No abstract available.
Biliary Tract*

The aim of this study was to evaluate spontaneous and LPS stimulated proinflammatory cytokines and chemokine release of alveolar macrophages in the patients with pulmonary tuberculosis and healthy individuals, as a control. Alveolar macrophages recovered from bronchoalveolar lavage fluids were cultured with or without LPS 0.1, 1, or 10 micrograms/ml for 24 and 48 hours in 37C, 5% CO2. TNF-alpha, IL-1beta IL-6 and IL-8 amount were evaluated using ELISA kit from the supernatants. There were a significant increase in the spontaneous 24 hours release of TNF-alpha and IL-6 from the involved segments of tuberculosis patients compared with uninvolved segments and normal control. There were also increasing trends of release of them after LPS stimulation in involved segments, but not significant. IL-1beta IL-6 and IL-8 were not evaluated from the involved segments of tuberculosis and there were not significant differences of them between uninvolved segments of tuberculosis and normal control. It is concluded that cytokine release of alveolar macrophages in the pulmonary tuberculosis was markedly increased, and it was localized to the alveolar macrophages from the involved segments.
Bronchoalveolar Lavage Fluid ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-6* ; Interleukin-8* ; Macrophages, Alveolar* ; Tuberculosis ; Tuberculosis, Pulmonary* ; Tumor Necrosis Factor-alpha*

BACKGROUND: In 1980, WHO made a definition in which the term "impairment" as applied to the respiratory system is used to describe loss of lung function, "disability" the resulting diminution in exercise capacity. The measurement of pulmonary function during exercise would give us information about overall functional capacity and respiratory performance that would be lacking in tests performed at rest. We conducted this study to investigate the role of resting pulmonary function test and exercise test for assessing impairment/disability in patients with chronic airflow obstruction(CAO). METHOD: We studied 19 patients with CAO. The spirometry and body plethysmograph were performed in stable condition. And then patients performed a progressive incremental exercise test to a symptom-limited maximum using cycle ergometer. Patients were divided in two groups, severe and non-severe impairment, according to the resting PFTs and compaired each other. A patient was considered to be severely impaired if FVC < 50%, FEV1 < 40% or FEV1/FVC < 40%. RESULTS: 1) The airway obstruction and hypoxemia of severe impairment group were more severe and exercise performance was markedly reduced compairing to non-severe impairment group. 2) The severe impairment group showed ventilatory limitation during exercise test and the limiting symptomes ware dyspnea in 9/10 patients. 3) The impairment and disability of the patients with tuberculous destructed lung were most marked in patients with CAO. 4) The FEV1 was the most prevalent criterion for the determination of severe impairment based on resting PFTs and was the varuable best correlated to VO2max(r=0.8l, p < 0.001). 5) The sensitivity of exercise limits for predicting severe disability according to resting PFTs was 80% and specificity 89%. CONCLUSION: In patients with severe CAO, FEV1 is a good predictive of exercise performance and impairment measured by resting PFTs can predict a disability by exercise test.
Airway Obstruction ; Anoxia ; Dyspnea ; Exercise Test* ; Humans ; Lung ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Function Tests* ; Respiratory System ; Sensitivity and Specificity ; Spirometry

BACKGROUND: Airway resistance(Raw) is measured with the body plethysmograph by displaying the relationship between airflow and alveolar pressure(V/PA). If the resistance curve on V/PA tracing is curved or looped, the estimation of Raw is difficult. This study was designed to examine wheather there is any correlation between the shape of resistance curve and the clinical status and the pulmonary function of patients. METHODS: The 146 pulmonary disease patients with increased Raw were included in this study. The shapes of resistance curves on V/PA tracing with body plethysmograph during quiet breathing were analyzed and compared with pulmonary function. RESULTS: The results were as follows ; 1) The shapes of resistance curves were summarized in 5 categories; type 1: linear, type 2: ovoid, type 3: sigmoid, type 4: scoop, type 5: paisley. The type 3 except 1 case, type 4 and type 5 were found to have loop mainly in expiratory phase. 2) Although the shapes of resistance curves were not typical for specific disease, the resistance curves of acute disease tended to belong to type 1 or 2 and those of chronic airflow obstruction tended to belong to type 3, 4 or 5. But resistance curves of bronchial asthma and destructive lung with tuberculosis showed all types in proportion to degree of airflow obstruction or destruction of parenchyme. 3) In the cases of resistance curves going to type 5 rather than type 1 and those with looping, airflow obstuction tended to be severe and airway resistance and residual volume tended to increase. CONCLUSIONS: Analysis of resistance curve on V/PA tracing measuring airway resistance is helpful for judging degree of airflow obstruction and air trapping. Although the shape of resistance curve is not typical for specific disease, there is a close association between looping and airway obstruction.
Acute Disease ; Airway Obstruction ; Airway Resistance* ; Asthma ; Colon, Sigmoid ; Humans ; Lung ; Lung Diseases ; Pulmonary Disease, Chronic Obstructive ; Residual Volume ; Respiration ; Tuberculosis

