• Title/Summary/Keyword: 손상대

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Clinical Application of Stent-graft in Thoracic Aortic Diseases (흉부 대동맥 질환에서 스텐트-그라프트의 임상적 적용)

  • Kim, Kyung-Hwan;Lee, Cheul;Chang, Ji-Min;Chung, Jin-Wook;Ahn, Hyuk;Park, Jae-Hyung
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.698-703
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    • 2001
  • Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

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Surgical Treatment of Primary Lung Cancer (원발성 폐암의 외과적 치료)

  • 김성완;구본원;이응배;전상훈;장봉현;이종태;김규태;강덕식
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.134-141
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    • 1998
  • Primary lung cancer has recently increased progressively in its incidence in Korea. It is clearly evident that surgical resection offers the best offortunity for cure of non-small cell carcinoma. This study was designed to analyse the clinical data of 100 primary non-small cell carcinoma patients who underwent lung resection surgery from January 1992 to July 1995 at the department of Thoracic and Cardiovascular Sugery, Kyungpook National University Hospital. There were 86 males and 14 females(6:1). In the age distribution, the peak incidence was recorded in the seventh decade(43%). The methods of tissue diagnosis were bronchoscopic biopsy in 53 patients(50.5%), percutaneous needle aspiration in 17 patients(16.2%), transbronchial lung biopsy in 11 patients(10.5%), mediastinoscopic biopsy in 2 patients (1.9%), sputum cytology in 2 patients(1.9%), and thoracotomy in 20 patients(19.0%). Fifty-five lobectomies, 22 pneumonectomies, 15 bilobectomies, 2 segmentectomies, 4 sleeve lobectomies, a sleeve pneumonectomy, and a wedge pneumonectomy were performed. Operative mortality occured in 4 cases(sepsis in 2 cases, respiratory failure in 1 case, and acute myocardiac infarction in 1 case). The histologic types of tumor were 67 squamous cell carcinomas, 26 adenocarcinomas, 6 large cell carcinomas, and an adenosquamous cell carcinoma. Eighteen patients with N2 mediastinal lymph node metastases had 8 squamous cell carcinomas(11.9%), 9 adenocarcinomas(34.6%), and a large cell carcinoma(16.7%). The primary tumors in these patients were in the right upper lobe in 4 patients, the right middle and lower lobe in 9 patients, the left upper lobe in 3 patients, and the left lower lobe in 2 patients. With regard to pathologic stages, 45 patients had stage I disease; 13 patients, stage II; 36 patients, stage IIIa; 5 patients, stage IIIb; and 1 patient, stage IV. The overall actuarial survival rate was 77.5% at 12 months, 56.1% at 24 months and 43.7% at 43 months. The actuarial survival rates at 43 months were 81.3% in Stage I, 20.8% in Stage II, 27.9% in Stage IIIa, 25.0% in Stage IIIb and 33.3% in Stage IV. These facts suggest that early detection and surgical resection are recommended for favorable postoperative survival in non-small cell lung cancer.

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The Legal Response and Future Tasks regarding Oil-Spill Damage to Korea - Focusing on the Hebei Spirit oil-spill (한국의 해양유류오염피해에 대한 법적 대응과 과제 - HEBEI SPIRIT호 유류유출사고를 중심으로 -)

  • Han, Sang-Woon
    • Journal of Environmental Policy
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    • v.7 no.3
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    • pp.89-120
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    • 2008
  • With petroleum being a major source of energy in Korea, the quantity of petroleum transported via ocean routes is on its way up due to increased consumption. Due to the increase, more than 300 cases of pollution caused by petroleum occur annually. Moreover, the number of oil-spill accidents is also on the rise. Causes of such accidents, not including the disposal of waste oil on purpose, turn out to be human error during navigation or defects in the vessels, showing that most accidents are caused by humans. Therefore, to prevent future oil spills, it is imperative that navigation efficiency be enhanced by improving the quality of navigators and replacing old vessels with newer ones. Nevertheless, such improvements cannot occur overnight, so long- and mid-term efforts should be made to achieve it institutionally. As large-scale oil-spill accidents can happen at anytime along the coastal waters of Korea, it is necessary to set-up institutional devices which go beyond the compensation limit of 92FC. The current special law regarding this issue has its limits in that it prescribes compensation be supplemented solely by national taxes. Therefore, the setting-up of a new 'national fund' is recommended for consideration rather than to subscribe to the '2003 Convention for the Supplementary Fund'. It is strongly suggested that a National fund be created from fees collected from oil companies based on the risks involved in oil transportation and according to the profiteers pay principle. In addition, a public fund should be created to handle general environmental damage, such as the large-scale destruction of the ecosystem, which is distinct from the economic damage that harms the local people. The posterior responses to the large-scale oil spill have always been unsatisfactory because of the symbolic nature of the disasters included in such accidents. Oil-spills can be prevented in advance, because they are caused by human beings. But once they occur, they inflict long-term damage to both human life and the natural ecosystem. Therefore, the best response to future oil-spills is to work to prevent them.

