• Title/Summary/Keyword: delayed mortality

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Coronary Artery Bypass Graft in Patient with Advanced Left Ventricular Dysfunction (중등도 이상의 좌심실 기능 부전 환자에서의 관상동 우회술의 임상 분석)

  • 정종필;김승우;신제균
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.901-908
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    • 2001
  • Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1%) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98%) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84%) and first degree of Rentrop classification(16 cases, 52%) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

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Effect of Soil Mulching Materials and Methods on Weed Occurring for the Growth and Flowering in Gypsophila paniculata Cultivation (토양피복에 따른 잡초발생과 안개초의 생육 및 개화에 미치는 영향)

  • Cheong, Dong-Chun;Oh, Jeong-Moon;Lim, Hoi-Chun;Song, Young-Ju;Kim, Jeong-Man
    • FLOWER RESEARCH JOURNAL
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    • v.19 no.1
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    • pp.15-21
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    • 2011
  • This study investigated the effect of soil mulching materials and methods on weed occurring for the growth and flowering characteristics in Gypsophila plants cultivation. For mulching materials were used black polyethylene (PE) film, black polypropylene (PP), and green polypropylene, and these were mulched in both ridge and furrow (BRF) or only furrow, respectively. The weed was occurred total $146.2g/m^2/yr$ as dry weight in non-mulching, but $4.1{\sim}4.2g/m^2/yr$ in BRF mulching by black or green PP. Also weed control were yearly required 27.9 persons/10a in non-mulching, whereas 2.4 persons/10a in BRF mulching by black or green PP. Flower budding and blooming were roughly delayed in non-mulching and furrow mulching. Flowering characteristics such as flower stalk length, primary branches number, and stem firmness were remarkably improved in BRF mulching of black or green PP. Cut flower yield was increased on black BRF mulching or green PP in summer cultivation, while green PP BRF mulching showed better yield in in autumn cultivation. Mortality rate of Gypsophila plants after summer season was lowest as 12.4% in furrow mulching with black PP, followed by about 19.0% in green PP mulching, but highest as 39.0% in BRF mulching with black PE film. Rosette formation rate was lower in furrow than BRF mulching, and was lowest as 13.1% in BRF mulching with green PP, followed by 15.2~15.8% in BRF mulching with black PE film or black PP. So it was thought that BRF mulching with green PP was highly effective in weed control and improvement of yield and cut flower quality in Gypsophila plants cultivation.

Clinical Study of Tuberculous Meningitis in Children (소아 결핵성 뇌막염의 임상적 고찰)

  • Kim, Woo Sik;Kim, Jong Hyun;Kim, Dong Un;Lee, Won Bae;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.4 no.1
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    • pp.64-72
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    • 1997
  • Purpose : The incidence of tuberculous meningitis in Korean children has been markedly decreased after 1980s, but this disease has still occurred with low rate. Therefore, it may be suspected that delayed diagnosis and treatment will be happened because of lacking of clinical experiences and indistinguishable other meningitis, so it is important to make early diagnosis and treatment of tuberculous meningitis concerning with the prognosis. In this aspect, we conducted study to concern and investigate sustainly about the diagnostic criteria, clinical characteristics, radiological findings, complications, and prognosis of typical or atypical tuberculous meningitis in children. Methods : Forty four children who were hospitalized and treated due to tuberculous meningitis in pediatric wards of Our Lady of Mercy Hospital, St. Holy Hospital, St. Vincent Hospital and Uijungbu St. Mary Hospital from January 1985 to June 1996 were included in this study. We reviewed medical records of these patients retrospectively. Results : 1) The tuberculous meningitis has occured continuosly since mid-1980s. The highest 2) The diagnosis was made by contact history of active tuberculous patients, positive tuberculin test, responses of antituberculous antibiotics and discovery of Mycobacterium tuberculosis from CSF or other specimens. Among patients, 7 children(16%) were not vaccinated with BCG, and only 18 children(40%) were positive in tuberculin test. 3) The symptoms and signs of our patients on initial examinations were fever, vomiting, headache, lethargy, poor feeding, weight loss, neck stiffness, convulsion, abdominal pain and motor deficits. 4) The findings of initial CSF samples revealed leukocyte $239.5/mm^3$(mean) with lymphocyte predominant, elevated protein levels(mean;259.5mg%) and low sugar level(mean;40.7mg%). And the ratio of CSF/blood sugar was 0.407. But, atypical CSF findings were seen in 31.8% patients. 5) On brain imaging study, 34 out of 39 children had findings of hydrocephalus, basilar meningeal enhancement, infarction and subarachnoidal inflammations etc. On chest X-ray, the findings of miliary tuberculosis(34.1%), normal finding(29.5%), parenchymal infiltrations (11.4%) and calcifications(9.1%) were showed. 6) In neurological clinical stage, there were twenty-six children(59%) in stage 1, fourteen children(32%) in stage 2 and four children(9%) in stage 3. The late sequeles were encountered by 29.5% with mild and 4.6% with severe neurological injury. The most common neurological injury was quadriplegia and the mortality rate was 6.8%. 7) The SIADH was developed in 20 children(45.5%) after the 4th hospital day. Half of all SIADH patients were symptomatic. Conclusion : Tuberculosis meningitis is still an important extrapulmonary disease with high morbidity and mortality. Early diagnosis with clinical contact history of active tuberculosis and radiological imaging examinations and early treatments are essential in order to prevent and decrase the rate of late sequeles and death.

