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The Results of using the Cabrol Technique for Aortic Root Replacement (대동맥 근부치환술에 대한 Cabrol 술식의 성적)

  • Kim, Jeong-Won;Lee, Jong-Tae;Cho, Joon-Yong;Kim, Kyu-Tae;Kim, Gun-Jik
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.573-579
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    • 2008
  • Background: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. Material and Method: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was $43.7{\pm}14.1$ years old (range: $6{\sim}65$ years) and the male and female ratio was 21:4 (84% : 16%). The patients' follow-up was 100% complete, and the mean follow-up period was $60.7{\pm}50.4$ (range:$1{\sim}162$) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was $177.2{\pm}44.9$ minutes and the mean aortic cross clamping time was $123.4{\pm}34.1$ minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. Result: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. Conclusion: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.

Clinical Study of Acute Pyogenic Osteomyelitis in Children (소아 급성 화농성 골수염의 임상적 고찰)

  • Park, Ji Sook;Yeom, Jeong Suk;Hwang, Sun Chul;Park, Eun Sil;Seo, Ji Hyun;Lim, Jae Young;Park, Chan Hoo;Woo, Hyang Ok;Youn, Hee Shang
    • Clinical and Experimental Pediatrics
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    • v.48 no.7
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    • pp.731-736
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    • 2005
  • Purpose : Acute pyogenic osteomyelitis is uncommon in children. Delayed diagnosis and inappropriate treatment are leading to growth failure and deformation. We review the clinical manifestations and treatment of acute osteomyelitis in children according to age. Methods : A retrospective analysis was made of 32 patients who underwent antibiotic management or operation between Aug 1989 and Dec 2003 for acute pyogenic osteomyelitis in age from 0 to 15 years old. Results : The study group was composed of 21 boys and 11 girls. The subjects were divided into four groups according to age : 0-1 yr(n=6), 1-5 yr(n=11), 6-10 yr(n=8), and 11-15 yr(n=7). Nineteen cases were diagnosed in Winter. Femur was the most common infected site(37.5%). There were no predisposing factor in 17 patients, and 7 of 15 patients had trauma history. Sepsis was important predisposing factor in neonates. The chief complaints were pain, swelling and fever. S. aureus(61%) is the most common organism. Twenty-nine patients were treated with operation and concomitant antibiotics. Two cases had sequelae in follow-up period : One is avascular necrosis of femur and the other is discrepancy of leg length. Conclusion : In our review, because of poor prognosis in septic neonates, we recommend to treat actively neonatal sepsis and prevent or detect osteomyelitis early. Because most of patients were diagnosed and treated in orthopedic surgery, the rate of operation was too high. So, protocol for further evaluation and management of acute osteomyelitis in pediatric patients were needed.

Complications of transcatheter closure of atrial septal defects using the amplatzer septal occluder (심방 중격 결손의 경피적 폐쇄술 후 발생한 합병증에 관한 연구)

  • Jea, Seo Jin;Kwon, Hyo Jin;Jang, Gi Young;Lee, Jae Young;Kim, Soo Jin;Son, Chang Sung;Lee, Joo Won
    • Clinical and Experimental Pediatrics
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    • v.51 no.4
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    • pp.401-408
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    • 2008
  • Purpose : Transcatheter closure of atrial septal defects (ASD) is currently established therapy as an alternative to surgery. But rarely, complications are reported in some studies. We report early and intermediate term complications associated with transcatheter closure of atrial septal defects using the Amplatzer septal occluder (ASO). Methods : From June 2003 to May 2006, 64 patients underwent transcatheter closure of secundum ASD or patent foramen ovale using the ASO. The ratio of male to female was 1:2.4, the median age was 17 years (range: 2.6-64 years) and their median weight was 47.5 kg (range: 2.6-64 kg). Results : The median diameter of ASD measured with transthoracic or transesophageal echocardiography was 15 mm (range: 6-28 mm), the median balloon stretched diameter was 18 mm (range: 6.5-34 mm), and the median size of device was 19.5 mm (range: 6-36 mm), was little difference with balloon stretched diameter. There were 10 cases of complications: arrhythmia (2), device malformation (2), aorta to right atrial fistula (1), hemolytic anemia (1), mitral valve encroachment (1), malposition (1), residual shunt (1), and inferior vena cava perforation (1). Conclusion : Transcatheter closure of ASD using ASO is effective and safe therapy. However, significant complications such as aorta to atrial fistula, atrial erosion, or device embolization can happen, so an appropriate selection of patient and device in relevance to size and anatomy of ASD is important for successful closure.

