• Title/Summary/Keyword: Double Operation

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Surgical Treatment of Left Main Coronary Artery Diseases (좌주관동맥협착의 외과적 치료)

  • 안병희;장원채
    • Journal of Chest Surgery
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    • v.29 no.12
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    • pp.1323-1328
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    • 1996
  • The obstructive diseases involving the left main coronary artery(LMCA) are serious. Surgical treatment is generally regarded as much more effective than medical therapy in terms of long-term survival and relief of symptoms. This study represents an attempt to present an analysis of early surgical results in 21 cases conducted at Chonnam University Hospital between October 1992 And August 1995. The subject. 12 males and 9 female, ranged in age from 25 to 67 years with a mean age of 49.3${\pm}$12.5 years. As for indications for operation, unstable angina was reported on 66.7% of the subjects, while stable angina and acute myocardial infarction in 4 and 3 cases, respectively. There were also 2 cases of Takayasu's aortitis and 1 case of failed percutaneous translumlnal coronary angioplasty(PTCA). Eleven subjects had isolated LMCA diseases compared to 10 subjects with associated LMCA diseases. Of the patients with ass;3ciated LMCA diseases, 4 subjects had single coronary artery disease, 3 had double coronary artery disease, remaining 3 suffered from triple coronary artery disease. As for the group with isolated LMCA disease, ostidl angioplasty llsing autopericardium was conducted with 5 subjects. The remaining subjects with the isolated diseases and all of the patients with associated LMCA disease underwent aortocoronary bypass grafts. The left internal mammary artery was used in all patients and the average number of anastomoses was 3.13 ${\pm}$0.93. One subject died of low cardiac output syndrome at the second postoperative day. There were 5 instances of postoperative complication including reoperation for bleeding in two patients, wound infection in two, and arrhythmia in one. Follow-up coronary angiogram were conducted with eights patients, including five patients who underwent ostial angioplasty. In these cases, the patients showed surf. ficient enlargement of the left coronary ostium and the grafted vessels kept their patency. In our experience, surgical treatment of the LMCA diseases has not shown a higher rAte of operative mortAlity or morbidity than other obstructive coronary artery diseases. To patients with ostial stenosis, which is frequently observed among young female, angioplasly utilizing autopericardium seems to be a desirable choice considering the cosmetic effect, chances of reoperation and hemodynamic characteristics.

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A STUDY ON THE JUJEON OF AUTOMATIC CLEPSYDRA IN EARLY JOSEON DYNASTY (조선 전기 자동물시계의 주전(籌箭) 연구)

  • YUN, YONG-HYUN;KIM, SANG HYUK;MIHN, BYEONG-HEE;OH, KYONG TAEK
    • Publications of The Korean Astronomical Society
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    • v.36 no.3
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    • pp.65-78
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    • 2021
  • Jagyeokru, an automatic striking water clock described in the Sejong Sillok (Veritable Records of King Sejong) is essentially composed of a water quantity control device and a time-signal device, with the former controlling the amount or the flow rate of water and the latter automatically informing the time based on the former. What connects these two parts is a signal generating device or a power transmission device called the 'Jujeon' system, which includes a copper rod on the float and ball-racked scheduled plates. The copper products excavated under Gongpyeong-dong in Seoul include a lot of broken plate pieces and cylinder-like devices. If some plate pieces are put together, a large square plate with circular holes located in a zigzag can be completed, and at the upper right of it is carved 'the first scheduled plate (一箭).' Cylinder-like devices generally 3.8 cm in diameter are able to release a ball, and have a ginkgo leaf-like screen fixed on the inner axis and a bird-shaped hook of which the leg fixes another axis and the beak attaches to the leaf side. The lateral view of this cylinder-like device appears like a trapezoid and mounts an iron ball. The function of releasing a ball agrees with the description of Borugak Pavilion, where Jagyeokru was installed, written by Kim Don (1385 ~ 1440). The other accounts of Borugak Pavilion's and Heumgyeonggak Pavilion's water clocks describe these copper plates and ball releasing devices as the 'Jujeon' system. According to the description of Borugak Pavilion, a square wooden column has copper plates on the left and right sides the same height as the column, and the left copper plate has 12 drilled holes to keep the time of a 12 double-hours. Meanwhile, the right plate has 25 holes which represent seasonal night 5-hours (Kyeong) and their 5-subhours (Jeom), not 12 hours. There are 11 scheduled plates for seasonal night 5-hours made with copper, which are made to be attached or detached as the season. In accordance with Nujutongui (manual for the operation of the yardstick for the clepsydra), the first scheduled plate for the night is used from the winter solstice (冬至) to 2 days after Daehan (大寒), and from 4 days before Soseol (小雪) to a day before the winter solstice. Besides the first scheduled plate, we confirm discovering a third scheduled plate and a sixth scheduled plate among the excavated copper materials based on the spacing between holes. On the other hand, the width of the scheduled plate is different for these artifacts, measured as 144 mm compared to the description of the Borugak Pavilion, which is recorded as 51 mm. From this perspective, they may be the scheduled plates for the Heumgyeonggak Ongru made in 1438 (or 1554) or for the new Fortress Pavilion installed in Changdeokgung palace completed in 1536 (the 31st year of the reign of King Jungjong) in the early Joseon dynasty. This study presents the concept of the scheduled plates described in the literature, including their new operating mechanism. In addition, a detailed model of 11 scheduled plates is designed from the records and on the excavated relics. It is expected that this study will aid in efforts to restore and reconstruct the automatic water clocks of the early Joseon dynasty.

