• 대한기계학회논문집B
• /
• 제38권8호
• /
• pp.715-720
• /
• 2014

좌심실보조장치(LVAD)가 심실부하감소에 미치는 영향을 극대화 하기 위해, 심실보조장치 치료를 위한 최적의 심부전 심각도 단계를 찾는 것은 중요하다. 우리는 심부전 정도에 따른 LVAD 의 박동효율을 이론적으로 예측하였다. 우리는 혈관시스템의 6 컴파트먼트의 Wind-kessel 모델과 연동된 심실의 삼차원 유한요소모델을 사용하였다. 이 모델을 이용하여, LVAD 치료 하에서 심부전의 정도에 따라 심실의 수축성 ATP 소모율, 좌심실압력, 심박출량, 심박출 분획, 1 회심박출량 등과 같은 심장응답을 예측하였다. LVAD 치료 중에 에너지학적 부하조건을 암시하는 수축성 ATP 소모율은 5 단계 심부전 조건에서 가장 크게 감소하였다. 따라서, 우리는 LVAD 를 회복으로의 가교로서 고려하고 있을 때, 심부전 5 단계에서 LVAD 치료를 시작하는 것이 가장 적절하다는 결론을 내린다.

• 대한한의학회지
• /
• 제27권4호
• /
• pp.74-83
• /
• 2006

Ssanghwatang (SHT) has been known to prove effective in the treatment for erectile dysfunction (ED), and its modified formula is widely used in clinical practice. However, its fundamental mechanism of action is not clearly known. It is well known that endothelial cells can achieve the relaxation of vascular smooth muscles by the release of nitric oxide (NO). NO is synthesized by the enzyme NO synthase (NOS) from L-arginine and oxygen. It is widely accepted that NO plays an important role in the relaxation of corpus cavernous smooth muscle and vasculature. In addition, in terms of the penile erection, the NO/cGMP pathway is more potent than the PCE1/cAMP pathway. The main purpose of the present study was to investigate the mechanism of the erectile effects of SHT by focusing on its direct effects on corpus cavernous smooth muscle cells. We investigated the NOS activity, nitrite concentration and cGMP levels in rat corpus cavernous smooth muscle cell lines activated by SHT extracts. Furthermore, we evaluated the effect of SHT extracts on penile smooth muscle relaxation following oral administration of SHT extract powder to rats by the dosage of 1 g/kg over fifteen days. As a result, we found that SHT stimulated NO release. NOS activity and cGMP levels were increased by SHT respectively. Furthermore, SHT relaxed the corpus cavernous smooth muscle. These results are consistent with the concept that penile erection by SHT is carried out through the NO/cGMP pathway. In conclusion, the present study shows that SHT increases the NOS activity, synthesizes NO and augments the cGMP, which mediates penile erection. Further determination of the SHT mechanism related with the NO/cGMP pathway strongly indicates that SHT can be used as a remedy for erectile impotence.

• Archives of Plastic Surgery
• /
• 제39권2호
• /
• pp.126-129
• /
• 2012

Background : Facial capillary malformations (CMs) rarely recede; they often become darker and raised in proportion to their growth. These malformations may hypertrophy in adulthood, resulting in increased disfigurement and dysfunction. Laser treatment is considered a first-line therapy for focal CMs, but thick wide lesions, which are accompanied by hypertrophy and have a well-circumscribed nodularity, may be treated with surgical excision and reconstruction. Methods : We retrospectively reviewed the records of 25 consecutive patients who had undergone complete or partial excisions of facial capillary malformations in our unit. After the excisions, the defects that encompassed their facial aesthetic units were subsequently covered by various methods, including primary closures, local flaps, expanded flaps, split-thickness skin grafts, and full thickness skin grafts. Results : The data demonstrated satisfactory results and reliability. Our patients were treated without significant complications, and all of the patients were moderately or fully satisfied with the outcome of their surgeries. Conclusions : Among the many reconstructive options for adult patients with facial capillary malformations, thick split-thickness skin grafts can be a good choice for the coverage of widely excised wounds.

• 대한핵의학회지
• /
• 제26권1호
• /
• pp.26-32
• /
• 1992

Minimal deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using $^{99m}Tc-HMPAO$ Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months fellowing head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with $^{99m}Tc-HMPAO$ Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using $^{99m}Tc-HMPAO$ Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

