• Title/Summary/Keyword: conventional method

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Pledget as a Useful Substitute for a Knot in Intracorporeal Continuous Gastrointestinal Suturing (복강 내 위장관 연속 손바느질에서 매듭 대용으로서의 Pledget의 유용성)

  • Kim, Jin-Jo;Song, Kyo-Young;Kim, Sung-Keun;Jun, Kyong-Hwa;Chin, Hyung-Min;Kim, Wook;Jeon, Hae-Myung;Park, Cho-Hyun;Park, Seung-Man;Lim, Keun-Woo;Park, Woo-Bae;Kim, Seung-Nam
    • Journal of Gastric Cancer
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    • v.7 no.3
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    • pp.146-151
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    • 2007
  • Purpose: Pledget is a PTFE felt that is usually used for suture reinforcement in cardiovascular surgery. In order to minimize the difficulty in intracorporeal continuous gastrointestinal suturing by reducing the number of tied knots, we have used pledget as substitute for a knot (pledget suturing). Materials and Methods: Thirty-two consecutive patients who underwent totally laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy in our institution were enrolled in this study, and the patients were divided into three groups according to the method of intracorporeal anastomosis. Basically, intracorporeal anastomosis was performed by several firings of linear staplers; however, the entry holes for the stapler at the jejunojejunostomy and the gastrojejunostomy were closed by pledget suturing in group A (8 patients), the entry hole for the stapler at jejunojejunostomy was closed by conventional suturing in group B (8 patients), and all of the entry holes for the stapler were closed by stapling in group C (16 patients). The surgical outcomes of each group were compared to each other. Results: The anastomotic time in group A was not longer than in group B, although there were more sutures used in group A, but it was longer than in group C. The number of stapler cartridges used in group A was the smallest among the three groups. In group B, there were two cases of a break of suture material during anastomosis, there were no such cases in group A. There was no complication related to anastomosis in all of the groups. Conclusion: Pledget was found to be useful for minimizing the difficulty in intracoproreal continuous gastrointestinal suturing and reducing the number of stapler cartilages used in intracorporeal anastomosis.

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Determination of Petroleum Aromatic Hydrocarbons in Seawater Using Headspace Solid-Phase Microextraction Coupled to Gas Chromatography/Mass Spectrometry (HS-SPME-GC/MS를 이용한 해수 내 유류계 방향족탄화수소 분석법)

  • An, Joon Geon;Shim, Won Joon;Ha, Sung Yong;Yim, Un Hyuk
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.17 no.1
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    • pp.27-35
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    • 2014
  • The headspace solid-phase microextraction (HS-SPME) followed by gas chromatography/mass spectrometry procedure has been developed for the simultaneous determination of petroleum aromatic hydrocarbons such as benzene, toluene, ethylbenzene and xylene isomers (BTEX) and polycyclic aromatic hydrocarbons (PAHs) in seawater. The advantages of SPME compared to traditional methods of sample preparation are ease of operation, reuse of fiber, portable system, minimal contamination and loss of the sample during transport and storage. SPME fiber, extraction time, temperature, stirring speed, and GC desorption time were key extraction parameters considered in this study. Among three kinds of SPME fibers, i.e., PDMS ($100{\mu}m$), CAR/PDMS ($75{\mu}m$), and PDMS/DVB ($65{\mu}m$), a $65{\mu}m$ PDMS/DVB fiber showed the most optimal extraction efficiencies covering molecular weight ranging from 78 to 202. Other extraction parameters were set up using $65{\mu}m$ PDMS/DVB. The final optimized extraction conditions were extraction time (60 min), extraction temperature (50), stirring speed (750 rpm) and GC desorption time (3 min). When applied to artificially contaminated seawater like water accommodated fraction, our optimized HS-SPME-GC/MS showed comparable performances with other conventional method. The proposed protocol can be an attractive alternative to analysis of BTEX and PAHs in seawater.

