• Tuberculosis and Respiratory Diseases
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• v.53 no.5
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• pp.510-518
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• 2002

Background : Bronchial anthracofibrosis (BAF) is a dark black or brown pigmentation of multiple large bronchi associated with a fibrotic stenosis or obliteration that is incidentally found during a diagnostic bronchoscopy some reporters have suggested endobronchial tuberculosis or tuberculous lymphadenitis as a possible cause of BAF. However, some BAF patients do not have any medical history of tuberculosis. The aim of this study was to elucidate the clinical features of simple BAF patients, which were not associated with tuberculosis. Methods : We reviewed the patients' charts retrospectiely and interviewed all BAF patients who were followed up for 1 year or more. Among the 114 BAF patients, 43 patents (38 %) had no associated tuberculosis, cancer and pneumoconiosis. The clinical characteristics, radiological findings and associated pulmonary diseases of these patients were evaluated. Results : Most patients were non-smokers, old aged, housewifes who resided in a farming village. The common respiratory symptoms were dyspnea, cough and hemoptysis. The predominant X-ray findings were a multiple bronchial wall thickening(89%), bronchial narrowing or atelectasis (76%) and a mediastinal lymph node enlargement with/without calcification (78%). Pulmonary function test usually showed mild obstructive ventilatory abnormalities but no patient showed a restrictive ventilatory pattern and the patients were frequently affected with chronic bronchitis(51%), post-obstructive pneumonia(40%) and chronic asthma(4%). Conclusion : Because BAF is frequently associated with chronic bronchitis and obstructive pneumonia as well as tuberculosis, a careful clinical evaluation and accurate differential diagnosis is more essential than empirical anti-tuberculous medication.

• Tuberculosis and Respiratory Diseases
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• v.47 no.1
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• pp.57-65
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• 1999

Backround : Pneumoconiosis is the parenchymal lung disease that results from the inhalation and deposition of dust, usually mineral dust of occupational or environmental origin. Most of the pneumoconiosis can be categorized to coal workers' pneumoconiosis (CWP) in Korea. No effective treatement is currently available, and the therapy for symptomatic CWP is limited to treatment of complication. Therefore authors analyzed and reviewed clinical features and radiological findings of 95 patients with pneumoconiosis for assessing the prognostic factors in disease progression. Method: We reviewed medical records of 95 cases with pneumoconiosis including history, chest X-ray, pulmonary function test, electrocardiography, AFB stain and culture of sputum, and routine blood examination between June 1995 and June 1997 in Seonam University Namkwang Hospital. Results: All of cases are male(mean age, 57.4 years), 91 cases out of them are miners. The mean duration of exposure to dust is 18.8 years. Major clinical symptoms are dyspnea (100%), sputum (71.6%), chest pain (55.8%), cough (23.2%), and hemoptysis (6.3%). 82 % of cases are over Morgan-Seaton Grade 2 in the degree of dyspnea. Small opacity on chest x-ray is 82.1 % and large opacity is 17.9%. Small opacity has tit type (37.2%), q/q type (25.6%) and r/r type (11.5%). B type is 42.2% in large opacity. For the pulmonary function test, restrictive type is 40.3%, mixed type 19.5% and obstructive type 8.3%. The more increasing chest Xray density, the more decreasing $FEV_1$ (p<0.01). 38% of patients show tuberculosis in chest X-ray, 15.8% positive smear of acid fast bacilli in sputum. The prevalence of pulmonary tuberculosis is high in patients with poor clinical condition. The cases with the active pulmonary tuberculosis have severe dyspnea. Expired cases show 100% and 75% of positive pulmonary tuberculosis in chest X-ray and sputum examination, respectively. 75% of expired cases show the chronic cor pulmonale, who died of acute respiratory failure. Conclusion: These findings indicate that tuberculoois infection has a decisive influence on the progress and prognoois of pneumoconioois.

