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Early Results of Heart Transplantaion: A Review of 20 Patients (심장이식술 20례의 조기성적)

  • Park, Chong-Bin;Song, Hyun;Song, Meong-Gun;Kim, Jae-Joong;Lee, Jay-Won;Seo, Dong-Man;Sohn, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.30 no.2
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    • pp.164-171
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    • 1997
  • Heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal hear failure. The first successful heart transplantation in humans was done in 1967 and the first case in Korea was performed in november, 1992. Since the first case in 1992, more than 50 cases have been performed in Korea. A total of 20 patients underwent orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The purpose of this study is to evaluate the early results and the follow-up course of 20 cases of heart transplantation done in Asan Medical Center. The average age of 20 patients was 39.9$\pm$11.8 years old(20~58). The mean follow-up duration was 14.4$\pm$11.2 months(1~41). All patients are alive till now. The blood type was identical in 14 and compatible in 6 patients. ihe original heart disease was dilated cardiomyopathy in 16, valvular heart disease in 2, ischemic cardiomyopathy in 1, and giant cell myocarditis in 1 patient. HLA cross matching for recipient and donor was done in 18 cases and the results were negative for T-cell and B-cell in 16 patients, pos tive for warm B-cell in 2 patients. Among 6 loci of A, B, and DR, one locus was matched in 8 cases, 2 loci in 5 cases, and 3 loci matched in 1 case. The number of acute allograft rejection averaged 2.8$\pm$0.5 (0~6) per case and the number of acute allograft rejection requiring treatment averaged 1.0$\pm$0.9 (1~3) per case. The time interval from operation to the first acute rejection requiring treatment was 35.5$\pm$20.4 days (5~60). Acute humoral rejection was suspected strongly in 1 case and was successfully treated. The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 17.5$\pm$6.8 (9~32)% to 58.9$\pm$2.0 (55~62)% after heart transplantation. Temporary pacing was needed in 5 patients over 24 hours but normal sinus rhythm appeared within 7 days in all cases. One patient has been taken permanent pacemaker implantation due to complete AV block appearing 140 days after heart transplantaion. One patient had cyclosporine-associated n urotoxicity during the immediate postoperative period and was recovered after 27 hours. The heart transplantation of Asan Medical Center is on a developing stage but the early result is comparable to that of well established centers in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in patients with terminal heart failure.

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Granulocytic Sarcoma(Chloroma) in Leukemic Patients (백혈병 환자의 과립구 육종(녹색종양))

  • Rhee, Seung-Koo;Kang, Yong-Ku;Bahk, Won-Jong;Jung, Yang-Kuk;Lee, Sang-Wook;Jeong, Ji-Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.54-61
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    • 2005
  • Purpose: The granulocytic sarcoma which developed in leukemic patients are quite rare and it will have bad prognosis, but it's tumor pathogenesis and also their treatment are not yet established. Through this study we have tried to know their clinical course, prognosis and their end result of recent treatment. Material and Methods: Total 20 patients of granulocytic sarcoma which were developed in total 2,197 leukemic patients from April, 1998 to September, 2004 were treated at the leukemic center and the orthopaedic department of St. Mary's hospital, Catholic University of Korea, and followed them for 1~78 months(average 18 months). Results: Total 20 cases of granulocytic sarcoma was found in 14 cases of total 1,331 acute myelocytic leukemic patients(AML), 4 cases of total 744 of chronic myelocytic leukemic patients(CML), and only one case in total 122 of acute biphenotype of leukemia. And so their occurrence rate in leukmic patients are actually 0.91%, total 20 cases of granulocytic sarcoma in total 2,197 leukemic patients at same period. Their ages are average 28.3 years(4~52 years), and male are predominant(13 cases) than female(7 cases). Single involvement was found in 11 cases but multiple lesions are in 9 cases, and spine, brain, extremities, chest, and pelvic bone are involved in frequency. The granulocytic sarcoma was developed in various stages of the leukemia, ie, 8 cases in complete remission of leukemia, and 12 cases in the treatment process of AML. The pathohistologic evaluation of granulocytic sarcoma was done in 6 cases which was developed in their extremities, and confirmed numerous immature myeloblasts and lymphocytes mixed. The treatment of these granulocytic sarcoma was mainly limited for the treatment of leukemia by Glivac and massive steroid therapy(19cases) and also combined with the bone marrow transplantation(13 cases), but radiation therapy with average 3,500 rads in 15 cases out of total 20 sarcomas was also done, and followed them for average 17.5 months after development of granulocytic sarcomas. Finally their prognosis was so bad that 12 patients(60%) out of total 20 granulocytic sarcoma were dead in 6.5 months after sarcoma developed and we found the granulocytic sarcoma was more fatal if they are developed during the process of CML(mortality: 100%(4/4cases). Conclusion: The prognosis of granulocytic sarcomas in leukemic patients are quite fatal, and much more studies for their pathogenesis and ways of treatment should be performed continuously.

