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Pulmonary Valve Replacement with Tissue Valves After Pulmonary Outflow Tract Repair in Children (소아에서 폐동맥유출로 재건 후 시행한 조직판막을 이용한 폐동맥판 대치술)

  • Lee, Jeong-Ryul;Hwang, Ho-Young;Chang, Ji-Min;Lee, Cheul;Choi, Jae-Sung;Kim, Yong-Jin;Rho, Joon-Ryang;Bae, Eun-Jung
    • Journal of Chest Surgery
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    • v.35 no.5
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    • pp.350-355
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    • 2002
  • Background: Most of pulmonary regurgitation with or without stenosis appears to be well tolerated early after the repair of pulmonary outflow tract. However, it may result in symptomatic right ventricular dilatation, dysfunction and arrhythmias over a long period of time. We studied the early outcome of pulmonary valve replacement with tissue valves for patients with the above clinical features. Material and Method: Sixteen consecutive patients who underwent pulmonary valve replacement from September 1999 to February 2002 were reviewed(9 males and 7 females). The initial diagnoses included tetralogy of Fallot(n=11), and other congenital heart anomalies with pulmonary outflow obstruction(n=5). Carpentier-Edwards PERIMOUNT Pericardial Bioprostheses and Hancock porcine valves were used. The posterior two thirds of the bioprosthetic rim was placed on the native pulmonary valve annulus and the anterior one third was covered with a bovine pericardial patch. Preoperative pulmonary regurgitation was greater than moderate degree in 13 patients. Three patients had severe pulmonary stenosis. Tricuspid regurgitation was present in 12 patients. Result: Follow-up was complete with a mean duration of 15.8 $\pm$ 8.5months. There was no operative mortality. Cardiothoracic ratio was decreased from 66.0 $\pm$ 6.5% to 57.6 $\pm$ 4.5%(n=16, p=0.001). All patients remained in NYHA class I at the most recent follow-up (n=16, p=0.016). Pulmonary regurgitation was mild or absent in all patients. Tricuspid regurgitation was less than trivial in all patients. Conclusion: In this study we demonstrated that early pulmonary valve replacement for the residual pulmonary regurgitation with or without right ventricular dysfunction was a reasonal option. This technique led to reduce the heart size, decrease pulmonary regurgitation and tricuspid regurgitation as well as to improve the patients'functional status. However, a long term outcome should be cautiously investigated.

Long-Term Observation of Temperature in the Coastal Waters Adjacent to the Wolsung Nuclear Power Plant (월성 원자력 발전소 주변 해역의 장기간 수온관측)

  • Chung, Jong-Yul;Kang, Hyoun-Woo;Shin, Young-Jae;Kim, Kye-Young;Jun, Ho-Kyung
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.3 no.4
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    • pp.183-192
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    • 1998
  • The long-term observation of temperature in the coastal waters adjacent to the Wolsung Nuclear Power Plant has been carried out from November 10, 1996 to August 22, 1997, for approximately 280 days using a real-time temperature measurement buoy system. The sea-surface temperature was measured at every 10 minute using 10 buoys. The vertical structure of temperature was investigated near the outlet of the plant with two thermistor chains equipped with 10 sensors at 1 m interval The monthly averaged temperature was the lowest with spatial average of $12.8^{\circ}C$ in February and was the highest in August with spatial average of $19.6^{\circ}C$. The extremely low temperature was frequently observed between June and August, which seems to be the consequence of the intrusion of cold water near the southeastern coast of Korea. Distributions of the daily and hourly averaged temperature show that the highest temperature always occurred near the outlet of the plant and the warm-water patch moved along the north-south direction with the semidiurnal period. The semidiurnal fluctuation of temperature was also observed near the surface of the vertical profiles. The spectral analysis of temperature between February and April 1997 shows that the semidiurnal components prevailed near the outlet. It is likely that the semidiurnal components were due to the prevailing semidiurnal tide in this region. In August 1997, the diurnal components were dominant at the surface water of all stations except Station 12, which suggests that the warm water from the outlet of the plant has less effects in summer on the surrounding waters than the strong solar radiation.

