• Title/Summary/Keyword: Early reconstruction

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The History of the Josadang and Its Meaning as Seen Through the Murals of Josadang Hall in Buseoksa, Yeoungju (부석사 조사당 신장 벽화를 통해 본 조사당 건립의 배경과 의미)

  • SHIM Yeoung Shin
    • Korean Journal of Heritage: History & Science
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    • v.56 no.1
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    • pp.64-78
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    • 2023
  • This article examines the background and meaning of the construction of Josadang Hall in Buseoksa Temple, Yeongju, by Seolsan Cheonhee(1307~1382) in the late 14th century through the characteristics of the hall's mural. Six guardian deities(the Four Heavenly Kings in the center, Indra and Brahma on each side of the kings) are depicted on the southern wall(location of the entrance) of the Josadang, facing the statue of the great monk Uisang(625~702 AD) on the north wall. This mural is the oldest among Korean temple murals and exhibits very unique characteristics. In general, scenes from the scriptures are depicted on the back wall of the central statue. In contrast, the Josadang mural depicts only the guardian deities facing the main statue with no scene description. The appearance of the deities, who seem to protect the main statue of the monk Uisang, and their expressions, as if drawn from relief statues, are not seen in other murals. Nevertheless, it is similar to the stupas of the Seon(Ch. Chan 禪) sect monks established from the late Silla(57 BC~935 AD) through early Goryeo(918~1392 AD), with guardian deities on their surface. The iconography of the deities is a classic form of the late Silla to early Goryeo. The fact that the Josadang was built to commemorate Uisang, who founded the Korean Hwaeom sect(Ch. Huayan sect, 華嚴宗), and that guardians were placed to protect Uisang's statue reveals the concept of worship for the monk who founded the sect. As a result, the reason Cheonhee built the hall can also be understood as an extension of the ideology behind the construction of the stupas of the Seon sect monks. The problem, however, is that Cheonhee is a monk of the Hwaeom sect, and Buseoksa is a representative temple of the Hwaeom sect, not the Seon sect. Therefore, to better understand the background of the hall's construction, this article examined the situation of Goryeo Buddhism in the 14th century as well as the activities of Seolsan Cheonhee. Since Ganhwa Seon(Ch. Kanhua Chan, 看話禪) was dominant in the 14th century, Cheonhee went to study in the Yuan Dynasty(1271~1368 AD) at the age of 58 and was approved by Chinese Ganhwaseon monks before taking the position of Guksa(國師 national monk). However, he was eventually pushed to Buseoksa Temple, where he worked hard to rebuild it. Cheonhee most likely sought to expand the Hwaeom sect, which had been shrinking compared to the Seon sect, by enhancing power with the reconstruction of Buseoksa. The desire that the Hwaeom sect, which was losing its power due to the rise of the Seon sect in the 14th century, attempted to develop it by building Josadang hall, is well revealed by the Josadang murals.

A Study on the Wooden Seated Vairocana Tri-kaya Buddha Images in the Daeungjeon Hall of Hwaeomsa Temple (화엄사 대웅전 목조비로자나삼신 불좌상에 대한 고찰)

