• Archives of Plastic Surgery
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• 제42권6호
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• pp.769-775
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• 2015

Background The radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap. Methods In this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance. Results Only one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars. Conclusions Performing the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients.

• Journal of Chest Surgery
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• 제29권11호
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• pp.1270-1275
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• 1996

폐동맥류는 매우 드문 질환으로 일반적으로 폐혈류량을 증가시키고 폐성 고혈압을 초래하는 선천성 심결손과 동반되어 발생되는 경우가 대부분이다. 폐동맥류의 예후는 매우 치명적 일 수 있는데, 그 이유는 동맥류의 파열에 대한 가능성과 대부분의 경우 심한 폐성 고혈압이 동반되어 있기 때문이다. 40세 여자 환자가 교통사고후 두통을 주소로 본원에 입원하였다. 내원 당시 이학적 검사상 좌흉골연을 따라 2번째와 3번째 늑간에서 연속성 심잡음이 청진되었고, 단순 흉부 X-선 사진상 좌측 폐문부의 석회화된 낭성 종괴가 우연히 발견되었다. 심도자검사상 좌-우 단락이 주폐동맥에서 관찰되었고, 폐동맥압이 증가되어 있었다. 그리고 폐동맥조영술상 주폐동맥에서 좌폐동맥 기시부로 연장되는 폐동맥류의 소견을 보였다. 저자들은 동맥관개존증을 동반한 주폐동맥류로 진단하고, 심폐우회하에 동맥류 절제, 동맥관 봉합 및 Dacron 이식편 치환술을 시행하였다. 술후 경과는 양호하였으며, 환자는 건강한 상태로 퇴원하였다.

• 중환자간호학회지
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• 제16권3호
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• pp.99-108
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• 2023

Purpose : This retrospective study aims to provide basic data for intervention to improve clinical outcomes and identify the characteristics of the rebound hyperthermia (RHG) and non-rebound hyperthermia (NRHG) groups by checking body temperature in patients with post-cardiac arrest syndrome. Method : The study involved 118 patients who completed target temperature management (TTM) in an acute-care unit. Data were analyzed for frequency, percentages, mean, standard deviation, median, and quartiles, and compared using the chi-squared test and Mann-Whitney U-test. Results : Rebound hyperthermia (RH) was observed in 74 (62.7%) patients, predominantly male (69.5%), with an average age of 64.54 ± 15.98, and a body mass index of 23.22 ± 4.75kg/m² (overweight). Hypertension (50%) was the most common co-morbidity, followed by diabetes and heart disease (33.1%). Neuron-specific enolase levels were higher in the NRHG 24, 48, and 72 hours after recovery of spontaneous circulation (p = .037, p < .001, p = .008). The APHCHE IV was also higher in the NRHG (p < .001). RH occurred 25.49 (7.28-52.96) hours after TTM completion, lasting for 2 (1-3) hours. Temperature reduction strategies included notifying doctors, administering antipyretics, and nursing intervention, with the latter being the most common at 94.6%. Half of the subjects in the RHG and 77.3% in the NRHG fell into cerebral performance categories 3, 4, and 5 (p = .003). Conclusion : RH is more likely a body mechanism related to CPR and TTM than a result of pathogenic infection. Therefore, we require an active intervention for hyperthermia, and a patient-specific nursing intervention protocol.

• 한국콘텐츠학회논문지
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• 제10권2호
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• pp.250-257
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• 2010

