• Journal of Trauma and Injury
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• v.18 no.2
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• pp.141-147
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• 2005

Purpose: Recently, The new Injury Severity Score (NISS) has become a more accurate predictor of mortality than the traditional Injury Severity Score (ISS) in the trauma population. Trauma Score Injury Severity Score (TRISS) method, regarded as the gold standard for mortality prediction in trauma patients, still contains the ISS as an essential factor within its formula. The purpose of this study was to determine whether a simple modification of the TRISS by replacing the ISS with the NISS would improve the prediction of in-hospital mortality in a trauma population with blunt head and neck trauma. Objects and Methods: The study population consisted of 641 patients from a regional emergency medical center in Kyoungsangnam-do. Demographic data, clinical information, the final diagnosis, and the outcome for each patient were collected in a retrospective manner. the ISS, NISS, TRISS, and modified TRISS were calculated for each patients. The discrimination and the calibration of the ISS, NISS, modified TRISS and conventional TRISS models were compared using receiver operator characteristic (ROC) curves, areas under the ROC curve (AUC) and Hosmer-Lemeshow statistics. Results: The AUC of the ISS, NISS, modified TRISS, and conventional TRISS were 0.885, 0.941, 0.971, and 0.918 respectively. Statistical differences were found between the ISS and the NISS (p=0.008) and between the modified TRISS and the conventional TRISS (p=0.009). Hosmer-Lemeshow chi square values were 13.2, 2.3, 50.1, and 13.8, respectively; only the conventional TRISS failed to achieve the level of and an excellent calibration model (p<0.001). Conclusion: The modified TRISS is a more accurate predictor of in-hospital mortality than the conventional TRISS in a trauma population of blunt head and neck trauma.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2003.09a
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• pp.108-108
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• 2003

식도 천공의 치료는 최근 치료법의 발전에도 불구하고 여전히 난해한 문제이다. 이 환자들은 천공의 원인이나 위치, 심한 정도가 다양한 이질적인 군이며, 반수 이상이 이미 식도에 기존의 질환을 가지고 있어 문제를 더욱 복잡하게 한다. 따라서 절대적이고 획일적인 치료방법은 아직 확립되어 있지 않으며 많은 다양한 방법들이 제시되고 있다. 2002년 11월부터 2003년 7월까지 총 8명의 환자가 식도 천공으로 동아대학교병원 흥부외과에서 치료를 받았으며, 원인별로는 의인성(iatrogenic) 손상이 6례, 자발성(spontaneous) 손상이 2례였고 부위별로는 경부가 3례, 흥부가 5례였다. 의인성 손상에는 내시경 검사중 정상 경부 식도에 발생한 1례, 부식성 식도협착 환자의 풍선 확장술과 스텐트 삽입시 흉부 식도에 발생한 경우가 각각 1례씩, 외상성 경추손상의 수술시 정상 경부 식도에 발생한 경우가 2례, 선천성 식도폐쇄증(esophageal atresia)의 술후 문합부 누출이 생긴 경우가 1례 있었으며, 자발성 손상에는 하부식도에 발생한 기압성(barogenic) 손상 1례와 상흉부 식도암 천공 1례가 있었다. 경부 식도 천공 3례는 모두 경부 배액(drainage)과 식이용 장루술(feeding jejunostomy)을 시행하였고, 부식성 식도협착이 있던 환자 2례는 식도절제술과 흉부내 식도-위 문합을 시행하였으며, Boerhaave씨 증후군 환자는 1차 봉합술, 술후 문합부 유출이 있었던 환자와 식도암 천공이 있었던 환자는 식도절제 및 경부 식도루(esophagostomy), 배액용 위루(gastrostomy), 식이용 장루술을 시행하였다. 모든 환자는 패혈증 등의 심각한 합병증으로의 진행 없이 회복되었다. 현재 위장관의 연속성이 유지 혹은 복원된 환자는 경구식이 중이며 그 외의 환자들은 장루를 통해 영양을 공급하며 식도재건술을 기다리고 있다. 식도 천공은 최근 항생제의 사용, 과영양요법(hyperalimentation), 술후 환자관리의 개선 등으로 치료에 많은 발전이 있었으나, 치료 방침에 있어서는 여전히 논란이 있으며 높은 사망률을 보이는 난제로 남아있다. 비록 일반적인 지침이 도움이 되겠지만, 치료 방침은 환자 개개인의 상황에 따라 적절하게 선택해야 하며, 임상경과에 따라 언제라도 방침을 변경할 수 있는 유연함이 필요하리라 생각한다.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1062-1068
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• 1997

