• Tuberculosis and Respiratory Diseases
• /
• 제51권3호
• /
• pp.270-274
• /
• 2001

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve ; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.

• Journal of Chest Surgery
• /
• 제7권2호
• /
• pp.189-200
• /
• 1974

The mitral valve replacement with Beall prosthetic valve was performed on three patients, and double valve replacement. aortic and mitral valve, was performed in this department.1) The preoperative studies about the first case were compatible with mitral steno-insufficency.The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary hypass using hypothermic hemodilution technique. The total perfusion time was eighty minutes. Immediate postoperative course was smooth, but this patient was died of asphyxia due to tracheomalacia complicated after tracheostomy 3 months after operation. Autopsy on this patient revealed that no thrombus and no ball variance could be found, and endothelization on the valve cuff was satisfactory. 2) The preoperative studies on the second case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary bypass using hypothermic hemodilution technigue. The total perfusion time was 123 minutes. This patient was discharged in good condition and follow-up study after 16 months revealed the patient had enjoyed healthy life. 3) The preoperative studies about the third case were compatible with aortic insufficiency and mitral stenoinsufficiency. The diseased valves were replaced with type 2 sutureless Magovern aortic valve and the medium sized Beall mitral prosthesis under cardiopulmonary bypass using hypothermic hemodilution technIque and coronary artery perfusion. The total perfusion time was 155 minutes. This patient was discharged in good condition, but thromboembolism was developed 2 months after discharge. 4) The preoperative studies about the fourth case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve. The total perfusion time was 132 minutes. The atrioventricular block developed just after operation but converted to normal sinus rhythmn on the third postperative day. The preoperative NYHA functional classification IV was converted to Class 1 or 11 at the time of discharge and this patient enjoyed healthy life. Attendum; The fifth case, nineteen years old male with mital insufficiency underwent Beall valve replacement and his course was uneventful 2 weeks after operation.

• Journal of Chest Surgery
• /
• 제29권7호
• /
• pp.759-762
• /
• 1996

Fifteen patients with esophageal perforation were treated at the Department of Thoracic and Cardiovacular Surgery, Chungnam National University Hospital during the period from June, 1985 to September, 1995. The ratio between male and female patients was 9 : 6, their age ranged from 19 years to 71 years old(a erage : 49 years old). The causes of the perforation were various, spontaneous in 4 cases, foreign body in 4 cases, instrumental trauma in ) cases, chest trauma in 1 case, drug ingestion (chlorocalchi) induced in 1 case, tracheostomy induced in 1 case, unknown in 1 case. The perforation sites were intrathoracic esophagus in 9 cases and cervical in 6 cases. The Patients complained of chest or cervi- cal pain in 11 cases, fever in 9 cases, dysphagia in 8 cases and dyspnea in 5 cases. We have performed the following surgical procedures : incision and drainage, primary repair, gastrostomy for cervical esophageal perf'oration and primary repair, primary repair and pleural flap reinforcement, gastrostomy for thoracic esophageal perforation. A patient died of sepsis.

• Journal of East-West Nursing Research
• /
• 제20권2호
• /
• pp.103-111
• /
• 2014

Purpose: The purpose of this study was to identify the characteristics of life-sustaining treatment and attitudes towards advance directives among geriatric patients. Methods: The elderly participants (N=146) were recruited from a university hospital from October 30, 2012 to March 31, 2013. A questionnaire for collecting data of participants' characteristics, their experiences related to life-sustaining treatment, and attitudes towards advance directives was used. The data were analyzed using SPSS WIN 17. Results: Most participants (84.9%) were in favor of advance directives. Although most of participants wanted to receive CPR for sudden cardiac arrest (78.8%) and pain control medication (74.0%), most preferred to refuse life-sustaining treatments such as tracheostomy (96.6%) or ventilator (87.0%). Participants who had a family or acquaintances with CPR experiences (U=852.00 p=.038), had discussed with their family and acquaintances regarding end-of-life sustaining treatment (t=2.91, p=.004), or made decisions about refusing the life sustaining treatments (t=3.19, p=.002) preferred to have advance directives than those who did not. Conclusion: The findings of this study suggested the potential benefits of educational programs about advance directives for the end-of-life for geriatric patients to make decisions for life-sustaining treatments in advance.

