• Journal of Fisheries and Marine Sciences Education
• /
• v.28 no.4
• /
• pp.994-1005
• /
• 2016

Expansion and spreading of marine telemedicine is rather restricted due to the conflict of laws relating to medical service and lack of provisions in the Seafarers' Act, Medical Service Act, etc. Thus, this study is intended to reveal the current status and problems of marine emergency medical advice system for the furtherance of health care of seafarers and emergency medical assistance conditions and deduce relevant proposals for legislative improvements thereof in order to resolve underlying problems and issues. The results of this study can be summated as follows. First, in respect of directions to provide marine emergency service based on marine telemedicine system, emergency radio medical advice system needs to be strengthened to meet domestic and international instrument, marine telemedicine system needs to be provided through integrating u-Health technology and special marine medical center needs to be established. Second, regarding directions to provide health promotion service based on the marine telemedicine system, a new process of health care service for seafarers needs to be devised and provided involving seafarers' life cycle covering from prior to boarding to after leaving a ship. The conclusions of this study can be given as follows. First, the following new provisions need to be introduced in the Seafarers' Act. (1) The Minister of Oceans and Fisheries and a shipowner shall conduct matters pertaining to preventive health promotion and care for seafarers; (2) a provisions regarding establishment of seafarers' health promotion center by the Minister; (3) a special exemption permitting marine telemedicine service and qualification requirements for marine telemedicine assistant; (4) shipowner's obligation of carrying seafarers' health measuring equipment on board. Second, the relevant provisions regarding medical care persons needs to be revised in such a way that master or chief officer shall be appointed to be in charge of medical care on board. Last but not least, it is also essential to amend and update the minimum standards on drug and medicines to be carried on board and medicine chest and equipment on board.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.559-566
• /
• 2011

Purpose: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. Methods: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. Results: AlloDerm was used in twenty-one patients (28 breasts) and Permacol was used in six patients (11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months (8~25 months). Two infections (7%) occurred in AlloDerm cases and four infections (36%) occurred in Permacol cases. Conclusion: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

• Journal of the Computational Structural Engineering Institute of Korea
• /
• v.35 no.3
• /
• pp.167-174
• /
• 2022

This study investigates the behavior of a jointless bridge that integrates superstructure and abutment without an expansion joint. Based on the sensitivity analyses conducted in previous studies, a shell-based model was determined to be the most suitable numerical analysis model for jointless bridges due to the similarity of the model's results compared with the obtained displacement shape, which was influenced by relative errors, precision, and practical aspects. Accordingly, the behavior of a jointless bridge was analyzed at various wall depths using shell element-based and solid element models. In addition, the results of MIDAS Civil and ABAQUS analysis programs were compared. In the case of semi-integrated bridges (A and B), the displacement decreased as the wall depth increased due to the ground reaction force in Case 1 under a linear spring condition and +30℃. In the case where temperature was -30℃, the change in displacement was small because the ground reaction did not occur. As for bridge C (a fully integrated alternating bridge) and bridge D (an integrated chest wall alternating bridge), the displacement decreased as the wall depth increased at both +30 and -30℃ due to pile resistance. As for the comparison between the analysis programs used, the relative error in Case 1 was small, whereas a significant difference in Case 2 was observed. The foregoing variation is possibly due to the difference in the application of the nonlinear spring in the programs.

• Journal of Chest Surgery
• /
• v.43 no.5
• /
• pp.513-517
• /
• 2010

Background: Diaphragmatic plication through a thoracoscopic approach has been an effective modality to treat diaphragmatic enventration. However, the conventional technique for thoracoscopic plication has some disadvantages. We have developed an improved and simplified technique with utilizing the head up position, $CO_2$ insufflation and figure-of-eight sutures. Material and Method: Between October 2005 and September 2009, 9 patients with diaphragmatic paralysis underwent repair using our modified technique. The mean patient age was $38.5{\pm}53.0$ years (range: 2~76 years). Result: The mean operation time was $46.7{\pm}15.9$ min (range: 30~85 min). None of the patients died due to this procedure, but there was one case of prolonged air leakage, and a case of re-expansion pulmonary edema, which required 3 days of ventilator support after the procedure. The mean hospital stay was $6.22{\pm}2.04$ days (range: 4~11 days). The mean follow-up duration was $27.2{\pm}11.6$ months (range: 2~43 months). All the patients had their symptoms relieved and there was no recurrence of eventration except for one patient who developed more than 2 cm elevation of the diaphragm compared to the immediate post-operation status. Conclusion: With our technique, thoracoscopic diaphragmatic plication was feasible via using only three 5 mm ports and without a working window and the midterm results were favorable. Therefore, we advocate thoracoscopic diaphragmatic plication as a preferred technique to the conventional open plication technique.

