• Clinical and Experimental Pediatrics
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• v.55 no.8
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• pp.297-300
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• 2012

Symptomatic pulmonary arterial hypertension (PAH) in patients with isolated atrial septal defect (ASD) is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg). The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg), and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.

• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.190-200
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• 1996

Background : Mechanical ventilation constitutes the last therapeutic method for acute respiratory failure when oxygen therapy and medical treatment fail to improve the respiratory status of the patient. This invasive ventilation, classically administered by endotracheal intubation or by tracheostomy, is associated with significant mortality and morbidity. Consequently, any less invasive method able to avoid the use of endotracheal ventilation would appear to be useful in high risk patient. Over recent years, the efficacy of nasal mask ventilation has been demonstrated in the treatment of chronic restrictive respiratory failure, particularly in patients with neuromuscular diseases. More recently, this method has been successfully used in the treatment of acute respiratory failure due to parenchymal disease. Method : We assessed the efficacy of Bilevel positive airway pressure(BiPAP) in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD). This study prospectively evaluated the clinical effectiveness of a treatment schedule with positive pressure ventilation via nasal mask(Respironics BiPAP device) in 22 patients with acute exacerbations of COPD. Eleven patients with acute exacerbations of COPD were treated with nasal pressure support ventilation delivered via a nasal ventilatory support system plus standard treatment for 3 consecutive days. An additional 11 control patients were treated only with standard treatment. The standard treatment consisted of medical and oxygen therapy. The nasal BiPAP was delivered by a pressure support ventilator in spontaneous timed mode and at an inspiratory positive airway pressure $6-8cmH_2O$ and an expiratory positive airway pressure $3-4cmH_2O$. Patients were evaluated with physical examination(respiratory rate), modified Borg scale and arterial blood gas before and after the acute therapeutic intervention. Results : Pretreatment and after 3 days of treatment, mean $PaO_2$ was 56.3mmHg and 79.1mmHg (p<0.05) in BiPAP group and 56.9mmHg and 70.2mmHg (p<0.05) in conventional treatment (CT) group and $PaCO_2$ was 63.9mmHg and 56.9mmHg (p<0.05) in BiPAP group and 53mmHg and 52.8mmHg in CT group respectively. pH was 7.36 and 7.41 (p<0.05) in BiPAP group and 7.37 and 7.38 in cr group respectively. Pretreatment and after treatment, mean respiratory rate was 28 and 23 beats/min in BiPAP group and 25 and 20 beats/min in CT group respectively. Borg scale was 7.6 and 4.7 in BiPAP group and 6.4 and 3.8 in CT group respectively. There were significant differences between the two groups in changes of mean $PaO_2$, $PaCO_2$ and pH respectively. Conclusion: We conclude that short-term nasal pressure-support ventilation delivered via nasal BiPAP in the treatment of acute exacerbation of COPD, is an efficient mode of assisted ventilation for improving blood gas values and dyspnea sensation and may reduce the need for endotracheal intubation with mechanical ventilation.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.558-570
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• 1996

Background : The detection of Collapsible airways has important therapeutic implications in chronic airway disease and bronchial asthma. The distinction of a purely collapsible airways disease from that of asthma is important because the treatment of the dormer may include the use of pursed lip breathing or nasal positive pressure ventilation whereas in the latter, pharmacologic approaches are used. One form of irreversible airflow limitation is collapsible airways, which has been shown to be a Component of asthma or to emphysema, it can be assessed by the volume difference between what exits the lung as determined by a spirometer and the volume compressed as measured by the plethysmography. Method : To investigate whether volume difference between slow and forced vital Capacity(SVC-FVC) by spirometry may be used as a surrogate index of airway collapse, we examined pulmonary function parameters before and after bronchodilator agent inhalation by spirometry and body plethysmography in 20 cases of patients with evidence of airflow limitation(chronic obstructive pulmonary disease 12 cases, stable bronchial asthma 7 cases, combined chronic obstructive pulmonary disease with asthma 1 case) and 20 cases of normal subjects without evidence of airflow limitation referred to the Pusan National University Hospital pulmonary function laboratory from January 1995 to July 1995 prospectively. Results : 1) Average and standard deviation of age, height, weight of patients with airflow limitation was $58.3{\pm}7.24$(yr), $166{\pm}8.0$(cm), $59.0{\pm}9.9$(kg) and those of normal subjects was $56.3{\pm}12.47$(yr), $165.9{\pm}6.9$(cm), $64.4{\pm}10.4$(kg), respectively. The differences of physical characteristics of both group were not significant statistically and male to female ratio was 14:6 in both groups. 2) The difference between slow vital capacity and forced vital capacity was $395{\pm}317ml$ in patients group and $154{\pm}176ml$ in normal group and there was statistically significance between two groups(p<0.05). Sensitivity and specificity were most higher when the cut-off value was 208ml. 3) After bronchodilator inhalation, reversible airway obstructions were shown in 16 cases of patients group, 7 cases of control group(p<0.05) by spirometry or body plethysmography d the differences of slow vital capacity and forced vital capacity in bronchodilator response group and nonresponse group were $300.4{\pm}306ml$, $144.7{\pm}180ml$ and this difference was statistically significant. 4) The difference between slow vital capacity and forced vital capacity before bronchodilator inhalation was correlated with airway resistance before bronchodilator(r=0.307 p=0.05), and the difference between slow vital capacity and forced vital capacity after bronchodilator was correlated with difference between slow vital capacity and forced vital capacity(r=0.559 p=0.0002), thoracic gas volume(r=0.488 p=0.002) before bronchodilator and airway resistance(r=0.583 p=0.0001), thoracic gas volume(r=0.375 p=0.0170) after bronchodilator, respectively. 5) The difference between slow vital capacity and forced vital capacity in smokers and nonsmokers was $257.5{\pm}303ml$, $277.5{\pm}276ml$, respectively and this difference did not reach statistical significance(p>0.05). Conclusion : The difference between slow vital capacity and forced vital capacity by spirometry may be useful for the detection of collapsible airway and may help decision making of therapeutic plans.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.931-939
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• 1996

