• Childhood Kidney Diseases
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• v.11 no.1
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• pp.41-50
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• 2007

Purpose : Dialysis in children with chronic renal failure presents with many difficulies. The purpose of this study is to find an improved method in chronic dialysis in infants and children less than 2 years of age by analyzing the experience with 10 cases. Methods : A retrospective review of the medical records of 10 patients(6 boys and 4 girls) was conducted. The patients had chronic renal failure and underwent chronic dialysis at Samsung medical center from March 1999 to February 2007. Results : At Initiation of dialysis, the median age was 3 months old(22 days-20 months), the median body weight was 3.75 kg(2.2-10.3 kg), and the median serum creatinine level was 4.3 mg/dL(2.0-11.4 mg/dL). The median duration of dialysis was 29.5 months(3-62 months). Dysplastic kidney disease was the most common underlying renal disease. Two patients were treated with hemodialysis, 4 patients with peritoneal dialysis, and 4 patients eventually switched dialysis modality. Nine of the 10 patients took erythropoietin and anti-hypertensive drugs. At the end of the follow up period, 1 patient received kidney transplantation, 2 patients died due to sepsis, and 5 patients were treated with peritoneal dialysis. Two patients were lost to follow up. The most common complication of dialysis was infection. Achieving vascular access and maintaining proper catheter function were the most important factors in treating patients with hemodialysis. The growth status of patients was aggravated after 6 month of dialysis but improved after 1 year of dialysis. Patients showed better growth on peritoneal dialysis than hemodialysis. Conclusion : Chronic dialysis can be performed successfully in infants and children under 2 years of age. Vascular access was the main limitation of hemodialysis, and infection was the common problem in both hemodialysis and peritoneal dialysis. To improve the patients survival rate and quality of life, major efforts should be directed toward the prevention of infection and preservation of catheter function. (J Korean Soc Pediatr Nephrol 2007;11:41-50)

• Journal of radiological science and technology
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• v.31 no.3
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• pp.259-266
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• 2008

Objective : The purpose of this study was to examine the relationship between bone mineral density (BMD) and the metabolic syndrome. Method : We conducted a cross-sectional study of 1204 adults(males: 364 females: 840) in a general hospital health promotion center. They were grouped into the normal and lower BMD group according to bone loss(osteopenia, osteoporosis), as determined by duel energy X-ray absorptiometery(DEXA). We analyzed the association between BMD and metabolic syndrome by multiple logistic regression analysis. After adjustment for age, weight, alcohol intake, smoking, regular exercise, regular intake of meals, and menopausal status, odds ratios for the prevalence of the metabolic syndrome by gender were calculated for lower BMD. Results : After adjustment for the effect of potential covariates, the prevalence of metabolic syndrome was associated with bone loss in men(p<0.001). If the odds ratio of normal group is 1.00, then that of the lower BMD group is 3.07(95% CI=1.83-5.16). The prevalence of metabolic alterations fitting the criteria of metabolic syndrome was significantly decreased in High BMI, Low HDL in men and in High BMI in women(p<0.05). Conclusions : This study shows that BMD was associated with metabolic syndrome. Further studies needed to obtain evidence concerning the association between BMD and metabolic syndrome.

• The Journal of Korean Society for School & Community Health Education
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• v.1 no.2
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• pp.29-48
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• 2000

