A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.
Adrenal Cortex Hormones ; Airway Obstruction* ; Asthma ; Bronchodilator Agents ; Bronchoscopy ; Dyspnea ; Extremities ; Humans ; Intubation ; Lung Diseases, Obstructive* ; Respiratory Sounds ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

BACKGROUND: The decision to institute mechanical ventilation for patients with COPD is very difficult. The accurate informaiton regarding weaning success and long-term survival will improve communication with patients and family and enhance informed consent. The aims of this study are to describe outcomes and identify variables associated with survival for patients experiencing mechanical ventilation with an acute respiratory failure of COPD. METHODS: The 53 cases of mechanical ventilation in the intensive care unit in the National Medical Center from 1989 to 1998 were included. Data were collected retrospectively from medical records. Weaning success rate and 3 month and 1 year survival rates were estimated. Factors associated with weaning success and survival were determined. RESULTS: Weaning success was 55%. For success group with 29 cases, 3 months survival rate was 61% and 1 year survival rate 37%. APACHE II scores in weaning success group were significantly lower than those in the failure group. Factors such as age, sex, comorbid-illnes, previous steroid use, causes of respiratory failure, RVH or arrhythmia on EKG, serum albumin level, arterial blood pH, PaO2, PaCO2, FEV1, duration of mechanical ventilation and steroid use during mechanical ventilation were not associated with weaning success. Only age and serum albumin level were associated with 3 month and 1 year survival. No COPD patients of age more than 75 years and serum albumin level less than 3g/dl had survived at 1 year after weaning success. CONCLUSION: While seaning success from mechanical ventilation can be predicted by APACHE IIscore in COPD patients, long-term outcomes of survivors may be influenced by nutritional status and age.
APACHE ; Arrhythmias, Cardiac ; Electrocardiography ; Humans ; Hydrogen-Ion Concentration ; Informed Consent ; Intensive Care Units ; Medical Records ; Nutritional Status ; Pulmonary Disease, Chronic Obstructive* ; Respiration, Artificial* ; Respiratory Insufficiency ; Retrospective Studies ; Serum Albumin ; Survival Rate ; Survivors ; Weaning

BACKGROUND: Joint symptoms frequently occur in the course of antituberculous chemotherapy and tend to be ignored and overlooked, but in some cases, they are often very troublesome in obstructing ordinary life. Joint symptoms that develop during antituberculous chemotherapy need to be understood, but there are few materials describing them systematically. METHOD: This study enrolled 33 patients with tuberculosis treated with first line antituberculous agents for more than 6months. In the course of treatment, joint symptoms not associated with specific cause, such as pre-existing joint disease or trauma, were investigated and compared with those of the asymptomatic group, We confirmed the incidence of joint symptoms and factors associated with them. RESULTS: Nineteen of 33 patients (58%) had joint symptoms. Joint symptoms developed 1.9±1.4 months after the beginning of chemotherapy and lasted for 3.6±2.5 months. IN 18 of 19 symptomatic patients, multiple joints were involved : shoulder(10 patients, 53%), knee(10,53%), finger(6,32%). Joint symptoms were expressed as pain(19 patients, 100%), stiffness(7,37%) and/or swelling (3,16%). Fourteen patients (74%) took analgesics to relieve their symptoms and in 2 patients, antituberculous agents were discontinued because of the severity of their symptoms. The symptoms seem to be caused by agents other than pyrazinamide, but it was very difficult to identify the definite causative agent. In age, sex, underlying disease and serum uric acid level, no significant differences were noted between the two groups. CONCLUSIONS: Although joint symptoms are common during antituberculous chemotherapy, their development is difficult to predict. Because some joint symptoms can become very bothersome, the physician should pay close attention to these symptoms.
Analgesics ; Arthralgia ; Drug Therapy* ; Humans ; Incidence ; Joint Diseases ; Joints* ; Pyrazinamide ; Tuberculosis ; Uric Acid

