Purpose: We aimed to evaluate shoulder muscle activities during shoulder external rotation exercises using an elastic band with the arm at the side or at 90° of abduction in static and dynamic body positions. Methods: In 2017, a total of 19 right-handed male subjects were included in this study. Surface electromyography signals were recorded from the anterior deltoid, middle deltoid, upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscles. The subjects underwent maximal voluntary isometric contraction testing of each muscle in the W position or 90/90 position. Subjects performed the exercise in the sitting, static squat, static rotational squat, dynamic squat to standing (DSS), and dynamic squat to standing and trunk rotation (DSSR) positions. Results: The main finding of this study was that shoulder external rotation exercises in the DSSR position were effective in reducing shoulder muscle activities except in the serratus anterior compared with static rotational squat position. Conclusion DSSR enabled effective control of scapular motion with less shoulder muscle activation. Therefore, the kinetic chain exercises incorporated with lower extremity, hip, or trunk would be beneficial for shoulder muscle exercises, which is required for patients with weak periscapular muscles, in whom the lower trapezius activities were found to be frequently decreased.

To determine overall detection rates of lung cancer by low-dose CT (LDCT) screening and to compare histopathologic and imaging differences of detected cancers between high- and low-risk groups, this study included 6,406 asymptomatic Korean adults with >or=45 yr of age who underwent LDCT for lung cancer screening. All were classified into high- (>or=20 pack-year smoking; 3,353) and low-risk (3,053; <20 pack-yr smoking and non-smokers) groups. We compared CT findings of detected cancers and detection rates between high- and low-risk. At initial CT, 35% (2,255 of 6,406) had at least one or more non-calcified nodule. Lung cancer detection rates were 0.36% (23 of 6,406). Twenty-one non-small cell lung cancers appeared as solid (n=14) or ground-glass opacity (GGO) (n=7) nodules. Cancer likelihood was higher in GGO nodules than in solid nodules (p<0.01). Fifteen of 23 cancers occurred in high-risk group and 8 in low-risk group (p=0.215). Therefore, LDCT screening help detect early stage of lung cancer in asymptomatic Korean population with detection rate of 0.36% on a population basis and may be useful for discovering early lung cancer in low-risk group as well as in high-risk group.
Adenocarcinoma/diagnosis ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/diagnosis ; Carcinoma, Squamous Cell/diagnosis ; Comparative Study ; Female ; Humans ; Korea ; Lung Neoplasms/*diagnosis ; Male ; Mass Screening/*methods ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed/*methods

BACKGROUND: Nonspecific interstitial pneumonia (NSIP) has been reported recently to show much better response to medical treatment and better prognosis compared with idiopathic UIP. However, clinical characteristics of idiopathic NSIP discriminating from UIP have not been defined clearly. METHOD: Among 120 patients with biopsy-proven diffuse interstitial lung diseases between July 1996 and March 2000 at Samsung Medical Center, 18 patients with idiopathic NSIP were included in this study. Retrospective chart review and radiographic analysis were performed. RESULTS: 1) At diagnosis, 17 patients were female and average age was 55.2 +/-8.4 years (44~73 years). The average duration from development of respiratory symptom to surgical lung biopsy was 9.9+/-17.1 months. Increase in bronchoalveolar lavage fluid lymphocytes (23.0 +/-13.1%) was noted. On HRCT, ground glass and irregular linear opacity were seen but honeycombing was absent in all patients. 2) Corticosteroids were initially given to 13 patients of whom medication was stopped in 3 patients due to severe side effects. Further medical therapy was impossible in 1 patient who experienced streroid-induced psychosis. Herpes zoster (n=3), tuberculosis (n=1), avascu lar necrosis of hip (n=1), cataract (n=2) and diabetes mellitus (n=1) developed during prolonged corticosteroid administration. Of 7 patients receiving oral cyclophosphamide therapy, hemorrhagic cystitis hindered one patient from continuous medication. 3) After medical treatment, 14 of 17 patients improved and 3 patients remained stable (mean w-up ; 24.1+/-11.2 months). FVC increased by 20.2 +/-11.2% of predicted value and the extent of ground glass opacity on HRCT decreased significantly (15.7+/-14.7%). 4) Of 14 patients who had stopped medication, 5 showed recurrence of NSIP and 2 aggravated during steroid tapering. All patients with recurrence showed deterioration within one year after completion of initial treatment. CONCLUSION: Since idiopathic NSIP has unique clinical profiles and shows a good prognosis, differential diagnosis from UIP and aggressive medical treatment are needed.
Adrenal Cortex Hormones ; Biopsy ; Bronchoalveolar Lavage Fluid ; Cataract ; Cyclophosphamide ; Cystitis ; Diabetes Mellitus ; Diagnosis ; Diagnosis, Differential ; Female ; Glass ; Herpes Zoster ; Hip ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases, Interstitial* ; Lymphocytes ; Necrosis ; Prognosis ; Psychotic Disorders ; Recurrence ; Retrospective Studies ; Tuberculosis