• Clinical and Experimental Pediatrics
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• v.46 no.4
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• pp.370-375
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• 2003

Purpose : It has been suggested that the exposure to aeroallergens during early infancy after birth is important in the subsequent development of sensitization and allergic diseases. In Korea, the level of house dust mites as one of the important aeroallergens is known to be the highest in autumn. The aim of this study was to test whether the distribution of month of birth bears a relationship to the presence of mite sensitization in children with respiratory allergy. Methods : Skin prick tests and methacholine provocation tests were performed on 1,327 patients with chronic respiratory symptoms who visited Seoul National University Children's Hospital from January 1995 to May 2002. An analysis of patients' month of birth distribution according to the presence of mite sensitization was performed. Results : Atopic subjects who had at least one positive skin test numbered 864(65.1%); and non-atopic subjects numbered 463(34.9%). Among atopic subjects, 787(59.3%) had positive skin tests to mites and 77(5.8%) had positive skin test only to minor allergens. A significantly greater than expected number of mite atopic subjects were born in the months between August and November(P=0.03), however, the birth month of non-atopic subjects didn't show a consistent seasonal preference. Asthma patients numbered 543(40.9%). Among these, atopic asthmatics numbered 421(77.5%) and non-atopic asthmatics, 122(22.5%). Dust-mite atopic asthmatics numbered 387(91.9%) out of 421 atopic asthmatics. Dust-mite atopic asthmatics were born significantly higher in the season lasting from August to November in comparison to non-atopic asthmatics(P=0.002). Conclusion : Month of birth seems to be related with sensitization to allergens. Our results show that August to November is the risk period for the development of mite sensitization in Korea.

• Journal of Sasang Constitutional Medicine
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• v.11 no.1
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• pp.119-135
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• 1999

The object of this study is 196 patients who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center during 33 months from January 1996,3 to June 1998,11. We proceeded the judgment of Sasang Constitution by 'Questionnaire of Sasang Constitution Classification(I)' and 'Questionnaire of Sasang Constitution Classification II(QSCCII)'. The following conclusion were made in comparison with Sasang Constitution and Questionnaire about disease and style of symptoms. 1. The subject of "increase of the weight of a body(gain weight), sweatier, the body swelled out, a lame pain, more like fat food, more like salty food", has significant differences in sasang constitution classification. The frequency of Taeeum group is more than that of Soeum group and Soyang group. 2. The subject of "the complextion is bas, uncomfortable feeling in the throat, insomnia, loss of appetite, apt to be fatigued easily, gastralgia what is not connected with food, diarrhea, headache, menorrhalgia, less like fat food, more like fresh food", has significant differences in sasang constitution classification. The frequency of Soeum group is more than that of Taeeum group and Soyang group. 3. It has not significant differences, but the frequency of Soyang group is more than that of Taeeum group and Soeum group in the subject of "the cough in the disease of the respiratory organs, hypomotility of the joint in the disease of the musculo-skeletal systems, menoxenia like menorrhagia and menostaxia and itching sensation of genitals in the disease of the gynecological organs, itching or boil in the dermatological disease", and fewer in the cardio-vascular disease, urinary disease and hematic disease. The frequency of Soeum group is more than that of Taeeum group and Soyang group in the subject of "the general disease of the digestive organs, uncomfortable feeling or pain of the throat in the disease of the respiratory organs, the general hematic disease, numbness or pain of the musculo-skeletal disease, psychical disease in the psychoneurotical disease, menorrhalgia, a lump of the breasts, leukorrhea in the gynecological disease, eruption or urticaria in the dermatological disease, the general visual and auditory disease". The frequency of Taeeum group is more than that of Soyang group and Soeum group in the subject of "a hoarseness in the disease of the respiratory organs, A lame pain of the musculo-skeletal disease, neurotical disease in the psychoneurotical disease, eruption or urticaria in the dermatological disease", and fewer in the the gynecological disease.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.15-23
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• 1992

