• Tuberculosis and Respiratory Diseases
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• 제69권5호
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• pp.323-330
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• 2010

A key mechanism in the pathogenesis of chronic obstructive pulmonary disease is thought to be an abnormal inflammatory response in the lungs to the inhalation of toxic particles and gases, derived from tobacco smoke, air pollution, and/or occupational exposures. This review highlights the potential participation of several alternative pathogenetic processes, particularly involving the potential participation of biological and pathobiological processes related to aging, including oxidative stress and enhanced expression of markers of senescence/aging in emphysematous lungs, and the potential for enhanced tissue destruction involving alveolar cell apoptosis.

• Journal of Chest Surgery
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• 제23권4호
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• pp.698-706
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• 1990

Congenital Cystic Lung Disease is a spectrum of closed related anomalies that arise during an early stage of embryonic lung bud maturation-namely bronchogenic cyst, congenital lobar emphysema, pulmonary sequestration and congenital cystic adenomatoid malformation. And they show similar surgical strategies. So they are called as the term bronchopulmonary-foregut malformations, firstly proposed by Gerle[1968]. From Aug. 1979 to Aug 1989, 47 patients were operated upon on Dept. of Thoracic & Cardiovascular Surgery at the CUMC. There were 21 females and 26 males ranging in age from age of 21 day to age of 56 year [15 cases under 15 years old]. 30 patients had bronchogenic cysts - 23 of intrapulmonary type, 7 of mediastinal type in location. Affected lobes and locations were as follows: 11 in upper lobe, 3 in middle lobe, 11 in lower lobe and anterosuperior, middle, and posterior mediastinal type were 3, 2, 2 respectively. There were 9 pulmonary sequestrations[all intralobar type] with the distribution of 5 in right lower lobe and 4 in left lower lobe. And associated anomalies were presented with arterial supply originating from thoracic aorta[8 cases], abdominal aorta[1 case] and with venous drainage into azygos vein[1 case]. They all were operated upon lower lobectomy [8 case], pneumonectomy[1 case] in case of pulmonary hypoplasia Congenital lobar emphysema and congenital cystic adenomatoid malformation had 4 cases respectively. Their affected lobes were as follows: the former were 3 in upper lobes, 1 in middle lobe and the latter were 3 in upper lobe, 1 in lower lobe. They were treated with lobectomy and segmentectomy. Diagnosis was aided by chest X - ray, bronchography, aortography, DSA and CT scan, They all were confirmed by pathologic exams. There were no hospital death but few minor morbidities such as, atelectasis-pneumonia[2], wound infection[2], prolonged chest tube placement[2]. We experienced surgical treatments of 47 cases for 10 years and reported them with literature review.

• Tuberculosis and Respiratory Diseases
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• 제72권1호
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• pp.37-43
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• 2012

Background: A lung bulla may rarely shrink as a result of an inflammation within the bulla or a closing of a bronchus involved in the inflammation process, which is termed 'autobullectomy'. The purpose of this study was to describe clinical features of patients with regressions of bullae during follow-up. Methods: We retrospectively reviewed the cases and individuals who showed unequivocal evidence of interval regressions in a pre-existing bulla. A total of 477 cases with a bulla >5 cm in diameter were screened manually. Thirty cases with bullae that showed regression during follow-up were selected. Results: Regressions of large bullae occurred in 30 of 477 cases (6.3%). The median age of those patients was 61 (range, 53~66) years and 87% of those patients were men. The main cause of a bulla was emphysema (80%). Among 30 cases, 16 cases had pneumonia in the lung parenchyma of the peribullous area. Another 7 cases had a regressed bulla accompanied by an air-fluid level within the bulla. The remaining 7 cases showed a spontaneous regression of the bulla without such events. Complete regression of a bulla occurred in 25 cases. A follow-up chest-X ray showed that in all cases except one, the bulla remained in a collapsed state after 24 months. Forced expiratory volume in one second ($FEV_1$) improved in 3 cases and the other 2 cases had increased forced vital capacity (FVC). In addition, total lung capacity (TLC) and residual volume (RV) decreased in another 2 cases. Conclusion: Regression of a lung bulla occurred not only after pneumonia or the presence of air-fluid level within the bulla, but also without such episodes. The clinical course of regression of a lung bulla varied. After regression of a bulla, lung function could be improved in some cases.

