• Journal of Chest Surgery
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• 제49권4호
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• pp.264-272
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• 2016

Background: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. Methods: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996-2015). Seventy percent of the cases were ascending aortic replacements, and 3 0% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of $6.6{\pm}4.6years$. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of $4.9{\pm}2.9years$. Results: There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in the ascending aortic replacement group, and 1 patient died of distal aortic rupture in the total arch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). Conclusion: The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections.

• Journal of Chest Surgery
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• 제23권3호
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• pp.488-500
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• 1990

Author compared the effect of surgical methods between 40 patients who received mitral valve replacement with complete excision of the mitral valve[resected group] and 41 patients who received mitral valve replacement with preservation of posterior chorda tendineae and posterior mitral leaflet[preserved group] from 1985. 2. to 1989. 4. at cardiothoracic department of Pusan National University Hospital.v 1. There was no significant difference between the preserved group and resected group in cardiopulmonary bypass time and aortic cross clamping time and NYHA classification. 2. In preserved group of Mitral stenosis and Mitral regurgitation, the left ventricular functions were much improved after mitral valve replacement than resected group, but there was not so difference between the preserved group and reserved group in Mitral steno-regurgitation. 3. There were remarkable decrease in complication rate in preserved group compared to resected group. And also the death rates were remarkably decreased in preserved group which was 4.9% compared to resected group which was 17.5%. As the preservation of the posterior mitral leaflet and chorda tendineae during mitral valve replacement in mitral valve disease showed significantly improved effects in the maintaining of left ventricular function and reducing the postoperative complication, I assume the preservation of posterior mitral leaflet and chordae during mitral valve replacement will bring better result.

• Journal of Chest Surgery
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• 제26권6호
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• pp.457-462
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• 1993

We retrospectively studied 34 patients who underwent operations of ascending aortic aneurysm and aortic valve replacement from August 1979 to July 1992 at the Yonsei Cardiovascular Center. Eight patients underwent supracoroanry non-composite graft replacement and separate aortic valve replacement[group I]. Twenty six patients underwent valved composite graft replacement with reimplantation of coronary arteries[group II]. Two cases in group II died within 1 month after the operation. Among the 32 survivors 28 patients have been followed up for an average of 59 months ranging from 1 months to 159 months. During the follow up periods, a pseudoaneurysm around the ascending aorta and a newly developed dissecting aneurysm in remaining aorta were noted in group II. There were 6 late deaths: 2 cases in group I and 4 cases in group II. Three cases among the 6 late deaths have stigmata of Marfan`s syndrome[1 cases in group I and 2 case in group II]. There was no statistically significant difference in actuarial survival rates between group I and group II[p > 0.05]. This study suggests that non-composite supracoronary graft interposition with separate aortic valve replacement is a safe surgical technique in patients who have normal aortic annulus and normal position of coronary ostia. However in degenerative disease such as cystic medial necrosis, composite graft replacement is recommended because this procedure eliminates entire abnormal tissue.But it seems to be important that the suture technique and strict follow-up in patients with diseased aortic wall.

• 벤처창업연구
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• 제9권2호
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• pp.81-86
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• 2014

본 논문에서는 그룹교체 정책과 예비품 재고정책을 동시에 고려하여 최적화하는 방안을 제시한다. 일반적으로 보전정책들은 예비품의 재고가 늘 가용하다고 가정하고 있으나 예비품의 재고 확보 여부에 의해 보전활동은 영향을 받을 수밖에 없다. 동일한 여러 유닛들이 동시에 운용될 때 이용되는 그룹교체정책을 바탕으로 이를 지원하기 위한 최적 재고수준을 결정한다. 일정한 개수의 유닛이 고장 나는 시점에서 그룹교체를 수행한다. 예비품의 재고는 일정 횟수의 그룹교체를 할 만큼 주문하여 유지한다. 보전비용과 재고비용 등 운용비용을 최소화할 수 있는 최적의 그룹교체 주기와 재고수준을 구한다.

• 성인간호학회지
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• 제18권2호
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• pp.183-193
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• 2006

Purpose: The purpose of the study was to test the effects of music therapy on postoperative pain in patients with total hip replacement. Method: The research design was a nonequivalent control group pretest-posttest design. The subjects were composed of thirty patients with total hip replacement. Fifteen of them were assigned to the experimental group and fifteen to the control group. Fifteen minutes tailored music therapy was given to the experimental group during five consecutive days. The instruments used for this study were pain NRS(numerical rating scale). The data were analyzed using percent, mean, standard deviation, ${\chi}^2-test$ and repeated measure ANOVA using SPSS WIN 11.0. Results: Hypothesis 1 "The score of pain NRS of experimental group will be lower than those of control group" was accepted(F=15.945, p<.001). Hypothesis 2 "The frequency of PCA analgesics of experimental group will be fewer than those of control group" was accepted (t=-2.312, p=.028). Hypothesis 3 "The vital signs(pulse, systolic BP and diastolic BP) of experimental group will be different from those of control group" was rejected. Conclusion: This music therapy can be recommended as an efficient nursing intervention to reduce postoperative pain in patients with total hip replacement.

