• Journal of Chest Surgery
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• 제10권2호
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• pp.241-249
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• 1977

Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

• Journal of Chest Surgery
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• 제10권2호
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• pp.230-240
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• 1977

Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

• Journal of Chest Surgery
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• 제9권2호
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• pp.220-238
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• 1976

Six cases of congenital heart disease were operated on by means of cardiopulmonary bypass between December, 1975 and April, 1976. Two cases of ventricular septal defects (VSD), two cases of VSD, associated with ruptured aneurysm of sinus Valsalva, two cases of atrial septal defects (ASD) and one case of pulmonic stenosis with patent ductus arteriosus were operated. Sarns roller pumps and Bentley Temptrol oxygenators were used for extracorporeal circulation. Pump oxygenator was primed with Ringer's lactate solution, 5% dextrose in water, mannitol, and ACD blood. Flow rate ranged from 2.0 to $2.4L/M^2/min$. Bicarbonate was added to the oxygenator with estimated amount as 15 mEq/L/hr. Venous catheters were introduced into superior and inferior vena cava, and oxygenated blood was returned to the body through aortic cannula inserted into ascending aorta. Moderate hypothermia ($30^{\circ}C$) was induced by core cooling. Aorta was cross clamped for 15 minutes and released for 3 minutes, and repeated clamping when necessary. Atrial and ventricular septal efects were closed by direct sutures. Aneurysms of sinus Valsalva ruptured into the right ventricle were repaired through right ventriculotomy by d:rect closure with Dacron patch reinforcement. Cardiopulmonary bypass time varied from 66 to 209 minutes, and aorta cross clamping time ranged from 13 to 56 minutes. Postoperative bleeding was minimal except one case who needed for evacuation of substernal hematoma. Intra- and postoperative urinary output was satisfactory. Acid-base balance, partial pressure of $O_2$, electrolytes, and hematological changes during intra- and post-perfusion period remained at the acceptable ranges. No mortality was experienced.

• Journal of Chest Surgery
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• 제31권10호
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• pp.945-951
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• 1998

개심술시 총순환정지는 매우 유용한 방법이나 뇌손상등 부작용으로 그 사용이 제한되고 있다. 이러한 뇌손상의 분석에 유용한 지표로서 뇌 허혈성 손상의 특이한 효소인 크레아티닌 카이네이즈 BB(CK-BB)의 유용성을 재고하고 뇌손상에 영향을 미치는 인자들의 분석을 시도하였다. 총순환정지를 이용하여 개심술을 시행한 18명의 환자를 대상으로 하였다. 이들은 다시 비청색증형 심기 형군과 청색증형 심기형군으로 나누어 각각 6명과 12명으로 하였다. 각 환자에서 총순환정지전 및 후 15, 30, 60, 120, 240, 480, 720분에 동맥혈을 채취하여 CK-BB분획을 측정하였고 이와 동시에 혈색소농도, 이 온화 칼슘농도, 혈당량 등을 측정하였다. 총순환정지시간과 CK-BB와 통계적으로 유의한 관계를 보이는 채혈시간은 찾을 수 없었다. 또 총순환 정지전의 문제로 인한 영향을 줄이기 위하여 각각의 측정치에서 총순환정지전의 측정치를 뺀 값을 구하 여 각기 CKBBD15, CKBBD30....등으로 표시하고 상관관계를 구하였으나 역시 유의한 상관관계를 보이 지 않았다. CKBB30과 CKBBD30값은 비청색증형 군과 청색증형 군 사이에 유의한 차이를 보이지 않았 다. CK-BB농도와 혈색소 농도는 유의한 상관관계를 보였다. 단일 채혈에 의한 CK-BB농도의 지표는 순환정지시간과 유의한 관계가 없음이 확인되었다. 또한 청색 증형 심질환군이 총순환정지에 의한 뇌손상에 비청색증형 심질환군에 비해 더 취약하지는 않은 것으로 생각된다.

