A case of bronchiolitis obliterans with bronchiectasis / 대한내과학회지

Bronchiolitis obliterans (BO) is a non-specific inflammatory injury that affects the small airways, resulting in progressive dyspnea and airflow limitation. The inflammatory process is characterized by granulation tissue filling the lumen of the terminal and respiratory bronchioles, extending into the distal air spaces. BO is usually described in association with bone marrow, heart-lung, or lung transplantation. Outside transplantation, it is rare. We report a 66-year-old female patient who presented with dyspnea that resulted in a diagnosis of BO with bronchiectasis.

Can Pulse Oximetry Plethysmography Waveform Amplitude in Respiratory Variations Predict fluid Responsiveness on Spontaneously Breathing Adult Shock Patients?

PURPOSE: It is difficult to predict volume responsiveness in hemodynamically unstable patients with spontaneous breathing activity. Our objective was to test whether the respiratory variations in pulse oximetry plethysmography (POP) waveform amplitude could predict fluid responsiveness to fluid resuscitation (FR) in spontaneously breathing adult shock patients. METHODS: We investigated 21 patients presenting with shock in the Emergency Room. We assessed hemodynamic status and calculated the respiratory variations in POP waveform amplitude before and after FR. Heart rate, blood pressures (MAP, SBP), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP, defined as deltaPOP = (POPmax - POPmin) / ([POPmax + POPmin] / 2) were recorded. We measured hemodynamic parameters by doppler ultrasound, USCOM(R). RESULTS: Comparisons of hemodynamic parameters between before and after FR showed no significant difference in heart rate, but POP showed significant differences in changes in SBP, MAP, cardiac index, stroke volume index and respiratory variations. In response group(> or =15% in delta CI), the change in cardiac index, stroke volume index, and the respiratory variation in the POP were not significantly different. CONCLUSION: In spontaneously breathing patients with shock, we suggest that delta POP is not a reliable parameter in the prediction of fluid responsiveness.

Variations in Pulse Oximetry Plethysmographic Waveform Amplitude and Hemodynamic Assessment Induced by Passive Leg Raising in Spontaneously Breathing Adult Volunteers / 대한구급학회지

BACKGROUND: In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsivenss is a difficult challenge. Our objective was to test whether the respiratory changes in pulse oxymetry plethysmographic waveform amplitude (POP) and in stroke volume (deltaSV) could predict fluid responsiveness to passive leg raising (PLR) in normal volunteers. METHODS: We investigated 25 normal volunteers. We assessed hemodynamic status (HR, SBP, MAP, CI and SVI) and calculated the respiratory variation in pulse oximetry plethysmographic waveform amplitude at supine and after PLR. We attached a pulse oximeter of 25 spontaneously breathing volunteers as several time points: after 1 min and 5 min in supine position and during PLR at 60degrees. Heart rate, non-invasive blood pressures (mean arterial pressure, systolic blood pressure), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP defined as (POPmax-POPmin)/[(POPmax+POPmin)/2] were recorded using monitor. RESULTS: Comparing to supine and PLR, systolic blood pressure and mean arterial pressure were not different, but the change in cardiac index, stroke volume and respiratory variation in POP were significant different. In response group (> or =10% in deltaCI), the change in cardiac index, stroke volume and respiratory variation in POP were significant greater. CONCLUSION: PLR induces a significant decrement of variation in POP amplitude among spontaneouely breathing volunteers. We suppose that the changes in stroke volume and the respiratory variation in pulse oximetry plethysmographic waveform amplitude induced by PLR predict fluid responsiveness in spontaneous breathing patients.

