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Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

  • Yang, Jung Dug;Kim, Min Chul;Lee, Jeong Woo;Cho, Young Kyoo;Choi, Kang Young;Chung, Ho Yun;Cho, Byung Chae;Park, Ho Yong
    • Archives of Plastic Surgery
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    • v.39 no.5
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    • pp.489-496
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    • 2012
  • Background In Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful. Methods From January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD) myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP) flap or a thoracodorsal artery perforator (TDAP) flap. Results The mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9), thoracoepigastric flap (n=7), ICAP flap (n=25), TDAP flap (n=12), and LD flap (n=54). There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results. Conclusions Oncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

A Prospective Study on the Changes of Serum 3,5,3'-Triiodothyronine Levels after Cardiopulmonary bypass in Pediatric Age (소아환자에서 개심술후 혈중 3,5,3'- 삼옥소타이로닌 [triiodothyronine] 농도 변화에 관한 연구)

  • Kim, Yeong-Tae;No, Jun-Ryang
    • Journal of Chest Surgery
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    • v.25 no.11
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    • pp.1209-1217
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    • 1992
  • Triiodothyronine[T3] is an important regulator of the tissue metabolism, and may have potential use as an inotropic agent. The change of serum T3 level was studied in the pediatric age patients after cardiopulmonary by pass. Thyroid function was tested pre-operatively in 33 patients and total triiodothyronine[TT3] levels were serially measured during and after cardiopulmonary bypass[CPB]. After correction of dilutional effect, effects of various factors on the TT3 levels were analyzed. Abrupt fall of TT3 level was demonstrated at 15 minutes after CPB[80.1$\pm$5.9ng/dL] from the initial level of 133.6$\pm$5.3ng/dL, with some recovery at 6 hours[115.4$\pm$6.7ng/dL]. After then, gradual decrease occured reaching to the level of 77.2$\pm$4.2ng /dL at 24 hours. These falls of the TT3 after CPB were statistically significant. [p<0.01 ANOVA] Statistically significant correlation were found between the degree of hemodilution and TT3 concentration at 15 and 30 minutes after CPB[p<0.05]. But, other factors were analyzed to have no effect on TT3 levels. As the degree of the hemodilution increases, TT3 decreased less. This observation probably supports the fact that decrease of TT3 during CPB may be a result of sequestration of T3 into peripheral tissue. Although it was not statistically significant[p=0.08], the fall of TT3 was greater in the group to which plasmanate was added, than those not added. This finding seemed to be due to the increase of albumin and other thyroid-hormone-binding-proteins in the serum. Increase of these binding proteins might potentiate the sequestration of T3 into the liver and the kidney from serum, and as a consequence, decrese the serum TT3 level further.

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The Application of a Bi-ventricular Assist Device for a Low Weight (2.4 kg) Neonate with Coarctation of the Aorta and Critical Aortic Stenosis (대동맥 축착증 및 심한 대동맥 협착을 가진 저체중 신생아(2.4 kg)의 수술 전후 발생한 심실 기능 부전의 치료에 대한 양심실 보조 장치 적용 치험 예)

  • Kwak, Jae-Gun;Park, Chun-Soo;Lee, Chang-Ha;Lee, Cheul
    • Journal of Chest Surgery
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    • v.43 no.3
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    • pp.304-307
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    • 2010
  • A 5-day-old neonate (body weight=2.4 kg) with coarctation of the aorta and critical aortic stenosis underwent an interventional balloon valvuloplasty for aortic stenosis. During the intervention, cardiac arrest occurred due to injury of the right carotid artery by the guide wire. An extracorporeal membrane oxygenator (ECMO) was applied. After 1 day's support, total surgical correction was achieved; however, in the immediate postoperative period, cardiac function was severely depressed. We applied a bi-ventricular assist device (bi-VAD) instead of an ECMO and we were able to wean the patient off the bi-VAD device after 3 days' support. The patient was discharged without severe complications.

Use of Cardiac Computed Tomography for Ventricular Volumetry in Late Postoperative Patients with Tetralogy of Fallot

