• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.861-870
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• 1997

Background : Though acute respiratory distress(ARDS) often occurs in the early stage of severe acute pancreatitis and significantly contributed to the mortality of the condition, the characteristics of the group who develops ARDS in the patients with acute pancreatitis have not been fully found. The objective of this investigation was to identify predictable factors which distinguish a group who would develop ARDS in the patients with acute pancreatitis. Method : A retrospective analysis of 94 cases in 86 patients who were admitted the Medical Intensive Care Unit with acute pancreatitis was done. ARDS were developed in 13 cases among them (13.8%). The possible clinical factors related to the development were analyzed using univariate analysis and $x^2$-test. Results : The risk of ARDS development was increased in the patients with abonormal findings of chest X-ray at admission compared to the patients with normal chest X-ray (p<0.05). The risk was also increased according to the sevecrity index score in abdominal computed tomography at the time of admission (p<0.05). The higher APACHE III score of the first day of admission, the more risk increment of ARDS development was observed (p<0.01). Patients with more than one points of Murray's lung injury score showed higher risk of ARDS compared to the patients with 0 points of that. The patients with sepsis and the patients with more than three organ dysfunction at admission had 3.5 times and 23.3 times higher risk of the development of ARDS compared to the patients without sepsis and without organ failure in each (p<0.05, p<0.01). Conclusion : The risk of ARDS development would be higher in the acute pancreatitis patients with abnormal chest X-ray, higher CT severity index, higher APACHE III or Murray's lung injury score, accompanying sepsis, and more than three organ failure at admission.

• Applied Microscopy
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• v.33 no.1
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• pp.1-16
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• 2003

As is well known that N-nitroso-N-methylurethane (NNNMU) causes acute lung injury (ALI) in experimental animals. And ALI caused by NNNMU is very similar to ARDS in human being in its pathology and progress. In its context, we investigated the pathogenetic mechanism of ARDS associated with oxidative stress by neutrophils in Sprague-Dawley rat model of NNNMU-induced ALI. NNNMU had increased lung weight/body weight ratio (L/B ratio), lung myeloperoxidase (MPO) activity, protein content and number of neutrophils in bronchoalveolar fluid (BALF) compared with those of control rat (p<0.001, respectively). In contrast, the amount of pulmonary surfactant in BALF was decreased by NNNMU (p<0.001). Morphologically, light microscopic examination denoted pathological findings such as formation of hyaline membrane, infiltration of neutrophils and perivascular cuffing in the lungs of NNNMU-treated rats. In addition, ultrastructural changes such as the necrosis of endothelial cells, swelling and vacuolization of lamellar bodies of alveolar type II cells, and the degeneration of pulmonary surfactant were identified after treatment of NNNMU. Very interestingly, cerium chloride electron microscopic cytochemistry showed that NNNMU had increased the production of cerrous-peroxide granules in the lung, which signified the increased production of hydrogen peroxide in the lung. Collectively, we conclude that NNNMU causes acute lung leak by the mechanism of neutrophilic oxidative stress of the lung.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.177-188
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• 2008

Background: To evaluate the effects of inhaled nitric oxide (NO) and sphingosine 1-phosphate (S1P) as potential therapeutic agents of acute lung injury, we analyzed the morphology in vivo of the pulmonary microstructure using intravital videomicroscopy in a rat model of acute lung injury. Material and Method: Sprague Dawley rats were divided into five groups: a control group that underwent normal saline aspiration, an acute lung injury (ALI) group that underwent hydrochloric acid aspiration, and three treatment groups that underwent hydrochloric acid aspiration and were administered therapeutic agents- the S1P group, the NO group, and the S1P+NO group (n=7 per group). To quantify alveolar compliance and interstitial edema, the diameters of all measurable alveoli and interalveolar septa were averaged at one and two hours after aspiration. Alveolar compliance was determined according to diameter changes during the respiratory cycle and the change in tidal volume. Result: At two hours after aspiration, the mean alveolar compliance (% change) in the All group decreased significantly versus the control group of rats (respiratory cycle: 1.9% for the ALI group vs 6.5% for the control group, p=0.03; tidal volume: 3.2% for the ALI group vs 9.1% for the control group, p=0.003) and versus the NO group (tidal volume: 3.2% for the ALI group vs 16.9% for the NO group, p=0.001). At two hours after aspiration, the mean interalveolar septal thickness in the NO group tended to be smaller as compared to that in the All group ($15.2{\mu}m$ for the ALI group vs $12.3{\mu}m$ for the NO group, p=0.06). S1P did not exert a significant effect on the pulmonary microstructure of the injured rat lung. Conclusion: Improved alveolar compliance and reduced interstitial edema, observed by intravital videomicroscopy, suggest that inhaled NO ameliorates lung injury.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.487-499
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• 2000

