• Title/Summary/Keyword: Incision

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Modification of the Cox-Maze Procedure for Atrial Fibrillation with Large Left Atrium ; Development of Surgical Technique to Increase the Left Atrial Contractility (좌심방 확장을 동반한 심방세동에 대한 Cox-Maze 수술법의 변형 -수술후 좌심방 수축력의 증진을 위한 수술법의 개량-)

  • 강창현;김기봉;손대원
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.249-254
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    • 1999
  • Background: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. Material and Method: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). Result: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). Conclusion: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.

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Result of Cox Maze Procedure with Bipolar Radiofrequency Electrode and Cryoablator for Persistent Atrial Fibrillation - Compared with Cut-sew Technique - (양극고주파전극과 냉동프로브를 이용한 지속성 심방세동의 수술 결과 - 절개/봉합술식과 비교 -)

  • Lee, Mi-Kyung;Choi, Jong-Bum;Lee, Jung-Moon;Kim, Kyung-Hwa;Kim, Min-Ho
    • Journal of Chest Surgery
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    • v.42 no.6
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    • pp.710-718
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    • 2009
  • Background: The Cox maze procedure has been used as a standard surgical treatment for atrial fibrillation for about 20 years. Recently, the creators have used a bipolar radiofrequency electrode (Cox maze IV procedure) instead of the incision and suture (cut-sew) technique to make atrial ablation lesions for persistent atrial fibrillation. We investigated clinical outcomes for the Cox maze procedure with a bipolar radiofrequency electrode and cryoablator in patients with persistent atrial fibrillation, and compared results with clinical outcomes of the cut-sew procedure. Material and Method: Between April 2005 and July 2007, 40 patients with persistent atrial fibrillation underwent Cox maze IV procedure with a bipolar radiofrequency electrode and cryoablator (bipolar radiofrequency group). Surgical outcomes were compared with those of 35 patients who had the cut-sew technique for the Cox maze III procedure. All patients had concomitant cardiac surgery. Postoperatively, the patients were followed up every 1 to 2 months. Result: At 6 months postoperatively, the conversion rate to regular sinus rhythm was not significantly different between the two groups: 95.0% for the bipolar radiofrequency ablation group; 97.1% for the cut-sew technique (p=1.0). At the end of the follow-up period, the conversion rate to regular sinus rhythm was also not significantly different (92.5% vs. 91.6%, p=1.0). In multivariate analysis using a Cox-regression model, the postoperative atrial dimension was an independent determinant of sinus conversion in the bipolar radiofrequency ablation group (hazard ratio 31, p=0.005). In the Cox-regression model for both groups, atrial fibrillation at 6 months postoperatively (hazard ratio 92.24, p=0.003) and the postoperative left atrial dimension (hazard ratio 16.05, p=0.019) were independent risk factors of continuance or recurrence of atrial fibrillation after Cox maze procedures. Aortic cross-clamp time and cardiopulmonary bypass time were significantly shorter in the radiofrequency group than in the cut-sew group. Conclusion: In the Cox maze procedure for patients with persistent atrial fibrillation, the use of bipolar radiofrequency ablation and a cryoablator is as good as the cut-sew technique for conversion to sinus rhythm. The postoperative left atrial dimension is an independent determinant of postoperative continuance and recurrence of atrial fibrillation.

A Resurrection of Gongampungbyeog Cliff and Geoyeonjeong Byeolseowonlim in Cheongdo (청도 공암풍벽과 거연정(Geoyeonjeong) 별서원림의 재조명)

