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Surgical Results of Complete Atrioventricular Septal Defect - 16 years experience - (완전방실중격결손증에 대한 외과적 교정의 16년 수술결과)

  • 이정렬;김홍관;이정상;김용진;노준량;배은정;노정일;최정연;윤용수
    • Journal of Chest Surgery
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    • v.35 no.12
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    • pp.854-861
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    • 2002
  • In this study, we reviewed our early and long-term surgical results of complete atrioventricular septal defect during the last 16 years at our hospital. Materials and Methods: Between April 1986 and March 2002, 73 patients with complete atrioventricular septal defect underwent total correction without preceding palliation. Age at repair ranged from 2 to 85 (median age, 7) months, and weight ranged from 3 to 22 (median weight, 5.9)kg. Follow-up was complete with a mean duration of 69$\pm$51 months. Results: Overall operative mortality was 16.4%(12) with 3 late deaths. One, 5, and 10 year actuarial survival rates were 96.3 %, 94.2 % and 94.2 % respectively Sixteen of 61 (22.2%) operative survivors have undergone reoperation for postoperative mitral regurgitation or left ventricular outflow tract obstruction (LVOTO). Freedom from mitral reoperation at 1, 5, and 10 years were 87.8 %, 72.4 %, and 57.8 % and freedom from LVOTO at 1, 5, and 10 years were 98.2 %, 86.3 %, and 83.2 % respectively. Summary: In this study, we found that our early surgical results improved with quite an acceptable long-term outcome. Close observation of remaining mitral regurgitation was necessary, A precise evaluation of the atrioventricular valve morphology, a meticulous surgical technique, and the adequate postoperative management are mandatory for the excellent results.

Temporal and Spatial Distribution of Biomass and Cell Size of Bacteria and Protozoa in Lake Paldang and Kyungan Stream (팔당호와 경안천에서 박테리아와 원생생물의 생물량과 세포크기의 시 ${\cdot}$ 공간적 분포)

  • Son, Ju-Youn;Kong, Dong-Soo;Hwang, Soon-Jin
    • Korean Journal of Ecology and Environment
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    • v.39 no.3 s.117
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    • pp.378-389
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    • 2006
  • Seasonal changes of biomass and cell size of bacteria and protozoa, and factors affecting their distribution in Lake Paldang and Kyungan Stream were analyzed from April to December, 2005. Bacterial abundance at Paldang Dam and Kyungan Stream was similar, but it did not much increase during hot summer period. Protozoan carbon biomass was much greater at Kyungan Stream compared to Paldang Dam. HNAN generally accounted for the majority of total protozoan biomass, but ciliates made up the highest proportion in April and November at Paldang Dam and June at both sites. PNAN showed low biomass at both sites, but it was high during spring and fall season. Small-sized HNAN ($3{\sim}7\;{\mu}m$) numerically predominated the protozoan community at both sites. Average cell size of HNAN was bigger at Kyungan Stream where nutrients concentration was much higher than Paldang Dam. Average cell size of ciliates varied seasonally; it was relatively small during the summer. HNAN biomass significantly correlated with Chl-a concentration and ciliates biomass at Paldang Dam, indicating that HNAN increase might link to the ciliates increase. At Kyungan Stream, HNAN biomass showed a significant relationship with PNAN biomass, and Chl-a concentration was closely related with both of HNAN and PNAN biomass. Ciliate biomass showed significant relationship with nutrient (TN, TP) and particulate matter (SS) only at Kyungan Stream. At both sites, protozoan biomass was significantly correlated with bacterial biomass, and ciliates were additionally related flagellates. High biomass of microbial components and the close relationships among them suggest that the energy transfer through the microbial loop may important in the plankton food web of Lake Paldang ecosystem.

