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Esophageal Atresia and Tracheoesophageal Fistula in Korea - A National Survey of Its Members by the Korean Association of Pediatric Surgeons - (선천성 식도 무공증 및 기관식도 누공 - 대한 소아외과학회 회원을 대상으로 한 전국 조사 -)

  • Park, W.H.;Kwon, S.I.;Kim, S.C.;Kim, S.K.;Kim, W.K.;Kim, I.K.;Kim, J.E.;Kim, H.H.;Park, K.W.;Park, Y.S.;Song, Y.T.;Yang, J.W.;Oh, S.M.;Yoo, S.Y.;Lee, D.S.;Lee, M.D.;Lee, S.C.;Lee, S.K.;Lee, T.S.;Chang, S.I.
    • Advances in pediatric surgery
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    • v.1 no.2
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    • pp.149-161
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    • 1995
  • The first national survey on esophageal atresia and tracheoesophageal fistula was conducted to access the current status of its incidence, clinical manifestation, preoperative diagnosis and management, type of its anomaly, associated anomalies, and surgical results and course. The 43 members of the Korea Association of Pediatric Surgeons received questionnaires and registration forms to be filled out on each patient who were born during the three years from January 1, 1992 through December 31, 1994. Questionnaires composed of six broad areas which include 1) preoperative diagnosis and management, 2) surgical technic, 3) long gap, 4) postoperative management, and 5) complications and courses. A total of 148 cases was returned by 28 members working at 23 institutions and 27 members returned questionnaires. We obtained the following results by analysis of the 148 cases of tracheoesophageal anomalies. The incidence of tracheoesophageal anomaly was about 1/10,000-11,000 in 1994, which is one third of that of anorectal malformations in Korea and the distribution of the patients was almost proportionate to the size of each province. Both sexes are about equally affected. Majority of the members make diagnosis of tracheoesophageal anomaly by taking a simple infantogram with a radiopaque tube in upper pouch and a little under half(46%) prefers to perform echocardiography as a part of preoperative management to identify congenital heart disease and lateralize the aorta. Esophageal atresia with distal TEF(87.5%) was by far the most common and there were pure esophageal atresia(5.6%), H-type TEF(2.1%), and so on. About half(49%) of the patients had one or more associated anomalies in addition to tracheoesophageal anomalies. Congenital heart disease was associated in 46 cases(31%), anorectral malfomations in 19 cases(13%), musculoskeletal anomalies in 15 cases(10%), genitourinary anomalies in 10 cases(7%) and gastrointestinal anomalies in 7 cases(5%). Postoperatively, parenteral nutrition and assisted ventilation were given in 66% and 52% of patients respectively. Ninety three(74%) of 126 cases who underwent sugical procedure, experienced one or more complications such as respiratory complication(65%), leak(22%), stricture(21%) and so on. The survival rates related to the Waterston risk categories were 90.2% in group A, 71.4-75% in $B_1$, $B_2$, and $C_1$, groups, and 28% in group $C_2$, and the overall survival rate was 71.4%. Thirty six(28.6%) of 126 cases died of pneumonia/sepsis(12 cases), respiratory failure(12 cases), and congenital heart disease(4 cases). With short term follow-up, 69% of patients have been excellent whereas remainders of the cases have suffered from some sort of morbidity related to gastroesophageal reflux, recurrent respiratory infection, and esophageal stricture.

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Analysis of the Geological Structure of the Hwasan Caldera Using Potential Data (포텐셜 자료해석을 통한 화산칼데라 구조 해석)

