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The Effect of the Histidine-Tryptophan-Ketoglutarate (HTK) Solution on Myocardial Protection in Isolated Rat Heart (흰쥐의 적출심장에서 HTK 용액의 심근보호 효과)

  • 송원영;장봉현;김규태
    • Journal of Chest Surgery
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    • v.37 no.8
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    • pp.632-643
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    • 2004
  • Background: The Histidine-Tryptophan-Ketoglutarate (HTK) solution has been shown to provide the excellent myocardial protection as a cardioplegia. The HTK solution has relatively low potassium as an arresting agent of myocardium, and low sodium content, and high. concentration of histidine biological buffer which confer a buffering capacity superior to that of blood.. Since HTK solution has an excellent myocardial protective ability, it is reported to protect myocardium from ischemia for a considerable time (120 minutes) with the single infusion of HTK solution as a cardioplegia. The purpose of this study is to evaluate the cardioprotective effect of HTK solution on myocardium when the ischemia is. exceeding 120 minutes at two different temperature (10 to 12$^{\circ}C$, 22 to 24$^{\circ}C$) using the Langendorff apparatus, Material and Method: Hearts from Sprague-Dawley rat, weighing 300 to 340 g, were perfused with Krebs-Henseleit solution at a perfusion pressure of 100 cm $H_2O$. After the stabilization, the heart rate, left ventricular developed pressure (LVDP), and coronary flow were measured. Single dose of HTK solution was infused into the ascending aorta of isolated rat heart and hearts were preserved at four different conditions. In group 1 (n=10), hearts were preserved at deep hypothermia (10∼12$^{\circ}C$) for 2 hours, in group 2 (n=10), hearts were preserved at moderate hypothermia (22∼24$^{\circ}C$) for 2 hours, in group 3 (n=10), hearts were preserved at deep hypothermia for 3 hours, and in group 4 (n=10), hearts were preserved at moderate hypothermia for 3 hours. After the completion of the preservation, the heart rate, left ventricular developed pressure, and coronary flow were measured at 15 minutes, 30 minutes, and 45 minutes after the initiation of reperfusion to assess the cardiac function. Biopsies were also done and mitochondrial scores were counted in two cases of each group for ultrastructural assessment. Result: The present study showed that the change of heart rate was not different between group 1 and group 2, and group 1 and group 3. The heart rate was significantly decreased at 15 minutes in group 4 compared to that of group 1 (p<0.05 by ANCOVA). The heart rate was recovered at 30 minutes and 45 minutes in group 4 with no significant difference compared to that of group 1. The decrease of LVDP was significant at 15 minutes, 30 minutes and 45 minutes in group 4 compared to that of group 1 (p < 0.001 by ANCOVA). Coronary flow was significantly decreased at 15 minutes, 30 minutes, and 45 minutes in group 4 compared to that of group 1 (p < 0.001 by ANCOVA). In ultrastructural assessment, the mean myocardial mitochondrial scores in group 1, group 2, group 3, and group 4 were 1.02$\pm$0.29, 1.52$\pm$0.26, 1.56$\pm$0.45, 2.22$\pm$0.44 respectively. Conclusion: The HTK solution provided excellent myocardial protection regardless of myocardial temperature for 2 hours. But, when ischemic time exceeded 2 hours, the myocardial hemodynamic function and ultrastructural changes were significantly deteriorated at moderate hypotherma (22∼ 24$^{\circ}C$). This indicates that it is recommended to decrease myocardial temperature when myocardial ischemic time exceeds 2 hours with single infusion of HTK solution as a cardioplegia.

