• 제목/요약/키워드: safety margins

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Recent Perspectives on Oncoplastic Breast Surgery in Korea (우리나라의 종양성형학적 유방암 수술에 대한 최신 동향)

  • Kang, Taewoo
    • Journal of Life Science
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    • v.30 no.6
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    • pp.563-569
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    • 2020
  • Oncoplastic surgery (OPS) combines oncologically safe tumor resection with aesthetically satisfying reconstruction of defects using established plastic surgery techniques. OPS is characterized by initial excision as extensive as is beneficial for oncological safety, and, once sufficient resection is complete, displacement or replacement techniques are selected based on remnant volume. The size of the lesion and the individual patient are important factors when considering the appropriate approach, and when pre-operative imaging, including MRI, is used to determine the technique, the complete removal of cancer cells by permanent pathology is essential. A frozen section is used during the operation to reduce the reoperation rate, but it is difficult to cover the entire margin surface theoretically and even harder in practice. A recent report about adequate margins has empowered OPS in its oncological safety. Considering the patients to whom each modality could be applied, basic breast volume is an important factor, and this is influenced by ethnic differences. In Europe or the US, for example, the average breast size is 36D (600 ㎤) and reduction mammoplasty is predominantly used. However, the average size of patients in our institution is 33A (300 ㎤), and so quite different approaches are selected in most cases. New techniques involving radiofrequency and fluorescence have been proposed as safe and easily accessible ways of reducing complications.

Determination of Optimal Hourly Water Intake Amount for H Arisu Purification Center using Linear Programming (선형계획법을 이용한 H 아리수 정수 센터 최적 취수량 결정)

  • Lee, Chulsoo;Lee, Kangwon
    • Journal of Korea Water Resources Association
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    • v.48 no.12
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    • pp.1051-1064
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    • 2015
  • Currently, the H purification plant determines the hourly water intake amount based on operator experience and skill. Therefore, inevitably, there are deviations among operators. While meeting time-varying demand and maintaining the proper water level in the clean water reservoir, the methodology for minimizing electricity cost, when dealing with different electricity rate time zones, is a very complicated problem, which is beyond an operator's capability. To solve this problem, a linear programming (LP) model is proposed, which can determine the optimal hourly water intake amount for minimizing the daily electricity cost. It is shown that an inaccurate estimate for the hourly water usage in the demand areas causes the water level constraint to be violated, which is the weak point of the proposed LP method. However, several examples with real-field data show that we can practically and safely solve this problem with safety margins. It is also shown that the safety margin method still works effectively whether the estimate is accurate or not. The operators need not attend the site at all times under the proposed LP method, and we can additionally expect reductions in labor costs.

A STUDY OF VON-MISES YIELD STRENGTH AFTER MANDIBULAR SAGITTAL SPLIT RAMUS OSTEOTOMY (하악지시상분할골절단술 시행 후 von-Miese 항복강도에 대한 유한요소법적 연구)

  • Yoon, Ok-Byung;Kim, Yeo-Gab
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.28 no.3
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    • pp.196-204
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    • 2002
  • For the study of its stability when the screw has been fixed after sagittal split ramus osteotomy(SSRO) of the mandible, the methods of screw arrangement are classified into two types, triangular and straight. The angles of screws to the bone surface are classified as perpendicular arrangements, the $60^{\circ}$ anterioinferior screw, known as triangular, and the most posterior screw, called straight arrangement, thus there are four types. The finite element method model has been made by using a three dimensional calculator and a supercomputer. The load directions are to the anterior teeth, premolar region, and molar region, and the bite force is 1 Kgf to each region. The distribution of stress, the von-Mises yield strength, and safety of margin refer to the total sum of transformed energy have been studied by comparison with each other. The following conclusion has been researched : 1. When shear stress is compared, in the triangular arrangement in the form of "ㄱ", the anterosuperior screw is seen at contributing to the support of the bone fragment. In the straight arrangement, substantial stress is seen to be concentrated on the most posterior angled screw. 2. When the von-Mises yield strength is compared, it seemed that the stress concentration on the angled anteroinferior screw is higher, it shows a higher possibility of fracture than any other screw. In the straight arrangement, stress appeared to be concentrated on the most posteriorly angled screw. 3. When the safety margins of the transfomed energy are compared, the energy conduction is much greater in the case of the angled screw than in the case of the perpendicular screw. The triangular arrangement in the form of "ㄱ" shows a superior clinical sign to that of the straight arrangement. Judging from the above results, when the screw fixation is made after SSRO in practical clinical cases, two screws should be inserted in the superior border of mandibular ramus and a third screw of mandibular inferior border should be inserted in the form of triangular. All screws on the bony surface should be placed perpendicularly-$90^{\circ}$ angles apparently best promote bony support and stability.

