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Coronary Artery Bypass Graft in Patient with Advanced Left Ventricular Dysfunction (중등도 이상의 좌심실 기능 부전 환자에서의 관상동 우회술의 임상 분석)

  • 정종필;김승우;신제균
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.901-908
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    • 2001
  • Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1%) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98%) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84%) and first degree of Rentrop classification(16 cases, 52%) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

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Comparison of the Mid-term Changes at the Remnant Distal Aorta after Aortic Arch Replacement or Ascending Aortic Replacement for Treating Type A Aortic Dissection (A형 급성대동맥박리증에서 대동맥궁치환술과 상행대동맥치환술 후 잔존 원위부 대동맥의 변화에 대한 중기 관찰 비교)

  • Cho, Kwang-Jo;Woo, Jong-Su;Bang, Jung-Hee;Choi, Pill-Jo
    • Journal of Chest Surgery
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    • v.40 no.6 s.275
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    • pp.414-419
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    • 2007
  • Background: Replacing the ascending aorta is a standard surgical option for treating acute type A aortic dissection. But replacing the aortic arch has recently been reported as an acceptable procedure for this disease. We compared the effects of aortic arch replacement for treating acute type A aortic dissection with the effects of ascending aortic replacement. Material and Method: From 2002 to 2006, 25 patients undewent surgical treatment for acute type A aortic dissection, 12 patients undewent ascending aortic replacement and 13 patients underwent aortic arch replacement. Among the aortic arch group, an additional distal stent-graft was inserted during the operation in 5 patients. 19 patients (11 arch replaced patients and 8 ascending aortic replaced patients) were followed up at the out patient clinic for an average of $756{\pm}373$ days. All the patients undewent CT scanning and we analyzed their distal aortic segments. Result: 4 patients who underwent ascending aortic replacement died, so the overall mortality rate was 16%. Among the 11 long term followed-up arch replacement patients, 2 patients (18.1 %) developed distal aortic dilatation and one of them underwent thoracoabdominal aortic replacement later on. However, among the 8 the ascending aortic replaced patients, 5 patients (62.5%) developed distal aortic dilatation. Conclusion: Aortic arch replacement is one of the safe options for treating acute type A aortic dissection. Aortic arch replacement for treating acute type A aortic dissection could contribute to a reduced distal aortic dilatation rate and fewer secondary aortic procedures.

Surgical Results for Treating Postpneumonectomy Empyema with BPF by Using an Omental Pedicled Flap and Thoracoplasty (전폐절제술 후 기관지 흉막루를 동반한 농흉에서 유경성 대망 이식편과 흉곽성형술을 이용한 수술적 치료에 대한 임상 고찰)

  • Jeong, Seong-Cheol;Kim, Mi-Jung;Song, Chang-Min;Kim, Woo-Shik;Shin, Yong-Chul;Kim, Byung-Yul
    • Journal of Chest Surgery
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    • v.40 no.6 s.275
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    • pp.420-427
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    • 2007
  • Background: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. Material and Mehod: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: $45.9{\pm}9$ years). The patients were followed up for a mean of 58 months (median: 28 months, range: $6{\sim}169$). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema, Result: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). Conclusion: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to 75-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.

The Implementation and limits of Involuntary Detention of the Tuberculosis Prevention Act (결핵예방법의 격리명령의 실행과 한계에 관하여)

  • Kim, Jang Han
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.55-84
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    • 2015
  • The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.

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A Study on the Damage of Pine Stand by Snowfall (항설(降雪)에 의(依)한 소나무 임분(林分)의 피해(被害)에 관(關)한 연구(硏究))

  • Ma, Ho Seop;Kang, Wee Pyeong;Kim, Jai Saing
    • Journal of Korean Society of Forest Science
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    • v.73 no.1
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    • pp.63-69
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    • 1986
  • In general, the snow injury in forestry is an unusual disaster. The degree of snow injury varies greatly depending on stand density and the local topography. This study was conducted to investigate the snow injury in analyzing the demaged by snow-fall in Jinju, Gyeongsangnamdo. The results obtained were summarized as follow; Among 466 total damaged trees, 425 trees were broken and 41 trees were uprooted, the ratio of damage were 5.22%, 2.49%, 0.92% and 0.2% for Pinus densiflora, Pinus thunbergii, Pinus rigida, Alnus hirsuta respectively. The 95% of the damage trees were in the range of 3 to 11 m for height and in the range of 3 to 20 cm for D. B. H.. The directions of the damage trees had a large influence by direction of the wind, but they shown at high tendency to aspect of the slope relatively. The 82% of the damaged trees ranged from 11 to 24 age. The ratio of broken height ($H_B/H$) indicated that the damage was most frequent in the part of stem as 24%, 45%, 31% in the part of the root collar (0.1), stem (0.2-0.4), crown (0.5-1.0) respectively. In general, trees with stem-form coefficient ($H_B/D$) over 0.7-0.8 are apt to suffer by snow damage. The average of stem-form coefficient of trees in this area was 1.06. Therefore, the ratio of damage was high tendency as 3.14%. These results indicate that it is necessary to apply pertinent tending which will increase in resistance of snow damage. As avalanches from the flank of soil erosion rise in an importance matter in present, it should also be considered to measures for prevention and restoration.

