A Study on the Difference of Psychosocial Characteristics and Quality of Life according to the Type of Functional Gastrointestinal Disorder / 정신신체의학

Objectives@#：The purpose of this study is to compare the psychosocial characteristics of patients diagnosed with functional gastrointestinal disorder (FGID) by classifying them into irritable bowel syndrome (IBS), functional dyspepsia (FD), functional constipation (FC), functional heartburn (FH) groups, and overlap group (two or more functional diseases) and to examine the factors associated with the quality of life (QoL) of patients with FGID. @*Methods@#：A total of 144 patients who were diagnosed with FGID were selected as the subjects. The demographical factors were investigated; Korean-Beck Depression Inventory-II (K-BDI-II), Korean-Beck Anxiety Inventory (K-BAI), Korean version of Childhood Trauma Questionnaire (K-CTQ), Multi-dimensional Scale of Perceived Social Support (MSPSS), Korean Version of Connor-Davidson Resilience Scale (K-CD-RISC), and World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were used to evaluate the psychosocial factors. @*Results@#：TThe overlap group had a significantly higher K-BDI-II score (F=11.09, p<0.001) and K-BAI score (F=8.93, p<0.001) compared to other groups. In childhood trauma, the IBS patients had a difference in emotional neglect (F=2.54, p=0.04) than the FD patients. The QoL of FGID patients had a negative correlation with depression (r=-0.196, p<0.01), anxiety (r=-0.235, p<0.01), and childhood trauma (r=-0.222, p<0.01), and a positive correlation with social support (r=0.512, p<0.01) and resilience (r=0.581, p<0.01). @*Conclusions@#：Overlap group had a higher level of depression and anxiety, and the IBS patient group had a higher level of emotional neglect than the FD patient group in terms of childhood trauma.

Influence of Transcranial Direct Current Stimulation on Lower Limb Muscle Activation and Balance Ability in Soccer Player

PURPOSE: This study is to investigate influence of tDCS on lower limb muscle activity and balance ability in soccer player. METHODS: Sessions were conducted with 15 subjects in tDCS group and 15 in action observation training group for 20 minutes, 5 sessions a week, for 8 weeks. All soccer players underwent 30 minutes of plyometric training before main exercise. To evaluate lower limb muscle activation, rectus femoris and biceps femoris were taken measure using surface electromyogram system and to evaluate balance ability, surface area, whole path length, limited of stability were measured using biorescue. RESULTS: Regarding balance shown in surface area, whole path length, limited of stability and muscle activation in rectus femoris and biceps femoris, tDCS group showed more significant change than action bservation training group. CONCLUSION: Therefore, intervention using tDCS is more effective in improving lower limb muscle activation and balance ability than action observation training.

Retrospective study for the change of bone density over 2 years in patients at Sorokdo hospital / 나학회지

INTRODUCTION: Author investigated the baseline of BMD and T-score through analysis of bone density for 254 ex-hansen patients in 2014. This study aims to evaluate the change of BMD and T-score after two years of medication to improve the BMD of those patients. MATERIALS AND METHODS: The 144 subjects received the tests for bone density at 2015 and 2016 consecutively and have taken medication since 2014. DXA machine was used on L1–L4 and femur neck and the results of BMD and T-score were compared with those in 2014. RESULTS: The rate of male to female was 1:1.08, their mean age was 77.3 years old. In comparison with the results of 2014, the change of BMDs(g/cm2) at femur neck were −0.08 in 60s, −0.11 in 70s, and −0.09 in 80s and older. For the change of T-score, they showed −0.70 in 60s, −0.81 in 70s, and −1.30 in 80s and older. But the BMDs at femur neck in 2016 increased by 0.04 in 60s and 0.01 in 80s and older. CONCLUSION: Both of the bone densities and T-scores at femur neck were decreased comparing with those of 2014. But the change of BMDs between 2015 and 2016 was almost absent. So, the effect of long term medication with bisphosphonate was thought to be effective for improving BMDs in old ex-hansen patients at national Sorokdo hospital.