• Radiation Oncology Journal
• /
• v.18 no.4
• /
• pp.345-354
• /
• 2000

Purpose : Conventional radiation therapy Portal images gives low contrast images. The purpose of this study was to enhance image contrast of a linacgram by developing a low-cost image processing method. Materials and Methods : Chest linacgram was obtained by irradiating humanoid Phantom and scanned using Diagnostic-Pro scanner for image processing. Several types of scan method were used in scanning. These include optical density scan, histogram equalized scan, linear histogram based scan, linear histogram independent scan, linear optical density scan, logarithmic scan, and power square root scan. The histogram distribution of the scanned images were plotted and the ranges of the gray scale were compared among various scan types. The scanned images were then transformed to the gray window by pallette fitting method and the contrast of the reprocessed portal images were evaluated for image improvement. Portal images of patients were also taken at various anatomic sites and the images were processed by Gray Scale Expansion (GSE) method. The patient images were analyzed to examine the feasibility of using the GSE technique in clinic. Results :The histogram distribution showed that minimum and maximum gray scale ranges of 3192 and 21940 were obtained when the image was scanned using logarithmic method and square root method, respectively. Out of 256 gray scale, only 7 to 30$\%$ of the steps were used. After expanding the gray scale to full range, contrast of the portal images were improved. Experiment peformed with patient image showed that improved identification of organs were achieved by GSE in portal images of knee joint, head and neck, lung, and pelvis. Conclusion :Phantom study demonstrated that the GSE technique improved image contrast of a linacgram. This indicates that the decrease in image quality resulting from the dual exposure, could be improved by expanding the gray scale. As a result, the improved technique will make it possible to compare the digitally reconstructed radiographs (DRR) and simulation image for evaluating the patient positioning error.

• Journal of Chest Surgery
• /
• v.29 no.9
• /
• pp.931-939
• /
• 1996

An experimental comparative study was done to determine the protective effects of three preservation solutions on isolated rabbit heart-lung bloc during acute ischemia and reperfusion of the lung during lung transplantation. Thirty Isolated rabbit heart-lung blocs were divided into 3 groups , group I(n:9) was preserved with Hartmann's solution, group II(n: 10) with modified University of Wisconsin solution, and group III(n: 1 1) with Kosin solution. The isolated heart-lung blocs were washed with Hartmann's so ution. Aftar infusion of each preservation solution into pulmonary artery, the heart-lung bloc was stored at 4'c cold preservation solution for each group for 4 hours and .then the heart-lung blocs were reventilated and reperfused. The changes of weight of heart-lung blocs, airway pressure, percent change of PCO2, level of lactate and adenosine deaminase(ADA) and microscopic structure of the lung parenchyme were evaluated. Results were as follows 1. A change of weight of the heart lung bloc after reperfusion was lowest in group 111(p< .05) 2. The airway pressure increased after reperfusion in group I but decreased in group II, and II. Especially in group II, post-reperfusion airway pressure returned to level lower than that of en-bloc resection. 3. Pulmonary artery pressure during reperfusion after 4 hour preservation was lowest in group III, and pulmonary artery pressure in group II was higher than in group I(P> 0.1). 4. The level of lactate and ADA in the lung tissue were higher in group III than in group I and II(P< .05) 5. The percent change of PCO2 in perfusate was slightly higher in group III than group I and II. 6. Microscopic changes in lung tissue after reperfusion were diffuse pulmonary edema, expansion of inter- stitial tissue, focal aggregation of erythrocytes, and basement membrane abnormalities, but no differences were found among the three groups. In conclusion, the protective effects of modified University of Wisconsin solution and Kosin solution were slightly superior to Hartmann's solution.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.655-662
• /
• 2010

Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

• Journal of Chest Surgery
• /
• v.42 no.3
• /
• pp.331-336
• /
• 2009

Background: Open surgical repair of abdominal aortic aneurysms was initiated by Dubost in 1952. Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized for curative intent. We retrospectively analyzed surgical outcome, complications, and mortality-related factors for patients with abdominal aortic aneurysms over a 6 year period. Material and Method: We analyzed 18 patients who underwent surgery for abdominal aortic aneurysms between March 2002 and March 2008. The indications for surgery were rupture, a maximal aortic diameter >60 mm, medically intractable hypertension, or pain. Result: The mean age was $66.6{\pm}9.3$ years (range, $49\sim81$ years). Twelve patients (66.7%) were males a 6 patients were females. Extension of the aneurysm superior to the renal artery existed in 6 patients (33.3%), and extension to the iliac artery existed in 13 patients (72.2%). Five patients (27.8%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $72.2{\pm}12.9$ mm (range, $58\sim109$ mm). Surgery was performed by a midline laparotomy, and 6 patients underwent emergency surgery. The mean total ischemic time from aorta clamping to revascularization was $82{\pm}42$ minutes (range, $35\sim180$ minutes). The mortality rate was 16.7%; the mortality rate for patients with ruptured aneurysms was 60%, and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included one each of renal failure, femoral artery and vein occlusion, and wound infection. The patients who were discharged had a long-term survival of $34{\pm}26$ months (range, $4\sim90$ months). Rupture and emergency surgery had a statistically significant mortality-related factor (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have a high mortality, but unruptured cases are repaired with relative safety. Successfully operated patients had long-term survival. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, aggressive application should be determined with care. Experience and systemic support of each center is important in the treatment plan.

• Journal of Chest Surgery
• /
• v.37 no.1
• /
• pp.1-10
• /
• 2004

Background: Currently, the cardiopulmonary machine with non-pulsatile pumps, which are low in internal circuit pressure and cause little damage to blood cells, is widely used. However, a great number of experimental studies shows that pulsatile perfusions are more useful than non-pulsatile counterparts in many areas, such as homodynamic, metabolism, organ functions, and micro-circulation. Yet, many concerns relating to pulsatile cardiopulmonary machines, such as high internal circuit pressure and blood cell damage, have long hindered the development of pulsatile cardiopulmonary machines. Against this backdrop, this study focuses on the safety and effectiveness of the pulsatile cardiopulmonary machines developed by a domestic research lab. Material and Method: The dual-pulsatile cardiopulmonary bypass experiment with total extracorporeal circulation was conducted on six calves, Extracorporeal circulation was provided between superior/inferior vena cava and aorta. The membrane oxygenator, which was placed between the left and right pumps, was used for blood oxygenation. Circulation took four hours. Arterial blood gas analysis and blood tests were also conducted. Plasma hemoglobin levels were calculated, while pulse pressure and internal circuit pressure were carefully observed. Measurement was taken five times; once before the operation of the cardiopulmonary bypass, and after its operation it was taken every hour for four hours. Result: Through the arterial blood gas analysis, PCO2 and pH remained within normal levels. PO2 in arterial blood showed enough oxygenation of over 100 mmHg. The level of plasma hemoglobin, which had total cardiopulmonary circulation, steadily increased to 15.87 $\pm$ 5.63 after four hours passed, but remained below 20 mg/㎗. There was no obvious abnormal findings in blood test. Systolic blood pressure which was at 97.5$\pm$5.7 mmHg during the pre-circulation contraction period, was maintained over 100 mmHg as time passed. Moreover, diastolic blood pressure was 72.2 $\pm$ 7.7 mmHg during the expansion period and well kept at the appropriate level with time passing by. Average blood pressure which was 83$\pm$9.2 mmHg before circulation, increased as time passed, while pump flow was maintained over 3.3 L/min. Blood pressure fluctuation during total extracorporeal circulation showed a similar level of arterial blood pressure of pre-circulation heart. Conclusion: In the experiment mentioned above, pulsatile cardiopulmonary machines using the doual-pulsatile structure provided effective pulsatile blood flow with little damage in blood cells, showing excellence in the aspects of hematology and hemodynamic. Therefore, it is expected that the pulsatile cardiopulmonary machine, if it becomes a standard cardiopulmonary machine in all heart operations, will provide stable blood flow to end-organs.