기관지 천식 환자에서 기도벽의 비후도와 폐기능 -고해상 전산화 단층 촬영을 이용한 평가-

임성용 ( Im Seong Yong ),신종욱 ( Sin Jong Ug ),김재열 ( Kim Jae Yeol ),박인원 ( Park In Won ),김양수 ( Kim Yang Su ),최병휘 ( Choe Byeong Hwi ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.3

HRCT를 이용한 천식의 중증도에 따른 기도개형의 평가

임성용 ( Seong Yong Lim ),김양수 ( Yang Soo Kim ),최병휘 ( Byoung Whui Choi ) 대한내과학회 2007 대한내과학회지 Vol.73 No.6

목적: 기도 개형은 천식의 특징으로 최근 HRCT가 기도벽의 비후와 같은 기도 개형의 평가에 유용한 것으로 알려지고 있다. 기도벽의 비후는 천식의 중증도와 연관이 있다고 알려지고 있지만 국내 연구는 드문 상태이다. 본 연구는 성인 천식 환자에서 중증도에 따른 기도벽의 비후도 차이를 비교하고 이와 폐기능 및 기관지 과민성과의 상관관계를 살펴보고자 하였다. 방법: 37명의 성인 천식 환자(경증 천식 17명, 중등증천식 11명, 중증 천식 9명)를 대상으로 HRCT를 시행하여 기도벽의 두께(T), 기도 내경(d)를 측정한 후, 기도 외경(D)을 계산하여 구한 T/D 비를 기도벽의 비후도 지표로 이용하여 각 군 사이의 차이를 살펴보고 폐기능 및 기관지 과민성과의 상관관계를 살펴보았다. 결과: 기도벽의 비후도(T/D 비)는 중등증과 중증 천식군에서 경증 천식군보다 전체 기도에서 크게 나타났다(0.278±0.014, 0.281±0.019 vs. 0.228±0.013; 각각 p=0.022, p=0.021). 소기도에서도 기도벽의 비후도는 중증 천식군에서 경증 천식군보다 컸다(0.313±0.018 vs. 0.253±0.013; p=0.009). 대기도에서는 세군간에 비후도 차이가 없었다. 기도벽의 비후도는 폐기능 상의 FEV1 절대값 및 % 예측치와 전체 기도(r=-0.519, p=0.001; r=-0.396, p=0.015), 소기도(r=-0.567, p<0.001; r=-0.450, p=0.008) 및 대기도(r=-0.395, p=0.015; r=-0.351, p=0.033)에서 유의한 역상관관계를 보였다. 기도벽의 비후도와 기관지 과민성과는 상관관계를 보이지 않았다. 결론: 기도벽의 비후는 경증 천식보다 중등증과 중증천식에서 심해지고 기도벽의 비후도가 클수록 기도 폐쇄가 심해진다. Background: Airway remodeling is characterized by an increase in the airway wall thickness. We aimed to compare the airway wall thickness among asthmatic subjects with different severity and to examine its relation to pulmonary function and airway hyperresponsiveness. Methods: Thirty-seven adult asthmatics were assigned to mild (MA, n=17), moderate (MoA, n=11), and severe (SA, n=9) groups according to the Global Initiative for Asthma classification. Patients with more than 10 pack-years of smoking history were excluded. We measured the airway wall thickness (T) and internal diameter (d) using high-resolution computed tomography, and then calculated the external diameter (D). The T/D ratio was compared between the groups and correlations between the T/D ratio and pulmonary function (methacholine PC20) were assessed. Results: The mean T/D ratio was significantly higher in the MoA and the SA groups than in the MA group for the total airways (0.278±0.014, 0.281±0 .019 vs. 0.228±0.013; p=0.022, p=0.021, respectively). The mean T/D ratio was also higher in the SA group than the MA group for the small airways (0.313±0.018 vs. 0.253±0.013; p=0.009). However, there were no significant differences for the large airways. The mean T/D ratio negatively correlated with FEV1 (L) and FEV1 (% of predicted) in total airways (r=-0.519, p=0.001; r=-0.396, p=0.015), small airways (r=-0.567, p<0.001; r=-0.450, p=0.008) and large airways (r=-0.395, p=0.015; r=-0.351, p=0.033). The methacholine PC20 was not related to the T/D ratio. Conclusions: This study suggests that patients with moderate to severe asthma have greater airway remodeling than those with mild asthma, and the degree of airway wall thickening correlates to the severity of airflow obstruction. (Korean J Med 73:631-637, 2007)

