• Title/Summary/Keyword: Early-age

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Airway Compression or Airway Anomaly Causing Respiratory Symptoms in Infants and Children with Cardiovascular Diseases (심혈관계 질환 환아에서 동반된 기도 압박 및 기도 기형의 임상적 특성)

  • Kim, Ja-Hyeong;Lee, So-Yeon;Kim, Hyo-Bin;Koo, So-Eun;Park, Sung-Jong;Kim, Young-Hui;Park, In-Suk;Ko, Jae-Gon;Seo, Dong-Man;Hong, Soo-Jong
    • Clinical and Experimental Pediatrics
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    • v.48 no.7
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    • pp.737-744
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    • 2005
  • Purpose : Infants and children with cardiovascular diseases often present with respiratory symptoms. However, missed or delayed evaluation for potential airway problem may complicate overall prognosis. The aim of this study is to determine the clinical characteristics of these patients and explore the cause of airway problem. Methods : We reviewed the medical records of 64 patients(M : F=33:31, mean age : $6.3{\pm}7.5$ months) whose airway problems were proven by computed tomography or bronchoscopy in perioperative periods at the Asan Medical Center from January 1997 to June 2004. Patients were divided into two groups based on the duration of ventilator care : ${\leq}7$ days(group 1 : 23 cases, M : F=10 : 13) and >7 days(group 2 : 41 cases, M : F=23 : 18). Results : The patients in group 2 significantly developed more post-operative respiratory symptoms than group 1(P<0.001) and had more airway problems including extrinsic obstruction, intrinsic anomaly, and combined problem than group 1 although not significantly different(P=0.082). Among underlying diseases, the most common diseases were vascular anomaly(26.2 percent) and aortic arch anomaly(26.2 percent) in group 1 and pulmonary atresia with ventricular septal defect(22.4 percent) in group 2. The most frequent respiratory symptoms were recurrent wheezing pre-operatively and failure of ventilator weaning post-operatively. The major types of airway anomaly were tracheomalacia and tracheal stenosis(in each case 18.2 percent). Nineteen patients with persistent airway problems underwent aortopexy or other vascular correction. Of the 19 patients, 13(68.4 percent) were improved, but 2 failed in weaning ventilator and 4 died of non-airway problems. Conclusion : Early evaluation and treatment for potential airway problems may affect natural or surgical prognosis in patients with cardiovascular diseases presenting with respiratory symptoms.

Study of Animation 3-Dimensional Motion Picture (애니메이션 입체 영화에 대한 연구)

