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Improvement of Fontan Circulatory Failure after Conversion to Total Cavopulmonary Connection (완전 대정맥-폐동맥 연결수술로 전환 후의 폰탄순환장애 개선)

  • Han Ki Park;Gijong Yi;Suk Won Song;Sak Lee;Bum Koo Cho;Young hwan Park
    • Journal of Chest Surgery
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    • v.36 no.8
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    • pp.559-565
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    • 2003
  • By improving the flow pattern in Fontan circuit, total cavopulmonary connection (TCPC) could result in a better outcome than atriopulmonary connection Fontan operation. For the patients with impaired hemodynamics after atriopulmonary Fontan connection, conversion to TCPC can be expected to bring hemodynamic and functional improvement. We studied the results of the revision of the previous Fontan connection to TCPC in patients with failed Fontan circulation. Material and method: From October1979 to June 2002, eight patients who had failed Fontan circulation, underwent revision of previous Fontan operation to TCPC at Yonsei University Hospital. Intracardiac anomalies of the patients were tricuspid atresia (n=4) and other functional single ventricles (n=4). Mean age at TCPC conversion was 14.0$\pm$7.0 years (range, 4.6~26.2 years) and median interval between initial Fontan operation and TCPC was 7.5 years (range, 2.4~14.3 years). All patients had various degree of symptoms and signs of right heart failure. NYHA functional class was 111 or IV in six patients. Paroxysmal atrial fibrillation (n:f), cyanosis (n=2), intraatrial thrombi (n=2), and protein losing enteropathy (PLE) (n=3) were also combined. The previous Fontan operation was revised to extracardiac conduit placement (n=7) and intraatrial lateral tunnel (n=1). Result: There was no operative death. Major morbidities included deep sternal infection (n=1), prolonged pleural effusion over two weeks (n=1), and temporary junctional lachyarrhythrnia (n=1). Postoperative central venous Pressure was lower than the preoperative value (17.9$\pm$3.5 vs. 14.9$\pm$1.0, p=0.049). Follow-up was complete in all patients and extended to 50,1 months (mean, 30.3$\pm$ 12.8 months). There was no late death. All patients were in NYHA class 1 or 11. Paroxysmal supraventricular tachycardia developed in a patient who underwent conversion to intraatrial lateral tunnel procedure, PLE was recurred in two patients among three patients who had had PLE before the convertsion. There was no newly developed PLE. Conclusion: Hemodynamic and functional improvement could be expected for the patients with Fontan circulatory failure after atriopulmonary connection by revision of their previous circulation to TCPC. The conversion could be performed with low risk of morbidity and mortality.

Tc-99m ECD Brain SPECT in Patients with Traumatic Brain Injury: Evaluating Distribution of Hypoperfusion and Assesment of Cognitive and Behavioral Impairment in Relation to Thalamic Hypoperfusion (뇌외상 환자의 Tc-99m ECD 뇌 SPECT에서 뇌 혈류감소의 분포 및 시상의 혈류감소에 대한 인지 및 행동장애 평가)

  • Park, Soon-Ah;Lim, Seok-Tae;Sohn, Myung-Hee
    • The Korean Journal of Nuclear Medicine
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    • v.34 no.6
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    • pp.445-455
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    • 2000
  • Purpose: We evaluated the distribution of hypoperfusion in patients with traumatic brain injury (TBI) and the relationship of thalamic hypoperfusion to severity of cognitive and behavioral sequelae. Materials and Methods: Tc-99m ECD SPECT and MRI were performed in 103 patients (M/F=81/22, mean age $34.7{\pm}15.4$ yrs) from 0.5 to 55 months (mean 10.3 months) after TBI. The patients were divided into three groups showing no abnormalities (G1), focal (G2) and diffuse injury (G3) on MRI. Psychometric tests assessed 11 cognitive or behavioral items. In all patients, we evaluated the distribution of hypoperfused areas in SPECT, and in 57/103 patients, neuropsychological (NP) abnormalities in patients with thalamic hypoperfusion were compared with those of patients without thalamic hypoperfusion. Results: The perfusion deficits were most frequently located in the frontal lobe (G1, 42.3%: G2 34.5%: G3 33.3%), temporal lobe ($24{\sim}26%$) thalami ($21{\sim}22.4%$), parietal and occipital lobe (${\leq}10%$). Numbers of NP abnormalities in the cases of cortical hypoperfusion with or without concomitant thalamic hypoperfusion were following: the former $4.7{\pm}1.5$ and the latter $3.2{\pm}1.4\;in\;G1,\;5.0{\pm}1.1\;and\;4.8{\pm}1.2\;in\;G2,\;6.8{\pm}1.8\;and\;6.3{\pm}1.1\;in\;G3$, respectively. This difference according to thalamic hypoperfusion was significant in G1 (p=0.002), but was not significant in G2 or G3. Conclusion: SPECT in patients with TBI had demonstrated hypoperfusion mostly involving the frontal, temporal and thalami. In normal group on MRI, frontal hypoperfusion was more prominent than that of any other group, Furthermore in this group, SPECT could predict severity of NP outcome by concomitant thalamic hypoperfusion with cerebral cortical abnormalities.

