복부접근법을 이용한 Morgagni Hernia의 교정 -1예 보고-

황정주,김도형,이양덕,김길동 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.10

Morgagni 탈장은 선천성 탈장의 약 3%를 차지하며 주로 증상이 없이 우연히 성인기에 발견된다. 단순 흉부촬영으로 쉽게 진단될 수 있으나 탈장이 없는 경우는 흉부 전산화 단층 촬영 등으로 진단된다. 장관의 감돈 위험이 있으므로 발견되면 수술적 치료가 바람직하다. 흉강이나 복강으로 접근이 가능하나 본 저자들은 복강경을 이용하여 교정이 가능하였기에 보고하는 바이다.

딥벨트의 가로막 수축압력과 초음파영상의 가로막 움직임 및 폐활량과의 상관성

이재석,강태욱 대한심장호흡물리치료학회 2022 대한심장호흡물리치료학회지 Vol.10 No.2

Purpose: This study was designed to determine the correlation between the diaphragmatic contraction pressure using diaphragmatic pressure belt (DiP Belt) and the ultrasound imaging of diaphragmatic motion and forced vital capacity. This study was conducted to confirm the usefulness of assessing the diaphragmatic function using the DiP Belt. Methods: This study included 41 healthy subjects (13 males and 28 females). The diaphragmatic motion was measured using sonography, and the forced vital capacity (FVC) was measured using a portable digital spirometer device. After 2 weeks, the diaphragmatic contraction pressure was measured during maximal inspiration using the DiP Belt. Results: The mean diaphragmatic contraction pressure (MDCP) and peak diaphragmatic contraction pressure (PMCP) using the DiP Belt were not significantly correlated with sonography imaging of diaphragmatic motion during quiet breathing but were significantly positively correlated with the diaphragmatic motion during deep breathing. Both the MDCP and PMCP were significantly positively correlated with FVC, forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). However, diaphragmatic motion was significantly positively correlated with FVC, FEV1, and PEF in only deep breathing. Conclusion: The Dip Belt can provide valuable information about the diaphragmatic function, particularly ultrasound imaging of diaphragmatic motion and lung capacity.

딥벨트를 이용한 일회성 가로막 호흡운동이 가로막 움직임과 노력성 폐활량에 미치는 영향

이재석,강태욱 대한물리치료과학회 2022 대한물리치료과학회지 Vol.29 No.2

Background: This study was to determine whether the diaphragmatic breathing exercise using a DiP Belt(Diaphragmatic Pressure Belt) is effective in in- creasing the diaphragmatic motion and forced vital capacity. Design: Pretest-Posttest design. Methods: A total of 44 subjects(15 male, 29 female) participated in this study. All subjects were measured the diaphragmatic motion with a sonography and the Forced Vital Capacity(FVC) was measured with a digital spirometer. After 4 weeks, the subjects were intervened the diaphragmatic breathing exercise using a DiP belt and were remeasured for diaphragm motion and FVC. Results: After exercise intervention, quiet breathing significantly increased with the change in dia- phragmatic motion and showed a moderate effect size (p<.01, Cohen's d = -0.53). In addition, it was sig- nificantly increased in deep breathing and showed a high effect size (p<.001, Cohen's d = -1.32). The mean diaphragmatic contraction pressure increased, but there was no significant difference and the peak diaphragmatic contraction pressure increased sig- nificantly (p<.05). Both diaphragmatic contraction pressure showed small effect sizes (respectively Cohen's d = -0.28, -0.33). In spirometry, FVC, Forced Expiratory Volume in 1 second (FEV1), and FEV1/FVC% all increased, but there was no sig- nificant difference. Only peak expiratory flow in- creased significantly and showed a small effect size (p<.05, Cohen's d = -0.41). Conclusion: The DiP belt diaphragmatic breathing ex- ercise that the principle of visual feedback can correct diaphragm breathing in a short time, so it is a useful breathing exercise device that can help the diaphragm breathing exercise in the right way in clinical practice.

실시간 초음파를 이용한 횡격막 호흡 훈련이 흉곽 가동성 제한이 있는 젊은 여성들의 폐 기능에 미치는 영향

남수진(Soo-jin Nam),심재훈(Jae-hun Shim),오덕원(Duck-won Oh) 한국전문물리치료학회 2017 한국전문물리치료학회지 Vol.24 No.2