Studies on the Iron Component of Soy Sauce, Bean Paste and Red Pepper Paste -Part I. Iron Content of Soy Sauce- (장류(醬類)의 철분(鐵分)에 관(關)한 연구(硏究) - 제1보(第一報). 간장중의 철분함량(鐵分含量) -)

  • Yoo, Hai-Yul;Park, Yoon-Joong;Lee, Suk-Kun;Son, Cheon-Bae
    • Applied Biological Chemistry
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    • v.22 no.3
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    • pp.160-165
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    • 1979
  • This study was carried out to investigate effects of iron content on the quality of soy sauce, bean paste and red pepper paste, and to elucidate the origin of iron and change of the contents during production processes. For the first step, the iron contents in commercial soy sauce and changes of the contents during brewing process were determined. The results obtained were as follows. 1, Iron contents of raw materials were 108 ppm in soy bean, 133ppm in defatted soy bean, 79 ppm in wheat, 5 ppm in sodium chloride, 58 ppm in seed koji, 300-2000 ppm in spore of Aspergillus oryzae, 240 ppm in wheat gluten, 20 ppm in sodium carbonate (above figures were of dry weight basis), 6 ppm in hydrochloric acid, 18 ppm in caramel and 0.3ppm in brewing water respectively. 2, Iron contents in koji were 200-240 ppm (as dry weight basis) and increased, more or less, in progress of koji-making period. 3. Iron contents in the mashes during fermentation were 40 rpm after 1 month, 43-47 ppm after 3 months and 49-62ppm after 6 months. 4. In chemical soy sauce, the iron content was 159 ppm after hydrolysis of wheat gluten with hydrochloric acid, and 184 ppm after neutralization. 5. Higher iron contents were detected both in fermented and chemical soy sauce when the concentration of total nitrogen increased, but the levels were higher in chemical soy sauce than in fermented one at the same concentration of total nitrogen. 6. In the case of fermented soy sauce, the iron content in the filtrate was decreased by press-filtration, but no significant change was found between before and after heat-sterilization. 7. Iron contents in commercial soy sauce were varied with the producers, however, the average value was 62.7 ppm as calculated as 1.0 percent of total nitrogen. And the average level of iron in home-made soy sauce produced by conventional method was 37.68 ppm.

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A Study on the Impact Factors of Contents Diffusion in Youtube using Integrated Content Network Analysis (일반영향요인과 댓글기반 콘텐츠 네트워크 분석을 통합한 유튜브(Youtube)상의 콘텐츠 확산 영향요인 연구)

  • Park, Byung Eun;Lim, Gyoo Gun
    • Journal of Intelligence and Information Systems
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    • v.21 no.3
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    • pp.19-36
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    • 2015
  • Social media is an emerging issue in content services and in current business environment. YouTube is the most representative social media service in the world. YouTube is different from other conventional content services in its open user participation and contents creation methods. To promote a content in YouTube, it is important to understand the diffusion phenomena of contents and the network structural characteristics. Most previous studies analyzed impact factors of contents diffusion from the view point of general behavioral factors. Currently some researchers use network structure factors. However, these two approaches have been used separately. However this study tries to analyze the general impact factors on the view count and content based network structures all together. In addition, when building a content based network, this study forms the network structure by analyzing user comments on 22,370 contents of YouTube not based on the individual user based network. From this study, we re-proved statistically the causal relations between view count and not only general factors but also network factors. Moreover by analyzing this integrated research model, we found that these factors affect the view count of YouTube according to the following order; Uploader Followers, Video Age, Betweenness Centrality, Comments, Closeness Centrality, Clustering Coefficient and Rating. However Degree Centrality and Eigenvector Centrality affect the view count negatively. From this research some strategic points for the utilizing of contents diffusion are as followings. First, it is needed to manage general factors such as the number of uploader followers or subscribers, the video age, the number of comments, average rating points, and etc. The impact of average rating points is not so much important as we thought before. However, it is needed to increase the number of uploader followers strategically and sustain the contents in the service as long as possible. Second, we need to pay attention to the impacts of betweenness centrality and closeness centrality among other network factors. Users seems to search the related subject or similar contents after watching a content. It is needed to shorten the distance between other popular contents in the service. Namely, this study showed that it is beneficial for increasing view counts by decreasing the number of search attempts and increasing similarity with many other contents. This is consistent with the result of the clustering coefficient impact analysis. Third, it is important to notice the negative impact of degree centrality and eigenvector centrality on the view count. If the number of connections with other contents is too much increased it means there are many similar contents and eventually it might distribute the view counts. Moreover, too high eigenvector centrality means that there are connections with popular contents around the content, and it might lose the view count because of the impact of the popular contents. It would be better to avoid connections with too powerful popular contents. From this study we analyzed the phenomenon and verified diffusion factors of Youtube contents by using an integrated model consisting of general factors and network structure factors. From the viewpoints of social contribution, this study might provide useful information to music or movie industry or other contents vendors for their effective contents services. This research provides basic schemes that can be applied strategically in online contents marketing. One of the limitations of this study is that this study formed a contents based network for the network structure analysis. It might be an indirect method to see the content network structure. We can use more various methods to establish direct content network. Further researches include more detailed researches like an analysis according to the types of contents or domains or characteristics of the contents or users, and etc.

