• Title/Summary/Keyword: 항응고치료

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A Case of Rectus Sheath Hematoma and Intraperitoneal Hematoma Induced by Cough (기침으로 유발된 복직근초 혈종 및 복강내 혈종 1예)

  • Jeong, Hae Bin;Kang, Hyeon Hui;Im, Eun Joo;Kim, Hyun Gyung;Lee, Su Yeon;Maeng, Il Ho;Lee, Ji Myoung;Jang, Eun Hee;Lee, Sang Haak;Moon, Hwa Sik
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.3
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    • pp.212-215
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    • 2008
  • Rectus sheath hematoma (RSH) is a rare condition that's caused by a sudden disruption of the deep epigastric vessels or direct damage to the rectus abdominis muscle. This condition is associated with old age, childbirth, abdominal surgery, severe cough, severe sneezing, anticoagulation therapy and/or coagulation disorders. RSH is characterized by abdominal pain and an abdominal mass, so that this is often misdiagnosed as a surgical condition such as appendicitis, intraabdominal abscess, torsion of the ovary and ruptured abdominal aortic aneurysm; this can lead to unnecessary surgery. Thus, we have to be cautious not to miss RSH when a patient with predisposing factors is suffered from abdominal pain and an abdominal mass. We report here on a case of rectus sheath hematoma that was induced by severe cough in a patient who was taking warfarin.

Determination of Practical Dosing of Warfarin in Korean Outpatients with Mechanical Heart Valves (인공심장판막 치환환자의 Warfarin 용량결정)

  • Lee Ju Yeun;Jeong Young Mi;Lee Myung Koo;Kim Ki-bong;Ahn Hyuk;Lee Byung Koo
    • Journal of Chest Surgery
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    • v.38 no.11 s.256
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    • pp.761-772
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    • 2005
  • Background: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objective of this study was to suggest a practical dosing guideline for Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). Material and Method: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997 to September, 2000. Patients who were at least 6 months post-valve replacement and had nontherapeutic INR value (less than 2.0 or greater than 3.0) were included. The data on 688 patients (1,782 visits) requiring dosing adjustment without any known drug or food interaction with warfarin were analyzed. The amount of adjusted dose and INR changes based on the INR at the time of the event were calculated. Aortic valve replacements (AVR) patients and mitral or double valve replacement (MVR/DVR) patients were evaluated separately. Result: Two methods for the warfarin dosage adjustment were suggested: Guideline I (mg-based total weekly dose (TWD) adjustment), Guideline II (percentage-based TWD adjustment). The effectiveness of Guideline 1 was superior to Guideline II overall in patients with both AVR and MVR/DVR. Conclusion: The guideline suggested in this study could be useful when the dosage adjustment of wafarin is necessary in outpatients with mechanical heart valves.

Production and biological applications for marine proteins and peptides- An overview (해양생물로부터 기능성 펩티드의 생산 및 응용)

  • Kim, Se-Kwon;Byun, Hee-Guk
    • Food Science and Industry
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    • v.51 no.4
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    • pp.278-301
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    • 2018
  • Although more than 80% of living organisms are found in marine ecosystems, only less than 10% of marine resources have been utilized for human food consumptions and other usages. It is well known that marine resources (fish, shellfish and algae) have exceptional nutritional properties; however, their functional characteristic has not been completely discovered. It is believed that metabolites (organic compounds, proteins, peptides, lipids, minerals, etc.) play an important role to show its biological properties. Marine proteins and peptides are considered to be future drugs due to their excellent biological activities with a fewer adverse side effect. Marine peptides show several biological activities, including antimicrobial, antioxidant, anti-inflammatory, anti-cancer, anti-viral, anti-tumor, anti-diabetic, anti-hypertensive, anti-coagulant, immunomodulatory, appetite suppressing and neuroprotective effects. Therefore, the pharmaceutical, nutraceutical, and cosmeceutical companies have been paid attention to the marine peptides to commercialize into products. This current review mainly focused on the above mentioned biological activities of marine peptides and protein hydrolysates as a functional food and pharmaceutical applications. To commercialize these materials in industrial level required large quantity in high-purity level, and it is complicated to produce huge quantity from the marine resources due to insufficient raw materials, unavailability of raw materials through a year, hinder the growth with geographical variations, and availability of compounds in extreme small quantities. The best solution for these issues is to introduce new modern technologies such as artificial intelligence robots, drones, submersibles and automated raw material harvesting vessels in farming industries instead of man power, which will lead to 4th industrial revolution.

