• Journal of Chest Surgery
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• v.36 no.2
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• pp.73-78
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• 2003

The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.321-326
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• 2005

Kawasaki disease is an acute systemic vasculitis of unknown origin. Giant coronary aneurysm is one of the most serious complications, although peripheral artery vasculitis can produce life-threatening events. Myocardial ischemia and infarction can be caused by coronary artery stenosis, aneurysm, and stagnation of blood flow in coronary arteries which triggers thromboembolism. Atypical presentation in young infants often interferes with prompt diagnosis and timely treatment, resulting in poor outcomes. We describe a 3-month-old infant with multiple giant coronary aneurysms with flow stagnation, stenosis and large mural thrombus due to Kawasaki disease. He presented with a prolonged course of severe coronary involvement in spite of all measures to reduce coronary complications. Finally, surgical intervention was tried because of the worsening coronary artery abnormalities. The patient died of acute cardiorespiratory failure shortly after weaning from cardiopulmonary bypass.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.210-217
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• 1993

To compare the myocardial viability in patients suffering from total occlusion of the right coronry artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) ($300{\sim}350{\mu}Ci$) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA ($200{\sim}250{\mu}Ci$) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar & SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 injection. Intravenous T1-201 reinjection (six pts) or $^{99m}Tc-MIBI$ (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201 (IV T1-201) images, ECG, and ventriculography. Intracoronary T1-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.

• 한국방재학회:학술대회논문집
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• 2011.02a
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• pp.101-101
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• 2011

현재 국내에서 시행되고 있는 '4대강 살리기 사업'은 하천에서 발생하는 홍수 및 가뭄재해방지를 위한 다양한 공학적 노력을 시도하고 있다. 특히 안정적인 수위 및 유량확보와 홍수방지를 위한 보(weir)가 4대강 유역에 16개 설치되고 있다. 이러한 보 구간에는 고정보와 가동보가 복합적으로 설치되고 있으며 가동보는 그 형상과 운영방식에 따라 다양한 설계방안이 적용되었다. '4대강 살리기 사업' 중 낙동강 23공구의 강정보 공사 구간에는 원호형태의 측면 형상을 갖는 라이징 섹터게이트(Rising sector gate)가 적용되었다. 라이징 섹터게이트는 구조물의 높이가 낮고 수문의 개폐장치가 수문피어 구조물 내에 설치되어 경관이 우수하며, 구조가 간단하여 비체와 수류의 안정성이 뛰어나기 때문에 4개의 공사구간에 적용되었다. 따라서 본 연구에서는 강정보의 가동보 구간 2문 중 1문을 1/100 축척으로 제작하여 가변경사 개수로에 설치하고, 홍수 빈도별 상류 유량 조건과 하류단 수위조건으로 케이스를 정하여 실험을 수행하였다. 본 실험에서 사용한 개수로 장치는 너비 0.6 m, 높이 0.8 m, 그리고 길이 15.0 m(측정가능 구간, 헤드탱크와 테일게이트 부제외)의 개수로 실험장치이다. 측부는 모두 강화유리로 되어 육안관찰 및 계측 시 용이하게 제작되었으며, 순환식 유량 공급장치를 구축하여 수로의 하부에 설치된 유량탱크로부터 계속적으로 순환하도록 설계되었다. 또한 수로 하단으로부터 상단방향으로 약 33 m 지점에 전동 유압식 Jack screw 2기가 설치되어 경사도를 조절할 수 있도록 제작되었다. 유량조절용 판넬의 제어기판에는 디지털 경사계가 설치되어 있기 때문에 보다 정확한 경사도의 조절이 가능하다. 보 모형의 총연장은 53 cm이며 폭은 45 cm이다. 섹터게이트의 게이트부분은 직경 15 cm로 설계하였다. 문주부분을 포함한 모든 모형은 아크릴로 제작하며 레이저의 주사를 방해하지 않으며 투과율을 최대로 할 수 있도록 고강도의 아크릴을 가장 얇게 하여 중공형태를 채택하였다. 실험조건은 우선 보의 운영방안에 따라 게이트의 4가지 개방도를 설정하였고, 특히 평수위조건에서는 보의 상류부에 퇴적된 퇴적물의 세척을 위한 flushing 운영개방도 포함되어 있다. 홍수시에 대한 유량조건은 2년 빈도에 해당하는 유량을 수문의 비율과 상사법칙에 따라 설정하였으며 하류단 수위조건도 동일한 조건에 대한 값을 채택하여 적용하였다. 유동장의 해석을 위해서는 비접촉식 계측방법인 PIV(Particle Image Velocimetry) 시스템을 채택하여 2차원(x-z 방향) laser sheet를 생성하고 주입된 particle에서 반사된 변위(displacement) 정보를 상호상관(cross-correlation)기법으로 유동장을 계산하였다. 또한 수리모형과 동일한 지형격자를 구축하여 3차원 CFD 프로그램인 FLOW-3D로 계산하여 결과를 비교하였다. 특히 flushing 운영방안에 대한 게이트부의 개방도를 세가지(30, 45, $60^{\circ}$)로 구분하여 모의하였고, 적절한 개방도를 제안하고자 하였다. 실험결과는 우선 4가지 운영방안에 대한 가동보 주변에서의 유속장을 파악하였고, 최대유속의 발생위치의 변화를 확인할 수 있었다. 그리고 이에 따른 보의 바닥에서 최대유속이 발생할 경우, 하상보호공 위치와 거리 등에 대해서 분석하였다. 이를 통해 가동보 운영에 따른 다양한 유속구조를 파악할 수 있게 되며 구조적 안정성 확보를 위한 검증자료로 활용될 수 있을 것으로 예상된다. 향후, 가동보 운영방안 중 수세효과(flushing effect)에 대한 효과분석을 위해 게이트부 상류구간에 적절한 입경과 비중의 퇴적물질을 설치하는 연구와 상류부에서의 유입유사농도 및 시간변화에 따른 퇴적에 관한 연구를 수행할 계획이다.

