• Title/Summary/Keyword: 화란

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Quantitative Assessment Technology of Small Animal Myocardial Infarction PET Image Using Gaussian Mixture Model (다중가우시안혼합모델을 이용한 소동물 심근경색 PET 영상의 정량적 평가 기술)

  • Woo, Sang-Keun;Lee, Yong-Jin;Lee, Won-Ho;Kim, Min-Hwan;Park, Ji-Ae;Kim, Jin-Su;Kim, Jong-Guk;Kang, Joo-Hyun;Ji, Young-Hoon;Choi, Chang-Woon;Lim, Sang-Moo;Kim, Kyeong-Min
    • Progress in Medical Physics
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    • v.22 no.1
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    • pp.42-51
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    • 2011
  • Nuclear medicine images (SPECT, PET) were widely used tool for assessment of myocardial viability and perfusion. However it had difficult to define accurate myocardial infarct region. The purpose of this study was to investigate methodological approach for automatic measurement of rat myocardial infarct size using polar map with adaptive threshold. Rat myocardial infarction model was induced by ligation of the left circumflex artery. PET images were obtained after intravenous injection of 37 MBq $^{18}F$-FDG. After 60 min uptake, each animal was scanned for 20 min with ECG gating. PET data were reconstructed using ordered subset expectation maximization (OSEM) 2D. To automatically make the myocardial contour and generate polar map, we used QGS software (Cedars-Sinai Medical Center). The reference infarct size was defined by infarction area percentage of the total left myocardium using TTC staining. We used three threshold methods (predefined threshold, Otsu and Multi Gaussian mixture model; MGMM). Predefined threshold method was commonly used in other studies. We applied threshold value form 10% to 90% in step of 10%. Otsu algorithm calculated threshold with the maximum between class variance. MGMM method estimated the distribution of image intensity using multiple Gaussian mixture models (MGMM2, ${\cdots}$ MGMM5) and calculated adaptive threshold. The infarct size in polar map was calculated as the percentage of lower threshold area in polar map from the total polar map area. The measured infarct size using different threshold methods was evaluated by comparison with reference infarct size. The mean difference between with polar map defect size by predefined thresholds (20%, 30%, and 40%) and reference infarct size were $7.04{\pm}3.44%$, $3.87{\pm}2.09%$ and $2.15{\pm}2.07%$, respectively. Otsu verse reference infarct size was $3.56{\pm}4.16%$. MGMM methods verse reference infarct size was $2.29{\pm}1.94%$. The predefined threshold (30%) showed the smallest mean difference with reference infarct size. However, MGMM was more accurate than predefined threshold in under 10% reference infarct size case (MGMM: 0.006%, predefined threshold: 0.59%). In this study, we was to evaluate myocardial infarct size in polar map using multiple Gaussian mixture model. MGMM method was provide adaptive threshold in each subject and will be a useful for automatic measurement of infarct size.

The Planting and Occurrence Status of Exotic Plants of the Folk Village as National Cultural Heritage - Focus in Hahoe.Yangdong.Hangae Villages - (국가지정 문화재 민속마을의 외래식물 식재 및 발생현황 - 하회.양동.한개마을을 대상으로 -)

