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Surgical Results and Risk Facor Analysis of the Patients with Single Ventricle Associated with Total Anomalous Pulmonary Venous Connection (총폐정맥연결이상증을 동반한 단심증 환아의 수술결과 및 위험인자 분석)

  • 이정렬;김창영;김홍관;이정상;김용진;노준량
    • Journal of Chest Surgery
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    • v.35 no.12
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    • pp.862-870
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    • 2002
  • The surgical results of the patients with single ventricle(SV) associated with total anomalous pulmonary venous connection(TAPVC) has been reported with high mortality and morbidity due to their morphologic and hemodynamic complexity. A retrospective review was undertaken to report the outcome of the first-stage palliative surgery in our institution and to determine the factors influencing early death. Material and Method: Between January 1987 and June 2002, 39 patients with SV and TAPVC underwent surgical intervention with or without TAPVC repair. Age at operation ranged from 1day to 10.7months (median age, 2.4month), and 29 patients were male. Preoperative diagnosis included 20 right-dominant SV, 15 SV with endocardial cushion defect, 3 left-dominant SV, and 1 tricuspid atresia. The pulmonary venous connection was supracardiac in 22, cardiac in 5, infracardiac in 11, and mixed in 1, Obstructed TAPVC was present in 11. First-stage palliative surgery was performed in 37. Repair of TAPVC, either alone or in association with other procedures, was performed during the initial operation in 31. Univariate and multivariate analyses were performed to analyze the risk factors influencing the operative death. Result: A mean follow-up period of survivors was 34.3 $\pm$ 43.0(0.53 ~ 146.2)months. Overall early operative mortality was 43.6%(17/39). The causes were low cardiac output in 8, failure of weaning from cardiopulmonary bypass in 3, sepsis in 2, pulmonary hypertensive crisis in 1, pulmonary edema in 1, pneumonia in 1, and postoperative arrhythmia in 1. Risk factors influencing early death in univariate analysis were body weight, surgical intervention in neonate, obstructive TAPVC, preoperative conditions including metabolic acidosis, and need for inotropic support, TAPVC repair in initial operation, operative time, and cardiopulmonary bypass(CPB) time. In multivariable analysis, body weight, age at initial operation, surgical intervention in neonate, preoperative conditions including metabolic acidosis, need for inotropic support and CPB time were the risk factors. Conclusion: In this study, we demonstrated that the patients with SV and TAPVC had high perioperative mortality. Preoperative poor condition, young age, the length of operative and CPB time, the presence of obstructive TAPVC had been proven to be the risk factors. This fact suggests that the avoidance of unnecessarily additional procedures may improve the surgical outcomes of the first-stage palliative surgery. However further observation and collection of the data is mandatory to determine the ideal surgical strategy.

Intermediate-term Result of Tricuspid Annuloplasty for Tricuspid Regurgitation Associated with Congenital Heart Disease in Adult (성인 선천성 심기형에 동반된 삼첨판막 폐쇄부전의 판막륜 성형술 후 중기성적)

  • Yun, Tae-Jin;Kim, Sang-Hwa;Lee, Jun-Wan;Park, Jeong-Jun;Song, Hyun;Lee, Jae-Won;Seo, Dong-Man;Song, Meong-Gun;Song, Jong-Min;Kang, Duck-Hyun;Song, Jae-Kwan;Jang, Wan-Sook;Kim, Young-Hwue;Ko, Jae-Kon;Park, In-Sook
    • Journal of Chest Surgery
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    • v.36 no.3
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    • pp.136-141
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    • 2003
  • We assessed the intermediate-term result of tricuspid annuloplasty (TAP) for tricuspid valve regurgitation (TR) associated with congenital heart disease in adults. Risk factors for residual TR were also analysed. Material and Method: From August 1989 to June 2001, seventy three adult patients, 51 females and 22 males, underwent TAP for TR associated with various congenital heart disease. Their age ranged from 46 years to 73 years (mean:43). Associated heart anomalies were atrial septal defect (55), ventricular septal defect (6), partial anomalous pulmonary venous return (4) and others (8). Preoperative and post-operative TR velocities were 3.25 m/sec and 2.56 m/sec respectively, and the types of TAP were De Vega in 43, Kay in 18 and Ring annuloplasty in 12. Postoperative follow-up duration was 2,347 patient-month (mean: 32.6 months), and 134 two-dimensional echocardiographic examinations were done during this period. Residual TR greater than III/IV was considered as TAP failure. Result: TAP failure was observed in 7 patients (9.6%), and one patient among them underwent tricuspid valve replacement. Risk factors for TAP failure were diagnosis other than atrial septal defect (p=0.001), preoperative (p=0.038) and postoperative (p=0.028) high TR velocity. There was no statistical significance in terms of TAP methods. Conclusion: Careful evaluation of valve morphology and aggressive surgical intervention are mandatory for the repair of TR with preoperative or residual RV pressure overload.

