• Journal of Chest Surgery
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• 제49권6호
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• pp.427-434
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• 2016

Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. Results: The risk of acute kidney injury was about ${\times}3$ higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.30-39
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• 2017

Objective : To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria. Methods : Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2-7 range of motion (ROM), FSU, and the adjacent segment were also checked. Results : The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were $8.6{\pm}2.3$ and $8.4{\pm}2.0$, and lower level motion values were $8.4{\pm}2.2$ and $8.3{\pm}1.9$. Preoperative and postoperative FSU heights were $37.0{\pm}2.1$ and $37.1{\pm}1.8$. In the group B, upper level adjacent segment motion values were $8.1{\pm}2.6$ and $8.2{\pm}2.8$, and lower level motion values were $6.5{\pm}3.3$ and $6.3{\pm}3.1$. FSU heights were $37.1{\pm}2.0$ and $36.2{\pm}1.8$. The postoperative FSU motion and height changes were significant (p<0.05). The patient's satisfaction rates for surgery were 88.2% in group A and 88.8% in group B. Conclusion : TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient's biomechanical characteristics and economic status should be understood and treated using the optimal procedure.

• 한국컴퓨터정보학회논문지
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• 제28권12호
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• pp.183-189
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• 2023

본 연구의 목적은 리포머를 이용한 스쿼트 운동이 엉덩관절전치환술 환자의 근력, 관절가동범위 그리고 보행 능력에 미치는 영향을 알아보고자 하였다. 본 연구는 G시 소재의 재활병원에 입원 중인 환자 20명을 대상으로 실험을 실시하였다. 중재 방법으로 주 7회 2주간 실험군은 리포머를 이용한 스쿼트 운동을, 대조군은 스쿼트 운동을 시행하였다. 리포머군의 그룹 내 비교에서는 엉덩관절 굽힘, 폄, 벌림 근력에서 유의한 차이가 있었다(p<0.05). 리포머군의 엉덩관절 폄과 벌림의 관절가동범위와 보행에서도 그룹 내 유의한 차이가 있었다(p<0.05). 그룹 간 비교에서는 엉덩관절 폄 근력, 엉덩관절 폄, 벌림 관절가동범위 그리고 보행에서 유의한 차이가 발생하였다(p<0.05).

• Applied Biological Chemistry
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• 제17권3호
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• pp.149-176
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• 1974

