Tuberculosis (TB) and diabetes mellitus (DM) are major global health problem. The link between DM and TB has been recognized for centuries. And, there are growing evidences that diabetes is a risk factor for tuberculosis. However, the risk varies according to races and regional prevalence, but limited data is available in South Korea. The report of Park et al. showed that the relative odds ratio was 2.220 (95% CI 1.090~4.523) in diabetic group, compared with hypertensive group. Although this study has some limitations, it is a meaningful data. A large-scale multi-center prospective study is needed in Korean population.
Aluminum Hydroxide ; Carbonates ; Continental Population Groups ; Diabetes Mellitus ; Humans ; Odds Ratio ; Prevalence ; Republic of Korea ; Risk Factors ; Tuberculosis

Tuberculosis (TB) is still an important cause of morbidity and mortality worldwide. Nearly one-third of the world's population is latently infected with Mycobacterium tuberculosis, and 10% of them will develop active TB during their lifetime. The tuberculin skin test or interferon-gamma release assay (IGRA) is the method for diagnosis of latent TB infection. Although commercially available IGRAs have limitations in serial testing, and testing children and immunosuppressive patients, IGRAs have superior sensitivity and specificity compared with conventional tuberculin skin testing, especially in Bacillus Calmette-Guerin vaccinated populations. For the treatment of latent TB infection, 9 months isoniazid is the standard treatment in Republic of Korea. However, shorter treatment regimens, including 4 months of rifampin, 3 months of isoniazid/rifampin, and once weekly isoniazid/rifapentine are currently alternatives. Identification and treatment of latent TB infection has lowered the TB incidence in developed countries. Therefore, for TB control, diagnosis and treatment of latent TB infection is important. However, there is lack of research on latent TB infection in South Korea. To revise the guideline, a large prospective trial on the treatment of latent TB infection is needed.
Bacillus ; Child ; Developed Countries ; Diagnosis* ; Humans ; Incidence ; Interferon-gamma Release Tests ; Isoniazid ; Latent Tuberculosis* ; Mortality ; Mycobacterium tuberculosis ; Republic of Korea ; Rifampin ; Sensitivity and Specificity ; Skin Tests ; Tuberculin ; Tuberculin Test ; Tuberculosis

BACKGROUND: Cardiopulmonary exercise test is a useful test for the evaluation of the cardiovascular and respiratory systems. Obese subjects have an increased resting metabolic rate (VO2) compared to non-obese subjects and the increase is more marked during dynamic exercise, which results in the limitation of maximal exercise in obese subjects. In this study, the influence of the obesity and fat distribution on the maximal exercise capacity were evaluated. METHODS: Maximal exercise capacity was represented by maximam maximum oxygen uptake and VO2 max in the cardiopulmonary test. Obesity, total fat content and abdominal obesity(waist to hip ratio, WHR) were measured by bioelectrical impedence method. Total of 42 volunteers(male 22, female 20) were evaluated. RESULTS: 1) Weight to height ratio(mean±SD) was 110%±14.9% in men and 100±11.1% in women. 2) Fat ratio(mean±SD) was 23.3±5.2% in men and 27.55±3.9% in woman. 3) Waist to hip ratio(mean±SD) was 0.85±0.04 in men and 0.8±0.03 in woman. 4) In men, VO2max/min/Kg was negatively correlate with obesity, fat ratio, and abdominal fat distribution. 5) In woman, VO2max/Kg was negatively correlated with obesity and fat ratio, but did not show significant relationship with abdominal fat distribution. CONCLUSION: Obesity was a limiting factor for maximal exercise in both men and women. Abdominal obesity was a limiting factor for maximal exercise in men but its implication to women needs further evaluation.
Abdominal Fat ; Exercise Test* ; Female ; Hip ; Humans ; Male ; Obesity ; Obesity, Abdominal ; Oxygen ; Respiratory System

BACKGROUND: pH measurement is an important test in assessing the etiology of pleurisy and in identifying complicated parapneumonic effusion. Although the blood gas analyzer is the' gold standard method' for pleural pH measurement, pH meter & pH strip methods are also used for this purpose interchangably. However, the correlation among the pH data measured by the three different methods needs to be evaluated. In this study, we measured the pH of pleural fluid with the three different methods respectively and evaluated the correlation among the measured data. METHODS: From August 1999 to March 2000, were measured the pleural fluid pH in 34 clinical samples with three methods-blood gas analyzer, pH meter, and pH strip. In the blood gas analyzer and pH meter methods, the temperature of plerual fluid was maintained around 0℃ in air-tight condition before analysis and measurement was performed within 30 minutes after collection. As for the pH strip method, the pleural fluid pH was checked in the ward immediately after tapping and in the clinical laboratory of our hospital. This part is unclear. RESULTS: The causes of pleural effusion were tuberculosis pleurisy in 16 cases, malignant pleural effusion 5 cases, parapneumonic effusion 9 cases, empyema 3 cases, and congestive heart failure 1 case. The pH of pleural fluid (mean±SD) was 7.34±0.12 with blood gas analyser, 7.52±0.25 with pH meter, 7.37±0.16 with pH strip of immediate measurement and 6.93±0.201 with pH strip of delayed measurement. The pH measured by delayed pH strip measurement was lower than those of other methods(p<0.05). The correlation of the results between the blood gas analyzer and pH meter(p=0.002, r=0.518) and the blood gas analyzer and pH strip of immediate measurement(p<0.001, r=0.607). CONCLUSION: In the determination of pH of pleural fluid, pH strip method could be a simple and reliable method under immediate measurement conditions after fluid tapping.
Empyema ; Heart Failure ; Hydrogen-Ion Concentration* ; Methods* ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Tuberculosis

Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist.
Adolescent ; Adult ; Ankle ; Causalgia ; Child ; Complex Regional Pain Syndromes ; Diagnosis ; Electrodes ; Ganglia, Sympathetic ; Head ; Humans ; Lower Extremity ; Neck ; Nerve Block ; Neuralgia ; Pain Clinics ; Psychiatry ; Recurrence ; Spinal Cord Stimulation* ; Spinal Cord* ; Splints ; Stress, Psychological ; Upper Extremity

No abstract available.
Head* ; Killer Cells, Natural* ; Lymphocytes* ; Neck*

Undifferentiated(embryonal) sarcoma of the liver developing predominantly in the late childhood is extremely rare in malignant hepatic tumors. It has been described by a variety of terms such as malignant mesenchymoma, embryonal sarcoma, fibromyxosarcoma, embryonal rhabdomyosarcoma or primary sarcoma of the liver. The tumor usually presents a huge mass containing solid and sometimes cystic components, and is cmposed of large stellate and spindle cells in an abundant myxoid matrix. The treatment of choice is surgical resection with or without adjuvant chemotherapy and/or radiotherapy, but the prognosis of this disease has been reported extremly poor. We experienced a case of undifferentiated(embryonal) sarcoma of the liver recently which was confirmed by pathological examinations in a 18-year-old boy. He visited our hospital for examination of the progressive growing RUQ abdominal mass detected incidentally. On physical examination, a firm, non-tender, hard, fixed, huge, abdominal mass was palpated in the right upper quadrant of abdomen. Abdominal ultrasonography, computerized tomography and magnetic resonance imaging showed a 10x15cm sized mass confined to the left lobe of the liver, and it was hypovascular mass on angiography. We performed left lobectomy including the tumor and it was confirmed as undifferentiated (embryonal) sarcoma of the liver by pathologic examination. We herein report this case including histologic, electronmicroscopic and flow cytometric results with the review of literatures.
Abdomen ; Adolescent ; Angiography ; Chemotherapy, Adjuvant ; Humans ; Liver* ; Magnetic Resonance Imaging ; Male ; Mesenchymoma ; Physical Examination ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma, Embryonal ; Sarcoma* ; Ultrasonography

No abstract available.
Ductus Arteriosus, Patent* ; Hernia, Diaphragmatic* ; Hernia, Umbilical* ; Nitric Oxide* ; Ventilation*

PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

Tuberculosis (TB) remains the world's leading cause of death from a single infectious disease. In addition, the incidence of TB is high in South Korea. Effective TB control requires early diagnosis and initiation of appropriate treatment. Therefore, it is very important for clinicians to understand evidence-based practical recommendations and to be familiar with up-to-date treatment regimens. In this review, we first describe anti-TB drugs, including new drugs. Secondly, we discuss the treatment of drug-susceptible TB. Finally, we present treatment strategies for drug-resistant TB, which is divided into isoniazid-resistant TB, rifampin-resistant TB, and multi-drug resistant TB. For the treatment of drug-susceptible TB, we recommend 2 months of 4 drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) followed by 4 months of 2 drugs (isoniazid and rifampin). For the treatment of isoniazid-resistant TB, we recommend 6 to 9 months of 4 drugs (rifampin, ethambutol, pyrazinamide, and levofloxacin or moxifloxacin). For the treatment of multi-drug resistant TB (MDR-TB), we recommend a minimum of 5 secondary drugs, including an injectable agent and quinolone. Although the World Health Organization recommended a shorter MDR-TB regimen in 2016, the Korean guidelines for tuberculosis have not yet accepted the shorter regimen. The treatment regimen of TB differs depending on the drug resistance pattern. Therefore, it is important to treat TB properly after confirming the drug resistance pattern. In addition, as new drugs are developed, new treatment guidelines for MDR-TB should be developed that are appropriate for circumstances in Korea.
Cause of Death ; Communicable Diseases ; Drug Resistance ; Early Diagnosis ; Ethambutol ; Incidence ; Korea ; Levofloxacin ; Pyrazinamide ; Rifampin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary ; World Health Organization