Reconstruction of Anterior Cruciate Ligament in Adolescent (청소년기에 시행한 전방십자인대 재건술)

  • Song Eun Kyoo;Shim Sang Don;Kim Hyung Jong;Kim Hyung Won
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.2
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    • pp.101-108
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    • 2002
  • Purpose: To evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction and to know the results of physeal injury by transphyseal tunnel in adolescents who had remaining growth potential. Materials and Methods : This study involved 12 patients under 19 years old out of 445 patients, who underwent ACL reconstruction between 1993 and 2001. The mean age at the time of operation was 15.9 $(13.1\~16.9)$ years and fellow-up period was 45.1 $(24\~120.6)$ months in avrarge. Autologous quadrupled hamstring tendon was used as graft in 11 cases and bone-patellar tendon-bone in 1 case. Clinical results were evaluated by Lysholm Knee Scoring Scale, range of motion and return to preinjury sports activities. Radiologic results were evaluated by $Telos^{\circledR}$ device. Bone maturity were analyzed by chronological age, standing height and the width of growth plate in AP and lateral view of knee joint at preoperatively. The growth disturbances were evaluated by measuring femorotibial angle, anatomical and mechanical lateral distal femoral angle, mechanical medial proximal tibial angle and leg length and by comparing those of uninjured site in last follow-up teleoroentgenogram. Results : The mean Lysholm Knee score was 51 $(25\~63)$points preoperatively and 98 $(94\~100)$ points at last follow up. The mean anterior displacement of the tibia by using $Telos^{\circledR}$ device was improved from 13.5 $(6\~27)$ mm to 2.9 $(1\~4)$ mm and there were no significant instabilities of the knee in all cases. There were no leg length discrepancies over 1 cm and no statistically significant abnormal alignment of the knee joint in all cases. Conclusion: ACL reconstruction using transphyseal tunnel for restoring stability and knee function is assumed as a good mettled of treatment without significant leg length discrepancy and abnormal alignment of the knee joint.

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A STUDY ON THE FOOD OF THE GOBY, SYNECHOGOBIUS HASTA (풀망둑 Synechogobius hasta (TEMMINCK et SCHLEGEL)의 먹이 조사)

