BACKGROUN: Many studies have shown that diabetes mellitus does not modify the clinical features and treatment outcomes. However, to our knowledge, those surveys for clinical features and treatment outcomes in pulmonary tuberculosis with diabetics were performed 15 years ago and have not been confirmed by more recent reports. Therefore, the purpose of this study is to investigate the effect of diabetes mellitus on microbiologic findings in far advanced stage of pulmonary tuberculosis and so to make some suggestions for the management of pulmonary tuberculosis with diabetes mellitus. METHODS: This study population was composed of 47 patients with far advanced stage of culture-proven pulmonary tuberculosis hospitalized in our department from 2000 through 2002. None of patients was intractable. Patients were divided into 4 groups; group1;nondiabetics with initial treatment, group2;diabetics with initial treatment, group3;nondiabetics with retreatment, group4; diabetics with retreatment. Treatment regimens were individualized on the basis of susceptibility results. A retrospective review of the records of all 47 patients with pulmonary tuberculosis and diabetes mellitus was carried out. The clinical features, bacteriologic, radiographic findings and treatment outcomes were compared among 4 groups. RESULTS: Time to negative conversion of AFB in sputum smear was significantly increased in diabetics group than nondiabetics, but time to negative conversion of AFB in sputum culture was not significant. Also time to negative conversion of AFB in sputum smear or culture was not affected by treatment pattern. The effect of antituberculosis medication significantly delayed response in diabetics with retreatment and resistance rate was higher in diabetics or retreatment. Time to negative conversion of AFB in sputum smear was related to cavitary size in radiographic findings, but time to negative conversion of AFB in sputum culture was related to drug sensitivity. Natural course of cavity on radiographic findings after antituberculosis therapy was not significant. CONCLUSION: It seems that diabetes mellitus does not affect bacteriological negative conversion rates except negative conversion rate of AFB in sputum smear, which chiefly related to cavitary size, in far advanced stage of pulmonary tuberculosis. Therefore, because the presence of AFB in sputum smear after 5th months of therapy is not necessarily a treatment failure in far advanced stage of pulmonary tuberculosis with diabetics, any decision regarding prologation or change in therapy maybe required based on the results of culture and drug susceptibility tests.
Bacteriology ; Diabetes Mellitus* ; Humans ; Retreatment ; Retrospective Studies ; Sputum ; Treatment Failure ; Treatment Outcome ; Tuberculosis, Pulmonary*

No abstract available.
Gonadotropin-Releasing Hormone* ; Puberty, Precocious*

BACKGROUND AND OBJECTIVES: The observation about the movements of laryngopharyngeal or surrounding structures is very important to understand the physiology of phonation or swallowing and to diagnose the disease. Many investigating methods were used but most of them were ineffective because those were invasive or indirect methods. Ultrasonographical examination of larynx can be applied, but the shortcomings of mechanics limits the usage of ultrasonographical study of larynx. Recently, the revolution of computer and videosystem made ultrasonographical study to be applied to the larynx. In this study, authors wanted to find out the availability of the ultrasonographical study of larynx. MATERIALS AND METHODS: 3.5 and 7.5 MHz probes were applied to anterior neck and the ultrasonographical findings were observed according to the various phonation types. RESULTS: In the axial plane, the movements of bilateral vocal folds were observed. Unilateral movement of vocal cord alone was seen in the case of unilateral vocal cord paralysis. In the parasagittal plane, the movements of whole laryngopharyngeal structures were observed simultaneously. A specific tongue shape was seen on each vowel phonation. On phonation with high pitch, hyoid bone and thyroid cartilage were elevated. And thyroid cartilage was elevated and laid upon the hyoid bone moving medially. On phonation with high pitch extremely, the hyoid bone went down. On phonation loudly, echogenicity of surrounding muscles was increased. CONCLUSION: Authors think that the ultrasonographical study can be applied to the physiologic study of phonation as well as diagnostic tools or therapeutic tools.
Deglutition ; Hyoid Bone ; Larynx* ; Mechanics ; Muscles ; Neck ; Phonation ; Physiology ; Thyroid Cartilage ; Tongue ; Ultrasonography ; Vocal Cord Paralysis ; Vocal Cords

