• Title/Summary/Keyword: Operation margin

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Laparoscopic Assisted Total Gastrectomy (LATG) with Extracorporeal Anastomosis and using Circular Stapler for Middle or Upper Early Gastric Carcinoma: Reviews of Single Surgeon's Experience of 48 Consecutive Patients (원형 자동문합기를 이용한 체외문합을 시행한 복강경 보조 위전절제술: 한 술자에 의한 연속적인 48명 환자의 수술성적분석)

  • Cheong, Oh;Kim, Byung-Sik;Yook, Jeong-Hwan;Oh, Sung-Tae;Lim, Jeong-Taek;Kim, Kab-Jung;Choi, Ji-Eun;Park, Gun-Chun
    • Journal of Gastric Cancer
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    • v.8 no.1
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    • pp.27-34
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    • 2008
  • Purpose: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performing LATG for the gastric cancer located in the upper or middle portion of the stomach. Materials and Methods: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. Results: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago-jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was $212{\pm}67$ minutes. The mean total number of retrieved lymph nodes was $28.9{\pm}10.54$ (range: $12{\sim}64$) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the 8MI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.

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A Research on Private apparel Brand's Product Strategy in Discounted Stores. (할인점의 의류PB 상품전략에 관한 연구)

  • Choi, Sung-Sik;Kim, Pan-Jin;Lee, Sang-Youn
    • The Journal of Industrial Distribution & Business
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    • v.2 no.2
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    • pp.25-38
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    • 2011
  • After the financial crisis, what has been the rapidly growth of large supermarkets, stores, and restaurants linked to concerns that have already reached saturation point, but the new opening large supermarkets is expected to continue into the future. The major supermarkets are continue to grow outward but growth slowed. And that is expected to continue differentiation of the product, acceptance the customer needs, acquiring high margin of sales products. Then the ongoing development of PB brand is to be positioned effective marketing strategy for overcoming the period of slow growth. In addition, big three local supermarkets continue to launch a clothing PB brand, expansion and operation strategy for the situation and based on this study and the success of the domestic large-Mart's PB and PB identifying problem and the need for differentiation and profit for the successful strategy is to discuss in this study. This research looks at the concept of major market's private brand, the strategy, the success example and the prospects, and views the globally rapid-growing private brands, not only having the limited role of distributing the products as retailers, but also having a control of the distribution channel as a manufacturing company. World's major advanced distribution companies, to differentiate their companies' products and increase the profitability, are putting a lot of efforts into private brand products, and there are many good examples that are globalizing, externally expanding, and creating high financial results. In this research, we presented three major domestic discount stores as examples to show that there is a need for a differentiated private brand management strategy in the saturated discount store industry in Korea. Also, we aim to provide a new product strategy for the future that has been saturated with discount stores to the limit, by providing suggestions that private brand products can be used as weapons with the strongest competiveness in the retail industry through pursuing store differentiations from thorough market analysis and product researches, meeting the customers' needs, and obtaining high margins. PB products, particularly clothing design, a thorough market analysis and product development trends and customer needs to reflect the acquisition of High margin differentiated powerful products and sustainable growth through the stores, large supermarkets, congested, a new breakthrough that can give a good opportunity to provide implications discount stores, new product strategy based on ways to limit proposed. This study discount the major three companies studied, the less strain is a generalization. In the future, domestic and local discount store brand PB, SPA brand that the multinational comparative analysis of the value of the PB expansion strategy centered on clothing, additional studies will be needed.

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Postoperative Radiation Therapy in the Soft-tissue Sarcoma (연부 조직 육종의 수술 후 방사선 치료 결과)