  • PAIK Eui-In
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.2 no.1
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    • pp.47-62
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    • 1969
  • A goby, Synechogobius hasta (Temminck et Schlegel) was studied to investigate the food consumed and the biological change of the food organisms, and the fish were sampled from the closed tributary and the lower Part of the Naktong River, near Pusan, during the period from November of 1967 to December of 1968. The fish were sampled from four stations (Fig. 1), the total number of fish being 1,295 and they were grouped and analysed monthly. The content of the alimentary canal was analysed in three categories according to modified Nilsson's method (Dahl 1962) with a slight alteration: 1) The number of each item of stomach contents was counted and the percentage of each item in proportion to the total number of food organisms is indicated by the letter 'N' representing numerical percentage in Table 2. 2) The percentage of fish which contained any items of food organisms in proportion to the total number of fish caught in a given season is indicated by the letter 'O' representing frequency of occurrence. 3) Dominant groups of food items were selected and the percentage of the number of each dominant item in proportion to the number of the food organisms belonging to the dominant groups is indicated by the letter 'D' representing dominance. All food organisms were classified in 50 food item categories and then they were grouped in 13 main groups (Fig. 2-1), and they were further divided into 1) obligatory bottom animals, 2) organic drifts and 3) actively swimming forms; according to the conditions of the animal communities within the habitat. Since the majority of its food was composed of the obligatory bottom animals ($94.6\%$), the fish appeard to be a typical bottom feeder. And the dominant food organisms of the fish is generally determined by the local composition of the benthic fauna within the fish habitat. And their seasonal rhythm occurs among the food organisms in the stomach by the biological interaction. Locality variation in the population of the same food organism occurs due to the difference of food organisms in the habitat of the fish at Seonam and Garak, and at Seongsan and Hadan the condition of the niche for the fish in the both regions seems to be the same since the composition and the seasonal variation of the organisms were the same. The results may be summarized as follows: 1) The goby mainly feed on the animals of bottom fauna, and the food organisms are deter-mined by the food compositions within the habitat. 2) Seasonal variation of the stomach content shows the seasonal rhythm due to the biological variation of the population and their interaction. 3) The goby shows no preference on specific food, and the food is composed of a variety of animals. 4) Major food items of the goby are Polychaeta, Palaemon modestus, Isopoda, Gammaridea, Insecta (nymphs and larvae), Ilyoplax deschampsi, and Paratye compressa. 5) Logitudinal succession oil the population of the food organisms is apparently recognized within the community of Seongsan, Garak and Seonam. 6) The goby begins to descend toward the estuary and sea around April when the water temperature reaches $20^{\circ}C$, and they begin to return to river waters in September.

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Closed Interlocking Intrmedullary Nailing of Metastatic Diaphyseal Fractures of the Humerus (상완골 간부 악성 병적골절의 비관혈적 고합성 골수강내 금속정 고정술)

  • Bahk, Won-Jong;Rhee, Seung-Koo;Kang, Yong-Koo
    • The Journal of the Korean bone and joint tumor society
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    • v.9 no.1
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    • pp.1-11
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    • 2003
  • Purpose: To analysis of the result of the treatment of metastatic diaphyseal fracture of the humerus with closed interlocking intrameduallry nailing. Materials and Methods: Among surgically treated 29 patients with pathologic or impending fracture of diaphysis of the humeurs, 13 patients (16 cases) treated with closed intramedullary interlocking nail were selected for the study. The final result of pain relief and functional recovery was evaluated by modified rating system of Perez et al. Results: Primary cancer was diagnosed after fracture was developed in 2 patients and pathologic or impending fracture was occurred average period of 28.9 months after primary cancer was diagnosed. The main primary malignancies were multiple myeloma, lung cancer and breast cancer. Mean survival after humeral metastasis was 11.7 months. The final result was superior to fair in 13 of 16 cases, and poor in 3 cases with progression of tumor spread or distant dissemination to the ipsilateral fingers. Except the latter 3 patients and other 3 patients, who died before 3 months postoperatively, bony union was achieved in 10 cases. There were no complications related to surgery. Conclusion: Closed interlocking intrameduallry nailing is accomplished with brief operative time, small amount of bleeding and provides immediate stability with resultant early return of function to the arm. Additionally it allows early postoperative irradiation. However, some of our cases shows that intramedullary nailing can accelerate tumor spread and metastases elsewhere, so that serious consideration must be given in planning this treatment. In conclusion, the functional status before fracture, life expectancy, type of tumor and extent of involvement should be carefully considered to decide operative treatment of metastatic disease.

