• Journal of Chest Surgery
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• v.34 no.11
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• pp.831-842
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• 2001

Background: Patients with cardiac diseases who have structural defects in their heart bring about metabolic insult such as preoperative acid-base imbalance. Cardiac operation requires many nonphysiologic procedures such as extracorporeal circulation, hypothermia, and hemodilution. We studied the acid-base status of surgical heart diseases pre-operatively, during extracorporeal circulation, and post-operatively and researched the treatment indications of acid-base disturbances. Material and Method: From January 1997 to May 1999, fifty two cases of open heart surgery were carried out under extracorporeal circulation, which divided into a set of pediatric and adult groups, congenital and acquired groups, non-cyanotic and cyanotic groups, The $\alpha$ -stat arterial blood gas analysis was done in each group during the preoperative period, during the operation with extracorporeal circulation, and during the postoperative period. Result: Before surgery, all patients present metabolic acidosis, PaO2 was low in adult group and acquired group and compensatory respiratory alkalosis was noted in cyanotic group. During extracorporeal circulation, adult group revealed alkalosis and normal in acquired group. Pediatric group presents low Pa$CO_2$, metabolic acidosis and respiratory alkalosis. Congenital group and non-cyanotic group showed non-compensatory alkalosis trend and non-compensatory respiratory acidosis were observed in cyanotic group during extracorporeal circulation. Postoperative acid-base status of adult group was recovered to normal and the standard bicarbonate was increased in the acquired group. All of the pediatric, congenital non-cyanotic, and cyanotic groups revealed the lack of buffer base.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.366-375
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• 2006

Background: Hypomagnesemia is a common complication after cardiac surgery with cardiopulmonary bypass. The purpose of this study was to assess the clinical beneficial effect of administration of magnesium sulfate in cardiac surgery. Material and Method: Thirty five patients scheduled for elective cardiac surgery were randomly assigned to magnesium group (n=20) which received magnesium sulfate in priming solution (1 g) and cardioplegic solution (1 g) or control group (n=15) which did not receive it. Arterial blood samples were drawn for measuring $Mg^{++}$ and electrolytes contents, blood gas analysis, CBC, total protein, albumin, blood urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, tumor necrosis factor-${\alpha}$ $(TNF-{\alpha})$, interleukin-6 (IL-6), interleukin-10 (IL-10), creatine phosphokinase (CpK), creatine kinase-MB (CK-MB), lactate dehydrogenase(LDH), troponin-1 (TNI), prothrombin time (PT) and activated pratial thromboplastin time level (aPTT). Venous blood samples were drawn before and after the operation for measuring activated clotting time level (ACT). Result: $Mg^{++}$ levels in magensium group were higher than those of control group at intraoperative and post-operative periods (p<0.05). dysrhythmias were lower in magnesium group (8 cases out of 17 patients, 46.4%) than in control group (10 cases out of 10, 100%, p=0.050). Conclusion: These results showed that administration of low dose magnesium sulfate during cardiac surgery prevented hypomagnesemia and lowered incidence of dysrhythmia.

• Analytical Science and Technology
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• v.24 no.2
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• pp.69-77
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• 2011