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Surgical Treatment for Carotid Artery Stenosis (경동맥 협착증의 수술적 치료)

  • Kim, Dae-Hyun;Yi, In-Ho;Youn, Hyo-Chul;Kim, Bum-Shik;Cho, Kyu-Seok;Kim, Soo-Cheol;Hwang, Eun-Gu;Park, Joo-Chul
    • Journal of Chest Surgery
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    • v.39 no.11 s.268
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    • pp.815-821
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    • 2006
  • Background: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications, We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the card endarterectomy. Material and Method: We analyzed retrospectively the medical records of 74 patients(76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. Result: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were $23.48{\pm}10.04$ mmHg in 25 cases with changes in electroencephalography(group A) and $47.16{\pm}16.04$ mmHg in 51 cases without changes in electroencephalography(group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups(p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site. Conclusion: Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroercephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper alway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.

Study on Analysis of Influence Factor for Wildbirds' Appearance in Urban Area around Urban Green Axis - A Case Sturdy of Gangdong-gu in Seoul - (도시 녹지축 주변 시가화지역 내 야생조류 출현 영향요인 분석 연구)

  • Kwak, Jeong-In;Lee, Kyoung-Jae;Han, Bong-Ho
    • Korean Journal of Environment and Ecology
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    • v.24 no.2
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    • pp.166-177
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    • 2010
  • This study is to identify potential factors to impact on appearance of wildbirds which live in the core forest around urban area in Gangdong-gu, Seoul. As a result of analysis of, studies on biotope showed most of urbanization biotope was biotope of residential areas with high green coverage and biotope of residential and business areas with low green coverage while most of biotope of green and openspace was core green biotope. The research area was divided into several blocks based on biotope types in the urbanization areas excluding green and openspace. As a result of research on wildbirds, total 51 species 3,419 individuals appeared in spring and total 35 species 4,213 individuals appeared in winter. 24 wild bird species were selected as subjects of this study among 31 species seen in urbanization areas, since urban birds, rapacious birds, waterside birds were excluded from the study for the proper consideration. Then this study looked at how many species and individuals of the subjects were observed at each research block in urbanization areas during spring and winter separately. Landuse structure and green structure in each block were examined to see whether these structures affect the number of wild birds observed in urbanization areas of Gangdong-gu. Furthermore, the distance between these blocks and green was assessed. While studying the potential links between the landuse structure and the number of wild birds observed in urbanization areas of Gangdong-gu, block area, green coverage, and building-to-land ratio were believed to affect the number of types and species of wild birds in the research area. In terms of correlation analysis of whether green structure affected the number of wild birds observed in urbanization areas of Gangdong-gu, crown volume of layers, the average green patch area, the average height of canopy layer were found to have an impact not only on the number of types but also species of wild birds in the research area.

A Low Irritant Liquid Cleanser Composition Developed by Multi-Screening Methods (다탐색(多探索)법을 통한 저자극성 액체 세정제 조성물 개발)

  • Kim Peter;Hyeon Ki-An;Chung Ji-Youn;Yoon Sam-Sook;Kang Han Chyul;Park Sun Hee;Ko King Il;Kim Ki Ho
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.31 no.1 s.49
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    • pp.51-58
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    • 2005
  • Alkyl ethoxy sulfate type surfactants, widely used in commercial cleansers, are easily adsorbed to skin to often cause skin irritation and inflammation if not thoroughly rinsed nut. In order to replace or complement existing surfactants, we screened the existing surfactants through protein denaturation method, cell cytotoxicity assay and human IL-1$\alpha$ assay, etc. Fourteen surfactants have been chosen from among too irritant anionic, cationic and/or zwitter-ionic ones and investigated for cell cytotoxicity in human fibroblast cell lines using monolayer culture with the thirteen commercially available cleansers for sensitive skin. From these results, we selected 5 surfactants and 2 commercial cleansers (names not shown), such as sodium laureth sulfate (anionic), sodium cocoyl isethionate (anionic), sodium lauroamphoacetate (zwitter-ionic), and cocamidopropyl betaine (zwitter-ionic), alkyl polyglycoside (non-ionic). 20 formulations were made out of 5 surfactants and five of them were chosen through a protein denaturation method (lower than 3 M sodium dodecyl sulfate solution ($13.2\%$)), cell cytotoxicity and human patch test. These five selected formulations containing preservatives were compared to two selected commercial cleansers by cell cytotoxicity and human IL-1$\alpha$ ELISA assay using dermal equivalent. Finally, we selected the best formulation. To this formulation, fructan ($3\%$ or $5\%$) or/and portulaca extract ($3\%$ or $5\%$) well known for its anti-inflammatory and moisturizing effects were added and investigated for cell cytotoxicity using dermal equivalent. In cytotoxicity assay using dermal equivalent, two formulations containing $5\%$ fructan and $3\%$ or $5\%$ portulaca extract were less toxic than the others. In cytotoxicity assay and human IL-1$\alpha$ ELISA using 3D culture, the selected formulation containing $5\%$ fructan and $5\%$ portulaca extract showed better efficiency than those of the others and 2 commercial cleansers. As a result, we could develop a low irritant and safe liquid cleanser.