  • Rho, Jae-Hyun;Oh, Hyun-Kyung;Han, Yun-Hee;Park, Kyung-Uk;Byun, Moo-Sup;Huh, Joon;Choi, Yung-Hyun;Shin, Sang-Sup;Lee, Hyun-Woo;Kim, Hyo-Jung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.31 no.2
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    • pp.1-19
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    • 2013
  • This study was carried out to analyze distribution situation of alien plants and to propose management plan in the 3 Folk village in Gyeongsangbuk-do which is Cultural property designated by the State; Hahoe, Yangdong and Hangae. This research is for improve of sincerity of historical site and provide basic information which use about administration of preservation. The results are as follows. 1. Overall flora and alien plants appearance The total flora in the 3 folk villages were listed total 752 taxa including 127 families, 430 genera, 614 species, 5 subspecies, 100 varieties and 33 forms. Among them, woody plants take 263 taxa(35.0%) and herbaceous plants take 489 taxa (65.0%). Flora in the Hahoe, Yangdong and Hangae village were total 534, 479 taxa and 408 taxa and exotic plant index was 30.1%, 38.2% and 37.0% respectively. In types of exotic plants, ornamental exotic plants were 135 taxa, deciduous exotic plants were 21 taxa, cultivating exotic plants were 64 taxa, and naturalized exotic plants were 80 taxa and those result lead that the ornamental exotic plants is the highest ratio. According to the villages, Hahoe village had 161 taxa(30.1%), Yangdong Village had 183 taxa(38.2%), and Hangae village had 151 taxa(37.0%) that Yangdong village showed the most number of exotic plants. 2. Planting of landscape exotic plants in the unit cultural assets Meanwhile, Ornamental exotic plants in old house's gardens in Andong Hahoe village which is designated as a unit assets, those are total 30 taxa; followed by the Okyeon house(8 taxa) is highest and the Yangjindang(7), the Hadong house(6) and the Chunghyodang(5). Magnolia denudata appears the most as for 4 times and Campsis grandiflora etc. each took 2 times. Based on the Yangdong village, Gyeongju, that are found total 51 taxa; followed by the Dugok house(16 taxa) the Sujoldang(14), the Mucheondang(13), and the Sangchunheon (12). High appearance rate of ornamental exotic plants were Viburnum opulus for. hydrangeoides, Lycoris squamigera, Caragagna sinica and Magnolia denudata etc. Based on the Hangae village, Seongju, that are designated total 62 taxa; followed by the Jinsa house(35 taxa), the Gyori house(25), the Hanju head family house(20), and the Hahoe house(16). Taxa with high appearance rates were Caragana sinica, Juniperus chinensis var. horizontalis, Magnolia denudata, Viburnum opulus for. hydrangeoides, Chaenomeles speciosa etc. 3. Problems of exotic plant landscapes in the outer spaces of the folk villages Problems of exotic plant landscapes in the outer spaces of the Hahoe village are as follows. In lower of the Mansongjeong forest, Ambrosia artemisifolia, which are ecosystem disturbance plants designated by the Ministry of Environment, live with high dominance value. This should be have a remove with Sicyos angulatus immediately. In the Nakdong river bed around the Mansongjeong forest is covered with a riparian vegetation forest belt of Robinia pseudoacacia L. forest, Populus nigra var. italic community, and Populus x tomentiglandulosa community colony. Based on the Yangdong village, the planted or naturally distributed Ailanthus altissima colony, sporadically distributed Robinia pseudoacacia as well as Amorpha fruticosa are detected all over the village and ecotones. Based on the Hangae village, Ailanthus altissima and Robinia pseudoacacia are sporadically distributed around the village and there is a sign of spreading. similarity of exotic plantsis 47.0% to 48.6% and a reason why this happened is all of research site in Gyeongsanbuk-do and that is why growth norm of plant is similar, exotic plant which is sales for ornamental and it infer to require related countermeasure of each villages and joint related countermeasure.

Studies on the Physiological Chemistry of Seed Development in Ginseng Seed (인삼식물의 종자발육 과정에 있어서의 생리화학적 연구)

