• Title/Summary/Keyword: two-staged

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Both Carotid Endarterectomy in Obstrution of Carotid Arteries and Bypass Graft with Kidney Preservation in Obstrution of Abdominal AoRta -A Report of Case (양측 경동맥협착의 혈관내막절제수술 및 신장보호액 주입을 이용한 복부대동백 폐색 수술 치험 -1례 보고-)

  • 김병철;편승환
    • Journal of Chest Surgery
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    • v.30 no.6
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    • pp.625-630
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    • 1997
  • A 56 years old male patient adklitted to our neurology department because of repeated tingling sensation in right 3, 4, 5th. (infers and weakness on grasping, which were progressively developed re ently. At this time, he had also suffered from claudication in both lower extremities. Carotid angiogram showed that right internal carotid artery was obstructed completely, and both common, both external and left internal carotid arteries had significant stenosis, Concommitantly, aortogram suggested complete obstruction just below the renal arteries. We plamled staged operation for two separated arterial lesions. Both carotid endarterectomy was performed. and we used carotid shunt for left side during operation. Abdominal aortic lesion was operated 2 weeks later We obligately clamped aorta just below the celiac artery and infuse4 kidney perservation solution to pertect kidney during ischemia. Reversed Y bypass graft and kidney perservation was successful despite of 40 minute ischemia. Postoperative courts was uneventful and patient was discharged without any specific problem.

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Numerical Analysis for the Pressure and Flow Fields past a Two-Staged Conical Orifice (이단 원추형 오리피스를 지나는 압력장과 유동장에 관한 수치적 연구)

  • Kim, Yeon-Su;Kim, Yu-Gon
    • Transactions of the Korean Society of Mechanical Engineers B
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    • v.26 no.2
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    • pp.278-287
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    • 2002
  • The objective of the paper was to calculate the pressure drop and to investigate the recirculation region of the conical orifices used in Kwang-yang Iron & Steel Company. The flow field with water used as a working fluid was the turbulent flow for Reynolds number of 2$\times$10$^4$. The effective parameters fur the pressure drop and the recirculation region were the conical orifice\`s inclined angle ($\theta$) against the wall, the interval(S) between orifices, the relative angle of rotation($\alpha$) of the orifices, the shape of the orifice's hole(circle, rectangle, triangle) having the same area, the number(N) of the orifice's holes having the same mass flow rate, and the thickness(t) of the orifices. It was fecund that the shape of the orifice's hole, the number of the orifice's holes and the thickness of the orifice affected the total pressure drop a lot and that the conical orifice's inclined angle against the wall, the relative angle of rotation of the orifices, the number of the orifice's holes and the thickness of the orifices affected the center location of the recirculation region. The PISO algorithm with FLUENT code was employed to analyze the flow field.

A Study on the Paradigm Phenomenon of Traditional Dance - Focusing on the Jinsoechum by Lee Dong An (전통춤의 전승 패러다임 현상에 관한 연구 - 이동안류 진쇠춤을 중심으로)

  • Bong, Jung-Min;Choi, Ji-Won
    • The Journal of the Korea Contents Association
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    • v.21 no.5
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    • pp.961-969
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    • 2021
  • In the historical trend of Korean dance, Korean traditional dance continues to evolve through the transition to stage dance due to the modernization process, the tangibleization of traditional dance, the reconstruction or re-creation of traditional dance. Moreover, the trend of reconstruction and re-creation of traditional Korean dances has been common in traditional dance performances since the 2000s, with two directions: performance of original restoration and preservation and evolution of traditional dances. Therefore, this study is a study of the change in the form of traditional dance and the process of the evolution of traditional dance, and among them, the change of the traditional paradigm of the Lee Dong-an Ryu Jin-so dance. The paradigm shift of traditional dance was staged through the trend of the times to the extent that the original's meaning and form were not undermined, and we can recognize that the paradigm of traditional dance is a way of introducing new aspects as a way of transmission.

