단심실증의 수술치험 2

박이태 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

A modified Fontan procedure was performed on two patients with Univentricular heart. The first patient had UVH of right ventricular type with trabecular pouch and had various associated anomalies, such as common atrium, common atrioventricular valve and combined pulmonary stenosis. The second patient had UVH of left ventricular type with outlet chamber and the associated anomalies were atrial septal defect, tricuspid stenosis and combined pulmonary stenosis. Postoperative hemodynamic insufficiency, fluid retention and renal insufficiency were occurred in the first patient, but relieved with the aid of inotropics and vasodilators. We thought that the good postoperative course and surgical result were gained from the widely patent atriopulmonary anastomosis.

종격동 종양 및 낭포

박이태 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.4

For the purpose of evaluation of clinical characteristics and histopathological properties in mediastinal tumors, 130 patients with mediastinal tumors treated during the period from 1958 to 1982 were reviewed. Cancers of unidentified primary site of origin, nonneoplastic lesions and the cases with clinical diagnosis only were excluded from this report. There were 69 males and 61 females, and their ages ranged from 2 months to 66 years, with the average age of 31.3 years. 19.2% of patients were younger than 15 years of age. The most frequently encountered tumors were teratodermoids, followed by neurogenic tumors, thymic tumors, benign cysts, malignant lymphomas and miscellaneous tumors in order of decreasing frequency. 75.4% of the mediastinal tumors were benign and 24.6% were malignant. 16.6% of the patients were asymptomatic at admission. There were 2 postoperative deaths with 1.7% of operative mortality rate, and 2 other deaths who were not operated upon, showing overall hospital mortality rate of 3.1%. Postoperative follow up was possible in 84 cases, and there were 4 late deaths.

개심술중 섬유소융해계의 활성화에 관한 연구

박이태,서경필,이정상,Park, Lee-Tae,Seo, Gyeong-Pil,Lee, Jeong-Sang 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4

Hemorrhagic tendency observed in open heart surgery patients has been attributed, among other causes, to increased fibrinolytic activity during extracorporeal circulation. But the exact mechanism of enhanced fibrinolytic activity which occurs during extracorporeal circulation is still unknown. So, we studied and compared the changes of parameters of fibrinolytic and protein C system according to time obtained from the plasma of 31 adult open heart surgery patients[EGG group] and 10 adult general thoracic surgery patients[control group], in order to confirm the hypothesis that the activated protein C system might affect the fibrinolytic system during extracorporeal circulation. In ECC group, the nature of the enhanced fibrinolytic activity that evolved during extracorporeal circulation was characterized by significant increase in fibrin degradation products[P < 0.01] and significant decrease in plasminogen and alpha2-antiplasmin[P < 0.05, P < 0.01] in spite of adequate amount of heparin administration. These changes were most pronounced in the early phase of extracorporeal circulation and normalized after termination of extracorporeal circulation. The results of these observations were the same after volume correction with the value of hematocrit. The change of volume corrected protein C ratio during extracorporeal circulation revealed similar pattern to those of plasminogen and alpha2-antiplasmin [P < 0.01], but volume corrected ratio of free protein S showed significant increase after the commencement of extracorporeal circulation then decreased after extracorporeal circulation. Although the above mentioned changes occur similarly in both bubble type oxygenator-used and membrane oxygenator-used patients groups, but the degree of decrease was more severe in membrane oxygenator-used patients group [P < 0.01] and showed much slower recovery to reach to the preextracorporeal circulation level. These results confirm the hypothesis that the enhanced fibrinolysis during extracorporeal circulation might be caused by the activation of protein C system and the activation is possibly linked to the appearance of thrombin from contact activation of blood after wide exposure to the synthetic surfaces of extracorporeal circuit. Key words: Extracorporeal circulation, Enhanced fibrinolysis, Protein C system.

단일판첨을 내재한 우심실유출로 Patch 를 이용한 활로 4 징증의 교정수

박이태 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

For the purpose of avoiding postoperative massive pulmonary insufficiency after transannular outflow tract reconstruction in patients with tetralogy of Fallot, we have used monocusp bearing outflow patch since June 1983. Right heart catheterization and pulmonary arteriography were performed in 7 patients among the total 11 patients corrected with monocusp bearing outflow patch during postoperative 14th day to 22nd day. Particular attention was paid to the evaluation of the pulmonary valve competence, and the results were; 1.One patient died of acute renal failure secondary to low cardiac output and the operative mortality was 9.1%. 2.The average PRV/FA ratio was 0.491 and the average systolic pressure gradient between right ventricle and pulmonary artery was 17.7mmHg. The average Qp/Qs was 1.13. 3.Inspite of using monocusp bearing outflow patch, the hemodynamic and pulmonary arteriographic results were unsatisfactory in respect to pulmonary valve competence.

