• Journal of Chest Surgery
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• 제30권12호
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• pp.1167-1174
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• 1997

저자들은 1991년부터 1996년까지 5년간 지연 흉골 폐쇄를 시행한 20명의 환자를 분석하고 추적 조사 하였다. 남녀비는 11:9였고 평균연령은 6.4개월(범위 7일-5년)이었다. 적응증으로는 개심술후 심근부종에 기인한장치한 불안정한 혈역학적 상태로 인한 것이 15례로 가장 많았고, 심폐기 이탈 불가로 심실 보조 장치를 경우에서가 3례, 폐동맥 밴딩술 후 저산소증으로 인한 것이 2례 등이었다. 흉골 봉합은 술후 평균 102시간(범위 4-213시간)에 이루어졌으며 시행 후 중심 정맥압의 유의한 상승이 관찰되었다. 종격 동염, 환부 감염 등은 없었으며 2례에서 패혈증이 관찰되었다. 5명이 사망하였고 생존환자 15명중 2명 이 술후 추적관찰 기간 중 사망하였다. 누적 생존률은 1년과 2년에서 각각 65.0%였다. 지연 흉골 봉합 은 혈역학적으로 불안정한 심장을 감압하는 좋은 방법이며 성공적인 결과를 얻기 위해서는 적응증에 대한 신중한 고려가 선행되어야 한다고 생각된다.

• 약학회지
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• 제32권2호
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• pp.101-111
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• 1988

$[^3H]$ Quinuclidinyl benzilate(QNB) binding assays were performed in the dog ventricular sarcolemma fraction enriched approx. 32-fold in sarcolemma compared to the starting homogenate to elucidate the effect of antihistaminics on cardiac muscarinic receptor. Chlorpheniramine(CHP) inhibited specific binding of $[^3H]$QNB and delayed the equilibrium binding. The rate constants at $37^{\circ}C$ for formation and dissociation of the QNB receptor complex were $0.38{\times}10^9\;M^{-1}$ and $1.6{\times}10^{-2}\;min^{-1}$, respectively. The mean value for the dissociation constant from the pairs of the rate constants was 43. 2 pM and this value was similar to the value(44.8pM) determined from Scatchard analysis. CHP decreased association rate constant, indicating increase in $K_D$ value. Decrease in affinity without affecting the binding site concentration$(B_{max})$ for $[^3H]$QNB binding by CHP was also demonstrated by Scatchard analysis. $K_i$ values for $H_i$-blockers that inhibited specific $[^3H]$QNB binding were $0.02{\sim}4.8{\mu}M$. Cimetidine with $K_i$ value of $230{\mu}M$, however, was ineffective in displacing $[^3H]$QNB binding at concentration of $50{\mu}M$. The Hill coefficient for $H_1$-blockers were about one. The results indicate that $H_1$-antihistaminics inhibit $[^3H]$ QNB binding by interaction with myocardiac muscarinic cholinergic receptor and anticholinergic side effects of these drugs are mainly due to this receptor blocking mechanism.

• Journal of Chest Surgery
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• 제29권11호
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• pp.1218-1222
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• 1996

근래에 와서 심장수술 기법 및 심근보호법의 현저한 향상에도 불구하고 심장수술 환자들의 약 0.1~0.8 % 에서는 여전히 심장수술후 약물 치료나 대동맥 풍선펌프 등의 전통적인 치료법에 반응하지 않는 급성 심부전증이 발생하고 있다. 이런 환자들에서는 보다 적극적인 순환보조법으로 심실보조를 시행할 필요가 있는데, 현재 이런 목적으로 원심성 펌프가 비용이 비교적 저렴하고 사용하기 편리하다는 점에서 세계적으로 가장 많이 사용되고 있다. 그러나 아직 국내에서는 이러한 심실보조장치로서의 원심성펌프의 사용에 관한 문헌 보고가 매우 드문 실정이다. 1992년 1월 부터 1996년 1월 까지 서울대학병원에서는 총 2986례의 개심술이 시행되었는데, 이들 환자 중 모두 10명에서 심장수술후 전통적인 치료법에 반응하지 않는 심부전증이 발생하여 Biomedicus 원심성 펌프를 이용한 심실보조를 시행하였다. 10명의 환자중 남자가 8명 여자는 2명이였으며 평균 연령은 50$\pm$20세였다(범위; 9세~77세). 환자들이 받은 수술로는 6명의 환자가 관상동맥우회수술을 받았으며 이중2명의 환자는 관상동맥우회수술과 함께 대동맥판막치환수술을 시행받았다. 그밖에 대동맥박리증 수술 2례, 그리고 폐색전제거술 및 심장이식수술이 각각 1례씩 있었다. 심실보조 형태로는 전체 환자 중 5명의 환자에서 좌심실 보조를 시행하였으며 1명에서 우심실보조 그리고 4명에서 양심실보조를 시행하였다. 심실보조 기간은 평균 76$\pm$51시간이였다(범위; 24시간~175 시간). 10명중 7명에서 심실보조 장치 이탈이 가능하였고 이중4명이 생존하여 퇴원하였다. 사망 환자들의 사망 원인으로는 진행성 심부전증 2례, 그리고 다장기 부전증, 심실세동, 비가역적 뇌손상, 기계적 문제가 각각 1례씩이였다. 사망환자와 생존 퇴원환자간의 심폐바이패스시간, 대동맥차단시간, 심실보조시간에서 통계학적인 차이는 없었다. 원심성 심실보조장치 삽입에 연관된 주된 합병증으로는 출혈(7), 급성 신부전증(6), 감염(3), 그리고 신경학적 합병증(2)등이 관찰되었다. 결론적으로 원심성 펌프는 단기 순환보조용으로 비교적 만족한 결과로 사용될 수 있었다.

