• Tuberculosis and Respiratory Diseases
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• 제62권5호
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• pp.421-426
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• 2007

진행성 간질환의 합병증으로 발생하는 문맥폐고혈압은, 이차성 폐동맥고혈압 중에서 진행성 간질환에 의한 문맥고혈압과 연관된 폐동맥고혈압으로 분류되며, 독특한 임상적, 병태생리학적 특징을 보인다. 임상양상은 점진적인 운동성 호흡곤란, 흉통 등을 호소하지만, 증상 없이 우연히 발견되는 경우도 있다. 심초음파 검사를 통해 예비적으로, 우심장 도관삽입으로 직접 우심실 및 평균 폐동맥압을 측정하여 진단할 수 있다. 치료는 칼슘통로차단제, 프로스타노이드 등을 사용하지만, 근본적인 치료를 위해서는 간 및 폐이식을 고려해야 한다. 저자들은 53세 여자로 20년 전에 간경변을 진단받은 후 호흡곤란으로 내원한 환자에게서, 간경변의 원인으로 원발성 담관성 간경변을 진단하고, 호흡곤란의 원인으로 문맥폐고혈압을 진단하여 치료하였기에 문헌고찰과 함께 보고한다.

• Journal of Chest Surgery
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• 제30권7호
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• pp.733-738
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• 1997

순차적 양측 폐이식수술은 수술시 및 수술후 합병증이 매우 다양하며 수술후 결과가 매우 불량하다. 저자 등은 양측 폐 이식수술후의 혈역학적 변화를 연구관찰하고자 하였으며 수술후 발생할 수 있는 거부반 응을 예방하기 위하여 양측 폐재식수술을 선택,시행하였으며 폐동맥의 뒤틀림이나 협착, 좌심방내의 혈전발 생 등을 예방하기 위하여 폐동맥 및 좌심방 부위를 혈관감자로 폐쇄시킨 후 폐측 폐동맥의 전면을 절단하였고, 폐측 상하 폐정맥부위 좌심방 전면을 절단한 후 1시간동안 폐동맥 절단부위를 통해 PGEI이 함유된 I-C 용액을 주입하였고 1시간동안 I-C용액이 함유된 거즈를 이용하여 냉각을 유지하였다. 다시 5-0 prolene을 이 용하여 봉합하였다. 좌심방을 봉합할 때 내면이 외 전되게끔 everted suture 방법으로 봉합하였다. 주기관지는 완전 절단후 telescope방법으코 단단문합하였으며 폐재식 수술전후의 동맥혈 산소가스치, 대퇴동맥 및 폐동맥 압을 측정하여 비교하였으며 수술전후의 뚜렷한 혈역학적 변화는 없었다. 절단 결찰된 폐는 PcEl이 함유된 I-c용액을 폐동맥으로 4o cmHlo 압력으로 Is ~h입분의 속도로 총량이 70 mfg되도록 주입하\ulcorner으며 그후 1시간동안 냉각된 I-C용액이 함유된 거즈를 이용하여 절단된 폐를 감싸서 냉각저류보관하여 허혈성 손상을 예방함으로써 수술수기에 대한 합병증이 없는한 양측 폐 이식수술후 성 적은 양호할 것으로 생각된다.

• Journal of Chest Surgery
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• 제34권9호
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• pp.680-685
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• 2001