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Questions and Answers about the Humidifier Disinfectant Disaster as of February 2017 (가습기살균제 참사의 진행과 교훈(Q&A))

  • Choi, Yeyong
    • Journal of Environmental Health Sciences
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    • v.43 no.1
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    • pp.1-22
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    • 2017
  • 'The worstest environment disaster', 'World's first biocide massacre', 'Home-based Sewol ferry disaster' are all phrases attached to the recent humidifier disinfectant disaster. In the spring of 2011, four of 8 pregnant women including 1 adult man passed away at a university hospital in Seoul due to breathing failure. Epidemiologic investigation conducted by the Korean CDC soon revealed the inhalation of humidifier disinfectant, which had been widely used in Korea during the winter, to be responsible for the disease. As well as lung fibrosis hardening of the lungs, other diseases including asthma, rhinitis, skin disease, liver disease, fetal disease or cancers have been researched for their relation with exposure to the products. By February 9, 2017, 5,342 cases had registered for health problems and 1,131 of them were already dead (20.8% mortality rate). Based on studies by government agencies and a telephone survey of the general population by Seoul National University and civic groups, around 20% of the general public of Korea has used these products. Since the market release of the first product by SK Chemical in 1994, over 7.1 million items from around 20 brands were sold up to 2011. Most of the products were manufactured by well-known large conglomerates such as SK, Lotte, Samsung, Shinsegye, LG, and GS, as well as some European companies including UK-based Reckitt Benckiser and TESCO, the German firm Henkel, the Danish firm KeTox, and an Irish company. Even though this disaster was unveiled in 2011 by the Korean government, the issue of the victims was neglected for over five years. In 2016, an unexpected but intensive investigation by prosecutors found that Reckitt Benckiser manipulated and concealed animal tests for its own brand and brought several university experts and company employees to court. The matter was an intense social issue in Korea from May to June with a surge in media coverage. The prosecutor's investigation and a nationwide boycott campaign organized by victims and environmental groups against Reckitt Benckiser, whose product had been used by more than 70% of victims, led to the producer's official apology and a compensation scheme. A legislative investigation organized after the April 2016 national election revealed the producers' faults and the government's responsibility, but failed to meet expectations. A special law for the victims passed the National Assembly in January 2017 and a punitive system together with a massive environmental epidemiology investigation are expected to be the only solutions for this tragedy. Sciences of medicine, toxicology and environmental health have provided decisive evidence so far, but for the remaining problems the perspectives of social sciences such as sociology and jurisprudence are highly necessary, similar to with the Minamata disease and Wonjin Rayon events. It may not be easy to follow this issue using unfamiliar terminology from medical and chemical science and the long, complicated history of the event. For these reasons the author has attempted to write this article in a question and answer format to render it easier to follow. The 17 questions are: Q1 What is humidifier disinfectant? Q2 What kind of health problems are caused by humidifier disinfectant? Q3 How many victims are there? Q4 What is the analysis of the 1,112 cases of death? Q5 What is the problem with the government's diagnostic criteria and the solution? Q6 Who made what brands? Q7 Has there been a recall? What is still on sale? Q8 Was safety not checked by any producers? Q9 What are the government's responsibilities? Q10 Is it true that these products were sold only in Korea? Q11 Why and how was it unveiled only in 2011 after 17 years of sales? Q12 What delayed the resolution of the victim issue? Q13 What is the background of the prosecutor's investigation in early 2016? Q14 Is it possible to report new victim cases without evidence of product purchase? Q15 What is happening with the victim issue? Q16 How does it compare with the cases of Minamata disease and Wonjin Rayon? Q17 Are there prevention measures and lessons?

