• Journal of Chest Surgery
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• v.30 no.2
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• pp.172-178
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• 1997

We present a etrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensBrylmotor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 1 1 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 1) patients while in the other patient p eoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease andfor atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B. K. amputation in 1 case who had severe atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered from ischemic heart diease. Preoperative angiography was not always needed for embol ectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, embolectomy of tibial artery was difficult.

• Journal of Korean Medical classics
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• v.22 no.2
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• pp.71-83
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• 2009

The documentary characteristics of acupuncture and moxibustion recorded in Dusagyeong(杜思敬)'s".Jesaengbalsu(濟生拔粹)" can be summarized into 3 major parts: 1. "Gyeolgo-ungichimbeop(潔古雲岐鍼法)" and "Dutaesachimbeop(竇太師鍼法)" 1) "Gyeolgo-ungichimbeop" was edited by Dusagyeong of the Won dynasty, and was recorded in "Jesaengbalsu". Du was influenced by his teacher Heohyeong(許衡) and followed Janggyeolgo(張潔古) and his son Jangbyeok(張璧), and collected his work "Chimgu-pyeon(鍼灸篇)" for Jang and named it "Gyeolgo-ungichimbeop", and took the content from the medical book of Jang and his student Wang-haejang(王海藏). (2) "Jesaengbalsu"'s original edition exists today. The "Gyeolgo-ungichimbeop" listed in "Jesaengbalsu"'s index contain two collections, the first collection being "Gyeolgo-ungichimbeop" and the second collection being "Dutaesachimbeop(竇太師鍼法)" (3) Gyeolgo(潔古)、Un-gija(雲岐子)'s acupuncture methods can be seen in Un-gija "Bomyeongjipryuyo(保命集類要)" and Wanghaejang "Chasananji(此事難知)". (4) The related acupuncture methods are 'Non-gyeong-rak-yeongsubosabeop(論經絡迎隨補瀉法)', 'Gyeong-rakchwiwonbeop(經絡取原法)', 'Jeopgyeongbeop(接經法)', and 'Sang-hanyeolbyeongjabeop(傷寒熱病刺法)' (5) Du's edition of the entire text of 'Gyeolgojajetongbeop(潔古刺諸痛法)' 'Jasimtongjehyeol(刺心痛諸穴)' and the first half of 'Jeopgyeongbeop(接經法)' is all recorded in "Somunbyeonggigi-uibomyeongjip(素問病機氣宜保命集)". The existing "Somunbyeonggigi-uibomyeongjip" is a combination of the unfinished posthumous work of Yuwanso(劉完素), "Gi-ui(氣宜)" and "Byeonggi(病機)" with works such as Jangwonso(張元素)'s '"Bomyeongseo(保命書)"'. (6) Of the titles "Gyeolgo-ungichimbeop" and "Dutaesachimbeop", the 14$\sim$19th chapters "Dutaesachimbeop" should be concentrated at the end of the chapter, and the 16th chapter that Du added was put after chapter 14 "Yujujiyobu(流注指要賦)", and chapters 20, 21 should be put in "Gyeolgoungichimbeop" after chapter 13. 2. "Chimgyeongjeok-yeongjip(鍼經摘英集)" (1) "Chimgyeongjeok-yeongjip" is a collection of the acupuncture and moxibustion contents of medical books from the Geum and Won dynasties that Dusagyeong collected and organized during the Won dynasty, which is consisted of 5 chapters : "Guchimshik(九鍼式)", "Jeolyangchwisuhyeolbeop(折量取腧穴法)", "Bosabeop(補瀉法)", "Yongchimhoheupbeop(用鍼呼吸法)", "Chibyeongjik-ralgyeol(治病直剌訣)". (2) First, the contents. The nine acupuncture needles[九鍼] listed in "Guchimshik(九鍼式)" is the first existing document recording to systematically illustrate the 'nine classical needles' in drawing and text form which reflects the forms of the needles of the era. Second, "Jeolyangchwisuhyeolbeop(折量取腧穴法)" has the same basic way of measuring points [量穴法] as Wang-yuil's "Dong-insuhyeolchimgudo-gyeong(銅人腧穴鍼灸圖經)" and the same point selection rules as "Jeonyeongbang(全嬰方)". Third, in "Bosabeop(補瀉法)", "Somun(素問)" and Janggyeolgo's "Yeongsubosabeop(迎隨補瀉法)" is put together. Fourth, in "Yongchimhoheupbeop(用鍼呼吸法)", the cold and heat supplementation and draining [寒熱補瀉] method that combines breathing with inner and outer rotation[外 內撚] is recorded. Fifth, "Chi-byeongjik-ralgyeol(治病直剌訣)" is the main part of "Chimgyeongjeok-yeongjip(鍼經摘英集)" listing 69 acupuncture treatments reflecting Du's scholastic ideas on aspects such as syndrome differentiation[辨證], needling method and type of needle[鍼具]. (3) The content of this book was quoted by "Bojebang Chimgumun(普濟方 鍼灸門)" and when Gomu compiled "Chimguchwiyeong", he put the acupuncture treatments for the main indications of the disease patterns[鍼方主治病證] of this book in the related main indications of acupuncture points[腧穴主治證], which influenced books on acupuncture points there after. 3. "Chimgyeongjeolyo(鍼經節要)" (1) Consists of 1 volume. The original title of this book is "Dong-insuhyeolchimgudo-gyeong (銅人腧穴鍼灸圖經)" and the author is Wang-yuil of the Northern Song dynasty, written in the 4th year of the Cheonseong(天聖) era of the Song dynasty(1026). (2) Dusagyeong selected the contents on pathology of the 12 meridians in volume one and two, the introduction and five transport points[五輸穴] in volume 5 of "Dong-indo-gyeong(銅人圖經)" and named it "Chimgyeongjeolyo." During the Won dynasty it was recorded in "Jesaengbalsu".

