Mid-term results of IntracardiacLateral Tunnel Fontan Procedure in the Treatment of Patients with a Functional Single Ventricle (기능적 단심실 환자에 대한 심장내 외측통로 폰탄술식의 중기 수술성적)
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- Journal of Chest Surgery
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- v.31 no.5
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- pp.472-480
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- 1998
We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.
Marketing financial services used to be easier. Today, the competition in financial services is fierce. Not only has the competition become more intense, financial services have also changed structurally. In an environment with various customer needs and severe competitions, the marketing in financial services industry is getting more difficult and more important than before. However, there are still not enough studies on financial services marketing in Korea whereas lots of research papers have been published frequently in some international journals. The purpose of this paper is (1)to review the literature on financial services marketing, (2)to investigate current marketing activities based on in-depth interview with financial marketing managers in Korea, and (3)to suggest some implications for future research on the financial services marketing. Financial products are not consumer products. In fact, they are not products at all in the way product marketing is usually described. Nor are they altogether like services. The financial industry operates in a unique way, and its marketing tasks are correspondingly complex. However, the literature review shows that there has been a lack of basic studies which dealt with inherent characteristics of financial services marketing compared to the research on marketing in other industries. Many studies in domestic marketing journals have so far focused only on the general customer behaviors and the special issues in some financial industries. However, for more effective financial services marketing, we have to answer following questions. Is there any difference between financial service marketing and consumer packaged goods marketing? What are the differences between the financial services marketing and other services marketing such as education and health services? Are there different ways of marketing among banks, securities firms, insurance firms, and credit card companies? In other words, we need more detailed research as well as basic studies about the financial services marketing. For example, we need concrete definitions of financial services marketing, bank marketing, securities firm marketing, and etc. It is also required to compare the characteristics of each marketing within the financial services industry. The products sold in each market have different characteristics such as duration and degree of risk-taking. It means that there are sub-categories in financial services marketing. We have to consider them in the future research on the financial services marketing. It is also necessary to study customer decision making process in the financial markets. There have been little research on how customers search and process information, compare alternatives, make final decision, and repeat their choices. Because financial services have some unique characteristics, we need different understandings in the customer behaviors compared to the behaviors in other service markets. And also considering the rapid growth in financial markets and upcoming severe competition between domestic and global financial companies, it is time to start more systematic and detailed research on financial services marketing in Korea. In the second part of this paper, I analyzed the results of in-depth interview with 20 marketing managers of financial services companies in Korea. As a result, I found that the role of marketing departments in Korean financial companies are mainly focused on the short-term activities such as sales support, promotion, and CRM data analysis although the size and history of marketing departments to some extent show a sign of maturity. Most companies established official marketing departments before 2001. Average number of employees in a marketing department is about 58. However, marketing managers in eight companies(40% of the sample) still think that the purpose of marketing is only to support and manage general sales activities. It shows that some companies have sales-oriented concept rather than marketing-oriented concept. I also found three key words which marketing managers think importantly in financial services markets. They are (1)Trust in customer relationship, (2)Brand differentiation, and (3)Rapid response to customer needs. 50% of the sample support that "Trust" is the most important key word in the financial services marketing. It is interesting that 80% of banks and securities companies think that "Trust" is the most important thing, whereas managers in credit card companies consider "Rapid response to customer needs" as the most important key word in their market. In addition, there are different problems recognition of marketing managers depending on the types of financial industries they belong to. For example, in the case of banks and insurance companies, marketing managers consider "a lack of communication with other departments" as the most serious problem. On the other hand, in the case of securities firms, "a lack of utilization of customer data" is the most serious problem. These results imply that there are different important factors for the customer satisfaction depending on the types of financial industries, and managers have to consider them when marketing financial products in more effective ways. For example, It will be necessary for marketing managers to study different important factors which affect customer satisfaction, repeat purchase, degree of risk-taking, and possibility of cross-selling according to the types of financial industries. I also suggested six hypothetical propositions for the future research.
This study aims at the psychological elucidation of some conscious aspects of the personality of Yi Sun-sin (1545-1598), the Korean national hero, and the unconscious teleologic meanings of his dreams mentioned in Nanjung Ilgi (Diary in War Time) from the viewpoint of analytical psychology of C.G. Jung. Yi Sun-sin was a man of discipline, incorporated with the spirit of Confucian filial piety, hyo (hsiao) and royalty, chung. He was a stern man but with a warm heart. In his diary, Yi Sun-sin poured forth his feelings of suffering, despair, and extreme solicitude caused by slanders of his political opponents, his grief for the loss of mother and son, and his worries about the fate of his country, which the Japanese invaders now plundered. The moon night offered him the opportunity to touch with his inner soul, by reciting poems, playing Korean string, 'Keomungo', and flute. Further, he widened his scope by asking for the answers from the 'Heaven' through divination and dream. Yi Sun-sin's attitude toward his mother who raised the future hero and maternal principles were considered in concern with the Jungian term 'mother complex'. Won Gyun, Yi Sun-sin's rival admiral, who persistently accused Yi Sun-sin of 'slanders,' certainly represents the unconscious shadow image of Yi Sun-sin. The reciprocal 'shadow' projection has intervened in the conflicting relationship between Yi and Won. In concern to the argument for the suicidal death of Yi Sun-sin, the author found no evidence supporting such an argument, No trace of latent suicidal wish was found in his dreams. For Yi Sun-sin, the determination of the life and death depends on Heaven. 