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Clinical Evaluation of Surgical Resection of Pulmonary Tuberculosis (폐결핵에 대한 외과적 치험)

  • Park, Seung-Kyu;Shon, Mal-Hyun;Han, Dong-Gi;Ha, Hyun-Chul;Jin, Young-Ho;Song, Sun-Dae
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.474-480
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    • 1995
  • Background: In spite of initial intensive and long-term chemotherapy for pulmonary tuberculosis, many problems remain in the treatment of the residual lesion. The role of surgical intervention for pulmonary tuberculosis is getting rid of such residual lesion of pulmonary tuberculosis to support the healing process and to induce bacteriologically negative conversion in the end. Method: We experienced 30 cases of pulmonary resection for pulmonary tuberculosis from Aug. 1994 through Apr. 1995 in National Masan Tuberculosis Hospital. We conducted retrospective study to analyze several variables for the cases. Results: 1) The ratio between male and female was 4:1(male 24, female 6) and the age of peak incidence was in 3rd and 4th decades. 2) Indications for pulmonary resection in the radiographic findings were cavitary lesions of 19 cases(63.3%), destroyed one side of 8 cases(26.7%) and destroyed one lobe of 3 cases(10%). 3) 16 of 20 cases with unilateral lesions and all of 10 cases with bilateral lesions on chest X-ray films showed AFB positive on preoperative sputum smears. 14 cases(87.5%) of unilateral lesions and 9 cases(90%) of bilateral ones were converted into AFB negative postoperatively. Negative conversion rates of pneumonectomy and lobectomy cases were 100% and 85.7%, respectively. 4) Preoperative combined disease was 3 cases(10%) of DM and postoperative complications were 2 cases(6.7%) of dead space and no death. Conclusion: Chemotherapy only has some limitation in treatment of all tuberculosis. So, surgical intervention for pulmonary tuberculosis is an effective method as partner of chemotherapy.

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Bronchial Responsiveness in Patients with Mitral Valvular Heart Disease (승모판 심장질환 환자에서 기관지 반응성에 대한 연구)

  • Kim, Ho-Cheol;Kim, Min-Gu;Hwang, Young-Sil
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.5
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    • pp.752-759
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    • 1995
  • Background: Bronchial asthma is characterized by noctunal dyspnea, cough and wheezing because of airway hyperresponsiveness to nonspecific stimuli. These symptoms and signs are also observed in patients with congestive heart failure. Therefore, this is so called "cardiac asthma". There are lots of experimental and clinical datas to suggest that airway dysfunctions occur in acute and chronic congestive heart failure. However, it is still controversial whether bronchial hyperresponsiveness is present in patients with congestive heart failure. To assess whether bronchial hyperresponsiveness is present in patients with congestive heart failure and to demonstrate the relationship between bronchial responsiveness and vascular pressure, we performed methacholine provocation test in 11 patients with mitral valvular heart disease. Methods: All patients were in the New York Heart Association functional class II and treated continuously with digoxin and/or dichlozid and/or angiotensin converting enzyme inhibitor except one patient. All patients were undergone right and left side heart catheterization for hemodynamic measurements. A 20 percent fall of peak expiratory flow rate were considered as positive response to methacholine provocation test. Results: 1) Only one patient who has normal pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index was positive in methacholine provocation test. 2) Their mean pulmonary artery pressure, pulmonary capillary wedge pressure were $21.72{\pm}9.70mmHg$, $15.45{\pm}8.69mmHg$ respectively which were significantly higher. Conclusion: It is speculated that in stable congestive heart failure patients, bronchial responsiveness as assessed by methacholine provocation test may not be increased.

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Studies on the Construction Method of Chwibyeong and Investigating Original Form of the Chwibyeong at the Juhapru in the Changdeok Palace (취병(翠屛)의 조성방법과 창덕궁 주합루(宙合樓) 취병의 원형규명)

