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Pulmonary Mycoses in Immunocompromised Hosts (면역기능저하 환자에서 폐진균증에 대한 임상적 고찰)

  • Suh, Gee-Young;Park, Sang-Joon;Kang, Kyeong-Woo;Koh, Young-Min;Kim, Tae-Sung;Chung, Man-Pyo;Kim, Ho-Joong;Han, Jong-Ho;Choi, Dong-Chull;Song, Jae-Hoon;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1199-1213
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    • 1998
  • Background : The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients is a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infiltrate in immunocompromised hosts. Method : All cases presenting as a new pulmonary infiltrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. Results : In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47 yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy(10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematologic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules(6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. Conclusion : When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.

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Research on Perfusion CT in Rabbit Brain Tumor Model (토끼 뇌종양 모델에서의 관류 CT 영상에 관한 연구)

  • Ha, Bon-Chul;Kwak, Byung-Kook;Jung, Ji-Sung;Lim, Cheong-Hwan;Jung, Hong-Ryang
    • Journal of radiological science and technology
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    • v.35 no.2
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    • pp.165-172
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    • 2012
  • We investigated the vascular characteristics of tumors and normal tissue using perfusion CT in the rabbit brain tumor model. The VX2 carcinoma concentration of $1{\times}10^7$ cells/ml(0.1ml) was implanted in the brain of nine New Zealand white rabbits (weight: 2.4kg-3.0kg, mean: 2.6kg). The perfusion CT was scanned when the tumors were grown up to 5mm. The tumor volume and perfusion value were quantitatively analyzed by using commercial workstation (advantage windows workstation, AW, version 4.2, GE, USA). The mean volume of implanted tumors was $316{\pm}181mm^3$, and the biggest and smallest volumes of tumor were 497 $mm^3$ and 195 $mm^3$, respectively. All the implanted tumors in rabbits are single-nodular tumors, and intracranial metastasis was not observed. In the perfusion CT, cerebral blood volume (CBV) were $74.40{\pm}9.63$, $16.08{\pm}0.64$, $15.24{\pm}3.23$ ml/100g in the tumor core, ipsilateral normal brain, and contralateral normal brain, respectively ($p{\leqq}0.05$). In the cerebral blood flow (CBF), there were significant differences between the tumor core and both normal brains ($p{\leqq}0.05$), but no significant differences between ipsilateral and contralateral normal brains ($962.91{\pm}75.96$ vs. $357.82{\pm}12.82$ vs. $323.19{\pm}83.24$ ml/100g/min). In the mean transit time (MTT), there were significant differences between the tumor core and both normal brains ($p{\leqq}0.05$), but no significant differences between ipsilateral and contralateral normal brains ($4.37{\pm}0.19$ vs. $3.02{\pm}0.41$ vs. $2.86{\pm}0.22$ sec). In the permeability surface (PS), there were significant differences among the tumor core, ipsilateral and contralateral normal brains ($47.23{\pm}25.45$ vs. $14.54{\pm}1.60$ vs. $6.81{\pm}4.20$ ml/100g/min)($p{\leqq}0.05$). In the time to peak (TTP) were no significant differences among the tumor core, ipsilateral and contralateral normal brains. In the positive enhancement integral (PEI), there were significant differences among the tumor core, ipsilateral and contralateral brains ($61.56{\pm}16.07$ vs. $12.58{\pm}2.61$ vs. $8.26{\pm}5.55$ ml/100g). ($p{\leqq}0.05$). In the maximum slope of increase (MSI), there were significant differences between the tumor core and both normal brain($p{\leqq}0.05$), but no significant differences between ipsilateral and contralateral normal brains ($13.18{\pm}2.81$ vs. $6.99{\pm}1.73$ vs. $6.41{\pm}1.39$ HU/sec). Additionally, in the maximum slope of decrease (MSD), there were significant differences between the tumor core and contralateral normal brain($p{\leqq}0.05$), but no significant differences between the tumor core and ipsilateral normal brain($4.02{\pm}1.37$ vs. $4.66{\pm}0.83$ vs. $6.47{\pm}1.53$ HU/sec). In conclusion, the VX2 tumors were implanted in the rabbit brain successfully, and stereotactic inoculation method make single-nodular type of tumor that was no metastasis in intracranial, suitable for comparative study between tumors and normal tissues. Therefore, perfusion CT would be a useful diagnostic tool capable of reflecting the vascularity of the tumors.