A Mixing Head Integrated, Multi-Ignition Device for Liquid Methane Engine (액체메탄엔진용 믹싱헤드 일체형 다중점화장치)

  • Lim, Byoungjik;Lee, Junseong;Lee, Keejoo;Park, Jaesung
    • Journal of the Korean Society of Propulsion Engineers
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    • v.26 no.3
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    • pp.54-65
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    • 2022
  • We are developing a compact ignition device that can provide a multi-ignition capability for an upper stage methane engine of a two staged small satellite launch vehicle. Firstly, the multi-ignition device is designed and built as an integral part of an additively manufactured mixing head. Secondly, the ignition device requires no separate high-pressure vessels to store ignition propellants as they are branched out from the main feed lines for the mixing head. We performed experiments at various levels, including igniter autonomous tests, thrust chamber ignition and combustion tests on the new compact ignition device which is integrated in the thrust chamber of one-tonf class liquid oxygen/liquid methane engine, and confirmed stable ignition performance.

Radiosurgery with Linac Based Photon Knife in Cerebral Arteriovenous Malformation (선형가속기를 이용한 Photon Knife 방사선수술에 의한 뇌동정맥기형의 치료)

  • Kim, Jin-Hee;Choi, Tae-Jin
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.1-9
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    • 2003
  • Purpose : The purpose of this study was to analyze the effect of a Linear accelerator based Photon Knife Radiosurgery System developed by the staff of Keimyung University Dongsan Medical Center for the treatment of cerebral arterlovenous malformation Material and Methods : Between December 1993 and October 2000, 30 patients with cerebral arteriovenous malformation (AVM) were treated with the Linac based Photon knife Radlosurgery System In the Department of Therapeutlc Radiology at Keimyung University Dongsan Medical Center. The median age was 34, ranging from 7 to 63 years, with a 2 : 1 male to female ratio. The locations of the AVM nidi were the frontal lobe (motor cortex), parletal lobe, and the thalamus, In that order. The diameters of the AVM nidi ranged 1.2 to 5.5 cm with a mean on 2.9 cm, and target volumes of between 0.5 and 20.5 cc, with a mean of 5.8 cc. The majority of patients received radiation doses of between 1,500 and 2,500 cGy, w14h a mean of 2,000 cGy, at 80% the isodose line. Twenty-five patients were treated with one isocenter, 4 with two, and 1 with four. The follow-up radiological evaluations were peformed with cranial computed tomogram (CT) or MRI between 6 month and one year interval, and if the AVM nidus had completely disappeared in the CT or MRI, we confirmed thls was a complete obliteration, with a cerebral or magnetic resonance angiogram (MRA). The median iollow-up period was 39 months with a range of 10 to 103 months. Results : Twenty patients were radloiogicaiiy followed up ior over 20 months, with complete obliteration observed in 14 (70%). According to the maximal diameter, all four of the small AVM (<2 cm) completely obliterated, 8 of the 10 patients with a medium AVW (2~3 cm) showed a complete obliteration, and two showed partial obliteration. Among the patients with a large AVM (>3 cm), only one showed complete obliteration, and S showed partial obliteration, but 3 oT these underwent further radiosurgery 3 years later. One who followed up for 20 months fellowing further radiosurgery eventually showed complete obliteration. Ten patients with seizure symptoms had no recurrent seizure due to radiosurgery and medication. One of the eleven patients who suffered intracranlal bleeding developed further bleeding at 9 and 51 months fellowing the radiosurgery although complete obliteration was eventually observed and the patient was managed in hospital then recovered. No patient suffered severe complications fellowing the radiosurgery. Conclusion : The radiosurgery with Linac-based Photon knife radiosurgery system, developed by the staff at our hospital, is a safe and effective treatment for AVM patients having diameters or volumes of less than 3 cm or 10 cm$^{3}$, respectively, located In Inoperable areas or who refused neurosurgery. We suggest that staged AVM radiosurgery may initially be considered, if the AVM target volume is above 10 cm$^{3}$

Optimization of Soil-Nailing Designs Considering Three Failure Modes (쏘일네일링의 세 가지 파괴모드를 고려한 설계 최적화에 대한 연구)

