• Tuberculosis and Respiratory Diseases
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• v.47 no.5
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• pp.609-617
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• 1999

Background: The aims of this study were to assess the etiologies, survival and prognostic factors of patients with chronic cor pulmonale visited Pusan National University Hospital. Methods : This study included 103 patients with chronic cor pulmonale. There were 67 men and 36 women. The diagnosis of chronic cor pulmonale was primarily based on the presence of underlying lung disorder and echocardiographic finding of enlarged or hypertrophied right ventricle. Other clinical data including patients' symptoms and signs, findings of arterial blood gas analysis, hematologic and biochemical laboratory and pulmonary function test were assessed. Results: The most common underlying lung disorder was pulmonary tuberculosis(59.2%) and chronic obstructive pulmonary disease was the next(28.2%). The survival rate was 57% in one year, 45% in two years, and 34% in three years. The prognostic factors were maximal voluntary ventilation(MVV), forced vital capaoity(FVC), $FEV_1$ serum Na, vital capacity(VC), serum albumin and peak expiratory flow(PEF) in univariate analysis. And in multivariate analysis, serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant. Conclusion: Pulmonary tuberculosis was the most important underlying lung disorder in chronic cor pulmonale. The survival rate was 57% in one year, 45% in two years, and 34% in three years. Serum albumin (p=0.0144) and VC(p=0.0078) were statistically significant prognostic factors.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.558-570
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• 1996

Background : The detection of Collapsible airways has important therapeutic implications in chronic airway disease and bronchial asthma. The distinction of a purely collapsible airways disease from that of asthma is important because the treatment of the dormer may include the use of pursed lip breathing or nasal positive pressure ventilation whereas in the latter, pharmacologic approaches are used. One form of irreversible airflow limitation is collapsible airways, which has been shown to be a Component of asthma or to emphysema, it can be assessed by the volume difference between what exits the lung as determined by a spirometer and the volume compressed as measured by the plethysmography. Method : To investigate whether volume difference between slow and forced vital Capacity(SVC-FVC) by spirometry may be used as a surrogate index of airway collapse, we examined pulmonary function parameters before and after bronchodilator agent inhalation by spirometry and body plethysmography in 20 cases of patients with evidence of airflow limitation(chronic obstructive pulmonary disease 12 cases, stable bronchial asthma 7 cases, combined chronic obstructive pulmonary disease with asthma 1 case) and 20 cases of normal subjects without evidence of airflow limitation referred to the Pusan National University Hospital pulmonary function laboratory from January 1995 to July 1995 prospectively. Results : 1) Average and standard deviation of age, height, weight of patients with airflow limitation was $58.3{\pm}7.24$(yr), $166{\pm}8.0$(cm), $59.0{\pm}9.9$(kg) and those of normal subjects was $56.3{\pm}12.47$(yr), $165.9{\pm}6.9$(cm), $64.4{\pm}10.4$(kg), respectively. The differences of physical characteristics of both group were not significant statistically and male to female ratio was 14:6 in both groups. 2) The difference between slow vital capacity and forced vital capacity was $395{\pm}317ml$ in patients group and $154{\pm}176ml$ in normal group and there was statistically significance between two groups(p<0.05). Sensitivity and specificity were most higher when the cut-off value was 208ml. 3) After bronchodilator inhalation, reversible airway obstructions were shown in 16 cases of patients group, 7 cases of control group(p<0.05) by spirometry or body plethysmography d the differences of slow vital capacity and forced vital capacity in bronchodilator response group and nonresponse group were $300.4{\pm}306ml$, $144.7{\pm}180ml$ and this difference was statistically significant. 4) The difference between slow vital capacity and forced vital capacity before bronchodilator inhalation was correlated with airway resistance before bronchodilator(r=0.307 p=0.05), and the difference between slow vital capacity and forced vital capacity after bronchodilator was correlated with difference between slow vital capacity and forced vital capacity(r=0.559 p=0.0002), thoracic gas volume(r=0.488 p=0.002) before bronchodilator and airway resistance(r=0.583 p=0.0001), thoracic gas volume(r=0.375 p=0.0170) after bronchodilator, respectively. 5) The difference between slow vital capacity and forced vital capacity in smokers and nonsmokers was $257.5{\pm}303ml$, $277.5{\pm}276ml$, respectively and this difference did not reach statistical significance(p>0.05). Conclusion : The difference between slow vital capacity and forced vital capacity by spirometry may be useful for the detection of collapsible airway and may help decision making of therapeutic plans.

