• Title/Summary/Keyword: Mechanical complication

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Clinical Results of the Mechanical Cardiac Valves (기계판막의 임상적 평가)

  • 박창권
    • Journal of Chest Surgery
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    • v.24 no.2
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    • pp.161-170
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    • 1991
  • Clinical results with the Mechanical cardiac valves were reviewed for 261 patients who underwent cardiac valve replacement from September, 1985 to July, 1990. of the Mechanical valves used, 156 were Carbomedics, 109 Duromedics, 52 St. Jude and 11 Bjork-Shiley. Overall hospital mortality was 14 out of 261[5,36%]: 9 out of 159[5.66%] for MVR, 1 out of 35[2.86%] for AVR and 4 out of 67[5.96%] for DVR[AVR+MVR]. Two hundred and forty seven operative survivors were followed up for a total 466.8 patient-years, ranged from 1 month to 4.9 years [a mean 1.8 years] and the follow up was 96.0%. There were 12 valve-related complications: three from thromboembolism, three from valve thrombosis, three from prosthetic valve endocarditis, two from paravalvular leak and the other one from hemorrhage. Actuarial rate free from all valve-related complication at 4.9 years was 96$\pm$1.3%. There were 11 late deaths: two from thromboembolism, one from valve thrombosis, one from prosthetic valve endocarditis, one from hemorrhage and the others 6 from non-valve-related complications. Actuarial survival rate at 4.9 years was 94$\pm$2.0%. 96$\pm$3.0% for MVR, 94$\pm$4.2% for AVR and 91$\pm$3.7% for DVR[AVR+MVR]. And there are 7 reoperations: three from paraprosthetic leak, two from prosthetic valve endocarditis and two from valve thrombosis. Actuarial rate free from reoperation at 9 years was 96$\pm$2.9%. On the basis of this 4.9 years of experience, the pyrolytic carbon mechanical valves appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance, low mortality and low thrombogenecity.

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The Effectiveness of Additional Treatment Modalities after the Failure of Recanalization by Thrombectomy Alone in Acute Vertebrobasilar Arterial Occlusion

  • Kim, Seong Mook;Sohn, Sung-Il;Hong, Jeong-Ho;Chang, Hyuk-Won;Lee, Chang-Young;Kim, Chang-Hyun
    • Journal of Korean Neurosurgical Society
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    • v.58 no.5
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    • pp.419-425
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    • 2015
  • Objective : Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO. Methods : Fourteen consecutive patients with AVBAO were treated with mechanical thrombectomy. Additional multimodal treatments were intra-arterial (IA) thrombolysis, balloon angioplasty, or permanent stent placement. Recanalization by thrombectomy alone and multimodal treatments were assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcome was determined using the National Institutes of Health Stroke Scale (NIHSS) at 7 days and the modified Rankin Scale (mRS) at 3 months. Results : Thrombectomy alone and multimodal treatments were performed in 10 patients (71.4%) and 4 patients (28.6%), respectively. Successful recanalization (TICI 2b-3) was achieved in 11 (78.6%). Among these 11 patients, 3 (27.3%) underwent multimodal treatment due to underlying atherosclerotic stenosis. Ten (71.4%) of the 14 showed NIHSS score improvement of >10. Overall mortality was 3 (21.4%) of 14. Conclusion : We suggest that mechanical thrombectomy is safe and effective for improving recanalization rates in AVBAO, with low complication rates. Also, in carefully selected patients after the failure of recanalization by thrombectomy alone, additional multimodal treatment such as IA thrombolysis, balloons, or stents can be needed to achieve successful recanalization.

Development of New Prototype of Mechanical Quality Assurance for Clinical Linear Accelerator (의료용 선형가속기의 기계적 점검을 위한 새로운 정도관리 프로토콜의 개발)

  • 윤형근;신교철;김기환;오영기;김진기;정동혁;김정기;조문준;박인규
    • Progress in Medical Physics
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    • v.13 no.3
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    • pp.109-113
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    • 2002
  • In recent years, the radiotherapy equipment has become much more sophisticated, and with the complication comes an increased set of quality assurance (QA) responsibilities. Today's computer controlled linear accelerator requiring QA of not only the radiation integrity, but also the mechanical accuracy of the linear accelerator. The existing QA sheets are adequate for acceptance testing and commissioning but those sheets are somewhat descriptive form for routine QA. establishing the QA sheets for a facility are more efficient if the sheets could estimate the long-term stability for the result of QA. We are going to develope new prototype of mechanical QA sheet to visualize and to verify long-term stability of mechanical QA for clinical linear accelerator. The items included in mechanical QA sheet were 1) gantry rotation, 2) collimator rotation, 3) couch rotation, 4) optical distance indicator (ODI), and 5) laser alignment. We compared new prototype sheet with conventional sheet for several hospitals in Korea for those items. The QA acceptance criteria in this study mainly followed published recommendations. The contents of test for mechanical QA are the following. Confirm that the digital and/or mechanical gantry angle readouts are correct. Verify that digital and/or mechanical readouts of collimator angle agree with the true angle, as determined with the protractor. Measure the light field using a graph paper and compare with the digital readouts. Confirm digital readout accuracy. Verify that the sagittal laser, the left and right lasers, and the ceiling laser intersect at the isocenter. In the design of new QA sheet, we emphasized the representation of the long-term stability of mechanical QA by using Excel program. By using the new prototype QA sheet, we simplified and visualized the mechanical QA process, and could estimate the long-term stability of mechanical error of linear accelerator.

