• 대한약리학회지
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• 제26권1호
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• pp.25-33
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• 1990

가토의 적출동맥평활근 절편에 대한 peptide YY(PYY)의 수축작용을 관찰하고, PYY의 수축기전상 동원되는 칼슘의 기원을 조사하여 다음과 같은 결과를 얻었다. 각 동맥의 나선형 절편은 PYY의 실험조내 첨가에 의하여 농도의존적인 수축반응을 보였다. 그중 대퇴동맥이 가장 강력하고 예민한 수축경향을 보였으며, 그 다음은 대뇌의 기저동맥, 총장골동맥, 상장간막동맥, 신동맥, 총경동맥의 순으로 예민하였다. PYY에 대한 반응성을 Norepinephrine(NE)에 대한 반응성과 비교해볼때, 총경동맥과 신동맥은 PYY보다 NE에 대해서 유의하게 $(p{\leqslant}0.05)$예민하였고, 기저동맥은 NE보다 PYY에 더 예민하였다$(p{\leqslant}0.05)$. 대퇴동맥 절편에서 칼슘통로봉쇄제인 verapamil과 세포내 저장칼슘유리를 억제하는 3,4,5-Trimethoxybenzoic acid 8-(diethylamino)octyl ester ${\ulcorner}TMB-8{\lrcorner}$는 각각 PYY에 의한 수축을 억제하였는데 $(p{\leqslant}0.05)$, verapamil과 TMB-8이 동시에 존재할 때는 PYY에 의한 수축은 거의 완전히 억제되었고, ethyleneglycol-bis-(beta-aminoethyl ether), N,N,N‘,N’-tetraacetic acid${\ulcorner}EGTA{\lrcorner}$0.5mM를 첨가한 칼슘배제용액 내에서도 PYY에 의한 수축은 거의 완전히 억압되었다. 이상의 결과를 종합하면, 혈중 PYY가 증가했을 때는 교감신경계흥분시보다 강한 뇌혈관의 수축이 일어날 수 있으며, 뇌동맥압은 교감신경계 흥분시보다 더 높을 수가 있으리라 추정된다. 또 PYY에 의한 혈관 평활근 수축에는 세포외액의 칼슘과 세포내저장칼슘의 이용이 공히 필수적이라고 생각된다.

• Advances in pediatric surgery
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• 제16권2호
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• pp.154-161
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• 2010

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The anomaly is characterized by absence of communication with the tracheobronchial tree and isolated blood supply from an anomalous systemic vessels. With the utilization of antenatal ultrasound, the diagnosis of asymptomatic neonatal PS has increased. Treatment options include observation, arterial embolization and surgical resection. The aim of the present study is to review the clinical course of PS and to share our experience with thoracoscopic resection. A total of 96 patients with PS were treated at Asan Children's Hospital between 1999 and 2010. The diagnosis of PS was established by CT in the cases managed by observation or embolization, and by tissue pathology in the surgical cases. Medical records and radiographic images were retrospectively reviewed. Thirty-nine patients were managed by embolization and 30 patients by surgery. The remaining 27 patients have been under observation without any procedures. Among 27 observation patients, 1 patient regressed completely and 10 patients were lost to follow up. Of the 39 embolizations patients, 2 had their lesion regress and sepsis was suspected after embolization. In 1 patient, the microcoil migrated to the iliac artery during the embolization procedure, and another patient developed renal abscess caused by renal artery embolization. Among 30 surgical cases, resection by thoracotomy was performed in 27 at the Department of Thoracic Surgery, and thoracoscopic resection in 3 at the Division of Pediatric Sugery. Only one wound complication ocurred. We conclud that surgical excision should be recommended for pulmonary sequestration, whether the sequestration is symptomatic or not because of the risk of infection, the low rate of natural regress, poor compliance, severe complications after embolization, and to exclude other pathology. In summary, thoracoscopic resection of the pulmonary sequestration is feasible, efficacious, safe and cosmetically superior even in neonatal period.

• The Korean Journal of Physiology
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• 제30권1호
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• pp.33-41
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• 1996

The present study was aimed to investigate the role of endothelium-derived nitric oxide (NO) in the control of renin release and to examine if NO is implicated in the development of two-kidney, one clip (2K1C) hypertension. Male Sprague-Dawley rats $(150{\sim}200\; g)$ were constricted at the left renal artery. They were then supplemented with $N^{G}-nitro-L-arginine\;methyl\;ester\;(L-NAME,\; 5mg/100\;mL)$ or with L-arginine hydrochloride (400 mg/100 mL) in the drinking water. The control group was supplied with normal tap water. The sham-clipped rats were operated as in 2K1C rats except for that no clip was made. The kidneys were taken to examine in vitro release of renin at days 7 and 14 following clipping the renal artery. Northern blot analysis was also done to assess the expression of renin gene in the kidney. In sham-clipped rats, L-NAME caused a sustained increase of the blood pressure, whereas L-arginine was without effect. Neither L-NAME nor L-arginine-supplementation significantly affected the development of hypertension in 2K1C rats. Plasma renin concentration (PRC) measured on day 28 did not significantly differ among the L-NAME, L-arginine and control groups either in 2K1C or in sham-clipped rats. Renin contents (RRC) in the clipped kidney were increased, while those in the contralateral kidney were decreased. The release of renin in vitro from cortical slices was also enhanced in the clipped kidney, whereas it was attenuated in the contralateral. Comparing the RRC and in vitro release, the latter was more rapidly decreased than the former in the contralateral kidney. The renin mRNA levels in the contralateral kidney were almost at their nadir at days 7 and 14 in 2K1C rats. It is suggested that NO does not affect the development of 2K1C hypertension in which the renin-angiotensin system has been activated. The data also confirm that RRC and renin gene expression are increased in the clipped kidney and suppressed in the contralateral kidney in 2K1C rats.

