• Journal of Chest Surgery
• /
• v.49 no.3
• /
• pp.165-170
• /
• 2016

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

• Journal of Chest Surgery
• /
• v.38 no.5 s.250
• /
• pp.377-381
• /
• 2005

Background: Extra-anatomic bypass was performed in the patient who could not use anatomic bypass due to many causes. The purpose of this study is to evaluate the efficacy of extra-anatomic bypass surgery. Material and Method: We reviewed 31 patients who underwent extra-anatomic bypass surgery at Pusan national university hospital. We analysed the combined diseases, etiologic diseases, symptoms, patency rate and the factors affecting patency rate retrospectively. Result: There were 26 cases of femoro-femoral bypass and 5 cases of axillo-bifemoral bypass among 31 patients. The mean age was 70.23 years. Combined disease were hypertension, hyperlipidemia, and ischemic heart disease in order of frequency. The indications for surgery were disabled claudication, tissue necrosis, rest pain, and a cute ischemia. We analysed the ages, smoking history, hypertension, ischemic heart disease, severity of limb ischemia, and hyperlipidemia as factors affecting patency rate. We could not find any statistical differences between these factors. The primary graft patency rates were $73.65\%$ one year, $73.65\%$ two year, and $65.46\%$ three year respectively according to the Kaplan-Meier method. Conclusion: Nevertheless extra-anatomic bypass has a relatively low patency rate, it has good merits that is less dangerous, simple and easy re-do surgery compared to anatomic bypass. We think that extra-anatomic bypass is one of the good treatment modalities for the high risk vascular patients.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.7 no.2
• /
• pp.256-270
• /
• 2000

Invasive hemodynamic monitoring has become a valuable assessment parameters in critical care nursing in patients undergoing open heart surgery patients. During cardiac surgery, the Swan Ganz catheter is placed in the pulmonary artery. Critical care nurses routinely obtain cardiac output, cardiac index, and pulmonary arterial pressure in these patients. Traditionally, patients are positioned flat and supine for cardiac output measurement. Numerous studies have dealt with the effects of changing position on the hemodynamic variables. However, there are a few studies dealing with patients who undergo cardiac surgery in Korea. Thus, the purpose of this study was to determine the effects of changing position on cardiac output, PAP, CVP, BP, HR and discomfort in patients after cardiac surgery. A sample of 21 adults who had CABG and/or valve replacement with Swan Ganz catheters in place was studied. The data were collected in the cardiac ICU of a university hospital in Seoul during the period from July 28, 1999 to August 30. 1999. In this study, the independent variable is patient position in the supine, 30 degree, and 45 degree angles. Dependent variables are C.O., C.I., CVP, PAP, MAP, HR and patients' perceived discomforts. Subject discomfort was measured subjectively by visual analogue scale. Other hemodynamic data where collected by the thermodilution method and by direct measurement. The data were analyzed by percentile, t-test, ANOVA, Linear regression analysis using SPSS-/WIN program. The results are as follows : 1) Changes in cardiac output were absent in different angle positions, 0, 30. 45 degrees(F=.070, P=.932). Changes in cardiac index were absent in different angle positions, 0. 30, 45 degrees(P>.05). 2) Changes in central venous pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 3) PAP had no change in different angle 0, 30, 45 degree positions; systolic PAP(P>.05), diastolic PAP(P>.05). 4) Changes in systolic blood pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 5) Changes in heart rates were absent in different angle positions, 0, 30, 45 degree(P>.05). 6) Patients' perceived discomfort was absent in different angle positions, 0, 30, 45 degree(p<.05). In conclusion, critical care nurses can measure C.O., C.I., PAP, BP, & CVP in cardiac surgery patients at 30 degree or 45 degree positions. This can improve the patients' comfort.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.19 no.9
• /
• pp.146-155
• /
• 2018

This study was conducted to evaluate the clinical outcomes of coronary artery bypass surgery for ischemic heart disease according to use of a cardiopulmonary bypass machine. The subjects were 10,981 patients who underwent coronary artery bypass grafting for ischemic heart disease from July 2008 to June 2012. Analysis data were retrospectively collected using health insurance claims data. The results of the study showed that mean time to surgery (280 min vs 357 min, p<0.0001) and intubation time (about 24 hours vs 40 hours, p<0.0001) were significantly shorter in the Off-Pump CABG (OPCAB) group than in the On-Pump CABG (ONCAB) group. The rate of reoperation because of postoperative bleeding and hematoma was lower in the OPCAB group (2.7% vs 8.3%, p<.0001). The odds ratio of risk adjusted 30 days mortality rate was 0.339 (0.266-0.434) and the postoperative length of stay was decreased in the OPCAB (p<0.0001). Overall, the 30 days mortality and reoperation rates were lower in the OPCAB, as was the resources use.

