Comparative Research into the Process of Forming the Theory of Constitution in Ancient Western Medicine and that of Four Trigrams Constitution in Korean Medicine and Contents of Two Theories of Constitution / 의사학

After conducting comparative research into the process of forming the Theory of Constitution in Ancient Western Medicine and that of Four Trigrams Constitution(Sasang Constitution) in Korean Medicine and contents of two Theories of Constitution in terms of medical history, both theories were found to be formed by an interaction between philosophy and medicine, followed by a combination of the two, on a philosophical basis. The Theory of Constitution in Ancient Western Medicine began with the Theory of Four Elements presented by Empedocles, followed by the Theory of Four Humors presented by Hippocrates and the Theory of Four Temperaments by Galenos, forming and developing the Theory of Constitution. After the Middle Ages, there was no significant advance in the Theory of Constitution by modern times ; however, it developed into the theory of constitution type of Kretschmer and others after the 19th century and into the scientific theory of constitution based on genetics presented by Garrod and others early in the 20th century. The Theory of Four Trigrams Constitution began with the Theory of Constitution in Huangdi Neijing, followed by developments and influences of existing medicine called beginning, restoration, and revival periods and DongeuisoosebowonSaSangChoBonGwon based on the original philosophy of Four Trigrams presented by Lee Je-ma, which is found in GyeokChiGo, DongMuYuGo and so on, ultimately forming and developing into the Theory of Four Trigrams Constitution in Dongeuisoosebowon. Recently, a lot of research is being conducted into making it objective in order to achieve reproducibility in diagnosis and so forth of Four Trigrams Constitution.

The actual condition of drug-resistant tuberculosis and treatment outcomes at a tuberculosis specialized hospital / 대한내과학회지

BACKGROUND: During the last decade, the reports of drug-resistant tuberculosis in Korea were not common. Therefore, we investigated the anti-tuberculosis drug resistance rate according to medical history and radiological findings, as well as the relationship between the drug resistance and treatment outcomes to provide guidelines for selection of drug regimen before drug sensitivity test. METHODS: The study population was composed of 745 hospitalized patients who received drug susceptibility test for M. tuberculosis and anti-tuberculosis chemotherapy for the last 5 years. RESULTS: The majority had resistance to at least one drug (91.3%; 3.8+/-2.6 drugs). Drug resistance rate of first line drugs was 25~55%; especially higher in retreatment cases and those with the cavity on chest X-ray. Drug resistance was not correlated with radiographic finding. The success rate for treatment was higher in new cases, patients with less severe disease status and those without cavity on chest X-ray. When new cases had no resistance to all of EHR (84.1%), the negative conversion rate by first line drugs was above 70~90%. For retreatment patients, the negative conversion rate was above 70% only when they were susceptible to all of EHR (31%). The relapse rate was 4~13%. CONCLUSIONS: Probably the prevalence of drug-resistant tuberculosis in Korea will be considerably high. The drug resistance and treatment outcome was affected more by history of previous medical treatment than radiological findings. The previous EHRZ regimen is very effective as the initial treatment in new case, but revised retreatment regimen composed of at least 4 drugs is needed in the previously treated patients.

The survey for clinical course of intractable pulmonary tuberculosis / 대한내과학회지

BACKGROUND: Although various standard anti-tuberculosis chemotherapy regimens were suggested by World Health Organization in pulmonary tuberculosis, as yet, treatment regimen has not been established in intractable pulmonary tuberculosis. Also those surveys for intractable pulmonary tuberculosis were few. Therefore, the purpose of this study is to investigate the clinical course of radiological finding and pulmonary function pattern in intractable pulmonary tuberculosis, to assess the factors that affect the fate and so to make some suggestions for the management of intractable pulmonary tuberculosis. METHODS: This study population was composed of 40 patients with culture-proven pulmonary tuberculosis hospitalized. Although all 40 patients were received regular standard anti-tuberculosis chemotherapy which was individualized on the basis of susceptibility results, all patients were chronic excretors of mycobacterium tuberculosis bacilli (chronics), whose sputum cultures tested positive at both 11 and 12 months after admission. RESULTS: The rate of male and female was about 6:1 and mean age was 47.8+/-14.6 years old. Resistance to most of anti-tuberculosis drugs was observed and especially high degree resistance of isoniazid (95%), rifampicin (92.5%), ethambutol (87.5%), prothionamide and ofloxacin was found. Irrespective of the type of anti-tuberculosis chemotherapy and use of sensitive drug, clinical course was not significantly changed. On the pulmonary function test, most represented restrictive (57.5%) or combined pattern (27.5%) and had no significant interval change. Also arterial blood gas analysis finding was not changed. On chest X-ray findings, 80% had cavitary lesions, 87.5% showed far advanced stage and most (85%) had no significant interval change. However, 15% has changed to aggravation state, which had high frequency in patient with more than 3 susceptible drugs and significant decrease of FEV1 and FEV1/FVC on pulmonary function test findings that did not affect the mortality. The mortality rate was 30%, the average interval from diagnosis to death was 30.6+/-20.3 months and the fate was not associated with radiological findings, arterial blood gas analysis findings and pulmonary function test findings but only body weight at diagnosis of intractable pulmonary tuberculosis. CONCLUSIONS: The clinical course of intractable pulmonary tuberculosis that had no specific treatment did not depend on radiological findings and pulmonary function test findings but nutrition state at diagnosis. Therefore, in addition to anti-tuberculosis treatment, intractable pulmonary tuberculosis patient is recommended to be received aggressive conservative treatment that focuses on nutrition balance. Also it is probably essential to prevent the spread of intractable pulmonary tuberculosis to healthy person.

