• Title/Summary/Keyword: residual pressure

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Long-term Results of Modified Lecompte Procedure for the Anomalies of Ventriculoarterial Connection (심실대혈관 연결 이상에 대한 변형된 Lecompte 술식의 장기 성적)

  • 임홍국;한국남;김웅한;이정렬;노준량;김용진
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.727-734
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    • 2004
  • The Lecompte procedure for transposition of the great arteries has an advantage because it obviates the need for an extracardiac conduit for the reconstruction of the pulmonary outflow tract. We evaluated the effectiveness and the application of the Lecompte procedure. Material and Method: A retrospective review was conducted of the records of 46 patients who underwent the Lecompte procedure during the past 15 years. Mean age at operation was 29.2$\pm$20.3 (range: 3∼83) months. The diagnoses involved anomalies of the ventriculoarterial connection with ventricular septal defect and pulmonary outflow tract obstruction, such as transposition of the great arteries, double-outlet right ventricle, and double-outlet left ventricle. Result: Early mortality was 4.4% (2 of 46 patients) and late mortality was 6.8% (3 of 44). The mean follow-up was 11.2$\pm$6.9 years. Eighteen patients (43.9% of survivors, n=41) had pulmonary stenosis (pressure gradient above 30 mmHg), the main reason for which was a calcified monocusp valve (n=15, 83.3%). Seventeen of 46 patients (37.0%) underwent reoperation: 15 for pulmonary stenosis, 5 for residual ventricular septal defect, 4 for left ventricular outflow tract obstruction, 3 for pulmonary insufficiency, and 4 for other causes. The cumulative survival rates were 91.3$\pm$4.2%, and 87.0$\pm$5.8% at 10 and 15 years, respectively. The actuarial probabilities of freedom from reoperation for pulmonary stenosis were 90.6$\pm$4.5%, 73.9$\pm$7.3%, and 54.0$\pm$10.4% at 5, 10, and 15 years, respectively. Conclusion: The Lecompte procedure is an effective treatment modality. Repair in early age is possible with acceptable morbidity and mortality, but recurrent right ventricular outflow tract obstruction caused by degeneration of the monocusp valve is a problem that needs resolution.

Effects on Surgical Repair of VSD by TATV (막성주위형 심실중격결손중의 봉합시 경삼첨판륜 절개방법의 외과적 치료효과)

  • Gwak, Mong-Ju;Kim, Bo-Yeong
    • Journal of Chest Surgery
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    • v.30 no.9
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    • pp.869-875
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    • 1997
  • Perimembranous ventri ular septal defects(PMVSDS) are the most common type of ventricular septal defects(VSDs) and consist morphologically of deficiency of the membranous septum and variable portions of the adjacent muscular septum. Repair of VSD has begun via a right ventriculotomy. Even with this exposure, however, it mght lead to ventricular dysfunction. Transatrial exposure of VSDs is luiown to a versatile approach to PMVSDS and even malaligunent defects can be repaired by this method. Although transatrial exposure can be improved by taking down'the atrioventricular valve at the annulus, surgeons have been hesitant to do so because of concern for valvular competence. Therefore, this study was undertaken to clarity the effects of transamlular approach of tricuspid valve (TATV) at operation of PMVSD. During last 5 years, twenty eight cases from 96 patients of PMVSD were closed by TATV and follow up study was done from 3 months to 33 months and results were obtained as follows. 1. Age at operation was fr m 4 months to 38 years and most patients(17, 62%) were above 5 years. 2. Preoperative pulmonary-systemic flow ratio(QPIQS) was ranged from 1 to 2.8 and 22 patients(79%) were less than 2. 3. Peak systolic pulmonary artery pressure was below 30mmHg in 8, 30-50mmHg in 17, above 50mmHg in 3 patients and 25 patients(89%) were less than 50mmHg. 4. Preoperative tricuspid regurgitation(TR) is none in 12, trivial in 6, mild in 3, moderate in 5, severe in 2 patients but postoperative TR was none in 18, trivial in 6, mild in 4 patients, so TR in most patients had decreased or not. 5. Indications for operation were based on the presence of a significant shunt. However, in patients with small shunts, indications for operation were included additional factors, tricuspid valve pouch, RVOT obstruction(right ventricular outflow tract obstruction), subacute bacterial endocarditis and associated anomalies. 6. There were no hospital deaths and residual shunts in postoperative echocardiography. Therefore TATV is especially a good method in PMVSn where patients have trcuspid valve pouch. And it is a safe and effective technique that improves exposure for PMVSD repair and does not adversely affect tricuspid valvular competence.

