• Archives of Plastic Surgery
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• 제37권5호
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• pp.547-554
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• 2010

Purpose: The purpose of this study is to delineate the optimal time of venous revascularization for preventing the flap necrosis due to venous occlusion, and to clarify the usefulness of tissue oxygen pressure ($TcpO_2$) in the determination of the point of time for venous revascularization. Methods: Thirty-six, $3{\times}3\;cm$ sized epigastric island flap was elevated in left abdomen of male Sprague-Dawley rat weighing 250 gram. Flaps were randomly assigned to six groups of six flaps according to the duration of venous occlusion with microvascular clamp; 10 minutes in the group I as the control, 60 minutes in the group II, 2 hours in the group III, 3 hours in the group IV, 4 hours in the group V, and 6 hours in the group VI, respectively. Just before removal of clamp after flap was reposed in situ, the ratio of $TcpO_2$ (tissue oxygen pressure) of the island flap to that of right abdomen was calculated in each group, and tissue specimen was harvested from the distal area of the flap for histological evaluation of vascular change. Five days later, survival area of the flap was estimated, and evaluated the correlation between the tissue oxygen pressure and the rate of flap survival. Results: The $TcpO_2$ and the survival rate of flap were decreased proportionally with the duration of venous occlusion. The ratio of the $TcpO_2$ of the flap is decreased abruptly to below sixty percentile compared to the $TcpO_2$ of normal tissue, and the survived area of the flap is decreased to nine-tenth of the designed size after three hours of total venous occlusion. Histologically, the number of congested vessels was increased according to venous occluded time, and proportionally increased after 3-hours of occlusion significantly. Conclusion: There is a close correlation between the $TcpO_2$ and the survival rate of flaps according to the duration of venous occlusion. Therefore, the $TcpO_2$ represents the hemodynamic changes within the flap, and thought to be an alternative effective tool in the flap monitoring for venous revascularization.

• 대한방사선기술학회지:방사선기술과학
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• 제26권3호
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• pp.25-31
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• 2003

급성 허혈성 뇌경색 환자에서 Deconvolution 관류 전산화 단층촬영(computed tomography, CT)의 뇌혈류용적(cerebral blood volume, CBV), 뇌혈류(cerebral blood flow, CBF) 그리고 평균 조영제 통과 시간(mean transit time, MTT) 지도를 확산 강조(Diffusion weighted) MRI과 비교하여 그 유용성을 알아보고자 하였다. 뇌관류 CT와 확산강조 자기공명영상(diffusion weighted MR imaging, DWMRI)을 시행한 급성뇌경색 환자를 대상으로 Deconvolution 기법으로 획득한 CBV, CBF, MTT 지도에서 병변의 면적과 DWMRI의 병변의 면적을 비교 측정하여 일치도를 알아보았다. 또한, 병변 부위와 정상측 대칭부위의 MTT시간을 측정하여 차이를 알아보았다. 본 연구의 모든 예에서 CBV, CBF, 그리고 MTT 세 지도 모두 관류 결손을 인지할 수 있었고, 관류 결손이 인지되는 부위에서 MTT 시간의 현저한 지연이 있었다. 뿐만 아니라, MTT 지도의 결손부위 면적은 DWMRI 보다 크게 나타나 허혈성 패넘브라를 추측할 수 있었다. 결론적으로 Deconvolution 관류 CT의 지도를 이용하면 뇌경색의 조기진단뿐만 아니라 허혈 중심부, 그리고 허혈성 페넘브라를 예측할 수 있어 DWMRI에 비해 관류결손 부위의 혈류 역학적 상태의 평가나 효과적인 치료계획을 세우는데 보다 유용할 것으로 생각된다.