  • Kim, Jeong-Moon;Jeong, Poo-Rum;Rho, Jae-Hyun
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.38 no.3
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    • pp.11-24
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    • 2020
  • The purpose of this study was to re-examine the neglected and forgotten Cheongdo Geoyeonjeong, to correct the wrong contents, examine the changes and conditions of the garden, and to establish basic data on the components of the forest in the future. In addition, it was extended to the Gongampungbyeog Cliff, the influence area of the Geoyeonjeongwonlim, and the results of the study were as follows; First, Based on the recitation of "Seonyu pungryu(仙遊風流)" in the "Cheongsuheon-yugo(聽水軒遺稿),", Dongchangcheon Stream and Gongampungbyeog(孔巖楓壁) were influenced by the outer gardens of the Georyeonjeongwonrim. Second, Small pavilion was built and arranged under the rock of Byeongam(Byeongpungbawi) in the management history of Geoyeonjeong Pavilion. The records show that Cheongsuheon used the Geoyeonjeong Pavilion as the original forest and even recognized Oewon, which is a scenic influence, as the Gongampungbyeog Cliff. Third, Many of the poems related to Gongam were recognized as Seunggyeong, which represents the Unmun area, and the eight scenery of Cheongdo and Unmungugok were established here as proof that Gongampungbyeog Cliff was very faithful to the traditional Seunggyeong aspect of Gongampungbyeog Cliff, and the crystalline structure of the location was implied as an external source of Geoyeonjeongwonlim. Fourth, The lower part of Dongchangcheon Stream, which stretches from Geoyeonjeongwonrim to Gongam, is filled with attractions consisting of cancerous areas such as Punghodae, Moseongam, Buangdae, Gokcheondae, Saganjeong, Hakgadae, and Hyeongjeam, which provide a clearer picture of the space and landscape of the Geyeonjeongwonrim Outer Garden. Fifth, The expression "dragging water, spilling it into the courtyard, and sending it back to the downtown of the field" of the Cheongsuheon-yugo suggests that the site of Geoyeonjeong Pavilion was originally a prevention. It is also inferred that Cheng Shu-heon also wanted to respect runners and pursue natural views like runners. Sixth, The record of planting a description of spring water and willow trees in "Geoyeonjeong Manyeong(居然亭晩影)」" and "Sanggukseol(霜菊說)」" suggests that the chrysanthemum was planted and planted, and that the chrysanthemum was used to describe the Osanggojeol(傲霜孤節), which means that he would not yield and keep his incision alone despite severe frost. Seventh, It is believed that the writing was written by Cheongsuheon in 1844 during the period of the creation of the Wonrim. The rock letters on the floor of Geoyeonjeong suggest the names of the receiving and the winning prizes. Most of the passages are based on nuclear power plants, including Muidogyo of the Zhuzi, and most of them incorporate the virtues of the Gunja and the natural views of the Eunja. In addition, the rock writing 'Gyeong(敬)' or 'Uidang(義堂)' is a substitute for special worship objects or introspection, adding to the significance and scenic properties of the Georyeon Garden Forest.

Endoscopic Carpal Tunnel Release Using Single Portal Technique (단일 입구를 이용한 내시경적 수근관 감압술)

  • Cheon Sang-Jin;Kim Hui-Taek;Suh Kuen-Tak;Suh Jeung-Tak;Yoo Chong-Il
    • Journal of the Korean Arthroscopy Society
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    • v.4 no.2
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    • pp.159-165
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    • 2000
  • Purpose : Endoscopic carpal tunnel release technique was developed and has being used to decrease postoperative morbidity and complications. The purpose of this study was to evaluate the clinical results and clinical usefulness of endoscopic carpal tunnel release using single portal technique. Methods and Materials : 18 carpal tunnel syndrome patients who were diagnosed by means of clinical symptoms, physical examination, and electrodiagnostic study had endoscopic carpal tunnel release using single portal technique with about 1 cm oblique wrist incision on 30 hands. And then they were followed-up and reviewed in the same way. Late results of operation were analysed by grading system according to patient's own assessments of relief of symptoms at the final fellow-up. The follow-up period ranged 6 to 13 months from surgery. Results : There were postoperative improvements with respect to clinical symptoms, physical examination, and electrodiagnostic study. 23 of 30 hands$(76.7\%)$ had complete resolution of symptoms. 27 hands$(90\%)$ were able to return to normal activities and work within 6 weeks, and 30 hands$(100\%)$ returned within 8 weeks. In grip strength study, 29 hands$(96.6\%)$ regained preoperative strength in 6 months. 12 of 22 hands$(55\%)$ had improvement with respect to thenar atrophy within 6 months. Late results were as follows . 23 hands$(76.7\%)$ was graded as excellent, 6 hands$(20\%)$ graded as good and 1 hand$(3.3\%)$ graded as fair, and there was no poor result. Conclusion : We think that endoscopic carpal tunnel release with single portal technique is technically safe and simple, if the surgeon takes step to stay within the safety zone based on local anatomy and selects an appropriate patient and that endoscopic carpal tunnel release does have advantages over open release. We agree that the surgeon must be prepared to perform an open technique, if technical difficulties arise, difficulty in introducing the device into the carpal tunnel is encountered, or the transverse fibers of the transverse carpal ligaments are not clearly seen.

