• Title/Summary/Keyword: Air Operation

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Mid-term results of IntracardiacLateral Tunnel Fontan Procedure in the Treatment of Patients with a Functional Single Ventricle (기능적 단심실 환자에 대한 심장내 외측통로 폰탄술식의 중기 수술성적)

  • 이정렬;김용진;노준량
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.472-480
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    • 1998
  • We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.

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Long Term Results of Bronchial Sleeve Resection for Primary Lung Cancer (원발성 폐암 환자에서의 기관지 소매 절제술의 장기 성적)

  • Cho, Suk-Ki;Sung, Ki-Ick;Lee, Cheul;Lee, Jae-Ik;Kim, Joo-Hyun;Kim, Young-Tae;Sung, Sook-Whan
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.917-923
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    • 2001
  • Background : Bronchial sleeve resection for centrally located primary lung cancer is a lung-parenchyma-sparing operation in patients whose predicted postoperative lung function is expected to diminished markedly. Because of its potential bronchial anastomotic complications, it is considered to be an alternative to pneumonectomy. However, since sleeve lobectomy yielded survival results equal to at least those of pneumonectomy, as well as better functional results, it became and accepted standard procedure for patients with lung cancer who have anatomically suitable tumors, regardless of lung function. In this study, from analyzing of occurrence rate of postoperative complication and survival rate, we wish to investigate the validity of sleeve resection for primary lung cancer. Material and Method : From January 1989 to December 1998, 45 bronchial sleeve resections were carried out in the Department of Thoracic Surgery of Seoul National University Hospital. We included 40 men and 5 women, whose ages ranged from 23 to 72 years with mean age of 57 years. Histologic type was squamous cell carcinoma in 35 patients, adenocarcinoma in 7, and adenosquamous cell carcinoma in 1 patients. Right upper lobectomy was peformed in 24 patients, left upper lobectomy in 11, left lower lobectomy in 3, right lower lobectomy in 1, right middle lobecomy and right lower lobectomy in 3, right upper lobectomy and right middle lobecomy in 2, and left pneumonectomy in 1 patient. Postoperative stage was Ib in 11, IIa in 3, IIb in 16, IIIa in 13, and IIIb in 2 patients. Result: Postoperative complications were as follows; atelectasis in 9, persistent air leakage for more than 7 days was in 7 patients, prolonged pleural effusion for more than 2 weeks in 7, pneumonia in 2, chylothorax in 1, and disruption of anastomosis in 1. Hospital mortality was in 3 patients. During follow-up period, bronchial stricture at anastomotic site were found in 7 patients under bronchoscopy, Average follow-up duration of survivals(n=42) was 35.5$\pm$29 months. All of stage I patients were survived, and 3 year survival rate of stage II and III patients were 63%, 21%, respectively. According to Nstage, all of N0 patients were survived and 3 year survival rates of Nl and N2 were 63% and 28% respectively. Conclusion: We suggest that this sleeve resection, which is technically demanding, should be considered in patients with centrally located lung cancer, because ttlis lung-saving operation is safer than pneumonectomy and is equally curative.

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Surgical Treatment of Congenital Cystic Lung Disease (선천성 낭성 폐질환의 수술적 치료)

  • Wi, Jin-Hong;Lee, Yang-Haeng;Han, Il-Yong;Yoon, Young-Chul;Hwang, Youn-Ho;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.335-342
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    • 2008
  • Background: Congenital cystic diseases of the lung are uncommon, and they share similar embryogenic and clinical characteristics. But they are sometimes vary widely in their presentation and severity. Therefore they are often difficult to make different diagnosis each other, and all require surgical treatment. Material and Method: From 1993 to 2006, 38 patients underwent surgical procedures under these diagnostic categories in the Depart. of Thoracic and. Cardiovascular Surgery, Busan-Paik Hospital, College of Medicine, Inje University. And we retrospectively reviewed these patients' charts for clinical presentations, surgical procedures, pathologic findings and postoperative morbidity and mortality. Result: There were 22 males and 16 females, ages ranged from 1 month after birth to 51 years and mean age was 20.8 years. The main symptoms were 19 fever, cough, sputum production due to recurrent infection, 7 dyspnea, 8 chest discomfort, 4 hemoptysis, but eight patients were asymptomatic. Computed tomography was chosen as diagnostic modalities and available for operation plan for all of patients. For all the cases, surgical resection were performed. Lobectomy was performed in 28 patients, simple excision (resection) in 8 patients, segmentectomy or wedge resection in 2 patients. There were 10 pulmonary sequestrations, 15 congenital cystic adenomatoid malformations (CCAM), 11 bronchogenic cysts, and 2 congenital lobar emphysemas. They all were confirmed by pathologic exams. The complications were 6 wound disruption or infection, 2 chylothorax, 1 ulnar neuropathy, but all of them were resolved uneventful. There was no persistent air leakage, respiratory failure, operative mortality and recurrence. Conclusion: We performed immediate surgical removal of congenital cystic lung lesions after diagnosis and obtained good results, so reported them with literature review.

