• Korean Journal of Radiology
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• 제25권6호
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• pp.565-574
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• 2024

Objective: To evaluate the safety and clinical outcomes of the Passeo-18 Lux drug-coated balloon (DCB) in endovascular revascularization procedures under real-world conditions in a Korean population with atherosclerotic disease of the infrainguinal arteries, including below-the-knee (BTK) arteries. Materials and Methods: Eight institutions in the Republic of Korea participated in this prospective, multicenter, single-arm, post-market surveillance study. Two hundred patients with Rutherford class 2-5 peripheral arterial disease and infrainguinal lesions suitable for endovascular treatment were competitively enrolled. Data were collected at baseline, the time of intervention, discharge, and 1-, 6-, 12-, and 24-month follow-up visits. The primary safety endpoint was freedom from major adverse events (MAE) within 6 months (except when limiting the time frame for procedure- or device-related mortality to within 30 days), and the primary effectiveness endpoint was freedom from clinically driven target lesion revascularization (CD-TLR) within 12 months after the procedure. Results: A total of 197 patients with 332 target lesions were analyzed. Two-thirds of the patients had diabetes mellitus, and 41.6% had chronic limb-threatening ischemia. The median target lesion length was 100 mm (interquartile range: 56-133 mm). Of the target lesions, 35.2% were occlusions, and 14.8% were located in the BTK arteries. Rate of freedom from MAE was 97.9% at 6 months, and the rate of freedom from CD-TLR was 95.0% and 92.2% at 12 and 24 months, respectively. Subgroup analysis of 43 patients and 49 target lesions involving the BTK arteries showed rate of freedom from MAE of 92.8% at 6 months and rates of freedom from CD-TLR of 88.8% and 84.4% at 12 and 24 months, respectively. Conclusion: The results of the present study, including the BTK subgroup analysis, showed outcomes comparable to those of other DCB studies, confirming the safety and effectiveness of Passeo-18 Lux DCB in the Korean population.

• Child Health Nursing Research
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• 제16권4호
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• pp.352-359
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• 2010

Purpose: To explore premature infants' pain response to routine procedures in the neonatal intensive care unit (NICU). Methods: The participants were 56 preterm infants who showed 149 pain responses to 8 high frequency routine procedures which were evaluated using the Premature Infant Pain Scale (PIPS). Videotaped recording was used for data collection. Data were analyzed with descriptive analysis, paired t-test, and Pearson's correlation coefficient. Results: PIPS scores for each procedure were as follows; for removal of central catheter dressing, 6.17 (2.04), venous sampling, 6.12 (2.87), intramuscular injection, 6.05 (2.38), insertion of a peripheral line, 5.38 (2.16), insertion of feeding tube, 4.40 (1.34), heel stick, 4.33 (1.23), insertion of central line, 4.00 (2.12), and endotracheal suctioning, 2.90 (1.25). PIPS score was negatively correlated with gestational age (r=-.218, p=.007) and birth weight (r=-.249, p=.002) among general characteristics of the infants. Conclusion: The majority of 8 routine procedures were found to be painful for premature infants in the NICU. Therefore, adequate pain management related to procedures should be provided to premature infant in the NICU.

• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.242-246
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• 2017

Acute limb ischemia (ALI) due to an embolism is associated with high mortality rate and poor prognosis, and early diagnosis with prompt revascularization is required to reduce the risk of limb amputation or even death. The etiologies of ALI are diverse, and it includes an embolism from the heart and thrombotic occlusion of the atherosclerotic native vessels, stents, or grafts. An uncommon cause of ALI is acute arterial thromboembolism, and atrial fibrillation (AF) is the single most important risk factors for systemic thromboembolism. It is important to correctly identify the source of ALI for secondary prevention, as it depends on the underlying cause. Percutaneous transluminal angioplasty (PTA) has been proven to be a safe and effective treatment for focal atherosclerotic and thrombotic occlusive diseases of the aorta and its major extremity branches. Herein, we report on a 77-year-old female patient with acute upper limb ischemia, treated by PTA using a catheter-guided thrombectomy. He was newly diagnosed with paroxysmal AF (PAF) while evaluation the cause of his acute arterial thromboembolism. We recommend that cardiologists always consider PAF as a possible diagnosis even in patients without any history of AF under ALI because it is possible to develop thromboembolism in clinical practice.

