• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.21-21
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• 1995

• Journal of Chest Surgery
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• v.36 no.8
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• pp.576-582
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• 2003

During the Off-Pump Coronary Arterial Bypass surgery (OPCAB), the manipulation of the heart can depress cardiac contractility and cause hemodynamic instability. In this study, hemodynamic parameters were measured during operation and the laboratory and clinical data were investigated to evaluate their effects on postoperative outcome. Material and Method: From March 2001 to August 2002, 50 consecutive patients who underwent OPCAB were included in this study. During the same period, total number of CABG was 71 The blood pressure, pulmonary artery pressure, mixed venous oxygen saturation, and cardiac index were measured before manipulation, after application of stabilizer, and at the end of anastomosis. Postoperatively, we measured the cardiac enzymes such as CK-MB, troponin 1 and checked the amount of inotropes required, chest tube drainage, the amount of transfusion, duration of ventilator support, and duration of ICU stay. Result: The number of mean distal anastomoses was 2.8$\pm$0.9 per patient. On elevation and stabilization of the heart, systolic blood pressure was depressed and pulmonary artery pressure was elevated significantly, but during each anastomosis no significant changes were detected. The peak level of cardiac markers was 29.2$\pm$46.7 for CK-MB, 0.69$\pm$0.86 for troponin 1 on postoperative day f. Among the intraoperative hemodynamic parameters, the ischemic change of EKG and bolus injection of inotropes significantly affected the posteroperative cardiac enzymes. But, no difference other than the level of cardiac enzymes between the two groups with or without the ischemic change of EKG and bolus injection of inotropes was noticed. Conclusion: The significant hemodynamic changes occurred when the heart was elevated and stabilized, however during anastomoses there were no significant changes. Serum cardiac enzymes rose significantly in the group that showed the ischemic charge of EKG or needed the bolus injection of inotropes for maintaining hemodynamic stability intraoperatively, but it did not affect the postoperative outcome. In conclusion, the ischemic change of EKG and the need for bolus injection of intropes during operation may be very indicative for probable ischemia.

• Journal of Acupuncture Research
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• v.27 no.6
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• pp.59-66
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• 2010

목적 : 태충($LR_3$)에 자침을 하는 것이 쥐의 유방 조직에 미치는 혈역학적 변화를 측정하기 위하여 diffuse optical imaging 기법을 사용하였다. 방법 : 실험에 사용한 쥐는 자침을 하지 않은 대조군 7마리, 태충에 자침을 한 실험군 8마리로 총 2개의 군으로 나누었다. 몸무게 170g 정도의 건강한 암컷 쥐는 100% 산소와 1.5% isoflurane을 혼합한 것을 이용하여 마취시켰다. 자침은 양 발등의 첫째와 둘째 중족골 사이의 지점인 태충($LR_3$)에 20분간 시행하였다. Beckman Laser Institute and Medical Clinic에서 개발된 modulated imaging system을 이용하여 자침하기 전과 자침하고 있는 동안에 산화혈색소(OHb), 탈산소혈색소(RHb), 총 혈색소(THb)와 조직 산소 포화도($StO_2$)의 영상을 얻었다. 결과 : 실험 결과 태충($LR_3$)에 자침을 한 실험군에서는 대조군에 비하여 유의성이 있는 OHb THb의 감소와 유의성이 없는 RHb의 증가가 나타났다. 결론 : Diffuse optical imaging 기법으로 자침 중에 조직 산소공급과 혈류량의 변화를 확인할 수 있었고, 이는 비침습적으로 자침의 효과를 측정하는 데 활용할 수 있다고 생각한다. 또한 자침으로 인한 유방조직의 혈역학적 조절은 암 검진뿐만 아니라 암 치료에도 다른 치료와 병행하여 활용할 수 있으리라 생각한다.

