• The Korean Journal of Pain
• /
• v.9 no.1
• /
• pp.235-238
• /
• 1996

Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q-wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronary spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.4
• /
• pp.292-300
• /
• 2008

Background: Respiratory failure is a common condition that requires intensive care, and has a high mortality rate despite the recent improvements in respiratory care. Previous reports of patients with respiratory failure focused on the specific disease or included a large proportion of surgical patients. This study evaluated the clinical characteristics, outcomes and prognostic factors of adult patients receiving mechanical ventilation in a medical intensive care unit. Methods: Retrospective chart review was performed on 479 adult patients, who received mechanical ventilation for more than 48 hours in the medical ICU of one tertiary referral hospital. Results: The mean age of the patients was $60.3{\pm}15.6$ years and 34.0% were female. The initial mean APACHE III score was $72.3{\pm}25$. The cause of MV included acute respiratory failure (71.8%), acute exacerbation of chronic pulmonary disease (20.9%), coma (5.6%), and neuromuscular disorders (1.7%). Pressure controlled ventilation was used as the initial ventilator mode in 67.8% of patients, and pressure support ventilation was used as the initial weaning mode in 83.6% of the patients. The overall mortality rate in the ICU and hospital was 49.3% and 55.4%, respectively. The main cause of death in hospital was septic shock (32.5%), respiratory failure (11.7%), and multiorgan failure (10.2%). Males, an APACHE III score >70, the cause of respiratory failure (interstitial lung disease, coma, aspiration, pneumonia, sepsis and hemoptysis), the total ventilation time, and length of stay in hospital were independently associated with mortality. Conclusion: The cause of respiratory failure, severity of the patients, and gender appears to be significantly associated with the outcome of mechanical ventilatory support in patients with respiratory failure.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.23 no.1
• /
• pp.45-49
• /
• 2019

Purpose Lung Ventilation Scan(LVS) images directly inhaled radiation gas to evaluate lung ventilation ability. Therefore, it is influenced by various factors related to inhalation, including number of breaths, respiratory duration, respiration rate, and breathing method. In actual LVS examinations, it is difficult for objectify the patient's ability to inhale, and there is currently no known index related to inhalation. Therefore, this study confirms the correlation between counts per second(cps) in LVS and the results of pulmonary function test(PFT) and evaluate its usefulness as an objective indicator of inhalation. Materials and Methods From October 2010 to September 2018, 36 Chronic Obstructive Pulmonary Disease(COPD) patients who had both LVS and PFT were classified by severity(Mild, Moderate, Severe). LVS was performed by creating Technegas with Vita Medical's Technegas Generator and inhaling it to the patient. LVS images were acquired with Philips's Forte equipment., and PFT used Carefusion's Vmax Encore 22. The correlation between the cps measured by setting the region of interest(ROI) of both lungs on the LVS and the forced vital capacity(FVC), forced expiratory volume in one second($FEV_1$), $FEV_1/FVC$ of the results of PFT was compared and analyzed. Results We analyzed the correlation between cps of LVS using Technegas and the results of PFT by classifying COPD patients according to severity. Correlation coefficient between $FEV_1/FVC$ and cps was Severe -0.773, Moderate -0.750, and Mild -0.437. The Severe and Modulate result values were statistically significant(P<0.05) and Mild was not significant(P=0.155). On the other hand, the correlation coefficient between FVC and cps was statistically significant only in Mild and it was 0.882(P<0.05). Conclusion According to the study, we were able to analyze correlation between cps of LVS using Technegas and the results of PFT in COPD Patients. Using this result, when performing a LVS, the results of PFT can be used as an index of inhaling capacity. In addition, it is thought that it will be more effective for the operation of the exam rooms.

• Tuberculosis and Respiratory Diseases
• /
• v.41 no.6
• /
• pp.663-669
• /
• 1994

Kartagener's sydrome is an autosomaly inherited recessive condition characterized by situs inversus, bronchiectasis, and chronic sinusitis. And recently it was recognized as a subclass of dyskinetic cilia syndrome which caused by a defect in mucociliary transport owing to immotile or dyskinetic beating of cilia. Electron microsopy of cilia from sperm tails, nasal and bronchial epithelium of patients reveals the partial or complete absence of dynein arms. Our four patients were diagnosed as a Kartagener's syndrome by classic triad. We carried out electron microscopy of cilia of the nasal mucosa. And many other tests were done. One patient had squamous cell carcinoma of the lung, and another one patient revealed features of adult respiratory distress syndrome at admission. All patients improved with conservative therapy such as physiotherapy, bronchodilater, antibiotics except one patient who mechanical ventilation was required. A brief review of literature was made.