Ethylene glycol (EG) is produced commercially in large amounts and is widely used as antifreeze or deicing solution for cars, boats, and aircraft. EG poisoning occurs in suicide attempts and infrequently, either intentionally through misuse or accidental as EG has a sweet taste. EG has in itself a low toxicity, but is in vivo broken down to higher toxic organic acids which are responsible for extensive cellular damage in various tissues caused principally by the metabolites glycolic acid and oxalic acid. The most conclusive analytical method of diagnosing EG poisoning is determination of EG concentration. However, victims are sometimes admitted at a late stage to hospitals or died during emergency treatment like a gastric lavage or found rotten dead, when blood EG concentrations are low or not detected. Therefore, in this study, the identification of EG was not only performed by gas chromatograpyc-mass spectrometry (GC-MS) following derivatization but also further toxicological analyses of metabolites, glycolic acid (GA) and oxalic acid (OA), were performed by ion chromatography in various biological specimens. A ranges of blood concentrations (3 cases) was $10\sim2,400\;{\mu}g/mL$ for EG, $224\sim1,164\;{\mu}g/mL$ for GA and ND $\sim40\;{\mu}g/mL$ for OA, respectively, In other biological specimens (liver, kidney, bile and pleural fluid), a range of concentrations (3 cases) was ND $\sim55,000\;{\mu}g/mL$ for EG, ND $\sim1,124\;{\mu}g/mL$ for GA and ND $\sim60\;{\mu}g/mL$ for OA, respectively. Liver and kidney tissues were recommended specimens including blood because OA, a final metabolite of EG, was identified large amounts in these despite no detectable EG caused by some therapy.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.504-512
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• 1994

Background: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant cuases of cirrhosis. It is uncertain that the same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia, Method: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. Results: The hypoxemia of $PaO_2$ less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). But there was no patient with significant hypoxemia of $PaO_2$ less than 60 mmHg. $PaO_2$ was significantly decreased in the patients with spider angioma than the pathients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of $11.4{\pm}4.1%$ than normoxemic group of $4.1{\pm}2.0%$ (p<0.05). Conclusions: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to p1ay a major ro1e in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.10 no.4
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• pp.243-249
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• 2016

In this paper, we evaluate the effectiveness of mechanical horseback riding exercise training for cardiopulmonary responses in 26 healthy adults (male 14, female 12) and suggest its clinical applicability. Exercise was performed using a mechanical horseback riding machine, JOBA(R) (Panasonic Electric Works, Osaka, Japan) and riding movement speed was increased from level 2 (0.73Hz), to 4 (0.9Hz), to 6 (1.03Hz), to 8 (1.2Hz), to 9 (1.3Hz) and maintained 3minutes in each level. Heart rate, blood pressure, maximum oxygen consumption (VO2max) were measured by respiratory gas analysis system (TruOne 2400, Parvo Medics, USA) and exercise tolerance test system(Q Stress, Cardiac Science, USA). To measure exercise intensity, metabolic equivalent (MET) were measured and percent of Heart rate reserve (%HRR), percent of peak heart rate (%peak HR) and calorie consumption were calculated. The results were analysed by SPSS 18.0. We found that the exercise intensity of mechanical horseback riding exercise using JOBA(R) for 15 minutes is moderate in healthy adult who received pre-training.

• Tuberculosis and Respiratory Diseases
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• v.57 no.6
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• pp.604-608
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• 2004

A 47-year-old-man was admitted to the emergency department with dyspnea, right pleuritic pain, and high fevers for 3 days. He had a nonproductive cough that exacerbated the chest pain. A clinical examination revealed distressed and slightly tachypneic patient, with blood pressure of 110/90 mmHg, temperature of $39^{\circ}C$, pulse of 90 beats/min, respiratory rate of 24 breaths/min. A chest examination showed significantly diminished breath sounds in the right lung with dullness to percussion. Laboratory investigation demonstrated leukocytosis and a raised C-reactive protein. The results of arterial blood gas analysis revealed moderate hypoxemia. A radiograph and a CT scan of the chest showed extensive consolidation with multifocal low densities, and pleural effusion in the right lung. A diagnostic thoracentesis revealed straw-colored fluid, which was found to be a neutrophil-predominant exudate. At 7 days after admission, the clinical symptoms had not improved and the temperature was still $39^{\circ}C$ despite the aggressive therapy of community-acquired pneumonia. After comprehensive history taking, we realized then that he accidentally aspirated kerosene while siphoning from fuel tank to put into the boiler 3 days ago. Bronchoscopy with bronchial washings could be successful in establishing the diagnosis of hydrocarbon pneumonitis by demonstration of a high lipid-laden macrophage index. Thereafter, the symptoms and radiographic opacities gradually improved, and he was discharged several days later.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.133-138
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• 2014

Purpose: If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide ($ETCO_2$) as a surrogate marker for predicting both the need for intervention and the prognosis. Methods: This is a prospective observational study. Nasal cannula was applied to measure $ETCO_2$, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients. Results: A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), $ETCO_2$ (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), $HCO_3$ (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only $ETCO_2$ (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, p-value= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas $ETCO_2$ (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)]. Conclusion: This study has revealed that $ETCO_2$, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.

