• Archives of Reconstructive Microsurgery
• /
• v.19 no.1
• /
• pp.37-45
• /
• 2010

Purpose: First introduced by Buncke and Rose in 1979, the neurovascular partial $2^{nd}$ toe pulp free tissue transfer has been attempted to reconstruct posttraumatic finger tip injuries. Although some surgeons prefer other reconstructive methods such as skin graft and local flap, we chose the partial $2^{nd}$ toe pulp flap owing to its many advantages. We report three successful surgical cases in which the patients had undergone this particular method of reconstruction. Methods: We retrospectively examined three cases of fingertip injury patients due to mechanical injury. Bone exposure was seen in all three cases, All had undergone partial toe pulp free flap for soft tissue defect coverage. Results: All flaps survived without any complications such as partial necrosis, hematoma or dehiscence. Although tingling sensation has returned in both cases, two-point discrimination has not returned yet. Currently no patient is complaining of any pain which gradually improved during their course of recuperation. All stitches were removed on postoperative 2 weeks. Patients are satisfied with the final surgical result and there are no signs of any edema or hematoma. Conclusion: The homodigital reconstruction of finger tip injury using the partial $2^{nd}$ toe pulp flap has numerous advantages compared to other reconstructive modalities such as its resistance to wear and tear and in that it provides a non-slip palmar digital surface. However it requires microsurgery which may not be preferred by surgeons. Advanced age of the patient can be a relative contraindication to this approach since atheromatous plaque from the donor toe can compromise flap circulation after surgery. We report three successful cases which patient age was considered appropriate. Further investigation with a larger number of cases and long term follow-up is deemed necessary.

• Journal of Preventive Medicine and Public Health
• /
• v.28 no.1 s.49
• /
• pp.207-223
• /
• 1995

A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospitals could not get any insurance benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992) from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it showed statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary care hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode. and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary care hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.

• Journal of Advanced Marine Engineering and Technology
• /
• v.37 no.5
• /
• pp.500-509
• /
• 2013

This study reports a numerical analysis of the internal flow characteristics of the integrated urea-SCR muffler system with the various geometries of the multi-perforated tube which is set up between the muffler inlet and in front of SCR catalysts. The multi-perforated tube is generally used to disperse uniformly the urea-water solution spray and to make better use of the SCR catalyst, resulting in the increased $NO_x$ reduction and decreased ammonia slip. The effects of the multi-perforated tube orifice area ratios on the velocity distributions in front of the SCR catalyst, which is ultimately quantified as the uniformity index, were investigated for the optimal muffler system design. The steady flow model was applied by using a general-purpose commercial software package. The air at the room temperature was used as a working fluid, instead of the exhaust gas and urea-water solution spray mixture. From the analysis results, it was clarified that the multi-perforated tube geometry sensitively affected to the formation of the bulk swirling motion inside the plenum chamber set in front of the SCR catalyst and to the uniformity index of the velocity distribution produced at the inlet of the catalyst.

• Journal of Korean Foot and Ankle Society
• /
• v.16 no.2
• /
• pp.94-100
• /
• 2012

Purpose: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). Materials and Methods: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. Results: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. Conclusion: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.

• The Journal of Korean Academy of Prosthodontics
• /
• v.35 no.1
• /
• pp.221-243
• /
• 1997