Factors of Cardiopulmonary Resuscitation Outcome for In-hospital Adult Patients / 대한구급학회지

BACKGROUND: The purpose of this study was to evaluate the factors of cardiopulmonary resuscitation (CPR) outcome for in-hospital adult patients, acquiring data with standardized reporting guideline of in-hospital cardiopulmonary resuscitation in Korea. METHODS: All adult cardiac arrest patients from July 2004 to December 2006 in this general hospital were included. Their clinical spectrums were reviewed retrospectively using Utstein-style based template. RESULTS: For the study time period, one hundred and forty-two patients underwent cardiac arrest in this hospital. 136 patients were performed CPR. Return of spontaneous circulation (ROSC) occurred in 42 cases, and 15 patients were survived to hospital discharge. A shorter CPR time and a lower Simplified Acute Physiology Score II (SAPS II) were significant for survivor to hospital discharge (p<0.01). Sex, age, and location in cardiac arrest were not attributed to survival to hospital discharge. CONCLUSIONS: In-hospital CPR patients, the high rate of ROSC and survival to hospital discharge were associated to the cause of arrest, shorter time of CPR, and lesser severity of disease (SAPS II). This result can be a great implication of survivor from CPR in-hospital adult patients in Korea. Further evaluation with consistent data acquisition of CPR using Utstein-style would contribute to improve CPR practice and outcome.

Clinical value of the biochemical and nutritional parameters of intensive-care unit patients on mechanical ventilation / 대한내과학회지

BACKGROUND: The nutritional status of critical-ill patients is important for recovering from the disease itself. Therefore, this present study was designed to assess the biochemical and nutritional parameters of Intensive-Care Unit (ICU) patients on mechanical ventilation. METHODS: We retrospectively reviewed the medicial records of 126 patients (male/female=72/54) who were on mechanical ventilationin the ICU. The nutritional parameters such as serum total protein, albumin, hemoglobin, hematocrit, calcium, phosphorus, total cholesterol, % lymphocytes, blood urea nitrogen (BUN), and creatinine (Cr) were measured at the beginning of mechanical ventilation. We also measured the outcome variables such as the duration of mechanical ventilation, the ICU length of stay and the hospitalization period. We analyzed the relationship between the nutritional parameters and the outcome variables of ICU patients on mechanical ventilation. RESULTS: The level of hemoglobin was negatively correlated with the outcome variables; the ICU length of stay (p<0.05), the hospitalized period (p<0.01), and the duration of mechanical ventilation (p<0.01). The creatinine level was positively correlated with the outcome variables; the ICU length of stay (p<0.01), the hospitalized period (p<0.01) and the duration of mechanical ventilation (p<0.05). On the multiple regression analysis, the serum total protein, albumin, calcium, inorganic phosphorus, BUN and creatinine were independent factors affecting the duration of mechanical ventilation. CONCLUSIONS: These findings indicate that ICU patients with mechanical ventilation have a risk for malnutrition and anemia. So, an adequate nutritional intervention is required for these patients in order to decrease the prevalence of malnutrition and anemia.

A Case of Pleural Lipoma Treated with Video-assisted Thoracic Surgery (VATS) / 결핵및호흡기질환

No abstract available.

Diagnostic Value of Ultrasonography for the Assessment of Rib Fractures

PURPOSE: Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of conventional chest radiography (chest PA, rib series) in showing a rib fracture is limited, particularly in those involving the cartilage part of the rib. We investigated the possible rib fractures. We used ultrasonography (US) to investigate possible rib fractures in patients with minor blunt chest trauma who showed no evidence of a rib fracture on the conventional chest radiography. METHODS: A total of 96 patients with minor blunt chest trauma and showing no evidence of a rib fracture on the conventional chest radiography were examined with US performed with a 7.5-MHz linear transducer. RESULTS: A total of 44(45.8%) patients showed a rib fracture whereas 52(54.2%) patients had no evidence of a rib fracture. Fracture of the rib with displacement 24 patients was the most common finding. CONCLUSIONS: Rib US is a useful imaging method in showing rib fractures overlooked on chest X-rays in cases of minor blunt chest trauma. Compared with conventional chest radiography, rib US takes a shorter time and is not difficult. Additionally, lesions combined with rib fractures and costal cartilage fractures are diagnosed more easily when using rib US.

