• Journal of Chest Surgery
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• v.34 no.6
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• pp.465-471
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• 2001

Background: Hypothermia protects the brain by suppressing the cerebral metabolism and it is performed well enough before the total circulatory arrest(TCA) in the operation of aortic disease. Generally, TCA has been performed depending on the rectal or nasopharyngeal temperatures; however, there is no definite range of optimal temperature for TCA or an objective indicator determining the temperature for safe TCA. In this study, we tried to determine the optimal range of temperature for safe hypothermic circulatory arrest by using the intraoperative electroencephalogram(EEG), and studied the role of EEG as an indicator of optimal hypothermia. Material and Method: Between March, 1999 and August 31, 2000, 27 patients underwent graft replacement of the part of thoracic aorta using hypothermia and TCA with intraoperative EEG. The rectal and nasopharyngeal temperatures were monitored continuously from the time of anesthetic induction and the EEG was recorded with a ten-channel portable electroencephalography from the time of anesthetic induction to electrocerebral silence(ECS). Result: On ECS, the rectal and nasopharyngeal temperatures were not consistent but variable(rectal 11$^{\circ}C$ -$25^{\circ}C$, nasopharynx 7.7$^{\circ}C$ -23$^{\circ}C$). The correlation between two temperatures was not significant(p=0.171). The cooling time from the start of cardiopulmonary bypass to ECS was also variable(25-127min), but correlated with the body surface area(p=0.027). Conclusion: We have found that ECS appeared at various body temperatures, and thus, the use of rectal or nasopharyngeal temperature were not useful in identifying ECS. Conclusively, we can not fully assure cerebral protection during hypothermic circulatory arrest in regards to the body temperatures, and therefore, the intraoperative EEG is one of the necessary methods for determining the range of optimal hypothermia for safe circulatory arrest. :

• Journal of Chest Surgery
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• v.30 no.6
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• pp.585-590
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• 1997

Between December 1994 and October 1996, 57 premature infants with evidence of a hemodynamically significant PDA associated with cardiopulmonary compromise underwent indomethcin therapy(Group I, n=48) or surgical ligation(Group II, n=9) because of indomethacin failure. The gestational alee(29.6$\pm$ 3.1weeks vs. 28.1 $\pm$ 1.6weeks) and birth weight(1,413 $\pm$ 580gm, ,098 $\pm$ 235gm) showed no significant differences between the two groups. Medical management included fluid restriction, diuretics, and indomethacin therapy(one or two cycles). Surgical libation was done at the neonatal intensive care unit(NICU) without moving the patient to the operation room. There was no complication associated with the operation. There were 9 deaths in Group I(19%, 9/48) and 2 deaths in Group II(22% , 219). The main causes of deaths were persistent bronchopulmonary dysplasia with sepsis(n=8) and intrapulmonary hemorrhage(n=3). The rate of medical treatment failure including death and complication in premature infants whose body weights were less than 1500gm was higher(41%, 15/38) than in premature infants whose body weights were more than 1500gm(16%, 3/19). Early surgical ligation of PDA may be applicable in the premature infant with a large size, low birth weight(<1500 gm), or associated intracardiac anomalies. Perfoming the operation in the NICU may be safe in s ead of moving the patient to the operating room.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.25-32
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• 2015

Background: We evaluated operative outcomes after third or more cardiac operations for valvular heart disease, and analyzed whether pericardial coverage with artificial membrane is helpful for subsequent reoperation. Methods: From 2000 to 2012, 149 patients (male : female=70 : 79; mean age at operation, $57.0{\pm}11.3$ years) underwent their third to fifth operations for valvular heart disease. Early results were compared between patients who underwent their third operation (n=114) and those who underwent fourth or fifth operation (n=35). Outcomes were also compared between 71 patients who had their pericardium open during the previous operation and 27 patients who had artificial membrane coverage. Results: Intraoperative adverse events occurred in 22 patients (14.8%). Right atrium (n=6) and innominate vein (n=5) were most frequently injured. In-hospital mortality rate was 9.4%. Total cardiopulmonary bypass time ($225{\pm}77$ minutes vs. $287{\pm}134$ minutes, p=0.012) and the time required to prepare aortic cross clamp ($209{\pm}57$ minutes vs. $259{\pm}68$ minutes, p<0.001) increased as reoperations were repeated. However, intraoperative event rate (13.2% vs. 20.0%), in-hospital mortality (9.6% vs. 8.6%) and postoperative complications were not statistically different according to the number of previous operations. Pericardial closure using artificial membrane at previous operation was not beneficial in reducing intraoperative events (25.9% vs. 18.3%) and shortening operation time preparing aortic cross clamp ($248{\pm}64$ minutes vs. $225{\pm}59$ minutes) as compared to no-closure. Conclusion: Clinical outcomes of the third or more operations for valvular heart disease were acceptable in terms of intraoperative adverse events and in-hospital mortality rates. There were no differences in the incidence of intraoperative adverse events, early mortality and postoperative complications between third cardiac operation and fourth or more.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.1-7
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• 2007