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Analysis of urine β2-microglobulin in pediatric renal disease (소아 신장질환에서 요 β2-microglobulin검사의 분석)

  • Kim, Dong Woon;Lim, In Seok
    • Clinical and Experimental Pediatrics
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    • v.50 no.4
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    • pp.369-375
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    • 2007
  • Purpose : There have been numerous researches on urine ${\beta}_2$-microglobulin (${\beta}_2$-M) concerned with primary nephrotic syndrome and other glomerular diseases, but not much has been done in relation to pediatric age groups. Thus, our hospital decided to study the relations between the analysis of the test results we have conducted on pediatric patients and renal functions. Methods : Retrospective data analysis was done to 102 patients of ages 0 to 4 with renal diseases with symptoms such as hematuria, edema, and proteinuria who were admitted to Chung-Ang Yongsan Hospital and who participated in 24-hour urine and urine ${\beta}_2$-M excretion test between January of 2003 and January of 2006. Each disease was differentiated as independent variables, and the statistical difference of the results of urine ${\beta}_2$-M excretion of several groups of renal diseases was analyzed with student T-test by using test results as dependent variables. Results : Levels of urine ${\beta}_2$-M excretion of the 102 patients were as follows : 52 had primary nephrotic syndrome [MCNS (n=45, $72{\pm}45{\mu}g/g$ creatinine, ${\mu}g/g-Cr$), MPGN (n=3, $154{\pm}415{\mu}g/g-Cr$), FSGS (n=4, $188{\pm}46{\mu}g/-Cr$], six had APSGN ($93{\pm}404{\mu}g/g-Cr$), seven had IgA nephropathy ($3,414{\pm}106{\mu}g/g-Cr$), 9 had APN ($742{\pm}160{\mu}g/g-Cr$), 16 had cystitis ($179{\pm}168{\mu}g/g-Cr$), and 12 had HSP nephritis ($109{\pm}898{\mu}g/g-Cr$). IgA nephropathy (P<0.05) and APN (P<0.05) were significantly higher than in other renal diseases. Among primary nephrotic syndrome, FSGS with higher results of ${\beta}_2$-microglobulin test had longer treatment period (P<0.01) when compared to the lower groups, but no significant differences in Ccr, BUN, or Cr were observed. Conclusion : IgA nephropathy and APN groups showed significantly higher level of ${\beta}_2$-M excretion value than other groups. Although ${\beta}_2$-microglobulin value is not appropriate as an indicator of general renal function and pathology, it seems to be sufficient in the differential diagnosis of the UTI and in the prediction of the treat-ment period of nephrotic syndrome patients.

Analysis of the Causes of and Risk Factors for Mortality in the Surgical Repair of Interrupted Aortic Arch (대동맥궁 단절증 수술 사망 원인과 위험인자 분석)

  • Kwak Jae Gun;Ban Ji Eun;Kim Woong-Han;Jin Sung Hoon;Kim Yong Jin;Rho Joon Ryang;Bae Eun Jung;Noh Chung Il;Yun Yong Soo;Lee Jeong Ryul
    • Journal of Chest Surgery
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    • v.39 no.2 s.259
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    • pp.99-105
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    • 2006
  • Background: Interrupted aortic arch is a rare congenital heart anomaly which still shows high surgical mortality. In this study, we investigated the causes of and the risk factors for mortality to improve the surgical outcomes for this difficult disease entity. Material and Method: From 1984 to 2004, 42 patients diagnosed as IAA were reviewed retrospectively. Age, body weight at operation, preoperative diagnosis, preoperative PGE1 requirement, type of interrupted aortic arch, degree of left ventricular outflow stenosis, CPB time, and ACC time were the possible risk factors for mortality. Result: There were .14 hospital deaths. Preoperative use of PGE1, need for circulartory assist and aortic cross clamp time proved to be positive risk factors for mortality on univariate analysis. Preoperative left ventricular outflow stenosis was considered a risk factor for mortality but it did not show statistical significance (p-value=0.61). Causes of death included hypoxia due to pulmonary banding, left ventricular outtract stenosis, infection, mitral valve regurgitation, long cardiopulmonary bypass time and failure of coronary transfer failure in TGA patients. Conclusion: In this study, we demonstrated that surgical mortality is still high due to the risk factors including preoperative status and long operative time. However preoperative subaortic dimension was not related statistically to operative death statistically. Adequate preoperative management and short operation time are mandatory for better survival outcome.

