• 제목/요약/키워드: Optimal method

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Video-assisted Talc Poudrage for the Treatment of Malignant Pleural Effusion: Analysis of Effects and Benefits (악성 늑막 삼출증에서의 비디오 흉강경하 탈크 분무의 효과 및 장점 분석)

  • Song, In-Hag;Chang, Won-Ho;Choi, Chang-Woo;Son, Jin-Sung;Kim, Dong-Hyun;Baek, Kang-Seok;Youm, Wook;Kim, Hyun-Jo
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.492-498
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    • 2007
  • Background: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. Material and Method: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). Result: The durations of chest tube placement after the procedure were $7.0{\pm}4.0$ days (group A) and $6.7{\pm}3.6$ days (group B). The hospital stays were $24.3{\pm}9.4$ days (group A) and $30.7{\pm}21.5$ days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group $A=8.5{\pm}2.2$ months, group B $8.0{\pm}7.4$ months). The collapsed portions of lung were better expanded in group A than in group B (p-value=0.011). Conclusion: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.

The In-hospital Clinical Outcomes of Extracorporeal Life Support after Adult Cardiovascular Surgery (성인 심혈관 수술 후 시행한 체외순환보조의 조기 임상결과)

  • Yie, Kil-Soo;Na, Chan-Young;Oh, Sam-Sae;Kim, Jae-Hyun;Ryu, Se-Min;Park, Sung-Min;Cho, Seong-Joon
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.464-472
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    • 2009
  • Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.

Clinical Study of Vascular Injuries (혈관 손상의 임상적 고찰)

  • Chung, Sung-Woon;Kim, Young-Kyu
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.480-484
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    • 2007
  • Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

A Study on Environmental Standards of School Building (교사환경기준에 관한 연구)

  • Hong, Seok-Pyo;Park, Young-Soo
    • The Journal of Korean Society for School & Community Health Education
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    • v.1 no.1
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    • pp.11-43
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    • 2000
  • The purpose of this study was, through analyzing the previous researches, to grasp the present status of environment of school building(ESB), research the sundry records of each element and, through comparative analysis of the standard of ESB in Korea, the United States, and Japan, select the normative standard of ESB, to clarify the point at issue presented in Regulation of Construction & facility Management for Elementary and and Secondary School in Korea, and to suggest an alternative preliminary standard of ESB. To carry out a research for this purpose, these were required: 1. to investigate the existing present status of ESB, 2. to make a comparative analysis of the standard of ESB in each country, 3. to suggest the normative standard of preliminary standard of ESB, 4. to analyze the controversial points of the standard of ESB in Korea, 5. to suggest an alternative preliminary standard of ESB. The conclusions were as follows: 1. Putting, through analyzing the previous researches, the existing present status of ESB together, it seemed that lighting environment, indoor air environment and noise environment were all in poor conditions. 2. In the result of a comparative analysis of the standard of ESB in Korea, Japan and the United States, in Korea the factors of each lighting and indoor air environment were not presented properly, in Japan, in lighting environment aspect, the standard on natural lighting and the factors on brightness were not presented., and in the USA the essential factors of each environment were throughly presented. In the comparison of the standards on each factor, Korea showed that the standard level presented was less properly prescribed than those of the USA and Japan but it also showed that the standard levels prescribed in the USA and in Japan were mostly similar to the standard levels in records investigated. 3. With the result of the normative standard selection on School Builiding environment factor of prescribed in this study, the controversial points of the standard of ESB in Korea were analyzed and the result was utilized to suggest new preliminary standard of ESB. 4. As the result of the analysis of the controversial points of the standard of ESB in Korea, it was found that the standard of ESB in Korea should be established on a basis of School Health Act and be concretely presented in School Health Regulation and School Health Rule. The factors of each environment was improperly presented in the existing standard of ESB in Korea. Moreover the standard of them was inferior to that of the records investigated and those of in the USA and in Japan and it also showed that the standard of it in Korea was improper to maintain Comfortable Learning Environment. 5. A suggested preliminary standard of ESB acquired through above study as follows: 1) In this study a new kind of preliminary standard of ESB is divided into lighting environment, indoor air environment, noise environment, odor environment and for above classification, reasonable factor and standard should be established and the controling way on each standard and countermeasures against it should be considered. 2) In lighting environment, the factors of natural lighting are divided into daylight rate, brightness, glare. In the standard on each factor, daylight rate should secure 5% of a mean daylight rate and 2% of a minimum daylight rate, brightness ratio of maximum illumination to minimum illumination should be under 10:1, and in glare there should not be an occurrence factor from a reflector outside of the classroom. And the factors of unnatural lighting are illumination, brightness, and glare. In the standard on each factor, illumination should be 750 lux or more, brightness ratio should be under 3 to 1, and glare should not occur. And Optimal reflection rate(%) of Colors and Facilities of Classroom which influences lighting environment should be considered. 3) In indoor air environment factors, thermal factors are divided into (1) room temperature, (2) relative humidity, (3) room air movement, (4) radiation heat, and harmful gases (5) CO, (6) $CO_2$ that are proceeded from using the heating fuel such as oval briquettes, firewood, charcoal being used in most of the classroom, and finally (7) dust. In the standard on each factor, the next are necessary; room temperature: $16^{\circ}C{\sim}26^{\circ}C$(summer : $E.T18.9{\sim}23.8^{\circ}C$, winter: $E.T16.7{\sim}21.7^{\circ}C$), relative humidity: $30{\sim}80%$, room air movement: under 0.5m/sec, radiation heat: under $5^{\circ}C$ gap between dry-bulb temperature and wet-bulb temperature, below 1000 ppm of ca and below 10ppm of $CO_2$, dust: below 0.10 $mg/m^3$ of Volume of dust in indoor air, and ventilation standard($CO_2$) for purification of indoor air : once/6 min.(about 7 times/40 min.) in an airtight classroom. 4) In the standard on noise environment, noise level should be under 40 dB(A) and the noise measuring way and the countermeasures against it should be considered. 5) In the standard on odor environment, odor level under Physical Method should be under 2 degrees, and the inspecting way and the countermeasures against it should be considered.

