• Archives of Plastic Surgery
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• v.51 no.6
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• pp.549-555
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• 2024

Most tracheostomy scars are depressive and adherent to the underlying trachea, which causes up and down movement when swallowing. This tracheocutaneous tethering causes discomfort, pain, dysphagia, and bad appearance. A tracheocutaneous fistula may be accompanied. Here, we present a new method for reconstructing a tracheostomy scar deformity with tracheocutaneous tethering: layer-by-layer restoration of the anatomical structure with a subcutaneous fat tissue blanket. The scar tissue was fully excised, with the associated skin and subcutaneous tissue. The bilateral strap muscles around the scar were dissected proximally and distally and approximated to the midline, secured without tension. Bilateral platysma muscle flaps cover them firmly. The subcutaneous tissue around the incision margin, which included the superficial cervical fascia was elevated to form a fat blanket, closed transversely. The skin was closed after confirming the absence of retraction upon swallowing. From 2010 to 2018, 10 patients with tracheocutaneous tethering and one patient with tracheocutaneous fistula underwent surgery. All patients were functionally and aesthetically satisfied with the results. The only complication was a hypertrophic scar in one patient, which was managed with a triamcinolone injection. An anatomical layer-by-layer restoration with a fat blanket provided consistent, satisfying results for correcting tracheostomy scar deformities without using additional tissue. This simple method was effective for reconstructing tracheocutaneous tethering.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.635-641
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• 2010

Background: Radiofrequency endovenous ablation of incompetent saphenous vein has gaining popularity over the conventional ligation and stripping as a minimally invasive technique. The latest version of radiofrequency endovenous catheter, $VNUS^{\circledR}Colosure$ fast VNUS medical Technologies, San Jose, CA, adopted a segmental ablation system, instead of continous pullback, is designed to reduce treatment time in comparison with the previous model $VNUS^{\circledR}Colosure$ plus VNUS medical Technologies, San Jose, CA. The purpose of this study is to compare the difference between two endovenous radiofrequency ablation systems in terms of treatment efficacy and complication rates. We analyze the initial efficacy and complication rates of $VNUS^{\circledR}Colosure$ fast with $VNUS^{\circledR}Colosure$ plus. Material and Method: Between June 2006 and August 2009, $VNUS^{\circledR}Colosure$ plus was performed to treat varicose vein on 59 limbs in 41. patients and $VNUS^{\circledR}Colosure$ fast was performed on 76 limbs in 67 patients. We retrospectively compared in both group with sex, mean treatment time, mean treatment diameter, conjugated treatment, and complications after the procedure. Result: All patient were symptomatic and diagnosed as varicose vein and underwent level 2 clinical classification with color duplex scan. The mean treatment time for the great saphenous vein was significantly less with $VNUS^{\circledR}Colosure$ fast ($17.0{\pm}6.5min$) than $VNUS^{\circledR}Colosure$ plus ($62.7{\pm}9.8min$). There was no significant difference in 1 yr closure rate between groups (p=0.32). Minor complications such as skin burn, thrombophlebitis, ecchymosis, hematoma, cellulitis, tenderness, and there were not different between the groups. Conclusion: Both $VNUS^{\circledR}Colosure$ fast and $VNUS^{\circledR}Colosure$ plus are effective methods of endovenous saphenous ablation. $VNUS^{\circledR}Colosure$ fast is superior to the previous model with less treatment time preserving compatible efficacy and complications. The efficacy of $VNUS^{\circledR}Colosure$ fast for long term closure rate remains to be established.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.434-440
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• 2009

Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.227-232
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• 2010

