• Journal of Medicine and Life Science
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• 제15권2호
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• pp.108-111
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• 2018

Extra-corporeal membrane oxygenation (ECMO) has the potential to rescue patients in cardiac arrest or respiratory failure. ECMO has two systems such as veno-arterial and veno-venous circulation. In cardiac arrest resulting from acute myocardial infarction, veno-arterial ECMO is mandatory for systemic circulation and oxygenation. A 75-year old female patient underwent primary coronary intervention for acute myocardial infarction. Despite successful revascularization, recurrent ventricular tachycardia and heart failure were progressing. We performed a veno-arterial ECMO through the femoral artery and vein, then the patient seemed to be stable clinically. However, laboratory studies, echocardiography, and vital signs indicated multi-organ failure and decreasing cardiac function. We found out an error that we performed veno-venous ECMO instead of veno-arterial ECMO. We added a femoral artery cannula and exchange the circuit system to veno-arterial ECMO. While the systemic circulation seemed to be recovered, the left ventricular function was decreased persistently. A hypovolemia resulting from pulmonary hemorrhage was occurred, which lead to ECMO failure. The patient died of cardiac arrest and multi-organ failure 23 hours after ECMO. Because the color of arterial and venous circuits represent the position and efficacy of ECMO, if unexpected or abnormal circuit colors are detected, prompt and aggressive evaluation for ECMO function is mandatory.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.245-254
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• 2022

Objective : The etiology of angiographically occult spontaneous subarachnoid hemorrhage (AOsSAH) is unclear. Three-dimensional (3D) high-resolution vessel wall magnetic resonance imaging (HVM) might be useful in detecting the hidden arterial wall angiopathy in patients with AOsSAH. We aimed to demonstrate the feasibility of HVM for detecting the arterial cause of AOsSAH. Methods : Patients, who were diagnosed with AOsSAH in the first evaluations and underwent HVM, were enrolled. Their clinical and radiologic data were retrospectively reviewed. Especially, focal enhancement of arterial wall on HVM and repetitive catheterized angiograms were precisely compared. Results : Among 251 patients with spontaneous SAH, 22 patients were diagnosed with AOsSAH in the first evaluations (8.76%). After excluding three patients who did not undergo 3D-HVM, 19 patients were enrolled and classified as convexal (n=2) or perimesencephalic (n=4), and diffuse (n=13) groups. In convexal and perimesencephalic groups, no focal enhancement on HVM and no positive findings on repetitive angiography were noted. In diffuse group, 10 patients showed focal enhancement of arterial wall on HVM (10/13, 76.9%). Repeated angiography with 3D reconstruction revealed four patients of angiographically positive causative arteriopathy and possible lesion in one case in the concordant location of intramural enhancement on 3D-HVM (5/10, 50%). Three of them were treated with endovascular stent insertion. All patients, except one, recovered with good clinical outcome (3-month modified Rankin score, 0 and 1). Conclusion : 3D-HVM was useful in detecting hidden true arteriopathy in AOsSAH. It may provide new insights into the etiologic investigation of AOsSAH by proving information about the arterial wall status.

• 운동영양학회지
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• 제25권1호
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• pp.16-22
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• 2021

[Purpose] Aerobic exercise training (AT) reverses aging-induced deterioration of arterial stiffness via increased arterial nitric oxide (NO) production. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, was decreased by AT. However, whether AT-induced changes in ADMA levels are related to changes in nitrite/nitrate (NOx) levels remains unclear. Accordingly, we aimed to clarify whether the relationship between plasma ADMA and NOx levels afected the AT-induced reduction of arterial stifness in middle-aged and older adults. [Methods] Thirty-one healthy middle-aged and older male and female subjects (66.4 ± 1.3 years) were randomly divided into two groups: exercise intervention and sedentary controls. Subjects in the training group completed an 8-week AT (60%-70% peak oxygen uptake [${\dot{V}}O_{2peak}$] for 45 min, 3 days/week). [Results] AT signifcantly increased ${\dot{V}}O_{2peak}$ (P < 0.05) and decreased carotid β-stifness (P < 0.01). Moreover, plasma ADMA levels were significantly decreased while plasma NOx levels and NOx/ADMA ratio were significantly increased by AT (P < 0.01). Additionally, no sex diferences in AT-induced changes of circulating ADMA and NOx levels, NOx/ADMA ratio, and carotid β-stifness were observed. Furthermore, the AT-induced increase in circulating ADMA levels was negatively correlated with an increase in circulating NOx levels (r = -0.414, P < 0.05), and the AT-induced increase in NOx/ADMA ratio was negatively correlated with a decrease in carotid β-stifness (r = -0.514, P < 0.01). [Conclusion] These results suggest that the increase in circulating NOx with reduction of ADMA elicited by AT is associated with a decrease in arterial stiffness regardless of sex in middle-aged and older adults.

