• Journal of Chest Surgery
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• v.31 no.11
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• pp.1063-1069
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• 1998

Background: Multi-loculated empyema makes treatment difficult, and more so when thoracentesis or chest tube drainage fails. Materials and methods: From December 1991 to December 1997, we performed closed rib resectional drainage for 18 cases of loculated empyema on the fibrinopurulent or early chronic phase. Results: Surgery was performed on patients with loculated empyema complaining of persistent symptoms due to failure of treatment by thoracentesis(8 cases) or chest tube drainage(10 cases). Predisposing factors of empyema were pneumonia in 13 cases, clotted hemothorax in 3 cases, cholecystectomy, and tuberculous pleurisy in 1 case. Causal organisms were cultured in 8 cases(42.1%), and methicillin-resistant staphylococcus aureus was found in 3 cases, pseudomonas aeruginosa in 2 cases, and enterococcus aerogens, α-hemolytic streptococcus, and acinetobacter baumannii were found in 1 case. Size of loculations was various, and computed chest tomogram showed multiple loculations of empyema numbering 1∼4(mean 1.78±1.00). Operating time was relatively short, about 55∼140 mins(mean 102.8±30.8). All toxic symptoms including fever disappeared postopratively and general conditions improved very quickly in all patients. Length of chest tube indwelling time and hospital stay after surgery were 3∼42 days(mean 11.4±11.5) and 6∼36 days(mean 12.9±8.1), respectively. Complications of prolonged drainage occurred in 2 cases and no death occurred. There were no recurrences and chest x-rays taken 3∼6 months after surgery showed normal findings in 14 cases and slight pleural thickening in 4 cases. Conclusions: Closed rib resectional drainage requires very simple techniques and has excellent outcomes and little complications, therefore, we think that it is the choice of operation for patients with loculated empyema on the fibrinopurulent or early chronic phase.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.739-744
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• 1999

Background: This study was designed to evaluate the effectiveness of T3 sympathicotomy in treatment of palmar hyperhidrosis. Material and Method: During the period of June to December 1998, 50 patients (24 females and 26 males) suffering from palmar hyperhidrosis either in isolation (n=37) or in combination with axillary hyperhidrosis (n=13) were operated. The mean age of the patients was 20 years. The bilateral sympathetic trunks were severed on the 3rd rib (2nd and 3rd ganglia) for the isolated palmar hyperhidrosis and on the 3rd and 4th ribs for the combined type using electrocoagulation scissors. A linear analogue scale was used to assess the degree of sweating on the palms, face, trunk, and feet (ranged 0 to 10:0 = anhidrosis: 10 = excessive sweating) as well as the patient's satisfaction with the surgery (ranged 0 to 10:0 = regret; 10 = completely satisfied). Result: All of the patients were relieved from palmar hyperhidrosis. A mean palmar sweat production score after T3 sympathicotomy was $1.5\pm$0.8. Some degree of compensatory sweating had occurred in 39 patients (78%) with a mean score of 3.4$\pm$1.6. Gustatory sweating occurred in 2 patients (4%). The mean score of the patient's satisfaction after the surgery was 8.5$\pm$1.2. Conclusion: Palmar hyperhidrosis can be successfully relieved by the T3 sympathicotomy. When considering the advantages of T3 sympathicotomy with respects to a better preservation of facial sympathetic function, less occurrence of severe compensatory sweating, and lower incidence of gustatory sweating. We recommend T3 sympathicotomy as a treatment of choice for palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.226-232
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• 2009

Background: Blunt chest trauma accounts for 90% of all chest traumas in Europe and the United States and this causes 20% of all trauma-related deaths. The major cause of morbidity and mortality after blunt chest trauma is undetected injuries. For this reason, chest computerized tomography has gained popularity for the evaluation of trauma, but it is expensive and it exposes patients to radiation. This study identified the clinical features associated with the diagnosic information obtained on a CT chest scan, as compared with a standard chest X-ray, for patients who sustained blunt trauma to the chest. This study also evaluated the role of a routine computed tomographic (CT) scan for these patients. The patients who had chest computed tomography done after the initial chest x-ray were analyzed separately for the presence of occult injuries. Material and Method: We studied 100 consecutive patients from November 2006 to July 2007: 74 patients after motor vehicle crashes and 26 patients after a fall from a height >2m. Simultaneous with the initial clinical evaluation, an anteroposterior chest radiograph and a helical chest CT scan were obtained for all the patients. The data extracted from the medical record included the vital signs, the interventions and the type and severity of injury (RTS). Result: Among the 100 cases, 79 patients showed at least more than one pathologic sign on their chest radiograph, and 21 patients had a normal chest radiograph. For 17 of the patients who had a normal chest X ray, the CT scan showed multiple injuries, which were pneumothorax, hemothorax, lung contusion, sternal fracture etc. This represents that a CT scan is statistically superior to a chest radiograph to diagnose the pathologic signs. But on the other hand, as for treatment, only 31 patients were diagnosed by CT scan and they were treated with chest tube insertion ect. 42 patients needed ony conservative management without invasive thoracosurgical treatment such as chest tube insertion or open thoracotomy. 27 patients were treated based on the diagnosis made by the chest radiograph and physical examination. Conclusion: Chest computerized tomography was significantly more effective than routine chest X-ray for detecting lung contusion, pneumothorax and mediastinal hematoma, as well as fractured ribs, scapula and, sternum. Although the occult findings increased, the number of patients who needed treatment was small. Therefore, we suggest making selective use of a CT scan to avoid its overuse in ERs.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.765-769
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• 2007

Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

• Asian-Australasian Journal of Animal Sciences
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• v.17 no.6
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• pp.848-856
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• 2004

Black Bengal goat is primarily reared for meat, skin comes here as a by-product. The present trial describes the effect of age on different carcass characteristics of Black Bengal goats of either sex. A total of 61 Black Bengal goats of different age and sex groups were slaughtered. They were reared under semi-intensive management on milk alone or with concentrates (of 10.14 MJ ME and 10.48 g M/kg DM) and freshly cut Napier grass (2 MJ ME and 25 g CP/kg of fresh matter) that provides the estimated NRC (1981) requirement. The four age groups were: pre-weaned kids (0-90 day), post-weaned kids (91-180 days), growing (181-365 days) and adult (>365 days). Goats were slaughtered according to 'Halal' method by severing the major vessels of the throat by a transverse cut. Different slaughter parameters of Black Bengal goat can be best predicted from the equations as follows: live weight (kg)=0.801 (shoulder height (cm))-24.32, ($r^{2}$=0.94); carcass weight (kg)=0.364 (height at hind legs (cm))-11.54, ($r^{2}$=0.91); edible weight (kg)=0.623 (shoulder height (cm))-19.94, ($r^{2}$=0.91) and saleable weight (kg)=0.701 (shoulder height (cm))-21.99, ($r^{2}$=0.92). Live weight, carcass weight, edible weight and saleable weight of castrated goat at one-year onward ranges from 20-22, 9.4-10.5, 14-16 and 16.6-18.8 kg, respectively, which are about 80% higher than most of the reported observations on Black Bengal goat of same age and sex. Slaughter weight, warm carcass weight, edible weight and saleable weight increased curvilinearly with age of slaughter but not affected (p>0.05) by sex. However, linearity of the response curve of affect of age on mentioned parameters ends at around 9 months. Visceral fat as per cent of live weight increased curvilinearly with age and attain its maximum (about 6%) at about 500 days. However, linear part of the quadratic model ends at about 300 days when visceral fat content is about 4.8% of body weight. Blood and skin yield for one-year old male goat was 797 g and 1.61 kg, respectively. Absolute yield of blood and skin increased curvilinealry and attained maximum level at about 400 days (13.3 months). Average proportion of different carcass cut were - round 27%, rump 7%, loin 10%, ribs (6-12th) 14%, shoulder 21%, Neck 7%, chest 14%. Thigh and shoulder constituted about 48.3% of the cold carcass weight. Overall crude protein content of meat samples of different carcass cuts progressively decreased with age starting from 57 at 0-90 days to 58, 47 and 33 per cent, respectively at 91-180, 181-365 and >365 days, respectively. Overall meat fat content increased almost linearly from 11.1% during 91-180 days to 22.9 and 39.5% during 181-365 and >365days, respectively. Results from this trial suggest that both carcass yield and carcass composition changes with age; and sex have little or no effect on carcass yield and carcass composition. However, caution should be made in using second conclusion as there were few female animals slaughtered relative to the male. Optimum slaughter age for Black Bengal goat reared under semi-intensive management with adequate feeding and management would be about 9 months when their live weight, warm carcass weight, edible and saleable weight of carcass can be about 16.74, 7.28, 12.05 and 13.81 kg, respectively.

• Journal of Nutrition and Health
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• v.39 no.7
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• pp.707-713
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• 2006

This study was conducted to investigate the side dishes preference of Korean food with 403 college students (197 males and 206 females) in Seoul using questionnaires. Regarding preference of soups, it was shown that male students liked $s{\breve{o}}ll{\breve{o}}ngt'$ang and beef soup and female students liked soybean paste soup. Male students had higher preferences for $s{\breve{o}}ll{\breve{o}}ngt'$ang, beef soup, dried pollack soup, and kimchi soup than female students (p<0.05). Both male and female students had the highest preferences for kimchi pot stew and soft-tofu pot stew, but the lowest preferences for fermented soybeans pot stew and frozen pollack pot stew (p<0.05). Stewed beef with soy sauce was preferred the most by both of them but female students had lower preferences for stewed bean with soy sauce and stewed pepper with soy sauce than male students (p<0.05). For the preference of panbroiled foods, stir-fried with marinated anchovy was disliked by both of them but stir-fried with marinated pork was shown to have high preference in male students and stir-fried with marinated kimchi was high in female students (p<0.05). Besides, roasted ribs, cucumber salad, and korean cabbage kimchi were preferred the most by both of them. But male students had higher preferences for roasted eel, grilled todok, roots of broad bellflower salad, mustard leaf kimchi, and white cabbage kimchi than female students (p<0.05).