  • Jung, Woo-Jin;Sim, Woo-Kyung
    • Korean Journal of Heritage: History & Science
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    • v.47 no.2
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    • pp.86-113
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    • 2014
  • This study has researched the characteristics and elements of Chwibyeong (翠屛), a sort of trellis in the Joseon Dynasty through the old documents, and the original form of Chwibyeong at Juhapru (宙合樓) in Changdeuk Palace. The results were as follow. First, as the result of literatures analysis for Imwon-gyeongje-ji (林園經濟志) and Jeungbo-sallim-gyeongje (增補山林經濟), the plant screen was classified as kinds of support[frame] material, plants and methods of planting. It was found that the supports of Chwibyeong were made of bamboo or the material such as the Jinjangmok (眞長木: a stick of oak) and Giryu (杞柳: Salix purpurea var. japonica). The evergreen coniferous trees including Pinus densiflora, Taxus cuspidata and Thuja orientalis were mainly used for the plant material of Chwibyeong. The general planting method of Chwibyeong was to plant on the ground, but sometimes the container planting was also found on the artificial ground. Second, the term of 'Chwibyeong' in the literatures was used in only the screen made by evergreen trees, and the superordinate category term of it was indicated by 'byeong (屛)'. Therefore Chwibyeong was a compound word formed from 'chwi (翠)' which means the characteristics of evergreen and 'byeong' as tree screen which the support was made by bamboo. And Chwibyeong had semantic context which was combined with the literary symbolization to describe a landscape of green peak and Taoist ideology be inherent from 'twelve peaks of Musan[巫山十二峰]' in Sichuan sheng (四川省). Thirdly, the photograph of Chwibyeong at Juhapru taken by the 1880s, showed that Chwibyeong was made with coniferous trees and was almost 2 meters high. The Chwibyeong at Juhapru was removed during the Japanese colonial era, but a few yew trees(Taxus cuspidata) used for Chwibyeong are still remaining. And some Juniperus chinensis which the composition time is unclear, were cultivated while hung loose its branchs at the sides of Eosumun (魚水門). This Junipers were presumed to be planted by Japanese after Japanese annexation of Korea(1910), and it was judged that both of the roofs of Eosumun's side gates might have been transformed into Japanese style at the same time. Lastly, Chwibyeong at Juhapru was restored in 2008 but it was restored in wrong way from original form without precise research. Especially Chwibyeong was restored with Sasa boreralis which is damaged by frost, so it requires exertion that should revive the originals to plant original material as much as possible. And it needs the development of fabrication technique for Chwibyeong and the application to current landscape architecture.

Epidemiological Studies of Clonorchiasis. - I. Current Status and Natural Transition of the Endemicity of Clonorchis sinensis in Gimhae Gun and Delta, a High Endemic area in Korea (간흡충증(肝吸虫症)의 역학(疫學) - I. 고도유행지(高度流行地) 김해지방(金海地方)에 있어서의 간흡충감염(肝吸虫感染)의 현황(現況)과 자연추이(自然推移))