  • Min, Kyung-Mi
    • Cartoon and Animation Studies
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    • s.9
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    • pp.127-142
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    • 2005
  • Not only in Korea but throughout the entire world millions of people are in contact with images. Images have become a medium through which to transmit anything from simple visualizations of moving images to knowledge and information. The age of the internet has arisen thanks to scientific development, and the internet generation's acquisition of information is continuously becoming faster. The spectators, ufo must choose amongst the excessive amount of available information, are changing along with it just as quickly. The method of visual transmission has changed to match the demands of the fast-changing pace of the new generation. In order to receive an instantaneous selection amongst much information, the primary requisite is attracting one's attention, and then presenting a corresponding feeling of satisfaction. The early stages of film arose from the desire to capture one's actual situation as it realty is. Unsatisfied with the still picture, people developed the motion picture. Research has succeeded in reproducing 3-dimensional images more realistic than the actual image we perceive as a result of the difference in visual perspective of both eyes and their response to rays of light From color film to 3-dimensional pictures, people enjoy the magnificent results of this. All fields within the category of film are continuously studying the human desire to pursue their visual side, namely the pursuit of visual images with a maximum sense of reality. The images that millions of people around the world see now are flat. The screen's depth and optical illusions effectively give a sense of reality while conveying information. However, although the flat screen is able to create a sense of depth using the different visual perspective of each eye for the realization of a cubic effect, there are limitations. Entering the 21s1 century, there is a quickly-arising branch within the field of image media which seeks to overcome these limitations Although 3-dimensional images began in films, entering the latter half of the 20th century, due to development of 3-dimensional images using the mediums of the animation field, cellular phones, advertisement screens, television etc., without restriction is designated as 'image.'. With research having started around 1900 and continuing for over 100 years, we are now able to witness the popularization of 3-dimensional films happening before our very eyes. Within our own country, we can frequently see them at amusement parks and museums. In the future, through the popularization of HDTV etc., there is a good outlook for practical use of 3-dimensional images in televisions with advanced picture qualify as well as in other areas. Together with the international current, research on 3-dimensional films has been activated in Korea and is rising as a main current in the film industry. Within this context, the contents and understanding of 3-dimensional images must keep in step with the pace of technical advancements. In order to accelerate of development of film contents to keep in pace with technical developments, this dissertation presents the techniques and technical aspects of future developments, and shows the need to prepare in advance to make the field grow- and thereby avoid having a lack of experts and being conquered by other nations in the field - rather than only advancing the technical aspects and importing the contents. This dissertation aims to stimulate interest and continual research by progressive-thinking people related to the film industry. Part II looks into the definition and types of 3-dimensional motion pictures, the terminology, the fundamentals of image formation, current market fluctuations, and looks into 3-dimensional techniques which can be borrowed and introduced in 3-dimensional animations. Part III concerns 3-dimensional animated films. It analyzes 3-dimensional production techniques while using the introduction of specific animation techniques in the 2004 production Lee Sun Shin and Nelson - Naval Heroes 3-dimensional animation produced in 2004 by Clay & Puppet Stop-Motion Animation & Computer Graphic. Original Korean title: 해전영웅 이순신과 넬슨. as an example, and it also looks into how current film techniques used in animations can be applied in 3-dimensional films. Additionally, the actual stages of the various fields of 3-dimensional animations are presented. Given the current direction and advancement of 3-dimensional films making use of animations and the possible realization of this field, the author plans to weigh the development of this yet unexploited new market Not looking at the current progress of the field, but rather the direction of the hypothetical types of animation techniques, the author predicts the marketability and possibility of development of each area.

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A study of the difference of Dongeui-Suse-Bowon and past Oriental-Medicine appeared in the argument of Interior-overheating-sympton of the Tae-Eum-In caused by liver's receiving heat (태음인(太陰人) 간수열(肝受熱) 이열병론(裡熱病論)을 통해 살펴본 과거의학(過去醫學)과 동의수세보원(東醫壽世保元)의 음양관(陰陽觀)의 차이(差異))

  • Kim, Jong-Weon
    • Journal of Sasang Constitutional Medicine
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    • v.9 no.1
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    • pp.127-153
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    • 1997
  • Sasang-Medicine can classify all sympton with more simple classifying system than past Oriental-Medicine, because Sasang Byeon-Zeung(=classifying system of the sympton) separate by four clearly. The merit of this Sasang Byeon-Zeung can be seen more clearly on the part of the pathology of the expiratory-scattering and inspiratory-gathering of the Tae-Eum and Tae-Yang. On this view point, this thesis discussed the following subjects. 1. Investigate the theory of raising-falling and scattering-gathering developed in the Dongeui-Suse-Bowon. 2. Investigate the changes of the recognition of the Yang-Dog sympton and Jo-Yeol sympton argued as Interior-overheating-sympton of the Tae-Eum-In caused by liver's receiving heat. 3. Investigate the Yi-Je-Ma's view on the Eum-Yang in the argument of interior-overheating-sympton of the Tae-Eum-In caused by liver's receiving heat. As a result, the following conclusions were led to. 1. Dongeui-Suse-Bowon considers Spleen-Kidney has the couple motion of the raising Yang and falling Eum, and Liver-Lung has the couple motion of the expiratory-scattering and inspiratory-gathering. This theory of raising-falling and scattering-gathering is same as in the concept with the gathering. This theory of raising-falling and scattering-gathering is same as in the concept with the theory of raising-falling and floating-sinking of past Oriental-Medicine, but more consistently systematized in the pathology and prescription. 2. Dongeui-Suse-Bowon considers the Yang-Dog sympton and Jo-Yeol sympton as the interior-overheating-sympton of the Tae-Eum-In. As following the book, the fire of desire weeken the expiratory-scattering power of the lung, and deepen the shortage of the expiratory-scattering power comparison to the inspiratory-gathering power. Therfore the sympton can be treated by releasing ourselves from the desire and taking medicine strengthening the expiratory-scattering power. 3. In the early stage of the orintal medicine, they used prescriptions composed of So-Yang medicine and Tae-Eum medicine which can cool heat. Galgeun, Mawhang and Seungma were used in the age of Sanghanron, thereafter Jugoing's Jojung-Tang and Gongsin's Galgeunhaegi-Tang were developed as prescriptions of the interior-overheating-sympton of the Tae-Eum-In, and finally Tea-Uem-In Galgeunhaegi-Tang was settled by Yi-Je-Ma.

