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Tc-99m ECD Brain SPECT in Patients with Traumatic Brain Injury: Evaluating Distribution of Hypoperfusion and Assesment of Cognitive and Behavioral Impairment in Relation to Thalamic Hypoperfusion (뇌외상 환자의 Tc-99m ECD 뇌 SPECT에서 뇌 혈류감소의 분포 및 시상의 혈류감소에 대한 인지 및 행동장애 평가)

  • Park, Soon-Ah;Lim, Seok-Tae;Sohn, Myung-Hee
    • The Korean Journal of Nuclear Medicine
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    • v.34 no.6
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    • pp.445-455
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    • 2000
  • Purpose: We evaluated the distribution of hypoperfusion in patients with traumatic brain injury (TBI) and the relationship of thalamic hypoperfusion to severity of cognitive and behavioral sequelae. Materials and Methods: Tc-99m ECD SPECT and MRI were performed in 103 patients (M/F=81/22, mean age $34.7{\pm}15.4$ yrs) from 0.5 to 55 months (mean 10.3 months) after TBI. The patients were divided into three groups showing no abnormalities (G1), focal (G2) and diffuse injury (G3) on MRI. Psychometric tests assessed 11 cognitive or behavioral items. In all patients, we evaluated the distribution of hypoperfused areas in SPECT, and in 57/103 patients, neuropsychological (NP) abnormalities in patients with thalamic hypoperfusion were compared with those of patients without thalamic hypoperfusion. Results: The perfusion deficits were most frequently located in the frontal lobe (G1, 42.3%: G2 34.5%: G3 33.3%), temporal lobe ($24{\sim}26%$) thalami ($21{\sim}22.4%$), parietal and occipital lobe (${\leq}10%$). Numbers of NP abnormalities in the cases of cortical hypoperfusion with or without concomitant thalamic hypoperfusion were following: the former $4.7{\pm}1.5$ and the latter $3.2{\pm}1.4\;in\;G1,\;5.0{\pm}1.1\;and\;4.8{\pm}1.2\;in\;G2,\;6.8{\pm}1.8\;and\;6.3{\pm}1.1\;in\;G3$, respectively. This difference according to thalamic hypoperfusion was significant in G1 (p=0.002), but was not significant in G2 or G3. Conclusion: SPECT in patients with TBI had demonstrated hypoperfusion mostly involving the frontal, temporal and thalami. In normal group on MRI, frontal hypoperfusion was more prominent than that of any other group, Furthermore in this group, SPECT could predict severity of NP outcome by concomitant thalamic hypoperfusion with cerebral cortical abnormalities.

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Comparison of the Results in Gastric Carcinoma Patients undergoing Billroth I and Billroth II Gastrectomiesy (원위부 위암에서 위절제술 후 위재건술식에 따른 잔위기능 및 영양 증상학적 삶의 질 비교)

  • Kim, Sung Geun;Kim, Young Kyun;Heo, Youn Jung;Song, Kyo Young;Kim, Jin Jo;Jin, Hyung Min;Kim, Wook;Park, Cho Hyun;Park, Seung Man;Lim, Keun Woo;Kim, Seung Nam;Jeon, Hae Myung
    • Journal of Gastric Cancer
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    • v.7 no.1
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    • pp.16-22
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    • 2007
  • Purpose: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastricemptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. Materials and Methods: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an $^{99m}Tc$-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. Results: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). Conclusion: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.

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Design and Implementation of a Web Application Firewall with Multi-layered Web Filter (다중 계층 웹 필터를 사용하는 웹 애플리케이션 방화벽의 설계 및 구현)

