A Case of Severe Pneumonia with Rhabdomyolysis Caused by Mycoplasma Pneumonia / 대한내과학회지

Mycoplasma pneumoniae is a common cause of respiratory tract infections and typically causes mild disease. Extrapulmonary manifestations of M. pneumoniae infection are also common, but rhabdomyolysis is a rare complication. Here, we describe the case of a previously healthy 23-year-old male who displayed the simultaneous onset of rhabdomyolysis and severe pneumonia requiring mechanical ventilation. Both conditions were resolved by a 10-day course of antimicrobial treatment and the patient was discharged without complication.

Extracorporeal Membrane Oxygenation as a Bridge to Definitive Airway Security in 3 Severe Acute Extrinsic Airway Compression Patients: A Case Report / 대한구급학회지

Extracorporeal membrane oxygenation (ECMO) has been used for cardiac and respiratory failure for over 30 years. Recently, however, ECMO has emerged as a useful means of short-term support in the management of hypoxic patients for nontraditional indications. Here, we report the use of veno-venous ECMO as a bridge to support a patient with severe airway obstruction because of tumor compression. Case 1: A patient with extrinsic airway compression secondary to a large metastatic cancer on neck was successfully managed using ECMO. Case 2: The successful use of ECMO to support a patient with extrinsic airway compression secondary to a recurred thyroid cancer. Case 3: A pregnant woman with airway obstruction secondary to metastatic lymphadenopathy of lung cancer who underwent successful tracheal stent insertion. The 3 patients were successfully weaned off ECMO without any complication. Although these conditions are uncommon indications, ECMO is a potential option for such life-threatening conditions.

Procalcitonin in 2009 H1N1 Influenza Pneumonia: Role in Differentiating from Bacterial Pneumonia / 결핵및호흡기질환

BACKGROUND: Procalcitonin is a well known marker in infection that plays a role in distinguishing between bacterial and viral infections in screening. The aim of the present study was to evaluate the role of procalcitonin in differentiating between 2009 H1N1 influenza pneumonia and community acquired pneumonia of bacterial origin, or mixed bacterial origin and 2009 H1N1 influenza infection. METHODS: A retrospective observational study was performed over the 6-month winter period during the 2009 H1N1 influenza pandemic. Ninety-six patient-subjects were enrolled, all of whom had been diagnosed with community acquired pneumonia in emergency department during the study period. On admission, laboratory studies were performed, which included 2009 H1N1 influenza real-time polymerase chain reaction of nasal secretions and procalcitonin on serum; the laboratory values were compared between the study groups. Receiver operating characteristic curve analyses were performed on the resulting data. RESULTS: Compared to those with bacterial or mixed infections (n=62) and bacterial pneumonia with confirmed organisms (n=30), patients with 2009 H1N1 pneumonia (n=34) were significantly more likely to have low procalcitonin levels (p=0.008, 0.001). Using cutoff of value >0.3 ng/mL, the sensitivity and specificity of procalcitonin for detection of patients with confirmed bacterial pneumonia were 76.2% and 60.6%, respectively. A significant difference in procalcitonin was found between 2009 H1N1 pneumonia and pneumonia caused by mixed influenza viral and bacterial infections (0.15 [0.05~0.84] vs. 10.3 [0.05~22.87] ng/mL, p=0.045). CONCLUSION: Serum procalcitonin measurement may assist in the discrimination between pneumonia of bacterial and of 2009 H1N1 influenza origin. High values of procalcitonin suggest that bacterial infection or mixed infection of bacteria and 2009 H1N1 influenza is more likely.

Associated Factor Related to Major Complications of Patients with Hospitalized for 2009 H1N1 Influenza Pneumonia / 결핵및호흡기질환

