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The Effect of Pleural Thickening on the Impairment of Pulmonary Function in Asbestos Exposed Workers (석면취급 근로자에서 늑막비후가 폐기능에 미치는 영향)

  • Kim, Jee-Won;Ahn, Hyeong-Sook;Kim, Kyung-Ah;Lim, Young;Yun, Im-Goung
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.923-933
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    • 1995
  • Background: Pleural abnormality is the the most common respiratory change caused by asbestos dust inhalation and also develop other asbestos related disease after cessation of asbestos exposure. So we conducted epidemiologic study to investigate if the pleural abnormality is associated with pulmonary function change and what factors are influenced on pulmonary function impairment. Methods: Two hundred and twenty two asbestos workers from 9 industries using asbestos in Korea were selected to measure the concentration of sectional asbestos fiber. Ouestionnaire, chest X-ray, PFT were also performed. All the data were analyzed by student t-test and chi-square test using SAS. Regressional analysis was performed to evaluate important factors, for example smoking, exposure concentration, period and the existence of pleural thickening, affecting to the change of pulmonary function. Results: 1) All nine industries except two, airborn asbestos fiber concentration was less than an average permissible concentration. PFT was performed on 222 workers and the percentage of male was 88.3%, their mean age was $41{\pm}9$ years old, and the duration of asbestos exposure was $10.6{\pm}7.8$ yrs. 2) The chest X-ray showed normal(89.19%), pulmonary Tb(inactive)(2.7%), pleral thickening (7.66%), suspected reticulonodular shadow(0.9%). 3) The mean values of height, smoking status, concentration of asbestos fiberwere not different between the subjects with pleural thickening and others, but age, cumulative pack-years, the duration of asbestos exposure were higher in subjects with pleural thickening. 4) All the PFT indices were lower in the subjects with pleural thickening than in the subjects without pleural thickening. 5) Simple regression analysis showed there was a significant correlation between $FEF_{75}$ which is sensitive in small airway obstruction and cumulative smoking pack-years, the duration of asbestos exposure and the concentration of asbestos fiber. 6) Multiple regression analysis showed all the pulmonary function indices were decreased as the increase of cumulative smoking pack-years and especially in the indices those are sensitive in small airway obstruction. Pleural thickening was associated with reduction in FVC, $FEV_1$, PEFR and $FEF_{25}$. Conclusion: The more concentration of asbestos fiber and the more duration of asbestos exposure, the greater reduction in $FEF_{50}$, $FEF_{75}$. Therefore PFT was important in the evaluation of early detection for small airway obstruction. Furthermore pleural thickening without asbesto-related parenchymal lung disease is associated with reduction in pulmonary function.

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Robo-Advisor Algorithm with Intelligent View Model (지능형 전망모형을 결합한 로보어드바이저 알고리즘)

