• Journal of Chest Surgery
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• 제56권3호
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• pp.206-212
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• 2023

Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.

• International Journal of Computer Science & Network Security
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• 제24권8호
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• pp.85-104
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• 2024

The DNA (Deoxyribonucleic Acid) database size increases tremendously transmuting from millions to billions in a year. Ergo for storing, probing the DNA database requires efficient lossless compression and encryption algorithm for secure communication. The DNA short pattern repetitions are of paramount characteristics in biological sequences. This algorithm is predicated on probing exact reiterate, substring substitute by corresponding ASCII code and engender a Library file, as a result get cumulating of the data stream. In this technique the data is secured utilizing ASCII value and engendering Library file which acts as a signature. The security of information is the most challenging question with veneration to the communication perspective. The selective encryption method is used for security purpose, this technique is applied on compressed data or in the library file or in both files. The fractional part of a message is encrypted in the selective encryption method keeping the remaining part unchanged, this is very paramount with reference to selective encryption system. The Huffman's algorithm is applied in the output of the first phase reiterate technique, including transmuting the Huffman's tree level position and node position for encryption. The mass demand is the minimum storage requirement and computation cost. Time and space complexity of Repeat algorithm are O(N²) and O(N). Time and space complexity of Huffman algorithm are O(n log n) and O(n log n). The artificial data of equipollent length is additionally tested by this algorithm. This modified Huffman technique reduces the compression rate & ratio. The experimental result shows that only 58% to 100% encryption on actual file is done when above 99% modification is in actual file can be observed and compression rate is 1.97bits/base.

• Journal of Korean Neurosurgical Society
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• 제41권2호
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• pp.77-81
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• 2007

Objective : In a variety of thoracolumbar diseases, corpectomy followed by interbody bone graft and anterior instrumentation has allowed direct neural decompression and reconstruction of the weight-bearing column by short segments fusion. In this study, we compared spinal stability of the two different anterior thoracolumbar instruments : Z-plate and Kaneda device representing plate and two-rods type, respectively. Methods : A retrospective review was performed for all the patients with thoracolumbar diseases or traumas treated with anterior corpectomy, autologous iliac bone graft, and fixation with instruments from 1996 to 2000. For the anterior instrumentation, Z-plate or Kaneda device was used for 24 [M:F=5:9, average age=37] and 12 [M:F=9:3, average age=41] patients, respectively. The plain AP and lateral flexion-extension films were taken immediately after surgery and at each follow-up. The sagittal and coronal Cobb's angles at the operation segments were used to observe the change of initial fixation status. The surgical time length and bleeding amount of the two groups were compared. Intra-operative and post-operative instrument associated complications were evaluated. Student t-test was used for statistical analysis and p-value less than 0.05 was considered to be significant. Results : Mean follow-up durations for Z-plate and Kaneda device were 24 and 21 months, respectively. The fusion rate was 91% for Z-plate and 100% for Kaneda device. Two cases of Z-plate group showed instrumentation failure during the follow up period, in which additional surgery was necessary. The mean differences of sagittal Cobb's angles among the AP images immediate after surgery and at follow-up were 7 and 2 degrees for Z-plate and Kaneda device, respectively [p<0.05]. The mean differences of coronal Cobb's angles were 5 and 2 degrees for Z-plate and Kaneda device, respectively [p<0.05]. No Intra-operative complication has occurred in both groups. There was no difference in surgery time and bleeding amount between two groups. Conclusion : We think that Kaneda device [rod type] is stronger than Z-plate [plate type] to keep the spinal stability after anterior thoracolumbar surgery.

• 한국항해항만학회지
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• 제30권1호
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• pp.29-34
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• 2006

연구는 1997년부터 2003년까지 우리나라 전국에서 발생한 스쿠버 잠수 사고 자료를 수집 및 분석하고 일본 및 미국에서 발생한 잠수 사고와 비교 분석하여 우리나라 스쿠버 잠수 사고의 특성을 밝혀내었다. 연구 결과는 잠수 사고 예방에 큰 기여를 할 수 있을 것으로 기대된다. 사고 자료는 대한수중협회의 기술위원회에 보고된 자료와 해양경찰청의 자료, 스쿠버 잠수 전문점에 전화 통화 및 방문 조사를 실시하여 얻은 정보, DAN(Diver Alert Network)에서 발행한 잠수 사고 보고 자료집, 월간 잡지에 수록된 잠수 사고 보고 자료, 그리고 세미나 발표 자료 등을 참조하였다. 자료 분석은 사망 사고에 국한하였으며 분석 결과 우리나라의 사망률이 일본의 2.8배, 미국의 2.2배 수준인 것으로 나타났다.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.5-10
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• 2008

Objective : To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis with patients who had failed medical management. Methods : A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed. Results : There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from $3.78{\pm}0.78$ preoperatively to $4.78{\pm}0.35$ at final follow up and mean VAS score was improved from $7.43{\pm}0.54$ to $2.07{\pm}1.12$. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations. Conclusion : According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.

