• Archives of Plastic Surgery
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• 제35권4호
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• pp.393-399
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• 2008

Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

• Journal of Chest Surgery
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• 제46권2호
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• pp.153-155
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• 2013

A 57-year-old man was diagnosed with lung cancer and underwent pneumonectomy and mediastinal lymph node dissection. He was discharged without acute complications, but on a regular outpatient follow-up, he was readmitted with postpneumonectomy empyema. He was successfully treated with a vacuum-assisted closure device and for 1 year period of outpatient follow-up, there was no recurrence of empyema or lung cancer.

• Journal of Chest Surgery
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• 제56권2호
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• pp.147-150
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• 2023

A child being supported with an extracorporeal ventricular assist device, such as the Berlin Heart EXCOR (Berlin Heart GmbH, Berlin, Germany), must have at least 2 large cannulae for a long period. Management of cannula wounds is crucial since a cannula forms a track of prosthetic material passing the mediastinum to the heart. Deep wound complications, if they occur, can be troublesome and difficult to control with conventional methods. We applied vacuum-assisted closure to a patient who had Berlin-Heart EXCOR and a gap at the cannulation site. Herein, we describe the technical aspects of management in detail.

• Clinical and Experimental Pediatrics
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• 제52권4호
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• pp.494-498
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• 2009

목 적 : 심방중격결손의 기구 폐쇄술은 현재 소아 영역에서 수술을 대체할 치료법으로 광범위하게 사용되고 있으나 수술과 비교하였을 때 적절한 시행 시기는 명확하지 않다. 본 연구에서는 3세 미만의 심방중격결손 소아에서 기구 폐쇄술의 안전성, 효용성 및 임상 결과를 평가하여 시술을 시행하기에 적절한 시기를 알아보고자 하였다. 방 법 : 2003년 5월부터 2005년 12월까지 연세대학교 의과대학 심장혈관병원 소아심장과에서 Amplatzer septal occluder(ASO)를 이용한 심방중격결손의 기구 폐쇄술을 시행 받은 환자 295명 중 3세 미만 소아 51명을 대상으로 하였다. 시술 소요 시간, 투시 검사 시간, 폐쇄 성공률, 잔류 단락율, 합병증의 종류 및 발생 빈도를 조사하였고, 기구 장착 전후의 체폐순환비, 폐동맥압, 우심실압을 측정하였으며 시술 후 1일, 1개월, 6개월, 12개월 및 이후 1년 간격으로 경흉부 심초음파를 시행하여 추적 관찰하였다. 결 과 : 대상 환자의 75% (38/51)가 여자였으며, 시술 당시 연령은 $2.0{\pm}0.6$세, 체중은 $11.8{\pm}1.7$ kg, 심방 중격 결손의 크기는 $16.6{\pm}3.6$ mm, 이들의 체폐순환비는 $2.4{\pm}0.9$이었고, 기구 폐쇄술 시행 후 추적 관찰 기간은 $19.8{\pm}6.4$개월이었다. 시술의 폐쇄성공률은 98% (50/51), 소요 시간은 $87.7{\pm}23.6$분, 방사선 투시 시간은 $31.8{\pm}14.7$분이었으며 잔류 단락은 시술 후 24시간 뒤 51명중 7명(15%)에서 관찰되었으나, 최종 추적 관찰 시에는 모두 폐쇄되었다. 폐쇄술 시행 전과 시행 직후의 체폐순환비는 $2.4{\pm}0.9$에서 $1.4{\pm}0.3$ (P<0.001)으로, 주폐동맥압은 $28.4{\pm}6.4$ mmHg에서 $25.5{\pm}5.6$ mmHg (P=0.04)로, 우심실압은 $41.3{\pm}11.8$ mmHg에서 $32.6{\pm}7.9$ mmHg (P<0.001)로 감소하였다. 대상 환자 중 2명에서 시술과 관련한 합병증이 있었으며 기구 이탈과 관련한 우심방 색전증 1예, 서혜부에 발생한 혈종 1예가 관찰되었다. 결 론 : 심방중격결손 소아에서 ASO를 이용한 경피적 심방중격결손 폐쇄술은 3세 미만의 작은 소아에서 안전하고 효과적으로 시행할 수 있으며 더 성장하기까지 시술을 연기할 필요는 없는 것으로 생각된다. 작은 영아에서의 효용성과 안전성에 대해서는 더 광범위한 연구가 필요하다.

