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Respiratory Assist by Use of Electrical Diaphragmatic Pacing (전기자극에 의한 횡격막 조율을 이용한 호흡보조장치)

  • 오중환;김은기;서재정;박일환;김부연;이상헌;이종국;이영희
    • Journal of Chest Surgery
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    • v.34 no.6
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    • pp.441-446
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    • 2001
  • Background: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. Methods: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. Results: Tidal volume increased from 143.3$\pm$51.3 ml to 272.3$\pm$87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7$\pm$4.0 mmHg to -10.5$\pm$4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1+2.5 mmHg to 1.2$\pm$4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3$\pm$6.7cmH$_{2}$O to 20.0$\pm$5.3 cmH$_{2}$O. Conclusion: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.

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Pulmonary Arterial Growth Pattern after Shunt Operation in Patients of Pulmonary Atresia with Ventricular Septal Defect Associated with Juxtaductal Stenosis (Juxtaductal stenosis가 동반된 PA/VSD환자에서 체폐단락술 부위에 따른 폐동맥 크기의 변화)

  • 이교준;박영환;최재영;조범구
    • Journal of Chest Surgery
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    • v.31 no.9
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    • pp.861-866
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    • 1998
  • Background: Pulmonary atresia (PA) with ventricular septal defect has various morphology of pulmonary arteries and pulmonary blood flow sources, so pulmonary arterial hypoplasia and arborization abnormality make this anomaly difficult to manage surgically. In cases associated with juxtaductal stenosis, we evaluated the change of the pulmonary arterial and juxtaductal stenotic site after shunt operations, and would like to find useful information in surgical planning and methodology of these patients. Material and Method: Among 59 cases diagnosed as PA with ventricular septal defect associated with juxtaductal stenosis, 29 cases who had cardiac catheterization before and after shunt operation were selected from July, 1991 to July, 1996. In 10 cases of right shunt operation(Group I) and 19 cases of left shunt operation (Group II), the diameters of the descending aorta, both pulmonary arteries, and the juxtaductal stenosis site were measured before and after the shunt operation. Result: In both Group I and II, the pre- and postoperative ratio of diameters of the ipsilateral pulmonary artery to the descending aorta was from 0.78${\pm}$0.31 units to 1.01${\pm}$0.26 units and from 0.67${\pm}$0.18 units to 0.84${\pm}$0.27 units respectively, showing a signigicant increase. The contralateral pulmonary artery index was increased from 0.92${\pm}$0.28 units to 1.05${\pm}$0.15 units and from 0.94${\pm}$0.27 units to 1.08${\pm}$0.37 units respectively, but could not be confirmed statistically. In both groups, the change of juxtaductal stenosis showed an aggravating tendency but of no statistical significance from 0.43${\pm}$0.27 units to 0.39${\pm}$0.25 units and from 0.32${\pm}$0.10 units to 0.30${\pm}$0.16 units respectively, and we experienced 2 total obstruction in Group II. Because the increased pulmonary blood flow by shunt operation has a favorable effect to the pulmonary arterial growth, the shunt operation is a recommended treatment in patients with hypoplastic pulmonary arteries. But in PA with ventricular septal defects, the change of juxtaductal stenosis is very important. In conclusion, the growth of ipsilateral (shunt site) pulmonary artery was promoted by shunt operation, but there is a tendency for the juxtaductal stenosis to be aggravated. And we experienced 2 total obstruction in Group II. Conclusion: Thus, in cases operated with shunt method, much careful postoperative follow up study including angiographic evaluation is needed, and after the shunt operation on the side of pulmonary artery associated with juxtaductal stenosis, early precise planning for total correction is recommended.

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Thermotropic Liquid Crystalline Properties of Cholesteryloxycarbonated and (Cholesteryloxycarbonyl) alkanoated Celluloses (콜레스테릴옥시카본화 그리고 (콜레스테릴옥시카보닐)알카노화 셀룰로오스들의 열방성 액정 특성)

  • Jeong, Seung-Yong;Ma, Yung-Dae
    • Polymer(Korea)
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    • v.32 no.2
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    • pp.169-177
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    • 2008
  • The thermal and optical properties of cellulose tri(cholesteryloxy) carbonate(CCE0) and cellulose tri(cholesteryloxycarbonyl)alkanoates (CCEn, n=$2{\sim}8$, 10, the number of methylene units in the spacer) were investigated. CCE0 formed an enantiotropic cholesteric phase, whereas all the CCEn exhibited monotropic cholesteric phases. CCEn with n=$3{\sim}8$ formed cholesteric phases with left-handed helical structures whose optical pitches (${\lambda}_m's$) decrease with increasing temperature. On the other hand, CCE0 and CCEn with n=2 or 10 did not display reflection colors over the full cholesteric range, suggesting that the helical twisting power of the cholesteryl group highly depends on the length of the spacer connecting the cholesteryl group to the main chain. The thermal stability and degree of order in the mesophase and the temperature dependence of the ${\lambda}_m$ observed for CCEn highly depended on n. The results were discussed in terms of the differences in the internal plasticization, the arrangement of the side groups, and the conformation of the molecules.

