The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.
Background: Refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We reviewed our experience with arrhythmia surgery in patients who had Fontan operation. Material and Method: Between July 1986 and December 2003, 275 early survivors after Fontan operation were reviewed. Fourteen patients underwent. arrhythmia surgery at reoperation after Fontan operation, and mean age at reoperation was 16.8$\pm$7.1 (range: 4.5 ∼ 30.6) years. Mechanisms of arrhythmia included atrial flutter in 8 patients, and atrial fibrillation in 2. Arrhythmia surgery has evolved from isthmus cryoablation in 12 patients to right-sided maze in 2 patients. Thirty-two patients. underwent prophylactic isthmus cryoablation concomitantly at initial Fontan operation. Result: Postoperative arrhythmias occurred in 68 patients (24.7%) among 275. There was no early and late mortality after the arrhythmia surgery. After redo Fontan operation, all patients maintained normal sinus rhythm. Atrial flutter recurred in 3 patients who had sinus conversion with medication and 7 required permanent pacemakers with a mean follow-up of 26.5$\pm$29.1 (range: 2 ∼ 73) months. All patients have improved to NYHA class I or II. After prophylactic cryoablation at initial Fontan operation, 29 patients (90.6%) had sinus rhythm, 1 patient had junctional tachycardia, 1 patient had sinus nodal dysfunction, and 1 patient had AV block with a mean follow-up of 51.3$\pm$19.8 (range: 4∼80) months. Conclusion: Redo Fontan operation, and concomitant arrhythmia surgery reduced atrial arrhythmias and improved NYHA functional classification.
Background : Early diagnosis and proper antibiotic treatment are very important in the management of ventilator-associated pneumonia (VAP) because of its high mortality. Bronchoscopy with a protected specimen brush (PSB) has been considered the standard method to isolate the causative organisms of VAP. However, this method burdens consumer economically to purchase a PSB. Another useful method for the diagnosis of VAP is quantitative cultures of aspirated specimens through bronchoscopic bronchoalveolar lavage (BAL), for which the infusion of more than 120 m1 of saline has been recommended for adequate sampling of a pulmonary segment. However, occasionally it leads to deterioration of the patient's condition. We studied the diagnostic efficacy of minibronchoalveolar lavage (miniBAL), which retrieves only 25 ml of BAL fluid, in the isolation of causative organisms of VAP. Methods: We included 38 consecutive patients (41 cases) suspected of having VAP on the basis of clinical evidence, who had received antibiotics before the bronchoscopy. The two diagnostic techniques of PSB and miniBAL, which were performed one after another at the same pulmonary segment, 'were compared prospectively. The cut-off values for quantitative cultures to define causative bacteria of VAP were more than $10^3$ colony-forming units (cfu)/ml for PSB and more than $10^4$ cfu/ml for BAL. Results: The amount of instilled normal saline required to retrieve 25 ml of BAL fluid was $93{\pm}32 ml$ (mean${\pm}$SD). The detection rate of causative agents was 46.3% (19/41) with PSB and 43.9% (18/41) with miniBAL. The concordance rate of PSB and miniBAL in the bacterial culture was 85.4% (35/41). Although arterial blood oxygen saturation dropped significantly (p<0.05) during ($92{\pm}10%$) and 10 min after ($95{\pm}3%$) miniBAL compared with the baseline ($97{\pm}3%$), all except 3 cases were within normal ranges. The significantly elevated heart rate during ($l25{\pm}24$/min, p<0.05) miniBAL compared with the baseline ($1l1{\pm}22$/min) recovered again in 10 min after ($111{\pm}26$/min) miniBAL. Transient hypotension was developed during the procedure in two cases. The procedure was stopped in one case due to atrial flutter. Conclusion: MiniBAL is a safe and effective technique to detect the causative organisms of VAP.
Cho, Jae Young;Shim, Jong Han;Lee, Hak Eun;Kwon, O Whon
Journal of Korean Society of Steel Construction
/
v.18
no.1
/
pp.33-45
/
2006
Cable-stayed bridges are more inherently vulnerable to wind during the erection stages than when they are already being used. Even if a bridge that is already being used is aerodynamically stable, it is prone to having aerodynamic instabilities within the design wind speed during construction. Therefore, when the bridge's designers deliberate on the method they will use in constructing the bridge, they must likewise come up with a suitable plan to ensure the stability of the bridge during its erection (e.g., conducting a wind-tunnel investigation). This paper describes the aeroelastic full-bridge model tests that were conducted to investigate the aerodynamic behavior of the bridge during erection, with emphasis on aerodynamic stability and the mitigation of the buffeting response through temporary stabilization. The aerodynamic performance of a cable -stayed bridge with a main span of 50 m was studied in its completed stage and in two erection stages, corresponding 50% and 90% completion, respectively. In the 50% erection stage tests, a balanced cantilever configuration, with wind cable and temporary support at the tower, was conducted. The system that was determined to be most effective in reducing wind action on the bridge during construction was proposed in the paper, based on the results of the comparative study that was conducted.