  • Kim Yeon Shil;Jang Hong Seok;Yoon Sei Chul;Ryu Mi Ryeong;Kay Chul Seung;Chung Su Mi;Kim Hoon Kyo;Kang Yong Koo
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.485-495
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    • 1998
  • Purpose : The major goal of the therapy in the soft tissue sarcoma is to control both local and distant tumor. However, the technique of obtaining local control has changed significantly over the past few decades from more aggressive surgery to combined therapy including conservative surgery and radiation and/or chemotherapy. We retrospectively analyzed the treatment results of the postoperative radiation therapy of soft tissue sarcoma and its prognostic factor. Materials and Methods : Between March 1983 and June 1994, 50 patients with soft tissue sarcoma were treated with surgery and postoperative radiation therapy at Kang-Nam St. Mary's hospital. Complete follow up was possible for all patients with median follow up duration 50 months (range 6-162 months). There were 28 male and 32 female patients. Their age ranged from 6 to 83 with a median of 44 years. Extremity (58$\%$) was the most frequent site of occurrence followed by trunk (20$\%$) and head and neck (12$\%$). Histologically malignant fibrous histiocytoma (23$\%$), liposarcoma (17$\%$), malignant schwannoma (12$\%$) constitute 52$\%$ of the patients. Daily radiation therapy designed to treat all areas at a risk for tumor spread upto dose of 4500-5000 cGy. A shrinking field technique was then used and total 55-65 Gy was delivered to tumor bed. Twenty-five patients (42$\%$) received chemotherapy with various regimen in the postoperative period. Results : Total 41 patients failed either with local recurrence or with distant metastasis. There were 29 patients (48$\%$) of local recurrence. Four patients (7$\%$) developed simultaneous local recurrence and distant metastasis and 8 patients (13$\%$) developed only distant metastasis. Local recurrence rate was rather higher than of other reported series. This study included patients of gross residual, recurrent cases after previous operation, trunk and head and neck Primary This feature is likely explanation for the decreased local control rate. Five of 29 Patients who failed only locally were salvaged by re-excision and/or re-irradiation and remained free of disease. Factors affecting local control include histologic type, grade, stage, extent of operation and surgical margin involvement, lymph node metastasis (p<0.05). All 21 patients who failed distantly are dead with progressive disease at the time of this report. Our overall survival results are similar to those of larger series. Actuarial 5 year overall survival and disease free survival were 60.4 $\%$, 30.6$\%$ respectively. Grade, stage (being close association with grade), residual disease (negative margin, microscopic, gross) were significant as a predictor of survival in our series (p<0.05). Conclusion : Combined surgery and postoperative radiation therapy obtained 5 year survival rate comparable to that of radical surgery.

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Pseudo-Integrators in the Evolution of Bores′s Broiler Integration (육계 통합체계(계열화) 전개 과정상의 사이비 계열주체 문제)

  • 김정주;박영인
    • Korean Journal of Poultry Science
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    • v.20 no.2
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    • pp.107-114
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    • 1993
  • The structure change in the broiler industry of Korea has been taking place very rapidly toward the direction of integrated production and marketing system. During the course of the evolution into the integrated structure, however, a number of small business entities, uncountable nationally but a minimum of a dozen, that previously engaged in the supply of production factors or live bird transaction also tended to get involved in the new system as a disguised or pseudo-integrator, having brought a lot of problems not only to the farmers but also to the development of integrated structure. The pseudo-integrator is generally characterized by limited functions in such a way of supplying chicks and feeds to and collecting grown birds from farmers under the contract at a fixed farmer's payment in practically the same pattern as a partial or quasi-integration, which intends to act as if an integrator in a stratagem to simply enjoy a margin simply from selling supplies and buying products for a certain period of time. The grower making a contract with appears to be a farmer who used to be an Independent and speculating but not able to join in the normal system of evolving integration. The problems of a pseudo-integrator center on the financial loss to a contract farmer, because the falsified integrator has to become easily bankrupt and run away when the price of live broiler continually stays below the cost of production, even though he is able to make a tremendous profit otherwise which is the real purpose of the operation for. It is true that the volatile market, fluctuating the price up more than doubled in a month and down to a half in a few weeks, makes the pseudo-integrator find the room for such a fraudulence. In addition, its activity also adversely affect the evolution of the integration due to rather negative image on structure change in general. It is recommended that the farmers need to better understand the real picture of the integrated system so as not to be swindled by a disguised, small scale agribusiness agent. By the same token, it is also equally required to have the whole industry integrated completely as early as possible. The Joint effort to get rid of pseudo-integrators' problems shall be put for the industry development moving toward the integration. No doubt a pseudo-integrator must be a temporary player for chance emerging during the course of structure change into the integrated, though.

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Adaptive Design Techniques for High-speed Toggle 2.0 NAND Flash Interface Considering Dynamic Internal Voltage Fluctuations (고속 Toggle 2.0 낸드 플래시 인터페이스에서 동적 전압 변동성을 고려한 설계 방법)

  • Yi, Hyun Ju;Han, Tae Hee
    • Journal of the Institute of Electronics and Information Engineers
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    • v.49 no.9
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    • pp.251-258
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    • 2012
  • Recently, NAND Flash memory structure is evolving from SDR (Single Data Rate) to high speed DDR(Double Data Rate) to fulfill the high performance requirement of SSD and SSS. Accordingly, the proper ways of transferring data that latches valid data stably and minimizing data skew between pins by using PHY(Physical layer) circuit techniques have became new issues. Also, rapid growth of speed in NAND flash increases the operating frequency and power consumption of NAND flash controller. Internal voltage variation margin of NAND flash controller will be narrowed through the smaller geometry and lower internal operating voltage below 1.5V. Therefore, the increase of power budge deviation limits the normal operation range of internal circuit. Affection of OCV(On Chip Variation) deteriorates the voltage variation problem and thus causes internal logic errors. In this case, it is too hard to debug, because it is not functional faults. In this paper, we propose new architecture that maintains the valid timing window in cost effective way under sudden power fluctuation cases. Simulation results show that the proposed technique minimizes the data skew by 379% with reduced area by 20% compared to using PHY circuits.