• 대한한방내과학회지
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• 제21권3호
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• pp.377-388
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• 2000

Objective : This study was undertaken to evaluate the effect of Sunghyangchungisan (SHCS) on the regulation of vascular tone and $Ca^{2+}$ metabolism in arterial tissues. Vascular rings isolated from rabbit carotid artery were myographed isometrically in isolated organ baths and the effect of SHCS on contractile activities, endothelial function and $Ca^{2+}$ metabolism were determined. Methods : In phentobarbital sodium-anesthetized rabbits, SHCS administered through ear vein (100 mg/Kg body wt.) or intragastric dwelling tube (300 mg/Kg body wt.) attenuated phenylephrine (PE, 10 ${\mu}g$/Kg, i.v.)-induced increases in both systolic and diastolic cartoid arterial blood pressure. Results : In experiments with isolated arterial strips, SHCS relaxed arterial rings which were pre-contracted by phenylephrine (PE, 1 ${\mu}M$). The responses to SHCS were partially dose-dependent at concentrations lower than 0.5 mg/ml. When SHCS was applied prior to the exposure to PE, it inhibited the PE-induced contraction by a similar magnitude which was comparable to the relaxation of pre-contracted arterial rings. Washout of SHCS after observing its relaxant effect resulted in a full recovery of PE-induced contractions, indicating that the action mechanism is reversible. The observation that SHCS did not change the $ED_{50)$ of PE oh its dose-response curve ruled out the possible interaction of SHCS with ${\alpha}$-receptors. The relaxant effect of SHCS was not affected by removal of endothelium or a nitric oxide synthase inhibitor, L-NAME. Methylene blue, an inhibitor of the soluble guanylate cyclase, did not affect the relaxant effect of SHCS. These results suggest that the action of SHCS is not mediated by the endothelium nor soluble guanylate cyclase. Constant cGMP production determined in arterial strips in the presence or absence of SHCS is consistent with this conclusion. When contraction was induced by additive application of $Ca^{2+}$ in arterial rings which were pre-depolarized by high $K^+$ in a $Ca^{2+}$-free solution, the relaxant effect of SHCS was attenuated by increasing the $Ca^{2+}$ concentration. SHCS, when applied to the arterial rings pre-contracted by PE and then relaxed by nifedipine, a $Ca^{2+}$ channel blocker, did not show additive relaxation. SHCS partially blocked $Ca^{2+}$ influx stimulated by PE and high $K^+$ which was determined by 5-min ^{45}Ca$ uptake, while it did not affect $Ca^{2+}$ efflux. Conclusions : From above results, it is suggested that SHCS relax PE-induced contraction of rabbit carotid artery in an endothelium independent manner, andinhibition of $Ca^{2+}$ influx may contribute to the underling mechanism.

• Journal of Chest Surgery
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• 제20권3호
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• pp.439-450
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• 1987