BACKGROUND: Nonspecific interstitial pneumonitis (NSIP) is most likely to be confused with usual interstitial pneumonitis (UIP). Unlike patients with UIP, the majority of patients with NSIP have a good prognosis, with most patients improving after treatment with corticosteroids. Therefore it is clinically important to differentiate NSIP from UIP. UP to now, the only means of differentiating these two diseases was by means of surgical lung biopsy. American Thoracic Society (ATS) proposed a clinical diagnostic criterial for UIP to provide assistance to clinicians in its diagnosis without surgical lung biopsy. This study is aimed to investigate whether there were clinical and radiological differences between NSIP and UIP, and the usefulness of ATS clinical diagnostic criteria for UIP in Korea. METHODS: we studied 60 patients with UIP and NSIP confirmed by surgical lung biopsy. Clinical manifestations, pulmonary function test, arterial blood gas analysis, bronchoalveolar lavage (BAL), and high resolution computed tomography (HRCT) were evaluated and analyzed by Chi-square test or t-test. The clinical criteria for UIP proposed by ATS were applied to all patients with idiopathic interstitial pneumonia. RESULTS: Forty-two patients with UIP and 18 with NSIP were pathologically identified. Among the 18 patients with NSIP (M : F = 1 : 17), the mean age was 55.2± 8.4 (44~73)yr. Among the 42 patients with UIP (M : F = 33 : 9), the mean age was 59.5±7.1 (45~74) yr (p=0.0460. Fever was more frequent in NSIP (39%) (p=0.034), but clubbing was frequently observed in UIP (33%) (p=0.023). BAL lymphocytosis was more frequent (23%) (p=0.0001) and CD4/CD8 ratio was lower in NSIP (p=0.045). On HRCT, UIP frequently showed honeycomb appearance (36 of 42 patients) through not in NSIP (p=0.0001). Six of 42 UIP patients (14.3%) met the ATS clinical criteria for IPF, and 3 of 16 NSIP patients (18.8%) met the diagnostic criteria. CONCLUSION: Being a relatively young female and having short duration of illness, fever, BAL lymphocytosis, low CD4/CD8 ratio with the absence of clubbing and honeycomb appearance in HRCT increase the likelihood of the illness being NSIP. The usefulness of ATS clinical diagnostic criteria for UIP may be low in Korea.
Adrenal Cortex Hormones ; Biopsy ; Blood Gas Analysis ; Bronchoalveolar Lavage ; Diagnosis ; Diagnosis, Differential* ; Female ; Fever ; Humans ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis* ; Korea ; Lung ; Lung Diseases, Interstitial* ; Lymphocytosis ; Prognosis ; Pulmonary Fibrosis ; Respiratory Function Tests

