• 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.

• The Korean Journal of Physiology
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• 제25권1호
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• pp.37-48
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• 1991

The characteristics of probenecid effect on renal urate excretion in the cat were studied by clearance method and compared with those in the rabbit. In the cat GFR was $3.03{\pm}0.09\;ml/min{\cdot}kg$, and endogenous plasma urate concentration was $1.12{\pm}0.57\;{\mu}g/ml$, which is less than that in the rabbit $(3.33{\pm}0.46\;{\mu}g/ml)$. In the rabbit, $FE_{ur}$ was $1.76{\pm}0.08$ and net urate secretion was observed, while, in the cat $FE_{ur}$ was $0.70{\pm}0.02$ and net reabsorption was observed. In the cat $FE_{ur}$ was dependent on urine flow and independent of plasma urate concentration. In the rabbit $FE_{ur}$ was suppressed by infusion of probenecid $(30\;mg/kg\;-0.6\;mg/kg{\cdot}min)$ into femoral vein. In the cat the same dose of probenecid increased $FE_{ur}$ and concomitantly increased urine flow. Thus, an increase in $FE_{ur}$ by probenecid could be considered to be resulted from a change in urine flow. In the cat infusion of probenecid $(2.5\;mg/kg{\cdot}min)$ into renal artery markedly suppressed $FE_{P\;A\;H}$, but the effects on $FE_{ur}$ and urine flow were similar to those when probenecid was infused into femoral vein. These results indicate that in the cat kidney urate filtered through glomerulus is reabsorbed by a probenecid-insensitive mechanism with no evidence for net secretion.

• Biomolecules & Therapeutics
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• 제4권4호
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• pp.349-353
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• 1996

The present study examined pharmacokinetic profiles of KBP31705-Cl27 and KBP30603-901, new platinum coordination complexes synthesized as anticancer candidates, in comparison with two well-known platinum-containing anticancer agents, cisplatin and carboplatin in rats. Under sodium pentobarbital anesthesia of male Sprague-Dawley rats, urinary bladder, and femoral artery and vein were catheterized for urine collection, blood sampling and drug injection, respectively Following i.v. administration of cisplatin (2 mg/kg), KBP31705-C127 (2 mg/kg), carboplatin (20 mg/kg) or KBP30603-901 (20 mg/kg), blood samples were collected at 2, 4, 6, 8, 10, 15, 20, 30, 45, 60 and 120 minutes. Urine samples were collected at 1-hr interval for 4 hr. Platinum concentrations in plasma and urine were measured using an inductively coupled plasmamass spectrometer. The plasma concentration-time curves were biphasic for all drugs during the time period studied. Compared with cisplatin, KBP31705-C127 showed similar decay patters in the alpha- and betaphases with slightly lower plasma concentrations. Urinary platinum excretion for cisplatin and KBP31705-C 127 was 56 and 52% of the administered dose in 4 hr, respectively. With regard to carboplatin and KBP 30603-901, a similar decay pattern was also observed in the alpha-phase. The half life of KBP30603-901 in the beta-phase, however, was much longer than that of carboplatin, which was consistent with the urinary excretion results that 46 and 59% of the administered dose were excreted in the urine in 4hr, respectively. The results suggest that platinum coordination complexes are primarily excreted via the renal route and KBP30603-901 can elicit longer duration of action due to slower renal excretion compared to carboplatin.

• 대한한의학회지
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• 제19권2호
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• pp.137-152
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• 1998

Acute complications of diabetes mellitus were diminished after Banting and Best discovered insulin. But chronic complications of diabetes mellitus have been increased. The main complications of diabetes mellitus are diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, diabetic foot lesion and macrovascular complication. These complications can result in renal failure, loss of sight, cerebral infarction and myocardial infarction. So it is very difficult to treat the complications of diabetes mellitus. In oriental medicine, the transformations(傳變症) of Sogal(消渴) are edema, carbuncle, loss of sight and so on. The comparative study between the trcmsformations(傳變症) of SogaI(消渴) and the complications of diabetes mellitus has come to the following conclusions. 1. In oriental medicine, diabetic retinopathy was expessed as loss of sight and the treament of diabetic retinopathy should be started at an early stage, to prevent vitreous hemorrhage and traction retinal detachment. 2. In oriental medicine. diabetic nephropathy was expressed as edema and the treatment should be started at an early stage of renal injury when the protein comes from urine.3. Symmetrical distal polyneuropathy is the main part of diabetic neuropathy and it was expressed as weakness of the lower limbs and pain of joints in the symptoms of Haso(下消). In Oriental medicine, acupuncture and herb medicine which effect is SopungHwalHyul can treat polyneuropathy. 4. Chief macrovascular complications are coronary artery disease and cerebrovascular disease, The cause of macrovascular complication is atherosclerosis. So the method of treating atherosclerosis should be studied in oriental medicine. 5. Diabetic foot were expressed as carbuncle and its main causes are decreasing perfusion of fool, diabetic neuropathy and infection. So these causes should be studied in oriental medicine. 6. The complications of diabetes mellitus afe very similar to the transfonnatiuns of Sogal(消渴).The control of blood glucose is indispensable to prevent and delay the complication of diabetes mellitus.