Clinical Research Article : Comparison of the ease of Laryngeal mask airway ProSeal insertion and the fiberoptic scoring according to the head position and the presence of a diffi cult airway

( Joo Hyun Jun ),( Hee Jung Baik ),( Jong Hak Kim ),( Youn Jin Kim ),( Ri Na Chang ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.4

Background: The sniffing position is recommended for conventional laryngeal mask airway (LMA) insertion. However, there has been a high success rate of LMA insertion with the head in the neutral position. The effect of a diffi cult airway on the ease of LMA insertion is not clear. In this study, we compared the ease of LMA ProSealTM (PLMA) insertion and the fiberoptic scoring according to the head position and the presence of a difficult airway. Methods: After obtaining informed consent from the subjects, we enrolled 144 adult patients (age range: 18-65) with an ASA physical status 1 or 2. After evaluation of the airway, all the patients were grouped into the EA (easy airway) group (n = 68) and the DA (difficult airway) group (n = 76). According to the head position, each group was divided into the EA-SE (extension) group (n = 35), the EA-SN (sniffing) group (n = 33), the DA-SE group (n = 39) and the DASN group (n = 37). The success rate and insertion time at the first attempt were evaluated. The position of the PLMA was fiberoptically scored from the mask aperture of the airway tube in the original head position. After the head position was changed to the sniffing and neutral positions in the SE and SN group, respectively, the position of PLMA was re-evaluated fiberoptically. Results: The success rate and insertion time at the first attempt and the fiberoptic score showed no significant difference among the groups. After head position was changed, there were no significant changes in the fiberopitc scores. Conclusions: A difficult airway and the head position had no influence on the ease of PLMA insertion and the fiberopic score. Therefore, the head position can be selected according to the individual patient`s situation. (Korean J Anesthesiol 2011; 60: 244-249)

Implementation and Outcomes of a Difficult Airway Code Team Composed of Anesthesiologists in a Korean Tertiary Hospital: A Retrospective Analysis of a Prospective Registry

정희준,Choi Ji Won,Kim Duk Kyung,Lee Sang Hyun,Lee Soo Yeon 대한의학회 2022 Journal of Korean medical science Vol.37 No.3

Background: In 2017, we established an airway call (AC) team composed of anesthesiologists to improve emergency airway management outside the operating room. In this retrospective analysis of prospectively collected data from the airway registry, we describe the characteristics of patients attended to and practices by the AC team during the first 4 years of implementation. Methods: All AC team activations in which an airway intervention was performed by the AC team between June 2017 and May 2021 were analyzed. Results: In all, 359 events were analyzed. Activation was more common outside of working hours (62.1%) and from the intensive care unit (85.0%); 36.2% of AC activations were due to known or anticipated difficult airway, most commonly because of acquired airway anomalies (n = 49), followed by airway edema or bleeding (n = 32) and very young age (≤ 1 years; n = 30). In 71.3% of the cases, successful intubation was performed by the AC team at the first attempt. However, three or more attempts were performed in 33 cases. The most common device used for successful intubation was the videolaryngoscope (59.7%). Tracheal intubation by the AC team failed in nine patients, who then required surgical airway insertion by otolaryngologists. However, there were no airway-related deaths. Conclusions: When coupled with appropriate assistance from an otolaryngologist AC system, an AC team composed of anesthesiologists could be an efficient way to provide safe airway management outside the operating room.

3D 프린터로 제작한 비강-인후두 기도 모델-예비연구

박안나,유영삼 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.6

Background and Objectives Flexible fiberscopy is essential in the examination of the nose to larynx airway. However, the instrument is sensitive to manipulation and can sometimes be damaged when excessive external force is applied. In addition, patients can be injured during fiberscopic examination. In this regard, a airway model mimicking the human airway passage was developed for the education of fiberscopy to minimize the danger to both patient and fiberscope. Materials and Method Neck CT data was used to 3D-print the airway model. Using the 3D doctor software, the outlines of the air-filled cavities were extracted. The outline data was modified to make the inside of the outline empty and the outside filled with 3D ink resin. The airway data was used to 3D-print the replica in three pieces, which were then assembled into one. Flexible laryngoscopic examination of nose to larynx was performed using the nose-to-larynx airway model, and for a male patient enrolled in the study. Virtual endoscopy was performed using the same CT data. The examination data were then compared frame by frame with regards to the shapes and positions of nasal inlet, inferior turbinate, torus tubarius, hypopharynx, epiglottis and vocal cord. Results The airway model was very similar in shape and position of the anatomic landmarks compared with real human airway examined by the fiberscope. Conclusion The results of 3D-printed airway model showed similar shapes as the real human airway, and real time endoscopy could be done using the model. This technique can be extended to make models of tubed organs such as the intestine or the bronchial tree. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(6):301-7