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Media Scholars and Power: The politicized intellectuals hanging on the dangerous rope (언론학자와 권력: 정치화된 지성의 위험한 줄타기)

  • Choi, Nakjin;Kim, Sunghae
    • Korean Journal of Legislative Studies
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    • v.22 no.2
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    • pp.113-156
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    • 2016
  • Media scholars take a lion stake in power circle. Not only do they take a part in media policies but seize prestigious positions like board members in Korea Communication Commission(KCC). Unfortunately, though, little has been known about who they are, what qualifications they have, and whether they meet public interests. This paper attempts to unveil the mechanism of those politicized intellectuals who are specialized on the media. Two categories divided into 'representative' and 'expertise' are employed for this purpose. On the one hand, the representative means the degree of committment into such public services as participation in conferences or non-profit organizations. On the other hand, the number of research articles, books and projects belong to the expertise. Evaluation levels consist of 'excellence, good and average' were allocated to those scholars who are(were) in 'Power Hole,' where decision makings come into being. Some interesting observations were made though this study. First of all, such criteria as representative and expertise vaguely suggested by the laws were hardly fit into those intellectuals, Rarely did they commit into public service let alone showing vigilance in academic activities. Secondly, both ideological loyalty and political activities in line with the government had much to do with taking such positions. Thirdly, not surprisingly, it showed that to graduate from Seoul National University and have Ph.D. degree from U.S.A. was one of the most essential factors. In final, most of them were very good at taking advantage of the press in way of boosting their publicity. To attend at policy making processes either in form of board members or advisers is inevitable for media experts. However, as shown in this study, such qualification of public service and academic eagerness shouldn't be underestimated. Academic integrity not selling intelligence solely for private interests needs to be protected as well. The authors hope this study to provide a valuable opportunity to establish a kind of ethical standards in participating into politics.

A study on the optimization of tunnel support patterns using ANN and SVR algorithms (ANN 및 SVR 알고리즘을 활용한 최적 터널지보패턴 선정에 관한 연구)

  • Lee, Je-Kyum;Kim, YangKyun;Lee, Sean Seungwon
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.24 no.6
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    • pp.617-628
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    • 2022
  • A ground support pattern should be designed by properly integrating various support materials in accordance with the rock mass grade when constructing a tunnel, and a technical decision must be made in this process by professionals with vast construction experiences. However, designing supports at the early stage of tunnel design, such as feasibility study or basic design, may be very challenging due to the short timeline, insufficient budget, and deficiency of field data. Meanwhile, the design of the support pattern can be performed more quickly and reliably by utilizing the machine learning technique and the accumulated design data with the rapid increase in tunnel construction in South Korea. Therefore, in this study, the design data and ground exploration data of 48 road tunnels in South Korea were inspected, and data about 19 items, including eight input items (rock type, resistivity, depth, tunnel length, safety index by tunnel length, safety index by rick index, tunnel type, tunnel area) and 11 output items (rock mass grade, two items for shotcrete, three items for rock bolt, three items for steel support, two items for concrete lining), were collected to automatically determine the rock mass class and the support pattern. Three machine learning models (S1, A1, A2) were developed using two machine learning algorithms (SVR, ANN) and organized data. As a result, the A2 model, which applied different loss functions according to the output data format, showed the best performance. This study confirms the potential of support pattern design using machine learning, and it is expected that it will be able to improve the design model by continuously using the model in the actual design, compensating for its shortcomings, and improving its usability.

A Study on the Establishment Case of Technical Standard for Electronic Record Information Package (전자문서 정보패키지 구축 사례 연구 - '공인전자문서보관소 전자문서 정보패키지 기술규격 개발 연구'를 중심으로-)