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.475-481
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• 2006

Purpose : As the prevalence of childhood obesity is increasing, hypertension, hyperlipidemia, insulin resistance and diabetes mellitus have become problems. High homocysteine levels and low vitamin $B_{12}$ supplementation are acknowledged to have a role in coronary artery disease, but there are few studies on homocysteine, insulin and vitamin $B_{12}$ levels in obese children. We aimed to study whether homocysteine, insulin, vitamin $B_{12}$, folic acid levels could have any difference and relation in obese children. Methods : The disease group consisted of 27 children from 8 to 11 years old, whose obesity index was over 130. The control group consisted of 30 healthy children of the same age group. Obesity index and body mass index were calculated by height and body weight of the children, and their systolic and diastolic blood pressures at resting state were checked. Total cholesterol, triglyceride, homocysteine, insulin, vitamin $B_{12}$, folic acid levels were studied after 10 hours of fasting. Intracellular fluid, extracellular fluid, protein, mineral, muscle mass, lean body fat, fat mass and fat percentages were checked by bioelectrical impedance. Results : Homocysteine levels were higher in obese children($8.1{\pm}2.1{\mu}mol/mL$ vs. $4.9{\pm}1.0{\mu}mol/mL$). Insulin levels were also higher in obese children($26.8{\pm}11.2{\mu}IU/mL$ vs. $12.5{\pm}5.24{\mu}IUl/mL$). Vitamin $B_{12}$ was lower in obese children($798.6{\pm}174.3pg/mL$ vs. $967.8{\pm}405.0pg/mL$). But there was not a difference in the folic acid levels between the two groups. In obese children, systolic blood pressure (r=0.535), triglyceride(r=0.517), total cholesterol(r=0.408), folic acid(r=0.408), vitamin $B_{12}$(r=0.338) and abdomoanl fat %(r=0.306) had a positive correlation. Conclusion : We found definite differences of insulin, homocysteine, and vitamin $B_{12}$ plasma levels in obese children, but we need more study to use those parameters as risk factors of metabolic syndrome in pediatric obese patients.

