• Title/Summary/Keyword: 장기 생존율

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Long-term Results of Modified Lecompte Procedure for the Anomalies of Ventriculoarterial Connection (심실대혈관 연결 이상에 대한 변형된 Lecompte 술식의 장기 성적)

  • 임홍국;한국남;김웅한;이정렬;노준량;김용진
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.727-734
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    • 2004
  • The Lecompte procedure for transposition of the great arteries has an advantage because it obviates the need for an extracardiac conduit for the reconstruction of the pulmonary outflow tract. We evaluated the effectiveness and the application of the Lecompte procedure. Material and Method: A retrospective review was conducted of the records of 46 patients who underwent the Lecompte procedure during the past 15 years. Mean age at operation was 29.2$\pm$20.3 (range: 3∼83) months. The diagnoses involved anomalies of the ventriculoarterial connection with ventricular septal defect and pulmonary outflow tract obstruction, such as transposition of the great arteries, double-outlet right ventricle, and double-outlet left ventricle. Result: Early mortality was 4.4% (2 of 46 patients) and late mortality was 6.8% (3 of 44). The mean follow-up was 11.2$\pm$6.9 years. Eighteen patients (43.9% of survivors, n=41) had pulmonary stenosis (pressure gradient above 30 mmHg), the main reason for which was a calcified monocusp valve (n=15, 83.3%). Seventeen of 46 patients (37.0%) underwent reoperation: 15 for pulmonary stenosis, 5 for residual ventricular septal defect, 4 for left ventricular outflow tract obstruction, 3 for pulmonary insufficiency, and 4 for other causes. The cumulative survival rates were 91.3$\pm$4.2%, and 87.0$\pm$5.8% at 10 and 15 years, respectively. The actuarial probabilities of freedom from reoperation for pulmonary stenosis were 90.6$\pm$4.5%, 73.9$\pm$7.3%, and 54.0$\pm$10.4% at 5, 10, and 15 years, respectively. Conclusion: The Lecompte procedure is an effective treatment modality. Repair in early age is possible with acceptable morbidity and mortality, but recurrent right ventricular outflow tract obstruction caused by degeneration of the monocusp valve is a problem that needs resolution.

Follow-up in Adult after Total Repair of Tetralogy of Fallot (수술 후 성인 Fallot 4징 환자의 임상적 고찰)

  • Jang, Gi Young;Kim, Sun Young;Moon, Joo Ryung;Huh, Joon;Kang, I-Seok;Park, Seung Woo;Jun, Tae Gook;Park, Pyo Won;Lee, Heung Jae
    • Clinical and Experimental Pediatrics
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    • v.46 no.7
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    • pp.661-667
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    • 2003
  • Purpose : This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. Methods : Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. Results : Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. Conclusion : The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.

Survival and Compliance with the Use of Radiation Therapy for Anaplastic Thyroid Carcinoma (미분화 갑상선암에서 방사선치료 순응도와 생존기간)

  • Oh, Yoon-Kyeong;Jang, Ji-Young;Chung, Woong-Ki
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.229-236
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    • 2008
  • Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from $6{\sim}70\;Gy$ (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from $1{\sim}104$ months (median, 5 months; mean, 20 months). Results: Five patients started the ERT without the presence of a gross mass and all of the patients competed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, $1{\sim}104$ months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. Conclusion: This study suggests that patients with a small initial tumor (${\leq}5\;cm$), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.

Germination Behaviors and Seed Longevities of Three Ulmus Species in Korea (한국산(韓國産) 느릅나무속 3수종(樹種)의 종자저장성(種子貯藏性) 및 발아특성(發芽特性))

  • Song, Jeong-Ho;Lim, Hyo-In;Jang, Kyung-Hwan
    • Korean Journal of Plant Resources
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    • v.24 no.4
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    • pp.438-444
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    • 2011
  • This study was conducted to investigate temperature effect on seed germination behaviors and seed viability changes by drying periods of three Ulmus species (Ulmus davidiana var. japonica (Rehder) Nakai, U. pumila L., and U. parvifolia Jacq.) distributed in Korea. Statistical analysis showed that temperature had a significant effect on mean germination time in three Ulmus species, but its effect on germination percentage was only shown in U. parvifolia (p<0.01). U. davidiana var. japonica and U. pumila germinated relatively consistent in all temperature conditions, especially the latter showed high germination behaviors in low temperatures (10-15$^{\circ}C$). U. parvifolia germinated well in high temperature (25$^{\circ}C$), while this species rarely germinated in low temperature conditions (10-20$^{\circ}C$). The results confirm that seeds of U. pumila and U. parvifolia are orthodox seeds which can be stored under 4-8% moisture condition, and U. davidiana var. japonica seed is recalcitrant seed which is difficult to store for a long time. In conclusion, these differences of the germination behaviors for three Ulmus species seem to be adaptive regimes of their natural habitats, respectively.

