• Journal of Chest Surgery
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• 제31권11호
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• pp.1049-1055
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• 1998

연구배경 : 관동맥우회술은 허혈성 심질환의 중요한 치료법의 하나이다. 수술로 인한 합병증과 수술사망률은 최근 현저히 감소하고 있는 추세이나 아직도 개선이 필요하다 재료 및 방법 : 이 연구에서는 술전 및 수술 변수들을 위험인자로 설정하고 이들의 영향을 후향적으로 분석하였다. 1992년부터 1997년 까지 허혈성 심질환 환자에서 관동맥우회술을 시행한 86명을 대상으로 하였다. 대상환자들의 임상적 특징을 살펴보면 평균 나이는 58.6±8.4(36~74)세 였고 남자가 61명 여자가 25명 이었다. 수술 전 관동맥 풍선확장술 혹은 stent 삽입술을 시행한 환자는 14명이 있었다. 불안전성 협심증이 41례로 48%를 차지하였고 삼중혈관 질환이 45례로 52%를 차지하였다. 좌심실 조영술상 구축률이 저하된 경우(<35%)가 7례 있었다. 응급수술은 10례에서 시행되었다. 동반수술로 승모판막 치환술이 2례, 대동맥판막 치환술이 2례, 심방중격결손 봉합이 1례 그리고 심실중격결손 봉합 1례를 시행하였다. 관동맥우회술의 평균 원위부 문합수는 환자당 3.5개 였으며 대동맥 차단시간은 평균 115분이었다. 이 연구에서 분석지표로 사용된 변수들은 고령 (70세 이상), 여성, 저체표면적(1.5M2이하), 술전 관동맥풍선확장술 혹은 stent 삽입력, 고지혈증, 흡연력, 고혈압, 당뇨, 만성 폐쇄성폐질환, 긴급 혹은 응급수술, 좌주관동맥질환, 좌심실구축률의 저하(35%이하), 동반수술 등이었다. 결과 : 수술 사망은 총 7례 였으며 그 원인으로는 저심박출증이 5례, 내과적 치료에 반응하지 않는 심실성 빈맥이 1례 그리고 심장압전증이 1례 있었다. 수술 합병증으로 술후 심근경색과 뇌졸증이 각각 6례로 가장 많았으며 출혈로 인한 재수술이 5례, 급성 신부전증이 4례 그리고 위장관 합병증과 종격동염이 각각 3례 였다. 합병증 발생의 위험인자로서는 저체표면적, 당뇨병력 그리고 좌심실구축률의 저하가 통계적으로 유의하였으며(p<0.05) 사망률의 위험인자로는 좌심실구축률의 저하가 의미있게 분석되었다(p<0.05). 결론 : 관동맥우회술과 관련된 수술합병증의 위험인자는 저체표면적, 당뇨병력 그리고 좌심실구축률의 저하 등이 있었고 사망률의 위험인자는 좌심실구축률의 저하로 나타난 것으로 보아서 좌심실기능장애가 심하지 않은 상태에서의 수술이 필요하다고 생각된다.

• 대한한의학회지
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• 제26권2호
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• pp.95-104
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• 2005

