Biopsy ; Diagnosis, Differential ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Diseases, Interstitial ; classification ; diagnostic imaging ; pathology ; Radiography

The presently used impairment rating guidelines in Korea do not accurately reflect the injury in various lung diseases. Therefore, they need to be made more objective and quantitative with new measurements, using indicators to more precisely represent impairment in the major respiratory diseases. We develop a respiratory impairment rating guideline to ensure that the same grade or impairment rating would be obtained regardless of surgeons who determinate it. Specialists in respiratory medicine and thoracic surgeons determined the impairment grades. Moreover, the impairment should be irreversible for more than 6 months. The impairment rating depends on the level of forced vital capacity, forced expiratory volume 1 second, diffusion capacity of carbon monoxide, arterial oxygen pressure, and arterial carbon dioxide pressure. The degree of whole body impairment is defined by each grade: first 81-95%, second 66-80%, third 51-65%, fourth 36-50%, and fifth 21-35%. In conclusion, we develop a respiratory impairment rating guideline for Koreans. Any qualified specialist can easily use it and judge objective scoring.
*Disability Evaluation ; Humans ; Korea ; Lung Diseases/classification/diagnosis ; Program Development ; Pulmonary Ventilation/physiology ; Respiratory Insufficiency/classification/*diagnosis ; Severity of Illness Index

The classification for pneumoconiosis which was developed by International Labour Office(ILO) on the basis of Radiological findings of simple chest radiography has been widely used for the study and diagnosis of pneumoconiosis. But many problems have been revealed during the pneumoconiosis study using this classification. Those problems come from simple radiography itself or classification systems. Among those, inter-reader and intra-reader variability are the severest problems, even though many efforts have been devoted to lessen the variability. With introduction of computed tomography (conventional CT and HRCT), we are learning many new aspects about the occupational lung diseases, especially pneumoconiosis. So the studies for pneumoconiosis using tomography are reviewed, focusing on silicosis, coalworkers' pneumoconiosis, and asbestosis. But in our country, the studies of that kind are very scant. It is necessary to study and diagnose pneumoconiosis by CT, because that is the need of workers and the responsibility of physicians working in the field of occupational medicine. CT is superior to simple radiography in early detection, determination of severity, and follow-up of pneumoconiosis. But simple radiography is and should be the main method for the study and diagnosis of pneumoconiosis. Although, because of radiation hazard, cost, time, and geographical availability, the method can not and should not be used on the routine basis, we have to consider the use of CT, if possible and if necessary. Before using CT widely, we should develop the standardized criteria regarding to scanning methods and reading criteria. If not, the same problems as those of simple radiography will be occurred, and then there will be no progress in occupational medicine and workers' health.
Asbestosis ; Classification ; Diagnosis* ; Follow-Up Studies ; Learning ; Lung Diseases ; Occupational Medicine ; Pneumoconiosis* ; Radiography* ; Silicosis ; Thorax

PURPOSE:The International Labor Organization (ILO) has established an international standard for chest X-ray diagnosis of pneumoconiosis since 1980. However, there is a need for improved diagnosis and staging in occupational disease. We evaluated Ga-67 citrate scintigraphy quantitatively and correlated the scintigraphic findings with pulmonary function tests and chest X-ray result. MATERIALS AND METHODS: Twenty-five patients underwent whole body scintigraphy with additional chest and abdomen images 48 hrs after intravenous injection of 185 MBq of Ga-67 citrate. Ten normal controls were also studied. Regions of interest (ROI) were drawn on the posterior image to measure counts from the liver and lungs (Lung/Liver Ratio). RESULTS: L/L ratio according to the stages of chest X-ray classification were as follows; stage 0 (normal, n=10): 0.3948+/-0.0692, stage 1 (n=10): 0.5763+/-0.1837, stage 2 (n=11): 0.6849+/-0.1459, stage 3 (n=4): 0.9913+/-0.0712. There was a significant correlation between the scintigraphic L/L ratio and the X-ray stage (r=0.618, p<0.05). However, no significant correlation between L/L ratio and pulmonary function tests were observed (p>0.05). CONCLUSION: Quantitative Ga-67 scintigraphy can be a useful method for staging of silicosis. However, it is not a method to assess pulmonary functional impairment.
Abdomen ; Citric Acid ; Classification ; Diagnosis ; Humans ; Injections, Intravenous ; Liver ; Lung ; Occupational Diseases ; Pneumoconiosis ; Radionuclide Imaging* ; Respiratory Function Tests ; Silicosis* ; Thorax*

