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In-Hospital Outcomes of Acute Renal Failure Requiring Continuous Renal Replacement Therapy in Patients with On-pump CABG (심폐기 가동하 관상동맥우회술 후 발생한 급성신부전 환자들에 있어 지속적 신대체요법의 병원 내 결과)

  • Kim, Young-Du;Park, Kuhn;Kang, Chul-Ung;Yoon, Jeong-Seob;Moon, Seok-Whan;Wang, Young-Pil;Jo, Kuhn-Hyun
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.32-36
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    • 2007
  • Background: Although acute renal failure (ARF) after coronary artery bypass graft (CABG) is relatively rare, but devastating complication with high mortality. Our study aims to evaluate the effectiveness of early application of CRRT in patients with ARF which developed after on-pump CABG. Material and Method: Two hundred and eighty seven patients underwent isolated on-pump CABG between May 2002 and Feb. 2006 at our institution, of whom 15 (5.2%) needed CRRT (11 patients for postoperatively developed ARF and the remaining 4 patients with preexisting dialysis-dependent chronic renal failure (CRF) for postoperative hemodynamic and metabolic control). Criteria for early application of CRRT were as follows; decreased urine output less than 0.5cc/h/kg for 2 consecutive hours and elevated serum creatinine level greater than 2.0 mg/dL. Result: The incidence of ARF requiring CRRT after on-pump CABG was 3.9% (11/283) and the overall hospital mortality of patient with CRRT was 33.3% (5/15). Of 5 deaths, 4 were patients with postoperatively developed ARF, and 1 was a patient with pre-existing dialysis-dependent CRF patient. The mean time between the operation and the initiation of CRRT was $25.8{\pm}5.8$ hours and the mean duration of CRRT was $62.1{\pm}41.2$ hours. Of the 7 survivors who were not on dialysis-dependent preoperatively, 6 patients fully recovered renal function during hospital stay and 1 patient required permanent renal supportive treatment after discharge from hospital. Conclusion: Early application of CRRT could maintain stable postoperative hemodynamic status and make outcomes better than those of previous reports in patients with ARF which developed after on-pump CABG.

Recent Early Operative Outcomes of Comprehensive Aortic Root & Valve Reconstruction (CARVAR) Procedure (종합적 대동맥 근부 및 판막 재건술의 최근 초기 수술성적)

  • Lee, Sung-Jun;Shin, Je-Kyoun;Kim, Dong-Chan;Kim, Jin-Sik;Kim, Jun-Seok;Chee, Hyun-Keun;Song, Meong-Gun
    • Journal of Chest Surgery
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    • v.42 no.6
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    • pp.696-703
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    • 2009
  • Background: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. Material and Method: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed, The mean patient age was 53 years (range: 14~84) The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the MR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. Result: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from $54.6{\pm}8.4$ mm to $38.3{\pm}3.8$ mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from $47.1{\pm}24.4$ mmHg to $15.1{\pm}11.7$ mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. Conclusion: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.

Mid to Long Term Outcomes of Surgical Treatment for Isolated Coarctation of Aorta (단순 대동맥 축착의 외과적 치료 후 중.장기 결과)

