• Journal of Korean Neurosurgical Society
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• 제42권2호
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• pp.97-102
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• 2007

Objective : The authors attempted to evaluate the pattern of the airway narrowing due to prevertebral soft tissue swelling after surgery of the anterior cervical spine and their clinical significances using plain cervical X-ray images. Methods : Twenty-four patients undergoing anterior cervical spine surgery were reviewed from January 2004 to December 2005. Postoperatively, in daily basis, lateral radiograph of the neck was obtained in neutral position. We measured the upper airway diameter above and below the epiglottis level and prevertebral soft tissue diameter every day for a week and finally 2 weeks after surgery using their simple lateral cervical X-ray films. Results : Both airway narrowing and prevertebral soft tissue swelling were maximum in postoperative 2 days, and decreased rapidly in postoperative 7 days. Airway narrowing was aggravated postoperatively but slowly decreased as prevertebral soft tissue swelling diminished. But, the severity of airway narrowing showed no clinical correlations with clinical symptom and radiologic severity. Conclusion : Not all patients who show severe airway narrowing and prevertebral soft tissue swelling on their plain cervical X-ray film complain respiratory insufficiency. But, the patients with undergoing anterior cervical spine surgery should be monitored carefully for respiratory insufficiency, especially during several days following operation because both airway narrowing and prevertebral soft tissue swelling become peak at postoperative 2-3 days.

• 대한치과의사협회지
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• 제48권3호
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• pp.178-183
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• 2010

Obstructive Sleep Apnea(OSA) is a form of sleep disordered breathing(SDB) characterized by the occurrence of episodes of complete or partial upper airway obstruction during sleep that is often quantified as the apnea-hyponea index(AHI). It is increasingly being recognized that OSA is a public health hazard and there is increasing evidence that it is associated with an increase in morbidity. Early recognition and diagnosis of this condition may lead to earlier treatments (eg, CPAP, Oral appliances) with reduction of the risk of metabolic disease, cardiovascular diseases, such as hypertension, ischemic heart disease, arrhythmias and pulmonary hypertension.

• Korean Journal of Radiology
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• 제20권1호
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• pp.50-57
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• 2019

In pediatric thoracic CT, respiratory motion is generally treated as a motion artifact degrading the image quality. Conversely, respiratory motion in the thorax can be used to answer important clinical questions, that cannot be assessed adequately via conventional static thoracic CT, by utilizing four-dimensional (4D) CT. However, clinical experiences of 4D thoracic CT are quite limited. In order to use 4D thoracic CT properly, imagers should understand imaging techniques, radiation dose optimization methods, and normal as well as typical abnormal imaging appearances. In this article, the imaging techniques of pediatric thoracic 4D CT are reviewed with an emphasis on radiation dose. In addition, several clinical applications of pediatric 4D thoracic CT are addressed in various thoracic functional abnormalities, including upper airway obstruction, tracheobronchomalacia, pulmonary air trapping, abnormal diaphragmatic motion, and tumor invasion. One may further explore the clinical usefulness of 4D thoracic CT in free-breathing children, which can enrich one's clinical practice.

• 대한치과의사협회지
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• 제52권10호
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• pp.602-614
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• 2014

폐쇄성 수면 무호흡증(OSAS)환자의 외과적 치료(surgical treatment)로는 다양한 방법들이 있고 수술 방법의 선택시 여러 인자들을 고려해서 선택해야 한다. 즉, 수술은 폐쇄성 수면 무호흡증(OSAS)을 조절하는데 있어 보존적 치료 (non-surgical treatment)의 좋은 대체 방안(alternative chance)이 될 수 있기에, 증상(OSAS)의 주관적(subjective), 객관적(objective), 심각성(severity)을 해부학적 이상(anatomic abnormality) 정도와 연관시켜 적절한 수술법(surgical procedure)을 선택해야 한다. 수술 방법은 한가지 방법을 사용(single-level)하는지, 여러 수술 방법을 통합하여 사용(multi-level)하는지에 따라 다양하며, 그 예후도 각각 다르다. 중요한 점은 다단계 폐색(multilevel obstruction)이 있는 경우에는 다단계 치료(multilevel treatment) 방법이 가장 추천된다는 것이며, 이는 단지 증상(OSAS)의 심각성(severity)을 기준으로만 평가해서는 안되며 경도나 중등도(mild to moderate)의 환자에서도 필요시 보존적 치료(non-surgical treatment)를 시행하기 전에 다단계 외과적 치료(multilevel surgical treatment) 방법을 적극적으로 고려해야 한다. 비록 다단계 치료(multilevel treatment)방법은 상대적으로 짧은 임상 기간을 거쳤지만, 앞으로 지속적인 연구 결과(evidence-based data)를 이어간다면, 개개 환자에 맞는 최적의 치료 방법(optimal surgical intervention)을 제시할 수 있을 것이다.

