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Surgical Treatment of Pulmonary Atresia with Intact Ventricular Septum -Effect of the size of tricuspid valve annulus on the surgical outcome- (영아기에 발견된 심실중격이 온전한 폐동맥 폐쇄증의 외과적 수술요법 술전 삼첨판륜 크기 가 수술 결과에 미치는 영향)

  • 이정렬;윤태진
    • Journal of Chest Surgery
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    • v.29 no.10
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    • pp.1081-1089
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    • 1996
  • Pulmonary atresia with intact ventricular septum has continued to have a high surgical mortality and morbidity. This mAy attribute to the non-uniformity of the anomaly. We reviewed a total of 34 infants with pulmonary atresla and intact ventricular septum managed in this hospital between 1987 and 1995. Mean age and body weight were 57.2 (range, 3-208) days and 4.1 (range, B.3∼6.8) kg. The preoperative Z-value of the diameter of the tricuspid valve was less than -2 in 85.2% of patients and less than -4 in 33. 3% . It is well correlated w th right ventricular cavity size (n=27. r10.68, p< 0.05). Coronary artery-right ventricular fistulas were identified in 3 patients, and right ventricular dependency was suspected in 1 Over All hospital mortality was 23.5%(8/34), although it decreased to 16.6%(4124) in 1990s. Subsequent procedures were performed in 6 patients between 3 days and 58 months after Initial palliation : one bidirectional cavopulmonary shunt and 1 Fontan operation after systemic-pulmonary shunt, 3 transannular patch + atrial septal defect closure and 1 additional systemic-pulmonary shunt after polmonary valvectomy or valvotomy. Changes of Z-values of the diameter of tricuspid valve have been followed up in 11 patients between 1 and 66 months postoperatively. Z-values were increased In 5 out of 8 transannular right ventriculAr outflow tract enlargement group and in 1 out of 3 pulmonary valvectomy or valvotomy group. Our data suggest that tailoring a treatment to right ventricular cavity size and coronary anom lies may improve the surgical outcome. A Z-value of the tricuspid valve diameter could be used.

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"Legal Study on Boundary between Airspace and Outer Space" (영공(領空)과 우주공간(宇宙空間)의 한계(限界)에 관한 법적(法的) 고찰(考察))

  • Choi, Wan-Sik
    • The Korean Journal of Air & Space Law and Policy
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    • v.2
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    • pp.31-67
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    • 1990
  • One of the first issues which arose in the evolution of air law was the determination of the vertical limits of airspace over private property. In 1959 the UN in its Ad Hoc Committee on the Peaceful Uses of Outer Space, started to give attention to the question of the meaning of the term "outer space". Discussions in the United Nations regarding the delimitation issue were often divided between those in favour of a functional approach ("functionalists"), and those seeking the delineation of a boundary ("spatialists"). The functionalists, backed initially by both major space powers, which viewed any boundary as possibly restricting their access to space(Whether for peaceful or military purposes), won the first rounds, starting with the 1959 Report of the Ad Hoc Committee on the Peaceful Uses of Outer Space which did not consider that the topic called for priority consideration. In 1966, however, the spatialists, were able to place the issue on the agenda of the Outer Sapce Committee pursuant to Resolution 2222 (xxx1). However, the spatialists were not able to present a common position since there existed a variety of propositions for delineation of a boundary. Over the years, the funtionalists have seemed to be losing ground. As the element of location is a decisive factor for the choice of the legal regime to be applied, a purely functional approach to the regulation of activities in the space above the Earth does not offer a solution. It is therefore to be welcomed that there is clear evidence of a growing recognition of the defect inherent to such an approach and that a spatial approach to the problem is gaining support both by a growing number of States as well as by publicists. The search for a solution of the problem of demarcating the two different legal regimes governing the space above the Earth has undoubtedly been facilitated, and a number of countries, among them Argentina, Belgium, France, Italy and Mexico have already advocated the acceptance of the lower boundary of outer space at a height of 100km. The adoption of the principle of sovereignty at that height does not mean that States would not be allowed to take protective measures against space activities above that height which constitute a threat to their security. A parallel can be drawn with the defence of the State's security on the high seas. Measures taken by States in their own protection on the high seas outside the territorial waters-provided that they are proportionate to the danger-are not considered to infringe the principle of international law. The most important issue in this context relates to the problem of a right of passage for space craft through foreign air space in order to reach outer space. In the reports to former ILA Conferences an explanation was given of the reasons why no customary rule of freedom of passage for aircraft through foreign territorial air space could as yet be said to exist. It was suggested, however, that though the essential elements for the creation of a rule of customary international law allowing such passage were still lacking, developments apperaed to point to a steady growth of a feeling of necessity for such a rule. A definite treaty solution of the demarcation problem would require further study which should be carried out by the UN Outer Space Committee in close co-operation with other interested international organizations, including ICAO. If a limit between air space and outer space were established, air space would automatically come under the regime of the Chicago Convention alone. The use of the word "recognize" in Art. I of chicago convention is an acknowledgement of sovereignty over airspace existing as a general principle of law, the binding force of which exists independently of the Convention. Further it is important to note that the Aricle recognizes this sovereignty, as existing for every state, holding it immaterial whether the state is or is not a contracting state. The functional criteria having been created by reference to either the nature of activity or the nature of the space object, the next hurdle would be to provide methods of verification. With regard to the question of international verification the establishment of an International Satelite Monitoring Agency is required. The path towards the successful delimitation of outer space from territorial space is doubtless narrow and stony but the establishment of a precise legal framework, consonant with the basic principles of international law, for the future activities of states in outer space will, it is still believed, remove a source of potentially dangerous conflicts between states, and furthermore afford some safeguard of the rights and interests of non-space powers which otherwise are likely to be eroded by incipient customs based on at present almost complete freedom of action of the space powers.