The Role of Duplex Sonography in Right Subclavian Double Steal Syndrome (우측 빗장밑이중혈류빼앗김증후군에서 이중초음파검사의 유용성)

  • Han, Minho;Jin, Bok Hee;Nam, Hyo Suk
    • Korean Journal of Clinical Laboratory Science
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    • v.49 no.3
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    • pp.316-321
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    • 2017
  • The occurrence of subclavian steal syndrome is possible in patients with either severe stenosis or occlusion in the left proximal subclavian or brachiocephalic arteries. Limited and insufficient blood flow in the vessel with a lesion induces blood supply from the opposite side via any of the connected vessels, which is called a subclavian steal phenomenon. The duplex sonography is useful for detecting this phenomenon. Some patients who experience this phenomenon complain of vertebrobasilar insufficiency, such as headache or numbness and weakness in the arm, and so on. Subclavian steal syndrome means subclavian steal phenomenon accompanied by these symptoms. We present a patient with focal severe stenosis of the brachiocephalic artery, manifested as blood flow reversal in the vertebral, and a "to-and-fro" waveform pattern in the external carotid, internal carotid, and common carotid arteries.

Therapeutic Shoeing for Spontaneous Quarter Cracks Induced by Sheared Heel in Thoroughbred Race Horse (더러브렛 경주말에서 부등제종 기인 특발성 제측열제 처치술)

  • Yang, Young-Jin;Shin, Sang-Kyung;Yun, Sung-Wook;Kim, Seung-Joon;Cho, Gil-Jae
    • Journal of Veterinary Clinics
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    • v.31 no.5
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    • pp.461-465
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    • 2014
  • A 3-year-old colt Thoroughbred horse was referred with obvious lameness (3/5G) and mild heat and pain on left hoof of forelimb. He was diagnosed with quarter cracks that have a typical conformation of sheared heel, which are a different length and height between medial/lateral heels. Various materials and techniques were carried out to repair quarter cracks by using many different kinds of clips, bar shoes on fifth times for about 10 months. It worked on him without pain and heat on the cracked hoof, and then he could retrain for racing from the 36th weeks beginning of therapeutic shoeing. We suggested that especially fiberglass reinforced plastic (FRP) material and therapeutic shoeing were a great help to treat quarter cracks induced by sheared heel.

Segmental Aplasia of the Right Uterine Horn in a Primiparous Holstein Cow (홀스타인 초산우에서 우측 자궁각의 부분무형성 일례)

  • Kim, Ill-Hwa;Kang, Hyun-Gu;Hur, Tai-Young;Lee, Hae-Rim;Mo, In-Pil
    • Journal of Veterinary Clinics
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    • v.29 no.5
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    • pp.427-430
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    • 2012
  • An infertile, three-year-old primiparous cow was diagnosed preliminarily with pyometra by rectal palpation at 180 days postpartum. Ultrasonography showed that the cranial portion of the right uterine horn was distended with fluid, while the base portion of the horn was missing. A dense band of tissue connected the cranial portion of the uterine horn to the uterine body. However, the left uterine horn was normal. Gross postmortem analysis of the reproductive organs confirmed the ultrasonographic observations. Histopathological observations also showed that dark red-brown mucus filled the thin-walled right uterine horn, where neither caruncles nor uterine glands were observed. Finally, this primiparous Holstein cow was diagnosed with segmental aplasia of the right uterine horn.

개선된 퍼지 ART 기반 RBF 네트워크와 PCA 알고리즘을 이용한 여권 인식 및 얼굴 인증

  • Jang, Do-Won;Kim, Kwang-Baek
    • Proceedings of the Korea Inteligent Information System Society Conference
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    • 2005.11a
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    • pp.547-556
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    • 2005
  • 본 논문에서는 출입국자 관리의 효율성과 제계적인 출입국 관리를 위하여 여권 코드를 자동으로 인식하고 위조 여권을 판별할 수 있는 여권 인식 및 얼굴 인증 방법을 제안한다. 여권 이미지가 기울어진 상태로 스캔되어 획득되어질 경우 개별 코드 인식과 얼굴 인증에 많은 영향을 미칠 수도 있으므로 기울기 보정은 문자 분할 및 인식, 얼굴 인증에 있어 매우 중요하다. 따라서 본 논문에서는 여권 영상을 스미어링한 후, 추출된 문자열 중에서 가장 긴 문자열을 선택하고 이 문자열의 좌측과 우측 부분의 두께 중심을 연결하는 직선과 수평선과의 기울기를 이용하여 여권 영상에 대한 각도 보정을 수행한다. 여권 모드 추출은 소벨 연산자와 수평 스미어링, 8 방향 윤곽선 추적 알고리즘을 적용하여 여권 코드의 문자열 영역을 추출하고, 추출된 여권 코드 문자열 영역에 대해 반복 이지화 방법을 적용하여 코드의 문자열 영역을 이진화한다. 이진화된 문자열 영역에 대해 CDM 마스크를 적용하여 문자열의 코드들을 복원하고 8 방향 윤곽선 추적 알고리즘을 적용하여 개별 코드를 추출한다. 추출된 개별 코드 인식은 개선된 RBF 네트워크를 제안하여 적용한다. 제안된 RBF 네트워크는 퍼지 논리 접속 연산자를 이용하여 경계변수를 통적으로 조정하는 개선된 퍼지 ART 알고리즘을 제안하여 RBF 네트워크의 중간층으로 적용한다. 얼굴 인증을 위해서는 얼굴 인증에 가장 보편적으로 사용되는 PCA 알고리즘을 적용한다. PCA 알고리즘은 고차원의 벡터를 저 차원의 벡터로 감량하여 전체 입력 영상들의 직교적인 공분산행렬을 계산한 후 그것의 고유 값에 따라 각 영상의 고유벡터를 구하므로 PCA 알고리즘을 적용하여 얼굴의 고유 벡터를 구한 후 특징 벡터를 추출한다. 따라서 여권 영상에서 획득되어진 얼굴 영상의 특징벡터와 데이터베이스에 있는 얼굴 영상의 특징벡터와의 거리 값을 계산하여 사진 위조 여부를 판별한다. 제안된 여권 인식 및 얼굴 인증 방법의 성능을 평가를 위하여 원본 여권에서 얼굴 부분을 위조한 여권과 기울어진 여권 영상을 대상으로 실험한 결과, 제안된 방법이 여권의 코드 인식 및 얼굴 인증에 있어서 우수한 성능이 있음을 확인하였다.

