Youn Young Nam;Lee Kyo Joon;Lee Gy Jong;Joo Hyun Chul;Lim Sang Hyun;Kim Seung Ho;Kwak Young Lan;Yoo Kyung Jong
Journal of Chest Surgery
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v.38
no.5
s.250
/
pp.349-356
/
2005
Background: Arterial conduits using in coronary artery bypass grafting (CABG) have been known a great long term patency rates, and improved short and long term clinical outcomes. It has been reported that Off pump CABG has better clinical results than CABG using cardiopulmonary bypass. To evaluate the advantage of arterial conduits over venous conduits and to avoid the adverse effects of cardiopulmonary bypass, we performed total arterial Off pump CABG. Material and Method: From January 2001 to October 2004, Off pump CABG using only arterial conduits was performed on 325 patients with a mean age of $59.3\pm11.9$ years ($36\~83$). Mean ejection fraction was $55.4\pm14.0\%\;(15\~86).$ Angiography showed left main disease or triple-vessel disease in $81.9\%$ of the patients. Indications of using arterial conduits was stenosis $\ge50\%$ of left anterior descending artery, stenosis $\ge80\%$ of branches of left circumflex artery, and stenosis $\ge90\%$ of right coronary artery and its branches. Multi-slice computed tomography was performed on 194 patients to evaluate the short term patency rates. Result: A total of 928 distal anastomoses were performed and the average anastomoses per a patient were $2.86\pm0.78$. There was 1 operative mortality. Postoperative complications were mediastinitis in 6 patients ($1.8\%$), renal failure in 4 patients ($1.2\%$), perioperative myocardial infarction in 3 patients ($0.9\%$), reoperation for bleeding in 3 patients ($0.9\%$). There was no postoperative stroke. Patency rate of arterial conduits was $99.3\%$ (581/585). There were 4 stenoses or competitive flows in 2 radial arteries and 2 right internal mammary arteries. Conclusion: Total arterial Off pump CABG appears to be safe, showing a low surgical mortality and morbidity and excellent short term patency rates of arterial conduits.
Background : Massive and untreated hemoptysis is associated with a mortality of greater than 50 percent. Since the bleeding is from a bronchial arterial source in the vast majority of patients, embolization of the bronchial arteries(BAE) has become an accepted treatment in the management of massive hemoptysis because it achieves immediate control of bleeding in 75 to 90 percent of the patients. Methods: Between 1990 and 1996, we treated 146 patients with hemoptysis by bronchial artery embolization. Catheters(4, 5, or 7F) and gelfoam, ivalon, and/or microcoil were used for embolization. Results: Pulmonary tuberculosis and related disorders were the most common underlying disease of hemoptysis(72.6%). Immediate success rate to control bleeding within 24hours was 95%, and recurrence rate was 24.7%. The recurrence rate occured within 6 months after embolization was 63.9%. Initial angiographic findings such as bilaterality, systemic-pulmonary artery shunt, neovascularity, aneurysm were not statistically correlated with rebleeding tendency(P>0.05). Among Initial radiographic findings, only pleural lesions were significantly correlated with rebleeding tendency(P<0.05). At additional bronchial artery angiograpy done due to rebleeding, recanalization of previous embolized arteries were 63.9%, and the presence of new feeding arteries were 16.7%, and 19.4% of patients with rebleeding showed both The complications such as fever, chest pain, headache, nausea and vomiting, arrhythmia, paralylytic ileus, transient sensory loss (lower extremities), hypotension, urination difficulty were noticed at 40 patients(27.4%). Conclusion: We conclude that bronchial artery embolization is relatively safe method achieving immediate control of massive hemoptysis. At initial angiographic findings, we could not find any predictive factors for subsequent rebleeding. It may warrant further study whether patients with pleural disease have definetely increased rebleeding tendency.