• Journal of Chest Surgery
• /
• 제24권3호
• /
• pp.310-321
• /
• 1991

Between April 1986 and September 1990, 34 patients with a single or dominant right ventricle underwent modified Fontan procedure for definite palliation in Seoul National University Children`s Hospital. Their age at operation ranged from 8 months to 14 years [Mean 5.5 years]. The ventricular chamber was solitary and of indeterminate trabecular pattern in 6 patients. 28 patients had posteriorly located rudimentary chamber, all of which were trabecular pouches having no communication with outlet septum. The patterns of atrioventricular connection were common inlet[9], double inlet [11], left atrioventricular valve atresia [12] and right atrioventricular valve atresia with L-loop [2]. Pulmonary outflow tracts were atretic in 7 patients and stenotic in 26 patients. Major associated anomalies included anomalous systemic venous drainage [15], dextrocardia [12] and total anomalous pulmonary venous connection[3]. Shunt operations were previously performed in 13 patients and pulmonary artery banding and atrial septectomy in 1 patients. Surgery included intraatrial baffling in 26 patients, bidirectional cavopulmonary shunt in 13 patients, atrioventricular valve obliteration in 3 patients and atrioventricular valve replacement in 3 patients. Central venous pressure measured postoperatively at intensive care unit ranged from 18cm H2O to 28cm H2O [mean 23.2cm H2O]. Hospital mortality was 35.3% [12/34], all died out of low output syndrome. Suspected causes of low output syndrome include ventricular dysfunction [8], hypoplastic or tortuous pulmonary artery [2] and elevated pulmonary vascular resistance [2]. 19 patients had 31 major complications including low output syndrome [18], arrhythmia [4], acute renal failure [3] and respiratory failure [3]. Mortality rate was significantly higher in the groups receiving intraatrial baffling and AV valve replacement respectively [p<0.05]. 20 patients were followed up postoperatively with the mean follow-up period 15.0$\pm$11.6 months. There were no late death and follow-up catheterization was performed in 10 patients. Mean right atrial pressure was 15.4$\pm$6.8mmHg and ventricular contraction was reasonable in all but one case. Thus, Fontan principle can be applied successfully to all the patients with complex cardiac anomaly of single ventricle variety and better results can be anticipated with judicious selection of patient and improvement of postoperative care.

• Journal of Trauma and Injury
• /
• 제27권2호
• /
• pp.20-24
• /
• 2014

Purpose: The temperature of a warm fluid infused into a patient is lowered because the line that allows the fluid to be infused into the patient is exposed to room air. This study evaluated the effects of aluminum foil used as an insulator surrounding the fluid infusion lines when using warm crystalloid fluids to treat traumatic shock patients. Methods: The study measured the differences in fluid temperature between infusion lines with and without the aluminum-foil insulation. We used 1L of normal saline at $40^{\circ}C$ as the infusion fluid, and the fluid infusion line was 200 cm long. The differences in temperature were measured for various fluid flow rates from 12,000 mL/min to 100 mL/min. We performed three experiments at each flow rate. Results: The results showed the differences in temperature between the groups with and without the aluminum insulation were significant for flow rates above 100 mL/min. Conclusion: Hypothermia in trauma patients results in many adverse complications such as peripheral vascular constriction, tissue hypoxia, metabolic acidosis, heart dysfunction and so on. Thus, the use of warm fluids and blood components is essential to reduce the probability of hypothermia. This study showed the aluminum foil wrapped around the infusion line had an insulator effect. As a result, such a wrapping can be used to avoid the adverse effects of hypothermia.

• Journal of Korean Neurosurgical Society
• /
• 제47권3호
• /
• pp.174-179
• /
• 2010

Objective : Cricothyrotomy and tracheostomy are performed by physicians in various disciplines. It is important to know the comprehensive anatomy of the laryngotracheal region. Hemorrhage, esophageal injury, recurrent laryngeal nerve injury, pneumothorax, hemothorax, false passage of the tube and tracheal stenosis after decannulation are well known complications of the cricothyrotomy and tracheostomy. Cricothyrotomy and tracheostomy should be performed without complications and as quickly as possible with regards the patients' clinical condition. Methods : A total of 40 cadaver necks were dissected in this study. The trachea and larynx and the relationship between the trachea and larynx and the surrounding structures was investigated. The tracheal cartilages and annular ligaments were counted and the relationship between tracheal cartilages and the thyroid gland and vascular structures was investigated. We performed cricothyrotomy and tracheostomy in eleven cadavers while simulating intensive care unit conditions to determine the duration of those procedures. Results : There were 11 tracheal cartilages and 10 annular ligaments between the cricoid cartilage and sternal notch. The average length of trachea between the cricoid cartilage and the suprasternal notch was 6.9 to 8.2 cm. The cricothyroid muscle and cricothyroid ligament were observed and dissected and no vital anatomic structure detected. The average length and width of the cricothyroid ligament was 8 to 12 mm and 8 to 10 mm, respectively. There was a statistically significant difference between the surgical time required for cricothyrotomy and tracheostomy (p < 0.0001). Conclusion : Tracheostomy and cricothyrotomy have a low complication rate if the person performing the procedure has thorough knowledge of the neck anatomy. The choice of tracheostomy or cricothyrotomy to establish an airway depends on the patients' clinical condition, for instance; cricothyrotomy should be preferred in patients with cervicothoracal injury or dislocation who suffer from respiratory dysfunction. Furthermore; if a patient is under risk of hypoxia or anoxia due to a difficult airway, cricothyrotomy should be preferred rather than tracheostomy.