BACKGROUND: To date, there are few data on the risk factors for severe cases and deaths associated with the 2009 pandemic H1N1 influenza A. Here, we describe the clinical and epidemiologic characteristics of patients hospitalized for pneumonia and identify those factors associated with the development of major complications (MC). METHODS: We reviewed the medical records of 41 cases of pneumonia admitted to a university-affiliated tertiary hospital between Aug 26 and Dec 10, 2009, and who had confirmed H1N1 influenza A based on real-time reverse transcriptase-polymerase-chain-reaction assay. There were 7,962 patients that fit these criteria. We compared the clinical features and demographic characteristics of patients who developed MC to with those who did not develop MC. RESULTS: During the study period, 10 patients developed MC (required admission to the intensive care unit, n=10; required ventilator therapy, n=6; death, n=4). Patients with MC were significantly older than those without MC and more frequently had underlying medical conditions (90.0% vs 41.9%, p-value <0.01). In the patients with developed MC, the median PaO2/FiO2 ratio of 230.0 (145.0~347.3) at admission and pneumonia severity index (PSI) score of 141.5 (88.3~158.5) were higher than patients without MC. However, no differences were observed in laboratory findings or in viral shedding between the 2 groups. CONCLUSION: In hospitalized pneumonia patients of 2009 H1N1 influenza, old age, a history of malignancy, initial hypoxemia, PaO2/FiO2 ratio, and PSI score appear to be risk factor significantly related to developing MC. These findings might be the basis to influence strategies for admitting patients to an intensive or intermediate care unit and for pre-emptive antiviral therapy.

Review 2006: Critical Care Medicine / 결핵및호흡기질환

No abstract available.

Selection of Reference Equations for Lung Volumes and Diffusing Capacity in Korea / 결핵및호흡기질환

BACKGROUND: The lung volume and diffusing capacity are influenced by ethnicity. However, there are no equations for predicting the normal lung volume in the adult Korean population, and there is only one equation for diffusing capacity. The aim of this study is to select the most suitable reference equation for the Korean population. METHOD: 30 men and 33 women at Hanyang University Guri Hospital, and 27 men and 34 women at Asan Medical Center in healthy nonsmoking adults were enrolled in this study. The subject's age, gender, height, weight, lung volume by plethysmography, and diffusing capacity by a single breathing method were obtained. The most suitable equation with the lowest sum of residuals between the observed and predicted values for lung volume and diffusing capacity was selected. RESULT: At Hanyang University Guri Hospital, the equations with the lowest sum of residuals in the total lung capacity were ECSC's equation in males (sum of residual: 0.04 L) and Crapo/Morris's equation (-1.04) in women. At the Asan Medical Center, the equations with the lowest sum of residuals in the total lung capacity were Goldman/Becklake's equation in males (sum of residual: -2.35) and the ECSC's equation -4.49) in women. The equations with the lowest sum of residuals in the Diffusing capacity were Roca's equation in males (sum of residual: -13.66 ml/min/mmHg) and Park's in women (25.08) in Hanyang University Guri hospital and Park's equation in all cases in the Asan Medical Center (male: -1.65 , female: -6.46). CONCLUSIONS: Until a reference equstion can be made for healthy Koreans by sampling, ECSC's equation can be used for estimating the lung volume and Park's can be used for estimating the diffusing capacity.

Effect of the Changing the Lower Limits of Normal and the Interpretative Strategies for Lung Function Tests / 결핵및호흡기질환

BACKGROUND: To interpret lung function tests, it is necessary to determine the lower limits of normal (LLN) and to derive a consensus on the interpretative algorithm. '0.7 of LLN for the FEV1/FVC' was suggested by the COPD International Guideline (GOLD) for defining obstructive disease. A consensus on a new interpretative algorithm was recently achieved by ATS/ERS in 2005. We evaluated the accuracy of '0.7 of LLN for the FEV1/FVC' for diagnosing obstructive diseases, and we also determined the effect of the new algorithm on diagnosing ventilatory defects. METHODS: We obtained the age, gender, height, weight, FEV1, FVC, and FEV1/FVC from 7362 subjects who underwent spirometry in 2005 at the Asan Medical Center, Korea. For diagnosing obstructive diseases, the accuracy of '0.7 of LLN for the FEV1/FVC' was evaluated in reference to the 5th percentile of the LLN. By applying the new algorithm, we determined how many more subjects should have lung volumes testing performed. Evaluation of 1611 patients who had lung volumes testing performed as well as spirometry during the period showed how many more subjects were diagnosed with obstructive diseases according to the new algorithm. RESULTS: 1) The sensitivity of '0.7 of LLN for the FEV1/FVC' for diagnosing obstructive diseases increased according to age, but the specificity was decreased according to age; the positive predictive value decreased, but the negative predictive value increased. 2) By applying the new algorithm, 34.5% (2540/7362) more subjects should have lung volumes testing performed. 3) By applying the new algorithm, 13% (205/1611) more subjects were diagnosed with obstructive diseases; these subjects corresponded to 30% (205/681) of the subjects who had been diagnosed with restrictive diseases by the old interpretative algorithm. CONCLUSION: The sensitivity and specificity of '0.7 of LLN for the FEV1/FVC' for diagnosing obstructive diseases changes according to age. By applying the new interpretative algorithm, it was shown that more subjects should have lung volumes testing performed, and there was a higher probability of being diagnosed with obstructive diseases.

