Revisiting the Cross-Leg Flap: A Degraded or Still Useful Method?

유하현,최영웅 대한수부외과학회 2019 대한수부외과학회지 Vol.24 No.2

Since the development of microsurgery, the cross-leg flap has not been a preferred method of lower extremity reconstruc-tion. However, it is being used in several centers and has shown favorable results. This report presents our experience in treating lower extremity injuries using the cross-leg flap. We studied three patients with lower extremity defect who underwent cross-leg flap surgery. As there was no proper perforator for local flap or recipient vessel for free flap in the ipsilateral leg, two underwent the posterior tibial artery island cross-leg flap and one had the latissimus dorsi free flap, wherein the recipient vessels comprised the contralateral posterior tibial vessels. All procedures were successful without any severe complications. We recommend that cross-leg flaps be considered not only in cases of multiple vessel injuries or when no other options are available but also in cases of broad trauma or where scar tissue is present around the defect.

Modified composite graft using diced autogenous cartilage for amputated ear reconstruction: A case report

유하현,Young Woong Choi 대한미용성형외과학회 2019 Archives of Aesthetic Plastic Surgery Vol.25 No.2

Trauma to the auricle is common given its prominent position, and various methods for ear reconstruction exist. Herein, we present our experience of ear reconstruction using diced autogenous cartilage. A 72-year-old woman fell from a 1-m height, damaging her ear in the process. The ear helix, which was approximately 3.5×3 cm2 in size, was amputated. The cartilage was diced into 1-mm pieces. The detached skin was made into a pocket and filled with the diced cartilage. Molding was performed with tie-over dressings on the anterior and posterior areas of the scaphoid fossa. Ten days post-surgery, the wound showed signs of successful recovery, and the contour of the ear helix was maintained. Ten months later, the cartilage in the damaged ear helix was intact. Conventional composite grafts on amputated ears have size limitations and exhibit significant resorption, and loss of anatomical structures and stability often occur. In this case, the operating time required to complete the composite graft was short, and molding the contour was not complex. The original ear structure was maintained over the long term and did not require an additional operation for aesthetic purposes. We believe that this is a useful method for the reconstruction of an amputated ear.

열원이 존재하는 작업장내 기류 및 온도장 예측

정유진,하현철,김태형,유근종 한국산업위생학회 2001 한국산업보건학회지 Vol.11 No.1

A CFD simulation of airflow and temperature filed in a heated room has been described in this paper. The thermal wall jet created by a radiator greatly influences the airflow pattern, temperature distribution. The area close to a heat source has a high risk of air-borne contamination and imposes a harmful effect on occupants in that area. The predicted flow field, temperature results show good agreement with the measured data. As the results were compared with experimental data. the applicability of CFD was satisfactorily verified. Also, the CFD simulation can capture the natural convective flow features. If a CFD simulation is applied ventilation design with a heat source, An effective design will be attained. Further study is required to improve the accuracy of CFD simulation.

위내시경 검사상 점막하 종양으로 표현되었던 스파르가눔양 병변 1예

박영환,박주상,유은실,홍원선,민영일,정훈용,김해련,하현권,양석균,최재원,김석균 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.5

Sparganosis in humans is caused by migrating larvae of the cestode Spirometra. Humans are considered the second intermediate host that are incidentally infected. Sparganosis usually infestates the subcutaneous tissues and visceral organs have rarely been reported to be involved. A case is herein reported however, a 67-year old female patient with sparganosis in the gastric wall and perigastric region, presented as a submucosal tumor upon gastrofiberscopy. The diagnosis was made after surgery by the pathologic findings determining a characteristic degenerated Sparganum and multiple tunnel-shape cavities surrounded by many inflammatory cells and necrotic materials.

