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Twenty-year Experience of Mitral Valve Replacement with the St. Jude Medical Mechanical Valve Prosthesis (St. Jude 기계 판막을 이용한 승모판막 치환술의 20년 장기성적)

  • Seo Yeon-Ho;Kim Kong-Soo;Jo Jung-Ku
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.527-533
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    • 2006
  • Background: A retrospective study was conducted to analyze the results of St. Jude Medical mitral valve replacement at the Chonbuk National University Hospital since the initial implant in May 1984. Material and Method: Between May of 1984 and December of 1996, 95 patients underwent MVR with the St. Jude Medical mechanical valve prosthesis at Department of Medical Science of Chonbuk National University Hospital and follow-up ended in May of 2004. Result: Age ranged from 19 to 69 years. Follow-up (mean${\pm}$standard deviation) averaged $10.6{\pm}4.2\;year$. Thirty-day operative mortality was 4.2% (4/95). Nine late deaths have occurred and actuarial survival was $90.5{\pm}3.0%,\;87.9{\pm}3.4%\;and\;83.2{\pm}4.6%$ at 5, 10 and 20 years, respectively. Probability of freedom from valve-rotated death was $95.5{\pm}2.1%,\;94.3{\pm}2.4%\;and\;91.0{\pm}3.9%$ at 5, 10 and 20 years, respectively. Seven patients have sustained thromboembolic events (1,05%/patient-year). Fifteen patients had anticoagulation related hemorrhage (3.56%/patient-year). There was no structural valve deterioration. Probability of freedom from all complications was $82.0{\pm}3.9%,\;71.3{\pm}4.8%\;and\;42.4{\pm}10.5%$ at 5, 10 and 20 years, respectively. Conclusion: We confirm the effective and excellent durability of the St. Jude Medical prosthesis in the mitral position with a low event rate at long-term follow-up. It also demonstrates the commonly encountered practical difficulty of adjusting the anti-coagulation protocol in patients with prosthetic mitral valves.

Early and Mid-Term Results of MIDCAB (최소 침습적 관상 동맥 우회술의 중단기 성적)

  • 손호성;방영호;황진욱;민병주;조양현;박성민;이성호;김광택;선경
    • Journal of Chest Surgery
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    • v.37 no.10
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    • pp.827-832
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    • 2004
  • Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.

Treatment of Pectus Carinatum with a Compressive Brace (압박 교정기를 이용한 새가슴의 치료)

  • Son, Jin-Sung;Jeon, Cheol-Woo;Lee, Seong-Jin;Lee, Chol-Sae;Lee, Kihl-Rho;Lee, Seock-Yeol
    • Journal of Chest Surgery
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    • v.40 no.5 s.274
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    • pp.369-375
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    • 2007
  • Background: Patients suffering with pectus carinatum complain of cosmetic problems when they stand and this in spite of wearing cloths. The standard surgical treatment of pectus carinatum is resection of the deformed cartilages, but the wide operative scar, post-operative pain and complications related with such an operation can occur. Therefore, we have peformed compressive brace therapy as a non-operative treatment for pectus carinatum and we observed the effects and the efficiency of this treatment. Material and Method: From January, 2001 to December, 2006, 109 patients wore the compressive brace for all day. The degree of satisfaction was evaluated after $6\sim9$ months of wearing the compressive brace. The degree of satisfaction was evaluated by a score of from $1\sim4$. A score of 1 was assigned when the status was worse, 2 when it was the same, 3 when there was partial improvement and 4 when remarkable improvement was observed. The degree of satisfaction was assessed subjectively by the parent if the patient was a child younger than middle school age, and the patients older than middle school age assessed the score themselves. Result: The mean score of the overall degree of satisfaction was $3.93{\pm}0.33$. Recurrence of pectus carinatum after removal of compressive brace occurred in 6 patients (5.5%) of the total 109 patients. But 4 patients of the total 6 recurred patients stopped wearing of compressive brace against our advice. The 6 recurred patients were re-corrected by re-wearing the compressive brace within 3 months after they originally removed the compressive brace. The complications were discomfort with initially wearing the compressive brace, which occurred in all patients, skin rash due to the compressive brace for 76 patients (69.7%) and skin discolorization with excessive compression for f6 patients (5.5%). The skin rash and discolorization returned to normal within a few months after removal of the compressive brace. Conclusion: This study demonstrated that non-surgical treatment with using the compressive brace for patients with pectus carinatum was effective, and especially for children and teenagers. Non-surgical treatment with using a compressive brace would be helpful for the patients suffering with pectus carinatum and who dislike surgical operations because of their fear about general anesthesia and operation-related complications. Yet long-term follow up is necessary to accurately evaluate the effectiveness of this compressive brace and the recurrences after removal of the compressive brace.