Short-Term Revisits to Emergency Medical Center

PURPOSE: More than a few patients revisit Emergency Departments (EDs) with the same complaint. It is generally assumed that a revisit within a short period happens due to an inadequate evaluation during the previous visit, which creates a quality problem in emergency care. The purpose of this study is to analyze patient's revisiting the ED within 48 hours after being discharged and to use this information as a tool for quality assurance in the ED. METHODS: We carried out a chart review of patients who have revisited the ED within 48 hours between March 1, 2000 and February 28, 2002. We divided the patients into three groups according to their age. Disease variables were analyzed according to the age groups and admission rates. RESULTS: A total of 78,182 patients visited the ED during the period. Of these, 66,974 patients were discharged from the ED and the others were admitted. Of these discharged, 1,012 patients revisited the ED with the same complaints within 48 hours. The common disease or complaint of the short-term revisiting patients in order were acute abdomen, acute pharyngotonsilitis, ureter stones, respiratory problems, etc. Admissions of revisiting patients were due to acute abdomen, acute gastroenteritis, acute appendicitis, intussucception, panperitonitis, ileus, etc. There were significantly different admission rates according to initial symptoms, diseases and the age group of the revisiting patient. CONCLUSION: For quality improvement of emergency care, we need to standardize a management protocol, and the guidance for patient care provided in this paper might be recommended. A short -stay unit in the ED may be useful in some cases.

Video-assisted Thoracoscopic Lung Volume Reduction Surgery in Severe Emphysema: A Case Report / 대한흉부외과학회지

Lung volume reduction surgery(LVRS) has recently been advocated as an alternative or a bridge to lung transplantation for patients with severe diabling emphysema. This procedure is a palliative treatment performed to alleviate the dyspnea of patients with emphysema and improve performance in the activities of daily living. The rationale of lung volume reduction for generalized emphysema is that the removing of the diseased and functionless lung may improve the function of remaining, less diseased lung. The factors critical to the success of LVRS are careful patient selection, accurate localization of target areas, meticulous anesthetic and operative technique, and intensive postoperative support. We have experienced a case of severe emphysema in a 59-year-old male patient. After selection process and pulmonary rehabilitation, the patient was treated with video-assisted thoracoscopic LVRS and the post-operative course was uneventful.

Reoperation of Essential Hyperhidrosis / 대한흉부외과학회지

Thoracic sympathectomy is the radical and definite treatment of palmar hyperhidrosis. From January 1992 to March 1997, 4 patients with recurrent hyperhidrosis underwent resympathectomy via VATS at the Department of General Thoracic and Cardiovacular Surgery, Young Dong Severance Hospital. There were 2 men and 2 women and mean age was 20.0 years. There were moderate to severe adhesions at previous resection site but no thoracotomies were performed. There was no sweating on palms in all cases and all patients were greatly satisfied with those results postoperatively. In conclusion, recurrent hyperhidrosis was successfully treated with resympathectomy via VATS. In order to prevent recurrence and minimize the postoperative complication, the proper localization of the 2nd sympathetic ganglion and the radical excision of anatomical variation including Kuntz fiber are needed.

Animal Model for Sequential Bilateral Reimplantation of the Lung in Dog / 대한흉부외과학회지

Sequential bilateral lung transplantation may result in a variety of perioperative and postoperative complications, showing high perioperative morbidity and mortality rates. This research was performed to investigate the hemodynamic changes in adult mongrel dogs after bilateral reimplantation, two methods preferred for avoiding or minimizing graft rejection. The anterior portion of the pulmonary artery and the left atrium proximal to the superior and the inferior pulmonary veins were resected out and then re-anastomosed one hour later to prevent torsion or stenosis of the anastomotic site and the formation of a thrombosis in the left atrium. An everted suture technique was employed for the left atrium; An hour after the division, however, the main bronchus was tightly anastomosed by interrupted sutures of No. 4-0 prolene in a telescope method. A modified E-C solution mixed with PGE1 was infused into the cut portion of the pulmonary artery at the rate of 15 ml/kg/min and at a pressure of 40 cmH2O for a total dosage of 70 ml/kg in order to preserve the transected lung. Topical cooling using wet gauzes soaked with cold E-C solution was performed for one hour to prevent ischemic lung injury. The above procedures are considered to be beneficial for achieving a satisfactory outcome for bilateral lung reimplantation.