• 대한간호학회지
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• 제30권3호
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• pp.549-559
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• 2000

The purpose of this study was to investigate the correlation between the knowledge and educational needs related to recurrent in coronary artery bypass graft patients as a basis to provide an individual nursing education for the population. The subjects consisted of 110 patients who had coronary artery bypass graft(CABG) at Asan Medical Center in Seoul and Sechong hospital in Buchon. Data was obtained from a knowledge questionnaire and a learning needs questionnaire between November 1998 and February 1999. Data were analyzed using SAS program for Wilcoxon rank sum test and Spearman correlation coefficient. The results were as follows : 1. With regard to the 18 items to measure knowledge, the mean (median) of items 'don't know' was 4.9(4) items. The mean (median) of items answered wrong was 3.2(3) items. The number of items answered 'don't know' tend to show higher in those who had less education, blue color jobs and myocardiac infarction history than in their counter parts. There were higher frequency of items answered 'don't know' in those who had no hypertension 2. With regard to the level of knowledge by questionnaire about CABG, The most "I dont know" (59.1%) highly response was 'He has to be treated with anticoagulant drug to prevent revasculized vessel from obstructing.' The seond highest response (56.4%) was 'If you were hypotensive, the coronary attack would collapse. 'During the hospitalized day, the patient has complete bedrest.' The highest error probability was cholesterol has not to intake.', 'After surgery, the sexual life is need controlled for 1 year. 3. The mean of educational needs was 3.38. With regard to the level of learning needs by sentence about CABG, 'Food that benefit heart disease', 'Recurrence possibility of heart disease', 'Management method of operation site', 'Risk symptom that visit hospital or report immediately' were higher than other sentenses. With regard to the level of learning needs by factor 'food(5 items)', 'disease(9 items)' and 'exercise(3 items)' showed the highest than other factors. The educational needs by patients characteristics tend to show higher in males, under the age of 49, middle or high school degree, previous experience of admission with coronary artery disease, history of myocardial infarction, expierience of PTCA, history of cerebro-vascular accident, previous expierience of smoking than in their counter parts. 4. The number of items answered 'don't know', wrong and correct weren't correlated with the level educational needs. As the results, the number of items answered 'don't know' tend to show higher in those who had less educated, blue color jobs and myocardiac infarction history than in their counter parts. There were higher frequency of items answered 'don't know' in those who had no hypertension .There were higher frequency of items answered 'don't know' on anti-thrombolitic theraphy, hypotension and pain relief. Also there were higher frequency of items answered wrong on bed rest period, cholesterol intake, and sexual life. Educational needs were higher in young age group, had previous experience of procesure and history of other disease. And when we educate CABG patients, education for diet, recurrence possibility of disease, management methods of operation site and risk symptom should be emphasized.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Journal of Chest Surgery
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• 제35권5호
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• pp.369-374
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• 2002

배경: 혈액 투석을 위한 투석로의 확보는 신부전증 환자의 치료에 필수적인 요소이지만, 여러 요소에 의해 투석로의 확보가 점점 어려워지고 있어서 인조 혈관의 사용 빈도가 증가하고 있는 추세이다. 저자들은 동정맥루 조성술을 시행받은 환자를 대상으로 자가 혈관 및 인조 혈관의 개통률의 차이와 인조 혈관의 종류에 따른 개통률의 차이, 동반 질환이 동정맥루 개존에 미치는 영향 및 이와 연관하여 재수술이 필요했던 경우 등을 분석하고자 하였다. 대상 및 방법: 1996년 1월부터 2000년 12월가지 고려대학교 구로병원 흥부외과에서 혈액투석을 위해 동정맥루 조성술을 시행한 186명의 환자를 대상으로 후향적으로 분석하였다. 대상 환자의 남녀 비는 99 : 87로 남자가 다소 많았고, 평균 연령은 54.37$\pm$12.89세이었으며, 대상 환자에서 시행한 전체 수술은 292건, 이 중 자가 혈관과 인조 혈관을 이용한 동정맥루 조성술이 각각 156과 116건이었다. 결과: 동정맥루의 1년 및 5년 개통률은 자가 혈관의 경우 각각 92.78$\pm$2.35%, 39.03$\pm$9.08%이었고, 인조 혈관의 경우는 각각 96.09$\pm$2.22%, 16.45$\pm$10.15%이었으나 두 군 사이의 통계적 유의성은 없었다. 신부전증과 동반된 질환 중 가장 많은 빈도를 보인 고혈압과 당뇨, 그리고 두 가지를 모두 가지고 있던 환자의 동정맥루 평균 개통 기간은 각각 52.99$\pm$2.05개월, 52.70$\pm$4.24개월, 53.49$\pm$2.33개월로 이러한 질환을 가지지 않는 환자의 평균개통 기간인 48.12$\pm$2.05개월과 비교해 각 군 사이의 통계적 유의성은 없었고, 수술에 사용된 여러 종류의 인조 혈관들의 1년 및 3년 개통률 사이의 비교에서도 서로 간의 통계적 유의성은 없었다. 수술 후 합병증 및 재수술이 필요했던 이유는 주로 혈전이나 혈류 감소, 동맥류 형성 및 인조 혈관 감염 등이었고, 재수술이나 3차 수술 후의 개통률도 첫수술과 비교하여 통계적 유의성은 없었다. 절론 자가 혈관에 비해 인조 혈관을 이용한 동정맥루의 개통률도 우수하였으나, 사용된 인조 철관의 종류에 따른 개통률의 차이를 비교하기 위해서는 인조 혈관에 따른 더 많은 증례가 축적되어야 할 것이다. 한편 동반 질환은 동정맥루 개통률에 영향을 미치지 않았다.

