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Outcomes of Patients with COPD Requring Mechanical Ventilation (만성폐쇄성폐질환 환자의 기계호흡시 생존 예측 인자 분석)

  • Baik, Jae-Joong;Kim, Sang-Chul;Lee, Tae-Hoon;Chung, Yeon-Tae
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.2
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    • pp.179-188
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    • 2000
  • Background : The decision to institute mechanical ventilation for patients with COPD is very difficult. The accurate information regarding weaning success and long-term survival will improve communication with patients and family and enhance informed consent. The aims of this study are to describe outcomes and identify variables associated with survival for patients experiencing mechanical ventilation with an acute respiratory failure of COPD. Methods : The 53 cases of mechanical ventilation in the intensive care unit in the National Medical Center from 1989 to 1998 were included. Data were collected retrospectively from medical records. Weaning success rate and 3 month and 1 year survival rates were estimated. Factors associated with weaning success and survival were determined. Results : Weaning sucess was 55%. For success group with 29 cases, 3 months survival rate was 61% and 1 year survival rate 37%. APACHE II scores in weaning success group were significantly lower than those in the failure group. Factors such as age, sex, comorbid-illnes. previous steroid use, causes of respiratory failure, RVH or arrhythmia on EKG, serum albumin level, arterial blood pH, $PaO_2$, $PaCO_2$, $FEV_1$ duration of mechanical ventilation and steroid use during mechanical ventilation were not associated with weaning success. Only age and serum albumin level were associated with 3 month and 1 year survival. No COPD patients of age more than 75 years and serum albumin level less than 3g/dl had survived at 1 year after weaning success. Conclusion : While weaning success from mechanical ventilation can be predicted by APACHE II score in COPD patients, long-term outcomes of survivors may be influenced by nutritional status and age.

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Comparison of PCR-Line Probe and PCR-SSCP Methods for the Detection of Rifampicin Resistant Mycobacterium Tuberculosis (Rifampicin 내성 결핵균의 검출에 있어서 PCR-line Probe법과 PCR-SSCP법의 비교)

  • Kim, Ho-Joong;Suh, Gee-Young;Chung, Man-Pyo;Kim, Jong-Won;Shim, Tae-Sun;Choi, Dong-Chull;Kwon, O-Jung;Rhee, Chong-H;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.714-722
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    • 1998
  • Background: Rifampicin (RFP) is a key component of the antituberculous short-course chemotherapy and the RFP resistance is a marker of multi-drug resistant (MDR) tuberculosis. RPoB gene encodes the $\beta$-subunit of RNA polymerase of M. tuberculosis which is the target of RFP. And the mutations of rpoB gene have been found in about 96% of rifampicin resistant clinical isolates of M. tuberculosis. So in order to find a rapid and clinically useful diagnostic method in identifying the RFP resistance, we compared the PCR -line probe method with PCR-SSCP for the detection of the rpoB gene mutation in cultured M. tuberculosis. Methods: 45 clinical isolates were collected from patients who visited Sung Kyun Kwan University Hospital. The RFP susceptibility test was referred to the referral laboratory of the Korean Tuberculosis Institute. 33 were rifampicin resistant and 12 were rifampicin susceptible. The susceptibility results were compared with the results of the PCR-BSCP and PCR-line probe method. Results: We could find rpoB mutations in 27/33(81.8%) RFP-resistant strains by PCR-line probe method, and in 23/33 (69.7%) by PCR-SSCP and there was no significant difference between two methods. There was no mutation in rifampicinn susceptible strains by both methods. Conclusion: PCR-line probe method would be a rapid, sensitive and specific method for the detection of rifampicin resistant Mycobacterium tuberculosis.