• Perspectives in Nursing Science
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• 제7권1호
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• pp.55-64
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• 2010

Purpose: The purpose of this study was to examine the effects of position change from supine to Fowler's on back pain and discomfort in patients who remained on bed rest after undergoing PCIs with a vascular closure device. Methods: Data was collected from 35 inpatients who were hospitalized in coronary-care unit to perform PCIs with a vascular closure device at S hospital in Seoul from December, 2006 to May, 2007. Back pain, discomfort, presence and grade of bleeding and hematoma from femoral arterial puncture site and blood pressure/pulse rate were measured prior to, 10 minutes, 1 hour and 2 hours after position change. Data was analyzed with descriptive statistics, $x^2$ tests and t-tests using SPSS/WIN 12.0 for Windows program. The level of significance (${\alpha}$) was set at 0.05 for this study. Results: We found that there was no significant difference in back pain and discomfort in 10 minutes after position change between the two groups. However, the experimental group reported significantly less back pain and discomfort than the control group in 1 hour (p<.01, respectively) and 2 hour (p<.01, respectively) after position change. There was no significant difference in the presence and grade of bleeding and hematoma at the puncture site, blood pressure, and pulse rate in 10 minutes, 1hour and 2hours after position change between the two groups. Conclusion: Fowler's position change after PCIs in, therefore, safe and effective method of reducing back pain and physical discomfort without causing additional bleeding and changes in blood pressure and pulse rate.

• Clinical and Experimental Pediatrics
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• 제51권4호
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• pp.401-408
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• 2008

목 적 : 이차공 심방 중격 결손의 경피적 폐쇄술은 수술을 대체할 수 있어 안전하고 효과적인 치료로서 자리를 잡아가고 있으나, 드물게 합병증의 발생이 보고되고 있어, Amplatzer septal occluder를 이용한 심방 중격 결손의 경피적 폐쇄술 후 발생한 초․중기 합병증 및 그 대책을 살펴보고자 하였다. 방 법 : 2003년 6월부터 2006년 5월까지 부천세종병원과 고려대학교 의료원에서 이차공 심방 중격 결손을 진단 받은 64명의 환자를 대상으로 하였다. 남녀 비는 1:2.4였고, 시술 당시 나이는 2.6에서 64세(중앙값 : 17세), 시술 당시 체중은 13 kg에서 100 kg (중앙값 : 47.5 kg)이었다. 결 과 : 경흉부 또는 경식도 심장 초음파 검사상 결손의 크기는 6 mm에서 28 mm (중앙값 : 15 mm), 풍선 확장 시 결손의 크기는 6.5 mm에서 34 mm (중앙값 : 18 mm)이었고, 사용한 Amplatzer septal occluder의 크기는 6 mm에서 36 mm (중앙값 : 19.5 mm)로 풍선 확장 시 결손의 크기와 같거나 1-2 mm 큰 크기의 기구가 사용되었다. 시술 후 발생한 합병증으로는 부정맥(2례), 기구 변형(2례), 대동맥 우심방 간 누공 형성 및 용혈성 빈혈(1례), 승모판 잠식(1례), 기구 위치 이상(1례), 잔류 단락(1례), 하대 정맥 천공(1례) 등이 있었다. 결 론 : ASO를 이용한 심방 중격 결손의 경피적 폐쇄술은 안전성이나 효과, 기술적인 면에서 수술을 대체할 수 있는 효율적인 치료로 생각된다. 그러나 드물게 발생하는 기구 이탈이나 부정맥, 심장막 삼출, 누공 형성 등의 합병증이 발생할 수 있으므로 시술 전 주의 깊게 대상 환자를 선정하고, 심방 중격 결손의 정확한 해부학적 이해와 기구 선택이 필요하며 시술 후 추적 관찰을 통해 합병증의 조기 발견 및 예방이 필요할 것으로 판단된다.