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Petrology of Host Body of Feldspar Deposits in Jechon Ganites (장석광상 모암인 제천반상화강암의 암석학적 특성)

  • Lee, Han-Yeang;Kim, Dai-Oap;Park, Joong-Kwon
    • Journal of the Korean earth science society
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    • v.22 no.5
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    • pp.405-414
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    • 2001
  • Jecheon granite can be divided into two types; porphyritic granite (K-feldspar megacryst bearing) and medium-grained biotite granite. Porphyritic granite, host body of feldspar deposits, is 8${\sim}$11 km in diameter and about 80 $km^{2}$ in area. It mainly contains K-feldspar, plagioclase, biotite and quartz, and magnetite, zircon, sphene and apatite are accessary minerals. Enclosed minerals in K-feldspar megacryst with 3${\sim}$10 cm in diameter are hornblende, plagioclase, quartz, magnetite, apatite, sphene and zircon. Mafic enclaves mainly consisting of hornblende, plagioclase and quartz are frequently observed in porphrytic granite. Medium-grained biotite granite consists of K-feldspar, plagioclase, biotite and hornblende as main, and hematite, muscovite, apatite and zircon as accessary minerals. Core and rim An contents of plagioclase from porphyritic granite, medium biotite granite, K-feldspar megacryst, and mafic enclave are 36 and 21, 40 and 32, 37 and 32, and 43 and 36, respectively. $X_{Fe}$ values of hornblende are 0.57 at biotite granite, 0.51 at K-feldspar mehacryst and 0.45 at mafic enclave. $X_{Fe}$ values of biotite and hornblende are homogeneous without chemical zonation. K-feldspar megacryst shows end member of pure composition with exsolved thin lamellar pure albites. Characteristics of mineral compositions and petrography indicate porphyritic granite is igneous origin and medium-grained biotite granite comes from the same source of magma; biotite granite is initiated to solidly and from residual melt porphyritic granite can be formed. Possibly K-feldspar megacrysts are formde under H$_{2}$O undersaturation condition and near K-feldspar solidus curve temperature; growth rate is faster than nucleation rate. Mafic enclaves are thought to be mingled mafic magma in felsic magma, which is formed from compositional stratigraphy. Estimated equilibrium temperature and pressure for medium-grained biotite granite are about $800^{\circ}C$ and 4.83${\sim}$5.27 Kb, respectively.

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Management of the Development of Insecticide Resistance by Sensible Use of Insecticide, Operational Methods (실행방식 측면에서 살충제의 신중한 사용에 의한 저항성 발달의 관리)

