• Journal of Chest Surgery
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• v.30 no.3
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• pp.282-286
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• 1997

In the era of coronary artery bypass grafting, the intraaortic balloon pump (IABP) is more widely used and its indication has been ex anded. We perf'orbed retrospective clinical analysis on the patients who have received IABP pre andfor postoperatively during the course of CABG. From January 1981 to June 1995, total 322 patients have received CABG at the Seoul National University Hospital and among them 50 patients (15.5%) were supported by IABP during the course of the operation. The mean age at the time. of the operation was 57.2 years (39∼ 75 years) and the male to female ratio was 33 : 17. The preoperative diagnosis was unstable angina in 33 (66%), stable angina in 7 (14%) and postinfarct angina in 8 patients(16%). As for the indications of the IABP, there were 13 cases(26%) with left main disease, 13 (26%) with class IV angina, 12 (24%) with difficulty in CPB weaning, 6 (12%) with postinfarct angina and 3 (6%) with severe LV dysfunction. In the remaining 3 cases, one patient was operated on after PTCA failure in emergency basis, another was a patient with AMI, and the other was one who had postoperative low c rdiac output syndrome. All IABPS were introduced via femoral artery and among them 45 cases (90%) percutaneously. The mean postoperative assist time was 22.3 hours (0.5 ∼ 168 hours) and IABP could be removed within 48 hours in most of them (44150). The operative mortality was 6.1% (3 cases) and postoperative morbidity was only one with lower extremity ischemia. The more general application of the IABP during the course of the CABG ,especially in patients with high preoperative risk factors or difficulty in CPB weaning is a good measure of protecting and recovering myocardial function with minimal risk.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.467-473
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• 2004

Background: The sinus conversion rate after the maze procedure in chronic atrial fibrillation using radiofrequency energy is lower than with either conventional 'cut and saw' technique or cryothermia. The creation of incomplete transmural lesions due to poor tissue-catheter contact is thought to be the main cause. To address this problem, the current study was aimed to evaluate the effectiveness of a specially constructed compression device designed to enhance tissue catheter contact during unipolar radiofrequency catheter ablation. Material and Method: Circum-ferential right auricular epicardial lesions were created with a linear radiofrequency catheter in 10 anesthetized pigs. A device specially designed to increase contact by compression of the catheter to the atrial wall was used in 5 pigs (study group). This device was not used in the control group (5 pigs). Conduction block across the right auricular lesion was assessed by pacing, and the transmurality of the lesions were confirmed by microscopic examination. Result: Conduction block was observed in a total of 8 pigs; 5 in study group and 3 in control group. Transmural injury was confirmed microscopically by the accumulation of acute inflammatory cells and loss of elastic fibers in the endocardium. In two pigs with failed conduction block, microscopic examination of the endocardium appeared normal. Conclusion: Failed radiofrequency ablation is strongly related to non-transmural energy delivery. The specially constructed compression device in the current study was successful in creating firm tissue-catheter contact and thereby generating transmural lesions during unipolar radiofrequency ablation.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.504-510
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• 2004

Background: Vasodilatory shock after cardiac surgery may result from the vasopressin deficiency following cardio-pulmonary bypass and sepsis, which did not respond to usual intravenous inotropes. In contrast to the adult patients, the effectiveness of vasopressin for vasodilatory shock in children has not been known well and so we reviewed our experience of vasopressin therapy in the small babies with a cardiac disease. Material and Method: Between February and August 2003, intravenous vasopressin was administrated in 6 patients for vasodilatory shock despite being supported on intravenous inotropes after cardiac surgery. Median age at operation was 25 days old (ranges; 2∼41 days) and median body weight was 2,870 grams (ranges; 900∼3,530 grams). Preoperative diag-noses were complete transposition of the great arteries in 2 patients, hypoplastic left heart syndrome in 1, Fallot type double-outlet right ventricle in 1, aortic coarctation with severe atrioventricular valve regurgitation in 1, and total anomalous pulmonary venous return in 1. Total repair and palliative repair were undertaken in each 3 patient. Result: Most patients showed vasodilatory shock not responding to the inotropes and required the vasopressin therapy within 24 hours after cardiac surgery and its readministration for septic shock. The dosing range for vasopressin was 0.0002∼0.008 unit/kg/minute with a median total time of its administration of 59 hours (ranges; 26∼140 hours). Systolic blood pressure before, 1 hour, and 6 hours after its administration were 42.7$\pm$7.4 mmHg, 53.7$\pm$11.4 mmHg, and 56.3$\pm$13.4 mmHg, respectively, which shows a significant increase in systolic blood pressure (systolic pressure 1hour and 6 hours after the administration compared to before the administration; p=0.042 in all). Inotropic indexes before, 6 hour, and 12 hours after its administration were 32.3$\pm$7.2, 21.0$\pm$8.4, and 21.2$\pm$8.9, respectively, which reveals a significant decrease in inotropic index (inotropic indexes 6 hour and 12 hours after the administration compared to before the administration; p=0.027 in all). Significant metabolic acidosis and decreased urine output related to systemic hypoperfusion were not found after vasopressin admin- istration. Conclusion: In young children suffering from vasodilatory shock not responding to common inotropes despite normal ventricular contractility, intravenous vasopressin reveals to be an effective vasoconstrictor to increase systolic blood pressure and to mitigate the complications related to higher doses of inotropes.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.511-516
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• 2004