• The Korean Journal of Physiology
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• 제16권1호
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• pp.1-11
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• 1982

Force development of smooth muscle cells is directly regulated by the concentration of free calcium ions in the sarcoplasm, and the sarcoplasmic concentration of calcium ion can be modulated by electrogenic Na-K pump. The role of Na-K pump on vascular tone was studied in isolated rabbit renal artery. Helical strips of arterial muscle were prepared from left renal arteries. All experiments were performed in $HCO_3^--buffered$ Tyrode solution which was aerated with $3%CO_2-97%\;O_2$ mixed gas and kept at $35^{\circ}C$. In some experiments, rabbit was injected intraperitoneally $18{\sim}24$ hours prior to the experiments, with a large dose(5 mg/kg body wt) of reserpine, in order to eliminate the catecholamines present in intrinsic adrenergic nerve terminate. Treatment used in this experiment that inhibits Na-K pump was the exposure of strips to K-free Tyrode solution. Contractile response to K free Tyrode solution developed slowly and the time required for maximum contracture was $20{\sim}30$ minutes. This K-free contracture was rapidly relaxed by the addition of potassium to the bathing solution. No K-free contracture occurred in a Ca-free Tyrode solution. But contraction developed rapidly when calcium ion was added to the bathing solution after 30 minute exposure of the strip to Ca-free Tyrode solution. This contracture was completely inhibited by Ca-antagonist, verapamil. The K-free contracture was abolished by ${\alpha}-adrenergic$ blocker, phentolamine, as well as by the catecholamine depletion from adrenergic nerve terminals. Even in reserpinized strip, the exogenous norepinephrine-induced contraction in K-free Tyrode solution was rapidly suppressed by the addition of potassium ion. The results of this experiment suggest that K free contracture develops by norepinephrine release from adrenergic nerve terminals, while the relaxation of K-free contracture is induced by the activation of electrogenic Na-K pump.

• Journal of Chest Surgery
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• 제30권2호
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• pp.172-178
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• 1997

인제대학교 서울 백병원에서 실시한 말초동맥 색전제거술을 후향적으로 분석하였다. 1987년 3월부터 1996년 2월까지 26명의 환자가 색전제거술을 시술받았고 남자는 18명 여자는 8명이였으며 평균연령은 56.8세 였다. 24명의 환자에서 휴식시 동통이 주소였고 2명의 환자에서 급성 증상의 회복후 장기간의 간헐적 파행을 호소하였으며 10명의 환자에서만 신경/근육 증상을 보였다. 대부분의 색전은 심인성으로 빈도가 높은 원인질환으로8명의 환자는 허혈성 심질환, 11명의 환자는 심장판막질환이 있었다. 동맥색전 부위는 상지동맥이 6명, 안장색전증이 2명, 하지동맥 18명이였고 대퇴동맥이 11명으로 가장 많았다. 술전 동맥조영술은13명의 환자에서 진단과 수술계획을 위해 실시하였으나 나머지 환자에서는 실시하지 않았다. 2명만이 6시간이내 색전제거술을 실시하였으나 나머지 환자는 모두 6시간 이후에 수술하였 다. 모든 환자에서 우회로 조성술 엄이 포가티 색전제거 카테터를 사용하여 색전제거술을 하였는데, 상지동맥 색전증은 상완동맥 절개로 수술하였고, 안장색전증의 경우 양측 서혜부 절개로 접근하였으며, 하지동맥 색전증은 경대퇴동맥 접근을 하 느립\ulcorner3명의 원위부 슬와-경골동맥 색전증 환자에서 재수술시 경술와 동맥 색전제거술을 시행하였다. 수술 전후로 18명의 환자가 헤파린이나 푸락시파린으로 항응 고제 요법을 받았고 17명의 환자에서 퇴원시 와파린을 투여하였으며 항응고제 투여의 적응증은 심판막 질환, 심방세동, 말초동맥 죽상경화증, 재발색전 등이었다. 색전제거술후 14명의 환자에서 좋은 결과가 있었고, 5명에서 재수술후 증상 호전되었으며, 심한 하지동맥 죽상경화증을 보인 환자 1명에서 슬관절 이하 하지절단을 시행하였다. 색전재발은 1명, 사망 환자는 2명이 였는데, 사인은 각각 급성 신부전과 뇌동맥 혈전증이였다. 색전제거술 합병증으로 재관류 손상, 가성동맥류, 내막박리 등이 각각 1례 발생하였다. 결론적으로 사지동맥 색전증치 진단이 지연되고 있고, 허혈성 심질환을가진 고령환자가 증가되고 있는 경향이었다. 술전 동맥조영술은 항상 진단과 수술을 위해 필요하지 않으며 항응고제는 적응증에 따라 선택적으로 투여하여 색전재발을 방지할 수 있다. 원위부 슬와-경골동맥 색전증의 경우, 경대퇴동 맥 접근으로 선택적인 경골동맥 색전제거에 어려움이 있었다.