Purpose: Continuous irrigation method is an important step in managing wound infection. V.A.C. devices have been used in intractable wounds for reducing discharge, improving local blood flow, and promoting healthy granulation tissue. We expect synergistic effects of reduced infection and more satisfactory, accelerated wound healing when using both methods simultaneously. This study evaluated continuous irrigation combined with V.A.C. appliance for treatment of infected chronic wounds. Methods: We reviewed data from 17 patients with infected intractable chronic wounds. V.A.C. device (Group A) was used in 9 patients, and V.A.C. with antibiotics irrigation (Group B) was used in 8 patients. We placed Mepitel$^{(R)}$ on the surface of wound and placed an irrigation and aspiration tube on each side. A sponge was placed on the Mepitel$^{(R)}$ and covered with film dressing. The wound was irrigated continuously with mixed antibiotics solution at the speed of 200 cc/hr and aspirated through the wall suction at the pressure of -125 mmHg. V.A.C. applied time, wound culture and wound size were compared between the two groups. Results: No complication were seen in two groups. Compared with Group A, in the Group B, V.A.C. applied time was shortened from 32.7 days to 25.6 days and showed efficacy in the reduction rate of wound size. No statistical differences were shown in bacterial reversion. Conclusion: V.A.C. appliance with continuous irrigation is an effective new method of managing infected chronic wounds and useful to reduce treatment duration and decrease wound size. Moreover it could be applied more widely to infected wound.

• Journal of Korean Theatre Studies Association
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• no.52
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• pp.359-397
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• 2014

This paper describes dramatherapy with a bulmina nervosa patient. She was in her early 20s and has been under the various psychotherapies for cure of deep depression since 2005. We had 24 sessions and 3 persons - the patient, the therapist, and the assist-therapist- participated in dramatherapy. I found there's a big collision between her important roles in the course of initial interview and diagnosis. Those roles are 'a good daughter of mom' and 'an independent adult'. Therefore I defined her bulmina nervosa as 'an symbolic behavior repeats compulsively the failure of separation from her mother.' And I set the general goals, the separation from her mother, the awareness and expression of negative emotions, and the diminuation of overeating and vomiting. To attain these object, we had many different dramatic experiences in dramatherapy. We made a self-portrait, the mask of bulmina nervosa, family sculpture, figure work, the past I and the present I, psychodramatic scene and several stories. In order to objective assessment, I used behavioral observation and 6PSM(6 Pieces Story Making) analysis. First of all the most noticeable change was a rapid decrease in over-eating and vomiting. Before the dramatherapy she had overeaten 30 times per week. At the closure it has fallen off to 1 time per week. Another behavioral changes were shift of outward appearance, not going church, working for living, and having a date with only one. She made 3 stories on 1th session, 13th session, and 23th session. And I comparatively analysed those stories with both qualitative and quantitative method. For qualitative analysis, I classified 5 structures according to the substantial similrarity. On protagonist structure, there's no difference. Three protagonists are dead things. The type of task structure is changed from an escape, a traveling, to metamorphosis. The type of obstruction structure is changed from the protagonist to an outside object. The type of closure structure is changed from an exaggerated happy ending, sad ending to probable happy ending. To quantitify the aspects of transformation, I developed an assesment tool using likert scale. It is composed of 4 sub-categories-reality testing, imagination, ego-strength, optimism problem-solving. In reality testing category, a shift of score was 9-11-15, imagination 2-5-5, ego strength 3-2-2, optimism 6-3-7, and total score 20-21-29. This change of score reflects the growth of problem solving capacity. Viewed in this light, dramatherapy with this girl was successful on the whole. The thing had significant effect on it was psycho-dynamic approach focused on separation from her mother and defence mechanism to avoid negative emotion. And assessment method used in this case will be full of suggestions to researches to come.

• Journal of the Society of Naval Architects of Korea
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• v.45 no.1
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• pp.29-41
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• 2008

The present paper provides a CFD analysis of diffraction problem for a ship with forward speed using an unsteady RANS simulation method, a WAVIS code. The WAVIS viscous solver adopting a finite volume method has second order accuracy in time and field discretizaions for the RANS equations. A two phase level-set method and a realizable ${\kappa}-{\varepsilon}$ turbulence model are adopted to compute the free surface and to meet the turbulence closure, respectively. To validate the capability of the present numerical methods for the simulation of an unsteady progressive regular wave, computations are performed for three grid sets with refinement ratio of ${\sqrt{2}}$. The main simulation is performed for a DTMB5512 model with a forward speed in a regular head sea condition. Validation of the present numerical method is carried out by comparing the present CFD results with available unsteady experimental data published in the 2005 Tokyo CFD Workshop: resistance, heave force, pitch moment, unsteady free surface elevations and velocity fields.