• Journal of Biomedical Engineering Research
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• v.21 no.2
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• pp.157-163
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• 2000

최근 MR영상을 허혈성 뇌졸중의 초급성기에 뇌조직의 관류 이상을 조기에 진단하려는 연구들이 진행되고 있으나 아직 일반적인 진단용 소프트웨어만 있을 뿐 영상 자료를 후처리하여 뇌조직의 구조 및 기능적인 정보를 제공하는 mapping 영상을 특수 소프트웨어는 실용화되어 있지 않다. 본 논문에서는 Gamma-variate 곡선 정합을 이용한 뇌관류 파라미터 영상 mapping의 알고리즘 구현에 관해 연구하였다. 관류 MR영상의 각 화소마다 측정된 시간에 따른 신호강도의 변화 곡선은 비선형적이어서 뇌관류에 관한 여러 가지 혈역학적 변수들을 보다 정확하게 계산할 수 없었다. 그래서 수렴속도가 빠르고 안정성이 높은 비선형 최적화 알고리즘인 Levenberg-Marquardt 알고리즘(LMA)을 활용하였다. 즉 시간에 따른 신호강도의 변화 곡선을 Gamma-variate 함수를 이용하여 곡선 정합한 후, CBV, MTT, CBF, TTP, BAT, MS의 여러 가지 혈역학적 변수를 LMA에 의해 계산하였다. 그 결과로 관류 MR영상으로부터 얻은 mapping 영상은 초급성 허혈성 뇌졸중에서 관류에 관한 혈역학적 변화를 평가함으로써 나중에 생길 뇌경색의 범위를 예견하는 데에 유용하였다.

• Clinical and Experimental Pediatrics
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• v.48 no.6
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• pp.649-654
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• 2005

Purpose : The present study examined how changes in cerebral hemodynamics in newborn piglets with bilirubin infusion can be evaluated by near infrared sepctroscopy(NIRS). Methods : Seventeen newborn piglets were randomly divided into the following three experimental groups : six in the control group(CG); seven in the bilirubin infusion group(BG), and four in the bilirubin infusion with 7-nitroindazole group(NG). To achieve the concentration of bilirubin above 20 mg/dL, we injected a bolus of 40 mg/kg of bilirubin intravenously, followed by 30 mg/kg/hr of bilirubin continuous intravenous infusion. All groups were monitored with cerebral hemodynamics using near infrared spectroscopy(NIRS) and their brain cortexes were harvested and the activities of $Na^+$, $K^+$-ATPase, level of conjugated dienes, ATP and phosphocreatine(PCr) were determined biochemically. Results : No changes took place in CG. In BG and NG, base excess, pH, and MABP decreased, and lactate level in blood increased. Cerebral $Na^+$, $K^+$-ATPase activity and ATP, PCr level in BG significantly decreased and conjugated dienes increased compared to CG. These abnormalities observed in the BG were significantly improved in the NG. In continuous NIRS monitoring, [$HbO_2$], [HbT], and [HbD] in BG were significantlly decreased compared to CG. However these abnormalities between NG and CG were not significantly different. There were no significant differences in $ScO_2$ between the study groups. Conclusion : Our study suggests cerebral hemodynamic changes could be monitored by non-invasive NIRS in newborn piglets with bilirubin infusion.

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.99-99
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• 1996

• Journal of Chest Surgery
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• v.29 no.7
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• pp.723-727
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• 1996

An adequate exposure is important in thoracoscopic procedures. The insufflation of $CO_2$has been demonstrated to aid in compressing lung parenchyma, and act as a retractor when combined with changes in patient's position. However, a recent study demonstrated that $CO_2$insufflation during thoracoscopy in the pig has adverse hemodynamic consequences. We prospectively studied 12 patients undergoing thoracoscopy to evaluate the effect of $CO_2$insufflation in the clinical setting. The mean arterial pressure, heart rate, central venous pressure, arterial oxygen saturation, and end-tidal $CO_2$pressure were monitored. Measurements were determined at baseline, at the initiation of one-lung ventilation, and at intrapleural pressure of 5, 10, 15 mmHg and following results were obtained. 1) The insufflation of 5 to 15 mmHg of $CO_2$had no significant effect on the mean arterial pressure, heart rate, arterial oxygen saturation. 2) The end-tidal $CO_2$pressure rose from 31.00$\pm$1.67 mmHg to 38.49$\pm$1.82 mmHg at an intrapleural pressure of 15 mmHg(p<0.05). 3) The central venous pressure rose from 7.75$\pm$0.76 mmHg to 12.83$\pm$1.64 mmHg and 16.16$\pm$l.97mmHg at an intrapleural pressure of 10 and 15 mmHg(p<0.05). 4) The low pressure (<10 mmHg) insufflation is a safe adjunct to the conduct of thoracoscopic surgical procedures.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.1-6
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• 1996

