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Surgical Treatment of Complications after Fontan Operation (Fontan수술후의 합병증에 대한 수술적 치료)

  • 박정준;홍장미;김용진;이정렬;노준량
    • Journal of Chest Surgery
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    • v.36 no.2
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    • pp.73-78
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    • 2003
  • The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.

Relationship Between Adenosine-Induced ST Segment Depression During $^{99m}Tc$-MIBI Scintigraphy and The Severity of Coronary Artery Disease (Adenosine 부하 $^{99m}Tc$-MIBI 심근 관류스캔도중 나타나는 ST절 하강과 관상동맥 질환의 중증도와의 관계)

  • Cho, Jung-Ah;Choi, Chung-Il;Kwak, Dong-Suk;Kim, Jeong-Gyun;Bae, Sun-Kun;Chung, Byung-Cheon;Lee, Jae-Tae;Lee, Kyu-Bo;Kang, Seung-Wan;Woo, Eon-Jo;Kim, Sin-Woo;Sohn, Sang-Kyun;Chae, Shung-Chull
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.2
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    • pp.177-185
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    • 1994
  • Pharmacologic coronary vasodilation in conjunction with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary artery disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress testing with myocardial perfusion imaging. Adenosine is a potent coronary vasodilator with rapid onset of action, short half-life, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocardial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate the relationship between adenosine-induced ST segment depression during $^{99m}Tc$-MIBI myocardial perfusion scintigraphy and the severity of coronary artery disease, we performed $^{99m}Tc$-MIBI imaging after intravenous Infusion of adenosine In 120 patients with suspected coronary artery disease. Of the 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during $^{99m}Tc$-MIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused Intravenously at a dose of 0.14mg/kg per minute lot 6minutes and $^{99m}Tc$-MIBI was injected at 3 minute. We then com-pared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart rate increased $90{\pm}19$ beats/minute in the group with ST depression compared with $80{\pm}16$ beats/minute in the group without ST depression(p<0.05). Baseline systolic blood pressure was significantly higher in the group with ST depression($152{\pm}27$ mmHg) than in the group without 57 depression($140{\pm}21$mmHg, p<0.05). Double product at baseline($10.90{\pm}2.77$ versus $9.55{\pm}2.34\;beats/minute{\times}mmHg$) and during adenosine infusion($12.72{\pm}3.89$ versus $10.83{\pm}2.98\;beats/minute{\times}mmHg$) were significantly higher in the group with ST depression(p<0.05). The incidence of anginal chest pain was also significantly higher in the group with ST depression(ST versus 29%, p<0.0001). The $^{99m}Tc$-MIBI images were abnormal in 23(96%) patients with ST segment depression and 66(69%) patients without ST segment depression(p<0.05). In patients with ST segment depression, there were more reversible perfusion defects than in patients without ST segment depression(83 versus 55%, p<0.05). The number of abnormal segments were significantly higher in the group with ST depression($3.05{\pm}2.01$ versus $1.51{\pm}1.45$, p<0.005). In patients with ST segment depression, there were more segments of reversible perfusion defects than in patients without segment depression($2.15{\pm}2.11$ versus $0.89{\pm}1.24$, p<0.05). There were no differences in the angiographic severity by vessel(p ; NS). We concluded that ST segment depression during $^{99m}Tc$-MIBI myocardial perfusion scintigraphy with Intravenous adenosine is related to the severity of coronary artery disease.

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Synthesis of Cyclen-Based Copper Complexes as a Potential Estrogen Receptor Ligand (에스트로젠 수용체 리간드로서 사이클렌을 기본 구조로 한 구리 착물의 합성)

