• Title/Summary/Keyword: cerebrovascular

Search Result 837, Processing Time 0.024 seconds

Analysis of Risk Factors in Coronary Artery Bypass Surgery (관동맥우회술의 위험인자 분석)

  • 정태은;한승세
    • Journal of Chest Surgery
    • /
    • v.31 no.11
    • /
    • pp.1049-1055
    • /
    • 1998
  • Background: Coronary artery bypass surgery is an important treatment for ischemic heart disease. Recently operative mortality and morbidity has decreased, however further improvement is necessary. Materials and methods: This study was designed to evaluate the risk of operative mortality and morbidity by retrospective method. From 1992 to 1997, eighty six patients underwent coronary artery bypass surgery. There were 61 males and 25 females aged 36~74 years(mean, 58.6). Fourteen patients(16%) had previous PTCA or stent insertion, 41 patients(48%) had unstable angina, and 45 patients(52%) had three vessel disease. Patients with low LV ejection fraction(<35%) were 7 cases and urgent or emergent operation were 10 cases. There were 6 cases of combined surgery which were mitral valve replacement(2 cases), aortic valve replacement(2 cases), ASD repair(1 case), and VSD repair(1 case). Average number of distal anastomosis was 3.5 per patient and average aortic cross clamp time was 115±38.3min. Preoperative risk factors were defined as follows: female, old age(>70 years), low body surface area(<1.5M2), PTCA or stent insertion history, hypercholesterolemia, smoking, hypertension, DM, COPD, urgent or emergent operation, left main disease, low LV ejection fraction(<35%), and combined surgery. Results: Operative mortality was 7cases(8%). As a postoperative morbidity, perioperative myocardial infarction was 6 cases, cerebrovascular accident 6 cases, reoperation for bleeding 5 cases, acute renal failure 4 cases, gastrointestinal complication 3 cases, and mediastinitis 3 cases. In the evaluation of operative risk factors, low body surface area, DM and low LV ejection fraction were found to be predictive risk factors of postoperative morbidity(p<0.05), and low ejection fraction was especially a risk factor of hospital mortality(p<0.05). Conclusions: In this study, low body surface area, DM and low LV ejection fraction were risk factors of postoperative morbidity and low ejection fraction was a risk factor of hospital mortality.

  • PDF

A Study in an Effective Programs for Emergency Care Delivery System (응급의료 전달체계의 충실 방안)

  • Kwon Sook Hee
    • Journal of Korean Public Health Nursing
    • /
    • v.9 no.1
    • /
    • pp.83-102
    • /
    • 1995
  • As the society is being industrialized, the fast-paced economic development that has caused substantial increase in cerebrovascular and coronary artery diseases and the industrial development and increased use of means of transportation have resulted in the rapid rise of incidents in external injuries as well. So the pubic has become acutely aware of the need for fast and effective emergency care delivery system. The goal of emergency care delivery system is to meet the emergency care needs of patients. The emergency care delivery system is seeking to efficiently satisfy the care needs of people. Therefore the purpose of this study is designed to develop an effective programs for emergency care delivery system in Korea. The following specific objectives were investigated. This emergency care delivery system must have the necessary man power, for transfering the patients, communication net work, and emergency care facilities. 1) Man power Emergency care requires n0t only specialized traning in the emergency treatment but also knowledge and experience i11 other related area, so emergency care personnel traning program should be designed in order to adapt to the specific need of emergency patients. It will be necessary to ensure professional personnel who aquires the sufficient traning and experience for emergency care and to look for legal basis. We have to develop re-educational programs for emergency nurse specialist. They should be received speciality of emergency nursing care so that they will work actively and positively in emergency part. Emergency medical doctor and nurse specialist should be given an education which is related in emergency and critical care. Emergency care personnel will continue to provide both acute and continuing care as partner with other medical team. 2) Transfering the patients. Successful management of pre-hospital care requires adequate traning for the emergency medical technician. Traning program should be required to participate in a actual first aids activites in order to have apportunities to acquire practical skills as well as theoretical knowledge. The system of emergency medical technician should be remarkablly successful with first responder firefighters. Establishing this system must add necessary ambulances operating at any given time. It will be necessary to standardize the ambulance size and equipment. Ambulance should be arranged with each and every fire station. 3) Communication net work. The head office of emergency commumication network should be arranged with the head office of fire station in community. It is proposed that Hot-line system for emergency care should be introduce. High controlled ambulance and thirtial emergency center should simultaneously equip critical-line in order to communication with each other. Ordinary ambulance and secondary emergency facility should also simultaneously equip emergency-line in order to communication with each other. 4) Emergency care facilities. Primary emergency care facilities should be covered with the ambulatory emergency patients-minor illness and injuires. Secondary emergency care facilities should be covered with the emergency admission patients. Third emergency care center should be covered with the critical patients who need special treatments and operation. Secondary and third emergency care facilities should employ emergency medical doctor and emergency nurse specialist to treat in-patients with severe and acute illness and multiple injuires. It should be fashioned for a system of emergency facilities that meets emergency patients needs. Provide incentives for increased number of emergency care facilities with traning in personal/clinical emergency care. 5) Finance It is recommended to put the finance of a emergency care on a firm basis. The emergency care delivery system should be managed by the government or accreditted organizations. In order to facilitate this relevant program the fund is needed for more efficient and effective emergency researchs, service, programs, and policy. 6) Gaining understanding and co-operation of pubic It is also important to undertake pubic education to improve understanding of first aids and C. P. R of individuals, communities and business. It is proposed that teachers and health officers be certified in C. P. R. The C. P. R education can be powerful influence save lives. Lastly appropriate emergency care information must be provided to the pubic for assisting them in choosing emergency care.

