• Archives of Plastic Surgery
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• 제34권3호
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• pp.358-364
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• 2007

Purpose: A life-threatening hemorrhage resulting from a severe facial fracture is rare, but it needs a prompt and aggressive treatment. Especially, a massive oronasal bleeding combined with midfacial fracture which may result from the rupture of the internal maxillary artery. With the recent advances in the radiologic intervention, its use has increased for managing these life threatening case. We reviewed its usefulness with our experiences and literatures. Methods: A retrospective review was performed to determine the usefulness of the transcatheter arterial embolization in patients with panfacial trauma. If the vital signs were unstable, cardiopulmonary resuscitation was performed. Oronasal bleeding was controlled with nasal packing and electrocautery. All injured regions were studied by radiologic study including CT. Even after primary management, if the oronasal bleeding was persistent, radiologic intervention was performed 10 patients were treated with transcatheter arterial embolization and the bleeding focus controlled by embolization with polyvinyl alcohol and gelfoam. Results: After the intervention, the vital signs became stable and there were no complications from embolization in the follow-up for 6 months. Also patients could recover through appropriate operations. Conclusion: Transcatheter arterial embolization for maxillofacial injury has many advantages for both, the doctor and the patient. First, less pain is induced than a compression device or an operation, which is another way to treat oronasal bleeding. Second, it does not need general anesthesia. And through a single procedure not only we can know the accurate bleeding point, but we can also bleeding by embolization.

• Journal of Welding and Joining
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• 제20권6호
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• pp.30-30
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• 2002

It has been reported that the creep characteristics on weldment which is composed of weld metal(W.M), fusion line(F.L), heat-affected zone(HAZ), and base meta(B.M) could be unpredictably changed in severe service conditions such as high temperature and high pressure. However, the studies done on creep damage in power plant components have been mostly conducted on B.M and not the creep properties of the localized microstructures in weldment have been thoroughly investigated yet. In this paper, it is investigated the creep characteristics for three microstructures like coarse-grain HAZ(CGHAZ), W.M, and B.M in X20CrMoV121 steel weldment by the small punch-creep-(SP-Creep) test using miniaturized specimen(l0×10×0.5mm). The W.M microstructure possesses the higher creep resistance and shows lower creep strain rate than the B.M and CGHAZ. In the lower creep load the highest creep strain rate is exhibited in CGHAZ, whereas in the higher creep load the B.M represents the high creep strain rate. The power law correlation for all microstructures exists between creep rate and creep load at 600℃. The values of creep load index (n) based on creep strain rate for B.M, CGHAZ, and W.M are 7.54, 4.23, and 5.06, respectively and CGHAZ which shows coarse grains owing to high welding heat has the lowest creep loade index. In all creep loads, the creep life for W.M shows the highest value.

• Journal of Welding and Joining
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• 제20권6호
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• pp.754-761
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• 2002

It has been reported that the creep characteristics on weldment which is composed of weld metal(W.M), fusion line(F.L), heat-affected zone(HAZ), and base meta(B.M) could be unpredictably changed in severe service conditions such as high temperature and high pressure. However, the studies done on creep damage in power plant components have been mostly conducted on B.M and not the creep properties of the localized microstructures in weldment have been thoroughly investigated yet. In this paper, it is investigated the creep characteristics for three microstructures like coarse-grain HAZ(CGHAZ), W.M, and B.M in X20CrMoV121 steel weldment by the small punch-creep-(SP-Creep) test using miniaturized specimen($10{\times}10{\times}0.5mm$). The W.M microstructure possesses the higher creep resistance and shows lower creep strain rate than the B.M and CGHAZ. In the lower creep load the highest creep strain rate is exhibited in CGHAZ, whereas in the higher creep load the B.M represents the high creep strain rate. The power law correlation for all microstructures exists between creep rate and creep load at $600^{\circ}C$. The values of creep load index (n) based on creep strain rate for B.M, CGHAZ, and W.M are 7.54, 4.23, and 5.06, respectively and CGHAZ which shows coarse grains owing to high welding heat has the lowest creep loade index. In all creep loads, the creep life for W.M shows the highest value.

