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Surgical Repair of Single Ventricle (Type III C solitus) (단심실 -III C Solitus 형의 수술치험-)

  • naf
    • Journal of Chest Surgery
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    • v.12 no.3
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    • pp.281-288
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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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Surgical Repair for Ebstein's Anomaly (Ebstein 기형의 수술 -2례 보고-)

  • naf
    • 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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Assessment of Water Purification Plant Vegetation for Enhancement of Natural Purification in Mankyeong River (만경강 본류의 자연정화능 향상을 위한 식생학적 진단)

  • Lee, Kyeong-Bo;Kim, Chang-Hwan;Kim, Jong-Gu;Lee, Deog-Bae;Park, Chan-Won;Na, Seoung-Yong
    • Korean Journal of Environmental Agriculture
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    • v.22 no.2
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    • pp.153-165
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    • 2003
  • This study was conducted to get some information on plants abilities to enhance water purification and to find out away to conserve the ecosystem in Mankyeong river. Vegetation were surveyed at 4 sites pointing by 1:5,000 topographical map, from June 2001 through March 2002. T-N content in water were high in all sites of Mankyeong river, the average T-N levels were 8.59 and 17.23 mg/L, summer and winter, respectively. The average T-P level during summer was 0.47 mg/L but that was 1.79 mg/L during winter. The BOD level in Mankyeong upstream ranged from 0.95 to 2.57 mg/L which would be in I or II grade according to water quality criteria by Ministry of Environment but BOD level in Mankyeong downstream ranged from 6.87 to 9.72 mg/L. The plant species of river flora were found 251, 98 and 85, upstream midstream and down stream, respectively. Among the surveyed plants, Ceratophyllum demersum, submerged plant and Nuphar subinteperrimum took up higher contents of phosphate and nitrogen than other piano. The Phragmites communis and Zizania latifolia having much biomass were thought to be suitable plants for enhancement of e natural water purification.

Study on Seombody Drying (섬바디의 건조에 관한 연구)

  • Park, Kyung-Kyu;Chung, Chang-Joo
    • Journal of Biosystems Engineering
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    • v.1 no.1
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    • pp.55-55
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    • 1976
  • An experimental work was conducted to develop an optimum operating system of various hay drying systems ; sun-drying with long hay, sun-drying after chopping, sun-drying after crushing, heated air drying after chopping using batch-type dryer and heated air drying after crushing using tunnel-type dryer. Seombody having 60 cm long and initial moisture content of approximately 79 % in wet basis was used for the experiment. The criteria selected for determining the optimum operating condition were the drying performance rate, the production cost and quality of dried matter of each drying systems. The result of this study are summarized as follows : 1. Drying characteristics of leaves of long stem hay, chopped seombody and crushed one were obtained by maintaining the oven temperature at 70 degrees centigrade. The required drying times for various samples to approximately 15% moisture content in wet basis were about 50 min .for leaves ; 160 min. for crushed hay ; 250 min. for chopped hay ; 340min. for ling hay and more than 360 min .for stems. The drying time of crushed hay was required about 50 % of that for the uncrushed long hay. Such a significant difference of drying of time between the leaf and long stem may indicate that an effective drying of seombody may not be achieved unless any kind of special process treatment for the whole hay is undertaken. 2. In each individual drying system, the following conclusions were drawn: a. After 8 days sun-drying on concrete floor under good days with average tempe?rature at $256{\circ}C$ and relative humidity at 55% at 2 P.M., the moisture content of long hay was still above 25 5'~ and the leaf loss during drying caused by wind and rough handling was more than 50 ~G. b. It was possible to dry the chopped seombody by sun-drying down to about 10 % moisture content within 5 days, however, a stock of heat and discolouration phenomena were observed during the drying, which may be due to the increased deposit-density by chopping, resulting in lowering the quality of the dried product. c. Sun-drying for the crushed material by hay-conditioner was required about 4 days to reduce the moisture content to about 10 %, keeping the quality of dried product at good grade. o. The optimum deposit-depth of the chopped seombody in the batch-type dryer used was about 28cm with about 42kg/hr of drying performance rate. However, it was necessary to overturn the materials between the upper and lower layers in order to obtain a good quality of dried product. d. The drying performance rate by the tunnel-type drier was highest among those of drying systems tested, giving the rate of approximately 400kg/day. 3. On reviewing the individual drying system for seombody, it was possible to draw conclusion that the best system was tunnel drying with the crushed seombody as far as the performance rate was concerned. However, the methods gives the highest operational cost. The system for the lowest operational cost with good quality of dried product was the sun-drying with the crushed material. Accordingly, it may be recommended that the system of sun-drying for the crushed seombody may be the most feasible system presently applicable to farm-level operation.