• Tuberculosis and Respiratory Diseases
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• v.42 no.5
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• pp.713-722
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• 1995

Background: Chest X-ray of coal workers' pneumoconiosis and shipyard welders' lung show similar and regular opacities mostly, it is very difficult that we distinguish the former from the latter by only chest X-ray. so we performed this study to understand the progression of the disease and to provide the disease by considering pulmonary function and other factors in proportion to the profusion of small regular opacities of chest X-ray in both groups. Method: 430 coal workers' pneumoconiosis were compared with 311 shipyard welders' lung by the number, the age, the duration of dust exposure, %vital capacity(%VC), %FEV1.0, the type of ventilatory impairment, the combined pulmonary disease according to the profusion of small regular opacities on the chest radiographs, which were classified into category 0/1, category 1, and category 2. Result: 1) the percent of category 2 in coal workers' pneumoconiosis was 54.4%. the percent of category 1, and category 2 in welders' lung were 60.0%, 7.4%. the progression to the category 2 was higher in coal workers' pneumoconiosis than in welders' lung 2) The mean age was higher in coal workers' pneumoconiosis than in welders' lung, significantly increased in proportion to the progresion of profusion of small regular opacities in both groups 3) There was no difference in the duration of dust exposure by category 1/0, but the duration of dust exposure by category 1, 2 in coal workers' pneumoconiosis more significantly increased than in welders' lung. the duration in the proportion of category 2 to category 0/1, 1 significantly increased in the proportion to small regular opacities in coal workers' pneumoconiosis. but there was no significant difference in the proportion to small regular opacities in duration of dust exposure in welders' lung. 4) There was no significant difference of mean values of %VC(%vital capacity)in both groups except for category 1. the mean values of %VC had no relationship between the progression of small regular opacities in both groups. 5) The mean values of %FEV1.0 decreased more significantly in coal workers' pneumoconiosis than in welders' lung except for category 0/1. and decreased significantly in proportion to the profusion of small regular opacities in coal workers' pneumoconiosis. there was significant difference of %FEV1.0 in the proportion of category 2 to category 011 in welders' lung. 6) there were no significant difference of %FEV1.0, %VC in smoker and nonsmoker in both groups. 7) With regard to the type of ventilation in both groups in coal workers' pneumoconiosis 21.4 percent of patients belonged to the restrictive type, 11.6 percent to the obstructive type, 5.6 percent to the combined type, but in welders' lung 21.8 percent to the restrictive type, 2.9 percent to the obstructive type, 1.9 percent to the combined type. 8. in the pulmonary disease, the incidence of the pulmonary tuberculosis was the most in both groups, was more in coal workers' pneumoconiosis than welders' lung Conclusion: If we compare coal workers' pneumoconiosis with electric arc welders'lung by considering pulmonary function and other factors in proportion to the profusion of chest X-ray, I think that we will have the better result in understanding the progression of the disease and provision of the disease in both groups.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.653-662
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• 2006

Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial $PaO_2/$FiO_2$ratio and COHb were $286.4{\pm}129.6mmHg$ and $7.8{\pm}6.6%$. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.367-371
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• 2008

Purpose : The surfactant dysfunction may play an important role in meconium aspiration syndrome (MAS). We aim to evaluate the effect of surfactant lavage in the treatment of term infants with MAS. Methods : The medical records of 15 neonates with severe MAS admitted at Yongdong Severance Hospital from 2005 to 2007 were reviewed and analyzed. Seven infants with severe MAS necessitating mechanical ventilation underwent tracheobronchial lavage with 20 mL/kg of diluted (5.3 mg phospholipid/mL) surfactant saline suspension ($Newfactan^{(R)}$). Data regarding clinical outcomes was assessed by comparison with 8 control infants with equally severe MAS retrospectively. Results : In the lavage group, radiological improvement was evident after 6 hours of treatment. The duration of artificial ventilation and duration of hospital day were also significantly shorten in the lavage group compared with the control group. The mean oxygen index, mean ventilation index improved significantly within the first 6 hours after treatment. No differences were found in the incidence of major complications and mortality between the two groups. Conclusion : The surfactant lavage seems to be an effective and safe method for treatment of severe MAS. A multicenter, large scaled randomized controlled trial is needed for further study.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1118-1122
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• 1996