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Adrenal Vein Sampling in Primary Aldosteronism: A Pictorial Essay for Optimal Left-Side Sampling (일차성고알도스테론혈증에서의 부신정맥채혈술: 최적의 좌측채혈을 위한 임상화보)

  • Gi Joo Kim;Myung Sub Kim;Hyun Pyo Hong;Young Rae Lee;Yeon Gyu Choi
    • Journal of the Korean Society of Radiology
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    • v.84 no.2
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    • pp.386-397
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    • 2023
  • Primary aldosteronism (PA) is a curable cause of hypertension. Recent studies have revealed that the actual prevalence of PA is higher than previously recognized. Adrenal vein sampling (AVS) is an essential diagnostic procedure for revealing the cause of PA and determining the treatment plan. The success of AVS is confirmed by comparing cortisol levels between the samples from each adrenal vein and peripheral vein. The failure rate of the procedure is reported to be high in the right adrenal vein, which is directly connected to the inferior vena cava, while that in the left adrenal vein is relatively low; however, this has rarely been reported. In this review, we introduce and analyze cases of failure in left adrenal vein sampling.

Modified Blalock-Taussig Shunt for the Patients with Complex Congenital Heart Defects in Early Infancy (조기 영아기에 시행된 복합 심기형 환자들에서의 변형 Blalock-Taussig 단락술)

  • Lim Hong Gook;Kim Woong-Han;Hwang Seong Wook;Lee Cheul;Kim Chong Whan;Lee Chang-Ha
    • Journal of Chest Surgery
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    • v.38 no.5 s.250
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    • pp.335-348
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    • 2005
  • Background: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. Material and Method: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was $23.1\pm16.2$ days ($5\~81\;days$), and the mean body weight was $3.4\pm0.7\;kg\;(2.1\~4.3\;kg)$. Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. Result: There were 11 ($19.0\%$) early, and 5 ($10.6\%$) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients ($41.4\%$) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. Conclusion: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.

Reconstructive Surgery for Caustic Esophageal Stricture (II) (부식성 식도협착에 대한 식도 재건술(II))

  • 정승혁;강경민
    • Journal of Chest Surgery
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    • v.29 no.4
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    • pp.420-426
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    • 1996
  • We previously reported 344 cases of esophageal reconstruction for caustic esophageal stricture between 1959 and 1982, and this is the second report of 69 cases during 12 year period from Jan. 1983 to Feb. 1995. There were 32 males and 37 females, ranging in age from 4 to 65 years(mean 36.4 years). Caustic materials were acid in 37 (53.7%) and alkali in 31 (44.9%). All cases underwent colon interposition without esophageal resection except 3 cases of cancer complication which were resected through thoracotomy. In 64 cases isoperistaltic right colon with teminal ileum interposition were performed, and 5 cases were interposed with left colon either isoperistaltic (2 cases) or antiperistaltic (3 cases) method. Anastomotic leakage was the most frequently encountered c mplication (14.4%, 10 cases), and they were 11.6%(8 cases) from cervical, 2.8% (2 cases) from ileocolostoma. Overall operative mortality was 2.9% (2169), main causes of death were sepsis due to graft necrosis and mediastinitis. During 6 months to 12years (mean 2.Syears) follow-up of survived 67 cases, 88.1% (59 cases) ate normally, 7.5% (5 cases) complained of moderate dysphagia (eating liquid diet), and 4.5% (3 cases) were unable to eat by mouth. In our experience, reconstruction of the esphagus with the colon is a satisfactory method that can be accomplished with acceptable morbidity and mortality. The right colon is a durable and functional esophageal substitute.

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