• Title/Summary/Keyword: Chest Support

Search Result 268, Processing Time 0.023 seconds

Relationship of Hemodynamic Changes during Off-Pump Coronary Bypass Grafting and Their Effects on Postoperative Outcome (심폐바이패스 없이 시행하는 관상동맥 우회수술 중의 혈역학적 변수들의 변화양상 및 수술 후 결과에 미치는 영향)

  • 허재학;장지민;김욱성;장우익;이윤석;정철현
    • Journal of Chest Surgery
    • /
    • v.36 no.8
    • /
    • pp.576-582
    • /
    • 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.

The Hope of the Stroke Patients (뇌졸중환자의 희망)

  • 김이순
    • Journal of Korean Academy of Nursing
    • /
    • v.27 no.1
    • /
    • pp.212-227
    • /
    • 1997
  • Cerebrovascular diseases in Korea is an important health problem since mortality and mobidity have been increased rapidly. It marked the 2nd cause of specific death rates in 1993. The stroke causes physical function disorder due to hemiparalysis and emotional disorder, and stroke patients experience helplessness, powerlessness. sense of alienation and loss of hope. These feelings make the rehabilitation difficult because they lose the will of life. The subjects of the study were seven citizens who live in Pusan, are over 50 years old and belong to low income-level. The data were collected from Jan. to Sep. 1995. The researcher as a caregiver and volunteer made confidence of them and asked for their agreement on the purpose of the study. The subjects expressed their experience as openheartedly as possible. The analysis of the data was made through the phenomenological analytic method suggested by Giorgi, which is as follows ; as an unit of description which include the subject' expressions and the researcher's observation, it is examined the theme that express the hope experience with the subject's language(underlining), and the focal meanings are identified. The focal meaning is the crystalization of the theme, which is written in the language of the researcher. After intergrating the focal meaning and make the situated structural description as the meaning of the hope experience identified on each subject's point. After intergrating the situated structural description and make the general structural description as the meaning of the hope experience identified on total subject's point then the systemizing of the structure of the hope experienced phenomena and the flowing of the conciousness was researched. The conclusions of this study was as follows : The ten sources of hope which the subjects experienced were sorted as under 〈mutual relations to others : spouse, children, relatives, fellow believer. health professioner. associate patient group〉, 〈spiritual dependence〉. 〈recovery of physical function〉. 〈rumination of the past life〉, 〈expectation of the future〉. 〈economic power〉, 〈belief〉, 〈ability〉. 〈spontaneous participation〉 and 〈recovery of roles〉. Their hope was spoken out by the following two kinds of linguistics. First. the hope was expressed in the affirmative expression as follows : 〈 to be dependable〉, 〈to make efforts〉, 〈to keep under control〉, 〈to desire〉, 〈to be pleasant〉, 〈to be peaceful〉, 〈to be grateful〉, 〈to give help〉, 〈self-confidence. Courage〉, 〈to be happy〉, 〈to satisfy oneself〉, 〈to share with others〉, 〈to understand〉 and 〈to be affected, be impressed〉 Second, the hope was expressed in the negative on pression as under : 〈to be distressed〉, 〈to be uneasy〉, 〈to be sorry, be unsatisfied〉 〈despair〉, 〈to abandon〉, 〈to be fearful〉, 〈to suffer〉, 〈to bear a burden〉 〈to be confused〉, 〈to be solitary〉, 〈chest trouble〉, 〈to feel heavy〉 〈grief〉, 〈to be daunted〉, 〈to get angry〉, 〈to be uncomfortable〉, 〈to have something regretable〉 and 〈to feel guilty〉. And their hope was expressed by the following four behavioral expressions : 〈physical sphere〉, 〈psychological sphere〉, 〈social support sphere〉 and 〈spiritual sphere〉. The reaction patterns of their hope experience appeared in the following 4 coping method : 〈conquest type〉, 〈dependence type〉, 〈adaptation type〉 and 〈fate type〉. Finally, in the hope structure the sense of certainty don't always coexict with the sense of uncertainty, When the stroke patients try to search for the best quality of life, the senses of certainty and uncertainty make a continual cyclic system in the hope structure.

  • PDF

Clinical Practice Guideline of Acute Respiratory Distress Syndrome

  • Cho, Young-Jae;Moon, Jae Young;Shin, Ein-Soon;Kim, Je Hyeong;Jung, Hoon;Park, So Young;Kim, Ho Cheol;Sim, Yun Su;Rhee, Chin Kook;Lim, Jaemin;Lee, Seok Jeong;Lee, Won-Yeon;Lee, Hyun Jeong;Kwak, Sang Hyun;Kang, Eun Kyeong;Chung, Kyung Soo;Choi, Won-Il
    • Tuberculosis and Respiratory Diseases
    • /
    • v.79 no.4
    • /
    • pp.214-233
    • /
    • 2016
  • There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

A Case Report of Heart-Lung Transplantation (심장-폐 이식 증례 보고)

