• Journal of Chest Surgery
• /
• v.25 no.12
• /
• pp.1508-1515
• /
• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• Archives of Reconstructive Microsurgery
• /
• v.18 no.2
• /
• pp.79-83
• /
• 2009

Purpose: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. Methods: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. Results: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. Conclusion: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.

• Archives of Reconstructive Microsurgery
• /
• v.22 no.1
• /
• pp.33-37
• /
• 2013

Purpose: The concept and development of perforator free flaps have led to significant advances in microsurgery. Ongoing developments in perforator free flap surgery are aimed at reducing complications and improving surgical outcomes. The aim of this study was to evaluate the effectiveness and application of supermicrosurgery in free flap surgery. Materials and Methods: A total of 267 patients with soft tissue defects of the lower extremity due to various etiologies from January, 2007 to January, 2013. The patients received either an anterolateral thigh free flap (n=83), a superficial circumflex iliac artery free flap (n=152), an upper medial thigh free flap (n=19), or a superior gluteal artery perforator free flap (n=13). Microanastomosis was performed using a perforator-to-perforator technique, either end-to-end or end-to-side. Results: The mean postoperative follow up period was eight months (range: one to 16 months) and flap loss occurred in 11 cases out of 267. All cases of flap loss occurred within two weeks of surgery due to either arterial insufficiency (n=5) or venous congestion (n=6). Conclusion: Supermicrosurgery enables the selection of the most efficient perforator for microanastomosis at the defect site. It also reduces the time required for dissection of recipient vessels, and reduces the possibility of injury to major vessels. Microsurgery using a vessel of less than 1 mm has been reported to increase the risk of flap failure; however, using the most advanced surgical tools and developing experience in the technique can produce success rates similar to those found in the literature.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.25 no.1
• /
• pp.8-18
• /
• 2011

To have effective treatment for shoulder arm pain, we searched the cause, symptom, etiology, classification of the pain areas, acupuncture points, and muscles along the meridians, and acquired the following results. Shoulder-pain is mainly divided into the malfunction of viscera and entrails, damage due to the weakness of essence and qi, abnormal status of muscle function, change of joints, disease in the nerve and vessel, and the internal injury due to seven modes of emotions. Pain of shoulder joints are pain in the local area of shoulder joints, referred pain of shoulder, neck, and shoulder-arm, numbnes and swelling of muscle, and muslce weakness. Shoulder-arm pain is classified as four types of pain: shoulder-joint pain, shoulder-back pain, shoulder-chest pain, and shoulder-arm-elbow pain. And shoulder-arm-elbow pain is again divided into the shoulder-blade pain, shoulder-arm pain, shoulder-elbow pain. The related meridians on shoulder pain are the three yin meridians of hand, Kidney Meridian, Conception Meridian, three yang meridians of hand, Bladder Meridian, Governor Meridian Acupuncture points for shoulder pain are in the acupuncture points of the 10 meridians and a-shi points. Thre related meridian muscles on shoulder-pain are the three yin and yang meridians of hand, and their related muscles are the ones that are connected with the front, back, and chest side muscles of shoulder joints, and the ones that are connected with the front and back side muscles of arm.

• Archives of Reconstructive Microsurgery
• /
• v.7 no.1
• /
• pp.68-72
• /
• 1998

With the advent of microvascular free-tissue transfer, this single stage resurfacing method for large scar and soft tissue defects around the wrist in the patients of electrical burn has distinctive advantage over the conventional multistage pedicle-flap transfer. Between 1992 and 1996, we treated 9 cases of 8 patients who had large scar around the wrist due to old electrical burn with free flaps as a preparation of staged tendon graft. Mean age was 30.3 years and average scar area was $6{\times}11cm$. The length of time the injury and free flaps was 9 months on an average. Prior to the free flap, we performed the angiography to all patients in order to evaluate the circulation of the forearm and hand and to choose the recipient vessel. In all cases, proximal ulnar arteries in the forearm remained intact and all radial arteries remained intact in 8 of 9 cases on angiogram. The interosseous arteries were well visualized in all cases. We used the ulnar arteries as a recipient artery. The types of flaps used were f scapular cutaneous flaps, 2 dorsalis pedis flaps and a radial forearm flap. Flap survial was 100 percents with satisfactory functional and cosmetic results. Free flaps using ulnar artery as a recipient artery is one of the useful reconstruction methods for the resurfacing of large scar around the wrist in the patients of old electrical burn.

