• 한국항해학회지
• /
• 제17권2호
• /
• pp.29-56
• /
• 1993

The International Convention for the Prevention of Pollution from Ship, 1973, as modified by the Proto-col of 1978 relating thereto, well known as MARPOL 73/78, is probably the most important international agreement on the subject of marine pollution. The main purpose of the Convention is to reduce the total oil remaining on board vessel to minimum. MARPOL is a combination of different sets of rules on oil, chemicals, noxious substances in package forms, sewage and garbage as shown on each Annex. Since the Convention has globally set forth in 1973, it has amended so often whenever reasonable articles are requi-red by contracting states under guidelines of IMO. The amendments, for instance, have continuously perfo-rmed more than 8 times regarding articles, protocols, and five annexes because the original text was badly drafted as the control measures were expressed in general way. This paper, therefore, is intend to summa-rize a main point relating to each amendment, so that persons who have an interest in the Convention would be completely understand for practical implementation. Especially, for legislative purpose or annen-dement of domestic law, it could timely be contributable if specific consolidation and unified interpretations are followed with this paper. Consequently it is much more worth to study for preventing marine pollution from ship with tracing every moment whenever the Convention formally adopted through amending up-to-data.

• Parasites, Hosts and Diseases
• /
• 제43권3호
• /
• pp.93-100
• /
• 2005

The present study was performed to investigate the infection status with helminth in a group of feral cats in Korea. More than 29 helminth species including adults or eggs were detected in visceral and fecal samples of the examined cats. Among these were a host of nematodes, including toxocarids, Ancylostoma sp. and the larva of Anisakis simplex; trematodes, including Clonorchis sinensis, Paragonimus westermani, Eurytrema pancreaticum, Pharyngostomum cordatum, Metagonimus spp., Heterophyes nocens, Pygidiopsis summa, Heterophyopsis continua, Stictodora fuscata, Stictodora lari, Acanthotrema felis, Stellantchasmus falcatus, Centrocestus armatus, Procerovum varium, Cryptocotyle sp., Echinostoma revolutum, Echinostoma hortense, Echinochasmus japonicus, Stephanoprora sp., Plagiorchis muris, Neodiplostomum sp. and diplostomulum. We also detected a variety of cestodes, including Spirometra erinacei, Taenia taeniaeformis and unidentified species of tapeworm. We also found examples of the acanthocephalan, Bolbosoma sp. In our assessment of the stools, we detected at least 12 species of helminth eggs. These findings confirmed that feral cats in Korea are infected with a variety of helminth parasite species. Furthermore, among the helminths detected, E. pancreaticum, S. fuscata, S. lari, A. felis, S. falcatus, C. armatus, P. varium, Cryptocotyle sp., E. revolutum, E. japonicus, Stephanoprora sp., P. muris, Neodiplostomum sp. and Bolbosoma sp. represent helminth fauna which have not been reported previously in feral cats in the Republic of Korea.

• Archives of Plastic Surgery
• /
• 제48권5호
• /
• pp.543-546
• /
• 2021

Despite the extensive use of lithotomy position in several plastic surgery procedures, most reports regarding the related incidence of complications are presented in the urologic, gynecologic, and anesthesiologic fields. We present the case of a 54-year-old male patient. polytrauma patient who underwent internal iliac artery embolization leading to extensive gluteal necrosis requiring: debridement, abdominoperineal resection and composite anterolateral thigh flap reconstruction with prolonged lithotomy position. The patient presented lower limb ischemia briefly after surgical theater. A computed tomography scan revealed the obstruction of the left superficial femoral artery requiring emergency revascularization. Arterial thrombosis is a potentially devastating complication and plastic surgeons should be aware of the possible dangers when performing surgeries in prolonged lithotomy position. Preoperative detection of patients at high risks for developing complications should be performed in order to implement preventive measures and avoid potentially life-threatening sequelae.

• Archives of Plastic Surgery
• /
• 제46권4호
• /
• pp.291-302
• /
• 2019

Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

• Archives of Plastic Surgery
• /
• 제49권3호
• /
• pp.453-456
• /
• 2022

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name "sombrero" as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design "sombrero" modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

• Archives of Plastic Surgery
• /
• 제49권3호
• /
• pp.448-452
• /
• 2022

Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced. We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.