Preliminary Results of the Prospective Randomized Phase III Trial on the Induction Chemotherapy in the Concurrent Chemoradiotherapy for the Locally Advanced Non-small Cell Lung Cancer

PURPOSE: To investigate the role of induction chemotherapy in relation to the treatment results and toxicities of concurrent chemoradiotherapy (CCRT) for locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients with unresectable and pathologically confirmed Stage III NSCLC were eligible. According to the stage and pathological subgroup, the patients were randomized into two arms. Arm A received two cycles of the induction chemotherapy composed of gemcitabine, 1,000 mg/m2 (D1 and D8), and cisplatin, 70 mg/m2 (D1), followed by CCRT with weekly paclitaxel, 50 mg/m2, and cisplatin, 20 mg/m2. Arm B received immediate CCRT without the induction chemotherapy. A daily 2.2 Gy radiation dose was delivered to the isodose line covering the planned target volume, which was defined as the gross tumor volume plus a 1.0 cm margin from the planning CT, using a 3-D conformal radiation therapy technique. RESULTS: Between May 2003 and 2004, 63 patients were enrolled. Forty four patients (Arm A 23, Arm B 21) were evaluable, with follow-up periods exceeded 1 month after the end of the assigned treatment. The median follow-up periods were 6 and 7 months for Arms A and B, respectively. The patients' characteristics, including gender, age, weight loss, performance status, pulmonary function and stage, were well balanced between the two arms. The median largest tumor diameters were 4.8 cm (3.0~15 cm) and 5.0 cm (2.5~10 cm) for Arms A and B, respectively. The one-year survival rates were 58 and 63% for Arms A and B respectively, which showed no statistical significance (p=0.6667). The compliance of the induction chemotherapy was 96% (22/23 patients), and those of the CCRT were 86% for both arms (18/21 patients). The response rate of the induction chemotherapy was 64% (14/22 patients) and those of the CCRT were 83 (15/18 patients) and 89% (16/18 patients) for Arms A and B, respectively, which showed no statistical significance (p=0.630). In the 23 patients of Arm A, 8 (35%) suffered grade 3~4 neutropenia during the induction chemotherapy and 1 expired due to sepsis. CCRT caused grade 3~4 neutropenia in 6 and 1 patients of Arms A (29%) and B (5%), respectively, showing statistical significance (p=0.038). Grade 3~4 radiation pneumonitis developed in 2 and patients from Arms A (10%) and B (5%), respectively, (p=0.464) and grade 3~4 acute esophagitis developed in 7 (Arm A) and 5 patients (Arm B) (p=0.495). CONCLUSION: Both treatment schemes showed acceptable treatment compliance and toxicities. However, the induction chemotherapy resulted in a higher incidence of severe neutropenia. The treatment outcomes, as yet, have shown no statistical significance. To evaluate the role of induction chemotherapy on the survival prolongation in CCRT for locally advanced NSCLC, more patients and a longer follow-up are mandatory

A Case of Pulmonary Nocardiosis in the Patient with Cushing's Disease / 결핵및호흡기질환

Even though nocardiosis is one of opportunistic infections, and can occur in Cushing's syndrome, it rarely occurs in patients with Cushing's disease. Herein, a case with Cushing's disease in whom nocardiosis had manifested as a pulmonary lesion, which after percutaneous needle aspiration, empyema and a breast abscess were also noted.

To a smoking doctor / 대한내과학회지

No abstract available.