• Journal of Chest Surgery
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• 제30권3호
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• pp.253-253
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• 1997

가토의 적출폐장보고시험의 모델을 이용하여 폐세척웅액과 폐장보존용액의 온도를 제 1군은 4℃로 제 2군은 10℃로 하여 6시간동안 적출폐장보존후에 재관류시켜 각각의 온도차이에 따른 폐기보존효과를 비교 실험하였으며 각 군은 10례씩으로 하였다. 폐정맥혈액산소분압, 폐포-동맥간 산소분압 차, 폐동 맥압 및 폐혈관저항은제 1군보다제 2군이 재관류동안에 성적이 우수하였으며 기도내압, 폐탄성도및 폐부종의 정도는 두 군간에 통계학적 유의성은 없었다. 결론적으로 가토의 적출폐기 보존온도에 따른 실험에서 10℃의 폐수*용액과 폐기보존온도가 4℃보다 재순환시 폐기능의 회복이 우수하였다.

• Clinical and Experimental Pediatrics
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• 제51권3호
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• pp.329-334
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• 2008

Kwashiorkor는 단백질 결핍으로 인한 영양실조로 저알부민혈증, 설사, 피부염, 부종을 증상으로 나타낸다. 단백질-열량 결핍은 면역결핍을 초래하고 이는 감염에 대한 감수성을 높임으로써 생명을 위협하는 상태가 될 수 있다. 치료는 조기 영양공급, 감염증 치료가 주이며, 치료 경과 중 확장성 심근증이 나타날 수 있으며 이 경우 예후가 안 좋다. Kwashiorkor는 주로 빈곤한 나라에서 생긴다고 알려져 왔으며, 기술적으로 진보한 나라에서 치명적인 결과까지 낳은 예는 보고된 바가 없었다. 치명적인 kwashiorkor 1례를 경험하였기에 보고하는 바이다. 환아는 가난때문이 아니라 부모의 잘못된 생각으로 2개월 동안 곡물에 태운 곡식가루만 먹었으며, 설사, 전신 부종, 홍반, 저체온증 등을 주소로 입원하였다. 면역 결핍이 있는 상태였으며, 혈액 배양 검사상 Alcaligenes Xylosoxidans가 동정되었다. 단백질 보충식이 및 항생제 치료, 정주용 면역글로불린치료, 미세영양소 보충하였으나 확장성 심근병증, 다발성 장기 부전으로 사망하였다.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.295-306
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• 2001

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

• Journal of Chest Surgery
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• 제29권3호
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• pp.278-284
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• 1996

1989년 5월부터 1994년 5월까지 9명의 대혈관전위증 환자에 대해 동맥전환술을 시행하였다. 연령 분 포는 생후 3일에서 90일까지로 평균 30일 (21일)이 었고 환자는 전례 에서 술전 심초음파 검사로 진단되 었 다. 8례는 심실중격결손을 동반한 대혈관전위증이었으며 1례는 심실중격결손을 동반하지 않은 단순대 혈관잔위증 환아였다. 동반기형으로는 동맥관개존이 8례, 심방중격결손이 7El,대동맥축약이 1례였다. 관동백의 분지 형태는 Yacoub type A가 7례 (77 %), Yacoub type D의 형태가 2례 (23 %)였다. 폐동맥 재 건은 Lecompte 술식을 8례 에서 적용하였고 자가심낭편을 이용하였다. 사망율은 55 %였다. 수술후 1 ~2 일내 사망한 3례는 좌심실 기능부전과 발작성 폐동맥 고혈압이 원인이었고, 수술후 2~3주에 사망한 2례는 술후 감염에 의한 폐혈증이 주원인이었다. 평균 추적 기간은 17개월이 었고 추적관찰에는 심초음파 를 이용하였으며 임상적으로 의미 있는 대동맥 판 폐쇄부전이나 폐동맥 판 상부 협착은 발견되지 않았다. 수술에 따르는 여러 위험 요소들(저체중, 장시간의 체외순환, 체외 순환중 과도한 혈희석, 저체온, 술후 용적 부하, 과도한 \ulcorner\ulcorner\ulcorner사용) 중 술후 과도한 강심제를 사용했을 경우에서만 통계학적 유의성을 가지는 위험인자로 나타났다.

