There are lots of reconstructive ways like direct closure, skin graft, local flap, regional flap, distant flap, free flap and so on. Microsurgical reconstruction is regarded as the last step in various reconstructive methods. So the failure of this last step causes the troublesome situation for both of patients and surgeon. The purpose of this paper is to investigate the problems in failed free flap surgery and to introduce the strategy of appropriate management in wound of free flap failure. We performed 252 cases of free flap surgeries from May, 1988 to June, 1998. Among these cases, we failed 9 cases of free flaps. Patients' age ranged from 19 to 63. There were 7 males and 2 females. Site of failure were 3 head and neck areas, 2 hands, and 4 lower extremities. However there was no failure in breast, trunk, buttock, and genitalia. 7 patients who had region of head and neck, and lower extremity underwent the second free flap surgery successfully in postoperative 4 to 16 days following debridement of necrotic tissue. However 2 patients who had region in hand were managed with conventional treatment like skin graft and distant flap. Vein grafts were needed in 3 cases of 7 second free flaps, and 1 patients needed sequentially-linked free flaps with two flaps. The second free flaps were inevitable for head and neck area because the large complex wound may cause the lifethreatening condition without immediate coverage with well vascularized flap. Lower extremity also needed second free flap for limb salvage. Hand could be managed with conventional method, even though healing time was quite delayed. We thought second free flap surgery in free flap failure cases should be performed with more careful preoperative evaluation and refined surgery. Success of second free flap surgery could recover the very difficult situation due to previously failed operation.
Purpose: An impacted tooth is defined as a tooth that shows delayed eruption and is expected to erupt incompletely by clinical and radiograph examination despite it reaching its expected time of eruption. The aims of this study were to investigate the clinical and radiological characteristics and treatment duration and method of impacted teeth in Korean patients. Materials and Methods: For this study we used clinical records, study models, panoramic radiographs and intraoral photographs of patients who attended Gachon University Gil Hospital Orthodontic Department between 2005 and 2008. There were 164 patients with a total number of 202 impacted teeth. Results: Male patients shows a little more prevalence than female patients (1.13:1). The under 12 age group had the highest prevalence of tooth impaction, and the over 19 age group showed the least prevalence of tooth impaction. The ratio of tooth impaction between the left to right ratio was 1.73:1 and maxilla and mandible was 1.84:1. The impacted teeth were most commonly positioned buccally (76 cases, 41.5%). Full nap closure technique (108 cases, 81.2%)was most frequently used for attachment of surgical traction hooks. Maxillary canine impaction was most commonly encountered both in male and female patients. The mean treatment period was 12.2 months and the success rate of treatment was 90.3%. The canine tooth shows the longest treatment time and highest failure rate. The ankylosis was the major cause of failure. Conclusion: Impacted teeth most commonly show in left side maxilla in the under 12 age group. And it is most commonly positioned buccally. The mean treatment period was 12.2 months, and the success rate of treatment was 90.3%.
Bolt degradation has become a major issue in the nuclear industry since the 1980's due to failure during operation. If small cracks in stud bolt are not detected early enough, they grow rapidly and cause catastrophic disasters. Their detection, despite its importance, is known to be a very difficult problem due to the complicated structures of the stud bolts. This paper presents a method of detecting and sizing a small crack in the root between two adjacent crests in threads. The key idea is from the fact that the Rayleigh wave propagates slowly along a crack from the tip to the opening and is reflected from the opening mouth. When there exists a crack, a small delayed pulse due to the Rayleigh wave is detected between large regularly spaced pulses from the thread. The delay time is the same as the propagation delay time of the slow Rayleigh wave and is proportional to the size of the crack. To efficiently detect the slow Rayleigh wave, three methods based on digital signal processing are proposed : modified wave shaping, dynamic predictive deconvolution, and dynamic predictive deconvolution combined with wave shaping.
Purpose: The advantages of air reduction are the ease of performing the procedure, reduced radiation time and lower morbidity rate if perforation occurs. But, patients who fail air reduction undergo a laparotomy at which 10% have spontaneously reduced. The first enema decreases the edema and venous congestion of bowel wall, thus repeated reduction may succeed. The aim of this study is to evaluate the efficacy of delayed repeated pneumatic reduction of intussusception in patients with failure of an initial attempt. Methods: Between January 1998 and December 1999, 21 patients with proven intussusception received repeated delayed reduction 1 to 3 hours following the first failed attempt. These patients were in stable condition and did not have peritonitis, shock or toxic sign. Results: Before reduction, the patients had symptoms and signs for 6 to 48 hours (median 24 hr). The interval from the first reduction to the repeated was 1 to 3 hours (median 2.2 hr). The success rate of repeated reductions was 76.2% (16 of 21 patients), and 23.8% (5 of 21 patients) required surgery. Four of 5 patients requiring surgery were manually reduced and 1 spontaneously reduced in the operating room. Conclusion: We recommended a repeated reduction in patients with intussusception who are in stable clinical condition after an unsuccessful initial reduction attempt.
