• Journal of Chest Surgery
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• v.34 no.6
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• pp.485-489
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• 2001

Background: The most important factor in preventing sternal complications is stable sternal approximation. We have tried to find the most effective sternal closure method by examining the incidence of sternal dehiscence with or without infection in patients with cardiac surgery through median sternotomy. Material and Method: This study was performed in 489 patients over 45 years of age with median sternotomy for open cardiac surgery. Simple closure with interrupted 6 wires was performed in 159 patients, figure-of-8 closure technique in 119, overlapping interrupted closure using 10 wires in 150, and combined closure technique of interrupted simple closure and figure-of-8 suture closure in 61. Two hundred thirty-four patients underwent valve and aortic operations and 213 patients coronary artery bypass surgery. Result: Sternal dehiscence with or without infection occurred in 12 (2.5 %) patients. The complication developed in 5 of 159 patients (3.1%) with six interrupted simple closure, in 4 of 119 patients (3.4%) with figure-of-8 closure, and in 3 of 150 patients (2.0%) with overlapping interrupted closure using 10 wires, but there was no complication in 61 patients with combined closure technique (relative risk for other closure techniques, p<0.05). There was no significant difference in the incidence of the sternal complication between valve and aortic operation group and coronary artery bypass group (3.0% vs 2.3%, not significant), but diabetes mellitus was a significant independent risk factor (odds ratio and multivariate analysis, p<0.05). Conclusion: The sternal closure technique that combines simple interrupted suture closure and figure-of-8 suture closure may be a more useful technique to enhance sternal stabilization compared to other closure techniques, such as simple interrupted closure, 8-figure closure, and overlapping interrupted closure.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.765-769
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• 2007

Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

• Journal of Chest Surgery
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• v.49 no.6
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• pp.421-426
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• 2016

Background: Median sternotomy is the standard approach for atrial septal defect (ASD) closure. However, minimally invasive cardiac surgery (MICS) has been introduced at many centers in adult/grown-up congenital heart patients. We retrospectively reviewed the results of right anterolateral thoracotomy compared with conventional median sternotomy (CMS) for ASD closure at Seoul National University Hospital. Methods: We retrospectively analyzed 60 adult patients who underwent isolated ASD closure from January 2004 to December 2013 (42 in the CMS group, 18 in the MICS group). Preoperative, operative, and postoperative data were collected and compared between the 2 groups. Results: The MICS group was younger (44.6 years vs. 32.4 years, p=0.002) and included more females (66.7% vs. 94.4%, p=0.025) than the CMS group. Operation time (188.4 minutes vs. 286.7 minutes, p<0.001), cardiopulmonary bypass time (72.7 minutes vs. 125.8 minutes, p<0.001), and aortic cross-clamp time (25.5 minutes vs. 45.6 minutes, p<0.001) were significantly longer in the MICS group. However, there were no significant differences in morbidity and mortality between groups. Only chest tube drainage in the first 24 hours (627.1 mL vs. 306.1 mL, p<0.001) exhibited a significant difference. Conclusion: MICS via right anterolateral thoracotomy is an alternative choice for ASD closure. The results demonstrated similar morbidity and mortality between groups, and favored MICS in chest tube drainage in the first 24 hours.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.702-708
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• 1999

Background: Surgical closure of the PDA in premature infants with complications or contraindications to indomethacin use, or recurrence of symptomatic PDA is a safe and effective procedure with low operative risk and minimal complications. Material and Method: From April 1996 to August 1998, 11 premature infants with body weight under 1.5 kg at operation underwent operation for a symptomatic PDA (male:5, female: 6). Associated dise ases were congenital heart disease(7), hyaline membrane disease(6), intraventricular hemor rhage(4), pneumonia(4), pneumothorax(3), hyperbilirubinemia(2), necrotizing enterocolitis(2), renal failure(1), epilepsy(1), and hydrocephalus(1). Surgical techniques are hemoclipping(8) and ligation(3). The size of PDA was 3~6 mm (5.0$\pm$1.2). Result: Systolic and diastolic blood pressure rised and heart rates decreased after PDA closure. ABGA improved postoperatively. There were no surgical complications. Six infants with improved ABGA data were weaned from mechanical ventilatory support. The follow-up durations after discharge were 3 month to 12 month. Five deaths were not related to operation. The causes of death were hyaline membrane disease(2), bronchopulmonary dysplasia with pneumonia(1), sepsis(1), and con gestive heart failure with respiratory distress syndrome(1). Conclusion: Early operative closure is the treatment of choice in most premature infants with a hemodynamically significant shunt(PDA), recurrence of symptomatic PDA, complications of Indomethacin, or contraindi cations to Indomethacin.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.477-480
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• 1994

A 62 year old female, who had suffered from severe pulmonary and cardiac failure with postinfarction VSD [NYHA class IV], underwent successful concomittant patch closure of ventricular septal defect and coronary artery bypass for obstructed first diagonal branch. The operation was performed electively 4 weeks after occurrence of the postinfarction VSD.

