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Background: Recently, lung abscess tends to be increased in patients with underlying disease, most of whom are unsuitable for surgery when medical treatment fails. The patients with giant lung abscesses do not frequently respond to antibiotics and often have life-threatening complications. Therefore, more intensive cares are required in these patients. We studied the results and effects of percutaneous catheter drainage in these patients. Method: We performed fluoroscopy-guided percutaneous pigtail catheter (8.3 F) drainage by Seldinger technique in 9 cases of lung abscess (in 7 cases, intractable to medical treatment for an average of 8.4 days and in 2 cases, catheter drainage immediately performed due to a large cavity that was initially 10 cm in diameter). We compared 10 cases of lung abscess as control group which had receieved conventional medical treatment alone. Results: Seven of the 9 patients in study group of percutaneous drainage and 7 of the 10 patients in control group of medical treatment alone clinically improved in the average of 1.8 and 8.7 days, respectively. The mean duration of drainage was 13.2 days. There were 3 cases of death from massive hemoptysis, asphyxia of pus, and sepsis in control group, as compared with 2 cases of death from hepatic encephalopathy and sepsis in study group. The malfunctions of catheter occurred in these 2 cases, obstruction and dislodgement. But there were no significant pleuropulmonary complications of percutaneous drainage. Conclusion: Percutaneous drainage is effective and relatively safe in the management of lung abscesses refractory to medical therapy or giant lung abscesses.

Background: To evaluate the risk factor of pneumothorax (PNX) which is the most common complication of CT-guided needle aspiration of the lung, we have examined the frequency of PNX according to the presence of obstructive ventilatory impairment determined by pulmonary function tests. Methods: A comparative study of analysis of forecd expiratory volume and folw-volume curves, and determinations of diffusing capacity taken before procedure were made between each 16 cases with PNX and controls with no PNX. Each of the control group was matched for sex, age, height, and size and depth of lesion with the former. Results: 1) In comparison of vital capacity and parameters derived from forced expiratory volume curve between two groups, VC and FVC were not significantly different, whereas , /FVC%, and FEF25-75% showed a significant decrease in the PNX gorup. Also, in the PNX group, all the observed values of parameters analyzed from flow-volune curve were siginificantly reduced in the PNX group compared with those in the control group. 2) The diffusing capacity tended to decrease along with varying individual differences in the PNX group. 3) Patients who had obstructive ventilatory impairment according to the results of pulmonary function tests experienced a twofold increase in the frequency of PNX and a sixfold increase in the frequency of chest tube drainage for treatment of PNX compared with those whose results were normal. Conclusion: These findings suggest that the exact evaluation of obstructive lung disease determined by pulmonary function test be considered assessing a pastient's risk for PNX in the patients who will take the CT-guided needle aspiration of the lung.

Background: Bronchiectasis is a irreversible disease, a lot of cases of which are associated with chronic bronchitis, pulmonary emphysema and bronchial asthma due to chronic recurrent pulmonary infection. Therefore, pulmonary functions in bronchiectasis may also vary with associated diseases or involved segments. Methods: For the evaluation of ventilatory dynamics in bronchiectasis with respect to the pathoanatomic types of bronchiectasis and the degree of dyspnea, a total of 93 cases comprising 45 cases of tubular, 30 saccular and 18 mixed type of bronchiectasis whose clinical diagnosis was confirmed by bronchography were analyzed retrospectively. They were also divided into two groups: those with Hugh-Jones dyspnea grade 1 & 2 (group I) and those with Hugh-Jones dyspnea grade 3 & 4 (group II). Pulmonary functions tested in this study were analyses of curves of forced expiratory volume and flow-volume, and determinations of maximal voluntary ventilation and closing volumes. Results: The results were as follows; 1) The vital capacity and parameters reflecting expiratory flow rate except PEF were significantly reduced in saccular and mixed type than that in tubular type of bronchiectasis. 2) In saccular and mixed type, the maximal voluntary ventilation tended to decrease while CV/VC tended to increase. 3) As the degree of dyspnea became serious, the involved segments were progressively increased. In contrast, ventilatory functions were significantly reduced in proportion to the severity of dyspnea. Conclusion: These findings suggest that in bronchiectasis, there be obstructive ventilatory impairment combined with mild restrictive ventilatory impairment, which becomes more prominent in saccular and mixed type and also as the degree of dyspnea progresses.

