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Arginine Vasopressin Therapy of Vasodilatory Shock after Cardiac Surgery (심장 수술 후 혈관 확장성 쇼크가 발생한 환자에서 바소프레신 투여 요법)

  • Ahn, Young-Chan;Park, Chul-Hyun;Kim, Gun-Woo;Lee, Jae-Ik;Jun, Yang-Bin;Choi, Chang-Hyu;Hyun, Sung-Youl;Park, Kook-Yang
    • Journal of Chest Surgery
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    • v.39 no.12 s.269
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    • pp.913-919
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    • 2006
  • Background: Vasodilatory shock has been implicated in life-threatening complications after open heart surgery, where the systemic inflammatory reaction is attributed to the cardiopulmonary bypass(CPB). The secretion of arginine vasopressin(AVP) has been found to be defective in a variety of vasodilatory shock states and administration of AVP markedly improves vasomotor tone and blood pressure. So we reviewed our experience of AVP therapy in patients with vasodilatory shock following heart surgery using CPB. Material and Method: From January 2004 to July 2006, we reviewed the records of patients who received AVP therapy for vasodilatory shock following heart surgery using CPB. Vasodilatory shock was defined as a mean arterial pressure lower(MAP) than 70 mmHg, a cardiac index greater than 2.5 $L/min/m^2$, peripheral vascular resistance lower than 800 $dyn/s/cm^5$, and vasopressor requirements. The hemodynamic responses of patients who received AVP therapy for vasodilatory shock after cardiac surgery were analyzed retrospectively. Result: One hundred ninety nine open cardiac surgery patients were consecutively included in this study. Twenty two patients(11.1%) met criteria for vasodilatory shock. Despite the administration of high dose catecholamine vasopressor, all patients were hypotensive with a mean arterial pressure less than 70 mmHg. AVP therapy increased MAP from $53.3{\pm}7.4\;to\;82.0{\pm}12.0$ mmHg at 1 hour (p<0.001) and decreased other vasopressor requirements from $25{\pm}7\;to\;18{\pm}6$ at 1 hour(p<0.001) and individually maintained it for 12 hours. Conclusion: Our date suggest that AVP may be a safe and an effective vasopressor in patients with vasodilatory shock. In patients exhibiting vasodilatory shock after heart surgery, replacement of AVP increases blood pressure and reduces catecholamine vasopressor requirements.

Evaluation of Usefulness on In-vivo Diode Dosimetry for Measuring the Tumor Dose of Oral Cancer Patient (구강암 환자의 종양 선량 측정을 위한 In-vivo Diode Dosimetry의 유용성 평가)

  • Na Kyung-Su;Lee Je-Hee;Park Heung-Deuk
    • The Journal of Korean Society for Radiation Therapy
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    • v.17 no.2
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    • pp.133-140
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    • 2005
  • Purpose : This test is designed to identify the validity of treatment plan by implementing real-time dosimetry by means of dose that is absorbed into PTV and OAR when preparing doses of 3D and POP plans. Materials and Methods : In treatment. error can be calculated be comparing Exp. Dose with the actual dose, which has been converted from 'the reading value obtained by placing diode detector on the area to be measured'. Same test can be repeated using Alderson-Rando phantom. Results : Errors were found: A patient(POP plan): 197.6/199=-1.2%, B patient(3D-plan): 199.9/198.7=+0.6%, C patient: 196/200=-1.5%. In addition, considering the resulted value of measuring OAR besides target-dose for C patient showed 96/200, representing does of 47%, the purpose of protection was judged to be duly accomplished. Also it was acknowledged the resulted value of -3.7% met the targeted dose within the range of ${\pm}5%$. Conclusion : Aimed for identifying the usefulness of pre-treatment dose measurement using diode detector, this test was useful to evaluate the validity of curing because it resulted in the identification of category to be protected as well as t dose. Moreover, it is thought to have great advantage in ascertaining the dose of target, dose of which is not calculated yet. Similar to L-gram before treatment, this test is thought to be very effective so that it can bring great advantages in the aspects such as validity of curing method and post-treatment plan as well.

