• Title/Summary/Keyword: Operation margin

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Reconstruction on Patellar Area with the Saphenous Island Flap (복재동맥 도서형 피판을 이용한 슬개골부의 재건)

  • Kim, Young Joon;Lee, Jong Wook;Ko, Jang Hyu;Seo, Dong Guk;Oh, Suk Joon;Jang, Young Chul
    • Archives of Plastic Surgery
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    • v.33 no.5
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    • pp.536-540
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    • 2006
  • Purpose: The soft tissue injuries of the patellar area are difficult problems because of insufficient arterial blood supply and lack of muscle layer. There have been many methods for reconstructing the soft tissue injuries of the patellar area such as primary closure, skin graft, local flap and free tissue transfer. However, each method has some limitations in their application. After the first introduction, the fasciocutaneous flaps are widely used to reconstruct the soft tissue injuries. The saphenous nerve, one of the superficial sensory nerves in the lower leg, is supplied by the saphenous artery and its vascular network. We used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. Methods: From March 2002 to May 2005, we used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. The flap was elevated with saphenous nerve, saphenous vein and saphenous artery and its vascular network. The flap donor site was reconstructed with primary closure or split-thickness skin graft. Results: Five cases survived completely but 1 case developed partial necrosis of the skin on the upper margin of the flap. However, the necrosis was localized on skin layer, and we reconstructed with debridement and split-thickness skin graft only. After the operation, there was no contracture or gait disturbance in any patient. Conclusion: In conclusion, the saphenous fasciocutaneous island flap is safe, comfortable and effective method to reconstruct the soft tissue injuries of the patellar area.

Tuberculous Mediastinitis Developed After Surgical Treatment of Giant Chondrosarcoma on Chest Wall-one case report- (흉부 거대 연골육종의 외과적 치료후 발생한 결핵성 종격동염-1례 보고-)

  • 이재훈;양수호;김혁;정원상;김영학;이철범;강정호;지행옥
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.348-348
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    • 1997
  • A 48 year old man, has been suffering from a growing chondrosarcoma of sternum which has deeply invading the anterior mediastinum: He underwent wide resection of the chest wall tumor including a 4 cm free margin of normal tissue on all portions. The tumor as 15 × 16× 10cm in size arising from sternum and include both proximal one third of the clavicle and the 1 st, 2nd, and 3rd coital cartilages. The resected skeletal defect in the anterior wall was very large after wide resection of the'tumor and reconstructed due to paradoxical chest wall movement with sandwich like method of double over lapping Marlex mesh and methylmethacreylate, and steel wires. The soft tissue reconstructive procedure was dont with myocutaneous flap transposition use of pectoralis muscle. But the patient go infected with tuberculosis in the mediastinum two months after the operation. We had removed all of previously inserted prosthetics and performed curettage and drainage. Recently we experienced a case with giant chondrosarcoma of the sternum associated with tuberculous mediastinitis. The patient had an uneventful postoperative course and was discharged with adjuvant treatment such as antituberculous medication for 1 year.

Tuberculous Mediastinitis Developed After Surgical Treatment of Giant Chondrosarcoma on Chest Wall -one case report (흉부 거대 연골육종의 외과적 치료후 발생한 결핵성 종격동염 -1례 보고)

  • 이재훈;양수호
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.248-252
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    • 1997
  • A 48 year old man, has been suffering from a growing chondrosarcoma of sternum which has deeply invading the anterior mediastinum: He underwent wide resection of the chest wall tumor including a 4 cm free margin of normal tissue on all portions. The tumor as 15 $\times$ 16$\times$ 10cm in size arising from sternum and include both proximal one third of the clavicle and the 1 st, 2nd, and 3rd coital cartilages. The resected skeletal defect in the anterior wall was very large after wide resection of the'tumor and reconstructed due to paradoxical chest wall movement with sandwich like method of double over lapping Marlex mesh and methylmethacreylate, and steel wires. The soft tissue reconstructive procedure was dont with myocutaneous flap transposition use of pectoralis muscle. But the patient go infected with tuberculosis in the mediastinum two months after the operation. We had removed all of previously inserted prosthetics and performed curettage and drainage. Recently we experienced a case with giant chondrosarcoma of the sternum associated with tuberculous mediastinitis. The patient had an uneventful postoperative course and was discharged with adjuvant treatment such as antituberculous medication for 1 year.