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The Exposure Status and Biomarkers of Bisphenol A in Shipyard Workers (일부 조선업 근로자들의 bisphenol A 노출실태와 생물학적 지표)

  • Kim, Cheong-Sik;Park, Jun-Ho;Cha, Bong-Suk;Park, Jong-Ku;Kim, Heon;Chang, Soung-Hoon;Koh, Sang-Baek
    • Journal of Preventive Medicine and Public Health
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    • v.36 no.2
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    • pp.93-100
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    • 2003
  • Objectives : Because shipyard workers are involved with various manufacturing process, they are exposed to many kinds of hazardous materials. Welders especially, are exposed to bisphenol-A (BPA) during the welding and flame cutting of coated steel, This study was conducted to assess the exposure status of the endocrine disrupter based on the job-exposure matrix. The effects of the genetic polymorphism of xenobiotic enzyme metabolisms involved in the metabolism of BPA on the levels of urinary metabolite were investigated. Methods : The study population was recruited from a shipyard company in the f province. A total of 84 shipbuilding workers 47 and 37 in the exposed and control groups, respectively, were recruited for this study. The questionnaire variables included, age, sex, use of personal protective equipment, smoking, drinking and work duration. The urinary metabolite was collected in the afternoon and correction made for the urinary creatinine concentration. The of the CYP1A1, CYP2E1 and UGT1A6 genotypes were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods with the DNA extracted from venous blood. Results : The urinary BPA level in the welders group was significantly higher than in the control group (p<0.05). The urinary BPA concentration with the wild type UGT1A6 was higher than the other UGT1A6 genotypes, but with no statistical significant. From themultiple regression analysis of the urinary BPA, the regression coefficient for job grade was statistically significant (p<0.05). Conclusions : The grade of exposure to BPA affected the urinary BPA concentration was statistically significant. However, the genetic polymorphisms of xenobiotics enzyme metabolism were not statistically significant. Further investigation of the genetic polymorphisms with a larger sample size is needed.

Early and Midterm Results of the Extracardiac Fontan Operation and the Change of Internal Diameter of the Conduit (심외도관 폰탄수술후 중단기 성적 및 심외도관의 내경의 변화)

  • 성시찬;김시호
    • Journal of Chest Surgery
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    • v.35 no.3
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    • pp.177-181
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    • 2002
  • Background: Follow-up studies have shown that although outcomes have improved substantially over time, results of the Fontan operation and its modifications remain suboptimal. In this study, we reviewed our experience with the extracardiac conduit Fontan operation, with a focus early and midterm change of internal diameter of PTFE conduit. Material and Method: Between April 1997 and July 2000 were reviewed. Twelve patients (M:6, F:6, mean age 42.04 $\pm$ 12.43months, mean body weight 13.80$\pm$ 1.94kg) underwent extracardiac conduit Fontan operation with expanded PTFE graft. Mean cardiopulmonary bypass time was 109.7$\pm$26.99minute and mean operation time was 455$\pm$89.51minute. Intraoperative fenestration was performed in 10 patients. The aortic cross clamping was not performed in all patients. Result: There was no early deaths and no postoperative dysrhythmia. Postoperative protein losing enteropathy and prolonged pleural effusion occurred in 1(8.3%) and 4 patients(33.3%). Conduit patency was evaluated by magnetic resonance imaging studies. A 9.84$\pm$3.84% mean reduction in conduit internal diameter and there was no statistical correlation between the change of internal diameter of conduit and the postoperative duration after partial correlation analysis(r=0.019, p=0.955). Conclusion: These results demonstrate that the extracardiac conduit Fontan operation provies good early and midterm results and may reduce the prevalence of late arrhythmia. And there is no correlation between the change of internal diameter of conduit and the postoperative duration after extracardiac conduit Fontan operation with the expanded PTFE graft conduit.