• Journal of Korean Neurosurgical Society
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• 제42권1호
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• pp.6-10
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• 2007

Objective : The purpose of this study was to determine the effect of bone cement augmentation of pedicular screwing in severe osteoporotic spondylolisthetic patients. Methods : Twenty patients with spondylolisthesis (8 : spondylolytic spondylolisthesis 12 : degenerative spondylolisthesis) who had undergone pedicular screwing and interbody fusion for osteoporotic lumbar spine (T-score on bone mineral density<-3.0) from 2002 to 2005 were reviewed. Mean age was 62.3 years with 3 male and 17 female patients. Average follow-up period was 14 months. Average T-score on bone mineral density (BMD) was -3.62. After decompression of neural elements, about 6cc of polymethylmethacrylate (PMMA) was injected into the each vertebral body through transpedicular route. All patients underwent one level interbody fusion and pedicular screw fixation. Clinical outcome was assessed using Oswestry Disability Index (ODI) on the last clinical follow-up. In addition, a modified MacNab's grading criteria was used to objectively assess patient's outcome postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up including fusion rate. Results : Eighteen of 20 patients were graded as excellent or good according to the modified MacNab's criteria. An significant improvement of ODI was achieved in both groups. Mean sagittal angle at the preoperative state, postoperative state and at the last follow-up state was $11.0^{\circ},\;20.1^{\circ}$ and $18.3^{\circ}$, respectively, with mean sagittal angle correction gain $7.3^{\circ}$. Firm fusion was achieved in all patients. There were one compression fracture above the fused segment after 6 months follow-up and one case of seroma. But there were no postoperative complications related to bone cement leakage and pedicular screwings such as screw pullout or screw cut-up. Conclusion : Bone cement augmentation of pedicular screwing can be an effective procedure for osteoporotic lumbar spine in spondylolisthetic patients.

• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.571-577
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• 2015

Direct removal of beak-type ossification of posterior longitudinal ligament at thoracic spine (T-OPLL) is a challenging surgical technique due to the potential risk of neural injury. Slipping off the cutting surface of a high-speed drill may result in entrapment in neural structures, leading to serious complications. Removal of T-OPLL with an ultrasonic osteotome, utilizing back and forth micro-motion of a blade rather than rotatory-motion of drill, may reduce such complications. We have applied the ultrasonic osteotome for posterior circumferential decompression of T-OPLL for three consecutive patients with beak-type OPLL and have described the surgical techniques and patient outcomes. The preoperative chief complaint was gait disturbance in all patients. Japanese orthopedic association scores (JOA) was used for functional assessment. Scores measured 2/11, 5/11, 2/11, and 4/11 for each patient. The ventral T-OPLL mass was exposed after posterior midline approach, laminotomy and transeversectomy. The T-OPLL mass was directly removed with an ultrasonic osteotome and instrumented segmental fixation was performed. The surgeries were uneventful. Detailed surgical techniques were presented. Gait disturbance was improved in all patients. Dural tear occurred in one patient without squeal. Postoperative JOA was 6/11, 10/11, 8/11, and 8/11 (recovery rate; 44%, 83%, 67%, and 43%) respectively at 18, 18, 10, and 1 months postoperative. T-OPLL was completely removed in all patients as confirmed with computed tomography scan. We hope that surgical difficulties in direct removal of T-OPLL might be reduced by utilizing ultrasonic osteotome.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.223-231
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• 2015

Purpose: Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not. Methods: The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings. Results: This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome. Conclusion: In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2008년도 추계학술대회A
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• pp.1547-1552
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• 2008

The tip of these catheter with straight needles is not able to reach in the vicinity of the disc bulging, which are the cause of the low back pain and because the far indirect radio-frequency treatment results in the decompression, the nucleoplasty has the limit. Many incurable diseases has not been solved due to the unexistence of the advanced technique for the MIS human body catheter device. To increase the possibility of nucleoplasty, the needle tip should be located at the closest area of the lesion. For this reason, the best way to increase the success rate of the operation is that the needle tip should access 3-dimensionally to the operating field as soon as possible. To achieve this aim, our studies are restricted as follows: 1) the SMA catheter design to control the 3-dimensional direction, 2) the security of the immediate response by the positive control of the SMA element thermal distribution using Peltier thermoelectric elements, 3) the aquisition of the control data by monitoring the relationship between the temperature of SMA element and the displacement, and 4) the design of the controller to guarantee the accurate location.

• 한국멀티미디어학회논문지
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• 제1권1호
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• pp.37-44
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• 1998

최근 SGML을 이용한 문서정보와 구축에 관한 연구가 많이 이루어지고 있으나, 현재 운영되고 있는 전자도서관에서는 기존의 출판물 문서를 이진 문서영상으로 스캐닝하여 사용자에게 그대로 서비스하는 방식을 이용하고 있다. 이때, 주로 200dpi로 스캐닝한 문서영상에 대하 TIFF 영상포맷에서의 ITU-T T.6 압축방법을 사용하여 제공하고 있는데, 이진 문서영상의 질 저하 현상과 낮은 압축율로 인해 어려움을 겪고 있다. 이에, 본 연구에서는 문서영상 데이터베이스의 확장성 및 효용성과 서비스 질의 향상성을 고려하여, 문서영상의 스캐닝 해상도는 600dpi가 적당하며, 압축방법은 JBIG이 타당함을 제시하였다. 아울러, 사용자 장비인 모니터와 프린터를 통한 서비스의 특성을 분석하여 이진 문서영상의 해상도를 단계별로 높여 서비스하는 방안을 제시함으로써, JBIG의 단점인 과다한 복구시간 문제를 해결하였다. 대표적인 문서영상들에 대한 실험을 통해, JBIG의 높은 압축율 및 제시된 단계별 서비스 방안의 타당성을 확인하였다.