Comparison of respiratory function recovery in video-assisted thoracic surgery and thoracotomy in patients with lung cancer

학위논문 (석사)-- 서울대학교 대학원 : 의학과, 2014. 2. 김영환.Introduction: Lobectomy is standard treatment for early lung cancer, with lobectomy by thoracotomy and video-assisted thoracic surgery (VATS) as the most common types. Some studies have shown that VATS lobectomy enables faster recovery of respiratory function than does thoracotomy because the former involves making only a small incision in the chest to access the lung. However, these studies featured only short-term follow-up periods. We evaluated and compared the advantages of VATS lobectomy and thoracotomy in terms of recovery of pulmonary function in patients with early lung cancer. We increased the follow-up period and analyzed respiratory recovery rate during the late postoperative phase. Methods: Data on 649 patients with early lung cancer who underwent VATS lobectomy and thoracotomy at Seoul University Hospital and Bundang Seoul University Hospital from January 2005 to December 2010 were retrospectively reviewed. We classified the patients into the VATS (n = 406) and thoracotomy groups (n = 243) and compared baseline characteristics, pulmonary function data including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak flow rate (PFR) at 3, 6, and 12 months after surgery. Results: Among the 649 patients, the pulmonary function testing was conducted on 300, 497, and 362 cases at 3, 6, and 12 months after surgery and only 91 patients underwent all 3-, 6-, and 12-month pulmonary function tests. Repeated-measures analysis of covariance was performed on these 91 patients, and the 649 patients with missing data were analyzed by linear mixed effect model. All confounding factors that may have affected pulmonary function recovery were adjusted. Of the 91 patients, the VATS group exhibited a better FVC than did the thoracotomy group (p < 0.005). After analyzing the 649 patients by linear mixed model, the VATS group also showed better FVC than that of the thoracotomy group and this effect had an interaction over time (103.66 ± 1.27 vs. 96.37 ± 1.49, p < 0.0001 at 6 months, 107.01 ± 1.30, 100.28 ± 1.54, p = 0.0003 at 12 months). No significant differences were observed for in FEV1 or PFR. Conclusions: VATS lobectomy presented more advantages in terms of recovery of late postoperative FVC than did thoracotomy after surgery, but no significant group differences were observed in FEV1 and PFR. Long-lasting postoperative pain after thoracotomy is thought to be the cause of this result.Introduction 1 Methods 2 Results 4 Discussion 12 Conclusion 15 References 16 Abstract in Korean 18Maste

A Study on Violin Sonata No.1 in G Major, Op. 78 By Johannes Brahms

본 논문은 요하네스 브람스(Johannes Brahms, 1833-1897)의 바이올린 소나타 1번(Violin Sonata No.1 in G Major, Op.78)에 관한 연구이다. 브람스는 ‘고전적 낭만주의’의 대표자로서 고전성과 낭만적 어법을 훌륭하게 조화시킨 위대한 작곡가로 평가받는 인물이다. 엄격함과 진중함, 부드럽고 우아한 서정성을 함께 포용하고 있는 브람스의 내적인 음악 성향은 특히 실내악에서 더욱 두드러지게 나타나는데, 그 중 그의 첫번째 바이올린 소나타는 손꼽히는 명곡 중 하나로 실내악의 정수를 담고 있다. 이 작품은 ‘비의 노래’라는 부제를 가진 것으로도 유명하며, 이는 이 곡의 3악장에 클라우스 그로트(Klaus Groth, 1819-1899)의 시를 주제로 만든 자신의 가곡 ‘비의 노래’와 ‘여운’의 선율을 인용하였기 때문이다. 총 3개의 악장으로 이루어져 있으며, 제 1 악장은 소나타 형식, 제 2 악장은 3부 형식, 제 3 악장은 론도 형식으로 전형적인 고전주의 소나타 구조를 취하고 있다. 전 악장을 관통하는 공통의 주제와 리듬적 요소를 활용하여 작곡함으로써 곡 전체에 통일성을 부여하였으며 이 과정에서 그의 뛰어난 대위법적 기법과 변주 기법, 그 안에 적절히 배치된 반음계와 이명동음을 통한 전조, 감7화음의 연속 사용, 당김음과 교차리듬의 사용 등의 낭만시대의 어법들을 찾아볼 수 있다. 본 논문에서는 브람스의 Violin Sonata No.1 in G Major, Op.78을 통해 그의 삶과 음악적 특성을 이해하고 작품을 연주함에 있어 도움이 되고자 한다.;This thesis is a study on Violin Sonata No. 1 In G Major, Op.78 of Johannes Brahms(1833-1897). He was one of the neo-classicism composers of the Romantic Era. He not only stuck to the tradition of his music, but also harmonized wonderfully inside the Romantic Style. Brahms&amp;apos;s internal musical tendency, which involves strictness, prudence, and soft and elegant lyricism appeared remarkably in chamber music. His first violin sonata is one of the most outstanding masterpiece collections and shows the essence of chamber music. This piece is wellknown for its subtitle, &amp;apos;The Song of Rain&amp;apos;. It sings of the warm landscape of Southland and of gentle sadness. &amp;apos;The Song of Rain&amp;apos; consists of three movements. The first movement is the sonata form, the second can be determined ternary form, and the third is a rondo form. It adopts the stereotype of Classical sonata form. He provided unity by composing the whole movement with the same theme and by using rhythmical elements. He used his excellent contrapuntal techniques and variation techniques. In these musical forms based on the style in Classical period, he arranged the characteristic elements of the Romantic Era appropriately; chromatic scales, enharmonic modulation, the consecutive diminished seventh, syncopation and cross rhythm. What we can feel through his pieces is not rigid formality and rule, stubbornness, or simple seriousness, but his longing for nature, his gentleness from deep inside, his hearty sadness, and his serious concern about life. He was a very religious person who allowed inspiration to pass through him in a moment&amp;apos;s flash. He pursued spiritual freedom which allowed him not to be bound to any kind of ideology. In that point of view, he was obviously not an old-fashioned traditionalist, but an artistic pioneer. He was a great contrapuntist who emphasized the importance of principles and formal rules. But, he also participated actively in the aesthetic thought that took the lead in the artistic current in those days. He had a resolute position as an apparent mainstream in that time. Brahms&amp;apos;s music endlessly affected the composers of post generations. His grand achievement appears well in his first violin sonata.Ⅰ. 서론 1 Ⅱ. 본론 2 A. 브람스의 생애 2 B. 브람스 음악의 특징 5 C. Violin Sonata No.1 in G Major, Op.78의 작품 배경 8 D. Violin Sonata No.1 in G Major, Op.78의 작품 분석 10 1. 제 1 악장 11 2. 제 2 악장 28 3. 제 3 악장 35 Ⅲ. 결론 43 참고문헌 44 Abstract 4