• Journal of Chest Surgery
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• v.32 no.11
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• pp.1009-1016
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• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.7
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• pp.3159-3163
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• 2012

Background: For cervical cancer the epidemiological profile is poorly known in Morocco and no data is available concerning the direct medical costs. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco. Methods: The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance. Extrapolation of the results to the whole country was used to calculate the total annual cost of cervical cancer treatments in Morocco. Results: Overall approximately 1,978 new cases of cervical cancer occur each year in Morocco. The majority (82.96%) of these cases were diagnosed at a late stage (stageII or more). The cost of one case of cervical cancer depends on stage of diagnosis, the lowest cost is $382 for stageCis followed by the cost of stageIA1 for young women (< 40 years) which is $2,952. The highest cost is for stageIV, which is $7,827. The total cost of cervical cancer care for one year after diagnosis is estimated at $13,589,360. The share allocated to treatment is the most important part of the global care budget with an annual sum of $13,027,609 whereas other cost components are represented as follows: $435,694 for annual follow-up activity and $126,057 for diagnosis and preclinical staging. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco.

• Journal of Technology Innovation
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• v.5 no.2
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• pp.126-154
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• 1997

This paper addresses a methodology for monitoring the first phase('92-94') progress and its implication fo Highly Advanced National R&D Projects (HAN or G7 project) in Korea. The authors suggest a three-stage life cycle model for the management of national R&D program; planning stage, implementing & monitoring stage, and evaluating & harvesting stage. The interim evaluation, the main focuses of this paper, is one of the key issues for the effective management of national R&D program at the implementing & monitoring stage. The conceptual framework of the interim evaluation was developed both through reviewing related literature and considering the characteristics of the HAN program. A stepwise procedure of interim evaluation was introduced: 'initial screen' and 'detailed examination'. At initial screen all 11 projects were reviewed in terms of both their relevance and performance in order to decide whether further detailed scrutiny is needed or not. If there exist critical problems on the relevance or on the intermediate progress of each project, it is to be under further detailed examination. Evaluation was initiated by the G7 Planning and Evaluation Committee, which was established for advising, directing, and monitoring the HAN Projects, with the help of large number of experts from industries, universities, and research institutes. The monitoring results were reported to the related ministries and project coordinating agencies, and reflected in the second phase.

• Journal of Environmental Impact Assessment
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• v.15 no.6
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• pp.373-383
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• 2006

The spatial mapping of risk is very useful data in planning for disaster preparedness. This research presents a methodology for making the landslide life risk map in the Boeun area which had considerable landslide damage following heavy rain in August, 1998. We have developed a three-stage procedure in spatial data analysis not only to estimate the probability of the occurrence of the natural hazardous events but also to evaluate the uncertainty of the estimators of that probability. The three-stage procedure consists of: (i)construction of a hazard prediction map of "future" hazardous events; (ii) validation of prediction results and estimation of the probability of occurrence for each predicted hazard level; and (iii) generation of risk maps with the introduction of human life factors representing assumed or established vulnerability levels by combining the prediction map in the first stage and the estimated probabilities in the second stage with human life data. The significance of the landslide susceptibility map was evaluated by computing a prediction rate curve. It is used that the Bayesian prediction model and the case study results (the landslide susceptibility map and prediction rate curve) can be prepared for prevention of future landslide life risk map. Data from the Bayesian model-based landslide susceptibility map and prediction ratio curves were used together with human rife data to draft future landslide life risk maps. Results reveal that individual pixels had low risks, but the total risk death toll was estimated at 3.14 people. In particular, the dangerous areas involving an estimated 1/100 people were shown to have the highest risk among all research-target areas. Three people were killed in this area when landslides occurred in 1998. Thus, this risk map can deliver factual damage situation prediction to policy decision-makers, and subsequently can be used as useful data in preventing disasters. In particular, drafting of maps on landslide risk in various steps will enable one to forecast the occurrence of disasters.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.80-87
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• 2000

