• Journal of Korean Neurosurgical Society
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• v.64 no.5
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• pp.791-798
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• 2021

Objective : The period of mechanical ventilator (MV)-dependent respiratory failure after cervical spinal cord injury (CSCI) varies from patient to patient. This study aimed to identify predictors of MV at hospital discharge (MVDC) due to prolonged respiratory failure among patients with MV after CSCI. Methods : Two hundred forty-three patients with CSCI were admitted to our institution between May 2006 and April 2018. Their medical records and radiographic data were retrospectively reviewed. Level and completeness of injury were defined according to the American Spinal Injury Association (ASIA) standards. Respiratory failure was defined as the requirement for definitive airway and assistance of MV. We also evaluated magnetic resonance imaging characteristics of the cervical spine. These characteristics included : maximum canal compromise (MCC); intramedullary hematoma or cord transection; and integrity of the disco-ligamentous complex for assessment of the Subaxial Cervical Spine Injury Classification (SLIC) scoring. The inclusion criteria were patients with CSCI who underwent decompression surgery within 48 hours after trauma with respiratory failure during hospital stay. Patients with Glasgow coma scale 12 or lower, major fatal trauma of vital organs, or stroke caused by vertebral artery injury were excluded from the study. Results : Out of 243 patients with CSCI, 30 required MV during their hospital stay, and 27 met the inclusion criteria. Among them, 48.1% (13/27) of patients had MVDC with greater than 30 days MV or death caused by aspiration pneumonia. In total, 51.9% (14/27) of patients could be weaned from MV during 30 days or less of hospital stay (MV days : MVDC 38.23±20.79 vs. MV weaning, 13.57±8.40; p<0.001). Vital signs at hospital arrival, smoking, the American Society of Anesthesiologists classification, Associated injury with Injury Severity Score, SLIC score, and length of cord edema did not differ between the MVDC and MV weaning groups. The ASIA impairment scale, level of injury within C3 to C6, and MCC significantly affected MVDC. The MCC significantly correlated with MVDC, and the optimal cutoff value was 51.40%, with 76.9% sensitivity and 78.6% specificity. In multivariate logistic regression analysis, MCC >51.4% was a significant risk factor for MVDC (odds ratio, 7.574; p=0.039). Conclusion : As a method of predicting which patients would be able to undergo weaning from MV early, the MCC is a valid factor. If the MCC exceeds 51.4%, prognosis of respiratory function becomes poor and the probability of MVDC is increased.

• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.628-637
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• 2004

Background : Percutaneous needle aspiration biopsy(PNAB) of the lung is a safe procedure for diagnosis of various pulmonary diseases but complications such as pneumothorax can occasionally develop. We reviewed the complications arising after PNAB and analysed the risk factors of pneumothorax. Method : We collected data by reviewing medical records and radiographic studies of 403 patients who underwent PNAB of the lung between 1988 and 2002 and analyzed the risk factors of pneumothorax. Result : The incidence of complication was 12.9%, 48 patients with pneumothorax and 4 patients with mild hemoptysis. Among the 48 pneumothorax patients, 35 patients showed mild(<20%) and was treated by only oxygen supply, 11 patients had severe pneumothorax(>50%) and chest tube insertion was done and 2 patients were treated by needle aspiration. As the results of multivariate analysis, size and location of lesion, location of approach, diagnosis of lesion showed no significant relationship, while age and gender of patients(p<0.05) and the depth of approach(p<0.001) were significantly related to pneumothorax. Smoking amount(p<0.001) as well as the smoking history(p<0.005) were also significantly related and the examiner displaying various incidence of pneumothorax from 4.0% to 23.1% among individuals also was a significant independent risk factor(p<0.05). While the average depth of approach for 13 patients treated by chest tube insertion or needle aspiration was $8.2{\pm}1.2cm$, 35 patiens treated only by oxygen supply was $6.7{\pm}1.6cm$ suggesting that the depth of approach was lead to a severe pneumothorax. Conclusion : The independent risk factors of pneumothorax, the most common complication after PNAB, are age and gender of patients, depth of approach, examiner of procedure, smoking history and smoking amount.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.64-67
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• 2016

