• Title/Summary/Keyword: Leak location

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Surgical Strategy for Skull Base Chordomas : Transnasal Midline Approach or Transcranial Lateral Approach

  • Wang, Benlin;Li, Qi;Sun, Yang;Tong, Xiaoguang
    • Journal of Korean Neurosurgical Society
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    • v.65 no.3
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    • pp.457-468
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    • 2022
  • Objective : The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. Methods : We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. Results : Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. Conclusion : The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.

Diagnostic Methods of Traumatic Tracheobronchial Injury (외상성 기관-기관지 손상의 진단 방법)

  • Son, Shin-Ah;Cho, Suk-Ki;Do, Young-Woo;Lee, Hong-Kyu;Lee, Eung-Bae
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.675-680
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    • 2010
  • Background: The aim of this study was to identify the distinguishing clinicoradiologic findings of traumatic tracheobronchial injury. Material and Method: Between January 2003 and December 2009, six patients who underwent surgical repair for traumatic tracheobronchial injury due to blunt trauma were included in this study. We evaluated the mechanism of the injury, the coexisting injuries, the time until the making diagnosis and treatment, the diagnostic methods, the anatomic location of the injury and the surgical outcomes. Result: The mechanisms of injury were traffic accident and crushing forces. The frequent symptoms were subcutaneous emphysema, dyspnea and pain, and the common radiologic findings were pneumothorax, mediastinal emphysema, rib fracture and lung contusion. Only 2 patients were diagnosed by chest CT and the others were not diagnosed preoperatively. The location of injury was the trachea in 2 patients and the bronchial tree in 4 patients. There was no postoperative mortality or anastomotic leak; however, vocal cord palsy occurred in one patient. The most distinguishing sign was persistent lung collapse even though the chest tube was connected with negative pressure. Conclusion: Although it was not easy to diagnose traumatic tracheobronchial injury without a clinical suspicion, the distinguishing clinical symptoms and CT findings could help to make an early diagnosis without performing bronchoscopy.

Facters Affecting Recurrence after Video-assisted Thoracic Surgery for the Treatment of Spontaneous Pneumothotax (자연기흉에 대한 비디오흉강경수술후 재발에 영향을 미치는 요인들)

  • 이송암;김광택;이일현;백만종;최영호;이인성;김형묵;김학제
    • Journal of Chest Surgery
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    • v.32 no.5
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    • pp.448-455
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    • 1999
  • Background: Recent developments in techniques of video-assisted thoracic surgery(VATS) and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery. Especially, it will probably become the treatment of choice of spontaneous pneumothorax(SP). There is, however, a high recurrence rate, high cost, and paucity of long-term results. We report the results of postoperative follow-up and analyze perioperative parameters affected to recurrence, retrospectively. Material and Method: From march 1992 to march 1997, 276 patients with spontaneous pneumothorax underwent 292 VATS procedures. Conversion to open thoracotomy was necessitated in eight patients, and this patients excluded from the study. Result: The sex distribution was 249 males and 31 females. The mean age was 28.1 12.2 years(range, 15 to 69 years). Primary SP was 237cases(83.5%) and secondary SP was 47cases(16.5%). The major underlying lung diseases associated with secondary SP were tuberculosis 27cases(57.4%) and emphysema 8cases (38.3%). Operative indications included Ipsilateral recurrence 123(43.9%), persistent air-leak 53(18.9%), x-ray visible bleb 40(14.3%), tension 30(10.7%), contralateral recurrence 21(7.5%), uncomplicated first episode 8(2.9%), bilateral 3(1.1%), complicated episode 2(0.7%). Blebs were visualized in 247cases(87%) and 244cases(85.9%) performed stapled blebectomy. Early postoperative complications occurred in 33 cases(11.6%): 16 prolonged air-leak more than 5 days(four of them were required a second operation and found missed blebs); 5 bleeding; 5 empyema; 2 atelectasis; 1 wound infection. No deaths occured. The mean operative time was 52.8 23.1 minutes(range, 20 to 165 minutes). The mean d ration of chest tube drainage was 5.0 4.5 days(range, 2 to 37 days). The mean duration ofhospital stay was 8.2 5.5 days (range, 3 to 43days). At a mean follow-up 22.3 18.4 months(range, 1 to 65 months), 12 patients(4.2%) were lost to follow-up. There were 24 recurrences and seven patients underwent second operation and 6 patients(85.7%) were found the missed blebs. 12 perioperative parameters(age, sex, site, underlying disease, extent of collapse, operative indication, size of bleb, number of bleb, location of bleb, bleb management, pleural procedure, prolonged postoperative air-leak) were analyzed statistically to identify significant predictors of recurrence. The significant predictors of recurrence was the underlying disease[17.0%(8/47): 6.8%(16/237), p=0.038], prolonged postoperative air-leakage[37.5%(6/16): 6.7%(18/268), p=0.001], and pleural procedure [11.4%(19/167): 4.3%(5/117), p=0.034]. Blebectomy has less recurrence rate then non-blebectomy [8.2%(20/244) : 10.0%(4/40), p>0. 5]. However, this difference was not statistically significant(p=0.758). Conclusion: We conclude that it is important that we shoud careful finding of bleb during VATS due to reducing of recurrnece, and cases of no bleb identified and secondary spontaneous pneumothorax were indicated of pleurodectomy. VATS is a valid alternative to open procedure for the treatment of spontaneous pneumothorax with less pain, shorter hospital stay, more rapid return to work, high patient acceptance, less scar and exellent cosmetics. But, there is high recurrence rate and high cost, and than it is necessary to evaluate of long-term results for recurrence and to observate carefully during VATS.