배경: 삼첨판막친환술은 매우 드물게 시행되는 수술이며 그 장기 성적은 만족치 못한 수준이다. 또한 어떤 종류의 인공판막을 사용하느냐에 대하여도 논란이 많은 상황이다. 서울대학교병원 흉부외과에서는 1989년 1월부터 1998년 12월까지 10년동안 71명의 환자에서 72례의 삼첨판막 치환술을 시행하였으며 이 결과를 토대로 장단기 성적과 위험요인들을 분석하였다. 대상 및 방법: 평균나이는 42$\pm$13세(16~65세)였으며 남여비는 32/39였다. 술전진단은 50례의 후천성판막질환과 18례의 선천성심장질환이 있었고 삼첨판폐쇄부전만 단독으로 있었던 경우도 4례 있었다. 사용된 인공판막은 기계판막이 69개, 조직판막이 3개였다. 승모판막치환술 또는 대동맥판막치환술과 같이 시행된 경우는 50례였고 1례에서는 폐동맥판막 치환술이 같이 시행되었다. 결과: 조기사망은 7례(9.7%), 만기사망은 7례(13.0%)였고 10년 생존율은 59.2$\pm$7.2%였다. 삼천판막혈전증은 5례에서 11번에 결쳐 발생하였으며 그중 1례는 재수술을 시행받았다. 생존자들의 대부분은 심장기능분류 I-II의 상태로 현재까지 외래 추적관찰중이다. 결론: 삼첨판막치환술은 비록 혈전증등의 위험이 상존하기는 하지만 비교적 낮은 사망률과 이환율을 보이고 있으며 기계판막의 경우에도 조직판막과 비교하여 큰 차이 없이 좋은 장기성적을 얻을 수 있었다.

• Tuberculosis and Respiratory Diseases
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• 제44권5호
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• pp.1114-1124
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• 1997

연구배경 : Endothelin(이하 ET로 약함)은 폐혈관 내피세포에서 생산되며 강한 혈관 수축작용이 있는 peptide이다. 일차성 폐동맥고혈압과 급성 폐동맥색전증 환자의 혈장내 ET이 증가하고 이들 질환에서의 심폐기능장애에 ET이 중요한 역할을 하리라고 추측되나 ET증가의 기전에 대해서는 알려진 바 없다. 이들 두 질환은 모두 혈전증이 중요한 병태생리 소견이므로 저자들은 혈소판과 활성화된 혈소판에서 유리된 매개체들이 폐혈관 내피세포에서 ET 생산을 증가시킬 것이라고 가정하고 이를 확인하기 위하여 연구를 시행하였다. 방 법 : 소 폐동맥내피세포 배양배지에 혈소판, thrombin(0.1~10u/ml), transforming growth factor-${\beta}1$(TGF-${\beta}1$, 1-1000pM), serotonin(1-100uM), 및 내독소(1ug/ml)를 첨가한 후 18시간 배양하여 배지내로 유리된 immunoreactive ET(이하 ir-ET로 약함)을 방사선면역측정법으로 정량분석 하였다. 결과 : 소 폐동맥내피세포 배양 상청액내 ir-ET은 배양 시간에 비례하여 증가하였으며 혈소판 $10^8/ml$을 첨가한 군에서는 배양 8시간 및 18시간 후에 대조배지군에 비해 유의하게 높았다(p<0.05). 혈소판 첨가군에서 배양 상청액내 ir-ET은 혈소판의 수가 증가함에 따라 증가하는 경향을 보였고 $10^8/ml$에서는 대조배지군에 비해 유의하게 높았다 (0<0.05). Ir-ET를 증가시키지 않는 혈소판 ($10^7/ml$)에 ir-ET을 유의하게 증가시키지 않는 농도의 thrombin (0.1u/ml) 또는 내독소(1ug/ml)를 각각 첨가한 군에서 배양 상청액내 ir-ET은 배지 대조군과 단독 첨가군 (thrombin 0.1u/ml, 내독소 1ug/ml)에 비해 각각 유의하게 높았다(p<0.05). 소 폐동맥내피세포 배양 상청액내 ir-ET은 thrombin(1-10ug/ml), TGF-${\beta}1$(100-1000pM) 첨가군에서 각각 대조배지군에 비해 유의하게 높았으며 (p<0.05), serotonin(1-100uM) 첨가군은 대조배지군파 유의한 차이가 없었다. 결 론 : 소 폐동맥 내피세포에서 ET 생산을 자극하며 그 기전은 혈소판과 활성화된 혈소판에서 유리되는 TGF-${\beta}1$ 등의 매개물에 의한 내피세포의 자극으로 생각되며 이외에 혈소판에 의한 내피세포의 ET 생산 반응 조절(priming) 가능성도 추측할 수 있다.

