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The Role of Axillary Artery Cannulation in Surgery for Type A Acute Aortic Dissection (급성 상행대동맥 박리증 수술에서 액와동맥 삽관술의 역할)

  • 유지훈;박계현;박표원;이영탁;김관민;성기익;양희철
    • Journal of Chest Surgery
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    • v.36 no.5
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    • pp.343-347
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    • 2003
  • Background: The femoral artery is the most common site of canuulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. Material and Method: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. Result: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorier in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263min and 49 min, respectively; P<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2%, in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. Conclusion: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection, It enabled us to approach the patients with aortic arch pathology more aggressively.

Diagnostic Accuracy of Rest T1-201/Stress Tc-99m-MIBI Myocardial SPECT in the Diagnosis of Coronary Artery Disease (휴식 T1-201/부하 Tc-99m MIBI 심근 SPECT의 관상동맥질환 진단 정확성)

  • Yeo, Jeong-Seok;Lee, Dong-Soo;Kang, Keon-Wook;Sohn, Dae-Won;Oh, Byung-Hee;Lee, Myung-Mook;Chung, June-Key;Park, Young-Bae;Lee, Myung-Chul;Seo, Jung-Don;Lee, Young-Woo;Koh, Chang-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.30 no.1
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    • pp.112-117
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    • 1996
  • Objective: Standard stress/rest Tc-99m MIBI and T1-201 myocardial perfusion study have some limitations such as stress/rest image overlap for Tc-99m-MIBI, low energy for T1-201 and long period of study time for two separate studies. Separate acquisition rest T1-201/stress Tc-99m MIBI dual isotope study is a potentially efficient myocardial perfusion imaging protocol that combines the high resolution of Tc-99m for stress perfusion assessment and T1-201 for viability assessment. This study assessed the usefulness and diagnostic accuracy for this new approach. Methods: We tried to evaluate sensitivity and specificity of dual isotope separate acquisition protocol in 67 patients. Immediately after resting T1-201 SPECT data was acquired, dipyridamole stress Tc-99m MIBI myocardial perfusion study was performed. Visual analysis was carried out qualitatively with 0 to 3 scoring system for 17 segments of left ventricle in the reconstructed horizontal long axis and short axis slices. Results: Total study was completed within 3 hours. In angiographic correlation, dual isotope SPECT demonstrated high sensitivity(85%) and in a small group of patients, high specificity was also observed (100%). Conclusion: Combined thallium-201/stress Tc-99m MIBI SPECT displayed similiar diagnostic accuracy to protocol using stress/rest Tc-99m MIBI SPECT. This protocol was completed in shorter period than the previous protocols and therefore enhance laboratory throughput and patients convenience.

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Spiritual Needs of Hospice Patients (호스피스 환자의 영적 요구)

  • Han, Young-Mi
    • Journal of Hospice and Palliative Care
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    • v.3 no.1
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    • pp.39-48
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    • 2000
  • Purpose : The purpose of the study is to disclose the spiritual needs of hospice patients. Method : The questionaire survey was carried out on 49 hospice patients and 40 caregivers who were in the 9 hospice institutions from lune to August in 1999. Results : In the patients, mean scores of the spiritual needs were significantly higher in the group with stomach cancer, college education, christians, $8{\sim}14$ days of hospice care and the group thinking that religion was important, and in the caregivers in the group of religions besides christianity and lives under $3{\sim}5$ years of medical treatment. In the total average of the spiritual needs, the patients's average was significantly lower than the caregiver's. Among the different categories, the patient's needs were highest in the area of meaning of life and the hope, the caregiver's needs in the love and the concern. However, both groups were low in the religion area. In the items of the love and the concern, the patient was highly responding to the 'wanting someone to give warm concern in conversation' and the caregiver was highly responding to the 'giving a warm response to questions on the sad and hard time'. And also, the patient was lowly responding to the 'wanting more concerns to him than other patients', and the caregiver was low responding to the 'patients wanting warm response in conversation'. In the categories of religious area both group were highly responding to the 'wanting to be helped to relax out of all'. And they gave lowest response to the 'wanting to introduce a book to know God'. In the area of meaning of life and hope, the both groups gave highest response to the 'wanting to be guided to have the hope' and lowest to the 'wanting to have opportunity to reconcile the person with bad relationship'. Conclusion : Summing up the above results, personal in-depth conversation is necessary to understand more deeply the spiritual needs of hospice patient. Moreover the hospice team needs to have more systematic approach to find out the spiritual needs of hospice patients.