• The Journal of Korean Physical Therapy
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• 제25권6호
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• pp.417-421
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• 2013

Purpose: This study was to identify the effect of cervical stabilization exercise on pain and structure in patients with cervical artificial disc replacement. Methods: Forty-four individuals with cervical artificial disc replacement volunteered to participate from FEB 2012 to MAR 2013 in this study. They were allocated to either Experimental Group (EG) or Control Group (CG), with 22 subjects in each group. Subjects from the EG performed cervical stabilization exercise program and subjects from the CG performed isometric exercise program. Assessment tools were made with the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Cervical Lordosis Angle (CLA). Results: In this study, in within-group and between-group comparison, the EG and CG showed significant differences in all parameters(p<0.05). But EG showed more improvement than CG at all parameters. Conclusion: These findings suggest that cervical stabilization exercise may be favorably used to improve VAS, NDI and CLA in patients with cervical artificial disc replacement. Further studies with larger sample and long-term follow-up period need to generalize the results of this study.

• Journal of Chest Surgery
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• 제18권3호
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• pp.446-455
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• 1985

A total and consecutive 156 patients have undergone cardiac valve surgery including 13 closed mitral commissurotomy, 13 open mitral commissurotomy, one mitral annuloplasty, 75 mitral valve replacement, one aortic annuloplasty, 24 aortic valve replacement, 3 tricuspid valve replacement, 25 double valve replacement and one triple valve replacement. 155 prosthetic valves were replaced in a period between September 1976 and August 1985. There were 68 males and 88 females with age range from 8 to 69 yrs [mean 36.5 yr]. Out of replaced valves, 61 was tissue valve including 54 Carpentier-Edwards, and 4 was mechanical valves including 74 St. Jude Medical, and the position replaced was 101 valves for mitral, 46 for aortic and 8 for tricuspid. Single valve replacement in 102 cases, double valve replacement in 25 cases [17 for AVR+MVR, and 8 for MVR+TVR], and only one case was noted in the triple valve replacement. Early mortality within 30 days after operation was noted in 11 cases [7%]; 7 after MVR, 2 after DVR, and each one after open mitral commissurotomy and mitral annuloplasty. Cause of death was valve thrombus, cerebral air embolism, low output syndrome, uncontrollable arrhythmia, parapneumonic sepsis, acute cardiac tamponade and left atrial rupture. 7 late deaths were noted during the follow-up period from 1 to 104 months [average 48 month]; three due to valve and left atrial thrombus formation, two due to CVA from overdose of warfarin, and each one due to congestive heart failure and chronic constrictive pericarditis, Anticoagulants after prosthetic valve replacement were maintained with warfarin, dipyridamole and aspirin to the level of around 50% of normal prothrombin time in 79 cases, and Ticlopidine with aspirin in 47 cases to compare the result of each group. There were 11 major thromboembolic episodes including 3 deaths in the warfarin group. Two cases of CVA due to overdose of warfarin was noted in the warfarin group. In the ticlopidine group, there was only one left atrial thrombus confirmed at the time of autopsy. Among the survived 138 cases, nearly all cases[136 cases] were included in NYHA functional class I and II during the follow-up period. In conclusion, surgical treatment of the cardiac valve disease in 156 clinical cases revealed excellent result with acceptable operative risk and late mortality. Prevention of thrombus formation with anti-platelet aggregator Ticlopidine has better result than warfarin group presently with no specific side effect such as bleeding or gastrointestinal trouble.

