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Diagnostic Approach to the Solitary Pulmonary Nodule : Reappraisal of the Traditional Clinical Parameters for Differentiating Malignant Nodule from Benign Nodule (고립성 폐결절에 대한 진단적 접근 : 악성결절과 양성결절의 감별 지표에 대한 재검토)

  • Kho, Won Jung;Kim, Cheol Hyeon;Jang, Seung Hun;Lee, Jae Ho;Yoo, Chul Gyu;Chung, Hee Soon;Kim, Young Whan;Han, Sung Koo;Shim, Young-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.4
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    • pp.500-518
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    • 1996
  • Background : The solitary pulmonary nodule(SPN) presents a diagnostic dilemma to the physician and the patient. Many clinical characteristics(i.e. age, smoking history, prior history of malignancy) and radiological characteristics( i.e. size, calcification, growth rate, several findings of computed tomography) have been proposed to help to determine whether the SPN was benign or malignant. However, most of these diagnostic guidelines are based on the data collected before computed tomography(CT) has been introduced and lung cancer was not as common as these days. Moreover, it is not well established whether these guidelines from western populations could be applicable to Korean patients. Methods : We had a retrospective analysis of the case records and radiographic findings in 114 patients presenting with SPN from Jan. 1994 to Feb. 1995 in Seoul National University Hospital, a tertiary referral hospital. Results : We observed the following results ; (1) Out of 113 SPNs, the etiology was documented in 94 SP IS. There were 34 benign SP s and 60 malignant SPNs. Among which, 49 SPNs were primary lung cancers and the most common hi stologic type was adenocarcinoma. (2) The average age of patients with benign and malignant SPNs was $49.7{\pm}12.0$ and $58.1{\pm}10.0$ years, respectively( p=0.0004), and the malignant SPNs had a striking linear propensity to increase with age. (3) No significant difference in the hi story of smoking was noted between the patients with benign SPNs($13.0{\pm}17.6$ pack- year) and those with malignant SPNs($18.6{\pm}25.1$ pack-year) (p=0.2108). (4) 9 out of 10 patients with prior history of malignancy had malignant SPNs. 5 were new primary lung cancers with no relation to prior malignancy. (5) The average size of benign SPNs($3.01{\pm}1.20cm$) and malignant SPNs($2.98{\pm}0.97cm$) was not significantly different(p=0.8937). (6) The volume doubling time could be calculated in 22 SPNs. 9 SPNs had the volume doubling time longer than 400 days. Out of these, 6 were malignant SPNs. (7) The CT findings suggesting malignancy included the lobulated or spiculated border, air- bronchogram, pleural tail, and lymphadenopathy. In contrast, calcification, central low attenuation, cavity with even thickness, well-marginated border, and peri nodular micronodules were more suggestive for benign nodule. (8) The diagnostic yield of percutaneous needle aspiration and biopsy was 57.6%(19/33) of benign SPNs and 81.0%(47/58) of malignant SPNs. The diagnostic value of sputum analysis and bronchoscopic evaluations were relatively very low. (9) 42.3%(11/26) of SPNs of undetermined etiology preoperatively turned out to be malignant after surgical resection. Overall, 75.4%(46/61) of surgically resected SPNs were malignant. Conclusions : We conclude that the likelihood of malignant SPN correlates the age of patient, prior history of malignancy, some CT findings including lobulated or spiculated border, air-bronchogram, pleural tail and lymphadenopathy. However, the history of smoking, the size of the nodule, and the volume doubling time are not helpful to determent whether the SPN is benign or malignant, which have been regarded as valuable clinical parameters previously. We suggest that aggressive diagnostic approach including surgical resection is necessary in patient with SPNs.