The Hardness Water Production By RO/NF/ED Linking Process From Deep Seawater (RO/NF/ED 연계 공정에 의한 고경도 담수 제조)

  • Moon, Deok-Soo;Kim, Kwang Soo;Gi, Ho;Choi, Mi Yeon;Jung, Hyun Ji;Kim, Hyun Ju
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.16 no.4
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    • pp.227-238
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    • 2013
  • The purpose of this study is to develop a process technology to produce high hardness drinking water which meet drinking water standard, remaining useful minerals like magnesium and calcium in the seawater desalination process while removing the sulfate ions and chloride ions. Seawater have been separated the concentrated seawater and desalted seawater by passing on Reverse Osmosis membrane (RO). Using Nano-filtration membrane (NF), We were prepared primary mineral concentrated water that sodium chloride were not removed. By the operation of electro-dialysis (ED) having ion exchange membrane, we were prepared concentrated mineral water (Mineral enriched desalted water) which the sodium chloride is removed. We have produced the high hardness water to meet the drinking water quality standards by diluting the mineral enriched desalted water with deionized water by RO. Reverse osmosis membranes (RO) can separate dissolved material and freshwater from seawater (deep seawater). The desalination water throughout the second reverse osmosis membrane was completely removed dissolved substances, which dissolved components was removed more than 99.9%, its the hardness concentration was 1 mg/L or less and its chloride concentration was 2.3 mg/L. Since the nano-filtration membrane pore size is $10^{-9}$ m, 50% of magnesium ions and calcium ions can not pass through the nano-filtration membrane, while more than 95% of sodium ions and chloride ions can pass through NF membrane. Nano-filtration membrane could be separated salt components like sodium ion and chloride ions and hardness ingredients like magnesium ions and calcium ions, but their separation was not perfect. Electric dialysis membrane system can be separated single charged ions (like sodium and chloride ions) and double charged ions (like magnesium and calcium ions) depending on its electrical conductivity. Above electrical conductivity 20mS/cm, hardness components (like magnesium and calcium ions) did not removed, on the other hand salt ingredients like sodium and chloride ions was removed continuously. Thus, we were able to concentrate hardness components (like magnesium and calcium ions) using nano-filtration membrane, also could be separated salts ingredients from the hardness concentration water using electrical dialysis membrane system. Finally, we were able to produce a highly concentrated mineral water removed chloride ions, which hardness concentration was 12,600 mg/L and chloride concentration was 2,446 mg/L. By diluting 10 times these high mineral water with secondary RO (Reverse Osmosis) desalination water, we could produce high mineral water suitable for drinking water standards, which chloride concentration was 244 mg/L at the same time hardness concentration 1,260 mg/L. Using the linked process with reverse osmosis (RO)/nano filteration (NF)/electric dialysis (ED), it could be concentrated hardness components like magnesium ions and calcium ions while at the same time removing salt ingredients like chloride ions and sodium ion without heating seawater. Thus, using only membrane as RO, NF and ED without heating seawater, it was possible to produce drinking water containing high hardness suitable for drinking water standard while reducing the energy required to evaporation.

The Role of Primary Radiotherapy for Squamous Cell Carcinoma of the Suprag1ottic Larynx (성문상부 상피세포암에서의 근치적 방사선치료의 역할)

  • Kim, Won-Taek;Kim, Dong-Won;Kwon, Byung-Hyun;Nam, Ji-Ho;Hur, Won-Joo
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.233-243
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    • 2000
  • Purpose : First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. Methods and Material : Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months, Twenty-seven patients (84.4$\%$) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional iymphatics with shrinking field technique. Ail patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had Induction chemotherapy with cisplatln and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6$\%$): stage II, 10/32 (31.3$\%$); stage III, 8/32 (25$\%$): stage IV, 9/32 (28.1$\%$). Results :The 5-year overall survival rate of the whole series (32 patients) was 51.7$\%$. The overall survival rate at 5-years was 80$\%$ in stage I, 66.7$\%$ in stage II, 42.9$\%$ in stage III, 25$\%$ in stage IV (p=0.0958). The S-year local control rates after radiotherapy were as fellows: stage I, 100$\%$; stage II, 60$\%$ stage III, 62.5$\%$; stage IV, 44.4$\%$ (p=0.233). Overall vocal preservation rates was 65.6$\%$, 100% In stage I, 70% in stage II, 62.5$\%$ In stage III, 44.4$\%$ in stage IV (p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotllerapy, emergent tracheostomy was done. Four patients were died from distant metastsis, . three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival (p=0.002). Conclusion : The role of radiotherapy treatment of supraglottic carcinoma is to important factor on survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supragiottic carcinomas could be successfully treated with either consewative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is Inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.

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