32 dreams from the diary and 3 from other historical references were reviewed and analyzed in the Jungian way. Symbols of anima, Self, and individuation process were found. His dream repeatedly suggests that Yi Sun-sin is an extraordinary man chosen by the divine man (神人). In the dream, Yi Sun-sin was a disciple of the divine man receiving instructions on various strategies, and he alone could see the great thing or events. The dream of a beautiful blue and red dragon, whom he was friendly touching, indicates Yi Sun-sin's eligibility for the kingship. Yi Sun-sin seemingly did not aware of this message of the unconscious. Perhaps he sensed something special but did not identify with 'the disciple of gods' and 'royal dragon' in his dream. His modest attitude toward the dream has prevented him from falling into ego inflation. There were warning signals in two dreams that suggested disorders in the dreamer's instinctive feminine drive. Spirits of the dead father and brothers appear in the dream, giving advice or mourning for the death of Sun-sin's mother. Though Yi Sun-sin was a genuine Confucian gentleman, a dream revealed his unconscious drive to destroy the Confucian authoritative 'Persona' by trampling down the cylindrical traditional Korean hat. To the dreams of synchronicity phenomena Yi Sun-sin immediately solves the problem in concrete reality. He understood dreams as valuable messages from the superior entity, for example, the Confucian Heaven (天) or Heaven's Decree (天命). Furthermore, the 'Heaven' presumably arranged for him the way to the national hero and imposed necessary trials upon him. Both his persecutors and advocates of him guided him in the way of a hero. Yi Sun-sin followed his destiny and completed the living myth of the hero. His mother, King Seon-jo, and prime minister Liu Seong Yong, all have contributed to embodying the myth of the hero. Yi Sun-sin died and became god, the divine healer of the nation.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
As relationship between buyer and seller has been brought closer and long-term relationship has been more important in B2B markets, the importance of service and service convenience increases as well as product. In homogeneous markets, where service offerings are similar and therefore not key competitive differentiator, providing greater convenience may enable a competitive advantage. Service convenience, as conceptualized by Berry et al. (2002), is defined as the consumers' time and effort perceptions related to buying or using a service. For this reason, B2B customers are interested in how fast the service is provided and how much save non-monetary cost like time or effort by the service convenience along with service quality. Therefore, this study attempts to investigate the impact of service convenience on relationship factors such as relationship satisfaction, relationship commitment, and relationship performance. The purpose of this study is to find out whether service convenience can be a new antecedent of relationship quality and relationship performance. In addition, this study tries to examine how five-dimensional service convenience constructs (decision convenience, access convenience, transaction convenience, benefit convenience, post-benefit convenience) affect customers' relationship satisfaction, relationship commitment, and relationship performance. The service convenience comprises five fundamental components - decision convenience (the perceived time and effort costs associated with service purchase or use decisions), access convenience(the perceived time and effort costs associated with initiating service delivery), transaction convenience(the perceived time and effort costs associated with finalizing the transaction), benefit convenience(the perceived time and effort costs associated with experiencing the core benefits of the offering) and post-benefit convenience (the perceived time and effort costs associated with reestablishing subsequent contact with the firm). Earlier studies of perceived service convenience in the industrial market are none. The conventional studies that have dealt with service convenience have usually been made in the consumer market, or they have dealt with convenience aspects in the service process. This service convenience measure for consumer market can be useful tool to estimate service quality in B2B market. The conceptualization developed by Berry et al. (2002) reflects a multistage, experiential consumption process in which evaluations of convenience vary at each stage. For this reason, the service convenience measure is good for B2B service environment which has complex processes and various types. Especially when categorizing B2B service as sequential stage of service delivery like Kumar and Kumar (2004), the Berry's service convenience measure which reflect sequential flow of service deliveries suitable to establish B2B service convenience. For this study, data were gathered from respondents who often buy business service and analyzed by structural equation modeling. The sample size in the present study is 119. Composite reliability values and average variance extracted values were examined for each variable to have reliability. We determine whether the measurement model supports the convergent validity by CFA, and discriminant validity was assessed by examining the correlation matrix of the constructs. For each pair of constructs, the square root of the average variance extracted exceeded their correlations, thus supporting the discriminant validity of the constructs. Hypotheses were tested using the Smart PLS 2.0 and we calculated the PLS path values and followed with a bootstrap re-sampling method to test the hypotheses. Among the five dimensional service convenience constructs, four constructs (decision convenience, transaction convenience, benefit convenience, post-benefit convenience) affected customers' positive relationship satisfaction, relationship commitment, and relationship performance. This result means that service convenience is important cue to improve relationship between buyer and seller. One of the five service convenience dimensions, access convenience, does not affect relationship quality and performance, which implies that the dimension of service convenience is not important factor of cumulative satisfaction. The Cumulative satisfaction can be distinguished from transaction-specific customer satisfaction, which is an immediate post-purchase evaluative judgment or an affective reaction to the most recent transactional experience with the firm. Because access convenience minimizes the physical effort associated with initiating an exchange, the effect on relationship satisfaction similar to cumulative satisfaction may be relatively low in terms of importance than transaction-specific customer satisfaction. Also, B2B firms focus on service quality, price, benefit, follow-up service and so on than convenience of time or place in service because it is relatively difficult to change existing transaction partners in B2B market compared to consumer market. In addition, this study using partial least squares methods reveals that customers' satisfaction and commitment toward relationship has mediating role between the service convenience and relationship performance. The result shows that management and investment to improve service convenience make customers' positive relationship satisfaction, and then the positive relationship satisfaction can enhance the relationship commitment and relationship performance. And to conclude, service convenience management is an important part of successful relationship performance management, and the service convenience is an important antecedent of relationship between buyer and seller such as the relationship commitment and relationship performance. Therefore, it has more important to improve relationship performance that service providers enhance service convenience although competitive service development or service quality improvement is important. Given the pressure to provide increased convenience, it is not surprising that organizations have made significant investments in enhancing the convenience aspect of their product and service offering.