• Journal of Chest Surgery
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• 제32권12호
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• pp.1065-1077
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• 1999

Background : Ventricular assist devices(VADs) are being used for patients in postcvardiotomy cardiogenic shock status bridge to cardiac transplant settings and in post-myocardial infarction cardiogenic shock. The VAD which was developed at the Deparment of medical engineering in Dankook University College of Medicine was a pneumatically driven device and can maintain pulsatile flow. The goal of this study is to develop animal experimental models using the VAD and to clarify the reliability and hemodynamic property adequacy of end organ perfusion durability and severity of thrombotic-hemolytic tendency of the device. Material and Method : The pneumatic VAD was applied to 8 adult female lambs, We examined some hemodynamic parameters such as arterial blood pressure pulmonary capillary wedge pressure(pcwp) pulmonary artery pressure(PAP) left atrial pressure hour urine output cardiac index VAD flow EKG to determine the reliability of the VAD and hemodynamic compatibility of the experimental animals within 24 hours of experiment. We also observed the end organ perfusion durability of the VAD and thrombotic-hemolytic property of the VAD after 24 hours of VAD insertion. Result: We could monitor all hemodynamic parameters including pcwp PAP cardiac index EKG, adn hour urine as true clinical settings. We observed that the reliability of the VAD was excellent and the hemodynamic property of the experimental animal and end organ perfusion were adequate within 24 hours of experiment. In four lambs surviving 24 hours after insertion the reliability of the VAD and end organ perfusion were excellent and no thrombotic-hemolytic tendency was noted. However after 15 days of experiment the diaphragm of the VAD was torn and it was recommende that the durability of the VAD should be extended. Conclusion : e conclude that the pneumatic VAD developed at Dankook University Biomedical Engineering has good hemodynamic property and low thromboembolic tendency and presents adequate end organ perfusion but we noted that the durability of the device should be expanded further. It will be possible to do more reliable experiment in the future according to the animal experimental method developed in this study especially with the heart failure models.

• 한국한의학연구원논문집
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• 제11권2호
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• pp.97-111
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• 2005

This study was performed to evaluate anti-thrombotic activities and anti-inflammatory effects of ChungyeolHaedogHwaeoTang water extract(CHHT). The results were summarized as follows. In experiment of anti-thrombotic effect; 1. CHHT inhibited human platelet aggregation induced by ADP and epinephrine as compared with the control group, and inhibited pulmonary embolism induced by collagen and epinephrine (inhibitory rate is 37.5%). 2. CHHT increased platelet number significantly, and also CHHT shortened PT and APTT significantly as compared with the control group in thrombus model induced by dextran. In experiment of anti-inflammatory effect; 3. CHHT inhibited $IL-1{\beta}$, IL-6, TNF-${\alpha}$, COX-2 and NOS-II mRNA expression as compared with the control group in a concentration-dependent degree, and inhibited NO production significantly at 50, 100 ${\mu}g/ml$, and also inhibited ROS production in a concentration-dependent degree as compared with the control of group in RAW 264.7 cell line. 4. CHHT inhibited $IL-1{\beta}$, IL-6 and TNF-${\alpha}$ production significantly in serum of acute inflammation-induced mice, and decreased $IL-1{\beta}$, IL-6 and TNF-${\alpha}$ production in spleen tissue, and also decreased $IL-1{\beta}$, and IL-6 production in liver tissue, but increased TNF-${\alpha}$ production in liver tissue of acute inflammation-induced Balb/c mice. 5. CHHT increased survival rate from the 3rd day in ICR mice with lethal endotoxemia induced by LPS. These results suggest that CHHT can be useful in treating diverse female diseases caused by thrombosis and inflammation such as menstrual pain, menstrual disorder, leukorrhea, vaginitis, cervicitis, pelvic inflammatory disease and so on.