BACKGROUND: Bronchofiberscopy is a procedure with a chance of airway irritation and it may cause pathophysiologic changes of respiratory system. So we tried to evaluate the influence of bronchofibercopy on O2 saturation, ABGA and PET by patient's basal status and procedure type. METHOD: O2 saturation was measured every 1 minute from the left index finger tip with percutaneous oximetry. ABGA was done before and right after the bronchofiberscopy and PFT was done before and within 10 minutes after the bronchofiberscopy. RESULTS: The mean time for bronehofiberscopy procedure was 14.5mim and SaO2 maximally fall to 89.0 below 8% of the baseline after mean time of 8.4mm, which was recorvered at the end of the procedure. SaO2 change amount was 8.4% on Non-O2 supply group, which was lower compared to 6.4% of the O2-supply group without statistically significance. Biopsy Group and BAL group showed more SaO2 fall than washing only group. The level of PaO2 and FEV1 of the patient didn's influence significantly on SaO2 fall during the procedure. ABGA taken before and after the bronchofiberscopy showed mild fall of Pa02 and mild rise of PaCO2. Whereas PET showed decrease of FEV1(P<0.05) and increase of RV without changes in airway resistance and pulmonary diffusion capacity. Comparing before and after the bronchofiberscopy, the washing group showed no significant changes on PET, while the biopsy group and the BAL group showed increase of RV & decrease of FEV1 after the bronchofiberscopy. BAL group showed more changing tendency rather than biopsy group although not statistically significant. CONCLUSION: Bronchofiberscopy is considered as a relatively safe procedure, but it would be better to be done with O2 supply especially in the patient with low PaO2 and in the case of biopsy and BAL
Airway Resistance ; Biopsy ; Diffusion ; Fingers ; Humans ; Oximetry ; Respiratory System

No abstract available.
Asthma* ; Dyspnea* ; Humans ; Respiratory Function Tests*

No abstract available.
Airway Resistance* ; Respiration*

OBJECTIVES: Despite the advances in medical practice and technology, a steady increase in the incidence of sepsis has been reported and the mortality has been persistently high ranging from 20 to 50%, especially in medical intensive care unit. Therefore, objective assessment of severity of illness based on risk estimates derived from severity of illness score has been important. Thus this study was designed for identification of risk factors and comparison of severity of illness scores: Acute physiology and chronic health evaluation II(APACHE II), Acute physiology and chronic health evaluation III (APACHE III), Multiorgan failure scoring system(MOF), Simplified acute physiology score(SAPS), Septic severity score(SSS). METHODS: A retrospective clinical study was done on 97 patients with sepsis treated in medical intensive care unit, who had been admitted to Ewha Womans University Mokdong Hospital from September 1994 to May 1997. Multiple factors which may influence mortality and severity of illness score were evaluated by univariate and logistic regression analysis. RESULTS: 1) Of the 97 patients, 52 were male and 45 were female. The mean age was 62 years and the overall mortality was 59.8%. 2) On severity of illness, sepsis was 21cases, severe sepsis 36 and septic shock 40. On primary source of infection, pulmonary origin was 39cases, gastrointestinal origin 23 and urinary tract origin 13. The infection caused by documented organism was 53cases. 3) Based on the univariate analysis, age, sex, respiratory rate, number of organ failure, admission source, ventilatory support, hematocrit, WBC, prothrombin time, Na and K, pH, PaO2/FiO2, D(A-a)O2 and the following severity of illness scores :APACHE II, APACHE III, MOF, SAPS, and SSS for predicting mortality risk were all significant factors discriminating between survivors and nonsurvivors. 4) In distribution curve of APACHE II, APACHE III, MOF, SAPS, and SSS, the cut-off values in predictive risk of 50% were 21, 88, 4, 15, and 29. By logistic regression analysis after substituting their cut off value, APACHE II and APACHE III were significant independent predictors influencing survival with odd ratio 3.82 in APACHE II and 4.62 in APACHE III. In predictive risk of 50%, sensitivity was 55%, specificity 85%, accuracy 85% and relative risk 6.77 in APACHE II. And sensitivity was 47%, specificity 97%, accuracy 88% and relative risk 7.62 in APACHE III. CONCLUSION: APACHE II and APACHE III were significant predictor influencing mortality in sepsis patients treated in medical intensive care unit and APACHE III was superior to that of its predecessor. In near future, prospective and multicentral studies are required to confirm these results.
APACHE ; Female ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intensive Care Units* ; Critical Care* ; Logistic Models ; Male ; Mortality* ; Physiology ; Prothrombin Time ; Respiratory Rate ; Retrospective Studies ; Risk Factors* ; Sensitivity and Specificity ; Sepsis* ; Shock, Septic ; Survivors ; Urinary Tract