  • Park, Jeong-Chan;Pandya, Darpan N.;Jeon, Hak-Rim;Lee, Sang-Woo;Ahn, Byeong-Cheol;Lee, Jae-Tae;Yoo, Jeong-Soo
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.4
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    • pp.326-334
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    • 2007
  • Purpose: The estrogen receptor (ER), which is over-expressed in ER-positive breast tumors, has been imaged by positron emission tomography (PET) using $[^{18}F]$ labeled estrogen ligands, especially $[^{18}F]FES$. However, $[^{18}F]$ has relatively short-lived half-life ($t_{1/2}$ =1.8 h) and the labeling yield of radio-fluorination is usually low compared with $^{64}Cu\;(t_{1/2}=12.7\;h)$. 1,4,7,10-tetraazacyclododecane (cyclen) is used to form stable metal complexes with copper, indium, gallium, and gadolinium. With these in mind, we prepared cyclen-based Cu complexes which mimic estradiol in aspect of two hydroxyl groups. Materials and Methods: 1.7-Protected cyclen, 1.7-bis (benzyloxycarbonyl)-cyclen was synthesized according to the reported procedure. After introducing two 4-benzyloxybenzyl groups at 4,10-positions, the benzyloxycarbonyl and benzyl groups were removed at the same time by hydrogenation on Pd/C to give 1,7-bis(4-hydroxybenzyl)-1,4,7,10-tetraazacyclododecane (1). Results: The prepared ligand 1 was fully characterized by $^1H,\;^{13}C$ NMR, and mass spectrometer. The synthesized ligand was reacted with copper chloride and copper perchlorate to give copper complexes $[Cu(1)]^{2+}2(CIO_4^-)\;and\;[Cu(1)Cl]^+Cl^-$ which were confirmed by high-resolution mass (FAB). Conclusion: We successfully synthesized a cyclen derivative of which two phenol groups are located on trans position of N-atoms. And, two Cu(ll) complexes of +2 and +1 overall charge, were prepared as a potential PET tracers for ER imaging.

A Study of the Relationship to the Student's Health Behavior, Belief, Value and Health Service Utilization -With Emphasis on Family Structure and Other Variables- (학생(學生)의 건강행위(健康行爲), 신념(信念), 가치(價値) 및 보건의료(保建醫療) 이용(利用)에 미치는 영향(影響)에 관(關)한 연구 -가족(家族)의 형태(形態) 및 제특성(諸特性)을 중심(中心)으로-)

  • Chung, Yeon Kang
    • Journal of the Korean Society of School Health
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    • v.6 no.1
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    • pp.9-44
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    • 1993
  • An explorative and descriptive study in order to determine the effect of family structure and other socio-demographic variables on health behavior, belief, locus, and value and utilization of public health service was carried out. Data were collected from 1,653 subjects randomly sampled in three areas, Seoul, Kyunggi province, and Cheju province. From Seoul 849 subjects were selected, 397 subjects Kyunggi, and 407 subjects from Cheju, respectively. Self-reporting questionaires were administered during the period from March to June, 1992. The major findings were as follows: 1) The subjects visited herb-doctor's at irregular intervals mainly to have tonic medicine prepared. They preferred herb-doctor's rather than with doctors at clinics and hospitals. Statistically significant difference was found among the regions studied (p<0.05). 2) The reason for visiting hospitals was primarily for treatment of diseases. They preferred hospital because they felt that the hospitals offer much highly reliable treatment services as well as medical accessibility. For the purpose of hospital utilization, statistically significant differences existed among sex, educational level, family type and region. However, no significance was found among sex, educational level, and region (p<0.05). 3) The subjects utilized general hospitals mainly for diagnosis and treatment of diseases. They preferred general hospitals because of their much better facilities and reliability. Statistical significance was found among sex, educational level, and region (p<0.05). 4) The subjects visited dentist at irregular intervals basis. They visited once half a year or three to four months. their purpose of visit was mainly for diagnosis and treatment of diseases. Statistical significance differences were found among educational level, region and economic standard (p<0.05). 5) Whenever their illnesses were mild and the pharmacies was located in nearby they visited to pharmacies. They visited once a month and patient medicines. Statistically significant differences were found among sex, educational level and region (p<0.05). 6) The subjects believed that herb medicine was quite efficacious for treatment of some diseases, particularly by information handed down through time-honored tradition and experience. However, they recognized that the efficacy of folk medicine can vary with type and severity of diseases. Statistical significance was among sex, educational level, region and economic standard (p<0.05). 7) The reason why subjects believed that pray and superstition are effective for treatment of certain type of diseases, particularly in neuropathy, was the belief in God's almighty. Statistically significant differences were found among sex, educational level, regions and economic standard (p<0.05). 8) Most of subjects under same condition preferred western medicine because they believed that it is more scientific and prompts in showing therapeutic effect. Statistical significance was not found in the choice of type of public health service among, regions. But significant differences were found among sex, educational level and region (p<0.05). 9) The subjects looked for pharmacy if they thought the symptom was mild. However, they visited hospitals for chronic disease and general hospitals for emergency treatment. Statistical significances were found among educational level, region and economic standard (p<0.05). 10) Although most of students wanted to have a healthy life as for the component of health standard and value, they think that they are not healthy (p<0.05). As for the health behavior, significant difference was found in the proportion of smoking and drinking between educational level and region (p<0.05). The health locus was affected by educational level, and health behavior was influenced by region, sex and educational level. The utilization of type of public health service was influenced by family type and region, and health belief by region and educational level, and the health values by region and economic standard respectively, most of correlation showed statistical significance. Among them, the highest correlation was seen between locus of control and external/internal locus of control, which is quite obvious. The correlation between health belief and behavior was the next highest, but still low (0.343). All the other variables are low but significant except only a few of those. These findings indicate that health education should be incorporated into the curriculum so as to develop desirable health habit, and ability of self-control in accordance with their growth stages. A systematic and scientific understanding on the herb/folk medicine is needed, and greater reliability of the utilization of public health services are is still required. Health policy for equal distribution of health service throughout the country along the hierarchical health service system and complementary mutual assistance and cooperation among various health organizations are also required.