• Journal of the Korea Computer Graphics Society
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• v.24 no.4
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• pp.29-38
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• 2018

In this paper, we propose an automatic segmentation method of meniscus in knee MR images by automatic meniscus localization, multi-atlas-based locally-weighted voting, and patch-based edge feature classification. First, after segmenting the bone and knee articular cartilage, the volume of interest of the meniscus is automatically localized. Second, the meniscus is segmented by multi-atlas-based locally-weighted voting taking into account the weights of shape and intensity distribution in the volume of interest of the meniscus. Finally, to remove leakage to the collateral ligaments with similar intensity, meniscus is refined using patch-based edge feature classification considering shape and distance weights. Dice similarity coefficient between proposed method and manual segmentation were 80.13% of medial meniscus and 80.81 % for lateral meniscus, and showed better results of 7.25% for medial meniscus and 1.31% for lateral meniscus compared to the multi-atlas-based locally-weighted voting.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.82-85
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• 2009

Purpose: In anterior cruciate ligament (ACL) reconstruction, preservation of the remnant original tissue might promote graft healing and be helpful in proprioception. But this procedure is difficult and causes the notch impingement. So we introduce a surgical technique that makes a transtibial femoral tunnel at 10 or 2 o'clock position with preservation of remnant tissue. Surgical approach: We tried to preserve the remnant tissue and synovium as much as possible, especially those of tibial attachment and extending to the posterior cruciate ligament (PCL), so as to have some tension and to prevent notch impingement. We set the tibial drill guide at 40~45 degrees and the intra-articular guide tip was 1 mm anterior and medial to the conventional site. The starting point of tibial guide pin was proximal to the pes anserinus and anterior to the medial collateral ligament. When the reamer approached the cortical bone of the tibial articular surface, the reamer must be advanced very carefully to minimize injury to the remnant tissue. The tibial and femoral tunnel at 10 or 2 o'clock position were made with the reamer, the diameter of which was same with that of the graft. Conclusion: We report a remnant preserving technique in ACL reconstruction that makes a transtibial femoral tunnel at 10 or 2 o'clock position

