• Journal of Chest Surgery
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• 제36권10호
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• pp.741-747
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• 2003

배경: 관상동맥 우회술은 가장 안전하게 시행할 수 있는 심장수술로 자리를 잡아왔다. 하지만 심한 관상동맥 질환으로 인한 심인성 쇼크 시 시행하는 응급 관상동맥 우회술은 선택적 수술에 비해 높은 사망률을 보인다. 본 연구에서는 응급 관상동맥 우회술을 시행받은 34명의 중장기 성적에 관하여 알아보았다. 대상 뜻 방법: 1994년 6월부터 2001년 12월까지 한림대학교 강동성심병원에서 시행한 34예의 응급 관상동맥 우회술을 대상으로 하였다. 병록과 외래추적 조사를 토대로 수술전 진단과 위험인자, 수술 전 관상동맥 조영술 소견, 수술방법, 수술 사망률, 수술 합병증, 수술후 증상의 재발과 치료, 만기 사망에 대해 후향적으로 분석하였다. 결과: 응급 관상동맥 우회술의 적응증으로는 심인성 쇼크가 29예(85.3%), 내과적 치료에 반응하지 않는 흉통이 4예(11.8%), 다형성 심실빈맥이 1예(2.9%)였다. 술 전 관상동맥 조영술상 삼혈관 질환이 16예(47.1%)였고, 좌주관상동맥 질환이 8예(23.5%)였다. 수술시 대복재 정맥 81문합, 좌측 내흉 동맥 14문합을 시행하였고, 환자당 평균 문합수는 2.8$\pm$0.8개였다. 평균 대동맥 차단 시간은 평균 91.9$\pm$34.6분이었고, 평균 심폐기 가동 시간은 262.7$\pm$198.3분이었다. 조기 사망률은 50%였고, 가장 많은 사망원인은 수술 후 저심박출증(7예, 20.6%)이었다. 평균 추적조사 기간은 30.9$\pm$35.7개월이었고, 추적조사 기간 중 증상의 재발이나 만기사망률을 보인 환자는 없었다. 결론: 응급 수술의 경우 신속한 조치로 혈역학적 안정을 확보함과 동시에 심장에 비가역적인 손상이 오기 전에 적극적인 수술적 치료를 시행하여야 한다.

• Journal of Yeungnam Medical Science
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• 제20권2호
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• pp.152-159
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• 2003

고지혈증이 관상동맥 죽상 동맥경화증의 가장 중요한 위험 인자이며 또한 고지혈증을 치료할 경우 관상동맥 질환의 발생이 감소한다고 인정되고 있다. 이러한 고지혈증 치료제로 새로 개발된 simvastatin($Zocor^{(R)}$)의 단기사용 시 효과와 안정성을 알아보기 위해 저자들은 simvastatin을 12주 사용하여 연구를 시행하였다. 대상 환자는 원발성 고콜레스테롤 혈증으로 진단받은 환자로서 첫(0주)방문일 기준으로 측정한 혈중 콜레스테롤 농도가 240 mg/dl이상이거나 220 mg/dl이상이면서 병력이 있는 환자를 대상으로 하였으며 HMG-CoA reductase 억제제인 simvastatin을 저녁에 1일 20 mg씩 경구투여하였다. 12주 후 시행한 혈액검사소견상 혈청 총 콜레스테롤치, 저비중 지단백 콜레스테롤치 및 중성지방은 치료전에 비하여 치료후에 의미있게 감소하였고(p<0.05) 고비중 지단백 콜레스테롤치는 변화가 없었으며 simvastatin 투여기간중 약물 부작용은 없었다. 이상의 결과로 보아 simvastatin은 고지혈증 환자의 치료에 단기간 사용할 경우 그 효과가 확실하고 안전한 치료제라 생각된다.