  • PDF

Computer Simulations of Hoffman Brain Phantom:Sensitivity Measurements and Optimization of Data Analysis of 〔Tc-99m〕ECD SPECT Before and After Acftazolamide Administraton (Acetazolamide 사용전후 〔Tc-99m〕 EDC SPECT 데이타 분석 방법의 최적화 및 민감도 측정)

  • Kim, Hee-Joung;Lee, Hee-Kyung
    • Progress in Medical Physics
    • /
    • v.6 no.2
    • /
    • pp.71-81
    • /
    • 1995
  • Consecutive brain 〔Tc-99m〕ECD SPECT studies before and after acetazolamide (Diamox) administration have been performed with patients for the evaluation of cerebrovascular hemodynamic reserve. However, the quantitaitve potential of SPECT Diamox imaging is limited as a result of degrading fractors such as finite detector resolution, attenuation, scatter, poor counting statistics, and methods of data analysis. Making physical measurements in phantoms filled with known amounts of radioactivity can help characterize and potentially quantify the sensitivities. However, it is often very difficult to make a realistic phantom simulating patients in clinical situations. By computer simulation, we studied the sensitivities of ECD SPECT before and after Diamox administration. The sensitivity is defined as ($\Delta$N/N)/($\Delta$S/S)$\times$100%, where $\Delta$N denotes the differences in mean counts between post-and pre-Diamox in the measured data, N denotes the mean counts before Diamox in the measure data, $\Delta$S denotes the differences in mean counts between post-and pre-Diamox in the model, and S denotes the mean counts before Diamox in the model. In clinical Diamox studies, the percentage changes of radioactivity could be determined to measure changes in radioactivity concentration by Diamox after subtracting pre-from post-Diamox data. However, the optimal amount of subtraction for 100% sensitivity is not known since this requires a thorough sensitivity analysis by computer simulation. For consecutive brain SPECT imaging model before and after Diamox, when 30% increased radioactivity concentrations were assingned for Diamox effect in model, the sensitivities were measured as 51.03, 73.4, 94.00, 130.74% for 0, 100, 150, 200% subtraction, respectively. Sensitivity analysis indicated that the partial voluming effects due to finite detector resolution and statistical noise result in a significant underestimation of radioactivity measurements and the amount of underestimation depends on the. % increase of radioactivity concentration and % subtraction of pre-from post-Diamox data. The 150% subtraction appears to be optimal in clinical situations where we expect approximately 30% changes in radioactivity concentration. The computer simulation may be a powerful technique to study sensitivities of ECD SPECT before and after Diamox administration.