• Tuberculosis and Respiratory Diseases
• /
• v.63 no.5
• /
• pp.423-429
• /
• 2007

Background: Alveolar recruitment (RM) is one of the primary goals of respiratory care for an acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The purposes of alveolar recruitment are an improvement in pulmonary gas exchange and the protection of atelectrauma. This study examined the effect and safety of the alveolar RM using pressure control ventilation (PCV) in early ALI and ARDS patients. Methods: Sixteen patients with early ALI and ARDS who underwent alveolar RM using PCV were enrolled in this study. The patients data were recorded at the baseline, and 20 minutes, and 60 minutes after alveolar RM, and on the next day after the maneuver. Alveolar RM was performed with an inspiratory pressure of $30cmH_2O$ and a PEEP of $20cmH_2O$ in a 2-minute PCV mode. The venous $O_2$ saturation, central venous pressure, blood pressure, pulse rate, $PaO_2/FiO_2$ ratio, PEEP, and chest X-ray findings were obtained before and after alveolar RM. Results: Of the 16 patients, 3 had extra-pulmonary ALI/ARDS and the remaining 13 had pulmonary ALI/ARDS. The mean PEEP was 11.3 mmHg, and the mean $PaO_2/FiO_2$ ratio was 130.3 before RM. The $PaO_2/FiO_2$ ratio increased by 45% after alveolar RM. The $PaO_2/FiO_2$ ratio reached a peak 60 minutes after alveolar RM. The Pa$CO_2$ increased by 51.9 mmHg after alveolar RM. The mean blood pressure was not affected by alveolar RM. There were no complications due to pressure injuries such as a pneumothorax, pneumomediastinum, and subcutaneous emphysema. Conclusion: In this study, alveolar RM using PCV improved the level of oxygenation in patients with an acute lung injury and acute respiratory distress syndrome. Moreover, there were no significant complications due to hemodynamic changes and pressure injuries. Therefore, alveolar RM using PCV can be applied easily and safely in clinical practice with lung protective strategy in early ALI and ARDS patients.

• Clinical and Experimental Pediatrics
• /
• v.46 no.2
• /
• pp.198-202
• /
• 2003

Of all toxic inhalant exposures, chlorine is one of the most common toxic chemical inhalants. When acutely inhaled, it can be responsible for symptoms ranging from upper air way irritation to more serious respiratory effects. It can also deteriorate lung function and lead to death. Chlorine and its compounds such as chlorinated cyanurates and hypochlorites are commonly used in water disinfection. The chemical agents discussed in this article are sodium dichloroiso cyanurate and calcium hypochlorite which are the two most popular products for swimming pool chlorination. They are both strong oxidizing agents which are soluble in water. Between the above two alkali agents, acid-base interaction occurred and generated heat. And the acid drove the combination of hypochlorous and chloride ions to form chlorine gas. We have experienced, two boys who had inhalation injuries caused by an accidental explosion which occurred in a swimming pool by mixing two different chlorinating agents : sodium dichloroiso cyanurate and calcium hypochlorite. The children suffered from respiratory difficulties after the exposure. They both required intensive care management and one needed the support of mechanical ventilation.

• Safety and Health at Work
• /
• v.13 no.2
• /
• pp.227-234
• /
• 2022

Background and Purpose: In 2021, lung cancer in school food workers was first recognized as an occupational cancer. The classification of the carcinogenicity of cooking fumes by International Agency for Research on Cancer (IARC) was based on Chinese epidemiological data. This study aimed to determine the hazard levels of school cooking fumes in Korea. Materials and Methods: Based on public school cafeterias in one area, 25 locations were selected for the survey according to the number per school type, ventilation states, and environmental pre-assessments of cafeterias. Two inside cooking areas using a heat source and one outside cooking area were selected as control measurement points. Measurements of CO, CO₂, polycyclic aromatic hydrocarbons (PAHs), and total volatile organic compounds (TVOCs), including benzene, formaldehyde, and particulate matter (PM10, PM2.5, PM1, respectively), were taken. The concentrations and patterns of each substance in the kitchens were compared with the outdoor air quality. Result: Known carcinogens, such as the concentrations of PAHs, formaldehyde, TVOC (benzene), and particulate matter in school cooking fumes, were all detected at similar or slightly higher levels than those found outside. Additionally, substances were detected at relatively low concentrations compared to the Chinese cooking fumes reported in the literature. However, the short-term exposure to high concentrations of CO (or composite exposure with CO₂) and PM2.5 in this study were shown. Conclusion: The school cooking fumes in South Korea was a relatively less harmful than Chinese cooking fumes, however short-term, high exposure of toxic substances can cause a critical health effect.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.5
• /
• pp.763-773
• /
• 1996

