• Land and Housing Review
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• v.6 no.2
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• pp.67-77
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• 2015

Now that it is the current situation that the smooth supply and demand are necessary for 2nd phase of beginning construction and stable development of Gaesung Industrial Complex, this study was willing to offer the planning criteria and model to establish the lodging for the workers in Gaesung Industrial Complex based on the agreement that both South and North Korea agreed in 2007. Regarding the plan, its standard and the alternative were reviewed considering welfare of workers, economic efficiency, technical validity, possibility of agreement and long-term development. The exclusive area per capita was calculated through Labor Standards Act of Korea and status survey of lodging for the workers provided to border line area between China and North Korea and the economic alternative based on one room for 6 persons with the public restroom was compared with that of development type based on one room for 4 persons with indoor restroom. Especially regarding the proposed site, the area with the optimized position was set by considering gradient, accessibility and convenience of development out of the area of Dongchang-ri where was agreed already and the priority of the proposed site that can keep the existing building site and provide was offered. The necessary period for whole construction was set as approximately 36 months. Regarding construction method, RC Rahmen method was selected as the optimized alternative considering the workmanship of manpower of North Korea and conditions of supply and demand of materials and cluster-type vehicle allocation plan based on 4~6 units considering the efficiency of supplying service facilities and convenient facilities along the simultaneous accommodation of 15,000 people was offered. It was analyzed that total business expenses of approximately 80~100 billion Korean Won would required though there were the difference for each alternative in the charged rental way that the development business owner develops by lending the inter-Korea Cooperation Fund and withdraws the rent by the benefit principle. The possibility of withdrawing the rent was analyzed assuming that the period of withdrawing the investment is 30 years. Especially for the operation management after moving, the establishment of the committee of operating the lodging for the workers of Gaesung Industrial Complex (tentative name) was offered with the dualized governance that the constructor takes charge of operational management, collecting fees and management of infrastructure and human resource management is delegated to North Korea.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.21-29
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• 2006

Purpose: This study explored the anal sphincter-saving rate and down-staging rate after preoperative chemoradiotherapy for treating lower rectal cancer. We also explored the prognosis of the patients who refused surgery after preoperative chemoradiotherapy. Materials and Methods: Thirty seven patients with histologically proven lower rectal cancer who underwent preoperative chemoradiotherapy were retrospectively analyzed. In each case, the tumor location was 0 to 5 em from the anal verge, and curative resection of the cancer with performing a sphincter-saving procedure was not feasible before chemoradiotherapy. In each case, the staging examinations, including biopsy, were done before starting radiotherapy and this was repeated at 1 month after radiation therapy. Results: After chemoradiotherapy, among the 37 included patients, 56.8% and 32.4% were downstaged to the T stage and N stage, respectively, when comparing the postradiotherapy stage with pre-radiotherapy stage. Twenty five patients underwent complete resection of cancer at 6 weeks after radiotherapy: eleven, eight and six patients underwent abdominoperineal resection, low anterior resection and local excision, respectively. The sphincter-saving rate among the 24 completely resected cases was 54.2%. Twelve patients refused surgery after radiotherapy. Among 6 patients who refused surgery with biopsy-proven complete remission after chemoradiotherapy, 5 patients were alive without disease at a median follow up period of 31 months, and only 1 patient had local failure. Conclusion: For lower rectal cancer, a high sphincter-saving rate was accomplished with preoperative chemoradiotherapy. The prognosis of the patients who refused surgery with biopsy proven complete remission after chemoradiotherapy was good and these patients need to be kept under close surveillance.

• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.35-41
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• 2006

Background: The radial arteries are being used more often for coronary artery bypass grafting, We tried to the endoscopic radial artery harvest to reduce the cosmetic problems and neurologic complications of the conventional open harvesting and report the techniques and early results. Material and Method: The 86 patients underwent coronary artery bypass grafting between May 2003 and April 2005 had their nondominant radial artery endoscopically removed through a 2 cm incision at the wrist. The radial pedicle was dissected and was divided at antecubial area through a 5 mm counterincision. Result: The 23 patients complained of neuralgias on territory of superficial raidal none but no one complained of neuralgias on territory of lateral antebrachial cutaneous none. There was no functional impairment of the hand. There was no wound complication except a localized hematoma. All patients were contacted by telephone after postoperative 7.9$\pm$3.6 months. The 4 patients still complained of neuralgia. All the patients were satisfied with the aesthetics of the wounds. The multidetectional tomography was done on the 66 patients for the estimation of early patency of radial artery. There were 2 cases of stenosis and a case of occlusion. Conclusion: Endoscopic radial artery harvest had no functional impairment of the hand, lesser rate of neurologic complications and outstanding aesthetics. The results of early patency of the radial artery was similar to conventional methods. Therefore, we think that endoscopic radial artery harvest is the optimal procedure.

