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사지에 발생한 악성섬유조직구종의 치료 경험 (Treatment of MFH(Malignant fibrous histiocytoma) in Extremity)

  • 강종화;이원재;유대현;나동균;탁관철
    • Archives of Plastic Surgery
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    • 제35권4호
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    • pp.439-445
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    • 2008
  • Purpose: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. Methods: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. Results: The average age was 62.8(46 - 73) years old, average follow up period was 7.7(1 - 17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1 - 5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). Conclusion: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

덕흥리(德興里) 고분벽화(古墳壁畵)의 복식사적(服飾史的) 연구(硏究) (A Study of Historical Costume from the Mural Tombs of Dukheungri)

  • 박경자
    • 복식
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    • 제5권
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    • pp.41-63
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    • 1981
  • The mural portraits of the ancient Dukheungri tombs are very important for the study of our traditional costume because the tomb contains a stone. with the in-scription of the date of its erection, 408 A.D. and the name, and official status of the buried. The costumes shown in the mural paintings will be the basis on which historical research can be made concerning costumes before and after 400 A. D. The costume in the mural paintings is classified into five different categories; You (jacket), Po (overcoat), Go (trousers), Sang (skirt), and Gwan (hat). Comparing these categories with those of other mural paintings lead us to the following conclusions. 1. The length of the You (jacket) reaches below the buttocks and the sleeves are narrow. The edges of the sleeves are decorated with stripes. The You (jacket) over-laps on the right, center, and left sides, and there are many Jikryong (V-collar) and Danryong (rounded collar) styles, but it has a similar tendency to others of the Pyongyang area which exhibit many foreign influences. In a departure from tradition. the belts on the men's You (jackets) have only 3 knots in the front, with the back having more knots than the front. The belts of the women's You (jacket) seem to have had a band or button for fastening. We must re-evaluate the assumption that the You (jacket) and Go (trousers) of the northern peoples had the common characters of a belted You (jacket) and Po (over-coat) and that the Gorum originated from the Goryo or Unified Silla dynasty. The outside of the sleeves are longer and more to the side than the inner garment (underwear) so that the sleeves of the inner garment frequently overlapped the outer dress. The above mentioned facts have lead to the discovery of the "Hansam," "Tosi" and "Geodoolgi." 2. The Po (overcoat) was used only by the upperclasses and differs from those found in other mural tombs. The Po (overcoat) of the noble on the tomb mural is centered with an overlapping Jikryong (V-collar) while the other Po (overcoats) of the upperclasses are characterized by an overlap on the left, a Danryong (rounded collar) with two types of sleeves (wide and narrow). Foreign influences and traditional influences coexist in Po (overcoat). Belts have frontal knots without exceptions. The facts that the belts on the You (jackets) are on the front and the belts on the Po (overcoats) are on the back must be reexamined. 3. Go (trousers) is usually narrow, being wider in the rear and narrower below the knees. They were used by hunters on the back of horses with similar Go (trousers) from the Noinwoowha tombs being typical of the northern peoples. 4. Sang (skirts) are pleated as commonly seen in the Goguryo murals. The size of the pleat is varied, each pleat being characteristically wider and having different colors. Same types of pleat are discovered in Central Asia and China. It is uncertain whether the pleat of Goguryo was originated in Central Asia and China or only interrelated with those of the areas. 5. There are three kinds of Gwan (hats); Nagwan, Chuck, and Heukgun. Nag-wan was worn by the dead lords and their close relations. Chuck has three cone shaped horns. Heukgun was worn by military bandmen and horsemen. There are two kinds of hair styles. The up-style was used by the upperclass people closely related to lords, and other people used the Pungimoung hair style. The hair styles of the men and women are characterized by the Pungimoung style. which is a Chinese influence, but still retain their originality. The costume has a similar tendency from those from Yaksuri mural tombs, Anak No. 2 and Anak No. 3. We need to reexamine the costumes from $4{\sim}5$ century murals according to the Dukheungri murals. The costumes of Goguryo share many common factors with those of Western Asia, Central Asia and Ancient China (Han). It seems due to the cultural exchanges among the Northern peoples, the Western and Central Asians, and the Ancient Chinese. It may have resulted from the structural identity or morphological identity of the peoples, or their common social and natural environments and life styles. It will be very valuable to study the costumes of Japan, China, and Korea to find out the common factors. It is only regretful that the study is not based on direct observations but reported information made by 77 persons, because Dukheungri is an off-limits area to us.

