• Journal of Chest Surgery
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• 제47권3호
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• pp.220-224
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• 2014

Background: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.15-19
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• 1998

Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to estabilish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats; weighing 250 to 300 gm, were used. The femoral artery and common carotid artery were exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a parallel tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65mmHg, with a mean arterial pressure of 106-109mmHg. An epigastiic skin flap, measuring $3{\times}3cm$, was raised with its vascular pedicle. The epigastric free flap was transfered in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor arteries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastpmosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.

• 대한안전경영과학회지
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• 제23권3호
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• pp.115-122
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• 2021

In this study, the purpose of this study was to examine the effect of twisting in the preparation of waterproofing in the process of unfolded donut-type staking method fire hoses in indoor hydrant system. The central pull-out method caused more twisting than the rolling method, and there was no significant difference in the number of twists according to the pull-out method in the case of male and female students. It was found that the time it took to untwist and prepare waterproofing was much shorter for male students. The angle valve and hose are connected, and the time to untwist and prepare for waterproofing after withdrawing the fire hose with the hose and nozzle connected was shorter than the unconnected state. In the rolling method, when a hose connected with two 15 m fire hoses was used and the angle valve-hose was connected, but the hose-nozzle was not connected, the least kinking occurred. The time to untwist and prepare for waterproofing was also the shortest. As a result, in the withdrawal method of the donut-type loaded fire hose in the indoor hydrant system, it is a rolling method rather than a central withdrawal method. With the angle valve and hose connected, unfold the fire hose with the hose and nozzle connected, if a large number of people unwind the twisted hose, the time to prepare for waterproofing can be shortened.

• Journal of Trauma and Injury
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• 제34권2호
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• pp.130-135
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• 2021

Celiac artery compression is a rare condition in which the celiac artery is compressed by the median arcuate ligament. Case reports of compression after trauma are hard to find. Blunt traumatic pericardium rupture is also a rare condition. We report a single patient who experienced both rare conditions from a single blunt injury. An 18-year-old woman was brought to the trauma center after a fatal motorcycle accident, in which she was a passenger. The driver was found dead. Her vital signs were stable, but she complained of mild abdominal pain, chest wall pain, and severe back pain. There were no definite neurologic deficits. Her initial computed tomography (CT) scan revealed multiple rib fractures, moderate lung contusions with hemothorax, moderate liver injury, and severe lumbar spine fracture and dislocation. She was brought to the angiography room to check for active bleeding in the liver, which was not apparent. However, the guide wire was not able to pass through the celiac trunk. A review of the initial CT revealed kinking of the celiac trunk, which was assumed to be due to altered anatomy of the median arcuate ligament caused by spine fractures. Immediate fixation of the vertebrae was performed. During recovery, her hemothorax remained loculated. Suspecting empyema, thoracotomy was performed at 3 weeks after admission, revealing organized hematoma without pus formation, as well as rupture of the pericardium, which was immediately sutured, and decortication was carried out. Five weeks after admission, she had recovered without complications and was discharged home.

• Composites Research
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• 제36권4호
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• pp.259-263
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• 2023

This study investigated the open hole tensile (OHT) properties of carbon fiber/epoxy composites and compared them to bolt joint tensile (BJT) properties. The net nominal modulus and strength (1376 MPa) were found to be higher than the gross nominal strength (1041 MPa), likely due to increasing hole size. The OHT and BJT specimens exhibited similar stiffness, as expected without bolt rotation causing secondary bending. OHT specimens experienced a sharp drop in stress indicating unstable crack propagation, delamination, and catastrophic failure. BJT specimens failed through shear out on the bolt side and bearing failure on the nut side, involving fiber kinking, matrix splitting, and delamination, resulting in lower strength compared to OHT specimens. The strength retention of carbon fiber/epoxy composites with open holes was 66%. Delamination initiation at the hole's edge caused a reduction in the stress concentration factor. Filling the hole with a bolt suppressed this relieving mechanism, leading to lower strength in BJT specimens compared to OHT specimens. Bolt joint efficiency was calculated as 15%. The reduction in strength in bolted joints was attributed to fiber-matrix splitting and delamination, aligning with Hart Smith's bolted joint efficiency diagram. These findings contribute to materials selection and structural reliability estimation for carbon fiber/epoxy composites. They highlight the behavior of open hole and bolt joint configurations under tensile loading, providing valuable insights for engineering applications.

