• Title/Summary/Keyword: Hartmann operation

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Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

  • Park, Won;Park, Won Cheol;Kim, Keun Young;Lee, Seok Youn
    • Annals of Coloproctology
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    • v.34 no.6
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    • pp.306-311
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    • 2018
  • Purpose: Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon's foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center. Methods: We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG). Results: The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients ($10.15{\pm}2.94days$) than among OG patients ($16{\pm}9.5days$). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%). Conclusion: If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

The Improvement of the Correlation Method for Shack-Hartmann Wavefront Sensors using Multi-Resolution Method (다중 해상도 중심점 탐색법을 이용한 샥-하트만 센서용 상관관계법의 속도 개선)

  • Yoo, Jae-Eun;Youn, Sung-Kie
    • Korean Journal of Optics and Photonics
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    • v.19 no.1
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    • pp.1-8
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    • 2008
  • Shack-Hartmann sensors are widely employed as a wavefront measuring device in various applications. Adaptive optics is one of the major applications. Since an adaptive optics system should be operated in real-time, high-speed wavefront sensing is essential. In high-speed operation, integration time of an image detector is very short. In this case, noises such as readout noise and photon noise greatly influence the accuracy of wavefront sensing. Therefore a fast and noise-insensitive centroid finding algorithm is required for the real-time wavefront sensing. In this paper, the multi-resolution correlation method is proposed. By employing multi-resolution images, this method greatly reduces the computation time when compared to the fast Fourier transform (FFT) correlation method. The verification is performed through the computational simulation. In this paper, the center of mass method, correlation method and multi-resolution correlation method are employed to compare the measurement accuracy of the centroid finding algorithms. The accuracy of a Shack-Hartmann wavefront sensor using the proposed algorithm is proved to be comparable to that of the conventional correlation method.

Changes of Potassium in Open Heart Surgery (개심술시의 포타시움 변화)

  • 이홍섭
    • Journal of Chest Surgery
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    • v.11 no.4
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    • pp.422-427
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    • 1978
  • Alterations in the serum and urine potassium were studied in twenty patients who underwent open heart surgery in National Medical Center during the period from Jan.1978 to June 1978. There were twelve cases congenital heart disease and eight acquired heart disease. Rigg-Kyvsgaad mark IV roller pump and Polystan bubble oxygenator were used in all patients. Hemodilution was carried out by priming the oxygenator with Hartmann`s solution. Measurements were made of the serum electrolyte, gas analysis and twenty four hour urine electrolytes. During the bypass, the serum potassium decreased Significantly from 4.2?.47 to 3.6?. 72 mEq. per liter. [p<0.05] Fifty seven miliequivalant of potassium chloride were added during operation-urine potassium was higher in the diuretic group than in the non diuretic group. Plasma potassium level in the diuretic group was more significantly reduced than nondiuretic group. In this series large amount of urine potassium loss was noted on the day of operation, the first and second post operative day.

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Effects of Starvation and Perioperative Fluid Therapy on the Blood Glucose Concentrations during Anesthesia in Children (소아마취시 금식과 수액투여가 혈당농도에 미치는 영향)

  • Suh, Ill-Sook;Song, Sun-Ok;Park, Dae-Pal
    • Journal of Yeungnam Medical Science
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    • v.1 no.1
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    • pp.89-93
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    • 1984
  • This study included 38 children patients of less than 4 years old and 18kg body weight. 93 After 8 hours of starvation, the children were divided into 2 groups: Group I received Hartmann's solution and Group II received Hartmann's dextrose solution. In both groups, the rates of infusion were 10ml/kg/hr before and during operation and blood samples were collected just before and 1 hr after induction of anesthesia, respectively. The results were as follows; 1) In the Group I, blood glucose concentration just before induction was decreased than control values that was checked at ward, and 1 hr values after induction was significantly increased than control values. 2) In the Group II, blood glucose concentration was increased just before and 1hr after induction than control values significantly respectively. 3) In the blood glucose concentration 1 hr after induction, difference between Group I and Group II was not significant. 4) In children, duration of starvation about 8 hrs did not significant influence on blood glucose concentration although dextrose was not administered.

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An integrated monitoring system for life-cycle management of wind turbines

  • Smarsly, Kay;Hartmann, Dietrich;Law, Kincho H.
    • Smart Structures and Systems
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    • v.12 no.2
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    • pp.209-233
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    • 2013
  • With an annual growth rate of about 30%, wind energy systems, such as wind turbines, represent one of the fastest growing renewable energy technologies. Continuous structural health monitoring of wind turbines can help improving structural reliability and facilitating optimal decisions with respect to maintenance and operation at minimum associated life-cycle costs. This paper presents an integrated monitoring system that is designed to support structural assessment and life-cycle management of wind turbines. The monitoring system systematically integrates a wide variety of hardware and software modules, including sensors and computer systems for automated data acquisition, data analysis and data archival, a multiagent-based system for self-diagnosis of sensor malfunctions, a model updating and damage detection framework for structural assessment, and a management module for monitoring the structural condition and the operational efficiency of the wind turbine. The monitoring system has been installed on a 500 kW wind turbine located in Germany. Since its initial deployment in 2009, the system automatically collects and processes structural, environmental, and operational wind turbine data. The results demonstrate the potential of the proposed approach not only to ensure continuous safety of the structures, but also to enable cost-efficient maintenance and operation of wind turbines.