Background: One of the theoretical advantages of skeletonized internal mammary artery harvesting in coronary artery bypass surgery is to minimize the interruption of the sternal blood flow inevitably accompanied by internal mammary harvesting. A study using bone scan is designed to determine the effects of internal mammary artery harvesting technique on the sternal blood flow. Material and Method: From April 2002 to March 2003, 27 patients out of 48 patients who underwent the isolated coronary bypass surgery were enrolled into the study. The enrolled patients underwent bone scan in the preoperative period and postoperative period respectively. Bilateral internal mammary artery was used in 8 patients (BIMA group) and single left internal mammary artery in 19 patients (LIMA group). The patients in LIMA group were divided into two groups: LlMA_skel group, in whom left internal mammary artery was harvested in skeletonized fashion (n=12), and LlMA_ped group, in whom left internal mammary artery was harvested in pedicled fashion (n=7). After the bone scan, the region of interest (ROI) was created on the left of the sternum and the mirror image with the same pixel numbers was placed on the right half of the sternum. The mean counts per pixel on the left side of the sternum was compared with those on the right side and expressed as left to right ratio (L/R ratio). Result: In LIMA group, the L/R ratio decreased from 94.6$\pm$4.1% to 87.9$\pm$6.9% (p=0.003) after the operation as compared to BIMA group, in which no change of the L/R ratio was observed. The changed of the L/R ratio in LlMA_skel group and LlMA_ped group were from 95.3$\pm$4.2% to 88.3$\pm$7.7% and from 93.4$\pm$3.9% to 87.4$\pm$5.8% respectively. The % changes in L/R ratio were -7.44 $\pm$7.08 in LIMA_skel group and -6.17$\pm$9.08 in LiMA_ped group, which did not reach the statistical difference. Conclusion: Ipsilateral sternal blood flow is interrupted by internal mammary artery harvesting as evidenced by the decrease in L/R ratio after left internal mammary artery harvesting irrespective of the harvesting techniques. Skeletonized harvesting did not show superiority in respect to sternal blood flow as compared to pedicled harvesting.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.482-491
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• 2004

Background: The xenogenic or allogenic valves after in Vitro repopulation with autologous cells or in vivo repo-pulation after acellularization treatment to remove the antigenicity could used as an alternative to synthetic polymer scaffold. In the present study, we evaluated the process of repopulation by recipient cell to the acellu-larized xenograft treated with NaCl-SDS solution and grafted in the right ventricular outflow tract. Material and Method: Porcine pulmonary valved conduit were treated with. NaCl-SDS solution to make the grafts acellularized and implanted in the right ventricular outflow tract of the goats under cardiopulmonary bypass. After evaluating the functions of pulmonary valves by echocardiography, goats were sacrificed at 1 week, 1 month, 3 months, 6 months, and 12 months after implantation, respectively. After retrieving the implanted valved conduits, histopathologic examination with Hematoxylin-Eosin, Masson' trichrome staining and immunohistochemical staining was performed. Result: Among the six goats, which had been implanted with acellularized pulmonary valved conduits, five survived the expected time period. Echocardiographic examinations for pulmonary valves revealed good function except mild regurgitation and stenosis. Microscopic analysis of the leaflets showed progressive cellular in-growth, composed of fibroblasts, myofibroblasts, and endothelial cells, into the acellularized leaflets over time. Severe inflammatory respon-se was detected in early phase, though it gradually decreased afterwards. The extracellular matrices were regenerated by repopulated cells on the recellularized portion of the acellularized leaflet. Conclusion: The acellularized xenogenic pulmonary valved conuits were repopulated with fibroblasts, myofibroblasts, and endothelial cells of the recipient and extracellullar matrices were regenerated by repopulted cells 12 months after the implantation. The functional integrity of pulmonary valves was well preserved. This study showed that the acellularized porcine xenogenic valved conduits could be used as an ideal valve prosthesis with long term durability.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.323-328
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• 2008