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Risk Factors Analysis and Results of the Arterial Switch Operation for Transposition of the Great Arteries with Intact Ventricular Septum (심실중격결손을 동반하지 않은 대혈관전위증 환자에서 동맥 전환술의 결과 및 위험인자 분석에 관한 연구)

  • 김용진;오삼세;이정렬;노준량;서경필
    • Journal of Chest Surgery
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    • v.32 no.2
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    • pp.108-118
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    • 1999
  • Background: To evaluate the risk factor and long-term result of arterial switch operation , a retrospective study was done. Material and Method: A retrospective analysis was done to evaluate the early and long-term results on 58 patients who underwent an arterial switch operation(ASO) for transposition of the great arteries(TGA) with intact ventricular septum, between January 1988 and December 1996. Beforesurgery, 36 patients(62.1%) underwent balloon atrial septostomy, 32 patients(51.7%) received PGE1 infusion, and preparatory banding of pulmonary artery was performed on 6 patients(mean LV/RV pressure ratio 0.53$\pm$0.11). Result: The age at operation ranged from 1 to 137 days(mean 24$\pm$26 days) and the weights ranged from 1.8 to 6.8 kg (mean 3.5$\pm$0.8 kg). There were 14 early deaths(24.1%), but of the last 24 patients operated on since 1994, there were only 2 early deaths(8.3%). In the risk factor analysis, the date of operation was the only risk factor for early death(p-value < 0.01). Eight of the 14 early deaths were due to acute myocardial failure(mainly inadequate coronary blood flow). The length of follow-up ranged from 2 months to 8 years, average of 36$\pm$27 months. The follow-up included sequential noninvasive evaluations and 21 catheterizations and angiographic studies performed 5 to 32 months postoperatively with particular attention to the great vessel and coronary anastomosis, ventricular function, valvular competence, and cardiac rhythm. There were 5 late deaths(11.4%), one of thesedeaths was related to the late coronary problems, two to aspiration, one to uncontrolled chronic mediastinitis, and one to progressive aortic insufficiency and heart failure. The most frequent postoperative hemodynamic abnormality was supravalvular stenosis and the degree of pulmonary or aortic obstruction had slowly progressed in some cases, however there were no children who had to undergo a reoperation for supravalvular pulmonary or aortic stenosis. Aortic regurgitation was identified in 9 patients, which was mild in 7 and moderate in 2 and had progressed in some cases. Two patients who had an unremarkable perioperative course were identified as having coronary artery obstructions. The other late survivors were in good condition, were in sinus rhythm, and had normal LV functions. Actuarial survival rate at 8 years was 68.8%. Conclusion: We concluded that anatomic correction will be established as the optimal approach to the TGA with intact ventricular septum, though further long-term evaluations are needed.