An experimental comparative study was done to determine the protective effects of three preservation solutions on isolated rabbit heart-lung bloc during acute ischemia and reperfusion of the lung during lung transplantation. Thirty Isolated rabbit heart-lung blocs were divided into 3 groups , group I(n:9) was preserved with Hartmann's solution, group II(n: 10) with modified University of Wisconsin solution, and group III(n: 1 1) with Kosin solution. The isolated heart-lung blocs were washed with Hartmann's so ution. Aftar infusion of each preservation solution into pulmonary artery, the heart-lung bloc was stored at 4'c cold preservation solution for each group for 4 hours and .then the heart-lung blocs were reventilated and reperfused. The changes of weight of heart-lung blocs, airway pressure, percent change of PCO2, level of lactate and adenosine deaminase(ADA) and microscopic structure of the lung parenchyme were evaluated. Results were as follows 1. A change of weight of the heart lung bloc after reperfusion was lowest in group 111(p< .05) 2. The airway pressure increased after reperfusion in group I but decreased in group II, and II. Especially in group II, post-reperfusion airway pressure returned to level lower than that of en-bloc resection. 3. Pulmonary artery pressure during reperfusion after 4 hour preservation was lowest in group III, and pulmonary artery pressure in group II was higher than in group I(P> 0.1). 4. The level of lactate and ADA in the lung tissue were higher in group III than in group I and II(P< .05) 5. The percent change of PCO2 in perfusate was slightly higher in group III than group I and II. 6. Microscopic changes in lung tissue after reperfusion were diffuse pulmonary edema, expansion of inter- stitial tissue, focal aggregation of erythrocytes, and basement membrane abnormalities, but no differences were found among the three groups. In conclusion, the protective effects of modified University of Wisconsin solution and Kosin solution were slightly superior to Hartmann's solution.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.103-110
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• 1998

Objectives : High co-morbidity of periodic limb movements during sleep(PLMS) and obstructive sleep apnea syndrome(OSAS) is well known and their incidences tend to increase in the elderly. Previous studies have inconsistently rep0l1ed increase or no change of periodic limb movement index(PLMI) by nasal continuous positive airway pressure(CPAP) in OSAS without analyzing possible variables affecting PLMI. We attempted to examine PLMI change evoked during CPAP titration and also factors affecting it in OSAS. Methods : Twenty-nine OSAS patients(M:F=26:3, mean age: $51.6{\pm}10.6\;yrs$) without other sleep disorders except for PLMS were selected, based on the nocturnal (baseline) polysomnograhy. Another night of noctumal polysomnography was performed for CPAP pressure titration. We compared between those two nights PLMI, mean and lowest $SaO_2$, and sleep variables. We also calculated PLMI differences between baseline and CPAP nights, named as delta PLMI (value of CPAP night PLMI minus value of baseline night PLMI). Correlations were calculated between delta PLMI and factors such as age, body mass index, applied CPAP pressure, baseline night values of respiratory disturbance index, mean and lowest $SaO_2$, and sleep parameter differences between baseline and CPAP nights. Results : Decrease of RDI(p<.01) and increase in mean and lowest $SaO_2$ (p<.05, p<.01) were observed during CPAP night. No sleep parameters showed significant change except for the decrease of total stage 1 sleep%(p<.01) during CPAP night. Ten out of 29 patients showed PLMI increase, while the other 19 patients showed either no change(n=14) or even PLMI decrease(n=5) during CPAP night. The 10 patients showing PLMI increase during CPAP night showed a significant positive correlation between delta PLMI and baseline night RDI(p<.05), which meant that PLMI increase was found to be more prominent in higher RDI patients than in lower RDI ones. There were no significant correlations between delta PLMI and other factors in the other 19 patients. Conclusions : We suggest that during the baseline night PLMS would have been underscored and/or masked due to the overlapping of PLMS and apneas/hypopneas or the arousals induced by apneas/hypopneas. Despite its still unknown mechanism, the CPAP application may unmask PLMS and increase PLMI in a subgroup of OSAS patients. It needs to be evaluated further whether the chronic CPAP use sustains the above finding.

• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.182-189
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• 2018

Background and Objectives : There were few literatures about the relationship between upper airway disorders and cardiovascular risk factors such as hypertension, although an association between impaired lower respiratory function and cardiovascular alterations was often reported. Our purpose was to assess the relationships between chronic sinusitis and hypertension. Materials and Methods : Three hundred subjects with bilateral chronic sinusitis who underwent functional endoscopic sinus surgery between 2015and 2017 were evaluated. Six hundred forty subjects without any nasal diseases were enrolled as a control group. Blood pressure and body mass index (BMI) were measured using a standardized method, and subjects were asked about current use of any antihypertensive medication, history of diabetes, smoking and alcohol drinking habits.Sinusitis group was assessed by nasal endoscopic examination, paranasal sinus CT scan and allergy test. Results : Average systolic and diastolic blood pressures were statistically significantly higher in subjects with sinusitis than control group. Chronic rhinosinusitis was associated with a 1.415-fold (95% confidence interval 1.053-1.930) increased hazard of hypertension after multivariate adjustment. Conclusions : These results suggest that sinusitis is associated with high blood pressure. Therefore patients with sinusitis may need special attention for blood pressure control. Further studies need to be performed to elucidate the pathogenesis behind such associations.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.253-253
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• 1997

Hypothermia during lung preservation decreases metabolic processes. After the rabbit lung was flushed with modified Euro-Collins solution, heart-lung block was harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. Heart-lung block was immersed in the same solution for 6 hours. The modified Euro-Collins solution and storage temperature of group 1(10 cases) was 4t, roup 2(10 cases) was l0℃. On completion of the storage period, the left lung was ventilated and reperfused with blood u:high used a cross-circulating paracorporeal rabbit as a "biologic deoxygenator" for 60 minutes. Pulmonary artery pressure, airway pressure, difference in oxygen tension between mow and outflow perfusate and degree of pulmonary edema were assessed at 10-minute intervals while the left lung was ventilated at 0.8 of the inspired oxygen fraction. The mean pulmonary venous oxygen tensions at 10 and 60 minutes after reperfusion were 209.52±42.46 and 103.48± 15.96 mmHg in group I versus 247.78±36.19 and 147.91 ± 11.07 mmHg in group II(p=0.049, (0.0001). The mean alveolar-arterial oxygen differences at 20 and 60 minutes after reperfusion were 357. 95± 12.84 and 437.31 14.26 mmHg in group I versus 310.88±3).47 and )90.93± 15.86 mmHg in group II (p=0.0092, (0.0001). The mean pulmonary arterial pressures at 10 and 60 minutes after reperfusion were 40.56± 18.66 and 87. 2± 17.22 mmHg in group I versus 31.22±6.84 and 65.78± 11.02 mmHg in group rl (p : 0.048, 0.0062). The mean pulmonary vascular resistances at 10 and 60 minutes after reperfusion were 2.69±0.85 and 4.36±0.86 mmHg/ml/min in group I versus 1.99±0.39 and 3.29±0.55 mmHg/ml/min in group II(p : 0.0323, 0.0062). There were no difference between groups in peak airway pressure, lung compliance and degree of pulmonary edema. In conclusion that preservation of lung at l0℃ was superior to preservation at 4℃.

• Sleep Medicine and Psychophysiology
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• v.9 no.1
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• pp.24-33
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• 2002