• Journal of Chest Surgery
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• 제35권11호
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• pp.779-784
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• 2002

최근 들어 관상동맥 질환자의 수가 급격히 증가하면서 관상동맥 우회술의 수도 급격히 증가하고 있다. 그러나 관상동맥 우회술은 영구적인 완전 교정술이 아니기 때문에 재수술이 필요할 수 있다. 저자들은 관상 동맥우회 재수술의 임상결과를 후향적 방법으로 고찰하여 보았다. 대상 및 방법: 1991년 1월부터 2001년 4월까지 연세 심장혈관 병원에서 관상동맥우회 재수술을 시행 받은 14명을 대상으로 하였으며 (남자:12명, 여자:2명), 평균 연령은 61.7$\pm$7.1(47~72세) 세였다. 처음 수술 받은 날부터 재수술시까지의 평균 기간은 121.9$\pm$50.5(6.1~179.6 개월) 개월이었다. 재수술시 13명의 환자들은 일반적인 심폐체외순환하에 수술을 하였고 1명의 환자는 심폐체외순환 없이 수술을 시행하였다. 동반 수술로는 1명의 환자에서 승모판막 재치환술을 시행하였고, 1명의 환자에서는 승모판막륜 성형술을 시행하였다. 재수술은 모두 정중 흉골절개하에 시행하였다. 재수술시 사용한 이식 혈관은 좌측 내흉동맥과 대 복재정맥을 사용한 경우가 6례, 좌측 내흉동맥과 좌측 요골 동맥을 사용한 경우가 2례, 좌측 내흉 동맥과 위장관 동맥을 사용한 경우가 1례, 대 복재정맥만을 사용한 경우가 5례(1례는 cephalic vein도 같이 사용) 있었으며, 평균 이식 편수는 2.1$\pm$0.9(1~4개) 개였다. 결과: 14명의 환자들 중에서 수술과 관련한 사망이나 조기 사망은 없었으며, 합병증은 신부전증, 호흡부전 및 경막하 출혈이 각각 1례 있었다. 평균 추적 관찰 기간은 40.1$\pm$38.6(1.1~l18.5) 개월 이었다. 추적기간 중 1명의 환자가 재수술 후 13개월에 협심증이 재발했고, 2명의 환자가 재수술 후 14.8개월 및 116.3개월에 만성 신부전증으로 사망하였다. 추적 기간 중에 3명의 환자에서 관상동맥 조영술을 시행하였는데 이식 혈관들은 모두 개존성을 보였다. 마지막 외래 내원시 생존 환자들의 평균 Canadian class는 1.3이었고, 재수술 후 9년까지 사건(event)이 없을 확률은 71.4$\pm$6.9%였으며, 생존률은 90.0$\pm$9.5%였다. 결론: 관상동맥우회 재수술은 수술 후에 환자 상태의 호전을 기대할 수 있고, 장기간의 생존률도 우수하기에, 수술적응이 된다면 수술을 적극적으로 고려하여야 할 것으로 생각한다.