Analysis of bone density for ex-hansen patients in one national hansen hospital in Korea / 나학회지

BACKGROUND: Most of those who have taken drugs for osteoporosis in Sorokdo hospital haven't got through any objective test for bone density to figure out the status of it. The purpose of this study is to get the baseline data for their bone densities using diagnostic instrument. METHOD: The subject was 258 ex-hansen patients who were available to take the bone densitometry. DXA machine was used on L1-L4 and femur neck analyzing the results according to WHO guideline for defining osteoporosis. RESULTS: The rate of male to female was 1:1.19 and their mean age was 74.6 years old. The bone density of femur neck was lower than vertebrae. For men, the prevalence of osteoporosis was 30% in 60s, 32.3% in 70s, 60% in 80s and older. For women, it was 35.5% in 60s, 59.7% in 70s, 74.3% in 80s and older. CONCLUSION: The baseline data of bone densities acquired from this study would be used as objective guideline for diagnosis of osteoporosis and evaluation of effectiveness of medication for it.

Feature of Nerve Conduction Study in people affected by leprosy / 나학회지

BACKGROUND: Nerve conduction study(NCV) in elderly patients is considered as a useful diagnostic tool for elderly patients with peripheral neuropathy. OBJECTIVE: Here the author investigates parameters of NCV in elderly Hansen patients out of Sorokdo hospital and compares them with those of healthy elders. METHODS: The author enrolled 28 patients who were visiting OPD for surgical wound care. Out of them 8 patients were dropped off because of hypersensitive response to the test stimulation or having failed to attatch the electrodes on severely deformed hands and fingers. Consequently parameters of NCV such as latency, amplitude, and conduction velocity in upper extremities of 20 patients were investigated and compared with those of healthy elders at similar age range. RESULTS: The patients were 12 in male and 73 years old on the average. In sensory nerve study, the parameters for median nerve showed 5.52+/-3.5msec in latency, 23.01+/-16.71uV in amplitude, and 29.03+/-13.16m/s in conduction velocity. For ulnar nerve, 5.82+/-3.76, 19.48+/-11.51, and 27.61+/-13.19 respectively. In motor nerve study, parameters for median nerve showed 9.35+/-1.64, 3.45+/-2.03, 47.95+/-9.91 respectively. And for ulnar nerve, they were 9.13+/-1.20, 2.95+/-2.50, and 43.70+/-7.24 respectively. In comparison with healthy elders, latency for Hansen patients was prolonged longer, lower amplitude, and also slower nerve conduction velocity. CONCLUSION: This study was performed for elderly Hansen patients for the first time demestically. Even the results may not be generalized for the whole Hansen patients because of the limited number of study cases and not being standarized according to the grade of disability, this study may be considered as a useful reference for further NCV for Hansen patients.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Cerebral Infarction after Transfemoral Carotid Angiography : Report of 2 Cases / 대한뇌혈관외과학회지

Computerized tomography angiography (CTA) and magnetic resonance angiography (MRA) have been frequently used as non-invasive methods for the evaluation of cerebral vessels. The use of an invasive therapeutic method, transfemoral carotid angiography (TFCA), has also recently increased. The complication rate after TFCA is reported to be 0.9 % to 4%, and it is continuously decreasing. We experienced 2 patients who underwent TFCA as a diagnostic tool. The embolic type of cerebral infarction, which occurred within 30 hours, was diagnosed with performing diffusion weighted MRI (DW-MRI). One patient developed temporary dysphasia and motor weakness, but the patient improved after 2 days. The other patient presented with an altered mentality and motor weakness with some permanent deficits. TFCA is a less invasive method for treating cerebral vessels, and because this is a popular therapeutic modality, the frequency of complications will increase. Clinicians should bear in mind that complications may occur when performing TFCA and so they should be prepared to deal with them.

Comparison of Anti-mycobacterial Drug Susceptibility Test Results by Institutes and Methods / 대한임상미생물학회지

BACKGROUND: The purposes of the current study were to evaluate the concordant rates of anti-mycobacterial drug susceptibility test (DST) results in different solid media performed in different institutes, and to determine reliable susceptible testing methods. METHODS: One hundred and twenty two Mycobacterium tuberculosis strains were isolated from patients in A Hospital in 2005. DSTs were performed by the absolute concentration method using L?wenstein Jensen medium in both A Hospital (method A-1) and B Institute (method B-1) and by the proportion method using Middlebrook 7H10 agar in B Institute (method B-2). Nine drugs were used including isoniazid and rifampin. Sensitivity and specificity of each method were estimated by using the acceptable standard of 90% for isoniazid and rifampin and 80% for other drugs. The therapeutic outcomes of quinolone-administered patients were evaluated according to ofloxacin susceptibility results. RESULTS: Method B-1 showed sensitivity and specificity levels over the acceptable standard levels for all drugs. Method B-2 showed specificity lower than the acceptable levels for rifampin and cycloserine. Method A-1 showed specificity lower than the acceptable levels for isoniazid, streptomycin, p-aminosalicylic acid, and ofloxacin and sensitivity lower than the acceptable levels for prothionamide and cycloserine. The concordance rates of therapeutic outcomes with method B-1, method B-2, and method A-1 were 77%, 74%, and 65%, respectively. CONCLUSION: The drug susceptibility results for some drugs were discordant between the testing laboratories and media, requiring an urgent application of quality control programs to raise the reliability of anti-mycobacterial DST.