  • Kim, Sung-Kyum
    • The Korean Journal of Archival Studies
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    • no.16
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    • pp.97-146
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    • 2007
  • Those days when people used paper to make up and manage all kinds of documents in the process of their jobs are gone now. Today electronic types of documents have replaced paper. Unlike paper documents, electronic ones contribute to the maximum job efficiency with their convenience in production and storage. But they too have some disadvantages; it's difficult to distinguish originals and copies like paper documents; it's not easy to examine if there is a change or damage to the documents; they are also prone to alteration and damage by the external influences in the electronic environment; and electronic documents require enormous amounts of workforce and costs for immediate measures to be taken according to the changes to the S/W and H/W environment. Despite all those weaknesses, however, electronic documents increasingly account for more percentage in the current job environment thanks to their job convenience and efficiency of production costs. Both the government and private sector have made efforts to come up with plans to maximize their advantages and minimize their risks at the same time. One of the methods is the Authorized Retention Center which is described in the study. There are a couple of prerequisites for its smooth operation; they should guarantee the legal validity of electronic documents in the administrative aspects and first secure the reliability and authenticity of electronic documents in the technological aspects. Responding to those needs, the Ministry of Commerce, Industry and Energy and the Korea Institute for Electronic Commerce, which were the two main bodies to drive the Authorized Retention Center project, revised the Electronic Commerce Act and supplemented the provisions to guarantee the legal validity of electronic documents in 2005 and conducted researches on the ways to preserve electronic documents for a long term and secure their reliability, which had been demanded by the users of the center, in 2006. In an attempt to fulfill those goals of the Authorized Retention Center, this study researched technical standard for electronic record information package of the center and applied the ISO 14721 information package model that's the standard for the long-term preservation of digital data. It also suggested a process to produce and manage information package so that there would be the SIP, AIP and DIP metadata features for the production, preservation, and utilization by users points of electronic documents and they could be implemented according to the center's policies. Based on the previous study, the study introduced the flow charts among the production and progress process, application methods and packages of technical standard for electronic record information package at the center and suggested some issues that should be consistently researched in the field of records management based on the results.

A Systematic Review of Community Elder Abuse Studies in South Korea (한국 지역사회 거주 노인학대 연구의 체계적 고찰)

  • Kim, Dong Ha;Kang, Serin;Lee, Yoon Kyoung;Cha, Ye Won;Yoo, Seunghyun;Kim, Hongsoo
    • 한국노년학
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    • v.36 no.4
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    • pp.1003-1024
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    • 2016
  • The human rights of older people have gotten more attention recently in South Korea, a country that is in transition to a super-aged society. This study aimed to systematically review studies on elder abuse and related factors among community-dwelling older adults in South Korea over twenty years (1994-2016). We searched major databases (Riss, DBpia, KISS, KMbase, and PubMed) and identified published studies relevant to the topic. Based on inclusion and exclusion criteria related to study quality, a total of 31 studies were selected for this review. We examined types, measurements, and risk factors of elder abuse as well as study designs in the selected studies, guided by Johannesen's theoretical framework on elder abuse. All of the reviewed studies on elder abuse in Korea were cross-sectional studies, most of which focused on older people living in urban areas, using a non-random sampling method. All of the studies focused on certain types of elder abuse only. Some adopted elder-abuse instruments that were not validated, and others used self-developed instruments without psychometric tests. As for the risk factors of elder abuse in South Korea, the physical and mental health of the victims and aggressors impacted the risk of elder abuse, but general sociodemographic factors such as age, sex, and education were less likely to be related to the risk. In addition, decreasing caregiver burden and building elder-friendly communities are important for the prevention of elder abuse. Needed are further empirical studies on elder abuse with a theoretical framework that gives consideration to the unique sociocultural contexts of Korea. It is also recommended to develop instruments to measure elder abuse reflecting the sociocultural contexts of Korea, and to examine the multi-dimensional risk factors of elder abuse.

Changes in Korean Consumers' Perception on Food Preservatives by a Risk Communication Booklet

  • Kim, Suna;Kim, Ji-Sun;Kang, Hee-Jin;Lee, Gunyoung;Lim, Ho Soo;Yun, Sang Soon;Kim, Jeong-Weon
    • Journal of Food Hygiene and Safety
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    • v.33 no.6
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    • pp.417-426
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    • 2018
  • Food preservatives are very important food additives for the biological and chemical safety of processed foods. The purposes of this study were to investigate Korean consumer's perception and information needs on food preservatives, to develop an educational booklet as a risk communication material on food preservatives, and to assess the educational effect of the developed booklet. To understand perception on food preservatives, a self-administered questionnaire survey was conducted by 381 parents having elementary school students at Seoul and Geoynggi area in Korea. Based on the survey results, brain storming of the authors along with consultation from the professionals, we developed a risk communication booklet about food preservatives. It was exposed to 35 parents of elementary school children, and their evaluation was collected by using a questionnaire and analyzed statistically. Respondents considered food safety (44.8%) as the most important factor while purchasing processed foods. They still perceived food additives as the most hazardous one (41.5%), and among those, food preservatives were the most concerned (45.9%). Total 67.7% of the respondents considered the consumption of food preservatives as hazardous or very hazardous. However, 90.6% of respondents did not have any educational experience about food additives and food preservatives. Based on their information needs, a science-based booklet consisting of the definition, classification, safety, intake, and management of food preservatives was developed. When the booklet titled as 'Food preservatives, Just Know Them!' was exposed to the parents via elementary school teacher, their negative perceptions on food additives and food preservatives were changed positively by increasing the understanding level on preservatives from 18.9% to 90.9% and obtaining 72.7% positive answers on their safety. Therefore, it could be used as an effective risk communication material on food preservatives.