• Journal of Chest Surgery
• /
• 제12권3호
• /
• pp.281-288
• /
• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
• /
• 제12권3호
• /
• pp.289-296
• /
• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
• /
• 제19권4호
• /
• pp.569-577
• /
• 1986

Between October 1979 and June 1986, modified Fontan procedures have been performed on 22 patients by the Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine. Twelve patients had tricuspid atresia; one, congenital tricuspid stenosis; five, single ventricle; two, I-transposition of the great vessels; one, double outlet right ventricle, and one, pulmonary atresia with an intact ventricular septum. There were 9 operative deaths [mortality; 40.9%]. The causes of death were right heart failure in six patients and pulmonary venous hypertension in one who misdiagnosed preoperatively. Another two were deceased due to sepsis and cerebrovascular accident at postoperative 35 and 34 days in each. There were 7 patients below 4 years of age at the time of operation and among them 4 patients were deceased. The operative death was not related with patients` age above and below 4[p=0.211]. The relation between operative death of tricuspid anomaly and another cardiac malformations was statistically significant [p=0.048]. The operative procedures with or without valved conduit [woven dacron] was related significantly [p=0.043] in the case of the 21 of the patients, but the modified Fontan operation with a valved conduit was performed early stage in this series. Since 1982, we operated on 4 patients, doing a right atrium-right ventricle anastomosis without a conduit. All survived and remained in functional class I [NYHA]. The right atrial pressure [RAP] was elevated significantly after operation [mean 9.9$\pm$4.8 ~16.9$\pm$3.6 mmHg, p<0.001]. The relation between the postoperative RAP of the survival group [16.5$\pm$4.3 mmHg] and the group who died [17.4$\pm$2.2 mmHg] was statistically significant [p=0.047]. There was no relation between any operative death and any previous palliation. All patients were followed for 4 months to 80 months, except one who was lost to follow up at 2 months following surgery [mean 11.4 months, 238 patient. months]. All were in functional class I with 5 on medications and 7 not. One was reoperated at 70 months following the first operation, due to conduit stenosis. She was moderately impaired in activity, with hepatomegaly after the second operation.

• 한국수학교육학회지시리즈A:수학교육
• /
• 제47권2호
• /
• pp.197-219
• /
• 2008

Unlike ordinary situations, deifinitions play a very important role in mathematics education in schools. Mathematical concepts have been mainly acquired by given definitions. However, according to didactical intentions, mathematics education in schools has employed mathematical concepts and definitions with less strict forms than those in pure mathematics. This research mainly discusses definitions used in geometry (promising) course in primary schools to cope with possibilities of creating misconception due to this didactical transformation. After analyzing problems with potential misconceptions, a survey was conducted $\underline{with}$ 80 primary school teachers in Jeju to investigate their recognitions in meaning of mathematical concepts in geometry and attitudes toward teaching. Most of the respondents answered they taught their students while they knew well about mathematical definitions in geometry but the respondents sometimes confused mathematical concepts of polygons and circles. Also, they were aware of problems in current mathematics textbooks which have explained figures in small topics (classes). Here, several suggestions are proposed as follows from analyzing teachers' recognitions and researches in mathematical viewpoints of definitions (promising) in geometric figures which have been adopted by current mathematics textbooks in primary schools from the seventh educational curriculum. First, when primary school students in their detailed operational stage studying figures, they tend to experience $\underline{a}$ collision between concept images acquired from activities to find out promising and concept images formed through promising. Therefore, a teaching method is required to lessen possibility of misconceptions. That is, there should be a communication method between defining conceptual definitions and Images. Second, we need to consider how geometric figures and their elements in primary school textbooks are connected with fundamental terminologies laying the foundation for geometrical definitions and more logical approaches should be adopted. Third, the consistency with studying geometric figures should be considered. Fourth, sorting activities about problems in coined words related to figures and way and time of their introductions should be emphasized. In primary schools mathematics curriculum, geometry has played a crucial role in increasing mathematical ways of thoughts. Hence, being introduced by parts from viewpoints of relational understanding should be emphasized more in textbooks and teachers should teach students after restructuring this. Mathematics teachers should help their students not only learn conceptual definitions of geometric figures in their courses well but also advance to rigid mathematical definitions. Therefore, that's why mathematics teachers should know meanings of concepts clearly and accurately.

