• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.910-916
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• 2009

Purpose : The arterial switch operation (ASO) has become the preferred procedure for the surgical management of transposition of the great arteries (TGA). We conducted a retrospective evaluation of our experience in 30 patients seen from January 2003 to July 2008, in order to determine outcomes and related risk factors after the arterial switch operation. Methods : Patients charts, surgical reports, and echocardiograms were retrospectively reviewed. And they were analyzed in 2 different groups: complex (n=16) versus simple TGAs (n=14). Complex TGAs are TGAs with VSD or the Taussig-Bing anomaly with or without aortic arch anomalies. Simple TGAs are defined as TGAs with intact ventricular septum having no such anomalies. Median follow-up time was 44 months (3-63 months). Results : Hospital mortality was 0%. However, follow-up echocardiographies revealed potential complications, including stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, and right or left ventricular outflow tract obstructions. Great arterial relationship (side-by-side), association of aortic arch anomalies, and the existence of the Taussig- Bing anomaly were assessed as significant risk factors of neo-aortic and/or neo-pulmonary valvar regurgitation in this series. On the other hand, right or left ventricular outflow tract obstructions were more frequently found in patients demonstrating VSD, side-by-side positioned great arteries, or associated coronary anomalies. Conclusion : The ASO is the procedure of choice in the treatment of TGA. However, special attention and follow-ups are needed to detect residual problems like the stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, as well as ventricular outflow tract obstructions.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.287-291
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• 2006

Purpose : Aneurysms of sinus valsalva are rare anormalies thought to be primarily congenital in origin, progressing into death by acute heart failure in cases of rupture. Surgical correction is the only method of treatment. With these clinical implications, we reviewed the clinical characteristics and surgical results of patients with ruptured sinus of valsalva aneurysm. Methods : Between January 1991 and February 2004, 17 patients with ruptured sinus of valsalva aneurysm were retrospectively reviewed for their clinical symptoms, physical findings, past history, coexistent cardiac anormalies, surgical results, and mid-term prognosis. Results : The 17 patients included 13 men and four women, with a mean age of 30 years(10-59 years). Preoperatively accompanying cardiac anormalies were ventricular septal defect(VSD, eight cases of doubly committed juxta-arterial VSD) and aortic insufficiency(11 cases). During operations, patterns of fistulous tracts were found to be right colonary sinus-right ventricle in 13 patients, right coronary sinus-right atrium in one, noncoronary sinus - right ventricle in two, noncoronary sinus - right atrium in one, and VSD was noticed in 14 patients(all were doubly committed juxta-arterial in type). The defects were closed with a patch in 13 patients, without a patch in four, with concommitant aortic valve replacement in four and with aortic valvuloplasty in two. There were no mortalities during operations or the mid-term follow-up periods($40{\pm}49$ months). Conclusion : Because, at least in Orientals, VSD(especially doubly committed juxta-arterial) was accompanied in large numbers of patients with aneurysms of sinus valsalva, preoperative evaluations of this congenital heart disease should be made very careful. And we may need to revise the algorithm of treatment policy in small sized doubly committed juxta-arterial VSD.

• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.1012-1017
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• 2008

Purpose : This study aimed to assess the mechanical properties of the abdominal aorta in school-aged patients treated for Kawasaki disease and in normal, healthy children. Methods : This study examined 28 children with Kawasaki disease who had been followed up on and 30 healthy subjects of the same age and gender. We recorded systolic (Ps) and diastolic (Pd) blood pressure values and the aortic diameter at both minimum diastolic (Dd) and maximum systolic (Ds) expansion using two-dimensional echocardiography. These measurements were used to determine 1) aortic strain: S=(Ds-Dd)/Dd; 2) pressure strain elastic modulus: Ep=(Ps-Pd)/S; and 3) normalized Ep: $Ep^*=Ep/Pd$. Results : Ep (P=0.008) and $Ep^*$ (P=0.043) of the Kawasaki disease group were relatively high compared to those of the control group. Ep (P=0.002) and $Ep^*$ (P=0.015) of patients with coronary aneurysm were also relatively high compared with those of patients without coronary aneurysm, but lipid profiles did not differ, except for homocysteine (P=0.008). Therefore, in patients with coronary aneurysm, aortic stiffness was higher, compared to not only the control group but also patients without coronary aneurysm. However, in patients without coronary aneurysm, aortic stiffness was not significant, different compared to the control group. Conclusion : Measuring aortic distensibility may be helpful in assessing the risk of early atheroscletic change in the long-term management of Kawasaki disease.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.542-547
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• 2002