폴란드 증후군 :1례 보고

박이태,홍장수,서경필,Park, I-Tae,Hong, Jang-Su,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.1

The Poland`s syndrome is very rare anomaly, which consists of congenital unilateral absence of the sternocostal pert of the pectoralis major muscle, with ipsilateral hand deformities. The clinical features are variable but all patients have absence of at least the sternal head of the pectoralis major muscle. The syndrome is not hereditary and is of unknown origin. Early recognition of Poland`s syndrome may give the provision of psychological and genetic counseling for anxious parents. We have encountered a patient with this entity, who showed striking paradoxical movement of the left anterior Ghest wall and recurrent pneumonia, and underwent successful surgical correction.

소아 및 청소년기에 있어서의 판막대치이식술에 관한 연구

박이태,이영균,Park, Lee-Tae,Lee, Yeong-Gyun 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.4

Valve replacement in children and adolescents, aging below 20 years [Mean 15 years 4 months], has been done at Seoul National University Hospital from March 1977 to September 1982 . Seventy-Seven patients have received 91 artificial valves 4 prosthetic valves and 87 bioprosthetic valves. 63 patients had acquired valve lesions and 14 patients had congenital valve lesions. Among the patients with acquired valve lesion, 32 patients had the history of rheumatic fever. Seventy-five patients survived operation: 12 patients [ 15.6%] died within one month postoperatively and 3 patients [3.9%] during the follow-up period with the overall mortality rate of 19.5% Thromboembolic complication occurred in 3 patients with 2 deaths: 3.9% embolic rate or 3.74% emboli per patient-year. One patient who had been on coumadin anticoagulation died from cerebral hemorrhage. Actuarial survival rate was 77.6% at 1 years after surgery, after then there were no death.

2 세 이하 유아기의 개심술

박이태,서경필,Park, Lee-Tae,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.4

A hundred and fifty-one patients with congenital heart disease less than 24 months old underwent intracardiac repairs from January 1982 to July 1983, which consists 24.2% of all the patients with congenital heart diseases operated during the same period. There were 98 patients[64.9%] with acyanotic congenital heart disease and 53 patients[35.1%] with cyanotic congenital heart disease, and 55 patients[36.4%] were less than 1 year of age. Twenty-two patients died within 30 days after surgery and 3 patients died after postoperative 30th day: Ventricular septal defect, four of 90 patients; Tetralogy of Fallot, five of 23 patients; Transposition of great arteries, nine of 17 patients; Tricuspid atresia, four of 5 patients; Pulmonary atresia, all of 2 patients; Single ventricle, one of single patients. Over all mortality was 16.6% and mortality of acyanotic congenital heart disease, cyanotic congenital heart disease and patients less then 1 year of age was 4.1%, 39.6% and 20.0% respectively. Still the mortality of cyanotic congenital heart disease is high. Careful preoperative evaluation of the detailed intracardiac anatomy and hemodynamics of the patients and proper selection of surgical treatment yield better clinical results.

단심실증의 수술치험 2례

박이태,유영선,이광숙 啓明大學校 醫科大學 1984 계명의대학술지 Vol.3 No.1

A modified Fontan procedure was performe on two patients with univentricular heart. The first patient had UVH of right ventricular type with trabecular pouch and had various associated anomalies, such as common atrium, common atrioventricular valve and combined pulmonary stenosis. The second patient had UVH of left ventricular type with ourlet chamber and the associated anomalies were atrial septal defect, tricuspid stenosis and combined pulmonary stenosis. Postoperative hemodynamic insufficiency, fluid retention and renal insufficiency were occured in the first patient, but relieved with the aid of inotropics and vasodilators. We thought that the good postoperative course and surgical result were gained from the widely patent atriopulmonary anastomosis.

