• Journal of Chest Surgery
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• v.35 no.2
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• pp.102-112
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• 2002

This study was undertaken to analyze the outcome of composite valve graftreplacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7 The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21$\pm$14 minutes, 186$\pm$68 minutes, and 132$\pm$42 minutes, respectively. Result: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2 $\pm$ 18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1$\pm$1.9% and 93.2$\pm$5.1%, respectively. Two patients required reoperation for complication of CYGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8$\pm$2.0% and 65.3$\pm$26.7%, respectively.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.583-589
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• 2003

With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. Material and Method: From March 200f to March 2003 at the depart-ment of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, post-operative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. Result: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardio-pulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p< 0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p< 0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). Conclusion: Contamination of pa-tients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.27-33
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• 1997

Retrograde myocardial protection is widely accepted in CABG operation because of the limitations of the antegrade method in the coronary arterial stenosis lesions. We analyzed 76 c ses of retrograde myocardial protection among 96 cases of CABG operation performed between April 1994 and August 1995, There were 48 males and 25 females, and the mean age was 58.2 $\pm$ 8.3 years. 53 patients (70%) were operated for unstable angina, 14 (18%) for stable angina, 6 (8%) for post-infarct angina, 1 (1%) for acute myocardial infarction, and 2()%) for failed PTCA. Preoperative coronary angiography revealed 3-vessel disease in 42 cases, 2-vessel disease in 11, 1-vessel disease in 10, and left main disease in 13 cases. We used SVG(63 cases), LIMA(69 cases), RIMA(11 cases), radial artery(6 cases), and gastroepiploic artery(1 case) for the grafts. Mean anastomosis was 3.2 $\pm$ 1.1. We protected the myocardium with antegrade induction and retrograde maintenance in all the cases except a case of retrograde induction and maintenance. During the aortic cross-clamping, blood cardioplegia was administered intermittently in 19 cases, and continuously in 57 In 39 cases, we used retrograde ardioplegia and antegrade perfusion of RCA graft simultaneously. We had no operative motality. Perioperative complications were arrhythmia in 15 cases, perioperatve myocardial infarction in 10, low cardiac output syndrome In 8, transient neurologic problem in 7, transient psychiatric problem in 6, ARF in 3, bleeding in 2, pneumonia in 2, wound infection in 1, and duodenal ulcer perforation in 1 . In this report, we experienced 76 cases of CABG operation with retrograde myocardial protection under the acceptable operative risk without operative mortality.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1197-1204
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• 1997

Between April 1981 and June 1996, 65 patients had aortic root replacement at our institution. Disease entities were pure aortic annuloectasia in 31 patients(47.7%), Stanford type A aortic dissection with annuloectasia in 8(43.1%), atherosclerotic aneurysm with aortic regurgitation in 4(6.2%), and paravalvular leakage after aortic valve replacement in 2(3.1 %). 34 patients(52.3%) had the clinical stigmata of the Marfan syndrome. The operative procedures were Bentall operation in 61 patients(93.8%); 3 of conventional procedure and 58 of Cabrol's modification, aortic valve-sparing operation in 2(3.1 %), and root replacement with homograft in 2(3.1%). Hospital deaths occurred in 3 patients(4.8%) because of uncontrolled bleeding(1) and bypass weaning failure due to low cardiac output(2), and all had emergency operation with Cabrol's procedure. Postoperative complications developed in 19(29.2%) patients and most of them were transient. Surviving 62 patients have been followed up to cumulative total 315.0 patient-years(mean 60.2 $\pm$42.4 months). Late deaths occurred in 7 patients(11.3%), aneurysmal changes of remaining aorta were detected in 12 patients(19.4%). Actuarial survival rate at 10 years was 72.0 $\pm$ 9.7%, and the subsequent aortic operation-free rate at 10 years was 68.0$\pm$ 8.9% In a multivariate analysis, Marfan syndrome, emergency operation, preoperative dissection, combined arch replacement, and total circulatory arrest emerged as significant risk factors for hospital death or subsequent aortic operation. Over 60 years of age was the only risk factor for late death. Our 16 years'cummulative experience shows that aortic root replacement, mainly by means of Cabrol's procedure, can be applied successfully to variety of aortic root disease. However, long-term follow up will be needed to determine the late result of aortic valve-saving operation and root replacement with homograft. When dissection is present or the distal native aorta is diseased in'Marfan patients, close follow-up is necessary because of the subsequent aneurysmal change of remaining aorta.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.595-601
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• 2003

