• Title/Summary/Keyword: 수술시기

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Rapid, Two-Stage Arterial Switch for Transposition of the Great Arteries with Intact Ventricular Septurn Beyond the Neonatal Period -A Case Report (신생아기를 넘긴 대혈관 전위증 환아에서 단기간에 걸친 2단계 동맥 전환술 -1례 보고-)

  • Yang, Hyeon-Ung;Choe, Jong-Beom
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1121-1124
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    • 1997
  • This is a report of a successful, rapid two-stage arterial switch operation in an infant with dextrotransposition of great arteries with an intact ventricular septum beyond the appropriate time for arterial switch operation.'A 4-month-old female infant was admitted due to severe cyanosis, respiratory insufficiency, and frequent dia rhea secondary to ischemic colitis. Echocardiographic examination presented marked leftward deviation of the interventricular septum, and left and right ventricular pressures as measured by cardiac catheterization were 40/4 mmHg and 85/2 mmHg, respectively. Fifteen days after a preparatory operation (pulmonary artery band with modified right Blalock-Taussig shunt), left ventricular-right ventricular systolic pressure ratio increased to 105/90. Arterial switch operation associated with the division of the right Blalock-Taussig shunt and the removal of pulmonary artery band was performed. A(leer the operation, the infant showed normal cardiac function with no postoperative complication.

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The Effects of Hypercapnia and High Flow on Cerebral Metabolism During Cardiopulmonary Bypass (심폐바이패스 시 고탄산분압과 고관류법이 뇌대사에 미치는 영향)

  • 강도균;최석철;윤영철;최국렬;정신현;황윤호;조광현
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.472-482
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    • 2003
  • Recent studies have demonstrated that cerebral desaturation during rewarming period of CPB was associated with postoperative neurologic dysfunction. The prevention of cerebral desaturation during CPB may reduce the incidences of neurologic and neuropsychological complications. The present study was prospectively undertaken to compare the clinical effects between two strategies (hypercapnic CPB and high flow CPB) to prevent cerebral desaturation for establishing a proper CPB technique. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized into either hypercapnic (Pa$CO_2$ 45~50mmHg, n=18) or high flow group (flow rate 2.75 L/ $m^2$/min and Pa$CO_2$ 35~40mmHg, n=18) during rewarming period of CPB. In each patient, middle cerebral artery blood flow velocity ( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), modified cerebral metabolic rate for oxygen (MCMR $O_2$), cerebral oxygen transport rate ( $T_{E}$ $O_2$), incidence of cerebral desaturation (internal jugular bulb blood oxygen saturation $\leq$ 50%), increased rate of S-100 $\beta$ concentration, and arterial and internal jugular bulb blood gas were measured during the five phases of the operation; Pre-CPB, CPB-10 min (steady-state CPB, nasopharyngeal temperature 29~3$0^{\circ}C$), Rewarm-1 (rewarming phase, nasopharyngeal temperature 33$^{\circ}C$), Rewarm-2 (nasopharyngeal temperature 37$^{\circ}C$), and CPB-off. Incidence of postoperative delirium and duration were assessed in all patients. All variables were compared between the two groups. Result: $V_{MCA}$ (157.88$\pm$10.87 vs 120.00$\pm$6.18%, p=0.006), internal jugular bulb $O_2$ saturation (68.01$\pm$2.75 vs 61.28$\pm$2.87%, p=0.03) and $O_2$ tension (41.01$\pm$2.25 vs 32.02$\pm$ 1,67 mmHg, p=0.03), and $T_{E}$ $O_2$(110.84$\pm$7.41 vs 81.15$\pm$8.11%, p=0.003) at rewarming periods were higher in the hypercapnic group than in the high flow group. C(a-v) $O_2$ (4.0$\pm$0.30 vs 4.84$\pm$0.38 mg/dL, p=0.04), COE (0.36$\pm$0.03 vs 0.42$\pm$0.03, p=0.04), increased rate of S- 100$\beta$ (391.67$\pm$23.40 vs 940.0$\pm$17.02%, p=0.003), and incidence of cerebral desaturation (2 vs 4 patients, p=0.04) at rewarming periods, and duration of postoperative delirium (18 vs 34 hr, p=0.02) were low in the hypercapnic group compared to the high flow group. Conclusion: These results indicate that hypercapnic CPB may provide relatively diminished cerebral injury and beneficial effects for cerebral metabolism relatively compared to high flow CPB.low CPB.

