• Title/Summary/Keyword: 심폐기

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Relationship and Clinical Usefulness between Preoperative Levels of Brain Natriuretic Peptide, Other Cardiac Markers and Perioperative Parameters in Patients with Coronary Artery Disease (관상동맥질환자에 있어 수술 전 brain natriuretic peptide 농도, 심장표지자, 수술전후기 변수들 간의 상관관계와 임상적 유용성)

  • Choi, Seok-Cheol;Kim, Yang-Weon;Hyun, Kyung-Yae;Hwang, Soo-Myung;Moon, Seong-Min
    • Journal of Life Science
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    • v.20 no.9
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    • pp.1299-1305
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    • 2010
  • Cardiac troponin-I (cTnI), creatine kinase-MB (CK-MB), and C-reactive protein (CRP) are routine cardiac markers for the diagnosis of cardiovascular disease. Recently, brain natriuretic peptide (BNP) has garnered attention as a marker of heart failure. This study was retrospectively designed to investigate the relationships between preoperative BNP, other cardiac markers levels and perioperative parameters in seventy-four adult patients that underwent off-pump coronary artery bypass grafting (OPCAB) and to assess its usefulness for predicting postoperative outcomes. Preoperative levels of BNP, cTnI, CK-MB, and CRP had significantly positive or negative correlations with echocadiographic parameters. There were significantly positive relationships between BNP, cTnI, CK-MB, and CRP concentration. Postoperative mechanical ventilation time had a positive correlation to preoperative levels of cTnI, CK-MB, and CRP, while ICU-staying period had a positive correlation with BNP, cTnI and CK-MB. These results reveal that a preoperative level of BNP is a good predictor and that its combination with cTnI, CK-MB, and CRP might be useful for diagnosis and comprehensive risk stratification of patients with coronary heart diseases, as well as prognosis of perioperative outcomes in OPCAB patients.

The Effects of Health Fitness and Body Composition in Elderly Men for 16 Weeks of Tai Chi Exercise (16주간의 태극권 운동이 남자 고령자들의 건강체력 및 신체조성에 미치는 영향)

  • Kim, Cheol-Woo
    • Journal of Life Science
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    • v.21 no.8
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    • pp.1127-1133
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    • 2011
  • Exercise has been shown to positively influence quality of life for elderly men with a wide variety of medical illnesses. Tai chi exercise, a slow and graceful form of exercise and meditation, has especially been offered as the ideal exercise for elderly men with diverse conditions, such as people suffering from chronic heart failure or breast cancer survivors. In one recent study, Tai Chi was found to improve exercise capacity, sleep stability, and quality of life in heart failure patients including elderly men. The purpose of the study was to examine the effects of 16 weeks of Tai Chi exercise (3 times/week, 60 min/trial, 40-50% HRR) on physical and physiological changes. Sixty four healthy volunteers without any particular disease between the ages of 65 and 79 years participated in the study. The results were as follows; Significant changes of cardiac endurance, strength, muscle endurance, flexibility and balance were observed following 16 weeks of Tai Chi exercise (p<0.05). In addition, significant changes of diastolic blood pressure, body fat and fat-free mass were observed following 16 weeks of Tai Chi exercise (p<0.05). These findings suggest that a brief period of Tai Chi exercise is beneficial, particularly to elderly men. It is especially beneficial for body composition, and physical fitness factors such as cardiopulmonary endurance, muscle endurance, flexibility, and balance. Further study is needed in this area for specific disease patients.

