• Title/Summary/Keyword: 확장술

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A Posterior Annuloplasty, Papillary Muscle Plication and Left Ventricle Reduction Through Left Ventriculotomy in Severe Ischemic Cardiomyopathy with Mitral Regurgitation (승모판 폐쇄 부전을 동반한 허혈성 심근병증에서 좌심실 절개를 통한 승모판 성형술 및 유두근 단축술과 좌심실 용적 축소술)

  • Jung Jong-Pil;Cho Won-Chul;Kim Joon-Bum;Lee Jae-Won
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.549-552
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    • 2006
  • In the mitral regurgitation (MR) accompanied with a serious ischemic cardiomyopathy (ICMP), coronary revascularization to viable myocardium, LV reduction and mitral reconstruction become the main surgery under the bad conditions that the cardiac transplantation is not so easy. The MR in ischemic cardiomyopathy appears as various pathologic factors, among them, the papillary muscle displacement in addition to the annular dilatation is pointed out as the important cause. Our hospital would like to report the experience of the surgery about coronary revascularization to the left main with 3-vessel coronary disease, severe ICMP patients accompanied with the MR, posterior mitral annuloplasty and papillary muscle plication through the LVtomy.

The Clinical Results of ACL Reconstruction with Tibialis Allograft Using Hybrid Femoral Fixation and $Retroscrew^{(R)}$ (Hybrid 대퇴 고정과 $Retroscrew^{(R)}$를 사용한 동종 경골건 이용 전방 십자 인대 재건술의 임상적 결과)

  • Kim, Doo-Sub;Rah, Jung-Ho
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.1
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    • pp.8-13
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    • 2009
  • Purpose: We used tibialis allograft for the reconstruction of ACL and used Hybrid femoral fixation utilizing $Endobutton^{(R)}$ and $Rigidfix^{(R)}$ for femoral fixation, and used $Retroscrew^{(R)}$ and additional fixation for tibial fixation to evaluate the clinical results. Materials and Methods: The ACL reconstruction were performed from February 2004 to February 2007 utilizing Hybrid femoral fixation and $Retroscrew^{(R)}$ and 32 patients, 32 cases which were available for year-long observation (12 to 25 months). The clinical results (Lysholm knee score, IKDC grade) and the radiologic results(bone tunnel expansion, Telos anterior displacement test) were evaluated. Results: The Lysholm knee score was improved from the average of $67.9{\pm}5.4$ points (range: 51~77) before operation and to $94.1{\pm}6.8$ points (range: 68~98) at the last follow up (p<0.05). 22 cases (69%) were evaluated normal (A), 9 cases (28%) were evaluated nearly normal (B) and only 1 case (3%) was evaluated not normal (C) at IKDC final evaluation and no case was evaluated abnormal. From $Telos^{(R)}$ stress x-ray evaluation, difference from the opposite knee was improved average 13.2 mm{\pm}5.8 (range: 6~21 mm) to average $3.4\;mm{\pm}2.8$ (range: 0~11 mm) after operation (p<0.05). The femoral and tibial tunnel were widened by 18.7% and 9.6% in the AP view and 12.4% and 8.5% in the lateral view, respectively (p<0.05). However, any statistic significance was not observed between bone tunnel expansion and knee joint functions (p>0.05). Conclusion: An ACL reconstruction with tibialis allograft using Hybrid femoral fixation and $Retroscrew^{(R)}$ enabled anatomical fixation of the graft tendon with satisfactory clinical results.

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Manufacturing Progress with Embodied Technological Change