  • PDF

Effect of Pancreatic Polypeptide Family on Cardiovascular Muscle Contractility: 1. Interactions with cyclic nucleotide activators and $K^+$ channel openers in canine cerebral arteries (Pancreatic Polypeptide Family의 심혈관계 근육 수축성에 대한 약리학적 작용: I. 개의 뇌혈관에서 cyclic nucleotide활성제와 칼륨통로개방제와의 상호작용)

  • Kim, Won-Joon;Lee, Kwang-Youn;Ha, Jeoung-Hee;Kwon, Oh-Cheol
    • The Korean Journal of Pharmacology
    • /
    • v.28 no.2
    • /
    • pp.147-162
    • /
    • 1992
  • The objectives of the present experiments were to characterize the effects of the peptides belonging to the pancreatic polypeptide family on the contractility of cerebral arteries and to observe the interactions of these peptides with the cyclic nucleotide activators and the potassium channel openers. Dogs of either sex, $20{\sim}30\;Kg$ in weight, were sacrificed. Basilar and middle cerebral arteries from brain were isolated and prepared for myography in the PSS equilibrated with 95% $O_2$ and 5% $CO_2$ at $37^{\circ}C$. The endothelial cells of the spiral strips were removed by CHAPS solution (0.3% w/v, 15 seconds). 1. PP, PYY and NPY contracted the arterial strips concentration-dependently with a rank order of potency of PYY>NPY>PP. These peptides were 20 to 200 times more potent than norepinephrine, and only PYY showed a greater potency than 5-HT. 2. Cyclic nucleotide activators, forskolin (for cAMP) and sodium nitroprusside (for cGMP) reduced the basal tone and inhibited the PP-, PYY- and NPY- induced contractions by concentration-dependent manners. Forskolin was more potent in reducing basal tone than sodium nitroprusside. 3. Potassium channel openers, RP 49356, P 1060 and BRL 38227 reduced the basal tone concentration-dependently and tended to inhibit the PP-, PYY- and NPY- induced contractions. Notably, BRL 38227 with low concentration $(0.1\;{\mu}M)$ enhanced the contractions induced by those peptides while P 1060 inhibited the contractions concentration-dependently. 4. The combinations of the cyclic nucleotide activators and the potassium channel openers were slightly additive in reducing the basal tone. P 1060 and BRL 38227 enhanced the relaxant effect of sodium nitroprusside significantly. On the PYY-induced contration $(0.1\;{\mu}M)$, $K^+$ channel openers tended to inhibit the inhibitory actions of forskolin and sodium nitroprusside. P 1060 and BRL 38227 antagonized the inhibitory action of sodium nitroprusside significantly. The results of the present study may be summarized that in canine cerebral arteries, not only NPY but also PYY may play a role in a cerebrovascular spasm, and intracellular concentration of either cAMP or cGMP may be involved in the mechanism of vasoconstrictive actions of these peptides, which may be affected either positively or negatively by a $K^+$ channel opener.

  • PDF

A Study of the "Ikkando Medicine" in Japanese Oriental Medicine (일본(日本) 한방의학(韓方醫學)의 체질의학(體質醫學)인 《일관당의학(一貫堂醫學)》에 관(關)한 고찰(考察))

  • Joh, Kiho;Park, Seong Sik;Terasawa, Katsutoshi;Shimada, Yutaka;Lee, Won Chul
    • Journal of Sasang Constitutional Medicine
    • /
    • v.9 no.1
    • /
    • pp.339-352
    • /
    • 1997
  • The oriental medicine based on the traditional chinese medicine has developed according to the historical and racial character respectively in China, Korea and Japan etcs. Particularly, the distinctive feature of Korea & Japan is characterized by the development of constitutional medicine compared with chinese medicine; Sasang Medicine of Korea and Ikkando Medicine of Japan. The constitutional medicines were so far developed by many clinical doctors, and in recent years much interest has centered on the application of these medicines in regarding originality, easiness and effectiveness etcs in treatment. Thus far only few attempts have been made at Ikkando medicine in Korea, what seems to be lacking, however, is practical application in clinic. Thus authors intend to help the clinical application by introducing Ikkando medicine to Korea oriental medicine through this paper. The Ikkando medicine was established by Dohaku Mori(1869~1931) and was known through the "Kampo Ikkando Medincine" which was published by his disciple, Kaku Yakazu(1893~1966), classified human beings into three types; type of blood stasis, type of stroke and type of allergy. The type of blood stasis may be responsible for factors which have occurred by a state of insufficient bleed circulation and blood stasis causing lesione of endothelial cells, and Tongdosan is mainly administrated. The predisposing factor of stroke's type is known as the excessive diet, and the prevalence of cerebrovascular accident is probably higher. In this type, it is likely that patients are prevented and cured with Bangpungtongsunsan. Allergy's type have three distinct types of childhood, adolescence and adult as to the age. Allergy's type of childhood predisposes patients such as these to upper respiratory infection and tuberculosis etcs, and Sihocheonggansan is frequently administrated. Allergy's type of adolescence has a tendency to rhinitis and infection of face legion etcs, and Heunggyeyeoungyotang is mainly administrated. Allergy's type of adult is subject to urogenital infection, and is more commonly treated with Yongdamsagantang. Judging from the above, we can say with fair certainty that Ikkando Medicine has considerable validity to clinical practice, though it should not be pushed too far.

