• 대한한의학원전학회지
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• 제25권3호
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• pp.127-147
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• 2012

Objective : Methods of Jang Cong-zheng's treatment related to his theories include of promoting the sweating-vomiting-purgation(汗吐下三法), prickling-bleeding method(瀉血療法), and emotional therapy(情志療法). He succeeded Liu wan-su(劉完素) as promoter of fire-heat pattern theory(火熱論), thereby emphasizing six qi(六氣), especially fire(火) and dampness(濕), as pathogens. He suggested that physician should treat patients whose diseases occurred due to fire(火) and dampness(濕) with promoting the sweating(汗)-vomiting(吐)-purgation(下) methods, which would remove pathogen qi(邪氣) and help circulation of qi and blood, therefore getting them back healthy qi(正氣). Method : I will try to describe the Jang Cong-zheng's treatment in "Ru-Men-Shi-Qin", and I would like to explain the sweating-vomiting-purgation(汗吐下三法), prickling-bleeding method(瀉血療法), and emotional therapy(情志療法). Result : For emotional diseases, he suggested that most should be caused by heart fire(心火) so they should be treated with methods of suppressing heart fire and medication would be using cool and cold herbal drugs which lead to clear heart fire. Conclusion : Theories of Zhang zi-he(張子和) can be applied to nurturing for modern world maintaining and improving health by his care methods. People these days suffer usually from excess intake or unbalanced diet problem, so wastes matter and pathogenic qi can be driven out of the human body by applying the sweating-vomiting-purgation methods. His medical theories could contribute to modernization of traditional medicine this way.

• Journal of Chest Surgery
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• 제25권2호
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• pp.149-157
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• 1992

Total 145 cases mitral vlave replacement were performed in Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from May 1983 to July 1991. Sixty-one patients were male and 84 patients were female and the range of age was from 12 to 66 years old with the mean of 37.9[$\pm$11.6] years. Valvular lesions were 49 cases of mitral stenosis, 18 cases of regurgitation and 78 cases of combined lesion. Used valve were Ionescu-Shiley[42 cases], Bjork-Shiley[49 cases], Inact[6 cases], St. Jude Medical[11 cases] and CarboMedics[37 cases]. Mean size of valve was 29.8$\pm$1.68mm. Early morality was 13.8%[20 cases] and low output syndrome was most common cause[9 cases]. Age, functional classification and biventricular hypertrophy were risk factors. All survived cases were followed up without missing. Mean follow up period were 3 years and 3 months. Total 14 cases of death[9.7%] were observed and heart failure, unexplained sudden death and bleeding were the causes in that order. Common late complications were heart failure and bleeding related with anticoagulation. Actuarial survival rate at 5 years was 83$\pm$5.4% in overall, 78$\pm$7.2% in tissue valve group, 87$\pm$6.8% in mechanical valve group. The actuarial freedom rate from thromboembolism at 7 years was 89$\pm$8.3% in overall, 86$\pm$9.9% in tissue valve group and 97$\pm$1.9% in mechanical valve group. Actuarial freedom rate from bleeding at 5 years with anticoagulation was 88.9$\pm$4.2% in overall, 96$\pm$3.9% in tissue valve group, 86$\pm$4.6% in mechanical valve group. Reoperation was done in 3 cases with heart failure with tricuspid regurgitation and thromboembolism in 2 cases. The functional status of survived cases was I or II.

• Journal of Chest Surgery
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• 제23권5호
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• pp.844-853
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• 1990