  • Chung, Bu-Keun;Park, Chung-Gyoo
    • Korean journal of applied entomology
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    • v.48 no.2
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    • pp.123-158
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    • 2009
  • An attempt was made to stimulate future research by providing exemplary information, which would integrate published knowledge to solve specific pest problem caused by resistance. This review was directed to find a way for delaying resistance development with consideration of chemical(s) nature, of mixture, rotation, or mosaics, and of insecticide(s) compatible with the biological agents in integrated pest management (IPM). The application frequency, related to the resistance development, was influenced by insecticide activity from potentiation, residual period, and the vulnerability to resistance development of chemical, with secondary pest. Chemical affected feeding, locomotion, flight, mating, and predator avoidance. Insecticides with negative cross-resistance by the difference of target sites and mode of action would be adapted to mixture, rotation and mosaic. Mixtures for delaying resistance depend on each component killing very high percentage of the insects, considering allele dominance, cross-resistance, and immigration and fitness disadvantage. Potential disadvantages associated with mixtures include disruption of biological control, resistance in secondary pests, selecting very resistant population, and extending cross-resistance range. The rotation would use insecticides in high and low doses, or with different metabolic mechanisms. Mosaic apply insecticides to the different sectors of a grid for highly mobile insects, spray unrelated insecticides to sedentary aphids in different areas, or mix plots of insecticide-treated and untreated rows. On the evolution of pest resistance, selectivity and resistance of parasitoids and predator decreased the number of generations in which pesticide treatment is required and they could be complementary to refuges from pesticides To enhance the viability of parasitoids, the terms on the insecticides selectivity and factors affecting to the selectivity in field were examined. For establishment of resistant parasitoid, migration, survivorship, refuge, alternative pesticides were considered. To use parasitoids under the pressure of pesticides, resistant or tolerant parasitoids were tested, collected, and/or selected. A parasitoid parasitized more successfully in the susceptible host than the resistant. Factors affecting to selective toxicity of predator are mixing mineral oil, application method, insecticide contaminated prey, trait of individual insecticide, sub-lethal doses, and the developmental stage of predators. To improve the predator/prey ratio in field, application time, method, and formulation of pesticide, reducing dose rate, using mulches and weeds, multicropping and managing of surroundings are suggested. Plant resistance, predator activity, selective insect growth regulator, and alternative prey positively contributed to the increase of the ratio. Using selective insecticides or insecticide resistant predator controlled its phytophagous prey mites, kept them below an economic level, increased yield, and reduced the spray number and fruits damaged.

Surgical outcome of severe pulmonary arterial hypertension secondary to left-to-right shunt lesions (심한 폐동맥 고혈압을 동반한 좌우 단락 질환 환자의 수술 후 경과)

  • Lee, Cha Gon;Jeong, Su-In;Huh, June;Kang, I-Seok;Lee, Heung Jae;Yang, Ji-Hyuk;Jun, Tae Gook
    • Clinical and Experimental Pediatrics
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    • v.53 no.2
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    • pp.195-202
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    • 2010
  • Purpose : Despite recent advances in pulmonary hypertension management and surgery, appropriate guidelines remain to be developed for operability in congenital heart disease with pulmonary artery hypertension (PAH). Our aim was to evaluate clinical outcomes of patients with severe PAH who underwent surgical closure of left-to-right shunt lesions (LRSL) on the basis of pulmonary reactivity. Methods : We retrospectively reviewed 21 patients who underwent surgical closure of LRSL with severe PAH (${\geq}8$ Wood unit) from January 1995 to April 2009. The median age at operation was 26 years. Atrial septal defect, ventricular septal defect (VSD), VSD and patent ductus arteriosus (PDA), and PDA was present in 11, 4, 4, and 2 patients, respectively. Results : Operability was based on vasoreactivity of PAH. Of the 21 patients, 5 showed response to pulmonary vasodilator therapy and 8 showed vasoreactivity after balloon occlusion of defects. The remaining 8 patients were considered operable because of significant left-to-right shunt (Qp/Qs ${\geq}1.5$). Five patients underwent total closure of defects and 16 were left with small residual shunts. The median follow-up duration was 32 months. There was no significant postoperative mortality or morbidity. Systolic pulmonary artery pressure (PAP) decreased in all but 2 patients. All patients except 1 showed improvement of New York Heart Association functional class. Conclusion : Closure of LRSL in patients with severe PAH on the basis of pulmonary vasoreactivity seems reasonable. PAP and clinical symptoms improved in most patients. Further research is needed for the evaluation of long-term results.

The Differences in Resting Pulmonary Function in Relation to the Nutritional status of Patients with Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환 환자의 영양상태에 따른 안정시 폐기능 차이)

