• 한국임상약학회지
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• 제21권2호
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• pp.170-181
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• 2011

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

• 한국임상수의학회지
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• 제30권6호
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• pp.468-472
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• 2013

12연령의 암컷 잡종개 (체중 6.2 kg)가 심한 복부 팽만, 지속적 기침 그리고 운동 불내성을 주증으로 진료 의뢰 되었다. 진단상에 복수, 경정맥 노장, 심한 좌우 심첨부 수축기 잡음 (4/6 단계), 후대정맥 확장을 동반한 전반적 심비대와 좌심방 확장이 관찰되었다. 심장 초음파에서는 퇴행성 이첨판막 그리고 삼첨판막 심내막증과 양심실성 울혈성 심부전이 관찰되었다. 좌우단락의 난원공 개존증 또한 있었다. 좌심실 수축능은 용적 과부하의 정도와 관계되어 떨어져 있었다. 진단적 결과에 기초하여, 본 증례는 ISACHC IIIa 심부전의 이첨판막과 삼첨판막 심내막증이 합병된 난원공 개존증으로 진단되었다. 이 개는 푸로세마이드 (2 mg/kg, q12hr, PO), 피모벤단 (0.3 mg/kg, q12hr, PO)와 스피로노락톤 (1 mg/kg, q12hr)으로 치료되었다. 임상 증상들은 약물 치료 후에 점차적으로 개선되었다.

• Journal of Chest Surgery
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• 제25권1호
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• pp.32-41
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• 1992

From August 1982 to December 1991, 58 consecutive infants with tetralogy of Fallot underwent primary repair. Age ranged from 22 days to twelve months [n=58, 8.7$\pm$2.7 months] and body weight from 3.1 to 13 kilograms [n=58, 7.8$\pm$1.7 kilograms]. Qne infant had absence of the pulmonary valve; one had Ebstein`s anomaly and one had supramitral ring. Thirty-two patients [56%] experienced anoxic spell. Preoperative pulmonary artery indices were measured in 38 cases, ranging 126-552mm2/M2BSA[n=38, 251$\pm$79mm2/M2BSA]. All infants required a right ventricular outflow tract patch; in 41, the patch extended across the pulmonary valve annulus, in 13 of them, monocusps were constructed. All had patch closure of ventricular septal defect. Two infants had REV operation for avoiding injury to the canal branch of the right coronary artery which cross the right ventricular out flow tract. Post repair PRV/LV were measured at operating room in 40 cases, which revealed mean value of 0.49$\pm$0.12 [range: 0.25-0.74]. The hospital mortality was 10.3% [6 patients], and causes of deaths were right heart failure due to sustained right ventricular hypertension[4] and right ventricular outflow tract obstruction, intractablesuraventricular tachyarrhythmia[1], hypoxia[1] due to residual right to left shunt across the atrial septal defect in patient associated with Ebstein`s anomaly. All infants were doing well at follow-up from 1 to 101 months[20.6 months /patient, 1, 072 patient-month] Serial postoperative echocardiograms revealed no residual ventricular septal defects and estimated RVOT gradients between 0 and 40 mmHg except 3 cases [50, 50, 60 mmHg]. There were no late deaths and late ventricular arrhythmias or congestive heart failure. Redo operations were done in 2 cases because of residual right ventricular outflow tract obstruction. This experience with infants with tetralogy of Fallot suggests that, if mortality is tolerable, eletive repair of tetralogy of Fallot could be reasonably undertaken during the first year of life, and even better results could be anticipated along with improvement of methods of myocardial protection and postoperative care.

• Journal of Chest Surgery
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• 제14권4호
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• pp.381-387
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• 1981