  • Shin, Dong-Wook
    • Journal of Technology Innovation
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    • v.1 no.1
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    • pp.84-99
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    • 1993
  • 오래도록 생산성향상곡선 (또는 학습곡선), 생산함수, 그리고 대체곡선 등은, 서로 관련이 없는 별개의, 그리고 순전히 경험적인 (empirical) 현상들인 것들로서 이해되어 왔었다. 그러나 1980년대 중반에 발표된 Muth 교수의 탐색이론 (Search Theory)의 생산성향상곡선에서 관찰된 제반현상들을 모두 설명함으로써 이들 현상은 하나의 통합이론체계에 의하여 일관되게 설명되게 되었다. 이 이론의 초기형태는 그 보편성을 구속하는 네 가지 가설 위에 설립되었었으나 점차적으로 이들 가설들이 완화되면서 (relaxed) 이 이론은 또한 해독 력에서 뿐만 아니라 일반성에 있어서도 계속 강화되어 왔다. 본 논문의 목적은, 이들 네 가지 가설들 중 유일하게 아직 완화되지 못하고 있는, 실제 현상과 다분히 유리된, 두 번째 가설, 즉$\ulcorner$생산성향상을 위한 탐색과정에서 새로이 발견된 개량 신기술 (또는 생산방식) 은 즉각적으로 채택될 것$\lrcorner$이라는 가설을 완화함으로써, 보다 현실에 대한 해석력과 일반성 면에서 개선된 모델을 제시하는 데 있다. 이를 위하여 제시된 모델은 Muth 교수의 탐색이론모델에 두가지 변수를 더함으로써 확장하여 만든 모델이다. 이 두 변수는 신기술의 채택 (또는 획득)을 위하여 지불하여야 하는 투자비변수와 탐색과정을 통하여 발견은 되었으나 아직 채택은 되지 않은, 유보상태 신기술의 운영비용 변수(또는 수익성변수)등이다. 이 모델의 내용은, 생산성향상은 신기술이 구현된 (embodied) 장비 (equipment)를 사용함으로써 실현되며, 따라서 창의적 활동의 이득은 이들 장비에 대한 투자행위로서 실현된다는 것이다. 이 모델은 보다 나은 신기술이 또 발견될 것이라는 기대 하에, 현재 발견된 최신기술을 채택하지 않는 투자지연현상을 예측.설명해 주며 따라서 이로 인한 기술적 비효율성의 존재이유를 제시한다. 또한 이 모델은 생산성 향상곡선의 초기굴곡현상, 정체현상, 그리고 도약현상 등을 모두 설명해 준다.

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Surgical Treatment of Bronchoesophageal Fistula in Adult (성인 식도 기관지루의 외과적 치료)

  • 곽영태;김동원
    • Journal of Chest Surgery
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    • v.29 no.1
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    • pp.67-72
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    • 1996
  • Bronchoesophageal fistula is a rare clinical entity whether congenital or acquired in adult. We experinced 8 cases of bronchoesophageal fistula and performed surgical correction from 1991 to 1994. Of the 8 patients, 5 patients were male and three were female aging from 21 to 61 years(mean 44.12$\pm$14.62 years). Seven of 8 patients had congenital bronchesophageal fistula and the other one had acquired bronchoesophageal fistula. According to the classification of Braimbridge and Keith, 4 cases were belonged to type I and 3 cases were type II . The diagnosis was confirmed by esophagogram in six patients, by bronchoscopy and bronchogram in two patients, and in one patient, the fistula was discovered i cidentally during operation. All patients received astulectomy and concomitant procedures were applied as follows ; 4 diverticulectomy, 4 right lower lobectomy, 1 bilobectomy, 1 left lower lobectomy and 1 wedge resection of left lower lobe. All but one patient were discharged without any complication and have been in good condition.

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Endoventricular Circular Patch Plasty (Dor Procedure) for Ischemic Left Ventricular Dysfunction (허혈성 좌심실 부전증에서의 좌심실내 원형 패취성형술)

  • Cho, Kwang-Ree;Lim, Cheong;Choi, Jae-Sung;Hong, Jang-Mee;Kim, Hyeong-Ryul;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.755-761
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    • 2004
  • We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure con-comitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141$\pm$64, 69$\pm$24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p < 0,01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32$\pm$9% to 52$\pm$11% (p<0.01). The asynergy portion decreased from 57$\pm$12% to 22$\pm$9%, and LVEDV/LVESV indexes improved from 125$\pm$39 mL/$m^2$, 85$\pm$30 mL/$m^2$ to 66$\pm$23 mL/$m^2$, 32$\pm$16 mL/$m^2$ (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase. Conclusion: After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.

Valve Replacement in Children (소아심장판막치환술)

  • 김재현;이광숙;윤경찬;유영선;박창권;최세영
    • Journal of Chest Surgery
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    • v.32 no.4
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    • pp.341-346
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    • 1999
  • Background: Thirty children ranging from 3 to 15 years of age underwent cardiac valve replacement at Dongsan Medical Center from 1982 to 1997. Material and Method: There were 16 boys and 14 girls. The mean age was 12.1. The underlying pathological cause for valve replacement was congenital heart disease in 17 children and acquired heart disease in 13. The valve replaced was mitral in 15 children, aortic in 11, tricuspid in 3, and combined aortic and mitral in 1. Twenty-one mechanical and 10 tissue valves were placed: primary mechanical valve have been utilized since 1985. Eight of ten patients with tissue valves have had successful second valve replacements 4 to 11 years after the initial operation. Result: The operative mortality was 6.7%, but mortality was higher among patients less than 5 years of age and patients who had previous cardiac operations. Of the 28 operative survivors, 4 patients were lost to follow-up: the remaining patients were observed for a total of 2091 patient/months(mean 74.7 months, maximum 187 months). There was one late death from dilated cardiomyopathy after mitral valve replacement in 7 year-old patient with atrioventricular septal defect. After the operation, all patients with mechanical valves were placed on a strict anticoagulant regimen with Coumadin. The actuarial survival rate was 96% at the end of the follow-up. No instance of thromboembolism or major bleeding were observed in the survivors. Conclusion: These results indicate that valve replacement can be performed with low mortality in children, and with satisfactory long-term survival.

