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Treatment of MFH(Malignant fibrous histiocytoma) in Extremity (사지에 발생한 악성섬유조직구종의 치료 경험)

  • Kang, Jong Hwa;Lee, Won Jai;Lew, Dae Hyun;Rah, Dong Kyun;Tark, Kwan Chul
    • Archives of Plastic Surgery
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    • v.35 no.4
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    • pp.439-445
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    • 2008
  • Purpose: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. Methods: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. Results: The average age was 62.8(46 - 73) years old, average follow up period was 7.7(1 - 17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1 - 5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). Conclusion: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

A Study of Historical Costume from the Mural Tombs of Dukheungri (덕흥리(德興里) 고분벽화(古墳壁畵)의 복식사적(服飾史的) 연구(硏究))

  • Park, Kyung-Ja
    • Journal of the Korean Society of Costume
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    • v.5
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    • pp.41-63
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    • 1981
  • The mural portraits of the ancient Dukheungri tombs are very important for the study of our traditional costume because the tomb contains a stone. with the in-scription of the date of its erection, 408 A.D. and the name, and official status of the buried. The costumes shown in the mural paintings will be the basis on which historical research can be made concerning costumes before and after 400 A. D. The costume in the mural paintings is classified into five different categories; You (jacket), Po (overcoat), Go (trousers), Sang (skirt), and Gwan (hat). Comparing these categories with those of other mural paintings lead us to the following conclusions. 1. The length of the You (jacket) reaches below the buttocks and the sleeves are narrow. The edges of the sleeves are decorated with stripes. The You (jacket) over-laps on the right, center, and left sides, and there are many Jikryong (V-collar) and Danryong (rounded collar) styles, but it has a similar tendency to others of the Pyongyang area which exhibit many foreign influences. In a departure from tradition. the belts on the men's You (jackets) have only 3 knots in the front, with the back having more knots than the front. The belts of the women's You (jacket) seem to have had a band or button for fastening. We must re-evaluate the assumption that the You (jacket) and Go (trousers) of the northern peoples had the common characters of a belted You (jacket) and Po (over-coat) and that the Gorum originated from the Goryo or Unified Silla dynasty. The outside of the sleeves are longer and more to the side than the inner garment (underwear) so that the sleeves of the inner garment frequently overlapped the outer dress. The above mentioned facts have lead to the discovery of the "Hansam," "Tosi" and "Geodoolgi." 2. The Po (overcoat) was used only by the upperclasses and differs from those found in other mural tombs. The Po (overcoat) of the noble on the tomb mural is centered with an overlapping Jikryong (V-collar) while the other Po (overcoats) of the upperclasses are characterized by an overlap on the left, a Danryong (rounded collar) with two types of sleeves (wide and narrow). Foreign influences and traditional influences coexist in Po (overcoat). Belts have frontal knots without exceptions. The facts that the belts on the You (jackets) are on the front and the belts on the Po (overcoats) are on the back must be reexamined. 3. Go (trousers) is usually narrow, being wider in the rear and narrower below the knees. They were used by hunters on the back of horses with similar Go (trousers) from the Noinwoowha tombs being typical of the northern peoples. 4. Sang (skirts) are pleated as commonly seen in the Goguryo murals. The size of the pleat is varied, each pleat being characteristically wider and having different colors. Same types of pleat are discovered in Central Asia and China. It is uncertain whether the pleat of Goguryo was originated in Central Asia and China or only interrelated with those of the areas. 5. There are three kinds of Gwan (hats); Nagwan, Chuck, and Heukgun. Nag-wan was worn by the dead lords and their close relations. Chuck has three cone shaped horns. Heukgun was worn by military bandmen and horsemen. There are two kinds of hair styles. The up-style was used by the upperclass people closely related to lords, and other people used the Pungimoung hair style. The hair styles of the men and women are characterized by the Pungimoung style. which is a Chinese influence, but still retain their originality. The costume has a similar tendency from those from Yaksuri mural tombs, Anak No. 2 and Anak No. 3. We need to reexamine the costumes from $4{\sim}5$ century murals according to the Dukheungri murals. The costumes of Goguryo share many common factors with those of Western Asia, Central Asia and Ancient China (Han). It seems due to the cultural exchanges among the Northern peoples, the Western and Central Asians, and the Ancient Chinese. It may have resulted from the structural identity or morphological identity of the peoples, or their common social and natural environments and life styles. It will be very valuable to study the costumes of Japan, China, and Korea to find out the common factors. It is only regretful that the study is not based on direct observations but reported information made by 77 persons, because Dukheungri is an off-limits area to us.

