• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.259-264
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• 2003

Purpose : We have performed an analysis on patients who received Rastelli operation in our institute and reviewed their progress postoperatively. Various factors with suspected relationship to the outcome have been considered to help in future treatment and follow-up. Methods : We analyzed retrospectively 43 patients who either received Rastelli operation in Yonsei University Cardiovascular Center from March 1995 to April 1997 or who received post-procedural cardiac catheterization and follow-up echocardiography in the out-patient department after the procedure. Results : No statistically valid relationships were found between the age of the patient, their body weight, preoperative pulmonary arterial index and pressure, presence of pulmonary branchial stenosis and postoperative results. Cases with atrioventricular concordance showed lower age and body weight, and discordant cases exhibited lower ejection fraction 3 days postoperatively. Upon follow up, lower NYHA score was seen in patients with severe residual stenosis. In the group that received cardiac catheterization after the procedure, residual stenosis and right ventricular pressure measurement in echocardiography showed good correlation with the catheterization data. Conclusion : In cases where conduit insertions of the right ventricular outflow tract are required to achieve total correction in complex cardiac deformity, early operation does not seem to provide a clear risk to the patient. In patients with atrioventricular discordance, careful postoperative observation of the ventricular function seems to be needed. Also, echocardiography appears to be a sound method in follow-up of patients after the correctional procedure.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.827-832
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• 2004

Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.

• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.97-102
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• 1994

Objectives : Since Mountain proposed the new staging system of non-small cell lung cancer in 1986, the indications for operation of NSCLC have been extended. However, operative mortality is from 3 to 6%. Therefore it is important to reduce unnecessary operation and to evaluate unresectability of tumor correctly, preoperatively. The purpose of this study is to find out the causes of unresectability in patients who were initially thought to be resectable preoperatively. Methods : By retrospective analysis, 64 patients out of 291 NSCLC patients who were undergone operation for curative resection in Seoul National University Hospital from Jan. of 1987 to Dec. of 1991, were found to be unresectable at operating room, were selected for this study. Out of 64 patients, 42 were evaluable. The analysis was focused on the change of pre- & post-operative staging and the causes of unresectability of tumors. Results : Among 42 patients with unresectable tumor who could be evaluated, preoperative CT finding showed resectable tumors in 55%(23 patients) and suspicious for unresectable tumors in 45%(19 patients). The causes of unresectability were technically unresectable T3 lesions in 7%(3 patients), T4 lesions in 62%(26 patients), N2 lesions in 17%(7 patients) and N3 lesions in 14%(6 patients). Conclusion : The major causes of unresectability of NSCLC were pulmonary artery invasions. It is suggested that careful evaluation of mediastinal structure, especially great vessels by additional imaging technique other than CT(like MRI) is indicated in selected NSCLC cases.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.27-33
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• 1997

Retrograde myocardial protection is widely accepted in CABG operation because of the limitations of the antegrade method in the coronary arterial stenosis lesions. We analyzed 76 c ses of retrograde myocardial protection among 96 cases of CABG operation performed between April 1994 and August 1995, There were 48 males and 25 females, and the mean age was 58.2 $\pm$ 8.3 years. 53 patients (70%) were operated for unstable angina, 14 (18%) for stable angina, 6 (8%) for post-infarct angina, 1 (1%) for acute myocardial infarction, and 2()%) for failed PTCA. Preoperative coronary angiography revealed 3-vessel disease in 42 cases, 2-vessel disease in 11, 1-vessel disease in 10, and left main disease in 13 cases. We used SVG(63 cases), LIMA(69 cases), RIMA(11 cases), radial artery(6 cases), and gastroepiploic artery(1 case) for the grafts. Mean anastomosis was 3.2 $\pm$ 1.1. We protected the myocardium with antegrade induction and retrograde maintenance in all the cases except a case of retrograde induction and maintenance. During the aortic cross-clamping, blood cardioplegia was administered intermittently in 19 cases, and continuously in 57 In 39 cases, we used retrograde ardioplegia and antegrade perfusion of RCA graft simultaneously. We had no operative motality. Perioperative complications were arrhythmia in 15 cases, perioperatve myocardial infarction in 10, low cardiac output syndrome In 8, transient neurologic problem in 7, transient psychiatric problem in 6, ARF in 3, bleeding in 2, pneumonia in 2, wound infection in 1, and duodenal ulcer perforation in 1 . In this report, we experienced 76 cases of CABG operation with retrograde myocardial protection under the acceptable operative risk without operative mortality.