  • Choe, Songeun
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.100
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    • pp.140-170
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    • 2021
  • This paper investigates the Wooden Seated Tri-kaya Buddha Images(三身佛像) of Vairocana, Rushana, and Sakyamuni enshrined in Daeungjeon Hall of Hwaeomsa temple(華嚴寺) in Gurae, South Cheolla Province. They were produced in 1634 CE and placed in 1635 CE, about forty years after original images made in the Goryeo period were destroyed by the Japanese army during the war. The reconstruction of Hwaeomsa was conducted by Gakseong, one of the leading monks of Joseon Dynasty in the 17th century, who also conducted the reconstructions of many Buddhist temples after the war. In 2015, a prayer text (dated 1635) concerning the production of Hwaeomsa Tri-kaya Buddha images was found in the repository within Sakyamuni Buddha. It lists the names of participants, including royal family members (i.e., prince Yi Guang, the eighth son of King Seon-jo), and their relatives (i.e., Sin Ik-seong, son-in-law of King Seonjo), court ladies, monk-sculptors, and large numbers of monks and laymen Buddhists. A prayer text (dated 1634) listing the names of monk-sculptors written on the wooden panel inside the pedestal of Rushana Buddha was also found. A recent investigation into the repository within Rushana Buddha in 2020 CE has revealed a prayer text listing participants producing these images, similar to the former one from Sakyamuni Buddha, together with sacred relics of hoo-ryeong-tong copper bottle and a large quantity of Sutra books. These new materials opened a way to understand Hwaeomsa Trikaya images, including who made them and when they were made. The two above-mentioned prayer texts from the repository of Sakyamuni and Rushana Buddha statues, and the wooden panel inside the pedestal of Rushan Buddha tell us that eighteen monk-sculptors, including Eungwon, Cheongheon and Ingyun, who were well-known monk artisans of the 17th century, took part in the construction of these images. As a matter of fact, Cheongheon belonged to a different workshop from Eungwon and Ingyun, who were most likely teacher and disciple or senior and junior colleagues, which means that the production of Hwaeomsa Tri-kaya Buddha images was a collaboration between sculptors from two workshops. Eungwon and Ingyun seem to have belonged to the same community studying under the great Buddhist priest Seonsu, the teacher of Monk Gakseong who was in charge of the reconstruction of Haweonsa temple. Hwaeomsa Tri-kaya Buddha images show a big head, a squarish face with plump cheeks, narrow and drooping shoulders, and a short waist, which depict significant differences in body proportion to those of other Buddha statues of the first half of 17th century, which typically have wide shoulders and long waists. The body proportion shown in the Hwaeomsa images could be linked with images of late Goryeo and early Joseon period. Rushana Buddha, raising his two arms in a preaching hand gesture and wearing a crown and bracelets, shows unique iconography of the Bodhisattva form. This iconography of Rushana Buddha had appeared in a few Sutra paintings of Northern Song and Late Goryeo period of 13th and 14th century. BodhaSri-mudra of Vairocana Buddha, unlike the general type of BodhaSri-mudra that shows the right hand holding the left index finger, places his right hand upon the left hand in a fist. It is similar to that of Vairocana images of Northern and Southern Song, whose left hand is placed on the top of right hand in a fist. This type of mudra was most likely introduced during the Goryeo period. The dried lacquer Seated Vairocana image of Bulheosa Temple in Naju is datable to late Goryeo period, and exhibits similar forms of the mudra. Hwaeomsa Tri-kaya Buddha images also show new iconographic aspects, as well as traditional stylistic and iconographic features. The earth-touching (bhumisparsa) mudra of Sakymuni Buddha, putting his left thumb close to the middle finger, as if to make a preaching mudra, can be regarded as a new aspect that was influenced by the Sutra illustrations of the Ming dynasty, which were imported by the royal court of Joseon dynasty and most likely had an impact on Joseon Buddhist art from the 15th and 16th centuries. Stylistic and iconographical features of Hwaeomsa Tri-kaya Buddha images indicate that the traditional aspects of Goryeo period and new iconography of Joseon period are rendered together, side by side, in these sculptures. The coexistence of old and new aspects in one set of images could indicate that monk sculptors tried to find a new way to produce Hwaeomsa images based on the old traditional style of Goryeo period when the original Tri-kaya Buddha images were made, although some new iconography popular in Joseon period was also employed in the images. It is also probable that monk sculptors of Hwaeomsa Tri-kaya Buddha images intended to reconstruct these images following the original images of Goryeo period, which was recollected by surviving monks at Hwaeomsa, who had witnessed the original Tri-kaya Buddha images.

Reoperations on the Aortic Root and Ascending Aorta (대동맥근부 혹은 상행대동맥의 재수술)

