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Blood Gas Management of a Membrane Oxygenator During Cardiac Surgery with Deep Hypothermic Circulatory Arrest (막형산화기에 의한 저체온 순환정지 심장수술시 혈액가스 조절)

  • Kim, W. G.;Lim, C.;Baek, Y. H.
    • Journal of Biomedical Engineering Research
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    • v.19 no.3
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    • pp.279-284
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    • 1998
  • Deep hypothermic circulatory arrest(DHCA), in which systemic temperatures of 2$0^{\circ}C$ or less are used to allow temporary cessation of the circulation, is an useful adjunct in cardiac surgery. Because man in natural circumstances is never exposed to the extreme hypothermic condition, however, one of the controversial aspects is appropriate blood gas management($\alpha$STAT versus PH-STAT) during DHCA. This study aims to compare $\alpha$STAT with PH-STAT management for control of blood gases in experimental cardiopulmonary bypass(CPB) circuits with a membrane oxygenator. Fourteen young pigs were assigned to one of two strategies of gas manipulation. After a median sternotomy, CPB was established. Core cooling was initiated and continued until nasopharyngeal temperature fell below 2$0^{\circ}C$. The flow rate was set at 2,500 ml/min. Once their temperatures were below 2$0^{\circ}C$, the animals were subjected to circulatory arrest for 40mins. During cooling, blood gas was maintained according to either $\alpha$$\alpha$STAT or pH-STAT strategies. After DHCA, the body was rewarmed to normal body temperature. Arterial blood gases were measured before the onset of CPB, before cooling, before DHCA, at the point of 27$^{\circ}C$ during re-warming, on completion of re-warming. Cooling time was significantly shorter in $\alpha$-STAT than PH-STAT strategy, while there was no significant differences in rewarming time between two groups. Carbon dioxide was added between 5.5 and 3.0% in PH-STAT, while no carbon dioxide was added in $\alpha$STAT management. Amounts of oxygen administration were gradually lowered as temperature decreased. In this way, criteria of PH, PaCO, and PaO adjustments were satisfied in both $\alpha$STAT and PH-STAT management groups.

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Radiation dose Assesment according to the Adaptive Statistical Iterative Reconstruction Technique of Cardiac Computed Tomography(CT) (심장 CT 검사시 ASIR 적용에 따른 선량 평가)

  • Jang, Hyun-Cheol;Kim, Hyun-Ju;Cho, Jae-Hwan
    • The Journal of the Korea Contents Association
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    • v.11 no.5
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    • pp.252-259
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    • 2011
  • To identify the effects of the application of the adaptive statistical iterative reconstruction (ASIR) technique in combination with the other two factors of body mass Index (BMI) and tube potential on radiation dose in cardiac CT. The patient receiving operation the cardiac CT examination was divided four groups into according to kVp.[A group(n=20), Non-ASIR, BMI < 25, 100 kVp; B group(n=20), Non-ASIR, BMI > 25, 120 kVp; C group(n=20), 40% ASIR BMI < 25, 100 kVp; D group(n=20), 40% ASIR, BMI > 25, 120 kVp] After setting up the region of interest in the main artery central part and right coronary artery and left anterior descending artery, the CT number was measured and an average and standard deviation were analyzed. There were A group and the difference which the image noise notes statistically between C. And A group was high so that the noise could note than C group (group A, 494 ${\pm}$ 32 HU; group C, 482 ${\pm}$ 48 HU: P<0.05) In addition, there were B group and the difference noted statistically between D. And B group was high so that the noise could note than D group (group B, 510 ${\pm}$ 45 HU; group D, 480 ${\pm}$ 82 HU: P<0.05). In the qualitative analysis of an image, there was no difference (p>0.05) which a group, B group, C group, and D as to average, A group 4.13${\pm}$0.2, B group 4.18${\pm}$0.1, and C group 4.1${\pm}$0.2 and D group note statistically altogether with 4.15${\pm}$0.1 as a result of making the clinical evaluation according to the coronary artery segments. And the inappropriate image was shown to the diagnosis in all groups. As to the radiation dose, a group 8.6${\pm}$0.9 and B group 14.9${\pm}$0.4 and C group 5.8${\pm}$0.5 and D group are 10.1${\pm}$0.6 mSv.

