• 한국콘텐츠학회논문지
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• 제8권4호
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• pp.237-246
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• 2008

본 연구는 한국의 사회 문화적 환경과 스포츠 환경들의 생태학적인 타당성을 고려하여 중 고교 양궁선수용 이완훈련 콘텐츠를 개발하고, 이를 현장에 적용하여 그 효과를 검증하는데 목적이 있다. 이완훈련 콘텐츠를 설계 및 개발하기 위해 국내 외 문헌 검토와 기존 훈련 프로그램을 분석하였으며, 스포츠심리학 박사 2인, 양궁 지도자 3인으로 구성된 전문가 회의를 통해 수정 보완과정을 실시하였다. 개발된 이완훈련 콘텐츠의 세부 내용으로는 이완훈련의 기초 교육, 호흡조절법, 근육이완법, 인지 재구성훈련, 명상법, 심박수 바이오피드백훈련, 자생훈련, 행동 수정법, 자기 조절법이다. 연구 대상은 2007년도 양궁 후보선수로 선발된 남 6명(M = 16.45, SD = 2.46)이다. 현장 적용에 대한 효과 검증의 도구로서 경쟁상태불안검사지, 시합 중 선수의 심박수 변화, 양궁 기록, 심층 면담이 활용되었다. 본 연구에서 개발된 이완훈련 콘텐츠의 현장 적용 결과, 신체적 인지적 상태불안이 유의하게 감소하였고, 경쟁 상황 시 이완훈련 실시 전보다 심박수가 낮아졌으며, 면담 결과 신체, 정신적으로 심리적 안정 상태를 느꼈으며 운동 수행에 긍정적인 것으로 나타났다. 결론적으로 본 연구에서 개발된 이완훈련 콘텐츠는 중 고교 양궁 선수의 이완훈련용으로 적합한 것으로 나타났다.

• Journal of Chest Surgery
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• 제27권10호
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• pp.846-849
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• 1994

Extra-anatomic bypass is indicated for the limb salvage of patients with threatened limb loss especially those who have high risk of infection and death after general anesthesia. We did extra-anatomic bypass procedure nineteen times over a seven year, two month period on sixteen patients. Their mean follow up period was 41.3 months. Male to female ratio was 7:1. Major complaints were resting pain[36.8%], claudication[31.6%], cyanosis[15.8%] and ulcerative change[15.8%]. Associated diseases were hypertension, tuberculosis, chronic renal failure, atrial fibrillation, complete heart block and laryngeal cancer. Postoperative patency rates were 76.9% at 1 year, 72.7% at 2 years and 70% at 3 years. Limb salvage rate was 78.9%. Postoperative mortality rate was 10.5%.

• Radiation Oncology Journal
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• 제25권1호
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• pp.34-42
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• 2007

목 적: 국소적으로 진행된 직장암환자에서 수술 전 동시화학방사선요법을 시행한 환자들의 항문 괄약근 보존율과 병기 강하율 등을 분석하고자 후향적 임상 연구를 시행하였다. 대상 및 방법: 2002년 1월부터 2005년 12월까지 조직학적으로 확진된 직장암 환자 중, 병기가 T2 이상이거나 림프절 전이가 있는 환자를 대상으로 하였다. 한림대학교 성심병원 방사선종양학과에서 수술 전 동시화학방사선요법을 시행 받은 36명 중, 본원에서 수술을 시행한 26명을 대상으로 연구를 시행하였다. 환자들은 수술 전 병기결정을 위한 검사를 시행하였고 방사선치료는 CT를 촬영하여 치료계획을 세웠으며 매일 1.8 Gy로 주 5회, 총 방사선 조사량 $45.0{\sim}52.2\;Gy$까지 3차원 방사선치료 방법으로 시행하였으며, 방사선치료 첫째 주와 다섯째 주에 5-FU와 leucovorine을 동시 투여하였다. 수술은 동시화학방사선요법 종료 후 약 $2{\sim}4$주경에 시행하였다. 결 과: 대상 환자의 연령 중앙값은 61.9세($34{\sim}78$)였으며, 남자가 21명, 여자가 5명이었고 추적 관찰 기간의 중앙값은 28개월($11{\sim}44$)이었다. 모든 환자에서 절제연 음성인 근치절제가 가능하였으나 병리적으로 완전 반응을 보인 경우는 없었다. 수술은 3예에서 복회음부 절제술을, 나머지 23예에서 하전방절제술이 시행되어 괄약근 보존율은 88.5% (23/26)였다. 수술 후 병기 강하는 12예로 병기 강하율은 46.2%였으며 19예에서 종양 크기가 감소되어 종양크기 감소율은 73%였다. 국소 재발이 1명, 원격 전이가 3명에서 관찰되었으며 3년 무재발 생존율은 96.7%, 3년 무전이 생존율은 87%, 그리고 3년 무진행 생존율은 83.1%였다. 치료와 관련된 급성 독성으로는 Grade 3 & 4 빈혈 각각 1예, Grade 3 백혈구 감소증 1예, Grade 3 장폐색 1예가 관찰되었다. 결 론: 직장암 환자들에서 수술 전 동시화학방사선요법은 근치적 수술을 시행한 경우 높은 괄약근보존율과 수술 후 병기감소율을 보였으며 치료에 따른 독성도 대부분 경미하고 높은 순응도를 보여 효과적인 방법으로 판단되며 앞으로 많은 환자들을 대상으로 장기간에 걸친 추적 관찰을 요한다.

