• Journal of Chest Surgery
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• 제12권3호
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제8권1호
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• pp.19-28
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• 1975

The thoracoscopic study was reported on 21 cases of spontaneous pneumothorax requiring surgical management, and clinical values of thoracoscopic examination on spontaneous pneumothorax were also discussed. patients were treated in the Department of .Thoracic Surgery, Hanyang University Hospital for the period of two Years from May 1972 to April 1974. For exact detection of etiologic factors on spontaneous pneumothorax, the thoracoscopic examination in the intrapleural space was performed in parallel with X-ray study. this study, the difference of diagnostic and therapeutic significance between radiological and thoracoscopic findings were observed and compared simultaneously. The results are summerized as follows: Patients age was distributed between 3 and 70 years old with highest incidence in the age group of sixty decade [33. 3%], and sex ratio of male to female was 5:2. The tuberculous processes which developed superficial subpleural layer in the lung parenchyme, on the pulmonary surface could be observed by thoracoscopic examination in a characteristic picture. detection ratio of pulmonary tuberculosis by the radiologic study to that by thoracoscopy was 8:2. The adhesion between the visceral and the parietal pleura which could possibly make a rupture of the alveola and the visceral pleura was found to be localized in a small area of the lung surface. The other part of the lung surface was free of the adhesion and, therefore, the movement of the lung took place completely without any difficulty. The ruptured orifice of the pleura and pathological changes surrounding the orifice can be detected by thoracoscopy, but not by other means such as radiologic examination. A single tuberculous bleb and multiple emphysematous blebs were found on 6 cases out of 21 cases of spontaneous pneumothorax. Among these cases, radiologic Study revealed the bleb only in one patient. On the other hand, the blebs were found in all the six patients by means of thoracoscopic examination. It gives the detection ratio of bleb by radiologic study to that by thoracoscopy was 1:6. By thoracoscopy, the rupture on the lung surface were visualized on the 10 patients out of a total of 21 patients [10 patients of visual rupture]. However, the rupture of the pleura was not observed on the rest of 11 patients even by thoracoscopic examination [11 patients of non visual rupture]. Five patients [50%] out of ten who had the visual rupture on the lung surface was required a surgical operation to remove pneumothorax. For the patients who were detected to have the visual rupture of the pleura by thoracoscopy, be considered in the early stage of closed thoracostomy. of 21 patients, 16 patients [11 patients of non visual rupture of the pleura and 5 patients of visual rupture of the pleura] who received no surgical management, were treated with closed thoracostomy with continuous suction, and the` pneumothorax was healed completely up in each cases. Therapeutic measures for the remaining 5 patients of visual rupture of the pleura who were subjected to surgical approach for radical treatment of spontaneous pneumothorax were accordingly complicated, and the following different procedures were properly indicated case by case, that is, rib resection thoracostomy, simple closure of ruptured visceral pleura, wedged resection of the lung, and lobectomy.

• 대한소아치과학회지
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• 제37권3호
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• pp.368-373
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• 2010

상악 중절치는 저작시 음식물을 찢거나 자르는 기능 외에도 심미적으로 중요한 기능을 하며 상악 악궁의 형태 및 얼굴의 형태와도 관계가 있다고 알려져 있다. 그리고 발음을 하는데 있어서도 전치부는 매우 중요한 역할을 한다. 예후가 불량한 치아의 일반적인 치료는 발거 후 공간 유지장치를 하는 것이다. 그러나 혼합치열기에 있어 상악 영구 중절치의 발거는 치조골의 흡수, 불량한 심미성, 발음과 저작의 문제 등 여러 가지 합병증을 일으킬 수 있다. 이러한 이유로 상악 전치부의 치료는 보존적으로 행해져야 한다. 예후가 불량한 상악 전치부의 치료시 고려해야 할 사항으로는 환아의 나이, 성장 잠재력, 교합 관계, 구강 위생상태, 경제력 그리고 환아의 치료에 대한 협조도 등이 있다. 본 증례는 짧은 치근으로 인해 치아의 동요도가 있어 상악 좌측 중절치의 예후가 불안정함에도 불구하고 치아를 발거하지 않고 치료를 통해 상악 좌측 중절치를 정상 위치로 배열하고 보존하였다. 짧은 치근과 치아 회전으로 인한 추가적인 치근 흡수와 치아 동요도 증가 등 예후가 불안정하였지만 환아의 심리적 안정성, 나이, 심미성 등을 고려하여 보존적인 치료 후 양호한 결과를 얻었기에 이를 보고하는 바이다.