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Symptom Clusters in Advanced Cancer Patients (진행암 환자의 증상군)

  • Hwang, Sun Wook
    • Journal of Hospice and Palliative Care
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    • v.16 no.3
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    • pp.139-144
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    • 2013
  • Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.

A Study on the Rule of Warranty in the English Law of Marine Insurance (영국 해상보험법상 담보(warranty)에 관한 연구)

  • Shin, Gun-Hoon
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.42
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    • pp.275-305
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    • 2009
  • Marine insurance contracts, which intended to provide indemnity against marine risks upon the payment of price, known as a premium, originated in Northern Italy in the late 12th and early 13th centuries. The law and practice were later introduced into England through the Continent. It is, therefore, quite exact that English and European marine insurance law have common roots. Nevertheless, significant divergences between English and European insurance systems occurred since the late 17th century, mainly due to different approaches adopted by English courts. The rule of warranty in English marine insurance was developed and clarified in the second part of the 18th century by Lord Mansfield, who laid the foundations of the modern English law of marine insurance, and developed different approaches, especially in the field of warranty in marine insurance law. Since the age of Lord Mansfield, English marine insurance law has a unique rule on warranty. This article is, therefore, designed to analyse the overall rule of the rule of warranty in English marine insurance law. The result of analysis are as following. First, warranties are incorporated to serve a very significant function in the law of insurance, that is, confining or determining the scope of the cover agreed by the insurer. From the insurer's point of view, such the function of warranties is crucial, because his liability, agreed on the contract of insurance, largely depend on in, and the warranties, incorporated in the contract play an essential role in assessing the risk. If the warranty is breached, the risk initially agreed is altered and that serves the reason why the insurer is allowed to discharge automatically further liability from the date of breach. Secondly, the term 'warranty' is used to describe a term of the contract in general and insurance contract law, but the breach of which affords different remedies between general contract law and insurance contract law. Thirdly, a express warranty may be in any form of words from which the intention to warrant is to be inferred. An express warranty must be included in, or written upon, the policy, or must be contained in some document incorporated by reference into the policy. It does not matter how this is done. Fourthly, a warranty is a condition precedent to the insurer's liability on the contract, and, therefore, once broken, the insurer automatically ceases to be liable. If the breach pre-dates the attachment of risk, the insurer will never put on risk, whereas if the breach occurs after inception of risk, the insurer remains liable for any losses within the scope of the policy, but has no liability for any subsequent losses. Finally, the requirements on the warranty must be determined in according to the rule of strict construction. As results, it is irrelevant: the reason that a certain warranty is introduced into the contract, whether the warranty is material to the insurer's decision to accept the contract, whether or not the warranty is irrelevant to the risk or a loss, the extent of compliance, that is, whether the requirements on the warranty is complied exactly or substantially, the unreasonableness or hardship of the rule of strict construction, and whether a breach of warranty has been remedied, and the warranty complied with, before loss.

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A study on Crack Healing of Various Glassy Polymers (part I) -theoretical modeling- (유리질 중합체의 균열 Healing에 관한 연구 (제1보) -이론 모델링-)