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Establishment of an Analytical Method for Novobiocin in Livestock Products Using HPLC-UVD (HPLC-UVD를 이용한 축산식품 중 Novobiocin의 시험법 확립)

  • Park, Hee-Ra;Kwon, Chan-Hyeok;Lee, Jong-Goo;Kim, Hyung-Soo;Chae, Young-Sik;Oh, Jae-Ho;Kwon, Ki-Sung
    • Korean Journal of Food Science and Technology
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    • v.44 no.3
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    • pp.263-268
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    • 2012
  • Novobiocin is a coumarin-containing antibiotic, and has a longer half-life in various animals than other veterinary medicines. A simple and rapid high-performance liquid chromatography assay for the determination of residual novobiocin levels in chicken, beef and milk has been developed and validated. The separation condition for HPLC/UVD was optimized by a MG II $C_{18}$ (4.6 mm $ID{\times}250$ mm, 5 ${\mu}m$) column with 0.1% formic acid in $H_2O$/0.1% formic acid in Acetonitrile (40/60, v/v) as the mobile phase at a flow rate of 1.0 mL/min and the detection wavelength was set at 340 nm. Residues were extracted from tissue by blending with methanol. After liquid-liquid partitioning, lipid materials were removed with n-hexane and purification as Silica (1 g, 6 mL) cartridge with 10 mL acetone/dichloromethane (10/90, v/v). Limit of quantification and linearity performed by the analytical method were 0.02 mg/kg and 0.999 ($r^2$), and the recovery range was $88.8{\pm}5.6-100.3{\pm}4.4$, $88.8{\pm}7.2-97.0{\pm}3.2$ and $88.1{\pm}4.3-92.8{\pm}3.6%$. It is expected that this analytical method with regards to novobiocin in chicken, beef and milk could be applied as an official method to administer food safety on veterinary medicines.

In Vitro Plant Regeneration for Mass Propagation of Epimedium koreanum Nakai (삼지구엽초의 다량번식을 위한 기내 식물체 분화)

  • Han, Young-Hee;Choi, Byoung-Ryourl;Soh, Ho-Seob;Lee, Seong-Jae;Choi, Young-Jin;Kim, Se-Young
    • Horticultural Science & Technology
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    • v.18 no.6
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    • pp.834-838
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    • 2000
  • As an endeavor to establish a micropropagation system for Epimedium koreanum Nakai., this study was carried out to define methods to disinfect its explants and media for callus induction, proliferation and plant regeneration. The lowest infection rates by fungi or bacteria on apical and axillary bud explants of rhizome were observed when they were immerged in 0.3% NaOCl solution for 20 min after soaked in 0.1% $AgNO_3$ solution for 30 min, but leaf explants were seldom infected with fungi or bacteria by this disinfectant method. The highest rate of plantlet formation was obtained from the explants disinfected in 0.3% NaOCl solution for 20 min after soaked in 0.1% $AgNO_3$ solution for 60 min for tip buds and in 0.1 % $AgNO_3$ solution for 30 min for axillary buds of rhizome. Induction rate of callus was the highest from the explants disinfectd in 0.3% NaOCl solution for 20 min after soaked in 0.2% $AgNO_3$ solution for 15 min. Callus growth was proper in a modified 1/2 MS medium including half strength of $NH_4NO_3$ with $0.02-0.2mg{\cdot}L^{-1}$ BA and $2.0mg{\cdot}L^{-1}$ NAA. Low rate of plantlet regeneration was obtained in 1/2 UM or 1/2 White medium with $2.0mg{\cdot}L^{-1}$ BA and $0.2mg{\cdot}L^{-1}$ AA.

