• Archives of Plastic Surgery
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• 제46권3호
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• pp.235-240
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• 2019

Background The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. Methods A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. Results Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 ($107.7{\pm}60.3cm^2$ vs. $61.4{\pm}33.8cm^2$, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. Conclusions Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

• 자원환경지질
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• 제35권4호
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• pp.325-337
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• 2002

백운 폐광산 주변에 방치된 폐석으로 인한 하천수 및 하상퇴적물의 중금속오염정도를 알아보고자 하였다. 광산활동과 관련되어 발생하는 주변 하천수의 Al 및 Pb, Zn, Cu, Cd, Mn, Fe 등의 중금속 및 기타 이온의 부화현상은 하천수의 TDS를 높이며 또한, 수질을 악화시키는 요인이 된다. 백운광산 주변의 하천수는 Ca와 SO$_4$가 주를 이루는 Ca-SO$_4$형을 보이며, 부분적으로 황화광물의 화학적 풍화로 인한 중금속부화현상을 보인다. 광산을 경유해서 흐르는 하천수는 알카리 및 알카리 토류원소에 의한 중화작용의 영향으로 pH는 6.S-7.1의 약산성내지 중성을 띤다 폐갱구로부터 홀러나오는 갱내수 또한 약산성 내지 중성을 띠며, 광산내의 광석과 맥석광물과의 화학적 풍화로 인해 높은 원소함량을 보인다. 백운 폐광산 주변의 하천수는 갱내수가 유입되는 지역에서 높은 농도를 보이다 하류로 갈수록 농도가 급격히 낮아진다. 이온농도가 낮아지고 pH가 중성을 띠는 것은 자연적으로 오염을 조정해주는 희석 및 침전, 흡착 등으로 인한 완충작용의 결과이다. 토양내에서 중금속의 이동성이나 생물학적 이용능력을 알아보기 위하여 단계별 추출법을 이용하여 하상퇴적물에서 Cd, Cu, Zn, Pb의 존재형태를 5가지 단계로 분류하였다: 이온교환형태, 탄산염형태, 철-망간 산화물형태, 유기물형태, 잔류상형태. 대부분의 퇴적물에서 Cu(21-92%) 및 Zn(28-89%), Pb(23-94%)는 잔류상형태가 우세하였으며, Cd는 퇴적물에서 다른 원소에 비해 낮은 농도(2.7-52.8 mg/kg)를 보여주었으나 대부분 불안정한 형태(68-97%)가 우세하였다. 상류 퇴적물에서는 폐석으로 인해 Pb의 농도가 높게 나타나며, 하류 퇴적물은 Zn이 높은 농도를 보여, Zn 과 불안정한 형태가 우세한 Cd이 이동성이 높은 원소임을 알 수 있었다.thing construction. The presentation coverages and relative difficulties of textbooks were, however, diverse. It is somewhat noticeable that, while fewer professors majoring in clothing construction participated in writing, generally more pages were allocated to clothing construction than other areas. While presentations on anthropometrics method, construction theory, draft theory, usage of sewing machine and fitting theory were insufficient most textbooks were dealing with drafting of basic slopers and sewing procedure, etc. Making-up techniques on the apparels items such as Korean traditional men's pants, pajamas, shirt vest skirt, pants, apron and Korean pouch were handled closely in each textbook.different from the one in the l980s worn by the demonstrators of popular movements and democratic movements, and it emerged as a new symbol with the characteristics of cultural movement like community consciousness and nature affiliation.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.611-616
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• 2007

Purpose: The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The most common complication of LD muscle flap is donor site seroma, reported to occur in 20 to 79 percent of cases. The formation of dead space under the flap is intimately associated with seroma formation. The authors think that the use of progressive tension suture at closing donor site can decrease the formation of dead space and ultimately reduce the incidence of donor site seroma. Methods: A retrospective review was performed with 38 patients who underwent latissimus dorsi muscle harvest for breast reconstruction from March 2003 to September 2004. Progressive tension sutures were used during donor site closure in 22 patients. This group was compared with controls group(16 patients) who underwent latissimus dorsi muscle harvest without using this technique. Operation time, length of hospital stay, period of drainage, complication, and satisfaction about postoperative scar of donor site were examined. Results: The average length of hospital stay was 10.2 days and 12.7 days, and the mean duration of drainage were 7.3 days and 11.7 days in each progressive suture group and control group. These results were statistically significant (p<0.05). In the 22 patients who underwent progressive tension suture, none had seroma, hematoma or skin necrosis. In control group(16 patients), there happened one seroma formation and one partial skin necrosis. These complications were healed by aspiration of seroma and wound revision. The patients' satisfaction was not statistically significant, but the higher points were given by the patients who underwent progressive tension suture. Conclusion: This technique, progressive tension suture, is an effective method to reduce or eliminate donor site seroma, which is the most common complication associated with latissimus dorsi muscle harvest.

