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Surgical Repair for Ebstein's Anomaly (Ebstein 기형의 수술 -2례 보고-)

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    • Journal of Chest Surgery
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    • v.12 no.3
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    • pp.289-296
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    • 1979
  • For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

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Estimating Saturation-paste Electrical Conductivities of Rose-cultivated Soils from their Diluted Soil Extracts (절화장미 재배토양에서 희석된 토양 침출용액으로부터 포화반죽 전기전도도 추정)

  • Lee, In-Bog;Ro, Hee-Myong;Lim, Jae-Hyun;Yiem, Myoung-Soon
    • Korean Journal of Soil Science and Fertilizer
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    • v.33 no.6
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    • pp.398-404
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    • 2000
  • We examined the effect of soil:water ratio on the equivalent concentration of individual electrolyte species and the electrical conductivities (EC) of the diluted extracts of 24 soil samples (loam or silt loam) collected from rose-cultivated plastic houses to estimate the EC of saturated soil-paste extracts (ECe) from diluted soil extracts. With increasing volume ratio of water (higher dilution), the equivalent concentrations of each electrolyte species and their sum increased. The relative contribution to the EC, however, was highest for $NO_3{^-}$, irrespective of soil:water ratio. The measured ECe was 6.36 for loam and $8.09dS\;m^{-1}$ for silt loam soils and the corresponding soil:water ratio was 0.38 and 0.50, respectively. The EC_e estimated from the EC of diluted extracts at 1:1, 1:2, or 1:5 soil:water ratios using their corresponding uniform diluted factors was lower than the measured EC_e and this difference was greater with higher dilution and EC values. Therefore, the alternative diluted factors (y) for each soil: water ratio were obtained following the definition of diluted factor and were correlated significantly with volume ratios of added water (x): y=1.55x+0.5 for loam and y=1.21x+0.48 for silt loam soils. On the other hand, correlation analyses of the EC of soil extracts (y) to the volume ratio of added water (x) on log-log scale yielded linear models: logy = -0.805logx + logb, SD of slope=0.05, b=sample specific constant, n=24). With known saturation percentage of a sample representing a group and and the EC of diluted extract of a given soil, the EC_e could be predicted using the proposed logarithmic equation.

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Legal Issue in Case of Death or Injury of an International Crew While on Board (국제항공운송 승무원이 항공기내에서 사상(死傷)을 당한 경우 법률관계 - 국내외 판례의 분석을 중심으로 -)

  • Kim, Sun-Ah
    • The Korean Journal of Air & Space Law and Policy
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    • v.35 no.2
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    • pp.137-168
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    • 2020
  • Air passengers may be compensated for damages based on the above agreement when the passenger suffers an accident to the extent that they are recognized as an accident under Article 17 of the Montreal Convention in 1999. If a flight or cabin crew and passengers both undergo an accident, passengers are subjected to compensation under the Montreal Convention however flight cabin crews will be compensated by the Labor Law, which is the governing law in the labor contract with the airline. The flight or cabin crew boarding the aircraft work is on a work contract, not a passenger transport contract. Therefore, if the flight or cabin crew on the aircraft is injured due to an accident, and the air carrier is liable for default due to a labor contract, the Labor Law, workers or survivors claim damages due to illegal acts against the employer. In which case, civil law will apply. In this regard, if a Chinese cabin crew working for a Chinese airline dies due to an accident in the Republic of Korea, whether the family of the deceased claims damages against the Chinese airline or not has international court jurisdiction in the Republic of Korea, which is the place of tort. We examined whether it is the law of the Republic of Korea or whether it's the Chinese law, the law applicable to the work contract, is applied. Also, Seoul District Court 1995.5.18. The sentence 94A 14144 was found that if the injured crew during the flight work was not satisfied with the insurance compensation under the Labor Standards Act and the Industrial Accident Compensation Insurance Act, he could claime to damage under the civil law against an air carrier or third parties responsible for the accident. This law case shows that you can claim a civil damage as a cause. In case of death due to an existing illness while on the way to work, the Korea Workers'Compensation and Welfare Service did not recognize the death of the deceased as an occupational accident, and the trial was canceled by the parents of the deceased for the survivor's benefit and funeral expenses. (Seoul Administrative Court 2017.8. 31. Although the sentence was judged as an occupational disaster in 2016, the 2016 8816 Decision), it was defeated in the appeals court (Seoul High Court 2018.7.19.Sentence 2017 No. 74186) and I criticized the judgment of the appeal by analyzing the deceased's disease and related the cause of it to workload. Sometimes, a flight or cabin crew is on board not for the flight duty such as transferring to another flight or returning to the home base or lay-over place after their scheduled flight, this is called "Deadheading". If the crew who is not considered the same as a passenger, but is not on duty, is injured in an accident, does the crew claim compensation for damages under the labor contract or whether the Montreal Convention is applied to the passenger. In conjunction with the discussion, there was a similar case, In re Mexico City Aircrash of October 31, 1979, 708 F.2d 400 (9th Cir. 1983), Demanes v. United Airlines, 348 F.Supp. 13 (C.D.Cal. 1972), Sulewski v. Federal Express Corp., 749 F.Supp. 506 (S.D.N.Y. 1990) and reviewed by the European Court of Justice (CJEU) at Wucher Helicopter GmbH and Euro-Aviation Versicherungs AG v. After examining several acts in several countries it's undeniably crucial to clearly understand the definition of "passenger" as stated in the Fridolin Santer case.

