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Open Heart Surgery after Pulmonary Artery Banding in Children (소아에서 폐동맥밴딩술후의 개심술 치료)

  • 김근직;천종록;이응배;전상훈;장봉현;이종태;김규태
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.781-789
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    • 1999
  • Background: Pulmonary artery banding(PAB) accompanies some risks in the aspect of band complications and mortality in the second-stage operation. To assess these risks of the second-stage operation after PAB, we reviewed the surgical results of the second-stage operation in the pediatric patients who had undergone PAB in infancy. Material and Method: From May 1988 to June 1997, a total of 29 patients with preliminary PAB underwent open heart surgery. Ages ranged from 2 to 45 months(mean 20.6$\pm$9.0 months). Preoperative congestive heart failure conditions were improved after PAB(elective operation group) in 27 patients, but early second-stage procedures were required in the remaining 2 patients due to sustaining congestive heart failure(early operation group). Preoperative surgical indications included 2 double outlet right ventricles(DORV group) and 27 ventricular septal defects as the main cardiac anomaly(VSD group). Result: The mean time interval from PAB to the second-stage operation was 15.5$\pm$8.7 months(range 5 days to 45 months). One patient in the DORV group underwent intraventricular tunnel repair and modified Glenn procedure in the other. In the VSD group, the VSD was closed with a Dacron patch in all patients. Concomitant procedures included a right ventricular infundibulectomy in 4 patients and a valvectomy of the dysplastic pulmonary valve in 1 patient. At the second-stage operations, pulmonary angioplasty was required due to the stenotic banding sites in 18 patients. One patient underwent complete ligation of the main pulmonary artery with the modified Glenn procedure. The mortality at the second-stage operation was 17.2%(5 patients). Causes of death were 4 low cardiac output, and 1 autoimmune hemolytic anemia. Diagnosis with DORV and the early operative group were the risk factors for operative death in this series. There was 1 late death. Conclusion: This study revealed the second-stage operation for pulmonary artery debanding and closure of VSD in children was complicated by the correction of the acquired lesions with a significantly high incidence of morbidity and early postoperative deaths. Primary repair is recommended for isolated VSD, if possible.

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Comparison of the Reconstruction Routes after Esophagectomy for Esophageal Cancer (식도암 절제후 식도 재건경로의 비교)

  • Lee, Seung-Yeoll;Kim, Kwang-Taik;Choi, Young-Ho;Kim, Il-Hyun;Baik, Man-Jong;Sun, Kyung;Lee, In-Sung;Kim, Hyoung-Mook
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.806-812
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    • 1999
  • Background: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. Material and Method: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. Result: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). Conclusion: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

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Postcardiotomy Ventricular Support with Biomedicus Pump (Biomedicus pump를 이용한 개심술후 심실보조)

  • Kim, Won-Gon;Lee, Chang-Ha;Kim, Ki-Bong;Ahn, Hyuk;Rho, Ryang-Joon
    • Journal of Chest Surgery
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    • v.29 no.11
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    • pp.1218-1222
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    • 1996
  • The reported incidence of postcardiotomy cardiogenic shock not responding to conventional therapy is still 0.1 to 0.8%. For this group of patients, more aggressive form of circulatory support must be employed. Centrifugal pumps are a ventricular assist device most commonly used on this purpose, due to low cost and easy availability. Currently, however, clinical experience of centrifugal pumps as a ventricular assist device is rarely reported in Korea. From January 1992 to January 1996, 2986 patients underwent cardiac operations on cardiopulmonary bypass at Seoul National University Hospital. Refractory postcardiotomy cardiac failure requring ventricular support with a Biomedicus centrifugal pump developed in ten of these patients. There were eight men and two women, ranged in age from nine years to 77 years with a mean of 50$\pm$20 years. The primary surgical procedures consisted of isolated coronary revascularization in four patients, combined coronary revascularization and aortic valve replacement in two, aortic dissection repair in two, pulmonary embolectomy in one, and heart transplantation in one. Of the ten patients, five had left ventricular assistance, one had right ventricular assistance, and four had biventricular assistance. Duration of ventricular assistance ranged from 24 to 175 hours, with a mean of 76$\pm$51 hours. Seven patients were weaned from ventricular assistance, and four of them discharged. The causes of death for nonsurvivors were progressive cardiac failure in two patients and multiorgan failure, intractable ventricular fibrillation, irreversible brain injury, and mechanical problem, respectively, in the other four. Survival was not predicted by time on cardiopulmonary bypass, aortic cross-clamp time, or duration of ventricular support. Major complications included bleeding(7), renal failure(6), infection(3) and neurologic complication(2). These results indicate that a centrifugal pump can provide reasonably satisfactory short-term circulatory support.

