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Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that typically affects the medium-sized muscular arteries, with occasional involvement of the small muscular arteries. As with other vasculitides, PAN can affect any organ system, including the cardiovascular, gastrointestinal and central nervous systems. The prognosis for patients with untreated PAN is relatively poor, with five-year survival rates of approximately 13 percent. The outcome has improved with proper therapy to approximately 80 percent survival at five years. We report here on a case of a 46 year old man with polyarteritis nodosa and who suffered from pulmonary tuberculosis.

Background: Due to the irreversible nature of chronic obstructive pulmonary disease (COPD), the treatment aim in patients with COPD is not to cure but to reduce the symptoms, increase lung function, and improve the quality of life. It has been suggested that depression is a common emotional disturbance in patients with COPD who are faced with a major physical impairment and embarrassing symptoms. This study evaluated the prevalence and risk factors of depression in patients with chronic obstructive pulmonary disease. Methods: A total of 59 patients with a registered diagnosis of chronic obstructive pulmonary disease were selected. Depression was assessed using the Centers for Epidemiologic Studies Depression (CES-D) scale. The quality of life was assessed using the Korean version of the St. George’s Respiratory Questionnaire. Results: The prevalence of depression was 17.0%. In the correlation model, the interaction of the FEV1% over predicted value and SGRQ score(symptom, activity, impact, overall score) was statistically significant. The interaction of the FEV 1% over predicted value and depression scale(CES-D) was also statistically significant. There was a positive correlation between the SGRQ scores(symptom, activity, impact, overall score) and the depression scale. Conclusion: The prevalence of depression in patients with chronic obstructive pulmonary disease is relatively high. The pulmonary function and the living standards were found to be significant risk factors for depression. (Tuberc Respir Dis 2008;65:191-197)

연구배경: COPD는 전세계적으로 유병률, 이환율 및 사망률이 급격히 증가하는 질환으로 환자의 삶의 질을 호전 시키고 사회, 경제적인 질병부담을 줄이기 위해 경증 COPD 환자를 조기에 진단하여 적절히 치료하는데 일차진료의사의 역할이 중요하다. 근거중심을 바탕으로 개발된 GOLD와 같은 COPD 진료지침은 이 목적을 위해 유용하나 우리나라의 진료실태가 반영되지 않은 문제점이 있다. 근거중심을 바탕으로 우리나라 진료실정이 반영된 진료지침을 개발하기 위해 우리나라 일차진료의사들의 진료 실태를 조사하여 보고한다. 방법: 진료실태는 웹을 기반으로 COPD의 진단, 치료, 위험인자, 교육, 진료지침에 대한 25개의 설문을 포함 제작하였고 총 217명의 일차진료의사가 설문조사에 동의하고 참여하였다. 참여자의 의사경력은 평균 17.7년이며 76.5%가 내과를 전공하였고 지역적으로는 63.6%가 서울, 경기지역에서 진료를 하고 있었다. 결과: 비교적 높은 비율(61.8%)로 폐기능검사기를 보유하고 있지만 실제 진료 시 활용도는 낮은(35.8%) 편임을 알 수 있었다. 안정 시, 급성악화 시 COPD의 치료에서 경구제제의 처방빈도가 흡입제제에 비해서 모두 높았다. COPD의 주요 위험인자인 흡연에 대해서는 흡연여부 확인율, 금연권유율 등이 90% 이상으로 높았으나 금연을 위한 처방에서 금연 성공률이 높은 니코친대체제와 부프로피온의 병용 처방률이 4.3%로 낮았다. COPD 진료지침에 대한 인지도는 56.7%였고 그대로 따르는 경우는 7.3%로 국내 진료실태를 반영한 진료지침의 개발이 요구되며 진료지침의 보급과 확산을 위해서는 진료지침책자를 포함한 인쇄자료의 보급이 효과적임을 알 수 있었다. 결론: 우리나라 일차진료의사들의 COPD 진료실태는 진단에서 폐기능검사의 보유율에 비해 사용률이 낮고 치료에서 흡입제에 비해 경구제제의 처방을 선호하는 경향을 보였다. GOLD 진료지침에 대한 인지도는 높으나 그대로 따르는 일차진료의사는 적으므로 이번 진료실태조사 결과를 바탕으로 근거중심이지만 국내실정을 반영한 COPD 진료지침의 개발 및 보급이 필요하리라 생각된다.

연구배경: 폐암은 우리나라 암 사망원인 질환의 가장 높은 비율을 차지하는 질환으로 특히 노령 인구에서 증가하는 추세이다. 그러나 노령의 폐암 환자는 동반된 질환, 노령에 따른 장기 기능의 저하 등의 이유로 적절한 치료를 받지못하는 경우가 많다. 이에 70세 이상의 노령 폐암 환자의 임상적 특징과 치료에 따른 생존기간 등을 알아보고자 한다. 방법: 2005년 1월부터 2005년 12월까지 대구, 경북지역에 소재하고 있는 대학병원 및 종합병원(경북대학병원, 구미 순천향병원, 대구가톨릭대학병원, 대구파티마병원, 동산의료원, 영남대학병원)에서 세포학적 혹은 조직학적으로 원발성 폐암을 진단받은 706명의 환자들을 70세 이상 환자군과 70세 미만 환자군으로 나누어 후향적으로 연구하였다. 결과: 전체 환자 중 70세 이상의 환자는273명(38.7%)이었다. 70세 이상의 환자는 70세 미만보다 호흡곤란의 증상이 많았으며(p＜0.001), 만성폐쇄성폐질환의 빈도가 높았고(p＜0.001), 활동도가 좋은 경우가 적었다(p＜0.001). 비소세포폐암 환자의 중앙생존기간은 70세 미만의 환자와 70세 이상의 환자에서 유의한 차이를 보였지만(962일 vs 298일, p=0.001), 한 가지라도 치료를 받았던 환자들을 대상으로 했을 때는 두 군간에 의미 있는 차이가 없었다(1,109일 vs 708일, p=0.14). 결론: 70세 이상의 비소세포폐암 환자에서 환자의 활동도 등을 고려하여 적극적인 치료를 시행하는 것이 바람직할 것으로 생각된다.

연구배경: 기관지천식과 만성폐쇄성폐질환과 같은 만성기도질환의 여러 가지 치료법 중 흡입제가 가장 효과적 방법이지만 상당수 환자에서 부정확하게 흡입제를 사용하고 있고, 순응도 또한 낮은 편이다. 저자들은 흡입제의 정확한 사용과 치료 순응도를 높이고자 전산화 흡입제 상담 서비스 프로그램을 개발하여 흡입제 사용에 대한 반복적 교육과 평가를 시행하여 흡입제의 사용 능력 및 치료 순응도에 미치는 효과를 알아보았다. 방법: 만성기도질환 환자를 대상으로 저자들이 개발한 전산화 흡입제 상담 서비스 프로그램을 실시하였다. 2회 이상 방문한 환자를 대상으로 흡입제의 사용능력을 9개 항목에 따라 교육과 함께 평가를 하였으며, 교육 전후 질병의 이해와 약물의 순응도를 알아보았다. 결과: 흡입제 사용 능력이 교육 전후, 1차와 2차, 2차와 3차 방문사이에 유의하게 향상되었다(p＜0.05). 자신의 질환에 대한 이해도는 1차 방문에서 70.7%, 2차 방문에서는 78.7%, 3차 방문에서는 78.9%로 증가하였다. 순응도는 2차 방문에서 70.1%, 3차 방문에서는 81.8%로 향상되었다. 결론: 저자들이 개발한 전산화 흡입제 상담 서비스 프로그램은 만성기도질환 환자에서 흡입제 사용능력 및 순응도, 질병에 대한 이해도를 향상시킬 수 있었다.

