• Journal of Chest Surgery
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• v.30 no.1
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• pp.17-26
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• 1997

Objeitives. The surgical mortality of congenital heart defects has been reduced (or the very young age group. Especially, young age at repair is an important risk factor for mortality after repair of tetralogy of Falloff. Some risk factors were analyzed Methods. Three hundred and sixty six patients underwent surgical Intervention. Ages ranged from 5 days to 64 years, and 80 patients were adults(over 15 years of age). The defects consisted of 313(84.2%) acyanotic and 53(15.8%) cyanotic anomalies. The surgical mortalities were evaluated by univariate and multivariate analysis. Results. The overall surgical mortality was 10.4%. Mos deaths occurred in the infant group younger than 6 months(20/38 deaths) and in cyanotic group(21/38 deaths). Surgical infant mortality younger than 12 months was 24.8%(25/101). Risk factors of mortality in open heart surgery were age(p< 0.0001), body weight(p< 0.0001), pump time(p< 0.0001), aortic cross clamp time(p< 0.0001), use of total circulatory arrest(p<0.0001) and cyanotic disease(p<0.0001) by univariate analysis. But by multivariate analysis, the risk factor of mortality in open heart surgery was disease entity(p=0.002) only. A disease group with the highest risk was a cyanotic group(odds ratio was 15.3 relative to ventricular septal defect) excluding tetralogy of Falloff(odds ratio=0.27). Conclusions. Even though the most important risk factor was disease entity, we should conentrate our efforts on the technically improvable factors affecting surgical mortality indicated by univarlate analysis.

• Journal of Chest Surgery
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• v.48 no.3
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• pp.164-173
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• 2015

Background: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods: This retrospective study included 225 consecutive patients (mean age, 65{\pm}10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. Results: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ${\geq}III$ (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p <0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. Conclusion: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.

• Journal of Chest Surgery
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• v.45 no.2
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• pp.80-84
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• 2012

Background: The aim of this study is to evaluate our institutional results of the aortic valve replacement through minimally invasive approaches compared with conventional sternotomy. Materials and Methods: From August 1997 to July 2010, 838 patients underwent primary isolated aortic valve replacement. Of them, 73 patients underwent surgery through minimally invasive approaches (MIAS group) whereas 765 patients underwent surgery through the conventional sternotomy (CONV group). Clinical outcomes were compared using a propensity score matching design. Results: Propensity score matching yielded 73 pairs of patients in which there were no significant differences in baseline profiles between the two groups. Patients in the MIAS group had longer aortic cross clamp than those in the CONV group ($74.9{\pm}27.9$ vs.. $66.2{\pm}27.3$, p=0.058). In the MIAS group, conversion to full sternotomy was needed in 2 patients (2.7%). There were no significant differences in the rates of low cardiac output syndrome (4 vs. 8, p=0.37), reoperation due to bleeding (7 vs. 6, p=0.77), wound infection (2 vs. 4, p=0.68), or requirements for dialysis (2 vs. 1, p=0.55) between the two groups. Postoperative pain was significantly less in the MIAS group than the conventional group (pain score, $3.79{\pm}1.67$ vs. $4.32{\pm}1.56$; p=0.04). Conclusion: Both minimally invasive approaches and conventional sternotomy had comparable early clinical outcomes in patients undergoing primary isolated aortic valve replacement. Minimally invasive approaches significantly decrease postoperative pain.

• The Korean Journal of Nuclear Medicine
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• v.31 no.1
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• pp.36-42
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• 1997

Though myocardial perfusion was usually expected to improve after coronary artery bypass graft(CABG) surgery, some myocardial segments were aggravated after operation, as we compared perfusion changes on postoperative SPECT with preoperative ones. In this study, we evaluated perfusion changes after operation in rest and stress myocardial SPECT in 44 patients (M:F=25:19, age 57.1 $year{\pm}8.2$) who had CABG before and 3 months after operation. We tried to find out possible causes for perfusion aggravation with multivariate logistic regression analysis regarding whether bypass graft was artery or vein and which coronary artery territory was operated. Among 616 myocardial segments which were operated, 89(14.4%) aggravated after operation. In the univariate analysis, myocardial segments in the left circumflex arteries(LCx) aggravated more often(p<0.01) than others and segments having operative angioplasty did less often(p<0.01). Multivariate logistic regression revealed that LCx was risk factor for perfusion aggravation [odds ratio=2.54 (95% confidence interval : 1.53-4.22, p<0.01)]. However, this was not the case when we analysed in terms of arterial territories. Among 106 coronary arterial territories which were operated, 27(25.5%) aggravated. The territories having aggravated had similar characteristics regarding whether they received arterial or venous grafts, angioplasty and whether the operated territories were left anterior descending, right coronary or left circumflex arteries. In conclusion, myocardial segments in the left circumflex artery tended to aggravate more often after bypass surgery than the others. In short-term comparison of perfusion after surgery, we could not find any tendency that arterial or venous graft was associated with more frequency of the aggravation of perfusion after operation.