• 대한구순구개열학회지
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• 제11권2호
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• pp.49-58
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• 2008

The development of fetal surgery has led to promising options for many congenital malformations, such as congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma. However, preterm labor (PTL) and premature rupture of membranes continue to be uniquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access techniques were developed and are increasingly employed recently. Lift-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Fetal surgery for repair of cleft lip and palate, a congenital anomaly which is not life threatening, is inappropriate until such time that the benefits are shown to outweigh the risks of both the procedure itself and preterm delivery. Further animal studies will be needed before intrauterine surgery for humans should be considered. For the better understanding of recent techniques and complications associated with fetal intervention of congenital facial defect patients, we reviewed recent related articles about the current knowledge and new perspectives of experimental fetal fetal surgery in the cleft lip and palate defects.

• 대한기계학회논문집A
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• 제26권10호
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• pp.2122-2129
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• 2002

Creep damage using a reference stress(RS) was analyzed for type 316LN stainless steel. The generalized K-R equation was reconstructed into the RS equation using a critical stress value $\sigma$. The RS equation was derived from the critical stress in failure time $t_f$ instead of material damage parameter $\omega$, which indicates the critical condition of collapse or approach to gross instability of materials during creep. For obtaining the reference stress, a series of creep tests and tensile tests were conducted with at 55$0^{\circ}C$ and $600^{\circ}C$. The stress-time data obtained from creep tests were applied to the RS equations to characterize the creep damage of type 316LN stainless steel. The value of creep constant r with stress levels was about 18 at 55$0^{\circ}C$ and 21 at $600^{\circ}C$. This value was almost similar with r = 24 in the K-R equation, which was obtained by using damage parameter $\omega$. Relationship plots of creep failure strain and life fraction $(t_f /t_r)$ were also obtained with different λ values. The RS equation was therefore more convenient than the generalized K-R equation, because the measuring process to quantify the damage parameter $\omega$ such as voids or micro cracks in crept materials was omitted. The RS method can be easily used by designers and plant operator as a creep design tool.

• Journal of Chest Surgery
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• 제52권2호
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• pp.70-77
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• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

• 한국산학기술학회논문지
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• 제16권7호
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• pp.4651-4655
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• 2015

둔상에 의한 쇄골하 동맥 가성동맥류의 발생은 드물며, 관통상 이후에 이차적으로 발생하는 경우가 있다. 대게 쇄골하 동맥은 주변의 인대, 근막뿐만 아니라 쇄골, 첫 번째 갈비뼈, 심부 경부 조직들에 의해 보호받고 있어 둔상으로 의한 합병증으로 쇄골하 동맥의 손상이 발생하는 경우는 드물다. 쇄골하 동맥의 손상은 외상 초기에 나타나며, 동맥 파열은 생명을 위협할 수 있는 출혈, 가성동맥류 형성, 상완신경총 압박 등을 유발할 수 있다. 쇄골하 동맥 손상은 쇄골골절, 총상, 관통상이나 중심정맥삽관 같은 술기의 합병증으로 발생하는 것이 대부분이다. 쇄골 주변의 큰 혈종이나 맥박이 느껴지는 종괴가 있다면 심각한 혈관 손상 가능성이 높아지므로 이러한 소견이 있는지 이학적 검사를 통해 확인해야만 한다. 1993년에 외상성 혈관손상의 치료에 있어 혈관 내 스텐트 삽입 시술이 처음 발표된 이후 혈관내 스텐트 삽입 시술을 통해 외상성 혈관 손상을 치료하는 사례가 점차적으로 많아지고 있다. 이 연구는 교통사고 10일 후에 발생한 쇄골하 동맥 가성동맥류 환자에서 혈관내 스텐트 삽입을 통한 성공적 치료와 관련된 임상양상과 추정되는 병태생리에 대해 보고한 사례연구이다.