BACKGROUND: Although there are improvements of clinical symtoms after bronchodilator inhalation in COPD patients, it has been noted that there was no increase of FEV1 in some cases. FEV1 did not reflect precisely the improvement of ventilatory mechanics after bronchodilator inhalation in these COPD patients. The main pathophysiology of COPD is obstruction of airway in expiratory phase but in result, the load of respiratory system is increased in inspiratory phase. Therefore the improvement of clinical symptoms after bronchodilator inhalation may be due to the decrease of inspiratory load. So we performed the study which investigated the effect of bronchodilator on inspiratory response of vetilatory mechanics in COPD patients. METHODS: In 17 stable COPD patients, inspiratory and expiratory forced flow-volume curves were measured respectively before bronchodilator inhalation. l0mg of salbutamol solution was inhaled via jet nebulizer for 4 minutes. Forced expiratory and inspiratory flow-volume curves were measured again 15 minutes after bronchodilator inhalation. RESULTS: FEV1, FVC and FEV1/FVC% were 0.92 +/-0.34L(38.3+/- 14.9% predicted), 2.5+/-0.81L (71.1 +/-21.0% predicted) and 43.1+/-14.5% respectively before bronchodilator inhalation. The values of increase of FEV1, FVC and PIF(Peak Inspiratory Flow) were 0.15 +/-0.13L(relative increase: 17.0%), 0.58+/-0.38 L(29.0%) and 1.0+/-0.56L/sec(37.5%) respectively after bronchodilator inhalation. The increase of PIF was twice more than FEV1 in average(p<0.001). The increase of PIF in these patients whose FEV1 was not increased after bronchodilator inhalation were 35.0%, 44.0% and 55.5% respectively. CONCLUSION: The inspiratory parameter reflected improvement of ventilatory mechanics by inhaled bronchodilater better than expiratory parameters in COPD patients.
Albuterol ; Humans ; Inhalation ; Mechanics ; Nebulizers and Vaporizers ; Pulmonary Disease, Chronic Obstructive* ; Respiratory System

We compared radiologically two groups of total hip prostheses, 36 porous-coated and 51 hydroxyapatite-coated, which had been implanted in 87 hips of 73 patients with avascular necrosis of the femoral head. Radiographs were taken at postoperative 1 year and 2 year, and used to compare various radiological parameters between the two groups. For the acetabular side radioluscent line and osteolysis were evaluated, and for the femoral side radioluscent line, osteolysis, stress shielding. endosteal new bone formation, subsidence and cortical hypertrophy were evaluated; their location was identified according to the zones described by DeLee and Charnley for the acetabulum and according to those described by Gruen et al for the femur. In both groups there was no subsidence. In terms of osteolysis, stress shielding and cortical hyper-trophy there was no significant difference between the two groups throughout the period. Radioluscent line in the acetabulum was more common around the porous-coated cup, but was focal and not progressive. The rate of radioluscent line in the femur was a little higher around hydroxyapatite-coated stem especially in zone 5. Endosteal new bone formation was excellent in both groups, but was more extensive around hydroxyapatite-coated stem. This study suggests that hydroxyapatite coating play a certain role in terms of bony ingrowth.
Acetabulum ; Durapatite* ; Femur ; Head ; Hip ; Hip Prosthesis ; Humans ; Hypertrophy ; Necrosis ; Osteogenesis ; Osteolysis

No abstract available.
Pneumonia* ; Squalene

We report a case of occupational asthma caused by cobalt associated with systemic symptoms. He was a non-atopic, ex-smoker and had worked in a glassware factory for 14 months. A skin prick test with CoSO4 up to 100 mg/ml showed a negative result. A bronchoprovocation test with CoSO4 demonstrated an isolated asthmatic response with systemic symptoms such as fever, arthralgia and myalgia. Although an initial methacholine bronchial challenge test showed a negative result, the following methacholine bronchial challenge test which was done 24 hours after the challenge testing demonstrated an increased airway hyperresponsiveness at 2.5 mg/ml which recovered 7 days later. An intradermal skin test with 10 mg/ml and 100 mg/ml CoSO4 solution demonstrated positive responses respectively(13 x 12/40 x 32, 20 x 15/40 x 37 (mm), histamine 16 x 14/64 x 50). A patch test including cobalt showed a negative result. Bronchoalveolar lavage fluid after the cobalt inhalation testing and other laboratory findings showed no evidence of hypersensitivity pneumonitis. These results suggested that cobalt could induce occupational asthma with systemic illness in an exposed worker.
Alveolitis, Extrinsic Allergic/chemically induced ; Asthma/*chemically induced ; Case Report ; Cobalt/*adverse effects ; Human ; Male ; Middle Age ; *Occupational Exposure ; Respiratory Function Tests