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Antithrombin-III as an early prognostic factor in children with acute lung injury (급성 폐손상 소아 환자에서 조기 예후 인자로서의 antithrombin-III)

  • Lee, Young Seung;Kim, Seonguk;Kang, Eun Kyeong;Park, June Dong
    • Clinical and Experimental Pediatrics
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    • v.50 no.5
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    • pp.443-448
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    • 2007
  • Purpose : To evaluate the potential prognostic value of the antithrombin-III (AT-III) level in the children with acute lung injury (ALI), we analyzed several early predictive factors of death including AT-III level at the onset of ALI and compared the relative risk of them for mortality. Methods : Over a 18-month period, a total of 198 children were admitted to our pediatric intensive care unit and 21 mechanically ventilated patients met ALI criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and $PaO_2/FiO_2$ lower than 300 without left atrial hypertension. Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as Pediatric Risk of Mortality-III (PRISM-III) scores and Lung Injury Score (LIS) at admission were collected. AT-III levels were measured within 3 hours after admission. These variables were compared between survivors and non-survivors and entered into a multiple logistic regression analysis to evaluate their independent prognostic roles. Results : The overall mortality rate was 38.1% (8/21). Non-survivors showed lower age, lower lung compliance, higher PEEP, higher oxygenation index (OI), lower arterial pH, lower $PaO_2/FiO_2$, higher PRISM-III score and LIS, and lower AT-III level. PRISM-III score, LIS, OI and decreased AT-III level (less than 70%) were independently associated with a risk of death and the odds ratio of decreased AT-III level for mortality is 2.75 (95% confidence interval; 1.28-4.12) Conclusion : These results suggest that the decreased level of AT-III is an important prognostic factor in children with ALI and the replacement of AT-III may be considered as an early therapeutic trial.

A Study of Task and Approach for the Insurance Fee Application of Packed Medical Herbs (첩약의 보험급여 적용을 위한 과제 및 접근방안에 대한 연구)

  • Park Yong-Sin;Cho Byung-Hee;Kim Ho;Lee Si-Baek
    • Journal of Society of Preventive Korean Medicine
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    • v.7 no.1
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    • pp.17-28
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    • 2003
  • We met results like the followings through the literatures and questionnaires about the tasks and solutions about the insurance fee of packed medical herbs. 1) It's turned out that 74.8% of herb doctors agrees to the insurance fee of packed medical herbs. However, in comparison with the same survey of the herb doctor association the percentage of general approval went somewhat lower, and especially the percentage of 'positive approval' became notably lower$(43.7%{\rightarrow}26.5%)$ and the percentage of 'active objection' raised about 2 times$(6.8%{\rightarrow}12.9%)$. Inquiring into the approval reasons on the insurance fee application of packed medical herbs some heads such as 'development toward treatment medical science' and 'decrease of publics burden' were higher than the one of 'management income and expenditure.' 2) As a result of the research, 36.0% of the patients and 42.8% of the residents recognized that the pay range of Chinese herb health insurance is narrow. They recognized that less people have the experiences of Chinese medical hospital use and internal application of the packed medical herbs as they are older, men rather than women. 85.4% of the patients and 74.9% of the residents agreed on the insurance pay of packed medical herbs. It's shown that they agree on the Chinese medical hospital use more as the economic standard is lower, on the insurance pay as they have ever taken the packed medical herbs. In the aspect of increase of insurance fee, 66.7% of the patients and 44.3% of the residents agreed on the insurance pay of packed medical herbs, and 18.1% and 36.1% disagreed on the insurance pay of packed medical herbs. The main objective reason why they disagree on the insurance pay of packed medical herbs was 'because the insurance fee goes up higher,' which answered 95.2% of the patients and 78.8% of the residents. 7.22% of the patients and 1.80% of the residents answered that they can pay more insurance fee in case of the insurance pay of packed medical herbs. However, in the priority order of the insurance pay, it hold the 5th position between 2 target research groups which was less than medical examination, charges for hospital accommodation and taking MRI. 3) According to the result of analysis about the cost of packed medical herbs, current practice price is 115,000 won and the average prime cost of a packed medical herb is 73,000 to 106,000 won. It's examined that the herb doctors regard that 95,000 won will be reasonable when the packed medical herb is payed in insurance. However, it was found out that the public generally thinks that the price would be appropriate on the level of 30,000 to 40,000 won and the percentage of the answers of 20,000 won to 30,000 was fairly high. 4) the central system of a prescription should be change into the central system of demonstration and the sick and wounded. 5) To solve this problem, the government should regulate it to pass by the circulation gradation of [importer, $peasantry{\rightarrow}manufacturer{\rightarrow}wholesaler{\rightarrow}distributor$(Chinese medical hospital, pharmacy dispensary of Chinese medicine)]And it should intervene into the quality and the circulation steps of Chinese medicine through 'the office or organization which is in charge of certification of Chinese medicine' and 'the office or organization which is in charge of the circulation of Chinese medicine.' And some actions such as simple severance, lavation, drying should be included into the conception of manufacture and the boundary between food and medical supplies should be made at a manufactory. And the regulation of standardized goods at one's own house should be improved so that, the peasantry can sell the materials of Chinese medicine only to the manufacturer. 6) In company with the insurance pay of packed medical herbs, the study about the separation of dispensary from medical practice in the Chinese medicine should be accomplished.