Background Weight loss is common in patients with chronic obstructive pulmonary disease (COPD). However, the mechanisms of this weight loss are still unclear. Methods Sixty male patients with stable COPD and 45 healthy male controls participated in this study. The COPD patients were divided into two groups, that is, the emphysema and chronic bronchitis groups, by the transfer coefficient of carbon monoxide. The body composition, resting energy expenditure (REE), plasma leptin levels and serum tumor necrosis factor-alpha (TNF-α) were measured in all the study participants. The difference and correlation of these parameters were investigated between the two groups. Results Emphysematous patients were characterized by a lower body mass index (BMI) and fat-mass (FM) compared with the chronic bronchitis patients (p

－Abstract－ Varicella is a contagious infection in childhood disease typically affecting children aged 2-8 years and usually follows benign outcome. In the adult, clinical presentation is more severe and more commonly associated with complications. Varicella pneumonia, although rare, is a potentially life-threatening complication that should be suspected in any adult with varicella and respiratory symptoms. We report a case of varicella pneumonia in immunocompetent patient. The characteristic radiographic findings consisted of diffuse scattered coarse nodular infiltrations, less than 1cm sized, with ground glass opacity and consolidation in both lung fields. The patients was started on intravenous acyclovir. The chest radiograph performed 2 weeks later showed complete resolution of the pulmonary lesions. 1)

Background: Malignant pulmonary nodules account for about 30 to 40 percent of solitary pulmonary nodules (SPN). Therefore, tissue characterization of SPNs is very important. Recently, PET/CT has been widely used for tissue characterization, and has become of importance. The purpose of this study was to compare and to assess multiple factors in PET/CT comparing benign and malignant nodules. Materials and Method: Nineteen patients with SPN underwent PET/CT and biopsy. The difference of standardized uptake value 1 (SUV1), standardized uptake value 2 (SUV2) and retention index in PET/CT between malignancy and benignancy were compared by Levene's test. Result: There were twelve malignant and seven benign nodules. SUV1 and SUV2 were significantly different between malignant nodule and benign nodule (p=0.006 and 0.022), but retention index was not significantly different between malignant nodule and benign nodule (p=0.526). By receiver-operating-characteristic (ROC) analysis, the sensitivity was 66.7% and the specificity was 71.4% at a cut off value of 5.40 in SUV1. The sensitivity was 75% and the specificity was 71.4% at cut off value of 7.45 in SUV2. Conclusion: There was a statistically significant difference in SUV1 and SUV2 between benign and malignant nodules. However, the cut off value of SUV1 and SUV2 by receiver-operating-characteristic (ROC) analysis was 5.40 and 7.45 which is different from previous studies. Therefore, studies on a larger sample of patients are required for confirmation.

During the device fabrication, thin dielectric layers experience a wide range of photoresist (PR) strip processes after various implantations carried out with the thin dielectric layers exposed. Degradation of the thin dielectric layers by the PR strip process using O 2 plasma is well known to cause yield reduction and reliability deterioration. This paper investigates a PR strip method using ozone (O 3 ) followed by sulfuric-peroxide mixture (SPM) solution cleaning and finds it significantly effective in PR strip performance even at the damaged PR by high-dose and high-energy implantations. The method dramatically reduces gate leakage current, resulting in significant improvement in gate oxide integrity. The PR strip technology is significantly effective for the reduction of plasma damage-induced dark current and white pixel defects of a 1.3 mega-pixel complementary metal oxide semiconductor image sensor fabricated with 0.18 μm technology node.

This paper presents a significantly effective new method to reduce defects generated during photo resist (PR) masked gate poly-silicon etch process in decoupled plasma source (DPS) etching reactor. In the new method, etching reactor cleaning by SF6/O2 plasma before processing product wafers is introduced to clear the extreme non-volatile by-products on the reactor surface, which is the source of defects. And, Y2O3 in stead of Al2O3 as reactor material is essential for the application of the SF6/O2 plasma cleaning to suppress instable by-product deposition after the SF6/O2 plasma cleaning. Additionally, the stabilization step in etching recipe is skipped to prevent the abrupt falling of by-products by instable plasma ignition at each etch step. The incorporation of the above three items significantly reduces the etch defects without any process performance shift in PR masked gate poly-silicon etch process using HBr/Cl2/O2 chemicals.

Background : Determining the cause of an exudative pleural effusion is sometimes quite difficult, especially between malignant and tuberculous effusions. Twenty percent of effusions remain undiagnosed even after a complete diagnostic evaluation, including pleural biopsy. The activity of tumor necrosis factor-alpha (TNF-), which is the one of proinflammatory cytokines, is increased in both infectious and malignant effusions. The aim of this study was to investigate the diagnostic efficiency of TNF- activity in distinguishing tuberculous from malignant effusions. Methods : 46 patients (13 with malignant pleural effusion, 33 with tuberculous pleural effusion) with exudative pleurisy were included. TNF- concentrations were measured in the pleural fluid and serum samples using an enzyme-linked immunosorbent assay (ELISA). In addition, TNF- ratio (pleural fluid TNF- : serum TNF-) was calculated. Results : TNF- concentration and TNF- ratio in the pleural fluid were significantly higher in the tuberculous effusions than in the malignant effusions (p in the malignant and tuberculous pleural effusions were similar (p>0.05). The cut off points for the pleural fluid TNF- level and TNF- ratio were found to be 136.4 pg/mL and 6.4, respectively. The sensitivity, specificity and area under the curve were 81%, 80% and 0.82 for the pleural fluid TNF- level (p ratio (p level and TNF- ratio can distinguish a malignant pleural effusion from a tuberculous effusion, and can be additional markers in a differential diagnosis of tuberculous and malignant pleural effusion. The level of TNF- in the pleural fluid could be a more efficient marker than the TNF- ratio.