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Effects of Activation Treatments and Culture Condition on In Vitro Development of Caprine In Vivo and In Vitro Oocytes (재래산양의 체내 및 체외유래 난자의 활성화 처리방법 및 배양조건이 단위발생란의 체외발달에 미치는 영향)

  • Park H. S.;Kim T. S.;Lee Y. H.;Jung S. Y.;Lee M. Y.;Jin J. I.;Park J. K.;Lee J. S.;Kim C. H.
    • Reproductive and Developmental Biology
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    • v.28 no.3
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    • pp.181-185
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    • 2004
  • This study was conducted to examine whether activation treatments, source of oocytes and culture conditions affect in vitro developmental ability of caprine oocytes. Mature Korean native goats were pretreated with intravaginal CIDR for 10 days. The goats were then treated with a single intramuscular injection of 1,000 IU PMSG on Day 8 or twice daily injection of a total of 70 mg FSH for 3 days from Day 8 of CIDR insertion for superovulation. All the goats were injected with 10 mg PGF/sub 2a/ on Day 8 and 400 IU hCG on Day 10 of CIDR. Oocytes were surgically collected by oviduct flushing(in vivo maturation) or direct follicle aspiration(in vitro maturation) through mid-ventral incision at 35 h after hCG injection. Fifteen to twenty oocytes were placed in TCM-199 medium containing 25 mM Hepes and hormones under mineral oil at 39℃ in a humudified atmosphere of 5% CO₂ in air for 22 to 24 h. After maturation, the oocytes were activated by electric stimulation or ionomycin + 6-DMAP. The activated oocytes were then cultured in M16, TCM-199 and mSOF media supplemented with proteins at 39℃ for 6 to 7 days. Activation treatments did not affect cleavage of the oocytes. The cleavage rates were 64.1% (41/64) in oocytes activated by electric stimulation and 76.5% (218/285) in oocytes activated by ionomycin + 6-DMAP. The proportion of development to blastocyst was 15.6% (34/218) in oocytes activated by ionomycin + 6-DMAP, but activation by electric stimulation did not support embryos developed beyond morula stage. There were no differences in the cleavage rates of activated oocytes experiencing in vivo (86.8%, 66/76) and in vitro maturation (69.0%, 127/184). However, the development rate to blastocyst stage was significantly (P<0.05) higher for oocytes matured in vivo (50.0%, 33/66) compared to in vitro (0.8%, 1/127). Culture conditions did not affect the cleavage of -activated oocytes. The cleavage rates were 51.6% (49/95) in M16, 64.3% (18/28) in TCM-199 and 81.0% (145/179) in mSOF, respectively. By contrast, the development rate of activated oocytes to stage was greater (P<0.05) for oocytes cultured in mSOF medium (23.4%, 34/145) than in M16 or TCM-199 (0.0%). Our results suggest that source of oocytes and culture conditions are major factors affecting in vitro development of caprine parthenogenetic oocytes.

THE EFFECTS OF THE PLATELET-DERIVED GROWTH FACTOR-BB ON THE PERIODONTAL TISSUE REGENERATION OF THE FURCATION INVOLVEMENT OF DOGS (혈소판유래성장인자-BB가 성견 치근이개부병변의 조직재생에 미치는 효과)

  • Cho, Moo-Hyun;Park, Kwang-Beom;Park, Joon-Bong
    • Journal of Periodontal and Implant Science
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    • v.23 no.3
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    • pp.535-563
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    • 1993
  • New techniques for regenerating the destructed periodontal tissue have been studied for many years. Current acceptable methods of promoting periodontal regeneration alre basis of removal of diseased soft tissue, root treatment, guided tissue regeneration, graft materials, biological mediators. Platelet-derived growth factor (PDGF) is one of polypeptide growth factor. PDGF have been reported as a biological mediator which regulate activities of wound healing progress including cell proliferation, migration, and metabolism. The purposes of this study is to evaluate the possibility of using the PDGF as a regeneration promoting agent for furcation involvement defect. Eight adult mongrel dogs were used in this experiment. The dogs were anesthetized with Pentobarbital Sodium (25-30 mg/kg of body weight, Tokyo chemical Co., Japan) and conventional periodontal prophylaxis were performed with ultrasonic scaler. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree III furcation defect was made on mandibular second(P2) and fourth(P4) premolar. For the basic treatment of root surface, fully saturated citric acid was applied on the exposed root surface for 3 minutes. On the right P4 20ug of human recombinant PDGF-BB dissolved in acetic acid was applied with polypropylene autopipette. On the left P2 and right P2 PDGF-BB was applied after insertion of ${\beta}-Tricalcium$ phosphate(TCP) and collagen (Collatape) respectively. Left mandibular P4 was used as control. Systemic antibiotics (Penicillin-G benzathine and penicillin-G procaine, 1 ml per 10-25 1bs body weight) were administrated intramuscular for 2 weeks after surgery. Irrigation with 0.1% Chlorhexidine Gluconate around operated sites was performed during the whole experimental period except one day immediate after surgery. Soft diets were fed through the whole experiment period. After 2, 4, 8, 12 weeks, the animals were sacrificed by perfusion technique. Tissue block was excised including the tooth and prepared for light microscope with H-E staining. At 2 weeks after surgery, therer were rapid osteogenesis phenomenon on the defected area of the PDGF only treated group and early trabeculation pattern was made with new osteoid tissue produced by activated osteoblast. Bone formation was almost completed to the fornix of furcation by 8 weeks after surgery. New cementum fromation was observed from 2 weeks after surgery, and the thickness was increased until 8 weeks with typical Sharpey’s fibers reembedded into new bone and cementum. In both PDGF-BB with TCP group and PDGF-BB with Collagen group, regeneration process including new bone and new cementum formation and the group especially in the early weeks. It might be thought that the migration of actively proliferating cells was prohibited by the graft materials. In conclusion, platelet-derived growth factor can promote rapid osteogenesis during early stage of periodontal tissue regeneration.

