• Title/Summary/Keyword: Operation margin

Search Result 402, Processing Time 0.031 seconds

Prostatic Bleeding after Prostatic Biopsy Effects Oncological Outcomes with Laparoscopic Radical Prostatectomy

  • Takai, Tomoaki;Inamoto, Teruo;Komura, Kazumasa;Tsujino, Takuya;Matsunaga, Tomohisa;Yoshikawa, Yuki;Uchimoto, Taizo;Saito, Kenkichi;Tanda, Naoki;Minami, Koichiro;Uehara, Hirofumi;Ibuki, Naokazu;Takahara, Kiyoshi;Nomi, Hayahito;Kiyama, Satoshi;Azuma, Hayahito
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.17 no.3
    • /
    • pp.1373-1377
    • /
    • 2016
  • Background: We vigorously reviewed patients' operation record who had adhesion of the Denonvilliers' fascia and found out most of these patients had prostatic bleeding after prostatic gland biopsies. We examined the magnitude of prostatic bleeding and frequency after biopsies and the relationship with oncological outcomes. Materials and Methods: A total of 285 patients were selected for the final analyses. Inclusion criteria were as follows: receiving MRI three weeks after biopsiesand laparoscopic radical prostatectomy within 300 days after biopsy. We divided the patients into two groups with (group A) or without (group B) prostatic bleeding. We examined the magnitude of prostatic bleeding after biopsies and the relationship with operation time (OT), positive surgical margin (PSM), biochemical recurrence (BCR) and other factors. Furthermore, we created a logistic-regression model to derive a propensity score for prostatic bleeding after biopsies, which included all patient and hospital characteristics as well as selected interaction terms, and we examined the relationship with PSM and BCR. Results: In all patients, the OT in the group B was shorter than the group A (p < 0.001). Prostatic bleeding was associated with PSM (p=0.000) and BCR (p=0.036). In this propensity-matched cohort, 11 of 116 patients in the group B had PSM as compared with 36 of 116 patients from group A (match-adjusted odds ratio, 4.30; 95%CI confidence interval, 2.06 to 8.96; P=0.000). In addition, eight of 116 patients in group B encountered BCR, as compared with 18 of 116 patients in group A (match-adjusted odds ratio, 2.48; 95%CI, 1.03 to 5.96; P=0.042). Kaplan-Meier analysis in the propensity matching cohort showed a significant biochemical recurrence-free survival advantage for being free of prostate bleeding after biopsies. Conclusions: Our findings in the present cohort should help equip surgeons to pay attention to careful excision especially for those who experienced deferred prostatic bleeding.

Giant Neurofibroma on Both Buttocks (양측 엉덩이의 거대 신경섬유종)

  • Kim, Ji Hoon;Burm, Jin Sik;Kim, Yang Woo;Kang, So Ra;Kim, Hyoung Kyoung
    • Archives of Plastic Surgery
    • /
    • v.36 no.4
    • /
    • pp.512-515
    • /
    • 2009
  • Purpose: Neurofibromatosis(NF) is an autosomal - dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop - shaped ligation before removal of the giant NF in both buttocks. And then we could successfully reduce the amount of hemorrhage during the operation. Methods: A 46 - year - old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about $30{\times}20cm$ in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop - shaped suture ligation(weaving the thread up and down in a loop - shaped pattern, leaving a space of 2 cm between each loop) with a straight needle and prolene 2 - 0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged - shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop - shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. Results: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscense did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow - up, the functional and cosmetic result was excellent. Conclusion: A continuous loop - shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.