Imatinib-mesylate (Gleevec, Glivec) is a protein-tyrosine kinase inhibitor that inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia chromosome abnormality in CML. Imat inib is also used to treat patients with c-kit (CD 117)-positive unresectable tumors, or metastatic malignant gastrointestinal stromal tumors, or both. Imatinib is a welltolerated drug with few side effects. However, it has been associated with gastrointestinal irritation, fluid retention and edema, skin rashes, depigmentation, hepatotoxicity, hemorrhage, and hematological toxicity (anemia, neutropenia, and thrombocytopenia). In addition, imatinib has been associated with dyspnea and cough, which are mainly secondary to the pleural effusion and pulmonary edema, which represent local or general fluid retention. These events appear to be dose related and are more common encountered in the elderly. Ho wever, there has been no report of hypersensitivity pneumonitis associated with imatinib -mesylate in Korea. We report a case of 51-year old woman who developed hypersensitivity pneumonitis that might have been induced by imatinib-mesylate during the treatment of a gastrointestinal stromal tumor. (Tuberc Respir Dis 2005; 59: 423-426)

Diffuse alveolar hemorrhage is a rare but serious and frequently life-threatening complication of a variety of conditions. The first goal in the management of patients with diffuse alveolar hemorrhage is to achieve or preserve stability of the respiratory status. Subsequently, the differential diagnosis is aimed at the identification of a remediable cause of the alveolar hemorrhage. The most common causes of diffuse alveolar hemorrhage with glomerulonephritis are microscopic polyangiitis and Wegener's granulomatosis, followed by Goodpasture syndrome and systemic lupus erythematosus. Microscopic polyangiitis (MPA) is a distinct systemic small vessle vasculitis affecting small sized vessels with few or no immune deposits and with no granulomatosus inflammation. The disease may involve multiple organs such as kidney, lung, skin, joint, muscle, gastrointestinal tract, eye, and nervous system. MPA is strongly associated with antineutrophil cytoplasmic autoantibody (ANCA) that is a useful serological diagnostic marker for the most common form of necrotizing vasculitis. Our report concerns a case of microscopic polyangiitis with diffuse alveolar hemorrhage in a 54-year-old man. He was admitted to our hospital due to dyspnea upon exertion and recurrent hemoptysis. Laboratory findings showed hematuria, proteinuria and deterioration of renal function. In the chest CT scan, diffuse ground glass appearance was seen in both lower lungs. A lung biopsy revealed small vessel vasculitis with intraalveolar hemorrhage and showed a positive reaction to against perinuclear ANCA. The patient was treated with prednisolone and cyclophosphamide. Chest infiltration decreased and hemoptysis and hypoxia improved. He is still being followed up in our hospital with a low dose of prednisolone.

연구배경 : 만성폐쇄성폐질환 환자의 체중감소는 질환의 자연경과로 조직의 산소소모량을 최소로 유지하기 위한 일종의 신체적응과정으로 이해하였다. 그러나 만성폐쇄성폐질환 환자의 체중감소가 에너지대사량 증가와 관계 있고, 체중감소가 심한 환자들은 폐기능의 감소정도와 상관없이 이환율과 사망률이 증가한다는 연...

Background : The effects of chemotherapy on pulmonary function are mainly a reduced diffusion capacity and a restrictive ventilatory impairment. Exercise can expose cardiovascular and pulmonary abnormalities not evident at rest. Exercise related cardiopulmonary function is important in patients with malignant disease as a determinant of quality of life. We performed this study to evaluate the changes of body composition and cadiopulmonary exercise perfoemance of patients with locally advanced, non-small cell, lung cancer (NSCLC) before and after chemotherapy. Methods : We evaluated resting pulmonary function, body composition, physiologic performance status, and cardiopulmonary exercise function in 11 patients with locally advanced NSCLC, at diagnosis and prior to the fourth cycle of chemotherapy. Results : After chemotherapy, 4 patients (36.4%) showed partial response and 7 (63.4%) had stable disease. After chemotherapy, diffusion capacity of the lung for carbon monoxide was reduced (, vs. ) but not significantly. There were no significant changes in body composition or the state of physiologic performance after chemotherapy. There was a significant impairment of cardiopulmonary exercise tolerance in patients with NSCLC, evidenced by a reduction of maximal oxygen uptake (max, ml/kg/min, : , pulse ( pulse, ml/beat, ,

Background: Interleukin-1(IL-1) and neutrophil appear to contribute to the pathogenesis of acute respiratory distress syndrome(ARDS). Elastase, as well as reactive oxygen species released from activated neutrophil, are thought to play pivotal roles in the experimental models of acute lung leak. This study investigated whether ICI 200,355, a synthetic elastase inhibitor, can attenuate acute lung injury induced by IL-1 in rats. Materials and Methods: We intratracheally instilled either saline or IL-1 with and without treatment of ICI 200,355 in rats. Lung lavage neutrophils, lung lavage cytokine-induced neutrophil chemoattractant(CINC) concentration, lung lavage protein concentration, lung myeloperoxidase(MPO) activity and lung leak index were measured at 5 hours of intratracheal treatment. Results: In rats given IL-1 intratracheally, lung lavage neutrophils, lung lavage CINC concentration, lung lavage protein concentration, lung MPO activity and lung leak index were higher. Intratracheal ICI 200,355 administration decreased lung lavage neutrophils, lung MFO activity and lung leak index, respectively, but did not decrease lung lavage CINC concentration. Conclusion: These results suggest that ICI 200,355 decreases lung inflammation and leak without decreasing lung lavage CINC concentration in rats given IL-1 intratracheally.

Background : Lung cancer is the leading cause of cancer-related mortality in both men and women. Although most cases of lung cancer occur in the sixty to eight decades of life, 5 to 10% are diagnosed at a young age. There are characteristic features in young patients with lung cancer that differ from those in older patients with lung cancer. The purpose of this study was to determine if the basal characteristics and survival in young patients with lung cancer differed from those of old patients. Methods : We retrospectively reviewed the medical records of 94 young patients who were under 45 years of age and compared them with 1,728 old patients (= 46 years of age) in 4 medical schools at Daegu, between August 1986 and July 1995. Results : Significantly more female patients and adenocarcinomas were found in the young patients group. when compared to the old patients. Cough and sputum were the most frequent presenting symptom in both age groups. This was followed by chest discomfort, dyspnea and hemoptysis. The rates of smoking was significantly lower in the young patients. There was no statistical difference in the severity of the disease in terms of staging between the two age groups. Young patients received treatment more frequently than the older patients. The location of the primary tumors was equally frequent in both the upper and lower lobe. However, the survival was bettrer in the young patients(median survival time, 67.3 weeks), when compared to the old patients (median survival time, 26.8 weeks) (p

Paraneoplastic nephrotic syndrome can be diagnosed from its clinical and immunological features. The development of several types of glomerular injury in patients with cancer have been recognized, and are considered as paraneoplastic syndrome. Most prominent are the occurrence of membranous glomerulonephritis in patients with carcinomas. We report a case of a 60-year-old-man with small cell lung cancer presenting as nephrotic syndrome. A renal biopsy revealed membranous glomerulonephritis. Six lots of chemotherapy were administered, which led to a complete tumor response with total resolution of the nephrotic syndrome following treatment.

The hallmarks of sleep apnea syndrome include daytime hypersomnolence, snoring, obesity, disturbed nocturnal sleep, and apneic episodes. Thyroid deficiency states are now a well recognized cause of sleep apnea. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A-33-yr-old man was admitted complaining of daytime hypersomnolence, snoring, sleep apnea and obesity. A polysomnogram showed obstructive pattern of sleep apnea syndrome. Physical examination and hormonal study revealed a narrowing of the upper airway and primary hypothyroidism. Dilated cardiomyopathy was diagnosed by echocardiogram. The poctients was treated for obstructive sleep apnea syndrome with nasal continuous positive airway pressure(CPAP) for 2 months and the underlying hypothyroidism with thyroid hormone therapy. This successfully controlled the snoring, sleep apnea, and other apnea-related symptoms. Here, we describe our experience of nasal CP AP and thyroid hormone therapy in a patient with primary hypothyroidism associated with obstructive sleep apnea syndrome and dilated cardiomyopathy with review of the relevant literature.

