Outcome of Cardiopulmonary Resuscitation for In-hospital Cardiac Arrest in a Tertiary Emergency Department

PURPOSE: The "In-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data from inhospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report guidelines for resuscitation in Korea. METHODS: A clinical analysis of 249 cases of in-hospital CPR performed in a tertiary emergency department from August 1995 to December 2001 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: During the period, 232 patients received 249 resuscitations. The immediate precipitating causes of cardiac arrest were cardiogenic in 61 cases (24.5%), traumatic in 58 cases (23.3%), respiratory in 41 cases (16.5%), and metabolic in 28 cases (11.3%). Initial EKG rhythms were bradyarrhythmia in 115 cases (46.2%), pulseless electrical activity in 69 cases (27.7%), ventricular fibrillation/tachycardia (VF/VT) in 36 cases (14.5%), and asystole in 26 cases (10.4%). The spontaneous circulation was returned in 153 of the 249 resuscitations (61.5%). In 59 of the 249 resuscitations (23.7%), spontaneous circulation was maintained for more than 24 hours. Sixteen of the 232 patients (6.9%) were discharged alive. The VF/VT group of initial EKG rhythm had a better outcome in comparison with non-VF/VT group. The prognosis for respiratory arrest was better (78% probability of survival) than it was for other causes of arrest. Patients suffering from traumatic arrest showed the worst outcomes (9% probability of survival). CONCLUSION: Although the "In-hospital Utstein Style" is very subjective as a report determining the outcome of resuscitation, it has many complementary factors. However, even with the "Utstein Style", new guidelines compatible with the actual circumstances of our emergency department must be developed.

Resistance to Cisplatin Renders High Metastatic Potential in Human Non-Small Cell Lung Cancer Cell Line / 대한흉부외과학회지

BACKGROUND: Resistance to cytotoxic drugs such as cisplatin is an important cause of treatment failure in lung cancer. The mechanisms are omplex and have yet to be clearly elucidated, but the acquisition of drug resistance possibly has resulted in poor survival. The purpose of the study is to evaluate whether the resistant tumor cells would gain more potential for metastasis. MATERIAL AND METHOD: we examined the metastatic potential of a cisplatin-reisistant cell line, H460/CIS, which was established from the human lung cancer cell line H460 by in vitro selection with gradually increased concentration of cisplatin. The parental cisplatin-sensitive cell line(H460) was used as the control and analysis on the expression of angiogenesis or growth-related factors, gelatin zymographic analysis and in vivo spontaneous metastatic experiment in nude mice were done. RESULT: Increased levels of vascular endothelial growth factor(VEGF) and basic fibroblast growth factor (bFGF) were found in H460/CIS. Gelatin zymographic analyses showed that proteinase A in the culture medium of H460/CIS was processed from latent to activated form. The in vivo experiment showed that H460/CIS cells spontaneously metastasized to the lungs but parental cells did not. CONCLUSION: resistance to the chemotherapeutic agents may render the tumor aggressi-veness and metastatic potential. Therefore, the risk, rather than benefit, from inadvertent application of adj uvant or neoadj uvant chemotherapy to early-staged lung cancer should be considered.

The Protective Effects of Ascorbic Acid on the Vascular Motilities in Streptozotocin-induced Diabetic Rat / 대한흉부외과학회지