Effects of Dietary Supplementation of Codonopsis pilosula Extract Powder on the Productivity and Immunity in Sows and Piglets (임신돈 사료 내 만삼추출분말의 첨가 급여가 모돈과 자돈의 생산성 및 면역력에 미치는 영향)

  • Kim, Ki-Hyun;Kim, Kwang-Sik;Kim, Jo-Eun;Jung, Hyun-Jung;Lee, Sung-Dae;Sa, Soo-Jin;Hong, Joon-Ki;Hur, Tai-Young;Park, Jun-Cheol;Kim, Young-Hwa
    • Korean Journal of Organic Agriculture
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    • v.21 no.3
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    • pp.423-435
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    • 2013
  • The Codonopsis pilosula is traditional oriental herb associated with immune-modulatory functions and has anti-inflammatory properties and antioxidative activity. The present study was conducted to investigate the effects of dietary supplementation of Codonopsis pilosula extract powder (CEP) on the immunity and productivity in sows and piglets. A total of 20 pregnant sows were randomly assigned to two dietary treatments, which was given a corn-soybean meal diet with 0% and 0.5% CEP from 40 days prepartum to weaning (25 days postpartum). The immune system of piglets was expected to build up, because the feeding of CEP might increase the colostrum contents in sows. We also predicted that the growth performance of piglets also could be increased by some compensation effects due to the increased immunity of piglets. In results, immunities of sows and piglets as well as growth performance of piglets were not affected by the supplementation of CEP. The correlation between the colostrum and the serum on the IgG contents tended to have a positive correlation, although there was no significant (coefficient, 0.435; P=0.102). This result suggests that the supplementation of CEP may increase IgG contents in sows and piglets and contribute to improve immunity of piglets. In conclusion, it is thought that the physiologically active substances of CEP did not influence to the immune synergic effects in vivo of sows. Thus, the metabolic and action mechanism of the physiologically active substances of CEP should be explored to evaluate the availability of CEP as a feed additive for the immunomodulator.

MEASUREMENT OF ADHESION OF ROOT CANAL SEALER TO DENTINE AND GUTTA-PERCHA (상아질과 Gutta-Percha에 대한 근관충전용 Sealer의 결합강도의 측정)

  • Her, Mi-Ja;Yu, Mi-Kyung;Lee, Se-Joon;Lee, Kwang-Won
    • Restorative Dentistry and Endodontics
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    • v.28 no.1
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    • pp.89-99
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    • 2003
  • The purpose of this study was to investigate the bonding of resin- based root canal sealer, AH26 when the sealer was applied as a thin layer between dentine and gutta-percha surface. In this study forty non-caries extracted human molars and resin-based root canal sealer(AH 26, DeTrey/Dentsply, Germany) were used. Disks of gutta-percha, 6mm in diameter.6mm thick (Diadent/Dentsply, Korea) for thermoplastic obturation were used and dentin surfaces were treated with 2% NaOCl(Group 1) or 2%NaOCl+17% EDTA(Group 3). Disks of gutta-Percha, 6mm in diameter.6mm thick (Diadent/Dentsply, Korea) for conventional obturation were used and dentin surface were treated with 2% NaOCl(Group 2) or 2%NaOCl+17% EDTA(Group 4). Enamel was removed by a horizontal section 1mm below the deepest portion of the central occlusal groove by using a watercooled low speed diamond saw. A second horizontal section was done around cementoenamel junction. Exposed dentin surface was cut to approximately $8{\times}8{\;}mm$ rectangular shape and was ground against 320, 400, 600 grade silicon carbide abrasive paper serially. After grinding, the dentine surface were soaked in a solution of 2% NaOCl for 30 minutes and twenty of specimens were treated with 17% EDTA solution for 1 minute. The treated specimens were washed and dried, Root canal sealer, AH26 was prepared according to the manufacture's instructions The Gutta-percha and dentin surface were coated with a thin layer of the freshly mixed seal or. The specimens were left overnight at room temperature. After their initial set, they were transferred to an incubator at $37$^{\circ}C$ for 72 h. After 72 hours, resin blocks were made. The resin block was serially sectioned vertically into stick of $1{\cdot}1mm$. Twenty sticks were prepared from each group. After that, tensile bond strength f3r each stick was measured with Microtensile Tester Failure patterns of the specimens at the interface between gutta-percha and dentin were observed under the SEM(x1000) and Stereomicroscope (LEICA M42O, Meyer Inst., TX U.S.A) at 1.25 x25 magnification. The results were statistically analysed by using a One-way ANOVA and Tukey's test. The results were as follows; 1. Tensile bond strengths($mean{\pm}SD$) were expressed with ascending order as follows: Group 1, $3.09{\pm}$ 1.05Mpa : Group 2, $6.23{\pm}1.16MPa$ : Group 3, $7.12{\pm}1.07MPa$ : Group 4, $10.32{\pm}2.06MPa$. 2. Tensile bond strengths of the group 2 and 4 used disks of gutta-percha for conventional obturation were significantly higher than that of the group 1 and 3 used fir thermoplastic obturation. (p < 0.05). 3. Tensile bond strengths of the group 3 and 4 treated with 2% NaOC1+17% EDTA were significantly higher than that of the group 1 and 2 treated with 2% NaOCl. (p < 0.05). 4. In analysis of failure patterns at the interface between sealer and gutta-percha, there were observed 49 (61%)cases of adhesive failure patterns and 31 (39%) cases of mixed failures patterns.