REMINERALIZATION EFFECT OF COMMERCIALLY AVAILABLE ANTICARIOGENIC PRODUCTS ON ARTIFICIAL CARIES LESION USING QLF (QLF를 이용한 항우식 제품의 인공우식 재광화 효과에 대한 연구)

  • Song, Ju-Hyun;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Kim, Chong-Chul;Hahn, Se-Hyun;Lee, Sang-Hoon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.2
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    • pp.287-296
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    • 2008
  • The purpose of this in vitro study was to compare the remineralization effect of commercially available anticariogenic products, exactly low level fluoride mouthrinse(500 ppm NaF), tooth cream with Casein phosphopeptide-amorphous calcium phosphate(CPP-ACP) and fluoride mouthrinse plus tooth cream on artificial caries lesion. Artificial caries lesion was induced at the buccal surface of permanent third molar and the specimens were then divided(16 specimens/group) into four group. Twice a day during 28 days specimens of each group were treated with a commercially anticariogenic product as follows and applied to the pH cycling system. Group 1: control group (No treatment) Group 2: Tooth $Mousse^{(R)}$ (GC Co. Japan) Group 3: $chikachika^{(R)}$ (Samil Co. Korea) Group 4: $chikachika^{(R)}$+Tooth Mousse$^{(R)}$ The long-term change of mineral loss(${\Delta}Q$) was evaluated by quantitative light-induced fluorescence (QLF) and the following results were obtained: 1. ${\Delta}Q$ of Group 1 was not noticed statistically significant during 28 days comparing that prior to treatment. There was a statistically significant increase in ${\Delta}Q$ of Group 2 and 3 since 14 days. So was in ${\Delta}Q$ of Group 4 since 7 days. 2. ${\Delta}Q$ was increased as follows: Group 1< Group 2, 3< Group 4. 3. Comparing with Group 1, Group 2 was a statistically significant increase since 7 days and Group 3 and 4 were since 3 days. Comparing Group 2 with 3, there was not noticed statistically significant during whole duration. Group 4 was significantly higher than Group 2 and 3 after 28 days. 4. All groups demonstrated a decrease in the rate of remineralization as time goes on.

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A Study of Mothers' and Nurses' Perception of the Nursing Needs of Women Experiencing Premature Labor (조기진통 산부의 간호 요구에 대한 산부와 간호사의 지각 차이에 대한 연구)

  • Han, Kyung-Ryu
    • Women's Health Nursing
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    • v.1 no.1
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    • pp.97-118
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    • 1995
  • The purpose of this study was to compare the nurses' perceptions with the women's about the women's needs in premature labor and to find out how to accomplish effective nursing intervention for the women to cope with their crises in premature labor. The objects of this study consisted of 33 hospitalized mothers in post partum because of premature labor, who were delivered of new born, in four university hospitals, a general hospital and a lower general hospital which has a neonatal intensive care unit in Seoul during 17 days(Oct. 4, 1994 to Oct. 20, 1994) and 32 nurses who have worked at delivery rooms in the hospitals above for 6 months or more, accomplishing nursing intervention. The results of this investigation were as follows : 1) General characteristics of women : Their mean age was 29.4 years(SD 4.37) and the mean of their gestational periods 3 days over 34 weeks(SD 2.48). Most of them were the married(93.9%) and held high school degree or more(93.9%). And some of them were the deligious(68.7%), multiparae(59.4%) and had their jobs(21.2%). The also had hospitalized experience due to premature labor(51.5%), experienced in premature delivery(33.3%), the prental care(78.6%), cesearean section(63.6%), and pregnancies less than twice(62.5%). The most mothers were included in 34 weeks and a day to 37 weeks(60.6%). It was also confirmed that most of the sustaining presences in labor were their husbands(81.2%). 2) General characteristics of nurses : Their mean age was 27.6 years(SD 4.50), and their carrier with the service on the average 6 months over 3 years long(SD 3.63). Numbers of them were staff nurses(84.4%), maiden ladies(71.9%), graduated from junior colleges of nursing(71.9%), and had no experiences in delivery(78.1%).Besides, none of them had experiences in premature labor. 3) The whole mean of needs perceived by pregnant women was identified as 3.086 points and the degree of their perception was given much weight in order of interdependence need(3.14), self concept need(3.11), physical physiologic need(3.09), and role function need(2.74). So it was proved that they regarded interdependence need as being the most important need in crises caused premature labor. 4) The whole mean of needs felt by the nurses was 3.092 points and the degree of their feelings was given much weigh in order of physical physiologic need(3.22), self concept need(3.15), interdependence need(3.06) and role function need(2.75). So it was ascertained that they felt physical physiologic need the most important, differing from the women in it. 5) There were few differences on the degrees of the perceptions that the nurses and the women showed on each of the four parts. 6) On each part of the questionnaires, it was examined that the women felt the need for the fetus to be the most important generally while the nurses perceived the need with the women to be more important than that. 7) The primiparae(40.6%) felt role function need be more important than multiparae(59.4%) (p<0.05), and the women from universities and above(39.4%) perceived self concept need to be more important than those holding the high school degrees and below(60.6%). (p<0.05) 8) The nurses having experience in delivery(21.9%) perceived interdependence need and role function need to be more important than important than those having no experiences(78.1%). (p<0.05) So far most of the nurses have concentrated their efforts on nursing for safety for the women in premature labor hospitalized in delivery rooms. But the women are not satisfied with just it because of having perceived the need for the fetus more important above all. In nursing for the future, therefore, every nurse caring for the women should offer them all the informations that they will want for their fetuses to adapt them to the crises effectively, understanding such their needs and making most of honest and simple terms for them, I insist. Through this study, I'm sure that inquiring into the need of women in premature labor minetely will show the way of more effective nursing interventions in clinic. And I suggest that the various kinds of studies about the more objects be done for the generalization of the results of this study in the future.