Background: It has been known that the most effective treatment method of hyperhidrosis is video-assisted thoracoscopic sympathetic nerve block. Postoperative compensatory hyperhidrosis and anhidrosis are major factors that decrease the postoperative satisfaction. Although sympathetic rami have been selectively blocked to decrease the complications, technical difficulties and excessive bleeding have prevented the universal application. Material and Method: Three pre-fixative cadavers were dissected before clinical application. Bilateral sympathetic chains were exposed in supine position after the whole anterior chest wall was removed. Second and third sympathetic rami were blocked using clips. After the sympathetic chains including ganglia were removed, we evaluated the extents of rami block. Twenty-five patients were subjected to the clinical application. Surgeries were performed in semi-fowlers position under general anesthesia and bilateral ventilation. 2 mm thoracoscopy and 5 mm trocar were intro-duced through third and fourth intercostal space, respectively. Second and third sympathetic rami were blocked using thoracoscopic clips. The postoperative complications, satisfaction, and compensatory hyperhidrosis rate were evaluated retrospectively. Result: Sympathetic rami were completely blocked in cadaver dissection study Hyper-hidrosis symptom was improved in all patients without operative complication. Operative time was shorter than that of traditional ramicotomy. All patients, except four, were satisfied with postoperative palmar hyperhidrosis. Com-pensatory hyperhidrosis was more severely happened in fifteen patients (60%). The remaining six patients had no complaint. Two patients had a minimal degree of gustatory hyperhidrosis. Conclusion: This operative method had shorter operative time and less complication rate, compared with traditional ramicotomy Operative success rate was similar to the traditional syrnpathicotorny; lower extent and occurrence rate of compensatory hyperhidrosis. The thoracic sympathetic rami clipping was suggested as an alternative method for treatment of palmar hyperhidrosis.

• Journal of Food Hygiene and Safety
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• v.23 no.4
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• pp.297-303
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• 2008

Naringin, major citrus flavonoids, has been identified to exert antioxidative, antidiabetic, and lipid lowering effects. In this study, we examined the effect of 0.2 g/kg, 0.5 g/kg naringin supplementation for 3 times/week for 5 weeks on lipid metabolism and antithrombotic capacity in rat. Eighteen five week-old Sprague Dawley(SD) female rats, which had initial body weights of $246{\pm}9g$, were randomly divided into three groups: Control (non naringin group); Low (0.2 g/kg naringin-supplemented group); High (0.5 g/kg naringin-supplemented group). Three groups of rats were supplemented with three experimental diets for 5 weeks and we investigated antithrombotic capacity before sacrifice. Naringin did not significantly alter the body weight gain, relative organ weight. However, the level of serum triglyceride, serum free fatty acid, serum total lipid and serum glucose levels were significantly lowered compared to those of control. The high group (0.5 g/kg naringin-supplemented group) was showed significantly increased bleeding time compared to control group. These results suggest that naringin supplemental diets reduces the level of hypertension, glycosuria and fatness on the female SD rats, when orally administered below the dosage 0.5 g/kg for 5 weeks.