  • Kim, Sunwoong
    • Journal of Intelligence and Information Systems
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    • v.25 no.2
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    • pp.39-55
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    • 2019
  • Recently banks and large financial institutions have introduced lots of Robo-Advisor products. Robo-Advisor is a Robot to produce the optimal asset allocation portfolio for investors by using the financial engineering algorithms without any human intervention. Since the first introduction in Wall Street in 2008, the market size has grown to 60 billion dollars and is expected to expand to 2,000 billion dollars by 2020. Since Robo-Advisor algorithms suggest asset allocation output to investors, mathematical or statistical asset allocation strategies are applied. Mean variance optimization model developed by Markowitz is the typical asset allocation model. The model is a simple but quite intuitive portfolio strategy. For example, assets are allocated in order to minimize the risk on the portfolio while maximizing the expected return on the portfolio using optimization techniques. Despite its theoretical background, both academics and practitioners find that the standard mean variance optimization portfolio is very sensitive to the expected returns calculated by past price data. Corner solutions are often found to be allocated only to a few assets. The Black-Litterman Optimization model overcomes these problems by choosing a neutral Capital Asset Pricing Model equilibrium point. Implied equilibrium returns of each asset are derived from equilibrium market portfolio through reverse optimization. The Black-Litterman model uses a Bayesian approach to combine the subjective views on the price forecast of one or more assets with implied equilibrium returns, resulting a new estimates of risk and expected returns. These new estimates can produce optimal portfolio by the well-known Markowitz mean-variance optimization algorithm. If the investor does not have any views on his asset classes, the Black-Litterman optimization model produce the same portfolio as the market portfolio. What if the subjective views are incorrect? A survey on reports of stocks performance recommended by securities analysts show very poor results. Therefore the incorrect views combined with implied equilibrium returns may produce very poor portfolio output to the Black-Litterman model users. This paper suggests an objective investor views model based on Support Vector Machines(SVM), which have showed good performance results in stock price forecasting. SVM is a discriminative classifier defined by a separating hyper plane. The linear, radial basis and polynomial kernel functions are used to learn the hyper planes. Input variables for the SVM are returns, standard deviations, Stochastics %K and price parity degree for each asset class. SVM output returns expected stock price movements and their probabilities, which are used as input variables in the intelligent views model. The stock price movements are categorized by three phases; down, neutral and up. The expected stock returns make P matrix and their probability results are used in Q matrix. Implied equilibrium returns vector is combined with the intelligent views matrix, resulting the Black-Litterman optimal portfolio. For comparisons, Markowitz mean-variance optimization model and risk parity model are used. The value weighted market portfolio and equal weighted market portfolio are used as benchmark indexes. We collect the 8 KOSPI 200 sector indexes from January 2008 to December 2018 including 132 monthly index values. Training period is from 2008 to 2015 and testing period is from 2016 to 2018. Our suggested intelligent view model combined with implied equilibrium returns produced the optimal Black-Litterman portfolio. The out of sample period portfolio showed better performance compared with the well-known Markowitz mean-variance optimization portfolio, risk parity portfolio and market portfolio. The total return from 3 year-period Black-Litterman portfolio records 6.4%, which is the highest value. The maximum draw down is -20.8%, which is also the lowest value. Sharpe Ratio shows the highest value, 0.17. It measures the return to risk ratio. Overall, our suggested view model shows the possibility of replacing subjective analysts's views with objective view model for practitioners to apply the Robo-Advisor asset allocation algorithms in the real trading fields.

Estimation of Fresh Weight and Leaf Area Index of Soybean (Glycine max) Using Multi-year Spectral Data (다년도 분광 데이터를 이용한 콩의 생체중, 엽면적 지수 추정)

  • Jang, Si-Hyeong;Ryu, Chan-Seok;Kang, Ye-Seong;Park, Jun-Woo;Kim, Tae-Yang;Kang, Kyung-Suk;Park, Min-Jun;Baek, Hyun-Chan;Park, Yu-hyeon;Kang, Dong-woo;Zou, Kunyan;Kim, Min-Cheol;Kwon, Yeon-Ju;Han, Seung-ah;Jun, Tae-Hwan
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.23 no.4
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    • pp.329-339
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    • 2021
  • Soybeans (Glycine max), one of major upland crops, require precise management of environmental conditions, such as temperature, water, and soil, during cultivation since they are sensitive to environmental changes. Application of spectral technologies that measure the physiological state of crops remotely has great potential for improving quality and productivity of the soybean by estimating yields, physiological stresses, and diseases. In this study, we developed and validated a soybean growth prediction model using multispectral imagery. We conducted a linear regression analysis between vegetation indices and soybean growth data (fresh weight and LAI) obtained at Miryang fields. The linear regression model was validated at Goesan fields. It was found that the model based on green ratio vegetation index (GRVI) had the greatest performance in prediction of fresh weight at the calibration stage (R2=0.74, RMSE=246 g/m2, RE=34.2%). In the validation stage, RMSE and RE of the model were 392 g/m2 and 32%, respectively. The errors of the model differed by cropping system, For example, RMSE and RE of model in single crop fields were 315 g/m2 and 26%, respectively. On the other hand, the model had greater values of RMSE (381 g/m2) and RE (31%) in double crop fields. As a result of developing models for predicting a fresh weight into two years (2018+2020) with similar accumulated temperature (AT) in three years and a single year (2019) that was different from that AT, the prediction performance of a single year model was better than a two years model. Consequently, compared with those models divided by AT and a three years model, RMSE of a single crop fields were improved by about 29.1%. However, those of double crop fields decreased by about 19.6%. When environmental factors are used along with, spectral data, the reliability of soybean growth prediction can be achieved various environmental conditions.