• Journal of Trauma and Injury
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• 제25권1호
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• pp.1-6
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• 2012

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

• Journal of Chest Surgery
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• 제31권6호
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• pp.591-597
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• 1998

배경: 이 연구의 목적은 대동맥판막 치환술의 조기 및 중기의 결과를 분석하였다. 대상 및 방법 : 1986년 1월부터 1996년 1월까지 대동맥판막 치환술을 시행한 61명의 환자를 대상으로 하였다. 남자가 38명이었고 여자는 28명으로 남녀의 비는 1.7:1로 남자에 많았고 연령분포는 10세에서 71세까지로 평균 40.5$\pm$11.2세이었다. 조기 사망률은 4.9%(3/61)이었다. 전체적인 추적 관찰은 퇴원한 58명의 환자 중 93.1%에서 이루어 졌으며 평균 추적기간은 51.5 환자-달이었다. 결과: 퇴원한 환자 58명 중 3명이 사망하여 만기 사망률은 5.2 %이었다. 5명의 환자에서 항응고제에 관련된 출혈이 있었으나 모두 경미하였고 3명의 환자에서 혈전경색을 보였다. 용혈이나 사용된 판막의 구조적인 실패는 없었고, 생존한 환자 중 NYHA 기능등급은 의의있게 호전되었다. 혈전경색과 항응고제에 관련된 출혈률은 각각 1.58 % 환자-년, 2.0% 환자-년이었다. 10년 생존률은 83.6%를 보였다. 결론 : 조기 및 중기의 추적관찰에서 대동맥판막 치환술에 사용한 기계판막은 낮은 인공판막에 연관된 합병증과 훌륭한 혈역학적 기능을 보이고 신뢰성이 있으면서 내구성이 좋은 인공판막이라 할 수 있었다.

• 대한디지털의료영상학회논문지
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• 제12권1호
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• pp.27-31
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• 2010

The purpose of this study was to investigated the usefulness of MR perfusion image comparing with SPECT image. A total of pediatric 30 patients(average age : 7.8) with Moyamoya disease were performed MR Perfusion with 32 channel body coil at 3T from March 01, 2010 to June 10, 2010. The MRI sequences and parameters were as followed : gradient Echo-planar imaging(EPI), TR/TE : 2000ms/50ms, FA : $90^{\circ}$, FOV : $240{\times}240$, Matrix : $128{\times}128$, Thickness : 5mm, Gap : 1.5mm. Images were obtained contrast agent administrated at a rate of 1mL/sec after scan start 10s with a total of slice 1000 images(50 phase/1 slice). It was measured with visual color image and digitize data using MRDx software(IDL version 6.2) and also, it was compared of measurement with values of normal and abnormal ratio to analyze hemodynamic change, and a comparison between perfusion MR with technique using Warm Color at SPECT examination. On MR perfusion examination, the color images from abnormal region to the red collar with rCBV(relative cerebral blood volume) and rCBF(relative cerebral blood flow) caused by increase cerebral blood flow with brain vascular occlusion in surrounding collateral circulation advancement, the blood speed relatively was depicted slowly with blue in MTT(Mean Transit Time) and TTP(Time to Peak) images. The region which was visible abnormally from MR perfusion examination visually were detected as comparison with the same SPECT examination region, would be able to confirm the identical results in MMD(Moyamoya disease)judgments. Hymo-dynamic change in MR perfusion examination produced by increase and delay cerebral blood flow. This change with digitize data and being color imaging makes enable to distinguish between normal and abnormal area. Relatively, MR perfusion examination compared with SPECT examination could bring an excellent image with spatial resolution without radiation expose.

• Journal of Chest Surgery
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• 제20권1호
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• pp.30-38
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• 1987