  • Baek, Man-Jong;Na, Chan-Young;Kim, Woong-Han;Oh, Sam-Se;Kim, Soo-Cheol;Lim, Cheong;Ryu, Jae-Wook;Kong, Joon-Hyuk;Kim, Wook-Sung;Lee, Young-Tak;Moon, Hyun-Soo;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.35 no.3
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    • pp.188-198
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    • 2002
  • Background: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem. This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. Material and Method: Between May 1995 and April 2001, 30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively. The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months). Seven patients(23.3%) had two or more previous operations. The indications for reoperations were true aneurysm in 7 patients(23.3%), prosthetic valve endocarditis in 6(20%), false aneurysm in 5(16.7%), paravalvular leak associated with Behcet's disease in 4(13.3%), malfunction of prosthetic aortic valve in 4(13.3%), aortic dissection in 3(10%), and annuloaortic ectasia in 1(3.3%). The principal reoperations performed were aortic root replacement in 17 patients(56.7%), replacement of the ascending aorta in 8(26.7%), aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%), patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1 (3.3%). The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%). The mean time of circulatory arrest, total bypass, and aortic crossclamp were 20$\pm$ 12 minutes, 228$\pm$56 minutes, and 143$\pm$62 minutes, respectively Result: There were three early deaths(10%). The postoperative complications were reoperation for bleeding in 7 patients(23.3%), cardiac complications in 5(16.7%), transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%), and the others in 5. The mean follow-up was 22.8 $\pm$20.5 months. There were two late deaths(7.4%). The actuarial survival was 92.6$\pm$5.0% at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%). The 1- and 6-year actuarial freedom from reoperation was 100% and 83.3$\pm$15.2%, respectively. One patient with Behcet's disease are waiting for reoperation due to false aneurysm, which developed after aortic root replacement with homograft. There were no thromboembolisms or anticoagulant related complications. Conclusions: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity, and adequate surgical strategies according to the pathologi conditions are critical to the prevention of the reoperation.

Mid-term Follow-Up Results of Cryopreserved Valved Conduit in RVOT Reconstruction (우심실 유출로에 사용된 냉동 동종 판막도관의 중기성적)

  • 장윤희;전태국;민호기;한일용;성기익;이영탁;박계현;박표원
    • Journal of Chest Surgery
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    • v.36 no.6
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    • pp.384-390
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    • 2003
  • Background: Since Ross and Sormeville first reported the use of aortic homograft valve for correction of pulmonary atresia in 1966, homograft valves are widely used in the repair of congenital anomalies as conduits between the pulmonary ventricle and pulmonary arteries. On the basis of these results, we have used it actively. In this report, we describe our experience with the use of cryopreserved valved homograft conduits for infants and children requiring right ventricle to pulmonary artery connection in various congenital cardiac anomalies. Material and Method: Between January, 1996 and December 2001, 27 infants or children with a median age of 16 months(range 9days to 18years) underwent repair of RVOTO using homograft valved conduit by two surgeons. We studied 22 patients who have been followed up at least more than one year. The diagnosis at operation included pulmonary atresia with ventricular septal defect (n=13), truncus arteriosus (n=3), TGA or corrected TGA with RVOTO (n=6). Homograft valved conduits varied in size from 15 to 26 mm (mean, 183.82 mm). The follow-up period ranged from 12 to 80.4 months (median, 48.4 months). Result: There was no re-operation due to graft failure itself. However, early progressive pulmonary homograft valve insufficiency developed in one patient, that was caused by dilatation secondary to the presence of residual distal pulmonary artery stenosis and hypoplasia after repair of pulmonary atresia with ventricular septal defect. This patient was required reoperation (conduit replacement). During follow-up period, there were significant pulmonary stenosis in one, and pulmonary regurgitation more than moderate degree in 3. And there were mild calcifications at distal anastomotic site in 2 patients. All the calcified homografts were aortic in origin. Conclusion: We observed that cryopreserved homograft conduits used in infant and children functioned satisfactorily in the pulmonic position at mid-term follow-up. To enhance the homograft function, ongoing investigation is required to re-establish the optimal strategy for the harvest, preservation and the use of it.

Mitral Valve Repair for Congenital Mitral Regurgitation in Children (선천성 승모판막 페쇄부전증이 있는 소아에서 승모판막 성형술에 대한 임상적 고찰)

  • Kim, Kun-Woo;Choi, Chang-Hyu;Park, Kook-Yang;Jung, Mi-Jin;Park, Chul-Hyun;Jeon, Yang-Bin;Lee, Jae-Ik
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.292-298
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    • 2009
  • Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

Scapular Free Flap (유리 견갑 피판 이식술)

  • Chung, Duke-Whan;Han, Chung-Soo;Yim, Chang-Moo
    • Archives of Reconstructive Microsurgery
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    • v.5 no.1
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    • pp.24-34
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    • 1996
  • There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

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Clinical Evaluation of Instrumental Esophageal Perforation (기구에 의한 식도천공에 대한 임상적 고찰)