  • Mun, Yeung-Chul;Yu, Sung-Keun;Park, Hye-Jung;Park, Jong-Won;Shin, Kyeong-Cheol;Chung, Jin-Hong;Lee, Kwan-Ho;Kim, Jung-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.6
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    • pp.570-578
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    • 2001
  • Background: With cases of chronic obstructive pulmonary disease(COPD), weight loss and low body weight have been found to correlate with increased mortality and poor prognosis. Therefore, nutritional aspects are an important part of the treatment in cases of COPD. In Korea, there is only limited data available for the changes of resting pulmonary function in relation to nutritional status. This study was carried out to investigate the differences of resting pulmonary function in relation to the nutritional status of patients with COPD. Method : 83 stable patients, with moderate to severe COPD, were clinically assessed for their nutritional status and resting pulmonary function. The patients' nutritional status was evaluated by body weight and fat-free mass (FFM), which was assessed by bioelectrical impedance analysis. According to their nutritional status, the 83 patients were divided into two groups, designated as the depleted, and non-depleted, groups. Result : Of the 83 patients, 31% were characterized by body weight loss and depletion of FFM, whereas 28% had either weight loss or depleted FFM. In the depleted group, significantly lower peak expiratory flow rate(p<0.05) and Kco(p<0.01), but significantly higher airway resistance(Raw, p<0.05) were noted. There was no difference for the non-depleted group in forced expiratory volume at one second, residual volume, inspiratory vital capacity, or total lung capacity. Maximal inspiratory pressure($P_{Imax}$) was also significantly lower in the depleted group(p<0.05). Conclusion : We conclude, from our clinical studies, that nutritional depletion is significantly associated with the change in resting pulmonary function for patients with moderate to severe COPD.

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Behavior Analysis of Concrete Structure under Blast Loading : (II) Blast Loading Response of Ultra High Strength Concrete and Reactive Powder Concrete Slabs (폭발하중을 받는 콘크리트 구조물의 실험적 거동분석 : (II) 초고강도 콘크리트 및 RPC 슬래브의 실험결과)

  • Yi, Na Hyun;Kim, Sung Bae;Kim, Jang-Ho Jay;Cho, Yun Gu
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.29 no.5A
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    • pp.565-575
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    • 2009
  • In recent years, there have been numerous explosion-related accidents due to military and terrorist activities. Such incidents caused not only damages to structures but also human casualties, especially in urban areas. To protect structures and save human lives against explosion accidents, better understanding of the explosion effect on structures is needed. In an explosion, the blast load is applied to concrete structures as an impulsive load of extremely short duration with very high pressure and heat. Generally, concrete is known to have a relatively high blast resistance compared to other construction materials. However, normal strength concrete structures require higher strength to improve their resistance against impact and blast loads. Therefore, a new material with high-energy absorption capacity and high resistance to damage is needed for blast resistance design. Recently, Ultra High Strength Concrete(UHSC) and Reactive Powder Concrete(RPC) have been actively developed to significantly improve concrete strength. UHSC and RPC, can improve concrete strength, reduce member size and weight, and improve workability. High strength concrete are used to improve earthquake resistance and increase height and bridge span. Also, UHSC and RPC, can be implemented for blast resistance design of infrastructure susceptible to terror or impact such as 9.11 terror attack. Therefore, in this study, the blast tests are performed to investigate the behavior of UHSC and RPC slabs under blast loading. Blast wave characteristics including incident and reflected pressures as well as maximum and residual displacements and strains in steel and concrete surface are measured. Also, blast damages and failure modes were recorded for each specimen. From these tests, UHSC and RPC have shown to better blast explosions resistance compare to normal strength concrete.

Postoperative Radiotherapy in the Rectal Cancers Patterns of Care Study for the Years of $1998\~1999$ (직장암의 방사선치료에 대한 Patterns of Care Study: $1998{\sim}1999$년도 수술 후 방사선치료 환자들의 특성 및 치료내용에 대한 분석결과)