배경 및 목적 : 만성폐쇄성 폐질환은 대부분 후천적으로 발생하며, 흡연은 가장 중요한 유발인자이다. 흡연력이 있는 만성폐쇄성 폐질환 환자들이 임상적 그리고 병리학적으로 차이가 분명한 만성기관지염과 폐기종의 두가지 형태로 진행한다는 사실은 단순한 흡연력 이외에 흡연과 관계가 있는 다른 인자가 관여함을 시사하고 있다. 저자들은 흡연력이 있는 남자 중 만성폐쇄성 폐질환으로 진단된 환자를 대상으로 흡연력과 흡연습관 및 행태를 조사하여 만성기관지염과 폐기종의 발생과 관련이 있는 흡연습관을 찾아보고자 하였다. 방 법 : 영남대학교 부속병원 호흡기내과를 방문하였던 환자 중 만성폐쇄성 폐질환으로 진단되고 흡연력이 있는 333명의 남자(폐기종 ; 143명, 만성기관지염 ; 190명)를 대상으로 흡연력에 대하여 설문조사를 하였다. 그러나, 악성 폐종양, 간질성 폐질환, 기관지 확장증, 진폐증, 폐허탈, 흉수 및 흉막유착 등이 있는 경우와 폐렴이나 폐결핵 등 현증 감염성 질환이 있는 경우, 그리고 1초간 노력성 호기량( $FEV_1$ )이 ${\beta}_2$ 항진제 사용후 10% 이상 증가하는 경우는 대상에서 제외하였다. 결 과 : 만성기관지염 환자에 비해 폐기종 환자는 평균 나이가 많고, 흡연량 및 절대흡연량이 많았으며, 흡연을 일찍 시작하였고, 담배연기를 갚이 흡입하는 경향이 있었다(p 【Background : Smoking is the most important and consistent determinant of the development and progression of COPD(Ed Note : Define COPD). The fact that cigarette smokers develop a different type of COPD, chronic bronchitis and emphysema, with different clinical and pathological aspects, suggests that the development of COPD has a relationship with other smoking-associated factors beyond just a simple smoking history. The aim of this was to analyze the smoking habits and history of patients with COPD and to evaluate the development of different types of COPD according to patient's smoking habits. Method : To evaluate the differences in the smoking patterns of patients with chronic bronchitis and emphysema, a pulmonary function test was conducted, and the smoking history and patterns was obtained through a smoking history questionnaire by a direct personal interview from 333 male cigarette smokers diagnosed with COPD, in the Yeungnam university medical center(190 patients diagnosed with chronic bronchitis, 143 patients diagnosed with emphysema). Result : The patients with emphysema smoked earlier and had a higher smoking history(ie, more packyears, more total amounts of smoked cigarette, and more deep inhalation and longer duration of plain cigarette exposure) than those with chronic bronchitis. The depth of inhalation was also significantly higher in the emphysema patients after taking into account age, cumulative cigarette consumption and the type of cigarette smoked. Conclusion : Emphysema was more associated with the increasing degree of inhalation as assessed by the depth of inhalation. A high alveolar smoke exposure may be a significant risk factor for the development of emphysema.】

Background: With cases of chronic obstructive pulmonary disease(COPD), weight loss and low body weight have been found to correlate with increased mortality and poor prognosis. Therefore, nutritional aspects are an important part of the treatment in cases of COPD. In Korea, there is only limited data available for the changes of resting pulmonary function in relation to nutritional status. This study was carried out to investigate the differences of resting pulmonary function in relation to the nutritional status of patients with COPD. Method : 83 stable patients, with moderate to severe COPD, were clinically assessed for their nutritional status and resting pulmonary function. The patients' nutritional status was evaluated by body weight and fat-free mass (FFM), which was assessed by bioelectrical impedance analysis. According to their nutritional status, the 83 patients were divided into two groups, designated as the depleted, and non-depleted, groups. Result : Of the 83 patients, 31% were characterized by body weight loss and depletion of FFM, whereas 28% had either weight loss or depleted FFM. In the depleted group, significantly lower peak expiratory flow rate(p) was also significantly lower in the depleted group(p

A proper pathologic diagnosis of small cell lung cancer(SCLC) is essential for the application of aggressive treatment modalities. However, various authors have suggested several subtypes of SCLC based on morphological features. Among them, the incidence of small cell lung cancer(SCLC) combined with squamous cell and/or adenocarcinoma, represents less than 1% to 3% of all SCLC tumors. Because of the rarity of SCLC combined with squamous cell and/or adenocarcinoma, very little is known about its clinical characteristics and response to therapy. We report a case of SCLC combined with squamous cell and adenocarcinoma in a 68 year old male who experienced pneumonectomy of the left lung.

연구배경 : 흡연이 폐암발생의 중요한 원인이라는 사실은 분명하지만 흡연 양이나 흡연기간 뿐만 아니라 흡연과 관련된 여러 요소들의 역할도 중요하게 고려해야 한다. 본 연구는 남녀별 흡연력 및 흡연과 관련된 요소들에 대한 폐암의 발생위험도를 구하여 담배 속 발암물질에 대한 남녀별 감수성 차이를 알아보았다. 방법 : 본 연구는 환자-대조군 연구로 영남대학교 의과대학 부속병원 내과를 방문하여 폐 기능 검사를 받았던 사람들을 대상으로 흡연력 및 흡연량, 흡연습관에 관한 설문조사를 하였다. 조직학적으로 원발성 폐암이 확인된 경우를 대상환자로 하였고, 다변량 회귀분석을 이용하여 교차비를 구하고, 이를 폐암발생의 상대적인 발생위험도로 인정하였다. 결과 : 흡연력이 있었던 여자는 흡연력이 없는 경우에 비하여 교차비는 1.9이었으며, 특히 Kreyberg I의 경우 교차비는 3.8로 증가하였다. 또한 여자 중 현재흡연자의 교차비는 4.0으로 남자의 2.3보다 훨씬 높았다. Kreyberg I 여자 환자로 20갑 년 이상 흡연하였을 때 교차비는 5.4(남자 : 1.6), 하루 1갑 이상 흡연 하였을 경우 교차비는 6.9(남자 : 5.0)로 남자보다 훨씬 높았다. 흡입정도에 따른 교차비는 중등도 이상 흡입한 경우 여자 6.7, 남자 2.4로 여자에서 현저하게 높았으며, 한 개피 당 동일한 길이의 담배를 피웠을 때도 폐암의 발생 위험도는 여자가 높았다(여자 3.7:남자 2.0). 또한 필터 유 무에 따른 폐암 발생위험도의 차이는 남녀 모두에게 있었으나 여자에서 더 뚜렷하였다. 결론 : 흡연에 따른 폐암발생의 감수성은 여자가 남자보다 더 높았으며, 이러한 성별간 감수성의 차이는 흡연 양이나 흡연습관, 또는 환경적인 요인 뿐만 아니라 발암물질의 활성이나 제거 등과 같은 대사의 차이에도 그 원인이 있을 것으로 생각된다. 【Background : With the increase of cigarette consumption by women and the young, the incidence of lung cancer is expected to increase during the next three or four decades in Korea. The purpose of this study was to analyze the smoking habits in patients with lung cancer and to identify the gender differences in terms of their susceptibility to cigarette related carcinogens. Method : This investigation was a hospital-based case control study, which included the data of 178 case subjects (72 females, 106 males) with lung cancer and 218 control subjects (97 females, 121 males) with diseases unrelated to smoking. The information was obtained through a direct personal interview and a questionnaire related to personal smoking history. Results : The relative frequency of the squamous cell carcinoma was substantially higher in males than in females (61.3% in males, and 29.2% in females), while adenocarcinoma including bronchoalveolar cell carcinoma was higher in females(31.9% in females, 18.9% in males). Kreyberg I lung cancer was of relatively higher frequencies in males and smokers, while Kreyberg II lung cancer was higher in females and never smokers. The odds ratios (ORs) at each exposure level were consistently higher in females than males. For all cell types, the risk of lung cancer was increased with the quantity of smoked cigarettes, duration of smoking, and depth of inhalation. Odds ratio was distinctly higher in Kreyberg I lung cancer than in total lung cancer and a steeper gradient of risk with increased smoking was observed in females. Conclusion : The relative risk for lung cancer was consistently higher in females than in males at every level of exposure to cigarette smoke. This is believed to be due to the higher susceptibility of females to tobacco carcinogens, such as gender associated differences of carcinogen activation and/or the elimination of smoking related metabolites.】