  • Lee, Seung-Cheol;Yoon, Tae-Jin;Park, Jeong-Jun;Song, Meong-Gun;Kim, Young-Hwee;Ko, Jae-Kon;Park, In-Sook;Seo, Dong-Man
    • Journal of Chest Surgery
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    • v.40 no.2 s.271
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    • pp.83-89
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    • 2007
  • Background: The surgical repair of an isolated coarctation of the aorta, without complex cardiac anomalies, has improved, with very good results. However, despite the success of surgical repair, many long-term complications, such as hypertension, re-coarctation and an aortic aneurysm, still exist. Material and Method: Between 1991 and 2006, 50 patients diagnosed with an isolated coarctation of the aorta were reviewed retrospectively. The incidence of re-coarctation and hypertension were compared with respect to age and surgical methods. Result: There were no early & late mortality, or post operative aortic aneurysms. Hypertension developed in 11 patients (22%). A greater number of patients in the child/adult group had hypertension (52.4%) than in the neonate/infant group (0%). With respect to the surgical methods, the patients in the graft interposition group suffered more hypertension (88.9%) than those in the EEEA (extended end to end anastomosis) group (5.3%). Post operative re-coarctation developed in 2 out of the 29 patients (6.9%) in the neonate/infant group and 2 out of the 21 patients (9.5%) in the child/adult group, but without any statistical difference. There were no statistical differences between the operative type-related groups. Conclusion: Even though the surgical outcomes have greatly improved, an isolated coarctation of the aorta still has many long-term problems, such as hypertension and re-coarctation. An isolated coarctation is accepted as a systemic vascular dysfunction, and often progresses to other cardiovascular diseases. Therefore, patients with a coarctation of the aorta have to be carefully followed-up, and aggressive management must be given when required.

Evaluation of Meteorological Elements Used for Reference Evapotranspiration Calculation of FAO Penman-Monteith Model (FAO Penman-Monteith 모형의 증발산량 산정에 이용되는 기상요소의 평가)

  • Hur, Seung-Oh;Jung, Kang-Ho;Ha, Sang-Keun;Kim, Jeong-Gyu
    • Korean Journal of Soil Science and Fertilizer
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    • v.39 no.5
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    • pp.274-279
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    • 2006
  • The exact estimation of crop evapotranspiration containing reference or potential evapotranspiration is necessary for decision of crop water requirements. This study was carried out for the evaluation and application of various meteorological elements used for the calculation of reference evapotranspiration (RET) by FAO Penman-Monteith (PM) model. Meteorological elements including temperature, net radiation, soil heat flux, albedo, relative humidity, wind speed measured by meteorological instruments are required for RET calculation by FAO PM model. The average of albedo measured for crop growing period was 0.20, ranging from 0.12 to 0.23, and was slightly lower than 0.23. Determinant coefficients by measured albedo and green grass albedo were 0.97, 0.95 and standard errors were 0.74, 0.80 respectively. Usefulness of deductive regression models was admitted. To assess an influence of soil heat flux (G) on FAO PM, RET with G=0 was compared with RETs using G at 5cm soil depth ($G_{5cm}$) and G at surface ($G_{0cm}$). As the results, RET estimated by G=0 was well agreed with RET calculated by measured G. Therefore, estimated net radiation, G=0 and albedo of green grass could be used for RET calculation by FAO PM.

Model Equations to Estimate the Soil Water Characteristics Curve Using Scaling Factor (Scaling Factor를 이용한 토양수분특성곡선 추정모형)

  • Eom, Ki-Cheol;Song, Kwan-Cheol;Ryu, Kwan-Shig;Sonn, Yeon-Kyu;Lee, Sang-Eun
    • Korean Journal of Soil Science and Fertilizer
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    • v.28 no.3
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    • pp.227-232
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    • 1995
  • The model equations including scaling factors to estimate the soil water characteristics curve(SWCC) without direct measurement of soil water tension were developed. Scaling were applied to a data set of soil water content, soil water tension, particle size distribution, and OM contents of the 134 soil samples with the 10 soil textural classes. The capability of the model equations was tested on another 205 soil samples. The parameter, ${\theta}^*$, of soil water contents was used by scale transformation as follows : ${\theta}^*=[{\theta}i-{\theta}(1.5MPa)]$/$[{\theta}(10KPa)-{\theta}(1.5MPa)]$ Using ${\theta}^*$ a model equation to estimate SWCC, which was applicable to all textural classes, was developed as follows: $H(0.1MPa)=0.13{\cdot}({\theta}^*)^{-2.04}$. Other model equations to estimate the water content at the soil water tension of 10KPa [${\theta}(10KPa)$] and 1.5MPa [${\theta}(1.5MPa)$], which are required to ${\theta}^*$ were developed by using scale factors of sand(S) and silt(Si) content and organic matter content(OM) as foilows : ${\theta}(10KPa)=26.80-3.99ln[S]+2.36{\sqrt{[Si]}}+2.88[OM]$ ($R=0.81^{**}$) ${\theta}(1.5KPa)=15.75-2.86ln[S]+0.55{\sqrt{[Si]}}+0.70[OM]$ ($R=0.76^{**}$) The measured and estimated values of ${\theta}(1/30MPa)$ on the 205 soil samples were highly correlated on 1 : 1 corresponding line with $R=0.85^{**}$.