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Clinical Experiences for Cardiac Myxomas (심장 점액종의 임상적 고찰)

  • Lee, Geun-Dong;Lee, Jae-Won;Jung, Jae-Seung;Jung, Sung-Ho;Je, Hyoung-Gon;Choo, Suk-Jung;Song, Hyun;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.41 no.6
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    • pp.703-709
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    • 2008
  • Background: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. Material and Method: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echo-cardiograms to find potential preoperative risk factors. Result: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was $54.5{\pm}14.3$ years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was $4.3{\pm}1.8$ (range $1.1{\sim}8\;cm$)cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down. to the mitral. annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was $5.1{\pm}1.0\;cm$, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was $36.2{\pm}37.5$ months, with recurrence reported in 2(2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. Conclusion: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.

Clinicopathologic features of Acute Interstitial Pneumonia (급성 간질성 폐렴의 임상적 고찰)

  • Shim, Jae-Jeong;Park, Sang-Muyn;Lee, Sang-Hwa;Lee, Jin-Gu;Cho, Jae-Yun;Song, Gwan-Gyu;In, Kwang-Ho;Yoo, Se-Hwa;Kang, Kyung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.58-66
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    • 1995
  • Background: Acute interstitial pneumonia is a relatively rare form of interstitial pneumonia, since the vast majority of interstitial pneumonia have a more chronic course. It corresponds to the lesion described by Hamman and Rich, as Hamman-Rich disease in 1944. Another name in the clinical literature is accelerated interstitial pneumonia, idiopathic acute respiratory distress syndrome (idiopathic ARDS), and the organizing stage of diffuse alveolar damage. Acute interstitial pneumonia differs from chronic interstitial pneumonia by clinical and pathologic features. Clinically, this disease is characterized by a sudden onset and a rapid course, and reversible disease. Method and Purpose: Five cases of pathologically proven acute interstitial pneumonia were retrospectively studied to define the clinical, radiologic, and pathologic features. Results: 1) The five cases ranged in age from 31 to 77 years old. The onset of illness was acute in all patients, it began with viral-like prodrome 6~40 days prior to shortness of breath, and respiratory failure eventually developed in all patients. In 2 cases, generalized skin rash was accompanied with flu-like symptoms. Etiologic agent could not be identified in any case. 2) All patients had leukocytosis and severe hypoxemia. Pulmonary function test of 3 available cases shows restrictive ventilatory defect, and one survived patient(case 5) has a complete improvement of pulmonary function after dismissal. 3) Diffuse bilateral chest infiltrates were present radiologically. Theses were the ground-glass, consolidation, and reticular densities without honeycomb fibrosis in all patients. The pathologic abnormalities were the presence of increased numbers of macrophages and the formation of hyaline membranes within alveolar spaces. There was also interstitial thickening with edema, proliferation of immature fibroblast, and hyperplasia of type II pneumocyte. In the survived patient(case5), pathologic findings were relatively early stage of acute interstitial pneumonia, such as hyaline membrane with mild interstitial fibrosis. 4) Of the 5 patients, four patients died of respiratory failure 14~90 days after onset of first symptom, and one survived and recovered in symptoms, chest X ray, and pulmonary function test Conclusion: These results emphasize that acute interstitial pneumonia is clinically, radiologically, and pathologically distinct form of interstitial pneumonia and should be separated from the group of chronic interstitial pneumonia. Further studies will be needed to evaluate the pathogenesis and the treatment of acute interstitial pneumonia.