A STUDY ON THE SIZE OF THE PERMANENT TEETH (영구치의 치아크기에 관한 연구)

  • Baik, Byeong-Ju;Park, Jeong-Yeol;Kim, Jae-Gon;Lee, Doo-Cheol
    • Journal of the korean academy of Pediatric Dentistry
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    • v.30 no.3
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    • pp.502-509
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    • 2003
  • After 800 students of Chonbuk National University was examined, 86 people (male : 43, female : 43, mean age : 22.2 years old) was selected as a group of normal occlusion. From their gypsum cast, this conclusion was obtained. 1. Intra-observer measurement errors in buccolingual diameter, maxillary lateral incisors have somewhat bigger errors. In mesiodistal diameter, maxillary first molars and maxillary second molar have bigger numerical value. Mean errors of measurement are 0.051mm at buccolingual diameter of crown and 0.083mm at mesiodistal diameter. 2. Fluctuating asymmetry is 0.030 average in buccolingual diameter, and 0.037 average in mesiodistal diameter. Statistically there are no big differences. 3. Male has longer buccolingual diameter than female in every permanent teeth. Teeth which have statistical difference in buccolingual diameter are maxillary lateral incisor, maxillary canine, maxillary second molar, mandibular central incisor, mandibular canine, mandibular second premolar, and mandibular first molar. In mesiodistal diameter maxillary central incisor, maxillary canine, and mandibular first molar have statistically difference. 4. Tooth which has the biggest difference depending on gender is maxillary lateral incisor in buccolingual diameter and mandibular canine in mesiodistal diameter. 5. Both sexes have similar crown index. Male has bigger value of crown module measurement and crown area measurement in every tooth. Crown area considered as size of tooth from occlusal surface was bigger in male than in female statistically except some teeth, maxillary first premolar, mandibular lateral incisor, first premolar and second premolar.

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CASE REPORTS OF TREATMENT OF ERUPTION-DISTURBED MX. FIRST MOLAR BY SURGICAL EXPOSURE (맹출 장애를 가진 상악 제1대구치의 외과적 노출을 이용한 치험례)

  • Seok, Choong-Ki;Nam, Dong-Woo;Kim, Hyun-Jung;Kim, Young-Jin;Nam, Soon-Hyeun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.1
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    • pp.11-18
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    • 2004
  • The eruption of permanent teeth represents the movement in the alveolar bone before appearance in oral cavity, to the occlusal plane after appearance in oral cavity, and additive movement after reaching th the occlusal plane. Tooth eruption is mostly controlled by genetic signals. The eruption stage is divided to preeruptive alveolar stage, alveolar bone stage, mucosal stage according to the process of growth and development. If the disturbance is occured in any stage of eruption, tooth does not erupt. The cause of eruption disturbance are ectopic position of the tooth germ, obstruction of the eruption path and defects in the follicle or PDL. In the treatment of eruption disturbance, surgical procedures are commonly used. There are three kind of surgical procedure ; surgical exposure, surgical repositioning, surgical exposure and traction Surgical exposure is basic procedure. This involves removal of mucosa, bone, lesion that are surrounding the teeth, dental sac when necessary to maintain a patent channel between the crown and the normal eruptive path into the oral cavity. To ensure this patency, many techniques including cementation of a celluloid crown, packing with gutta-percha or zinc oxide-eugenol, or a surgical pack, are used. When surgical exposure is conducted, operators should not expose any part of cervical root cement and not injure periodontium or root of adjunct tooth. After surgical exposure, tooth should be surrounded by keratinized gingiva. There is direct relationship between the extent of development of pathophysiologic aberrations and the intensity of the manipulative injury inflicted on the tooth by surgical treatment, so operator should consider this thing. In these cases, surgical exposure is conducted on Maxillary 1st milars that have a eruption disturbance and improve the eruption disturbance effectively.