The Comparision of Right Anterolateral Thoracotomy and Median Sternotomy in the Atrial Septal Defect Repair. (심방중격결손증 수술에서 우전측부개흉술과 정중흉골절개술의 비교)

  • Kim, Hyuck;Kim, Sang-Heon;Kim, Young-Hak;Chung, Won-Sang;Kang, Jung-Ho;Lee, Chul-Beom;Jee, Heng-Ok;Kim, Nam-Soo;Kim, Kyung-Soo
    • Journal of Chest Surgery
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    • v.36 no.1
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    • pp.1-6
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    • 2003
  • Currently, atrial septal defect repair has been considered low risk operation duo to the development of open heart surgery Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. Material and Method: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy(group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. Result: The mean weight of group A was 38.77$\pm$15.57kg and 38.21$\pm$21.82kg in group B. In group A, mean operation (OP) time was 197.6$\pm$61.40min, mean cardiopulmonary bypass(CPB) time was 48.66$\pm$13.02min and mean fibrillation time or aortic cross clamp(ACC) time was 30$\pm$11.64min. In group B, mean OP time was 212.33$\pm$31.95min, mean CPB time was 55$\pm$12.10min, and mean fibrillation or ACC time was 29.33$\pm$9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78$\pm$0.78 hours, mean postoperative ICU stay was 1.2$\pm$0.47 days and mean postoperative hospital stay was 10.20 41.08 days. In group B, mean mechanical ventilation time was 5.95$\pm$3.73 hours, mean post operative ICU stay was 1.41$\pm$0.61 days, and mean postoperative hospital stay was 12.20$\pm$3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33$\pm$90.54cc vs 352.33$\pm$239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block. Conclusion: Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument(p.0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.

Analysis of the Causes of Subfrontal Recurrence in Medulloblastoma and Its Salvage Treatment (수모세포종의 방사선치료 후 전두엽하방 재발된 환자에서 원인 분석 및 구제 치료)

  • Cho Jae Ho;Koom Woong Sub;Lee Chang Geol;Kim Kyoung Ju;Shim Su Jung;Bak Jino;Jeong Kyoungkeun;Kim Tae_Gon;Kim Dong Seok;Choi oong-Uhn;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.165-176
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    • 2004
  • Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.

A Study on the Fabrication of the Laminated Wood Composed of Poplar and Larch (포푸라와 일본잎갈나무의 집성재 제조에 관한 연구)

  • Jo, Jae-Myeong;Kang, Sun-Goo;Kim, Ki-Hyeon;Chung, Byeong-Jae
    • Journal of the Korean Wood Science and Technology
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    • v.2 no.2
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    • pp.25-31
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    • 1974
  • 1. Various gluing qualities applying Resorcinol Plyophen #6000 were studied on aiming the strength relationships of laminated woods resulted by single species [poplar (Populus deltoides), larch(Larix leptolepis)], mixed species of (poplar and larch), preservatives, treated poplar the scarf joint with mixed species of poplar and larch and the scarf joint treated with preservatives. 1. 1 On the block shear and on the DVL tension test, the mean wood failure ratio showed an excellent value i.e., above 65% and the tangential strength for larch was higher than that of radial, but it was reversed for poplar as shown in Tables 1 and 2. 1. 2 The lamina treated with Na-PCP reduced slightly the strength but the limited strength allowed for manufacturing laminated wood was not influenced by treating Na-PCP as shown in Tables 3 and 4. 1. 3 The safe scarf ratio in the plane scarf joint was above 1/12 for larch and 1/6 for poplar regard less of the chemical treatment or untreatment as shown in Tables. 5, 6, 7 and 8. 2. In the normal and boiled state, the gluing quality of the laminated wood composed of single[poplar (Populus deltoides), larch (Larix leptolepis)] and double species (poplar and larch) glued with Resorcinol Plyophen #6000 were measured as follow, and also represented the delamination of the same laminated wood. 2.1 The normal block shear strength of the straight and curved laminated wood (in life size) were more than three times of the standards adhesion strength. And, the value of the boiled stock was decreased to one half of the standard shear adhesion strength, but it was more than twice the standard strength for the boiled stock. Thus, it was recognized that the water resistance of the Resorcinol Plyophen #6000 was very high as shown in Tables 9 and 10. 2. 2 The delamination ratio of the straight and curved laminated woods in respect of their composition were decraesed, in turn, in the following order i. e., larch, mixed stock (larch+poplar) and poplar. The maximum value represented by the larch was 3.5% but it was below the limited value as shown in Table 11. 3. The various strengthes i.e., compressive, bending and adhesion obtainted by the straight laminaced wood which were constructed by five plies of single and double species of lamina i. e., larch (Larix leptolepis) and poplar (Populus euramericana), glued with urea resin were shown as follows: 3. 1 If desired a higher strength of architectural laminated wood composed of poplar (P) and larch (L), the combination of the laminas should be arranged as follows, L+P+L+P+L as shown in Table 12. 3.2 The strength of laminated wood composed of laminas which included pith and knots was conside rably decreased than that of clear lamina as shown Table 13. 3.3 The shear strength of the FPL block of the straight laminated wood constructed by the same species which were glued with urea adhesives was more than twice the limited adhesion strength, thus it makes possible to use it for interior constructional stock.