High quality topological insulator Bi2Se3 grown on h-BN using molecular beam epitaxy

  • Park, Joon Young;Lee, Gil-Ho;Jo, Janghyun;Cheng, Austin K.;Yoon, Hosang;Watanabe, Kenji;Taniguchi, Takashi;Kim, Miyoung;Kim, Philip;Yi, Gyu-Chul
    • Proceedings of the Korean Vacuum Society Conference
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    • 2016.02a
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    • pp.284-284
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    • 2016
  • Topological insulator (TI) is a bulk-insulating material with topologically protected Dirac surface states in the band gap. In particular, $Bi_2Se_3$ attracted great attention as a model three-dimensional TI due to its simple electronic structure of the surface states in a relatively large band gap (~0.3 eV). However, experimental efforts using $Bi_2Se_3$ have been difficult due to the abundance of structural defects, which frequently results in the bulk conduction being dominant over the surface conduction in transport due to the bulk doping effects of the defect sites. One promising approach in avoiding this problem is to reduce the structural defects by heteroepitaxially grow $Bi_2Se_3$ on a substrate with a compatible lattice structure, while also preventing surface degradation by encapsulating the pristine interface between $Bi_2Se_3$ and the substrate in a clean growth environment. A particularly promising choice of substrate for the heteroepitaxial growth is hexagonal boron nitride (h-BN), which has the same two-dimensional (2D) van der Waals (vdW) layered structure and hexagonal lattice symmetry as $Bi_2Se_3$. Moreover, since h-BN is a dielectric insulator with a large bandgap energy of 5.97 eV and chemically inert surfaces, it is well suited as a substrate for high mobility electronic transport studies of vdW material systems. Here we report the heteroepitaxial growth and characterization of high quality topological insulator $Bi_2Se_3$ thin films prepared on h-BN layers. Especially, we used molecular beam epitaxy to achieve high quality TI thin films with extremely low defect concentrations and an ideal interface between the films and substrates. To optimize the morphology and microstructural quality of the films, a two-step growth was performed on h-BN layers transferred on transmission electron microscopy (TEM) compatible substrates. The resulting $Bi_2Se_3$ thin films were highly crystalline with atomically smooth terraces over a large area, and the $Bi_2Se_3$ and h-BN exhibited a clear heteroepitaxial relationship with an atomically abrupt and clean interface, as examined by high-resolution TEM. Magnetotransport characterizations revealed that this interface supports a high quality topological surface state devoid of bulk contribution, as evidenced by Hall, Shubnikov-de Haas, and weak anti-localization measurements. We believe that the experimental scheme demonstrated in this talk can serve as a promising method for the preparation of high quality TI thin films as well as many other heterostructures based on 2D vdW layered materials.

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Concepts concerning various nitrogen efficiencies and their interrelation in rice plant (수도(水稻)에서 여러 질소효율의 개념(槪念)과 상호관계(相互關係))