• Horticultural Science & Technology
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• v.18 no.3
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• pp.368-372
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• 2000

The fruit structure of 'Fuji' apples from full bloom to maturing was observed from 1997 to 1998. Cell division period of the fruit was found to be 4 to 5 weeks after full bloom. Vascular bundles in the inner part of the fruit skin which were not described in the books illustrating apple fruit structure was observed, as they were tentatively named as outer vascular bundles (OVB), and another vascular bundles were also observed newly in periphery of locules, as they were tentatively named as inner vascular bundles (IVB). In the observation of the inner epidermis (IE) in the inner part of the locules on 2 days prior to full bloom, the guard cells were observed and these were disappeared in the observation made 2 days later, i.e. on full bloom. The formation of fruit skin was observed at the microscope 65 days after full bloom and the number of cell which organized the fruit skin did not change from this time to maturation period. Tannin which is mainly in the fruit skin changing from continuously during fruit growth, specially the tannin of epidermis disappeared completely 100 days after full bloom stage, and then constituted again. Starch was not almost found out in cell division period of fruit from full bloom stage after this time it constituted much at flesh part and decreased at maturation period. Epidermis was developed by uniform cells of a layer the cell of epidermis constituted irregularity after pigmentation stage, the organization of fruit was not close because the very big intercellular space constituted at hypodermis and flesh structure.

• Childhood Kidney Diseases
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• v.14 no.2
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• pp.223-229
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• 2010

Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.477-486
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• 1996

Endogenous analgesic systems are known to be activated by peripheral noxious stimulation as well as arterial carbon dioxide elevation. In the present study, neuronal Activities in the rostral ventrolateral med- ulla were identified and classified in according to their rhythmic activities, and their responses to noxious peripheral nerve stimulations before and after elevating the arterial carbon dioxide partial pressure were investigated Using extracellular recording technic, a total of 53 spontaneously active neurons were recorded from the rostral ventrolateral medulla in u-chloralose anesthetized cats. These were classified as cardiovascular (28), respiratory (16), both cardiovascular and respiratory (2) and noncardiovascular - nonrespiratory (7). - Among the 28 cardiovascular neurons eleven showed increased activities during arterial hypercapnia, thirteen showed decreased responses, and four showed no change. Nine respiratory neurons showed increased responses to arterial hypercapnia, six showed decreased responses and one showed no change. neither of the cardiovascular and respiratory neurons showed significant change in its activity during ar- terial hypercapnia, however, four of the noncardiovascular - nonrespiratory neurons exhibited decreased their activities in response to arterial hypercapnia while two exhibited increased activities. Arterial hypercapnia increased the responses of cardiovascular neurons to peripheral nerve stimulation with C-inteniity, while not changing the responses to Ak_stimulation significantly . From the above results it was conclllded that during arterial hypercapnia, some cardiovascular neurons and respiratory neurons have increased activities as well as increased reponses to C-Hber stimulation.

• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.187-198
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• 2001

Background: The purpose of this study was to evaluate the relationship between variable factors and clinical results following the operative treatment of the tibial plateau fractures. Materials and Methods: The clinical and radiological analysis was performed on 29 cases of the tibial plateau fractures who had been treated with operative treatment and followed up for more than 1 year from January 1991 to December 1997. The analysis of clinical results was performed dividing into age, cause of injury, fracture type of Schatzker classification, associated soft tissue injury and method of operative treatment. Results: According to Schatzker classification, 2 cases(6.9%) were type I, 11 cases(37.9%) were type II, 1 case(3.5%) was type III, 5 cases(17.2%) were type IV, 4 cases(13.8%) were type V, and 6 cases(20.7%) were type VI. In all cases, bony unions were obtained. According to Blokker evaluation, 23 cases(79.3%) of 29 cases were acceptable. Conclusion: We could expect good clinical results if early knee joint mobilization following minimal invasive open reduction and internal fixation could be obtained. Bad clinical results were related with young age group under 30, more than Schatzker classification type IV of high energy trauma and associated injury of anterior cruciated ligment or meniscus.