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진행암 환자의 증상군 (Symptom Clusters in Advanced Cancer Patients)

  • 황선욱
    • Journal of Hospice and Palliative Care
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    • 제16권3호
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    • pp.139-144
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    • 2013
  • 진행성 암환자들은 동시에 여러 가지 증상을 겪고 있으며 그 정도가 중등도 이상으로 매우 높은 편이다. 환자 증상 조절을 위해 지금까지는 통증, 우울증, 피로 등 여러 각각의 증상에 대해서 치료하는 방법에 대해서 주로 연구 되어서 많은 발전이 있었지만 진행성 암환자의 특성상 동시에 발생하는 여러 가지 증상을 동시에 조절하는 데에는 한계가 있다. 따라서 최근에는 더욱 효과적인 증상 조절을 위해 이러한 각각의 증상에 대한 접근 방법에서 동시에 발생하는 여러 증상군(symptom cluster)에 대한 접근 방법에 대한 연구가 진행되고 있다. 증상군은 원인과 기전에 상관없이 다른 군과 독립적이면서 2개 이상의 서로 연관성 있는 동시에 발생하는 증상을 의미한다. 진행성 암환자에서 이러한 증상군을 이용하여 증상들 간에 연관성, 공통된 기전 등을 이해하면 개별 증상 치료보다 더 효과적으로 조절할 수 있고 약물 부작용 등을 줄일 수 있다. 또한 다른 증상을 예측할 수 있고 환자의 기능 평가, 생존 예측에도 도움이 된다. 아직 밝혀지지 않은 기전이 많고 증상 측정 도구와 인자 분석 방법이 다양하기 때문에 증상군이 일정하지 않은 면이 있지만 더욱 많은 연구를 통해서 효과적인 증상 조절과 삶의 질 향상에 기여하게 될 것이다.

영국 해상보험법상 담보(warranty)에 관한 연구 (A Study on the Rule of Warranty in the English Law of Marine Insurance)

  • 신건훈
    • 무역상무연구
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    • 제42권
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    • pp.275-305
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    • 2009
  • Marine insurance contracts, which intended to provide indemnity against marine risks upon the payment of price, known as a premium, originated in Northern Italy in the late 12th and early 13th centuries. The law and practice were later introduced into England through the Continent. It is, therefore, quite exact that English and European marine insurance law have common roots. Nevertheless, significant divergences between English and European insurance systems occurred since the late 17th century, mainly due to different approaches adopted by English courts. The rule of warranty in English marine insurance was developed and clarified in the second part of the 18th century by Lord Mansfield, who laid the foundations of the modern English law of marine insurance, and developed different approaches, especially in the field of warranty in marine insurance law. Since the age of Lord Mansfield, English marine insurance law has a unique rule on warranty. This article is, therefore, designed to analyse the overall rule of the rule of warranty in English marine insurance law. The result of analysis are as following. First, warranties are incorporated to serve a very significant function in the law of insurance, that is, confining or determining the scope of the cover agreed by the insurer. From the insurer's point of view, such the function of warranties is crucial, because his liability, agreed on the contract of insurance, largely depend on in, and the warranties, incorporated in the contract play an essential role in assessing the risk. If the warranty is breached, the risk initially agreed is altered and that serves the reason why the insurer is allowed to discharge automatically further liability from the date of breach. Secondly, the term 'warranty' is used to describe a term of the contract in general and insurance contract law, but the breach of which affords different remedies between general contract law and insurance contract law. Thirdly, a express warranty may be in any form of words from which the intention to warrant is to be inferred. An express warranty must be included in, or written upon, the policy, or must be contained in some document incorporated by reference into the policy. It does not matter how this is done. Fourthly, a warranty is a condition precedent to the insurer's liability on the contract, and, therefore, once broken, the insurer automatically ceases to be liable. If the breach pre-dates the attachment of risk, the insurer will never put on risk, whereas if the breach occurs after inception of risk, the insurer remains liable for any losses within the scope of the policy, but has no liability for any subsequent losses. Finally, the requirements on the warranty must be determined in according to the rule of strict construction. As results, it is irrelevant: the reason that a certain warranty is introduced into the contract, whether the warranty is material to the insurer's decision to accept the contract, whether or not the warranty is irrelevant to the risk or a loss, the extent of compliance, that is, whether the requirements on the warranty is complied exactly or substantially, the unreasonableness or hardship of the rule of strict construction, and whether a breach of warranty has been remedied, and the warranty complied with, before loss.