A Study on Movement of the Free Face During Bench Blasting (전방 자유면의 암반 이동에 관한 연구)

  • Lee, Ki-Keun;Kim, Gab-Soo;Yang, Kuk-Jung;Kang, Dae-Woo;Hur, Won-Ho
    • Explosives and Blasting
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    • v.30 no.2
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    • pp.29-42
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    • 2012
  • Variables influencing the free face movement due to rock blasting include the physical and mechanical properties, in particular the discontinuity characteristics, explosive type, charge weight, burden, blast-hole spacing, delay time between blast-holes or rows, stemming conditions. These variables also affects the blast vibration, air blast and size of fragmentation. For the design of surface blasting, the priority is given to the safety of nearby buildings. Therefore, blast vibration has to be controlled by analyzing the free face movement at the surface blasting sites and also blasting operation needs to be optimized to improve the fragmentation size. High-speed digital image analysis enables the analyses of the initial movement of free face of rock, stemming optimality, fragment trajectory, face movement direction and velocity as well as the optimal detonator initiation system. Even though The high-speed image analysis technique has been widely used in foreign countries, its applications can hardly be found in Korea. This thesis aims at carrying out a fundamental study for optimizing the blast design and evaluation using the high-speed digital image analysis. A series of experimentation were performed at two large surface blasting sites with the rock type of shale and granite, respectively. Emulsion and ANFO were the explosives used for the study. Based on the digital images analysis, displacement and velocity of the free face were scrutinized along with the analysis fragment size distribution. In addition, AUTODYN, 2-D FEM model, was applied to simulate detonation pressure, detonation velocity, response time for the initiation of the free face movement and face movement shape. The result show that regardless of the rock type, due to the displacement and the movement velocity have the maximum near the center of charged section the free face becomes curved like a bow. Compared with ANFO, the cases with Emulsion result in larger detonation pressure and velocity and faster reaction for the displacement initiation.

An Analysis of Velocity Patterns and Improvement Effect after Application of Domestic Roundabout Design Guidelines (Focusing on Busan Metropolitan City) (국내 회전교차로 설계지침 적용에 따른 속도패턴과 개선효과 분석 - 부산광역시를 중심으로 -)

  • Lim, Chang-Sik;Choi, Yang-Won
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.33 no.1
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    • pp.305-316
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    • 2013
  • To find out if modern roundabout is still effective under drivers behavior and driving conditions in Busan Metropolitan City, the effects before and after introduction of roundabout were analyzed. According to analysis on velocity profile at roundabout, velocity deviation decreased, and average vehicle speed was close to design speed. As a result, it has been confirmed that most roundabouts were properly built. In terms of traffic operation, average vehicle speed improved by 87.2% when a traffic intersection was replaced by a roundabout. therefore, it has been found out that the introduction of roundabout has a positive effect on increasing vehicle speed by reducing traffic congestion. In addition, annual benefits expected from the replacement from a traffic intersection to a roundabout were KRW 872 million as follows; KRW 410 million in traffic communication, KRW 39 million in transportation safety, KRW 255 million in energy saving, KRW 95 million in reduction of air pollution and KRW 73 million in reduction of traffic signal installation cost. In other words, if 10% (193 spots) of all traffic intersections (1,926 spots in total) in Busan City are replaced by roundabouts, the municipal authority would be able to save about KRW 168.3 billion. According to analysis on the benefits expected from the installation of roundabouts compared to the investment cost for traffic intersections, about KRW 679 million could be saved per roundabout. Considering 10% of all traffic intersections in the City of Busan, about KRW 131 billion could be saved annually. The traffic accidents in roundabout usually occur because drivers aren't aware of right-of-way rules. Once the right-of-way rules settle, the number of traffic accidents would significantly decrease. In addition, it is urgent to promote education and campaign for drivers, pedestrians and bikers on the roundabout.