• Journal of Chest Surgery
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• 제39권5호
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• pp.394-398
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• 2006

배경: 원발성 자연기흉에 대한 초 치료의 목적은 흉막강 내의 공기 제거와 폐장의 재팽창 유도이며, 이를 위해 통상적으로 20 Fr이상 크기의 흉관을 흉막강에 삽입한다. 그러나 원발성 자연기흉의 병태 생리를 고려할 때보다 작은 크기의 흉관으로도 소기의 목적을 달성할 수 있다는 생각에서, 7 Fr 크기의 도관을 흉관으로 사용하여 그 효용성과 보완점을 제시하고자 하였다. 대상 및 방법: 2003년 5월부터 2005년 4월까지 원발성 자연기흉으로 입원 치료를 한 환자 중 초 치료로 흉강삽관술을 시행한 111명의 환자를 대상으로 의무기록을 토대로 후향적으로 조사하여, 7 Fr 흉관을 사용한 환자들과 24 Fr 흉관을 사용한 환자들의 흉관 거치기간, 진통제의 사용여부, 폐의 재팽창 정도, 합병증 등에 대해 분석하였다. 결과: 흉관의 평균 거치기간은 7 Fr군이 $2.4{\pm}1.1$일, 24 Fr군이 $2.3{\pm}1.3$일로 차이가 없었다. 주사 진통제의 사용은 7 Fr군에서는 없었으나 24 Fr군에서는 모든 환자들이 사용하였다. 7 Fr 흉관만을 사용하여 치료한 환자들의 77%에서 폐장의 완전 재팽창을 얻을 수 있었다. 7 Fr 흉관의 문제점은 도관의 꺾임이며, 5.6%에서 발생하였다. 결론: 7 Fr 흉관을 이용한 원발성 자연기흉의 초 치료는 기존의 24 Fr 흉관과 비교하여 공기제거, 폐의 재팽창, 통증경감, 미용적 측면에서 모두 만족할 만 하였으나, 꺾임을 방지할 수 있게 도관의 개량이 필요하다고 생각한다.

• 자원환경지질
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• 제40권2호
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• pp.171-189
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• 2007

경상분지 남동부에 위치한 양산단층 동편의 화강암질암, 화산암류, 퇴적암류를 대상으로 총 77개 지점으로부터 독립적으로 정향된 542개의 코어시료를 채취하여 대자율 이방성(AMS) 연구를 실시하였다. 총 대자율 측정, 고온대자율 실험 및 등온잔류자기 획득실험을 통하여 연구대상 암석들의 주 자성광물이 자철석 위주의 티탄자철석계열의 것임이 밝혀졌다. 연구의 주 대상암체인 화강암질암에는 자기적 엽리구조와 자기적 선구조 모두가 존재하고 있으며, 자기적 엽리구조의 주향은 북동-남서가 지배적이다. 이 자기적 엽리구조는 화강암질암의 변형에 대한 강한 저항의 물성, 주변 모암의 자기적 엽리구조와의 불일치, 고화 이후 취성변형으로 만들어진 소단층이나 절리 등의 지질구조와의 모순점, 현미경에서 관찰되는 조직 등의 증거로부터 마그마가 관입정치하여 완전히 고화되기 전에 응력을 받아 생성된 일차 미세구조(primary fabric)로 판단된다. 이 북동-남서 주향의 자기적 엽리구조는 북서-남동의 압축력으로 만들어질 수 있는데 이러한 응력은 양산단층의 좌수향 주향운동의 산물로 해석된다. 연구지역 화강암질암의 연령이 약 $60\sim70Ma$로 알려져 있음을 감안하면 양산단층은 이 시기(백악기 말에서 신생대 초)에 걸쳐서 좌수향 주향이동 운동을 하였음을 알 수 있다.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.43-50
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• 2011