We have performed 27 cases of orthotopic homologous cardiac transplantation using Korean mongrel dogs and one case of sham operation for the evaluation of harmful effect of cardiopulmonary bypass itself on the dog from April, 1989 to June, 1990. Our previous reports have already demonstrated basal hemodynamic and hematologic data on the canine homologous heart transplantation and the fundamental principles of transplantation of the heart. The mean body weight of recipients was 13.2$\pm$1.2kg with a rage of 11 ~ 15kg, and the hemodynamic and hematologic pictures were almost same as the result of previous reports from our hospital, except marked decrease in postoperative platelet count[from 3.18 $\pm$0.80x106/mm3 to 1.41$\pm$0 37x 106/mm3]. Mean survival time was 24.82$\pm$49.40 hours with the longest survival of 264 hours. Donor cardiectomy included coronary vasodilatation with diltiazem, potassium arrest, and the rapid cooling of the heart suspending in the specially designed ice-bath. Median sternotomy provided excellent exposure of the surgical field. 6 \ulcorner0 prolene suture was used for the anastomosis of both atrial cuffs and the great arteries, and we found the fact that stenosis, bleeding, thrombus formation around the anastomotic site could be decreased with the use of everted horizontal mattress suture techniques. Immunosuppression was done with a combination of lower dose Cyclosporin-A, Azathioprine, methyl-prednisolone, but our cases still showed too short survival to worry about graft rejection. Still poor was our quality control of experimental animal, we had much difficulties in postmortem evaluation of the dogs. Low cardiac output due to biventricular failure, intractable supraventricular or ventricular tachyarrhythmia, postoperative massive bleeding, sepsis were most frequent findings that could be thought as a cause of death. A few cases showed subendocardial patch hemorrhage in both ventricular cavity or atrial septum at autopsy, suggesting acute subendocardial infarction. Although our team overcome most of the technical problems of orthotopic heart transplantation, we should pile up further knowledges about donor heart preservation, quality control of animal, infection, rejection, the effect of the cardiopulmonary bypass to improve the results.

• Journal of Chest Surgery
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• 제6권2호
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• pp.131-142
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• 1973

Studies of cardiopulmonary function and acid-base balance were performed on 29 dogs during control period, during oligemic hypotension and following return of blood to the animals. Intravenous morphine and local anesthesia were used. Fifteen of the 29 animals survived the complete experiment. The 14 animals that failed to survive the experimental period died between 15 to 90 minutes after the onset of bleeding. The results were as follows. 1. The heart rate increased after the onset of bleeding and failed to return to control level following reinfusion. Stroke volume decreased markedly after bleeding and failed to recover after return of blood from the reservoir. Cardiac output also decreased during oligemic hypotension and was maintained at this level after re-infusion. Total peripheral resistance decreased significantly immediately after bleeding, however it increased soon over the pre-bleeding level. Central venous pressure decreased after the onset of bleeding and remained at lower level for the rest of the experimental period. Arterial blood pressure, clown to 40-45 mmHg by acute hemorrhage, was elevated near to control level. Left ventricular work decreased tremendously during oligemic hypotension and failed to return to control level with the re-infusion of blood. Hematocrit value showed no significant decrease after bleeding and increased after re-infusion. Hemoglobin decreased after the onset of bleeding and recovered to control value after re-infusion. 2. The respiratory rate fell rapidly after bleeding from 124 to 29 and remained at this lower level for the remainder of the experiment. The tidal volume increased after bleeding and was maintained at this level for the remainder of the experiment. The respiratory minute volume showed no significant changes throughout the experimental period. Oxygen consumption fell lightly in all animals during oligemic hypotension and returned to normal levels following re-infusion. Arterial oxygen content and arterial oxygen saturation decreased following bleeding and the values returned to normal levels after the return of blood from the reservoir The arterio-venous oxygen difference increased after the onset of bleeding. It failed to return to normal values following re-infusion. Arterial $Pco_2$ decreased in all animals after the beginning of the bleeding. Partial pressure of $Co_2$ continued to fall until re-infusion, after which the values returned toward normal. Animals became acidotic. The pH fell to lower level following bleeding. Lactic acid and lactate: pyruvate ratio also increased during same period. Arterial pH and lactic acid failed to return to control value and lactate: pyruvate ratio increased more after re-infusion. Sodium bicarbonate decreased after bleeding and returned to control value following re-infusion.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.314-317
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• 2007

Ventriculoperitoneal [VP] shunt is a common treatment for hydrocephalic patients. However, complications, such as shunt tube occlusion, infection, intracranial hemorrhage, seizure can occur. Of these, intracranial hemorrhage may occur due to intracranial vascular injury or a rapid decrease of intracranial pressure [ICP]. Most of these hemorrhages are subdural hematomas [SDH] while a few are epidural hematomas [EDH]. It is extremely rare for an intracranial hemorrhage to occur due to an extension of the bleeding from an injured extracranial vessel. We report two cases of EDH due to occipital artery injury following VP shunt and extraventricular drainage [EVD].

