Kim, Jeong-Eun;Namgung, Ran;Park, Min-Soo;Park, Kook-In;Lee, Chul;Kim, Myung-Jun
Neonatal Medicine
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v.17
no.1
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pp.34-43
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2010
Purpose : The aim of this study was to examine whether hypercapnia during the first seven days of life was associated with severe intraventricular hemorrhage (IVH) in preterm infants requiring mechanical ventilation. Methods : A matched pair analysis was performed for 19 preterm infants with severe IVH(grade$\geq$3) and 38 infants with no severe IVH (normal or grade 1), who required mechanical ventilation for more than seven days. The univariate and multivariate analysis of severe IVH with maximal and minimal $PaCO_2$, averag $PaCO_2$, SD of $PaCO_2$, and difference in the $PaCO_2$ were assessed. The major perinatal factors and maximal ventilator index (VI) were also compared. Results : Infants with severe IVH had a higher maximal $PaCO_2$ (86.1$\pm$18.4 mmHg vs. 60.1$\pm$ 11.6 mmHg, P <0.001) and mean $PaCO_2$ (47.5$\pm$5.6 mmHg vs. 41.2$\pm$6.3 mmHg, P=0.004) and a larger SD or difference in $PaCO_2$ (14.0$\pm$4.4 mmHg vs. 9.0$\pm$2.4 mmHg; 60.3$\pm$20.9 mmHg vs. 35.5$\pm$11.8 mmHg, P <0.001). However the minimal $PaCO_2$ values did not differ between the groups. Disseminated intravascular coagulation, pulmonary hemorrhage, and the air leak syndrome were more frequent in the IVH group than in the controls. The maximal VI on each day was higher in the IVH group. The multivariate logistic regression analysis after controlling for bleeding tendency showed that the air leak syndrome, maximal VI, and maximal $PaCO_2$ were independently associated with severe IVH [OR, 1.324 (95% CI, 1.011-1.733; P=0.041)]. Conclusion : Extreme hypercapnia was significantly associated with severe IVH in preterm infants, after adjustment for major perinatal risk factors. Frequent monitoring of the $PaCO_2$ may be important for early detection of inadvertent hypercapnia and prompt correction of high PaCOS levels.
Background: Video-assisted thoracoscopic surgery(VATS) has been established as a new method for treatment of spontaneous pneumothorax. We compared the clinical results of VATS with those of thoracotomy performed during the recent 5 years. Material and Method: We analyzed 126 patients whose medical records were available among the 154 patients who underwent operations for spontaneous pneumothorax from 1992 to 1996. The mean age was 27.1 years(15 to 75 years). 87 patients were operated on by VATS(Group A) and the other 39 by thoracotomy(Group B). The mean follow-up period was 14.7 months. Result: The operation time was shorter in group A than in group B(90.6${\pm}$38.6minutes: 117.2${\pm}$58.9minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than in group B(6.7${\pm}$4.2: 9.4${\pm}$3.3 days, p<0.05). The amount of analgesics(nalbuphin HCl, ketoprofen) used postoperatively were 2.4${\pm}$2.8 ampules in group A, which is less than the 6.5${\pm}$5.6 ampules in group B(p<0.05). The number of staples used in group A was smaller(2.7${\pm}$1.3 in group A, 1.76${\pm}$1.1 in group B, p<0.05). The duration of chest tube indwelling(4.3${\pm}$4.0 days in group A, and 5.6${\pm}$3.0 days in group B, NS), the recurrence rate(13.8% in group A, 2.6% in group B, NS), and the duration of air leakage(1.3${\pm}$3.3 days in group A, and 1.0${\pm}$2.5days in group B, NS) were not statistically different between the two groups. Conclusion: The application of VATS for the treatment of spontaneous pneumothorax has brought in better clinical results(shorter operation time, shorter hospital stay, less pain, and better cosmetic merits) than the thoracotomy without increasing any morbidity. However no advantages in recurrence rates and duration of postoperative air leakages are revealed.
Korea Gas Safety Corporation is developing consequence analysis system for combustible materials release events to enhance risk assessment technology and its efficiency. Unlike general consequence analysis programs, the final consequence area was implemented through ETA analysis based on API-581 standard, and a convenient user interface was constructed based on HTML5-based responsive web technology. In addition, a phase equilibrium module using third-order state equations (such as Peng-Robinson, SRK, and RK) and fugecity was implemented to analyze the mixture quality. Also. using the consequence analysis algorithm introduced in CCPS books and TNO Yellow Book, we developed material leak analysis module, fireball, pool fire, jet fire, flash fire, and vapor cloud explosion consequence assessment module. In addition, the conditions for calculating the safety distance were prepared with using the control values in the EIGA standard, PAC, and Bevi Reference Book.