  • Kim, Jong-Hoon;Oh, Do-Hoon;Kang, Ki-Moon;Kim, Woo-Cheol;Kim, Won-Dong;Kim, Jung, Soo;Kim, June-Sang;Kim, Jin-Hee;Kil, Hak-Jae;Suh, Chang-Ok;Sohn, Seung-Chang;Ahn, Yong-Chan;Yang, Dae-Sik
    • Radiation Oncology Journal
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    • v.23 no.1
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    • pp.22-31
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    • 2005
  • Purpose : To conduct a nationwide survey on the principals in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. Materials and Methods : We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were Inputted to the web based PCS system by each investigators in 19 institutions. Results : Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59 : 41, and the most common location of tumor was lower rectum ($46\%$). Preoperative CEA was checked in $79\%$ of cases and its value was higher than 6 ng/ml in $32\%$. Pathologic stage were I in $1.5\%$, II in $32\%$, III in $53\%$, and IV in $1.6\%$. Low anterior resection was the most common type of surgery and complete resection was peformed in $95\%$ of cases. Distal resection margin was less than 2 cm in $30\%$, and number of lymph node dissected was less than 12 in $31\%$. Chemotherapy was peformed in $91\%$ and most common regimen was 5-FU and leucovorine ($59\%$). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique ($65.0\%$), and there was no AP-PA parallel opposing field used. Patient position was prone in $81.2\%$, and the boost field was used in $61.8\%$. To displace bowel outward, pressure modulating devices or bladder filling was used in $40.1\%$. Radiation dose was prescribed to isocenter in $45.3\%$ and to isodose line in 123 cases ($39.8\%$). Percent delivered dose over $90\%$ was achieved in $92.9\%$. Conclusion : We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.

Occurrence and Chemical Composition of Dolomite from Komdok Pb-Zn Deposit (검덕 연-아연 광상의 돌로마이트 산상과 화학조성)

  • Yoo, Bong Chul
    • Korean Journal of Mineralogy and Petrology
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    • v.34 no.2
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    • pp.107-120
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    • 2021
  • The Komdok Pb-Zn deposit, which is the largest Pb-Zn deposit in Korea, is located at the Hyesan-Riwon metallogenic zone in Jiao Liao Ji belt included Paleoproterozoic Macheolryeong group. The geology of this deposit consists of Paleoproterozoic metasedimentary rocks, Jurassic Mantapsan intrusive rocks and Cenozoic basalt. The Komdok deposit which is a SEDEX type deposit occurs as layer ore and vein ore in the Paleoproterozoic metasedimentary rocks. Based on mineral petrography and paragenesis, dolomites from this deposit are classified four types (1. dolomite (D0) as hostrock, 2. early dolomite (D1) associated with tremolite, actinolite, diopside, sphalerite and galena from amphibolite facies, 3. late dolomite (D2) associated with talc, calcite, quartz, sphalerite and galena from amphibolite facies, 4. dolomite (D3) associated with white mica, chlorite, sphalerite and galena from quartz vein). The structural formulars of dolomites are determined to be Ca1.00-1.20Mg0.80-0.99Fe0.00-0.01Zn0.00-0.02(CO3)2(D0), Ca1.00-1.02M0.97-0.99Fe0.00-0.01Zn0.00-0.02(CO3)2(D1), Ca0.99-1.03Mg0.93-0.98Fe0.01-0.05Mn0.00-0.01As0.00-0.01(CO3)2(D2) and Ca0.95-1.04Mg0.59-0.68Fe0.30-0.36Mn0.00-0.01 (CO3)2(D3), respectively. It means that dolomites from Komdok deposit have higher content of trace elements (FeO, MnO, HfO2, ZnO, PbO, Sb2O5 and As2O5) compared to the theoretical composition of dolomite. These trace elements (FeO, MnO, ZnO, Sb2O5 and As2O5) show increase and decrease trend according to paragenetic sequence, but HfO2 and PbO elements no show increase and decrease trend according to paragenetic sequence. Dolomites correspond to Ferroan dolomite (D0, D1 and D2), and Ferroan dolomite and ankerite (D3), respectively. Therefore, 1) dolomite (D0) as hostrock was formed by subsequent diagenesis after sedimentation of Paleoproterozoic (2012~1700 Ma) silica-bearing dolomite in the marine evaporative environment. 2) Early dolomite (D1) was formed by hydrothermal metasomatism origined metamorphism (amphibolite facies) associated with intrusion (1890~1680 Ma) of Paleoproterozoic Riwon complex. 3) Late dolomte (D2) was formed from residual fluid by a decrease of temperature and pressure. and dolomite (D3) in quartz vein was formed by intrusion (213~181 Ma) of Jurassic Mantapsan intrusive rocks.