The Effect of the Simple Fogarty Thromboembolectomy (단순 Fogarty 혈전색전 제거술의 효과)

  • Oh, Joong-Hwan;Park, Il-Hwan;Lee, Chong-Kookk
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.480-486
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    • 2009
  • Background: The Fogarty thromboembolectomy catheter technique was devised to extract distal arterial emboli and it represents a milestone for the treatment of patients with acute arterial occlusion since the 1960s. The major causes of arterial occlusion have changed from emboli of a heart origin to atherosclerosis over the past 30 years. Accordingly, questions have been raised about the effectiveness of simple Fogarty thromboembolectomy. Material and Method: During the period from March 1990 through August 2008, 156 patients who requiring Fogarty thromboembolectomy were analyzed. The patients were divided into two groups: those with simple Fogarty thromboembolectomy (Group 1, 79 patients) and those with additional vascular bypass graft surgery (Group 2, 77 patients). The duration of symptoms, the cause of thrombi, admission via the emergency room, a history of acupuncture or misdiagnosis, combined diseases, the anatomic occlusion site and the cause of death were analyzed using T-tests, cross tab tests, Chi square tests and Kaplan-Meier tests, respectively. Result: The mean age was 64$\pm$10 years in the 2 groups. The duration of symptoms (pain) in Group 1 vs Group 2 was 12$\pm$4 days vs 71$\pm$14 days (p=0.001). 50 (63%) patients in Group 1 were admitted via the emergency room vs 18 (23%) patients in Group 2 (p=0.005). Misdiagnosis and the treatment for herniated intervertebral disc or acupuncture were given to, 20 (25%) patients in Group 1 vs 30 (39%) patients in Group 2. Anticoagulation treatment before admission was performed in 22 (28%) patients in Group 1 vs 11 (14%) patients in Group 2. The causes of thrombi were heart disease in, 24 (30%) patients in Group 1 vs 6 (8%) patients in Group 2 (p=0.001), atherosclerosis in 46 (58%) patients in Group 1 vs 67 (87%) patients in Group 2 (p=0.001) and trauma in 9 (11%) patients in Group 1 vs 6 (8%) patients in Group 2. The combined diseases were cerebrovascular accident, hypertension and diabetes mellitus in 22 $\sim$ 37% of the total patients. The occlusion sites were mainly in the iliac and femoral arteries. Endarterectomy was performed in 7 (9%) patients in Group 1 vs 18 (23%) patients in Group 2 (p=0.012). Treatment was successful in 27 (34%) patients in Group 1 and in 40 (52%) patients in Group 2 (p=0.019). Reocclusion occurred in 37(47%) patients in Group 1 vs 20 (26%) patients in Group 2 (p=0.000), Amputation was done in 4 (5%) patients in Group 1 vs 12 (16%) patients in Group 2 (p=0.012) and death occurred in 10 (13%) patients (Group 1) vs 3(4%) patients (Group 2) (p=0.044). Conclusion: The recent past has shown a decline in the effectiveness of simple Fogarty thromboembolectomy with a changing pattern of acute arterial occlusion from a rheumatic heart origin to atherosclerosis. Additional bypass procedures play a role for the treatment of arterial occlusion instead of always performing simple Fogarty thromboembolectomy.

Depression and Coronary Artery Disease(I) : Pathophysiologic Mechanisms (우울증과 관상동맥 질환(I) : 병태생리적 기전)

  • Bae, Kyung-Yeol;Kim, Jae-Min;Yoon, Jin-Sang
    • Korean Journal of Biological Psychiatry
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    • v.15 no.4
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    • pp.275-287
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    • 2008
  • Depression and coronary artery disease are both highly prevalent diseases. Many previous studies suggest that depression is a common comorbid condition in patients with coronary artery disease and has a significant negative impact on the onset, course, and prognosis of coronary artery disease. However, the exact mechanisms that underlie the association between these two diseases remain unclear. Pathophysiologic mechanisms that may explain the effect of depression on coronary artery disease include hypercoagulability, hypothalamus-pituitary-adrenal axis and autonomic nervous system dysregulation, altered inflammatory response. On the contrary, pathophysiologic mechanisms in coronary artery disease that affect depression are less well known. It is also suggested that both diseases may share a common genetic vulnerability. The authors reviewed the literature on the pathophysiologic relationships of depression and coronary heart disease.