  • Hee-Chun Yang
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.17
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    • pp.115-133
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    • 1974
  • This study was done on the metabolism of chemical components during the seed development of ginseng. The changes of the chemical components were inspected in the following periods: from the early stage of flower organ formation to flowering time, from the early stage of fruiting to maturity, during the moisture stratification before sowing. From flower bud forming stage to meiosis stage, the changes in the fresh weight, dry weight, contents of carbohydrates, and contents of nitrogen compounds were slight while the content of TCA soluble phosphorus and especially the content of organic phosphorus increased markedly. From meiosis stage to microspore stage the fresh and dry weights increase greatly. Also, the total nitrogen content increases in this period. Insolub]e nitrogen was 62-70% of the total nitrogen content; the increase of insoluble nitrogen seems to have resulted form the synthesis of protein. The content of soluble sugar (reducing and non-reducing sugar) increases greatly but there was no observable increase in starch content. In this same period, TCA soluble phosphorus reached the maximum level of 85.4% of the total phosphorus. TCA insoluble phosphorus remained at the minimum content level of 14.6%. After the pollen maturation stage and during the flowering period the dry weight increased markedly and insolub]e nitrogen also increased to the level of 67% of the total nitrogen content. Also in this stage, the organic phosphorus content decreased and was found in lesser amounts than inorganic phosphorus. A rapid increase in the starch content was also observed at this stage. In the first three weeks after fruiting the ginseng fruit grows rapidly. Ninety percent of the fresh weight of ripened ginseng seed is obtained in this period. Also, total nitrogen content increased by seven times. As the fruits ripened, insoluble nitrogen increased from 65% of the total nitrogen to 80% while soluble nitrogen decreased from 35% to 20%. By the beginning of the red-ripening period, the total phosphoric acid content increased by eight times and was at its peak. In this same period, TCA soluble phosphorus was 90% of total phosphorus content and organic phosphorus had increased by 29 times. Lipid-phosphorus, nucleic acid-phosphorus and protein-phosphorus also increased during this stage. The rate of increase in carbohydrates was similar to the rate of increase in fresh weight and it was observed at its highest point three weeks after fruiting. Soluble sugar content was also highest at this time; it begins to decrease after the first three weeks. At the red-ripening stage, soluble sugar content increased again slightly, but never reached its previous level. The level of crude starch increased gradually reaching its height, 2.36% of total dry weight, a week before red-ripening, but compared with the content level of other soluble sugars crude starch content was always low. When the seeds ripened completely, more than 80% of the soluble sugar was non-reducing sugar, indicating that sucrose is the main reserve material of carbohydrates in ginseng seeds. Since endosperm of the ripened ginseng seeds contain more than 60% lipids, lipids can be said to be the most abundant reserve material in ginseng seeds; they are more abundant than carbohydrates, protein, or any other component. During the moisture stratification, ginseng seeds absorb quantities of water. Lipids, protein and starch stored in the seeds become soluble by hydrolysis and the contents of sugar, inorganic phosphorus, phospho-lipid, nucleic acid-phosphorus, protein phosphorus, and soluble nitrogen increase. By sowing time, the middle of November, embryo of the seeds grows to 4.2-4.7mm and the water content of the seeds amounts to 50-60% of the total seed weight. Also, by this time, much budding material has been accumulated. On the other hand, dry stored ginseng seeds undergo some changes. The water content of the seeds decreases to 5% and there is an observable change in the carbohydraes but the content of lipid and nitrogen compounds did not change as much as carbohydrates.

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Relationships between Micronutrient Contents in Soils and Crops of Plastic Film House (시설재배 토양과 작물 잎 중의 미량원소 함량 관계)

  • Chung, Jong-Bae;Kim, Bok-Jin;Ryu, Kwan-Sig;Lee, Seung-Ho;Shin, Hyun-Jin;Hwang, Tae-Kyung;Choi, Hee-Youl;Lee, Yong-Woo;Lee, Yoon-Jeong;Kim, Jong-Jib
    • Korean Journal of Environmental Agriculture
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    • v.25 no.3
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    • pp.217-227
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    • 2006
  • Micronutrient status in soils and crops of plastic film house and their relationship were investigated. Total 203 plastic film houses were selected (red pepper, 66; cucumber, 63; tomato, 74) in Yeongnam region and soil and leaf samples were collected. Hot-water extractable B and 0.1 N HCl extractable Cu, Zn, Fe, and Mn in soil samples and total micronutrients in leaf samples were analyzed. Contents Zn, Fe, and Mn in most of the investigated soils were higher than the upper limits of optimum level for general crop cultivation. Contents of Cu in most soils of cucumber and tomato cultivation were higher than the upper limit of optimum level, but Cu contents in about 30% of red pepper cultivation soils were below the sufficient level. Contents of B in most soils of cucumber and tomato were above the sufficient level but in 48% of red pepper cultivation soils B were found to be deficient. Micronutrient contents in leaf of investigated crops were much variable. Contents of B, Fe, and Mn were mostly within the sufficient levels, while in 71% of red pepper samples Cu was under deficient level and in 44% of cucumber samples Cu contents were higher than the upper limit of sufficient level. Contents of Zn in red pepper and cucumber samples were mostly within the sufficient level but in 62% of tomato samples Zn contents were under deficient condition. However, any visible deficiency or toxicity symptoms of micronutrients were not found in the crops. No consistent relationships were found between micronutrient contents in soil and leaf, and this indicates that growth and absorption activity of root and interactions among the nutrients in soil might be important factors in overall micronutrient uptake of crops. For best management of micronutrients in plastic film house, much attention should be focused on the management of soil and plant characteristics which control the micronutrient uptake of crops.

