• Journal of Chest Surgery
• /
• v.41 no.4
• /
• pp.430-438
• /
• 2008

Background: All the patients with mechanical valves require warfarin therapy in order to prevent them from developing thromboembolic complications. According to the ACC/AHA practice guidelines, after AVR with bileaflet mechanical prostheses in patients with no risk factors, warfarin is indicated to achieve an INR of 2.0 to 3.0. After MVR with any mechanical valve, warfarin is indicated to achieve an INR of 2.5 to 3.5. But in our clinical experience, bleeding complications (epistaxis, hematuria, uterine bleeding, intracerebral hemorrhage etc.) frequently developed in patients who maintained their INR within this value. So, we retrospectively reviewed the patients with bileaflet mechanical heart valve prosthesis and we determined the optimal anticoagulation value. Material and Method: From January 1984 to February 2007, 311 patients have been followed up at a national medical center. We classified the AVR patients (n=60) into three groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II and an INR from 2.5 to 3.0 in Group III. We classified the MVR (n=171) and DVR (n=80) patients into four groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II, an INR from 2.5 to 3.0 in Group III and an INR from 3.0 to 3.5 in Group III. We compared the groups for their thromboembolic and bleeding complications by means of the Kaplan Meier method. Result: In the AVR patients, 2 thromboembolic complications and 4 bleeding complications occurred and the log rank test failed to identify any statistical significance between the groups for thethromboembolic complication rate, but groups I and II had lower bleeding complication rates than did group III. Thirteen thromboembolic complication and 15 bleeding complication occurred in the MVR and DVR patients, and the log rank test also failed to identify statistical significance between the groups for the thromboembolic complication rate, but groups I and II had lower bleeding complication rates that did groups III and IV. Conclusion: The thromboembolic complication rate was not statistically different between groups I and II and groups III and IV, but the bleeding complication rates of groups I and II were lower than those of groups III and IV. So this outcome encouraged us to continue using our low intensive anticoagulation regime, that is, an INR of 1.5 to 2.5.

• Clinical and Experimental Pediatrics
• /
• v.53 no.4
• /
• pp.532-537
• /
• 2010

Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.

• Radiation Oncology Journal
• /
• v.12 no.1
• /
• pp.59-66
• /
• 1994

Seventy-five patients with tumors of the head and neck treated with either radiation therapy alone or combined with surgery or chemotherapy were studied prospectively to evaluate the effects of radiation therapy to the neck on thyroid gland between September 1986 and October 1992. All patients were serially monitored for thyroid function tests before and after radiation therapy. Radiation dose to the thyroid gland ranged from 35 to 60 Gy with a median dose of 50 Gy. Median follow-up time was 30 months with a range of 11 to 85 months. The incidence of thyroid dysfunction was 40$ \% $: forty-five patients(60$ \% $) euthyroid, 2 patients(3$ \% $) clinical hypothyroidism, 27 patients(36$ \% $) subclinical hypothyroidism and 1 patient(1$ \% $) hyperthyroidism. No thyroid nodules or thyroid cancer were detected in any patients. Thyroid dysfunction appeared earlier in patients who underwent surgery than in those patients treated with radiation therapy alone or combination of chemotherapy and radiation therapy(P=0.0013). By multivariate analysis, risk factors that significantly influenced a higher incidence of thyroid dysfunction were female sex(p=0.0293) and combination of total laryngectomy and radiation therapy(p : 0.0045). In conclusion, evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests are recommended to detect thyroid dysfunction in time and thyroid hormone replacement therapy is recommended whenever thyroid dysfunction develops.

• Childhood Kidney Diseases
• /
• v.11 no.2
• /
• pp.203-211
• /
• 2007

Purpose : We attempted to compare the independent factors such as age, sex, C-reactive protein(CRP), and white blood cell count(WBC) in children with radiologic studies and assess the necessity of performing voiding cystourethrography(VCUG). Method : 98 children who have been diagnosed their first time febrile urinary tract infection from Janurary 2002 to Januray 2005 were enrolled. In all patient, the duration of fever which occurred before and after treatment was recorded, and CRP, WBC, $^{99m}Tc$-2,3-dimercaptosuccinic acid($^{99m}Tc$-DMSA) renal scans, renal ultrasound and VCUG were analyzed. Results : Of the 98 children diagnosed with urinary tract infection(UTI), 52 were male and 46 were female. 18 had abnormalities in VCUG, 17 had abnormalities in kidney ultrasound, and 20 had partial defects or diffuse uptake decrease in $^{99m}Tc$-DMSA renal scans. There were no significant relationship between incidence of radiologic abnormalities and age. The risk of renal scar was significantly higher in children who had a longer febrile period before treatment than in those with shorter period. Both CRP and WBC were significantly elevated in children with the radiological abnormalities. A positive of $^{99m}Tc$-DMSA renal scans and renal ultrasound were highly associated with vesicoureteral reflux(VUR). Conclusion : If there are abnormalities in the kidney ultrasound and $^{99m}Tc$-DMSA renal scan of a child with initial UTI, a VCUG is recommended. Even in cases without abnormal findings in $^{99m}Tc$-DMSA renal scan and renal ultrasound, clinical data such as CRP and WBC should be assessed, and VCUG should be Performed for the undetected VUR.