BACKGROUND: More than 70% of morbidity and mortality of diabetes mellitus is due to macrovascular complications. These complications may be associated with defect of endothelium-dependent vascular relaxation. There have been suggestions that this defect might be due to direct toxicities of oxygen-free radical. So in this study ascorbic acid was used as a dietary supplement in streptozotocin induced diabetic rats to correct this defect. MATERIAL AND METHOD: Sixty male Sprague-Dawley rats were used in this study. They were divided into control and experimental groups. Streptozotocin was injected to the 33 rats of experimental group and then divided into two the other receiving subgroups; one receiving ascorbic acid supplement(1 g/l in drinking water); and nosupplements. At 6, 9 and 12 weeks, abdominal aortic rings were obtained to make tissue preparations for evaluation of vascular smooth muscle contractility. RESULT: While control group showed good response to acetylcholine induced relaxation, diabetic group showed decreased relaxation regardless of ascorbic acid supplement at the experiments 6 weeks after streptozotocin treatment. This abnormal endothelium-dependent vascular relaxation was markedly reversed at 9 and 12 weeks into the diabetic group with ascorbic acid supplement. There were no differences in sodium nitroprusside induced relaxation responses between control and experimental groups; also, norepinephrine induced contractile responses did not show any remarkable effects. CONCLUSION: These results strongly suggest that the endothelial cells have defects in diabetic rats. Dietary supplement of ascorbic acid can reverse the defects of diabetic endothelial cells through its antioxidant effects and it may further protect against vascular disease in diabetic patients.

Analysis of Predicting Factors for Cardiovascular Injuries in Sternal Fractures / 대한흉부외과학회지

BACKGROUND: The aims of this study are to determine the predicting factors related with cardiovascular injuries in sternal fractures and to suggest the indication of emergency echocardiography. MATERIAL AND METHOD: A retrospective review of the Ewha Womans University Mok-Dong Hospital trauma registry revealed 40 patients, that visited the hospital with a sternal fracture a over 5-year period. We analyzed 4 factors as predicting factors; 1) presence of restraint, 2) presence of associated injuries, 3) presence of a past medical history involving cardiovascular system, and 4) Revised Trauma Score(RTS). We, also, assessed the utility of conventional study methods involving cardiovascular injuries, such as ECG, chest X-ray, and enzyme level. Based on the methods, we inferred an indication for emergency echocardiography in sternal fractures. RESULT: Statistically significant predicting factors were the presence of a past medical history involving cardiovascular system and abnormal RTS on admission. Usage of emergency echocardiography depended upon the predicting factors and the results from conventional evaluations. We can now suggest the indications of emergency echocardiography in sternal fractures as 1) if more than two studies reveal abnormality without any significant predicting factors, and 2) if more than one study reveals abnormality with any significant predicting factors. CONCLUSION: The past medical history involving cardiovascular system and initial vital signs imply the presence of cardiovascular injuries in sternal fractures. And if needed, emergency echocardiography should be performed.

Relationship between normal heart size and body indices in Korean

We provided a curve-fit equation to predict the normal heart weight (g) in Koreans by examining 422 autopsies (215 males and 207 females, from newborn to age 77 yr) who were relatively in good general condition. Heart weight was well correlated with body surface area (m2), body weight (kg), and body height (cm) but poorly with age in both sex. Heart weight progressively increased from birth to the earlier 3rd and 4th decades in male and female, respectively, and then gradually decreased; mean heart weight of all age group was greater in male than in female and significantly different from birth to 4th decade. In both sex, heart weight exponentially increased in accordance with the increase of body height, body weight, and body surface (in male, heart weight=0.00312 x body height(2.239), r2=0.750, p<0.0001; in female, heart weight=0.00443 x body height(2170), r2=0.781, p<0.0001; in male, heart weight=9.22 x body weight(0.853), r2=0.770, p<0.0001; in female, heart weight=9.00 x body weight0.855, r2=0.820, p<0.0001; in male, heart weight=155.18 x body surface area1.290, r=0.808, p<0.0001; in female, heart weight=124.13 x body surface area1.242, r=0.834, p<0.0001). These results indicate that heart weight is better correlated with body surface area than with body weight; however, body weight should be a better determinant of a predicted heart weight, since body surface area is entirely dependent on body height and body weight.