Interstitial lung disease is a generic term for a heterogeneous group of lung disease that primarily affect the interstitium although the disease is not clearly restricted to the interstitium. The majority of interstitial lung diseases represent inflammatory insults to the microscopic anatomic space bounded by the basement membrane of epithelial and endothelial cells, which may occur as slowly developing process and ultimately end up as end-stage honeycomb fibrosis. The currently prevalent classification of interstitial pneumonia with practical utility and easy reproducibility pertaining only to idopathic interstitial pneumonia encompasses several different entities some of which may represent different aspects of the same condition. Honeycomb fibrosis is usually caused by a variety of pulmonary disease including chronic interstitial lung disease. It is important to recognize that usual inter-stitial pneumonia and honeycomb fibrosis are not synonymous. In the era of chemotherapy for malignant tumor, aggressive immunosuppression for autoimmune diseases and transplant recipients and acquired immunodeficiency syndrome, lung disease in the immunocompromised host has been common. Diagnostic lung biopsy becomes increasingly needed because proper treatment of interstitial lung disease relies on correct morphologic diagnosis. This review summarizes the pathologic spectrum of idiopathic interstitial pneumonias together with other inflammatory process with known or suggestive etiologies simulating interstitial pneumonias.
Acquired Immunodeficiency Syndrome ; Autoimmune Diseases ; Basement Membrane ; Biopsy ; Classification ; Diagnosis ; Drug Therapy ; Endothelial Cells ; Fibrosis ; Idiopathic Interstitial Pneumonias ; Immunocompromised Host ; Immunosuppression ; Lung ; Lung Diseases ; Lung Diseases, Interstitial* ; Pathology* ; Pneumonia ; Transplantation

Idiopathic interstitial pneumonia (IIP) is a histologically identifiable pulmonary disease without a known cause that usually infiltrates the lung interstitium. IIP is largely classified into idiopathic pulmonary fibrosis, idiopathic non-specific interstitial pneumonia, respiratory bronchiolitis-interstitial lung disease (ILD), cryptogenic organizing pneumonia, desquamative interstitial pneumonia, and acute interstitial pneumonia. Each of these diseases has a different prognosis and requires specific treatment, and a multidisciplinary approach that combines chest high-resolution computed tomography (HRCT), histological findings, and clinical findings is necessary for their diagnosis. Diagnosis of IIP is made based on clinical presentation, chest HRCT findings, results of pulmonary function tests, and histological findings. For histological diagnosis, video-assisted thoracoscopic biopsy and transbronchial lung biopsy are used. In order to identify ILD associated with connective tissue disease, autoimmune antibody tests may also be necessary. Many biomarkers associated with disease prognosis have been recently discovered, and future research on their clinical significance is necessary. The diagnosis of ILD is difficult because patterns of ILD are both complicated and variable. Therefore, as with other diseases, accurate history taking and meticulous physical examination are crucial.
Biomarkers ; Biopsy ; Classification ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia ; Diagnosis ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases ; Lung Diseases, Interstitial ; Physical Examination ; Prognosis ; Respiratory Function Tests ; Thorax

