• Title/Summary/Keyword: Non-emergency

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Mid-Term Results of 292 cases of Coronary Artery Bypass Grafting (관상동맥 우회술 292례의 중기 성적)

  • 김태윤;김응중;이원용;지현근;신윤철;김건일
    • Journal of Chest Surgery
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    • v.35 no.9
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    • pp.643-652
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    • 2002
  • As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF<40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.

A Study on the Creation and Use of Nokgakseong and Underwater Wooden Fence (조선시대 녹각성과 수중목책의 조성 및 활용에 관한 연구)

  • SHIM Sunhui;KIM Choongsik
    • Korean Journal of Heritage: History & Science
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    • v.56 no.4
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    • pp.230-246
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    • 2023
  • The wooden fence(木柵), which began to appear in the Bronze Age and is presumed to be the oldest defense facility in human history, was used as a fortress for the purpose of further strengthening military defense functions until after the Japanese Invasion of Korea in 1592 in the Joseon Dynasty(壬辰倭亂). As it was established as the concept of a fortress or a fence installed outside a fence castle(城柵) or barracks fence(營柵), its importance as an essential facility for defense was further highlighted. This study is the result of exploring wooden fence that were used as official facilities during the Joseon Dynasty, focusing on literature surveys such as 『Annals of the Joseon Dynasty』 and 『New Jeungdonggukyeojiseungram』 In this study, in particular, the conclusion of this study is as follows, focusing on the use and function of Nokgakseong(鹿角城), underwater wooden fence, installation methods, and materials of wooden fences, is as follows. The conclusions of this study, which focused on the materials of the wooden fence, are as follows. First, as invasions by foreign enemies became more frequent in the late Goryeo and early Joseon Dynasty, wooden fences played a major role as a major out-of-castle defense facility((防禦施設). In addition, wooden fences were modified and installed into various types such as wooden fences(木柵城), Nokgakseong, a fence made up of large branches in the shape of a deer antler, and underwater wooden fences(水中木柵) according to the circumstances of the times, government policy, and location environment. Second, wooden fences were installed in strategic locations in defense facilities for military purposes, such as mountain fortress(山城), fortresses(營), camps(鎭), forts(堡), and castles(邑城) in strategic locations, and were used for defense in case of emergency. According to the urgency of farming, it was installed in accordance with the non-farming season, when it is easy to mobilize manpower to avoid the busy farming season. The size of the wooden fence of the Joseon Dynasty, which are confirmed through literature records, was converted into Pobaekchuk(布帛尺), and the circumference was very diverse from 4,428chuk(2,066m) to 55chuk(25m). Third, Nokgakseong is an efficient combat support facility that is more aggressive than a general wooden fence, and the records of Nokgakseong in the Annals of the Joseon Dynasty appeared during the King Sejong period the record was 20 times, the most. By region, it was found that it was mainly installed in coastal rugged areas such as Pyeongan and Hamgildo(12), which are the 6-jin areas of the 4th Army. Fourth, in the early 15th century, as the royal court established a maritime defense strategy for the coastal area of the southern coast, after the Sampo Invasion(三浦倭亂), riots by Japanese settlers in Sampo in 1510, major military posts including eupseong(邑城), camps, and forts were established. The installation of underwater barriers around various government facilities rapidly increased as a defense facility to block the warships of Japanese pirates around various government facilities. Fifth, between the 15th and 17th centuries before and after the Japanese Invasion of Korea in Sampo, underwater fences were installed in the Southern coast and Ganghwa Island. In particular, in the 15th century, underwater fences were intensively installed in coastal areas of Gyeongsangnam-do, such as Jepo. Pine trees and Oaks are the main materials used for underwater fences, but other materials such as Oldham's meliosma, Loose-flower hornbeam and The vines of arrowroots were also used as materials for wooden fences.