• Journal of Chest Surgery
• /
• 제9권2호
• /
• pp.207-214
• /
• 1976

Operations for cardiac valvular disease has been progressed in various ways. Since 1949 when Lord Russel operated mitral stenosis by closed technique at Johns Hopkins Hospital then much progress has been achieved and that nowadays severely diseased cardiac valve has been replaced by prosthetic valve, which is almost ideal in hemodynamic aspect, but still it has many problems such as thromboembolism, destruction of red blood cell, pressure gradient, and disturbance of left ventricular function, so in case of delicate situations, valve replacement should be decided carefully. Besides prosthetic valve, there are some kinds of reconstructive procedures and these have been resulted in better prognosis than prosthetic valve replacement in selected cases. So, authors have reviewed 61 Cases of cardiac patients who have been operated reconstructive valvular surgery by cardiopulmonary bypass, at Yonsei University, from Jan. 1963 to Mar. 1976. Out of 61 cases, 9 patients were replaced by prosthetic valve and rest of the patients were operated upon in various reconstructive procedures such as commissurotomy, valvotomy, valvuloplasty, and annuloplasty. Twenty cases of congenital heart diseases with valvular lesion, which had been operated for valvular lesion were also included in this statistics. Out of 9 cases of prosthetic valvular replacement five cases of prosthetic valvular replacement was done combined with other reconstructive procedures after attempted valvuloplasty. Comparative prognosis of both procedures are somewhat variable by reporters, average 19% of mortality after reconstructive surgery and 38% of mortality after prosthetic valve replacement in long term results. Most common cause of death in postoperative period was low output syndrome in both cases. It seems that good preoperative evaluation and proper reconstructive surgery will afford good prognosis in selected cardiac valvular diseased patient.

• Journal of Chest Surgery
• /
• 제32권11호
• /
• pp.1017-1022
• /
• 1999

Background: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. Material and Method: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. Result: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. Conclusion: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.

• Journal of Chest Surgery
• /
• 제48권6호
• /
• pp.407-410
• /
• 2015

A two-month-old infant presented with coarctation of the aorta, severe left ventricular dysfunction, and moderate to severe mitral regurgitation. Through median sternotomy, the aortic arch was repaired under cardiopulmonary bypass and regional cerebral perfusion. The patient was postoperatively supported with a left ventricular assist device for five days. Left ventricular function gradually improved, eventually recovering with the concomitant regression of mitral regurgitation. Prompt surgical repair of coarctation of the aorta is indicated for patients with severe left ventricular dysfunction. A central approach for surgical repair with a back-up left ventricular assist device is a safe and effective treatment strategy for these patients.

• Journal of Chest Surgery
• /
• 제51권1호
• /
• pp.1-7
• /
• 2018

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was $18.1{\pm}8.6months$. Results: The mean age of the patients was $77.1{\pm}5.8years$ and their mean Society of Thoracic Surgeons score was $9.2{\pm}17.7$. The mean cardiopulmonary bypass and aortic cross-clamp times were $94.5{\pm}37.3$ minutes and $54.9{\pm}12.5minutes$, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, $13.9{\pm}8.6mm\;Hg$ and peak, $27.2{\pm}15.0mm\;Hg$) at a mean of $9.9{\pm}4.2months$. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was $83.3%{\pm}10.8%$. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

• 대한전자공학회논문지TC
• /
• 제44권8호
• /
• pp.33-41
• /
• 2007

IEEE 802.11 DCF 채널 접근 기능은 충돌을 피하고 hidden-terminal과 exposed-terminal 문제를 회피하기 위하여 두 홈 네트워크 내에서는 단일 전송을 허락한다. 이러한 단일 전송은 전송자의 이웃 노드가 전체 왕복시간 동안 데이터 프레임을 기다리게 하며, 프레임 지연의 증가와 네트워크 처리량을 낮게 하는 결과를 초래한다. 실시간 응용들은 낮은 매체 이용, 특히 높은 네트워크 트래픽에 대해 심하게 영향을 받는다. 본 논문은 IEEE 802.11의 프레임 집합화 기술을 이용하여 기본적인 DCF 기능을 유지한 단일 전송 장애를 극복하는 새로운 방안을 제시한다. 제안한 방안은 비 간섭 동기화 슬롯에서 병렬 전송을 허용한다. 병렬 전송은 몇몇 상황에서 물리적인 전송자 감지와 랜덤 백오프 타임을 회피하며, 프레임 지연을 줄이고 매체 이용과 네트워크 용량을 증가시킨다.