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Clinicopathologic Characteristics of and Surgical Strategy for Patients with Submucosal Gastric Carcinomas (위 점막하층암의 임상병리학적 특징과 수술 방법)

  • Park Chan Yong;Seo Kyoung Won;Joo Jai Kyun;Park Young Kyu;Ryu, Seong Yeob;Kim Hyeong Rok;Kim Dong Yi;Kim Young Jin
    • Journal of Gastric Cancer
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    • v.5 no.2
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    • pp.89-94
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    • 2005
  • Purpose: Early gastric cancer (EGC) has an excellent prognosis compared to advanced gastric cancer. The 5-year survival rate for EGC now exceeds $90\%$, and EGC is recognized as a curable malignancy. The important prognostic factor in EGC is the status of lymph-node metastasis. Despite conserving surgery being suggested for EGC at present, it is of vital importance to select a surgical method appropriate to each individual case. This retrospective study was undertaken to clarify clinicopathologic features and factors related to lymph-node metastasis in submucosal gastric cancer in order to determine an appropriate therapy. Materials and Methods: This study analyzed the clinicopathologic features for 279 patients with a submucosal gastric carcinoma (Group I) and compared with those of patients with mucosal (Group II) or muscularis proprial gastric carcinoma (Group III). All patients were operated on from 1981 to 1999 at Chonnam University Hospital. There were no statistically significant differences among the groups with respect to age, gender, tumor location, hepatic metastasis, or peritoneal dissemination. Results: Positive lymph node metastasis was found in 47 ($16.8\%$) of the 279 patients with a submucosal gastric carcinoma. The incidence of lymph-node metastasis was significantly higher in patients with a submucosal gastric carcinoma than in patients with a mucosal gastric carcinoma ($16.8\%\;vs.\;3.9\%\;$; P<0.01). Therefore, depth of invasion was a significant factor affecting in lymph-node metastasis. The 5-year survival rates were $88.6\%$ for patients in Group I, $95.2\%$ for patients in Group II, and $72.7\%$ for patients in Group III (P<0.01 for Group I vs. Group II; Group I vs. Group III). In patients with a submucosal gastric carcinoma, the survival rate with positive lymph nodes was significantly poorer than that of patients without lymph-node metastasis ($87.3\%\;vs.\;94.2\%$; P<0.01). Conclusion: Gastrectomy with D2 lymph node dissection is an appropriate operative procedure for patients with a submucosal gastric carcinoma.

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Studies on Properties of Superplasticized Fly Ash Concrete (고류동화제(高流動化劑)를 사용한 플라이애쉬 콘크리트의 제성질(諸性質)에 관한 연구(硏究))