  • Kim, Ho Jin;Mun, Da Na;Goo, Hyun Woo;Yun, Tae-Jin
    • Journal of Chest Surgery
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    • v.50 no.2
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    • pp.71-77
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    • 2017
  • Background: Cardiac computed tomography (CT) has emerged as an alternative to magnetic resonance imaging (MRI) for ventricular volumetry. However, the clinical use of cardiac CT requires external validation. Methods: Both cardiac CT and MRI were performed prior to pulmonary valve implantation (PVI) in 11 patients (median age, 19 years) who had undergone total correction of tetralogy of Fallot during infancy. The simplified contouring method (MRI) and semiautomatic 3-dimensional region-growing method (CT) were used to measure ventricular volumes. Results: All volumetric indices measured by CT and MRI generally correlated well with each other, except for the left ventricular end-systolic volume index (LV-ESVI), which showed the following correlations with the other indices: the right ventricular end-diastolic volume index (RV-EDVI) (r=0.88, p<0.001), the right ventricular end-systolic volume index (RV-ESVI) (r=0.84, p=0.001), the left ventricular end-diastolic volume index (LV-EDVI) (r=0.90, p=0.001), and the LV-ESVI (r=0.55, p=0.079). While the EDVIs measured by CT were significantly larger than those measured by MRI (median RV-EDVI: $197mL/m^2$ vs. $175mL/m^2$, p=0.008; median LV-EDVI: $94mL/m^2$ vs. $92mL/m^2$, p=0.026), no significant differences were found for the RV-ESVI or LV-ESVI. Conclusion: The EDVIs measured by cardiac CT were greater than those measured by MRI, whereas the ESVIs measured by CT and MRI were comparable. The volumetric characteristics of these 2 diagnostic modalities should be taken into account when indications for late PVI after tetralogy of Fallot repair are assessed.

Study on Optimization of Fatigue Damage Calculation Process Using Spectrum (스펙트럼을 이용한 피로손상도 계산과정 최적화 연구)

  • Kim, Sang Woo;Lee, Seung Jae;Choi, Sol Mi
    • Journal of Ocean Engineering and Technology
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    • v.32 no.3
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    • pp.151-157
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    • 2018
  • Offshore structures are exposed to low- and high-frequency responses due to environmental loads, and fatigue damage models are used to calculate the fatigue damage from these. In this study, we tried to optimize the main parameters used in fatigue damage calculation to derive a new fatigue damage model. A total of 162 bi-modal spectra using the elliptic equation were defined to describe the response of offshore structures. To calculate the fatigue damage from the spectra, time series were generated from the spectra using the inverse Fourier transform, and the rain-flow counting method was applied. The considered optimization variables were the size of the frequency increments, ratio of the time increment, and number of repetitions of the time series. In order to obtain optimized values, the fatigue damage was calculated using the parameter values proposed in previous work, and the fatigue damage was calculated by increasing or decreasing the proposed values. The results were compared, and the error rate was checked. Based on the test results, new values were found for the size of the frequency increment and number of time series iterations. As a validation, the fatigue damage of an actual tension spectrum found using the new proposed values and fatigue damage found using the previously proposed method were compared. In conclusion, we propose a new optimized calculation process that is faster and more accurate than the existed method.

Modified Abbé flap for reconstruction of Cupid's bow and vermilion tubercle in secondary cleft lip deformity

  • Lee, Jun Won;Lee, Seong Joo;Suh, In Suck;Lee, Chong Kun
    • Archives of Craniofacial Surgery
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    • v.19 no.1
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    • pp.13-19
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    • 2018
  • Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

Clinical efficacy of intermittent magnetic pressure therapy for ear keloid treatment after excision

  • Jun, Dongkeun;Shin, Donghyeok;Choi, Hyungon;Lee, Myungchul
    • Archives of Craniofacial Surgery
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    • v.20 no.6
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    • pp.354-360
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    • 2019
  • Background: Keloids are benign fibro-proliferative lesion, related to excessive inflammatory reactions in certain anatomical areas, including the auricles. Their specific etiology remains unclear; nonetheless they exhibit tumor-like characteristics of significant recurrence and cause emotional distress, even with various treatment strategies. We applied intermittent magnetic pressure therapy on ear keloids in combination with surgical excision, and present its effectiveness herein. Methods: Ear keloid patients were treated with surgical excision followed by magnetic pressure therapy. The keloid tissues underwent excision and keloid marginal flaps were utilized for wound closure. Intermittent magnetic pressure therapy was applied 2 weeks after the surgical procedure. The pressure therapy consisted of a 3-hour application and 2-hour resting protocol (9 hr/day), and lasted for 6 months. The results were analyzed 6 months after the therapeutic procedures, using the scar assessment scale. Results: Twenty-two ear keloids from 20 patients were finally reviewed. Among the keloids that completed the therapeutic course, 20 ear keloids out of 22 in total (90.9%) were successfully eradicated. Two patients (2 keloids) exhibited slight under-correction. Postoperative complications such as wound dehiscence or surgical site infection were not noted. The scar assessment scale demonstrated a significant improvement in each index. The intermittent pressure therapy led to patient compliance, and avoided pressure-related pain and discomfort. Conclusion: Excision followed by intermittent pressure application using a magnet successfully reduced the burden of fibro-proliferative keloids, and had good patient compliance. The role of intermittent pressure application and resting should be studied with regard to keloid tissue remodeling.

