• Title/Summary/Keyword: Early Failure

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Score System for Operative Risk Evaluation in Coronary Artery Bypass Surgery (관상동맥 우회로술의 수술 위험인자에 대한 스코어 시스템)

  • Kang Joon-Kyu;Kim Chong-Wook;Sheen Seung-Soo;Chung Cheol-Hyun;Lee Jae-Won;Song Meong-Gun;Lee Jung-Sook;Song Hyun
    • Journal of Chest Surgery
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    • v.39 no.10 s.267
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    • pp.749-753
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    • 2006
  • Background: The purpose of this study is to assess a score system for operative risk evaluation of CABG. Material and Method: From January 2001 to September 2005, retrospective study for various perioperative factors of 2993 cases was done. Result: The early operative mortality was 2.4% and the beta coefficients of 7 core variables related to it (preoperative LV dysfuction, preoperative renal failure, MI within 1 week, reoperation, combined surgery, preoperative atrial fibrillation, preoperative IABP) were adjusted to score system. ROC curve and Hosmer and Lemeshow goodness of fit test was done. Conclusion: This score system was effective in assessing operative risk of CABG. But It is necessary to gather larger volume of case and perform multicenter study.

A Study on the Development of Fire Alarm System with Evacuation Lighting and Voice Alarm Functions (피난조명 및 음성경보 기능을 내장한 화재경보시스템 개발에 관한 연구)

  • Lee, Gun-Ho;Choi, Su-Gil;Kim, Si-Kuk
    • Fire Science and Engineering
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    • v.32 no.4
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    • pp.25-34
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    • 2018
  • This study investigated the development of a fire alarm system with evacuation lighting and voice alarm functions. The performance of a fire detector and system with independently built-in evacuation lighting and voice alarm functions was confirmed for early recognition of fire and to allow visibility of the evacuation route in the event of fire. This new system satisfied model recognition and product testing technological standards with 1.62 lx average illumination, 89.7 dB average sound and 86.1 dB average voice. From additionally testing the evacuation performance of this new system, it was confirmed that the evacuation time decreased by 63.08% to 67.82% under the experimental conditions compared to conventional systems. The new system can minimize fire damage by setting off voice alarms to prevent failure of fire recognition and by flashing emergency lighting to secure the minimum required visibility range for evacuation. Therefore, it is considered that it will be utilized as a fire alarm system with appropriateness and usefulness by considering people with hearing or visual impairment.

Salvage of Infected Breast Implants

  • Song, Joon Ho;Kim, Young Seok;Jung, Bok Ki;Lee, Dong Won;Song, Seung Yong;Roh, Tai Suk;Lew, Dae Hyun
    • Archives of Plastic Surgery
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    • v.44 no.6
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    • pp.516-522
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    • 2017
  • Background Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. Methods We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. Results The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. Conclusions Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.

Curative Radiotherapy of Supralottic Cancer (성문상부암의 근치적 방사선치료)

  • Kim, Yong-Ho;Chai, Gyu-Young
    • Radiation Oncology Journal
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    • v.16 no.2
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    • pp.139-145
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    • 1998
  • Purpose : The purpose of this study was to evaluate the efficacy of curative radiotherapy in the management of supralottic cancer. Materials and Methods : Twenty-one Patients with squamous cell carcinoma of the supralottis were treated with radiotherapy at Gyeongsang National University Hospital between 1590 and 1994. Median follow-up period was 36 months and 95% were observed for at least 2 years. Results : Actuarial survival rate at 5 years was 39.3% for 21 patients. The 5-rear actuarial survival rate was 75.0% in Stage I, 42.9% in Stage II, 33.3% in Stage III and 28.6% in Stage IV(p=0.54), The 5-year local control rate was 52.0% for 21 patients. The 5-rear local control rate was 75.0% in Stage I, 57.1% in Stage II, 66.7% in Stage III, and 28.6% in Stage IV(p=0.33). Double primary cancer was developed in 3 patients and those were all esophageal cancers. Conclusion : In early stage(Stage I and II) supralottic cancer, curative radiotherapy would be a treatment of choice and surgery would be better to be reserved for salvage of radiotherapy failure. In advanced stage(Stage III and IV), radiotherapy alone is inadequate for curative therapy and combination with surgery should be done in operable patients. This report emphasizes the importance of esophagoscopy and esophagogram at the follow-up of patients with supralottic cancer.