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A Study on Nutrition Status by Diet of Female College Students of Masan City - 1. Focus on Diet Survey - (여대생의 체중감량이 영양상태에 미치는 영향 - 제1보. 다이어트 실태조사를 중심으로 -)

  • 김종현
    • The Korean Journal of Food And Nutrition
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    • v.11 no.2
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    • pp.185-191
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    • 1998
  • This study was performed to investigate the nutrition status by weight loss(diet) of 287 female college students, focus on questionnaire about diet survey. The subjects mainly had irregularly one or two meal per a day so food behavior was not good. Over half of subjects had a tendency to overestimate body shape of self. The desired weight(46.95$\pm$0.39kg) was significant lower than real weight(50.32$\pm$0.9)(p=0.0114). The time when diet is first tried was mainly after high school(94.51%). Mean weight loss was 1~4kg but most of subjects didn't maintain the lost weight. The diet approach method tried was sequently the fasting 1 meal or the more in a day(23.61%), exercise(21.92%), restricting calories(15.85%) etc. The source of diet was orderly newspaper or magazine(30.86%), friends or relatives or family(28.86%) etc. The group who recognized the self body shape was normal or a little fat had higher self notion of health than other groups.

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Wind Stability of Commercially Important Tree Species and Silvicultural Implications, Daegwallyeong Korea (대관령 지역 경제림에 대한 내풍 안정성 분석 및 임업적 적용)

  • Moktan, Mani Ram;Kwon, Jino;Lim, Joo-Hoon;Shin, Moon-Hyun;Park, Chan-Woo;Bae, Sang-Won
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.17 no.1
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    • pp.58-68
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    • 2015
  • This study compares the wind stability of Larix kaempferi (Lamb.) Carr., Pinus koraiensis Sie. & Zucc. and Abies holophylla Maxim. to understand and inform wind risk management of these plantation trees at Daegwallyeong, Korea. Temporary square plots of $20m{\times}20m$ ($400m^2$) were laid out, and DBH (Diameter at Breast Height) and height for trees greater than 10 cm in DBH were measured by species. A total of 15 plots with 5 plots each in L. kaempferi, P. koraiensis and A. holophylla stands were sampled at random. Among the species, A. holophylla and P. koraiensis have comparatively lower h/d (Height/DBH) ratios than L. kaempferi. These results indicate that the former two species are more wind firm than the latter species. About 9% of the L. kaempferi trees have higher h/d ratios than the critical threshold limit 80. These trees are vulnerable to wind damage and should be removed in the next thinning regime. The analysis of variance detected a significant difference (p < 0.05) in the h/d ratios and Gini coefficient indicating species differences and DBH size variation, respectively. Gini coefficient was 16.4% in A. holophylla, 15.9% in P. koraiensis and 14% in L. kaempferi stands indicating limited DBH size variation. Lower h/d ratios are attributed to thinning in these stands and tree morphological differences. To increase wind firmness, low thinning should concentrate to remove trees with the h/d ratio above 80 coinciding at the time of stand distinction phase. Forest managers and practitioners should measure and maintain h/d ratios of trees below the critical threshold limit of 80 through stand density management. Variable density thinning approach should be tested to increase tree DBH sizes of the even-aged stands.