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A Study on the Quantitative Process Facility Standards that Require H2S Toxic Gas Detectors and Location Selection for Emergency Safety (H2S 독성가스감지기가 필요한 정량적 공정설비 기준 및 비상시 안전을 위한 위치선정 방안에 대한 연구)

  • Choi, Jae-Young;Kwon, Jung-Hwan
    • Journal of the Korean Institute of Gas
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    • v.22 no.2
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    • pp.90-96
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    • 2018
  • Design techniques for minimizing the damage caused by leakage of $H_2S$ gas, contained in natural gas and petroleum, have been widely studied abroad in chemical plants that purify and process natural gas and petroleum. However, there is no domestic engineering practice and regulation of $H_2S$. In accordance with the circumstances, this study proposes the quantitative criteria of process equipment to install $H_2S$ toxic gas detector as 500 ppm and explains the valid basis. The $H_2S$ gas dispersion radius up to IDLH 100 ppm is calculated by ALOHA under previous $H_2S$ gas leak accident scenario. The weather conditions of modeling include the conditions of Ulsan, Yeosu and Daesan, the three major petrochemical complexes in Korea. The long radius up to 100 ppm was derived in order of Ulsan, Daesan, Yeosu. For emergency safety the dispersion radius up to 100 ppm of the $H_2S$ gas obtained in this study should be extended to apply the additional $H_2S$ toxic gas detector, and local climate conditions should be considered.

Exergy Analysis of Cryogenic Air Separation Unit for Oxy-fuel Combustion (순산소 연소를 위한 초저온 공기분리장치의 엑서지 분석)

  • Choi, Hyeung-chul;Moon, Hung-man;Cho, Jung-ho
    • Journal of the Korean Institute of Gas
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    • v.23 no.1
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    • pp.27-35
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    • 2019
  • In order to solve the global warming and reduce greenhouse gas emissions, $CO_2$ capture technology was developed by applying oxy-fuel combustion. But there has been such a problem that its economic efficiency is low due to the high price of oxygen gases. ASU is known to be most suitable method to produce large quantity of oxygen, to reduce the oxygen production cost, the efficiency of ASU need to be improved. To improve the efficiency of ASU, exergy analysis can be used. The exergy analysis provides the information of used energy in the process, the location and size of exergy destruction. In this study, the exergy analysis was used for process developing and optimization of large scale ASU. The process simulation of ASU was conducted, the results were used to calculate the exergy. As a result, to reduce the exergy loss in the cold box of ASU, a lower operating pressure process was suggested. It was confirmed the importance of heat leak and heat loss reduction of cold box. Also, the unit process of ASU which requires thermal integration was confirmed.

A Numerical Study of Building Orientation Effects on Evacuation Standard in Case of Toxic Gas Leakage (독성 가스 누출 시 건물 방향이 대피 기준에 미치는 영향에 관한 수치 해석 연구)

  • Seungbum Jo
    • Journal of the Korean Institute of Gas
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    • v.27 no.4
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    • pp.12-18
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    • 2023
  • The effective evacuation strategy according to the accident scenario is crucial to minimize human casualties in the event of toxic gas leak accidents. In this study, the effect of the direction of a building and the location of an industrial complex on the increase in indoor concentration and outdoor diffusion was examined under the same leakage conditions, and effective evacuation criteria were established. In addition, the guidelines for building directions were suggested when constructing buildings that would mitigate human damage caused by chemical accidents. Three scenarios where buildings faced the front, side, and rear of the leakage direction were investigated through CFD simulations. The results revealed that when the building faced the industrial complex, both indoor and outdoor average gas concentrations increased significantly, reaching up to 120 times higher than the other two orientations. Moreover, the indoor space was filled with toxic gas substances more than twice in the same time due to the rapid increase of indoor concentration rate. In cases where the building's windows were positioned at the front, toxic gas stagnation occurred around the building due to pressure differences and reduced flow velocities. Based on our findings, the implementation of these guidelines will contribute to safeguarding residents by minimizing exposure to toxic gas during chemical accidents.