  • Sa Young-Jo;Kang Chul-Ung;Cho Kyu-Do;Park Kuhn;Wang Young-Pil;Park Jae-Kil
    • Journal of Chest Surgery
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    • v.39 no.5 s.262
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    • pp.387-393
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    • 2006
  • Background: Esophageal perforation is an uncommon problem, but it is associated with high mortality. We performed a retrospective review of patients with instrumental esophageal perforation to assess the outcome of current management techniques. Material and Method: We retrospectively analyzed all cases of instrumental esophageal perforation diagnosed at our hospital from January 1999 through to March 2005. The study group consisted of 12 patients (8 women and 4 men) with a mean age of 48.8 years (range, $21{\sim}83$ years). We reviewed the effects of the surgical or medical treatments in various conditions of patients, such as of various sites of perforation and time delayed after injury. Result: Perforations were due to diagnostic endoscopy (50.0%, 6/12), esophageal bougination for benign stricture (33.3%, 4/12), endoscopic port insertion (8.3%, 1/12), and tracheal intubation (8.3%, 1/12). The perforated sites were thoracic in 7 patients and cervical in 5. The treatment included resection and reconstruction (5 cases), incision and drainage (4 cases), medical treatment (2 cases), and closed thoracostomy drainage only (1 case). Post-operative complications of transient pneumonia and wound infection were developed in 1 patient respectively. Both occurred in two patients with diffuse mediastinal abscess formation. The overall mortality was 8.3% (1/12) in one old patient who was managed medically for cervical esophageal perforation. Conclusion: We concluded that surgical treatment for esophageal perforations was safe and effective whether diagnosed early or lately.

Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

  • Kim, Hyung-Tae;Sung, Si-Chan;Chang, Yun-Hee;Jung, Won-Kil;Lee, Hyoung-Doo;Park, Ji-Ae;Huh, Up
    • Journal of Chest Surgery
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    • v.44 no.6
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    • pp.392-398
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    • 2011
  • Background: The tetralogy of Fallot (TOF) with pulmonary atresia (PA) and a ductus-dependent pulmonary circulation (no major aorto-pulmonary collateral arteries (MAPCAs)) has been treated with staged repair or primary repair depending on the preference of surgeons or institutions. We evaluated the 19-year outcome of staged repair for this anomaly to find out whether our surgical strategy should be changed. Materials and Methods: Forty-four patients with TOF/PA with patent ductus arteriosus (PDA) who underwent staged repair from June 1991 to October 2010 were included in this retrospective study. The patients with MAPCAs were excluded. The average age at the first palliative shunt surgery was $40.8{\pm}67.5$ days (range: 0~332 days). Thirty-one patients (31/44, 70%) were neonates. The average weight was $3.5{\pm}1.6$ kg (range: 1.6~8.7 kg). A modified Blalock-Taussig (BT) shunt was performed in 38 patients, classic BT shunt in 4 patients, and central shunt in 2 patients. Six patients required concomitant procedures: pulmonary artery angioplasty was performed in 4 patients, pulmonary artery reconstruction in one patient, and re-implantation of the left pulmonary artery to the main pulmonary artery in one patient. Four patients required a second shunt operation before the definitive repair was performed. Thirty-three patients underwent definitive repair at $24.2{\pm}13.3$ months (range: 7.3~68 months) after the first palliative operation. The average age at the time of definitive repair was $25.4{\pm}13.5$ months (range: 7.6~68.6 months) and their average weight was $11.0{\pm}2.1$ kg. For definitive repair, 3 types of right ventricular outflow procedures were used: extra-cardiac conduit was performed in 30 patients, trans-annular patch in 2 patients, and REV operation in 1 patient. One patient was lost to follow-up after hospital discharge. The mean follow-up duration for the rest of the patients was $72{\pm}37$ months (range: 4~160 months). Results: Ten patients (10/44, 22.7%) died before the definitive repair was performed. Four of them died during hospitalization after the shunt operation. Six deaths were thought to be shunt-related. The average time of shunt-related deaths after shunt procedures was 8.7 months (range: 2 days~25.3 months). There was no operative mortality after the definitive repair, but one patient died from dilated cardiomyopathy caused by myocarditis 8 years and 3 months after the definitive repair. Five-year and 10-year survival rates after the first palliative operation were 76.8% and 69.1%, respectively. Conclusion: There was a high overall mortality rate in staged repair for the patients with TOF/PA with PDA. Majority of deaths occurred before the definitive repair was performed. Therefore, primary repair or early second stage definitive repair should be considered to enhance the survival rate for patients with TOF/PA with PDA.

