• Journal of Chest Surgery
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• 제12권3호
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제12권3호
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• 한국임상수의학회지
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• 제33권1호
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• pp.6-9
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• 2016

Bronchoarterial (BA) ratio is a commonly used criterion to define airway dilatation despite the lack of normative human and animals. The objective of our study was to compare the range of normal bronchial to accompanying arterial diameter ratio with previous reports on CT scan of the thorax in dogs and assess influence anesthetics on BA ratio in dogs. Dogs undergoing multidetector CT scan of the chest for nonpulmonary conditions at a single center were prospectively identified. High-resolution reconstruction was performed on those included and both airway lumen and vessel diameters were measured in the lobar bronchi of the left cranial (cranial and caudal parts), right cranial, right middle, left caudal, and right caudal lung lobes. Eight dog were included; Mean of the mean BA ratios was $1.43{\pm}0.24$ (95% CI = 1.36 - 1.50) in inhalation anesthetic group. In propofol group, the mean of the mean BA ratios was $1.13{\pm}0.29$ (95% CI = 1.04 - 1.22). In medetomidine group, the mean of the mean BA ratios was $0.89{\pm}0.19$ (95% CI = 0.83 - 0.95). Comparing individual lobes within anesthetic category, there was no signicant difference in mean BA ratio between lung lobes or between dog according to inhalation, propofol, and medetomidine group (P = 0.630, P = 0.878, and P = 0.508, respectively). The BA ratio in these clinically normal dogs was consistent and may be a useful tool in evaluating for bronchiectasis on CT images. However, some different criteria for bronchiectasis were applied by the anesthetic methods.

• 한국산학기술학회논문지
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• 제10권11호
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• pp.3418-3426
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• 2009

본 연구의 목적은 비외상성 심정지 환자에게 적용하는 심폐소생술에 대한 현장업무 프로토콜의 유용성을 검증하는 것이다. 연구는 2008년 5월 1일부터 동년 6월 27일까지, 전라남도와 전라북도에 소재한 J, K대학에 재학 중인 응급구조과 학생 150명을 대상으로 하였다. 비동등성 대조군 전.후 유사 실험 설계(nonequivalent control group pretest-posttest design)를 사용하여, 실무적합성 검증을 실시하였다. 현장업무 프로토콜을 적용한 실험군과 기존의 심폐소생술을 적용한 대조군으로 나누어, 각 프로토콜 항목들의 소요시간을 비교하여 통계 분석하였다. 연구 결과, 5개항목(의식상태 평가, 기도유지, 인공호,,흡 2회 실시, 순환 확인, 심폐소생술 5주기 실시)을 제외한 나머지 18개 항목에서 3초 이상 수행시간이 단축되었다. 60초 이상의 단축을 보인 항목은 6개로, 기관삽관 튜브 고정(78.70초), 말초정맥로 확보(64.45초), 의식상태 재평가, 동공반사 확인(110.05초), 목동맥 확인(112. 55초), 활력징후 평가(85.7초)였으며, 전체시간은 110.85초가 단축되었다. 실험군과 대조군의 프로토콜 적용에 따른 사전.사후 변화에서 전체시간(t=-6.580, p=.000)은 통계학적으로 유의하게 감소한 것으로 나타났다. 따라서 비외상성 심정지 환자의 심폐소생술에 대한 현장업무 프로토콜은 정확하고 신속한 의사결정을 지원할 수 있는 지침으로 활용될 수 있으며 응급의료 서비스를 향상시킬 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제73권2호
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• pp.107-114
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• 2012

