• Journal of Chest Surgery
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• v.34 no.12
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• pp.937-943
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• 2001

Background: The aims of this study are to determine the predicting factors related with cardiovascular injuries in sternal fractures and to suggest the indication of emergency echocardiography. Material and Method: A retrospective review of the Ewha Womans University Mok-Dong Hospital trauma registry revealed 40 patients, that visited the hospital with a sternal fracture a over 5-year period. We analyzed 4 factors as predicting factors; 1) presence of restraint, 2) presence of associated injuries, 3) presence of a past medical history involving cardiovascular system, and 4) Revised Trauma Score(RTS). We, also, assessed the utility of conventional study methods involving cardiovascular injuries, such as ECG, chest X-ray, and enzyme level. Based on the methods, we inferred an indication for emergency echocardiography in sternal fractures. Result: Statistically significant predicting factors were the presence of a past medical history involving cardiovascular system and abnormal RTS on admission. Usage of emergency echocardiography depended upon the predicting factors and the results from conventional evaluations. We can now suggest the indications of emergency echocardiography in sternal fractures as 1) if more than two studies reveal abnormality without any significant predicting factors, and 2) if more than one study reveals abnormality with any significant predicting factors. Conclusion: The past medical history involving cardiovascular system and initial vital signs imply the presence of cardiovascular injuries in sternal fractures. And if needed, emergency echocardiography should be performed.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.32-37
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• 1996

Between May 1991 and September 1995, 7 patients underwent surgical repair of ventricular septal defect (VSD) complicated with myocardial infarction in Asan Medical Center. The patients included two male and five female. The ages of patients were ranged from 54 years to 76 years with a mean of 65 years. The sites of postinfarction ventricular septal defect were consist of anterior septal defect in 6 patients and anteroposterior septal defect in 1 patient. Preoperative 2D-echocardiography & angiography were performed in all patients in order to measure ventricular function and evaluate the extent of coronary artery disease. The operations were delayed till mean 24 $\pm$ 12days after myocardial infarction. All patients underwent infarctectomy and Teflon patch closures through the area of the left ventricle infarction or aneurysm in the anterior or apical aspect of postinfarction ventricular septal defect. The ventricular septal defect repaired simultaneously with coronary artery b pass graft in 3 patients, with ventricular aneurysmectomy in 5 patients, and with left ventricular thrombectomy in 1 patient. Patch fixation in the left side of interventricular septum by tracts-septal interrupted pledget suture reduced the recurrence rate of VSD. There were 2 postoperative complications : One with pneumonia, 1 patient with the skin necrosis of left thigh. There was ilo early death. The 6 patients except for one emigrant were followed up postoperatively between 3 and 63 months(mean .28 months), without any sequelae and late death. They are in New York Heart Association functional class I-II.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.755-761
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• 2004

We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure con-comitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141$\pm$64, 69$\pm$24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p < 0,01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32$\pm$9% to 52$\pm$11% (p<0.01). The asynergy portion decreased from 57$\pm$12% to 22$\pm$9%, and LVEDV/LVESV indexes improved from 125$\pm$39 mL/$m^2$, 85$\pm$30 mL/$m^2$ to 66$\pm$23 mL/$m^2$, 32$\pm$16 mL/$m^2$ (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase. Conclusion: After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.297-300
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• 2007

Idiopathic hypereosinophilic syndrome is a rare systemic, leukoproliferative disorder characterized by eosinophilmediated tissue injury causing multiple organ failure, including the heart. Cardiac involvement occurs in more than 75% of patients with hypereosinophilic syndrome. Cardiac manifestations include subendocardial fibrosis, thrombus leading to peripheral emboli, restrictive cardiomyopathy, and valvular dysfunction. It is more common in men than in women (9 : 1), and trends to present between the ages of 20 and 50 years. Presentation in childhood is unusual. We report for the first time a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic aortic valve dysfunction that was successfully treated by steroid and hydroxyurea therapy after surgical valvular replacement.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.8 no.2
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• pp.259-269
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• 2001