• Journal of Chest Surgery
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• 제37권4호
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• pp.322-327
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• 2004

심폐바이패스 없이 시행하는 관상동맥 우회술은 이제 심장수술자에게 일반적인 시술이 되었다. 저자들은 이 수술방법의 합병증 및 사망률을 분석하여 수술의 안정성 및 효능성을 알아보고자 했다. 대상 및 방법: 1999년 6월부터 2002년 8월까지의 심폐바이패스 없이 시행한 관상동맥 우회로술 100예와 심폐바이패스하의 관상동맥 우회로술 100예를 대상으로 했으며 관상동맥 수술 외에 다른 수술을 동반한 경우는 제외하였다. 결과: 양 그룹에서 술 전 위험요소나 관상동맥 질환 정도의 차이는 없었다. 심폐바이패스 없이 시행한 관상동맥 우회술에서 심폐바이패스하의 관상동맥 우회술보다 평균수술 시간(295$\pm$73분 vs 323$\pm$83분, p＞0.05)과 평균 입원 기간(15.34$\pm$6.02일 vs 13.80$\pm$4.95일, p＞0.05)은 유의한 차이가 없었으나, 평균 인공 호흡기 거치 시간은 심폐바이패스 없이 수술한 경우에 의미 있게 짧았다. (17.3$\pm$11.27시간 vs 24.98$\pm$16.1시간, p＜0.05) 심폐바이패스 없이 시행한 관상동맥 우회술 중 술 중 심폐바이패스로 전환한 예는 없었다. 술 중 혈역학적인 불안정을 보인 경우는 6예에서 있었는데 2예는 둔각분지 시 4예는 우관상동맥 문합 시 생겼다. 술 후 사망은 심폐바이패스 없이 시행한 관상동맥 우회술 시 1예, 심폐바이패스하의 관상동맥 우회술 시 2예가 있었다. 대동맥 내 풍선펌프는 각각 1예와 2예가 있었다. 술 후 뇌경색은 심폐바이패스 없이 시행한 관상동맥 우회술에서는 없는 반면 심폐바이패스하의 관상동맥 우회술에서는 2예가 있었다. 술 후 심부정맥은 각각 4예와 6예 있었으며 급성 신기능 부전은 각각 3예와 2예가 있었다. 결론: 심폐바이패스 없이 시행한 관상동맥 우회로술은 술 후 합병증 및 사망률, 환자의 회복과정에서 안전하고 효율적인 수술방법으로 생각된다.

• Journal of Chest Surgery
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• 제14권1호
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• pp.40-48
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• 1981

Total anomalous venous return defines a group of congenital heart disease which have in common the entire pulmonary venous drainage returning directly or indirectly to the right atrium instead of to the left atrium. Despite of recent advance in treatment, this severe malformation in its various anatomical forms has a high surgical mortality during early infancy. Because of the high mortality in the untreated infant and the surgical risk in the first year of life, the timing of the operation remains important for optimal result. Three cases of T APV R, two supracardiac types and one mixed type, were treated with extracorporeal circulation during last three years in the Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. The first one was 10 months old male with supracardiac type which drained through left innominate vein, and he was operated with profound hypothermia and total circulatory arrest but failed. The second case was 7 years old male with supracardiac type drained through left innominate vein, and he was well post operatively, and followed periodically for 12 months. The third case was 24 years old female with mixed type drainage (left upper pulmonary vein drained through left innominate vein, and the others through coronary sinus) was successfully corrected, and she was followed for 4 month without problem. All cases were diagnosed with cardiac catheterization and angiocardiogram, and also with echocardiogram in last two cases. In first two cases of supracardiac type, total circulatory arrest was used in brief period during anastomosis between common pulmonary venous trunk and left atrium. In the last case of mixed type, usual cardiopulmonary bypass with moderate hypothermia was used and total circulatory arrest was not needed.

• Journal of Acupuncture Research
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• 제19권3호
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• pp.126-137
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• 2002

Objective : There is accumulating data that cardiovascular diseases, including hypertension, cerebro-vascular accident, coronary heart disease, relate to atherosclerotic changes. Increased serum levels of lipids could play a role in these circumstances. the SDPTG(the second derivative of photoplethysmogram waveform) is noninvasive methods for evaluating the pulse wave and is correlated with age and other risk factors for atherosclerosis. Methods : To study the effects of serum lipid levels on the SDPTG in the middle-age adults, data on serum lipid levels and the SDPTG were collected in 80 healthy middle age with varying serum lipid concentrations. Biological vascular age was assessed using the SDPTG. the SDPTG consists of an a, b, c, and d wave in systole and an e wave in diastole; an SDPTG aging index(Al) was calculated as (b-c-d-e)/a. Results : Serum triglyceride, total cholesterol, total lipid, phospholipid, HDL cholesterol levels were respectively and significantly correlated with SDPTG Al. Serum lipid levels and blood pressure are age-dependent and the SDPTG is blood pressure-dependent. Restricting analysis to age and blood pressure yield strong positive correlations between serum triglyceride, total lipid levels and SDPTG Al, but no correlations between serum total cholesterol, phospholipid levels and SDPTG Al. Conclusion : The results of this study suggest that preventive acupuncture programs or herbal medications for reducing serum lipid, especially triglyceride, levels in middle-age should include a evaluation of biological vascular aging with the second derivative of photoplethysmogram waveform.

