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Outcomes of Combined Mitral Valve Repair and Aortic Valve Replacement (대동맥판막 치환술과 동반시행한 승모판막 성형술 결과)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Se;Kim, Woong-Han;Whang, Sung-Wook;Lee, Cheol;Chang, Yun-Hee;Jo, Won-Min;Kim, Jae-Hyun;Seo, Hong-Ju;Kim, Soo-Cheol;Lim, Cheong;Kim, Wook-Sung;Lee, Young-Tak;Choi, Hyun-Seok;Moon, Hyun-Soo;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.463-471
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    • 2003
  • The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.

Immediate Reoperation for Failed Mitral Valve Repair (승모판막성형술 실패 직후에 시행한 재수술)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Se;Kim, Woong-Han;Whang, Sung-Wook;Lee, Cheol;Chang, Yun-Hee;Jo, Won-Min;Kim, Jae-Hyun;Seo, Hong-Ju;Kim, Wook-Sung;Lee, Young-Tak;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.929-936
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    • 2003
  • We analysed the surgical outcomes of immediate reoperations after mitral valve repair. Material and Method: Eighteen patients who underwent immediate reoperation for failed mitral valve repair from April 1995 through July 2001 were reviewed retrospectively. There were 13 female patients. The mitral valve disease was regurgitation (MR) in 12 patients, stenosis (MS) in 3, and mixed lesion in 3. The etiologies of the valve disease were rheumatic in 9 patients, degenerative in 8, and endocarditis in 1. The causes of reoperation was residual MR in 13 patients, residual MS in 4, and rupture of left ventricle in 1. Fourteen patients had rerepair for residual mitral lesions (77.8%) and four underwent replacement. Result: There was no early death. After mean follow-vp of 33 months, there was one late death. Echocardiography revealed no or grade 1 of MR (64.3%) in 9 patients and no or mild MS in 11 patients (78,6%). Reoperation was done in one patient. The cumulative survival and freedom from valve-related reoperation at 6 years were 94% and 90%, respectively. The cumulative freedom from recurrent MR and MS at 4 years were 56% and 44%, respectively. Conclusion: This study suggests that immediate reoperation for failed mitral valve repair offers good early and intermediate survival, and mitral valve rerepair can be successfully performed in most of patients. However, because mitral rerepair have high failure rate, especially in rheumatic valve disease, adequate selections of valvuloplasty technique and indication are important to reduce the failure rate of mitral rerepair.

Granulocytic Sarcoma(Chloroma) in Leukemic Patients (백혈병 환자의 과립구 육종(녹색종양))

  • Rhee, Seung-Koo;Kang, Yong-Ku;Bahk, Won-Jong;Jung, Yang-Kuk;Lee, Sang-Wook;Jeong, Ji-Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.54-61
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    • 2005
  • Purpose: The granulocytic sarcoma which developed in leukemic patients are quite rare and it will have bad prognosis, but it's tumor pathogenesis and also their treatment are not yet established. Through this study we have tried to know their clinical course, prognosis and their end result of recent treatment. Material and Methods: Total 20 patients of granulocytic sarcoma which were developed in total 2,197 leukemic patients from April, 1998 to September, 2004 were treated at the leukemic center and the orthopaedic department of St. Mary's hospital, Catholic University of Korea, and followed them for 1~78 months(average 18 months). Results: Total 20 cases of granulocytic sarcoma was found in 14 cases of total 1,331 acute myelocytic leukemic patients(AML), 4 cases of total 744 of chronic myelocytic leukemic patients(CML), and only one case in total 122 of acute biphenotype of leukemia. And so their occurrence rate in leukmic patients are actually 0.91%, total 20 cases of granulocytic sarcoma in total 2,197 leukemic patients at same period. Their ages are average 28.3 years(4~52 years), and male are predominant(13 cases) than female(7 cases). Single involvement was found in 11 cases but multiple lesions are in 9 cases, and spine, brain, extremities, chest, and pelvic bone are involved in frequency. The granulocytic sarcoma was developed in various stages of the leukemia, ie, 8 cases in complete remission of leukemia, and 12 cases in the treatment process of AML. The pathohistologic evaluation of granulocytic sarcoma was done in 6 cases which was developed in their extremities, and confirmed numerous immature myeloblasts and lymphocytes mixed. The treatment of these granulocytic sarcoma was mainly limited for the treatment of leukemia by Glivac and massive steroid therapy(19cases) and also combined with the bone marrow transplantation(13 cases), but radiation therapy with average 3,500 rads in 15 cases out of total 20 sarcomas was also done, and followed them for average 17.5 months after development of granulocytic sarcomas. Finally their prognosis was so bad that 12 patients(60%) out of total 20 granulocytic sarcoma were dead in 6.5 months after sarcoma developed and we found the granulocytic sarcoma was more fatal if they are developed during the process of CML(mortality: 100%(4/4cases). Conclusion: The prognosis of granulocytic sarcomas in leukemic patients are quite fatal, and much more studies for their pathogenesis and ways of treatment should be performed continuously.