Objectives: This was a double blinded, randomized, placebo-controlled clinical study for evaluation of safety and effective dose finding of Cardiotonic Pills$^{(R)}$ in patients with chest pain and discomfort. Cardiotonic Pills$^{(R)}$ are composed of Salviae Miltiorrhizae Radix (丹蔘), Notoginseng Radix (三七根) and Borneolum (龍腦). Major effects of Salviae Miltiorrhizae Radix and Notoginseng Radix are vasodilatation, sedation and analgesic action. Borneolum has an antibacterial effect, and can stimulate the central nervous system. All of these substances are oriental herbs that have been used for a long time in east Asia. Cardiotonic Pills fi received Investigational New Drug (IND) approval from the Food and Drug Administration (FDA) in the USA and 40 million people in the world take this pill. We performed a phase IV clinical study to confirm its efficacy and safety in patients who have probable cardiogenic or psychogenic chest pain or chest stifling. Methods: This study was planned for a multi-center clinical trial including four university hospitals of oriental medicine in Korea. This was the first time to evaluate the 'planning treatment according to diagnosis (辨證施治)' of chest pain or chest discomfort according to oriental medical guidelines. The patients who were included in this trial were adult volunteers from 20 to 70 years old who had chest pain or chest discomfort more than twice during a recent month, and we received written consent to participate in this study from all of them. After administration of Cardiotonic Pills$^{(R)}$ for 8 weeks, number of occurrences, duration, appearance and degree of chest pain or chest discomfort was observed and degree of symptoms (severity of illness, global improvement) were measured using a patient's global assessment composite scale. Results: In the patient's global assessment scale, the severity of illness of the Cardiotonic Pills$^{(R)}$ group (n=25) was 14/25=0.56 but of the placebo group (n=25) was 7/25=0.28 (p-value=0.0449). This result indicates Cardiotonic Pills$^{(R)}$have a positive effect on the symptoms of chest pain and discomfort. However, the global improvement of the Cardiotonic Pills$^{(R)}$group was 23/25=0.92, and of the placebo group was 22/25=0.88 (p-value=0.6374). The total symptom score of the Cardiotonic Pills$^{(R)}$ group was $1.68\pm20.06$, and of the placebo group was $16.76\pm72.l4$(p-value=0.2285). The number of symptom events of the Cardiotonic Pills$^{(R)}$ group was $72\pm29.78$, and of the placebo group (n=25) was $10.80\pm38.42$ (p­value=0.3660). We could not find any effects on the other factors examined besides the severity of illness, beyond the difference of standard deviations. Conclusions: Cardiotonic Pills$^{(R)}$ significantly reduced chest pain and chest discomfort in patients. Therefore, we expect that Cardiotonic Pills$^{(R)}$ will be helpful for patients with chest pain and chest discomfort not only caused by heart disease but also by other diseases.

• 동의생리병리학회지
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• 제16권4호
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• pp.724-728
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• 2002

Angiotensin-converting enzyme (ACE) gene polymorphism, which consists of presence (insertion, I) or absence (deletion, D) of a 250-bp fragment, is associated with ischemic heart disease, renovascular disease, systemic lupus erythematosus. Subjects with the DD genotype have higher levels of circulating ACE than subjects with the II genotype and show an increased tendency towards vascular wall thickness and contribute to the development of vascular disease. But the association between I/D polymorphism of the ACE gene and cerebrovascular disease is still controversial. The aim of this study was to determine whether the DNA polymorphism of the ACE are associated with cerebrovascular disease in Korean population. The study group comprised 377 Korean patients admitted to Kyunghee Oriental Medical Center in the year of 2000 for the treatment of brain infarction or brain hemorrhage. Magnetic resonance imaging(MRI) was performed for each patient to determine the stroke phenotype, infarction or hemorrhage. The 183 subjects without evidence of brain infarction or brain hemorrhage were selected from the some ethnical population(control group). Venous blood samples were drawn from each subject for the extraction of DNA. Genotypes of ACE were determined by polymerase chain reaction amplification of the genomic DNA. Case and control genotype frequencies were compared by chi-square testing. Both the patients and the controls were classified respectively into 4 groups: age less than forty years, age forty one to fifty, age fifty one to sixty, age greater than sixty years. There were no significant differences in the distributions of ACE genotypes among the patients with infarction, with hemorrhage and controls (Infarction: D/D 15.8%, I/D 46.7%, I/I 37.5%, Hemorrhage: D/D 15.1%, I/D 46.5%, I/I 38.4%, Control: D/D 18.6%, I/D 50.3%, I/I 31.2%). There was a significant difference in the distribution of ACE genotypes between the age greater than sixty year subgroup of patient with brain hemorrhage and the control (Hemorrhage: D/D 0%, I/D 55.6%, I/I 44.4%, Control: D/D 13.0%, I/D 63.0%, I/I 23.9%; Pearson Chi-Square value 5.956, P<0.05). Furthermore, the frequency of the ACE D/D type declined with increasing age both in the patient and control group (Patient group: age < 50 D/D 21.5%, age > 50 D/D 14.42%; Control group: age < 50 D/D 21.0%, age > 50 D/D 14.2%). In conclusion there is no clear association between ACE polymorphism and cerebrovascular disease in Korean population. Although, there was a tendency for the frequency of the ACE D/D type declined with increasing age in both patients and controls.

