• Proceedings of the KOR-BRONCHOESO Conference
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.10.3-11
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• 1982

Recently through the advancement of medical and surgical managements and the development of low pressure cuffed endotracheal tube, incidence of tracheal stenosis was decreased significantly. Though its incidence was decreased markedly, stenosis was developted unfortunately in the situations such as long term use of respirator, heavy infection, trauma of the trachea and long term intubation etc. Tracheal stenosis had been handled with various methods such as mechanical dilatation, tissue graft techniques, luminal augumentation and end to end anastomosis due to their individual advantages but their effects were not satisfactory. In 1959 Lester had been found the regenerated cartilage from the perichondrium of the rib incidentaly. Since then Skoog, Sohn and Ohlsen were reported chondrogenic potential of perichondrium through the animal experiments. Though many different materials have been tried to rebuild stenosis and gaping defect of trachea, tracheal reconstruction has been a perplexing clinical problems. We choose the perichondrium as the graft material because cartilage is the normal supporting matrix of that structure and it will be an obvious advantage to be able to position perichondrium over a defect and obtain new cartilage there. The young rabbits, which were selected as our experimental animals, were sacrified from two to eight weeks after surgery. The results of our experiment were as follows; 1) In control group, the defect site of trachea was covered with fibrosis and vessels but graft site was covered with hypertrophied perichondrium and vessels. 2) Respiratory mucosa was completely regenerated in defect sites both control and grafted groups. 3) The histologic changes of the grafted sites were as follows: 2 weeks- microvessel dilatation, inflammatory reaction, initiation of fibrosis 4 weeks- decreased microvessel engorgement, submucosal fibrosis, decreased inflammatory reaction immatured cartilage island was noted in the grafted perichondrium (one specimen) 6 weeks- mild degree vascular engorgement submucosal fibrosis. chronic inflamatory reaction cartilage island and endochondrial ossification was noted in the grafted perichondrium (Two specimens) 8 weeks- minute vascular engorgement dense submucosal fibrosis. loss of inflammatory reaction. cartilage island was noted in the grafted perichondrium (two specimens) 4) There was no significant differences in regeneration between active surface in and out groups. 5) We observed immatured cartilage islands and endochondrial ossification in the perichondrial grafted groups where as such findings were not noted in control groups except fibrosis. We concluded that perichondrium was the adequate material for the reconstruction of defected trachea but our results was not sufficient in the aspect of chondrogenic potential of perichondrium. So further research has indicated possibility of chondrogenic potential of perichondrium.

• Tuberculosis and Respiratory Diseases
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• 제41권4호
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• pp.372-378
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• 1994

Background: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiraory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by an endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object: The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation(IMV) in facilitating weaning precess compaired to IMV mode alone. Method: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant throught the weaning period. For the patients who required mechanical ventilation for less than 72 hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning trial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. Results: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. Conclusion: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm $H_2O$ did not induce significant physiologic changes during weaning process.

• Proceedings of the KOR-BRONCHOESO Conference
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.11.2-11
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• 1983

Vocal nodules and polyps are much more frequent in singers, public speakers, teachers and actors. Voice trauma and voice misuse, at times associated with mild inflammatory reaction, appear to be important in their etiology. It is generally agreed that vocal cord nodules and polyps are inflammatory in nature and they arise in the subepithelial layer of loose connective tissue of the vocal cord. Since the junction of anterior and middle thirds of the membranous cord and has the greatest amplitude of vibration. This is the site of predilection for vocal cord nodules. The author performed laryngomicrosurgery for 70 cases of vocal nodules and polyps at Ewha Womans University Hospital during the period of 5 years. The result obtained were as follows ; 1) Surgical excision is not necessarily the best approach because vocal nodules in the early stages will resolve with the simplest voice therapy. 2) In children, surgery is rarely indicated because most nodules in children regress during adolescence. 3) For patients who use their voices professionally, voice therapy is indicated for three months. 4) If after three month of conservative treatment the cord lesion does not improve and the patient it still dissatisfied with his voice, laryngomicrosurgery can then be considered. 5) The small cuffed endotracheal tube in the interarytenoid space helps to keep the cords immobile and in an abducted position. 6) Removal of the nodule shoule be started by gentle retraction posteriorly and as soon as a tear appears anterior to the nodule. 7) On occasion it is preferable to start the dissection with a siccle knife while the nodule is held on the stretch. 8) Voice rest should be maintained for a week following which the free edges of the cords are usually healed.