• Archives of Plastic Surgery
• /
• 제46권6호
• /
• pp.589-593
• /
• 2019

Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues.

• 대한치과보철학회지
• /
• 제37권1호
• /
• pp.71-92
• /
• 1999

This study is to analyze the stress and displacement on the jaws during the bilateral and unilateral clenching task on three dimensional finite element model of the dentated skull. For this study, the computed tomography(G.E.8800 Quick, USA) was used to scan the total length of human skull in the frontal plane at 1.9mm intervals. The CAD data were extracted from the tomograms through digitizer(Summa Sketch III, USA) and then reconstructed by means of the spline method in the CAD program. In this project, a commercial software I-DEAS(Master Series ver-sion 3.0, SDRC Inc, USA) was used for three-dimensional stress analysis on the finite element model. which consists of articular disc, maxilla, mandible, teeth, periodontal ligament and cranium. The results are as follows. ; 1. During the bilateral clenching, each major muscle forces caused high stresses on various areas of skull: masseter muscle on articular disc and teeth ; temporal muscle on mandible and periodontal ligament ; medial pterygoid muscle on the temporomandibular joint. During the unilateral clenching, masseter muscle induced the maximum stress ; medial pterygoid muscle the minimum stress. 2. During the bilateral clenching, higher compressive stresses on articular disc were generated by the masseter muscle and higher deformation occurred on the most front outer sites. And during the unilateral clenching, temporal muscle and medial pterygoid muscle exerted their forces to twist temporomandibular joint area of the balancing side and induced a higher compressive stresses on the front outer sites of articular disc. 3. During the bilateral clenching, the masseter muscle bended the mandible outwardly, and then caused tensile stresses on the lingual surface of mandibular symphysis. And the medial pterygoid muscle caused tensile stresses on the labial surface of mandibular symphysis. 4. When each muscles were simultaneously applied on jaws, a high stress and displacement took place on mandible rather than on the maxilla. Also, a high stress and displacement took place during the unilateral clenching rather than during the bilateral clenching.

• Restorative Dentistry and Endodontics
• /
• 제22권2호
• /
• pp.648-658
• /
• 1997

The purpose of this study was to compare the effects of various techniques on the quality and quantity of instrumentation in curved canals. Instrumentation time was evaluated too. Forty eight canals of resin blocks($35^{\circ}$) were divided into three groups and filed. In group A, 16 blocks were instrumented using a step-back technique with stainless steel(SS) K-file(Mani, Matsutani Seisakusho Co.,Japan). In group B, canals were prepared with SS K-files using the Endo-Angle (Nakanishi Dental MFG.CO.,LTD.,Japan). Group C was prepared using N i-Ti engine-driven instruments (Quantec Series $2000^{TM}$ system). Group A and B were filed from # 5 to # 25 at the apex followed by a 1 mm stepback technique, and the coronal half of the canals were flared with Gates Glidden burs(#2,3,4). Group C was instrumented from # 1 to # 8. After the instrumentation time was measured, canals were filled with India ink, and photographed, which to magnify the canal images 8 times. Using these photographs the apical portions were evaluated And scored from 1 to 4 according to the severity of ledging and zipping. On the same photographs, the area of the coronal two thirds of the canals were measured using a personal computer with the computer program Brain and Digitizer (SummaSketch III). The following results were obtained. 1. Instrumentation time was significantly shorter for group C, as opposed to group A and B(ANOVA, P<0.05). 2. The qualitative evaluation of the apical portions of the canals showed no significant difference between the groups(Kruscal-Wallis, p>0.05). 3. The area removed by group C was significantly smaller than group A and B(ANOVA, P<0.05).

• Archives of Plastic Surgery
• /
• 제48권2호
• /
• pp.224-230
• /
• 2021

Background Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation. Methods Thirteen consecutive patients with a median age of 55 years (range, 21-70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed. Results All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10-51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5℃ and 25% at 25℃). Conclusions Finer sensation could be partially restored. However, thermal sensation remained poor.