  • Kim, D.C.;Lee, O.Y.;Lee, J.S.;Ahn, J.S.;Chang, Y.M;Son, S.C.;Moon, I.S.
    • Journal of agricultural medicine and community health
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    • v.8 no.1
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    • pp.44-65
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    • 1983
  • As a part of the epidemiological studies of clonorchiasis, this study was conducted to evaluate the current endemicity and the natural transition of the Clonorchis infection in Gimhae Gun and delta area a high endemic area in Korea in recent years, prior to the introduction of praziquantel which will eventually influence the status of the prevalence. The data obtained in this study in 1983 were evaluated for natural transition of the infection in comparison with those obtained 16 years ago in 1967 by the author(Kim, 1974). The areas of investigation, villages and schools surveyed, methods and techniques used in this study were the same as in 1967, except for the contents of the questionnaire for raw freshwater fish consumption by the local inhabitants. 1) The prevalence rate of clonorchiasis in the general population of the villages was 48.1% on the average out of a total of 484 persons examined. The average of those of the riverside-delta area was 65.2% and 43.0% in the inland area. Among the schoolchildren, the prevalence rate was 8.2% on the average out of a total of 1,423 examined. By area, the prevalence rate was 10.8% in the riverside delta area and 2.8% in the inland area. By sex, difference in the prevalence was seen only in the inhabitants of the inland area showing 52.4% in the male and 33.5% in the female. 2) In the natural transition of the infection, the prevalence rate among the inhabitants has decreased from 68.8% in 1967 to 48.1% in 1983, and in the schoolchildren from 56.4% in 1967 to 8.2% in 1983. The reduction rate was higher in the riverside-delta area than in the inland area. 3) In the prevalence rate by age, 11.9% was first seen in the 5-9 age group and the rate gradually increased up to 75.0% in the 50-59 age group. By sex, the rate was higher in the male than in the female in the 20-29 age group and over. 4) In the natural transition of the prevalence rate by age, the reduction rate of the infection during the past 16 years was greater in the younger age groups up to the 40-49 age group and reached the same level in the age group 50-59. Reduction was seen again in the age group over 60s. By sex, the reduction rate was greater in the female than in the male in the 20-29 age group and over. By area, the reduction rate was greater in the riverside delta area than in the inland area, particularly in the young age groups. 5) In the intensity of the infection among the cases, the mean egg out-put per mg feces per infected cases(EPmg) in the inhabitants was 6.3. EPmg of those of the river-side-delta area was 15.4 and that of the in-land was 2.8. On the other hand, in the schoolchildren, EPmg was 3.2, and no difference was seen between the two areas, the river-side-delta area and the inland area. 6) In the transition of the intensity of the infection by area, EPmg among the inhabitants inexplically increased from 7.8 in 1967 to 15.4 in 1983. This was probably caused by uneven specimen collection in the process of sampling the population. EPmg of the inhabitants in the inland area and those of the schoolchildren of both riverside delta and inland areas showed a similar decrease in the past 16 years. 7) The intensity of the infection by age showed a relatively low level in the 20-29 age group and below, and EPmg 5.1-9.5 was seen in the 30-39 age group and over. Sex, Epmg was 5.8 in the male and 4.7 the female. By in 8) In the transition of the intensity of the infection, EPmg decreased from 6.2 in 1967 to 5.4 in 1983. By age, in contrast to the figures of 1967 in which EPmg gradually increased with some fluctuation from 1.1 in the 0-4 age group to peak 10.5 in the 50-59 age group, in 1983 lower intensity of the infection was seen in the age group from 10-14 to 20-29 with the EPmg range of 0.6-2.7. 9) In the distribution of the clonorchiasis cases by the range of EPmg value, 43.2% of the cases were in 0.1 0.9 and 34.6% in 1.0-4.9. As a whole by cumulative percent, 44.6% of them were under 0.9 as light infection and 86.1% of them under 9.9 up to moderate infection. By sex, no difference was seen in Epmg. 10) In the transition of the distribution by the range of Epmg, the cases were distributed up to the range 80.0-99.9 in 1967 and to 60.0-79.9 in 1983. By cumulative percent, in the range of 0.1-0.9 and less, light infection, 34.3% of them were distributed in 1967 and 44.6% in 1983 with about 10% increase. In the range of 5.0-9.9 and less, up to moderate infection, 83.2% in 1967 and 86.1% in 1983 of the cases were seen, respectively. 11) The practice of raw freshwater fish consumption among the inhabitants seems to have decreased in recent years. Those who admitted to raw freshwater fish consumption in the last two years among the infected inhabitants were 59.3%, although 86.8% of them professed to have experience with raw freshwater fish consumption. 31.7% of those who have had experience of the raw freshwater fish consumption denied any further consumption in recent years. From an interview of 543 school-children, 24.1% of them admitted to an experience of raw freshwater fish consumption. However, those who have practised in the past two years comprized 17.9%. Those who denied raw freshwater fish consumption in recent years among those who had such experience were 26.0% out of 131 interviewed. The rate of raw freshwater fish consumption in both inhabitants and schoolchildren were higher in the male than in the female. On the contrary, the rate of those who did not practise in recent years among those who had experience of raw freshwater fish consumption was higher in the female than in the male. 12) The major reason for the reduction of raw freshwater fish consumption among the local inhabitants was the risk of the fluke infection. However, it has become apparent that such change of taste has resulted from water pollution impact which has affected throughout the areas of the freshwater systems in this locality since last several years. 13) In animal survey, Clonorchis infection was seen in 14.8% of 88 dogs examined and 3.7% of 27 house rats examined. It was noted that populations of dogs and cats have increased in the villages surveyed. Although the prevalence rate was lower in the present survey than those of 1967, the significance of the animals as the reservoir host has not changed. 14) Prevalence rate of Clonorchis infection by cercariae in the first intermediate host, Parafossarulus manchouricus, was 0.6% out of 517 snails examined. The infection rate was lower in comparison with 2.3% out of 2,124 examined in 1967. Moreover, sharp decreases in number and distribution of the intermediate host snails in many watershed areas of the huge freshwater systems in this locality seemed to reduce transmission of Clonorchis in connection with the intermediate host stage of its life cycle. 15) Clonorchis infection in the second intermediate fish hosts was relatively low. The mean number of Clonorchis metacercaria per fish in Pseudorasbora parva was 517 in 1983, whereas it was 1943 in 1968 through 1969. Environmental water pollution has also caused the decreased fish population density in these areas, and this has also apparently affected to the practice of raw freshwater fish consumption among the local inhabitants. 16) In conclusion, endemicity of Clonorchis infection in Gimhae Gum and delta area of the Nagdong River has sharply decreased during the past 16 years. The major cause of the regressive transition of the infection was the water pollution of the land water systems of this locality. The pollution has upset the ecosystems comprizing of the intermediate hosts of Clonorchis in many areas, and also affected to a significant extent to the discontinuance of the local inhabitants for raw freshwater fish consumption.