64 절편 MDCT를 이용하여 측정된 좌심실 구혈률에 성별과 연령, 체질량지수, 혈압, 심박동수 등의 요인이 영향을 미치는지 비교 분석하였다. 164명(남자 84명, 여자 80명)을 대상으로 혈압, 체질량지수, 심박동수를 측정하였고, 심장 CT 검사를 실시하여 좌심실 구혈률을 구하였다. 체질량지수 25kg/$m^2$ 미만 군에서 좌심실 구혈률은 52.00${\pm}$118.95%, 25 kg/$m^2$이상 군에서 59.50${\pm}$16.05%였다(p<0.05). 정상 혈압군에서 좌심실 구혈률이 57.26${\pm}$17.84%, 고혈압군에서는 49.95${\pm}$17.63%로 고혈압군에서 유의하게 낮았다(p<0.05). 분당 심박동수 60회 미만 군에서는 60.76${\pm}$17.26%, 60-70회군에서 54.14${\pm}$16.56%, 70회 이상 군에서 50.83${\pm}$20.56%였다(p<0.05). 좌심실 구혈률과 연령(r=-0.283), 심박동수(r=-0.231)는 각각 음의 상관관계가 있었고, 체질량지수(r=0.228)와는 양의 상관관계가 있었다. 좌심실 구혈률에 영향을 미치는 요인으로는 연령, 체질량지수, 수축기혈압, 심박동수 등이었다. 결론적으로 연령, 체질량지수와 혈압, 심박동수에 따라서 구혈률이 차이가 나므로 이를 확인하여 평가하여야 한다.

• 한국콘텐츠학회논문지
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• 제9권12호
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• pp.339-347
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• 2009

연구목적: 64 절편 MDCT를 이용한 심장 CT의 진단일치도를 알아보고, 심박동수와 관상동맥 석회화가 진단일치도에 영향을 미치는지 확인하여 심장 CT 검사 시 기초 자료로 활용하고자 함이다. 연구방법: 심장 CT와 관상동맥 조영술을 함께 시행한 178명(남자 84명, 여자 94명)을 대상으로 심장 CT에서 관상동맥 협착과 심박동수, 석회화 수치를 측정하였고, 관상동맥조영술에서 좌전하행동맥, 좌회선동맥, 우관상동맥의 유의한 협착($\geq50%$)이 있는지 확인하였다. 관상동맥 조영술의 결과를 표준으로 심장 CT의 민감도, 특이도, 양성예측도, 음성예측도, kappa index($\kappa$)를 계산하였다. 연구결과: 환자별 협착의 정도를 평가한 결과 심장 CT의 정확도는 96.6%였다. 혈관별로는 LAD, LCX, RCA 각각 86.5%, 84.3%, 92.1%로 높은 진단일치도를 보였다. 체질량지수와 혈압은 심장 CT의 진단일치도에 영향을 미치지 않았다. 심박동수는 60/min 미만에서 정확도 90.1%, $\kappa$값 0.78이었고, 70/min 이상에서는 정확도가 75.8%, $\kappa$값 0.52이었다. 관상동맥 석회화지수 100 미만에서는 정확도가 91.3%, $\kappa$값 0.81이었고, 석회화지수 400 이상에서는 정확도 68.6%, $\kappa$값 0.33으로 떨어졌다. 결론: 64 절편 MDCT를 이용한 심장 CT는 관상동맥 조영술과 거의 비슷한 진단일치도를 나타냈다. 하지만 심박동수 70/min 이상, 관상동맥 석회화지수 400 이상에서는 진단일치도가 저하되었기 때문에 심장 CT 검사 시 심박동수와 관상동맥 석회화지수를 확인하여 검사하여야 하고, 심박동수가 70/min 이상이면 베타차단제를 사용하여 심박동수를 조절하여야 한다.

• Journal of Chest Surgery
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• 제40권8호
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• pp.574-577
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• 2007

심낭에서 발생한 원발성 섬유육종은 매우 드문 질환으로 주로 급격한 혈성 심낭 삼출을 유발한다. 평소에 간헐적인 흉부압박감을 느껴왔던 30세 남자 환자가 내원 하루 전 갑작스런 흉통과 심한 호흡곤란으로 근처 병원에서 협심증 진단 하에 전원되어 심초음파 검사, 흉부 전산화 단층촬영 및 자기공명검사 등 정밀검사를 시행받았고, 그 결과 심낭 기형종 파열에 의한 심낭압전의 진단하에 수술을 받았다. 수술소견 상 혈성 심낭 삼출액이 다량 있었고, 심낭 종괴는 완전 절제하였으나 동결절편검사 상악성종양이 의심되었다. 수술 후 병리조직 검사상 심낭 종괴는 원발성 심낭 섬유육종으로 진단되었고 심낭 삼출액에서 암세포는 발견되지 않았다. 환자는 특별한 합병증 없이 퇴원 후 전원되어 추가적인 방사선치료를 받고 있다. 임상적으로 긴급을 요하는 심낭압전을 동반한 원발성 심낭 섬유육종 1예를 치험하였기에 보고하는 바이다.