Epileptogenic Properties of Balloon Cells in Cortical Tubers of Tuberous Sclerosis: Upregulation of Drug Resistance Proteins

OBJECTIVES: Balloon cells and dysplastic neurons are histopathological hallmarks of the cortical tubers of tuberous sclerosis complex (TSC) and focal cortical dysplasia (FCD) of the Taylor type. They are believed to be the epileptogenic substrate and cause therapeutic drug resistant epilepsy in man. P-glycoprotein (P-gp) is the product of multidrug resistance gene (MDR1), and it maintains intracellular drug concentration at a relatively low level. The authors investigated expression of P-gp in balloon cells and dysplastic neurons of cortical tubers in patients with TSC. METHODS: An immunohistochemical study using the primary antibody for P-gp, as an indicative of drug resistance, was performed in the cortical tuber tissues in two patients of surgical resection for epilepsy and six autopsy cases. RESULTS: Balloon cells of each lesion showed different intensity and number in P-gp immunopositivity. P-gp immunopositivity in balloon cells were 28.2%, and dysplastic neurons were 22.7%. These immunoreactivities were more prominent in balloon cells distributed in the subpial region than deeper region of the cortical tubers. Capillary endothelial cells within the cortical tubers also showed P-gp immunopositivity. CONCLUSION: In this study, the drug resistance protein P-glycoprotein in balloon cells and dysplastic neurons might explain medically refractory epilepsy in TSC.

Epidemiology and Characteristics of Recurrent Stroke: The Occurrence Type of Restroke is Similar as Previous Stroke

OBJECTIVE: Despite improvement of therapeutic regimen, incidence of stroke increases and it remains a leading cause of death. Our study aims at offering variable data on recurrent strokes. METHODS: There were 59 patients who admitted from Jan. 2002 to Dec. 2004 due to recurrent strokes. A retrospective longitudinal cohort study was done. RESULTS: Four-hundred-seventy five patients, diagnosed with acute stroke, experienced 491 strokes in 3 years, and there were 75 recurrent strokes (15.3%) in 59 patients. These 59 patients were included in the study. First hemorrhagic cases (H) were 19 (32%), and the first infarction cases (I) were 40 (68%). Subsequent strokes after first stroke were as follows : H-->H 14 (23.7%)cases, H-->I 5 (8.5%), I-->H 8 (13.6%), I-->I 32 (54.2%). A Cox regression analyses showed that the first type of stroke was a significant factor to the second stroke as follows : if one has had a hemorrhagic stroke, the possibility of second hemorrhagic attack (H-->H attack) increase 3.2 times than ischemic type and in ischemic stroke (I-->I attack) 3.6 times increased incidence of second ischemic attack. CONCLUSION: The recurrence rate of stroke was 12.4% (59 of 475 patients). If the first stroke is hemorrhage or infarction, the next stroke would have high potentiality of hemorrhage, or infarction. The possibility of same type in second stroke increase over 3 times. In H-->H group, the time interval between first and second stroke was shorter and the age of onset was earlier than in I-->I group. Moreover, the infarction was more frequent than hemorrhage in multiple strokes. There was a correlation in lacunar type infarction between first and second attack.

Relations between Polymorphism of NRAMP1 Gene and Susceptibility to Pulmonary Tuberculosis / 결핵및호흡기질환