Bronchoscopic Electrocautery with Electroprobe and Diathermic Snare in Patients with Malignant Airway Obstruction (중심성 폐암환자에서 악성 기도폐쇄에서 전기 탐침과 투열올가미를 사용한 전기 소작술의 효과)

  • You, Hong Jun;Choi, Pyoung Rak;Park, Eun Ho;Yang, Jae Hong;Choi, In Su;Kim, Hyoung Jun;Kim, Joo Hoon;Oak, Chul Ho;Cho, Hyun Myung;Jang, Tae Won;Jung, Maan Hong
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.5
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    • pp.504-509
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    • 2005
  • Background : Endobronchial tumors cause life-threatening dyspnea and can lower the quality of life due to central airway obstruction. In those cases with an intraluminal tumor, various bronchoscopic techniques are available for tumor debulking. The therapeutic effect of bronchoscopic electrocautery for palliation in patients with a symptomatic tumor obstruction was studied. Method : Nineteen patients with bronchogenic carcinomas (n=15) and metastatic tumors affecting the bronchi (n=4), between March 2002 and March 2005, were enrolled in this study. Electrocautery was performed under local anesthesia using an electroprobe and diathermic snare. Using flexible bronchoscopy, a follow-up bronchoscopic examination was performed 3-4 days later. Symptom improvement was evaluated by $FEV_1$, FVC and dyspnea score (Modified Borg Category Scale (0~10)), both before and after the electrocautery. Results : The success rate of electrocautery on the follow up examination was 84%. Patients with endoluminal airway lesions had a mean overall decrease in the size of the obstruction to $47.8{\pm}15.7%$. The mean Improvement in the dyspnea score immediately after the endobronchial tumor debulking was $2.78{\pm}1.42$. The average improvements in the $FEV_1$ and FVC after electrocautery were $0.32{\pm}0.19L$ and $0.5{\pm}0.22L$, respectively. There were 2 cases of complications related with electrocautery (one each of pneumothorax and pneumonia). Conclusion : Electrocautery using an electroprobe and diathermic snare was an effective and safe palliative treatment for a symptomatic endoluminal airway obstruction in lung cancer.

Effect of Nonsolvent Additive in Casting Solutions on Polysulfone Membrane Preparation (Polysilfone 막의 제조에 있어 제막용액에 첨가된 비용매의 영향)

  • 한명진
    • Membrane Journal
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    • v.6 no.3
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    • pp.157-165
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    • 1996
  • Polysulfone(PS) membranes were prepared from homogeneous PS solutions by the phase inversion technique. When propionic acid(PA) was added into a casting solution of n-methylpyrrolidone(NMP) and PS, precipitation rate of the solution film was accelerated. This kind of acceleration was consistent, even though a precipitating nonsolvent was changed from water to isopropanol. These phenomena were caused by decrease of nonsolvent tolerance in the casting solution due to addition of PA. PS powder was prepared by precipitation of a 3wt% solution in dimethylformamide(DMF) using ethanol as nonsolvent. Gas adsorption analysis of the powder showed that the capillary condensation sites were found in the powder structure. Membranes prepared from PS solution(15wt%) in NMP had the following characteristics of gas adsorption and water permeation. In gas adsorption analysis, the membrane precipitated using isopropanol showed low uptake of nitrogen gas and the capillary condensation sites were not found. On the contrary, a significant amount of the capillary condensation sites was found in the membrane coagulated by water, which was related to increase of nitrogen uptake. tn the membrane prepared froin the solution including PA, an increase of the Henry's law sites and the Langmuir sites was not found clearly. However, the capillary condensation sites were significantly increased, and the water transport also increased.

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Occurrence and Deformation of Fe-Ti ores from the Proterozoic Hadong Anorthosites, Korea (원생대 하동회장암체 내 철-티탄 광체의 산상과 변형)

  • Jung, Jae-Sung;Kim, Jong-Sun;Cho, Hyeong-Seong;Song, Cheol-Woo;Son, Moon;Ryoo, Chung-Ryul;Chi, Sei-Jeong;Kim, In-Soo
    • The Journal of the Petrological Society of Korea
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    • v.19 no.1
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    • pp.31-49
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    • 2010
  • Nearly NS-trending Fe-Ti ore bodies intermittently occur in the Hadong anorthosites, south Korea, irrespective of the rock types of the anorthosites. In order to determine their occurrence mode and deformation history, we collected the features of occurrence and geological structures in the field, petrographic features using thin sections of the principal constituent rocks, and geochemical data of ilmenites in the ore body using electron probe microanalysis. Fe-Ti ore bodies examined in this study are divided into two types: dike- and lamina-types. It is steadily supported that the dike-type has intruded into the anorthositic rocks after their emplacement and solidification. And the laminar-type is probably a result of the mylonitization and transposition of the dike-type ore bodies parallel to the shear planes, due to later strong dextral ductile shearing. In the meantime, the Fe-Ti ore bodies have experienced the stronger dextral shearing in the more northern part of the study area, i.e. Cheongryong-ri, Wolhoeng-ri, Jonghwa-ri, and Jayangri and Baekun-ri in ascending order of its strength, together with the less content of $TiO_2$. All ilmenites of the ore bodies have very similar chemical composition, as pure ilmenite of 52~55 wt.% in $TiO_2$ content, irrespective of the occurrence mode and degree of later ductile shearing of the ore bodies. And they didn't experience to exsolve into magnetite. The structural data indicate that the Hadong anorthosites have deformed by NNE-trending folding, intrusion of the Fe-Ti ore bodies, NNW~NNE-trending dextral ductile shearing, NW~NNW-trending sinistral semi-brittle shearing, and intrusion of NNE~NE-trending mafic dykes in descending order of chronology after the formation of foliation of the anorthositic rocks. The foliation is interpreted as a result of the accumulation of crystals that settle out from the magma by the action of gravity.

