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Bilateral Sequential Lung Transplantation in Dogs (황견에서 동종 순차적 양측 폐이식 수술에 관한 연구)

  • 이두연;김해균;문동석;윤용한;홍윤주;이성수
    • 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.

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Follow-Up Method in Patients with Kawasaki Disease who had No Coronary Artery Abnormalities in the Convalescent Period (회복기 심초음파 검사상 관상동맥 내경 크기가 정상 범위인 가와사끼병 환자에서 추적관찰 방법에 대한 고찰)

  • Joo, Hee Jung;Song, Min Seob;Kim, Chul Ho
    • Clinical and Experimental Pediatrics
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    • v.48 no.2
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    • pp.165-173
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    • 2005
  • Purpose : We performed the study to evaluate the value of the follow-up echocardiogram performed 6 months to 1 year after the onset of Kawasaki disease(KD), as recommended by American Heart Association(AHA) guidelines, when echocardiograms in the convalescent period were normal. Methods : Patients were selected from 147 cases diagnosed with KD at Pusan Paik hospital from January 2000 to October 2003. A total of 45 KD patients belonged to AHA risk level I and II were performed follow-up echocardiography. The patient's medical records and echocardiogram were reviewed. Additionally, we sought the opinion of pediatric cardiologists on the subject by means of a multiple-choice survey. Results : 37 children were belonged to AHA risk level I and the remaining 8 patients were belonged to risk level II. Of these 45 children, none were noted to have abnormalities on later follow-up echocardiogram. In the results of questionnaire, 37 percent of the participants advocate no follow-up after convalescent period for risk level I, and 33.3 percent favor periodic follow-up with echocardiography for risk level II up to one year. But there were no consensus about the diagnostic criteria of coronary abnormalities and how to follow-up these patients. Conclusion : All children with KD should have an echocardiogram at present and a follow-up study 6 to 8 weeks after the onset of fever. However, additional echocardiographies are not justified if the 6- to 8-week follow-up echocardiogram is normal. We would recommend that the more reasonable diagnostic criteria for coronary abnormalities and the Korean guidelines for long-term cardiovascular management and follow-up of KD need to be established.

Establishment of Featal Heart Surgery with an Improvement of the Placental Blood Flow in Cardiopulmonary Bypass Using Fetal Lamb Model (양태아를 이용한 심폐우회술에서의 태반혈류개선을 통한 태아심장수술의 기반기술 확립)

  • 이정렬;박천수;임홍국;배은정;안규리
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.11-18
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    • 2004
  • Background: We tested the effect of indomethacine and total spinal anesthesia on the improvement of placental flow during cardiopulmonary bypass on fetal lamb. Material and Method: Twenty fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Ten served as a control group in which placenta was worked as an oxygenator during bypass (Control group). The remainder worked as an experimental group in which pretreatment with indomethacine and total spinal anesthesia was performed before bypass with the same extracorporeal circulation technique as control group (Experimental group). Observations were made every 10 minutes during a 30-minute bypass and 30-minute post bypass period. Result: Weights of the fetuses ranged from 2.2 to 5.2 kg. In Control group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of Pa$CO_2$ increased from 61.9 to 129.6 mmHg at each time points during bypass. Flow rate was suboptimal (74.3 to 97.0 $m\ell$/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. On the contrary, in Experimental group, means of arterial pressure reamined higher (45.8 to 30 mmHg) during bypass (p<0.05). Means of Pa$CO_2$ were less ranging from 59.8 to 79.4 mmHg during bypass (P<0.05). Flow rates were higher (78.8 to 120.2 $m\ell$/kg/min) during bypass (p<0.05). There were slower deterioration of cardiac function after cessation of bypass. Conclusion: In this study, we demonstrated that the placental flow was increased during fetal cardiopulmonary bypass in the group pretreated with indomethacine and total spinal anesthesia. However, further studies with modifications of the bypass including a creation of more concise bypass circuit, and a use of axial pump are mandatory for the clinical application.