• Clinical and Experimental Pediatrics
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• v.49 no.12
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• pp.1348-1353
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• 2006

Purpose : The reticuloendothelial system is composed of sinusoidal capillaries, through which even large protein molecules are freely movable between plasma and interstitial space, including the lymphatic system. Therefore, high-dose intravenous immunoglobulin (IVIG) would cause a redistribution of proteins between two compartments. To investigate this hypothesis, we measured plasma protein and lipid levels in patients with Kawasaki disease before and after high-dose IVIG treatment. Methods : Thirty four children with Kawasaki disease who had complete responses to high-dose IVIG treatment (1 g/kg/day for two consecutive days), were analyzed. Before and after the administration of IVIG, serum analyses were performed for such parameters as total protein, albumin, ${\gamma}$-globulins (IgG, IgM, IgA), ${\alpha}1-$, ${\alpha}2-$, and ${\beta}-$ globulin fractions, and lipid profiles (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride). Results : The levels of ${\gamma}$-globulins including IgG, IgM, IgA were significantly increased, and IgG was increased by $1,779{\pm}304mg/dL$ after two-dose of IVIG infusion. The levels of albumin, ${\alpha}1-$, ${\alpha}2-$, and ${\beta}$ globulin fractions were significantly decreased by 18 percent, 24 percent, 19 percent and 12 percent, respectively. HDL-cholesterol level was significantly decreased by 20 percent, while LDL-cholesterol and triglyceride levels were significantly increased by 21 percent and 50 percent, respectively. The total cholesterol level was not changed. Conclusion : High-dose IVIG treatment decreased the levels of a variety of proteins except immunoglobulins, and the increase of IgG after IVIG treatment was lower than expected. Our results suggest that a part of infused IVIG and plasma proteins, including etiologic proteins for Kawasaki disease, may be distributed to the extravascular compartments. The rapid improvement of symptoms induced by IVIG in Kawasaki disease might be explained by this mode of action of IVIG.

• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.881-887
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• 2009

Purpose : The survival rate of very low birth weight infant (VLBWI) had increased as a result of advances in neonatal intensive care. We evaluated the changes in outcomes of VLBWI who admitted to the neonatal care unit of Hallym University Kangnam Sacred Heart Hospital. Methods : Retrospective review of 339 VLBWI who were born from 1st January 1997 to 31th December 2008 were performed. Outcomes including survival rate, birth weight (BW), gestational age (GA), morbidities, and mortality between period I (1997- 2003) and period II (2004-2008) were compared. Results : Overall incidence of VLBWI was 2.3% and it was significantly higher in period II(3.3%). Mean BW and GA were significantly decreased in period II (P<0.001, P=0.01). The survival rate increased from period I (59.1%) to period II (74.2%). BW-specific survival rate increased in 1,000-1,249 gm and GA-specific survival rate significantly increased in 27-28 weeks and 29-30 weeks. The incidences of respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), sepsis, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, periventricular leukomalacia, and necorotizing enterocolitis were same except patent ductus arteriosus. Conclusion : The survival rate of VLBWI was increased in period II, especially in less than 1,000 gm and below 27 weeks. This may be due to recent dramatic improvement of neonatal care. But more efforts are needed to improve outcome during initial phase and to reduce long term complication such as BPD and ROP.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1200-1205
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• 2007