Ischemic Preconditioning and Its Relation to Glycogen Depletion / 대한흉부외과학회지

BACKGROUND: Recent studies have suggested that the cardioprotective effect of ischemic preconditioning (IP) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G)-free perfusate. MATERIAL AND METHOD: Hearts isolated from New Zealand white rabbits (1.5~2.0 kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 45 min global ischemia followed by 120 min reperfusion with IP(IP group, n=13) or without IP(ischemic control group, n=10). IP was induced by single episode of 5 min global ischemia and 10 min reperfusion. In the G-free preconditioned group(n=12), G depletion was induced by perfusionwith G-free Tyrode solution for 5 min and then perfused with G-containing Tyrode solution for 10 min; and 45 min ischemia and 120 min reperfusion. Left ventricular functionincluding developed pressure(LVDP), dP/dt, heart rate, left ventricular end-distolic pressure (LVEDP) and coronary flow (CF) were measured. Myocardial cytosolic and membrane PKC activities were measured by 32P-gamma-ATP incorporation into PKC-specific peptide and PKC isozymes were analyzed by Western blot with monoclonal antibodies. Infarct size was determined by staining with TTC (tetrazolium salt) and planimetry. Data were analyzed by one-way analysis of variance (ANOVA) and Turkey's post-hoc test. RESULT: In comparison with the ischemic control group, IP significantly enhanced functional recovery of the left ventricle; in contrast, functional significantly enhanced functional recovery of the left ventricle; in contrast, functional recovery were not significantly different between the G-free preconditioned and the ischemic control groups. However, the infarct size was significantly reduced by IP or G-free preconditioning (39+/-2.7% in the ischemic control, 19+/-1.2% in the IP, and 15+/-3.9% in the G-free preconditioned, p<0.05). Membrane PKC activities were increased significantly after IP (119%), IP and 45 min ischemia(145%), G-free [recpmdotopmomg (150%), and G-free preconditioning and 45 min ischemia(127%); expression of membrane PKC isozymes, alpha and beta, tended to be increased after IP or G-free preconditioning. CONCLUSION: These results suggest that in isolated Langendorff-perfused rabbit heart model, G-free preconditioning (induced by single episode of 5 min G depletion and 10 min repletion) colud not improve post-ischemic contractile dysfunction(after 45-minute global ischemia); however, it has an infarct size-limiting effect.

Cardioprotective Effect of Calcium Preconditioning and Its Relation to Protein Kinase C in Isolated Perfused Rabbit Heart / 대한흉부외과학회지

BACKGROUND: It has been documented that brief repetitive periods of ischemia and reperfusion (ischemic preconditioning, IP) enhances the recovery of post-ischemic contractile function and reduces infarct size after a longer period of ischemia. Many mechanisms have been proposed to explain this process. Recent studies have suggested that transient increase in the intracellular calcium may have triggered the activation of protein kinase C(PKC); however, there are still many controversies. Accordingly, the author performed the present study to test the hypothesis that preconditioning with high concentration of calcium before sustained subsequent ischemia(calcium preconditioning) mimics IP by PKC activation. MATERIAL AND METHOD: The isolated hearts from the New Zealand White rabbits(1.5~2.0 kg body weight) METHOD: The isolated hearts from the New Zealand White rabbits(1.5~2.0 kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 45-minute global ischemia followed by a 120-minute reperfusion with IP(IP group, n=13) or without IP(ischemic control, n=10). IP was induced by single episode of 5-minute global ischemia and 10-minute reperfusion. In the Ca2+ preconditioned group, perfusate containing 10(n=10) or 20 mM(n=11) CaCl2 was perfused for 10 minutes after 5-minute ischemia followed by a 45-minute global ischemia and a 120-minute reperfusion. Baseline PKC was measured after 50-minute perfusion without any treatment(n=5). Left ventricular function including developed pressure(LVDP), dP/dt, heart rate, left ventricular end-diastolic pressure(LVEDP) and coronary flow(CF) was measured. Myo car ial cytosolic and membrane PKC activities were measured by 32P-gamma-ATP incorporation into PKC-specific pepetide. The infarct size was determined using the TTC (tetrazolium salt) staining and planimetry. Data were analyzed using one-way analysis of variance(ANOVA) variance(ANOVA) and Tukey's post-hoc test. RESULT: IP increased the functional recovery including LVDP, dP/dt and CF(p<0.05) and lowered the ascending range of LVEDP(p<0.05); it also reduced the infarct size from 38% to 20%(p<0.05). In both of the Ca2+ preconditioned group, functional recovery was not significantly different in comparison with the ischemic control, however, the infarct size was reduced to 19~23%(p<0.05). In comparison with the baseline(7.31 0.31 nmol/g tissue), the activities of the cytosolic PKC tended to decrease in both the IP and Ca2+ preconditioned groups, particularly in the 10 mM Ca2+ preconditioned group(4.19 0.39 nmol/g tissue, p<0.01); the activity of membrane PKC was significantly increased in both IP and 10 mM Ca2+ preconditioned group (p<0.05; 1.84 0.21, 4.00 0.14, and 4.02 0.70 nmol/g tissue in the baseline, IP, and 10 mM Ca2+ preconditioned group, respectively). However, the activity of both PKC fractions were not significantly different between the baseline and the ischemic control. CONCLUSION: These results indicate that in isolated Langendorff-perfused rabbit heart model, calcium preconditioning with high concentration of calcium does not improve post-ischemic functional recovery. However, it does have an effect of limiting(reducing) the infart size by ischemic preconditioning, and this cardioprotective effect, at least in part, may have resulted from the activation of PKC by calcium which acts as a messenger(or trigger) to activate membrane PKC.