• Proceedings of the KOSOMBE Conference
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• v.1996 no.05
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• pp.315-319
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• 1996

We have developed a prototype patient monitoring system including module-based bedside units, interbed network, and central stations. A bedside unit consists of a color monitor and a main CPU unit with peripherals including a module controller. It can also include up to 3 module cases and 21 different modules. In addition to the 3-channel recorder module, six different physiological parameters of ECG, respiration, invasive blood pressure, noninvasive blood pressure, body temperature, and arterial pulse oximetry with plethysmogaph are provided as parameter modules. Modules and a module controller communicate with up to 1Mbps data rate through an intrabed network based on RS-485 and HDLC protocol. Bedside units can display up to 12 channels of waveforms with any related numeric informations simultaneously. At the same time, it communicates with other bedside units and central stations through interbed network based on 10Mbps Ethernet and TCP/IP protocol. Software far bedside units and central stations fully utilizes gaphical user interface techniques and all functions are controlled by a rotate/push button on bedside unit and a mouse on central station. The entire system satisfies the requirements of AAMI and ANSI standards in terms of electrical safety and performances. In order to accommodate more advanced data management capabilities such as 24-hour full disclosure, we are developing a relational database server dedicated to the patient monitoring system. We are also developing a clinical workstation with which physicians can review and examine the data from patients through various kinds of computer networks far diagnosis and report generation. Portable bedside units with LCD display and wired or wireless data communication capability will be developed in the near future. New parameter modules including cardiac output, capnograph, and other gas analysis functions will be added.

• Journal of Veterinary Clinics
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• v.38 no.3
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• pp.163-168
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• 2021

A 6-year-old, spayed female, Maltese dog with tachypnea and dry cough was presented to Gyeongsang National University Veterinary Medical Teaching hospital. On physical examination, its respiration rate was 132 per minute. Decreased partial pressure of oxygen, partial pressure of carbon dioxide, and hyperlactatemia were found on arterial blood gas analysis. Its diastolic blood pressure was 80 mmHg. Auscultation revealed arrhythmia. Electrocardiogram revealed P pulmonale, P mitrale, and ventricular premature complexes. Thoracic radiographs revealed mild enlargement of both atrium and moderate enlargement of the left ventricular. There was also a moderate alveolar pattern in the right and caudal part of the left cranial lung lobe. Two-dimensional echocardiography showed enlargement of generalized four chambers without remarkable findings of valvular degeneration. M-mode echocardiography showed decreased left ventricular fractional shortening and enlarged left ventricular internal diameter at both end-systolic and end-diastolic. Color-flow Doppler imaging revealed eccentric turbulent flow starting below the left ventricular outflow tract and extending into the left atrium during systole. Spectral Doppler recordings revealed a high velocity flow through the mitral, tricuspid, aorta, and pulmonic regurgitation. Restrictive transmitral flow revealed high E-wave velocity, short E-wave deceleration time, and reduced A-wave velocity. There was also low ejection velocity thorough left ventricular out tract flow. Based on echocardiographic examination, dilated cardiomyopathy was the tentative diagnosis. The dog was medicated with inotropes, angiotensin converting enzyme inhibitor, and diuretics. At the 10-day following-up, the dog died suddenly. This report describes echocardiographic diagnosis and prognosis of dilated cardiomyopathy rarely reported in small breed dogs.