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Surgical Treatment of Mitral Stenosis (승모판막 협착증의 외과적 요법)

  • 김용진
    • Journal of Chest Surgery
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    • v.10 no.2
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    • pp.241-249
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    • 1977
  • Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

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Clinical Studies on Congenital Atrial Septal Defects in Koreans (심방중격결손증에 대한 임상적 고찰)

  • 이두연
    • Journal of Chest Surgery
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    • v.10 no.2
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    • pp.230-240
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    • 1977
  • Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

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Primary neurofibroma of the Diaphragm (횡격막에 발생한 신경섬유종 1례)

  • 유회성
    • Journal of Chest Surgery
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    • v.8 no.2
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    • pp.149-152
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    • 1975
  • In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

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Clinical Characteristics of Acute Pure Organophosphate Compounds Poisoning - 38 Multi-centers Survey in South Korea - (국내 유기인계 농약 중독 환자의 특성 분석 - 다기관 연구 보고 분석 -)

  • Lee, Mi-Jin;Kwon, Woon-Yong;Park, Joon-Seok;Eo, Eun-Kyung;Oh, Bum-Jin;Lee, Sung-Woo;Suh, Joo-Hyun;Roh, Hyung-Keun
    • Journal of The Korean Society of Clinical Toxicology
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    • v.5 no.1
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    • pp.27-35
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    • 2007
  • Purpose: Organophosphate (OP) compounds insecticides are the most commonly associated with serious human toxicity all over the world. The aim of this study was to identify sociocultural factors that contribute to high incidence of pure OP poisoning and prevent OP poisoning in order to reduce the factors responsible for deaths in South Korea. Methods: This is the 38 multi-centers survey and prospective study of pure OP poisoning by structural reporting system and hospital records from August 2005 to July 2006. 238 patients with acute pure OP poisoning were enrolled. We collected patient information regarding poisoning, clinical, and demographic features. Results: The mean age was $55.32{\pm}17.3$ years old. The most frequent site of exposure was their own residence(85.7%). Frequent compounds involving pure OP poisoning were dichlorvos(22.7%), methidathion(8.4%), and phosphamidon(6.7%). Intentional poisoning was 77.9%. The most frequently route of exposure was ingestion(94.5%). The mean arrival time to hospital after poisoning was 12.7 hours and mean hospitalization duration was 12.9 days. 2-PAM was administered to 101 patients in mean doses of 6.3 g/day intravenously. Atropine was administered to 81 patients in mean doses of 74.6 mg/day (maximal 910 mg/day). The presence of lower level of GCS score, respiratory complications, hypotension, acute renal failure, and serious dysrhythmia was associated with serious and fatal poisoning. Overall final mortality in pure OP poisoning was 9.7%(23/238). Conclusion: This study highlights the problem of pure OP poisoning in South Korea as a basic national survey. Futhermore this might help the establishment of strict policies availability of OP and the statistics of OP poison exposure in South Korea.

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Screening test of commercial catalysts for direct synthesis of Dimethyl ether from syngas produced using coal and waste (석탄 및 폐기물로부터 생산된 합성가스로부터 Dimethyl ether의 직접합성을 위한 상용촉매 스크린테스트)

