A lower laryngeal and upper tracheal stenosis that is of idiopathic origin is occasionally seen. It is called an idiopathic tracheal stenosis. These circumferential fibrous stenosis is rare and they are most often located in the subglottic larynx and extend to varying distances predominantly in young women. Because of the unknown nature of the disease process and uncertainty about its future progression, patients were approached conservatively. Recently, surgical resection and reconstruction have been increasingly performed, as favorable results were obtained. Three female patients with dyspnea were admitted. For two patients, they were diagnosed this conditions as bronchial asthma by mistake. All patients were performed computed tomography and bronchoscopy. For two patients with subglottic stenosis, subglottic resection was performed by cervical collar incision, and for the other one patient with distal tracheal stenosis, tracheal resection was performed by right posterolateral thoracotomy. A diagnosis of idipathic tracheal stenosis was confirmed by postoperatively pathologic finding. For one case, because of anastomosis site infection and restenosis, a whole tracheal exposure was performed by cervical collar incision and median sternotomy. And reoperation was peformed successfully.
The purpose of the present study was to investigate the effect of cimetidine on theophylline pharmacokinetics in Korean healthy normal subjects. Eight subjects were enrolled and open label, two period cross-over study was conducted without significant drug related adverse reactions. Cimetidine seemed that significantly inhibited the metabolism of theophylline, oral clearance decreased significantly when cimetidine was coadministered. Coadministered cimetidine increased $AUC_t$ and $C_{max}$ of theophylline. All subjects were genotyped using PCR-RFLP methods to evaluate the differences in metabolic capacity in accordance with CYP1A2 genotypes, but no mutant genotype was found. This suggests that metabolic capacities were not significantly affected by CYP1A2 genotypes among subjects. In conclusion, disposition of theophylline was significantly affected by coadministered cimetidine. Further evaluation with well-designed drug interaction study in accordance with various genotype of CYP1A2 is needed.
Yang, Joo Youn;Lee, Ho Youn;Kim, Nam Hee;Kim, Youn Seup
Tuberculosis and Respiratory Diseases
/
v.61
no.2
/
pp.137-142
/
2006
Background: Recent studies have suggested an association between chronic cough and gastroesophageal reflux. Our study aimed to assess the utility of a proton-pump inhibitor in unexplained chronic cough patients. Methods: Patients with chronic cough of unknown etiology were evaluated using a chest x-ray, methacholine challenge test, and an empirical trial of postnasal drip therapy. After excluding other potential causes of the cough, forty patients were included in the study and treated for 8 weeks with a proton-pump inhibitor. Results: Eleven and three patients in the first and second 4 weeks were lost to follow-up, leaving twenty-six patients finally included in the study. Of these patients, two were unimproved, eight partially responded to the proton-pump inhibitor and sixteen responded completely after the 8 week treatment. Conclusion: We suggest that empirical treatment with a proton pump inhibitor in all patients with persistent cough, which is not secondary to asthma or postnasal drip syndrome, represents a practical and simple approach to this ailment.
The respiratory tract is an essential part of the respiratory system involved in the process of respiration. However, if stenosis occurs, it interferes with breathing and can even lead to death. Asthma is a typical example of a reversible cause of airway narrowing, and the number of patients suffering from acute exacerbation is steadily increasing. Therefore, it is important to detect airway narrowing early and prevent the patient's condition from worsening. Optical coherence tomography (OCT), which has high resolution, is suitable for observing the microstructure of tissues. In this study we developed an endoscopic OCT system. We combined a 1300-nm OCT system with a servo motor, which can rotate at a high speed. A catheter was pulled back using a linear stage while imaging with 360° rotation by the motor. The motor was selected considering various requirements, such as torque, rotational speed, and gear ratio of pulleys. An ex vivo rabbit tracheal model was used as a sample, and the sample and catheter were immobilized by acrylic structures. The OCT images provided information about the structures of the mucosa and submucosa. The difference between normal and stenosed parts in the trachea was confirmed by OCT. Furthermore, through a three-dimensional (3-D) reconstruction process, it was possible to identify and diagnose the stenosis in the 3-D image of the airway, as well as the cross-sectional image. This study would be useful not only for diagnosing airway stenosis, but also for realizing 3-D imaging.