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유리질 중합체의 균열 Healing에 관한 연구 (제1보) -이론 모델링- (A study on Crack Healing of Various Glassy Polymers (part I) -theoretical modeling-)

  • 이억섭
    • 한국정밀공학회지
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    • 제3권1호
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    • pp.40-49
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    • 1986
  • Crack, craze and void are common defects which may be found in the bulk of polymeric materials such as either themoplastics or thermosets. The healing phenomena, autohesion, of these defects are known to be a intrinsic material property of various polymeric materials. However, only a few experimental and theoretical investigations on crack, void and craze healing phenomena for various polymeric materials have been reported up to date [1, 2, 3]. This may be partly due to the complications of healing processes and lacking of appropriate theoretical developments. Recently, some investigators have been urged to study the healing phenomena of various polymenic materials since the significance of the use of polymer based alloys or composites has been raised in terms of specific strength and energy saving. In the earlier published reports [1, 2, 3, 4], the crack and void healing velocity, healing toughness and some other healing mechanical and physical properties were measured experimentally and compared with predicted values by utilizing a simple model such as the reptation model under some resonable assumptions. It seems, however, that the general acceptance of the proposed modeling analyses is yet open question. The crack healing processes seem to be complicate and highly dependent on the state of virgin material in terms of mechanical and physical properties. Furthermore, it is also strongly dependent on the histories of crack, craze and void development including fracture suface morphology, the shape of void and the degree of disentanglement of fibril in the craze. The rate of crack healing may be a function of environmental factors such as healing temperature, time and pressure which gives different contact configurations between two separated surfaces. It seems to be reasonable to assume that the crack healing processes may be divided in several distinguished steps like stress relaxation with molecular chain arrangement, surface contact (wetting), inter- diffusion process and com;oete healing (to obtain the original strength). In this context, it is likely that we no longer have to accept the limitation of cumulative damage theories and fatigue life if it is probable to remove the defects such as crack, craze and void and to restore the original strength of polymers or polymer based compowites by suitable choice of healing histories and methods. In this paper, we wish to present a very simple and intuitive theoretical model for the prediction of healed fracture toughness of cracked or defective polymeric components. The central idea of this investigation, thus, may be the modeling of behavior of chain molecules under healing conditions including the effects of chain scission on the healing processes. The validity of this proposed model will be studied by making comparisons between theoretically predicted values and experimentally determined results in near future and will be reported elsewhere.

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자궁경부암의 방사선치료성적 (Radiotherapy Result of the Carcinoma of Uterine Cervix)

