg,Cu,P phosphor has shown the 2.5 eV of electron trap energy with a second order. This experiments guided the dose evaluation accuracy is within 1% +2.58% of discrepancy. The TLD powder of LiF:Mg,Cu,P was analyzed to dosimetric characterists of electron captured energy and order by glow shape, and dose-TL response curve guided the accuracy within 1.0+2.58% of output dose discrepancy.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.350-354
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• 2009

Background: Complicated pleural space occupying lesions (SOL) have been treated by thoracentesis, closed thoracotomy drainage (CTD) or surgical intervention with using a video thoracosocpe or open thoracotomy depending on the extent of the disease. With the development of video assisted thoracoscopic surgery (VATS), VATS pleural adhesiolysis and decortication have revealed good results as compared to those for open thorcotomy. To assess the effectiveness of VATS pleural adhesiolysis and decortication, we retrospectively analyzed the medical record and radiologic findings of the patients with complicated pleural SOL and who were treated by this surgery. Material and Method: From May 1996 to April 2006, 64 patients (mean age: 41.8 years) with complicated pleural SOL underwent 65 VATS. To analyze the surgical outcome, we classified the postoperative findings on the simple chest X-rays into 4 classes as Class I: no or minimal pleural lesion, Class II: blunting of the cardiophrenic angle and mild pleural thickening, Class III: an elevated diaphgram or persistent lung collapse and Class IV: complicated or recurrent effusion. Result: Before VATS, the patients underwent the diagnostic or therapeutic procedures: single or repeat diagnostic tapping for 41, thoracoscotomy drainage for 11, pigtail catheter drainage for 10 and intrapleural fibrinolytics for 10. The mean duration between the onset of symptom and surgery was 18.4 days. There was neither mortality nor severe complications. The surgical outcomes were class 1 for 28, class 2 for 13, class 3 for 19 and class 4 for 5. There were statistically significant differences between the symptom duration and the classes, and between the operation time and the classes. Conclusion: VATS pleural adhesiolysis and decortication are effective, safe treatments for managing complicated pleural SOL, and an earlier operation is needed for obtaining a better surgical outcome.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.290-295
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• 2002

Backgroud: Pneumonectomy carries the possibility of numerous dangerous complications as well as the vast effect the operation itself has on the cardiopulmonary function. Most of operations are done with the insertion of the chest tubes upon completion, but because of the high incidence of pyothorax as its complications, we have tried to analyze and compare the cases without inserting the chest tubes. Material and Method: During a 5 year period from January, 1996 to December 2000, 100 cases, which were operated at the Hanyang University Hospital, were selected using the patient's charts. The age, gender, indication of operation, associated diseases, and operation site(left or right) were classified accordingly and the postoperative complications and mortality were statistically analyzed using the $\chi$ 2-test. After resecting the lung, the intrathoracic pressure was set at -15 ~ -20cm $H_2O$ using the nelaton catheter, and the thoracotomy site was then closed. The gradual collection of the fluid and blood in the thorax of the operated side, as well as the mediastinum location, were observed carefully for 4~5 days postoperatively with the aid of the simple chest x-rays. Result: Of the 100 cases, 16 cases of pulmonary tuberculosis(16%), 81 cases of lung tumor(81%), 2 cases of bronchiectasis(2%), and 1 case of aspergilloma associated bronchiectasis were noted. There were 8 mortality cases(8%), and of the 34 cases(34%), 44 complications were noted. The age, sex, and operation site(left or right) were not statistically significant with the complications. 7 of the 16 cases of pulmonary tuberculosis(44%) and 27 of the 81 cases of lung tumor(33%) had complications, but they were found not to be statistically significant. The increase of the complication rate in the pulmonary tuberculosis patients was 3.86. The evidence of postoperative bleeding was observed in 6 cases with the 3 cases being the pulmonary tuberculosis patients and the 3 cases were others. This shows that the increase in postoperative bleeding in the pulmonary tuberculosis is statistically significant(p=0.019). Of the 100 cases, there were 8 mortality cases(8%), with 5 cases from the 81 cases of the lung tumor group(6.1%), 3 cases from the 16 cases of pulmonary tuberculoses group(18.7%).

