• Archives of Plastic Surgery
• /
• 제39권4호
• /
• pp.323-328
• /
• 2012

Background Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft. Methods From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications. Results The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used ($8.9{\times}12.5$ mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched ($5{\times}15$ mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha ($9{\times}13.5$ mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site. Conclusions An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.

• Archives of Plastic Surgery
• /
• 제44권6호
• /
• pp.530-538
• /
• 2017

Background A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. Methods Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. Results A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. Conclusions Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.

• 감성과학
• /
• 제8권4호
• /
• pp.345-354
• /
• 2005

본 연구는 직물구조인자인 위사밀도와 직물의 조직을 변화시켜 시직한 면직물을 이용하여 역학특성 및 태의 변화를 KES-FB System을 이용하여 측정하였다. 그 결과 위사밀도가 증가할수록 굽힘특성 및 전단특성이 증가하는 것으로 나타났고, 위사밀도의 변화에 따른 역학특성치 중 굽힘 및 전단특성의 값은 평직이 높게 나타났으며, 인장특성, 압축특성 그리고 표면특성의 값은 조직 및 밀도에 크게 영향을 받지 않는 것으로 나타났다. 한편, 위사밀도 변화에 따른 의복착용성능 중 WC/T, MMD/SMD를 제외한 B/W 및 2HG/G, 2HB/B, 2HB/W, W/T, 그리고 WC/W는 위사밀도에 영향을 받는 것으로 나타났다. 위사방향의 직축은 굽힘특성, 전단특성, 압축회복도(RC), 표면거칠기(SMD), 태와 의복착용성능에 높은 상관을 보이는 것으로 나타났다. 그리고 Tightness는 굽힘특성, 전단특성, 압축특성 그리고 표면 마찰계수와 높은 상관을 보였고, 기본태 및 T.H.V., 의복착용성능에도 높은 상관이 있는 것으로 나타났다.

• Journal of Gastric Cancer
• /
• 제15권2호
• /
• pp.77-86
• /
• 2015

Laparoscopic proximal gastrectomy (LPG) is theoretically a superior choice of minimally-invasive surgery and function-preserving surgery for the treatment of proximal early gastric cancer (EGC) over procedures such as laparoscopic total gastrectomy (LTG), open total gastrectomy (OTG) and open proximal gastrectomy (OPG). However, LPG and OPG are not popular surgical options due to three main concerns: the first, oncological safety; the second, functional benefits; and the third, anastomosis-related late complications (reflux symptoms and anastomotic stricture). Numerous recent studies have concluded that OPG and LPG present similar oncological safety profiles and improved functional benefits when compared with OTG and LTG. While OPG with modified esophagogastrostomy does not provide satisfactory results, OPG with modified esophagojejunostomy showed similar rates of anastomosis-related late complications when compared to OTG. At this stage, no standard reconstruction method post-LPG exists in the clinical setting. We recently showed that LPG with double tract reconstruction (DTR) is a superior choice over LTG for proximal EGC in terms of maintaining body weight and preventing anemia. However, as there is no definitive evidence in favor of LPG with DTR, a randomized clinical trial comparing LPG with DTR to LTG was recommended. This trial, the Korean Laparoscopic Gastrointestinal Surgery Study-05 (NCT01433861), is expected to assist surgeons in choice of surgical approach and strategy for patients with proximal EGC.

• Advances in pediatric surgery
• /
• 제11권2호
• /
• pp.131-140
• /
• 2005

The purpose of this study is to review the operative management and outcome of operation for Crohn's disease. The medical records of 17 patients who underwent operations for Crohn's disease at Seoul National University Children's Hospital from January of 1988 to June of 2005 were reviewed. The male-to -female ratio was 1.8: 1. The median age at the onset of symptoms and the time of diagnosis was 9 years 6 months and 11 years 6 months respectively. The median time interval from diagnosis to operation was 2 years and 1 month (0 month~8 years). The ileocolic or ileocecal region was the most common site of involvement. The indications for operation were intractable symptoms (8 cases) and obstruction or stricture (7 cases). The median postoperative hospitalized days were 14.4 days (8~35 days). Five patients (29 %) experienced postoperative complications. Symptom free state or symptom relief was observed in 11 cases after surgery and 6 cases had intermittent episodes of remissions and recurrences. In pediatric Crohn's disease patients who present with intractable symptoms despite medical treatment or develop surgical complications, symptom free state or symptom relief can be achieved by minimal resection of the diseased segment.

• Journal of Chest Surgery
• /
• 제30권11호
• /
• pp.1117-1120
• /
• 1997

충남대학교병원에서 1980년7월부터 1995년 8월까지 경험한 식도이물 10례를 수술 치료하였다. 나이는 25 세에서 71세로, 평균 나이는 45.3세였고 남녀의 비는 6:4였다 가장 흔한 증상은 연하곤란, 발열, 이물감, 경부 동통이였다. 이물질은 생선뼈 3례였고, 거품 약포장지가 2례였고, 맥주병 마개,욕조 물마개, 깨진 사발 조각, 닭고기, 콩이 각각 1례였다. 진단은 수용성 식도 조영제와 식도 내시경을 이용하였다. 10례중 2례에서는 과거에 가성소다 섭취로 인해 식도 협착이 있었다. 1례에서는 정신과적 문제가 있었다. 식도이물은 모두 수술적 처치로 제거하였다 5례에서는 경부식도절게술을 시행하였고 1례는 우측 개흉술 을, 1례는 개복하여 위를 통해 위관을 역류성으로 통과 제거하였으며, 2례는 경부농양이 있어 절개후 배농하 였다. 3례는 수술 후 누출이 있었으나 수술치료없이 보존적 요법으로 호전되었으며,1례는 일시적인 애성이 있 었다. 1례는 외상성 기흉이 발생하여 폐쇄적 홉관 삽관술로 치료하였다. 수술 사망자는 없었다.