Purpose : Asthma is defined as chronic inflammation of the lower small airways, and bronchial hyperreactivity (BHR) is a pathophysiologic feature of asthma. It has been proposed that although there is no direct variable capable of assessing the small airways, a forced expiratory flow of between 25 and 75 percent ($FEF_{25-75}$) might be considered a more sensitive early marker of small airway obstruction than the forced expiratory volume in 1 second ($FEV_1$). Thus, we proposed that the presence and degree of positive responses to bronchial methacholine testing were related to the difference (DFF) and ratio (RFF) between $FEV_1$ and $FEF_{25-75}$ in asthmatic children. Methods : The subjects were 583 symptomatic children, including 324 children with BHR and 259 controls. Pulmonary function tests, methacholine challenge tests, and skin prick tests were performed, and the total eosinophil count, total serum IgE, and serum eosinophil cationic protein level were measured in all subjects. From a concentration-response curve, the methacholine concentration required to produce a decrease of 20% from post-saline $FEV_1$ was calculated ($PC_{20}$). Results : The median DFF and RFF values decreased in controls compared to subjects with bronchial hyperresponsiveness, and this trend was found in groups ranked by its severity. $PC_{20}$ had a negative correlation with DFF and RFF. Cutoff values of 0.5 for DFF and 1.042 for RFF were identified, and sensitivity and specificity were calculated. Conclusion : This study revealed that DFF and RFF might be predictive of bronchial hyperresponsiveness in the context of normal $FEV_1$ in children.

• Journal of Yeungnam Medical Science
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• v.13 no.2
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• pp.243-250
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• 1996

Extravasation of toxic chemotherapeutic agents cause severe skin ulceration and necrosis which often need secondary surgical intervention. Still, there were not established antidote agent in case of extravasation with mitomycin-c. Dimethyl sulfoxide is known as an effective chemical scavenger of toxic hydroxyl free radical and sodium thiosulfate also was demonstrated significant protector from mitomycin-c induced ulceration by a few experimental studies. Author investigated necrotic area of mitomycin-c injected site and compare to the effectiveness of topical treatment with dimethyl sulfoxide and intradermal injection of sodium thiosulfate according to starting times, forty five mice were divided into 3 groups. Control group(n=5) had no treatment after subcutaneous injection of mitomycin-c. Experimental group I and II were 20 mice treated dimethyl sulfoxide and sodium thiosulfate, respectively. Depending on the starting time of treatment, group I and II were subdivided into 1, 2, 3 and 4 as immediate, 6 hours, 12 hours and 24 hours after mitomycin-c injection. Histologic studies of the necrotic area and survival area after treatment were performed using hematoxylin-eosin staining. The mean necrotic area of group I was significantly decreased depending on the starting time of treatment compared with control group(p<0.01). The results means there was no necrosis area which was treated with topical sodium thiosulfate within 6 hours, and it showed also significant decrease of necrosis area within 24 hours. There was also no necrosis area in group II-1 and significant decrease of necrosis area II-2 and III-3. But, effctiveness of intradermal injection of sodium thiosulfate was not found in group II-4 which was started after 24 hours. Hisotolgic findings showed a bland coagulative necrosis without inflammatory changes and no granulation tissue. The significant difference that cytoplasmic loss of subcutaneous fat and decrease number of hair follicles between two groups resulted from the methods of treatment by topical application and intradermal injection. In conclusion, immediate treatments with topical dimethyl sulfoxide or intradermal injection of sodium thiosulfate signifcantly prevents necrosis by extravasation of mitomycin-c.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.5
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• pp.1082-1090
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• 2009

Peak expiratory flow rate(PEF) is a very important diagnostic parameter obtained from the forced vital capacity(FVC) test. The expiratory flow rate increases during the short initial time period and may cause measurement error in PEF particularly due to non-ideal dynamic characteristic of the transducer. The present study evaluated the initial rise slope($S_r$) on the flow rate signal to compensate the transducer output data. The 26 standard signals recommended by the American Thoracic Society(ATS) were generated and flown through the velocity-type respiratory air flow transducer with simultaneously acquiring the transducer output signal. Most PEF and the corresponding output($N_{PEF}$) were well fitted into a quadratic equation with a high enough correlation coefficient of 0.9997. But only two(ATS#2 and 26) signals resulted significant deviation of $N_{PEF}$ with relative errors>10%. The relationship between the relative error in $N_{PEF}$ and $S_r$ was found to be linear, based on which $N_{PEF}$ data were compensated. As a result, the 99% confidence interval of PEF error was turned out to be approximately 2.5%, which was less than a quarter of the upper limit of 10% recommended by ATS. Therefore, the present compensation technique was proved to be very accurate, complying the international standards of ATS, which would be useful to calibrate respiratory air flow transducers.

