• Tuberculosis and Respiratory Diseases
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• v.66 no.2
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• pp.116-121
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• 2009

Background: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. Methods: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. Results: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). Conclusion: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.

• Tuberculosis and Respiratory Diseases
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• v.60 no.1
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• pp.49-56
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• 2006

배경 : 급성 폐손상은 폐내, 외의 원인질환들에 의해 폐포-모세혈관의 투과성이 증가하며, 폐부종에 의해 급성 저산소성 호흡곤란이 유발되는 증후군이다. 헤파린은 항응고작용 외에 자체적으로 항염증효과를 가지고 있으나, 염증성질환에 헤파린을 투여하면 출혈성 합병증이 발생하기 때문에 실제로 임상에서 이용하는데 제약이 있다. 하지만 헤파린에서 2-O와 3-O sulfate를 제거하면, 항응고 효과가 제거되고 항염증효과는 지니고 있는 비항응고성 헤파린 (nonanticoagulant heparin)으로 변화한다. 본 연구에서는 흰쥐에게 내독소 (LPS)를 투여하거나, 출혈성 쇼크를 일으켜서 유발된 급성폐손상에서 비항응고성 헤파린의 치료효과를 살펴보았다. 방법 : 각 군당 5 마리 이상의 흰쥐 (Balb/c mouse)를 이용하였다. 미정맥 (tail vein)을 통해 생리식염수 또는 비항응고성 헤파린 (50 mg/kg)을 투여한 직후에 내독소를 복강으로 투여하거나 (1 mg/kg), 심장천자를 통해 총 혈액의 1/3 정도로 제거하여 출혈성 쇼크를 유도하여 급성폐손상을 유발하였다. 내독소 투여 또는 출혈성 쇼크 유발 1 시간 후에 흰쥐를 희생시키고 폐를 적출하였고, 폐의 염증성 변화는 사이토카인 ($TNF-{\alpha}$, MIP-2, $IL-1{\beta}$)을 측정하여 살펴보았고, 폐손상의 정도는 myeloperoxidase (MPO) assay와 wet-to-dry weight ratio를 측정하여 알아보았다. 결 과 : 내독소를 투여한 흰쥐의 폐에서 대조군의 폐에 비해 사이토카인의 발현이 증가하고 ($TNF-{\alpha}$; $196.1{\pm}10.8$ vs $83.7{\pm}18.4pg/ml$, MIP-2; $3,000{\pm}725$ vs $187{\pm}26pg/ml$, $IL-1{\beta}$; $6,500{\pm}1167$ vs $266{\pm}25pg/ml$, p<0.05, respectively), 폐의 MPO 활성이 증가하였다 ($27.9{\pm}6.2$ vs $10.5{\pm}2.3U/g$ of lung protein, p<0.05). 출혈성 쇼크를 일으킨 흰쥐의 폐에서 대조군의 폐에 비해 사이토카인의 발현은 증가되지 않았으나, MPO 발현은 증가되었다 ($16.5{\pm}3.2$ vs $10.5{\pm}2.3U/g$ of lung protein, p<0.05). 내독소 투여 또는 출혈성 쇼크에 의해 급성폐손상이 유발된 흰쥐에서 생리적 식염수를 투여하거나 비항응고성 헤파린을 투여한 군 사이에 사이토카인의 발현이나 MPO 활성에 의미있는 차이는 관찰되지 않았다. 결론 : 이상의 결과로 비항응고성 헤파린은 내독소를 투여하거나 출혈성 쇼크를 일으키고 한 시간 뒤에 측정한 흰쥐의 급성폐손상에서 의미있는 치료효과를 보이지 않았다.