Background: The prognosis of lung cancer remains poor and early detection and curative surgery is still the most effective treatment for many. In the early detection of lung cancer, sputum cytology and simple chest x-ray are used, but both of these tests are far from being perfect. So we studied the characteristics of patients diagnosed as lung cancer without demonstrable mass lesion on simple chest x-ray to help in the early diagnosis of lung cancer. Methods: We conducted a retrospective study on 11 subjects who were diagnosed as lung cancer at Seoul National University Hospital between August 1986 and June 1989 and had no demonstrable mass lesion on simple chest x-rays. Results: Ten of 11 patients were male, 8 had a history of smoking, most frequent symptoms were sputum, cough, and hemoptysis, and 3 patients either had wheezing or stridor. In 3 of the cases, although there were no mass lesion, there were ill-defined infiltration, major fissure thickening, and fibrostreaky density mimiking tuberculosis where the tumor was eventually found and in one patient tumor was masked by a rib shadow. Also in one case, lateral chest film demonstrated a retrocardiac mass. Both bronchoscopy and computed tomogram were useful in the localization of the tumor. Seven of 11 had relatively early disease (less than StageII). Four of 11 are still alive without any evidence of recurrence between 2 and a half and 4 years after the operation. Conclusion: We conclude that in patients with respiratory symtoms in whom cancer cannot be ruled out, sputum cytology and lateral chest x-rays should be taken and that if necessary further studies like computed tomogram and bronchoscopy should be done to aid in the early diagnosis of lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.60 no.2
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• pp.221-227
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• 2006

Background : Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short- term effects of inhaled corticosteroid on chronic cough Methods : Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler $800{\mu}g/day$ for ten days. The primary outcome measure was a decrease in the cough score after treatment. Results : Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment. Conclusion : Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.

• Tuberculosis and Respiratory Diseases
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• v.62 no.4
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• pp.276-283
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• 2007

Background: A national health care initiative recommends routine spirometry screening of all smokers over age 45 or patients with respiratory symptoms. In response to the recommendation, new, simple, and inexpensive desktop spirometers for the purpose of promoting widespread spirometric screening were marketed. The performance of these spirometers was evaluated in vivo testing with healthy subjects. However, the clinical setting allows spirometric assessment of various pathologic combinations of flow and volume. Objective: The aim of this study was to compare the accuracy of a desktop spirometer to a standard laboratory spirometer, in a clinical setting with pathologic pulmonary function. Method: In a health check-up center, where screening pulmonary funct test was performed using the HI-801 spirometer. Subjects who revealed the ventilation defect in screening spirometry, performed the spirometry again using the standard Vmax spectra 22d spirometer in a tertiary care hospital pulmonary function laboratory. Pulmonary function test with both spirometer was performed according to the guidelines of the American Thoracic Society. Results: 109 patients were enrolled. Pulmonary function measurements (FVC, $FEV_1$, PEFR, FEF25%-75%) from the HI-801 correlated closely (r=0.94, 0.93, 0.81, 0.84, respectively) with those performed with the Vmax spectra 22d and showed the good limits of agreement and differences between the 2 devices; FVC +0.35 L, $FEV_1$ +0.16 L, PEFR +1.85 L/s, FEF25%-75%-0.13 L/s. With the exception of $FEV_1$, FEF25%-75%, these differences were significant(p<0.05) but small. Conclusion: The HI-801 spirometer is comparable to the standard laboratory spirometer, Vmax spectra 22d, with high accurary for $FEV_1$ and FVC and acceptable differences for clinical use.

