• Journal of Chest Surgery
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• 제41권1호
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• pp.49-54
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• 2008

배경: 대동맥질환은 전 부위의 대동맥이 병변을 일으키는 특성이 있으므로 수술을 받은 후 다른 부위에 이차 수술의 가능성이 언제나 남게 된다. 이차 대동맥 수술의 특징과 문제점을 알아보고자 본 연구를 시행하였다. 대상 및 방법: 2003년 4월에서부터 2007년 6월까지 본원에서 대동맥 이차 수술로 흉복부 대동맥 치환술을 받은 12명의 환자(남자 6명 여자 6명)를 대상으로 임상 경과를 조사하였다. 수술은 대퇴동정맥간 우회로술로 시행한 하부 흉복부대동맥치환술 4예와 극저체온하 순환정지하에서 시행한 광범위 흉복부대동맥치환술을 8예 시행하였다. 결과: 수술 사망이나 하지 마비는 없었고 국소 합병증으로 창상감염 3예, 출혈로 인한 재수술 2예, 오염된 혈종으로 인한 재수술 1예 등이 발생하였다. 그 외 혈액투석 1예, 호흡부전 1예 등이 있었으며 평균 입원기간은 $30{\pm}21$일이었다. 평균외래 추적 $626{\pm}542$일 동안 재수술 증례 없이 모두 경과 관찰 중이다. 결론: 응급 상황에 도달하기 전의 적절한 시기에 극저체온 순환정지법을 사용한다면 흉복부대동맥치환술은 이차 대동맥 수술의 좋은 치료법이 될 수 있을 것이다.

• Journal of Chest Surgery
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• 제29권11호
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• pp.1212-1217
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• 1996

경북대학교병원 흉부외과에서는 1993년 12월부터 1995년 5월까지 14례(남자 9명, 여자 5명)의 상행대동맥 및 대동맥궁질환을 수술하였으며, 환자들의 나이는 25세 에서 65세로 평균 50.4세였다. 진단은 급성 대동맥 박리가 6례(43%)로 4례는 파열이 되었으며, 상행 대동맥류가 4례(29%)로 1례에서 대동맥궁까지 확장되어 있었고 3례에서 파열이 되었으며, 대동맥 판륜확장이 3례(21%)로 1례에서 파열이 동반되었고, 대동맥궁류가 1례(7%)였다. 전례에서 심초음파와 컴퓨터 단층촬영을 시행하였으며, 혈관촬영은 2례에서 시행하였다. 수술의 적응은 파열 5례, 급성 대동맥 박리 5례, 심한 울혈성 심부전 2례, 진행성의 대동맥판막 폐쇄부전 1례 및 동맥류가 커서 파열의 위험성이 있는 경우 1례였다. 수술은 10례(71%)에서 응급으로 시행하였다. Cabrol 수술 6례, 대동맥궁 치환을 겸한 Cabrol 수술 1례, 변형된 Bentall수술 1례, 상행 대동맥 치환 4례, 대동맥궁 치환 1례 및 대동맥궁 치환을 겸한 상행 대동맥 치환의 경우가 1례였다. 술후 합병증으로는 순환정지를 62분 시행한 환자가 경련을 보였고, 심방세동이 2례, 흉골 열개가 1례 그리고 종격동염이 1례 있었다. 술후 조기사망은 2례(14%)에서 있었으며 각각 과다 출혈과 다발성 장기부전이 원인이었다. 심실 부정맥으로 인한 만기사망이 1례(7%)에서 있었다. 11명의 생존 환자들의 추적관찰기간은 2개월에서 20개월로 전례에서 경과는 양호하였다.

• Journal of Chest Surgery
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• 제18권1호
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• pp.54-61
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• 1985

One-hundred-and-seven patients were the consecutive cases of double replacement of the mitral and the aortic valves at the same time using the lonescu-Shiley bovine pericardial xenograft valve during the period between May, 1979 and June, 1984. They were 64 males and 43 females, and their ages ranged from 13 to 62 years [mean age, 34.011.9 years]. Eight patients died within 30 days after surgery [operative mortality rate, 7.5%], and 7 others thereafter [late mortality rate, 6.5%; or 4.21%/patient-year]. Ninety-nine early survivors were followed up for a total duration of 166.1 patient-years [mean duration, 20.116.1 months]. Two patients experienced thromboembolic complication with no death [1.20%/patient-year]; five developed prosthetic valve endocarditis [3.01%/patient-year] with one death; and three had a new development of aortic regurgitant murmur and they were, along with a mortality from endocarditis, classified into the cases of tissue valve failure [2.41%/patient-year]. The actuarial survival rate including the operative mortality was 82.24.7% at 6 years after surgery. The probabilities of freedom from thromboembolism and from valve failure were 97.61.7% and 88.67.6% at 6 years respectively. Symptomatic improvement was excellent in most of the cases at the follow-up end, showing the mean of the postoperative NYHA Classes of 1.120.33 from the preoperative one of 2.860.54. These results compares favorably with the ones reported from the major institutions. Clinical results of isolated replacement of the mitral valve and of the aortic valve were previously reported. The clinical results of a total and consecutive patients with replacement of single mitral and single aortic and double mitral and aortic valves on the mortality rate, survival rate, complication frequency, and symptomatic improvement all fully stands for the good therapeutic modalities of the valvular heart diseases with severely damaged lesions.