A Design of Parallel Turbo Decoder based on Double Flow Method Using Even-Odd Cross Mapping (짝·홀 교차 사상을 이용한 Double Flow 기법 기반 병렬 터보 복호기 설계)

  • Jwa, Yu-Cheol;Rim, Chong-Suck
    • Journal of the Institute of Electronics and Information Engineers
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    • v.54 no.7
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    • pp.36-46
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    • 2017
  • The turbo code, an error correction code, needs a long decoding time since the same decoding process must be repeated several times in order to obtain a good BER performance. Thus, parallel processing may be used to reduce the decoding time, in which case there may be a memory contention that requires additional buffers. The QPP interleaving has been proposed to avoid such case, but there is still a possibility of memory contention when a decoder is constructed using the so-called double flow technique. In this paper, we propose an even-odd cross mapping technique to avoid memory conflicts even in decoding using the double-flow technique. This method uses the address generation characteristic of the QPP interleaving and can be used to implement the interleaving circuit between the decoding blocks and the LLR memory blocks. When the decoder implemented by applying the double flow and the proposed methods is compared with the decoder by the conventional MDF techniques, the decoding time is reduced by up to 32% with the total area increase by 8%.

Genome-wide Response of Normal WI-38 Human Fibroblast Cells to 1,763 MHz Radiofrequency Radiation

  • Im, Chang-Nim;Kim, Eun-Hye;Park, Ae-Kyung;Park, Woong-Yang
    • Genomics & Informatics
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    • v.8 no.1
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    • pp.28-33
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    • 2010
  • Increased exposure of human to RF fields has raised concerns for its potential adverse effects on our health. To address the biological effects of RF radiation, we used genome wide gene expression as the indicator. We exposed normal WI-38 human fibroblast cells to 1763 MHz mobile phone RF radiation at a specific absorption rate (SAR) of 60 W/kg with an operating cooling system for 24 h. There were no alterations in cell numbers or morphology after RF exposure. Through microarray analysis, we identified no differentially expressed genes (DEGs) at the 0.05 significance level after controlling for multiple testing errors with the Benjaminiochberg false discovery rate (BH FDR) method. Meanwhile, 82 genes were differentially expressed between RF-exposed cells and controls when the significance level was set at 0.01 without correction for multiple comparisons. We found that 24 genes (0.08% of the total genes examined) were changed by more than 1.5-fold on RF exposure. However, significant enrichment of any gene set or pathway was not observed from the functional annotation analysis. From these results, we did not find any evidence that non-thermal RF radiation at a 60-W/kg SAR significantly affects cell proliferation or gene expression in WI-38 cells.

Expected Years of Life Lost Due to Adult Cancer Mortality in Yazd (2004-2010)

  • Mirzaei, Mohsen;Mirzadeh, Mahboobahsadat;Mirzaei, Mojtaba
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.sup3
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    • pp.101-105
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    • 2016
  • The number of deaths is often measured to monitor the population health status and priority of health problems. However, number of years of life lost (YLL) is a more appropriate indicator in some cases. We have calculated the YLL of adult cancers and its trend over the past few years in Yazd to provide planners with baseline data. Data obtained from death registration system were used to calculate the YLL, based on each individual's age at death, and the standardized expected YLL method was applied with a discount rate of 0.03, an age weight of 0.04, and a correction factor of 0.165. All data were analyzed and prepared in Epi6 and Excel 2007. A total of 3,850 death records were analyzed. Some 550 patients in Yazd province aged ${\geq}20$ die annually due to cancer (male: female ratio 1.3). The average ages at death in lung, CNS, breast cancer and leukemia cases were 68.5, 59, 58.7 and 61, respectively. The age group of 40-59 with 21 % had the highest cancer mortality percentage. Premature cancer deaths have caused 40,753 YLL (5,823 YLL annually). Females lose on average more life years to cancer than do men (11.6 vs 9.8 years). Lung cancer (12.1%), CNS tumors (11.7%) and leukemia (11.4 %) were the leading causes terms of YLL due to all cancers in both sexes. From 2004 to 2010, cancer-caused YLL as a fraction of all YLL increased from 12.8 to 15.2 %. This study can help in the assessment of health care needs and prioritization. Cancer is the major cause of deaths and the trend is increasing. The use of YLLs is a better index for measurement of premature mortality for ranking of diseases than is death counts. Longer periods of observation will make these trends more robust and will help to evaluate and develop, better public health interventions.