BACKGROUND: Dyspnea is common among patients with cardiopulmonary disease, and "daily disability" is defined as a functional impairment resulting from exercise intolerance. The maximal oxygen uptake(VO2max) during exhausting work is not only the best single physical indicator of the capacity of a man for sustaining hard muscular work, but also the most objective method by which one can determine the physical fitness of an individual as reflected by his cardiovascular system. However, the expense, time and personnel requirements make this procedure prohibitive for testing large group. The walking test is well-known type of exercise and it cost nothing to perform and have good reproducibility. Thus we performed the walking test and investigated correlations with spirometry, ABG and exercise test. METHOD: We observed the walking test and exercise test by cycle ergometer in 37 patients who visited our hospital because of dyspnea. Arterial blood gas analysis and spiromety, dyspnea index were performed, too. RESULT: (1) The VO2max was significantly lower in patients with COPD and cardiovascular disease than asthma and dyspnea on exertion group(p<0.05). The walking test distance was also lower in former. (2) The 12 minute walking test was significantly correlated with VO2max, PaCO2, FVC(%), FEV1(%) in all patients(p<0.05), and the walking test was only correlated with VO2max in patients with COPD(p<0.05). (3) In COPD patients, the VO2max was best correlated with FEV1(%) and FVC(%) and significantly correlated with walking test. But there was no correlation between walking test and FEV1(%) & FVC(%). (4) The 6 minute walking test was well correlated with 12 minute walking test(r=0.92, p<0.01). CONCLUSION: The walking test is the simple method for assessing exercise performance in patient with cardiopulmonary disease and a reliable indicator for VO2max. And the walking test is practical method for assessing on everyday disability rather than maximal exercise capacity. The 6 minute walking test is highly correlated with 12 minute walking test and a less exhausting for the patients and a time-saving for the investigator.
Asthma ; Blood Gas Analysis ; Cardiovascular Diseases ; Cardiovascular System ; Dyspnea ; Exercise Test ; Humans ; Lung* ; Oxygen ; Physical Fitness ; Pulmonary Disease, Chronic Obstructive ; Research Personnel ; Spirometry ; Walking*

Lymphomatoid granulomatosis was described by Liebow as a peculiar angiocentric and angiodestructive lymphoreticular proliferative granulomatous disease. Although the lung is most frequently involved, lymphomatoid granulomatosis is also commonly found in the upper respiratory tract, skin, kidneys and central nervous system. Pulmonary infiltrates are histologically polymorphous and show variable degree of cytologic atypic in the lymphoid cells. Infrequent involvement of the bone marrow, spleen and peripheral lymph nodes initially supported the distinction of lymphomatoid granulomatasis from lymphoma. We experienced a rare case of 26-year-old female diagnosed as lymphomatoid granulomatosis by per cutaneous needle aspiration biopsy and transbronchial lung biopsy with symptoms of fever, cough, sputum and right chest pain. After 4th chemotherapy it showed partial remission and chemotherapy is going on.
Adult ; Biopsy ; Biopsy, Needle ; Bone Marrow ; Central Nervous System ; Chest Pain ; Cough ; Drug Therapy ; Female ; Fever ; Humans ; Kidney ; Lung ; Lymph Nodes ; Lymphocytes ; Lymphoma ; Lymphomatoid Granulomatosis ; Needles ; Respiratory System ; Skin ; Spleen ; Sputum