팔종(八種)의 치환(置換) diphenyl ether 제초제(除草劑)를 Rayonet 광화학(光化學) 반응기(反應器)를 사용(使用)한 모조환경조건하(模造環境條件下)에서 용액상(溶液相) 광분해(光分解)시켜 그 분해산물(分解産物)에 관(關)하여 연구(硏究)하였다. 시료(試料)로 사용(使用)된 화합물(化合物)들은 300 nm에서 광화학반응(光化學反應)을 일으키기에 충분(充分)한 energy를 흡수(吸收)하였으며 분해산물(分解産物)은 tlc, glc, ir, ms, 그리고 nmr 등(等)에 의(依)하여 확인(確認)하였다. 그 결과(結果)를 요약(要約)하면 C-6989의 용액상(溶液相) 광분해(光分解) : p-nitrophenol이 다량(多量) 생성(生成)됨을 보아 ether결합(結合)의 결렬이 주반응(主反應)이며 치환기(置換基) $NO_2{\rightarrow}NH_2$의 광화학적(光化學約) 환원반응(還元反應)과 $CF_3{\rightarrow}COOH$의 산화반응(酸化反應)도 관찰되었다. p-Nitrophenol의 수중(水中) 광분해(光分解) : quinone(0.28%), hydroquinone(0.66%) 및 p-aminophenol(0.42%)과 비교적(比較的) 소량(少量)의 미지화합물(未知化合物)이 생성(生成)됨을 확인(確認)하였고 모화합물(母化化合物)은 대부분(大部分) 작용(作用)을 받지 않은 채로 존재(存在)하였다. 이들 분해산물(分解産物)의 형성기구(形成機構)는 $n{\rightarrow}{\pi}^*$ 및 여기(勵起)를 거친 nitro-nitrite재배열(再配列) 및 자유기(自由基)에 의(依)한 수소탈취(水素脫取)를 통(通)한 광환원(光還元)으로 추측(推測)되었다. Nitrofen의 용액상(溶液相) 광분해(光分解) : n-hexane중(中)에서는 $NO_2$기(基)의 광환원(光遷元)이 주반응(主反應)이었고 수용액(水溶液) 중(中)에서는 광환원(光遷元) 및 hydroxylation이 ether결합(結合) 결렬 보다 현저하였다. hydroxide ion에 의한 친핵적(親核的) 치환(置換), hydroxyl기(基) 및 소량(少量)이긴 하지만 수소(水素)에 의한 염소(鹽素)의 치환(置換)도 다소 관찰되었다. MO-338의 용액상(溶液相) 광분해(光分解) : n-hexane용액중(中) nitro기(基)의 광환원(光遷元) 반응(反應)과 수용액중(水溶液中)에서의 광환원(光遷元) 및 hydroxylation이 주반응(主反應)이었으며 hydroxyl기(基)와 수소(水素)에 의(依)한 염소(鹽素)의 치환(置換) 및 ether결합(結合)의 결렬도 볼 수 있었다. n-Hexane과 cyclohexane중(中)에서의 MC-4379, MC-3761, MC-5127, MC-6063 및 MC-7181의 광분해(光分解) : nitro기(基)의 광환원반응(光還元反應)과 수소(水素)에 의(依)한 halogen의 치환반응(置換反應)이 주(主)로 일어났다. MC-4379의 수중(水中) 광분해(光分解) : ether결합(結合)의 결렬, hydroxyl기(基)에 의한 carboxymethyl기(基)의 치환(置換), hydroxylation, hydroxyl기(基)에 의한 nitro기(基)의 치환(置換)이 주(主)로 일어났고 광환원(光還元) 및 광염소화반응(光鹽素化反應)도 약간 일어났다. MC-3761의 수중(水中) 광분해(光分解) : ether결합(結合)의 결렬, hydroxyl기(基)에 의한 carboxymethyl기(基)의 치환(置換) 및 hydroxylation이 수반되는 광환원(光還元)이 주반응(主反應)이었다. MC-5127의 수중(水中) 광분해(光分解) : 수소(水素)에 의한 carboxyethyl기(基)의 치환(置換)이 현저 하였고 ether결합(結合)의 결렬, 광환원(光還元) 및 탈염소화반응(脫鹽素化反應)도 약간 관찰되었으며 decarboxyethylation은 decarxy-methylation보다 용이함을 볼 수 있었다. MC-6063의 수중(水中) 광분해(光分解) : ether결합(結合)의 결렬과 탈염소화반응(脫鹽素化反應)이 주(主)로 관찰되었다. MC-7181의 수중(水中) 광분해(光分解) : 수소(水素)에 의한 carboxymethyl기(基)의 치환(置換)과 monodechlorination이 현저하였고 ether결합(結合) 결렬과 hydroxylation도 약간 일어났다. 3-Carboxymethyl-4-nitrophenol의 수중(水中) 광분해(光分解) : 방향족(芳香族) ester에서 흔히 볼 수 있는 광유도(光誘導) Fries rearrangement는 이 화합물(化合物)의 carboxymethyl기(基)에서는 볼 수 없었고 $nitro{\to}nitroso$반응(反應)이 주(主)로 일어났다.

• Journal of Chest Surgery
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• 제17권1호
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• pp.3-11
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• 1984

Prosthetic valve replacement has resulted in marked improvement in the functional status of many patients with valvular heart disease. But valve failure from various causes has necessitated re-replacement of prosthetic valve in some of these patients. This selective group of patients has many inherent problems. This report presents our experience with seven patients who received re-replacement of prosthetic valve in the Seoul National University Hospital from 1981, to 1983. The patients included one woman and six men in the range of 9 and 49 years old. As the first valve operations, there were five MVR using tissue valves, one DVR [Bjork-Shiley and Ionescu-Shiley valve] and one case of modified Bentall operation with composite graft [Ionescu-Shiley valve]. Reoperations on prosthetic valve failure were performed 17 to 54 months after the first operation [mean 34 months]. Amon8 seven patients, there were two cases of prosthetic valve endocarditis and five cases of primary tissue failure. Gross calcification of the xenograft was found in two children with Ionescu-Shiley valve. All except one had relatively successful operative results. The unsuccessful one died intraoperatively from low output syndrome.

