• Journal of Chest Surgery
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• v.42 no.3
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• pp.292-298
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• 2009

Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

• Journal of the korean veterinary medical association
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• v.44 no.9
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• pp.803-818
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• 2008

동물의 결핵은 Mycobacterium bovis의 감염에 의한 만성 소모성 질병이며 인수공통전염병이다. 동물로부터 사람으로의 결핵 전염은 생유 섭취하던 시대에 상당히 많이 보고되었다. 우유의 살균처리와 소에서 피내진단에 의한 양성우 살처분 및 보상금 지급 정책을 전개하면서 M. bovis의 사람전염은 급격히 감소하였다. 소 결핵은 우리나라에서 연간 0.15% 내외의 발생을 보이고 있으며, 발생의 주원인으로는 외부입식소, 인근발생농장, 과거발생농장의 사후관리소홀 등이다. 사람 결핵의 주원인균인 M. tuberculosis와 M. bovis는 유전체가 99.9% 유사하며, M. bovis를 M. tuberculosis의 아종으로 분류하기도 한다. 두 세균은 M. tuberculosis complex에 속하며, M. tuberculosis와 M. bovis이외에도 M. africanum, M. canettii, M. microti, M. pinnipedii 등이 있다. M. bovis는 M. tuberculosis complex중에서 가장 넓은 숙주범위를 가진다. M. bovis의 대표적인 숙주는 종이름에도 나타나 있듯이 소이다. 소결핵 전파원으로서는 M. bovis에 감염된 소가 가장 중요하다. 소 이외에도 면양, 산양, 말, 돼지, 사슴, 엘크, 영양 (antelope, kudus, elands, sitatungas, oryxes, addaxes), 개, 고양이, 흰족제비 (ferrets), 낙타, 여우, 밍크, 오소리, 쥐, 영장류, 라마, 맥 (tapirs), 코끼리, 코뿔소 (rhinoceroses), 주머니쥐, 땅다람쥐 (ground squirrels), 수달 (otters), 물개, 산토끼 (hares), 두더쥐 (moles), 너구리 (raccoons), 코요테, 사자, 호랑이, 표범, 살쾡이 (lynx) 등에 감염될 수 있으나, 대부분 종결숙주 (spillover host)로 가축의 결핵방제가 유지되고 있는 국가에서는 야생동물 결핵의 가축 전염이 문제시되고 있다. M. bovis는 주로 호흡기와 소화기를 통하여 감염되며, 결핵결절이 형성되는 부위를 관찰하면 감염경로를 추정할 수 있다. 결핵에 감염되면, 초기에는 뚜렷한 임상증상을 보이지 않으나, 아침, 추운 날씨, 또는 운동 중에 심한 기침을 하며, 호흡곤란을 일으킬 수 있다. 결핵은 감염되어도 대부분 무증상이기 때문에 피내진단, 결핵결절 병리소견, 원인균 분리 등에 의해 진단하여야 한다. 감염된 결핵균은 탐식세포에 탐식되어 특징적인 육아종성 결절 병변으로 진행된다. 현재 결핵은 피내진단과 결핵결절 병리소견 등에 의해 판정하고 있다. 최신 진단법으로는 피내진단을 대체할 수 있는 인터페론 감마 검사법과 우군의 결핵 스크리닝과 말기 결핵 검사에 우수한 항체진단법이 개발되어 있다. 그러나, 소 결핵 근절을 위해서는 일관성있는 진단법과 진단기준을 적용하는 것이 중요한 성공요인중 하나이다. 소결핵 청정국인 호주와 캐나다에서는 피내진단과 도축장 결절검사를 결핵 양성우 색출방법의 근간으로 삼고 있으며, 소결핵 근절의 최종단계에 이르러서는 특이적인 검사법을 적용하였지만, 근절목적상 민감성이 높은 피내진단법을 사용하였다. 이와 더불어, 피내진단 양성우의 부검소견과 원인균 분리를 통해 결핵을 확진하여 출처농장의 역추적 검사를 통하여 결핵 양성소를 제거하였다. 한편, 결핵의 농장간 및 지역간 전파방지를 위해 결핵 청정농장과 결핵 오염농장, 결핵 청정지역과 결핵 오염지역 구분을 통하여 결핵 오염농장과 결핵 오염지역으로부터 결핵 청정농장과 결핵 청정지역으로의 이동전 결핵 검진을 통해 개체 이동에 따른 결핵 전파를 근본적으로 차단하는 시스템을 엄격히 적용한 것이 주요한 성공 요인중 하나였다. 호주 결핵 근절정책 성공요인을 요약하면, 일관성 있는 결핵진단법 적용, 양성우 출처농장의 철저한 역추적 검사, 개체 이동전 결핵 음성증명 확인, 농가단체의 경제적 및 방역상 적극적인 지원 및 협조 결핵의 지속적인 모니터 링과 현장요구에 부응하는 방제신기술의 지속적인 연구개발 등을 들 수 있다. 최근 들어 국내 동물 결핵은 소, 특히, 한우의 결핵발생이 증가하고 있으며, 사슴 결핵발생도 증가하고 있다. 농장간 및 지역간에 결핵 감수성 가축, 특히, 소와 사슴의 거래가 아주 복잡하게 이루어지고 있는 현실을 고려할 때, 결핵전파의 주원인인 결핵감염 소나 사슴의 농장내 반입을 철저히 차단해야 할 것이다. 이때, 개체 검사는 물론이고, 출처농장에 대한 결핵 음성을 확인한 후 입식하여야 할 것이며, 입식 후에도 60일정도 격리사육하면서 피내진단등 결핵검진 후 음성인 경우에만 합사하여야 할 것이다. M. bovis는 사람을 비롯한 거의 모든 온혈동물에서 결핵을 일으킬 수 있기 때문에, 결핵 감염소로 판정된 농장 종사자는 각 시도 보건소의 협조를 받아 결핵검진을 받도록 해야 한다. 농장 가축에 접촉할 수 있는 야생동물의 접촉을 차단하여야 하며, 특히, 농장 사료의 야생동물에 의한 오염을 방지할 수 있는 사료창고관리를 철저히 해야 한다. 결핵 감염소를 다룰 때는 분비물 또는 가검물에 의해 감염될 수 있기 때문에 개인방역장비 - 방역복, 마스크, 비닐장갑, 비닐장화 - 를 착용한 상태에서 다루어야 한다. 특히, 결핵 감염소를 매몰 또는 소각하는 과정에서 결핵 감염소의 배설물 및 분비물 처리를 철저히 하여야 한다. 모든 작업을 마친 후에는 개인방역장비, 매몰 또는 소각에 사용하였던 장비 등을 청소 및 소독하고 필요시 소각 또는 매몰하여야 하며, 개인감염위험과 타인 감염위험을 방지하기 위해 노출부위를 세척하여야 한다.

