• 대한의생명과학회지
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• 제10권4호
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• pp.459-465
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• 2004

The use of hemofiltration has been proposed to reduce excessive body fluid and inflammatory mediators produced during cardiac surgery with cardiopulmonary bypass (CPB) in infants and children. This study was undertaken to evaluate the efficacy of hemofiltration in adult cardiac surgery using (CPB). Twenty adult patients scheduled for elective cardiac surgery were randomly assigned to control group without hemofiltration (n=10) or hemofilter group with hemofiltration during CPB (n=lO). CBC and serum levels of interleukin-6 (IL-6), D-dimer, endothelin-l (ET-1), and cortisol were measured at before the initiation and immediately after the termination of CPB (Pre-CPB and End-CPB, respectively). Clinical data were assessed at postoperative period. In hemofilter group hematocrit was significantly higher (30.04±2.63％ vs 23.30±2.71％, P=0.0014) whereas total leukocyte count was lower than in control group (7.71±1.78×10³/㎣ vs 16.01 ±3.12x10³/㎣, P=0.021) at End-CPB. Increased rate of IL-6 (311.56±97.31％ vs 825.45±102.56％, P=0.012) and D-dimer levels (154.55±89.04％ vs 308.33±157.64％, P=0.026) at End-CPB were significantly less in hemofilter group than in control group. Postoperative blood transfusion in hemofilter group was low compared with that of control group (741.00±38.07 ml vs 1,137.50±169.82 ml, P=0.037). There were no significant differences between two groups in platelet count, ET -1, cortisol, pulmonary index, mechanical ventilation, postoperative blood loss, ICU-stay and hospitalization. Hemofiltration technique applied in the present study provided partly beneficial effect in adult cardiac surgery.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7627-7632
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• 2015

Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5359-5364
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• 2014

Background: To determine surgical outcomes, perioperative complications, and patient outcomes in gynecologic cancer patients undergoing robotic surgery. Materials and Methods: Surgical outcomes, including docking time, total operative time, console time, estimated blood loss (EBL), conversion rate and perioperative complications were retrospectively reviewed in 30 gynecologic cancer patients undergoing robotic surgery. Patient outcomes included recovery time and patient satisfaction, as scored by a visual analogue scale (VAS) from 0-10. Results: The operations included 24 hysterectomies with pelvic lymphadenectomy (PLD) and/or para-aortic lymphadenectomy, four radical hysterectomies with PLD, and two radical trachelectomies with PLD. Mean docking time was $12.8{\pm}9.7min$, total operative time was $345.5{\pm}85.0min$, and console time was $281.9{\pm}78.6min$. These times were decreased in the second half of the cases. There was no conversion rate. Three intraoperative complications, including one external iliac artery injury, one bladder injury, and one massive bleeding requiring blood transfusion were reported. Postoperative complications occurred in eight patients, most were minor. Only one patient had port herniation that required reoperation. Mean hospital stay was $3.5{\pm}1.7days$, and recovery time was $14.2{\pm}8.1days$. Two-thirds of patients felt very satisfied and one-third felt satisfied; the mean satisfaction score was 9.4 +0.9. Two patients with stage III endometrial cancer developed isolated port site metastasis at five and 13 months postoperatively. Conclusions: Robotic surgery for gynecologic cancer appears to be feasible, with acceptable perioperative complication rate, fast recovery time and high patient satisfaction.

• 한국동물위생학회지
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• 제34권2호
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• pp.191-193
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• 2011

A 3-month-old intact male, Labrador retriever was presented with the history of coagulopathy and anemia. The results of initial screening tests of the hemostatic system yielded a tentative diagnosis of hemophilia. Activated partial thromboplastin time (APTT) was distinctly prolonged (106 seconds) and prothrombin time (PT) was not detected due to markedly prolonged test time. Whole blood transfusions (20 me l/kg body weight) were carried out prior to assays of coagulation factor. After transfusion, the patient recovered well and hemorrhage ceased. Blood samples were assessed for coagulation factor activity. The patient showed markedly low factor IX coagulation activity (5%, reference range: 7~140%) and was diagnosed with hemophilia B. After recovery, the patient was discharged from the hospital. However, 4 months later the patient was re-hospitalized for recurrence of the initial symptoms. The owner did not want to pursue further treatment and the patient died of respiratory distress two days later.