Dose Verification Study of Brachytherapy Plans Using Monte Carlo Methods and CT Images (CT 영상 및 몬테칼로 계산에 기반한 근접 방사선치료계획의 선량분포 평가 방법 연구)

  • Cheong, Kwang-Ho;Lee, Me-Yeon;Kang, Sei-Kwon;Bae, Hoon-Sik;Park, So-Ah;Kim, Kyoung-Joo;Hwang, Tae-Jin;Oh, Do-Hoon
    • Progress in Medical Physics
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    • v.21 no.3
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    • pp.253-260
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    • 2010
  • Most brachytherapy treatment planning systems employ a dosimetry formalism based on the AAPM TG-43 report which does not appropriately consider tissue heterogeneity. In this study we aimed to set up a simple Monte Carlo-based intracavitary high-dose-rate brachytherapy (IC-HDRB) plan verification platform, focusing particularly on the robustness of the direct Monte Carlo dose calculation using material and density information derived from CT images. CT images of slab phantoms and a uterine cervical cancer patient were used for brachytherapy plans based on the Plato (Nucletron, Netherlands) brachytherapy planning system. Monte Carlo simulations were implemented using the parameters from the Plato system and compared with the EBT film dosimetry and conventional dose computations. EGSnrc based DOSXYZnrc code was used for Monte Carlo simulations. Each $^{192}Ir$ source of the afterloader was approximately modeled as a parallel-piped shape inside the converted CT data set whose voxel size was $2{\times}2{\times}2\;mm^3$. Bracytherapy dose calculations based on the TG-43 showed good agreement with the Monte Carlo results in a homogeneous media whose density was close to water, but there were significant errors in high-density materials. For a patient case, A and B point dose differences were less than 3%, while the mean dose discrepancy was as much as 5%. Conventional dose computation methods might underdose the targets by not accounting for the effects of high-density materials. The proposed platform was shown to be feasible and to have good dose calculation accuracy. One should be careful when confirming the plan using a conventional brachytherapy dose computation method, and moreover, an independent dose verification system as developed in this study might be helpful.

Study on the Growth of the Aortic Aannulus. Root, and Anastomosis After Arterial Switch Operation in Infancy (영아기에 시행한 동맥전환술 후의 대동맥판륜, 근부, 및 문합부위 성장에 관한 연구)

  • 이정렬;박정준
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.479-485
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    • 1997
  • We investigated changes of the size of neoaortic annulus, root, and aortic anastomosis after arterial switch operation for complete transposition of the great arteries performed in infancy. A total of 23 patients were included in this study. Age ranged from 6 to 153 days. Body weight averaged 3.9$\pm$0.8kg and 17 patients were male. The preoperative angiocardiographic dimensions of the pulmonary annulus, the pulmonary root, and the sinotubular junction, standardized to the diameter of descending aorta at the level of diaphragm, were compared to the size of postoperative measurements of the neoaortic annulus, the neoaortic root, and the aortic an stomosis at a mean interval of 17.2$\pm$ 9.4 months. Mean dimensions of the neoaortic annulus and the neoaortic root were significantly increased postoperatively(n=23, annulus; p<0.01, root; p<0.01), however, those of the aortic anastomosis did not reveal significant change(n=23, p=0.06). There were no significant differences in changes of diameters of the neoaortic annulus, the root, and the aortic anastomosis between patients with(n=8) and without(n=15) postoperative neoaortic regurgitation(annulus; p=0.32, root; p=0.29, anastomosis; p=0.86). Postoperative dimensions of the neoaortic root and annulus between patients with ventricular septal defect(n: 10) and without ventricular septal defect(ni 13) were not significantly changed compared to the preoperative measurements(annulus; p=0.09, root; p=0.07) but mean diameters of the aortic anastomosis decreased significantly after operation in patients with ventricular septal defect(p=0.04). This study revealed that the site of the aortic an stomosis grows in proportion to patient's somatic growth after arterial switch operation. Although we could not demonstrate the relation between the aortic root dilatation and the postoperative neoaortic regurgitation in this study, a continuous close follow-up might be necessary to detect a possible progression of the aortic root dilatation and the resulting significant aortic valve regurgitation.

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The Change of Total Scan Time in Accordance with the Time of the Decision of Scan Time (스캔 시간의 결정시기에 따른 총 스캔 시간 변화에 관한 연구)