• Archives of Reconstructive Microsurgery
• /
• 제13권2호
• /
• pp.93-100
• /
• 2004

This study was designed to investigate the optimal period of pedicles implantation in the prefabricated periosteofascial flap with a vascular tissue transfer. The flap prefabrication was prepared with a transposition of left occipital pedicles on the calvarial fascia of male Sprague-Dawley rats. Thirty flaps were divided into five groups of six flaps, including control group (group I) of the conventional periosteofascial flap based on the lateral border of the rat calvarium. The prefabricated flap was elevated as an $1{\times}1cm$ sized island flap based on the implanted pedicle at 1, 2, 3, and 4 weeks after the pedicles transfer in groups II, III, IV, and V, respectively. After the completion of creating a critical-sized calvarial defect and implanting with hydroxyapatite granules, the flap was sutured back for covering the defect and kept isolated from surrounding tissues. Six weeks after flap repositioning, the osseous changes of the defect were examined with simple radiographic findings, radiodensitometric analysis, and histological studies. By simple radiographic findings, specimens of the control, groups IV and V showed homogeneous radioopacity within the defect. But in groups II and III, focal radiolucency was observed in the defect. In the radiodensitometric analysis, the control group and the group V showed significant increased radiodensites statistically. Histologically, the implanted hydroxyapatite was absorbed partly in the defect in groups II, III, and IV. In the defects of the control group and the group V, the implanted hydroxyapatite was kept in its volume and the deposition of the bone cells was observed sparsely. In conclusion, the prefabricated periosteofascial flap can be created with a vascular tissue transfer and the pedicles should be implanted at least for 4 weeks to bring out positive osseous changes in the calvarial defect.

• Clinics in Shoulder and Elbow
• /
• 제8권2호
• /
• pp.97-104
• /
• 2005

Purpose: To report the results of surgical treatment of comminuted fractures of distal humerus and to identify factors that affect the results. Materials and Methods: Thirty-two patients who were treated with open reduction and internal fixation for comminuted fracture of distal humerus were enrolled. According to the AO classification, A2.3 was 1 case, A3.2, 2 cases, A3.3, 8 cases, B1.3, 1 case, B2.3, 1 case, C2.2, 5 cases, C2.3, 4 cases, C3.2, 3 cases and C3.3, 7 cases. As fixation technique, 17 cases were fixed by double plates, 4 cases by only K-wires, 4 cases by only screws, 3 cases by K-wires and screws and 4 cases by one plate and screws. The mean age at the time of the operation was 49 years(range, $19{\sim}77$ years). The mean follow-up period was 16 months(range, $8{\sim}51$ months). Results: At the last follow-up, the mean maximum flexion was $116.4^{\circ}\;(range,\;85{\sim}140^{\circ})$ and the mean loss of terminal extension was $11.8^{\circ}\;(range,\;0{\sim}40^{\circ})$. The average Mayo elbow performance score was $91.4^{\circ}\;(range,\;55{\sim}100^{\circ})$. Overall 29 cases(91%) showed good to excellent results. The mean range of motion of extraarticular and intraarticular fracture group was $105.5^{\circ}\;(range,\;65{\sim}140^{\circ})$ and $104^{\circ}\;(range,\;55{\sim}140^{\circ})$, respectively. The average elbow score of both groups was$93^{\circ}\;(range,\;70{\sim}100^{\circ})$ and $90.7^{\circ}\;(range,\;55{\sim}100^{\circ})$. Over 90% showed more than good results. 30 cases(94%) showed complete bony union but two cases, nonunion. One case of the nonunion cases underwent replating with bone graft as revision surgery and total elbow arthroplasty was performed in the other case. At the last follow-up, 27 patients(84.4%) showed subjective satisfaction. Conclusion: Open reduction and internal fixation with appropriate surgical technique for comminuted fractures of distal humerus showed good results, which were not affected by age at the time of operation, fixation methods and anterior transposition of the ulnar nerve. Transolecranon approach may be considered as good choice for intraarticular comminuted fractures of distal humerus.

• 한국임상수의학회지
• /
• 제31권5호
• /
• pp.425-429
• /
• 2014

식욕부진, 호흡부전, 또는 비출혈을 보이는 두 마리 개가 내원하였다. 신체검사에서 호흡곤란, 개구호흡 및 커다란 구개 종양을 확인하였다. 신체검사 중 2 번 증례에서 호흡부전으로 인한 심정지가 발생하였고 심폐소생술과 산소 공급을 통해 안정화 되었다. 1 번 증례의 CT 촬영에서 경구개 연구개를 포함하는 구강 인두, 인두 내 입구, 인후두 부위의 종양을 확인하였다. 연하곤란 및 호흡부전 개선을 위해 보호자 동의 하에 완화 수술을 결정하였다. 종양 제거 후 발생한 결손 부위 재건을 위해 구강 내 점막을 사용하여 회전 및 전진 피판술과 양측 90o 자리바꿈 피판술을 1 및 2 번 증례에 각각 적용하였다. 조직 검사 결과, 두 마리의 개 모두에서 무멜라닌 색소성 흑색종이 진단되었다. 수술 후 7 일째 두 마리 모두에서 정상 연하와 호흡이 확인되었다. 수술 후 4 주째 1 번 증례의 수술 부위에서 재발된 종양이 관찰되었다. 보호자가 추가적인 치료를 원하지 않았고, 연락 두절로 인하여 수술 후 2 개월 이후의 확인은 불가능하였다. 수술 후 3 주째 2 번 증례의 신체검사 및 방사선 촬영에서 국소적인 재발 및 전이는 확인 되지 않았다. 수술 후 7 주째 유선상으로 확인한 결과, 2 번 증례에서 원인불명의 갑작스러운 사망이 확인되었다.