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Effects of Systematic Variation Application of Fe, Mn, Cu, and Zn on the Dry Matter Yields of Orcharograss and White Clover (Fe, Mn, Cu 및 Zn의 Systematic Variation 시비가 Orchardgrass 및 White Clover의 건물수량에 미치는 영향)

  • Jung, Yeun-Kyu
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.24 no.3
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    • pp.193-200
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    • 2004
  • This pot experiment was conducted to investigate the effects of systematic variation application of Fe, Mn, Cu, and Zn on forage performance of orchardgrass and white clover. The treatments of systematic variation were 0/100, 25/75, 50/50, 75/25, and $100/0\%$ in the Fe/Cu(trial-1), Mn/Zn(trial-2), and Fe+Cu/Mn+Zn(trial-3), respectively. The treatments of Fe/Mn/Cu/Zn(trial-4) were composed of $70\%$ in main element and $10\%$ in other 3 elements, respectively. 1. By the systematic variations of Fe, Mn, Cu, and Zn, the yields were more significantly influenced in white clover than in orchardgrass. In addition, the yields of white clover were closely correlated to the trends of root/nodule growth and flowering. In the Fe/Cu trial, the relatively high yields were obtained at the $100/0\%$ in orchardgrass and at the $75/25\%$ in white clover. The yields of white clover were more negatively influenced by the 100/0(Cu control) than by the 0/100(Fe control). The yields of orchardgrass, however, tended to be opposite to the above trends. 2. In the Mn/Zn trial, both forages showed generally high yields at the high ratios of Mn/Zn. Compared with orchardgrass, the yields of white clover were greatly decreased by the Mn-deficiency(low ratio of Mn/Zn). The effects of Zn on forage yields, however, were not recognized. 3. In the Fe+Cu/Mn+Zn trial, the yields of orchardgrass tended to be slightly different among the treatments. The yields of white clover, however, were relatively' high at the 75/25, and showed a severe decrease at the 100/0 in the 2nd half cuts. In the Fe/Mn/Cu/Zn trial, the yields of white clover tended to be relatively high at the Cu and Zn treatments. It was likely to be caused by the balanced Fe/Mn ratio.

Survey on Quality of Hospice.Palliative Care Programs in Korea (한국 호스피스.완화의료기관 실태 조사)

  • Yun, Young-Ho;Choi, Eun-Sook;Lee, In-Jeong;Rhee, Young-Sun;Lee, Jung-Suk;You, Chang-Hoon;Kim, Hyun-Sook;Paek, Yu-Jin
    • Journal of Hospice and Palliative Care
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    • v.5 no.1
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    • pp.31-42
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    • 2002
  • Purpose : The purpose of this study was to evaluate the present status of hospice palliative care programs in Korea as a basic database for standardization of hospice palliative care. Method : The data was collected from July to October, 2001. The instrument used for this study was the questionnaires which was consisted of the general characteristics of organization, recipient of service, manpower, contents of service, financial conditions and facilities. Sixty-four hospice palliative care programs answered the questionnaires, confirmed by telephone. Results : They were 40 hospital-based hospice palliative care programs and 24 nonmedical hospice palliative care programs. 11 Hospital-based hospice palliative programs have isolated unit or hospital affiliated free standing hospice. 6 Non-hospital hospice palliative programs have a free standing hospice. Major subjects of hospice palliative program were terminal cancer patients but patients with non-terminal illness were also included. Only 24 of 64 hospice palliative programs had all of the essential professionals : physicians, nurses, social workers, and clergies. Home hospice palliative care programs have a referral system in hospital based (89.7%) and nonmedical programs (73.7%). 24hr hospice are were provided in 26 hospital-based (65.0%) and 9nonmedical programs (37.5%). There were rooms for family in half of hospital-based programs. 73.9% of hospice palliative care programs have financial problems. 62.0% of Hospice palliative care programs need financial support from government. Conclusion : 64 Hospice palliative care programs provided hospice palliative services but had many problems in manpower, quality of care and facility. For improving the quality of terminal patients' life and promoting the cost effectiveness of health care resources, it is necessary to consider the standardization and institutionalization of hospice palliative care.