  • Lee, Jong-Hun;Ryu, Jae-Kwang;Chung, Woo-Young
    • The Korean Journal of Nuclear Medicine Technology
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    • v.13 no.3
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    • pp.81-85
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    • 2009
  • Purpose: The examination of nuclear medicine observes the change in accordance with the time elapsed in the same region purposed and there are many examinations to acquire the image during the same term. At this time, the same parameter should be applied. The hepatobiliary scan, lung scan etc, are the acquired examination in the divided time with a regular term. Pre-set time that is applied in continued next image is set in order to acquire the fixed counts. The same scan time should be applied for each image. This study will look for the rational plan and analyze the change of scan time in accordance with the time of the decision of scan time at examination that pre-set time is applied. Methods: The hapatobiliary scan that use the radio pharmaceutical $^{99m}Tc$-mebrofenin is choosed as compensation from Jan. 2009 to Mar. 2009 in the department of nuclear medicine in ASAN MEDICAL CENTER. Scan is started after 5 minutes from when 222 MBq (6 mCi) is injected to patient. We let patient stand up between both detectors, and possibly close to the front of detector. When scan time reach 10%, 25%, 50%, 75% of total scan time, we measured the expected total scan time. After finishing all of scan, we compared the total scan time and the expected total scan time, while image is acquiring. and we observed the change of scan time in accordance with radio activity by using phantom. Results: After starting scan, a difference of when scan time reach 10%, 25%, 50%, 75% of total scan time is that the biggest difference is 5 seconds on 10%. There statistically is difference between 25% (t:2.88, p<0.01) and 50% (t:2.05, p<0.01). Conclusions: When the same the scan time is applied in the examination that acquire the many frame, concluding the same scan time has a important effect on a quantitative analysis. Although method that decide the scan time after finish all of the examinations, there is a few problem to apply practical affairs. This may cause an inaccurate result on the examination that need a quantitative analysis. We think that operator should try to improve it. At least, after reach 50% of total scan time, deciding the total scan time mean that you can minimize error of a quantitative analysis caused by unmatched scan time from a gap of image.

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A Study on Visitor Motivation and Satisfaction of Urban Open Space - In the Case of Waterfront Open Space in Seoul - (도시 오픈스페이스 방문동기 및 만족도 연구 - 서울시 하천변 오픈스페이스를 중심으로 -)

  • Zoh, Kyung-Jin;Kim, Yong-Gook;Kim, Young-Hyun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.1
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    • pp.27-40
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    • 2014
  • The functions of urban open space, which embraces community revitalization, are diverse. It is the means of public healthcare, learning centers for children, hub of arts and cultural programs, as well as promoter of urban tourism. However, in-depth discourse and research on the topic of urban open spaces has been limited so far. Hence, this study aims to investigate the motivations and satisfaction of visitation based on four representative waterfront open space in Seoul; Cheongyecheon Waterfront, Seoul Forest Park, Seonyudo Park and Banpo Hangang Park. The methods of study are literature review, observation investigation, and questionnaire survey. The findings are analyzed through the Exploratory Factor Analysis, Reliability Analysis, ANOVA Analysis and Regression Analysis by SPSS 18.0. The results of the study are as follows. First, urban waterfront open spaces in Seoul has 5 factors of visitor motivation; community amenity, nature access, cultural and educational assets, aesthetic enjoyment, and lastly means of escape. Second, factors of recognizing urban waterfront open spaces as community amenity and nature access indicate meaningful differences in visitor's perception by spatial characteristics. Third, distances between the destination and the visitor's residence influence significantly their perceived motivation. Close-range visitors perceived nature access as a principal factor, whilst medium to long-range visitors perceived visitation for aesthetic purposes more importantly. Lastly, the will to escape was shown as the influential factor in visitor satisfaction. Visiting open spaces for the enjoyment of nature and aesthetic purposes were factors that also closely relate to visitor satisfaction. In addition, it was found that there are different visitor motivations that influence visitor satisfaction in accordance with the spatial characteristics of each open space. In summary, it can be said that urban waterfront open space is a hybrid space connected to various types of urban contents beyond daily experiences. It was found that several visitor motivations including community development, design aesthetics, education and culture, entertainment, enjoyment of natural landscape, and relaxation, affect the overall satisfaction of the visiting experience. It is anticipated that the results of the study will be used by the local government in setting up strategies for the creation and management of successful urban waterfront open space, and for those involved in planning and design act as a starting point for spatial programming and amenities arrangement in accordance to the city's tourism and urban marketing approach.