• Journal of Chest Surgery
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• 제8권2호
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• pp.135-142
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• 1975

Total body perfusion using Sarns Heart-Lung-Machine, five head pump motor system with Travenol disposable bubble oxygenator was attempted in the dogs by the hemodilution method with total prime of buffered Hartman`s solution under moderate hypothermia. The first of all, the functions of Sarns Heart-Lung-Machine and effects of the hemodilution perfusion by buffered Hartman`s solution was studied. At the same time the changes of pressure of artery and vein, gas contents of the blood, and influence on the blood pictures were observed before, during, and after perfusion in 1-2 days. Hemodilution rates were the ranges of 85.0ml/kg to 97.3ml/kg and perfusion flow rates were maintained with the average 80. 5ml/kg/min [the ranges of 73.3ml/kg/min to 92.8ml/kg/min]. Hypothermia was employed between $35^{\circ}C$ and $31^{\circ} of the esophageal temperature. The total body perfusion was continued for 50-60 minutes. In the total cardiopulmonary bypass, atriotomy, ventriculotomy, and atrioventriculotomy were performed respectively. Arterial pressure was ranged approximately between 50 mmHg and 140 mmHg, but generally, it was maintained over 75 mmHg. Venous pressure was measured between 3.8 cm$H_2O$ and 16.0 cm$H_2O$. Optimum oxygenation could be achieved when oxygen flow into the oxygenator was maintained approximately at 5. 5L/min. In this way, the $pO_2$, $pCO_2$, and oxygen saturation were measured before, during, and afterperfusion in 1-2 days. The $pCO_2$ ranged approximately between 26.0 mmHg and 38.5 mmHg, but generally, it was maintained in the average 30.9-32.5mmHg. The $pO_2$ was ranged between 73.0mmHg and 332.2 mmHg, but it was maintained in the average 103.0-219.0 mmHg. Oxygen saturation was measured over 95. 0% during and after extracorporeal circulation respectively. Erythrocyte count, hemoglobin, hematocrit, and leucocyte count were decreased to 49.2%, 49.0%, 49.4%, and 21. 1% of the preoperative value during extracorporeal circulation respectively and these reductions were not recovered until 1-2 days after perfusion. These. resulted from relatively high degree of hemodilution rate and operative bleeding during these experimental studies. The platelets count was also decreased about to 71% during perfusion, on the contrary, it was increased progressively after perfusion and in 1-21 days after perfusion, the value was returned to preoperative contro1 level. Three dogs were all recovered after extracorporeal circulation.

• Journal of Chest Surgery
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• 제4권2호
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• pp.69-80
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• 1971