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A Study on Jeong Su-yeong's Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers through the Lens of Boating and Mountain Outings (선유(船遊)와 유산(遊山)으로 본 정수영(鄭遂榮)의 《한임강유람도권》 고찰)

  • Hahn, Sangyun
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.96
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    • pp.89-122
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    • 2019
  • In this paper, I argue that the Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers by Jeong Su-yeong (1743~1831, pseudonym: Jiwujae) is a record of his private journeys to several places on the outskirts of Hanyang (present-day Seoul) and that it successfully embodies the painter's subjective perspective while boating on these rivers and going on outings to nearby mountains. Around 1796, Jeong Su-yeong traveled to different places and documented his travels in this 16-meter-long handscroll. Several leaves of paper, each of which depicts a separate landscape, are pieced together to create this long handscroll. This indicates that the Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers reflected the painter's personal subjective experiences as he went along his journey rather than simply depicts travel destinations. The Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers features two types of travel: boating and mountain outings on foot. Traveling by boat takes up a large portion of the handscroll, which illustrates the channels of the Hangang and Imjingang Rivers. Mountain outings correspond to the sections describing the regions around Bukhansan, Gwanaksan, and Dobongsan Mountains. Jeong Su-yeong traveled to this wide span of places not just once, but several times. The fact that the Hangang River system are not presented in accordance with their actual locations shows that they were illustrated at different points. After visiting the riversides of the Hangang and Namhangang Rivers twice, Jeong Su-yeong delineated them in fourteen scenes. Among them, the first eight illustrate Jeong's initial trip by boat, while the other six scenes are vistas from his second trip. These fourteen scenes occupy half of this handscroll, indicating that the regions near the Hangang River are painted most frequently. The scenes of Jeong Su-yeong's first boating trip to the system of the Hangang River portray the landscapes that he personally witnessed rather than famous scenes. Some of the eight scenic views of Yeoju, including Yongmunsan Mountain, Cheongsimru Pavilion, and Silleuksa Temple, are included in this handscroll. However, Jeong noted spots that were not often painted and depicted them using an eye-level perspective uncommon for illustrating famous scenic locations. The scenes of Jeong's second boating trip include his friend's villa and a meeting with companions. Moreover, Cheongsimru Pavilion and Silleuksa Temple, which are depicted in the first boating trip, are illustrated again from different perspectives and in unique compositions. Jeong Su-yeong examined the same locations several times from different angles. A sense of realism is demonstrated in the scenes of Jeong's first and second boating trips to the channels of the Hangang River, which depict actual roads. Furthermore, viewers can easily follow the level gaze of Jeong from the boat. The scenes depicting the Imjingang River begin from spots near the Yeongpyeongcheon and Hantangang Rivers and end with places along the waterways of the Imjingang River. Here, diverse perspectives were applied, which is characteristic of Imjingang River scenes. Jeong Su-yeong employed a bird's-eye perspective to illustrate the flow of a waterway starting from the Yeongpyeongcheon River. He also used an eye-level perspective to highlight the rocks of Baegundam Pool. Thus, depending on what he wished to emphasize, Jeong applied different perspectives. Hwajeogyeon Pond located by the Hantangang River is illustrated from a bird's-eye perspective to present a panoramic view of the surroundings and rocks. Similarly, the scenery around Uhwajeong Pavilion by the Imjingang River are depicted from the same perspective. A worm's-eye view was selected for Samseongdae Cliff in Tosangun in the upper regions of the Imjingang River and for Nakhwaam Rock. The scenes of Jeong Su-yeong's mountain outings include pavilions and small temple mainly. In the case of Jaeganjeong Pavilion on Bukhansan Mountain, its actual location remains unidentified since the pavilion did not lead to the route of the boating trip to the system of the Hangang River and was separately depicted from other trips to the mountains. I speculate that Jaeganjeong Pavilion refers to a pavilion either in one of the nine valleys in Wooyi-dong at the foot of Bukhansan Mountain or in Songajang Villa. Since these two pavilions are situated in the valleys of Bukhansan Mountain, their descriptions in written texts are similar. As for Gwanaksan Mountain, Chwihyangjeong and Ilganjeong Pavilions as well as Geomjisan Mountain in the Bukhansan Mountain range are depicted. Ilganjeong Pavilion was a well-known site on Gwanaksan that belonged to Shin Wi. In this handscroll, however, Jeong Su-yeong recorded objective geographic information on the pavilion rather than relating it to Shin Wi. "Chwihyangjeong Pavilion" is presented within the walls, while "Geomjisan Mountain" is illustrated outside the walls. Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers also includes two small temples, Mangwolam and Okcheonam, on Dobongsan Mountain. The actual locations of these are unknown today. Nevertheless, Gungojip (Anthology of Gungo) by Yim Cheonsang relates that they were sited on Dobongsan Mountain. Compared to other painters who stressed Dobong Seowon (a private Confucian academy) and Manjangbong Peak when depicting Dobongsan Mountain, Jeong Su-yeong highlighted these two small temples. Jeong placed Yeongsanjeon Hall and Cheonbong Stele in "Mangwolam small temple" and Daeungjeon Hall in front of "Okcheonam small temple." In addition to the buildings of the small temple, Jeong drew the peaks of Dobongsan Mountain without inscribing their names, which indicates that he intended the Dobongsan peaks as a background for the scenery. The Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers is of great significance in that it embodies Jeong Su-yeong's personal perceptions of scenic spots on the outskirts of Hanyang and records his trips to these places.