Human lung injury caused by the inhalation of nitrogen dioxide() has been reported in occupational situations other than agriculture, including arc welding, production of nitric acid or explosives, and blasting operations. Nitrogen dioxide reacts with the water in the respiratory tract to form nitric acid. The nitrates and nitrites formed from dissociation of nitric acid cause extensive local and systemic tissue damage. We present two cases of acute lung injury due to accidental inhalation of gas in occupational situtions with a review of the literature.

Pulmonary function studies were made on 292 patients with pulmonary tuberculosis. All patients were divided into four groups, namely, those with normal ventilation (NV) restrictive ventilatory insufficiency (RVI) obstructive ventilatory insufficiency (OVI) and mixed ventilatory insufficiency(MVI) based upon vital capacity, timed vital capacity and air velocity index , and the functional characteristics of each group were compared.The incidence of NV has progressively decreased and that of MVI has progressively increased as the extent of the disease process progressed, as expected, and this was particularly true in female patients. However, the incidence of OVI was higher among male patients whereas that of RVI was higher among female patients regardless of the extent of the disease process. Vital capacity was within normal range in patients with NV and OVI but it was significantly decreased in those with RVI and MVI. Timed vital capacity in those with NV and RVI showed no deviation from that of normal value but significant decrease was noted in those with OVI and MVI. Air velocity index was within normal range or even higher than normal in patients with NV and RVI but it was lower in those with OVI and MVI. However, even in patients with OVI and MVI the mean values of air velocity index were well above the lower Iimit of the normal, suggesting that this test is not a very sensitive one for the detection of air trapping. Maximal breathing capacity was within normal limits in patients with NV but modcrately decreased in the remaining groups, particularly in those with MV I. Also notcd was a greater decrease in maximal breathing capacity in patients with RVI in comparison to those with OVI. thus suggesting that a decrease in the vcntilating area of the lung rather than airway obstruction playcd a more significant role in the production of ventilatory insufficiency in pulmonary tuberculosis. Changcs in breathing reservc ratio and ventilatory factor according to each type of ventilation were very similar to those of maximal breathing capacity.And the decreases in breathing reserve ratio and ventilatory factor were caused in most of cases by a decrease in maximal breathing capacity. Air trapping index and Leslie’s index not only showed no close correlation to timed vital capacity and air velocity index but even some controversy was present. lt was felt that air trapping index andLeslie's s index were not valuable tests for the diagnosis of air trapping. Changes in capacity ratio according lo each type of ventilation were very similar to those of air velocity index. Minute ventilation, oxygen consumption, ventilation equivalent and oxygen diffusion were approximate of the same range regardless of the type of ventilatory insufficiency.

No abstract available.