Background : Acute lung injury is an hypoxic respiratory failure resulting from damage to the alveolar-capillary membrane, which can be developed by a variety of systemic inflammatory diseases. In this study the therapeutic effects of intra-tracheal pulmonary surfactant instillation was evaluated in the intratracheal endotoxin induced acute lung injury model of a rat. Methods : Twenty Sprague-Dawley rats were divided into 4 groups, and normal saline (2 ml/kg, for group 1) or LPS (5 mg/kg, for group 2, 3, and 4) was instilled into the trachea respectively. Either normal saline (2 ml/kg, for group 1 & 2, 30 min later) or bovine surfactant (15 mg/kg, 30 min later for group 3, 5 hr later for group 5) was instilled into the trachea. The therapeutic effect of intratracheal surfactant therapy was evaluated with one chamber body plethysmography (respiratory frequency, tidal volume and enhanced pause), ABGA, BAL fluid analysis (cell count with differential, protein concentration) and pathologic examination of the lung. Results : Intratracheal endotoxin instillation increased the respiration rate decreased the tidal volume and int creased the Penh in all group of rats. Intratracheal instillation of surfactant decreased Penh, increased arterial oxygen tension, decreased protein concentration of BAL fluid and decreased lung inflammation at both times of administration (30 minute and 5 hour after endotoxin instillation). Conclusion : Intratracheal instillation of surfactant can be a beneficial therapeutic modality as discovered in the acute lung injury model of rats induced by intratracheal LPS intillation. It deserves to be evaluated for treatment of human acute lung injury.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.475-478
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• 2006

Background: The simultaneous bilateral spontaneous pneumothorax is a rare clinical event. Contrary to the unilateral pneumothorax, the patients with simultaneous bilateral spontaneous pneumothorax sometimes complains of severe respiratory distress, cyanosis and chest pain without tention pneumothorax. It is often dangerous; therefore, the chest drain should be inserted immediately. Material and Method: Between March 1994 and February 2004, 802 patients were treated in our department for spontaneous pneumothorax. Among these, the simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%). Result: Out of fourteen patients, two females and twelve males presented with simultaneous bilateral spontaneous pneumothorax. The patient age ranged between 0 and 79 years with mean age of 31.2 years. In eleven patients, this was the first episode of pneumothorax. One patient had combined hemopneumothorax and two patients had combined pyopneurnothorax. Six patients had smoking history (42.8%, average 17.3 p-y). Five patients had pulmonary tuberculosis history and among these, two patients had active pulmonary tuberculosis. Three patients were died due to meconium-aspiration pneumonia (1 patient) and ARDS (Acute Respiratory Distress Syndrome) with pneumonia (2 patients). We treated these patients with nasal oxygen inhalation, chest drain insertion, thoracotomy, VATS (Video-Assisted Thoracoscopic Surgery) and chemical pleurodesis. Conclusion: The simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%) among 802 patients. Prompt insertion of chest drain is needed for a relief of severe symptoms, and to reduce the risk of recurrence, early thoracotomy or VATS should be performed rather than chest drain insertion only.