Hydrogeochemical Characteristics and Contamination of Dissolved Major ions and Heavy Metals in Waters and Sediments from the Tancheon River (탄천의 하상퇴적물과 하천수내 주요 용존 이온과 중금속의 수리지구화학적 특성과 오염)

  • 이성은;김규한;이진수;전효택
    • Economic and Environmental Geology
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    • v.35 no.1
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    • pp.25-41
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    • 2002
  • In order to investigate the hydrogeochemical characteristics and contamination of dissolved major ions and heavy metals in the Tancheon River, river water and sediment samples were collected at 18 locations, along a distance of 69 km, between Yongin-si in Kyunggi-do and Samsung-dong in Seoul on October in 2000 and April in 2001. After appropriate sample preparation, waters were analyzed for the dissolved constituents and sediments. The pH values of river waters were in the range of 7.0 to 9.3 and could be plotted in the area of surface environment. The level of $Ca^{2+}$, , CI-, sol-, N0$_{3}$ and HC0$_{3}$ in the Tancheon River were higher than those in world average river water. Most of dissolved constituents in the river waters increased toward downstream from upstream. In particular, high concentrations of Zn2+, Na$_{+}$, CI$^{-}$, SO$_{4}^{2-}$ and N03- were found near densely residential areas and the Sungnam waste water treatment plant. The relative ion enrichment was caused by the inflow of local domestic and industrial sewages. Also, Ca2+ and HC03- concentrations were enriched in the middle of the Tancheon River due to the dissolution of cements. This indicates that the apartment complexes were built on a large scale in the upriver since these ten years and large amounts of construction materials such as cements were flowed into the Tancheon River. Concentrations of heavy metals (Mn, Cd, Cu, Pb, Zn) in sediments from the Tancheon River exceeded the lower limit of tolerence level in bottom sediment established by the Ontario Ministry of the Environment (OME) of Canada. In particular, these metals were highly elevated in sediment (TSM-12) collected from near the Sungnam waste water treatment plant. Heavy metals were higher enriched in sediments collected from dry period rather than wet period.

Hydrothermal Alteration Related to Cretaceous Felsic Magmatism in the Seongsan Dickite Deposits, Korea; Estimation of Ore - Forming Temperature and aNa+/aK+ Ratio of the Hydrothermal Fluid (성산딕카이트광상에서의 백악기산성마그마티즘에 관련된 열수변질작용 ; 광상형성온도의 측정 및 열수용액의 aNa+/aK+)

  • Kim, In Joon
    • Economic and Environmental Geology
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    • v.25 no.3
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    • pp.259-273
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    • 1992
  • The Seongsan mine is one of the largest dickite deposits in the southwestern part of the Korean Peninsula. The main constithent minerals of the ore are dickite and quartz with accessory alunite, kaolinite and sericite. The geology around the Seongsan mine consists mainly of the late Cretaceous felsic volcanic rocks. In the studied area, these rocks make a synclinal structure with an axis of E-W direction plunging to the east. Most of the felsic volcanic rocks have undergone extensive hydrothermal alteration. The hydrothermally altered rocks can be classified into the following zones: Dickite, Dickite-Quartz, Quartz, Sericite, Albite and Chlorite zones, from the center to the margin of the alteration mass. Such zonal arrangement of altered rocks suggests that the country rocks, most of which are upper part of the rhyolite and welded tuff, were altered by strongly acid hydrothermal solutions. It is reasonable to consider that initial gas and solution containing $H_2S$ and other compounds were oxidized near the surface, and formed hydrothermal sulfuric acid solutions. The mineralogical and chemical changes of the altered rocks were investigated using various methods, and chemical composition of fifty-six samples of the altered rocks were obtained by wet chemical analysis and X.R.F. methods. On the basis of these analyses, it was found that some components such as $SiO_2$, $Al_2O_3$, $Fe_2O_3$, CaO, MgO, $K_2O$, $Na_2O$ and $TiO_2$ were mobilized considerably from the original rocks. The formation temperature of the deposits was estimated as higher than $200^{\circ}C$ from fluid inclusion study of samples taken from the Quartz zone. On the basis of the chemical composition data on rocks and minerals and estimated temperatures, the hydrothermal solutions responsible for the formation of the Seongsan dickite deposits were estimated to have the composition: $m_{K^+}=0.003$, $m_{Na^+}=0.097$, $m_{SiO_2(aq.)}=0.008$ and pH=5.0, here "m" represents the molality (mole/kg $H_2O$).

