PURPOSE: To describe the radiological differences between tuberculous(TBB) and non-tuberculous bronchiectasis(NTBB). MATERIALS AND METHODS: Chest radiographs(n=62), bronchograms(n=18), and CT scans(n=52) of 37 patients with TBB and 25 patients with NTBB were reviewed retrospectively. Diagnostic basis for TBB were positive sputum AFB with or without history of anti-tuberculous chemotherapy(n=35), and radiological findings of pulmonary tuberculosis (n=2). Four of NTBB had a history of severe respiratory tract infection in childhood. RESULTS: Air-fluid levels on chest radiographs were seen in 2% of TBB, and 20% of NTBB. On bronchograms, all patients with TBB had combined focal bronchostenosis, whereas patients with NTBB had tubular(50%), cystic(17%), or mixed(33%) pattern of dilatation without stenosis. On CT scans, focal emphysema was seen in 86% of the patients with TBB, and 38% of the patients with NTBB. Peribronchiolar infiltration were seen in 78% and 44% of patients with TBB and NTBB, retrospectively. CONCLUSION: Basic radiological difference between TBB and NTBB was that the former had coexistent sten.
Bronchiectasis* ; Constriction, Pathologic ; Dilatation ; Humans ; Pulmonary Emphysema ; Radiography, Thoracic ; Respiratory Tract Infections ; Retrospective Studies ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

Both idiopathic pulmonary fibrosis (IPF) and pulmonary involvement of collagen vascular disease(CVD) are well known cause of diffuse interstitial lung disease which lead to fibrosis and honeycombing. We analyzed HRCT findings of 33 patients with IPF and 14 patients with CVD in terms of predominant pattern, site of involvement, mediastinal lymph node enlargement, pleural change and pulmonary volume loss. Criteria of mediastinal lymph node enlargement and pleural thickening were 15mm in long diameter and 3mm, respectively. Volume loss of the lung was measured by using hilar height ratio (apex to hilum/hilum to diaphragmatic dome). Mean age was 61 years for IPF and 46 years for CVD and male: female ratio was 27:6, 4:10, respectively. Predominant HRCT pattern was honeycombing for IPF (63%), and ground-glass opacity for CVD (66%) (p=0.001). Predominantly, subpleural involvement was seen in 90% for IPF and 74% for CVD. Mediastinal lymph node enlargement was seen in 47% of the patient with IPF and 14% with CVD (p=0.004). pleural thickening was seen in 97% of the patients with IPF and 42% with CVD (P=0.002), Pleural effusion was seen in 10% of the patients with IPF and 36% with CVD (P=0.009). Hilar height ratio of more than 1.5 was seen in 84% of the patients with IPF and 29% with CVD. In conclusion, our study shows that patients with IPF are prone to have more progressed stage of pulmonary fibrosis than the patients with CVD on HRCT.
Collagen* ; Female ; Fibrosis ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Pleural Effusion ; Pulmonary Fibrosis

The increase in size of lymph node on Ct scan is the single most important finding of lymphadenopathy. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with idiopathic pulmonary fibrosis with no evidence of malignancy or current infection. CT scans of 70 patients (16 with conventional CT and 54 with high-resolution CT) were assessed for lymph node size and locations. The duration of symptoms, and the extent and patterns of the parenchymal lung disease on CT scans were correlated with lymph node enlargement. In 54 of 70 patients, more than one lymph nodes were larger than 1-1.5cm. The prevalence of mnode enlargement increased significantly with a longer duration of symptom (p=0.001), larger extent of the disease (p=0.043), and with a greater proportion of honeycomb pattern (p=0.0344). Right paratracheal, subcarinal, right tracheobronchial, and paraesophageal nodes were the most common sites of nodes enlargement. In conclusion, mediastinal lymph node enlargement is common in patients with idiopathic pulmonary fibrosis and is more frequently seen in patients with a longer duration of clinical symptoms, greater extent of the disease, and with a larger proportion of honeycomb pattern.
Humans ; Idiopathic Pulmonary Fibrosis* ; Lung Diseases ; Lymph Nodes* ; Lymphatic Diseases ; Prevalence ; Tomography, X-Ray Computed*

