기능적 단심실 환자에 대한 심장내 외측통로 폰탄술식의 중기 수술성적 (Mid-term results of IntracardiacLateral Tunnel Fontan Procedure in the Treatment of Patients with a Functional Single Ventricle)
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- Journal of Chest Surgery
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- 제31권5호
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- pp.472-480
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- 1998
서울대학교 어린이병원 흉부외과에서는 1990년부터 1996년까지 104례의 기능적 단심실을 가진 선천성심기형 환아에 대하여 심장내 외측통로술을 이용한 완전폰탄술을 시행하였다. 환아의 연령 및 체중분포는 각각 평균 35.9(범위 10-72) 개월, 12.8 (범위 6.5-37.8) kg이었다. 술전진단은 삼첨판폐쇄증(18), 단심실연결을보이는 중복개구심실(53) 및 기타 기능적 단심실을 동반한 복잡심기형(33)이었다, 50례의 환아에 대하여 체폐동맥 단락술 (37), 폐동맥밴딩(13), 외과적 심방중격절제술(15), 동맥전환술(2), 대동맥하 누두부제거술(2), 총폐정맥이상연결증(2), 폐동맥-대동맥봉합술(Damus-Stansel-Kaye, 1) 등의 고식술이 시행되었다. 완전폰탄술식전 19례의 양방향성 체정맥-폐동맥단락술과 1례의 전(全)체정맥-폐동맥단락술(Kawashima procedure)이 진행되었다. 술전 혈역학소견상, 평균 폐동맥압/폐혈관저항은 14.6 (범위 5-28mmHg) / 2.2 (범위0.4-6.9)wood.unit였으며, 폐혈류/체혈류비가 평균 0.9 (범위0.3-3.0)였다. 이완기말심실압은 평균 9.0 (범위 3.0-21.0) mmHg였고 동맥혈의 산소포화도는 평균 76.0 (범위 45.6-88.0) %였다. 수술은 분계능(terminal crest) 2cm 외측으로 우심이부터 우심방-하공정맥경계부에 종절개를 가하고 하공정맥개구부부터 상공정맥개구부 또는 우심이까지 Gore-Tex 인조도관을 이용하여 외측통동을 형성시키는 방법으로 시행하였으며 필요한 경우 통로상에 4-5.5 mm 직경의 구멍을 만들어 주었다. 동시에 시행한 술식은, 폐동맥성형술(22), 심방중격절제술(21), 폐정맥이상연결증 교정(4), 영구적인 인공심박동기거치(3) 등이었고, 32례에 대하여 통로내 구멍을 만들어 주었으며 그중 1례는 조절형(adjustable)으로 시행하였다. 심방-폐동맥 연결 방법으로 시행한 폰탄술 후 4년후에 발생한 재발성 난치성 상심실형 부정맥환아 1례에 대하여 외측통로형의 변환 폰탄술식이 시행되었다. 수술 직후 혈역학 소견상 평균 폐동맥압, 이완기말심실압, 실온에서 동맥혈의 산소포화도가 각각 12.7 (8-21)mmHg, 7.6 (범위4-12)mmHg, 89.9 (범위68-100) %였다. 병원사망율은 6.7 (7/104) %였고 술후 합병증으로 지속적인 늑막삼출(11), 부정맥(8), 유미흉(9), 중추신경계손상(5), 감염 및 염증(5), 급성신부전(4)이 발생하였다. 평균 27.2 (범위1-85) 개월동안의 외래 추적결과 5명의 만기 사망이 있었다. 저자등은 본연구결과를 토대로 심장내 외측통동폰탄술식이 기능적 단심실 환자에 대하여 비교적 낮은 사망율 및 합병증과 우수한 혈역학으로 시행될수 있는 수술방법이란 사실을 입증하였다.
