• Title/Summary/Keyword: 동시치료

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Early Result of Surgical Management of the Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (관상동맥-폐동맥 이상 기시증에 대한 수술의 조기 결과)

  • Yoon Yoo Sang;Park Jeong Jun;Yun Tae Jin;Kim Young Hwue;Ko Jae Kon;Park In Sook;Seo Dong Man
    • Journal of Chest Surgery
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    • v.39 no.1 s.258
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    • pp.18-27
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    • 2006
  • Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, but is one of the most common causes of myocardial ischemia which would result in high mortality within the first year of life. This is our early result of the surgical management for these patients. Material and Method: From June 1989 to July 2003, 6 patients with ALCAPA and one patient with ARCAPA (Anomalous origin of the Right coronary artery from the pulmonary artery) underwent surgical repair. We have reviewed the all medical records, electrocardiogram, chest X-ray and echocardiography retrospectively. Result: Three of the patients were boys and four were girls. The median age at the operation was 5.4 months (Range: 3$\∼$33 months). The average body weight of at the operation was 6.7 kg (Range: 3.7$\∼$11.3 kg). A mean follow up period was 18 months. Only 3 patients were initially diagnosed as ALCAPA. And 3 patients had moderate mitral regurgitation. Immediate coronary artery reimplantation on diagnosis with the aim of restoring a two-coronary system circulation was done. The average bypass time was 114$\pm$37 minutes, and the average aortic cross clamping time was 55$\pm$22 minutes. The average stay of intensive care unit was 5$\pm$3 days, the mean mechanical ventilator time was 38$\pm$45 hours and the hospital stay after operation was 12$\pm$5 days. There were significant improvements in electrocardiogram and chest X-ray of the all patients except one late death patient. The ventricular function showed almost normal recovery after operation; the EF (Ejection Fraction) increased from 41.2$\pm$ 10.3$\%$ to 60.5$\pm$ 15.8$\%$ within 1 month and to 59.8$\pm$13.9$\%$ within 1 year after operation, the SF (Shortening Fraction) increased from 23.6$\pm$4.7$\%$ to 38.6$\pm$8.4$\%$ within 1 month and to 37.4$\pm$7.9$\%$ within 1 year after operation, LVEDDI (Left Ventricular End-diastolic Dimension Index) decreased from 100.8$\pm$25.6 mm/$m^{2}$ to 90.3$\pm$ 19.2 mm/$m^{2}$ within f month and to 79.3$\pm$ 15.8 mm/$m^{2}$ within 1 year after operation. Concomitant mitral repair was done in two patients with anterior mitral leaflet prolapse. In every patient, mitral valve showed less than mild regurgitation during follow up. One late death occurred in which patient Dor procedure was applied 10 months after initial operation due to the dilated cardiomyopathy Conclusion: In the management of this rare and could be fatal Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), early suspicion and correct diagnosis is of most important. But, after diagnosis, immediate restoration of 2 coronary systems could result in good outcome.

Surgical Treatment for Isolated Aortic Endocarditis: a Comparison with Isolated Mitral Endocarditis (대동맥 판막만을 침범한 감염성 심내막염의 수술적 치료: 승모판막만을 침범한 경우와 비교 연구)

  • Hong, Seong-Beom;Park, Jeong-Min;Lee, Kyo-Seon;Ryu, Sang-Woo;Yun, Ju-Sik;CheKar, Jay-Key;Yun, Chi-Hyeong;Kim, Sang-Hyung;Ahn, Byoung-Hee
    • Journal of Chest Surgery
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    • v.40 no.9
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    • pp.600-606
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    • 2007
  • Background: Infective endocarditis shows high surgical mortality and morbidity rates, especially for aortic endocarditis. This study attempts to investigate the clinical characteristics and operative results of isolated aortic endocarditis. Material and Method: From July 1990 to May 2005, 25 patients with isolated aortic endocarditis (Group I, male female=18 : 7, mean age $43.2{\pm}18.6$ years) and 23 patients with isolated mitral endocarditis (Group II, male female=10 : 13, mean age $43.2{\pm}17.1$ years) underwent surgical treatment in our hospital. All the patients had native endocarditis and 7 patients showed a bicuspid aortic valve in Group I. Two patients had prosthetic valve endocarditis and one patients developed mitral endocarditis after a mitral valvuloplasty in Group II. Positive blood cultures were obtained from 11 (44.0%) patients in Group I, and 10 (43.3%) patients in Group II, The pre-operative left ventricular ejection fraction for each group was $60.8{\pm}8.7%$ and $62.1{\pm}8.1%$ (p=0.945), respectively. There was moderate to severe aortic regurgitation in 18 patients and vegetations were detected in 17 patients in Group I. There was moderate to severe mitral regurgitation in 19 patients and vegetations were found in 18 patients in Group II. One patient had a ventricular septal defect and another patient underwent a Maze operation with microwaves due to atrial fibrillation. We performed echocardiography before discharge and each year during follow-up. The mean follow-up period was $37.2{\pm}23.5$ (range $9{\sim}123$) months. Result: Postoperative complications included three cases of low cardiac output in Group I and one case each of re-surgery because of bleeding and low cardiac output in Group II. One patient died from an intra-cranial hemorrhage on the first day after surgery in Group I, but there were no early deaths in Group II. The 1, 3-, and 5-year valve related event free rates were 92.0%, 88.0%, and 88.0% for Group I patients, and 91.3%, 76.0%, and 76.0% for Group II patients, respectively. The 1, 3-, and 5-year survival rates were 96.0%, 96.0%, and 96.0% for Group I patients, and foo%, 84.9%, and 84.9% for Group II patients, respectively. Conclusion: Acceptable surgical results and mid-term clinical results for aortic endocarditis were seen.