BACKGROUND: Recent technological developments have introduced a new method to identifying M. tuberculosis complex DNA in clinical samples directly. The direct amplification test (DAT) is approved for identifying M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). When there is a discrepancy between the AFB smear and DAT, no information on their clinical utility is currently available. In this study, the diagnostic reliability of DAT was investigated in suspected pulmonary tuberculosis patients whose sputum AFB smear was negative. METHODS: From June 1, 1998 through May 30, 1999, 909 patients with presumed active pulmonary tuberculosis were enrolled. A sputum AFB stain, culture, DAT and /or biopsy were performed. using the criteria of clinical tuberculosis or confirmed tuberculosis, the positive predictive value of DAT in diagnosing pulmonary tuberculosis was investigated. RESULTS: The positive predictive value of DAT was 82.1% by the clinically active tuberculosis criteria. However, it decreased to 61.5% when diagnosis was restricted to only to culture positive or biopsy proven cases. The false positive rate of DAT was 18.0%. CONCLUSION: The DAT is a valuable diagnostic method in suspected patients whose sputum AFB is was negative.
Biopsy ; Diagnosis* ; DNA ; Humans ; Polymerase Chain Reaction* ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary*

Kerosene is one of the petroleum distillates with low viscosity and high volatility. Kerosene is widely used in Korean home in heating and cooking. Kerosene ingestion or aspiration is one of the most common poisonings in young children but extremely rare in adults because kerosene is not taken with the intention of committing suicide. We report four adult cases of aspiration pneumonitis by accidental aspiration of kerosene with similar clinical presentation.
Adult ; Apoptosis ; Child ; Cooking ; Eating ; Epithelial Cells ; Heating ; Helicobacter pylori ; Hot Temperature ; Humans ; Intention ; Kerosene* ; Neutrophils ; Petroleum ; Pneumonia* ; Poisoning ; Suicide ; Viscosity ; Volatilization

Mercury is one of the heavy metals that cause intoxications. Mercury can cause muscular tremor, psychic irritability, renal toxicity and so on. Mercury intoxications usually occur chrough chronic respiratory ingestion. We describe a case in that a woman had applicated inorganic mercury to her whole body and developed mercury intoxications which can be characterized by the whole body skin rash, fever, acute renal failure and the hepatotoxicity appeared. We managed the patient with diuretics, antibiotics and continuous veno-venous hemodiafiltration. On the 6th hospital day, serum creatinine was normalized. Since then, the skin rash and hepatotoxicity were gradually alleviated.
Acute Kidney Injury* ; Anti-Bacterial Agents ; Creatinine ; Diuretics ; Eating ; Exanthema ; Female ; Fever ; Hemodiafiltration ; Humans ; Metals, Heavy ; Skin* ; Tremor

BACKGROUND: Many studies have shown that pulmonary function differs widely among race, age and geographical residency. By virtue of the improvement of nutrition and environment, the elderly population in Korea is markedly increasing and so are the ages of patients complaining respiratory symptoms. However, we do not have our own data on the pulmonary functional reserve of elderly persons in Korea. We evaluate the deterioration of pulmonary functional reserve and standardize the predictive values of pulmonary function in the elderly population. METHOD: Pulmonary function tests were conducted in 100 men and 100 women over the age of 65. We analyzed changes of FVC and FEV1 according to age and height by linear regression. We compared our new multiple linear regression equation with other equations currently used in Korea. RESULTS: In men, the mean age was 71.5±5.2(mean±SD) years and the mean height was 163.6±6.2cm. The mean FVC was 3.42±0.49ℓ and the mean FEV1, 2.72±0.40ℓ. In women, the mean age was 72.0±5.1 years and the mean height was 149.1±5.9cm. The mean FVC was 2.22±0.42ℓ and the mean FEV1, 1.83±0.34ℓ. Multiple linear regression equation using age and height as an independent factors was as follows : FVC(ℓ)=1.857-0.0356×age(year)+0.02157×height(cm) (p<0.01, R2=0.279), FEV1(ℓ)=1.340-0.02698×age(year)+0.02021×height(cm) (p<0.01, R20.255) in men, FVC(ℓ)=-0.09765-0.03332×age(year)+0.03164×height(cm) (p<0.01, R2=0.435), FEV1(ℓ)=-0.169-0.02469×age(year)+0.02539×height(cm) (p<0.01, R2=0.41) in women. CONCLUSION: We established prediction regressions for pulmonary functional tests in the elderly Korean population. We also confirmed that currently adopted equations do not exactly anticipate the expected pulmonary functional reserve in the aged person over 65 years old. We suggest that our new equations from this study should be applied to interpret the pulmonary function tests in the elderly population in Korea.
Aged* ; Aging* ; Continental Population Groups ; Female ; Humans ; Internship and Residency ; Korea ; Linear Models ; Male ; Respiratory Function Tests* ; Virtues