A Clinical Review of Acute Respiratory Distress Syndrome (ARDS) Due to Miliary Tuberculosis (급성호흡곤란증후군으로 발현된 속립성 결핵의 임상적 고찰)

  • Ahn, Young-Soo;Lee, Sang-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.1
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    • pp.17-26
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    • 2002
  • Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

A Study on the Born Global Venture Corporation's Characteristics and Performance ('본글로벌(born global)전략'을 추구하는 벤처기업의 특성과 성과에 관한 연구)

  • Kim, Hyung-Jun;Jung, Duk-Hwa
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.3
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    • pp.39-59
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    • 2007
  • The international involvement of a firm has been described as a gradual development process "a process in which the enterprise gradually increases its international involvement in many studies. This process evolves in the interplay between the development of knowledge about foreign markets and operations on one hand and increasing commitment of resources to foreign markets on the other." On the basis of Uppsala internationalization model, many studies strengthen strong theoretical and empirical support. According to the predictions of the classic stages theory, the internationalization process of firms have been recognized and characterized gradual evolution to foreign markets, so called stage theory: indirect & direct export, strategic alliance and foreign direct investment. However, termed "international new ventures" (McDougall, Shane, and Oviatt 1994), "born globals" (Knight 1997; Knight and Cavusgil 1996; Madsen and Servais 1997), "instant internationals" (Preece, Miles, and Baetz 1999), or "global startups" (Oviatt and McDougall 1994) have been used and come into spotlight in internationalization study of technology intensity venture companies. Recent researches focused on venture company have suggested the phenomenons of 'born global' firms as a contradiction to the stages theory. Especially the article by Oviatt and McDougall threw the spotlight on international entrepreneurs, on international new ventures, and on their importance in the globalising world economy. Since venture companies have, by definition. lack of economies of scale, lack of resources (financial and knowledge), and aversion to risk taking, they have a difficulty in expanding their market to abroad and pursue internalization gradually and step by step. However many venture companies have pursued 'Born Global Strategy', which is different from process strategy, because corporate's environment has been rapidly changing to globalization. The existing studies investigate that (1) why the ventures enter into overseas market in those early stage, even in infancy, (2) what make the different international strategy among ventures and the born global strategy is better to the infant ventures. However, as for venture's performance(growth and profitability), the existing results do not correspond each other. They also, don't include marketing strategy (differentiation, low price, market breadth and market pioneer) that is important factors in studying of BGV's performance. In this paper I aim to delineate the appearance of international new ventures and the phenomenons of venture companies' internationalization strategy. In order to verify research problems, I develop a resource-based model and marketing strategies for analyzing the effects of the born global venture firms. In this paper, I suggested 3 research problems. First, do the korean venture companies take some advantages in the aspects of corporate's performances (growth, profitability and overall market performances) when they pursue internationalization from inception? Second, do the korean BGV have firm specific assets (foreign experiences, foreign orientation, organizational absorptive capacity)? Third, What are the marketing strategies of korean BGV and is it different from others? Under these problems, I test then (1) whether the BGV that a firm started its internationalization activity almost from inception, has more intangible resources(foreign experience of corporate members, foreign orientation, technological competences and absorptive capacity) than any other venture firms(Non_BGV) and (2) also whether the BGV's marketing strategies-differentiation, low price, market diversification and preemption strategy are different from Non_BGV. Above all, the main purpose of this research is that results achieved by BGV are indeed better than those obtained by Non_BGV firms with respect to firm's growth rate and efficiency. To do this research, I surveyed venture companies located in Seoul and Deajeon in Korea during November to December, 2005. I gather the data from 200 venture companies and then selected 84 samples, which have been founded during 1999${\sim}$2000. To compare BGV's characteristics with those of Non_BGV, I also had to classify BGV by export intensity over 50% among five or six aged venture firms. Many other researches tried to classify BGV and Non_BGV, but there were various criterion as many as researchers studied on this topic. Some of them use time gap, which is time difference of establishment and it's first internationalization experience and others use export intensity, ration of export sales amount divided by total sales amount. Although using a mixed criterion of prior research in my case, I do think this kinds of criterion is subjective and arbitrary rather than objective, so I do mention my research has some critical limitation in the classification of BGV and Non_BGV. The first purpose of research is the test of difference of performance between BGV and Non_BGV. As a result of t-test, the research show that there are statistically efficient difference not only in the growth rate (sales growth rate compared to competitors and 3 years averaged sales growth rate) but also in general market performance of BGV. But in case of profitability performance, the hypothesis that is BGV is more profit (return on investment(ROI) compared to competitors and 3 years averaged ROI) than Non-BGV was not supported. From these results, this paper concludes that BGV grows rapidly and gets a high market performance (in aspect of market share and customer loyalty) but there is no profitability difference between BGV and Non_BGV. The second result is that BGV have more absorptive capacity especially, knowledge competence, and entrepreneur's international experience than Non_BGV. And this paper also found BGV search for product differentiation, exemption strategy and market diversification strategy while Non_BGV search for low price strategy. These results have never been dealt with other existing studies. This research has some limitations. First limitation is concerned about the definition of BGV, as I mentioned above. Conceptually speaking, BGV is defined as company pursue internationalization from inception, but in empirical study, it's very difficult to classify between BGV and Non_BGV. I tried to classify on the basis of time difference and export intensity, this criterions are so subjective and arbitrary that the results are not robust if the criterion were changed. Second limitation is concerned about sample used in this research. I surveyed venture companies just located in Seoul and Daejeon and also use only 84 samples which more or less provoke sample bias problem and generalization of results. I think the more following studies that focus on ventures located in other region, the better to verify the results of this paper.