• 한국의료질향상학회지
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• 제2권2호
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• pp.156-171
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• 1996

Background: Nosocomial infection control is one of important means to assure the quality of medical care in the hospital, however, it has been neglected by most of the hospital personnels. Of nosocomial infections, urinary tract infection is the highest incidence, which is related to the indwelling catheter. It is, therefore, necessary to pay primary attention to the patients with the indwelling catheter in intensive care unit in order to control nosocomial Infection and to improve the quality of medical care in the hospital. Methods : The subjects of this study were patients with indwelling catheter who were admitted to the ICU of Pusan Paik Hospital from March 1994 to May 1995. The author calculated UTI rate among the subjects through the cultivation of the urine, identified the related factors of the UTI through brain storming of study team and head nurses working at ICU, and analized the effectiveness of the proposed approaches through comparing the infection rates of before and after activities. Results : The major activities carried out by the study team were to conduct in-service education programs for the staffs working at ICU about the importance of the nosocomial infection control in QA, and nursing intervention to reduce the UTI rate among the patients with indwelling catether. 1. The major nursing interventions that the study team had implemented were as follows ; 1) Drainage system was changed from partial open system to completely closed system. 2) Bladder irrigation which was routinely practised in all patients stopped among the noninfected patients. 3) Bladder irrigation set was changed to the disposable one. 4) Catheter was inserted under the anesthesia for patients to be operated. 5) Male patient receiving wrapped with gauze after perineal care was not wrapped. 6) Clamp which had not been before was newly attached to drainage tube. 7) Urine bag which had been packed into a lot of pieces was done into each piece. 8) The interval of change of indwelling catheter had regularly been four weeks, however it was used continously until it worked well. 9) Catheter was attached well at the defined site. 10) Paper towel was used instead of cotton towel. 11) Mats at the entrance were removed and cleansing of wards was enhanced. 2. The UTI rate by month was 34.4% in maximum and 9.8% in minimum during the period of this study, however it had gradually decreased. After 6 months from initiating infection control activities, the trend of rates was relatively stable. It was identified that UTI rate was different by season 12.5% in winter and 27.2% in summer. 3. Utilization rate of indwelling catheter was maintained at under 50%, but it was increased above 57% from April 1995. 4. The number of bladder irrigation sets used per day was 33.3 sets in maximum and 2.8 sets in minimum. The number used per day were also remarkably deceased. Conclusion : It was found that a program to control UTI could contribute to nosocomial infection control, and it was, in turn, a mean to assure the quality of medical care in the hospital. The nursing interventions which this study team had implemented were effective in the reduce of UTI rates.

• Journal of Chest Surgery
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• 제42권6호
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• pp.719-724
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• 2009

배경: 심장이식이 최근 증가하면서 거부반응과 감염외의 외과적합병증도 증가하고 있다. 이 논문에서는 한 외과의에 실시된 심장이식후에 발생한 외과적합병증을 보고하고자 한다. 대상 및 방법: 1994년 4월부터 2003년 9월까지 실시된 37명의 심장이식환자를 대상으로 하였으며 심장이식의 적응은 확장성 심근증, 허혈성심근증, 판막심근증, 가족력심근증 등이었다. 결과: 총 15명의 이식환자에서 20예의 합병증이 발생하였으며 실시된 외과적 수술의 종류는 출혈로 인한 재개흉(5), 심낭액저류배액술(4), 인공박동기거치술(1), 아스페르질루스증에 의한 우하엽절제술(1), 요석제거술(1), 담낭제거술(1), 직장주위절개술(1), 부비동배액술(1), 고관절치환술(1), 치주비대에 의한 치주절개술(1), 뇨도절개술(1), 추간판 탈출증수술(1), 자궁근종으로 인한 자궁적출술(1)이 있었다. 합병증의 위치는 흉곽내가 10예, 흉곽외가 10예였다. 결론: 심장이식 수술후에는 흉곽 뿐만 아니라 다른 부위장기에 많은 합병증을 가져올 수 있기 때문에 장기생존율을 높이기 위해서는 다학제간의 적극적인 치료가 매우 중요하다.