• 대한지역사회영양학회지
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• 제4권2호
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• pp.186-193
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• 1999

Recent epidemiologic and clinical students have shown that plasma cholesterol and triglyceride levels are independent risk factors for coronary heart disease. However, there is not much data on the characteristics of anthropometry and lipid profiles of hypercholesterolemia patients with hypertiglyceridemia. In this study, 112 hypercholesterolemic subjects$(T.C{\ge}240mg/dl)$ were divided into two groups by their plasma triglyceride levels. We compared the anthropometric measurements and lipid profiles of the subjects between the two groups : the simples hypercholesterolemic group(SHC, TG<200mg/dl) and the combined hypercholesterolemic group$(CHC, TG{\ge}250mg/dl)$. The distribution of the subjects into the SHC and CHC groups was 36.6% and 47.3%, respectively. The frequency of the CHC patients decreased with age. The subjects in this group had higher weight, BMI, HWR, cricumferences of mid arm, waist, hip and thigh, and skinfold thicknesses of biceps and triceps than those of the SHC subjects. The difference of plasma total cholesterol level was mainly due to the difference of VLDL-C levels. These differences resulted in the CHC subjects having higher atherogenic indexes and T-C/HDL-C ratios than those of the SHC subjects. Also, the former had higher Apo-B and insulin levels than those the latter. However, blood pressure, fasting blood glucose and HDL-C levels were not significantly different between the two groups. These results suggest that hypercholesterolemic patients with hypertriglyceridemia have riskier lipid profiles for CHD than those of patients with normal triglyceridemia. They also indicate that CHC is closely associated with glucose resistance syndrome(obesity, hyperglycemia, hyperinsulinemia and hypertriglyceridemia), and more prevalent in young people.

• Journal of Dairy Science and Biotechnology
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• 제22권1호
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• pp.13-25
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• 2004

담즙산은 cholesterol의 대사산물로 체내에서 cholesterol을 제거하는 주경로로서, 체내 cholesterol 대사를 조절하는 중요한 수단이다. 최근에 복합담즙산 분해활력이 높은 L. acidophilus에 의한 혈중 cholesterol 저하효과에 관한 많은 연구들이 보고되고 있으며, 이것은 복합담즙산의 분해로 생성되는 유리 담즙산의 분 배출 증가와 장내 cholesterol 흡수에 필요한 복합 micelle 형성의 방해에 의한 것으로 알려져 있다. 즉, 유리 담즙산은 장내에서 복합담즙산보다 용해성이 낮아서 흡수되지 않고 분으로 배출되기 쉬워, 간에서는 분으로 배출된 양만큼의 부족한 복합담즙산을 보충하기 위해 cholesterol을 이용하여 새로운 복합담즙산을 생성하기 때문에 결국은 체내의 혈중 cholesterol 수준을 감소시키는 것으로 생각된다. 또한 담즙으로 분비되는 복합담즙산은 소장내에서 cholesterol의 용해 흡수에 도움을 주지만 유리 담즙산은 cholesterol 용해성이 낮기 때문에, 장내 cholesterol 흡수에 영향을 미치는 것으로 생각된다.