A Study on the Performance Evaluation of G2B Procurement Process Innovation by Using MAS: Korea G2B KONEPS Case (멀티에이전트시스템(MAS)을 이용한 G2B 조달 프로세스 혁신의 효과평가에 관한 연구 : 나라장터 G2B사례)

  • Seo, Won-Jun;Lee, Dae-Cheor;Lim, Gyoo-Gun
    • Journal of Intelligence and Information Systems
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    • v.18 no.2
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    • pp.157-175
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    • 2012
  • It is difficult to evaluate the performance of process innovation of e-procurement which has large scale and complex processes. The existing evaluation methods for measuring the effects of process innovation have been mainly done with statistically quantitative methods by analyzing operational data or with qualitative methods by conducting surveys and interviews. However, these methods have some limitations to evaluate the effects because the performance evaluation of e-procurement process innovation should consider the interactions among participants who are active either directly or indirectly through the processes. This study considers the e-procurement process as a complex system and develops a simulation model based on MAS(Multi-Agent System) to evaluate the effects of e-procurement process innovation. Multi-agent based simulation allows observing interaction patterns of objects in virtual world through relationship among objects and their behavioral mechanism. Agent-based simulation is suitable especially for complex business problems. In this study, we used Netlogo Version 4.1.3 as a MAS simulation tool which was developed in Northwestern University. To do this, we developed a interaction model of agents in MAS environment. We defined process agents and task agents, and assigned their behavioral characteristics. The developed simulation model was applied to G2B system (KONEPS: Korea ON-line E-Procurement System) of Public Procurement Service (PPS) in Korea and used to evaluate the innovation effects of the G2B system. KONEPS is a successfully established e-procurement system started in the year 2002. KONEPS is a representative e-Procurement system which integrates characteristics of e-commerce into government for business procurement activities. KONEPS deserves the international recognition considering the annual transaction volume of 56 billion dollars, daily exchanges of electronic documents, users consisted of 121,000 suppliers and 37,000 public organizations, and the 4.5 billion dollars of cost saving. For the simulation, we analyzed the e-procurement of process of KONEPS into eight sub processes such as 'process 1: search products and acquisition of proposal', 'process 2 : review the methods of contracts and item features', 'process 3 : a notice of bid', 'process 4 : registration and confirmation of qualification', 'process 5 : bidding', 'process 6 : a screening test', 'process 7 : contracts', and 'process 8 : invoice and payment'. For the parameter settings of the agents behavior, we collected some data from the transactional database of PPS and some information by conducting a survey. The used data for the simulation are 'participants (government organizations, local government organizations and public institutions)', 'the number of bidding per year', 'the number of total contracts', 'the number of shopping mall transactions', 'the rate of contracts between bidding and shopping mall', 'the successful bidding ratio', and the estimated time for each process. The comparison was done for the difference of time consumption between 'before the innovation (As-was)' and 'after the innovation (As-is).' The results showed that there were productivity improvements in every eight sub processes. The decrease ratio of 'average number of task processing' was 92.7% and the decrease ratio of 'average time of task processing' was 95.4% in entire processes when we use G2B system comparing to the conventional method. Also, this study found that the process innovation effect will be enhanced if the task process related to the 'contract' can be improved. This study shows the usability and possibility of using MAS in process innovation evaluation and its modeling.

