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The Clinical Outcomes of Damus-Kaye-Stansel Procedure According to Surgical Technique

  • Yang, Chan Kyu;Jang, Woo Sung;Choi, Eun-Suk;Cho, Sungkyu;Choi, Kwangho;Nam, Jinhae;Kim, Woong-Han
    • Journal of Chest Surgery
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    • v.47 no.4
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    • pp.344-349
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    • 2014
  • Background: The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used. Methods: We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed. Results: There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up. Conclusion: The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.

Changes of the Biventricular Outflow Tract after a Half Turned Truncal Switch Operation in Patients with Transposition of the Great Arteries, a Ventricular Septal Defect and Pulmonary Stenosis - 2 case reports - (반회전 동맥간 전환술 후 양심실 유출로의 중단기 변화 - 2예 보고 -)

  • Kim, Jeong Won;Cho, Joon-Yong;Kim, Gun-Jik;Lee, Jong-Tae;Kim, Kyu-Tae
    • Journal of Chest Surgery
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    • v.43 no.1
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    • pp.58-62
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    • 2010
  • Rastelli repair has been considered the procedure of choice for surgically repairing transposition of the great arteries combined with ventricular septal defect and pulmonary stenosis. However, the long term results have been less than optimal and these patients who ungo this procedure can eventually display conduit obstruction, left ventricular outflow tract obstruction and arrhythmias. Many new procedures are now available and they are technically challenging for making a more normal anatomic repair. In our hospital, two patients who had a TGA with VSD and PS have been repaired with a Half Turned Truncal Switch Operation and a Lecompte maneuver in 2003 and 2006, respectively. We report on our two experiences with performing a Half Turned Truncal Switch Operation, and we discuss the changes of the biventricular outflow tract.

The Effect of Endogenous and Exogenous Estrogen on Risk Factors of Coronary Heart Disease -Part II : On Platelet Aggregation- (내인성 및 외인성 Estogen이 관상동맥질환 위험인자에 미치는 영향 -제2보: 내인성 및 외인성 Estrogen이 혈소판 응집에 미치는 영향-)

  • 박유신
    • Journal of Nutrition and Health
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    • v.32 no.5
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    • pp.561-569
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    • 1999
  • In the atherosclerotic subjects, arterial endothelial cell injury and plaque formation are suspected to be strong causable factors in developing acute coronary syndrome, and it was revealed that platelets have a very important role in this case. Women are exposed to atherosclerosis at a different degree after menopause or oral contraception. The purpose of this study was to determine the effects of endogenous and exogenous estrogen on the degree of platelet aggregation in platelet rich plasma(PRP) in twenty nonsmoking healthy Korean women for 12 weeks. The subjects were assigned to three groups: (1) eight women aged 49 to 60(yr) for the postmenopausel(Pst) group, (2) eight, aged 22 to 30(yr) for the premenopausa(Pre) group, (3) four, aged 23 to 30(yr) for the oral contraceptive (OC) group which used triphasic OC formulation. Fasting blood sample were obtained from the subjects, (1) once per 6 weeks in the Pst group, (2) every phase of the menstrual cycle in the Pre group, (3) each once during and after OC administration in the OC group. ADP, collagen and epinephrine were used as aggregating reagents, and platelet aggregation and time(Δt: time reaching to the maximum point of aggregation) in PRP were measured at the maximum point of aggregation in five minutes. All the data were adjusted for dietary effects, personality type and body mass index(BMI) by using analysis of covariation(ANCOVA). Platelet aggregation to ADP and collagen(MADP and MCOLL) were not significantly different among the three groups, and Δt to ADP and collagen(TADP and TCOLL) were not either. But maximum platelet aggregability and Δt to epinephrine(MEPIN and TEPIN) were significantly different among the three groups, and the OC group showed the lowest value (p<0.01). Maxtimum platelet aggregability and Δt during the menstrual cycle were not significantly different in the Pre group. Any other significant differences in the maximum platelet aggregability and Δt were found between oral contraception phase and washing out phase(menstruation) in the OC group. In results, maximum platelet aggregability and aggregation time to ADP and collagen seemed not to be affected by endogenous and exogenous estrogen, even though MEPIN and TEPIN showed significantly low in the OC group among the three groups.