  • Seo, Hyung-Joon;Lee, Gang-Hyun;Park, Jeong-Jun;Lee, In-Mo
    • Journal of the Korean Geotechnical Society
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    • v.28 no.7
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    • pp.5-16
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    • 2012
  • Soil-nailing is the most popular method of reinforcing for slope stability. In general, two factors are considered as failure modes during the soil-nailing design stages: pullout failure mode and shear failure mode that will occur on the most probable failure plane. In many cases, however, shallow failure can also occur when the ground near the slope face is swept away by the horizontal stress release during the staged top-down excavation. In this paper, an optimized soil-nailing design methodology is proposed by considering the three failure modes mentioned above: pullout failure; shear failure; and shallow failure. The variables to be optimized include the bonded length and number of soil-nailings, and the confining pressure that should be applied at the slope face. The procedure to obtain the optimized design variables is as follows: at first, optimization of soil-nailings, i.e. bonded length and number, against pullout and shear failure modes; and then, optimization of confining pressure at each excavation stage that is needed to prevent shallow failure. Since the two processes are linked with each other, they are repeated until the optimized design variables can be obtained satisfying all the constrained design requirements in both of the two processes.

The Heterogeneity of T2NO Glottic Carcinoma Treated by Irradiation (T2NO 병기 성문암의 방사선치료-예후인자 분석)

  • Lee Hyung Sik;Moon Sun Rock;Ahn Ki Jung;Chung Eun Ji;Suh Chang Ok;Kim Gwi Eon;Loh John J K
    • Radiation Oncology Journal
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    • v.8 no.2
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    • pp.199-205
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    • 1990
  • During a ten-year period from 1978 through 1987, 44 patients with T2NOMO glottic cancer were treated with radical radiation therapy at the Yonsei University Medical Center. Forty-two patients had a minimum follow-up of 3 years, and $81\%$ had at least five years of follow-up. Patients were staged according to the AJCC system. Forty-two patients have been analyzed in detail with respect to two variables: the status of vocal cord mobility and the degree of local extension of the disease. Five-year local recurrence free survival rates were as follows: All 42 patients, $53.3\%$ patients with normal vocal cord mobility (n =18), $69.1\%$ versus patients with impaired vocal cord mobility (n=24), $43.4\%$(p<0.05); patients with subglottic extension (n=15), $36.7$ versus patients without subglottic extension (n=29), $61.9\%$ (p<0.05). The most favorable Prognostic group included the patients with normal mobility without subglottic extension (n=14), $83.1\%$. On the basis of this analysis, we confirmed the presence of heterogeneity in T2NOMO glottic cancer This study indicates that further randomized controlled trials are warranted to evaluate.

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Treatment of Combat-related Gunshot and Explosive Injuries to the Extremities (전투 상황에서 발생한 사지 총상 및 폭발창의 치료)

  • Lee, Jung Eun;Lee, Young Ho;Baek, Goo Hyun;Lee, Kyung-Hag;Cho, Young Jae;Kim, Yeong Cheol;Suh, Gil Joon
    • Journal of Trauma and Injury
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    • v.26 no.3
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    • pp.111-124
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    • 2013
  • Purpose: We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries. Methods: Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery. Results: All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases. Conclusion: The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.

Locally Advanced Rectal Carcinoma : Curative Surgery Alone vs. Postoperative Radiotherapy and Chemotherapy (국소적으로 진행된 직장암에 대한 근치적 수술 단독 치료군과 수술후 보조적 방사선 및 항암화학요법 병행군의 치료결과 분석)

