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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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    • 제41권1호
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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.

Preservation of World Records Heritage in Korea and Further Registry (한국의 세계기록유산 보존 현황 및 과제)

  • Kim, Sung-Soo
    • Journal of Korean Society of Archives and Records Management
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    • 제5권2호
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    • pp.27-48
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    • 2005
  • This study investigates the current preservation and management of four records and documentary heritage in Korea that is in the UNESCO's Memory of the World Register. The study analyzes their problems and corresponding solutions in digitizing those world records heritages. This study also reviews additional four documentary books in Korea that are in the wish list to add to UNESCO's Memory of the World Register. This study is organized as the following: Chapter 2 examines the value and meanings of world records and documentary heritage in Korea. The registry requirements and procedures of UNESCO's Memory of the World Register are examined. The currently registered records of Korea include Hunmin-Chongum, the Annals of the Choson Dynasty, the Diaries of the Royal Secretariat (Seungjeongwon Ilgi), and Buljo- Jikji-Simche-Yojeol (vol. II). These records heritage's worth and significance are carefully analyzed. For example, Hunmin-Chongum("訓民正音") is consisted of unique and systematic letters. Letters were delicately explained with examples in its original manual at the time of letter's creation, which is an unparalleled case in the world documentary history. The Annals of the Choson Dynasty("朝鮮王朝實錄") are the most comprehensive historic documents that contain the longest period of time in history. Their truthfulness and reliability in describing history give credits to the annals. The Royal Secretariat Diary (called Seungjeongwon-Ilgi("承政院日記")) is the most voluminous primary resources in history, superior to the Annals of Choson Dynasty and Twenty Five Histories in China. Jikji("直指") is the oldest existing book published by movable metal print sets in the world. It evidences the beginning of metal printing in the world printing history and is worthy of being as world heritage. The review of the four registered records confirms that they are valuable world documentary heritage that transfers culture of mankind to next generations and should be preserved carefully and safely without deterioration or loss. Chapter 3 investigates the current status of preservation and management of three repositories that store the four registered records in Korea. The repositories include Kyujanggak Archives in Seoul National University, Pusan Records and Information Center of National Records and Archives Service, and Gansong Art Museum. The quality of their preservation and management are excellent in all of three institutions by the following aspects: 1) detailed security measures are close to perfection 2) archiving practices are very careful by using a special stack room in steady temperature and humidity and depositing it in stack or archival box made of paulownia tree and 3) fire prevention, lighting, and fumigation are thoroughly prepared. Chapter 4 summarizes the status quo of digitization projects of records heritage in Korea. The most important issue related to digitization and database construction on Korean records heritage is likely to set up the standardization of digitization processes and facilities. It is urgently necessary to develop comprehensive standard systems for digitization. Two institutions are closely interested in these tasks: 1) the National Records and Archives Service experienced in developing government records management systems; and 2) the Cultural Heritage Administration interested in digitization of Korean old documents. In collaboration of these two institutions, a new standard system will be designed for digitizing records heritage on Korean Studies. Chapter 5 deals with additional Korean records heritage in the wish list for UNESCO's Memory of the World Register, including: 1) Wooden Printing Blocks(經板) of Koryo-Taejangkyong(高麗大藏經) in Haein Temple(海印寺); 2) Dongui-Bogam("東醫寶鑑") 3) Samguk-Yusa("三國遺事") and 4) Mugujeonggwangdaedaranigyeong. Their world value and importance are examined as followings. Wooden Printing Blocks of Koryo-Taejangkyong in Haein Temple is the worldly oldest wooden printing block of cannon of Buddhism that still exist and was created over 750 years ago. It needs a special conservation treatment to disinfect germs residing in surface and inside of wooden plates. Otherwise, it may be damaged seriously. For its effective conservation and preservation, we hope that UNESCO and Government will schedule special care and budget and join the list of Memory of the Word Register. Dongui-Bogam is the most comprehensive and well-written medical book in the Korean history, summarizing all medical books in Korea and China from the Ancient Times through the early 17th century and concentrating on Korean herb medicine and prescriptions. It is proved as the best clinical guidebook in the 17th century for doctors and practitioners to easily use. The book was also published in China and Japan in the 18th century and greatly influenced the development of practical clinic and medical research in Asia at that time. This is why Dongui Bogam is in the wish list to register to the Memory of the World. Samguk-Yusa is evaluated as one of the most comprehensive history books and treasure sources in Korea, which illustrates foundations of Korean people and covers histories and cultures of ancient Korean peninsula and nearby countries. The book contains the oldest fixed form verse, called Hyang-Ka(鄕歌), and became the origin of Korean literature. In particular, the section of Gi-ee(紀異篇) describes the historical processes of dynasty transition from the first dynasty Gochosun(古朝鮮) to Goguryeo(高句麗) and illustrates the identity of Korean people from its historical origin. This book is worthy of adding to the Memory of the World Register. Mugujeonggwangdaedaranigyeong is the oldest book printed by wooden type plates, and it is estimated to print in between 706 and 751. It contains several reasons and evidence to be worthy of adding to the list of the Memory of the World. It is the greatest documentary heritage that represents the first wooden printing book that still exists in the world as well as illustrates the history of wooden printing in Korea.