Sixty-eight consecutive patients have been subjected to total corrective surgery of tetralogy of Fallot at the Hanyang University Hospital between August 1975 and December 1984. Of these, the pressure of chambers and great arteries were measured, before and immediately following an operation in 39 of the survived group and 11 of the expired group. The values of postoperative peak pressure were correlated with the outcome of the operation. The result are as followings; 1] Compared to the average peak pressure of right atrium in the survived group, 14.46*4.16 mmHg, that in the expired group, 19.36*8.19 mmHg, was significantly lower, 2] Compared to the average systolic pressure of right ventricle in the survived group, 56.72z16.37 mmHg, that in the expired group, 70.45*15.26 mmHg, was significantly lower. 3] Compared to the average systolic pressure of pulmonary artery in the survived group, 33.26*12.95 mmHg, that in the expired group, 37.55*11.63 mmHg, was higher. But the difference was not significant. 4] Compared to the average peak pressure of left atrium in the survived group, 17.41*6.90 mmHg, that in the expired group, 31.18*12.47 mmHg, was significantly higher. 5] Compared to the average systolic pressure of left ventricle in the survived group, 103.82~12.83 mmHg, that in the expired group, 90.55*20.02 mmHg, was significantly lower. 6] Compared to the average value of the right ventricle-pulmonary artery systolic pressure gradient [RV-PA] in the survived group, 24.95a15.44 mmHg, that in the expired group, 35.09*17.01 mmHg, was significantly higher. 7] Compared to the average value of the right ventricle to left ventricle systolic pressure ratio [RV/LV] in the survived group, 0.55*0.15, that in the expired group, 0.80a0.20, was significantly higher. 8] Compared to the average value of the pulmonary artery-left atrium peak pressure gradient [PA-LA] in 15.85x12.29 mmHg that in the expired group, 4.18x6.00 mmHg, was significantly lower. It is, therefore, suggested that in the operating room, PA-LA is as valuable as RV - PA, RV/LV in making important surgical decision and predicting the prognosis.

• Journal of Korean Neurosurgical Society
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• 제57권2호
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• pp.88-93
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• 2015

Objective : Elevated cellular retinoic acid binding protein-I (CRABP-I) is thought to be related to the abnormal proliferation and migration of smooth muscle cells (SMCs). Accordingly, a higher CRABP-I level could cause disorganized vessel walls by causing immature SMC phenotypes and altering extracellular matrix proteins which could result in vulnerable arterial walls with inadequate responses to hemodynamic stress. We hypothesized that elevated CRABP-I level in the cerebrospinal fluid (CSF) could be related to subarachnoid hemorrhage (SAH). Moreover, we also extended this hypothesis in patients with vascular malformation according to the presence of hemorrhage. Methods : We investigated the CSF of 26 patients : SAH, n=7; unruptured intracranial aneurysm (UIA), n=7; arteriovenous malformation (AVM), n=4; cavernous malformation (CM), n=3; control group, n=5. The optical density of CRABP-I was confirmed by Western blotting and presented as mean${\pm}$standard error of the measurement. Results : CRABP-I in SAH ($0.33{\pm}0.09$) was significantly higher than that in the UIA ($0.12{\pm}0.01$, p=0.033) or control group ($0.10{\pm}0.01$, p=0.012). Hemorrhage presenting AVM (mean 0.45, ranged 0.30-0.59) had a higher CRABP-I level than that in AVM without hemorrhage presentation (mean 0.16, ranged 0.14-0.17). The CRABP-I intensity in CM with hemorrhage was 0.21 and 0.31, and for CM without hemorrhage 0.14. Overall, the hemorrhage presenting group (n=11, $0.34{\pm}0.06$) showed a significantly higher CRABP-I intensity than that of the non-hemorrhage presenting group (n= 10, $0.13{\pm}0.01$, p=0.001). Conclusion : The results suggest that elevated CRABP-I in the CSF could be related with aneurysm rupture. Additionally, a higher CRABP-I level seems to be associated with hemorrhage development in vascular malformation.

• The Korean Journal of Pain
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• 제14권1호
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• pp.61-67
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• 2001