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Preliminary Results of Phase I/II Study of Simultaneous Modulated Accelerated (SMART) for Nasopharyngeal Carcinoma (비인강암의 치료에서 동시차등조사가속치료를 적용한 제1상/2상 연구의 예비적 결과)

  • Park Jin-Hong;Back Geum-Mun;Yi Byong-Yong;Choi Eun-Kyung;Ahn Seung-Do;Shin Seong-Soo;Kim Jung-Hun;Kim Sang-Yoon;Lee Bong-Jae;Nam Soon-Yuhl;Choi Seung-Ho;Kim Seung-Bae;Lee Sang-Wook
    • Radiation Oncology Journal
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    • v.24 no.1
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    • pp.1-10
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    • 2006
  • Puroose: To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the 'step and shoot' SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week. Results: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had RTOG grade 3 mucositis, whereas nine (45%) had grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no grade 3 or 4 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively. Conclusion: IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.

Studies on the Simplified Hemagglutination Reaction to Pasteurella multocida and the Stabilization of Erythrocytes (Pasteurella multocida에 대(對)한 간이적혈구(簡易赤血球) 응집반응(凝集反應)과 적혈구(赤血球)의 안정화(安定化)에 관(關)한 연구(硏究))

  • Lee, Hak Cheul;Chung, Yung Gun;Kim, Kyo-Joon
    • Korean Journal of Veterinary Research
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    • v.10 no.1
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    • pp.11-23
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    • 1970
  • Recently Carter(1952) reported the capsule antigens of Pasteurella multocida could be divided into four serological types A,B,C and D by means of precipitation tests. Subsequently he showed that the most sensitive for identification of these types involved the use of capsule substance adsorbed by erythrocytes in hemagglutination test. It may be somewhat difficult to conduct the hemagglutination test in small laboratory, because relatively large amounts of antisera and erythrocytes of the human O type are required for the test. A simple method for serological typing of P. multocida was the slide agglutination test employed by Little et al. (1943) and Namioka et al. (1962), but this method is still in controversy. The author tried adapting Carter's hemagglutination method to the slide method so called "micromethod technique", and studied on the stabilization of erythrocytes for use of slide hemagglutination to P. multocida although many invesigators reported the stabilization of erythrocytes. The results obtained are summarized as follows: 1. A simplified method (slide method) for capsule typing of the organism was developed by adapting Carter's hemagglutination reaction(tube method). Antibody-containing serum can be diluted serially on Boerner's microtest slide with capillary or serological pipetts with a considerable accuracy. The slide reaction can be carried out with case on the slide by adding $0.05m{\ell}$ of antigen-sensitized erythrocytes suspension diluted to one percent on $0.05m{\ell}$ of serially diluted antibody-containing sera, and the final result can be read after 60 minutes at the room temperature ($15^{\circ}C$). 2. It is difficult to determine superiority of inferiority between the slide method and the tube method on the pattern of the reaction of hemagglutination. 3. The pH range of 6.6 to 8.3 is optimal for the slide hemagglutination reaction. 4. The antigen-sensitization against erythrocytes at $37^{\circ}C$ is optimal for the slide hemagglutination. 5. Both the doses and concentration of antigen do not influence the antigen-adsorbing capacity of erythrocytes. 6. The reduction of antigen-sensitizing hours does not influence the antigen-adsorbing capacity of erythrocytes even 30 minutes. 7. The tannic acid treatment against formalinized and non-formalinized erythrocytes showed no effect on the reaction of hemagglutination. 8. The erythrocytes preserved at $4^{\circ}C$ in the ACD solution do not decrease the reactivity on the reaction of hemagglutination for 60 days, while they begin slight hemolysis 30 days after preserving. 9. The stable preparation of erythrocytes can be obtained by treating the cells at $37^{\circ}C$ for 20 hours with from 4 to 8 percent of formalin in saline or buffer. These cells can be preserved at $4^{\circ}C$ for more than 8 months experimented without hemolysis. With low concentration of formalin, the cells were not sufficiently stabilized resulting in the hemolysis after short period of preservation at $4^{\circ}C$. 10. The erythrocytes treated with 16 percent of formalin remain constantly or increase the reactivity for the reaction of hemagglutination. On the contrary, the cells treated with I to 8 percent of formalin decrease the reactivity. 11. There is no difference between nontreated fresh erythrocytes and the erythrocytes preserved in the ACD solution on the reactivity against the hemagglutination, and the erythrocytes treated with 16 percent of formalin showed the reactivity of higher level than that of the above two kinds of erythrocytes. 12. There is no difference between the saline and the isotonic buffer solution on the reaction of hemagglutination.