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The Legal nature of a contract for supply of a special purpose aircraft -The legitimacy of contract cancellation on the grounds that the performance specification is not satisfied in the purchase specification- (특수 항공기 공급계약의 법적 성질 - 구매규격서상 성능요건 미달을 이유로 한 계약해제의 정당성 -)

  • Kwon, Chang-Young
    • The Korean Journal of Air & Space Law and Policy
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    • v.31 no.2
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    • pp.37-72
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    • 2016
  • In the aerospace field, besides special purpose airplanes, contracts for supply of various types of products such as prototypes, unmanned aerial vehicles and space launch vehicles are increasing. In the case of the contractor, it was planned to spend a large amount of money to supply the production, but if the purchase specification that presents the quality and performance standard of the product is poor or lacks the capacity to judge the performance, consuming enormous amounts of time and money. Even if the undertaker does not have the ability to supply the products with the required performance and quality to achieve the purpose of the contract, he/she must pay the cost of burial due to the incompleteness of the work and the compensation for the cancellation of the contract. In this case, the defendant ordered the plaintiff to supply the aircraft by the Happy Box method, which is capable of ILS Offset flight as specified in the Purchase Specification, but the plaintiff attempted to supply the aircraft by the RNAV method. Although the ILS ground signal can be inspected by the RNAV method, the aircraft manufactured in the manner claimed by the plaintiff does not have the ILS Offset flight function required by the purchase specification, so the defendant can not achieve the purpose required by the purchase specification. It was a question of whether a defendant's cancellation of contract was legitimate. The aircraft, which is the object of this contract, is a subordinate substitute, so the case contract is of undertaking. Therefore, in order to complete the work in this contract, the major structural parts of the aircraft must be manufactured as agreed and have the performance generally required in the social sense. However, the aircraft delivered by the plaintiff has serious defects because the defendant can not achieve the purpose required by the purchase specification due to the lack of the ILS Offset flight function required by the purchase specification. This deficiency is impossible for the plaintiff to repair, so the defendant 's cancellation of the contract is legitimate.