• Childhood Kidney Diseases
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• v.7 no.1
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• pp.60-66
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• 2003

Purpose : Neonatal hydronephrosis has been detected with increasing frequency with the widespread use of prenatal ultrasonography, but the consensus about its postnatal management has not yet been reached, especially about surgical intervention. We attempted to determine the guideline of follow-up study and surgical intervention of hydronephrosis by analyzing clinical outcomes of neonates with hydronephrosis. Materials and Methods : Between 1994 and 2000, 128 hydronephrotic kidneys were postnatally confirmed. Cases associated with other urologic anomalies were excluded and 90 unilateral hydronephrotic kidneys with a minimum follow-up of 12 months were enrolled in this study. We classified the patients into 6 groups according to the anterior posterior pelvic diameter(APPD) at initial ultrasonography(USG) within 1 month after birth. Renal USG and $Tc^{99m}-mercaptoacetyl$ triglycerine(MAG3) scan were done according to a set protocol, and pyeloplasty was performed when indicated according to our protocol. Results : Most cases whose APPD were below 10 mm improved or resolved. Only few cases with APPD above 20 mm showed spontaneous improvement and most(88%) had undergone operation. Those with initial APPD within 10-19 mm showed variable outcomes. When the risk factors for irreversible renal functional deterioration were analyzed, the age at pyeloplasty and pre-operative functional deficit were significant. Conclusion : We concluded that in infants with initial APPD below 10 mm, consideration of surgery is not needed, and in those with initial APPD above 20 mm, early operation is recommended. Our set protocol based on initial USG is useful, but the cut-off value of relative renal function(RRF) for operation might be increased to 40% to improve post operative RRF.

• Strategy21
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• s.46
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• pp.89-122
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• 2020

The longing for submarine manufacture and the fear of her power had exited for a long time, but submarine that could submerge and attack was built from 20th century by science technology development. The question, 'Submarine can exercise her power in naval warfare?' had exited before World War I, but the effective value of submarine was shown in the procedure of a chain of naval warfare during World War I and World War II. Germany and the United States made the best use of submarines at that time. The submarines of these nations mounted fierce attack on the enemy's battleships and merchant ships and blocked the sea lanes for war material. These fierce attack on ships became impossible After World War II, and the major powers reduced and coordinated the defence budget, so they considered the role of submarine. However, submarine is still powerful weapon system because she can secretly navigate under the water, and one of the most important force in the navy. The aim of this thesis is analyzing submarine roles in each naval warfare and integrating maritime strategy and weapon system technology into her roles. First, the research about represent submarine roles like anti-surfaceship warfare, anti-submarine warfare, intelligence gathering, land attack, supporting special operation and mine landing warfare will be presented, then the major naval warfare where submarine participated(during ex-World War I, World War I, World War II, The Cold War Era and post Cold War) and the analyzing of submarine roles by time will be presented. Submarine was developed for anti-surfaceship warfare during ex-World War I but could not make remarkable military gain in naval warfare because her performance and weapon was inadequate. However, the effective value of submarine in the procedure of a chain of naval warfare was shown during World War I and World War II. The major powers put battleships into naval warfare undiscriminatingly to command the sea power and submarines did massive damage to enemy navy power, so put a restraint the maritime power of enemy, and blocked the sea lanes for war material. After World War II, the battlefield situation changed rapidly and the concept of preemption became difficult to apply in naval warfare. Therefore, the submarine was unable to concentrate on anti-surfaceship mission. Especially during the Cold War era, nuclear submarine came to appear and her weapon system developed rapidly. These development gave submarines special missions: anti-submarine warfare and intelligence gathering. At that time, United States and Soviet submarines tracked other nation's submarines loaded with nuclear weapons and departing from naval their base. The submarines also collected information on the volume of ships and a coastal missile launching site in company with this mission. After Cold War, the major powers despatched forces to major troubled regions to maintain world peace, their submarines approached the shores of these regions and attacked key enemy installations with cruise missiles. At that time, the United States eased the concept of preemption and made the concept of Bush doctrine because of possible 911 terrorism. The missiles fired from submarines and surface battleships accurately attacked key enemy installations. Many nations be strategically successful depending on what kind of mission a submarine is assigned. The patterns of future naval warfare that my country will provide against will be military power projection and coalition/joint operations. These suggest much more about what future missions we should assign to submarines.