• Journal of Chest Surgery
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• 제31권8호
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• pp.749-755
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• 1998

배경: 1988년 2월부터 1997년 7월까지 경북대학교병원 흉부외과에서 비청색성 팔로사징(acyanotic tetralolgy of Fallot) 환자 12례에 대하여 개심술에 의한 완전교정술을 시행하였다. 대상 및 방법: 이들 비청색성 팔로사징 환자는 같은 기간에 본원에서 팔로사징의 진단하에 치료를 받았던 전체 팔로사징 환자 121례의 9.92%를 차지하였다. 비청색성 팔로사징의 진단기준은 심초음파검사, 심혈관조영검사 및 수술소견상으로 배열부정 심실중격결손(malaligned ventricular septal defect)과 함께 누두부협착(infundibular stenosis)에 기인하는 폐동맥협착이 있음이 확인된 환자들 중에서 임상적으로 안 정시에 청색증 소견이 전혀 없는 경우로 하였다. 환자의 연령은 생후 12개월부터 42개월까지로, 평균연령은 25.2개월이었다. 결과: 술전의 동맥혈산소포화도는 평균 93.5%, 헤마토크리트치는 평균 38.8%였다. 심초음파검사상 에서 심실중격결손을 통한 혈류단락의 방향은 좌-우단락이 4례, 양방향 단락이 2례, 그리고 단락이 없었던 경우가 6례 있었다. 폐동맥협착에 의한 우심실-폐동맥간의 혈압차이는 심초음파검사상으로 52.3 mmHg, 심도 자검사상에서는 평균 48.4 mmHg 였다. 수술에 있어서 심실중격결손은 전례에서 우심방절개창을 통해 포편 봉합하였고, 폐동맥협착의 교정은 판막절제, 누두부근육절제 및 경판륜폐동맥패취성형술을 시술했던 경우가 6례, 누두부근육절제만 했던 경우가 4례, 판막교련부절개와 누두부근육절제를 함께 시행한 경우가 2례 있었다. 개심술시의 체외순환시간 및 대동맥차단시간은 각각 평균 135.0분 및 87.8분이었다. 수술후 병원사망례나 만기사망례는 없었으며, 술후 합병증으로는 재수술을 요한 출혈 1례와 유미흉 1례가 있었으나 별문제 없이 해결되었다. 술후 퇴원전후에 시행한 심초음파검사상에서 심실중격결손의 봉합부위에 경미한 잔류단락이 5례에서 있었고, 우심실유출로에 평균 15.3 mmHg의 혈압차가 남아 있었다. 술후 추적기간은 평균 18.1개월 이었으며, 모두 별다른 투약가료 없이 NYHA 등급상 1등급이하의 양호한 상태를 유지하고 있었다. 결론: 결론적으로 비청색성 팔로사징은 팔로사징중에서는 흔하지 않는 유형에 속하며, 교정수술을 시행하면 양호한 수술성적을 보일 수 있는 심질환이다.