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Single and Double-row Repair in Rotator Cuff Tears (회전근 개 파열의 일열 봉합술과 이열 봉합술)

  • Park, Jin-Young;Choi, Jin-Hyung;Park, Hong-Keun;Yu, Je-Wook;Seo, Joong-Bae
    • Clinics in Shoulder and Elbow
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    • v.9 no.1
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    • pp.89-95
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    • 2006
  • Purpose: Arthroscopic repair of rotator cuff tears are many techniques that have been developed to improve the initial postoperative strength of the repair. There was a doubt that current arthroscopic cuff repairs using a single row of suture anchors reproduce insufficient area of the anatomic cuff insertion, and concerns about failure of fixation often lead surgeons to limit early motion. Newer technique of double-row repair in arthroscopic treatment may provide initial stronger fixation and more contact with bone at the repair site than single-row repair did. We studied the comparison between clinical outcomes of arthroscopic single- and double-row repair in cuff tears at 1year postoperatively. Materials and methods: We retrospectively analyzed 40 shoulders with single-row repair and 38 shoulders with double-row repair of full-thickness rotator cuff tears between May 2002 and October 2004. Out of total 78 shoulders, 42 (54%) were male patients and 36 (46%) were female patients and the mean age at surgery was 56 years. All patients were diagnosed by physical examination and MRI. At 1year' follow-up after operation, we evaluated with the ASES and the Constant scoring system, and measured muscle power of abduction, internal and external rotation of the affected shoulder then compared with each other. Results: Mean ASES scores and Constant scores in double-row repair group improved more than single-row repair group significantly at 1year postoperatively. Muscle power of abduction and internal rotation, especially abduction power, improved more significantly in double-row repair group than in single-row repair. Conclusion: Arthroscopic double-row repair for the full thickness rotator cuff tear may be a superior technique, which showed better clinical outcomes and restoration of muscle power compared with single-row repair at relatively short period of postoperative follow-up. Restoration of footprint close to normal anatomy by double-row repair seems to play an important role in the recovery of muscle strength.

Treatment of Anaplastic Thyroid Cancer (미분화 갑상선암의 치료)

  • Chang Hang-Seok;Yoon Jong-Ho;Chung Woong-Youn;Lee Mi-Kyung;Park Cheong-Soo
    • Korean Journal of Head & Neck Oncology
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    • v.14 no.2
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    • pp.220-227
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    • 1998
  • The clinical and pathological features of 35 cases of anaplastic thyroid cancer were studied. These tumors occurred in 12 men and 23 women ranging in age from 19 to 83 years(mean age; 61.7 years). A rapidly enlarging thyroid mass was the most common presentation. The duration of the presence of mass varied from 20 days to 12 months with an average of 2.7 months. Systemic metastasis at the time of initial examination was found in 14 patients(40.0%) and the lung was the most common site of involvement. The overall rate of distant metastasis was about 65.7%. The tumors were subdivided morphologically into giant cell type of 10 cases, spindle cell type of 7 cases, epidermoid cell type of 1 cases, and mixed giant cell and spindle cell type of 5 cases. The mean survival period of 6 among 35 patients who had biopsy alone was 1.4 months. The 22 patients underwent the incomplete combined treatment modalities (palliative surgery with or without chemotherpy or radiation therapy) survived for a mean period of 3.0 months, among them, 7 patients who had surgery combined with chemotherapy and radiation therapy showed mean survival period of 3.7 months. The mean survival of 7 patients who had complete combined treatment modality(curative surgery combined with chemotherapy and hyperfractionated radiation therapy) was 6.6 months, only one patient survived for 21 months and one patient has been alive for 1 month after operation, and the others survived for a mean period of 4.8 months. So far, as of July 31, 1998, 34 patients among 35 were died(one has been survived for 1 month) despite the various treatment modalities, and the main cause of death were failure of local control and systemic metastasis. None of the various treatment modalities gave consistently favourable results. However, a combination of surgery, radiation therapy and chemotherapy seemed to have a slight positive effect on survival. Furthermore, the aggressive treatment modalities will be indicated only in the early diagnosed and minimal cases.

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Impact of antimicrobial resistance in the $21^{st}$ century

  • Song, Jae-Hoon
    • Proceedings of the Korean Society for Applied Microbiology Conference
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    • 2000.04a
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    • pp.3-6
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    • 2000
  • Antimicrobial resistance has been a well-recognized problem ever since the introduction of penicillin into clinical use. History of antimicrobial development can be categorized based on the major antibiotics that had been developed against emerging resistant $pathogens^1$. In the first period from 1940 to 1960, penicillin was a dominating antibiotic called as a "magic bullet", although S.aureus armed with penicillinase led antimicrobial era to the second period in 1960s and 1970s. The second stage was characterized by broad-spectrum penicillins and early generation cephalosporins. During this period, nosocomial infections due to gram-negative bacilli became more prevalent, while those caused by S.aureus declined. A variety of new antimicrobial agents with distinct mechanism of action including new generation cephalosporins, monobactams, carbapenems, ${\beta}$-lactamase inhibitors, and quinolones characterized the third period from 1980s to 1990s. However, extensive use of wide variety of antibiotics in the community and hospitals has fueled the crisis in emerging antimicrobial resistance. Newly appeared drug-resistant Streptococcus pneumoniae (DRSP), vancomycin-resistant enterococci (VRE), extended-spectrum ${\beta}$-lactamase-producing Klebsiella, and VRSA have posed a serious threat in many parts of the world. Given the recent epidemiology of antimicrobial resistance and its clinical impact, there is no greater challenge related to emerging infections than the emergence of antibiotic resistance. Problems of antimicrobial resistance can be amplified by the fact that resistant clones or genes can spread within or between the species as well as to geographically distant areas which leads to a global concern$^2$. Antimicrobial resistance is primarily generated and promoted by increased use of antimicrobial agents. Unfortunately, as many as 50 % of prescriptions for antibiotics are reported to be inappropriate$^3$. Injudicious use of antibiotics even for viral upper respiratory infections is a universal phenomenon in every part of the world. The use of large quantities of antibiotics in the animal health industry and farming is another major factor contributing to selection of antibiotic resistance. In addition to these background factors, the tremendous increase in the immunocompromised hosts, popular use of invasive medical interventions, and increase in travel and mixing of human populations are contributing to the resurgence and spread of antimicrobial resistance$^4$. Antimicrobial resistance has critical impact on modem medicine both in clinical and economic aspect. Patients with previously treatable infections may have fatal outcome due to therapeutic failure that is unusual event no more. The potential economic impact of antimicrobial resistance is actually uncountable. With the increase in the problems of resistant organisms in the 21st century, however, additional health care costs for this problem must be enormously increasing.

