• 제목/요약/키워드: Segmental Method

검색결과 264건 처리시간 0.03초

기관 폐쇄 병변에서 시행된 기관 절제 및 재건술에 대한 결과 (Results of Segmental Resection and Reconstruction of the Trachea for Obstructive Tracheal Lesions)

  • 김명천;박주철;조규석;유세영;김범식
    • Journal of Chest Surgery
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    • 제31권8호
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    • pp.792-798
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    • 1998
  • 배경: 기관의 폐쇄 질환은 기관 삽관과 기관 절개술에 의한 협착, 기관 종양, 갑상선 종양, 기관내 결핵등 다양한 질환이 원인이 될 수 있는데 최근 이런 기관 질환에 대해 병변 부위를 완전히 절제한 후 단단 문합 술을 시행하여 좋은 결과를 얻고 있다. 대상 및 방법: 이에 저자들은 1985년에서 1996년까지 38명의 기관 폐쇄 병변에 대해 실시한 기관 절제 및 재건술의 성적과 결과를 분석하였다. 기관 절제 길이는 2 cm이하에서 6 cm까지 다양하였으며, 수술 방법은 경부 횡절개 22례, 경부 및 부분 흉골 정중절개 12명, 우측 흉부절개 를 4례에서 시행하였으며, 기관 병변 주위를 완전 절제한후 32명의 환자에서 기관 단단 문합술을, 6명의 환자에게 윤상연골 절제가 동반된 후두 기관 문합술을 시행하였다. 이중 3명에서 봉합부 장력을 감소시키기 위해 후두 분리가 필요하였다. 결과: 합병증으로 창상 감염 4례, 문합 부위 육아종 증식 2례, 성대 마비 1례, 폐렴 2례, 전신성 캔디디아시스 1례가 발생하여 그중 수술전 의식이 명료하지 않아서 수술후 T-tnbe 삽입이 필요하였던 2명 환자가 폐렴에 의해, 외상에 의해 전신성 캔디디아시스가 발생한 1례가 사망하였다. 결론: 이상의 성적으로 6 cm 까지의 기관 병변에서 기관 절제가 재건술로 좋은 결과를 얻을 수 있었으나 의식 상태나 전신상태가 나쁜 환자에서의 기관절제와 재건술은 수술후 합병증 및 사망률이 높으므로 보존적 치료가 좋을 것으로 사료된다.

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Functional outcome predictors following mandibular reconstruction with osteocutaneous fibula free flaps: correlating early postoperative videofluoroscopic swallow studies with long-term clinical results

  • Gonzalez, Santiago R.;Hobbs, Bradley;Vural, Emre;Moreno, Mauricio A.
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제41권
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    • pp.30.1-30.8
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    • 2019
  • Background: Advancements in the field of microvascular surgery and the widespread adoption of microvascular surgical techniques have made the use of osteocutaneous fibula free flaps the standard of care in the surgical management of segmental mandibular defects. Although the literature possesses abundant evidence to support the effectiveness of fibula free flaps as a reconstructive method, there are relatively few studies reporting on outcomes as objectively measured by videofluoroscopic swallowing studies (VFSS). The purpose of this study is to explore the potential correlation between early postoperative VFSS and the long-term swallowing outcomes in patients who underwent mandibular reconstruction with fibula free flaps. Methods: We performed a retrospective chart review of 36 patients who underwent mandibular reconstruction with osteocutaneous fibular free flaps between 2009 and 2012. Demographics, clinical variables, VFSS data, and diet information were retrieved. Penetration and aspiration findings on VFSS, long-term oral feeding ability, and the need for gastrostomy tube were statistical endpoints correlated with postoperative clinical outcomes. Results: Thirty-six patients were reviewed (15 females and 21 males) with a mean age of 54 years (7-81). Seventeen cases were treated for malignancy. The size of the bony defect ranged from 3 to 15 cm (mean = 9 cm). The cutaneous paddle, a surrogate for soft tissue defect, ranged from 10 to 125 ㎠ (mean = 52 ㎠). A gastrostomy tube was present in patients preoperatively (n = 8), and postoperatively (n = 14). Seventeen patients had neoadjuvant exposure to radiation. Postoperative VFSS showed penetration in 13 cases (36%) and aspiration in seven (19%). Overall, 29 patients (80.6%) achieved unrestricted diet, and this was statistically correlated with age (p = 0.037), radiation therapy (p = 0.002), and preoperative gastrostomy tube (p = 0.03). The presence of penetration or aspiration on VFSS was a strong predictor for long-term unrestricted oral diet (p < 0.001). Conclusion: Early postoperative VFSS is an excellent predictor for long-term swallowing outcomes in patients undergoing mandibular reconstruction with osteocutaneous fibula free flaps.