• Management & Information Systems Review
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• v.22
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• pp.137-165
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• 2007

It seems high time to increase productivity by adopting e-business to overcome challenges posed by both external factors including the appreciation of Korean won, oil hikes and fierce global competition and domestic issues represented by disparities between large corporations and small and medium enterprises (SMEs), Seoul metropolitan and local cities, and export and domestic demand all of which weaken future growth engines in the Korean economy. The demands of the globalization era are for innovative changes in businessprocess and industrial structure aiming for creating new values. To this end, e-business is expected to play a core role in the sophistication of the Korean economy through new values and innovation. In order to examine business performance in e-business-adopting industries, this study analyzed the home shopping industry by closely looking into the financial ratios including the ratio of net profit to sales, the ratio of operation income to sales, the ratio of gross cost to sales cost, the ratio of gross cost to selling, general and administrative (SG&A) expense, and return of investment (ROI). This study, for best outcome, referred to corporate financial statements as a main resource to calculate financial ratios by utilizing Data Analysis, Retrieval and Transfer System (DART) of the Financial Supervisory Service, one of the Korea's financial supervisory authorities. First of all, the result of the trend analysis on the ratio of net profit to sales is as following. CJ Home Shopping has registered a remarkable increase in its ratio of net profit rate to sales since 2002 while its competitors find it hard to catch up with CJ's stunning performances. This is partly due to the efficient management compared to CJ's value of capital. Such significance, if the current trend continues, will make the front-runner assume the largest market share. On the other hand, GS Home Shopping, despite its best organized system and largest value of capital among others, lacks efficiency in management. Second of all, the result of the trend analysis on the ratio of operation income to sales is as following. Both CJ Home Shopping and GS Home Shopping have, until 2004, recorded similar growth trend. However, while CJ Home Shopping's operating income continued to increase in 2005, GS Home Shopping observed its operating income declining which resulted in the increasing income gap with CJ Home Shopping. While CJ Home Shopping with the largest market share in home shopping industryis engaged in aggressive marketing, GS Home Shopping due to its stability-driven management strategies falls behind CJ again in the ratio of operation income to sales in spite of its favorable management environment including its large capital. Companies in the Group B were established in the same year of 2001. NS Home Shopping was the first in the Group B to shift its loss to profit. Woori Home Shopping has continued to post operating loss for three consecutive years and finally was sold to Lotte Group in 2007, but since then, has registered a continuing increase in net income on sales. Third of all, the result of the trend analysis on the ratio of gross cost to sales cost is as following. Since home shopping falls into sales business, its cost of sales is much lower than that of other types of business such as manufacturing industry. Since 2002 in gross costs including cost of sales, SG&A expense, and non-operating expense, cost of sales turned out to have remarkably decreased. Group B has also posted a notable decline in the same sector since 2002. Fourth of all, the result of the trend analysis on the ratio of gross cost to SG&A expense is as following. Due to its unique characteristics, the home shopping industry usually posts ahigh ratio of SG&A expense. However, more than 80% of SG&A expense means the result of lax management and at the same time, a sharp lower net income on sales than other industries. Last but not least, the result of the trend analysis on ROI is as following. As for CJ Home Shopping, the curve of ROI looks similar to that of its investment on fixed assets. As it turned out, the company's ratio of fixed assets to operating income skyrocketed in 2004 and 2005. As far as GS Home Shopping is concerned, its fixed assets are not as much as that of CJ Home Shopping. Consequently, competition in the home shopping industry, at the moment, is among CJ, GS, Hyundai, NS and Woori Home Shoppings, and all of them need to more thoroughly manage their costs. In order for the late-comers of Group B and other home shopping companies to advance further, the current lax management should be reformed particularly on their SG&A expense sector. Provided that the total sales volume in the Internet shopping sector is projected to grow over 20 trillion won by the year 2010, it is concluded that all the participants in the home shopping industry should put strategies on efficient management on costs and expenses as their top priority rather than increase revenues, if they hope to grow even further after 2007.