  • Lee, Ouk-Sub
    • Journal of the Korean Society for Precision Engineering
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    • v.3 no.1
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    • pp.40-49
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    • 1986
  • Crack, craze and void are common defects which may be found in the bulk of polymeric materials such as either themoplastics or thermosets. The healing phenomena, autohesion, of these defects are known to be a intrinsic material property of various polymeric materials. However, only a few experimental and theoretical investigations on crack, void and craze healing phenomena for various polymeric materials have been reported up to date [1, 2, 3]. This may be partly due to the complications of healing processes and lacking of appropriate theoretical developments. Recently, some investigators have been urged to study the healing phenomena of various polymenic materials since the significance of the use of polymer based alloys or composites has been raised in terms of specific strength and energy saving. In the earlier published reports [1, 2, 3, 4], the crack and void healing velocity, healing toughness and some other healing mechanical and physical properties were measured experimentally and compared with predicted values by utilizing a simple model such as the reptation model under some resonable assumptions. It seems, however, that the general acceptance of the proposed modeling analyses is yet open question. The crack healing processes seem to be complicate and highly dependent on the state of virgin material in terms of mechanical and physical properties. Furthermore, it is also strongly dependent on the histories of crack, craze and void development including fracture suface morphology, the shape of void and the degree of disentanglement of fibril in the craze. The rate of crack healing may be a function of environmental factors such as healing temperature, time and pressure which gives different contact configurations between two separated surfaces. It seems to be reasonable to assume that the crack healing processes may be divided in several distinguished steps like stress relaxation with molecular chain arrangement, surface contact (wetting), inter- diffusion process and com;oete healing (to obtain the original strength). In this context, it is likely that we no longer have to accept the limitation of cumulative damage theories and fatigue life if it is probable to remove the defects such as crack, craze and void and to restore the original strength of polymers or polymer based compowites by suitable choice of healing histories and methods. In this paper, we wish to present a very simple and intuitive theoretical model for the prediction of healed fracture toughness of cracked or defective polymeric components. The central idea of this investigation, thus, may be the modeling of behavior of chain molecules under healing conditions including the effects of chain scission on the healing processes. The validity of this proposed model will be studied by making comparisons between theoretically predicted values and experimentally determined results in near future and will be reported elsewhere.

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Radiotherapy Result of the Carcinoma of Uterine Cervix (자궁경부암의 방사선치료성적)

  • Park, Charn-Il;Ha, Sung-Whan;Kang, Soon-Beom;Lee, Hyo-Pyo;Shin, Myon-Woo
    • Radiation Oncology Journal
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    • v.2 no.1
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    • pp.107-113
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    • 1984
  • One hundred sixty one patients with the carcinoma of uterine cervix received curative radiotherapy at the Department of Therapeutic Radiology, Seoul National University Hospital between December, 1979 and December, 1982. According to FIGO classification; stage $I_a 1(0.6\%)\;1_b\;8(5.0\%),\;II_a\;31(19.3\%),\;II_b\;66(41.0\%),\;III_a\;3(1.8\;%),\;III_b\;46(28.6\%)\;and\;IV_a\;6(3.7\;%)$. The proportion of early stage cancer is too small because most of them treated by surgery. External beam whole pelvic irradiation was done first with 10MV x-ray or Co-60 gamma ray upto 4,000 or 5,000 rad for early and advanced cases, followed by one or two courses of intracavitary radiation using Fletcher-Suit Applicator loading c Cs-137. Supplementary external radiation to pelvic side wall to bring dose to 6,000 or 6,500 rads, if there is parametrial involvement or positive pelvic lymph node. Of the 161 Patients, 49 Patients were lost to follow-up but only 22 patients were lost in disease free state. And so, 86.3 percent of the patients were followed to time of recurrence or to date. The results are as follows ; 1. Locoregional control rates according to stage is: stage I $100\%,\;II_a\;90.3\;%,\;II_b\;75.8\%,\;III_a\;66.7\%,\;III_b\;58.7\%\;and\;IV_a\;16.7\%$, respectively. 2. Persistent or recurrent disease were localized in pelvic cavity in 32 of 50 patients and 6 had distant metastasis only. 3. Rectal bleeding was the most common complication and appeared mostly between 6 and 24 months after radiotherapy. Most of them had transient minor bleeding and only 2 patients needed transfusion and 1 patient needed colostomy due to rectovaginal fistula. 4. The 3 year disease free survival rate is: stage I $100\%,\;II_a\;78.0\%,\;II_b\;60.6\%,\;III_a\;66.7\;III_b\;46.3\%\;and\;IN_a\;16.7\%$, respectively.

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Chinese Growth Enterprise Market and Business Performance Analysis on Small and Medium Sized Firms and Venture Firms Before and After Listing (중국의 창업판시장과 중소벤처기업의 상장전후 경영성과 분석에 관한 연구)