  • Park, Gye-Soon;Yoo, Hee-Young;Yang, Jun-Mo;Lee, Heui-Soon;Kwon, Byung-Doo;Eom, Joo-Young;Kim, Dong-O;Park, Chan-Hong
    • Journal of the Korean earth science society
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    • v.29 no.1
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    • pp.1-12
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    • 2008
  • A geophysical mapping was performed for Hwasan caldera which is located in Euisung Sub-basin of the southeastern part of the Korean Peninsula. In order to overcome the limitation of the previous studies, remote sensing technic was used and dense potential data were obtained and analyzed. First, we analyzed geological lineament for target area using geological map, digital elevation model (DEM) data and satellite imagery. The results were greatly consistent with the previous studies, and showed that N-S and NW-SE direction are the most dominant one in target area. Second, based on the lineament analysis, highly dense gravity data were acquired in Euisung Sub-basin and an integrated interpretation considering air-born magnetic data was made to investigate the regional structure of the target area. The results of power spectrum analysis for the acquired potential data revealed that the subsurface of Euisung Sub-basin have two density discontinuities at about 1 km and 3-5 km depth. A 1 km depth discontinuity is thought as the depth of pyroclastic sedimentary rocks or igneous rocks which were intruded at the ring vent of Hwasan caldera, while a 3-5 km depth discontinuity seems to be associated with the depth of the basin basement. In addition, three-dimensional gravity inversion for the total area of Euisung Sub-basin was carried out, and the inversion results indicated two followings; 1) Cretaceous Palgongsan granite and Bulguksa intrusion rocks, which are located in southeastern part and northeastern part of Euisung Sub-basin, show two major low density anomalies, 2) pyroclastic rocks around Hwasan caldera also have lower density when compared with those of neighborhood regions and are extended to 1.5 km depth. However, a poor vertical resolution of potential survey makes it difficult to accurately delineate the detailed structure caldera which has a vertically developed characteristic in general. To overcome this limitation, integrated analysis was carried out using the magnetotelluric data on the corresponding area with potential data and we could obtain more reasonable geologic structure.

Studies on $\beta$-Glucuronidase Activities in Liver, Stomach and Small Intestinal Tissues of Rabbits Infected with Clonorchis sinensis (간디스토마 감염토끼의 소화기관에 대한 $\beta$-Glucuronidase의 활성치에 관한 연구)

  • Park, Byong-Kyoo;Song, Soo-Bok;Hahn, Jae-Kum
    • Parasites, Hosts and Diseases
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    • v.24 no.2
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    • pp.137-144
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    • 1986
  • The author has studied the $\beta$-glucuronidase activity in several tissues such as liver, stomach and small intestine of the male and female rabbits infected with different doses of metacercariae of Clonorchis sinensis. The metacercariae of Clonorchis sinensis were isolated from Pseudorasbora parva caught in Kim Hae by digestion technic. The experimental animals were sacrificed in the period of 1, 7, 14, 21, 28 and 35th days following the infection. The results obtained were summarized as follows. 1. In the groups infected with 100 metacercariae, $\beta$-glucuronidase activity was slightly increased during the entire periods than control rabbits. It was the highest in the first day with 1.535 and $1.421m{\mu}/g$, 14th days with 2.521 and $2.200m{\mu}/g$, and then lowered by the time, gradually. 2. In the groups infected with 500 metacercariae, $\beta$-glucuronidase activity was highly increased on the first day with 1.535 and $1.856m{\mu}/g$ than that 100 metacercariae groups according to each organs. It was the highest on the 7th day and 14th day. 3. In the groups infected with 1,000 metacercariae, $\beta$-glucuronidase activity was remarkably increased in the first and 14th days according to each organs, and then lowered gradually day by day. 4. $\beta$-glucuronidase activity of all organs was more increased than that of normal organs and the highest activity in the liver with $2.521m{\mu}/g$, intestine(1.612) and stomach (1.581) respectively. 5. $\beta$-glucuronidase activity of rabbits was higher in the female than in the male. On the basis of these results, it was suggested that $\beta$-glucuronidase activity was affected by the duration of infection and by the number of Clonorchis sinensis, according to the organs and sex of the rabbits.