• Journal of Technology Innovation
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• v.2 no.1
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• pp.1-57
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• 1994

본 고는 지속적 개발 론에 입각한 적극적인 에너지수요 관리정책을 추진한다는 전제하에 2001년과 2006년의 우리 나라 가정부문 전력수요를 전망하고자 한다. 본 고는 지속적 개발 시나리오를 추정함에 있어서 기존의 계량모형보다 일종의 공학적 모형인 공정분석(process analysis)을 선호한다. 계량모형이 주로 과거 수요의 소득 및 가격 탄성 치를 바탕으로 미래의 수요를 예측하는데 비하여 공정분석모형은 기술발전에 따른 미래의 효율변화(향상)를 비교적 잘 반영할 수 있기 때문이다. 본 고는 덴마크공과대학교 Norgard 교수팀이 개발한 모형을 도입하여 분석모형(수식 (6))을 전력수요 = 기기 수 $\times$ 전력서비스$\times$ 전력집약도와 같이 설정하고 이를 사용하여 냉장고, 텔레비전, 조명 기기, 난방기기 등과 같은 전력사용 기기 별로 2001년과 2006년이 전력수요를 전망하였다. 본 고는 전력수요를 전력사용 기기의 사용용량(300리터 용량의 냉장고 등)과 사용시간을 나타내는 전력서비스와 전력 서비스당 필요 전력사용량을 나타내는 전력집약도로 나누어 구분하고 있는 모형을 이용함으로써 소득향상효과와 함께 기술발전에 따른 효율개선효과를 분석할 수 있다. 1) 생활수준 향상에 따라 전력서비스는 지금과 같이 증가한다, 2) 현실적으로 가능한 범위 내에서 전력사용 기기에 대한 최저 에너지 효율 제를 실시한다, 3) 현재 사용중인 기기 들은 원칙적으로 수명이 다한 후 고효율 기기 들로 자연 교체한다, 4) 최저 에너지 효율 제를 제외한 다른 제도 및 정책개선, 사용자의 에너지소비형태 개선에 따른 절전 잠재 량을 고려하지 않는다 등의 가정 하에 전력수요를 추정한 결과 1992년에 796 GWh(100)이었던 우리 나라 가정부문 전력수요는 2001년과 2006년에 29,237 GWh(134)와 33,118 GWh(152)로 각각 34%와 52%증가할 것으로 나타났다. 이 경우 1992년부터 2006년까지 가정용 전력수요 증가율은 연평균 3%로 추정된다. 기기의 서비스(가구수$\times$기기의 보급 율$\times$기기의 전력서비스)가 소득향상에 따라 증가하는데도 불구하고 전력수요의 증가율이 GDP(같은 기간 동안 연평균 증가율 5.7%)보다 매우 낮은 것은 기기의 대형화와 기기의 보급을 증가에 따른 전력의 추가수요가 기기의 에너지효율 개선으로 대부분 상쇄될 것이기 때문이다. 향후 10년 내에 기기에 따라 전력사용량을 25%~50%정도까지 줄일 수 있을 것으로 분석된다. 기술발전에 따른 기기의 에너지효율 개선효과는 본 고의 2006년도 가정용 전력수요의 전망치 33,118 GWh가 기존방식에 의한 한전의 전망치 61,155 GWh의 54%수준밖에 되지 않는데 서도 잘 나타나고 있다. 한편 본 고는 경제성장과 환경보존을 동시에 달성할 수 있는 지속적 개발의 실천방안으로서 에너지 수요관리를 논하고자 한다. 고효율 기기의 개발과 조기도입을 촉진시키는 에너지 수요관리 통하여 우리는 에너지효율을 대폭 개선시키며 대기오염 배출량도 대폭 줄일 수 있다. 본 고는 에너지 공급관리(공급확충)위주에서 에너지 수요관리위주로서의 에너지정책 전환은 불가피하다고 판단한다. 에너지 공급시스템보다 에너지 수요시스템위주로 전체 에너지시스템을 획기적으로 개선시키기 위해서는 최저 에너지효율제의 광범위한 실시와 함께 고효율 기기의 개발과 보급에 필요한 유인책의 도입, 고효율 기기와 에너지의 효율적 이용에 대한 정보 등이 필요시 되고 있다. 우리 나라의 경우 현재의 산업구조와 기술수준을 고려하여 에너지 효율의 기준을 미국보다 다소 낮게 설정한다면 최저 에너지효율제의 도입이 문제가 되지 않을 것으로 판단된다. 본 고는 고효율 기기의 개발과 조기도입을 지원하기 위한 가칭 대기환경보존 및 에너지 수요관리기금의 창설을 제안한다. 전력부문의 경우 기금은 1. 탄소세, 2. 전력소비에 대한 수요 관리 세의 도입 혹은 3. 한국전력공사 전력판매수입의 일정 분으로 조성될 수 있을 것으로 본다. 예를 들어 선진국들이 탄소세를 예정대로 도입한다는 전제하에 우리 나라가 2000년을 기준으로 탄소 톤당 8달러(석유 배럴 당 85센트)의 탄소세를 도입한다면 연간 7억 2,000만 달러(약5,760억 원)규모의 기금을 조성할 수 있다. 이 중 연간 2,000억 원 정도를 고효율 기기의 개발과 조기도입에 지원한다면 우리 나라 에너지 시스템 효율은 대폭 개선될 수 있을 것으로 예상된다.