  • Park, Hoon
    • Korean Journal of Soil Science and Fertilizer
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    • v.8 no.2
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    • pp.69-80
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    • 1975
  • Relationships between yield and various nitrogen efficiencies, between efficiencies and between efficiency and nitrogen uptake amount of rice plant were proposed and tested using data from N.P.K simple trials about 30 to 50 locations, for three years. Established relationships are well in accordance with experimental results by showing highly significant correlations between them. The overall indications are that high yielding capacity of fields with fertilizer application, depends primarily on high fertilizer nitrogen uptake by increasing fertilizer use efficiency (Eu), secondly the efficiency (Ef) of absorbed fertilizer nitrogen (Nf) and fertilization efficiency (Fe) and also depends much on nitrogen efficiency for grain yield (E) to great extend and that the efficiency (Es) of soil nitrogen (Ns) contributes to E more than Ef does. All nitrogen efficiencies are negatively correlated with the uptake amount of corresponding nitrogen and counterpart efficiency. Es and Ef could be determined firstly by difference method and secondly E versus Cs (Cs=Ns/Ns+Nf) plotting and thirdly E-Cs plotting with labelled fertilizermethod using the equation E=Es Cs+B where B=Ef Cf but a constant under the given condition and at last Y-Ns plotting with labelled fertilizer using Eq Y=$Es{\cdot}Ns+B$ where B=$Ef{\cdot}Nf$. Es which seems not much variable from field to field is mostly greater (about 80% of tested fields) than Ef which is much variable and depends much on fertilizer form. The relationships tested and well agreed are as follows: 1. Y=$Es{\cdot}Ns+Ef{\cdot}Nf$ (Y is yield) 2. E=$Es{\cdot}Cs+Ef{\cdot}Cf$ where Cf=Nf/Nf+Ns 3. E=b-aN where E=E, Es or Ef and N=N, Ns or Nf respectively, (E=Y/N, N=Nf+Ns), b is theoretical maximum under the given system and a is tangent at N=O of the curve, Y=EN. 4. Fe=Ef Eu and Se=$Es{\cdot}Eu$ where Se is efficiency of soil available nitrogen. 5. E=$(Se{\cdot}Cs+Fe{\cdot}Cf)/Eu$ 6. Y=$Es{\cdot}Eu{\cdot}Sf+Ef{\cdot}Eu{\cdot}Fn$or Y=$Es{\cdot}Eu{\cdot}Ea{\cdot}Sn+Ef{\cdot}Eu{\cdot}Fn $where Sf=$Ea{\cdot}Sn$, Ea is soil available nitrogen equivalent to fertilizer(Sf) divided by total soil nitrogen (Sn).

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Strength and Deformation Capacities of Short Concrete Columns with Circular Section Confined by GFRP (GFRP로 구속된 원형단면 콘크리트 단주의 강도 및 변형 능력)

  • Cho, Soon-Ho
    • Journal of the Korea Concrete Institute
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    • v.19 no.1
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    • pp.121-130
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    • 2007
  • To investigate the enhancement in strength and deformation capacities of concrete confined by FRP composites, tests under axial loads were carried out on three groups of thirty six short columns in circular section with diverse GFRP confining reinforcement. The major test variables considered include fiber content or orientation, wrap or tube type by varying the end loading condition, and continuous or discontinuous confinement depending on the presence of vortical spices between its two halves. The circumferential FRP strains at failure for different types of confinements were also investigated with emphasis. Various analytical models capable of predicting the ultimate strength and strain of the confined concrete were examined by comparing to observed results. Tests results showed that FRP wraps or tubes provide the substantial increase in strength and deformation, while partial wraps comprising the vertical discontinuities fail in an explosive manner with less increase in strength, particularly in deformation. A bilinear stress-strain response was observed throughout all tests with some variations of strain hardening. The failure hoop strains measured on the FRP surface were less than those obtained from the tensile coupons in all tests with a high degree of variation. In overall, existing predictive equations overestimated ultimate strengths and strains observed in present tests, with a much larger scatter related to the latter. For more accuracy, two simple design- oriented equations correlated with present tests are proposed. The strength equation was derived using the Mohr-Coulomb failure criterion, whereas the strain equation was based on entirely fitting of test data including the unconfined concrete strength as one of governing factors.

