• 한국산학기술학회논문지
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• 제18권10호
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• pp.354-362
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• 2017

인구 고령화와 서구화된 생활로 인한 허혈성 심장질환이 지속적으로 증가하고 있으며, 우리나라는 OCED 국가 중에서 허혈성 심장질환의 재원일수가 높은 국가에 속한다. 재원일수 증가는 진료비 상승의 주요 원인이므로, 허혈성 심장질환의 재원일수 관리방안 마련이 필요하다. 이에 본 연구는 허혈성 심장질환자의 재원일수에 영향을 미치는 요인을 파악하여 재원 일수 관리에 필요한 기초자료를 제공하고자 시도되었다. 연구대상자는 일개 상급종합병원의 2015년1월1일부터 12월31일까지 순환기내과의 퇴원환자 중에서 주진단명이 허혈성 심장질환인 환자 566명이다. 자료분석은 IBM SPSS ver. 23.0을 이용하여 빈도분석, 교착분석, Fisher's test, One-way ANOVA, $Scheff{\acute{e}}$ test, 더미변수를 이용한 다중회귀분석을 실시하였다. 연구결과는 첫째, 흉통을 주호소로 입원한 환자가 가장 많았다. 둘째, 평균 재원일수는 4.89일이었으며, 허혈성 심장질환 종류별로 재원일수에 차이가 있었다. 셋째, 75세이상, 당뇨병, 호흡곤란 증상이 재원일수를 증가시키는 요인으로 나타났다. 따라서 허혈성 심장질환의 적정 재원일수 관리를 위해서는 당뇨병을 동반한 허혈성 심장질환자의 경우에는 혈당조절을 통해서 질병의 진행을 막는 것이 중요하며, 증상이 나타났을 경우 빠른 시간 내에 의료기관을 방문할 수 있는 체계마련이 필요하다.

• Journal of Korean Neurosurgical Society
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• 제30권10호
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• pp.1200-1209
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• 2001

Objective : A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of $Labb{\acute{e}}$ in surgical removal of petroclival meningiomas. Patients and Methods : The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent & equal on both sides), Type B(confluent & non-dominant on tumor side), Type C(confluent & dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of $Labb{\acute{e}}$ was analyzed with respect to its draining point and its collaterals to other superficial veins. Results : Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of $Labb{\acute{e}}$, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. Conclusion : For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of $Labb{\acute{e}}$.

• 대한한방내과학회지
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• 제28권2호
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• pp.284-293
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• 2007

Objectives : Hypertension(HTN), diabetes mellitus(DM) and hyperlipidemia(HL) are the most common risk factors of cerebro-vascular attack(CVA). To prevent CVA, early diagnosis (awareness before CVA) of HTN, DM and HL is essential, and for the effective early diagnosis we need to analyze the data of CVA patients concerned with HTN, DM and HL. In this study, we studied characteristics of patients early diagnosed before CVA. Methods : We analyzed the data of 363 patients with acute ischemic stroke from Hanbang Stroke Registry supported by the Ministry of Science and Technology of Korea. Subjects' enrollment was done in the oriental medical hospitals of 3 universities located in the metropolitan region from October 2005 to October 2006. We analyzed all registered data about HTN. DM and HL, for example, how many patients were aware of their HTN, DM or HL before CVA, differences in characteristics of early diagnosed patients, effects of early diagnosis on CAV, etc. Results : Patients aware of their HTN. DM and HL before CVA have more past history and family history about HTN, DM or HL. Early diagnosis rate of HL is lower than HTN and DM, and early diagnosed HL patients were younger and deucated longer than patients who weren't aware of their HL before CVA. These results mean that publicity is the key to promoting early diagnosis rates of HTN, DM and HL. In DM and HL, early diagnosed patients had more SVO type cerebral infarction than patients who weren't aware of risk factors. We can thus see that early diagnosis even affects CVA types. Conclusion : This work helps us to understand the realities and importance of early diagnosis of HTN, DM and HL before CVA. There should be further research, which can contribute to much more improved early diagnosis rates of HTN, DM and HL.

• 대한한방내과학회지
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• 제38권5호
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• pp.628-640
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• 2017

Purpose: To describe the effectiveness of traditional Korean medicine (TKM) on the patients with secondary dementia (case 1: Rt. MCA infarction; case 2: traumatic subacute subdural hemorrhage and traumatic intracranial hemorrhage; case 3: delayed encephalopathy after carbon monoxide poisoning). Methods: We used a complete TKM treatment. The acupoints used were as follows: acupoints frequently used in hemiparesis (GV20, GV24, ST4, LI11, LI14, ST36, GB34, SP9, and LR3), and we used herbal medicine (補腎益腦湯加味, Boshiniknoe-tang-gami). The efficacy was evaluated using the Mini-Mental State Examination for Dementia Screening (MMSE-DS) and the Modified Barthel Index (MBI). Results: After treatment, the total MMSE-DS score was increased from 14 to 24 (case 1), 14 to 19 (case 2), and 0 to 17 (case 3). The total K-MBI was increased from 30 to 44 (case 1), 82 to 86 (case 2), and 30 to 86 (case 3) Conclusions: We suggest that TKM could positively influence cognition and improve activity of daily living (ADL). This study has limitations, so further studies are needed.

