• Journal of Chest Surgery
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• v.42 no.6
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• pp.696-703
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• 2009

Background: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. Material and Method: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed, The mean patient age was 53 years (range: 14~84) The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the MR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. Result: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from $54.6{\pm}8.4$ mm to $38.3{\pm}3.8$ mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from $47.1{\pm}24.4$ mmHg to $15.1{\pm}11.7$ mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. Conclusion: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1095-1101
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• 1996

From July 1983 to June 1995, 95 consecutive patients with mitral stenosis were treated surgically in the Department of Thoracic and Cardiovascular Surgery, Chonbuk national University Hospital, mitral valve replacement(MVR) in 62 patients and open mitral commissurotomy(OMC) in 33 patients. Mitral stenosis combined with coronary artery disease, with aortic valve disease, or wish mitral valvular Insufficiency, were excluded from this study. Surgical procedures for mitral stenosis were evaluated, according to complication, reoperation, mor- tality, nd functional change at mid- and long-term postoperative period. Cardiothoracic ratio in the MVR group was greater than the OMC group(0.59 $\pm$0.07 in MVR, 0.53 $\pm$0. 07 in OMC, p<0.05), but other variables(age, sex, MYHA functional classification, EKG finding, echocardiographic finding) did not show significant difference between two groups in the preoperative periods. Even though pathologic valvular lesion(Sellor's pathologic type m: 35 in MVR, 13 in OMC) and valvular calcification(35 in MVR, 11 in OMC) were severe in the MVR group(p=0.001) at intraoperative observation, OMC was possible in 11 patients(23.9%) among 46 patients with valvular calcification and in 13 patients(27.1 %) among 61 patients with Sellor's pathologic type IH . There was no significant difference in early and late mortality, actuarial survival(75% in MVR, 87.6% in OMC at 12 year), but early and late hemorrhagic, thromboembolic complications in the MVR group were greater than in the OMC. Functional changes in NYHA functional classification, EKG lEnding, cardiothoraclc ratio, and echocardiographic finding(EF, LVIDS, LWDd, LAD) did not differ between two groups in mid- and long-term postoperative periods. We conclude that our efforts for preservation of the native valve would be continued, because hemorrhagic and thromboembolic complications in the MVR were greater than in the OMC, and OMC was possible even in patients with severely stenotic and calcified mitral valve, although there was no sis-nificant difference in the functional change, mortality, and survival between the M VR and OMC.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.441-446
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• 2009

Background: Side clamping of ascending aorta during proximal graft anastomosis in coronary bypassing surgery in-creases the risk of direct aortic injury as well as embolization of intimal atheroma. Heartstring proximal sealing system (Guidant Corporation, Santa Clara, Calif), developed to avoid aortic side clamping, may minimize risks of such complications. The aim of the current study is to compare the surgical outcomes of the two proximal anastomosis techniquesi.e., Heartstring system versus aortic side clamping in off pump coronary bypassing' surgery (OPCAB). Material and Method: From January 2003 to August 2008, 499 patients underwent OPCAB. Of them, proximal graft anastomosis was performed using Heartstring system in 182 patients (Group I) and conventional manual anastomosis in 317 patients (Group II). The two groups were compared for postoperative major complications and mortality. Result: Two groups showed similar characteristics in terms of preoperative demographic data, left ventricular ejection fraction, renal function and history of diabetes, hypertension and smoking. Although there was no inter-group difference in the history of cerebral ischemia (p=0.48), preoperative brain magnetic resonance angiography revealed greater incidence of severe carotid artery stenosis (>75% of lumen) in the Group I than in the. Group II (44.5% in the Group I and 30.0% in the Group II, p=0.003). There were no inter-group differences in postoperative mortality (p=0.40) and complications (p=0.47) including neurologic events (3 in the Group land 2 in the Group II, p=0.258). Whereas neurologic events all comprised transient ischemic attacks in the Group I, they comprised multiple embolic strokes in the Group II. One patient in the Group II experienced aortic dissection during proximal anastomosis which resulted in ascending aortic replacement. Conclusion: Although proximal anastomosis using Heartstring system did not show statistically significant benefit over aortic side clamping, the. absence of embolic stroke maybe a definite benefit which may be better defined through further studies over a larger cohort.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.472-478
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• 2001

