A Case of Balanced Type Double Aortic Arch Diagnosed Incidentally by Transthoracic Echocardiography in an Asymptomatic Adult Patient

A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.

A case of chronic neutrophilic leukemia / 대한내과학회지

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative disorder characterized by clonal proliferation of mature neutrophils, hepatosplenomegaly, elevated leukocyte alkaline phosphatase score (ALP score) and a negative Philadelphia chromosome. To date, approximately 150 cases have been reported in the literature, including some cases presenting with a 'leukemic' state reflected by a neutrophilic reaction. The term 'true' CNL, recently introduced by Reilly, highlights the need for more experience with CNL cases to improve the diagnostic criteria. In Korea, about 10 cases have been reported in the literature and some of those cases did not meet the WHO diagnostic criteria for CNL. We present a typical case of CNL in a 66-year-old man who complained of general weakness and weight loss. On admission, the white blood cell count from the peripheral blood was 175,600/L with 80% segmented neutrophils. The cytogenic study was negative for the Philadelphia chromosome and had a normal karyotype.

A Prospective Study for Comparing the Effects of Macrolide and Second-generation Cephalosporin on the Treatment of Pneumonia among Combat Policemen / 결핵및호흡기질환

BACKGROUND: The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. PATIENTS AND METHODS: From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. RESULTS: The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>5). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce?phalosporin had been infused. CONCLUSION: Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

A case of peripheral T-cell lymphoma with Reed-Sternberg like cells associated with Epstein-Barr virus / 대한내과학회지

The Reed-Sternberg like cells (RS-like cells) are by no means specific to Hodgkin lymphoma, but they have been reported in various other lymphoproliferative disorders, including infectious mononucleosis. Many studies have postulated that Epstein-Barr virus (EBV) infection may play a role in the development of RS-like cells in non-Hodgkin's lymphoma. There are many accounts in the literature about these RS-like cells in lymph node aspirates and biopsies creating diagnostic confusion with Hodgkin lymphoma, but no report in Korea. We experienced a case of a 44 year-old male patient who had multiple lymph nodes enlargement with the history of treatment of Hodgkin lymphoma 15 years ago. At this time, this patient was diagnosed as peripheral T-cell lymphoma with RS-like cells associated with EBV in lymph node biopsy. Here, we report this case with a review of the relevant literature.

Severe Hypercalcemia in Oliguric Phase of Acute Renal Failure Associated with Rhabdomyolysis / 대한신장학회잡지

Hypercalcemia rarely develops in patients with acute renal failure associated with rhabdomyolysis. If hypercalcemia occurs, it happens mostly in diuretic phase and rarely in oliguric phase. Secondary hyperparathyroidism, abnormal metabolism of Vitamin D, immobilization of patient, and release of calcium from injured muscle are considered as possible pathogenetic mechanisms of hypercalcemia in acute renal failure associated with rhabdomyolysis. Among them, dissolution of calcium from injured muscle into extracellular fluid is accepted as the major mechanism of pathogenesis of hypercalcemia. A twenty year old male patient, combat policeman, developed syncope in the course of regular physical training. He was diagnosed of acute renal failure associated with rhabdomyolysis at the hospital he initially visited. After being subjected to three sessions of acute hemodialysis, he was transferred to our hospital. During the treatment, laboratory test was performed upon his continuous complaints of lower extremity weakness. It showed severe hypercalcemia with plasma calcium level of 17.6 mg/dL. He was in oliguric phase at the time of this severe hypercalcemia. Patient's lower extremity weakness was gradually improved by hemodialysis using low calcium dialysate. He was discharged after his renal function became normal. He has been followed on regular basis.

