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Usefulness of modified ambu® in patients who need artificial ventilation (인공 환기가 필요한 환자에서 변형된 수동식 인공호흡기(Ambu®)의 유용성)

  • Ha, Kee Soo;Moon, Il Hong;Lee, Hee Sun;Shin, Dong Han;Eun, So Hee;Eun, Baik-Lin;Hong, Young Sook;Lee, Joo Won
    • Clinical and Experimental Pediatrics
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    • v.49 no.11
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    • pp.1194-1201
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    • 2006
  • Purpose : The comatose mentality can be catastrophic, especially if the condition is severe or the duration is prolonged. Therefore, delayed diagnosis can result in a poor outcome or death. The best radiologic modality to differentiate from cerebral lesions in patients suffering from cerebral diseases is magnetic resonance imaging (MRI) rather than computed tomography (CT). Special apparatuses with metal materials such as ventilators, and cardiac pacemakers belonging to patients cannot be located in the magnetic field. We aimed to exhibit the possibility of examining MRI, maintaining ventilation at a relative long distance by means of modified $Ambu^{(R)}$. Methods : Self-inflating bags as a sort of a manual ventilator, connected with relatively long extension tubes instead of mechanical ventilators, were adopted to obtain MRI. PVC (polyvinyl chloride) extension tubes had different lengths and diameters. Lengths were 1, 2, and 3 cm and diameters were 15, and 25 mm. The work of breathing and expiratory changes of expiratory tidal volume (TVe), minute volume of expiration (MVe), peak inspiratory pressure (PIP) were measured by use of the mechanical ventilator, $Servoi^{(R)}$, as the alteration of TVi (inspiratory tidal volume), extension tube lengths and diameters with other values fixed. Results : Measured TVe and MVe by ventilator were the same values with control at every TVi, regardless of extension tube lengths and diameters, but PIP were increased with the rise of TVi, tube lengths, with decline of tube diameters, these were statistically significant. Conclusion : MRI examination can be carried out with a self-inflating bag connected with an extension tube at a long distance in patients who need artificial ventilation.

The anti-tumor mechanisms of p53 through the regulation of expression and glycosylation of insulin-like growth factor binding protein-3 (암억제 유전자 p53에 의한 insulin-like growth factor binding protein-3의 발현과 glycosylation를 통한 항암작용)

  • Kim, Sun Young;Kim, Se Rim;Lee, Jung Chang;Yi, Ho Keun;Lee, Dae Yeol;Hwang, Pyoung Han
    • Clinical and Experimental Pediatrics
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    • v.49 no.4
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    • pp.431-438
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    • 2006
  • Purpose : Insulin-like growth factor binding protein(IGFBP)-3 has been known as a tumor suppressor gene, and its anti-tumor function was divided into insulin-like growth factor(IGF)-dependent and IGF-independent mechanism. In IGF-independent mechanism, IGFBP-3 directly interacts with a cell without binding of IGFs, becoming an interesting object in oncology. Several studies demonstrate that one of the well-known tumor suppressor genes, p53, induces directly IGFBP-3 transcription, and the increment of IGFBP-3 expression induces apoptosis of many cancer cells. Recently, the anti-tumor mechanisms of IGFBP-3 have been reported, but post-translational modification of IGFBP-3 and its anti-tumor mechanism are not well known. In this study, we examined whether p53 regulated the glycosylation of IGFBP-3, and analysed the meaning of IGFBP-3 glycosylation related to the apoptosis of cancer cell. Methods : The p53-mutated status of MDA-MB-231 human breast cancer cells was used in this experiment. The expression and glycosylation of IGFBP-3 were tested by Western blot analysis after infection of adenovirus mediated Ad/p53 and/or Ad/IGFBP-3. Results : Ad/p53 infected cells resulted in growth retardation and the induced apoptosis. p53 induced direct expression and glycosylation of IGFBP-3. The increase of glcosylated IGFBP-3 was able to promote cellular apoptosis, and the glycosylation of IGFBP-3 was more activated by the double treatment of Ad/p53 and Ad/IGFBP-3. Conclusion : From this study, the anti-tumor activity of IGFBP-3 was shown to improve the stabilization of IGFBP-3 through the increment of glycosylation of IGFBP-3 by p53. This result suggests that the combined gene therapy of p53 and IGFBP-3 may appropriate treatment of cancer.