  • Jang, Sung-Min;Won, Yoo-Hun
    • Journal of the Korea Society of Computer and Information
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    • v.14 no.12
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    • pp.157-167
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    • 2009
  • Recently, the leakage of confidential information and personal information is taking place on the Internet more frequently than ever before. Most of such online security incidents are caused by attacks on vulnerabilities in web applications developed carelessly. It is impossible to detect an attack on a web application with existing firewalls and intrusion detection systems. Besides, the signature-based detection has a limited capability in detecting new threats. Therefore, many researches concerning the method to detect attacks on web applications are employing anomaly-based detection methods that use the web traffic analysis. Much research about anomaly-based detection through the normal web traffic analysis focus on three problems - the method to accurately analyze given web traffic, system performance needed for inspecting application payload of the packet required to detect attack on application layer and the maintenance and costs of lots of network security devices newly installed. The UTM(Unified Threat Management) system, a suggested solution for the problem, had a goal of resolving all of security problems at a time, but is not being widely used due to its low efficiency and high costs. Besides, the web filter that performs one of the functions of the UTM system, can not adequately detect a variety of recent sophisticated attacks on web applications. In order to resolve such problems, studies are being carried out on the web application firewall to introduce a new network security system. As such studies focus on speeding up packet processing by depending on high-priced hardware, the costs to deploy a web application firewall are rising. In addition, the current anomaly-based detection technologies that do not take into account the characteristics of the web application is causing lots of false positives and false negatives. In order to reduce false positives and false negatives, this study suggested a realtime anomaly detection method based on the analysis of the length of parameter value contained in the web client's request. In addition, it designed and suggested a WAF(Web Application Firewall) that can be applied to a low-priced system or legacy system to process application data without the help of an exclusive hardware. Furthermore, it suggested a method to resolve sluggish performance attributed to copying packets into application area for application data processing, Consequently, this study provide to deploy an effective web application firewall at a low cost at the moment when the deployment of an additional security system was considered burdened due to lots of network security systems currently used.

Graves' Disease in Prepubertal Children Compared with Pubertal Children (소아 Graves병의 임상적 고찰 : 사춘기 이전군과 사춘기군의 비교)

  • Kim, Hyun Mi;Yoon, Ju Yun;Jung, Min Ho;Suh, Byung Kyu;Lee, Byung Churl
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.76-82
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    • 2003
  • Purpose : The aim of this study was to determine whether differences exist in the presentation, clinical course, and outcome of Graves' disease between prepubertal children and adolescents. Methods : A retrospective chart review of 14 prepubertal(PREPUB, $7.2{\pm}0.9yr) and 38 pubertal (PUB, $12.4{\pm}1.5yr$) children with Graves' disease between January 1989 and November 1995 at St. Mary's Hospital and Kangnam St. Mary's Hospital was undertaken. Results : There were no significant differences in $T_3$, $T_4$, TSH between two the groups at diagnosis. The PUB group had significantly higher titers of antimicrosomal antibody(positive dilution factor $11,727.3{\pm}22,888.4$) than did the PREPUB group($2,111.5{\pm}2,285.0$, P<0.001). The PREPUB group had significantly higher titers of TSH-binding inhibitory immunoglobulin(TBII, $62.5{\pm}39.6$) than did the PUB group($44.9{\pm}10.4$, P<0.05) before treatment started. The duration(months) of medical therapy before thyroid function tests were normalized was longer in the PREPUB group than in the PUB group($T_3:6.8{\pm}5.0$ vs. $5.4{\pm}13.2$, $T_4:2.3{\pm}1.9$ vs. $2.1{\pm}2.2$, $TBII:26.7{\pm}24.0$ vs. $20.8{\pm}12.1$), especially that of TSH was significantly longer in the PREPUB group($14.6{\pm}11.0$ vs. $6.8{\pm}7.8$, P< 0.05). Total length of medical therapy was significantly longer in the PREPUB group than the PUB group($52.3{\pm}19.3$ vs. $37.9{\pm}16.3months$, P<0.01). During three years of antithyroid drug therapy, in the PREPUB group, the remission rate was lower and the relapse rate was higher than in the PUB group. Total length of treatment correlated negatively with chronological age(P=0.03). Conclusion : Prepubertal children require longer medical therapy to achieve a remission than do pubertal children. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.

