• Journal of Chest Surgery
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• 제25권1호
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• pp.32-41
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• 1992

From August 1982 to December 1991, 58 consecutive infants with tetralogy of Fallot underwent primary repair. Age ranged from 22 days to twelve months [n=58, 8.7$\pm$2.7 months] and body weight from 3.1 to 13 kilograms [n=58, 7.8$\pm$1.7 kilograms]. Qne infant had absence of the pulmonary valve; one had Ebstein`s anomaly and one had supramitral ring. Thirty-two patients [56%] experienced anoxic spell. Preoperative pulmonary artery indices were measured in 38 cases, ranging 126-552mm2/M2BSA[n=38, 251$\pm$79mm2/M2BSA]. All infants required a right ventricular outflow tract patch; in 41, the patch extended across the pulmonary valve annulus, in 13 of them, monocusps were constructed. All had patch closure of ventricular septal defect. Two infants had REV operation for avoiding injury to the canal branch of the right coronary artery which cross the right ventricular out flow tract. Post repair PRV/LV were measured at operating room in 40 cases, which revealed mean value of 0.49$\pm$0.12 [range: 0.25-0.74]. The hospital mortality was 10.3% [6 patients], and causes of deaths were right heart failure due to sustained right ventricular hypertension[4] and right ventricular outflow tract obstruction, intractablesuraventricular tachyarrhythmia[1], hypoxia[1] due to residual right to left shunt across the atrial septal defect in patient associated with Ebstein`s anomaly. All infants were doing well at follow-up from 1 to 101 months[20.6 months /patient, 1, 072 patient-month] Serial postoperative echocardiograms revealed no residual ventricular septal defects and estimated RVOT gradients between 0 and 40 mmHg except 3 cases [50, 50, 60 mmHg]. There were no late deaths and late ventricular arrhythmias or congestive heart failure. Redo operations were done in 2 cases because of residual right ventricular outflow tract obstruction. This experience with infants with tetralogy of Fallot suggests that, if mortality is tolerable, eletive repair of tetralogy of Fallot could be reasonably undertaken during the first year of life, and even better results could be anticipated along with improvement of methods of myocardial protection and postoperative care.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권3호
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• pp.94-102
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• 2014

Purpose: This study aims to validate the effect of autoclaved autogenous bone (AAB), incorporating Escherichia coli-derived recombinant human bone morphogenetic protein-2 (ErhBMP-2), on critical-sized, segmental radius defects in rabbits. Delivery systems using absorbable collagen sponge (ACS) and fibrin glue (FG) were also evaluated. Methods: Radius defects were made in 12 New Zealand white rabbits. After autoclaving, the resected bone was reinserted and fixed. The animals were classified into three groups: only AAB reinserted (group 1, control), and AAB and ErhBMP-2 inserted using an ACS (group 2) or FG (group 3) as a carrier. Animals were sacrificed six or 12 weeks after surgery. Specimens were evaluated using radiology and histology. Results: Micro-computed tomography images showed the best bony union in group 2 at six and 12 weeks after operation. Quantitative analysis showed all indices except trabecular thickness were the highest in group 2 and the lowest in group 1 at twelve weeks. Histologic results showed the greatest bony union between AAB and radial bone at twelve weeks, indicating the highest degree of engraftment. Conclusion: ErhBMP-2 increases bony healing when applied on AAB graft sites. In addition, the ACS was reconfirmed as a useful delivery system for ErhBMP-2.

• 핵의학기술
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• 제13권3호
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• pp.67-75
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• 2009