Clinical and Histopathological Study in Repaired Cartilage after Microfracture Surgery in Degenerative Arthritis of the Knee (퇴행성 슬관절염에서 미세 천공술후 재생된 연골의 임상 및 병리조직학적 연구)

  • Bae, Dae-Kyung;Yoon, Kyoung-Ho;So, Jae-Keun
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.4 no.1
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    • pp.18-28
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    • 2005
  • Purpose: The purpose of this study is to evaluate the clinical, radiological and histopathological results after microfracture surgery for degenerative arthritis of the knee. Materials and Methods: From Oct. 1997 to Dec. 1998, 48 knees in 46 patients were treated by microfracture technique. Their mean age at the time of operation was 56 years(range, 40-75 years) and mean period of follow-up study was one year(range, 7-20 months). For 24 knees in 22 patients, 'second-look' arthroscopies and biopsies were performed at 6 months following microfracture. At the last follow up clinical results were evaluated with Baumgaertner's scale. The specimens of 24 cases were stained with H-E, Safranin-O, and Masson's trichrome. Eighteen of 24 cases were stained immunohistochemically and the Western blotting test was performed on 12 cases for type II collagen. We analyzed the relationship of the Western blotting for type II collagen with clinical score, preoperative varus deformity, joint space widening in radiological result, extent of repaired articular cartilage in '2nd-look' arthroscopic findings, patient's age and weight. Results: Clinical results were excellent in 90% and good in 10%. Among the 24 knees, more than 80% of areas of chondral defect were covered with regenerated cartilage in 21 knees Histologically, the repaired tissue appears to be a hybrid of hyaline cartilage and fibrocartilage. Repaired cartilage contains variable amounts of type II collagen with immunohistochemical staining. The results of the Western blotting test were similar. The amounts of type II collagen formation had positive correlation with the extent of repaired cartilage and preoperative varus deformity. Conclusion: 'Second-look' showed that the chondral defect areas were covered with newly grown grayish white tissue. Articular cartilage repair was confirmed with histological and immunohisto-chemical study qualitatively, and the amount of type II collagen was calculated with the Western blotting test quantitatively. The exact nature and fate of repaired cartilagenous tissues need further long term follow-up study. The results of this study provide the rationale to select osteoarthritic patients indicated for microfracture surgery.

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Role of Wetland Plants as Oxygen and Water Pump into Benthic Sediments (퇴적물내의 산소와 물 수송에 관한 습지 식물의 역할)

  • Choi, Jung-Hyun;Park, Seok-Soon
    • Korean Journal of Ecology and Environment
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    • v.37 no.4 s.109
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    • pp.436-447
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    • 2004
  • Wetland plants have evolved specialized adaptations to survive in the low-oxygen conditions associated with prolonged flooding. The development of internal gas space by means of aerenchyma is crucial for wetland plants to transport $O_2$ from the atmosphere into the roots and rhizome. The formation of tissue with high porosity depends on the species and environmental condition, which can control the depth of root penetration and the duration of root tolerance in the flooded sediments. The oxygen in the internal gas space of plants can be delivered from the atmosphere to the root and rhizome by both passive molecular diffusion and convective throughflow. The release of $O_2$ from the roots supplies oxygen demand for root respiration, microbial respiration, and chemical oxidation processes and stimulates aerobic decomposition of organic matter. Another essential mechanism of wetland plants is downward water movement across the root zone induced by water uptake. Natural and constructed wetlands sediments have low hydraulic conductivity due to the relatively fine particle sizes in the litter layer and, therefore, negligible water movement. Under such condition, the water uptake by wetland plants creates a water potential difference in the rhizosphere which acts as a driving force to draw water and dissolved solutes into the sediments. A large number of anatomical, morphological and physiological studies have been conducted to investigate the specialized adaptations of wetland plants that enable them to tolerate water saturated environment and to support their biochemical activities. Despite this, there is little knowledge regarding how the combined effects of wetland plants influence the biogeochemistry of wetland sediments. A further investigation of how the Presence of plants and their growth cycle affects the biogeochemistry of sediments will be of particular importance to understand the role of wetland in the ecological environment.