Calculation Method of Oil Slick Area on Sea Surface Using High-resolution Satellite Imagery: M/V Symphony Oil Spill Accident (고해상도 광학위성을 이용한 해상 유출유 면적 산출: 심포니호 기름유출 사고 사례)

  • Kim, Tae-Ho;Shin, Hye-Kyeong;Jang, So Yeong;Ryu, Joung-Mi;Kim, Pyeongjoong;Yang, Chan-Su
    • Korean Journal of Remote Sensing
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    • v.37 no.6_1
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    • pp.1773-1784
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    • 2021
  • In order to minimize damage to oil spill accidents in the ocean, it is essential to collect a spilled area as soon as possible. Thus satellite-based remote sensing is a powerful source to detect oil spills in the ocean. With the recent rapid increase in the number of available satellites, it has become possible to generate a status report of marine oil spills soon after the accident. In this study, the oil spill area was calculated using various satellite images for the Symphony oil spill accident that occurred off the coast of Qingdao Port, China, on April 27, 2021. In particular, improving the accuracy of oil spill area determination was applied using high-resolution commercial satellite images with a spatial resolution of 2m. Sentinel-1, Sentinel-2, LANDSAT-8, GEO-KOMPSAT-2B (GOCI-II) and Skysat satellite images were collected from April 27 to May 13, but five images were available considering the weather conditions. The spilled oil had spread northeastward, bound for coastal region of China. This trend was confirmed in the Skysat image and also similar to the movement prediction of oil particles from the accident location. From this result, the look-alike patch observed in the north area from the Sentinel-1A (2021.05.01) image was discriminated as a false alarm. Through the survey period, the spilled oil area tends to increase linearly after the accident. This study showed that high-resolution optical satellites can be used to calculate more accurately the distribution area of spilled oil and contribute to establishing efficient response strategies for oil spill accidents.

The Effects of Autologous Blood Pleurodesis in the Pneumothorax with Persistent Air Leak (지속성 기흉에서 자가혈액을 이용한 흉막유착술의 효과)

  • Yoon, Su-Mi;Shin, Sung-Joon;Kim, Young-Chan;Shon, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Chung, Won-Sang;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.724-732
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    • 2000
  • Background : In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known that inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous bood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. Methods : Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical out∞me, chest radiography and pulmonary function tests. Results : The mean duration of air leak was 18.4${\pm}$6.16 days before ABP (autologous blood and dextrose pleurodesis) and $5.2{\pm}1.68$ days after ABP. The mean severity of pain was $2.3{\pm}0.70$ for DP(doxycycline pleurodesis) and $1.7{\pm}0.59$ for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of $0.6{\pm}0.63$. The mean dyspnea scale was $1.7{\pm}0.46$ before pneumothrax and $2.0{\pm}0.59$ after ABDP (p>0.05). The mean $FEV_1$ was $1.47{\pm}1.01$ before pneumothorax and $1.44{\pm}1.00$ after ABDP (p>0.05). Except in 1 patient, 14 patients had no recurrent pneumothorax. Conclusion : Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.

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The Clinical Application and Results of Palliative Damus-Kaye-Stansel Procedure (고식적 Damus-Kaye-Stansel 술식의 임상적 적용 및 결과)

  • Lim, Hong-Gook;Kim, Soo-Jin;Kim, Woong-Han;Hwang, Seong-Wook;Lee, Cheul;Shinn, Sung-Ho;Yie, Kil-Soo;Lee, Jae-Woong;Lee, Chang-Ha
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.1-11
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    • 2008
  • Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.