• Journal of Pharmaceutical Investigation
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• v.33 no.4
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• pp.287-292
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• 2003

A novel antitumor agent, antibody-endostatin fusion protein $(anti-HER2/neu\;IgG3C_H3-Endostatin,\;AEFP)$ formed by genetic engineering procedure from antibody (Ab) which specifically targets to tumor cells ad angiogenesis inhibitor, endostatin (Endo) that has excellent antitumor effect, minimizes the toxicity of normal cells and selectively kills only tumor cells. The purpose of this study is to evaluate the phamacokinetic parameters and to analyze the localization of AEFP. After an intravenous injection of $150\;{\mu}l\;(5\;{\mu}Ci)\;[^{125}I]Ab,\;[^{125}I]AEFP$ to mice, blood was collected though retroorbital plexus from 15 min to 2880 min. Following the jugular vein injetion of $150\;{\mu}l\;(10\;{\mu}Ci)\;[^{125}I]Endo$, blood was collected by the use of carotid artery cannulation from 0.25 min to 30 min. Consequently, Endo was very rapidly removed from plasma compartment within 30 min. On the other hand, AEFP similar to Ab was slowly cleared from plasma. Also, Endo was metabolized about 40% within 30 min. However, AEFP was shown to metabolize less than 10% within 2880 min. The organ distribution of Endo was in order kidney, lung, spleen. Both Ab and AEFP were localized in order spleen, kidney, liver. Futhermore the tumor/blood distribution ratio of AEFP at 96 hours after injection is about 20 times higher than it of Endo at one hour after injection. In conclusion, these studies demonstrate that the anti-cancer or suppression of angiogenesis effect of Endo may be improved by the use of AEFP because the longer half life and stability of AEFP is able to selectively target antigens expressed on tumors.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.248-251
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• 2009

Nonocclusive mesenteric ischemia (NOMI) is a rare complication that occurs in about 0.05% of patients after openheart surgery, and NOMI refers to the mesenteric ischemia that's caused by splanchnic vasospasm without occlusion of the great intestinal vessels. In the presently reported case, NOMI developed to maintain the blood flow to the heart and brain after several minutes of a hypotensive status and the latter was caused by acute aortic dissection that complicated an aortic cannulation procedure. Unfortunately, the patient died even though the problems were diagnosed early and proper treatment was administered. Early diagnosis of NOMI by angiography and the selective infusion of vasodilators are thought to be the only way to improve survival for patients with clinically suspected NOMI.

• The Korean Journal of Pain
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• v.31 no.1
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• pp.39-42
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• 2018

Background: Venipuncture pain is an uncomfortable suffering to the patient. It creates anxiety, fear and dissatisfaction. The ketoprofen transdermal patch is a proven treatment for musculoskeletal and arthritic pain. We planned this study to evaluate the efficacy of the ketoprofen patch to reduce venipuncture pain. Methods: Two hundred adult patients, aged 18-60 years, of either sex, ASA grade I or II, were enrolled. Presuming that therapy would decrease venipuncture pain by 30%, a power calculation with ${\alpha}=0.05$ and ${\beta}=0.80$ required enrollment of at least 24 patients into each group. However, 100 patients in each group were recruited. Group I (Control) received a placebo patch; Group II (Ketoprofen) received a 20 mg ketoprofen patch. A selected vein on the dorsum of the patient's non-dominant hand was cannulated with 18 g intravenous cannula 1 h after the application of the respective patch. Assessment of pain was done by a 10 cm visual analogue scale (VAS) of 0-10, where 0 depicts "no pain" and 10 is "the worst imaginable pain". The venipuncture site was assessed for the presence of skin erythema, swelling and rashes at 12 h, 24 h and at the time of decannulation. Results: Incidence of pain was 100% (94/94) in the control group as compared to 93% (85/91) in the ketoprofen group. The severity of the venipuncture pain was 6 (2) and 2 (2) for control and ketoprofen groups respectively (P < 0.05). Conclusions: Application of a ketoprofen patch at the proposed site of venipuncture one hour before the attempt is effective and safe for attenuating venipuncture pain.

• Journal of Chest Surgery
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• v.49 no.3
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• pp.151-156
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• 2016

Background: Survival of children experiencing cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest. Methods: Patients who were <18 years and underwent ECPR between November 2013 and January 2016 were including in this study. We retrospectively investigated patient medical records. Results: Twelve children, median age 6.6 months (range, 1 day to 11.7 years), required ECPR. patients' diseases spanned several categories: congenital heart disease (n=5), myocarditis (n=2), respiratory failure (n=2), septic shock (n=1), trauma (n=1), and post-cardiotomy arrest (n=1). Cannulation sites included the neck (n=8), chest (n=3), and neck to chest conversion (n=1). Median duration of extracorporeal membrane oxygenation was five days (range, 0 to 14 days). Extracorporeal membrane oxygenation was successfully discontinued in 10 (83.3%) patients. Nine patients (75%) survived more than seven days after support discontinuation and four patients (33.3%) survived and were discharged. Causes of death included ischemic brain injury (n=4), sepsis (n=3), and gastrointestinal bleeding (n=1). Conclusion: ECPR plays a valuable role in children experiencing refractory cardiac arrest. The weaning rate is acceptable; however, survival is related to other organ dysfunction and the severity of ischemic brain injury. ECPR prior to the emergence of end-organ injury and prevention of neurologic injury might enhance survival.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.115-118
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• 2007