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Clinical Manifestations of the Lung Involvement in Behçet's Syndrome (Behçet 증후군에서 폐침범의 임상양상에 관한 고찰)

  • Park, Kwang Joo;Park, Seung Ho;Kim, Sang Jin;Kim, Hyung Jung;Chang, Joon;Ahn, Chul Min;Kim, Sung Kyu;Lee, Won Young
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.5
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    • pp.763-773
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    • 1996
  • Background : Behçet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behçet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behçet's syndrome is a unique clinical feature, differing from other vasculitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behçet's syndrome. Methods: We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behçet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses. Results: 1) The incidence of the lung involvement in Behçet's syndrome was 2%(10/487). The male to female ratio was 8 : 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary aneries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis. Conclusion : Pulmonary vasculitis is a main feature of the lung involvement of Behçet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behçet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

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Surgical Treatment for Multivalvular Heart Disease (중복 심장판막 질환의 외과적 치료)

  • Kim, Jin; Jo, Jung-Ku;Kim, Kong-Soo
    • Journal of Chest Surgery
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    • v.29 no.8
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    • pp.875-882
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    • 1996
  • Multlvalvular heart surgery was performed In 78 cases, in the Department of Thoracic & Cardiovascu far Surgery of Chonbuk national University Hospital from november 1983 to March 1994. There Where 31 men and 47 women. whose ranged from 14 to 63 years. The causes of the valvular lesions were 57 rheumatic origin, 18 degenerative, 1 previous endocarditls, 1 prosthetic valve mal-function. There were 25 double valve replacement with or wit out tricuspid valve repair, i M VR and aortic valve repair, 18 MVR and tricuspid valve repair, 1 MVR and aortic and tricuspid valve repair, 10 AVR and mi- tral valve repair, 1 AVR and tricuspid valve repair, 8 mitral aortic valve repair, 13 mitral and tricuspid valve repair. They were improved mean New York Heart Association functional cldss, from 2.72% 121 Early deaths were 5 cases(6.4%). The cause of death wet'e low cArdiac output syndrome. veritricular tachycardia, massive bleeding and cerebral thromboembolism. All the survivors belonged to New York Heart Association functional class I or ll at discharge. The patients who had had valve replacement operation were medicated with warfarin to maintain the level of 30∼ 50% of normal prothrombin time. During follow-up(93.6%, mean 49.9 months), 2 late deaths were developed. One was due to intracranial hemorrhage and the other congestive heart failure. The pre-operative New York Heart Association Functional class IV was statistically sig ificant operat- ive risk factors(p< 0.05).

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Plateletpheresis: the Process, Devices, and Indicators of Product Quality (혈소판성분채집술: 채집과정, 장비, 성분채집혈소판 질의 지표들)

  • Jang, Chul-Soo;Kim, Sung-In;Kim, Hyun-Kyung;Kweon, Chang-Oh;Kim, Byung-Won;Kim, Dong-Chan;Kim, Yoon Suk;Rhee, Ki-Jong;Ryu, Jae-Ki
    • Journal of Life Science
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    • v.24 no.9
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    • pp.1030-1038
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    • 2014
  • Platelet products are used to treat hemorrhagic or platelet dysfunction diseases. Plateletpheresis involves collecting the platelet components of blood using an apheresis blood-collection system. Various indicators are available for evaluating the qualities of the apheresis platelets. The productivity of platelet collection is evaluated through both the collection efficiency and collection rates. Platelet storage quality can be evaluated in vitro using several indicators, including visual appearance, metabolic activities, volume, platelet count, white blood cell count, microparticles, and various platelet activation markers. Platelet activation markers have been used as indicators of storage quality in various studies. Post-transfusion platelet quality can be evaluated based on the corrected count increment and the percentage of platelet recovery. Although various studies have investigated the aspects of plateletpheresis, no article has systemically presented assessments of the platelet products obtained from different plateletpheresis devices. The present study provides a review of plateletpheresis, including the specifics of the process, the types of devices employed, the platelet quality, the overall efficacy, and the evaluation indicator qualities. Furthermore, the differences in functionality among the different apheresis devices are discussed. Although adverse reactions to the citrate anti-coagulant have been reported, apheresis processing may provide a safer option for donors who are at a high risk for presyncopal or syncopal reactions related to whole blood collection.