The effect of diabetes mellitus on treatment outcomes in pulmonary tuberculosis / 대한내과학회지

BACKGROUN: Many studies have shown that diabetes mellitus does not modify the clinical features and treatment outcomes. However, to our knowledge, those surveys for clinical features and treatment outcomes in pulmonary tuberculosis with diabetics were performed 15 years ago and have not been confirmed by more recent reports. Therefore, the purpose of this study is to investigate the effect of diabetes mellitus on microbiologic findings in far advanced stage of pulmonary tuberculosis and so to make some suggestions for the management of pulmonary tuberculosis with diabetes mellitus. METHODS: This study population was composed of 47 patients with far advanced stage of culture-proven pulmonary tuberculosis hospitalized in our department from 2000 through 2002. None of patients was intractable. Patients were divided into 4 groups; group1;nondiabetics with initial treatment, group2;diabetics with initial treatment, group3;nondiabetics with retreatment, group4; diabetics with retreatment. Treatment regimens were individualized on the basis of susceptibility results. A retrospective review of the records of all 47 patients with pulmonary tuberculosis and diabetes mellitus was carried out. The clinical features, bacteriologic, radiographic findings and treatment outcomes were compared among 4 groups. RESULTS: Time to negative conversion of AFB in sputum smear was significantly increased in diabetics group than nondiabetics, but time to negative conversion of AFB in sputum culture was not significant. Also time to negative conversion of AFB in sputum smear or culture was not affected by treatment pattern. The effect of antituberculosis medication significantly delayed response in diabetics with retreatment and resistance rate was higher in diabetics or retreatment. Time to negative conversion of AFB in sputum smear was related to cavitary size in radiographic findings, but time to negative conversion of AFB in sputum culture was related to drug sensitivity. Natural course of cavity on radiographic findings after antituberculosis therapy was not significant. CONCLUSION: It seems that diabetes mellitus does not affect bacteriological negative conversion rates except negative conversion rate of AFB in sputum smear, which chiefly related to cavitary size, in far advanced stage of pulmonary tuberculosis. Therefore, because the presence of AFB in sputum smear after 5th months of therapy is not necessarily a treatment failure in far advanced stage of pulmonary tuberculosis with diabetics, any decision regarding prologation or change in therapy maybe required based on the results of culture and drug susceptibility tests.

Humoral and Cell Mediated Immune Response After Immunization with Varicella Vaccine (Oka/LG)

PURPOSE: We evaluated the humoral and cellular immune response to varicella-zoster virus after vaccination with varicella vaccine (Oka/LG strain). METHODS: The seroprevalence rate of fluorescent antibody to membrane antigen (FAMA) was evaluated among 178 children and 15 adults. After vaccination, seroconversion rate of FAMA, varicella-zoster virus (VZV) specific IgG and cell mediated immune response to glycoprotein I was performed. RESULTS: The seropositive rate of FAMA against VZV in healthy children ages 3 to 6 was 43.1%. A past history of chickenpox illness was confirmed in 15.2% of children who had positive response in FAMA assay in 90.9%. 34.5% of those without a past history of chickenpox had antibodis. The seropositive rate in children vaccinated with varicella vaccine in the past was found to be 46.3% in questionnaire and 44.4% in immunization schedule, lower than that of other studies (greater than 90%). The seroconversion rates in children vaccinated with the Oka/LG were 97.1% with 2,500pfu and 100.0% with 5,000pfu. Antibodies appearing after the Oka/LG vaccination were found to have glycoprotein I zone confirmed by western blotting. The rate of cell mediated immune response was 88.2% in children and 100.0% in adults. CONCLUSION: Further investigation about the effect of the various varicella vaccines used in Korea and about the cause of their immunzation failure after vaccination is needed.