• Radiation Oncology Journal
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• v.17 no.2
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• pp.100-107
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• 1999

Purpose: This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer. Materials and Methods Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45~67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in T2, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal Iymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intravenous cis-Platin (100 mg/m$^{2}$) on day 1 and oral Etoposide (50 mg/m$^{2}$/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression. Results : Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred In 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/l3) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post-operative tumor stagings were pT0 in 3 patients, pTl in 6, and pT2 in 3. Lymph node status findings were pN0 in 8 patients, pN1 in 1, and pN2 in 3. Pathologic tumor down-staging was 61.5% (8/13) including complete response in three patients ($23.7%). Tumor stage was unchanged in four patients (30.8%) and progression was in one (7.7%). Conclusions : Pre-operative concurrent chemoradiotherapy for Stage IIIA (N2) non-small cell lung cancer demonstrated satisfactory results with no increased severe acute complications. This treatment shceme deserves more patinet accrual with long-term follow-up.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.15
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• pp.1-31
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• 1974

Introducing genes for earliness of wheat varieties is important to develop early varieties in winter wheat. In oder to obtain basic informations on the response of heading to the different day length and temperature treatments and on the inheritance of heading dates, experiments were conducted at the field and greenhouse of the Crop Experiment Station, Suwon. Varieties used in this experiments were, early variety Yecora F70, medium varieties Suke #169, Parker and Yukseung #3, and late varieties Changkwang, Bezostaia, Sturdy and Blueboy. The parents and F$_1$s of partial diallel crosses of above eight varieties were subjected the following four different treatments; 1. high temperature and long day, 2. high temperature and short day, 3. low temperature and long day, and 4. low temperature and short day. The same materials were grown also in field condition. Parents, F$_1$ and F$_2$ generation were grown also in both greenhouse under high temperature and short day and in field. The results obtained were summarized as follow: 1. No effects of temperature and daylength on the number of leaves on the main stem were found when -varieties were vernalized. The number of main stem leaves were fewer for spring type of varieties than for winter type of varieties. 2. The effects of temperature and daylength on the days to flag leaf opening were dependent on the speed of leaf emergence. The speed of leaf emergence were faster for lower leaves than for upper leaves. 3. The response to short day and long day (earliness of narrow sense) of varieties were found to be direct factor responsible to physiology of heading dates in vernalized varieties. Great difference of varieties to heading date was found in high temperature and short day treatment, but less differences were found in high temperature and long day, low temperature and long day and low temperature and short day treatments respectively. The least varietal difference for heading dates was found in the field condition. 4. Changkwang and Parker were found to be the most sensitive to short day treatment (photosensitive) and the heading of these varieties were delayed by short day treatment. No great varietal differences were found among other varieties. 5. Varietal differences of heading dates due to daylength were greater in high temperature than in low temperature. 6. Varietal differences of heading dates due to temperature were not great. but in general the heading dates of varieties were faster under high temperature than under low temperature. 7. Earliness of heading dates was due to partial dominance effect of genes involved in any condition. The degree of dominance was greater under short day than under long day treatment. 8. The varietal differences of heading date under high temperature and long day were due to earliness or narrow sense (response to long day) of varieties. The degree of dominance was greater for Yecora F70, spring type than for other winter type of varieties. No differences or less differences of degree of dominance was found among winter type of varieties. The estimated number of effective factor concerned in the earliness of narrow sense was one pair of allele with minor genes. 9. The insensitivity of varieties to short day treatment in heading dates was due to single dominant gene effect. Under the low temperature the sensitivity of varieties to short day treatment was less apparent. 10. The earliness of short day and long day (earliness of narrow sense) sensitivities of varieties appearea to be due to partial dominance of earliness over lateness. In strict sense, the degree of the dominance should be distinguished. 11. Dominant gene effects were found for the thermo-sensitivity of varieties, and the effect was less, significant than the earliness in narrow sense. 12. One pair of allele, ee and EE, for photosensitivity was responsible for the difference in the heading dates between Changkwang and Suke #169. Two pairs of alleles, ee, enen and EE, EnEn. appeared to be responsible for the difference between Changkwang and Yecora F70. The effects of EE and EnEn were, additive to the earliness and the effects of EE were greater than EnEn under short day. However, the effects of EE were not evident in long day but the effects of EnEn were observed in long day. 13. Two pairs of dominant alleles for the earliness were estimated from the analysis of F$_1$ diallels in the field but the effects of these alleles in F$_2$ were not apparent due to low temperature and short day treatment in early part of growth and high temperature and long day treatment in later part of growth. The F$_2$ population shows continuous variation due to environmental effects and due to other minor gene effects. 14. The heritabilities for heading dates were ranged from 0.51 to 0.72, indicating that the selection in early generation might be effective. The extent of heritability for heading dates varied with environments; higher magnitude of heritability was obtained in short day treatment and high temperature compared with long day and low temperature treatments. The heritabilities of heading date due to response to short day were 0.86 in high temperature and 0.76 in low temperature. The heritabilities of heading date due to temperature were not significantly high. 15. The correlation coefficients of heading dates to the number of grains per spike, weight of 1, 000 grains. and grain yield were positive and high, indicating the difficulties of selections of high yielding lines from early population. But no significant correlation coefficient was obtained between the earliness and the number of spikes, indicating the effective selection for high tillering from early varieties for high yielding.

