• 제목/요약/키워드: Mobilization and Response Time

검색결과 13건 처리시간 0.019초

진구성 상완 신경총 마비에 대한 유리박근이식술 (Gracilis Muscle Transplantation in Neglected Brachial Plexus Palsy)

  • 정덕환;한정수;옥재철;조창현
    • Archives of Reconstructive Microsurgery
    • /
    • 제6권1호
    • /
    • pp.73-79
    • /
    • 1997
  • Complete denervation after severe brachial plexus injury make significant muscle atrophy with loss of proper function. It is much helpful to reconstruct the essential function of the elbow flexion movement in patient with total loss of elbow flexion motion after brachial plexus lesion which was not recovered with nerve surgery or long term conservative treatment from onset. In whole arm type brachial plexus injury, if there were no response to neurotization or neglected from injury, the volume of the denervated muscle is significantely reduced month by month. About 18 months most of the muscle fibers change to fibrous tissues and markedly atrophied irreversibly, further waiting is no more meaningful from that period. Authors performed 14 cases of functioning gracilis muscle transfer from 1981 to 1995 with microneurovascular technique, neuromusculocutaneous free flaps were performed for reconstruction of lost elbow flexion function. Average follow-up period was 5 years and 6 months. We used couple of intercostal nerves as a recipient nerve which were anastomosed to muscular nerve from obturator nerve in all cases. Recipient vessels were three deep brachial artery and eleven brachial artery which were anastomosed to medial femoral circumflex artery with end to end or end to side fashion. Average resting length of the transplanted gracilis were 24 cm. We can get average 54 degree flexion range of elbow with fair muscle power from flail elbow. There were one case of muscle necrosis with lately developed thrombosis of microvascular anastomosed site which comes from insufficient recipient arterial condition, 3 cases of partial marginal necrosis of distal skin of the transplanted part which were not significant problem with spontaneously solved with time goes by gracilis muscle has constant neurovascular pattern with relatively easy harvesting donor with minimal donor morbidity. Especially it has similar length and shape with biceps brachii muscle of upper arm and longer nerve pedicle which can neurorrhaphy with intercostal nerve without nerve graft if sufficient mobilization of the nerves from both sides of gracilis and intercostal region. Authors can propose gracilis muscle transplantation with intercostal nerves neurotization is helpful method with minimal donor morbidity for neglected brachial plexus palsy patients.

  • PDF

천안함 폭침 이후 북한의 군사도발 양상과 전망 (Trends and Prospects of N. Korea Military Provocations After the Sinking of ROKS Cheon-an)