• Journal of Chest Surgery
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• 제12권4호
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• pp.383-394
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• 1979

Treatment of valvular heart disease with valve replacement has been one of the most popular procedures in cardiac surgery recently. Although, first effort was directed toward the prosthetic valve, it soon became popular that bioprosthesis, the valvular xenograft, was prefered in the majority cases. Valvular xenograft has some superiority to the artificial prosthetic valve in some points of thromboembolism and hemolytic anemia, and it also has some inferiority of durability, immunologic reaction and resistance to Infection. Tremendous efforts were made to cover the inferiority with several methods of collection, preservation, and valve mounting of the porcine valve or pericardium of the calf, and also with surgical technique of the valvular xenograft replacement. Auther has collected 320 porcine aortic valves immediately after slaughter, and aortic cusps were coapted with cotton balls in the Valsalva sinuses to protect valve deformity after immersion in the Hanks' solution, and oxidation, cross-linking and reduction procedures were completed after the proposal of Carpentier in 1972. Well preserved aortic valves were suture mounted in the hand-made tissue valve frame of 19, 21, and 23 mm J.d., and also in the prosthetic vascular segment of 19 mm Ld. with 4-0 nylon sutures after careful trimming of the aortic valves. Completed valves were evaluated with bacteriologic culture, pressure tolerance test with tolerane gauge, valve durability test in the saline glycerine mixed solution with tolerance test machine in the speed of 300 rpm, and again with pathologic changes to obtain following results: 1. Bacteriologic culture of the valve tissue in five different preservation method for two weeks revealed excellent and satisfactory result in view of sterilization including 0.65% glutaraldehyde preservation group for one week bacteriologic culture except one tissue with Citobacter freundii in 75% ethanol preserved group. 2. Pressure tolerance test was done with an apparatus composed of V-connected manometer and pressure applicator. Tolerable limit of pressure was recorded when central leaking jet of saline was observed. Average pressure tolerated in each group was 168 mmHg in glutaraldehyde, 128 mmHg in formaldehyde, 92 mmHg in Dakin's solution, 48 mmHg in ethylene oxide gas, and 26 mmHg in ethanol preserved group in relation to the control group of Ringer's 90 mmHg respectively. 3. Prolonged durability test was performed in the group of frame mounted xenograft tissue valve with 300 up-and-down motion tolerance test machine/min. There were no specific valve deformity or wearing in both 19, 21, and 23 mm valves at the end of 3 months (actually 15 months), and another 3 months durability test revealed minimal valve leakage during pressure tolerance test due to contraction deformity of the non-coronary cusp at the end of 6 months (actually 30 months) in the largest 23 mm group. 4. Histopathologic observation was focussed in three view points, endothelial cell lining, collagen and elastic fiber destructions in each preservation methods and long durable valvular tolerance test group. Endothel ial cell lining and collagen fiber were well preserved in the glutaraldehyde and formaldehyde treated group with minimal destruction of elastic fiber. In long durable tolerance test group revealed complete destruction of the endothelial cell lining with minimal destruction of the collagen and elastic fiber in 3 month and 6 month group in relation to the time and severity. In conclusion, porcine xenograft treated after the proposal of Carpentier in 1972 and preserved in the glutaraldehyde solution was the best method of collection, preservation and valve mounting. Pressure tolerance and valve motion tolerance test, also, revealed most satisfactory results in the glutaraldehyde preserved group.

• Journal of Chest Surgery
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• 제42권2호
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• pp.157-164
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• 2009

