• Journal of Yeungnam Medical Science
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• 제21권1호
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• pp.114-119
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• 2004

This report concerns an unusual case of acute postoperative pulmonary edema without any apparent causes in a 45-year-old man. The patient was subjected to the removal of a previously placed device on the left tibia, and the excision of a benign mass on the right forearm. Unexpected acute bilateral pulmonary edema occurred immediately after the completion of the procedures. The etiologies were reviewed in relation to the patient's condition and clinical manifestations. Fluid overloading was excluded as a cause in view of the patient's perioperative state and postoperative chest X-ray results. We could not find any symptoms of upper airway obstruction during emergence from general anesthesia. We had doubts about tourniquet or fentanyl-induced pulmonary edema, but these factors were not sufficient to bring about pulmonary edema in this case. To our knowledge, the cause of acute pulmonary edema in this case is indeterminate.

• Tuberculosis and Respiratory Diseases
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• 제87권3호
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• pp.309-318
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• 2024

Background: There is limited data regarding the clinical outcomes of clonal hematopoiesis of indeterminate potential (CHIP) in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the clinical significance of CHIP as a COPD biomarker. Methods: This retrospective study was conducted on patients with COPD who were enrolled prospectively in the Seoul National University Hospital Airway Registry from January 2013 to December 2019 and underwent pulmonary function and blood tests. We evaluated the CHIP score according to smoking status and severity of airflow obstruction. Results: We analyzed next-generation sequencing data to detect CHIP in 125 patients with COPD. Current smokers had a higher prevalence of CHIP in combination of DNMT3A, TET2, and PPM1D (DTP), DNA methyltransferase 3 alpha (DNMT3A), and protein phosphatase, Mg²⁺/Mn²⁺ dependent 1D (PPM1D) genes than in never- or ex-smokers. CHIP of DTP and DNMT3A genes was significantly associated with current smokers (adjusted odds ratio [aOR], 2.80; 95% confidence interval [CI], 1.01 to 7.79) (aOR, 4.03; 95% CI, 1.09 to 14.0). Patients with moderate-to-severe airflow obstruction had a higher prevalence of CHIP in most of the explored genes than those with mild obstruction, although the difference was not statistically significant. CHIP in ASXL transcriptional regulator 1 (ASXL1) genes was significantly associated with history of mild, severe, and total acute exacerbation. Conclusion: Given that CHIP in specific genes was significantly associated with current smoking status and acute exacerbation, CHIP can be considered as a candidate biomarker for COPD patients.

• Tuberculosis and Respiratory Diseases
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• 제77권4호
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• pp.193-196
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• 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

• Tuberculosis and Respiratory Diseases
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• 제44권5호
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• pp.1051-1062
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• 1997

연구배경 : 기관지 천식은 가역적인 기도 폐쇄를 특징으로 하지만 치료에 대한 호전 정도에 차이를 보이며 기도의 비가 역적 구조 변화와 관련되는 것으로 보인다. 저자들은 폐 환기능과 고해상 CT를 이용하여 치료 후 기도폐쇄의 호전 차이가 기도의 구조적 변화와 관련되는가를 알아보고자 하였다. 방 법 : 단순 흉부 방사선 촬영에서 정상 소견을 보이는 천식환자 40명을 대상으로 치료 시작 3일내 폐 기능 검사와 고해상 CT를 시행하였다. 매일 PEFR을 측정하였고 그 변화에 따라 대상 환자들을 분류하였다. 초기 PEFR이 정상 범위이면 경증군 (=Group0), PEFR의 30% 증가가 3일이내면 조기반응군(=Group1), 2주이내면 후기반응군(=Group2)으로 분류하였고 다시 PEFR의 정상 범위 도달시기가 3일이내면 조기정상반응군(=Group3), 2주이내면 후기정상반응군(=Group4), 2주내에 도달하지 못한 경우 미정상반응군(=Group5)으로 분류하였다. 결 과 : 연령은 경증군에서 다른 군들에 비해 유의하게 낮았으나 다른 군들간에는 유의한 차이가 없었다. 이환기간은 후기반응군에서 경증군, 조기반응군 보다 유의하게 길었다. FVC(%), $FEV_1$(%)는 치료에 대한 반응이 느릴수록 유의하게 낮았다. $FEV_1$/FVC(%)는 조기반응군과 후기반응군에서 경증군에 비해 유의하게 낮았으며 미정상반응군에서 경증군, 조기 및 후기정상반응군보다 유의하게 낮았다. 공기포획은 호전이 느릴수록 유의하게 많았다. 점액저류는 경증군에서 조기 및 후기반응군에 비해 많았으며, 경증군, 후기정상반응군, 미정상 반응군에서 조기정상반응군보다 많았다. 결 론 : 비교적 단기간내에 기도 폐쇄에서 호전되는데 차이를 보이는 것은 만성적인 염증 반응의 지속시간이 중요하며, 초기 기도폐쇄의 정도가 관련이 있어서, 본 연구에서는 고해상 CT를 통한 구조적 변화의 차이를 뚜렷이 볼 수는 없었지만, 집중적인 치료를 통해 만성 염증 반응을 소실시카고 기도폐쇄가 없는 무증상 상태로 이르도록 하는 것이 환자의 예후에 중요할 것으로 본다.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.455-458
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• 2015