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1063-1069
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• 1998

Background: Multi-loculated empyema makes treatment difficult, and more so when thoracentesis or chest tube drainage fails. Materials and methods: From December 1991 to December 1997, we performed closed rib resectional drainage for 18 cases of loculated empyema on the fibrinopurulent or early chronic phase. Results: Surgery was performed on patients with loculated empyema complaining of persistent symptoms due to failure of treatment by thoracentesis(8 cases) or chest tube drainage(10 cases). Predisposing factors of empyema were pneumonia in 13 cases, clotted hemothorax in 3 cases, cholecystectomy, and tuberculous pleurisy in 1 case. Causal organisms were cultured in 8 cases(42.1%), and methicillin-resistant staphylococcus aureus was found in 3 cases, pseudomonas aeruginosa in 2 cases, and enterococcus aerogens, α-hemolytic streptococcus, and acinetobacter baumannii were found in 1 case. Size of loculations was various, and computed chest tomogram showed multiple loculations of empyema numbering 1∼4(mean 1.78±1.00). Operating time was relatively short, about 55∼140 mins(mean 102.8±30.8). All toxic symptoms including fever disappeared postopratively and general conditions improved very quickly in all patients. Length of chest tube indwelling time and hospital stay after surgery were 3∼42 days(mean 11.4±11.5) and 6∼36 days(mean 12.9±8.1), respectively. Complications of prolonged drainage occurred in 2 cases and no death occurred. There were no recurrences and chest x-rays taken 3∼6 months after surgery showed normal findings in 14 cases and slight pleural thickening in 4 cases. Conclusions: Closed rib resectional drainage requires very simple techniques and has excellent outcomes and little complications, therefore, we think that it is the choice of operation for patients with loculated empyema on the fibrinopurulent or early chronic phase.

• Tuberculosis and Respiratory Diseases
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• v.47 no.1
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• pp.77-89
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• 1999

Background: High-dose chemotherapy is increasingly employed in many refractory malignant diseases. This therapy has been reported to increase response rate and survival benefits but it is also associated with higher treatment-related morbidity and mortality. We evaluated clinical characteristics and course of the pulmonary toxicity following high-dose chemotherapy with peripheral blood stem cell transplantation. Methods: Ninety-seven patients who had received high-dose chemotherapy with peripheral blood stem cell transplantation were evaluated. Five patients who developed lung lesions which were not related to infection nor primary malignant disease underwent transbronchial lung biopsy. The patients' clinical characteristics, treatments, and prognosis were reviewed retrospectively. Results: Five patients(5.1%) developed idiopathic pneumonia syndrome. The high dose chemotherapy regimens employed were cyclophosphamide, BCNU, and cisplatin in 3 cases, one case of BCNU, etoposide, Ara-C, and cyclophosphamide combination, and a regimen consisting of BCNU, etoposide, Ara-C, and melphalan. The total dose of BCNU used was 300-400 mg/$m^2$ and that of cyclophosphsmide was 6,000 mg/$m^2$. All of 5 patients received radiation therapy before this treatment. After an average duration of 14 weeks (4-26 weeks) of high-dose chemotherapy, patients developed cough, dyspnea and fever. The chest X-rays showed bilateral diffuse infiltration in 3 cases and the focal infiltration in the other 2 cases. All the patients received corticosteroid therapy as a treatment for the lung lesions. Two of them progressed to acute respiratory distress syndrome and died. Three patients recovered without residual lung lesion but one of them died of dilated cardiomyopathy. Conclusion: High-dose chemotherapy with peripheral blood stem cell transplantation especially which containing BCNU regimen may develop idiopathic pneumonia syndrome related to pulmonary toxicity and corticosteroid therapy may be bel1eficial in some cases.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1188-1193
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• 2007

