• Journal of Chest Surgery
• /
• v.38 no.5 s.250
• /
• pp.382-384
• /
• 2005

Background: It is very difficult to choose the ideal valved conduit used in right ventricle outflow reconstruction in child. We can use the cryopreserved homograft but there is a limit of application because of its difficulties in the size matching and supply capacity. The $Shelhigh^{(R)}$porcine-valved conduit is commercially available and used as an alternative choice in these days. We report two cases of early Shelhigh conduit failure in right ventricular outflow tract after Ross operation in congenital aortic stenosis.

• Journal of Chest Surgery
• /
• v.40 no.10
• /
• pp.715-718
• /
• 2007

Neurogenic tumors of the brachial plexus are rare. An malignant schwannoma originates from the schwan cells or nerve sheath cells. Occasionally, schwannomas are associated with Von Rechlinghausen's disease, but this is rare. We were recently presented with a thirty-five year old female patient with a history of pulmonary tuberculosis about ten years prior. The patient also presented with a mass that has been slowly growing for one year. Onset of pain occurred six months after the tumor began to grow. The mass was $5{\times}7cm$ in size. The patient underwent on bloc resection of the tumor as the mass recurred twice in spite of postoperative radiotherapy.

• Proceedings of the Korea Water Resources Association Conference
• /
• 2022.05a
• /
• pp.178-178
• /
• 2022

일반적으로 하천은 상류에서 하류로 흐르지만, 하구에서 일어나는 해안으로부터의 염수의 역류 혹은 상류에서 홍수 발생 시 순간적으로 나타나는 역류 등 주 흐름을 거스르는 흐름이 종종 발생하는데 이는 예상치 못한 피해를 가져올 수 있으므로 최대한 방지해야 한다. 즉, 양방향 흐름이 일어나는 지역을 단방향 흐름으로 바꿔줄 수 있는 수리 구조물의 설치가 필요하다. 역방향 흐름을 제어하는 대표적인 예로는 보가 있는데, 보는 충분한 수위 확보뿐만 아니라 하구에서 역류하는 해수를 방지하는 역할도 한다. 다만, 상류와 하류를 수직적으로 분리함에 따라 물고기의 자유로운 이동을 제한하는 등 생태계를 단절시키는 부작용이 나타날 뿐만 아니라, 최근 정부의 정책에 따라 세종보, 죽산보 등의 보 해체 결정이 이루어지면서 이를 대체할 방안이 필요하다. 따라서 이번 연구에서는 수직적인 구조물이 아닌 수평적인 수리 구조물을 고안함으로써 생태계에 큰 영향을 주지 않으면서 가장 효과적으로 양방향 흐름을 제어할 수 있는 구조물 설계 모형을 탐구해보았다. 구조물 설계 아이디어는 심장의 판막에서 고안하였다. 판막은 특정한 방향성을 갖는 구조로 이루어져 있으면서 혈액의 역류를 방지하는 기관으로, 비슷한 방식으로 하천에도 특정 각도를 갖는 구조물의 설치를 통해 단방향 흐름을 유도할 수 있다고 판단하였다. 실제 하천 규모에서의 실험은 불가능하다고 판단, 전산 유체 프로그램 OpenFOAM을 이용하여 가상 수로의 모델링을 진행하였다. 얇은 판 형태의 흐름 제어 구조물을 수로 측면에 각각 설치 후, 같은 조건에서 정방향 흐름과 역방향 흐름에 대해 각각 시뮬레이션을 진행하였다. 이때, 두 흐름의 하류 유량 크기의 차이를 단방향 흐름을 정량화하는 수치로 산정한다. 시뮬레이션은 구조물과 흐름 방향이 이루는 각도, 구조물의 개수 및 간격, 구조물의 비대칭성 등 여러 가지 조건을 바꿔가면서 진행하고, 유속 분포 및 후류의 크기 등의 수리학적 현상을 파악하여 계산 결과를 분석한다. 분석 결과를 바탕으로 하류의 유량 차이가 가장 크게 나타나는 수리 구조물의 조건을 결정하고, 해당 구조물의 실제 적용 가능 여부를 판단한다.

• Radiation Oncology Journal
• /
• v.28 no.3
• /
• pp.177-183
• /
• 2010

Purpose: Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Materials and Methods: Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inframammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. Results: The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. Conclusion: The use of 3D CT based planning reduced the radiation field in early breast cancer patients with small breasts in relation to conventional planning. Though a coherent definition of the breast is needed, CT-based planning generated the better plan in terms of reducing the irradiation volume of normal tissue. Moreover it was possible that 3D CT based planning showed better CTV coverage including postoperative change.

• Journal of Chest Surgery
• /
• v.39 no.8 s.265
• /
• pp.579-587
• /
• 2006

Background: Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have poor surgical outcome; prolonged pleural drainage, protein losing enteropathy, pulmonary thromboembolism and death. We hypothesized that low pulmonary vascular compliance (PVC) is a risk factor for prolonged pleural effusion drainage after the Fontan operation. Material and Method: A retrospective review of 96 consecutive patients who underwent the Extracardiac Fontan procedures (median age: 3.9 years) was performed. Fontan risk score (FRS) was calculated from 12 categorized preoperative anatomic and physiologic variables. PVC $(mm^2/m^2{\cdot}mmHg)$ was defined as pulmonary artery index $(mm^2/m^2)$ divided by total pulmonary resistance $(W.U{\cdot}/m^2)$ and pulmonary blood flow $(L/min/m^2)$ based on the electrical circuit analogue of the pulmonary circulation. Chest tube indwelling time was log-transformed (log indwelling time, LIT) to fit normal distribution, and the relationship between preoperative predictors and LIT was analyzed by multiple linear regression. Result: Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 $mm^2/mmHg/m^2$ (median: 24.8), 3 to 268 days (median: 20 days), and 1.1 to 5.6 (mean: 2.9, standard deviation: 0.8), respectively. FRS, PVC, cardiopulmonary bypass time (CPB) and central venous pressure at postoperative 12 hours were correlated with LIT by univariable analyses. By multiple linear regression, PVC (p=0.0018) and CPB (p=0.0024) independently predicted LIT, explaining 21.7% of the variation. The regression equation was LIT=2.74-0.0158 PVC+0.00658 CPB. Conclusion: Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after the extracardiac Fontan procedure.