• Food Science and Industry
• /
• v.50 no.2
• /
• pp.12-26
• /
• 2017

Processing steps such as washing and cutting, involved in preparing fresh-cut produce causes tissue damage, leading to rapid quality deterioration. Major defects of fresh-cut produce are discoloration, softening, off-odor development, and microbial growth. Packaging of fresh-cut produce has been changed to reduce these quality problems. Flexible packaging film is widely used to pack fresh-cut produce. Vacuum packaging was the popular packaging method in the beginning of fresh-cut industry in Korea. Vacuum packaging creates high $CO_2$ and low $O_2$ levels to control browning of fresh-cut produce. However, these conditions induce some visual defects and off-odor development. Discoloration problem was also found when fresh-cut produce was packaged with conventional packaging film or plastic tray. Modified atmosphere (MA) packaging is effective for prolonging shelf-life of fresh-cut produce by decreasing $O_2$ and increasing $CO_2$ concentration in the package. Retail MA packaging using different oxygen transmission rate (OTR) film and micro-perforated film has started to be applied to fresh-cut produce in Korea. Proper MA package design that provides optimum range of $O_2$ and $CO_2$ partial pressures is one of the major challenges in the industry. An initial package flushing with $N_2$ or an low $O_2$/high $CO_2$ atmosphere is also used to more rapidly establish steady-state MA condition. Film OTR and $O_2$ flushing affects the fermentative volatile production, off-odor development, electrolyte leakage, discoloration, $CO_2$ injury, microbial population of fresh-cut produce. There is also a demand for convenient packaging to attract consumers. Rigid fresh-cut produce container for retail market has increased since the packaging provides excellent protection from physical damage during transport. Rigid tray used as actual serving vessel for the consumer is increasing in Korea. The tray with flexible lid to wrap or seal fresh-cut produce is more and more gaining popularity. Further practical technology to control quality change and microbial growth for each fresh-cut product has been studied since various fresh-cut items were required. The fresh-cut industry also focuses on searching for more convenient and environmentally friendly packaging.

• Journal of the Society of Naval Architects of Korea
• /
• v.59 no.6
• /
• pp.385-392
• /
• 2022

Naval ship could face a variety of threats in isolated seas. In particular, fires and flooding are defined as disasters that are very likely to cause irreparable damage to ships. These disasters have a very high risk of personal injury as well. Therefore, when a disaster occurs, it must be quickly suppressed, but if there are people in the disaster area, the protection of life must be given priority. In order to quickly evacuate the ship crew in case of a disaster, we would like to propose a plan to quickly explore the evacuation route even in urgent situations. Using commercial escape simulation software, we obtain the data for deep neural network learning with simulations according to aisle characteristics and the properties and number of evacuation person. Using the obtained data, the passage prediction model is trained with a deep learning, and the passage time is predicted through the learned model. Construct a numerical map of a naval ship and construct a distance matrix of the vessel using predicted passage time data. The distance matrix configured in one of the path search algorithms, the Dijkstra algorithm, is applied to explore the evacuation path of naval ship.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.34
• /
• pp.77-108
• /
• 2007