• Acute and Critical Care
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• 제33권4호
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• pp.246-251
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• 2018

Background: Target temperature management (TTM) improves neurological outcomes for comatose survivors of out-of-hospital cardiac arrest. We compared the efficacy and safety of a gel pad cooling device (GP) and a water blanket (WB) during TTM. Methods: We performed a retrospective analysis in a single hospital, wherein we measured the time to target temperature ($<34^{\circ}C$) after initiation of cooling to evaluate the effectiveness of the cooling method. The temperature farthest from $33^{\circ}C$ was selected every hour during maintenance. Generalized estimation equation analysis was used to compare the absolute temperature differences from $33^{\circ}C$ during the maintenance period. If the selected temperature was not between $32^{\circ}C$ and $34^{\circ}C$, the hour was considered a deviation from the target. We compared the deviation rates during hypothermia maintenance to evaluate the safety of the different methods. Results: A GP was used for 23 patients among of 53 patients, and a WB was used for the remaining. There was no difference in baseline temperature at the start of cooling between the two patient groups (GP, $35.7^{\circ}C$ vs. WB, $35.6^{\circ}C$; P=0.741). The time to target temperature (134.2 minutes vs. 233.4 minutes, P=0.056) was shorter in the GP patient group. Deviation from maintenance temperature (2.0% vs. 23.7%, P<0.001) occurred significantly more frequently in the WB group. The mean absolute temperature difference from $33^{\circ}C$ during the maintenance period was $0.19^{\circ}C$ (95% confidence interval [CI], $0.17^{\circ}C$ to $0.21^{\circ}C$) in the GP group and $0.76^{\circ}C$ (95% CI, $0.71^{\circ}C$ to $0.80^{\circ}C$) in the WB group. GP significantly decreased this difference by $0.59^{\circ}C$ (95% CI, $0.44^{\circ}C$ to $0.75^{\circ}C$; P<0.001). Conclusions: The GP was superior to the WB for strict temperature control during TTM.

• Korean Journal of Radiology
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• 제22권11호
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• pp.1918-1928
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• 2021

Objective: With the recent development of various MRI-conditional cardiac implantable electronic devices (CIEDs), the accurate identification and characterization of CIEDs have become critical when performing MRI in patients with CIEDs. We aimed to develop and evaluate a deep learning-based algorithm (DLA) that performs the detection and characterization of parameters, including MRI safety, of CIEDs on chest radiograph (CR) in a single step and compare its performance with other related algorithms that were recently developed. Materials and Methods: We developed a DLA (X-ray CIED identification [XCID]) using 9912 CRs of 958 patients with 968 CIEDs comprising 26 model groups from 4 manufacturers obtained between 2014 and 2019 from one hospital. The performance of XCID was tested with an external dataset consisting of 2122 CRs obtained from a different hospital and compared with the performance of two other related algorithms recently reported, including PacemakerID (PID) and Pacemaker identification with neural networks (PPMnn). Results: The overall accuracies of XCID for the manufacturer classification, model group identification, and MRI safety characterization using the internal test dataset were 99.7% (992/995), 97.2% (967/995), and 98.9% (984/995), respectively. These were 95.8% (2033/2122), 85.4% (1813/2122), and 92.2% (1956/2122), respectively, with the external test dataset. In the comparative study, the accuracy for the manufacturer classification was 95.0% (152/160) for XCID and 91.3% for PPMnn (146/160), which was significantly higher than that for PID (80.0%,128/160; p < 0.001 for both). XCID demonstrated a higher accuracy (88.1%; 141/160) than PPMnn (80.0%; 128/160) in identifying model groups (p < 0.001). Conclusion: The remarkable and consistent performance of XCID suggests its applicability for detection, manufacturer and model identification, as well as MRI safety characterization of CIED on CRs. Further studies are warranted to guarantee the safe use of XCID in clinical practice.