• Journal of the Korean Society of Food Science and Nutrition
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• v.37 no.6
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• pp.729-737
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• 2008

The purposes of this study were to investigate supporting status and subsidy for school food service and to analyze the perception of school food service officials at the educational board on using rice bread to the school food service menu. The questionnaire was developed by content analysis, situation analysis, in-depth interview and checked by the school food service officials at the educational board. The questionnaires were responded by 33 officials (respondent rate: 86.8%) during September 1 to October 26 in 2007. The major findings of this study were as follows: First, most of the respondents were women (93.9%), and worked an average of 104.36 months at school-related work. The metropolitan & provincial office of education had prevalently jurisdiction over 272.3 rural and self-operation type of elementary schools, 115.50 rural and self-operation type of middle schools and 73.0 rural and self-operation type of high schools. In the case of the district office of education, 23.3 urban and self-operation type of elementary schools, 11.6 urban and self-operation type of middle schools and 5.3 urban and contracted type of high schools were averagely managed. Second, all the respondents supported meal cost for low-income group and 50.5% provided reimbursement for organic environmental agricultural products. The highest subsidy was 16.8 billion won as meal cost for low-income group in metropolitan & provincial office and 1,050 million won as labor cost in district office. Third, the experience of performing policies for using rice was relatively lower than perception of rice bread application to school food service menu. Fourth, the advantages of using rice bread were acceleration of consuming rice (32.0%), excellence of nutrition (24.0%) and promotion of healthy image (22.7%). On the other hand, the difficulties of using rice bread were lack of facilities (72.7%), higher cost compared to wheat bread (54.5%), limitation of menu application and cooking method (15.7% each). Fifth, the opinion of utilizing rice and that of applying rice bread were significantly correlated (p<0.001). Desirability and willingness were correlated with reality for applying rice bread to the school food service menu (p<0.001). Also, comparative analysis between divided groups by perception of utilizing rice showed that willingness and experience were significantly different.

• The Korean Journal of Air & Space Law and Policy
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• v.30 no.2
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• pp.83-153
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• 2015