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A Study of the Relation between Food Habits , Anthropometric and Clinical Data in a Health Promoting Elementary School in Changwon (창원시 건강증진 시범학교 일부 아동의 식습관 , 체격지수 , 혈액성상에 관한 연구)

  • Lee, Gap-Yeon;Ju, Jeong;Lee, Bu-Ok
    • Journal of the Korean Dietetic Association
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    • v.7 no.4
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    • pp.331-348
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    • 2001
  • The purpose of this study was to obtain basic data for nutrition education of the children in a health promoting elementry school. The data was collected by a questionaire of food habits, and anthropometric measurement and biochemical test in comparison with obesity index. The study subjects were boys and girls aged 10 to 12 years who participated in the “99 Children Nutrition Camp”. The average obesity index was 1.7$\pm$21.6% in boys and -11.4$\pm$12.6% in girls. After school, major leisure items were significnatly different by gender but both boys and girls played mainly computer game. In concern for body image and eating habits, girls had more concern and girls had attempted weight control more than boys. 80.2% of subjects had prejudice for special food, especially, all subjects in the severely underweight group had prejudice. But this tendency was significantly decreased with the increasing obesity index. The lowest preferency was for vegetables(64.4%). The tendency of prejudice of subjects was higher whose mother are thirties than those of subjects whose mother are in fourties. The serum GOT and GPT values were significantly higher in overweight and obese group than the other groups. The only serum T-chol was significantly higher in boys than in girls. The number of risk factors related to coronary heart disease(CHD) based on coresponding criteria of TG, T-chol, HDL-chol, and LDL-chol was not increased significantly with the degree of obesity index. The results indicated the need of nutritional management for the children. At a point of view, to educate children early who are able to change food habits and life-styles means to help heathy growth and to deliver up heathy adults. Active nutrition education for both children and mothers will be recommended with joint participation of nutritionists in community public health center and elementary school.

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Effect of Dietary Therapy on Blood Lipid in Outpatients with Hypercholesterolemia (고콜레스테롤혈증 환자에서 식사요법이 혈청 지질농도에 미치는 영향)

  • Im, Hyeon-Suk;Sin, Min-Jeong;Jeong, Nam-Sik;Jo, Seung-Yeon;Kim, Seong-Sun
    • Journal of the Korean Dietetic Association
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    • v.7 no.4
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    • pp.313-319
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    • 2001
  • High serum cholesterol level is a major risk factor for coronary heart disease(CHD). Nutrition therapy of hypocholesterolemic diets with increased physical activity is the essential step in the treatment of the hypercholesterolemic patients. The purpose of this study was to evaluate the short-term effect of intensive dietary therapy combined with regular exercise in lowering serum cholesterol level. Seventy three hypercholesterolemic outpatients(mean: 268.0$\pm$24.7mg/dL), aged 34 to 73(mean: 56$\pm$9.8yrs), who visited cardiology OPD of Yonsei Cardiovascular Center from April through October, 1998 were studied. Anthropometric measurements, usual nutrient intake survey using semiquantitative food frequency questionnaire, and daily nutrient intake analysis were performed. The nutrition counseling for the hypocholesterolemic diet and exercise therapy was performed individually. After a 4 week intensive dietary therapy, comparisons of body weight, nutrient intakes, and blood lipid concentrations were evaluated for the hypocholesterolemic effect of intensive diet therapy. After 4 weeks of intensive diet therapy, significant reductions in percent ideal body weight(p<0.01), saturated fat intake(p<0.01), and cholesterol intake(p<0.01) were observed. There were significant reductions in serum total cholesterol and LDL-cholesterol levels after 4 weeks of therapy by 8.1%(p<0.01) and 9.7%(p<0.01), respectively. Our results showed that intensive dietary therapy was effective in reductions of serum total and LDL-cholesterol levels. The goal for this dietary modification should not be temporary but rather be permanent in eating behavior accompanied by appropriately increased physical activity.