Clinical Analysis According to $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ Expression in Gastric Cancer (위암에서의 $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ 단백 발현)

  • Kim, Sin-Sun;Park, Yong-Geun;Jun, Kyong-Hwa;Jung, Hun;Song, Gyo-Young;Kim, Jin-Joo;Chin, Hyung-Min;Kim, Wook;Park, Cho-Hyun;Park, Seung-Man;Lim, Keun-Woo;Kim, Seung-Nam;Jeon, Hae-Myung
    • Journal of Gastric Cancer
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    • v.6 no.1
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    • pp.36-42
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    • 2006
  • Purpose: The $p21^{Waf1/Cip1}$ protein Inhibits the cell cycle by Inhibiting the phosphorylation at the $G1{\rightarrow}S$ check point, and the $p27^{kip1}$ protein similarly performs the suppressor function by controlling the p27-mediated G1 arrest. In this study, we analysed the clinical status and survival rates in correlations with p21 and p27 expression patterns in gastric cancer. Materials and Methods: Between 1993 and 1997, 192 patients who underwent surgeries in Catholic Medical Center were analysed retrospectively in this study. Immunohistochemical staining was performed and if the nuclei of the tumor cells were stained, we assumed those as positive results. Statistical analysis was based on clinicopathological findings and differences in survival rates. Results: The expression rate of p27 was 28.1% and 15.6% in p21 each. The ratio of T1-2(80.0%) was significantly high in p21 (+), but the ratio of T3-4 (50.6%) was slightly high in p21 (-). There was no statistical significance regarding other factors. The results in p27 was not much different from expression rate of p21 in T-stage. In addition, p27 expression in diffuse type (91.3%) was higher than in intestinal type (62.7%) by Lauren's classification (P<0.05). Also, there was no statistical significance in other factors. In the correlation of p21 and p27, p27 was positive when p21 was positive (53.5%). Conversely, p27 was negative when p21 was negative (76.5%, p<0.05). In the p21 and p27 combination test, there was higher rate of T1-2 (87.5%) in p21 (+)/p27 (+), and higher rate of T3-4 (58.1%) in p21 (-)/p27 (-) (P<0.05). Results showed higher rate of intestinal type (100%) in p21 (+)/p27 (+), and diffuse type (87.0%) was dominant in p21 (-)/p27 (-) (P<0.05) by Lauren's classification. Moreover, there was no statistical significance in the 5-year survival rate in the expression of p21 and p27, and the 5-year survival rate was highest in the case of p21 (+)/p27 (+) without statistical significance. Conclusion: In our study, $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ expressed similar patterns. The expression of $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ affected the degree of invasiveness of the tumor, and. Combined examination result revealed the correlation of $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ with Lauren's classification and depth of invasion of the tumor. However, we assumed that little difference between the survival rates depending on expression of $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ has limited their value as predictable prognostic indicators.

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Early Results of Coronary Artery Bypass Grafting Using Multiple Arterial Grafts (다동맥이식편을 이용한 관상동맥우회술의 조기성적)