Comparison Study of the Pulmonary Function and Serum Carboxyhemoglobin Level Between the Traffic Policmen and Clerk Policemen / 결핵

BACKGROUND: A large number of pollutants such as sulfur dioxide, nitric oxide, carbon monoxide, particulate matter, and ozone influence on the body. These pollutants put a burden on the lung and the sequelae resulting from the oxidative stress are thought to contribute to the development of fibrotic lung disease, emphysema, chronic bronchitis and lung cancer. Also, carbon monoxide generated from the incomplete combustion of carbon-containing compounds is an important component of air pollution caused by traffic exhaust fumes and has the toxic effect of tissue hypoxia and produce various systemic and neurologic complications. The objective of this study is to compare the difference of pulmonary function and serum carboxyhemoglobin(CO-Hb) level between the traffic policemen and clerk policemen. METHODS: Three hundred and twenty-nine of traffic policemen, and one hundred and thirty clerk policemen were included between 2001 May and 2002 August. The policemen who took part in this study were asked to fill out a questionnaire which included questions on age, smoking, drinking, years of working, work-related symptoms and past medical history. The serum CO-Hb level was measured by using carboxyoximeter. Pulmonary function test was done by using automated spirometer. Additional tests, such as elecrocardiogram, urinalysis, chest radiography, blood chemistry, and CBC, were also done. RESULTS: FEV1(%) was 97.1+/-0.85%, and 105.7+/-1.21%(p<0.05). FVC(%) was 94.6+/-0.67%, and 102.1+/-1.09%, respectively(p<0.05). Serum CO-Hb level was 2.4+/-0.06%, and 1.8+/-0.08%(p<0.05). After correction of confounding factors (age, smoking), significant variables were FVC(%), FEV1(%) and serum CO-Hb level(%)(p<0.05). CONCLUSION: Long exposure to air pollution may influence the pulmonary function and serum CO-Hb level. But, further prospective cohort study will be needed to elucidate detailed influences of specific pollutants on pulmonary function and serum carboxyhemoglobin level.

Correlation of srum collagen type IV levels with histo-pathological findings assessed by liver biopsy in hepatitis B carrier with normal liver function test / 대한내과학회지

BACKGROUND: We compared the results of liver biopsy and the levels of serum type IV collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type IV collagen in predicting the progression of histopathological findings. METHODS : Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type IVcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. RESULTS: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type IV collagen levels of Group A, B and C were 3.53 +/- .57 ng/mL, 3.56 +/- .17 ng/mL and 3.97 +/- .88 ng/mL, respectively. The average of serum type IV collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p > 0.05). The averages of serum type IV collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73 +/- 1.06 ng/mL and 3.55 +/- .88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p > 0.05). CONCLUSION : In chronic hepatitis B carriers with normal LFT findings, levels of serum type IV collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.

Clinical study of rhabdomyolysis developed after the training / 대한내과학회지

BACKGROUND: It is important to recognize rhabdomyolysis in clinical settings, because 10~30% of rhabdomyolysis patients develop acute renal failure as a complication and patients with such complication have risk of high mortality. Recently, there have been frequent reports about healthy people who developed rhabdomyolysis after heavy exercise, but few prospective studies on exercise-induced rhabdomyolysis have been reported. METHODS: To evaluate the degree of muscle cell necrosis during the regular combat-police training, we examined the level of creatine kinase, plasma myoglobin and bone scan in 173 combat-police before the training and on fourth day after the training. Average ambient temperature and humidity during the study were 25degrees C and 78%, respectively. RESULTS: From the laboratory findings, 98 out of 173 combat-police were diagnosed as having rhabdomyolysis. Upon regressional analysis, an increase in amount of exercise correlated with the elevation of the levels of plasma creatine kinase and myoglobin. Among variables related to rhabdomyolysis only the levels of myoglobin, aspartate aminotransferase were significantly elevated. The level of plasma creatinine was elevated along with the elevation of plasma myoglobin. Bone scan not only provided detailed information on the location and degree of muscle cell damage, but also could be of diagnostic value in patients whose creatine kinase had been normalized. CONCLUSION: In people who developed rhabdomyolysis after heavy exercise, the level of plasma creatinine was elevated along with the elevation of plasma myoglobin. So early diagnosis of rhabdomyolysis and early detection of acute renal failure may be useful with monitoring of plasma myoglobin level.

