• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.10
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• pp.354-362
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• 2017

Due to population aging and westernized lifestyle, ischemic heart diseases are increasing, and Korea has one of the highest lengths of stay for ischemic heart diseases. Since the increase in the length of stay is a major cause of the increase in medical expenses, it is necessary to prepare a plan to manage the length of stay. Accordingly, this study was conducted to identify the factors influencing the length of stay of ischemic heart disease, and provide the elementary resources necessary for the management of the length of stay. The study subjects were 566 ischemic heart disease patients of a tertiary hospital. As the result of the study, first, the number of inpatients with chest pain as the chief complaint was the largest. Second, the average length of stay was 4.89 days, and the length of stay varied depending on the type of ischemic heart disease. Third, the age of over 75 years, diabetes, and dyspnea were the factors increasing the length of stay. Therefore, for management of adequate length of stay for ischemic heart disease, it is important to prevent the progression of illness through blood sugar control for ischemic heart disease patients with diabetes. Also, it is necessary to prepare a system where patients can visit hospitals as fast as possible if they have any symptoms.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.297-305
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• 1979

Occlusive coronary artery disease presents a potential threat to a significant population in the United States. According to many case reports, the increasing incidence of coronary artery disease due to atherosclerosis is noted in Korean, recently. Operative vascular procedures have increased steadily in number over the past 20 years in the United States. There have been many isolated case reports about coronary artery surgery, but these had little clinical impact. Nowadays, major three coronary bypass surgery has developed principally at three cardiac centers in the United States since 1967. Among three coronary bypass operation, the aorta-coronary artery saphenous vein bypass graft was first demonstrated by Favolaro and Effler at the Cleveland Clinic in 1967. We experienced one case of coronary artery disease, which was treated successfully by aorta-coronary saphenous vein graft with mild hypothermia under extracorporeal circulation in May, 1977. Saphenous vein was removed from above the knee and was 2.5 mm in diameter. The left ventricle was not vented for the left ventricle was not overdistended. Temporary artificial pace-maker-Medtronic-was implanted for the prevention and treatment of post-operative arrhythmia and heart block in post-operative first day. He is a 57 year old male businessman who had been suffered from hypertension [200 mmHg in systolic pressure] since 4 years ago, who had intermittent conservative treatment at local clinic. He had been afflicted with severe chest pain with choking sensation for 50 days. This symptom was aggravated exposing cold weather, or cold water, but was respond to rest. Pre-operative ECG revealed no any other ischemic sign except sinus bradycardia. Significant S-T segment depression was noted at lead II, AVF after double 5 minutes exercise, indicating positive Master`s test. Serum cholesterol was slight elevated to 253 mg/dl. Final pre-operative diagnosis was made by coronary arteriogram, which showed about 1.0-cm segmental 90 % occlusive atherosclerotic lesion in the proximal part of right coronary artery above the origin of acute marginal artery. Left coronary artery revealed good patency and there was no collateral circulation between right and left coronary artery .Hospital course was not eventful. He was discharged with good result on the post-operative day. He has been free from chest pain for longer than 2 years. And also the arterial flow in the coronary bypass graft is auscultated with the pocket-sized ultrasonic velocity detector, which shows the patency of the coronary bypass graft good.

• Korean Journal of Community Nutrition
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• v.10 no.6
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• pp.963-970
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• 2005

Recently elevated plasma homocysteine concentration is considered an independent risk factor for atherosclerosis and thrombosis with coronary artery disease. Folate and vitamin $B_{12}$ are cofactors and closely related with metabolism of homocysteine. The purpose of this study is to evaluate the correlation between homocysteine and folate and vitamin $B_{12}$ in patients with ischemic heart disease. Twenty-six patients, in whom coronary angiographic finding revealed more than $50\%$ of stenosis at least in one coronary vessel were enrolled as the patient group, and thirty subjects, in whom angiographic finding revealed in not significant stenosis, but complained of chest pain, were selected as the control group. Fasting venous blood was obtained and measured the concentration of plasma total homocysteine, folate and vitamin $B_{12}$ by high performance liquid chromatography and fluorescence detection method. We examined the correlation between homocysteine and folate and/or vitamin $B_{12}$ in the control group and the patient group, respectively. Compared with the control group, the patient group had relatively higher plasma total homocysteine concentration ($10.7\pm4.2\;vs\;9.6\pm3.5$ umol/L), but showed no significant difference. Folate and vitamin $B_{12}$ concentration are low in the patient group, but showed no significant difference between patient and control group. Plasma total homocysteine concentration showed negative correlation with folate and vitamin $B_{12}$ in both the control group and the patient group, and showed significantly negative correlation in patient group {r = -0.550 (p < 0.01) vs r = -0.609 (p < 0.01)}. We knew that the plasma total homocysteine concentration were relatively elevated in patient group compared with the control group. Because plasma total homocysteine concentrations are closely negative correlated with folate and vitamin $B_{12}$ in the patient group, folate and vitamin $B_{12}$ supplement can lower the mortality and morbidity of ischemic heart disease. (Korean J Community Nutrition 10(6) : $963\∼970$, 2005)

• Journal of Chest Surgery
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• v.28 no.3
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• pp.274-279
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• 1995