The Changes of Intestinal Normal Flora in Neonates for Seven Days Postnatally (정상 신생아의 대변에서 생후 1주일 동안 장내세균총의 변화)

  • Sung, Nam-ju;Lee, Seung Gue;Kim, Me Jin;Kim, Young Ho;Yang, Seung;Hwang, Il Tae;Jung, Ji A;Lee, Hae Ran;Kim, Jae-Seok
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.9 no.2
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    • pp.162-168
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    • 2006
  • Purpose: Microbial colonization of the intestine begins just after birth and development of the normal flora is a gradual process. The first bacteria colonizing the intestine in newborns are Staphylococcus, Enterobacteriaceae and Streptococcus. For several days after birth, the number of Bifidobacterium spp. increase. The aim of this study was to investigate the changes of microflora for seven days postnatally in neonatal stool. Methods: Fifteen neonates (breast : formula : mixed feeding 1 : 8 : 6, vaginal delivery : cesarean section 3 : 12) who were born at the Kangdong Sacred Heart Hospital, Hallym University were enrolled. First meconium and stools of postnatal 1-, 3-, and 7-day were innoculated. Blood agar plates for total aerobes, trypton bile X-glucuronide agar for E. coli, phenylethyl alcohol agar for gram positive anaerobes, MRS agar for Lactobacillus spp., bifidobacterium selective agar for Bifidobacterium spp. and cefoxitin-cycloserine-fructose agar for Clostridium difficile were used in the general incubator ($CO_2$ free incubator), $CO_2$ incubator or the anaerobic chamber for 48 or 72 hours at $37^{\circ}C$ and then colony forming units were counted. Results: No microflora was identified in the first meconium. Total aerobes, E. coli, and gram positive anaerobes were significantly increased with advancing postnatal days. In only one baby, Lactobacillus acidophilus was detected $2{\times}10^5CFU/g$ in the seven-day stool. Bifidobacterium spp. was detected in two babies. Clostridium difficile was not detected during the seven days. There were no significant differences in the bowel flora depending on the delivery pattern and feeding method. Conclusion: This study shows many changes in the intestinal normal flora in neonatal stool during seven days postnatally. If these findings are confirmed with larger studies, the data may be preliminary findings to support use of probiotics in neonates.

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The Changes of Serum Angiotensin Converting Enzyme Activity in Lung Cancer Patients (폐암 환자의 혈청 Angiotensin Converting Enzyme 활성도의 변화)

  • Jeong, Ki-Ho;Choi, Hyung-Seok;Yoo, Chul-Gyu;Lee, Kye-Young;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo;Kim, Keun-Youl;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.4
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    • pp.310-317
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    • 1992
  • Background: Angiotensin converting enzyme is a glycoprotein peptidyldipeptide hydrolase which cleaves the c-terminal dipeptides of several oligopeptides. It is a menbrane-bound protein mainly synthesized by the endothelial cells. Since the lung has the largest capillary bed of any organ in the body, it is here that ACE acts on circulating substrates like angiotensin I and bradykinin. It is well known that ACE correlates with disease activity in sarcoidosis and also there are reports that changes in serum ACE activity are found in many acute and chronic lung diseases. So we planned this study to see if serum ACE activity can act as a prognostic factor in lung cancer. Methods: Forty-one newly diagnosed lung cancer patients were included in the study group. There were 19 patients with squamous cell lung cancer, 13 with adenocarcinoma, and 9 with small cell carcinoma. Patients were excluded from the study if they had high blood pressure, heart disease, liver disease, renal disease, or other lung disease. Serum ACE activity was analyzed according to cell type, staging, mode of treatment, and clinical response to treatment. Results: 1) There was no difference in serum ACE activity between lung cancer patients and the control group. Also no difference in serum ACE activity was found according to cancer cell type or staging. 2) In patients who underwent curative resection of lung cancer, serum ACE activity was decreased significantly after the operation. 3) In patients who were diagnosed as non-small cell lung cancer and were treated with 4 cycles of anti-cancer chemotherapy without clinical improvement, changes in serum ACE activity were not seen after the treatment. 4) In patients diagnosed as small cell lung cancer treated with 4 cycles of anti-cancer chemotherapy with clinical improvement, changes in serum ACE activity were also not observed. Conclusion: Serum ACE activity was decreased after lung resection but had no relation to cell type, staging, or clinical response to treatment in lung cancer patients. Therefore, serum ACE activity is not suitable in predicting clinical outcome of lung cancer patients.