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Clinical Significance of Reverse Redistribution on Tc-99m MIBI and T1-201 Myocardial Perfusion SPECT Images (Tc-99m MIBI와 T1-201 심근 SPECT에서 역재분포의 임상적 의의)

  • Song, Ho-Cheon;Bom, Hee-Seung;Kim, Ji-Yeul;Jeong, Myung-Ho;Gill, Kwang-Chae;Park, Joo-Hyung;Cho, Jeong-Gwan;Park, Jong-Choon;Kang, Jung-Chaee
    • The Korean Journal of Nuclear Medicine
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    • v.30 no.1
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    • pp.95-103
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    • 1996
  • Reverse redistribution(RRD) refers to a perfusion defect that develops or becomes more evident on rest imaging compared with the stress imaging. This phenomenon was not uncommonly noted on myocardial perfusion single photon emission computed tomography (SPECT). However, the clinical significance and pathophysiological mechanism of RRD were unclear. The aim of this study was to evaluate the incidence and clinical significance of RRD on either dipyridamole T1-201 or Tc-99m MIBI myocardial perfusion SPECT. RRD was defined as ${\geq}10%$ decrease in relative T1-201 and Tc-99m MIBI uptakes on rest images compared to the stress images or as an appearance of new perfusion defects on rest images. It was observed in both T1-201 (44/463, 9.5%) and Tc-99m MIBI (124/999, 12.4%) myocardial SPECTs similarly, with an overall incidence of 11.5%(168/1462). Many apparent)y unrelated disease groups showed the finding: post-revascularization(53.9%), coronary artery disease(24.6%), myocardial infarction(12.3%), and those with normal coro-nary arteries (9.2%). Clinical and angiographic characteristics of 65 consecutive patients who underwent coronary arteriography in 168 patients who had RRD on myocardial perfusion SPECT were reviewed. Tc-99m MIBI was used in 44 patients, and T1-201 was used in 21 patients. Of the 81 myocardial segments analyzed which showed RRD, 32 segments(39.5%) were in septum, 24(29.5%) in inferior wallL, 12(14.8%) in anterior wall, 7(8.7%) in apex and 6(7.4%) in lateral wall. There was no clear association between RRD and coronary arterial stenosis or Presence of collateral circulations. Ventriculographical wall motion was evaluated in 27 regions with RRD; it was normal in 12 regions, hypokinetic in 12 regions and dyskinetic in 3 regions. In 14 of 21 patients who showed RRD on T1-201 myocardial SPECT, T1-201 reinjection was performed immediately after the 3-4 hour redistribution studies. Ten of 14 (71.4%) showed enhanced T1-201 activity(${\geq}10%$ increased) after reinjection. We conclude that RRD is not related to mode of stress or radiopharmaceuticals. RRD might represent many inhomogeneous pathophysiological processes.