A Study on Purchasing Decision Making and Adoption : Focused on the RFID Purchasing Customer (구매의사 결정과 수용에 대한 연구 : RFID 구매고객 중심으로)

  • Seo, Pil-Su;Jang, Jang-Yi;Shim, Kyeng-Su
    • 한국벤처창업학회:학술대회논문집
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    • 2008.11a
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    • pp.257-282
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    • 2008
  • RFID (Radio Frequency Identification) is regarded as a core technology of ubiquitous computing. Although it has some technical limitations such as technological standardization of RFID tags as well as economical limitations, many companies around the world have already accepted RFID to improve their management efficiency. In this regard, this study is to meet with results that the adoption of RFID technology willbring opportunities that companies' operational process are improved and customer satisfaction is highly strengthened. This research focuses on providing more understanding for building RFID marketing strategy to suppliers who want to sell their RFID products to customers through analyzing purchasing process. The findings are as follows; First, the study shows that buying center members usually take product reliability and precision of technical specification in the case of new-task buying situation while they put their first purchasing priority on prices in the straight rebuy. Second, the finding presents that in new-task buying situation and the straight rebuy purchasing personnel get information about new products through product performance test, organizational engineers, opinions from other companies' purchasing personnel, and checking out samples. Third, this research demonstrates when it comes to purchasing risk in their first purchasing, the persons who are in charge of material purchasing are inclined to be aware of the risk most in technical problems, followed by financial problems and time delay problems in order. And in addition to those risks are mentioned above, once-again-purchasers take the risk like an opportunity loss for better products into consideration. Fourth, the study shows that the role of concerning departments makes no difference in each purchasing stage. Accordingly marketers need to beef up the differentiated strategy to persuade their customers. Fifth, the findings of this study demonstrate that purchasing decision making is much influenced by the final users. So suppliers are supposed to perform the most active marketing strategy at the first stage of purchasing through various resources. Finally, the study presents that the suppliers who will have had close relationships with their customers need to give consistent information to them so that their customers can have lower motive in purchasing products from competitors.

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Risk Factor's Affecting long-term Outcome of Alport syndrome (Alport 증후군의 예후와 관련된 위험요인 분석)

  • Byun Ji-Yoon;Baek Seoung-Yon;Lee Young-Mock;Kim Ji-Hong;Lee Jae Seung;Kim Pyung-Kil;Hong Soon-Won;Jeong Hyeon-Joo;Kim Soon-Il;Kim Yu-Seun;Park Ki-Il
    • Childhood Kidney Diseases
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    • v.5 no.2
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    • pp.164-175
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    • 2001
  • Purpose : Alport syndrome is a hereditary nephrotic disease characterized by progressive nephrotic symptom, sensorineural hearing loss, ophthalmic abnormality, typical microscopic findings, and familial occurrence. In this study, we tried to find the risk factors related with its prognosis by taking a close observation on clinical symptoms of children with Alport syndrome reviewing retrospectively. Materials & methods : We chose children diagnosed as Alport syndrome in renal biopsy during 20 years(from 1980, Jan. until 1999, Dec.) who could receive follow up studies in tile department of pediatrics. They were divided into two groups by comparing renal function at the time of diagnosis and at current status. We compared several clinical aspects in them, and applied nonparametric test for statistical analysis. Results : The sex ratio(male:female) of 24 children was 3:1. The most common clinical symptom presented at their first visit was gross hematuria. Among those 24 children, 11 cases($46\%$) of progressing into chronic renal failure(Group II) were observed. Hypertension, proteinuria and edema were seen much frequently in group II. The level of serum protein, albumin, and creatinine clearance were decreased while BUN, creatinine were relatively increased. All the results were statistically significant. Conclusion Clinically significant risk factors related to prognosis in Alport syndrome were the presence of hypertension, edema, and proteinuria at the time of diagnosis. Also, the level of serum protein, albumin, BUN, creatinine, and glomerular filtration rate were proved to be important factors in predicting prognosis. We believe that studies on these possible risk factors would be of great help in treating and predicting prognosis of children suffering with Alport syndrome. (J Korean Soc Pediatr Nephrol 2001;5 : 164-75)

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Analysis of Urinary Mass Screening for Second Grade of Elemantary School Children in Paju City (파주 지역 초등학교 2학년생에게 실시된 집단 뇨검사 분석)