• Economic and Environmental Geology
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• v.44 no.2
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• pp.95-107
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• 2011

The Hwangsan volcanic rocks, hosting the Moisan epithermal Au-Ag deposit arc widely distributed throughout the Seongsan district, and associated with large hydrothermal alteration. They were analyzed as the Moisan and around voleanic rocks, and most of them show dacitic to rhyolitic compositions. Hydrothermal alteration related to epithermal system causes the host rocks to show the geochemical variation due to high mobility of alkali elements. These features can be applied for quantitative estimates of alteration intensity. Alteration intensity of volcanic rocks from the Moisan ranges from subtle to intense, based on AI vs. $Na_2O$ diagram. The pattern that ($CaO+Na_2O$) content decrease with increasing $K_2O$ content results from sericitic alteration, in which hydrothermal fluids continually provide $K^+$ into country rocks but remove $Ca^{2+}$ and $Na^{2+}$ of feldspars within country rocks. The decrease of ($CaO+Na_2O$) with decreasing $K_2O$ in some samples from the Moisan may be caused by advanced argillic alteration that all alkali elements are entirely removed from country rocks by acid hydrothermal fluids. Two alteration trends, based on Al and CCPI alteration indices suggest both sericitic alterations of feldsaprs to illite and sericite+chlorite$^{\circ}{\ae}$pyritc alteration of high Mg and Fe activities. Trace and Rare Earth Elements patterns show the similar geochemical variation related to hydrothermal alteration. Of LIL elements, strong depletion of $Sr^{2+}$, substituting for $Ca^{2+}$ in feldspars, appears to be resulted from removal of $Ca^{2+}$, during replacement of feldspars to alumino-silicates or phyllo silicates minerals by hydrothermal fluids. Relatively low total REEs contents (Moisan: 119-182 ppm; Seongsan: 111-209 ppm) and gently negative slopes suggest that significant mobility of LREEs appear to occur during hydrothermal alteration.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.825-830
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• 2007