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The Smoking Status and Its Associated Factors of Some Army Soldiers (일부(一部) 병사(兵士)들의 흡연실태(吸煙實態)와 관련요인(關聯要因))

  • Jung, S.J.;Lee, C.G.;Ryu, S.Y.;Kim, K.S.
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.5
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    • pp.426-436
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    • 2001
  • Objective : This study was performed to determine the smoking status and its associated factors in military life among young Korean men to provide data for smoking prevention in military areas as a part of the health promotion program for soldiers. Methods : 1,033 infantrymen serving in 17 military units, which are located in suburbs of K city, were enrolled in this study. A questionnaire on the soldiers smoking status and other various characteristics was obtained from October 2nd to 12th, 2000. Logistic regression analysis was performed on the various variables in order to determine the factors related to smoking. Results : 1) 830(80.3%) out of 1033 subjects had smoked cigarettes and 759 persons(73.4%) were regular smokers. 2) Among the 734 soldiers who started smoking before their military service, 714 soldiers(97.2%) continued to smoke after, while 45 soldiers(15.0%) among the 299 non-smokers started smoking after joining the army. 3) Through the logistic regression analysis. the education level. specialty in the army. smoking amongst the friends they met before military service, smoking amongst soldiers in the army. dating girl friends, drinking, satisfaction with their army lives and the presence of convenient smoking places at the barracks were significant factors related to the prevalence of smoking in soldiers. Conclusion : The factors related with incidence of smoking in the army are the complicated interactions among the individuals personal background, general characteristics of the soldier and the special environment in the barracks. Therefore, to improve national soldiers' health, an active non-smoking campaign and education should be pushed to discourage smoking in the barracks.

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Study on Operating Strategy for Recreation Forests through Comparing the Level of User Satisfaction according to Clusters (군집별 만족도 비교를 통한 자연휴양림의 효율적 운영 방안 연구)

  • Gang, Kee-Rae;Lee, Kee-Cheol
    • Journal of the Korean Institute of Landscape Architecture
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    • v.38 no.1
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    • pp.39-48
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    • 2010
  • Recreation forests are in the spotlight as the place for personality development, mind and body comfort, companionship, and environment education in forests and valleys. Visitors to recreation forests have been on the increase along with booming in recreation forest building since 1988. Recreation forests are being categorized according to some features such as regional and environmental condition. Recreation forests, however, have not met the expectations of some visitors who want to take a rest with calmness due to the influence of the 5-day-work-week system, increasing interest in rest, leisure, and well-being, and users converge during weekends, summer, and the tourist season. In order to improve visitors' satisfaction efficiently, this study surveyed the level of satisfaction in each cluster based on the precedent study which had classified 85 national or public recreation forests in Korea into clusters. Questionnaires were distributed properly to each cluster and, of the 1,132 questionnaires collected, 1,015 were valid and used for analysis. Reliability of questionnaires and statistical validity of the model were verified. As a result, there are meaningful differences in the ranking of independent variables which affect the level of satisfaction according to clusters. Variables in rest and fatigue recovery have the strongest influence on the level of satisfaction in the clusters of potential factor, internal activation factor, and mixed potential capacity factor. In the use performance and visiting condition factor cluster, appropriateness of visit cost is most influential and, in the education cluster, connectivity with tourist attractions around it is most affective. These results can provide priority in services and maintenance of recreation forests for improving the level of satisfaction and differentiate the distribution of resources according to clusters.