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The Correction Factor of Sensitivity in Gamma Camera - Based on Whole Body Bone Scan Image - (감마카메라의 Sensitivity 보정 Factor에 관한 연구 - 전신 뼈 영상을 중심으로 -)

  • Jung, Eun-Mi;Jung, Woo-Young;Ryu, Jae-Kwang;Kim, Dong-Seok
    • The Korean Journal of Nuclear Medicine Technology
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    • v.12 no.3
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    • pp.208-213
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    • 2008
  • Purpose: Generally a whole body bone scan has been known as one of the most frequently executed exams in the nuclear medicine fields. Asan medical center, usually use various gamma camera systems - manufactured by PHILIPS (PRECEDENCE, BRIGHTVIEW), SIEMENS (ECAM, ECAM signature, ECAM plus, SYMBIA T2), GE (INFINIA) - to execute whole body scan. But, as we know, each camera's sensitivity is not same so it is hard to consistent diagnosis of patients. So our purpose is when we execute whole body bone scans, we exclude uncontrollable factors and try to correct controllable factors such as inherent sensitivity of gamma camera. In this study, we're going to measure each gamma camera's sensitivity and study about reasonable correction factors of whole body bone scan to follow up patient's condition using different gamma cameras. Materials and Methods: We used the $^{99m}Tc$ flood phantom, it recommend by IAEA recommendation based on general counts rate of a whole body scan and measured counts rates by the use of various gamma cameras - PRECEDENCE, BRIGHTVIEW, ECAM, ECAM signature, ECAM plus, IFINIA - in Asan medical center nuclear medicine department. For measuring sensitivity, all gamma camera equipped LEHR collimator (Low Energy High Resolution multi parallel Collimator) and the $^{99m}Tc$ gamma spectrum was adjusted around 15% window level, the photo peak was set to 140-kev and acquirded for 60 sec and 120 sec in all gamma cameras. In order to verify whether can apply calculated correction factors to whole body bone scan or not, we actually conducted the whole body bone scan to 27 patients and we compared it analyzed that results. Results: After experimenting using $^{99m}Tc$ flood phantom, sensitivity of ECAM plus was highest and other sensitivity order of all gamma camera is ECAM signature, SYMBIA T2, ECAM, BRIGHTVIEW, IFINIA, PRECEDENCE. And yield sensitivity correction factor show each gamma camera's relative sensitivity ratio by yielded based on ECAM's sensitivity. (ECAM plus 1.07, ECAM signature 1.05, SYMBIA T2 1.03, ECAM 1.00, BRIGHTVIEW 0.90, INFINIA 0.83, PRECEDENCE 0.72) When analyzing the correction factor yielded by $^{99m}Tc$ experiment and another correction factor yielded by whole body bone scan, it shows statistically insignificant value (p<0.05) in whole body bone scan diagnosis. Conclusion: In diagnosing the bone metastasis of patients undergoing cancer, whole body bone scan has been conducted as follow up tests due to its good points (high sensitivity, non invasive, easily conducted). But as a follow up study, it's hard to perform whole body bone scan continuously using same gamma camera. If we use same gamma camera to patients, we have to consider effectiveness of equipment's change by time elapsed. So we expect that applying sensitivity correction factor to patients who tested whole body bone scan regularly will add consistence in diagnosis of patients.

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Summer-Time Behaviour and Flux of Suspended Sediments at the Entrance to Semi-Closed Hampyung Bay, Southwestern Coast of Korea (만 입구에서 부유퇴적물 거동과 플럭스: 한반도 서해 남부 함평만의 여름철 특성)

