• Title/Summary/Keyword: Punctures

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The First Neurosurgical Analysis of 8 Korean Children with Sotos Syndrome

  • Lim, Jae-Joon;Yoon, Soo-Han
    • Journal of Korean Neurosurgical Society
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    • v.44 no.4
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    • pp.240-244
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    • 2008
  • Objective : Sotos Syndrome is characterized by macrocephaly, overgrowth, and developmental delay, and more than 300 patients have been reported worldwide to date. The authors reviewed the clinical characteristics of 8 patients with Sotos Syndrome in Korea for a new understanding and treatment strategies. Methods : The medical records of a total of eight Korean children with Sotos Syndrome were reviewed. All patients underwent developmental checkup, lumbar punctures for measurement of intracranial pressure (ICP), brain and spine magnetic resonance imaging and computerized tomography. Results : All 8 patients showed macrocephaly and the characteristic craniofacial features of Sotos Syndrome. Other clinical characteristics shown were overgrowth (7/8), developmental delay (7/8), congenital heart defect (3/8), flat foot (8/8), scoliosis (4/8), spina bifida (8/8), hydrocephalus (4/8), cavum vergae (3/8), and increased subdural fluid collection (5/8). Mean ICP measured via lumbar puncture was $27.35{\pm}6.25\;cm$ $H_2O$ (range 20 to 36 cm $H_2O$). Two patients received ventriculo-peritoneal shunt, and 1 patient underwent subduro-peritoneal shunt with improvement. Spinal orthosis was applied to 4/5 patients with scoliosis and 4/8 children with flat foot were provided with foot orthosis. Conclusion : In this first Korean study of 8 Sotos Syndrome patients we demonstrated the presence of spina bifida and increased ICP, which had not been previously described. The authors therefore suggest that all patients with Sotos Syndrome should undergo examination for the presence of spina bifida, and that shunt procedures would improve development and alleviate clinical symptoms.

Viscoelastic Properties of Fruit Flesh(I) - Stress Relaxation Behavior - (과실(果實)의 점탄성(粘彈性) 특성(特性)(I) - 응력이완거동(應力弛緩擧動) -)

  • Kim, M.S.;Park, J.M.;Choi, D.S.
    • Journal of Biosystems Engineering
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    • v.17 no.3
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    • pp.260-271
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    • 1992
  • Fruits are generally subjected to mechanical forces during harvesting, handling, and transportation that may cause damage in the form of bruises, punctures, and cracks. In order to prevent damage, and insure better quality fruits for consumers, it is very essential to study physical properties of these materials. The studies were conducted to examine the effect of storage period, storage condition, and other factors, such as loading rate and initial strain, on the stress relaxation behavior of the fruit flesh, and develop nonlinear viscoelastic models to represent its stress relaxation behavior. The following results were obtained from the study : 1. Since the viscoelastic behavior of the fruits flesh was nonlinear, the behavior was satisfactorily modelled as follows ; $${\delta}({\varepsilon},\;t)={\varepsilon}^A[B\;{\exp}(-Ct)+D\;{\exp}(-Ft)+G(-Ht)]$$ But, for the every strain applied, the stress relaxation behavior of the fruit flesh, such as apple and pear, could be well described by the Generalized Maxwell model, respectively. 2. The effect of loading rate on the stress relaxation behavior was remarkable. The higher loading rate resulted in the higher initial stress, and the faster stress relaxation. 3. The higher initial strain resulted in the higher initial stress, and stress relaxed at the large initial strain was also much higher than at the small initial strain. 4. Stress relaxation rate and quantity stored in the fruits at the low temperature storage were much higher than those at the normal temperature storage in the same storage period. Also, in all fruits tested, the longer storage period was the more relaxation rate and quantity were shown. These trends in the normal temperature condition was the more significant than in the low temperature condition.

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Cost Analysis of Using a Closed-System Transfer Device (CSTD) for Antineoplastic Drug preparation in a Malaysian Government-Funded Hospital

  • Chan, Huan Keat;Lim, Yik Ming
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.11
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    • pp.4951-4957
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    • 2016
  • Background: Apart from reducing occupational exposure to cytotoxic hazards, the PhaSeal(R) closed-system transfer device (CSTD) can extend the beyond-use dates (BUDs) of unfinished vials of antineoplastic drugs for up to 168 hours (seven days). In this study, the total material cost incurred by its use in a Malaysian government-funded hospital was calculated. Methods: A list of vial stability following initial needle punctures of 29 commonly-used antineoplastic drugs was compiled. The amount of the materials used, including drugs, infusion bottles, the PhaSeal(R) CSTD and other consumables, was recorded on a daily basis for three months in 2015. The total cost was calculated based on the actual acquisition costs, and was compared with that of a hypothetical scenario, whereby conventional syringe-needle sets were used for the same amounts of preparations. Results: The use of the PhaSeal(R) CSTD incurred a cost of MYR 383,634.52 (USD 92,072.28) in three months, representing an average of MYR 170.5 (USD 40.92) per preparation or an estimated annual cost of MYR 1,534,538.08 (USD 368,289.14). Compared with conventional syringe-needle approach, it is estimated to lead to an additional spending of MYR 148,627.68 (USD 35,670.64) yearly. Conclusion: Although there was a reduction of drug wastage achieved by extending BUDs of unfinished vials using the PhaSeal(R) CSTD, cost saving was not observed, likely attributable to the wide use of lower-priced generic drugs in Malaysia. Future studies should further evaluate the possibility of cost saving, especially in health settings where branded and high-cost antineoplastic drugs are more commonly used.