Suitability Assessment of Domestic Natural Waters as a Culture Medium for Daphnia magna (Daphnia magna의 배양배지로서 국내 자연수의 적절성 평가)

  • Yeom, Dong-Hyuk;Jeon, Chan-Sig
    • Korean Journal of Ecology and Environment
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    • v.45 no.3
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    • pp.271-277
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    • 2012
  • The present study was conducted to assess the suitability of domestic natural waters as a Daphnia magna culture medium. In order to assess survival rate and reproductive output, young female daphnids (parent animals), aged less than 24 hours at the start of the test and produced in the Elendt M4 medium, were exposed to Elendt M4 medium, de-chlorinated tap water, and natural mineral water for 21 days. D. magna cultured in Elendt M4 medium (reference medium) and natural mineral water met the criteria of OECD No. 211, Daphnia magna Reproduction Test Guidelines in terms of percent adult survival, first day of reproduction, and average young production. However, the mortalities of adult daphnids observed in de-chlorinated tap water were more than 20% in two reproduction tests for 21 days. Mortality was observed on exposure days 13, 15, and 18 in de-chlorinated water. The use of D. magna is recommended in water of hardness >80 mg $CaCO_3\;L^{-1}$. However, the hardness of de-chlorinated tap water used in the present study was 50~53 mg $CaCO_3\;L^{-1}$. Therefore, it is judged that the delayed mortalities observed in de-chlorinated tap water were caused by a rapid decreased in hardness when the medium was changed from Elendt M4 to de-chlorinated tap water. When D. magna is cultured using domestic natural waters (underground water, surface water, and de-chlorinated water), the quality-control (QC) data should be maintained through a standardization for health assessment method, toxicity test method using reference chemical, test intervals of reference toxicant toxicity test, and data treatment and interpretation. In the long term, national research programs are needed for the development of test species which are representative of domestic aquatic environmental conditions among indigenous daphnids.

Surgical Experience of Open Heart Surgery in Neonates (신생아개심술의 외과적 경험)

  • 이용훈;조은희
    • Journal of Chest Surgery
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    • v.29 no.8
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    • pp.828-835
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    • 1996
  • From January 1993 to April 1995, 27 neonates (under age of 30 days underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Center. Mean age and weight were 12.1 days(2days∼306ays) and 3.29 kg(2.6kg∼4.1 kg) respectively. Cardiac anomalies were simple complete transposition of great arteries(TGA) in 11 neonates, TGA with coarctation of aorta(COA) in 1 , total anomalous pulmonary venous connection(TAPVC) in 5, double inlet right ventricle with TAPVC in 1, interrupted aortic arch(IAA) with ventricular septal defect(VSD) in 3, pulmonary atresia(PA) with intact ventricular septum(IVS) in 3, pulmonary stenosis with IVS in 1, Taussig-Bing anomaly with IAA in 1, and hypoplastic left heart syndrome(HLHS) in 1 . Postoperative complications were myocardial and/or pulmonary edema which caused open sternum in 13 patients(54.2%), acute renal failure( RF) in 10(37.0%), Intractable low cardiac output syndrome (LCOS) including weaning failure from cardiopulmonary bypass in 7(25.9%), bronchopulmonary dysplasia in 1, wound infection in 1, and paroxysmal supraventricular tachycardia in 1. Nine of 13 patients with postoperative open sternum were recovered with delayed sternal closure, and seven of 10 patients survived postoperative ARF with peritoneal dialysis. There were 8 operative deaths(29.6%): 3 in the patients with simple complete TGA, 1 In TCA with COA, 1 in PA with IVS, 1 in Taussig-Bing anomaly with IAA, 1 in DIRV with TAPVC, and 1 in HLHS. One late death occurred after arterial switch operation in simple TGA. The mosts common cause of death was low cardiac output syndrome. Our initial experience of open heart surgery in neonates showed high operative mortality and morbidity, especially in complex anomalies.