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Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

  • Lee, Youngok;Cho, Joon Yong;Kwon, O Young;Jang, Woo Sung
    • Journal of Chest Surgery
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    • v.49 no.5
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    • pp.337-343
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    • 2016
  • Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous return (TAPVR) repair. However, the surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following in situ TAPVR repair without total circulatory arrest (TCA), and to identify the risk factors associated with surgical outcomes. Methods: We retrospectively reviewed 29 cases of surgical intervention for TAPVR conducted between April 2000 and July 2015. All patients were newborns or infants who underwent in situ TAPVR repair without TCA. Results: Four anatomic subtypes of TAPVR were included in this study: supracardiac (20 cases, 69.0%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%), and mixed (1 case, 3.4%). The median follow-up period for all patients was 42.9 months. Two (6.9%) early mortalities occurred, as well as 2 (6.9%) cases of postoperative pulmonary venous obstruction (PVO). Preoperative ventilator care (p=0.027) and preoperative PVO (p=0.002) were found to be independent risk factors for mortality. Conclusion: In situ repair of TAPVR without TCA was associated with encouraging mid-term outcomes. Preoperative ventilator care and preoperative PVO were found to be independent risk factors for mortality associated with TAPVR repair.

Effect of Supplementation of Fish Oil on Serum Lipid in Young Healthy Females (어유의 섭취가 젊은 여성의 혈청 지질에 미치는 영향)

  • 장현숙
    • Journal of Nutrition and Health
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    • v.23 no.1
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    • pp.1-10
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    • 1990
  • This study was designed to investigate the effect of supplementation of fish oil on serum lipid in young healthy females. Eighteen female college students were divided into 3 groups. Each group fed a typical Korean diet supplemented with 15g, 12g and 9g of fish oil respectively for 1 week. Blood samples were obtained 4 times before supplementation, immediatly after supplementation, 1 week after stopping supplementation and 3 week after stopping supplementation. After 6 week break, the doses of fish oil were interchanged among 3 groups and the experiment was repeated to reduce interindivisual variation. The level of total cholesterol(TC), triglyceride(TG), lipoprotein, high density lipoprotein(HDL)-cholesterol, low density lipoprotein(LDL)-cholesterol in the serum samples were determined immediately after stopping supplementation and then the value compared with those of the before supplementation period. The results obtained are summarised as follows; The serum TC levels decreased significatly(p<0.01) immediately after supplementation of fish oil and 1 week after stopping supplementation. The serum TG levels also decreased significantly(p<0.05) immediately after supplementation of fish oil. The HDL-cholesterol levels increased significantly(p<0.05) at 2 week and 3 weeks after stopping supplementation of fish oil in the 12g and the 15g supplementation groups. The LDL-cholesterol levels decreased significantly(p<0.05) immediately after and 1 week after stopping supplementation of fish oil. The ratio of HDL-C to TC increased significantly(p<0.01) and the ratio of LDL-C to HDL-C, and index of artherogenesity, decreased significantly(p<0.05).

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Effect of inhibition on Browning and Microbial Growth of Minimally Processed Lettuce (최소가공 처리에 의한 양상추의 갈변 및 미생물 증식억제 효과)

  • Cha Hwan-Soo;Kim Soon-1m;Kim Byeong-Sam;Kim Sang-Hee;Park Seon-Ju;Cho Han-Sun;chd Hye-Yeon
    • Food Science and Preservation
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    • v.11 no.3
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    • pp.331-335
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    • 2004
  • This study was carried out to improve quality of minimally processed lettuce with various treatments. The treatments for preventing enzymatic browning were using different chemical immersion solutions and controlling microbial growth were using chlorine, electrolyzed water, and organic acid. The solution with ascorbic acid 1$\%$ and citric acid 1 $\%$ showed a positive effect on antibrowning of minimally processed lettuce. In the inhibition of microorganisms growth, 200 ppm NaCIO solution was more effective than fermented pollen solution and Na-dichloroisocyanurate solution. In electrolyzed water system, no-diaphragm system showed inhibitory effect of microorganisms growth. Also, total microorganisms count of minimally processed lettuce with ascorbic acid and citric acid solution was lower by about 4 log cycle after 4 days storage at l0$^{\circ}C$.