Mitral Valve Reconstruction in Patients with Moderate to Severe Left Ventricular Dysfunction (중등도 이상의 좌심기능부전 환자에서 승모판성형술)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Sae;Kim, Woong-Han;Whang, Sung-Wook;Kim, Soo-Cheol;Lim, Cheong;Kim, Wook-Sung;Lee, Young-Tak;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.11
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    • pp.812-819
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    • 2003
  • Background: Left ventricular dysfunction is one of the important prognostic factors of early mortality and long-term survival after valve operation. We studied the intermediate term results of mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction. Material and Method: Forty four patients who underwent mitral valve reconstruction with a left ventricular ejection fraction (EF) of <45% or less (20∼45%) from April 1995 through July 2001 were reviewed retrospectively. Ages ranged from 10 to 67 years (46∼14 years) and 32 patients were in NYHA class III-IV. The mitral valve diseases were regurgitation (MR) in 28 patients, stenosis(MS) in 10, and mixed lesion in 5. The etiologies of mitral valve disease were rheumatic in 20 patients, degenerative in 14, ischemic in 5, annular dilatation in 2, congenital in 2, and endocarditis in 1. Operatively, all patients had annuloplasty and/or various valvuloplasty techniques, and a total of 52 procedures were concomitantly performed. Total cardiopulmonary bypass and aortic crossclamp time were 160$\pm$57 minutes and 112$\pm$45 minutes respectively. Result: Two operative deaths occurred as a result of left ventricular failure (4.5%). After the mean follow-up of 39 months (range, 10∼83 months), there was no late death. Transthoracic echocardiography revealed no or grade I of MR in 29 patients (72.5%) and no or mild MS in 35 patients (87.5%). The actuarial survival at 5 years was 100%. Four patients required mitral valve replacement due to progressive mitral valvular disease. The actuarial freedom from valve-related reoperation at 5 years was 84$\pm$9%. Conclusion: This study suggests that mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction offers good early and intermediate survival and acceptable freedom from valve-related reoperation, and it is the strategy for effective management for these patients.

Quality characteristics of fermented vinegar prepared with Seomaeyaksuk (Artemisia argyi H.) extract (섬애약쑥 주정 추출물로 제조한 발효식초의 품질특성)

  • Shin, Ji Hyeon;Kang, Min Jung;Byun, Hee Uk;Bea, Won Yoel;Shin, Jeong Yeon;Seo, Weon Tack;Choi, Jine Shang;Shin, Jung Hye
    • Food Science and Preservation
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    • v.24 no.5
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    • pp.647-657
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    • 2017
  • This study was carried out to investigate the quality characteristics of vinegars containing jaceosidin and eupatilin using Artemisia argyi H. ethanol extract (AEE). 10% malt extract (ME) and water extract of Artemisia argyi H. (AWE) were also prepared for vinegar production. Three kinds of materials were mixed in the same amount to prepare vinegar as follows; CO (ME, water, 18% edible ethanol), SE (ME, water, and AEE), SW (ME, AWE, and 18% edible ethanol) and SM (ME, AWE, AEE). All samples were fermented by Acetobacter pasteurianus A8 at $30^{\circ}C$ for 25 days and analyzed at 10, 15, 20 and 25 days. The pH decreased significantly during the fermentation. pH was lower in SE and SM than CO and SW. The acidity increased significantly during the fermentation, and was highest in SM (4.44%) at 25 days of fermentation. The concentration of acetic acid was higher than other organic acids for all vinegars. Jaceosidin and eupatilin were not detected in both CO and SW, but both were detected in the SE and SM. At 25 days of fermentation, jaceosidin and eupatilin concentrations in SE and SM were 6.49-6.88 mg/kg and 2.23-2.24 mg/kg, respectively. From these results, we confirmed that production of vinegar containing jaceosidin, eupatilin and phenolic compounds can be prepared by using Artemisia argyi H. edible ethanol extract.