The traditional name given to the insurance of third party liabilities and certain contractual liabilities which arise in connection with the operation of ships is protection and indemnity(P & I) insurance. P & I insurance is very different from traditional hull and machinery insurance in that shipowners' hull and machinery insurance is designed primarily to protect the assured against losses to his vessel, whereas P & I insurance seeks to indemnify an shipowner in respect of the discharge of legal liabilities he has incurred in operating his own vessels. This study is to examine the background of establishment of British P & I clubs md, therefore, the identity of P & I insurance. The present British P & I clubs are the remote descendants of the many small and local hull mutual insurance clubs that were formed by British shipowners in the end of 18th century. At that time, British shipowners were dissatified with the state of marine insurance market and, therefore, established clubs together in mutual hull insurance clubs. After the removal of the company monopoly in 1824, greater competition had a good effect on the rates, terms of cover and service offered by the commercial marine insurance market and by Lloyd's underwriters, and the hull clubs became less necessary and went into decline. The burden of British shipowners on liabilities to third parties was steadily increased after the middle of the 19th century, but the amount insured under hull policy was limited in the insured value of the ship. Eventually, the first protection club, that is, the Shipowners' Mutual Protection Society was formed in 1855. It was designed to like past mutual hull clubs, but to cover liabilities for loss of life and personal injury and also the collision risks excluded from the current marine policies, particularly the excess above the limits in hull policies. In 1870, the risks of liability for loss of or damage to cargo carried on board the insured ship was first awarded by the British shipowners. After 1874, many protection clubs formed indemnity club to cover the risk of liability for loss or damage to cargo. As mentioned above, British P & I clubs have been steadily changed according to the response of shipowners under the rapidly changing law of British shipowners' liability, and so on in the future.

• Journal of Trauma and Injury
• /
• v.26 no.3
• /
• pp.183-189
• /
• 2013

Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients. Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV's anterior-posterior (AP) vessel wall on the longitudinal scan's midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV's internal center on screen's midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 $cmH_2O$, $5{\leq}$ middle CVP ${\leq}10\;cmH_2O$, and high CVP>10 $cmH_2O$) and compared their mean anterior posterior (AP) diameters and optimal angles. Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups($0.68{\pm}0.30$, $1.06{\pm}0.31$, and $1.23{\pm}0.49$ cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups' mean optimal angles ($28.1{\pm}6.1$, $30.1{\pm}4.5$, and $28.0{\pm}5.0$ degree respectively). Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV's diameter is altered in proportion to the CVP.

• Korean Journal of Clinical Laboratory Science
• /
• v.41 no.3
• /
• pp.111-122
• /
• 2009

Cadmium (Cd) is known to exert gonadotoxic and spermiotoxic effects. The present study was performed to investigate the morphological effects and metallothionein (MT) expression by zinc pretreatment in the course of time of cadmium-induced testicular injury in rat. Fifty male Spraque-Dawley rats weighing 160~180 g were divided into two groups : saline-pretreated cadmium group and zinc-pretreated cadmium group. Rats of two groups received subcutaneous injection of saline and 100 mg/kg $ZnSO_4$ at 0, 2, 5 and 8 hrs intervals respectively. Cadmium chloride (4.5 mg/kg $CdCl_2$) was administrated intraperitoneally at 2 hrs after zinc injection and rats were killed 0, 12, 24, 48 and 72 hrs later. Testicular tissue damages, interstitial (Leydig) cells status and MT expression were determined using hematoxylin-eosin stained sections and a computerized image analysis system on sections immunostained with a mouse anti-metallothionein respectively. Zinc pretreatment was significantly reduced testicular damages in five pathological categories after cadmium administation. The number of surviving interstitial cells was significantly higher in the zinc-pretreated group than in the saline-preatreated group at 48 and 72 hrs after cadmium administration. Non-damaged testis showed the positivity of MT staining in spermatogenic cells, Sertoli cells and endothelium of blood vessel, but not in the Leydig cells. The positivity of MT staining in saline-pretreated group was significantly reduced at 24 hrs after cadmium administration, whereas zinc-pretreated group showed strong MT positive staining similar to the 0 hr by 42 hrs after cadmium administration. In damaged testis, MT positive staining was also observed in the Leydig cells of both groups. These results suggest that a major preventive effect of zinc against cadmium-induced testicular toxicity may be due to its ability to reduce the cytotoxicity of cadmium in spermatogenic cells and Leydig cells by inhibiting the susceptibility of the testis to cadmium but not MT production by cadmium.