Comparison of Resistance to Fowl Typhoid among Crossbreed (산란계 합성종의 가금티푸스 저항성 비교 연구)

  • 김기석;이영주;강민수;한성욱;오봉국
    • Korean Journal of Poultry Science
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    • v.29 no.1
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    • pp.59-75
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    • 2002
  • The present study was conducted to compare the disease resistance to fowl typhoid among White Leghorn (WL) known as possessing greater genetic resistance to Salmonella, Rhode Island Red (RIR) susceptible to the disease and their mating crossbreed, WL ${\times}$RIR. Also, it was carried out to compare fowl typhoid-resistance among Hyline white${\times}$Hyline brown(HwHb), Hw${\times}$lsa brown(Hwlb), Isa white${\times}$lb(Iwlb), Iw${\times}$ Hb(IwHb) and Ib ${\times}$ Iw(IbIw) in order to select crossbreed chickens which have disease resistance to fowl typhoid and simultaneously produce the brown eggs which our domestic consummers prefer There was no death of WL chickens challenged with Sal. gallinarum at each 2, 5 and 8 wk of age, while average 86.2 to 64.1% of RIR chickens tested died at the same challenge age during the test period of 2 weeks. Their maiting crossbreed, WL ${\times}$ RIR were intermediate between the two breeds. weight gains of tested chickens were significantly higher in WL and WL ${\times}$RIR without difference between them than RIR. In recovery rate of tested strain of Sal. gallinarum from braun, heart, fiver, spleen and cecum of chickens challenged, WL ${\times}$RIR fell between the other two breeds, with somewhat higher rate then WL but much lower then RIR. In the disease resistance determination test using HwHb, Hwlb, Iwlb, IwHb and IbIw$.$ crossbreed chickens experimentally infected with Sal. gallinarum, it was recognized that all of crossbreeds tested developed marked resistance to fowl typhoid, based on the results judged by the measurement parameters of mortality, weight gain, recovery rate of challenged strain of bacteria, and positive rate of agglutination antibody, and HwHb had a tittle higher disease resistance then ethers.

Changes of Coagulability after Off-pump CABG: Comparison with On-pump CABG (심폐바이패스 없이 시행하는 관상동맥우회술 후 혈액응고 기늠의 변화: 심폐바이패스하 관상동맥우회술 후 혈액응고 상태와의 비교)