• Journal of Chest Surgery
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• 제29권3호
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• pp.346-349
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• 1996

This 32 year old female patient underwent left radical mastectomy due to ductal carcinoma on May 1990, and treated with FAM (5-fluorouracil, Adriamycin and Mitomycin C) regimen postoperatively. However, right cervical Iymph node enlargement and facial edema progressively developed since December 199). On April 1994, operation was performed, and findings were as followes; x4$\times$5$\times$7 to 1 : 1 $\times$ 1 cm sized multiple enlarged and hyperemic Iymph nodes were scatterred throughout submandibular area to the junction of superior vents cave and pericardium, and partially invaded both anterior segmental lobe, sternum and both distal tip of clavicles. After radical dissection of the nodes of neck and mediastinal nodes, and wedge resection of both anterior segments of lung, and partial resection of both clavicle tips and total sternum. The both innominate veins and superior vena cava were partially obstructed by invaded cancer SVC reconstruction was done with preclotted 10$\times$ 10$\times$ 18mm Y shap d woven Dacron graft, which was anastomosed to the point of the junction of subclavian vein and jugular vein after cross clamping both veins and 2cm above the pericardial junction with one arm clamp. After maintaining blood drainage to the SVC from the right side, left innominate vein was anastomosed with 4-0 Prolene continuous running suture. Bone cement was used for resected sternal portion and clavicular ends were fixed to postal portion with 18 Gauge wires. The patient was treated with radiation and chemotherapy after discharge, and there were no evidence of regrowing of the mass nor obstruction of the graft inspite of no antithrombotic therapy.

• Tuberculosis and Respiratory Diseases
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• 제47권2호
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• pp.259-264
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• 1999

저자들은 흉부 불쾌감 및 호흡곤란을 주소로 내원한 19세 여자환자에서 우연히 흉부사진상 반월도(scimitar) 모양의 음영 및 우측 폐 형성부전이 발견되어 심초음파, 전산화 단층촬영 혈관조영술, 심도자 및 심혈관 조영술 등으로 확진하여 보존적 치료를 시행한 성인형 Scimitar 증후군을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 한국지반공학회논문집
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• 제18권2호
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• pp.87-96
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• 2002

자가굴착식 프레셔미터를 이용한 변형률 유지 시험은 점성토 지반의 수평방향 압밀계수를 추정하는데 있어 효과적으로 사용되고 있다. Clarke등(1979)이 제시한 일반적인 해석 방법은 여러 가지 단순화한 가정으로 인해 압밀계수산정에 문제점을 내포하고 있다. 따라서, 본 논문에서는 실제 시험 과정 및 조건들을 최대한 반영하기 위하여 프레셔미터 시험기의 유한한 길이, 계파시의 부분배수, 소산시험 시작시의 공동 변형률 등의 여러 가지 해석 조건들이 초기 과잉간극수압의 분포 및 소산 거동에 미치는 영향을 고려한 유한요소해석을 수행하였다. 그 결과, 수평방향 압밀계수를 추정하는데 필요한 50% 압밀도에서의 시간계수를 제안하였고, 이를 국내 2개 현장에서 수행한 변형률 유지시험에 적용하여 압밀계수를 산정하고, 다른 현장 시험 및 실내시험 결과와 비교.분석하여 그 적용성을 확인하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.7029-7032
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• 2013

Background: Cholangiocarcinoma (CCA) is a very common cancer in Northeastern Thailand. Most CCA patients see a physician at a late stage when curative surgery is not possible. After diagnosis, they generally are treated by partial surgery/percutaneous drainage, chemotherapy and supportive treatment. Objective: This study aimed to assess the survival rates of CCA patients after supportive treatment. Methods: A retrospective cohort design was applied in this study. Data for 746 CCA patients were extracted from the hospital-based cancer registry of Srinagarind Hospital, Khon Kaen University. The patients were diagnosed (at least by ultrasonography) between 1 January, 2009 and 31 December, 2009 and then followed up for current status until 30 June, 2011. The cumulative survival rate was calculated by the Kaplan-Meier method, and independent prognostic factors were investigated using Cox regression. Results: The total follow-up time was 5,878 person-months, and the total number of deaths was 637. The mortality rate was therefore 10.8 per 100 person-year (95%CI : 10.1-11.7). The cumulative 3, 6, 9, 12 and 24 month survival rates were 59%, 39%, 31%, 24% and 14%, respectively. The median survival time after supportive treatment was 4 months. After adjusting for gender, age, stage, distant metastasis, histological grading and treatment, stage was a significant predictor of survival of CCA patients. Those in stage III and stage IV had a 6.78 fold higher mortality than the stage I and stage II cases (95% CI : 1.6-28.7). Conclusion: It is very important to encourage patients to see health personnel at an early stage.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.51-56
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• 2011

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were $4{\times}16$ cm and $5{\times}5$ cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was $5{\times}18$ cm for case 1 and $18{\times}10$ cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.