Objectives : The authors present a retrospective analysis of 100 consecutive adult patients harboring craniopharyngiomas who underwent microsurgical resection between 1981 and 1999 to assess the long-term outcome of surgical treatment and to determine the most optimal management strategy. Methods : The extent of surgical removal was divided into four categories ; GTR(gross total removal), RSTR(radical subtotal removal), STR(subtotal removal),and PR(partial removal). The median follow-up period was 50 months(4-198). CT scan and/or MR imaging and hormonal status were evaluated to the last follow-up. Results : Visual disturbance was the most common presentation, which was improved in 42 cases and aggravated in 19 cases following the operation. Hypopituitarism was detected in 56 patients preoperatively, 82 during the immediate postoperative period, and 76 at the last follow-up. Improvement of pituitary function was not observed in any of these patients. Twenty of 100 patients showed recurrence at the mean of 27 months(3 to 196). The median progression-free survival(PFS) time of all patients was 145 months and 5-year PFS rate was 74%. Five-year PFS rate of GTR or RSTR group(71%) was significantly higher than that of STR or PR group(30%)(p=0.01). Postoperative radiation therapy significantly prolonged the PFS from 94 months in non-radiation group to 182 months(p=0.002). However, there was no statistical difference in number of patients who required hormonal replacement therapy between radiation and non-radiation group. Conclusion : Visual disturbance can be improved by early diagnosis and surgical decompression. GTR or RSTR in selected patients is considered a proper surgical strategy. Post-operative radiation therapy for residual tumors must be considered, although the ideal timing of radiation therapy is to be determined.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.165-170
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• 2005

Background: It is difficult to treat tourniquet-induced hypertension despite adequate anesthesia, and the mechanism of that is not known. And it may be possible that intraoperative continuous infusion of opioid induces preemptive analgesia postoperatively. We investigated the effect of intraoperative continuous i.v. fentanyl on tourniquet induced cardiovascular changes and postoperative preemptive analgesia in total knee replacements. Methods: Sixty patients were randomly assigned to two groups; In study group ($1.5{\mu}g/kg$ loading and $0.5{\mu}g/kg/hr$ continuous infusion of fentanyl before skin incision and tourniquet inflation) and control group (no treatment). Anesthesia was maintained with enflurane (1-2 MAC) and 50% nitrous oxide in oxygen. Arterial pressure and heart rate were compared between two groups. They received postoperative pain treatment with patient-controlled analgesia (PCA) with fentanyl during the postoperative 48 hours after total knee replacement. Visual analog scale (VAS) scores at either rest or movement were used to assess pain. Total fentanyl dose delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. Results: There were no significant differences between the two groups on cardiovascular changes by tourniquet induced pain effect. VAS, PCA delivered dose and PCA demands at movement in the 24-48 hour decreased in study group compared with control group (P < 0.05). But there were no significant differences between the two groups on the other time periods except 24-48 hour's patient satisfaction and adverse events. Conclusions: We suggest that intraoperative continuous i.v. fentanyl infusion dose not affect cardiovascular change by tourniquet induced pain. But it may induce preemptive analgesia postoperatively.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.459-466
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• 2011

Purpose: This study evaluated the capability of bone formation with silk fibroin/nano-hydroxyapatite/corn starch composite scaffold as a bone defect replacement matrix when grafted in a calvarial bone defect of rabbits $in$ $vivo$. Methods: Ten New Zealand white rabbits were used for this study and bilateral round-shaped defects were formed in the parietal bone (diameter: 8.0 mm). The silk fibroin 10% nano-hydroxyapatite/30% corn starch/60% composite scaffold was grafted into the right parietal bone (experimental group). The left side (control group) was grafted with a nano-hydroxyapatite (30%)/corn starch (70%) scaffold. The animals were sacrificed at 4 weeks and 8 weeks. A micro-computerized tomography (${\mu}CT$) of each specimen was taken. Subsequently, the specimens were decalcified and stained with Masson's trichrome for histological and histomorphometric analysis. Results: The average ${\mu}CT$ and histomorphometric measures of bone formation were higher in the control group than in the experimental group at 4 weeks and 8 weeks after surgery though not statistically significant ($P$ >0.05). Conclusion: The rabbit calvarial defect was not successfully repaired by silk fibroin/nano-hydroxyapatite/corn starch composite scaffold and may have been due to an inflammatory reaction caused by silk powder. In the future, the development of composite bone graft material based on various components should be performed with caution.