  • Lee, Jae-Won;Ryu, Sang-Wan;Kim, Kun-Il;Choo, Suck-Jung;Song, Hyun;Kim, Jong-Ook;Song, Myeong-Gun
    • Journal of Chest Surgery
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    • v.34 no.1
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    • pp.45-50
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    • 2001
  • 배경: 관상동맥우회술은 허혈성 심질환 환자에서 증상을 완화하고 급사를 방지할 수 있는 효과적인 치료방법으로 확립되었다. 그러나 80년대에 들어와 지금까지 사용되었던 대복재정맥편에 비해 동맥이식편의 장기개통율이 월등함이 알려지면서 좌내유동맥과 함께 사용할 수 있는 동맥이식편에 대한 관심이 증가하였다. 본원에서는 1998년부터 다동맥이식편을 이용하여 관상동맥 우회술을 시행하고 있으며, 조기성적에 대해 대복재정맥을 사용한 경우와 비교하고자 하였다. 대상 및 방법: 1998년 6월부터 1999년 5월까지 본원에서 관상동맥우회술을 시행받았던 355명의 환자중 심정지액을 이용하여 시행했던 153명을 대상으로 하였다. 76명의 단일 동맥편을 사용한 환자를 I군, 두 개 이상의 다동맥편을 사용한 77명의 환자를 II군으로 분류하여 수술전후 임상기록, 심초음파 및 관상동맥 조영술 소견등을 후향적으로 분석하였다. 결과: 술전 양군간에는 II군의 환자가 I군의 환자에 비해 더 젊고 흡연자가 많다는 것 이외에는 통계학적으로 차이는 없었다. 술후 조기사망은 각 군에서 1례씩 있었고 환자당 문합갯수에 통계학적으로 차이가 있는 것 이외에는 수술과정 및 술후 결과에서 차이는 없었다. 결론: 다동맥편을 이용한 관상동맥우회술을 시행한 결과 본원에서 학습기(learning period)임에도 불구하고 조기성적에 있어 대복재정맥을 이용한 경우와 차이가 없었다. 물론 중기 및 장기성적에 대한 지속적인 추적관찰이 필요하겠으나 이러한 조기성적은 동맥이식편을 이용한 관상동맥우회술이 환자의 장기생존에 도움을 줄 수 있으리라 사료된다. 또한 이러한 결과를 토대로 완전 동맥이식편 관상동맥우회술로의 전환이 이루어질 수 있으리라 생각된다.

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지질시대 및 지구조별 국내대리석 석재자원의 분류와 물성

  • 윤현수;홍세선;박덕원;이병대;김주용
    • Proceedings of the Mineralogical Society of Korea Conference
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    • 2002.10a
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    • pp.153-169
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    • 2002
  • 국내 대리석류 석재자원은 지질시대 및 지구조별로 선캠브리아기의 경기육괴와 영남육괴, 시대미상의 옥천대 남서부, 캠브리아-오오도비스기의 옥천대 북동부 그리고 일부 기하시대의 옥천대 북동부 등으로 분류될 수 있다. 전자는 변성퇴적암류내에 협재된 결정질 석회암, 화강암질 편마암내 포획된 결정질 석회암 등s으로 경기육괴의 포천, 김포, 온수리, 목계와 신림도폭 그리고 영남육괴의 춘양, 현동, 울진, 중평동 장기리와 장계도폭 등이 해당된다. 시대미상암류는 옥천대 남서부로서 목계 충주 괴산, 강경, 남원과 송정도폭, 그리고 캠브리아기는 풍촌석회암으로 임계, 호명, 서벽리도폭 등이 해당된다. 오오도비스기는 정선석회암이 분포하는 석병산, 평창, 정선과 임계도폭, 화천리층이 분포하는 문경도폭, 그리고 황강리도폭 등이 해당한다. 기타시대는 시대미상의 각력질 석회암과 상부석탄기의 홍점층군내 협재하는 결정질 석회암으로 이들은 각각 정선도폭과 석병산도폭에 위치한다. 선캠브리아기, 시대미상, 캠브리아기 및 오오도비스기 대리석류의 물성 중에서 흡수율과 공극율은 선캠브리아기, 오오도비스기 시대미상과 캠브리아기의 순으로 점차 감소한다 이들의 공극율은 비중에 대하여 대체로 불규칙하며, 흡수율은 공극율에 대하여 거의가 뚜렷한 정의 상관관계를 이룬다. 압축강도는 공극율에 대하여 다소 불규칙한, 그리고 인장강도에 대하여 정의 상관관계를 이룬다. 그리고 마모경도는 압축강도와 인장강도에 대하여 대체로 뚜렷한 정의 경향을 각각 보인다. 이들 대리석류는 선캠브리아기 중경암-경암, 시대미상 중경암-경암, 캠브리아기 거의가 중경암-경암, 그리고 오오도비스기는 경암에 각각 해당한다.역할을 충실히 담당하고 있는 것으로 분석되었다. 그러나 과학기술의 급격한 발달, 소비패턴의 변화, 생활환경과 삶의 질을 중시하는 새로운 가치관의 확산 등으로 광업의 역할도 새로운 변화의 전기를 맞이하고 있음을 볼 수 있다. 국내광업이 21C 급변하는 산업환경에 적응하여 생존하기 위해서는 각종 첨단산업에서 요구하는 소량 다품종의 원료광물을 적기에 공급 할 수 있는 전문화된 기술력을 하루속히 확보해야 하며, 이를 위해 고품위의 원료광물 확보를 위한 탐사 및 개발을 적극 추진하고 가공기술의 선진화를 위해 선진국과의 기술제휴 등 자원산업 글로벌화 정책이 절실히 요구되고 있음을 알 수 있다. 또한 삶의 질을 향상시키려는 현대인의 가치관에 부합하기 위해서는 각종 소비제품의 원료를 제공하는 광업의 본래 목적 이외에도 자연환경 훼손을 최소화하며 개발 할 수밖에 없는 구조적인 어려움에 직면할 수밖에 없다. 이처럼 국내광업이 안고 있는 여러 가지 난제들을 극복하기 위해서는 업계와 정부가 합심하여 국내광업 육성의 중요성을 재인식하고 새로운 마음가짐으로 관련 정책을 수립 일관성 있게 추진해 나가야 할 것으로 보인다.의 연구 결과를 요약하면 다음과 같다. 첫째, 브랜드 이미지와 서비스 품질과의 관계에서 브랜드이미지는 서비스 품질의 선행변수가 될 수 있음을 증명하였으며 4개 요인의 이미지 중 사풍이미지를 제외한 영업 이미지, 제품 이미지, 마케팅 이미지가 서비스 품질에 영향을 미치고 있음을 알 수 있다. 둘째, 지각된 서비스 품질과 가격 수용성과의 관계에서, 서비스 품질은 최소 가격에 신뢰서비스 요인에서 정의 영향을 미치고 있으나 부가서비스, 환경서비스에서는 역의 영향을

