• Journal of Chest Surgery
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• 제19권1호
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• pp.50-57
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• 1986

Sixty-nine patients with various types of cyanotic congenital heart disease underwent systemic-pulmonary artery shunts with a microporous polytetrafluoroethylene [PTFE] prosthesis between 1979 and 1985. Their ages ranged from 2 months to 39 years [mean$\pm$SD: 5.2$\pm$7.4, median: 3.3 years]. Diagnosis included the following: Tetralogy of Fallot, 45: Double outlet right or left ventricle, 11: Single ventricle, .5: Transposition of great vessels, 4: Tricuspid atresia, 3 and Pulmonary atresia with intact ventricular septum, 1. Forty-eight patients had subclavian-pulmonary artery anastomosis, 12 patients aorta-right pulmonary artery anastomosis, 6 patients aorta-main pulmonary artery anastomosis, and 3 patients descending aorta-pulmonary artery anastomosis. The PTEE graft of 3 mm in diameter was used in 1, 4 mm in 29, 5 mm in 35 and 6 mm in 4 patients. Ten patients were died within 30 days after operation [mortality rate: 14.5%]. Among them, 6 patients were operated in urgency due to cardiac arrest or severe anoxic spell after cardiac catheterization, and so surgical mortality of elective operation is 9.5%. The 59 survivors showed improvement of the arterial oxygen saturation [65.4% - 9.8%] and hemoglobin [18.8 gm/dl - 16.0 gm/dl] values [V<0.01]. The follow up period ranged from 1 month to 67 months, [752 patient-months] and during this periods there were 4 late shunt failures after 3 months postoperatively with 4 mm graft, and 2 with 5 mm graft. The over-all patency rate of 4 mm PTFE was 85.9$\pm$9.2% [SEM] in 12 months and 40.9$\pm$22.5% in 24 months. The over-all patency rate of 5 mm PTFE was 87.5$\pm$9.6% in 12 months and 58.3$\pm$24.6% in 36 months. The lowest systolic pressure in death group was 64.9$\pm$15.0 mmHg and in survival group, 86.4$\pm$12.1 mmHg [P<0.001]. We think that the PTFE graft is useful in palliative shunt operation, but the effectiveness of the 4 mm PTFE graft may be limited. The blood pressure also may play an important role in patency of Prosthesis.

• Journal of Chest Surgery
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• 제19권1호
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• pp.75-82
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• 1986

The use of the Angell-Shiley porcine xenograft cardiac valve was limited in number at Seoul National University Hospital chiefly because of the cessation of supply from the manufacturer, Forty-eight Angell-Shiley valves along with the 5 other mechanical or tissue valves were used in 46 patients during the period from 1977 to 1980, and a total of consecutive cases was studied for their early and long-term clinical results. The operative mortality rate was 4.3%; no death after single and 2 deaths after double valve replacement within 30 days of surgery. The 44 early survivors were followed up for a total of 171.6 patient-years and a mean of 46.8$\pm$31.1 months. Four died during the follow-up period with a linealized late mortality rate of 2.33%/patient-year. Four patients had experienced 5 episodes of thromboembolism and one died; a linealized incidence of 2.91% emboli/patient-year. A single case each had a bleeding complication related to the anticoagulants, 0.58% bleeding/patient-year, and prosthetic valve endocarditis, 0.58% endocarditis/patient-year. The clinical improvement was excellent by 70% of the survivors having no cardiac symptoms at the end of the follow-up. The actuarial survival rates were 89.9$\pm$4.9% at 5 years and 69.2$\pm$15.0% at 9 years after surgery. The probabilities of freedom from thromboembolic complication were 92.3$\pm$5.5% and 80.9$\pm$9.0% at 5 and 9 years after surgery. And, the probability of freedom from overall valve failure was 83.4$\pm$6.3% at 5 years and it declined sharply down to 55.9$\pm$22.2% at 9th year of the follow-up. These results are comparable with those in the major reports, except a more accelerated and time-related increases in valve failure after 5 or 6 years after operation with the Angell-Shiley valve. The durability of the xenograft tissue valve remains as the most important debate and the need of more durable tissue valves was also discussed.