Kim, Dong Soon;Paik, Sang Hoon;Lim, Chae Man;Lee, Sang Do;Koh, Younsuck;Kim, Woo Sung;Kim, Won Dong
Tuberculosis and Respiratory Diseases
/
v.43
no.6
/
pp.954-964
/
1996
Background : The type of the infiltrating cells in al veolitis may be determined by the chemokines in the lesion. MIP-1 ${\alpha}$, a C-C type chemokine, stimulates proliferation and cytokine secretion from macrophages and induces early neutrophilic and later monocytic inflammation in vi vo. IL-8, a C-X-C type chemokine is known to attract neutrophils and T-lymphocytes. This study is performed to find out the relative role of two different chemokines in diffuse interstitial lung disease. Subject and Method : We measured the secretion of MIP- 1 ${\alpha}$ and IL-8 from alveolar macrophages(AM), and their level in BAL fluid of 26 patients with DILD (10 IPF, 4 collagen disease, 10 sarcoidosis, and 2 hypersensitivity pneumonitis) and 7 normal control. Result: IL-8 secretion was significantly increased in patients with DILD ($8.15{\pm}4.58$ ng/ml) than in normal ($1.10{\pm}0.93$ ng/ml, p=0.0003). Significant correlation was found between IL-8 secretion and total cell number in BAL fluid (r=0.484, p=0.0068), %(r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte, and % of AM (r=-0.505, 0.0032). MIP- 1 ${\alpha}$ secretion was also increased in DILD ($2.41{\pm}1.45$ ng/ml) compared to control ($0.63{\pm}0.30$ ng/ml, p=0.0031), and showed a tendency of correlation with total cell number (r=0.368, p=0.0456) and No. of alveolar macrophages (r=0.356, p=0.0579) in BAL fluid. The concentration of IL-8 in BAL fluid was significantly increased in the patients with DILD ($40.4{\pm}34.5$ pg/ml) compared to control ($3.90{\pm}2.47$ pg/ml, p=0.0094) and it showed a significant correlation with the total cell number (r=0.484, p=0.0068), %(r=-0.505, p=0.0032) of AM, and % (r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte in BAL fluid. But there was a no significant difference in MIP- 1 ${\alpha}$ concentration in BAL fluid between normal control group and the patients with DILD. Conclusion : From the above results, we concluded that AM of DILD releases increased amount of both IL-8 and MIP- 1 ${\alpha}$ but IL-8 has better correlation with the type of alveolitis.
Background: Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiologic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. Diagnosis of choice was not definded yet and role of bronchoscopy on diagnosis was not described yet. Methods: From 1989 to 1998, we experienced 17 cases of thoracic actinomycosis. We have reviewed the case notes of 17 patients with thoracic actinomycosis. The mean age at presentation was $53{\pm}13$ years, 11 were male. Results: Cough, hemoptysis, sputum production, chest pain and weight loss were the commonest symptoms. The mean delay between presentation and diagnosis was $6.6{\pm}7.8$ months. There were six patients who presented with a clinical picture of a suppurative lesion and eleven patients were suspected of having primary lung tumor initially. In no cases was made an accurate diagnosis at the time of hospital admission. Associated diseases were emphysema (1 case), bronchiectasis (2 cases) and tuberculosis (2 cases). Bronchoscopic findings were mucosal swelling and stenosis(n=4), mucosal swelling, stenosis and necrotic covering (n=2), mass (n=3), mass and necrotic covering (n=1) and normal(n=6). Radiologic findings were mass lesion(n=8), pneumonitis(n=3), atelectasis(n=3), pleural effusion(n=2), and normal(n=3). Final diagnosis was based on percutaneous needle aspiration and biopsy (n=3), bronchoscopic biopsy specimens (n=9), mediastinoscopic biopsy (n=1) and histologic examination of resected tissue in the remaining patients(n=4) who received surgical excision. Among 17 patients, 13 were treated medically and the other 4 received surgical intervention followed by antibiotic treatment. Regarding the surgically treated patients, suspected malignancy is the most common indication for operation. However. both medically and surgically treated patients achieved good clinical results. Conclusion: Thoracic actinomycosis is rare. but should still be considered in the differential diagnosis of a chrinic, localized pulmonary lesion. Thoracic actinomycosis may co-exist with pulmonary tuberculosis or lung cancer. If the lesion is located in the central of the lung. the bronchoscopy is recommanded for the diagnosis.
As Korea was merged into Japan, the official documents during Kabo Reform and The Great Han Empire time were handed over to the Government-General of Chosun and reclassified from section based to ministry based. However they had been reclassified before many times. The footprints of reclassification can be found in the classification stamps and warehouse number stamps which remained on the cover of official documents from Kabo Reform to The Great Han Empire. They classified the documents by Section in the classification system of Ministry-Department-Section, stamped and numbered them. It is consistent with the official document classification system in The Great Han Empire, which shows the section based classification was maintained. Although they stamped by Section and numbered the documents, there were differences in sub classification system by Section. In the documents of Land Tax Section, many institutions can be found. The documents of the same year can be found in different group and documents of similar characteristics are classified in the same group. Customs Section and Other Tax Section seemed to number their documents according to the year of documents. However the year and the order of 'i-ro-ha(イロハ) song' does not match. From Kabo Reform to The Great Han Empire the documents were grouped by Section. However they did not have classification rules for the sub units of Section. Therefore, it is not clear if the document grouping of classification stamps can be understood as the original order of official document classification system of The Great Han Empire. However, given the grouping method reflects the document classification system, the sub section classification system of the Great Han Empire can be inferred through the grouping method. In this inference, it is understood that the classification system was divided into two such as 'Section - Counterpart Institution' and 'Section - Document Issuance Year'. The Government-General of Chosun took over the official documents of The Great Han Empire, stored them in the warehouse and marked them with Warehouse Number Stamps. Warehouse Number Stamp contained the Institution that grouped those documents and the documents were stored by warehouse. Although most of the documents on the shelves in each warehouse were arranged by classification stamp number, some of them were mixed and the order of shelves and that of documents did not match. Although they arranged the documents on the shelves and gave the symbols in the order of 'i-ro-ha(イロハ) song', these symbols were not given by the order of number. During the storage of the documents by the Government-General of Chosun, the classification system according to the classification stamps was affected. One characteristic that can be found in warehouse number stamps is that the preservation period on each document group lost the meaning. The preservation period id decided according to the historical and administrative value. However, the warehouse number stamps did not distinguish the documents according to the preservation period and put the documents with different preservation period on one shelf. As Japan merged Korea, The Great Han Empire did not consider the official documents of the Great Han Empire as administrative documents that should be disposed some time later. It considered them as materials to review the old which is necessary for the colonial governance. As the meaning of the documents has been changed from general administrative documents to the materials that they would need to govern the colony, they dealt with all the official documents of The Great Han Empire as the same object regardless of preservation period. The Government-General of Chosun destroyed the classification system of the Great Han Empire which was based on Section and the functions in the Section by reclassifying them according to Ministry when they reclassified the official documents during Kobo Reform and the Great Han Empire in order to utilize them to govern the colony.
