CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy / 결핵및호흡기질환

BACKGROUND: We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. METHODS: We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. RESULTS: There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. CONCLUSION: The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.

The Comparison of the Conversion Rate and Duration after Multipuncture BCG vaccination / 소아알레르기및호흡기학회지

PURPOSE: During the childhood, Mantoux test is very popular for detecting tuberculous infection and also useful for evaluating the immunity against tuberculosis after BCG vaccination. But the response and conversion rate is affected by the age of vaccination, the quality of vaccine, the duration after vaccination and the frequency of the test. Recently percutaneous multipuncture technique of BCG vaccination was introduced and used because of local side effect and technical problem of intradermal BCG vaccination, however there is only a study of conversion rate and side effect at 3month after multipuncture BCG vaccination. We performed this study to evaluate of the difference of the Mantoux reaction and conversion rate according to duration (3month, 9month and 15month) after vaccination, gestational age, sex, and feeding type. METHODS: 174 neonates (155 of full term infants, 19 of preterm infants) who were born Kangnam St. Mary's Hospital were given multipuncture BCG vaccination within 4weeks after birth between July, 1995 and June 1997. All subjects was performed Mantoux test using 5TU PPD (NIH, Korea) at 3month, 9month and 15month. Injecting BCG and interpretating the result of the Mantoux test was done by the same person. RESULTS: 1) The positive rates of Mantoux test which was done 3month , 9month and 15month after vaccination were 38.7%, 58.1%, 71.6% in the full term infant group and 31.6%, 31.6%, 47.4% in the preterm infant group. 2) The size of induration in Mantoux test, which was done 3month, 9month and 15month after vaccination were 7.3 mm, 9.4 mm, and 10.6 mm in the full term infant group and 5.6 mm, 7.7 mm, 9.2 mm in the preterm infant group. The size of induration was significantly lower in the preterm infant group as compared with that of the full term infant group 9month after vaccination. 3) The positive conversion rate, less than 5 mm to more than 10 mm, was 6.3% (3 infants of 48 infants who were negative Mantoux test 3month became positive 9month) and 26.3% (5 infants of 19 infants who were negative 9month became positive 15month) in the full term infant group, and 33.3% (one infant of 5 infants who were negative 9month became positive 15month). 4) There is no difference in conversion rate of Mantoux test according to the sex, feeding type in both groups5) Complication rate for multipuncture is 3.2%, which is leaded by local ulceration and fever in the full term infant group, and 5.3%, which is only fever in the preterm infant group. CONCLUSION: In those result the size of induration and conversion rate is increased as the duration after vaccination, then their smaller size in the preterm group 9month after vaccination maybe due to immunological immaturity of preterm group.

Accuracy of Denver II in Developmental Delay Screening / 대한소아신경학회지

PURPOSE : Developmental screening tests are in widespread use, but few reliable and valid tests are available. One of the oldest and best known developmental screening test was recently restandardized and revised as Denver II. Because the Denver II was published without evidence of its accuracy in developmental screening, we evaluate its accuracy in chidren with developmental delay to see whether it can be used on Korean children. METHODS : The Denver II was translated and was administered to 244 children attending the child development clinic in Kangnam St. Mary's Hospital to evaluated motor delay(Group I, n=68), language delay(Group II, n=84) or other problem(Group III, n=92). RESULTS : 1) The ratio of male to female and the mean age of the subject were 2.4:1 and 25.1 months overall, 1.6:1 and 11.8 months in Group I, 4.6:1 and 35.6 months in Group II, and 1.3:1 and 25.4 months in Group III. 2) The distribution of results(abnormal, normal and questionable) were 76%, 13% and 10% in Group I, 76%, 10% and 14% in Group II, and 38%, 53% and 9% in Group III. 3) The neurologic problems were determined 75%(cerebral palsy, central hypotonia, infantile spasm, myopathy etc.) in Group I, 74%(mental retardation, developmental language disorder, epilepsy, cerebral palsy etc.) Group II and 39%(mental retardation, epilepsy, cerebral palsy etc.) in Group III. 4) The sensitivity and the specificity of Denver II were 0.88 and 0.41 in Group 1, 0.90 and 0.27 in Group II, 0.81 and 0.77 in Group III, and 0.85 and 0.59 overall. CONCLUSION: Although the Denver II in identifying children at risk for developmental delay has a excellent sensitivity, it has a poor specificity, especially in identifying children at risk for language delay. These results demonstrate that the Denver fail to reliably identify children in need of developmental delay evaluation. So the Denver II should be standardized and modified to be used on Korean children with developmental delay.