Background: Research efforts to improve the pulmonary function of people with limited chest function have focused on the diaphragmatic ability to control breathing pattern. Real-time ultrasonography is appropriate to demonstrate diaphragmatic mechanism during breathing. Objective: The purpose of this study was to investigate the effects of diaphragmatic breathing training using real-time ultrasonographic imaging (RUSI) on the chest function of young females with limited chest mobility. Methods: Twenty-six subjects with limited chest mobility were randomly allocated to the experimental group (EG) and control group (CG) depending on the use of RUSI during diaphragmatic breathing training, with 13 subjects in each group. For both groups, diaphragmatic breathing training was performed for 30-min, including three 10-min sets with a 1-min rest interval. An extra option for the EG was the use of the RUSI during the training. Outcome measures comprised the diaphragmatic excursion range during quiet and deep breathing, pulmonary function (forced vital capacity; FVC, forced expiratory volume in 1-sec; FEV1, tidal volume; TV, and maximal voluntary ventilation; MVV), and chest circumferences at upper, middle, and lower levels. Results: The between-group comparison revealed that the diaphragmatic excursion range during deep breathing, FVC, and middle and lower chest circumferences were greater at post-test and that the changes between the pretest and post-test values were greater in the EG than in the CG (p<.05). In addition, the subjects in the EG showed increased post-test values for all the variables compared with the pretest values, except for TV and MVV (p<.05). In contrast, the subjects in the CG showed significant improvements for the diaphragmatic excursion range during quiet and deep breathings, FVC, FEV1, and middle and lower chest circumferences after the intervention (p<.05). Conclusion: These results indicate that using RUSI during diaphragmatic breathing training might be more beneficial for people with limited chest mobility than when diaphragmatic breathing training is used alone.

Diaphragmatic hernia following liver resection

Francesco Esposito,Chetana Lim,Chady Salloum,Michael Osseis,Eylon Lahat,Philippe Compagnon,Daniel Azoulay 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.3

Backgrounds/Aims: Postoperative diaphragmatic hernia, following liver resection, is a rare complication. Methods: Data of patients who underwent major hepatectomy for liver tumors, between 2011 and 2015 were retrospectively reviewed. The literature was searched for studies reporting the occurrence of diaphragmatic hernia following liver resection. Results: Diaphragmatic hernia developed in 2.3% of patients (3/131) with a median delay of 14 months (4-31 months). One patient underwent emergency laparotomy for bowel obstruction and two patients underwent elective diaphragmatic hernia repair. At last follow-up, no recurrences were observed. Fourteen studies including 28 patients were identified in the literature search (donor hepatectomy, n=11: hepatectomy for liver tumors, n=17). Diaphragmatic hernia was repaired emergently in 42.9% of cases and digestive resection was necessary in 28.5% of the cases. One patient died 3 months after hepatectomy, secondary to sepsis, from a segment of small bowel that perforated into the diaphragmatic hernia. Conclusions: Although rare, diaphragmatic hernia should be considered as an important complication, especially in living donor liver transplant patients. Diaphragmatic hernia should be repaired surgically, even for asymptomatic patients.

Delayed presenting traumatic diaphragmatic hernia: four case reports

김의태 대한응급의학회 2019 大韓應急醫學會誌 Vol.30 No.4

A traumatic diaphragmatic hernia is a rare combined problem involving injuries to the thorax and abdomen that may not be diagnosed at the time of injury. Surgical management is mandatory when the patient displays any signs of bowel strangulation due to the herniation because a herniated bowel has a very high risk of necrosis or perforation. Four patients were diagnosed with delayed traumatic diaphragmatic hernia 14 to 96 months after injury. In two patients, the diaphragmatic injury was missed at the time of injury. Reduction and diaphragm repair surgery were performed. One diaphragm was repaired with artificial mesh. Traumatic diaphragmatic injury is caused by a blunt or penetrating injury to the abdomen or thorax. After migration of the intra-abdominal contents into the chest, a narrow herniation defect can disturb the bowel circulation and passage of bowel contents. Early detection and reduction, and repair surgery are mandatory for patients with a delayed presentation of complicated traumatic diaphragmatic hernia. Any patient with injury around the thorax or upper abdomen should be examined carefully considering the possibility of diaphragmatic hernia. Even if diaphragmatic injuries are not found in the initial evaluation, a radiology examination in a short period of time can correct the missed diagnosis of traumatic diaphragmatic hernia.

선천성 가로막 이탈로 오인된 우측 가로막 내장탈출

김경수 ( Kyoung Soo Kim ),정재일 ( Jae Il Joung ),김정호 ( Jeong Ho Kim ),김봉성 ( Bong Seong Kim ),박기영 ( Kie Young Park ),이정주 ( Jung Joo Lee ),박종빈 ( Jong Bin Park ),최수정 ( Soo Jung Choi ) 대한주산의학회 2004 Perinatology Vol.15 No.2

Diaphragmatic eventration is an abnormal elevation of an intact diaphragm into the thoracic cavity as a result of paralysis, aplasia or atrophy of muscular fibers, which accounts for 5~10% of all diaphragmatic disorders. Congenital eventration result from a incomplete muscularization of the pleuroperitoneal membranes at 8~10 weeks` menstrual age, the cause of this failure is not known. Although some patients are asymptomatic and find out incidentally, significant compression of the affected chest contents can result in severe respiratory distress. The differentiation between congenital diaphragmatic eventration and congenital diaphragmatic hernia by sonography may be difficult, but important because of a significant differences in postnatal management and prognosis. We experienced a case of right congenital diaphragmatic eventration with severe respiratory distress during immediate postnatal period, who was initially diagnosed as congenital diaphragmatic hernia and performed plication at 18 hours after birth. So we report this case with review of literatures.