Backgrounds : Obstructive sleep apnea syndrome(OSA) can divided into two groups, positional(PP) and non-positional(NPP) obstructive sleep apnea syndrome, according to the body position while sleeping. In this study, we evaluated the differences of anthropometric data and polysomnographic recordings between the two types of sleep apnea syndrome. Materials : Fifty patients with OSA were divided two groups by Cartwright's criteria. The supine respiratory disturbance index (RDI) was at least two times higher than the lateral RDI in the PP group, and the supine RDI was less than twice the lateral RDI in the NPP group. This patients underwent standardized polysomnographic recordings. The anthropometric data and polysomnographic data were analyzed, statistically. Results : Of all 50 patients, 30% were found to be positional OSA. BMI was significantly higher in the PP group(p28.2min, 333.346.0min, (p6.4%, 85.69.9%, p10.6, 28.513.3, p1.8%. p

Background : Patients with locally advanced non-small cell lung cancer are often treated with radiation alone or in combination with chemotherapy. Both modalities have a potentially damaging effect on pulmonary function. In order to examine changes in the cardiopulmonary exercise function of patients with locally advanced non-small cell lung cancer before and after conventional radiotherapy, we conducted a prospective study involving patients with such cancer, that had received radiation therapy. Method : Resting pulmonary function test, thoracic radiographic finding and cardiopulmonary exercise test(CPET) were assessed prior to and 4 weeks following radiation therapy in 11 male patients with locally advanced non-small cell lung cancer. Patient with endobronchial mass were excluded. Results : The forces vital capacity (FVC), forced expiratory volume in 1 second ( and maximal voluntary ventilation (MVV) did not decreased between before and 4 weeks after radiation but the diffusing capacity (DLCO) had decreased by 11% 4 weeks after radiation, which was not statistically significant. No changes in maximal oxygen consumption (max), carbon dioxide production (), exercise time and work load were attributed to radiation therapy. Follow up cardiopulmonary exercise testing revealed unchanged cardiovascular function, ventilatory function and gas exchange. No difference in cardiopulmonary exercise test performance was observed between pre- and post-radiation. Conclusion : Cardiopulmonary exercise function did not decrease within the short-term after the radiation of patients with locally advanced non-small cell lung cancer.

Background : The aim of this study was to analyze the clinical manifestations and efficacy of treatment regimens in order to determine the adequate combination of anti-tuberculotic agents and duration of treatment for tuberculous lymphadenitis. Methods : We made a review of 373 patients with tuberculous lymphadenitis, who were admitted to four medical college hospitals in Taegu Korea from 1989 to 1998, and their diagnoses were confirmed histologically and bacteriologically. Results : The incidence of tuberculous lymphadenitis was 71.3% in women and 57.7% were between the ages of 20 and 39 years. The most common symptom was painless swelling. The most commonly involved lymph nodes were unilateral superficial cervical lymph node groups. Tuberculous lymphadenitis was accompanied with active pulmonary tuberculosis, commonly. The sensitivity of fine needle aspiration(FNA) in tuberculous lymphadenitis was 79.6%, and 92.2% of the patients had a strong positive reaction to the tuberculin skin test. The most commonly prescribed anti-tuberculotic regimen was the combination of INH, RMP, EMB, and PZA(62.6 %). Eighty percent of patient were treated for 9-12 months. There was no significantly difference in the recurrence rate of tuberculous lymphadenitis between the combinations of anti-tuberculotic agent, including INH and RMP, and between the durations of treatment, for a period of 6 months of more. Conclusion : The combination of FNA cytologic examination and tuberculin skin test may be helpful in the diagnosis of tuberculous lymphadenitis. We propose that the combination of anti-tuberculotic agents, INH, RMP, EMB, and PZA, be prescribed to patients for 6 to 9 months.