• Journal of the Korean Society of Radiology
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• 제85권1호
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• pp.138-146
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• 2024

Purpose To evaluate whether the image quality of chest radiographs obtained using a camera-type portable X-ray device is appropriate for clinical practice by comparing them with traditional mobile digital X-ray devices. Materials and Methods Eighty-six patients who visited our emergency department and underwent endotracheal intubation, central venous catheterization, or nasogastric tube insertion were included in the study. Two radiologists scored images captured with traditional mobile devices before insertion and those captured with camera-type devices after insertion. Identification of the inserted instruments was evaluated on a 5-point scale, and the overall image quality was evaluated on a total of 20 points scale. Results The identification score of the instruments was 4.67 ± 0.71. The overall image quality score was 19.70 ± 0.72 and 15.02 ± 3.31 (p < 0.001) for the mobile and camera-type devices, respectively. The scores of the camera-type device were significantly lower than those of the mobile device in terms of the detailed items of respiratory motion artifacts, trachea and bronchus, pulmonary vessels, posterior cardiac blood vessels, thoracic intervertebral disc space, subdiaphragmatic vessels, and diaphragm (p = 0.013 for the item of diaphragm, p < 0.001 for the other detailed items). Conclusion Although caution is required for general diagnostic purposes as image quality degrades, a camera-type device can be used to evaluate the inserted instruments in chest radiographs.

• Tuberculosis and Respiratory Diseases
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• 제45권4호
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• pp.813-822
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• 1998

Background: Extubation is recommended to be performed at minimum pressure support (PSmin) during the pressure support ventilation (PSV). In field, physicians sometimes perform additional 1 hr T-piece trial to the patient at PSmin to reduce re-intubation risk. Although it provides confirmation of patient's breathing reserve, weaning could be delayed due to increased airway resistance by endotracheal tube. Methods: To investigate the effect of additional 1 hr T-piece trial on weaning outcome, a prospective study was done in consecutive 44 patients who had received mechanical ventilation more than 3 days. Respiratory mechanics, hemodymic, and gas exchange measurements were done and the level of PSmin was calculated using the equation (PSmin=peak inspiratory flow rate $\times$ total ventilatory system resistance) at the 15cm $H_2O$ of pressure support. At PSmin, the patients were randomized into intervention (additional 1 hr T-piece trial) and control (extubation at PSmin). The measurements were repeated at PSmm, during weaning process (in cases of intervention), and after extubation. The weaning success was defined as spontaneous breathing more than 48hr after extubation. In intervention group, failure to continue weaning process was also considered as weaning failure. Results: Thirty-six patients with 42 times weaning trial were satisfied to the protocol. Mean PSmin level was 7.6 (${\pm}1.9$)cm $H_2O$. There were no differences in total ventilation times (TVT), APACHE III score, nutritional indices, and respiratory mechanics at PSmin between 2 groups. The weaning success rate and re-intubation rate were not different between intervention group (55% and 18% in each) and control group (70% and 20% in each) at first weaning trial. Work of breathing, pressure time product, and tidal volume were aggravated during 1 hr T-piece trial compared to those of PSmin in intervention group ($10.4{\pm}1.25$ and $1.66{\pm}1.08$ J/L in work of breathing) ($191{\pm}232$ and $287{\pm}217$cm $H_2O$ s/m in pressure time product) ($0.33{\pm}0.09$ and $0.29{\pm}0.09$ L in tidal volume) (P<0.05 in each). As in whole, TVT, and tidal volume at PSmin were significantly different between the patients with weaning success ($246{\pm}195$ hr, $0.43{\pm}0.11$ L) and the those with weaning failure ($407{\pm}248$ hr, $0.35{\pm}0.10$L) (P<0.05 in each). Conclusion : There were no advantage to weaning outcome by addition of 1 hr T-piece trial compared to prompt extubation to the patient at PS min.