• 대한핵의학회지
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• 제29권4호
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• pp.478-483
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• 1995

We compared the influences of reconstruction methods using $180^{\circ}$ or $360^{\circ}$ data upon contrasts and discriminating capability and diagnostic accuracy in $^{99m}Tc-MIBI$ stress/rest myocardial SPECT. We reviewed SPECT images reconstructed only with $180^{\circ}$ projection data or with $360^{\circ}$ data in 18 patients and in 11 normal subjects. To compare counts of surface structures and deep structures, we measured ape# posterior wall ratios in 11 normal subjects. To compare the contrasts of images, we measured apex/ventricle ratios. To compare contrasts between normal and diseased myocardial segments, we measured count ratios of defect and normal segments in 4 patients who had single coronary artery diseases. To compare diagnostic accuracy, we scored SPECT images made with $180^{\circ}$ and $360^{\circ}$ data segmentally. Sensitivity and specificity for the diagnosis of coronary artery disease and for the revelation of diseased arteries with both $180^{\circ}$ and $360^{\circ}$ SPECT images. If involved coronary arteries had more narrowing than 50% In coronary angiogram, we considered them as diseased arteries Apex/posterior wall ratios were not different significantly in normal subjects. Apex/ ventricle ratios in normal subjects were different significantly between $180^{\circ}$ and $360^{\circ}$ SPECT images. Defect/normal ratios were different significantly between $180^{\circ}$ and $360^{\circ}$ SPECT images in single vessel disease patients. The overall diagnostic accurracy was the same between $180^{\circ}$ and $360^{\circ}$ data collection. Sensitivity was 94% and specificity was 91% for both types of data collection in this sample population. Sensitivity and specificity of each coronary artery territory were not significantly different between the images made with $180^{\circ}$ and $360^{\circ}$ data. The images made with $180^{\circ}$ data had better contrast between ventricle and myocardium and between hypoperfused and normal myocardium, though no difference was found between the ratios of the myocardial counts of surface and deep structures. However, diagnostic sensitivities of diseased artery territories were not different significantly and so were overall diagnostic accuracy between both methods of making images with $180^{\circ}$ and $360^{\circ}$ data.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제12권2호
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• pp.256-262
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• 2001

연구 목적：측뇌실의 확장은 성인기의 정신분열병에서 잘 확립된 소견이지만, 조기에 발병한 정신증적 장애에서는 아직 논란이 있다. 본 연구에서는 자기공명영상을 이용한 후향적인 방법을 통하여 지금까지 비교적 연구가 많이 시행되지 않았던 조기발병한 정신분열병·양극성 장애 환아들을 대상으로 측뇌실의 구조적인 이상을 연구하여, 이러한 뇌의 구조적 이상이 병의 초기부터 시작되어 정상과는 다른 경과로 진행되는 것인가를 알아보고자 하였다 방 법：정신분열병과 양극성 장애의 DSM-III-R 진단 기준에 부합하는 14명의 환아(평균 연령 14.0세, 표준편차 2.1)와 26명의 두통 대조군에서 뇌자기공명 영상상을 후향적으로 모집하였다. 분석을 위하여 측뇌실이 가장 잘 보이는 축 영상(axial image)를 선택하였다. 뇌자기공명영상상은 평판형 스캐너로 읽어들여서 NIH IMAGE 프로그램을 통하여 분석하였다. 결 과：환자군에서는 측뇌실 크기, 측뇌실확장지수가 연령의 증가에 따라 함께 증가하는 상관관계를 나타내었으나, 대조군에서는 연령과 측뇌실 크기, 측뇌실확장지수 등이 유의한 상관관계를 보이지 않았다. 환자군에서는 정상군에서 보이는 좌우 측뇌실 비대칭성이 소실된 결과를 보였다. 그리고 통계적으로 유의한 정도는 아니었으나 환자군이 대조군에 비해 측뇌실과 측뇌실확장지수가 큰 경향을 보였다. 결 론：정신증적 환자에서의 뇌의 구조적 이상은 병의 비교적 초기 경과에서부터 시작되며, 정상과는 다소 다른 경과를 취하며 진행한다는 것을 시사하는 결과라 할 수 있다.