인공심폐기분리시 우심실과 좌심실충만압의 상호작용에 관한 연구

박이태,유영선 啓明大學校 醫科大學 1987 계명의대학술지 Vol.6 No.1

The period of terminating cardiopulmonary bypass is one of the high-risk periods because it possesses a great deal of hemodynamic changes, This transition must be carefully controlled because a poorly performed transition can injure the patient. We inserted balloon-tipped thermo-dilution catheter in 12 patients who underwent valve replacement for evaluation of the hemodynamic changes and defining the reliable hemodynamic criteria of cardiopulmonary bypass weaning with the aid of cardiac output computer. In 7 patients, cardiopulmonary bypass weaning was uneventful at first attempt. The mean cardiac index was 2.73±0.32/min/m²and the mean CVP/PCWP ratio was 0.59±0.15. In 5 patients, at the first attempt of cardiopulmonary bypass weaning, the mean cardiac index was 1.74±0.20/min/m²and the amen CVP/PCWP ratio was 1.33±0.36. So cardiopulmonary bypass was resumed and the abnormal hemodynamic finding were corrected, then the cardiac index was resumed and the abnormal hemodynamic findings were corrected, then the cardiac index was 2.62±0.36/min/M²CVP/PCWP ratio was 0.83±0.05. These data suggest that the relationship between right and left ventricular filling pressures, the CVP/PCWP ratio, may be a more valuable guide during cardiopulmonary bypass weaning than the individual right and left ventricular filling pressures.

문항반응이론을 적용한 영상평가의 양호도 검증

이태구(Tae Koo Lee),박인용(In Yong Park),이한주(Han J. Lee) 한국체육측정평가학회 2010 한국체육측정평가학회지 Vol.12 No.2

이 연구는 이한주와 이태구(2004)의 후속연구로 제7차 교육과정 체육교과에서 도입된 수행평가의 실제성을 잘 반영한 평가방법인 영상평가를 고전검사이론과 문항반응이론 3모수 로지스틱 모형을 적용하여 검사 양호도를 검증하는 것이 목적이다. 이 목적을 달성하기 위하여 10문항으로 구성된 영상평가를 중학교 2학년 학생 453명을 대상으로 시행하였으며, 피검자의 응답데이터를 이용하여 타당도, 신뢰도, 문항특성, 검사특성을 살펴보았다. 또한, 문항의 편파성을 살펴보기 위해 집단 간 차별적으로 기능하는 문항을 선별하였다. 그 결과, 공인타당도는 .48로 나타났고, 고전검사이론을 적용한 신뢰도 지수(Cronbach`α)는 0.543, 문항반응이론을 적용한 신뢰도 지수(marginal reliability)는 0.558로 나타났다. 고전검사이론을 통한 문항의 분석 결과 1, 3, 7, 8번 문항이 난이도 혹은 변별도 측면에서 양호하지 않은 문항으로 나타났고, 문항반응이론을 통항 문항의 분석 결과 1, 6, 7, 8번 문항이 난이도, 변별도, 혹은 추측도 측면에서 양호하지 않은 문항으로 나타났다. 또한 남녀별 문항특성곡선과 M-H방법을 이용하여 차별기능문항을 선별한 결과 2, 9번 문항이 남, 녀 집단에 따라 차별적으로 기능하는 문항으로 나타났다. 검사정보의 경우 피검자의 능력수준이 0에서-2사이에 가장 높은 값을 산출하는 것을 확인하였다. 이러한 결과를 통해, 이 연구에서는 영상평가의 양호도 정도와 문항의 특성, 영상평가의 양식효과, 검사정보, 차별기능문항에 대한 논의를 제공하고 있다. Lee and Lee (2004) developed a multimedia test program for basketball unit using audio, video, and text to evaluate the 8th graders` knowledge such as rules, regulations, and traditions. The preliminary test contained live video clips of 10 questions. Although Lee and Lee (2004) provided the content validity and test-retest reliability, specific information about the goodness of test has not been reported. Thus, the purpose of this study was to examine goodness of multimedia test program. Participants were eighth graders (N=453) in middle school. Students completed 10 item multimedia test. Using students` test scores, validity, reliability, item and test characteristics were examined. Also, differentially functioning item were explored to examine item bias. Three parameter logistic model in item in item response theory (IRT) as well as classic test theory (CTT) was used. Results showed that concurrent validity was 0.48, reliability coefficient 0.543, and IRT`s marginal reliability was 0.558. Test items were analyzed using the CTT as well as the IRT. The CTT identified as unsual items (i.e., item number 1, 3, 7, and 8) showing lack of discrimination power. The IRT identified item number 1, 6, 7 and 8 were not appropriate in terms of the discrimination power. Test characteristics curve in gender and Mantel-Haenszel method identified differentially functioning item (i.e., item number 2 and 9) indicating two items are in favor of male students. Test information indicated that examinees with ability level between 0 and 2 showed best score. Discussions were provided in terms of the degree of goodness and item characteristics, and discrimination power of multimedia test program.