목적 : Tl-201 심근관류 SPECT의 정량적 평가를 위해 사용되는 다양한 프로그램은 자료의 분석 방법에 있어서 각각 차이가 있는 것으로 보고되고 있다. 따라서 동일한 환자의 자료를 대상으로 정량적 분석을 하여도 프로그램 상호간의 측정치 오차가 발생할 것으로 예상된다. 그 중 심근의 관류결손 정도를 표현할 수 있는 정량적 지표를 이용하여 현재 각 병원에서 가장 일반적으로 사용하고 있는 심근관류분석 프로그램 QPS (Quantitative Perfusion SPECT)와 4DM (4DMSPECT) 그리고 ECT (Emory Cardiac Toolbox)의 분석값을 이용하여 프로그램 상호간의 연관성을 알아보고자 한다. 실험재료 및 방법 : 2008년 12월 1일 부터 2009년 2월 14까지 서울아산병원 핵의학과에서 Tl-201을 이용하여 게이트 심근관류 SPECT를 시행한 환자 145명을 대상으로 하였다. 이들 중 심혈관 질환의 가능성이 비교적 적다고 판단된 정상군 80(남/여=38/42, $65.1{\pm}9.9$세)명과 게이트 심근관류 SPECT의 판독결과를 통해 가역성 관류결손이나 고정 관류결손 등 심혈관 질환의 판정을 받은 비정상군 65(남/여=45/20, $63.0{\pm}8.7$세)명을 선별하였다. QPS와 4DM 그리고 ECT 프로그램을 이용하여 각각의 군에서 분석된 정량적 지표인 LAD, LCX, RCA 영역에서의 관류결손 범위율의 합(Total Defect Extent, TDE)과 부하기 관류점수합(Summed Stress Score, SSS)을 이용하여 상관관계 분석과 차이분석(paired t-test, Bland-Altman)을 이용하여 통계 결과를 비교 분석하였다. 결과 : 연구 대상 145명의 4DM:QPS, QPS:ECT, ECT:4DM 프로그램의 상관 계수는 SSS에서 각각 0.84, 0.86, 0.82이었고, TDE에서 각각 0.87, 0.84, 0.87로 SSS와 TDE 모두 높은 상관관계가 있었다. paired t-test 분석 결과에서는 QPS:ECT만 SSS (p=0.92)와 TDE (p=0.33) 모두 통계적으로 유의한 차이가 없었고, 4DM:QPS, ECT:4DM은 SSS와 TDE 모두 통계적으로 유의한 차이가 있었다(p<0.01). 비정상군 65명의 4DM/QPS, QPS/ECT, ECT/4DM 프로그램의 상관 계수는 SSS에서 각각 0.72, 0.72, 0.70이었고, TDE에서 각각 0.77, 0.70, 0.77로 SSS와 TDE 모두 높은 상관관계가 있었다. 비정상군 역시 paired t-test 분석 결과 QPS:ECT만 SSS (p=0.89)와 TDE (p=0.23) 모두 통계적으로 유의한 차이가 없었고, 4DM : QPS, ECT:4DM은 SSS와 TDE 모두 통계적으로 유의한 차이가 있었다(p<0.01). 정상군 80명의 분석 결과에서도 QPS : ECT만 SSS (p=0.95)와 TDE (p=0.73) 모두 통계적으로 유의한 차이가 없을 뿐, 4DM:QPS, ECT:4DM은 SSS와 TDE 모두 통계적으로 유의한 차이가 있었다(p<0.01). 결론 : 심혈관 질환을 가진 환자뿐 아니라 심혈관 질환의 가능성이 적은 환자에서도 Tl-201 심근 관류 SPECT의 관류 결손을 분석한 결과, 4DM은 QPS와 ECT 프로그램에 비해 SSS와 TDE 모두 낮게 분석되는 경향을 보였지만 프로그램 상호간에는 좋은 상관관계가 있다는 것을 확인 할 수 있었다. 하지만 이와 같이 좋은 상관관계에도 불구하고 Bland-Altman 분석 결과에서 프로그램간의 큰 변이 차이 때문에 임상에서 각각의 프로그램을 이용한 분석값을 서로 호환하여 사용할 수는 없을 것으로 판단된다. 그렇지만 이러한 분석결과는 임상적인 판독을 위한 참고 자료로서 유용하게 이용될 수 있을 것이라 기대된다.

• Childhood Kidney Diseases
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• 제21권1호
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• pp.35-39
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• 2017

Azathioprine is commonly used as immunosuppressive therapy for various inflammatory diseases including chronic glomerulonephritis. Myelosuppression is a common side effect of azathioprine, resulting in the need for dose reduction. However, severe pancytopenia or alopecia is not often encountered. Here, we report a case of severe myelosuppression, and alopecia totalis that occurred after azathioprine treatment in a patient with IgA nephropathy. A 10-year-old boy with IgA nephropathy was treated with oral deflazacort and later with azathioprine. After 4 weeks, the patient complained of hair loss, and despite a dose reduction in azathioprine, he developed bone marrow suppression and alopecia totalis in two weeks. The blood indices and alopecia of the patient had returned to normal after azathioprine withdrawal and 3 consecutive doses of granulocyte colony-stimulating factor. We suggest that physicians remain vigilant to the side effects of azathioprine. Unusual hair loss after azathioprine treatment might suggest a defect in the metabolism of the drug, warranting the discontinuation of azathioprine to prevent more severe side effects.

