• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.19.1-19.7
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• 2015

Background: The purpose of this retrospective study was to investigate the usefulness of tracheostomy scoring system in the decision of postoperative airway management in oral cancer patients. Materials and methods: A total of 104 patients were reviewed in this retrospective study, who underwent radical resection with or without neck dissection and free flap reconstruction due to oral cancer. The patients were classified into three groups according to the timing of the extubation; extubated groups (n = 51), overnight intubation group (n = 45), and tracheostomy group (n = 8). Cameron's score was used to evaluate the relation between the state of the patient's airway and the type of the operation. Results: Tracheostomy was performed in eight patients (8/104, 7.7 %). A total of 22 patients (21.2 %) had more than 5 points of which 17 patients (77.3 %) did not have a tracheostomy and any postoperative emergency airway problems. The tracheostomy scores were significantly different among the three groups. Hospital stay showed a significant correlation with the tracheostomy score. Conclusions: The scoring system did not quite agree with the airway management of the authors' clinic; however, it can be one of the clinical factors predicting the degree of the postoperative airway obstruction and surgical aggressiveness for recovery. The further studies are needed for clinically more reliable scoring systems.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.288-294
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• 2015

Background Surgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps. Methods Among 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy. Results The mean defect size was $436.2cm^2$. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02). Conclusions Three types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

• Journal of Chest Surgery
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• 제44권3호
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• pp.197-207
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• 2011

Background: In cardiac surgery, especially in the reconstruction of vascular structures and intracardiac defects, glutaraldehyde has usually been used as the reagent for fixing porcine or bovine pericardial tissues. But the well-known problem of calcification or cytotoxicity of glutaraldehyde motivates the search for a replacement. The aim of this study is to investigate the physical, mechanical, and biochemical characteristics of bovine pericardial tissues fixed with genipin, which is known to be a less toxic and more natural fixing reagent. Materials and Methods: Bovine pericardial tissues were fixed with different concentrations and conditions of glutaraldehyde and genipin. To determine the physical, mechanical, and biochemical differences among different concentrations and conditions, we divided the tissue into 18 groups by concentration, the addition of organic solvents, and the timing of adding the organic solvents, and compared the characteristics of each group. Results: Tensile strength, physical activity, and thermal stability tests revealed that the tissues fixed with glutaraldehyde were better with regard to mechanical strength and biochemical durability. However, the difference was not significant statistically. Conclusion: Genipin can be used as an alternative crosslinking agent for pericardial tissue, considering given its physical, mechanical, biochemical characteristics and low cytotoxicity comparable to glutaraldehyde. However, further studies are needed on the immune reaction and the long term changes in genipin-fixed tissues in the human body.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권6호
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• pp.257-262
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• 2013

Objectives: Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. Materials and Methods: An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. Results: Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. Conclusion: Patients who undergo tibial grafts must be careful of excessive external force after the operation.

• 대한구순구개열학회지
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• 제8권2호
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• pp.87-94
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• 2005

Patients with unilateral cleft lip and palate (UCLP) generally demonstrate the asymmetries in the lip, nose and the naso-maxillary complex. And their skeletal asymmetries are known to be derived from the displacement of nasal septum, anterior nasal spine (ANS) and the pre-maxilla toward the non-affected side during the developmental and growth period. Due to the interruption of the important facial muscles, which are critical for the symmetric growth of premaxilla, functional matrix system fails to develop and results in the displacement of the ANS toward the non-affected side and nasal asymmetry. Therefore the rhinoplasty for CLP patients is required to have inter-skeletal and muscular rearrangement in the naso-maxillary complex in order to let them recover from esthetic and physiologic imbalances. And functional cheilorhinoplasty (FCR) has been a representative treatment of choice for this concept of treatment modality. The outcome and prognosis of primary or repair FCR have been known to be definitely affected by timing of the operation as well as adequate reconstruction of naso-labial muscles. However, sometimes FCR has an ineffective treatment results for patients after the facial growth period, and the limited rhinoplasty around the nose often fails to bring satisfying results. In order to circumvent this limitation, we performed ANS osteotomy for patients with unilateral CLP showing asymmetric nose, as an alternative way for corrective rhinoplasty. We could observe that the nose was rearranged along the facial mid-line by this osteotomy design and asymmetries were evidently improved postoperatively. Here we present this osteotomy method in CLP patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.13.1-13.8
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• 2017