Usefulness of MRI 3D Image Reconstruction Techniques for the Diagnosis and Treatment of Femoral Acetabular Impingement Syndrome(Cam type) (대퇴 골두 충돌 증후군(Cam type)의 진단과 치료를 위한 자기공명 3D 영상 재구성 기법의 유용성)

  • Kwak, Yeong-Gon;Kim, Chong-Yeal;Cho, Yeong-Gi
    • The Journal of the Korea Contents Association
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    • v.15 no.11
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    • pp.313-321
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    • 2015
  • To minimize CT examination for Hip FAI diagnosis and operation plan. also, whether the MRI 3D images can replace Hip Clock face image was evaluated when performing Hip FAI MRI by using additional 3D image. This study analyzed Hip MRI and 3D Hip CT images of 31 patients in this hospital. For the purpose of evaluating the images, one orthopedic surgeon and one radiology specialist reconstructed Clock face, at MR and CT modality, by superior 12 o'clock, labrum front 3 o'clock, and the other side 9 o'clock, centering on Hip joint articular transverse ligament 6 o'clock. Afterwards, by the Likert Scale 5 point scale (independent t-test p<0.005), this study evaluated the check-up of A. retinacular vessel, B. head neck junction at 11 o'clock, A. Epiphyseal line, B. Cam lesion at 12 o'clock, and Cam lesion, Posterior Cam lesion at 1,2,3 and 4 o'clock. As for the verification of reliability among observers, this study verified coincidence by Cohen's weighted Kappa verification. As a result of Likert scale for the purpose of qualitative evaluation about the image, 11 o'clock A. retinacular vessel MR average was $3.69{\pm}1.0$ and CT average was $2.8{\pm}0.78$. B. head neck juncton didn't have a difference between two observers (p <0.416). 12 o'clock A. Epiphyseal line MR average was $3.54{\pm}1.00$ and CT average was $4.5{\pm}0.62$(p<0.000). B. Cam lesion didn't have a difference between two observers (p <0.532). 1,2,3,4 Cam lesion and Posterior Cam lesion were not statistically significant (p <0.656, p <0.658). As a result of weighted Kappa verification, 11 o'clock A.retinacular vessel CT K value was 0.663 and the lowest conformity. As a result of coincidence evaluation on respective item, a very high result was drawn, and two observers showed high reliability.

Clinical Analysis of 500 Cases of Coronary Artery Bypass Grafting (관상동맥 우회술 500례의 임상적 고찰)

  • Shin, Yoon-Cheol;Kim, Ki-Bong;Ahn, Hyuk;Chae, Hurn;Rho, Joon-Ryang;Suh, Kyung-Phill
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.525-531
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    • 1999
  • Background: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. Material and Method: There were 330 males and 170 females with a mean age of 57.4$\pm$8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. Result: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2$\pm$1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25$\pm$23 months and there were 5 cases of reoperation. Conclusion: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.

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The In-hospital Clinical Outcomes of Extracorporeal Life Support after Adult Cardiovascular Surgery (성인 심혈관 수술 후 시행한 체외순환보조의 조기 임상결과)

  • Yie, Kil-Soo;Na, Chan-Young;Oh, Sam-Sae;Kim, Jae-Hyun;Ryu, Se-Min;Park, Sung-Min;Cho, Seong-Joon
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.464-472
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    • 2009
  • Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.