TNF-α induces the late-phase airway hyperresponsiveness and airway inflammation through cytosolic phospholipase A₂ activation

Choi, Il-Whan,Sun-Kim, Il-Whan,Kim, Young-Suk,Ko, Hyun-Mi,Im, Suhn-Young,Kim, Jae-Hong,You, Hye-Jin,Lee, Yong-Chul,Lee, Jae-Hoon,Park, Young-Min,Lee, Hern-Ku Elsevier 2005 The Journal of allergy and clinical immunology Vol.116 No.3

<P><B>Background</B></P><P>Late-phase airway hyperresponsiveness (AHR) in asthma is considered the event leading to persistent inflammation in the lungs, but the molecular mechanisms involved in this process are poorly understood.</P><P><B>Objective</B></P><P>To examine the role of TNF-α in the development of a late AHR and airway inflammation in asthma.</P><P><B>Methods</B></P><P>We established a murine model of asthma with not only biphasic AHR to methacholine but also airway eosinophilia. The effect of TNF-α blockade was determined by using anti–TNF-α antibody and TNF-α knockout mice. Cytosolic phospholipase A<SUB>2</SUB> (cPLA<SUB>2</SUB>) mRNA expression and activity were assessed by using RT-PCR and 1-stearoyl-2-[1-<SUP>14</SUP>C] arachidonyl-sn-glycero-3-phosphocholine as the substrate, respectively.</P><P><B>Results</B></P><P>TNF-α blockade resulted in significant inhibition of the late AHR without affecting the early AHR, and reduction in airway eosinophilia and inflammation. cPLA<SUB>2</SUB> activity was increased in asthmatic lungs in a TNF-α–dependent way, and cPLA<SUB>2</SUB> inhibitor blocked late AHR and airway eosinophilia. TNF-α also stimulated the synthesis of cPLA<SUB>2</SUB> metabolites such as leukotriene B<SUB>4</SUB> and platelet-activating factor in the airway. Specific inhibitors of cPLA<SUB>2</SUB> metabolites inhibited the late AHR and airway eosinophilia.</P><P><B>Conclusions</B></P><P>TNF-α is the proximal key cytokine capable of developing late-phase AHR and subsequent airway inflammation through expression/activation of cPLA<SUB>2</SUB>.</P>

항로변경죄상 ‘항로’의 의미와 죄형법정원칙 - 대법원 2017. 12. 21. 선고 2015도8335 전원합의체 판결 -

변종필 ( Byun Jong Pil ) 법조협회 2018 최신판례분석 Vol.67 No.1

이 논문은 이른바 ‘땅콩회항’ 사건으로 불리며 그 동안 세간의 관심과 이목을 집중시켰던 사건에 대한 대법원판례를 대상으로 그 쟁점사항을 제시하고 비판적으로 분석한 글이다. 대상판례의 쟁점은, 피고인이 푸시백 중이던 비행기를 탑승구로 돌아오게 한 행위가 항공보안법 제42조에 정한 항공기의 항로를 변경하게 한 것에 해당하는지 여부이다. 이에 대해 다수의견은 항공기의 지상 이동경로는 항로변경죄상의 ‘항로’에 포함되지 않으므로 피고인의 행위는 항공기의 항로를 변경하게 한 것에 해당하지 않는다고 본 반면, 반대의견은 항공기의 지상 이동경로 역시 항로변경죄상의 ‘항로’에 포함되므로 피고인의 행위는 항공기의 항로를 변경하게 한 것에 해당한다고 보았다. 이와 관련하여 이 글에서는 필자가 정리한 몇 가지 쟁점사항(항로의 의미를 규정하기 위한 접근방법, 법문의 구조에 따른 해석의 문제, 항로와 항공로의 동일시 문제, 처벌의 필요성과 공백의 문제, 불충분한 자료에 기초한 해석의 정당화 문제)을 중심으로 양 의견을 비교 검토하면서, 특히 근거제시의 (합리성 내지 적절성의)측면에서 어떤 해석이 타당한지를 살펴보았다. 검토결과, 필자는 항로와 운항을 밀접하게 연계시키는 접근방법에 기초하여 제시된 반대의견의 해석론은, 비록 그것이 하나의 가능한 해석일 수는 있지만, 그러한 가능성을 넘어 합리적 근거제시를 통한 설득력 있는 논증을 보여주는 데까지는 이르지 못했다고 판단하였다. 따라서 형법해석상 죄형법정원칙의 취지에 비추어 ‘항로’개념의 사전적 정의 등 일상적 의미를 고려하여 피고인의 행위가 항로변경죄를 구성하지 않는다고 본 다수의견이 결론적으로 타당하다고 보았다. This paper treats the validity of Supreme Court's judgment about so-called peanut-flying back case. In this case, the accused was prosecuted on a charge of airway-change in because she made the airplane in the course of push back return to a boarding gate. The legal issue in this case is whether or not such an act of the accused conforms to changing the airway which is a component of the airway- change crime regulated in flight security law. The point of the majority opinion about this issue is that the act of the accused does not conform to changing the airway in the respect of the lexical definition of the word 'airway', whereas the opposing opinion says that the act conforms to changing the airway in because the implication of the airway in the airway-change crime is wider than that of the lexical definition. In connection of this dispute I examined, based on some important points, the validity of each opinion. As a result, I evaluated that the opposing opinion failed in providing supportive reasons in grounding its validity although it could be regarded as an interpretation. Therefore, it is my opinion that the majority opinion is proper and valid because it matches up to the principle of legality( namely, the principle of "nulla poena sine lege").