Background: This study attempted to investigate the main causes of hemoptysis, the type of examinations used for diagnosis, the treatment modalities and outcomes. Methods: A retrospective study was conducted on the medical records of 221 patients admitted to the Chonnam National University Hospital, between January 2005 and February 2010, with hemoptysis. Results: Bronchiectasis (32.6%), active pulmonary tuberculosis (18.5%), fungus ball (10.8%), and lung cancer (5.9%) accounted for most causes of hemoptysis. Computed tomography scan was the most sensitive diagnostic test when employed alone, with positive yield of 93.2%. There were 161 cases of conservative treatment (72.9%), 42 cases of bronchial artery embolization (BAE) (19.0%), and 18 cases of surgery (8.1%). Regarding the amount of hemoptysis, 70 cases, out of 221 cases, were mild (31.5%), 36 cases moderate (16.2%), and 115 cases massive hemoptysis (52.0%). Most of the patients were treated conservatively, but if there was more bleeding present, BAE or surgery was more commonly performed than the conservative treatment ($p{\leq}0.0001$). In the multivariate model, severe hemoptysis and lung cancer were independently associated with short-term recurrence. BAE was independently associated with long-term recurrence, and lung cancer was associated with in-hospital mortality. The overall in-hospital mortality rate was 11.3%. Conclusion: Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with malignancy had a poorer prognosis. In-hospital mortality was strongly related to the cause, especially in lung cancer.

• Tuberculosis and Respiratory Diseases
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• 제63권5호
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• pp.449-453
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• 2007

항암제 치료 등을 위해서 피하매몰 중심정맥포트를 유치한 환자에서 도관 골절 및 원위부의 색전증은 드물게 발생하는 합병증으로 일반적인 경우는 경피적으로 도관의 제거가 가능하나, 임상의사들이 미리 이러한 합병증을 예측할 수 있는 임상적 및 방사선학적인 소견을 인지하고 조기에 발견하여 올바른 처치를 하는 것이 중요하며, 이러한 합병증을 예방하기 위한 방법 등에 대해서 숙지하는 것이 필요하다.

• Tuberculosis and Respiratory Diseases
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• 제50권1호
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• pp.122-126
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• 2001

저자들은 신경섬유종증 환자에서 우측 내유동맥에 생긴 가성동맥류의 파열로 인한 자연 혈흉을 진단하고 혈관색전술로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 한국자원식물학회지
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• 제21권5호
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• pp.395-401
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• 2008

Flavonoid는 거의 모든 야채와 과일에 함유된 주요한 구성 성분이며 flavonol은 flavonoid 그룹 중 하나로 우리가 식품으로 섭취하는 대표적인 성분으로는 kaempferol과 quercetin이 알려져 있다. kaempferol과 auercetin은 퇴행성질병의 예방에 효과가 있다고 알려져 있어 식품 첨가물로 사용되고 있다. 본 연구의 목적은 항산화제로도 알려진 kaempferol과 quercetin을 이용하여 다양한 농도에서의 소의 폐혈관내피 세포주에 대한 각각의 산화스트레스 보호효과와 두 가지 물질의 동시 처리 시에 나타날 수 있는 상승효과를 밝히기 위함이다. 1 mM의 $H_{2}O_{2}$를 처리하여 산화스트레스를 가한 세포나 가하지 아니한 세포에서나 모두 kaempferol과 quercetin의 처리로 세포의 활성도가 높았다. 그러나 특히 산화스트레스를 가한 세포에서 항산화물의 산화스트레스 극복효과가 현저하게 나타났다. 항산화물의 농도가 고농도의 경우 오히려 증가된 세포활성도가 저하되는 반응을 보여 너무 높은 농도의 처리는 오히려 항산화효과를 억제할 수 있음을 알 수 있었다. 일반적으로 우리가 섭취하는 식품에는 kaempferol과 quercetin이 함께 포함되어 있으므로 이 두 가지 물질을 일정 비율로 서로 섞은 다음 산화스트레스 처리와 함에 처리하여 조사한 결과 단독으로 처리한 결과와 달리 고농도 조건에서도 세포활성도가 아주 높게 나타났다. 이상의 결과에서 항산화물은 생체에서 일어날 수 있는 많은 산화스트레스 상태를 완화시킬 수 있으나 가장 우수한 효능을 나타낼 수 있는 적정 농도의 조사가 중요하며 특히 각각의 항산화물을 단독으로 사용하는 것 보다 함께 사용하는 것이 상승효과를 나타낼 수 있음을 알 수 있었다.