음료$\cdot$다류 산업

  • 손헌수
    • Food Industry
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    • s.180
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    • pp.27-64
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    • 2004
  • 국내 제조업 전체에서 식음료품은 $6.31\%$를 차지하고 있다. 2000년을 기준으로 식품산업의 총매출실적을 보면 32조 3,463억원을 기록하고 있는데, 이 중 식료품은 26조 921억원, 알콜올음료를 포함한 음료품은 6조 2,516억원을 차지하고 있다. 2001년, 음료시장의 규모는 약 2조 7,900억원 정도였다. 빠르게 성장하던 전체 음료시장의 매출은 IMF 이후 약간 주춤하는 경향을 보였지만 지속적으로 매출액이 상승하여 2002년에는 3조 4천억원의 매출을 기록하였다. 이것은 사이다, 후레바, 정통주스, 냉장주스, 스포츠 음료, 두유 및 기능성음료 등이 성장을 주도하였다. 2003년 상반기, 1조 6,500억원으로 전년 동기대비 $3\%$ 감소하였지만 2003년 전체 실적은 대략 지난해와 비슷한 3조 5,000억원 규모로 전망된다. 내수량의 경우 탄산음료와 과즙음료가 감소하는 경향을 나타냈지만, 전체적으로는 증가하였다. 다류시장의 규모는 약 650억원, 캔커피시장의 규모는 2,400억원 정도로 나타났다. 이처럼 음료$\cdot$다류 시장은 전체적으로 약 4조원의 거대시장규모를 형성하고 있으며 내수가 지속적으로 증가되고 있어, 점차 시장규모도 증가할 것으로 전망되고 있다. 최근에는 기능성 음료 및 다류의 시장규모가 전체의 $20\%$에 달할 정도로 신장하였으며, 기능성음료 및 다류의 특허출원도 지속적으로 증가하고 있는 실정이다. 이는 비단 국내에서 뿐만 아니라 세계적인 현상이며 이러한 추세는 앞으로 지속될 것으로 전망되고 있다. 이처럼 기능성음료 및 다류의 성장이 두드러지고 있는 것은 시대가 변하면서 현대인들의 생활방식과 식생활 변화, 질병형태 다양화 등 여러 사회적 여건이 변화되고 있는데 기인하며, 현대인의 건강에 대한 관심의 증대는 음료시장의 쾌속성장과 틈새수요를 지속적으로 창출하고 있다. 현재 세계 건강기능성 식품의 시장 규모는 약 160조원이며, 국내의 경우 약 1조원에 이르는 실정이다. 이 중 기능성음료 시장은 국내에서 약 4천억원 규모로 기능성식품 시장의 $40\%$를 차지하고 있다. 이처럼 기능성음료 시장은 최근 연간 $7\%$ 정도의 빠른 성장률을 보이고 있으며 향후에도 $6.7\%$의 실질 연간 성장률을 지속할 것으로 전망되고 있다. 전해질(이온)음료나 식이섬유를 포함하는 다이어트음료에서 출발한 기능성음료는 숙취해소, 성인병 예방, 스트레스 해소에 이르기까지 각종 질병의 치료 및 예방으로 확대되고 있다. 앞으로는 BT 및 나노 기술 등을 이용한 신기능 소재들에 대한 다각적인 효능의 규명에 따른 음료$\cdot$다류 소재의 개발과 더불어 체질개선, 다이어트, 숙취해소 등의 특정한 기능성과 관련한 음료$\cdot$다류의 특허출원이 계속될 것으로 전망된다. 복잡한 한약의 제조과정을 단순화하여 티백이나 캔 형태로 만든 맛과 기능이 조화된 음료$\cdot$다류 분야의 연구개발이 지속될 것으로 보이며, 시장 규모의 확대와 더불어 기능성과 간편성을 동시에 추구하는 신세대 소비자들의 성향을 겨냥하여 기존의 음료$\cdot$다류 전문 업체 외에도 제약회사 등의 비음료 업체도 다양한 형태의 음료$\cdot$다류 기술개발을 지속할 것으로 예상되고 있다. 특히 새로운 신기능성 소재를 개발하는 것은 고부가가치 기술로써 BT, NT 등의 최첨단 기술의 발전과 도입으로 인해 그동안 수입에 의존하던 기능성 소재들도 국내 기업들의 축전된 기반기술을 통하여 대거 참입할 것으로 보인다. 하지만, 여러 업체의 음료$\cdot$다류시장 진출에 따라 야기될 수 있는 비위생이고 효능이 불확실한 식품의 유통, 업체간의 과열경쟁에 따른 유통질서 문란 등은 모처럼 활기를 되찾은 음료$\cdot$다류 분야의 기술개발을 위축시킬 수도 있으므로 정부차원에서 체계적이고 효율적인 관리가 조속히 이루어져야 할 것이며 이를 제도적으로 뒷받침하기 위한 정책이 수립되고 시행되어야 할 것으로 보인다. 특히, 원료적인 측면에서의 무역 불균형은 반드시 해소되어야 할 부분이다. 대부분이 수입 기능성 원료에 의존하고 있는 현실에서 국내의 BT 기술 확충에 더욱 많은 투자와 노력이 집중되어야 할 것이다. 세계적으로 경쟁이 될 수 있는 기능성 소재의 개발과 이를 통한 신기능 음료의 개발은 단순한 수학적 계산을 넘어서 국가의 기술력을 홍보할수 있는 좋은 계기가 되기 때문이다. 바야흐로 음료$\cdot$다류 분야에 대한 열기가 식품시장을 주도하면서, 시장이 안정적으로 확대되기 위해서는 지속적인 기술개발이 이루어져야 한다는 것은 재론의 여지가 없다고 하겠다.