• 한국임상수의학회지
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• 제26권1호
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• pp.72-75
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• 2009

Pulmonary bullae are air-filled spaces within the lung parenchyma that result from the destruction, dilatation and confluence of adjacent alveoli. Pulmonary bullae are found most often in healthy, middle aged, large breed or deep-chested dogs that have no previous history of lung disease and bulla may occur as a result of emphysema, inflammation or trauma. Clinical signs include respiratory distress, anorexia, depression and tachypnea. In this study, a dog with respiratory distress by traffic accident was diagnosed as pulmonary bullae with pneumothorax using radiography at Veterinary Medical Teaching Hospital, GNU. In radiographs, various sized, smooth margin, well defined, oval shaped, gas or fluid filled multiple bullae are shown in the left cranial, left caudal and right accessory lobes. At the initial stage of observation, there were indications of four bullae, two of which were not found in the following radiograph. At the same time, there were serious indications of lung consolidation that caused respiratory distress of patient. Ultimately, the patient was expired after ten hours.

• Journal of Ginseng Research
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• 제48권2호
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• pp.181-189
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• 2024

Background: Cigarette smoke is generally accepted as a major contributor to chronic obstructive pulmonary disease (COPD), which is characterized by emphysematous lesions. In this study, we investigated the protective effects of Korean Red Ginseng (KRG) against cigarette smoke condensate (CSC)-induced emphysema. Methods: Mice were instilled with 50 mg/kg of CSC intranasally once a week for 4 weeks, KRG was administered to the mice once daily for 4 weeks at doses of 100 or 300 mg/kg, and dexamethasone (DEX, positive control) was administered to the mice once daily for 2 weeks at 3 mg/kg. Results: KRG markedly decreased the macrophage population in bronchoalveolar lavage fluid and reduced emphysematous lesions in the lung tissues. KRG suppressed CSC-induced apoptosis as revealed by terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling staining and Caspase 3 immunohistochemistry. Additionally, KRG effectively inhibited CSC-mediated activation of Bcl-2-associated X protein/Caspase 3 signaling, followed by the induction of cell survival signaling, including vascular endothelial growth factor/phosphoinositide 3-kinase/protein kinase B in vivo and in vitro. The DEX group also showed similar improved results in vivo and in vitro. Conclusion: Taken together, KRG effectively inhibits macrophage-mediated emphysema induced by CSC exposure, possibly via the suppression of pro-apoptotic signaling, which results in cell survival pathway activation. These findings suggest that KRG has therapeutic potential for the prevention of emphysema in COPD patients.

• Tuberculosis and Respiratory Diseases
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• 제46권5호
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• pp.628-635
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• 1999