Assessment of the Position of the Mandibular Foramen and Mandibular Lingula in Children and Adolescents using CBCT (소아 청소년에서 하악공 및 하악소설의 위치에 대한 CBCT 분석)

  • Lee, Jihye;Choi, Namki;Kim, Byunggee;Kim, Seonmi
    • Journal of the korean academy of Pediatric Dentistry
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    • v.48 no.1
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    • pp.64-76
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    • 2021
  • The purpose of this study is to evaluate the position of the mandibular foramen and location and morphological characteristics of the mandibular lingula using Cone-Beam Computed Tomography (CBCT). Mandibular CBCT images of children aged 6 - 16 years were collected. A total of 180 patients were divided into 3 groups, 6 - 7, 10 - 11 and 15 - 16 years, with 30 male and female patients per group. Either side of the ramus was analyzed. The shortest distances from the anterior, posterior, superior and inferior border of the ramus to the mandibular lingula were measured. The shortest distance between the mandibular lingula and the mandibular foramen was also measured. The vertical distance from the mandibular lingula and the mandibular foramen to the occlusal plane was measured. The shapes of the mandibular lingula was classified into 4 types according to the criteria. The distances of the mandibular lingula from the anteroposterior and vertical reference points of the ramus increased in all directions with age. The distance between the mandibular lingula and the mandibular foramen also increased with age. The location of the mandibular lingula and the mandibular foramen in relation to the occlusal plane moved upwards with age. The most common shape of the mandibular lingula was triangular, followed by nodular, truncated and assimilated, and there was no difference in the shape according to age. It is recommended that the horizontal insertion point of the anesthesia from the anterior border of the ramus increased to 17 mm, 18 mm, and 19 mm according to the age groups. It is also suggested that the vertical insertion point increased by 2 - 3 mm, 5 - 6 mm and 9 - 10 mm above the occlusal plane according to the age groups.

Oxide Films Formed on Hot-Dip Aluminized Steel by Plasma Electrolytic Oxidation and Their Films Growth Stages (플라즈마 전해 산화법에 의해 용융알루미늄도금 강판 상 형성한 산화층과 그 성장 과정)