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Sixty Years History of the Korean Geographical Society as a Numerical Record (숫자로 본 대한지리학회 60년)

  • Hyong, Kie-Joo
    • Journal of the Korean Geographical Society
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    • v.40 no.6 s.111
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    • pp.748-761
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    • 2005
  • This study attempts to describe and periodinate the sixty years history of Korean Geographical Society. For the purpose, several numerical records concerned with the society were employed. The Korean Geographical Society was established in 1945 as a first academic society in geography. The international participation of Korean geographers started when it applied for the IGU membership in 1959. Next year, Korean's application was approved at the 19th IGC in Stockholm. The 40 years later, Korea came to host the 29th IGC in Seoul. This means that the activity of Korean geographers has been vigorous during the 40 years in accordance with high growth of Korean economy. The number of the society member reached 116 in the latter part of 1960s. It grew steadily from 1970s to 1990s and now amounts to around one thousand. It is believed that such trend is associated with the increase of geographical department and the development of graduate programs during past 40 years in Korea. The number of the advanced degree holders was only 2 in 1960, and now reachs 338 among which 166($43\%$) obtained from the foreign country. The Int issue of the society journal 'Geagraphy' -the title was changed to 'Journal of the KGS' in 1993-was published in 1963. It has gradually developed into the annual for $1966{\~}1973$, the semi-annual for $1974{\~}1990$, the quaterly for $1991{\~}1997$, and the hi-monthly until 2005. One issue per year has been published in English since 1993. The annual number of papers accepted by the editorial board has increased from 7 in 1960s-1970s to 52 in the new millennium. In terms of the specialty distribution of total 725 papers after 1963, many Korean geographers have been preferable to the field of socio-economic and urban geography as their major, and next histro-cultural and physical geography. Recently, a growing number of younger geographers are more interested in such diversified fields as ecological geography, socio-historical geography, applied geography concerned with GIS technic, geography education and so on. Such trend is a reflection of the new era which is characterized by diversity, software, high technology, globalization and others. The sixty years history of the society nay be summarized into the five phases of periodization: (1) establishment and chaos($1945{\~}1959$), (2) reconstruction(1960${\~}$1969), (3)reorganization(1970${\~}$1989), (4) jump and rush($1990{\~}1999$), (5)globalization($2000{\~}\;$).

A Study on the animation music video production for the viral marketing purposes A case study of project (바이럴 마케팅용 애니메이션 뮤직비디오 제작 연구 : 월드컵 응원가 <일어나라 대한민국> 사례를 중심으로)

  • Han, Sang-Gyun;Kim, Tak-Hoon;Kim, Yu-Mi
    • Cartoon and Animation Studies
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    • s.22
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    • pp.47-63
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    • 2011
  • Recently, contemporary cultural contents have been shown its diversity changes followed by the birth of new media platforms with consumers' new needs in the global market. Also, developments of Internet and computer system networks are the main contributors of making this changes happened rapidly. This study aims to know that how to usefully use those new media platforms through the great example of stop-motion animation music video by analyzing its production and marketing process. The music video production had been focused to be completed with high quality by adjusting the production process economically in spite of the relatively short period(less than one month)from its crank-up to the deadline. Because the production was planned that main characters lead the whole story, the creative team had been tried to reduce the production hours by commonly use the same mold when they make original clay models by collecting the similarities of characters' appearances. By using CG technic, could overcome the visual monotonous from the similarities which inferred above. Also, the repeated rhythm in the music video, the similar scenes of backgrounds were commonly used by copy of the original scene. At the point of directing, the creative team considered both economical and art aspects for the quality work. In details, they divided the scenes into foreground and background, and removed unnecessary parts to save the production hours and budget but make depth of fields in the scenes. Except the viral marketing purposes, was searching for the methods to compensate the production cost. For this, the characters in the music video dressed the same T-shirts which are world-cup logo on, and those were designed for the sale after released the music video. Even the result of the sales was not enough to satisfied, it was estimated a great attempt to the domestic animation industry.

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Socio-Medical Approach to the Welfare of Rural Residents Through the Education of Community Health Personnel (농촌지역사회 보건요원의 교육을 통한 주민의 보건복지향상에 관한 사회의학적 연구)

