• Journal of Chest Surgery
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• v.43 no.4
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• pp.381-386
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• 2010

Background: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). Material and Method: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. Result: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). Conclusion: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.122-128
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• 2007

This study aims to analyze the voices of the patients with voice disorders including vocal fold paralysis, vocal fold cyst and vocal nodule/polyp in the aspect of acoustic phonetics. This study intends to collect subsidiary acoustic data in order to make a speech treatment and an standardization of vocal disorders. Subjects and Methods: The subjects of this study were 64 adult patients who underwent indirect laryngoscopy and laryngostroboscopy, and were diagnosed as vocal fold paralysis, vocal fold cyst or vocal nodule/polyp. Experimental group consisted of 20 patients who were diagnosed as vocal fold paralysis, 21 patients who were diagnosed as vocal fold cyst and had the average age of 42.0 $({\pm}10.03)$ ; and 23 patients who were diagnosed as vocal nodule/polyp and had the average age of 40.9 $({\pm}13.75)$. For the methodology of this study, the patients listed above were asked to sit in a comfortable position at intervals of 10cm apart from the patient's mouth and a microphone, and subsequently to phonate a vowel sound /e/ for the maximum phonation time with natural tone and vocal volume then the sound was directly inputted on a computer. During recording, sampling rate was set to 44,100Hz and the 1-second area corresponding to stable zone except the first and the last stage of waveform of the vowel sound /e/ vocalized by the individual patients was analyzed. Results: First, there was no statistically significant difference in jitter and shimmer between vocal fold paralysis and vocal fold cyst, while there was highly statistically significant difference in them between vocal fold paralysis and vocal nodule/polyp. Second, looking into the mean values obtained from NNE, HNR and SNR results associated with noise ratio, the disease showing the most abnormal characteristics was vocal fold paralysis, followed by cyst and nodule/polyp in order. For NNE, there was statistically significant difference between vocal nodule/polyp, and cyst or paralysis. In other words, it was found that the NNE of vocal nodule/polyp was weaker than that of cyst or paralysis. Similarly, HNR and SNR also showed the same characteristics; there was statistically significant difference between vocal fold paralysis and vocal fold cyst or nodule/polyp, and HNR and SNR values of vocal fold paralysis were lower than those of vocal fold cyst or nodule/polyp. Conclusion: For vocal fold paralysis, the abnormal values of acoustic parameters associated with frequency, amplitude and noise ratio were statistically significantly higher than those of vocal fold cyst and nodule/polyp. This finding suggests that the voices of the patients with vocal fold paralysis are the most severely injured due to less stability of vocal fold movement, asymmetry and incomplete glottic closure. In addition, there was no statistically significant difference in the acoustic parameters of tremor among vocal fold paralysis, vocal fold cyst and vocal nodule/polyp. Further studies need to ascertain reasonable acoustic parameters with various vocal disorders as well as to clarify the correlation between acoustics-based objective tools and subjective evaluations.

• Korean Journal of Heritage: History & Science
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• v.52 no.2
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• pp.80-105
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• 2019