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A STUDY ON THE TEMPERATURE CHANGES OF BONE TISSUES DURING IMPLANT SITE PREPARATION (임플랜트 식립부위 형성시 골조직의 온도변화에 관한 연구)

  • Kim Pyung-Il;Kim Yung-Soo;Jang Kyung-Soo;Kim Chang-Whe
    • The Journal of Korean Academy of Prosthodontics
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    • v.40 no.1
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    • pp.1-17
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    • 2002
  • The purpose of this study is to examine the possibility of thermal injury to bone tissues during an implant site preparation under the same condition as a typical clinical practice of $Br{\aa}nemark$ implant system. All the burs for $Br{\aa}nemark$ implant system were studied except the round bur The experiments involved 880 drilling cases : 50 cases for each of the 5 steps of NP, 5 steps of RP, and 7 steps of WP, all including srew tap, and 30 cases of 2mm twist drill. For precision drilling, a precision handpiece restraining system was developed (Eungyong Machinery Co., Korea). The system kept the drill parallel to the drilling path and allowed horizontal adjustment of the drill with as little as $1{\mu}m$ increment. The thermocouple insertion hole. that is 0.9mm in diameter and 8mm in depth, was prepared 0.2mm away from the tapping bur the last drilling step. The temperatures due to countersink, pilot drill, and other drills were measured at the surface of the bone, at the depths of 4mm and 8mm respectively. Countersink drilling temperature was measured by attaching the tip of a thermocouple at the rim of the countersink. To assure temperature measurement at the desired depths, 'bent-thermocouples' with their tips of 4 and 8mm bent at $120^{\circ}$ were used. The profiles of temperature variation were recorded continuously at one second interval using a thermometer with memory function (Fluke Co. U.S.A.) and 0.7mm thermocouples (Omega Co., U.S.A.). To simulate typical clinical conditions, 35mm square samples of bovine scapular bone were utilized. The samples were approximately 20mm thick with the cortical thickness on the drilling side ranging from 1 to 2mm. A sample was placed in a container of saline solution so that its lower half is submerged into the solution and the upper half exposed to the room air, which averaged $24.9^{\circ}C$. The temperature of the saline solution was maintained at $36.5^{\circ}C$ using an electric heater (J. O Tech Co., Korea). This experimental condition was similar to that of a patient s opened mouth. The study revealed that a 2mm twist drill required greatest attention. As a guide drill, a twist drill is required to bore through a 'virgin bone,' rather than merely enlarging an already drilled hole as is the case with other drills. This typically generates greater amount of heat. Furthermore, one tends to apply a greater pressure to overcome drilling difficulty, thus producing even greater amount heat. 150 experiments were conducted for 2mm twist drill. For 140 cases, drill pressure of 750g was sufficient, and 10 cases required additional 500 or 100g of drilling pressure. In case of the former. 3 of the 140 cases produced the temperature greater than $47^{\circ}C$, the threshold temperature of degeneration of bone tissue (1983. Eriksson et al.) which is also the reference temperature in this study. In each of the 10 cases requiring extra pressure, the temperature exceeded the reference temperature. More significantly, a surge of heat was observed in each of these cases This observations led to addtional 20 drilling experiments on dense bones. For 10 of these cases, the pressure of 1,250g was applied. For the other 10, 1.750g were applied. In each of these cases, it was also observed that the temperature rose abruptly far above the thresh old temperature of $47^{\circ}C$, sometimes even to 70 or $80^{\circ}C$. It was also observed that the increased drilling pressure influenced the shortening of drilling time more than the rise of drilling temperature. This suggests the desirability of clinically reconsidering application of extra pressures to prevent possible injury to bone tissues. An analysis of these two extra pressure groups of 1,250g and 1,750g revealed that the t-statistics for reduced amount of drilling time due to extra pressure and increased peak temperature due to the same were 10.80 and 2.08 respectively suggesting that drilling time was more influenced than temperature. All the subsequent drillings after the drilling with a 2mm twist drill did not produce excessive heat, i.e. the heat generation is at the same or below the body temperature level. Some of screw tap, pilot, and countersink showed negative correlation coefficients between the generated heat and the drilling time. indicating the more the drilling time, the lower the temperature. The study also revealed that the drilling time was increased as a function of frequency of the use of the drill. Under the drilling pressure of 750g, it was revealed that the drilling time for an old twist drill that has already drilled 40 times was 4.5 times longer than a new drill The measurement was taken for the first 10 drillings of a new drill and 10 drillings of an old drill that has already been used for 40 drillings. 'Test Statistics' of small samples t-test was 3.49, confirming that the used twist drills require longer drilling time than new ones. On the other hand, it was revealed that there was no significant difference in drilling temperature between the new drill and the old twist drill. Finally, the following conclusions were reached from this study : 1 Used drilling bur causes almost no change in drilling temperature but increase in drilling time through 50 drillings under the manufacturer-recommended cooling conditions and the drilling pressure of 750g. 2. The heat that is generated through drilling mattered only in the case of 2mm twist drills, the first drill to be used in bone drilling process for all the other drills there is no significant problem. 3. If the drilling pressure is increased when a 2mm twist drill reaches a dense bone, the temperature rises abruptly even under the manufacturer-recommended cooling conditions. 4. Drilling heat was the highest at the final moment of the drilling process.