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a diffuse inflammatory and fibrosing process that occurs within the interstitium and alveolus of the lung with invariably poor prognosis. The major problem in management of IPF results from the variable rate of disease progression and the difficulties in predicting the response to therapy. The purpose of this retrospective study was to evaluate the shortterm efficacy of steroid and immunosuppressive therapy for IPF and to identify the pre-treatment determinants of favorable response. METHOD: Twenty patients of IPF were included. Diagnosis of IPF was proven by thoracoscopic lung biopsy and they were presumed to have active progressive disease. The baseline evaluation in these patients included clinical history, pulmonary function test, bronchoalveolar lavage (BAL), and chest high resolution computed tomography (HRCT). Fourteen patients received oral prednisolone treatment with initial dose of 1mg/kg/day for 8 to 12 weeks and then tapering to low-dose prednis olone (0.5mg/kg/day). Six patients who previously had experienced significant side effects to steroid received 2mg/kg/day of oral cyclophosphamide with or without low-dose prednisolone. Follow-up evaluation was performed after 6 months of therapy. If patients met more than one of followings, they were considered to be responders: (1)improvement of more than one grade in dyspnea index, (2)improvement in FVC or TLC more than 10% or improvement in DLco more than 20% (3) decreased extent of disease in chest HRCT findings. RESULT: One patient died of extrapulmonary cause after 3 month of therapy, and another patient gave up any further medical therapy due to side effect of steroid. Eventually medical records of 18 patients were analyzed. Nine of 18 patients were classified into responders and the other nine patients into nonresponders. The histopathologic diagnosis of the responders were all nonspecific interstitial pneumonia (NSIP) and that of nonresponders were all usual interstitial pneumonia (UIP) (p<0.001). The other significant differences between the two groups were female predominance (p<0.01), smoking history (p<0.001), severe grade of dyspnea (p<0.05), lymphocytosis in BAL fluid (23.8+/-16.3% vs 7.83+/-3.6%, p < 0.05), and less honeycombing in chest HRCT findings (0% vs 9.22+/-2.3%, p < 0.001). CONCLUSION: Our results suggest that patients with histopathologic diagnosis of NSIP or lymphocytosis in BAL fluid are more likely to respond to steroid or immunosuppressive therapy. Clinical results in large numbers of IPF patients will be required to identify the independent variables.
Biopsy ; Bronchoalveolar Lavage ; Cyclophosphamide ; Diagnosis ; Disease Progression ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung ; Lung Diseases, Interstitial ; Lymphocytosis ; Medical Records ; Prednisolone ; Prognosis ; Respiratory Function Tests ; Retrospective Studies ; Smoke ; Smoking ; Thorax

BACKGROUND: With variable symptoms and nonspecific radiographic appearances, pulmonary embolism (PE) is a frequent and often undiagnosed cause of mortality and morbidity. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study suggested that the majority of patients undergoing ventilation-perfusion (V-Q) scan would require additional studies to establish or to exclude the diagnosis of PE. Pulmonary angiography has been regarded as gold standard for diagnosis of PE. However, it is an invasive procedure that may be associated with significant notable mo rbidity and mortality. Thus, availability of an accurate, noninvasive screening examination is highly desirable. METHOD: From October 1994 to February 1997, twenty patients (male 13, female 7, range 23-91 years, median 58 years) who were suspected as pulmonary embolism on the basis of clinical evidence and underwent the spiral volumetric computed tomography (spiral CT), were studied retrospectively to evaluate the effectiveness of spiral CT as a diagnostic tool in PE. RESULTS: PE could be excluded with spiral CT in 4 patients; diagnoses of these patients were lung cancer, pneumonia with lung abscess, bilateral pleural effusion due to congestive heart failure, nonspecific pulmonary abnormality retrospectively. One patient who disclosed high probability in V/Q scan, could be diagnosed as pneumonia with lung abscess and underlying emphysema with spiral CT. Among 4 patients who showed intermediate and low probability in V/Q scan, 3 patients could be confirmed as PE with spiral CT. Spiral CT were helpful in 3 patients, in whom V/Q scan could not be performed due to other reasons (e.g. night time, mechanical ventilation) to confirm the diagnosis of PE. Spiral CT could demonstrate embolus above lobar artery level in 11 patients, and up to segmental artery level in 5 patients. CONCLUSION: This study demonstrated that spiral CT could allow accurate demonstration of thrombotic clots in centrally localized embolism. Spiral CT could be effective, specific, noninvasive and useful diagnostic screening modality for the diagnosis of pulmonary embolism.
Angiography ; Arteries ; Cone-Beam Computed Tomography ; Diagnosis ; Embolism ; Emphysema ; Female ; Heart Failure ; Humans ; Lung Abscess ; Lung Neoplasms ; Mass Screening ; Mortality ; Pleural Effusion ; Pneumonia ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, Spiral Computed*