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A Novel in Vitro Method for the Metabolism Studies of Radiotracers Using Mouse Liver S9 Fraction (생쥐 간 S9 분획을 이용한 방사성추적자 대사물질의 새로운 체외 측정방법)

  • Ryu, Eun-Kyoung;Choe, Yearn-Seong;Kim, Dong-Hyun;Lee, Sang-Yoon;Choi, Yong;Lee, Kyung-Han;Kim, Byung-Tae
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.4
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    • pp.325-329
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    • 2004
  • Purpose: Usefulness of mouse liver S9 fraction was evaluated for the measurement of the metabolites in the in vitro metabolism study of $^{18}F$-labeled radiotracers. Materials and Methods: Mouse liver S9 fraction was isolated at au early step in the course of microsome preparation. The in vitro metabolism studies were tarried out by incubating a mixture containing the radiotracer, S9 fraction and NADPH at $37^{\ciirc}C$, and an aliquot of the mixture was analyzed at the indicated time points by radio-TLC. Metabolic defluorination was further confirmed by the incubation with calcium phosphate, a bone mimic. Results: The radiotracer $[^{18}F]1$ underwent metabolic defluorination within 15 min, which was consistent with the results of the in vivo method and the in vitro method using microsome. Radiotracer $[^{18}F]2$ was metabolized to three metabolites including $4-[^{18}F]fluorobenzoic$ acid within 60 min. It is likely that the one of these metabolites at the origin of radio-TLC was identical with the one that obtained from the in vivo and in vitro (microsome) method. Compared with the in vitro method using microsome, the method using S9 fraction gave a similar pattern of the metabolites but with a different ratio, which can be explained by the presence of cytosol in the S9 fraction. Conclusion: These results suggest that the findings of the in vitro metabolism studies using S9 fraction can reflect the in vivo metabolism of novel radiotracers in the liver. Moreover, this method can be used as a tool to determine metabolic defluorination along with calcium phosphate absorption method.

Acute Respiratory Distress Syndrome in Respiratory Intensive Care Unit (호흡기계 중환자실에서 치료 관리된 급성호흡곤란증후군의 임상특성)

  • Moon, Seung-Hyug;Song, Sang-Hoon;Jung, Ho-Seuk;Yeun, Dong-Jin;Uh, Su-Tack;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1252-1264
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    • 1998
  • Background : Patients with established ARDS have a mortality rate that exceeds 50 percent despite of intensive care including artificial ventilation modality, Mortality has been associated with sepsis and organ failure preceding or following ARDS ; APACHE II score ; old age and predisposing factors. Revised ventilator strategy over last 10 years especially at ARDS appeared to improve the mortality of it. We retrospectively investigated 40 ARDS patients of respiratory-care unit to examine how these factors influence outcome. Methods : A retrospective investigation of 40 ARDS patients in respiratory-care unit with ventilator management over 46 months was performed. We investigated the clinical characteristics such as a risk factor, cause of death and mortality, and also parameters such as APACHE II score, number of organ dysfunction, and hypoxia score (HS, $PaO_2/FIO_2$) at day 1, 3, 7 of severe acute lung injury, and simultaneously the PEEP level and tidal volume. Results : Clinical conditions associated with ARDS were sepsis 50%, pneumonia 30%, aspiration pneumonia 20%, and mortality rate based on the etiology of ARDS was sepsis 50%, pneumonia 67%(p<0.01 vs sepsis), aspiration pneumonia 38%. Overall mortality rate was 60%. In 28 day-nonsurvivors, leading cause of death was severe sepsis(42.9%) followed by MOF(28.6%), respiratory failure(19.1 %), and others(9.5%). There were no differences in variables of age, sex, APACHE II score, HS, and numbers of organ dysfunction at day 1 of ARDS between 28-days survivor and nonsurvivors. In view of categorized variables of age(>70), APACHE II score(>26), HS(<150) at day 1 of ARDS, there were significant differences between 28-days survivor and nonsurvivors(p<0.05). After day 1 of ARDS, the survivors have improved their APACHE II score, HS, numbers of organ dysfunction over the first 3d to 7d, but nonsurvivors did not improve over a seven-day course. There were significant differences in APACHE II score and numbers of organ dysfunction of day 3, 7 of ARDS, and HS of day 7 of ARDS between survivors and nonsurvivors(p<0.05). Fatality rate of ARDS has been declined from 68% to less than 40% between 1995 and 1998. There were no differences in APACHE II score, HS, numbers of organ dysfunction, old age at presentation of ARDS. In last years, mean PEEP level was significantly higher and mean tidal volume was significantly lower than previous years during seven days of ARDS(p<0.01). Conclusions : Improvement of HS, APACHE II score, organ dysfunction over the first 3d to 7d is associated with increased survival Decline in ARDS fatality rates between 1995 and 1998 seems that this trend must be attributed to improved supportive therapy including at least high PEEP instead of conventional-least PEEP approach in ventilator management of acute respiratory distress syndrome.