As our economy grows and the number of aircraft increase, the number of civil execution against aircraft cases are likely to increase as well in the future. The purpose of this article is to present the legal theory on the civil execution against aircrafts by drawing on the legal theory on the civil execution against vessels which constitute a relatively large number of cases thus observed. The provisions of the civil execution against immovables or vessel, shall basically apply mutatis mutandis to the civil execution against aircraft or light aircraft. The civil execution against ultra-light flying devices or a foreign aircraft shall be executed in conformity with the civil execution against movables. There are a compulsory auction, an auction to execute a security right to aircraft, and an auction under the right of retention, etc. in the civil execution against an aircraft. A compulsory execution against an aircraft means an execution carried out by a creditor against a debtor's aircraft to obtain satisfaction of claims for the purpose of payment of money. The court of execution of a compulsory execution against an aircraft shall be the district court having jurisdiction over the airport of stoppage or storage of such aircraft at the time of seizure. The forums of execution of a compulsory execution against an aircraft shall be exclusive forums. When a court has rendered an order on commencing an auction, it shall order an execution officer to receive a certificate of the aircraft's registration and other documents as required for its operation, and to submit them to the court. A court may revoke the procedures for a compulsory auction when an execution officer fails to obtain a transfer of the aircraft's registration certificate, etc. and the location of the aircraft is not evident, not later than an elapse of 2 months from the date on which an order on commencing an auction has been rendered. In the case where it is deemed that there exists a business-related need or other based on proper reasoning, the court may permit the aircraft's operation, upon the motion submitted by the debtor. In this case, there shall be a consent from the creditor, the highest bidder, the next highest bidder and successful bidder. A court may, upon a motion submitted by the creditor, make the dispositions required for observing and preserving the aircraft. When a debtor has submitted the documents under subparagraph 2 or 4 of the Article 49 of the Civil Execution Act, and furnished the guarantee equivalent to the claims of the execution creditors and the creditors demanding a distribution and to the costs for execution, before a declaration of bid, the court shall, upon request, revoke other procedures than those for distribution. The provisions of a obligatory auction against vessel or aircraft and an auction to execute a security right to real estate or vessel, shall apply mutatis mutandis to an auction to execute the security right to aircraft. In an auction to execute the security right to aircraft case, an executive title is not necessary. An executory exemplification is not necessary in an application for an auction to execute the security right to aircraft. A court should examine the existence of security right and claim secured. No order on commencing an auction procedure shall be issued with non-existence or invalidity of the security right and absence or extinguishment of the claim secured. Furthermore, these prohibitions are the reason of a decision on non-permit for sale, the court overlooked these prohibitions, and the decision on a permit for sale became final and conclusive, the successful bidder who paid the price and registered of ownership could not acquire ownership of the aircraft sold. A court may render a ruling to put plural aircrafts up for a blanket auction, only when they are in restraint and related matter (Supreme Court Order 2001Ma3688 dated on August 22, 2001). A righter of retention on aircraft may file a request for an auction against the aircraft. The provisions of an auction to execute a security right to aircraft shall apply mutatis mutandis to the formal auction. Airport facility fee and an aircraft are not in restraint and related matter, so an airport management corporation does not hold the right of retention on the aircraft (Supreme Court Decision 2011Da29291 decided on April 10, 2014). In an auction in accordance with the right of retention, all encumbrances (e.g., mortgages) on the sold aircraft shall be extinguished by a sale under the legal conditions for sale. Not only creditors who have claims for preferential payment but also general creditors could demand for distribution. The precedence of the claim of the right of retention on aircraft and that of general creditor's claims are equal.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1972.03a
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• pp.6-7
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• 1972

