• Korean Journal of Bronchoesophagology
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• v.17 no.2
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• pp.92-97
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• 2011

MMinimally invasive surgery (MIS) for early stage lung cancer has been an important treatment modality. However, the ergonomic discomfort and counterintuitive instruments hindered the application of video-assisted thoracic surgery (VATS) to more advanced procedures. To improve the compliance with MIS, robotic surgery was adopted. This advance aimed to alleviate the shortcomings of VATS by maximizing the comfort of the surgeon while providing instruments that enabled technically demanding operations and three-dimensional views with increased freedom for intrathoracic movement owing to EndoWrist$^{(R)}$. In this session, we introduced the clinical applications and its results of robot-assisted thoracic surgery in the field of lung cancer surgery. In conclusion, robot-assisted pulmonary resection with lymph node dissection for lung cancer is safe as well as feasible, and it results in a satisfying postoperative outcome. Robot-assisted surgery may provide a good alternative to conventional open or thoracoscopic surgery for lung cancer, provided that the cost effectiveness and long-term prognosis are confirmed.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1054-1062
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• 1995

Discrete bullae are a well-recognized feature in patients with generalized emphysematous lung disease. They result in space occupation, expanding preferrentially at the expense of adjacent lung tissue, which has a more normal compliance.The presence of these bullae may aggravate the dyspnea consequent to generalized disease. We underwent operation for emphysematous lung disease using a modification of a technique first described by Monaldi for the drainage of pulmonary cavities after tuberculous infection.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.177-188
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• 2008

Background: To evaluate the effects of inhaled nitric oxide (NO) and sphingosine 1-phosphate (S1P) as potential therapeutic agents of acute lung injury, we analyzed the morphology in vivo of the pulmonary microstructure using intravital videomicroscopy in a rat model of acute lung injury. Material and Method: Sprague Dawley rats were divided into five groups: a control group that underwent normal saline aspiration, an acute lung injury (ALI) group that underwent hydrochloric acid aspiration, and three treatment groups that underwent hydrochloric acid aspiration and were administered therapeutic agents- the S1P group, the NO group, and the S1P+NO group (n=7 per group). To quantify alveolar compliance and interstitial edema, the diameters of all measurable alveoli and interalveolar septa were averaged at one and two hours after aspiration. Alveolar compliance was determined according to diameter changes during the respiratory cycle and the change in tidal volume. Result: At two hours after aspiration, the mean alveolar compliance (% change) in the All group decreased significantly versus the control group of rats (respiratory cycle: 1.9% for the ALI group vs 6.5% for the control group, p=0.03; tidal volume: 3.2% for the ALI group vs 9.1% for the control group, p=0.003) and versus the NO group (tidal volume: 3.2% for the ALI group vs 16.9% for the NO group, p=0.001). At two hours after aspiration, the mean interalveolar septal thickness in the NO group tended to be smaller as compared to that in the All group ($15.2{\mu}m$ for the ALI group vs $12.3{\mu}m$ for the NO group, p=0.06). S1P did not exert a significant effect on the pulmonary microstructure of the injured rat lung. Conclusion: Improved alveolar compliance and reduced interstitial edema, observed by intravital videomicroscopy, suggest that inhaled NO ameliorates lung injury.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.527-530
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• 2003

Reexpansion pulmonary edema is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. But occasionally, severe morbidity and death may result. Reexpansion pulmonary edema occurs when chronically collapsed lung is rapidly reexpanded by evacuation of large amounts of air or fluid. In the treatment of the chronically collapsed lung, physicians must remember the possible events and prevent the complications. When the difference in airway resistance or lung compliance between the two lungs is exaggerated, conventional mechanical ventilation might lead to preferential ventilation with hyperexpansion of one lung and gradual collapse of the other. Differential ventilation has been advocated to avert this problem. By differential lung ventilation, we successfully treated a severe reexpansion pulmonary edema in two patients. Therefore we suggest that differential lung ventilation is the treatment of choice for severe reexpansion pulmonary edema.

• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.251-259
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• 2002