PURPOSE: Histologic classification plays a key role in the classification of idiopathic interstitial pneumonia (IIP) into clinically meaningful categories in terms of natural history, prognosis and treatment. The implications of histological diagnosis, clinical features and prognosis in children has not been described. This study aimed to analyze the clinical features of IIP in children. METHODS: A total of 15 patients with IIP were recruited, who had a surgical lung biopsy. The age, sex, symptoms, initial oxygen saturation, radiologic findings and clinical courses were retrospectively investigated. RESULTS: The median age at diagnosis was 3 years. Cough (93.3%), tachypnea (86.7%) and dyspnea (80%) were the most common symptoms, and laboratory findings were nonspecific. Acute interstitial pneumonia (n=6), chronic pneumonitis of infancy (n=4) nonspecific interstitial pneumonia (n=3) were relatively common. All patients received corticosteroid therapy and the mortality rate was 26.7% (n=4). CONCLUSION: IIP has diverse clinical features according to subtypes. Knowledge of the underlying histopathology will allow the prediction of more accurate prognosis, the decision of appropricate therapy, and the clinical investigation of novel therapeutic agents in patients with IIP.
Biopsy ; Child ; Classification ; Cough ; Diagnosis ; Dyspnea ; Humans ; Idiopathic Interstitial Pneumonias* ; Lung ; Lung Diseases, Interstitial ; Mortality ; Natural History ; Oxygen ; Pneumonia ; Prognosis ; Retrospective Studies ; Tachypnea

Algorithms ; Biopsy, Needle ; Child ; China ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Diseases, Interstitial ; classification ; diagnosis ; etiology ; Mass Screening ; Societies, Medical ; Tomography, X-Ray Computed

Animals ; Diagnosis, Differential ; Humans ; Idiopathic Interstitial Pneumonias ; pathology ; Lung ; diagnostic imaging ; pathology ; Lung Diseases, Interstitial ; classification ; pathology ; Pulmonary Fibrosis ; pathology ; Tomography, X-Ray Computed

INTRODUCTION: Diffuse interstitial lung diseases (DILD) comprise of a large group of lung diseases with diverse etiologies. They are classified into four categories based on the etiology and pathological findings. In Korea, epidemiological data on DILD has never been reported in a prospective manner. METHOD: From May 2002 to April 2004, total 487 patients with DILD were prospectively registered at Samsung Medical Center. The prospective observational analysis of the etiologies, its classification based on 2002 ATS/ERS (American Thoracic Society/European Respiratory Society) guidelines, as well as diagnostic tests and the retrospective analysis of the treatment modalities were carried out. Any infectious and malignant causes were excluded. RESULTS: 1) The patients were classified into idiopathic interstitial pneumonia (IIP) in 269 patients (55.2%), known causes of DILD in 168 patients (34.5%), sarcoidosis in 27 patients (5.5%), other forms of DILD in 14 patients (2.9%), and undetermined DILD in 9 patients (1.9%). 2) The diagnostic test showed that most patients had undergone chest high resolution computed tomography (HRCT) and pulmonary function test (PFT) (97%, 89%). Transbronchial lung biopsy (TBLB) and surgical lung biopsy (SLB) were performed in limited patients (38%, 29%). 3) Among 269 patients with IIP, 220 (82%) had idiopathic pulmonary fibrosis (IPF) while 23 (9%) had nonspecific interstitial pneumonia. SLB was carried out in 36% of patients with IIP. 4) Symptomatic supportive care was given to 67% of IPF, but specific medical treatment including corticosteroids was administered to 89% of non-IPF patients. CONCLUSION: A nationwide registry of DILD patients is required to determine the annual incidence, etiology, and practice pattern of diagnosis and treatment in Korea.
Adrenal Cortex Hormones ; Biopsy ; Classification ; Diagnosis ; Diagnostic Tests, Routine* ; Humans ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis ; Incidence ; Korea ; Lung ; Lung Diseases ; Lung Diseases, Interstitial ; Respiratory Function Tests ; Retrospective Studies ; Sarcoidosis ; Thorax