• Tuberculosis and Respiratory Diseases
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• v.63 no.6
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• pp.515-520
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• 2007

Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.273-277
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• 2006

Purpose : The prevalence of Reye syndrome has decreased since late 1980's. But we report that recently there were concentrative attacks of Reye syndrome after acute enteritis during the neonatal period. Methods : Clinical symptoms and laboratory results(quantitative organic acid analysis, routine chemistry, arterial blood gas analysis, serum ammonia) of seven patients admitted at the Samsung Medical Center, Sanggye Paik Hospital, Wonju Christian Hospital and Chuncheon Sacred Heart Hospital, referred from Jan. 2005 to Apr. 2005, were analysed retrospectively. The major clinical symptoms were derived from the patients' clinical records sended with urine samples and quantification of organic acids were done with gas chromatography and mass spectrometry. Results : The mean age of seven cases is 18 days and the major preceding symptoms were gastrointestinal symptoms(vomiting, diarrhea, refusal to feeding). The major clinical symptoms were clouded conciousness, repiratory difficulty, vomiting, seizures, and diarrhea. One patient died; that patient's serum ammonia was twenty times higher than normal. Conclusion : The seven patients were neonates. Reye syndrome has been known to be closely related with upper respiratory infections as a preceding disease and to internal use of aspirin, but in our study, the major preceding disease of the seven cases was gastrointestinal infection and none of these used aspirin.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.206-211
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• 2008

Streptococcus pneumoniae is a common cause of acute otitis media, sinusitis, pneumonia, and the invasive bacterial infections in children. Rarely, S. pneumoniae is an uncommon cause of hemolytic-uremic syndrome (HUS). We report a 33 month-old girl who presented with pneumonia, and subsequently developed HUS. Her pulmonary infection was complicated by necrotizing pneumonia and acute respiratory distress syndrome. Cultures from blood and pleural fluid grew S. pneumoniae, serotype 19A. She was treated with antibiotics, dialysis and mechanical ventilatory support. She was discharged with normal renal function after 2 months of management. She remained healthy without renal complications at the 5 year follow-up visit.

• Tuberculosis and Respiratory Diseases
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• v.60 no.5
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• pp.564-570
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• 2006

Toxic gases and soot deposition as a consequence of smoke inhalation can cause direct injury to the upper and lower airways and even to the lung parenchyma. A delay in proper and prompt therapy can be detrimental to critically ill burn patients with an inhalation injury. Therefore, serial chest radiography is an important diagnostic tool for pulmonary complications during treatment. The radiographic findings of the chest include normal, consolidation, interstitial and alveolar infiltrates, peribronchial thickening, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, and a pneumothorax as acute complications of smoke inhalation. In addition, bronchiectasis, bronchiolitis obliterans and pulmonary fibrosis can occur as late complications. We encountered a case of 44-year-old male who presented with acute lung injury after an inhalation injury. He required endotracheal intubation and mechanical ventilation due to respiratory failure. He was managed successfully with conservative treatment. Later, a cavitary lesion of the left upper lobe was observed on the chest radiography and computed tomography, which was complicated by massive hemoptysis during the follow-up. However, the cavitary lesion disappeared spontaneously without any clinical consequences.

• Membrane Journal
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• v.15 no.3
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• pp.224-232
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• 2005

The use of the lung assist device (LAD) would be well suited for acute respiratory failure (ARF) patients, combining the simplicity of mechanical ventilation with the ability of extracoporeal membrane oxygenators (ECMO) to provide temporary relief for the natural lungs. This study's specific attention was focused on the effect of membrane vibration in the LAD. Quantitative experimental measurements were performed to evaluate the performance of the device, and to identify membrane vibration dependence on blood hemolysis. We tried to decide upon excited frequency band of limit hemolysis when blood hemolysis came to through a membrane vibration action. The excited frequency of the module type 5, consisted of 675 hollow fiber membranes, showed the maximum gas transfer rate. We concluded that the maximum oxygen transfer rate seemed to be caused by the occurrence of maximum amplitude and the transfer of vibration to hollow fiber membranes. It was excited up to $25{\pm}5$ Hz at each blood flow rate of module type 5. We found that this frequency became the 2nd mode resonance riequency of the flexible in blood flow. Blood hemolysis was low at the excited frequency of $25{\pm}5$ Hz. Therefore, we decided that limit hemolysis frequency of this LAD was $25{\pm}5$ Hz.