A Study on Optimization of Spray Type Flue Gas Desulfurization (FGD) System (모사 탈황흡수탑을 이용한 Spray Type 탈황설비 최적운전 방안에 관한 연구)

  • An, Hi-Soo;Park, Seung-Soo;Kim, Ki-Hyoung;Kim, Young-Ho
    • Applied Chemistry for Engineering
    • /
    • v.18 no.1
    • /
    • pp.29-35
    • /
    • 2007
  • Recently, due to narrow margin on design factor of flue gas desulfurization (FGD) systems or aging of systems, some problems such as decrease of $SO_2$ removal efficiency and difficulty on coping with unstable state are arising on FGD systems. On this study, to cope with these problems several methods such as adjustment of reagent pH, inlet $SO_2$ concentration, variation of units of operation pump, installation of liquid distribution ring (LDR) were attempted to increase the $SO_2$ removal using spray type simulated FGD system. Also, sulfite and Al/Fx ion effects on limestone blinding were experimented. When three absorber recirculation pumps were operated, $SO_2$ removal was increased by 12% in comparison with that of two pumps operation. $SO_2$ removal was increased by 2~7% after installation of LDR. Dissolved oxygen increased up to 0.5 ppm and limestone binding effect was alleviated after injection of dibasic acid (DBA) with the concentration of 500 and 1,000 ppm. When $Al^{3+}$ and $F^-$ ions were coexisting, the dissolution rate of limestone was decreased by 20%.

Joint Design and Strength Evaluation of Composite Air Spoiler for Ship (선박용 복합재 에어 스포일러의 체결부 설계 및 강도 평가)

  • Pi, June-Woo;Jeon, Sang-Bae;Lee, Guen-Ho;Jo, Young-Dae;Choi, Jin-Ho;Kweon, Jin-Hwe
    • Composites Research
    • /
    • v.28 no.4
    • /
    • pp.219-225
    • /
    • 2015
  • Air spoiler, which can reduce the drag during operation, can be considered as a possible means to reduce carbon dioxide emission and to increase fuel efficiency. In this study, a composite air spoiler was designed and tested by static and repeated loads. The Green Water Pressure of 0.1 MPa a ship experiences during operation was perpendicularly applied to the air spoiler. Air spoiler was manufactured with sandwich panel which has glass fabric face and balsa core. Multiple sandwich panels were assembled to steel frame by bolt joint. The joint was designed to have bearing failure and examined by static and fatigue tests. Tests showed that the designed joint has enough margin of safety to endure joint failure. The developed sandwich panel to air spoiler is planned to be applied to a large scale commercial ship.

Analysis of the Impact of the 8th Basic Plan for Long-term Electricity Supply and Demand on the District Heating Business Through Optimal Simulation of Gas CHP (가스 열병합발전 최적 시뮬레이션 분석을 통한 집단에너지 사업자에 미치는 8차 전력 수급계획의 영향 분석)

  • Kim, Young Kuk;Oh, Kwang Min;Kim, Lae Hyun
    • Korean Chemical Engineering Research
    • /
    • v.56 no.5
    • /
    • pp.655-662
    • /
    • 2018
  • To respond effectively to climate change following the launch of the new climate system, the government is seeking to expand the use of distributed power resources. Among them, the district heating system centered on Combined Heat and Power (CHP) is accepted as the most realistic alternative. On the other hand, the government recently announced the change of energy paradigm focusing on eco-friendly power generation from the base power generation through $8^{th}$ Basic Plan for Long-term Electricity Supply and Demand(BPE). In this study, we analyzed the quantitative effects of profit and loss on the CHP operating business by changing patterns of the heat production, caused by the change of energy paradigm. To do this, the power market long-term simulation was carried out according to the $7^{th}$ and $8^{th}$ BPE respectively, using the commercialized power market integrated analysis program. In addition, the CHP operating model is organized to calculate the power and heat production level for each CHP operation mode by utilizing the operating performance of 830MW class CHP in Seoul metropolitan area. Based on this, the operation optimization is performed for realizing the maximum operating profit and loss during the life-cycle of CHP through the commercialized integrated energy optimization program. As a result, it can be seen that the change of the energy paradigm of the government increased the level of the ordered power supply by Korean Power Exchange(KPX), decreased the cost of the heat production, and increased the operating contribution margin by 90.9 billion won for the 30 years.