  • 김성만
    • Strategy21
    • /
    • 통권34호
    • /
    • pp.58-92
    • /
    • 2014
  • Even after S. Korea took 5.24 Measure(24 May 2014), N. Korea has not stopped raising provocations such as the shelling of Yeonpyeong Island, electronic and cyber attacks. To make matters worse, the communist country lunched long-range missiles(twice) and conducted 3rd nuclear test, escalating tensions which could possibly lead to an all-out war. Korean Government failed to respond properly. However, escalation into an all-out war was deterred by the CFC immediately carrying out its peacetime duty(CODA). The US made a rapid dispatch of its augmentation forces(Aircraft carrier, nuclear-powered submarine, strategic bomber, F-22) to the Korean Peninsula. In recognition of the importance of the Combined Forces Command, since May 2013 the Park Geun-Hye Administration has been pushing ahead with re-postponement of Wartime Operational Control Transfer(which initially meant the disassembling of the CFC as of 1 December 2015) More recently, there has been a series of unusual indicators from the North. Judging from its inventory of 20 nuclear weapons, 1,000 ballistic missiles and biochemical weapons, it is safe to say that N. Korea has gained at least war deterrence against S. Korea. Normally a nation with nuclear weapons shrink its size of conventional forces, but the North is pursuing the opposite, rather increasing them. In addition, there was a change of war plan by N. Korea in 2010, changing 'Conquering the Korean Peninsula' to 'Negotiation after the seizure of the Greater Seoul Metropolitan Area(GSMA)' and establishing detailed plans for wartime projects. The change reflects the chain reaction in which requests from pro-north groups within the South will lead to the proclamation of war. Kim, Jeong-Un, leader of N. Korean regime, sent threatening messages using words such as 'exercising a nuclear preemptive strike right' and 'burning of Seoul'. Nam, Jae-June, Director of National Intelligence Service, stated that Kim, Jung-Un is throwing big talks, saying communization of the entire Korean Peninsula will come within the time frame of 3 years. Kim, Gwan-Jin, Defense Minister, shared an alarming message that there is a high possibility that the North will raise local provocations or a full-fledged war whenever while putting much emphasis on defense posture. As for the response concept of the Korean Government, it has been decided that 'ROK·US Combined Local Provocation Counter-Measure' will be adopted to act against local provocations from the North. Major provocation types include ▲ violation of the Northern Limit Line(NLL) with mobilization of military ships ▲ artillery provocations on Northwestern Islands ▲ low altitude airborne intrusion ▲ rear infiltration of SOF ▲ local conflicts within the Military Demarcation Line(MDL) ▲ attacking friendly ships by submarines. Counter-measures currently established by the US involves the support from USFK and USFJ. In order to keep the sworn promise, the US is reinforcing both USFK and USFJ. An all-out war situation will be met by 'CFC OPLAN5027' and 'Tailored Expansion Deterrence Forces' with the CFC playing a central role. The US augmentation forces stands at 690,000 troops, some 160 ships, 2,000 aircraft and this comprise 50% of US total forces, which is estimated to be ninefold of Korean forces. The CFC needs to be in center in handling both local provocations and an all-out war situation. However, the combat power of S. Korean conventional forces is approximately around 80% of that of N. Korea, which has been confirmed from comments made by Kim, Gwan-Jin, Defense Minister, during an interpellation session at the National Assembly. This means that S. Korean forces are not much growing. In particular, asymmetric capabilities of the North is posing a serious threat to the South including WMD, cyber warfare forces, SOF, forces targeting 5 Northwestern Islands, sub-surface and amphibious assault forces. The presence of such threats urgently requires immediate complementary efforts. For complementary efforts, the Korean Government should consider ① reinforcement of Korean forces; putting a stoppage to shrinking military, acquisition of adequate defense budget, building a missile defense and military leadership structure validity review, ② implementation of military tasks against the North; disciplinary measures on the sinking of ROKS Cheon-an/shelling of Yeonpyeong Islands, arrangement of inter-Korean military agreements, drawing lessons from studies on the correlation between aid for N. Korea, execution of inter-Korean Summit and provocations from the North, and ③ bolstering the ROK·US alliance; disregarding wartime operational control transfer plan(disassembling of CFC) and creation of a combined division.

저산소증이 흰쥐 관류부신에서 DMPP, McN-A-343, Excess $K^+$ 및 Ach의 카테콜아민 분비작용에 미치는 영향 (Influence of Hypoxia on Catecholamine Secretion Evoked by DMPP, McN-A-343, Excess $K^+$ and ACh from The Perfused Rat Adrenal Gland)

  • 임동윤;허재봉;박유환
    • 대한약리학회지
    • /
    • 제31권1호
    • /
    • pp.63-74
    • /
    • 1995
  • 저산소 상태에서는 부신수질로부터 카테콜아민 (CA) 유리작용이 활성화되지만 반면에 소의 배양 chromaffin cell에서는 고통도의 $K^+$에 의한 CA 분비작용이 억제된다고 알려져 있다. 본 연구에서는 적출 흰쥐 관류부신에서 콜린성 자극과 막탈분극에 의한 CA 분비작용에 대한 저산소증의 영향을 검색하고 그 작용기전을 규명코자 하였다. 본 연구목적을 위하여, 적출 흰쥐 관류부신을 이용, 저산소증이 니코틴($N_1$), 무스카린($M_1$) 수용체 흥분약, 막탈분극 약물, 칼슘채널 활성화 약물, 세포내 칼슘유리 약물 및 ACh에 의한 CA 분비에 미치는 영향을 연구하였으며, 저산소증은 95% 질소 및 5% 이산화탄소 혼합가스를 Krebs액에 주입하여 유발시켰으며, $3{\sim}4$시간동안 유지하였다. 저산소증 유발시, DMPP ($100{\mu}M$), McN-A-343 ($100{\mu}M$), ACh (5.32 mM), Bay-K-8644 ($10{\mu}M$) 및 high $K^+$ (56 mM)에 의한 CA 분비작용을 시간의존적으로 점차 유의성인 감소를 나타내었다. 그러나, cyclopiazonic acid ($10{\mu}M$)에 의한 CA 분비반응에는 하등의 영향을 일으키지 못하였다. 또한 저산소증 자체가 CA의 기초분비 작용에는 영향을 미치지 않았다. 이와같은 실험결과로 보아, 저산소증시 콜린성 자극 및 막탈분극에 의한 CA 분비 작용이 억제되며, 이러한 억제작용은 chromaffin cell내로 $Ca^{++}$ 유입을 직접적으로 억제시키는 결과에 기인되며, 세포내 칼슘저장고로부터 칼슘유리작용과는 관계없는 것으로 사료된다.

  • PDF