This study was designed to diagnose the correlations between health promotion behavior and primary school students' demographic characteristics and their self-concept, and also this study was aimed at representing the basic data of proper instruction method and school health program with the respective to primary school students' health promotion behavior through the above things. For this, author selected as 5th, 6th graders, 400 persons at 5 elementary schools located on Kyonggi province. This data utilized ANOVA, multiple regression analysis and correlation analysis by SPSS program. The findings of this study were as follows; First, there showed meaningful differences concerning their health promotion behavior according to students' demographic traits. There were a birth date, living standard, domestic environments etc. as a factors which influenced on their health promotion behavior. With this, from ex-past-facto verification for these variable factors, as their birth date was faster, living standard was higher, domestic environments was better, as their health promotion behavior was more promotive. Second, students' health promotion behavior marked 3.61 among total 5 paint with the respective to its fulfillment degree, their self-concept marked 3.45 among total 5 paint. Their mental health promotion behavior marked 3.71 with the respective to inferior category of health promotion behavior, which was the highest score. In the other hands, their physical health promotion behavior marked 3.71, social health promotion behavior marked 3.45. contrary the disease prevention, first-aid & safety, oral health, health & nutrition(P>.05). Third, there show meaningful difference, in the level of p-value <.001 with the respective to the correlations between primary school students' health promotion behavior and their self-concept, more their self-concept was positive, more their more their whole health promotion behavior(r=.479), the fulfillment degree of physical health promotion behavior(r=.384), mental health promotion behavior(r=.543), social health promotion behavior(r=.372) were high. Fourth, with the respective to the results of difference verification concerning their fulfillment degree of health promotion behavior according to the upper, middle, inferior group of self-concept, there showed statistically meaningful difference, in the level of p-value<.001. In the long run, more their self-concept was positive, more their whole health promotion behavior was high. With this, from the results of $Scheff\acute{e}$ verification, there showed meaning differences among the upper and middle group, upper and inferior group, middle and inferior group. Fifth, self-concept played the role as the most important prognostic factor with the respective to primary school students' health promotion behavior(23.0%), in the other hands, there showed positive weight of 24.0% concerning the fulfillment of whole health promotion behavior by domestic environments(1.0%). From the above results, primary school students' the fulfillment degree of health promotion behavior didn't reach to middle or inferior level. In the other hands, there showed positive effects in the correlations between self-concept and the fulfillment degree of health promotion behavior, and also high self-concept group was much positive considering inferior group in the fulfillment degree of health promotion behavior. Accordingly, more their self-concept was positive, more their fulfillment degree of health promotion behavior was effective. Eventually, in the future, there have to make an efforts to develope positive, substantial programs through their self-concept enhancement etc. in the adequate planning or operation for primary school students' health education and school health program.

• Korean Journal of Soil Science and Fertilizer
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• v.37 no.4
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• pp.199-206
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• 2004

Factors of universal soil loss equation, USLE, and its revised version, RUSLE for Korean soils were reevaluated to estimate the national scale of soil loss based on digital soil maps. Rainfall erosivity factor, R, of 158 locations of cities and counties were spacially interpolated by the inverse distance weight method. Soil erodibility factor, K, of 1321 soil phases of 390 soil series were calculated using the data of soil survey and agri-environmental quality monitoring. Topographic factor, LS, was estimated using soil map of 1:25,000 scale with soil phase and land use type. Cover management factor, C, of major crops and support practice factor, P, were summarized by analyzing the data of lysimeter and field experiments for 27 years (1975-2001) in the National Institute of Agricultural Science and Technology. R factor varied between 2322 and 6408 MJ mm $ha^{-1}$ $yr^{-1}$ $hr^{-1}$ and the average value was 4276 MJ mm $ha^{-1}$ $yr^{-1}$ $hr^{-1}$. The average K value was evaluated as 0.027 MT hr $MJ^{-1}$ $mm^{-1}$. The highest K factor was found in paddy rice fields, 0.034 MT hr $MJ^{-1}$ $mm^{-1}$, and K factors in upland fields, grassland, and forest were 0.026, 0.019, and 0.020 MT hr $MJ^{-1}$ $mm^{-1}$, respectively. C factors of upland crops ranged from 0.06 to 0.45 and that of grassland was 0.003. P factor varied between 0.01 and 0.85.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.335-348
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• 2005

Background: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. Material and Method: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was $23.1\pm16.2$ days ($5\~81\;days$), and the mean body weight was $3.4\pm0.7\;kg\;(2.1\~4.3\;kg)$. Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. Result: There were 11 ($19.0\%$) early, and 5 ($10.6\%$) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients ($41.4\%$) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. Conclusion: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.