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Analytical Study on the Jehotang in Literature in Terms of Cooking Science (문헌 속 제호탕의 조리학적 분석 연구)

  • Ji, Myoung-Soon;Kim, Jong-Goon
    • Journal of the East Asian Society of Dietary Life
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    • v.18 no.4
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    • pp.446-454
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    • 2008
  • The traditional Korean drink "Jehotang", which is one of the most commonly prescribed drugs for treatment of the heat stroke accompanied by high fever, severe sweat and thirst, it is effective far quenching thirst strengthening the stomach, stopping diarrhea and regulating intestinal function. It is also known to play a role in activating the growth of useful microbes in the intestine and in multiplying intestinal immune cells. Thus, this study investigated all aspects of the drink in an effort to develop a new functional beverage. In the course of this study, the analytical research into the literature concerning Jehotang an error in the secrets of preparing the drink. The Japanese apricot, which was given the botanical name, "Prunusmume", should only be used with the flesh (scientifically referred to as "Fructusmume"), which is fumigated with straw fire before drying. and the seed should be thrown away. The honey should only be used after it is heated with a gentle fire, before removing the white foam that farms on its surface to make the "Yeonmil". Two kinds of cooking processes were found in the ancient literature. One procedure boiling down the powered Fructus mume mixed with the Yeonmil, while the other procedure involved preparing the Fructus mume's water by adding water to it and blending the water with the Yeonmil and the rest of the raw ingredient before boiling them down. The current procedure, in which the cooking is done in a double boiler, has been widely adopted to its simplicity. The finished Jehotang is put in porcelain, kept at room temperature, and consumed after mixing with cold water.

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Torque and mechanical failure of orthodontic micro-implant influenced by implant design parameters (교정용 마이크로 임플란트의 디자인이 토오크와 파절강도에 미치는 영향)

  • Yu, Won-Jae;Kyung, Hee-Moon
    • The korean journal of orthodontics
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    • v.37 no.3 s.122
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    • pp.171-181
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    • 2007
  • Objective: The present study was aimed at an analytical formulation of the micro-implant related torque as a function of implant size, i.e. the diameter and length, screw size, and the bony resistance at the implant to bone interface. Methods: The resistance at the implant to cancellous bone interface $(S_{can})$ was assumed to be in the range of 1.0-2.5 MPa. Micro-implant model of Absoanchor (Dentos Inc. Daegu, Korea) was used in the course of the analysis. Results: The results showed that the torque was a strong function of diameter, length, and the screw height. As the diameter increased and as the screw size decreased, the torque index decreased. However the strength index was a different function of the implant and bone factors. The whole Absoanchor implant models were within the safe region when the resistance at the implant/cancellous bone $(=S_{can})$ was 1.0 or less. Conclusion: For bone with $S_{can}$ of 1.5 MPa, the cervical diameter should be greater than 1.5 mm if micro-implant models of 12 mm long are to be placed. For $S_{can}$ of 2.0 MPa, micro-implant models of larger cervical diameter than 1.5 mm were found to be safe only if the endosseous length was less than 8 mm.

