• Journal of Chest Surgery
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• 제31권5호
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• pp.472-480
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• 1998

서울대학교 어린이병원 흉부외과에서는 1990년부터 1996년까지 104례의 기능적 단심실을 가진 선천성심기형 환아에 대하여 심장내 외측통로술을 이용한 완전폰탄술을 시행하였다. 환아의 연령 및 체중분포는 각각 평균 35.9(범위 10-72) 개월, 12.8 (범위 6.5-37.8) kg이었다. 술전진단은 삼첨판폐쇄증(18), 단심실연결을보이는 중복개구심실(53) 및 기타 기능적 단심실을 동반한 복잡심기형(33)이었다, 50례의 환아에 대하여 체폐동맥 단락술 (37), 폐동맥밴딩(13), 외과적 심방중격절제술(15), 동맥전환술(2), 대동맥하 누두부제거술(2), 총폐정맥이상연결증(2), 폐동맥-대동맥봉합술(Damus-Stansel-Kaye, 1) 등의 고식술이 시행되었다. 완전폰탄술식전 19례의 양방향성 체정맥-폐동맥단락술과 1례의 전(全)체정맥-폐동맥단락술(Kawashima procedure)이 진행되었다. 술전 혈역학소견상, 평균 폐동맥압/폐혈관저항은 14.6 (범위 5-28mmHg) / 2.2 (범위0.4-6.9)wood.unit였으며, 폐혈류/체혈류비가 평균 0.9 (범위0.3-3.0)였다. 이완기말심실압은 평균 9.0 (범위 3.0-21.0) mmHg였고 동맥혈의 산소포화도는 평균 76.0 (범위 45.6-88.0) %였다. 수술은 분계능(terminal crest) 2cm 외측으로 우심이부터 우심방-하공정맥경계부에 종절개를 가하고 하공정맥개구부부터 상공정맥개구부 또는 우심이까지 Gore-Tex 인조도관을 이용하여 외측통동을 형성시키는 방법으로 시행하였으며 필요한 경우 통로상에 4-5.5 mm 직경의 구멍을 만들어 주었다. 동시에 시행한 술식은, 폐동맥성형술(22), 심방중격절제술(21), 폐정맥이상연결증 교정(4), 영구적인 인공심박동기거치(3) 등이었고, 32례에 대하여 통로내 구멍을 만들어 주었으며 그중 1례는 조절형(adjustable)으로 시행하였다. 심방-폐동맥 연결 방법으로 시행한 폰탄술 후 4년후에 발생한 재발성 난치성 상심실형 부정맥환아 1례에 대하여 외측통로형의 변환 폰탄술식이 시행되었다. 수술 직후 혈역학 소견상 평균 폐동맥압, 이완기말심실압, 실온에서 동맥혈의 산소포화도가 각각 12.7 (8-21)mmHg, 7.6 (범위4-12)mmHg, 89.9 (범위68-100) %였다. 병원사망율은 6.7 (7/104) %였고 술후 합병증으로 지속적인 늑막삼출(11), 부정맥(8), 유미흉(9), 중추신경계손상(5), 감염 및 염증(5), 급성신부전(4)이 발생하였다. 평균 27.2 (범위1-85) 개월동안의 외래 추적결과 5명의 만기 사망이 있었다. 저자등은 본연구결과를 토대로 심장내 외측통동폰탄술식이 기능적 단심실 환자에 대하여 비교적 낮은 사망율 및 합병증과 우수한 혈역학으로 시행될수 있는 수술방법이란 사실을 입증하였다.

• 천문학회지
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• 제29권spc1호
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• pp.63-64
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• 1996

The nature of distant faint blue field galaxies remains a mystery, despite the fact that much attention has been devoted to this subject in the last decade. Galaxy counts, particularly those in the optical and near ultraviolet bandpasses, have been demonstrated to be well in excess of those expected in the 'no-evolution' scenario. This has usually been taken to imply that galaxies were brighter in the past, presumably due to a higher rate of star formation. More recently, redshift surveys of galaxies as faint as B$\~$24 have shown that the mean redshift of faint blue galaxies is lower than that predicted by standard evolutionary models (de-signed to fit the galaxy counts). The galaxy number count data and redshift data suggest that evolutionary effects are most prominent at the faint end of the galaxy luminosity function. While these data constrain the form of evolution of the overall luminosity function, they do not constrain evolution in individual galaxies. We are carrying out a series of observations as part of a long-term program aimed at a better understanding of the nature and amount of luminosity evolution in individual galaxies. Our study uses the luminosity-linewidth relation (Tully-Fisher relation) for disk galaxies as a tool to study luminosity evolution. Several studies of a related nature are being carried out by other groups. A specific experiment to test a 'no-evolution' hypothesis is presented here. We have used the AUTOFIB multifibre spectro-graph on the 4-metre Anglo-Australian Telescope (AAT) and the Rutgers Fabry-Perot imager on the Cerro Tolalo lnteramerican Observatory (CTIO) 4-metre tele-scope to measure the internal kinematics of a representative sample of faint blue field galaxies in the red-shift range z = 0.15-0.4. The emission line profiles of [OII] and [OIII] in a typical sample galaxy are significantly broader than the instrumental resolution (100-120 km $s^{-l}$), and it is possible to make a reliable de-termination of the linewidth. Detailed and realistic simulations based on the properties of nearby, low-luminosity spirals are used to convert the measured linewidth into an estimate of the characteristic rotation speed, making statistical corrections for the effects of inclination, non-uniform distribution of ionized gas, rotation curve shape, finite fibre aperture, etc.. The (corrected) mean characteristic rotation speed for our distant galaxy sample is compared to the mean rotation speed of local galaxies of comparable blue luminosity and colour. The typical galaxy in our distant sample has a B-band luminosity of about 0.25 L$\ast$ and a colour that corresponds to the Sb-Sd/Im range of Hub-ble types. Details of the AUTOFIB fibre spectroscopic study are described by Rix et al. (1996). Follow-up deep near infrared imaging with the 10-metre Keck tele-scope+ NIRC combination and high angular resolution imaging with the Hubble Space Telescope's WFPC2 are being used to determine the structural and orientation parameters of galaxies on an individual basis. This information is being combined with the spatially resolved CTIO Fabry-Perot data to study the internal kinematics of distant galaxies (Ing et al. 1996). The two main questions addressed by these (preliminary studies) are: 1. Do galaxies of a given luminosity and colour have the same characteristic rotation speed in the distant and local Universe? The distant galaxies in our AUTOFIB sample have a mean characteristic rotation speed of $\~$70 km $s^{-l}$ after correction for measurement bias (Fig. 1); this is inconsistent with the characteristic rotation speed of local galaxies of comparable photometric proper-ties (105 km $s^{-l}$) at the > $99\%$ significance level (Fig. 2). A straightforward explanation for this discrepancy is that faint blue galaxies were about 1-1.5 mag brighter (in the B band) at z $\~$ 0.25 than their present-day counterparts. 2. What is the nature of the internal kinematics of faint field galaxies? The linewidths of these faint galaxies appear to be dominated by the global disk rotation. The larger galaxies in our sample are about 2"-.5" in diameter so one can get direct insight into the nature of their internal velocity field from the $\~$ I" seeing CTIO Fabry-Perot data. A montage of Fabry-Perot data is shown in Fig. 3. The linewidths are too large (by. $5\sigma$) to be caused by turbulence in giant HII regions.