• Journal of the Korean Institute of Educational Facilities
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• v.3 no.3
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• pp.59-70
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• 1996

장안초등학교는 한국전쟁 이후인 1955년에 개교된 초등학교이다. 처음에는 8학급의 가교사시설에 18학급으로 편성되어 초기부터 시설이 양적으로 부족하였다. 또한 이 지역의 학생수 증가로 거의 매년에 걸쳐 학급수의 증가와 교실증축이 함께 이루어 졌다. 현재 건물의 건립년도를 살펴보면 1965년 6월에 처음 신관 1층 부분이 건설되어 70년대와 80년대에 걸쳐 꾸준히 증축되어 왔으며, 대지 동측의 별관은 1993년 12월에 건설된 새건물로, 학교교사 건물이 30년된 건물과 최근의 건물이 함께 공존하고 있다. 철근콘크리트 건물이 구조적으로는 100년도 견딘다 하지만 실제로는 약 30년이면 콘크리트의 산성화가 가속화되면서 구조적으로 안전하지 못하다는 학설이 인정되어, 최근 30년이 경과된 학교 건축의 재건축이 사회적 문제로 대두되고 있다. 실제로는 25년이상 경과된 건물에서도 구조적인 하자가 발생하는 예 가 많아 교육부에서는 대체로 25년이상 경과된 건물에 대하여 재건축을 실시하고 있다. 장안초등학교는 20년에서 30년 경과된 건물이 많은 부분을 차지하는 관계로 재건축이 실시되는 예이다. 아직까지 사용이 가능하다고 판단되는 건물은 본관의 남측부분의 교사(1983년 증축)과 신관의 우측부분(1985년 9월 23일 증축)과 별관(1993년 12월 14일 신축)교사동을 들수 있다. 때문에 이 부분에 대하여 철거할 것인가 혹은 그대로 사용할 것인가에 대한 의견이 있어, 최종적으로 별관은 그대로 사용하는 것을 원칙으로 하고 본관 남측부분은 가장 마지막 건설시기에 철거하고 신관 우측부분은 규모가 작아 철거하기로 하였다. 학교건축은 다른 일반건물과는 달리 교육이라는 기능을 충분히 발휘할수 있는 공간구성이 필수적이라 할수 있다. 여기서 말하는 교육이란 예전의 주입식 교육이 아니라 21세기를 바라보는 정보화 세계화를 지향하는 교육으로 학생 개개인의 창의성과 자주성을 발휘시킬수 있는 교육이라는 점에 대하여 의견은 없을 것이다. 이러한 교육이란 다양한 교육방법을 전제로 하며 하나의 학년을 하나의 학습그룹으로 생각하는 것은 중요한 출발점이 될 것이다. 한 학년의 그룹을 교대상의 기본으로하여 이러한 그룹에 대하여 일제학습, 그룹학습, 팀티칭, 개별학습이 이루어 질수 있는 공간을 제공하는 점을 본 장안초등학교 기본계획에서 출발점으로 하였다. 물론 학교전체 학생을 콘트롤할 수 있는 교육방법도 존재한다. 