• Proceedings of the Korea Water Resources Association Conference
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• 2007.05a
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• pp.683-687
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• 2007

우리나라의 축산업은 대략 1970년대 이후부터 급속한 산업화에 따른 인구 증가 및 국민 소득의 증가로 식품 소비 형태가 변화하면서 육류 및 유제품의 소비가 증가하게 되고 농가에서 새로운 소득원으로 축산업이 활성화되면서 전통적인 재래식 가축사육 형태에서 전업식 사육형태로 점차적으로 규모가 커지기 시작하였다. 반면, 우루과이라운드(UR) 협상에 따라 농산물을 비롯한 축산물 등 완전시장개방에 따라 국제경쟁력 약화 및 축산폐수 규제의 강화에 대한 우려 등으로 겸엽(兼業)농식의 축산업은 도태 감소하게 되고 그 규모에 있어서 전업 전문화, 대규모화로 변모되어 가고 있는 추세임은 분명하다. 따라서 축산물 시장개방에 효율적으로 대처하기 위해서는 축산전업농가 육성과 계열화와 그에 따른 고품질 축산물 생산을 통한 축산업 경쟁력 제고에 노력해야 하며 아울러 축산폐수처리에 대한 기술개발 및 연구투자 확대와 더불어 축분 유기질비료의 생산 및 유통을 촉진하기 위한 법적 근거를 마련 등을 추진함으로서 국내 축산업의 경쟁력을 유지하며 친 환경적인 축산 경영을 이루어야 할 것이다. 이에 본 연구에서는 현재 날로 심각해지는 가축분뇨가 환경에 미치는 영향을 평가가 필요하여, 기초데이터의 확충 및 현황 파악을 위하여 축산 농가 내의 분뇨처리 실태를 조사 하고 문제점을 도출하고자 하였다. 또한 현재 조사된 자료를 바탕으로 가축 분뇨에 의한 오염 발생여부 및 발생량을 예측하고, 가축분뇨에 의한 오염 방지 및 수계에 미치는 영향을 안정적으로 유지하기 위하여 가축분뇨 이용 및 관리를 전반적으로 검토함으로써 가축분뇨를 효율적으로 관리하고 앞으로의 이용에 관한 여러 대안을 제시하는 것을 목적으로 한다.요했던 출혈(2예), 흉골 지연봉합(2예), 급성 신부전(2예), 폐렴(1예), 대동맥내 풍선펌프로 인한 혈전색전증(1예),수술 후 섬망(2예) 등이 있었다. 생존한 10명의 환자들 중 1명을 제외한 나머지 9명의 환자에서 $38{\pm}40$개월간의 추적관찰이 되었는데, 추적 관찰 기간 중에 3명이 사망하였고 생존한 6명의 환자는 모두 양호한 상태(NYHA 기능등급, $I{\sim}II$)를 보였으며, 그 중 3명에서는 혈역학적으로 큰 의미가 없는 잔여단락이 있었다. 결론: 급성 심근경색증 후 심실중격 결손은 수술위험도가 높은 질환이지만, 수술 전 대동맥내 풍선펌프를 삽입하고 조기에 심실중격 결손부의 infarct exclusion 술식과 함께 관상동맥우회술을 시행함으로써 만족할 만한 수술 및 중기 결과를 얻을 수 있었다.출물 투여로 저하되었으나 NC군보다는 높게 나타났다. 간 중 중성지질 함량은 참나물 에탄올 추출물 투여 용량에 따른 유의차가 없었으나, 총콜레스테롤 함량은 고용량 병합투여한 HC-PBH군만 유의하게 저하되었다. 혈청 및 간 중의 지질 함량 변화는 정상식이를 급여한 NC군과 NC-PB군 간에는 유의차가 없었다. 따라서 고콜레스테롤식이를 급여하면서 참나물 에탄올 추출물을 병합투여 시에만 지질대사 개선 효과가 있는 것으로 여겨지며, 고용량 병합투여 시 효능이 더 큰 것으로 나타났다. 고콜레스테롤식이로 인한 산화적 스트레스가 고콜레스테롤혈증을 유발하였으며, 이는 참나물 에탄올 추출물에 함유된 항산화물질을 포함한 여러 생리활성물질이 영향을 미친 것으로 사료된다. 이상의 실험 결과에서 참나물 에탄올 추출물은 고콜레스테롤식이