Method to Derive the Optimal Vent Position when Flammable Liquid Leaks Based on CFD (CFD 기반 인화성 액체 누출 시 최적의 환기구 배치 도출 방안)

  • Eun-Hee Kim;Seung-Hyo An;Jun-Seo Lee;Byung-Chol Ma
    • Journal of the Korean Institute of Gas
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    • v.28 no.1
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    • pp.11-18
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    • 2024
  • If flammable liquid leaks, vapor evaporated from the pool can cause poisoning or suffocation to workers, leading to secondary accidents such as fires and explosions. To prevent such damage, ventilation facilities shall be installed when designing indoor workplaces. At this time, the behavior varies depending on the characteristics of the leaked chemical, so it is necessary to select a suitable vent location according to the material. Therefore, 3D CFD simulations were introduced to derive optimal vent position and ventilation efficiency was quantitatively evaluated by vent position. At this time, assuming a situation in which flammable liquids leak at indoor workplaces to form pools, the concentration of vapor evaporated from pools was compared to derive the optimal vent position. As a result of research on toluene with high vapor density, ventilation efficiency was confirmed to be the highest at the upper supply-lower exhaust, and it is judged that introducing it can achieve about 3.7 times ventilation effect at the same maintenance cost. Through this study, it is expected that the workplace will be able to secure workers' safety by applying simulation results and installing ventilation ports.

A Study on the Fengshui Shapes of the Four Propitious Sites Recorded in The Canonical Scripture (『전경』에 기록된 사명당(四明堂)의 풍수 물형(物形) 연구)

  • Shin Young-dae
    • Journal of the Daesoon Academy of Sciences
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    • v.41
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    • pp.133-178
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    • 2022
  • This study investigates if four propitious sites (四明堂, sa myeongdang) identified in Daesoon Jinrihoe's The Canonical Scripture correspond with the orthodox descriptions of dragon, energy hub, sand, and water (龍穴砂水, yong hyeol sa su) which are held by Fengshui as conditions necessary for that specific designation. In this study, these conditions, based on the shape of the site-formations, were observed via through on-site surveys and the application of the theories presented by traditional books on Fengshui. First, the dragon veins (龍脈, yongmaek) of the energy hub of the Five Immortals Playing Baduk (五仙圍碁穴 oseonwigi- hyeol) on Mount Hoemun in Sunchang consists of solid soil, is like a spiderweb, rises and lays prone, winds in every direction, and looks almost disconnected while actually remaining connected. Second, the Fengshui characteristics of the energy hub of Worship Held by Buddhist Monks from Abroad (胡僧禮佛穴, hoseungyebul- hyeol) on Mount Seungdal in Muan is that the branching feet (枝脚 jigak) support the mountain range by forming a valley to the left and right of the dragon veins that stretch from the peak of Mount Seungdal. Also, the direction-changing helm (橈棹 yodo) supports the mountain range solidly can be said to be well-developed. It is likewise noted that there is an excellent change in dragon veins in that exhibit curvature that spans being high, low, rising, and lying. This makes it appear as though the dragon is wriggling back and forth. Third, the state of the energy hub of Celestial Maidens Weaving Silk (仙女織錦穴, seonnyojikgeum-hyeol) on Sonryong Ridge in Jangseong County demonstrates overall harmony between mountain and water as it is near Mount Ju and Mount An and has a solid water outlet to which it is tightly fastened such that its energy does not leak out. Meanwhile, the positioning of its blue dragon of the east, red phoenix of the south, white tiger of the west, and black tortoise of the north is so intimate that its long flow can be said to be spinning. The Songryong Ridge area where energy hub was formed between soil and bedrock is the right land for a great favored location as it corresponds with Fengshui logic in an exemplary manner. Fourth, the Fengshui characteristics of the energy hub of Subjects Receiving the Imperial Command (群臣奉詔穴, gunshinbongjo-hyeol) at Baerye-jeon Field in Taein can be described as embracing the village snuggly as it centers around Mount Wangja, and its blue dragon and white tiger respond to each other. Additionally, a clear distinction between host and guest is noticeable in the positions of Mount Ju and Mount An. The flowing body of water in front of the village wraps around that village as a Horizontal Water Formation (橫水局, hoengsuguk), and vigorous vapor from the earth draws breath as the yin-yang energy of the landscape courses through the earth. As dragon veins, the range of the mountain, are like the blood vessels within the human body and the dragon is compared to the limbs, the energy hub of Subjects Receiving the Imperial Command at Baerye-jeon Field in Taein can be identified as a favored location that was formed directly by the sky and earth.