A Study of Improvement Plans for Urban Parks through the Application of Barrier-free Living Environment Certification Standards - A Focus on Boramae Park- (장애물 없는 생활환경 인증기준을 적용한 도시공원 개선계획 - 보라매공원을 대상으로 -)

  • Seo, Eun-Sil;Koo, Bon-Hak
    • Journal of the Korean Institute of Landscape Architecture
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    • v.43 no.5
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    • pp.100-110
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    • 2015
  • With the trend for the construction of barrier-free living environments in accordance with the ever-increasing external activity of the aging population, multi-culture families and socially disadvantaged, there is also a demand for the facilities improvement at parks for their convenience of use. This study analyzed the possibility of Barrier-Free Certification of an existing open space and defined its prototype renovation plan. This study is intended to help develop Borame Park into a barrier-free park by securing a barrier-free line of movement linking the major facilities sites within the park, improving park facilities lest there should be inconvenience in the use of the major facilities, and a guidance system convenient for use by physically and mentally impaired people. The significance of this study lies in the fact that it diagnosed the possibility of the BF Certification of existing urban parks and established a barrier-free park, which is easy for anyone to use. In the course of doing research on this, this study was able to discover the limitations of the BF Certification system, and its related tasks to be solved in the future as follows: The first thing this study shows is that there is a lack of understanding and awareness of the BF Certification system. Basically, there is a need for giving consideration to the development of a barrier-free living environment from the planning and design phase of a park, but in actuality, an examination of the certification is undertaken at the time of the completion of design and construction, which causes a large loss both time-wise and economically. Second, as evaluative items for the BF Certification of a park, applied are detailed evaluation items that fail to reflect the characteristics of an outdoor space whose natural constraints are large, such as geographical highs and lows and existing trees, plants, etc. Third, guidelines for establishment of a barrier-free park must be created in the light of the locational conditions of the park, followed by improvements of its BF Certification evaluation items.

Effects of adherence to Korean diets on serum GGT and cardiovascular disease risk factors in patients with hypertension and diabetes (고혈압 및 당뇨병 환자에서 한식 섭취가 혈청 GGT와 심혈관질환 위험인자에 미치는 영향)

  • Jung, Su-Jin;Chae, Soo-Wan
    • Journal of Nutrition and Health
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    • v.51 no.5
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    • pp.386-399
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    • 2018
  • Purpose: This study examined whether the supply of healthy Korean diets for 12 weeks is effective in improving the risk factors related to serum GGT and cardiovascular diseases in patients with hypertension and diabetes. Methods: This study selected 41 patients, who were treated with hypertension and diabetes. The Korean diet was composed of cooked-rice, soup, kimchi, and various banchan with one serving called bapsang, which emphasize proportionally high consumption of vegetables and fermented foods, moderate to high consumption of legumes and fish, and low consumption of animal foods. The control group was instead instructed to "eat and exercise as usual" while following the Korean Diabetes Association's dietary guidelines with an intake that can assist in glycemic control, maintain adequate weight, and meet the nutritional requirements. The Korean diet group (21 patients) were served three healthy Korean meals a day for 12 weeks, and the control group (20 patients, who trained in the diet guideline of diabetes) maintained their usual diabetic diet. The serum GGT, blood pressure, heart rate, glycemic control data, cardiovascular risk indicators, and changes in diet measured at the four visits (week 0, 4, 8, and 12) during the course of 12 weeks were compared and evaluated. Results: The serum GGT (p < 0.001), HbA1c (p = 0.004), heart rate (p = 0.007), weight (p = 0.002), Body Mass Index (p = 0.002), body fat mass (p < 0.001), body fat (%) (p < 0.001), and free fatty acid (p = 0.007) in the Korean diet group decreased significantly after the dietary intervention compared to the control group. The amount of intake of rice, whole grains, green vegetables, Kimchi, and soybean fermented food were increased significantly compared to the control group (p < 0.001). The Korean diet group showed significant decreases (p < 0.001) in the intake of animal protein, lipid, and cholesterol derived from animal foods compared to the control group but significant increases (p < 0.001) in the intake of total calories, folic acid, dietary fiber, sodium, potassium, and vitamins A, E, and C. Conclusion: In patients with hypertension and diabetes, it was confirmed that regular eating of a healthy Korean diet helps improve the risk factors for GGT and cardiovascular diseases.

