Backgrouds: It is almost universally accepted that occlusive vascular diseases are best managed by anatomical reconstruction. However, the mortality and the morbidity have limited this operation for patients with high operation risks. In these patients, palliative operations such as extra-anatomic bypass and lumbar sympathectomy, are accepted as useful treatment. Material and Method: A retrospective study was conducted in 38 patients who underwent palliative operations for occlusive vascular disease at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 60.37 $\pm$ 17.65 years, and preoperative diagnoses were atherosclerosis in 32 patients, Buerger's disease in 4 patients, Raynaud's syndrome in 1 patient and SVC syndrome in 1 patient. Result: Extra-anatomic bypass(40procedures), lumbar sympathectomy(17), thromboembolectomy(7) and femoral artery graft interposition(1) were performed. Six patients were required reoperation due to graft flow failure or fistula. Three year primary patency rate of entire operations was 78.29 $\pm$ 8.81%, and the correlation between type of operation and patency rate was not statistically significant. Conclusion: Palliative operations for occlusive vascular disease are useful treatment in limited patients with high operation risks or limited life expectancy.
Paraplegia remains unresolved as the most dreaded operative complication with surgical treatment of descending thoracic and thoracoabdominal aortic diseases. In this study, the neuroprotective effect of trimetazidine that has been used clinically for ischemic heart disease was investigated in a rabbit spinal cord ischemia model. Material and Method: Thirty-three New Zealand white rabbits were randomized as follows: control group undergoing abdominal aortic occlusion but receiving no pharmacologic intervention(Group 1, n= 17); TMZ group(Group 2, n= 16) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta. Ischemia was induced by clamping the abdominal aorta just distal to the left renal artery for 30 minutes. Neurologic status was assessed at 2, 24, and 48 hours after the operation according to the modified Tarlov scale, then the lumbosacral spinal cord was processed for histopathologic examinations 48 hours after the final assessment. Result: The average motor function score was significantly higher in the TMZ group(3.20 $\pm$ 0.77 vs 1.13 $\pm$ 1.25 at 2 hours, 3.50 $\pm$ 0.76 vs 1.45 $\pm$ 1.57 at 24 hours, and 3.91 $\pm$ 0.30 vs 1.86 $\pm$ 1.86 at 48 hours after operation; p value$\leq$0.05). Histologic observations were correlated with the motor scores. Conclusion: The results suggested that trimetazidine reduced spinal cord injury during aortic clamping and that it may have clinical utility for the thoracoabdominal aortic surgery:
Fourteen patients underwent orthotopic heart transplantation between March 1994 and May 1996 in Seoul National University Hospital. There were 9 male and 5 female patients, and the mean age was 40.8 $\pm$ 12.4 years ranged from 12 to 56 years. All patient were in NYHA Fc III or IV preoperatively. The underlying heart diseases were dilated cardiomyopathy in 11 and restrictive cardiomyopathy in 3. The mean age of donors was 24.9$\pm$ 10.2 years and the causes of the brain death were head trauma by traffic accidents in 8, subarachnoid hemorrhage in 2, 1 asphyxia, 1 fall down injury, 1 brain tumo , and 1 drowning, respectively The blood type was identical in 11, compatible in 2, and incompatible in 1 patient. The direct bicaval anastomosis technique was used in 11 cases, and standard right atrial anastomosis was done in the remaining 3 cases. The graft ischemic time was 158$\pm$44 minutes ranged 94 to 220 minutes. There were two hospital deaths(14.3%). The causes of deaths were 1 right ventricular failure followed by suspected cyclosporine induced hemolytic uremic syndrome and rejection, and 1 delayed massive bleeding, probably from rupture of the anastomotic pseudoaneurysm, respectively. The follow-up duration was 16$\pm$9 months(3 to 28 months). There was one late death(8.3%). All the other patients were in NYHA Fc I except one patient who was in hospital because of the acute rejection. The actuarial survival rates including hospital deaths were 93.7% at 1 month, 86.9% at 6 months, and 77$\pm$12% at 2 years. Conclusively, heart transplantation is the good strategy for the management of end stage heart disease with acceptable operative mortality and early follow-up results.