Background: Postpneumonectomy empyema(PPE) is an infrequent but potentially life-threatening complication. To date, various surgical efforts have been made to manage this complication. We reviewed our 20-year surgical experience of PPE and long-term follow-up data. Material and Method: Total of 37 patients who were treated for PPE between fan, 1980 and Jun, 2000 were included. Various clinical factors such as micro-organism, operative method and timing, presence of bronchopleural fistula(BPF), underlying disease and fate of empyema cavity were retrospectively reviewed and analyzed. Result: Majority of patients(34) underwent Eloesser operation for effective drainage. There was only one operative mortality. The causative organisms were Staphylococcus species and Pseudomonas species in 46% BPF was found in 20 cases, among which spontaneous closures took place in 4 cases. The chest wall was closed in 40%(8/20) of patients with BPF, compared to 59%(10/17) without BPF. The closure rate was statistically better in patients without BPF(p=0.006). Even though the patients with benign disease showed higher closure rate(50%) than those with lung cancer (31%), the difference was not significant(p=0.25). Conclusion: Eloesser procedure was an effective method for initial drainage of PPE cavity with low operative mortality. Given the findings of low spontaneous closure rate of BPF, aggressive approach to close the BPF is mandatory to achieve the final goal of chest wall closure. It was found that majority of patients still left their chest cavity opened, even after controlling the active inflammation of the empyema cavity. More aggnessive approach for chest wall closure is recommended in all patents with benign disease and in selective patients with lung cancer if there is no evidence of recurrence at several years after the initial operation.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.341-350
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• 2007

Background: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. Material and Method: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. Result: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. Conclusion: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.737-744
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• 2005

Purpose : Infants and children with cardiovascular diseases often present with respiratory symptoms. However, missed or delayed evaluation for potential airway problem may complicate overall prognosis. The aim of this study is to determine the clinical characteristics of these patients and explore the cause of airway problem. Methods : We reviewed the medical records of 64 patients(M : F=33:31, mean age : $6.3{\pm}7.5$ months) whose airway problems were proven by computed tomography or bronchoscopy in perioperative periods at the Asan Medical Center from January 1997 to June 2004. Patients were divided into two groups based on the duration of ventilator care : ${\leq}7$ days(group 1 : 23 cases, M : F=10 : 13) and >7 days(group 2 : 41 cases, M : F=23 : 18). Results : The patients in group 2 significantly developed more post-operative respiratory symptoms than group 1(P<0.001) and had more airway problems including extrinsic obstruction, intrinsic anomaly, and combined problem than group 1 although not significantly different(P=0.082). Among underlying diseases, the most common diseases were vascular anomaly(26.2 percent) and aortic arch anomaly(26.2 percent) in group 1 and pulmonary atresia with ventricular septal defect(22.4 percent) in group 2. The most frequent respiratory symptoms were recurrent wheezing pre-operatively and failure of ventilator weaning post-operatively. The major types of airway anomaly were tracheomalacia and tracheal stenosis(in each case 18.2 percent). Nineteen patients with persistent airway problems underwent aortopexy or other vascular correction. Of the 19 patients, 13(68.4 percent) were improved, but 2 failed in weaning ventilator and 4 died of non-airway problems. Conclusion : Early evaluation and treatment for potential airway problems may affect natural or surgical prognosis in patients with cardiovascular diseases presenting with respiratory symptoms.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.456-465
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• 1998