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Morphological study on abdominal organs of healthy cats using omnidirectional radiography and fluoroscopy (다각도 방사선촬영 및 투시법을 이용한 정상 고양이 장기의 형태학적 연구)

  • Shin, Sa-kyeng;Hirose, Tsuneo;Sato, Motoyoshi;Miyahara, Kazuro
    • Korean Journal of Veterinary Research
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    • v.36 no.4
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    • pp.949-966
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    • 1996
  • To establish the method for the most effective radiography and fluoroscopy, the abdominal organs of cats were investigeted using omnidirectional angles with the center of the body as the axis using an omnidirectional protective shielding X-ray system and a $360^{\circ}$ rotary restraint unit for use in small animals. The organs examined were the diaphragm, liver, stomach, colon, spleen and kidney. The results obtained in the present study were as follows: 1. Regardless of gas in the stomach present or not, it was feasible to distinguish the left and right crura in the lumbar portion of diaphragm in the oblique projection inclined over $30^{\circ}$ and under $90^{\circ}$ from the lateral projection. 2. Outlines of the exterior left lobe and the interior right lobe of the liver were observed in the oblique image inclined up to $60^{\circ}$ from the lateral image, while that of the exterior right lobe was noted in the oblique image inclined up to $60^{\circ}$ from the ventrodorsal-dorsoventral images. 3. It was necessary to have gas present in the stomach for detailed morphological observations of the stomach. It was most clearly observed in the right $30^{\circ}$ ventral-left dorsal oblique projection($120^{\circ}$ image) and the left $60^{\circ}$ dorsal-right ventral oblique projection($300^{\circ}$ image). 4. Morphology of the colon was observable in detail by the oblique projection inclined over $30^{\circ}$ from the lateral projection. 5. To observe the whole spleen it was required to have images from the ventrodorsal projection ($90^{\circ}$ image) to the right $60^{\circ}$ ventral-left dorsal oblique projection ($150^{\circ}$ image) as well as those from the dorsoventral projection ($270^{\circ}$ image) to the left-right lateral projection $0^{\circ}$ image). 6. Dorsal and ventral sides of the kidney were observable in the oblique images inclined $30^{\circ}$ from the lateral image. 7. Considering above findings collectively, it was thought that the results of present study might be useful for the analysis of abnormalies in each organ of cat.