Cell surface antigenic relationships between pathogenic mycobacteria have been investigated by the enzyme-linked immunosorbent assay using phenolkilled cells and their rabbits antisera. Homologous and heterologous reactions of Mycobacterium avium-intracellulare antisera before and after homologous and heterologous absorption revealed a close antigenic relationship between strains of the same species and between species if they were members of M. avium(MA)-intracellulare(MI)-scrofulaceum(MG) complex. MAI sera showed a considerable reaction with M. kansasii(MK) and tuberculosis(MTB), but not with the other species. MA(K40004) antiserum reacted with other mycobacteria except few strains of MI and 50~89% of homologous reaction was reduced by heterologous absorption with cells of MI or MS. Intraspecific reaction of MI antisera was natural1y stronger than interspecific reaction and different in extent due to a magnitude of antigenic sharing. Antigenic relationships between N-260D, N-260R, N-260T, and K41014 was somewhat closer than that with N-242D, N-257T, N-28ID, and N-275T. M. nonchromogenicum(MNC) antisera showed a strong interspecific reaction with exception of M. chelonei(MC) and triviale(MTV) to which they reacted weakly or none. Antigenic sharing with M. terrae(MTR) and MG(K30003) was next to intraspecific sharing. NC-3 shared antigens considerably with MA, MC, and M. fortuitum(MF) while NC-11 did not. MTR antisera showed a strong cross-reaction with MI but their homologous reaction was not reduced by MI absorption indicating a paucity of shared antigen of MTR surface. Intraspecific antigenic sharing of course was large with on exception between T-8 and T-13. A considerable amount of antigenic sharing was also found with MNC, MC and MF. Unlike T-8 serum, T-13 antiserum strongly cross-reacted with MA, MG, MK, and MTB. In general, antigenic relationships of mycobacteria, that have been elucidated in this study, well conformed to taxons delineated by the various biological and biochemical means.

Pulmonary alveolar proteinosis(PAP) is thought to be a rare disease of unknown etiology characterized by the accumulation of strong PAS-positive lipoproteinaceous material in the pulmonary alveolar spaces. The defect in the clearance and degradation of intra-alveolar phospholipoproteinaceous material in PAP likely represents dysfunction of type II pneumocytes. Although the causative treatment of PAP is not well known, yet whole lung bronchopulmonary lavage is a relatively safe and effective treatment. We experienced three cases of PAP, which were confirmed by light and electron microscopic examinations of lung tissues obtained by open lung biopsy, transbronchial lung biopsy and lung lavage, so we present 3 cases of PAP with a review of the literature.

Background: Long-term low flow oxygen therapy not only increases survival, but also improves the quality of life in patients with chronic obstructive pulmonary disease (COPD) with chronic hypoxemia. For the assessment and improvement of the status of home oxygen therapy, we analyzed clinical experience of 26 patients who have been administered low flow oxygen at home. Method: Twenty-six patients (18 men and 8 women) who have been received long-term oxygen therapy (LTOT) at home were examined. We reviewed physical characteristics, clinical history, pulmonary function test, ECG, arterial blood gas analysis, hemoglobin and hematocrit, types of oxygen devices, inhalation time per day, concentration of administered , duration of therapy, and problems in the home oxygen therapy. Results: The underlying diseases of patients were COPD 14 cases, far advanced old pulmonary tuberculosis 9 cases, bronchiectasis 2 cases, and idiopathic pulmonary fibrosis 1 case. The reasons for LTOT at home were noted for cor pulmonale 21 cases, for dyspnea on exertion and severe ventilatory impairment 4 cases, and for oxygen desaturation during sleep 1 case. The mean values of aterial blood gas analysis before home oxygen therapy were 57.7 mmHg, 48.2 mmHg, and 87.7%. And the mean values of each parameters in the pulmonary function test were VC 2.05 L, 0.92 L, and /FVC% 51.9%. Nineteen patients have used oxygen tanks as oxygen devices, 1 patient oxygen concentrator, 2 patients oxygen tank and liquid oxygen, and other 4 patients oxygen tank together with portable oxygen. The duration of oxygen therapy was below 1 year in 3 cases, 1~2 years in 15 cases, 3~5 years in 6 cases, 9 years in 1 case, and 10 years in 1 case. All patients have inhalated oxygen with flow rate less than 2.5 L/min. And only 10 patients have inhalated oxygen more than 15 hours per day, but most of them short time per day. Conclusion: For the effective oxygen administration, it is necessary that education for long-term low flow oxygen therapy to patients, their family and neighbor should be done, and also the institutional backup for getting convenient oxygen devices is required.