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Effects of Feeding Non-Salt Diet on the Induced Molting in Laying Hens (무염 사료의 급여가 유도환우에 미치는 영향)

  • Hong, E.C.;Na, J.C.;You, D.C.;Kim, H.K.;Chung, W.T.;Lee, H.J.;Kim, I.H.;HwangBo, J.
    • Korean Journal of Poultry Science
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    • v.34 no.4
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    • pp.279-286
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    • 2007
  • This study was conducted to induce molting with DDGS and non-salt diet and compare the effect of feeding molting and fasting molting on the performance, egg quality, and visceral organs in laying hens for animal welfare. One-hundredeight 62-wk-old White Leghorn hens that egg production was over 80% and average weight was $1.8{\pm}0.1kg$ were used in this study. Treatments were control(non-molt treatment), feeding molt treatment(DDGS, non-salt diet), and fasting molt treatment. The four treatments were administered to three replicate group of nine hens wherein each group. All treatment groups were fed the basal diet(CP 15%, ME 2,700 kal/kg) for two weeks as the adaptation period. Test Periods were 28 days at all treatments. Egg production decreased for 18 days to be 0% at feeding molting treatment, and for 17 days to be 0% at non-salt feeding molting treatment. Egg production stopped for 6 days at fasting molting treatment. Egg production restarted after 12 days molt at feeding molting treatment, while after 16 days at fasting molting treatment. On the egg quality was improved at molting treatments (p<0.05) except egg yolk. Egg shell tissue was crowded at molting treatment to compare to control. Liver weights, heart weight, and oviduct weight of laying hens decreased at molting treatments(p<0.05). Finally, feeding molting might could be replaced fasting molting on the welfare and further studies were needed about molting program.

A Study on Neuroticism in College Students (신경증적 척도에 의한 대학생의 정신건강 평가)

  • Lee, Jung-Hoon;Park, Hyeong-Bae;Cheung, Sung-Douk
    • Journal of Yeungnam Medical Science
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    • v.2 no.1
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    • pp.135-147
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    • 1985
  • The authors studied neuroticism, using Eysenck's Maudsley Personality Inventory (MPI), in 3,893 male college students and 1,976 female college students of Yeungnam University. There was significant difference in the mean averages of total neuroticism scores between male and female students, male students scored $13.45{\pm}7.44$, female students scored $16.89{\pm}7.19$. The items relating to (16) Do you sometimes feel happy, sometimes depressed, without any apparent reason? (38) Do you daydream a lot? (1) Do you have dizzy turns? (2) Do you get palpitations or thumping in your heart? and (35) Do you worry about your health? were scored highly in male, and the items relating to (16) Do you sometimes feel happy, sometimes depressed, without any apparent reason? (1) Do you have dizzy turns? (38) Do you daydream a lot? (8) Do you worry too long over humiliating experiences? (9) Do you consider yourself rather a nervous person? were scored highly in female. Three hundreds and ninety eight male students (10.3%) showed seriously high neuroticism scores of 24 or higher, while 256 female students (13.0%) showed high neuroticism scores of 26 or higher. In a comparison between male students in different school grades, freshman showed the highest level of neuroticism scores. Among the psychosocial factors, there were strong tendencies toward higher neuroticism scores in the students who were dissatisfied with their colleges or departments, and who had pessimistic views of self-image in the past, present, or future in both groups. The male students whose educational fees were paid by their parents, and whose spending money per month was under 10,000 won, showed higher neuroticism scores. The female students whose educational fees were paid by their brothers or sisters, and whose maturation locations were U-P, and who resided in dormitory or other residencies, showed higher neuroticism scores.