Purpose : The prevalence of rickets in the world is on the rise not only in developing but also in developed countries. In Korea, breastfeeding has increased. There have been few studies on the possible association of rickets with breastfeeding. The purpose of this study was to identify the development and the clinical presentation of subclinical rickets in breastfed infants. Methods : We investigated patients who were breastfed and had hypovitaminosis D in the blood from May 2006 to April 2007, and who were diagnosed with vitamin D deficient rickets from May 2003 to April 2006. We evaluated the results of blood tests, x-rays and other relevant information in the medical record. A questionnaire that included questions on the diet of patients, the mothers activity during pregnancy and place of residence was administered. Results : Twelve patients (66%: male, 34%: female) were enrolled in this study. There were eight in the asymptomatic and four in the symptomatic group. The median age for each group was 8 months (range 4-11 month) and 5.5 months (5-8 month). All patients in the symptomatic group were breastfed until diagnosed. In the asymptomatic group, they were breastfed for four to six months, and then weaned with only thin rice soup and vegetables. Nine patients had a vitamin D concentration below 20 ng/mL and three patients had levels between 20 and 29 ng/mL. Alkaline phosphatase (ALP) and parathyroid hormone (PTH) were elevated in both groups. There were statistically significant $25-OHD_3$ levels in the blood in both groups (P=0.008). Ten of the patients (83%) also had iron deficient anemia. Conclusion : Vitamin D deficiency and subclinical rickets has been identified in Korea. However, the prevalence of this disease has not been determined. The main limitation of this study was the small number of patients and the absence of a control group.

• Progress in Medical Physics
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• v.23 no.3
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• pp.138-144
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• 2012

Dose distribution throughout the clinical organ range of motion was analyzed using a respiratory-motion simulator that was equipped with a polymer gel dosimeter and EBT2 film. The normoxic polymer gel dosimeter was synthesized from gelatin, MAA, HQ, THPC and HPLC. The gel dosimeter and EBT2 film were irradiated with Co-60 gamma rays that were moved along the x-axis and y-axis in ${\pm}1.5cm$ steps at five-second intervals. The field size was $5{\times}5cm^2$. The SSD was 80 cm and set to 10 Gy at a depth of 2 cm. The PDD at a depth of 50 mm was 75.2% in the ion chamber, 82.3% in the static state and 86.1% in the dynamic state in the gel dosimeter. The penumbra for the dynamic state target, which was measured using the gel dosimeter, averaged 10.89 mm, this is a 40.5% increase over the penumbra of the static state target of 7.74 mm. In addition, when measuring with gel dosimetry, the value for the penumbra is 36.6% smaller in the static state and 29.4% smaller in the dynamic state compared to measuring with film. The aim of this study was to investigate the dosimetric properties of a normoxic polymethacrylic acid gel dosimeter in static and dynamic states and to evaluate the potentiality as a relative dosimeter for dynamic therapeutic radiation.

• Progress in Medical Physics
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• v.21 no.1
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• pp.86-92
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• 2010

The purpose of this study was to measure curvature contour skin dose using radiochromic film and TLD for a conventional open field. We also attempted to quantify the degradation of skin sparing associated with use of immobilization devices for high energy photon beams and to calculate the skin dose with a help of Monte Carlo (MC) simulation. To simulate head-and-neck and shoulder treatment, a cylindrical solid water phantom 11 cm in diameter was irradiated with 6 MV x-rays using $40{\times}40\;cm^2$ field at 100 cm source axis distance (SAD) to the center of the phantom. Aquaplastic mesh mask was placed on the surface of the cylindrical phantom that mimicked relevant clinical situations. The skin dose profile was obtained by taking measurements from $0^{\circ}$ to $360^{\circ}$ around the circumference of the cylindrical phantom. The skin doses obtained from radiochromic film were found to be 47% of the maximum dose of $D_{max}$ at the $0^{\circ}$ beam entry position and 61% at the $90^{\circ}$ oblique beam position without the mask. Using the mask (1.5 mm), the skin dose received was 59% at $0^{\circ}$ incidence and 78% at $80^{\circ}$ incidence. Skin dose results were also gathered using thin thermoluminescent dosimeters (TLD). With the mask, the skin dose was 66% at $0^{\circ}$ incidence and 80% at $80^{\circ}$ incidence. This method with the mask revealed the similar pattern as film measurement. For the treatments of the head-and-neck and shoulder regions in which immobilization mask was used, skin doses at around tangential angle were nearly the same as the prescription dose. When a sloping skin contour is encountered, skin doses may be abated using thinner and more perforated immoblization devices which should still maintain immoblization.