• 대한임상독성학회지
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• 제4권2호
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• pp.137-142
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• 2006

Our records include two cases of DIC in snakebite patients. One patient, who was 48-years old, was bitten in his left ankle 3 days before admission to our hospital. Initial symptoms were painful swelling, extensive ecchymosis, and persistent bleeding at the bite site. He visited and was admitted to a local hospital, but his condition did not improve with supportive care that included a single dose of antivenin. He was transferred to our hospital. His condition was compatible with DIC. We tried multi-dose antivenin therapy and blood product transfusion. At the seventh hospital day, the patient's symptoms were completely resolved. The other patient, who was 75 years old, was bitten in his right thumb. Initial symptoms were painful swelling of the right arm and persistent bleeding at the bite site, and within minutes of hospital admission, the patient experienced massive hematochezia. We peformed laboratory tests, the results of which were compatible with DIC, and the next day a sigmoidscopic examination showed ischemic colitis. We administered multi-dose antivenin therapy and blood product tranfusion. At the third hospital day mild anemia still existed, but the patient's clinical condition was improved. No signs or symptoms of gastrointestinal bleeding were observed. In these two cases, multi-dose antivenin therapy and transfusion effectively resolved symptoms of DIC. Platelet concentrate transfusion was required only for acute thrombocytopenia. After resolution of DIC, platelet counts were returned to normal ranges within a few days. The authors propose that multidose antivenin therapy and coagulation factor transfusion might be useful for improving coagulopathy in snakebite patients.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.121-126
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• 2011

Purpose: Vaccum-assisted closure (VAC) has rapidly evolved into a widely accepted treatment of contaminated wounds, envenomations, infiltrations, and wound complications. This results in a sealed, moist environment where tissue is given the opportunity to survive as edema is removed and perfusion is increased. Many plastic surgeons now place a VAC device directly over the fasciotomy site at the time of the initial procedure. Large amounts of the fluid are withdrawn, and fasciotomies can be closed primarily sooner. This study was designed to observe the effect of VAC in preventing complications in snake bitten hands. Methods: In our study of three cases of snake bite, three of them underwent the VAC treatment & fasciotomy of the wound in the hand. This cases, the posterior compartment of the hand was bitten for a few days, releasing incisions were made of the posterior hand and 125 mmHg of continuous vacuum was applied to fasciomy incision site and the biting wound. The dressings were changed three times per week. Results: Our study examining the effects of applied vacuum in preventing snake bite wounds showed that the incidence of tissue necrosis and compartment syndrome was significantly lower for vacuum-treated wounds than for conservative wounds. Serum myoglobin, CK-MB, and CPK levels measured after fasciotomy incision were significantly decreased. We obtained satisfactory results from early dorsal fasciotomy, drainage of the edema with the VAC system, and then primary closure. The postoperative course was uneventful. Conclusion: Envenomation is a term implying that sufficient venom has been introduced into the body to cause either local signs at the site of the bite and/or systemic signs. Use of the vacuum-assisted closure device in snake bite can result in a decreased rate of tissue necrosis, lymphatic fluid collection, hemolytic fluid collection, and edema. Early fasciotomy of the dorsal hand and VAC apply is the alternative treatment of the snake bite.

• 한국전기전자재료학회논문지
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• 제26권5호
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• pp.367-372
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• 2013

In this paper, micro dried bio-potential electrodes are demonstrated for sEMG (surface ElectroMyoGraphic) signal measurement using conductive epoxy on the textile fabric. Micro dried bio-potential electrodes on the textile fabric substrate have several advantages over the conventional wet/dry electrodes such as good feeling of wearing, possibility of extended-wearing due to the good ventilation. Also these electrodes on the textile fabric can easily apply to the curved skin surface. These electrodes are fabricated by the screen-printing process with the size of $1mm{\times}10mm$ and the resultant resistance of these electrodes have the average value of $0.4{\Omega}$. The conventional silver chloride electrode shows the average value of $0.3{\Omega}$. However, the electrode on the textile fabric are able to measure the sEMG signal without feeling of difference and this electrode shows the lower resistance of $1.03{\Omega}$ than conventional silver chloride electrode with $2.8{\Omega}$ in the condition of the very sharp curve surface (the radius of curvature is 40 mm).

• Archives of Plastic Surgery
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• 제35권2호
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• pp.165-168
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• 2008

Purpose: The dog bite injury is expected to increase as westernizing lifestyle and the number of pet raisers increase. The bite injuries may cause serious sequelae. The purpose of this study is to contributes to establish a suitable management and treatment principle for domestic situation with a clinical analysis data of the dog bite injuries. Methods: We reviewed the hospital records of 76 patients with dog bite injuries who were treated in the emergency unit or out patient department of our hospital from January 2000 to May 2006. Results: The majority of patients were children less than 10 years of age, 21 case(27.6%). Injuries occurred most often in May and 14 patients(18.4%) were bitten by the kinds of Cockerspaniel. By Lackmann's classification, 36 patients(47.4%) had Stage I injuries, 27 patients (35.5%) Stage II, 11 patients(14.5%) Stage III and 2 patients(2.6%) Stage IVa. The most frequent injury site was the head and neck area with 55 cases(72.4%). Also, 58 cases(76.3%) were received the initial treatment within 30 minutes after being bitten and the most of case except emergency operation repaired within 3 days.Conclusion: The dog bite injuries increased by more than 20% every year over the study period and it says that it may continue to increase more in the future. However, There are little report or literature for suitable management and treatment principle for domestic situation. The authors think this clinical analysis data and treatment experience can be useful for establishing a suitable treatment principle for domestic situation.