• 임상간호연구
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• 제23권3호
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• pp.293-301
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• 2017

Purpose: The purpose of this study was to examine the effects of bed angles and bed rest time combined with hemostatic methods on discomfort and hemorrhagic complications in patients after transfemoral cerebral angiography. Methods: Data were collected from 93 inpatients following transfemoral cerebral angiography, from April 20 to September 23, 2016. Patients were grouped according to bed angle ($0^{\circ}$ vs. $30^{\circ}$) and bed rest time combined with hemostatic methods (4-hour bed rest after manual compression vs. 2-hour bed rest after applying vascular closure device). Results: There was a significant group differences on discomfort (F=46.44, p<.001). The post-hoc analysis showed the lowest score of discomfort in those with bed angle $30^{\circ}$ and 2-hour bed rest. There was no difference in hemorrhagic complications among 4 groups. Conclusion: The postangiograpy discomfort can be effectively reduced with the least hemorrhagic complications by bed angle $30^{\circ}$ elevation and 2-hour bed rest after applying vascular closure device for those underwent transfemoral cerebral angiography.

• Journal of Chest Surgery
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• 제46권5호
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• pp.383-387
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• 2013

Vacuum-assisted closure therapy is an alternative method for a massive subcutaneous emphysema treatment. It is easily applicable and shows rapid effectiveness in massive subcutaneous emphysema, intractable with chest tube drainage.

• Clinical and Experimental Pediatrics
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• 제56권9호
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• pp.396-400
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• 2013

Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA) by using an Amplatzer vascular plug (AVP). Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared. Results: The mean age of the patients was $54.9{\pm}45.7$ months old. The PDAs were of type C (n=5), type D (n=12), and type E (n=3). The mean pulmonary end diameter of the PDA was $1.7{\pm}0.6$ mm, and the aortic end diameter was $3.6{\pm}1.4$ mm. The mean length was $7.3{\pm}1.8$ mm. We used 3 types of AVP devices: AVP I (n=5), AVP II (n=7), and AVP IV (n=8). The ratio of AVP size to the pulmonary end diameter was $3.37{\pm}1.64$, and AVP size/aortic end ratio was $1.72{\pm}0.97$. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P=0.002). The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter ($1.10{\pm}0.31$, P=0.032). Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1167-1174
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• 1997

저자들은 1991년부터 1996년까지 5년간 지연 흉골 폐쇄를 시행한 20명의 환자를 분석하고 추적 조사 하였다. 남녀비는 11:9였고 평균연령은 6.4개월(범위 7일-5년)이었다. 적응증으로는 개심술후 심근부종에 기인한장치한 불안정한 혈역학적 상태로 인한 것이 15례로 가장 많았고, 심폐기 이탈 불가로 심실 보조 장치를 경우에서가 3례, 폐동맥 밴딩술 후 저산소증으로 인한 것이 2례 등이었다. 흉골 봉합은 술후 평균 102시간(범위 4-213시간)에 이루어졌으며 시행 후 중심 정맥압의 유의한 상승이 관찰되었다. 종격 동염, 환부 감염 등은 없었으며 2례에서 패혈증이 관찰되었다. 5명이 사망하였고 생존환자 15명중 2명 이 술후 추적관찰 기간 중 사망하였다. 누적 생존률은 1년과 2년에서 각각 65.0%였다. 지연 흉골 봉합 은 혈역학적으로 불안정한 심장을 감압하는 좋은 방법이며 성공적인 결과를 얻기 위해서는 적응증에 대한 신중한 고려가 선행되어야 한다고 생각된다.