An Integrated Model based on Genetic Algorithms for Implementing Cost-Effective Intelligent Intrusion Detection Systems (비용효율적 지능형 침입탐지시스템 구현을 위한 유전자 알고리즘 기반 통합 모형)

  • Lee, Hyeon-Uk;Kim, Ji-Hun;Ahn, Hyun-Chul
    • Journal of Intelligence and Information Systems
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    • v.18 no.1
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    • pp.125-141
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    • 2012
  • These days, the malicious attacks and hacks on the networked systems are dramatically increasing, and the patterns of them are changing rapidly. Consequently, it becomes more important to appropriately handle these malicious attacks and hacks, and there exist sufficient interests and demand in effective network security systems just like intrusion detection systems. Intrusion detection systems are the network security systems for detecting, identifying and responding to unauthorized or abnormal activities appropriately. Conventional intrusion detection systems have generally been designed using the experts' implicit knowledge on the network intrusions or the hackers' abnormal behaviors. However, they cannot handle new or unknown patterns of the network attacks, although they perform very well under the normal situation. As a result, recent studies on intrusion detection systems use artificial intelligence techniques, which can proactively respond to the unknown threats. For a long time, researchers have adopted and tested various kinds of artificial intelligence techniques such as artificial neural networks, decision trees, and support vector machines to detect intrusions on the network. However, most of them have just applied these techniques singularly, even though combining the techniques may lead to better detection. With this reason, we propose a new integrated model for intrusion detection. Our model is designed to combine prediction results of four different binary classification models-logistic regression (LOGIT), decision trees (DT), artificial neural networks (ANN), and support vector machines (SVM), which may be complementary to each other. As a tool for finding optimal combining weights, genetic algorithms (GA) are used. Our proposed model is designed to be built in two steps. At the first step, the optimal integration model whose prediction error (i.e. erroneous classification rate) is the least is generated. After that, in the second step, it explores the optimal classification threshold for determining intrusions, which minimizes the total misclassification cost. To calculate the total misclassification cost of intrusion detection system, we need to understand its asymmetric error cost scheme. Generally, there are two common forms of errors in intrusion detection. The first error type is the False-Positive Error (FPE). In the case of FPE, the wrong judgment on it may result in the unnecessary fixation. The second error type is the False-Negative Error (FNE) that mainly misjudges the malware of the program as normal. Compared to FPE, FNE is more fatal. Thus, total misclassification cost is more affected by FNE rather than FPE. To validate the practical applicability of our model, we applied it to the real-world dataset for network intrusion detection. The experimental dataset was collected from the IDS sensor of an official institution in Korea from January to June 2010. We collected 15,000 log data in total, and selected 10,000 samples from them by using random sampling method. Also, we compared the results from our model with the results from single techniques to confirm the superiority of the proposed model. LOGIT and DT was experimented using PASW Statistics v18.0, and ANN was experimented using Neuroshell R4.0. For SVM, LIBSVM v2.90-a freeware for training SVM classifier-was used. Empirical results showed that our proposed model based on GA outperformed all the other comparative models in detecting network intrusions from the accuracy perspective. They also showed that the proposed model outperformed all the other comparative models in the total misclassification cost perspective. Consequently, it is expected that our study may contribute to build cost-effective intelligent intrusion detection systems.