선진 외국의 예를 살펴보면 아동의 능력별 교육을 위하여 무학년제(Non-Grade)를 도입하는 경우도 있지만 아직 우리나라에서는 학급단위가 중요시되고 있다. 이 학급단위는 교육단위이면서 생활지도 단위이기도 하다. 이러한 점을 인식하여 학교건축의 간장 기본 단위가 되는 보통교실 계획을 보통교실과 오픈스페이스를 연속시킨 유니트로 계획하여 일제학습, 그룹학습, 팀티칭, 개별학습 등이 이루어 질수 있도록 하였다. 실제로는 36학급을 계획할 경우, 한학년의 6개 학급이 하나의 공통된 공간내에 그룹핑 되는 것이 바람직하지만(제3안의 배치에서 제안하여 보았지만 북측교실, 오픈스페이스의 통로화등의 문제점이 있었다), 그 규모가 너무 커서 3개학급을 하나의 유니트로 하였다. 물론 한학년이 동일한 층에 배치시켜 서로의 관련성을 높게 하였다. 특별교실 계획은 보통교실과의 관련성과 장래 지역개방의 역할을 고려하여 계획하여야 할 것이다. 장안 초등학교의 경우는 별관을 그대로 사용 한다는 조건이 있기 때문에 기존의 편복도 형식의 교실에서는 보통교실 계획의 어려움이 있어 특별 교실동으로 고려하였다. 때문에 지역개방에 대해서는 문제점을 안고 있다. 체육관은 기준령에는 권장시설로 되어 있지만 학교시설에 필수적인 시설이라 생각한다. 체육은 국민건강에 직결되기 때문이다. 또한 체육관 건설은 실외체육 실내체육에 대응할 뿐 아니라 학교 행사등에 유용히 사용되기 때문에 더욱 필요시설이라 할수 있겠다. 또한 지역개방을 위하여 정문 혹은 후문 가까이에 배치시키는 것은 필수적이다. 별관, 체육관, 운동장, 후문측에 12학급용의 단독건물 등의 기본적인 제약조건을 고려하여 배치하자면 자연히 교실동들이 분산되는 결과를 낳게된다. 이러한 각각의 교사동을 A동을 중심으로 구름다리로 연결하여 동선의 불편함을 해소시켰다. 주차장은 후문 가까이에 약 10정도의 주차공간이 확보가능하다. 이외에는 운동장을 사용하는 방법과 체육관의 1층부분을 필로티로 하여 그곳에 20대 정도 주차시키는 방안이 있다. 주차는 많을수록 편리는 하겠지만 제한된 대지에 모두 만족 시켜주기는 불가능하다. 공공용의 주차와 소방에 필요한 동선이 요구된다. 특히 도심주차난을 생각할 때는 차라리 적극적으로 지하주차장을 계획하는 방안이 있을 것이다. 마지막으로 현재 67학급은 초대형 규모로 초등학교 규모로는 적합하지 못하다. 장래를 고려하여 48학급에서 최종적으로 36학급으로 계획하였으나 한동안은 67학급이 그대로 유지될 것으로 보인다. 신설 초등학교가 가까운 시기에 개교될 것을 기대한다.

• Journal of Korean Historical Folklife
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• no.44
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• pp.145-176
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• 2014