Purpose : We performed this study to investigate the outcome of surfactant replacement therapy (SRT) in above nearterm neonates who were required mechanical ventilatory care due to meconium aspiration pneumonia (MAP), respiratory distress syndrome (RDS) or other severe pneumonia (PN). Methods : 48 patients, gestational period ${\geq}36weeks$, who were admitted in NICU of Dongsan Medical Center, Keimyung University between July 1999 and June 2004 were enrolled. They were divided into three groups, MAP group (15 cases), RDS group (27 cases) and PN group (6 cases). All patients were received SRT and evaluated several clinical data (gestational age, oxygen index, duration of ventilator care) and outcome (complications and mortality rate) between pre-SRT and post-SRT. The mean dose of surfactant (modified bovine surfactant, Newfacten, Yuhan Co., Seoul, Korea) was 120 mg/kg. Results : Among each groups, mean pre-SRT OI was higher in MAP group ($21{\pm}3.2$) than other groups, mean duration (days) of ventilatory care and oxygen therapy were similar distributions. Compared with pre-SRT values, significant improvements (P<0.05) in mean values for FiO2 and oxygenation index were documented at 12 hours after SRT. Early complications (persistent pulmonary hypertension of newborm, pneumothorax) and survival rate were lower in MAP group. Within RDS group, earlier SRT (given before 12 hours of life) revealed significantly lower early complication rate than later SRT (given after 12 hours of life) (13.3% vs 58.3%, P<0.05) Conclusion : Our study suggested that SRT seems to be an effective therapy in above nearterm neonates with severe pulmonary disease, and earlier SRT tends to reduce complications in RDS group than later therapy.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.704-712
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• 2008

Purpose : A prospective, controlled trial was conducted to evaluate growth, efficacy, safety and nutritional status for very low birth weight infants fed with human milk fortified with Maeil human milk fortifier (Maeil $HMF^{(R)}$; Maeil Dairies Co., Ltd.). Methods : We enrolled 45 premature infants with a birth weight <1,500 g and gestational age <33 weeks, who were born at Dong-A University Hospital from October, 2006 through December, 2007. They were divided into 2 groups: infants in one group were fed with human milk fortified with $HMF^{(R)}$, and the second were fed with preterm formula. Growth, biochemical indices, feeding tolerance, and other adverse events in each group were assessed serially and compared relatively. Follow-up data were also collected after discharge at 1, 3, and 6 months corrected age. Results : Characteristics of the 2 groups including average gestational age, birth weight, sex, respiratory distress syndrome, patent ductus arteriosus, and other adverse events (sepsis, retinopathy of prematurity, and intraventricular hemorrhage) showed no significant difference. Average feeding start day ($8.00{\pm}3.27d$ vs. $8.86{\pm}5.37d$) (P=0.99) and the number of days required to reach full feeding after start feeding ($41.78{\pm}20.47d$ vs $36.86{\pm}20.63d$) (P=0.55) were not significantly different in the group fed human milk fortified with $HMF^{(R)}$ when compared with the group that was fed preterm formula. The duration of total parenteral nutrition and the incidence of feeding intolerance also showed no differences between the 2 groups. Although infants fed with human milk fortified with $HMF^{(R)}$ showed faster weight gain than those fed with preterm formula at the end stage of the admission period, other growth indices of the two groups showed no significant difference. No significant correlations were found between the 2 groups with regard to weight gain velocity, height gain velocity, head circumference velocity, and post-discharge follow up growth indices. Conclusion : Premature infants fed human milk fortified with $HMF^{(R)}$ showed no significant difference compared with those fed preterm formula in growth, biochemical indices, and adverse events. Using human milk fortifier can be an alternative choice for very low birth weight infants, who need high levels nutritional support even after discharge from NICU.