• Clinics in Shoulder and Elbow
• /
• v.14 no.1
• /
• pp.105-110
• /
• 2011

Purpose: The purpose of this article is to identify and understand the complications of RTSA and to review the current methods of preventing and treating this malady. Materials and Methods: Previous constrained prostheses (ball-and-socket or reverse ball-and-socket designs) have failed because their center of rotation remained lateral to the scapula, which has limited of the motion of the prostheses and produced excessive torque on the glenoid component, and this leads to early loosening. The Grammont reverse prosthesis imposes a new biomechanical environment for the deltoid muscle to act, thus allowing it to compensate for the deficient rotator cuff muscles. Results: The clinical experience does live up to the lofty biomechanical concept and expectations: the reverse prosthesis restores active elevation above $90^{\circ}$ in patients with a cuff-deficient shoulder. However, external rotation often remains limited and particularly in patients with an absent or fat-infiltrated teres minor. Internal rotation is also rarely restored after a reverse prosthesis. Failure to restore sufficient tension in the deltoid may result in prosthetic instability. Conclusion: Finally, surgeons must be aware that the results are less predictable and the complication/revision rates are higher in revision surgery than that in the first surgery. A standardized monitoring tool that has clear definitions and assessment instructions is surely needed to document and then prevent complications after revision surgery.

• Journal of Life Science
• /
• v.21 no.1
• /
• pp.9-14
• /
• 2011

Perceived exertion involves detection and interpretation of sensations arising from the body during physical exercise. Physiological variables such as heart rate and oxygen consumption positively correlate with ratings of perceived exertion (RPE). It is unknown whether the accuracy of predicting exercise intensity from RPE differs between men and women. Therefore, it was examined whether men or women could predict relative exercise intensity, determined by oxygen consumption, more accurately from RPE. Ten male and ten female young adult subjects aged 25.1${\pm}$3.52 yr volunteered to participate. RPE were determined by the Borg 15-category scale, and a standard Bruce treadmill protocol was used to perform graded exercise testing. There was no significant difference in slope means between males and females (p=0.501). No significant difference was observed when plotting rates of perceived exertion (RPE) vs. percentage of $VO_2$ max. The relative maximal oxygen consumptions ($VO_{2max,\;}_{rel}$) were 52.36${\pm}$7.35 ml/kg/min for males and 41.44${\pm}$6.71 ml/kg/min for females, respectively and there was a significantly high difference between the two groups in the relative $VO_{2max}$, as well as figures of 4.05${\pm}$0.36 l/min for males and 2.53${\pm}$0.39 l/min for females in the absolute $VO_{2max}$ in this study. There were no significant differences in slope, y-intercept, and standard error of estimate (SEE) between males and females. No significant difference with RPE according to exercise intensity was found between males and females. However, RPE was a useful predictor of exercise intensity in independent genders.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.4
• /
• pp.366-379
• /
• 2017

In this study, we performed a systematic review and meta-analysis to identify the effects of exercise on endothelial progenitor cells (EPCs) in patients with cardiovascular disease (CVD). We conducted database searches (Cochrane Library, PubMed, EMBASE, ScienceDirect, CINAHL, Scopus, KoreaMed, KISS, RISS, KMBASE) for the effect of exercise on cardiovascular disease, using heart disease, coronary artery disease, heart failure, cardiovascular disease, exercise, motor activity, rehabilitation, and endothelial progenitor cells as the keywords. Of the 539 studies identified, 9 met the inclusion and exclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze the effect size and the publication bias was checked with a funnel plot. Exercise was found to improve the VEGF (vascular endothelial growth factor), CD34+KDR+, and endothelial function, assessed via FMD (flow-mediated dilation), in the exercise vs. control groups, viz. 2.008 (95% CI 0.204-3.812), 1.399 (95% CI 0.310-2.489), and 1.881 (95% CI 0.848-2.914), respectively. Exercise improved the VEGF, number of EPCs, and endothelial function in the CVD patients. Considering the increasing prevalence and mortality rates for cardiovascular disease in Korea, the findings of this study that analyzed the effects of exercise on EPCs might provide guidelines for planning exercise interventions for patients with CVD.