추나의학 용어 표준화 필요성 연구 (A Study for the Necessity of Terminology Standardization in Chuna Medicine)

  • 권정주;김민우;박경무;장건;조현철;남항우;신병철;임형호;송윤경
    • 척추신경추나의학회지
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    • 제7권1호
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    • pp.1-13
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    • 2012
  • Objectives: Although chuna medicine has progressed distinguishingly, yet chuna medical terminology hasn't been standardized. So there are a lot of difficulties in translating chuna related book and their meaning cannot be conveyed properly. For this reason, we could say standardization of chuna medical terminology is very essential. Purpose of our study was to develope a standard database of concept terms for chuna medicine, in addition, we considered establishing fundamental principles of chuna medical terminology. Methods: To select standard chuna medical terms, we sorted important chuna medical index words. Then we sorted those words into a group that has same meanings and united to one single term. In the meantime, we extracted index words from 26 domestic and foreign manual technique related books and sorted them out and based on these word, we translated chuna medical terms to Korean terms. In the case of chuna technique terms, we searched chuna text books for term those were wrongly used, and corrected them by suggesting fundamental principles of terminology. Results: 664 chuna words were selected as standard chuna terms and have been translated to English terms. In the process, adscititious words such as anatomical terms and title of books were exempted and selected only important words that could be used as index of chuna terms. In deciding essential elements of chuna technique terms, patient position, contact point, segmental contact point, malposition, procedure method were selected. Conclusions: Correcting chuna medical terms in a sort period could cause confusion, but in long term perspective, in the aspect of conveying the meaning clearly and education purpose, standardizing of chuna medical terminology must be done. From this study, standardization of chuna medical terms were chosen in large category, but further studies must be followed in order to standardize terms of subdivisional categories.

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늑간 신경 냉동요법에 의한 개흉술후 흉부 동통 관리 (Cryoanalgesia for the Post-thoracotomy Pain)