To evaluate clinical pattern and operative outcome of atherosclerotic obstructive disease in the lower extremity, surgical experience in 25 patients between September 1987 and June 1994 was analyzed. There were 24 male patients and 1 female patient. The age of the patients ranged between 36 and 77 years[mean:60.9 years . Disabing intermittent claudication, rest pain, or ischemic gangrene[or ulceration was the operative indication. The patients were classified into three groups according to the level of obstruction: Aortoiliac level[11 cases/44% , femoropopliteal level[6 cases/24% , and whole level[8 cases/32% . Anatomic bypass with prosthetic graft was performed in all cases: aortobifemoral or aortofemoral bypass in 15 procedures, iliofemoral bypass in 5 procedures, femoropopliteal bypass in 13 procedures. The perioperative mortality rate was 12%. Two patients received postoperative major amputation. Twenty two patients were followed-up for 1 to 70 months[mean: 21 months . Late graft obstruction occurred in two patients. The cumulative patency rate at 3 years was 69.5%. The cumulative limb salvage rate at 3 years was 92.0%.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1273-1277
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• 1992

Percutaneous Transluminal Angioplasty[PTA] was introduced by Dotter and JudKins [1964], using coaxial catheters of increasing diameter. The remarkable advances in vascular catheter technology over the past several decades have permitted the development. But the application of the balloon catheters carries with it the risk of arterial injury, thrombosis, embolism, and loss of life or limb. A 53-year-old man was admitted to other hospital due to a intermittent claudication in his right leg for 10 years. and PTA was performed at that hospital. Thereafter he was transferred to our hospital because of coldness, pulselessness, rest pain, ischemic ulcer, and progressing gangrene at the anterior aspect of left lower leg. The left lower extremity was salvaged by left ilio-femoral bypass and later saphenous in situ femoro-popliteal bypass.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1492-1496
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• 1992

Takayasu`s arteritis is a nonspecific inflammatory vascular disease of unknown origin. It most often cuases stenosis of the aorta or its branch arteries with ischemic changes in the organs supplied, but the vessels inside these organs are not directly involved. From 1983 to 1991, we performed operation on 6 patients with Takayasu`s arteritis. There were 6 female patients ranging in age from 17 years to 36 years. Symptoms included headache, dizzness, visual disturbance, and motor weakness or pain of arm. In 5 cases, bypass graft arised from ascening aorta[ventral aorta] were done, and in one, stenotic segments of left subclavian and vertebral arteries were resected an graft interposition done. Follow-up has been 62.4$\pm$34.8 months[ranging from 11 to 113 months], results of each patient were exellent, except one postoperative death.

• Journal of Chest Surgery
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• v.44 no.3
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• pp.266-268
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• 2011

Cystic adventitial disease is rare, but it is one of the well-recognized causes of non-atherosclerotic arterial stenosis or obstruction. Despite one of its most common symptoms being chronic intermittent claudication, it may be misdiagnosed as arterial embolism when presented with acute ischemic symptoms. Surgical resection is recommended because of recurrence or a low success rate with aspiration or endovascular stent. We performed resection and repair with autologous vein patch for cystic adventitial disease of the popliteal artery of a 57-year-old man presenting with pain, pallor, and paresthesia, without any postoperative complications or recurrence.

• Journal of Yeungnam Medical Science
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• v.16 no.2
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• pp.283-295
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• 1999

Background: Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were $1.1{\pm}0.9$ in non-cardiac diseases, $1.4{\pm}1.1$ in cardiac diseases and $1.7{\pm}1.1$ in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. Conclusion: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.

• Journal of Digestive Cancer Research
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• v.5 no.1
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• pp.58-61
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• 2017

5-Fluorouracil (5-FU) has been widely used in the treatment of various solid tumors. However, 5-FU cardiotoxicity is being reported with increasing frequency. The main symptom of cardiotoxicity is chest pain at rest with ischemic electrocardiographic changes. Up until now, the underlying mechanism has been suspected to be coronary artery spasm. However, this chest pain associated with 5-FU has several characteristics that are incompatible with coronary artery spasm; eg, inefficacy of calcium-channel blocker and a slow increase in cardiac enzyme levels. We experienced a case of 5-FU-induced cardiotoxicity which showed clinical findings consistent with acute myocardial infarction. Based on the clinical findings, coronary angiography, and no stenosis was noted. However, we concluded that the cardiotoxicity in this case was due to ischemia caused by coronary artery spasm. Because vasodilatator was effective and secondary attack was followed.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.412-420
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• 1986

From 1968 through September 1986, the authors have experienced 34 cases of peripheral arterial surgery using various vascular grafts. Almost all patients [32] were men, and age distribution was variable according to the disease entities. There were twenty eight cases of chronic occlusive peripheral vascular disease including ASO [21], Buerger`s disease [6], Aortoenteric fistula complicating infrarenal abdominal aortic aneurysm [1], four cases of vascular trauma, one case of acute arterial embolism [1] and one case of unknown etiology. The indications of operations for chronic vascular disease was intermittent claudication in 48%, rest pain in 45%, ischemic pregangrene or gangrene in 28%, and sensory change in 10% of patients. Types of operation used were arterial bypass in 28 cases [Aortobifemoral in 5, Aortoiliac in 3, Aortofemoral in 4, Aortoiliac with Aortofemoral in 1, Femorofemoral in 1, Femoropopliteal in 8, Femoroperoneal in 2, Axillofemoral in 3 cases of patients], graft interposition in four and patch angioplasty in three cases. Thirty four prosthetic vascular grafts including Dacron, Gore-Tex, Nylon and two autogenous saphenous vein graft and patch were used for vascular reconstruction in thirty four patients. Unfortunately recently performed one vein bypass was failed immediate postoperatively due to severity of disease and poor case selection. The authors experienced five post operative complications: wound infection [1], graft infection [1], bleeding [1], great saphenous neuralgia [1], pseudoaneurysm [1]. Twenty two of thirty four patients were followed up for more than one month and their cumulative patency rate was 81% [17/22] at 1 month and, 31% [7/22] at 5 month.