Electro chemical characteristics of $(MnX)O_2$ electrode prepared by thermal decomposition method (열분해법으로 제조된 $(MnX)O_2$ 전극의 전기화학적 특성)

  • Kim, Hyun-Sik;Lee, Hae-Yon;Huh, Jeoung-Sub;Kim, Jong-Ryung;Lee, Dong-Yoon
    • Proceedings of the Korean Institute of Electrical and Electronic Material Engineers Conference
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    • 2003.11a
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    • pp.348-351
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    • 2003
  • 산소 과전압이 낮은 $MnO_2$를 촉매로 사용하여 반도체 산화물계의 산소선택성 전극을 제조하고 산화물 coating층의 미세구조와 전기화학적 특성을 분석하였다. Ti 기판에 열분해 법을 이용하여 $MnO_2$ 피막을 형성하였고, 또한 PVDF : $MnO_2$의 함량비를 1 : 1에서 1 : 40까지 정량적으로 변화시키고 DMF의 함량을 각각의 고정된 PVDF : $MnO_2$의 함량비에서 변화시켜 Pb전극에 1.5 mm/sec의 속도로 5회 dipping하여 $MnO_2$ 피막층을 형성 하였다. $450^{\circ}C$에서 1시간 열분해하여 약 $1\;{\mu}m$$MnO_2$ 피막층이 형성되었으나 Ti 기판과의 접착력이 약하여 피막자체에 대한 전기화학적 특성을 관찰할 수 없었다. PVDF : DMF = 4 : 96인 경우 pb 전극의 피막층이 얇기 때문에 박리현상이 일어났으며 이는 산화물 용제의 낮은 점도 때문인 것으로 판단된다. 또한 PVDF : DMF = 10 : 90의 경우는 5회 dipping 하여 약 $150\;{\mu}m$의 피막층을 형성하였다. PVDF : $MnO_2$의 함량비가 1:1에서 1:6 까지는 DMF의 함량에 무관하게 전극 특성이 나타나지 않았지만 $MnO_2$의 양이 상대적으로 증가하면 cycle이 증가하더라도 거의 일정한 전류 값을 갖고 $MnO_2$와 PVDF의 비가 20:1 이상의 조성에서는 균일한 CV 특성을 나타냈다. 이는 $MnO_2$가 효과적으로 촉매 작용을 한 것으로 판단되며 anodic polarization에 의한 산소 발생 과전압도 약 1.4V 정도로 감소되었다.동등한 MSIL 코드를 생성하도록 시스템을 컴파일러 기법을 이용하여 모듈별로 구성하였다.적용하였다.n rate compared with conventional face recognition algorithms. 아니라 실내에서도 발생하고 있었다. 정량한 8개 화합물 각각과 총 휘발성 유기화합물의 스피어만 상관계수는 벤젠을 제외하고는 모두 유의하였다. 이중 톨루엔과 크실렌은 총 휘발성 유기화합물과 좋은 상관성 (톨루엔 0.76, 크실렌, 0.87)을 나타내었다. 이 연구는 톨루엔과 크실렌이 총 휘발성 유기화합물의 좋은 지표를 사용될 있고, 톨루엔, 에틸벤젠, 크실렌 등 많은 휘발성 유기화합물의 발생원은 실외뿐 아니라 실내에도 있음을 나타내고 있다.>10)의 $[^{18}F]F_2$를 얻었다. 결론: $^{18}O(p,n)^{18}F$ 핵반응을 이용하여 친전자성 방사성동위원소 $[^{18}F]F_2$를 생산하였다. 표적 챔버는 알루미늄으로 제작하였으며 본 연구에서 연구된 $[^{18}F]F_2$가스는 친핵성 치환반응으로 방사성동위원소를 도입하기 어려운 다양한 방사성의 약품개발에 유용하게 이용될 수 있을 것이다.었으나 움직임 보정 후 영상을 이용하여 비교한 경우, 결합능 변화가 선조체 영역에서 국한되어 나타나며 그 유의성이 움직임 보정 전에 비하여 낮음을 알 수 있었다. 결론: 뇌활성화 과제 수행시에 동반되는 피험자의 머리 움직임에 의하여 도파민 유리가 과대평가되었으며 이는 이 연구에서 제안한 영상정합을 이용한 움직임 보정기법에 의해서 개선되었다. 답이 없는 문제, 문제 만들기, 일반화가 가능한 문제 등으로 보고, 수학적 창의성 중 특히 확산적 사고에 초점을 맞추어 개방형 문제가 확산적 사고의 요소인 유창성, 독창성, 유연성 등에 각각 어떤 영향을 미치는지 20주의 프로그램을 개발, 진행하여 그 효과를 검증하고자