Congenital Bronchoesophageal Fistula of Adult in Korea (한국내 성인에서의 선천성 기관지 식도루)

  • Yum, Ho-Kee;Choi, Soo-Jeon;Kim, Dong-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.4
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    • pp.907-913
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    • 1997
  • Background : Congenital bronchoesophageal fistula(BEF) presented in adult life is a rare disorder and has characteristic clinical findings such as paroxysmal cough after water ingestion and recurrent respiratory infections. It usually manifested recurrent pneumonia and chronic cough with purulent phlegmon which was mis-or under-diagnosed as chronic bronchitis, bronchiectasis or lung abscess so forth. Methods : We reviewed retrospectively 13 cases of congenital BEF in adult of Paik Hospital, College of Medicine, Inje University including 22 cases of congenital BEF previously reported in literature of Korea from 1979 through 1995. Results : The mean age at diagnosis was $40.2{\pm}14.3$. There was no difference in sex ratio(Male : Female 18 : 17). The most common symptom was cough(91.4%), followed by chronic sputum(74.3), hemoptysis(25.7), and paroxysmal nocturnal cough at specific position(20%). Twenty one of 31 patients who were able to review have the most specific sign, Ono's sign presented as paroxysmal cough after liquid ingestion. By classification of Braimbridge-Keith, Fourteen(45.1%) of 31 patients were group I (associated with esophageal diverticulum), 15(48.4%) were group II (simple fistula), and group Ill and IV was one case in each. The opening of fistula confined to right lower lobe in 26(76.5%), left lower lobe in 6(17.6%), and left main bronchus in 2(5.9%) cases. Conclusion : Congenital bronchoesophageal fistula is uncommon disorder which has characteristic histories and specific symptoms such as chronic and recurrent lower respiratory infections, and paroxysmal cough after liquid ingestion. Medical attention and careful history should be done in patients who have localized recurrent lower respiratory infections in right lower lobe.

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Effects of Scatter Correction on the Assessment of Myocardial Perfusion and Left Ventricular Function by gated Tc-99m Myocardial SPECT (게이트 Tc-99m 심근관류 SPECT에서 산란보정이 심근관류 및 좌심실기능평가에 미치는 영향)

  • Jeong, Hwan-Jeong;Son, Hye-Kyung;Bom, Hee-Seung
    • The Korean Journal of Nuclear Medicine
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    • v.35 no.1
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    • pp.33-42
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    • 2001
  • Purpose: The purpose of this study was to evaluate the effect of scatter correction on the assessment of myocardial perfusion and left ventricular function by gated Tc-99m myocardial SPECT. Materials and Methods: Subjects were 11 normal volunteers, 20 patients with non-cardiac chest pain and 13 patients with coronary artery diseases. We classified above 3 groups into normal and diseased groups. Scatter correction was done using dual-energy-window scatter correction method (DEW-SC). We compared acquired counts, image contrast, corrected maximum relative counts, indices of left ventricular function, extent and severity of perfusion defects calculated by 'CEqual program' between scatter non-corrected and corrected images. Results: Scatter corrected studios was lower in counts by $18{\pm}3%$ than uncorrected studies, but image contrast were improved in all cases. Scatter correction using DEW-SC took 3 minutes to complete, and 512 kB memory to store. There were no significant differences among indices of left ventricular function between scatter non-corrected and corrected images. Although extents of perfusion defects were not significantly different, severity was severer in scatter corrected images. Conclusion: Scatter correction using DEW-SC is simple to do, and improves image contrast without changing other indices of myocardial perfusion and function.

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Digital painting: Image transfonnation, simulation, heterologie and transfonnation (현대회화에서의 형태와 물질 -Digital Transfiguration에 관한 연구-)

