• Journal of Chest Surgery
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• v.28 no.5
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• pp.499-503
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• 1995

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

• Korean Journal of Clinical Laboratory Science
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• v.43 no.4
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• pp.188-193
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• 2011

Obstructive sleep apnea (OSA) is the most common type of sleep apnea and is caused by obstruction of the upper airway. Since it is closely related to sleep parameter and body indices, the study was focused on the relationship with them. The results of polysomnography (PSG) in obstructive sleep apnea was done at ENT department of Ewha women university Mokdong hospital from March to September 2010 with 52 subjects (male 35, female 17). The leads were placed to measure electroencephalogram (EEG), electrooculogram (EOG), mandibular and anterior tibialis electromyogram (EMG), airflow in nasal and oral cavity, chest and abdominal breathing pattern, snoring sound and arterial oxygen saturation ($SpO_2$) level. From sleep parameter and body indices of adult obstructive sleep apnea compared to normal adult revealed that age (p<0.01) and snoring sound (p<0.05) were increased, stage 1 sleep (p<0.01) was increased, the deeper stages (3&4) of sleep (p<0.05) were reduced. Respiratory disturbance index (RDI) (p<0.01), mean $SpO_2$ (p<0.05) and lowest $SpO_2$ (p<0.01) were also decreased. The correlation analysis from sleep parameter and body indices of OSA showed the positive correlation with age (r=0.463, p<0.001), snoring sound (r=0.278, p<0.05), stage 1 sleep (r=0.391, p<0.01) and RDI (r=0.409, p<0.01), but showed the negative correlation with the deeper stages (3&4) of sleep (r=-0.307, p<0.05), mean $SpO_2$=(r=-0.274, p<0.05) and lowest $SpO_2$ (r=-0.392, p<0.01). This study proves that obstructive sleep apnea and indices have closed related.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.220-225
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• 1998

Background: The patients of facial hyperhidrosis have been known that they had much difficulties in interpersonal relationships and social activities due to excessive hidrosis when they were in stress, hot weather, or having meals. Previous drug therapy and stellate ganglion block have only temporary effects. The surgical method, $T_1$ sympathetomy has the risk of Hornor's syndrome. For that reasons, the sympathicotomy of proximal and distal portions of $T_2$ sympathetic ganglion with electroresectoscope used in transurethral resection seemed to be appropriate procedure, and we would like to report the results of our procedure. Method: Under the general anesthesia with semi-sitting position, and the portal was made through the small incision along the upper border of the 4th rib at the crossing point of mid-axillary line. After the partial collapse of lung by insufflation of 300 to 500 ml of $CO_2$, $T_2$ sympathetic ganglion was identified and resected proximally and distally with electro-cauterization. Finally the lung was expanded by limiting flow until the airway pressure reached 30 to 40 cm$H_2O$, and the wound was closed after removal of electroresectoscope. Result: There was no postoperative complication requiring surgical interventions. The facial sweating was stopped immediately after the operation and all the patients appeared to be satisfied. Conclusion: $T_2$ sympathicotomy with TUR electroresectoscope is thought be the minimal invasive and highly successful method in the treatment of facial hyperhidrosis. But longer terms follow-up will be needed to prove this result.

• Journal of The Korean Society of Clinical Toxicology
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• v.10 no.2
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• pp.91-96
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• 2012

Purpose: A retrospective study with a literature review was conducted to identify the clinical characteristics and prognosis after the acute ingestion of glacial acetic acid. Methods: The medical records of 20 patients,who had presented to the emergency department of Ajou University Hospital complaining of the acute ingestion of glacial acetic acid between January 2006 and December 2011, were examined retrospectively. Results: Among the 172 patients admitted for caustics injury, 20 patients ingested glacial acetic acid. The mean age of the patients was $55{\pm}23.5$, and the mean volume of the acid was $84.5{\pm}71.3$ ml. The clinical features included 1) oral ulcers in 12 patients (63.2%), 2) respiratory difficulties in 11 patients (57.9%), 3) oliguria in 8 patients (42.1%), 4) renal toxicity in 7 patients (36.8%), 5) hepatic failure in 7 patients (36.8%), 6) disseminated intravascular boagulopathyin 7 patients (36.8%), 7) low blood pressure in 8 patients (42.1%), and 8) mental changes in 9 patients (47.4%). Ten patients required endotracheal intubation. Nine patients were admitted to the intensive care unit, and 5 patients expired. Conclusion: The ingestion of glacial acetic acid can cause severe symptoms, such as metabolic acidosis, multiple organ failure and upper airway swelling frequently and has a high mortality rate. Therefore, aggressive treatment, including endotracheal intubation, should be considered at the early stages.