The foreign bodies in air way require the emergent managements in the otolaryngolagic field, and if the diagnosis and treatment were delayed, unexperted catastrophic situations may occur. The authors had analysed the airway foreign bodies of 50 cases which had been ventilating bronchoscopy. 1. In sex distribution, male to female ratio was 2.8 : 1. 2. In the age incidence, 58% were 1∼5 yrs. 3. Frequent symptoms, were coughing (68%), dyspnea (52%) and cyanosis (18%) in the oder. 4. The significant foreign body histories were noticed in 33 cases (66%). The initial misdignosis were 28%, and af which 57.1% were URI 5. In auscultation, decreased breathing sounds were noticed in 46%, wheezing were 24% and 26% were with in normal limit. 6, In duration af lodgement, 68% were removed within 24 hours. 7. Tracheostomy were performed in 24%, and foreign bodies were removed by ventilating bronchoscope in 72%. 8. The foreign bodies were vegetable (46%), metal (28%), plastic (18%) and fish bone (8%). 9. The prevalent site of foreign body were right main bronchus, left main bronchus, and trachea in the order mentioned.
The statistical study was done on 74 cases of foreign bodies in the air passages, who visited the department of otolaryngology of SNUH during recent 5 years from 1975 to 1980. The result was as follows, 1) Of the total 74 cases, 55 cases were male and 18 cases were female. The ratio between male and female was 3 : 1. 41.8% of all-cases were under 2 years of age, 75.5% were under 3 years, and 83.6% were under 5 years. 2) Major symptoms on visit were dyspnea, cough, cyanosis. No significant symptoms was noted in 6.7%. Initial physical findings were coarse breathing sound, decreased breathing sound, and stridor. No abnormal physical findings were noted in 10.8%. 3) 48.6% of total cases visited hospital within 24 hours. There was one case who visited hospital over 2 years later. 4) Initial simple chest film showed atelectasis in 25.0%, emphysema in 32.8%, definite foreign body shadow in 17.2% and within normal limit in 17.2%. 5) 60.8% of total cases were vegetables, 15.5% were metals, 16.2% were fish bone, and 2.7 % were others. 6) Vegetables were most frequent foreign bodies in the cases under 5 years of age. 7) 40.5% of total cases were lodged in the right main bronchus, 31.0% were in the left main bronchus, 9.8% were in trachea and 6.7% were in multiple sites, 8) Foreign bodies were removed by ventilating bronchoscopy in 82.3%, by tracheostomy only in 2.7%, by tracheal suction in 2.7%, by spontaneous removal in 1.3%, by thorachotomy in 5.4% and 5.4% of total cases were expired.
Hur, Hae Young;Kwak, Ji Hee;Kim, Hyoung Yun;Jung, Da Wun;Shin, Yoon Ho;Han, Man Yong
Clinical and Experimental Pediatrics
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v.51
no.8
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pp.842-847
/
2008
Purpose : Measurement of forced expiratory volume in 1 second ($FEV_1$) is usually difficult to obtain in children under six years of age because it requires active cooperation. This study evaluates the sensitivity of impulse oscillometry system (IOS) parameters for detecting airway obstruction in comparison with $FEV_1$. Methods : We studied 174 children who performed the lung function and methacholine challenge tests to diagnose asthma by IOS and spirometry. Children were divided into two subgroups according to their $PC_{20}$, which is a parameter for bronchial sensitivity. We compared IOS parameters with $FEV_1$ at the baseline, post-methacholine challenge, and evaluated their correlation. Results : At the baseline, reactance at 5 Hz (X5) and resistance at 5 Hz (R5) significantly differed between the $PC_{20}$ positive ($PC_{20}{\leq}16mg/mL$) group and $PC_{20}$ negative ($PC_{20}$ >16 mg/mL) group; however, $FEV_1$, $FEV_1$ % predicted, $FEV_1_-Zs$ (Z score) did not differ. $FEV_1$ is correlated with X5 (r=0.45, P<0.01) and R5 (r=-0.69, P<0.01). $FEV_1_-Zs$ is also correlated with X5_Zs (r=-0.26, P<0.01) and R5_Zs (r=-0.31, P<0.01). After the methacholine challenge test, dose-response slopes in $FEV_1$ and X5 significantly differed between the two subgroups (P<0.05). Conclusion : IOS parameters were more discriminative than $FEV_1$ for detecting decreased baseline lung function between two subgroups and have a good correlation with $FEV_1$.
