• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.699-704
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• 2005

Background: Coronary artery fistula is rare congenital anomaly, which account for $0.27\~0.40\%$ of all congenital heart diseases. We report the clinical observations of 45 patients with coronary artery fistula. Material and Method: We reviewed all patients presented with or without symptoms of coronary artery fistula between 1987 and 2004. Age ranged from 1 to 83 years. Twenty-six patients were female. The patients were divided into 2 groups according to the presenting symptoms. Twelve patients were in group A (asymptomatic) and 33 patients in group B (symptomatic). The most common clinical presentation in group B was angina (18) followed by dyspnea (7), atypical chest pain (5), syncope (1), fatigue (1), and palpitation (1). Twenty-five patients were associated with other cardiac diseases, which were atrial septal defect (4), coronary artery occlusive disease (6), hypertension (12), and valvular heart disease (2). Result: Patients were followed-up for a mean period of $64.8\pm62.7$ months. There was no complication related to coronary artery fistula during the follow-up period in both group. There was no mortality related to coronary artery fistula. Conclusion: In symptomatic patients, early surgical treatment is recommended considering the low perioperative morbidity. In asymptomatic patients receiving medical treatment, close follow up may be necessary.

• Clinical and Experimental Pediatrics
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• v.46 no.5
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• pp.490-494
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• 2003

Purpose : We'd like to determine the incidence of congenital heart disease and arrhythmia in elementary school children in Busan, and to provide adequate prevention and treatment. Methods : A total of 23,802(male 12,909, female 10,893) 1st grade elementary school children living in Busan were studied. All children were 7-8 years old. We obtained their medical history by questionnaire and checked elecrocardiography(ECG). Subsequent screening tests including a 2nd ECG, chest X-ray, phonocardiogram and CBC for the students who had abnormal findings at the first screening test. The third screening test was done for students who had cardiac murmurs or abnormal ECG findings in the second screening test by echocardiogram, treadmill test and 24-hour Holter monitoring. Results : Among 23,802 children participants, 605(2.54%) had abnormal ECG findings at the first screening test. Q wave abnormality(0.58%) was observed most frequently, and complete right bundle branch block(RBBB)(0.26%), sinus tachycardia(0.24%), right axis deviation(0.22%) and ventricular premature contraction(VPC)(0.21%) followed in order. Four hundred and twenty four children participated in the second ECG screening test. Two hundred and two children(47.6%) had an abnormality such as sinus tachycardia(18.8%), VPC(17.8%), or complete RBBB(17.3%). After completing the third examination including echocardiogram, we couldn't find the students with ventricular tachycardia (VT) or SVT at the third arrhythmia screening test. Conclusion : A high incidence of arrhythmia was found in the 1st grade elementary school children in Busan despite their healthy appearances, although fatal heart diseases were not noted. Early diagnosis, adequate preventative measures and treatment will prevent and decrease the frequency of emergent situations like syncope and sudden death.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.537-545
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• 1994

Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.645-653
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• 1999

Introduction : Although myocardial ischemia tends to occur more frequently than can he documented in ventilated patients, it has not been well studied on the factors related to the occurrence of the ischemia. Methods : To investigate the related factors to ischemia development, a prospective study was done in 95 cases with consecutive 73 patients who had received mechanical ventilation(MV) in MICU. In addition to 24 h holter monitoring, echocardiogram, electrolytes, cardiac enzymes, hemodynamic, and gas exchange measurements were done within 24 h after initiation of MV in 69 cases. The measurements were repeated at weaning period in 26 cases. The ischemia was defined by the ST segment changes; up-sloping depression more than 1.5 mm or down-sloping or horizontal depression more than 1.0 mm from isoelectric baseline for 80 ms following J point. Results : Twelve patients(12.6% in 95 cases) developed ischemia in total. The incidence of ischemia development showed an increased tendency in the initial 24 hr after MV (15.9%) and in patients with left-sided heart failure found by echocardiogram (18.2%) compared with that of the weaning period (3.8%) and patients without heart failure (10.9%) (P=0.12, P=0.09, in each). There were no differences in APACHE III score, baseline ECG findings, electrolytes abnormalities, use of inotropics or bronchodilators, presence of sepsis or shock, mode of ventilation, and survival rate according to the development of ischemia. Maximal heart rates and mean arterial pressure also were not different between patients with ($137.2{\pm}30.9/min$, $82.5{\pm}15.9$ mm Hg) and without ischemia ($l29.5{\pm}29.7/min$, $83.8{\pm}17.6$ mm Hg). Conclusion : Although the incidence of myocardial ischemia was 12.6% in total, there were no clinically predictable factors to the development of ischemia during mechanical ventilation.