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Clinical experience with amitriptyline for management of children with cyclic vomiting syndrome (주기성 구토 증후군 소아에서 구토 예방을 위한 amitriptyline의 임상 경험)

  • Sim, Ye-Jee;Kim, Jung-Mi;Kwon, Soonhak;Choe, Byung-Ho
    • Clinical and Experimental Pediatrics
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    • v.52 no.5
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    • pp.538-543
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    • 2009
  • Purpose : To report the clinical experience with amitriptyline for managing children with cyclic vomiting syndrome (CVS). Methods : Totally, eleven children (eight males) were diagnosed with CVS. Of these, medical records were reviewed for eight children treated with amitriptyline; three children were not treated because one was not followed up and two were kept under observation to study the natural course without medication, because the frequency of vomiting had recently decreased to less than one episode per year. The eight amitriptyline-treated children were divided into three groups by the therapeutic response: (1) complete remission (CR), with no recurrence of symptoms after treatment; 2) partial remission (PR), in which the frequency of symptoms decreased by almost 50% after treatment; and (3) no response. Results : For the eight amitriptyline-treated children, the mean age of symptom onset was 4.7 (0.3-7) yr and mean age at diagnosis was 8.9 (6.0-11.3) yr. The mean number of vomiting episodes was 8.8 (2-25) per year, and the duration of vomiting in each episode ranged from 3 hours to 5 days. CR was achieved in five (62.5%) of the eight amitriptyline-treated children (0.2-0.8 mg/kg/day orally, at night) and PR was achieved in three children (37.5%). Two children relapsed on discontinuation of amitriptyline by their parents decision but showed improvement on remedication. No adverse effects were noted throughout the study period. Conclusion : Amitriptyline can be used in long-term prophylaxis for the management of children with CVS aged over 6 yr. However, a large-scale study is needed to ascertain its effects.

Field Study For The Improvement of Medication System and Method for Inpatients at General Hospital (입원환자의 투약체계와 방법의 개선을 위한 현장연구)

