• Journal of Chest Surgery
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• v.9 no.2
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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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• v.31 no.10
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• pp.945-951
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• 1998

Background: Although profound hypothermia with total circulatory arrest(TCA) is a valuable maneuver in cardiac surgery, its applications have been limited due to serious complications, especially cerebral damage. In this study, the possible role of creatinine kinase-BB(CK-BB), an index enzyme of ischemic cerebral damage, was assayed as a parameter for the assessment of the cerebral complications after TCA. Hemoglobin(Hb), ionized calcium(Ca++), and blood glucose levels were also assessed as clinical parameters involved in cerebral damage. Materials and methods: Among patients with congenital heart disease, 18 patients who had been operated on with TCA were randomly selected and divided into two groups: 6 with acyanotic and 12 with cyanotic heart disease. Arterial blood from each patient was collected before and after TCA at scheduled times(15 min., 30 min, 1, 2, 4, 8, and 12hr). The levels of CK-BB, Hb, Ca++, and blood glucose were assessed in each sample. Results: As a whole, correlation between CK-BB level and blood sampling time after TCA was not statistically significant. Also, the difference in the level of CK-BB after TCA was not significant between the acyanotic and cyanotic groups. The levels of Hb and CK-BB correlated significantly. Conclusions: The results, which showed no correlation between the alterations in CK-BB level and the TCA duration, suggest that the single assay of the CK-BB level is not a representative measurement for the assessment of cerebral damage after TCA. Also, the cyanotic congenital heart disease group is not more vulnerable to cerebral damage induced by TCA.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.253-253
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• 1997

Hypothermia during lung preservation decreases metabolic processes. After the rabbit lung was flushed with modified Euro-Collins solution, heart-lung block was harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. Heart-lung block was immersed in the same solution for 6 hours. The modified Euro-Collins solution and storage temperature of group 1(10 cases) was 4t, roup 2(10 cases) was l0℃. On completion of the storage period, the left lung was ventilated and reperfused with blood u:high used a cross-circulating paracorporeal rabbit as a "biologic deoxygenator" for 60 minutes. Pulmonary artery pressure, airway pressure, difference in oxygen tension between mow and outflow perfusate and degree of pulmonary edema were assessed at 10-minute intervals while the left lung was ventilated at 0.8 of the inspired oxygen fraction. The mean pulmonary venous oxygen tensions at 10 and 60 minutes after reperfusion were 209.52±42.46 and 103.48± 15.96 mmHg in group I versus 247.78±36.19 and 147.91 ± 11.07 mmHg in group II(p=0.049, (0.0001). The mean alveolar-arterial oxygen differences at 20 and 60 minutes after reperfusion were 357. 95± 12.84 and 437.31 14.26 mmHg in group I versus 310.88±3).47 and )90.93± 15.86 mmHg in group II (p=0.0092, (0.0001). The mean pulmonary arterial pressures at 10 and 60 minutes after reperfusion were 40.56± 18.66 and 87. 2± 17.22 mmHg in group I versus 31.22±6.84 and 65.78± 11.02 mmHg in group rl (p : 0.048, 0.0062). The mean pulmonary vascular resistances at 10 and 60 minutes after reperfusion were 2.69±0.85 and 4.36±0.86 mmHg/ml/min in group I versus 1.99±0.39 and 3.29±0.55 mmHg/ml/min in group II(p : 0.0323, 0.0062). There were no difference between groups in peak airway pressure, lung compliance and degree of pulmonary edema. In conclusion that preservation of lung at l0℃ was superior to preservation at 4℃.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.329-334
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• 2008

Kwashiorkor is a syndrome of severe protein malnutrition, which manifests itself in hypoalbuminemia, diarrhea, dermatitis, and edema. It can be life-threatening due to associated immune deficiency and an increased susceptibility to infections. Kwashiorkor should be treated early with nutritional support and the control of infection. Dilated cardiomyopathy may develop during the treatment and in such cases a poor prognosis is expected. Kwashiorkor has been known as a common disease of poor countries. To date, in fact, there has been no report of kwashiorkor leading to death in technically advanced countries. We here report a fatal case of a baby girl admitted with kwashiorkor. She had been fed only with cereal grain mixed with juice, without any protein supplement, for 2 months. This diet was deficient not because of poverty, but due to the illiteracy of her parents. The patient suffered from diarrhea, whole body edema, hypothermia, and dermatitis. Laboratory findings revealed an immune-deficient state featuring leukopenia and decreased immunoglobulin. Blood and urine cultures revealed Alcaligenes Xylosoxidans growth. The patient was fed frequent small amounts of protein-containing formula and intravenous albumin and micronutrients were administered for nutritional support. She was also treated with intravenous immunoglobulin and antibiotics in order to control infection. Nevertheless, she developed dilated cardiomyopathy and multi-organ failure and died. We review this case in light of the literature.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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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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• v.29 no.3
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• pp.278-284
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• 1996