• Clinical and Experimental Pediatrics
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• 제55권6호
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• pp.212-214
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• 2012

Rubinstein-Taybi syndrome (RTS) is characterized by peculiar facies, mental retardation, broad thumbs, and great toes. Approximately one-third of the affected individuals have a variety of congenital heart diseases. They can also have upper airway obstruction during sleep, due to hypotonia and the anatomy of the oropharynx and airway, which make these patients susceptible to obstructive sleep apnea (OSA). In our case, pulmonary hypertension was caused, successively, by congenital heart defects (a large patent ductus arteriosus and arch hypoplasia) and obstructive sleep apnea during early infancy. The congenital heart defects were surgically corrected, but persistent pulmonary hypertension was identified 2 months after the operation. This pulmonary hypertension was due to OSA, and it was relieved by nasal continuous positive airway pressure. This case is the first report of pulmonary hypertension from OSA in a young infant with RTS.

• 대한한방소아과학회지
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• 제17권1호
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• pp.17-27
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• 2003

Background: Snoring in children, is associated Kith adenotonsillar hypertrophy and sinusitis which contribute to upper airway obstruction, so we studied the sinusitis and adenoid size of snoring children with plain radiography Materials and method: Fifty patients having snoring, nasal obstruction in our hospital between November 2001 and November 2002 were studied using plain radiology PNS(water's view) and Neck lateral view(adenoid size with A/N ratio) Results: 1. In oriental medicine, Hu-Bi means laryngopharyngeal edema and obstruction, laryngopharyngeal disease are due to Hwa-Yeoul( fire and hot), sinus disease are due to Fung-Han(wind and cold) and Fung-Yeoul(wind and hot). 2. Age ranged from 2 to 17 year-old ( mean age: 6 years), 5-7 year-old were 18 patients (36%). Age of on set, 25 patients were 1-4 year-old (50%). 3. Of the 50 snoring patients, 37 patients were sinusitis(74%), 20 patients had enlarged adenoid(40%). Of the 20 large adenoid patients, 19 patients were sinusitis(95%). 4. Of the 50 snoring patients, size of tonsil were flowed. Fifteen were severe(3+), 17 patients were moderate(2+) and 15 patients were mild(1+). Of the 20 enlarged adenoid patients, size of tonsil flowed. Five were severe(3+), 11 patients were moderate(2+) and 4 patients were mild(1+). Conclusion : Of the 50 Snoring patients, 37 patients showed sinusitis(74%), 32 patients showed large tonsil(64%), 20 patients showed large adenoid(40%).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권2호
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• pp.150-156
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• 2004

The etiology of the obstructive sleep apnea includes the various factors such as anatomical abnormality in upper airway, craniofacial structure, obesity and personal habit. To establish reasonable treatment plan, multi-department approach is should be emphasized because the treatment modality is depend on the result of analysis for degree & site of obstruction and various behavioral factors. In Sleep Clinic in Keimyung University Medical Center, the standard of care for sleep apnea patient was established according to the Standard of practice committee of Americal Sleep Disorders Association. After one year experience of comprehensive approach for sleep apnea we could achieve following recommendation for the treatment. 1) The multi-department examination and diagnosis could prevent unnessesary treatment because the treatment plan could be established under comprehensive discussion. 2) Determination of the site of obstruction is important for treatment planning. However, no single determinant could be found. We expect multi-department approach can reduce the mistake in detection of obstruction. 3) Further evaluation of treatmet outcome should be succeeded to establish Korean standard of care for sleep apnea treatment.