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Emergency Coronary Artery Bypass Operation for Card iogen ic Shock (심인성 쇼크에 대한 응급 관상동맥 우회술)

  • 김응중;이원용
    • Journal of Chest Surgery
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    • v.30 no.10
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    • pp.966-972
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    • 1997
  • Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ve'ntricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Pive out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical sten sis limited to left main coronary artery, left main coronary angioplasty was performed. Pive patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.

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Studies on the Relationship between Silkworm Rearing and Tobacco Cultivation I. Tobacco Field Cultivated in Mulching System Affecting the Silkworm Rearing in Autumn Season (연초재배가 양잠에 미치는 영향에 관한 연구 I. 뽕밭 부근의 담배개량 Mulching 재배가 추잠작에 미치는 영향에 관한 시험)

  • 정태암;이상풍;김정배;홍기원;김계명;마영일
    • Journal of Sericultural and Entomological Science
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    • v.17 no.2
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    • pp.141-149
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    • 1975
  • Silkworm is known to be damaged under the unfavorable environmental conditions. Recently, it has been often argued that nicotine is a main factor to affect the silkworm nutritional balance and to result in decrease of quantitative characters, and unbalance of larval nutrition. Especially in spring season, there is tendency to produce nicotine damage to silkworm fed with the mulberry leaf near to tobacco field early cultivated in mulching system. In these connections, the trial was made in the different pots placing by the different distance 10rn, 20m, 40m, and 60m in the direction of east-north from the tobacco field. Location of pot near to the tobacco fold is 40m below the tobacco Held and gradually higher than the tobacco field by 10 degree of slope. In addition, when the mulberry field is divided into two areas from the east-south to west-north, southern east zone is lowering down below 10 degree of slope and has 36% of east-south wind, 21% of south-east wind and 16% of south wind, etc. Pots are left on the mulberry field from the completion of lower part leaf harvest to just before upper part leaf harvest is completed for 32 days. Then silkworm at 4th-5th stage was fed with the leaf grown during the period and larval characters are statistically analyzed. The results are summarized as follows: 1. 10-40m distant pot statistically at the same level has the longest larval duration and 60m distant pot is. not significant at 5% level. Whole larval duration has same tendency as in the 5th larval duration. 2. Percentage of delayed molting larvae at the 5th stage is increased in 10m distant pot and there is no significance statistically in other pots, as compared with that of control. 3. It is not showed that there is no damage to mortality of the old larvae in 60m distant pot. 4. 10-20m distant pot produces a low pupation and others are at the same level statistically at 5% significance, 5. It is showed that nicotine damage is occurred in single cocoon freight and cocoon shell weight up to 60m distant pot, rather higher damage in cocoon shell weight than in single cocoon weight. 6. It is showed that cocoon yield from 10, 000 molted larvae including double cocoon is decreased up to 40m distant pot far from the tobacco field in which 40% of cocoon yield in 10m distant pot by 7kg, 26% of cocoon yield in 20m distant pot by 3.9kg, 24% of cocoon yield in 40m distant pot by 3.6kg, and 12% of cocoon yield in 60m distant pot by 1.8kg, as compared with control. However, there is no significance statistically at 5% level in 60m distant pot. With these above results, it is concluded that nicotine da mage could be occurred in cocoon yield and cocoon quality up to 60m distant far from the tobacco field.