• 한국임상수의학회지
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• 제26권3호
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• pp.205-211
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• 2009

Perioperative pain relief is essential in veterinary practice. However, the cat is one of the most poorly understood species regarding pain control management. Ovariohysterectomy(OHE) produces considerable postoperative pain in cats. Practitioners are often reluctant to administer analgesics due to lack of familiarity with available drugs, concern about side effects, or frustration with the need for record keeping of controlled substances. The purpose of this study was to determine if intraperitoneal administration of bupivacaine can provide relief of pain following OHE in cats. Twelve healthy female cats were randomly divided into two groups. OHE was performed under general inhalation anesthesia. Just prior to complete closure of the linea alba, 6 cats in SAL group received 0.88 ml/kg 0.9% saline, 6 cats in BUP group received 4.4 mg/kg 0.75% bupivacaine diluted to an equivalent volume with saline in the intraperitoneal space. Cats were scored at 0, 1, 2, 4, 8, 12 and 24 hours post-extubation by one observer. Cats were evaluated using a visual analogue scale(VAS) and composite pain scale(CPS) that included physiologic variables. There were no significant differences in body weight, anesthesia time, surgery time, and incision length between the two groups. Cats in the BUP group had significantly(p<0.05) lower VAS-pain scores than cats in the SAL group at 4, 8, 12 hours after surgery. Cats in the BUP group had significantly lower CPS scores than cats in the SAL group at 8, 12 hours after surgery. No adverse side effects were observed. These results support that the intraperitoneal administration of bupivacaine following OHE can be used for the prevention of postoperative pain and pain-induced behavioral changes in cats.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권1_2호
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• pp.1-21
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• 1992

In order to find the causes of velopharyngeal incompetency after primary palatorrhaphy in cleft patients, we analyzed the form and function of the velopharyngeal space of fifteen operated cleft palate patients and five normal subjects. The velopharyngeal function was evaluated by lateral cephalometric radiography, velopharyngography and hypernasality cul-de-sac test. The obtained results were as follows. 1. The rate of velopharyngeal incompetency was twenty percent, three of the fifteen operated patients. Two of them were complete cleft palate and the other was incomplete one. 2. The length of soft palate and levator eminence were longer in normal group than those of good speech group and complete cleft palate group during phonation of /i/ (P<0.05). The lengthening rate of soft palate was smaller in good and poor speech group than that of normal group(P<0.05), and, reduced in order, normal group, complete cleft palate group and incomplete palate group(P<0.05). 3. The nasopharyngeal distance had no significant difference between all groups at rest, but, smaller in normal group than that of both cleft palate group(P<0.05), good speech group and poor speech group(P<0.05) during phonation of /i/ The difference in nasopharyngeal distance between rest and /i/ phonation was greater in normal group than that of both cleft palate group, good speech group and poor speech group. 4. The moving distance of sop palate reduced in order, normal group, incomplete cleft palate group, complete cleft palate group(P<0.05). 5. The distance between lateral pharyngeal wall had no significant difference between all groups in rest, but, smaller than that of complete cleft palate group in normal group(P<0.01) and increased in order normal group, good speech group, poor speech group(P<0.01) during phonation of /a/. The mobility of lateral wall was reduced in order, normal group, good speech group poor speech group(P<0. 01). 6. There was low corelationship between the mobility of lateral pharyngeal wall and soft palate. Therfore, it suggest that the movements of lateral pharyngeal wall and soft palate occurs independently.

