• Title/Summary/Keyword: 비만 수술

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Clinical Usefulness of Preoperative Levels of Leukocyte and D-Dimer in Predicting Perioperative Outcomes of Cardiovascular Disease (심혈관질환의 수술기주위 결과예측에 있어 수술 전 백혈구 수 및 D-dimer 농도의 임상적 유용성)

  • Choi, Seok-Cheol;Kim, Yang-Weon;Hwang, Soo-Myung
    • Journal of Life Science
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    • v.20 no.10
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    • pp.1458-1467
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    • 2010
  • The present study was retrospectively designed to define whether preoperative levels of leukocytes and D-dimer are potentially useful factors in predicting perioperative outcomes of coronary heart disease (CHD). There was no relationship between preoperative leukocyte counts (Pre-OP leukocyte) and preoperative D-dimer levels (Pre-OP D-dimer). Pre-OP leukocyte counts each had positive correlation with cardiac troponin-I, creatine kinase-MB or C-reactive protein (cardiac markers) levels at preoperative and postoperative periods. Pre-OP D-dimer levels were positively associated with each cardiac marker at the same periods. Pre-OP leukocyte counts positively related with aspartate aminotransferase and alanine aminotransferase (liver markers), whereas Pre-OP D-dimer level positively or negatively correlated with bilirubin (liver marker), creatinine (renal marker) or glucose levels at preoperative and/or postoperative periods. Pre-OP leukocyte and Pre-OP D-dimer were inversely associated with Pre-OP high density lipoprotein cholesterol levels or left ventricular ejection fraction. Pre-OP leukocyte counts each had positive correlation operation duration and postoperative mechanical ventilation-time (PMVT), whereas Pre-OP D-dimer levels had positive relationship with PMVT, intensive care unit-staying period and hospitalization. The retrospective data suggest that Pre-OP leukocyte and Pre-OP D-dimer levels may be clinically useful factors for predicting perioperative outcomes in patients with CHD.

Influence Factors for Predicting Postoperative Nausea and Vomiting (수술 후 오심과 구토의 영향요인)

  • Cho, Eun-A;Jang, Ji-Sun;Kim, Kye-Ha
    • The Journal of the Korea Contents Association
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    • v.17 no.6
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    • pp.632-642
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    • 2017
  • The purpose of this study was to determine influence factors for predicting postoperative nausea and vomiting(PONV) for postoperative 24hr. Participants were 332 general surgery(GS), neurosurgery(NS), orthopedic surgery(OS), obstetrics and gynecology(OBGY), otorhinolaryngology (ENT) surgical patients at one hospital in G city. Data were collected from December 2014 to December 2015, and the data were analyzed by t-test, $x^2$-test and logistic regression analysis. Multivariate analysis revealed that non smoking (p=.011), history of motion sickness (p=.020), history of PONV (p=.001), post operative pain (p=.001) were influence factors for PONV. Preoperative intensive management of PONV is necessary if there is a history of non smoker, history of motion sickness and history of PONV before surgery, and postoperative pain should be actively intervened.

Membranous PTEE Monocusp Vlave on the Right Ventricular Outflow Tract (막형 PTEE 단엽판막을 이용한 우심실 유출로 확장수술)

  • 박영환;홍유선;이현성;이종균;조범구
    • Journal of Chest Surgery
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    • v.34 no.4
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    • pp.322-328
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    • 2001
  • 배경: 우심실 유출로 재건술후에는 폐동맥판막부전이 우심실기능에 나쁜 영향을 미친다. 이를 막기 위해 여러 재료로 판막을 제조하여 사용하는데 가피 형성이 적은 막형 ePTEE(expanded polytetrafluoroethylene, Goretex) 단엽판막의 효과를 알아보고자 연구를 시행하였다. 대상 및 방법; 1996년 3월부터 1997년 2월까지 우심실유출로 재건술을 시행받고 수술 1일까지 우심실 압력을 측정할 수 있었던 47명중 막형 Goretex단엽판막을 사용한 환자(비교군) 19명, 사용하지 않은 환자(대조군) 28명에서 단엽판막의 유용성을 조사하였다. 두 군간에는 나이, 체중 그리고 McGoon ratio 등에는 통계학적 차이가 없었다.(p>0.05) 이전의 수술은 대조군에서 19번, 비교군에서 22번을 시행하였다. 우심실 유출로에 대한 수술은 대조군에서 REV수술 2예, 우심실폐동맥 연결수술 8예, 우심실 유출로 재개건술 2예, 우심실 유출로에 대한 수술은 대조군에서 16예였으며, 비교군에서는 REV 수술 5예, Rastelli 씨 수술 6예, 재우심실 유출로 재건술 5예, 그리고 우심실 재건술 3예였다. 결과: 대동맥 차단 시간이나 총심폐순환시간에는 두군간의 차이는 없었다. 또한 수술직후와 수술후 1일째 측정한 우심실 압력 및 좌심방압력의 차이도 두군간에는 차이가 없었으며 수술후 7일째 시행한 심에코도 결과 ejection fraction., 우심실/ 좌심실 압력비 , 그리고 우심실 유출로의 압력차, 강심제 투여일수, 호흡기 사용 기간 등에서도 두군간의 차이는 없었으나 흉관 삽입기간이 비교군에서 의미있게 짧았다. 추적 조사 기간 중 비교군 1예에서 사망을 하였으나. Goretex 단엽판막에 의한 것은 아니였으며 심초음파검사상 우심실 유출로 압력차이나 재수술은 두군간에 차이는 없었으나 폐동맥 폐쇄부전은 비교군에서 의미 있게 낮은 것을 보이고 있다. 결론; 막형 Goretex 단엽판막의 조기성적은 우수하였으며 폐동맥 폐쇄분전의 정도를 적게 하는 효과를 보이나 앞으로 이들이 성장함에 따라 우심실 유출로에 폐쇄를 일으키는지는 계속적인 추적관찰이 요구된다.