• Fire Science and Engineering
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• v.30 no.4
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• pp.121-127
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• 2016

This study analyzed the structural and electrical characteristics of an iron fittings type Corrugated Stainless Steel Tubing (CSST) damaged by the Primary Current Injection Test System (PCITS). CSST consists of cladding, tube, nuts, clamp ring, flare cap, socket, and ball valve. For an evaluation of the dielectric withstand voltage, the area between the live part and non-live part of the CCST shall withstand a voltage of 220 V AC for one minute. For an evaluation of the insulation performance by 500 V DC, it is required that the insulation exceed more than $1M{\Omega}$ before the temperature rise test, $0.3M{\Omega}$ after the test. Although the average resistance of the product was $11.5m{\Omega}$, that of the product damaged at a current of 130 A by the PCITS was $11.50m{\Omega}$. Furthermore, parts of the cladding were melted and black smoke appeared when a current of 130 A applied for 10 s. After 60 s, most parts were heated and turned red. At 120 s, the parts that turned red had widened. Although it did not form a normal distribution because the P value was 0.019 with a confidential interval of 95%, it revealed outstanding characteristics with an AD (Anderson-Darling) value of 0.896 and a standard deviation of 0.5573.

• Journal of Chest Surgery
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• v.24 no.7
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• pp.674-684
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• 1991

The surgical treatment of tetralogy of Fallot [TOF] was initiated by Blalock and Taussig in 1945 with the establishment of the subclavian artery to pulmonary artery anastomosis. In an imaginative and daring effort, in 1954, Lillehei and collaborators [1955] using controlled cross-circulation, carried out the first intracardiac repair of TOF by closing the ventricular septal defect [VSD] and relieving the pulmonary stenosis under direct vision. Nowadays, total correction is the ideal operation for treatment of TOF and is accomplished with extracorporeal circulation. And the results of surgery for TOF have steadily improved over the years, thanks to important contributions of many surgeons. Nevertheless because of its protean physiologic and anatomic presentation, TOF continues to offer challenges to cardiologist and cardiac surgeons. Thirty two cases of TOF have undergone total corrective surgery using extracorporeal circulation in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, Inje University, from Oct. 1985 to Feb. 1990. Clinical considerations were applied to these cases and the results were obtained as follows. 1. The heart lung machine used for extracorporeal circulation was SarnsO 7000, 5-head roller pump, and the number and type of oxygenators were 10 of bubble type and 22 of membrane type. The mean bypass time was 148.9 minutes and the mean aortic cross clamp time was 123.8 minutes. The GIK [glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 2. 20 cases were male and 12 were female, the mean age was 8 years old and the mean body weight was 25Kg. 3. The preoperative symptoms were cyanosis [29 cases], squatting [27 cases] and etc. The mean values of preoperative Hb., Hct., and SaO2 were 16.5 gm /dl, 50.3%, and 78.5%. 4. Combined anomalies were noticed in 16 cases [50%]. Among them 10 cases were PFO and 6 cases were ASD. 5. The degree of aorta overriding were 25% in 5 cases, 25 ~ 50% in 22 cases and above 50% in 5 cases. The dPA/Ao [ratio of diameter of pulmonary artery trunk to ascending aorta] were below 25% in 5 cases, 25 ~ 50% in 10 cases, 50 ~ 70% in 6 cases and above 75% in 11 cases. 6. The types of RVOT [right ventricular outflow tract] stenosis were valvular and infundibular in 14 cases [43.6%], diffuse hypoplastic type in 12 cases [37.5%], infundibular in 5 cases, and valvular and supravalvular in 1 case. 7. One stage radical corrective surgery was applied to the all cases. In widening of the RVOT, 3 types of patches were used: MVOP [monocusp ventricular outflow patch, Polystan BioprosthesesO] in 3 cases, knitted Dacron vessel patches in 2 cases, and double layer with bovine pericardium and woven Dacron prosthesis in 26 cases. 8. Postoperative complications were occurred in 15 cases. Among them, low output syndrome were occurred in 10 cases [31.3%] and 2 of them were expired postoperatively.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.27 no.4
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• pp.313-323
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• 2017

