• Korean Circulation Journal
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• 제53권9호
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• pp.594-605
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• 2023

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.

• Journal of Chest Surgery
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• 제42권1호
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• pp.107-110
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• 2009

자가 또는 이식혈관의 감염은 반복적인 파열 및 패혈증으로 인해 환자의 생명을 위협하는 심각한 질병이다. 대퇴동맥을 포함한 서혜부 감염이 생긴 경우 가장 성공적인 치료원칙은 감염된 조직의 광범위한 절제와 동맥재건술이다. 본원에서는 뇌동정맥루, 뇌출혈환자에서 대퇴동맥을 천자하여 시행한 혈관조영술후 패혈증을 동반한 감염된 가성동맥류가 발생하여 폐쇄공우회술을 이용하여 치험하였기에 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제44권5호
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• pp.314-319
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• 2008

Objective: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. Methods: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall. 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients Results: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. Conclusion: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.

• Journal of Chest Surgery
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• 제40권7호
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• pp.512-516
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• 2007

기계적인 순환보조장치는 급성호흡부전이나 심부전에서 생명을 구할 수 있는 방편의 하나이다. 현재 여러 가지 형태의 순환 보조장치가 있으며 Twin-Pulse Life Support (T-PLS) system은 박동형 펌퍼의 한 종류다. 3예의 심한 심폐기능부전 상태 환자에게 순환보조장치로 T-PLS system을 사용하였다. 적응증은 인공호흡기와 강심제를 최대한 사용함에도 불구하고 지속되는 호흡부전이나 심부전이었다. 감염에 의한 호흡부전환자가 2예, 심근염에 의한 심부전 환자가 1예였다. 각각 한 명의 호흡부전환자와 신부전 환자가 생존하였는데 보조장치의 사용시간은 각각 3일과 5일이었다. T-PLS system은 순환보조장치로 유용하게 사용할 수 있으며 다발성 장기부전이 오기 전에 적용하여야 할 것으로 생각된다.

• Journal of Chest Surgery
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• 제32권1호
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• pp.75-79
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• 1999

Budd-Chiari syndrome은 하공정맥에서 우심방으로의 혈류장애로 인한 간부전증이다. 본 증례의 남자 45세 환자는 1987년 선천적인 막의 하공정맥 폐쇄로 인한 하공정맥 폐색막 제거와 확장술을 자가심낭으로 이용하여 수술을 받았다. 술후 10년이 경과한 후 하공정맥이 재협착되어 비침습적인 방법인 Gianturco stent 확장술을 받았으나 치료적인 효과를 얻지 못하였다. 재수술은 Gore-Tex 인조 혈관의 일부를 오각형으로 재단하여 하공정맥의 협착 부위를 절개한후 부착 봉합후 손가락 두행지가 통과할수 있도록 확장하였다. 수술후 출혈이나 합병증없이 양호한 경과를 보였으며 항응고제 사용없이 수술 2주 경과후 퇴원 하였다. Gore-Tex 인조혈관을 일부 제단한 patch를 수술에 사용하여 좋은 결과를 얻었으며 Budd-Chiari syndrome의 재수술의 경우로 인공심폐기하에도 수술시야에 심한 출혈이 발생 하므로 신속하고 정확한 지혈 수기가 요구된다고 할수 있다.

• Journal of Chest Surgery
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• 제18권4호
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• pp.537-541
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• 1985

Recently, we met a 12 year old female patient who suffered from bacterial endocarditis and pericarditis which were complicated by patent ductus arteriosus. She was admitted to our hospital because of dyspnea, fever, headache, and generalized ache for 10 days. The initial diagnosis was bacterial endocarditis and pericarditis complicated by patent ductus arteriosus and congestive heart failure. At first, we tried to treat the patient medically with digitalis, diuretics, and massive antibiotics. On echocardiography large amount of pericardial fluid was accumulated mainly right anterior aspect and also noted a large vegetation at pulmonary valve area. With vigorous medical treatment including repeated pericardiocentesis, the patient showed no improvement. So we decided to perform pericardiectomy for elimination of the most probable septic focus. On operation, we encountered an unpredicted event, the pericardium was thickened, distended, and its surface showed pulsating which meant connecting to systemic circulation. We decided to close the operative wound and reoperate her under cardiopulmonary bypass later. On the next day, we operated her under cardiopulmonary bypass later. On the next day we operated her under cardiopulmonary bypass. The operative findings were ruptured main pulmonary artery about 1.5cm in diameter on its ventral portion, the blood from the ruptured main pulmonary artery was filled up the localized pericardial sac due to previous pericarditis. Through the ruptured main pulmonary artery, we also found 0.5cm diametered patent ductus arteriosus. With the aid of partial cardiopulmonary bypass and inserting 24F ballooned Foley catheter at aorta, pericardiectomy was performed first. After completion of the pericardiectomy, total cardiopulmonary bypass was established. With minimum pump flow [0.3L/min/m2] the PDA was closed with two Teflon-felted 4-0 Prolene interrupted sutures. The ruptured main pulmonary artery was also closed using thickened pericardium with three Teflon-felted 4-0 Prolene interrupted sutures. The operation was successful and postoperative course was uneventful. She was discharged on the 16th POD. We report this case as a very rare secondary complication of bacterial endocarditis complicated by patent ductus arteriosus.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제5권8호
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• pp.15-22
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• 1999

Corresponding to the change of the environment of oriental medicine, oriental medicine hospital in today is adjusting between the specific element of oriental medicine and the systematic application of occidental medicine hospital. According to this situation, this study aims to represent the material of the architectural planning of the the oriental medicine hospital. As its method, including the concept of the cooperative examination and treatment between oriental and occidental medicine hospital, the circulation of the patient and staff, and the type of the plane figure of the outpatient department are estimated.

• Journal of Chest Surgery
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• 제26권9호
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• pp.701-704
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• 1993

Four to seven percent of infants born with aortic atresia have a normal-sized left ventricle in association with a ventricular septal defect and a normal mitral valve. In contrast to the more common group of infants with aortic atresia whose left ventricle is hypoplastic, this important subgroup has potential for complete operative correction involving both the right and left ventricle. Our approach was to perform complete repair at one stage. The patient who underwent single-stage repair was discharged from the hospital in good condition. Achieving a physiologically normal circulation simplifies the postoperative management of this condition.

• Journal of Chest Surgery
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• 제26권8호
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• pp.643-645
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• 1993

It is generally acknowledged that congenital coronary artery fistula is an abnormal communication of the coronary artery with the right ventricle, right atrium,left atrium and left ventricle. In young people the symptoms are unusual , but significant symptoms and complications appear among the older age group such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension. Therefore, early surgical treatment is recommended. We experienced a case of coronary arteriovenous fistula that was involving the circumflex branch of the left coronary artery with the right ventricle. It was 10mm in diameter with multiple vegetation. We repaired the fistula under extracoporeal circulation. The patient was discharged in a healthy condition twelve days after operation .

• 대한전기학회:학술대회논문집
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• 대한전기학회 2011년도 제42회 하계학술대회
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• pp.2053-2054
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• 2011

Cardiopulmonary resuscitation(CPR) is performed by artificial ventilation and thoracic compression for the patient under emergent situation to maintain at least the minimum level of respiration and blood circulation for life survival. Good quality CPR requires monitoring respiration. We developed a system for continuous monitoring respirational signal while CPR, using respirational airflow sensor for CPR. Signal extraction circuit obtains pressure signal while CPR. Obtained signal would be performed analog-digital conversion and changed to airflow value by characteristic formula. Single inspiration and expiration were considered a period. Detected valid data were displayed LCD.