  • Choe, In-Hye;Kim, Chang-Min;Park, Jun-Mu;Park, Jae-Hyeok;Hwang, Seong-Hwa;Lee, Myeong-Hun
    • Proceedings of the Korean Institute of Surface Engineering Conference
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    • 2017.05a
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    • pp.165-165
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    • 2017
  • 지난 수 십 년 동안, 전 세계적으로 자원의 소비가 급격히 증가하게 되면서 최근 자원 고갈은 물론 환경오염이 커다란 이슈로 문제가 되고 있다. 이에 따라 재료 관련 분야에 있어서는 보다 효율적이고 친환경적인 방법으로 자원을 활용해야 된다는 필요성이 대두되었고 이와 같은 관점에서 목적하는 성분이 우수하고 환경 친화적인 표면처리 재료 개발연구가 활발하게 진행되고 있는 실정이다. 그 중 플라즈마 전해 산화(Plasma Electrolytic Oxidation, PEO)는 알루미늄, 마그네슘 등의 경금속의 경도를 향상시키고 높은 내마모성, 내식성을 갖게 하는 표면처리로써 그 관심이 증가하고 있다. 이 플라즈마 전해 산화는 일반적으로 공정비용 대비 효과적이고 환경 친화적이며 코팅 성능 면에서 우수하다고 알려져 있다. 이러한 고유한 특성으로 인해 플라즈마 전해 산화 코팅은 최근 몇 년 동안 기계, 자동차, 우주항공, 의학 및 전기 산업 등의 분야에서 그 적용이 점차 증가하고 있는 상황이다. 한편, 플라즈마 전해 산화 코팅을 하는 모재들의 경우 부동태 산화피막을 용이하게 형성할 수 있는 특성의 모재에 한정되고 있어서 그 응용확대에 한계가 있는 것이 사실이다. 따라서 본 연구에서는 플라즈마 전해 산화법을 사용하여 용융알루미늄도금 강판 상에 산화피막 형성을 시도하였다. 전원공급 장치의 양극은 전해질 속에 잠겨있는 작동전극에 연결하고 음극은 대전극 역할을 하는 스테인레스강 전해질 용기에 연결되었다. 전해질은 Sodium Aluminate 및 기타 첨가제를 함유한 것을 사용하였고 온도는 열교환기를 사용하여 $30^{\circ}C$ 이하로 유지되었다. 또한 여기서 전류밀도는 $5{\sim}10A/dm^2$, 실험 주파수는 700Hz, Duty cycle은 30 및 90%의 각 조건에서 공정처리 시간을 각각 30분 및 60분 동안 진행하였다. 이와 같은 조건에서 형성한 막들에 대해서는 주사형전자현미경(SEM)을 이용하여 코팅 막의 표면 및 단면의 모폴로지를 관찰하였음은 물론 EDS 및 XRD 측정을 통하여 원소조성분포 및 결정구조를 각각 분석하였다. 또한 이 코팅 막들에 대한 내식성은 5% 염수분무 환경 중 노출시험(Salt spray test), 3% NaCl 용액에서의 침지 시험 및 전기화학적 동전위 양극분극(Potentiodynamic Polarization) 시험을 진행하여 평가하였다. 이상의 실험결과에 의하면, 제작조건별 플라즈마 전해 산화 코팅 막의 모폴로지 및 결정구조가 상이하게 나타나는 것을 알 수 있었다. 코팅 막의 모폴로지 관찰 결과, 공정 시간에 비례하여 표면에 존재하는 원형 기공의 수는 감소하였으나 그 크기가 커지고 크레이터의 직경 또한 커진 것이 확인되었다. 이 기공은 마이크로 방전에 의해 형성된다고 알려져 있는데 공정 시간이 증가함에 따라 코팅 두께가 점차 증가하여 마이크로 방전의 빈도수가 줄어들고 그 강도는 증가하게 되어 기공 크기가 증가한 것으로 사료된다. 또한 공정시간이 긴 시편에서 표면에 크랙이 다수 존재하는 것으로 확인되었다. 이것은 방전에 의해 고온이 된 소재가 차가운 전해질과 만나게 되어 생긴 큰 온도구배로 인해 강한 열응력이 발생하여 균열을 초래한 것으로 보인다. 조성원소 분석 결과 원형 기공 주변의 크레이터 영역에는 알루미늄이 풍부하였으며 그 주변에 결절상을 갖는 구조에서는 전해질 성분의 원소가 포함되어 있는 것이 확인되었다. 이러한 코팅 막의 표면 특성은 내식성에 영향을 주게 된 원인으로 사료된다. 동전위 분극측정 결과에 의하면 플라즈마 전해 산화 공정 시간이 길어질수록 부식전류밀도가 증가하였다. 이것은 공정시간이 길어짐에 따라 강한 방전이 발생하여 기공의 크기가 증가하고 크랙이 발생하게 되면서 내식성이 저하된 것으로 판단된다. 종합적으로 재료특성 분석 및 내식성 평가를 분석한 결과, 플라즈마 전해 산화의 공정 시간이 너무 길게 되면 오히려 내식성은 저하되는 것이 확인되었다. 이상의 연구를 통하여 고내식 특성을 갖는 플라즈마 전해 산화 막의 유효성을 확인하였으며 용융알루미늄강판 상에 실시한 플라즈마 전해 산화 처리에 대한 기초적인 응용 지침을 제시할 수 있을 것으로 사료된다.

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The Pattern of Pusan Station Shopping District( I ) (부산역(釜山驛) 상점가(商店街)의 패턴( I ))

