• Archives of Plastic Surgery
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• v.49 no.5
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• pp.617-632
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• 2022

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1-13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1-43%), 7% (95% CI < 1-34%) for dermal graft interposition, < 1% (95% CI < 1-37%) for radial forearm free flap, < 1% (95% CI < 1-52%) for ligation of the fistula, 17% (95% CI < 1-64%) for interposition of a deltopectoral flap, 9% (95% CI < 1-28%) for primary closure, and 2% (95% CI < 1-20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

• Clinical and Experimental Pediatrics
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• v.46 no.10
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• pp.1008-1012
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• 2003

Purpose : We aimed to ascertain whether lumbar punctures should be done to prove febrile seizure, and to study what conditions can delay or abolish lumbar puncture. Methods : This retrospective study was done for four years, from January, 1996 to December, 1999. The subjects were the patients who visited Masan Samsung Hospital for the first convulsion with fever, and whose age ranged from 1-month to 5-years old. The total number of patients was 197. We investigated the rate of meningitis, which was classified by age, season, convulsion type, associated symptoms, and results of blood test. All data were tested chi-square. Results : The diagnosis rate of meningitis among all 197 patients was 7.6%, and of these only one patient was proved to have bacterial meningitis. The rate was high in the young(below 6 month), in males and in summer and autumn. Although the general appearance was good after resolution of the fever, the rate of meningitis was 6.5%. Patients with nausea and vomiting totalled 11%; 9.1% of them were diagnosed with meningitis. The diagnosis rate of meningitis in cases in which additional seizures took place were 33.3%. Conclusion : The ultimate goal of lumbar punctures in seizure patients with accompanying fever is to rule out bacterial meningitis, which, has been demonstrated to be rare. So we think that lumbar puncture can be postponed by close observation of pediatrics specialists and skilled nurses.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.642-647
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• 2010

Background: It is very important to obtain vascular access that resists repeated punctures and maintains an adequate blood flow for performing hemodialysis in patients with ESRD. This study was designed to identify the risk factors that may influence the patency rate of arteriovenous fistula (AVF) using perforating vein on antecubital fossa. Material and Method: We analyzed 205 cases of AVF in 195 patients who underwent hemodialysis access surgery on antecubital fossa in our hospital from May 2006 to December 2009. Result: The patency rate of AVF from 6 months after surgery using perforating vein was 75.91%. The risk factors that influence the patency rate was age. There was no statistic difference between used vessels. Conclusion: The patency of the AVF using perforating vein on antecubital fossa was comparable. The condition of sex and location and presence or absence of diabetes and hypertension and other cardio-neurovascular disease did not make statistically significant effect on the AVF patency rate. The age was an independent risk factor for patency rate.

• The Journal of Korean Society for Radiation Therapy
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• v.11 no.1
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• pp.43-48
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• 1999

Purpose : For practical application of the MR image for stereotactic radiosurgery, the target point achieved by acquisition of MR image in a relatively homogeneous phantom has to agree with the actual isocenter of irradiation in real radiosurgery and the amount of distortion of the MR image should be known. Materials and Methods : A dosimetric film with a random target point was inserted into a radish vertically and horizontally on axis Z and they were fixed with a headring. After image acquisition by stereotactic radiosurgery planning system, we achieved stereotactic coordinate of the target point and examined irradiation using the coordinate acquired as isocenter. After the irradiation, the film in the radish was developed and processed and the degree of coincidence between the target point marked on the film and the center of the radiation distribution. In order to measure the degree of distortion of the MR image in a different way, an acryl phantom was made and punctures were made at intervals of 1 cm and a drop of oil was dropped into it. Then, it was inserted into the radish vertically and horizontally on axis Z to acquire the MR image. Each coordinate was achieved and the estimation of distortion of MR image was made both in vertical and horizontal directions Results : The film from the radio was developed and for the one inserted vertically on axis Z, there was a good coincidence in the discrepancy between the target point marked on the film and the center of the radiation distribution. For the one inserted horizontally, the discrepancy between them was under 0.5 mm. As a result of estimating distortion of MR image using acryl, the discrepancy was under 0.45 mm in the case of the phantom inserted vertically on axis Z, and that of the one inserted horizontally was 1.4 mm. Conclusion : We were able to confirm good coincidence in homogeneous phantom in actual treatment position of radiosurgery using the MR image and the discrepancy measured in the analysis of distortion of the MR image did not exceed the permissible level. Therefore, it was evident the system of the hospital is suitable for radiosurgery using MR image.