  • Cui, Wen;Sun, Zhong Yuan;Chang, Seog Ju
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.9 no.3
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    • pp.129-138
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    • 2014
  • After global economic crisis, China has become one of the two pillars in the global economies and the country contributing to the Korean economy. Nevertheless, the research on Chinese financial market, particularly capital market, is rare to date. This study examined the growth enterprise market that emergedat the Shenzhen stock exchange and made comparative analysis on before and after listing for the Chinese small and medium sized firms and venture firms. The listing requirements at the Chinese growth enterprise market for the technologically innovative venture firms and fast-growing small and medium sized firms with financing purpose were more alleviated than the main board of Shenzhen stock exchange. Moreover, the listing procedures are simplified as well. Accordingly, many Chinese enterprises tend to list and the competition for listing is also intense. In particular, with the 36 initially listed firms at growth enterprise market as the research target, the investigation for the business performance before and after listing reveals that the three indexes including return on common equity, debt ratio and operating profit growth rate dropped dramatically for most all the firms. That is, the profitability and growth for the venture firms and small and medium sized firms listed on the Chinese growth enterprise market decreased rapidly after going public, only the stability improved due to the great financing. Taking a step forward, this phenomenon may result from the exaggerated reporting for the business performance before listing with the purpose of going public by the venture firms and small and medium sized firms. Thus, Chinese Securities Regulatory Commission should strengthen the accounting evaluation standard and regulation for the listing firms before going public. In addition, strict sanctions should be imposed on the firms with fraudulent accounting to establish healthy capital market.

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Design and Development of Multiple Input Device and Multiscale Interaction for GOCI Observation Satellite Imagery on the Tiled Display (타일드 디스플레이에서의 천리안 해양관측 위성영상을 위한 다중 입력 장치 및 멀티 스케일 인터랙션 설계 및 구현)

  • Park, Chan-Sol;Lee, Kwan-Ju;Kim, Nak-Hoon;Lee, Sang-Ho;Seo, Ki-Young;Park, Kyoung Shin
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.18 no.3
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    • pp.541-550
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    • 2014
  • This paper describes a multi-scale user interaction based tiled display visualization system using multiple input devices for monitoring and analyzing Geostationary Ocean Color Imager (GOCI) observation satellite imagery. This system provides multi-touch screen, Kinect motion sensing, and moblie interface for multiple users to control the satellite imagery either in front of the tiled display screen or far away from a distance to view marine environmental or climate changes around Korean peninsular more effectively. Due to a large amount of memory required for loading high-resolution GOCI satellite images, we employed the multi-level image load technique where the image was divided into small tiled images in order to reduce the load on the system and to be operated smoothly by user manipulation. This system performs the abstraction of common input information from multi-user Kinect motion and gestures, multi-touch points and mobile interaction information to enable a variety of user interactions for any tiled display application. In addition, the unit of time corresponding to the selected date of the satellite images are sequentially displayed on the screen and multiple users can zoom-in/out, move the imagery and select buttons to trigger functions.

Regional Asymmetries and Development Cooperation in MERCOSUR (남미공동시장의 역내 비대칭성과 지역개발협력)

  • Hyun, Min
    • Iberoamérica
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    • v.21 no.1
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    • pp.57-105
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    • 2019
  • This paper deals with the regional asymmetries of MERCOSUR and regional development cooperation for its solution. Through the formation of a common market, the countries of Southern Cone expected to grow evenly. However MERCOSUR had structural asymmetry from the beginning and exposed policy asymmetry over time. It is basically due to the overwhelming influences of Brazil on MERCOSUR. With regard to asymmetries, Paraguay calls for special and differential treatment. Uruguay wants equitable application of market liberalization. Argentine emphasizes production integration based on the development of value chains. In the issue of asymmetries, while Paraguay, Uruguay and Argentine act as petitioners, Brazil is capable of selecting the initiatives. Under these circumstances MERCOSUR has established FOCEM as regional redistribution mechanism. FOCEM has achieved some results as seen in Paraguay, but there are still problems such as financial limitations and lack of enforcement. In oder to activate the redistributive mechanism for regional integration and to coordinate the policies to resolve regional disparities, transnational governance is essential but all member countries are reluctant to it. To date, regional asymmetries or development gaps have persisted and disparities in individual countries remains a problem.

Role of Adjunctive Tranexamic Acid in Facilitating Resolution of Chronic Subdural Hematoma after Surgery

  • Kiyoon Yang;Kyung Hwan Kim;Han-Joo Lee;Eun-Oh Jeong;Hyon-Jo Kwon;Seon-Hwan Kim
    • Journal of Korean Neurosurgical Society
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    • v.66 no.4
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    • pp.446-455
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    • 2023
  • Objective : Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution. Methods : Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA, and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated. Results : A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p<0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p<0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p<0.001). There was no TXA-related adverse event. Conclusion : The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.