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Comparison of marginal fit before and after porcelain build-up of two kinds of CAD/CAM zirconia all-ceramic restorations (두 종류의 CAD/CAM 지르코니아 전부도재관의 도재 축성 전후의 변연적합도 비교)

  • Shin, Ho-Sik;Kim, Seok-Gyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.5
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    • pp.528-534
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    • 2008
  • Purpose: Marginal fit is one of the important components for the successful prosthodontic restoration. Poor fitting margin of the restoration causes hypersensitivity, secondary caries, and plaque accumulation, which later result in prosthodontic failure. CAD/CAM zirconia all-ceramic restorations, such as $LAVA^{(R)}$ (3M ESPE, St.Paul, MN) and $EVEREST^{(R)}$ (KaVo Dental GmbH, Biberach, Germany) systems were recently introduced in Korea. It is clinically meaningful to evaluate the changes of the marginal fit of the CAD/CAM zirconia systems before and after build-up. The purposes of this study are to compare the marginal fit of the two CAD/CAM all-ceramic systems with that of the ceramometal restoration, before and after porcelain build-up Material and methods: A maxillary first premolar dentiform tooth was prepared with 2.0 mm occlusal reduction, 1.0 mm axial reduction, chamfer margin, and 6 degree taperness in the axial wall. The prepared dentiform die was duplicated into the metal abutment die. The metal die was placed in the dental study model, and the full arch impressions of the model were made. Twenty four copings of 3 groups which were $LAVA^{(R)}$, $EVEREST^{(R)}$, and ceramometal restorations were fabricated. Each coping was cemented on the metal die with color-mixed Fit-checker $II^{(R)}$ (GC Cor., Tokyo, Japan). The marginal opening of each coping was measured with $Microhiscope^{(R)}$ system (HIROX KH-1000 ING-Plus, Seoul, Korea. X300 magnification). After porcelain build-up, the marginal openings of $LAVA^{(R)}$, $EVEREST^{(R)}$,and ceramometal restorations were also evaluated in the same method. Statistical analysis was done with paired t-test and one-way ANOVA test. Results: In coping states, the mean marginal opening for $EVEREST^{(R)}$ restorations was $52.00{\pm}11.94\;{\mu}m$ for $LAVA^{(R)}$ restorations $56.97{\pm}10.00\;{\mu}m$, and for ceramometal restorations $97.38{\pm}18.54\;{\mu}m$. After porcelain build-up, the mean marginal opening for $EVEREST^{(R)}$ restorations was $61.69{\pm}19.33\;{\mu}m$, for $LAVA^{(R)}$ restorations $70.81{\pm}12.99\;{\mu}m$, and for ceramometal restorations $1115.25{\pm}23.86\;{\mu}m$. Conclusion: 1. $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations in comparison with ceramometal restorations showed better marginal fit, which had significant differences (P < 0.05) in coping state and also after porcelain build-up . 2. The mean marginal opening values between $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations did not showed significant differences after porcelain build-up as well as in coping state (P > .05). 3. $EVEREST^{(R)}$, $LAVA^{(R)}$ and ceramometal restorations showed a little increased marginal opening after porcelain build-up, but did not show any statistical significance (P > .05).