  • 김욱진;최영호;김형묵
    • Journal of Chest Surgery
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    • 제24권1호
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    • pp.54-63
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    • 1991
  • Post-thoracotomy pain is so severe that lead to postoperative complications, such as sputum retention, segmental or lobar atelectasis, pneumonia, hypoxia, respiratory failure due to the patient`s inability to cough, deep breathing and movement. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1974, Nelson and associates introduced the intercostal nerve block using the cryoprobe. The application of cold directly to the nerves causes localized destruction of the axons while preserving the endoneurium and connective tissue, thereby introducing a temporary pain block and able to complete regeneration of intercostal nerves. One hundred and two patients, who undergoing axillary or posterolateral thoracotomy at the Department of Thoracic and Cardiovascular Surgery in Korea University Medical Center between April 1990 and August 1990, were evaluated the effects of cryoanalgesia for the post-thoracotomy pain reduction. The patients were divided into two groups: Group A, control, the patients without the cryoanalgesia[No.=50], Group B, trial, the patients with cryoanalgesia[No.=52]. Before the thorax closed, in the group A, local anesthetics, 2% lidocaine 3cc, were injected to the intercostal nerves[one level with the thoracotomy, one cranial and caudal intercostal level and level of drainage tube insertion]. In the group B, cryoprobe was directly applied for 1 minute at the same level. Postoperative analgesic effects were evaluated by the scoring system which made arbitrary by author: The pain score 0 to 4, The limitation of motion score 0 to 3, The analgesics consumption score 0 to 3, The total score, the sum of above score, 0 to 10. For the evaluation of immediate analgesic effects, the score were evaluated at the operative day, the first postoperative day, the second postoperative day, and the seventh postoperative day. The effects of incision type, and rib cut to the post-thoracotomy pain were also evaluated. The results were as follows; 1. The intercostal block with cryoanalgesia reduced the immediate postoperative pain significantly compare with control group. 2. The intercostal block with cryoanalgesia improved the motion of the operation side significantly compare with control group. 3. The intercostal block with cryoanalgesia reduced the analgesics requirements at the immediate postoperative periods significantly. 4. The intercostal block with cryoanalgesia lowered the total score significantly compare with control group. 5. The intercostal block with cryoanalgesia were more effective to the mid-axillary incision than to the posterolateral incision 6. The intercostal block with cryoanalgesia were more effective to the patients without rib cut than to the patients with rib cut. 7. No specific complication need to be treated were not occurred during follow-up.

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신혈관성 고혈압의 진단에 있어서 캅토프릴 신스캔의 의의 (Captopril $^{99m}Tc-DTPA$ Renal Scintigraphy in Diagnosis of Renovascular Hypertension)

  • 양형인;이동수;김승철;배상균;최창운;정준기;김성권;이명철;이정상;고창순
    • 대한핵의학회지
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    • 제26권2호
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    • pp.312-317
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    • 1992
  • To evaluate the sensitivity and specificity of captopril renal scan for renovascular hypertension, we employed the captopril renal scan in conjunction with renal angiography in 81 patients, 159 kidneys, who were referred to evaluate the cause of hypertension. We defined the renovascular hypertension by the criteria of demonstration of renal artery stenosis by angiography, and improvement or cure of hypertension by revascularization. Visual and quantitative evaluation of $^{99m}Tc-DTPA$ renal scan was peformed pre and post captopril administration. The prevalence rate of renovascular hypertension was 40% in comparing with renal angiography, and 70% in confirmed cases. The causes of renovascular hypertension in 81 patients were Takayasu's arteritis, fibromuscular dysplasia, atherosclerosis, essential hypertension, chronic pyetonephritis etc. The sensitivity and specificity of captopril renal scan in comparing with renal angiography were 80%, 86.5%, respectively and also 84.2%, 72.6% in confirmed cases of renovascular hypertension, respectively. The causes of false negative cases were nonfunctioning kidney due to complete obstruction or long duration of disease in basal scan, segmental branch artery stenosis, unknown causes, and suspicious true negative cases without confirmation. The false positive cases were abdominal aortic stenosis or aneurysm, dehydration, unknown causes, and suspicious true positive cases. We conclude that captopril renal scintigraphy is highly sensitive, reasonably specific diagnostic method and comparable to other techniques very favorably.

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운율경계정보를 이용한 HMM기반 한국어 TTS 자연성 향상 연구 (Improvement of Naturalness for a HMM-based Korean TTS using the prosodic boundary information)