Background: Several lines of evidence suggest that a host's genetic factors influence the outcome of exposure to Mycobacterium tuberculosis. The aim of this study was to determine whether polymorphism in NRAMP1 (natural resistance associated macrophage protein 1) gene is associated with the susceptibility or resistance to tuberculosis infection for patients with drug-sensitive pulmonary tuberculosis (DS-TB) and multi-drug resistant pulmonary tuberculosis (MDR-TB). Methods: Eight genetic polymorphisms of the NRAMP1 gene were investigated in patients suffering with DS-TB (n=100) or MDR-TB (n=102), and in healthy normal controls (NC, n=96). The genetic polymorphisms of NRAMP1 were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The frequency of D543N A/G heterogygotes was significantly higher in the DS-TB subjects than the NCs (OR=2.10, 95% CI: 1.00 to 4.41, p=0.049). The frequency of 823C/T T/C heterozygotes was significantly higher in the DS-TB subjects (OR=2.79, 95% CI: 1.11 to 7.04, p=0.029) and the MDR-TB subject (OR=3.30, 95% CI 1.33 to 8.18, p=0.010) than in the NCs. However, the frequency of these genotypes was not different between the DS-TB and MDR-TB subjects. Conclusion: A significant association was found between NRAMP1 823 C/T polymorphism and pulmonary tuberculosis. This result suggests that NRAMP1 polymorphism may be involved in the development of pulmonary tuberculosis in Koreans.

Effect of Continuous External Ventricular Drainage on Delayed Ischemic Neurologic Deficits after Aneurysmal Clipping in Spontaneous Subarachnoid Hemorrhage

OBJECTIVE: The purpose of this reports is to describe the influence of continuous external ventricular drainage (EVD) on delayed ischemic neurologic deficit (DIND) after early surgery in ruptured aneurysmal patients. METHODS: The authors reviewed 229 patients with aneurysmal subarachnoid hemorrhage (SAH) who had been treated with clipping at a single institution between 1998 and 2004. Of these, 121 patients underwent continuous EVD (Group A) postoperatively, whereas 108 patients did not (Group B). EVD was performed at ipsilateral Kocher's point and maintained 2 to 14 days postoperatively. RESULTS: DIND occurred in 15.7% (19 cases) of patients in Group A, 25% (27 cases) from Group B (P value=0.112). Compared with Group A, Group B was more likely to suffer acute symptom of DIND and showed poor response to 3- H therapy. Major symptoms of DIND in Group A were mild confusion (36.8%) and mild deterioration of mental state (26.3%), contrary to weakness of extremities (59.2%) in Group B. At discharge, Glasgow Outcome Scales (GOS) of Group A were: good recovery (63.2%), moderately disabled (21%), severely disabled (10.5%), dead (5.3%) and Group B : good recovery (48.1%), moderately disabled (37%), severely disabled (14.8%) and dead (0%). Of 121 patients from group A, 35 patients (28.9%) suffered ventriculitis. CONCLUSION: Continuous EVD after aneurysmal clipping in patients with SAH reduced the risk of DIND and its sequelae, relieved its symptoms, and improved the outcome.

Cross-resistance Between Rifampicin and Rifabutin and Its Relationship with rpoB Gene Mutations in Clinically Isolated MDR-TB Strains / 결핵및호흡기질환

BACKGROUND: Despite the emerging danger of MDR-TB to human beings, there have only been a limited number of drugs developed to treat MDR-TB since 1970. This study investigated the cross-resistance rate between rifampicin (RFP) and rifabutin (RBU) in order to determine the efficacy of rifabutin in treating MDR-TB. In addition, the results of rifabutin were correlated with the rpoB mutations, which are believed to be markers for MDR-TB and RFP resistance. METHODS: The MICs of RBU were tested against 126 clinical isolates of MDR-TB submitted to the clinical laboratory of National Masan TB Hospital in 2004. Five different concentrations (10-160 microgram/ml) were used for the MICs. The detection of the rpoB mutations was performed using a RFP resistance detection kit with a line probe assay(LiPA), which contains the oligonucleotide probes for 5 wide type and 3 specific mutations (513CCA, 516GTC, and 531TTG). The rpoB mutation was determined by direct sequencing. RESULTS: The rate of cross-resistance between RFP and RBU was 70.5%(74/105) at 20 microgram/ml RBU(ed note: How much RFP?) Most mutations (86.3%) occurred in the 524~534 codons. The His526Gln, His526Leu, Leu533Pro, Gln513Glu, and Leu511Pro mutations(Ed note: Is this correct?) were associated with the susceptibilty to RBU. CONCLUSION: Based on the cross-resistance rate between RFP and RBU, RBU may be used effectively in some MDR-TB patients. Therefore, a conventional drug susceptibility test for RBU and a determination of the critical concentration are needed. However, rpoB gene mutation test may be have limited clinical applications in detecting RBU resistance.