Study on Seombody Drying (섬바디의 건조에 관한 연구)

  • 박경규
    • Journal of Biosystems Engineering
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    • v.1 no.1
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    • pp.56-63
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    • 1976
  • An experimental work was conducted to develop an optimum operating system of various hay drying systems ; sun-drying with long hay, sun-drying after chopping, sun-drying after crushing, heated air drying after chopping using batch-type dryer and heated air drying after crushing using tunnel-type dryer. Seombody having 60 cm long and initial moisture content of approximately 79 % in wet basis was used for the experiment. The criteria selected for determining the optimum operating condition were the drying performance rate, the production cost and quality of dried matter of each drying systems. The result of this study are summarized as follows : 1. Drying characteristics of leaves of long stem hay, chopped seombody and crushed one were obtained by maintaining the oven temperature at 70 degrees centigrade. The required drying times for various samples to approximately 15% moisture content in wet basis were about 50 min .for leaves ; 160 min. for crushed hay ; 250 min. for chopped hay ; 340min. for ling hay and more than 360 min .for stems. The drying time of crushed hay was required about 50 % of that for the uncrushed long hay. Such a significant difference of drying of time between the leaf and long stem may indicate that an effective drying of seombody may not be achieved unless any kind of special process treatment for the whole hay is undertaken. 2. In each individual drying system, the following conclusions were drawn: a. After 8 days sun-drying on concrete floor under good days with average tempe\ulcornerrature at $256{\circ}C$ and relative humidity at 55% at 2 P.M., the moisture content of long hay was still above 25 5'~ and the leaf loss during drying caused by wind and rough handling was more than 50 ~G. b. It was possible to dry the chopped seombody by sun-drying down to about 10 % moisture content within 5 days, however, a stock of heat and discolouration phenomena were observed during the drying, which may be due to the increased deposit-density by chopping, resulting in lowering the quality of the dried product. c. Sun-drying for the crushed material by hay-conditioner was required about 4 days to reduce the moisture content to about 10 %, keeping the quality of dried product at good grade. o. The optimum deposit-depth of the chopped seombody in the batch-type dryer used was about 28cm with about 42kg/hr of drying performance rate. However, it was necessary to overturn the materials between the upper and lower layers in order to obtain a good quality of dried product. d. The drying performance rate by the tunnel-type drier was highest among those of drying systems tested, giving the rate of approximately 400kg/day. 3. On reviewing the individual drying system for seombody, it was possible to draw conclusion that the best system was tunnel drying with the crushed seombody as far as the performance rate was concerned. However, the methods gives the highest operational cost. The system for the lowest operational cost with good quality of dried product was the sun-drying with the crushed material. Accordingly, it may be recommended that the system of sun-drying for the crushed seombody may be the most feasible system presently applicable to farm-level operation.