Prognostic Value of Fibroblastic Foci in Patients with Usual Interstitial Pneumonia / 결핵

BACKGROUND: Usual interstitial pneumonia (UIP) is a progressive disorder characterized by a poor response to conventional immunosuppressive agents and significant mortality. The histologic hallmark of UIP is patchy subpleural fibrosis with interposed fibroblastic foci(FBF) and relatively normal appearing lung. FBF is a collection of actively proliferating myofibroblasts, which may represent the activity of IPF. However, there were contradictory reports about the correlation between the degree of FBF and survival. The objective of this study was to investigate the roles of FBF as prognostic marker of UIP. METHOD: This was a retrospective study on the 46 patients(M:F=33:13, mean age:59+/-12 years) who had the surgical lung biopsy done at the Asan Medical Center, Seoul, Korea between 1990 and 2000 and had follow-up of more than a year. All the biopsy specimens were reevaluated and diagnosed as UIP according to the new classification. Semiquantitative grading of FBF(absent, 0; mild 1; moderate 2; marked 3) was performed by the experienced pathologists and compared to the clinical data and the follow up course. RESULTS: Thirteen patients(28.2%) died of UIP progression during the study period. The median survival time of all the subjects was 26 months after the biopsy. The FVC, DLco, smoking history and the grade of FBF were significantly related to the risk of death. The survival was longer in subjects with lesser degrees of FBF, higher DLco, higher FVC and history of smoking .The multivariate analysis with Cox regression test showed the extent of FBF was the only independent prognostic marker of UIP. CONCLUSION: These data suggested that the extent of FBF on the surgical lung biopsy can be used as a prognostic marker of UIP.

A Case of Bacterial Tracheitis Associated with Endotracheal Intubation and Corticosteroid / 결핵

Bacterial tracheitis is a very rare complication in adults after endotracheal intubation. We report a case of bacterial tracheitis associated with endotracheal intubation and corticosteroids. The patient was discharged with a permanent tracheostomy, and a resection and an end-to-end anastomosis of the trachea is planned.

The Changes of Cuff Pressure from Endotracheal Intubation for Long-term Mechanical Ventilation / 결핵

BACKGROUND: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure (Pcuff) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired g as exchange due to cuff leakage is related to a low Pcuff. To prevent these complications, the Pcuff should be kept appropriately because the appropriate Pcuff appears to change according to the patients' bedside. To address the necessity of continuous Pcuff monitoring, the change in the Pcuff was evaluated at various Vcuff levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continous monitoring Pcuff was also investigated. METHOD: The change in Pcuff according to the increase in Vcuff was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in Pcuff daily during the mechanical ventilation days. In addition, the Pcuff measured by mercury column sphygmomanometer was compared with the Pcuff measured by an automatic cuff pressure manager. RESULTS: There were no statistically significant changes of Pcuff during more than 14 days of intubation for mechanical ventilation. However the Vcuff required to maintain the appropriate Pcuff varied from 1.9cc to 9.6cc. In addition, the intra-individed variation of the Pcuff was observed from 10cmH2O to 46cmH2O at constant 3cc Vcuff. The Pcuff measured by the bedside mercury column sphymomanometer is well coincident with that measured by the automatic cuff pressure manager. CONCLUSION: Continuous monitoring and management of the Pcuff to maintain the appropriate Pcuff level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.