• Korean Journal of Radiology
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• 제24권12호
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• pp.1221-1231
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• 2023

Objective: To clinically validate the feasibility and accuracy of cine images acquired through the multitasking method, with no electrocardiogram gating and free-breathing, in measuring left ventricular (LV) function indices by comparing them with those acquired through the balanced steady-state free precession (bSSFP) method, with multiple breath-holds and electrocardiogram gating. Materials and Methods: Forty-three healthy volunteers (female:male, 30:13; mean age, 23.1 ± 2.3 years) and 36 patients requiring an assessment of LV function for various clinical indications (female:male, 22:14; 57.8 ± 11.3 years) were enrolled in this prospective study. Each participant underwent cardiac magnetic resonance imaging (MRI) using the multiple breath-hold bSSFP method and free-breathing multitasking method. LV function parameters were measured for both MRI methods. Image quality was assessed through subjective image quality scores (1 to 5) and calculation of the contrast-to-noise ratio (CNR) between the myocardium and blood pool. Differences between the two MRI methods were analyzed using the Bland-Altman plot, paired t-test, or Wilcoxon signed-rank test, as appropriate. Results: LV ejection fraction (LVEF) was not significantly different between the two MRI methods (P = 0.222 in healthy volunteers and P = 0.343 in patients). LV end-diastolic mass was slightly overestimated with multitasking in both healthy volunteers (multitasking vs. bSSFP, 60.5 ± 10.7 g vs. 58.0 ± 10.4 g, respectively; P < 0.001) and patients (69.4 ± 18.1 g vs. 66.8 ± 18.0 g, respectively; P = 0.003). Acceptable and comparable image quality was achieved for both MRI methods (multitasking vs. bSSFP, 4.5 ± 0.7 vs. 4.6 ± 0.6, respectively; P = 0.203). The CNR between the myocardium and blood pool showed no significant differences between the two MRI methods (18.89 ± 6.65 vs. 18.19 ± 5.83, respectively; P = 0.480). Conclusion: Multitasking-derived cine images obtained without electrocardiogram gating and breath-holding achieved similar image quality and accurate quantification of LVEF in healthy volunteers and patients.

• 혜화의학회지
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• 제8권2호
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• pp.383-397
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• 2000

Background/Aims: Dong-Moo Lee Jae-Ma(1837-1900) confirmed the sasangchaejil theory based on the sasang-medicine. This theory has been the main-stem of oriental medicine during 100 years in Korea. But rarely anyone has tried to prove this theory systemicaly. So we have a trial to clarify any relationship between the sasangchaejil and the laboratory and clinical results of mass screening tests. Methods: We evaluated the laboratory values of 280 people who had taken many clinical and laboratory tests. The laboratory examinations were complete blood count, liver and kidney function test, ultrasonogram of the abdomen and breasts, gastrofiberscope, many tumor markers body mass index, blood pressure, glucose, and electrocardiogram, etc. Results: 1) Among the 280 subjects, 187/66.8% were sowumin, 58/20.7% were taewumin and 35/12.5% were soyangin. 2) Those who reacted positive to HBsAb were 22 subjects(62.8%) in soyangin, 57.2% in sowumin and 55.1% in raewumin. But there were no significant correlations. 3) 45 subjects(72.4%) in taewumin had obesity, fatty liver and hyperlipidemia.(P<0.05) 4) 20.6% in taewumin had abnormal LFT suggesting hepatic disease. It was statistically sigificant.(P<0.05) 5) An anemic state was present in women of soyangin and sowumin mostly. Since an iron deficiency anemia is common in women, there were no significant corelations among sasangchaejil. Also urinary tract infectons were common in women. 6) 6 subjects in taewumin(10.3%) had cardiac problems, while only one case(2.8%) occured in soyangin and 7 cases(3.7%) in sowumin. Taewumin was significantly high.(P<0.05) 7) In the case of gastric disease, there was no distinguishable difference among sasangchaejil.(taewumin 37.9%, soyangin 31.4% and sowumin 35.2% rrespectively) 8) There was no significant difference beteen subjects with different blood types using sasangchaejil. Conclusions: There were some significant relationship between sasangchaejil and diseases prevalent to them by the theory of sasang-medicine. But Lee didn't considered the differences of gender, the change of body status according to the development of culture, and circumstances of their lives. Also he didn't consider the existence of infectious agents. Now more systemic study with larger populations are requied.