Nine infants with transposition of great arteries have undergone arterial switch operation from May 1989 to May 1994 in the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. Patients' age ranged from 3 days to 90 days, averaging 30$\pm$21 days. Diagnosis was made by two-dimensional echocardiography in all patients. Eight patients were diagnosed as transposition of great arteries with ventricular septal defect and one patient was a simple transposition of great arteries. Associated anomalies were patent ductus arteriosus (8), atrial septal defect (7) and coarctation of aorta(1). The anatomy of the coronary arteries were 7 (77 %) type A and 2 (23 %) type D according to the Yacoub classification. Pulmonary artery reconstruction was done according to Lecompte maneuver with tautologous pericardial patch in 8 patients. Overall operative mortality rate was 55% Left heart failure and pulmonary hypertensive crisis were the cause of death on postoperative 1~2 days in three patients, and two succumbed to death due to sepsis on postoperative 2~ 3 weeks. The mean follow-up period was mean 17 months. No patient had clinically significant postoperative aortic regurgitation and supravalvular pulmonary stenosis. The excessive use of inotropic support postoperatively was identified as a stastically significant risk factor following the arterial switch operation. But other variables such as low body weight, long cardiopulmonary bypass time, excessive hemodilution during cardiopulmonary bypass, hypothermia and volume loading were not significant risk factors.

• Journal of Oriental Medical Thermology
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• v.1 no.1
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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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• v.62 no.12
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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.

• Journal of Life Science
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• v.20 no.2
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• pp.314-320
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• 2010

As the nature of triathlons is competition in three successive sports, triathletes experience elevated levels of stress on the body that are absent in single-sport athletic events, and consequently there are more potential medical problems to prepare for. Triathletes can also experience problems such as hypothermia, heat illness, excessive exposure to ultraviolet radiation, musculoskeletal injuries and trauma, immunosuppression, and haemolysis. Depending on the potentiality of such above-listed problems occurring in any given race, race organizers will prepare preventative measures and treatments accordingly. Olympic distance is not the only triathlon racing distance. Sprints, which are normally around half the Olympic distance, are common distances, as well as Long (2 km swim, 80 km bike, 20 km run), Ironman (3.8 km swim, 180 km bike, 42 km run), and ultra-distance events varying in length. Races of longer duration normally result in a higher percentage of athletes experiencing the above-mentioned medical problems, as well as inducing additional health risks such as hyponatraemia. Minimizing the occurrences of serious health issues is possible through the following means: carefully preparing for the probable race-day weather conditions; proper management and organization of the race; preparing an extensive water-safety and ground-course safety plan; distributing necessary nutrition along the course; and stressing the importance for athletes to have proper knowledge concerning race nutrition, biomechanical technique, physical preparation, and utilization of safe equipment. While risks of competing in triathlon are many, the instances of such medical problems are not excessive, and the triathlon has a reputation of being a reasonably safe sport as long as athletes with high risk take added precautions.

• Journal of Korean Academy of Nursing
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• v.29 no.4
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• pp.903-916
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• 1999

The purpose of this study was to compare the ear-based rectal temperature measured with a tympanic thermometer with the rectal temperature measured with a glass mercury thermometer in order to test the accuracy of tympanic thermometer and to determine relationship among rectal, axilla, and abdominal temperature in neonates. The samples consisted of thirty four neonates admitted to the neonatal intensive care unit and nursery at an university affiliated hospital. The mean age of the subjects was 4.9 days. The ear-based rectal temperatures were taken with a tympanic thermometer in rectal mode (First Temp Genius 3000). Rectal and axilla temperatures were taken with a glass mercury thermometer, Abdominal temperature was continuously monitored with the probe connected to the servo controller of incubator. The results of the study can be summarized as follows : 1. Intrarater comparison : Agreement between the first and the second ear-based rectal temperature was 97% within 0.1$^{\circ}C$. 2. Comparison of ear-based rectal temperature and the rectal temperature from a glass mercury thermometer : ear-based rectal temperature ranged from 36.95$^{\circ}C$d to 37.95$^{\circ}C$, with a mean of 37.58$^{\circ}C$(SD＝0.22$^{\circ}C$). Rectal temperature from a glass mercury thermometer ranged from 36.2$0^{\circ}C$ to 37.2$0^{\circ}C$, with a mean 36.75$^{\circ}C$(SD＝0.29). The mean difference between both temperatures was 0.84$^{\circ}C$. The correlation coefficient between both temperatures was r＝0.77(p＝0.00). 3. Comparison of rectal and axilla temperature : Axilla temperature ranged from 35.8$0^{\circ}C$ to 37.1$0^{\circ}C$, with a mean of 36.55$^{\circ}C$. The mean absolute difference between the rectal and axilla temperature was 0.23$^{\circ}C$. The correlation coefficient between rectal and axilla was r＝0.67. 4. Comparison of axilla and abdominal temperature : Abdominal temperature ranged from 36.2$0^{\circ}C$ to 37.0$0^{\circ}C$, with a mean of 36.58$^{\circ}C$. The mean absolute difference between axilla and abdominal temperature was only -0.03$^{\circ}C$. Findings of this study suggest that ear-based rectal temperature overestimates the actual rectal temperatures in neonates. Therefore, the interchangeble use of both temperatures in clinics seems problematic. The site offset(adjustment value) programmed in rectal mode of the tympanic thermometer needs to be readjusted. Choosing one optimal site for temperature measurement for each patient, and using the specific site consistently would result in more consistent measurements of changes in body temperature, and thus can be more effective in diagnosing fever or hypothermia.