배경: 폐동맥 판막 협착 혹은 형성 부전을 동반한 여러 선천성 심장기형의 수술적 치료를 위하여, 다양한 종류의 우심실-폐동맥간 도관이 사용되었다. 장기 성적이 우수한 냉동동종 이식편(cryopreserved homograft)의 공급의 제한으로 이를 대체할 이종 조직 이식편의 석회화 방지를 위한 효과적인 기법의 확립이 필요하다. 본 연구에서는 L-lysine을 이용한 diamine bridge의 항석회화 효과를 Ethanol과 비교하여 알아보고자 하였다. 대상 및 방법: 0.625% glutaraldehyde ($4^{\circ}C$에서 2일, 상온에서 7일간) 고정한 돼지 심낭을 80% Ethanol (상온에서 1일), 혹은 0.1M L-lysine ($37^{\circ}C$에서 2일)로 처리 한 후 각각의 두께(thickness)와 장력(tensile strength)을 측정하였다. 각각의 항석회화 처리한 돼지 심낭을 생후 3주된 쥐의 피하조직에 이식하고 8주 뒤 칼슘을 정량하고 조직학적 소견을 관찰하였다. 결과: 0.625% glutaraldehyde 고정만 시행한 군$(51.2{\pm}8.5ug/mg)$과 비교하여 0.625% glutaraldehyde 고정 후에 80% Ethanol 처리한 군($13.6{\pm}10.0ug/mg$, p=0.008)과, 0.625% glutaraldehyde 고정 후에 L-lysine 처리한 군($15.3{\pm}1.0ug/mg$, p=0.002), 그리고 0.625% glutaraldehyde 고정 후에 80% Ethanol과 L-lysine 처리한 군($16.1{\pm}11.1ug/mg$, p=0.012)은 통계적으로 의미 있게 칼슘의 침착량이 적었다. 0.625% glutaraldehyde 고정 후에 80% Ethanol 처리한 군의 두께와 장력은 각각 $0.18{\pm}0.02mm,\;1.20{\pm}0.30kg$중/5mm로 0.625% glutaraldehyde 고정 후에 L-lysine 처리한 군의 $0.13{\pm}0.03mm$, $0.85{\pm}0.36$ 1.0kg 중/5mm 보다 증가되어 있었다(p<0.01, p=0.035). 결론: L-lysine을 이용한 diamine bridge는 Ethanol과 비교하여 비슷한 항석회화 효과를 보여 주었으며 Cross-link를 증가시켜 이종 이식편의 두께와 장력을 증가시켜 주는 효과가 있었다.

• 대한약리학회지
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• 제7권1호
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• pp.53-65
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• 1971

It is well known that diabetes mellitus is associated with metabolic derangements, such as hyper-glycemia, ketosis, glycosuria, and also widespread alterations in the blood vessels, kidneys, eyes, peripheral nerves and heart. It is also recognized that healing of skin wound is delayed in diabetics. In bone, according to Aegerter, osteopenia develops in diabetes mellitus and it is chiefly ascribed to overutilization of protein. Shim claims that total blood flow to the entire skeletal system is approximately 4 to 8 percent of resting cardiac output and blood supply to the skeletal system would be decreased on account of secondary arteriosclerotic changes in the diabetics. An adequate blood supply is an essential factor in the healing process of fracture, and disturbed blood flow, either local or systemic, will invariably delay union of the fragments or the fragments from being fused. As the author has encountered several cases of diabetics in whom healing of fracture was delayed or incomplete, this experimental study was undertaken to elucidate the effects of hyperglycemia and diabetes mellitus on the healing process of fracture. In this experiment adult albino rabbits, weighing about 2 kg. were used and divided into 6 groups. The femur of each animal was fractured surgically, and then the healing process of fracture was periodically checked by radiography at an interval of one week for a period of 6 weeks. Thereafter, all the rabbits were killed to obtain tissue preparation of the femur. The experimental groups were as follows; 1) Control group: Six rabbits sustained a surgical fracture to the femur, without being given any other treatment or drug. 2) Alloxan-treated group: For inducing diabetes, alloxan was given intravenously to 17 rabbits in various dose as follows; to 7 of them 40 mg/kg, to 6 rabbits 80 mg/kg and to 4 rabbits 120 mg/kg of body weight, respectively. 