Total body perfusion using Rygg-Kyvsgaard Heart-Lung-Machine, Mark IV, Polystan was attempted in the dogs by the hemodilution method with total prime of buffered Hartman's solution and under hypothermia. The first of all, the functions of Rygg--Kyvsgaard Heart-Lung-Machine and the effects of the hemodilution perfusion by buffered Hartman's solution was studied. At the same time the changes of blood pressure, oxygen consumption, and influence on the blood pictures were observed before, during, and in 1-3 days after perfusion. Hemodilution rates were the average 74. 22cc/Kg(the ranges of 67 to 81 cc/Kg) and perfusion flow rates were maintained in the mean 62. 6cc/Kg/min., Although it was possible to check up to 87 cc/ Kg/min. The total body perfusion continued for 60-80 minutes. Hypothermia was employed between $36^{\circ}C$ and $32^{\circ}C$ of the rectal temperature. Arterial pressure was ranged approximately between 68mmHg and 149mmHg, but generally, it was maintained over 80mmHg. Venous pressure was measured between 6.5cm $H_2O$and 11.5cm $H_2O$. Optimum oxygenation can be expected when oxygen flow into the disposable bubble oxygenator was maintained approximately at 3.5 L/min .. Inthis way, the oxygen contents were measured in the mean value of 13.11${\pm}$O.56 vol. % of arterial blood and 8.67+1.08 vol.% of venous blood(P${\pm}$0.86 vol.% in arteriovenous oxygen difference and 2. 97${\pm}$0.62cc/Kg in oxygen consumption were calculated. According to these dates, it is as plain as pikestaff that excellent oxygenation and good tissue perfusion was accomplished. Erythrocyte, hemoglobin and hematocrit were decreased about 38% during extracorporeal circulation and these were not recovered until 1-3 days after perfusion. These decrease was resulted from relatively high degree of hemodilution rate and no blood transfusion to compensate during these experimental studies. The platelets were also decreased about 76% during perfusion, but on the contrary, it was increased progressively after perfusion and in 1-3 days after perfusion was returned to the control level. Leucocyte were also decreased during perfusion, but it was increased progessively after perfusion and in 1-3 days after perfusion exceed the control level. This increase was resulted from postoperative infection of the wound, but its analysis were not changed significantly.

• 생명과학회지
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• 제13권1호
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• pp.21-28
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• 2003

본 연구의 목적은 10명의 비만여성을 체지방율에 의해 두 그룹(A:30~35%, B:35~40%)으로 분류하여 여러 동일한 속도(5.5, 6.0, 6.5, 7.0km.$hr^{-1}$)에서 걷기와 달리기 시 에너지 소비율과 심박수, 호흡교환율, 근동원량 등을 비교하는 것이었다. 본 실험결과 트레드밀 속도증가에 따른 산소 소비량은 두 그룹모두 걷기시 비선형적으로 증가하는 경향을 나타내었으나, 달리기 시에는 선형적 증가를 나타내어 두 그룹 모두에서 속도 6.5~7km/hr내에서 걷기의 에너지 소비율이 달리기시보다 높아지는 시점을 나타내었다. 두 그룹간 비교에서 유의한 차이는 나타나지 않았으나 A그룹 보다 B그룹이 다소 낮은 속도에서 걷기의 에너지효율성이 달리기시보다 떨어지는 경향을 보였다. 심박 수의 측정결과에서는 체 지방 율이 높은 그룹이 낮은 그룹보다 높은 심박 수 반응을 보여 체 지방 율이 높을수록 운동스트레스가 커지는 결과를 보였다. 호흡교환율 또한 체 지방 율이 낮은 그룹 보다 높은 그룹에서 운동시 탄수화물의 에너지참여비율이 높게 나타나 대사적 스트레스가 높은 것으로 나타났다. 이상의 결과로써 비만여성에서 걷기와 달리기 시 체 지방 율이 높을수록 대사적 스트레스를 증가시킬 수 있는 것으로 나타났고 에너지 소비 율도 영향을 받음으로써 걷기시 에너지 효율성에 비만인간 차이가 발생될 수 있지만, 이러한 차이는 크지 않은 것으로 생각된다.

• Journal of Chest Surgery
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• 제57권2호
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• pp.169-177
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• 2024

Background: Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods: We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results: All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion: This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.253-257
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• 2023

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.129-134
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• 2015