• 대한전자공학회:학술대회논문집
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• 대한전자공학회 2009년도 정보 및 제어 심포지움 논문집
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• pp.138-140
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• 2009

Hemorrhage shock occupies high rate in trauma patient's mortality and blood pressure is the variance that judges early diagnosis and the effect of remedy. Systolic blood pressure is related to pulse transit time(PTT). PTT means the time that is required to flow from the heart to peripheral artery. PTT is influenced from the length, cross section and stiffness of the blood vessels. It is hard to evaluate the correlation between systolic blood pressure and PTT because they are variable in human body. In this paper, we evaluated the correlation between the systolic blood pressure and PTT in normal and hemorrhage states using standardized rat. PTT is defined as the time differences between the R peak and the peak of pulse wave. The analyzed time differences of ECG and blood pressure are analyzed every 5minutes for 30 seconds when there is before and after bleeding. Before bleeding, systolic blood pressure and PTT are steadily preserved but when the bleeding comes started, systolic blood pressure is declined. However PTT was increased and decreased. Under the circumstance that the standardized rat is controlled by age, the length of the blood vessels, and any disease, it shows that PTT measurement using systolic blood pressure of bleeding is impossible.

• Journal of Chest Surgery
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• 제23권3호
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• pp.438-451
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• 1990

Pneumatic total artificial heart[TAH] has been clinically applied for the purpose of permanent or temporary use followed by cardiac transplantation in the patients with end stage heart diseases. In spite of the good durability of the pneumatic TAH, thrombus formation, bleeding and infection resulted in death. The Tomasu heart, which is a type of pneumatic TAH, was used in this study. This model is a modified Jarvik heart and consists of atrial cuffs, outflow vascular grafts and thin-layer seamless diaphragm type of ventricles. Cardiac outputs of the left artificial heart were measured by Donovan`s mock circulation under variable conditions of driving parameters, and an experimental artificial heart implantation was performed in 4 calves to observe the changes of hemodynamic parameters in early postoperative period and hematologic and bio-chemical changes in a long-term survival case. In the mock circulation test, cardiac output of the heart was increased with the increase of the left atrial pressure and left driving pressure. Maximum cardiac output was obtained at the heart rate of 120 to 130/min and percent systole of 40 to 45Zo under the condition of a constant left driving pressure of 180mmHg and left atrial pressure of 10mmHg. During the first 24 hours of TAH pumping, driving pressure ranged from 178$\pm$5mmHg to 187$\pm$8mmHg for the left heart and from 58$\pm$6mmHg to 78$\pm$28mmHg for the right heart. The Mean arterial pressure significantly increased between 2 and 8 hours after the start of pumping. The survival time ranged from 27 hours to 46 days. The causes of death were respiratory failure in 2 cases, mechanical valve failure in one, and left ventricular outflow obstruction due to thrombus in a 46-day survival case. This study demonstrated that Tomasu artificial heart operated effectively during the first 24 hours of artificial heart pumping, but thrombus formation around the valve holding area was the main problem in long-term survival case.

• Journal of Chest Surgery
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• 제38권4호
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• pp.312-315
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• 2005

심내막 심박조율기 이식 후 도자에 의한 심장 천공으로 출혈이 발생하는 경우는 드물다. 본원에서는 영구 경정맥 심박조율기 이식 후 우심실 천공에 의한 좌측 혈흉이 발생하였던 환자를 경험하였기에 보고하는 바이다. 수술 소견 상 심박조율기 도자가 우심실 천공 후 심낭막과 흉막을 차례로 관통하였으나 혈심낭 소견은 관찰되지 않았다.