• Tuberculosis and Respiratory Diseases
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• v.38 no.3
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• pp.255-261
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• 1991

Frequently patients with chronic obstructive pulmonary disease have lowered arterial oxygen saturation in daytime. During sleep, they are apt to experience additional hypoxemia. These episode of nocturnal hypoxemia are usually associated with periods of relative hypoventilation. Noctunal hypoxemia may be associated with cardiac arrhythmia and with acute increase in pulmonary arterial pressure and may be implicated in the development of chronic pulmonary hypertension and cor pulmonale. We selected 14 patients with chronic obstructive pulmonary disease, 9 with emphysema dominant type and 5 with chronic bronchitis dominant type, to examine the frequency and severity of nocturnal hypoxemia and the effect of oxygen in prevention of nocturnal hypoxemia. The results were as follows; 1) On PFT, FVC, $FEV_1$, and $FEV_1$/FVC showed no significant difference between the emphysema dominant type (pink puffers, PP) and the chronic bronchitis dominant type (blue bloaters, BB). But DLCO/VA for the PP group was $45.7{\pm}15.1%$ which was significantly different from BB group, $82.4{\pm}5.6%$. 2) The daytime arterial oxygen saturation ($SaO_2$) and the lowest $SaO_2$, during sleep for the BB group were significantly lower than for the PP group. 3) The hypoxemic episodes during sleep were more frequent in BB group and the duration of hypoxemic episode was longer in BB group. 4) In both group studied, although there was a tendency for a lower L-$SaO_2$ (the lowest $SaO_2$, during sleep), an increase in hypoxemic episodes and duration as the daytime $SaO_2$, fell lower, the only parameter which showed significant correlation was daytime $SaO_2$, and the frequency of hypoxemic episodes in the PP group (r=-0.68, P<0.05). 5) In PP group, with oxygen supplementation, L-$SaO_2$, during sleep showed significant increase, and there was a tendency for the frequency of hypoxemic episodes and duration to fall but it was not significant. 6) In BB group, oxygen supplementation significantly increased the L-$SaO_2$ during sleep and also significantly decreased the frequency and duration of hypoxemic episode. From these results, we can see that oxygen supplementation during sleep can prevent the decrease in $SaO_2$ to some extent and that this effect of oxygen can be seen more prominently in the BB group.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.501-508
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• 1993

Background: Sleep apnea syndrome is a common disorder which is estimated to affect about 1~4% of adult male population. And if untreated, sleep apnea can cause significant sequelae, such as hypertension, nocturnal cardiac arrhythmia, daytime hypersomnolence, and cognitive impairment. Various kinds of treatment for obstructive sleep apnea (OSA) have been developed. Among them nasal CPAP, first introduced by Sullivan et al in 1981, has received widespread interest and acclaim as a treatment of OSA, and is currently recommended as first-line treatment for OSA. We evaluated the effect of nasal CPAP in OSA and the side effects of nasal CPAP hindering patients from using nasal CPAP. Methods: We performed sleep studies in 20 OSA patients at 2 consecutive nights; baseline night at first day and CPAP night at second day. We compared apnea index, lowest oxygen concentration during apnea, maximal apnea time, and total apnea duration per total sleep time before and after CPAP. We also evaluated the side effects of CPAP with inquiry to the patients. Results: 1) Apnea index was significantly decreased after CPAP in 17 out of 20 OSA patients (85%) and increased in 3 patients (15%). 2) Average apnea index was significantly decreased after CPAP ($34.1{\pm}18.9/h{\rightarrow}15.4{\pm}10.3/h$, p<0.01). 3) Total apnea duration per total sleep time was also significantly decreased after CPAP ($28.5{\pm}16.0%{\rightarrow}11.9{\pm}9.3%$, p<0.05). 4) The lowest oxygen satuation and maximal apnea time were not significantly changed after CPAP. 5) The most frequent side effect of nasal CPAP was mask discomfort (80%), and the next was drying of nasal passages (65%). Conclusion: Nasal CPAP is an effective treatment for OSA. Futher studies should be concentrated on long term follow up of nasal CPAP for its therapeutic effects and the study of methods to enhance patients' compliance.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1223-1235
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• 1998