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Open Heart Surgery During the first 3 Months of Life (3개월 이하의 영아에서의 개심술)

  • 서경필
    • Journal of Chest Surgery
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    • v.26 no.3
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    • pp.180-185
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    • 1993
  • From February 1982 to December 1991, 49 neonates and 105 infants in less than 3 months of age underwent open heart surgery in Seoul National University Hospital. There were 98 males and 56 females, and their mean ages were 16 days in neonatal group and 67 days in early infant group. Their body weight and height were less than 3 percentile of normal developmental pattern. In order of decreasing incidence, the corrected conditions included Transposition of great arteries with or without ventricular septal defect [43], isolated ventricular septal defect [34], Total anomalous pulmonary venous return [21], Pulmonary atresia with intact ventricular septum [9] and others [47]. Various corrective or palliative procedures were performed on these patients; Arterial switch operation [36], patch closure for ventricular septal defect [34], Repair of total anomalous pulmonary venous return [21], RVOT reconstruction for congenital anomalies with compromised right ventricular outflow tract [17]. Profound hypothermia and circulatory arrest were used in 94 patients [ 61% ]: 42 patients [ 85.7% ] for neonatal group and 52 patients [ 49.5% ] for early infant group. The durations of circulatory interruption were within the safe margin according to the corresponding body temperature in most cases [ 84% ]. The hospital mortality was 36.4% ; 44.9% in neonatal group and 32.4% in infant group 1 to 3 months of age. The mortality was higher in cyanotic patients [ 46.6% ], in those who underwent palliative procedures [ 57.8% ], in patients whose circulatory arrest time was longer than safe periods [ 60% 0] and in patients who had long periods of cardiopulmonary bypss and aortic crossclamping. In conclusion, there has been increasing incidence of open heart surgery in neonates and early infants in recent years and the technique of deep hypothermia and circulatory arrest was applied in most of these patients, and the mortality was higher in cyanotic neonates who underwent palliative procedures and who had long cardiopulmonary bypass , aortic cross-clamping and circulatory arrest.

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NONSPECIFIC INFLAMMATION IN THE FACE (안면부에 발생한 비특이성 염증)

  • Hyun Young-Min;Park Rae-Chung;Jung Hwan-Sug;Choi Soon-Chul;Park Tae-Won;You Dong-Soo
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.27 no.1
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    • pp.273-281
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    • 1997
  • Patient with complaints of swelling, pain in the maxillaly region and discomfort visited Seoul National University Dental Hospital in August last year. Clinical examination and diagnostic imagings implied he was suffered from fungal hyphal infection but no causative fungus was found by the histopathologic and microbiologic investigation. Therefore he was diagnosed with nonspecific inflammation. But as yet, we do think this case is very similar to some kinds of mucormycosis. So we presented this case for more thorough discussion.Followings are founded in the examination. 1. Patient had suffered from Diabetes mellitus and complained of stuffness, headache, swelling in buccal cheeks and paresthesia And we found more maxillary bony destruction and ulcer with elevated margin in the palate by clinical examination. 2. In the first visit, Plain films revealed general bony destruction of the maxilla, radiopaqueness in the sinonasal cavities. or and MRI showed soft tissue mass filled in the paranasal sinus except frontal sinus and bony destruction in involved bones. 3. No causative bacteria and fungus was found in the biopsy and microbiologic cultures. 4. Caldwell-Luc operation and curettage were carried and antJbiotics were taken for 4 months. But now he was worse than in the past 5. In the second visit, involvement of orbit, parapharyngeal sinus, clivus, cavernous sinus and middle cranial fossa were seen clearly in the or and MRI.

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Treatment of Salivary Duct Carcinoma: A Case Report (타액선관 상피암의 치험례)

  • Moon, Suk Ho;Yoo, Gyeol;Choi, Yun Seok;Lim, Jin Soo;Han, Ki Taik
    • Archives of Craniofacial Surgery
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    • v.9 no.1
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    • pp.23-26
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    • 2008
  • Salivary duct carcinoma is a high-grade adenocarcinoma arising from the ductal epithelium and has very low prevalence. We report a case of salivary duct carcinoma in high risk group with satisfactory result. A 65-year-old male was referred to our clinic complaining of mass on Rt. cheek. Preoperative CT and MRI shows $2.0{\times}1.9cm$ sized multilobulated, cystic mass on the superficial lobe of Rt. parotid gland and multiple lymph node enlargement thorough the Rt. internal jugular chain. Total parotidectomy and modified radical neck dissection with adjuvant radiation therapy was performed. Pathologic result was salivary duct carcinoma and resection margin was free. Postoperative radiation therapy with 6400 cGy($200cGy{\times}12fx$) was performed. During the 24-months of follow up periods, recurrence or complications associated with operation and radiation therapy was not observed. Salivary duct carcinoma is rare disease with very poor prognosis. Lymph node metastasis is commonly accompanied at the time of diagnosis. Distant metastasis is the most common cause of death. Total parotidectomy, radical neck disssection and adjuvant radiation therapy can be the appropriate modality for the control of the salivary duct carcinoma especially in high risk group.