연구배경: 유기인제는 국내에서 1950년대부터 농업용 살충제로 널리 사용되고 있으며, 최근 공업용 화공약품으로 사용이 증가하면서 이로 인한 중독 환자가 증가하고 있다. 아트로핀, PAM 또한 호흡부전 발생시 인공호흡기를 이용한 적극적인 치료로 사망률은 과거보다 감소하였으나, 호흡부전으로 인한 사망은 유기인제 중독의 주요한 사망 원인이다. 저자들은 유기인제 중독시 호흡부전의 발생 빈도 및 그 유발 인자를 관찰 분석하여 유기인제 중독으로 인한 사망률을 줄여 보고자 하였다. 방 법: 영남대학교 의과대학 부속병원에서 유기인제 중독증으로 진단 받은 111례를 대상으로 하였으며, 특히 호흡부전이 발생한 31례의 임상 소견 및 치료 방법, 혈중 cholinesterase 활성도 등을 조사하여 호흡부전 발생과 관계가 있는 요인들을 알아보았다. 결 과: 유기인제 중독환자 111례 중 자살 목적인 경우가 81례로 가장 많았고, 중독 정도도 가장 심하였다. 환자 중 15례에서 사망하였으며, 사망률은 14%였다. 호흡부전이 발생한 31례 중 23예가 중독 후 24시간이내, 8례는 25시간에서 96시간이내 발생하였으며, 중독 정도가 심할수록 호흡부전 발생 빈도가 높았다. 호흡부전이 발생한 31례 중 15례에서 사망하였고, 호흡부전이 발생하지 않은 경우에서는 사망한 예가 없었다. 16예의 환자에서 폐렴이 발생하였으며 이중 14례에서 호흡부전이 생겨, 폐렴이 생긴 대부분의 환자에서 호흡부전이 발생하였다. 심혈관 허탈은 5례에서 발생하였으며 이중 2례에서 호흡부전이 생겼으나 통계적으로 유의하지 않았다. 첫 24시간동안 아트로핀의 평균 요구량은 $56{\pm}65mg/dl$ 이고, 급성 호흡부전인 경우 아급성 호흡부전이나 호흡부전이 발생하지 않았을 때보다 아트로핀 요구량이 더 많아 중독 정도가 심할수록 아트로핀 요구량이 더 많았다. PAM으로 치료하였던 95례 중 26예와, 치료하지 않았던 16예 중 5례에서 호흡부전이 발생하여 PAM 치료 여부와 호흡부전 발생간의 유의한 차이를 보이지 않았다. 혈중 cholinesterase 활성도는 호흡부전이 발생하였을 때보다 인공호흡기 이탈시 7배정도 높았으며, 인공호흡기로 치료한 기간은 급성 호흡부전이 생겼을 때 유의하게 길었다. 결 론: 급성 유기인제 중독에 의한 호흡부전은 중독 후 첫 96시간 이내 주로 발생하며, 중독 정도와 폐렴 발생이 호흡부전 발생의 중요한 유발 인자로 생각된다. 따라서 중독 후 첫 96시간 동안 세심한 관찰이 필요하고 적극적인 아트로핀 투여와 기도 확보 및 흡인성 폐렴 방지로 호흡부전 발생 빈도를 줄일 수 있을 것으로 생각된다. 【Background: Because of the widespread use and availability of agricultural insecticides, acute organophosphate poisoning as a suicide or an accident is becoming the most common type of poisoning and serious problem in Korea. The mortality of organophosphate poisoning varied from 10 to 86 percent. The cause of death was thought to be a combination of excessive bronchial secretion, bronchospasm, respiratory muscle paralysis and depression of respiratory center, summarily respiratory failure. We evaluated the respiratory complications in patients with acute organophosphate intoxication to determine the predisposing, factors to respiratory failure and to reduce the incidence of respiratory failure or mortality. Method: We conducted a retrospective study of 111 patients with the discharge diagnosis of organophosphate poisoning who were hospitalized at Yenugnam University Hospital during the 5 years. The diagnosis of organophosphate poisoning has based on the followings (1) a history of exposure to an organophosphate compounds. (2) the characteristic clinical signs and symptoms. (3) decrease in the cholinesterase activity in the serum. Results: Respiratory failure developed in 31(28%) of 111 patients with acute organophosphate poisoning. All cases of respiratory failure developed within 96 hours after poisoning and within 24 hours in 23 patients. The 80 patients who did not develop respiratory failure survived. In 31 patients with respiratory failure, 15(44%) patients were dead. The patients with respiratory failure had more severe poisoning, that is, the lower level of serum cholinesterase activity on arrival, the higher mean dosage of atropine administered within first 24 hours. In 16 patients with pneumonia, 14 patients developed respiratory failure. In 5 patients with cardiovascular collapse, 2 patients developed respiratory failure. There was no correlation to between age, sex, the use of pralidoxime and respiratory failure. The serum cholinesterase level in survivors at time of respiratory failure and weaning was $66.05{\pm}85.48U/L$ , $441{\pm}167.49U/L$ , respectively. Conclusion: All the respiratory failure complications of acute organophosphate poisoning occurred during the first 96 hours after exposure. The severity of poisoning and pneumonia were the predisposing factors to respiratory failure. Aggressive treatment and prevention of the above factors will reduce the incidence of respiratory failure.】

Background : Pleural effusion is a common clinical problem and many clinical and laboratory evaluations, such as tumor marks, have been studied to discriminate malignant pleural fluid from benign pleural fluid. However their usefulness in the diagnosis of pleural effusion is still not established fully. We studied the diagnostic value of cyfra 21-1 in diagnosis of malignant pleural effusion. Methods: Pleural fluid was obtained from 45 patients with malignant diseases(32 lung cancer patients, 13 metastatic malignant diseases) and 47 patients with benign diseases. The level of cyfra 21-1 in the pleural fluid and serum were determined using a CYFRA 21-1 enzyme immunoassay kit(Cis-Bio International Co.). The t-test was used for comparison between two diseases groups and receiver operating characteristic(ROC) curves were constructed by calculating the sensitivities and specificities of the cyfra 21-1 at several points to determine the diagnostic accuracy of the cyfra 21-1. Results: In patients with primary lung cancer, the level of cyfra 21-1 in the pleural fluid was significantly higher than those of patients with benign diseases and had positive correlations between the level of cyfra 21-1 in the pleural fluid and serum levels. In the ROC curve analysis of the pleural fluid, the curve for primary lung cancer group was located closer to the left upper comer and the cut off value, sensitivity and specificity of the cyfra 21-1 of the primary lung cancer group was determined as 22.25ng/ml, 81.8% and 78.7% respectively. Conclusions: Our data indicates that the measurement of cyfra 21-1 level in pleural effusion has useful diagnostic value to discriminate malignant pleural effusion in primary lung cancer from benign pleural effusion.

연구배경: 45세 이하의 약년자에서 발생하는 폐암은 전체 폐암의 6% 미만이지만 진행속도가 빠르고 이미 진행된 상태에서 발견되는 경우가 많아 예후가 좋지 않은 것으로 알려져 있다. 그러나 약년자 폐암의 이와 같은 원인에 대해서는 현재까지도 잘 규명되어 있지 않다. 정상적인 p53 유전자는 종양억제유전자로 작용하지만 돌연변이 등에 의한 p53 유전자 변이는 폐암의 예후에 나쁜 영향을 미친다. 저자들은 약년자 폐암이 노년자 폐암보다 예후가 나쁜 원인을 알아보고자 45세 이하의 약년자 폐암 환자와 55세 이상의 노년자 폐암환자에서 p53 유전자 변이에 의한 비정상적 p53 단백질의 발현율과 발현정도를 알아보기 위하여 이 연구를 하였다. 방 법: 1990년 1월부터 1998년 8월까지 영남의대 부속병원에서 조직생검에 의하여 폐암으로 진단된 45세 이하의 폐암 25례와 대조군으로 p53에 대한 면역조직화학염색을 실시하였던 55세 이상의 폐암환자 26례를 대상으로 비정상적 p53에 대한 발현율과 발현정도를 비교하였다. 결 과: 비정상적 p53 발현율은 약년자 폐암 25례 중 19례(76.0%), 55세 이상의 폐암 26례 중 20례(76.9%)에서 양성이었으며 양 군에서 유의한 차이는 없었다. p53 발헌정도는 45세 이하환자 19례 중 score 1이 6례, score 2가 13례였으며, 55세 이상 환자 20례 중 score 1이 4례, score 2가 16례로 두 군 사이에 의미 있는 차이가 없었다. 두 군 사이에 p53 발현율과 폐암의 조직학적 형태, 병기와도 유의한 차이가 없었다. 결 론: 45세 이하의 약년자 폐암 환자와 55세 이상의 노년자 폐암 환자에서 비정상적 p53 단백질의 발현율과 발현정도 사이는 유의한 차이가 없었다. 【Background: Lung cancer in younger patients seems to be a more aggressive disease and their prognosis may be worse than that of older patients. Abnormal p53 expression in primary lung cancer may be an independent prognostic factor for poor prognosis. This study was conducted to determine the difference of abnormal p53 mutation in patients with primary non-small cell lung cancer (NSCLC) under 45 years of age and 55 years old or greater. Method: The present study was performed to compare the clinical and pathological features of primary NSCLC between patients younger than 45 years old and older than 55 years old and to evaluate the difference of abnormal p53 mutation between two groups. Immunohistochemical detection of abnormal p53 mutation was assessed in all primary NSCLC specimens by pathologist. Results: Positive nuclear staining of p53 mutation was found in 76.0% of younger patients and in 76.9% of older patients with variable intensity of staining. And there was no significant correlation between abnormal p53 mutation according to the disease stage or histologic subtype. Conclusion: In this investigation, these were no difference in p53 mutation between two groups.】