We study the predictive power of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in neurosurgical intensive care unit (ICU) patients. Retrospective investigation was conducted on 672 consecutive ICU patients during the last 2 yr. Data were collected during the first 24 hours of admission and analyzed to calculate predicted mortality. Mortality predicted by two systems was compared and, multivariate analyses were then performed for subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI) patients. Observed mortality was 24.8% whereas predicted mortalities were 37.7% and 38.4%, according to APACHE II and SAPS II. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC). In SAH patients, SAPS II was an independent predictor for mortality. In TBI patients, both systems had independent prognostic implications. Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting. TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.
*APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Brain Injuries/diagnosis/*mortality/surgery ; Child, Preschool ; Female ; *Hospital Mortality ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Subarachnoid Hemorrhage/diagnosis/*mortality/surgery ; Time Factors

We study the predictive power of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in neurosurgical intensive care unit (ICU) patients. Retrospective investigation was conducted on 672 consecutive ICU patients during the last 2 yr. Data were collected during the first 24 hours of admission and analyzed to calculate predicted mortality. Mortality predicted by two systems was compared and, multivariate analyses were then performed for subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI) patients. Observed mortality was 24.8% whereas predicted mortalities were 37.7% and 38.4%, according to APACHE II and SAPS II. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC). In SAH patients, SAPS II was an independent predictor for mortality. In TBI patients, both systems had independent prognostic implications. Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting. TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.
*APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Brain Injuries/diagnosis/*mortality/surgery ; Child, Preschool ; Female ; *Hospital Mortality ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Subarachnoid Hemorrhage/diagnosis/*mortality/surgery ; Time Factors

Human pulmonary dirofilariasis has been documented from many parts of the world, but not in Korea so far. We experienced a patient of pulmonary dirofilariasis who had visited a local clinic because of chest pain for 1 month. On chest radiograph, a coin lesion of 2 cm diameter and enlargement of the mediastinal lymph node were shown. An exploratory lung resection was done. Pathologically the lesion was a pulmonary dirofilariasis complicated with necrotic pneumonia, fibrosis, and infarction. At the center of the lesion, degenerated nematode sections with multilayered cuticle, thick musculature, and bilateral internal ridges on each side were found, which was identified to be Dirofilaria immitis. This is the first report of human pulmonary dirofilariasis in Korea.
Case Report ; Dirofilariasis/pathology* ; Dirofilariasis/diagnosis ; Human ; Lung Diseases, Parasitic/pathology* ; Lung Diseases, Parasitic/diagnosis ; Male ; Middle Age

OBJECTIVE: To determine the relationship between whole body vibration (WBV) induced helicopter flights and degenerative changes of the cervical and lumbar spine. METHODS: We examined 186 helicopter pilots who were exposed to WBV and 94 military clerical workers at a military hospital. Questionnaires and interviews were completed for 164 of the 186 pilots (response rate, 88.2%) and 88 of the 94 clerical workers (response rate, 93.6%). Radiographic examinations of the cervical and the lumbar spines were performed after obtaining informed consent in both groups. Degenerative changes of the cervical and lumbar spines were determined using four radiographs per subject, and diagnosed by two independent, blinded radiologists. RESULTS: There was no significant difference in general and work-related characteristics except for flight hours and frequency between helicopter pilots and clerical workers. Degenerative changes in the cervical spine were significantly more prevalent in the helicopter pilots compared with control group. In the cervical spine multivariate model, accumulated flight hours (per 100 hours) was associated with degenerative changes. And in the lumbar spine multivariate model, accumulated flight hours (per 100 hours) and age were associated with degenerative changes. CONCLUSION: Accumulated flight hours were associated with degenerative changes of the cervical and lumbar spines in helicopter pilots.
Aircraft* ; Hospitals, Military ; Humans ; Informed Consent ; Military Personnel ; Spine* ; Vibration ; Surveys and Questionnaires