3) Insulin-treated group: Protamine-zinc insulin was injected subcutaneously to each of 6 rabbits in a daily dose of 1 unit per kilogram of body weight. 4) Group treated with insulin after alloxan: Four rabbits were given 80 mg of alloxan once and than 1 unit of insulin per kilogram of body weight daily. Another 5 rabbits were injected 1 unit of insulin per kg of body weight daily following administration of alloxan in a dose of 120 mg/kg. 5) Homotransplantation group: Following intravenous injection of alloxan in a dose of 120 mg/kg, 10 rabbits underwent homotransplantation of a short bone segment to the femur. Five of them were subsequently given 1 unit/kg of insulin daily. 6) Sugar-treated group: six rabbits were fed $15{\sim}20$ gm of sugar daily throughout the period of experiment. The results obtained are summarized as follows; 1. Blood sugar level and damage to the pancreatic islet increased proportionately when alloxan was given to the rabbits in various doses. No appreciable change could be observed in the islets when the blood sugar level was altered by either oral administration of sugar or subcutaneous injection of insulin. 2. Comparing with the control group, healing of fracture was delayed in the alloxan-treated group, while callus formation and periosteal reaction were shown to be more prominent in this group and subsequently, the ultimate osseous tissue formed at the fracture site was significantly smaller in amount and less compact. These findings were more marked as the amount of alloxan increased. 3. Administration of insulin prevented the delay in healing process of fracture in the rabbits with alloxan-induced hyperglycemia. In this case, the course and progression of fracture healing were almost similar to those of control group. 4. Union between the host bone and the fragment transplanted from other rabbit of the same species was more delayed in the group treated with alloxan alone than in the group to which insulin was administered after development of alloxan-induced diabetes. In both groups periosteal new bone developed from the ends of the host bone, above and below the transplanted fragment, and directly fused with failure of periosteal callus to bridge the adjacent ends of the host bone and the transplanted fragment. 5. The healing process of fracture was not inhibited by alteration in blood sugar level when the blood sugar was abnormally increased by excessive sugar intake or lowered by administration of insulin alone. The healing of fracture in these groups progressed similarly as in the control group. In brief summary, it appears that the healing process of fracture would be definitely disturbed in diabetic state brought about by damage to the pancreatic islet. As such an inhibition could be overcome with insulin, it seems that insulin plays an important role in healing of fracture, but alteration in blood sugar level alone does not modify healing process of fracture to significant degree.