• Radiation Oncology Journal
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• v.8 no.2
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• pp.219-223
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• 1990

This is a retrospective review of 33 patients with large cell lung carcinoma treated at Yonsei University Cancer Center between Jan.1985 and Dec.1989. Of the thirty-three patients, twenty eight were men and five women. Median age was 59 years. Large cell undifferentiated carcinoma was the most common pathologic type, $78.8\%$. Twenty one of thirty three patients had far advanced diseases, stage IIIB-IV at the time of initial diagnosis. Pleural effusion was initially presented in 12 patients, and SVC syndrome appeared in 5 patients. As to location of the primary tumor,19($57.6\%$) appeared in the right lung and 14 ($42.4\%$) in the left. Patients with a centrally located primary tumor mass were nearly the same as those peripherally located (17 vs.16). Fifteen of thirty three patients developed metastasis involving not only bone, brain, the opposite lung, adrenal gland but also soft tissue, skin, pancreas and appendix. Treatment was individualized with 19 treated radically and 14 palliatively. After treatment, only two patients showed a complete response. Long term survival was observed in 4 patients: 1 (24 mo.),2 (41 mo.) and 1 (54 mo.). The overall 2 year survival rate was $14.3\%$ while the median survival time was 6.0 months. Through the analysis of the various factors affecting survival, we observed that pleural effusion-absent group and complete response group had a statistical significant better survival rate (p<0.01).

• Journal of Chest Surgery
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• v.32 no.8
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• pp.715-721
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• 1999

Background:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. Material and Method: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. Result: Mean age was 68${\pm}$1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 ${\pm}$0.81 and mean aortic cross-cramp time was 69.84${\pm}$18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23${\pm}$10.62% preoperatively to 58.14${\pm}$9.88% postoperatively(p<0.05). Postoperative complication was pneumonia in 2 patients, acute renal failure in 2 patients, sternal wound infection in 1 patient, and postoperative myocardial infarction in 1 patient. There were two postoperative deaths. The causes of deaths were low output syndrome in one patient, and sepsis due to pneumonia in the other patient. The hospital mortality was higher in the elderly group(4.4 versus 2.86%) but was not statistically significant(p>0.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27${\pm}$12.51 vs 15.55${\pm}$6.99 days; p＜ 0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58${\pm}$19.56 months). There was no late mortality of cardiac origin. Conclusion: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.275-281
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• 1997

The radial artery as a graft for myocardial revascularization was introduced by Carpentier in the early 1970s. Mid-term results were unfortunately discoura ing, and the clinical experience with this graft was interrupted. At the end of the 1980s, these authors reproposed the same arterial conduit with more satisfying results, because of improved technique and pharmacological management of the graft. Between October 1994 and July 1995, 36 patients underwent myocardial revascularization with a radial artery graft in Seiong General Hospital. Left internal mammary artery was concomitantly used as a pedicled Vift in 34 patients. Fifteen patients (42%) had a complete arterial waft revascularization. A total of 12) distal anastomoses were performed (average 3.4 per patient), including 36 left internal mammary artery wafts (two sequential in 2 patients), and 23 saphenous vein grafts. The remaining 64 distal anastomoses were perFormed with radial artery grafts (mean 1.8 per patient). The radial arteries were anastomosed to the circumflex (n=38), diagonal (n= 18), right coronary(n=G), and left anterior descending coronary artery(n=2). The percent ge of radial artery graft anastomoses (64) to the total anastomoses(123) was 52%. The radial artery was used as a single graft in 10 patients, as a sequential graft in 25 patients, and two grafts in 1 patient. Twenty patients underwent associated procedures coronary endarterectomy (14), coronary artery patch angioplasty (4), mitral valve repair (1), and repair of ventricular septal rupture (1). One patient died of low cardiac output syndrome and the others had no perioperative myocardial infarction. There are no ischemic and functional complications in the arm or hand aftcr removal of the radial artery. Only 1 patient required reexploration of the am, for the hematoma evacuation, and 2 patients complained transient thumb dysesthesia of the side of the havested arm. This dysesthesia improved within one month. Postoperative angiovaphic controls were obtained in 11 patients(31%) postoperative 79 to 210 days (mean 126 days). The patency rate were as follows : left internal mammary artery (100%), saphcnous vein (100%), and radial artery(95%). We concluded that the radial artery is useful alternative graft, but long term clinical and angiographic studies are required to derterminc whether wider application is warranted.