  • Yum, Yong-Tae;Lee, Myung-Sook;Cho, Byung-Hee
    • Journal of agricultural medicine and community health
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    • v.17 no.1
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    • pp.34-45
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    • 1992
  • In this county, the gap between the urban 'haves' and the rural 'have-nots' continues to be an increasing problem. WHO and UNICEF see primary health care(PHC) as the key to achieving an acceptable level of health throughout the world as a community development. PHC is essential health care made accessible to individuals and families in the community by means acceptable to them. It is the first level of contact of individual, the family, and community with the national health system. It includes at least education on health system. It includes at least education on health problems, promotion of food supply, MCH including family planning, immunization against infectious diseases, control of endemic diseases, treatment of common diseases and injuries, promotion of mental health, and provision of essential drugs. However, of the aboves, education concerning of mental health problems and the methods to identify, prevent, and control them is the principal step of establishment. In Korea, the category of PHC worker includes the physician as public doctor and nurse as primary health care practitioner and community health leader as village health worker. PHC workers of the aboves will thus function best if they are appropriately trained to respond to the health needs of the community. However in this country, since the national PHC service project launched in 1980, the government has not developed and performed appropriate and enough education and training activities. In light of above reasons, several categories of health education activities had been planned and performed being aimed at above specific target groups and the main focus was on the village health workers for about one year from July 1991 to July 1992 in Yeoju Kun of Kyonki Province. At the end of the period, evaluation of education input was carried out to measure the improvement of healthful life of people in terms of awareness, attitude, and practice. At the end of the period, evaluation of education input was carried out to measure the improvement of healthful life of people in terms of awareness, attitude, and practice. The totals of 80 village health workers, 13 public health practitioners and 9 public docters took in the course of health education for a few hours at every month and the evaluation works of educational effect were taken. The results the study were as follows. 1) Number of persons who realized the maxim "health care of the people is a duty of the government" increased after the education course, On the other hand, the rate of satisfaction on the effort of government for health promotion of the people decreased. 2) Public doctors and primary health care practitioners(nurses) liked and enjoyed the education schedule as a meeting of peer group. It provided chances of communication with staffs of Korea University Hospital. It was said that lectures covered great deal of knowledge and technic they urgently needed in the field. 3) After finishing the education course, more of village health workers(VHW) thought they adapted themselves to their roles and functions showing increased number of home visit and contact with primary health care practitioners by month. 4) In case of patient refer, VHW preferred primary health care practitioners to public doctors. 5) Capability of VHWs in most of their functions increased dramatically after when the education course finished except tuberculosis control.

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A Statistical Study on the Key Words in the Titles of Nursing Related Theses (학위논문의 주요어 분석 (간호학 및 간호학관련 학위논문을 중심으로 : 1960-1991. 8))