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Performance Characteristics of Organic Rankine Cycles Using Medium Temperature District Heating Water as Heat Source (지역난방용 중온수 열원 유기랭킨사이클 성능 특성)

  • Park, Woo-Jin;Yoo, Hoseon
    • Plant Journal
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    • v.12 no.1
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    • pp.29-36
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    • 2016
  • It is becoming increasingly important to make use of alternative energy source. because It is not able to rely on only fossil fuel for the recent increasing demand of energy consumption. With this situation, lots of studies for utilizing low grade energy such as industrial waste heat, solar energy, and geothermal energy have been conducted. The aim of this study is to predict the operation characteristics of working fluid by using performance analysis program (ThermoFlex) through the system analysis which is not mixing district return water but using ORC(Organic Rankine Cycle, hereinafter ORC) as a downstream cycle when accumulating district heating (hereinafter DH). In this study, We conducted the performance analysis for the case which has the district heating water temperature($120^{\circ}C$) and Flow rate of $163m^3/h$ (including District Heating return water flow), and examined several working fluid which is proper to this temperature. The case using R245fa (which is the best-case) showed 269.2kW power output, 6.37% efficiency. Additionally, Cut down on fuel was expected because of the boiler inlet temperature increase by being Formed $57.3{\sim}85^{\circ}C$ in a temperature of district heating return water, depending on a pressure change of a condenser in ORC system.

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A Quantitative Risk Analysis of Related to Tower Crane Using the FMEA (타워크레인의 정량적 위험성 평가가법에 관한 연구(FMEA 기법 위주))

  • Shim, Kyu-Hyung;Rie, Dong-Ho
    • Journal of the Korean Society of Safety
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    • v.25 no.6
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    • pp.34-39
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    • 2010
  • The purpose of this study is to suggest objective evaluation model as a plan to utilize as opportunity in establishing judgment standard of mutual inspection criteria and to upgrade inspection ability by reviewing and analyzing level of danger and importance in advance based on inspection results of inspection institutions regarding tower cranes used in construction fields. Tower crane is a mechanical device transporting construction supplies and heavy materials to places over 20~150M high from the ground for the period ranging from a short time of 2~3 months to two years after being installed in construction sites in vicinity of buildings or structures and is an important facility indispensable for construction sites. However, since use period after installation is short and professional technical ability of technicians working on-site about of tower crane is poor, systematic and quantitative safety management is not carried out As a part of researches on procedure of RBI(Risk Based Inspection) possible to apply to Knowledge Based System based on knowledge and experiences of experts as well as to tower cranes for solving these problems, quantitative RPN(Risk Priority Number) was applied to RPN utilizing technique of FMEA(Failure Mode and Effect Analyses). When general RBI 80/20 Rule was applied parts with high level of risks were found out as wire rope, hoist up/down safety device, reduction gear, and etc. However, since there are still many insufficient parts as risk analyses of tower crane were not established, it is necessary for experts with sufficient experiences and knowledge to supplement active RBI techniques and continuous researches on tower cranes by sharing and setting up data base of important information with this study as a starting point.

Neuropsychiatric Evaluation of Head-Injured Patients(I) : Comparison of Structural and Functional Brain Studies in Post-Traumatic Organic Mental Disorder (두부외상 환자의 신경정신의학적 평가(I) : 외상후 기질성정신장애 환자에서 뇌의 구조적 및 기능적 검사소견의 비교)

  • Yi, Jang Ho;Chang, Hwan-Il
    • Korean Journal of Biological Psychiatry
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    • v.3 no.1
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    • pp.57-65
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    • 1996
  • The Evaluation of patients complaining of psychiatric symptoms following head injury is much affected by the results of various tests. The objecive of this paper is to investigate the effectiveness of each lest by comparing the structual and fuctional brain studies. The subjects were 93 organic menial disorder in and out patients at the Dept. of Neuropsychiatry of the Kyung Hee University Hospital. After carrying out MRI, CT, SPECT, EEG, the results of each were analysed for the sesitivity and ability to detect focal lesion. The degree of inter-test correlations of lest results were also investigated. Furthermore, the characteristic features of psychological tests were studied and the relationship between each of above mentioned tests and psychological test was examined. As for the test sensitivity to diagnosis, the SPECT was the most superior followed by MRI, CT, EEG in thai order. In the case of abnormality, SPECT ranked 1st in detection of focal lesion, followed by MRI, CT in that order. In the inter-test result correlation, the correlation of SPECT-MRI was statistically significant. When mare than moderate abnormality EEG finding was reported, it correlated significantly with that of MRI findings. In the MMPI, the average scores on F, Hs, D, Hy, Pa, Pt, Sc subscales were above 60. Abnormal SPECT group scored significantly high on the F, Pd, Pa, Sc, Ma scales and therefore in comparison ot the SPECT normal group, displayed more psychotic features. In K-WAIS, the mean full scale IQ was down to 77. 23(Verbal IQ : 78.76, Performance IQ : 77.44) but there was no characterogic significant relationship between the lowered to and abnormal SPECT, MRI, CT and EEG results. In conclusion, 1) The SPECT was mast superior in sensitivity and detection of focal lesions. In comparision with other tests, the results of SPECT correlated well with MRI had thus is thought to be very usefull testing method in the evaluation of organic mental disorder patients. 2) The MRI had relatively high sensitivity, ability to detect focal lesion and superior correlation with other test. 3) Although EEG fared less an sensitivity in comparison to other tests, the results of above moderate abnormal grade group and that of MRI correlated significantly. 4) In the MMPI highly scored in F, Hs, D, Hy, Pa, Pt, Sc subscales and abnormal SPECT patients were shown to display more sever psychotic features. There was no significant character relationship between the lowered IQ(in K-WAIS) and abnormal findings on MRI, CT, SPECT, EEG.