• 한국어류학회지
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• 제27권1호
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• pp.26-32
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• 2015

참붕어 심장의 조직학적 구조를 광학현미경을 이용하여 관찰하였다. 참붕어의 심장은 정맥동, 심방, 심실 및 동맥구가 연속적으로 배열되어 있었다. 정맥동은 조직학적으로 심내막, 심근층, 심외막층으로 구분되었고, 심방과 심실은 심내막, 심내막하층, 심외막하층 및 심외막으로 구분되었으며, 동맥구는 심내막, 심내막하층, 중간층, 심외막하층 및 심외막으로 구분되었다. 정맥동과 심방, 심방과 심실 및 심실과 동맥구 사이에는 판막이 존재하였다. 정맥동은 대부분 아교질로 구성된 외벽을 가지고 있었으며 정맥동과 심방의 연결부위에는 고리 모양의 조직이 분포하였다. 심방은 얇은 심근층에 의해서 형성된 비연속적인 테두리가 소주들에 의해 형성된 해면성 심근을 둘러싸고 있었고, 심외막하층과 소주에는 아교질이 분포하였다. 심실의 심근층은 해면성 심근으로 이루어져 있고, 심외막하층에는 혈관이 분포하였으며, 심실의 심외막하층과 소주에는 아교질이 분포하였다. 동맥구에서 심내막하층에 의해 형성된 이랑은 직경과 길이가 매우 다양했고, 심내막 세포는 볼록한 모양이었으며, 심내막하층의 세포들은 불규칙한 모양이었으나 무리를 지어 분포하지는 않았다. 중간층의 세포들은 배열방향이 다르게 불규칙한 층을 이루었고, 심외막하층에서는 서로 다른 모양의 세포들이 관찰되었다. 동맥구의 심내막하층, 중간층 및 심외막하층에는 아교질과 탄력소가 풍부하였고, 심외막은 한 층의 편평한 세포들로 이루어져 있었다.

• 대한약리학회지
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• 제30권1호
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• pp.49-57
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• 1994

Oxomemazine이 muscarinic receptor subtypes에 대하여 선택성을 가지는지에 관한 지견을 얻고자, 대뇌, 심실 및 회장 muscarinic receptor에 대한 oxomemazine의 결합성질을 조사, 비교하였다. $[^3H]QNB$ 포화결합실험 결과 세 조직의 muscarinic receptor는 $[^3H]QNB$에 대해서는 affinity가 약 60pM인 단일 receptor인 것으로 추정되었다. 대뇌에서 pirenzepine과 oxomemazine의 $[^3H]QNB$ 결합억제에 대한 Hill coefficient는 각각 0.67 및 0.8로서 대뇌에는 이들 약물에 대하여 affinity가 서로 다른 두 종류의 muscarinic receptor subtypes가 존재하는 것으로 나타났으며, pirenzepine에 대한 high $affinity(M_1)$와 $low affinity(M_2)$ receptor 및 oxomemazine에 대한 high $affinity(O_H)$와 $low\;affinity (O_L)$ receptor의 분포비는 약 60:40 및 40:60이었고, $M_1$과 $M_2$ receptor에 대한 pirenzepine의 $K_i$치는 16nM 및 431 nM, $O_H$와 $O_L$, receptor에 대한 oxomemazine 의 $K_i$치는 80nM 및 1350nM이었다. 그러나 심실과 회장에서 이들 약물의 $[^3H]QNB$ 결합억제에 대한 Hill coefficient는 1에 가까웠다. 심실과 회장 muscarinic receptor에 대한 pirenzepine의 $K_i$치는 850nM 및 250nM, oxomemazine의 $K_i$치는 1460nM 및 670nM로서 대피에서 이들 약물의 low affinity receptor에 대한 $K_i$치에 가까웠다. 즉, muscarinic receptor에 대한 affinity면에서 oxomemazine은 pirenzepine과 같이 대뇌에서 가장 높았으며, 회장에 대해서는 중등도였고, 심실에서 가장 낮았다. 이로 보아 oxomemazine은 $M_1\;receptor$에 선택성이 있는 것으로 추정된다.