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Minimally invasive cardiac surgery with the partial mini-sternotomy in children (소아연령군에서의 부분흉골소절개를 통한 최소침투적심장수술)

  • 이정렬;임홍국;성숙환;김용진;노준량;서경필
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.466-471
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    • 1998
  • Purpose: The safety and efficacy of minimally invasive techniques in congenital heart surgery were tested in this study. Materal and method: Between July 1997 and November 1997, a total of 46 children were underwent minimally invasive cardiac operations at Seoul National University Children's Hospital. Age and body weight of the patients averaged 34.6${\pm}$41.8 (Range: 1∼148) months and 14.5${\pm}$9.9(Range: 3.0∼40.0) kg, respectively. Twenty eight patients were male. Preoperative surgical indications included 15 atrial septal defects, 25 ventricular septal defects, 1 foreign body in aorta, 3 partial atrioventricular septal defects, 1 total anomalous pulmonary venous connection(cardiac type), and 1 tetralogy of Fallot. After creating a small lower midline skin incision starting as down as possible from the sternal notch, a vertical midline sternotomy extended from xyphoid process to the level of the second intercostal space, where one of the T-, J-, I- or inverted C-shaped lower lying mini-sternotomy was completed with a creation of unilateral right or bilateral trap door sternal opening. A conventional direct aortic and bicaval cannulation was routine. Result: A mean length of skin incision was 6.1${\pm}$1.0(range: 4.0∼9.0) cm. A mean distance between the suprasternal notch and the upper most point of the skin incision was 4.0${\pm}$1.1 (range: 2.0∼7.0) cm. Mean cardiopulmonary bypass time, aortic cross-clamp time, and the operation time were 62.9${\pm}$20.0(range: 28∼147), 29.8${\pm}$12.8(range: 11∼79), and 161.1${\pm}$34.5 (range: 100-250) minutes. A mean total amount of postoperative blood transfusion was 71.0${\pm}$68.1 (range: 0∼267) cc. All patients were extubated mean 11.3${\pm}$13.8(range: 1∼73) hours after operation. A mean total amount of analgesics used was 0.8${\pm}$1.8(range: 0∼9) mg of morphine. The mean duration of stay in intensive care unit and hospital stay were 35.0${\pm}$32.2 (range: 10∼194) hours and 6.2${\pm}$2.0(range: 3∼11) days. There were no wound complications and hospital deaths. Conclusion: This short-term experience disclosed that the minimally invasive technique can be feasibly applied in a selected group of congenital heart disease as well as is cosmetically more attractive approach.

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Survival and Problems after Repair of Tetralogy of Fallot (Fallot 4징 교정수술후의 생존 및 문제점)