Evaluation of Structural Robustness of External Fuel Tank and Pylon for Military Aircraft under Random Vibration (랜덤진동에서 군용 항공기 외부연료탱크 및 파일런 구조 강건성 평가)

  • Kim, Hyun-Gi;Kim, Sungchan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.22 no.3
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    • pp.777-783
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    • 2021
  • Aircraft are affected by various vibrations during maneuvering. These vibrations may have a fatal effect on the survival of aircraft in some cases, so the safety of components applied to the aircraft should be proven against various vibrations through random vibration analysis. In this study, the structural robustness of an external fuel tank and pylon for military aircraft was evaluated under random vibration conditions using commercial software, MSC Random. In the random vibration analysis, a frequency response analysis was performed by imposing a unit load on the boundary condition point, and then excitation was performed with a PSD profile. In this process, the required mode data was extracted through a modal analysis method. In addition, the random vibration profile specified in the US Defense Environment Standard was applied as random vibration conditions, and the PSD profile given in units of G's was converted into units of gravitational acceleration. As a result of the numerical analysis, we evaluated the structural robustness of the external fuel tank and pylon by identifying the safety margins of beam elements, shell elements, and solid elements in a numerical model for random vibration in the x, y, and z directions.

Proximal Anterior-Antrum Posterior (PAAP) Overlapping Anastomosis in Minimally Invasive Pylorus-Preserving Gastrectomy for Early Gastric Cancer Located in the High Body and Posterior Wall of the Stomach

  • Park, Ji-Hyeon;Kong, Seong-Ho;Choi, Jong-Ho;Park, Shin-Hoo;Suh, Yun-Suhk;Park, Do-Joong;Lee, Hyuk-Joon;Yang, Han-Kwang
    • Journal of Gastric Cancer
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    • v.20 no.3
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    • pp.277-289
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    • 2020
  • Purpose: To evaluate the feasibility and safety of intracorporeal overlapping gastrogastrostomy between the proximal anterior wall and antrum posterior wall (PAAP; PAAP anastomosis) of the stomach in minimally invasive pylorus-preserving gastrectomy (PPG) for early gastric cancer (EGC). Materials and Methods: From December 2016 to December 2019, 17 patients underwent minimally invasive PPG with PAAP anastomosis for EGC in the high body and posterior wall of the stomach. Intraoperative gastroscopy was performed with the rotation maneuver during proximal transection. A longer antral cuff (>4-5 cm) was created for PAAP than for conventional PPG (≤3 cm) at the point where a safe distal margin and good vascular perfusion were secured. Because the posterior wall of the proximal remnant stomach was insufficient for intracorporeal anastomosis, the anterior wall was used to create an overlapping anastomosis with the posterior wall of the remnant antrum. The surgical and oncological outcomes were analyzed, and the stomach volume was measured in patients who completed the 6-month follow-up. The results were compared to those after conventional PPG (n=11 each). Results: PAAP anastomosis was successfully performed in 17 patients. The proximal and distal resection margins were 2.4±1.9 cm and 4.0±2.6 cm, respectively. No postoperative complications were observed during the 1-year follow-up esophagogastroduodenoscopy (n=10). The postoperative remnant stomach (n=11) was significantly larger with PAAP than with conventional PPG (225.6±118.3 vs. 99.1±63.2 mL; P=0.001). The stomach length from the anastomosis to the pylorus was 4.9±2.4 cm after PAAP. Conclusions: PAAP anastomosis is a feasible alternative for intracorporeal anastomosis in minimally invasive PPG for highly posteriorly located EGC.

A Successful Direct Phrenic Nerve Reconstruction in the Course of Malignant Thymoma Resection (악성 흉선종 절제술 중의 성공적인 횡격막 신경 직접 재건술)

  • Lee, Seong-Kwang;Kim, Yeon-Soo;Park, Kyung-Taek;Jang, Woo-Ik;Ryoo, Ji-Yoon;Kim, Chang-Young;Cho, Seong-Joon;Choe, Hyun-Min
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.401-403
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    • 2009
  • We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.

The Safety of Microsurgical Head and Neck Reconstruction in the Elderly Patients (고령 환자군에 있어서 유리피판술을 이용한 두경부재건의 안전성)

  • Choi, Bong Kyoon;Kim, Young Seok;Lee, Won Jai;Lew, Dae Hyun;Tark, Kwan Chul
    • Archives of Plastic Surgery
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    • v.33 no.3
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    • pp.289-293
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    • 2006
  • By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer

A Study on the Quality of a Frozen Section of Breast Resection Margin during Breast-Conserving Surgery (유방 보존술 중 절제면 동결절편검사의 질 향상에 관한 연구)