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Shaping characteristics of two different motions nickel titanium file: a preliminary comparative study of surface profile and dentin chip (두 가지 다른 행정의 니켈 티타늄 파일의 성형 성상: 표면 성상, 상아질 삭편과 도말층에 대한 예비적 비교 연구)

  • Park, So-Ra;Park, Se-Hee;Cho, Kyung-Mo;Kim, Jin-Woo
    • Journal of Dental Rehabilitation and Applied Science
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    • v.30 no.2
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    • pp.121-130
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    • 2014
  • Purpose: To assess the surface profile of dentinal wall, dentin chips and smear layer during the canal shaping with rotary (ProTaper) and ProFile and reciprocating (WaveOne) nickel-titanium file. Materials and Methods: Sixty human extracted mandibular premolars and incisors with single canals were randomly selected. Three experimental groups (n = 20) were instrumented with ProTaper (F2), ProFile (25/.06), WaveOne (25/.08) with irrigation of 2.5% NaOCl. The dentin chips were collected from flute of file during each canal preparation. After canal preparation, roots were grinded and each group was divided into two subgroups (n = 10) for surface profile and smear layer of dentinal wall of shaped root canal. Each specimen was observed under scanning electron microscope for evaluating size of dentin chips, root canal surface recessions and smear layer. Scores of Smear layer were statistically analyzed using Kruskal Wallis test and Mann Whitney test at P = 0.05 level. Results: The size of dentin chips from ProFile, ProTaper and WaveOne was up to $7{\mu}m$, $6.5{\mu}m$, and$4{\mu}m$, respectively. In the surface profile, the width of surface irregularity was measured and Profile, ProTaper and WaveOne was up to $150{\mu}m$, $70{\mu}m$, and $80{\mu}m$, respectively. Completely cleaned root canals were not found. In the middle and apical third of the canals, WaveOne group showed higher smear layer score than ProFile and ProTaper groups (P < 0.05). Conclusion: Within limits of this study, reciprocating motion WaveOne group was not significant difference of shaping ability with the full-sequence ProFile and ProTaper systems except canal clearness of middle and apical third of root canal. When using WaveOne to shaping root canal, thorough root canal irrigation is recommended.

The Change of Cortical Activity Induced by Visual Disgust Stimulus (시각혐오자극으로 유발된 대뇌 피질 활성도 변화)

  • Jung, Wook;Park, Doo-Heum;Yu, Jae-Hak;Ryu, Seung-Ho;Ha, Ji-Hyeon;Shin, Byoung-Hak
    • Sleep Medicine and Psychophysiology
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    • v.20 no.2
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    • pp.75-81
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    • 2013
  • Objectives: There are a lot of studies that analyze the interaction between the emotion of disgust and the functional brain images using fMRI and PET. But studies using sLORETA (standardized low resolution brain electromagnetic tomography) almost do not exist. The aim of this research is to explore the relationship of the emotion of disgust and the cortical activation using sLORETA analysis. Methods: Forty five healthy young adults ($27.1{\pm}2.6$ years) participated in the study. While they were watching 4 neutral images and 4 disgusting images associated with mutilation selected from the international affective picture system (IAPS), participants' EEGs were taken for 30 seconds per one picture. Through these obtained EEG data, sLORETA analysis was performed to compare EEGs associated with neutral and negative images. Results: During looking for visual disgusting stimulus, all participants reported unpleasantness, arousal and stress. In sLORETA analysis, the decrease of current density in theta wave was shown at left frontal superior gyrus (BA10) and middle gyrus (BA10, 11). This voxel cluster consists of a total of 11 voxels and the threshold of t value indicating statistically significant decreases in the current density (p<0.05) was -1.984. There were no differences between male and female in the degree of being disgusted by the stimuli. Conclusion: This finding may suggest that the activation of dorsolateral prefrontal cortex might be associated with regulating disgust emotion.