• Journal of Veterinary Clinics
• /
• v.36 no.6
• /
• pp.306-313
• /
• 2019

It is important to identify the most suitable anesthetic agent that has minimal side effects to be able to control and perform surgeries on bears. In this study, we examined and compared the induction and recovery times as well as the physiological changes occurring during anesthesia induced by medetomidine-zolazepam/tiletamine (MZT) and xylazine-zolazepam/tiletamine (XZT) at general anesthesia for laparoscopic salpingectomy in 326 female Asiatic black bears. The body temperature, heart rate, respiratory rate, and levels of PaO₂ and EtCO₂ were the physiological changes measured during surgical procedures in female bears after anesthesia. In addition, the levels of pO₂, pCO₂, and sO₂ were measured using a portable blood gas analyzer. To induce recovery from anesthesia, bears anesthetized with MZT were intravenously administered atipamezole and bears anesthetized with XZT were intravenously administered yohimbine. The combination MZT, at dosages of 0.019 ± 0.001 mg/kg for medetomidine and 1.4 ± 0.1 mg/kg for ZT, or the combination XZT, at dosages of 2.0 ± 0.1 mg/kg for xylazine and 3.0 ± 0.1 mg/kg for ZT, proved to be reliable and effective in anesthetizing Asiatic black bears for a 40-min handling period for routine clinical procedures. The average anesthesia induction times were 16.5 ± 0.95 min for the bears in the MZT group and 12.0 ± 0.44 min for those in the XZT group. A significant difference was noted between the two drugs (P < 0.001) in terms of the average anesthesia induction time. The anesthesia induction time was shorter for bears with lower body weights than those with higher body weights (P < 0.05). The recovery time of MZT was significantly faster than that of XZT (11.3 ± 0.45 min vs. 18.5 ± 0.83 min) (P < .001). The bears anesthetized with MZT exhibited lower cardiopulmonary suppression than those anesthetized with XZT (P < 0.05). The body temperatures and EtCO₂ of bears in the M ZT group were significantly lower than those in the XZT group as time progressed after anesthesia (P < 0.05). The average pO₂ before the bears were supplied with oxygen was 64.8 ± 3.7 mmHg, but it increased to 211.5 ± 42.5 mmHg afterwards (P < 0.001). In conclusion, our results indicate that bears anesthetized with MZT have longer anesthesia induction time, shorter recovery time, slower heart and respiratory rates, and lower body temperatures and EtCO₂ than those anesthetized with XZT. These findings suggest that XZT is preferable to MZT, warranting further research on its uses and clinical responses in bears.

• Annals of Coloproctology
• /
• v.34 no.6
• /
• pp.286-291
• /
• 2018

Purpose: Stage-IIIC colon cancer is an advanced disease; however, its oncologic outcomes and prognostic factors remain unclear. In this study, we aimed to determine the predictors of disease-free survival (DFS) in patients with stage-IIIC colon cancer. Methods: From a multicenter database, we retrospectively enrolled 611 patients (355 men and 256 women) who had undergone a potentially curative resection for a stage-IIIC colon adenocarcinoma between 2003 and 2011. The primary endpoint was the 5-year DFS. Results: The median age was 62 years; 213 and 398 patients had right-sided colon cancer (RCC) and left-sided colon cancer (LCC), respectively. The 5-year DFS in all patients was 52.0%; median follow-up time was 35 months (range, 1-134 months). A multivariate Cox regression revealed that female sex (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.19-1.90; P < 0.01), right-sided tumor location (HR, 1.65; 95% CI, 1.29-2.11; P < 0.01), lymphatic invasion (HR, 1.52; 95% CI, 1.08-2.15; P < 0.01) and a high (${\geq}0.4$) metastatic lymph node ratio (HR, 3.72; 95% CI, 2.63-5.24; P < 0.01) were independent predictors of worse 5-year DFS. Female patients with RCC were 1.79 fold more likely to experience recurrence than male patients with LCC. Conclusion: Female sex and right-sided tumor location are associated with higher tumor recurrence rates in patients with stage-IIIC colon cancers. Aggressive treatment and close surveillance should be planned for patients in these groups.

• Journal of the Korean Dietetic Association
• /
• v.28 no.4
• /
• pp.281-292
• /
• 2022

The lower elementary school grades are an important period in which eating habits are formed. We examined the relationship between eating habits and school meal intake in the lower grades of an elementary school in Seoul. The eating habits were investigated using the Nutrition Quotient (NQ) for children. The school meal intake rates and preferred menus were obtained by automatically scanning the plate before and after meals using an artificial intelligence food scanner. The average school meal intake rate for the 347 subjects was 68.5±12.2%, and the nutrient intakes through the school meals were 353.5±70.0 kcal of energy, 51.8±10.2 g of carbohydrates, 14.6±3.1 g of proteins, 10.3±2.3 g of fats, 87.0±20.0 mg of calcium, and 1.8±0.4 mg of iron. The preferred menus were rice, grilled food, and dairy products, and non-preferred menus were salad, beverages, and stewed food. The eating habits that showed a positive correlation with the school meal intake rate were 'Diverse side dishes (r=0.332, P<0.001)', 'Vegetable side dishes (r=0.166, P<0.01)', 'Kimchi side dish (r=0.230, P<0.001)' and 'Less TV watching and computer game time (r=0.105, P<0.05)'. The NQ score also showed a positive correlation with the rate of school meal intake (r=0.216, P<0.001). The balance score was positively correlated with fruit (r=0.192, P<0.001), and the diversity score had the highest positive correlation with Kimchi (r=0.362, P<0.001). The regularity score was positively correlated with fried food (r=0.114, P<0.05). In conclusion, it was found that elementary school students in the lower grades had a higher school meal intake rate when their eating habits included eating side dishes evenly, and consuming vegetable side dishes and Kimchi.