• Journal of Korean Academy of Nursing Administration
• /
• 제15권4호
• /
• pp.527-538
• /
• 2009

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제39권4호
• /
• pp.175-181
• /
• 2013

Objectives: This retrospective study was performed to evaluate the clinical impact of diabetes mellitus on the prognosis in secondary space infection. Materials and Methods: Medical records, radiographic images, computed tomography, and microbial studies of 51 patients (25 diabetic patients and 26 non-diabetic patients) were reviewed. Patients were diagnosed as secondary fascial space infections with odontogenic origin and underwent treatment at Chonnam National University Hospital, in Department of Oral and Maxillofacial Surgery, from January 2007 to February 2009. Results: Compared to patients without diabetes, patients with diabetes were presented with the following characteristics: older age (diabetic patients: 62.9 years, non-diabetic patients, 47.8 years), more spaces involved (diabetic patients, 60%; non-diabetic patients, 27.3%), more intense treatment, longer hospitalization (diabetic patients, 28.9 days; non-diabetic patients, 15.4 days), higher white blood cell and C-reactive protein values, higher incidence of complication (diabetic patients, 40%; non-diabetic patients, 7.7%), and distinctive main causative microorganisms. Conclusion: These results suggest that the prognosis of diabetic patients is poorer than that of non-diabetic patients in secondary space infections since they had greater incidence rates of involved spaces, abnormal hematologic findings, more complications, and additional procedures, such as tracheostomy.

• Korean Journal of Adult Nursing
• /
• 제18권5호
• /
• pp.718-726
• /
• 2006

Purpose: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. Method: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). Results: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M=61.61mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). Conclusion: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a $50_cc$ syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제41권5호
• /
• pp.251-258
• /
• 2015

Objectives: This study was performed to evaluate the impact of glycosylated hemoglobin (HbA1c) level on characteristics and prognosis of maxillofacial fascial infection in diabetic patients. Materials and Methods: We reviewed the medical records of 72 patients (35 patients with HbA1c lower than 7.0% and 37 patients with HbA1c higher than 7.0%) diagnosed with maxillofacial fascial space infection and hospitalized for treatment at the Department of Oral and Maxillofacial Surgery in Dankook University Hospital (Cheonan, Korea) from January 2005 to February 2014. We compared demographics, parameters of glucoregulation (HbA1c), laboratory parameters of inflammation (white blood cell [WBC], C-reactive protein [CRP] count), type and number of involved spaces, type and number of antibiotics, period of hospitalization, number of surgical operations, need for tracheostomy, complications, computed tomography (CT), and microorganisms between the two groups. Results: Compared with the well-controlled diabetes mellitus (DM) group (HbA1c <7.0%), patients in the poorly-controlled (HbA1c ${\geq}7.0%$) DM group had the following characteristics: longer hospitalization periods, higher values of laboratory parameters of inflammation (WBC, CRP count) at the time of admission, higher number of antibiotics prescribed, more frequent complications, frequent deep neck space involvement, and distinctive main causative microorganisms. As the HbA1c level increases, hospitalization periods and incidence of complications increase gradually. Conclusion: This retrospective study suggests that regulation of DM significantly impacts maxillofacial fascial infection. Poorly controlled DM with high HbA1c level negatively influences the prognosis of infection.

• The Journal of Internal Korean Medicine
• /
• 제33권2호
• /
• pp.172-179
• /
• 2012

Objectives : This study was designed to quantify the characteristics, main diagnosis and complications in the intensive care unit (ICU) at an Oriental Medical Hospital. Methods : The medical records of 44 patients admitted to the ICU at Kyunghee Oriental Medical Hospital between January 1, 2011 and December 31, 2011 were reviewed. Basic characteristics of patients, admission channel, main diagnosis, east-western medical therapy, mortality, and complications were investigated retrospectively based on medical notes. Results : 1. The total number of patients was 44. Males were 63.6%, females 36.3%. Average admission days was 15.9. 2. The most frequent age group is eighties, 38.6%. 3. The most frequent disease is cerebrovascular disease, 61.3%. 4. The medical therapy done after admission to ICU was intubation. Central vein insertion was performed next, followed by Foley's catheter insertion, ventilator, tracheostomy, nasogastric intubation, and thoracentesis in order. The proportion of Oriental medical treatment provided to the patients of ICU was as follows: herbal medication only 6.8%; herbal medication plus acupuncture 31.8%; herbal medication, acupuncture electro-acupuncture, plus subcutaneous acupuncture 2.3%; and none 27.3%. 5. The number of cases of complications occurred since ICU admission was 18. The most frequently observed complication was infection, including 6 cases of pneumonia and 4 cases of urinary tract infection. Conclusions : We suggest that ICUs of Oriental medical hospitals need to be managed effectively to treat diseases including cerebrovascular disease and prevent complications.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권17호
• /
• pp.7627-7632
• /
• 2015

Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.