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Control Allocation and Controller Design for Marine Vessel based on H Control Approach (선박운동제어를 위한 제어력분배 및 제어기설계에 관한 연구)

  • Ji, Sang-Won;Kim, Young-Bok
    • Journal of Ocean Engineering and Technology
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    • v.26 no.3
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    • pp.20-25
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    • 2012
  • In this paper, the authors propose a new approach to the control problem of marine vessels that are moored or controlled by actuators. The vessel control system is basically based on Dynamic Positioning System (DPS) technology. The main object of this paper is to obtain a more useful control design method for DPS. In this problem, the control allocation is a complication. For this problem, many results have been given and verified by other researchers using a two-step process, with the controller and control allocation design processes carried out individually. In this paper, the authors provide a more sophisticated design solution for this issue. The authors propose a new design method in which the controller design and control allocation problems are considered and solved simultaneously. In other words, the system stability, control performance, and allocation problem are unified by an LMI (linear matrix inequality) based on control theory. The usefulness of the proposed approach is verified by a simulation using a supply vessel model.

A Study on the Static/Dynamic Stability for the Structure of a Mill Turret with a B-Axis Tilting Facility (B축 회전 기능을 갖춘 복합공구대 구조물의 정/동적 안정성에 관한 연구)

  • Kang, Seung-Hee;Kim, Chae-Sil
    • Journal of the Korean Society of Manufacturing Process Engineers
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    • v.13 no.1
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    • pp.39-44
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    • 2014
  • Techniques of tool posts are developing such that variable machining is possible using only one machine for the complication of a product's shape and to reduce the machining time. In order to develop a mill turret with a variable machining function with the mounting of mill turret units on a B-axis tilting table, we determine the static/dynamic stability of the structure of the mill turret. To this end, a static structural analysis and a modal analysis were conducted. From the results of the static structural analysis, the maximum stress was found to be less than the allowable stress. By the comparing the results of the modal analysis of the excitation frequencies of the mill turret, there were no resonance regions found. Therefore, the mill turret with the B-axis tilting facility is shown to have good structural integrity.

Mid-term Experience with the Pyrolytic Carbon Bileaflet Mechanical Valves (쌍엽 기계판막에대한 임상연구)

  • 박계현
    • Journal of Chest Surgery
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    • v.25 no.2
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    • pp.137-148
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    • 1992
  • Until March 1991, 435 St. Jude Medical valves and 330 CarboMedics valves were implanted in 358 and 251 patients, respectively. 300 patients were male and 309 were female with the mean age of 35.6 years[from 2 month to 68 years]. 458 valves were implanted in the mitral, 272 in the aortic, 25 in the tricuspid, and 10 in the pulmonic position. Postoperatively, all patients except for very young patients were given coumadin with or without dipyridamole for anticogulation Operative mortality was 7.3%[45 deaths per 618 operations]. A total follow-up of 1244.8 patient-years was achieved for the operative survivors with a follow-up rate of 96.8%, [mean follow-up period=26.3 months /patient, ranging from 1 to 80 months]. Functional improvement was evident; 66.7% of these patients were in NYHA functional class III or IV preopratively, whereas 98.4% are in class I or II pos-toperatively. There occurred 13 late deaths[7 valve-related] and 55 valve-related complications. Linearized rates of late death and valve-related complications were 1.0%/ patient-year, 4.42%/patient-year, respectively. Rates of thromboembolism, anticoagluation-related hemorrhage were 1.12%/patient-year, 1.69% /patient-year, respectively. Actuarial survival at 5 years is 96.0% and complication-free survival at 5 years is 83.9%. No difference in survival and incidence of complications was found between the St. Jude and CarboMedics valves. On the basis of this experience, we believe that the pyrolytic carbon bileaflet mechanical valves are safe and preferable choice among current valve prostheses.