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Retrieval of Pollen Optical Depth in the Local Atmosphere by Lidar Observations (라이다를 이용한 지역 대기중 꽃가루의 광학적 두께 산출)

  • Noh, Young-Min;Lee, Han-Lim;Mueller, Detlef;Lee, Kwon-Ho;Choi, Young-Jean;Kim, Kyu-Rang;Choi, Tae-Jin
    • Korean Journal of Remote Sensing
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    • v.28 no.1
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    • pp.11-19
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    • 2012
  • Air-borne pollen, biogenically created aerosol particle, influences Earth's radiative balance, visibility impairment, and human health. The importance of pollens has resulted in numerous experimental studies aimed at characterizing their dispersion and transport, as well as health effects. There is, however, limited scientific information concerning the optical properties of airborne pollen particles contributing to total ambient aerosols. In this study, for the first time, optical characteristics of pollen such as aerosol backscattering coefficient, aerosol extinction coefficient, and depolarization ratio at 532 nm and their effect to the atmospheric aerosol were studied by lidar remotes sensing technique. Dual-Lidar observations were carried out at the Gwangju Institute of Science & Technology (GIST) located in Gwagnju, Korea ($35.15^{\circ}E$, $126.53^{\circ}N$) for a spring pollen event from 5 to 7 May 2009. The pollen concentration was measured at the rooftop of Gwangju Bohoon hospital where the building is located 1.0 km apart from lidar site by using Burkard trap sampler. During intensive observation period, high pollen concentration was detected as 1360, 2696, and $1952m^{-3}$ in 5, 6, and 7 May, and increased lidar return signal below 1.5km altitude. Pollen optical depth retrieved from depolarization ratio was 0.036, 0.021, and 0.019 in 5, 6, and 7 May, respectively. Pollen particles mainly detected in daytime resulting increased aerosol optical depth and decrease of Angstrom exponent.

Studies on Silk Textile Wash and Wear Finishing (絹織物 Wash and Wear 加工硏究)

  • Choe, Byong-Hee;Lee, Yang-Hoo
    • Journal of Sericultural and Entomological Science
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    • v.23 no.1
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    • pp.47-55
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    • 1981
  • Silk textile finishing has been studied for many years by many workers in order to meet more utilities for various endusers. Such studies, however, could not be successful because any natural fibers are hardly change their natures by artificial treating methods. Textile finishing is of course to improve the mechandise qualities and the poor natures of silk so that it may be available as the best textile fiber in the world. Sometimes, famous trade marked textile plays more power than its quality in the silk market, nevertheless, this should be over line of research activities. Meantime, the silk demand has been also transferred from ladies stocking to other clothes since nylon or other synthetic fibers were developed. That is why, the extension of silk demand should be developed by various research works. Specially, silk is known as difficult textile to handle it during washing or ironing process which happened to depress down the silk usage for house wives. In order to solve such problems, the reporter has been worked for many years and now, he believes that he has developed a proper finishing method to coversuch problems. The developed finishing method may be said to eligible with economical aspect and shorten the dry duration after water washing in half against normal silk textile without harming the specific silk nature. As all of us know, silk fiber starts to denature since it was spinned by silkworm and the fiber is formed as overlapped "S" type curves during its concooning process. After it is made as raw silk or sericin silk, it shows as straight line form, but it changes in to waved form in case refining or degumming process in order return to its original spinned form. Such nature is continued during its textile form and ends with hard ironing nature than other textile fibers. Mean while, the silk fiber keeps to continue its denaturing and this is iniciated by repeat of washing and drying which takes many years to reach its final stage, The reporter has found the iniciating denature of silk by his finishing process, with out heat, decreasing the swollen nature which ended with shortening the drying duration after wash. Each washing was carried out by soaking the previously weighed sample in cold water for one hour, then pressed the sample for ten minutes to eliminate its free water component before weighing with same condition. According to this, the treated silk showed much denaturing after the finishing, but the standard silk progressed the denaturing by and by with the repeat of washing and drying, finally reached the same swollen degree of treated silk, Such treating result explains that the treated silk happened to be stebilized nature by the treating immediately. On the other that the treated silk happened to be stebilized nature by the treating immediately. On the other hand, standard silk may reach to such condition by the time of worn out clothes after repeat of washing and drying for many years while the clothes will be no more useful. The decreased swelling nature has brought about the drying period in half against standard silk after all. Not only the tests of tenacity and elongation but also crease resistance recovery, stiffness and shrinkage tests were carried out after each washing and drying which he has found better result on the treated silk textile against the standard silk. The most important thing was to keep the textile feeling of silk by such finishing work before improve any poor nature of silk. The general silk has a nature to absorb smoke or dirt from its surrounding air and reaches to dirty color shade upon such exposure, but the treated one has improved such nature because of its artificial denaturing, another word, it keeps clean longer than the normal silk. Many previous finishing works could improve some specific nature of silk, but it happened to deprave other important natures. The reporters work is, however, specialized to improve the silk to be useful as Wash and Wear Silk without harming its standard natures. So far, this work happened to be a overall innovative finishing method of silk textile.