Elastofibroma Scapulae (견갑부 탄성섬유종)

  • Kang, Hyun-Guy;Cho, Hwan-Seong;Park, Weon-Seo;Lee, Joo-Hyuk;Kim, Han-Soo
    • The Journal of the Korean bone and joint tumor society
    • /
    • v.12 no.2
    • /
    • pp.118-125
    • /
    • 2006
  • Purpose: We report elastofibroma which is a rare fibrous lesion that most commonly occurs in the between subscapularis and thoracic cage. Materials and Methods: Four patients include one man and three women, the average age was 70 years and the average follow up period was six months. Two patients had on left side, two patients had on both sides. Main symptom was palpable mass. One patient complained mild pain, two complained scapular snapping. Results: All four masses removed with marginal or wide margin. Average mass size was 9.7${\times}$7.2${\times}$3.8 cm. Preoperative symptoms disappeared after surgery. All of the patients have returned to their daily living and showed no recurrence. There was no serious complication such as limitation of shoulder motion and winged scapula. Conclusion: Elastofibroma scapulae can be diagnosed through patient's age, tumor location and radiological finding without preoperative biopsy. When patient is symptomless, observation is enough without surgical operation. Surgical operation considered for relieve of symptoms of pain and snapping.

  • PDF

Small Break LOCA Analysis for RCP Trip Strategy for YGN 3&4 Emergency Procedure Guidelines (영광3, 4호기 비상운전지침용 원자로냉각재펌프 정지전략을 위한 소형냉각재상실사고 분석)

  • Seo, Jong-Tae;Bae, Kyoo-Hwan
    • Nuclear Engineering and Technology
    • /
    • v.27 no.2
    • /
    • pp.203-215
    • /
    • 1995
  • A continued operation of RCPs during a certain small break LOCA may increase unnecessary inventory loss from the RCS causing a severe core uncovery which might lead to a fuel failure. After TMI-2 accident, the CEOG developed RCP trip strategy called “Trip-Two/Leave-Two” (T2/L2) in response to NRC requests and incorporated it in the generic EPG for CE plants. The T2/L2 RCP trip strategy consists of tripping the first two RCPs on low RCS pressure and then tripping the remaining two RCPs if a LOCA has occurred. This analysis determines the RCP trip setpoint and demonstrates the safe operational aspects of RCP trip strategy during a small break LOCA for YGN 3&4. The trip setpoint of the first too RCPs for YGN 3&4 is calculated to be 1775 psia in pressurizer pressure based on the limiting small break LOCA with 0.15 ft$^2$ break size in the hot leg. The analysis results show that YGN 3&4 can maintain the core coolability even if the operator fails to trip the second too RCPs or trips at worst time. Also, the YGN 3&4 RCP trip strategy demonstrates that both the 10 CFR 50.46 requirements on PCT and the ANSI standards 58.8 requirements on operator action time can be satisfied with enough margin. Therefore, it is concluded that the T2/L2 RCP trip strategy with a trip setpoint of 1775 psia for YGN 3&4 can provide improved operator guidance for the RCP operation during accidents.

  • PDF

Reconstruction of Congenital Absence of Vagina using Vulvoperineal Fasciocutaneous Flap: A Case Report (외음회음 근막피부피판을 이용한 선천성 질결여증의 재건례)