• Archives of Pharmacal Research
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• 제29권3호
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• pp.241-248
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• 2006

Angiotensin converting enzyme (ACE) inhibitors have cardioprotective effects in different species including human. This cardioprotective effect is mainly due to the inhibition of bradykinin (BK) degradation rather than inhibition of the conversion of angiotensin I to angiotensir. II. Bradykinin, a nonapeptide, has been considered to be the potential target for various enzymes including ACE, neutral endopeptidase 24.11, carboxypeptidase M, carboxypeptidase N, proline aminopeptidase, endopeptidase 24.15, and meprin. In the present study, the coronary vascular beds of Sprague Dawley rat isolated hearts were perfused (single passage) with Krebs solution alone or with different concentrations of BK i.e. $2.75{\times}10^{-10},\;10^{-7},\;10^{-6}\;and\;10^{-5}M$ solution. Percent degradation of BK was determined by radioimmunoassay. The degradation products of BK after passing through the isolated rat-hearts were determined using RP-HPLC and mass spectroscopy. All the four doses of BK significantly decreased the perfusion pressure during their passage through the hearts. The percentage degradation of all four doses was decreased as the concentration of drug was increased, implying saturation of a fixed number of active sites involved in BK degradation. Bradykinin during a single passage through the hearts degraded to give [1-7]-BK as the major metabolite, and [1-8]-BK as a minor metabolite, detected on HPLC. Mass spectroscopy not only confirmed the presence of these two metabolites but also detected traces of [1-5]-BK and arginine. These findings showed that primarily ACE is the major cardiac enzyme involved in the degradation of bradykinin during a single passage through the coronary vascular of bed the healthy rat heart, while carboxypeptidase M may have a minor role.

• 생명과학회지
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• 제34권1호
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• pp.1-8
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• 2024

Brain-type natriuretic peptide (BNP)은 뇌나트륨이뇨펩티드로, 좌심실의 심근세포에서 분비되는 호르몬으로, 심장과 신장에 작용하여 혈관 확장과 나트륨 이뇨 작용 등을 하는 것으로 알려져 있으나, 최근에는 다양한 조직에서 대사 작용을 조절하는 것으로 보고된다. 본 연구에서는 간 조직에서 BNP의 영향을 알기 위해 BNP가 고지방식이에 의해 유도되는 인슐린 저항성을 개선하는지를 조사하였다. BNP을 주입한 쥐와 control로서 saline을 주입한 쥐들 간에는 몸무게, 체지방양(fat mass), 제지방량(lean body mass)의 변화는 없었다. 고인슐린혈증 정상혈당 글루코스 클램프(Hyperinsulinemic Euglycemic Glucose Clam) 동안, BNP를 주입한 고지방 식이 쥐들은 saline을 주입한 고지방식이 쥐에 비해 혈당(blood glucose)은 감소하였으며, 포도당 주입 속도(glucose infusion rate)는 증가하였다. 또한 BNP은 포도당 신생 및 중성지방 합성 관련 유전자들의 발현을 감소시켜, 간에서 포도당 생성과 중성지방의 양을 감소시켰다. BNP는 saline을 주입한 쥐에 비해 간 조직에서 Akt와 AMP-activated protein kinase (AMPK)의 인산화를 증가시켰는데, 이는 BNP을 처리한 AML12 간세포에서도 BNP는Akt와 AMPK 인산화를 증가시켰다. 이상의 결과는 BNP가 간에서 인슐린 저항성을 개선하여 포도당 생성과 중성 지방 생성을 억제함을 알 수 있었다.