• Journal of Korean Tunnelling and Underground Space Association
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• v.20 no.2
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• pp.469-483
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• 2018

Steel bars have been widely used as the primary reinforcement for Precast Segmental Concrete Lining for TBM Tunnels. Previously, studies have been carried out to gauge the potential for steel fiber reinforcement to replace the use of steel bar reinforcements in the segmental lining to reduce the amount of the steel bar reinforcement. Steel fiber reinforcements have been investigated and widely applied to SFRC TBM linings to improve the constructability of SFRC TBM linings worldwide. However, the steel fiber reinforcement often caused punctures to the water membranes inside tunnel lining and had long-term durability deterioration issues caused by steel corrosion, as well as cosmetic problems. Therefore, this paper sought to gauge the potential of synthetic fiber reinforcements, which have proven to be very attractive substitutes for steel fiber reinforcements. This study analyzed the performance of both steel and synthetic fiber reinforcements in segmental linings and evaluated the applicability of the fiber reinforcements to the TBM Precast Concrete Segmental Linings of TBM tunnels. As a conclusion, this study demonstrates that the potential use of steel and synthetic fibers in various combination, can substitute the rebar reinforcement in the concrete mix for segmental concrete linings.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.342-348
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• 2004

It is very important for hemodialysis in patients with end stage renal disease to obtain vascular access that resists repeated punctures and maintains adequate blood flow. This study was designed to indentify factors that may influence early patency rate of autogenous arteriovenous fistula. Material and Method: 49 cases in 47 patients who underwent radiocephalic fistula formation in our hospital from June 2002 through May 2003 were reviewed and analyzed. Result: The early patency rate was 79.6%. Age, sex, hypertension, and diabetes mellitus were not significant factors for patency. Body mass index and duration of hypertension and diabetes did not influence the early results either. Cephalic vein diameter measured preoperatively and blood flow at radio-cephalic fistula were significantly positive correlative factors. Groups with the vein diameter less than 2.7mm, or with the blood flow less than 100 mL/min had significantly lower early patency rate than the other groups. Conclusion: To improve early patency rate of radiocephalic fistula, large sized cephalic vein should be selected and if the intraoperative flow at radiocephalic fistula is less than 100 mL/min, another arteriovenous fistula formation should be considered.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• Pediatric Infection and Vaccine
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• v.17 no.2
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• pp.101-107
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• 2010

Purpose : In evaluation of patients, laboratory results are crucial in determination of a treatment plan. Obtaining venous blood from infants and children is a difficult procedure. Substitution of a capillary blood sample for a venous blood sample has been suggested. However, there are few studies showing mutual correlation between C-reactive protein (CRP) results in capillary and venous blood. This study was designed to determine whether the result of the capillary sample is the same as the result of the venous blood sample. Methods : After informed consent, a pair of venous and fingertip capillary blood samples were simultaneously collected from 100 children. The LC-178CRPTM was used for analysis of capillary blood and the Hitachi 7180 automatic hematology analyzer was used for analysis of venous blood. We compared CRP of both venous and capillary blood samples. Results were analyzed by crosstabulation analysis, simple regression analysis and the Bland Altman Plot method. Results : A close correlation (90.63%) was observed between capillary and venous blood analyzed by crosstabulation analysis. CRP results were similar between the two groups and showed a high coefficient correlation ($\beta$=1.3434, $R^2$=0.9888, P<0.0001) when analyzed by a simple regression model. The average value in venous blood was also higher compared to capillary blood. According to Bland Altman Plot analysis, lab results were measured at a 95% confidence interval. Conclusion : CRP results from capillary blood showed close correlation with venous blood sampling. At present, venous blood sampling is the preferred method. However, due to difficulty in venous blood sampling, capillary sampling could be considered as an alternative technique for use with children.