Background : Behçet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behçet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behçet's syndrome is a unique clinical feature, differing from other vasculitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behçet's syndrome. Methods: We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behçet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses. Results: 1) The incidence of the lung involvement in Behçet's syndrome was 2%(10/487). The male to female ratio was 8 : 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary aneries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis. Conclusion : Pulmonary vasculitis is a main feature of the lung involvement of Behçet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behçet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

• Tuberculosis and Respiratory Diseases
• /
• v.48 no.4
• /
• pp.448-463
• /
• 2000

Background : Pulmonary infiltrate is a frequent cause of morbidity and mortality in patients with leukemia. It is often hard to obtain a reliable diagnosis by clinical and radiologic findings alone. The aim of this study was to evaluate diagnostic and therapeutic benefits of invasive procedures for new lung infiltrates in leukemia. Methods : Patients with leukemia who developed new lung infiltrates from December 1994 to March 1999 were included in this study. These patients were classified into the empirical group who received empirical therapy only and into the invasive group who underwent bronchoscopy or surgical lung biopsy for the diagnostic purpose of new lung infiltrates. A retrospective chart review was done to find the etiologies of new lung infiltrates, the yield of invasive procedures, outcome as well as predicting factors for survival. Results : 1) One hundred-two episodes of new lung infiltrates developed in 90 patients with leukemia. Invasive procedures were performed in 44 episodes while 58 episodes were treated with empirical therapy only. 2) Invasive procedures yielded a specific diagnosis in 72.7%(32/44), of which 78.1% had infectious etiology. Therapeutic plan was changed in 52.3%(23/44) of patients after invasive procedures. None of them showed procedure-related mortality. 3) The overall survival rate was 62.7%(64/102). Survival rate in the invasive group (79.5%) was significantly better than that in the empirical group (50.0%) (p=0.002). 4) Upon multivariate analysis, the performance of invasive procedures, no need for mechanical ventilation and achievement of complete remission of leukemia after induction chemotherapy were the independent predicting factors for survival in patients with leukemia and new lung infiltrates. Conclusion : Bronchoscopy and surgical lung biopsy are useful in the diagnosis of new lung infiltrates in patients with leukemia. However, survival benefits of invasive procedures should be considered together with disease status of leukemia and severity of respiratory compromise.

• Environmental Analysis Health and Toxicology
• /
• v.31
• /
• pp.11.1-11.6
• /
• 2016

Objectives A hazard assessment of di(2-ethylhexyl) phthalate (DEHP), a commonly used workplace chemical, was conducted in order to protect the occupational health of workers. A literature review, consisting of both domestic and international references, examined the chemical management system, working environment, level of exposure, and possible associated risks. This information may be utilized in the future to determine appropriate exposure levels in working environments. Methods Hazard assessment was performed using chemical hazard information obtained from international agencies, such as Organization for Economic Cooperation and Development-generated Screening Information Data Set and International Program on Chemical Safety. Information was obtained from surveys conducted by the Minister of Employment and Labor ("Survey on the work environment") and by the Ministry of Environment ("Survey on the circulation amount of chemicals"). Risk was determined according to exposure in workplaces and chemical hazard. Results In 229 workplaces over the country, 831 tons of DEHP have been used as plasticizers, insecticides, and ink solvent. Calculated 50% lethal dose values ranged from 14.2 to 50 g/kg, as determined via acute toxicity testing in rodents. Chronic carcinogenicity tests revealed cases of lung and liver degeneration, shrinkage of the testes, and liver cancer. The no-observed-adverse-effect level and the lowest-observed-adverse-effect level were determined to be 28.9 g/kg and 146.6 g/kg, respectively. The working environment assessment revealed the maximum exposure level to be $0.990mg/m^3$, as compared to the threshold exposure level of $5mg/m^3$. The relative risk of chronic toxicity and reproductive toxicity were 0.264 and 0.330, respectively, while the risk of carcinogenicity was 1.3, which is higher than the accepted safety value of one. Conclusions DEHP was identified as a carcinogen, and may be dangerous even at concentrations lower than the occupational exposure limit. Therefore, we suggest management of working environments, with exposure levels below $5mg/m^3$ and all workers utilizing local exhaust ventilation and respiratory protection when handling DEHP.