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BACKGROUND: Chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension and cor pulmonale, which are predictors of mortality. OBJECTIVE: To identify predictors of increased pulmonary artery pressure (PAP) in COPD patients without resting hypoxaemia, and to characterise COPD patients with increased PAP. DESIGN: A study of 117 COPD patients from the Korean Obstructive Lung Disease (KOLD) cohort who had measurable tricuspid regurgitant flow under transthoracic Doppler echocardiography and no resting hypoxaemia. RESULTS: The mean patient age was 67 years. Mean forced expiratory volume in 1 second (FEV 1 ) was 47% predicted, mean haemoglobin (Hb) concentration was 145 g/l and mean systolic PAP (sPAP) was 33 mmHg. Multiple linear regression analysis showed that Hb was the only factor independently associated with sPAP (beta = ―1.752, P = 0.005). Cluster analysis using FEV 1 % predicted, sPAP and Hb concentration as variables indicated three patient clusters: Cluster 1 (n = 36; mean FEV 1 44% predicted, mean sPAP 39 mmHg, mean Hb 132 g/l), Cluster 2 (n = 45; FEV 1 35% predicted, sPAP 31 mmHg, Hb 154 g/l), and Cluster 3 (n = 36; FEV 1 65% predicted, sPAP 29 mmHg, Hb 148 g/l). CONCLUSION: Elevated PAP was linked to low haemoglobin levels in COPD without resting hypoxaemia.

In children, the ratio of forced expiratory volume in 1 s (FEV 1 ) to forced vital capacity (FVC) is reportedly constant or falls linearly with age, whereas the ratio of residual volume (RV) to total lung capacity (TLC) remains constant. This seems counter-intuitive given the changes in airway properties, body proportions, thoracic shape and respiratory muscle function that occur during growth. The age dependence of lung volumes, FEV 1 /FVC and RV/TLC were studied in children worldwide. Spirometric data were available for 22,412 healthy youths (51.4% male) aged 4–20 yrs from 15 centres, and RV and TLC data for 2,253 youths (56.7% male) from four centres; three sets included sitting height (SH). Data were fitted as a function of age, height and SH. In childhood, FVC outgrows TLC and FEV 1 , leading to falls in FEV 1 /FVC and RV/TLC; these trends are reversed in adolescence. Taking into account SH materially reduces differences in pulmonary function within and between ethnic groups. The highest FEV 1 /FVC ratios occur in those shortest for their age. When interpreting lung function test results, the changing pattern in FEV 1 /FVC and RV/TLC should be considered. Prediction equations for children and adolescents should take into account sex, height, age, ethnic group, and, ideally, also SH.

Korea is an intermediate-burden country with high rates of tuberculosis (TB) drug resistance.To evaluate the performance of the GenoType® MTBDRplus (MTBDR) assay in diagnosing drug-resistant TB in routine practice in Korea.The MTBDR assay was performed on 428 samples, and the results were retrospectively compared with the results of conventional drug susceptibility testing (DST). The interval between treatment and diagnosis of drug resistance was also compared.The sensitivity, specificity and positive and negative predictive values of the MTBDR assay were respectively 96.6%, 98.9%, 93.4% and 99.5% for the detection of rifampicin (RMP) resistance; 93.8%, 98.3%, 92.7% and 98.6% for isoniazid (INH) resistance; and 91.1%, 99.2%, 99.4% and 98.7% for multidrug-resistant TB (MDR-TB). The median interval between the start of anti-tuberculosis chemotherapy and the reporting of results was 88.9 days for conventional DST and 19.8 days for MTBDR using clinical specimens.The specificity of the MTBDR assay in detecting MDR-TB was very high, although the sensitivity in detecting INH resistance and MDR-TB was not optimal (95%). Although the turnaround time in detecting drug resistance was dramatically reduced with MTBDR compared to conventional DST, more effort is needed to shorten the turnaround time.

The QuantiFERON-TB Gold (QFT-G) test can be used to distinguish between tuberculosis (TB) and non-tuberculous mycobacterial disease, but a high background TB infection rate may pose a problem. Although the QuantiFERON-TB (QFT) test, the first-generation QFT-G test, employs a non-specific PPD antigen, avium sensitin is also used as a stimulating antigen.To evaluate the utility of these two interferon gamma release assays (IGRAs), QFT-G and QFT, and the tuberculin skin test (TST), to differentiate TB from Mycobacterium avium complex (MAC) disease in an intermediate TB burden country.We compared the diagnostic performance of these three tests in 38 prospectively enrolled patients with TB and 40 with MAC lung disease.The TST yielded positive results in 70.6% of TB and 47.5% of MAC patients; the proportions were respectively 89.5% and 34.3% for QFT-G and 86.8% and 35.3% for QFT. The three tests were of similar accuracy, sensitivity and specificity in diagnosing TB.Our findings indicate that the TST and IGRAs could not discriminate between active TB and MAC disease or latent TB infection in a TB-endemic area.