• Journal of Yeungnam Medical Science
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• 제9권1호
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• pp.90-101
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• 1992

흰쥐 신동맥 결찰로 허혈을 유도하여 허혈상태의 핵산 및 핵산 대사산물의 변화가 정상조직과 어떠한 차이가 있는지를 알아 보기 위하여 HPLC(high performance liquid chromatography)를 이용하여 nucleotides를 분리하고 분석 및 정량한 결과이다. 60분간의 허혈후 핵산 및 핵산 대사산물의 변화를 보면 조직 1 gram당의 IDP농도는 대조군 $217.4{\pm}12.68{\mu}g$에서 $80.7{\pm}18.39{\mu}g$으로(P<0.01), ATP는 $307.2{\pm}56.63{\mu}g$에서 $47.6{\pm}5.95{\mu}g$으로(P<0.01), ADP+AMP는 $227.1{\pm}7.98{\mu}g$에서 $61.4{\pm}3.92{\mu}g$으로(P<0.01), $NAD^+$ $217.9{\pm}4.49{\mu}g$에서 $126.6{\pm}10.44{\mu}g$으로(P<0.01), GTP는 $202.5{\pm}23.76{\mu}g$에서 $117.7{\pm}14.24{\mu}g$으로(P<0.05), GMP는 $54.5{\pm}9.03{\mu}g$에서 $23.7{\pm}0.46{\mu}g$으로(P<0.05), 그리고 inosine은 $16.6{\pm}3.45{\mu}g$에서 $7.8{\pm}0.87{\mu}g$으로(P<0.05) 유의하게 감소한 반면, hypoxanthine은 $113.0{\pm}15.58{\mu}g$에서 $159.7{\pm}12.07{\mu}g$으로(P<0.05), xanthine은 $87.7{\pm}6.77{\mu}g$에서 $173.1{\pm}12.52{\mu}g$으로(P<0.01) 유의하게 증가하였다. 허혈의 지속시간에 따른 변화는 ATP가 10분에 대조군의 39.9%, 30분에 19.8% 그리고 60분에 15.5%로 감소하였으며, ADP+AMP는 10분에 70.3%, 30분에 67.3%, 60분에 27.0%로 감소하는 경향이었고, hypoxanthine과 xanthine은 각각 10분에 121.5%와 127.1%로, 30분에 126.0%와 174.4%로, 그리고 60분에 141.4%와 197.3%로 증가하는 경향이었다. 허혈 60분동안 고 에너지원인 adenosine nucleotide의 총량은 대조군의 20.3%로 감소하였고, purine nucleotide의 대사산물인 hypoxanthine과 xanthine의 총량은 157.5%로 증가하였다. 이상의 결과로 보아 쥐의 허혈 신조직에서의 핵산 및 그 대사산물의 농도는 허혈의 정도를 알 수 있는 유용한 지표라고 생각된다.

• Journal of Chest Surgery
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• 제24권3호
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• pp.310-321
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• 1991

Between April 1986 and September 1990, 34 patients with a single or dominant right ventricle underwent modified Fontan procedure for definite palliation in Seoul National University Children`s Hospital. Their age at operation ranged from 8 months to 14 years [Mean 5.5 years]. The ventricular chamber was solitary and of indeterminate trabecular pattern in 6 patients. 28 patients had posteriorly located rudimentary chamber, all of which were trabecular pouches having no communication with outlet septum. The patterns of atrioventricular connection were common inlet[9], double inlet [11], left atrioventricular valve atresia [12] and right atrioventricular valve atresia with L-loop [2]. Pulmonary outflow tracts were atretic in 7 patients and stenotic in 26 patients. Major associated anomalies included anomalous systemic venous drainage [15], dextrocardia [12] and total anomalous pulmonary venous connection[3]. Shunt operations were previously performed in 13 patients and pulmonary artery banding and atrial septectomy in 1 patients. Surgery included intraatrial baffling in 26 patients, bidirectional cavopulmonary shunt in 13 patients, atrioventricular valve obliteration in 3 patients and atrioventricular valve replacement in 3 patients. Central venous pressure measured postoperatively at intensive care unit ranged from 18cm H2O to 28cm H2O [mean 23.2cm H2O]. Hospital mortality was 35.3% [12/34], all died out of low output syndrome. Suspected causes of low output syndrome include ventricular dysfunction [8], hypoplastic or tortuous pulmonary artery [2] and elevated pulmonary vascular resistance [2]. 19 patients had 31 major complications including low output syndrome [18], arrhythmia [4], acute renal failure [3] and respiratory failure [3]. Mortality rate was significantly higher in the groups receiving intraatrial baffling and AV valve replacement respectively [p<0.05]. 20 patients were followed up postoperatively with the mean follow-up period 15.0$\pm$11.6 months. There were no late death and follow-up catheterization was performed in 10 patients. Mean right atrial pressure was 15.4$\pm$6.8mmHg and ventricular contraction was reasonable in all but one case. Thus, Fontan principle can be applied successfully to all the patients with complex cardiac anomaly of single ventricle variety and better results can be anticipated with judicious selection of patient and improvement of postoperative care.