• 대한소아치과학회지
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• 제27권2호
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• pp.208-215
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• 2000

선천성 심장질환 환자는 감염성 심내막염에 감수성을 가지고 있고, 치과치료후에 균혈증에 의해서 감염성 심내막염이 발생할 수 있다. 따라서 선천성 심장질환 환자에 있어서 감염성 심내막염을 유발할 수 있는 치과치료를 시행 시에는 예방적항생제의 투여가 추천된다. 1997년 미국 심장학회에서는 감염성 심내막염의 예방을 위한 개정된 지침을 발표하였다. 개정된 지침은 예방적 항생제 투여의 적응증, 항생제의 선택, 투여용량 등에 있어서 이전의 지침과 차이가 있다. 이전의 지침은 출혈을 유발할 수 있는 모든 치과시술에 대해서 예방적 항생제의 투여를 추천하고 있으나 개정된 지침은 술자의 판단에 따라 심한 출혈이 있는 경우에만 예방적 항생제를 투여할 것을 추천하고 있다. 또한 이전의 지침에선 술전과 술후 2회의 예방적 항생제 투여를 추천하였으나 개정된 지침에서는 술후 투여가 없어지고 술전 1회만 예방적 항생제를 투여 할 것을 추천하고 있다. 본 증례는 미국심장학회에서 최근에 발표한 선천성 심장질환 환자의 치과치료시의 예방적 항생제 투여 지침에 따라서 3명의 선천성 심장질환 환아를 대상으로 치과치료 후 그 예후를 관찰한 것이다.

• Journal of Chest Surgery
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• 제18권4호
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• pp.753-758
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• 1985

Hemorrhage is an important complication after operation with cardiopulmonary bypass and sometimes necessitates a further emergency operation. Between July, 1962 and June, 1985, reoperation for hemorrhage was carried out on 81 patients [3.1%] out of a total 2634 patients who had previously undergone cardiopulmonary bypass surgery at the Department of Thoracic and Cardiovascular Surgery, Yonsei University Medical Center. There were 38 males and 43 females, with an average age of 25 years [ranging 6 months to 60 years] and an average body weight of 38 kg [ranging 5 to 77 kg].There were 43 patients of cyanotic heart disease, 32 patients of acquired valvular heart disease, 4 patients of coronary artery occlusive disease, 2 patients of ascending aorta aneurysm and annuloaortic ectasia. The average amount of blood loss in the case of cyanotic heart disease was 71.7140ml/kg, in acyanotic heart disease 45.16.3ml/kg, in acquired heart disease, 56.514.4ml/kg and in coronary artery occlusive disease, 50.618.7ml/kg during first post operative day. But there was no statistical difference [p>0.05]. The mean blood loss below 10 years old was 70.412.1 ml/kg. Those below 10 years old were believed to bleed more than any other group. But there was also no statistical difference [p>0.05]. Indications for reoperation were continued excessive blood loss [74%], cardiac tamponade or hypotension [23%] and radiological evidence of a large hematoma in the thorax and pericardium [2%]. Average bypass time was 2.10.1 hours [ranging 30 minutes to 5 hours]. The interval between operation and reoperation was as follows; less than 12 hours in 49 patients [60%], 12 to 24 hours in 20 patients [25%], 24 to 48 hours in 8 patients [10%], more than 48 hours in 4 patients [5%]. The commonest sites for bleeding were chest wall [36%], heart [34%], aorta [12%], pericardium [6%], thymus [5%] and others [6%]. But no definite source was found in ll patients [31%]. Twenty seven out of 81 patients [31%] had wound problems and 5 patients [6%] were expired. [Mean SEM]. In conclusion, in order to decrease the amount of blood loss after open heart surgery with cardiopulmonary bypass, shortening of bypass time and bleeding control at the wire suture site during chest wall closure were important. If the amount of blood loss was over 45 ml/kg or 8 m/kg/hour, reoperation should be considered as soon as possible. After operating, careful wound dressings were applied to prevent wound problems.