We developed an experimental model of brain death using dogs. Brain death was induced by increasing the intracranial pressure (ICP) gradually by continuous Infusion of saline through an epidural Foley catheter in 5 mongrel dogs (weight, 18~22kg). Hemodynamic and electrocardiographic changes were evaluated continuously during the process of brain death and obtained the following results. 1. The average volume and time required to induce brain death was 4.8$\pm$1.0ml and 143.0$\pm$30.9minutes respectively. 2. There was a steady rise of the ICP after starting the constant infusion of saline, and ICP rised continuously until the brain death (122.0$\pm$62.5mmHg). After reaching to the maximal value (125.0$\pm$47.7mmHg) at 30 minutes after brain death, the ICP dropped and remained approximately constant at the slightly higher level than the mean arterial pressure (MAP). 3. MAP showed no change until the establishment of brain death and it declined gradually. The peak heart rate reached to 172.6$\pm$35.3/min at 30 minutes after the brain death. 4. Even though the body temperature and all hemodynamic variables, such as cardiac output, mean pulmonary arterial pressure, left ventricular (LV) end-diastolic pressure and LV maximum + dp/dt, were slightly greater than those of basal state, at the point of brain death, there was no statistically significant change during t e process of brain death. 5. There was no remarkable arrhythmias during the experiment except ventricular premature beats which was observed transiently in one dog at the time of brain death. Hemodynamic changes in the brain death model induced by gradual ICP increment were inconspicuous, and arrhythmias were rarely seen. Hyperdynamic state, which was observed at the point of brain death in another brain death model caused by abrupt ICP increase, was not observed.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.437-442
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• 1995

We developed an experimental model of brain death using dogs. Brain death was caused by increasing the intracranial pressure[ICP suddenly by injecting saline to an epidural Foley catheter in five female mongrel dogs[weight, 20-25Kg .Hemodynamic and electrocardiographic changes were evaluated continuously during the process of brain death. 1. Abrupt rise of ICP after each injection of saline followed by a rapid decline to a new steady-state level within 15 minutes and the average volume required to induce brain death was 7.6$\pm$0.8ml.2. Body temperature, heart rate, mean pulmonary arterial pressure, left ventricular[LV enddiastolic pressure and cardiac output was not changed significantly during the process of brain death, but there was an increasing tendency.3. Mean arterial pressure and LV maximum +dP/dt increased significantly at the time of brain death.4. Hemodynamic collapse was developed within 140 minutes after brain death.5. Marked sinus bradycardia followed by junctional rhythm was seen in two dogs and frequent VPB`s with ventricular tachycardia was observed in one dog at the time of brain death. Hyperdynamic state develops and arrhythmia appears frequently at the time of brain death. Studies on the effects of brain death on myocardium and its pathophysiologic mechanism should be followed in the near future.

• Journal of the korean veterinary medical association
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• v.40 no.3
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• pp.227-240
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• 2004

심부전증(Heart failure)이란 심장이 조직에서 필요로 하는 산소나 영양분을 제대로 공급하지 못하는 상태로 심장 자체의 구조적 결함이외에도 혈역학(hemodynamics)에 영향을 주는 신장 질환이나 고혈압등에 의해서도 발생한다. 심장은 커다란 펌프로 혈역학적 변화에 능동적으로 대처할 능력을 가지고 있다. 하지만 이러한 혈역학의 변화를 유발하는 원인을 제거하지 않은채 장기적으로 원인이 지속할 경우, 심장, 특히 심실은 재구성(remodeling)이 일어나게되고(좌심실의 벽이 비후되고 우심실의 벽이 얇아지는 변화) 이로인하여 심장의 혈역학 변화에 따른 보상 반응은 점차 무력화 되게된다. 이로인하여, 혈액 정체에 따른 폐부종이나 복수증 및 산소 부족에 의한 허혈성 손상이 여러 장기에 나타나게 된다. 심장 질환은 불량한 예후와 치료의 제한성때문에 그동안 수의 분야에서 간과되어왔지만, 우리나라도 애완동물의 노령화가 시작되고 있고 고급 진료에 대한 축주들의 요구가 증가하고 있어서 점파 심장 질환의 진료가 늘어갈 것으로 사료된다. 따라서 본 종설에서는 심부전증에 대한 여러 가지 병리 기전과 이에 따른 치료 방법에 대해 기술하고자한다.