  • 손세정;한재진;이영탁;김성호
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.237-248
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    • 1999
  • Background: The late results of repair of tetralogy of Fallot(TOF) are favorable in most patients. Some portion of the patients with tetralogy, however, require reoperation for residual lesions or result in late death. The outcome of patients after tetralogy repair performed during the past 13 years was studied, with an emphasis on postrepair survival and problems including reoperations. Material and Method: A retrospective review of clinical, echocardiographic and catheterization data was performed in 569 of 775 patients with TOF who underwent corrective repair between 1983 and 1995 at Sejong General Hospital, Buchon, Korea. Result: Of 28(4.9%) early deaths(defined as 30 days postrepair), 12 deaths(42.9%) were <1 year of age, with an operative mortality of 15.4%. The surviving 541 patients(age 2.8 months to 43.4 years, median 23 months) have been followed up from 1 month to 12.6 years(median 35 months) postoperatively. Most patients were in good functional class and had normal right ventricular(RV) function. Postrepair results were compared between the transatrial-transpulmonary approach and the conventional right ventriculotomy. The former technique provided a lesser incidence of significant pulmonary regurgitation(P<0.001) and alesser degree of RV dysfunction(P<0.05) compared with those in the latter. There were 10(1.8%) late deaths during the follow-up period and 6 of the deaths were directly related to reoperation or ventricular dysfunction. The 10-year actuarial survival rate was 96.7%. There were 44 reoperations(8.1%) in 39 patients(7.2%), with an operative mortality of 10.3%. The main indications or reoperation included residual ventricular septal defect(VSD) (n=6), pulmonary stenosis(PS) (n=11), VSD with PS(n=17), pulmonary regurgitation(n=7), and tricuspid regurgitation(n=2). The 5- and 10-year freedom from reoperation were 89.4% and 76.1%, respectively. Conclusion: Although the majority of patients with repaired TOF are clinically well, with a high rate of survival, approximately 7% of patients have residual lesions that require surgical therapy. Therefore, the timely and meticulous corrective repair is mandatory to avoid reoperation, and continued close surveillance is also needed for the early detection of residual problems.

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Efficacy of 2 mm Videothoracoscopic Examination and Application of Fibrin Glue in Bullectomy of Primary Spontaneous Pneumothorax (원발성 자연기흉 환자에서 2mm 흉강경 검사와 기포절제술 후 Fibrin Glue 도포의 효용성)

  • 이덕헌;금동윤;박창권
    • Journal of Chest Surgery
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    • v.37 no.5
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    • pp.438-443
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    • 2004
  • Background : The treatment strategy for urinary spontaneous pneumothorax has progressively changed with the introduction of video-assisted thoracic surgery (VATS). Recently, we modified the strategy of primary spontaneous pneumothorax. If the patient had mild dyspnea and the lung was minimally collapsed, 2 mm thoracoscopic examination was performed. If no blob or bullae was inspected, the intrathoracic air was evacuated through the 2 mm thoracoscopic troca without closed thoracostomy, and if the blob and bullae was noted, the 10 mm thoracoscopic bullecotomy was carried out immediately and also application of fibrin glue was substituted for pleural abrasion. We compared the clinical outcomes of modified treatment strategy with conventional strategy in primary spontaneous pneumothorax. Material and Method: Patients were divided into four groups. Group I (n=21) underwent 2 mm thoracoscopic examination. Group II (n=68) underwent closed thoracostomy. Group III (n=56) underwent VATS and application of fibrin glue. Group IV (n=87) underwent VATS and pleural abrasion. The duration of chest tube drainage, the duration of hospitalization and the recurrence rate were compared between group I and group II and between group III and group IV. Result: Mean age, sex, location of pneumothorax were not different in all groups. In group I, the blob or bullae were existed in 12 patients, In remaining 9 patients, the bleb or bullae was not inspected. The mean duration of hospitalization in 9 patients were 2.4 $\pm$1.0 day and in group II were 3.9$\pm$2.1 day (p=0.014). There was 1 case of recurrence among the 9 patients in group I and 26 recurrences in group II (p=0.149). The mean duration of chest tube drainage were not difference in group III and IV (group III: 2.8$\pm$1.8 day, group IV: 3.0$\pm$2.5 day). The mean duration of hospitalization was shorter in group III than group IV (group III: 5,6$\pm$2.7 day, group IV: 1.3$\pm$3.3 day)(p=0.002). There was no recurrence in group III and 7 recurrences in group IV (p=0.043). Conclusion: Our modified treatment strategy of primary spontaneous peumothorax was effective in short hospital course and low recurrence rate.