• Title/Summary/Keyword: 수술시기

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Analysis of the Correlations between the Serum Levels of Cytokines and Postoperative Outcomes in Valvular Heart Surgery with Cardiopulmonary Bypass (체외순환을 동반한 심장판막 수술 시 혈청 사이토카인 농도와 수술 후 결과와의 상관관계 분석)

  • Moon, Seong-Min;Ki, Chong-Rak;Kim, Yun-Tae;Choi, Seok-Cheol
    • Journal of Life Science
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    • v.18 no.11
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    • pp.1551-1560
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    • 2008
  • Cytokines play a pivotal role in systemic inflammatory response following cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to investigate the perioperative changes in proinflammatory [tumor necrosis factor-$\alpha$ (TNF-$\alpha$) and interleukin-6 (IL-6)] and antiinflammatory cytokines [interleukin-10 (IL-10)], and each correlation between the cytokines and other variables in valvular heart surgery with CPB. Serum IL-6 and IL-10 levels and leukocyte counts significantly increased following CPB. CPB caused hepatic, renal and myocardial dysfunctions. IL-6 levels had positive correlations with IL-10 levels at postoperative periods. TNF-$\alpha$ levels had correlations with leukocyte counts and myocardial marker levels at postoperative 24 hr (PO-24 h). Furthermore, IL-6 or IL-10 levels had positive correlations with other variable such as hepatic, renal or myocardial marker at postoperative periods. These results showed that balance between proinflammatory and antiinflammatory cytokines is maintained during cardiac surgery with CPB, and that these cytokines exert postoperatively inflammatory and antiinflammatory reactions.

Clinical Experience with IABP in Cardiac Surgery (개심술시 Intra-aortic balloon pump (IABP)의 임상적 적용)

  • 옥창석;지현근
    • Journal of Chest Surgery
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    • v.30 no.1
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    • pp.34-39
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    • 1997
  • Between May, 1994 and December, 1995, 122 adult cardiac surgical procedures requiring cardiopulmonary bypa s were performed at Kang Dong Sacred Heart Hospital, including 18 cases(14.8%) that were associated with preoperative(n:9), intraoperative(n=7), postoperative(n:2) use of an IABP (intra-aortic balloon pump). The reasons for IABP were low cardiac output and PTCA(percutaneous transluminal coronary angioplasty) failure in preoperative period, CPB(cardiopulmonary bypass) weaning difficulty in intraoperative period, and intractable arrhythmia in postoperative period. The mean age of the IABP patients was 61.8 $\pm$ 6.9 years(range, 39 to 75years). The overall hospital mortalities in patients with preoperative and intraoperative IABP insertion were 3 and 42.9% respectively. Two patients with postoperative IABP insertion are alive. The rate of IABP weaning is 66.7% for preoperative group, 85.7% for intraoperative group and 100% for postoperative group . In conclusion, if there were no irreversible myocardial damages, IABP could be used safely and emergently at any perioperative period for hemo ynamic stability, CPB weaning, and to overcome low cardiac output syndrome.

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Clinical Analysis of Infective Endocarditis (감염성 심내막염의 임상적 고찰)

  • Kim, Hyuck;Kim, Young-Hak;Chung, Won-Sang;Shin, Kyung-Wook;Kim, Ji-Hoon
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.619-626
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    • 2010
  • Background: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. Material and Method: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was $20.78{\pm}16.00$ days. There were 12 (52.2%) urgent operations. The average follow up period was $49.26{\pm}33.21$ months. Result: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was $24.39{\pm}15.98$ days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value < 0.05). Conclusion: We could obtain the satisfactory results without any moftalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.

A Clinical Study of Hypertrophic Pyloric Stenosis (비후성 유문 협착증의 임상적 고찰)

  • Kim, Yoon Hee;Jung, Myung Sup;Byun, Soon Ok
    • Clinical and Experimental Pediatrics
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    • v.45 no.11
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    • pp.1389-1396
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    • 2002
  • Purpose : This study was done to analyze the changes in the clinical conditions and the diagnosis of hypertrophic pyloric stenosis. Methods : We report a retrospective clinical analysis of 39 patients with hypertrophic pyloric stenosis from Jan. 1992 to Aug. 2001. The age and sex distribution, family and birth history, clinical symptoms, the ultrasonographic and the operative sizes of pyloric canals were compared. Results : The body weight was below the 3 percentile at admission in eight cases(20.5%). "Olive like mass" in right upper quadrant was palpated during physical examination in 23 cases(59%) and gastric peristaltic wave observed in six cases(15%). The ultrasonographic measurements showed that the pyloric muscle thickness to be $4.95{\pm}0.99mm$($mean{\pm}SD$), pyloric diameter $14.42{\pm}2.64mm$, and pyloric length $20.17{\pm}3.92mm$. Fredet-Ramstedt pyloromyotomy was employed in all cases. The operative measurements of the pyloric muscle thickness was $5.11{\pm}1.01mm$, pyloric diameter $15.01{\pm}2.47mm$, and pyloric length $22.32{\pm}3.43mm$. Conclusion : There was no significant difference between the ultrasonographic and operative measurements. Currently, the hypertrophic pyloric stenosis patients showed lesser clinical hallmarks of the disease. The earlier diagnosis using imaging studies before development of significant metabolic abnormalities is becoming an important factor that change the future outcomes of hypertrophic pyloric stenosis.