The Effect of Antihistamine of Endotoxin-induced Acute Lung Injury / 결핵

BACKGROUND: Sepsis-induced acute lung injury (ALI) is caused by many cellular and humoral mediators induced by an endotoxin. Histamine, which is widely distributed in the lungs and has been considered as an importa nt mediator of sepsis. It increases P-selectin expression on the endothelial cell surfaces and induces IL-8 secretion. Therefore, an endotoxin-induced histamine may be related to neutrophil-mediated ALI by inducing the migration and activation of neutrophils in the lung tissue. However, the role of endogenous histamine in endotoxin-induced ALI had not been clarified. The purpose of this study was to investigate how endotoxin-induced ALI is influenced by endogenous histamine and to identify the possible mechanism of action. METHODS: The study consisted of 4 groups using Sprague-Dawley rats : 1) control group, where the rats were infused intratracheally by normal saline, 2) an endotoxin group, where lipopolysaccharide (LPS) was administered intratracheally 3) the H2 receptor antagonist-treated group (H2 group) and 4) the H1 receptor antagonist-treated group (H1 group), where H2 receptor blocker (ranitidine) and H1 receptor blocker (pyrilamine) were co-treated intravenously with the intratracheal administration of an endotoxin. The lung leak index using I125-BSA, the total protein and LDH concentration in the lung lavage fluid, myeloperoxidase (MPO) activity in the lung tissue, the pathologic score and the total number of neutrophils, TNF-alpha, IL-Ibeta and IL-10 in lung lavage (BAL) fluid were measured in each group as the indices of lung injury. RESULTS: Compared to the control group, the endotoxin group exhibited significant increasis in all lung injury indices. Significant reductions in the encotoxin-mediated increases in lung leak index (p<0.05) were observed in both the H1and H2 groups. In addition, the total protein (p<0.05) and LDH concentration (p<0.05) in the BAL fluid were also lower in the H2 group compared to the endotoxin group. However, there was no change in the MPO activity in the lung tissue, the pathologic score and the total number of neutrophils in the BAL fluid in both the H2and H1 groups compared to the endotoxin group. The increases in TNF-alpha, IL-Ibeta and IL-10 concentrations in the BAL fluid observed in the endotoxin group were not reduced in the H2and H1 groups. CONCLUSION: Antigistamine attenuated the enhanced alveolar-capillary permeability induced by the endotoxin via the H2 receptor. However the attenuation mechanism may not be related to the pathogenesis of neutrophil dependent lung injury.

Detection of Mycobacterium Tuberculosis in Bronchial Specimens Using a Polymerase Chain Reaction in Patients with Bronchial Anthracofibrosis / 결핵

No abstract availalbe.

The Effect of Heat Co-treatment on Acute Lung Injury of the Rat Induced by Intratracheal Lipopolysaccharide / 결핵

BACKGROUND: The heat shock protein (HSP) 70 families are known to protect cells against the irreversible tissue injury induced by stress and to induce the recovery of cell function during stress. Heat pretreatment was reported to decrease the acute lung injury(ALI) of rats induced by lipopolysaccharide (LPS). However the role of heat shock with LPS co-treatmenton ALI is unclear. The purpose of this study was to investigate the effect of heat treatment, which was given immediately after the beginning of ALI induced by LPS intratracheally administered in rats. METHODS: Either saline (saline group) or LPS was intratracheally instilled without heat treatment (LPS group). In addition, heat was conducted 18 hours prior to the instillation of LPS (pre-treatment group) and conducted immediately after instillation of LPS (co-treatment group). Six hours after the LPS or saline treatment, blood, bronchoalveolar lavage (BAL) fluid and lung tissue samples were obtained. The myeloperoxidase (MPO) activity and the heat shock protein expression in the lung tissue, the differential counts of the polymorphonuclear leukocytes (PMN) in the BAL fluids, and the LDH, protein, IL-1beta, TNF-alpha and IL-10 levels in BAL fluid and serum were measured. RESULTS: 1)The MPO activity, the differential PMN counts in the BAL fluid, BAL fluid and serum cytokines were higher in the LPS, the heat pre-treatment and co-treatment group than those of the saline group (p value <0.05). 2)The MPO activity and the protein level in the BAL fluid from the heat co-treatment group were similar to those of the LPS group. 3) The serum TNF-alpha level of the heat co-treatment group was significantly higher than that of the LPS group (p=0.01) . CONCLUSIONS: Heat shock response administered immediately after a LPS instillation did not attenuate the ALI in this model.

Murine Typhus as a Cause of Acute Respiratory Distress Syndrome in Endemic Area / 결핵

BACKGROUND: Murine typhus is a fea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild byt sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the pateints who showed acute respiratory distress syndrome as the initial presentation. METHODS: The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress syndrome (ARDS) was define according to the American-European Consensus Conference. The characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. RESULTS: Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. CONCLUSIONS: Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.