Patients with mediastinal teratoma are usually asymptomatic, but may develop symptoms by rupture into adjacent structures which result in pneumonia, hemoptysis, pleural effusion, pericardial effusion, or pneumothorax. Rarely, life-threatening acute respiratory distress require a emergenc y surgery. Rupture into pleural cavity may result in pleuritis and pleural effusion with severe anterior chest or back pain. The symptom must be differentiated from other common intrathoracic distress diseases. Clinical, cytologic and radiologic examinatio ns of pleural effusion, and moreover, measurement of enzymes such as amylase or insulin, which is secreted from pancreatic tissues, in pleural effusion and cystic fluid enabled us to make the diagnosis of rupture of mediastinal teratoma preoperatively.
Amylases ; Back Pain ; Diagnosis ; Hemoptysis ; Humans ; Insulin ; Pericardial Effusion ; Pleural Cavity* ; Pleural Effusion ; Pleurisy ; Pneumonia ; Pneumothorax ; Rupture ; Rupture, Spontaneous* ; Teratoma* ; Thorax

Respiratory failure is the most serious manifestation and usual cause of death in acute organophosphate poisoning, and is common in acute cholinergic crisis. But the respiratory failure may appear suddenly in a patient who is recovering from the cholinergic crisis, even while receiving conventional therapy. These are case report of 37 years old male and 24 years old female with intermediate syndrome in organophosphate poisoning. The two patients ingested organophosphate(fenthion and mixture of DDVP with chlorpyrifos respectively) incidentally and in a sucide attempt respectively. After apparent recovery from the cholinergic crisis with a conventional therapy but before the expected onset of delayed polyneuropathy , the respiratory failure appeared suddenly with a muscular weakness, affecting predominantly the proximal limb muscles, neck flexors, territories of several motor cranial nerves. The two patients needed mechanical ventilatory support and recovery from the intermediate syndrome was complete in both patients, although one subsequently developed hypoxic encephalopathy. The clinical manifestation and electrophysiologic study support the clinical diagnosis of intermediate syndrome. The syndrome carries a risk of death, because of respiratory paralysis, if not recognized early and treated adequatedly. Prompt endotrachial intubation and mechanical ventilatory support is the cornerstone of treatment of the intermediate syndrome. Therefore, all patient should be observed in a hospital for up to 5 days after poisoning.
Adult ; Cause of Death ; Chlorpyrifos ; Cranial Nerves ; Diagnosis ; Dichlorvos ; Extremities ; Female ; Humans ; Hypoxia, Brain ; Intubation ; Male ; Muscle Weakness ; Neck Muscles ; Organophosphate Poisoning* ; Poisoning ; Polyneuropathies ; Respiratory Insufficiency* ; Respiratory Paralysis ; Young Adult

BACKGROUND: Phospholipase D (PLD) is a widely distributed enzyme that hydrolyzes phosphatidylcholine, a major phospholipids in the cell membrane, to form phosphatidic acid (PA) which acts by itself as a cellular messenger. PLD can also be transformed by PA phosphohydrolase into diacylglycerol (DAG), which is essential for the activation of protein kinase C (PKC). PLD has been shown to induce the proliferation of T cells and to activate by Der p 1 in peripheral blood mononuclear cells from atopic dermatitis. Single nucleotide polymorphism (SNP) has recently served as a key marker to discover the genetic mechanism of special chronic diseases. METHODS: One hundred eighteen children with atopic dermatitis were recruited, and graded as 23 mild (<25), 48 moderate (25-50) and 47 severe (>50) by measuring SCORAD index. Genomic DNA were purified from blood and made into PCR primers attaching GC-Clamp, and 26 exons of PLD were amplified by PCR-DGGE (denaturing gradient gel electrophoresis). RESULTS: Polymorphism was found in four subjects. Of them, three PLD1 cSNP (Exon23: G2658A, T2664A, G2684A) were detected in exon 23 of 26 exons of PLD1. Four cases among 118 subjects had cSNP of G2658A (3.4%), two T2664A cases (1.7%), one G2684A case (0.8%). There were no significant correlations between IgE and detected cSNP. CONCLUSION: Three PLD1 gene cSNPs (G2658A, T2664A, G2684A) were detected in the blood of children with atopic dermatitis. Among them, G2658A polymorphism seems to be correlated to the serum IgE level, but PLD1 cSNP does not appear to contribute to the pathogenic processing of atopic dermatitis.
Cell Membrane ; Child* ; Chronic Disease ; Dermatitis, Atopic* ; DNA ; Exons ; Humans ; Immunoglobulin E ; Phosphatidic Acids ; Phosphatidylcholines ; Phospholipase D ; Phospholipases* ; Phospholipids ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Protein Kinase C ; T-Lymphocytes