• Journal of Chest Surgery
• /
• v.30 no.4
• /
• pp.363-372
• /
• 1997

One hundred forty-four patients underwent operation for coarctation of the aorta at Seoul National University Children's Hospital between June 1986 and Decembsr 1995. Age ranged 0.1 to 191 months. Of these 78.5%(113) were infants. We classified the patients in terms of the anatomic location of coarctatiln and the associatCd anomalies(I[401= primary coarctation, 11(741=isthmic hypoplasia, lIIf30)=tubular hypoplasia involving transverse arch, Ar63 =with ventricular septal defect, B(28)=with other major cardiac defects). Subcalvian flap coarctoplasty(60), resection & anastomosis(44), extended aortoplasty(26), and onlay patch(14) were used as surgical methods. Overall operative mortality was 16.0(23/144)%. The hospital mortality was signific'antly higher in patheints with type 111, subtype B, younger age(under 3 months), extended aortoplasty(p(0.01). However, one-stage total repair in patients with subtype A or B were not found to be a predictor of hospital death. Restenosis had occured in 18 patients among 121 survivals(14. 9%). The mean follow-up period was 29.1 $\pm$28.8(0~129.2) months. Preoperative, immediate postoperative(within 3 months after operation) and postoperative(later than 6 months after operation) echocardiographic data on the dimensions of ascending aorta(AA), transverse arch(TA), an4 aortic isthmus(Al) were available in 77 patients(I=20, ll=42, 111= 15). Preoperative and postoperative aortic isthmus(All) and tra sverse arch indices(TAI), defined as TAIAA & AIIAA respectively, were compared. Immediate postoperative All in type 1, II and TAI in type 111 were significantly smaller in stenotic than non-stenotic group suggesting incomplete relieves of stenotic segment Younger age, subclavian coarctoplasty in patient under 3 months of age were round to be the risk factors for restenosis in this series. In conclusion, We found that aortic arch index and transverse arch index can be a useful tool to figure out the anatomic and clinical characteristics of the patients with aortic coarctation, and that anatomy, associated anomalies, age, and surgical methods may influence the surgical outcome of the coarctation repair.

• Journal of Chest Surgery
• /
• v.36 no.4
• /
• pp.261-266
• /
• 2003

Background: Surgery of abdominal aortic aneurysm revealed high operative mortality. We reviewed our 11-years' experiences of abdominal aortic aneurysm operation and wish to obtain information on the treatment. Material and Method: From Jan. 1990 to Dec. 2000, 48 patients were operated due to abdominal aortic aneurysm in Yonsei Cardiovascular Center Mean age was $62.8{\pm}12.7$ and there were 40 males and 8 females. Among 48 patients, nine patients had ruptured abdominal aortic aneurysm, and mean aneurysm diameter of non-ruptured cases was $8.8{\pm}2.4$cm. Result: There were 6 early deaths, and early mortality was 12.5%. Among 9 patients of preoperative aneurysm rupture, three patients died (33.3%), and among 39 patients of non-ruptured cases, 3 patients died (7.7%). Among preoperative variables, age (p<0.05), preoperative BUN level (p<0.05), and DM (p<0.05) were risk factors of early mortality. Among discharged 42 patients, 40 patients were followed up (f/u rate=95.2%) and mean follow up was $3.6{\pm}0.2$ years. During follow up periods, five patients died (late mortality=11.9%), and Kaplan-Meier survival analysis revealed $81.7{\pm}7.6$% survival rate at five and ten year. Linealized incidence of graft related event was 3.53% per patient-year. Conclusion: Surgical mortality of ruptured abdominal aortic aneurysm was higher than non-ruptured cases; therefore, early resection of the aneurysm can decrease the surgical mortality.