The objective of this study was to characterize the mechanical properties of $Y_{2}O_{3}$-containing glass infiltrated ceramic core material, which was made by pressureless powder packing method. A pure alumina powder with a grain size of about $4{\mu}m$ was packed without pressure is silicon mold to form a bar shaped sample, and applied PVA solution as a binder. Samples were sinterd at $1350^{\circ}C$ for 1 hour. After cooling, $Y_{2}O_{3}$-containing glass($SiO_{2},\;Y_{2}O_{3},\;B_{2}O_{3},\;Al_{2}O_{3}$, ect) was infiltrated to the sinterd samples at $1300^{\circ}C$ for 2 hours and cooled. Six different proportions $Y_{2}O_{3}$ of were used to know the effect of the mismatch of the thermal expansion coefficient between alumina powder and glass. The samples were ground to $3{\times}3{\times}30$ mm size and polished with $1{\mu}m$ diamond paste. Flexural strength, fracture toughness, hardness and other physical properties were obtained, and the fractured surface was examined with SEM and EPMA. Ten samples of each group were tested and compared with In-Ceram(tm) core materials of same size made in dental laboratory. The results were as follows : 1. The flexural strengths of group 1 and 3 were significantly not different with that of In-Ceram, but other experimental groups were lower than In-Ceram. 2. The shrinkage rate of samples was 0.42% after first firing, and 0.45% after glass infiltration. Total shrinkage rate was 0.87%. 3. After first firing, porosity rate of experimental groups was 50%, compared with 22.25% of In-Ceram. After glass infiltration, porosity rate of experimental groups was 2%, and 1% in In-Ceram. 4. There was no statistical difference in hardness between two materials tested, but in fracture toughness, group 2 and 3 were higher than In-Ceram. 5. The thermal expansion coefficients of experimental groups were varied to $4.51-5.35{\times}10^{-6}/^{\circ}C$ according to glass composition, also the flexural strengths of samples were varied. 6. In a view of SEM, many microparticles about $0.5{\mu}m$ diameter and $4{\mu}m$ diameter were observed in In-Ceram. But in experimental group, the size of most particles was about $4{\mu}m$, and a little microparticles was observed. The results obtained in this study showed that the mismatch of the thermal expansion coefficients between alumina powder and infiltrated glass affect the flexural strength of alumin/glass composite. The $Y_{2}O_{3}$-containing glass infiltrated ceramic core made by powder packing method will takes less time and cost with sufficient flexural strength similar to all ceramic crown made with slip casting technique.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.3
• /
• pp.292-295
• /
• 2016

Objective : To investigate the variation of pelvic radius and related parameters in low-grade isthmic lumbar spondylolisthesis. Methods : Seventy-four patients with isthmic lumbar spondylolisthesis and 47 controls were included in this study. There were 17 males and 57 females between 30 and 66 years of age, including 30 with grade I slippages and 44 grade II slippages; diseased levels included 34 cases on L4 and 40 cases on L5. Thoracic kyphosis (TK), the pelvic radius (PR), the pelvic angle (PA), pelvic morphology (PR-S1), and total lumbopelvic lordosis (PR-T12) were assessed from radiographs. Results : Statistically significant differences were found for the PA, PR-T12, and PR-S1 ($24.5{\pm}6.6^{\circ}$, $83.7{\pm}9.8^{\circ}$, and $25.4{\pm}11.2^{\circ}$, respectively) of the patients with spondylolisthesis and the healthy volunteers ($13.7{\pm}7.8^{\circ}$, $92.9{\pm}9.2^{\circ}$, and $40.7{\pm}8.9^{\circ}$, respectively). The TK/PR-T12 ratios were between 0.15 and 0.75. However, there were no differences in all the parameters between the L4 and L5 spondylolysis subgroups (p>0.05). The TK and PR-S1 of grade II were less than grade I, but the PA was greater. The PR-T12 of female patients were less than male patients, but the PA was greater (p<0.05). Conclusion : Pelvic morphology differed in patients with low-grade isthmic lumbar spondylolisthesis compared to controls. Gender and the grade of slippage impacted the sagittal configuration of the pelvis, but the segment of the vertebral slip did not. Overall, the spine of those with spondylolisthesis remains able to maintain sagittal balance despite abnormal pelvic morphology.

• Journal of Korean Society of Steel Construction
• /
• v.21 no.4
• /
• pp.421-432
• /
• 2009

In this study, push-out and static loading tests were conducted to evaluate the behavioral characteristics of composite beams with a perfobond rib shear connector. The shear capacity of the perfobond rib was found to be proportional to its concrete strength, which is in turn affected by the increase in the concrete end-bearing strength and concrete dowel action to resist the shear force. The relative slips of the push-out specimen, however, which was used to assess the ductility of the shear connector, increased to some extent, but it no longer increased when it reached the critical concrete strength because of the flexibility of the transverse rebar in the rib hole. The static-loading-test results revealed a crack on the concrete slab in the composite beam with a perfobond rib on the side of the rib hole and transverse rebar for the applied moment and shear force to the rib hole, depending on the static loading. The shear resistance characteristics of the perfobond rib shear connector were found to resist the shear force from the relative slip on the interface of the composite beam. Thus, the sectional effect of the shear connector to the composite beam with a perfobond rib should be considered when designing the composite beam because the behavior of the composite beam can change owing to the shear connector.