Clinical significance of plasma Antithrombin III in various liver diseases / 대한내과학회지

BACKGROUND: Antithrombin III (AT-III) produced from hepatocytes and endothelial cells is a coagulation inhibitor. The authors investigated the activity levels of AT-III in patients with liver disease and attempt to elucidate the clinical significance of activity levels of AT-III in relation to various liver disease. METHODS: This study includes 158 patients with liver disease, who visited the National Police Hospital between October 1997 and March 2002. We performed laboratory tests such as LFT, AFP and either abdominal sonography or abdominal CT. At the same time, AT-III activity levels was measured by chromogenic method using ACL 3000 (IL, Lexington, USA). AT-III activity level of 70~120% was regarded as normal. RESULTS: AT-III activity level of liver cirrhosis patients was decreased along with severity of the disease evaluated by Child-Pugh Classification. AT-III activity level of liver cirrhosis patients and hepatocellular carcinoma patients with liver cirrhosis, whose serum AFP were within normal limits, were 50.11+/-2.86% and 75.58+/-6.61%, respectively. The difference between the two groups was statistically significant (p < 0.001). CONCLUSION: Considering the results of the decrease of AT-III activity level in liver cirrhosis patients and the increase in hepatocellular carcinoma patients with liver cirrhosis, further evaluation for the possibility of hepatocellular carcinoma in liver cirrhosis patients without decrease of AT-III level or increase of AFP, may be in need.

An epidemiological and clinical study of leptospirosis acquired by twelves combat policemen in september, 2000 / 대한내과학회지

BACKGROUND: There were two occurrences of typhoon and the floods in Korea from early to late September, 2000. The Korean Combat Police and policemen participated in cleaning activities at the flooded area. Leptospirosis broke out among these participants. This study describes the epidemiological and clinical characteristics of leptospirosis patients among policemen. METHODS: Of 16,750 individuals involved, 3,752 subjected to passive hemagglutination antibody (PHA) test at the Regional Health Care Units or the National Police Hospital. With 1 case of dead plus 12 cases which were turned out to be seropositive by PHA test and confirmed by microagglutination (MA) test, epidemiological and clinical characteristics were studied by questionnaire survey, laboratory test, and history of treatment while being hospitalized. RESULTS: The seropositive rate of leptospira antibody was 0.3% (12/3,752). All 12 seropositives were bare-footed while working at the flooded area and of these, 8 patients (67%) were noticed abrasions either on hand or feet. However, no statistically significant correlation was found between the duration of outdoor activity and the seropositive rate (r=-0.46, p=0.36). There were clinical difference among patients who has the same serotype of leptospirosis, physical conditions, circumstance and the same work area. Two abnormal EKG results are present, the one who complained of chest pain is myocardial ischemia and the other who didn't complain of any symptoms is sinus pause. Correlation between the febrile period before and the duration of fever after the use of antibiotics was estimated as; febrile period after antibiotics use = 0.102804 + 0.995327 x febrile period before antibiotics use (p=0.058). CONCLUSION: When leptospirosis is related to group activities, it is possible to educate in advance and to manage systematically afterwards, it may prevent the occurrence of leptospirosis or the related complications.

A case report of near-triploid in adult acute lymphocytic leukemia / 대한내과학회지

In addition to age, white cell count and immunophenotype, karyotype has been reported to be one of the important prognostic factors in acute lymphocytic leukemias.Furthermore 70 percent of patients with acute B lymphocytic leukemia presented chromosomal abnormalities, which is known to have a close relationship with the prognosis. Among the abnormalities, triploid is rare and known to have the worse prognosis. Structural chromosomal abnormality of the 11q23 band is more common in childhood acute lymphocytic leukemia and has been rarely reported in adult lymphocytic leukemia. We present a case of a 29 year - old male patient with acute lymphocytic leukemia, who had triploid and chromosomal translocation including 11q23 band along with the review of related literature.

