Surgical Experience with Infective Endocarditis and Aortic Root Abscess

이삭,박한기,장병철 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: This study was conducted to evaluate the surgical outcomes of active infectiveendocarditis with aortic root abscess formation. Materials and Methods: Between February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients’ mean age was 50±14 years, and 36 patientswere male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed. Results: There were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram,there was significant improvement of left ventricular dimension (LVEDD, from 58.8±11.8 mm to 52.6±8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4±12.0% to 49.8±16.5%, p<0.001). The mean follow-up duration was 68.7±40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantlyimproved from 3.2±0.7 to 1.2±0.4 (p<0.001). Kaplan-Meier estimated survivalat 10 years was 87.2%. Conclusion: Surgical treatment for active endocarditiswith aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.

유아 환아에서 양방향성 상대정맥-폐동맥 단락술의 임상적 효율성

이삭,박영환,박한기,홍순창,곽영태,조범구 대한흉부외과학회 2006 Journal of Chest Surgery (J Chest Surg) Vol.39 No.3

배경: 양방향성 상대정맥-폐동맥 단락술은 복잡심기형의 일차적 고식수술 중 하나로, 여러가지 장점이 있으나 유아 환아들에서는 수술 후 위험성이 높은 것으로 알려져 있다. 대상 및 방법: 1995년부터 2003년까지 48명의 1세 이하 환아들이 연세대학교 심장혈관병원에서 양방향성 상대정맥-폐동맥 단락술을 시행 받았다. 모든 환아들은 단심실로 인한 폰탄수술의 대상자였다. 환아들은 수술당시의 나이에 따라 두 군으로 분류되었다. A군(<3개월, 12명)과 B군(3∼12개월, 36명) 간에 평균 나이(67.58 3.78 vs. 212.91 13.44일)와 평균 몸무게(4.51 0.29 vs. 6.62 0.27 kg)를 제외한 술 전 변수들은 차이가 없었다. 결과: A군에서 연속적으로 측정한 동맥혈 산소 포화도가 통계학적으로 유의하게 낮게 나타났다. 병원 내 사망률은 각각 25%와 19%였다. 추적관찰 기간동안 A군에서 2명, B군에서 5명의 만기 사망이 있었다. 결론: 본 연구에서는 유아기의 환아들에서도, 수술 위험성이 나이가 든 환아들과 비교하여 비슷하여 양방향성 상대정맥-폐동맥 단락술이 후에 시행될 폰탄수술의 위험성을 높일 수 있는 반복적인 고식적 수술을 피할 수 있는 수술방법이라고 생각한다. 하지만, 폐동맥고혈압이나 Heterotaxia 증후군 등이 동반된 고위험군 환아에서는 다른 고식적 수술을 고려하는 것이 좋을 것으로 생각한다.

게이미피케이션 기반 AI 챗봇 활용 수업이 초등학생의 영어 말하기 수행 및 정의적 영역에 미치는 영향

이삭 한국초등영어교육학회 2019 초등영어교육 Vol.25 No.3

This study aims to investigate the effects of Gamification-based artificial intelligence chatbot activities on elementary English learners’ speaking performance and affective domain. To accomplish the purpose, Gamification-based AI chatbot activities were designed and implemented in experimental lessons with the experimental group. The participants were 15 students of grade 6 who performed 3 speaking practice activities and 3 speaking usage activities during experimental lessons. Their performance was, then compared to that of the control group learners. The learners’ speaking performances were recorded and analyzed quantitatively and qualitatively. Their speaking pre/post-test score, and each score of speaking performance during the experimental class were collected and analyzed. Affective aspects were analyzed through survey to assess any differences between the groups or if any changes within the group occurred during the lesson. Semi-structured interview data was also presented to reveal the effects of Gamification-based AI chatbot activity in terms of English speaking, interest, attitude, and confidence. It was found that the Gamification-based AI chatbot activity is effective as English speaking practice and usage to all level learners. Specifically, AI technology seemed to help learners have linguistic awareness and Gamification strategy made learners engaged during tasks. The findings of this study suggest designing classroom-based AI assisted language learning model. Also, more empirical evidence is required through classroom-based action research.