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Correlation Between Left Ventricular Peak Systolic Pressure/End-Systolic Volume Ratio and Symptomatic Improvement with Valve Replacement in Patients with Aortic Regurgitation and Enlarged End-Systolic Volume (대동맥판역류증과 좌심실수축말기용적 확장이 있는 환자에서 좌심실최고수축기압/수축말기용적비와 판막치환후의 증상적 호전과의 관계)

  • Kim, Woong-Han;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.29 no.8
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    • pp.867-874
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    • 1996
  • This study was designed to assess the left ventricular peak systolic pressure/end-systolic volume (PSP/ESV) ratio in predicting symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged left von'lrlcular volume. We studied 21 patients (15 men and 6 women aged 15 to 60 years) with moderate or severe aortic regur- gitation, no other cardiovascular abnormalities and left ventricular end-systolic volume over 60 m11m2. In this group we assessed the preoperative variables which routinely were measured at cardiac catheterlzation to predict symptomatic improvement with valve replacement. Six months after operation, symptoms were alleviated in 13 patients(62%), and unchanged in 8()8%). By multivariate analysis, the PSP/ESV rati was a strong predictor for functional class 6 months after surgery(p=0.005) and also for change- in functional class prior to an operation to 6 months postoperatively(p=0.0)2). By 6 months after receiving valve replacement, all patients with a ratio over 1. 71 mmHglml/m'were in functional class I or II , in contrast, of those with a ratio < 1.71 mmHg/ml/m2, 40% were in functional class III. The PSP/ESV ratio may help to predict which patients with aortic regurgitation and enlarged left ven- tricular end-systolic volume will have symptomatic improvement with valve replacement.

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AIDS board

  • 대한에이즈예방협회
    • RED RIBBON
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    • s.65
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    • pp.46-46
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    • 2005
  • 의료혜택을 받지 못하는 노숙자 및 국내거주 외국근로자를 대상으로 입원 및 수술비 등을 무료로 지원하는 사업을 실시하기로 발표하였다. 보건복지부의 무료진료사업 지침에 따르면 현재 입원 및 수술이 필요한 환자나 자원봉사단체 등은 적십자병원 또는 지방공사의료원을 방문하거나 입원 및 전원을 의뢰할 경우 우선적으로 진료를 받을 수 있다고 밝혔다.

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The Change of Cardiothoracic Ratio after Ligation of Patent Ductus Arteriosus in Adult -Report of 30 cases- (성인의 동맥관 개존증 결찰술 시행후 심흉비의 변화 -30례 보고-)