  • Lee, Hee-Jun;Park, Eun-Sun;Lee, Yeon-Gyu;Jeong, Kap-Sik;Chu, Yong-Shik
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.5 no.2
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    • pp.105-118
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    • 2000
  • Anchored measurements (12.5 hr) of suspended sediment concentration and other hydrodynamic parameters were carried out at two stations located at the entrance to Hampyung Bay in summer (August 1999). Tidal variations in water temperature and salinity were in the range of 26.0-27.9$^{\circ}C$ and 30.9-31.5, respectively, indicating exchange offshore and offshore water mass. Active tidal mixing processes at the entrance appear to destroy the otherwise vertical stratification in temperature and salinity in spite of strong solar heating in summer. On the contrary, suspended sediment concentrations show a marked stratification with increasing concentrations toward bottom layer. Clastic particles in suspended sediments consist mostly of very fine to fine silt (4-16 ${\mu}$m) with a poorly-sorted value of 14.7-25.9 ${\mu}$m. However, at slack time with less turbulent energy, flocs larger than 40 ${\mu}$m are formed by cohesion and inter-collision of particles, resulting in a higher settling velocity. Strong ebb-dominated and weak flood dominated tidal currents, in the southwestern and the northeastern part, respectively, result in a seaward residual flow of -10${\sim}$-20 cm $s^{-1}$ at station H1 and a bayward residual flow less than 5.0 cm $s^{-1}$ at station H2. However, mean concentration of suspended sediments at station H1 is higher at flood (95.0-144.1 mg $1^{-1}$) than in ebb (75.8-120.9 mg $1^{-1}$). On the contrary, at the station H2, the trend is reversed with higher concentration at the ebb (84.7-158.4 mg $1^{-1}$) than that at the flood (53.0-107.9 mg $1^{-1}$). As a result, seaward net suspended sediment fluxes ($f_{s}$) are calculated to be -1.7 ${\sim}$-$15.610^{3}$ kg $m^{-2}$ $s^{-1}$ through the whole water column. However, the stations H1 and H2 show definitely different values of the flux with higher ones in the former than in the latter. Alternatively, depth-integrated net suspended sediment loads ($\c{Q}_{s}$) for one tidal cycle are also toward the offshore with ranges of 0.37${\times}$$10^{3}$ kg $m^{-1}$ and 0.21${\times}$$10^{3}$ kg $m^{-1}$, at station H1 and H2, respectively. This seaward transport of suspended sediment in summer suggests that summer-time erosion in the Hampyung muddy tidal flats is a rather exceptional phenomenon compared to the general deposition reported for many other tidal flats on the west coast of Korea.

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The Clinical Application and Results of Palliative Damus-Kaye-Stansel Procedure (고식적 Damus-Kaye-Stansel 술식의 임상적 적용 및 결과)

  • Lim, Hong-Gook;Kim, Soo-Jin;Kim, Woong-Han;Hwang, Seong-Wook;Lee, Cheul;Shinn, Sung-Ho;Yie, Kil-Soo;Lee, Jae-Woong;Lee, Chang-Ha
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.1-11
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    • 2008
  • Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

Comparison of the One-year Follow-up Results after Coronary Bypass Surgery versus Percutaneous Coronary Intervention with Drug-eluting Stents in Patients with Left Main Coronary Artery Disease (좌주간지 병변에 대한 약물방출스텐트시술과 관상동맥우회수술의 1년 추적결과 비교)