본 시험은 착즙부산물 발효사료가 육성돈의 영양소 소화율, 분뇨 배설량 그리고 질소 균형에 미치는 영향을 알아보고자 실시하였다. 삼원교잡종 24두(개시체중 46.79 kg)를 공시하여 10일간의 적응기를 거쳐 7 일간 대사 케이지 (
본 연구는 호맥 사일리지의 급여와 급여기간이 비육돈의 생산성, 혈액성상 및 도체특성에 미치는 영향에 대하여 알아보기 위하여 시험을 실시하였다. 3원 교잡종(
본 연구는 산채을 활용한 어린잎 혼합 포장 상품의 개발하기 위해 기존 어린잎채소에 많이 사용되고 있는 어린잎 적로메인상추(Lactuca sativa 'Red romaine')에 어린잎 산채로 갯기름나물(Peucedanum japoincum Thunberg)과 곤달비(Ligularia stenocephala)을 혼합하여 적합한 비율을 알아보고자 수행하였다. 적로메인과 산채의 혼합비율은 적로메인0 : 갯기름5 : 곤달비5(R0:P5:L5), 적로메인3.3 : 갯기름3.3 : 곤달비3.3(R3.3:P3.3:L3.3), 적로메인5 : 갯기름2.5 : 곤달비2.5(R5:P2.5:L2.5), 적로메인8 : 갯기름1 : 곤달비1(R8:P1:L1), 적로메인10 : 갯기름0 : 곤달비0(R10:P0:L0)으로 처리하였다. 모든 처리구는 OTR(Oxygen transmission rate) 10,000cc·m-2·day-1·atm-1 필름으로 포장하여 2℃/85%RH 저온고에서 27일간 저장하며 생체중 감소율, 포장내 이산화탄소/산소/에틸렌 농도, 외관, 엽록소 함량, 색도를 조사하였다. 생체중은 R8:P1:L1 처리구가 0.4% 미만의 가장 낮은 감소율을 보였고, 이를 제외한 나머지 처리구들은 0.5% 내외의 수치를 나타내었으나 통계적 유의성은 없었다. 포장내 산소와 이산화탄소 농도는 작물의 호흡률에 영향을 받았는데, 호흡률이 낮았던 상추의 혼합비율이 높아질수록 포장내 산소농도가 높았고, 이산화탄소 농도는 낮았다. 산소농도는 15일이후 크게 감소하였으나, 16%이상은 유지되었고, 이와 반대로 이산화탄소 농도의 경우 15일까지 1-4%로 유지되다가 서서히 증가하여 27일차에는 2-5%로 증가하였다. 에틸렌 농도는 저장 종료일까지 3-6µL·L-1 내외의 농도를 유지하였다. 저장 종료일의 외관상품질은 모든처리구가 상품성 한계점인 3점에 다소 못 미치는 정도를 보였다. 엽록소 함량(SPAD)은 처리구간 통계적 유의성은 없었으나, 적로메인과 곤달비의 경우 R8:P1:L1 처리구에서, 갯기름나물은 R5:P2.5:L2.5과 R8:P1:L1처리구에서 가장 적게 감소하였다. Heat map으로 비교한 3가지 작물의 엽색(L∗, a∗, b∗, chroma)은 R5:P2.5:L2.5와 R8:P1:L1 처리구에서 저장 후 가장 변화가 적었다. 이중 R8:P1:L1 처리구는 엽록소 함량도 가장 높게 유지되었으며 포장내 에틸렌 농도도 2번째로 낮았고 이산화탄소 농도는 2-3% 수준을 유지하였다. 따라서 적로메인 8, 곤달비 1, 갯기름 1(R8:P1:L1)의 혼합한 비율이 이 3가지 작물의 어린잎 혼합 포장에 가장 적합한 것으로 판단된다.