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Geology of Athabasca Oil Sands in Canada (캐나다 아사바스카 오일샌드 지질특성)

  • Kwon, Yi-Kwon
    • The Korean Journal of Petroleum Geology
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    • v.14 no.1
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    • pp.1-11
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    • 2008
  • As conventional oil and gas reservoirs become depleted, interests for oil sands has rapidly increased in the last decade. Oil sands are mixture of bitumen, water, and host sediments of sand and clay. Most oil sand is unconsolidated sand that is held together by bitumen. Bitumen has hydrocarbon in situ viscosity of >10,000 centipoises (cP) at reservoir condition and has API gravity between $8-14^{\circ}$. The largest oil sand deposits are in Alberta and Saskatchewan, Canada. The reverves are approximated at 1.7 trillion barrels of initial oil-in-place and 173 billion barrels of remaining established reserves. Alberta has a number of oil sands deposits which are grouped into three oil sand development areas - the Athabasca, Cold Lake, and Peace River, with the largest current bitumen production from Athabasca. Principal oil sands deposits consist of the McMurray Fm and Wabiskaw Mbr in Athabasca area, the Gething and Bluesky formations in Peace River area, and relatively thin multi-reservoir deposits of McMurray, Clearwater, and Grand Rapid formations in Cold Lake area. The reservoir sediments were deposited in the foreland basin (Western Canada Sedimentary Basin) formed by collision between the Pacific and North America plates and the subsequent thrusting movements in the Mesozoic. The deposits are underlain by basement rocks of Paleozoic carbonates with highly variable topography. The oil sands deposits were formed during the Early Cretaceous transgression which occurred along the Cretaceous Interior Seaway in North America. The oil-sands-hosting McMurray and Wabiskaw deposits in the Athabasca area consist of the lower fluvial and the upper estuarine-offshore sediments, reflecting the broad and overall transgression. The deposits are characterized by facies heterogeneity of channelized reservoir sands and non-reservoir muds. Main reservoir bodies of the McMurray Formation are fluvial and estuarine channel-point bar complexes which are interbedded with fine-grained deposits formed in floodplain, tidal flat, and estuarine bay. The Wabiskaw deposits (basal member of the Clearwater Formation) commonly comprise sheet-shaped offshore muds and sands, but occasionally show deep-incision into the McMurray deposits, forming channelized reservoir sand bodies of oil sands. In Canada, bitumen of oil sands deposits is produced by surface mining or in-situ thermal recovery processes. Bitumen sands recovered by surface mining are changed into synthetic crude oil through extraction and upgrading processes. On the other hand, bitumen produced by in-situ thermal recovery is transported to refinery only through bitumen blending process. The in-situ thermal recovery technology is represented by Steam-Assisted Gravity Drainage and Cyclic Steam Stimulation. These technologies are based on steam injection into bitumen sand reservoirs for increase in reservoir in-situ temperature and in bitumen mobility. In oil sands reservoirs, efficiency for steam propagation is controlled mainly by reservoir geology. Accordingly, understanding of geological factors and characteristics of oil sands reservoir deposits is prerequisite for well-designed development planning and effective bitumen production. As significant geological factors and characteristics in oil sands reservoir deposits, this study suggests (1) pay of bitumen sands and connectivity, (2) bitumen content and saturation, (3) geologic structure, (4) distribution of mud baffles and plugs, (5) thickness and lateral continuity of mud interbeds, (6) distribution of water-saturated sands, (7) distribution of gas-saturated sands, (8) direction of lateral accretion of point bar, (9) distribution of diagenetic layers and nodules, and (10) texture and fabric change within reservoir sand body.

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