Studies on the Hemodilution Perfusion with Rygg-Kyvsgaard Oxygenator (혈액희석 체외순환법에 관한 임상적 관찰 -상온하 Rygg-Kyvsgaard 산화기 및 Sigmamotor pump 사용예를 중심으로-)

  • 손광현
    • Journal of Chest Surgery
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    • v.3 no.2
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    • pp.73-90
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    • 1970
  • Clinical perfusion data on 16 cases of cardiopulmonary bypass using Sigmamotor pump and RyggKyvsgaard Oxygenator which performed at Seoul National University Hospital during the period of Aug. 1968 to Aug. 1970 was analized. AIl cases were hemodiluted and the perfusion was carried out under the normothermic condition. The age of the patients ranged between 6 and 43 years. The b:dy weight varied between 18.3 and 54.0 kg and the body surface area between 0.78 and 1. 59$M^2$. The priming solution was consiste:I with fresh ACD blood. Hartmann solution and Mannitol. The average amount of priming was approximately 2242 ml. The average hemodilution rate was 17%. The flow rate ranged from 1.7L to 3.5L/Min/$M^2$ and averaged 2.4L/Min/$M^2$ or 78mI/Min/kg. The duration of perfusion varied from 22 to 110 min with average of 56.9 minutes. Some hemodynamic responses were observed. The arterial pressure dropped immediately after the initiation of partial perfusion and was more marked after the total perfusion foIlowed by gradual increase to the safety level. The central venous pressure reflected the reduced blood volume especially in the cases of prolonged perfusion which lasted over 60 min. In most of the cases, red blood cell count decreased and white blood ceIl count increased after the perfusion. Hemoglobin level was decreased, averaging of 12.5mg%, Hct 3.3% and platelets count of 18% postoperatively. Plasma hemoglobin increased mildly, from pre-perfusion average value of 4. 06mg% to postperfusion value of 22.5mg%. Serum potassium was 4.4mEq/L pre-operatively and was decreased to 3.7mEq/L postoperatively. Five cases showed definite hypopotassemia immediately after the operation. Sodium and chloride decreased mildly. These electrolyte changes are thought to be related with hemodilution. diuretics and reduced blood volume during and after the perfusion. Arterial blood pH value revealed minimal to moderate elevation from preperfusion average value of 7.376 to 7.461 during perfusion and then 7.365 after perfusion. The pC02 and hicarbonate showed minimal to moderately lowered values. The total CO2 was decreased. Buffer base decreased during perfusion (Av. 42.6mEq/L) and further decreased after the perfusion (Av. 40.8mEq/L). These arterial blood acid base changes suggested that the metabolic acidosis was accompanied by respiratory alkalosis during and immediately after the perfusion. Authors belived that the acidosis could more effectively be corrected with the more additional dose of bicarbonate than we used by this study. The chest tune drainage during the first 24 hours following operation was 1158 ml in average. One case (Case No. 15) showd definite bleeding tendency and it was believed that the cause might be due to the defect of heparin and protamine titration. The average urinary out put during 24 hours post-perfusion was 1291ml. One case (Case No. ]) showed definite post perfusion oliguria. As conclusion hemodilution using fresh ACD blood. Hartmann and Mannitol solution added with Bivon and high flow rate unler normothermia. was thought to amelioratc the severity of mctabolic acidosis during and after perfusion with relatively satisfactory effect on the diuresis and bleeding tendency.

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Colorectal Cancer in Children - 2 Cases Report - (소아에서 발생한 결장암)

  • Choi, June-Young;Kim, Hyun-Young;Park, Kwi-Won
    • Advances in pediatric surgery
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    • v.10 no.2
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    • pp.145-149
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    • 2004
  • A 12-year-old boy with severe periumbilical pain visited the emergency room. Physical examination, abdominal ultrasonography, colonoscopy and CT, identified a lesion of sigmoid colon. Endoscopic biopsy showed a signet ring cell carcinoma of the sigmoid colon. On explorative laparotomy, cancer invasions of the adjacent structures and metastases on peritoneal wall were noticed. We performed palliative loop-ileostomy. He underwent chemotherapy and radiotherapy for 3 months. The second case was a 16-year-old boy with abdominal pain and hematochezia, transferred to our hospital with the diagnosis of acute appendicitis with periappendiceal abscess. Although he underwent appendectomy, the abdominal pain persisted. Digital rectal examination revealed a lumen-obstructing fungating mass in the rectum. Endoscopic biopsy revealed a adenocarcinoma. Cancer invasion of the adjacent structures and metastases involving the mesentery of the small intestine were found at laparotomy. A palliative procedure, a Hartmann's operation and end-colostomy at the sigmoid colon were performed. The patient died 8 month later due to pneumonia and sepsis. Chemotherapy was not applied.