1970~1971년(年)에 걸쳐 잣나무의 자웅화(雌雄花)가 개화(開花)하여 구과(毬果)가 성숙(成熟)하기까지 임업시험장(林業試驗場) 서울시험임내(試驗林內)에 고정모수(固定母樹) 2본(本)과 보조모수(補助母樹) 3본(本)을 선정(選定)하여 7~10일간격(日間隔)으로 구과(毬果)를 채취(採取)하여 외부형태(外部形態)와 내부조직(內部組織)의 변화상(變化相)을 밝히고 구과(毬果)의 종자(種子)의 함수량(含水量)을 비롯하여 유지(油脂), 당(糖), 단백질(蛋白質) 등(等) 함유물질(含有物質)의 변화(變化)와 발아력(發芽力)을 갖게되는 시기등(時期等)을 종합적(綜合的)으로 연구(硏究)하였으며 그 결과(結果)를 요약(要約)하면 다음과 같다. 1. 웅화(雄花) 1) 4월하순(月下旬)~5월상순(月上旬) 화분모세포군(花粉母細胞群)이 형성(形成)되고 다시 5월상순(月上旬)~5월중순(月中旬)에 환원분열(還元分裂)을 하여 사분자(四分子)가 되고 단핵상(單核狀)의 화분(花粉)은 그후분열(後分裂)하여 5월하순(月下旬) 성숙비산(成熟飛散)하였다. 2) 한 개의 웅화수(雄花穗)의 웅예수(雄蘂數)는 구과(毬果)의 유효인편수(有效鱗片數)와 거의 비슷한 69~102개(個)로서 1개(個)의 웅예내(雄蘂內)에는 5800~7300립(粒)의 화분(花粉)이 들어있다. 3) 성숙화분(成熟花粉)의 형태(形態)는 원형(圓形) 또는 타원형(楕圓形)으로 좌우(左右)에 기낭(氣囊)이 달렸으며 화분(花粉)의 길이는
식욕에 부합되는 적정양의 먹이 섭취는 잉어의 성장을 증가시키고, 동시에 먹이의 허비를 막으며, 그로 인해서 사육수질의 오염을 막는 부수적인 효과도 가지게 된다. 이 목적을 달성하기 위하여 식욕 유발과 그에 따른 빠른 성장의 중요한 요인으로서 용존산소에 관한 정밀한 연구가 필요하다. 수온
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The objective of this research is to test the feasibility of developing a statewide truck traffic forecasting methodology for Wisconsin by using Origin-Destination surveys, traffic counts, classification counts, and other data that are routinely collected by the Wisconsin Department of Transportation (WisDOT). Development of a feasible model will permit estimation of future truck traffic for every major link in the network. This will provide the basis for improved estimation of future pavement deterioration. Pavement damage rises exponentially as axle weight increases, and trucks are responsible for most of the traffic-induced damage to pavement. Consequently, forecasts of truck traffic are critical to pavement management systems. The pavement Management Decision Supporting System (PMDSS) prepared by WisDOT in May 1990 combines pavement inventory and performance data with a knowledge base consisting of rules for evaluation, problem identification and rehabilitation recommendation. Without a r.easonable truck traffic forecasting methodology, PMDSS is not able to project pavement performance trends in order to make assessment and recommendations in the future years. However, none of WisDOT's existing forecasting methodologies has been designed specifically for predicting truck movements on a statewide highway network. For this research, the Origin-Destination survey data avaiiable from WisDOT, including two stateline areas, one county, and five cities, are analyzed and the zone-to'||'&'||'not;zone truck trip tables are developed. The resulting Origin-Destination Trip Length Frequency (00 TLF) distributions by trip type are applied to the Gravity Model (GM) for comparison with comparable TLFs from the GM. The gravity model is calibrated to obtain friction factor curves for the three trip types, Internal-Internal (I-I), Internal-External (I-E), and External-External (E-E). ~oth "macro-scale" calibration and "micro-scale" calibration are performed. The comparison of the statewide GM TLF with the 00 TLF for the macro-scale calibration does not provide suitable results because the available 00 survey data do not represent an unbiased sample of statewide truck trips. For the "micro-scale" calibration, "partial" GM trip tables that correspond to the 00 survey trip tables are extracted from the full statewide GM trip table. These "partial" GM trip tables are then merged and a partial GM TLF is created. The GM friction factor curves are adjusted until the partial GM TLF matches the 00 TLF. Three friction factor curves, one for each trip type, resulting from the micro-scale calibration produce a reasonable GM truck trip model. A key methodological issue for GM. calibration involves the use of multiple friction factor curves versus a single friction factor curve for each trip type in order to estimate truck trips with reasonable accuracy. A single friction factor curve for each of the three trip types was found to reproduce the 00 TLFs from the calibration data base. Given the very limited trip generation data available for this research, additional refinement of the gravity model using multiple mction factor curves for each trip type was not warranted. In the traditional urban transportation planning studies, the zonal trip productions and attractions and region-wide OD TLFs are available. However, for this research, the