• Journal of Chest Surgery
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• 제23권2호
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• pp.236-244
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• 1990

To improve the prognosis of mitral valve replacement surgery, analysis and evaluation of pre and intra operative risk factors will be very much valuable. Author studied 205 cases of mitral valve replacement from Feb 1982 to June 1989 for the risk factors of hospital death. 90 patients were male and 115 were female, and age was from 16 to 59 years, Mitral stenosis dominant lesions were 91 cases and regurgitation 114. Suspected risk factors were NYHA functional class, cardiothoracic ratio, implanted valve type and size, operation time, age and sex, thrombus in left atrium, atrial fibrillation, aortic cross clamping time, left ventricular end diastolic and systolic dimension, nephropathy, hepatopathy and respiratory insufficiency. Statistic analysis was performed by X2 test between survivors and death group. Statistical significances as pre and intraoperative risk factors of hospital death after mitral valve replacement were confirmed in those presence of AF on the EKG, NYHA functional class[>IV], cardiothoracic ratio[>70%], and implanted valve size[>33mm]

• Journal of Chest Surgery
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• 제14권1호
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• pp.17-25
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• 1981

In 1980, 416 cases of open heart surgery were done in this Department with over all operative mortality of 12.3%. 1. There were 288 congenital anomalies consisting of 174 acyanotic and 114 cyanotic varieties, which showed operative mortality of 6.9% and 25.4% respectively. 2. There were 128 cases of acquired lesions, 124 valvular disease and 3 myxoma being the main lesions. 3. There were 128 cases of valve replacement with operative mortality of 7.8%. 4. The most frequently operated anomaly was VSD, 90 pure VSD and 21 cases were associated with one or 2 cardiac anomalies. Over all operative mortality in 111 VSD cases was 8.1% but in 90 pure VSD cases it was 6.7%. 5. Tetralogy of Fallot showed the highest incidence in cyanotic group with 88 cases, consisting of 68 pure and 20 with other cardiac anomalies. Over all mortality in 88 cases was 19.3% but in pure form 16.2%. 6. In 128 valve replacement cases over all mortality was 9.4%. There were 85 mitral, 11 aortic, 2 tricuspid, 21 mitral with aortic, 6 mitral with tricuspid, 3 mitral, aortic, and tricuspid valve replacement cases. For mitral valve replacement operative mortality was 5.9%. 7. Twenty-one cases of babies under 10kg body weight were operated on with over all operative mortality of 28.6%. Sixteen cases of VSD were found with operative mortality of 25%. 8. Among 128 cases of valve replacement 7 were under the age of 15 years and 12 were between 15 and 20 years old. Five pediatric cases underwent mitral valve replacement without mortality, 9 year old boy was the youngest among them. In this Department open heart surgery for infancy and complex anomalies showed still hip operative risk which should be improved in the coming years. For open heart surgery Shiley oxygenators and 2 sets of A-O de-lux 5 head roller pump were utilized exclusively. For valve replacement Ionescu-Shiley bovine pericardial xenografts were mainly used. In pediatric and rural patients Persantin with aspirin regimen was satisfactorily administered for anticoagulation after valve replacement. Routinely Coumadin was administered for one year after valve replacement* In patients who had thrombus on valve sites, chronic atrial fibrillation, and giant left atrium Persantin-Aspirin regimen was used when one year coumadin administration was discontinued.