  • Kim, Mi-Sun;Kim, Chul-Han;Lee, Yong-Sek;Kang, Sang-Gue;Tark, Min-Sung
    • Archives of Plastic Surgery
    • /
    • v.37 no.6
    • /
    • pp.831-834
    • /
    • 2010
  • Purpose: Congenital absence of the vagina is a rare case. It occurs as a result of Mullerian duct aplasia or complete androgen insensitivity syndrome. The reconstructive modality includes skin graft, use of intestine and various methods of flap. We report a patient who underwent vulvoperineal fasciocutaneous flap to reconstruct congenital absence of the vagina, while the external genitalia and ovaries are normal. Methods: A 26-year-old woman presented with vaginal agenesis. Under general anesthesia, a U-shaped incision was made between the urethral meatus and the anus. The new vaginal pocket was created up to the level of the peritoneal reflection between the urinary structures and the rectum. Next, the vulvoperineal fasciocutaneous flaps were designed in a rectangular fashion. Flap elevation was begun at the lateral margin which the adductor longus fascia was incised and elevated, and the superficial perineal neurovascular pedicle was invested by the fascial layer. The medial border was then elevated. A subcutaneous tunnel was created beneath the inferior of the labia to rotate the flaps. The left vulvoperineal flap was rotated counterclockwise and the right was rotated clockwise. The neovaginal pouch was formed by approximating the medial and lateral borders. The tubed neovagina was then transposed into the cavity. Results: In 3 weeks, the vaginal canal remained supple After 6 weeks, the physical examination showed normalappearing labia majora and perineum with an adequate vaginal depth. A year after the operation, the patient had a 7 cm vagina of sufficient width with no evidence of contractures nor fibrous scar formation. The patient was sexually active without difficulty. Conclusion: Although many methods were described for reconstruction of vaginal absence, there is not a method yet to be approved as a perfect solution. We used the vulvoperineal fasciocutaneous flap to reconstruct a neovagina. This method had a following merits: a single-stage procedure, excellent flap reliability, the potential for normal function, minimal donor site morbidity and no need for subsequent dilatation, stents, or obturators. We thought that this operation has a good anatomic and functional results for reconstruction of the vagina.

A Comparison of Minilaparotomy and Laparoscopic Sterilization (Minilaparotomy 불임술(不妊術)과 복강경불임술(腹腔鏡不妊術)에 관(關)한 비교연구(比較硏究))

  • Bai, Byoung-Choo
    • Clinical and Experimental Reproductive Medicine
    • /
    • v.4 no.1
    • /
    • pp.17-25
    • /
    • 1977
  • Anderson(1937), Power and Barnes(1941) reported a study concerning a method of tubal sterilization in association with peritoneoscopy or laparoscopy in which they cauterized the tubes. There appears to have been a hiatus of interest in sterilization (cold or hot) associated with laparoscopy until reintroduction by Palmer(1963), Frangenheim(1964) and Steptoe(1967). On the other hand, for interval female sterilization, however, minilaparotomy is relatively new. By Saunder and Munsick(1972), John Lyle(1974), Frank Stubb(1974), Vitoon(1973) and B.C. Bai(1975), their own technique for interval female sterilization requires 2.0 to 2.5cm, incision at the margin of the mons pubis. In Korea, female sterilization by means of minilaparotomy firstly reported by B.C. Bai using Bai's uterine elevator, of his own device, early in 1975. Recently inteval female sterilization by laparoscopy and minilaparotomy are widely accepted throughout the world especially in Asian countries. Minilaparotomy is carried out from 1974, laparoscopic sterilization from 1976, and in this study each of 250 cases of those were analysed and discussed for the comparison at Seoul Red Cross Hospital. (1) In the age distribution, numerous clients were in their age of $31{\sim}35$ in laparoscopy as well as minilaparotomy. Average 33.7 years in L and 33.2 years in M. (M=minilaparotomy, L=laparoscopic sterilization) (2) As regarding living children, women having 3 children represented the greatest number, 113 cases out of 250 in M group and 102 cases out of 250 in L group. Average No. of child are 2.9 in Land 3.1 in M. (3) Concidering the operation day in the menstrml cycle, the greatest number of cases, those who underwent tubal sterilization during the days of $26{\sim}$, next during the $6{\sim}10$ days of the cycle in both group. (4) Concidering the operation time, 188 cases by laparoscopy were performed in $6{\sim}10$ minutes, 33 cases within 5 minutes and 24 cases in $11{\sim}15$ minutes. Maximum 50 minutes, minimum 4 minutes and average 8.3 minutes. The majority of cases (154 cases) by minilaparotomy required $6{\sim}10$ minutes and 67 cases $11{\sim}15$ minutes, 6 cases within 5 minutes. Maximum 30 minutes, minimum 4 minutes and average 10.4, minutes. In both groups, most of the reasons for the extra length were surgical difficulties such as thick abdominal wall, pelvic adhesion, less cooperation of patients in early period of this study. (5) Hospital stay after operation in L group required $3{\sim}4$ hours in 125 cases, $2{\sim}3$ hours in 41 cases, $4{\sim}5$ hours in 32 cases out of 250. Maximum 8 hours, minimum 1 hour and average 3.8 hours. In M group hospital stay required $6{\sim}7$ hours in 100 cases, over 7 hours in 85 cases, $5{\sim}6$ hours in 46 cases and so on. Maximum 14 hours, minimum 2 hours and average 6.5 hours. (6) The time between operation and gas passing in the majority cases of both groups, were $12{\sim}36$ hours. A veragetime 20.3 hours in L and 27.2 in M. (7) Laparoscopic sterilization coincident with induced abortion were carried out in 27 cases, laparoscopy with minilaparotomy to control for mesosalpingeal hemorrhage in 1 case. Minilaparotomy coincident with induced abortion were performed in 65 cases, D and C whit polypectomy, menstrual regulatian, and remaval of IUD in 1 case respectively. (8) In L group, 1 case of mesosalpingeal hemorrhage, 1 case of abdominal wall infection were complicated during operation. In M group, 1 case of uterine perfaration, 1 case of abdominal wall infection, 1 case of hemorrhage from omentum and 1 case of bloody vaginal discharge were complicated. No intensive medical treatment was required for those minor complications in both groups. (9) No failure has been recognized and these two sterilization techniques might be the simple, safe and the most effective method for permanent contraception at present time. There is no significant clinical defference between L and M group in this study.