• Journal of Chest Surgery
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• 제40권12호
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• pp.817-824
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• 2007

목적: 심장판막치환술 시에 선택하는 판막에는 크게 기계판막과 조직판막이 있다. 두 가지는 각기 피할 수 없는 단점이 있는데 조직판막의 경우 판막의 퇴행성 변화에 따른 재수술이 가장 문제가 되며 판막재치환술의 위험도가 적다면 조직판막의 사용이 증가되리라 생각된다. 이에 저자들은 심장판막치환술 후 재치환술의 위험도 및 사망률을 심장판막 일차치환술과 비교 평가하였다. 대상 및 방법: 1995년 1월부터 2004년 12월까지 최근 10년간 본 병원에서 연속적으로 시행한 심장판막수술 환자 239명 중 심장판막치환술 후 재치환술을 받은 25명과 심장판막일차치환술을 받은 158명의 한자를 후향적으로 비교, 분석하였다. 결과: 심장판막 재치환술군과 심장판막 일차치환술군 간의 나이, 성별, 술전심박출률 등은 통계적으로 큰 차이가 없었다. 재치환군에서 첫 수술의 판막은 기계판막 3예, 조직판막 22예로 이중 대동맥판막과 승모판막을 동시에 조직판막으로 치환한 경우가 1명 있었으며, 재수술까지의 기간은 기계판막의 경우 92개월, 조직판막인 경우 평균 160개월이었다. 체외순환 및 대동맥차단의 평균시간은 재치환술의 경우 152분, 108분, 일차치환술의 경우 130분, 89분으로 통계적인 유의함을 보였다. IABP의 사용은 재치환술의 경우 2예(8%), 일차치환술은 6예(3.8%)로 차이를 보였으며, 수술사망은 재치환술의 경우 1예(4%), 일차치환술의 경우 9예(5.1%)였다. 술 후 합병증 중에서 술 후 48시간 이상의 인공호흡이 재수술에서는 13.6%, 1차 수술에서 5.7%로 차이를 보였고 다른 인자에서는 큰 차이를 보이지 않았다. 수술 후 평균 추적기간은 $6.5{\pm}3.2$년이고 재치환술 환자의 5년 생존율은 74%였으며 일차치환술의 경우 5년 생존율은 95%를 보여 유의한 차이를 보였다. 결론: 심장판막재치환술은 일차치환술과 비교하여 볼 때 수술 위험도는 약간 증가되나 사망률에서는 큰 차이를 보이지 않았다. 따라서 재수술 위험을 고려하여 조직판막을 너무 기피하는 것은 재고되어야 하며 다른 장점이 많은 조직판막의 선택적인 사용이 권장된다. 그러나 재치한술의 경우 술전 상태가 나빴던 환자에서 만기사망률이 높으므로 일차치환술 후 적절한 심장기능 및 환자상태의 평가가 필요하며 너무 늦지 않은 적정한 시기에 재치환술을 고려해야 겠다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.13-21
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• 1987

To clarify the difference between the outcome of warfarin anticoagulation and the antiplatelet [Aspirin, Dipyridamole] therapy after bioprosthetic heart valve replacement, we compared the following two groups. Group I [Warfarin group] consisted of 557 patients undergone lonescu - Shiley valve replacement between January, 1979 and December, 1985, and treated with scheduled warfarin therapy at Seoul National University Hospital. Group II [Antiplatelet group] consisted of 128 patients undergone lonescu - Shiley, Carpentier - Edwards or Wessex bioprosthetic valve replacement between March, 1983 and December, 1986, and treated primarily with antiplatelet therapy [Aspirin plus Dipyridamole] at SeJong General Hospital. The two groups were similar with respect to age, number of valves utilized per patient, type of operation and risk factors of thromboembolism. In group I, 522 patients excluding 35 hospital death [hospital mortality 6.3%], and in group II, 119 survivors excluding 9 hospital death [hospital mortality 7.0%] were followed. In group I, there were 13 fatal complications, of which seven were thromboembolic [0.6% / pt-yr] and six hemorrhagic [0.5%/pt-yr] during the period of four years. In group II, there were 3 fatal thromboembolic complications [2.3%/pt-yr] during the period of four years. This showed no statistically significant difference. Apart from fatal complications, there were lots of warfarin related minor complications in group I comparing with those of group II. The actuarial probability of the freedom from thromboembolism and of the freedom from fatal complications were very similar at each corresponding years postoperatively. As a result, warfarin anticoagulation in patients with bioprosthetic valve replacement did not reveal any significant advantages over antiplatelet therapy.

• 대한안전경영과학회지
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• 제6권1호
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• pp.61-70
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• 2004

In this paper, a group replacement policy based on a failure count is analysed. For a group of identical repairable units, a maintenance policy is performed with two phase considerations: a repair interval phase and a waiting interval phase. Each unit undergoes minimal repair at failure during the repair interval. Beyond the interval, no repair is made until a number of failures. The expected cost rate expressions under the policy is derived. A method to obtain the optimal values of decision variables are explored. Numerical examples are given to demonstrate the results.