• Progress in Medical Physics
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• v.22 no.4
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• pp.178-183
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• 2011

The applicability and feasibility of TomoTherapy in the lung radiation surgery was analyzed by comparison of the calculated dose distribution in TomoTherapy planning with the results of conventional IMRS (intensity modulated radiation surgery) using LINAC (linear accelerator). The acquired CT (computed tomograph) images of total 10 patients whose tumors' motion were less than 5 mm were used in the radiation surgery planning and the same prescribed dose and the same dose constraints were used between TomoTherapy and LINAC. The results of TomoTherapy planning fulfilled the dose requirement in GTV (gross tumor volume) and OAR (organ at risk) in the same with the conventional IMRS using LINAC. TomoTherapy was superior in the view point of low dose in the normal lung tissue and conventional LINAC was superior in the dose homogeneity in GTV. The calculated time for treatment beam delivery was long more than two times in TomoTherapy compared with the conventional LINAC. Based on the results in this study, TomoTherapy can be evaluated as an effective way of lung radiation surgery for the patients whose tumor motion is little when the optimal planning is produced considering patient's condition and suitability of dose distribution.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.733-738
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• 1997

Sequential bilateral lung transplantation may result in a variety of perioperative and postoperative complications, showing high perioperative morbidity and mortality rates. This research was performed to investigate the hemodynamic changes in adult mongrel dogs after bilateral reimplantation, two methods preferred for avoiding or minimizing graft rejection. The anterior portion of the pulmonary artery and the left atrium proximal to the superior and the inferior pulmonary veins were resected out and then re-anastomosed one hour later to prevent torsion or stenosis of the anastomotic site and the formation of a thrombosis in the left atrium. An everted suture technique was employed for the left atrium; An hour after the division, however, the main bronchus was tightly anastomose by interrupted sutures of No. 4-0 prolene in a telescope method. A modified I-C solution mixed with PGEI was infused into the cut portion of the pulmonary artery at the rate of 15 mllkglmin and at a pressure of 40 cmH20 for a total dosage of 70 mlfkg in order to preserve the transected lung. Topical cooling using wet gauzes soaked with cold I-C solution was performed for one hour to prevent ischemic lung injury. The above procedures are considered to be beneficial for achieving a satisfactory outcome for bilateral lung reimplantation.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.396-401
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• 1997

Tailoring thoracoplasty is employed prior to, following, or concomitant with pulmonary resection when it is anticipated that insufHclent lung tissue will remain to fill the pleural space following a pulmonary resection. This study reviewed a series of eight patients treated with tailoring thoracoplasty between 1990 and 1995. Indications were to close a persistent space In four patients and to tailor the thoracic cavity to accept diminished lung volume concomitant with a pulmonary resection in the other four patients. The primary underlying disease was lung cancer in three patients and pulmonary tuberculosis In five patients, two of whom had concomitant aspcrgilloma, two, pneumothora , and one, empyema with bronchopleural fistula. In four patients with a prior pulmonary resection, the tailoring thoracoplasty was performed within eight days after the resection surgery. There was no failure to accommodate the thoracic cavity to insufficient lung tissue, even though two patients needed a second thoracoplasty. We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural space and to accommodate diminished lung volume with acceptable cosmetic results Early, after, or concomitant with pulmonary resection in selected patients.

• Neonatal Medicine
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• v.15 no.2
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• pp.142-151
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• 2008

Purpose : The aim of this study was to compare the clinical effects of modified porcine (Curosurf$^{(R)}$) and bovine (Newfactan$^{(R)}$) surfactants in the treatment of neonatal respiratory distress syndrome. Methods : Between April 2004 and December 2006, 65 neonates (birth weight ${\leq}$2,500 g and gestational age ${\leq}$35 weeks) with neonatal respiratory distress syndrome were treated in our neonatal intensive care unit with surfactant. Thirty-one neonates received Curosurf$^{(R)}$ and 34 neonates received Newfactan$^{(R)}$. The neonates were not enrolled if they had major congenital anomalies or meconium aspiration syndrome. We compared the changes in respiratory parameters after surfactant instillation, the incidences of acute and chronic complications, and the mortality between the two treatment groups. Results : Neonatal and maternal demographic characteristics were not different between the groups. The patterns of change in the respiratory parameters after surfactant instillation were not statistically different between the groups. The incidences of surfactant reinstillation and acute complications, such as pneumothorax, patent ductus arteriosus, pulmonary hemorrhage, and grade 3-4 intraventricular hemorrhage, were not different between the neonates who received Curosurf$^{(R)}$ and the neonates who received Newfactan$^{(R)}$. There were no statistically significant differences in the duration of mechanical ventilation, oxygen therapy, hospitalization, prevalence of bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and mortality between the groups. Conclusion : In the present comparative study, no significant differences in the clinical effects of Curosurf$^{(R)}$ and Newfactan$^{(R)}$ were observed.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1096-1101
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• 2005