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A Proposal to Control System and the Problems of the Problems of the Report about Supply and Demand for Medical Technicians and Management Policy ("의료기사인력수급에 관한 보고서"의 문제점과 관리제도의 개선방안)

  • Kim, Sang-Hyun;Lim, Yongmoo
    • Journal of Korean Ophthalmic Optics Society
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    • v.13 no.4
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    • pp.25-30
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    • 2008
  • Purpose: In this paper, we have analyzed the problems of the Oh's report which is used to the basic data for supply and demand of medical technicians and studied a proposal for improvement to control system and supply and demand of korean optometrists. Methods: We have analyzed errors of Oh's report including supply and demand for medical technicians and management policy, expecting number for future optician, inaccurate estimation by limited data (employment rate, retirement rate, mortality rate) and an incorrect method of measurement for future supply and demand. Results: Oh's report showed the 18% error for estimation of supply which exclude the irregular entrance students. The estimation of supply was calculated by graduation rate 62.6% (college and University of Technology are 78.9% and 85.98% respectively), employment rate 65.8% (the average employment between 2002 and 2007 is 73.96%) and retirement rate is 2.3% (the retirement of pharmacists is 1.3%) but it showed the significant differences to objective data. For estimate the suitable ratio of optometrists to the population, the ratio use of medical facilities by an age group was used, and suggested spectacle wearers 1,280 persons (populations 2,928 persons) per optometrist but the different from reference of Germany (4,706 persons), America (1,789 persons) and Korea (1,825 persons/an optometrist) are applied to estimation on supply. This report applied the low employment rate and argued that maintain the present situation, but claimed that utilize unemployment persons. The above result has induced double weighting effect on estimation of supply. Conclusions: To solve the related problems of supply and demand, we have to make a search for exact data and optimum application model, have to take an example of nation similar job category as Germany and the research result of the job satisfaction into consideration. After we get the integrated research result, we must carried out the policy with fairness and balance for the estimation of supply and demand. Therefore exact research is required prior to beginning policy establishment, government and related group have to make a clear long-term plan and permanent organization for medical technician to establish supply and demand of medical technician.

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Investigation and Risk Assessment of Asbestos-Containing Materials used in Buildings (건축물에 사용된 석면함유물질(ACMs)의 조사 및 위해성 평가)

  • Kim, Hong-Kwan;Chon, Young Woo;Roh, Young Man;Hong, Seung-Han;Kim, Chi-Nyon;Lee, Ik-Mo
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.28 no.1
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    • pp.35-42
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    • 2018
  • Objectives: The objectives of this study are to research the usage characteristics of asbestos-containing building materials and to conduct exposure risk assessment by applying no. 2016-230 "Methods of Risk Assessment of Asbestos-Containing Buildings" from the Ministry of Environment. Methods: One hundred buildings located in the Seoul and Gyeonggi-Incheon area were chosen, with 29 in Seoul, 20 in Incheon, and 51 in Gyeonggi-do Province. The year of construction was divided between three buildings in the 1970s, 11 buildings in the 1980s, 42 buildings in the 1990s, and 44 buildings in the 2000s. The bulk samples were analyzed by using a polarizing microscope after a pre-process using a stereomicroscope in a hood with an HEPA filter. This study defined ACMs(asbestos-containing materials) as asbestos when the content percentage was over 1% in the analysis result. Methods and standards of risk assessment of asbestos-containing building materials were conducted by refering to no. 2016-230 "Method of Risk Assessment of Asbestos-Containing Buildings" from the Ministry of Environment. The risk of exposure to ACMs was rated by a score based on three categories(high, middle, low risk of asbestos exposure). Results: In this study, 30 of the 100 buildings and 36 of the 416 bulk samples(8.6%) were found to have had asbestos. Asbestos was detected at a high rate, in 18 out of 42, in buildings constructed in the 1990s and at the lowest rate(7 out of 44) for buildings constructed in the 2000s. As a result of the evaluation according to no. 2016-230 "Method of Risk Assessment of Asbestos-Containing Buildings" of the Ministry of Environment, the risk assessment level of two asbestos-containing building materials was found to be "Medium", and 28 buildings materials were found to be at the "Low" level. Conclusion: As asbestos is regulated by the government, it is required to conduct active management and implemention by introducing methods of risk assessment of asbestos exposure that are supported by data from various situations. In the case of buildings owned by individuals, building owners should be aware of the risk of exposure to asbestos.