North Korea's uranium enrichment facility is a matter of international concern. It is of particular alarming to South Korea with regard to the security and safety of the country. This situation requires continuous monitoring of the DPRK and emergency preparedness on the part of the ROK. To assess the detectability of an undeclared uranium enrichment plant in North Korea, uranium concentrations in the air at both a short and a long distance from the enrichment facility were estimated. $UF_6$ source terms were determined by using existing information on North Korean facility and data from the operation experience of enrichment plants from other countries. Using the calculated source terms, two atmospheric dispersion models (Gaussian Plume Model and HYSPLIT models) and meteorological data were used to estimate the uranium particle concentrations from the Yongbyon enrichment facility. A maximum uranium concentration and its location are dependent upon the meteorological conditions and the height of the UF6 release point. This study showed that the maximum uranium concentration around the enrichment facility was about $1.0{\times}10^{-7}g{\cdot}m^{-3}$. The location of the maximum concentration was within about 0.4 km of the facility. It has been assumed that the uranium sample of about a few micrograms (${\mu}g$) could be obtained; and that few micrograms of uranium can be easily measured with current measurement instruments. On the contrary, a uranium concentration at a distance of more than 100 kilometers from the enrichment facility was estimated to be about $1.0{\times}10^{-13}{\sim}1.0{\times}10^{-15}g{\cdot}m^{-3}$, which is less than back-ground level. Therefore, based on the results of our paper, an air sample taken within the vicinity of the Yongbyon enrichment facility could be used to determine as to whether or not North Korea is carrying out an undeclared nuclear program. However, the air samples taken at a longer distance of a few hundred kilometers would prove difficult in detecting a clandestine nuclear activities.
Background: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure ($P_{cuff}$) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired gas exchange due to cuff leakage is related to a low $P_{cuff}$. To prevent these complications, the $P_{cuff}$ should be kept appropriately because the appropriate $P_{cuff}$ appears to change according to the patient's daily respiratory mechanics. However, the constant cuff volume($V_{cuff}$) has frequently been instilled to the cuff balloon on a daily basis to maintain the optimal $P_{cuff}$ instead of monitoring the $P_{cuff}$ directly at the patients' bedside. To address the necessity of continuous $P_{cuff}$ monitoring, the change in the $P_{cuff}$ was evaluated at various $V_{cuff}$ levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continuous monitoring $P_{cuff}$ was also investigated. Method: The change in $P_{cuff}$ according to the increase in $V_{cuff}$ was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in $P_{cuff}$ daily during the mechanical ventilation days. In addition, the $P_{cuff}$ measured by mercury column sphygmomanometer was compared with the $P_{cuff}$ measured by an automatic cuff pressure manager. Results : There were no statistically significant changes of $P_{cuff}$ during more than 14 days of intubation for mechanical ventilation. However the $V_{cuff}$ required to maintain the appropriate $P_{cuff}$ varied from 1.9 cc to 9.6 cc. In addition, the intra-individual variation of the $P_{cuff}$ was observed from 10 $cmH_2O$ to 46 $cmH_2O$ at constant 3 cc $V_{cuff}$. The $P_{cuff}$ measured by the bedside mercury column sphygmomanometer is well coincident with that measured by the automatic cuff pressure manager. Conclusion: Continuous monitoring and management of the $P_{cuff}$ to maintain the appropriate $P_{cuff}$ level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.
Purpose : This study was conducted for the use of nasal continuous positive airway pressure (CPAP), by comparing the early use of non-invasive nasal CPAP with low intermittent mandatory ventilation(low IMV) and endotracheal CPAP in weaning a mechanical ventilator from infants with moderate respiratory distress syndrome(RDS). Methods : Thirty infants in the study group, with moderate RDS from November 2001 to June 2002, were administered surfactants and treated with the mechanical ventilator, and applied the nasal CPAP in weaning. Thirty infants of the control group, from January 1999 to September 2001, were applied low IMV and endoctracheal CPAP in weaning. Results : There were no significant differences in the characteristics, the severity of clinical symptoms, the initial laboratory findings and settings of the mechanical ventilator. After weaning, the study group showed no significant changes in $PaCO_2$. However, the control group showed a slight $CO_2$ retension after one and 12 hours. Twenty eight infants(93.3%) of the study group and 24 infants(80%) of the control group were successfully extubated. The primary cause of failure was apnea. There were no significant differences in the duration of weaning and the mechanical ventilator treatment between the groups. Complications in weaning were related to the fixation of nasal CPAP and the mechanical problems caused by endotracheal tube. Conclusion : Aggressive weaning is possible for moderate RDS, in which the nasal CPAP was used without the low IMV and the endotracheal CPAP process. It had no difficulties. In conclusion, the nasal CPAP is an adequate weaning method for moderate RDS.