Purpose: The purpose of this study was to investigate the effects of an intensive teaching program on the knowledge level of MI in patients with a myocardial infarction. Method: The subjects were 47 patients with a myocardial infarction. Of the subjects 23 were assigned to the experimental group and 24 to the control group. The data were collected through a questionnaire (Lee, 1992; Nam, 1998) survey of knowledge level. The data collection was done about MI between September 15, 1999 and December 31, 2000 after hospital discharge. Data were analyzed using the SAS program and the results are as follows. Results: 1. There were no significant difference in knowledge level of the MI (P=0.621) between the two groups before the teaching program was given. 2. After 4 weeks the knowledge level about MI was significantly higher in the experimental group compared to the control group (P = 0.000). 3. After 12 weeks the knowledge level about MI was significantly higher in the experimental group compared to the control group (P= 0.000). 4. After 4 weeks the experimental group was at a higher scores of knowledge category about MI for nature of disease (P=0.000). risk factors, (P=0.000), diet (P=0.000), medication (P=0.000) exercise and daily activities (P=0.000) as compared to the control group. 5. After 12 weeks the experimental group was at a higher scores of knowledge category about MI for nature of disease (P=0.000). risk factors (P=0.001). diet (P=0.000), medication (P=0.000) exercise and daily activities (P=0.000) as compared to the control group. Conclusion: The above findings indicate that the intensive teaching program used for the experimental group in this study was effective in increasing the knowledge level about MI of the patients with a myocardial infarction.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.108-118
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• 1999

Background: To evaluate the risk factor and long-term result of arterial switch operation , a retrospective study was done. Material and Method: A retrospective analysis was done to evaluate the early and long-term results on 58 patients who underwent an arterial switch operation(ASO) for transposition of the great arteries(TGA) with intact ventricular septum, between January 1988 and December 1996. Beforesurgery, 36 patients(62.1%) underwent balloon atrial septostomy, 32 patients(51.7%) received PGE1 infusion, and preparatory banding of pulmonary artery was performed on 6 patients(mean LV/RV pressure ratio 0.53$\pm$0.11). Result: The age at operation ranged from 1 to 137 days(mean 24$\pm$26 days) and the weights ranged from 1.8 to 6.8 kg (mean 3.5$\pm$0.8 kg). There were 14 early deaths(24.1%), but of the last 24 patients operated on since 1994, there were only 2 early deaths(8.3%). In the risk factor analysis, the date of operation was the only risk factor for early death(p-value < 0.01). Eight of the 14 early deaths were due to acute myocardial failure(mainly inadequate coronary blood flow). The length of follow-up ranged from 2 months to 8 years, average of 36$\pm$27 months. The follow-up included sequential noninvasive evaluations and 21 catheterizations and angiographic studies performed 5 to 32 months postoperatively with particular attention to the great vessel and coronary anastomosis, ventricular function, valvular competence, and cardiac rhythm. There were 5 late deaths(11.4%), one of thesedeaths was related to the late coronary problems, two to aspiration, one to uncontrolled chronic mediastinitis, and one to progressive aortic insufficiency and heart failure. The most frequent postoperative hemodynamic abnormality was supravalvular stenosis and the degree of pulmonary or aortic obstruction had slowly progressed in some cases, however there were no children who had to undergo a reoperation for supravalvular pulmonary or aortic stenosis. Aortic regurgitation was identified in 9 patients, which was mild in 7 and moderate in 2 and had progressed in some cases. Two patients who had an unremarkable perioperative course were identified as having coronary artery obstructions. The other late survivors were in good condition, were in sinus rhythm, and had normal LV functions. Actuarial survival rate at 8 years was 68.8%. Conclusion: We concluded that anatomic correction will be established as the optimal approach to the TGA with intact ventricular septum, though further long-term evaluations are needed.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.534-543
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• 2006

Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

• The Monthly Diabetes
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• s.217
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• pp.21-23
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• 2007

당뇨병환자에서 혈당조절의 중요성은 '앙꼬 없는 찐빵' 또는 '김 없는 김밥'과의 관계와 같다. 당뇨병이 우리가 먹은 음식이 우리 몸에서 잘 활용되지 못하고, 소변으로 당이 넘쳐흘러서 나오는 현상을 보고 붙여진 이름인 것을 생각하면 둘 간의 관계는 땔래야 땔 수 없는 관계라 할 수 있습니다. 우리가 무서워하는 당뇨병의 합병증은 혈당조절을 잘 하게 되면 많은 부분 예방이 가능하다는 것을 알 수 있습니다. 제 1형 당뇨병의 대표적 연구인 DCCT 연구 결과를 보면 당화혈색소를 8.0%에서 7.2%로 낮추면 망막증의 진행을 40$\sim$50%를 줄일 수 있었습니다. 제 2형 당뇨병의 대표적 연구인 UKPDS연구는 당화혈색소 1%를 줄이면 미세혈관합병증은 37%, 심근경색은 14% 감소된다는 것을 확인해 주었습니다. 그 이외에도 많은 연구들에서 결과의 차이는 있지만 적극적이고 엄격한 혈당조절은 합병증의 발생을 예방하며, 발생된 합병증의 진행 속도를 늦출 수 있는 가장 효과적인 방법으로 증명하고 있습니다. 그런데 여러분들께서는 위에 언급한 '당화혈색소'를 알고 계십니까? 공복 혈당조절 목표를 알고 계십니까? 식후 혈당조절 목표를 알고 계십니까? 혹시 모르고 계시다면 100미터 출발 선상에서 출발 신호가 났지만 어디로 달려갈지 모르고 있는 것과 같습니다. 아무리 잘 달리고 훌륭한 선수라도 뛰어갈 방향을 모르고 있다면 좋은 성적을 낼 수 없는 것과 같습니다. 혈당조절의 중요성을 알고 관리 목표를 알고 현재 나의 수치를 그 목표를 행해 열심히 실행한다면 건강한 삶을 영위할 수 있습니다.