Dosimetry of the Low Fluence Fast Neutron Beams for Boron Neutron Capture Therapy (붕소-중성자 포획치료를 위한 미세 속중성자 선량 특성 연구)

  • Lee, Dong-Han;Ji, Young-Hoon;Lee, Dong-Hoon;Park, Hyun-Joo;Lee, Suk;Lee, Kyung-Hoo;Suh, So-Heigh;Kim, Mi-Sook;Cho, Chul-Koo;Yoo, Seong-Yul;Yu, Hyung-Jun;Gwak, Ho-Shin;Rhee, Chang-Hun
    • Radiation Oncology Journal
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    • v.19 no.1
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    • pp.66-73
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    • 2001
  • Purpose : For the research of Boron Neutron Capture Therapy (BNCT), fast neutrons generated from the MC-50 cyclotron with maximum energy of 34.4 MeV in Korea Cancer Center Hospital were moderated by 70 cm paraffin and then the dose characteristics were investigated. Using these results, we hope to establish the protocol about dose measurement of epi-thermal neutron, to make a basis of dose characteristic of epi-thermal neutron emitted from nuclear reactor, and to find feasibility about accelerator-based BNCT. Method and Materials : For measuring the absorbed dose and dose distribution of fast neutron beams, we used Unidos 10005 (PTW, Germany) electrometer and IC-17 (Far West, USA), IC-18, ElC-1 ion chambers manufactured by A-150 plastic and used IC-l7M ion chamber manufactured by magnesium for gamma dose. There chambers were flushed with tissue equivalent gas and argon gas and then the flow rate was S co per minute. Using Monte Carlo N-Particle (MCNP) code, transport program in mixed field with neutron, photon, electron, two dimensional dose and energy fluence distribution was calculated and there results were compared with measured results. Results : The absorbed dose of fast neutron beams was $6.47\times10^{-3}$ cGy per 1 MU at the 4 cm depth of the water phantom, which is assumed to be effective depth for BNCT. The magnitude of gamma contamination intermingled with fast neutron beams was $65.2{\pm}0.9\%$ at the same depth. In the dose distribution according to the depth of water, the neutron dose decreased linearly and the gamma dose decreased exponentially as the depth was deepened. The factor expressed energy level, $D_{20}/D_{10}$, of the total dose was 0.718. Conclusion : Through the direct measurement using the two ion chambers, which is made different wall materials, and computer calculation of isodose distribution using MCNP simulation method, we have found the dose characteristics of low fluence fast neutron beams. If the power supply and the target material, which generate high voltage and current, will be developed and gamma contamination was reduced by lead or bismuth, we think, it may be possible to accelerator-based BNCT.

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Study on Fabric and Embroidery of Possessed by Dong-A University Museum (동아대학교박물관 소장 <초충도수병>의 직물과 자수 연구)

  • Sim, Yeon-ok
    • Korean Journal of Heritage: History & Science
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    • v.46 no.3
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    • pp.230-250
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    • 2013
  • possessed by Dong-A University Museum is designated as Treasure No. 595, and has been known for a more exquisite, delicate and realistic expression and a colorful three-dimensional structure compared to the 'grass and insect painting' work and its value in art history. However, it has not been analyzed and studied in fabric craft despite it being an embroidered work. This study used scientific devices to examine and analyze the Screen's fabric, thread colors, and embroidery techniques to clarify its patterns and fabric craft characteristics for its value in the history of fabric craft. As a result, consists of eight sides and its subject matters and composition are similar to those of the general paintings of grass and insects. The patterns on each side of the 'grass and insect painting' include cucumber, cockscomb, day lily, balsam pear, gillyflower, watermelon, eggplant, and chrysanthemums from the first side. Among these flowers, the balsam pear is a special material not found in the existing paintings of grass and insect. The eighth side only has the chrysanthemums with no insects and reptiles, making it different from the typical forms of the paintings of grass and insect. The fabric of the Screen uses black that is not seen in other decorative embroideries to emphasize and maximize various colors of threads. The fabric used the weave structure of 5-end satin called Gong Dan [non-patterned satin]. The threads used extremely slightly twisted threads that are incidentally twisted. Some threads use one color, while other threads use two or mixed colors in combination for three-dimensional expressions. Because the threads are severely deterioration and faded, it is impossible to know the original colors, but the most frequently used colors are yellow to green and other colors remaining relatively prominently are blue, grown, and violet. The colors of day lily, gillyflower, and strawberries are currently remaining as reddish yellow, but it is anticipated that they were originally orange and red considering the existing paintings of grass and insects. The embroidery technique was mostly surface satin stitch to fill the surfaces. This shows the traditional women's wisdom to reduce the waste of color threads. Satin stitch is a relatively simple embroidery technique for decorating a surface, but it uses various color threads and divides the surfaces for combined vertical, horizontal, and diagonal stitches or for the combination of long and short stitches for various textures and the sense of volume. The bodies of insects use the combination of buttonhole stitch, outline stitch, and satin stitch for three-dimensional expressions, but the use of buttonhole stitch is particularly noticeable. In addition to that, decorative stitches were used to give volume to the leaves and surface pine needle stitches were done on the scouring rush to add more realistic texture. Decorative stitches were added on top of gillyflower, strawberries, and cucumbers for a more delicate touch. is valuable in the history of paintings and art and bears great importance in the history of Korean embroidery as it uses outstanding technique and colors of Korea to express the Shin Sa-im-dang's 'Grass and Insect Painting'.