• Journal of Chest Surgery
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• v.34 no.9
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• pp.704-710
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• 2001

Background: Extracorporeal circulation using pump-oxygenator is an inevitable process to keep vital sign during cardiac arrest for open heart surgery. However, the diversion of blood through nonendothelialized channels appears to stimulate inflammatory response, and leukocyte activation may lead to cardiopulmonary edema. Our study evaluated the effect of leukocyte-induced cardiopulmonary edema using three different pump-oxygenator priming solutions; non-hemic crystalloid solution ; leukocyte-depleted homologous blood; non leukocyte-depleted homologous blood in priming solutions. Material and Method: Each different priming solution was used on five dogs, and the effect of leukocyte-induced cardiopulmonary edema during cardiopulmonary bypass(CPB) was evaluated. For each dog after 2 hours of exracorporeal circulation and another 4 hours of post-pump period, the dog was sacrificed and its heart and lung tissues were obtained for measuring Wet/Dry ratio. Arterial $O_2$partial pressure(PaO$_2$) and $CO_2$partial pressure(Pa$CO_2$) were checked. For the evaluation of ventilatory function, $CO_2$partial pressure difference between arterial blood (Pa$CO_2$) and exhaled air(Et$CO_2$) was measured. Result: 1. No significant difference was seen in arterial PaO$_2$and Pa$CO_2$among groups. 2. Ventilatory function evaluated by Pa$CO_2$and Et$CO_2$showed no significant difference between non-hemic and blood-mixed priming solution (P<0.05). 3. Cardiac and lung Wet/Dry ratios were remarkedly lower in the leukocyte-depleted group. There was no significant difference between the non-hemic and blood-mixed groups. Conclusion: Based upon this result, we concluded that the leukocyte depletion from homologous blood of CPB priming solution has a beneficial effect in reducing cardiopulmonary edema compared with non leukocyte-depleted or crystalloid priming solutions.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.505-510
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• 2006

Background: Small animal cardiopulmonary bypass (CPB) model would be a valuable tool for investigating path-ophysiological and therapeutic strategies on bypass. The main advantages of a small animal model include the reduced cost and time, and the fact that it does not require a full scale operating environment. However the rat CPB models have a number of technical limitations. Effective maintenance and control of core temperature by a heat exchanger is among them. The purpose of this study is to confirm the effect of rectal temperature maintenance using a heat exchanger of cardioplegia system in cardiopulmonary bypass model for rats. Material and Method: The miniature circuit consisted of a reservoir, heat exchanger, membrane oxygenator, roller pump, and static priming volume was 40 cc, Ten male Sprague-Dawley rats (mean weight 530 gram) were divided into two groups, and heat exchanger (HE) group was subjected to CPB with HE from a cardioplegia system, and control group was subjected to CPB with warm water circulating around the reservoir. Partial CPB was conducted at a flow rate of 40 mg/kg/min for 20 min after venous cannulation (via the internal juglar vein) and arterial cannulation (via the femoral artery). Rectal temperature were measured after anesthetic induction, a ter cannulation, 5, 10, 15, 20 min after CPB. Arterial blood gas with hematocrit was also analysed, 5 and 15 min after CPB. Result: Rectal temperature change differed between the two groups (p<0.01). The temperatures of HE group were well maintained during CPB, whereas control group was under progressive hypothermia, Rectal temperature 20 min after CPB was $36.16{\pm}0.32^{\circ}C$ in the HE group and $34.22{\pm}0.36^{\circ}C$ in the control group. Conclusion: We confirmed the effect of rectal temperature maintenance using a heat exchanger of cardioplegia system in cardiopulmonary bypass model for rats. This model would be a valuable tool for further use in hypothermic CPB experiment in rats.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.108-112
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• 1998

Experimental trials of unilateral lung transplantation in dogs have been attempted and satisfactory results were obtained without any noticeable difficulty in surgical techniques. Fourteen dogs with the body weight of around 25 kg were anesthesized by 20~30 mg/kg of intravenous Entobar,; one was sacrificed to make available blood for use during transplantation for the recipient dog. A mid-sternotomy incision was performed and 20 mg/kg of Prostaglandin E1 was infused through the pulmonary artery and Euro-Collin's(E-C) preservation solution, cooled down to 4$^{\circ}C$, was perfused at the rate of 70cc/kg by a pressure of 30 cmH2O. The heart-lung block was then resected out and promptly immersed in the prepared preservation solution at 4$^{\circ}C$. One lung preserved in the EC solution at 4$^{\circ}C$ was anastomosed to the recipient dog in the order of the pulmonary vein, bronchus then pulmomary artery and the thoracotomy incision was closed after the bleeding control and tube thoracostomy. Then the pneumonectomy in the opposite side was perfomed in the same manner and the tailored lung was transplanted in the order of the pulmonary vein, bronchus, then pulmonary artery. We conclude that in the bilateral sequential lung transplantation, the right lung transplantation should precede to better expose the operative field and to prevent reperfusion injury; also, the cardiopulmonary bypass should be consider for certain appropriate cases.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.597-603
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• 2009