  • 임기정;이정철
    • 한국컴퓨터정보학회논문지
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    • 제17권9호
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    • pp.75-84
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    • 2012
  • HMM 기반 음성합성시스템은 성능향상을 위해 일반적으로 대용량 음성 DB로부터 생성된 문맥의존 tri-phone을 이용한다. 그리고 대용량 DB의 경량화를 위해서 문맥의존정보를 이용하여 결정트리 방식으로 발화특성이 유사한 문맥의존음소들을 군집화한다. 군집화에 사용하는 문맥의존정보는 음소열 뿐만 아니라 운율정보도 포함하는데 이는 합성음의 자연성이 끊어 읽기, 억양패턴, 음의 장단과 같은 운율에 의해 크게 좌우되기 때문이다. 그러나 복잡한 운율정보를 사용할 경우 훈련과정에 포함되지 않은 문맥의존음소는 하나의 대표값으로 평활화되며 이로 인해 합성음의 자연성이 크게 저하된다. 본 논문에서는 합성음의 자연성을 향상시키기 위해 복잡한 운율정보 대신 억양 변화를 상승, 평탄, 하강으로 구분함으로써 운율정보표현을 간소화시킨 운율경계정보를 포함하는 문맥의존정보에 대한 문맥질의, 그리고 해당 질의의 패턴을 정의하는 방법을 제안하였다. 본 논문에서 제안하는 세 가지 운율경계정보를 포함한 문맥의존정보를 이용하여 합성음을 생성하고 MOS평가를 수행한 결과 운율경계정보를 이용한 HMM기반 한국어 TTS 합성음의 자연성이 향상됨을 확인하였다.

보온 재료에 따른 구명 조끼 별 단열성능의 비교 실험 및 해석 (Comparative Studies of Thermal Insulation Performance of Life Vests by Numerical Analysis and Experiment)

  • 김성찬;이경훈;황세윤;장호상;이장현
    • 한국항해항만학회지
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    • 제40권1호
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    • pp.7-14
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    • 2016
  • 구명 조끼는 익수자의 부력을 유지시키는 기능을 가지며, 낮은 해수 온도에서 저체온증에 빠지는 시간을 단축 시킬 수 있는 역할을 할 수 있다. 본 논문은 서멀 마네킹 실험과 수치적 방법을 적용하여 단열성능을 향상 시키기 위해서 개발된 팽창형 구명 조끼와 폼형 구명 조끼의 단열성능 및 저체온증 방지 효과를 평가하였다. 단열성능 평가를 위해서 서멀마네킨을 이용하여 열유속 및 열저항을 계측하였으며, 본 연구에서 제시된 구명 조끼의 단열성능을 기존의 제품과 비교하여 검토하였다. 또한 저체온증에 빠지는 정도를 상대적으로 파악하기 위해서 유한요소해석을 이용하여 구명 조끼의 종류에 따른 체온 저감 시간을 예측하고 이를 비교 평가하였다. 저체온증 예측모델은 Pennes의 신체 열전달 해석 모델을 기반으로 작성되었으며, 실험으로부터 계측한 열저항 값을 이용하여 대류 열전달 조건을 환산하여 계산되었다. 그 결과 본 연구에서 단열성능을 향상시키기 위해서 제시된 하는 구명 조끼가 기존 제품에 비해 단열성능이 우수하게 평가됨을 확인하였다.

익수자 체온 저하에 미치는 팽창식 구명동의의 단열효과 수치 분석 (Thermal Insulation Effect of Inflatable Life Vest on the Drowned Individual estimated by Numerical Analysis)

  • 김성찬;이경훈;황세윤;이진성;이장현
    • 한국항해항만학회지
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    • 제39권4호
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    • pp.285-291
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    • 2015
  • 해상 사고에 의한 익수자는 저체온증에 의한 사망 위험에 노출되어 있다. 구명 동의 등을 착용함으로써 부력은 유지할 수 있으나 해수의 낮은 온도에 의한 신체의 열손실은 짧은 시간 내에 체온을 하강시키고 그에 따른 저체온증 사망이 우려된다. 전통적인 구명 동의는 고체형 부력체를 사용하여 부력을 향상 시키고 있으나, 구명 동의에 공기를 채움으로써 부력 및 체온 보존 효과를 얻을 수 있을 것으로 판단된다. 본 연구는 고체형 충진재를 이용한 기존의 비 팽창형 구명 동의와 공기를 채운 팽창형 구명 동의의 단열 성능을 비교하고, 각각의 방법이 체온 변화에 미치는 영향을 정성적으로 평가하고자 한다. 먼저 열저항 모델을 이용한 대략적인 단열 성능의 비교를 실시하고, 유한요소법을 이용하여 Pennes의 신체 열전달 해석을 수행하여 시간에 따른 체온 변화를 수치적으로 검토하였다.