• Clinical and Experimental Pediatrics
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• 제51권12호
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• pp.1359-1362
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• 2008

혈우병 환자에서 가장 효과적인 치료 방침은 응고 인자의 보충으로, 그를 위해 안전하고 오래 사용할 수 있는 정맥 확보가 필요하다. 그러나 중심 정맥으로의 port는 전신 마취와 일정한 입원이 필요하고, 혈우병 환자에서 시행할 경우 보험 삭감의 문제도 있다. 본 저자는 두 명의 중증 혈우병 항체 환자에게 말초 삽입 중심 정맥관을 삽입하였다. 환자들은 잦은 출혈 소견 때문에 응고 인자를 투여 받았으며, 그로 인하여 혈관 확보에 어려움이 있었다. 환자 나이는 7세와 11세였다. 제 8 응고 인자 활성도는 모두 1% 이하였으며, 제 8 응고 인자 항체 수치는 각각 160과 26.3 BU/mL였다. 말초 삽입 중심 정맥관은 초음파 인도 하에, 외래에서, 국소 마취로 쉽게 삽입되었다. 말초 삽입 중심 정맥관 삽입은 잦은 출혈을 보이는 혈우병 환자에게 사용해 볼 수 있는 방법이다.

• Journal of Chest Surgery
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• 제5권1호
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• pp.19-24
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• 1972

The recent development of cardiovascular surgery as well as aortoarteriogaphy has been established excellent operative result with great aid of limb-salvage. However, less consideration or less experience still exists on the regard of vascular accident and vascular disease, as well as vascular surgery in Korea. During the last 13 years, we experienced only two cases of aorto-iliac occlusion,acute and chronic, regardless of having had more than 300 cases of mitral valvotomy and gradual increasing tendency of arteriosclerosis and hypertension in Korea. Therefore it is noteworthy to report the cases in order to promote the consideration for vascular surgery. Case 1; 52 year old female who had 20 years history of mitral stenosis with uricular fibrillation and received medical treatment for recent 1 year in the medical department. 10 days before admission, acute saddle emboli developed and 15 days after the onset, embolectomy through both common femoral arteries on the groin and abdominal approach was made. The progression of emboll to the right popliteal bifurcation was found by arteriography on operating table and retrograde flushing with heparin solution by the polyethylene catheter inserted through posterior tibial artery. The operation was successful, but 9 hours after operation sudden death occurred. Considering this case, first, mitral valvotomy already before might prevent peripheral embolizatlon, secondarily, the more early detection and surgery might also prevent the progression of emboli. Thirdly, although preoperative or postoperatlve heparinization is controversial for mitraI stenosis, heparinization might prevent additional emboli to vital organs in this case Cases 2; 66 year old female who had 4 years history of left hip and calf intermittent claudication and has had rest pain, inability to walk and ischemic necrosis on the the left leg since last 3 months prior to admission to the orthopedic department under the suspicion of herniated disc. Absence of pulsation on the groin and aortography evidenced aortoillac occlusion predominantly on the left side. Thromboendarterectomy was made and the operative result was successful with absence of claudication, healing of ulcer and aortographic patency of occlusive site. This chronic occlusion is considered to result from arteriosclerosis in origin with the evidence of moderate hypertension, x-ray evidence of calcified plaque on the aortic knob and operative finding of palpable plaques.

• The Korean Journal of Pain
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• 제8권2호
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• pp.286-292
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• 1995

Buerger's disease(Thromboangiitis Obliterans) is characterized by peripheral arterial occlusion of the extremities in young smokers, and leading to ischemia of the tissue and gangrene. Most of these patients suffered from severe pain. therapy for Buerger's disease not enable to undergo reconstructive arterial surgery has been discouraging while multiple modes of analgesics have advanced. Eight subjects who had been operated due to Buerger's disease or diagnosed with this disease were evaluated retrospectively. Continuous epidural block was done at L 2~3 or L3~4 intervertebral space and multiday continuous infusor was connected to epidural catheter. The content of the infusor was clonidine-bupivacaine or clonidine-morphine-bupivacaine mixture. The minimum dose of clonidine was 75 ${\mu}g/day$ and the maximum 450 ${\mu}g/day$. The results were as follows: The analgesia produced by clonidine was superior to any other analgesics. 2) The incidence of the side effects produced by clonidine-bupivacaine mixture were less than that of clonidine-morphine-bupivacaine mixture. 3) Minimum dose of clonidine for the pain relief was required more than 225 ${\mu}g$ per day. From the above results, we recommend that clonidine is an effective agent to provide pain relief for the patients with Buerger's disease.