The Production Structure of Genetic Information in South Korea (한국의 유전적 정보 생산 구조)

  • Yi Cheong-Ho
    • Journal of Science and Technology Studies
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    • v.5 no.1 s.9
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    • pp.55-92
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    • 2005
  • The factors contributing to the formation of an important scientific concept in South Korea and its circulation in the society are the scientific knowledge that had been already formed, matured, and established in the U.S.A, Europe and Japan and has been introduced into Korea, and the institutions that have been formed during the recent modernization in South Korea. The concept of 'genetic information' cannot be an exception in this context. The concept of genetic information is the one that has been extended and intensified by the genomics and bioinformatics formed and matured through the Human Genome Projects from the former concept of inheritance or heredity within the framework of classical and molecular genetics. The purpose of this study was to find out 'how the production structure of genetic information in South Korea has been formed', under the perspective of the conceptual, epistemic, and institutional holisticity or integratedness in the concept and knowledge production structure idealized in Western advanced nations. The discourse of genetic engineering popular in the mid 1980's in South Korea has catalyzed the development of molecular biology. However, the institutional balance that had been established for the biochemistry departments in Natural Science College and Medical College was not formed between the genetic engineering and genetics departments in South Korea. Therefore, they were unable to achieve the more integrative and macro-level disciplinary impact on life sciences, largely due to institutional lack of the capable (human) genetics departments in some leading Korean colleges of Medicine. In genomics, the cutting-edge reprogramming and restructuring of the traditional genetics in the West, South Korea has not invested, even meagerly, in the infrastructure, fund, and research and development (R & D) for the Basic or First Phase of the research trajectory in the Human Genome Project. Without a minimal Basic Phase, the genomics research and development in Korea has been running more or less for the Advanced or Second Phase. Bioinformatics has started developing in Korea under a narrow perspective which regards it as a mere sub-discipline of information technology (IT). Having developed itself in parallel with genomics, bioinformatics contains its own unique logics and contents that can be both directly and indirectly connected to the information science and technology. As a result, bioinformatics reveals a defect in respect of being synergistically integrated into genetics and life sciences in Korea. Owing to the structural problem in the production, genetic information appears to be produced in a fragmented pattern in the Korean society since its fundamental base is weak and thin. A good example of the conceptual and institutional fragmentedness is that 'the genetics of individual identification' is not a normal integrated part of the Korean genetics, but a scientific practice exercised in the departments of legal medicine in a few Medical Colleges. And the environment contributing to the production structure of genetic information in South Korea today comprises 'sangmyung gonghak'(or life engineering) discourse and non-governmental organization movement.

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THE EFFECT OF NEW BONE FORMATION OF ONLAY BONE GRAFT USING VARIOUS GRAFT MATERIALS WITH A TITANIUM CAP ON THE RABBIT CALVARIUM (가토의 두개골에서 티타늄 반구를 이용한 다양한 onlay bone graft시 골형성 능력)

  • Park, Young-Jun;Choi, Guen-Ho;Jang, Jung-Rok;Jung, Seung-Gon;Han, Man-Seung;Yu, Min-Gi;Kook, Min-Suk;Park, Hong-Ju;Ryu, Sun-Youl;Oh, Hee-Kyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.31 no.6
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    • pp.469-477
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    • 2009
  • Purpose: This study was performed to evaluate the effect of various graft materials used with a titanium cap on the ability of new bone formation in the rabbit calvarium. Materials and Methods: A total of 32 sites of artificial bony defects were prepared on the calvaria of sixteen rabbits by using a trephine bur 8 mm in diameter. Each rabbit had two defect sites. 0.2 mm deep grooves were formed on the calvaria of sixteen rabbits by using a trephine bur 8 mm in diameter for the fixation of a titanium cap. The treatments were performed respectively as follows: without any graft for the control group (n=8), autogenous iliac bone graft for experimental group 1 (n=8), alloplastic bone graft ($SynthoGraft^{(R)}$, USA) for experimental group 2 (n=8), and xenogenic bone graft ($NuOss^{(R)}$, USA) for experimental group 3 (n=8). After the treatments, a titanium cap (8 mm in diameter, 4 mm high, and 0.2 mm thick) was fixed into the groove. At the third and sixth postoperative weeks, rabbits in each group were sacrificed for histological analysis. Results: 1. In gross examination, the surgical sites showed no signs of inflammation or wound dehiscence, and semicircular-shaped bone remodeling was shown both in the experimental and control groups. 2. In histological analysis, the control group at the third week showed bone remodeling along the inner surface of the cap and at the contact region of the calvarium without any specific infiltration of inflammation tissue. Also, there was no soft tissue infiltration. Bone remodeling was observed around the grafted bone and along the inner surface of the titanium cap in experimental group 1, 2, and 3. 3. Histologically, all groups at the sixth week showed the increased area of bone remodeling and maturation compared to those at the third week. In experimental group 2, the grafted bone was partially absorbed by multi nucleated giant cells and new bone was formed by osteoblasts. In group 3, however, resorption of the grafted bone was not observed. 4. Autogenous bone at the third and sixth week showed the most powerful ability of new bone formation. The size of newly formed bone was in decreasing order by autogenous, alloplastic, and heterogenous bone graft. There was no statistically significant difference among autogenous, alloplastic, and heterogenous bones(p>0.05). Summary: This result suggests that autogenous bone is the best choice for new bone formation, but when autogenous bone graft is in limited availability, alloplastic and xenogenic bone graft also can be an alternative bone graft material to use with a suitably guided membrane.