  • 박찬일;하성환;강순범;이효표;신면우
    • Radiation Oncology Journal
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    • 제2권1호
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    • pp.107-113
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    • 1984
  • One hundred sixty one patients with the carcinoma of uterine cervix received curative radiotherapy at the Department of Therapeutic Radiology, Seoul National University Hospital between December, 1979 and December, 1982. According to FIGO classification; stage $I_a 1(0.6\%)\;1_b\;8(5.0\%),\;II_a\;31(19.3\%),\;II_b\;66(41.0\%),\;III_a\;3(1.8\;%),\;III_b\;46(28.6\%)\;and\;IV_a\;6(3.7\;%)$. The proportion of early stage cancer is too small because most of them treated by surgery. External beam whole pelvic irradiation was done first with 10MV x-ray or Co-60 gamma ray upto 4,000 or 5,000 rad for early and advanced cases, followed by one or two courses of intracavitary radiation using Fletcher-Suit Applicator loading c Cs-137. Supplementary external radiation to pelvic side wall to bring dose to 6,000 or 6,500 rads, if there is parametrial involvement or positive pelvic lymph node. Of the 161 Patients, 49 Patients were lost to follow-up but only 22 patients were lost in disease free state. And so, 86.3 percent of the patients were followed to time of recurrence or to date. The results are as follows ; 1. Locoregional control rates according to stage is: stage I $100\%,\;II_a\;90.3\;%,\;II_b\;75.8\%,\;III_a\;66.7\%,\;III_b\;58.7\%\;and\;IV_a\;16.7\%$, respectively. 2. Persistent or recurrent disease were localized in pelvic cavity in 32 of 50 patients and 6 had distant metastasis only. 3. Rectal bleeding was the most common complication and appeared mostly between 6 and 24 months after radiotherapy. Most of them had transient minor bleeding and only 2 patients needed transfusion and 1 patient needed colostomy due to rectovaginal fistula. 4. The 3 year disease free survival rate is: stage I $100\%,\;II_a\;78.0\%,\;II_b\;60.6\%,\;III_a\;66.7\;III_b\;46.3\%\;and\;IN_a\;16.7\%$, respectively.

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중국의 창업판시장과 중소벤처기업의 상장전후 경영성과 분석에 관한 연구 (Chinese Growth Enterprise Market and Business Performance Analysis on Small and Medium Sized Firms and Venture Firms Before and After Listing)

  • 최문;손종원;장석주
    • 벤처창업연구
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    • 제9권3호
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    • pp.129-138
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    • 2014
  • 글로벌 경제위기이후 중국은 세계경제의 두 축의 하나로 부상하였으며, 한국경제에 가장 큰 영향을 미치는 국가로 자리매김 하고 있다. 그럼에도 불구하고, 현재까지 한국에서는 중국의 금융시장 특히는 자본시장에 관한 연구가 매우 적은 실정이다. 본 연구는 중국 심천증권거래소에 출범한 창업판시장을 살펴보고, 중국 중소벤처기업의 상장전후 경영성과를 비교분석하였다. 기술혁신 벤처기업과 고성장형 중소기업들의 자금조달을 목적으로 하는 중국 창업판시장에서 기업의 상장요건은 상해와 심천 증권거래소의 주시장보다 완화되어 있으며, 상장절차도 간소화되어 있다. 따라서 중국의 많은 기업들이 상장하고자 하며, 상장 경쟁도 매우 치열하다. 그리고 창업판시장에 최초로 상장한 36개 기업의 상장 전후의 경영성과를 살펴본 결과, 자기자본 순이익률 부채비율 영업이익증가율 등 3개 지표는 모두 크게 하락하였으며, 거의 모든 기업에서 이런 현상이 나타났다. 즉, 중국 창업판시장에 상장한 중소벤처기업들의 수익성과 성장성은 상장후 급속하게 하락하였으며, 많은 자금조달로 인하여 안정성만이 개선되어 있었다. 나아가 이러한 현상은 중소벤처기업들이 상장을 위하여 상장전 경영성과를 과대 포장한데서 기인한 것으로 분석되었다. 따라서 중국 증권감독관리위원회는 향후 상장기업에 대한 회계심사기준과 심사제도를 강화하여야 할 것이며, 분식회계기업에 대해서는 엄중한 제재조치를 실시하여 건전한 자본시장 풍토를 정착시켜야 할 것이다.

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타일드 디스플레이에서의 천리안 해양관측 위성영상을 위한 다중 입력 장치 및 멀티 스케일 인터랙션 설계 및 구현 (Design and Development of Multiple Input Device and Multiscale Interaction for GOCI Observation Satellite Imagery on the Tiled Display)