Background: Minimally invasive cardiac surgery appears to offer certain advantages such as earlier postoperative recovery and a greater cosmetic effect than that achieved through conventional sternotomy. However, this approach has not yet been widely adopted in Korea to replace complex open heart surgery such as mitral valve reconstruction. This study compared the results of robot assisted minimally invasive mitral valve repair with those results of conventional sternotomy. Material and Method: From December 1993 to December 2005, 520 consecutive patients underwent mitral valve reconstruction for mitral regurgitation in our institution. These patients were subdivided according to those whose surgery used the conventional sternotomy approach (Group S, n=432) and those who underwent minimally invasive right anterior thoracotomy (Group M, n=88); we then compared the clinical results of both groups. When we performed minimally invasive right thoracotomy, we used a robot (AESOP 3000) and made an incision less than 5 cm. Result: Our study patients in both groups were similar for their age, gender and preoperative ejection fraction. There were two hospital mortalities in group S. but there was no mortality in the group M patients. Significant reductions in the ICU stay and the postoperative hospital stay were observed in the group M patients compared with the group S patients. However, both the bypass time and the aortic cross-clamp time were significantly longer in the group M patients. In spite of the confined incision in the group M patients, there were no limitations on the mitral valve repair techniques. There was a similar frequency of postoperative significant residual mitral regurgitation in both groups. Conclusion: In this study, the minimally invasive mitral valve repair showed comparable early results with the conventional sternotomy patients. We will now need long-term follow-up of these patients who underwent minimally invasive mitral valve repair, but we anticipate that based on the results of this study, we will begin to routinely perform minimally invasive cardiac surgery as out primary approach for mitral valve reconstruction.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.179-186
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• 1997

The frequency of primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with Lean 57.1) $\pm$ 7.15 and 80.5% (70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9'1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left slde in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in'16. 1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage olla 54.1% and stage lIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal Iymph node involvement was observed in 17 cases, and multi-level mediastinal Iymph node involvement in 23 cases. Lower paratracheal Iymph node and subcarinal Lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic Iymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95 $\pm$ 17.21 months. Overall one-year survival rate was 75.1 % and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage 1, 92.2% and 30.5% for st ge ll, and 61.2% and 17.4% for stage llla, respectively. These findings correlate survival rate with tumor size, mediastinal Iymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal Iymph node metastasis and complete surgical resection.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.172-178
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• 1997

We present a etrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensBrylmotor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 1 1 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 1) patients while in the other patient p eoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease andfor atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B. K. amputation in 1 case who had severe atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered from ischemic heart diease. Preoperative angiography was not always needed for embol ectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, embolectomy of tibial artery was difficult.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.137-145
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• 1997

From July 1983 to December 1993, total 112 consecutive mitral valve replacements in 107 patients were performed in patient with mitral valvular abnormalities. To estimate the risk factor related to operative death, all patient's perioperative data were reviewed retrospectively. Except 20 patients received concomitant aortic valve replacement and 2 patients had incomplete data, 85 patients were included in this study. Mean age were $37.3\pm$ 13.1 years ranging from 13 to 72 years. Thirty-seven patients were male and fourty-eight patients were female. Mean follow-up durations were $51.1\pm33.8$ months ranging from 6 months t 11 years. Patients in this study showed improvement in mean NYHA functional clssification, from $3.02\pm0.73$ to 1 $78\pm0.55,$ and also in cardiothoracic ratio, from 0.61 $\pm0.09$ to $0.58\pm0.08$ at 6 months follow-up after operation. Operative complications were detected in 23 patients(27.1 %) and common postoperative complications were rhythm disturbance in 7 cases, pulmonary complications in 6 cases and low cardiac output syndrome in 6 cases. Early mortality was 10.6%(n=9) and the most common cause of death was a congestive heart failure due to low cardiac output syndrome. Main cause of our higher operative mortality than other study was that operative mortality in the initial period of our mitral surgery was high(5 operative deaths among 19 mitral valve replacement from July 1983 to December 1985). Actuarial survival was 80.8% at 5 years, 71.8% at 11 years including operative deaths. Actuarial freedom from anticoagulant-related bleeding was 85.3% at 5 years, 78.3% at 11 years. 95.1% at 5 years and 88.8% at 11 years among the patient in this study were free from thromboembolism, and 97.5% at 5 years and 75.1% at 11 years were free from reoperation. Preoperative cardiothoracic ratio and patient's age were statistically significant operative risk factors.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.125-130
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• 1997