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Comparison of VATS with Thoracotomy for the Treatment of Spontaneous Pneumothorax (자발성 기흉의 치료에서의 비디오 흉강경 수술과 개흉술의 비교)

  • 김문수;김영태;김기봉;김원곤;성숙환;김주현
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.294-298
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    • 1999
  • Background: Video-assisted thoracoscopic surgery(VATS) has been established as a new method for treatment of spontaneous pneumothorax. We compared the clinical results of VATS with those of thoracotomy performed during the recent 5 years. Material and Method: We analyzed 126 patients whose medical records were available among the 154 patients who underwent operations for spontaneous pneumothorax from 1992 to 1996. The mean age was 27.1 years(15 to 75 years). 87 patients were operated on by VATS(Group A) and the other 39 by thoracotomy(Group B). The mean follow-up period was 14.7 months. Result: The operation time was shorter in group A than in group B(90.6${\pm}$38.6minutes: 117.2${\pm}$58.9minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than in group B(6.7${\pm}$4.2: 9.4${\pm}$3.3 days, p<0.05). The amount of analgesics(nalbuphin HCl, ketoprofen) used postoperatively were 2.4${\pm}$2.8 ampules in group A, which is less than the 6.5${\pm}$5.6 ampules in group B(p<0.05). The number of staples used in group A was smaller(2.7${\pm}$1.3 in group A, 1.76${\pm}$1.1 in group B, p<0.05). The duration of chest tube indwelling(4.3${\pm}$4.0 days in group A, and 5.6${\pm}$3.0 days in group B, NS), the recurrence rate(13.8% in group A, 2.6% in group B, NS), and the duration of air leakage(1.3${\pm}$3.3 days in group A, and 1.0${\pm}$2.5days in group B, NS) were not statistically different between the two groups. Conclusion: The application of VATS for the treatment of spontaneous pneumothorax has brought in better clinical results(shorter operation time, shorter hospital stay, less pain, and better cosmetic merits) than the thoracotomy without increasing any morbidity. However no advantages in recurrence rates and duration of postoperative air leakages are revealed.

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Effects of Modified Ultrafiltration in Pediatric Open Heart Surgery (소아 개심술에 있어서 변형초여과법의 효과)

  • 전태국;박표원
    • Journal of Chest Surgery
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    • v.30 no.6
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    • pp.591-597
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    • 1997
  • Cardiopulmonary bypass in children is associated with capillary leak which results in an increase in total body water after open heart surgery The purpose of these studies was to assess the cardiopulmonary effects of modified ultrafiltration after pediatric open heart surgery Study h: Twenty-six consecutive children aged 0.1 ~ 10 years(median 7 months) underwent cardiac operation inc rporating modified ultrafiltration. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at the flow rate of 100~ 15011min for 3 ~ 14 min. After modified ultrafiltration, elevation of hematocrit(28.3% $\pm$ 3.6% vs. 33.8olo $\pm$ 4.Ooloi p < 0.001), increased systolic 1)loots Pressure(66.7 $\pm$ 11.2mmHg vs. 76.2$\pm$ 11.BmmHg, p < 0.02), and decreased central venous pressure(7.8 $\pm$ 3.7mmHg vs. 6.9$\pm$ 2.gmmHg, p<0.001) were observed. Study B: Twenty-six children who underwent cardiac operation with the diagnosis of VSD under 2 years were assigned to control(n= 14) or modified ultrafiltration(n= 12). Peak inspiratory pressure checked immediately after operation was significantly lower in modified ultrafiltration group than in control group(20.0$\pm$ 2.4 cmH20 vs.22.4$\pm$ 2.3cmH20, p < 0.03). Modified ultrafiltration after cardiopillmonary bypass in children improves early homodynamics and pulmonary mechanics, and represents an excellent option for perioperative managemen of accumulation of fluid in the tissues. We will continually employ the modified ultrafiltration technique in pediatric cardiac operations.