A Study on the Costume Style of Civil Servants' Stone Images Erected at Tombs of the Kings for Yi-dynasty (조선왕조(朝鮮王朝) 왕릉(王陵) 문인석상(文人石像)의 복식형태(服飾形態)에 관한 연구)

  • Kwon, Yong-Ok
    • Journal of the Korean Society of Costume
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    • v.4
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    • pp.87-114
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    • 1981
  • A costume reveals the social characteristics of the era in which it is worn, thus we can say that the history of change of the costume is the history of change of the living culture of the era. Since the Three States era, the costume structure of this country had been affected by the costume system of the China's historical dynasties in the form of the grant therefrom because of geographical conditions, which affection was conspicuous for the bureaucrat class, particularly including but not limited to the Kings' familities. Such a grant of the costume for the bureaucrat class (i.e., official uniform) was first given by the Dang-dynasty at the age of Queen Jinduck, the 28th of the Shilla-dynasty. Since then, the costume for the bureaucrats had consecutively been affected as the ages had gone from the unified Shilla, to the Koryo and to the Yi-dynasty. As the full costumes officially used by government officials (generally called "Baek Gwan") in the Yidynasty, there existed Jo-bok, Gong-bok and Sang-bok. Of such official costumes, Gong-bok was worn at the time of conducting official affairs of the dynasty, making a respectful visit for the expression of thanks or meeting diplomatic missions of foreign countries. It appears no study was made yet with regard to the Gong-bok while the studies on the Jo-bok and the Sangbok were made. Therefore, this article is, by rendering a study and research on the styles of costumes of civil servants' stone images erected at the Kings' tombs of the Yi-dynasty, to help the persons concerned understand the Gong-bok, one of the official costume for Baek Kwan of that age and further purports to specifically identify the styles and changes of the Gong-bok, worn by Baek Gwan during the Yi-dynasty, consisting of the Bok-doo (a hat, four angled and two storied with flat top), Po (gown), Dae (belt), and Hol (small and thin plate which was officially held by the government officials in hand, showing the courtesy to and writing brief memorandums before the King) and Hwa (shoes). For that purpose, I investigated by actually visiting the tombs of the Kings of the Yi-dynasty including the Geonwon-neung, the tomb of the first King Tae-jo and the You-neung, the tomb of the 27th King Soon-jong as well as the tombs of the lawful wives and concubines of various Kings, totalling 29 tombs and made reference to relevant books and records. Pursuant. to this study, of the 29 Kings' tombs the costume styles of civil servants' stone images erected at the 26 Kings' tombs are those of Gong-bok for Baek-gwan of the Yi-dynasty wearing Bok-doo as a hat and Ban-ryeong or Dan-ryenog Po as a gown with Dae, holding Hol in hand and wearing shoes. Other than those of the 26 tombs, the costume styles of the Ryu-neung, the tomb of the Moon-jo who was the first son of 23rd King Soon-jo and given the King's title after he died and of the You-neung, the tomb of the 27th King Soon-jong are those of Jobok with Yang-gwan (a sort of hat having stripes erected, which is different from the Bok-doo), and that of the Hong-neung, the tomb of the 26th King Go-jong shows an exceptional one wearing Yang-gwan and Ban-ryeong Po ; these costume styles other than Gongbok remain as the subject for further study. Gong-bok which is the costume style of civil servants' stone images of most of the Kings' tombs had not been changed in its basic structure for about 500 years of the Yi-dynasty and Koryo categorized by the class of officials pursuant to the color of Po and materials of Dae and Hol. Summary of this costume style follows: (1) Gwan-mo (hat). The Gwan-mo style of civil servants' stone images of the 26 Kings' tombs, other than Ryu-neung, Hong-neung and You-neung which have Yang-gwan, out of the 29 Kings' tombs of the Yi-dynasty reveals the Bok-doo with four angled top, having fore-part and back-part divided. Back part of the Bok-doo is double the fore-part in height. The expression of the Gak (wings of the Bokdoo) varies: the Gyo-gak Bok-doo in that the Gaks, roundly arisen to the direction of the top, are clossed each other (tombs of the Kings Tae-jong), the downward style Jeon-gak Bok-doo in that soft Gaks are hanged on the shoulders (tombs of the Kings Joong-jong and Seong-jong) and another types of Jeon-gak Bok-doo having Gaks which arearisen steeply or roundly to the direction of top and the end of which are treated in a rounded or straight line form. At the lower edge one protrusive line distinctly reveals. Exceptionally, there reveals 11 Yang-gwan (gwan having 11 stripes erected) at the Ryu-neung of the King Moon-jo, 9 Yang-gwan at the Hong-neung of the King Go-jong and 11 Yang-gwan at the You-neung of the King Soon-jong; noting that the Yang-gwan of Baek Kwan, granted by the Myeong-dynasty of the China during the Yi-dynasty, was in the shape of 5 Yang-gwan for the first Poom (class) based on the principle of "Yideung Chaegang" (gradual degrading for secondary level), the above-mentioned Yang-gwans