Problems of Environmental Pollution (환경오염의 세계적인 경향)

  • 송인현
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1972.03a
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    • pp.3.4-5
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    • 1972
  • 생활수준이 낮은 단계에 있어서는 우선 식량에 대한 수요가 강하다. 인간의 욕구가 만족스럽게 먹는다는 것에 대하여 제일 강하게 발동하는 것이다 그러나 점차 과학기술과 산업과 경제가 발전하여 성장과정에 오르게 되고 소득수준도 향상하게 되면 시장기구를 통해서 구입 할 수 있는 개인의 물적 소비재에 대해서는 점차 충족하게 되며 식량이외에도 의복, 전기기구 및 일용생활용품, 자동차 등에 이르기까지 더욱 고차원의 소비재가 보급하게 되는 것이다. 이렇게 되며는 사람의 욕구는 사적 재물이나 물적 수요에서 점진적으로 공공재나 또는 질적 수요(주택, 생활환경 등)의 방향으로 움직이게 되는 것으로써 여기에 환경오염 또는 공해문제에 대하여 의식하게 된다. 그러나 여기에서 더욱이 문제점이 되는 것은 소득 수준의 향상 과정이란 그 자체가 환경오염의 커다란 요인이라는 점이며 자동차의 급격한 보급과 생활의 편의성을 구하여 집중되는 도시인구의 집적, 높은 소득을 보장하기 위한 생산성 높은 중화학공업의 발전 등등은 그 자체가 환경권이란 사람이 요구하는 고차원의 권리를 침해하는 직접적인 요인이 된다는 것이다. 이와 같은 환경오염이나 공해문제에 대한 세계적인 논의는 이미 시작된 지 오래이지만 현재는 우리의 건강보호를 위해서나 생활환경의 보전을 위해서라는 점에서는 그치는 것이 아니고, 더욱 넓혀서 자연의 보호, 자원의 보호라는 견지로 확대되고 있다. 이와 같은 세계적인 확대된 이해와 이에 대한 대책강구의 제안은 1968년 국제연합의 경제사회이사회에서 스웨덴 정부대표에 의하여 제시되었으며 1969년의 우- 탄트 사무총장의 인간환경에 관한 보고서, 1970년 Nixon 미대통령의 연두일반교서 그리고 1972년 5월 6일 스웨덴의 스톡홀롬에서 개최되는 인간환경회의의 주제 등을 통해서 알 수 있고, 종래의 공해나 생활환경의 오염문제라는 좁은 개념에서가 아니고 인간환경전체의 문제로 다루고 있는 것이다. 즉 환경개발(도시, 산업, 지역개발에 수반된 문제), 환경오염(인위적 행위에 의하여 환경의 대인간조건이 악화하는 문제) 자연ㆍ자원의 보호관리(지하, 해양자원, 동식물, 풍경경치의 문제)란 3개 측면에서 다루고 있는 것이다. 환경오염이란 문제를 중 심하여 보면 환경을 구성하는 기본적인 요소로서 대기, 물, 토지 또는 지각. 그리고 공간의 사대요소로 집약하여 생각할 수 있음으로 이 4요소의 오염이 문제가 되는 것이다. 