• Tuberculosis and Respiratory Diseases
• /
• v.46 no.3
• /
• pp.350-362
• /
• 1999

Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

• Journal of Chest Surgery
• /
• v.31 no.4
• /
• pp.393-397
• /
• 1998

A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction(LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle(LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator(EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.

• Sleep Medicine and Psychophysiology
• /
• v.4 no.2
• /
• pp.129-139
• /
• 1997

The data collected to date indicate that sleep-related breathing disorders, including sleep-disordered breathing(sleep apnea) and underlying respiratory system diseases, are one of the important risk factors for cardiovascular dysfunction. Sleep-disordered breathing(sleep apnea) is now recognized as one of the leading causes of systemic hypertension, cardiac arrhythmias, coronary heart disease, pulmonary hypertension, right heart failure, and stroke. Sleep may exert a profound effect on breathing in patients with underlying respiratory system disease including bronchopumonary diseases, chest wall abnormalities, central alveolar hypoventilation syndromes or respiratory neuromuscular disorders. Chronic hypoxia and hypercapnia in these patients may accelerate the development of long term cardiovascular complications such as cardiac arrhythmias, pulmonary hypertension, and right heart failure(cor pulmonale). Several recent studies reported that sleep-related breathing disorders are associated with long-term cardiovascular morbidity and mortality. Careful assessment of respiratory and cardiovascular function in these patients is critical. Aggressive and highly effective treatment of sleep-related breathing disorders using tracheostomy, mechanical ventilation, nasal continuous positive airway pressure therapy(nCPAP), intercurrent oxygen therapy or other interventions can reduce the prevalence of cardiovascular dysfunction and the long-term mortality.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.18 no.3
• /
• pp.488-499
• /
• 1996

Diabetes mellitus revealed a chronic disorder of lipid, carbohydrate and protein metabolism characterized by insulin deficiency, and a striking tendency toward development of atherosclerosis, microangiopathy, nephropathy, neuropathy and recently cardiomyopathy etc. The mechanism of heart failure in patients with diabetic cardiomyopathy is not clear but diabetic cardiomyopathy usually occurs in persons with long standing diabetes. After diabetes induced in made Sprague- Dawley strain rats by injection of streptozotocin(60mg/kg), cardiac tissue with hematoxylin-eosin and Masson's trichrome stain was examined at 3 days, 1, 2, 4, 6 weeks later under light microscope. The results were obtained as follows : 1. In H&E stain of control group, myocardiac cells were shorter than skeletal muscle cell, which was branched out and connected each other at terminal with striation, intercalated disk and nucleus at center of cell. 2. In MT stain of control group, a few of collagen fibrile were seen at periva scular interstium, but wasn't seen between skeletal muscle fiber, and cardiac muscle was seen in various size. 3. In MT stain of experimental group, increased collagen fiber deposition at perivascular interstiums were seen periodically. 4. In MT stain of experimental group, increased collagen fiber deposition at interstitial matrix between perimyocardiac cells were seen at 3 day, 4 weeks and 6 weeks after DM induction. 5. In H&E stain of experimental group, partial degeneration of myocardiac cells was seen after 4 weeks of DM induction. From above results, streptozotocin induced diabetes mellitus increased collagen around perivascular and between intercellular matrix in heart.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.739-742
• /
• 2010

Two stents were placed across the right subclavian vein due to stenosis of the right subclavian vein in a 40-year-old patient with chronic renal failure on hemodialysis. During the follow up period, one of stents migrated into the right ventricle inducing tricuspid valve insufficiency. Percutaneous stent removal had failed and the stent was removed by open heart surgery with Tricuspid valve repair with a good result, and then we report the case.

• Journal of Yeungnam Medical Science
• /
• v.5 no.1
• /
• pp.159-166
• /
• 1988

Dissecting aortic aneurysm is relatively rare in those under 40 years of age without high risk factors. After dessecting aortic aneurysm is occured, the coronary artery is rarely perfused by false lumen. We present a thirty two-year-old man who showed Debakey type 1 dissecting aortic aneurysm with right coronary artery perfused by false lumen of ascending aorta and with congestive heart failure due to aortic insufficiency without discernible risk factor. Medical and surgical treament(Modified Bentall's operation) were successfully performed. The pathologic report showed combined cystic medial necrosis. Now he is well tolerated and stable only with anticoagulation during follow up 18 months.