• The Korean Journal of Pain
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• 제35권4호
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• pp.433-439
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• 2022

Background: Repeated administration of opioid analgesics for pain treatment can produce paradoxical hyperalgesia via peripheral and/or central mechanisms. Thus, this study investigated whether spinally (centrally) administered orexin A attenuates opioid-induced hyperalgesia (OIH). Methods: [D-Ala², N-Me-Phe⁴, Gly⁵-ol]-enkephalin (DAMGO), a selective µ-opioid receptor agonist, was used to induce mechanical hypersensitivity and was administered intradermally (4 times, 1-hour intervals) on the rat hind paw dorsum. To determine whether post- or pretreatments with spinal orexin A, dynorphin A, and anti-dynorphin A were effective in OIH, the drugs were injected through an intrathecal catheter whose tip was positioned dorsally at the L3 segment of the spinal cord (5 ㎍ for all). Mechanical hypersensitivity was assessed using von Frey monofilaments. Results: Repeated intradermal injections of DAMGO resulted in mechanical hypersensitivity in rats, lasting more than 8 days. Although the first intrathecal treatment of orexin A on the 6th day after DAMGO exposure did not show any significant effect on the mechanical threshold, the second (on the 8th day) significantly attenuated the DAMGO-induced mechanical hypersensitivity, which disappeared when the type 1 orexin receptor (OX1R) was blocked. However, intrathecal administration of dynorphin or an anti-dynorphin antibody (dynorphin antagonists) had no effect on DAMGO-induced hypersensitivity. Lastly, pretreatment with orexin A, dynorphin, or anti-dynorphin did not prevent DAMGO-induced mechanical hypersensitivity. Conclusions: Spinal orexin A attenuates mechanical hyperalgesia induced by repetitive intradermal injections of DAMGO through OX1R. These data suggest that OIH can be potentially treated by activating the orexin A-OX1R pathway in the spinal dorsal horn.

• 임상간호연구
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• 제15권2호
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• pp.115-126
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• 2009

Purpose: The purpose of this study was to assess the frequency and characteristics of occupational blood and body fluid exposure for operating room personnel during surgical procedures and identify risk factors. Methods: A self-report questionnaire was used to survey 519 operating room personnel who participated in 132 surgeries in an acute care hospital in Seoul between April 12 and 20, 2006. Results: The response rate was 82% (530/646) and analyzed total 519 except for improper 11 questionnaires. Exposure rate was 45.5% (60/132) during operations and 20.4% (106/519) for operating room personnel. By job categories, the exposure rate was as follows; anesthesiologists and nurses 31.2% (44/141), operators and assistants 22.1% (32/145), circulating nurses 12.0% (11/92), scrub nurses 11.4% (14/123). The mucous membrane-eye exposure with a high risk of transmitting infection was 6.6% (7/106) and the most frequent route of exposure was blood and body fluid touching unprotected skin. In multivariate analysis, the risk factors of exposure were services, duration of operation, a patient who had a peripheral arterial catheter line, and job category. Conclusion: Educational programs and appropriate use of personal protective equipment are necessary to prevent operating room personnel from being exposed to blood and body fluid.

• Pediatric Infection and Vaccine
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• 제6권1호
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• pp.116-122
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• 1999