Effect of Reperfusion after 20 min Ligation of the Left Coronary Artery in Open-chest Bovine Heart: An Ultrastructural Study / 대한흉부외과학회지

BACKGROUND: It has been well documented that transient occlusion of the coronary artery causes myocardial ischemia and finally cell death when ischemia is sustained for more than 20 minutes. Extensive studies have revealed that ischemic myocardium cannot recover without reperfusion by adequate restoration of blood flow, however, reperfusion can cause long-lasting cardiac dysfunction and aggravation of structural damage. The author therefore attempted to examine the effect of postischemic reperfusion on myocardial ultrastructure and to determine the rationales for recanalization therapy to salvage ischemic myocardium. MATERIALS AND METHODS: Young Holstein-Friesian cows (130~140 Kg body weight; n=40) of both sexes, maintained with nutritionally balanced diet and under constant conditions, were used. The left anterior descending coronary artery (LAD) was occluded by ligation with 4-0 silk snare for 20 minutes and recanalized by release of the ligation under continuous intravenous drip anesthesia with sodium pentobarbital (0.15 mg/Kg/min). Drill biopsies of the risk area (antero-lateral wall) were performed at just on reperfusion (5 minutes), 1-, 2-, 3-, 6-, 12-hours after recanalization, and at 1-hour assist (only with mechanical respiration and fluid replacement) after 12-hour recanalization. The materials were subdivided into subepicardial and subendocardial tissues. Tissue samples were examined with a transmission electron microscope (Philips EM 300) at the accelerating voltage of 60 KeV. RESULTS: After a 20-minute ligation of the LAD, myocytes showed slight to moderate degree of ultrastructural changes including subsarcolemmal bleb formation, loss of nuclear matrix, clumping of chromatin and margination, mitochondrial destruction, and contracture of sarcomeres. However, microvascular structures were relatively well preserved. After 1-hour reperfusion, nuclear and mitochondrial matrices reappeared and intravascular plugging by polymorphonuclear leukocytes or platelets was observed. However, nucleoli and intramitochondrial granules reappeared within 3 hours of reperfusion and a large number of myocytes were recovered progressively within 6 hours of reperfusion. Recovery was apparent in the subepicardial myocytes and there were no distinct changes in the ultrastructure except narrowed lumen of the microvessels in the later period of reperfusion. CONCLUSIONS: It is likely that the ischemic myocardium could not be salvaged without adequate restoration of coronary flow and that the microvasculature is more resistant to reversible period of ischemia than subendocardium and subepicardium. Therefore, thrombolysis and/or angioplasty may be a rational method of therapy for coronarogenic myocardial ischemia. However, it may take a relatively longer period of time to recover from ischemic insult and reperfusion injury should be considered.