  • 장우익;김기봉;김욱성;정철현;허재학;장지민;이동순;한규섭
    • Journal of Chest Surgery
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    • v.37 no.3
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    • pp.245-251
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    • 2004
  • Hemostatic function is regarded to be preserved after an off-pump coronary artery bypass grafting (CABG), compared to conventional CABG, and the preserved hemostatic function may increase thrombotic occlusion of the graft. We studied the changes of hemostatic variables in patients undergoing off-pump CABG, and compared to those of on-pump CABG. We studied the changes of coagulation function in 11 patients who underwent off-pump CABG (group I), and compared them with those of 11 patients who underwent on-pump CABG and Dor procedure (group II). Coagulation status was evaluated by thromboelastography and blood coagulation test preoperatively, postoperative 1$^{st}$ day, 2$^{nd}$ day, 3$^{rd}$ day, and 5$^{th}$ day, respectively. Among the variables measured by thromboelastography (such as r time, k time, $\alpha$ angle, and MA value) and blood coagulation test (such as factor Ⅶ, protein S, protein C, antithrombin III, activated protein C resistance test, plasminogen, D-dimer, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and fibrinogen), there were significant differences in the MA value, $\alpha$ angle, and platelet counts between the two groups. MA values were 140$\pm$72% and 153$\pm$98% in group I, and 87$\pm$27% and 78$\pm$28% in group II, at postoperative 3$^{rd}$ and 5$^{th}$ days, respectively (p<0.05). $\alpha$ angle was 122$\pm$92% in group I and 69$\pm$23% in group II at postoperative 3$^{rd}$ day (p=0.09). Platelet count was 63$\pm$55% in group I and 33$\pm$13% in group II at postoperative 3$^{rd}$ day (p<0.05). Patients who underwent off-pump CABG showed increased coagulability during postoperative periods, compared to those who underwent on-pump CABG. Our data suggest that aggressive perioperative anticoagulation therapy is warranted in patients undergoing off-pump CABG. CABG.

AMP-activated Kinase Regulates Adipocyte Differentiation Process in 3T3-L1 Adipocytes Treated with Selenium (AMP-activated protein kinase가 셀레늄으로 처리된 3T3-L1 지방세포의 분화과정 억제에 관한 연구)

  • Park, Song-Yi;Hwang, Jin-Taek;Lee, Yun-Kyoung;Kim, Young-Min;Park, Ock-Jin
    • Journal of Life Science
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    • v.19 no.4
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    • pp.423-428
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    • 2009
  • Selenium was investigated using human origin preadipocytes to see whether it possesses preventive or therapeutic effects for obesity. Unveiling the potential of selenium in the reduction of adipogenesis can help predict the therapeutic capabilities of selenium in obesity. In the present study, the molecular mechanism of the inhibition of adipogenesis by selenium was explored to unravel the involvement of the AMP-activated protein kinase. There is emerging evidence that AMPK, a sensor of cellular energy status, is a possible molecular target of controlling adipocyte differentiation on the basis of discovery that AMPK is responsible for the major metabolic responses to exercise, and integration of nutritional and hormonal signals to modulate feeding behavior or energy expenditure in the hypothalamus. Treatment of selenium resulted in inhibition of the adipocyte differentiation process and induction of mature apoptosis in 3T3-L1 adipocytes. We hypothesized that selenium may exert anti-adipogenic potential though modulating AMPK. We have found that selenium significantly activated AMPK and phosphorylated its substrate acetyl-CoA carboxylase ($ACC-serine^{79}$) during the inhibitory process of adipocytes. Also, the inhibition process of adipocyte differentiation by selenium was comparable to either reveratrol or a synthetic AMPK activator, AICAR (5-aminoimidazole-4-carboxamide-1-${\beta}$-D-ribofuranoside). To evaluate the involvement of AMPK in anti-lipogensis, we applied AICAR and Compound C, an AMPK inhibitor, to 3T3-L1-adipocytes and found that AMPK is required for the adipocyte differentiation blocking process. These results suggest that selenium has a potential to control adipogenesis and that this effect is mediated by AMPK, an essential kinase for both inhibition of adipocyte differentiation and apoptosis of mature adipocytes.

Surgical Treatment of Aneurysm of the Sinus of Valsalva Eight Year Experience (발살바동 동맥류의 외과적 치료)

  • 오상준;유완준
    • Journal of Chest Surgery
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    • v.29 no.9
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    • pp.983-988
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    • 1996
  • Aneurysm of the sinus of Valsalva is fairly rare. Between 1987 and 1994, we operated on a total of 12 cases of aneurysm of the sinus of Valsalva at the Inje University Seoul Paik Hospital. This represents 0.7% of all cardiac operation under cardiopulmonary bypass. There were eight male and four female patients aged from 8 to 38 years(mean, 19.2 years). 8 of 12 patients had ruptured aneurysms. The origin of aneurysm of the sinus of Valsalva was the right coronary sinus in 10(83. 3%), and the noncoronary sinus in 2(16.6%). In ruptured aneurysm, the origin was the right oronary sinus in 6, and the noncoronary sinus in 2. The aneurysms originating from the right coronary sinus ruptured into the right ventricle in 5, and into both the right atrium and right ventricle in 1. The aneurysms originating from the noncoronary sinus ruptured into the right ventricle in 1, and into the right atrium in 1. Associated congenital cardiac defects included ventricular septal defect in 10(83.3%) patients 39 cases of these were associated with the aneurysms of the right coronary sinus), aortic regurgi- tation in 3 (all of these had an additional ventricular septal defect), mitral regurgitation in 1, and double chambered right ventricle in 1. No hospital deaths occurred, although one late death occurred as a result of endocarditis 15 months after the first operation. The mean follow-up period was 29 months, range from 4 to 60 months. Eleven patients except one late death were in New York Heart Association class 1. Due to the low mortality risk o( an operation for aneur sm of the sinus of Valsalva, a ruptured aneurysm of the sinus of Valsalva should be corrected surgically when the diagnosis is mane, and unruptured aneurysm of the sinus of Valsava with complication should also be operated. In most cases the aorta was opened to examine the morphology of the aneurysm and the aortic cusps, and an associated aortic valve defect should be corrected simultaneously.