Setting Eleven referring hospitals in South Korea. Objective To compare therapeutic responses in chronic obstructive pulmonary disease (COPD) subgroups, classified by diffusing capacity of the lung for carbon monoxide (DL(CO)) and lung volume. Design A total of 130 stable male COPD patients were classified into four subgroups according to baseline DL(CO) and residual volume/total lung capacity (RV/TLC) ratio. We compared therapeutic responses to short acting β(2)-agonist (SABA) and 3-month combined inhalation of long-acting β(2)-agonist (LABA) and corticosteroid among patients with these subgroups. Results Among the 130 COPD patients, 41 (31.5%) had normal DL(CO) and RV/TLC, 28 (21.5%) low DL(CO) and normal RV/TLC, 31 (23.8%) normal DL(CO) and high RV/TLC, and 30 (23.1%) low DL(CO) and high RV/TLC. The normal DL(CO)/high RV/TLC subgroup showed a significantly larger flow response (changes in forced expiratory volume in 1 s) to salbutamol than the normal DL(CO)/RV/TLC subgroups, and a larger volume response (changes in forced vital capacity) than the two normal RV/TLC subgroups. The normal DL(CO)/high RV/TLC subgroup also showed significantly larger flow and volume response to 3-month combined inhalation of LABA and corticosteroid than the two normal RV/TLC subgroups. Conclusion COPD subgroups classified by DL(CO) and RV/TLC may have different pulmonary function responses to pharmacological treatment.

South Korea, 2005-2007.Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules (NTM-SPN) are rare and may be misdiagnosed as tuberculoma.Eleven NTM-SPN patients were enrolled retrospectively and compared with two groups each of 33 patients with upper lobe cavitary (UC) and nodular bronchiectatic (NB) type NTM diseases, respectively.The patients' median age was 52 years. Compared with UC-type disease, NTM-SPN patients showed female (n = 9) and never smoker (n = 8) predominance and fewer comorbidities (n = 0; P0.05 for each). Mycobacterium avium (n = 9) was predominant in NTM-SPN patients, followed by M. intracellulare (n = 2), whereas M. intracellulare was most frequently isolated from patients with both UC- and NB-type NTM (P0.05). The nodules were a median of 2.3 cm in diameter (range 1.6-6.3 cm) and were distributed evenly in all lobes. In all patients, percutaneous needle aspiration/biopsy was performed with a median 71 days of diagnostic delay. Ten patients successfully completed treatment, and one showed spontaneous reduction of nodule size without treatment. Reverse blot hybridisation assays of six DNA samples identified four subjects with M.avium-intracellulare complex (MAC), in line with conventional test data.NTM-SPN was caused exclusively by MAC. Although clinical outcome was favourable, confirmatory diagnosis was delayed. Molecular methods are needed for early diagnosis of NTM-SPN.

To evaluate the value of the QuantiFERON-TB Gold (QFT-G) assay and chest computed tomography (CT), in addition to the conventional use of the tuberculin skin test (TST) and chest radiography (CXR), in a contact investigation of a tuberculosis (TB) outbreak.In a contact investigation of a TB outbreak in a high school, TST and CXR were performed on all 1044 employees and students. QFT-G was performed on TST-positive subjects, and CT on QFT-G-positive subjects and students with TSTor =20 mm.TST was positive in 388 subjects (37.2%), while QFT-G was positive in 7.6% (30/394). CXR showed abnormal findings suggestive of TB in 10 (1.0%) subjects, all of whom were TST-positive and six of whom were QFT-G-positive. Findings suggestive of active TB were noted in 17 (32.7%) of 52 subjects by CT. Collectively, among 21 (1.1%) TB patients, all were TST-positive, 12 (57.1%) were QFT-G-positive and active TB was diagnosed by CT, and not by CXR, in 11 subjects.Compared to the conventional approach, the additional use of QFT-G in TST-positive subjects and chest CT in subgroups with a high probability of infection was found to be more effective in the differentiation between active TB, latent TB and non-infected subjects in a contact investigation.