Acute renal failure and delayed neuropathy due to anti-freeze ingestion / 대한내과학회지

Antifreeze contains ethylene glycol up to ninty five percent. Ethylene glycol is colorless, odorless, sweet-tasting and water-soluble compound and has been widely used as a chemical solvent. Ethylene glycol has been reported as a common cause of incidental poisoning all over the world because of its easy access. However, in Korea, it is not easy to find statistical references on incidences of ethylene glycol intoxication, except two reported cases. Ethylene glycol itself is not toxic substance. But, many other daughter metabolites are very toxic and lethal. Acid metabolites among them can cause metabolic acidosis. Oxalate, end-product of ethylene glycol, is quickly transformed to calcium oxalate crystals, which precipitate in body tissues such as brain, kidney, heart, liver, and pancreas. We report a case of acute renal failure and neuropathy due to ethylene glycol intoxication along with a review of toxic effects of ethylene glycol.

A Case of Hereditary Factor VII Deficiency Performed Operation without any Replacement Therapy / 대한혈액학회지

Hereditary factor VII deficiency is a rare disorder transmitted by autosomal recessive pattern and its clinical feature is extremely variable. Recently we have experienced a case who was performed herniorrhaphy without any cryoprecipitate or fresh frozen plasma replacement therapy. A 21-year-old patient who had undergone intermittent nasal bleeding was noted for prolonged prothrombin time(INR of 1.5). The level of the factor VII of the patient was decreased at 22% of the normal activity. His parents had normal level of factor VII activity. Both his sister and brother had decreased level of factor VII at 41% and 24% respectively. Herniorrhaphy was performed without factor replacement therapy and there was no visible postoperative bleeding. We report here a case of factor VII deficiency performed an operation successfully without any replacement therapy.

Transient Elliptocytosis Associated with Acute Lymphoblastic Leukemia / 대한혈액학회지

Elliptocytosis has been known to be a rare disease, especially in oriental people. Most of them are transmitted as an autosomal dominant trait but we experienced one case of transient elliptocytosis associated with acute lymphoblastic leukemia by morphologic examination of the peripheral blood and bone marrow biopsy. The results of the peripheral blood smears of the patient and his family are as follows : he showed about 50~60% of elliptocytes and anemia without hemolytic event; his family, however, showedno sign of elliptocytosis. The patient was treated for acute lymphoblastic leukemia. On follow-up check after one month, the peripheral blood showed almost normal RBC morphology. Therefore, we diagnosed this case as transient elliptocytosis associated with acute leukemia. So we report a case of transient elliptocytosis associated with acute leukemia with a brief review of the relevant literature.

Effect of Propranolol on Portal Vein Pressure in Patients with Chronic Liver Disease: Evaluation by Perrectal Portal Scintigraphy / 대한핵의학회잡지

PURPOSE: Propranolol is known to decrease portal pressure by reducing blood flow of portal vein. Per-rectal portal scintigraphy with Tc-99m pertechnetate has been introduced to evaluate the portal circulation and early diagnosis of liver cirrhosis. We evaluated the effects of propranolol on portal circulation by using per-rectal portal scintigraphy. MATERIALS AND METHODS: We analyzed the portal hemodynamics by per-rectal portal scintigraphy in 51 patients with liver cirrhosis, 10 chronic hepatitis and 10 normal subjects. 38 patients with cirrhosis underwent per-rectal portal scintigraphy before and after propranolol medication. Per-rectal portal scintigraphy was performed after per-rectal administration of 370 MBq of Tc-99m pertechnetate. The shunt index was calculated as the ratio, expressed as a percentage of heart radioactivity to the sum of heart and liver radioactivity during the first 30 seconds. RESULTS: The shunt index in 40 patients with cirrhosis (59.8+/-27.2%) was significantly higher than that of normal control (5.0+/-1.2%, p<0.01) and chronic hepatitis (11.4+/-3.5%, p<0.01). Shunt index was significantly different according to Child's classification and the degree of esophageal varix (p<0.01). After propranolol medication, shunt index was significantly decreased from 59.9+/-27.3% to 51.3+/-15.3% (p<0.01) in 38 patients with liver cirrhosis. There was no significant difference of the amount of shunt index reduction after propranolol according to Childs' classification and the degree of esophgageal varix. CONCLUSION: The effect of propranolol on portal circulation was demonstrated as decreasing shunt index on per-rectal portal scintigraphy in patients with liver cirrhosis. Per-rectal portal scintigraphy may be useful to evaluate the portal circulation and to predict the effect of propranolol in patients with liver cirrhosis.