  • Kim, Eun-Jin;Han, Gi-Bo;Park, No-Kuk;Ryu, Si-Ok;Lee, Tae-Jin
    • 한국신재생에너지학회:학술대회논문집
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    • 2005.11a
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    • pp.689-692
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    • 2005
  • 2020년까지 전 세계 수송에너지의 수요가 현재의 2배까지 증가할 것으로 예상되면서 석유 자원의 안정적 공급이 어려워지기 이전에 이를 대체할 수 있는 에너지원 개발이 시급하다. 이러한 노력의 일환으로 최근 들어 대두되고 있는 가스화용융 기술은 석탄 폐기물 등으로부터 합성가스를 생산하는 고청정 고효율 기술이다. 여기에서 생산되는 합성가스는 천연가스를 대체하여 전기 및 화학원료를 생산하기 위한 원료로 이용 가능하다. 폐기물로부터 가스화용융기술을 통하여 생산되는 합성가스로부터 DME(dimethyl ether)를 생산할 수 있다. 가스화용융기술로부터 생산되는 합성가스는 자체의 일산화탄소와 수소의 조성비가 DME를 합성하는데 적당하다고 알려져 있다. DME는 에너지원의 다원화와 대기오염 물질의 저감, 지구온난화 대응 등과 아울러 제 4세대 수송 연료로 부각되고 있다. DME를 합성하는 방법은 합성가스로부터 메탄올의 합성 단계를 거친 후 DME를 합성하는 간접법과 단일단계의 반응에서 합성가스로부터 직접적으로 DME를 합성하는 직접법이 있다. 현재는 화학 평형적 측면 경제적 측면에서 이점을 가지고 있는 직접법에 관한 연구가 활발히 이루어지고 있다. DME 직접합성법에서는 메탄올 합성 촉매와 메탄올 탈수촉매의 물리적 혼합에 의한 혼성촉매가 주로 이용되고 있는 것으로 알려져 있다 본 연구에서는 일산화탄소와 수소로 이루어진 합성 가스로부터 직접 DME를 생산할 수 있는 직접 합성 공정에 적용 가능한 고효율 촉매 기술을 개발하기 위해 상용촉매의 스크린 테스트를 수행하였다. 상용촉매로는 sud-chemi사에서 메탄을 합성 촉매와 탈수촉매를 각각 구입하였으며, 이들 촉매를 원하는 조성비로 물리적으로 혼합한 다음 반응온도 ($250-290^{\circ}C$) 압력 (30-50 atm), $H_2$/CO 몰비 (0.5-2.0) 등의 다양한 반응조건 하에서 스크린 테스트를 수행하였다.대장조영영상을 얻을 수 있어 대장암의 위치에 관한 정보를 삼차원적으로 제공하므로 대장암의 성상을 정확히 알 수 있는데 도움을 주었다.요인은 없는 것으로 사료된다. 이 중 2예의 CT에서 선상 혹은망상형의 음영을 보였다. 결론: 유방암 환자의 방사선 치료 후 CT 소견은 방사선 치료의 방법에 따라 폐첨부 혹은 폐의전면 흉막하 부위에 선상 혹은 망상형의 음영으로서 방사선 폐렴 혹은 섬유화 소견이다. CT는 단순 흉부 촬영보다 이상 소견의 발견이 쉽다.이러한 소견은 후에 합병될 수 있는 다른 폐질환의 감별 진단에 도움이 될 것으로 보인다.moembolization via the radial artery approach were involved in this study. All underwent Allen’s test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating t\ulcorner selec\ulcorneron ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. Results: Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5, and the

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Salvage Treatment of Nasopharyngeal Carcinoma (비인강암종의 구제치료)

  • Choi Jong-Ouck;Kim Yong-Hwan;Min Hun-Ki;Choi Geon;Kweon Hee-Weon
    • Korean Journal of Head & Neck Oncology
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    • v.12 no.1
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    • pp.3-7
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    • 1996
  • Nasopharyngeal carcinoma(NPC) is a disease whose primary initial treatment is radiation. Results of radiation therapy in early stage disease is promising; however, in stage IV disease, the best reported five-year survival is only about 30%. In patients with post-radiation recurrent disease, radiation controls only a small portion of patients, as well as being associated with significant radiation injury. In this paper we discuss the use of salvage treatment modalities for post-radiation recurrence. A retrospective chart review and analysis of salvage treatment results were performed for 39 patients with recurrent post-radiation NPC and positive cervical lymph nodes during the period beginning 1985 until 1995. Mean age of these patients was 52.3$\pm$10.37 years and male: female ratio was 1.8 : 1. Twenty patients were treated with salvage treatment, and ten patients were treated by salvage chemotherapy. A total of nine patients underwent surgical salvage treatment, including neck dissection(6), transnasal laser surgery and booster radiotherapy(2), and primary surgery(1). Salvage treatment were effective in reducing patients' pain in twenty patients (51.3%) and prolonging life in nine patients(23.1%); however, recurrence of disease within six months and/or residual disease by clinical or radiologic exam was noted in all patients receiving salvage radiotherapy, chemotherapy, laser surgery with radiotherapy, and primary site surgery. In the group undergoing salvage neck dissection, three patients(50%) were disease free for at least two years. Of the different modalities, radiotherapy was associated with the best quality of life while catastrophic salvage surgery resulting in insignificant prolongation of life was associated with the poorest quality of life. We conclude that salvage surgery is the optimal choice of treatment for regional recurrence such as nodal failure, however palliative salvage therapy could be preferred in other cases with recurrent post-radiation NPC.

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A Case Report of Heart-Lung Transplantation (심장-폐 이식 증례 보고)

  • 노준량;허재학;오삼세;김영태;이정렬;이기봉;오병희;한성구
    • Journal of Chest Surgery
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    • v.31 no.10
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    • pp.1004-1008
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    • 1998
  • We report a case of heart-lung transplantation in a 32 year-old female with Eisenmenger syndrome secondary to patent ductus arteriosus. She has been suffered from congestive heart failure since June 1996 and repeatedly treated at Intensive Care Unit with intravenous inotropic support since July 1997. Preoperative echocardiography showed a patent ductus arteriosus with right to left shunt, severe regurgitation of tricuspid valve and estimated right ventricular systolic pressure of 100mmHg. The brain-dead donor was an 18 year-old male with head trauma from traffic accident 3 days ago. Heart-lung block procurement was performed at another general hospital and was transported to the Seoul National University Hospital by ambulance. Total ischemic time of the transplanted heart and lung were 249 minutes and 270 minutes, respectively. The immunosuppressive therapy was commenced preoperatively with cyclosporine and azathioprine. Corticosteroid was not used until postoperative 3 weeks in order to avoid infection and delayed healing at the tracheal anastomotic site. The patient was discharged at 31st postoperative day, and has been regularly followed up at outpatient clinic without specific complication. The follow-up bronchoscopy, performed 2 weeks and 4 months after surgery, revealed no evidence of cellular rejection.