Angio-$Seal^{TM}$ $Evolution^{TM}$ versus Manual Compression for Common Femoral Artery Puncture in Neurovascular Diagnostic Angiography: A Prospective, Non-Randomized Study

  • Chung, Joon-Ho;Lee, Dong-Woo;Kwon, Ok-Sim;Kim, Bum-Soo;Shin, Yong-Sam
    • Journal of Korean Neurosurgical Society
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    • v.49 no.3
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    • pp.153-156
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    • 2011
  • Objective : This prospective, non-randomized study compared the safety and efficacy of the Angio-$Seal^{TM}$ $Evolution^{TM}$ to that of manual compression for common femoral artery punctures in neurovascular diagnostic angiography. Methods : From June 2009 to September 2009, we performed 169 diagnostic trans-femoral cerebral angiographies, using either the Angio-$Seal^{TM}$ $Evolution^{TM}$ or manual compression to achieve hemostasis. We included 60 patients in this study, 30 in each group. We defined minor complications as those requiring no further treatment such as hematoma size less than 6 cm and bruise size less than 25 cm. Major complications were those requiring surgery of the femoral artery pseudoaneurysm and/or the second line increase of hospital stay even without further treatment. Results : Mean time to hemostasis was $0.42{\pm}0.04$ minutes for the angioseal and $15.83{\pm}1.63$ minutes for manual compression (p<0.001). Overall complication rate did not differ between the 2 groups. After the patients were fully mobile, at 24 hours, the rate of onset of new complication differed significantly between the 2 groups (p=0.032). In the angioseal group, 5 (16.7%) of the 30 patients experienced the onset of a new complication after 24 hours, including 3 (60.0%) of the 5 who experienced major complications. Conclusion : The Angio-$Seal^{TM}$ $Evolution^{TM}$ is effective at decreasing mean time to hemostasis, like other closing devices. However, it may not be effective at producing early ambulation and discharge, compared to manual compression, because delayed complications may occur significantly after 24 hours.

A Novel Implantable Cerebrospinal Fluid Reservoir : A Pilot Study

  • Byun, Yoon Hwan;Gwak, Ho Shin;Kwon, Ji-Woong;Kim, Kwang Gi;Shin, Sang Hoon;Lee, Seung Hoon;Yoo, Heon
    • Journal of Korean Neurosurgical Society
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    • v.61 no.5
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    • pp.640-644
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    • 2018
  • Objective : The purpose of this pilot study was to examine the safety and function of the newly developed cerebrospinal fluid (CSF) reservoir called the V-Port. Methods : The newly developed V-Port consists of a non-collapsible reservoir outlined with a titanium cage and a connector for the ventricular catheter to be assembled. It is designed to be better palpated and more durable to multiple punctures than the Ommaya reservoir. A total of nine patients diagnosed with leptomeningeal carcinomatosis were selected for V-Port insertion. Each patient was followed up for evaluation for a month after the operation. Results : The average operation time for V-Port insertion was 42 minutes and the average incision size was 6.6 cm. The surgical technique of V-Port insertion was found to be intuitive by all neurosurgeons who participated in the pilot study. There was no obstruction or leakage of the V-Port during intrathecal chemotherapy or CSF drainage. Also, there were no complications including post-operative intracerebral hemorrhage, infection and skin problems related to the V-Port. Conclusion : V-Port is a safe and an easy to use implantable CSF reservoir that addresses problems of other implantable CSF reservoirs. Further multicenter clinical trial is needed to prove the safety and the function of the V-Port.

