• Journal of Chest Surgery
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• v.32 no.5
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• pp.471-479
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• 1999

Background: Patients with tetralogy of Fallot(TOF), pulmonary atresia(PA) and major aortopulmonary collateral arteries(MAPCAs) have been managed by heterogenous surgical strategies. We have taken 5 different surgical approaches to this lesion. In this study, relative advantages and disadvantages of each strategy were discussed by analyzing our surgical results. Material and Method: Between January 1986 and June 1998, 50 patients aged 1 to 177(39${\pm}$31) months at a various morphologic spectrum of this lesion were treated at our institution. The groups, which were classified according to the initial approaches, consisted of one-stage unifocalization(A-1, n=9), staged unifocalization(A-2, n=11), right ventricle to pulmonary artery connection(RV-PA)(B-1, n=11), one-stage RV-PA plus unifocalization (B-2, n=11), and one-stage definitive repair(C, n=8). Morphologic charateristics, operative mortalities, and probabilities of definitive repair were compared between the groups and the causes of death, complications and the follow-up results were described. Result: Mean ages at the first operation were 57${\pm}$18(A-1), 42${\pm}$48(A-2), 18${\pm}$14(B-1), 52${\pm}$55(B-2), and 32${\pm}$34(C) months (p<0.05). Mean numbers of MAPCAs were least in group C (A-1=4.3${\pm}$1.0, A-2=4.5${\pm}$1.3, B-1=4.1${\pm}$1.9, B-2=4.1${\pm}$1.6, C=3.4${\pm}$1.8 : p<0.05). The ratios of the direct and the indirect MAPCAs in each group were not different between the grousps (A-1=91%/9%, A-2=78%/22%, B-1=80%/20%, B-2=80%/20%, C=81%/19% : p>0.05). Nineteen patients had more than 1 dependent MAPCAs. True pulmonary arteries were not present 13 patients and they were confluent in 29. A total of 101 operations were performed. Operative mortalities of initial procedures were 33%(3/9, A-1), 18%(2/11, A-2), 0%(0/11, B-1), 36%(5/11, B-2) and 13%(1/8, C) (p<0.05). Percentages of the definitive repair among the patients of each group were 22%(2/9, A-1), 18%(2/11, A-2). 45%(5/11, B-1), 27%(4/11, B-2), and 100%(8/8, C)(p<0.05). Hypoxic respiratory and cardiac failure(6), hypoxic encephalopathy(2) and sepsis(4) were the major causes of death. Phrenic nerve palsy occured in 5 patients. Thirty-one patients among the survivals have been followed up for a mean duration of 74${\pm}$42(3-145) months. One and five year actuarial survival rates were 73% and 73 %. Conclusion: In conclusion, Right ventricle to pulmonary artery connection used in patients with TOF/PA/MAPCA as an inital procedure appeared to be highly successful in enhancing the chance of satisfactory definitive repair without the significant surgical risks. One-stage total repair at an ealier age group could be performed safely with the resonable outcomes. Unifocalization approach, whether it was performed in a single stage or in the multiple stages, resulted in the high operative mortality and the lowest chance of definitive repair, however more tailored selection of the patients and the long follow-up is mandatory to prove the usefulness of this approach.

• Journal of Korean Medical classics
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• v.9
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• pp.432-552
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• 1996

