• Journal of Chest Surgery
• /
• 제33권10호
• /
• pp.785-791
• /
• 2000

Left ventricular dysfuction is common in immediate postoperative periods after surgical correction of heart diseases with chronic left ventricular volume overload. We speculated postoperative changes of left ventricular volume and unction in patients with patent ductus osus(PDA) who had underwent surgical repair at ages older than 16 years. Factors influencing postoperative left ventricular volume and function were also analyzed. Material and Method: From August 1989 to August 1999 thirty-siz adult patients with PDA 28 females and 8 males. were enrolled in this study. Their age ranged from 16 years to 57 years(mean :32 years). Types of surgical repair were division with primary closure in 22, division with patch closure in 6, internal obliteration using cardiopulmonary bypass in 4 and ligation in 4. Aortic clamping was combined during surgical repair in 22(61%) and cardiopulmonary bypass was used in 8(22%) Two-dimensional echocardiography studies were performed in 34(94%) preoperatively and in 25(66%) immediate postoperatively to assess postoperative changes of left ventricular internal dimensions. left ventricular volume and ejection fraction. Duration of postoperative follow-up ranged from 1 month to 99 months (mean:22 months) and 10 patients underwent 16 echocardiographic evaluation during this period Result : Preoperative and postoperative left ventricular systolic dimensions(LVIDs) were 42$\pm$8.0mm and 42$\pm$8.3mm left ventricular diastolic dimensions(LVIDd) were 64$\pm$10.0mm and 56$\pm$7.4mm left ventricular end systolic volumes(LVESV) were 62$\pm$19cc (z=1.87$\pm$0.06) and 59$\pm$24cc(z=1.78$\pm$0.08) left ventricular end diastolic volumes(LVEDL) were 169$\pm$40cc(z-1.17$\pm$0.1) and 112$\pm$29cc(z=0.85$\pm$0.1) and ejection fractions(EF) were 66$\pm$6.7% and 48$\pm$12.6% respectively. There were statistically significant differences between preoperative and postoperative values in LVDIDd(p=0.001) LVEDV(p=0.001) and EF(p=0.0001) while no significant difference is LVIDs and LVESV. Postoperative depression of ejcection fraction was significantly related with z-score of preoperative LVESV and LVEDV by univariateanalysis while LVEDV only was significant risk factor for postoperative LV dysfunction by multiple regressioin analysis ($\Delta$LVEF=-13.3-4.62$\times$LVEDV(z), p=0.001) During the follow-up periods ejection fractions become normalized in all except one patients. Conclusion ; Left ventricular function is usually deteriorated after the surgical correction of PDA in adult age and preoperative LVEDV is a major determinant of postoperative LV function.

• 대한치과의사협회지
• /
• 제50권8호
• /
• pp.474-481
• /
• 2012

The periodontal flap surgery is the most widely utilized surgical procedure to reduce the pocket depth and to access the subgingival root surfaces for scaling and root planing. The diagnosis of the periodontal lesion and the objective of the surgery will dictate the type of flap procedure which will be utilized to obtain the best result. The incisions, type of flap and the selection of suturing design must be planned and executed to fit the problem. Periodontal flaps are designed to preserve gingival integrity and to gain access to root surfaces for residual calculus removal and to thoroughly remove granulation tissue so bone defects can be visualized and treated. Gentle and efficient procedures result in optimum healing and minimal postoperative pain. When flaps need to be repositioned apically or less often, coronally, then the flaps must sit passively at the appropriate level before suturing. To ensure this, buccal and lingual flaps need to be elevated beyond the mucogingival junction so the elasticity of the mucosa allows for flap mobility. Sometimes it may be necessary to extend the flap elevation apically with a split incision approach to minimize the effect of the less elastic periosteum. Vertical incisions can aid in flap positioning by allow ing the clinician to suture the flap at a different level to the adjacent untreated gingiva. In osseous periodontal surgery, flaps are apically positioned to minimize postoperative pocket depth. In regenerative periodontal surgery including implant surgery, soft tissue cove rage of bony defects, graft materials, membranes, and bio logic agents is important so sulcular incisions and light suturing techniques are crucial.

• 수산경영론집
• /
• 제37권2호
• /
• pp.33-59
• /
• 2006

This study describes approaches to fisheries management that restrict access by fishers to an area in some way. When fishery closure is established as a technical conservation measure it is a form of input control as a Korea fisheries management system. There are many compelling reasons why a fisheries manager should seriously consider closed areas and/or time restrictions, either as a complement to other measures or as the primary facet of the Korean fisheries management strategy. Fishery closures have been shown to be effective in many fisheries and are an important tool in the management armoury. In many respects justifications for their use and the process of implementation are likely to be relatively straightforward compared to permanent area closures. From a Korean fisheries management perspective, the benefits that flow from fishery closures are usually less easy to predict than for other management measures. Moreover, even if one accepts that implementation of fisherg clossures will provide higher production levels in adjacent fished areas, the potential benefits may often be in danger of being largely dissipated. If, for example, the fishery remains open access, the increased production is likely to attract new entrants into the fishery, thereby driving it back towards bioeconomic equilibrium. From a Korean wider fisheries conservation perspective, however, fishery closures have important and clearly defensible roles to play and some form of zoning arrangement will often effectively serve conservation values. Given the increasing trend towards the establishment of national networks of fisherg closures, it seems likely that fisheries managers throughout the world will need to ensure that they are familiar with the issues surrounding these approaches. The importance of being explicit about the goals for fishery closures in Korea have been continually emphasised throughout this study. There may, of course, be multiple justifications for the measure, in which case it is important to try and specify them in order of priority.