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

BACKGROUND: Since the advent of AIDS, tuberculosis has become a major public health problem in the western society. Therefore, it is essential that pulmonary tuberculosis be rapidly diagnosed. Light microscopic detection of acid-fast organisms in sputum has traditionally been used for rapidly diagnosing tuberculosis. However positive smears are only observed in about one-half to three-quarters of cases. Studies using PCR for diagnosing pulmonary tuberculosis disclosed several shortcomings suggesting an inability to distinguish between active and treated or in active tuberculosis. In this study, the clinkcal significance of a PCR-bases rapid technique for detecting Mycobacterium tuberculosis DNA in peripheral blood investigated. MATERIALS AND METHODS: From July 1, 1998 through to August 30, 1999, 59 patients with presumed tuberculosis, who had no previous history of anti-tuberculosis medication use whithin one year prior to this study were recruite and followed up for more than 3 months. AFB stain and culture in the sputum and/or pleural fluids and biopsies when needed were performed. Blood samples from each of the 59 patients were obtained in order to identify Mycobacterium Tuberculosis DNA by a PCR test. RESULTS: 1) Forty five out of 59 patients had a final diagnosis of tugerculosis; Twenty eight were confirmed as having active pulmonary tuberculosis by culture or biopsy. Four were clinkcally diagnosed with pulmonary tuberculosis. The othe 13 patients were diagnosed as having tuberculous pleurisy (9) and extrapulmonary tuberculosis (4). 2) Fourteen patients showed a positive blood PCR test. The PCR assay correctly identified active tuberculosis in 13 out of 14 patients. The overall sensitivity and specificity of this blood PCR assay for diagnosing tuberculosis were 29% and 93%, respectively. The positive predictive value was 93%, the negative predictive value was 29% and diagnostic accuracy was 44%. 3) Six out of 14(43%) patients with blood PCR positive tuberculosis were immunologically compromised hosts. 4) A simple chest radiograph in blood PCR positive tuberculosis patients showed variable and inconsistent findings. CONCLUSION: A peripheral blood PCR assay for Mycobacterium tuberculosis is not recommended as screening method for diagnosing active tuberculosis. However, it was suggested that the blood PCR assay could contribute to an early diagnostic rate due to its high positive predictive value.
Biopsy ; Diagnosis ; DNA* ; Humans ; Mass Screening ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction ; Public Health ; Radiography, Thoracic ; Sensitivity and Specificity ; Sputum ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

PURPOSE: Color Doppler Imaging(CDI) has shortcomings, including random noise, aliasing, and angle dependence. To overcome these, a method using CD US, termed power doppler or Color Doppler Energy(CDE), has recently been introduced. The purpose of this study was to show the clinical usefulness of CDE. MATERIALS AND METHODS: We retrospectively analyzed the CDI and CDE of 61 cases(20 renal pseudotumors, 8 musculoskeletal inflammations, 17epididymitis or epididymo-orchitis, 3 vaicoceles, 1 normal testis, 1 hepatocellualar carcinoma, 7 renal cell carcinomas, 1 renal angiomyolipoma, and 3 splenic varices). CDI and CDE scans were obtained at the same region with constant scan plane. The color gain was increased until noise first became perceptible, and scans were always obtained in such a way that the maximum amount af vascularity was shown. There after, the vascularity, vascular displacement, and the vascular relationship between CDI and CDE were compared. RESULT: In 17 of 20 cases of pseudotumor in the kidney, normal vascularity was identified in CDI and CDE, but was more clearly visible in CDE. In three cases, there was no visible vascularity in CDI, but normal vascularity in CDE. In eight cases of musculoskeletal inflammation and 17 cases of epididymitis with or without or chitis, the vascularity was increased due to hyperemia, which was more prominently seen in CDE than in CDI. In three varicoceles, CDE appeared to bebetter in demonstration low velocity flow. In one patient who was suspected of having acute testicular torsion, CDE was helpful in excluding this suspicion. In one case of hepatocellular carcinoma, seven cases of renal cell carcinoma, one case of renal angiomyolipoma, and three cases of splenic varices, CDE was better than CDI in showing the vascularity, vascular relationship, and vascular displacement. CONCLUSION: CDE is a potential lyuseful adjunct to standard CDI.
Angiomyolipoma ; Carcinoma, Hepatocellular ; Epididymitis ; Humans ; Hyperemia ; Inflammation ; Kidney ; Male ; Noise ; Testis ; Varicocele ; Varicose Veins