• Journal of the Microelectronics and Packaging Society
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• v.21 no.3
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• pp.25-29
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• 2014

Plasma organic thin film for PCB surface finish is a potential replacement of the conventional PCB finishes because of environment-friendly process, high corrosion-resistance and long shelf life over 1 year. In this study, solder joint properties of the plasma organic surface finish were estimated and compared with OSP surface finish. The plasma surface finish was deposited by chemical vapor deposition from fluorine-based precursors. The thickness of the plasma organic coating was 20 nm. Sn-3.0Ag-0.5Cu (SAC305) solder was used as solder joint materials. From a salt spray test, the plasma organic coating had higher corrosion resistance than the OSP surface finish. The spreadability of SAC305 on plasma organic coating was higher than that on OSP surface finish. SEM and TEM micrographs showed that the interfacial microstructure of the plasma surface finish sample were similar to that of the OSP sample. Solder joint strength of the plasma finish sample was also similar to that of the OSP finished sample.

• Asian-Australasian Journal of Animal Sciences
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• v.17 no.5
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• pp.621-628
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• 2004

Twenty male buffalo calves of 6-9 months of age (average body weight, 97 kg) were randomly allocated into two main groups of four (control) and sixteen (supplemented) calves. The supplemented group was further divided in to four equal sub-groups, with the two groups supplemented with a liquid preparation of urea-molasses, UML1, containing fish meal and UML2, containing formaldehyde treated deoiled mustard cake (FDMC) and the other two, with a semi-solid preparation, UMC1 with FDMC and deoiled rice bran (DORB) contributing similar level of CP as in UML2 and UMC2 with double the level of FDMC to that in UMC1. The control group was fed with DORB along with ad libitum wheat straw at 40:60 ratios. The rest of the groups were fed on the above diet supplemented with 500 g (as fed basis) of urea-molasses preparations. The experimental feeding was carried out for 24 weeks including a metabolism trial towards the end of experimental feeding. Daily feed intake and fortnightly change in live weight were also recorded during the study. Catalytic supplementation of 500 g urea-molasses induced 8-25% higher voluntary feed intake of wheat straw, resulting in 15-25% higher DM and OM intake. The digestibility of DM, OM, total carbohydrate, NDF, ADF, hemicellulose and cellulose in all the dietary groups were comparable. The CP digestibility of calves in supplemented groups were higher (p<0.05) than the control group. The balance of nutrients, viz. N, Ca and P, was also higher in the supplemented groups. Significantly higher intake of digestible CP coupled with other digestible nutrients attributed to higher TDN (1.67-1.78 vs. 1.37 kg) and ME (5.94-6.31 vs. 4.87 Mcal) intake in urea-molasses supplemented groups which resulted in higher live weight gain compared to that in control group (p<0.01). Between the supplements, UML2 and UMC2 faired non-significantly, indicating formalin treated mustard cake as a suitable replacement to fishmeal in the supplement. The overall ranking based on intake and digestibility of nutrients, live weight gain, economic evaluation and input-output relationship revealed that the rations with UML2 and UMC1 to be of greater value compared to other types. From the study it can be concluded that young ruminants can be reared successfully on a basal diet of deoiled rice bran and wheat straw supplemented with cheaper urea-molasses-mineral mix.