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A Comparative Study of the Handicaps in and Satisfaction with the Ordinary Life before and after the Plastic Operation for Artificial Joint Replacement-Centering around Those Who suffer from Joint Diseases (인공관절 전치환 성형 수술 전후의 일상활동 장애정도 및 삶의 만족도 비교연구 - 관절 질환 환자를 중심으로 -)

  • Kang, Shin-Hwa
    • Journal of muscle and joint health
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    • v.3 no.1
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    • pp.37-49
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    • 1996
  • The joint diseases threaten modern people's healthy life. They bring about a long pain, an anasarca, loss of joint function or even deformation and rigidity of joint, limiting people's ordinary activities much. The chronic joint patients may be subject to some hypochondria caused by anxiety for their life, social isolation, financial problem and physical disability. Therefore, this population should continue to be duely taken care of by medical personnels. In particular, nurses should adequately help these people to recover and improve their health through suitable adaptations. With such basic conceptions in mind, this study was aimed at reviewing these patients' conditions in their ordinary life before and after a plastic operation for artificial joint replacement as well as their satisfaction with their life. For this purpose, those patients who underwent some plastic operations for artificial joint replacement at university hospitals in Seoul from January 2, 1993 to June 30, 1995 were selected as the population of this study. Among them, 87 people were randomly sampled to answer a questionnaire designed specially. For the surveying tools, Jette's (1980) scale was applied to address the sample people's inconveniences experienced and supports received in their ordinary life, while the scale of Wood, Wylie & Sheafer was used to measure their satisfaction with their life. The collected data were analyzed for percentiles, means, SD, t-test and Pearson's correlations. The results of survey can be summarized as follows ; As a result of t-test the frequencies of other people's support before and after the plastic operation, it was disclosed that those who underwent the operation were supported less frequently. In addition, as a result of t-testing their satisfaction with life before and after the operation, it was found that the operation increased their satisfaction with life significantly. Meanwhile, as a result of t-test inconveniences, frequencies of supports and life satisfaction before and after the plastic operation for artificial knee replacement, it was disclosed that only the inconveniences were significantly reduced after the operation. In contrast, the t-test the variables before and after the plastic operation for artificial hip replacement, it was found that only the frequencies of other people's supports were significant reduced after the operation. Furthermore, the differences 6 months, one year and two years after the plastic operation for artificial joint replacement were t-tested on the variables. As a result, it was disclosed that people's inconvenience, frequencies of supports and life satisfaction were not improved 6 months after the operation but their frequencies of supports decreased significantly one year after, while their inconveniences and life satisfaction were significantly improved two years after. As a result of analyzing the variables with Pearson's correlations, inconveniences and frequency of supports were negatively correlated significantly with the life satisfaction. In conclusion, the plastic operation for artificial joint replacement significantly improved people's living inconveniences, reduced their frequency of other people's support and enhanced their satisfaction with life. To break don the plastic operation for artificial knee replacement improved patients' inconveniences, while the plastic operation for artificial hip replacement not only improved patients' inconveniences but reduced the frequencies of other people's support also. Finally, the finding that the plastic operation for artificial joint replacement brought about the improvement two years after suggests that this period is needed for the patients to adapt themselves to the post-operation conditions.

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The Impact of Service Level Management(SLM) Process Maturity on Information Systems Success in Total Outsourcing: An Analytical Case Study (토털 아웃소싱 환경 하에서 IT서비스 수준관리(Service Level Management) 프로세스 성숙도가 정보시스템 성공에 미치는 영향에 관한 분석적 사례연구)