This study analyzed official duties and personnel practices of Hyangcheong(鄕廳), administrative organization in which sajok(士族) participate this office, and Jakcheong(作廳), hyangree(鄕吏)'s office, of Anbyeon of Hamgyeong Province in the 19th century. Although there have beeen somewhat of case study of Gyeongsang, Honam, etc., study on Hamgyeong Province has been almost nonexistent because of the limitation of materials. Hence, this paper specifically examined Hyangcheong and Jakcheong's official duties and personnel practices through an article of 'a list of Hyangcheong and Jakcheong's officials' of Anbyeon, newly found, which is in the possession of this writer. Especially, this study virtually traced individual ststus and family by analyzing Hyangcheong and Jakcheong's 40-official duties and a list of 330-ofiicial duties for sixs years. And then by comparing it against Jokbo(族譜), I have grasped 19-Famlily of them. Executives of Hyangcheong could be grasped as they were status of Yangban(兩班), but members of Jakcheong were hardly identified because they were status of hyangree, thus most of them were not enscrolled in Jokbo. Hyangcheong and Jakcheong's official duties could be found by compare it with other area in Ehubgi(邑誌) Hamgyeong Province. the features of officiak duties are as in the following. On general administrative organization, Sajok's Hayngcheong, Jakcheong as general administrative organization and Jangcheong(將廳) as police work existed. As Pyeongando and Hamgyeongdo were border areas, Jangcheong was independent and led other institutions. However, in Anbyeon, Hojang(戶長) of Hayngcheong and Jakcheong divided dudies and commanded. Hojang'role was higher than any other areas, Because Hojang is in charge of Jangcheong's functions. Jakcheong was centrally operated by Hojang, Eebang(吏房), and Hyeongbang(刑房), so-called 'Samgonghyeong(三公兄)', Whereas Anbyeon was operated by Hojang, Eebang, Chunchong(千摠). In the general areas, While Juasu(座首) Byeolgam(別監), Executive of Hyangcheong, manages each warehouse(倉) where the nation's tax revenues are kept, In Anbyeon besides Joasu, Hyangso(鄕所). The principle of Hyangcheong and Jakcheong's personnel practices was one-period, but there were many consecutive terms, every other year terms, or tranference into other area. Police work was assumed by specific persons because it was relatively specialized job, However in case of Ghamsaek(監色) of each warehouse(倉), Hyangso(鄕所) of Hyangcheong or Hojang of Jakcheong had held plural offices, and was solely responsible it. On the overall features of its operation, Hyangcheong held plural offices, but rotation was made only within Hyangcheong. On the other hand, in the case of Jakcheong, Hojang, Eebang, and even Buriebang circulated their positions, but the other Hyangree rotated each Saek(色) and Guamguan of each warehouse(倉). This writer confirmed that unlike Gyeongsang and Hamgyeong, Hyangcheoung or duties of Hyangree were not handed from generation to generation by several families and, many families shared their work by circulating positions.

• Magazine of the Korean Society of Agricultural Engineers
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• v.13 no.2
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• pp.2262-2275
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• 1971

Fourteenes rervoirs maintained by the local land improvement associations in the province of Chullabuk-Do and 20 reservoir maintained by thos in the province of Chullanam-Do, were surveyed in connection with a correction between storage capacity and sediment deposit. In addition to this survey, 3,347 of small reservoir, that lie scattered around in the above-mentioned two provinces were investigated by using existing two provinces were investigated by using existing records pertaining to storage capacity in the office of City and country, respectively. According to this investigation the following comclusions are derived. 1. A sediment deposition rate is high, being about $10.63m^3/ha$ of drainage area, and resulting in the average decreasc of storage capaity by 27.5%. This high rate of deposition coule be mainly attributed to the serve denudation of forests due to disorderly cuttings of trees. Easpecially, in small reservoir, an original average design storage depth of 197mm in irrigation water depth is decreased to about 140mm. 2. An average unit storage depth of 325.6mm as the time of initial construction is decreased to 226mm at present. This phenomena causes a greater shortage irrigation water, since it was assumed that original storage quantity was already in short. 3. Generally speaking, seepage rates through dam abutment intakepipe, etc, are high due to insufficient maintenance and management of reservoir. 4. It is recommended that sediment deposit should be dredged when a reservoir is dry in drought. 5. Farmers usually waste excessive irrigation water. 6. Water saving methods should be practiced by applying only necessary water for growing stage of rice. 7. In are as where water defficiency for irrigation is severe, a soil moisture content should be kept at about 70% by applying water once in several days. 8. Tube wells should be provided so as to exploit ground water and subsurface current below stream bed as much as possible. 9. If an intake weir was constructed, a water collection well should be built for the use in drought. 10. Water conservation should be forced by converting devastated forests contained in the drainage area of reservoir to protected forests so as to take priority of yrefor estation, gully control, the prohibition of disorderly cutting of trees, etc. 11. Collective rice nurseries should be adopted, and it should be recommended that irrigation water for rice nurseries is supplied by farmer themselves. 12. Sediment desposit in reservoir should be thoroughly dreged so as to secure a original design storage capacity. 13. The structure of overflow weir should be automatic so as to freely control flood level and not to increase dam height.

