Evolution of Interferon-Gamma Release Assay Results and Submillisievert Chest CT Findings among Close Contacts of Active Pulmonary Tuberculosis Patients / 결핵및호흡기질환

Background@#Latent tuberculosis (TB) infection among TB contacts is diagnosed using plain chest radiography and interferon-gamma release assays (IGRAs). However, plain chest radiographs often miss active TB, and the results of IGRA could fluctuate over time. The purpose of this study was to elucidate changes in the results of the serial IGRAs and in the findings of the serial submillisievert chest computed tomography (CT) scans among the close contacts of active pulmonary TB patients. @*Methods@#Patients age 20 or older with active pulmonary TB and their close contacts were invited to participate in this study. Two types of IGRA (QuantiFERON-TB Gold In-Tube assay [QFT-GIT] and the T-SPOT.TB test [T-SPOT]) and submillisievert chest CT scanning were performed at baseline and at 3 and 12 months after enrollment. @*Results@#In total, 19 close contacts participated in this study. One was diagnosed with active pulmonary TB and was excluded from further analysis. At baseline, four of 18 contacts (22.2%) showed positive results for QFT-GIT and T-SPOT; there were no discordant results. During the follow-up, transient and permanent positive or negative conversions and discordant results between the two types of IGRAs were observed in some patients. Among the 17 contacts who underwent submillisievert chest CT scanning, calcified nodules were identified in seven (41.2%), noncalcified nodules in 14 (82.4%), and bronchiectasis in four (23.5%). Some nodules disappeared over time. @*Conclusion@#The results of the QFT-GIT and T-SPOT assays and the CT images may change during 1 year of observation of close contacts of the active TB patients.

Motor Recovery in Relation to the Site of Subcortical Stroke Lesions

OBJECTIVE: The purpose of this study was to evaluate the motor recovery of initial and plateau period in the patients with subcortical stroke lesion which were different locations. METHOD: We studied the 42 stroke patients with subcortical lesions who had been admitted to the Department of Rehabilitation Medicine from 1998 to 2000, retrospectively. Patients were divided into four groups according to the information from brain CT or MRI; Group 1: basal ganglia, group 2: anterior limb of internal capsule and/or basal ganglia, group 3: posterior limb of internal capsule and/or basal ganglia and group 4: thalamus only. Quantitative assessments of motor recovery using the Brunnstrom stage and results were correlated with sites of lesion. RESULTS: 1) Brunnstrom stages at initial and plateau period were the highest in the patients with thalamic lesion and the lowest in the patients with posterior limb of internal capsule and/or basal ganglia lesion. The patients with thalamic lesion showed higher stage than the patients with basal ganglia with anterior limb lesion in hand and low extremity (p<0.05). 2) Significant motor recovery was occurred in all patients except the lesion located in thalamus (p<0.05). CONCLUSION: There were significant differences of motor recovery at plateau period in the patients with thalamic lesions comparing with basal ganglia with anterior limb lesion about hands and lower extremities and patients with basal ganglia and/or capsular lesion showed good motor recovery.

Recovery from Motor Weakness of Ipsilateral Upper Limb Following Stroke Comparison on Recovery of Proximal Portion with That of Distal Portion

OBJECTIVE: To observe the ipsilateral upper limb function after stroke comparing proximal with distal part and to determine how they recover after stroke. METHOD: Cohort study of 72 patients with stroke in the middle cerebral arterial territory undergoing multidisciplinary stroke rehabilitation program. The main outcome was assessed by the Manual Function Test (MFT) for upper limb function, weekly. RESULTS: The recovery time of the ipsilateral upper limb to maximum function was 32.4+/-15.4 days. The functions of the ipsilateral shoulder and hand after stroke decreased significantly. Even at the maximum recovery, complete recovery was not seen. For ipsilateral shoulder, more severe functional deficits were seen with subcortical lesion than with cortical lesion, whereas for ipsilateral hands, no difference was seen between them. CONCLUSION: Therefore, the fact that recoveries of the shoulders and hands were different according to the presence of cerebral cortical or subcortical lesions suggests that the brain structures that control these areas or the recovery mechanisms might be different.

Characteristics of Dysphagia in Children with Cerebral Palsy via Videofluoroscopy

OBJECTIVE: To describe the characteristics of specific swallowing abnormalities in children with cerebral palsy and identify the risk factors related to aspiration via videofluoroscopy. METHOD: Thirty-one children with cerebral palsy, aged from 1.3 years to 15.5 years, were investigated. After taking feeding history and physical examination, videofluoroscopic swallowing studies (VFSS) were performed according to the modified Logemann's protocol with liquid and puree mixed with barium. The swallowing patterns of oral and pharyngeal phase and presence or absence of aspiration were observed. RESULTS: In VFSS, children with cerebral palsy showed oral phase abnormalities in 87.1% (27/31) including impairment of bolus formation, food pocketing and pharyngeal phase abnormalities in 83.9% (26/31) including pooling in valleculae, weak pharyngeal peristalsis. CONCLUSION: The majority of children with cerebral palsy evaluated in this study had swallowing abnormalities. The main swallowing impairments were tongue movement in oral phase and pharyngeal peristalsis in pharyngeal phase.