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Summer Water Quality Management by Ecological Modelling in Ulsan Bay (생태계 모델을 이용한 울산만의 하계 수질관리)

  • Park, Sung-Eun;Hong, Sok-Jin;Lee, Won-Chan;Jung, Rae-Hong;Cho, Yoon-Sik;Kim, Hyung-Chul;Kim, Dong-Myung
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.16 no.1
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    • pp.1-9
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    • 2010
  • Numerical study on coastal water quality management was conducted to examine the response of summer water quality to the flow into the sea of land based pollution load in Ulsan Bay, Korea The abatement of pollution load. from point sources of land was estimated on the basis of Korean coastal water quality standard using an ecosystem model. The results of the ecological model simulation showed that COD values in the inner part of the bay were greater than 280mg/L, and exceeded the grade III limit of Korean coastal water quality standard 30% of all land based pollution loads or organic and inorganic material loads from point sources should be cut down to keep the COD levels below 2mg/L. As environmental carrying capacity was estimated to be 7,193kgCOD/day to keep the COD levels below 2mg/L in Ulsan Bay, 3,083kgCOD/day of land based organic loads should be reduced. The phytoplankton blooms have occurred in the Teahwa river mouth or estuary repetitively, so it is important to control land based nutrients loads for removal of autochthonous organic loads around Ulsan Bay.

Study on Analysis for Factors Inducing the Whangryeong Mountain Landslide (황령산 산사태 원인 분석에 대한 연구)

  • 최정찬;백인성
    • The Journal of Engineering Geology
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    • v.12 no.2
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    • pp.137-150
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    • 2002
  • Recently, plane failure mode occurred frequently along the bedding plane having low angle dip about 20 degree when cutting slopes were constructed in sedimentary rock region of the Gyeongsang Basin. Landslide of the Whangryeong Mountain which was occurred at Busan Metropolitan City in 1999 belongs to the category mentioned above. Reconstruction for cutting slope of the Whangryeong Mountain has finished in 2000 and final grade of reconstructed cutting slope is 1:2.0. To analyze slope failure mode for landslide of the Whangryeong Mountain, various analyses were performed such as in-situ investigation and test, drilling, laboratory test, aerial photograph interpretation, X-ray diffraction analysis, and slope stability analysis using Stereographic Projection and Limit Equilibrium methods. As the result, it is identified that tension cracks had been developed one year before the landslide took place. The tension crack semis to be formed by merging several joint sets. It appears that failure blocks broke down along the sliding planes of different layers. Risk of plane failure is conformed as a result of stability analysis using Stereographic Projection and Limit Equilibrium methods in case that greenish gray tuffaceous shales, regared as sliding planes, are weathered. From now on, a detailed investigation is needed for the thin layers which is sensitive to weathering, and stability analysis for this layer is performed at cut slope construction site having similar geological condition.