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Efficacy of the Antibiotics Chosen by ATS Guideline in the Treatment of Korean Patients with Community-acquired Pneumonia Admitted to a Tertiary Hospital (3차 병원에 입원한 한국 지역사회획득 폐렴 환자에서 미국흉부학회 추천 항생제의 유용성)

  • Oh, Sung-Yong;Park, Sang-Joon;Kang, Kyeong-Woo;Koh, Young-Min;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Choi, Dong-Chull;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.4
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    • pp.460-470
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    • 1999
  • Background : In 1993, American Thoracic Society (ATS) recommended a guideline for the initial management of adults with community-acquired pneumonia(CAP). However, etiologic organisms and medical system in Korea seem to be different from those in Western countries. Retrospective analysis was done to evaluate the efficacy of antibiotics chosen by ATS guideline in the treatment of Korean patients with CAP admitted to a tertiary university medical center. Methods : Hospitalized patients with CAP at Samsung Medical Center from April 1997 through March 1998 were retrospectively reviewed. Patients who fulfilled all of the following criteria were included in this study : (1) fever ${\geq}38^{\circ}C$ (2) purulent sputum (3) pulmonary infiltrates on chest X-ray. Patients were classified as : 1) ATS group ; patients whose initial antibiotics were chosen by ATS guideline 2) Non-ATS overuse group ; additional antibiotics administered more than those of ATS guideline, and 3) Non-ATS underuse group ; initial antibiotics were insufficient to ATS guideline. Response of empirical antibiotics and etiologic organisms of 3 groups were identified. Results : Sixty-four patients were enrolled. Thirty-six patients were classified into ATS group, 10 patients Non-ATS overuse group, and 18 patients Non-ATS underuse group. Thirty-three patients of 36 ATS group, 9 patients of 10 Non-ATS overuse group, and 14 patients of 18 Non-ATS underuse group showed improvement by initial empirical antibiotics. There was no statistical difference in antibiotic response between 3 groups (p>0.05). S. pneumoniae (12.5%), K. pneumoniae (9.4%), and P. aeruginosa (4.7%), Mycoplasma (3.1%) were the most commonly isolated organisms. In 18 patients with severe CAP, P. aeruginosa was isolated only in 1 patient and Legionella organism not isolated. Conclusion : Initial empirical antibiotics chosen by ATS guideline were effective in the management of Korean patients with CAP admitted to a tertiary hospital. However, well-designed large-scale prospective study is needed to identify etiologic organisms and choose an adequate initial empirical antibiotics in Korean adults patient with severe CAP.

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Clinical Course of Untreated Sarcoidosis (스테로이드 치료를 받지 않은 유육종증 환자의 임상경과)

  • Koh, Young-Min;Chung, Kyeong-Jae;Park, Sang-Joon;Kang, Kyeong-Woo;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.6
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    • pp.807-816
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    • 1999
  • Background: Sarcoidosis, uncommon in Korea, has variable clinical course, ranging from benign self-limited recovery to life-long disability regardless of corticosteroid therapy. The purpose of this study is to observe the clinical course of untreated sarcoidosis. Methods: Twenty four patients who were confirmed as sarcoidosis by tissue diagnosis were included. For average 12month follow-up periods, subjective symptoms, radiologic findings, and parameters of pulmonary function test(FVC, $FEV_1$, DLco) were evaluated every 3mooths compared between corticosteroid treated(n=5) and non-treated(n=19) patients. 'Deterioration' was defined if patients met more than one of followings (1) decrement in any parameters of pulmonary function test(2) worsening in the degree of dyspnea(3) increase in radiologic extents, and (4) newly developed extrapulmonary sarcoidosis. 'Stable' was defined as no significant interval changes in every parameters. 'Improvement' was defined as decrement of extension of the radiologic lesions without deterioration. Results: Among 19 untreated sarcoidosis patient, one deteriorated, 14 improved(13 of them showed complete resolution in radiology), and 4 were remained stable. On the other hand, five corticosteroid treated patients, uveitis was developed in one, 2 improved, and 2 remained stable. Conclusion : These findings suggest that patient with sarcoidosis, especially those without serious extrapulmonary disease, has stable clinical course and would not need corticosteroid therapy.