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인터뷰 - 김세창 세창화학(주) 회장

  • Jo, Na-Ri
    • The monthly packaging world
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    • s.339
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    • pp.102-105
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    • 2021
  • 친환경 산업용 잉크 및 코팅제 전문 제조기업 세창화학(주)(대표이사 김세창·김동규)이 지난해 말 경기도 안산 MTV단지로 확장 이전했다. 대규모 투자를 통해 최신 설비는 물론 풍부한 직원 복지시설까지 갖춘 세창화학(주)을 찾아 김세창 회장을 만났다. 새로운 보금자리에서 제2의 도약을 꿈꾸고 있는 김 회장으로부터 신 공장에 대한 소개, 최근 개발 중인 신기술, 새로운 목표 등과 함께 쉬지 않고 도전할 수 있는 비결이 무엇인지 들어보았다.

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CT Evaluation of Long-Term Changes in Common Bile Duct Diameter after Cholecystectomy (담낭 절제술 후 총담관 직경의 장기 변화에 대한 CT 평가)

  • Sung Hee Ahn;Chansik An;Seung-seob Kim;Sumi Park
    • Journal of the Korean Society of Radiology
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    • v.85 no.3
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    • pp.581-595
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    • 2024
  • Purpose The present study aimed to investigate the frequency and extent of compensatory common bile duct (CBD) dilatation after cholecystectomy, assess the time between cholecystectomy and CBD dilatation, and identify potentially useful CT findings suggestive of obstructive CBD dilatation. Materials and Methods This retrospective study included 121 patients without biliary obstruction who underwent multiple CT scans before and after cholecystectomy at a single center between 2009 and 2011. The maximum short-axis diameters of the CBD and intrahepatic duct (IHD) were measured on each CT scan. In addition, the clinical and CT findings of 11 patients who were initially excluded from the study because of CBD stones or periampullary tumors were examined to identify distinguishing features between obstructive and non-obstructive CBD dilatation after cholecystectomy. Results The mean (standard deviation) short-axis maximum CBD diameter of 121 patients was 5.6 (± 1.9) mm in the axial plane before cholecystectomy but increased to 7.9 (± 2.6) mm after cholecystectomy (p < 0.001). Of the 106 patients with a pre-cholecystectomy axial CBD diameter of < 8 mm, 39 (36.8%) showed CBD dilatation of ≥ 8 mm after cholecystectomy. Six of the 17 patients with long-term (> 2 years) serial follow-up CT scans (35.3%) eventually showed a significant (> 1.5-fold) increase in the axial CBD diameter, all within two years after cholecystectomy. Of the 121 patients without obstruction or related symptoms, only one patient (0.1%) showed IHD dilatation > 3 mm after cholecystectomy. In contrast, all 11 patients with CBD obstruction had abdominal pain and abnormal laboratory indices, and 81.8% (9/11) had significant dilatation of the IHD and CBD. Conclusion Compensatory non-obstructive CBD dilatation commonly occurs after cholecystectomy to a similar extent as obstructive dilatation. However, the presence of relevant symptoms, significant IHD dilatation, or further CBD dilatation 2-3 years after cholecystectomy should raise suspicion of CBD obstruction.

Reduction Aortoplasty with Suture Plication Technique for Dilatation of the Ascending Aorta associated with Aortic Valve Disease (대동맥판막 질환과 동반된 상행대동맥 확장에 대한 봉합봉축법에 의한 대동맥 축소성형술)

  • Na Chan-Young;Oh Sam-Sae;Lee Chang-Ha;Whang Seong Wook;Lee Cheol;Lim Hong Gook;Kim Jae Hyun;Seo Hong Ju;Kim Gun Gyk;Baek Man-Jong
    • Journal of Chest Surgery
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    • v.38 no.3 s.248
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    • pp.221-228
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    • 2005
  • Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. Material and Method: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7$\pm$6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve, Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III$\~$IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7$\~$5.4 (7 to 24) months. Result: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4$\pm$3.5 mm preoperatively to 33.2$\pm$3.4 mm postoperatively (p <0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. Conclusion: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.