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Arthroscopic Meniscal Repair with Rapid Loc Device (Rapid Loc 기기를 이용한 관절경적 반월상 연골판 봉합술)

  • Kwon, Duck-Joo;Lee, Kee-Byung;Joeng, Woong-Kyo;Lee, Byung-Taek;Park, Sang-Wook
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.180-185
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    • 2005
  • Purpose: To purpose of this study is to evaluate the clinical and radiological results of arthroscopic meniscus repair using Rapid Loc device. Materials and Methods: A retrospective study was performed on 44 cases which had been turned out longitudinal tear without degeneration. We repaired all cases with Rapid Loc device. Patients were evaluated using clinical examination, Orthopaedische Arbeitsgemeinschaft Knie (OAK) scheme, and MRI. We regarded patients with joint line tenderness, swelling or McMurray positive test as clinical failure. Results: A mean age was 33.3 years and follow-up period was average 15 months. Clinical results were excellent 15 cases(34.1%), good 20 cases(45.5%), fair 7 cases(15.9%), poor 2 cases(4.5%). MRI showed grade 115 cases(33.3%), grade II 22 cases(50%), grade III 7 cases(16.7%). Clinical failures were 8 cases and only one complication was developed. Conclusion: Rapid Loc device showed the excellent results in meniscus repair. We regard it has a lot of advantages in safety, softness, ease, ability to control tension at repair site.

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Design of Data Fusion and Data Processing Model According to Industrial Types (산업유형별 데이터융합과 데이터처리 모델의 설계)

  • Jeong, Min-Seung;Jin, Seon-A;Cho, Woo-Hyun
    • KIPS Transactions on Software and Data Engineering
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    • v.6 no.2
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    • pp.67-76
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    • 2017
  • In industrial site in various fields it will be generated in combination with large amounts of data have a correlation. It is able to collect a variety of data in types of industry process, but they are unable to integrate each other's association between each process. For the data of the existing industry, the set values of the molding condition table are input by the operator as an arbitrary value When a problem occurs in the work process. In this paper, design the fusion and analysis processing model of data collected for each industrial type, Prediction Case(Automobile Connect), a through for corporate earnings improvement and process manufacturing industries such as master data through standard molding condition table and the production history file comparison collected during the manufacturing process and reduced failure rate with a new molding condition table digitized by arbitrary value for worker, a new pattern analysis and reinterpreted for various malfunction factors and exceptions, increased productivity, process improvement, the cost savings. It can be designed in a variety of data analysis and model validation. In addition, to secure manufacturing process of objectivity, consistency and optimization by standard set values analyzed and verified and may be optimized to support the industry type, fits optimization(standard setting) techniques through various pattern types.

Analysis of Treatment Result of Nasopharyngeal Cancer (비인강암의 치료 결과 분석)

  • Ryu Samuel;Kim Sang Bo;Kim Jae Cheol;U Hong;Park In Kyu;Park Jun Sik
    • Radiation Oncology Journal
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    • v.8 no.2
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    • pp.177-182
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    • 1990
  • From 1984 to 1988, fourty two patients with nasopharyngeal cancer were treated at the Department of Radiation Oncology in Kyungpook National University Hospital. Thirteen patients refused treatment and the median survival time was 7.8 months. Twenty nine patients received a full course of radiation at least 70 Gy to the primary site and 60 Gy to the nodal sites. These patients were all belonged to stage III or IV, The local control rate was $75\% in squamous cell carcinomas, and all the patients with lymphoepithelioma showed a complete response. Overall locoregional failure was $27.6\%. Distant metastasis was the predominant pattern of failures; 4/6 in lymphoepithelioma, 4/10 En squamous cell carcinoma. The Three-year-survival rate for squamous cell carcinoma was $40.5\%$, and for lymphoepithelioma $25.9\%, respectively. This may be due to the more frequent distant metastases in lymphoepithelioma and ineffective chemotherapy. No survival correlation was found with the level of neck node involvement. Though adjuvant chemotherapy was found to be of no benefit in overall survival, more prudent and aggressive chemotherapy would be necessary.

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