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Effect of Hypothermia on the Prevention of Ventilator-Induced Lung Injury in Rats (백서에서 저체온 전처치가 환기기유발폐손상 억제에 미치는 효과)

  • Lim, Chae-Man;Hong, Sang-Bum;Koh, Youn-Suck;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.5
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    • pp.540-548
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    • 2001
  • Backgrounds : Because ventilator-induced lung injury is partly dependent on the intensity of vascular flow, we hypothesized that hypothermia may attenuate the degree of such an injury through a reduced cardiac output. Methods : Twenty-seven male Sprague-Dawley rats were randomly assigned to normothermia ($37{\pm}1^{\circ}C$)-injurious ventilation (NT-V) group (n=10), hypothermia ($27{\pm}1^{\circ}C$)-injurious ventilation (HT-V) group (n=10), or nonventilated control group (n=7). The two thermal groups were subjected to injurious mechanical ventilation for 20 min with peak airway pressure 30 cm $H_2O$ at zero positive end-expiratory pressure, which was translated to tidal volume $54{\pm}6\;ml$ in the NT-V group and $53{\pm}4\;ml$ in the HT-V group (p>0.05). Results : Pressure-volume (P-V) curve after the injurious ventilation was almost identical to the baseline P-V curve in the HT-V group, whereas it was shifted rightward in the NT-V group. On gross inspection, the lungs of the HT-V group appeared smaller in size, and showed less hemorrhage especially at the dependent regions, than the lungs of the NT-V group. [Wet lung weight (g)/body weight (kg)] ($1.6{\pm}0.1$ vs $2.4{\pm}1.2$ ; p=0.014) and [wet lung weight/dry lung weight] ($5.0{\pm}0.1$ vs $6.1{\pm}0.8$ ; p=0.046) of the HT-V group were both lower than those of the NT-V group, while not different from those of the control group($1.4{\pm}0.4$, $4.8{\pm}0.4$, respectively). Protein concentration of the BAL fluid of the HT-V group was lower than that of the NT-V group($1,374{\pm}726\;ug/ml$ vs $3,471{\pm}1,985\;ug/ml$;p=0.003). Lactic dehydrogenase level of the BAL fluid of the HT-V group was lower than that of the NT-V group ($0.18{\pm}0.10\;unit/ml$ vs $0.43{\pm}0.22\;unit/ml$;p=0.046). Conclusions : Hypothermia attenuated pulmonary hemorrhage, permeability pulmonary edema, and alveolar cellular injuries associated with injurious mechanical ventilation, and preserved normal P-V characteristics of the lung in rats.

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Talc Pleurodesis via Video-Assisted Thoracoscopic Surgery(VATS) in Malignant Pleural Effusions (악성 흉막삼출 환자에서 비디오 흉강경을 이용한 Talc 흉막유착술)

  • Park, Sang-Joon;Ahn, Seok-Jin;Kang, Kyeong-Woo;Koh, Young-Min;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Kim, Kwhan-Mien;Kim, Jhin-Gook;Shim, Young-Mog;Rhee, Chong-H
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.785-794
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    • 1998
  • Background: Chemical pleurodesis is a widely used method for the control of symptomatic and recurrent malignant pleural effusions. Talc has been accepted to be the most effective sclerosing agent for chemical pleurodesis. This study was undertaken to evaluate the usefulness of talc pleurodesis via video-assisted thoracoscopic surgery (VATS) in treatment of malignant pleural effusions. Methods : A retrospective analysis of the medical records and radiographic findings was performed. The success of the procedure was defined as daily pleural fluid drainage below 100ml within 1 week after pleurodesis and complete expansion of the lung on simple chest radiograph. Recurrence was defined as reaccumulation of pleural fluid on follow-up chest radiographs, and complete response as no fluid accumulation on follow-up chest radiographs. Results: Between October 1994 and August 1996, talc pleurodesis via VATS was performed in 35 patients. Duration of follow-up ranged from 5 days to 828 days(median 79days). The initial success rate of procedure was 88.6%(31 of 35 cases). Complete responses were observed in 92.8% at 30 days, 75.7% at 90 days and 64.9% at 180 days. Postoperative complications were fever (54.3%), subcutaneous emphysema(11.4%), reexpansion pulmonary edema(2.9%) and respiratory failure(5.7%). But procedure related mortality or respiratory failure was not found. Conclusion: Talc pleurodesis via VATS is a safe and effective method for the control of symptomatic malignant pleural effusions.