The air pollutants can be classified into the irritant gas and the asphixation gas, and the irritant gas is closely related to the otorhinolaryngological diseases. The common irritant gases are nitrogen oxides, sulfur oxides, hydrogen carbon compounds, and the potent and irritating PAN (peroxy acyl nitrate) which is secondarily liberated from photosynthesis. Those gases adhers to the mucous membrane to result in ulceration and secondary infection due to their potent oxidizing power. 1. Sulfur dioxide gas Sulfur dioxide gas has the typical characteristics of the air pollutants. Because of its high solubility it gets easily absorbed in the respiratory tract, when the symptoms and signs by irritation become manifested initially and later the resistance in the respiratory tract brings central about pulmonary edema and respiratory paralysis of origin. Chronic exposure to the gas leads to rhinitis, pharyngitis, laryngitis, and olfactory or gustatory disturbances. 2. Carbon monoxide Toxicity of carbon monoxide is due to its deprivation of the oxygen carrying capacity of the hemoglobin. The degree of the carbon monoxide intoxication varies according to its concentration and the duration of inhalation. It starts with headache, vertigo, nausea, vomiting and tinnitus, which can progress to respiratory difficulty, muscular laxity, syncope, and coma leading to death. 3. Nitrogen dioxide Nitrogen dioxide causes respiratory disturbances by formation of methemoglobin. In acute poisoning, it can cause pulmonary congestion, pulmonary edema, bronchitis, and pneumonia due to its strong irritation on the eyes and the nose. In chronic poisoning, it causes chronic pulmonary fibrosis and pulmonary edema. 4. Ozone It has offending irritating odor, and causes dryness of na sopharyngolaryngeal mucosa, headache and depressed pulmonary function which may eventually lead to pulmonary congestion or edema. 5. Smog The most outstanding incident of the smog occurred in London from December 5 through 8, 1952, because of which the mortality of the respiratory diseases increased fourfold. The smog was thought to be due to the smoke produced by incomplete combustion and its byproduct the sulfur oxides, and the dust was thought to play the secondary role. In new sense, hazardous is the photochemical smog which is produced by combination of light energy and the hydrocarbons and oxidant in the air. The Yonsei University Institute for Environmental :pollution Research launched a project to determine the relationship between the pollution and the medical, ophthalmological and rhinopharyngological disorders. The students (469) of the "S" Technical School in the most heavily polluted area in Pusan (Uham Dong district) were compared with those (345) of "K" High School in the less polluted area. The investigated group had those with subjective symptoms twice as much as the control group, 22.6% (106) in investigated group and 11.3% (39) in the control group. Among those symptomatic students of the investigated group. There were 29 with respiratory symptoms (29%), 22 with eye symptoms (21%), 50 with stuffy nose and rhinorrhea (47%), and 5 with sore thorat (5%), which revealed that more than half the students (52%) had subjective symptoms of the rhinopharyngological aspects. Physical examination revealed that the investigated group had more number of students with signs than those of the control group by 10%, 180 (38.4%) versus 99 (28.8%). Among the preceding 180 students of the investigated group, there were 8 with eye diseases (44%), 1 with respiratory disease (0.6%), 97 with rhinitis (54%), and 74 with pharyngotonsillitis (41%) which means that 95% of them had rharygoical diseases. The preceding data revealed that the otolaryngological diseases are conspicuously outnumbered in the heavily polluted area, and that there must be very close relationship between the air pollution and the otolaryngological diseases, and the anti-pollution measure is urgently needed.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.247-256
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• 2008