Comparative analysis of status of safety accidents and importance-performance analysis (IPA) about precautions of safety accidents by employment type of industry foodservices in Jeonbuk area (전북지역 산업체급식소 조리종사자의 고용형태에 따른 안전사고 실태 및 안전사고 예방관리에 대한 중요도와 수행도 분석)

  • So, Hee;Rho, Jeong Ok
    • Journal of Nutrition and Health
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    • v.50 no.4
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    • pp.402-414
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    • 2017
  • Purpose: The purpose of the study was to evaluate the status of safety accidents and importance-performance analysis (IPA) between regular and non-regular employees in industry foodservices. Methods: The participants were regular employees (n = 119) and non-regular employees (n = 163) in industry foodservices in the Jeonbuk area. Demographic characteristics, status of safety accidents, safety education, and importance and performance status were assessed using a self-administered questionnaire. Results: Approximately 66.4% of regular employees and 53.4% of non-regular employees experienced safety accidents (p < 0.05). Types of safety accidents of regular and non-regular employees were mostly burns, and causes were mostly from their own negligence. Approximately 98.3% of regular employees and 95.1% of non-regular employees experienced safety education. Approximately 88.9% of regular employees and 96.8% of non-regular employees received safety education from dietitians. Approximately 41.9% of regular employees and 50.0% of non-regular employees had difficulty applying the contents of safety education due to lack of time during work. As a result of IPA, regular and non-regular employees were aware of the importance of the following and performed them well: 'Clean the floor of the work place', 'Arrange in the work area', 'Wear safety shoes', 'Check for heater cord', and 'Safety cooking when using oil'. On the other hand, they were not aware of the importance of the following and performed them insufficiently: 'Check for the MSDS', 'Aware of chemical signs', 'Wear protection gloves etc.', 'Do stretching exercise', and 'Using ancillary tools'. Conclusion: Therefore, it is necessary to improve the consciousness of dietitians for effective application of safety education contents, development of contents, especially MSDS, and related things.

Incase of Same Region Treatment by using a Tomotherapy and a Linear Accelerator Absorbed Dose Evaluation of Normal Tissues and a Tumor (토모테라피와 선형가속기를 이용한 동일 부위의 치료 시 종양 및 정상조직의 흡수선량 평가)

  • Cheon, Geum-Seong;Kim, Chang-Uk;Kim, Hoi-Nam;Heo, Gyeong-Hun;Song, Jin-Ho;Hong, Joo-Yeong;Jeong, Jae-Yong
    • The Journal of Korean Society for Radiation Therapy
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    • v.22 no.2
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    • pp.97-103
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    • 2010
  • Purpose: Treating same region with different modalities there is a limit to evaluate the total absorbed dose of normal tissues. The reason is that it does not support to communication each modalities yet. In this article, it evaluates absorbed dose of the patients who had been treated same region by a tomotherapy and a linear accelerator. Materials and Methods: After reconstructing anatomic structure with a anthropomorphic phantom, administrate 45 Gy to a tumor in linac plan system as well as prescribe 15 Gy in tomotherapy plan system for make an ideal treatment plan. After the plan which made by tomoplan system transfers to the oncentra plan system for reproduce plan under the same condition and realize total treatment plan with summation 45 Gy linac treatment plan. To evaluate the absorbed dose of two different modalities, do a comparative study both a simple summation dose values and integration dose values. Then compare and analyze absorbed dose of normal tissues and a tumor with the patients who had been exposured radiation by above two differents modalities. Results: The result of compared data, in case of minimum dose, there are big different dose values in spleen (12.4%). On the other hand, in case of the maximum dose, it reports big different in a small bowel (10.2%) and a cord (5.8%) in head & neck cancer patients, there presents that oral (20.3%), right lens (7.7%) in minimum dose value. About maximum dose, it represents that spinal (22.5), brain stem (12%), optic chiasm (8.9%), Rt lens (11.5%), mandible (8.1%), pituitary gland (6.2%). In case of Rt abdominal cancer patients, there represents big different minimum dose as Lt kidney (20.3%), stomach (8.1%) about pelvic cancer patients, it reports there are big different in minimum dose as a bladder (15.2%) as well as big different value in maximum dose as a small bowel (5.6%), a bladder (5.5%) in addition, making treatment plan it is able us to get. Conclusion: In case of comparing both simple summation absorbed dose and integration absorbed dose, the minimum dose are represented higher as well as the maximum dose come out lower and the average dose are revealed similar with our expected values data. It is able to evaluate tumor & normal tissue absorbed dose which could had been not realized by treatment plan system. The DVH of interesting region are prescribed lower dose than expected. From now on, it needs to develop the new modality which are able to realize exact dose distribution as well as integration absorbed dose evaluation in same treatment region with different modalities.