• Journal of Chest Surgery
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• 제42권5호
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• pp.597-603
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• 2009

배경: 기능적 단심 실에서 방실판막 폐쇄부전은 폰탄수술 후 사망과 그 만기성적의 중요한 위험인자로 알려져 있다. 단심실의 공통방실판 페쇄부전에 대한 이분성형술(bivavaltion valvuloplasty)의 중단기 성적을 조사하였다. 대상 및 방법: 1999년부터 2007년까지 판막 이분성형술을 시행한 기능적 단심실 환자 11명을 대상으로 하였다. 공통방실판 역류의 정도는 color Doppler 심초음파로 결정하였다 (경미(trivial); 1, 경도(mild); 2, 중등도(moderate); 3, 고도(severe); 4). 판막 수술 당시 평균 나이는 생후 $6.9{\pm}7.0$개월(중간 값 4개월, 범위 24일$\sim$21개월)이었고 평균 체중은 $6.2{\pm}2.8\;kg$ (범위: $3.1{\sim}11.3\;kg$)이었다. 9명의 환자가 심방이형증(atrial isomerism)을 갖고 있었으며 이 중 두 명은 총폐정맥연결 이상을 동반하였다. 1예를 제외한 모든 예에서 동시에 다른 수술이 함께 시행되었다. 판막 이분성형술 이외에 같이 시행된 판막 술식은 3예에서 교련봉합술, 또 다른 3예에서 교련부 판륜성형술을 시행하였다. 결과: 병원사망이 1예 있었는데 술 전 인공호흡이 필요하였던 생후 32일된 환아로, 폐동맥교약술과 함께 판막 이분성형술을 시행한 후 4.3개월에 기도와 폐 질환으로 사망하였다. 평균 추적기간은 40개월(범위: $4.3{\sim}114$개월)이었다. 평균 수술 전 공통방실판 역류는 $3.3{\pm}0.6$이었고 이는 수슬 후 $1.9{\pm}0.7$로 개선되었다(p<0.0001). 이 잔존 역류는 평균 14.3개월 후 $2.2{\pm}0.4$로 조금 증가하였으나 통계학적 유의성은 없었다. 6명(60%)의 환아에서 잔존 역류로 인해 양방성 상공정맥-폐동맥 단락술이나 폰탄수술 시에 판막에 대한 재수술이 필요하였다. 1예는 우측 방실판막에 엡스타인기형 형태를 갖고 있었던 환아로 방실판 협착 및 역류로 인해 판막치 환술을 시행하였다. 다른 1명의 환아는 우측 방실판막에 가장자리 봉합술(edge-to-edge technique)을 시행하였으며 나머지 4명의 환아에게는 전후 브리징판엽(bridging leaflet)사이에 봉합을 추가하였다. 모든 환자에서 마지막 추적 초음파에서 경미 혹은 경도의 역류를 보였다. 결론: 기능적 단심실의 공통판막 역류에서 판막 이분성형 술은 효과적이고 안전한 술식이다. 그러나 많은 환자에서 잔존 역류를 가지고 있었으며 반수 이상의 환자에서 다음 단계의 수술에서 판막의 재수술이 필요하다 공통판 역류의 진행에 대한 장기적 추적조사가 꼭 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제28권6호
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• pp.565-570
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• 1995