  • Kim, Seong Wan;Sung, Chan Yong;Cho, Il Ho
    • Korean Journal of Agricultural Science
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    • v.16 no.2
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    • pp.212-224
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    • 1989
  • This paper reports results of an investigation to determine properties of superplasticizered fly ash concrete. The mixture proportions of fly ash were 0, 10, 20 and 30%, by weight of cement, and superplasticizer was added as a percentage of fly ash, 0, 0.6, 12 and 1.8%. To investigate the effective use of the superplasticized fly ash concrete, the basic data were analyzed. The results obtained were summarized as follows : 1. The unit water content was decreased by 1%, 6% and increased by 2% to the ratio of addition of fly ash 10%, 20%, 30%, respectively, but in case of the superplasticized fly ash concrete, it was decreased by 3~16%, 4~14% and 10~17%, at 0.6, 12, and 1.8% dosage of superplasticizer, respectively. 2. In the properties of the fresh fly ash concrete, the slump loss was reduced with the ratio of replacement of fly ash increased, and with times went by. When using superplasticizer in fly ash substituting concrete, the fludity in the concrete was not decreased. 3. The compressive strength of fly ash concrete at early ages was lower than that of ordinary concrete. At the later age of 28 days, the compressive strength with 20% addition of fly ash was increased than that of ordinary concrete. In cased of 10%, 30% addition of fly ash, the compressive strength were reduced. From this, it was proved that the optimum amount of fly ash appears to be about 20%. The compressive strength at all ages of superplasticized fly ash concrete was significantly higher than that of fly ash concrete, with increasing fly ash content. 4. In case of the tensile strength, the effects of the increasing strength with the ages were similar to those of the compressive strtength, and at the later ages was seen a decreasing tendency of strengths. 5. The correlation between compressive and tensile strength of superplasticized fly ash concrete was highly significant. The multiple regression equations of compressive and tensile strength were obtained on a function of the mixture proportion of fly ash and the addition of superplasticizer. The relation between compressive and tensile strength is higher than for ordinary concrete. The strength ratio is 7~11, and it is higher than that of ordinary concrete, 8~10. 6. Bulk density was decreased by 1~3% compared with ordinary concrete with the mixture proportion of fly ash increased, 10~30%, and decreased by 1~2% with the superplasticizer added 0.6~1.8%.

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K-Ar and $^{40}$ Ar/$^{39}$ Ar Ages from Metasediments in the Okcheon Metamorphic Belt and their Tectonic Implication (옥천 변성대 변성퇴적암의 K-Ar및 $^{40}$ Ar/$^{39}$ Ar 연대와 그 의의)

  • 김성원;오창환;이덕수;이정후
    • The Journal of the Petrological Society of Korea
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    • v.12 no.2
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    • pp.79-99
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    • 2003
  • Muscovite and biotite from 52 metasediments and 5 granites in the Hwasan area, the southwest of the Okcheon metamorphic belt and the Miwon-Jeungpyeong area, central Okcheon metamorphic belt were dated by the K-Ar and $^{40}$ Ar/$^{39}$ Ar methods. Muscovite and biotite ages from metapelitic and psammitic rocks (metasediments) of the Boeun and Pibanryeong units in the Hwasan area are concentrated in the mid-Jurassic (149-180 Ma). K-Ar and $^{40}$ Ar/$^{39}$ Ar ages for metapelitic and psammitic rocks of the Boeun and Pibanryeong units in the Miwon-Jeungpyeong area show complicated age distribution. Muscovite and biotite ages are classified by three groups, 142-194 Ma, 216-234 Ma, and 241-277 Ma. Younger (Cretaceous) ages occur only in metasediments close to Cretaceous granitic rocks in the southeastern region and the older ages of 216-277 Ma are restricted to the middle Part of the Jeungpyeong area. Most ages in the other area of the central Okcheon metamorphic belt fall between 142-194 Ma (Jurassic). K-Ar and $^{40}$ Ar/$^{39}$ Ar ages for granite from the northern part in the both the southwest and central Okcheon metamorphic belt also gave middle Jurassic ages (156-168 Ma). The similar ages from both metasediments and granites in the study areas indicate simultaneous cooling of both rocks to 300-350$^{\circ}C$ during the middle Jurassic. The state of graphitization of carbonaceous material of all metasediments in the study areas Indicates fully ordered graphite falling within a small range, from 3.353 to 3.359 ${\AA}$, which indicate amphibolite facies regional metamorphism. In the southern sector of the Boeun unit from the Hwasan area, metamorphic grade indicated by mineral paragenesis during regional intermediate-P/T metamorphism is greenschist facies. Whereas, the $d_{002}$ values for carbonaceous materials in the same sector show fully ordered graphite (ca. 500$^{\circ}C$) indicating amphibolite facies. This result with the concentration of mica ages of metasediments into the middle Jurassic, the presence of low-P/T thermal metamorphic zone (>500$^{\circ}C$) in the metasediments close to the Jurassic granite and the regional intrusion of Jurassic granites and their middle Jurassic intrusion and cooling ages may indicate the low-P/T regional thermal event during the early(\ulcorner)-middle Jurassic after main intermediate-P/T metamorphism which formed main mineral assemblage regionally in the study area. The regional thermal event failed, however, to reset the mineral assemblage of regional intermediate-P/T metamorphism except for narrow aureole (1-2 km) around Jurassic granite because e duration of thermal effect was relatively short by repid cooling of the Jurassic granite. In the middle part of the Jeungpyeong area, central Ogcheon metamorphic belt, muscovite and biotite K-Ar ages from 5 samples are 263-277 Ma and 241-249 Ma, respectively. An intermediate-P/T metamorphism is currently accepted to have occurred between 280 and 300 Ma. Therefore, the muscovite and biotite ages can be interpreted as cooling ages after Ml metamorphism indicating rapid cooling to ca 350$^{\circ}C$ between 280-300 Ma and 263-271 Ma, and biotite ages indicate slower cooling to ca. 300$^{\circ}C$ between 263-277 Ma and 241-249 Ma. However, more detail study is needed to confirm why the Permian to Triassic ages occur only in the middle Part of the Jeungpyeong area.a.