DENTAL TREATMENT FOR A PATIENT WITH NOONAN SYNDROME UNDER GENERAL ANESTHESIA: CASE REPORT (누난 증후군(Noonan syndrome) 환자의 전신마취 하 치과치료 : 증례보고)

  • Seo, Meekyung;Song, Ji-Soo;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Jung-Wook;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Young-Jae
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.13 no.1
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    • pp.37-42
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    • 2017
  • Noonan syndrome is a relatively common genetic disorder which is autosomal dominant. Prevalence of Noonan syndrome is varying from 0.04% to 0.1%. It is characterized by distinctive facial features, chest deformity, short stature and congenital heart disease. Oral findings in patient with Noonan syndrome include high arched palate, dental malocclusion, articulation difficulties, and micrognathia. The purpose of this case report is to describe dental treatment of a children with Noonan syndrome. 5 year old boy with Noonan syndrome visited to the Seoul National University Dental Hospital for dental treatment. Due to need for close monitoring, concern about seizure and poor cooperation, we planned to perform the dental treatment under general anesthesia. Under general anesthesia, caries treatment was successfully performed and there was no postoperative complications related to general anesthesia. High arched palate was observed which is characteristic in Noonan syndrome.

Clinical features and results of recent neonatal cardiac surgery - A review of 82 cases in one hospital (최근 신생아 심장 수술의 특징과 결과 - 단일 병원에서의 82례 고찰)

  • Oh, Ki Won;Kim, Jung Ok;Cho, Joon Yong;Hyun, Myung Chul;Lee, Sang Bum
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.665-671
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    • 2007
  • Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

Clinical Analysis of Postoperative Acute Renal Failure in the Patients undergoing Cardiovascular Operation with CPB (개심술 후 발생한 급성 신부전의 임상적 고찰)

  • 편승환;노재욱;방정희;조광조;성시찬;우종수
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.494-501
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    • 1998
  • From May 1, 1993 to May 31 1995, the authers studied retrospectively 211 patients who underwent cardiovascular operation with cardiopulmonary bypass(CPB). Because we were interested in new development of ARF(prevalence, mortality rate, and main risk factors), we performed a multivariate statistical analysis about data of patients with preoperative serum creatinine values of less than 1.5 mg/dL. Normal renal function before operation(serum creatinine level less than 1.5 mg/dL) was registered in 198(74%) patients. Of these, 27(14%) patients showed postoperative renal complication, including 20(10%) patients classified as renal dysfunction(serum creatinine level between 1.5 and 2.5 mg/dL) and 7(4%) patients as acute renal failure(serum creatinine level higher than 2.5 mg/dL). The mortality rate was 5.8% in normal patients, 5% in patients with renal dysfunction, and 43% when acute renal failure developed(p=0.036). Indeed, the renal impairment proved to be an independent predictor of mortality(odd ratio 2.52∼11.25), along with cardiovascular(odd ratio 4.20) and respiratory(odd ratio 2.18) complications. Multivariate analysis identified the following variables as independent risk factors for postoperative renal impairment : advanced age(odd ratio 1), need for emergency operation(odd ratio 3.78), low-output syndrome(odd ratio 3.66), respiratory complication(odd ratio 1.30), need for deep hypothermic circulatory arrest(odd ratio 1.4). The 13 patients(7%) with preoperative renal failure showed a significantly higher morbidity and mortality rate than those without renal complications before operation. We concluded that the likelihood of severe renal complications is resonably low in the patients undergoing cardiac operation without preexisting renal dysfunction, but associated mortality remains high. A prominant role of hemodynamic factor in the development of postoperative acute renal failure must be recognized during preoperative, intraoperative, and postoperative periods.

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Histologic Changes of the Immunologically Untreated Xenogenic Valved Conduit (면역학적 처리 없는 이종 심장 판막 도관의 조직학적 변화에 관한 연구)