Effect of Seleniferous Whole Crop Barley Silage on Growth Performance, Blood and Carcass Characteristics, and Tissue Selenium Deposition in Finishing Hanwoo Steers (셀레늄 강화 청보리 사일리지 급여가 비육기 거세한우의 생산성, 혈액성상 및 도체특성과 조직 내 셀레늄 축적에 미치는 영향)

  • Hwangbo, Soon;Jo, Ik Hwan;Kim, Guk Won;Choi, Chang Weon;Lee, Sung Hoon
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.33 no.4
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    • pp.281-289
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    • 2013
  • This study was conducted to investigate the effects of feeding seleniferous whole crop barley silage (WCBS) on the growth performance, blood and carcass characteristics, and tissue selenium deposition infinishing Hanwoo steers. A total of 20 growing Hanwoo steers were selected and assigned to one of the following feed groups: control (0.1 ppm Se), T1 (0.3 ppm Se), T2 (0.9 ppm Se), and T3 (0.9 ppm of inorganic Se). Five steers were allocated to each treatment group, and the trial lasted for 90 days. All experimental diets combined seleniferous and/or non-seleniferous WCBS up to a ratio of 30%. For the T3 diet, 0.9 ppm Se in the form of sodium selenite was added to the control diet. Dietary level and type of selenium did not affect feed intake and body weight gain. Blood total lipid and triglyceride concentrations were significantly (p<0.05) lower in the T2 group than in control. Blood immunoglobulin G concentration increased significantly (p<0.05) with increasing levels of dietary selenium; concentrations were significantly (p<0.05) higher in T2 and T3 than in control. Blood selenium concentration was the highest (p<0.05) in T2. No significant difference was observed in dressing rate, ribeye area, marbling score, meat color and fat color. Further, no association was found between levels and chemical form of dietary selenium and quality and quantity of meat. To the contrary, tissue selenium content in kidney, liver, and hind leg increased significantly (p<0.05) with increasing levels of selenium; however, feeding inorganic selenium did not introduce a significant increase in tissue selenium content of finishing Hanwoo steers. The results indicated that the selenium present in seleniferous WCBS was an effectively absorbable selenium source, suitable for increasing tissue selenium content in beef. Approximately 100 g of hind leg muscle from steers fed on the T2 diet met approximately 69% of the recommended daily selenium requirements.

Development of the Korean version of Postconcussional Syndrome Questionnaire (한글판 뇌진탕후증후군 척도의 개발)

  • Yoon, Mi-Ri;Ko, Young-Hoon;Han, Chang-Su;Joe, Sook-Haeng;Jeon, Sang-Won;Han, Chang-Woo
    • Korean Journal of Psychosomatic Medicine
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    • v.23 no.1
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    • pp.26-35
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    • 2015
  • Objectives:The purpose of this study was to evaluate reliability and validity of the Korean version of the Postconcussional Syndrome Questionnaire(KPCSQ) which was originally developed in 1992 by Lees-Haley. Methods:Patients with traumatic brain injury were recruited from April 2009 to December 2011 from the Korean University Ansan Hospital. We selected patients that met the ICD-10 diagnostic criteria of postconcussional syndrome and organic mental disorder including organic mood disorder, organic emotionally labile disorder, organic anxiety disorder and organic personality disorder. The KPCSQ, Trait and State Anxiety Inventory(STAI-I, II), and Center for Epidemiologic Studies Depression Scale(CESD) were administered to all subjects. Factor analysis of the items were performed and test-retest correlation were evaluated. Internal consistency of the KPCSQ and its subscales was assessed with Cronbach's alpha. External validity of the KPCSQ were examined by correlation coefficient with the STAI-I, II, and CESD. Results:The Cronbach's alpha coefficient of the total PCSQ was 0.956. The test-retest reliability coefficient was 0.845. The PCSQ showed significant correlation with STAI-I, II and CESD. The factor analysis of the PCSQ yielded 4 factors model. Factor 1 represented 'affective and cognitive symptoms', factor 2 represented 'somatic symptoms', factor 3 represented 'infrequent symptoms' and factor 4 represented 'exaggeration or inattentive response'. There was no significant difference between the PCS group and the organic mental disorder group in the score on each measure. The scores on KPCSQ and its subscales in the subjects that had scored 5 or more in 'exaggeration or inattentive response' are significantly higher than those in the subjects had scored 4 in 'exaggeration or inattentive response'. Conclusions:This study suggests that the Korean version of PCSQ is a valid and reliable tool for assessing psychiatric symptomatology of patients with traumatic brain injury. Further investigations with greater numbers of subjects are necessary to assess the clinical usefulness of the KPCSQ.