• Journal of Sericultural and Entomological Science
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• v.35 no.2
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• pp.145-148
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• 1993

생산성 저해 요인의 제거는 바로 생산성 향상으로 연결된다. 뽕밭의 생산성을 저해하는 요인은 여러가지지만 그 중에서 토양의 이화학적 불량과 농약 공해가 비중이 가장 크다고 볼 수 있다. 우리나라 뽕밭은 입지가 경사지에 많으므로 토심이 얕은데 비해, 뽕나무는 영년성 심근성 작물이므로 식재후 근권의 물리성에 따라 생산성이 좌우되는 비중이 매우 크다. 그러나 식재후 토양 물리성 개량은 화학성 개량보다도 어려우므로 그 결과 생산성이 낮은 상태를 벗어날 수 없다. 따라서 정기적인 심경이나 심토 파쇄를 통한 물리성 개량이 요망된다. 계속적인 금비위주의 비배관리에 의해 강산성 반응을 보이는 토양이 대부분이므로 석회에 의한 산성개량이 필요하다. 질소질의 과다시비는 수량을 감소시킬 뿐만 아니라, 엽질을 악화시키고 질산태 질소가 지하로 흘러 들어가 지하수의 오염을 일으켜 청색증과 암을 일으키는 원인이 될 수 있다. 심각한 정도로 축적된 인산과 칼리도 수량을 떨어뜨리고 환경을 해치는 원인이 되므로, 축적 양분의 재활용에 대한 연구가 계속되어져야 한다. 특히 사용의 편리성 때문에 고농도의 복합비료 위주의 비배관리가 반복되고 있는 실정이므로 토양검정을 받아서 단비를 이용하여 적정한 시비를 해야 할 것이다. 이러한 방법은 생산성의 향상, 영농비의 절감, 공해의 유발을 억제하는 여러가지 효과가 있다. 농약과 산업공해로부터 양잠의 보호를 위해서는 안전지대에 잠업의 단지화, 인근 농과와의 대화를 통해서 양잠에 안전한 농약을 사용토록 하는 한편, 연구분야에서는 심도 있는 연구를 통해 양잠농가를 보호할 수 있는 대책의 수립이 요망되고 있다. 종합해서 말하자면 연구기관의 심도있는 연구가 더욱 활발히 이루워져야 할 것이며, 농민은 개발된 새기술에 보다 깊은 관심을 갖고 활용하는 한편, 필요로 하는 기술을 연구기관에 개발을 요청할 정도의 적극적인 자세가 요구된다. 또한 연구기관의 농민의 중간 교량역할을 하는 지도부문에서도 보다 적극적인 활동이 요청된다.

• Korean Journal of Veterinary Research
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• v.32 no.1
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• pp.99-109
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• 1992

Pathological studies by light and electron microscope were carried out on the twenty piglets naturally affected by encephalomyocarditis virus infection. Gross findings included pale or yellow, small necrotic foci on myocardium, together with pulmonary edema and liver congestion in some cases. On light microscopy, nonsuppurative interstitial endocarcitis, epicarditis and myocarditis, myocardial infarction, and dystrophic calcification or fibtosis were observed in heart. Perivascular cuffings, gliosis and nonsuppurative meningitis were appeared in brain. Focal or diffuse necrosis with mononuclear cell infiltration in lacrimal gland and multifocal necrosis in liver were observed in some cases. Congestion and edema of lung, hyperemia, hemorrhage and deletion of lymphocytes of lymph nodes and spleen were recognized. On electron microscopy, severe swelling and vacuolization of mitochondria and sarcoplasmic reticulum, large intracellular vacuolation and edema, separation and fragmentation of myofibrils were observed. Virus particles were seen in the sarcoplasm of degenerated cardiac muscle cell.