폐쇄성 수면 무호흡증 환자에 있어서 하악 재위치 장치 장착과 체위에 따른 상기도 구조와 근활성도의 변화에 관한 EMG 및 두부방사선학적 연구

박영철,배응권,이정권,이종석,김태관 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.4

폐쇄성 수면 무호흡증(obstructive sleep apnea, 이하 OSA로 표시)은 수면 도중 계속 반복 되어 일어나는 상기도 폐쇄로 인하여 무호흡증을 나타내는 장애(disorder)이다. 근래의 연구에 의하면 상기도 구조의 해부학적 요인뿐 아니라 생리적 요인도 무호흡 발생에 기여한다고 하였으며 또한 이설근이 상기도 유지에 중요한 역할을 한다고 하였다. OSA의 치료를 위해 다양한 술식이 시행되었으며 하악 재위치 장치를 통한 치료 역시 양호한 결과를 나타낸다고 하였다. 그러나 하악 재위치 장치 장착에 따른 구조적 생리적 작용기전에 대한 연구는 미비한 상태이다. 이에 본 저자는 연세대학교 치과대학병원 교정과에 내원한 OSA 환자 26명(남 17명, 여 9명)과 일반 정상 성인 20명(남 10명 여 10명)을 대상으로 앙와위에서 장치 장착 전후의 두부방사선사진을 채득하여 장치에 따른 상기도의 구조 변화를 연구하고 두군 사이의 장치 장착에 따른 효과를 비교하였으며, 또한 OSA 환자 14명(남자 10명 여 4명)을 대상으로 체위 변화와 장치장착에 따른 이설근 근전도 변화를 연구하여 다음과 같은 결론을 얻었다. 1. 상기도 구조에 대한 두부계측학적 측정치 중 연구개의 길이, 연구개 최대 두께와 SPAS, MAS, VAL, H-H1. MP-H에서 정상군과 OSA군 사이의 통계적 유의차를 보였으며, IAS와 EAS는 두 군간에 통계적 유의차를 보이지 않았다. 2. 정상군과 OSA군 모두에서 장치 장착에 따라 후두개가 전방 이동하면서 후두개 수준(epiglottis level)의 기도 폭경은 증가하였고 연구개의 최대 두께가 변하였으며 설골은 전방 이동하였으나 두 군 모두 IAS에서는 다양한 반응을 나타내었다. 장치 장착에 따른 상기도 구조에 대한 효과는 두 군 사이에 서로 차이을 나타내었다. 3. 체위 변화에 따라 앙와위에서 이설근 근전도가 증가하는 경향을 나타내었으나 통계적 유의차는 없었으며, 직립위와 앙와위 모두에서 하악 재위치 장치 장착시에 통계적으로 유의하게 이설근 근전도가 증가하였다. 하악 재위치 장치는 상기도의 해부학적 구조뿐 아니라 상기도 영향을 미치는 것으로 생각되며 장치에 대한 반응은 정상군과 OSA군 사이에 차이를 나타내었고, 두 군은 상기도 생리에 있어서도 서로 다르다고 사료된다. Obstructive sleep apnea (OSA)is a disorder characterized by repetitive episode of upper airway collapse during sleep. Recent studies showed that not only the anatomic factors but the physiologic factors of the upper airway also have effects on the occurrence of apnea and that the genioglossus muscle also plays in important role in the maintenance of the upper airway. A variety of therapies were performed to treat OSA, and among them the use of mandibular repositioning appliances showed reasonable results. But there is still a lack of research on the structural and physiological mechanism upon the use of mandibular repositioning appliances. The author selected 26(male 17, female 9) OSA patients that came to the Yonsei University Dental Hospital, Department of Orthodontics, and 20 normal adults (male 10, female 10) and took cephalometric radiographs of them in a supine position before and after the palcement of the mandibular repositioning appliance to see the structural changes of the upper airway and compare the therapeutic effects between the two groups. We also studied the waking genioglossus muscle activity in OSA patients and investigated the difference in the electromyogram of the genioglosssus muscle upon the change in body posture and the use of mandibular repositioning appliance. Following results were obtained. 1. Among the cephalometric measurements of the upper airway structure, the length of the soft palate, maximum thickness of the soft palate and SPAS, MAS, VAL, H-HI, MP-H showed statistically significant differences between the normal and OSA groups, but the IAS and EAS showed no statistically significant differences between the two groups. 2. In both the normal and OSA groups, as the epiglottis moved forward on wearing the mandibular repositioning appliance, the epiglottis level of the upper airway increased and the maximum thickness of the soft palate changed and the hyoid bone also moved forward, but the IAS in both groups showed various results and the effect of the mandibular repositioning appliance on the structure of the upper airway was different in the two groups. 3. Upon changing the position, the electromyogram of the genioglossus muscle showed a increasing tendency but there was no statistically significant differences, and when the mandibular repositioning appliance were worn there was a statistically significant increase in the electromyogram of the genioglossus muscle in both the upright and supine positions. The mandibular repositioning appliances not only have an effect on the anatomical structure of the upper airway but also on the physiology of the upper airway. There are different responses to the use of mandibular repositioning appliance between the normal and OSA groups therefore it could be considered to have the different physiology of the upper airway between the two groups.