  • Kim Sung Kee;Kim Young Kyoun;Park Yong Won;Lee Chong Guk
    • Childhood Kidney Diseases
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    • v.5 no.2
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    • pp.156-163
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    • 2001
  • Purpose We performed urinary mass screening(UMS) program for 2,804 children of second grade elemantary school 8 years of age in Paju city with cooperation of Paju City Health Center to determine the prevalence of asymptomatic proteinuria and hematuria, and to estimate the risk of incipient renal diseases. Also we attempted to evaluate the significance of hematuria in UMS in addidtion to proteinuria. Methods : 2,804 children of the 2nd grade of elementary school who lived in Paju city were included to our UMS program in 2000. They were constituted with 1,428 boys and 1,376 girls. The screening program was carried out in 3 steps The 1st screenig test was performed at schools and then students with abnormal results were examined repeatedly at Paju City Health Center and our hospital. Those students who showed proteinuria and/or hematuria in the 1st and 2nd test were referred to our hospital to undertake the 3rd close examination including physical examination, laboratory tests and radiologic tests. Results : (I) The prevalence of urinary abnormality in the 1st screening test was $8.3\%$(233 students), comprised of $5.9\%$ of boys, $10.8\%$ of girls. (2) Among 2,804 children tested in the first screening, prevalences of asymptomatic proteinuria and isolated hematuria were 64($2.3\%$), 163($5.8\%$) respectively, and the prevalence of proteinuria with hematuria was 6($0.2\%$). (3) Among 233 students with urinary abnormalities at the 1st screening test, 102 students applied to the 2nd test. 32 children, about one third of them, were also found to have abnormal urinary findings ; isolated hematuria 30, proteinuria with hematuria 2. (4) Those findings of clinical evaluation for children with isolated hematuria at the hospital showed as follows: idiopathic isolated microscopic hematuria 21, normal 6, urinary tract infection 1, idiopathic hypercalciuria 1 and simple renal cyst 1. Those 2 students with proteinuria and hematuria seemed to have chronic glomerulonephritis. Conclusion : (1) The clinical evaluation for children who showed positive results at the 1st screening test should be done judiciously. Because of high false positive rate, almost who showed positive results was normal, only a few of them had pathologic conditions. In this study, actual incidence of incipient renal diseases in children of 8 year old was calculated to be $0.4\%$. (2) The definite conclusion whether a urinary mass screening test can alter the prognosis of incipient renal diseases could not be drawn with this study. Further study must be necessary (3) We could acknowledge the significance of hematuria in UMS, but it is necessary that one should be judicious in managing and follow-up those that show abnormal results. (J Korean Soc Pediatr Nephrol 2001;5 : 156-63)

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Distribution and remediation design of heavy metal contamination in farm-land soils and river deposits in the vicinity of the Goro abandoned mine (고로폐광산 주변 농경지 토양 및 하천 퇴적토의 중금속 오염 분포 및 복원 대책 설계)

  • 이민희;최정찬;김진원
    • Economic and Environmental Geology
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    • v.36 no.2
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    • pp.89-101
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    • 2003
  • River deposits and farmland soils were analyzed to investigate the pollution level of heavy metals in the vicinity of the Goro abandoned Zn-mine. Surface (0-40 cm) and subsurface (40-100 cm) soils were collected around a main river located at the lower part of the Goro mine, and analyzed by ICP-MS for Cd, Cu, Pb, Zn and Cr after 0. 1N HCI extraction and by AAS for As after IN HCI extraction. Concentrations of cadmium and lead at the surface river deposits close to the mine were over the Soil Pollution Warning Limit (SPWL), and 43% of sample sites (6 of 14 samples) were over SPWL for As suggesting that river deposits were broadly contaminated by arsenic. Results from farmland soil analysis showed that surface soils were contaminated by heavy metals, while only arsenic was over SPWL at 50% of sampling sites. Main pollution mechanism around the Goro mine was the discharge of mine tailing and waste rocks from the storage site to the river and to adjacent farmland during flood season. Pollution Grades for sample locations were prescribed by the Law of Soil Environmental Preservation, suggesting that the pollution level of heavy metals around the Goro mine was serious, and the remediation operation fur arsenic and the isolation of mine tailing and waste rocks from river and farmland should be activated to protect further contamination. The area needed to clean up was estimated from pollution distribution data and the remediation methods such as a soil washing method and a soil improvement method were considered as the further remediation operation for arsenic contaminated soils and river deposits around the Goro abandoned mine.