Cardiopulmonary bypass(CPB) in children is associated with the accumulation of body water after cardiac operation, as a consequence of an inflammatory capillary leak. Following work by Elliott in 1991, modified ultrafiltration(MUF) was introduced after bypass as a means of hemoconcentrating patients and a potential way of removing water from the tissues. We have carried out a prospective randomized study of 20 children undergoing open heart surgery, comparing MUF with nonfiltered controls. MUF was carried out for a mean of 18.9 minutes after completion of CPB to a hematocrit of 37.1%(mean). The mean water volulme removed by the ultrafiltration was 38.4 ml/kg and the mean blood volume retransfused from the oxygenator during the ultrafiltration was 32.1 ml/kg. Fluid balance, hemodynamics, hematocrit, osmolarity and dosage of drug treatment were recorded for 4∼12 hours postoperatively. The results were analyzed using Student t-test and ANOVA, comparing controls(n=10) to MUF(n=10). Blood loss(ml/kg/24hr) was 14.5(mean) in MUF versus 13.7 in controls; blood transfused(ml/kg/24hr) 6.6 in MUF versus 15.2 in controls; plasma transfused(ml/kg/24hr) 65.7 in MUF versus 59.6 in controls. There was rise in arterial blood pressure and hematocrit during MUF. Percent rise of systolic blood pressure was 28.8% in MUF versus 18.7% in controls(p=0.366); percent rise of diastolic blood pressure was 28.8% in MUF versus 8.5% in controls(p=0.135); and percent rise of mean blood pressure was 36.2% in MUF versus 8.2% in controls (p=0.086). Percent rise of hematocrit was 40.0% in MUF versus 23.5% in controls(p=0.002). There was no significant difference in the inotropic requirement and the postoperative serum osmolarity between two groups. The number of days on the ventilator, the duration of stay in the intensive care unit, and the postoperative hospital stay were not significantly different between the two groups.

• Journal of the Korean Institute of Gas
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• v.22 no.3
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• pp.74-83
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• 2018

Anyone who wants to install local ventilation system must obtain a permission from the Ministry of Employment and Labor even if he has permission from the Ministry of Environment. This is because not only the Atmospheric Environmental Protection Act, but also the manufacturing industry's hazardous risk prevention plan under Article 48 Clause 2 of the Industrial Safety and Health Act is to be submitted by 15 days before the construction. Under the current Environmental Protection Act, the Ministry of Environment regulates only the emission of pollutants from local exhaust ventilation systems into the atmosphere and the contents of workers' safety and health within industrial sites are managed by the Ministry of Employment and Labor. Even with the approval of the Ministry of Environment, the number of unsuccessful cases by the Ministry of Employment and Labor has increased, causing a growing discontent among the sites due to production delays and additional costs of improvement. In addition, local exhaust systems that are at greater risk of fire explosion have increased the risk of severe industrial accidents due to fire explosion. This is due to insufficient design of air volume, control speed, return speed, duct size, and risk of fire explosion. This is because the criteria and procedures for approval of local exhaust ventilation systems are similar, but the Industrial Safety and Health Act adds additional screening items for safety and safety of workers and fire and explosion. In this study, the Environment Ministry and the Employment and Labor Ministry seek to find a reasonable way to operate the system by comparing local exhaust ventilation system installation approval standards.

• Proceedings of the Korea Water Resources Association Conference
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• 2005.05b
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• pp.1430-1434
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• 2005