Stability Analysis of Open Pit Slopes in the Pasir Coal Field, Indonesia (인도네시아 Pasir 탄전에서의 노천채탄장 사면의 안전성해석)

  • 정소걸;선우춘;한공창;신희순;박연준
    • Proceedings of the Korean Society for Rock Mechanics Conference
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    • 2000.09a
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    • pp.183-193
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    • 2000
  • A series of studies such as geological logging data analysis, detailed geological survey, rock mass evaluation, in-situ and laboratory tests, rock strength and mechanical properties of the rock were concerned. The stability of the slope were carried out inorder to design the pit slope and individual benches using the stereographic projection analysis and numerical methods in Roto Pit of Pasir coal fetid. The bedding plane was one of the major discontinuities in the Roto Pit and the dip of which is about $60^{\circ}$in the northern part and $83^{\circ}$in the southern part. The dip of bedding becomes steeper from north to south. The plane and toppling failures are presented in many slopes. In laboratory test the average uniaxial compressive strength of mudstone was 9 MPa and that of weak sandstone was 10 MPa. In-situ test showed that the rocks of Roto north mining area are mostly weak enough to be classified in grade from R2(weak) to R3(medium strong weak) and the coal is classified in grades from R1(Very weak) to R2(Weak). The detailed stability analysis were carried out on 4 areas of Roto north(east, west, south and north), and 2 areas of Roto south(east and west). In this paper, the minimum factor of safety was set to 1.2 which is a general criterion for open pit mines. Using the stereographic projection analysis and the limit equilibrium method, slope angles were calculated as 30~$36^{\circ}$for a factor of safety greater than 1.2. Then these results were re-evaluated by numerical analysis using FLAC. The final slope angles were determined by rational described abode. A final slope of 34 degrees can guarantee the stability for the eastern part of the Roto north area, 33 degrees for the western part, 35 degrees for the northern part and 35 degrees for the southern part. For the Roto south area, 36 degrees was suggested for both sides of the pit. Once the pit slope is designed based on the stability analysis and the safety measures. the stability of 니ope should be checked periodically during the mining operations. Because the slope face will be exposed long time to the rain fall, a study such aspreventive measures against weathering and erosion is highly recommended to be implemented.

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Stability Analysis of Open Pit Slopes in the Pasir Coal Field, Indonesia (인도네시아 Pasir 탄전에서의 노천채탄장 사면의 안정성 해석)

  • 정소걸;선우춘;한공창;신희순;박연준
    • Tunnel and Underground Space
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    • v.10 no.3
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    • pp.430-440
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    • 2000
  • A series of studies such as geological logging data analysis, detailed geological survey, rock mass evaluation, in-situ and laboratory tests, rock strength and mechanical properties of the rock were concerned. The stability of the slope were carried out inorder to design the pit slope and individual benches using the stereographic projection analysis and numerical methods in Roto Pit of Pasir coal field. The bedding plane was one of the major discontinuities in the Roto Pit and the dip of which is about 60$^{\circ}$ in the northern part and 83$^{\circ}$ in the southern part. The dip of bedding becomes steeper from north to south. The plane and toppling failures are presented in many slopes. In laboratory test the average uniaxial compressive strength of mudstone was 9MPa and that of weak sandstone was 10MPa. In-situ test showed that the rocks of Roto north mining area are mostly weak enough to be classified in grade from R2(weak) to R3(medium strong weak) and the coal is classified in grades from R1(Very weak) to R2(Weak). The detailed stability analysis were carried out on 4 areas of Roto north (east, west, south and north), and 2 areas of Roto south(east and west). In this paper, the minimum factor of safety was set to 1.2 which is a general criterion for open pit mines. Using the stereographic projection analysis and the limit equilibrium method, slope angles were calculated as 30∼36$^{\circ}$ for a factor of safety greater than 1.2. Then these results were re-evaluated by numerical analysis using FLAC. The final slope angles were determined by rational described above. A final slope of 34 degrees can guarantee the stability for the eastern part of the Roto north area, 33 degrees for the western part, 35 degrees for the northern part and 35 degrees for the southern part. For the Roto south area, 36 degrees was suggested for both sides of the pit. Once the pit slope is designed based on the stability analysis and the safety measures, the stability of slope should be checked periodically during the mining operations. Because the slope face will be exposed long time to the rain fall, a study such aspreventive measures against weathering and erosion is highly recommended to be implemented.