Seventy-three patients with isolated total anomalous pulmonary venous connection the patients associated with other major cardiac anomalies such as single ventricle, DORV[Double Outlet Right Ventricle and large VSD[Ventricular Septal Defect were excluded were underwent surgical repair from January 1980 through October 1993. There were 45 boys and 28 girls. The mean age at operation was 19.9 months[range 6 days to 24 years and mean body weight was 7.1kg[range 2.6kg to 45kg . The anomalous locations of connection were supracardiac in 38, cardiac in 21, infracardiac in 5, and mixed in 9. In 38 patients[52% , the venous drainage was obstructed. The obstruction ratios according to the connection type were as follows: 53%[28/38 in supracardiac, 52%[11/21 in cardiac, 100%[5/5 in infracardiac, 22%[2/9 in mixed type. The associated cardiac anomalies were persistent left SVC[2 , tricuspid valve regurgitation[3 , cor triatriatum[1 , and mitral cleft[1 . And associated noncardiac anomalies were imperforate anus[1 and Neil Weightman syndrome[1 . The operative mortality was 23%. The causes of death were pulmonary hypertensive crisis, perioperative myocardial failure, pneumonia with sepsis, arrhythmia and etc. The statistically significant factors in postoperative mortality were the pulmonary venous obstruction and age [p<0.01 . The operative mortality was high in groups of age under 1 month and pulmonary venous obstruction. The mean follow-up was 27.1 months. There were two late deaths. The first patient was three months old boy with supracardiac type and severe obstructive symptoms. The postoperative echocardiography was showed anastomotic stenosis and reoperations were performed twice but the patients expired due to pneumonia and sepsis. The second patient was three month old boy with supracardiac type and total correction was done and was doing well postoperatively. Eight years later, he expired suddenly due to arrhythmia. But all the other patients were in NYHA Fc I and received no medications. The 5-year survival rate excluding early expired patients is 97.1 $\pm$ 0.03 %. In conclusion, although the operative mortality of total anomalous pulmonary venous connection was relatively high compared to other major cardiac anomalies, we could expect excellent long-term results by early surgical correction.

• Journal of Chest Surgery
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• 제49권2호
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• pp.107-111
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• 2016

Hypoplastic left heart complex (HLHC) consists of less severe underdevelopment of the left ventricle without intrinsic left valvular stenosis, i.e., a subset of hypoplastic left heart syndrome (HLHS). HLHC patients may be able to undergo biventricular repair, while HLHS requires single ventricle palliation (or transplant). However, there is no consensus regarding the likelihood of favorable outcomes in neonates with HLHC selected to undergo this surgical approach. This case report describes a neonate with HLHC, co-arctation of the aorta (CoA), and patent ductus arteriosus (PDA) who was initially palliated using bilateral pulmonary artery banding due to unstable ductus-dependent circulation. A postoperative echocardiogram showed newly appearing CoA and progressively narrowing PDA, which resulted in the need for biventricular repair 21 days following the palliation surgery. The patient was discharged on postoperative day 13 without complications and is doing clinically well seven months after surgery.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.166-172
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• 2017

Purpose: Thoracic traumas represent 10-15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI. Methods: This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed. Results: The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4). Conclusions: This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

• 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.

• Biomolecules & Therapeutics
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• 제3권3호
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• pp.192-198
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• 1995

The affinity of mequitazine, a non-sedating antihistamine, for muscarinic receptors was evaluated in the guinea-pig ventricle and ileum by in vitro binding techniques and functional studies. In binding studies, [$^3$H]quinuclidinyl benzilate (QNB) identified a single class of muscarinic receptors with similar apparent $K_{D}$ value of about 100 pM in two tissues. Mequitazine inhibited [$^3$H]QNB binding to muscarinic receptors competitively. Analysis of the mequitazine inhibition curve of [$^3$H]QNB binding to ventricular microsome and ileal homogenate indicated the presence of a single homogeneous binding site with Ki value of 25 nM and 18 nM, respectively. In functional studies, mequitazine caused parallel rightward shifts of concentration-response curves for carbachol and histamine in the isolated guinea-pig ileum. The slope values obtained from Schild plot analysis for the antagonistic action of mequitazine on muscarinic and histamine $H_1$-receptors were not significantly different from unity. The p $A_2$values of mequitazine for muscarinic and histamine $H_1$-receptors were about 7.6 ( $K_{M}$= 25.1 nM) and 8.88 ( $K_{H}$= 1.32 nM), respectively. These results indicate that the muscarinic receptor blocking action of mequitazine is 15 times less potent than the $H_1$receptor blocking action, but high concentration of this drug may cause the peripheral muscarinic receptor blocking effect.t.t.t.