금강 유역과 같이 복잡한 하천유역 시스템의 관리를 위해서는 시스템 요소들을 통합적으로 분석할 수 있는 효과적인 의사결정지원 도구가 필요하다. K-MODSIM 모형은 단기 물관리, 장기 운영계획, 가뭄 대비계획 및 물관련 분쟁 해결을 위해 보다 개선된 유역관리 전략을 수립하기 위한 컴퓨터 기반 도구로 개발되었으며, 본 연구에서는 K-MODSIM 모형에 저수지 운영률을 반영하여 유역의 용수배분을 평가하였다. 유역 저수지군 운영 환경 및 제약조건을 반영한 네트워크를 구성한 후, 두 단계의 모형 검정을 수행하였다. 먼저 물리적 검정을 통해서 전체 대상 수계의 상하류 물수지를 검토하고, 다음 단계인 운영 측면의 검정에서 물리적으로 나타나는 상황이 댐 운영이나 제약 조건 등에 부합하는지의 여부를 검토하였다. 대청댐과 용담댐의 통합 운영을 위한 최적 운영률의 개발은 동적계획법 소프트웨어인 CSUDP를 이용하여 수행하였으며, 여기서 사유한 접근법은 음해 추계학적 동적계획법이다. 이 접근방법은 유입량 시계열을 추계학적으로 모의발생시키고, CSUDP 모형은 모의발생시킨 유입량 시계열에 대한 최적운영률을 찾기 위해 사용하며, CSUDP의 최적화 결과에 대한 통계적인 분석을 통해 월단위 운영률을 도출하였다. K-MODSIM 모형에 저수지 운영률을 반영하여 유역의 용수배분을 평가하였다. 유역 저수지군 운영 환경 및 제약조건을 반영한 네트워크를 구성하고, 대청댐과 용담댐의 통합 운영을 위한 최적연계 운영를을 개발하여 다음과 같은 운영 시나리오들을 개발하고 평가하였다. $\cdot$ 금강수계에 대한 용당댐의 영향 평가 $\cdot$ 댐 연계운영시 수요량 변화에 따른 영향 평가 $\cdot$ 하도추적을 고려한 일별모형의 검증 개발된 운영률과 하도추적방법을 K-MODSIM 모형에서 검증하기 위해서 vb.net 스크립트 파일을 개발하여 적용하였다.L이하로 이를 유등천 상류부에 공급할 경우 유등천의 수질은 BOD 6.7mg/L, TN 9.80mg/L, TP 0.90mg/L를 나타낼 것으로 예측된다. 고도처리시설의 도입 후 금강 합류점에서 갑천의 예측 BOD는 7.4mg/L로 현재 9.0mg/L에 비하여 개선되지만 이는 금강수계 오염총량 관리계획의 시$\cdot$도 경계지점 목표수질인 5.9mg/L를 만족시키지 못하므로, 이를 만족시키기 위해서는 방류수 BOD 7.2mg/L이하로 처리해야 할 것으로 판단된다.which support only concepts or image features.방하는 것이 선계기준에 적합한 것으로 나타났다. 밸브 개폐에 따른 수압 변화를 모의한 결과 밸브 개폐도를 적절히 유지하여 필요수량의 확보 및 누수방지대책에 활용할 수 있을 것으로 판단된다.8R(mm)(r^2=0.84)$로 지수적으로 증가하는 경향을 나타내었다. 유거수량은 토성별로 양토를 1.0으로 기준할 때 사양토가 0.86으로 가장 작았고, 식양토 1.09, 식토 1.15로 평가되어 침투수에 비해 토성별 차이가 크게 나타났다. 이는 토성이 세립질일 수록 유거수의 저항이 작기 때문으로 생각된다. 경사에 따라서는 경사도가 증가할수록 증가하였으며 $10\% 경사일 때를 기준으로 $Ro(mm)=Ro_{10}{\times}0.797{\times}e^{-0.021s(\%)}$로 나타났다.천성 승모판 폐쇄 부전등을 초래하는 심각한 선천성 심질환이다. 그러나 진단 즉시 직접 좌관상동맥-대동맥 이식술로 수술적 교정을 해줌으로써 좋은 성적을 기대할 수 있음을 보여주었다.특히 교사들이 중요하게 인식하는 해방적 행동에 대한 목표를 강조하여 적용할 필요가 있음을 시사하고 있다.교하여 유의한 차이가 관찰되지 않았다. 또한 HSP 환자군에서도 $IL1RN^{*}2$ allele 빈도와

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.7
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• pp.4508-4515
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• 2014

Real-time body detection has been researched actively. On the other hand, the detection rate of color distorted images is low because most existing detection methods use static skin color model. Therefore, this paper proposes a new method for detecting the skin color region using a gradient map and saturation features. The basic procedure of the proposed method sequentially consists of creating a gradient map, extracting a gradient feature of skin regions, noise removal using the saturation features of skin, creating a cluster for extraction regions, detecting skin regions using cluster information, and verifying the results. This method uses features other than the color to strengthen skin detection not affected by light, race, age, individual features, etc. The results of the detection rate showed that the proposed method is 10% or more higher than the traditional methods.