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A Numerical Study of Hydraulic Fractures Propagation with Rock Bridges (Rock bridges를 고려한 수치 해석적 수압파쇄 균열거동 연구)

  • 최성웅
    • Proceedings of the Korean Society for Rock Mechanics Conference
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    • 2000.09a
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    • pp.201-210
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    • 2000
  • Rock bridge in rock masses can be considered as one of several types of opening-mode fractures, and also it has been known to have a great influence on the stability of structures in rock mats. In the beginning of researching a rock bridge it used to be studied only in characteristics of its behavior, as considering resistance of material itself. However the distribution pattern of rock bridges, which can affect the stability of rock structures, is currently researched with a fracture mechanical approach in numerical studies. For investigating the effect of rock bridges on the development pattern of hydraulic fractures, the author analyzed numerically the stress state transition in rock bridges and their phenomena with a different pattern of the rock bridge distributons. From the numerical studies, a two-crack configuration could be defined to be representative of the most critical conditions for rock bridges, only when cracks are systematic and same in their length and angle. Moreover, coalescence stresses and onset of propagation stresses could be known to increase with decreasing s/L ratio or increasing d/L ratio. The effect of pre-existing crack on hydraulic fracturing was studied also in numerical models. Different to the simple hydraulic fracturing modeling in which the fractures propagated exactly parallel to the maximum remote stress, the hydraulic fractures with pre-existing cracks dial not propagate parallel to the maximum remote stress direction. These are representative of the tendency to change the hydraulic fractures direction because of the existence of pre-existing crack. Therefore s/L, d/L ratios will be identical as a function effective on hydraulic fractures propagation, that is, the $K_{I}$ vague increase with decreasing s/L ratio or increasing d/L ratio and its magnification from onset to propagation increases with decreasing s/L ratio. The scanline is a commonly used method to estimate the fracture distribution on outcrops. The data obtained from the scanline method can be applied to the evaluation of stress field in rock mass.s.

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A Numerical Study of Hydraulic Fractures Propagation with Rock Bridges (Rock bridges를 고려한 수치 해석적 수압파쇄 균열거동 연구)

  • 최성웅
    • Tunnel and Underground Space
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    • v.10 no.3
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    • pp.447-456
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    • 2000
  • Rock bridge in rock masses can be considered as one of several types of opening-mode fractures, and also it has been known to have a great influence on the stability of structures in rock mass. In the beginning of researching a rock bridge it used to be studied only in characteristics of its behavior, as considering resistance of material itself. However the distribution pattern of rock bridges, which can affect the stability of rock structures, is currently researched with a fracture mechanical approach in numerical studies. For investigating the effect of rock bridges on the development pattern of hydraulic fractures, the author analyzed numerically the stress state transition in rock bridges and their phenomena with a different pattern of the rock bridge distributions. From the numerical studies, a two-crack configuration could be defined to be representative of the most critical conditions for rock bridges, only when cracks are systematic and same in their length and angle. Moreover, coalescence stresses and onset of propagation stresses could be known to increase with decreasing s/L ratio or increasing d/L ratio. The effect of pre-existing crack on hydraulic fracturing was studied also in numerical models. Different to the simple hydraulic fracturing modeling in which the fractures propagated exactly parallel to the maximum remote stress, the hydraulic fractures with pre-existing cracks did not propagate parallel to the maximum remote stress direction. These are representative of the tendency to change the hydraulic fractures direction because of the existence of pre-existing crack. Therefore s/L, d/L ratios will be identical as a function effective on hydraulic fractures propagation, that is, the K$_1$ value increase with decreasing s/L ratio or increasing d/L ratio and its magnification from onset to propagation increases with decreasing s/L ratio. The scanline is a commonly used method to estimate the fracture distribution on outcrops. The data obtained from the scanline method can be applied to the evaluation of stress field in rock mass.

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In Situ Surfactant Flushing of Contaminated Site (계면 활성제를 이용한 In Situ 토양 세척)

  • 염익태;안규홍
    • Journal of Korea Soil Environment Society
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    • v.2 no.2
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    • pp.9-24
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    • 1997
  • Surfactant-aided in situ soil flushing has been proposed as an alternative for the expensive and time consuming 'pump and treat' technology in remediation of contaminated soil and groundwater Injected surfactants can effectively solubilize contaminants sorbed to the soil matrix or nonaqueous phase liquids(NAPLs) in residual saturation. The contaminants solubilized in groundwater are recovered and treated further. The theoretical background of the technology and the results of the field operations, mostly in the US. were summarized. In addition, the factors crucial to the successful application of the technology were discussed. Cost analyses and technical limitations in current applications were also discussed. In conclusion, it is likely that in situ surfactant flushing become a viable option for soil remediation in limited cases. Currently, further advances with respect to operation cost and to treatment efficiency are required for more extensive application of the technology. However, the current trends in soil remediation, specially the growing emphasis on risk based corrective action and natural attenuation, will increase the competitiveness of the technology. For example, removal of easily washable contaminants by short term soil flushing followed by long term monitoring and natural attenuation can greatly reduce the operation cost and time.

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