Contents of Heavy Metals in Marine Invertebrates from the Korean Coast (한국 연안산 해산 무척추동물의 중금속 함량)

  • Mok, Jong-Soo;Lee, Ka-Jeong;Shim, Kil-Bo;Lee, Tae-Seek;Song, Ki-Cheol;Kim, Ji-Hoe
    • Journal of the Korean Society of Food Science and Nutrition
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    • 제39권6호
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    • pp.894-901
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    • 2010
  • To measure the heavy metal contents of marine invertebrates, we collected 239 individuals representing 52 species from the eastern (Pohang), western (Gunsan), and southern (Tongyeong) coasts of Korea: 34 species of molluscan shellfish (Gastropoda and Bivalvia), 6 species of Cephalopoda, 8 species of Crustacea, and 4 other species. The mean levels of the heavy metals in the samples taken from the edible portion of each Gastropoda were high in the order of Zn ($21.471\;{\mu}g/g$), Cu ($4.115\;{\mu}g/g$), Mn ($0.868\;{\mu}g/g$), Ni ($0.254\;{\mu}g/g$), Pb ($0.238\;{\mu}g/g$), Cd ($0.154\;{\mu}g/g$), and Cr ($0.110\;{\mu}g/g$). The heavy metals in the Bivalvia were high in the order of Zn ($35.655\;{\mu}g/g$), Mn ($5.500\;{\mu}g/g$), Cu ($3.129\;{\mu}g/g$), Cd ($0.423\;{\mu}g/g$), Ni ($0.402\;{\mu}g/g$), Cr ($0.233\;{\mu}g/g$), and Pb ($0.232\;{\mu}g/g$). The heavy metals in the Cephalopoda were high in the order of Zn ($18.380\;{\mu}g/g$), Cu ($3.594\;{\mu}g/g$), Mn ($0.630\;{\mu}g/g$), Cr ($0.150\;{\mu}g/g$), Pb ($0.068\;{\mu}g/g$), Cd ($0.034\;{\mu}g/g$), and Ni ($0.030\;{\mu}g/g$). The heavy metals in the Crustacea were high in the order of Zn ($25.333\;{\mu}g$/g), Cu ($9.042\;{\mu}g/g$), Mn ($0.659\;{\mu}g/g$), Cr ($0.592\;{\mu}g/g$), Cd ($0.207\;{\mu}g/g$), Pb ($0.126\;{\mu}g/g$), and Ni ($0.094\;{\mu}g/g$). Therefore, the mean levels of the harmful heavy metals (Cd and Pb) in marine invertebrates were high in the order of Bivalvia>Crustacea=Gastropoda>Cephalopoda. The average daily intakes of the heavy metals from the fisheries products were as follows: Cd ($6.88\;{\mu}g$), Cr ($19.13\;{\mu}g$), Cu ($137.02\;{\mu}g$), Mn ($156.13\;{\mu}g$), Ni ($11.39\;{\mu}g$), Pb ($7.01\;{\mu}g$) and Zn ($1,025.94\;{\mu}g$). The average weekly intakes of Cd, Cu, Pb and Zn from the fisheries products were 11.47%, 0.46%, 3.27% and 1.71% respectively, as compared with PTWI (Provisional Tolerable Weekly Intakes) established by FAO/WHO Expert Committee for Food Safety Evaluation.