The Effect of Stage of Maturity on the Composition and Feeding Value of Silage (생육시기가 Silage의 사용가치에 미치는 영향)

  • 신정남;윤익석
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.4 no.1
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    • pp.41-60
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    • 1983
  • Experiments were conducted to study the effect of stage of maturity at harvest on the quality of silage. Herbage samples taken from the barley plant, rye plant, wheat plant, oat plant, Orchardgrass, Italian ryegrass, a mixed grass sward of Orchardgrass and Italian ryegrass and corn plant at different stages of maturity and ensiled in order to evaluate the effect of maturity on the chemical composition and feeding value as well as digestibility using sheep. Forage material were ensiled in small concrete silo. 1. The dry matter yield per 10a increased with advancing the maturity. Yield of brarley plant was 404, 635 and 900 kg at heading, milk and milk dough stage, respectively. Rye plant yield was 279, 589, 708, 10,000, 1,265, 1,376 and 1,492 kg at booting, before heading, early heading, late heading, early flowering, late flowering and after flowering stage, respectively. Italian ryegrass yield was 355, 613, 844 and 1,109 kg at vegetative, booting, heading and flowering, respectively. Orchardgrass/Italian ryegrass production was 477, 696, 891 and 1,027 kg at before was 458, 1,252, 1,534, 1,986 and 2,053 kg at tassel, early milk, yellow ripe and ripe stage, respectively. 2. Dry matter content increased with advancing maturity, but crude protein declined markedly. The NFE content decreased with advancing maturity of all the herbages except corn plant where NFE content increased, but corn plant increased. The content of crude fiber increased with advancing maturity except corn plant. The content of crude ash decreased with advancing maturity. In the rye plant, the content of neutral detergent fiber (NDF), acid detergent fiber (ADF) and cellulose increased with advancing maturity. 3. In vitro dry matter digestibilities of the rye plant was 53.6, 54.1, 50.7, 47.1, 44.9, 40.1 and 38.9% booting, before hcading, early heading, late heading, early flowering, late flowering and after flowering stage, respectively. The regression equation was $Y=56.22-0.74X+0.009X^2$ (X=cutting date from the first cut, Y=dry matter digestibilities). 4. In vitro digestible dry matter yield (kg/10a) of rye plant increased with advancing maturity, but declined from the flowering stage. The regression equation was $Y=168.88+26.09X-0.41X^2$ (X=cutting date from the first cut). 5. In vitro digestibility of dry matter in the corn plant was 69.2, 71.5, 69.8 and 69.9% at tassel, early milk, milk and yellow ripe stage, respectively. 6. The digestibility of crude protein and crude fiber of all plants decreased with advancing matuity, but NFE of the barley and corn generally increased. 7. The TDN contents on the dry matter basis decreased, but those of barley and corn silage were not different. TDN content of barley was 57.8, 57.1 and 57.9% at heading, milk and milk dough stage, respectively. That of rye silage was 50.0, 27.2 and 43.7% at early flowering, after flowering and milk stage, respectively. Italian ryegrass silage was 67.9, 63.7, and 54.9% at before heading, early heading and after heading, respectively. In case of Orchardgrass silage the TDN was 54.8, 52.9 and 46.1% at after heading, after flowering and milk, respectively. Corn shows TDN value of 59.5, 62.8 and 61.6% at milk, yellow ripe and ripe, respectively. 8. The pH value increased slightly by advancing maturity. 9. the content of organic acid decreased by advancing maturity and also increasing the DM content.

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