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Changes in atlas position with Class ll activator treatment in Class II malocclusion patients (II급 부정교합자에서 액티베이터 사용에 따른 atlas의 위치 변화에 관한 연구)

  • Cho, Moon-Ki;Cha, Kyung-Suk;Chung, Dong-Hwa;Lee, Jin-Woo
    • The korean journal of orthodontics
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    • v.37 no.1 s.120
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    • pp.44-55
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    • 2007
  • Objective: Previous studies have reported that morphological features of the first cervical vertebra (atlas) have been associated with mandibular growth direction. The purpose of this study was to show the possible positional and morphological changes of the Atlas from activator treatment in Class II malocclusion patients. Methods: Lateral cephalometric radiograph tracings were made at initial, middle and final stages of treatment. Angular and linear measurements of skeletal and morphological features were measured on the anatomical landmarks and reference planes. Results: The skeletal effects of activator treatment on Class II malocclusion patients were evident on ramal height, body length, effective body length, ANB, and overjet. Clockwise rotation of the long axis of the Atlas was found in Group 1, but there was no inclination change of the Atlas in groups 2 and 3. There was no significant correlation between anterior and posterior positions of the atlas or morphological change in all groups. - except for posterior movements of the Atlas found in group 1. Conclusion: Clockwise rotation of the atlas axis resulted from activator treatment in Cl II malocclusion patients. Change in atlas axis can be thought of as an indicator for success of activator treatment.

Comparison study of dermal cell toxicity and zebrafish brain toxicity by humidifier sterilizer chemicals (PHMG, PGH, CMIT/MIT) (가습기 살균제 성분(PHMG, PGH, CMIT/MIT)의 사람 피부세포 독성 및 제브라피쉬 뇌신경 독성 비교 연구)