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Cosmetic Results of Conservative Treatment for Early Breast Cancer (조기유방암에서 유방보존수술 및 방사선치료후의 미용적 결과)

  • Kim Bo Kyoung;Shin Seong Soo;Kim Seong Deok;Ha Sung Whan;Noh Dong-Young
    • Radiation Oncology Journal
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    • v.19 no.1
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    • pp.21-26
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    • 2001
  • Purpose : This study was peformed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. Materials and Methods : From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients $(90\%)$ and lumpectomy or excisional biopsy for 10 patients $(8.3\%)$. Forty six patients $(38\%)$ received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the sternal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. Results : Cosmetic score was excellent or good in $76\%$ (91/120), fair in $19\%$ (23/120) and poor in $5\%$ (6/120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (N0 versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0.0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. Conclusion : Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary node metastasis and treated with less extensive surgery without chemotherapy.

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A Study on BRCA1/2 Mutations, Hormone Status and HER-2 Status in Korean Women with Early-onset Breast Cancer (젊은 한국인 유방암 환자에서 BRCA1/2 돌연변이와 호르몬 수용체, HER-2 상태에 관한 연구)

  • Choi, Doo-Ho;Jin, So-Young;Lee, Dong-Wha;Kim, Eun-Seog;Kim, Yong-Ho
    • Radiation Oncology Journal
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    • v.26 no.1
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    • pp.65-73
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    • 2008
  • Purpose: Women with breast cancer diagnosed at an age of 40 years or younger have a greater prevalence of germline BRCA1 and BRCA2 mutations than the prevalence of women with breast cancer diagnosed at older ages. Several immunohistochemical characteristics have been identified in breast cancers from studies of Caucasian women with BRCA1/2 mutations having familial or early-onset breast cancers. The aim of this study is to determine whether early-onset breast cancer in BRCA1 or BRCA2 mutation carriers, who were not selected from a family history, could be distinguished by the use of immunohistochemical methods and could be distinguished from breast cancer in women of a similar age without a germline BRCA1 or BRCA2 mutation. We also analyzed the prognostic difference between BRCA1/2 related and BRCA1/2 non-related patients by the use of univariate and multivariate analysis. Materials and Methods: Breast cancer tissue specimens from Korean women with early-onset breast cancers were studied using a tumor tissue microarray. Immunohistochemical staining of estrogen receptor(ER), progesterone receptor(PR) and HER-2, as well as the histology and grade of these specimens, were compared. The prognostic impact of immunohistochemical and histological factors as well as the BRCA1/2 mutation status was investigated separately. Results: There were 14 cases and 16 deleterious BRCA1/2 mutations among 101 patients tested. A family history(4/14) and bilateral breast cancers(3/9) were high risk factors for BRCA1/2 mutations. BRCA1/2-associated cancers demonstrated more expression of ER-negative(19.4% versus 5.1%, p=0.038) and HER-2 negative than BRCA1/2 negative tumors, especially for tumors with BRCA1 tumors The BRCA1/2 mutation rate for patients with triple negative tumors(negative expression of ER, PR and HER-2) was 24.2%. Tumor size, nodal status, and HER-2 expression status were significantly associated with disease free survival, as determined by univariate and multivariate analysis, but the BRCA1/2 status was not a prognostic factor. Conclusion: Breast cancer that occurs in women with a germline BRCA1 or BRCA2 mutations have recognizable immunohistochemical features, which may be useful in identifying individuals that are more likely to carry germline mutations. Although the BRCA1/2 mutation status was not a prognostic factor in Korean women with early-onset breast cancer, more cases with a longer follow-up period are needed for further study.