Epidemiology and Clinical Manifestations of $Henoch-Sch\"{o}nlein$ Purpura in Children (소아 $Henoch-Sch\"{o}nlein$ 자반증의 역학 및 임상양상)

  • Kim Se-Hun;Lee Chong-Guk
    • Childhood Kidney Diseases
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    • v.7 no.2
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    • pp.166-173
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    • 2003
  • Purpose : The cause and pathogenesis of $Henoch-Sch\"{o}nlein$ purpura has been studied for many years but the results are disappointing. Recently the hypothesis that abnormalities involving the glycosylation of the hinge region of immunoglobulin Al(IgAl) may have an important role in the pathogenesis of $Henoch-Sch\"{o}nlein$ purpura is being approved. $Henoch-Sch\"{o}nlein$ purpura is the most common vasculitis Ihat affects children and the prognosis is good. But if kidney invovement occurs, the course may be chronic and troublesome. So we evaluated children with $Henoch-Sch\"{o}nlein$ purpura especially from the point of epidemiology and clinical manifestations. Methods : Investigation of 124 children who were diagnosed with $Henoch-Sch\"{o}nlein$ purpura at Inje University Ilsan Paik Hospital from December 1999 to July 2003 was performed retrospectively through chart review. Efforts were made to get informations about the profile, epidemiology, clinical manifestations, progress of the disease and recurrence rate of patients. Results : The patients were 69 boys and 55 girls, with a mean age of $6.1{\pm}2.7$ years at the time of data collection. The male to female ratio was 1.25 : 1. The occurrence rate was much higher in autumn(from September to November, 31.5%) and winter(from December to February, 28.2%) than in spring and summer, with a peak in November. Joint involvement was shown in 66.9% of patients mostly on the foot/ankle(75.9%), knee(39.8%). Seventy(56.5%) out of 124 patients had abdominal pain and 10 patients(8.1%) showed bloody stools. Renal involvement was observed in 24 patients(19.4%) after 21.1 days on the average. IgA was elevated in 10 of 21 patients(47.6%). $C_3$ and $C_4$ levels were normal in 40 of 49 patients (81.7%) and 47 of 48 patients(97.9%), respectively Antistreptolysin-O(ASO) titer was elevated over 250 Todd units in 29 of 62 Patients(46.8%). Mycoplasma antibody titer was elevated in 21 of 49 patients(42.9%) equal or greater than 1:80. Radiologic studies were peformed in 23 patients. Seven patients(30.4%) showed bowel wall thickening and one of them received intestinal resection and anastomosis operation due to terminal ileum necrosis. Eighty four patients took steroid 1.4 mg/kg/day in average. Recurrence rate was 2.5 in 37 patients(29.8%). Conclusion : $Henoch-Sch\"{o}nlein$ purpura in childhood appears most in about 6 years of age. The occurrence rate is much higher in autumn and winter relatively. Diagnosis can be made through the perspective history taking and the inspection of clinical manifestations, but the laboratory findings are not of great help. A small portion of the patients might show abdominal pain or arthritis before purpura develops, therfore various diagnosis can be made. Radiologic evaluation should be performed to avoid surgical complications in cases accompanying abdominal pain, and long term follow up should be needed especially in patients suffering from kidney involvement. In about 30% of the patients $Henoch-Sch\"{o}nlein$ purpura would recur. Steroid can be used safely without side effects.

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