• The Korean Journal of Pharmacology
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• v.24 no.2
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• pp.203-216
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• 1988

To delineate the mechanisms of vasoconstriction and vasodilation in cerebral arteries the effects of some vasoconstrictors and calcium antagonists on the basilar artery (BA) and arterial circle of Willis (WC) were examined and also the role of endothelium in the action of these drugs was investigated in pigs, cats and rabbits. In pig cerebral arteries, dose-dependent contractile responses were elicited by KCI, histamine, 5-hydroxytryptamine (5-HT) and angiotensin, but norepinephrine (NE), phenylephrine (PE) and epinephrine (EP) elicited dose-dependent contractions only under pretreatment with propranolol 10-6 M. The magnitudes of maximal contractile effects of these drugs were different from each other, and 5-H~ was the largest and angiotensin the smallest. Some calcium antagonists dose-dependently inhibited KCI (35 mM)-induced contraction and the order of potency in inhibiting the contraction was nifedipine > > diltiazem > flunarizine > oxybutynin > isosorbide dinitrate (ISDN) > glyceryl trinitrate. 5-HT (10-6 M)-induced contraction was dosedependently inhibited by nifedipine but slightly inhibited by diltiazem and ISDN. In rings with intact endothelium, KCI (35 mM)-induced contraction was not affected by acetylcholine (ACh) but $PGF_{2{\alpha}}$ (lO-SM)-induced contraction was dose-dependently relaxed by ACh and adenosine. This endothelium-dependent relaxation was not affected by nifedipine (l0-6M)-pretreatment but markedly inhibited by methylene blue (50,uM)-pretreatment. In the porcine arterial rings without endothelium, ACh had no effect or even contracted the $PGF_{2{\alpha}}-induced$ contraction. However, the dosedependent relaxing effect of ACh appeared when the deendothelized porcine ring and rabbit thoracic aorta with intact endotheli urn were simultaneously suspended into a bath and this relaxing effect was also inhibited by methylene blue-pretreatment. In cat cerebral arteries, 5-HT and NE elicited dose-dependent contractile responses and ACh also produced dose-dependent contraction regardless of the existence of endothelium. ACh-induced contraction was most prominent. 5-HT (IO-SM)induced contraction was not relaxed but contracted additionally by ACh even in the intact endothelial ring. In rabbit cerebral arteries, 5-HT and NE elicited dose-dependent contractile responses and 5-HT-induced contraction was more prominent. In the intact endothelial preparations, 5-HT (lO-s M)-induced contraction was markedly relaxed by the addition of ACh( IO-SM) and this endothelium-dependent relaxing effect was inhibited by atropine (l0-7M)-pretreatment but notaffected by diltiazem (l0-6M)-pretreatment. These results suggest that ACh elicits endotheliumdependent relaxing effect mediated by muscarinic receptors in cerebral arteries of pig and rabbit, and that ACh acts as vasoconstrictor in cat cerebral artery.

• The Korean Journal of Pharmacology
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• v.29 no.2
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• pp.213-223
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• 1993

To investigate the endothelium dependent vascular reactivity of the systemic arterial and the pulmonary arterial system in acute renal hypertensive rats of 2-kidney, 1-ligation type (RHRs), acetylcholine (ACh)-induced vasodilation and depressor effects were evaluated in isolated arteries and in vivo, respectively, in the presence and absence of functional endothelium. ACh $(10^{-5}\;M)$ relaxed the intact thoracic aortas from RHRs and normotensive rats (NRs), but the effect was significantly smaller for those from RHRs (34 and 86%, respectively, p<0.01). ACh-induced vasodilation was completely abolished after removal of endothelial cell or pretreatment with EDRF inhibitors, L-NAME and MB, indicative of its dependence on intact endothelial or EDRF function. ACh also induced vasorelaxation of the intact pulmonary arteries from RHRs and NRs; however, unlike the effects on the thorcic aorta, no significant difference in amplitude was noted between two groups. ACh $(0.1{\sim}10\;{\mu}g/kg,\;i.v.)$ reduced mean systemic arterial pressure in anesthetized RHRs and in NRs to the similar magnitude (% change: 39 and 46% at $10\;{\mu}g/kg$, respectively) and these hypotensive effects were significantly decreased after pretreatment with L-NAME (30 mg/kg, i.v.). Deprssor effects of ACh on mean pulmonary arterial pressure were similar in RHRs and NRs with and without pretreatment of L-NAME. However, in both NRs and RHRs, the depressor effects of ACh on mean pulmonary arterial pressure were significantly reduced compared with those for mean systemic arterial pressure, and the increment of mean pulmonary arterial pressure noted after L-NAME $(0.1{\mu}100\;mg/kg,\;i.v.)$ was significantly smaller than that for mean systemic arterial pressure. These results indicate that in RHRs the endothelial cell function was impaired, at least in part, in systemic arterial system, but not in pulmonary arterial system, and both ACh-evoked and basal release of EDRF was less in the pulmonary arterial system than in systemic arterial system of both NRs and RHRs.