A Retrospective Study for Relapse Rate According to the Discontinuance of Para-aminosalicylic acid(PAS) after Bacteriological Conversion during the Course of Chemotherapy for Multidrug-Resistant Tuberculosis(MDR-TB) / 결핵및호흡기질환

BACKGROUND: Para-aminosalicylic acid(PAS) is a 2nd-line drug that can cause severe adverse reactions leading to poor patient compliance. This study evaluated the relapse rate according to the discontinuance of PAS at a certain point after bacteriological conversion during the course of chemotherapy for multidrug-resistant tuberculosis(MDR-TB). METHODS: 42 out of 452 MDR-TB patients were enrolled in this study. All subjects were receiving chemotherapy including PAS at National Masan TB Hospital between Jan. 1, 2000 and Dec. 31, 2001. The relapse rate was evaluated after the discontinuance of PAS from their initial regimen as a result of the severe adverse reactions at a certain point after the bacteriological conversion during the course of chemotherapy for MDR-TB. RESULTS: The male to female ratio was 2.5:1, and the mean age was 47.2 years old. The average number of past histories, used drugs and resistant drugs was 1.2, 3.9 and 4.3. The mean number of sensitive drugs included in the inirial regimen was 3.9. The mean time for bacteriological conversion and discontinuance of the PAS was 2.3 months after initiating treatment and 6 months after bacteriological conversion, respectively. There was no relapse after discontinuing PAS during a mean follow up period of 31.6 months. CONCLUSION: PAS may be discontinued in the cases of serious gastrointestinal problems approximately 6 months after bacteriological conversion without concern about relapse.

The Current Status of Multidrug-resistant Tuberculosis in Korea / 결핵및호흡기질환

PURPOSE: Multidrug-resistant tuberculosis (MDR-TB) is an emerging threat to human beings. However, there is little data on the current status of MDR-TB in Korea. This study investigated the current status of MDR-TB in Korea using a survey of all the data from drug susceptibility tests (DST) performed across the country over the last three years. METHOD: The DST results between Jan. 2000 and Dec. 2002 from 7 laboratories, which were in charge of all antituberculous DSTs across the country as of March 2002, were collected and analyzed to determine the actual number of drug-resistant or MDR-TB patients, annual trend, degree and pattern of resistance against anti-TB drugs, etc. RESULTS: Six laboratories used the absolute concentration method for DST and one used the proportional method. 59, 940 tests had been performed over the 3 year study period. The number of DST performed annually was 18,071, 19,950, and 21,919 in 2000-2002, respectively. The number of resistant tuberculosis patients (resistant against at least one anti-TB drug) had increased by 16.9% from 6,338 in 2000 to 7,409 in 2002. The rate of resistant tuberculosis among all DST results was 35.1% in 2000, 34.5% in 2001, and 33.8% in 2002. The number of MDR-TB patients (resistant against at least both isoniazid and rifampin) showed an increasing trend (14.5%) from 3,708 in 2000 to 4,245 in 2002. CONCLUSION: Approximately 4,000 MDR-TB cases are newly identified by DST annually and the number is showing an increasing trend. This study suggests that in order to cope with the current MDR-TB situation, the DST methods will need to be standardized and more aggressive measures will be required.

Clinical Observational study of Pulmonary Tuberculosis for admitted patients at a National Tuberculosis Hospital: Comparison with the previous results in 1995 / 결핵및호흡기질환

BACKGROUND: The last national tuberculosis survey was carried out in 1995. In 2000, the KTBS(Korean Tuberculosis Surveillance System) replaced a previous national survey. However, the KTBS does not show some of the important epidemiological indexes such as the prevalence of positive tuberculosis or the drug resistance rate. The aim of this study was to compare the clinical features of pulmonary tuberculosis patients admitted to a national tuberculosis hospital in 1995 and 2002. From this study, the authors expect to estimate the trend of the clinical features of tuberculosis in Korea even though it can not represent the Korean tuberculosis situation as a whole. METHOD: A cross sectional analysis of the clinical features for 331 pulmonary tuberculosis in-patients admitted to the National Masan Tuberculosis Hospital as of Dec. 2002, was carried out and these results were compared with those reported in 1995. RESULTS: In comparison with the data reported in 1995, the mean age was increased by 3.6 years (44.1+/-14.6 vs 47.7+/-16.4, p<0.01). The number of past tuberculosis history and used anti-tuberculous drugs prior to admission decreased from 2.0+/-1.7 and 6.1+/-2.3 to 1.7+/-1.8 and 4.6+/-3.6(p<0.05, p<0.001), respectively. While the resistance rate for anti-tuberculous drugs was similar (81.0% vs 77.6%), the initial resistance rate(10.5% vs 21.4%) and initial MDR rate(2.4% vs 16.5%) increased significantly(p=0.012, p=0.001, respectively). In 1995, the public health communities were in charge of approximately 65% of newly diagnosed tuberculosis cases, but this reduced to 40.5% in 2002(p<0.001). CONCLUSION: The existing national TB program (NTP) needs to be revised and strengthened in order to cope with the unfavorably changing situation of the domestic TB problem because the number of TB patients has not decreased and the initial resistance rate has increased greatly. Furthermore, the public and private sectors should cooperate each other to control the TB problem effectively because the private sector is now managing more than half of the TB patients.