관상동맥루의 임상적 고찰

이삭,박영환,박한기,임상현,홍유선,장병철,강면식,조범구 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.10

Background: Coronary artery fistula is rare congenital anomaly, which account for 0.27~0.40% of all congenital heart diseases. We report the clinical observations of 45 patients with coronary artery fistula. Material and Method: We reviewed all patients presented with or without symptoms of coronary artery fistula between 1987 and 2004. Age ranged from 1 to 83 years. Twenty-six patients were female. The patients were divided into 2 groups according to the presenting symptoms. Twelve patients were in group A (asymptomatic) and 33 patients in group B (symptomatic). The most common clinical presentation in group B was angina (18) followed by dyspnea (7), atypical chest pain (5), syncope (1), fatigue (1), and palpitation (1). Twenty-five patients were associated with other cardiac diseases, which were atrial septal defect (4), coronary artery occlusive disease (6), hypertension (12), and valvular heart disease (2). Result: Patients were followed-up for a mean period of 64.8±62.7 months. There was no complication related to coronary artery fistula during the follow-up period in both group. There was no mortality related to coronary artery fistula. Conclusion: In symptomatic patients, early surgical treatment is recommended considering the low perioperative morbidity. In asymptomatic patients receiving medical treatment, close follow up may be necessary. 배경: 관상동맥루는 모든 선천성 심질환의 0.27∼0.40%를 차지하는 매우 드문 선천성 기형으로 알려져 있다. 저자들은 45명의 관상동맥루 환자들을 대상으로 임상결과를 살펴보았다. 대상 및 방법: 1987년부터 2004년까지 본원에서 증상의 유무와 관계없이 관상동맥루를 진단받은 모든 환자들을 대상으로 하였다. 나이는 1세부터 83세까지의 분포를 보였고, 여자가 26명이었다. 환자들을 증상의 유무에 따라 두 군으로 나누었다. 12명의 환자에서는 증상이 없이 우연히 발견된 경우로 A군으로 분류되었으며, 33명의 환자는 증상이 있는 군으로 B군으로 분류되었다. B군에서 가장 흔한 증상은 흉통(18) 이었고, 그 외에 호흡곤란(7), 비전형적 흉통(5), 실신(1), 피로감(1), 심계항진(1) 등이 있었다. 25명의 환자에서는 다른 심혈관질환이 동반되었는데, 심방중격결손증(4), 관상동맥협착증(6), 고혈압(12), 심장판막질환(2) 등이 있었다. 결과: 평균 추적관찰 기간은 64.8 62.7개월이었다. 추적관찰기간동안 두 군 모두에서 관상동맥루 관련 합병증은 없었다. 또한 관상동맥루 관련 사망 역시 두 군 모두에서 한 예도 없었다. 결론: 수술전후의 사망률이 낮은 것을 고려해 볼 때 증상이 있는 환자들에서는 조기에 수술적 교정을 시행하는 것이 바람직할 것으로 생각된다. 무증상으로 약물치료를 시행하는 환자들에서는 집중적인 추적관찰이 필요할 것으로 생각된다.

Pulmonary Artery Embolization of Intravenous Leiomyomatosis Extending into the Right Atrium

이삭,Do-Kyun Kim,Kyoung Shik Narm,Sang-Ho Cho 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.3

A 43-year-old woman was diagnosed with an intravenous leiomyomatosis at a previous hospital and transferred to our hospital to undergo surgical treatment. Emergency one-stage operation for coincidental removal of intra-abdominal,right atrial, and intravenous masses were planned. Upon arriving at the operating room, she suffered a sudden onset of severe dyspnea and showed hemodynamic instability. Intraoperative TEE showed pulmonary embolization of a right atrial mass. Removal of the pulmonary artery mass and the intra-abdominal mass, and the cardiopulmonary bypass were performed without any complications.

급성 심근경색 후 좌심실류절제술을 받은 환자에서 재 좌심실용적감소술의 시행 치험 1예 보고

이삭,이창영,이교준,유경종 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.1

Surgical anterior ventricular endocardial restoration (SAVER) is a technique that improves hemodynamic status by excluding akinetic or dyskinetic portions of the left ventricle, restores the ventricle to normal elliptical shape and reduces ventricular wall tension to normal level in patients with acute anterior wall myocardial infarction that accompanies aneurysm. We performed redo-SAVER procedure in a 40-year old man with remodeled dilated ventricle who had already underwent LV aneurysmectomy 12 years earlier, and the results were satisfactory. 전벽의 급성심근경색에 의한 좌심실류가 있는 경우 수술적 전측심실내복원술(SAVER)은 좌심실의 무운동과 이상운동 구획을 분리하여 정상적인 좌심실 원형구조와 심근벽의 긴장도를 정상적인 수준으로 감소시켜 줌으로써 혈역학적 향상을 기할 수 있는 술식이다. 저자들은 급성심근경색에 의한 좌심실류로 좌심실류절제술을 시행 받은 과거력이 있는 40세 남환에서 12년간에 걸친 remodelling의 결과로 진행된 말기심부전의 치료방법으로써 다시 수술적 전측심실내복원술을 시행한 후 만족할 만한 결과를 얻었기에 이를 보고하는 바이다.