Changes in midpalatal suture area and adjacent periodontal tissues of individual tooth following rapid palatal expansion in young adult dogs ; Histomorphologic and immunohistochemical study (유성견 급속 구개확장시 정중구개봉합부 및 치아주위 조직 변화에 관한 조직형태학적 및 면역조직화학적 연구)

  • Lee, Ju-Young;Lee, Jin-Woo;Cha, Kyung-Suk
    • The korean journal of orthodontics
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    • v.30 no.3 s.80
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    • pp.317-333
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    • 2000
  • The purpose of this study was to determine the proliferative activity of the osteoblasts and fibroblasts in the midpalatal area and to investigate the adjacent periodontal tissues of individual tooth following rapid expansion of the palate. Ten young adult dogs, aged approximately ten months, were used in the experiment. The experimental design was consisted of 1 week expansion group(Group E1, 3 dogs), 2 week expansion group(Group E2, 3 dogs), 2 week expansion and 2 week retention group(Group E3, 3 dogs), and control group(Group C, 1 dog). For each group, expansion screw was activated one time per day(1/4 turn;$90^{\circ}$) following Hyrax-screw application. The experimental animals in each group were sacrificed at 1, 2 and 4 weeks following palatal expansion. Maxillary tissue blocks were obtained and prepared ior the histomorphologic and immunohistochemical studies. Light mcroscope, polarizing microscope, and soft X-ray apparatus were used in this study, and following results were obtained. 1. In polarizing microscopic study, the expansion groups(E1 & E2) showed blue color representing bone resorption and new bone formation in midpalatal suture area. E3 groups skewed less blue color compared to the E1 and E2 group. But yellow color increased by calcification in the E3 groups. 2. Immunohistochemical study revealed that positive responses of the osteoblasts to PCNA and undifferentiated fibroblasts to EGF in E1 group were somewhat increased. Positive response to PCNA and EGF were increased in fibroblasts and the osteoblasts forming new bone in E2 group. In E3 group, the positive response cell concentrated the periphery of edge of palatal process in both PCNA and EGF. 3. Throughout the expansion period(E1 & E2), light microscopic study showed the edges of the extensive resorption and new palatal processes, indicating bone remodeling within the suture. E3 group exhibited less remodeling of midpalatal suture area. E2 group and E3 group showed cementum formation and resorption at the apex of 3rd premolar and 1st molar E3 group exhibited extensive hyalinized zone on the cervical portion of buccal side of 1st molar. 4. Soft X-ray analysis of E1 group showed hypomineralized defect and microfractures in various parts of the suture areas when compared with control animals. There was no significant difference in the degree of mineralization in the midpalatal suture region between the C and E3 groups. Tooth axis showed tipping of 3rd premolar and 1st molar in the E2 group and E3 group. Based upon these experimental results, it is concluded that the undifferentiated mesenchymal cells always presented in midpalatal suture area following RPE. Differentiated osteoblasts and fibroblasts possess proliferating cellular activity until the 2 week retention period. The posterior teeth are tend to tip buccally as RPE force applied. Retention group exhibited irreversible response with severe hyalinized zone on the buccal surface of the first molar.

