• Title/Summary/Keyword: Fenestrations

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Surgical Management of the Chronic Dissecting Aneurysm of Ascending Aorta with Aortic Regurgitation (만성 해리성 대동맥류 환자에서의 Bentall 씨 수술적응진성 및 가성 내강 동시 혈류공급술)

  • 강면식
    • Journal of Chest Surgery
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    • v.21 no.1
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    • pp.184-190
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    • 1988
  • The treatment of aortic aneurysm of ascending aorta has been fraught with difficult surgical problems. For the most part, these were resolved in 1968 with the introduction of a technique of total replacement of ascending aorta and reimplantation of the coronary arteries by Bentall and De Bono. This technique however, with all of its advantages, caries a certain problems. In chronic dissecting aneurysms, there is frequently a marked disparity in circumference between the true and false lumen distally. Distal perfusion is directed into both the true and false lumens by removing segment of the septum between the two lumens and constructing the distal graft anastomosis is to the outer layer of aortic adventitia. The distal false lumen, aortic branches and fenestrations have matured and healed in most cases. And importantly, major aortic tributaries may be solely dependent on the false lumen for perfusion. We are presenting two cases of chronic dissecting aneurysm of ascending aorta with aortic regurgitation, who have good result by surgical correction of so-called Bentall procedure with maintenance of blood flow directed into both true and false lumen.

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BEPAT: A platform for building energy assessment in energy smart homes and design optimization

  • Kamel, Ehsan;Memari, Ali M.
    • Advances in Energy Research
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    • v.5 no.4
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    • pp.321-339
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    • 2017
  • Energy simulation tools can provide information on the amount of heat transfer through building envelope components, which are considered the main sources of heat loss in buildings. Therefore, it is important to improve the quality of outputs from energy simulation tools and also the process of obtaining them. In this paper, a new Building Energy Performance Assessment Tool (BEPAT) is introduced, which provides users with granular data related to heat transfer through every single wall, window, door, roof, and floor in a building and automatically saves all the related data in text files. This information can be used to identify the envelope components for thermal improvement through energy retrofit or during the design phase. The generated data can also be adopted in the design of energy smart homes, building design tools, and energy retrofit tools as a supplementary dataset. BEPAT is developed by modifying EnergyPlus source code as the energy simulation engine using C++, which only requires Input Data File (IDF) and weather file to perform the energy simulation and automatically provide detailed output. To validate the BEPAT results, a computer model is developed in Revit for use in BEPAT. Validating BEPAT's output with EnergyPlus "advanced output" shows a difference of less than 2% and thus establishing the capability of this tool to facilitate the provision of detailed output on the quantity of heat transfer through walls, fenestrations, roofs, and floors.

Cor triatriatum associated with partial anomalous pulmonary venous drainage: one case report (폐정맥 환류이상을 동반한 삼중방심 치험 1)

  • Kim, Yeong-Ho;Kim, Gong-Su
    • Journal of Chest Surgery
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    • v.17 no.3
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    • pp.381-388
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    • 1984
  • Cor triatriatum is rare congenital cardiac anomaly first described by Church in 1868. The anomaly consists of an abnormal partitioning of the left atrium by a fibromuscular membrane that divides the atrium into an upper chamber, which receives the pulmonary veins, and a lower chamber, which contains the atrial appendage and the mitral valve. The upper and lower chambers communicate through a stenotic fenestration in the membrane, which has the hemodynamic consequence of pulmonary venous obstruction. Recently we experienced cot triatriatum associated with partial anomalous pulmonary drainage to right atrium. The upper chamber was connected to right atrium through a sinus venous type of ASD and received left superior and both inferior pulmonary vein, whereas the lower chamber so called true left atrium communicated with right atrium through foramen ovale type of ASD, left atrial appendage and mitral orifice. And the anomalous membrane has no fenestrations which permit blood flow. The operation was made right atrial approach under the CPB. We excised completely the anomalous septum and reconstructed atrial septal defect with pericardial patch to drain the right upper pulmonary vein to the left atrium. The postoperative course has been good during follow up.