Acute high speed accidents that results in full thickness skin defect and exposure of tendon, nerve, vessel and periosteum over denuded bone demands soft tissue coverage. Exposed bone often ensues chronic infection and requires free flap transplantation which surely covers defects in one stage operation and enhances transport of oxygen-rich blood and converts a non-osteogenic or partially osteogenic site into a highly osteogenic site, but exposed bone which had performed free flap transplantation sometimes necroses and needs secondary bone procedure. Scar contracture limits joint motion should be excised and covered with normal soft tissue to restore normal range of motion. Authors have performed the large latissimus dorsi myocutaneous free flap in 8 cases of extensive soft tissue defect and exposed bone lesion in the leg and 1 case of the flap was failed. The secondary ilizarov bone procedure was performed in 3 of 8 cases. 2 cases of large burn scar contracture and 1 case of posttraumatic scar contracture in lower extremity were restored with the large latissimus dorsi myocutaneous free flap. Authors concluded that large latissimus dorsi myocutaneous free flap is the most acceptable microvascular procedure in large soft tissue defect combined with exposed periosteum and bone requiring secondary bone procedure and in large burn scar contracture limiting knee joint motion.

• The Journal of the Korean dental association
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• v.17 no.12 s.127
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• pp.919-922
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• 1979

Corticotomy is one of the orthognathic surgery for facilitating orthodontic treatment. The indications of the procedure, its planning consideration, surgical methods and the experiences gained in the use of corticotomy completed in the stage operation are presented.

• Communications for Statistical Applications and Methods
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• v.7 no.1
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• pp.297-312
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• 2000

A three stage sampling procedure designed to estimate the difference betweentwo normal means is proposed and evaluated within a unified decision-theoretic framework. Both point and fixed-width confidence interval estimation are combined in a single decision rule to make full use of the available data. Adjustments to previous solutions focusing on only one of the latter objectives are indicated. The sensitivity of the confidence interval for detecting shifts in true mean difference is also investigated Numerical and simulation studies are presented to supplement the theoretical results.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.593-597
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• 2018

Sternal malunion, or loss, developed after a median sternotomy cannot only be difficult to manage and treat, but also may diminish one's quality-of-life drastically. The technique presented here represents a multispecialty approach in one stage for the reconstruction of an unstable thoracic cage. The procedure utilized a donated sternum and ribs. The sternum with ribs harvested from a single donor included adipose derived stromal vascular fraction (ADSVF) cells with marrow also from the same donor. Autologous muscle flaps, stabilized with acellular dermal matrix were utilized to provide a robust blood supply to the ADSVF cells and bone grafts. Acellular dermal matrix was used to construct the ribs and stabilize the plugs of stem cells and bone. These procedures, in the hands of multispecialty physicians, have led to several successful reconstructions involving complex chest wall deformities. This surgical intervention was performed in a one stage operation. This represents the first successful complete sternal transplant in a patient with return to normal activities and increased quality-of-life.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.620-624
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• 1984

The optimal surgical management of the coarctation of the aorta associated with ventricular septal defect is still debated. Sixteen patients with the coarctation of the aorta and VSD were operated upon between November, 1980 and September 1984 at Seoul National University Hospital. They were 11 males and 5 females. All presented between 5 months and 11.5 years of age [mean= 5.5 years]. Presenting symptoms were congestive heart failure in 11 [69%], cyanosis on crying in 3 [19%], and frequent upper respiratory infection in 2 [13%]. In all cases two-stage operation was applied except one in which one stage procedure was taken. Resection and end-to-end anastomosis was used in 3, Dacron graft in 5, Gortex graft in 1, and left subclavian flap angioplasty in 4. Remaining two were missed on the operating table before correction of the coarctation of the aorta. Overall operative death in repair of the coarctation of the aorta were 3[20%]. Among the 12 survivors after repair of the coarctation of the aorta, 4 required patch closure of VSD, 2 required primary closure, 2 showed spontaneous closure [17%], one [8%] showed decrease in its size, 3 were under observation. It might be safe to approach the coarctation of aorta plus VSD with initial repair of the coarctation of the aorta without banding of main pulmonary artery and later management of VSD as usual manner in simple VSD.

• Journal of Veterinary Clinics
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• v.26 no.3
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• pp.286-289
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• 2009

Perineal laceration commonly occurs due to dilation of the birth canal at the time of foaling in primiparous mares. A 7-year-old Thoroughbred mare was presented with faecal contamination of the external genitalia. She was having history of constant straining three days after the mare's first foaling. Physical examination revealed the tearing extended from the deep part of vagina through muscles of the perineal body involved rectal floor and anal sphincter. Tentative diagnosed was third-degree perineal laceration therefore one-stage surgical procedure and a modified surgical procedure at three-week intervals was performed. During postoperative care for 3 weeks, soft faces was a key factor in success. After 3 weeks, the patient was recovered to normal condition completely.