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Effects of Dietary Carbohydrase Enzyme Complex and Microbial Phytase Supplementation on Productivity and Nutrient Digestibility in Growing Pigs (탄수화물 분해 복합효소제와 미생물 파이테이즈의 첨가가 육성돈의 생산성 및 영양소 소화율에 미치는 영향)

  • Shim, Y.H.;Chae, B.J.;Lee, J.H.
    • Journal of Animal Science and Technology
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    • v.45 no.4
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    • pp.569-576
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    • 2003
  • An experiment was conducted to investigate the effect of microbial phytase (Natuphos$^{\circledR}$) supplementation, individually and in combination with carbohydrase enzyme complex (composed of enzymes targeted to SBM dietary components such as $\alpha$-galactosides and galactomannans; ENDO-POWER$^{\circledR}$) to corn-soy basis diet with low nutrient levels on growth performance and nutrient digestibility of growing pigs. A total of 48 crossbred weaned pigs (Landrace${\times}$Yorkshire${\times}$Duroc), 29.1$\pm$0.14 kg of initial body weight, were randomly allotted to four dietary treatments, based on weight and age, according to a Randomized Complete Block Design. There were three pens per treatment and 4 pigs per pen. The dietary treatments were 1) CON (control diet with 3,380 kcal/kg of metabolizable energy, 18.96% of crude protein, 1.10% of lysine, 0.75% of calcium and 0.35% of available phosphorus), 2) LP+NTPS (CON diet with 0.15% unit lower available P levels+0.1% phytase (500 FTU/kg; Natuphos$^{\circledR}$)), 3) LEL+ENP (CON diet with 3.0% unit lower ME and lysine levels + 0.1% carbohydrase enzyme complex (ENDO-POWER$^{\circledR}$), and 4) LPEL+ENZ (CON diet with 0.15% unit lower available P levels and 3.0% unit lower ME and lysine levels+0.1% ENDO-POWER$^{\circledR}$ and 0.1% Natuphos$^{\circledR}$ (500 FTU/kg). There was no significant difference (p〉0.05) in average daily gain (ADG), average daily feed intake (ADFI) and feed conversion ratio (FCR) among dietary treatments during the whole experimental period (0 to 4 weeks). Apparent digestibility of gross energy was greater in LP+NTPS and LPEL+ENZ groups than in the LEL+ENP (p<0.05). Apparent digestibility of phosphorus was greater in LP+NTPS than in LEL+ENP (p<0.05). Dry matter excretion was lowest in LPEL+ENZ and phosphorus excretion was lowest in LP+NTPS (p<0.05). Overall, pigs fed on LPEL+ENZ group tended to have better nutrient digestibility (dry matter, gross energy, crude protein and phosphorus) than pigs fed on control group. All dietary enzyme treatment groups showed lower feed cost/body weight gain of pigs than control group. In conclusion, the results from the present study suggest that the simultaneous inclusion of phytase and carbohydrase enzyme complex to diets is advantageous with respect to reducing nutrient excretion of growing pigs and may contribute to increased economic return when added to corn-soy based growing pig diets.