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Oligomeric Structure of ${\beta}$-Glucosidases

  • Kim, Sang-Yeob;Kimm, In-Soo
    • Journal of Photoscience
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    • v.11 no.3
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    • pp.121-127
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    • 2004
  • The${\beta}$-glucosidases occur widely in all living organisms and has in general a tendency to form oligomers of varying numbers of subunits or aggregates, although the functional implications of such diverse oligomerization schemes remain unclear. In particular, the assembly mode of the oat ${\beta}$-glucosidase is very unique in that it multimerizes by linear stacking of a hexameric building block to form long fibrillar multimers. Some structural proteins such as actin and tubulin assemble into long fibrils in a helical fashion and several enzymes such as GroEL and Pyrodictium ATPase functional complexes, 20S proteasome of the archaebacterium Thermoplasma acidophilum, and lutamine synthetase fromblue-green algae, assemble into discrete oligomers upto 4 stacked rings to maintain their enzymatic activities. In particular, oat ${\beta}$-glucosidase exists in vivo as a discrete long fibrillar multimer assembly that is a novel structure for enzyme protein. It is assembled by linear stacking of hollow trimeric units. The fibril has a long central tunnel connecting to the outer medium via regularly distributed side fenestrations. The enzyme active sites are located within the central tunnel and multimerization increases enzyme affinity to the substrates and catalytic efficiency of the enzyme. Although it is suggested that oligomerization may contribute to the enzyme stability and catalytic efficiency of ${\beta}$-glycosidases, the functional implications of such diverse oligomerization schemes remain unclear so far.

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Implant Fixture Installation in the Posterior Maxilla Using a Tooth-supported Surgical Template Based on Computer Assisted Treatment Planning (컴퓨터 보조 기반 치아 지지 서지컬 템프레이트를 이용한 상악구치부 임플란트 식립)

  • Kim, Soung Min;Kim, Myung Joo;Lee, Jee Ho;Myoung, Hoon;Lee, Jong Ho;Kim, Myung Jin
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.6
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    • pp.381-389
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    • 2013
  • Two patients with partial edentulous maxilla were scheduled to undergo installation of implant fixtures using a tooth-supported surgical template based on computer assisted treatment planning. After 3-dimensional (3D) computed tomographic scanning was transferred to the OnDemand3D (Cybermed Co., Seoul, Korea) software program for virtual planning, fixtures of MK III Groovy RP implant of the Br${\aa}$nemark System (Nobel Biocare AB Co., G$\ddot{o}$teborg, Sweden) was installed using the In2Guide (CyberMed Co., Seoul, Korea) tooth-supported surgical template with a Quick Guide Kit (Osstem Implant Co., Seoul, Korea) system in the posterior maxilla of each patient. Sinus floor elevation with a xenogenic bone graft procedure was also performed simultaneously in one patient. Fixture installations were completed successfully without complications, such as sinus mucosa perforation, bony bleedings, fenestrations, or others. During the last two-year follow-up period after prosthetics delivery, each implant was found to be fine with no other minor complications. The entire procedures are reported and the literatures on use of tooth-supported surgical template was reviewed.

Implant Fixture Installation in the Anterior Mandible by Use of a Mucosa Supported Surgical Template Based on Computer Assisted Treatment Planning (컴퓨터보조 기반 점막지지 서지컬템프레이트를 이용한 하악전치부 임플란트 식립)

  • Lee, Jee-Ho;Kim, Soung-Min;Kim, Myung-Joo;Park, Jung-Min;Seo, Mi-Hyun;Myoung, Hoon;Lee, Jong-Ho;Kim, Myung-Jin
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.33 no.2
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    • pp.158-165
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    • 2011
  • A 73-year-old Korean female patient with a fully edentulous mandible was planned to have five implant fixtures installed in the anterior mandible for the fixed prosthesis. After 3-dimensional (3D) computed tomographic scanning was transferred to OnDemand3D$^{(R)}$ (Cybermed Co., Seoul, Korea) software program for the virtual planning, five fixtures of MK III Groovy RP implants of Branemark System$^{(R)}$ (Nobel Biocare AB Co., Goteborg, Sweden) were installed in the anterior mandible between both mental foramens using In2Guide$^{(R)}$ (CyberMed Co., Seoul, Korea) mucosa-supported surgical template with Quick Guide Kit$^{(R)}$ (Osstem Implant Co., Seoul, Korea) systems. Fixture installations were completed successfully without any complications, such as mental nerve injury, bony bleedings, fenestrations and other unexpected events. Postoperative computed tomographic scans were aligned and fused to the planned implant, then angular and linear deviations were compared with the planned virtual implants. The mean angular deviation between the planned and actual implant axes was $3.42{\pm}1.336^{\circ}$. The mean distance between the planned and actual implant at the neck area was $0.544{\pm}0.290$ mm horizontally and $0.118{\pm}0.079$ mm vertically. The average distance between the planned and actual implant at the apex area was $1.166{\pm}0.566$ mm horizontally and $0.14{\pm}0.091$ mm vertically. These results could be considered more precise and accurate than previous reports, and even our recent results. The entire procedures of this case are reported and reviewed.