• Journal of Chest Surgery
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• 제34권4호
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• pp.338-344
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• 2001

배경: 말기 신부전 환자에서 심장병, 특히 관상 동맥 질환의 이환이 늘어나면서 관상동맥 우회수술의 대상 환자가 지속적으로 증가하고 있다. 이들 환자군은 수술후 유병률과 사망률이 매우 높고 고위험군으로 알려져 있다. 대상 및 방법: 1996년 3월부터 2000년 5우러까지 서울 중앙 병원 흉부외과에서 술전 말기 신부전증으로 진단 받은 후 관상 동맥 우회수술을 시행받은 환자 25명을 대상으로 의무 기록을 중심의 후향적 분석을 하였다. 술전 위험 인자 및 술전 신기능, 수술 결과, 술후 경과, 수술후 합병증, 사망률 및 생존률 등을 분석하였다. 결과: 술전 평균 크레아티닌 청소율은 12.7$\pm$5ml/mim였고 술전 평균 혈중 크레아티닌 치는 6.2$\pm$3mg/dl(1.7-14.4)였다. 술전 투석을 시행중인 환자는 11례(44%)였고 술전 투석을 시행하지 않았던 14례(56%)중 8례(8/14, 57.1%)는 수술전후로 새로이 투석이 필요하였다. 술전 혈액 투석 중이었던 9례중 2례에서 수술후 복막 투석으로 전환하였다. 수술 사망률은 2례(8%)로 흡인성 폐렴과 종격동염으로 1례, 그리고 수술후 출형과 종격도염으로 1례가 사망하였다. 수술후 합병증은 14명(56%)의 환자에서 발생하여 매우 높은 발생율을 보였다. 만기사항은 2례(8%)에서 발생하였으며 사망원인은 카테터에 의한 복막염이었다. 생존 환자의 4년 생존률은 82$\pm$13% 였다. 결론: 말기 신부전 환자에서의 관상동맥 우회수술을 비교적 만족스러운 범위의 수술 사망률(8%)을 보였으나 합병증 발생률이 매우 높고 합병증 발생 시 사망률이 매우 높아 수술주위 감염 예방과 세심한 환자 관리가 필요하다.

• Journal of Chest Surgery
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• 제37권7호
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• pp.553-558
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• 2004

심장 박동상태에서 시행하는 관상동맥우회술(off-pump CABG)은 심폐체외순환하에서 시행하는 관상동맥우회술(on-pump CABG)에 비해 수술 후 유병률을 줄일 수 있는 방법으로 보고되고 있다. 저자들은 특히 수술 후 합병증의 발생 가능성이 높은 당뇨환자에 있어서 off-pump CABG와 on-pump CABG의 임상 결과를 비교하여 off-pump CABG가 당뇨환자의 유병률에 미치는 영향을 알아보고자 한다. 대상 및 방법: 2001년 1월부터 2003년 6월까지 연세대학교 심장혈관병원에서 관상동맥우회출만을 시행받은 682명(off-pump CABG군: 424명, on-pump CABG: 258명)의 환자들 중 당뇨가 있는 환자 244명을 대상으로 하였다. 이 중 off-pump CABG는 154명, on-pump CABG는 90명의 환자들에서 시행하였다. 이 환자들을 대상으로 수술 전 위험요소들과 수술 후 결과를 비교하였다. 결과: 연령, 남녀 비 및 수술 전 고혈압 등의 위험요소와, 수술 전 뇌경색이나 심근경색의 기왕력 등 수술위험 요소도 두 군간의 통계적인 차이를 보이지 않았다. 이식편수는 on-pump CABG에서 유의하게 많았으나, 수술 시간은 off-pump CABG에서 통계적으로 유의하게 짧았고, 수술 후 강심제 사용빈도는 off-pump CABG에서 유의하게 낮았다. 수술 사망은 차이가 없었으며, 수술 후 측정한 CK-MB, 중환자실 인원기간 및 호흡기 사용시간은 off-pump CABG에서 통계적으로 유의하게 낮았다. 그러나 출혈로 인한 재수술, 수술 후 심근경색증, 감염, 신부전증, 신경학적 합병증 및 수술 후 입원 기간 등은 두 군간에 통제적 유의성이 없었다. 결론: 당뇨환자에서 시행한 off-pump CABG는 on-pump CABG에 비해 심근의 손상이 적으면서 수술 후 회복이 빨랐다. 따라서 두 방법 모두 좋은 결과를 보여 주었으나, off-pump CABG가 당뇨환자에서 좀 더 효과적인 수술 방법이라고 생각한다. 그러나 전향적인 연구 등 더 많은 연구가 필요하리라 생각한다.