• 한국어병학회지
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• 제23권3호
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• pp.409-420
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• 2010

Effects of various concentrations of garlic powder and garlic extract in the diets on growth, serum chemistry and immune response of olive flounder were determined. Thirty-five juvenile fish averaging 5.1 g were randomly distributed into 21 of 180 L flow-through tanks. Seven experimental diets with various concentrations of garlic powder (GP) and garlic extract (GE) were prepared in triplicate: GP-0 without garlic supplementation, GP-0.5, GP-1, GP-2, GP-3 and GP-5 diets containing garlic powder at the concentrations of 0.5, 1, 2, 3 and 5%, respectively at the expense of wheat flour and finally, GE-0.4 diet containing 0.4% garlic extract were prepared. At the end of the 8-week feeding trial, serum chemistry of fish was measured. In addition, twenty fish from each tank were artificially infected with E. tarda for the following 96 h to monitor cumulative mortality. Weight gain of fish fed GP-0 diet was higher than that of fish fed GP-1, GP-2, GP-3 and GP-5 diets. No difference in serum criteria (total protein, glucose, glutamate oxaloacetate transaminase, cholesterol and triglyceride levels) of olive flounder was found among the experimental diets except for glutamate pyruvate transaminase. Lysozyme activity of fish fed GP-0, GP-1, GP-3 and GE-0.4 diets was higher than that of fish fed GP-5 diet. The highest cumulative mortality was 93.3% in fish fed GP-0 diet at 96 h after E. tarda infection, followed by GP-3, GP-1, GP-5, GP-2, GP-0.5 and GE-0.4 diets. In considering these results, dietary inclusion of garlic powder and garlic extract has no distinctive positive effect on improvement in growth, serum chemistry and immune response of olive flounder in this experimental conditions, therefore, its application should be carefully considered.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.173-180
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• 2022

Purpose: The use of surgical stabilization of rib fractures (SSRF) has steadily increased over the past decade. Recent literature suggests that a larger population may benefit from SSRF, and that the geriatric population-as the highest-risk population-may receive the greatest improvement from these interventions. We sought to determine the overall utilization of SSRF in the United States. Methods: The National Trauma Database was analyzed between 2016 and 2017. The inclusion criteria were all patients ≥65 years old with rib fractures. We further stratified these patients according to age (65-79 vs. ≥80 years old), the presence of coding for flail chest, three or more rib fractures, and intervention (surgical vs. nonoperative management). The main outcomes were surgical interventions, mortality, pneumonia, length of stay, intensive care unit length of stay, ventilator use, and tracheostomy. Results: Overall, 93,638 patients were identified. SSRF was performed in 992 patients. Patients who underwent SSRF had improved mortality in the 65 to 79 age group, regardless of the number of ribs fractured. We identified 92,637 patients in the age group of 65 to 79 years old who did not undergo SSRF. This represents an additional 20,000 patients annually who may benefit from SSRF. Conclusions: By conservative standards and the well-established Eastern Association for the Surgery of Trauma clinical practice guidelines, SSRF is underutilized. Our data suggest that SSRF may be very beneficial for the geriatric population, specifically those aged 65 to 79 years with any rib fractures. We hypothesize that roughly 20,000 additional cases will meet the inclusion criteria for SSRF each year. It is therefore imperative that we train acute care surgeons in this skill set.

• 한국의료질향상학회지
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• 제10권1호
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• pp.28-41
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• 2003

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

• 사상체질의학회지
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• 제25권4호
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• pp.432-441
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• 2013

Objectives Despite the treatment with antibiotics, patients with sepsis has a high mortality (80%) in the underlying disease group. The aim of this study was to report the improvement of septic condition of the cholangiocarcinoma patient after the treatment with Handayeolso-tang, Fel Tauri, and antibiotics. Methods We retrospectively reviewed the medical records. The patient's subjective symptoms such as chilling and abdominal pain were evaluated by NRS and the performance status was evaluated by ECOG. This case was literally compared with relevant published studies on prognosis of sepsis. Results Despite poor prognostic factor(MEDS score 18), the patient's symptoms such as fever, chilling, abdominal pain, and diarrhea and ECOG(Eastern Cooperative Oncology Group) improved. The patient was hemodynamically stabilized on 3rd day from the treatment, and her laboratory test results were normalized on 7th day. Conclusions A female patient of metastatic cholangiocarcinoma came to the hospital for cholangitis, later causing septic shock. Both her symptoms and laboratory tests showed significant improvement after the treatment of antibiotics, Handayeolso-tang and Fel Tauri. To our knowledge, this is the first case reporting the synergistic combination of Korean oriental medicine and Western medicine approaching to sepsis.