The influence of the four noted physicians of Geum-Won era(金元代) on the completion of the medicine in the Chosun dynasty(朝鮮朝) can be summarized as follows. 1. The four noted physicians of Geum-Won era were Yoo-Wan-So(劉完素), Jang-Jong-Jung(張從正), Lee-Go(李杲), Ju-Jin-Heung(朱震亨). 2. Yoo-Wan-So(劉完索) made his theory on the basic of Nae-Kyung("內經") and Sane-Han-Lon("傷寒論"), his idea of medicine was characterized in his books, for exemple, application of O-Oon-Yuk-Ki(五運六氣), Ju-Wha theory(主火論) and hang-hae-seng-je theory(亢害承制論). from his theory and method of study, many deviations of oriental medicine occurred. He made an effort for study of Nae-Kyung, which had been depressed for many years, on the contrary of the way old study that Nae-Kyung had been only explained or revised, he applied the theory of Nae-Kyung to clinical care. The theory of Yuk-Gi-Byung-Gi(六氣病機) and On-Yeul-Byung(溫熱病) had much influenced on his students and posterities, not to mention Jang-Ja-Wha and Ju-Jin-Heung, who were among the four noted physicians therefore he became the father of Yuk-Gi(六氣) and On-Yeul(溫熱) schools. 3. Jang-Jong-Jung(張從正) emulated Yoo-Wan-So as a model, and followed his Yuk-Gi-Chi-Byung(六氣致病) theory, but he insisted on the use of the chiaphoretic, the emetic and the paregoric to get rid of the causes, specially he insisted on the use of the paregoric, so they called him Gong-Ha-Pa(攻下派). He insisted on the theory that if we would strenthen ourselves we should use food, id get rid of cause, should use the paregoric, emetic and diaphoretic. Jang-Jong-Jung'S Gang-Sim-Wha(降心火) theory, which he improved Yoo-Wan-So's Han-Ryang(寒凉) theory influenced to originate Ju-Jin-Heung'S Ja-Eum-Gang-Wha(滋陰降火) theory. 4. Lee-Go(李杲) insisted on the theory that Bi-Wi(脾胃) played a loading role in the physiological function and pathological change, and that the internal disease was originated by the need of Gi(氣) came from the disorder of digestive organs, and that the causes of internal disease were the irregular meal, the overwork, and mental shock. Lee-Go made an effort for study about the struggle of Jung-Sa(正邪) and in the theory of the prescription he asserted the method of Seung-Yang-Bo-Gi(升陽補氣), but he also used the method of Go-Han-Gang-Wha(苦寒降火). 5. The authors of Eui-Hak-Jung-Jun("醫學正傳"), Eui-Hak-Ib-Moon("醫學入門"), and Man-Byung-Whoi-Choon("萬病回春") analyzed the medical theory of the four noted physicians and added their own experiences. They helped organizing existing complicated theories of the four noted physicians imported in our country, and affected the formation of medical science in the Choson dynasty largely. Eui-Hak-Jung-Jun("醫學正傳") was written by Woo-Dan(虞槫), in this book, he quoted the theories of Yoo-Wan-So, Jang-Jong-Jung, Lee-Go, Ju-Jin-Heung, especially, Ju-Jin-Heung was respected by him, it affected the writing of Eui-Lim-Choal-Yo("醫林撮要"). Eui-Hak-ib-Moon("醫學入門"), written by Lee-Chun(李杲), followed the medical science of Lee-Go and ju-jin-heung from the four noted physicians of Geum-Won era. Its characteristics of Taoism, idea of caring of health, and organization affected Dong-Eui-Bo-Kham("東醫寶鑑"). Gong-Jung-Hyun(龔延賢) wrote Man-Byung-Whoi-Choon("萬病回春") using the best part of the theories of Yoo-Wan-So, Jang-Jong-Jung, Lee-Go, Ju-Jin-Heung, this book affected Dong-Eui-Soo-Se-Bo-Won("東醫壽世保元") partly. 6. our medical science was developed from the experience of the treatment of disease obtained from human life, these medical knowledge was arranged and organized in Hyang-Yak-Jib-Sung-Bang("鄕藥集成方"), medical books imported from China was organized in Eui-Bang-Yoo-Chwi("醫方類聚"), which formed the base of medical development in the Chosun dynasty. 7. Eui-Lim-Choal-Yo("醫林撮要") was written by Jung-Kyung-Sun(鄭敬先) and revised by Yang-Yui-Soo(楊禮壽). It was written on the base of Woo-Dan's Eui-Jung-Jun, which compiled the medical science of the four noted physicians of Geum-Won era. It contained confusing theories of the four noted physicians of Geum-Won era and organized medical books of Myung era, therefore it completed the basic form of Byun-Geung-Non-Chi (辨證論治) influenced the writing of Dong-Eui-Bo-Kham("東醫寶鑑"). 8. Dong-Eui-Bo-Kham("東醫寶鑑") was written on the base of basic theory of Eum-Yang-O-Haeng(陰陽五行) and the theory of respondence of heaven and man(天人相應說) in Nae-Kyung. It contained several theories and knowledge, such as the theory of Essence(精), vitalforce(氣), and spirit(神) of Taoism, medical science of geum-won era, our original medical knowledge and experience. It had established the basic organization of our medical science and completed the Byun-Geung-Non-Chi (辨證論治). Dong-Eui-Bo-Kham developed medical science from simple medical treatment to protective medical science by caring of health. And it also discussed human cultivation and Huh-Joon's(許浚) own view of human life through the book. Dong-Eui-Bo-Kham adopted most part of Lee-Go(李杲) and Ju-Jin-Heung's(朱震亨) theory and new theory of "The kidney is the basis of apriority. The spleen is the basis of posterior", so it emphasized the role of spleen and kidney(脾腎) for Jang-Boo-Byung-Gi(臟腑病機). It contained Ju-Jin-Heung's theory of the cause and treatment of disease by colour or fatness of man(black or white, fat or thin). It also contained Ju-Jin-Heung's theory of "phlegm break out fever, fever break out palsy"(痰生熱 熱生風) and the theory of Sang-Wha(相火論). Dong-Eui-Bo-Kham contained Lee-Go's theory of Wha-Yu-Won-Bool-Yang-Lib (火與元氣不兩立論) quoted the theory of Bi-Wi(脾胃論) and the theory of Nae-Oi-Sang-Byun(內外傷辨). For the use of medicine, it followed the theory by Lee-Go. lt used Yoo-Wan-So'S theory of Oh-Gi-Kwa-Keug-Gae-Wi-Yul-Byung(五志過極皆爲熱病) for the treatment of hurt-spirit(傷神) because fever was considered as the cause of disease. It also used Jang-Jons-Jung's theory of Saeng-Keug-Je-Seung(生克制勝) for the treatment of mental disease. 9. Lee-je-ma's Dong-Eui-Soo-Se-Bo-Won("東醫壽世保元") adopted medical theories of Song-Won-Myung era and analyzed these theories using the physical constitutional theory of Sa-Sang-In(四象人). It added Dong-Mu's main idea to complete the theory and clinics of Sa-Sang-Eui-Hak(四象醫學). Lee-Je-Ma didn't quote the four noted physicians of Geum-Won era to discuss that the physical constitutional theory of disease and medicine from Tae-Eum-In(太陰人), So-Yang-In(少陽人), So-Eum-In(少陰人), and Tae-Yang-In(太陽人) was invented from their theories.