• The Journal of Korean Academy of Prosthodontics
• /
• v.42 no.4
• /
• pp.386-396
• /
• 2004

Statement of problem: It is not clear how to make a stable bonding between zirconia ceramic and resin cement. And the study about surface treatment of zirconia ceramic or bonding resin cement are not enough. Purpose: To measure and compare the shear bond strength of some resin cements on zirconia ceramic after different surface treatments. Material and method: 48 ceramic discs were made of 3 ceramic materials, zirconia ceramics (Zi-Ceram), heat-pressed ceramics (IPS Empress 2) and slip cast alumina ceramics (In-Ceram). According to the surface treatments of ceramic specimens and resin cements, specimens were classified into 6 groups and each group was composed of 8 specimens. For the surface treatment of Zi-Ceram group (test group), sandblasting and diamond bur preparation were applied and Superbond C&B and Panavia F were bonded respectively. For IPS Empress 2 group (control group), Variolink II was bonded after sandblasting, acid etching, silanization and for In-Ceram ALUMINA group (control group), Panavia F was bonded after sandblasting. After storing specimens in distilled water for 24 hours, the shear bond strength was measured by the universal testing machine. Results and conclusion: 1. Zi-Ceram group with Superbond C&B cement showed higher bond strength than with Panavia F cement regardless to the surface treatments (p<0.05). 2. In Zi-Ceram group with Superbond C&B cement, sandblasting treatment group (12.1MPa) showed higher bond strength than diamond bur treatment group (7.7MPa) (p<0.05). In Zi-Ceram group with Panavia F cement, there were no significant differences in the bond strength according to the surface treatments (p>0.05). 3. Zi-Ceram group with sandblasting and Superbond C&B cement (12.1MPa) showed the highest bond strength. The bond strength of this group was not significantly different from In-Ceram ALUMINA group (10.4MPa) (p>0.05) and lower than IPS Empress 2 group (15.9MPa) (p<0.05).

• Journal of Environmental Science International
• /
• v.12 no.1
• /
• pp.47-54
• /
• 2003

This paper have examined the optimum combination of SNCR and SCR by varying SNCR injection temperature and NSR ratio along with SCR space velocity. NOx reduction experiments using a SNCR/SCR combined process have been conducted in simple NO/NH$_3$/O$_2$ gas mixtures. Total gas flow rate was kept constant 4 liter/min throughout the SNCR and SCR reactors, where initial NOx concentration was 500 ppm in the presence of 5% O$_2$. Commercial catalyst, sulfated V$_2$O$\_$5/-WO$_3$/TiO$_2$, was used for SCR NOx reduction. The residence time and space velocity were around 1.67 sec, 2,400 h$\^$-1/ and 6,000 h$\^$-1/ in the SNCR and SCR reactors, respectively. SNCR NOx reduction effectively occurred in a temperature window of 900-950$^{\circ}C$. About 88% NOx reduction was achieved with an optimum temperature of 950$^{\circ}C$ and NSR=1.5. SCR NOx reduction using commercial V$_2$O$\_$5/-WO$_3$-SO$_4$/TiO$_2$ catalyst occurred in a temperature window of 200-450$^{\circ}C$ 80-98% NOxreduction was possible with SV=2400 h$\^$-1/ and a molar ratio of 1.0-2.0. A SNCR/SCR(SV=6000 h$\^$-1/) combined process has shown same NOx reduction compared with a stand-alone SCR(SV=2400 h$\^$-1/) unit process of 98% NOx reduction. The NH$_3$-based chemical could routinely achieve SNCR/SCR combined process total NOx reductions of 98% with less than 5 ppm NH$_3$ slip at NSR ranging from about 1.5 to 2.0, SNCR temperature of 900$^{\circ}C$-950$^{\circ}C$, and SCR space velocity of 6000 h$\^$-1/. Particularly, more than 98% NOx reduction was possible using the combined process under the conditions of T$\_$SNCR/=950$^{\circ}C$, T$\_$SCR/=350$^{\circ}C$, 5% O$_2$, SV=6000 h$\^$-1/ and NH$_3$/NOx=1.5. A catalyst volume was about three times reduced by SNCR/SCR combined process compared with SCR process under the same controlled conditions.

• Journal of Korean Neurosurgical Society
• /
• v.51 no.4
• /
• pp.215-218
• /
• 2012

Objective: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and reg ion of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. Methods: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (Cl) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe intracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. Results: The mean (SO) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. Conclusion: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.