information available for the development .of the GM model is limited to Ground Counts (GC) and a limited set ofOD TLFs. The GM is calibrated using the limited OD data, but the OD data are not adequate to obtain good estimates of truck trip productions and attractions .. Consequently, zonal productions and attractions are estimated using zonal population as a first approximation. Then, Selected Link based (SELINK) analyses are used to adjust the productions and attractions and possibly recalibrate the GM. The SELINK adjustment process involves identifying the origins and destinations of all truck trips that are assigned to a specified "selected link" as the result of a standard traffic assignment. A link adjustment factor is computed as the ratio of the actual volume for the link (ground count) to the total assigned volume. This link adjustment factor is then applied to all of the origin and destination zones of the trips using that "selected link". Selected link based analyses are conducted by using both 16 selected links and 32 selected links. The result of SELINK analysis by u~ing 32 selected links provides the least %RMSE in the screenline volume analysis. In addition, the stability of the GM truck estimating model is preserved by using 32 selected links with three SELINK adjustments, that is, the GM remains calibrated despite substantial changes in the input productions and attractions. The coverage of zones provided by 32 selected links is satisfactory. Increasing the number of repetitions beyond four is not reasonable because the stability of GM model in reproducing the OD TLF reaches its limits. The total volume of truck traffic captured by 32 selected links is 107% of total trip productions. But more importantly, ~ELINK adjustment factors for all of the zones can be computed. Evaluation of the travel demand model resulting from the SELINK adjustments is conducted by using screenline volume analysis, functional class and route specific volume analysis, area specific volume analysis, production and attraction analysis, and Vehicle Miles of Travel (VMT) analysis. Screenline volume analysis by using four screenlines with 28 check points are used for evaluation of the adequacy of the overall model. The total trucks crossing the screenlines are compared to the ground count totals. L V/GC ratios of 0.958 by using 32 selected links and 1.001 by using 16 selected links are obtained. The %RM:SE for the four screenlines is inversely proportional to the average ground count totals by screenline .. The magnitude of %RM:SE for the four screenlines resulting from the fourth and last GM run by using 32 and 16 selected links is 22% and 31 % respectively. These results are similar to the overall %RMSE achieved for the 32 and 16 selected links themselves of 19% and 33% respectively. This implies that the SELINICanalysis results are reasonable for all sections of the state.Functional class and route specific volume analysis is possible by using the available 154 classification count check points. The truck traffic crossing the Interstate highways (ISH) with 37 check points, the US highways (USH) with 50 check points, and the State highways (STH) with 67 check points is compared to the actual ground count totals. The magnitude of the overall link volume to ground count ratio by route does not provide any specific pattern of over or underestimate. However, the %R11SE for the ISH shows the least value while that for the STH shows the largest value. This pattern is consistent with the screenline analysis and the overall relationship between %RMSE and ground count volume groups. Area specific volume analysis provides another broad statewide measure of the performance of the overall model. The truck traffic in the North area with 26 check points, the West area with 36 check points, the East area with 29 check points, and the South area with 64 check points are compared to the actual ground count totals. The four areas show similar results. No specific patterns in the L V/GC ratio by area are found. In addition, the %RMSE is computed for each of the four areas. The %RMSEs for the North, West, East, and South areas are 92%, 49%, 27%, and 35% respectively, whereas, the average ground counts are 481, 1383, 1532, and 3154 respectively. As for the screenline and volume range analyses, the %RMSE is inversely related to average link volume. 