Recent Progress in Air-Conditioning and Refrigeration Research : A Review of Papers Published in the Korean Journal of Air-Conditioning and Refrigeration Engineering in 2013 (설비공학 분야의 최근 연구 동향 : 2013년 학회지 논문에 대한 종합적 고찰)

  • Lee, Dae-Young;Kim, Sa Ryang;Kim, Hyun-Jung;Kim, Dong-Seon;Park, Jun-Seok;Ihm, Pyeong Chan
    • Korean Journal of Air-Conditioning and Refrigeration Engineering
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    • v.26 no.12
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    • pp.605-619
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    • 2014
  • This article reviews the papers published in the Korean Journal of Air-Conditioning and Refrigeration Engineering during 2013. It is intended to understand the status of current research in the areas of heating, cooling, ventilation, sanitation, and indoor environments of buildings and plant facilities. Conclusions are as follows. (1) The research works on the thermal and fluid engineering have been reviewed as groups of fluid machinery, pipes and relative parts including orifices, dampers and ducts, fuel cells and power plants, cooling and air-conditioning, heat and mass transfer, two phase flow, and the flow around buildings and structures. Research issues dealing with home appliances, flows around buildings, nuclear power plant, and manufacturing processes are newly added in thermal and fluid engineering research area. (2) Research works on heat transfer area have been reviewed in the categories of heat transfer characteristics, pool boiling and condensing heat transfer and industrial heat exchangers. Researches on heat transfer characteristics included the results for general analytical model for desiccant wheels, the effects of water absorption on the thermal conductivity of insulation materials, thermal properties of Octadecane/xGnP shape-stabilized phase change materials and $CO_2$ and $CO_2$-Hydrate mixture, effect of ground source heat pump system, the heat flux meter location for the performance test of a refrigerator vacuum insulation panel, a parallel flow evaporator for a heat pump dryer, the condensation risk assessment of vacuum multi-layer glass and triple glass, optimization of a forced convection type PCM refrigeration module, surface temperature sensor using fluorescent nanoporous thin film. In the area of pool boiling and condensing heat transfer, researches on ammonia inside horizontal smooth small tube, R1234yf on various enhanced surfaces, HFC32/HFC152a on a plain surface, spray cooling up to critical heat flux on a low-fin enhanced surface were actively carried out. In the area of industrial heat exchangers, researches on a fin tube type adsorber, the mass-transfer kinetics of a fin-tube-type adsorption bed, fin-and-tube heat exchangers having sine wave fins and oval tubes, louvered fin heat exchanger were performed. (3) In the field of refrigeration, studies are categorized into three groups namely refrigeration cycle, refrigerant and modeling and control. In the category of refrigeration cycle, studies were focused on the enhancement or optimization of experimental or commercial systems including a R410a VRF(Various Refrigerant Flow) heat pump, a R134a 2-stage screw heat pump and a R134a double-heat source automotive air-conditioner system. In the category of refrigerant, studies were carried out for the application of alternative refrigerants or refrigeration technologies including $CO_2$ water heaters, a R1234yf automotive air-conditioner, a R436b water cooler and a thermoelectric refrigerator. In the category of modeling and control, theoretical and experimental studies were carried out to predict the performance of various thermal and control systems including the long-term energy analysis of a geo-thermal heat pump system coupled to cast-in-place energy piles, the dynamic simulation of a water heater-coupled hybrid heat pump and the numerical simulation of an integral optimum regulating controller for a system heat pump. (4) In building mechanical system research fields, twenty one studies were conducted to achieve effective design of the mechanical systems, and also to maximize the energy efficiency of buildings. The topics of the studies included heating and cooling, HVAC system, ventilation, and renewable energies in the buildings. Proposed designs, performance tests using numerical methods and experiments provide useful information and key data which can improve the energy efficiency of the buildings. (5) The field of architectural environment is mostly focused on indoor environment and building energy. The main researches of indoor environment are related to infiltration, ventilation, leak flow and airtightness performance in residential building. The subjects of building energy are worked on energy saving, operation method and optimum operation of building energy systems. The remained studies are related to the special facility such as cleanroom, internet data center and biosafety laboratory. water supply and drain system, defining standard input variables of BIM (Building Information Modeling) for facility management system, estimating capability and providing operation guidelines of subway station as shelter for refuge and evaluation of pollutant emissions from furniture-like products.

Comparison of the Reconstruction Routes after Esophagectomy for Esophageal Cancer (식도암 절제후 식도 재건경로의 비교)

  • Lee, Seung-Yeoll;Kim, Kwang-Taik;Choi, Young-Ho;Kim, Il-Hyun;Baik, Man-Jong;Sun, Kyung;Lee, In-Sung;Kim, Hyoung-Mook
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.806-812
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    • 1999
  • Background: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. Material and Method: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. Result: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). Conclusion: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

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