  • Cho, Kyung-Hyun;Kim, Jae-Ryong
    • Korean Journal of Environmental Biology
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    • v.38 no.2
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    • pp.271-277
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    • 2020
  • Toxicities to many organs caused by humidifier disinfectants have been reported. Recently, humidifier disinfectants have been reported to cause cardiovascular, embryonic, and hepatic toxicities. This study was designed to investigate the toxic mechanism of humidifier disinfectants and compare toxicity in a cellular model and a zebrafish animal model. Because brain toxicity and skin toxicity have been less studied than other organs, we evaluated toxicity in a human dermal cell line and zebrafish under various concentrations of humidifier disinfectants that included polyhexamethyleneguanidine phosphate (PHMG), oligo-[2-(2-ethoxy)-ethoxyethyl-guanidinium-chloride] (PGH) and methylchloroisothiazolinone/methylisothiazolinone (CMIT/MIT). A human dermal fibroblast cell line was treated with disinfectants (0, 2, 4, 6, 8, and 16 mg L-1) to compare their cytotoxicity. The fewest PHMG-treated cells survived (up to 33%), while 49% and 40% of the PGH- and CMIT/MIT-treated cells, respectively, survived. The quantification of oxidized species in the media revealed that the PHMG-treated cells had the highest MDA content of around 28 nM, while the PGH- and CMIT/MIT-treated cells had 13 and 21 nM MDA, respectively. As for brain toxicity, treatment of the zebrafish tank water with CMIT/MIT (final 40 mg L-1) for 30 min resulted in a 17-fold higher production of reactive oxygen species (ROS) than in the control. Treatment with PGH or PHMG (final 40 mg L-1) resulted in 15- and 11-fold higher production, respectively. The humidifier disinfectants (PHMG, PGH, and CMIT/MIT) showed severe dermal cell toxicity and brain toxicity. These toxicities may be relevant factors in understanding why some children have language disorders, motor delays, and developmental delays from exposure to humidifier disinfectants.

Viability of Endothelial Cells in Preserved Human Saphenous Vein Allografts (보존된 사람 동종 복재정맥 이식편혈관 내피세포의 생활성에 관한 연구)

  • 지현근;김용진
    • Journal of Chest Surgery
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    • v.36 no.4
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    • pp.229-241
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    • 2003
  • Background:Autogenous vein is the preferred vascular graft for patients who require coronary artery bypass surgery or peripheral arterial bypass surgery. When an autogenous vein is not available, an allograft saphenous vein can be used as an alternative conduit. Although arterial homograft has been under investigation since the beginning of this century, the viability of endothelial cells and the optimum mode of storage for the venous and arterial allografts is controversial. In addition, with the recently gained knowledge of vascular endothelial functions, such as the production of nitric oxide or thrombomodulin, the viability and antigenicity of endothelial cells are being studied again. The purpose of this study was to evaluate the viability of endothelial cells in the preserved human saphenous veins. Material and Method: The veins were stored in a $4^{\circ}C$ RPMI (Roswell Park Memorial Institute) 1640 solution including 10% fetal calf serum, for one, three, five, seven or fourteen days. After the completion of the storage period, the veins were divided into two groups: Group I: studied immediately at $4^{\circ}C$ (cold) storage (I-1, I-3, I-5, I-7, I-14), and Group II: studied after storage at $-196^{\circ}C$ liquid nitrogen tank (cryopreservation) in an RPMI 1640 solution containing 10% DMSO for two weeks (II-1, II-3, II-5, II-7, II-14). Light microscopy and scanning electron microscopy (SEM), frypan blue exclusion testing, and thrombomodulin immunohistochemistry were performed. Result: In a morphometric study using SEM, there was statistically significant increase in Gundry Score in Groups I-7, I-14, II-5, II-7, and II-14 and showed cellular destruction (p<0.05). In the thrombomodulin immunohistochemistry study, there was reactivity in Groups I-1, I-3, and I-5, but the cryopreserved group revealed decreased reactivity (p<0.05). The trypan blue exclusion testing also showed superior viability in cold storage Group I. Conclusion: Venous allografts preserved in a $4^{\circ}C$ RPMI 1640 solution showed well preserved endothelial cellular integrity and thrombomodulin expression at up to seven days of preservation. Although cryopreservation of venous allografts stored in 10% DMSO -RPMI 1640 solution maintained the endothelial cellular structure on SEM, immunohistochemistry from the thrombomodulin and trypan blue exclusion testing showed decreased viability, It remains to be seen whether the decreased thrombomodulin reactivity could be restored, and what the nature to the relationship is between thrombomodulin and long-term patency of allografts.