• Journal of Gastric Cancer
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• v.8 no.2
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• pp.97-103
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• 2008

Purpose: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. Materials and Methods: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. Results: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was $449.00{\pm}87.39minutes$. The mean distance between the proximal resection margin and the cancer was $6.56{\pm}3.65cm$; the maximum size of the tumor was $9.90{\pm}3.97cm$. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. Conclusion: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.

• Journal of Sericultural and Entomological Science
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• v.2
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• pp.49-61
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• 1962

The insect Diplosis mori Yokoyama is causing extensive destruction of mulberry trees in Korea with a resultant loss in silk production. This study was made to determine an effective method of control. Methods and Materials Used Preliminary studies were made to determine more exactly the life cycle of the insect. Based on this information, various control measures were tested, including the use of spray methods with BHC and control of larvae by tilling. Results Obtained 1. Life cycle studies (a) In the Suwon area, this-insect has 5 generations per year. The first starts in the later part of June and the final cycle ends in the later part of September. (b) The adult insects appear about 7: 00-8: 00 P.M. and live for 2-5 days. Females live in longer periods than the male. (c) Larvae lives inside the second and third stipules (A. B.) before mulberry leaf development. They cause extensive damage to the leaves at the point where they are attached to the stem. (d) Weather conditions considerably affect the life cycle. The pupa particularly are affected and not be able to change into the moth stage when there is a long period of no rain. (e) Larvae are large......0.3 to 2.0mm......and are milky-white immediately after hatching but turn to pinkish as the worm matures. The matured worm has a jumping ability up to 15-20cm. The worm burrows into the ground 1.5 to 3.0 cm before changing into the pupal stage. (f) The pupal stage usually lasts 7-8 days, in summer weather conditions and the pupa is surrounded with a coarse cocoon. (g) These insects, as a general rule, overwinter as pupae but sometimes as larvae. 2. Control measures (a) BHC dust applied on the ground seem most effective. It should be done 4-5 days after the worm has burrowed into the ground. For this control, it is recommended that 6kg of a 2% formation Tanbo(l0ares) be used. (b) For the effective spraying against the fly, it is recommended that a formulation of liquid BHC spray terials be used at the rate of 400-600 liters per Tanbo. (c) Tillage methods which provide a cover of soil 5cm or more in depth above infested areas will effect-maively prevent the emergence of the fly from the pupal stage. 3. Conclusions Methods of control against Diplosis mori Yokoyama can be tied more closely to the life cycle of the insect with more effective results. Further studies are needed to complete information on possible controls during or after hibernation. Economic studies on the cost of these control measures are also needed.

• Tuberculosis and Respiratory Diseases
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• v.48 no.3
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• pp.357-364
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• 2000

Background : Complicated exudative pleural fluid collections have traditionally been treated by either closed tube thoracostomy drainage or by open surgical drainage. Complete drainage is important in order to control pleural sepsis, restore pulmonary function, and entrapment. Recently intracavitary fibrinolytic therapy has been advocated as a method to facillitate drainage of complicated exudative pleural effusion and to allow enzymatic debridemant of the restrictive fibrinous sheets covering the pleural surface. The purpose of this study is to prospectively evaluate the effects of image-guided catheter drainage with high dose urokinase(UK) instillation in the treatment of complicated pleural effusions. Patients : Twenty complicated pleural effusion patients that poorly respond to image-guided drainage were allocated to receive UK. There were 8 pneumonia and 12 tuberculosis. Methods : Drugs were diluted in 250 mL normal saline and were infused intrapleurally through the chest tube or pig-tail catheter in a daily dose of 250,000 IU of UK. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasound and/or computed tomography. Results : The mean UK instillation time was $1.63{\pm}0.10$. The mean volume drained UK instillation was $381.3{\pm}314.4\;mL$, and post-UK was $321.6{\pm}489.5\;mL$. The follow up duration after UK therapy was mean $212.9{\pm}194.5$ days. We had successful results in 19 cases (95.0%). There were 12 pleural thickenings (60.0%), 2 markedly decreased effusions (10.0%) and 5 cases of no thickening or effusion. There was recurrence after treatment in only one patient(5%) with complicated pleural effusiondue to tuberculosis. Conclusions : Image-guided drainage with high dose UK instillation (250,000 U/day) in complicated pleural effusion is a safe and more effective method than closed thoracostomy drainage. And this management, in turn, can obviate surgery in most cases.