Astragalin Inhibits Allergic Inflammation and Airway Thickening in Ovalbumin-Challenged Mice

Kim, Yun-Ho,Choi, Yean-Jung,Kang, Min-Kyung,Park, Sin-Hye,Antika, Lucia Dwi,Lee, Eun-Jung,Kim, Dong Yeon,Kang, Young-Hee American Chemical Society 2017 Journal of agricultural and food chemistry Vol.65 No.4

<P>Lung inflammation and oxidative stress are the major contributors to the development of obstructive pulmonary diseases. Macrophages are involved in pulmonary inflammation and alveolar damage in emphysema. Astragalin is an anti-inflammatory flavonoid present in persimmon leaves and green tea seeds. This study elucidated that astragalin inhibited inflammatory cell infiltration induced by 20 mu M H2O2 and blocked airway thickening and alveolar emphysema induced by 20 pig of ovalbumin (OVA) in mice. OVA induced mouse pulmonary MCP-1, and H2O2 enhanced the expression of MCP-1/ICAM-1/ccv integrin in bronchial airway epithelial BEAS-2B cells. Such induction was inhibited by supplying 10-20 mg/kg of astragalin to OVA-challenged mice and 1-20 mu M astragalin to oxidant-stimulated cells. Oral administration of 20 mg/kg of astragalin reduced the induction of F4/80/CD68/CD11b in airways of mice challenged with OVA. Additionally, emphysema tissue damage was observed in OVA-exposed alveoli. Mast cell recruitment in the airway subepithelium was blocked by supplementing astragalin to OVA-challenged mice. Orally treating 20 mg/kg of astragalin reduced alpha-SMA. induction in inflammation-occurring airways and appeared to reverse airway thickening and constriction induced by an OVA episode. These results revealed that astragalin may improve airway thickening and alveolar destruction with blockade of allergic inflammation in airways. Therefore, astragalin may be a therapeutic agent antagonizing asthma and obstructive pulmonary diseases.</P>

마네킹을 이용한 어려운 기도에서 부지 기관 내 삽관의 효과

심규식,방성환,안희정 사단법인 한국응급구조학회 2020 한국응급구조학회지 Vol.24 No.2

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.