Background: Usually, lumbar epidural block is performed on the $L_{3-4}$ interspace. This study was designed to evaluate the analgesic efficacy and shortening of labor duration comparing the $L_{1-2}$ and $L_{3-4}$ interspace epidural blocks in nulliparous normal vaginal deliveries and then investigates side effects following the blocks. Methods: Eighty healthy nulliparous women were divided into two groups, $L_{1-2}$ (n = 40) and $L_{3-4}$ (n = 40). Epidural blocks, lumbar epidural block were performed at the $L_{1-2}$ and $L_{3-4}$ interspace with a catheter advancing 3 cm cephalad. The initial dose of 12 ml (0.167% bupivacaine, fentanyl $50{\mu}g$ and clonidine $75{\mu}g$) was injected epidurally at 4 cm dilatation of cervix and severe pain of labor. If a visual analogue scale (VAS) score was more than 4 points, an additional dose was administered epidurally using the same volume as the above mentioned, but with the exception that the bupivacaine was diluted to 0.1 percentage. The maternal blood pressure, pulse rate, respiration rate and fetal heart rate were measured at 10 min intervals for the first 30 min, at 15 min interval for the next 30 min and at 30 min interval for the last one hour following the blocks. The duration of the first (active) and second stages of labor was counted and the neonatal Apgar score was recorded at one and five min after delivery. The degree of motor block, pruritus, nausea and vomiting were also noted. Results: The patients in group $L_{1-2}$ had lower pain scores than group $L_{3-4}$ at 5, 20, 30, 60 mins. The duration of 1st and 2nd labor stage in the $L_{3-4}$ epidural block were $272{\pm}33.5$ min, $49.2{\pm}27.4$ min respectively but those in the $L_{1-2}$ epidural block were $253.5{\pm}32.5$ min, $37.3{\pm}22.3$ min, respectively. Conclusions: We concluded the analgesic efficacy and shortening of labor duration in $L_{1-2}$ epidural block was better than those in $L_{3-4}$ epidural block. Maternal hemodynamic change, motor block. pruritus, nausea, vomiting and Apgar score showed no significant differences between the two groups.

• The Korean Journal of Physiology
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• 제24권1호
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• pp.51-65
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• 1990

The purpose of the present study was to examine the hemodynamic responses, especially in arterial and skin blood flows, in conjunction with the changes of plasma catecholamine levels as an indirect marker of adrenergic tone during the early stage of head-down tilt (HDT), and to evaluate the early physiological regulatory mechanism in simulated weightlessness. Ten mongrel dogs, weighing8\;{\sim}\;14\;kg, were intravenously anesthetized with nembutal, and postural changes were performed by using the tilting table. The postural changes were performed in the following order: supine, prone, HDT $(-6^{\circ}C)$ and lastly recovery prone position. The duration of each position was 30 minutes. The measurements were made before, during and after each postural change. The arterial blood flow $({\.{Q}})$ at the left common carotid and right brachial arteries was measured by the electromagnetic flowmeter. Blood pressure (BP) was directly measured by pressure transducer in the left brachial artery. To evaluate the peripheral blood flow, skin blood flow $({\.{Q}})$ was calculated by the percent changes of photoelectric pulse amplitude on the forepaw, and skin temperature was recorded. The peripheral vascular resistance (PR) was calculated by dividing respective mean BP values by ${\.{Q}}$ of both sides of common carotid and brachial arteries. Heart rate (HR), respiratory rate (f) and PH, $Po_{2},\;Pco_{2}$ and hematocrit of arterial and venous blood were also measured. The concentration of plasma epinephrine and norepinephrine was measured by radioenzymatic method. The results are summarized as follows: Tilting to head-down position from prone position, HR was initially increased (p<0.05) and BP was not significantly changed. While ${\.{Q}}$ of the common carotid artery was decreased (p<0.05) and PR through the head was increased, ${\.{Q}}$ of the brachial artery was increased (p<0.05) and PR through forelimbs was decreased. ${\.{Q}}$ of the forepaw was initially increased (p<0.05) and then slightly decreased, on the whole revealing an increasing trend. Plasma norepinephrine was slightly decreased and the epinephrine was slightly increased. f was increased and arterial pH was increased (p<0.05). In conclusion, the central blood pooling during HDT shows an increased HR via Bainbridge reflex and an increased ${\.{Q}}$ of the forepaw and brachial ${\.{Q}}$, due to decreased PR which may be originated from the depressor reflex of cardiopulmonary baroreceptors. It is suggested that the blood flow to the brain was adequately regulated throughout HDT $(-6^{\circ}C)$ in spite of central blood pooling. And it is apparent that the changes of plasma norepinephrine level are inversely proportional to those of ${\.{Q}}$ of the forepaw, and the changes of epinephrine level are paralleled with those of the brachial ${\.{Q}}$.

• Tuberculosis and Respiratory Diseases
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• 제73권3호
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• pp.151-161
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• 2012

Background: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. Results: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, $1.3{\pm}0.5{\mu}g/kg/min$; day 2, $0.9{\pm}0.4{\mu}g/kg/min$; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; $r_s$=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; $r_s$=0.77), and RASS and BIS ($r_s$=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. Conclusion: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.