• 한국임상수의학회지
• /
• 제35권3호
• /
• pp.71-76
• /
• 2018

In 22 dogs with medial patellar luxation (MPL) of grade 3 or lower, resection of the vastus medialis oblique muscle, patellar anti-rotational suture, fascia lata overlap, and tibial tuberosity transposition (TTT) were undertaken to stabilize the patella without trochleoplasty. Data including signalment, clinical symptoms, details of the affected hindlimb, preoperative and postoperative patellar luxation grades, postoperative recovery time, and postoperative complications were obtained from medical records. The grade of lameness was evaluated preoperatively and postoperatively. Mean (${\pm}SEM$) grade of medial patellar luxation was $2.64{\pm}0.11$ preoperatively and $0.2{\pm}0.27$ postoperatively. Mean (${\pm}SEM$) grade of lameness was $1.73{\pm}0.27$ preoperatively and $0.18{\pm}0.15$ postoperatively. Patellar reluxation occurred in 1 of 22 (4.5%) cases requiring additional surgery. At final follow-up, 2 of the 22 (9.0%) dogs, including one with reluxation, had occasional lameness. Client-based questionnaire results demonstrated significant improvements in all parameters. Surgical treatment of MPL that included resection of the vastus medialis oblique without femoral trochlear groove deepening improved surgical outcomes in dogs with up to grade 3 MPL.

• 대한소아치과학회지
• /
• 제41권3호
• /
• pp.241-246
• /
• 2014

이 연구는 2008년 1월부터 2013년 1월까지 전북대학교 치과병원 소아치과에 내원한 만 7~15세 사이 환자 중 파노라마 방사선사진을 촬영한 3278명(남자 1814명, 여자 1464명)의 환자를 대상으로 상악 왜소측절치의 유병률 및 상악 왜소측절치와 연관된 치아발육장애의 발생빈도에 관하여 조사하였다. 상악 왜소측절치의 유병률은 2.62%(86명)로 나타났고 남자 47명, 여자 39명으로 남자에서 약간 높았다. 상악 왜소측절치를 가진 환자 중 발생빈도가 높게 나타난 치아발육장애는 선천성 치아결손 29.1%, 치내치 19.8%, 매복치 12.8%, 과잉치 9.3%, 전위 4.7% 순으로 나타났다. 이로서 상악 왜소측절치는 다른 치아발육장애와 동반되어 나타나는 경우가 많았으므로 진단 및 치료계획 수립 시 이를 고려해야 할 것으로 생각한다.

• 한국정보통신학회:학술대회논문집
• /
• 한국정보통신학회 2017년도 춘계학술대회
• /
• pp.559-562
• /
• 2017

도심에서 배전선로는 지중과 가공 선로의 구성, 연가, 건물과 나무로 인한 시야 방해로 추적하기가 어렵다. 이러한 3상 4선식 배전계통에서 특정 수용가가 어떤 변압기 또는 어떤 선로로부터 공급되는지를 결정하는 것이 현장의 전기 기술자에게 어려운 문제다. 배전선로 사이의 부하 평형 등을 위해 선로의 정확한 추적기술이 필요하다. 기존의 임펄스 전류를 사선에 주입하는 방식과는 다르게 활선에 고주파 신호를 주입하는 식별 방법을 제안한다. 배전선로에 고주파 전력 신호를 주입하여 분석 한 결과 고주파 신호는 배전선에서 전달 능력에 한계 능력을 갖는다. 보통 배전계통의 전력 변압기는 그러한 고주파 신호의 전달을 차폐하게 된다. 이러한 전송제한 특성을 사용하여 변압기와 배전선로를 식별하는 방법을 제안한다. 측정 배전선로의 양단에서 전기신호에 대한 동일 선로 여부를 판별하는 방식이다. 어려운 점은 원격 두 지점이 동기화되어야 하는데, 동기화 시간을 제공하는 GPS를 사용하지 않고 두 지점에 동기화를 달성한다. 새로운 형태의 선로 및 변압기 식별시스템을 설계 및 구현한다. 시스템은 전력선 통신 모듈을 바탕으로 송수신기로 구성된다. 이론적 개념을 검증하기 위해서 일반 상업용 건물에서 실험이 행하여진다.