Design of the Condenser and Automation of a Solar Powered Water Pump (태양열 물펌프의 운전 자동화 설계)

  • Kim Y. B.;Son J. G.;Lee S. K.;Kim S. T.;Lee Y. K.
    • Journal of Animal Environmental Science
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    • v.10 no.3
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    • pp.141-154
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    • 2004
  • The solar powered water pump is very ideal equipment because solar power is more intensive when the water is more needed in summer and it is very helpful in the rural area, in which the electrical power is not available. The average so]ar radiation energy is 3.488 kWh/($m^2{\cdot}day$) in Korea. In this study, the automatic control logic and system of the water pump driven by the radiation energy were studied, designed, assembled, tested and analyzed for realizing the solar powered water pump. The experimental system was operated automatically and the cycle was continued. The average quantity of the water pumped per cycle was about 5,320 cc. The cycle time was about 4.9 minutes. The thermal efficiency of the system was about $0.030\%$. The pressure level of the n-pentane vapour in flash tank was 150$\%$450 hPa(gauge) which was set by the computer program for the control of the vapour supply. The pressure in the condenser and air tank during cycles was maintained as about 600 hPa and 1,200 hPa respectively. The water could be pumped by the amount of 128kg/($m^2{\cdot}day$) with the efficiency of $0.1\%$ and the pumping head of 10 m for the average solar energy in Korea.

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Growth Characteristics of Common Ice Plant (Mesembryanthemum crystallinum L.) on Nutrient Solution, Light Intensity and Planting Distance in Closed-type Plant Production System (완전제어형 식물 생산 시스템에서 배양액, 광도 및 재식거리에 따른 Common Ice Plant의 생육 특성)

  • Cha, Mi-Kyung;Park, Kyoung Sub;Cho, Young-Yeol
    • Journal of Bio-Environment Control
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    • v.25 no.2
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    • pp.89-94
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    • 2016
  • This study was conducted to determine the optimum nutrient solution, pH, irrigation interval, light intensity and planting density to growth of common ice plant (Mesembryanthemum crystallinum L.) in a closed-type plant production system. Three-band radiation type fluorescent lamps with a 12-h photoperiod were used. Nutrient film technique systems with three layers were used for the plant growth system. Environmental conditions, such as air temperature, relative humidity and $CO_2$ concentration were controlled by an ON/OFF operation. Treatments were comparison of the nutrient solution of Horticultural Experiment Station in Japan (NHES) and the nutrient solution of Jeju National University (NJNU), pH 6.0 and 7.0, irrigation interval 5 min and 10 min, light intensity 90 and $180{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$, and within-row spacing 10 cm, 15 cm, 20 cm and 25 cm with between-row spacing 15 cm. Optimum macronutrients were composed N 7.65, P 0.65, K 4.0, Ca 1.6 and Mg $1.0mM{\cdot}L^{-1}$. There were no significant interactions between pH 6.0 and 7.0 about shoot fresh weight and shoot dry weight of common ice plant. Irrigation interval 5 min and 10 min was also the same result. Shoot fresh weight and shoot dry weight were highest at $180{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$. Shoot fresh weight and shoot dry weight were decreased according to increasing the planting density. From the above results, we concluded that optimum nutrient solution, optimum levels of pH, irrigation interval, light intensity and planting density were 6.0-7.0 and 10 min, $180{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$ and $15{\times}15cm$, respectively for growth of common ice plant in a closed-type plant production system.

Aideo-Assisted Thoracic Surgery in Pleural Adhesion (늑막유착을 동반한 질환에서의 비디오 흉부수술)

  • Seong, Suk-Hwan;Kim, Hyeon-Jo;Lee, Chang-Ha;Kim, Ju-Hyeon
    • Journal of Chest Surgery
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    • v.29 no.8
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    • pp.916-922
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    • 1996
  • In patients with pleural adhesion, video-assisted thoracic surgery (VATS) has been regarded as a contra- indication. When such adhesions were found during a thoracoscopic trial, the thoracotomy proceeded with for fear of parenchymal Injury and bleeding. We had a question whether or not thoracoscopic surgery should be done in such pleural adhesions. Of the 226 consecutive thoracoscopic surgeries from Jul. 1992 through Sep. 1995, pleural adhesions were detected intraoperatively in 50 cases (22.1%): a detailed breakdown is as follows: pneumothorax (16 cases), pleural disease (15), benign pulmonary nodule(7), mediastinal mass(5), hyperhidrosis (2), diffuse parenchymal or interstitial lung disease (2), bronchiectasis(2), and primary lung cancer(1). We classified pleural adhesions according to their extent and severity. Extent is categorized as the involved area of the lung: degree 1, II, or III; severity is given one of four grades: mild, moderate, severe, or ve y severe. In cases of very severe severity requiring decortication, the possibility of VATS was excluded. Of the 50 cases, mild adhesions were detected in 15 cases(30.0%), moderate in 29 (58.0%), and severe in 6 (12.0%). As for the extent of the adhesions, 8 cases (16.0%) were categorized as degree 1, 32 cases (64. 0%) as degree II, and 10 cases (20.0%) as degree III. For patients with pleural adhesions, the operation time, the chest tube indwelling time, and the postoperative hospital stay were all longer than for patients in the non-adhesion group. Postoperative complications, namely prolonged air-leakage and pleural drain- age, were more common (18.0% and 6.0%, respectively) than in the non-adhesion group (5.1% and 1.7%, respectively). Only two bronchiectatic patients (4%) were converted to an open thoracotomy because of in- ability to control bleeding. Although complications were encountered more frequently in the group with adhesions, patients were still able to enjoy the benefi s of thoracoscopic surgery. It is advisable to proceed with thoracoscopic surgery even in cases of unpredicted pleural adhesions.