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INHIBITORY EFFECT OF Er:YAG LASER ON THE GROWTH OF STREPTOCOCCUS MUTANS (Er:YAG 레이저 조사가 Streptococcus mutans의 증식억제에 미치는 효과)

  • Song, Gwang-Chul;Lee, Chang-Seop;Lee, Sang-Ho;Lee, Nan-Young
    • Journal of the korean academy of Pediatric Dentistry
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    • v.30 no.1
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    • pp.15-24
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    • 2003
  • The purpose of this study is to investigate the sterilization effect of Er:YAG laser against the intraoral acid producing bacterium, S. mutans, by irradiating the culture solution containing S. mutans KCTC 3065 with Er:YAG laser having a $650{\mu}m$ diameter beam through the non-contact method. We obtained the following results after examining the temperature changes of the culture solution, numbers of bacterial colonies, and acid-producing ability and attaching ability on teeth by measuring the amount of extracellular polysaccharide produced by S. mutans. The number of bacterial colony was decreased in $10{\mu}l$ culture solution irradiated with laser in overall compared to the control solution. The number decreased as the irradiation intensity and pulse repetition rate were larger and as the exposure time was increased. However, it did not change significantly in $100{\mu}l$ culture solution compared to the control solution. Although the acid-producing ability of S. mutans was inhibited for a certain duration after laser irradiation in 10r1 bacterial culture solution, it did not change in $100{\mu}m$ solution compared with the control solution. The amount of extracellular polysaccharide synthesized by S. mutans was partially decreased through laser irradiation in $10{\mu}m$ culture solution but did not change in $100{\mu}m$ culture solution. Based on these findings, we concluded that Er:YAG laser has an sterilization effect on S. mutans in which we presume that the mechanism is through the heat effect rather than the mechanical effect from development of ultrasound.

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An Experimental Study on Dynamic Behavior Evaluation of Transitional Track (접속부 궤도의 동적거동분석을 위한 실험적 연구)

  • Cho, Sung-Jung;Choi, Jung-Youl;Chun, Dae-Sung;Kim, Man-Cheol;Park, Yong-Gul
    • Proceedings of the KSR Conference
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    • 2007.11a
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    • pp.1379-1385
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    • 2007
  • In domestic transitional zone design, there is regulation to prevent generation of irregular substructure behaviors that negatively influence in prevention of plasticity settlement on approach section and contact section as well as relieve overall track rigidity by reducing sectional foundation and track stiffness difference, but design guideline that considers dynamic behavior of transitional track in actual service line is very insignificant. Therefore in this study, characteristics of transitional track dynamic behaviors by substructure stiffness are researched and measured dynamic response of transitional track by substructure stiffness in order to prove correlation between substructure and track and calculate elasticity(stiffness) and track load of transitional track by using measurement and formula to provide basic information for developing design guideline considering dynamic behavior of service line transitional track.

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A Study on the Permeability Reduction Methods of the Riverbed Ground during Urban Railway Tunnel construction (도시철도터널공사 시 하저통과구간의 지반투수저하 공법에 대한 연구)

  • Kim, Joon-Jeong;Cho, Kook-Hwan;Lee, Jun-Seok
    • Proceedings of the KSR Conference
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    • 2007.11a
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    • pp.551-557
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    • 2007
  • This paper describes a study on the permeability reduction of the riverbed ground during urban railway tunnel construction. The research is mainly concentrated on the study of the grouting or injection methods among permeability reduction methods which can be adapted in the riverbed ground. Firstly, the various grouting methods are theoretically reviewed and compared based on the previous research papers and case study results. It is also evaluated the grouting methods in view of a safe construction of the river crossing railway tunnel. Baced on the literature review and previous construction data, the design technology of grouting methods considering the long term hydro-geological behaviour in the riverbed, is suggested. Two injection methods namely, Natural Durable Stabilizer(N.D.S) and Space-Multi Injaction Grouting(S.M.I) methods, are introduced as new approach methods which can be adopted to modify the riverbed ground. In order to evaluate the ground that grouted and modified by the N.D.S and S.M.I method, the pilot test programmes including the field and laboratory permeability tests, are carried out in the river crossing tunnel construction sites. The results obtained from pilot test programme, are also reviewed. In conclusion, the grouting efficiency of the S.M.I method using the non-alcalimeter silica sol is better than that of NDS method using cement. In addition, it hopes that the research results are contributed to develop the grouting design technology.