• Nutritional Sciences
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• 제7권3호
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• pp.174-182
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• 2004

Women have a greater incidence of coronary heart disease (CHD) after menopause. This relates to hormone imbalance-induced changes in known CHD risk factors, especially hyperlipidemia. The purpose of this study was to explore d1e differences in food consumption and food sources of nutrients in the Korean diet between postmenopausal women aged 50-74 years with normocholesterolemia(NC) and those with hypercholesterolemia(HC). Each subject was either classified as part of the NC group (n=39, serum total cholesterol con. ＜200 mg/$dl$) or the HC group (n=31, serum total cholesterol con. $\geq$240 mg/dl) based on the Guideline for Korean Hyperlipidemia.l Diet was assessed through a validated semi-quantitative food frequency questionnaire. Consumption of foods such as biscuits and/or crackers, squid and eggs was significantly (p＜0.05) higher in the HC group than in the NC group. On the other hand, consumption of potatoes/starches and carrots was significantly (p＜0.05) lower in the HC group than in the NC group. There was no significant difference between the two groups in terms of the consumption of legumes and legume products containing phytoestrogen and we could not find a relationship between legumes and legume products and serum cholesterol levels. Consumption of green tea tended to be lower in the HC group than in the NC group. Major sources of cholesterol, cholesterol-saturated index and vitamin A in the diets of the HC group consisted of foods high in cholesterol. Our results confirm that postmenopausal women with hypercholesterolemia in Korea tend to consume cholesterol-rich foods and dishes.

• Journal of Nutrition and Health
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• 제42권6호
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• pp.547-558
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• 2009

This study was carried out to compare the effect of smoking on dietary habits, nutrient intakes and blood lipid profiles in 173 adult male drinkers. Subjects were classified by two groups, alcohol-only and alcohol-smoking, based on their alcohol or smoking habits. The BMI of the alcohol-smoking group was significantly lower than those of alcohol-only group. In dietary habits, the alcohol-smoking group had higher irregular breakfast and dinner intakes than alcoholonly group (p < 0.05). Plant lipid intake of the alcohol-smoking group was higher than those of alcohol-only group (p < 0.05) and the vitamin C intake of the alcohol-smoking group was lower than those of alcohol-only group (p < 0.05). With regard to the diet quality evaluation of subjects, the alcohol-smoking group showed significantly lower values than alcohol-only group in the nutrient density of carbohydrate, dietary fiber, sodium, potassium, vitamin $B_6$, and vitamin C. Also, with regard to the index of nutrition quality (INQ) and the nutrient adequacy ratio (NAR), the alcohol-smoking group showed significantly lower value than alcohol-only group in vitamin C. With these results, we found that the alcohol-smoking group had lower diet quality evaluation. The results of blood analysis showed that HDL-cholesterol in the alcohol-smoking group was significantly lower than that in the alcohol-only group. In conclusion, the alcohol-smoking group had greater health risk than the alcohol-only group. Particularly, alcohol-smoking caused irregular eating patterns and unbalanced nutrition intakes compared to alcohol-only and also changed blood composition as shown in the decrease of HDL-cholesterol. Besides, the index of coronary heart disease such as AI was higher in both groups suggesting that alcohol-only or alcohol-smoking cause health problems. Since there is the limiting point in which the comparative analysis of non-drinkers and non-smokers is unable to be performed in this study, further wide research is needed on that matter.

• 대한영양사협회학술지
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• 제7권4호
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• pp.331-348
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• 2001

The purpose of this study was to obtain basic data for nutrition education of the children in a health promoting elementry school. The data was collected by a questionaire of food habits, and anthropometric measurement and biochemical test in comparison with obesity index. The study subjects were boys and girls aged 10 to 12 years who participated in the “99 Children Nutrition Camp”. The average obesity index was 1.7$\pm$21.6% in boys and -11.4$\pm$12.6% in girls. After school, major leisure items were significnatly different by gender but both boys and girls played mainly computer game. In concern for body image and eating habits, girls had more concern and girls had attempted weight control more than boys. 80.2% of subjects had prejudice for special food, especially, all subjects in the severely underweight group had prejudice. But this tendency was significantly decreased with the increasing obesity index. The lowest preferency was for vegetables(64.4%). The tendency of prejudice of subjects was higher whose mother are thirties than those of subjects whose mother are in fourties. The serum GOT and GPT values were significantly higher in overweight and obese group than the other groups. The only serum T-chol was significantly higher in boys than in girls. The number of risk factors related to coronary heart disease(CHD) based on coresponding criteria of TG, T-chol, HDL-chol, and LDL-chol was not increased significantly with the degree of obesity index. The results indicated the need of nutritional management for the children. At a point of view, to educate children early who are able to change food habits and life-styles means to help heathy growth and to deliver up heathy adults. Active nutrition education for both children and mothers will be recommended with joint participation of nutritionists in community public health center and elementary school.