대기의 오염은 환경의 오염중 가장 널리 알려진, 또 가장 오랜 역사를 가진 오염의 문제로써 이에 속하는 오염인자는 분진, 매연, 유해가스(유황산화물, 불화수소, 염화수소, 질소산화물, 일산 화염소 등) 등 대기의 1차 오염과 1차 존재한 물질이 자외선의 작용으로 변화발생 하는 오존, PAN등 광화학물질이 형성되는 2차적인 오염을 들 수 있다. 기외 카도미움, 연등 유해중금속이나 방사선물질이 대기로부터 토지를 오염시켜서 토지에 서식하는 생물의 오염을 야기케 한다는 점등이 명백하여지고 있으며 대기의 오염은 이런 오염물질이 대기중에서 이동하여 강우에 의한 침강물질의 변화를 일으키게 되며 소위 광역오염문제를 발생케하며 동시에 토지의 토질저하등을 가져오게 한다. 물의 오염은 크게 내육수의 오염과 해양의 오염의 양면으로 나누어 볼 수 있다. 하천의 오염을 방지하고 하천을 보호하기 위한 움직임 역시 환경오염의 역사상 오래된 문제이며 시초에는 인분뇨와의 연결에서 오는 세균에 의한 오염이나 양수 기타 일반하수와의 연결에서 오는 오염에 대비하는 것부터 시작하였지만 근래에는 산업공장폐수에 의한 각종 화학적유해물질과 염료 그리고 석유화학의 발달에 의한 폐유등으로 인한 수질오탁문제가 점차 크게 대두되고 있다. 이것은 측 오염이란 시초에 우리에게 주는 불쾌감이 크므로 이것을 피하자는 것부터 시작하여 인간의 건강을 지키고 각종 사용수를 보존하자는 용수보존으로 그리고 이제는 건강과 용수보존뿐만 아니라 이것이 농림 수산물에 대한 큰 피해를 주게됨으로써 오는 자연환경의 생태계보전의 문제로 확대전환하고 있는 것이다. ?간 특히 해양오염에 대한 문제는 국지적인 것에만 끝이는 것이 아니고 전세계의 해양에 곧 연결되는 것이므로 세계각국의 공통관심사로 등장케 되었으며 이것은 특히 폐유가 유류수송 도중에 해양에 투기되는 유류에 의한 해양의 유막성형에서 오는 기상의 변화와 물피해등이 막심함으로 심각화 되고 있다. 각국이 자국의 해안과 해양을 보호하기 위하여 조치를 서두르고 있는 현시점에서 볼 때에는 이는 국제문제화하고 있으며 세계적인 국제적 협력과 협조의 필요성이 강조되는 좋은 예라 하겠다. 토양의 오염에 있어서는 대기나 수질의 오염이 구국적으로 토양과 관련되고 토양으로 환원되는 것이지만 근래에 많이 보급사용되는 농약과 화학비료의 문제는 토양자체의 오염에만 그치는 것이 아니고 농작물을 식품으로 하여 섭취함으로써 발생되는 인체나 기타생물체의 피해를 고려할 때 더욱 중요한 것이며, 또 토질의 저하를 가져오게 하여 농림생산에 미치는 영향이 적지 않을 것이다. 지반강하는 지각 에 주는 인공적 영향의 대표적인 것으로써 지하수나 지하 천연가스를 채취이용하기 위하여 파들어 감으로써 지반이 침하 하는 것이며 건축물에 대한 영향 특히 풍수해시의 재해를 크게 할 우려가 있는 것이다. 공간에 있어서의 환경오염에는 소음, 진동, 광선, 악취 등이 있다. 이들은 특수한 작업환경의 경우를 제외하고는 건강에 직접적인 큰 피해를 준다고 생각할 수 없으나 소음, 진동, 관선, 악취 등은 일반 일상시민생활에 불쾌나 불안을 줌으로써 안정된 생활을 방해하는 요인이 되는 것이다. 