Congenital tuberculosis (TB) is a rare disease that is associated with high mortality. Mycobacterium tuberculosis, the causative agent, may be transmitted from the infected mother to the fetus by the transplacental route or by aspiration of infected amniotic fluid. Clinical symptoms and signs are not specific. Miliary patterns are the most common findings in the chest X-rays of many infants with congenital TB. In this case, an 18-day-old boy had jaundice on the fifth day of birth, and fever and respiratory distress appeared on the 18th day. Chest X-ray showed diffuse fine bilateral infiltration. Clinically, pneumonia or sepsis was suspected. Respiratory symptoms and chest X-ray findings worsened despite empirical antibiotic therapy. The lungs showed miliary infiltration suggestive of TB. Gastric aspirates were positive for M. tuberculosis. Respiratory distress and fever were gradually improved after anti-TB medication. Congenital TB is difficult to detect because of minimal or no symptoms during pregnancy and nonspecific symptoms in neonates. Hence, clinicians should suspect the possibility of TB infection even if neonates have non-specific symptoms. Early diagnosis and meticulous treatment are required for the survival of neonates with TB.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.122-128
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• 1999

Granular cell tumor(formerly named to be granular cell myoblastoma) was first described by Abrikossoff in 1926 and is a rare tumor thought to be of Schwann cell origin. It can occur at any soft tissue of the body, but most cases are found at the tongue, skin, breast and GI tract Only 6% of them occur in respiratory system. We report two cases of asymptomatic granular cell tumor of the bronchus that were detected incidentally by bronchoscopy. One patient had aspiration pneumonia, the other had immotile cilia syndrome. The former patient was simply observed and bronchoscopic extirpation of the tumor was done in the latter patient.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.89-93
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• 2014

Background: This study was conducted to investigate the epidemiological features, clinical courses, and diagnoses of neonates who are transferred to neonatal intensive care unit of Yeungnam University Hospital due to tachypnea soon after birth. Methods: Based on medical records, we performed a retrospective study of neonatal intensive care unit admissions due to tachypnea from January 2010 to December 2013. Results: A total of 311 neonates were included in this study. The patient characteristics showed male predominance at 2.65:1. Among the 311 neonates with tachypnea, 127 (40.8%) neonates needed oxygen supply, and 54 (17.4%) neonates needed assisted mechanical ventilation. Transient tachypnea of the newborns (TTN) (158, 50.8%) showed the highest incidence, followed by pneumonia (63, 20.3%), extrapulmonary infection (37, 11.9%), respiratory distress syndrome (21, 6.8%), air leak (16, 5.1%), meconium aspiration syndrome (12, 3.9%), congenital heart disease (5, 1.6%), metabolic acidosis (3, 1%), primary pulmonary hypertension of newborns (2, 0.6%) and anemia (2, 0.6%). Conclusion: Although the neonates with tachypnea showed no other respiratory distress symptom, clinicians should be aware of the possibility of other pulmonary diseases as well as TTN and their extra-pulmonary causes. If tachypnea does not improve within a few hours, the clinician should consider further evaluation and management as soon as possible.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.154-162
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• 1996

Purpose : Adenoviruses(Ad) have been shown to play an important role in the etiology of severely acute respiratory diseases, particulary in infants and young children, and the occurrence of fatal outcome and chronic pulmonary sequelae in association with adenoviral infection has been a cause of great interest and concern. This report presents the resul of a retrospective analysis on 30 cases of lower respiratory infection from which adenovirus was isolated. Patients & Methods : The 30 patients in this study represent all detected cases of adenovial infection out of 240 children who were admitted to Sang Sung Medical Center between February to June 1996 showing signs and symptoms of lower respiratory tract infection. The diagnosis of adenovirus infection was based on microscopic visualization of typical cytopathic effect in HEp-2 tissue culture and used monoclonal Ab with nasopharyngeal aspiration. Results : The male/female ratio was 2:1 and the majority of age range was below 36months. Clinical diagnoses in all 30 patients were pneumonia(n=21), bronchitis and Bronchiolitis(n=5) and ARDS(n=4). We recieved the most of patients in the month of May. The chief complaints were fever(93.3%) and cough(80%) and extrapulmonary symptoms were diarrhea(n=5), seizure(n=4), abdominal pain(n=1). The mean duration of fever was $11.95{\pm}6.54$days. Physical examination on admission were crackles(73.3%), coarse breathing sounds(60%), hepatosplenomegaly(33.3%), decreased brething sounds(30%). In WBC counts, 8cases were below $4000/mm^3$ and 14 cases were above $10,000/mm^3$. In platelets counts, 4cases were below $150,000/mm^3$ and 10 cases were above $450,000/mm^3$. 21 cases were above 1 in CRP. GOT and GPT were abnormal in some cases. Chest X-ray revealed diffuse pulmonary infiltration(n=15), pleural effusion(n=6), consolidation(n=4) and hyperaeration(n=3). Seven patients were treated at the peditric intensive care unit with respiratory support and high dose of gammaglobulin. However, one patients died even through he was treated with NO ventilation and high frequency ventilation. Conclusion : Those with adenoviral pneumonia and respiratory infection having long fever duration and symptoms like bacterial pneumonia must be carefully differentiated in order to provide proper treatement and preventive measures due to possible fatal outcome.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.5 no.1
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• pp.22-28
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• 1994