  • Yoo, Hyung-Sook;Kuwan, Young-Mi;Song, Mi-Sook;Kim, Hyung-Ae;Park, Kyung-Sook
    • Journal of Korean Academy of Nursing Administration
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    • v.1 no.1
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    • pp.147-211
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    • 1995
  • Medication is a kind of medical service and a therapeutic nursing function which takes large portion of nursing service and requires complicated procedures. So many different medical personnel should be involved and cooporate each other in order to accomplish medication. Medication is also a vital nursing service, So nurse feels heavy responsibi lity in that she gives medication to the patient finally, so she has much responsibility if medication error is happened. Therefore it seems very important to clarify the problem of medication system and method, and find the subculture of medication situation because it may promote nursing productivity. The study was conducted to 1. Describe and interpret medication situation. 2. Find out the problem of medication system and method and on alternatives. 3. Compare the medication system and method of hospitals which are located in Seoul with object hospital Ethnographic methodology was used to study medication situation by doing participant observation and interview of health care personnel. Ten nurses and three nurse aids were interviewed. Two residents and internists, two phamacists and two accountants were also interviewed. Data was obtained and analized according to Developmental Research Sequence introduced by Spradly. On the basis of this data the results were as follows. 1. The overall flow of medication system was devided into six stage : first, checking doctor's order : second writing doctor's order, : third, transfering slip into the related departments such as account department, pharmacy : fourth, distribution of medication from pharmacy to unit : fifth, identifing medication by nurses : and finally, medicating to the patient. Behaviorors have been under a lot of stress in that they have to do much works, especially paperworks, So too much time were needed. They also have been suffered interpersonal conflicts among health care personnel and role conflicts in the process of doing medication service. 2. In the process of checking order, the problem was that too much time was required for checking order and paperwork. The more the order changes the more the paperwork is. Nurses have been suffering difficulties in calling internist in order to get bill. Even if writing down slip for medication order is doctor's job, Sometimes nurse has been expected to write slip by doctors or nurse would write slip beacuse of two much complexities and efforts for calling doctors. If the slip were incorrect, much time complicated procedures were more required for correcting it. So delay of administering drug would be resulted consequently. Drugs were delivered from pharmacy to units by delivery agent and phamacist. But because drugs were delivered without arranging room number of patient. Nurse should rearrange drugs in order of the room number So it had made waste time and effort, and Even when emergency drugs were needed, Prompt delivery of drug was not easy because of many reasons. For nurses, it took too long in the identification of the right drug. Actually nurses have heavy burden when medication error happens because nurse is the final actor who gives medication to the patient, So every three shift nurse ought to check drugs as soon as every shift begins. That's why it took too much time due to repeated confirming procedure. When nurses had to go patient room in order to give medications, there were difficulties in watching patient until the patient take medicine correctly. So it was impossible to check every patient wheather he took medicine or not especially in hectic situation. 3. There were many hospitals in Seoul which have similar medication system and method as object hospital according to the results of questionaire. This means that many hospitals have been suffering srimilar problems which were identified in object hospital. 4. Recommendations for promoting simplification of medication system and method were the following : Redesigning of slip from two pieces of paper into one : early discharge announcement system, and slip confirming through computer and controlling of period of prescreption from one day to two or three days : designing personal drug storage box for each patient and using it. If nurses follow the recommendations, they will make medication short & simple, and also have enough time of direct nursing care 5. Even though there were many difficulties in medicating patients. Medication itself has been considered as a caring among nurses because it makes rapport between nurse and patient. So nurses had better accept medication as a portion of nusing service not a original portion of phamacist. There are some limits in this research in terms of confining to only one unit of one hospital, and treating it especially in view of nurses' aspects, So further researchs should be continnued from various kmds of viewpoints of doctors, phamacists and so on. ${\cdot\cdot\cdot}$. Especially esthnographic study of computerized medication system and method seems to be followed.

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Effect of Cynanchi wilfordii Radix Extracts on Lipid Compositions and Blood Pressure in Spontaneously Hypertensive Rats (백하수오(Cynanchi wilfordii Radix) 추출물이 선천성 고혈압 흰쥐의 지질성분 및 혈압에 미치는 영향)

  • Choi, Jun-Hweok;Lee, Hye-Sung;Kim, Young-Eon;Kim, Byoung-Mok;Kim, In-Ho;Lee, Chang-Ho
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.41 no.3
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    • pp.345-350
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    • 2012
  • The purpose of this study was to observe the effects of Cynanchi wilfordii Radix extracts (CRE) on the improvement of the lipid compositions and blood pressure level in spontaneously hypertensive rats (SHR) fed an experimental diet for 5 weeks. The rats were divided into 3 groups: a control group, a 0.5% CRE treated group, and a 1% CRE treated group. Consumption of CRE extract for 5 weeks in SHR significantly suppressed blood pressure rise with aging (p<0.05). After eating the experimental diets, the triglycerides in serum was significantly lower in the CRE group than that in the control group. The fasting glucose levels of the 0.5% and 1% CRE group had a tendency to be lower compared with those of the control group. Total cholesterol, HDL-cholesterol and HTR (HDL-cholesterol/total cholesterol) of the SHR in the 0.5% and 1% CRE diet were significantly increased compared to the control diet. Thus, long term consumption of CRE might be beneficial in lowering high blood pressure and the improvement of lipid metabolism in SHR rats.