공간의 오염물로써 새로운 주목을 끌게된 것은 도시산업폐기물로써 이들은 대기나 물 또는 토지를 오염시킬 뿐만 아니라 공간을 점령함으로써 도시의 미관이나 기능을 손상케 하는 것이다. 즉 노배폐차의 잔해, 냉장고등고형폐기물등의 재생불가능한 것이나 비니루등 합성물질로 된 용기나 포장 등으로 연소분해 되지 않은 내구소비재가 이에 해당하는 것으로 이는 maker의 양식에 호소하여 그 책임 하에 해결되어야 할 문제로 본다. 이렇듯 환경오염은 각양각색으로 그 오염물질의 주요 발생원인 산업장이나 기타 기관에서의 발생요인을 살펴보며는 다음과 같은 것으로 요약할 수 있다. A. 제도적 요인 1. 관리체재의 미비 2. 관리법규의 미비 3. 책임소재의 불명확 B. 자재적 요인 1. 사용자재의 선택부적 2. 개량대책급 연구의 미흡 C. 기술적 요인 1. 시설의 설계불량, 공정의 결함 2. 시설의 점검, 보전의 불충분 3. 도출물의 취급에 대한 검사부족 4. 발생방지 시설의 미설치, 결함 D. 교육적 요인 1. 오염물질 방제지식의 결여 2. 법규의 오해, 미숙지 E. 경제적 요인 1. 자금부족 2. 융자상의 문제 3. 경제성의 문제 F. 정신적 요인 1. 사회적 도의심의 결여(이기주의) 2. 태만 3. 무지, 무관심 등이다. 따라서 환경오염의 방지란 상기한 문제의 해결에 기대하지 않을 수 없으나 이를 해결하기 위하여는 국내적 국제적 상호협조에 의한 사회각층의 총력적 대책이 시급한 것이다. 이와 같은 환경오염이 단속된다 하며는 미구에 인류의 건강은 물론 그 존립마저 기대하기 어려울 것이며, 현재는 점진적으로 급성피해에 대하여는 그 흥미가 집중되어 그 대비책도 많이 논의되고 있지만 미량의 단속접촉에 의한 만성축적에 관한 문제나 이와 같은 환경오염이 앞으로 태어날 신생률에 대한 영향이나 유전정보에 관한 연구는 장차에 대비하는 문제로써 중요한 것이라 생각된다. 기외에 우려되는 점은 오염방지책을 적극 추진함으로써 올 수 있는 파생적인 문제이다. 즉 오염을 방지하기 위하여 생산기업체가 투자를 하게 되며는 그만큼 생산원가가 상승할 것이며 소비가격도 오를 것이다. 반면 이런 시책에 뒤떨어진 후진국의 값싼 생산국은 자연 수입이 억제 당할 것이며, 이렇게되면 후진국은 무역경쟁에서 큰 상처를 입게될 것이고 뿐만 아니라 선진국에 필요한 오염물질의 발생이 높은 생산기기를 자연후진국에 양도하게 될 것임으로 후진국의 환경오염은 배가할 우려가 있는 것이다. 또 해양오염을 방지할 목적에서와 같이 자국의 해안보호를 위하여 마련된 법의 규제는 타국의 선박운항에 많은 제약을 가하게 될 것이며 이것 역시 시설이 미약한 약소후진국의 선박에 크게 영향을 미치게 될 것임으로 교통, 해운, 무역등을 통한 약소후진국의 경제성장에 제동을 거는 것이 될 것이다. 이렇듯 환경오염의 문제는 환경자체에 대해서만 아니라 부산물적으로 특히 후진국에는 의외 문제를 던져주게 되는 것임으로 환경오염에 대해서는 물론, 전술한 바와 같이 인간환경전체의 문제로써 Nixon 대통령이 말한 결의와 창의와 그리고 자금을 가지고 과감하게 대처해 나가야 할 것이다.