  • 고옥자;김상혜;김희걸;이금재;이영숙
    • Journal of Korean Academy of Nursing
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    • v.24 no.1
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    • pp.58-69
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    • 1994
  • In order to see the development of Nursing related research activities in Korea over the last three decades, abstracts of almost all of the Master and Ph.D theses that appeared from 1961 up to August 1991 were collected. The number of theses was 2354, from which an index of key words has been constructed. Key words were defined as those terms in each thesis title that convey major objectives of the given thesis study and the important nursing concepts dealt with in the thesis. Although all the key words were picked from the thesis title only, full use was made of the abstracts in deciding the principal objectives and essential contents of the thesis studies and their important concepts as well. In total, 539 kinds of key words were identified from the 2354 titles, and the identified words were all found to be in the International Nursing Index. On an average each title has two key words. Which key words were most frequently used, how they have changed with time, what kind of concept is preferably dealt with by each graduate school, and the concepts to which a given key word is likely to be connected were examined. The results are summerized below : 1) For each decade the theses numbers were as follows : 54(2.3%) from the 60’s, 413(17.5%) from the 70’s, 1523(64.7%) from the 80’s, and 364(15.5%) from the 90’s. Master’s thesis contributed 96% (2252) of the papers and Ph. D’s theses filled the remaining 4%(102). 2) A total of 539 key words were used, averaging about 2 for each thesis. The most frequently used key words were ‘Nurse’, ‘Anxiety’, ‘Knowledge / Attitude /Practice’, ‘Stress /Stressor’, ‘Attitude’, ‘Job-Satisfaction’, ‘Mental Disorder’, ‘Operation’, ‘Elderly’, ‘Nursing Role’. 3) Each decades key words can be classified as : the 60’s : ‘Nursing Education’, ‘Pulmonary Tuberculosis’, ‘Mother-Child Health’, ‘Growth & Development’, ‘Public Facilities’, ‘Mental Disorder’ : the 70’s : ‘Nurse’, ‘Family Planning’, ‘Attitude’ / ‘Knowledge, Attitude / Practice’, ‘Curriculum in Nursing Education’, ‘Clinical Practice in Nursing’, ‘Analysis of the Work of the Nurse’, ‘Health Education of School’, : the 80’s : ‘Nurse’, ‘Anxiety’, ‘Stress /Stressor’, ‘Operation’, ‘Nursing Role’, ‘Job Satisfaction’ : the 90’s : ‘Nurse’, ‘Elderly’, ‘Family-Support’, ‘Stress /Stressor’, ‘Home Care’. Key word ‘Nurse’ appears continuously and most frequently through the years, which indicates that there has been active study of the characteristics of nurses and related fields. The concept ‘Anxiety’ has been studied steadly from the 80’s and it shows that interest in health and disease are increasing Which comes as a result of society changing to an industrial and informational community. 4) Looking into each graduate school’s study area key words ‘Anxiety’, ‘Nurse’, ‘Mental Disorder’, ‘Stress /Stressor’, ‘Operation’, ‘Attitude’, ‘Hemo-dialysis’, were studied in the regular graduate school : ‘Family Planning /Contraception’, ‘Knowledge / Attitude /Practice’, ‘Physical Health-State /Physical Health Examination’, ‘Nurse’, ‘Using Clinical Facilities’, ‘Health Education of School’, were studied in the Graduate School of Public Health’ ; ‘Nurse’, ‘Anxiety’, ‘Stress / Stressor’, ‘Job-Satisfaction’, ‘Clinical Practice Education’, ‘Nursing Education’, were studied in the Graduate School of Education : ‘Nurse’, ‘Job Satisfaction’, ‘Nursing Role’, ‘Administration - Employment /Employment Management’, ‘Leadership’, ‘Personnel Profile’, ‘Nursing Manpower / Changing Working Place’, were studied in the Graduate School of Public Administration. 5) The Connection between key words were : ‘Nurse Job Satisfaction’, ‘Stress / Stressor ⇔ Coping / Ajustment’, ‘Nurse ⇔ Nursing Role’, ‘Anxiety ⇔ Giving Information’, ‘Nurse ⇔ Stress / Stressor’, ‘Anxiety ⇔ Operation’, ‘Nurse ⇔ Burnout’, ‘Knowledge, Attitude, Practice ⇔ Family Planning’, ‘Nurse Administration ⇔ Employment’, ‘Anxiety Muscle ⇔ Relaxation Technic’, ‘Anxiety ⇔ Mental Disorder’. From the above it can be noted that many nursing concepts were handled in the thesis titles. But there were more than enough papers on the characteristics of the nurse. It is suggested that in depth research be made on ‘Nursing Accidents’, t-‘Ethics’, ‘Nurse - Patient Interactions’, ‘Spritual Care’, ‘Dying’, ‘Hospice’, ‘Resident Helper’ and that there should be in depth research relating to the physical and mental development of youth and in particular physical concepts like ‘Drug - Abuse’, ‘Child -Abuse and Teaching’.

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Characteristics and Production Period of Goryo(高麗) Iron 'Sung(成)' Inscribed Celadon (고려(高麗) 철화(鐵畵) '성(成)' 명청자(銘靑瓷)의 특징(特徵)과 제작시기(製作時期))

