• Journal of Chest Surgery
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• v.42 no.4
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• pp.464-472
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• 2009

Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.99-105
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• 2021

Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.20-24
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• 2010

Background: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. Material and Method: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was $20{\pm}6%$ according to transthoracic echocardiography. Result: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of $107{\pm}70$ hours of running. The mean EF after discharge was $56{\pm}7%$ without dilated cardiomyopathy. Conclusion: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.

• Journal of Trauma and Injury
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• v.24 no.1
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• Journal of the Korean Society of Clothing and Textiles
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• v.37 no.3
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• pp.280-291
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• 2013

This paper analyzes desirable breast types using measurements from 31 selected female subjects based on the ratio of breast in works of art and to design a brassiere cup design according to the breast type of 182 female subjects in their 20s. The subjects selected for this paper are somewhat larger than a previous study on aesthetically perfect breasts of foreigners according to chest breadth, center neck point to breast point, breast circumference, and breast volume. However, the aesthetic breasts of foreigners are larger than the subjects selected for this study according to chest depth, under-bust circumference, and bust point to bust point. Comparing various breasts types and aesthetic breasts, padding is necessary to complement the form of flat breasts to increase the volume and diameter. Brassiere cups for cone-shaped breasts should be designed to increase breast volume through an increase in nipple height. Hemisphere breasts should be designed to increase the overall volume-leaving diameter. Protrusion breasts should enhance the functions of aggregating and supporting without any increase or decrease of the breast volume. Drooping breasts require the ability to support a large volume to stabilize the breast. Subjects were selected depending on the ratio of breast silhouette as works of art and who have large breasts in disproportional to a slender trunk. Three items, the circumferential length of breast, height of the nipple, and the depth of inner breast using the anthropomorphic measurements of 182 subjects were measured through regression equations for breast volume. Breast volume = -394.86 + 27.52 ${\times}$ (the circumferential length of breast) + 18.73 ${\times}$ (height of the nipple) + 12.85 ${\times}$ (the depth of inner breast). Regression equations to extract the aesthetic breast volume in measurements irrelevant to breasts using the anthropomorphic measurements of 31 subjects were as follows. Aesthetic breast volume = -611.30 + 17.67 ${\times}$ (bust circumference) -24.29 ${\times}$ (under-bust circumference) + 16.31 ${\times}$ (neck point to breast point to waistline) + 22.83 ${\times}$ (bust breadth) + 12.22 ${\times}$ (waist depth) -8.34 ${\times}$ (interscye- front). This prediction equation is useful to develop a breast type brassiere pattern, complement breast enhancement surgery, or minimize the effect a mastectomy.

• Journal of the Korean Society of Radiology
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• v.16 no.2
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• pp.169-175
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• 2022

In this study, envisioned a laboratory equipped with virus blocking equipment for chest X-ray examinations of respiratory or droplet-transmitted virus-infected patients, and the material with the least deterioration in X-ray output and image quality among the proven blocking materials that block viruses in the design process. and experimented to find the thickness. As a result, when 1 cm of acrylic was applied, the X-ray output was reduced by only about 3.27 % compared to the absence of the barrier material, the SNR was 40.7 and CNR was 30.9, which was the best. The SSIM index result was analyzed as 0.891, which was analyzed to be implemented as the most similar image compared to the original image. The barrier material applied in the research method was objective in that it used a product approved by the Ministry of Food and Drug Safety. the results of this study are expected to provide useful information when installing X-ray examination facilities for the diagnosis and treatment of respiratory-related virus-infected patients in the future.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1218-1222
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• 1996

The reported incidence of postcardiotomy cardiogenic shock not responding to conventional therapy is still 0.1 to 0.8%. For this group of patients, more aggressive form of circulatory support must be employed. Centrifugal pumps are a ventricular assist device most commonly used on this purpose, due to low cost and easy availability. Currently, however, clinical experience of centrifugal pumps as a ventricular assist device is rarely reported in Korea. From January 1992 to January 1996, 2986 patients underwent cardiac operations on cardiopulmonary bypass at Seoul National University Hospital. Refractory postcardiotomy cardiac failure requring ventricular support with a Biomedicus centrifugal pump developed in ten of these patients. There were eight men and two women, ranged in age from nine years to 77 years with a mean of 50$\pm$20 years. The primary surgical procedures consisted of isolated coronary revascularization in four patients, combined coronary revascularization and aortic valve replacement in two, aortic dissection repair in two, pulmonary embolectomy in one, and heart transplantation in one. Of the ten patients, five had left ventricular assistance, one had right ventricular assistance, and four had biventricular assistance. Duration of ventricular assistance ranged from 24 to 175 hours, with a mean of 76$\pm$51 hours. Seven patients were weaned from ventricular assistance, and four of them discharged. The causes of death for nonsurvivors were progressive cardiac failure in two patients and multiorgan failure, intractable ventricular fibrillation, irreversible brain injury, and mechanical problem, respectively, in the other four. Survival was not predicted by time on cardiopulmonary bypass, aortic cross-clamp time, or duration of ventricular support. Major complications included bleeding(7), renal failure(6), infection(3) and neurologic complication(2). These results indicate that a centrifugal pump can provide reasonably satisfactory short-term circulatory support.