Purpose: The purpose of this study is to evaluate anal sphincter preservation rates, survival rates, and prognostic factors in patients with rectal cancer treated with preoperative chemoradiotherapy. Materials and Methods: One hundred fifty patients with pathologic confirmed rectal cancer and treated by preoperative chemoradiotherapy between January 1999 and June 2007. Of the 150 patients, the 82 who completed the scheduled chemoradiotherapy, received definitive surgery at our hospital, and did not have distant metastasis upon initial diagnosis were enrolled in this study. The radiation dose delivered to the whole pelvis ranged from 41.4 to 46.0 Gy (median 44.0 Gy) using daily fractions of $1.8{\sim}2.0\;Gy$ at 5 days per week and a boost dose to the primary tumor and high risk area up to a total of $43.2{\sim}54\;Gy$ (median 50.4 Gy). Sixty patients (80.5%) received 5-fluorouracil, leucovorin, and cisplatin, while 16 patients (19.5%) were administered 5-fluorouracil and leucovorin every 4 weeks concurrently during radiotherapy. Surgery was performed for 3 to 45 weeks (median 7 weeks) after completion of chemoradiotherapy. Results: The sphincter preservation rates for all patients were 73.2% (60/82). Of the 48 patients whose tumor was located at less than 5 cm away from the anal verge, 31 (64.6%) underwent sphincter-saving surgery. Moreover, of the 34 patients whose tumor was located at greater than or equal to 5 cm away from the anal verge, 29 (85.3%) were able to preserve their anal sphincter. A pathologic complete response was achieved in 14.6% (12/82) of all patients. The downstaging rates were 42.7% (35/82) for the T stage, 75.5% (37/49) for the N stage, and 67.1% (55/82) for the overall stages. The median follow-up period was 38 months (range $11{\sim}107$ months). The overall 5-year survival, disease-free survival, and locoregional control rates were 67.4%, 58.9% and 84.4%, respectively. The 5-year overall survival rates based on the pathologic stage were 100% for stage 0 (n=12), 59.1% for stage I (n=16), 78.6% for stage II (n=30), 36.9% for stage III (n=23), and one patient with pathologic stage IV was alive for 43 months (p=0.02). The 5-year disease-free survival rates were 77.8% for stage 0, 63.6% for stage I, 58.9% for stage II, 51.1% for stage III, and 0% for stage IV (p<0.001). The 5-year locoregional control rates were 88.9% for stage 0, 93.8% for stage I, 91.1% for stage II, 68.2% for stage III, and one patient with pathologic stage IV was alive without local recurrence (p=0.01). The results of a multivariate analysis with age (${\leq}55$ vs. >55), clinical stage (I+II vs. III), radiotherapy to surgery interval (${\leq}6$ weeks vs. >6 weeks), operation type (sphincter preservation vs. no preservation), pathologic T stage, pathologic N stage, pathologic overall stage (0 vs. I+II vs. III+IV), and pathologic response (complete vs. non-CR), only age and pathologic N stage were significant predictors of overall survival, pathologic overall stage for disease-free survival, and pathologic N stage for locoregional control rates, respectively. Recurrence was observed in 25 patients (local recurrence in 10 patients, distant metastasis in 13 patients, and both in 2 patients). Acute hematologic toxicity ($\geq$grade 3) during chemoradiotherapy was observed in 2 patients, while skin toxicity was observed in 1 patient. Complications developing within 60 days after surgery and required admission or surgical intervention, were observed in 11 patients: anastomotic leakage in 5 patients, pelvic abscess in 2 patients, and others in 4 patients. Conclusion: Preoperative chemoradiotherapy was an effective modality to achieve downstaging and sphincter preservation in rectal cancer cases with a relatively low toxicity. Pathologic N stage was a statistically significant prognostic factor for survival and locoregional control and so, more intensified postoperative adjuvant chemotherapy should be considered in these patients.

• Applied Biological Chemistry
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• v.29 no.1
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• pp.62-72
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• 1986

At present, the definition and chemical analysis method of available soil phosphorus for plants have not been standardized because of the complexity of crop and soil characteristics in Korea and many analysis methods have been suggested with different extraction conditions. Suitable analytical method of available soil P should be established by the trial of various methods based on crop nutrition and soil conditions. To establish the most suitable analysis method of available soiIP, a pot experiment with young maize was conducted over 44 different upland soils collected over the land of Korea. The amount of uptaken P by the plant was determined by ten different chemical methods for the available soil P. The results obtained were as follows: 1. Total phosphorus content in the sample soils ranged ranged $533{\sim}4917\;ppm$, and showed significant positive correlation with the content of organic matter. 2. The P content was relatively low in the acid sulfate soil and very high in the volcanic ash soil although both types of soil contained high level of orgic matter. 3. The amount of extractable P determined by ten different methods were varied more or less, and the ratios of the extractable P to the total soil P were in the range of $1{\sim}48%$. 4. The relative values to the amount of extractable soil P by different methods were in the order of $H_2O(5\;min.)\;1.0\;<\;H_2O(60min.)\;2.27\;<\;NH_4HCO_3\;5.57\;<\;NaHCO_3\;7.42\;<\;Double\;lactate\;9.71\;<\;Bray\;No.1\;12.53\;<\;Lancaster\;17.63\;<\;Nelson\;25.96\;<\;AcOH\;27.6\;<\;CAL-method\;50.27$ 5. The amount of extractable P determined by all of applied methods was very low in acid sulfate soil, volcanic ash soil and coarse textured soil. 6. Soil pH and total soil P generally showed significant positive correlation with the chemically extracted P, and soil organic matter was negatively correlated with the determined by Nelson-and CAL-method. Olsen method which showed significant correlation with exchangeable calcium seemed to be recommendable for calcareous soils. 7. Total amount of uptaken P by Young maize through continuos twice cropping was 4.05% of total soil P in average, and the uptake in the second cropping was twice as much as that of the first cropping. 8. Three determination methods, i.e. Soltanpour-, Double lactate and Bray No. 1-method seemed to be more suitable than Lancaster method which is widely practiced at present in Korea. However, further study should be carried out with other crops and soils to most adequate chemical method for determination of available soil P.