Metabolic syndrome is a cluster of metabolic risk factors associated with increased risk of cardiovascular diseases. Recently, the prevalence of metabolic syndrome has increased in Korea. The aim of this study was to develop a Healthy Han-sik Nutrition Education Program (HHNEP) based on commonly recognized Korean foods in order to decrease metabolic syndrome risks. The target population of the HHNEP is adults with metabolic risk factors. The initial version of the HHNEP was developed based on a review of literature and various dietary guidelines by expert committees as well as the results of a survey on the perception of common Korean dishes and foods as Han-sik. The focus group discussion conducted of nine participants from the target population. After minor modification, the final version was developed. The contents included five sections: 1) aims, 2) introduction of Korean Food Guidance System, 3) cholesterol contents in food, 4) menu planning method using Han-sik, and 5) examples of daily Han-sik menu. The Han-sik list was selected based on the results from a Han-sik perception answered by 35 Korean adults aged 30-60 years using 517 frequently consumed Korean foods from the fourth Korea National Health and Nutrition Examination Survey. The nutrition education program was developed based on scientific evidence for the prevention of metabolic syndrome and focuses on tailoring education to an individual's dietary problems. Educational method was developed by a group of expert committees based in planned behavior theory and related research results. The education method consisted of assessment of current diet, four face-to-face nutrition education sessions over 8 weeks, and evaluation after 8 and 16 weeks. Initial version of nutrition education materials and methods was tested for feasibility by a select group of nine Korean healthy adults. Successful implementation of the program would include application by nutritional professionals at the health promotion center of the hospitals, public health center, and work sites. Intervention studies are needed to evaluate the feasibility and effectiveness of this program before large-scale applications.
Kim, Han Wool;Lim, Goh-Woon;Cho, Hye Kyung;Lee, Hyunju;Won, Tae Hee;Park, Kyoung Un;Kim, Kyung-Hyo
Pediatric Infection and Vaccine
/
v.18
no.1
/
pp.80-84
/
2011
Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Tuberculous empyema necessitatis is a rare complication of tuberculosis. We experienced a 21-month-old boy with tuberculous empyema necessitatis with osteomyelitis in the right $7^{th}$ rib. He presented with a mass on the right lateral chest wall, which was soft and nontender, enlarging for one month. He also had mild fever. The plain radiograph of his chest revealed soft tissue swelling and calcified lymph node on the left axilla, and his PPD skin test was positive. CT scan of the chest showed empyema necessitatis at the right lower chest and upper abdominal walls with osteomyelitis of the right $7^{th}$ rib. He did not have concurrent pulmonary tuberculosis. Surgery was performed for diagnosis and treatment. In histopathologic findings, chronic granulomatous inflammation with caseation necrosis was shown and was positive for acid fast bacilli stain. In addition, M. tuberculosis complex was found as etiology by polymerase chain reaction. The patient has been treated with anti-tuberculous medication without any specific complication.
Seo, Hyun-Ju;Kim, Chong-Soon;Chang, Yun-Kyun;Park, Il-Geun;Kim, Soo-Geun
Journal of Preventive Medicine and Public Health
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v.39
no.3
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pp.229-234
/
2006
Objectives: Cardiovascular disease is one of the main causes of death and morbidity in Korea. In this study, the prevalence and incidence of developing hypertension in a male-workers' cohort were investigated during 3-years follow-up with a view to find the risk factors that affected the development of hypertension. Methods: Among the 5,374 people who participated in a routine health check up, 3,852 people with normal blood pressure and who had no history of hypertension were prospectively followed up for 3 years. The classification of hypertension was based on the JNC7 report (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). Life style factors and underlying diseases that were related to the risk factors of hypertension were collected by using a self-report questionnaires via the internet. Results: The prevalence of hypertension was 28.3% (1,520/5,374) at the first screening (2001). It was found that the incidence in 2004 of hypertension for the follow-up subjects (3,711) who had normal blood pressure in 2001 was 7.6 per 100 person-year. Multiple logistic regression analysis of the variables related to the risk factors of hypertension was carried out. The relative risks were 1.037 (95% CI=1.022-1.053) as the age increased 1 year and 1.039 (95% CI=1.023-1.055) as the body mass index increased $1kg/m^2$. The relative risk for the prehypertensive group was 2.501 (95% CI=1.986-3.149) compared to the normotensive group. These results showed that age, body mass index and the baseline blood pressure were significantly related to the incidence of hypertension. Conclusions: The incidence of hypertension was 7.6 per 100 person-year during follow-up. It was concluded that the risk factors for developing hypertension in the short-term were age, BMI, and prehypertension; Especially, this showed that it is necessary for prehypertensives to manage their body weight and blood pressure to prevent hypertension in middle-age by modifying their life style.