• Journal of Chest Surgery
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• 제5권1호
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• pp.45-56
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• 1972

Esophageal perforation is one of the most grave prognostic problems among thoracic and general surgical emergencies which necessitate urgent operative measures. In Korea,there are still many persons ingesting lye for suicidal attempt and thoracic surgeons in Korea have more chances to deal with lye burned esophagus with or without instrumental perforation than those in Western countries. Main cause of esophageal perforation in Korea is instrumental perforation in patients with lye stricture of the esophagus during diagnostic endoscopy or therapeutic bouginage. Other causes are corrosion of the esophagus due to ingestion of caustic agents, pathologic perforation, surgical trauma, stab wound and spontaneous rupture of the esophagus in our series. Therapeutic measures are various,and depend on duration of perforation, severity of its complications, pathology of perforated portion of the esophagus and degrees of inflammation at the point of perforation. The most important therapeutic measures are prevention of this grave condition during esophagoscopy, bouginage and surgical procedures on lungs and mediastinal structures and to make early diagnosis with prompt therapeutic measures. During the period of January, 1959, to December, 1971, the authors experienced 65 cases ofesophageal perforation including acquired esophagorespiratory fistula at Dept. of Chest Surgery, the National Medical Center in Seoul, and obtained following results in the series. 1. Female were 35 cases, and peak age incidence was 2nd and 3rd decades of life. 2. Among 65 cases, 43 were corrosive esophagitis or benign stricture of the esophagus due to caustic agents, 7 were patients with esophageal cancer. and there were 5 cases of esophageal perforation developed after pneumonectomy or pleuropneumonectomy. 3. Causes of perforation are instrumental perforation in 45, acute corrosion in 7, pathologic perforation in 7, surgical trauma in 3, stab wound in 2 cases, and one spontaneous rupture of the esophagus. 4. Most frequent sites of esophageal perforation were upper and mid thoracic esophagus, and 8 were cases with cervical esophageal perforation. 5. Complications of esophageal perforation were mediastinitis in 42, empyema or pneumothorax in 35, esophagorespiratory fistula in 12, retroperitoneal fistula or abscess in 5,pneumoperitoneum in 3, and localized peritonitis in 1 case. 6. Cases with malignant esophagorespiratory fistula were only 3 in the series which is predominant cause of acquired esophagorespiratory fistula in Western countries. 7. Various therapeutic measures were applied with mortality rate of 27.7% in the series. 8. In usual cases early treatment gave better prognosis, and least mortality rate in cases with perforation in mid thoracic esophagus. 9. Main causes of death were respiratory complications,acute hemorrhage with asphyxia, and septic complications. 10. Esophageal perforation developed after pneumonectomy gave more difficult therapeutic problems which were solved in only 1 among 5 cases.

• 한국안전학회지
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• 제22권3호
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• pp.98-104
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• 2007

산업사회의 발전과 더불어 인간의 삶에 대한 욕구도 날로 급변하고 있으며, 주 40시간제가 도입되면서 피크닉을 즐기는 세대가 늘어나고 있는 실정이다. 또한 가스에 의한 사고는 토요일과 일요일에 가장 많이 발생하고 있다. 따라서 가스안전교육원에서는 이러한 가스의 폭발사고에 대한 영향이 매우 위험하다는 것을 교육생에게 알려 현장에서 가스안전관리에 만전을 기하도록 하고자 폭발실험을 실시하고 있다. 본 논문에서는 이러한 폭발실험으로 교육에 참관하는 교육생에게 미치는 영향을 알아보고자 폭발로 인한 과압은 Hopkinson의 삼승근법을 이용하여 계산하고, 인간에게 미치는 영향은 Probit 모델에 적용하여 사고피해예측을 평가하였다. 폭발위치에서 50m 떨어진 곳에서의 피크과압은 1.35kPa이고, 25m 떨어진 곳에서는 3.2kPa이다. 이 값은 Probit 모델에 적용하면 손상가능성이 0%로 나타났다.