Blood-neural Barrier: Intercellular Communication at Glio-Vascular Interface

  • Kim, Jeong-Hun;Kim, Jin-Hyoung;Park, Jeong-Ae;Lee, Sae-Won;Kim, Woo-Jean;Yu, Young-Suk;Kim, Kyu-Won
    • BMB Reports
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    • v.39 no.4
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    • pp.339-345
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    • 2006
  • The blood-neural barrier (BNB), including blood-brain barrier (BBB) and blood-retinal barrier (BRB), is an endothelial barrier constructed by an extensive network of endothelial cells, astrocytes and neurons to form functional 'neurovascular units', which has an important role in maintaining a precisely regulated microenvironment for reliable neuronal activity. Although failure of the BNB may be a precipitating event or a consequence, the breakdown of BNB is closely related with the development and progression of CNS diseases. Therefore, BNB is most essential in the regulation of microenvironment of the CNS. The BNB is a selective diffusion barrier characterized by tight junctions between endothelial cells, lack of fenestrations, and specific BNB transporters. The BNB have been shown to be astrocyte dependent, for it is formed by the CNS capillary endothelial cells, surrounded by astrocytic end-foot processes. Given the anatomical associations with endothelial cells, it could be supposed that astrocytes play a role in the development, maintenance, and breakdown of the BNB. Therefore, astrocytes-endothelial cells interaction influences the BNB in both physiological and pathological conditions. If we better understand mutual interactions between astrocytes and endothelial cells, in the near future, we could provide a critical solution to the BNB problems and create new opportunities for future success of treating CNS diseases. Here, we focused astrocyte-endothelial cell interaction in the formation and function of the BNB.

Redo Opeations for Recurrent Dissection After Operation for Type A Aortic Dissection (A형 대동맥 박리 수술 후 재발성 박리의 재수술)

  • 홍유선;강정한;윤치순;이현성;박형동
    • Journal of Chest Surgery
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    • v.34 no.8
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    • pp.604-610
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    • 2001
  • Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 200, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. Material and method: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. Result: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperationc ases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years.

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Cone-beam computed tomographic evaluation of mandibular incisor alveolar bone changes for the intrusion arch technique: A retrospective cohort research

  • Lin Lu;Jiaping Si;Zhikang Wang;Xiaoyan Chen
    • The korean journal of orthodontics
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    • v.54 no.2
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    • pp.79-88
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    • 2024
  • Objective: Alveolar bone loss is a common adverse effect of intrusion treatment. Mandibular incisors are prone to dehiscence and fenestrations as they suffer from thinner alveolar bone thickness. Methods: Thirty skeletal class II patients treated with mandibular intrusion arch therapy were included in this study. Lateral cephalograms and cone-beam computed tomography images were taken before treatment (T1) and immediately after intrusion arch removal (T2) to evaluate the tooth displacement and the alveolar bone changes. Pearson's and Spearman's correlation was used to identify risk factors of alveolar bone loss during the intrusion treatment. Results: Deep overbite was successfully corrected (P < 0.05), accompanied by mandibular incisor proclination (P < 0.05). There were no statistically significant change in the true incisor intrusion (P > 0.05). The labial and lingual vertical alveolar bone levels showed a significant decrease (P < 0.05). The alveolar bone is thinning in the labial crestal area and lingual apical area (P < 0.05); accompanied by thickening in the labial apical area (P < 0.05). Proclined incisors, non-extraction treatment, and increased A point-nasion-B point (ANB) degree were positively correlated with alveolar bone loss. Conclusions: While the mandibular intrusion arch effectively corrected the deep overbite, it did cause some unwanted incisor labial tipping/flaring. During the intrusion treatment, the alveolar bone underwent corresponding changes, which was thinning in the labial crestal area and thickening in the labial apical area vice versa. And increased axis change of incisors, non-extraction treatment, and increased ANB were identified as risk factors for alveolar bone loss in patients with mandibular intrusion therapy.

Surgical Treatment of Complications after Fontan Operation (Fontan수술후의 합병증에 대한 수술적 치료)

  • 박정준;홍장미;김용진;이정렬;노준량
    • Journal of Chest Surgery
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    • v.36 no.2
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    • pp.73-78
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    • 2003
  • The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.