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Sensory Characteristics of White and Black Sesame Gruels with Different Mixing Ratio and Decortication (깨의 함량과 전처리에 따른 깨죽과 흑임자죽의 기호도 연구)

  • 김진숙;손정우;염초애
    • Korean journal of food and cookery science
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    • v.12 no.4
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    • pp.547-556
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    • 1996
  • The purpose of this study was to invesitage the optimum cooking method, which ingridients mixing ratio and decortication of white and black sesame gruels, were examined by sensory and mechanical tests. As the results of sensory evaluation for the decortication white and black sesame gruels with the levels of 50, 100, 150, and 200% sesame per rice l00g, the flavor, nutty taste, and the overall preference were increased with the increase of sesame add. The gruel which made with decorticated sesame roafting for 7 minutes was proferable. The gruels 150% decorticated white and black sesame roasted 7 min had better overall preference. In the mechanical measurement for the white sesame gruels, L value tended to be decreased, while ‘a' and ‘b' values as well as viscosity tented to be increased as the sesame ratio and roasting time increased. In black sesame gruels, L value tended to be decreased, while ‘a' and ‘b' values as well as viscosity tended to be increased when sesame ratio was increased. In correlation between sensory evaluation and mechanical measurement of the white and black sesame gruels, color, flavor, nutty taste of sensory evaluation were correlated with the mechanical measurement. The optimal material mixing ratio for gruels was rice 100 g, white and black sesame 150 g, and water 1075 g.

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Double Tension Band Osteosynthesis in Intra-articular Fractures of the Distal Humerus (AO type C) in Elderly Osteoporotic Patients (고령 환자의 상완골 원위부 AO-C형 골절에서 이중 강선 장력대 고정술)

  • Cheon, Sang Jin;Lee, Dong Ho;Goh, Tae Sik
    • Clinics in Shoulder and Elbow
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    • v.16 no.1
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    • pp.33-39
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    • 2013
  • Purpose: The aim of this study is to evaluate the clinical result of intra-articular fractures of the distal humerus (AO type C) in elderly osteoporotic patients treated with double tension band osteosynthesis. Materials and Methods: From January 2006 to December 2010, 10 elderly osteoporotic patients(1 male, 9 females) with intra-articular fractures of the distal humerus (AO type C) were treated with double tension band osteosynthesis. The mean age of patients at the time of surgery was 74.6(66~84) years and the mean follow-up period was 39.2(20~74) months. The fracture union and complications were assessed and the functional result was evaluated by the rating system of Jupiter et al. and the Mayo elbow performance index. Results: Bone union was achieved in all patients with no secondary displacement. The mean time for union was 16.6(13~22) weeks. The average postoperative arc of elbow flexion was 119(100~140) degrees with a mean flexion contracture of 8.5(0~15) degrees. The recovery in two patients was rated as excellent, in 7 as good, and in 1 as fair in terms of the Mayo elbow performance index with average value of 82(70~90) points. Seven patients were rated as excellent, 1 as good, and 2 as fair in terms of the rating system of Jupiter et al. Changing tension band wiring was performed in one patient as skin irritation was noticed due to tension band knots. Heterotopic ossification developed in one patient but had no symptom. Conclusion: Double tension band osteosynthesis in intra-articular fractures of distal humerus (AO type C) in elderly osteoporotic patients can provide sufficient and secure stability to allow early rehabilitation.