Background: We hypothesized that ketamine, when administered as the anesthetic induction agent, may prevent cardiovascular depression during high-dose remifentanil administration, unlike propofol. To test our hypothesis, we retrospectively compared the hemodynamic effects of ketamine, during high-dose remifentanil administration, with those of propofol. Methods: Thirty-eight patients who underwent oral surgery at the Nagasaki University Hospital between April 2014 and June 2015 were included in this study. Anesthesia was induced by the following procedure: First, high-dose remifentanil ($0.3-0.5{\mu}g/kg/min$) was administered 2-3 min before anesthesia induction;next, the anesthetic induction agent, either propofol (Group P) or ketamine (Group K), was administered. Mean arterial pressure (MAP) and the heart rate were recorded by the automated anesthesia recording system at four time points: immediately before the administration of high-dose remifentanil (T1);immediately before the administration of propofol or ketamine (T2);2.5 min (T3), and 5 min (T4) after the administration of the anesthetic induction agent. Results: In Group P, the MAP at T3 ($75.7{\pm}15.5mmHg$, P = 0.0015) and T4 ($68.3{\pm}12.5mmHg$, P < 0.001) were significantly lower than those at T1 ($94.0{\pm}12.4mmHg$). However, the MAP values in the K group were very similar (P = 0.133) at all time points. The heart rates in both Groups P (P = 0.254) and K (P = 0.859) remained unchanged over time. Conclusions: We showed that ketamine, when administered as the anesthetic induction agent during high-dose remifentanil administration, prevents cardiovascular depression.

• Journal of Chest Surgery
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• 제35권1호
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• pp.1-10
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• 2002

배경 : 관상동맥 결찰법에 의한 만성 심부전 모델은 실험 사망률이 비교적 높음에도 불구하고 임상적 연관성때문에 지속적인 연구 대상이 된다. 특히 대동물에서 만성 심부전 모델 확립은 소동물에서는 검증할 수 없는 기계 또는 생물학적 순환보조시스템의 연구분석에 대단히 유용하게 사용될 수 있다 이런 관점에서 본연구는 양에서 homonymous artery(사람의 좌전하행지에 해당)와 diagonal branch를 순차적으로 결찰 하는 방법으로 신뢰성 있는 만성 심부전 모델을 확립하고자 하였다. ·재료 및 방법: 모두 9마리의 Corridale 양을 사용하였다. 2마리 양에서 homonymous artery 와 diagonal branch를 동시에 결찰 하였고 7마리에서는 homonymous artery와 diagonal branch를 1시간 간격으로 결찰 하였다. 좌전 개흉술로 심장을 노출시킨 후 심첨부에서 기저부까지의 거리를 기준으로 하여 심첨부에서 40% 위치에서 homonymous artery를 결찰 하였다. diagonal branch는 homonymous artery와 동일한 위치에서 결찰 하였다. 관상동맥 결찰 전, homonymous artery 결찰 후,그리고 diagonal branch 추가 결찰 후 각각 동맥압, 심전도, 그리고 thermodilution catheter로 중심정맥압, 폐동맥압, 폐동맥쐐기압, 심박출량을 측정하였다. 같은 시점에 초음파 검사를 통해 좌심실 이완말기 크기, 좌심실수축말기 크기, 좌심실 구혈률, 좌심실 벽두께, 좌심실 구획단축률과 좌심실 벽운동을 분석하였다. 실험 동물은 2개월 또는 3개월 사육한 뒤 같은 분석 과정을 거친 후 희생시켰다. 실험양의 심장은 적출하여 병리조직학적 검사를 하였다. 결과 Homonymous artery 와 diagonal branch를 동시에 결찰 한 2마리는 결찰 직후 모두 사망하였다. 반면 homonymous artery 와 diagonal branch를 순차적으로 결찰 한 7마리는 모두 생존하였는데 이중 5마리는 2개월 그리고 2마리는 3개월 사육후 심장을 적출하였다. 결찰 2~3개월 후 양에서 중심정맥압, 폐동맥압, 폐동맥쐐기압, 좌심실 이완말기 및 수축말기 크기의 유의한 증가가 관찰되었다(p<0.05) 반면 homonymous artery 결찰 직후에는 동맥압의 유의한 감소(p<0.05)가 diagonal branch의 추가 결찰 후에는 동맥압, 심박출량의 감소 및 폐동맥쐐기압의 유의한 증가가 관찰되었다(p<0.05). 좌심실 벽운동은 결찰 직후부터 다양한 정도의 anteroseptal akinesia또는 dyskinesia가 관찰되었다. 적출 심장의 병리 분석 결과 주위와 잘 구별되는 섬유화 경색 부위가 관찰되었다. 결론: 양에서 homonymous artery와 diagonal branch를 순차적으로 결찰하는 방법으로 신뢰성 있는 만성 심부전 모델을 확립할 수 있었다.