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Efficacy of mechanical pleurodesis for the treatment of spontaneous pneumothorax with VATS - A comparison of short-term recurrence according to the intensities of pleural abrasion - (비디오 흉강경을 이용한 자연기흉 수술에서 기계적 흉막유착술의 효과 -기계적 흉막유착술의 강도에 따른 단기 재발율의 비교-)

  • 허진필;이정철;정태은;이동협;한승세
    • Journal of Chest Surgery
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    • v.31 no.11
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    • pp.1070-1075
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    • 1998
  • Background: With the advent of thoracoscopy, there has been increasing interest in less invasive surgical bullectomy and pleurodesis. The recurrence rate, however, has been reported higher in surgery with thoracoscopy than with open thoracotomy and it is thought to be caused by inappropriate mechanical pleurodesis during thoracoscopic surgery. Materials and methods: We compared the short-term recurrence rates according to the intensities of pleural abrasion in 62 patients who underwent VATS for treatment of spontaneous pneumothorax from April 1996 to August 1997. The patients were divided into 2 groups: group A(n=32) included patients who received relatively weak pleural abrasion using Endo-forcep instrument for grasping the gauze, and group B(n=30) received strong pleural abrasion using conventional instrument wrapped tightly with gauze. Each intensity of pleural abrasion allowed petechia on the parietal pleura in group A, and some tearing and bleeding in group B. Results: Indications for operation, sex distribution, and age were comparable in both groups. There were no differences in chest tube indwelling time(3.78±3.35 vs 3.80±2.49 days), hospital stay(4.72±1.87 vs 4.67±2.20 days), and the amount and duration of analgesics required postoperatively. Persistent air-leak more than 7 days after surgery occurred in 4/32(12.5%) and 2/30(6.7%) in group A and B, respectively. No bleeding-related complication occured. Pneumothorax recurred 12.5%(4/32) and 0%(0/30) of patients at a mean follow-up of 9.7 and 9.6 months in group A and B, respectively, and it was statistically significant(p<0.05). Conclusions: Proper intensity of pleural abrasion is very important factor to reduce recurrence after VATS for spontaneous pneumothorax. During short-term follow-upafter surgery, we could achieve excellent result in reducing recurrence rate with VATS and strong pleural abrasion which is comparable to thoracotomy.

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A Study on Process Optimization for CSOs Application of Horizontal Flow Filtration Technology (수평흐름식 여과기술의 CSOs 적용을 위한 공정 최적화 연구)

  • Kim, Jae-Hak;Yang, Jeong-Ha;Lee, Young-Shin
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.2
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    • pp.56-63
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    • 2018
  • The management of Combined Sewer Overflows(CSOs) and Separated Sewer Overflows(SSOs) discharge directly to the effluent system in an untreated state, which occurs when the facility capacity is exceeded due to heavy rain, has become an important issue in recent years as the heavy rain becomes a regular phenomenon. Despite the continuous development of filtration technology, targeting densely populated urban areas, CSOs are rarely applied. Therefore, this study was carried out to optimize the process to apply CSOs in a pilot-scale horizontal flow filtration system with a rope-type synthetic fiber. The research was carried out in two steps: a preliminary study using artificial samples and a field study using sewage. In the preliminary study using an artificial sample, head loss of the filter media itself was analyzed to be approximately 1.1cm, and the head loss was increased by approximately 0.1cm as the linear velocity was increased by 10m/hr. In addition, the SS removal efficiency was stable at 81.4%, the filtration duration was maintained for more than 6 hours, and the average recovery rate of 98% was obtained by air backwashing only. In the on-site evaluation using sewage, the filtration duration was approximately 2 hours and the average removal efficiency of 83.9% was obtained when belt screen (over 450 mesh) was applied as a pre-treatment process to prevent the premature clogging of filter media. To apply the filtration process to CSOs and SSOs, it was concluded that the combination with the pre-treatment process was important to reinforce the hydraulic dimension for the stable maintain of operation period, rather than efficiency. Compared to the dry season, the quality of incoming sewage was lower in the rainy season, which was attributed to the characteristics of the drainage area with higher sanitary sewerage. In addition, the difference in removal efficiency according to the influent quality of the wet season and dry season was small.