In this study, software products developed in the course of testing, software managers in the process of testing software and tools for effective learning effects perspective has been studied using the NHPP software. The delayed software S-shaped reliability model applied to distribution was based on finite failure NHPP. Software error detection techniques known in advance, but influencing factors for considering the errors found automatically and learning factors, by prior experience, to find precisely the error factor setting up the testing manager are presented comparing the problem. As a result, the learning factor is greater than automatic error that is generally efficient model could be confirmed. This paper, numerical example of applying using time between failures and parameter estimation using maximum likelihood estimation method, after the efficiency of the data through trend analysis model selection were efficient using the mean square error and $R^2$(coefficient of determination).
Objective : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4-8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4-8 weeks of antibiotic treatment is sufficient. Methods : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4-8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.
The Journal of the Institute of Internet, Broadcasting and Communication
/
v.22
no.3
/
pp.193-200
/
2022
In this study, the finite-failure NHPP software reliability model was applied to the software development model based on the Weibull lifetime distribution (Goel-Okumoto, Rayleigh, Type-2 Gumbe), which is widely used in the software reliability field, and then the cost attributes were compared and evaluated. For this study, failure time data detected during normal operation of the software system were collected and used, the most-likelihood estimation (MLE) method was applied to the parameter estimation of the proposed model, and the calculation of the nonlinear equation was solved using the binary method. As a result, first, in the software development model, when the cost of testing per unit time and the cost of removing a single defect increased, the cost increased but the release time did not change, and when the cost of repairing failures detected during normal system operation increased, the cost increased and the release time was also delayed. Second, as a result of comprehensive comparative analysis of the proposed models, it was found that the Type-2 Gumble model was the most efficient model because the development cost was lower and the release time point was relatively faster than the Rayleigh model and the Goel-Okumoto basic model. Third, through this study, the development cost properties of the Weibull distribution model were newly evaluated, and the analyzed data is expected to be utilized as design data that enables software developers to explore the attributes of development cost and release time.
Purpose: We retrospectively analyzed the radiographic and clinical results after the first ray of forefoot osteotomy using low profile wedge plate without additional cancellous bone grafting for pes planus correction. Materials and Methods: Twenty-four patients were enrolled in this study. Medial cuneiform opening wedge osteotomy was performed in 12 patients (Cotton osteotomy, group C) and first metatarsal base osteotomy was performed in 12 patients (group MT). Results: On average, the wedge size was 5.61 mm (5~6 mm). The mean time to radiographic union was 3.18 and 3.27 months in groups C and MT, respectively. Postoperative talonavicular coverage angle, talo-first metatarsal angle (anteroposterior), talo-first metatarsal angle (lateral), talo-calcaneal angle (lateral), medial cuneiform height, and American orthopaedic foot, as well as ankle society midfoot scale were significantly improved in both groups. Nonunion, delayed union or fixation failure was not presented in our series. Conclusion: We have shown that low profile wedge plate was effective in the case of first ray forefoot osteotomy for pes planus correction without any additional cancellous bone grafting.
Journal of the Korean Operations Research and Management Science Society
/
v.24
no.4
/
pp.27-47
/
1999
Many enterprises are interested in using the IS development methodologies as a means of increasing system performance and solving the problems of delayed delivery time, excessive budget, and failure of integrated systems. Even if previous researches showed that the system productivity and quality improvement using the system development methodologies are very poor, we tried to find that the methodologies are meaningful as an innovative means for IS performance. We defined that the IS development methodology as a technical and managerial innovation for IS department. We intended to study the relationship between the implementation process of the IS development methodology divided into four steps and IS performance. A cross-sectional field survey with IS departments of domestic companies was conducted, and we used LISREL 8.12a to perform the structural equation model analysis and hypothesis verification. We found the meaningful relationship between the development methodology and qualitative performance. We reconfirmed that the relationship between the development methodology and quantitative performance is not meaningful as expected, which is the same result with the previous researches. But the qualitative performance affects very strongly to the quantitative performance. As a results, we suggest that IS managers and developers keep the principles of the IS development methodologies to get the quantitative performance through the qualitative performance improvement.
Kim, Yun-Mi;Yoo, Byung-Won;Choi, Jae-Young;Sul, Jun-Hee;Park, Young-Hwan
Clinical and Experimental Pediatrics
/
v.54
no.2
/
pp.86-89
/
2011
Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.
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