Surgical Treatment of Multidrug-resistant Pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: Recently, medical treatment of multi-drug resistant pulmonary tuberculosis has been unsuccessful. Through analyzing the cases with surgical treatment, we hope to provide some help in treating multi-drug resistant pulmonary tuberculosis in the future. MATERIAL AND METHOD: A retrospective review was performed with 138cases of surgical treatment of multi-drug resistant tuberculosis during 10years from January 1994 to December 2003 at National Masan Hospital. RESULTS: The ratio of men to women, 5.1:1 indicates that there were more incidences in men. The number of the resistant drugs was 5.3 with a mean age of 42.6 years. Cavitary lesions on the plain chest X-rays were seen in 94cases (68.1%). 128cases had positive sputum culture preoperatively. Types of operations were 24 pnemonectomies, 83 lobectomies, 10 bilobectomies, 19 lobectomies with segmentectomies or wedge resections, 1 wedge resection, and 1 carvenoplasty. There was no death after operation. There were 6cases of air leakage over a week, 6cases of postoperative bleeding, 8cases of bronchopleural fistula and empyema, 16cases of dead space, 1case of atelectasis, 1case of wound infection, 1case of cyst as postoperative complication. Postoperative complication showed higher long-term negative conversion rate of 92.8%. CONCLUSION: There has been many discussions about operative indications, postoperative drug regimens, length of postoperative chemotherapy. In our study, we showed higher long-term success rate of postoperative chemotherapy with pulmonary resection on multi-drug resistant pulmonary tuberculosis.

Common interleukin 10 polymorphism associated with decreased risk of tuberculosis

Interleukin 10 (IL10) is a powerful TH2-cell cytokine that inhibits lymphocyte replication and secretion of inflammatory cytokines. The genetic associations of polymorphisms in IL10 with clinical manifestations of tuberculosis (TB) were examined in a large number of patients with clinical TB infection (n=459) and normal controls (n=871). One common promoter SNP (IL10 -592 A>C) was found to be significantly associated with decreased risk of TB manifestation. The frequency of the "C"-bearing genotype was higher in normal controls than in patients with clinical TB infection (P=0.005, OR=0.69). A summary of the genetic effect of IL10 -1082 A>G, the other nearby promoter SNP, in other ethnic groups is also presented.

Polymorphisms of interleukin-1beta and interleukin-1 receptor antagonist genes in patients with pulmonary tuberculosis / 대한내과학회지

BACKGROUND: Several lines of evidence suggest that host genetic factors influence the outcome of exposure to Mycobacterium tuberculosis. The aim of this study was to determine whether polymorphisms in interleukin-1beta (IL-1beta) and Interleukin-1 receptor antagonist (IL-1Ra) genes associate with the susceptibility or resistance to pulmonary tuberculosis in Korean. METHODS: IL-1beta and IL-1Ra gene polymorphism were investigated in 60 drug sensitive (DS) and 100 multidrug-resistant (MDR) pulmonary tuberculosis cases, and 96 healthy controls. IL-1beta-511/-31/+3954 and IL-1Ra genotype were determined by polymerase chain reaction. RESULTS: Allelic and genotypic frequencies of IL-1beta-511/-31/+3954 showed no significant difference in 3 groups. IL-1Ra allele 2 heterozygotes were less frequent in DS (p=0.03, OR=0.26, 95% CI 0.07 to 0.95) and MDR tuberculosis (p=0.008, OR=0.26, 95% CI 0.09 to 0.75) than controls, but there was no significant difference between DS and MDR tuberculosis (p=1.00). CONCLUSION: IL-1Ra allele 2 heterozygote may be associated with resistance to pulmonary tuberculosis in Korean. Further studies will be required to confirm whether these results are of biologic significance.