Background: Oronasal/antral communication, loss of teeth and/or tooth-supporting bone, and facial contour deformity may occur as a consequence of maxillectomy for cancer. As a result, speaking, chewing, swallowing, and appearance are variably affected. The restoration is focused on rebuilding the oronasal wall, using either flaps (local or free) for primary closure, either prosthetic obturator. Postoperative radiotherapy surely postpones every dental procedure aimed to set fixed devices, often makes it difficult and risky, even unfeasible. Regular prosthesis, tooth-bearing obturator, and endosseous implants (in native and/or transplanted bone) are used in order to complete dental rehabilitation. Zygomatic implantology (ZI) is a valid, usually delayed, multi-staged procedure, either after having primarily closed the oronasal/antral communication or after left it untreated or amended with obturator. The present paper is an early report of a relatively new, one-stage approach for rehabilitation of patients after tumour resection, with palatal repair with loco-regional flaps and zygomatic implant insertion: supposed advantages are concentration of surgical procedures, reduced time of rehabilitation, and lowered patient discomfort. Cases presentation: We report three patients who underwent alveolo-maxillary resection for cancer and had the resulting oroantral communication directly closed with loco-regional flaps. Simultaneous zygomatic implant insertion was added, in view of granting the optimal dental rehabilitation. Conclusions: All surgical procedures were successful in terms of oroantral separation and implant survival. One patient had the fixed dental restoration just after 3 months, and the others had to receive postoperative radiotherapy; thus, rehabilitation timing was longer, as expected. We think this approach could improve the outcome in selected patients.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.140-143
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• 2008

Degloving injuries result from the tangential force against the skin surface, with resultant separation of the skin and the subcutaneous tissue from the rigid underlying muscle and fascia. These injuries are associated with extensive soft tissue loss and occasionally with exposure of bone, and they require reconstructive modality for resurfacing and successful rehabilitation that considers the vascular anatomy and the timing of the operation. A 19-year-old male patient was transferred to our facility with degloving injury extending from the lower third of the right thigh to the malleolar area. The tibial bone was exposed to a size of $2{\times}3.5cm^2$ on the upper third of the lower leg at the posttraumatic third day. The exposed soft tissue was healthy, and the patient did not have any other associated disease. At the posttraumatic sixth day, one-stage resurfacing was performed with a medial gastrocnemius muscle flap transposition for the denuded bone and a split-thickness skin graft for the entire raw surface. The transposed gastrocnemius muscle attained its anatomical shape quickly, and the operating time was relatively short. No transfusion was needed. This early reconstruction prevented the accumulation of chronic granulation tissue, which leads to contracture of the wound and joint. The early correction of the gastrocnemius muscle flap transposition made early rehabilitation possible, and the patient recovered a nearly full range of motion at the injured knee joint. The leg contour was almost symmetric at one month postoperatively.

• 대한전자공학회논문지SP
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• 제42권2호
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• pp.27-36
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• 2005

년 논문에서는 MPEG과 JPEG, H.26X 계열 등의 DCT-기반 영상/비디오 컨텐츠에 효과적인 암호화 방법을 제안하였고, 이를 최적화된 하드웨어로 구현하여 고속동작이 가능하도록 하였다. 영상/비디오의 압축, 복원 및 암호화로 인한 많은 연산량을 고려하여 영상의 중요한 정보(DC 및 DPCM계수)만을 암호화 대상 데이터로 선정하여 부분 암호화를 수행하였다. 그 결과 암호화에 소요되는 비용은 원 영상 전체를 암호화하는 비용이 감소하였다. 여기서 Nf는 GOP내의 프레임수이고 PI는 B와 P 프레임에 존재하는 인트라 매크로블록의 수이다. 암호화 알고리즘으로는 다중모드 AES, DES, 그리고 SEED를 선택적으로 사용할 수 있도록 하였다. 제안한 암호화 방법은 C++로 구현한 소프트웨어와 TM-5를 사용하여 약 1,000개의 영상을 대상으로 실험하였다 그 결과 부분 암호화된 영상으로부터 원 영상을 추측할 수 없어 암호화 효과가 충분함을 확인하였으며, 이 때 암호화에 의한 압축률 감소율은 $1.6\%$에 불과하였다. Verilog-HDL로 구현한 하드웨어 암호화 시스템은 하이닉스 $0.25{\mu}m$ CMOS 팬텀-셀 라이브러리를 사용하여 SynopsysTM의 디자인 컴파일러로 합성함으로써 게이트-수준 회로를 구하였다. 타이밍 시뮬레이션은 CadenceTM의 Verilog-XL을 이용해서 수행한 결과 100MHz 이상의 동자 주파수에서 안정적으로 동작함을 확인하였다. 따라서 제안된 암호화 방법 및 구현된 하드웨어는 현재 중요한 문제로 대두되고 있는 종단간(end-to-end) 보안에 대한 좋은 해결책으로 유용하게 사용될 수 있으리라 기대된다.