• International Journal of Advanced Culture Technology
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• 제10권1호
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• pp.187-195
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• 2022

Since most of the first witnesses of cardiac arrest in clinical settings are nurses, the ability to perform CPR is important. The purpose of this study is to provide basic data for developing education that strengthens CPR performance in the future by examining inactive nurses' CPR knowledge, attitude, performance confidence, device discomfort, continued use intention, and educational achievement. The final subjects of this study were 88 inactive nurses residing in B city. The study period was from June 23, 2020 to December 24, 2020. The collected data were analyzed by descriptive statistics and Pearson correlation using SPSS WIN 24.0 program. After obtaining the subject's consent for the study, an inactive nurse who understood the purpose of the study and voluntarily consented to the study participated. To investigate the perception of experience, the subjects watched 360-degree virtual reality contents about CPR in the hospital using HMD. The data of this study were analyzed using SPSS WIN 22.0.program. As a result of this 360-degree study on CPR in the hospital, the average score for the inactive nurses on CPR knowledge was 12.70±3.43, the average score for performance confidence was 6.04±2.45, and the average score for attitude was 4.63±0.80. As a result of experience recognition of 360-degree virtual reality contents for CPR in hospitals, the average score for device discomfort was 4.01±0.94, the average score for continued use intention was 2.07±0.85, and the average score for educational achievement was 2.11±0.79. As a result of correlation analysis, educational achievement and continued use intention were significantly positively correlated (r=.77, p<.001). Based on the results of this study, in order to strengthen the CPR performance capability of inactive nurses in emergency situations, it is necessary to increase CPR knowledge and confidence in performing CPR, and to cultivate a positive attitude toward performing CPR. In addition, it is necessary to implement CPR simulation education based on patient cases by applying content that considers educational achievement and continuous use intention.

• Clinical and Experimental Pediatrics
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• 제49권9호
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• pp.917-929
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• 2006

Over the last several decades there has been a remarkable change in the therapeutic strategy of congenital heart disease. Development of new tools and devices, accumulations of experience, technical refinement have positively affected the outcome of interventional treatment. Many procedures including atrial septostomy, balloon valvuloplasty, balloon dilation of stenotic vessel with or without stent implantation, transcatheter occlusion of abnormal vascular structure, transcatheter closure of patent arterial duct and atrial septal defect, are now performed as routine interventional procedures in many institutes. In diverse conditions, transcatheter techniques also provide complementary and additive role in combination with surgery. Intraoperative stent implantation on stenotic vessels, perventricular device insertion, and hybrid stage 1 palliative procedure for hypoplastic left heart syndrome have been employed in high risk patients for cardiac surgery with encouraging results. Transcatheter closure of ventricular septal defect has been performed safely showing comparable result with surgery. Investigational procedures such as percutaneous valve insertion and valve repair are expected to replace the role of surgery in certain group of patients in the near future. Continuous evolvement in this field will contribute to reduce the risk and suffering from congenital heart disease, while surgery will be still remained as a gold standard for significant portion of congenital heart disease.

• Journal of Chest Surgery
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• 제46권6호
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• pp.391-401
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• 2013

Mechanical circulatory support (MCS) in the pediatric heart failure population has a limited history especially for infants, and neonates. It has been increasingly recognized that there is a rapidly expanding population of children diagnosed and living with heart failure. This expanding population has resulted in increasing numbers of children with medically resistant end-stage heart failure. The traditional therapy for these children has been heart transplantation. However, children with heart failure unlike adults do not have symptoms until they present with end-stage heart failure and therefore, cannot safely wait for transplantation. Many of these children were bridged to heart transplantation utilizing extracorporeal membranous oxygenation as a bridge to transplant which has yielded poor results. As such, industry, clinicians, and the government have refocused interest in developing increasing numbers of MCS options for children living with heart failure as a bridge to transplantation and as a chronic therapy. In this review, we discuss MCS options for short and long-term support that are currently available for infants and children with end-stage heart failure.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.594-598
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• 2019

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel's sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

• 대한의용생체공학회:의공학회지
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• 제38권4호
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• pp.211-217
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• 2017

During the emergency situation such as cardiac arrest, cardiopulmonary resuscitation(CPR) is the most important treatment to maintain patient's blood circulation. Since the quality of CPR can not be easily measured or evaluated by the eye, an assistive device with an accelerometer can help to assess the pressure depth of CPR. In this study, we propose a single frequency analysis method to reduce the error of the accelerometer by extracting only one frequency component from the Fourier transform process. To verify the effectiveness of the single frequency analysis, acceleration data at CPR conditions were measured at a sampling rate of 50 / sec using a wristband equipped with an acceleration sensor. Then, We compared the existing distance estimation method and the single frequency analysis method using the measured data. The amplitude value proportional to the compression depth was obtained by applying the single frequency analysis method.