  • 황상원;이연재;김한용;유병하
    • Journal of Chest Surgery
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    • v.32 no.1
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    • pp.22-26
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    • 1999
  • Background: Treatment of adult patent ductus arteriosus(PDA) has many difficulty such as pulmonary hypertension, arterial wall calcification, aneurysmal chage of ductus. We tried to evaluate the effect of surgical interruption of PDA on postopeative change of heart size. Material and Method : From 1987 to 1997 we experienced 30 cases of the ligation of patent ductus arteriosus in adult at the department of cardiovacular surgery in Masan Samsung General Hospital. Result: There were 9 males and 21 females and their ages ranged from 16 to 44 years, with a mean age of 26.1 years. 15 patients had pulmonary hypertension and 9 patients complained of dyspnea with a degree of functional NYHA class III. Operation method was double or triple ligation using Teflon felt. Postoperative complications were wound dehiscence in 3 patients and transient hoarseness in 1 patient. The mean preoperative cardiothoracic ratio was 54.7%, and mean postoperative cardiothoracic ratio was 51.9%. The change of cardiothoracic ratio was more typical in the cases who had congestive heart failure. Their mean preoperative cardiothoracic ratio was 64.8% and the mean postoperative cardiothoracic ratio was 58.5% there was no postoperative deaths. Conclusion: We canclude that the improvement in cardiothoracic ratio may result from surgical intervention of PDA.

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Surgical Anatomy of the Sternal Median and Paramedian Approaches on the Junction of the Veins and the Arteries of the Pig Heart (흉골 정중선 절개와 방정중선 절개 접근술에 따른 돼지 심장 대혈관들의 외과적 해부구조의 육안적 비교)

  • Mi-young An
    • Journal of Veterinary Clinics
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    • v.16 no.1
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    • pp.95-99
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    • 1999
  • 돼지 심장의 해부학적 구조에 대해서는 많은 연구가 보고되어 있으나 흉골 정중선 절개와 방정중선 절개 후 절개선에 나타나는 돼지 심장 대혈관들의 외과적 해부구조에 대한 보고는 아직 없고 심장적출 및 수술에 외과적 해부구조의 숙지가 필수적이므로, 체중 15kg - 25kg의 돼지 12마리를 4마리씩 3군, 즉 정중선절개군, 우측방정중선절개군, 좌측방정중선절개군으로 나누어 흉골열개 후 나타난 심장 대혈관들의 육안적 외과구조를 보고하고 심장적출술을 시도해 각 수술절개 접근법에 따른 수술의 용이성을 관찰하여 더 나은 수술접근법을 선택하는데 필요한 정보를 제공하고자 본 실험을 실시하였다. 그 결과, 우측과 좌측 방정중선절개법에 의해 흉골을 완전 열개시에는 제 1흉골과 갑상연골 부위에서 정중선으로 접근하는 초승달형 절개를 통해 internal mammary artery의 절개 위험성을 피할 수 있음을 발견하였고 흉골정중선절개에서는 상행대동맥의 정 중앙부에 aortic cannula를 쉽게 장착할 수 있었고 특히 비숙련자에게 더 적절한 수술 방법임을 알 수 있었다. 한편 숙련자가 심장적출이 아닌 동맥관개존증등과 같은 심장수술의 경우에는 방 정중선절개로써 환축의 수술 후 통증을 감소시키고 조기치유가 가능하다면, 초승달형 절개법을 응용한 방정중선 절개를 권할 수 있고 이에 따른 임상적 관찰이 요구되는 바이다.

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Analysis of Risk Factors in Poststernotomy Sternal Wound Infection and Mediastinitis after Open-heart Surgery (흉골절개술을 이용한 개심술 후 발생한 흉골 감염 및 종격동염의 위험인자 분석)

  • Chang, Won-Ho;Park, Han-Gyu;Kim, Hyun-Jo;Youm, Wook
    • Journal of Chest Surgery
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    • v.36 no.8
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    • pp.583-589
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    • 2003
  • With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. Material and Method: From March 200f to March 2003 at the depart-ment of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, post-operative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. Result: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardio-pulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p< 0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p< 0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). Conclusion: Contamination of pa-tients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.

A Successful Management of an Esophageal Perforation Caused by Esophageal Foreign Body with a Non-operative Treatment in a Dog (개에서 식도 이물에 의한 식도 천공의 비침습적 치료를 통한 성공적 관리 증례)

  • Lee, Hyeon-Suk;Baek, Dae-Seung;Ju, Ho-Jong;Kim, Jun-Hwan;Hong, Yeon-Jung;Park, Jin-Ho;Cho, Ho-Seong;Park, Chul
    • Journal of Veterinary Clinics
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    • v.29 no.6
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    • pp.506-508
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    • 2012
  • A 5-year-old, intact female, Pomeranian was presented with a persistent vomiting for 5 days after swallowing a chicken bone. The dog was diagnosed with an esophageal foreign body, and a small perforation was found after the endoscopic removal of the chicken bone. The dog was determined to be treated with a non-operative management, and a complete closure of the perforation was confirmed by a flexible endoscopy 3 weeks after removal of a chicken bone. This paper reports the case of esophageal perforation caused by foreign body in esophagus managed with the non-operative therapy instead of surgical correction.