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.173-182
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• 2002

Background : Nontuberculous mycobacteria (NTM) have usually been considered to be contaminants of colonizers when isolated from respiratory specimens in Korea, where there is a high prevalence of tuberculosis and a low rate of HIV infections. Therefore, there has been few studies on the clinical significance of NTM species in immunocompetent patients were investigated. Methods : Thirty-five NTM isolates, for which species identification was requested by the treating physicians during 1999 at the Asan Medical Center, were retrospectively analyzed. They were identified to the species level by mycolic acid analysis using high-performance liquid chromatography. The medical records of the patients with the NTM isolates were reviewed to identify those patients who met the American Thoracic Society (ATS)'s criteria for mycobacterial pulmonary infection. Their antimicrobial susceptibility data were compared with the clinical outcomes. Results : The NTM were identified as M. intracellulare (6 isolates), M. avium (5), M. abscessus (5), M. gordonae (5), M. terrae complex (4), M. szulgai (2), M. kansasii (2), M. fortuitum (2), M. peregrinum (1), M. mucogenicum (1), M. celatum (1), and M. chelonae (1). All 35 patients showed clinical symptoms and signs of chronic lung disease, but none had a HIV infections; 16 (45.7%) patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria, 5 and 4 cases were affected with M. intracellulare and M. abscessus, respectively; 8 patients had a history of pulmonary tuberculosis. 13 patients received antimycobacterial therapy for an average of 21 months and 9 patients were treated with second-line drugs. Only 4 patients had improved radiologically. Conclusion : A NTM should be considered a potential pathogen of pulmonary infections in immunocompetent patients with chronic pulmonary diseases. Most NTM infections were left untreated for a prolonged period and showed a poor outcome as a result, M. intracellulare and M. abscessus were the two most frequent causes of NTM pulmonary infections in this study. Species identification and antimycobacterial susceptibility tests based on the species are needed for the optimum management of a NTM pulmonary infection in patients.

• 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.

• Sleep Medicine and Psychophysiology
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• v.8 no.2
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• pp.113-120
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• 2001

Objectives: Obstructive sleep apnea syndrome is common and may produce various symptoms and serious complications. A substantial number of research articles on obstructive sleep apnea syndrome have been published in Korea. However, we found such limitations as lack of sufficient sample size and lack of polysomnography-proven cases. Therefore, we aimed at studying clinical features and sleep structure in a sufficient number of Korean patients with obstructive sleep apnea syndrome diagnostically confirmed with polysomnography. Methods: We studied 801 subjects referred to the Division of Sleep Studies, Seoul National University Hospital, who were diagnosed as having obstructive sleep apnea syndrome with polysomnography. Subjects were excluded if they had central sleep apnea syndrome, periodic limb movement disorder, narcolepsy or REM sleep behavior disorder. Foreign patients were also excluded. First of all, we studied the clinical features of the subjects. Secondly, we compared sleep-related parameters of the study subjects with those of age/sex-matched normal values. Thirdly, correlations of respiratory disturbance index (RDI) with each of the sleep-related parameters were calculated. Results: Among the 801 subjects, 668 were male subjects (83.4%) and 133 female subjects (16.4%). Their mean age was 46.6 years (${\pm}13.5$). The mean body mass index (BMI) was 25.8 (${\pm}3.8$) and subjects with BMI was over 28.0 accounted for 22.8% of the total. Fifty subjects (6.2%) were found to take benzodiazepines. Mean RDI and mean nocturnal oxygen saturation of all subjects was 31.2 (${\pm}24.4$) and 94.5% (${\pm}3.6$), respectively. In comparison with normal values, the subjects showed longer sleep latency, lower sleep efficiency, decreased total slow wave sleep % (TSWS %), and decreased total REM sleep % (TREM %)(p<0.01 in all). RDI had a negative correlation with each TSWS % and TREM % (p<0.01, p<0.01). However, RDI did not have significant correlation with either sleep latency or sleep efficiency. Conclusion: In this study, 6.2% of patients diagnosed as having obstructive sleep apnea syndrome were found to take benzodiazepines, although they are generally considered to be of litte benefit or even dangerous because of the respiratory suppressing effect. The proportion of obese subjects was only 22.8% and Korean patients with obstructive sleep apnea syndrome seem to be less obese than those described in foreign journals. This study also suggests that the severity of obstructive sleep apnea syndrome may have a more significant effect on sleep architecture defined as TSWS % and TREM % than on sleep efficiency.