New horizon of geographical method (인문지리학 방법론의 새로운 지평)

  • ;Choi, Byung-Doo
    • Journal of the Korean Geographical Society
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    • v.38
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    • pp.15-36
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    • 1988
  • In this paper, I consider the development of methods in contemporary human geography in terms of a dialectical relation of action and structure, and try to draw a new horizon of method toward which geographical research and spatial theory would develop. The positivist geography which was dominent during 1960s has been faced both with serious internal reflections and strong external criticisms in the 1970s. The internal reflections that pointed out its ignorance of spatial behavior of decision-makers and its simplication of complex spatial relations have developed behavioural geography and systems-theoretical approach. Yet this kinds of alternatives have still standed on the positivist, geography, even though they have seemed to be more real and complicate than the previous one, The external criticisms that have argued against the positivist method as phenomenalism and instrumentalism suggest some alternatives: humanistic geography which emphasizes intention and action of human subject and meaning-understanding, and structuralist geography which stresses on social structure as a totality which would produce spatial phenomena, and a theoretical formulation. Human geography today can be characterized by a strain and conflict between these methods, and hence rezuires a synthetic integration between them. Philosophy and social theory in general are in the same in which theories of action and structural analysis have been complementary or conflict with each other. Human geography has fallen into a further problematic with the introduction of a method based on so-called political ecnomy. This method has been suggested not merely as analternative to the positivist geography, but also as a theoretical foundation for critical analysis of space. The political economy of space with has analyzed the capitalist space and tried to theorize its transformation may be seen either as following humanistic(or Hegelian) Marxism, such as represented in Lefebvre's work, or as following structuralist Marxism, such as developed in Castelles's or Harvey's work. The spatial theory following humanistic Marxism has argued for a dialectic relation between 'the spatial' and 'the social', and given more attention to practicing human agents than to explaining social structures. on the contray, that based on structuralist Marxism has argued for social structures producing spatial phenomena, and focused on theorising the totality of structures, Even though these two perspectives tend more recently to be convergent in a way that structuralist-Marxist. geographers relate the domain of economic and political structures with that of action in their studies of urban culture and experience under capitalism, the political ecnomy of space needs an integrated method with which one can overcome difficulties of orthhodox Marxism. Some novel works in philosophy and social theory have been developed since the end of 1970s which have oriented towards an integrated method relating a series of concepts of action and structure, and reconstructing historical materialism. They include Giddens's theory of structuration, foucault's geneological analysis of power-knowledge, and Habermas's theory of communicative action. Ther are, of course, some fundamental differences between these works. Giddens develops a theory which relates explicitly the domain of action and that of structure in terms of what he calls the 'duality of structure', and wants to bring time-space relations into the core of social theory. Foucault writes a history in which strategically intentional but nonsubjective power relations have emerged and operated by virtue of multiple forms of constrainst wihthin specific spaces, while refusing to elaborate any theory which would underlie a political rationalization. Habermas analyzes how the Western rationalization of ecnomic and political systems has colonized the lifeworld in which we communicate each other, and wants to formulate a new normative foundation for critical theory of society which highlights communicatie reason (without any consideration of spatial concepts). On the basis of the above consideration, this paper draws a new norizon of method in human geography and spatial theory, some essential ideas of which can be summarized as follows: (1) the concept of space especially in terms of its relation to sociery. Space is not an ontological entity whch is independent of society and has its own laws of constitution and transformation, but it can be produced and reproduced only by virtue of its relation to society. Yet space is not merlely a material product of society, but also a place and medium in and through which socety can be maintained or transformed.(2) the constitution of space in terms of the relation between action and structure. Spatial actors who are always knowledgeable under conditions of socio-spatial structure produce and reproduce their context of action, that is, structure; and spatial structures as results of human action enable as well as constrain it. Spatial actions can be distinguished between instrumental-strategicaction oriented to success and communicative action oriented to understanding, which (re)produce respectively two different spheres of spatial structure in different ways: the material structure of economic and political systems-space in an unknowledged and unitended way, and the symbolic structure of social and cultural life-space in an acknowledged and intended way. (3) the capitalist space in terms of its rationalization. The ideal development of space would balance the rationalizations of system space and life-space in a way that system space providers material conditions for the maintainance of the life-space, and the life-space for its further development. But the development of capitalist space in reality is paradoxical and hence crisis-ridden. The economic and poltical system-space, propelled with the steering media like money, and power, has outstriped the significance of communicative action, and colonized the life-space. That is, we no longer live in a space mediated communicative action, but one created for and by money and power. But no matter how seriously our everyday life-space has been monetalrized and bureaucratised, here lies nevertheless the practical potential which would rehabilitate the meaning of space, the meaning of our life on the Earth.