• Tuberculosis and Respiratory Diseases
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• 제54권5호
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• pp.532-541
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• 2003

연구배경 : 장의 재관류로 발생하는 급성폐손상에서 group II $PLA_2$의 억제제로 알려진 doxycyclin의 치료효과와 그 작용기전을 알아보기 위하여 본 연구를 시행하였다. 특히 장의 재관류에 의한 급성폐손상이 호중구에 의한 산화성 스트레스에 의하며 이 과정에서 group II $PLA_2$가 관여한다는 사실에 근거하여 doxycyclin의 산화성 스트레스억제를 확인하는 것이 본 연구의 목적이었다. 방법 : 체중 300g 내외의 Sprague-Dawley 흰쥐에서 상장간막동맥을 60분간 clamp한 뒤 120분간의 재관류를 시키면 급성폐손상이 유도된다. 이때 호중구에 의한 산화성스트레스가 유발되고 여기에 $PLA_2$가 관여하는 것을 관찰하기위해 lung leak, lung MPO 활성도, CeCl3 cytochemical electron microscopy, cytochrome-c reduction assay 및 lung $PLA_2$ 활성도를 측정하였다. 또한 doxycyclin의 효과를 확인하기 위하여 doxycyclin hyclate(10mg/kg)를 복강내 주사한 뒤 위에서 언급한 모든 parameter를 측정, 비교하였다. 결과 : 장의 재관류로 유도된 급성폐손상에서 doxycyclin은 폐손상을 감소시켰는데 이것은 doxycyclin에 의한 lung MPO, 산소기생성, lung $PLA_2$ 활동도의 감소에 의한 것으로 생각되었다. 결론 : 장의 재관류로 유도된 급성폐손상은 호중구에서 생성되는 산소기, 특히 $PLA_2$의 활성화에 의해 생성된 산소기에 의한 것으로 생각되며 이때 doxycyclin은 $PLA_2$를 억제하여 산화성 스트레스를 감소시킴으로서 폐손상의 감소를 가져오는 것으로 생각된다.

• Journal of Chest Surgery
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• 제29권12호
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• pp.1342-1346
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• 1996

이전에 정중흉골절개를 통해 심장 수술을 받았던 환자중 15명이 우측 개흉술을 통해 승모판 재수술을 받았다. 저자들은 승모판 재수술시 우측 개흉술을 선택하였다. 이는 유착이 없는 흉강을 통하기 때문에 심장과 주요혈관의 손상을 피할 수 있고, 상하대정맥 삽관이 용이하고, 약간의 박리로 좌우심방으로 접근이 가능하며, 수술시야가 매우 양호하기 때문이다. 또한 대부분의 심낭막을 박리하지 않기 때문에 출혈이 있을시 곧 흉관을 통해 배출되거나 흉강내로 나가심 압전을 일으킬 소지가 없다. 동맥도관의 삽관은 13예는 상행대동맥에 2예는 대퇴동맥에 했다. 정맥도관의 삽관은 초기에는 우심방을 통해 상하대정맥에 각각하고 올가미를 하였으나 후기에는 올가미 없이 삽관하거나 90$^{\circ}$각진 도관을 우심방에 단일삽관하였다. 수술중 심근보호를 위해 심정지액을 간헐적으로 사용하였고 저체온법은 저자들이 보통의 심 장수술시 주로 사용하는 25~3$0^{\circ}C$ 보다 5$^{\circ}C$ 정도 더 낮추어 시행하였다. 심실제세동은 1예는 내부패들 (Internal Paddle)을 10예는 소독된 외부패들(External Paddle)을 사용하였으며 4예에서는 체온을 높임으로 자연적으로 심박동이 돌아왔다 수술후 호흡기는 48시간 이내에 제거할 수 있었고 폐 합병증은 없었다. 1명의 환자가 술후 10일째 갑작스런 심실빈맥으로 사망하였고 나머지 14예는 합병증 없이 퇴원하였다.