Separating the patient from hypothermic cardiopulmonary bypass(CPB) before achieving adequate rewarming often results in afterdrop, which can predispose to electrolyte disturbances, arrhythmia, hemodynamic alterations, and shivering-induced increase of oxygen consumption. In an attempt to find an adequate end point temperature of rewarming after hypothermic CPB, 50 pediatric cardiac surgical patients were r ndomly assigned for end point temperature of rewarming of 35.5$^{\circ}C$ (Group 1) or 37t (Group 2), rectal temperature. Thereafter the rectal temperature was measured half, one, four, eight, and 16 hour after arrival to the intensive care unit(ICU), with heart rate and blood pressure. Additionally the rectal temperature was compared with esophageal temperature during CPB, and axillary temperature luring stay in the ICU. Nonpulsatile perfusion with a roller pump was used in all patients and a membrane or bubble oxygenator was used for oxygenation. Both groups were comparable with respect to age, sex, body surface area, total bypass time, and rewarming time. There was no afterdrop in both groups, and there were no statistical differences in the rectal temperatures between two groups. There were also no statistical dilyerences with respect to the heart rate and blood pressure between two groups. At the end of rewarming the esophageal temperature was higher than the rectal temperature. The axil ary temperature measured in ICU was always lower than the rectal temperature. No shivering was noted in all patients. In conclusion, with restoration of rectal temperature above 35.5$^{\circ}C$ at the end of CPB in pediatric patients, we did not observe an afterdrop.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.891-898
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• 1997

Between May 1984 and January 1996, 130 patients were replaced cardiac valve using 150 St. Jude Medical prosthetic valves(42 aortic, 68 mitral, 20 aortic and mitral valve replycements). Follow-up was 97.6% complete. The early mortality rate was 5.4%, and late mortality rate was 4.9%. The valve-related late mortality rate was 3.3%. Of late complications, there were 6 anticoagulant related hemorrhages, 4 thromboembolisms and 1 paravalvular leakage. Linearized rates of late complication and valve-related late mortality were as follows: total late complications, .1.68o per patient-year: anticoagulant related hemorrhages, 0.92% per patient-year: thromboembolism, 0.61% per patient-year: paravalvular leakage, 0.15% per patient-year: reoperation, 0.15% per patient-year: and valve-related late mortalities, 0.61% per patient-year. Actuar al event free rate at 10 years was 87.4 $\pm$ 3.2%. The overall actuarial survival rate was 90.4$\pm$2.7% at 5 years, 87.5$\pm$3.3% at 10 years. Ninety eight percent of the survivors were in the New York Heart Association functional class I or II at the end of follow-up. There was significant improvement of cardiothoracic ratio. In conclusion, this study suggests the excellent durability of the St. Jude Medical Heart valve and remarkable functional benefit for the majority of the patients. However, prosthesisrelated complications are still common. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.920-926
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• 1997

Remarkable effect of pain relief and prevention of the postoperative Complications after thoracotomy has been achieved by continuous intravenous analgesia. This study was carried out with thirty patients who underwent posterolateral thoraco tony. The patients were divided into three groups: Group I(n= 10), the patients with intermittent intramuscular analgesia(piroxicam 20 mg), Group II(n=10), the patients with continuous epidural analgesia(0.5% bupivacaine 30m1 + normal saline 30 ml + morphine 10 mg), and Group III(n= 10) the patients with controlled intravenous infusion of analgesics(fentanyl 2500 mfg +normal saline 10 ml). The results w re as follows; 1) There were no significant changes of vital signs, between groups. 2) Tidal volume and FVC were significantly improved in the group II and III compared with the group I during the first postoperative day. 3) A significant reduction of immediate post-thoracotomy pain was achieved in the group II and III compared with the group I. 4) The limitation of motion in the operative side was less in the group II and III compared with the group I. 5) A signi(icant reduction of the postoperative analgegics consumption was noticed in group II and III. 6) Significant complications were not occured during follow-up period in all groups.