• 대한한방내과학회지
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• 제38권5호
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• pp.641-649
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• 2017

Objective: Our aim was to report a case of hematoma in the lower extremity induced by anti-platelet agents (Astrix, Plavix). Methods: The patient was prescribed anti-platelet agents and a hematoma occurred three times in the lower extremity. Before admission, the hematoma had occurred in the lateral compartment area of left lower extremity ($2{\times}2cm$). We detected a spontaneous hematoma in the lateral compartment area of right lower extremity ($8{\times}4cm$) and we stopped the Astrix medication. We also used herbal medicine (大黃左經湯加味方 (Daehwangjwagyeong-tang-gami)), external therapy of 大黃梔子 (Dae-hwang-Chi-ja) powder, and wet cupping therapy. We then detected a spontaneous hematoma in the posterior compartment area of the left lower extremity ($5{\times}5cm$) and we stopped the Plavix medication. We also used herbal medicine and external therapy. Results: After cessation of the anti-platelet agents (Astrix, Plavix), no recurrence of hematoma was observed in lower extremity and there was no recurrence of cerebral infarction. Conclusions: When anti-platelet agents are administered, attention should be paid to the patient's age and adverse events of the drugs. Bleeding symptoms and adverse effects should be continuously monitored.

• Journal of Chest Surgery
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• 제44권3호
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• pp.215-219
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• 2011

Background: Selective antegrade perfusion via axillary artery cannulation along with circulatory arrest under deep hypothermia has became a recent trend for performing surgery on the ascending aorta and aortic arch and when direct aortic cannulation is not feasible. The authors of this study tried using moderate hypothermia with right brachial and femoral artery perfusion to complement the pitfalls of single axillary artery cannulation and deep hypothermia. Materials and Methods: A retrospective analysis was performed on 36 patients who received ascending aorta or aortic arch replacement between July 2005 and May 2010. The adverse outcomes included operative mortality, permanent neurologic dysfunction and temporary neurologic dysfunction. Results: Of these 36 patients, 32 (88%) were treated as emergencies. The mean age of the patients was 61.9 years (ranging from 29 to 79 years) and there were 19 males and 17 females. The principal diagnoses for the operation were acute type A aortic dissection (31, 86%) and aneurysmal disease without aortic dissection (5, 14%). The performed operations were ascending aorta replacement (9, 25%), ascending aorta and hemiarch replacement (13, 36%), ascending aorta and total arch replacement (13, 36%) and total arch replacement only (1, 3%). The mean cardiopulmonary bypass time was $209.4{\pm}85.1$ minutes, and the circulatory arrest with selective antegrade perfusion time was $36.1{\pm}24.2$ minutes. The lowest core temperature was $24{\pm}2.1^{\circ}C$. There were five deaths within 30 post-op days (mortality: 13.8%). Two patients (5.5%) had minor neurologic dysfunction and six patients, including three patients who had preoperative cerebral infarction or unconsciousness, had major neurologic dysfunction (16.6%). Conclusion: When direct aortic cannulation is not feasible for ascending aorta and aortic arch replacement, the right brachial and femoral artery can be used as arterial perfusion routes with the patient under moderate hypothermia. This technique resulted in acceptable outcomes.

• Biomolecules & Therapeutics
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• 제22권3호
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• pp.223-231
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• 2014

In this study, we prepared cordycepin-enriched (CE)-WIB801C, a n-butanol extract of Cordyceps militaris-hypha, and investigated the effect of CE-WIB801C on collagen-induced human platelet aggregation. CE-WIB801C dose-dependently inhibited collagen-induced platelet aggregation, and its $IC_{50}$ value was $175{\mu}g/ml$. CE-WIB801C increased cAMP level more than cGMP level, but inhibited collagen-elevated $[CA^{2+}]_i$ mobilization and thromboxane $A_2$ ($TXA_2$) production. cAMP-dependent protein kinase (A-kinase) inhibitor Rp-8-Br-cAMPS increased the CE-WIB801C-downregulated $[CA^{2+}]_i$ level in a dose dependent manner, and strongly inhibited CE-WIB801C-induced inositol 1, 4, 5-trisphosphate receptor ($IP_3R$) phosphorylation. These results suggest that the inhibition of $[CA^{2+}]_i$ mobilization by CE-WIB801C is resulted from the cAMP/A-kinase-dependent phosphorylation of $IP_3R$. CE-WIB801C suppressed $TXA_2$ production, but did not inhibit the activities of cyclooxygenase-1 (COX-1) and $TXA_2$ synthase (TXAS). These results suggest that the inhibition of $TXA_2$ production by WIB801C is not resulted from the direct inhibition of COX-1 and TXAS. In this study, we demonstrate that CE-WIB801C with cAMP-dependent $CA^{2+}$-antagonistic antiplatelet effects may have preventive or therapeutic potential for platelet aggregation-mediated diseases, such as thrombosis, myocardial infarction, atherosclerosis, and ischemic cerebrovascular disease.