• Imaging Science in Dentistry
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• v.46 no.3
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• pp.167-171
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• 2016

Purpose: Obstructive sleep apnea (OSA) is a common medical disorder with serious complications if untreated. Dentists play a vital role in the early diagnosis of this condition, thereby improving patients' prognoses. The purpose of this study was to identify patients with a high risk of OSA using simple cephalometric measurements in patients receiving routine dental care. Materials and Methods: The present study was conducted on 206 patients divided into a high-risk group and a control group after answering the Berlin questionnaire. Cephalometric analysis of a digital cephalogram was performed to measure the upper airway diameter (UAD) and mandibular-to-hyoid bone distance (MP-H) by 2 observers at 2 different times. Results: Among 206 patients, 93 (45%) were included in the high-risk group and 113 (55%) were in the control group. No significant difference was present between the groups with regard to gender, and the patients ranged in age from 18 to 65 years. The UAD measurements in the high-risk group were significantly lower than in the control group, and the MP-H measurements were significantly higher in the high-risk group than in the control group. The UAD was lower in middle-aged patients in both groups. Conclusion: Our study found that the UAD was lower in individuals with a high risk of OSA. Also, we found that middle-aged individuals of both genders were more likely to develop OSA. Dentists play a vital role in diagnosing patients at a high risk for OSA via thorough clinical examinations, risk factor analyses, and simple cephalometric analyses.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.238-243
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• 1995

Sleep Apnea Syndrome is characterized by hypersomnolence, snoring, and sleep apnea. The symptoms of hypothyroidism include apathy, somnolence, lethargy, personality change, and intellectual deterioration and may be related to hypothyroid-related sleep disorders. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A 60-yr-old man was admitted due to hypersomnolence, snoring and generalized edema. Polysomnogram showed obstructive pattern of sleep apnea syndrome. Neck CT scan revealed narrowing of upper airway which is consistent with obstructive sleep apnea syndrome. Physical examination and hormonal study also disclosed the evidence of hypothyroidism. We report a case of sleep apnea syndrome due to primary hypothyroidism with review of literatures.

• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.450-456
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• 2002

Idiopathic tracheal stenosis is a type of benign stenosis that possesses specific characteristics but is of unknown origin. It is a rare disease characterized by extensive fibrosis of a portion of trachea, and predominantly found in women. The lesion presents as circumferential fibrotic stenosis that usually occurs at upper trachea and the subglottic larynx, but lower trachea may also be involved. Diagnosis is made from the clinical characteristics accompanide by compatible pathologic features and by exclusion of other etiologies. Conservative management such as laser resection, dilatation and stent insertion can be tried initially, but surgical resection is recommended for definitive treatment due to frequent restenosis and maintenance problems of conservative approach. We report a case of idiopathic tracheal stenosis treated with tracheal resection and anastomosis followed by insertion of a retrievable stent for immediate relief of airway obstruction.

• Clinical and Experimental Pediatrics
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• v.53 no.10
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• pp.863-871
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• 2010

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.313-316
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• 2007

Negative pressure pulmonary edema (NPPE) during anesthetic recovery is a rare, but potentially serious complication for patients who are undergoing different surgical procedures. The proposed mechanism is the generation of high negative pressure during markedly respiratory effort and upper airway obstruction from glottis closure and laryngospasm, and this all leads to pulmonary edema. We report here on a case of a healthy 26-year-old male who immediately developed NPPE and hemoptysis following extubation after partial rib resection due to benign rib tumor; the patient was treated conservatively. We also include a review of the review literatures.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.25 no.2
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• pp.99-103
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• 2014

A laryngeal web is connective tissue covered with epithelium stretching between both sides of the true vocal cords. Laryngeal webs were first reported by Fleischmann in 1882, and they cause upper airway obstruction and abnormalities of phonation. Congenital webs result from an arrest of reabsorption of the epithelium of the larynx at the tenth week of the fetus. The most common site of webbing is the anterior commissural glottic area, followed by other glottic areas and rarely subglottic or supraglottic areas. We have experienced two cases of congenital laryngeal webs. The webs were operated in two different methods. The first was excised under magnified vision through a laryngoscope, with a silastic keel secured between the raw surfaces of the separated mucosa. In the second case, the deepithelialized surfaces were exposed for a certain time length to mitomycin C to prevent postoperative webbing. We, hereby, report our experience of the diagnosis and management of two cases of a rare entity known as the congenital laryngeal web, and discuss the results with relevant studies.