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Accuracy of Spirometry at Predicting Restrictive Pulmonary Impairment (제한성 환기장애의 진단에서 폐활량검사의 정확성)

  • Ahn, Young Mee;Koh, Won-Jung;Kim, Cheol Hong;Lim, Seong Yong;An, Chang Hyeok;Suh, Gee Young;Chung, Man Pyo;Kim, Hojoong;Kwon, O Jung
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.3
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    • pp.330-337
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    • 2003
  • Background : Low spirometric forced vital capacity(FVC) in conjunction with a normal or high ratio of the forced expiratory volume at 1 second to the forced vital capacity($FEV_1$/FVC%) has traditionally been classified as a restrictive abnormality. However, the gold-standard diagnosis of a restrictive pulmonary impairment requires a measurement of the total lung capacity (TLC). This study was performed to determine the predictive value of spirometric measurements of the FVC for diagnosing a restrictive pulmonary abnormality. Methods : Test results from 1,371 adult patients who undertook both spirometry and lung volume measurements on the same visit from January 1999 to December 2000 were enrolled in this study. The test values for the FVC, the TLC that was below 80% of predicted value, and a $FEV_1$/FVC% that was below 70%, were classified as being abnormal. Results : Of the 1,371 patients, 353 patients had a reduced a FVC. Of these patients, 186 patients had a reduced TLC. Therefore, the positive predictive value was 52.7%. Of the 196 patients with a normal $FEV_1$/FVC% and a reduced FVC, 148(75.5%) patients had a lower TLC. Thirty eight (24.2%) patients out of 157 patients with a low $FEV_1$/FVC% and a low FVC showed a restrictive defect. Conclusion : Spirometry is useful to rule out a restrictive pulmonary abnormality, but a restrictive pattern on the spirometry dose not mean there is a true restrictive disease. For the patients with a low FVC, TLC measurements are essential for diagnosing a restrictive pulmonary impairment.

Clinical Value of a Desktop Spirometer (HI-801) for Spirometry Screening (선별 검사를 위한 탁상용 폐활량기 (HI-801)의 임상적 유용성에 관한 고찰)

  • Choi, Hye Sook;Choi, Cheon Woong;Park, Myung Jae;Kang, Hong Mo;Yoo, Hong Ji
    • Tuberculosis and Respiratory Diseases
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    • v.62 no.4
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    • pp.276-283
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    • 2007
  • Background: A national health care initiative recommends routine spirometry screening of all smokers over age 45 or patients with respiratory symptoms. In response to the recommendation, new, simple, and inexpensive desktop spirometers for the purpose of promoting widespread spirometric screening were marketed. The performance of these spirometers was evaluated in vivo testing with healthy subjects. However, the clinical setting allows spirometric assessment of various pathologic combinations of flow and volume. Objective: The aim of this study was to compare the accuracy of a desktop spirometer to a standard laboratory spirometer, in a clinical setting with pathologic pulmonary function. Method: In a health check-up center, where screening pulmonary funct test was performed using the HI-801 spirometer. Subjects who revealed the ventilation defect in screening spirometry, performed the spirometry again using the standard Vmax spectra 22d spirometer in a tertiary care hospital pulmonary function laboratory. Pulmonary function test with both spirometer was performed according to the guidelines of the American Thoracic Society. Results: 109 patients were enrolled. Pulmonary function measurements (FVC, $FEV_1$, PEFR, FEF25%-75%) from the HI-801 correlated closely (r=0.94, 0.93, 0.81, 0.84, respectively) with those performed with the Vmax spectra 22d and showed the good limits of agreement and differences between the 2 devices; FVC +0.35 L, $FEV_1$ +0.16 L, PEFR +1.85 L/s, FEF25%-75%-0.13 L/s. With the exception of $FEV_1$, FEF25%-75%, these differences were significant(p<0.05) but small. Conclusion: The HI-801 spirometer is comparable to the standard laboratory spirometer, Vmax spectra 22d, with high accurary for $FEV_1$ and FVC and acceptable differences for clinical use.