From January 1990 through December 1995, 43 patients underwent diaphragmatic plication for the management of phrenic nerve palsy .complicating various pediatric cardiovascular surgery. Their mean age at plication was 11.1 months and sex ratio was 31 males to 12 females. In order of decreasing incidence, the primary cardiovascular procedures included modified Blalock-Taussig shunt (7), total correction for the Tetralogy of Falloff (7), arterial switch operation (6), unifocalization for the pulmonary atresia with VSD (3), modified Fontan operation (3), VSD patch closure (3) and others. The involved sides of diaphragm were right in 17, left in 2) and bilateral in 3. Extensive pericardial resection with electocauterization of resected margin was thought to be the most common cause of phrenic nerve palsy (20). The interval between primary operation and plication ranged from the day of operation to 98 days (median 11 days). The methods of plication were central pleating technique(plication with phrenic nerve branch preservation) in 41, and other technique In 2. 10 patients died after plication (7: early, 3; late), and the causes of death were thought to be unrelated to plication itself. Among the 36 early survivors, extubation or cessation of positive pressure ventilation could be accomplished between 1 and 24 days postoperatively(mean : 4.5). Cumulative follow-up was 92 patient years without major complications. Postoperative follow-up fluoroscopy was performed in 6 patients, and the location and movement of plicated diaphragms were satisfactory in 5 patients. We concluded that diaphragmatic plication with preservation of phrenic n rve branch could lead to cessation of positive pressure ventilation and complete recovery of diaphragmatic function in the long term, unless the phrenic nerve was irreversibly damaged.

• The Korean Journal of Physiology
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• v.11 no.2
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• pp.45-50
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• 1977

The maximum voluntary ventilation (MVV) is one of the most widely used pulmonary function test, but its measuring method was very difficult and unreliable. However, it is need to get more easy and simple measuring method of MVV. Therefore, this study was attempted to get more easy and simple measuring method of MVV by means of the forced expiratory volume $(FEV_{T})$. The young and healthy 1,000 Korean students(592 male and 408 female) were cheesed for this purpose and whose ages were from 8 to 20 years. A spirometer (9L, Collins Co.) was used for the MVV and FEV, and they were measured 3 times at standing position, and the highest value was used. In the measurements, the subjects for MVV were asked for the breath as fast and deeply as possible for 12 seconds, and for FEV were asked for the rapid and forceful exhalation after a maximal inhalation (forced expiratory curve). In the FEV measurements toward the end of the expiration, the subjects were exhaused to continue the effort until no further gas was expired. During these measurements, the investigator stood by the subject to give a constant encouragement. FEV were calculated in the volume exhaled during the one-half $(FEV_{0{\cdot}5,}\;ml)$, the first second $(FEV_{1{\cdot}0,}\;ml)$ and the percentage of the total vital capacity exhaled during the one-half second $(FEV_{0{\cdot}5,}\;%)$. The results are summarized as follows: 1) The values of MVV were increased linearly with ages until 20 in both sexes. The values of male at the age of 20 was $168.2{\pm}2.5L/min$, and female at the age of 17 was $112.3{\pm}3.0L/min$, respectively. 2) The values of FEV (ml) were increased linearly with ages until 20 in both sexes. The values of $FEV_{0{\cdot}5}$ were $2,797{\pm}65.7ml$ in the male of 20 years and were $2,088{\pm}54.6ml$ in the female of 17 years, and of $FEV_{1{\cdot}0$ were $4,119{\pm}68.2ml$ in the male of 20 years and were $2,897{\pm}65.9ml$ in the female of 17 years, respectively. 3) The correlation coefficients between MVV and $FEV_{0{\cdot}5}\;or\;FEV_{1{\cdot}0$ (ml) were 0.82 or 0.85 in the male, and 0.77 or 0.79 in the female, respectively. 4) The prediction formulae for MVV to be derived from above results were: For male: MVV (L/min) =7.19+$0.05{\times}FEV_{0\cdot5}(ml)$, MVV (L/min)=11.25+$0.04{\times}FEV_{1\cdot0}(ml)$ For female: MVV (L/min)=16.03+$0.05{\times}FEV_{0\cdot5}(ml)$, MVV (L/min)=9.47+$0.03{\times}FEV_{1\cdot0}(ml)$.

• Tuberculosis and Respiratory Diseases
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• v.47 no.3
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• pp.356-364
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• 1999