Previous studies reveal that in English there is no EMG evidence fur the feature tense-lax distinction. The technique of electro-myography(EMG) was used to see if the existing claim holds true, particularly in unstressed syllable. It was found that in unstressed syllable, the peak EMG amplitude from the orbicularis oris superior muscle was significantly greater in /p/ than in /b/, while in stressed syllable this difference was negligible. It was hypothesized that in stressed syllable, /p/ and /b/ may be differentiated by the EMG activities from a muscle other than the orbicularis oris superior muscle, e.g. the respiratory muscles relating to 'aspiration' or depressor anguli oris muscle. In Korean, there was a clear labial gestures for the feature tense-lax distinction. The phoneme-sensitive manifestation of stress and some possible reasons for the inter-speaker variability in the data and the variability within a given speaker were discussed.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.315-320
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• 1989

Dysphagia is common symptom in patients with advanced esophageal cancer, which is not to be resected surgically. Especially when esophagorespiratory fistula is complicated, it leads to rapid deterioration and death due to pulmonary infection. Esophageal intubation relieves dysphagia as simple surgical execution and offers rapid effectiveness. For six patients with inoperable esophageal cancer including three esophago-respiratory fistulas, the palliative esophageal intubation was performed in Korea Cancer Center Hospital, in 1988. Traction technique via high gastrotomy with Celestin tube was used. Adequate palliation of dysphagia was achieved in 5 patients, but wound infection was developed in 2 patients, tube migration in 2 patients, and 2 died in hospital due to sepsis on the 16th and 42nd postoperative day, respectively. In 3 patients with esophagorespiratory fistula complicated after radiation therapy, the intubation was performed urgently and the result was satisfactory in 2 of them that the fistula was occluded successfully and aspiration or pulmonary infection was prevented.

• Korean Journal of Bronchoesophagology
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• v.4 no.2
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• pp.240-243
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• 1998

Subcutaneous emphysema is an unusual and rarely reported complication of tonsillectomy. The more commen complications are hemorrhage, infection and following anesthesia, aspiration, cardiac arrhythmia, and laryngeal trauma can occur. Posttonsillectomy subcutaneous emphysema results directly from the introduction of air into the tonsillar bed either during the surgical procedure itself or in the postoperative period. This condition is generally benign and self limiting and usually requires treatment only for the primary respiratory disease. In this report, we describe a 40-year-old female patient in whom subcutaneous emphysema developed shortly after tonsillectomy. She was observed for 5 days, at which point subcutaneous emphysema was seen on the follow up soft tissue neck X-ray to disappeared.

• Korean Journal of Adult Nursing
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• v.28 no.6
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• pp.628-636
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• 2016

Purpose: This study examined the effects of a program designed to prevent ventilator-associated pneumonia (VAP) on VAP rate and endotracheal colonization. The program focused on aspiration prevention and oral care. Methods: A nonequivalent control group post-test only design was utilized. One hundred patients admitted to a medical intensive care unit (MICU) or coronary care unit (CCU) were assigned to either a experimental group (n=50) or a control group (n=50). The participants were selected 48 hours following an endotracheal intubation. VAP prevention program given to the experimental group includes keeping the head of the bed to $30^{\circ}{\sim}45^{\circ}$ high, maintaining continuous endotracheal cuff pressure at 25 cm $H_2O$, performing endotracheal suction before change position, and providing oral care with 0.1% chlorhexidine every four hours. The control group received usual care. Data were analyzed using t-test, $x^2$ test, Mantel-Haenszel $x^2$ and Cox proportional harzard regression model. Results: The experimental group showed a lower VAP rate than the control group although the difference was not statistically significant ($x^2=0.79$, p=.375). The experimental group showed lower colonization in tracheal secretion than the control group ($x^2=14.59$, p<.001). Conclusion: Results showed that a VAP prevention program is effective in reducing colonization of tracheal secretion. Therefore, VAP prevention programs are recommended as an ICU nursing intervention.