  • Kim, Won-Kyung
    • Journal of the Korean association of regional geographers
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    • v.5 no.1
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    • pp.25-75
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    • 1999
  • This study concern with the pattern of Pusan Station Shopping District within Pusan City, Korea, one of the third ranked centers within Pusan-the first ranked is CBD, the second is subCBD, the third are Spa Shopping district, Tongnae shopping district, Jobang-Ap shopping district and Yangjeong shopping district. This paper serves as a part of series studies which attempt to clarify the internal structure of Pusan as a whole. Part(I) of this study deals with the pattern of functions including information & culture, business, recreation and retailing. The results are as follows. 1. Pusan Station is one of higher ranked class of central places within Pusan City. But the ratio of dwelling houses is the highest in Pusan Station among the 9 higher ranked central places within Pusan. It means that the residential areas still remain along the maze type of narrower streets inner part of the blocks, especially western belt of this shopping district. 2. Business functions are one of the important criteria which classified the central places within the city and Pusan Station is the first ranked shopping districts in terms of these criteria among the 9 higher ranked central places including CBD within Pusan City. It suggests that Pusan Station is the miniature of the CBD, SubCBD is not the miniature of CBD in the view point of business function. It also means that Pusan Station Shopping District has been developed as a special shopping district or as a special central place. It has not been evolved as a center of the hierarchy of central places within the city by the natural or organic growth. 3. Pusan Station as 'the third space or drinking place' and it's characteristics as a amusement center presents at so called the 'Texas Town'-free tax area- whose customers are mainly U. S. soldiers and foreign sailors. But from the 1990s, this 'Town' changed to 'Russian Town', You can easy to meet many Russians and Russian lettered signboards-not English- along the street. 4. Convenient stores distribute mainly at back streets or along the narrower streets. It means that this kinds of stores have a residential oriented character. And a certain convenient stores locate with almost same distances. It suggests that it's hinterland is limited in nearer neighborhoods.

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Stress distribution following face mask application using different finite element models according to Hounsfield unit values in CT images (CT상의 HU 수치에 따른 상악골 전방견인 효과의 유한요소 분석)

  • Chung, Dong-Hwa
    • The korean journal of orthodontics
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    • v.36 no.6
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    • pp.412-421
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    • 2006
  • Objective: The result of finite element analysis depends on material properties, structural expression, density of element, and boundar or loading conditions. To represent proper elastic behavior, a finite element model was made using Hounsfield unit (HU) values in CT images. Methods: A 13 year 6 month old male was used as the subject. A 3 dimensional visualizing program, Mimics, was used to build a 3D object from the DICOM file which was acquired from the CT images. Model 1 was established by giving 24 material properties according to HU. Model 2 was constructed by the conventional method which provides 2 material properties. Protraction force of 500g was applied at a 45 degree downward angle from Frankfort horizontal (FH) plane. Results: Model 1 showed a more flexible response on the first premolar region which had more forward and downward movement of the maxillary anterior segment. Maxilla was bent on the sagittal plane and frontal plane. Model 2 revealed less movement in all directions. It moved downward on the anterior part and upward on the posterior part, which is clockwise rotation of the maxilla. Conclusion: These results signify that different outcomes of finite element analysis can occur according to the given material properties and it is recommended to use HU values for more accurate results.

Therapeutic Outcome and Recurrence Rate of Helicobacter pylori Infection in Children (소아에서 Helicobacter pylori 감염에 대한 치료결과 및 재발률)

  • Choi, Won-Jun;Kim, Je-Woo;Chung, Ki-Sup
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.1 no.1
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    • pp.37-44
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    • 1998
  • Purpose: This study aimed at evaluating the therapeutic outcome, cost effectiveness and recurrence rate in children with H. pylori infection after the treatment using various medications. Methods: Seventy five children (mean age $11.4{\pm}2.5$ years) were given an endoscopy with biopsy and H. pylori status assessed by CLO test and histologic examination (Warthin Starry stain). Children were given one of following medications such as DA ($Denol^{(R)}$ and amoxycillin), OA (omeprazole and amoxycillin), DC ($Denol^{(R)}$ and clarithromycin) as primary treatment. And one of following medications such as DAM ($Denol^{(R)}$, amoxycillin and metronidazole), DC, OA, OC (omeprazole and clarithromycin) were used in children who failed the eradication of H. pylori. Results: The endoscopic diagnoses were: nodular gastritis (46 cases), gastric ulcer (9), duodenal ulcer (6), superficial gastritis (6), and normal (8). H. pylori eradication rate was 91% (63 of 69 children) on 4 weeks course of DA, 50% (1 of 2 cases who had treatment failure on DA) on DAM, and 75% (3 of 4 cases who treated on DC primarily) and 50% (1 of 2 cases who had treatment failure on DA) on DC, and 100% on OA (all of 2) and on OC (all of 1 who failed on DA). In 3 of 7 children in whom H. pylori had not been eradicated by primary medications (DA 6 and DC 1 case), H. pylori was re-eradicated by secondary medications (DA 1, DAM 1 and DC 1 case). But in remaining 4 cases, H. pylori infection persisted. Reinfection of H. pylori was found in 4 of 75 children between 3 months and 3 years after completion of the treatment of DA, yielding recurrence rate of 5.3%. In 2 of 4 cases who had relapsed, H. pylori was re-eradicated by secondary medications (OC 1 and DA 1 case). But in remaining 2 cases, H. pylori infection persisted. Conclusion: These results suggest that dual therapy with $Denol^{(R)}$ and amoxycillin is the effective medications in treating H. pylori infection in children. Concerning the cost effectiveness, it can be recommended as first line treatment of choice as well.