횡경막 탈장으로 오인된 일측 선천성 횡경막 내장전위 1 예

양정인(Jeong In Yang),오기석(Kie Suk Oh),김행수(Haeng Soo Kim),이준서(June Seo Lee),홍정(Jeong Hong) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm as a result of developmental failure of muscular fibers during the fetal period. Mediastinal shift to the contralateral side may cause significant compression of the affected chest contents resulting in compromised pulmonary function especially when bilaterally involved. The differentiation between congenital diaphragmatic eventration and diaphragmatic hemia is very difficult but eventration has a better perinatal outcome compared to diaphragmatic hernia. We report a case of congenital diaphragmatic eventration on left side with good perinatal outcome after plication in which the initial prenatal diagnosis of diaphragmatic hernia was made by prenatal ultrasonography.

Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients

( Mostafa Ibrahim Elshazly ),( Khaled Mahmoud Kamel ),( Reem Ibrahim Elkorashy ),( Mohamed Said Ismail ),( Jumana Hesham Ismail ),( Hebatallah Hany Assal ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.4

Background: Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. Methods: We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. Results: There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cutoff value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cut-off value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. Conclusion: The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.

유산소 운동과 복식호흡 훈련의 병행이 경계성 고혈압 성인의 혈압 및 뇌기능지수에 미치는 영향

심태영 한국스포츠학회 2024 한국스포츠학회지 Vol.22 No.1

요약이 연구는 유산소 운동과 복식호흡 훈련의 병행이 경계성 고혈압 남자 성인의 혈압 및 뇌기능지수에 미치는 영향을 규명하기 위한 실험연구이다. 연구대상은 A광역시에 거주하는 40대 남자로 B병원에 등록된 경계성 고혈압 판정받은 성인들이다. 유산소 운동 집단, 복식호흡 훈련 집단, 유산소 운동과 복식호흡 훈련 병행 집단을 구성하고 12주간 주 5회의 빈도로 40~60분 유산소 운동을 실시하였으며, 복식호흡 훈련을 매일 3회 30분씩 추가적으로 실시하였다. 연구결과는 다음과 같다. 첫째, 12주간의 유산소운동과 복식호흡 훈련의 병행에 따른 경계성 고혈압 남자 성인의 체중, 허리둘레, 체지방률, BMI 모든 하위요인에서 감소가 나타나 신체조성에 긍정적인 효과가 있는 것으로 나타났다. 둘째, 12주간의 유산소운동과 복식호흡 훈련의 병행에 따른 경계성 고혈압 남자 성인의 수축기 혈압과 이완기 혈압 하위요인에서 감소가 나타나 안정 시 혈압에 긍정적인 효과가 있는 것으로 나타났다. 셋째, 12주간의 유산소운동과 복식호흡 훈련의 병행에 따른 경계성 고혈압 남자 성인의 자기조절지수, 기초율동지수, 주의지수, 활성지수, 정서지수, 항스트레스지수, 좌우뇌 균형, 브레인지수 하위요인에서 증가가 나타나 뇌기능지수에 긍정적인 효과가 있는 것으로 나타났다. 이는 유산소 운동과 복식호흡 훈련이 병행될 때 그 효과가 가장 높은 것으로 나타났다. AbstractThis study aimed to investigate the effects of concurrent aerobic exercise and diaphragmatic breathing training on blood pressure and brain function index in adult males with borderline hypertension. The study participants were adult males in their 40s residing in City A who were diagnosed with borderline hypertension and registered at Hospital B. Three groups were formed: an aerobic exercise group, a diaphragmatic breathing training group, and a concurrent aerobic exercise and diaphragmatic breathing training group. They engaged in aerobic exercise for 40-60 minutes, five times a week for 12 weeks, and additionally performed diaphragmatic breathing training three times a day for 30 minutes each session. The results of the study are as follows: Firstly, a decrease in weight, waist circumference, body fat percentage, and BMI, indicating positive effects on body composition, was observed in adult males with borderline hypertension after 12 weeks of concurrent aerobic exercise and diaphragmatic breathing training. Secondly, a decrease in systolic and diastolic blood pressure, indicating positive effects on resting blood pressure, was observed in adult males with borderline hypertension after 12 weeks of concurrent aerobic exercise and diaphragmatic breathing training. Thirdly, an increase in self-regulation index, basal rhythm index, attention index, activation index, emotional index, stress index, hemispheric balance, and brain index, indicating positive effects on brain function index, was observed in adult males with borderline hypertension after 12 weeks of concurrent aerobic exercise and diaphragmatic breathing training. This suggests that the highest efficacy is achieved when aerobic exercise and diaphragmatic breathing training are performed concurrently.