  • Choi, Jin-Ho;Lim, Cheong;Park, Kay-Hyun;Chung, Eui-Suk;Chung, Woo-Young;Chae, In-Ho;Choi, Dong-Ju
    • Journal of Chest Surgery
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    • v.41 no.2
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    • pp.210-215
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    • 2008
  • Background: Drug-eluting stents are contributing to the exponential growth of percutaneous coronary intervention, and even in the patients with left main coronary artery disease, owing to the decreased restenosis rate. Our study aimed at comparing the one-year results after coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents in patients with left main coronary artery disease. Material and Method: Those patients who underwent coronary bypass surgery or stenting at our hospital under the diagnosis of left main coronary artery disease were divided in two groups. The variables for comparison were the preoperative disease severity, the length of the hospital stay, the early mortality and the cumulative incidence of mortality, myocardial infarction and repeated revascularization. Result: There were 101 cases in the surgery group and 78 cases in the stent group. Age, gender, the risk factors, the left ventricular ejection fraction and the proportion of acute coronary syndrome showed no significant differences between the two groups. The surgery group showed a more severe condition according to the Euroscore, a greater incidence of urgency, a longer hospital stay and a greater incidence of multi-vessel disease. The early mortality and one-year cumulative mortality were not different between the groups. The Euroscore-matched comparison for the surgery group (41 patients) and the stent group (78 patients) showed no significant differences in the Euroscore, age, gender, risk factors and the proportion of acute coronary syndrome. The surgery group in the Euroscore-matched comparison showed more multi-vessel disease and a longer hospital stay. The surgery group showed lower early mortality and lower one-year cumulative mortality, but this was statistically insignificant (0% vs 2.6%, respectively, p=0.55; 0% vs 6.6%, respectively, p=0.30). The rates of repeated revascularization and major adverse events (death or myocardial infarct) were lower in the CABG group, but this was not statistically significant (13.3% vs 6.3%, respectively, p=0.48; 10.0% vs 0%, respectively, p=0.09). Conclusion: Percutaneous coronary intervention using drug-eluting stents in low-risk patients with left main coronary artery disease resulted in a shortened length of the hospital stay, as compared with that of the CABG group of patients. However, the patients who underwent percutaneous coronary intervention using drug-eluting stents showed a tendency for an increased rate of repeated revascularization and higher one-year cumulative mortality. Further studies with large populations and longer follow-up will be necessary to reaffirm our findings.

Genetic Environments of the High-purity Limestone in the Upper Zone of the Daegi Formation at the Jeongseon-Samcheok Area (정선-삼척 일대 대기층 상부 고품위 석회석의 생성환경)

  • Kim, Chang Seong;Choi, Seon-Gyu;Kim, Gyu-Bo;Kang, Jeonggeuk;Kim, Kyeong Bae;Kim, Hagsoo;Lee, Jeongsang;Ryu, In-Chang
    • Economic and Environmental Geology
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    • v.50 no.4
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    • pp.287-302
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    • 2017
  • The carbonate rocks of the Daegi Formation are composed of the limestone at the upper and lower zones, and the dolomite at the middle zone, in which the upper zone has higher CaO content than others. The colors of carbonate rock in the Daegi Formation can be divided into five types; white, light brown, light gray, gray, and dark gray. The white to light gray colored rocks correspond to the high purity limestone with 53.15 ~ 55.64 wt. % CaO, and the light brown colored rocks contain 20.71 ~ 21.67 wt. % MgO. The bleaching of carbonate rocks are not related to CaO composition of the rocks, as light gray rocks tend to be higher in CaO content than those of the white rocks at the lower zone. The pelitic components are also occasionally increased in white limestone than light grey one. $Al_2O_3$ is one of the most difficult content to remove during hydrothermal processes, so the interpretation that the limestone is purified together with hydrothemral bleaching, has little merit. The wide range (over 16 ‰) of ${\delta}^{18}O_{SMOW}$, smaller variation (within 2 ‰) of ${\delta}^{13}C_{PDB}$ are apparent in both the upper and lower zones, which indicate the Daegi Formation had been affected overall by hydrothermal fluids. The K-Ar isotopic age of hydrothermal alteration in the GMI limestone mine is $85.1{\pm}1.7Ma$. Gradual change from grey through light grey to white limestone is accompaned by lower oxygen stable isotope values, which is major evidence that the hydrothermal effect is the main process of the bleaching. Although the Daegi Formation has suffered from hydrothermal activity and increase in whiteness, there is no clear evidence demonstrating the relationship between bleaching and high purity of limestone. The purification of limestone has nothing to do with the hydrothermal activity in this area. Instead, it should be considered that the change of sedimentary environment related to see-level fluctuation which can prevent deposition of pelitic components especially $Al_2O_3$ contrbuted to the formation of the high purity limestone in the upper zone of the Daegi Formation. Considering the evidences such as increase in CaO content of limestone by depth, gradual change from calcite to dolomite at the lower zones, and occurring the high purity limestone at the upper zone, the interpretation of sequence stratigraphic aspect to the formation of the high purity Daegi limestone appears to be more suitable than that of hydrothermal alteration origin.