연구배경 : 만성 폐쇄성 폐질환을 대변하는 폐기종에서 주요 기능적 장애는 호기의 장애이며, 최대 호기류량은 기도의 크기, 폐의 탄력반동압 그리고 기도의 함몰성에 의해 결정된다. 기도의 항몰성은 폐기종에서 기류를 제한하는 하나의 기전으로 작용하지만, 폐용적과 폐의 과팽창을 유지하는 기전으로 작용하여 가스교환을 증진시킨다는 주장도 있다. 따라서 폐기종에서 기관이 호흡에 미치는 생리학적 역할이 무엇인지를 알아보고자 본 연구를 수행하였다. 방 법 : 1997년 1월 1일부터 8월 31일까지 보라매병원 호흡기내과를 방문하여 단순 흉부방사선검사, 체간용적기록계(body plethysmography)를 포함하는 폐기능검사 및 HRCT를 통해 폐기종으로 진단된 20명을 대상으로 하였다. HRCT에서 대동맥궁의 정상부위에서 기관의 단면적을 호흡주기에 따라 측정하고 이를 체표면적으로 보정한 값과 동맥혈의 이산화탄소분압 및 산소분압, 기도저항, 폐유순도 등 폐기능지표와의 상관 관계를 분석하였다. 결 과 : 폐기종에서 기관의 단면적은 호기시 동맥혈의 이산화탄소분압(r=-0.61, p<0.05) 및 산소분압(r=0.6, p<0.05) 그리고 매분환기량(r=0.73, p<0.05)과 유의한 상관관계가 있었지만, 흡기시에는 상관관계가 없었다(이산화탄소분압과는 r=-0.22, p>0.05, 산소분압과는 r=0.26, p>0.05, 매분환기량과는 r=0.44, p>0.05). 매분환기량은 상시호흡량(tidal volume)과는 r=0.45(p<0.05)로 유의한 상관관계가 있었지만, 호흡수와는 r=-0.31(p>0.05)로 상관관계가 없었다. 폐기종에서 기관의 단면적은 호흡주기와 상관없이 $FEV_1$ FVC, $FEV_1$/FEC, 최대 호기류량, 잔기용적, 폐확산능, 기도저항, 폐유순도 등의 다른 폐기능지표와는 상관관계가 없었다. 결 론 : 폐기종에서 호기시 기관의 단면적은 주로 가스 교환(gas exchange)의 지표들과 유의한 상관관계가 있었지만, 폐용적이나 폐의 과팽창을 시사하는 지표와는 상관관계가 없었다. 따라서 폐기종에서는 호기시 동일 압력점의 개념에 의해 발생하는 기도압박으로 기관의 단면적이 감소하고 이러한 현상이 기류를 제한하는 하나의 기전으로 작용하는 것이지 폐용적이나 폐의 과팽창을 유지시켜 가스교환을 증진시키는 것은 아니라고 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제45권5호
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• pp.992-999
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• 1998

연구배경: CT상 폐기종의 정량적 분석을 위해서 "Density mask"를 이용하거나 육안적으로 관찰하여 폐기종 지수를 구하고, 폐기종 지수와 폐기능 검사 지표 사이에 상관관계가 있는 지를 알아보았으며, 폐기종 지수를 구하는 여러 방법을 비교하여 보다 간단하고 객관적인 방법을 구하고자 하였다. 방 법: 17명의 폐기종 환자를 대상으로 고해상 전산화 단층 촬영을 시행하였고(모두 남자 환자임, 평균연령 62세), 모든 환자에서 폐확산능과 폐기능 검사를 시행하였다. 환자마다 전체 폐를 포함하는 모든 스캔에서 "Density mask"를 이용하여 -400HU를 기준으로 한 전체 폐용적에 대한 -880, -900, -920HU를 기준으로 한 폐기종 영역의 비를 각각 구하여 폐기종 지수(ESW)를 얻었다. 또 대동맥궁 첨부에서 4cm 간격으로 5-단면을 선택하여 "Density mask"를 이용한 폐기종 지수(ESR)를 구하고, 육안적으로 관찰하여 폐기종 지수(ESV)를 구하였다. 각각의 폐기종 지수를 폐기능 검사지표와 비교하여 통계학적으로 유의한 상관관계가 있는지 알아 보았으며, 폐기종 지수를(ESW, ESR, ESV) 사이에 유의한 차이가 있는지 알아보았다. 곁 과: 폐기종 환자에서 "Density mask"로 전체 폐를 이용하여 얻은 폐기종 지수(ESW)는 폐확산능 (r=0.61)과 $FEV_1/FVC$(r=0.51) 등의 안정시 폐기능 검사지표와 상관관계가 있었다. -880, -900, -920HU로 기준치를 달리 하여 얻은 각각의 ESW 사이에는 유의한 차이가 없었다. 5-단면을 이용하여 얻은 ESR는 ESW와 밀접한 상관관계가 있었고, 상기한 폐기능 검사지표와도 좋은 상관관계를 보였다. 육안적 폐기종 지수는 DLCO(r=0.71)와 physiologic dead space ratio(r=0.58)를 제외한 모든 폐기능 검사와 유의한 상관관계가 없었다(p<0.05). 결 론: CT상 "Density mask"를 이용해 폐기종을 정량분석한 폐기종 지수 (ESW, ESR)와 폐기능 검사지표와 유의한 상관관계가 있었고 폐기종의 중증도의 평가에 유용한 방법으로 생각되며, 또한 폐기능 검사 지표에 대해 ESW가 육안적으로 구한 폐기종 지수(ESV)보다 높은 상관관계를 보였다. 대표적인 5-단면에서 얻은 폐기종 지수(ESR)는 간단하고 정확하여 실제 임상에 권장된다.