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The Clinical Experience of 610 Cases Open Heart Surgery (개심술 610례에 관한 임상적 고찰)

  • 정황규
    • Journal of Chest Surgery
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    • v.21 no.1
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    • pp.36-47
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    • 1988
  • 610 cases of open heart surgery was performed in the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital from July 1981 to September 1987. The clinical data was summarized as follows: 1. The age distribution of congenital heart surgery patients was 2 to 41 years old [mean; 13.2 years] and surgery for acquired heart disease was 10 to 57 years old [mean: 32.8 years]. 2. There were 389 cases [63.8%] of acyanotic congenital heart anomalies, 63 cases [10.3%] of cyanotic congenital anomalies and 158 cases [25.9%] of acquired heart disease. 3. For myocardial protection, Bretschneider and potassium glucose solution had been used as cardioplegic solution and then since 1983, GIK solution has been used with repeated infusion method once for every 20 to 30 minutes of time interval after starting initial cardioplegia during operation with excellent results. 4. The ingredient of the priming solution is Hartmann`s solution, sodium bicarbonate, mannitol, potassium chloride, fresh ACD whole blood, calcium chloride, heparin and dexamethasone. 5. There were 96 cases [15.7%] of mild hypothermia, 333 cases [54.6%] of moderate hypothermia and 181 cases [29.7%] of intermediate hypothermia. 6. The mortality rate was 2.3% [9 out of 389 cases] in acyanotic congenital heart disease, 36.5% [23 out of 63 cases] in cyanotic congenital heart disease and 10.8% [17 out of 158 cases] in acquired heart disease, with overall mortality rate of 8.0% [49 out of 610 cases].

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SAFETY ANALYSIS METHODOLOGY FOR AGED CANDU® 6 NUCLEAR REACTORS

  • Hartmann, Wolfgang;Jung, Jong Yeob
    • Nuclear Engineering and Technology
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    • v.45 no.5
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    • pp.581-588
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    • 2013
  • This paper deals with the Safety Analysis for $CANDU^{(R)}$ 6 nuclear reactors as affected by main Heat Transport System (HTS) aging. Operational and aging related changes of the HTS throughout its lifetime may lead to restrictions in certain safety system settings and hence some restriction in performance under certain conditions. A step in confirming safe reactor operation is the tracking of relevant data and their corresponding interpretation by the use of appropriate thermal-hydraulic analytic models. Safety analyses ranging from the assessment of safety limits associated with the prevention of intermittent fuel sheath dryout for a slow Loss of Regulation (LOR) analysis and fission gas release after a fuel failure are summarized. Specifically for fission gas release, the thermal-hydraulic analysis for a fresh core and an 11 Effective Full Power Years (EFPY) aged core was summarized, leading to the most severe stagnation break sizes for the inlet feeder break and the channel failure time. Associated coolant conditions provide the input data for fuel analyses. Based on the thermal-hydraulic data, the fission product inventory under normal operating conditions may be calculated for both fresh and aged cores, and the fission gas release may be evaluated during the transient. This analysis plays a major role in determining possible radiation doses to the public after postulated accidents have occurred.

Corrosion of Containment Alloys in Molten Salt Reactors and the Prospect of Online Monitoring

  • Hartmann, Thomas;Paviet, Patricia
    • Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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    • v.20 no.1
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    • pp.43-63
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    • 2022
  • The aim of this review is to communicate some essential knowledge of the underlying mechanism of the corrosion of structural containment alloys during molten salt reactor operation in the context of prospective online monitoring in future MSR installations. The formation of metal halide species and the progression of their concentration in the molten salt do reflect containment corrosion, tracing the depletion of alloying metals at the alloy salt interface will assure safe conditions during reactor operation. Even though the progress of alloying metal halides concentrations in the molten salt do strongly understate actual corrosion rates, their prospective 1st order kinetics followed by near-linearly increase is attributed to homogeneous matrix corrosion. The service life of the structural containment alloy is derived from homogeneous matrix corrosion and near-surface void formation but less so from intergranular cracking (IGC) and pitting corrosion. Online monitoring of corrosion species is of particular interest for molten chloride systems since besides the expected formation of chromium chloride species CrCl2 and CrCl3, other metal chloride species such as FeCl2, FeCl3, MoCl2, MnCl2 and NiCl2 will form, depending on the selected structural alloy. The metal chloride concentrations should follow, after an incubation period of about 10,000 hours, a linear projection with a positive slope and a steady increase of < 1 ppm per day. During the incubation period, metal concentration show 1st order kinetics and increasing linearly with time1/2. Ideally, a linear increase reflects homogeneous matrix corrosion, while a sharp increase in the metal chloride concentration could set a warning flag for potential material failure within the projected service life, e.g. as result of intergranular cracking or pitting corrosion. Continuous monitoring of metal chloride concentrations can therefore provide direct information about the mechanism of the ongoing corrosion scenario and offer valuable information for a timely warning of prospective material failure.