• 대한한방체열의학회지
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• 제1권1호
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• pp.38-46
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• 2002

1. Objectives Among many symptoms that the climacteric patients complain of, the major subjective symptom is both heat in the upper part and cold in the lower part of the body(e.g foot, knee, and leg). We use DITI as a method to prove the symptoms of climacteric patients such as both heat in the upper part and cold in the lower part of the body, diagnose these symptoms, and follow up the progress of the clinical treatments. 2. Subjects and Methods We compare the subcutaneous heat of the climacteric patients with the symptom of heat in the upper part and cold in the lower part of the body with young women without any specific disease. The age distribution of the experimental group is 28 patients in 40's, and 22 in 50's. The mean age of the experimental group is $48.5{\pm}4.25$. The age distribution of the control group is 17 patients in teen, 26 in 20's, 7 in 30's. The mean age of the control group is $23.31{\pm}6.45$. We measure the subcutaneous heat on the cheeks, upper arms, palms, thighs, knees, dorsum pedis, lower back, hip, upper abdomen, lower abdomen of both groups and analyse the results. 3. Statistical methods All the results are statiscally analysed using student T-test of Microsoft Exel program. Statistically significant value by the analysis of variance procedure is P<0.05. 4. Results 1. The subcutaneous heat of the whole body of the experimental group shows hypothermia compared with control group, and the hypothermic pattern gets severe on the periphery. ${\Delta}T$ between the right and left side of the body in experimental group is larger than that of control group. 2. ${\Delta}T$ between the cheeks and the hypogastric in the experimental group is significantly larger than that of the control group, which shows cold face. 3. ${\Delta}T$ between the upper arms and the palms in the experimental group is significantly larger than that of the control group, which shows cold hand. 4. ${\Delta}T$ between the thighs and the knees in the experimental group is significantly larger than that of the control group, which shows cold knee. 5. ${\Delta}T$ between the thighs and the feet in the experimental group is significantly larger than that of the control group, which shows cold foot. 6. ${\Delta}T$ between the hip and the lower back in the experimental group is significantly larger than that of the control group. That shows the Lower back is warmer than the hip. 7. ${\Delta}T$ between the upper and the lower abdomen in the experimental group is significantly larger than that of the control group, which shows cold hypogastric.

• Clinical and Experimental Pediatrics
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• 제62권12호
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• pp.444-449
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• 2019

Background: Sixty percent of infants with severe neonatal hypoxic-ischemic encephalopathy die, while most survivors have permanent disabilities. Treatment for neonatal hypoxic-ischemic encephalopathy is limited to therapeutic hypothermia, but it does not offer complete protection. Here, we investigated whether hypoxia-inducible factor (HIF) promotes cell survival and suggested neuroprotective strategies. Purpose: HIF-1α deficient mice have increased brain injury after neonatal hypoxia-ischemia (HI), and the role of HIF-2α in HI is not well characterized. Copper-zinc superoxide dismutase (SOD)1 overexpression is not beneficial in neonatal HI. The expression of HIF-1α and HIF-2α was measured in SOD1 overexpressing mice and compared to wild-type littermates to see if alteration in expression explains this lack of benefit. Methods: On postnatal day 9, C57Bl/6 mice were subjected to HI, and protein expression was measured by western blotting in the ipsilateral cortex of wild-type and SOD1 overexpressing mice to quantify HIF-1α and HIF-2α. Spectrin expression was also measured to characterize the mechanism of cell death. Results: HIF-1α protein expression did not significantly change after HI injury in the SOD1 overexpressing or wild-type mouse cortex. However, HIF-2α protein expression increased 30 minutes after HI injury in the wild-type and SOD1 overexpressing mouse cortex and decreased to baseline value at 24 hours after HI injury. Spectrin 145/150 expression did not significantly change after HI injury in the SOD1 overexpressing or wild-type mouse cortex. However, spectrin 120 expression increased in both wild-type and SOD1 overexpressing mouse at 4 hours after HI, which decreased by 24 hours, indicating a greater role of apoptotic cell death. Conclusion: HIF-1α and HIF-2α may promote cell survival in neonatal HI in a cell-specific and regional fashion. Our findings suggest that early HIF-2α upregulation precedes apoptotic cell death and limits necrotic cell death. However, the influence of SOD was not clarified; it remains an intriguing factor in neonatal HI.