Park, Soo-Jung;Choi, Na-Rae;Kim, Koo;Yoo, Jong-Hyang;Lee, Si-Woo;Joo, Jong-Cheon
Journal of Sasang Constitutional Medicine
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v.25
no.4
/
pp.373-383
/
2013
Objectives The purpose of this clinical trial was evaluate the safety and efficacy of Mahwangjeongcheon-tang (MJT). Methods Twenty six volunteers were recruited as subjects. They were divided into two groups, which were MJT test group and placebo group. The investigated items related to the safety were the weight, the results of renal function and liver function. The investigated items related to the efficacy are the results of the spirometer, the clinical asthma measurement scale in oriental medicine-V (CAMSOM-V) and the quality of life questionnaire for adult Korean asthmatics (QLQAKA). Results There are no difference in the weight, the results of the renal functions and the liver functions between MJT test group and placebo group. There are the some differences in the result of the questionnaires related to the efficacy between MJT test group and placebo group. The significant difference were observed in the CAMSOM-V at the 4th visit. Conclusion MJT is the safe and effective herbal prescription that is useful to the asthma patients.
Objectives : Asthma is considered an inflammation disease characterized by airway hyperresponsiveness and pulmonary eosinophilia. Chungsang boha-tang is a herbal medication which has been frequently used in traditional therapeutic agents for asthma. We aimed to observe the clinical effects of Chungsangboha-tang on blood eosinophil, serum IgE, AST, ALT and pulmonary function in asthmatic outpatients. Methods : The subjects consisted of 66 asthmatic patients who had been treated with Chungsangboha-tang among all the asthmatic patients who visited the 5th Internal Medicine of the Oriental Medicine Hospital of Kyung Hee University from November,2004 to November,2009. We observed blood eosinophil, serum IgE, AST, ALT levels and pulmonary function test results as well as medical records of patients to evaluate the effects. Results : Pulmonary function significantly improved after 8 weeks of treatment, and blood eosinophil and serum IgE level significantly decreased after 8 weeks of treatment. AST, ALT levels changed in normal ranges. Chungsangboha-tang was significantly effective on the male patients who had a smoking history and worse initial lab findings. We also observed a significant improvement of pulmonary function and decrease of eosinophil and serum IgE levels in the patient group who had a single treatment of Chungsangboha-tang without steroid therapy. Conclusions : This study shows that Chungsangboha-tang has effects on the improvement of pulmonary function and decrease of eosinophil and serum IgE levels as well as improvement of symptoms. And, 8 weeks of long-term treatment showed no negative effects such as significant increase of AST, ALT levels.
Objectives : Based on the changes of quality of life and pulmonary function test, we aimed to identify the effects and side-effects of Gamichuongsangboha-tang and in asthmatic patients. Methods : The subjects consisted of 30 patients with asthma who were treated with Gamichuongsangboha-tang extract for four weeks. Gamichuongsangboha-tang extract is the extracted powder form of the modified herbal decoction Chuongsangboha-whan, which has been used as the traditional therapeutic agent for asthma. Pulmonary function test (PFT) was checked before and after 4 weeks of treatment. Quality of Life QuestionnaireQ for Adult Korean Asthmatics (QLQAKA) was checked before and after 2 and 4 weeks of treatment. Unpleasant symptoms were checked in all patients at 2 weeks and 4 weeks from the beginning of treatment. Results : Treatment with Gamichuongsangboha-tang extract for four weeks resulted in significant increase in $FEV_{1.0}%$, PEFR%, and QLQAKA. The total efficacy rate of QLQAKA in the patient group was 53.3% after 4 weeks. The QLQAKA of the step 2, step 3, and step 4 groups (n=18, 55.6%) classified by global initiative for asthma (GINA) consistently increased, and significant improvement of QLQAKA occurred in the step3 group. In the step 4 group, FEV1.0%, and PEFR% were significantly increased. A total of 15 patients experienced unpleasant symptoms during the first 2 weeks of treatment, but these symptoms disappeared in all but 2 cases with no need of further treatment during the 2nd 2-week period. Conclusions : This study shows that Gamichuongsangboha-tang extract has effects on improvement of pulmonary function and quality of life, especially in persistent symptomatic asthmatics. Obviously further study concerning all these is still necessary.
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