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Quality Characteristics of Bread with Added Black Garlic Extract (흑마늘 추출액을 첨가한 식빵의 품질 특성)

  • Yang, Seung-Mi;Shin, Jung-Hye;Kang, Min-Jung;Kim, Sung-Hyun;Sung, Nak-Ju
    • Korean journal of food and cookery science
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    • v.26 no.5
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    • pp.503-510
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    • 2010
  • Different amounts of black garlic extract(0, 1, 3, 6, 9 and 12%(W/W)) were added to white pan bread, and the quality characteristics were evaluated. The pH and density of dough was decreased with increasing concentration of black garlic extract. There was no marked difference in the fermentation power of the dough expansion among the samples. The pH of bread decreased, and there were no significant differences in baking loss rate, dough yield or bread specific volume as the concentration of black garlic extract was increased. Regarding crust and crumb color values, lightness gradually diminished with increased amounts of black garlic extract in bread, whereas redness and yellowness increased. For measurement of texture, the highest hardness and gumminess of bread were observed in the 1% added group, and there was no remarkable difference between the 3% added group and control. Sensory evolution was the highest when 6% black garlic extract was added, but there were no significant differences in terms of color or overall acceptability. The results imply that addition of black garlic extract to white pan bread created a healthy and functional bread.

Analysis of Exploratory Thoracotomy in Non-Small Cell Lung Cancer (원발성 폐암에서의 시험적 개흉술의 분석)

  • 허재학;성숙환;김영태
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.536-542
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    • 1999
  • Background: The purpose of this study is to improve the quality of the diagnostic procedures in the preoperative evaluation so as to reduce the unnecessary thoracotomy and to ensure resectability in non-small cell lung cancer. Material and Method: Of 616 patients who underwent thoracotomy for primary lung cancer from January 1990 to December 1996, 59 patients(9.6%) turned out to have inoperable lesions after the thoracotomy. We reprospectively reviewed the bronchoscopic findings, methods of tissue diagnosis, CT scans, pulmonary function test and lung perfusion scan, reasons for nonresectability, and adjuvant therapy, and then followed up on the survival rate after exploratory thoracotomy. Result: The cell types were squamous cell carcinoma in 38, adenocarcinoma in 15, large cell carcinoma in 3 and others in 3. Primary loci were RUL in 20, RML in 6, RLL in 8, LUL in 13, LLL in 4 and others in 8. The reasons for non-resectability were various; direct tumor invaison to mediastinal structures(n=41), seeding on pleural cavity(n=8), poor pulmonary function(n=2), invasions to extranodal mediastinal lymph node(n=2), technical non- resectability due to extensive chest wall invasion (n=3), small cell carcinoma (n=1), malignant lymphoma(n=1), and multiple rib metastases(n=1). In the follow-up of 58 patients, 1-year survival rate was 55.2% and 2-year survival rate was 17.2% and the mean survival time was 14 months. When compared according to cell types or postoperative adjuvant therapeutic modalities, no significant difference in the survival rates were found. The squamous cell carcinoma was frequently accompanied by local extension to contiguous structures and was the main cause of non-resectability. In adenocarcinoma, pleural seeding with malignant effusion was frequently encountered, and was the major reason for non-resectability. Conclusion: These data revealed that if appropriate preoperative diagnostic tools had been available, many unnecessary thoracotomies could have been avoided. Both the use of thoracoscopy in selected cases of adenocarcinoma and the more aggressive surgical approach to the locally advanced tumor could reduce the incidence of unnecessary thoracotomies for non-small cell lung cancers.

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THREE DIMENTIONAL FORCE ANALYSIS OF FORCE SYSTEM IN CONTINUOUS ARCHWIRE BY FINITE ELEMENT METHOD (CONTINUOUS ARCHWIRE의 FORCE SYSTEM에 대한 3차원 유한 요소법적 연구)

  • Row, Joon;Ryu, Young-Kyu
    • The korean journal of orthodontics
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    • v.26 no.1 s.54
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    • pp.17-32
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    • 1996
  • It is important to understand the operating mechanism and force system of fixed appliance that most effective for individual tooth movement in various orthodontic appliances. The archwire system of fixed appliance is devided into 3 types, which is continuous arch, segmented arch and sectional arch. The last two types have longer interbracket distance and simple force operating points, so it is easy to control force system by operator. But the continuous arch has shorter interbracket distance and various bracket geometry, so it is hard to control and anaylze the force system. The purpose of this study was three dimentional force and moment analysis of continuous arch system by finite element method, which is similar situation to three dimentional elastic beam in structural engineering. Several sample form of various bracket geometry and artificial lower crowding typodont made by author were constructed, analyzed and compared each other. The results were as follows : 1. The force magnitude is linear proportional to the degree of displacement or tilting of the bracket. 2. The force magnitude is inversely non-linear proportional to the interbracket distance. 3. In three dimensional typodont model, while the force can be compared with that of the sample form in the area where adjacent bracket geometry is simple, the force is much more than the expected value in the area where adjacent bracket geometry is complex.