• Advances in pediatric surgery
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• v.8 no.2
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• pp.143-155
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• 2002

A survey on biliary atresia was made among 26 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and a case registration form for each patient during the twentyone-year period of 1980-2000. Three hundred and eighty patients were registered from 18 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:1.3. The age of patients on diagnosis with biliary atresia was on average $65.4{\pm} 36.2$ days old. The national distribution was 32.8% in Seoul, 25.3% in Gyoungki-Do, 21.6% in Gyoungsang-Do, 9.27% in Choongchung-Do, etc. in order. The most common clinical presentation was jaundice (98.4%) and change of stool color (86.2%) was second. Two hundred eighty (74.7%) of 375 patients were operated by 80 days of age. Three hundred thirty six (9 1.9%) of 366 patients were operated on by the original Kasai procedure, and 305 (84.3%) of 362 patients were observed by bile-drainage postoperatively. The overall postoperative complication rate was 18.5% and the overall postoperative mortality rate was 6.8%. The associated anomalies were observed in 72 cases (22.5%). One hundred ninty five (64.7%) of 302 patients have been alive in follow-up and 49 (25.1%) have survived over 5 years without problem after operation. Ascending cholangitis, varices and ascites affected survival significantly, and the important long-term prognostic factor was the occurrence of complications.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.140-152
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• 1998

Background: Prone position improves oxygenation in patients with ARDS probably by reducing shunt Reduction of shunt in prone position is thought to be effected by lowering of the critical opening pressure (COP) of the dorsal lung because the pleural pressure becomes less positive in prone position compared to supine position. It can then be assumed that prone position would bring about greater improvement in oxygenation when PEEP applied in supine position is just beneath COP than when PEEP is above COP. Hemodynamically, prone position is expected to attenuate the lifting of cardiac fossa induced by PEEP. Based on these backgrounds, we investigated whether the effect of prone position on oxygenation differs in magnitude according to the level of PEEP applied in supine position, and whether impaired cardiac output in supine position by PEEP can be restored in prone position. Methods: In seven mongrel dogs, $PaO_2/F_1O_2$(P/F) was measured in supine position and at prone position 30 min. Cardiac output (CO), stroke volume (SV), pulse rate (PR), and pulmonary artery occlusion pressure (PAOP) were measured in supine position, at prone position 5 min, and at prone position 30 min. After ARDS was established with warmed saline lavage(P/F ratio $134{\pm}72$ mm Hg), inflection point was measured by constant flow method($6.6{\pm}1.4cm$ $H_2O$), and the above variables were measured in supine and prone positions under the application of Low PEEP($5.0{\pm}1.2cm$ $H_2O$), and Optimal PEEP($9.0{\pm}1.2cm$ $H_2O$)(2 cm $H_2O$ below and above the inflection point, respectively) consecutively. Results : P/F ratio in supine position was $195{\pm}112$ mm Hg at Low PEEP and $466{\pm}63$ mm Hg at Optimal PEEP(p=0.003). Net increase of P/F ratio at prone position 30 min, however, was far greater at Low PEEP($205{\pm}90$ mm Hg) than at Optimal PEEP($33{\pm}33$ mm Hg)(p=0.009). Compared to CO in supine position at Optimal PEEP($2.4{\pm}0.5$ L/min), CO in prone improved to $3.4{\pm}0.6$ L/min at prone position 5 min (p=0.0180) and $3.6{\pm}0.7$ L/min at prone position 30 min (p=0.0180). Improvement in CO was attributable to the increase in SV: $14{\pm}2$ ml in supine position, $20{\pm}2$ ml at prone position 5 min (p=0.0180), and $21{\pm}2$ ml at prone position 30 min (p=0.0180), but not to change in PR or PAOP. When the dogs were turned to supine position again, MAP ($92{\pm}23$ mm Hg, p=0.009), CO ($2.4{\pm}0.5$ L/min, p=0.0277) and SV ($14{\pm}1$ ml, p=0.0277) were all decreased compared to prone position 30 min. Conclusion: Prone position in a dog with saline-lavaged acute lung injury appeared to augment the effect of relatively low PEEP on oxygenation, and also attenuate the adverse hemodynamic effect of relatively high PEEP. These findings suggest that a PEEP lower than Optimal PEEP can be adopted in prone position to achieve the goal of alveolar recruitment in ARDS avoiding the hemodynamic complications of a higher PEEP at the same time.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.987-996
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• 1996