Objective : This study investigated the relationship between diet and lifestyle and Sasang constitution (SC) in acute stroke patients. Methods : From October 2005 to March 2007, 379 acute stroke patients were included. Patients were hospitalized within 14 days after the onset of stroke at DongGuk University International Hospital, Kyungwon University In-cheon Oriental Medical Hospital or Department Cardiovascular and Neurologic Diseases (stroke center), Kyung Hee University Oriental hospital. We assessed the type of SC of acute stroke patients by Questionnaire for Sasang Constitution Classification II (QSCC II). We investigated general characteristics, stroke types, dietary preferences (meat, sea food, fast food, alcohol drinking, coffee and green tea drinking) and lifestyle (smoking, exercise) according to SC. Results : This study showed that out of the total patients, the proportion of So-yang to Tae-eum to So-eumwas equal to 2.6 to 2 to 1. Of note, this study showed a higher proportion in age of So-eum & weight of Tae-eum. The ratio of cerebral hemorrhage to cerebral infarction was 1 to 9. SVO, LAA, SUE are the 3 types of cerebral infarction classified by TOAST; SVO ranked the highest while SUE ranked the lowest in all constitutions. There were no significant differences between So-yang and Tae-eum in the aspect of the preference for meat, but the majority of So-eum displayed high preferences for seafood. In the aspect of alcohol drinking and smoking history, So-yang recorded significantly bigger proportion while So-eum & Tae-eum patients represented a bigger proportion than So-yangin the aspect of no exercise habits. Conclusion : According to the result above, we could observe the general disposition of various characteristic distributions according to SC of acute stroke patients. Also, we could observe a relationship between diet and lifestyle and Sasang constitution (SC) in acute stroke patients. Further studies will be needed to better understand the relationship between diet and lifestyle and Sasang constitution (SC) in acute stroke patients.
Kim, Jung-Hyun;Kang, Kyung-Won;Yu, Byeong-Chan;Choi, Sun-Mi;Baek, Hye-Ki;Lim, Seung-Min;An, Jung-Jo;Seol, In-Chan;Kim, Yoon-Sik
The Journal of Internal Korean Medicine
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v.28
no.4
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pp.830-837
/
2007
Background and purpose : Stroke is one of the most deadly diseases and a leading cause of disability. Lipids confer an increased risk for cardiovascular morbidity and mortality. In spite of many studies on the relationship between stroke and lipids, their relationship is not clear. This study was undertaken to determine whether lipids were associated with stroke. Method : We compared the components of blood lipids between stroke patients group (n=217,Cases), non-stroke control group (n=160, Controls) and healthy control group without hypertension, diabetes mellitus, ischemic heart disease, or hyperlipidemia (n=140, Normals). These data were statically analyzed by general linear models and binary logistic regression analysis to get each adjusted odds ratio. Result : The results were as follows. The blood levels of total cholesterol (T-Chol), triglyceride (TG) and low density lipoprotein cholesterol (LDL-Chol) were significantly higher in patients of ischemic stroke, while the blood levels of T-Chol and LDL-Chol were significantly lower, and the blood levels of TG significantly higher in patients of hemorrhagic stroke. The blood level of high density lipoprotein cholesterol (HDL-Chol) was significantly lower in all cases. Conclusion : These results suggest that high TG and low HDL-Chol may be risk factors of hemorrhagic stroke and ischemic stroke, high T-Chol and LDL-Chol may be risk factors of ischemic stroke, and low T-Chol and LDL-Chol may be risk factors of hemorrhagic stroke in Koreans.