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Comparison of Clinical Characteristics of Pneumocystis Carinii Pneumonia Between HIV Infected and Non-infected Persons (인간 면역결핍 바이러스 감염자와 비감염자에서 발생한 주폐포자충 폐렴의 임상 양상 비교)

  • Choi, Jun Yong;Lee, Kkot Sil;Park, Yoon Soo;Cho, Cheong Ho;Han, Sang Hoon;Choi, Suk Hoon;Chin, Bum Sik;Park, Yoon Seon;Chang, Kyung Hee;Song, Young Goo;Kim, June Myung
    • Tuberculosis and Respiratory Diseases
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    • v.55 no.4
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    • pp.370-377
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    • 2003
  • Background : Pneumocystis carinii pneumonia (PCP) is one of the most common cause of infection in patients with HIV infection. Recently, the incidence of PCP have been increasing in immunocompromised hosts without HIV infection. We compared the clinical characteristics of PCP between HIV infected and non-infected persons. Patients and Methods : We retrospectively reviewed the charts of 25 patients diagnosed as PCP from 1996 to 2002. Age, sex, underlying conditions, use of immunosuppressants, clinical courses, laboratory findings, treatment and prognosis were compared between HIV infected and non-infected persons. Results : Twenty-five patients with PCP were identified. 16 were HIV infected, and 9 were HIV non-infected. The mean age of overall patients was $43.4{\pm}13.2$ years. Underlying conditions in HIV non-infected persons were hematologic malignancy (7 cases), solid organ transplant (1 case), and autoimmune disease (1 case). Seven cases (77.8%) of HIV non-infected persons had a history of steroid use. Mean duration of symptoms was longer in HIV infected persons than in HIV non-infected persons, but it was not statistically significant. PaO2 was lower in HIV infected persons ($61.2{\pm}16.9$ mmHg vs. $65.4{\pm}15.4$), but it was not statistically significant. Chest X ray showed typical ground glass opacity in 12 cases (75%) of HIV infected persons and in 4 cases (44.4%) of HIV non-infected persons. Twelve cases (75%) of HIV infected persons were treated with steroid, as were 6 cases (66.7%) of HIV non-infected persons. Ventilator care was needed in 6 cases (37.5%) of HIV infected persons and in 2 cases (22.2%) of HIV non-infected persons. Mortality of HIV infected persons was 50%, and that of HIV non-infected persons was 11.1%. Conclusions : PCP showed some different clinical characteristics between HIV infected and non-infected persons. Prospective studies regarding the risk factors of PCP, prophylaxis, treatment and prognosis in HIV infected and non-infected persons are warranted.

Clinical Experiences of Continuous Warm Blood Cardioplegia ; Valvular Heart Surgery (연속 온혈 심정지액의 임상경험 - 심장 판막 수술 환자 대상 -)

  • 이종국;박승일;조재민;원준호
    • Journal of Chest Surgery
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    • v.31 no.4
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    • pp.353-361
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    • 1998
  • Hypothermia is widely acknowledged as fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. The ideal way to rotect the heart is to electromechanically arrest it and perfus it with blood that is aerobic arrest. However alternative technique has been developed, based on the principles of electromechanical arrest and normothermic aerobic perfusion using continuous warm blood cardioplegia. To determine if continuous warm blood cardioplegia was beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Group included is 31 patients undergoing valvular surgery who received intermittent cold crystalloid cardioplegia. Group II included 30 patients undergoing valvular surgery who received continuous warm blood cardioplegia. Our results suggest that the heartbeat in 100% of patients treated with continuous warm blood cardioplegia converted to normal sinus rhythm spontaneously after the removal of the aortic cross-clamp, compared to only 31% of the cold cardioplegia group. After operation, pericardial closure rate was 90% area in the warm group, compared to 35% area in the cold group. 12 hours after the operation, the total amount of urine output in the warm group was greater than that in the cold group(2863${\pm}$127 ml versus 2257${\pm}$127 ml; p<0.05). After the operation, left diaphragmatic elevation developed in 55% of the cold group but in 0% of the warm group. CK-MB level in the warm group was significantly lower than cold group(2.28${\pm}$0.62 versus 9.96${\pm}$2.12; p<0.01) 1 hour after operation and CK-MB level in the warm group was significantly lower than cold group(1.80${\pm}$1.01 versus 6.00${\pm}$1.74; p<0.05) 12hours after operation. Continuous warm blood cardioplegia is at least as safe and effective as hypothermic technique in patients undergoing cardiac valvular surgery. Conceptually, this represents a new approach to the problem of maintaining myocardial preservation during cardiac operations.

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