• 약학회지
• /
• 제37권5호
• /
• pp.442-452
• /
• 1993

Previous experimental and clinical investigations suggest a possible role of new nootropic drug, oxiracetam, in improving cognitive performances in patients affected by organic brain syndrome. In this study, the cognitive and behavioral effects of oxiracetam treatment in patients with clinical symptoms of organic brain syndrome were evaluated. Sixty-six patients were enrolled and assigned to either oxiracetam or placebo, according to a randomized, double-blind design between two patient-groups. Either oxiracetam or placebo was orally given bid for 8 weeks ; daily dose of oxiracetam was 1600mg. All the patients, enrolled in this study, were diagnosed as having mild to moderate cognitive dysfunction as defined by a baseline Mini Mental State ExaminationKorean version (MMSE-K) score between 14 and 25. The patients under-went, at baseline, 4 weeks and 8 weeks after, routine laboratory study (CBC, SMA12, U/A, EKG) and the following neuropsychological tests ; MMSE-K, modified Korean Wechsler Intelligence Scale(MKWIS), Nurses' Observation Scale for Geriatric patients(NOSGER). Fifteen patients of whom were dropped out or excluded from the analysis because of poor compliance or violation of the protocol. Fiftyone patients (aged 54~78 years, male 25, female 26) were analyzed (vascular dementia, 30 ; senile dementia of Alzheimer type, 9 ; mixed type, 5 ; other cause, 7). Statistical analysis of the data demonstrated that the two groups were comparable at baseline. At the end of each study period the oxiracetam group scored significantly better on the majority of the tests evaluating cognitive function, psychometricity and the improvement rating scale of subjective symptoms than placebo group, in which worsening trends or no changes were seen on the whole. No side effects were noted during oxiracetam treatment. The present study, showing positive clinical findings after oxiracetam therapy, confirmed that this drug can be useful pharmacological treatment in organic brain syndrome.

• The Journal of Korean Physical Therapy
• /
• 제15권4호
• /
• pp.199-207
• /
• 2003

신생아의 정상적인 발달을 저해하고 조기 사망의 주된 원인이 되고 있는 주산기 뇌손상에 관한 신경병리적 기전을 살펴보고자 하였다. 발달하고 있는 과정에서의 주산기 뇌손상은 주로 저산소성-허혈성 뇌손상과 출혈성 뇌손상에 의한 경우가 많다. 저산소성-허혈성 뇌손상과 관련하여 에너지 부전, 세포흥분독성, 미성숙 백질의 선택적 취약성을 고려해 볼 수 있다. 첫번째, 세포호흡에 관여하는 미토콘드리아의 손상과 관련하여 즉각적인 병리와 함께 지연된 양상의 손상을 보인다. 미토콘드리아의 호흡률이 감소하고 칼슘이온의 농도가 상승하여 세포 괴사 및 세포사멸 과정이 진행된다. 두번째, 흥분성 아미노산과 관련하여 미성숙한 뇌에는 NMDA 수용기-채널 복합체의 기능이 매우 풍부하고, phosphoinositide 가수분해가 높아서 흥분독성에 상당히 취약하다. 세 번째, 수초 형성에 중요한 역할을 하는 희돌기교세포가 주산기 뇌손상 특히, 저산소성-허혈성 손상에 취약하다. 희돌기교세포는 글루타메이트에 의한 자유유리기과 사이토카인 손상에 취약하다. 뇌출혈과 관련하여, 미성숙한 뇌는 뇌실 주위에 혈관층이 풍부하나 매우 약한 상태로 재관류 혹은 혈류의 증가로 인해 쉽게 파열된다. 특히 32주 이내인 경우 이러한 손상으로 인해 뇌실주위 백질연화증이 초래된다.

• 대한관절경학회지
• /
• 제10권2호
• /
• pp.135-140
• /
• 2006

불안정성 견관절에 대한 진단과 치료는 정형외과 영역에서 가장 어려운 분야 중에 하나이다. 관절와 위에서 움직이는 상완골두의 아탈구와 정상적인 전이, 통증과 기능 저하를 일으키는 이완의 정도는 구별하기가 용이하지 않는 경우가 많다. 불행하게도 이 불안정성을 일으키는 모든 병변에 시행할 수 있는 가장 좋은 한가지의 치료법은 개발되어 있지 않다. 그러므로 불안정성의 방향과 정도뿐만 아니라 동반된 문제까지도 정확히 진단하는 것이 절대 필요하다. 해부학적 결손은 반드시 확인해야 한다. 불안정성에 대한 봉합술의 실패에 영향을 미칠 수 잇는 흔한 요인은 다음과 같다. 정확한 해부학적 병리소견을 확인하는 올바른 진단, 올바른 치료 방법에 대한 이유, 필요 없는 내고정물의 사용이나 불안정성, 관절염, 신경 및 혈관 손상 등을 남길 수 있는 도달법의 사용과 같은 기술적 결함 등이 있다. 술후 견관절의 안정성, 유연성, 지구력을 회복시켜 강도높은 스포츠나 노동에 복귀할 수 있는 잘 준비된 재활을 통해 추가적인 손상을 막아야 한다.