  • Sung, Ki-Ick;Seo, Jeong-Wook;Kim, Won-Gon
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.1-7
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    • 2007
  • Backgound: It has been shown that the endothelium of cardiac valves and adjacent great vessels have a reduced immune reaction compared to other vessels. We investigated the clinical feasibility of using immunologically untreated xenogenic valves, in a pig-to-goat pulmonary valve conduit implantation model. Material and Method: Porcine pulmonary valve conduits were prepared without specific immunologic treatment and implanted into the right ventricular outflow tract of goats while undergoing cardiopulmonary bypass. Two goats each were assigned to the following observation time intervals: one day, one week, three months, six months and twelve months. Echo-cardiographic examinations were performed prior to sacrifice of the goat to evaluate pulmonary valve function. After the xenograft specimens were retrieved, histological changes were evaluated microscopically. Result: Ten of the twelve animals survived the predetermined observation time intervals. Aneurysmal dilatations, of the anterior wall of the implanted pulmonary artery, were observed at each of three and twelve month-survival animals. A variable degree of pulmonary valve regurgitation was observed on echocardiography. However, valve stenosis, thrombotic occlusion and vegetation were not seen. Microscopically, the nuclei of the donor tissue disappeared as a result of pyknosis and karyolysis; however the three components of the implanted xenografts (the pulmonary artery, the valve and the infundibulum) were gradually replaced by host cells over time, while maintaining their structural integrity. Conclusion: Immunologically untreated xenogenic pulmonary valve conduits were replaced by host cells with few observed clinical problems in a pig to goat pulmonary valve implantation model. Therefore, they might be an alternative bioprosthesis option.

Evaluation of Respiration Reproducibility of Chest General X-ray Examination using Self-made Respiratory Synchronization Device (자체 제작한 호흡 동기화 장치를 통한 흉부 일반촬영 검사의 호흡 재현성 평가)

  • Kwon, Oh-Young;Lee, Chang-Hun;Yong, Keum-Ju;Jin, Seon-Hui;Jung, Da-Bin;Heo, Yeong-Cheol
    • Journal of the Korean Society of Radiology
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    • v.15 no.7
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    • pp.1049-1056
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    • 2021
  • The purpose of this study was to develop a respiratory synchronization device for X-ray (X-RSD) to increase the reproducibility of inspiration when examining the Chest X-ray of a patient who difficulty in breathing coordination. The X-RSD was self-made using an air pressure sensor and air was injected by connecting a ventilator to the mannequin for CPR. At this time, the amount of injected air was quantified using the SkillReporting device. After placing the X-RSD on the chest of the mannequin, the amount of air was tested in 6 steps from 200 to 700 cc by 100 cc increased. For the accuracy evaluation, the sensitivity of X-RSD was measured by repeating a total of 80 measurements, and the sensitivity was 100%, and very precise results were obtained. After that, the images examined while viewing the X-RSD of the chest lateral examination and the images obtained by the blind examination were compared and evaluated. The lung volume of X-RSD was larger than that of the blind test, and the deviation was smaller. Overall, the use of X-RSD can help with chest X-ray examination of patients who have difficulty in cooperating, and it is thought that it will be possible to contribute to the reduction of exposure dose by reducing the repeat rate of general X-ray examinations.

The Role of Perfusionists during the COVID-19 Pandemic and Clinical Laboratory Technologists: Comparison of Training Systems in Japan and the United States (코로나19를 통해서 바라본 체외순환사의 역할과 임상병리사: 일본과 미국의 양성체계를 비교)

  • Dong-Ok, Aum;Dae Jin, Kim;Dae Eun, Kim;Myong Soo, Kim;Bon-Kyeong, Koo
    • Korean Journal of Clinical Laboratory Science
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    • v.54 no.4
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    • pp.293-297
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    • 2022
  • In 2022, Korea reported a total of 224 perfusionists, employing nurses or clinical laboratory technologists (also known as medical technologists) to provide hospital self-education or reliable education. In 2021, the total number of perfusionists in Japan was 2,100, mainly supported by clinical engineering technologists. During the same period, the number of perfusionists reported in the United States was 4,212, who had received training in the master's program, post-bachelor certificate program, and bachelor's program. Most personnel in the USA were graduates of healthcare sciences or life sciences. Perfusionists must be knowledgeable in heart anatomy, physiology, pharmacology, pathology, hemodynamics, laboratory analysis, and quality assurance, as well as techniques to operate the cardiopulmonary bypass machine (heart-lung bypass machine). These are jobs similarly handled by clinical laboratory technologists. The importance of perfusionists became more prominent during two major crises: the MERS-CoV and COVID-19 pandemic. Currently, perfusionists play a significant role in the rapidly expanding field of extracorporeal membrane oxygenation (ECMO) and extracorporeal circulation during cardiac surgery. Results of the current study indicate that hospitals offering cardiac surgery and infectious disease hospitalization need to be institutionalized to secure a certain number of qualified perfusionists. In the future, we look forward to establishing a perfusion technology association under the Korean Society for Clinical Laboratory Physiology to provide academic exchanges.