  • PDF

Comparison of the Neurologic Outcome according to the Method of Proximal Graft Anastomosis at the Aortic Side during Off-pump Coronary Artery Bypass Grafting: The Heartstring Sealing System versus Conventional Manual Anastomosis (무심폐기 관상동맥 우회술에 있어서 이식편의 대동맥부 근위부 문합 방법에 따른 수술 후 신경학적 합병증 발생의 비교: 하트스트링을 이용한 방법 대 고식적인 수기 문합술)

  • Cho, Won-Chul;Kim, Joon-Bum;Kim, Hee-Jung;Kim, Hwan-Wook;Kim, Yun-Seok;Jung, Jae-Seung;Choo, Suk-Jung
    • Journal of Chest Surgery
    • /
    • v.42 no.4
    • /
    • pp.441-446
    • /
    • 2009
  • Background: Side clamping of ascending aorta during proximal graft anastomosis in coronary bypassing surgery in-creases the risk of direct aortic injury as well as embolization of intimal atheroma. Heartstring proximal sealing system (Guidant Corporation, Santa Clara, Calif), developed to avoid aortic side clamping, may minimize risks of such complications. The aim of the current study is to compare the surgical outcomes of the two proximal anastomosis techniquesi.e., Heartstring system versus aortic side clamping in off pump coronary bypassing' surgery (OPCAB). Material and Method: From January 2003 to August 2008, 499 patients underwent OPCAB. Of them, proximal graft anastomosis was performed using Heartstring system in 182 patients (Group I) and conventional manual anastomosis in 317 patients (Group II). The two groups were compared for postoperative major complications and mortality. Result: Two groups showed similar characteristics in terms of preoperative demographic data, left ventricular ejection fraction, renal function and history of diabetes, hypertension and smoking. Although there was no inter-group difference in the history of cerebral ischemia (p=0.48), preoperative brain magnetic resonance angiography revealed greater incidence of severe carotid artery stenosis (>75% of lumen) in the Group I than in the. Group II (44.5% in the Group I and 30.0% in the Group II, p=0.003). There were no inter-group differences in postoperative mortality (p=0.40) and complications (p=0.47) including neurologic events (3 in the Group land 2 in the Group II, p=0.258). Whereas neurologic events all comprised transient ischemic attacks in the Group I, they comprised multiple embolic strokes in the Group II. One patient in the Group II experienced aortic dissection during proximal anastomosis which resulted in ascending aortic replacement. Conclusion: Although proximal anastomosis using Heartstring system did not show statistically significant benefit over aortic side clamping, the. absence of embolic stroke maybe a definite benefit which may be better defined through further studies over a larger cohort.

Treatment Status and Its Related Factors of the Hypertensives Detect ed Through Community Health Promotion Program (지역사회 보건사업에서 발견된 고혈압환자의 치료실태와 관련요인)