• Journal of the Society of Naval Architects of Korea
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• v.48 no.2
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• pp.147-157
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• 2011

A RANS(Reynolds averaged Navier-Stokes) based numerical method is developed for the evaluation of ship resistance and self-propulsion performances. In the usability aspect of CFD for the hull form design, the field grid around practical hull forms is generated by solving a grid Poisson equation based on the hull surface grid generated from station offsets and centerline profile. A body force technique is introduced to model the effects of the propeller in which the propeller loads are obtained from potential flow analysis using an unsteady lifting surface method. The free surface is captured by using a two-phase level-set method and the realizable $k-{\varepsilon}$ model is used for turbulence closure. The hull attitude in vertical plane, i.e., trim and sinkage, is calculated by using a quasi-steady method and then considered in the computation by translating and rotating the grid system according to the values. For the validation of the proposed method, the numerical results of resistance tests for KCS, KLNG, and KVLCC1 and of self-propulsion test for KCS are compared with experimental data.

• Journal of Korean Society of Steel Construction
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• v.20 no.1
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• pp.121-129
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• 2008

study proposes a new key-segment closing method using thermal effect as a substitute to the process of set-back and reset-back for the FCM construction of a partially earth-anchored cable-stayed bridge. The proposed method is to artificially heat up the inside of girders located in the main span before closing the key-segment in a cantilever state. Then, the heat is removed after finishing the closure in a continuous bridge state. Using the changes in boundary conditions and structural systems, the proposed method can generate new member forces that reflect the advantage of the partially earth-anchored cable system. From the construction sequence analysis, it is found that the proposed method increases the efficiency of a partially earth-anchored cable-stayed bridge by reducing the compressive axial forces on the girders.

• International Journal of Naval Architecture and Ocean Engineering
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• v.11 no.2
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• pp.883-898
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• 2019

This paper employs computational tools to predict power increase (or speed loss) and propulsion performances in waves of KVLCC2. Two-phase unsteady Reynolds averaged Navier-Stokes equations have been solved using finite volume method; and a realizable k-ε model has been applied for the turbulent closure. The free-surface is obtained by solving a VOF equation. Sliding mesh method is applied to simulate the flow around an operating propeller. Towing and self-propulsion computations in calm water are carried out to obtain the towing force, propeller rotating speed, thrust and torque at the self-propulsion point. Towing computations in waves are performed to obtain the added resistance. The regular short head waves of λ/LPP = 0.6 with 4 wave steepness of H/λ = 0.007, 0.017, 0.023 and 0.033 are taken into account. Four methods to predict speed-power relationship in waves are discussed; Taylor expansion, direct powering, load variation, resistance and thrust identity methods. In the load variation method, the revised ITTC-78 method based on the 'thrust identity' is utilized to predict propulsive performances in full scale. The propulsion performances in waves including propeller rotating speed, thrust, torque, thrust deduction and wake fraction, propeller advance coefficient, hull, propeller open water, relative rotative and propulsive efficiencies, and delivered power are investigated.

• Journal of Welding and Joining
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• v.13 no.2
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• pp.96-105
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• 1995

A modified method for the analysis of short fatigue crack growth has been presented, and calculations based upon the modified method are compared with experimental results for S45C carbon steel. It is also shown that the modified method is in good agreement with experimental data. The proposed equation for the fatigue crack growth rates includes a material constant which relates the threshold level to the endurance limit, a correction for elastic-plastic behaviour and a means for dealing with the effects of crack closure. In this study one of the modifications is to substitute the Forman' s elastic expression of the stress intensity factor range into the geometrical factor The other is a consideration of the bending effect which is developed from the moment caused by the eccentric cross sectional geometry as the crack grows. Thus, this method is useful for residual life prediction of the mechanical structures as well as the welding structures.