The Effect of Steroid Therapy in Patients with Late ARDS / 결핵

BACKGROUND: The mortality from acute respiratory distress syndrome(ARDS) in the late stage, which is characterized by progressive pulmonary fibroproliferation, is >or=80%. Although previous prospective trials failed to show a survival benefit of steroid therapy in early ARDS, recently, a few of reports have described the survival benefit of the long-term use of steroid in patients with late ARDS. In this study, we analyzed the effect of steroid therapy on patietns with late ARDS. In this study, we analyzed the effect of steroid therapy on patients with late ARDS retrospectively in a single. Medral intensive care unit. METHODS: Over a 3-year period, the medical records of 48 ARDS patients who had veen on mechanical ventilation more than 8 days were reviewed. 14 patients were treated by the long-term use of methylprednisolone and another 34 patients served as a control. Both groups were comparable regarding clinical and physiologic data lung injury score(LIS), multiple organ failure score, APACHE III and SAPS II score. Because steroid was instituted after 8 days of advanced mechanical ventilatory support in average, we arbitrarily defined the 8th day of ARDS as first day of the study. RESULTS: Initially, the group had similar PF(PaO2/FiO2)ratio, LIS, APA CHE III and SAPS II score. By 7th day after the start of steroid therapy, there were significant improvements in PF ratio, LIS, APACHE III and SAPS II score. The mortality in the steroid treated group was significantly lower(42.9% vs 73.5%, p<0.05). CONCLUSIONS: Although the data of this study was retrospective and was not randomized, in order to improve the patients's outcomes, steroid therapy should be considered in late ARDS patients. However, prospective trials are needed to define the indication and the effect of steroid therapy in late ARDS.

The Change of Respiratory Mechanics by a Bronchodilator Inhalation Under the Variable Level of PEEP in Patients with Acute Respiratory Distress Syndrome / 결핵

BACKGROUND: Reduced lung compliance and increased lung resistance are the primary lung mechanical abnomalities in acute respiratory distress syndrome (ARDS). Although there is little information regarding the mecha nisms responsible for the increases in the respiratory resistance of ARDS, bronchodilators have been frequently administered in mechanically ventilated ARDS patient. To determine the effect of a bronchodilator on the respiratory mechanics depending on the level of applied positive end-expiratory pressure (PEEP), the change in the respiratory mechanics by salbutamol ingalation was measured under the variable PEEP level in patients with ARDS. METHODS: Fifteen mechanically ventilated paralyzed ARDS patientss (14 of male, mean age 57 years) were enrolled in this study. The respiratory system compiance, and the maximum and minimun inspiratory occlusion method during constant flow inflaction using the CP-100 pulmonary monitor (Bicore, Irvine, CA, USA). The measurements were performed at randomly applied 8, 10 and 12 cm H2O PEEP before and 30 mins after administrating salbutamol using a meter-dose-inhaler (100 micro gram X 6). RESULTS: 1) The maximum inspiratory resistance of the lung was higher than the reported normol values due to an increase in the minimal inspiratory resistance and additional resistance. 2) The maximum inspiratory resistance and peak airway pressure were significantly higher at 12 cm H2O of PEEP compared with those at 10cm H2O 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 12 cm H2O of PEEP (from 15.66+/-1.99 to 13.54+/-2.41, from 10.24+/-2.98 to 8.04+/-2.34, and from 5.42+/-3.41 to 5.50+/-3.58 cm H2O/l/sec, respectively). 4) The lung compliance did not change at the applied PEEP and salbutamol inhalation levels. CONCLUSIONS: The bronchodiator response would be different depending on the level of applied PEEP despite the increased respiratory resistance in patients with ARDS.

A Case of Vocal Cord Dysfunction Masqueraded as Exercised-Induced Asthma / 결핵

Vocal cord dysfunction (VCD) is respiratory disorder characterized by paradoxical closure of the vocal cord during the respiratory cycle leading to obstructive airway symptoms. The clinical presentation of VCD is often dr amatic and its misdiagnosis as asthma of exercise-induced brochospasm(EIB) has led to inappropriate treatment including high dose corticosteroids, intubation, and tracheostomy. Many VCD patients are asympromatic at rest and require exercise challenge to elicit symptoms and vocal cord abnormalities. The "gold standard" for the diagnosis of VCD remains laryngoscopy of bronchoscopy with direct visualization of paradoxical adduction of the vocal cords. We report a case of exercise-induced Vocal cord masqueraded as exercise-induced asthma unresponsive to corticosteroids. And bronchodilator confirmed by typical bronchoscopic findings with paradoxial adduction of the vocal cords.