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Clinical Trial of Nasal Flumazenil Administration (플루마제닐의 경비 투여)

  • Hong, Soo-Jin;Kim, Hyun-Jung;Yum, Kwang-Won
    • Journal of the korean academy of Pediatric Dentistry
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    • v.28 no.3
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    • pp.441-446
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    • 2001
  • Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

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DEVELOPMENT OF THREE DIMENSIONAL MEASURING PROGRAM WITH FRONTAL AND LATERAL CEPHALOMETRIC RADIOGRAPHS -PART 1. COMPUTATION OF THE THREE-DIMENSIONAL COORDINATES BY COMPENSATION OF THE ERROR OF THE HEAD POSITION IN ORDINARY NON-BIPLANAR CEPHALOSTAT- (정모 및 측모 두부 방사선 규격사진을 이용한 3차원 계측 프로그램의 개발 -1. 단일 방사선원으로 촬영된 두부 방사선사진의 두부 위치 보정을 이용한 3차원 좌표의 산출-)

  • Lee, Geun-Ho;Lee, Sang-Han;Jang, Hyon-Joong;Kwon, Tae-Geon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.3
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    • pp.214-220
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    • 2001
  • The clinical application of the three-dimensional radiographic technique had been limited to standard Broadbent-Bolton cephalometer with biplanar stereoradiography. We developed a new method for compensating the error of head position in ordinary non-biplanar cephalostat. It became to possible to use the three dimensional cephalogram commonly in clinical bases. 1. The method of methemetical compensation of head positioning error in non-biplanar condition was evaluated with dry skull. The error of the method of first and the second trial was $0.46{\pm}1.21$, $0.33{\pm}0.90mm$, which means the error of the head positioning correction in conventional cephalogram was within clinical acceptance. 2. The reproducibility of this system for clinical application was 0.54 mm ($-2.99{\sim}2.26mm$) which defines the absolute mean difference of the first and second trial. Compare to the The landmark identification error $1.2{\pm}1.6mm$, the error of the measurement was within the range of landmark identification error. The result indicates the adequate clinical accuracy of the computation of three-dimensional coordinates by compensation of the error of the head position in ordinary non-biplanar cephalostat.

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Preparation and Characteristics of Bread by Medicinal Herb Composites with Immunostimulating Activity (면역활성을 가진 생약복합물을 이용한 빵의 제조 및 특성)

  • Kim, Hee-Suk;Kang, Jin-Soon
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.37 no.1
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    • pp.109-116
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    • 2008
  • In this study, the breads with medicinal herbs (MH) composites showing immunostimulating activity were prepared and their characteristics were examined. Fourteen kinds of medicinal herbs were extracted with hot water and divided into 3 groups (MH-1, MH-2, MH-3) based on their contents. All groups showed immunostimulating activity in terms of macrophage phagocytosis, nitrite production, cytostatic activity and cytokine production. In the preparation of breads containing MH extracts of various contents (0, 30, 50, 70, and 100%), there was no significant difference among dough pHs of all groups after first fermentation, but loaf volume was significantly (p<0.05) increased in 70% added group while decreased in 30%, 50%, and 100% added groups compared to the control. The "a" and "b" values of bread crumb increased with the content of MH extracts while "L" value decreased, but these values of bread crust were similar to the control group. Most improvements in hardness, adhesiveness, gumminess and chewiness of bread were noticed by the addition of 70% MH extracts, but those of springiness, cohesiveness and resilience were mostly by the 50% addition ones. Through the sensory evaluation, it was revealed that mouth feeling, taste and overall preference decreased at breads containing 70% and 100% extracts, although appearance and crumb texture were not significantly (p<0.05) different among all groups.