• Asian-Australasian Journal of Animal Sciences
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• v.28 no.6
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• pp.903-910
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• 2015

To maintain a predominantly pasture-based system, the large herd milked by automatic milking rotary would be required to walk significant distances. Walking distances of greater than 1-km are associated with an increased incidence of undesirably long milking intervals and reduced milk yield. Complementary forages can be incorporated into pasture-based systems to lift total home grown feed in a given area, thus potentially 'concentrating' feed closer to the dairy. The aim of this modelling study was to investigate the total land area required and associated walking distance for large automatic milking system (AMS) herds when incorporating complementary forage rotations (CFR) into the system. Thirty-six scenarios consisting of 3 AMS herds (400, 600, 800 cows), 2 levels of pasture utilisation (current AMS utilisation of 15.0 t dry matter [DM]/ha, termed as moderate; optimum pasture utilisation of 19.7 t DM/ha, termed as high) and 6 rates of replacement of each of these pastures by grazeable CFR (0%, 10%, 20%, 30%, 40%, 50%) were investigated. Results showed that AMS cows were required to walk greater than 1-km when the farm area was greater than 86 ha. Insufficient pasture could be produced within a 1 km distance (i.e. 86 ha land) with home-grown feed (HGF) providing 43%, 29%, and 22% of the metabolisable energy (ME) required by 400, 600, and 800 cows, respectively from pastures. Introduction of pasture (moderate): CFR in AMS at a ratio of 80:20 can feed a 400 cow AMS herd, and can supply 42% and 31% of the ME requirements for 600 and 800 cows, respectively with pasture (moderate): CFR at 50:50 levels. In contrast to moderate pasture, 400 cows can be managed on high pasture utilisation (provided 57% of the total ME requirements). However, similar to the scenarios conducted with moderate pasture, there was insufficient feed produced within 1-km distance of the dairy for 600 or 800 cows. An 800 cow herd required 140 and 130 ha on moderate and high pasture-based AMS system, respectively with the introduction of pasture: CFR at a ratio of 50:50. Given the impact of increasing land area past 86 ha on walking distance, cow numbers could be increased by purchasing feed from off the milking platform and/or using the land outside 1-km distance for conserved feed. However, this warrants further investigations into risk analyses of different management options including development of an innovative system to manage large herds in an AMS farming system.

• Nutritional Sciences
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• v.9 no.2
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• pp.82-91
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• 2006

This study was performed to investigate the effect of normal diet with or without naringin supplement on the lipid and antioxidant metabolism in ethanol-treated rats for a short tenn. Male Sprague-Dawley rats were divided into three groups (n=10), which were assigned to one of three dietary categories : $E_8$ : ethanol diet for 8 wks, $E_4N_4$ : ethanol diet for the first 4 wks and normal diet for the last 4 wks, $E_4Nna_4$ : ethanol diet for the first 4 wks and normal diet with naringin supplement for the last 4 wks. Plasma total cholesterol concentrations were significantly higher in ethanol fed rats for 8 weeks. The HDL-C/total-C ratios of the $E_4N_4$ and the $E_4Nna_4$ groups were significantly higher than that of the $E_8$ group, while the atherogenic index was lower in the $E_4N_4$ and the $E_4Nna_4$ groups than in the $E_8$ group. The $E_4N_4$ and $E_4Nna_4$ diets significantly lowered both the hepatic cholesterol and triglyceride levels compared to the $E_8$ group. Accumulation of hepatic lipid droplets was observed to be the highest in the $E_8$ group. In the current study, the naringin supplement to normal diet significantly lowered both the hepatic HMG-CoA reductase and ACAT activities in ethanol pre-treated rats for 4 weeks. Antioxidant enzyme activities were also upregulated when ethanol feeding was ceased. Naringin supplement given for 4 weeks after ethanol cessation resulted in a significant decrease in the plasma cholesterol and hepatic lipids and plasma TBARS as well as the hepatic HMG-CoA reductase and ACAT activities compared to the rats given ethanol diet for the entire 8 weeks. Replacement of normal diet following a short tenn ethanol feeding was effective for the recovery of ethanol-induced fatty liver and for normalizing plasma and hepatic lipid profiles and antioxidant enzyme activities, regardless of an additional phytochemical supplement, naringin. The effect of naringin could seemingly be more evident if its supplementation period had been extended longer than 4 weeks after ethanol cessation.