Backgrounds: Previous reports have revealed a high morbidity and mortality in fatal asthma patients, especially those treated in the medical intensive care unit(MICU). But it has not been well known about the predictable factors for the mortality of fatal asthma(F A) with acute respiratory failure. In order to define the predictable factors for the mortality of FA at the admission to MICU, we analyzed the relationship between the clinical parameters and the prognosis of FA patients. Methods: A retrospective analysis of all medical records of 59 patients who had admitted for FA to MICU at a tertiary care MICU from January 1992 to March 1997 was performed. Results: Over all mortality rate was 32.2% and 43 patients were mechanically ventilated. In uni-variate analysis, the death group had significantly older age ($66.2{\pm}10.5$ vs. $51.0{\pm}18.8$ year), lower FVC($59.2{\pm}21.1$ vs. $77.6{\pm}23.3%$) and lower $FEV_1$($41.4{\pm}18.8$ vs. $61.l{\pm}23.30%$), and longer total ventilation time ($255.0{\pm}236.3$ vs. $98.1{\pm}120.4$ hour) (p<0.05) compared with the survival group (PFT: best value of recent 1 year). At MICU admission, there were no significant differences in vital signs, $PaCO_2$, $PaO_2/FiO_2$, and $AaDO_2$, in both groups. However, on the second day of MICU, the death group had significantly more rapid pulse rate ($121.6{\pm}22.3$ vs. $105.2{\pm}19.4$ rate/min), elevated $PaCO_2$ ($50.1{\pm}16.5$ vs. $41.8{\pm}12.2 mm Hg$), lower $PaO_2/FiO_2$, ($160.8{\pm}59.8$ vs. $256.6{\pm}78.3 mm Hg$), higher $AaDO_2$ ($181.5{\pm}79.7$ vs. $98.6{\pm}47.9 mm Hg$), and higher APACHE III score ($57.6{\pm}21.1$ vs. $20.3{\pm}13.2$) than survival group (p<0.05). The death group had more frequently associated with pneumonia and anoxic brain damage at admission, and had more frequently developed sepsis during disease progression than the survival group (p<0.05). Multi-variate analysis using APACHE III score and $PaO_2/FiO_2$, ratio on first and second day, age, sex, and pneumonia combined at admission revealed that APACHE III score (40) and $PaO_2/FiO_2$ ratio (<200) on second day were regarded as predictive factors for the mortality of fatal asthma (p<0.05). Conclusions: APACHE III score ($\geq$40) and $PaO_2/FiO_2$ ratio (<200) on the second day of MICU, which might reflect the response of treatment, rather than initially presented clinical parameters would be more important predictable factors of mortality in patients with FA.

• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.55-64
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• 1995

During sleep, relatively major respiratory physiological changes occur in healthy subjects. The contributions and interactions of voluntary and metabolic breathing control systems during waking and sleep are quite different Alterations of ventilatory control occur in chemosensitivity, response to mechanical loads, and stability of ventilation. The activities of intercostal muscles and muscles involved in regulating upper airway size are decreased during sleep. These respiratory physiological changes during sleep compromise the nocturnal ventilatory function, and sleep is an important physiological cause of the nocturnal alveolar hypoventilation. There are several causes of chronic alveolar hypoventilation including cardiopulmonary, neuromuscular diseases. Obstructive sleep apnea syndrome (OSAS) is an important cause of nocturnal hypoventilation and hypoxia. Coexistent cardiopulmonary or neuromuscular disease in patients with OSAS contributes to the development of diurnal alveolar hypoventilation, diurnal hypoxia and hypercapnia. The existing data indicates that nocturnal recurrent hypoxia and fragmentation of sleep in patients with OSAS contributes to the development of systemic hypertension and cardiac bradytachyarrhythmia, and diurnal pulmonary hypertension and cor pulmonale in patients with OSAS is usually present in patients with coexisting cardiac or pulmonary disease. Recent studies reported that untreated patients with OSAS had high long-term mortality rates, cardiovascular complications of OSAS had a major effect on mortality, and effective management of OSAS significantly decreased mortality.

• Sleep Medicine and Psychophysiology
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• v.4 no.2
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• pp.129-139
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• 1997

The data collected to date indicate that sleep-related breathing disorders, including sleep-disordered breathing(sleep apnea) and underlying respiratory system diseases, are one of the important risk factors for cardiovascular dysfunction. Sleep-disordered breathing(sleep apnea) is now recognized as one of the leading causes of systemic hypertension, cardiac arrhythmias, coronary heart disease, pulmonary hypertension, right heart failure, and stroke. Sleep may exert a profound effect on breathing in patients with underlying respiratory system disease including bronchopumonary diseases, chest wall abnormalities, central alveolar hypoventilation syndromes or respiratory neuromuscular disorders. Chronic hypoxia and hypercapnia in these patients may accelerate the development of long term cardiovascular complications such as cardiac arrhythmias, pulmonary hypertension, and right heart failure(cor pulmonale). Several recent studies reported that sleep-related breathing disorders are associated with long-term cardiovascular morbidity and mortality. Careful assessment of respiratory and cardiovascular function in these patients is critical. Aggressive and highly effective treatment of sleep-related breathing disorders using tracheostomy, mechanical ventilation, nasal continuous positive airway pressure therapy(nCPAP), intercurrent oxygen therapy or other interventions can reduce the prevalence of cardiovascular dysfunction and the long-term mortality.