• Journal of Chest Surgery
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• 제32권1호
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• pp.70-74
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• 1999

승모판의 기계판막치환술 후 판막이나 좌심방 내 혈전증은 판막 기능장애나 혈전색전증을 일으킨다. 조기 진단과 적절한 치료는 중요하지만 임상에서 쉽지 않다. 혈전용해 치료는 혈전증으로 인한 재수술의 위험성을 줄일 수 있어 혈전증 치료에 적절한 한 방법이 될 수 있다. 본 보고는 저분자량 헤파린과 와파린으로 혈전용해 치료를 한 3명의 환자를 보고하고자 하였다. 한 명의 임산부를 포함한 2명의 환자는 판막 혈전증으로 인한 판막폐쇄와 개폐운동 장애가 있었고 다른 한 명은 내원 5일전 혈전색전증으로 뇌경색이 발생한 좌심방내 혈전증 환자였다. 환자들은 프락시파린 0.3cc (7,500 ICU AXa)을 하루에 2∼3번씩 피하로 투여하여 치료를 받았다. 퇴원 당시 판막과 좌심방 내 혈전은 완전히 혹은 거의 완전히 용해되었고 판막의 개폐운동은 정상이었다. 혈전용해 때부터 외래 추적 기간동안 특별한 부작용은 없었다.

• 대한핵의학회지
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• 제28권1호
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• pp.17-21
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• 1994

경련을 주소로 내원하여 뇌혈류 SPECT와 MRI 또는 CT, 뇌파도가 시행되었던 115명을 대상으로 경련의 원인과 뇌혈류 SPECT의 유형을 비교하고자 하였다. 대상환자 115명중 28명이 기질적인 원인에 의한 경련이었으며 42명이 전신성 경련, 45명이 부분적 발작이었다. 전신성 경련환자의 뇌혈류 SPECT 유형은 22명이 정상이었고 8명이 미만성의 혈류감소, 4명이 전두엽, 5명이 측두엽, 3명이 전두엽과 측두엽에 걸친 혈류감소를 보였다. 부분적 발작환자 54명중 19명이 뇌파도와 일치하는 부위에 혈류감소를 보였다. 결론적으로 간질 발작간의 뇌혈류 SPECT는 기질적인 원인을 비교적 예민하게 찾을 수 있었고, 전신성 경련환자에서는 정상이거나 육안적으로 경미한 정도의 전두엽 또는 측두엽의 혈류감소를 보였다. 이러한 혈류 감소가 전신성 경련환자와 부분적 발작 환자에서 인지기능이나 항경련제 등과의 연관성에 대해서는 더욱 연구가 되어야 할 것이다.

• 대한핵의학회지
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• 제28권1호
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• pp.22-30
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• 1994

Encephalo-duro-arterio-synangiosis (EDAS) is a relatively new surgical procedure for treatment of childhood moyamoya disease. We assessed regional cerebral perfusion in moyamoya patients before (1.3 mo) and after (6.8 mo) EDAS with $^{99m}Tc$-HMPAO brain SPECT. A total of 21 EDAS operations in 17 moyamoya patients was included. Preoperative CT or MRI showed cerebral infarction in 14 patients and carotid angiography showed Suzuki grade I to V stenosis in 6%, 9%, 62%, 12% and 12% of the hemispheres respectively. Preoperative SPECT showed regional hypoperfusion in all patients, bilateral frontal and temporal lobes being the most frequently involved site. $4{\times}4$ pixel sized ROIs were applied on the frontotemporal cortex in 3 slice averaged transverse tomographic images. An index of regional perfusion was measured as: PI (%)=average F-T activity/average cerebellar activity${\times}100$ Pre-EDAS ipsilateral PI ranged from 23.7 to 98.4% (mean: $74.3{\pm}17%$) and increased significantly after operation ($81.4{\pm}17%$, p<0.001). Individual post-EDAS PI improved in 15/21 cases, showed no significant change in 5 and was slightly aggravated in 1. The amount of clinical improvement (${\Delta}CI$) was graded with a scale of 0 to 4 based on frequency and severity of TIA attacks. When patients were grouped according to pre-EDAS PI, group II (PI 70-89) showed a significantly higher ${\Delta}CI$ (3.3) compared to group I (PI< 70, 1.57) or group III (PI >90, 0.5) (P< 0.001). The amount of perfusion improvement (${\Delta}PI$) showed significant correlation with ${\Delta}CI$ (r=0.42, p=0.04). ${\Delta}PI$ did not, however, correlate with the amount of neovascularization assessed angiographically in 8 patients. Serial HMPAO SPECT is an useful noninvasive study for assessing perfusion improvement after EDAS in childhood moyamoya patients.