• Journal of Plant Biology
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• v.38 no.1
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• pp.95-105
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• 1995

Complete microsporogenesis of Hibiscus syriacus L. were carried out employing LM, TEM, and SEM to investigate the pollen ontogeny that undergoes considerable structural differentiation. The process first began with several cell diYisions in the anther primordium that produces 3 different tissues of epidennal, archesporial, and connective tissues. Only archesporial tissue involved further differentiation into the tapetum and formation of reproductive cells, pollen mother cells (PMC). The tapetum and PMC were closely associated with each other structurally and metabolically by exhibiting numerous plasmodesmata, mitochondria, and many small vacuoles in their dense cytoplasm. A callosic wall began to surround the PMC while meiosis took place in the PMC to produce 4 microspores. When thick callose encircled each microspore as a frame, the sporodenn development initiated from the plasma membrane of a pollen grain in a tetrad. The first fonned sporoderm layer was bacules and tectum of sexine that originated from the plasma membrane. After the dissolution of a callose, further development Qf sporoderm continued in the order of nexine 1, nexine 2, and intine layer. The nexine layer was thicker (ca. $2-3.5\;\mu\textrm{m}$) than the intine layer whose thickness was about $0.9-1.5\;\mu\textrm{m}$. Upon completion of the sporoderm development, that is after intine formation, spines and apertures of pollen surface ornamentation initiated from the tectum. Spines were dimorphic, about $4-9\;\mu\textrm{m}\;an;15-20\;\mu\textrm{m}$ in length, and no basal cushion was detected. The mature pollen grains ranged $100-200\;\mu\textrm{m}$ in diameter, but their average was about $170\;\mu\textrm{m}$. About 120 spines were observed over the spheroidal pollen surface. Apertures were simple punctures of $2-3\;\mu\textrm{m}$ in diameter and about 50 apertures were arranged somewhat helically over the surface. Comparing such features of form and size of the pollen, sporodenn sculpture and structure, and aperture and spine conditions with known evolutionary trends in the genus Hibiscus, Hibiscus syriacus seemed to possess many advanced features in the sporodenn differentiation.iation.

• Korean Journal of Agricultural and Forest Meteorology
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• v.10 no.4
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• pp.158-166
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• 2008

The pumpkin fruit fly, Bactrocera depressa (Tephritidae: Diptera), is one of the most important pests in Cucurbitaceae plants. This study was conducted to investigate the basic ecology of B. depressa, and to develop a forecasting model for predicting the time of adult emergence in early season. In green pumpkin producing farms, the oviposition punctures caused by the oviposition of B. depressa occurred first between mid- and late July, peaked in late August, and then decreased in mid-September followed by disappearance of the symptoms in late September, during which oviposition activity of B. depressa is considered active. In full-ripened pumpkin producing farms, damaged fruits abruptly increased from early Auguest, because the decay of pumpkins caused by larval development began from that time. B. depressa produced a mean oviposition puncture of 2.2 per fruit and total 28.8-29.8 eggs per fruit. Adult emergence from overwintering pupae, which was monitored using a ground emergence trap, was first observed between mid- and late May, and peaked during late May to early June. The development times from overwintering pupae to adult emergence decreased with increasing temperature: 59.0 days at $15^{\circ}C$, 39.3 days at $20^{\circ}C$, 25.8 days at$25^{\circ}C$ and 21.4 days at $30^{\circ}C$. The pupae did not develop to adult at $35^{\circ}C$. The lower developmental threshold temperature was calculated as $6.8^{\circ}C$ by linear regression. The thermal constant was 482.3 degree-days. The non-linear model of Gaussian equation well explained the relationship between the development rate and temperature. The Weibull function provided a good fit for the distribution of development times of overwintering pupae. The predicted date of 50% adult emergence by a degree-day model showed one day deviation from the observed actual date. Also, the output estimated by rate summation model, which was consisted of the developmental model and the Weibull function, well pursued the actual pattern of cumulative frequency curve of B. depressa adult emergence. Consequently, it is expected that the present results could be used to establish the management strategy of B. depressa.