• Journal of Chest Surgery
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• 제35권11호
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• pp.792-798
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• 2002

활동성 심내막염의 외과적 치료시기에 대해서는 아직 논란의 여지가 있지만 최근에는 조기 수술에 대한 좋은 보고들이 있다. 이에 저자들은 활동성 심내막염에 대한 수술 결과를 수술 전 항생제 사용기간에 따라 분석해 보았다. 대상 및 방법 : 1995년 3월부터 2001년 10월까지 활동성 심내막염으로 삼성서울병원 흉부외과에서 수술 받은 환자 51명에 대해서 후향적으로 분석을 하였다 남녀 성비는 39 : 12였고, 평균 연령은 44.5$\pm$17.8세(범위 13~74세)였다. 감염된 판막은 승모판막이 17례(33.3%), 대동맥판막이 15례(29.4%), 승모판막 및 대동맥 판막이 12례(23.5%), 삼첨판막이 5례(9.8%)였다. 그 중 인공판막 심내막염이 10례(19.6%)였다. 감염 균주는 포도상구균이 19례(37.3%), 연쇄상구균이 17례(33.3%), 장내구균이 3례(5.9%), 진균이 3례(5.9%), 기타균이 5례(9.8%), 균주가 동정되지 않은 경우가 6례(11.8%)였으며, 4례(7.8%)에서는 2가지 균주가 동정되었다. 이 환자들을 수술 전 항생제 사용기간에 따라 2군으로(A : 7일 이하, B : 8일 이상) 나누어 두 군간의 수술 성적을 비교하였다. 결과 : A군은 16명이었으며 B군은 35명이었다. 판막륜 재건을 A군에서는 10례(62.5%), B군에서 10례(28.6%)로 통계적으로 유의한 차이가 있었다(p ＜ 0.05). 수술 후 조기 사망은 B에서 1례 있었다. 2명을 제외한 49명(96.1%)의 환자에서 추적관찰이 이루어졌으며, 평균 추적관찰 기간은 28.7 $\pm$ 23.6개월로 재발은 A군에서 1례, B군에서 2례 있었다. 만기 사망은 B군에서 3례에서 있었다. 재발률과 생존율 모두 두 군에서 통계적으로 유의한 차이가 없었다. 결론 : 활동성 심내막염에서 조기 수술하는 경우도 수술 전항생제를 충분히 사용한 경우와 비슷한 좋은 결과를 보여 활동성 심내막염의 조기 외과적 치료가 효과적으로 감염을 제거할 수 있다고 사료된다.

• 한국발생생물학회지:발생과생식
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• 제3권1호
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• pp.75-85
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• 1999

생쥐 초기 배아의 형태형성에 영향을 주는 세포질내 인자의 기원과 작용기작을 연구하기 위해 단백질 합성과 단백질 활성화 효소 (protein kinase)의 억제제를 처리한 배아의 세포질로 재조합된 배아에서 발생과 RNA합성, 단백질 인산화를 조사하였다. 단백질 합성 억제제인 cycloheximide (CHX)가 함유된 배양액에서 24시간 배양한 1-세포 배아의 제핵된 세포질을 두 개의 전핵을 모두 가진 절반의 1-세포 배아와 재조합한 P+P-CHX군의 배아 발생과 유전자의 활성화는 P+P군의 배아와 유사하였으나, 밀집 형성과 밀집형성이 일어나는 세포 시기는 빨라져서 P+2군과 유사하였다. 또한 초기 배아의 발생 시 1-세포기에서 2-세포기 사이에 일어나는 단백질 인산화가 형태형성과정에 미치는 영향을 알아보기 위해, tyrosine protein kinase와 serine-threonine protein kinase의 억제제인 genistein (Gen)과 6-dimethylaminopurine (6-DMAP)이 처리된 배아의 제핵된 세포질과 2개의 전핵을 가진 절반의 1-세포 배아를 융합시킨 P+2-Gen과 P+2-DMAP군 배아의 발생과 밀집현상을 대조군인 P+P와 P+2군과 비교하였다. P+2-Gen과 P+2-DMAP군 배아에 발생은 대조군에 비해 빨랐으며, 특히 P+2-Gen군 배아는 밀집이 4-세포기에 일어나 8-세포기에 일어나는 P+2-DMAP군의 배아에 비해 일어나는 시간과 세포 시기가 빨라졌다. SDS-PAGE 방법으로 분석한 재조합 3시간째 P+2-Gen과 P+2-DMAP군의 단백질 인산화량은 대조군인 P+P와 P+2군에 비해 증가하였으나 종류의 변화는 없었다. 한편 2차원 전기영동법을 이용하여 P+2-DMAP군의 배아에서 P+2-Gen에 비해 80KD와 110KD 단백질의 인산화가 억제된다는 결과를 얻었다. 이상의 결과들은 생쥐의 초기 배아에서 형태 형성의 조절은 유전자 활성화 또는 난자내 모계 mRNA에 의해 수정 후 합성되는 새로운 단백질에 의한 것이 아니고, 난자내에 존재하는 인자에 의해 조절됨을 시사한다. 이 인자들 중 단백질의 인산화는 배아 발생과 형태형성에 밀접한 관계가 있으며, 특히 초기 1∼2세포기 사이에 serine-threonine protein kinase에 의해 인산화되는 단백질이 밀집현상을 조절하는 데 중요한 역할을 하는 것으로 사료된다.