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TOOTH MOVEMENTS TO THE SITE OF ALVEOLAR BONE GRAFT (구순구개열 환아에서의 치조골이식)

  • Cho, Hae-Sung;Park, Jae-Hong;Kim, Gwang-Chul;Choi, Seong-Chul;Lee, Keung-Ho;Choi, Yeung-Chul
    • Journal of the korean academy of Pediatric Dentistry
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    • v.34 no.1
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    • pp.140-149
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    • 2007
  • Cleft lip and palate are congenital craniofacial malformation. Reconstruction of dental arch in patient with alveolo-palatal clefts is very important, because they have many problems in functions and esthetics. Malnutrition, poor oral hygiene, respiratory infections, speech malfunctions, maxillofacial deformity, and psychological problems may be occured without proper treatment during the long period of management of the cleft lip and palate. So the treatment should be managed with a multidisciplinary approach. Bone grafting is a consequential step in the dental rehabilitation of the cleft lip and palate patient A complete alveolar arch should be achieyed of the teeth to erupt in and to form a stable dentition. And the presence of the cleft complicate the orthodontic treatment. Therefore bone grafting in patients with cleft lip and palate is a widely adopted surgical procedure. Grafted bone stabilizes the alveolar process and allows the canine or incisor to move into the graft site. After the bone grafting, orthodontic closure of the maxillary arch has become a common practice for achieving dental reconstruction without any prosthodontic treatment. Various grafting materials have been used in alveolar clefts. Iliac bone is most widely fovoured, but tibia, rib, cranial bone, mandible have also been used. And according to its time of occurrence, the bone graft may be divided into primary, early secondary, secondary, late secondary. Bone grafting is called secondary when performed later, at the end of the mixed dentition. It is the most accepted procedure and has become part of treatment of protocol A secondary bone graft is performed preferably before the eruption of the permanent canine in order to provide adequate periodontal support for the eruption and preservation of the teeth adjacent to the cleft. In this report, we report here on a patient with unilateral cleft lip and palate, who underwent iliac bone graft. The cleft was fully obliterated by grafted bone in the region of the alveolar process. The presence of bone permitted physiologic tooth movement and the orthodontic movement of adjacent tooth into the former cleft area. Satisfactory arch alignment could be achieved in by subsequent orthodontic treatment.

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Echocardiographic Diagnosis of Pulmonary Arterial Hypertension in Chronic Lung Disease with Hypoxemia (만성 저산소성 폐질환의 폐동맥 고혈압에 대한 심초음파 검사)

  • Chang, Jung-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.6
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    • pp.846-855
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    • 1999
  • Background : Secondary pulmonary hypertension is an important final endpoint in patients with chronic hypoxic lung disease, accompanied by deterioration of pulmonary hemodynamics. The clinical diagnosis of pulmonary hypertension and/or cor pulmonale could be difficult, and simple noninvasive evaluation of pulmonary artery pressures has been an relevant clinical challenge for many years. Doppler echocardiography might to be a more reliable method for evaluating pulmonary hemodynamics in such patients in terms of the accuracy, reproducibility and easiness for obtaining an appropriate echocardiographic window than M-mode echocardiography. The aim of this study was to assess echocardiographic parameters associated with pulmonary arterial hypertension, defined by increasing right ventricular systolic pressure(RVSP), calculated from trans-tricuspid gradient in patients with chronic hypoxic lungs. Method : We examined 19 patients with chronic hypoxic lung disease, suspected pulmonary hypertension under the clinical guidelines by two dimensional echocardiography via the left parasternal and subcostal approach in a supine position. Doppler echocardiography measured RVSP from tricuspid regurgitant velocity in continuous wave with 2.5MHz transducer and acceleration time(AT) on right ventricular outflow tract in pulsed wave for the estimation of pulmonary arterial pressure. Results : On echocardiography, moderate to severe degree of pulmonary arterial hypertension was defined as RVSP more than 40mmHg, presenting tricuspid regurgitation. Increased right ventricular endsystolic diameter and shortened AT were noted in the increased RVSP group. Increased RVSP was correlated negatively with the shortening of AT. Other clinical data, including pulmonary functional parameters, arterial blood gas analysis and M mode echocardiographic parameters were not changed significantly with the increased RVSP. Conclusion : These findings suggest that shortened AT on pulsed doppler can be useful when quantifying pulmonary arterial pressure with increased RVSP in patients with chronic lung disease with hypoxemia. Doppler echocardiography in pulmonary hypertension of chronic hypoxic lungs is an useful option, based on noninvasiveness under routine clinical practice.