Coordinative movement of articulators in bilabial stop /p/

  • Son, Minjung
    • 말소리와 음성과학
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    • 제10권4호
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    • pp.77-89
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    • 2018
  • Speech articulators are coordinated for the purpose of segmental constriction in terms of a task. In particular, vertical jaw movements repeatedly contribute to consonantal as well as vocalic constriction. The current study explores vertical jaw movements in conjunction with bilabial constriction in bilabial stop /p/ in the context /a/-to-/a/. Revisiting kinematic data of /p/ collected using the electromagenetic midsagittal articulometer (EMMA) method from seven (four female and three male) speakers of Seoul Korean, we examined maximum vertical jaw position, its relative timing with respect to the upper and lower lips, and lip aperture minima. The results of those dependent variables are recapitulated in terms of linguistic (different word boundaries) and paralinguistic (different speech rates) factors as follows. Firstly, maximum jaw height was lower in the across-word boundary condition (across-word < within-word), but it did not differ as a function of different speech rates (comfortable = fast). Secondly, more reduction in the lip aperture (LA) gesture occurred in fast rate, while word-boundary effects were absent. Thirdly, jaw raising was still in progress after the lips' positional extrema were achieved in the within-word condition, while the former was completed before the latter in the across-word condition. Lastly, relative temporal lags between the jaw and the lips (UL and LL) were more synchronous in fast rate, compared to comfortable rate. When these results are considered together, it is possible to posit that speakers are not tolerant of lenition to the extent that it is potentially realized as a labial approximant in either word-boundary condition while jaw height still manifested lower jaw position in the across-word boundary condition. Early termination of vertical jaw maxima before vertical lower lip maxima across-word condition may be partly responsible for the spatial reduction of jaw raising movements. This may come about as a consequence of an excessive number of factors (e.g., upper lip height (UH), lower lip height (LH), jaw angle (JA)) for the representation of a vector with two degrees of freedom (x, y) engaged in a gesture-based task (e.g., lip aperture (LA)). In the task-dynamic application toolkit, the jaw angle parameter can be assigned numerical values for greater weight in the across-word boundary condition, which in turn gives rise to lower jaw position. Speech rate-dependent spatial reduction in lip aperture may be able to be resolved by means of manipulating activation time of an active tract variable in the gestural score level.

72m 초고강도 콘크리트 프리스트레스트 박스 거더의 수치 해석 (Numerical Simulation of 72m-Long Ultra High Performance Concrete Pre-Stressed Box Girder)

  • 비엣 징 마이;한상묵
    • 한국전산구조공학회논문집
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    • 제35권2호
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    • pp.73-82
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    • 2022
  • 이 논문은 72m 초고강도 콘크리트 섬유보강 콘크리트 프리스트레스트 박스거더의 비선형 거동을 해석하는 3차원 해석방법을 제시하였다. UHPC재료의 비선형 거동을 나타내기 위해 콘크리트 손상소성(CDP)모델을 채택하였다. 제시된 응력-변형률 관계 곡선에 근거한 수치해석 모델은 50m UHPC 프리스트레스트 박스 거더 휨실험결과로 검증하였다. 검증된 해석모델을 사용하여 72m UHPC 프리스트레스트 박스거더의 휨거동을 파악하는데 적용하였다. 각 하중단계에 따른 하중 변위관계, 응력상태 및 연결부분 상세를 해석하였다. 하중-변위관계 곡선과 설계하중 및 극한하중 비교 결과는 UHPC 박스거더 휨거동을 해석하는 적절한 수단으로써 비선형 유한요소법의 적용성을 입증하고 있다.