• Journal of Chest Surgery
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• 제40권3호
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• pp.180-192
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• 2007

배경: 최근 이종 심장 이식에서 이종항원 및 항체로 인한 초급성 또는 급성 거부반응이 중 또는 대구경의 혈관이나 판막에서는 일어나지 않는다는 보고들이 있다. 이는 이런 부위에서 이종 항원의 발현이 다른 부위보다 낮고 내피세포에 미치는 전단력이 크기 때문인 것으로 알려져 있다. 본 연구에서는 이들 보고를 바탕으로 돼지-염소 모델에서 중 또는 대구경의 혈관에 해당하는 경동맥을 이용한 이종 동맥 이식을 시행하고 정해진 기간 경과 후 이식편을 적출하여 이종 이식 혈관의 생체 내 중, 장기 개통성 및 조직병리학적 변화 양상을 관찰하여 이종 혈관 이식의 생체 내 장기 적합성을 알아보고자 하였다. 대상 및 방법: 10쌍의 돼지-염소 조합을 실험군으로 하여 1주, 1개월, 3개월, 6개월 및 12개월의 정해진 기간으로 나누어 각 기간마다 2마리의 돼지에서 양측 경동맥을 채취하여 얻은 4개의 경동맥편을 다른 처리를 하지 않고 $-70^{\circ}C$에서 보존한 후 2마리의 염소의 양측 경동맥에 각각 이식하였다. 보존 기간은 2일에서 7일로 대부분 7일 이내에 동물 실험을 시행하였다. 이식 후 주기적인 도플러 초음파 검사로 개통성을 평가하였고, 정해진 기간이 경과한 후에 염소에서 이식된 혈관 도관을 적출하여 관찰한 후 hematoxylin-eosin과 Masson's trichrome 염색을 시행하였다. 또한 T 임파구 표식자와 von Willebrand factor에 대한 면역화학염색을 시행하였다. 결과: 실험군 중 1주와 1년으로 정해진 2마리의 염소가 실험 과정과는 무관한 이유로 사망하였고, 나머지 8마리가 실험 종료시점까지 생존하였다. 생존한 8마리의 염소 가운데 3개월로 지정된 염소에서 일측 경동맥의 폐색이 발견되었으나 나머지 염소에서는 혈관의 개통성이 잘 유지되었으며, 동맥류를 형성한 이식편은 없었다. 정해진 기간 별로 적출하여 관찰하였을 때 혈관 문합부위는 잘 보존되어 있었고, 석회화는 관찰되지 않았다. 조직학적 검사에서 이식편의 혈관 내피세포는 이식 1주 후에는 소실되어 있었고, 1개월째에는 수용체인 염소의 내피세포로 재세포화 되는 양상을 보였다. 중막 및 외막에도 염증반응과 함께 수여자의 섬유아세포 및 근섬유아세포가 침윤되는 양상을 보였다. 재내피세포화 과정은 양측 문합 부위에서 시작하여 이식된 혈관의 중간 부위로 진행되는 양상이었으며, vWF에 대한 면역조직화학 염색을 통해 이식 후 1개월에 이식편의 전체에 걸쳐 재내피세포화가 이루어졌음을 관찰할 수 있었다. 신생 내막의 비후와 외막의 염증반응이 이식 후 3개월까지 심하였으나 그 이후에는 감소된 양상을 보였다. 이식 편에서 T 임파구 표식자인 CD3 양성인 세포들의 비율은 매우 낮았다. 결론: 신선 동결된 이종 동맥은 조직학적으로 이종 면역 반응에 큰 영향을 받지 않고 생체 내에서 장기 개통성을 유지하였다.

• 대한두경부종양학회지
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• 제7권2호
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• pp.120-128
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• 1991

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

• 한국임상수의학회지
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• 제26권5호
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• pp.441-444
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• 2009