Journal of the Korean Society of Fisheries and Ocean Technology
/
v.43
no.2
/
pp.101-115
/
2007
The pound net fishery is very important one in Korean coastal fishery and it need to grasp the characteristics of the net affected by many factors. It is considered that the structure and the shape of the pound net can be changed by the direction and speed of current, wave height, depth and conditions of sea bed. However, most of all, the speed of current and wave height influence more upon the pound net than any other factors to deform and flutter. In this study, author carried out the experiments with a model of double one-side pound net made by the similarity law as 1:100 scales at a real experimental area, and additionally the model net experiments were conducted in the circulating water channel in Pukyong National University. The author analyzed the data of transformation of shape and tension of the model pound net to recognize the characteristics of the current and wave acting on it. Regardless of the direction of flow affecting on the fish court net or bag net, the deformed angle and depth to the side panel and bottom of box nets becomes bigger as the wave gets higher and the period of wave is faster. The tension in both upward or downward tends to be changed by the speed of wave. Those value of changes occurred similarly in either fish court net or bag net. Generally, when bag net is located at upward of flow, the value of tension was bigger 10% than any other location or nets. Regardless of the setting direction, the tension of the pound net is increased in proportion to flow speed, wave height and period of wave, and it becomes bigger about 15-30% at upward to flow than downward. Where the flow is upward in the court net, the tension in the wave increased to 37% compared to the one in the flow only in the condition of flow of 0.1-0.3m/s. Where the flow is upward in the bag net, the tension in the wave increased to 52% in the flow of 0.1m/s, and the tension increased to 48% in the flow of 0.2-0.3m/s.
Journal of the Korean Society of Hazard Mitigation
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v.4
no.1
s.12
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pp.15-24
/
2004
Generally, a ${\pi}$-type girder composed of two I-type girders is known to have a significant disadvantage in wind resistance design because of aerodynamic instability. A representative bridge for this girder was Tacoma Narrows Bridge. Since Tacoma Narrows Bridge had very low stiffness of the bridge structure and its cross-section shape had aerodynamic instability, the bridge collapsed after severe torsion and vibration events in 19m/s wind speed. Aerodynamic vibration can be avoided by enhancing structural stiffness and damping factor and conducting a study of cross-section shapes. This study shows the angle of attack for the four-span cable stayed bridge having ${\pi}$-type cross-section and describes the aerodynamic characteristics of the changed cross-section with aerodynamic vibration damping additions, by carrying out two-dimension vibration tests. As a result of uniform flow and turbulent flow, the study shows that because the basic ${\pi}$-type cross-section alone can have efficient wind resistant stability, there is no need to have additional aerodynamic damping equipment. Since this four 230m-main-span bridge has a large frequency and also has a big stiffness compared to other bridges containing a similar cross-section, it has aerodynamic stability under the design wind speed.
We propose a method to measure atrial arrhythmias (AA) such as atrial fibrillation (Afb) and atrial flutter (Afl) with a SQUID magnetocardiograph (MCG) system. To detect AA is one of challenging topics in MCG. As the AA generally have irregular rhythm and atrio-ventricular conduction, the MCG signal cannot be improved by QRS averaging; therefore a SQUID MCG system having a high SNR is required to measure informative atrial excitation with a single scan. In the case of Afb, diminished f waves are much smaller than normal P waves because the sources are usually located on the posterior wall of the heart. In this study, we utilize an MCG system measuring tangential field components, which is known to be more sensitive to a deeper current source. The average noise spectral density of the whole system in a magnetic shielded room was $10\;fT/{\surd}Hz(a)\;1\;Hz\;and\;5\;fT/{\surd}Hz\;(a)\;100\;Hz$. We measured the MCG signals of patients with chronic Afb and Afl. Before the AA measurement, the comparison between the measurements in supine and prone positions for P waves has been conducted and the experiment gave a result that the supine position is more suitable to measure the atrial excitation. Therefore, the AA was measured in subject's supine position. Clinical potential of AA measurement in MCG is to find an aspect of a reentry circuit and to localize the abnormal stimulation noninvasively. To give useful information about the abnormal excitation, we have developed a method, separative synthetic aperture magnetometry (sSAM). The basic idea of sSAM is to visualize current source distribution corresponding to the atrial excitation, which are separated from the ventricular excitation and the Gaussian sensor noises. By using sSAM, we localized the source of an Afl successfully.