• 한국간호교육학회지
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• 제9권1호
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• pp.17-29
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• 2003

This study investigated the degree of self-care practice to maintain the stable respiratory function and the required respiratory nursing needs upon the elderly with chronic obstructive pulmonary diseases. The research subjects were 115 elderly people over 60 years old, who were diagnosed to have chronic obstructive pulmonary diseases (the mixed type, chronic bronchitis, bronchial asthma, emphysema) and were hospitalized in 3 university hospitals in Busan or treated as outpatient, and the data was collected over the period between June 1, 2002 and September 30, 2002. In order to measure the respiratory self-care practice degree and nursing needs of the subjects, the instrument on the self-care practice and the instrument on nursing needs were developed by the researcher. The research results are as follows: 1. The mean of respiratory self-care practice degree by the subjects was 2.41 out of 4 for each clause, and the degree of practicing general management was the highest(2.70), and nutrition control(2.66), respiratory exercise(2.65), expectoration of sputum (2.63), oxygen therapy(2.60), environment control(2.50), and medication control(2.36) succeeded. 2. The degree of self-care practice had a significant difference depending on age(F=2.82, P=0.02), frequency of hospitalization(F=3.11, P=0.01), and diagnosed disease(F=15.66, P=0.00). 3. The subjects nursing needs of respiratory system were 3.07 on the average out of 4.00, and 'I want to know how to prevent the infection of respiratory system such as cold scored the highest 3.83, while the clauses like 'want to know how to face the respiratory disorder properly'(3.77) and 'want the specific explanation of the symptoms of my disease'(3.66) also had scored high points. 4. The nursing needs of the respiratory system had a significant difference depending on diagnosed disease such as mixed type of chronic obstructive pulmonary diseases, emphysema, bronchitis, and asthma (F=6.70, P=0.00). The research showed that the subjects degree of self-care practice of respiratory system was low on the whole, while the nursing needs for managing respiratory organ were relatively high. Therefore, specific education concerning the nursing of the disease and self-care upon the elderly having chronic obstructive pulmonary disease is necessary.

• Neonatal Medicine
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• 제16권2호
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• pp.101-109
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• 2009

Pulmonary surfactant (PS) therapy in premature infants has a remarkable impact on improving survival and outcomes in neonatal respiratory distress syndrome (RDS). Early PS therapy involves instillation of PS upon delivery of very premature infants or if there is evidence of RDS, such as an increased requirement of oxygen 2 hours after birth, especially in infants <30 weeks gestation. Early PS treatment in very premature infants results in a significant reduction in the severity of RDS, mortality, and incidence of pneumothorax, pulmonary interstitial emphysema, and bronchopulmonary dysplasia in comparison with late PS treatment. According to European and American consensus guidelines on the management of neonatal RDS, early PS instillation should be considered for infants <30 weeks gestation, infants with a birth weight <1,250 g, or if the mother has not received antepartum corticosteroids. We suggest that the Korean health insurance policy on RDS be modified so that PS can be used for better clinical outcomes of very premature infants.

• 고신대학교 의과대학 학술지
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• 제33권3호
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• pp.409-414
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• 2018

Giant pulmonary bulla (GPB) is a rare manifestation of emphysema and usually enlarges gradually over time, occasionally resulting in complications. Hence, more often than not, the surgical intervention of a Bullectomy is the standard method of treatment for GPB. However, there are case reports that show the complete resolution of GPB after its inflammation process even without surgical intervention. A 51-year-old man was admitted to our clinic due to pleuritic pain. After a chest X-ray and CT scan, a new air-fluid level within the GPB was revealed in the right upper lobe of his lung. His clinical status had improved promptly with intravenous antibiotics. A one-year follow-up study showed the GPB was completely resolved.