허혈/재관류 손상은 장기이식 분야에서 해결해야 할 주요 문제점으로 알려져 있다. 본 연구에서는 대퇴 동,정맥 부위에서 기존의 혈관 문합법 대신 맥관 connector를 이용하여 간단하면서 효과적인 체외 재관류 모델을 개발하였기에 소개하고자 한다. 개발된 모델이 허혈/재관류 손상연구에 효과적인지 알아보기 위해 혈액 동력학적 평가와 신장의 재관류 후 손상 양상을 분석하였다. 기존의 재관류 모델에서 사용되는 문합 부위인 복강 대동맥의 혈압과 본 연구에서 재관류 부위로 활용된 대퇴동맥의 혈압은 유의적 차이가 없었다. 허혈 손상 후 재관류 효과를 알아보기 위해 미니돼지에서 적출한 신장을 HTK 용액에 24, 48시간 동안 각각 저온보관 후 대퇴부에 이식하여 재관류 한 결과, 신장의 재관류까지 수술시간은 평균 $7.0{\pm}1.1$분 소요되었으며, 3시간 재관류 후 재관류 손상 정도는 저온보관시간에 따라 증가되는 것이 확인되었다. 이는 개발된 모델이 맥관 문합 없이 간단한 관류방법이면서도 기존의 복잡한 수술에 의한 재관류 방법과 유사한 손상 모델을 만들 수 있는 효과적인 허혈/재관류 동물모델이라는 것을 의미한다. 따라서 본 연구에서 개발한 신장 재관류 모델은 초기 허혈/재관류 손상 연구와 장기이식에서 이식면역연구에 효과적인 모델이라 사료된다.

• Journal of Chest Surgery
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• 제46권6호
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• pp.413-425
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• 2013

Background: Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine. Methods: Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats. Results: The anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group. Conclusion: NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent.

• Bulletin of the Korean Chemical Society
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• 제34권6호
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• pp.1663-1667
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• 2013

Neointimal hyperplasia causes vascular access dysfunction in hemodialysis patients with synthetic arteriovenous (AV) grafts. Several studies have reported that paclitaxel- or sirolimus-eluting AV grafts inhibit neointimal hyperplasia and display lower rates of stenosis compared with control grafts. However, there have been few comparative studies of the efficacy of paclitaxel- and sirolimus-eluting grafts. We compared the neointimal hyperplasia of paclitaxel- and sirolimus-eluting grafts. AV grafts were implanted laterally between the common carotid artery and the external jugular vein in 12 female Landrace pigs. The animals were sacrificed six weeks after surgery. The neointimal hyperplasia at the anastomosis sites of the grafts was quantified using the ratio of the intragraft hyperplasia to the graft area (H/G ratio) at the graft-vessel interface. The area of intimal hyperplasia at the venous (paclitaxel 1.06 [0.72-1.56] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) and arterial anastomosis sites (paclitaxel 0.93 [0.57-1.48] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) was significantly different between the two groups. However, the H/G ratios for the venous anastomosis site (paclitaxel 0.25 (0.17-0.38) vs sirolimus 0.38 (0.2-0.66), P = 0.4) and the arterial anastomosis site (paclitaxel 0.19 (0.08-0.39) vs sirolimus 0.41 (0.34-0.50), P = 0.1) did not differ significantly between the groups. In conclusion, there was no significant difference in the inhibition of neointimal hyperplasia by sirolimus- and paclitaxel-eluting AV grafts.

• Biomaterials and Biomechanics in Bioengineering
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• 제1권1호
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• pp.27-39
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• 2014

We have previously described a new multilayer alginate microcapsule system, and the goals of the present study were to assess the in vitro function of islets encapsulated in its inner layer, and the angiogenic ability of FGF-1 delivered from the external layer in an omentum pouch. Following isolation and culture, islets were encapsulated in the inner core of microspheres ($500-600{\mu}m$ in diameter) with a semi-permeable poly-L-ornithine (PLO) membrane separating two alginate layers, and both unencapsulated and encapsulated islet function was assessed by a dynamic glucose perifusion. For angiogenesis experiments, one group of microcapsules without FGF-1 (control) and another (test) containing FGF-1 with heparin encapsulated in the external layer were made. One hundred microcapsules of each group were transplanted in Lewis rats (n = 5/group) and were retrieved after 14 days for assessment of angiogenesis. Glucose perifusion of unencapsulated and encapsulated islets resulted in similar stimulation indices. The release of FGF-1 resulted in increased vascular density compared to controls. In conclusion, islets encapsulated in the core of multilayer alginate microcapsules maintain functionality and the microcapsule's external layer is effective in delivery of FGF-1 to enhance graft neovascularization in a retrievable omentum pouch.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.467-473
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• 2009

Purpose: The aim of this study is to compare volume and revascularization of autogenous block bone grafts in simultaneously cortical perforation of recipient beds and grafts, and only cortical perforation of recipient beds. Materials and methods: Two block bone in 8mm diameter was harvested in both skull using trephine bur on 20 New Zealand white rabbits. Harvested block bone was grafted on both inferior border of mandible. On the left side(experimental side), cortical bone of recipient beds and graft were perforated, and on the right side(control side), the only recipient bed was perforated. The rabbits had been sacrificed and infused the India ink for the observation of revascularization at 20 day and 40 day after surgery. The specimens were processed for H-E staining and quantitative analysis(independent t-test, p<0.01) was made under an optical microscope. In additional, specimens were processed for the observation of revascularization. Results: After 20 days, more bone volume was observed in experimental group, but no significant difference between two groups(p=0.106). There were significantly more bone volume in the experimental group at 40 days after surgery(p<0.01). After 20 days, more discrete vascular sprouts were observed in experimental side, but no difference at 40 days after surgery. Conclusion: We conclude that the cortical perforation of both the recipient beds and grafts improve revascularization at early stage and overall graft persistence.