Background : The causes of solitary pulmonary nodule are many, but the main concern is whether the nodule is benign or malignant. Because a solitary pulmonary nodule is the initial manifestation of the majority of lung cancer, accurate clinical and radiologic interpretation is important. Bayes' theorem is a simple method of combining clinical and radiologic findings to estimate the probability that a nodule in an individual patients is malignant. We estimated the probability of malignancy of solitary pulmonary nodules with a specific combination of features by Bayesian approach. Method : One hundred and eighty patients with solitary pulmonary nodules were identified from multi-center analysis. The hospital records of these patients were reviewed and patient age, smoking history, original radiologic findings, and diagnosis of the solitary pulmonary nodules were recorded. The diagnosis of solitary pulmonary nodule was established pathologically in all patients. We used to Bayes' theorem to devise a simple scheme for estimating the likelihood that a solitary pulmonary nodule is malignant based on radiological and clinical characteristics. Results : In patients characteristics, the probability of malignancy increases with advancing age, peaking in patients older than 66 year of age(LR : 3.64), and higher in patients with smoking history more than 46 pack years(LR : 8.38). In radiological features, the likelihood ratios were increased with increasing size of the nodule and nodule with lobulated or spiculated margin. Conclusion : In conclusion, the likelihood ratios of malignancy may improve the accuracy of the probability of malignancy, and can be a guide of management of solitary pulmonary nodule.

Background: Nearly 10% of cancer patients will develop a second primary cancer within ten years after surgical removal of the primary tumor. The detection of risk factors for developing multiple primary tumors would be important This study was conducted to evaluate the clinical characteristics and abnormal p53 expression of lung cancer associated with multiple primary cancer(MPC). Method: Clinical characteristics and abnormal p53 expression were compared between 20 cases of lung cancer(NSCLC ; 16 cases, SCLC ; 4 cases) associated with MPC and 26 cases of primary non-small cell lung cancer. Result: MPC associated with lung cancer was gastric cancer(8), lung cancer(2), esophageal cancer(2), colon cancer(2), laryngeal cancer(1), bladder cancer(1), small bowel cancer(l), adrenal cancer(1), hepatocellular carcinoma(1), and breast cancer (1) in order. The clinical stage of primary NSCLC was relatively advanced, but NSCLC associated with MPC was even distribution at each stage. The detected incidences of abnormal p53 expressions were 62.5% in NSCLC associated with MPC and 76.9% in primary NSCLC(p>0.05). Conclusion: There was no difference in abnormal p53 expression between non-small cell carcinoma associated with multiple primary cancer and primary non-small cell carcinoma.

연구목적: 호흡기에 대한 자율신경 기능도 기도 및 혈관의 평활근, 접막하선의 점액분비. 기관지 순환 혈류조절, 비만 세포의 염증 반응에 관계되는 매개물의 분비등 매우 다양하게 나타나며 이들 자율신경 장애는 기도 폐쇄의 원인으로 작용한다. 천식은 자율신경계 이상이 원인으로 작용하고 특히 부교감신경 기능 항진이 중요한 원인으로 알려져 있다. 저자들은 심혈관계와 호흡기 자율신경 지배가 공통적으로 일어난다는 사실을 기초로 비관혈적이고 안정한 심혈관 지율신경 검사를 실시하여 만성 폐쇄성 폐질환 환자에서 자율신경 장애유무를 알아보았다. 방 법: 대상은 영남대학교 의과대학 부속병원에서 만성 폐쇄성 폐질환으로 진단 받은 환자 20명과 건강진단 센터에서 건강한 것으로 판정 받은 비슷한 나이의 20명을 대조군으로 하였다. 만성 폐쇄성 폐질환은 American Thoracic Society의 정의를 따랐으며 허혈성 심장질환, 부정맥, 당뇨병, 중심성 및 말초성 신경질환 등과 같은 자율신경계에 영향을 미칠 수 있는 질환이 동반된 경우는 제외하였다. 자율신경검사는 Ewing과 Clarke의 방법을 사용하였으며 모든 대상에서 동맥혈 가스분석과 폐기능 검사를 동시에 실시하였다. 결 과: 만성 폐쇄생 폐질환 환자는 건강한 사랑에 비하여 빈번하게 자율신경 장애가 동반되어 있었으며 만성 폐쇄성 폐질환 환자에서 교감신경 장애보다 부교감신경 장애가 더 뚜렷하였다. 만성 폐쇄성 폐질환은 질병 이환 기간이 길거나, 흡연량이 많거나, 폐기능 검사상 $FEV_1$ 및 FVC 감소 정도가 심할수록 그리고 저산소혈증이 심한 경우에 자율신경 장애가 심하였으나 연령, 만성폐쇄성 폐질환의 종류 및 동맥혈 이산화탄소 분압과는 차이가 없었다. 결 론: 만성 폐쇄성 폐질환은 부교감신경 장애가 동반되어 있으며, 부교간신경 장애는 만성 폐쇄성 폐질환의 정도가 심할수록 더 뚜렷하게 나타났다. 이러한 부교감신경 장애는 만성 폐쇄성 폐질환의 원인으로 작용하기보다는 질병의 진행으로 인한 자율신경계의 기능 저하로 생각된다. 【Background: Neural control of airway function is through parasympathetic, sympathetic and non-adrenergic, non-cholinergic mechanisms. The autonomic nervous system controls the airway smooth muscle tone, mucociliary system, permeability and blood flow in the bronchial circulation and release of mediators from the mast cells and other inflammatory cells. The cardiovascular and respiratory autonomic efferent fibers have a common central origin, so altered cardiovascular autonomic reflexes could reflect the altered respiratory autonomic status. Therefore, we performed this study to assess the autonomic abnormality and determine the correlating factors of severity of autonomic neuropathy in patients with chronic obstructive pulmonary disease(COPD) using easily reproducible cardiovascular autonomic reflex function test. Method: The study included 20 patients with COPD and 20 healthy persons obtained on Health Promotion Center in Yeungnam university hospital. All the patients had history and clinical features of COPD as defined by the American Thoracic Society. Any patients with myocardial ischemia, cardiac arrythmia, hypertension, central or peripheral nervous system disease, diabetes mellitus, or any other diseases known to produce autonomic neuropathy, has excluded. The autonomic nervous system function tests included three tests evaluating the parasympathetic system and two tests evaluating the sympathetic system. And also all subjects were subjected to pulmonary function test and arterial blood gas analysis. Results: Autonomic dysfunction was more commonly associated with patients with COPD than healthy person The parasympathetic dysfunction was frequent in patient with COPD, but sympathetic dysfunction seemed preserved. The severity of parasympathetic dysfunction in patients with COPD was correlated with the degree of duration of disease, smoking, reductions in the value of $FEV_1$ and FVC, and arterial hypoxemia but no such correlation existed for age, type of COPD, $FEV_1$ /FVC, or $PaCO_s$ . Conclusion: There is high frequency of parasympathetic dysfunction associated with COPD and the parasympathetic abnormality in COPD is increased in proportion to severity of airway disease. In COPD, parasympathetic dysfunction probably does not the cause of disease, but it may be an effect of disease progression.】