• Asian-Australasian Journal of Animal Sciences
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• 제9권1호
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• pp.1-25
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• 1996

The pathogenesis of atherosclerosis can not be summarized as a single process. Lipid infiltration hypothesis and endothelial injury hypothesis have been proposed and investigated. Recent developments show that there are many points of potential interactions between them and that they can actually be regarded as two phases of a single, unifying hypothesis. Among the many risk factors of atherosclerosis, plasma homocysteine and lipoprotein(a) draw a considerable interest because they are independent indicators of atherogenicity. Triglyceride (TG)-rich lipoproteins (chylomicron and VLDL) are not considered to be atherogenic but they are related to the metabolism of HDL cholesterol and indirectly related to coronary heart disease (CHD). LDL can of itself be atherogenic but the oxidative products of this lipoprotein are more detrimental. HDL cholesterol has been considered to be a favorable cholesterol. The so-called 'causalist view' claims that HDL traps excess cholesterol from cellular membranes and transfers it to TG-rich lipoproteins that are subsequently removed by hepatic receptors. In the so-called 'noncausalist view', HDL does not interfere directly with cholesterol deposition in the arterial wall but instead reflects he metabolism of TG-rich lipoproteins and their conversion to atherogenic remnants. Approximately 70-80% of the human population shows an effective feedback control mechanism in cholesterol homeostasis. Type of dietary fat has a significant effect on the lipoprotein cholesterol metabolism and atherosclerosis. Generally, saturated fatty acids elevate and PUFA lower serum cholesterol, whereas MUFA have no specific effect. EPA and DHA inhibit the synthesis of TG, VLDL and LDL, and may have favourable effects on some of the risk factors. Phospholipids, particularly lecithin, have an antiatherosclerotic effect. Essential phospholipids (EPL) may enhance the formation of polyunsaturated cholesteryl ester (CE) which is less sclerotic and more easily dispersed via enhanced hydrolysis of CE in the arterial wall. Also, neutral fecal steroid elimination may be enhanced and cholesterol absorption reduced following EPL treatment. Antioxidants protect lipoproteins from oxidation, and cells from the injury of toxic, oxidized LDL. The rationale for lowering of serum cholesterol is the strong association between elevation of plasma or serum cholesterol and CHD. Cholesterol-lowing, especially LDL cholesterol, to the target level could be achieved using diet and combination of drug therapy. Information on the link between cholesterol and CHD has decreased egg consumption by 16-25%. Some clinical studies have indicated that dietary cholesterol and egg have a significant hypercholesterolemic effect, while others have indicated no effect. These studies differed in the use of purified cholesterol or cholesterol in eggs, in the range of baseline and challenge cholesterol levels, in the quality and quantity of concomitant dietary fat, in the study population demographics and initial serum cholesterol levels, and clinical settings. Cholesterol content of eggs varies to a certain extent depending on the age, breed and diet of hens. However, egg yolk cholesterol level is very resistant to change because of the particular mechanism involved in yolk formation. Egg yolk contains a factor of factors responsible for accelerated cholesterol metabolism and excretion compared with crystalline cholesterol. One of these factors could be egg lecithin. Egg lecithin may not be as effective as soybean lecithin in lowering serum cholesterol level due probably to the differences of fatty acid composition. However, egg lecithin may have positive effects in hypercholesterolemia by increasing serum HDL level and excretion of fecal cholesterol. The association of serum cholesterol with egg consumption has been widely studied. When the basal or control diet contained little or no cholesterol, consumption of 1 or 2 eggs daily increased the concentration of plasma cholesterol, whereas that of the normolipemic persons on a normal diet was not significantly influenced by consuming 2 to 3 eggs daily. At higher levels of egg consumption, the concentration of HDL tends to increase as well as LDL. There exist hyper-and hypo-responders to dietary (egg) cholesterol. Identifying individuals in both categories would be useful from the point of view of nutrition guidelines. Dietary modification of fatty acid composition has been pursued as a viable method of modifying fat composition of eggs and adding value to eggs. In many cases beneficial effects of PUFA enriched eggs have been demonstrated. Generally, consumption of n-3 fatty acids enriched eggs lowered the concentration of plasma TG and total cholesterol compared to the consumption of regular eggs. Due to the highly oxidative nature of PUFA, stability of this fat is essential. The implication of hepatic lipid accumulation which was observed in hens fed on fish oils should be explored. Nutritional manipulations, such as supplementation with iodine, inhibitors of cholesterol biosynthesis, garlic products, amino acids and high fibre ingredients, have met a limited success in lowering egg cholesterol.

• 대한약리학회지
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• 제13권2호
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• pp.1-9
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• 1977

최근 강심작용 약물로 보고된 부자 부타놀 분획의 가토 심방근에서의 자극빈도에 따른 강심효과를 분석한 결과는 다음과 같다. 1) 가토 심방근의 수축력은 자극빈도에 따라 polyphasic한 수축양상을 보였으며 rested-state contraction은 $120{\sim}400sec$의 interval에서 나타났으며 이후 10sec의 간격까지는 급격한 수축력의 감소를 보이는, 축적NIEA가 PIEA의 양을 능가하는 양상을 보였으며 이 이하의 자극 빈도에서는 수축력의 증가를 보였고 대부분 0.25 sec이하의 빈도의 자극으로는 수축력의 감소를 보였다. 2) Ouabain은 저 농도에서는 interval-strength curve에 대하여 rested-state contraction의 증가와 전 자극빈도에서 비슷한 수축력의 증가를 나타내었으며, 고농도에서는 rested-state contraction의 증가와 축적 NIEA의 소멸 속도를 증가시켰으나 이는 rested-state contraction을 나타내는 시간의 단축에 따른 이차적 효과로 판정하였다. 또한 ouabain 자극빈도에 따른 강심 효과의 양상은 세포외 calcium 농도를 증가시킨 때와 유사한 양상이었다. 3) Norepinerhrine은, rested-state contraction에는 거의 영향을 주지 않았으며, 고 빈도에서 더욱 현저한 강심 작용을 나타내었고 축적 PIEA의 양의 증가와 매 beat 당 산출하는 PIEA의 양의 증가를 나타내었다. 4) 부자 부타놀 분획은 norepinephrine과 유사하고 빈도에서 수축력의 증가가 현저 하였으며, 수축력의 증가는 용량 반응 상관을 보였으며, PIEA 축적량 및 매 beat 당 산출하는 PIEA를 증가 시켰다. 따라서 고빈도에서의 강력한 수축력의 증가는 PIEA에 대한 효과에 의할 것으로 사료하였다.