• Journal of Chest Surgery
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• v.41 no.5
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• pp.568-572
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• 2008

Background: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. Material and Method: Fifteen patients were analyzed. Their mean age was $31{\pm}6$ years. The mean ASD size was $24{\pm}5mm$ and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a $4{\sim}5cm$ inframammary skin incision, CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were $160{\pm}47\;and\;70{\pm}26 $minutes, respectively. Result: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was $5.9{\pm}1.8$ days. The mean follow-up duration was $10.7{\pm}6.4$ months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. Conclusion: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.351-355
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• 2007

Background: Postinfarction ventricular septal rupture is associated with mortality as high as $85\sim90%$, if it is treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated surgically, Material and Method: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of $70{\pm}11$ years (age range: $50\sim84$ years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was $2.0{\pm}1.3$ days (range: $1\sim5$ days). Operation was performed at an average of $2.4{\pm}2.7$ days (range: $0\sim8$ days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients. Result: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being $1.0{\pm}0.8$. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of $38{\pm}40$ months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class. Conclusion: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.123-131
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• 2005

Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. Material and Method: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of $77.0\pm2.4$ years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. Result: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was $3.3\%$. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below $40\%$ were univariate predictors of overall complications. Actuarial probability of survival was $94.9\%,\;89.8\%,\;and\;83.5\%$ at postoperative 1, 3 and 5 years respectively. During the follow-up period $93.3\%$ of patients were in NYHA class I, or II and $91.1\%$ were free from angina. Conclusion: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.901-908
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• 2001

Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1％) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98％) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84％) and first degree of Rentrop classification(16 cases, 52％) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.430-438
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• 2002

It is known that low birth weight is a risk factor for poor outcome in cardiac surgery for many cardiac defects. We reviewed our recent surgical experiences on congenital heart defect (other than patent ductus arteriosus) in low birth weight babies. Material and Method: From September 1994 to February 2001, 31 consecutive infants weighing 2500 g or less underwent cardiac surgery with (OHS group n=12) or without cardiopulmonary bypass (CHS group n=19). A retrospective study was carried out to evaluate short-and intermediate-term outcome. Mean gestational age and age at operation were 36.9 weeks(range, 32.3-42weeks) and 32.1days (range, 0-87days) respectively. Mean body weight at birth and operation were 1972g (range, 1100-2500g) and 2105g (range, 1450-2500 g) respectively. There was no difference between the two groups in age and body weight. Defects included ventricular septal defect (VSD) (n=3), VSD with arch anomaly (n=2), total anomalous pulmonary venous return (n=2), transposition of the great arteries (TGA) (n=2), truncus arteriosus (n=2), and univentricular heart with cor triatriatum (n=1) in OHS group, and coarctation of aorta (n=7), tetralogy of Fallot (TOF) (n=3), TOF with pulmonary atresia (n=3), multiple muscular VSDs (n=1), double outlet right ventricle (n=1), pulmonary atresia with intact ventricular septum (n=2), tricuspid atresia (n=1), and TGA with multiple VSD (n=1) in CHS group. 13 patients (41.9%) were intubated pre-operatively. Result: There were 4 early deaths(＜30 days); 1 (8.3%) in OHS group and 3 (15.8%) in non-OHS group. All these early deaths were related to the pulmonary artery banding(PAB). There was no operative mortality in infants undergoing complete repair and palliative operations other than PAB. Delayed sternal closure was required in 3 patients. Prolonged postoperative mechanical ventilation (>7 days) was required in 7 patients(58.3%) in OHS and 7(38.8%) in CHS group. Late mortality occurred in 3 patients, two of which were non-cardiac. A patient in OHS group was documented to have neurologic sequelae. All the survivors except two are in NYHA class 1. Conclusion: Complete repair and palliative operations other than PAB can be performed in low birth weight infants with low operative mortality and an acceptable intermediate-term result. However, about a half of the patients required long-term postoperative mechanical ventilation.