Radiotherapy in Supraglottic Carcinoma - With Respect to Locoregional Control and Survival - (성문상부암의 방사선치료 -국소종양 제어율과 생존율을 중심으로-)

  • Nam Taek-Keun;Chung Woong-Ki;Cho Jae-Shik;Ahn Sung-Ja;Nah Byung-Sik;Oh Yoon-Kyeong
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.108-115
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    • 2002
  • Purpose : A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. Materials and Methods : From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were $6\;(5\%),\;16\;(14\%),\;53\;(45\%),\;32\;(27\%),\;10\;(9\%)$, respectively. Eighty patients were treated by radical radiotherapy in the range of $61.2\~79.2\;Gy$ (mean : 69.2 Gy) to the primary tumor and $45.0\~93.6\;Gy$ (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of $45.0\~68.4\;Gy$ (mean : 56.1 Gy) to the primary tumor bed and $45.0\~59.4\;Gy$ (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (${\pm}lymph$ node dissection), three had a supraglottic horizontal laryngectomy (${\pm}lymph$ node dissection), and one had a primary excision alone. Results : The 5-year survival rate (5YSR) of all patients was $43\%$. The 5YSRs of the patients with stage I+II, III+IV were $49.9\%,\;41.2\%$, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was $100\%$. The 5YSRs of patients who underwent surgery plus radiotherapy (S+RT) vs radiotherapy alone (RT) in stage II, III, IVA were $100\%\;vs\;43\%$ (p=0.17), $62\%\;vs\;52\%$ (p=0.32), $58\%\;vs\;6\%$ (p<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was $57\%$. The 5YLCR of the patients with stage I, II, III, IVA, IVB was $100\%,\;74\%,\;60\%,\;44\%,\;30\%$, respectively (p=0.008). The 5YLCR of the patients with S+RT vs RT in stage II, III, IVA was $100\%\;vs\;68\%$ (p=0.29), $67\%\;vs\;55\%$ (p=0.23), $81\%\;vs\;20\%$ (p<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were $76\%,\;20\%,\;0\%$, respectively (p<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. Conclusion : In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.

Clinical Results and Optimal Timing of OPCAB in Patients with Acute Myocardial Infarction (급성 심근경색증 환자에서 시행한 OPCAB의 수술시기와 검색의 정도에 따른 임상성적)

  • Youn Young-Nam;Yang Hong-Suk;Shim Yeon-Hee;Yoo Kyung-Jong
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.534-543
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    • 2006
  • Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.