Backgound: It has been shown that the endothelium of cardiac valves and adjacent great vessels have a reduced immune reaction compared to other vessels. We investigated the clinical feasibility of using immunologically untreated xenogenic valves, in a pig-to-goat pulmonary valve conduit implantation model. Material and Method: Porcine pulmonary valve conduits were prepared without specific immunologic treatment and implanted into the right ventricular outflow tract of goats while undergoing cardiopulmonary bypass. Two goats each were assigned to the following observation time intervals: one day, one week, three months, six months and twelve months. Echo-cardiographic examinations were performed prior to sacrifice of the goat to evaluate pulmonary valve function. After the xenograft specimens were retrieved, histological changes were evaluated microscopically. Result: Ten of the twelve animals survived the predetermined observation time intervals. Aneurysmal dilatations, of the anterior wall of the implanted pulmonary artery, were observed at each of three and twelve month-survival animals. A variable degree of pulmonary valve regurgitation was observed on echocardiography. However, valve stenosis, thrombotic occlusion and vegetation were not seen. Microscopically, the nuclei of the donor tissue disappeared as a result of pyknosis and karyolysis; however the three components of the implanted xenografts (the pulmonary artery, the valve and the infundibulum) were gradually replaced by host cells over time, while maintaining their structural integrity. Conclusion: Immunologically untreated xenogenic pulmonary valve conduits were replaced by host cells with few observed clinical problems in a pig to goat pulmonary valve implantation model. Therefore, they might be an alternative bioprosthesis option.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.295-300
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• 2012

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.179-187
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• 2015

For patients who are near the end of life, an inevitable step is discussion of a do-not-resuscitate (DNR) order, which involves patients, their family members and physicians. To discuss DNR orders, patients and family members should know the meaning of the order and cardiopulmonary resuscitation (CPR) which includes chest compression, defibrillation, medication to restart the heart, artificial ventilation, and tube insertion in the respiratory tract. And the following issues should be considered as well: patients' and their families' autonomy, futility of treatment, and the right for death with dignity. Terminal cancer patients should be informed of what futility of treatment is, such as a low survival rate of CPR, unacceptable quality of life after CPR, and an irremediable disease status. In Korea, two different law suits related to life supporting treatments had been filed, which in turn raised public interest in death with dignity. Since the 1980s, knowledge of and attitude toward DNR among physicians and the public have been improved. However, most patients are still alienated from the decision making process, and the decision is often made less than a week before death. Thus, the DNR discussion process should be improved. Early palliative care should be adopted more widely.

• The Korean Journal of Emergency Medical Services
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• v.1 no.1
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• pp.28-41
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• 1997

The purpose of this study was to identify the change of perceptions related to E.M.T. profession of E.M.T. student and to provide the basic data for development of curriculum. The subjects of the survey were 216 students from 3 junior college by questionaire from November 25 to November 29, 1996 in Kwang-Ju, Cheong-Ju, and Kong-Ju. The results were analyzed using the SAS and can be summerized as follows : 1. The view on profession was a statistically significant difference inspecial knowledge & skill training (t=-1.686, P<.001), high income (t=-0.753, P<.05) 2. The view on competence as a E.M.T. was a statistically significant differncein sufficient professional knowledge on the E.M.T. (t=-1.144, P<.001), own's health (t=-0.808, P<.001), sincerity and responsibility (t=-1.429, P<.01), satisfaction and effort (t=-1.335, P<.01), boundary of affairs (t=-1.356, P<.01) 3. The view on E.M.T. profession was a statistically significant difference inprotect of pt. life & to relieve the pain (t=-2.388, P<.001) 4. The view on necessary knowledge of E.M.T. was a statistically significant difference in patient assessment (t=-2.168, P<.001), ACLS (t=1.678, P<.001), hemorrhage & shock (t=-3.252, P<.001), trauma (t=-4.284, P<.001), cardiopulmonary disturbance (t=-2.897, P<.001), acute abdomen (t=-4.284, P<.001), neonatal disease (t=-4.032, P<.001), OBGY disease(t=-4.151, P<.001), emergency delivery (t=-2.825, P<.001), infectious disease (t=-2.930, P<.001), environmental emergency (t=-3.123, P<.05), recording(t=2.22, P<.05) 5. The view on ideology of E.M.T. was a statistically significant difference in belief & faith (t=-2.344, P<.001), knowing of own (t=-2.142, P<.01), humanity (t=-2.581, P<.05), knowing of patient (t=-2.079, P<.05).