게임 활용 초등 영어 수업에 대한 교사와 학생의 인식 및 운영 실태 분석

이삭 한국초등영어교육학회 2018 초등영어교육 Vol.24 No.3

The purpose of this study is to analyze the current situation of game-based primary English lessons, and the perceptions that teachers and students have thereof. In order to accomplish this purpose, teacher and student perceptions of the application of game activities in class were analyzed through surveys such as questionnaires and interviews. The survey data were mainly measured quantitatively, while the open-question questionnaire and interview data were analyzed qualitatively to extract the codes of each response. Frequency and percentage were also calculated. Semi-structured interview data were presented to support the findings. It was found that there are significant differences between teacher and student perceptions, and comparative results were also found in intra groups. The observed teacher-specific phenomena related to preparation and usage of game activities in English classes were also presented. Eight significant elements were found to be needed when designing and implementing game activities. The findings of this study suggest the needs to gamify English lessons, and to take critical perspective of implementing game-based primary English learning.

Clinical Results of Minimally Invasive Open-Heart Surgery in Patients with Mitral Valve Disease: Comparison of Parasternal and Low-Sternal Approach

이삭,장병철,임상현,홍유선,유경종,강면식 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.2

Clinical results of minimally invasive mitral valve surgery were retrospectively reviewed, and two different surgical approaches were compared in this study. Between 1997 and 2004, a total of 86 patients with mitral valve disease underwent minimally invasive surgery at theYonsei University Cardiovascular Center. Age of patients averaged 41.6±14.0 years and 69 patients were female. Surgical approach included low- sternal incisions with mini-sternotomy, and right parasternal or thoracotomy approach. Either direct aortic or femoral arterial and bicaval cannulations were used in all patients. Patients were divided into two groups according to the method of surgical approach (parasternal (P) vs low-sternal (L)), and the results were compared. Postoperative NYHA functional class improved to 1.1±0.4 in all patients (no significant statistical difference between two groups). Mean wound length (P: 9.21 ±1.10 vs L: 11.24±0.82cm, p<0.05), and mechanical ventilation time (P: 10.42±4.36 vs L: 12.90±5.00 min, p=0.04) was significantly shorter in parasternal group, and mean operation time(P:294.74±59.41 vs. L:259.31±54.36 min, p=0.03) was significantly shorter in low-sternal group. Mean cardiopulmonary bypass time, and aortic cross clamp time was also shorter in low-sternal group without statistical difference. There were 2 minor wound complications in all patients (p=NS), and no hospital death. Comparing the two different surgical approach of minimally invasive mitral valve surgery, parasternal approach is thought to be more beneficial in reducing postoperative scar, and intubation time.

Acupuncture Induced Necrotizing Aortitis with Infected Pseudoaneurysm Formation

이삭,임상현,김도균,주현철 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.2

Necrotizing aortitis is a rare and life-threatening complication of local or generalized bacterial infections and most commonly affects the abdominal aorta. We described a case of a 79-year-old man with an acupuncture-induced bacterial aortitis associated with pseudoaneurysm formation causing near rupture. The patient underwent emergent explolapartomy, resection of the infected aorta, wide debridement of surrounding infected tissues, and extra-anatomic axillary to bifemoral graft bypass. The microbiologic examination revealed Escherichia coli and methicillin resistant Staphylococcus aureus (MRSA). Necrotizing aortitis is very serious and fatal disease, careful history taking as well as rapid diagnosis and urgent treatment are of critical importance.

Bentall 수술 10년 후 발생된 좌관상동맥 가성동맥류의 수술 치료

이삭,홍유선,강면식,임상현,장병철 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.3

대동맥 wrap-inclusion 술식은 고유의 Bentall 수술에서 수술 후 지나친 수술의 예방을 위해 자주 사용되었다. 비록 이 수술이 대동맥근질환이 있는 환자의 경과를 향상시켰다고는 하나 관상동맥 연결부위의 관상동맥 협착, 비틀림, 가성동맥류 형성 등의 조기 및 만기 합병증의 발생률이 높은 것으로 알려져 있다. Wrap-inclusion 술식을 이용한 복합이식 후 대동맥 주위 가성동맥류 형성은 비교적 드물지만 치명적인 합병증으로 본원에서는 45세의 여자 환자에서 inclusion technique으로 Bentall수술을 받은 후 10년만에 발생한 대동맥주위 가성동맥류를 Cabrol 방법을 이용하여 성공적으로 치료하였기에 보고하는 바이다.