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Study on Measuring the Value of Recreational Forests Using Contingent Valuation Method (조건부가치측정법을 이용한 자연휴양림 휴양가치 측정)

  • Kang, Kee-Rae
    • Journal of the Korean Institute of Landscape Architecture
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    • v.37 no.5
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    • pp.42-52
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    • 2009
  • Recreational forests are catching on as places for personal development through recreation, association with people, education about nature, mind relaxation and spiritual peace. However, the value and significance of recreational forests with various functions are easily overlooked. Whoever pays fees for admission to facilities are able to enjoy fresh air, a comfortable environment, and space for rest. It should be taken into consideration whether the fee which customers pay is appropriate for the value of nature they are enjoying. This study is involved in giving the right recognition to the value of recreation and environment by estimating economically the value of the environment in which visitors stay, and presenting the appropriate price. The most efficient way to achieve this goal is through an economic approach, which suggests following established research skills and yielding suitable and accurate amounts of money. The environmental value of a recreational forests is estimated through contingent valuation method(CVM), which is chosen among several methods to estimate public facilities because the value of recreational forests has strong characteristics as public facilities which are not traded in the market. The annual recreation value per person of surveyed recreational forests is Willingness To Pay(WTP) with a mean between about 16,000 won and 25,400 won. The recreation value of one recreational forest surveyed is annually between approximately 1.7 billions won and 2.7 billions won. The annual recreation value of 85 national and public recreational forests is presumed to be between about 140 billions won and 230 billions won. The presumed amount of money is the environment in which visitors can enjoy whenever they invest some money and time. Indeed, it is more than that; it provides visitors with a greater sense of satisfaction and the recognition of the preciousness of nature and the environment.

An Exploratory Study on Measuring Brand Image from a Network Perspective (네트워크 관점에서 바라본 브랜드 이미지 측정에 대한 탐색적 연구)

  • Jung, Sangyoon;Chang, Jung Ah;Rho, Sangkyu
    • The Journal of Society for e-Business Studies
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    • v.25 no.4
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    • pp.33-60
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    • 2020
  • Along with the rapid advance in internet technologies, ubiquitous mobile device usage has enabled consumers to access real-time information and increased interaction with others through various social media. Consumers can now get information more easily when making purchase decisions, and these changes are affecting the brand landscape. In a digitally connected world, brand image is not communicated to the consumers one-sidedly. Rather, with consumers' growing influence, it is a result of co-creation where consumers have an active role in building brand image. This explains a reality where people no longer purchase products just because they know the brand or because it is a famous brand. However, there has been little discussion on the matter, and many practitioners still rely on the traditional measures of brand indicators. The goal of this research is to present the limitations of traditional definition and measurement of brand and brand image, and propose a more direct and adequate measure that reflects the nature of a connected world. Inspired by the proverb, "A man is known by the company he keeps," the proposed measurement offers insight to the position of brand (or brand image) through co-purchased product networks. This paper suggests a framework of network analysis that clusters brands of cosmetics by the frequency of other products purchased together. This is done by analyzing product networks of a brand extracted from actual purchase data on Amazon.com. This is a more direct approach, compared to past measures where consumers' intention or cognitive aspects are examined through survey. The practical implication is that our research attempts to close the gap between brand indicators and actual purchase behavior. From a theoretical standpoint, this paper extends the traditional conceptualization of brand image to a network perspective that reflects the nature of a digitally connected society.