  • Cho, Geun Su;An, Joon Mo;Min, Hyoung Jin
    • Asia pacific journal of information systems
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    • v.23 no.2
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    • pp.21-39
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    • 2013
  • As the utilization of information technology and the turbulence of technological change increase in organizations, the adoption of IT outsourcing also grows to manage IT resource more effectively and efficiently. In this new way of IT management technique, service level management(SLM) process becomes critical to derive success from the outsourcing in the view of end users in organization. Even though much of the research on service level management or agreement have been done during last decades, the performance of the service level management process have not been evaluated in terms of final objectives of the management efforts or success from the view of end-users. This study explores the relationship between SLM maturity and IT outsourcing success from the users' point of view by a analytical case study in four client organizations under an IT outsourcing vendor, which is a member company of a major Korean conglomerate. For setting up a model for the analysis, previous researches on service level management process maturity and information systems success are reviewed. In particular, information systems success from users' point of view are reviewed based the DeLone and McLean's study, which is argued and accepted as a comprehensively tested model of information systems success currently. The model proposed in this study argues that SLM process maturity influences information systems success, which is evaluated in terms of information quality, systems quality, service quality, and net effect proposed by DeLone and McLean. SLM process maturity can be measured in planning process, implementation process and operation and evaluation process. Instruments for measuring the factors in the proposed constructs of information systems success and SL management process maturity were collected from previous researches and evaluated for securing reliability and validity, utilizing appropriate statistical methods and pilot tests before exploring the case study. Four cases from four different companies under one vendor company were utilized for the analysis. All of the cases had been contracted in SLA(Service Level Agreement) and had implemented ITIL(IT Infrastructure Library), Six Sigma and BSC(Balanced Scored Card) methods since last several years, which means that all the client organizations pursued concerted efforts to acquire quality services from IT outsourcing from the organization and users' point of view. For comparing the differences among the four organizations in IT out-sourcing sucess, T-test and non-parametric analysis have been applied on the data set collected from the organization using survey instruments. The process maturities of planning and implementation phases of SLM are found not to influence on any dimensions of information systems success from users' point of view. It was found that the SLM maturity in the phase of operations and evaluation could influence systems quality only from users' view. This result seems to be quite against the arguments in IT outsourcing practices in the fields, which emphasize usually the importance of planning and implementation processes upfront in IT outsourcing projects. According to after-the-fact observation by an expert in an organization participating in the study, their needs and motivations for outsourcing contracts had been quite familiar already to the vendors as long-term partners under a same conglomerate, so that the maturity in the phases of planning and implementation seems not to be differentiating factors for the success of IT outsourcing. This study will be the foundation for the future research in the area of IT outsourcing management and success, in particular in the service level management. And also, it could guide managers in practice in IT outsourcing management to focus on service level management process in operation and evaluation stage especially for long-term outsourcing contracts under very unique context like Korean IT outsourcing projects. This study has some limitations in generalization because the sample size is small and the context itself is confined in an unique environment. For future exploration, survey based research could be designed and implemented.

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Analysis and Design of Profiling Adaptor for XML based Energy Storage System (XML 기반의 에너지 저장용 프로파일 어댑터 분석 및 설계)

  • Woo, Yongje;Park, Jaehong;Kang, Mingoo;Kwon, Kiwon
    • Journal of Internet Computing and Services
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    • v.16 no.5
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    • pp.29-38
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    • 2015
  • The Energy Storage System stores electricity for later use. This system can store electricity from legacy electric power systems or renewable energy systems into a battery device when demand is low. When there is high electricity demand, it uses the electricity previously stored and enables efficient energy usage and stable operation of the electric power system. It increases the energy usage efficiency, stabilizes the power supply system, and increases the utilization of renewable energy. The recent increase in the global interest for efficient energy consumption has increased the need for an energy storage system that can satisfy both the consumers' demand for stable power supply and the suppliers' demand for power demand normalization. In general, an energy storage system consists of a Power Conditioning System, a Battery Management System, a battery cell and peripheral devices. The specifications of the subsystems that form the energy storage system are manufacturer dependent. Since the core component interfaces are not standardized, there are difficulties in forming and operating the energy storage system. In this paper, the design of the profile structure for energy storage system and realization of private profiling system for energy storage system is presented. The profiling system accommodates diverse component settings that are manufacturer dependent and information needed for effective operation. The settings and operation information of various PCSs, BMSs, battery cells, and other peripheral device are analyzed to define profile specification and structure. A profile adapter software that can be applied to energy storage system is designed and implemented. The profiles for energy storage system generated by the profile authoring tool consist of a settings profile and operation profile. Setting profile consists of configuration information for energy device what composes energy saving system. To be more specific, setting profile has three parts of category as information for electric control module, sub system, and interface for communication between electric devices. Operation profile includes information in relation to the method in which controls Energy Storage system. The profiles are based on standard XML specification to accommodate future extensions. The profile system has been verified by applying it to an energy storage system and testing charge and discharge operations.

A Semantic Classification Model for e-Catalogs (전자 카탈로그를 위한 의미적 분류 모형)