• Journal of Chest Surgery
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• 제52권1호
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• pp.9-15
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• 2019

Background: Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR. Methods: Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was $32.2{\pm}13.9$ years. The mean follow-up duration was $18.3{\pm}5.8$ years. Results: There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was $13.1{\pm}6.1$ years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively. Conclusion: The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1570-1577
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• 1992

The vascular surgery is the field that has developed in early 20 century and is progressing nowadays. Recent advance in surgical technique accompanying with excellent medical diagnosis and treatment, prompt angiographic usage, development of variable prosthetic material, and concomitant use of anti-coagulant have made remarkable results of vascular surgery. 83 cases of vascular surgery have been performed at Thoracic and Cardiovascular Surgery Department of Pusan National Unversity Hosaital since 1971 till 1990, for 20 years and their results are followed. Patient ductus arteriosus and Buerger`s disease were omited in this study. 1. The age distribution shows that the fifth and sixth decades are most frequently affected and mean age was 56.1 years old. Male to female ratio is 1: 2.32. 2. Among the 83 cases of all, number of occlusive vascular disease is 46 and that of aneurysmal disease is 33. 3. In clinical manifestation, most common symptom of occlusive disease is pulselessness and pain was next. Mass sensation is most commonly complained by patients of aneurysmal disease. 4. CT scan was more important in diagnosis of aneurysmal diseases and angiogram was more commonly used in occlusive diseases. 5. The common site of arterial occlusion was common iliac artery, femoral artery, aortic bifurcation, and external iliac artery, as its frequency rate. The most commonly affecting portion of aortic aneurysm was abdminal aorta, and descending thoracic aorta and femoral artery were next 6. Preoperative associated diseases were atherosclerosis[41 cases], hypertension[21 cases], valvular heart disease[11 cases], and diabetes mellitus[9 cases], etc, 7. Operative methods in ocllusive diseases were thrombectomy[36.9%], endarterectomy [10.9%], and bypass graft insertion[52.7%]. Among the bypass graft, Y-graft was used in 7 case, straight graft was used in 17 cases, and saphenous venous graft was used in 2 cases. 8. Postoperative complications were developed in 17 cases, and morbidity rate was 36. 9. Eleven patient were died within 1 month after operation, so operative mortality rate was 13.3%. 10. Duration of patency was beteween 7 and 58 months[average 27.5 months] in occlusive diseases and their 5-year patency rate was 56.3%. Duration of patency of aneurysmal disease was 20 months in aveage and their 5-year patency rate was 51.3%. 11. Patients of eleven cases of occlusive disease and two cases of aneurysmal disease required reoperation for variable reason. 12. 35 cases of patient have used anticoagulants: coumadin, ticlid, and persanthin-ASA combination.

• Journal of Chest Surgery
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• 제26권11호
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• pp.874-880
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• 1993

A personal computer, IBM compatible 386, was utilized to analyse total series of 1867 cases of cardiovascular operations including 1060 cases of open cardiac surgeries performed at the Cardiac Center of Paik Hospital from 1986 to 1992.All data were first assembled from the operation files and the operation records from the patient charts. Code numbers were placed to the diagnosis, the operations and the diseases.The analysis revealed the distributions of 1867 cases of operations;819 cases[77%] of the congenital heart diseases and 207 cases[20%] of the acquired heart diseases among 1060 open heart operations. The operative mortalities were 3.7% for the congenital heart diseases and 6.3% for the acquired heart diseases.The vascular operations showed the operative mortalities of 11.8% for the aortic surgery under extracorporeal circulation and 0.7% for the other vascular surgery.

• 전자공학회논문지SC
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• 제45권3호
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• pp.68-79
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• 2008