• Journal of Oriental Neuropsychiatry
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• v.25 no.1
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• pp.29-38
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• 2014

Objectives: The objective of this study is to examine the effects of Emotion Freedom Techniques (EFT) group treatment program for Hwa-byung patients. Methods: Thirteen Hwa-byung patients have participated in the four weeks program of EFT group treatment and the program was executed once a week, for about one hour. After every session, the participants performed EFT by themselves in order to control their symptoms. Four weeks after the program ended, we interviewed the participants by using the semi-structured interview method to observe changes of Hwa-byung. All the data collected was summarized through the qualitative analysis method. Results: Results showed effects of the EFT group treatment program, with regards to the physical, cognitive and emotional aspects. Most of the participants experienced reliefs of Hwa-byung symptoms like chest tightness, hot flashes, insomnia and so on. Their ability to cope with stress improved and their re-experiences of past memories decreased. And their distorted self-images were also restored. Lastly, there was a decrease in negative emotions and an increase in positive emotions experienced by the participants. The participants could control their symptoms by performing self-enforcement. In addition, regarding the form of group therapy, the treatment was effective as it helped the participants to feel solidarity and social support. Conclusions: The EFT group treatment program can relieve the physical, cognitive and emotional symptoms of Hwa-byung. This program can be applied to the psychotherapy of Hwa-byung.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.18 no.2
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• pp.201-209
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• 2011

Purpose: The purpose of this study was to evaluate the learning experience, knowledge, and performance of cardiopulmonary resuscitation (CPR) in newly graduated nurses, and to identify differences related to learning experience. Methods: The participants were 114 new nurses in the hospital. They were asked to complete a questionnaire, which included CPR learning experience. They were evaluated by a written test and a skill test using a manikin and check list. Results: All participants attended CPR lectures and underwent practice while in university. Only 12.28% of participants were taught by a certified Basic Life Support (BLS) instructor. The mean scores of the written and skill tests were $79.82{\pm}12.69$ and $64.41{\pm}11.71$, respectively. The nurses lacked CPR knowledge related to checking breathing, the frequency of 30 chest compressions, compression rate, and automated external defibrillator use. They also lacked skill in performing CPR related to checking breathing and pulse and giving 2 breaths. CPR performance differed according to learning time (p=.047) and BLS educator (p=.029). Conclusion: The findings of this study reveal that CPR performance by newly graduated nurses is poor and suggest that CPR education by trained instructors, practice-based education, and reeducation programs must be provided to newly graduated nurses in the hospital.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.317-325
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• 2017

Background: Extracorporeal membrane oxygenation (ECMO) has become an important treatment modality in pediatric patients with cardiopulmonary failure, but few studies have been conducted in Korea. Methods: We conducted a retrospective review of pediatric patients younger than 18 years who were placed on ECMO between January 2004 and December 2014 at Samsung Medical Center. Results: We identified 116 children on ECMO support. The overall rate of successful weaning was 51.7%, and the survival to discharge rate was 37.1%. There were 39, 61, and 16 patients on ECMO for respiratory, cardiac, and extracorporeal cardiopulmonary resuscitation, respectively. The weaning rate in each group was 48.7%, 55.7%, and 43.8%, respectively. The survival rate was 43.6%, 36.1%, and 25.0%, respectively. Sixteen patients on ECMO had functional single ventricle physiology; in this group, the weaning rate was 43.8% and the survival rate was 31.3%. Ten patients were on ECMO as a bridge to transplantation (8 for heart and 2 for lung). In patients with heart transplantation, the rate of survival to transplantation was 50.0%, and the overall rate of survival to discharge was 37.5%. Conclusion: An increasing trend in pediatric ECMO utilization was observed. The outcomes were favorable considering the early experiences that were included in this study and the limited supply of specialized equipment for pediatric patients.