• 대한영상의학회지
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• 제83권3호
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• pp.658-668
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• 2022

목적 혈액투석경로의 기능부전에 대한 인터벤션 치료 시 경요골 동맥 접근법의 유용성을 연구하고자 한다. 대상과 방법 2008년 1월부터 2019년 4월까지 73명의 환자에서(남성 43명, 여성 30명, 평균 연령 67.4세; 범위 42-92세) 경요골 동맥 접근법을 이용한 시술을 시행한 환자들에 대해 후향적 연구를 시행하였다. 환자들의 기본적인 특성과 병변의 특성, 경요골 동맥 접근을 통한 인터벤션 시술의 기술적 및 임상적 성공률, 시술과 연관된 합병증에 대해 조사하였고 장기 개통성에 대해서는 카플란-마이어 방법을 이용하여 분석하였다. 결과 모든 환자에서 요골 동맥을 통한 혈관조영술을 성공적으로 시행하였고, 기술적 성공률은 98.6%(72/73), 임상적 성공률은 91.7%(67/73)였다. 일차적 개통률의 중앙값은 18.8 ± 15.9개월이었고, 3, 6, 12개월 누적 개통률은 각각 82.1%, 68.6%, 그리고 63.9%였다. 모든 환자에서 손의 허혈과 같은 주요한 합병증은 발생하지 않았으며 경요골 동맥 천자와 연관한 즉각적인 합병증 또한 발생하지 않았다. 결론 혈액투석경로 기능 부전 환자에서 경요골 동맥 접근법을 통한 인터벤션 시술은 안전하고 임상적으로 유용한 방법으로 생각된다. 또한 선별된 환자에서 전통적인 경정맥 접근법에 대해 대안으로 기능할 수 있을 것으로 생각된다.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.256-266
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• 2020

Purpose: This study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer. Materials and Methods: Forty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured. The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index. Results: The postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013-0.649; P=0.017). Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy. Conclusions: Early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.

• Korean Journal of Acupuncture
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• 제25권2호
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• pp.199-210
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• 2008

Objectives : This study was performed to investigate the effect of invasive laser acupuncture therapy with green light (LAT-G) at HT7(Sinmun), SP3(Taebaek) on the blood pressure in hypertensive rat induced by two kidney one clip. Methods : The experiments were performed on Sprague Dawley rats. 2K1C hypertension model was prepared by constricting the left renal artery with a sliver clip. Animals were divided into four groups, which were simple acupuncture treatment group with straight needle insertion on the square(AT-SS), acupuncture treatment group with reducing manipulation in the opposite channel direction(AT-RD), laser acupuncture treatment group with green light 532 nm, 10mW power in the opposite channel direction(LAT-G10) and laser acupuncture treatment group with green light 532 nm, 20mW power in the opposite channel direction(LAT-G20). The treatments were performed once per two days for 10 days. Results : Body weight was increased significantly in LAT-G20 group compared with AT-RD group. The blood pressure was significantly decreased in LAT-G20 and LAT-G10 groups compared with AT-SS group. Conclusions : These results suggest that green laser acupuncture therapy at SP3 ${\cdot}$ HT7 is more effective than straight needle insertion on the square for controlling hypertension. It is possible that invasive green laser acupuncture therapy (532 nm) can be used as a reducing method of the traditional acupuncture techniques.

• The Korean Journal of Physiology
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• 제28권2호
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• pp.225-231
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• 1994

The present study was undertaken to investigate the role of endogenous nitric oxide in renin release under different physiological conditions. In the first series of experiments, renin release was either inhibited by acute volume-expansion (VE) or stimulated by clipping one renal artery in the rat. VE was induced by intravenous infusion of saline (0.9% NaCl) up to 5% of the body weight over 45 min under thiopental (50 mg/kg, IP) anesthesia. VE caused a decrease of plasma renin concentration (PRC). With $N^G-nitro-L-arginine$ methyl ester $(L-NAME,\;5\;{\mu}g/kg\;per\;min)$ superadded to VE, PRC decreased further. The magnitude of increase in plasma atrial natriuretic peptide levels following VE was not affected by the L-NAME. In two-kidney, one clip rats, L-NAME-supplementation resulted in a decrease, and L-arginine-supplementation an increase of PRC. Plasma atrial natriuretic peptide levels were significantly lower in the L-arginine group than in the control. Blood pressure did not differ among the L-NAME, L-arginine, and control groups. In another series of experiments, the renin response to a blockade of NO synthesis was examined using in vitro preparations from isolated renal cortex. L-NAME significantly increased basal renin release, although it was without effect on the isoproterenol-stimulated release. These findings suggest that endogenous nitric oxide significantly contributes to the renin release. Since many factors may affect the renin release in vivo, an interaction between NO and renin under various pathophysiological states is to be further defined.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1017-1022
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• 1999

Background: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. Material and Method: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. Result: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. Conclusion: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.