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A CASE OF SUPERNUMERARY TEETH IN THE MANDIBULAR INCISOR REGION : (하악에 발생한 과잉치의 치험례)

  • Park, Jung-Ah;Choi, Nam-Ki;Kim, Seon-Mi;Jang, Hee-Suk;Yang, Kyu-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.32 no.4
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    • pp.644-648
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    • 2005
  • Supernumerary tooth was resulted from excessive proliferation of dental lamina and associated with familial tendency and a congenital syndrome such as Cleidocranial dysostosis or Gardner's syndrome. Incidence reports identify a range of $0.3{\sim}0.8%$ in primary dentition, $1.0{\sim}3.5%$ in permanent dentition with males being affected twice as frequently as females, maxilla nine times as frequently as mandible. The most common supernumerary tooth is the mesiodens, which located between the maxillary central incisors, and the next common site is the fourth molar and lateral incisors. Supernumerary teeth are uncommon in the mandible, but premolars are the most common supernumerary teeth and occurrence is very rare in the incisor region of the mandible and the incidence is 2%. We need a early diagnosis and appropriate treatment plan because of possiblilty of diastema and eruption failure displacement, rotation of the associated permanent teeth, root resorption and dentigerous cyst with presence of the supernumerary teeth. In this two case, one supernumerary tooth located in the mandibular incisor region, the other supernumerary tooth located in premolar region. We could get normal alignment of mandibular dentition by extraction and orthodontic treatment.

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A Study on Egress Algorithm for High-rise Buildings Using Egress Simulation (피난시뮬레이션을 이용한 초고층건물의 피난 알고리즘 연구)

  • Kim, Won Kook;Seo, Dong Hyun
    • Fire Science and Engineering
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    • v.32 no.1
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    • pp.33-39
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    • 2018
  • When the fire in the high-rise building was not extinguished in its early stage and propagated over its origin, safe egress becomes one of the most important factor to minimize the casualties. Recently fire protection for high-rise building has been reinforced after experiencing the series of disastrous fires. But, we still find many high-rise buildings do not comply with those reinforcement. And also there is a possibility of failure of reinforced fire protection system. Under these situation safe egress guide would be the final layer of protection. In this study existing egress methods were identified and evaluated. According the result of study, priority in egress should be given to the tenants on the floor of fire origin and floors exposed to the risk of fire. Then, the rest of the tenants can be evacuated simultaneously. Floors exposed in fire risk shall be determined by fire tests and/or fire simulations. But, the result of fire monitoring shall override preliminary estimations. Egress time for each algorithm was estimated by egress simulation and the result was compared. There was a little difference in egress time between total egress and phased egress, and a big difference between using stairs only and using elevators and stairs together. to a constant thickness between layers constituting a firefighter's protective clothing should be considered in the future.

Continuous Anaerobic H2 Production with a Mixed Culture (혐기성 수소 생산 공정의 연속운전)

  • Kim, Sang-Hyoun;Han, Sun-Kee;Youn, Jong-Ho;Shin, Hang-Sik
    • Journal of the Korea Organic Resources Recycling Association
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    • v.11 no.1
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    • pp.70-76
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    • 2003
  • Continuous anaerobic hydrogen production with a mixed culture was investigated. With a sucrose concentration of 5g COD/L in the feed, hydrogen production exceeded $0.5mole\;H_2/mole\;hexose$ was found at the early stage, however it did not maintain longer than 9days. It was assumed that the failure was caused by insufficient active hydrogen producing bacteria in the reactor. Therefore, effects of pH control, repeated heat treatment and substrate concentration on sustainable continuous anaerobic hydrogen production was examined to find out operating conditions to sustainable hydrogen production. Decrease of hydrogen production was not overcome by only pH control at 5.3. Repeated heat treatment could recover hydrogen producing activity without any external inoculum supply. However, frequent heat treatment was needed because the treated sludge also showed the tendency in decrease of hydrogen production. With a sucrose concentration of 30g COD/L in the feed, hydrogen production maintained $1.0-1.4mole\;H_2/mole\;hexose$ in continuously stirred tank reactor and $0.2-0.3mole\;H_2/mole\;hexose$ in anaerobic sequencing batch reactor) for 24days. More than 90% of soluble organics in effluent was organic acids, in which n-butyrate was the most one.

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