• 대한임상독성학회지
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• 제7권2호
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• pp.105-112
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• 2009

Purpose: There have been local wound complications in patients who have received first aid after venomous snake bites. Yet first aid in relation to local wound complications has not been well studied. Methods: We conducted a 5-year retrospective study of 111 snake bite patients who visited the emergency departments of several medical centers between January 2004 and December 2008. We categorized the patients into those who had complications with inadequate first aid, those who had complications without first aid those who had complications with adequate first aid. We compared the genera characteristics and the laboratory and clinical findings of the three groups. Results: The ale o female ratio was 1.36. The most common bite site was fingers. The most common systemic symptom was dizziness (6.3%) and the most common complication was rhabdomyolysis (23.4%). The inadequate first aids group had more local complications (cellulitis, skin necrosis) than did the group with adequate first aid or the group with no first aids. Conclusion: Inadequate first aid after snake bite leads to local complications, so we must be careful to administer first aid after snake bite and evaluate this first aid in elation to local complications.

• 대한임상독성학회지
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• 제7권2호
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• pp.97-104
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• 2009

Purpose: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. Methods: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. Results: The 32 patients had an average age of $54.0{\pm}14.5$ years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. Conclusion: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2003년도 하계학술대회 논문집 B
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• pp.1350-1352
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• 2003

For developing a 100 kW MCFC power generation system, Several design parameters for a fuel cell stack and system analysis results by Cycle Tempo, a processing computer soft ware, were described. Approximately two substacks with 90 cells are required to generate 100 kW at a current density of $125\;mA/cm^2$ with $6000\;cm^2$ of cells. An overall heat balance was calculated to predict exit temperature. The 100 kW power is expected only under pressurized operation condition at 3 atm. Recycle of cathode gas by more than 50% is recommended to run the stack at $125\;mA/cm^2$ and 3 atm. Manifolds should be designed based on gas flow rates for the suggested operating condition. The fuel cell power generation system was designed conceptually with several choices of utilization of anode exhaust gas. To operate and evaluate the MCFC system, control and measurement system and operation mode are designed before 100 MCFC system construction. In system control schematics, OS, PLC and MMI were consisted and have roles for MCFC system control. For operation of 100 kW MCFC system, NS, PS PR mode were considerated step by step and simulated.

• 한국임상수의학회지
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• 제24권2호
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• pp.137-141
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• 2007

The medical records of 69 dogs with history of bite wounds, between 1998 and 2006, were reviewed. Information obtained from these files included the general statistics of the patients (sex, age, breed, weight), season on occurrence of injuries, body areas wounded, therapeutic regime used and mortality rates. Intact male dogs were more frequently bitten. The weight distribution of the bitten population was varied 41% for small, 16% for medium and 17% for large dogs. The highest incidence was in young animals. The distribution of bite wound injuries over the year was recorded with peaks in April (13%), March (12%), August (12%) and September (10%). The common regions of injury were the head (22), fore-limbs (17), hind-limbs (15), abdomen (15), thorax (15) and neck (14). Mortality tends to be increased in cases of thoracic or abdominal injury. The results about the prevalence of bite wounds in Daejeon and Chungnam area are intended to use as a reference data in veterinary practice.

• 대한임상독성학회지
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• 제20권2호
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• pp.45-50
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• 2022

Purpose: This study utilizes the NEDIS (National Emergency Department Information System) database to suggest a predictive model for snakebite and envenomation in Korea by analyzing the geographical distribution and seasonal variation of snakebite patients visiting the ER. Methods: This was a retrospective study on snakebite patients visiting the ER using the NEDIS database from January 2014 to December 2019. The subjects include patients with the KCD (Korea Standard Classification of Disease) disease code T63.0 (Toxic effect of contact with snake venom). Geographical location, patient gender, patient age, date of ER visit, treatment during the ER stay, and disposition were recorded to analyze the geographical distribution and seasonal variation of snakebite patients in Korea. Results: A total of 12,521 patients were evaluated in this study (7,170 males, 54.9%; 5,351 females, 40.9%). The average age was 58.5±17.5 years. In all, 7,644 patients were admitted with an average admission time of 5.04±4.7 days, and 2 patients expired while admitted. The geographical distribution was Gyeongsang 3,370 (26.9%), Cheonra 2,692 (21.5%), Chungcheong 2,667 (21.3%), Seoul Capital area 1,999 (16.0%), Kangwon 1,457 (11.6%), and Jeju 336 (2.7%). The seasonal variation showed insignificant incidences in winter and higher severity in spring and summer than in fall: winter 27 (0.2%), spring 2,268 (18.1%), summer 6,847 (54.7%), and fall 3,380 (27.0%). Conclusion: Patients presenting with snakebites and envenomation in the emergency room were most common in the Gyeongsang area and during summer. The simple seasonal model predicted that 436 snakebites and 438 envenomation cases occurred in July and August. The results of this study can be applied to suitably distribute and stock antivenom. Appropriate policies can be formed to care for snakebite patients in Korea.

• 대한임상독성학회지
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• 제20권2호
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• pp.51-57
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• 2022

Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.