Anatomical observation on the Triple Energizer Meridian Muscle in human (수소양 삼초경근의 해부학적 연구)

  • Park, Kyoung-Sik
    • Korean Journal of Acupuncture
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    • v.24 no.1
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    • pp.65-77
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    • 2007
  • 목 적 : 본 연구(硏究)는 수소양삼초경근(手少陽三焦頸筋)의 이론적(理綸的) 근거(根據)를 해부학적(解剖學的)으로 제공(提供)하고 임상(臨床)에 경근(經筋)의 정확(正確)한 적용(適用)을 위함이다. 방 법 : Cadaver에 경근(經筋)을 표시(表示)하고 각각(各各)의경 경혈부위(經穴部位)에 표식(標識)와 pore 작업을 수행하고 각 경혈부(經穴部)를 피부(皮膚), 근막(筋膜), 그리고 근육(筋肉)의 천층(淺層), 중문층(中問層), 그리고 심층부(深層部)를 순서적(順序的)으로 해부(解剖)하여 근육(筋肉), 신경(神經), 혈관(血管) 등을 관찰(觀察)한다. 결 과 및 결 론 : 수소양삼초경근(手少陽三焦經筋)의 해부학적(解剖學的) 고찰(考察) 결과(結果)는 다음과 같다. 1) 근(筋) 육(肉) : 천층에 근막(TE1), 근막확장대(TE2), 근막과 근간결합(TE3), 근막과 신근지대(TE4), 근막과총지신근건(TE5), 근막및 총지신근과 소지신근간(TE6), 근막과 소지신근(TE7), 총지신근(TE8), 척측수근신근과 소지신근간(TE9), 상완삼두근건(TE10, 11), 상완삼두근(TE12), 삼각근(TE13), 삼각근및 극하근과 극상근간(TE14). 승모근(TE15), 흉쇄유돌근(TE-16, 17, 18), 후이개근(TE19, 22), 상이개근(TE20), 전이개근및 이하선근막(TE21), 안륜근(TE23), 중층에 소지신근건과 총지신근건간(TE4), 측두근막과 측두근(TE2O, 22, 23), 심층에 배측골간근(TE3), 시지신근과 골간막(TE5) 장모지신근(TE6), 시지신근(TE7), 장지신근과 장모지외전근간(TE8, 9), 상완삼두근(TE13), 견갑거근(TE15), 두판상근(TE16), 경상설골근과 하악이복근간(TE17) , 이복근(TE18) .2) 신(神) 경(經) : 천층에 척골신경의 배측지(TE1, 2, 3), 후전완피신경(TE4, 5, 6, 8, 9, 10, 11), 내측전완피신경(TE5, 6, 7, 8, 9, 10, 11), 후상완피신경(TE12, 13), 상외측상완피신경(TE13), 외측쇄골상신경(TE14, 15),대이개신경(TE16, 17, 18, 19), 소후두신경(TE19, 20), 이개측두신경(TE20, 21, 22), 안면신경측두지(TE22, 23), 관골측두신경(TE23), 중층에 견갑상신경(TE15), 견갑배신경(TE15), 경상설골근신경(TE17), 후이개신경(TE18, 19, 20), 안면신경측두지(TE20, 21, 22), 심층에 후골간신경(TE5, 6, 7), 요골신경심지(TE8, 9, 12, 13), 견갑상신경(TE14), 액와신경가지(TE14), 부신경(TE16), 안면신경과 부신경가지(TE17), 설인신경(TE17), 설하신경(TE17), 경신경고리(TE17), 미주신경(TE17), 안면신경 (TE18). 3) 혈(血) 관(管) : 천층에 척측정맥배측지(TE1, 2), 고유수장지동맥배측지(TE1), 배측중수골동맥배측지(TE2), 배측중수골정맥(TE3), 척측피정맥(TE4, 5, 6, 7, 8, 9, 10, 11), 배측정맥궁(TE4), 부요측피정맥(TE6, 8, 9),요측피정맥(TE10, 11), 후견봉정맥가지(TE13, 14), 후이개동 ${\cdot}$ 정맥(TE16, 17, 18, 19, 20), 전이개동 ${\cdot}$ 정맥(TE20), 천측두동 ${\cdot}$ 정맥(TE22, 23), 중층에 후상완회선동맥(TE14), 견갑배동맥(TE15), 견갑상동맥(TE15),천측두동 ${\cdot}$ 정맥(TE21), 관골측두동 ${\cdot}$ 정맥(TE23), 심층에 배측중수골동맥(TE3), 배측수근동맥궁(TE4), 후골간동맥(TE4, 5, 6, 7, 8, 9), 전골간동맥(TE6, 7, 9), 심상완동맥(TE10, 11), 상완동맥측부지(TE10, 11), 중간 측부동맥(TE12), 요측측부동맥(TE12), 심상완동맥가지(TE13), 후상완회선동맥(TE13), 견갑상동맥(TE14), 후두동 ${\cdot}$ 정맥(TE16, 17), 내경정맥(TE17). 결 론 : 1. 수소양삼초경근(手少陽三焦經筋)은 근육(筋肉), 그리고 관련(關聯) 신경(神經), 혈관(血管)으로 구성된다. 2. 본 연구(硏究)는 경근(經筋)에 관한 기존(旣存)의 연구(硏究)와 비교(比較)하여 볼 때에 경근(經筋)의 구성요소(構成要素)에 있어서 약간(若干)의 차이(差異)를 보여준다. 3. 해부학적(解剖學的) 연구결동(硏究結東), 경근(經筋) 근육(筋肉)을 지배(支配)하는 신경(神經)${\cdot}$혈관(血管)의 개념(槪念)과 경근(經筋)을 스쳐 지나가는 신경(神經)${\cdot}$혈관(血管)의 개념(槪念)은 구분(區分)된다.