대동맥 증강지수는 심실의 부하뿐만 아니라 대동맥의 탄력성을 직접적으로 나타낼 수 있는 장점 때문에 동맥의 경직도를 평가하는 지표로 주목받고 있다. 하지만, 정확한 대동맥 증강지수를 계산하기 위해서는 직접 카테터를 피험자에 삽입하여 측정해야 하기 때문에 임상에 적용하기에는 한계가 존재한다. 이러한 문제점 때문에 전달함수를 이용하여 요골 동맥 맥파로부터 대동맥 맥파를 간접적으로 추정하는 방법이 이용되고 있다. 본 논문에서는 전달함수를 구하기 위하여 Millar 카테터를 이용한대동맥 맥파와 토노메트릭 방식의 압력센서를 이용하여 요골동맥 맥파를 측정하였다. 또한, 기존의 증강점 검출 알고리즘 대신단계적으로 미분 차수를 증가시키면서 증강점을 검출하는 새로운 알고리즘을 제안하였다. 10차 ARX 모델을 이용하여 전달함수를 구현하였으며, 잔차 분석을 통하여 모델을 검증하였다. 증강점 검출 알고리즘 검증을 위하여 네 가지 종류의 합성파를 만들어 제안된 알고리즘이 기존 알고리즘 보다 더 정확한 결과를 나타내는 것을 확인할 수 있었다. 본 연구는 쉽게 측정할 수 있는 요골동맥 맥파를 이용하여 대동맥의 경직도를 평가할 수 있는 방법을 제시하였으며 이를 통하여 다양한 심혈관 질환의 조기 진단에 기여할 수 있을 것이다.

• Biomolecules & Therapeutics
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• 제19권4호
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• pp.477-486
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• 2011

The purpose of the present study was to investigate whether polyphenol-rich fraction extracted from fruit wine of Rubus coreanum M (PCRC) can affect the contractility of the thoacic aortic strips isolated from spontaneously hypertensive rats (SHRs), and to clarify its mechanism of action. PCRC (200-800 ${\mu}g/mL$) concentration-depenedently blocked phenylephrine (10 ${\mu}M$)-induced contractile responses of the isolated aortic strips of SHRs. PCRC (400 ${\mu}g/mL$), added in to bath medium, also depressed the contractile active tension evoked by both phenylephrine (3 and 10 ${\mu}M$) and high potassium (25 and 56 mM). In the simultaneous presence of PCRC (400 ${\mu}g/mL$) and L-NAME (a selective inhibitor of NO synthase, 300 ${\mu}M$), the contractile responses evoked by phenylephrine and high $K^+$ were recovered to considerable level of the corresponding control contractility compared with those effects of PCRC-treatment alone. However, in the simultaneous presence of indomethacin (10 ${\mu}M$, a selective cyclooxygenase inhibitor) and PCRC (400 ${\mu}g/mL$), they were not affected. In the endothelium-denuded aortic strips by CHAPS-treatment, PCRC did not affect the contractile responses induced by phenylephrine or high potassium. Interestingly, PCRC (1.0, 3.0 and 10.0 mg/kg/30 min, i.v., respectively) dose-dependently suppressed norepiphrine-induced vasopressor responses in anesthetized SHRs. Collectively, we concluded that PCRC causes vasorelaxation in the thoracic aortic strips with intact endothelium of SHRs at least partly by the increased NO production through the activation of NO synthase of vascular endothelium, but not through the activation of cyclooxygenase. These results suggest that PCRC might be helpful to prevent or alleviate cardiovascular diseases, including hypertension.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권2호
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• pp.67-72
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• 2014

Necrotizing fasciitis (NF) is defined as rapidly progressive necrosis of subcutaneous fat and fascia. Although NF of the face is rare, its mortality rate is nearly 30%. It usually originates from dental infection and can lead to involvement of the neck, mediastinum, and chest wall. Complications resulting from pre-existing systemic diseases can increase the mortality rate. Known complication factors for NF include diabetes, malnutrition, advanced age, peripheral vascular disease, renal failure, and obesity. Here, we report a case of NF originating from dental infection in an 88-year-old woman already diagnosed with hypertension, thoracic aortic aneurysm, and renal diseases. Such conditions limited adequate surgical and antibiotic treatment. However, interdisciplinary treatment involving multiple departments was implemented with good results.

• Journal of Chest Surgery
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• 제27권9호
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• pp.738-745
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• 1994

In order to evaluate the myocardial injury in cardiac valvular and coronary surgery, variables of creatine kinase[CK], myocardial band of CK[CK-MB], lactate dehydrogenase[LDH], aspartate aminotrasferase[AST] were measured in the preoperative[Preop], the operation day[POD0], and the first[POD1], third[POD3], fifth[POD5], seventh[POD7], ninth[POD9] day after operation in 29 patients. The subjects were divided into two groups according to the diseases: group V [valvular disease, n=16] and group C[coronary artery disease, n=13]. Each group was subdivided into two subgroups according to the duration of aortic crossclamping time[ACT]; group VI[ACT 120min, n=7] and group VII[ACT>120min, n=9]; group CI[ACT 120min, n=6] and group CII[ACT>120min, n=7]. The results were as followed 1. The values of CK between group V and group C had no significant difference. The values of CK in group CII were significantly greater than those in group CI and the values of CK in group VII were significantly greater than those in group VI. 2. Percentages of CK-MB between groups had no significant difference. 3. The serum levels of LDH in group V were significantly greater than those in group C. The serum levels of LDH in group VII were significantly greater than those in group VI. 4. The serum levels of AST in group VII were significantly greater than that in group VI. We were concluded that myocardial injury was more related with the duration of aortic cross clamping time rather than the type of diseases.