  • 노준량;허재학;오삼세;김영태;이정렬;이기봉;오병희;한성구
    • Journal of Chest Surgery
    • /
    • v.31 no.10
    • /
    • pp.1004-1008
    • /
    • 1998
  • We report a case of heart-lung transplantation in a 32 year-old female with Eisenmenger syndrome secondary to patent ductus arteriosus. She has been suffered from congestive heart failure since June 1996 and repeatedly treated at Intensive Care Unit with intravenous inotropic support since July 1997. Preoperative echocardiography showed a patent ductus arteriosus with right to left shunt, severe regurgitation of tricuspid valve and estimated right ventricular systolic pressure of 100mmHg. The brain-dead donor was an 18 year-old male with head trauma from traffic accident 3 days ago. Heart-lung block procurement was performed at another general hospital and was transported to the Seoul National University Hospital by ambulance. Total ischemic time of the transplanted heart and lung were 249 minutes and 270 minutes, respectively. The immunosuppressive therapy was commenced preoperatively with cyclosporine and azathioprine. Corticosteroid was not used until postoperative 3 weeks in order to avoid infection and delayed healing at the tracheal anastomotic site. The patient was discharged at 31st postoperative day, and has been regularly followed up at outpatient clinic without specific complication. The follow-up bronchoscopy, performed 2 weeks and 4 months after surgery, revealed no evidence of cellular rejection.

  • PDF

Clinical Considerations of the Surgical Closure of the PDA in the Premature Infants (미숙아 동맥관 개존증의 외과적 교정에 관한 임상적 고찰)

  • 김상익;박철현;현성열;김정철;권진형;박국양
    • Journal of Chest Surgery
    • /
    • v.32 no.8
    • /
    • pp.702-708
    • /
    • 1999
  • Background: Surgical closure of the PDA in premature infants with complications or contraindications to indomethacin use, or recurrence of symptomatic PDA is a safe and effective procedure with low operative risk and minimal complications. Material and Method: From April 1996 to August 1998, 11 premature infants with body weight under 1.5 kg at operation underwent operation for a symptomatic PDA (male:5, female: 6). Associated dise ases were congenital heart disease(7), hyaline membrane disease(6), intraventricular hemor rhage(4), pneumonia(4), pneumothorax(3), hyperbilirubinemia(2), necrotizing enterocolitis(2), renal failure(1), epilepsy(1), and hydrocephalus(1). Surgical techniques are hemoclipping(8) and ligation(3). The size of PDA was 3~6 mm (5.0$\pm$1.2). Result: Systolic and diastolic blood pressure rised and heart rates decreased after PDA closure. ABGA improved postoperatively. There were no surgical complications. Six infants with improved ABGA data were weaned from mechanical ventilatory support. The follow-up durations after discharge were 3 month to 12 month. Five deaths were not related to operation. The causes of death were hyaline membrane disease(2), bronchopulmonary dysplasia with pneumonia(1), sepsis(1), and con gestive heart failure with respiratory distress syndrome(1). Conclusion: Early operative closure is the treatment of choice in most premature infants with a hemodynamically significant shunt(PDA), recurrence of symptomatic PDA, complications of Indomethacin, or contraindi cations to Indomethacin.

  • PDF

Kriging Analysis for Spatio-temporal Variations of Ground Level Ozone Concentration

  • Gorai, Amit Kumar;Jain, Kumar Gourav;Shaw, Neha;Tuluri, Francis;Tchounwou, Paul B.
    • Asian Journal of Atmospheric Environment
    • /
    • v.9 no.4
    • /
    • pp.247-258
    • /
    • 2015
  • Exposure of high concentration of ground-level ozone (GLO) can trigger a variety of health problems including chest pain, coughing, throat irritation, asthma, bronchitis and congestion. There are substantial human and animal toxicological data that support health effects associated with exposure to ozone and associations have been observed with a wide range of outcomes in epidemiological studies. The aim of the present study is to estimate the spatial distributions of GLO using geostatistical method (ordinary kriging) for assessing the exposure level of ozone in the eastern part of Texas, U.S.A. GLO data were obtained from 63 U.S. EPA's monitoring stations distributed in the region of study during the period January, 2012 to December, 2012. The descriptive statistics indicate that the spatial monthly mean of daily maximum 8 hour ozone concentrations ranged from 30.33 ppb (in January) to 48.05 (in June). The monthly mean of daily maximum 8 hour ozone concentrations was relatively low during the winter months (December, January, and February) and the higher values observed during the summer months (April, May, and June). The higher level of spatial variations observed in the months of July (Standard Deviation: 10.33) and August (Standard Deviation: 10.02). This indicates the existence of regional variations in climatic conditions in the study area. The range of the semivariogram models varied from 0.372 (in November) to 15.59 (in April). The value of the range represents the spatial patterns of ozone concentrations. Kriging maps revealed that the spatial patterns of ozone concentration were not uniform in each month. This may be due to uneven fluctuation in the local climatic conditions from one region to another. Thus, the formation and dispersion processes of ozone also change unevenly from one region to another. The ozone maps clearly indicate that the concentration values found maximum in the north-east region of the study area in most of the months. Part of the coastal area also showed maximum concentrations during the months of October, November, December, and January.