Clinical Study of Long Term Effect of Transvaginal Ultrasound Guided Radiofrequency Myolysis for Treatment of Uterine Leiomyoma (자궁근종 치료를 위한 질경유 초음파 유도하 고주파 자궁근종용해술의 장기간 효과에 대한 임상적 연구)

  • Lee, Woo-Seok;Lee, Il-Han;Kim, Dong-Ho;Lee, Sang-Hun
    • Clinical and Experimental Reproductive Medicine
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    • v.35 no.1
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    • pp.77-82
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    • 2008
  • Objective: This study was performed to investigate the efficacy and safety of radiofrequency (RF) myolysis under transvaginal ultrasound guidance. Methods: Transvaginal RF myolysis had been performed in one hundred nine women with uterine leiomyoma at Chung-Ang University hospital between Dec. 2004 and Mar. 2007. All patients, mean aged $42.8{\pm}5.8$ years, desired their uterine conservation. Patients underwent physical examination, transvaginal pelvic ultrasound for measurement of the lesions preoperatively. Follow up was done at 1 week, 1 month, 3 months, 6 months after RF myolysis by same physician and measurement of size and volume of myoma and improvement of myoma specific symptoms such as menorrhagia and dysmenorrhea were checked at each visit. Results: The mean maximal diameter of myomas treated by RF myolysis was $6.1{\pm}0.5\;cm$ and average time of the procedure was $16.3{\pm}8.5$ minutes. A significant decrease of myoma size and volume was observed at 1 month after myolysis. Mean reduction in maximal diameter was $29.9{\pm}4.8%$ at 1 week (p<0.001), $41.5{\pm}1.5%$ at 1 month (p=0.05), $46.2{\pm}3.9%$ at 3 months (p=0.003), $54.6{\pm}6.1%$ at 6 months (p<0.001) after RF myolysis respectively. Mean reduction in volume was $44.4{\pm}8.3%$ (p=0.001), $68.1{\pm}4.2%$ (p=0.035), 73.9$73.9{\pm}4.8%$ (p=0.042), $84.5{\pm}5.1%$ (p<0.001) at the same follow up period respectively. Significant improvement of symptom was observed at 3 months after RF myolysis. Transient low abdominal pain and prolonged vaginal bleeding were detected in 3 patients each but spontaneously resolved and no serious complication has been noticed or found. Conclusion: This study shows transvaginal RF myolysis could be a safe and effective method to treat uterine leiomyoma, allowing uterine conservation with significant volume reduction and rapid return to normal activity.

A Study on the K-REITs of Characteristic Analysis by Investment Type (K-REITs(부동산투자회사)의 투자 유형별 특성 분석)

  • Kim, Sang-Jin;Lee, Myenog-Hun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.11
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    • pp.66-79
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    • 2016
  • A discussion has recently emerged over the increase of approvals of K-REITs, which is concluded on the basis of how to raise funds for business activity, fulfill the expected rate of return and maximize the management of managing investment funds. In addition, corporations need to acknowledge the necessity of the capital structure reflected in the current economic environment and decision-making processes. This research analyzed the characteristics by investment types and influence factors about the debt ratio of K-REITs. The data were collected from general management about business state, investment, and finance from 2002 to 2015 in K-REITs (except for the GFC period of 2007~2009). The results of the research demonstrated the high ratios of the largest shareholder characteristics, which are corporation, pension funds, mutual funds, banks, securities, insurance, and, recently, the increasing ratio of the largest shareholder and major stockholder. The investment of K-REITs is increasing the role of institutional investors that take a leading development of K-REITs. The behaviors of simultaneous investment of institutional investors were analyzed to show that they received higher interest rates than other financial institutions and ran in parallel with attraction and compensation. The results of the multiple regressions analysis, utilizing variables about debt ratio were as follows. The debt ratio showed a negative (-) relation that profitability is increasing, which matches the pecking order theory and trade off theory. On the other hand, investment opportunities (growth potential) showed a negative (-) relation and assets scale that indicated a positive (+) relation. The research results are reflected as follows. K-REITs focused on private equity REITs more than public offering REITs, and in the case of financing the capital of others, loan capital is operated under the guarantee of tangible assets (most of real estate) more than financing of the stock market. Further, after the GFC, the capital of others was actively utilized in K-REITs business, and the debt ratio showed that the determinant factors by the ratio and characteristics of the largest shareholder and investment products.