Accuracy and Safety of Bedside External Ventricular Drain Placement at Two Different Cranial Sites : Kocher's Point versus Forehead

  • Park, Young-Gil;Woo, Hyun-Jin;Kim, Il-Man;Park, Jae-Chan
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.317-321
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    • 2011
  • Objective : External ventricular drain (EVD) is commonly performed with a freehand technique using surface anatomical landmarks at two different cranial sites, Kocher's point and the forehead. The aim of this study was to evaluate and compare the accuracy and safety of these percutaneous ventriculostomies. Methods : A retrospectively review of medical records and head computed tomography scans were examined in 227 patients who underwent 250 freehand pass ventriculostomy catheter placements using two different methods at two institutions, between 2003 and 2009. Eighty-one patients underwent 101 ventriculostomies using Kocher's point (group 1), whereas 146 patients underwent 149 forehead ventriculostomies (group 2). Results : In group 1, the catheter tip was optimally placed in either the ipsilateral frontal horn or the third ventricle, through the foramen of Monro (grade 1) in 82 (81.1%) procedures, in the contralateral lateral ventricle (grade 2) in 4 (3.9%), and into eloquent structures or non-target cerebrospinal space (grade 3) in 15 (14.8%). Intracerebral hemorrhage (ICH) >1 mL developed in 5 (5.0%) procedures. Significantly higher incidences of optimal catheter placements were observed in group 2. ICH>1 mL developed in 11 (7.4 %) procedures in group 2, showing no significant difference between groups. In addition, the mean interval from the EVD to ventriculoperitoneal shunt was shorter in group 2 than in group 1, and the incidence of EVD-related infection was decreased in group 2. Conclusion : Accurate and safe ventriculostomies were achieved using both cranial sites, Kocher's point and the forehead. However, the forehead ventriculostomies provided more accurate ventricular punctures.

Effects of Jasmonic Acid and Wounding on Polyphenol Oxidase Activity in Senescing Tomato Leaves

  • Jin, Sun-Young;Hong, Jung-Hee
    • Environmental Sciences Bulletin of The Korean Environmental Sciences Society
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    • v.4 no.4
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    • pp.231-240
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    • 2000
  • Effects of Jasmonic Acid and Wounding on Polyphenol Oxidase Activity in Senescing Tomato Leaves The effects of jasmonic acid(JA) and wounding on polyphenol oxidase(PPO) during leaf senescence was investigated by measuring the PPO activity in detached tomato(Lycopersicon esculentum Mill.) leaves of two-week-old seedlings. The PPO activity in the detached senescing leaves increased significantly in the dark. The leaf segments responded to the application of JA with accelerated senescence, as indicated by the loss of chlorophyll and rapid increase in the PPO activity. The senescence-promoting action of JA differed in the light and dark. Wounding the detached senescing leaves by scraping surface segments or making punctures with needles considerably delayed the loss of chlorophyll and had a significant effect on the PPO activity, the amounts of which were roughly proportional to the intensity of the wounding. In the dark, the combination of wounding plus JA resulted in stable levels of chlorophyll and PPO. JA and ABA acted similarly in both unwounded and wounded leaves, however, the amount of chlorophyll and PPO in the wounded segments was always higher than in the respective controls. JA was found to eliminate the senescence-retarding action of benzyladenine. In a histochemical localization test, the PPO activity was found to be localized in the cell walls of the parenchyma tissue, thereby indicating moderate cytoplasmic reactions. In the JA-treated plants, the PPO activity was intense in the cells of the cortex and phloem parenchyma. Accordingly, based on these observations it would appear that PPO is a component of a defense response maker, whereas JA plays an integral role in the intracellular signal transduction involved in inducible defense mechanisms.

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An Experimental Study on the Performance of Liquid Spill Stopper to Prevent Flood through the Hull Punctures (선박파공으로 인한 선박침수 방지를 위한 파공봉쇄장치 성능의 실험적 연구)

  • Moon, Jung-Hwan;Kim, Jin-Kyeong;Kwon, Ki-Seng;Jung, Kyung-Tae;Yun, Jong-Huwi
    • Journal of Navigation and Port Research
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    • v.37 no.2
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    • pp.149-154
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    • 2013
  • This paper considers the issue of LSS(Liquid Spill Stopper)'s performance verification testing against external resisting force. The importance of the test is to ascertain the possibility of liquid spill stop quickly and efficiently by LSS. The method adopted in this research is the experimental device for puncture's inflow pressure and test the adhesive (magnetic) force on shell plates during the sailing. The major results of the paper are the followings : (a) The performance of LSS against 40 and 100mm diameter puncture was confirmed under 1.0bar. (b) LSS near bow detached first at 20.2 knots. This indicates that LSS can recover the damaged movability needed to naval warships' operation as well as merchant ships.

Predictive value of C-reactive protein for the diagnosis of meningitis in febrile infants under 3 months of age in the emergency department

  • Lee, Tae Gyoung;Yu, Seung Taek;So, Cheol Hwan
    • Journal of Yeungnam Medical Science
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    • v.37 no.2
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    • pp.106-111
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    • 2020
  • Background: Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants. Methods: We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed. Results: In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701-0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360-0.550) and that for ANC was 0.453 (95% CI, 0.359-0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis. Conclusion: CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

  • Escandon, Joseph M.;Mohammad, Arbab;Mathews, Saumya;Bustos, Valeria P.;Santamaria, Eric;Ciudad, Pedro;Chen, Hung-Chi;Langstein, Howard N.;Manrique, Oscar J.
    • 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.