From April 1987 to May 1996, 13 infants underwent a Norwood operation for complex congenital heart diseases including hypoplastic left heart syndrome (n : 7), mitral stenosis with small VSD and subaortic stenosis (n : 1), mitral atresia with ventricular septal defect, coarctation of aorta, and subaortic stenosis (n = 1), interrupted aortic arch with ventricular septal defect and subaortic stenosis (n : 1), tricuspid atresia with transposition of the great arteries (n = 1), and complex double-inlet left ventricle (n : 2). All patients without hypoplastic left heart syndrome were associated wit hypoplasia of ascending aorta and arch. Age at operation ranged from 3 days to 8.7 months (mean 60.6 $\pm$ 71.6 days, median 39 days). The operative mortality( < 30 days) was 46% (6 patients). Late mortality was 15% (2 patients). All operative deaths occured during the Erst 24 hours after the operation as a result of cardiopulmonary bypass weaning failure (5 patients) and sudden hemodynamic instability postoperatively (1 patient). Late death was due to aspiration pneumonia in two cases. There are 5 long-term survivals (39%). Three of them have undergone a two-stage repair with a modified Fontan operation in two and total cavopulmonary shunt in one at 12, 17, 4.5 months after Norwood procedure with no mortality. Two patients have entered a three-stage repair strategy by undergoing a bidirectional cavopulmonary shunt at 3 and 5.5 months after initial operation with 1 operative death. The actuarial survival rate for all patients at the first-stage operation, including hospital deaths and ate death was 30.8% at 1 year. In conclusion, the operative mortality of Norwood operation was relatively high compared to other operation for major cardiac anomalies, continuing experience will lead to an improvement in result.
Kim, Hyung-Sook;Lee, Eun-Young;Kim, Kyungmin;Kim, Kyung Won;Pyun, Jinwon;Chung, Sang-Jin;Kwon, Young Hye;Yeo, Ikhyun;Lee, Sangyun;Nam, Kisun
Korean Journal of Community Nutrition
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v.18
no.4
/
pp.365-371
/
2013
High intakes of sodium may increase the risk of hypertension or cardiovascular diseases. According to the 2010 Korea National Health and Nutrition Survey, the average intake of sodium was 4,878 mg/day with salt, kimchi, soy sauce, fermented soybean paste and Ramyeon being the five main sources of sodium. In order to identify solutions to reduce the intake of sodium, we investigated the intake patterns and eating behaviors of Ramyeon among 347 college students (male 146, female 201) using survey questionnaires. The average age of study subjects was 23.7 years for males and 20.5 years for females. The average Body Mass Index ($kg/m^2$) was 21.9 for males and 20.1 for females. The average frequency of Ramyeon intake was 2.0 times/week. The main reason for eating Ramyeon was convenience (56%), followed by good taste (27%), low price (11%) and other reasons (9%). The criteria for choosing Ramyeon were taste (72%), convenience (14%), price (7%), nutrition (1%), and the other factors (2%). Males' average intake of Ramyeon soup (61%) was higher than that of the females (36%). The estimated intake of Ramyeon soup by survey showed a positive correlation with the measured intake of Ramyeon soup. Sodium contents of Ramyeon were measured separately for the noodles and the soup, which were 1,185 mg/serving and 1,148 mg/serving each. Therefore, the amount of sodium intake can be reduced if students eat less Ramyeon soup. Also, we observed that dietary behaviors and soup intakes of Ramyeon between the sexes were different. Appropriate nutritional education for proper eating habits may help decrease the intake of sodium.
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