Background: Atrioventricular valve regurgitation in pediatric patients with a functional single ventricles (FSV) - has been known as one of the important risk factors for death and unfavorable long-term results after a Fontan operation. We evaluated early and mid-term results of bivalvation valvuloplasty in FSV patients. Material and Method: We retrospectively evaluated 11 patients with a functional single ventricle who underwent bivalvationvalvuloplasty between 1999 and 2007. The degree of common atrioventricular valve regurgitation (CAVVR) was determined by color Doppler echocardiography (regurgitation grade scoring, trivial; 1, mild; 2, moderate; 3, severe; 4). Mean age at valve surgery was $6.9{\pm}7.0$ months (median 4 months, 24 days$\sim$21 months)and mean body weight was $6.2{\pm}2.8\;kg$ ($3.1{\sim}11.3\;kg$). Nine patients had isomerism heart and two of them had TAPVC. The concomitant procedures were performed in all but one patient. Additional commissural closure was performed in 3 patients and commissural annuloplasty in another 3 patients. Result: There was one hospital death after. surgery. A 32-day old patient who had been preoperatively dependent on a ventilator died of air way and lung problems 4.3 months after pulmonary artery banding and bivalvation valvuloplasty. Mean follow-up duration was 40 months ($4.3{\sim}114$ months). Mean preoperative CAVVR score was $3.3{\pm}0.6$, which decreased to $1.9{\pm}0.7$ postoperatively (p<0.0001). This residual regurgitation slightly increased to $2.2{\pm}0.4$ (no statistical significance) after a mean follow-up of 1.4.3 months. Six patients (60%) required re-operations for residual regurgitation at a subsequent bidirectionalcavopulmonary shunt or Fontan operation. One patient with Ebsteinoid malformation of the right sided atrioventricular valve required valve replacement due to stenoinsufficiency. Another patient required edge-to-edge repair at the right sided AV valve (between the right mural leaflet and the bridging leaflets). The remaining 4 patients required additional suture placements between bridging leaflets with or without commissural annuloplasty. All survivor had trivial or mild CAVVR at the latest follow-up. Conclusion: Bivalvation valvuloplasty for CAVVR in FSV patients is. an effective and safe procedure. However, significant numbers of the patients have small residual regurgitation and require additional valve procedures at subsequent operations. Long-term observations to monitor progression of the CAVVR is mandatory.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.417-422
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• 2008

Background: The aim of this study is to evaluate the long term results of creating various right ventricle to pulmonary artery conduits for treating complex congenital heart disease. Material and Method: Between June 1986 and July 2006, we retrospectively reviewed 245 patients who underwent reconstruction of the right ventricular outflow tract with various kinds of conduits. 410 operations were done in 245 patients, the mean age at operation was $3.2{\pm}4.9$ years (range: 7 days$\sim$45 years) and the mean body weight was $12.5{\pm}8.7\;kg$ (range: $2.4\sim76.3\;kg$). Result: We used the following conduits: Polystan conduit, Shelhigh conduit, Carpenter-Edward conduit, Dacron graft with an artificial valve, valveless Gore Tex vascular graft, homograft and hand-made bovine or autologous pericardial conduit. The mean follow up duration was $6.3{\pm}5.2$ years. Redo operation for RV-PA conduit dysfunction was performed in 131 patients, a second redo was done in 31 and a third redo was done in 3. The reoperation free rates were 67.3%, 48.5% and 39.4% for 5 years, 10 years and 15 years, respectively. The homograft showed the best durability, followed by the Dacron graft with artificial valve and the Carpentier-Edward conduit. The larger sized conduit showed better durability. Conclusion: The homograft showed lowest reoperation rate and a smaller size of conduit showed the highest reoperation rate. The reoperation rate for the RV-PA conduit was about 35% at 5 years, so it is mandatory to develop the more durable conduit for RV outflow.