• 기본간호학회지
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• 제21권2호
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• pp.162-173
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• 2014

Purpose: This study was done to identify learning experiences and self-confidence and to analyze nursing students' self-confidence according to learning experiences for core nursing skills (CNS). Method: Participants were 502 final year nursing students. Data were collected using a structured questionnaire and analyzed using descriptive statistics and t-test. Results: Over 60% of participants had practiced 15 items of the 24 CNS in the basic nursing lab (BNL). In clinical practice (CP), they had practiced five items but experienced only one item in a simulation lab (SL). Items with the highest confidence level were vital signs (4.69) followed by blood sugar test (4.60), pulse oximeter (4.38), and oral medication (4.12). Items with the lowest confidence level were blood transfusion (2.17) followed by enema (2.64) and indwelling catheterization (2.67). The group with CNS experience in the practice curriculum was generally more confident than the group with no experience. Self-confidences in some skills was significantly different depending on availability of SL, credits for BNL and CP, and presence of preceptors. Conclusion: Results indicate a need to develop practice education strategies such as changing the CP to practice-centered learning with preceptors and including well-designed SL to increase confidence of nursing students.

• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.247-253
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• 2001

Objective : In general, to perform posterior lumbar interbody fusion(PLIF), it has been used more invasive procedure than simple discectomy. However we try to perform PLIF with TFC with smaller invasion almost same as in simple discectomy. This study is about its procedure and clinical results. Materials and Methods : The authors retrospectively analyzed 43 cases of minimally invasive PLIF with TFC from July 1998 to May 2000. Operative procedure, operative complication, change of disc height, blood loss, ambulation time, hospitalization period, clinical success rate, and bony fusion rate were analyzed. Results : 40 patients were capable to walk on the 2nd day of the post-operation. The average hospitalization period is 5.6 days. The average blood loss was 0.19L/level with no transfusion or wound drainage. The height of disc changed from 8.84mm to 13.54mm. Clinical success rate is 95% when evaluated by the Prolo's scale. The complication was delayed wound infection(2) and transient paresthesis(1). The bony fusion was shown in 17 patients (94.4%) out of 18 patients who passed one year. Conclusion : As a result of minimally invasive PLIF, pain was decreased and early ambulation and short hospitalization was possible. Complication was similar or lower than other studies, and the bony fusion rate and clinical success rate were also similar during follow-up.

• 한국동물위생학회지
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• 제45권2호
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• pp.139-143
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• 2022

A 10-year-old, spayed female miniature schnauzer was referred to the Veterinary Medical Teaching Hospital of Chungnam National University due to evaluation of sudden polyuria (PU) and, polydipsia (PD) (540 mL/kg/day) with severe anemia and weight loss. Blood examination results were normal except for severe anemia (hematocrit, [HCT]: 11.8%). Urinalysis revealed a urine specific gravity (USG) of 1.003, whereas urine sediment was not specific. Urine osmolality was 90 mOsm (reference range: 800~2500 mOsm), and plasma osmolality was 303 mOsm. No specific lesions were found using diagnostic imaging including radiography, ultrasonography and magnetic resonance imaging (MRI). The serum cortisol level was normal in cosyntropin stimulation test. Plasma arginine vasopressin (AVP) concentration was <0.4 pg/mL (reference range: 3.49~5.45 pg/mL). Blood transfusion was initiated in addition to an oral prescription of desmopressin acetate (DDAVP, 0.1 mg/head) thrice a day for one week. The patient was rechecked for clinical signs, urine osmolality, and USG; the clinical signs of PU/PD were resolved, urine osmolality increased to 1106 mOsm, and, USG increased to 1.021. Considering the improved clinical signs, and increased urine osmolality, and USG after DDAVP treatment, the dog was diagnosed with central diabetes insipidus. USG and urine osmolality increased to >1.030 and 2200 mOsm, respectively. Anemia also gradually improved and HCT increased to >37%. DDAVP was tapered to 0.1 mg/head twice a day and all clinical signs in the patient have completely resolved.