• Journal of Embryo Transfer
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• v.20 no.3
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• pp.255-269
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• 2005

This study was aimed to investigate genetic relationships, variables, and correlations between economic traits and metabolic materials in serum components according to bleeding periods and breeding locations for the castrated and not castrated Hanwoo cattle at National Livestock Research Institute. Analysis of variance for serum hormones and metabolic materials showed significant differences by breeding locations except for testosterone and globulin. Statistical differences for serum components were detected by birth year except for cortisol, total protein, globulin and creatinine, and by castration except for total protein and BUN. All the serum components were tended to have sire effects except for testosterone resulting in some degree of additive gene actions. Breeding locations showed statistical significances for carcass weight and back fat thickness, but not in carcass rate, KPH, live weight and transportation weight loss. Effects of breeding locations and castration were significant for all weight measurement periods except for 9 month and 6 month, respectively. A significant sire effect was observed in all weight measurements. Least squared means for concentration of serum components by breeding year, season and castration were not significant. High concentration of cortisol, creatinine and triglyceride and low concentration of IGF-1 and glucose were detected in castrated cattle. Concentration of testosterone with castrated cattle was $5.2\%$ corresponding to non castrated cattle. Estimation of heritabilities of serum components using a sire model with restricted maximum likelihood were ranged 0.07 to 0.58. High heritabilities were estimated for total protein, albumin, globulin, cortisol, creatinine and BUN were 0.53, 0.54, 0.42, 0.45, 0.58 and 0.54, respectively. Low heritabilities were estimated fur calcium, testosterone and IGF-1 for 0.07, 0.15 and 0.12, respectively. Heritabilities for carcass weight, back fat thickness, meat yield index, KPH, and IMF were estimated as 0.39, 0.45, 0.30 0.13, and 0.93. Heritabilities of weights on 18, 12, 9, 6, and 24 month were estimated as 0.78, 0.76, 0.62, 0.58 and 0.58. Estimated heritabilities for average daily gain on 6${\~}$2, 12${\~}$18, and 18${\~}$24 month were 0.80, 0.75 and 0.19, respectively.

• Journal of Veterinary Clinics
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• v.26 no.6
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• pp.539-546
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• 2009

The effect of hemorrhage on the electroencephalogram(EEG) was investigated in fifteen mixed-breed dogs anesthetized with ketamine, propofol and isoflurane. Animals were randomly allocated to three groups (n = 5) by anesthetic agents; group 1 (ketamine 5 mg/kg, IV), group 2 (propofol $156\;{\mu}g$/kg/min, IV) and group 3 (isoflurane 2.0% end-tidal concentration). Medetomidine ($40\;{\mu}g$/kg, IM) was used in all dogs as a preanesthetic agent. Recording electrode for EEG was positioned at CZ. EEG, heart rate, systolic/diastolic blood pressure, $pCO_2$, $pO_2$ and blood pH were measured before anesthesia, after anesthesia and after every bleedings. Three bleedings were accomplished by drawing blood through the femoral artery catheter at a rate of 7 ml/kg (10% of total blood volume) for 10 minutes. In the course of hemorrhage, a systolic/diastolic pressure continuously decreased in all groups. The $pCO_2$ values and heart rates were increased in all groups. The $pO_2$ values were most significantly increased in group 1 compared with those in other groups. The pH values were not significantly changed. On statistical analysis of EEG, there was no significant changes in group 1 and 3. But in group 2, band 3, 4 and 7 were significantly altered after 2nd and 3rd bleeding. Power alterations of band 3, 4 and 7 were thought to be related with hemorrhage over 20% of total blood volume in group 2. In conclusion, the regulation of infusion rate would be considered when a dog, anesthetized with propofol, bleed over 20% of total blood volume.