To evaluate the efficacy of unipedicular kyphoplasty in the treatment of patients with osteoporotic vertebral compression fractures, we compared the pre- and postoperative clinical and radiological results in the unipedicular and bipedicular kyphoplasty groups. The clinical and radiological results of unipedicular kyphoplasty were as good as those of bipedicular kyphoplasty.The purpose of this study was to evaluate the efficacy of unipedicular kyphoplasty in the treatment of patients with osteoporotic vertebral compression fractures. We compared the pre- and postoperative compression ratios (CRs), kyphotic angles (KAs), and visual analogue scale (VAS) scores of the patients in the unipedicular and bipedicular kyphoplasty groups. The results showed that the clinical and radiological results of unipedicular kyphoplasty were as good as those of bipedicular kyphoplasty. Percutaneous balloon kyphoplasty is a therapeutic option for patients with painful osteoporotic vertebral compression fractures (VCFs). Due to the relatively high-risk nature of the patient population, complications such as myocardial events, seizures, agitation, or dyspnea may occur and render completion of the procedure imprudent. We analyzed the clinical and radiological results of unipedicular and bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures.We retrospectively reviewed the records of 45 patients who underwent balloon kyphoplasty for the treatment of VCFs between January 2005 and April 2008. A unipedicular approach was used in 15 patients and a bipedicular approach was used in 30 patients. The CR, KA, and 100-point VAS score for pain were measured pre- and postoperatively in each patient.There was no significant difference in restoration of the CR (p = 0.376) and KA (p = 0.888) between the unipedicular and bipedicular kyphoplasty groups. The patients in the unipedicular group showed greater improvement in VAS score than those in the bipedicular group (p0.001). There were no postoperative complications, such as nerve injury or pedicle fracture, in either of the two groups.The clinical and radiological results of unipedicular balloon kyphoplasty for the treatment of VCFs were as good as those of bipedicular balloon kyphoplasty. Thus, unipedicular balloon kyphoplasty can be used as an alternative treatment for patients with VCFs.

A private university hospital in South Korea.To investigate the incidence of tuberculosis (TB) among health care workers (HCWs) employed at a university hospital in South Korea.The occurrence of TB cases among HCWs over a 6-year period (2001-2006) was reviewed. The prevalence of TB was compared with that of the general population using a prevalence ratio (PR) adjusted by age and sex.The study involved 8433 people. TB developed in 61 HCWs (0.72%). The prevalence ratio among all HCWs was 1.05 (95%CI 0.80-1.35). In occupational subgroups, the PRs for doctors, nurses and employees in other departments were respectively 0.58 (95%CI 0.30-1.01), 1.81 (95%CI 1.21-2.59) and 0.95 (95% CI 0.58-1.46). For nurses working in TB-related departments, the relative risk of developing TB was 3.4 times higher (95%CI 1.52-8.25) than for employees in other departments (P=0.005). The PR for nurses working in TB-related department was 5.1 (95%CI 3.23-8.42).Among HCWs, nurses working in TB-related departments were at increased risk of developing TB. This suggests that some TB develops via in-hospital infection.

A 78-year-old man with hypertension and diabetes was referred because of 3 days of diplopia and ophthalmoplegia. Neurologic examination disclosed exotropia of both eyes (wall-eyed) and bilateral internuclear ophthalmoplegia (WEBINO) with impaired convergence (figure, A).1 Vertical saccades and smooth pursuit were also limited, but improved during the …

Seoul, Korea, a country with an intermediate tuberculosis (TB) burden and low prevalence of human immunodeficiency virus (HIV) infection.To determine the frequency of ofloxacin (OFX) resistance in Mycobacterium tuberculosis, and to assess whether short-term use of fluoroquinolones (FQNs) induces ofloxacin-resistant M. tuberculosis.The subject cohort consisted of 2788 patients with culture-confirmed TB with drug susceptibility testing data; only four were HIV-positive. The patients were divided into two groups: those who were or were not recently exposed to FQNs.Of the 2788 isolates, the rates of OFX resistance were 1.1% and 8.5% in initially treated and retreated patients, respectively (P0.05). Of the 94 OFX-resistant isolates, 83 (88.3%) were multidrug-resistant (MDR). There was no difference in rates of OFX resistance throughout the study period, or between the FQN-exposed (1/39, 2.6%) and control groups (93/2749, 3.4%). The median duration of FQN treatment was 7 days (range 1-47 days). One OFX-resistant isolate in the FQN-exposed group was MDR.The rate of OFX-resistant M. tuberculosis was low and stationary throughout the study period in Korea. Most OFX resistance was accompanied by MDR, and the frequency of OFX-resistant M. tuberculosis was low in subjects taking short-term FQNs.