• 대한방사선치료학회지
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• 제27권2호
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• pp.175-181
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• 2015

목 적 : 좌측 유방암 환자의 방사선 치료 시 바로 누운 자세 및 엎드린 자세 에 따른 환자 자세변화 시 발생하는 반대편 유방의 산란선량을 사방향 조사방법에 따라 측정하여 분석하고자 한다. 대상 및 방법 : Human Phantom (Anderson Rando Phantom. USA)을 대상으로 실제 좌측 유방암 환자로 가정한 후, Supine용 Breast Board와 본원에서 주문 제작된 Prone Breast Board를 이용하여 처방선량 50 Gy/25회로 치료계획(Conventional technique, Field-in-Field, IMRT)을 수립하였다. 치료 계획 수립 후 Human Phantom 의 중심축을 기준점으로 하여 우측방향으로 0 mm, 10 mm, 30 mm, 50 mm 떨어진 위치에 유리 선량계(GD-302M, SRS Technol, Japan)를 부착한 후 환자 자세에 따른 치료 방법에 따라 산란선량을 측정하였다. 이 때 각각의 자세 측정 시 모의치료 계획과 동일한 자세를 유지하기 위해 측정 전 EPID를 이용하여 L-gram 촬영을 실시하였으며 Prone-Device를 이용한 측정 시에는 동일한 입사 점을 확인하기 위해 Human Phantom 에 입사점을 표시하여 5회 측정된 평균값으로 각각의 치료계획 선량과 비교 분석하였다. 결 과 : 각각의 자세에 따른 치료방법에 따라 반대 측 유방의 산란선량을 측정한 결과 바로 누운 자세가 엎드린 자세에 비하여 평균 1.2%~1.8% 이상 치료계획 선량 보다 증가함을 보였고 엎드린 자세일 때는 오히려 치료계획 선량보다 평균 0.81~0.9% 이상 감소함을 보였다. 그러나 엎드린 자세 일 때 반대 측 유방의 위치 별 흡수선량 값은 바로 누운 자세일 때 비하여 총 처방선량의 평균 2.7%로 최대 4% 이상 나타났으며 Conventional technique이 Field-in-Field나 IMRT 비하여 평균 3.3%이상 높게 나타남을 보였다. 결 론 : 본 연구는 Human Phantom 을 이용하여 좌측 유방암 환자의 방사선 치료 시 환자의 자세 변화에 따른 반대편 유방의 산란선량을 치료 방법 별로 비교분석 하였다. 실제 환자의 자세 변화에 따른 유방변화를 가정하여 Human Phantom을 위치시켰으나 실제 환자의 개별적 특성에 따라 차이가 발생할 수 있으며 특히 엎드린 자세 시 환자의 자세 재현의 어려움에 따른 오차가 더욱 크게 발생할 수 있다. 이런 오차로 인하여 좌측 폐 및 심장 등의 선량을 급격히 줄여주는 장점에도 불구하고 반대측 유방에 산란선량을 증가시킬 수 있는 가능성이 있음을 확인하였다. 따라서 실제 환자를 대상으로 prone position을 적용할 경우, 치료방법 및 환자 자세확인을 위한 정확한 검증과정의 임상적 노력이 필요할 것으로 사료된다.