The Effect of Epidural Pain Block After Thoracotomy / 대한흉부외과학회지

Continuous epidural pain block with a local anesthetic agents is a commonly employed technique for pain relief after thoracotomy. In this study, we evaluated the effectiveness of the continuous epidural pain block in 19 patients undergoing elective lateral or posterolateral thoracotomy with control group(n=19) from November 1994 to July 1995. Epidural lidocaine and morphine mixtures were injected via an epidural catheter as a bolus after operation, and then bupivacaine and morphine mixtures were injected continuously following 5 or 6 days. The pain score, upper arm elevation(ROM score), and respiratory rate were significantly changed(P<0.05) from 30min after injection. The CO2 tension of arterial blood was decreased significantly(P<0.05) from 2hr after injection. The postoperative hospital days were decreased significantly(P<0.05). Side effects of the epidural pain block were urinary retention(n=10), urticaria(n=2) and a case of headache. There was no postoperative lung atelectasis. We conclude that the continuous epidural pain block is good for prevention of the postoperative lung complication and early recovery after thoracotomy.

Squamous Cell Carcinoma of Lung mixed with Malignant Lymphoma: 1 case report / 대한흉부외과학회지

We have experienced a case of squamous cell carcinoma of lung mixed with malignant lymphoma. The patient was a 19-years-old male. He was a non-smoker. Right pneumonectomy was done. We could not find any evidences of metastasis. The postoperative course was uneventful. The tissue diagnosis was confirmed by immunohistochemical method. The lymphoma recurred at 3 months after operation and the patient was dead at 5 months after operation because of respiratory failure

Thoracoscopic Lung Biopsy for Diffuse Interstitial Lung Disease / 대한흉부외과학회지

Diffuse lung disease is amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with those associated with standard open lung biopsy. Video assisted thoracoscopic lung biopsy was performed in 22 patients for the diagnosis of diffuse lung disease during the period from August 1994 to December 1996, and the following results were obtained: 1. The patients were 14 men and 8 women. The average age was 54.6 years. 2. 13 lung biopsy specimens were obtained from the right lower lobe, 4 from the right upper lobe, 3 from the right middle lobe, 3 from the left upper lobe, and 3 from the left lower lobe. 3. A comparison of pulmonary function tests between preoperative and postoperative values showed no significant differences in FVC, FEV1, and FEV1/FVC(p>0.05). 4. All patients were pathologically diagnosed and the most common disease was usual interstitial pneumonia(8/22). In conclusion, thoracoscopic lung biopsy was a safe and effective diagnostic method of diffuse lung disease.

Esophageal perforation: 6 case report / 대한흉부외과학회지

No abstract available.

The effect of intrapleural injection of bupivacaie for pain relief following thoracotomy / 대한흉부외과학회지

No abstract available.

The effect of temperature of cardioplegic solution on myocardial protection from ischemia / 대한흉부외과학회지

No abstract available.

A case of primary malignant fibrous histiocytoma of the lung / 결핵

No abstract available.

Palliative Surgery for Tetralogy of Fallot: Report of 43 Cases

Forty three cases of the Tetralogy of Fallot for whom palliative surgical treatment was performed at the Department of Thoracic Surgery from January 1962 to October 1971 were reviewed in this study. 1. Sex ratio of the observed patients was 1.9:1, showing relating relatively high incidence on the male patients. 2. The age distribution in the series ranged from 2 to 24 years of age. and 31 patients were under 10 years of age. 3. On the electrocardiogram right ventricular hypertrophy pattern was observed in all of the patients and right axis deviation patern was observed in all except two cases which had dextrocardia and situs inversus visceralis. 4. The so-called "Pentalogy of Fallot" associated with atrial septal defect was observable in 7 cases and one of the pentalogy case had persistent left superior vena cava. Dextrocardia with situs inversus visceralis was observed in two cases. 5. Procedures employed in this series were as follows; Glenn operation in 13 cases, Bakulev operation in 1 cases, Blalock operation in 16 cases, Brock operation in 3 cases, Waterston's operation in 10 cases. 6. The operative mortality was 18.6% (8 cases).;i.e., 2 cases after Glenn operation, 2 cases after Brock operation, 1 case after Blalock operation, and 3 cases during or following Waterston's operation.