  • Kam, Sin;Kim, In-Ki;Chun, Byung-Yeol;Lee, Sang-Won;Lee, Kyung-Eun;Ahn, Soon-Ki;Jin, Dae-Gu;Lee, Kyeong-Soo
    • Journal of agricultural medicine and community health
    • /
    • v.26 no.2
    • /
    • pp.133-146
    • /
    • 2001
  • The purpose of this study was to investigate the treatment status and its related factors of the newly detected rural hypertensives through community health promotion program. A questionnaire survey and blood pressure measurement were performed to 6,977 residents of a rural area, and 282 hypertensives detected by blood pressure measurement were selected as subjects of the study. The study employed the health belief model as a hypothetical model. The major results of this study were as follows: The proportion of person experienced treatment among hypertensives was 12.0%. Treatment experience rate was significantly related with age and educational level(p<0.01). That is, if they were older, lower educational level, the treatment experience rate was higher. The major reasons of no treatment were 'they had not hypertensive symptoms ' (45.6%), 'their blood pressure was not high so much that they received treatment ' (43.2%). The chief facilities for treatment were public health institutions(57.9%) such as health center and health subcenter, and hospital/ clinics(29.8%). The treatment experience rate was higher when they had higher perceived severity for hypertension, lower perceived barrier to treatment, although statistically not significant. Treatment experience rate was significantly related with cues to action and health education experience(p<0.05). That is, if they had hypertension related symptoms such as headache previously, patients suffered from hypertension complication and health education experience for hypertension, the treatment experience rate was higher. In multiple logistic regression analysis for treatment experience, having a cerebrovascular patient in their acquaintance and the experience of health education for hypertension were significant variables. On consideration of above findings, it would to be essential to provide knowledge about hypertension and its treatment, and severity of hypertension complications through health education.

  • PDF

Development of the Information Delivery System for the Home Nursing Service (가정간호사업 운용을 위한 정보전달체계 개발 I (가정간호 데이터베이스 구축과 뇌졸중 환자의 가정간호 전산개발))

  • Park, J.H;Kim, M.J;Hong, K.J;Han, K.J;Park, S.A;Yung, S.N;Lee, I.S;Joh, H.;Bang, K.S
    • Journal of Home Health Care Nursing
    • /
    • v.4
    • /
    • pp.5-22
    • /
    • 1997
  • The purpose of the study was to development an information delivery system for the home nursing service, to demonstrate and to evaluate the efficiency of it. The period of research conduct was from September 1996 to August 31, 1997. At the 1st stage to achieve the purpose, Firstly Assessment tool for the patients with cerebral vascular disease who have the first priority of HNS among the patients with various health problems at home was developed through literature review. Secondly, after identification of patient nursing problem by the home care nurse with the assessment tool, the patient's classification system developed by Park (1988) that was 128 nursing activities under 6 categories was used to identify the home care nurse's activities of the patient with CAV at home. The research team had several workshops with 5 clinical nurse experts to refine it. At last 110 nursing activities under 11 categories for the patients with CVA were derived. At the second stage, algorithms were developed to connect 110 nursing activities with the patient nursing problems identified by assessment tool. The computerizing process of the algorithms is as follows: These algorithms are realized with the computer program by use of the software engineering technique. The development is made by the prototyping method, which is the requirement analysis of the software specifications. The basic features of the usability, compatibility, adaptability and maintainability are taken into consideration. Particular emphasis is given to the efficient construction of the database. To enhance the database efficiency and to establish the structural cohesion, the data field is categorized with the weight of relevance to the particular disease. This approach permits the easy adaptability when numerous diseases are applied in the future. In paralleled with this, the expandability and maintainability is stressed through out the program development, which leads to the modular concept. However since the disease to be applied is increased in number as the project progress and since they are interrelated and coupled each other, the expand ability as well as maintainability should be considered with a big priority. Furthermore, since the system is to be synthesized with other medical systems in the future, these properties are very important. The prototype developed in this project is to be evaluated through the stage of system testing. There are various evaluation metrics such as cohesion, coupling and adaptability so on. But unfortunately, direct measurement of these metrics are very difficult, and accordingly, analytical and quantitative evaluations are almost impossible. Therefore, instead of the analytical evaluation, the experimental evaluation is to be applied through the test run by various users. This system testing will provide the viewpoint analysis of the user's level, and the detail and additional requirement specifications arising from user's real situation will be feedback into the system modeling. Also. the degree of freedom of the input and output will be improved, and the hardware limitation will be investigated. Upon the refining, the prototype system will be used as a design template. and will be used to develop the more extensive system. In detail. the relevant modules will be developed for the various diseases, and the module will be integrated by the macroscopic design process focusing on the inter modularity, generality of the database. and compatibility with other systems. The Home care Evaluation System is comprised of three main modules of : (1) General information on a patient, (2) General health status of a patient, and (3) Cerebrovascular disease patient. The general health status module has five sub modules of physical measurement, vitality, nursing, pharmaceutical description and emotional/cognition ability. The CVA patient module is divided into ten sub modules such as subjective sense, consciousness, memory and language pattern so on. The typical sub modules are described in appendix 3.