A seroepidemiological study of anti-HAV IgG in korean combat policemen / 대한내과학회지

BACKGROUND: Hepaitis A virus(HAV) infection occurs commonly during early childhood. Recent improvements in sanitation and hygiene have resulted in a decrease in HAV infection among children, while the clinical illness of hepatitis A and prevalence of antibody to HAV(anti-HAV IgG) have been increased, particularly in the 3rd decade of young male adults. We studied a seroepidemiology of anti-HAV IgG in combat policemen who were living together during their service in the combat police force. METHODS: We measured anti-HAV IgG(HAVAB, Abbott) from 1,009 healthy subjects with no history of transfusion of any blood products during the last 6 months. The mean age was 20.8 years. RESULTS: Overall, anti-HAV IgG was detected in 30.2% of study subjects. According to age, the positive rates of antibody were 15.7%, 25.9%, 31.5%, 38.1%, 43.5%, and 50.0% in 19, 20, 21, 22, 23, and 24 years respectively. The positive rates of anti-HAV IgG as to period of service were 17.3%, 28.1%, 40.9% in 0 month, 1-12 months, 13-24 months respectively. The positive rates of anti-HAV IgG were 27.0% in the urban group, 39.8% in the rural group. CONCLUSION: The positive rates of anti-HAV IgG in our data low compared with those of previous reports. We think that group living condition such as living in dormitories or barracks can be a risk factors for hepatitis A infection and that improvements to the sanitary system and active immunization would be necessary for prevention of it.

A Case of Neuro-Behcet's Disease: Comparison of Neurological Symptoms with PET, SPECT, and MRI Findings / 대한핵의학회잡지

We describe a 27-year-old man who developed gait disturbance and dysarthria 2 years after the onset of cardinal symptoms of Behcet's disease. Positron emission tomography with 18F-fluorodeoxyglucose revealed severe hypometabolism in the cerebellum, in accordance wih cerebellar symptoms and sign of the patient. However, single-photon emission tomography with Tc-99m-HMPAO and Tc-99m-ECD did not disclose significant perfusion abnormalities in the brain. Routine brain magnetic resonance imaging did not show signal abnormalities. The findings of imaging studies compared with neurological manifestations of the patient are discussed.

The Evaluation of Gallbladder Function by Tc-99m-DISIDA Scintigraphy in Diabetic Patients / 대한내과학회지

OBJECTIVES: Diabetic autonomic neuropathy is a common complication of long standing diabetes mellitus and is well known to induce the motor dysfunction of cardiovascular system, genitourinary system and diges tive system. Although many studies have done to eval uate the diabetic autonomic neuropathy, gallbladder motor function and biliary dynamic study to evaluate the change of gallbladder function in diabetic patients is relatively rare. This study was performed to measure the gall bladder ejection fraction using Tc- 99m-DISIDA with fatty meal in order to evaluate the gallbladder motor func tion in diabetic patients and to examine the usefulness of it in analyzing diabetic autonomic neuropathy. METHODS: 51 diabetic patients(males 31, females 18, mean age 57yr(39-77yr)) and 18 control subjects(males 14, females 4, mean aged 47yr(31-70yr)) without gall stone and impaired liver function were enrolled in our study. Also the diabetic patients were categorized by age, disease duration, body weight and diabetic complications such as retinopathy, peripheral neuropathy and cardiovas cular autonomic neuropathy accompanying with or not. RESULTS: 1) Median value and interquartile range of gallbladder ejection fraction(%) were 66%(48-79%) in diabetic pa tients group and 75%(64-80%) in control subjects. There was no statistically significant difference between the two groups, but the mean value of diabetic patients was slightly lower than that of control subjects. 2) There was no significant difference between the two groups in mean value of gallbladder ejection fraction in every age group(P>0.05). 3) Median value of gallbladder ejection fraction in diabetic groups with less than 10 years of duration (both under 5 years and 5 to 10 years groups) was similar to that of control subjects. However in patients whose diabetic conditions last more than 10 years, the median range of gallbladder ejection fraction was significantly lower than that of control subjects(p0.05). Also seven diabetic patients whose gallbladder ejection fraction was reduced under 35% have had at least two diabetic complications. CONCLUSION: We observed that gallbladder ejection fraction of diabetic patients was reduced compared with that of control subjects. This is due to the reduced gallbladder muscle contractility resulting from diabetic autonomic dysfunction. These results suggest that the assessment of gallbladder ejection fraction using 99m- Tc-DISIDA would be useful to diagnose diabetic auto nomic neropathy.