Objectives: Nasal continuous positive airway pressure (CPAP) corrected elevated blood pressure (BP) in some studies of obstructive sleep apnea syndrome (OSAS) but not in others. Such inconsistent results in previous studies might be due to differences in factors influencing the effects of CPAP on BP. The factors referred to include BP monitoring techniques, the characteristics of subjects, and method of CPAP application. Therefore, we evaluated the effects of one night CPAP application on BP and heart rate (HR) reactivity using non-invasive beat-to-beat BP measurement in normotensive and hypertensive subjects with OSAS. Methods: Finger arterial BP and oxygen saturation monitoring with nocturnal polysomnography were performed on 10 OSAS patients (mean age $52.2{\pm}12.4\;years$; 9 males, 1 female; respiratory disturbance index (RDI)>5) for one baseline night and another CPAP night. Beat-to-beat measurement of BP and HR was done with finger arterial BP monitor ($Finapres^{(R)}$) and mean arterial oxygen saturation ($SaO_2$) was also measured at 2-second intervals for both nights. We compared the mean values of cardiovascular and respiratory variables between baseline and CPAP nights using Wilcoxon signed ranks test. Delta ($\Delta$) BP, defined as the subtracted value of CPAP night BP from baseline night BP, was correlated with age, body mass index (BMI), baseline night values of BP, BP variability, HR, HR variability, mean $SaO_2$ and respiratory disturbance index (RDI), and CPAP night values of TWT% (total wake time%) and CPAP pressure, using Spearman's correlation. Results: 1) Although increase of mean $SaO_2$ (p<.01) and decrease of RDI (p<.01) were observed on the CPAP night, there were no significant differences in other variables between two nights. 2) However, delta BP tended to increase or decease depending on BP values of the baseline night and age. Delta systolic BP and baseline systolic BP showed a significant positive correlation (p<.01), but delta diastolic BP and baseline diastolic BP did not show a significant correlation except for a positive correlation in wake stage (p<.01). Delta diastolic BP and age showed a significant negative correlation (p<.05) during all stages except for REM stage, but delta systolic BP and age did not. 3) Delta systolic and diastolic BPs did not significantly correlate with other factors, such as BMI, baseline night values of BP variability, HR, HR variability, mean SaO2 and RDI, and CPAP night values of TWT% and CPAP pressure, except for a positive correlation of delta diastolic pressure and TWT% of CPAP night (p<.01). Conclusions: We observed that systolic BP and diastolic BP tended to decrease, increase or remain still in accordance with the systolic BP level of baseline night and aging. We suggest that BP reactivity by CPAP be dealt with as a complex phenomenon rather than a simple undifferentiated BP decrease.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.125-132
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• 2008

Background: In chronic obstructive pulmonary disease (COPD) patients, the serum levels of C-reactive protein (CRP) are elevated and an increase of CRP is more exaggerated in the acute exacerbation form of COPD (AECOPD) than in stable COPD. Pulmonary arterial hypertension is a common complication of COPD. An increased level of CRP is known to be associated with the risk of systemic cardio-vascular disorders. However, few findings are available on the potential role of CRP in pulmonary arterial hypertension due to COPD. Methods: This study was performed prospectively and the study population was composed of 72 patients that were hospitalized due to AECOPD. After receiving acute management for AECOPD, serum CRP levels were evaluated, arterial oxygen pressure ($PaO_2$), was measured, and the existence of pulmonary arterial hypertension under room air inhalation was determined in the patients. Results: The number of patients with pulmonary arterial hypertension was 47 (65.3%)., There was an increased prevalence of pulmonary arterial hypertension and an increase of serum CRP levels in patients with the higher stages of COPD (e.g., patients with stage 3 and stage 4 disease; P<0.05). The mean serum CRP levels of patients with pulmonary arterial hypertension and without pulmonary arterial hypertension were $37.6{\pm}7.4mg/L$ and $19.9{\pm}6.6mg/L$, respectively (P<0.05). However, there was no significant difference of the mean values of $PaO_2$ between patients with pulmonary arterial hypertension and without pulmonary arterial hypertension statistically ($77.8{\pm}3.6mmHg$ versus $87.2{\pm}6.0mmHg). Conclusion: We conclude that higher serum levels of CRP can be a sign for pulmonary arterial hypertension in AECOPD patients.

• Sleep Medicine and Psychophysiology
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• v.13 no.1
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• pp.27-32
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• 2006

Objectives: Nasal continuous positive airway pressure (nCPAP) is the treatment of choice and has been shown to reduce the frequency of nocturnal respiratory events, improve sleep architecture, and decrease daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). However, little is known about the compliance of nCPAP treatment in Korea. Our objective was to look into the nCPAP compliance and examine the factors influencing it. Methods: We reviewed the records of one hundred and twenty consecutive patients with OSAS referred for nocturnal polysomnography with nCPAP pressure titration during the period of January 1995 through April 1999 to the Seoul National University Hospital. We performed a telephone interview and obtained data from eighty-three patients. Results: In sixty patients who had accepted nCPAP treatment, twenty-six patients (43.3%) were still using nCPAP device, while thirty-four patients (56.7%) stopped using it. Fifteen patients (25%) were using nCPAP device everyday. In thirty-four patients who discontinued nCPAP use, twenty-five patients (73.5%) did within the first three months, and thirty-one (91.2%) within the first year. Significant predictor of long-term nCPAP use was the presence of subjective daytime sleepiness before nCPAP application. Conclusions: Long-term compliance with nCPAP treatment appears to be associated with the presence of subjective daytime sleepiness before nCPAP application. Long-term compliance with nCPAP may be mostly predicted from the usage pattern within the first three months of use.