A study on the pulse symptoms of Shanghanlun (상한론(傷寒論)의 조문중(條文中) 맥증(脈證)에 관한 연구(硏究))

  • Kim, Jong-Soo;Park, Won-Hwan
    • The Journal of Dong Guk Oriental Medicine
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    • v.9
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    • pp.73-93
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    • 2000
  • Shanghanlun principally dealt with the differentiation of 'The six channels'(Taiyang, Yangming, Shaoyang, Tayin, Shaoyin, Jueyin), summing up such rich experiences as diagnoses and remedies about an acute fever before the Han dynasty, and establishing the basis of the differentiation of symptoms and signs based on prescriptions. And making it a principle to think of both pulse and symptoms important, it made a more organic method of diagnoses which compounded a reason, ncle, prescriptions and drugs, and considerably contributed to the development of Diagnostics. Therefore, as a result of classifying the contents concerned with the differentiation of Shanghanlun through the pulse symptoms, which is a way of research about the field of pulse feeling, it provided us with somewhat knowledge. 1. The pulse symptoms corresponds with the latter classification on the pulse symptoms. That is why, it seems, the traditional concept, which regarded the pulse and the symptoms as the basis of the differentiation and established the principle of the differentiation of symptoms and signs based on prescriptions, largely has an effect on the establishment of the latter pulse science. 2. The contents concerned with the pulse symptoms, including general principles and dicoction symptoms of each chapter, mounted up to 38%, and so the pulse symptoms informed that the pulse symptoms was the grounds of transformation and development, mechanism of differentiation of syndromes, advance or retreat of pathologic factors and application of drugs of each course of Shanghanlun. 3. Of pulse syndromes, there appeared Floating pulse most, and in addition there were also the high frequency of Yin pulse like Indistinctive pulse, Tense pulse, Deep pulse, and so on. 4. Any regularity between the pulse syndrome and the abdominal syndrome cannot be found.

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Analysis of volatile compounds and metals in essential oil and solvent extracts of Amomi Fructus (사인으로부터 추출한 정유와 용매 추출물의 휘발성 물질 및 금속성분 분석)

  • Lee, Sam-Keun;Eum, Chul Hun;Son, Chang-Gue
    • Analytical Science and Technology
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    • v.28 no.6
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    • pp.436-445
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    • 2015
  • Amomi Fructus with anti-oxidative activity was chosen and essential oil was obtained by SDE (simultaneous distillation extraction), and 39 constituents were determined by GC-MS (gas chromatography-mass spectrometry). Major components were camphor, borneol acetate, borneol, D-limonene and camphene. Three solvent extracts such as hexanes, diethyl ether and methylene chloride from Amomi Fructus were obtained. These were analyzed by GC-MS and 4 more constituents were identified in addition to 39 components discovered in essential oil. Five major components such as camphor, borneol acetate, borneol, D-limonene and camphene were also detected, however the relative peak percents of those components were different from those of constituents in essential oil. To estimate the kind and the amount of materials evaporated at certain temperature and conditions from essential oil and solvent extracts, dynamic headspace apparatus was used and materials evaporated and trapped at certain conditions were analyzed by GC-MS. Recovery yield of SDE method from Amomi Fructus was measured by using camphor and standard calibration solution of camphor methanol solution and, the yield was 82.0%. Content of Hg was measured by mercury analyzer and contents of Cd, Pb, Cr, Mn, Co, Ni, Cu and Zn in Amomi Fructus, essential oils and solvent extracts were determined by ICP-MS (Inductively coupled plasma-mass spectrometer). Pb, Cd and Hg were measured in the concentration of 0.72 mg/kg, <0.10 mg/kg and 0.0023 mg/kg, respectively and these were below permission level of purity test. Contents of Mn, Cu and Zn in Amomi Fructus were 213 mg/kg, 8.29 mg/kg and 31.0 mg/kg, respectively and which were relatively higher than other metals such as Cr, Co and Ni. Metals such as Mn (0.65 ~ 9.08 mg/kg), Cu (1.16 ~ 4.40 mg/kg) and Zn (1.10 ~ 3.80 mg/kg) in essential oil and solvent extracts were detected. At this point it is not clear that the metals were cross-contaminated in the course of treating Amomi Fructus or metals were contained in Amomi Fructus. The influence evaluation toward biological model study of these metals in essential oil and solvent extracts will be needed.