Clinical features and surgical results of ruptured sinus of valsalva aneurysm (발살바동 동맥류 파열의 임상적 고찰)

  • Lee, Tae Ho;Lee, Dong Won;Cho, Joon Yong;Hyun, Myung Chul;Lee, Sang Bum
    • Clinical and Experimental Pediatrics
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    • v.49 no.3
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    • pp.287-291
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    • 2006
  • Purpose : Aneurysms of sinus valsalva are rare anormalies thought to be primarily congenital in origin, progressing into death by acute heart failure in cases of rupture. Surgical correction is the only method of treatment. With these clinical implications, we reviewed the clinical characteristics and surgical results of patients with ruptured sinus of valsalva aneurysm. Methods : Between January 1991 and February 2004, 17 patients with ruptured sinus of valsalva aneurysm were retrospectively reviewed for their clinical symptoms, physical findings, past history, coexistent cardiac anormalies, surgical results, and mid-term prognosis. Results : The 17 patients included 13 men and four women, with a mean age of 30 years(10-59 years). Preoperatively accompanying cardiac anormalies were ventricular septal defect(VSD, eight cases of doubly committed juxta-arterial VSD) and aortic insufficiency(11 cases). During operations, patterns of fistulous tracts were found to be right colonary sinus-right ventricle in 13 patients, right coronary sinus-right atrium in one, noncoronary sinus - right ventricle in two, noncoronary sinus - right atrium in one, and VSD was noticed in 14 patients(all were doubly committed juxta-arterial in type). The defects were closed with a patch in 13 patients, without a patch in four, with concommitant aortic valve replacement in four and with aortic valvuloplasty in two. There were no mortalities during operations or the mid-term follow-up periods($40{\pm}49$ months). Conclusion : Because, at least in Orientals, VSD(especially doubly committed juxta-arterial) was accompanied in large numbers of patients with aneurysms of sinus valsalva, preoperative evaluations of this congenital heart disease should be made very careful. And we may need to revise the algorithm of treatment policy in small sized doubly committed juxta-arterial VSD.

Clinical Characteristics and Genetic Analysis of Prader-Willi Syndrome (Prader-Willi 증후군의 임상 양상 및 유전학적 진단에 관한 고찰)

  • Lee, Ji Eun;Moon, Kwang Bin;Hwang, Jong Hee;Kwon, Eun Kyung;Kim, Sun Hee;Kim, Jong Won;Jin, Dong Kyu
    • Clinical and Experimental Pediatrics
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    • v.45 no.9
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    • pp.1126-1133
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    • 2002
  • Purpose : Prader-Willi syndrome(PWS) is a complex disorder affecting multisystems with characteristic clinical features. Its genetic basis is an expression defect in the paternally derived chromosome 15q11-q13. We analyzed the clinical features and genetic basis of PWS patients for early detection and treatment. Methods : We retrospectively studied 24 patients with PWS in Department of Pediatrics, Samsung Medical Center, from September 1997 to September 2001. We performed cytogenetic and molecular genetic techniques using high resolution GTG banding techniques, fluorescent in situ hybridization and methylation-specific PCR for CpG island of SNRPN gene region. Results : The average birth weight of PWS patients was $2.67{\pm}0.47kg$ and median age at diagnosis was 1.3 years. The average height and weight of PWS patients under one year at diagnostic time were located in a 3-10 percentile relatively, and a rapid weight gain was seen between two and six years. Feeding problems in infancy and neonatal hypotonia were the two most consistently positive major criteria in over 95% of the patients. In 18 of the 24 cases(75%), deletion of chromosome 15q11-q13 was demonstrated and one case among 18 had an unbalanced 14;15 translocation. In four cases without any cytogenetic abnormality, it may be considered as maternal uniparental disomy and the rest showed another findings. Conclusion : We suggest diagnostic testing for PWS in all infants/neonates with unexplained feeding problems and hypotonia. It is necessary for clinically suspicious patients to undergo an early genetic test. As the genetic basis of PWS was heterogenous and complex, further study is required.