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The Clinical Characteristics of Diffuse Alveolar Hemorrhage : A Retrospective Study of 21cases (미만성 폐포 출혈의 임상 양상과 예후)

  • Ham, Hyoung-Suk;Roh, Gil-Hwan;Kang, Eun-Hae;Kang, Soo-Jung;An, Chang-Hyeok;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.5
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    • pp.614-623
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    • 2000
  • Background : Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. Method : A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveolar lavage or lung biopsy. Results : Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD ($3.27{\pm}3.15$ mg/dl vs. $1.19{\pm}0.94$ mg/dl, p=0.030). The corresponding drop in hemoglobin level was $2.69{\pm}1.26$ g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by $1.38{\pm}4.22$ days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). Conclusion : The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.

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Host Preference of Ricania spp. (Hemiptera: Ricaniidae) at Different Developmental Stages (갈색날개매미충의 발육단계별 기주선호성)

  • Choi, Yong-Seok;Seo, Hwa-Young;Jo, Shin-Hyuk;Whang, In-Su;Lee, Young-Su;Park, Deog-Kee
    • Korean journal of applied entomology
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    • v.56 no.4
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    • pp.319-329
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    • 2017
  • We investigated the host preference of Ricania app. at different developmental stages to select the effective control methods. Ricania spp. at different developmental stages preferred different host plants. During the nymphal period, individuals moved to the bottom due to environmental factors such as wind and rain, rather than inhabiting trees, and fed on various plants ranging from 1 year-old herbaceous plants to shrubs. Especially, at Palbong Mt. in Gonju, Ricania spp. nymphs preferred Symplocos chinensis f. pilosa, Celastrus orbiculatus, Euonymus alatus, Kalopanax septemlobus, Aralia elata, Styrax japonicas, Rubus parvifolius, Ru. coreanus, Ru. crataegifolius, Quercus acutissima, Cornus officinalis, Lespedeza bicolor, Albizia julibrissin, L. maximowiczii, Rhododendron schlippenbachii and Rh. indicum. At Yongbong Mt. in Hongseong, Ricania spp. adults preferred herbaceous plants, such as Helianthus annuus, Solanum nigrum, and Oenothera biennis rather than trees during the pre-oviposition stage. Subsequently, as the oviposition season began, Ricania spp. adults were rarely found in H. annuus, S. nigrum, or O. biennis and appeared to migrate to the perennial trees and shrubs hosts to lay eggs. At Palbong Mt., the main laying hosts of Ricania spp. adults were Weigela subsessilis, Ailanthus altissima, Q. aliena, Boehmeria platanifolia, Diospyros lotus, Ziziphus jujubae var. inermis, St. japonicus, Prunus mume, P. serrulata var. spontanea, Spiraea prunifolia f. simpliciflora, Ru. crataegifolius, Salix koreensis, Ru. yedoense f. poukhanense, and Co. controversa. The degree of egg laying, number of egg masses and adult Ricania spp. were significantly higher in sunlit areas than in shaded areas, in addition, the lower the altitude, the more adults were present. This study contributes toward the development of traps that can attract and control Ricania spp. and reduce the density of Ricania spp. that disturb the ecosystem.