The Clinical Experience of the Aortic Arch Replacement in Acute Type A Aortic Dissection (급성대동맥박리증에서 궁치환술의 임상 경험)

  • 조광조;우종수;성시찬;김시호;이길수
    • Journal of Chest Surgery
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    • v.36 no.5
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    • pp.335-342
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    • 2003
  • Background: The aortic arch replacement in an acute aortic dissection is technically demanding procedure that has a lot of postoperative morbidity and high mortality The authors have applied several techniques of aortic arch replacement to overcome the risks of the procedure. Therefore we analysed the results of these techniques. Material and Method: From March of 1996 to July of 2002, we performed 31 cases of the aortic arch replacement in the Stanford type A acute aortic dissection. There were 12 male and 19 female patient's with 59.6$\pm$9.4 years of mean age. Among them 18 cases were treated with the hemiarch replacement and 13 cases with the total arch replacement. We approached the aortic arch through median sternotomy in all but 3 cases of Clamshell incision and applied the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The associated procedures were 2 Bentall's procedures, an axillobifemoral bypass, a femorofemoral bypass and a carotid artery bypass. Result: The postoperative morbidities were 8 acute renal failures, 3 CNS complications, 2 low cardiac output syndromes, 2 malpefusion syndromes, and 2 deep wound infections. There were 4 cases of early hospital mortality which were from an acute renal failure a postoperative bleeding, a low cardiac output syndrome, and a reperfusion syndrome. There were 3 cases of late hospital mortality which were from an acute renal failure, and 2 multiorgan failures. So the total mortality rate was 22.5%. There were 4 cases of late mortality after the discharge, which were form 2 cases of distal anastomotic rupture and 2 cases of intracranial hemorrhage. Conclusion: The hemiarch replacement has relatively shorter operative time and lower hospital mortality but higher late mortality than the total arch replacement. The total arch replacement needs more technically demanding procedure.

Surgical Treatment of Ventricular Tachycardia After Total Correction of Tetralogy of Fallot- Report of a case (TOF 완전교정술후 발생한 심실빈맥의 외과적 절제술 -치험1례보고-)

  • 장병철;김정택
    • Journal of Chest Surgery
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    • v.29 no.6
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    • pp.639-645
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    • 1996
  • A 14-year-old male patient with previous surgical repair of tetralogy of Fallot was admitted with hemodynamically significant ventricular tachycardia (VT). On preoperative electrophysiologic study (EPS), the morphology of documented VT was RBBB of vertical axis with 320 msec cycle length. The endocardial mapping during VT delineated the origin of VT at right ventricular outflow tract (RVOT), where the patch was attached. The clinical VT had a clockwise reentry circuit around the patch with the earliest activation at the same site seen during the preoperative EPS. The previously placed right ventricular outflow patch and fibrous tissue were removed. During a postoperative EPS, it was no longer possible to induce the VT. Ventricular tachycardia following repair of tetralogy of Fallot seen in this patient was caused by a macro-reentry around the right ventricular outflow patch. We were able to ablate the VT with the aid of a detailed mapping of its epicardial activation sequence.

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Effects of Mockhyangjokisan and Haewooljoweetang on the Production of Collagen and the Regeneration of Liver Cells Damaged by Bile Duct Ligation and Dimethylnitrosamine (목향조기산(木香調氣散)과 해울조위탕(解鬱調胃湯)의 실험적(實驗的) 간경변(肝硬變)에 대(對)한 효과(效果))