BACKGROUND: With variable symptoms and nonspecific radiographic appearances, pulmonary embolism (PE) is a frequent and often undiagnosed cause of mortality and morbidity. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study suggested that the majority of patients undergoing ventilation-perfusion (V-Q) scan would require additional studies to establish or to exclude the diagnosis of PE. Pulmonary angiography has been regarded as gold standard for diagnosis of PE. However, it is an invasive procedure that may be associated with significant notable mo rbidity and mortality. Thus, availability of an accurate, noninvasive screening examination is highly desirable. METHOD: From October 1994 to February 1997, twenty patients (male 13, female 7, range 23-91 years, median 58 years) who were suspected as pulmonary embolism on the basis of clinical evidence and underwent the spiral volumetric computed tomography (spiral CT), were studied retrospectively to evaluate the effectiveness of spiral CT as a diagnostic tool in PE. RESULTS: PE could be excluded with spiral CT in 4 patients; diagnoses of these patients were lung cancer, pneumonia with lung abscess, bilateral pleural effusion due to congestive heart failure, nonspecific pulmonary abnormality retrospectively. One patient who disclosed high probability in V/Q scan, could be diagnosed as pneumonia with lung abscess and underlying emphysema with spiral CT. Among 4 patients who showed intermediate and low probability in V/Q scan, 3 patients could be confirmed as PE with spiral CT. Spiral CT were helpful in 3 patients, in whom V/Q scan could not be performed due to other reasons (e.g. night time, mechanical ventilation) to confirm the diagnosis of PE. Spiral CT could demonstrate embolus above lobar artery level in 11 patients, and up to segmental artery level in 5 patients. CONCLUSION: This study demonstrated that spiral CT could allow accurate demonstration of thrombotic clots in centrally localized embolism. Spiral CT could be effective, specific, noninvasive and useful diagnostic screening modality for the diagnosis of pulmonary embolism.
Angiography ; Arteries ; Cone-Beam Computed Tomography ; Diagnosis ; Embolism ; Emphysema ; Female ; Heart Failure ; Humans ; Lung Abscess ; Lung Neoplasms ; Mass Screening ; Mortality ; Pleural Effusion ; Pneumonia ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, Spiral Computed*

Approximately 100 drugs have been reported to affect the lungs adversely. Among these, pulmonary toxicity caused by antieneoplastic agent is being recognized more frequently. Cyclophosphamide is an immunosuppressive alkylating agent used for the treatment of a wide variety of malignant and nonmalignant diseases. The incidence of pulmonary toxicity is probably less than 1 percent The first case was reported in 1967. Since then, more than 20 well-documented cases of pulmonary toxicity associated with cyclophosphamide have been reported in the literature. In Korea, three patients were identified with cyclophosphamide-induced lung disease. The typical features of toxicity include dyspnea, fever, cough, new parenchymal infiltrates, gas exchangs abnormalities on pulmonary function tests, and pleural thickening on chest roentgenogram. The best approach to management is early diagnosis, discontinuation of the offending drug and administration of corticosteroid therapy. Recently, we experienced a case of diffuse alveolar damage induced by cyclophosphamide. The patient presented with early-onset pulmonary toxicity and died of repiratory failure despite early use of corticosteroid.
Cough ; Cyclophosphamide* ; Dyspnea ; Early Diagnosis ; Fever ; Humans ; Incidence ; Korea ; Lung ; Lung Diseases ; Respiratory Function Tests ; Thorax

We report a rare case of primary tracheal malignent melanoma documented by careful clinical examination. Differentiation between primary and metastatic malignant melanoma is very difficult. We conclude that this tracheal tumor is a primary malignant melanoma based on characteristic pathologic features and the exclusion of the possibility of spontaneous regression of the primary site by patient's history and physical examination.
Melanoma* ; Physical Examination ; Trachea

Invasive pulmonary aspergillosis is a disease occuring predominantly in patients with defects in immunity such as neutropenia, hematologic malignancies or with defects in cell-mediated immunity. The isolation of Aspergillus from respiratory tract of normal host usually signifies tracheobronchial colonization, making this diagnosis difficult. There are isolated case reports occuring in normal hosts but most of them were diagnosed postmortem at autopsies indicating that early diagnosis of invasive aspergillosis in normal host is difficult. We describe here a case of invasive aspergillosis in a immunocompetent host diagnosed by lung biopsy which was successfully treated with Amphotericin-B. Invasive pulmonary aspergillosis should be included as one of the differential diagnosis if a patient with pneumonic consolidation does not respond to usual therapy, even if the patient does not have any defect in immunity.
Aspergillosis ; Aspergillus ; Autopsy ; Biopsy ; Colon ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Hematologic Neoplasms ; Humans ; Immunity, Cellular ; Invasive Pulmonary Aspergillosis* ; Lung ; Neutropenia ; Respiratory System