• Journal of Distribution Science
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• v.12 no.2
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• pp.73-79
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• 2014

Purpose - The Korean government has revised the distribution industry development law to regulate large-scale retailer operations to protecting medium- and small-scale retailers and traditional markets. According to the revised law, large-scale retailers must follow regulations on operating hours and compulsory store closures two days per month. Based on the revised distribution industry development law, most local governments regulate operation hours and they have adopted compulsory closure programs for large-scale retail stores. However, it is argued that fresh food producers suffer from a decrease in sales based on the compulsory closure of stores operated by large-scale retailers. Large-scale retailers reduce their fresh food orders from agricultural and fishery producers because of the compulsory store closures. Fresh food producers also suffer from a decrease in prices because reduced orders lead to a decrease in auction prices based on the availability of excess goods in wholesale markets. This paper investigates the effects of operation regulations for large-scale retailers on agricultural producers by surveying agricultural and fishery producer organizations. Research design, data, methodology - A survey was conducted on 117 producer organizations of fruits and vegetables, cereals, fisheries, and livestock products from September 10 to October 4, 2012. Survey items are annual sales, shares of sales accounted for by large-scale retailers, reduction of orders and prices from large-scale retailers, methods to deal with the sales reduction, unfair trade practices of large-scale retailers, opinion of the large-scale retailer regulations, and so on. The average sales of the sampled producer organizations are 13.7 billion won and the average share of sales accounted for by large-scale retailers is 35.4%. Results - Survey results show that the sample producer organizations' sales decreased 10.1% because of the compulsory closures of stores operated by large-scale retailers. It is estimated that the total sales of producer organizations decreased 371.2 billion won because of the regulations on the operation of large-scale retailers. In addition to the direct effect of a sales decrease due to order reduction, agricultural and fishery producer organizations suffered from the secondary effect of price reduction in wholesale markets. When orders from large-scale retailers decreased, most agricultural and fishery producer organizations shipped redundant products to wholesale markets, decreasing auction prices. It was estimated that the price received decreased 21.9% when sold in other marketing channels. As producer organization sales decreased, it was reported that the labor force employed by producer organizations also decreased by 15.1%. Therefore, we can conclude that the regulations for large-scale retailer operations resulted in negative impacts on agricultural producers. Conclusions - Although the sales reduction due to the regulations for large-scale retailer operations are not great, the cumulative effects due to the continued compulsory closure of stores operated by large-scale retailers could be great. This paper suggests governmental programs that could help agricultural producer organizations to find new and effective marketing channels such as direct marketing, farmers' markets, exports, Internet shopping, and so on.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.254-269
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• 1988

52 cases of ventricular septal defect [VSD] associated with aortic insufficiency [Al] were found among 1271 patients with simple VSD operated during 27-year period [1959, August-1987, June] at Seoul National University Hospital. Their preoperative data, intraoperative findings and postoperative short-term and long-term follow-up data were evaluated to find the proper timing and method of surgical treatment. The result of this survey shows as follows: 1. To obtain the proper surgical indication, cardiac catheterization and angiography, especially root aortography, was essential. 2. Of all 52 patients, the VSD were type I in 40 patients [77%], type II in 8 [15%] and combination of type I and II in 4 [3%]. Patch closure of VSD were performed in 46 patients and direct suture closure of small VSD in 6. Most common pathologic findings of Al were prolapse of right coronary cusp [40 cases, 77%]. Aortic valve reconstruction were performed in 19 patients, aortic valve replacement in 6 and VSD closure alone in 27. 3. There were 3 surgical deaths [mortality 5.8%], and the long-term follow-up shows that VSD closure alone might have been sufficient to arrest progression of Al in younger patients [less than 10-year old], particularly in those with mild insufficiency. Valve reconstructions, when necessary, were more effective when done at an early age [less than 15-year old]. In a conclusion, we could recommend followings: 1. If patient at any age having VSD with Al is diagnosed, prompt operation is recommended. As for the surgical method, VSD closure only may be fit for mild degree of Al when patient is less than 10-year old, but the management of valve itself may be needed for moderate to severe degree of Al, especially when patient is over 10 year old. The management of valve itself may be variable, but valve reconstruction should be considered as a first choice in less than 15-year old patient. If patient is diagnosed less than 5-year old without evidence of Al, close follow-up observation is recommended. But if Al evidences of clinical findings and/or echocardiography during follow-up examination are notified, corrective operation should be accomplished while the Al is mild. If cusp prolapse and/or even type I VSD of significant size is demonstrated on aortogram, without Al, it should be corrected as early as possible before the patient is about 5 years old.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.125-128
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• 2013

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

• Journal of Korean Society of Water and Wastewater
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• v.23 no.3
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• pp.295-303
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• 2009

In the present study, a reliability analysis calculating the probability of system failure has been performed using cut set and results of numerical analysis for unsteady flow in pipe. Especially, the probability of system failure has been evaluated regarding the effect of valve closure which is a really important activity in operation of piping system. In spite of small amount of demand, it was found that fast valve closure can generate high probability of system failure. Furthermore, it was confirmed that surge tank can reduce the unsteady effects and probability of system failure in water distribution system. From the results, it was found that the unsteady flow has a significant effect on the probability of system failure Furthermore, it was able to find which pipe or cut set has high probability of system failure. So it could be used to determine which pipe or cut set has a priority of repair and replacement. Therefore, reliability analysis regarding unsteady flow has to be performed for the planning, designing, maintenance, and operation of piping system.

• Proceedings of the KSME Conference
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• 2003.11a
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• pp.1358-1363
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• 2003

Due to the application of Integrated Head Assembly (IHA) in KSNP+ reactor design, an investigation of reactor internals integrity is carried out to assure that the adoption of IHA does not affect the safety of reactor operation. One of the postulated accident events is the R.V. closure head fall from 5.5m high directly above the reactor vessel that may occur during the refueling operation. The analysis model consists of lumped mass elements of the entire reactor vessel and internals. Because of extreme load, separate elastic-plastic analyses are done for the members that undergo plastic deformation. The analysis verified that the stresses of the reactor internals and the fuel assemblies are within the bound of allowable stress limits and the integrity of the fuel assemblies is maintained.