A Philological Comparative Study on HwanWoong of Samgukyusa and YanDi-ShenNong (『삼국유사(三國遺事)』의 환웅(桓雄)과 염제신농(炎帝神農)과 기록학적 비교고찰)

  • Yoon, Soon
    • Journal of Korean Society of Archives and Records Management
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    • v.1 no.2
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    • pp.57-79
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    • 2001
  • [Go-Choseon], the first volume of Samgukyusa, is composed of two parts, the part of myth and that of history. There are very similar divinities between Hwanwoong in the myth of Dangun and YanDi-ShenNong of China: the solar divinity essential for survival of mankind and agriculture, the agriculture divinity said to have taught fanning, the medicine divinity said to have taught the characteristics of herbs and how to prevent diseases, the cultural hero who delivered civilization, and son on. During the transition from the age of myth to the age of history, the roles of gods had changed from the creation of the world to civilization and rule. The roles of Hwanwoong and YanDi-ShenNong were civilization and it was related with their divinities. Hence, regardless of a little difference, the myth of Hwanwoong and that of YanDi-ShenNong were created at the same stage of spiritual and material civilizations of Korea and China. This paper looks at the essence of [Wiseo] and the age of Hwanwoong through historical records. In my opinion, [Wiseo] is not a chinese history' book. The record, "According to [Wiseo] there had been Dangun-Wanggum 2,000 years ago" indicates the time [Wiseo] was written. 'Wi' means Wlman-choseon. Going back about 2,000 years from Wiman-choseon, the historical dates of the establishment of [Go-Choseon] almost dovetails to the age of King 'lao. So, there is a possibility that [Wiseo] is a history book of Wiman-Choseon dynasty which was written to prove the legitimacy of the dynasty by showing it succeeded to the Dangilll-Choseon dynasty. The sentences, "governed the country for 1,500 years" and "conferred Gija the position of king of Choseon" are very important records showing the age of the establishment of Dangun-Choseon. Gija came to Choseon in B.C 1122 when Yin replaced Zhou in the Choinese Continent. From the fact that Dangun had governed Choseon, we could reason out that Go-Choseon was established in B.C. 2622 that is much eariler than the era of king Yao, and that corresponds 'With the era of HuangDi(B.C 2698-2358). Hence, the era of Hwanwoong, the father-god of Dangun, might be later than B.G 3000 which conforms to the era of YanDi-ShenNong(B.C 3218-2600). Therefore, this paper contends lhat Hwanwoong and YanDi-ShenNong played the role of civilization in the same era [Go-Choseon], the first volume of Samgukusa is philologically very valuable material for research on the origin of Korean nation and its ancient history.

The effects of mandibular setback osteotomy on the oropharyngeal airway space in mandibular prognathic patients (하악전돌 환자에서 하악골 후퇴수술이 기도공간에 미치는 영향)

  • Kim, Hyo-Young;Choi, Hyun-Gue;Kim, Eun-Kyung;Kim, Jong-Ghee
    • The korean journal of orthodontics
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    • v.27 no.5 s.64
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    • pp.733-741
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    • 1997
  • As a result of surgical orthodontic treatment of mandibular prognathism, changes take place in the skeletal and soft orofacial components. Although some investigators had stated that permanent reduction of airway space was observed after mandibular setback surgery, it was not clear that this permanent reduction was sustained during long-term follow-up. The purpose of this study was to assess the changes in oropharyngeal airway space and soft tissue orofacial component following the mandibular setback surgery and during the follow-up period. The correlation between the changes of the oropharyngeal airway space and the changes of other soft tissue orofacial component was also assessed. The findings of this study were as follows ; 1. The oropharyngeal airway space area decreased following mandibular setback surgery for mandibular prognathism and continued to decrease during the follow-up period(p<0.05). 2. The pharyngeal depth at Xi point level and the 2nd cervical vertebra point level decreased after the surgery and remained during the follow-up period(p<0.05). The decrease of these pharyngeal depth was correlated with the decrease of oropharyngeal airway space area(p<0.01). 3. The decrease of pharyngeal depth at the 3rd and 4th cervical vertebra point level was not significant after the surgery and during the follow up period. 4. The hyoid bone moved downward after the surgery(p<0.05), but returned to its original position during the follow-up period. 5. The length & height of tongue and the Position of epiglottis base did not change significantly(p>0.05). 6. The soft palate was displaced posteriorly after the surgery and remained to its changed position during the follow-up period(p<0.05) due to posterior displacement of tongue. The changes of soft palate were significantly correlated with the decrease of oropharyngeal airway space area(p<0.01). 7. The narrowing of oropharyngeal airway space was due to the posterior displacement of tongue above the level of epiglottis tip. The posterior displacement of tongue following mandibular setback osteotomy remained during the follow-up period.

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