• Pediatric Infection and Vaccine
• /
• v.2 no.2
• /
• pp.200-206
• /
• 1995

Myocarditis refers to inflammation, necrosis, or myocytolysis that may be due to many infectious, connective tissue and many other causes affecting the myocardium or involvement of the endocardium or pericardium. The most common manifestation is congestive heart failure, although arrhythmias and sudden death may be the first sign of myocarditis. Viral myocarditis is typically a sporadic but occasionally epidemic illness, noted as an acute potentially fulminant disease of 1-to 4-wk-old infants, as an acute but more benign myopericarditis of toddlers and young children. The most common casuative agent in viral myocarditis is Coxsackievirus and the outcome of the biopsy-proven chronic dilated cardiomyopathy associated with Coxsackievirus is poor without therapy. Myocarditis may be confirmed by percutaneous endomyocardial biopsy and the viral myocarditis may be diagnosed by the serological viral study with the clinical manifestations. He was admitted for the management of tachyarrhythmias occurred suddenly without prodromal symptoms and signs and diagnosed as viral pancarditis by serological Coxsackievirus study, echocardiogram, chest x-ray, EKG and other clinical manifestations.

• Imaging Science in Dentistry
• /
• v.38 no.4
• /
• pp.229-231
• /
• 2008

Brown tumor is a histologically benign lesion that is a serious complication of renal osteodystrophy because it may result in severe deformity and discomfort. We report a case of brown tumor, which occurred in a 35-year-old woman with chronic renal failure, who had been treated with hemodialysis for 14 years. The lesion was found on the lingual side of the mandible. Standard panoramic radiograph showed generally decreased bone mineral density, loss of lamina dura, and thin cortical plates. Computed tomography (CT) revealed multilocular expansile lesions with heterogeneous attenuation in the anterior mandible, as well as generalized trabecular alteration with homogeneous sclerosis, and thinning or obliteration of cortical plates. Excision of the mandibular lesion and curettage of the affected bone were performed. (Korean J Oral Maxillofac Radiol 2008; 38: 229-31)

• Journal of Veterinary Clinics
• /
• v.30 no.3
• /
• pp.151-158
• /
• 2013

This study aimed to evaluate the plasma concentration of NT-proBNP in dogs with different stages of heart failure by chronic mitral valve insufficiency (CMVI). Fifty small-breed dogs with CMVI and 7 healthy control dogs without cardiac disease and critical systemic diseases were included in the study population. As a preliminary study, we compared the plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the echocardiographic parameters between dogs of the International Small Animal Cardiac Health Council (ISACHC) classes. Then, we evaluated the associations between NT-proBNP and echocardiographic parameters. Plasma NT-proBNP levels showed a significant difference among the ISACHC groups. In the comparison between echocardiographic parameters and NT-proBNP, NT-proBNP were found to be associated with left atrium/aorta (LA/AO), early diastolic transmitral flow (E) velocity, late diastolic transmitral flow (A) velocity, end diastolic volume index (EDVI). Our study found plasma NT-proBNP might be useful to predict the disease progression in dogs with CMVI.

• Journal of Veterinary Clinics
• /
• v.33 no.2
• /
• pp.81-86
• /
• 2016

Cystatin C is a low molecular weight 13 kilodalton protein. It is known to be a more sensitive marker of glomerular filtration rate than creatinine in humans. The purpose of the present study was to demonstrate the changes of renal markers including cystatin C according to the severity of chronic mitral valve insufficiency (CMVI) and to investigate the clinical relevance of cystatin C as an early renal marker in dogs with CMVI. A retrospective study was performed to assess renal function according to International Small Animal Cardiac Health Council (ISACHC) system classification of heart failure in dogs with CMVI. Thirty seven dogs were divided into a group 1 (healthy dogs ; n = 10), a group 2 (ISACHC I ; n = 10) and a group 3 (ISACHC II-III ; n = 17). In all dogs, serum concentrations of bun (sUr), creatinine (sCr) and cystatin C (sCys-C) were measured with an automated analyzer. In dogs with CMVI, sCys-C concentrations were significantly correlated with sCr concentrations and were independent of age, BW, SBP, and sex. Renal dysfunction tended to occur more frequently as the severity of CMVI increases. In dogs with mild CMVI, only sCys-C concentrations were statistically higher than in healthy dogs. This study demonstrates the clinical relevance of sCys-C. sCys-C may be a valuable renal marker for early diagnosis of renal dysfunction in dogs with CMVI.