With the increasing complexity and irregularity of disaster types, the need for cultural asset preservation and management from a proactive perspective has increased as a number of cultural properties have been destroyed and damaged by various natural and humanistic factors. In consideration of these circumstances, the Cultural Heritage Administration enacted an Act in December 2005 to enforce the regular commission of surveys for the systematic preservation and management of cultural assets, and through a recent revision of this Act, the investigation cycle has been reduced from five to three years, and the object of regular inspections has been expanded to cover registered cultural properties. According to the ordinance, a periodic survey of city- or province-designated heritage is to be carried out mainly by metropolitan and provincial governments. The Seoul Metropolitan Government prepared a legal basis for commissioning regular surveys under the Seoul Special City Cultural Properties Protection Ordinance 2008 and, in recognition of the importance of preventive management due to the large number of cultural assets located in the city center and the high demand for visits, conducted regular surveys of the entire city-designated cultural assets from 2016 to 2018. Upon the first survey being completed, it was considered necessary to review the policy effectiveness of the system and to conduct a comprehensive review of the results of the regular surveys that had been carried out to enhance the management of cultural assets. Therefore, the present study examined the comprehensive management status of the cultural assets designated by the Seoul Metropolitan Government for three years (2016-2018), assessing the performance and identifying limitations. Additionally, ways to improve it were sought, and a DB establishment plan for the establishment of an integrated management system under the auspices of the Seoul Metropolitan Government was proposed. Specifically, survey forms were administered under the Guidelines for the Operation of Periodic Surveys of National Designated Cultural Assets; however, the types of survey forms were reclassified and further subdivided in consideration of the characteristics of the designated cultural assets, and manuals were developed for consistent and specific information technologies in respect of the scope and manner of the survey. Based on this analysis, it was confirmed that 401 cases (77.0%) out of 521 cases were generally well preserved; however, 102 cases (19.6%) were found to require special measures such as attention, precision diagnosis, and repair. Meanwhile, there were 18 cases (3.4%) of unsurveyed cultural assets. These were inaccessible to the investigation at this time due to reasons such as unknown location or closure to the public. Regarding the specific types of cultural assets, among a total of 171 cultural real estate properties, 63 cases (36.8%) of structural damage were caused by the failure and elimination of members, and 73 cases (42.7%) of surface area damage were the result of biological damage. Almost all plants and geological earth and scenic spots were well preserved. In the case of movable cultural assets, 25 cases (7.1%) among 350 cases were found to have changed location, and structural damage and surface area damage was found according to specific material properties, excluding ceramics. In particular, papers, textiles, and leather goods, with material properties that are vulnerable to damage, were found to have greater damage than those of other materials because they were owned and managed by individuals and temples. Thus, it has been confirmed that more proactive management is needed. Accordingly, an action plan for the comprehensive preservation and management status check shall be developed according to management status and urgency, and the project promotion plan and the focus management target should be selected and managed first. In particular, concerning movable cultural assets, there have been some cases in which new locations have gone unreported after changes in ownership (management); therefore, a new system is required to strengthen the obligation to report changes in ownership (management) or location. Based on the current status diagnosis and improvement measures, it is expected that the foundation of a proactive and efficient cultural asset management system can be realized through the establishment of an effective mid- to long-term database of the integrated management system pursued by the Seoul Metropolitan Government.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.27-34
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• 2004

Background: Infective endocarditis shows higher operative morbidity and mortality rates than other cardiac diseases. The vast majority of studies on infective endocarditis have been made on aortic endocarditis, with little attention having been paid to infective endocarditis on the mitral valve. This study attempts to investigate the clinical aspects and operative results of infective endocarditis on the mitral valve. Meterial and Method: The subjects of this study consist of 23 patients who underwent operations for infective endocariditis on the mitral valve from June 1995 to May 2003. Among them, 2 patients suffered from prosthetic valvular endocarditis and the other 21 from native valvular endocarditis. The subjects were evenly distributed age-wise with an average age of 44.8$\pm$15.7 (11∼66) years. Emergency operations were performed on seventeen patients (73.9%) due to large vegetation or instable hemodynamic status. In preoperative examinations, twelve patients exhibited congestive heart failure, four patients renal failure, two patients spleen and renal infarction, and two patients temporary neurological defects, while one patient had a brain abscess. Based on the NYHA functional classification, seven patients were determined to be at Grade II, 9 patients at Grade III, and 6 patients at Grade IV. Vegetations were detected in 20 patients while mitral regurgitation was dominant in 19 patients with 4 patients showing up as mitral stenosis dominant on the preoperative echocardiogram. Blood cultures for causative organisms were performed on all patients, and positive results were obtained from ten patients, with five cases of Streptococcus viridance, two cases of methicillin-sensitive Staphylococcus aureus, and one case each of Corynebacteriurn, Haemophillis, and Gernella. Operations were decided according to the AA/AHA guidelines (1988). The mean follow-up period was 27.6 $\pm$23.3 (1 ∼ 97) months. Result: Mitral valve replacements were performed on 43 patients, with mechanical valves being used on 9 patients and tissue valves on the other 4. Several kinds of mitral valve repair or mitral valvuloplasty were carried out on the remaining 10 patients. Associated procedures included six aortic valve replacements, two tricuspid annuloplasty, one modified Maze operation, and one direct closure of a ventricular septal defect. Postoperative complications included two cases of bleeding and one case each of mediastinitis, low cardiac output syndrome, and pneumonia. There were no cases of early deaths, or death within 30 days following the operation. No patient died in the hospital or experienced valve related complications. One patient, however, underwent mitral valvuloplasty 3 months after the operation. Another patient died from intra-cranial hemorrhage in the 31st month after the operation. Therefore, the valve-related death rate was 4.3%, and the valve-related complication rate 8.6% on mid-term follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, 3-, and 5-year survival rates were 100%, 88.8%, and 88.8%, respectively. Conclusion: The findings suggest that a complete removal of infected tissues is essential in the operative treatment of infectious endocarditis of the mitral valve. It is also suggested that when infected tissues are completely removed, neither type of material nor method of operation has a significant effect on the operation result. The postoperative results also suggest the need for a close follow-up observation of the patients suspected of having brain damage, which is caused by preoperative blood contamination or emboli from vegetation, for a possible cerebral vascular injury such as mycotic aneurysm.