Effect of Glycopyrrolate on Cardiovascular System in Dogs Sedated with Medetomidine-Midazolam Combination (개에서 Medetomidine과 Midazolam 병용 투여 시 Glycopyrrolate가 심맥관계에 미치는 영향)

  • Han, Dae-Kyung;Shin, Beom-Jun;Lee, Jae-Yeon;Jee, Hyun-Chul;Park, Ji-Young;Kim, Myung-Cheol;Jeong, Seong-Mok
    • Journal of Veterinary Clinics
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    • v.26 no.4
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    • pp.317-323
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    • 2009
  • This study was performed to evaluate the effect of intravenous administration of glycopyrrolate on cardiovascular and respiratory system in dogs given intravenous medetomidine (20 ${\mu}g$/kg) and intramuscular midazolam (0.3 mg/kg) (MM). Prior to administration of MM, glycopyrrolate was administered intravenously at doses of 5 ${\mu}g$/kg (Gly-5), 10 ${\mu}g$/kg (Gly-10) or 20 ${\mu}g$/kg (Gly-20), respectively. For the control group saline was administered intravenously. In the cardiovascular system, HR, BP, RAP, PAWP, CI, SI, SVR, and PVR were measured. RR, $V_T$, $P_{ETCO2}$, and arterial blood gas analysis were measured for respiratory system. Although rapid and satisfied depth of sedation was obtained by MM, life-threatening bradycardia, the outstanding side-effect on cardiovascular system in dogs were observed. This combination also decreased CO and increased SVR, RAP, and PAWP significantly. The bradycardia could be prevented in all the glycopyrrolate treated groups, but tachycardia was observed in Gly-10 and Gly-20 groups. Significant increases in blood pressure were shown in glycopyrrolate treated groups. Also, tachycardia depends on dose of glycopyrrolate, compensating the CO. However, these were not fully reserved. In conclusion, MM combination could induce rapid and satisfied depth of sedation but was not the suitable method for the deep sedation of dogs with cardiovascular or circulatory problems.

Surgical Results of Complete Atrioventricular Septal Defect - 16 years experience - (완전방실중격결손증에 대한 외과적 교정의 16년 수술결과)

  • 이정렬;김홍관;이정상;김용진;노준량;배은정;노정일;최정연;윤용수
    • Journal of Chest Surgery
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    • v.35 no.12
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    • pp.854-861
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    • 2002
  • In this study, we reviewed our early and long-term surgical results of complete atrioventricular septal defect during the last 16 years at our hospital. Materials and Methods: Between April 1986 and March 2002, 73 patients with complete atrioventricular septal defect underwent total correction without preceding palliation. Age at repair ranged from 2 to 85 (median age, 7) months, and weight ranged from 3 to 22 (median weight, 5.9)kg. Follow-up was complete with a mean duration of 69$\pm$51 months. Results: Overall operative mortality was 16.4%(12) with 3 late deaths. One, 5, and 10 year actuarial survival rates were 96.3 %, 94.2 % and 94.2 % respectively Sixteen of 61 (22.2%) operative survivors have undergone reoperation for postoperative mitral regurgitation or left ventricular outflow tract obstruction (LVOTO). Freedom from mitral reoperation at 1, 5, and 10 years were 87.8 %, 72.4 %, and 57.8 % and freedom from LVOTO at 1, 5, and 10 years were 98.2 %, 86.3 %, and 83.2 % respectively. Summary: In this study, we found that our early surgical results improved with quite an acceptable long-term outcome. Close observation of remaining mitral regurgitation was necessary, A precise evaluation of the atrioventricular valve morphology, a meticulous surgical technique, and the adequate postoperative management are mandatory for the excellent results.