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Antithrombotic Activities of Cheongkookjang and Cheongkookjang Fermented with Green Tea or Mugwort (청국장 및 녹차, 쑥이 첨가된 청국장의 항혈전 활성)

  • Lee, Kyung-Ae;Jang, Jeong-Oak;Yoon, Hye-Kyung;Kim, Moo-Sung
    • Korean Journal of Microbiology
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    • v.43 no.4
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    • pp.298-303
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    • 2007
  • Antithrombotic activities of water extract of cheongkookjang and cheongkookjang fermented with green tea or mugwort were evaluated on some antithrombosis related activities in vitro and thrombotic death inhibition in vivo. Cheongkookjang made of white soybean (Glycine max) or black small soybean (Rhynchosia nulubilis) showed potent antioxidative activities. Addition of green tea or mugwort during cheongkookjang fermentation increased the antioxidative activity, cheongkookjang with green tea showed more drastic increase compared with cheongkookjang with mugwort. Nitrite scavenging effects of the cheongkookjang extracts were prominent but the addition of green tea or mugwort seldom increased the scavenging effects. All the cheongkookjang extracts showed strong inhibitory activities on platelet aggregation. The inhibitory activities of cheongkookjang were increased considerably by addition of green tea or mugwort even with low concentration. Plasmin unit as fibrinolytic activity was not affected considerably by addition of green tea. Addition of mugwort decreased the activity transiently at low concentration ($0.3{\sim}1.0%$) but increased again slowly at higher concentration ($1{\sim}3%$). In vitro thrombotic death inhibition test, the antithrombotic activity of cheongkookjang made of black small bean with green tea was higher by about 1.5 times compared to that without green tea. As results, cheongkookjang might inhibit antithrombosis not only by fibrinolytic action but also by inhibition of platelet aggregation and antioxidative action. The addition of functional materials such as green tea or mugwort could increase the antithrombotic function, even at low concentration.

A CASE-ANALYSIS OF THE PSYCHIATRIC SEQUELAE IN ADOLESCENTS VICTIMIZED BY SCHOOL VIOLENCE (학교폭력 피해 청소년의 정신의학적 후유증에 관한 사례 연구)

  • Yook, Ki-Hwan;Lee, Ho-Bun;Noh, Kyung S.;Song, Dong-Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.8 no.2
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    • pp.232-241
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    • 1997
  • The psychological problems following the experiences of school-violence could be more important than the physical problems. Victims could suffer from fear, depression, anger, lowered self-esteem, suicidal thought, and personality changes. To study the risk factors for school violence and the psychiatric problems after the experiences to school-violence provide us important informations to prevent and solve the problems of school violence. We examined clinical characteristics and psychosocial backgrounds of 13 adolescents who visited the psychiatric clinic after exposures to school violence from September, 1996 to May, 1997. The clinical data included intensity, motivations, durations, and methods of violence, psychiatric symptoms following exposure, findings of psychological test, and treatment course. The socioeconomic data included developmental characteristics of subjects, family characteristics, school life, and peer relationships. Of the 13 adolescents who experienced exposure to violence, 8 have experienced chronic psychiatric disturbances, 5 experienced transient psychiatric symptoms such as anxiety, depression, suicidal attempt who eventually returned to home and school life. Of the 8 adolescents who experienced chronic psychiatric disturbances, 4 experienced PTSD and depression lasting 3-6 months more, otherwise 4 showed converted features, such as aggressive behavioral disorder or perpetrator by strong compensatory effects after psychological shock. The subjects who have experienced chronic psychiatric disturbance have clinical characteristics such as physical or emotional abuse, physical illness or handicap, defects of ego functionings, and lack of family support. In summary, victims by school-violence manifested serious psychiatric disturbances, and they had clinically significant risk factors and some of them became perpetrators of school-violence.