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A User Optimer Traffic Assignment Model Reflecting Route Perceived Cost (경로인지비용을 반영한 사용자최적통행배정모형)

  • Lee, Mi-Yeong;Baek, Nam-Cheol;Mun, Byeong-Seop;Gang, Won-Ui
    • Journal of Korean Society of Transportation
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    • v.23 no.2
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    • pp.117-130
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    • 2005
  • In both deteministic user Optimal Traffic Assignment Model (UOTAM) and stochastic UOTAM, travel time, which is a major ccriterion for traffic loading over transportation network, is defined by the sum of link travel time and turn delay at intersections. In this assignment method, drivers actual route perception processes and choice behaviors, which can become main explanatory factors, are not sufficiently considered: therefore may result in biased traffic loading. Even though there have been some efforts in Stochastic UOTAM for reflecting drivers' route perception cost by assuming cumulative distribution function of link travel time, it has not been fundamental fruitions, but some trials based on the unreasonable assumptions of Probit model of truncated travel time distribution function and Logit model of independency of inter-link congestion. The critical reason why deterministic UOTAM have not been able to reflect route perception cost is that the route perception cost has each different value according to each origin, destination, and path connection the origin and destination. Therefore in order to find the optimum route between OD pair, route enumeration problem that all routes connecting an OD pair must be compared is encountered, and it is the critical reason causing computational failure because uncountable number of path may be enumerated as the scale of transportation network become bigger. The purpose of this study is to propose a method to enable UOTAM to reflect route perception cost without route enumeration between an O-D pair. For this purpose, this study defines a link as a least definition of path. Thus since each link can be treated as a path, in two links searching process of the link label based optimum path algorithm, the route enumeration between OD pair can be reduced the scale of finding optimum path to all links. The computational burden of this method is no more than link label based optimum path algorithm. Each different perception cost is embedded as a quantitative value generated by comparing the sub-path from the origin to the searching link and the searched link.