  • Ahn Seung Do;Choi Eun Kyung;Kim Jin Cheon;Kim Sang Hee
    • Radiation Oncology Journal
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    • v.13 no.3
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    • pp.253-258
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    • 1995
  • Purpose : To evaluate the effects of postoperative radiotherapy and chemotherapy on the pattern of failure and survival for locally advanced rectal carcinoma, we analyzed the two groups of patients who received curative resection only and who received postoperative radiochemotherapy retro-spectively. Materials and Methods : From June 1989 to December 1992, ninety nine patients with rectal cancer were treated by curative resection and staged as B2-3 or C. Group I(25) patients received curative resection only and group II(74) patients postoperative adjuvant therapy. Postoperative adiuvant group received radiation therapy (4500cGy/25fx to whole pelvis) with 5-FU (500mg/$m^2$, day 1-3 IV infusion) as radiosensitizer and maintenance chemotherapy with 5-FU(400mg/$m^2$ for 5 days) and leucovorin (20mg/m^2$ for 5 days) for 6 cycles. Results : The patients in group I and group II were comparable in terms of age sex, performance status, but in group II $74{\%}$ of patients showed stage C compared with $56{\%}$ of group I. All patients were followed from 6 to 60 months with a median follow up of 29 months. Three year overall survival rates and disease free survival rates were $68\%,\;64\%$ respectively in group I and $64\%,\;61\%$, respectively in group II. There was no statistical difference between the two treatment groups in overall survival rate and disease free survival rate. Local recurrences occurred in $28{\%}$ of group I, $21{\%}$ of group II (p>.05) and distant metastases occurred in $20{\%}$ of group I, $27{\%}$ of group II(p>.05). The prognostic value of several variables other than treatment modality was assessed. In multivariate analysis for prognostic factors stage and histologic grade showed statistically significant effect on local recurrences and lymphatic or vessel invasion on distant metastasis. Conclusion : This retrospective study showed no statistical difference between two groups on the pattern of failure and survival. But considering that group II had more advanced stage and poor prognostic factors than group I, postoperative adjuvant radiochemotherapy improves the results for locally advanced rectal carcinoma as compared with curative surgery alone.

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Change in the Alignment and Distal Junctional Kyphosis Development after Posterior Cervical Spinal Fusion Surgery for Cervical Spondylotic Myelopathy - Risk Factor Analysis

  • Lee, Jung Jae;Park, Jin Hoon;Oh, Young Gyu;Shin, Hong Kyung;Park, Byong Gon
    • Journal of Korean Neurosurgical Society
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    • v.65 no.4
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    • pp.549-557
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    • 2022
  • Objective : This study analyzed the risk factors in patients who developed distal junctional kyphosis (DJK) after posterior cervical fusion. Methods : We retrospectively analyzed the clinical and radiographic outcomes of 64 patients, aged ≥18 years (51 and 13 male and female patients, respectively), who underwent single-staged multilevel (3-6 levels) posterior cervical fusion surgery due to multiple cervical spondylotic myelopathy. The surgeries were performed by a single spinal surgeon between January 2012 and December 2017. Demographic data, clinical outcomes, and radiological results were collected. We divided the patients into a DJK group and a non-DJK group according to the presence of DJK and investigated the risk factors by comparing the differences between the two groups. Results : Of the 64 patients, 13 developed DJK. No significant differences in clinical results were observed between the two groups before and immediately after the surgery. At the final follow-up, a higher visual analog score for neck pain was observed in the DJK group compared to the non-DJK group (p<0.01). The DJK group had a significantly lower T1 slope and a significantly higher C2-7 sagittal vertical axis (SVA) before surgery compared to the non-DJK group (p=0.03 and p<0.01, respectively). Immediately after surgery, the difference between the two groups decreased and no significant difference was observed. However, at the last follow-up, a significantly higher C2-7 SVA was observed in the DJK group (p<0.01). At the last follow up, there is no discrepancy in T1S-CL. In multiple logistic regression analysis, preoperative higher C2-7 SVA and preoperative lower T1 slope were identified as independent risk factors (p=0.03 and p<0.01, respectively). As a result, it was confirmed that DJK occurred along the process of returning to preoperative values. Conclusion : DJK can be considered to be caused by cervical misalignment due to excessive change in the surgical site in patients with low T1 slope and high C2-7 SVA before surgery. This also affects the clinical outcome after surgery. It is recommended to refrain from excessive segmental lordosis changes during multilevel cervical post fusion surgery, especially in patients with a small preoperative T1 slope and a large SVA value.