Purpose : Recently, early surfactant replacement and tidal volume based gentle ventilation has been a fundamental treatment of respiratory distress syndrome(RDS). The aims of this study were to survey the changes in ventilator care duration and rate of complication in RDS groups. Methods : We performed a retrospective study of 255 newborn infants less than 1,500 g admitted to the neonatal intensive care unit(NICU) and discharged from January 1999 to December 2003. 141 of 255 newborn infants were RDS groups that required invasive management, such as endotracheal intubation, surfactant replacement and assisted ventilation. We analyzed epidemiologic data to study the changes in ventilator care duration and outcome of RDS groups. Results : Of 141 RDS groups, 135 were mild to moderate RDS groups and only 6 were severe RDS groups. 24(17.8%) of 135 mild to moderate RDS groups and 3(50%) of 6 severe RDS groups were antenatal no use of maternal dexamethasone. 127(90.1%) of 141 RDS groups underwent replacement of surfactant during 3 hours after birth. 121(85.9%) weaned within 48 hours. Conclusion : Our study shows a decreased frequency of severe RDS by a antenatal use of maternal dexamethasone and decreased duration of ventilator care by early surfactant replacement and gentle ventilation.

• Clinical and Experimental Pediatrics
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• v.53 no.1
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• pp.21-27
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• 2010

Purpose : In contrast with traditional time-cycled, pressure-limited ventilation, during volume-controlled ventilation, a nearly constant tidal volume is delivered with reducing volutrauma and the episodes of hypoxemia. The aim of this study was to compare the efficacy of pressure-regulated, volume controlled ventilation (PRVC) to Synchronized intermittent mandatory ventilation (SIMV) in VLBW infants with respiratory distress syndrome (RDS).Methods : 34 very low birth weight (VLBW) infants who had RDS were randomized to receive either PRVC or SIMV with surfactant administration : PRVC group (n=14) and SIMV group (n=20). We compared peak inspiratory pressure (PIP), duration of mechanical ventilation, and complications associated with ventilation, respectively with medical records. Results : There were no statistical differences in clinical characteristics between the groups. After surfactant administration, PIP was significantly lower during PRVC ventilation for 48hrs and accumulatevive value of decreased PIP was higher during PRVC ventilation for 24hrs (P<0.05). Duration of ventilation and incidence of complications was no significant difference. Conclusion : PRVC is the mode in which the smallest level of PIP required to deliver the preset tidal volume in VLBW infants with RDS, adaptively responding to compliance change in lung after surfactant replacement.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.833-837
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• 2010

This is a report of successful management for pulmonary metastasis following chemotherapy in patient with testicular germ cell tumor. Postchemotherapy PET-CT was not uptake FDG in metastatic lesion. Pulmonary metastasectomy was performed, which is important to manage a residual postchemotherapy lung mass in testicular germ cell tumor for histological correlation with primary testicular lesion to select the patients who require subsequent chemotherapy. Our patient was well 6 months after operation, not carried out chemotherapy because of no viable tumor.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.703-706
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• 2003

Postpneumonectomy syndrome is a rare condition characterized by dyspnea due to an extreme mediastinal shift and bronchial compression of the residual lung after a right pneumonectomy or a left pneumonectomy with the right aortic arch, Severe fibrosis of the lung such as tuberculsosis (TB) - destroyed lung can cause similar clinical features in the absence of pneumonectomy. We report a unique case of postpneumonectomy syndrome without pneumonectomy, which was successfully treated with pneumonectomy and mediastinal repositioning with tissue expanders.