• Clinical and Experimental Pediatrics
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• 제61권8호
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• pp.239-244
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• 2018

Purpose: Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. Methods: The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above $23.0^{\circ}C$, and a check-list was used for feedback. Results: Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <$36.0^{\circ}C$) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from $35.5^{\circ}C$ to $36.0^{\circ}C$. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from $35.4^{\circ}C$ to $35.9^{\circ}C$ and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. Conclusion: Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.

• 자원ㆍ환경경제연구
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• 제15권5호
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• pp.859-884
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• 2006

대기오염물질의 직접적인 건강피해는 조기사망률과 질병률을 급속도로 증가시키는 것이고 이는 선진국과 개발도상국에서 심각한 문제로 대두되고 있다. 또한 대기오염은 사람들의 활동을 제약하거나 의료지출을 증가시키는 등 사회적으로 심각한 비용을 초래한다. 본 연구에서는 이와 같은 대기오염의 건강효과에 대한 WTP를 도출하기 위해 컨조인트 분석법을 적용하였다. 본 연구에서는 기존연구와는 달리 건강피해 속성의 편익을 측정하기 위해, 폐암사망, 유아사망, 천식, 만성 기관지염, 급성 기관지염 등 총 다섯 가지 건강 관련 속성을 식별하였다. 분석결과, 유아사망 1단위(1%) 감소를 위한 가구당 연간 MWTP는 853.85원이었으며, 폐암, 천식, 급성 기관지염, 만성 기관지염이 한 단위(1,000만 명당 1명) 감소시키기 위한 가구당 MWTP는 각각 1,672원, 34.911원, 0.018원, 2.101원인 것으로 나타났다. 이 같은 분석결과를 토대로, 개선 가능한 최고수준의 대기질에 대한 건강효과의 가구당 WTP를 계산한 결과, 연간 3만 8,856원으로 나타났으며, 수도권 전체지역의 연간 가치는 연간 약 2,528억 원에 달하는 것으로 나타났다. 본 연구에서 도출된 실증분석 결과는 소비자들의 선호가 반영된 것이므로, 대기오염 정책결정과정에 정량적인 편익을 제시해 줄 수 있으며, 다양한 정책대안들에 대해 편익을 평가할 수 있게 해 준다.

• 생태와환경
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• 제37권3호통권108호
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• pp.332-343
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• 2004

본 연구에서는 여과섭식성 이매패류인 참재첩(Corbicula leana)의 섭식에 따른 수체내 영양염 및 입자성 물질의 변화를 mesocosm (width ${\times}$ length ${\times}$ depth: 3 m ${\times}$ 3 m ${\times}$ 0.5 m)에서 분석함으로써 수질개선기법으로의 적용가능성을 검토하였다. 짧은 기간 동안의 mesocosm실험은 패류의 교체를 통한 연속적인 두 단계로 수행되었다. 첫 번째 단계는 패류 투입 이후 8일 동안이며 패류의 교체 이후의 진행된 8일 동안의 실험은 두 번째 단계로 구분된다. 이러한 연속적인 실험을 통해 조개의 섭식에 따른 수질변화를 좀더 명확하게 비교할 수 있었다. 재첩 투입 직후 높은 패사율을 보였으나 처리구의 교체가 있던 8일의 재첩의 패사율은 4 ind $day^{-1}$ 이하로 안정된 상태를 유지하였다. 엽록소 a 농도는 투입 직후의 수체 내 농도와 비교해 패류의 교체전과 후에 각각 71%, 88% 감소하였고 부유물질은 70%, 77% 감소하였으며, 여과율은 평균 0.46과 0.61 mL AFDW $mg^{-1}$ $hr^{-1}$이였다. 폐사율이 높았던 시기에 수중 내 암모니아성 질소와 용존총인이 증가하였다. 폐사율과 암모니아 농도는 양의 상관성을 보인 반면에 (r = 0.95, P<0.001), 용존총인의 농도는 폐사율과 음의 상관성을 나타냈다 (r = 0.94, P<0.001). 패류의 폐사율이 낮았던 교체 이후에도 암모니아의 농도는 증가하였고 실험 초기 대조구와 비교해 높은 농도를 유지하였다(P= 0.042, ANOVA). 반면에, 용존 총인은 비록 농도가 증가하였으나 초기 대조구와 비교해 큰 차이는 없었다(P= 0.509, ANOVA). 이러한 결과들은 만약 패류가 투입 초기에 새로운 서식지에 성공적으로 정착한다면 부영양 호수의 수질을 효과적으로 개선할 수 있는 방법이 될 수 있음을 시사한다.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.159-165
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• 2012

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.