Purpose: A eutectic mixture of local anesthetics (EMLA$^{(R)}$) cream has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 40 to 60 minutes before the painful procedure. Because of the long application period, EMLA$^{(R)}$ is not useful in the emergency department (ED). The purpose of this study was to determine whether a 20-minute application of 9.6% lidocaine would be useful in reducing the pain of routine peripheral intravenous cannulation in the ED. Methods: We examined 27 male and 19 female patients ages over 18 years of age who required intravenous cannula insertion. Intravenous insertion was performed on 46 patients: 24 patients in the placebo group (mean age: 40.0 years) and 22 in the 9.6% lidocaine group (mean age: 37.6 years). The 9.6% lidocaine or placebo gel was applied and covered with an occlusive dressing for 20 minutes. Pain was scored by the patients using a 0- to 10-cm visual analogue scale. Results: The patients in the 9.6% lidocaine group (mean pain score: 3.4) experienced less pain than those in the placebo group (mean: 5.3), and the difference was statistically significant (p=0.029). Conclusion: We concluded that a 20-minute application of 9.6% lidocaine is safe and effective for reducing pain associated with venipuncture.

• Journal of Chest Surgery
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• v.34 no.9
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• pp.724-728
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• 2001

We report a case of an 8 years and 11 month-old male patient who had developed severe tricuspid insufficiency(TI) after correction of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA). Transthoracic echocardiogram and coronary angiography confirmed ALCAPA, ischemic mitral regurgitation and trivial TI. He underwent direct reimplantation of the left coronary artery to the aortic root by using additional cannulation at the main pulmonary artery for arterial inflow and cardioplegia delivery to the left coronary artery. After the correction of ALCAPA, transesophageal echocardiogram(TEE) revealed good antegrade flow at the aortic implantation site of the left coronary artery and severe TI(Gr III-IV/IV). Cardiopulmonary bypass was reestablished and tricuspid valve was repaired with Kay-type annuloplasty, artificial chordae formation and chordal shortening plasty. The postrepair TEE revealed trivial to mild TI.

• Journal of Korean Neurosurgical Society
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• v.47 no.6
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• pp.415-419
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• 2010

Objective : It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri- or intraventricular tumors without hydrocephalus. Methods : Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. Results : Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. Conclusion : Endoscopic biopsy or resection of peri- or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.108-111
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• 2004

Reoperation on the recurrent aortic aneurysm adjuvent to sternum remains a challenging problem in regard to the risk of the massive hemorrhage at the time of resternotomy resulting from inadvertent entry into the aneurysmal sac. The cardiopulmonary bypass technique of femoral cannulation and deep hypothermic circulatory arrest can provide a safe resternotomy. The left ventricle is likely to distend due to lack of contraction with ventricular fibrillation during core cooling. To prevent ventricular distention during core cooling, sufficient venous drainage is mandatory, We report a technique in which deep hypothermic circulatory arrest is achieved before resternotomy without left ventricular distention by active venous drainage using centrifugal pump.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.25-31
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• 2019

Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.

• Korean Circulation Journal
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• v.48 no.12
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• pp.1120-1130
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• 2018

Background and Objectives: Feasibility of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via left snuffbox approach is still concerned. We aimed to investigate efficacy and safety of the left snuffbox approach for CAG and PCI. Methods: Left snuffbox approach was tried in 150 patients who planned to perform CAG or PCI for suspected myocardial ischemia between 1 November 2017 and 31 March 2018. Results: Success rate of radial artery (RA) cannulation via snuffbox approach was 88.0% (n=132). Among 132 individuals, 58 (43.9%) acute coronary syndrome (ACS) patients were included. The diameter of snuffbox RA was significantly smaller than conventional RA (2.57 mm vs. 2.72 mm, p<0.001) from quantitative computed angiography of 101 patients. However, CAG via snuffbox approach by 6 French sheath was successfully performed in all 132 patients. In addition, there was significant correlation between the snuffbox and conventional RA diameter (r=0.856, p<0.001). In 42 PCI cases, including 25 patients with acute myocardial infarction (AMI), the success rate of PCI via snuffbox approach was 97.6% (n=41). Intravascular imaging-guided PCI was performed in 8 (19.5%) patients and multi-vessel PCI in 4 (9.8%) cases. Regarding vascular complication, forearm swelling with bruising, not requiring surgery or transfusion, occurred in 2 (4.9%) PCI cases. Conclusions: Left snuffbox approach is suitable for CAG and PCI compared with the conventional radial approach.