Effect of treadmill exercise on autophagy related protein expression in the cardiac muscle of high-fat diet fed rats (트레드밀 운동이 고지방 식이 쥐 심근세포의 자가포식 관련 단백질 발현에 미치는 영향)

  • Jeong, Jae-Hoon;Kang, Eun-Bum
    • Journal of the Korean Applied Science and Technology
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    • v.37 no.1
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    • pp.91-101
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    • 2020
  • The purpose of this study was to investigate the influence of obesity on the expression of autophagy-related proteins in cardiac muscle. To this end, obesity was induced in rats through 20 weeks of high-fat diet, and the animals were then subjected to 8 weeks of treadmill exercise. Subsequently, the expression of proteins that regulate the induction of autophagy, formation of autophagosome, and fusion of autophagosome and lysosome was confirmed. Obesity was induced in the experimental animals (SD rats) through 20 weeks of high-fat diet (carbohydrate: 20%, fat: 60%, and protein: 20%), and they were subsequently subjected to 8 weeks of treadmill exercise (5 days/week, 30 min/day, 5 minutes; 8m/min, 5 minutes; 11m/min, 20 minutes; 14m/min). The experimental groups comprised the normal diet control group (ND-CON, n=10), high-fat diet comparison group (HFD-CON, n=10), and high-fat exercise group (HFD-TE, n=10). Oral glucose tolerance test was conducted before and after 8 weeks of treadmill exercise, and the area under the curve (AUC) was calculated. Through fasting insulin and fasting glucose levels, HOMA-IR, which is an index of insulin resistance, and abdominal visceral fat/body weight (AVF/BW) were calculated for comparison. Moreover, autophagy-related proteins were analyzed from cardiac tissue to investigate the effects of exercise training. Obesity was successfully induced in the HFD-CON group through long-term high-fat diet, and the HFD-CON group had higher body weight, AUC, HOMA-IR, and AVF/BW compared to the ND-CON group. The HFD-TE group, which underwent 8 weeks of treadmill exercise, showed improvements in AUC, HOMA-IR, and AVF/BW. Although the body weight tended to decrease as well, there was no statistically significant difference. mTOR and AMPK, which are involved in the induction of autophagy, both decreased in obesity but increased upon exercise. Beclin-1, BNIP3, ATG-7, p62, and LC3, which are related to the formation of autophagosomes, all increased in obesity and decreased after exercise. Cathepsin L and LAMP2, which regulate the fusion of autophagosome and lysosome, both decreased in obesity and increased upon exercise. Physical activity, including treadmill exercise, was found to induce normal autophagy and improve pathological phenomena observed in metabolic diseases. Therefore, the findings suggest the need to consider treadmill exercise as a primary means to achieve effective prevention and treatment of cardiac diseases.

The Nopsae;a Foehn type wind over the Young Suh region of central Korea (영서지방의 푄현상)

  • ;Lee, Hyon-Young
    • Journal of the Korean Geographical Society
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    • v.29 no.3
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    • pp.266-280
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    • 1994
  • Upper-air synoptic data and surface weather elements such as temperature, relative humidity, wind speed, cloud and precipitation were analyzed in some detail to determine the characteristics of Nopsae, a foehn-like surface wind over the Youngsuh region of Central Korea. NOAA AVHRR and GMS images are also referenced to identify the distribution of clouds and precipitation to classify the tpyes of foehn over the study area. The data period examined is from 1982 until 1993 of spring and summer months from March through August. Results of the anaylsis are as follows. Warm and dry air penetration over the Younesuh region has experienced on foehn days occured between March 21 and August 10 during study perion. The mean annual number of foehn the days were 28. Foehn phenomena were prominent during March 21-25, April 5-15, May 25-June 10, and June 26-30 pentads. The intensity of the phenomena can be evaluated as the difference of daily maximum temperature and relative humidity between windward sites and leeward sites. The intensity of daily maximum temperature reached 14.5$^{\circ}C$, but most values were in the range of 5.0-7.5$^{\circ}C$ (61%). Although strong intensity of foehns usually develop in June, it is common that farmers in the region experince more aridity during the foehnday of April and May due to the transplantation of rice seedlings. Long-run foehn are not common phenomena and 55% of foehn terminate in one day, but there is a record that Nopsae persisted up to 9 days continuously. The author identified using the cloud and precipitation data out of NOAA-11, AVHRR and GMS images is that one of them has no precipitation over windward side. The available data and the results of the analysis are somewhat inadequate. Since the results imply that wave phenomenon is potentially important in terms of local surface weather and vertical momentum transport, more detailed theoretical and observational studies are necessary to clarify the mechanism and the impacts of Nopsae.

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