A bibliographic study on medical science ancient period (上古時代) and the era of the old-Korea (古朝鮮時代) (상고시대(上古時代)와 고조선시대(古朝鮮時代)의 의학(醫學)에 관(關)한 문헌적(文獻的) 고찰(考察))

  • Kwon, Hak Cheol;Park, Chan-Guk
    • Journal of Korean Medical classics
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    • 제3권
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    • pp.218-247
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    • 1989
  • As mentioned above, I got the next conclusion since I had considered the medical contents of the ancient period(上古時代) and the era of the old-Korea(古朝鮮時代) through several bibliographic records. 1. There were Pung-baeg(風伯), Uh-sa(雨師), Un-sa(雲師) that were the names of the governmental officials during the ancient period of Whan-ung(桓雄). Among them, Uh-sa specially managed the treatment for diseases. When we think of the significance of Pung(風)-which means the winds, Uh(雨)-which means the rain, Un(雲)-which means of clouds, we will find out that the human life will be affected by all kinds of phenomena of the nature. So I can infer that ancestries could prevent and treat diseases with adjusting them tn the changes in the weather. 2. There were five government officials(五事) in the ancient period of Whan-ung(桓雄上古時代). They are Uh-ga(牛加), Ma-ga(馬加), Ku-ga(狗加), Cheo-ga(猪加) and Yang-ga(羊加), and had charges of five important duties. Among them, Cheo-ga was set to a charge of treatment for diseases. So we can notice that there existed people who treated for diseases professionally. When we think of the meanings of Uh(牛)-which intends cows or bulls. Ma(馬)-which intends horses, Ku(狗)-which intends dogs, Cheo(猪)-which intends wild boars and Yang(羊)-which intends sheep, we can see that livestocks would be raised at that time, and they came to have more chances to digest meat. Since the digestion of meat became to be a burden on the stomach and the intestines, it might cause a lot of indigestive troubles. 3. When I compared Tan-gun Pal-ga(檀君八加) with the Oh-ga(五加) in the ancient period of Whan-ung(桓雄上古時代), I could tell that the community of Tan-gun's period is more advanced and specialized than one of Whan-ung's. When I think of the next sentence ; "The Prince Imperial, Bu-u(夫虞) become to be a Ro-ga(鷺加), who treat for diseases professionally.", I am sure that the treatment for diseases was more importment than any other things, because he was the third son of Tan-gun(檀君). 4. According to Tan-gun(檀君) mythology, Whan-ung(桓雄) came down from the heaven of the pure Yang(純陽) to the earth and then changed into a man who had had more Yang(陽) than Yin(陰). And a bear came up from the underground(or the cave) to the ground and then changed into a women who had had more Yin(陰) than Yang(陽). So both of them became to hold together. This story implicated that ancestors had taken a serious view of each of them, namely the ancestors didn't give the ascendance to the one side of them, and made much account of the mutual harmony. So I am sure that this fact coincided with the basic theories of oriental medical science. To refer to two proverbs of Tan-gun mythology that are "Ki-Sam-Chil-Il(忌三七日)" which means caring for twenty one days, and "Pul-Gyon-Il-Gwang-Baeg-Il(不見日光百日)" which means keeping indoors for one hundred days, I can tell you that "twenty-one-day" involves the principle of the birth of life, and "one-hundred-day" contains a preparatory period or the period of death to bear another life. 5. From the medical stuff, such as wormwood(艾), garlic(蒜), or wonder-working herbage(靈草), that had been written at the bibliographic papers of the ancient period(上古時代) and the era of the old-Korea(古朝鮮時代), I consider that many people might get a lot of women's diseases, indigestive troubles, and other diseases that were caused by the weakness, but with using various spices, such as the leaves of water pepper(蔘), they could prevent the occurrance of all kinds of diseases previously. So I regard this treatment as the medicine from food. 6. One of the sayings at Nae-gyong(內經) is that "The stone accupuncture(砭石) came from the orient." We can see both "wonder-wor-king wormwood(靈草)" and "dried wormwood(乾艾)" in the several bibliographic papers of the ancient history of the old-Korea(朝鮮上古史). From these records, I can be convinced that ancestors would utilize the acupuncture(針) and the moxa cautery(灸) to cure a patient of a disease. 7. Even though someone claimed that the book, "medical science and chemistry(醫學化學)" and "medical treatment(醫學大方)" had had been written during the ancient period of the old-Korea(上古朝鮮時代), such a fact can't have been ascertained historical evidence. But it has been handed down that there existed the original phonetic alphabet, such as the "Ka-Im-To alphabet(加臨土文字)" at that time. The terms about the diseases, which had been occurred at the community of the old-Korea(古朝鮮地域), were recorded fragmentarily at other records after that time. The origin of confucianism came from the race of the eastern barbarians, and Tae-Ho-Pok-Hi(太嗅伏義) and the king. Sun(舜) came from the eastern barbarians, too. The divination of tortoise shells at the country of Un(殷) is another from which was developed at the eastern barbarians' fortune-telling of animal bones. From these facts, I can infer that, by all means, they might record the medical knowledge which had been stored for thousands of years while contacting with china directly.

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