Objectives: This study aimed to assess exposure to black carbon(BC) among forklift operators and to identify environmental and occupational factors influencing their BC exposure. Methods: We studied a total of 23 forklift operators from six workplaces manufacturing paper boxes. A daily BC exposure assessment was conducted during working hours from January to April 2017. A micro-aethalometer was used to monitor daily BC exposure, and information on work activities was also obtained through a time-activity diary(TAD) and interviews. BC exposure records were classified into four categories influencing BC exposure level: working environment, workplace, forklift operation, and job characteristics. Analysis of variance(ANOVA) was used to compare average BC exposure levels among the four categories and the relationships between potential factors and BC exposure were analyzed using a multiple linear regression model. Results: The operators' daily exposure was $12.9{\mu}g/m^3$(N=9,148, $GM=7.5{\mu}g/m^3$) with a range: $0.001-811.4{\mu}g/m^3$. The operators were exposed to significantly higher levels when they operate a forklift in a room ${\leq}20,000m^3$($AM=12.3{\mu}g/m^3$), in indoor workplaces($AM=16.3{\mu}g/m^3$), when they operate a forklift manufactured before 2006 ($AM=13.2{\mu}g/m^3$), a forklift with a loading limit of four-tons($AM=27.1{\mu}g/m^3$), with a roll and bale type clamp($AM=17.1{\mu}g/m^3$), and with no particulate filter($AM=15.7{\mu}g/m^3$). Conclusions: Occupational factors including temperature, smoking, season, daytime, room volume($m^3$), location of operating, and manufacturing era and model of forklift influenced the BC exposure of forklift operators. The results of this study can be used to minimize the BC exposure of forklift operators.

• Journal of Mushroom
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• v.10 no.4
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• pp.151-159
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• 2012

The button mushroom (Agaricus bisporus) is one of the most widely cultivated important edible mushroom species. In the breeding of new button mushroom, 'Seolgang' was developed by crossing two monokaryons 'CM020913-27' and 'SSU423-31'. Because of the secondarily homothallism, only a small percentage of the basidia produce 3 or 4 spores, which are mostly haploid (n) and do not fruit. Single spore cultures derived from these types of spores produce a vegetative mycelium that also contain a variable number of genetically identical nuclei per cell called monokaryon. The lack of clamp connections between monokaryon and dikaryon required a series of mycelial culture and fruiting test. After crossing, hybrids were cultivated on a small scale and on a commercial scale at a farm. For this, the spawn was made by a commercial spawn producer and the spawned compost by a commercial compost producer. Mycelial growth of 'Seolgang' on CDA was better at $20^{\circ}C$ and $25^{\circ}C$ when it was compared with that of '505 Ho'. The mature cap shape of new strain 'Seolgang' is oblate spheroid and the immature cap shape is round to oblate spheroid. The cap diameter was 41.2 mm on average. In comparison with white strain '505 Ho', the strain had a yield that was 9% higher. It produced fruiting bodies which had a higher weight on average per fruiting body and were 19% firmer with a good shelf life. Days of fruiting body were 3-4 days later than those of '505 Ho'. The physical characteristics such as elasticity, chewiness, adhesiveness were better than that of '505 Ho'. Genetic analysis of the new strain 'Seolgang' showed different profiles compared to '505 Ho', CM02913-27, SSU413-31, when RAPD primers A02 and O04 were used.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.340-345
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• 2013

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of $16.5{\pm}9.7$. Group II comprised 14 female and 3 male patients with an average age of $18.5{\pm}9.8$ showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was $1.8{\pm}0.2$. The average pulmonary artery pressure was $35{\pm}10$ mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

• Journal of the Korean Vacuum Society
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• v.11 no.2
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• pp.113-118
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• 2002

We developed engineering methods to control gas flow in a plasma reactor in order to achieve good etch depth uniformity for large area GaAs etching. Finite difference numerical method was found quite useful for simulation of gas flow distribution in the reactor for dry etching of GaAs. The experimental results in $BCl_3/N_2/SF_6/He$ ICP plasmas confirmed that the simulated data fitted very well with real data. It is noticed that a focus ring could help improve both gas flow and etch uniformity for 150 mm diameter GaAs plasma etch processing. The simulation results showed that optimization of clamp configuration could decrease gas flow uniformity as low as $\pm$ 1.5% on an 100 mm(4 inch) GaAs wafer and $\pm$ 3% for a 150 m(6 inch) wafer with the fixed reactor and electrode, respectively. Comparison between simulated gas flow uniformity and real etch depth distribution data concluded that control of gas flow distribution in the chamber would be significantly important in order or achieve excellent dry etch uniformity of large area GaAs wafers.