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Cell-mediated immunity in mice infected with Acanthumoeba culbertsoni (Acanthamoeba culbertsoni 감염에 있어서 세포 매개성 면역)

  • Kim, Myeong-Jun;Sin, Ju-Ok;Im, Gyeong-Il
    • Parasites, Hosts and Diseases
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    • v.28 no.3
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    • pp.143-154
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    • 1990
  • Observations were made on the differences of cell-mediated responses in mice of three infectiorl groups di여erently scheduled in their severity with pathogenic Acanthamoeba culbertseni. Infections were done by dropping $5{\;}{\mu}l$ saline suspension containing $3{\times}10^3,{\;}1{\times}10^4,{\;}or{\;}1{\times}10^5$ trophosoites, respectively. Amoebae were cultured anenically in CGV medium and inoculated into the right nasal cavity of CSH/HeJ mice aging around 6∼8 weeks, under the anesthesia by intraperitoneal injection of secobarbital. Delayed type hypersensitivity (DTH) responses in footpad and blastogenlc responses of mouse spleen cells using ($^3H$)-thymidine and the serum antibody titer were measured up to day 14 after infection, and natural killer cell activities were measured up to day, i after infection. The results obtained in this study were as follows: 1. The mice infected with $3{\times}10^3$ trophosoites showed mortality rate of 17%, and 345 in the mice infected with $1{\times}10^4$ trophozoites and 65% with $1{\times}10^5$ trophozoites. 2. In regard to DTH responses in all experimental groups, the level increased on day 7 and declined on day 14 after infection, but their differences could not be noted between infected and control groups. 3. The blastogenic responses of splenocytes treated with amoeba Iysates and lipopolysaccharides (LPS) showed no difference from the control group. The blastogenic responses of splenocytes treated with concanavalin A were declined significantly in the experimental group as compared with the control group, but the blastogenic responses of splenocytes treated with polyinosinic acid were not different from the control group. There was also no difference among three infected groups. 4. The cytotoxic activity of the natural killer cells was activated on day 1 after infection and declined to the level of control group on day 2 in all experimental groups. On day 5 after infection, the natural killer cell cytotoxicity was significantly suppressed as compared with the control groups. 5. The serum antibody titers of the infected mice increased after day 7, but there was no statistical difference between the three infected groups. In summary of the results, there was no difference in cell-mediated immune responses of three experimental groups scheduled with different infection intensities. But there was a significant difference in cell$.$mediated immune responses between infected and control mice. It is considered that cell-mediated immune responses should be involved in murine model infected with A. culbertsoni.

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Breeding of New Synthetic Egg Production Line in Domestic Chicken by Introducing Sex Linked Gene II. Selection of Superior Lines from Cross Breeding (성 감별 유전자를 도입한 다산계계통 신품종 육종에 관한 연구 II. 우량 교배조합 선발 시험)

  • 오봉국;손시환;조윤연
    • Korean Journal of Poultry Science
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    • v.20 no.1
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    • pp.1-9
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    • 1993
  • This study carried out to build up new synthetic egg production lines which had sex-linked gene for feather color sexing and also superior combining ability for producing the best commercial chicks. The closed flock breeding method was utilized to improve the general performances in the first experiment and combining ability for heterosis was tested for new synthetic line in the second experimental year. In order to test for the egg production ability in cross breeds synthetic lines, the crossing of B$\times$4 B$\times$C, two imported strains and two domestic strains as controls were compared for the general performances. There was on difference in mortality, body weight to 56 weeks of age. Sexual maturity was delayed about 10 days by comparing with other reports, except 153 days of the Manina White, but no difference among mating systems in this experiment. The hen housed egg production in B$\times$A, B$\times$C was 186.3, 191.3 respectively and it was better than the other controls, except ISA imported lines. The hen-day egg production of B$\times$A, B$\times$C was better than other controls, with 75.7%, 76.8% respectively. In the average egg weight, the B$\times$C cross breed was highest with 64.5g. As the sex of hatching chicks was identified by difference of feather color, the genetic composition of synthetic lines must be homogenized. The feather color of female chicks was brown and that of male was silver (99%), In conclusion, the egg production ability of B$\times$A, B$\times$C cross breeds was superior to the imported and domestic lines. Therefore, it suggest that the synthetic lines with sex-linked gene might be utilized for improving egg production performances.

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