• 대한두경부종양학회지
• /
• 제16권1호
• /
• pp.26-32
• /
• 2000

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

• 대한두개안면성형외과학회지
• /
• 제14권2호
• /
• pp.129-132
• /
• 2013

Cutaneous squamous cell carcinoma is the second-most common skin cancer and represents 20% of all skin cancers. Cutaneous squamous cell carcinoma often spreads to the parotid gland through lymph nodes, but, direct invasion of an adjacent organ may also occur. We present the case of 78-year-old man with ulcerated mass on the right infra-auricular area. The histopathologic finding was squamous cell carcinoma. There was no evidence of distant metastasis, but the mass was found to invade the superficial lobe of the right parotid gland. The mass was widely excised and superficial parotidectomy was performed while preserving the facial nerve. The defect was covered by primary closure. Postoperative radiotherapy was performed. At 20 months after surgery, our patient had no facial palsy, local recurrence, or metastasis. Cutaneous squamous cell carcinoma involving the parotid gland is an aggressive, rapidly advancing lesion, which if not recognized and treated early will result in high morbidity and mortality. Squamous cell carcinoma of the parotid gland has shown that patients who receive adjuvant radiotherapy have a lower recurrence rate and a higher survival rate than patients treated with surgery alone. The role of elective neck dissection remains controversial.

• 대한두경부종양학회지
• /
• 제1권1호
• /
• pp.35-61
• /
• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• Archives of Reconstructive Microsurgery
• /
• 제10권2호
• /
• pp.163-168
• /
• 2001

The defects of the abdominal wall could be brought about either congenitally, for instances in such cases as omphalocele or gastroschisis, or by various acquired causes-trauma, excision of tumors, excision of burn scar, tissue necrosis caused by infection, hematoma after abdominal surgery, tissue necrosis after radiation therapy and so on. As for the techniques of the reconstruction of the abdominal wall defects, many authors have developed and reported diverse methods. To summarize, primary closure, skin graft, local skin flaps, various myocutaneous flaps, free flap, fascia graft, artificial mesh, tissue expansion, etc could be used in the reconstruction of the abdominal wall defects. The periumbilical perforator-based island skin flap has a many advantages such as no significant sacrifice of the rectus abdominis muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for flap, and for middle-aged, obese patients, the donor site may be the best from the cosmetic point of view. We used perforator-based island skin flap in 5 cases with reasonable result from March 1999 to May 2001. There were no significant complications and donor sites could be repaired primarily.

• Archives of Reconstructive Microsurgery
• /
• 제21권1호
• /
• pp.14-20
• /
• 2012

Purpose: Defect after ablation of hypopharyngeal cancer often requires reconstruction by free tissue transfer. Since neo-hypopharynx is totally buried, various methods have been suggested for monitoring. We propose a modified design of anterolateral thigh (ALT) free flap for reconstruction of pharyngolaryngectomy defect, which has an exteriorized part for clinical monitoring and allows for primary closure. Materials and Methods: Three consecutive patients with hypopharyngeal cancer were reconstructed with ALT flap with modified design: 1) distal part of flap was elongated into fusiform shape and used as exteriorized monitoring segment with a deepithelized bridge and 2) proximal part was designed as curve so the maximum width of the flap was reduced to less than 10 cm. Results: Patient 1, 2 had uneventful postoperative course with healthy skin color and fresh pin prick bleeding. In patient 3, defect after cancer ablation was shorter than usual and deepithelized bridge was longer. When the general hemodynamic status of the patient was aggravated in postoperative course, the color of monitoring skin was changed. Viability of the whole flap was confirmed by endoscopy. However, leakage developed after 3 weeks and repair was necessary. In all patients the donor sites were closed primarily. Conclusion: By the modified design of ALT flap, clinical monitoring can be possible by examining exteriorized monitoring flap and also donor site can be closed primarily. However possibility of false positive exists and technical caution and patient selection is needed because of danger of leakage.

• Journal of Trauma and Injury
• /
• 제28권3호
• /
• pp.129-133
• /
• 2015

Purpose: The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment. Methods: A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed. Results: Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is $13.6{\pm}9.6$. The mean AIS is $8.9{\pm}6.5$. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%. Conclusion: ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.

• Journal of Trauma and Injury
• /
• 제24권2호
• /
• pp.82-88
• /
• 2011

Background: The incidence of abdominal trauma with intra-abdominal organ injury or bowel rupture is increasing. Articles on the diagnosis, symptoms and treatment of small bowel perforation due to blunt trauma have been reported, but reports on the relationship of mortality and morbidity to clinical factors for prognosis are minimal. The purposes of this study are to evaluate the morbidity and mortality of patients with small bowel perforation after blunt abdominal trauma on the basis of clinical examination and to analyze factors associated with the prognosis for blunt abdominal trauma with small bowel perforation. Methods: The clinical data on patients with small bowel perforation due to blunt trauma who underwent emergency surgery from January 1994 to December 2009 were retrospectively analyzed. The correlation of each prognostic factor to morbidity and mortality, and the relationship among prognostic factors were analyzed. Results: A total of 83 patients met the inclusion criteria: The male was 81.9%. The mean age was 45.6 years. The mean APACHE II score was 5.75. The mean time interval between injury and surgery was 395.9 minutes. The mean surgery time was 111.1 minutes. Forty seven patients had surgery for ileal perforations, and primary closure was done for 51patients. The mean admission period was 15.3 days, and the mean fasting time was 4.5 days. There were 6 deaths (7.2%), and 25 patients suffered from complications. Conclusion: The patient's age and the APACHE II score on admission were important prognostic factors that effected a patient's progress. Especially, this study shows that the APACHE II score had effect on the operation time, admission period, the treatment period, the fasting time, the mortality rate, and the complication rate.