  • Jeong, Suk-Yeong
    • Journal of Science of Art and Design
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    • v.10
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    • pp.161-181
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    • 2006
  • The words which appeared in my theoretical study and work are image transformation to digital painting, simulation, heterologie and transfiguration, etc. Firstly, let's look into 'digital era' or 'new media era'. Nowadays, the image world including painting within the rapid social and cultural change, which is called as digital era, is having the dramatic change. Together with the development of scientific technology, large number of events which was deemed to be impossible is happening as real in image world Moreover, these changes in image world is greatly influencing to our life. The word which compresses this change of image world and shows is 'digital'. Digit, which means fingers in Latin, indicates separately changing signal, and to be more narrow, it indicates the continual signal of '0' and ' 1' in computer. The opposite word is 'analogue'. As analogue is the word meaning 'infer' or 'similarity', it indicates the signal or form which continuously changes along the series of time when it is compared to digital. Instead of analogue, digital is embossed as a major ruler along the whole area of our current culture. In whole culture and art area, and in whole generalscience, digital is appearing as it has the modernism and importance. The prefix, 'digital', e.g. digital media, digital culture, digital design, digital philosophy, etc, is treated as the synonym of modernism and something new. This advent of digital results the innovative change to the image world, creates the new beauty experience which we could not experience before, and forecasts the formation of advanced art and expansion of creative area. Various intellectual activities using computer is developing the whole world with making the infrastructure. Computer in painting work immediately accomplishes the idea of painters, takes part in simulation work, contingency such as abrupt reversal, extraction, twisting, shaking, obscureness, overlapping, etc, and timing to stimulate the creativity of painters, and provides digital formative language which enables new visual experience to the audience. When the change of digital era, the image appeared in my work is shown in 'transfiguration' like drawing. The word, 'transfiguration' does not indicate the completed and fixed real substance but indicate endlessly moving and floating shape. Thus, this concept is opposite to the substantial consideration, so that various concepts which is able to replace this in accordance with the similar cases are also exist such as change, deterioration, mutation, deformity of appearance and morphing which is frequently used in computer as a technical word. These concepts are not clearly classified, and variably and complicatedly related. Transfiguration basically means the denial of "objectivity' and '(continual) stagnation' or deviation from those. This phenomenon is appeared through the all art schools of art ever since the realism is denied in the 19th century. It is called as 'deformation' in case of expressionism, futurism, cubism, etc, in the beginning of the century, which its former indication is mostly preserved within the process of structural deviation and which has the realistic limit which should be preserved. On the contrary, dramatic transfiguration which has been showing in the modern era through surrealism is different in the point that dramatic transfiguration tends to show the deterioration and deviation rather than the preservation of indicated object. From this point, transfiguration coming out from morphing using computer deteriorates and hides the reality and furthermore, it replaces the 'reality'. Moreover, transfiguration is closely approached to the world of fake or 'imaginary' simulation world of Baudrillard. According to Baudrillard, the image hides and deteriorates the reality, and furthermore, expresses 'not existing' to 'imaginary' under the name of transfiguration. Certain reality, that is, image which is absent from the reality is created and overflowed, so that it finally replaces the reality. This is simulation as it is said by Baudrillard. In turn, Georges Bataille discusses about the image which is produced by digital technology in terms of heterologie. Image of heterologie is the visual signal which is established with the media. Image of media is to have the continuous characteristics of produce, extinction, and transformation, and its clear boundary between images becomes meaningless. The meaning of composition, excess, violation, etc of digital image is explained to heterological study or heteologie suggested as important meaning of Georges Bataille who is a heretic philosopher. As the form and image of mutation shows the shape in accordance with mechanical production, heterologie is introduced as very low materialism (or bas materialisme), in this theory. Heterologie as low materialism which is gradually changing is developing as a different concept and analysis because of the change of time in the late 20s century beside high or low meaning. Including my image, all images non-standardizes and transforms the code. However, reappearance and non-standardization of this code does not seem to be simple. The problem of transformation caused by transfiguration which appears in my digital drawing painting, simulation, heterologie, etc, are the continual problems. Moreover, the subject such as existence of human being, distance from the real life, politics and social problems are being extended to actual research and various expressing work. Especially, individual image world is established by digital painting transfiguration technique, and its change and review start to have the durability. The consciousness of observers who look at the image is changing the subject. Together with theoretical research, researchers are to establish the first step to approach to various image change of digital era painting through transfiguration technique using our realistic and historical image.