• Journal of Service Research and Studies
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• v.14 no.2
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• pp.37-47
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• 2024

Currently, social interest in post-cremation funerals is growing due to the establishment of cremation culture. In addition, as awareness of nature-friendly funeral methods spreads in modern times, the demand for tree burial grounds and tree groves, which are representative natural burial methods, is increasing. However, if the current method of relying on trees is used, the forest burial may damage the forest and turn it into another cemetery. The tree decoration is a funeral method that contains the temporal meaning of humans returning to the space of nature that we have, and the philosophical meaning that humans return in compliance with nature. Like this, there are quite a few concerns. Even though tree burials are not the traditional burial facilities we are familiar with, many of the facilities and operating systems adopt the standards of park cemeteries and have stricter standards and restrictions than natural burials under the law. This rigidity is intended to preserve the forest, but the reality is that it limits the expansion and operation of tree plantations. To this end, this study seeks to find specific improvement measures for sustainable tree plantation operation. To this end, we look at the types of natural fields in foreign countries and find directions for tree planting that can be effectively applied and established in accordance with the sentiments of the people. Specific improvement measures include an enshrinement method that does not rely on memorial trees, the operation of anonymous or anonymous tree planting, a change in the method of visiting and commemorating, and various mountaineering methods, thereby suggesting alternatives to sustainable tree planting in Korea. The place where tree planting is implemented is the forest, that is, the forest itself. I should be a place where the spirit of natural return, which is the essence of the deceased, can be celebrated through the forest, not a funeral facility. By doing so, it will be possible to provide the public value of the forest, that is, the social function of the forest, in the name of an eco-friendly funeral service.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.1-6
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• 2003

Currently, atrial septal defect repair has been considered low risk operation duo to the development of open heart surgery Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. Material and Method: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy(group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. Result: The mean weight of group A was 38.77$\pm$15.57kg and 38.21$\pm$21.82kg in group B. In group A, mean operation (OP) time was 197.6$\pm$61.40min, mean cardiopulmonary bypass(CPB) time was 48.66$\pm$13.02min and mean fibrillation time or aortic cross clamp(ACC) time was 30$\pm$11.64min. In group B, mean OP time was 212.33$\pm$31.95min, mean CPB time was 55$\pm$12.10min, and mean fibrillation or ACC time was 29.33$\pm$9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78$\pm$0.78 hours, mean postoperative ICU stay was 1.2$\pm$0.47 days and mean postoperative hospital stay was 10.20 41.08 days. In group B, mean mechanical ventilation time was 5.95$\pm$3.73 hours, mean post operative ICU stay was 1.41$\pm$0.61 days, and mean postoperative hospital stay was 12.20$\pm$3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33$\pm$90.54cc vs 352.33$\pm$239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block. Conclusion: Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument(p.0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.472-480
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• 1998

We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.