  • Kim Dongkyu;Lee Sang-goo;Chun Jonghoon;Choi Dong-Hoon
    • Journal of KIISE:Databases
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    • v.33 no.1
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    • pp.102-116
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    • 2006
  • Electronic catalogs (or e-catalogs) hold information about the goods and services offered or requested by the participants, and consequently, form the basis of an e-commerce transaction. Catalog management is complicated by a number of factors and product classification is at the core of these issues. Classification hierarchy is used for spend analysis, custom3 regulation, and product identification. Classification is the foundation on which product databases are designed, and plays a central role in almost all aspects of management and use of product information. However, product classification has received little formal treatment in terms of underlying model, operations, and semantics. We believe that the lack of a logical model for classification Introduces a number of problems not only for the classification itself but also for the product database in general. It needs to meet diverse user views to support efficient and convenient use of product information. It needs to be changed and evolved very often without breaking consistency in the cases of introduction of new products, extinction of existing products, class reorganization, and class specialization. It also needs to be merged and mapped with other classification schemes without information loss when B2B transactions occur. For these requirements, a classification scheme should be so dynamic that it takes in them within right time and cost. The existing classification schemes widely used today such as UNSPSC and eClass, however, have a lot of limitations to meet these requirements for dynamic features of classification. In this paper, we try to understand what it means to classify products and present how best to represent classification schemes so as to capture the semantics behind the classifications and facilitate mappings between them. Product information implies a plenty of semantics such as class attributes like material, time, place, etc., and integrity constraints. In this paper, we analyze the dynamic features of product databases and the limitation of existing code based classification schemes. And describe the semantic classification model, which satisfies the requirements for dynamic features oi product databases. It provides a means to explicitly and formally express more semantics for product classes and organizes class relationships into a graph. We believe the model proposed in this paper satisfies the requirements and challenges that have been raised by previous works.

A study of SCM strategic plan: Focusing on the case of LG electronics (공급사슬 관리 구축전략에 관한 연구: LG전자 사례 중심으로)

  • Lee, Gi-Wan;Lee, Sang-Youn
    • Journal of Distribution Science
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    • v.9 no.3
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    • pp.83-94
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    • 2011
  • Most domestic companies, with the exclusion of major firms, are reluctant to implement a supply chain management (SCM) network into their operations. Most small- and medium-sized enterprises are not even aware of SCM. Due to the inherent total-systems efficiency of SCM, it coordinates domestic manufacturers, subcontractors, distributors, and physical distributors and cuts down on cost of inventory control, as well as demand management. Furthermore, a lack of SCM causes a decrease in competitiveness for domestic companies. The reason lies in the fundamentality of SCM, which is the characteristic of information sharing, process innovation throughout SCM, and the vast range of problems the SCM management tool is able to address. This study suggests the contemplation and reformation of the current SCM situation by analyzing the SCM strategic plan, discourses and logical discussions on the topic, and a successful case for adapting SCM; hence, the study plans to productively "process" SCM. First, it is necessary to contemplate the theoretical background of SCM before discussing how to successfully process SCM. I will describe the concept and background of SCM in Chapter 2, with a definition of SCM, types of SCM promotional activities, fields of SCM, necessity of applying SCM, and the effects of SCM. All of the defects in currently processing SCM will be introduced in Chapter 3. Discussion items include the following: the Bullwhip Effect; the breakdown in supply chain and sales networks due to e-business; the issue that even though the key to a successful SCM is cooperation between the production and distribution company, during the process of SCM, the companies, many times, put their profits first, resulting in a possible defect in demands estimation. Furthermore, the problems of processing SCM in a domestic distribution-production company concern Information Technology; for example, the new system introduced to the company is not compatible with the pre-existing document architecture. Second, for effective management, distribution and production companies should cooperate and enhance their partnership in the aspect of the corporation; however, in reality, this seldom occurs. Third, in the aspect of the work process, introducing SCM could provoke corporations during the integration of the distribution-production process. Fourth, to increase the achievement of the SCM strategy process, they need to set up a cross-functional team; however, many times, business partners lack the cooperation and business-information sharing tools necessary to effect the transition to SCM. Chapter 4 will address an SCM strategic plan and a case study of LG Electronics. The purpose of the strategic plan, strategic plans for types of business, adopting SCM in a distribution company, and the global supply chain process of LG Electronics will be introduced. The conclusion of the study is located in Chapter 5, which addresses the issue of the fierce competition that companies currently face in the global market environment and their increased investment in SCM, in order to better cope with short product life cycle and high customer expectations. The SCM management system has evolved through the adaptation of improved information, communication, and transportation technologies; now, it demands the utilization of various strategic resources. The introduction of SCM provides benefits to the management of a network of interconnected businesses by securing customer loyalty with cost and time savings, derived through the consolidation of many distribution systems; additionally, SCM helps enterprises form a wide range of marketing strategies. Thus, we could conclude that not only the distributors but all types of businesses should adopt the systems approach to supply chain strategies. SCM deals with the basic stream of distribution and increases the value of a company by replacing physical distribution with information. By the company obtaining and sharing ready information, it is able to create customer satisfaction at the end point of delivery to the consumer.

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