• 한국산림과학회지
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• 제106권1호
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• pp.1-9
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• 2017

산림 벌채 후 형성되는 가장자리 효과의 발생 여부과 회복 과정을 이해하는 것은 생태계 천이와 경관 및 서식지의 공간 영향을 분석하고 이해하는 필수 요소임에도 불구하고, 우리나라에서 관련 주제의 실증 연구는 찾아보기 어렵다. 본 연구는 강원 남부 지역의 소나무림 벌채 후 1, 3, 10, 16년이 경과한 장소에 형성된 벌채지 및 임내 가장자리에서 비생물 및 생물 요인의 변화 양상을 선 (20개) 및 방형구 (340개) 조사법을 병용하여 조사하였다. 벌채 후 초기(3년 이내)는 가장 자리에서 인접 숲 내부 방향으로, 15m 깊이까지 식생 피도, 풍부도, 수관 열림도, 그리고 대기 온도 및 습도가 급격하게 변화하였다. 가장자리 형성 이후, 비생물 요인 및 식물 풍부도의 안정화는 각각 10년 및 16년이 소요되었다. 교목종이 초본식물에 비하여 가장자리 환경에서 더 높은 증가 양상을 나타내었고, 교목종의 높은 증가는 하층식생의 동태에 영향을 주었다. 본 연구 결과를 통해 벌채에 의한 직 간접적인 서식지 변화는 최소 인접 산림의 15 m에서 20 m까지, 그리고 16년 수준까지 지속적으로 영향을 미치는 것으로 나타났다. 본 연구 결과는 경관 및 서식지 패치 평가에 필수적인 가장자리 효과의 깊이에 대한 첫 국내 첫 실증 연구자료로 친환경벌채 기준제시 등 활용성이 높다.

• 한국비블리아학회지
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• 제32권3호
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• pp.45-65
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• 2021

현 코로나 시대 속에도 실제 도서관들은 어떠한 영향을 받고 있으며, 또 이를 극복하기 위한 방안들로 무엇을 계획하고 활동하고 있을까? 이러한 질문을 바탕으로 본 연구에서는 도서관발전종합계획 2020년도 시행계획 추진실적, 2021년도 시행계획 내 코로나 관련 동향을 분석하여 공공도서관들의 코로나에 따른 영향 및 변화, 코로나 대응 방향을 분석하고자 하였다. 2020년도 공공도서관들의 추진상의 문제점들은 크게 코로나19의 전염성으로 인한 도서관 휴관 또는 축소 운영, 예산 삭감 및 예산 한계, 이용자들의 관심 및 참여 저하 문제, 급격한 서비스 변화에 따른 인프라 한계 및 운영상의 한계 등으로 나타났다. 이러한 한계점에 대한 개선조치 및 향후 추진계획으로는 1) 비대면 프로그램 개발 및 제공, 2) 온라인 기반 서비스 개발 및 제공, 3) 정보자료 및 인프라 확대 및 안정화, 4) 수요 대응을 위한 예산 확충, 5) 코로나 대비 공간 마련, 6) 협업 확대 등으로 구분할 수 있다. 아울러 향후 공공도서관에서는 체계적으로 코로나19를 대응하기 위해서는 첫째, 하이브리드 형태의 프로그램과 서비스 운영, 둘째, 온라인 및 비대면 서비스를 위한 인프라 확보, 셋째, 예산 활용의 유연성 확보가 필요할 것으로 전망된다.

• 대한치과교정학회지
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• 제27권6호
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• pp.905-916
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• 1997

본 연구는 교정치료시 발치가 안모의 수직 변화에 어떠한 영향을 미치는지 규명하기 위해서 비발치군과 발치군으로 구분하였고, 발치군은 비교분석을 위해 제1소구치 발치군, 제2소구치 발치군, 제2대구치 발치군으로 구분하여 교정치료 전, 후의 안모의 수직변화 여부를 평가함으로서 발치가 안모의 수직변화에 미치는 영향을 규명하고자 했다. 연구대상은 조선대학교 부속치과병원 교정과에 내원하여 교정치료를 받은 환자 중, 제2대구치까지 맹출하여 성장에 의한 변화요인이 적다고 인정되는 비발치군 남녀 50명, 발치군 남녀 88명으로 하였으며, 비발치군은 비교분석을 위해 42명의 제1소구치 발치군, 24명의 제2소구치 발치군, 22명의 제2대구치 발치군으로 구분하였다. 안모의 수직변화 여부를 규명할 수 있는 14개의 두부방사선 계측항목을 선정하여 교정치료 전, 후의 안모의 수직변화량을 측정하였고, $SPSS/PC^+$ 통계프로그램을 이용하여 교정치료 전, 후의 안모의 수직변화여부를 비교 분석함으로 써 다음과 같은 결과를 얻었다. 1. 교정적 발치여부에 관계없이 모든 군에서 교정치료 전,후의 두부방사선 계측치 사이에 통계학적인 유의성이 없었다. 2. 상, 하악 구치는 모든 군에서 교정치료에 의해 정출되었다. 이는 대부분의 교정치료의 역계 자체가 치아를 정출시키는 기전을 지니고 있음을 의미하며, 특히 발치에 의한 교정치료시 발치공간 폐쇄 및 치아배열을 위해 작용되는 역계로 인해 일어나는 결과로 보인다. 3. 제 2재구치 발치군에서 안모의 수직고경은 교정치료 후에 모두 증가되었다. 이는 치아배열 공간을 확보하기 위해 치열이 후방이동된 결과로 보인다. 4. 교정적 발치와 안모의 수직변화 사이에는 통계학적인 유의성이 없었다. 이는 안모의 수직변화와 교정적 발치는 아무런 관련이 없음을 나타낸다. 5. 두부방사선 계측항목 중 안모의 수직변화에 있어서 각 군 사이에 통계학적으로 유의성 있는 영향을 미치는 항목은 PP-MP, OP-MP, $\underline{1}$ to PP, $\overline{1}$ to MP였다.