  • PDF

Clinicopathologic Characteristics of Stage IV Early Gastric Cancer (IV기 조기위암의 임상병리학적 특성)

  • Kim, Min Kuk;An, Ji Yeong;Choi, Min Gew;Noh, Jae Hyung;Sohn, Tae Sung;Kim, Sung
    • Journal of Gastric Cancer
    • /
    • v.8 no.3
    • /
    • pp.136-140
    • /
    • 2008
  • Purpose: Stage IV early gastric carcinoma (EGC) is a rare disease. We report here on 10 cases of EGC that showed metastasis in more than 15 lymph nodes. Materials and Methods: A total of 8354 cases of gastric carcinoma in patients who underwent surgical procedures between January 2001 and January 2007 at Samsung Medical Center were studied, and 10 cases were classified as stage IV EGC. We investigated their clinicopathologic characteristics. Results: There were 5 males and 5 females. Their ages at operation ranged from 46 to 76 years with a mean age of 61. All of the 10 patients had undergone curative resection for gastric cancer. The pathological diagnosis confirmed that all of the patients had tumor confined to the submucosa. The median size of the tumors was 5.3cm and the mean number of dissected nodes was 45.5 with a mean number of 22.2 involved nodes. Six cases were classified as the diffuse type and 4 were classified as the intestinal type by Lauren's classification. Histologically, 3 cases were signet ring cell carcinoma, 3 were poorly differentiated, 2 were moderately differentiated and 2 were well differentiated adenocarcinoma. Endolymphatic invasion was found in 9 cases. The median follow-up was 31 months. Adjuvant chemotherapy was done in 9 patients, and the patient who did not receive chemotherapy died by cerebrovascular accident. 2 patient had recurrence of gastric cancer and 7 survived without recurrence. Conclusion: More cases should be collected and further studies on the molecular and cellular tumor characteristics are required to characterize these tumors that show aggressive lymphatic spread.

  • PDF

Cost Analysis of Home Nursing Care Patients in Rural Hospital (농촌 지역 중소병원의 가정간호사업소 등록환자의 방문비용분석)

  • Kim, Jin-Soon;Kum, Ran;HwangBo, Soo-Ja
    • Journal of agricultural medicine and community health
    • /
    • v.24 no.1
    • /
    • pp.91-101
    • /
    • 1999
  • The home nursing care system is an integral part of the health care delivery system in order to meet the various needs of consummer, in particular, early discharge patient from the hospital, patient with long term care needed and the elderly. To find out the cost of home nursing care services, the home nursing care records of patients registered by home nursing care units established in public hospital with 150beds during the period of 1996 - 1997 were analyzed. The subjects were 102patients, 45 of male patients and 57 of female patients, those who live in a rural area in Kymiggi - Do The results obtained are as follows : 1. The male patients accounted for 44.1% of the total, with 45cases : group aged 60 years and more was the largest group, accounting for 79.5%. 2. The most frequent disease revealed was the osteoporosis which constitute 35.3% of the total registered patients, followed, in order, by malignant tumor, cerebrovascular disease. 3. It revealed that the cost per visit for the male was 47,764won ; the female, 46,078 won per visit. Noteworthy the cost per visit was high in the older patient. It was clearly that the gender, years of age and the cost per visit were statistically significant at 0.01 level and 0.05 level. 4. The cost per visit for the non complicated disease was slightly higher than the complicated disease, but it is not statistically significant, the cost per visit by type of disease varied, the cost per visit for COPD was the highest, followed, in order, by in malignant tumor, cancer, diabetes, osteoporosis etc. 5. It revealed that home nursing care cost for a eligible disease for home nursing care was less than the cost for hospitalization of the same disease, therefore, we expect that the home nursing care is cost efficiency. In conclusion, the home nursing care costs are needed to analyze further in comparison with the hospitalization costs for a certain disease.

  • PDF