Case Report of Breast Reconstruction with SIEA Flap (얕은 하복벽동맥 천공지 피판을 이용한 유방 재건술 - 2예 보고 -)

  • Lee, Min-Young;Eom, Jin-Sup;Lee, Taik-Jong
    • Archives of Reconstructive Microsurgery
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    • v.19 no.1
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    • pp.56-60
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    • 2010
  • Purpose: Breast reconstruction with abdominal flap has many advantages. However, it might cause abdominal complications such as bulging or hernia. SIEA (Superficial inferior epigastric artery) flap is the most advanced form of abdominal flap which has no adverse effect on abdominal fascia. We report 2 cases of breast reconstruction with SIEA flap with reference review. Methods: From Jun 2006 to Jan 2009, 110 patients underwent breast reconstruction with free abdominal flap. We tried to find the SIEA in every cases and adopted SIEP flap if the diameter was larger than 1mm and it had visible pulsation. 2 patients underwent breast reconstruction with SIEA flap. After design of abdominal flap SIEA was investigated with portable Doppler. SIEA was usually found 4-5 cm lateral to the midline. Flap was elevated with SIEA and SIEV to their maximal length at hiatus. Results: There were no complications, such as infection, hematoma, and necrosis of flap. In both cases, flaps survived completely with excellent vascularity and breast reconstruction was successful. In one case, there was skin necrosis of mastectomy flap, and it was healed by conservative management. Conclusion: With the SIEA flap, donor site morbidity can be minimized along with reduction of operation time. If there is reliable SIEA, SIEA flap would be the preferred skills. However, the limitation of the SIEA flap is difficulty in identifying the SIEA. The reason for less availability of the flap in Korea might include high prevalence of the Caesarian section scar and relatively higher level of the lower margin of the flap.

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The noise impacts of the open bit line and noise improvement technique for DRAM (DRAM에서 open bit line의 데이터 패턴에 따른 노이즈(noise) 영향 및 개선기법)

  • Lee, Joong-Ho
    • Journal of IKEEE
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    • v.17 no.3
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    • pp.260-266
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    • 2013
  • The open bit line is vulnerable to noise compared to the folded bit line when read/write for the DRAM. According to the increasing DRAM densities, the core circuit operating conditions is exacerbated by the noise when it comes to the open bit line 6F2(F : Feature Size) structure. In this paper, the interference effects were analyzed by the data patterns between the bit line by experiments. It was beyond the scope of existing research. 68nm Tech. 1Gb DDR2, Advan Tester used in the experiments. The noise effects appears the degrade of internal operation margin of DRAM. This paper investigates sense amplifier power line splits by experiments. The noise can be improved by 0.2ns(1.3%)~1.9ns(12.7%), when the sense amplifier power lines split. It was simulated by 68nm Technology 1Gb DDR2 modeling.

Application of Cubic Spline Synthesis in On-Line Core Axial Power Distribution Monitoring (실시간 노심출력분포 측정을 위한 3차 SPLINE합성법의 응용)

  • In, Wang-Kee;Yoo, Hyung-Keun;Auh, Geun-Sun;Lee, Chong-Chul;Kim, Si-Hwan
    • Nuclear Engineering and Technology
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    • v.23 no.3
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    • pp.316-320
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    • 1991
  • The Core Operating Limit Supervisory System (COLSS) is digital computer based on-line monitoring system that is designed to assist the operator in monitoring of the Limiting Conditions for Operation. A current COLSS calculates axial power distribution based on in-core detector signals using 5th order Fourier series method. It was found that the 5th elder Fourier series method was not accurate for certain axial power shapes, especially saddle power shapes, resulting in thermal margin decrease. A cubic spline synthesis was applied to the COLSS in order to improve the axial power distribution monitoring for the various axial power shapes. The results showed that the cubic spline synthesis simulated more accurately the axial power shapes, up to 5% in RMS errors, compared to those of the Fourier series.

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A FLOW AND PRESSURE DISTRIBUTION OF APR+ REACTOR UNDER THE 4-PUMP RUNNING CONDITIONS WITH A BALANCED FLOW RATE

  • Euh, D.J.;Kim, K.H.;Youn, Y.J.;Bae, J.H.;Chu, I.C.;Kim, J.T.;Kang, H.S.;Choi, H.S.;Lee, S.T.;Kwon, T.S.
    • Nuclear Engineering and Technology
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    • v.44 no.7
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    • pp.735-744
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    • 2012
  • In order to quantify the flow distribution characteristics of APR+ reactor, a test was performed on a test facility, ACOP ($\underline{A}$PR+ $\underline{C}$ore Flow & $\underline{P}$ressure Test Facility), having a length scale of 1/5 referring to the prototype plant. The major parameters are core inlet flow and outlet pressure distribution and sectional pressure drops along the major flow path inside reactor vessel. To preserve the flow characteristics of prototype plant, the test facility was designed based on a preservation of major flow path geometry. An Euler number is considered as primary dimensionless parameter, which is conserved with a 1/40.9 of Reynolds number scaling ratio. ACOP simplifies each fuel assembly into a hydraulic simulator having the same axial flow resistance and lateral cross flow characteristics. In order to supply boundary condition to estimate thermal margins of the reactor, the distribution of inlet core flow and core exit pressure were measured in each of 257 fuel assembly simulators. In total, 584 points of static pressure and differential pressures were measured with a limited number of differential pressure transmitters by developing a sequential operation system of valves. In the current study, reactor flow characteristics under the balanced four-cold leg flow conditions at each of the cold legs were quantified, which is a part of the test matrix composing the APR+ flow distribution test program. The final identification of the reactor flow distribution was obtained by ensemble averaging 15 independent test data. The details of the design of the test facility, experiment, and data analysis are included in the current paper.