OBJECTIVES: In diabetics the disturbance of circardian variation of blood pressure and heart rate has been supposed to be related to diabetic autonomic neuropathy and diabetic nephropathy. We performed this study to evaluate the circardian variation of blood pressure and heart rate and the difference of affecting factors between normoalbuminuric patients and microalbuminuric patients. METHODS: We studied 50normotensive NIDDM patients without overt nephropathy, divided two grooups, which are normoalbuminuric patients(D1 group) and microalhuminuric patients(D2 group), according to the urinary albumine excretion rate(AER) on 24-h urine collection. We simultaneosly measured 24-hour blood pressure and heart rate by using of ambulatory 24-hour blood pressure monitoring (ABPM). RESULTS: 1) In group Kb, 24-h systolic and diastolic blood pressure were significantly higher than in C(normal control group) and D1 2) 24-h heart rate values did not significantly differ between the groups, but night heart was significantly elevated in group D2 than C and D1. 3) The night/day ratio of SBP(systolic blood pressure) and HR(heart rate) was significantly higher in D2 than C and D1, but the night/day ratio of DBP(diastolic blood pressure) was significantly higher in D2 compaired with C only. 4) The night/day ratio of SBP correlated significantly with duration of diabetes, log of AER, HDL, HbAlc and 24-h DBP. The determinants selected in a multiple stepwise regression were duration of diabetes and HbAlc. 5) The night/day ratio of DBP was related to duration of diabetes, log of AER, 24-h DBP and night HR. The determinants selected in a multiple stepwise regression were duration of diabetes and 24-h DBP. 6) The night/day ratio of HB was related to neuropathy, 1/creatinine, HDL, night SBP, duration of diabetes and log of AER. The determinants selected in a multiple stepwise regression were neruopathy and night SBP. CONCLUSION: In this study, the normal circardian variation of blood pressure was disturbed in a group of micoralbuminuric patients. But it seems that AER was not a principle independent factor and circardian variation of blood pressure and heart rate were affected by different several factors identified in this study. The nocturnal heart rate was significantly elevated in microalbuminuric group, suggesting the possibility of the presence of parasympathetic neuropathy which is supposed to be related with sudden cardiac death. So it is thought that blunted circardian variation of blood pressure and heart rate can be a prognostic indicator and further prospective study is necessary.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure Monitors ; Blood Pressure* ; Death, Sudden, Cardiac ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Neuropathies ; Heart ; Heart Rate ; Humans ; Urine Specimen Collection

BACKGROUND AND OBJECTIVES: It is hard to determine the efficacy of several treatment options of Meniere's disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as 'effective' in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Meniere's disease. MATERIALS AND METHODS: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Meniere's disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed. RESULTS: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option. CONCLUSIONS: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Meniere's disease in Korea.
Academies and Institutes ; Aminoglycosides ; Consensus ; Diet ; Endolymphatic Sac ; Evidence-Based Medicine ; Gentamicins ; Hearing ; Humans ; Korea ; Meniere Disease ; Surveys and Questionnaires ; Recurrence

BACKGROUND/AIMS: Inflammatory bowel disease is commonly accompanied by colonic dysmotility and causes changes in intestinal smooth muscle contractility. In this study, colonic smooth muscle contractility in a chronic inflammatory condition was investigated using smooth muscle tissues prepared from interleukin-10 knockout (IL-10(-/-)) mice. METHODS: Prepared smooth muscle sections were placed in an organ bath system. Cholinergic and nitrergic neuronal responses were observed using carbachol and electrical field stimulation with L-NG-nitroarginine methyl ester (L-NAME). The expression of interstitial cells of Cajal (ICC) networks, muscarinic receptors, neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) was observed via immunofluorescent staining. RESULTS: The spontaneous contractility and expression of ICC networks in the proximal and distal colon was significantly decreased in IL-10(-/-) mice compared to IL-10(+/+) mice. The contractility in response to carbachol was significantly decreased in the proximal colon of IL-10(-/-) mice compared to IL-10(+/+) mice, but no significant difference was found in the distal colon. In addition, the expression of muscarinic receptor type 2 was reduced in the proximal colon of IL-10(-/-) mice. The nictric oxide-mediated relaxation after electrical field stimulation was significantly decreased in the proximal and distal colon of IL-10(-/-) mice. In inflamed colon, the expression of nNOS decreased, whereas the expression of iNOS increased. CONCLUSIONS: These results suggest that damage to the ICC network and NOS system in the proximal and distal colon, as well as damage to the smooth muscle cholinergic receptor in the proximal colon may play an important role in the dysmotility of the inflamed colon.
Animals ; Baths ; Carbachol ; Colon* ; Inflammatory Bowel Diseases* ; Interleukin-10* ; Interstitial Cells of Cajal ; Mice ; Mice, Knockout* ; Muscle, Smooth ; Nitrergic Neurons ; Nitric Oxide Synthase Type I ; Nitric Oxide Synthase Type II ; Receptors, Muscarinic ; Relaxation