• The Korean Journal of Nuclear Medicine
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• v.32 no.3
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• pp.276-289
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• 1998

Purpose: To evaluate dysphagia objectively and quantitatively, and to clarify the effect of neck position and viscosity changes in patients with aspiration and laryngeal penetration. Materials and Methods: We studied 35 patients with dysphagia and 21 normal controls using videofluoroscopy and scintigraphy. Videofluoroscopy was performed with barium with three different viscosity, and scintigraphy was done with water, yogurt, and steamed egg mixed with Tc-99m tin colloid. If aspiration was found during videofluoroscopic examination, patient's neck position was changed and study repeated. Videofluoroscopy was analyzed qualitatively. We calculated 7 quantitative parameters from scintigraphy. According to the videofluoroscopic findings, we divided patients into 3 subgroups; aspiration, laryngeal penetration, and no-aspiration group. Results: The result of videofluoroscopy revealed that the most common finding was the delay in triggering pharyngeal swallow. Pharyngeal transit time (PTT) and pharyngeal swallowing efficiency(PSE) in patients with aspiration were signifi-cantly different from other groups. After neck position change, aspiration could be reduced in all of 7 patients, and laryngeal penetration reduced by about 82%. PTT and PSE were also improved after position change. Aspiration and laryngeal penetration occurred more frequently in thin liquid swallowing than in thick liquid and solid swallowing. Conclusion: PTT and PSE were useful for the evaluation of dysphagia. Aspiration and laryngeal penetration could be reduced when appropriate position assumed. We could decrease the chance of aspiration by changing the patient diet consistency. Scintigraphy might be useful tool to quantitate and follow up these changes.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.12-20
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• 2008

Purpose: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. Methods: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a $^{99m}Tc$-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. Results: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). Conclusion: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.6
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• pp.327-331
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• 2006

Purpose: Aspiration scintigraphy is a procedure of nuclear imaging to evaluate aspiration and of quantifying the amount of aspirate. The ultimate goal of our study is to define the correlation between aspiration and aspiration pneumonia by aspiration scintigraphy and this is a preliminary report of its trial. Materials and methods: Ten patients with positive findings by videofluoroscopy were selected. The patients ingested semi-solid food containing Tc-99m tin colloid 92.5 MBq (2.5 mCi) and images were acquired immediately after the ingestion and 3 hrs later. A fraction of aspiration to the ingested was calculated using an equation with a decay correction. Results: Five patients were interpreted positive by aspiration scintigraphy. Four patients were positive at initial images and the fractions of aspiration were 0.11%, 0.11%, 0.81%, and 0.11%. The one patient who was shown aspirated at both images had initial 5.82% and delayed 2.26%. Conclusion: Aspiration scintigraphy enables us to localize the aspiration at any desired time of the test and to quantify its amount. Follow-up studies are warranted.

• Korean Journal of Adult Nursing
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• v.21 no.2
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• pp.141-154
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• 2009

Purpose: The purpose of this study was to compare the difference of change in oxygen saturation, vital signs and suction time taken for the suctioning during endotracheal suctioning performed with closed suction system and with opened suction system. Methods: Data were collected from 31 adult patients with ventilator treatment who were admitted to a university hospital in Seoul and the collection period was from July 1 to November 15, 2005. Oxygen saturation, heart rate, respiration rate and mean arterial pressure were collected immediately prior to the suctioning intervention, during and 1 and 5 minutes after the suctioning from opened suction system and closed suction system. Results: 1) The difference in oxygen saturation was statistically significant in recovery time for oxygen saturation to return to baseline values after suctioning was significantly rapid on closed suction system (p<.05). 2) The difference in heart rate, respiration rate and mean arterial pressure was statistically insignificant 3) The suction time was shorter in closed suction system. Conclusion: Closed suction system is more efficient, as compared with the open suction system in the ventilator treatment.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.1
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• pp.48-52
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• 2013

Purpose: Bed, living a long time is required in adult patients with brain lesions such as stroke, traumatic brain injury, and Parkinson's disease, causing pneumonia and respiratory diseases may be due to aspiration of food or saliva. In patients with recurrent pneumonia or pulmonary symptoms, there is a need to determine the possibility of pulmonary aspiration due to aspiration of saliva. Materials and Methods: Saliva due to aspiration pneumonia diagnosis in patients with brain lesions request for inspection to the Department of Nuclear Medicine, 10 patients (male 6, female 4) were included in this study. Patients were fasted before the test, $^{99m}Tc_{O4}$ 185 MBq (5 mCi) of less than 1 mL of solution was administered in the oral cavity. Administration and 20 minutes of dynamic imaging acquisition, and immediately after that the static images were acquired. Delayed scan after 2-4 hours if necessary. Results: Positivity rate of all 10 patients was 60%. In 4 patients showed positive reactions after the administration of oral cavity in a 20-minute dynamic imaging were able to confirm whether the aspiration. In the remaining 2 patients, four hours of additional delay tests were able to confirm whether the aspiration. Conclusion: Does not require changes in patient posture compared to the other checks that can be diagnosed with aspiration pneumonia. A simple test and takes less time. Therefore be useful in providing information for the diagnosis and treatment modality.

• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.536-540
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• 2003

Purpose : Aspiration of foreign material into the lungs can cause acute or chronic pulmonary diseases. It is difficult to detect small amounts of aspiration due to the lack of safe, sensitive and specific diagnostic tests. Recently, in animal or human studies, it has been reported that immunochemistry for lactalbumin can be used to detect the minimal aspiration. So, the authors' investigation was designed to determine whether human milk phagocytized alveolar macrophages can be detected in human milk aspirated mice. Methods : Sixty four male mice, 6-8 weeks old and 30-40 gm weighing, were used for this study. About 0.05 mL of human milk or normal saline were given intranasally once per day for 1 day or 3 days. Under anesthesia with ketamine and xylazine, the trachea of each mouse was cannulated with an 18G Jelco needle and then, each mouse's lungs were lavaged three times with 0.5 mL of phosphate buffer solution at 2, 8, 24, and 48 hours after the last milk or normal saline instillation. Cells in bronchoalveolar lavage fluid were stained with Oil Red O and immunocytochemistry for alpha-lactalbumin. Results : Immunocytochemical reactivity for alpha-lactalbumin or lipid-laden alveolar macrophages were not observed in the normal saline aspirated groups. Immunocytochemical reactivity for alpha-lactalbumin were observed in the human milk aspirated groups. They showed a peak at 8 hours and decreased markedly at 24 hours but persisted even at 48 hours after aspiration. Immunocytochemical stain positive alveolar macrophages were noted similarly in number between single and multiple aspiration groups. Conclusion : These observations suggested that alveolar macrophages for lactalbumin could be more easily detected on immunocytochemistry than Oil Red O stain, and immunocytochemistry could be used as a sensitive and specific diagnostic test for the detection of human milk aspiration.

• Korean Journal of Soil Science and Fertilizer
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• v.6 no.2
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• pp.83-88
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• 1973

The newly devised column set is better than the conventional method with centrifuge, suction filter instruments for saturating of the salt and washing out the excess of salt for C. E. C. determination in soils. 1. The new method has a high significance with one suction filter set. 2. The new method deminishes the time and effort of analysis by one third. It can analyze many samples at a time. 3. It is able to analyze without expensive instruments (e. g. vaccum pump, shaker, suction apparatus and centrifuge).

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.198-206
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• 2008

Background: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. Methods: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. Results: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were $10.58 for multiple-use, open suction, $28.27 for single-use, open suction and $23.76 for multiple-use, closed suction. Conclusion: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

• Journal of the Korean Society of Radiology
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• v.4 no.3
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• pp.19-25
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• 2010

Dysphagia is common and serious problems in post-stroke patients. The post-stroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death. Up to date, gag reflex and choking history used to decide the aspiration in clinical. The purpose of this study was to evaluate the aspiration and to choice the proper meal formation using by video fluoroscpic swallowing study(VFSS) with post-stroke dysphagia patients. 58 post-stroke patients and ten normal person participated to perform the VFSS with liquid type, puding, yoplait, rice mixed with barium(Ba). Two rehabilitation medicine doctors and a radiological technologist analysed the phase(oral, pharyngeal, esophageal phase)with video film, and checked the pharyngeal transition time(PTT). 38 patients showed abnormality in pharyngeal phase, 13 patients in oral and pharyngeal phase, 3 patients in oral phase, and 2 patients in pharyngeal and esophageal phase. 43 patients(65.2%) occured the aspiration, but 23 of 43 patients improved by the chin tuck position. Aspiration occured 34 patients in liquid type, 2patients in rice gruel and nothing in boiled rice. After VFSS, 13 of 23 patients change the intaking pathway from nasogastric tube(NGT) to oral, On the contrary with 3 of 42 patients from oral to NGT. Consequently VFSS is clearly effective to evaluate the aspiration with post-stroke dysphagia patients.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.781-784
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• 2007

Foreign body aspiration (FBA) is a common accident in young children. Undiagnosed and retained foreign bodies may result in severe early and late complications such as asphyxia, pneumonia, atelectasis and bronchiectasis. Moreover, because it can mimic bronchiolitis, croup or asthma, an accurate history and a high index of suspicion are of paramount importance for early diagnosis. With our experience on bronchial FBA initially misdiagnosed as acute bronchiolitis, we emphasize that a minute radiological finding should not be neglected and a repeat chest radiograph may be helpful when the initial study shows normal findings. Multidetector computed tomography is a very useful noninvasive diagnostic modality for FBA.