• Journal of Oral Medicine and Pain
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• 제35권3호
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• pp.193-202
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• 2010

저자는 상기도부의 동적변화를 관찰하여 수면시의 협착부위와 그 정도를 확인하며, 하악의 전방이동이 상기도부에 미치는 영향과 부위를 조사하고자 하였으며 총 9명의 건강한 피험자를 대상으로 임상적 검사, 방사선학적 검사 및 간이수면다원검사를 실시하여 코골이 및 수면무호흡증 등의 수면장애가 없음을 확인한다. 각성시 및 수면시, 하악의 안정위 및 전방이동시에서 각각 전자선 단층촬영(EBT)을 시행하여 각 조건하의 구인두의 부위별 최대 최소 단면적 및 허탈지수를 구하였다. 이때 수면의 유도를 위해 Dormicum$^{(R)}$을 정맥투여하였다. 그 결과, 각 조건에 따라 비교하였을때 수면 및 하악 전돌에 따른 상부, 중간부, 하부 상기도간의 최소 단면적 및 허탈지수의 유의한 차이는 없었다. 반면 하악 안정위에서 각성 및 수면상태간의 비교시에 구인두의 하부에서 단면적의 유의성 있는 차이가 관찰되었다. 한편, 각성상태에서 하악 안정시와 전돌시간의 비교시에는 중간부에서 단면적의 유의성 있는 차이과 관찰되며 수면상태에서는 하악 안정시와 전돌시 단면적의 변화율을 나타내는 허탈지수에 있어 유의한 차이는 없었다.

• Tuberculosis and Respiratory Diseases
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• 제43권1호
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• pp.88-91
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• 1996

급성 후두개염은 상기도 폐색에 따른 치명적인 결과를 초래할 수 있는 질환으로 주의 깊은 호흡관찰과 아울러 급성 상기도 폐색의 초기 징후를 빨리 인지하고 적절한 기관내 삽관술이나 기관 절개술 등으로 기도를 확보해야 하는 심각한 질환이다. 1978년 Cantrell 등은 호흡곤란을 동반한 소아의 급성 후두개염 환자에서 후두의 부종이 진행함에 따라 앉은 자세에서 상체를 구부리고 턱을 내밀어서 호흡하는 특이한 이학적 소견을 기술한 바 있는데, 이러한 자세를 취함으로서 기관이 당겨져 상부기도의 장력을 증가시켜 후두개 및 주위 연조직의 부종에 의한 기도 폐쇄를 완화시킬수 있기 때문인 것으로 생각된다. 따라서 급성 후두개염 환자에서 턱을 내말고 목을 쭉 뻗어서 호흡하는 이학적 소견은 후두 부종에 의한 상기도 폐색이 임박하였음을 시사하는 소견이라 할 수 있겠다. 본 저자들은 앉은 자세에서 목을 쭉 뻗어서 호흡하는 특이한 이학적소견을 보이는 급성 후두개염 환자 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제47권5호
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• pp.483-486
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• 2014

A 76-year-old male underwent a left upper lobectomy with wedge resection of the superior segment of the left lower lobe using video-assisted thoracoscopic surgery (VATS) for non-small-cell lung cancer of the left upper lobe. He presented with shortness of breath, fever, and leukocytosis. Chest radiography showed atelectasis at the remaining left lower lobe. Bronchoscopy revealed narrowing of the left lower bronchus with purulent secretion, and computed tomography showed downward kinking of the left lower lobar bronchus. He underwent exploratory VATS, and intraoperative findings showed an inferiorly kinked left lower lobar bronchus with upward displacement of the left lower lobe. After adhesiolysis, the kinked bronchus was straightened, and bronchopexy was performed to the pericardium to prevent the recurrence of bronchial kinking. Also, the inferior pulmonary ligament was reattached to prevent upward displacement. Postoperative follow-up bronchoscopy revealed no evidence of residual bronchial obstruction, and chest radiography showed no atelectasis thereafter.