Excessive dynamic airway collapse (EDAC) is a disease entity of excessive reduction of the central airway diameter during exhalation, without cartilage collapse. An 80-year-old female presented with generalized edema and dyspnea at our hospital. The patient was in a state of acute decompensated heart failure due to pneumonia with respiratory failure. We accordingly managed the patient with renal replacement therapy, mechanical ventilation and antibiotics. Bronchoscopy confirmed the diagnosis of EDAC. We scheduled extubation after the improvement of pneumonia and heart condition. However, extubation failure occurred due to hypercapnic respiratory failure with poor expectoration. Her EDAC was improved in response to high flow nasal oxygen therapy (HFNOT). Subsequently, the patient was stabilized and transferred to the general ward. HFNOT, which generates physiologic positive end expiratory pressure (PEEP) effects, could be an alternative and effective management of EDAC. Further research and clinical trials are needed to demonstrate the therapeutic effect of HFNOT on EDAC.

• Journal of Chest Surgery
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• 제23권1호
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• pp.201-204
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• 1990

The double aortic arch is the commonest anomaly among the vascular rings are relatively rare congenital vascular anomalies. This anomaly is malformation of the aortic arch system may, by compression of the trachea and esophagus, cause respiratory distress and dysphagia. We experienced one case of double aortic arch with right sided descending aorta with predominant right anterior arch treated surgically at Kyung Hee University Medical Center. 1-year-old male patient with acute airway obstruction due to combination of double aortic arch and right descending aorta. The diagnosis was made by simple X-ray & confirmed by barium esophagogram & aortogram. The operative approach was through left thoracotomy & underwent division of the left aortic arch & division of ligamentum arteriosum & suspension of divided proximal end of anterior arch to anterior thoracic wall. The postoperative courses was uneventful and doing well on the 3 years.

• 대한기관식도과학회지
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• 제9권1호
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• pp.92-95
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• 2003

Laryngeal foreign bodies are not common among the foreign bodies of aerodigestive tract. It is relatively easy to diagnose in acute phase of entry because of a readily\ulcorner available history of intake, and signs or symptoms referable to the foreign body in the highly sensitive air passage. However, on occasion, sudden death by respiratory failure occurs due to complete obstruction of airway. Therefore, it is common and safe to remove the laryngeal foreign bodies by suspension laryngoscope under general anesthesia after tracheostomy. Recently, the authors experienced a case of metallic foreign body in larynx penetrating neck, which was removed by suspension laryngoscope under general anesthesia without any life threatening complication.

• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.283-288
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• 2022

Asthma is a chronic inflammatory disease of the airways characterized by varying and recurrent symptoms, reversible airway obstruction, and bronchospasm. In this paper, clinical important studies on asthma published between March 2021 and February 2022 were reviewed. A study on the relationship between asthma and chronic rhinosinusitis, bronchiectasis, and hormone replacement therapy was published. A journal on the usefulness of fractional exhaled nitric oxide for the prediction of severe acute exacerbation was also introduced. Studies on the effect of inhaler, one of the most important treatments for asthma, were published. Studies on the control of severe asthma continued. Phase 2 and 3 studies of new biologics were also published. As the coronavirus disease 2019 (COVID-19) pandemic has been prolonged, many studies have explored the prevalence and mortality of COVID-19 infection in asthma patients.

• Tuberculosis and Respiratory Diseases
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• 제53권4호
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• pp.420-430
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• 2002

연구배경 :임상적으로 만성 기관지염 환자의 호흡기 증상이 급격히 악화되는 것으로 정의되는 만성 기관지염의 급성악화는 기도의 폐쇄를 조장하여 만성 폐쇄성 폐질환으로의 진행을 촉진시키는 것으로 알려져 있다. 방 법 :만성 기관지염의 급성악화 환자 40명을 대상으로 하였으며 대상 환자를 무작위로 moxifloxacin군과 clarithromycin군으로 나누어 항생제를 경구투여 하였다.항생제를 복용 하기 전과 항생제를 7일간 복용한 후 각각 객담을 유도 처리하여 유도객담 상층액 내의 IL-8, SLPI, MMP-1, MMP-9, TIMP-1의 농도를 ELISA 방법으로 측정하였다. 결 과 : 항생제 투여에 의해 유도객담 내 TIMP-l의 농도와 TIMP-1/MMP-1의 분자량 비율이 유의하게 감소하였고 (p<0.05), 유도객담 내 SLPI의 농도는 유의하게 증가하였다(p<0.01) 급성악화 시 유도객담 내의 TIMP-1의 농도(p<0.01, r=0.751)와 TIMP-l/MMP-1의 분자량 비율(p<0.01, r=0.752)은 IL-8과 유의한 상관관계를 보이고 있었으며 항생제 치료로 호전이 된 이후에도 IL-8과의 상관관계는 계속 관찰되었다. 급성악화 시 유도객담 내 SLPI의 농도는 유도객담 내 TIMP-1(p<0.01, r=-0.496)과 TIMP-1/MMP-1(p<0.01, r=-0.456)의 분자량 비율 변화와 유약한 상관관계가 있었다. 그러나 유도객담 내 MMP-1, MMP-9의 농도 그리고 TIMP-l/MMP-9의 분자량 비율은 IL-8이나 SLPI의 농도와 유의한 상관관계가 없었다. 결 론 : 만성 기관지염의 급성 악화에 의해 TIMP와 MMPs의 불균형이 초래되며 TIMP가 상대적으로 많이 증가함으로써 기도 내 ECM이 축적되는데 적절한 항생제를 사용하지 않았을 때에는 이러한 기도벽의 재구성이 반복되어 기도의 폐쇄가 심해질 것으로 생각된다. TIMP와 MMPs의 불균형은 항생제 치료에 의하여 호전이 됨으로 적절한 항생제 치료는 만성 기관지염의 급성악화에 의한 비가역성 기도 폐쇄가 진행되는 것을 어느 정도 예방할 수 있을 것으로 생각된다.

• 대한후두음성언어의학회지
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• 제27권2호
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• pp.130-133
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• 2016

Rheumatoid arthritis (RA) is a connective tissue disease involving the larynx in 30 % of the patients. Foreign body sensation, hoarseness, and cough are common symptoms in laryngeal involvement. An urgent tracheostomy is required when acute airway obstruction occurs in case of bilateral vocal fold paralysis. The most common cause of bilateral vocal fold paralysis in RA patients is a cricoarytenoid joint arthritis. Laryngeal nerve degeneration is rare cause of bilateral vocal fold paralysis in RA patients. In this case report, an emergent tracheostomy was performed on a 64-years-old male patient with acute dyspnea, and concurrent involvement of RA on laryngeal nerve and cricoarytenoid joint was revealed by laryngeal electromyography and histopathology. The vocal fold mobility was restored after 3-months medical treatment.