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Bronchial Hyperresponsiveness in Liver Cirrhosis (간경변증 환자에서 기관지 반응성에 대한 연구)

  • Kim, Ki-Ryang;Kim, Min-Gu;Lee, Sang-Kab;Jang, Se-Ho;Park, Jong-Hwa;Lee, Jong-Deog;Hwang, Yung-Sil
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.3
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    • pp.639-648
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    • 1997
  • Background : Arterial hypoxemia has been noted in patients with liver cirrhosis because of bronchial vessel dilatation. Cabenes et al. reported that bronchial hyperresponsiveness to the metacholine inhalation was observed in patients of left side heart failure, he suggested that one of the mechanism was bronchial vessel dilatation. We hypothesized that patients of liver cirrhosis might have bronchial hyperresponsiveness to metacholine inhalation due to portal hypertension. We evaluate the relationship between bronchial responsiveness and severity of liver cirrhosis, severity of portal hypertension. Methods : In the 22 patients of the liver cirrhosis with clinical portal hypertension, metacholine provocation test was done and determined $PC_{20}FEV1$. We classified liver cirrhosis according to Pugh-Child classification. Esophagogastroscopies were performed for the evaluation of the relationship between bronchial hyperresponsiveness and severity of esophageal varix. Results : In the 22 cases of the liver cirrhosis with clinical portal hypertension. The causes of liver cirrhosis, alcoholic hepatitis was 9 cases, hepatitis B virus was 12 cases, hepatitis C virus was 1 case, and 151 cases (68.18%) of total 22 cases were positive in metacholine provocation test. In positive cases. There was no significant relationship between $PC_{20}FEV1$ and severity of liver cirrhosis which were classified by Pugh-Child classification or severity of esophageal varix(p<0.05). Conclusion : we observed that bronchial responsiveness to metacholine increased in the patients of liver cirrhosis and there was no significant relationship between the severity of liver cirrhosis and the severity of esophageal varix.

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Modification of the Cox-Maze Procedure for Atrial Fibrillation with Large Left Atrium ; Development of Surgical Technique to Increase the Left Atrial Contractility (좌심방 확장을 동반한 심방세동에 대한 Cox-Maze 수술법의 변형 -수술후 좌심방 수축력의 증진을 위한 수술법의 개량-)

  • 강창현;김기봉;손대원
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.249-254
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    • 1999
  • Background: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. Material and Method: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). Result: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). Conclusion: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.

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Christian Education for Human Spirit Transformation (인간 영의 변형을 위한 기독교교육)

  • Woo, Ji Yeon
    • Journal of Christian Education in Korea
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    • v.66
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    • pp.413-437
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    • 2021
  • Humans are created as spiritual beings that can relate to God. However, when a human spirit refuses to transform through confronting God, it experiences a crisis. A spiritual crisis results from disconnecting with God, who is the ultimate foundation, but we humans try to overcome such absence through accomplishments and efforts. In this technological age, the ethics issues of AI (Artificial Intelligence), robots, and cloning are related to anthropology. The development of the mind, heart, and logic cannot suggest a basis for destruction and confusion as much as the development of the world. In fact, education focused on the human mind cannot be considered holistic. Mind, together with thought, will, and belief, plays a crucial role in making choices and leading a human life. So it is actively studied in other domains other than Christian education. However, although the human spirit takes care of some territory of humanity, unlike the mind, it can neither be partial nor fragmentary. Instead, it manages the transformation that influences the core of human life. Therefore, Christian education must clearly concentrate on the spirit rather than on other human elements, intentionally concerning spiritual transformation through encounters with God. In other words, Christian education is the passage connecting a human spirit to God's presence at work, which enables us to understand the human being as a whole. For this, we must put our efforts to increase the chances of encountering God through Christian education. While "Encounter" requires both parties' interaction, "Transformation" stresses God as the main agent and His proactive nature. I also want to emphasize "worship" as the opportunity to communicate and experience God in our daily lives. By examining the preparation and the process of the spiritual transformation of humans, this paper would offer a theological foundation for continued transformation of the human spirit in the faith community, rather than personal experience or conviction.