  • Choi, Byung-Il;Chin, Su-Sie
    • Korean Journal of Clinical Laboratory Science
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    • v.53 no.3
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    • pp.233-240
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    • 2021
  • Evaluation of the resected margins of the frozen section during breast-conserving surgery can determine the presence of cancer cells in a short time and have a significant impact on the scope of surgery and the prognosis of the patient. However, breast tissue is composed of adipose tissue, which affects the accuracy of the test. In this study, a new method was applied to the resected surface of the frozen section in which wiping the surface of the frozen section block with alcohol was expected to expose the parenchyma to the surface as the adipose tissue would melt momentarily. Indeed, of the total of 98 cases, 37 cases showed a better exposure ratio of the parenchyma in the improved frozen section test than in the previous frozen section test. Of the 37 cases with increased visibility of parenchymal sections obtained by this method, two cases of ductal carcinoma in situ (DCIS) were detected. Although there are limitations such as turnaround time (TAT), the diagnostic accuracy of histopathologic examination of the frozen section may improve through this method and may have a direct impact on patient safety, and should therefore be researched further.

Discrimination and Authentication of Eclipta prostrata and E. alba Based on the Complete Chloroplast Genomes

  • Kim, Inseo;Park, Jee Young;Lee, Yun Sun;Lee, Hyun Oh;Park, Hyun-Seung;Jayakodi, Murukarthick;Waminal, Nomar Espinosa;Kang, Jung Hwa;Lee, Taek Joo;Sung, Sang Hyun;Kim, Kyu Yeob;Yang, Tae-Jin
    • Plant Breeding and Biotechnology
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    • v.5 no.4
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    • pp.334-343
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    • 2017
  • Eclipta prostrata and E. alba are annual herbal medicinal plants and have been used as Chinese medicinal tonics. Both species are widely distributed in tropical and subtropical regions as well as in Korea. Both species have similar morphological features but E. alba has smoother leaf blade margins compared with E. prostrata. Although both species are utilized as oriental medicines, E. prostrata is more widely used than E. alba. Morphological semblances have confounded identification of either species. Here, we report the complete chloroplast genomes of both species to provide an authentication system between the two species and understand their diversity. Both chloroplast genomes were 151,733-151,757 bp long and composed of a large single copy (83,285-83,300 bp), a small single copy (18,283-18,346 bp), and a pair of inverted repeats (25,075-25,063 bp). Gene annotation revealed 80 protein coding genes, 30 tRNA genes and four rRNA genes. A phylogenetic analysis revealed that the genus Eclipta is grouped with Heliantheae tribe species in the Asteraceae family. A comparative analysis verified 29 InDels and 58 SNPs between chloroplast genomes of E. prostrata and E. alba. The low chloroplast genome sequence diversity indicates that both species are really close to each other and are not completely diverged yet. We developed six DNA markers that distinguish E. prostrata and E. alba based on the polymorphisms of chloroplast genomes between E. prostrata and E. alba. The chloroplast genome sequences and the molecular markers generated in this study will be useful for further research of Eclipta species and accurate classification of medicinal herbs.

Short-term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer: Comparison Between Extracorporeal and Intracorporeal Gastrogastrostomy

  • Alzahrani, Khalid;Park, Ji-Hyeon;Lee, Hyuk-Joon;Park, Shin-Hoo;Choi, Jong-Ho;Wang, Chaojie;Alzahrani, Fadhel;Suh, Yun-Suhk;Kong, Seong-Ho;Park, Do Joong;Yang, Han-Kwang
    • Journal of Gastric Cancer
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    • v.22 no.2
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    • pp.135-144
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    • 2022
  • Purpose: This study aimed to compare the surgical and oncological outcomes between totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with intracorporeal anastomosis and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with extracorporeal anastomosis. Materials and Methods: A retrospective analysis was performed in 258 patients with cT1N0 gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy using two different anastomosis methods: TLPPG with intracorporeal anastomosis (n=88) and LAPPG with extracorporeal anastomosis (n=170). The following variables were compared between the two groups to assess the postoperative surgical and oncological outcomes: proximal and distal margins, number of resected lymph nodes (LNs) in total and in LN station 6, operation time, postoperative hospital stay, and postoperative morbidity including delayed gastric emptying (DGE). Results: The average length of the proximal margin was similar between the TLPPG and LAPPG groups (2.35 vs. 2.73 cm, P=0.070). Although the distal margin was significantly shorter in the TLPPG group than in the LAPPG group (3.15 vs. 4.08 cm, P=0.001), no proximal or distal resection margin-positive cases were reported in either group. The average number of resected LN was similar in both groups (36.0 vs. 33.98, P=0.229; LN station 6, 5.72 vs. 5.33, P=0.399). The operation time was shorter in the TLPPG group than in the LAPPG (200.17 vs. 220.80 minutes, P=0.001). No significant differences were observed between the two groups in terms of postoperative hospital stay (9.38 vs. 10.10 days, P=0.426) and surgical complication rate (19.3% vs. 22.9%), including DGE (8.0% vs. 11.8%, P=0.343). Conclusions: The oncological safety and postoperative complications of TLPPG with intracorporeal anastomosis are similar to those of LAPPG with extracorporeal anastomosis.