• Journal of Chest Surgery
• /
• 제43권2호
• /
• pp.164-167
• /
• 2010

여러 가지 원인에 의해 발생된 급성 호흡부전에서 체외순환막형산화요법은 폐기능을 회복시키는데 도움이 될 수 있다. 물놀이 사고로 인해 발생된 급성 호흡부전 환자에서 기존의 적절한 치료에 반응하지 않는 경우 체외순환막형산화요법으로 성공적으로 치료한 보고들이 있다. 저자들은 물놀이 사고로 급성호흡부전이 발생한 2명의 환자를 정정맥 체외순환막형산화요법으로 치료를 하였다. 정맥 도관의 삽입은 모두 경피적으로 양측 대퇴정맥을 이용하였다. 2명의 환자 모두 성공적으로 체외순환막형산화요법을 제거할 수 있었으나, 1명의 환자에서 저 산소성 뇌손상과 거미막 및 출혈이 발생하였다.

• 한국정보과학회논문지:컴퓨팅의 실제 및 레터
• /
• 제14권3호
• /
• pp.321-325
• /
• 2008

위치정보기반 라우팅을 이용하는 무선 센서망은 자연환경 혹은 센서 노드들의 불균형적인 에너지 소비로 인한 라우팅 홀(hole)로 인해 높은 통신 장애 가능성이 존재한다. 이에 대해 연구된 대부분의 기법들은 그런 라우팅 홀을 우회하는 방법으로 접근하는 경향을 보인다. 그러나 홀 우회를 위한 라우팅은 홀 주변 센서노드들의 불균형적인 에너지 소비를 유도하기 때문에, 그들의 통신장애 및 네트워크 수명에 장애를 발생시킬 수 있다. 우리는 이미 홀 우회를 위한 라우팅 방안을 제안하였지만, 그 또한 갖는 문제점 때문에 가우시안 함수를 활용하여 그 연구에 대한 확장 방안을 새롭게 제안한다.

• Journal of Chest Surgery
• /
• 제27권12호
• /
• pp.989-994
• /
• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.

• Nuclear Engineering and Technology
• /
• 제27권3호
• /
• pp.317-326
• /
• 1995

증기발생기의 수위제어시스템에 대해 특히 저출력시 수위제어의 문제점을 분석고찰하고 퍼지제어기 법을 기반으로 한 안정되고도 신속한 수위제어에 관한 연구가 주로 수행되었다. 문제해결의 한 방안으로서, 중요 제어변수임에도 불구하고 저출력운전시 저유량구간의 추정불량으로 인해 사용할 수 없는 유량신호를 대신하여 밸브개도를 이용한 대체정보를 채용하였으며 또한 소속함수크기의 유동적인 조정방법을 이용하여 수위오차가 크게 발생한 과도상태시에는 신속한 수위회복이 이루어지도록 하였다. 실제운전환경에서 제시된 제어기를 튜닝 하기 위한 방법으로서 제어성능지수 및 decent method를 이용한 소속함수의 self-tuning 기법을 제시하였다. 원자력 연구소의 연수원에 설치된 교육훈련용 시뮬레이터에서 수행된 실험결과는 제시된 제어기 및 튜닝방법의 안정되고 우수한 성능구현 및 실질적 인 유용성을 보여주고 있다.

• IMMUNE NETWORK
• /
• 제13권2호
• /
• pp.63-69
• /
• 2013

IL-12 is a secretory heterodimeric cytokine composed of p35 and p40 subunits. IL-12 p35 and p40 subunits are sometimes produced as monomers or homodimers. IL-12 is also produced as a membrane-bound form in some cases. In this study, we hypothesized that the membrane-bound form of IL-12 subunits may function as a costimulatory signal for selective activation of TAA-specific CTL through direct priming without involving antigen presenting cells and helper T cells. MethA fibrosarcoma cells were transfected with expression vectors of membrane-bound form of IL-12p35 (mbIL-12p35) or IL-12p40 subunit (mbIL-12p40) and were selected under G418-containing medium. The tumor cell clones were analyzed for the expression of mbIL-12p35 or p40 subunit and for their stimulatory effects on macrophages. The responsible T-cell subpopulation for antitumor activity of mbIL-12p35 expressing tumor clone was also analyzed in T cell subset-depleted mice. Expression of transfected membranebound form of IL-12 subunits was stable during more than 3 months of in vitro culture, and the chimeric molecules were not released into culture supernatants. Neither the mbIL-12p35-expressing tumor clones nor mbIL-12p40-expressing tumor clones activated macrophages to secrete TNF-${\alpha}$. Growth of mbIL-12p35-expressing tumor clones was more accelerated in the $CD8^+$ T cell-depleted mice than in $CD4^+$ T cell-depleted or normal mice. These results suggest that $CD8^+$ T cells could be responsible for the rejection of mbIL-12p35-expressing tumor clone, which may bypass activation of antigen presenting cells and $CD4^+$ helper T cells.