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Open Heart Surgery of Congenital Heart Diseases -Report of Four Cases- (선천성심질환(先天性心疾患)의 심폐기(心肺器) 개심수술(開心手術) - 4례(例) 보고(報告) -)

  • Kim, Kun Ho;Park, Young Kwan;Jee, Heng Ok;Kim, Young Tae;Rhee, Chong Bae;Chung, Yun Chae;Oh, Chull Soo
    • Journal of Chest Surgery
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    • v.9 no.1
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    • pp.1-9
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    • 1976
  • The present. study reports four cases of congenital heart diseases, who received open heart surgery by the Sarn's Heart-Lung-Machine in the department of Thoracic Surgery, Hanyang University Hospital during the period between July 1975 and May 1976. The Heart-Lung-Machine consisted of the Sarn's five head roller pump motor system (model 5000), heat exchanger, bubble trap, the Rygg-Kyvsgaard oxygenator, and monitors. The priming of pump oxygenator was carried out by the hemodilution method using Hartman's solution and whole blood. Of the four cases of the heart diseases, three whose body weight were below 30kg, received the partial hemodilution priming and the remaining one whose body weight was 52kg received the total hemodilution priming with Hartman's solution alone. The rate of hemodilution was in the average of 60.5ml/kg. Extracorporeal circulation was performed at the perfusion flow rate of the average 94.0ml/kg/min, and at the moderate hypothermia between 35'5"C and 30'5"C of the rectal temperature. In the total cardiopulmonary bypass, arterial blood pressure was anged between 30 mmHg and 85 mmHg, generally maintaining over 60 mmHg and venous pressure was measured between 4 and $23cmH_2O$, generally maintaining below $10cmH_2O$. The first case: The patient, a nine year old girl having the symptoms and physical signs typical to cardiac anomaly was definitely diagnosed as isolated pulmonary stenosis through the cardiac catheterization. There was, however, no cyanosis, no pathological finding by X-ray and E.C.G. tracings. The valvulotomy was performed through the arteriotomy of pulmouary artery under the total cardiopulmonary bypass. Postoperative course of the patient was uneventful, and murmur and the clinical symptoms disappeared. The second case: A 12 year old boy with congenital heart anomaly was positively identified as having ventricular septal defect through the cardiac catheterization. As in the case with the first case, the patient exhibited the symptoms and physical signs typical to cardiac anomaly, but no pathological abnormality by X-ray and E.C.G. tracings. The septal defect was localized on atrioventricular canal and was 2 by 10 mm in size. The septal defect was closed by direct simple sutures under the cardiopulmonary bypass. Postoperative hemodynamic study revealed that the pressure of the right ventricle and pulmonary artery were decreased satisfactory. Postoperative course of the patient was uneventful, and murmur and the clinical symptoms disappeared. The third case: The patient, a 19 year old girl had been experienced the clinical symptoms typical to cardiac anomaly for 16 years. The pink tetralogy of Fallot was definitey diagnosed through the cardiac catheterization. The patient was placed on an ablolute bed rest prior to the operation because of severe exertional dyspnea, fatigability, and frequent syncopal attacks. However, she exhibited very slight cyanosis. Positive findings were noted on E.C.G. tracings and blood picture, but no evidence of pathological abnormality on X-ray was observed. All of the four surgical approaches such as Teflon patch closure (3 by 4cm in size) of ventricular septal defect, myocardial resection of right ventricular outflow tract, valvulotomy of pulmonary valvular stenosis, and pericardial patch closing of ventriculotomy wound were performed in 95 minutes under the cardiopulmonary bypass. Postoperative hemodynamic study revealed that the pressure of the right ventricle was decreased and pulmonary artery was increased satisfactorily. Postoperative course of the patient was uneventful, and murmur and the clinical symptoms disappeared. The fourth case: The patient, a 7 1/4 year old girl had the symptoms of cardiac anomaly for only three years prior to the operation. She was positively identified as having acyanotic tetralogy of Fallot by open heart surgery. The patient showed positive findings by X-ray and E.C.G. tracings, but exhibited no cyanosis and normal blood picture. All of the three surgical approaches, such a myocardial resection of hypertrophic sight ventricular outflow tract, direct suture closing of ventricular septal defect and pericardial patch closing of ventriculotomy wound were carried out in 110 minutes under the cardiopulmonary bypass. Postoperative hemodynamic study revealed that the pressure of the right ventricle was decreased and pulmonary artery was increased satisfactorily. Postoperative course of the patient was uneventful, and the symptoms disappeared.

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