• 대한한방부인과학회지
• /
• 제15권4호
• /
• pp.136-148
• /
• 2002

This study was performed to investigate the relation between Iridological constitution and Gynecological disease. Iris is one of the most complicated part of our bodies. It reflects perfectly organ's status, toxic accumulation, person's characteristics and healing effects. Many signs of Iridology were closely researched to examine the relation between Iridology and disease. After studying these matters, we could find that lacuna and auto-nerve wreath are intimately related. Especially the portions of auto-nerve wreath loss are accorded with the organ's present illness. Most of patients have scurf ring and vessel congestion sign. Large Intestine's structure also shows us the meaningful result that ballooned is the most common, spasticity and stricture are next. Connective tissue weakness constitution is 39.22%, complex 35.29% and blood-originated 25.49%. According to the three-step constitution by the Genetic facter, average type is 52.94%, weak type 35.29% and strong type 11.76%. Above these results, we can reach a conclusion that Iridological constitution are intimately related with Gynecological disease. And further study are requested to get a objectivity in a Gynecological diagnose. Iridology is a bright prospective study and interesting diagnostic method. If we deeply investigate this science, before long we can have a great outcome and more objective diagnostic skill.

• 음성과학
• /
• 제1권
• /
• pp.153-200
• /
• 1997

In languages such as Japanese, it is very common to observe that short peripheral vowel are completely voiceless when surrounded by voiceless consonants. This phenomenon has been known as Montreal French, Shanghai Chinese, Greek, and Korean. Traditionally this phenomenon has been described as a phonological rule that either categorically deletes the vowel or changes the [+voice] feature of the vowel to [-voice]. This analysis was supported by Sawashima (1971) and Hirose (1971)'s observation that there are two distinct EMG patterns for voiced and devoiced vowel in Japanese. Close examination of the phonetic evidence based on acoustic data, however, shows that these phonological characterizations are not tenable (Jun & Beckman 1993, 1994). In this paper, we examined the vowel devoicing phenomenon in Korean using data from ENG fiberscopic and acoustic recorders of 100 sentences produced by one Korean speaker. The results show that there is variability in the 'degree of devoicing' in both acoustic and EMG signals, and in the patterns of glottal closing and opening across different devoiced tokens. There seems to be no categorical difference between devoiced and voiced tokens, for either EMG activity events or glottal patterns. All of these observations support the notion that vowel devoicing in Korean can not be described as the result of the application of a phonological rule. Rather, devoicing seems to be a highly variable 'phonetic' process, a more or less subtle variation in the specification of such phonetic metrics as degree and timing of glottal opening, or of associated subglottal pressure or intra-oral airflow associated with concurrent tone and stricture specifications. Some of token-pair comparisons are amenable to an explanation in terms of gestural overlap and undershoot. However, the effect of gestural timing on vocal fold state seems to be a highly nonlinear function of the interaction among specifications for the relative timing of glottal adduction and abduction gestures, of the amplitudes of the overlapped gestures, of aerodynamic conditions created by concurrent oral tonal gestures, and so on. In summary, to understand devoicing, it will be necessary to examine its effect on phonetic representation of events in many parts of the vocal tracts, and at many stages of the speech chain between the motor intent and the acoustic signal that reaches the hearer's ear.

• 폴리머
• /
• 제36권2호
• /
• pp.163-168
• /
• 2012

최근에 내시경 관련기술의 진보에 따라서 시술 편리성, 회복시간 단축, 환자 고통 경감 등의 장점으로 인해 스텐트 삽입술이 빠르게 진보하였다. 본 연구에서 양성담관 협착 치료를 목적으로 파클리탁셀을 이용한 약물방출 스텐트를 전기분사 방법에 의해 제조하였으며, 이 때 사용된 고분자는 polyether-based polyurethane(상표명 : PELLETHANE 2363-80AE$^{(R)}$)과 첨가제로서 Pluronic F127, 약물로서 파클리탁셀을 사용하여 금속스텐트 표면에 코팅하였다. 그 결과로서, 약물이 코팅된 고분자 필름의 물리적 특성은 SEM, FTIR, 접촉각 측정기, XRD에 의해 확인하였으며, 약물방출속도는 약물함량이 높을수록 감소하였음을 알 수 있었다.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
• /
• pp.7.1-7
• /
• 1983

식도천공은 임상에서 특히 이비인후과영역에서 드물게 보는 질환으로서 여러 가지 중요한 합병증을 야기하는데 그것은 식도 주위에 대한 해부학적 관계가 원인이 되는 것으로서 긴급을 요하며 사망율도 높다. 식도천공의 원인은 대부분 외부손상, 기계적 손상, 부식성 식도염 및 협착 등이 있는데 이물섭취에 의한 경우도 많다. 이물섭취로는 주로 동전, 생선뼈, 닭뼈 및 의치 등이 식도 벽에 걸려서 천공을 일으키게 되는데 이 천공은 이물 자체가 일으킬 수도 있지만 때로는 이 이물을 제거하기 위해 내시경조작을 할 때에 발생할 수도 있다. 최근 저자는 이물을 오연한 뒤 연하곤란이나 호흡곤란 없이 식도의 경한 동통, 이물감 및 미열을 주소로 내원하여 X선 검사결과 식도이물 및 식도주위에 조영제 유출이 인지 되어 응급으로 전신마취하에 식도이물제거술과 경부종격동절개술을 시행하였으며 술후 7일째 식도조영술 결과 좋은 효과를 경험하였기에 보고하는 바이다.