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A STUDY ON THE POSTOPERATIVE STABILITY OF OCCLUSAL PLANE IN ORTHOGNATHIC SURGERY PATIENTS DEFENDING ON THE DIFFERENCE OF OCCLUSAL PLANE (악교정 수술시 교합평면의 차이에 따른 술후 안정성에 관한 연구)

  • Hwang, Chung-Ju;Lim, Seon-A
    • The korean journal of orthodontics
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    • v.28 no.2 s.67
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    • pp.237-253
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    • 1998
  • Surgical-orthodontic treatment is performed for the skeletal Class III patients with no remaining growth and too big a skeletal discrepancy (or camouflage treatment, and two jaw surgery is needed in order to have maximum effect in such patients. In two jaw surgery cases, surgical alteration of the occlusal plane is necessary to establish optimal function, esthetics and postoperative sability, therefore the establishment of the occlusal plane is essential in diagnosis and treatment. The object of this study is to evaluate the stability of the indiviual ideal occlusal plane bsaed on the architectural and structural craniofacial analysis of Delaires. Thus, the subjects of this study were 48 patients who underwent two jaw surgery, and divided in two groups. Each group were composed of 24patients, A group were operated with ideal occlusal plane and B group were not. Two groups were compared at the preoperative, immediate postoperative (average 4.3days), and long-term postoperative (average 1.3years) lateral cephalometric radiographs. The following results were obtained: 1. There was no significance in occlusal plane angulation between $T_2\;and\;T_3$. Average long term follow-up changes of occlusal Plane angle were $0.24^{\circ}{\pm}2.43$, with FH plane and $0.15{\circ}{\pm}2.16{\circ}$ with SN plane in all 48 patients. These results demonstrated that the occlusal plane after two jaw surgery in skeletal Class III malocclusion was stable. 2. There was no significance in postoperative stability of occlusal plane between A and B group. 3. There was no significance in postoperative stability of occlusal plane depending on surgeon and operative method within each group. 4. The postoperative changes of occlusal plane were correlated to the postoperative changes of jaw rather than tooth position. 5. There was no correlation between the postoperative changes of occlusal plane and maxillary impaction and mandibular setback with surgery.

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The Effect of Pleurodesis with Doxycycline in the Rabbit (토끼에서 Doxycycline을 이용한 흉막유착 효과)

  • Won, Kyoung-Sook;Park, Keon-Uk;Jeon, Won-Ho;Baik, Jae-Jung;Jeong, Yeon-Tae;Suh, Jung-Il;Son, Jin-Hee
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.5
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    • pp.531-536
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    • 1994
  • Background: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. Method: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were devided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. Results: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. Conclusion: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.

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Concurrent Docetaxel/Cisplatin and Thoracic Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer (국소 진행성 비소세포 폐암에서 Docetaxel Cisplatin을 사용한 화학-방사선 동시치료의 효과)

  • Jang, Tae Won;Park, Jung Pil;Kim, Hee Kyoo;Ok, Chul Ho;Jeung, Tae Sig;Jung, Maan Hong
    • Tuberculosis and Respiratory Diseases
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    • v.57 no.3
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    • pp.257-264
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    • 2004
  • Background : There are many combinations of treatment for locally advanced non-small cell lung cancer (NSCLC). Recent studies have showed the efficacy of concurrent chemoradiotherapy (CCRT) in NSCLC. At present, however, there is no consensus about the optimal dosages and timing of radiation and chemotherapeutic agents. The aims of study were to determine the feasibility, toxicity, response rate, and survival rate in locally advanced NSCLC patients treated with doxetaxel and cisplatin based CCRT. Method : Sixteen patients with unresectable stage III NSCLC were evaluated from May 2000 until September 2001. Induction chemoradiotherapy consisted of 3 cycles of docetaxel (75 $mg/m^2/IV$ on day 1) and cisplatin (60 $mg/m^2/IV$ on day 1) chemotherapy every 3 weeks and concomitant hyperfractionated chest irradiation (1.15 Gy/BID, total dose of 69 Gy) in 6 weeks. Patient who had complete or partial response, and stable disease were applied consolidation chemotherapy of docetaxel and cisplatin. Results : All patients showed response to CCRT. Four patients achieved complete response (25%), partial responses in 12 patients (75%). The major common toxicities were grade III or more of neutropenia (87.3%), grade III esophagitis (68.8%), pneumonia (18.8%) and grade III radiation pneumonitis (12.5%). Thirteen patients were ceased during follow-up period. Median survival time was 19.9 months (95% CI; 4.3-39.7 months). The survival rates in one, two, and three years are 68.7%, 43.7%, and 29.1%, respectively. Local recurrence was found in 11 patients (66.8%), bone metastasis in 2, and brain metastasis in 1 patient. Conclusion : The response rate and survival time of CCRT with docetaxel/cisplatin in locally advanced NSCLC were encouraging, but treatment related toxicities were high. Further modification of therapy seems to be warranted.