The Method and Meaning of the Archiving Project of Suicide Survivors (자살유족 기록작업의 방법과 의미)

  • Lee, Young-nam
    • The Korean Journal of Archival Studies
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    • no.59
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    • pp.207-275
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    • 2019
  • This archiving project of the survivors of suicide was done with the survivor supporting team of the Seoul Suicide Prevention Center. The survivor supporting team was operating a Self-help Support Group for the emotional support of the survivors of suicide. A Self-help Support Group is a place for the survivors of suicide to regularly meet and share their suffering by talking of topics hard to discuss elsewhere. As the Self-help Support Group progressed members who acted as the leader of the group appeared. They formed an essay group that writes together. Two fathers who lost their sons, two mothers who lost their daughters, a mother who lost her son, a wife who lost his husband. The essay group met each week in a place facing Sajik Park. Through the windows that took up the whole side of the room, evening was coming in. The things that happened during the day went away towards Inwang mountain following the setting sun. Ten people (six members of the essay group, three from the survivor support team, a historian for unique conversation) sat around a table, facing each other. "Now, what shall we do?" History for unique conversation is a time that archives life by sharing conversations. At times a complete stranger, and other times people who share their ordinary lives sit around together (3-9 people, sometimes about 15). On the table there is coffee, bread, fruits and salads, and sometimes a dish someone heartily prepared. When a bottle of wine is placed on the table, each takes a glass. Morning, afternoon, the time the evening is welcomed in, late night. It does not matter which. For six months, 3 hours when meeting every week, 6 hours when at every other week. A room where the ambience is like that of a kitchen where sunlight enters, or a cozy living room is the best location. However, there are many times when it is held in a multipurpose room in the suburbs where many meetings are held, or in a classroom of a school. The meeting place is decided according to different situations of the time. There are no participation requirements as it is said to be for themselves to write down according to archiving form while looking back their lives thoroughly, and they are the only ones to stop themselves. The archives landscape from far away would seem like trying to do some talking. However, when going into a microscopic situation one must leave themselves to the emotional dynamics. It is because it archives the frustration and failures one experienced through life. A participator of history for unique conversation must face the sufferings of their life. The archiving project took place in 2013 to 2014. Many years have passed. Has the objective distance for archiving the situation of that time been secured? That may be uncertain, but I will speak of a few stray thoughts on archiving while depicting the process and method of operation.

Ecological Renewal Plan of Urban Parks for the Revitalization of Urban Green Axis in Gangdong-Gu (강동구 도시 녹지축 기능 활성화를 위한 도시공원의 생태적 리뉴얼 방안 연구)

  • Park, Jeong-Ah;Han, Bong-Ho;Kwak, Jeong-In
    • Journal of the Korean Institute of Landscape Architecture
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    • v.51 no.2
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    • pp.12-27
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    • 2023
  • In this study, among the construction-type parks in Gangdong-gu, targeting parks with high environmental and ecological value located on the urban green axis, a plan was prepared for the ecological renewal of urban parks, and a design that applied to them was proposed. The renewal target site was selected by analyzing the general condition of Gangdong-gu and urban parks, the land use and green area ratio, park green area, and the green axis of Gangdong-gu. Gangdong-gu has 54 parks, including 2 neighborhood parks and 52 children's parks. In the first stage of the current status review, 17 parks were extracted through locational value analysis, such as location and adjacency to the natural axis and green axis. In the second stage, eight parks were selected among the first-stage extraction parks based on the ratio of green spaces and open spaces within each park service area. In the third stage, two of the second stage extraction parks were selected based on whether the legal standard of the park area was met, and in the fourth stage, one of the third stage extraction parks was selected through an aging survey of the park. As for the urban ecological status of the renewal target site, the status of land use in the aspect of entropy reduction, the status of soil cover in the aspect of water circulation, and the status of planting structure in the aspect of biodiversity were investigated. As for the status of the three renewal sites, the green area was insufficient at 18.3-45.3%, and the facility area was 54.7%-81.7%, which was judged to have low urban temperature reduction effects. The impervious pavement area accounted for 34.5% to 48.9% of the park area, accounting for most of the facility area, and it was judged that the water circulation function was insufficient. The planting structure consisted of a single layer and a double layer structure, and although the tree layer was good, the lower vegetation was poor, and there was no planting site of edible plants or large hardwood trees, so the biodiversity was low. After the ecological renewal design of Seonrin Children's Park, Dangmal Children's Park, and Saemmul Children's Park, which were selected as the renewal targets in this study, the ecological area ratio of each park increased by 1.4 to 3 times than before the renewal. If the urban parks located on the urban green axis are examined from the perspective of the urban ecosystem and renewed ecologically, it is judged that the expected effect will be high in reducing entropy, improving water circulation, and laying the foundation for biodiversity in terms of the urban ecosystem.