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都市地域 死亡實體에 關한 硏究

Study on the Status of Death in Urban Area

대한의학협회지 1963년 6권 4호 p.389 ~ 410
원명수 (  ) - 서울대학교 의과대학 예방의학교실

Abstract


1) This is to report 5 cases of congenital Cardiac Anomalies treated by open cardiac surgery. The cases included 3 cases of pure pulmonic stenosis, 1 case of interatrial septal defect of secumdum type and 1 case of interventricular septal defect.
2) The heart-lung apparatus that the author utilized consisted of sigma moter, disposable bag oxygenator and heat- exchanger (Tonokura type, Japan). Blood pressure was measured on brachial artery, superior vena, internal mammary artery, and telethermoneter was placed in the esophagus to measure the body temperature.
3) ECG and BCG reveal RVH pattern in every case except in the case of IVSD where LVH pattern was seen. Rt. sided cardiac catheterization was performed on every case. Pressure gradient between, Rt. ventricle and pulmonary artery was 102, 125 and 134 respectively in 3 cases of pulmonic stenosis. Oxygen gontent difference between the right atrium an vena cava was 3.8 Vol. % in the case of IASD, and 0.2 content difference between Rt. ventricle and Rt. atrium was 2.1 % in the case of IVSD
4) Mild of moderate hypothermia was applied to every case. For hypothermia, ice bag or ice water tub and/or thermoblanket, was used and esophageal temperature was maintained from 28C-34C. General anesthesia with pentothal induction and N(2^)O plus curare for maintainance was applied. Patient was premedicated with chloropromazine, morphine sulfate, and atrophine sulfate.Chloropromazine was found effective in cooling the patients at a rapid rate. In every case, afterdrom of 1℃~3℃ was observed following interruption of colling. The heatexchanger applied in combination with the heartlung machine, facilitated the control of body temperature. Patient was rewarmed with hot bags and/ or thermoblanket. Heparinaqation started 10 minutes prior to by-passing and polybrene was administrated following the removal of femoral arterial canula.
5) Transsternal incision was made on every case. The time required for perfusion ranged from 7 minutes to 25 minutes. Perfusion rate was 25~34cc./kg./min.,2,500~3,000cc. of heparinized blood was used for priming.
6)The result was good in every patient, and there was no mortality. Postoperatively the 1st case with PS.PS was catheterized to show RV pressure down to 40. Hg.(9months post Op.) The other patients have been followed up by ECG, BCG and clinical evalluation. Complications were encountered in 2 cases in whom minor skin infection developed, which subsequently cleared up by irrigation and closure by secondary intention.
7) I believe this paper is first successful case report for extracorporeal ciculation using Pump Oxygenator in Korea

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