In this paper, the wind tunnel test for the measurement of aerodynamic characteristics of transmission conductors with asymmetric sections is described. A single conductor model and bundled conductor models with ice accreted shapes are tested both in steady and turbulent flow, and the aerodynamic coefficients are acquired. Transmission conductor galloping is a kind of wind-induced vibration which is characterized by primarily vertical oscillation with a very low frequency and a high amplitude. It is well known that transmission conductor galloping is generally caused by moderately strong, steady winds when a transmission conductor has an asymmetric cross-section shaped by accreted ice. Galloping should be considered from the design stage of overhead lines because it can cause severe wear and fatigue damage to attachments as well as transmission conductors. It is reported that there have been normally 20 events of galloping per year in Korea, which may be followed by serious consequences in the electric power system. Therefore, this research is performed to measure aerodynamic characteristics of ice accreted transmission conductors to understand and control transmission conductor galloping so that it would help to prevent unexpected failures and reduce the maintenance costs caused by galloping.
KSCE Journal of Civil and Environmental Engineering Research
/
v.36
no.3
/
pp.349-359
/
2016
In order to analytically evaluate buffeting responses, the analysis of wind characteristics such as turbulence intensity, turbulence length, gust, roughness coefficient, etc must be a priority. Static aerodynamic force coefficients, flutter coefficients, structural damping ratios, aerodynamic damping ratios and natural frequencies affect the analytical responses. The bridge interested in this paper has being been used for 32 years. As the time passes, current terrain conditions around the bridge are different markedly from the conditions it was built 32 years ago. Also, wind environments were considerably varied by the climate change. For this reason, it is necessary to evaluate the turbulence intensity, length, spectrum and roughness coefficient of the bridge site from full-scale measurements using the structural health monitoring system. The evaluation results indicate that wind characteristics of bridge site is analogous to that of open terrain although the bridge is located on the coastal area. To calculate buffeting responses, the analysis variables such as damping ratios, static aerodynamic force coefficients and natural frequency were evaluated from measured data. The analysis was performed with regard to 4 cases. The evaluated variables from measured data are applied to the first and second analysis cases. And the other analysis cases were performed based on Design Guidelines for Steel Cable Supported Bridges. The calculated responses of each analysis cases are compared with the buffeting response measured at less than 25m/s wind speed. It is verified that the responses by the numerical analysis applying the estimated variables based on full-scale measurements are well agreed with the measured actual buffeting responses under wind speed 25m/s. Also, the extreme wind speed corresponding to a recurrence interval 200 years is derived from Gumbel distribution. The derived wind speed for return period of 200 years is 45m/s. Therefore the buffeting responses at wind speed 45m/s is determined by the analysis applying the estimated variables.
The Baekje Gilt-bronze Incense Burner which was excavated in an ancient temple site in Neungsan-ri, within the City wall of Buyeo-Gun on 23rd December 1993, was a quintessence of the Bakje Arts that people could not have imagined until that time. The Baekje Gilt-bronze Incense Burner transcended 1400 years of time and space. The censer that finally came up to us delivered a kind of a powerful message to us. The power was so strong and mysterious that as if an ancestor who had been sleeping in the grave with a great silent had woken up and become alive to tell us something very precious. Baekje Gilt-bronze Incense Burner, unlike any other existing artifacts, might have a possibility that could provide an insight of the ancients' psych who once lived on our land. This kind of view from several archaeologists, therefore, made our hearts be filled with excitement and flutter. We call 21st century as an era of culture. This era requests that the culture needs to be ethnical but the culture also needs to go beyond that ethnic. In other words, a culture without an ethnic cannot exist, and a culture that puts an ethnic the very first before any other things cannot exist as well. Regaining our identities first and then embracing and harmonizing various cultures can be an wise way overcoming above problem. Hence, through this study, I intend to recognize characteristic of plasticity for Baekje Gilt-bronze Incense Burner, understand the world of Baekje people's spirit and thus provide an opportunity to shed new light on the Baekje Arts. By doing so, I would like to publicize a metal craft of Korea to the world. I also try to seek for an identity of Korea's craft culture which is receding and find a direction for the Korea's craft.
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