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Outcome of Tracheostomy (기관절개술의 임상적 고찰)

  • 신화균;백효채;이두연
    • Korean Journal of Bronchoesophagology
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    • v.6 no.2
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    • pp.177-180
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    • 2000
  • Backgrounds: Patients with respiratory failure may require prolonged mechanical ventilation. The purpose of this study was to determine the optimal time for tracheostomy and complications of tracheostomy. Methods : All medical records of 27 patients who underwent tracheostomy in department of thoracic & cardiovascular surgery at Yondong Severance hospital between January 1, 1990 and December 31, 1998, were reviewed. Variables analyzed include underlying disease, primary indication of tracheostomy, interval from 1st intubation to tracheostomy, duration from tracheostomy to weaning ventilator, duration of decannulation, and complication. There were 18 men and 9 women. Mean age at the time of the tracheostomy was 54 years (rage, 11 to 64 yeras). Results : Underlying diseases included lung cancer in 14 patients (51.9%), trauma in 8 patients (29.6%), and TE fistula in 2 patients. The indication for tracheostomy were as follows: prolonged mechanical ventilation in 13 patients, purpose of bronchial toilet in 9 patients, and tracheal stenosis in 5 patients. The mean interval between the first intubation and tracheostomy was 8.1 days. The mean duration from tracheostomy to weaning ventilator was 10.1 days. Conclusions : Timing of tracheostomy Is very important. Tracheostomy may benefit patients because it can accelerate the process of weaning and thus lead to a reduction in the duration of ventilation, length of hospitalization, and cost.

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Study of Via-Typed Air-Gap for Logic Devices Applications below 45 nm Node

  • Kim, Sang-Yong;Kim, Il-Soo;Jeong, Woo-Yang
    • Transactions on Electrical and Electronic Materials
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    • v.12 no.4
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    • pp.131-134
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    • 2011
  • Back-end-of-line using ultra low-k (ULK; k < 2.5) has been required to reduce resistive capacitance beyond 45 nmtechnologies, because micro-processing units need higher speed and density. There are two strategies to manufacture ULK inter-layer dielectric (ILD) materials using an air-gap (k = 1). The former ULK and calcinations of ILD degrade the mechanical strength and induce a high cost due to the complication of following process, such as chemical mechanical polishing and deposition of the barrier metal. In contrast, the air-gap based low-k ILD with a relatively higher density has been researched on the trench-type with activity, but it has limited application to high density devices due to its high air-gap into the next metal layer. The height of air-gap into the next metal layer was reduced by changing to the via-typed air-gap, up to about 50% compared to that of the trench-typed air-gap. The controllable ULK was easily fabricated using the via-typed air-gap. It is thought that the via-type air-gap made the better design margin like via-patterning in the area with the dense and narrow lines.

What Happens without Treating Chronic Lateral Ankle Instability (외측 발목 불안정성을 치료하지 않으면 어떻게 되는가)

  • Woo, Seung Hun;Chung, Hyung-Jin
    • Journal of Korean Foot and Ankle Society
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    • v.25 no.1
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    • pp.6-9
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    • 2021
  • The term chronic lateral ankle instability (CLAI) embraces a spectrum of conditions that involve functional and mechanical instability, both in athletes and lower-demand patients. The hallmarks of CLAI are recurrent sprains, persistent pain, and repeated episodes of the ankle giving way. CLAI is the main complication of acute ankle sprains, which can cause discomfort in daily and sports activity. Approximately 10% to 30% of patients with acute ligament ruptures will develop chronic instability over the course of a year from the index injury. An accurate diagnostic approach and successful treatment plan should be established based on a comprehensive understanding of the concept of functional and mechanical instability. Unfortunately, the optimal modality for the management of CLAI is unclear. Even after conservative treatment or surgical intervention, it could result in degenerative changes to the ankle joint in the long term. Thus far, the incidence of ligamentous posttraumatic ankle osteoarthritis was reported to be 13% to 78%. The mean latency time between injury and osteoarthritis was at least 10 to 34.3 years. CLAI is an important pathological condition that can cause discomfort or dysfunction in daily activity in the short term, resulting in joint destruction in the long term. Therefore, it is important to understand the various complications that can occur when CLAI is not treated properly.

Repairment of abutment and abutment screw fracture in implant prosthesis: A case report (지대주 혹은 지대주 나사 파절이 발생한 임플란트 보철물에서 효과적인 수리 방법)

  • Kim, Jae Hoon;Yoo, Jin Joo;Kim, Man Yong;Yoon, Joon-Ho
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.1
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    • pp.37-41
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    • 2019
  • Dental implants are an effective and predictable treatment for restoration of missing teeth. However, as the use of implants increases, complications are also increasing. The mechanical complications are not only highly frequent, but also increasing as life span of an implant increases, thus, solutions should be prepared. In this report, we will present a case dealing with abutment fracture and abutment screw fracture which are the most common mechanical complication of the implant, focusing on preserving and reusing existing components by reconstructing only the damaged parts.