  • PDF

The Causes of Reoperation after Meniscectomy of the Lateral Discoid Meniscus (원판형 연골 절제술 후 재수술의 원인)

  • Lim, H.C.;Shim, J.H.;Ha, H.S.
    • Journal of the Korean Arthroscopy Society
    • /
    • v.3 no.2
    • /
    • pp.115-120
    • /
    • 1999
  • Purpose : After the total or partial meniscectomy of the lateral discoid meniscus, many patients complain the residual pain or the recurrent symptoms of the meniscus, and some of them need reoperation. We analyzed the causes of the reoperation after initial meniscectomy. Material & Method : Two hundred seventy three patients with the symptomatic lateral discoid meniscus were treated by arthroscopic meniscectomy between October, 1989 and September, 1998. Of the 273 patients, 69 patients were treated by total meniscectomy and 204 patients were treated by partial meniscectomy. The male to female sex ratio was 1:1.04, and the average of the age was 23.1 years old(from 4 to 59 years old). The reoperation was done in 8 patients, of which 1 was the case of total meniscectomy at the initial operation, and the rest 7 were the case of partial meniscectomy. Results : Of the 8 reoperations, 3 patients recurred the meniscal symptoms within the 3rd week after the initial operation, and 5 patients recurred beyond the 3rd week after the initial operation. Among the 3 patients of carly recurrence, 2 patients showed inadequate sizes of the remnant meniscus, and 1 patient showed posterolateral instability of the remained meniscus. Among the 5 patients of late recurrence, 3 patients showed rerupture of the meniscus, and 2 patients showed associated pathology of degenerative arthritis following osteochondritis dissecans. Conclusions : The reoperation rate after initial meniscectomy of the lateral discoid meniscus was higher in partial meniscectomy than total meniscectomy. During the operation of the lateral discoid meniscus, we must determine the adequate resectional margin, confirm the remnant meniscus by probing, and look for the associated pathologies.

  • PDF