The arterial blood pressure response elicited by stimulating the peripheral afferent fibers of different groups and origins was studied in cats. Experimental animals were anesthetized with a-chloralose [60mg/kg] and artificially ventilated with a respirator. The lumbosacral spinal cord was exposed through a laminectomy and L7 ventral root was isolated. The sural, medial gastrocnemius and common peroneal nerves were also exposed in the hindlimb. The arterial blood pressure was monitored continuously while the exposed peripheral nerves and L7 ventral root were being stimulated. Then, spinal lesions were made on the dorsolateral sulcus area, dorsolateral funiculus and other areas at the thoracolumbar junction. The arterial blood pressure responses were compared before and after making spinal lesions. The following results were obtained. 1. The mean arterial blood pressure was elevated from 103*7.3 to 129*8, 1 [mean*S.E.] mmHg [p<0.001] during stimulation of the sural nerve with C-strength [1000T], 20Hz. Stimulation with Ad-strength, 1Hz resulted in the depression of the arterial pressure by 8 mmHg [p<0.01]. 2. Stimulation of the medial gastrocnemius nerve with Ad-strength did not elicit any significant change in arterial blood pressure. Stimulation with C-strength, 20 Hz induced a pressor response from 102*6.2 to 117*6.4 mmHg [p<0.01] while that with C-strength, 1Hz induced a depressor response from 104*6.1 to 93*4.9 mmHg [p<0.001]. 3. A pressor response by 56 [from 107*7 5 to 163*9.4] mmHg [p<0.001] was induced during stimulation of the common peroneal nerve with C-strength, 20Hz stimuli. Stimulation with A4-strength, 1Hz depressed the arterial blood pressure from 111~9.3 to 94*7.8 mmHg [P<0.005]. The activation of the ventral root afferent fibers with C-strength, 20 Hz stimuli induced a pressor response by 22 mmHg [from 115*9.4 to 137*8.6 mmHg] [p<0.001]. 4. The pressor response elicited during stimulation of the sural nerve was abolished by making lesions on the dorsolateral sulcus area bilaterally. With the medial gastrocnemius nerve, the pressor response had not been abolished completely by the dorsolateral sulcus lesions. The pressor response disappeared completely with addition of the bilateral dorsolateral funiculus lesions. 5. The depressor response induced by stimulation of the sciatic nerve with Ad-strength, 1Hz was decreased by making lesions on the dorsolateral funiculus. 6. From the above results it is concluded that the difference in the blood pressure responses to the activation of the muscular afferent and the cutaneous afferent fibers is responsible for the groups of afferent fibers and the spinal ascending pathways.

• 대한골관절종양학회지
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• 제19권2호
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• pp.50-55
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• 2013

목적: 천골 및 골반골에 발생한 거대세포종에 대한 동맥 색전술의 효용성을 규명하고자 하였다. 대상 및 방법: 1996년 12월부터 2008년 5월까지 연속적 동맥 색전술을 시행한 9예를 대상으로 그 임상 결과 및 동맥 색전술에 대한 거대세포종의 치료 반응성을 후향적으로 분석하였다. 결과: 9예 중 6예에서 거대세포종이 진행되어 연속적 동맥 색전술은 천골 및 골반골 거대세포종 치료에 있어서 효과적인 치료 방법은 아닌 것으로 나타났다. 5예의 경우에서는 수술, 방사선 치료 등의 추가적인 치료를 시행 했음에도 불구하고 거대세포종이 진행되었다. 9예 중 3예에서 거대세포종의 호전 및 완치 소견을 보여, 카이제곱 검정을 통해 이와 관련된 인자들에 대해 분석하였다. 첫 혈관조영술 시행 시 거대세포 종양의 영양 혈관수가 6개 미만인 경우(p=0.048), 측부 순환의 개수가 3개 미만인 경우(p=0.048) 만이 동맥 색전술에 대한 치료 반응성과 연관이 있는 것으로 나타났으며, 첫 동맥 색전술 시행 후 잔존 종양 염색 유무와 반복 시행 횟수는 연관이 없었다. 결론: 천골 및 골반골 거대세포종의 치료에 있어서 연속적 동맥 색전술은 일반적으로 사용될 수 있는 효과적인 치료 방법은 아니나, 첫 혈관 조영술 시행 시 종양의 혈관 분포가 적은 경우에 한해서 시행한 다면 좋은 치료 결과를 기대할 수 있다.

• Journal of Chest Surgery
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• 제16권2호
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• pp.213-220
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• 1983