The window ventilation system based on the heat recovery device was developed which make air ventilation possible without opening the windows. However, mechanical and aerodynamic noises were come to pass which annoyed people in rooms. In the present study, noise of new window ventilation system was measured in both general room and anechoic chamber. Also, the noise path was detected to find cause of noise generation and vulnerable area of the device. Sound absorptive and insulation materials were applied to mitigate the noise. Finally, an alternative noise control method was suggested which can satisfy with the indoor noise standards. As a result, it was shown that the cause of noise was the low transmission loss in the ventilation system. As a result, it was shown that the main noise source of the ventilation system was the blower and the major cause of noise was the low transmission loss of the ventilation system. It is also concluded that the noise levels complies with the noise standards of 40 dBA when 2 mm rubber sheet is applied inside the ventilation system.
From 1991 to 1994, We performed 75 cases of pulmonary resection. These were divided into two groups according to the method of bronchial stump closure : 51 cases automatic staplers were a plied in 49 patients (Group 1), 24 patients were closed with manual interrupted suture (Group II). Disease entities of the patients were malignant tumor in 33 patients(Group I: Group II, 22· II, bronchiectasis in 23(18:5), benign tumor in 5(3:2), aspergilloma in 5(2:3), tuberculosis(2:1) in 3, bronchogenic cyst in 2 (0 : 2) and so on. Surgical Procedure% for these Patients were 21 Pneumonectomies(18:3), 13 bilobectomies(11:2), 26 lobectomles (14:12), 11 segmentectomies (6:5) and 4 lobectomy with segmentectomies (4:0). In conclusion, the Amount of tube drainage was smaller and the removal of chest tube after surgery was shorter than manual bronchial closure group by means of statistical significance (p=0.047, p=0.005). Although there were no statistical significance, the duration of air leakage was reduced and incidence of bronchopleural rstula was reduced in the stapler used group compared with manual bronchial closure.
Journal of Dental Rehabilitation and Applied Science
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v.27
no.3
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pp.337-342
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2011
Congenital or traumatic loss on the oral and maxillary area or the loss of jaws due to the surgical excision of a tumor causes functional problems, such as masticatory and swallowing disorders, phonetic problems and psychological disorders in patients. In most cases, a prosthetic restoration is needed to resolve these problems and restore the damaged tissue and function. When loss occurs on the maxilla, foods and liquids leak into the nasal cavity, and a nasal sound can be heard due to air leakage into the removed area. In these cases, the palatal obturator can be used to improve the esthetic and functional aspects because it restores the removed area of the maxilla and closes the opened route between the oral cavity and maxillary sinus or nasal cavity. In this case report, a palatal obturator was applied to patients who had a hemimaxillectomy due to the occurrence of squamous cell carcinoma on the right maxillary area. Therefore, fundamental functions, such as phonetic and swallowing functions were restored, and the esthetic aspects of the facial profile were improved.
Objectives: The goal of this study is to identify the distribution of the foliar fluorine content of vegetation surrounding the area where hydrofluoric acid was accidently released in Gumi, Gyeongsangbuk-do on September 27, 2012. In addition, it also aims to estimate the concentration of hydrogen fluoride in the air on the day of the accident. Methods: Samples of plant leaves were collected on October 7, 2012 within 1 km from the site where the accident occurred. These samples were analyzed for soluble fluorine ion with an ion selective electrode. The ambient concentration of hydrogen fluoride was calculated using the fluoride content in the plant via the dose-rate equation (${\Delta}F$=KCT). Results: The arithmetic and geometric means of the concentrations were 2158.2 and 1183.7mg F $kg^{-1}$ for leaves and, 2.4 and 1.1 ppm HF for the air, respectively. The highest concentration of hydrogen fluoride in the air was 14.7 ppm, which is higher than the maximum concentration reported by the government (1 ppm) and the exposure limit (ceiling, 3 ppm). The concentrations of both fluorine and hydrogen fluoride decreased with increasing distance from the accident site and showed a significant decrease outside of a 500m radius from the site (p <0.05). Conclusions: The area around the accident site was highly polluted with hydrogen fluoride according to the results of this study. Considering the persistency of hydrogen fluoride in the environment, long-term monitoring and environmental impact assessment should be pursued.
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