An Experimental Study of the Healing Process on Several Heterogenous Bone Grafts in Rabbit Mandible;Histologic and Biometric study (가토(家兎) 상악골(上顎骨) 결손부(缺損部)에 수종(數種)의 이종골(異種骨) 이식후(移植後) 치유과정(治癒過程)에 관(關)한 연구(硏究))

  • Oh, Hee-Kyun;Ryu, Sun-Youl
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.11 no.1
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    • pp.117-129
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    • 1989
  • The commercial availability of processed heterogenous bone has provided the surgeons with almost unlimited supply, avoidance of additional operation and prevention of the postoperative complications. In addition to these merits, unnecessary bone bank, easy availibility and storage have been achieved. The purpose of this study was to compare and examine the healing capacity of Kiel bone, Pyrost and Osteovit which used as the processed heterografts for the reconstruction of bony defect. Twenty rabbits weighing about 1.7-2.0 Kg were selected and divided into two groups. In experimental group A, the left mandibular defect was allowed to fill with blood, and the right defect was filled with Kiel bone. In experimental group B, the left defect was grafted with Pyrost, and the right with Osteovit. The experimental animals were sacrified after 1, 2, 4 and 8 weeks and the grafted site was studied histologically. To evaluate the strength of healed bone, 2 rabbits from each experimental group and a nonoperated control were sacrified at the 6th week after implantation and used for biometric testing on universal testing machine. The results obtained were as follows : 1. It was considered that these heterogenous bone grafts has feeble or absent immunogenicity since all of them appeared to evoke little inflammatory or forign body reaction. 2. In all experimental groups, new bone formation began from the adjacent region of host bone and extended progressively into the defect sites. New bone was partly formed within the intertrabecular space of the implant and gradually united with the bone that formed at the margin of the host bone. 3. With Pyrost bone formation was rapid and prominent comparing with other graft materials. 4. Osteovit was begun to be absorbed from 2 weeks, and Kiel bone from 4 weeks, however Pyrost was remained to be intact until the end of 8 weeks. 5. As the results of tensile test, the mean values of maximum tensile stress were 1.11${\uparrow}$ $Kgf/mm^{2}$ in Pyrost implanted specimens, 0.85 $Kgf/mm^{2}$ in Osteovit, 0.42 $Kgf/mm^{2}$ in Kiel bone, 0.66 $Kgf/mm^{2}$ in blood filled specimens and 1..13 $Kgf/mm^{2}$ in control. These results indicate that heterogenous bones grafted have little antigenicity to the host tissue, and that they mediate effectively osteoconduction by providing the scaffold for the bone formation. Pyrost and Osteovit appeared to be suitable for the clinical use.

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AN EXPERIENCE OF UNILATERAL INCOMPLETE CLEFT LIP REPAIR BY USING BARDACH'S TRIANGULAR FLAP (Bardach 삼각피판법을 이용한 편측성 불완전 구순열의 수복 경험)

  • Ryu, Sun-Youl;Han, Chang-Hun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.4
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    • pp.348-355
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    • 2006
  • Tennison was the first to recognize and to preserve the Cupid's bow by lowering the peak in the margin of the cleft. Randall had modified the Tennison's repair based on accurate measurements. Bardach's technique evolved from the basic concept of triangular flap cleft lip repair described by Tennison-Randall method. Precise measurements are used to define the dimensions of the equilateral triangular flap, which is created on the cleft side and is inserted into an equilateral triangular defect on the noncleft side. Two symmetrical vertical distances on either side of the cleft are thus formed. It is essential that the incisions in the skin correspond precisely with those on the muscles and mucosa, and that all layers are sutured with the use of the triangular flap, thus preventing vertical scar contracture. This procedure produces a symmetric, balance lip with a well-defined Cupid's bow, a symmetric vermilion, and a properly aligned orbicularis oris muscle. We had treated three patients with unilateral incomplete cleft lip by using Bardach's triangular flap method. The operation scars could be reduced comparing to Millard method because Bardach's method did not use the columella base and the alar base incision. And the flap design was more simple and accurate comparing to Tennison-Randall method. On the other hand, the postoperative scars on the philtrum pointed as a disadvantage of triangular flap method were cosmetically acceptable because the three patients had incomplete cleft lip. We have experienced that Bardach's triangular flap is a recommendable technique for the repair of unilateral incomplete cleft lip.

