• Journal of Chest Surgery
• /
• 제17권4호
• /
• pp.632-635
• /
• 1984

Hypoplastic RV was rarely combined with various other intracardiac anomalies. We experienced the excellent result after surgical correction in these 2 patients. 1. F/7: Combined anomalies were, [1] Hypoplastic Rt. Coronary art.[2] Hypoplastic RV [3] ASD [secundum] & [4] PS [infundibular & valvular] After CP Bypass, [1] Direct suture of ASD [2] Infundibulectomy [3] Pul valvulotomy & [4] Patch enlargement of RVOT with Pericardial monocusp were done 2. F/14: Combined anomalies were, [1] Hypoplastic RV [2] P5 [infundibular] [3] T5 [4] VSD [Type II] [5] ASD [secundum] & [6] 2\ulcornerA-V Block fter CP Bypass, [1] Infundibulectomy [2] Tricuspid valvulotomy [3] Patch repair of VSD & ASD & [4] Implantation of permanent pacemaker were done. Above operations resulted in marked improvement with disappearance of cyanosis & dyspnea.

• Journal of Chest Surgery
• /
• 제36권2호
• /
• pp.98-100
• /
• 2003

최근 심폐기를 가동하지 않는 최소 절개를 이용한 최소침습적 관상동맥우회술(MIDCAB)이 급속도로 발전하고 있다. 저자들은 좌전소절개술을 통해 최소침습적 관상동맥우회술을 시도하려 하였으나, 심한 늑막유착으로 인해 상부 부분흉골절개술로 연장하여 심폐기를 가동하지 않는 관상동맥우회술을 시행하여 만족스러운 결과를 얻었기에 문헌고찰과 더불어 보고하는 바이다.

• KSII Transactions on Internet and Information Systems (TIIS)
• /
• 제13권8호
• /
• pp.4212-4226
• /
• 2019

In this paper, a design and implementation for direct deal distribution platform is proposed to bypass the complex traditional distribution structure of agricultural market, as one of the fields where distribution patterns have changed. In the case of domestic agricultural distribution, demand and supply are unstable since the sales market is excessively concentrated in the designated wholesale market. Besides sales must go through multiple stages of distribution leading to problems in freshness and stability of agricultural products and downward pressure on profit margins for producers. To solve the above mentioned issues, we propose a cloud service convergence direct deal distribution platform based on asynchronous-driven Node.js. The proposed platform can facilitate a variety of direct trading functions and also access to visualization information related to agricultural products, which may increase user confidence at an intermediary-free direct transactions platform. First, we describe the requirements of intermediary-free direct transactions of agricultural products and transaction entities. Next the database structure and transaction functions are designed and then implemented according to those requirements. Finally, an API based cloud convergence service structure is designed to provide the analyzed information to ensure a trustworthy system.

• Journal of Korean Neurosurgical Society
• /
• 제54권6호
• /
• pp.477-483
• /
• 2013

Objective : Although surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications. Methods : Between September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography. Results : Of the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely. Conclusion : The key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.

• Journal of Chest Surgery
• /
• 제26권3호
• /
• pp.228-233
• /
• 1993

Patients with anomalous connection of the left coronary artery to the pulmonary artery are at risk for myocardial infarction, and early or sudden death. Between 1986 to 1992, a total of 4 of these patients underwent surgical intervention with various operative techniques at our institution. Age at operation ranged from 2 months to 43 years. Three infant patients had congestive heart failure, 2 of them had mitral regurgitaion, and 1 had ST-T change on elctrocardiogram. Operative techniques included direct coronary artery transfer to the aorta[n=2], intrapulmonary tunnel from the aortopulmonary window[n=1], coronary artery bypass using saphenous vein[n=1]. One deaths occured at 2 weeks after direct coronary arterial transfer due to respiratory failure caused by Respiratory Syncitial virus pneumonia. Supravalvar pulmoanry stenosis occured after intrapulmoanry tunnel. We recommend direct aortic implatation of the anomalous coronary artery at the time of diagnosis. Intrapulmonary tunnel from aortopulmonary window or subclavian-coronary anastomosis could be alternatives in whom aortic implantation is not feasible anatomically.

• Journal of Chest Surgery
• /
• 제47권2호
• /
• pp.106-110
• /
• 2014

Background: There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. Methods: The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, $18.3{\pm}10.3$ months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. Results: There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. Conclusion: HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.

• Journal of Chest Surgery
• /
• 제32권11호
• /
• pp.1009-1016
• /
• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Archives of Plastic Surgery
• /
• 제36권1호
• /
• pp.89-92
• /
• 2009

Purpose: The clinical syndrome of unilateral finger ischemia, caused by digital artery occlusions from embolization from the palmar ulnar artery associated with repetitive striking of the palm, has been called the hypothenar hammer syndrome (HHS). We report the case of a man with this unique disease probably caused by manual work. Methods: A 52 - year - old male left - hand dominant manual worker complained of pain and coldness in the left 4,5th finger. On physical examination, there was a tip necrosis and the result of Allen's test was mildly positive(sluggish filling of hand from the ulnar artery). Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch and distal digital artery. Surgical bypass with reverse autologous vein grafting was performed between ulnar artery and superficial palmar arch, common digital artery. Results: He had an uneventful postoperative course and has remained asymptomatic for 18 months since discharge. Patency has been confirmed by color doppler with resolution of cold intolerance and successful digital preservation. Conclusion: We introduce very unique pattern of vascular ischemic disease and recommend the arterial bypass with vein interpositional grafting.

• 한국자동차공학회논문집
• /
• 제12권6호
• /
• pp.38-45
• /
• 2004

This paper studies the effects of intake port configuration on the swirl that is key parameter in the flow field of direct injection diesel engines. In-cylinder flow characteristics is known to have significant effects on fuel air mixing, combustion and emissions. To investigate the swirl flow generated by various intake ports, steady state flow tests were conducted to evaluate the swirl. Helical port geometry, SCV shape and bypass were selected as the design parameters to increase the swirl flow and parametric study was performed to choose the optimal port shape that would generate a high swirl ratio efficiently. The results revealed that a key factor in generating a high swirl ratio was to suitably control the direction of the intake air flow passing through the valve seat. For these purposes, we changed the distance of helical and tangential port as well as installed bypass near the valve seat and the effects of intake port geometry on in-cylinder flow field were visualized by a laser sheet visualization method. From the experimental results, we found that the swirl ratio and mass flow rate had a trade off relation. In addition, the result indicates that the bypass is a effective method to increase the swirl ratio without sacrificing mass flow rate.

• Journal of Chest Surgery
• /
• 제28권6호
• /
• pp.610-618
• /
• 1995

Three neonates with interrupted aortic arch with VSD underwent one stage repair using revised technique of cardiopulmonary bypass with short period of circulatory arrest. A left posterolateral thoracotomy was made to permit mobilization of the descending aorta and placement of polytetrafluoroethylene[PTFE graft for distal aortic perfusion. Then the patient was placed in the supine position and a median sternotomy was performed to permit the proximal dissection, VSD repair, and direct anastomosis between the ascending aorta and descending aorta. This technique has advantages to facilitate direct anastomosis between the ascending aorta and the descending aorta, to lessen circulatory arrest time, and to prevent dangerous laceration and post-operative narrowing of the thin small ascending aorta at cannulation site. There was no operative mortality but postoperative stenosis developed in one case which was relieved with balloon aortoplasty.