• Journal of Chest Surgery
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• v.42 no.4
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• pp.502-508
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• 2009

Background: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. Material and Method: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4$\pm$15.91 years (range: 17$\sim$76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. Result: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6$\pm$0.81 (range: 1$\sim$4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. Conclusion: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.

• Journal of Environmental Health Sciences
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• v.34 no.2
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• pp.161-169
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• 2008

This study evaluates the protective effects of Korean garlic juice against the toxicity of methyl mercuric chloride (MMC) in relation to fetal ossification in pregnant Fischer 344 rats. This study has as its basis, both theory and data that neutral amino acids in garlic juice have protective effects against mercury poisoning. Pregnant rats were dosed in various combination with 20 mg MMC/kg body wt. and 0.5 or 1.0 garlic juice/kg body wt. on the 7th day of gestation. Fetuses were extracted from the dams on 20th day of gestation, and the fetal bones were stained and measured. The results obtained are as follows: 1. Fetal body weights, body lengths, and head length were significantly decreased by as much as 23.5%, 21.3%, 15.5% respectively in 20 mg/wt kg methyl mercuric chloride groups (p<0.05). But in the garlic treated groups, they were almost similar to the controls. 2. The ossification centers were significantly decreased by as much as 35.1% in pelvic phalanges, 53.5% in pectoral phalanges, 74.1% in ternebrae, 76.2% in tail in 20 mg/wt kg methyl mercuric chloride groups (p<0.05). But in the garlic treated groups, they were significantly increased by as much as $81.2{\sim}88.7%$ and $94.8{\sim}98.9%$ of controls. 3. The ossified pectoral girdles were significantly decreased by as much as 66.6% in clavicle, and in other areas $74.2{\sim}87.4%$ in the 20 mg/wt kg methyl mercuric chloride groups (p<0.05). But in the garlic treated groups, they were significantly increased by as much as $81.2{\sim}88.7%$ and $94.8{\sim}98.9%$ of the controls. 4. The ossified pelvic girdles were significantly decreased by as much as 57.1% and 56.1% in two ischium, $67.2{\sim}81.7%$ in metacarpals in the 20 mg/wt kg methyl mercuric chloride groups (p<0.05). But in the garlic treated groups, they were significantly increased by as much as $67.0{\sim}85.6%$ and $90.1{\sim}98.7%$ of the controls. 5. The ossified terenebrae were unchanged or significantly decreased; 0.0% in 5th, 54.1% in 1st, 83.9% in 2nd, 75.0% in 3rd, 72.7% in 4th, 79.8% in 6th of 20 mg/wt kg methyl mercuric chloride groups (p<0.05). But in the garlic treated groups, they were significantly increased by as much as $29.5{\sim}55.1%$ and $54.5{\sim}84.0%$ of the controls. 6. The ossified ribs were significantly decreased by as much as $8.3{\sim}18.0%$ in 20 mg/wt kg methyl mercuric chloride groups (p<0.05). But in the garlic treated groups, they were significantly increased by as much as $87.1{\sim}93.5%$ and $96.3{\sim}99.7%$ of the controls. In conclusion, Korean garlic juice significantly protected against the toxicity of MMC in relation to the fetal ossification in pregnant rats.

• KSCE Journal of Civil and Environmental Engineering Research
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• v.13 no.2
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• pp.95-109
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• 1993

In this study, the optimal configuration of arch structure has been tested by a decomposition technique. The object of this study is to provide the method of optimizing the shapes of both two hinged and fixed arches. The problem of optimal configuration of arch structures includes the interaction formulas, the working stress, and the buckling stress constraints on the assumption that arch ribs can be approximated by a finite number of straight members. On the first level, buckling loads are calculated from the relation of the stiffness matrix and the geometric stiffness matrix by using Rayleigh-Ritz method, and the number of the structural analyses can be decreased by approximating member forces through sensitivity analysis using the design space approach. The objective function is formulated as the total weight of the structures, and the constraints are derived by including the working stress, the buckling stress, and the side limit. On the second level, the nodal point coordinates of the arch structures are used as design variables and the objective function has been taken as the weight function. By treating the nodal point coordinates as design variable, the problem of optimization can be reduced to unconstrained optimal design problem which is easy to solve. Numerical comparisons with results which are obtained from numerical tests for several arch structures with various shapes and constraints show that convergence rate is very fast regardless of constraint types and configuration of arch structures. And the optimal configuration or the arch structures obtained in this study is almost the identical one from other results. The total weight could be decreased by 17.7%-91.7% when an optimal configuration is accomplished.