• Journal of Chest Surgery
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• 제42권3호
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• pp.311-316
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• 2009

배경: 광범위한 clopidogrel의 사용으로 인해 관상동맥우회로술 전 많은 경우에서 clopidogrel 복용 환자들을 경험하게 된다. 그러나 clopidogrel은 그 고유한 약리 작용으로 인하여 술 후 출혈과 관련한 합병증을 일으킬 수 있다. 저자들은 술 전 clopidogre니 사용이 무심폐기하 관상동맥우회로술(off-pump coronary bypass grafting, OPCAB)후의 수혈 요구량, 지혈을 위한 재수술율 및 출혈과 관련한 재입원율 등에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 이 연구는 2005년 1월부터 2007년 11월까지 단일 수술자에 의해 시행된 무심폐기하 관상동맥우회로술을 받은 환자 중, 수술 전 clopidogrel을 복용하고 있던 103명의 환자를 대상으로 하였다. 이 중 clopidogrel을 수술 5일 전에 복용을 중단한 군을 그룹 1 (n=45)으로 하고, 수술 5일 이내에도 계속 복용한 군을 그룹 2 (n=58)로 나누어 출혈과 관련한 재수술율 및 재입원율, 혈액 투여량, 술 후 출혈양 등을 비교 검토하였다. 결과: 두 군 간의 인구학적 특성, 심초음파, 혈액학적인 특성은 비슷하였다. 술 후 출혈양은 통계적으로 유의하게 차이가 나지는 않았지만, 술 후 수혈양은 그룹 2에서 더 많았다(p=0.018). 지혈을 목적으로 한 재수술율과 출혈과 연관된 재입원율은 그룹 1에서는 각각 0%, 0%였고, 그룹 2에서는 6.9%, 5.2%였다. 그러나 두군 간의 통계적인 차이는 없었다. 결론: 무심폐기하 관상동맥우회로술 시행 전 clopidogrel의 계속적인 사용은 술 후 주요한 출혈을 일으키지는 않지만 어느 정도는 출혈에 영향을 주고, 술 후 수혈양은 증가시켰다. 응급인 경우가 아니라면 술 전 clopidogrel을 일정 기간 끊는 것이 술 후 회복에 좋으리라 생각된다.

• 대한수혈학회지
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• 제23권2호
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• pp.115-126
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• 2012

배경: 제대 조직은 간엽줄기세포(mesenchymal stromal cells, MSCs)의 유망한 공급원 중 하나이다. 본 연구에서는 동결 보관한 제대 조직에서 유래한 간엽줄기세포의 특성을 신선 제대 조직에서 유래한 간엽줄기세포와 비교함으로써, 제대 조직을 동결한 보관 후 해동하여 간엽줄기세포를 획득하기 위해 제대 조직의 동결 보관 가능성을 제시하고자 하였다. 방법: 각각의 제대 조직을 두 가지 크기($1{\sim}2mm^3$과 0.5 cm)로 처리하여, 두 가지 동결 보존제(자가제대혈장과 RPMI 1640)를 사용하여 액체질소에 동결 보관하였다. $1{\sim}2mm^3$로 잘게 자른 신선 제대 조직을 대조군으로 하였다. 1주일 후 해동하여 세포 배양하였으며, 0.5cm 크기로 동결 보관한 제대 조직은 해동 후 $1{\sim}2mm^3$로 잘게 세포 배양하였다. 각각의 경우에 수확한 세포의 수와 생존율, 세포 증식능, 세포표면항원을 분석하였으며, 배양액에 존재하는 다양한 성장인자(EGF, IGF-1, PDGF, TGF-${\beta}$, bFGF, VEGF)를 측정하였다. 결과: 11개의 제대를 대상으로 하였다. 자가제대혈장을 동결 보존제로 사용한 경우보다 RPMI 1640을 동결 보존제로 사용한 경우에 세포 획득율이 높았으며, 동결 전에 $1{\sim}2mm^3$로 잘게 잘라 동결 보존한 제대 조직보다는 0.5 cm 크기로 동결하였다가 해동 시 잘게 자른 제대 조직에서 세포 획득율이 높았다. 신선 제대 조직과 동결 제대 조직에서 유래한 세포들 간에 증식능의 차이는 없었다. 신선 제대 조직의 배양액보다 RPMI 1640을 이용하여 동결 보관한 제대 조직의 배양액에 성장인자가 더 많이 존재하였다. 결론: 본 연구 결과, 동결 보관한 제대 조직에서 간엽줄기세포뿐만 아니라 배양액의 성장인자도 얻을 수 있었으며, 제대혈을 동결 보관하는 것처럼 향후에는 간엽줄기세포와 성장인자를 필요한 시점에 얻기 위해 제대 조직을 동결 보관하는 것도 가능해질 것으로 기대된다.