'The SELINK adjustments of productions and attractions resulted in a very substantial reduction in the total in-state zonal productions and attractions. The initial in-state zonal trip generation model can now be revised with a new trip production's trip rate (total adjusted productions/total population) and a new trip attraction's trip rate. Revised zonal production and attraction adjustment factors can then be developed that only reflect the impact of the SELINK adjustments that cause mcreases or , decreases from the revised zonal estimate of productions and attractions. Analysis of the revised production adjustment factors is conducted by plotting the factors on the state map. The east area of the state including the counties of Brown, Outagamie, Shawano, Wmnebago, Fond du Lac, Marathon shows comparatively large values of the revised adjustment factors. Overall, both small and large values of the revised adjustment factors are scattered around Wisconsin. This suggests that more independent variables beyond just 226; population are needed for the development of the heavy truck trip generation model. More independent variables including zonal employment data (office employees and manufacturing employees) by industry type, zonal private trucks 226; owned and zonal income data which are not available currently should be considered. A plot of frequency distribution of the in-state zones as a function of the revised production and attraction adjustment factors shows the overall " adjustment resulting from the SELINK analysis process. Overall, the revised SELINK adjustments show that the productions for many zones are reduced by, a factor of 0.5 to 0.8 while the productions for ~ relatively few zones are increased by factors from 1.1 to 4 with most of the factors in the 3.0 range. No obvious explanation for the frequency distribution could be found. The revised SELINK adjustments overall appear to be reasonable. The heavy truck VMT analysis is conducted by comparing the 1990 heavy truck VMT that is forecasted by the GM truck forecasting model, 2.975 billions, with the WisDOT computed data. This gives an estimate that is 18.3% less than the WisDOT computation of 3.642 billions of VMT. The WisDOT estimates are based on the sampling the link volumes for USH, 8TH, and CTH. This implies potential error in sampling the average link volume. The WisDOT estimate of heavy truck VMT cannot be tabulated by the three trip types, I-I, I-E ('||'&'||'pound;-I), and E-E. In contrast, the GM forecasting model shows that the proportion ofE-E VMT out of total VMT is 21.24%. In addition, tabulation of heavy truck VMT by route functional class shows that the proportion of truck traffic traversing the freeways and expressways is 76.5%. Only 14.1% of total freeway truck traffic is I-I trips, while 80% of total collector truck traffic is I-I trips. This implies that freeways are traversed mainly by I-E and E-E truck traffic while collectors are used mainly by I-I truck traffic. Other tabulations such as average heavy truck speed by trip type, average travel distance by trip type and the VMT distribution by trip type, route functional class and travel speed are useful information for highway planners to understand the characteristics of statewide heavy truck trip patternS. Heavy truck volumes for the target year 2010 are forecasted by using the GM truck forecasting model. Four scenarios are used. Fo~ better forecasting, ground count- based segment adjustment factors are developed and applied. ISH 90 '||'&'||' 94 and USH 41 are used as example routes. The forecasting results by using the ground count-based segment adjustment factors are satisfactory for long range planning purposes, but additional ground counts would be useful for USH 41. Sensitivity analysis provides estimates of the impacts of the alternative growth rates including information about changes in the trip types using key routes. The network'||'&'||'not;based GMcan easily model scenarios with different rates of growth in rural versus . . urban areas, small versus large cities, and in-state zones versus external stations. cities, and in-state zones versus external stations.