• Childhood Kidney Diseases
• /
• v.7 no.1
• /
• pp.60-66
• /
• 2003

Purpose : Neonatal hydronephrosis has been detected with increasing frequency with the widespread use of prenatal ultrasonography, but the consensus about its postnatal management has not yet been reached, especially about surgical intervention. We attempted to determine the guideline of follow-up study and surgical intervention of hydronephrosis by analyzing clinical outcomes of neonates with hydronephrosis. Materials and Methods : Between 1994 and 2000, 128 hydronephrotic kidneys were postnatally confirmed. Cases associated with other urologic anomalies were excluded and 90 unilateral hydronephrotic kidneys with a minimum follow-up of 12 months were enrolled in this study. We classified the patients into 6 groups according to the anterior posterior pelvic diameter(APPD) at initial ultrasonography(USG) within 1 month after birth. Renal USG and $Tc^{99m}-mercaptoacetyl$ triglycerine(MAG3) scan were done according to a set protocol, and pyeloplasty was performed when indicated according to our protocol. Results : Most cases whose APPD were below 10 mm improved or resolved. Only few cases with APPD above 20 mm showed spontaneous improvement and most(88%) had undergone operation. Those with initial APPD within 10-19 mm showed variable outcomes. When the risk factors for irreversible renal functional deterioration were analyzed, the age at pyeloplasty and pre-operative functional deficit were significant. Conclusion : We concluded that in infants with initial APPD below 10 mm, consideration of surgery is not needed, and in those with initial APPD above 20 mm, early operation is recommended. Our set protocol based on initial USG is useful, but the cut-off value of relative renal function(RRF) for operation might be increased to 40% to improve post operative RRF.

• Journal of the Korean Society of Food Science and Nutrition
• /
• v.31 no.2
• /
• pp.306-314
• /
• 2002

The purpose of this study is to examine the relation between vegetarian diet and the risk factors of cardiovascular disease. The subjects of the study were 127 Buddhist nuns (age: 23 ~79 yr) for vegetarians and 235 healthy female adults (age: 23 ~79 yr) for non-vegetarians. This study covers food consumption survey, anthropometric measurement, amount of energy expenditure, physical activity and clinical examination. Average body mass index (BMI) of vegetarians and non-vegetarians were 22.47 and 21.08, waist/hip ratio (WHR) was 0.85 and 0.84, percentage of body fat (%BF) was 28.79 and 26.55, respectively. Average duration of vegetarian diet of the vegetarians was 13.16 years. The triglyceride levee of the vegetarians was significantly lower for those who take nutrient tablet compared to those who either take vitamins or who do not take any nutrient supplement. Taking vitamins or nutrient tablet did not give any significant difference in total-cholesterol and LDL-cholesterol for vegetarians, while significantly high triglyceride was observed for the non-vegetarians taking nutrient tablet than the ether non-vegetarians. Taking vitamins or nutrient tablet did not affect the lever of HDL-cholesterol for either vegetarians or non-vegetarians. Athrogenic index (AI) was lower for the vegetarian group tailing nutrient tablet and for the non-vegetarian group not taking vitamins and nutrient tablet, than the other respective groups. Blood sugar of the vegetarians who take nutrient tablet was significantly lower than those tailing vitamins, while blood sugar of the non-vegetarians not taking any nutrient supplement was significantly lower than those taking nutrient tablet.

• Journal of the Institute of Electronics and Information Engineers
• /
• v.51 no.12
• /
• pp.180-188
• /
• 2014

It is very important accurate diagnosis and quick treatment in cerebrovascular disease, i.e. stenosis or occlusion that could be caused by risk factors such as poor dietary habits, insufficient exercise, and obesity. Time-of-flight magnetic resonance angiography (TOF-MRA), it is well known as diagnostic method without using contrast agent for cerebrovascular disease, is the most representative and reliable technique. Nevertheless, it still has measurement errors (also known as overestimation) for length of stenosis and area of occlusion in celebral infarction that is built by accumulation and rupture of plaques generated by hemodynamic turbulence. The purpose of this study is to show clinical trial feasibility for 3D-SPACE T2, which is improved by using signal attenuation effects of fluid velocity, in diagnosis of cerebrovascular disease. To model angiostenosis, strictures of different proportions (40%, 50%, 60%, and 70%) and virtual blood stream (normal saline) of different velocities (0.19 ml/sec, 1.5 ml/sec, 2.1 ml/sec, and 2.6 ml/sec) by using dialysis were made. Cross-examinations were performed for 3D-SPACE T2 and TOF-MRA (16 times each). The accuracy of measurement for length of stenosis was compared in all experimental conditions. 3D-SPACE 2T has superiority in terms of accuracy for measurements of the length of stenosis, compared with TOF-MRA. Also, it is robust in fast blood stream and large stenosis than TOF-MRA. 3D-SPACE 2T will be promising technique to increase diagnosis accuracy in narrow complex lesions as like two cerebral small vessels with stenosis, created by hemodynamic turbulence.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.2
• /
• pp.329-337
• /
• 1997

Background : Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. Methods : The subjects were 34 patients(M : F = 20 : 14, mean age = $61{\pm}17yre$) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group 1(decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. Results : Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26%(9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.6%(4/14) of group 2 and 44%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p > 0.01). In three cases of group 3 whose respiratory indices could be measured until 48 hr after extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. Conclusions : Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubation may increase in the patients who have increased WOB immediately after extubation.