Bone-level implants placed in the anterior maxilla: an open-label, single-arm observational study

  • Gao, EnFeng;Hei, Wei-Hong;Park, Jong-Chul;Pang, KangMi;Kim, Sun Kyung;Kim, Bongju;Kim, Soung-Min;Lee, Jong-Ho
    • Journal of Periodontal and Implant Science
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    • v.47 no.5
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    • pp.312-327
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    • 2017
  • Purpose: This study assessed marginal bone remodeling and soft tissue esthetics after the loading of single bone-level implants in the anterior maxilla. Methods: An open, single-arm observational clinical trial with 3 years of follow-up was performed, including 22 implants. The patients presented with a single tooth gap in the anterior maxilla (tooth positions 14-24), with natural or restored adjacent teeth. An implant was placed at least 8 weeks post-extraction and healed submerged for 6 weeks. After the second-stage operation, a fixed provisional prosthesis was provided. The final restoration was placed 6 months after the provisional restoration. The time of the provisional crown connection was considered to be the baseline in this study. Esthetic parameters and the marginal bone level were assessed at 6, 12, 24, and 36 months. Results: All implants were well integrated in the bone. A statistically significant increase was found in the mean implant stability quotient between the time of the provisional prosthesis and the time of the final prosthesis. Most implants (95.5%) revealed marginal bone resorption (<0.5 mm), and just 1 implant (4.5%) showed a change of 2.12 mm from baseline to 36 months (mean $0.07{\pm}0.48mm$), while the crestal bone level decreased significantly, from $2.34{\pm}0.93mm$ at baseline to $1.70{\pm}1.10mm$ at 36 months. The facial gingival margin and papilla were stable and the esthetic scores indicated high patient and dentist satisfaction. Conclusions: Platform-switching bone-level implants placed in maxillary single-tooth gaps resulted in successful osseointegration with minimal marginal bone resorption. The peri-implant soft tissue was also esthetically satisfying and stable.

Dermatofibrosarcoma Protuberans ; Treatment and Prognosis (융기성 피부섬유육종의 치료 및 예후)

  • Lee, Soo-Yong;Park, Jong-Hoon;Jeon, Dae-Geun;Lee, Jong-Seok;Kim, Sug-Jun
    • The Journal of the Korean bone and joint tumor society
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    • v.6 no.1
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    • pp.17-21
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    • 2000
  • Purpose : Dermatofibrosarcoma protuberans(DFSP) is a rare tumor of the skin with a strong tendency of infiltration to surrounding tissues. Inadequate surgical intervention brings about frequent recurrence and poor prognosis. We attempted to find a guideline for adequate treatment for DFSP. Materials and Methods : Fourteen cases who had been treated in our department since Mar. 1993 and followed up for more than 12 months postoperatively were reviewed. Including nine cases who were transferred from other hospital after recurrence, thirteen cases underwent wide resection. One case was treated by intralesional resection followed by chemotherapy (CYVADIC) due to neurovascular abutment to the mass in the inguinal area. Results : The nine cases who were transferred due to recurrences experienced recurrence in average 1.3(1-2) times and the average period until first local recurrence from primary operation was 11.8(2-24) months. The thirteen cases with wide surgical margin showed no recurrence at the final follow up. One case treated by intralesional resection and chemotherapy showed multiple recurrence and died of the disease due to lung metastasis. Conclusions : From these data, we could find that primary wide resection can be the way of reducing recurrence and metastasis, and the follow up period for the detection of recurrence should be at least two years.

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Epithelioid Sarcoma (유상피 육종)

  • Cho, Wan-Hyeong;Jeon, Dae-Geun;Park, Jong-Hoon;Song, Won-Seok;Lee, Soo-Yong;Koh, Jae-Soo;Koh, Han-Sang
    • The Journal of the Korean bone and joint tumor society
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    • v.12 no.1
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    • pp.30-36
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    • 2006
  • Purpose: Epitheliod sarcoma is an obscure clinical entity. This study analyzes the correlation between the clinical course and the AJCC stage, presence of residual tumor and ezrin-expression. Materials and Methods: Twenty-three cases of epithelioid sarcoma were eligible. All the cases had operation. Fifteen cases had systemic chemotherapy and 6 cases had adjuvant radiotherapy. Immumohistochemical analysis was done for 15 cases. Analyzed factors were initial stage, adjuvant treatment, local recurrence, residual tumor immumohistochemical results and surgical margin. Results: The event free survival rate of 15 stage II, III cases was 47.4% at 129 months. The actual survival rate of 8 stage IV cases was 37.5% at 80 months. The presence of residual tumor tissue on re-excision specimen showed statistical significance on event free survival rate(P=0.03). Adjuvant therapy showed no impact on outcome. The stage IV and locally recurrent cases had a positive relation with Ezrin-positivity. Conclusion: Residual tumor showed correlation in the outcome of epitheliod sarcoma. Chemotherapy and radiation therapy did not affect the outcome. Further case collection and analysis is needed for the significance between Ezrin expression and clinical behavior.

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