Fourteen Infants with congenital cardiac anomalies underwent primary surgical Intervention within the first 12 months of life. There were eight patients with ventricular septal defect, two with total anomalous pulmonary venous return [TAPVR], and the remainders with tetralogy of Fallot, transposition of great arteries [d-TGA], Taussing-Bing malformation, and coronary A-V fistula. The age of the patients ranged from 5 to 12 months, with a mean age of 9.9 months. The mean weight was 6.7 Kg [3.8 to 9.5 KS]. Congestive heart failure persisting despite intensive medical treatment was present In 8 patients [56%], and was the most common indication for operation. Early operation was necessary in 5 of these patients [35%], because of failure to thrive and recurrent pulmonary infection. In one patient with TOF, frequent hypoxic spell prompted the necessity for early operation. In cases of VSD, TAP. VR, TOF, and coronary A-V fistula, Intracardiac repair was done with conventional cardiopulmonary bypass, chemical cold cardioplegia, and topical myocardial cooling. Deep hypothermic circulatory arrest with surface induced cooling, followed by core cooling and core rewarming, was employed .for better exposure in the cases of d-TGA and Taussing-Bing malformation. The results were however, not satisfactory. The overall mortality was 28 per cent. There were no deaths in the eight patients with VSD. The one with coronary A-V fistula survived. The other 5 cases all expired either on the table or immediately after operation. The non-fatal post-operative complications included low cardiac output, respiratory insufficiency, bleeding, and temporary A-V block. The causes of death were prolonged circulatory arrest time in d-TGA, complete A-V block and low cardiac output in TOF and Taussing-Bing malformation and prolonged bypass time and Inadequate correction in TAPVR.

• Journal of Chest Surgery
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• 제14권4호
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• pp.388-398
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• 1981

Fourteen Infants with congenital cardiac anomalies underwent primary surgical Intervention within the first 12 months of life. There were eight patients with ventricular septal defect, two with total anomalous pulmonary venous return [TAPVR], and the remainders with tetralogy of Fallot, transposition of great arteries [d-TGA], Taussing-Bing malformation, and coronary A-V fistula. The age of the patients ranged from 5 to 12 months, with a mean age of 9.9 months. The mean weight was 6.7 Kg [3.8 to 9.5 KS]. Congestive heart failure persisting despite intensive medical treatment was present In 8 patients [56%], and was the most common indication for operation. Early operation was necessary in 5 of these patients [35%], because of failure to thrive and recurrent pulmonary infection. In one patient with TOF, frequent hypoxic spell prompted the necessity for early operation. In cases of VSD, TAP. VR, TOF, and coronary A-V fistula, Intracardiac repair was done with conventional cardiopulmonary bypass, chemical cold cardioplegia, and topical myocardial cooling. Deep hypothermic circulatory arrest with surface induced cooling, followed by core cooling and core rewarming, was employed .for better exposure in the cases of d-TGA and Taussing-Bing malformation. The results were however, not satisfactory. The overall mortality was 28 per cent. There were no deaths in the eight patients with VSD. The one with coronary A-V fistula survived. The other 5 cases all expired either on the table or immediately after operation. The non-fatal post-operative complications included low cardiac output, respiratory insufficiency, bleeding, and temporary A-V block. The causes of death were prolonged circulatory arrest time in d-TGA, complete A-V block and low cardiac output in TOF and Taussing-Bing malformation and prolonged bypass time and Inadequate correction in TAPVR.

• Journal of Chest Surgery
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• 제30권9호
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• pp.941-944
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• 1997

폐경색은 임상적으로나 방사선학적으로 폐암, 폐출혈, 울혈성 무기폐, 단순괴사와 감별이 힘든 질환으로 흉부외상과 관련되어 보고된 예는 없다. 환자는 45세 남자로 약 3주전 흉부외상에 의한 우측의 다발성 늑골골절과 쇄골골절로 치료를 받아오 다가 증상이 점점 악화되어 본원에 전원된 후 우상엽 절제술을 받았으며, 조직검사 결과 폐경 색으로 진 단되었다. 전원 당시 흉부의 컴퓨터 단층활영상 우상엽에 거대한 종괴음영이 있었고, 양측 폐야에 5개 정도의 작 은 결절상 음영이 있었으나 폐 생검에서 암세포는 발견되지 않았고, 우상엽 절제술 당시 대부분의 작은 결절들은 자연 소실되어 있었다 절제된 우상엽에서 육안적으로 인지되는 혈전은 보이지 않았고, 조직검사상 주로 폐동맥의 분지인 0.6 ∼2.0 mm 정도의 근형 동맥들이 혈전에 의해 폐쇄되어 있었으며 일부는 더 진행하여 기질화를 보이거나 혈류의 재소통이 이루어진 곳도 관찰되었다.