Background and Objective : Although prone positioning has been reported to improve gas exchange, prone positioning alone does not seem to be sufficient to increase systemic oxygen transport in an acute lung injury. The objective of this study was to investigate whether the combined therapy of low dose nitric oxide (NO) inhalation and prone positioning has an additive effect on the oxygenation and hemodynamics in patients with severe ARDS. Patients and Methods : Twelve patients with ARDS were included. Prone positioning alone, later combined with nitric oxide inhalation (5~10 ppm) from the supine position (baseline) were performed with serial measurement of gas exchange, respiratory mechanics and hemodynamic at sequential time points. The patient was regarded as a responder to prone positioning if an increase in $PaO_2/FiO_2$ of more than 20 mm Hg at 30 min or 120 min intervals after prone positioning was observed compared to that of the baseline. The same criterion was applied during nitric oxide inhalation. Results : Eight patients (66.5%) responded to prone positioning and ten patients (83.3%) including the eight just mentioned responded to the addition of NO inhalation. The $AaDO_2$ level also decreased promptly with the combination of prone positioning and NO inhalation compared to that of prone positioning alone ($191{\pm}109$ mm Hg vs. $256{\pm}137$ mm Hg, P<0.05). Hemodynamic parameters and lung compliance did not change significantly during prone positioning only. Following the addition of NO inhalation to prone positioning, the mean pulmonary artery pressure and pulmonary artery occlusion pressure decreased and cardiac output, stroke volume and oxygen delivery increased (P < 0.05) compared to those of prone 120 min. Conclusion : These findings indicate that NO inhalation would provide additional improvement in oxygenation and oxygen transport to mechanically ventilated patients with ARDS who are in a prone position.

• Tuberculosis and Respiratory Diseases
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• v.39 no.6
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• pp.511-516
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• 1992

Background: It is well known that cigarette smoking is the risk factor of lung cancer, chronic obstructive pulmonary disease and ischemic heart disease. But there are few reports about the immediate effect of cigarette smoking on the cardiopulmonary functions. The serum level of carbon monoxide increases during cigarette smoking. It is known that carbon monoxide increases respration rate, heart rate and cardiac output, with decrease in maximal oxygen consumption. So we have studied to determine the immediate effects of cigarette smoking on the cardiopulmonary function during exercise. Method: Thirteen healthy smoking male subjects were included in this study. Each subject was undertaken pulmonary function test and incremental exercise test on two separate days, one without smoking (control) and the other after smoking three cigarettes per hour for five hours. The order of the two tests was randomized. Results: 1) The mean age of the subjects was $25{\pm}4.9$ year-old and the mean smoking history was $6{\pm}5$ pack years. 2) The mean blood level of carbon monoxide on the smoking day was higher than that on the nonsmoking day ($5.97{\pm}1.34%$ vs. $1.45{\pm}0.83%$; p<0.01). 3) The mean maximal oxygen consumption on the smoking day was lower than that on the nonsmoking day ($2.09{\pm}0.32$ L/min vs. $2.39{\pm}0.32$ L/min; p<0.05). 4) The mean anaerobic threshold on the smoking day was lower than that on the nonsmoking day ($1.33{\pm}0.24$ L/min vs. $1.53{\pm}0.20$ L/min; p<0.05). 5) The mean heart rate at rest on the smoking day was higher than that on nonsmoking day ($84.38{\pm}11.06$ beats/min vs. $75.46{\pm}5.83$ beats/min; p<0.05). But the means of maximal heart rate on both days were not different. 6) The pulmonary function tests were similar on both days. Conclusion: There was no change in pulmonary function test, but the maximal oxygen consumption and anaerobic threshold were decreased on the smoking day. So it was concluded that cigarette smoking impaired the cardiovascular functions immediately during exercise.

• Journal of the Korean Society of Food Science and Nutrition
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• v.40 no.1
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• pp.128-136
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• 2011

This study was carried out to investigate the factors of food service satisfaction of the elderly in Busan. The survey was conducted from September 1 to October 15, 2009 by questionnaires and data analyzed by SPSS program. Fifty point nine percent of the subjects lived alone and the source of living expenses of 70.5% of the subjects was subsidy from government. The most important reason for the elderly to participate in meal service was 'economic difficulty' and 'to meet friend'. The subjects had various chronic degenerative diseases, such as arthritis, hypertension, diabetes, osteoporosis and cardiac disease. Sixty-six point eight percent of the subjects needed diet therapy for their diseases, but 87.1% of them don't want to pay the extra fee. Thirty six point five percent of the subjects attained information about lunch program because it was 'close to home' but 20.7% was 'from public officials'. The reasons for the use of the meal service were 'economic difficulty' (40.0%), 'to meet friends' (22.6%), and 'bother to prepare meal' (16.50%). The services provided by welfare center were health care, physical exam and haircut. The score given by the subjects on the satisfaction of meal service was 3.84 on the 5-point maximum scale. Higher satisfaction on kindness of staff, satisfaction of social support and awareness of support resulted in higher satisfaction of food service. It would be effective to provide food service models that meet specific needs of the elderly according to social welfare service and social community activities.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.504-512
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• 1994

Background: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant cuases of cirrhosis. It is uncertain that the same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia, Method: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. Results: The hypoxemia of $PaO_2$ less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). But there was no patient with significant hypoxemia of $PaO_2$ less than 60 mmHg. $PaO_2$ was significantly decreased in the patients with spider angioma than the pathients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of $11.4{\pm}4.1%$ than normoxemic group of $4.1{\pm}2.0%$ (p<0.05). Conclusions: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to p1ay a major ro1e in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.