  • Park, Young-Kweon;Kim, Kang-San;Kang, Byung-Ki;Jeon, Byung-Hun
    • The Journal of Korean Medicine
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    • v.18 no.1
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    • pp.480-498
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    • 1997
  • This study was to investigate the protective and anticirrhotic effects of Mockhyangjokisan and Haewooljoweetang on the liver cirrhosis or fibrosis induced by prolonged bile duct ligation; a new experimental model for cirrhosis and the intraperitoneal injection of dimethylnitrosamine in the rat. The development of fibrosis or cirrhosis and its inhibition by the two prescriptions were examined by the chemical analysis of AST, ALT, and hydroxyproline. The results obtained were as follows. 1. The increase of serum asparate aminotransferase induced by bile duct ligation was inhibited by the administration of Mockhyangjokisan and Haewooljoweetang extract. 2. The increase of serum alanine aminotransferase induced by bile duct ligation was inhibited by the administration of Mockhyangjokisan and Haewooljoweetang extract. 3. The increased level of serum AST and AL T induced by the intraperitoneal injection of dimethylnitrosamine was inhibited by the administration of Mockhyangjokisan and Haewooljoweetang extract. 4. The increasing level of hydroxyproline volume in the damaged liver tissues in the rat was decreased by the oral administration of Mockhyangjokisan and Haewooljoweetang extract. But there were no significant differences in the inhibition rate between the two experimental groups.

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Studies on the Preparation of Fruit Bases for Mixed Yoghurt -Changes in Texture of Fruit Fresh during Heat Treatment- (혼합(混合) 요구르트 과실기제(果實基製)의 가공(加工)에 관한 연구(硏究) -열처리과정중(熱處理過程中) 과실(果實)의 조질변화(組質變化)에 대(對)하여-)

  • Kim, Eun Joo;Choi, Woo Young
    • Korean Journal of Agricultural Science
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    • v.7 no.2
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    • pp.182-189
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    • 1980
  • This experiment was carried out to study on methods of processing the fruit base which is to be used for preparing the fruit yoghurts. Common fruits were compared and peach was chosen among them for this purpose by determing the rate of decrease in hardness during the process of cooking. The maturity, temperature of cooking and methods of peeling were tested to maintain the desirable hardness during the process, and the effects of metallic ion addition on the hardness of the flesh were also studied. The results obtained were as follows. 1. The peaches were keeping the most stable texture during cooking, among common fruits, however the hardness of apples were decreased markedly. Rate of decreases in the flesh hardness were high during the initial stages of cooking then slowered in all fruits tested. 2. Flesh hardness of the peaches were largely affected by the temperature of cooking. And the texture of freeze-stored fruits was severly damaged during thawing, so that could be used only for the limited purposes such as for stirred-type yoghurt. 3. Divalent matallic ions, especially calcium ion, were effective for supporting the flesh hardness of peaches during cooking. 4. The optimal concentration of calcium chloride addition was 0.3%, and this resulted in its final concentration in the product under the legal dosage without any subsquent changes in colour and flavor. 5. The effects of calcium chloride addition were greater in the froms of dices than in those of slices, and in overmature fleshs than in immature ones. 6. Treatment of calcium chloride by soaking the slices or dices of lye-peeled peaches in 0.3% solution was found to be adaptable for the practical process.

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Effect of Inferior Alveolar Nerve Block Anesthesia on Taste Threshold (하치조신경 전달마취가 미각역치에 미치는 영향)

  • Ahn, Young-Joon;Kim, Seung-Whan;Kim, Mee-Eun;Kim, Ki-Suk
    • Journal of Oral Medicine and Pain
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    • v.32 no.2
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    • pp.177-185
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    • 2007
  • Iatrogenic injury following dental treatments and the use of local anesthetics may cause taste disorders. The aims of this study were to investigate quantitative and qualitative changes of taste due to unilateral inferior alveolar nerve block anesthesia and further to evaluate potential effects on taste function related to anesthesia or hypoesthesia of inferior alveolar nerve, possibly occurring after dental procedure. 30 healthy volunteers in their twenties participated in this study (male to female = 1:1, mean age of $24.0{\pm}1.8$ years). Each subject received inferior alveolar nerve block anesthesia on his or her right side with 2% lidocaine HCl containing 1:100,000 epinephrine. Before and after anesthesia, electrogustometric test and chemical localized test for salty, sweet, sour and bitter tastes were performed on the eight sites in the oral cavity; right and left anterior and lateral tongue and circumvallate papilla of the tongue and soft palate. Unilateral inferior alveolar nerve anesthesia produced elevation of electrical taste threshold and reduction of intensity ratings for all 4 tastes (salty, sweet, sour and bitter) over anterior and lateral tongue and circumvallate papilla on the ipsilateral side (p<0.05). Contralateral sides exhibited decreased intensity ratings for salty and sweet taste (p<0.05) on anterior and lateral tongue while there was no significant difference in electrogustometric testing. Based on the results of this study, it is assumed that unilateral local anesthesia on inferior alveolar nerve can affect chorda tympani and glossopharyngeal nerves on the same side, leading to taste deficits. Taste intensity on the contralateral side may, in part, be deteriorated as well.