Arterial Switch Operation for Transposition of G rest Arteries (대혈관전위증에 대한 동맥전환술)

  • 이호철;류한영
    • Journal of Chest Surgery
    • /
    • v.29 no.3
    • /
    • pp.278-284
    • /
    • 1996
  • Nine infants with transposition of great arteries have undergone arterial switch operation from May 1989 to May 1994 in the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. Patients' age ranged from 3 days to 90 days, averaging 30$\pm$21 days. Diagnosis was made by two-dimensional echocardiography in all patients. Eight patients were diagnosed as transposition of great arteries with ventricular septal defect and one patient was a simple transposition of great arteries. Associated anomalies were patent ductus arteriosus (8), atrial septal defect (7) and coarctation of aorta(1). The anatomy of the coronary arteries were 7 (77 %) type A and 2 (23 %) type D according to the Yacoub classification. Pulmonary artery reconstruction was done according to Lecompte maneuver with tautologous pericardial patch in 8 patients. Overall operative mortality rate was 55% Left heart failure and pulmonary hypertensive crisis were the cause of death on postoperative 1~2 days in three patients, and two succumbed to death due to sepsis on postoperative 2~ 3 weeks. The mean follow-up period was mean 17 months. No patient had clinically significant postoperative aortic regurgitation and supravalvular pulmonary stenosis. The excessive use of inotropic support postoperatively was identified as a stastically significant risk factor following the arterial switch operation. But other variables such as low body weight, long cardiopulmonary bypass time, excessive hemodilution during cardiopulmonary bypass, hypothermia and volume loading were not significant risk factors.

  • PDF

Radiotherapy for initial clinically positive internal mammary nodes in breast cancer

  • Kim, Jina;Chang, Jee Suk;Choi, Seo Hee;Kim, Yong Bae;Keum, Ki Chang;Suh, Chang-Ok;Yang, Gowoon;Cho, Yeona;Kim, Jun Won;Lee, Ik Jae
    • Radiation Oncology Journal
    • /
    • v.37 no.2
    • /
    • pp.91-100
    • /
    • 2019
  • Purpose: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.

Early Results of Mitral Valve Reconstruction in Mitral Regurgitation (승모판막 폐쇄부전에 있어 승모판막 성형술의 단기성적)

  • Kim, Kyung-Hwan;Won, Tae-hee;Kim, Ki-Bong;Ahn, Hyuk
    • Journal of Chest Surgery
    • /
    • v.33 no.1
    • /
    • pp.32-37
    • /
    • 2000
  • Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

  • PDF

Post Discharge Nursing Needs of Patients with Open Heart Surgery (개심술 환자의 퇴원후 간호요구에 대한 조사연구)

  • 김명희
    • Journal of Korean Academy of Nursing
    • /
    • v.23 no.4
    • /
    • pp.664-677
    • /
    • 1993
  • The purpose of this study was to provide basic data for the development of educational material in Korean for patient3 being discharge after open heart surgery. The subjects were 45 adult patients who were seen in the out -patient department of the thoracic surgery unit of P University hospital between February 1993 and May 1993. The data were collected through a chart review and interview. Nursing needs, and the patients status related to diet, activity, medication, physical and psychoemotional limitations were analyzed. The results are summarized as follows ; 1. Mitral valve replacement was the most frequent type of surgery(91.2%). In most cases, a mechanical valve was used (91.0%) . The duration of admission after the operation was two to four weeks for most of the patients(48.9%). The follow-up period was between one and two years for 28.9% of the patients and below 6 years for all of the patients. 2. Many Patients didn’t know the importance of a low salt diet(57.8%), and did not get any education on low salt diet (66.7%). Gimchi was included as one of the most commonly ingested foods (77.8%). All of the patients indicated nursing needs related to education about low salt diets and further they indicated a major interest in foods that are harmful (57.7%) or foods that are safe(51.1% ). 3. Most patients did not recognize the need for limitations on physical activity(84.4%). Further, 31.1% of them could not return to work at the time of the study. All patients had nursing needs related to physical activity, with the most frequent questions being about the permissble degree of activity and special cautions dictated by their illness (60.0%). 4. Many patients were ignorant of the necessity of medication(55.6%) . Forty percent of the patients were taking additional drugs, usually herb drugs. The time and duration of medication and the side effects of drugs were common concerns (57.7%) related to nursing. needs about medication and were mentioned by all of the patients. 5. All of the patients complained of physical discomfort including the following : memory disturbance(62.2%), weight gain(60.0%), chest tightness (55.6%), hair loss(51.1%), sleep disturbance(46.7%) and other symptoms in that order of frequency. Nursing needs related to physical condition were a concern for all of them. The viability and function of the replaced valve(53.3%) and weight gain(60.0%) were mal or concerns. 6. Looking at their psychoemotional condition it was found that 36 patients(80.0%) were emotionally unstable. The causes were physical discomfort(17 patients), insufficient knowlege of open heart surgery(6 patients), fear of death(6 patients), familial over protection(2 patients ) and lack of support (5 patients).

  • PDF