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Preliminary Results of Stereotactic Radiosurgery Using Stereotactic Body Frame (정위 체부 고정틀을 이용한 체부 방사선수술의 예비적 결과)

  • Ahn Seung Do;Yi Byong Yong;Choi Eun Kyung;Kim Jong Hoo;Nho Young Ju;Shin Kyung Hwan;Kim Kyoung Ju;Chung Won Kyun;Chang Hyesook
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.251-256
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    • 2000
  • Purpose : To evaluate efficacy and complication of stereotactic radiosurgery using stereotactic body frame. Methods and Materials :From December 1997 to June 1999, 11 patients with primary and metastatic tumors were treated with stereotactic radiosurgery using stereotactic body frame(Precision TherapyTu). Three patients were treated with primary hepatoma and seven with metastatic tumor from liver, lung, breast, trachea and one with arteriovenous malformation on neck. We used vacuum pillow for immobilization and made skin marker on sternum and tibia area with chest marker and leg marker. Diaphragm control was used for reducing movement by respiration. CT-simulation and treatment planning were peformed. Set-up error was checked by CT-Simulator before each treatment. Dose were calculated on the 80$\~$90$\%$ isodose of isocenter dose and given consecutive 3 fractions for total dose of 30 Gy (10 Gy/fraction). Results :Median follow-up was 12 months. One patient (9$\%$) showed complete response and four Patients (36$\%$) showed partial response and others showed stable disease. Planning target volumes (PTV) ranged from 3 to 111 cc (mean 18.4 n). Set-up error was within 5 mm in all directions (X, Y, Z axis). There was no complication in all patients. Conclusion :In Primary and metastatic tumors, stereotactic body frame is very safe, accurate and effective treatment modality.

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Epidemiology of central venous catheter related blood stream infections in pediatric patients (중심정맥 도관 관련 감염의 역학 고찰)

  • Kim, Jung Hyun;Eun, Ho Sun;Choi, Kyung Min;Kim, Dong Soo;Young, Dong Eun
    • Clinical and Experimental Pediatrics
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    • v.49 no.2
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    • pp.157-161
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    • 2006
  • Purpose : The purpose of this study is to investigate the pathogens of central venous catheter-related blood stream infections and search for the association among the insertion site, the duration and the underlying conditions with the prevalence of central venous catheter-related blood stream infections under 15 years old. Methods : A retrospective study was performed from Jan, 2003 to Dec, 2003 in Severance Hospital on 112 patients who undertook central venous catheter insertions. Results : We examined 112 patients who undertook central venous catheter insertion. The mean age of patients was $4.77{\pm}4.12$ years old. Coagulase negative Staphylococci was the most common organism of central venous catheter-related blood stream infections accounting for 33.9 percent, followed by Eenterococcus faecium(9.3 percent), and Staphylococcus aureus(7.5 percent), The most common insertion site was the right femoral vein, followed by the right jugular vein and the left femoral vein. The mean insertion period was $14.17{\pm}12.00$ days. Conclusion : Central venous catheter-related blood stream infections were not only related to the underlying conditions, but also to the insertion site. We need to study the clinical importance of coagulase negative Staphylococci as it is part of the normal flora of the skin. In future, more studies are needed to take preventive measures and improve treatment methods.