Background : Reduced lung compliance and increased lung resistance are the primary lung mechanical abnormalities in acute respiratory distress syndrome (ARDS). Although there is little information regarding the mechanisms responsible for the increases in the respiratory resistance of ARDS, bronchodilators have been frequently administered in mechanically ventilated ARDS patients. To determine the effect of a bronchodilator on the respiratory mechanics depending on the level of applied positive end-expiratory pressure (PEEP), the changes in the respiratory mechanics by salbutamol inhalation was measured under the variable PEEP level in patients with ARDS. Materials and Methods : Fifteen mechanically ventilated paralyzed ARDS patients (14 of male, mean age 57 years) were enrolled in this study. The respiratory system compliance, and the maximum and minimum inspiratory resistance were obtained by the end-inspiratory occlusion method during constant flow inflation using the CP-100 pulmonary monitor (Bicore, Irvine, CA, USA). The measurements were performed at randomly applied 8, 10 and 12 cm $H_2O$ PEEP before and 30 mins after administrating salbutamol using a meter-dose-inhaler (100ug${\times}$6). Results : 1) The maximum inspiratory resistance of the lung was higher than the reported normal values due to an increase in the minimal inspiratory resistance & additional resistance. 2) The maximum inspiratory resistance and peak airway pressure were significantly higher at 12cm $H_2O$ of PEEP compared with those at 10cm $H_2O$ of PEEP. 3) Salbutamol induced a significant decrease in the maximum and the minimum inspiratory resistance but no significant change in the additional resistance only was observed at 12cm $H_2O$ of PEEP(from $15.66{\pm}1.99$ to $13.54{\pm}2.41$, from $10.24{\pm}2.98$ to $8.04{\pm}2.34$, and from $5.42{\pm}3.41$ to $5.50{\pm}3.58cm$ $H_2O$/L/sec, respectively). 4)The lung compliance did not change at the applied PEEP and salbutamol inhalation levels. Conclusion : The bronchodilator response would be different depending on the level of applied PEEP despite the increased respiratory resistance in patients with ARDS.

• Nuclear Engineering and Technology
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• v.52 no.10
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• pp.2313-2319
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• 2020

The goal of this project is to achieve an accurate segmentation of the pulmonary tumors besides shortening the time and increasing the accuracy. Here, improved region growing (IRG) algorithm is introduced in order to segment the lung tumor with a sufficient accuracy in a shorter time compared to the other basics methods. This comprehensive algorithm was applied on 4 patients CT images and the results of the various steps on segmentation improvement shown 98% accuracy as compared to the basic algorithm. The combination of "multipoint growth start" produced a desirable outcome in accurately bounding the tumor. The proposed algorithm improved tumor identification by less than 13% along with a sufficient percentage of compliance accuracy.

• The Korean Journal of Physiology
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• v.15 no.1
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• pp.27-36
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• 1981

Relatively little has been done on the metabolic changes of the lung produced by the excessive alcohol ingestion to the point of the acute alcohol intoxication. In the present study, an effort was made to clarify the possible changes of the pulmonary surfactant system by the acute alcohol ingestion. The dynamic pulmonary compliance and the levels of protein and inorganic phosphorus (Pi) of both lung lavage and extract were chosen as the parameters of the pulmonary surfactant activities. The albino rats of both sexes were used, and 1.5 ml of 50% ethanol per 100 g body weight was given by oral intubation, and the experiment was performed at 1, 3, 6, 12, and 24 hours after the alcohol ingestion. The rat was sacrificed by cutting the carotid arteries, and blood sample for the determination of hematocrit(Hct) and the blood alcohol concentration was obtained. Both lungs were completely removed without dammage to the lung tissue, and the pulmonary compliance was measured by the changes of pressure-volume(P-V) curves by inflating or deflating the lung with air. Immediately after the P-V curves were recorded, the lung lavage was obtained by washing the lobes with 15ml of isotonic saline 3 times with a syringe. Next, total lungs were homogenized and filtered to obtain the lung extract. The protein and Pi levels were measured using the lung lavage and extract as the samples, and the lung/body weight ratio(L/B ratio) was also calculated. The results thus obtained were compared with the normal values and summarized as follows. The blood alcohol concentration reached the highest level of $0.71{\pm}0.02\;g\;%$ at 1 hr and gradually decreased until 24 hrs$(0.36{\pm}0.02\;g%)$ after the alcohol ingestion, but all the experimental groups showed significant increase comparing with the normal. The highest Hct value was obtained at 1hr$(64.86{\pm}2.45%)$ and significantly elevated value was continued throughout the experiment. The L/B ratio was significantly lowered from 3hrs until 24hrs after the alcohol ingestion but from 6 th hr on, a generally elevated value was observed with a significant value at 12 hrs and gradual recovery to the normal value at 24 hrs after the alcohol ingestion. The pulmonary compliance at inflation and deflation did not change appreciablly from the normal until 3 hrs after the alcohol ingestion but from 6 th hr on, a generally elevated value was observed with a significant value at 12 hrs and gradual recovery to the normal value at 24 hrs after the alcohol ingestion. The protein level of the lung lavage stowed a significantly increased value of $12.36{\pm}0.35\;mg/gm(3rd hr)$, $12.70{\pm}0.74\;mg/gm(12 th hr)$, and $12.65{\pm}0.88\;mg/gm(24 th hr)$, respectively, comparing with the normal value of $10.65{\pm}0.62\;mg/gm$, and the Pi level also showed a similar tendency of significant increase at 12th hr $(7.65{\pm}0.63\;{\mu}mol/gm)$ and 24 th hr$(6.70{\pm}0.36\;{\mu}mol/gm)$ comparing with the normal value of $5.32{\pm}0.20\;{\mu}mol/gm$. The protein level of the lung extract in the alcohol group was generally similar to the normal value with a slight decrease at 1st and 3 rd hr, tut the Pi level of the lung extract was generally increased in the alcohol group, and a significant increase was observed at 6 th hr$(17.77{\pm}1.54\;{\mu}mol/gm)$, 12 th hr$(13.92{\pm}0.78\;{\mu}mol/gm)$ and 24 th hr$(14.57{\pm}0.53\;{\mu}mol/gm)$ of the alcohol ingestion comparing with the normal value of $10.34{\pm}0.37\;{\mu}mol/gm$. From the above, it may be concluded that the acute alcohol intoxication produces the metabolic changes of the lungs by the increased surfactant activities and elevated pulmonary compliance.