• 한국임상수의학회지
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• 제29권5호
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• pp.416-421
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• 2012

10살령의 4 kg 암컷 치와와가 심한 울혈성심부전의 수술적 치료를 위해서 내원하였다. 여러 가지 진단을 통해 이 환자는 심한 이첨판 폐쇄부전과 중등도의 삼천판 폐쇄부전이 확인되었다. 약물에 대한 치료적인 반응이 여의치 않아, 수술적으로 이첨판을 교정하는 치료방법으로 지시되었다. 체외순환을 이용한 심폐순환기하에서 이첨판교정술이 실시되었다. 하지만 이 환자는 교정 후에 마취에서 회복되지 못하고 사망하였다. 심장수술에 있어 실패를 유발하는 여러 가지 원인들에는 심폐순환기 운용, 저체온증, 장기부전, 출혈, 저혈압, 전해질과 산-염기 불균형, 그리고 감염 등이 있다. 비록 이 환자는 사망하였지만, 그 원인을 밝혀 내는 일은 수의학 분야에서 중요한 일이다. 이 증례의 사망원인을 고찰해 본 결과, 심한 저체온증에 의한 가스환기와 산소공급의 이상 그리고 심장수술과 관련한 저심박출량 증후군으로 인한 낮은 심박동수를 동반한 저혈압으로 사망한 것으로 생각되었다. 이 증례의 원인 규명을 위한 고찰은 이첨판성형술의 성공을 위해서는 좀더 세심한 주의가 요구됨을 알 수 있게 해주었고, 나아가 앞으로의 수술에서 성공률을 높일 수 있는 중요한 계기가 될 것이다.

• Journal of Chest Surgery
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• 제14권1호
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• pp.49-59
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• 1981

This is one case report of surgically treated partial atrioventricular canal. The 22 year-old male patient had no definitive history of frequent respiratory infection and cyanosis in his early childhood. Since his age of 7 years, dyspnea was manifested on exertion. First appearance of congestive heart failure was at his age of 16 years old. The physical examination revealed that the neck veins were distended and heaving of precordium. A thrill was palpable on the left 3rd-4th intercostal space extending from the sternal border toward the apex and Grade IV/VI systolic ejection murmur was audible on it. Neither cyanosis nor clubbing was noted. Liver was palpable about 5 finger breadths. Chest X-ray revealed increased pulmonary vascularity and severe cardiomegaly (C-T ratio = 74%). EKG revealed LAD, clockwise rotation, LVH and trifascicular block. Echocardiogram showed paradoxical ventricular septal movement, narrowed left ventricular outflow tract and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted in large left to right shunt (Qp : Qs = 5.7: 1), ASD and moderate pulfllonary hypertension. Finally, left ventriculogram revealed typical goose neck appearance of left ventrlcalar outflow tract. On Oct. 10, 1980, open heart surgery was performed. Operative findings were: 1. Large primum defect ($6{\times}5$ Cm in diameter) 2. Cleft on the anterior leaflet of mitral valve. 3. The upper portion of ventricular septum was descent but no interventricular communication. 4. Downward attachment of the atrioventricular valves on the ventricular muscular septum. 5. Medium sized secumdum defect ($2{\times}1$ Cm in diameter). The cleft was repaired with 4 interrupted sutures. The primum defect was closed with Teflon patch and the secundum defect was closed with direct suture closure. Postoperatively atrial flutter-fibrillation in EKG and Grade U/VI apical systolic murmur were found. The postoperative course was uneventful and discharged on 29th postoperative day in good general conditions.

• 한국동물위생학회지
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• 제41권3호
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• pp.217-220
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• 2018

A female Russian rat snake, Elaphe schrenckii, was presented for loss of movement. Physical examination showed the swelling in the area of heart. Radiographic examination revealed cardiomegaly, pericardial effusion, and a soft opacity in the area of swelling. Although pericardiocentesis to remove fluid out from the heart as well as vigorous treatments were given to the Russian rat snake, it died during treatments. Postmortem examination confirmed pericardial effusion of pale yellow, translucent fluid with mild dilation of the right atrium and ventricle. Formalin -fixed paraffin embedded tissue sections were stained with routine H&E and the classical von Kossa's method for histopathological demonstration. Histopathological examination revealed multifocal calcification in myocardium and consists of the displacement of muscular fiber by limy deposits. Congestive heart failure was suspicious for the snake when it was alive. In wild reptiles, muscle degeneration has been reported with nutrition disorders but the present case is the first report of myocardial degeneration in a Russian rat snake and contributes to the rare reports of cardiac disease in snakes.

• Journal of Chest Surgery
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• 제27권12호
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• pp.989-994
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• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.