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Metabolism and Pharmacokinetics of Albendazole in Korean Native Cattle (한우에서 Albendazole의 대사 및 약물동태학)

  • Yun, Hyo-in;Park, Byung-Kwon;Park, Kyoung-hwan;Lim, Jong-hwan;Hwang, Youn-hwan
    • Journal of Veterinary Clinics
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    • v.18 no.3
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    • pp.195-200
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    • 2001
  • Metabolism and phamacokinetics of albendazole have been studied in Korean native cattle after oral administration of 5 mg/kg of albendazole. As ABZ is known to be rapidly biotransformed to many metabolites in most animal species, it is very imperative to establish the analytical conditions for its metabolites. LC/MS methods for ABZSO and ABZS $O_2$met every requirement enough to study the metabolism of pharmacokinetics of albendazole in Korean native cattle. The parent drug (ABZ) was only measured at first two time points of 0.5 h and 1h, whereas two metabolites were consistently formed between 0.5 h to 48-72 h post-treatment. Formation kinetics for ABZSO and ABZS $O_2$were similar. Time to peak concentration (Tmax) of ABZ-SO appeared at 12h post-treatment of ABZ, faster than that of ABZS $O_2$at 24h. Cmax of ABZS $O_2$(1.05$\pm$0.05 ug/ml) was 1.09 times higher than that of ABZSO (0.96$\pm$0.15). Elimination half-life of ABZS $O_2$(4.2 h) was much shorter than ABZS $O_2$(7.0h) (p<0.005). ABZSO was detected until 48h post-administration but ABZS $O_2$was measurable even at 72h post-dosing. AU $C_{0longrightarrow{\infty}}$ of ABZSO was smaller than that of ABZS $O_2$. Regimen of ABZ is advised to take into consideration is metabolite profiles, especially that of ABZSO, an active metabolite.

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A Clinical Study about Effectiveness of Essential Oil-Containing Dental Paste in Controlling Oral Malodor (아로마 함유 치약이 구취에 미치는 영향에 관한 임상적 연구)

  • Jeon, Lee-Sun;Kang, Soo-Kyung;Chun, Yang-Hyun;Hong, Jung-Pyo
    • Journal of Oral Medicine and Pain
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    • v.30 no.2
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    • pp.141-148
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    • 2005
  • Since many reports for the influence of the essential oils on the oral microorganism were presented, it is important to use the essential oils in clinical field. At the present day which emphasized the quality of life, oral malodor is one of the serious problems, so we need to try to decrease of oral malodor. This study was designed to make on evidence of the effect of essential oils to oral malodor clinically and to develop on effective treatment for oral malodor by using the dental paste which contains essential oils. 40 dental students volunteered to participate in this study and double blind test was used. At the beginning, all subjects were measured their morning malodor prior to this experiment, at the 3cm posterior to their incisal edge of the oral cavity by Halimeter(Interscan Co. Chatsworth, CA). After that we divided the students in half into two groups A and B. We have supplied different tooth pastes, dental paste A and B, to two groups respectively. The dental paste B contained essential oils which are tea tree, lemon and peppermint. All students used different tooth pastes everyday for 3 weeks. And all students were measured their morning malodor every week with the same method by using Halimeter. This study was resulted that ; 1. The dental paste which contains essential oils has continuously decreased the morning malodor during the whole period of experiments. 2. The number of students with increase in their morning malodor was generally decreased in the group B who used the toothpaste which contains essential oils, compared with the group A who used the toothpaste which didn't contain essential oils on the 2nd and 3rd week of the experiment. 3. In the group B, the average data on increasing rate of morning malodor was less than in the group A. 4. In the 2nd and 3rd week of the experiment, the data on the rate of morning malodor of the group B was generally decreased continuously compared with the group A. These results have statistically significance under 95% confidence interval of the difference.(p$\leq$0.05) As the result, the toothpaste which was containing essential oils was effective in decreasing the morning malodor.