• 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℃.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.493-504
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• 1997

Background : Non-small cell lung cancer is one of the most frequent cause of death due to cancer in men, and its incidence among women is rapidly increasing. Although there has been a recent surge of interest in combined modality therapy for stageIII non-small cell lung cancer(NSCLC), the optimal treatment is still not well established. Thoracic irradiation has long been the gold standard for locally advanced unresectable NSCLC. However, although conventional radiotherapy(XRT) can palliate symptom and improve local control of disease, it has at most only a modest effect on survival. Recently, cisplatin(cis-diamminedichloroplatinum) has been reported to enhance the cell-killing effect of radiation For patients with unresectable NSCLC, cisplatin-based concurrent chemoradiotherapy(CCRT) had the advantage of therapeutic response over XRT alone and therapeutic side effect more commonly occurred in CCRT group in EORTC(European Organization for Research and Treatment of Cancer) and other trials. Objectives : We compared therapeutic response, compliance, and side effects between CCRT and XRT in patients with advanced NSCLC. Patients and Method : Thirty patients with biopsy-proven inoperable NSCLC were randomized to one of two treatment arms. Arm A consisted of XRT, radiotherapy for 4~6 weeks(1.8 Gy given 20~33 times, in five fractions a week), and arm B consisted of CCRT, radiotherapy for 2 weeks(3 Gy given to times, in five fractions a week), followed by 3 week rest period and then radiotherapy 2 more weeks(2.5 Gy given 10 times, in five fractions a week), combined with 6mg cisplatin per square meter, given daily before radiotherapy. We evaluate therapeutic response, compliance, change of performance status, side effects, and radiation pneumonitis by using the author's made scoring system. Results : There was no significant difference in therapeutic response and compliance. But there was a significantly lower laboratory complication and radiation pneumonitis in CCRT group (p < 0.05). There's significant negative correlation between stage and therapeutic response score in both groups(R=0.353, p < 0.05) In both groups, patients with squamous cell carcinoma had a tendency to higher therapeutic response score than those with adenocarcinoma. Conclusion : There was no difference between CCRT and XRT in respect to therapeutic response and compliance. But CCRT had a advantage of decreased side effects.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1030-1039
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• 1997

Background : Impulse Oscillometry is a noninvasive and effort-independent test used to characterize the mechanical impedance of the respiratory system. The clinical potential of the IOS is rapid and demands only passive cooperation which makes it especially appealing for children, for epidemiologic surveys and for conditions in which quiet breathig instead of forced expiratory maneuvers are preferred. However, several studies have shown conflicting results that the role of IOS about detection of smoking induced small airway diseases or early airway obstruction Methods : Study was to evaluate the clinical ability of the IOS to detect about smoking induced early airway obstruction in persons with normal spirometry test. Respiratory asymptomatic study groups were formed that one is non-smoking group, another is smoking group. Results : The parameters of spirometry were not significantly differences between non-smoking group and smoking group. Among the parameters of IOS, total resistance(non-smoking group : smoking group=$2.22{\pm}1.20$ : $2.58{\pm}1.71$), peripheral resistance($1.25{\pm}0.62$ : $1.47{\pm}0.10$), bronchial compliance($0.44{\pm}0.12$ : $0.47{\pm}0.16$) were not statistically significant different (p<0.05), but central resistance and lung compliance were not statistically significant different (unit ; resistance=hPa/l/s, compliance=l/hPa). Resistance(Rrs) was not statistically significant different with changes of frequences(5, 10, 15, 20, 25, 30, 35Hz), but Reactance(Xrs) was statistically significant different with low frequences that X5(non-smoking group : smoking group=$-0.62{\pm}0.28$ : $-0.76{\pm}0.48$, p<0.001) and X10($-0.06{\pm}0.19$ : $-0.15{\pm}0.33$, p<0.013) (unit; hPall/s, $hPa{\cong}cmH_2O$). Conclusion : Impulse oocillometer(IOS) is clinically available method to detect about smoking induced early airway obstruction. And clinically potential parameters of IOS were considers that total resistance, peripheral resistance, bronchial resistance, and reactance of low frequency at 5Hz, 10Hz.