Reliability Based Stability Analysis and Design Criteria for Reinforced Concrete Retaining Wall (신뢰성(信賴性) 이론(理論)에 의한 R.C.옹벽(擁壁)의 안정해석(安定解析) 및 설계규준(設計規準))

  • Cho, Tae Song;Cho, Hyo Nam;Chun, Chai Myung
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.3 no.3
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    • pp.71-86
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    • 1983
  • Current R.C. retaining wall design is bared on WSD, but the reliability based design method is more rational than the WSD. For this reason, this study proposes a reliability based design criteria for the cantilever retaining wall, which is most common type of retaining wall, and also proposes the theoretical bases of nominal safety factors of stability analysis by introducing the reliability theory. The limit state equations of stability analysis and design of each part of cantilever retaining wall are derived and the uncertainty measuring algorithms of each equation are also derived by MFOSM using Coulomb's coefficient of the active earth pressure and Hansen's bearing capacity formula. The levels of uncertainties corresponding to these algorithms are proposed appropriate values considering our actuality. The target reliability indices (overturning: ${\beta}_0$=4.0, sliding: ${\beta}_0$=3.5, bearing capacity: [${\beta}_0$=3.0, design for flexure: [${\beta}_0$=3.0, design for shear: ${\beta}_0$=3.2) are selected as optimal values considering our practice based on the calibration with the current R.C. retaining wall design safety provisions. Load and resistance factors are measured by using the proposed uncertainties and the selected target reliability indices. Furthermore, a set of nominal safety factors, allowable stresses, and allowable shear stresses are proposed for the current WSD design provisions. It may be asserted that the proposed LRFD reliability based design criteria for the R.C. retaining wall may have to be incorporated into the current R.C. design codes as a design provision corresponding to the USD provisions of the current R.C. design code.

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Microassisted Fertilization of Human Oocytes with Intracytoplasmic Sperm Injection in IVF-ET Patients with History of Failure in Fertilization or Extremely Low Fertilization Rate in Previous Cycles (미수정 및 저수정율의 기왕력을 지닌 체외수정시술 환자에서의 난자 세포질내 정자 주입술을 이용한 미세보조 수정술에 관한 연구)

  • Moon, Shin-Yong;Kim, Seok-Hyun;Chae, Hee-Dong;Kim, Kwang-Rye;Lee, Jae-Hoon;Kim, Hee-Sun;Ryu, Buom-Yong;Oh, Sun-Kyung;Suh, Chang-Suk;Choi, Young-Min;Kim, Jung-Gu;Lee, Jin-Yong
    • Clinical and Experimental Reproductive Medicine
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    • v.24 no.1
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    • pp.83-93
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    • 1997
  • Although IVF-ET is widely applied in the treatment of couples with male factor infertility, it may fail in many infertile couples with normal semen parameters, and certain couples cannot be accepted for standard IVF-ET due to unfertilization or extremely low fertilization rate of oocytes. Recently, several procedures of microassisted fertilization (MAF) using micromanipulation have been introduced, and pregnancies and births have been obtained after partial zona dissection (PZD), subzonal insertion (SUZI), and intracytoplasmic sperm injection (ICSI). This clinical study was performed to develop and establish ICSI as an effective procedure of MAF in infertile couples who could not undergo standard IVF-ET repetitively because of failure in fertilization or extremely low fertilization rate of oocytes with the conventional fertilization technique in the previous IVF-ET cycles. From March, 1995 to May, 1996, 27 cycles of IVF-ET with ICSI in 19 infertile patients were included in study group, and the outcomes of ICSI were analyzed according to fertilization rate, cumulative embryo score (CES), and pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was $10.50{\pm}6.13$ in 30 previous cycles, and $10.57{\pm}5.53$ in 27 ICSI cycles. In ICSI cycles, the number of oocytes optimal for ICSI procedure was $7.89{\pm}4.30$, and the fertilization rate of $67.9{\pm}20.2%$ could be obtained after ICSI. The number of embryos transferred was $1.43{\pm}2.40$ in previous cycles, and $4.36{\pm}1.77$ with the mean CES of $41.8{\pm}27.4$ in ICSI cycles. In ICSI cycles, the overall pregnancy rate was 29.6% (8/27) per cycle and 42.1% (8/19) per patient with the clinical pregnancy rate of 22.2% (6/27) per cycle and 31.6% (6/19) per patient. In conclusion, MAF of human oocytes with ICSI is a promising fertilization method for IVF-ET patients, especially with the past history of failure in fertilization or low fertilization rate of oocytes in the previous IVF-ET cycles, and ICSI using micromanipulation procedures applied to human oocytes will provide a range of novel techniques which may dramatically improve the pregnancy rate in IVF-ET program and contribute much to effective management of infertile couples.

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