목 적 : 신생아 중환자에 대한 치료법이 급속도로 발전함에도 불구하고 신생아 감염은 여전히 큰 문제이다. 특히 정맥천자나 여러 침습적 처치가 많은 신생아 중환자에서 이를 통해 피부 상주균에 의한 패혈증이 증가하고 있다. 이는 시술상의 문제로 야기될 수 있지만 처치 전 소독제의 소독력에 문제가 있을 수 있다. 특히 병원에서 희석하여 사용하고 있는 알코올 솜은 공기중에 자주 노출되어 알코올 성분이 증발되기 쉬워 소독력에 문제가 있을 수 있다. 이에 포비돈 소독제가 알코올 소독제보다 소독력이 좋은 것이라는 가정하에 이 연구를 시행 하였다. 대상 및 방법 : 신생아 중환자실에 입원한 미숙아 및 신생아중 정맥 수액요법이 필요하였던 신생아들을 대상으로 정맥 천자가 주로 시행되는 부위의 피부에서 멸균된 면봉으로 멸균 생리 식염수를 묻혀 피부를 문질러 배양 검사를 시행하였고 피부가 마른 후 무작위로 알코올군은 병원에서 희석하여 만든 70% 알코올 솜으로 닦고 마른 후 같은 방법으로 피부를 닦아 배양검사를 하였고(20례), 포비돈군은 10% 포비돈(1% iodine) 솜으로 닦고 마른 후 70% 알코올 솜으로 다시 닦아 마른 후 피부 배양검사를 하였다(20례). 대조군은 생리 식염수 솜으로 닦은 후 배양검사를 하였다(10례). 결 과 : 소독 전 알코올 군과 포비돈군 각각 20례중 9례에서 균이 자랐고, 대조군은 10례중 8례에서 균이 검출되었다. 소독후 알코올 군은 3례, 포비돈군 2례, 대조군은 8례에서 균이 계속 자라 세군간에 유의한 차이가 있었다(p=0.0387). 포비돈군의 소독효과는 알코올군과 비슷하였고, 대조군보다는 높았지만(p=0.0156), 알코올군은 대조군과 비교하여 유의한 차이가 없었다. 결 론 : 포비돈 솜의 소독효과는 알코올 솜과 비슷하였지만, 생리식염수 솜보다는 높았다. 그러나 알코올 솜의 소독효과는 생리식염수 솜과 유의한 차이가 없었다. 병원에서 사용되는 알코올의 순도, 알코올 솜의 정도관리, 소독방법 등에 대한 재평가가 필요함을 시사한다.

• Clinical and Experimental Pediatrics
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• 제49권5호
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• pp.494-499
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• 2006

목 적: Acinetobacter baumannii는 숙주 저항력이 저하된 고위험군에서 주요 원내 감염균으로 잘 알려져 있으나 A. baumannii 이외의 Acinetobacter species의 경우 드물게 감염과 연관된 것으로 받아들여지는 등 임상적 중요성과 원내 감염원으로써의 역학에 대해 알려진 바가 적다. 저자들은 신생아 집중치료실에서 A. baumannii가 아닌 것으로 확인된 Acinetobacter species에 의해 집단 발생한 패혈증 11례를 경험하였기에 이에 대한 임상적, 역학적 특징을 알고자 본 연구를 실시하였다. 방 법: 2004년 2월 4일부터 24일까지 일신기독병원 신생아 집중치료실에서 감염되었던 환아의 혈액에서 Acinetobacter species가 배양된 11례를 대상으로 임상적 특징을 조사하였고, 집단 발생의 역학을 조사하기 위해 두 차례에 걸쳐 의료진 및 환경 검체에 대한 배양을 실시하였으며, 항생제 감수성 검사를 통해 환아에서 배양된 균주가 동일 균주인지를 알고자 하였다. 결 과: 임상 양상은 발열, 수유 부진, 복부 팽만, 설사, 혈변, 구토, 빈호흡, 무호흡 등 다양하였으나 다른 원인에 의한 감염증과 비슷하였다. 집중 치료를 요하는 중증 경과를 보인 경우가 없었고 항생제 치료에 즉각적인 반응을 보이며 회복되어 A. baumannii 감염증에서 흔히 보이는 중증의 임상 증상과 높은 사망률(11-57%)과 비교하여 경한 경과를 보였다. 도관 관련 균혈증 2례, 도관 관련 균혈증 의증 9례로 말초 정맥 도관이 중요 유발 인자로 고려되었다. 감염의 역학을 알고자 두 차례에 걸쳐 의료진의 손과 환경 검체에 대한 배양 검사를 실시하였으나 동일 균주를 분리하는데는 실패하였다. 결 론: 우리의 연구를 통해 A. baumannii 이외의 Acinetobacter species의 경우 상대적으로 비병원성으로 여겨졌으나 임상 증상이 동반되면서 환자에서 배양되면 감염의 원인균임을 알 수 있었다.