This paper critically examines the history of the theories connected to the Wongaksa Temple Pagoda that have developed over the last 100 years focusing on the original number of stories the pagoda would have reached. Part II of this paper retraces the dynamic process of the rediscovery of the Wongaksa Temple Pagoda by Westerners who traveled to Korea during the port-opening period. Koreans at the time viewed the Wongaksa Temple Pagoda as an object of no particular appeal or even as an eyesore. However, Westerners appreciated it as a wonder or magnificent sight. Since these Westerners had almost no prior knowledge of Buddhist pagodas, they were able to write objective travelogues. At the time, these visitors generally accepted the theory common among Joseon intellectuals that Wongaksa Temple Pagoda once had thirteen stories. Part III focuses on Japanese government-affiliated scholars' academic research on the Wongaksa Temple Pagoda after the proclamation of the Korean Empire and the Japanese Government-General of Korea's subsequent management of the pagoda as a cultural property during the colonial era. It also discusses issues with Japanese academic research and management. In particular, this portion sheds light on the shift in theories about the original number of stories of the Wongaksa Temple Pagoda from the ten-story theory supported by Sekino Tadashi (關野 貞), whose ideas have held a great influence on this issue over the last 100 years, to the thirteen-story theory and then to the idea that it had more than thirteen. Finally, Part IV addresses the change from the multi-story theory to the ten-story theory in the years after Korea's liberation from Japan until 1962. Moreover, it highlights how Korean intellectuals of the Japanese colonial era predominantly accepted the thirteen-story theory. Since 1962, a considerable quantity of significant research on the Wongaksa Temple Pagoda has been published. However, since most of these studies have applied the ten-story theory suggested in 1962, they are not individually discussed in this paper. This retracing of the history of theories about the Wongaksa Temple Pagoda has verified that although there are reasonable grounds for supporting the thirteen-story theory, it has not been proved in the last 100 years. Moreover, the number of pagoda stories has not been fully discussed in academia. The common theory that both Wongaksa Temple Pagoda and Gyeongcheonsa Temple Pagoda were ten-story pagodas was first formulated by Sekino Tadashi 100 years ago. Since the abrasion of the Wongaksa Temple Stele was so severe the inscriptions on the stele were almost illegible, Sekino argued that the Wongaksa Temple Pagoda was a ten-story pagoda based on an architectural analysis of the then-current condition of the pagoda. Immediately after Sekino presented his argument, a woodblock-printed version of the inscriptions on the Wongaksa Temple Stele was found. This version included a phrase that a thirteen-story pagoda had been erected. In a similar vein, the Dongguk yeoji seungnam (Geographic Encyclopedia of Korea) published by the orders of King Seongjong in the late fifteenth century documented that Gyeongcheonsa Temple Pagoda, the model for the Wongaksa Temple Pagoda, was also a thirteen-story pagoda. The Wongaksa Temple Stele erected on the orders of King Sejo after the establishment of the Wongaksa Temple Pagoda evidently shows that Sekino's ten-story premise is flawed. Sekino himself wrote that "as [the pagoda] consists of a three-story stereobate and a ten-story body, people call it a thirteen-story pagoda," although he viewed the number of stories of the pagoda body as that of the entire pagoda. The inscriptions on the Wongaksa Temple Stele also clearly indicate that the king ordered the construction of the Wongaksa Temple Pagoda as a thirteen-story pagoda. Although unprecedented, this thirteen-story pagoda comprised a ten-story pagoda body over a three-story stereobate. Why would King Sejo have built a thirteen-story pagoda in an unusual form consisting of a ten-story body on top of a three-story stereobate? In order to fully understand King Sejo's intention in building a thirteen-story pagoda, analyzing the Wongaksa Temple Pagoda is necessary. This begins with the restoration of its original name. I disprove Sekino's ten-story theory built upon flawed premises and an eclectic over-thirteen-story theory and urge applying the thirteen-story theory, as the inscriptions on the Wongaksa Temple Stele stated that the pagoda was originally built as a thirteen-story pagoda.
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