• 대한치과교정학회지
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• 제33권5호
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• pp.339-350
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• 2003

본 연구에서는 활주법을 이용한 전치부 후방 견인시 micro-implant의 다양한 수직적 위치와 전치부에서 힘의 적용점에 따른 치아 이동 양상을 관찰하여 공간 폐쇄시 전치부의 설측 경사와 정출력을 방지할 수 있는 micro-implant의 위치와 전치부 힘의 적용점의 위치를 알아보고자 하였다. 유한 요소 모델을 이용하여 제1소구치가 발거된 상악 치열궁 형태를 제작하고 $.022"{\times}.028"$ 슬롯 브라켓을 모형화하여 치아에 부착시켰다. $.019"{\times}.025"$ stainless steel 선재를 3차원 beam모형으로 제작하고 상악 측절치와 견치 브라켓 사이의 선재 상에 $.032"{\times}.032"$ 크기의 stainless steel hook을 수직으로 8mm의 높이로 형성하였으며, 선재로부터 2mm높이에서 1mm간격으로 8mm까지 힘 적용점을 설정하였다. 지름 1.2mm,길이 6mm의 micro-implant를 제2소구치와 제1대구치 사이의 치조골에 선재로부터 4mm에서 10mm까지 2mm간격으로 4개를 위치시켰다 각각의 micro-implant와 전치부 hook에 150gm의 힘을 적용시켜 다양한 힘 적용점에 따른 치아의 초기 변위를 분석하여 다음의 결과를 얻을 수 있었다. 1. Micro-implant 높이가 4m일 경우 5mm이하의 전치부 hook 높이에서는 전치부 설측 경사 이동이 일어났으며 전치부 hook 높이가 6m이상 되었을 때 전치부 순측 경사 이동이 일어났다. 2. Micro-implant높이가 6mm일 경우 5mm이하의 전치부 hook높이에서 전치부 설측 경사 이동이 일어났으며 전치부 hook 높이가 6mm 이상 되었을 때 전치부 순측 경사 이동이 일어났다 이것은 4mm micro-implant에서의 실험결과와 유사한 이동 양상을 나타내었지만, micro-implant높이가 6mm일 때 전치부 설측 경사 이동이 좀더 감소하였다. 3. Micro-implant높이가 8m일 경우 전치부 hook높이가 2mm일 때 전치의 설측 경사 이동이 일어났으며 3mm이상의 전치부 hook 높이에서 순측 경사 이동이 비례적으로 증가하였다. 4. Micro-implant높이가 10mm일 경우 전치부 hook 높이가 2mm 이상에서 전치의 순측 경사 이동이 비례적ㅇ로 증가하였다. 5. 전치부 hook 높이가 증가할수록 전치의 순측 경사 이동이 증가되지만 선재의 뒤틀림에 의한 변형이 증가되므로 견치와 소구치 부위에서 정출력이 발생하는 바람직하지 못한 치아 이동 양상이 일어났다. 6. Micro-implant를 이용한 상악 5전치 후방 견인시 구치부의 이동은 선재와 브라켓 사이의 마찰력에 의해서 원심경사 이동이 발생하였다.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.