Background: In contrast to a healthy person, patients who have acute lower respiratory tract infection with underlying pulmonary diseases have various pathogens, a rapidly progressive downhill course, and a poor response to prior antimicrobial therapy. Broad spectrum antibacterial therapy is needed for full evaluation. Materials and Methods: To evaluate the efficacy and safety of cefpirome, we administered 1gm cefpirome, twice a day to 30 patients, who had signs and symptoms of acute lower respiratory infection regardless of their underlying disease, except to those who had an allergic history to antibiotics or severe systemic diseases. Results: The results were as follows: 1) Among 30 cases, 21 cases(70.0%) showed excellent improvement, and 7 cases(23.3%) showed good improvement in their symptoms and signs of acute lower respiratory infection. 2) In 14 cases with isolated pathogens, we observed bacteriologic eradication in 11 cases(78. 6%). 3) Significant side effects were not found. Conclusion: Above results suggest that cefpirome was effective as a monotherapy in patients with acute lower respiratory infection, especially on those with an underlying chronic obstructive pulmonary disease(COPD).

Background: Lung cancer-associated hypercalcemia is one of the most disabling and life-threatening paraneoplastic disorders. Humoral hypercalcemia is responsible for most lung cancer-associated hypercalcemia. Patients with hypercalcemia are usually in the advanced stage with obvious bulky tumor and carry a poor prognosis. Materials and Methods: Total 29 patients satisfied the following criteria: histologically proven primary lung cancer, corrected calcium level 10.5 mg/dL, and symptoms which could possibly be attributed to hypercalcemia. In this retrospective study, we evaluated the various clinical aspects of hypercalcemia, in relation to cancer stage, histologic cell type, mass size, bone metastasis, performance status, and other possible characteristics. Results: Total 29 lung cancer patients with hypercalcemia were studied, and most of them had squamous cell carcinoma in their histologic finding. The incidence of hypercalcemia was significantly higher between 50 and 69 years of age, and in the advancement of cancer stage. Although serum calcium level showed positive correlation with mass size, performance status, and bone metastasis, it was not significant statistically. Altered consciousness was significantly more frequent in the patients with higher serum calcium level. There were no differences in effectiveness among therapeutic regimens. Hypercalcemia was more frequently in the later stage of disease than during the initial diagnosis of lung cancer. Most of the patients died within 1 month after development of hypercalcemia. Conclusion: We concluded that hypercalcemia in lung cancer is related to extremely poor prognosis, and may be one of the causes of death and should be treated aggressively to prevent sudden deterioration or death.

연구배경: 수면 중 산소포화도의 감소는 만성 폐쇄성 폐질환에 흔히 동반되며, 이러한 현상은 이차적으로 폐동맥압 상승, 폐성심 등의 혈역학적 변화와 심부정맥 등을 일으켜 환자가 사망할 수도 있다. 수면 중 동맥혈 산소포화도 감소와 안정시 동맥혈 산소분압과의 관계는 어느 정도 알려져 있으나, 낮 동안 저산소혈증 없이 발생하기도 한다. 저자들은 만성 폐쇄성 폐질환 환자에서 수면시 및 안정시의 동맥혈 산소포화도와 운동부하 심폐기능을 측정하여, 수면 중 산소포화도 감소와 관련 있는 인자 및 수면 중 산소포화도 감소를 예측하는 데 있어 운동부하심폐기능 검사법의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 만성 폐쇄성 폐질환으로 진단된 환자 중 안정상태로 회복된 환자 12명을 대상으로 하였으며, 수면 무호흡증 환자, 심질환자, 심한 빈혈이 있는 환자는 대상에서 제외하였다. 대상 환자 모두에서 일반 폐기능검사, 운동부하심폐기능검사, 수면다원검사를 시행하였고, 안정시, 운동시 그리고 수면시 산소포화도를 측정하였다. 결과: 대상 환자는 모두 남자였으며, 모두 흡연력이 있었다. 산소포화도는 최대 운동시에 비해 수면 중에 뚜렷이 감소하였으며( $13.1{\pm}9.3%$ 대 $6.4{\pm}3.3%$ ), 수면 중 산소포화도 감소는 운동시 최저 산소포화도 (r=-0.90, p 【Background: Nocturnal hypoxemia occurs in patients with chronic obstructive pulmonary disease(COPD) and the detection and treatment of nocturnal hypoxemia should be part of the management of COPD patients. We performed this study to evaluate the factors influencing to sleep related arterial oxygen desaturation( $SaO_2$ ) in patients with COPD. Methods: Resting and exercise cardiopulmonary function test, polysomnography, and $SaO_2$ during resting, exercise and sleep were measured in 12 patients with COPD. Results: The $SaO_2$ fell twice as much during sleep as during maximal exercise( $13.1{\pm}9.3%$ fall in nocturnal $SaO_2$ vs. $6.4{\pm}3.3%$ , p $SaO_2$ was well correlated with mean exercise $SaO_2$ (r=-0.78, p $SaO_2$ (r=-0.90, p $SaO_2$ (Cr=-0.82, p $SaO_2$ was well correlated with mean exercise $SaO_2$ (r=0.80, p $SaO_2$ (r=0.90, p $SaO_2$ (r=0.84, p $SaO_2$ was well correlated with nocturnal $SaO_2$ , but exercise study add no additional information to predicting the nocturnal oxygen desaturation in patients with COPD.】

Sparfloxacin is a new synthetic quinolone antimicrobial developed at the Research Laboratories of Dainippon Pharmaceutical Co, Ltd. To evaluate the efficacy and safety of sparfloxacin in acute pulmonary infection, we administered sparfloxacina(100mg) twice in a day to 30 patients who had signs and symptoms of acute pulmonary infectious diseases regardless of their underlying lung disease for 7 days. The results were as follows: 1) A total 30 patients were enrolled in the trial. Among them, 24 cases(80%) had underlying lung problems such as chronic obstructive pulmonary disease(36.4%), bronchiectasis(36.4%), bronchial asthma(3.3%), or lung cancer(3.3%). 2) In 26 cases(86.6%), we observed effective improvement, and 4 cases(13.4%) show mildly effective improvement of symptoms and signs of respiratory infection. 3) In 23 cases(73.4%), we observed bacteriological eradication in culture or decreased the number of bacteria by Gram stain which found dominantly in previous Gram stain. 4) The significant side effect was not noted. The above results suggested that sparfloxacin was effective as a first line therapy in patients with acute respiratory infection.