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The Sympathetic Skin Responses after Thoracic Sympathicotomy for Patients with Palmar Hyperhidrosis (수장부 다한증환자의 흉부 교감신경절단술후 교감신경 피부반응)

  • 김오곤;홍종면;이석재;홍장수;이광래;김상규
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.579-583
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    • 1999
  • Background: Thoracic sympathicotomy has been used safely and successfully to manage palmar hyperhidrosis. The preoperative and postoperative recording of Sympathetic Skin Responses(SSR) was performed for objective evaluation and follow-up of thoracic sympathicotomy in hyperhidrosis patients, and also for ascertaining the clinical usefullness of SSR. Material and Method: The recording of SSR was performed on 15 patients suffering from palmar hyperhidrosis with Medelec Sapphire Plus electromyogragh before and after thoracic sympathicotomy. Eletrical stimuli on the right median nerve was made in patients in supine position and results were recorded on right and left palms with soles at the same time by 4 channels. Skin temperatures were also monitored simultaneously. T2,3 sympathicotomy was performed with VATS in every patients. SSR was done in 2 patients one month later. Result: Clinically, all patients had symptomatic improvement with satisfaction. Postoperative complication was small amount of residual pneumothorax in 5 patients but it was absorbed sponteneously. There was no recurrence during follow-up period and ten patients(66%) complained compensatory hyperhidrosis. After operation, SSR change was shown in every 15 patients. Abolition of SSR on both palms was achieved in 12 patients(80%) and on both soles in 6 patients. In the other 3 patients, the latencies were significantly delayed and the amplitudes were significantly reduced at both palms and soles. In two patients who were examined at one month later after operation, similar results with postoperative SSRs were shown. The skin temperature on preoperative both palm and sole were lower than normal temperature, and those on postoperative both palm and sole were increased. Those had statistical significance(p<0.05), and the temperature on the palm was increased higher that than on the sole. Conclusion: After thoracic sympathicotomy was performed on palmar hyperhidrosis patients, an increment of skin temperatures and SSR changes were achieved at both palms and soles of all patients. Palmar SSRs were completely abolished in 12 patients(80%), and similar results of postoperative SSRs were achieved. The recording of SSR may be useful to easily and objectively assess the completeness of sympathicotomy and the follow-up of recurrence in hyperhidrosis patients.

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Analysis of Diagnostic Performance of CT and EUS for Clinical TN Staging of Gastric Cancer (위암의 임상적 병기 설정을 위한 전산화단층촬영 및 초음파 내시경의 진단력 평가)

  • Shin, Ru-Mi;Lee, Ju-Hee;Lee, Moon-Soo;Park, Do-Joong;Kim, Hyung-Ho;Yang, Han-Kwang;Lee, Kuhn-Uk
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.177-185
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    • 2009
  • Purpose: Preoperative clinical staging of gastric cancer is very important for determining the treatment plans and predicting the prognosis. The previous reports regarding the accuracy of computed tomography or endoscopic ultrasound for the preoperative staging of gastric cancer have shown various outcomes. We analyzed the diagnostic performance of CT and EUS, which are important staging tools for the staging of TN gastric cancer. Materials and Methods: We retrospectively analyzed 1,174 patients who underwent gastrectomy for gastric cancer at Seoul National University Bundang Hostpital from May, 2003 to December, 2007. We derived the Kappa value to examine the agreement of the preoperative staging obtained from CT and EUS with the pathological staging. Results: The mean age of the 1,174 patients was $59.31{\pm}11.98$ years. Six hundred thirty seven patients had early gastric cancer and 536 had advanced gastric cancer. The diagnostic performance between CT and EUS for the T staging showed no significant difference between CT and EUS for the kappa values. The kappa values showed moderate agreement at 0.4039 (P=0.021) and 0.4201 (P=0.026), respectively. This suggests that there is no difference between the two examinations for the overall T staging. Analysis of the discrimination of mucosal and submucosal lesions with EUS showed an accuracy of 58.92% and a Kappa value of 0.206 (P<0.001), suggesting fair agreement and a lower diagnostic performance than expected. To differentiate lesions with stages higher than or equal to T2 or T3 from the lesion with stages lower than T2 or T3, respectively, adoption of the higher stage from the CT staging or the EUS staging showed a larger AUC of 0.84 than that from either stage alone. The CT-derived node stage had the higher diagnostic performance (68.55%) than that of the EUS-derived node stage (60.82%) for the node staging. Conclusion: The CT-derived stage and EUS-derived stage showed comparable results for determining the T stage of gastric cancer. Yet the higher stage of the two stages from CT and EUS most accurately discriminated between those lesions with stages higher than T2 and those lesions with stages lower than T2.

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