Background : We prospectively evaluated the applicability and effect of noninvasive ventilation (NIV) in acute respiratory failure and tried to find out the parameters that could predict successful application of NIV. Methods : Twenty-six out of 106 patients with either acute ventilatory failure (VF: $PaCO_2$ > 43 mm Hg with pH < 7.35) or oxygenation failure (OF: $PaO_2/AO_2$ < 300 mm Hg with $pH{\geq}7.35$) requiring mechanical ventilation were managed by NIV (CPAP + pressure suppon, or BiPAP) with face mask. Eleven out of 19 cases with VF (57.9%) (M : F=7 : $55.4{\pm}14.6$ yrs) and 15 out of 87 cases with OF (17.2%) (M : F=12 : 3, $50.6{\pm}15.6$ yrs) were s uilable for NIY. Respiratory rates, arterial blood gases and success rate of NIV were analyzed in each group. Results: 81.8% (9/11) of YF and 40% (6/15) of OF were successfully managed on NIV and were weruled from mechanical ventilator without resorting to endotracheal intubation. Complications were noted in 2 cases (nasal skin necrosis 1, gaseous gastric distension 1). In NIV for ventilatory failure, the respiration rate was significantly decreased at 12 hour of NIV ($34{\pm}9$ /min pre-NIV, $26{\pm}6$ /min at 12 hour of NIV, p=0.045), while $PaCO_2$ ($87.3{\pm}20.6$ mm Hg pre-NIV, $81.2{\pm}9.1$ mm Hg at 24 hour of NIV) and pH ($7.26{\pm}0.04$, $7.32{\pm}0.02$, respectively, p <0.05) were both significantly decreased at 24 hour of NIV In NIV for oxygenation failure, $PaCO_2$ were not different between the successful and the failed cases at pre-NIV and till 12 hours after NIV. The $PaO_2/FIO_2$ ratio, however, significantly improved at 0.5 hour of NIV in successful cases and were maintained at around 200 mm Hg (n=6 : at baseline, 0.5h, 6h, 12h : $120.0{\pm}19.6$, $218.9{\pm}98.3$, $191.3{\pm}55.2$, $232.8{\pm}17.6$ mm Hg, respectively, p=0.0211), but it did not rise in the failed cases (n=9 : $127.9{\pm}63.0$, $116.8{\pm}24.4$, $100.6{\pm}34.6$, $129.8{\pm}50.3$ mm Hg, respectively, p=0.5319). Conclusion : From the above results we conclude that NIV is effective for hypercapnic respiratory failure and its success was heralded by reduction of respiration rale before the reduction in $PaCO_2$ level. In hypoxic respiratory failure, NIV is much less effective, and the immediate improvement of $PaO_2/FIO_2$ ratio at 0.5h after application is thought to be a predictor of successful NIV.