• Smart Structures and Systems
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• 제14권4호
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• pp.569-594
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• 2014

Damage detection methods based on modal analysis have been widely studied in recent years. However the calculation of mode shapes in real structures can be time consuming and often requires dedicated software programmes. In the present paper the combined application of proper orthogonal decomposition and gapped smoothing method to structural damage detection is presented. The first is used to calculate the dynamic shapes of a damaged structural element using only the time response of the system while the second is used to derive a reference baseline to which compare the data coming from the damaged structure. Experimental verification is provided for a beam case while numerical analyses are conducted on plates. The introduction of a stiffener on a plate is investigated and a method to distinguish its influence from that of a defect is presented. Results highlight that the derivatives of the proper orthogonal modes are more effective damage indices than the modes themselves and that they can be used in damage detection when only data from the damaged structure are available. Furthermore the stiffened plate case shows how the simple use of the curvature is not sufficient when analysing complex components. The combined application of the two techniques provides a possible improvement in damage detection of typical aeronautical structures.

• Journal of Periodontal and Implant Science
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• 제40권5호
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• pp.249-253
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• 2010

Purpose: The purpose of this study was to evaluate the improvement of periodontal health of generalized aggressive periodontitis (GAgP) diagnosed patients treated with non-surgical periodontal therapy accompanying systemic antibiotics administration. Methods: Two patients with GAgP were chosen for this study. Clinical indices were taken and a radiographic examination was performed at the baseline of the study and they were treated by periodontal therapy accompanying systemic antibiotics administration. Post-surgical visits were scheduled at regular intervals to check clinical and radiographic changes. Results: Through non-surgical periodontal therapy accompanying systemic antibiotics administration, GAgP patients showed decreased probing pocket depth, sulcus bleeding index, and increased attachment level and clinical index when comparing the initial and six month follow up data. In the six month follow-up radiographic examination after non-surgical periodontal therapy, resolution of the bony defect was observed. Conclusions: Non-surgical therapy combined with systemic antibiotics administration in GAgP patients is suggested to be an effective approach to enhance the periodontal health.

• Journal of Chest Surgery
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• 제56권3호
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• pp.155-161
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• 2023

Background: Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. Methods: A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. Results: During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m², p=0.025). Conclusion: Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.740-746
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• 2011

Purpose: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. Methods: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. Results: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative. Conclusion: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

• 대한기계학회논문집A
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• 제35권10호
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• pp.1205-1210
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• 2011

척추 불안정성은 요통과 관련되어 있다고 알려져 있다. 하지만 척추 불안정성과 관련된 임상적 연구가 충분하지 않아서 불안정성의 정의가 정량적으로 확립되어 있지 않다. 또한 추간판 퇴행 및 손상, 인대 결손, 협부 결손 등이 불안정성을 발생시키는 요인으로 알려져 있으나, 척추 불안정성에 미치는 영향이 명확하게 분석되어 있지 않다. 본 연구에서는 요추 단분절의 3 차원 유한요소 모델을 이용하여 인대 결손과 협부 결손이 단독 또는 복합적으로 척추 불안정성에 미치는 영향을 정량적으로 분석하였다. 여기서 굽힘 및 신전 시 척추의 시상각과 전위거리가 척추 불안정성을 나타내는 지표라고 가정하였다. 본 연구의 결과는 척추 불안정성의 원인과 기전을 이해하는데 도움이 될 수 있을 것이다.

• 대한임상검사과학회지
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• 제36권2호
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• pp.121-126
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• 2004

The primary goal of six sigma is to improve patient satisfaction, and thereby profitability, by reducing and eliminating defects. Defects may be related to any aspect of customer satisfaction: high product quality, schedule adherence, cost minimization, process capability indices, defects per unit, and yield. Many six sigma metrics can be mathematically related to the others. Literally, six means six standard deviations from the mean or median value. As applied to quality metrics, the term indicates that failures are at least six standard deviations from the mean or norm. This would mean about 3.4 failures per million opportunities for failure. The objective of six sigma quality is to reduce process output variation so that on a long term basis, which is the customer's aggregate experience with our process over time, this will result in no more than 3.4 defect Parts Per Million(PPM) opportunities (or 3.4 Defects Per Million Opportunities. For a process with only one specification limit (upper or lower), this results in six process standard deviations between the mean of the process and the customer's specification limit (hence, 6 Sigma). The results of applicative six sigma experiment studied on 18 items TP, ALB, T.B, ALP, AST, ALT, CL, CK, LD, K, Na, CRE, BUN, T.C, GLU, AML, CA tests in clinical chemistry were follows. Assessment of process performance fits within six sigma tolerance limits were TP, ALB, T.B, ALP, AST, ALT, CL, CK, LD, K, Na, CRE, BUN, T.C, GLU, AML, CA with 72.2%, items that fit within five sigma limits were total bilirubin, chloride and sodium were 3 sigma. We were sure that the goal of six sigma would reduce test variation in the process.