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Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system (국소 간 병변의 발견: 1.5-T 자기공명영상에서의 자유호흡과 호흡유발 확산강조 영상의 비교)

  • Park, Hye-Young;Cho, Hyeon-Je;Kim, Eun-Mi;Hur, Gham;Kim, Yong-Hoon;Lee, Byung-Hoon
    • Investigative Magnetic Resonance Imaging
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    • v.15 no.1
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    • pp.22-31
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    • 2011
  • Purpose : To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. Materials and Methods: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. Results : Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratory-triggered DWI ($87.6{\pm}41.4$, $41.2{\pm}62.5$) were higher than free-breathing DWI ($38.8:{\pm}13.6$, $24.8{\pm}36.8$) (p value < 0.001, respectively). Conclusion: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

A Study on the Location of Urban Parks for Green-Network Revitalization - Based on Downtown of Busan - (도시공원 입지특성에 따른 그린네트워크 활성화 연구 - 부산광역시 도심권을 대상으로 -)

  • Kim, Sung-Hwan;Lee, Gyu-Hong;Park, Sung-Bum
    • Journal of the Korean Institute of Landscape Architecture
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    • v.38 no.2
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    • pp.75-93
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    • 2010
  • Seen topographically, Busan is a city that is coastal and hilly. In the city, most parks have been formed around mountain areas that are not so useful. They also are unbalanced in location among different regions of the city. The purpose of this study is to find how to manage urban parks towards green network promotion. For the purpose, this researcher first analyzed physical and environmental characteristics of urban parks located within the main living spheres of Busan. Then, the researcher examined interactive relations between those parks and downtown areas surrounding them to classify types of the parks. In association, the researcher classified the entire of the city into inland and coastal regions. And the researcher examined mountainous and hilly urban parks that were 150 to 300 meters above sea level in the former region and 100 to 150 meters above sea level in the latter. Findings of the study can be summarized as follows. The above examination found that parks of Busan feature physically penetrating and overlapping with downtown areas of the city. How well the green zones of Busan in form of urban park are inter-connective and influential to each other heavily depends on shapes and functions that the downtown areas of the city have. In this study, urban parks of Busan were grouped according to their types and then analyzed. Based on results of the analysis, the researcher tried to find how to increase the utility of another urban parks that are expected to be formed and how to promote so-called the green network that integrates greens. Considering findings of the study, the researcher would make the following suggestions. In case of forming an urban park in a gently sloped green zone which is easily accessible and noticeable, it's important that the park should include a stream to which another green zone is converged or, if the park is located near a costal area, contribute to promote urban functions and openness. While, in a high-altitude green zone, it's more effective to form so-called the green way that consists of some limited usable site of the zone and greens behind it and then form a hub of regional community at the intersection between the main road and main gate to the urban park, contributing to the green network promotion.

The Surgical Treatment of Atrial Fibrillation in Patients Undergoing Simultaneous Open Heart Surgery (심장세동의 수술요법)

  • Kim, Gi-Bong;Lee, Chang-Ha;Son, Dae-Won
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.287-292
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    • 1997
  • .Itrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze 111 procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defEct (VSD). Mean duration of atrial fibrillation was 36 months (:42 months) (range, 1 to 132 months). T e past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombus was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVd and tricuspid annuloplasty(TAP) in 4, mitral valvuloplasty(Mln) in 3, Mln and Tln in 1, MIW and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, but, recurrent atrial fibrillation was converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegic in 1, and acute renal failure in 1. Mean follow-up interval of patient was 16.5 months (range, 10.5 to 24 months) and all patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.

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