Successful Treatment of Progressive Rheumatoid Interstitial Lung Disease With Cyclosporine: A Case Report

Treatment of interstitial lung disease (ILD) in rheumatoid arthritis (RA) has been controversial. Although there have been several anecdotal reports on the efficacies of corticosteroids or cytotoxic agents such as methotrexate, cyclophosphamide, azathioprine, and D-penicillamine for the treatment of ILD associated with RA, no controlled studies have been performed. To date, corticosteroids have been a central agent for the treatment of this disease, but their effects are partial and temporary in most cases. In addition, the adverse effects of these agents are considerable. On the other hand, limited information is available on the cyclosporine use in ILD associated with RA. We describe a 49-yr old female patient with RA and ILD that had initially responded to high dose prednisolone and cyclophosphamide intravenous pulse therapy, and the lung disease was aggravated with the tapering of prednisolone. After 10 months of follow-up loss, the patient was successfully treated with low dose cyclosporine without high dose corticosteroids.

Coil Embolization of Rasmussen Aneurysm Diagnosed by Helical CT: A Case Report Dae

We report a case of Rasmussen aneurysm diagnosed by helical CT that well shows vascular imaging. Coil embolization of Rasmussen aneurysm stopped the bleeding successfully.

Effect of Additional 1 hour T-piece Trial on Weaning Outcome to the Patients at Minimum Pressure Support / 결핵

BACKGROUND: Extubation is recommended to he performed at minimum pressure support (PSmin) during the pressure support ventilation (PSV). In field, physicians sometimes perform additional 1 hr T-piece trial to the patient at PSmin to reduce re-intubation risk. Although it provides confirmation of patient's breathing reserve, weaning could be delayed due to increased airway resistance by endotracheal tube. METHODS: To investigate the effect of additional 1 hr T-piece trial on weaning outcome, a prospective study was done in consecutive 44 patients who had received mechanical ventiIation more than 3 days. Respiratory mechanics, hemodymic, and gas exchange measurements were done and the level of PSmin was calculated using the equation (PSmin=peak inspiratory flow rate x total ventilatory system resistance) at the 15cm H2O of pressure support. At PSmin, the patients were randomized into intervention (additional 1 hr T-piece trial) and control (extubation at Psmin). The measurements were repeated at PSmin. during weaning process (in cases of intervention), and after extubation. The weaning success was defined as spontaneous breathing more than 48hr after extuintion. In intervention group, failure to continue weaning process was also considered as weaning failure. RESULTS: Thirty-six patients with 42 times weaning trial were satisfied to the protocol Mean PSmin level was 7.6 (+/-1.9)cm H2O. There were no differences in total ventilation times (TVT), APACHE III score nutritional indices, and respiratory mechanics at PSmin between 2 groups. The weaning success rate and re-intubation rate were not different between intervention group (55% and 18% in each) and control group (70% and 20% in each) at first weaning trial. Work of breathing, pressure time product, arid tidal volume were aggravated during 1 hr T-piece trial compared to those of PSmin in intervention group (10.4+/-1.25 and 1.66+/- 1.08 J/L in work of breathing)(191+/-232 and 287+/-217cm H2Os/m in pressure time product) (0.33+/-0.09 and 0.29+/-0.09 L in tidal volume) (P<0.05 in each). As in whole, TVT, and tidal volume at PSmin were significantly different between the patients with weaning success (246+/-195 hr, 043+/-0.11 L) and the Those with weaning failure (407+/-248 hr, 0.35+/-0.10L) (P<0.05 in each). CONCLUISON: There were no advantage to weaning outcome by addition of 1 hr T-piece trial compared to prompt extubation to the patient at PSmin.

Comparison of Clinical Efficacy Between Percutaneous Dilatational Tracheostomy and Surgical Tracheostomy / 결핵

BACKGROUND: Surgical tracheostomy(ST) is usually performed by surgeons in operating room. For a patient with mechanical ventilation, however, transportation to operating room for ST could be dangerous for patients. In addition, ST is often delayed due to unavailability of operating room or surgeon. Percutaneous dilatational tracheostomy (PDT), although novel in Korea, is gaining popularity as a bedside procedure in the hospitals of western countries. We evaluated the technical ease and safety of PDT in comparison with ST. METHOD: Thirty-eight patients in medical intensive care unit (ICU) who were either under mechanical ventilation for more than 7 days or required airway protection, were randomly assigned to ST(18 patients) or PDT(20 patients). Between two groups, there was no significant clinical difference except that female to male ratio was higher in the ST group. ST was performed by second year residents of the department of otolaryngology while PDT was performed by third grade medical resident and pulmonologist under bronchoscopic guide using Ciaglia Percutaneous Tracheostomy Set (Cook Critical Care, Bloomington, USA) in medical ICU. The following factors were compared between two groups : number of delayed cases after the decision for tracheostomy, procedural time, complications related to tracheostomy. RESULTS: Delayed cases were 11 in ST group and 3 in PDT group (P0.05). CONCLUSION: Since percutaneous dilatational tracheostomy was easy to practice and its complications wert not different from surgical tracheostomy, PDT can be a useful bedside procedure for mechanically ventilated patients.

Exercise Capacity in the Elderly: The Kinetics of Recovery Oxygen Consumption After Maximal Exercise

BACKGROUND: Limited exercise capacity is common in the elderly. Kinetics of recovery oxygen consumption plays an important role in determining exercise capacity. This study was performed to evaluate the kinetics of recovery oxygen consumption as well as peak oxygen consumption during exercise and recovery in the elderly. METHODS: Thirty healthy volunteers were included for this study. They were divided into three groups according to their ages(20 to 39; 40 to 59; and over 60). All subjects performed symptomlimited maximal treadmill exercise. RESULTS: Peak oxygen consumption(pVO2, ml/min/kg) was gradually decreased with the age. Half-recovery time of peak oxygen consumption(T1/2VO2) was maintained from third to sixth decades without significant changes, and then rapidly delayed in the elderly. CONCLUSION: Kinetics of recovery oxygen consumption was rapidly and markedly delayed in the elderly and this may result in the exercise intolerance.