  • Han, Sung Uk
    • Korean Journal of Heritage: History & Science
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    • v.41 no.2
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    • pp.61-78
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    • 2008
  • Celadons painted in underglaze iron brown 'Sung(成)' inscription are characteristic celadons excavated only at the No. 7 kiln site located at Sadang-ri(沙堂里), Daegu-myeon(大口面), Gangjin-gun(康津郡), Jeollanamdo(全羅南道), Korea and has inscription in the inner center of the foot by brush. The inscription was marked where it is not easily seen. it can be assumed that since it showed a variety of hand writings, many people were involved in manufacturing these celadons and the 'Sung' inscription was marked after workshop rather than manufacturer. It was also found that quality of glaze, paste, shape, pattern and firing method were same and these were manufactured with the same techniques in the same period. Kinds of these celadons were mainly sets of tablewares including bowl with handle, bowl, plate, cup, bowl with cover and bottle. Raised relief designs using extrusion technic were especially preferred rather than incised designs and inlaid designs. Cases of using inlaid designs were not frequently found compared to incised designs, thus it can be assumed that in this period, inlaid designs were not generally used. Special designs having the meaning of authority or dignity such as chrysanthemum, peony, parrot and lotus plate designs were not found. Foot was molded with 'U' type except some bowls with cover and plates and firing was done after glazing the whole surface of the ceramic with the support of quartzite at 3 to 4 places of inner bottom of foot. Production period of these celadons with 'Sung' inscription can not be confirmed from other excavation sites outside of No. 7 kiln site at Sadang-ri since there are no other excavation sites whose relics bear 'Sung' inscription. Through comparison research with other relics bear the characteristics of these celadons from tombs, temple sites, shipwrecks, production period of these celadons with 'Sung' inscription can be assumed as second quarter of 13th century. And since the quality of these celadons are generally inferior to the top-quality celadons which were supplied to royal familes and high-ranking aristocrats, it can be deducted that these celadons with 'Sung' inscription were supplied to classes lower than royal familes and high-ranking aristocrats. So it is considered that Celadons with 'Sung' inscription have a great significance as a chronological material to complement the blank of the first half of the 13th century because most of celadons with raised relief designs and engraved relief designs were attributed to 12th century, the period of prosperity.

A Study on Differentiation and Improvement in Arbitration Systems in Construction Disputes (건설분쟁 중재제도의 차별화 및 개선방안에 관한 연구)

  • Lee, Sun-Jae
    • Journal of Arbitration Studies
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    • v.29 no.2
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    • pp.239-282
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    • 2019
  • The importance of ADR(Alternative Dispute Resolution), which has the advantage of expertise, speed and neutrality due to the increase of arbitration cases due to domestic and foreign construction disputes, has emerged. Therefore, in order for the nation's arbitration system and the arbitration Organization to jump into the ranks of advanced international mediators, it is necessary to research the characteristics and advantages of these arbitration Organization through a study of prior domestic and foreign research and operation of international arbitration Organization. As a problem, First, education for the efficient promotion of arbitrators (compulsory education, maintenance education, specialized education, seminars, etc.). second, The effectiveness of arbitration in resolving construction disputes (hearing methods, composition of the tribunal, and speed). third, The issue of flexibility and diversity of arbitration solutions (the real problem of methodologies such as mediation and arbitration) needs to be drawn on the Arbitration laws and practical problems, such as laws, rules and guidelines. Therefore, Identify the problems presented in the preceding literature and diagnosis of the defects and problems of the KCAB by drawing features and benefits from the arbitration system operated by the international arbitration Institution. As an improvement, the results of an empirical analysis are derived for "arbitrator" simultaneously through a recognition survey. As a method of improvement, First, as an optimal combination of arbitration hearing and judgment in the settlement of construction disputes,(to improve speed). (1) A plan to improve the composition of the audit department according to the complexity, specificity, and magnification of the arbitration cases - (1)Methods to cope with the increased role of the non-lawyer(Specialist, technical expert). (2)Securing technical mediators for each specialized expert according to the large and special corporation arbitration cases. (2) Improving the method of writing by area of the arbitration guidelines, second, Introduction of the intensive hearing system for psychological efficiency and the institutional improvement plan (1) Problems of optimizing the arbitration decision hearing procedure and resolution of arbitration, and (2) Problems of the management of technical arbitrators of arbitration tribunals. (1)A plan to expand hearing work of technical arbitrator(Review on the introduction of the Assistant System as a member of the arbitration tribunals). (2)Improved use of alternative appraisers by tribunals(cost analysis and utilization of the specialized institution for calculating construction costs), Direct management of technical arbitrators : A Study on the Improvement of the Assessment Reliability of the Appraisal and the Appraisal Period. third, Improvement of expert committee system and new method, (1) Creating a non-executive technical committee : Special technology affairs, etc.(Major, supports pre-qualification of special events and coordinating work between parties). (2) Expanding the standing committee.(Added expert technicians : important, special, large affairs / pre-consultations, pre-coordination and mediation-arbitration). This has been shown to be an improvement. In addition, institutional differentiation to enhance the flexibility and diversity of arbitration. In addition, as an institutional differentiation to enhance the flexibility and diversity of arbitration, First, The options for "Med-Arb", "Arb-Med" and "Arb-Med-Arb" are selected. second, By revising the Agreement Act [Article 28, 2 (Agreement on Dispute Resolution)], which is to be amended by the National Parties, the revision of the arbitration settlement clause under the Act, to expand the method to resolve arbitration. third, 2017.6.28. Measures to strengthen the status role and activities of expert technical arbitrators under enforcement, such as the Act on Promotion of Interestments Industry and the Information of Enforcement Decree. Fourth, a measure to increase the role of expert technical Arbitrators by enacting laws on the promotion of the arbitration industry is needed. Especially, the establishment of the Act on Promotion of Intermediation Industry should be established as an international arbitration agency for the arbitration system. Therefore, it proposes a study of improvement and differentiation measures in the details and a policy, legal and institutional improvement and legislation.