Lunate revascularization with the vascularized bone grafts is a current concept in the treatment of Kienbo${\ddot{o}}$ck disease. The aim of this study is to present our experience and preliminary results of the treatment using the fourth extensor compartment artery (4 ECA) vascularized bone graft for Kienbo${\ddot{o}}$ck disease. Between May 2009 and June 2010, five patients (3 men and 2 women) with Kienbo${\ddot{o}}$ck disease were treated with 4 ECA vascularized bone grafts. The mean age was 32.8 years and mean follow-up time was 13 months. The patients were composed of two patients in stage II and three patients in stage IIIa according to Lichtman's classification. Modified Mayo wrist score including pain, grip strength, range of motion and functional status and radiographic parameters such as carpal height ratio and radioscaphoid angle were evaluated at a final follow-up. Pain was markedly diminished and modified Mayo wrist score was 82 at last follow up period. There were no or little changes in carpal height ratio and radioscaphoid angle. All patients showed satisfactory bony union and no further lunate collapse on follow-up radiographs. The 4 ECA vascularized bone graft is a reliable alternative procedures among revascularization procedures for treatment of Kienbo${\ddot{o}}$ck's disease. It is less invasive and has low risk of kinking of pedicle compared to the 4+5 ECA vascularized bone graft. However, long term follow-up and MRI evaluation at follow up period should be needed for the future.

• Advances in pediatric surgery
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• 제12권2호
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• pp.167-174
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• 2006

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time: 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.

• Journal of Chest Surgery
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• 제36권4호
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• pp.255-260
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• 2003

최근 활로 4징 교정술의 향상된 성적에도 불구하고, 수술 후 폐동맥 폐쇄부전과 우심실 유출로 확장으로 인한 좌폐동맥의 뒤틀림과 협착의 가능성이 보고되고 있다. 이에 좌폐동맥의 협착이 동반되었거나 협착이 없더라도 우심실 유출로 첩포 확장 시 좌폐동맥이 예각을 이루어 좌폐동맥 뒤틀림의 가능성이 있는 환자에서 첩포를 사용하지 않고 자가 주폐동맥 플랩만을 이용한 새로운 좌폐동맥 혈관성형술의 결과를 보고하고자 한다. 대상 및 방법： 1998년 10월부터 2001년 1월까지 24명의 활로4징 환자에서 완전교정술 시 좌폐동맥 입구를 자가 주폐동맥 플랩을 이용하여 선택적으로 혈관성형술을 시행하였다. 환자의 연령(중앙값)은 10개월(4∼145개월)이었다. 주폐동맥 플랩 좌폐동맥 성형술은 좌폐동맥 입구의 협착이 있었던 19예(79%)와 해부학적 협착은 없었으나 주폐동맥과 좌폐동맥이 예각을 이루어 좌폐동맥 뒤틀림의 위험이 예상되는 5예(21%)에서 시행되었다. 결과: 수술 사망예는 없었다. 24명 중 15명(62%)에서 경판막윤 우심실유출로 확장술을 시행하였으며, 나머지 9명에서 폐동맥 판막윤을 보존하면서 폐동맥 혹은 누두부 확장술을 시행하였다. 24명 중 5명(21%)에서는 어떤 첩포도 사용하지 않고 자가 주폐동맥 플랩만으로 좌폐동맥을 포함한 주폐동맥확장술을 시행하였다. 1 명을 제외한 23명의 추적관찰 기간(중앙값)은 20개월(6∼42개월)이었으며, 만기 사망 및 재수술의 예는 없었다. 2명에서 우폐동맥 근위부 협착으로, 1명에서 좌, 우폐동맥 입구의 협착으로 풍선 혈관성형술이 필요하였다. 결론: 주폐동맥 플랩을 이용한 좌폐동맥 성형술의 보다 장기적인 관찰이 필요하나, 첩포를 사용하지 않아 이와 관련된 문제점들을 피할 수 있고, 자가 주폐동맥플랩의 성장을 기대할 수 있을 것으로 생각된다. 또한 주폐동맥과 좌폐동맥 사이를 둔각으로 유지함으로써 향후 폐동맥 폐쇄부전과 관련된 우심실유출로 확장에 의한 좌폐동맥의 뒤틀림의 가능성을 줄일 수 있을 것으로 생각한다.