변성발성장애 환자에 대한 음성치료의 효과

  • 표화영
    • Proceedings of the KSLP Conference
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    • 1998.11a
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    • pp.197-197
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    • 1998
  • 변성발성장애는 변성기의 시기를 지났음에도 불구하고 적절한 음도저하를 습득하지 못함으로써 야기되는 음성장애의 한 가지로, 이런 환자들에 대해서는 제3형 갑상연골성형술을 통한 수술적 처치나 음성치료로 그 문제를 해결할 수 있다. 본 논문에서는 이중 음성치료적인 측면에 초점을 맞추어, 음성치료에 의한 변성발성장애 치료의 효율성에 대해 고찰해 보고자 한다. (중략)

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A Case of Urinary Ascites with Urinoma Secondary to Ureteropelvic Junction Obstruction in a Neonate (신생아에서 신우요관이행부 폐색으로 인해 발생한 요낭종 및 요성복수 1례)

  • Choi, Min-Seon;Kim, Eun-Young;Park, Sang-Kee;Kim, Dong-Hyun;Jung, Hyun-Jin
    • Neonatal Medicine
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    • v.18 no.2
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    • pp.379-382
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    • 2011
  • Spontaneous intraperitoneal extravasation of urine is rare. Perirenal urinoma may develop when obstruction to urinary flow creates sufficient back pressure to produce extravasation of urine. Urinary ascites most commonly indicate a disruption to the integrity of the urinary tract. We report a case of urinary ascites with urinoma resulting from an ureteropelvic junction obstruction in a neonate.

Fault Detection and Reuse of Self-Adaptive Module (자가 적응 모듈의 오류 탐지와 재사용)

  • Lee, Joon-Hoon;Lee, Hee-Won;Park, Jeong-Min;Jung, Jin-Su;Lee, Eun-Seok
    • Proceedings of the Korean Information Science Society Conference
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    • 2007.10b
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    • pp.247-252
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    • 2007
  • 오늘날 컴퓨팅 환경은 점차 복잡해지고 있으며, 복잡한 환경을 관리하는 이 점차 중요해 지고 있다. 이러한 관리를 위해 어플리케이션의 내부 구조를 드러내지 않은 상태에서 환경에 적응하는 자가치유에 관한 연구가 중요한 이슈가 되고 있다. 우리의 이전 연구에서는 자가 적응 모듈의 성능 향상을 위해 스위치를 사용하여 컴포넌트의 동작 유무를 결정하였다. 그러나 바이러스와 같은 외부 상황에 의해 자가 적응 모듈이 정상적으로 동작하지 않을 수 있으며 다수의 파일을 전송할 때 스위치가 꺼진 컴포넌트들은 메모리와 같은 리소스를 낭비한다. 본 연구에서는 이전 연구인 성능 개선 자가 적응 모듈에서 발생할 수 있는 문제점을 해결하기 위한 방법을 제안한다. 1) 컴포넌트의 동작 여부를 결정하는 스위치를 확인하여 비정상 상태인 컴포넌트를 찾아 치유를 하고, 2) 현재 단계에서 사용하지 않는 컴포넌트를 다른 작업에서 재사용한다. 이러한 제안 방법론을 통해 파일 전송이 않은 상황에서도 전체 컴포넌트의 수를 줄일 수 있으며 자가 적응 제어 모듈을 안정적으로 작동할 수 있도록 한다. 본 논문에서는 명가를 위하여 비디오 회의 시스템 내의 파일 전송 모듈에 제안 방법론을 적용하여 이전 연구의 모듈과 제안 방법론을 적용한 모듈이 미리 정한 상황들에서 정상적으로 적응할 수 있는지를 비교한다. 또한 파일 전송이 많은 상황에서 제안 방법론을 적용하였을 때 이전 연구 방법론과의 컴포넌트 수를 비교한다. 이를 통해 이전 연구의 자가 적응 모듈의 비정상 상태를 찾아낼 수 있었고, 둘 이상의 파일 전송이 이루어 질 때 컴포넌트의 재사용을 통해 리소스의 사용을 줄일 수 있었다.위해 잡음과 그림자 영역을 제거한다. 잡음과 그림자 영역을 제거하면 구멍이 발생하거나 실루엣이 손상되는 문제가 발생한다. 손상된 정보는 근접한 픽셀이 유사하지 않을 때 낮은 비용을 할당하는 에너지 함수의 스무드(smooth) 항에 의해 에지 정보를 기반으로 채워진다. 결론적으로 제안된 방법은 스무드 항과 대략적으로 설정된 데이터 항으로 구성된 에너지 함수를 그래프 컷으로 전역적으로 최소화함으로써 더욱 정확하게 목적이 되는 영역을 추출할 수 있다.능적으로 우수한 기호성, 즉석에서 먹을 수 있는 간편성, 장기저장에 의한 식품 산패, 오염 및 변패 미생물의 생육 등이 발생하지 않는 우수한 생선가공, 저장방법, 저가 생선류의 부가가치 상승 등 여러 유익한 결과를 얻을 수 있는 효과적인 가공방법을 증명하였다.의 평균섭취량에도 미치지 못하는 매우 저조한 영양상태를 보여 경제력, 육체적 활동 및 건강상태 등이 매우 열악한 이들 집단에 대한 질 좋은 영양서비스의 제공이 국가적 차원에서 시급히 재고되어야 할 것이다. 연구대상자 특히 배달급식 대상자의 경우 모집의 어려움으로 인해 적은 수의 연구대상자의 결과를 보고한 것은 본 연구의 제한점이라 할 수 있다 따라서 본 연구결과를 바탕으로 좀 더 많은 대상자를 대상으로 한 조사 연구가 계속 이루어져 가정배달급식 프로그램의 개선을 위한 유용한 자료로 축적되어야 할 것이다.상범주로 회복함을 알수 있었고 실험결과 항암제 투여후 3 일째 피판 형성한 군에서 피판치유가 늦어진 것으로 관찰되어 인체에서 항암 투여후 수술시기는 인체면역계가 회복하는 시기를 3주이상 경과후 적어도 4주째 수술시기를 정하는 것이 유리하리라 생각되