국소침습진행위암의 다검출기전산화단층촬영: 인접장기침습유무 결정에 있어 관상사면 재구성 영상의 유용성

정진희,김아영,김혜진,육정환,유은실,장윤진,박성호,신용문,하현권 대한영상의학회 2010 대한영상의학회지 Vol.62 No.1

Purpose: To evaluate the diagnostic value of oblique coronal reconstructed CT images to determine the local invasion of advanced gastric cancer (AGC). Materials and Methods: Thirty-four consecutive patients, who were suspected to have locally invasive advanced gastric cancer (more than T3 stage) on a preoperative MDCT scan and underwent a diagnostic or curative laparotomy, were enrolled in this study. Two reviewers performed an independent blind review of three series of MDCT images in random order; axial (AXI), conventional coronal (CCI), and oblique coronal (OCI) (parallel to long axis of gastric body and pancreas) images. In assessing the local invasion, the reader’s confidence for the local invasion of AGC was graded using a five point scale (1 = definitely negative, 5 = definitely positive: T4). With surgical findings and histopathological proofs as reference standards, the diagnostic performance of the three different plans of CT images was employed for the verification of local invasion of AGC on a preoperative CT scan using the receiver operating characteristic (ROC) method. Agreements between the two reviewers were analyzed using weighted kappa statistics. Results: In 19 out of 34 patients, local invasion was confirmed surgically or histopathologically (13 pancreas invasion, 6 liver invasion, 4 major vascular invasion, 3 colon and mesocolon invasion, and 2 spleen invasion). The diagnostic performance of OCI was superior to AXI or CCI in the local invasion of AGC. The differences in the area under the curve of AXI (0.770 ± 0.087, 0.700 ± 0.094), CCI (0.884 ± 0.058, 0.958 ± 0.038), and OCI (0.954 ± 0.050, 0.956 ± 0.049), were statistically significant for both reviewers. Inter-observer agreement was excellent for OCI (κ= .973), which was greater than CCI (κ= .839), and AXI (κ= .763). Conclusion: On a CT scan, OCI might be a useful imaging technique in evaluating locally invasive advanced gastric cancer. 목적: 진행위암환자에서 다검출기전산화단층촬영술(MDCT)로 인접장기침습여부를 결정하는데 있어 위장종축에 평행하게 재구성한 관상사면 영상의 유용성을 축상 및 관상 영상과 비교하여 알아보고자 하였다. 대상과 방법: 위암으로 수술 전 시행한 CT 소견상 인접장기침습의 가능성이 있을 것으로 생각하는 국소침습진행위암환자 중 개복술이나 복강경을 시행한 환자 34명을 대상으로 하였다. 영상분석은 두 명의 복부영상의학전문의가 독립적으로, 축상, 관상, 그리고 관상사면 영상별로 종양의 인접장기침습유무를 분석하였으며, 진단신뢰도를 평가하기 위해 주위장기침습이 의심되는 정도를 5단계 등급으로 나누어, 장기침습가능성이 전혀 없음을 1, 확실한 장기침습을 5로 기록하였다. 결과: 개복술이나 복강경 소견에서 34명의 환자 중 19명(56%)에서 주위장기침습이 있었으며, 장기 별로는 췌장 13예, 간 6예, 주요 혈관이 4예, 결장 및 결장간막 3예, 비장이 2예였다. 민감도, 특이도, 양성예측도, 음성예측도, 정확도를 분석한 결과 전체적으로 축상영상보다 관상영상에서, 관상영상보다는 관상사면영상에서 높은 성적을 보였다. 또한, receiver operating characteristic (ROC) 분석 방법을 이용한 진단신뢰도에서, 두 분석자 모두에서 관상사면영상(0.979 ± 0.022 대 0.977 ± 0.023), 관상영상(0.907 ± 0.050 대 0.905 ± 0.051), 축상영상(0.705 ± 0.089 대 0.763 ± 0.082) 순으로 나왔다. 분석자간 진단 일치도를 weighted kappa statistics를 이용하여 구한 결과 역시 관상사면영상(κ= .973)이 관상 (κ= .839) 및 축상 영상(κ= .763) 보다 좋은 결과를 보였다. 결론: 국소침습진행위암환자에서 관상사면영상은 인접장기침습유무 판별에 유용하게 사용될 수 있을 것으로 생각한다.

Positioning During CT Gastrography in Patients with Gastric Cancer: the Effect on Gastric Distension and Lesion Conspicuity

김혜진,김아영,이진혁,육정환,유은실,하현권 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.3

Objective: We wanted to prospectively evaluate the effect of various positions of the patient on gastric distension and lesion conspicuity during performance of CT gastrography (CTG). Materials and Methods: One hundred thirteen consecutive patients with gastric cancer underwent CTG in the 30 left posterior oblique (LPO), supine, and prone positions. Two radiologists scored (a grade from 1-4) the degree of gastric distension and the lesion conspicuity according to the three scanning positions and the three gastric portions. Two- (2D) and three-dimensional (3D) images were used for analysis. Finally, these data were compared with the endoscopic findings and surgical results. Results: The mean scores of gastric distension and lesion conspicuity for the LPO and supine positions were higher than those for the prone position (p < 0.001) in the gastric middle and lower portions. However, there was no significant difference between the LPO and supine positions (p 0.21). As for the gastric upper portion, the mean scores of gastric distension in the prone position were higher than those in the two other positions (p < 0.001). The prone position showed better lesion conspicuity than the two other positions for only one of two cases of gastric cancer in the upper portion of the stomach. Conclusion: CTG performed in the LPO position or the supine position combined with CTG performed in the prone position is optimal for achieving good gastric distension and evaluating the lesion conspicuity of gastric cancer. Objective: We wanted to prospectively evaluate the effect of various positions of the patient on gastric distension and lesion conspicuity during performance of CT gastrography (CTG). Materials and Methods: One hundred thirteen consecutive patients with gastric cancer underwent CTG in the 30 left posterior oblique (LPO), supine, and prone positions. Two radiologists scored (a grade from 1-4) the degree of gastric distension and the lesion conspicuity according to the three scanning positions and the three gastric portions. Two- (2D) and three-dimensional (3D) images were used for analysis. Finally, these data were compared with the endoscopic findings and surgical results. Results: The mean scores of gastric distension and lesion conspicuity for the LPO and supine positions were higher than those for the prone position (p < 0.001) in the gastric middle and lower portions. However, there was no significant difference between the LPO and supine positions (p 0.21). As for the gastric upper portion, the mean scores of gastric distension in the prone position were higher than those in the two other positions (p < 0.001). The prone position showed better lesion conspicuity than the two other positions for only one of two cases of gastric cancer in the upper portion of the stomach. Conclusion: CTG performed in the LPO position or the supine position combined with CTG performed in the prone position is optimal for achieving good gastric distension and evaluating the lesion conspicuity of gastric cancer.

수직형 합성 베어링 내부유동특성에 관한 수치해석

김철환(C. H. Kim),최훈기(H. K. Choi),유근종(G. J. Yoo),하현천(H. C. Ha) 한국트라이볼로지학회 2010 한국트라이볼로지학회 학술대회 Vol.2010 No.11