Development of Standard Process for Private Information Protection of Medical Imaging Issuance (개인정보 보호를 위한 의료영상 발급 표준 업무절차 개발연구)

  • Park, Bum-Jin;Yoo, Beong-Gyu;Lee, Jong-Seok;Jeong, Jae-Ho;Son, Gi-Gyeong;Kang, Hee-Doo
    • Journal of radiological science and technology
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    • v.32 no.3
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    • pp.335-341
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    • 2009
  • Purpose : The medical imaging issuance is changed from conventional film method to Digital Compact Disk solution because of development on IT technology. However other medical record department's are undergoing identification check through and through whereas medical imaging department cannot afford to do that. So, we examine present applicant's recognition of private intelligence safeguard, and medical imaging issuance condition by CD & DVD medium toward various medical facility and then perform comparative analysis associated with domestic and foreign law & recommendation, lastly suggest standard for medical imaging issuance and process relate with internal environment. Materials and methods : First, we surveyed issuance process & required documents when situation of medical image issuance in the metropolitan medical facility by wire telephone between 2008.6.1$\sim$2008.7.1. in accordance with the medical law Article 21$\sim$clause 2, suggested standard through applicant's required documents occasionally - (1) in the event of oneself $\rightarrow$ verifying identification, (2) in the event of family $\rightarrow$ verifying applicant identification & family relations document (health insurance card, attested copy, and so on), (3) third person or representative $\rightarrow$ verifying applicant identification & letter of attorney & certificate of one's seal impression. Second, also checked required documents of applicant in accordance with upper standard when situation of medical image issuance in Kyung-hee university medical center during 3 month 2008.5.1$\sim$2008.7.31. Third, developed a work process by triangular position of issuance procedure for situation when verifying required documents & management of unpreparedness. Result : Look all over the our manufactured output in the hospital - satisfy the all conditions $\rightarrow$ 4 place(12%), possibly request everyone $\rightarrow$ 4 place(12%), and apply in the clinic section $\rightarrow$ 9 place(27%) that does not medical imaging issuance office, so we don't know about required documents condition. and look into whether meet or not the applicant's required documents on upper 3month survey - satisfy the all conditions $\rightarrow$ 629 case(49%), prepare a one part $\rightarrow$ 416 case(33%), insufficiency of all document $\rightarrow$ 226case(18%). On the authority of upper research result, we are establishing the service model mapping for objective reception when image export situation through triangular position of issuance procedure and reduce of friction with patient and promote the patient convenience. Conclusion : The PACS is classified under medical machinery that mean indicates about higher importance of medical information therefore medical information administrator's who already received professional education & mind, are performer about issuance process only and also have to provide under ID checking process exhaustively.

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Analysis of Neurological Complications on Antegrade Versus Retrograde Cerebral Perfusion in the Surgical Treatment of Aortic Dissection (대동맥 박리에서 전방성 뇌 관류와 역행성 뇌 관류의 신경학적 분석)

  • Park Il;Kim Kyu Tae;Lee Jong Tae;Chang Bong Hyun;Lee Eung Bae;Cho Joon Yong
    • Journal of Chest Surgery
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    • v.38 no.7 s.252
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    • pp.489-495
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    • 2005
  • In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. Material and Method: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. Result: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was $17.2^{\circ}C\;and\;22.8^{\circ}C$ in the group A, and $16.0^{\circ}C\;and\;19.7^{\circ}C$ in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. Conclusion: The Antegrade, cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.