A Case of metastatic lid carcionoma of stomach cancer / 대한내과학회지

Eyelid tumors, including metastatic lid tumors, present clinically as recurrent chalazia, multicentric nodules, ul cerated lesions, diffuse swelling, or chronic blepharocon juntivitis. Lid tumors consist of benign lesions(69%) and malignant lesions(31%). Basal cell carcinoma and squa mous cell carcinoma account for 92% of the malignant lesions. Metastatic lid disease was found to be of rare occurence, accounting for 0.1% of all lid lesions and 0.3% of malignant lid lesions. We report a case of metastatic lid carcinoma of sto mach cancer. A 60-year-old man developed a painless, slow-growing nodular lesion of his right lower eyelid. Excisional biopsy revealed metastatic undifferentiated ade nocarcinoma. We believe this is the first case in Korean literature.

The Diagnostic Significance of 67 Gallium Lung Scan and High Resolution Computed Tomography in Patients with Pulmonary Tuberculosis / 대한내과학회지

OBJECTIVE: The activity of pulmonary tuberculosis has been usually detarmined by smear and culture of AFB in sputum and serial chest X ray. However it is sorntimes difficult to determine the activity of pulmonary tuberculosis by either. We have studied Gallium lung scan 4 HRCT in the patients with pulmonary tuberculosis to determine its activity and compared their diagnostic significance. METHODS: 67Gallium lung scan and HRCT were examined in 63 patients with pulmonary tuberculosis suspected by chest X ray and were compared each other with their possible diagnostic significance in determination of activity. The active pulmonary tuberculosis was defined by positive AFB smear and/ or culture in sputum and changes of findings in serial chest X ray. RESULTS: 1) Of 63 patients with pulmonary tuberculosis, 37 patients has been diagnosed active 9 patients were diagnosed by positive AFB smear in sputum, 20 patients by positive AFB culture in sputum and 8 patients by changes of findings in serial chest X ray. 2) In the 37 patients with active pulmonary tuberculosis, chest X ray revealed active pulmonary tuberculosis findings in 28 patients, inactive in 4 patients and undetermined in 5 patients. On the contrary, In the 26 patients with inactive pulmonary tuberculosis, the chest X ray revealed active pulmonary tuberculosis findings in 6 patients, inactive in 16 patients and undetermined in 4 patients. 3) 67Gallium lung scan showed positive uptake in 34 patients of the 37 patients with active pulmonary tuberculosis, but did not show any uptake at all in 26 patients with inactive pulmonary tuberculosis. 4) HRCT showed active findings in 36 patients of the 37 patients with pulmonary tuberculosis. And it showed active findings in 4 patients of the 26 patients with inactive pulmonary tuberculosis. CONCLUSION: The Gallium lung scan showed 82% of sensitivity and 8% of false negativity. And HRCT showed 97% of sensitivity and 15% of false positivity. In the aspect of laboratory examinations for the determination of activity in pulmonary tuberculosis the 67Gallium lung scan and the HRCT appeared useful.