Development of KD- Propeller Series using a New Blade Section (새로운 날개단면을 이용한 KD-프로펠러 씨리즈 개발)

  • J.T. Lee;M.C. Kim;J.W. Ahn;H.C. Kim
    • Journal of the Society of Naval Architects of Korea
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    • v.28 no.2
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    • pp.52-68
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    • 1991
  • A new propeller series is developed using the newly developed blade section(KH18 section) which behaves better cavitation characteristics and higher lift-drag ratio at wide range of angle-of-attack. The pitch and camber distributions are disigned in order to have the same radial and chordwise loading distribution with the selected circumferentially averaged wake input. Since the geometries of the series propeller, such as chord length, thickness, skew and rate distribations, are selected by regression of the recent full scale propeller geometric data, the performance prediction of a propeller at preliminary design stage can be mure realistic. Number of blades of the series propellers is 4 and the expanded blade area ratios are 0.3, 0.45, 0.6 and 0.75. Mean pitch ratios are selected as 0.5, 0.65, 0.8, 0.75 and 1.1 for each expanded area ratio. The new propeller series is composed of 20 propellers and is named as KD(KRISO-DAEWOO) propeller series. Propeller open water tests are performed at the experimental towing tank, and the cavitation observation tests and fluctuating pressure measurements are carried out at the cavitation tunnel of KRISO. $B_{P}-\delta$ curves, which can be used to select the optimum propeller diameter at the preliminary design stage, are derived from a regression analysis of the propeller often water test results. The KD-cavitation chart is derived from the cavitation observation test results by choosing the local maximum lift coefficient and the local cavitation number as parameters. The caviy extent of a propeller can be predicted more accurately by using the KD-cavitation chart at a preliminary design stage, since it is derived from the results of the cavitation observation tests in the selected ship's wake, whereas the existing cavitation charts, such as the Burrill's cavitation chart, are derived from the test results in uniform flow.

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Study on the Antioxidant and Human Neutrophil Elastase Inhibitory Activities of Mushroom Ramaria formosa Extracts (붉은싸리버섯 추출물의 항산화 및 Human Neutrophil Elastase 저해활성)

  • Kim, Kwan-Chul;Kwon, Yong-Beom;Jang, Hae-Dong;Kim, Jae Wha;Jeong, Jae Cheol;Lee, Ik-Soo;Ha, Byung-Jo;Yoo, Ick-Dong
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.42 no.3
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    • pp.269-278
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    • 2016
  • In searching for novel agents for skin anti-aging from natural resources, we found that the extract of the fruiting bodies of Ramaria formosa (R. formosa) had significant antioxidant and human neutrophil elastase (HNE) inhibitory activities. R. formosa extract exhibited a considerable DPPH radical scavenging activity with an antioxidant content of 117.0mg/mL (ascorbic acid equivalents) at the concentration of $500{\mu}g/mL$. The capacity of R. formosa extract to scavenge peroxy radicals measured by ORAC assay also showed dose-dependent antioxidant effect with $ORAC_{Roo}$ (trolox equivalents, $1{\mu}M$) values of 0.8, 5.2, and 7.8 at the concentrations of 1, 10, and $20{\mu}g/mL$. The cellular antioxidant capacity of R. formosa extract was investigated by assaying the cellular fluorescence intensity using dichlorodihydrofluorescein (DCF). The cellular oxidative stress induced by AAPH, $Cu^{2+}$ or $H_2O_2$ in HepG2 cells was significantly attenuated by more than 30% at $20{\mu}g/mL$ of R. formosa extract. HNE activity was reduced by treatment with R. formosa extract in a dose-dependent manner, and the $ED_{50}$ value for the ethanol extract of R. formosa was $42.9{\mu}g/mL$. R. formosa extract did not exhibited antimicrobial activity against four microorganisms including Bacillus subtilis (B. subtilis), Escherichia coli (E. coli), Candida albicans (C. albicans), Aspergillus oryzae (A. oryzae). Furthermore, the extract did not affect the inflammatory cytokine production of interleukin-10 and interferon-${\gamma}$ in NK92 cells. From the above results, we found that R. formosa extract has considerable antioxidant and elastase inhibitory effects, and does not stimulate immune cells. These findings suggest that R. formosa extract may be used as a bioactive component in cosmetic composition.