Pulmonary function is the determinant of blood gas tension. However, Acid-Base disturbances can also alter partial pressures of oxygen and carbon dioxide in arterial blood. During respiratory acidosis $PO_2$ will be lowered and reverse changes will be produced during respiratory alkalosis. On the other hand, in metabolic acidosis $PO_2$ will be elevated and $PCO_2$ will be lowered by the respiratory compensation, and reverse response will be induced in metabolic alkalosis. Urinary gas tension has many influencing factors than arterial blood and difficult to estimate the tendency of its alterations. Urinary $PO_2$ and $PCO_2$ are not always identical level as venous blood. It is to be altered by blood gas tension, flow rate of urine, metabolic rate of kidney, and Acid-Base status of blood. Particularly countercurrent exchange of oxygen and carbon dioxide in the renal medulla will make larger alteration of gas tension than venous blood. After induction of Acid-Base disturbances [disturbances] arterial and urinary $PCO_2$, $PO_2$, urinary volume, and osmolarity were determined in dogs, and the relationships between arterial and urinary $PCO_2$ , $PO_2$ Acid-Base disturbances, urinary volume, and osmolarity were investigated. 1. During the acute Metabolic and Respiratory disturbances urinary pH did not respond on respiratory origin. However, there were immediate urinary response in pH on metabolic origin. 2. Urinary $PO_2$, $PCO_2$, did not always follow arterial or venous gas tension and Acid-Base disturbance. Urinary $PCO_2$, correlate well with the urinary volume. The larger the urinary volume, $PCO_2$ lowered to the venous level. The smaller the urinary volume, urinary $PCO_2$ tends to be higher. However urinary $PO_2$ did not have any particular correlation with urinary volume. 3. Correlation between urinary $PCO_2$ and $PO_2$ were inversely proportional to arterial blood. Differences of $PCO_2$ between arterial blood and urine also did not have any particular correlation with urinary volume. This may suggest that changes on blood gas tensions can influence on urinary $PCO_2$. 4. There were eminent clear inverse correlation between urinary $PCO_2$ and osmolar concentrations of urine. Above results strongly suggest that partial pressure of gas in urine primarily depend upon counter-current exchanges in renal medullary tissues.

• Journal of Chest Surgery
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• 제29권5호
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• pp.477-486
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• 1996

통각정보나 과탄산증이 내재진통계를 활성화 시켜서 진통효과를 가져온다는 것은 잘 알려져 있다. 이 러한 일련의 과정에서 중추신경세포의-역활에 대한 체계적인 연구가 요구되는 바, 16마리의 성숙한 고 양이를 u-chloralose로 마취한 후 연수 및 좌골신경을 노출시켜, 상부연수의 복외측부(rostral ventrolateral medulla, 이후 RVLM으로 칭함)세포활동이 탄산가스분압의 변동에 어떠한 영향을 받는 지를 관찰하였다. RVLM에서 세포의 기록법으로 그 변화를 관찰한 바, 총 53개의 세포에서 자발적 인 활동을 보였고, 이 중 28개는 심맥관계 세포, 16개는 호흡관련 세포, 2개는 심맥관계-호흡 동시 관련 세포이었으며, 7개는 자발적 활동은 보이나 심 장주기나 호흡주기와 무관 하였다. 28개의 심맥관계 세포중 11개에서는 동맥혈내 탄산가스분압이 상승하였을때 세포 활동이 증가하고, 13개 세포에서는 반대로 감소하였으며, 나머지 4개 에서는 특별한 변화가 없었다. 16개의 호흡관련 세포중 9개에서는 동맥혈내 탄산가스분압이 상승하였을때 활동이 증가하고, 6개에 서는 감소하였으며 1개는 특별한 변화가 없었다 B개의 심맥관계-호흡관련 세포에서는 탄산\ulcorner스 분압의 상승에 큰 영향을 받지 않았다. 심 장 혹은 호흡주기와 무관하였던 7개의 세포중 4개는 동맥 혈 탄산가스 분압이 상승하였을때 세포 활 동이 감소하였고, 2개는 상승하였으며 1개는 큰 영향을 받지 않았다 말초신경 자극과 동시에 탄산가스분압을상승시켰을 때 심먹관계 세포의 A반응은큰 영향이 없었으 나 C반응은 상승하였다. 결론적으로 RVLM에는 동맥혈 탄산가스 분압이 상승하였을 때 활동이 증가하는 세포들이 존재하고, 이때 말초화학 감수기의 영 향보다는 탄산가스가 중추에 직접 작용할 가능성이 크며 과탄산증에 의한 내 재진통작용도 RVLM을 통하지는 않는다고 생각된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.117-128
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• 2006