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Risk of Seizures after Operative Treatment of Ruptured Cerebral Aneurysms (뇌동맥류 파열 환자의 수술 후 경련발작의 위험인자)

  • Chang, In-Bok;Cho, Byung-Moon;Shin, Dong-Ik;Shim, Young-Bo;Park, Se-Hyuck;Oh, Sae-Moon
    • Journal of Korean Neurosurgical Society
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    • v.30 no.6
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    • pp.705-710
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    • 2001
  • Objective : Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. Methods : Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. Results : In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p = 0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p <0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p <0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. Conclusion : Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.

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Arterial Switch Operation: The Technical Modification of Coronary Reimplantation and Risk Factors for Operative Death (동맥전환술: 판상돔맥이식 수기변형과 수술사망의 위험인자)

  • 성시찬;이형두;김시호;조광조;우종수;이영석
    • Journal of Chest Surgery
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    • v.37 no.3
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    • pp.235-244
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    • 2004
  • Anatomic correction of the transposition of the great arteries (TGA) or Taussig-Bing anomaly by means of the arterial switch operation is now accepted as the therapeutic method of choice. This retrospective study was conducted to evaluate the risk factors for operative deaths and the efficacy of technical modification of the coronary transfer. 85 arterial switch operations for TGA or Taussig-Bing anomaly which were performed by one surgeon from 1994 to July 2002 at Dong-A university hospital were included in this retrospective study Multivariate analysis of perioperative variables for operative mortality including technical modification of the coronary transfer was peformed. Overall postoperative hospital mortality was 20.0% (17/85). The mortality before 1998 was 31.0% (13/42), but reduced to 9.3% (4/43) from 1998. The mortality in the patients with arch anomaly was 61.5% (8/13), but 12.5% (9/72) in those without arch anomaly. In patients who underwent an open coronary reimplantation technique, the operative mortality was 28.1% (18/64), but 4.8% (1/21) in patients undergoing a technique of reimplantation coronary buttons after neoarotic reconstruction. Risk factors for operative death from multivariated analysis were cardiopulmonary bypass time ($\geq$ 250 minutes), aortic cross-clamping time ($\geq$ 150 minutes), aortic arch anomaly, preoperative event, and open coronary reimplantation technique. Operative mortality has been reduced with time. Aortic arch anomaly and preoperative events were important risk factors for postoperative mortality. However atypical coronary artery patterns did not work as risk factors. We think that the technical modification of coronary artery transfer played an important role in reducing the postoperative mortality of arterial switch operation.