A Study on Understanding of Middle-East Terrorism : Focusing on Islamic Fundamentalism (이슬람 원리주의를 통해 본 중동지역테러리즘의 이해)

  • Park, Gi-Beom;Kang, Min-Wan;Jun, Yong-Tae
    • Korean Security Journal
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    • no.12
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    • pp.149-175
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    • 2006
  • The purpose of this study is to understand and analyze the character of Islamic fundamentalism and Middle-Ease Terrorism. The aim of Islamic fundamentalism is reconstruction of Ummah(Muslim Unity), thee early society of Muhammad's age. Islamic movement insist to restore the spirit of Islam and purify the society of Islam from the United State and Western world. Now, Islamic fundamentalism movement as a new ideology, appeals to muslim in the world. The concept of modern national state from the Western countries do not accord with the traditional Islamic principles of reign and a spirit of nationalism. On the other hand, Islamic movement have no legitimacy in the system of modern state which govern the Arab world, regardless of the form of government. For this reasons, Islamic fundamentalist have an insecure position and their political activities. It is yet far from their purpose, to reconstruct the muslim unity, to realize the Islamic political principle close to their practical methods. Yet Islamic fundamental movement have not overcome the system of secular state. The Middle East terrorism supported by government might be eradicated by America's anti-terrorism policy. However, it will be serious and spread all over the world that the terrorist attack against the U. S. and western countries is acted by militant warriors of Islamic fundamentalism, uniting Arab and Islamic people's emotions against America and western countries. There are some reasons that we need to focus on the Arab and Islamic fundamentalism. We need to get out of misunderstanding and discrimination about Islamic religion and culture from America's and Western' standard Which are only their new world order. The discrimination of America and western nations against muslim could make other ideologies, opposite to the world peace. There are a lot of foreign workers from Islam countries in Korea. We need to give consideration and attention to them for the our globalization and world peace. It is time to consider what to do for the nation's profit(economical, political, strategic)with right understanding. We are not safe and free from the terrorism yet.

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Lecompte Procedure in Complex Congenital Heart Diseases (선천성 복잡 심기형에서의 Lecompte 술식의 유용성 및 임상적용에 관한 연구)

  • Kim, Yong-Jin;Kim, Kyung-Hwan;Lee, Suk-Jae;Song, Hyun;Oh, Sam-Se;Lee, Jeong-Ryul;Rho, Joon-Ryang;Suh, Kyung-Phill
    • Journal of Chest Surgery
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    • v.31 no.7
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    • pp.660-667
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    • 1998
  • Background: This study is to evaluate the effectiveness and application of Lecompte procedure as a treatment for various complex cardiac anomalies with pulmonary outflow tract obstruction. Methods: Between July 1988 and December 1997, 44 patients underwent Lecompte procedure in Seoul National University Children's Hospital. The male to female ratio was 24 to 20 and the mean age was 29.2 months(range, 3 to 83). Of these patients, 28(63.6%) had transposition of great arteries with ventricular septal defect and pulmonary stenosis(or pulmonary atresia), 14(31.8%) had double outlet right ventricle with pulmonary stenosis(or pulmonary atresia), and so on. The principles of the technique are 1) extension of the ventricular septal defect or conal resection, 2) construction of a intracardiac tunnel connecting the left ventricle to the aorta, and 3) direct connection, without a prosthetic conduit, of the pulmonary trunk to the right ventricle. Results: There were 3 in-hospital deaths and their causes were sustained hypoxia, myocardial failure, and sepsis, respectively. There was 1 late death due to sepsis. Reoperations were performed in 6 patients who had pulmonary outflow tract obstructions(4 cases), residual muscular ventricular septal defect(1 case), and recurrent septic vegetation(1 case). The cumulative survival rates by the Kaplan-Meier method were 92.7%, 92.7%, and 92.7% at 1, 2, and over 4 years. The reoperation free survival rates were 92.7%, 92.7%, and 70.2% at 1, 3, and over 5 years. Among the risk factors for the operative death, aortic cross clamping time had statistical significance(p<0.05) and all the risk factors for the recurrent pulmonary stenosis such as age, pulmonary artery index, and materials used for the pulmonary outflow tract reconstruction had no statistical significance(p>0.05). Conclusions: Our review suggests that Lecompte procedure is an effective treatment modality for various complex cardiac anomalies with pulmonary outflow tract obstruction. Repair in early age is possible and the rates of mortality and morbidity are also acceptable.

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