The Study of Maternal Characteristics of Low Birth-Weight Infant (저체중아 출생과 관련된 산모의 특성 연구)

  • Hong, Pil-Soon;Park, Kyoung-Sook
    • Women's Health Nursing
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    • v.5 no.1
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    • pp.80-95
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    • 1999
  • The purpose of this study was to investigate the characteristics of low birth-weight infants and their's mothers, and to identify the factors which influenced to delivery of L.B.W infants. The data derived from K. General Hospital and J. obs & gyn clinic in pusan from January, 1998 to August, 1998, which were from mothers of having B. W infants. The factors used for this study were characteristics of general, obstetrical, environmental aspects and physical and psychological life experiences during pregnancy. Analysis of data obtained were computerized statistically by using SPSS 7.5 WIN program. the data were analysed as number, frequency, percentage, t-test and ANOVA. The major results obtained of this study were as follows : 1) Gender that L.B.W infants were male in 47.2% and female in 52.8%, body weight of 2001~2500gm was above 8 in 68.5%, and below 5 in 1.8%. The L.B.W infants with complications were 7, which were 6.5%. The kinds of malformations were the Cleft palate & lip, Hyper-kalemia, Hypoglycemia, Meningocele, CHD, Down syndrome and each of them marked 0.9%. 2) In the general characteristics of pregnant women, the age group of 25~29 years was the most common as 46.3%. Over 35 years of age, elderly gravidas were in 7.5%. the height of 156~160cm was the most common as 52.8%. pregnant women of below 150cm height was in 3.7%. body weight of 51~55kg was the most common as 38%. pregnant women of below 45kg were in 19.4%. The women with smoking and drinking episodes during pregnancy were 1.9% and 25%. In the status of marriage, married women were in 95.4%, unmarried ones were in 1.9%, and unmarried couples were in 2.8%. Iin he obstetrical characteristics of pregnant women, pregnant women with gestational age under 37wks were in 45.4%, and the ones over 38wks were 54.6%. At the methods of delivery, normal spontaneous vaginal deliveries were in 51.9%, which were the most common, cesarian section deliveries were in 47.2%, and breech deliveries were in 0.9%. In the environmental characteristics of pregnant women, 40.8% of pregnant women lived in house or apartments with stairs, 23.1% of them lived in the high altitude. the pregnant women who ran a household without a helper were in 65.7%. In the pregnant women who had underwent life experiences of physical and psychological stress during pregnancy. life experiences of physical stresses were described as persistent fatigue due to lifestyle, traumatic experience, illness, move away with an effort, physical impact caused by discord. life experiments of psychological stresses were describeded as trouble with their husbands, discord with one's husband family, family problems, and conflicts due to environmental factors, etc. The number of the pregnant women who had complications during pregnancy was 32, which was 29.6% totally. Among them, pre-eclampsia was in 12.1% and the premature rupture of membrane in 7.4%. 3) In the analysis of the general, obstetrical, and circumstantial characteristics and L.B.W infants. There were statistical difference significantly between the gestational age of pregnant women(F=12.035, P=.000), and the status of marriage(F=3.207, P=.044), and maternal complication(t=2.344, P=.021) etc.

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A CASE OF TYPE II7 MIRIZZI SYNDROME (Type II Mirizzi 증후군 1례)

  • Kim, Hong-Jin;Lee, Joo-Hyeong;Shin, Myeong-Jun;Kwun, Koing-Bo;Chang, Jae-Chun;Chung, Moon-Kwan
    • Journal of Yeungnam Medical Science
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    • v.7 no.2
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    • pp.197-202
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    • 1990
  • Mechanical obstruction of the common hepatic duct includes the following causes ; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the "syndrome del conducto hepatico" in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mirizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a varient of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of $38^{\circ}C$, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/$cm^2$;albumin 2.6g/dl(normal 3.9-5.1) ; SGOT 183u/L(normal 0-50) ; SGPT167u/L(normal 0-65) ; bilirubin, 8.2mg/dl(normal 0-1) with the direct bilirubin, 4.4mg/dl(normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction(Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.

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