  • 박찬솔;이관주;김낙훈;이상호;서기영;박경신
    • 한국정보통신학회논문지
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    • 제18권3호
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    • pp.541-550
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    • 2014
  • 본 논문은 타일드 디스플레이에서 여러 사용자들이 천리안 해양관측 위성영상을 관측 및 분석하기 위하여 다중 입력 장치를 활용한 멀티스케일 인터랙션 기반의 가시화 시스템을 설명한다. 이 시스템은 멀티터치 스크린, 키넥트 동작 인식, 모바일 인터페이스를 제공하여 여러 사용자들이 타일드 디스플레이 화면에 근접하거나 원거리에서 다양한 인터랙션을 통하여 한반도 중심의 해양 환경 및 기후 변화 정보를 효과적으로 관측할 수 있다. 천리안 해양관측 위성영상은 고화질의 메모리양이 많아서 원본 영상을 작은 영상으로 분할한 멀티레벨 이미지 로드 기법을 사용하여 시스템의 부하를 줄이면서 사용자의 다양한 조작에서 타일드 디스플레이 화면에 매끄럽게 출력되도록 하였다. 이 시스템은 다중 사용자의 키넥트 제스처와 터치 포인트 입력 및 모바일 장치로 부터 입력된 정보를 일반화 처리하여 타일드 디스플레이 응용프로그램에 공통적으로 활용 가능한 다양한 인터랙션을 지원하였다. 또한 특정 날짜에 해당하는 시간 단위의 해양관측 위성 영상이 순차적으로 화면에 출력되며, 여러 사용자들이 동시에 위성영상을 자유롭게 확대 축소하고 상하좌우로 이동하며 다양한 기능의 버튼을 누르는 등의 인터랙션을 할 수 있도록 하였다.

남미공동시장의 역내 비대칭성과 지역개발협력 (Regional Asymmetries and Development Cooperation in MERCOSUR)

  • 현민
    • 이베로아메리카
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    • 제21권1호
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    • pp.57-105
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    • 2019
  • 본 논문은 남미공동시장의 역내 비대칭성의 특징과 해소를 위한 지역개발협력 중 FOCEM의 사례를 다루고 있다. 서던콘지역 국가들은 남미공동 시장의 형성을 통해 역내 균등 성장을 기대하였다. 그러나 출범 초기부터 구조적 비대칭성을 지니고 있었던 남미공동시장은 통합이 진척됨에 따라 정책적 비대칭성 또한 노출하였다. 이러한 구조적·정책적 비대칭성은 기본적으로 역내 '특수지위'를 점하고 있는 브라질의 남미공동시장에 대한 압도적 영향 때문이다. 이러한 역내 비대칭성에 대해 파라과이는 최약소국으로서 차별적 대우를, 우루과이는 역내 시장자유화의 동등한 적용을 원하며 아르헨티나는 글로벌가치사슬에 기반한 역내 생산통합을 강조한다. 비대칭 성문제에서 있어 일종의 청원자의 위치에 있는 파라과이, 우루과이, 아르헨티나에 비해 브라질은 민족적 이해에 따라 여러 선택을 할 수 있다. 이러한 상황 하에서 남미공동시장은 역내 비대칭성 해소를 위해 일종의 지역재분배기제인 FOCEM(구조조정수렴기금)을 설립하였다. FOCEM은 파라과이의 예에서 보듯이 일부 개발지표의 개선을 통해 개발격차해소를 가져왔지만 여전히 재정상의 한계와 시행력 부족 등이 문제로 남아 있다. 지역재분배 기제의 활성화와 비대칭성 해소를 위한 정책 조정을 위해서는 초국적 거버넌스를 통한 적극적인 정책이 요구되지만 이는 일정 정도의 주권의 위임이 요청하기에 회원국들은 이에 대해 주저하는 상황이다. 남미공동시장의 역내 비대칭성에 대한 해소 노력에도 불구하고 역내 비대칭성과 개발격차는 여전히 문제로 남아 있으며 또한 개별 국가 내 불균등 또한 난제로 남아 있다.

Role of Adjunctive Tranexamic Acid in Facilitating Resolution of Chronic Subdural Hematoma after Surgery

  • Kiyoon Yang;Kyung Hwan Kim;Han-Joo Lee;Eun-Oh Jeong;Hyon-Jo Kwon;Seon-Hwan Kim
    • Journal of Korean Neurosurgical Society
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    • 제66권4호
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    • pp.446-455
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    • 2023
  • Objective : Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution. Methods : Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA, and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated. Results : A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p<0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p<0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p<0.001). There was no TXA-related adverse event. Conclusion : The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.