Survival Value of Myocutaneous Flaps in the Management of Epidermoid Carcioma of the Oral Cavity (구강내 상피암의 치료에서 근피부판이 생존율에 미치는 영향)

  • Seel David John;Park Chul-Young;Yoo Chung-Joon;Lee Samuel;Park Yoon-Kyu
    • Korean Journal of Head & Neck Oncology
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    • v.6 no.2
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    • pp.79-84
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    • 1990
  • This paper is a review of our experience with radical resection for cancer of the oral cavity with particular emphasis upon the value of myocutaneous(i.e., musculocutanous) flaps employed in the surgical reconstruction in patient survival. During the past 15 years, 98 patients underwent resection of cancer arising in the oral cavity and oropharynx. Of these, 14 had composite resections in which the mandible was not sectioned, and 4 underwent en bloc resections without neck dissections in the face of post-radiation recurrence. When these excluded, 84 patients who underwent COMMANDO procedures with or without myocutaneous flaps were suitable for analysis of recurrence and survival according to the various surgical technics employed. 1) According to the surgical technic, there were 24 standard COMMANDO procedures in whom no regional or myocutanous flap was used; 12 patients who underwent reconstruction employing a forehead flap; 19 patients in whom a posterior cervical 'nape' flap was employed; 27 patients who underwent myocutaneous or osteo-myocutaneous flap repair; and two patients who had double flap repair. 2) The uncorrected two-year disease free survival was 41% for standard COMMANDOs, 17% for forehead flap COMMANDOs; 35% for nape flap COMMANDOs; and 35% for myocutaneous flap COMMANDO procedures. 3) The two-year disease-free survival by Stage was 100% in Stage I, 45% in Stage II, 41% in Stage III, and 18% in Stage IV. 4) When myocutanous flaps cases were compared with Group I, comprised of matched historical controls including both Standard COMMANDOs and those who had undergone regional flap repairs(that is, forehead and nape flap COMMANDOs)there was no difference, both groups showing a 40% 2-year disease-free survival. 5) When musculocutanous flap cases were compared with Goup II, which was composed of matched historical controis limited to patients who had undergone regional flap repairs(that is, forehead and nape flap cases only)there was no difference, both groups showing a 27% 2-year desease-free survival. 6) When musculocutanous flap cases were compared with Group III, composed of patients who had undergone classic COMMANDO procedures without any sort of flap repair, there was a striking difference; the patients undergoing MC flap repair showed 50% 2-year disease-free survival, whereas the classic COMMANDO cases showed a 25% survival free of disease. 7) Locoregional recurrence was also evaluated in the four categories; for standard COMMANDO cases it was 25%, for nape flap cases 26% ; for forehead flap cases, 33%, and for the musculocutaneous flap cases, the lowest recurrence rate, 22%. These results are of particular significance in view of the fact that the proportion of advanced cases(Stage III and IV)in each category was 67% of standard cases, 79% of nape flap patients, 100% of forehead flap cases, and 96% of musculocutaneous flap cases.

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