• Anxiety and mood
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• v.4 no.1
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• pp.34-41
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• 2008

Objective : The aim of this study is to examine the characteristics of somatic symptoms in patients with PTSD according to trauma type. Methods : The subjects of this study were 84 patients diagnosed with PTSD according to the DSM-IVTR and CAPS criteria. The subjects ranged in age from 18 to 76 years, and they were recruited from 18 hospitals across the nation. All participants were asked about their trauma history, and they all completed the Davidson Trauma Scale (DTS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R) and Korean-Physical Somatic Symptom Inventory (K-PSI). The items of the K-PSI were categorized into 5 groups according to organ system, and the participants were classified into 6 groups according to trauma type. We compared the results of the social demographical scale, DTS, BDI, STAI, IES-R and each recategorized subscale of the K-PSI among the six groups. Results : There were significant differences between the 6 groups in terms of the Korean-Physical Somatic Symptom Inventory scores for each organ system, except for the cardiopulmonary system, as well as the BDI scores. Post hoc analysis revealed differences between the combat-related trauma group and all other groups but not among any of the other groups. Conclusion : Our result showed that there were significant differences in the somatic symptom scores among the 6 trauma groups. However, patient age and the time elapsed since the traumatic event may have hada crucial influence on the result of this study.

• Journal of Veterinary Clinics
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• v.36 no.6
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• pp.306-313
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• 2019

It is important to identify the most suitable anesthetic agent that has minimal side effects to be able to control and perform surgeries on bears. In this study, we examined and compared the induction and recovery times as well as the physiological changes occurring during anesthesia induced by medetomidine-zolazepam/tiletamine (MZT) and xylazine-zolazepam/tiletamine (XZT) at general anesthesia for laparoscopic salpingectomy in 326 female Asiatic black bears. The body temperature, heart rate, respiratory rate, and levels of PaO₂ and EtCO₂ were the physiological changes measured during surgical procedures in female bears after anesthesia. In addition, the levels of pO₂, pCO₂, and sO₂ were measured using a portable blood gas analyzer. To induce recovery from anesthesia, bears anesthetized with MZT were intravenously administered atipamezole and bears anesthetized with XZT were intravenously administered yohimbine. The combination MZT, at dosages of 0.019 ± 0.001 mg/kg for medetomidine and 1.4 ± 0.1 mg/kg for ZT, or the combination XZT, at dosages of 2.0 ± 0.1 mg/kg for xylazine and 3.0 ± 0.1 mg/kg for ZT, proved to be reliable and effective in anesthetizing Asiatic black bears for a 40-min handling period for routine clinical procedures. The average anesthesia induction times were 16.5 ± 0.95 min for the bears in the MZT group and 12.0 ± 0.44 min for those in the XZT group. A significant difference was noted between the two drugs (P < 0.001) in terms of the average anesthesia induction time. The anesthesia induction time was shorter for bears with lower body weights than those with higher body weights (P < 0.05). The recovery time of MZT was significantly faster than that of XZT (11.3 ± 0.45 min vs. 18.5 ± 0.83 min) (P < .001). The bears anesthetized with MZT exhibited lower cardiopulmonary suppression than those anesthetized with XZT (P < 0.05). The body temperatures and EtCO₂ of bears in the M ZT group were significantly lower than those in the XZT group as time progressed after anesthesia (P < 0.05). The average pO₂ before the bears were supplied with oxygen was 64.8 ± 3.7 mmHg, but it increased to 211.5 ± 42.5 mmHg afterwards (P < 0.001). In conclusion, our results indicate that bears anesthetized with MZT have longer anesthesia induction time, shorter recovery time, slower heart and respiratory rates, and lower body temperatures and EtCO₂ than those anesthetized with XZT. These findings suggest that XZT is preferable to MZT, warranting further research on its uses and clinical responses in bears.

• Journal of the Korean Applied Science and Technology
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• v.38 no.4
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• pp.1117-1128
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• 2021

The purpose of the current study was to investigate the effects of 4-week health promotion intervention program consisting of high-intensity aerobic exercise to improve energy consumption and cardiorespiratory capacity, circuit training to strengthen muscular strength and endurance and education for lifestyle changes on the obesity level, physical fitness, insulin resistance and metabolic syndrome among overweight or obese elementary school students. Twenty three overweight or obese children as obese group and 15 normal body weight children as normal group were recruited. The health promotion program consisted of two exercise sessions and one education session, 3days/week in 4-week. Obesity level(body mass index, waist circumference, %body fat), physical fitness(muscular strength, muscular endurance, flexibility, cardiopulmonary fitness), insulin resistance(homeostasis model assessment of insulin resistance) and metabolic syndrome risk factors(blood pressure, fasting glucose, triglycerides, high density lipoprotein cholesterol) were measured. There was not significant decrease in obesity level; however, there were significant improvement in physical fitness, insulin resistance and metabolic syndrome risk factors after program participation among obese children. As a result, through participation in the summer camp consisting mainly of exercise, the improvement of the physical fitness level and the decrease of insulin resistance had an effect on the reduction of the metabolic syndrome frequency.