• Korean Journal of Veterinary Research
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• v.15 no.2
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• pp.147-152
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• 1975

Although considerable research has been done on the blood picture of the horse, hot-blooded and cold-blooded, little work has been made of the blood picture of the army pack horse, Jeju horse. The object of the present investigation was to make good this deficiency, and to suggest standard for the blood picture of army pack horses kept under the regular military training and the ideal feeding in the heart of a mountain. Blood samples were drawn from the jugular vein through a 15-gauge bleeding needle from 41 males and 28 females, aging 3 to 9 years old. It was taken between seven and nine o'clock in the morning. Animals were handled as quietly as possible to avoid any excitation. No restraint other than a halter was used. Enumeration of erythrocyte, total and differential leukocyte count, determination of hemoglobin in blood, and the value of packed cell volume were male in the usual manner, and erythrocytic constant was calculated by the method of Wintrobe. Erythrocyte count was $7.83{\pm}0.20(4.95{\sim}11.05){\times}10^6/mm^3$(SE). This value was much lower than hot-horses, but slightly higer than the values of cold-horse reported from foreign country. Concentration of hemoglobin in blood was $13.0{\pm}0.33(9.5{\sim}17.8)g/100ml$. This value was much higher than that of cold-horses observed by the other authors, approaching to the values of hot-horses. Packed cell volume was $32.1{\pm}0.92(22{\sim}42)ml/100ml$. This vague was a little higher than that of the other cold-horses. Mean corpuscular volume was $41.5{\pm}1.20(26.6{\sim}59.3){\mu}m^3$. This value matched so well with the other results recorded by various investigators. Mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration were $16.9{\pm}0.43(12.3{\sim}25)$ pg and $41.0{\pm}0.45(29.1{\sim}51.1)g/100ml$, respectively. These values were significantly higher than the values found by the other investigations. Total leukocyte enumeration was $10.5{\pm}0.41(5.6{\sim}17.9){\times}10^3/mm^3$, being considered as normal. And differential leukocyte count of neutrophil was $44.5{\pm}2.23(15{\sim}76)%$, $5,527{\pm}234(2,231{\sim}9,144)/mm^3$, of lymphocyte $50.5{\pm}1.19(19{\sim}77)%$, $4,307{\pm}125(1,456{\sim}11,098)/mm^3$, of monocytel (0~4)%, $105(0{\sim}352)/mm^3$, of eosiophil 3.2(0~14)%, $340(0{\sim}1,232)/mm^3$ and of basophil 0.25(0~3)%, $23(0{\sim}236)/mm^3$. The percentage of the differential count obtained from the present work showed a good agreement with the results of various authors. Of the horses examined monocyte was found from 42 horses, eosinophil from 62 horses and basophil from 10 horses. No significant differences recognized between male and female horses, and the effect of age was not observed between three to nine years old. Judging from the blood picture of the present investigation, it could be stated that the army pack horses on training were kept better than the average farming conditions.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.335-342
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• 2003

Background: The aortic arch replacement in an acute aortic dissection is technically demanding procedure that has a lot of postoperative morbidity and high mortality The authors have applied several techniques of aortic arch replacement to overcome the risks of the procedure. Therefore we analysed the results of these techniques. Material and Method: From March of 1996 to July of 2002, we performed 31 cases of the aortic arch replacement in the Stanford type A acute aortic dissection. There were 12 male and 19 female patient's with 59.6$\pm$9.4 years of mean age. Among them 18 cases were treated with the hemiarch replacement and 13 cases with the total arch replacement. We approached the aortic arch through median sternotomy in all but 3 cases of Clamshell incision and applied the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The associated procedures were 2 Bentall's procedures, an axillobifemoral bypass, a femorofemoral bypass and a carotid artery bypass. Result: The postoperative morbidities were 8 acute renal failures, 3 CNS complications, 2 low cardiac output syndromes, 2 malpefusion syndromes, and 2 deep wound infections. There were 4 cases of early hospital mortality which were from an acute renal failure a postoperative bleeding, a low cardiac output syndrome, and a reperfusion syndrome. There were 3 cases of late hospital mortality which were from an acute renal failure, and 2 multiorgan failures. So the total mortality rate was 22.5%. There were 4 cases of late mortality after the discharge, which were form 2 cases of distal anastomotic rupture and 2 cases of intracranial hemorrhage. Conclusion: The hemiarch replacement has relatively shorter operative time and lower hospital mortality but higher late mortality than the total arch replacement. The total arch replacement needs more technically demanding procedure.