• 대한한방부인과학회지
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• 제19권3호
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• pp.151-173
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• 2006

Purpose : This study was performed to evaluate anti-thrombotic and anti-inflammatory effects of BokbangHongdeungPaejangSan water extract (BHPS). Methods : BHPS was investigated using cultured cells and a murine models. As for the parameters of inflammation, levels of several inflammatory cytokines and chemical mediators which are known to be related to inflammation were determined in mouse lung fibroblast cells (mLFC) and RAW 264.7 cells. Results : In experiment of anti-thrombotic effect, BHPS inhibited the platelet aggregation induced by ADP and epinephrine, and inhibited pulmonary embolism induced by collagen and epinephrine. BHPS increased Platelet number and fibrinogen amount, and shortened PT and APTT in thrombus model induced by dextran. In experiment of anti-inflammatory effect, BHPS inhibited IL-1${\beta}$, IL-6, TNF-${\alpha}$, COX-2 and NOS-II mRNA expression in a concentration-dependent manner in RAW 264.7 cell line, and inhibited significantly NO production at 50, 100 ${\mu}g/ml$, and also inhibited ROS production in a concentration-dependent manner. BHPS inhibited IL-1${\beta}$, IL-6 and TNF-${\alpha}$ production significantly in serum of acute inflammation-induced Balb/c mice, and decreased IL-1${\beta}$, IL-6 and TNF-${\alpha}$ production in spleen tissue, but increased IL-1${\beta}$, IL-6 and TNF-${\alpha}$ production in liver tissue. BHPS increased survival rate at the 3th day in ICR mice with lethal endotoxemia induced by LPS. Conclusion : These results suggest that BHPS can be used for treating diverse female diseases caused by thrombosis and inflammation such as endometriosis, pelvic pain, cervicitis, pelvic inflammatory disease and pelvic tuberculosis and so forth.

• 간호행정학회지
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• 제23권1호
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• pp.63-75
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• 2017

Purpose: This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience. Methods: An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol. Results: There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention. Conclusion: Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.

• 대한의용생체공학회:의공학회지
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• 제39권1호
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• pp.36-42
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• 2018

The risk of venous thromboembolism (VTE) is known higher in cancer patients and lower incidence in the east country. This study was conducted in order to check the incidence rate of VTE in the Korean high risk patients who are treated in the intensive care unit (ICU), and to verify the correlation of the incidence of VTE and prophylaxis methods. This study was conducted as a retrospective study for 492 cancer patients from April 2011 to December 2014. According to the medical records of subjects, their prophylaxis methods and the incidence of VTE were surveyed and then correlation of them was investigated with statistical methods. 385 patients met the inclusion criteria. VTE occrred in 17 of them (4.4%). The prophylaxis methods are consisted of medical method (136 subjects), mechnical method(33 subjects), and medical & mechnkcal method (124 subjects). VTE occurred in 14 patients (4.8%) from 293 patients (76%) who were given at least one prophylaxis method. From all of 93 patients without prophylaxis, three patients experienced VTE (3.3%). The target patients were high risk in VTE, but the incidence rate of VTE was lower than reported in previous studies. The reason of this is considered that more active prophylaxis intervention was applied to the subjects because of their high risk status. As a result, it is considered that in the high risk patients, it would be effective to apply active and complex prophylaxis intervention for the prevention of VTE.

• Archives of Plastic Surgery
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• 제43권4호
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• pp.352-359
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• 2016

Background The objective of this study was to develop a new surgical technique by combining traditional abdominoplasty with liposuction. This combination of operations permits simpler and more accurate management of various abdominal deformities. In lipoabdominoplasty, the combination of techniques is of paramount concern. Herein, we introduce a new combination of liposuction and abdominoplasty using deep-plane flap sliding to maximize the benefits of both techniques. Methods Deep-plane lipoabdominoplasty was performed in 143 patients between January 2007 and May 2014. We applied extensive liposuction on the entire abdomen followed by a sliding flap through the deep plane after repairing the diastasis recti. The abdominal wound closure was completed with repair of Scarpa's fascia. Results The average amount of liposuction aspirate was 1,400 mL (700-3,100 mL), and the size of the average excised skin ellipse was $21.78{\times}12.81cm$ (from $15{\times}10$ to $25{\times}15cm$). There were no major complications such as deep-vein thrombosis or pulmonary embolism. We encountered 22 cases of minor complications: one wound infection, one case of skin necrosis, two cases of undercorrection, nine hypertrophic scars, and nine seromas. These complications were solved by conservative management or simple revision. Conclusions The use of deep-plane lipoabdominoplasty can correct abdominal deformities more effectively and with fewer complications than traditional abdominoplasty.