• Journal of Chest Surgery
• /
• v.39 no.5 s.262
• /
• pp.347-353
• /
• 2006

Background: Despite recent advances in surgical technique and perioperative care of total anomalous pulmonary venous return (TAPVR), post-repair pulmonary vein stenosis (PVS) remains as a serious complication. We thought that the most important factors of TAPVR repair to prevent PVS were good exposure, proper alignment, and sufficient stoma size. We analyzed our experience retrospectively. Material and Method: Between Jan. 1995 and Feb. 2005, we studied 74 patients diagnosed with TAPVR suitable for biventricular repair. Supra-cardiac type (n=41, 55.4%) was the most common. Mean CPB time, ACC time, and TCA (40.5%, 30/74) time were $92.1{\pm}25.9\;min,\;39.1{\pm}10.6\;min$, and $30.2{\pm}10.7\;min$, respectively. Mean follow-up duration was $41.4{\pm}29.1$ months and follow-up was possible in all patients. Result: The median age and body weight at operation were 28.5 days ($0{\sim}478$ days) and 3.4 kg $(1.4{\sim}9\;kg)$. Early mortality was 4.1% (3/74). Causes of death were pulmonary hypertensive crisis, sepsis, and sudden death. There was PR-PVS in 2 patients (early: 1, late: 1). Both patients were cardiac type TAPVR drained to coronary sinus. Re-operations were done but only one patient survived. Cumulative survival rate in 5 year and percent freedom from PVS were $94.5{\pm}2.7%\;and\;97.2{\pm}2.0%$, respectively. Conclusion: There was no PVS in patients who underwent extra-cardiac anatomosis between LA and CPVC. Therefore it could be said that our principle might be effective in preventing PR-PVS in patients suitable two-ventricle.

• Journal of Chest Surgery
• /
• v.35 no.8
• /
• pp.634-637
• /
• 2002

Thymic carcinoid or neuroendocrine tumor of thymus is a very rare disease and has poor prognosis due to frequent recurrence and distant metastasis. A 43-year-old man was refered to our hospital because of Rt. chest pain and tightness. Chest X-ray revealed $7{\times}8$cm sized mass on Rt. anterior mediastinum. Surgical excision was performed and light microscopic, immunohistochemical and electron microscopic findings were confirmed as atypical thymic carcinoid tumor with thymic cyst. The patient has been followed up without recurrence or distant metastasis postoperatively for 3 months to now. We report a case of atypical thymic carcinoid with thymic cysts.

• Journal of Chest Surgery
• /
• v.31 no.11
• /
• pp.1106-1109
• /
• 1998

Primary malignant melanoma of the esophagus(PMME) is an uncommon neoplasm. And the world literature reports only about 200 cases. A case of primary malignant melanoma of the esophagus is presented, and followed by review of the literature. In our patient, the walnut-sized melanoma was located at the midportion of esophagus and there were two small satellite lesions at the esophagogastric junction. The main mass was diagnosed as primary malignant melanoma histologically and immunohistologically. The tumor was curatively resected by the transthoracic subtotal esophagectomy and the 2 fields node dissection. Post- operative immunotherapy was performed but the tumor recurred 7 months later at the stomach.

• Journal of Chest Surgery
• /
• v.16 no.1
• /
• pp.40-48
• /
• 1983

Tetralogy of Fallot is characterized by the interventricular septal defect associated with obstruction of the right ventricular outflow. The importance of the latter anatomic malformation was clinically evaluated according to the angiographic measurements of the pulmonary arteries along with the pulmonary valve annulus. Seventy of a total 76 patients operated on during a whole year of 1981 were the patients for clinical evaluation. Fifteen patients died within 1 month after operation with the operative mortality of 21.4%. The young age and the severity of pulmonary arterial hypoplasia were ones among the surgical risk factors at a total corrective surgery of tetralogy. Preoperative angiographic measurements of the pulmonary arteries to speculate the expected postoperative ratio between the left ventricular and the right ventricular pressures were retrospectively calculated according to the formula. The predicted values of P RV/LV greater than 0.5 carried apparenliy higher complication and mortality rates than the group of P RV/LV less then 0.5. The selection of the candidates for either a total correction or the staged operation In tetralogy of Fallot can be evaluated on the preoperative angiographic measurements and the expected Improvements of the clinical results were discussed.

• Journal of Chest Surgery
• /
• v.29 no.4
• /
• pp.449-453
• /
• 1996

A successful resection of dissecting thoracoabdominal aortic aneurysm is presented in a patient who had undergone kidney transplantation 20 months previously. Because the transplanted kidney is more sensitive to ischemia than the normal kidney, a femoro-femoral bypass with a pump oxygenator was used for perfusion of the transplanted kidney during crossclamping. During the clamping time of 1)8 minutes, kidney perfusion was maintai ed with a perfusion pressure of (19 to 31) 27mmHg and the flow was 0.53 to 0.81 L/min. 32mm sized Hemashield (22 Cm in length) was interposed. The postoperative course was uncomplicated. We believe that performing the femoro- femoral bypass with a pump oxygenator is an effective and simple method for renal and spinal protection in such operations.