are very contrary to the principle and I do not touch such issue in this study, leaving for further study. (2) Po (gown). (a) Git (collar). Collar style of Po was the Ban-ryeong (round collar) having small neck-line in the early stage and was changed to the Dan-ryeong (round collar having deep neck-line) in the middle of the: dynasty. In the Dan-ryeong style of the middle era (shown at the tomb of the King Young-jo); a, thin line such as bias is shown around the internal side edge and the width of collar became wide a little. It is particularly noted that the Ryu-neung established in the middle stage and the You-neung in the later stage show civil servants in Jo-bok with the the Jikryeong (straight collar) Po and in case of the Hong-neung, the Hong-neung, the tomb of the King Go-jong, civil servants, although they wear Yang-gwan, are in the Ban-ryeong Po with Hoo-soo (back embroidery) and Dae and wear shoes as used in the Jo-bok style. As I could not make clear the theoretical basis of why the civil servants' costume styles revealed, at these tombs of the Kings are different from those of other tombs, I left this issue for further study. It is also noted that all the civil servants' stone images show the shape of triangled collar which is revealed over the Godae-git of Po. This triangled collar, I believe, would be the collar of the Cheomri which was worn in the middle of the Po and the underwear, (b) Sleeve. The sleeve was in the Gwan-soo (wide sleeve) style. having the width of over 100 centimeter from the early stage to the later stage arid in the Doo-ri sleeve style having the edge slightly rounded and we can recognize that it was the long sleeve in view of block fold shaped protrusive line, expressed on the arms. At the age of the King Young-jo, the sleeve-end became slightly narrow and as a result, the lower line of the sleeve were shaped curved. We can see another shape of narrow sleeve inside the wide sleeve-end, which should be the sleeve of the Cheom-ri worn under the Gong-bok. (c) Moo. The Moo revealed on the Po of civil servants' stone images at the age of the King Sook-jong' coming to the middle era. Initially the top of the Moo was expressed flat but the Moo was gradually changed to the triangled shape with the acute top. In certain cases, top or lower part of the Moo are not reveald because of wear and tear. (d) Yeomim. Yeomim (folding) of the Po was first expressed on civil servants' stone images of the Won-neung, the tomb of the King Young-jo and we can seemore delicate expression of the Yeomim and Goreum (stripe folding and fixing the lapel of the Po) at the tomb of the Jeongseong-wanghoo, the wife of the King Young-jo, At the age of the King Soon-jo, we can see the shape of Goreum similar to a string rather than the Goreum and the upper part of the Goreum which fixes Yeomim was expressed on the right sleeve. (3) Dae. Dae fixed on the Po was placed half of the length of Po from the shoulders in the early stage. Thereafter, at the age of the King Hyeon-jong it was shown on the slightly upper part. placed around one third of the length of Po. With regard to the design of Dae, all the civil servants' stone images of the Kings' tombs other than those of the Geonwon-neung of the King Tae-jo show single or double protrusive line expressed at the edge of Dae and in the middle of such lines, cloud pattern, dangcho (a grass) pattern, chrysanthemum pattern or other various types of flowery patterns were designed. Remaining portion of the waist Dae was hanged up on the back, which was initially expressed as directed from the left to the right but thereafter expressed. without orderly fashion,. to the direction of the left from the right and vice versa, Dae was in the shape of Yaja Dae. In this regard, an issue of when or where such a disorderly fashion of the direction of the remaining portion of waist Dae was originated is also presented to be clarified. In case of the Ryuneung, Hong-neung and You-neung which have civil servants' stone images wearing exceptional costume (Jo-bok), waist Dae of the Ryu-neung and Hong-neung are designed in the mixture of dual cranes pattern, cosecutive beaded pattern and chrvsenthemum pattern and that of You-neung is designed in cloud pattern. (4) Hol. Although materials of the Hol held in hand of civil servants' stone images are not identifiable, those should be the ivory Hol as all the Baek Gwan's erected as stone images should be high class officials. In the styles, no significant changes were found, however the Hol's expressed on civil servants' stone images of the Yi-dynasty were shaped in round top and angled bottom or round top and bottom. Parcicularly, at the age of the King Young-jo the Hol was expressed in the peculiar type with four angles all cut off. (5) Hwa (shoes). As the shoes expressed on civil servants' stone images are covered with the lower edges of the Po, the styles thereof are not exactly identifiable. However, reading the statement "black leather shoes for the first class (1 Poom) to ninth class (9 Poom)," recorded in the Gyeongkook Daejon, we can believe that the shoes were worn. As the age went on, the front tips of the shoes were soared and particularly, at the Hong-neung of the King Go-jong the shoes were obviously expressed with modern sense as the country were civilized.

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