• 한국콘텐츠학회논문지
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• 제12권3호
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• pp.222-232
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• 2012

본 연구는 슬관절 전치환술을 시행하고 난 후 3주 이내의 환자 24명에게 과제 지향 훈련과 체중 이동 훈련이 정적 균형과 동적 균형에 어떠한 영향을 미치는지 알아보기 위해서 실시하였다. 대상자는 과제 지향 훈련군(실험군) 12명과 체중 이동 훈련군(대조군) 12명을 2그룹으로 무작위 배정하였다. 각 군의 운동 효과를 알아보기 위하여 Gaitview 시스템과 기능적 팔 뻗기 검사를 통해 정적 균형을 측정하였고, Balance 시스템을 이용하여 동적 균형을 측정하였다. 통계 분석은 실험 전과 후의 차이를 알아보기 위하여 대응표본 t검정을 실시하였고, 그룹 간 차이를 알아보기 위하여 독립표본 t검정을 실시하였다. 그 결과 과제 지향 훈련군이 체중 이동 훈련군에 비해 정적, 동적 균형 능력에 유의한 차이를 보였다(p<0.05). 따라서 이번 연구 결과를 통해 슬관절 전치환술을 시행한 조기 환자들에게 과제 지향 훈련이 균형 능력에 효과적이라는 것을 알 수 있었다.

• Journal of Chest Surgery
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• 제38권3호
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• pp.204-213
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• 2005

인공심장판막의 성능 향상과 심장 수술의 발전에도 불구하고 심장판막치환술에 따르는 합병증은 아직도 빈도가 높다. 고려대학교 안암병원에서는 지난 26년간 시행한 심장판막치환술의 임상성적을 분석하였다. 대상 및 방법: 1916년 12월부터 2003년 12월까지 고려대학교부속 안암병원에서 심장판막치환술을 받은 환자 571명을 대상으로 하였다. 결과: 승모판치환술이 304예로 가장 많았고 대동맥판막치환은 122예였으며 대동맥판막과 승모판 동시치환은 111예였다. 47명의 환자가 두번째 수술을 받았으며 그 중 재치환술은 승모판재치환술 31예를 포함하여 38예였다. 조직판막치환군의 $32.5\%$가 재치환술을 받았고 평균 10.2$\pm$3.9년만에 재수술을 받았다. $24.3\%$ (139/571)에서 판막관련 합병증이 나타났으며 뇌경색의 빈도가 가장 높았다. 심방세동이 동반된 환자군의 합병증 발생빈도가 높았고 기계판막을 치환한 환자군에서는 출혈합병증이 많았다. 수술사망률은 $3.68\%$였고 수술사망의 원인은 저심박출증후군이 가장 많았다. 90년 이전의 수술사망률이 이후보다 높았으며 기계판막치환군의 수술사망률이 조직판막치환군보다 높았다. 5년 생존율은 $92.2\%$, 10년은 $85.7\%$로 나타났다. 결론: 심장판막치환술의 수술사망률은 향상되었으며 기계판막치환군에서는 출혈합병증이 많았고 조직판막치환군에서는 재치환술의 빈도가 높았다.

• Journal of Chest Surgery
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• 제20권3호
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• pp.512-519
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• 1987

In the department of chest surgery of Pusan National University hospital cardiac valve surgery was done in 118 cases from March, 1982, to June, 1986. Among these, 90 were mitral valve replacement, 9 mitral commissurotomy, 5 mitral valvuloplasty, 4 aortic valve replacement, 4 double valve replacement, 4 mitral annuloplasty, one mitral annuloplasty with commissurotomy and valvuloplasty. 48 were male and 70 were female and age distribution ranged from 6 to 57 years [mean 30.6 years]. Early death within 30 days after operation was 14 cases: 10 had mitral valve replacement, 2 double valve replacement and 2 mitral annuloplasty respectively. Confirmed causes of death were low cardiac output syndrome in 9 cases, congestive heart failure in one case, cardiac tamponade in one case, malfunction of valve in one case, cardiac rupture in one case and renal failure in one case. The 104 cases were followed up for a total 190 years and range was from 2 to 54 months [Mean*SD: 21.9*16.5 months]. During follow-up period, 2 late deaths were developed: one was due to subdural hematoma and the other was congestive heart failure combined with fulminant hepatitis. Anticoagulation therapy was done with warfarin to the level of 20 to 40% of normal prothrombin time in 53 cases, dipyridamole and aspirin in 18 cases, or ticlopidine hcl in 15 cases. The frequency of bleeding due to anticoagulation therapy was 1.0% episodes per patient-years: one was in warfarin group and another was in dipyridamole and aspirin group. Among the studied 102 cases, 93 cases [91.2%] of patients were in NYHA class I or II during follow up period.