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. Many studies has been published in microvascular anastomosis with histologic effect for irrigating solution. But local irrigation solution has been used clinically in microvascular anastomosis, the comparison with each solution, microhistological study for endothelial cell repair and vascular patency has not been reported. The heparin which is anti-thrombotic agent, and urokinase which is fibrinolytic agent are used for this study. Vascular patency and thrombus formation in experimental micro-arterial anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-arterial anastomosis, equal effects of good vascular patency were obtained in group of local irrigation with heparin and urokinase. 2. In thrombus formation in 7 days after micro-arterial anastomosis, equal effects of minimal thrombus formation were obtained in group of local irrigation with heparin and urokinase. 3. In toluidin blue staining in 7 days after micro-arterial anastomosis, local destruction of endothelial cell and inner elastic lamina were seen and endothelial repair was not seen. 4. In scanning electron microscope examination in 7 days after micro-arterial anastomosis, endothelial cell was not seen in peripheral to suture materials, thrombus associated fibrin network was observed. 5. In transmission electron microscope examination in 7 days after micro-arterial anastomosis, inflammatory cell was seen within smooth muscle cells in site of endothelial cell destruction, smooth muscle cell around suture material were arranged irregularly, some collagenous change were seen. From the results obtained in this study, same results of good vascular patency and anti-thrombotic effect of heparin and urokinase were obtained as a local irrigation solution, and repair of endothelial cell was not seen in 7 days after micro-arterial anastomosis.

• Journal of Chest Surgery
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• 제38권8호
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• pp.551-556
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• 2005

배경: 완전 동맥 무인공 심페 바이패스 관상동맥우회술(OPCAB)에서 하나 혹은 두 개의 동맥 이식편을 사용한 연쇄 문합(Sequential graft)의 결과는 우수한 것으로 보고되고 있다. 하지만 충분하지 않은 이식편의 길이나 관류저하, 이식편의 굴절, 이식편의 부자유스런 경로 등이 문제점이 될 수 있다. 이러한 문제점들을 해결하기 위해 연쇄 문합대신 다중 복합 Y동맥 이식편(Multiple Y composite Graft)을 사용했으며 이방법의 유용성과 임상적 결과를 분석하였다. 대상 및 방법: 2003년 2월부터 2004년 10월까지 다중 복합 Y동맥 이식편을 이용한 완전 동맥 무인공 심폐 바이패스 관상동맥우회술을 시행 받은 71명의 환자를 대상으로 하였으며, 사용한 동맥은 좌, 우내유동맥과 요골동맥이었다. 대부분 좌내유동맥을 inflow 동맥으로 사용했으며, 그 외 좌, 우내유동맥을 동시에 혹은 우내유동맥을 inflow동맥으로 사용하였다. 모든 동맥을 획득한 후 요골동맥은 원위 문합 부위에 맞게 길이를 측정하여 원위부 문합 수에 따라 분절로 나누었다. 그 중 하나를 내유동맥에 Y 문합하고, 다른 요골동맥 분절은 이미 문합한 요골동맥 이식편에 다시 Y문합하는 방법으로 다중 복합 Y동맥 이식편을 완성하였다. 완성된 이식편을 각각의 원위부 문합 부위에 end to side형태의 문합을 시행하였다. 수술 후 총 61명 의 환자에서 multi-slice컴퓨터 단층촬영을 시행하여 이식편의 개통률을 조사했다. 결과: 환자들의 평균나이는 $61.6\pm9.4$세(34$\sim$79세)였고 이 중 57명이 남자였다. 평균 $2.5\pm0.6$개의 동맥이 사용됐으며 $3.7\pm0.7$개의 원위부 문합을 시행하였다. 수술 후 심근경색이나 저관류증과 같은 심각한 합병증이나 사망한 환자는 없었다. 수술 후 평균 CK-MB치는 $17.4\pm29.7\;IU/L$였다. 전체적인 이식편의 개통률은 $99.1\%\;(214/216)$(좌내유동맥 $100\%$, 요골동맥. $98.4\%$, 우내유동맥: $100\%$)를 보였다. 결론: 다중 복합 Y 동맥 이식편을 이용한 완전 동맥 무인공 심폐 바이패스 관상동맥우회술을 기술적인 문제점 없이 시행할 수 있었으며, 우수한 초기 임상 결과와 개통률을 보였다. 저자들은 특히 심장의 둔각 모서리 부위의 우회술시에 기존의 연쇄 문합에 비해 기술적으로 더 용이하며 복잡한 관상동맥우회술이 필요한 환자에게도 도움이 될 것으로 생각한다.