From August 1989 to January 1996, a total of 105 cases of bidirectional Glean operations have been done as the interim stage for the patien s with some risk of univentricular correction at Sejong General Hospital. From December 1992, we started the conversion to Fontal operations for them, and 42 cases underwent Fontal-stage operation till February 1996. Their diagnoses were univentricular heart in 19(right ventricular type : 14), tricuspid atresia 11, double outlet of right ventricle 9, and others in 3 cases. The median age of bidirectional Glerln-stage operation was 12.5 months(range 2 months to 8 years) and Fontan-stage operation was at 59.6 months of median age(range 1 year 5 months to ,9 year 7 months). The mean waiting interval between the two operations was 33.88 $\pm$ 17.85 months with a range of 10 months to 6 years 3 months. During the waiting periods, 18 patients developed significant systemic-pulmonary collaterals andfor systemic verso-veno collateral channels. There were 5 hospital deaths after operations due to low cardiac output in 4 and sepsis in one. Most of the Fontal-stage operations were done by the late al tunneling with Core-Tex tube graft patch and fenestrated with the size of 2.5 ~6 mm. All the patients were followed-up(7 months to 4 years 2 months, mean 21.97$\pm$10.82 months) and there were 5 late deaths(postoperatively 6 months to 2 years) due to thromboembolism in 1, after heart transplantation 1, plastic bronchitis 1, protein loosing enteropathy 1, and pneumonia in 1. Dividing the patients by the waiting interval of 2 years, the early correction to Fontal group (N=16) showed the better results(hospital mortality 1116, late mortality 1116, significant collateral development 2/16) compared to the other group(N=26) (4/26, 4/26, 16/26). In conclusion, after the bidirectional Glean-stage operation successfully got rid of the previous risk factors, we recommand to do the Fontan-stage operation no later than 2 years of interval.

• The Korean Society of Law and Medicine
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• v.24 no.1
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• pp.101-130
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• 2023

Korea has very easy access to tertiary hospitals, including university hospitals, among OECD countries, and patients can reach the emergency room of a university hospital within 1-2 hours. However, there are many so-called 'essential medical' blind spots where people die because they do not receive surgery in time. In particular, in the case of essential medical care in the surgical field, despite basic surgery, there is a shortage of medical staff to perform outpatient surgery in emergency situations at university hospitals. Although this lack of manpower has a problem with low insurance premiums for surgery, it also has a very large impact on the burden of criminal liability for medical malpractice, which increases the incidence in case of emergencies. Here, we propose crime immunity to solve the manpower shortage of converged smart surgical essential medical (SES) hospitals. Currently, the medical community agrees on the need for crime immunity, but it is an ambiguous scope of immunity that has not reached a national consensus. We would like to present clear standards for essential medical practices (surgery) that require criminal immunity.

• Journal of Preventive Medicine and Public Health
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• v.9 no.1
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• pp.129-138
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• 1976

The causes and problems underlying deaths in perinatal period are often similar and might be expected to yield to same type of preventive measures. This is one of the reasons for attempting to develop a reporting of perinatal mortality and its related matters. This study aims at figuring out the biologic risk factors onto the perinatal death. Considering stillbirth and early neonatal mortality separately, considerable associations between stillbirth and reproductive history of women, are observed, ana it is found that prematurity is the the far most important factor in the early neonatal mortality.

• Clinical and Experimental Pediatrics
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• v.51 no.11
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• pp.1179-1184
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• 2008

Purpose : Pulmonary interstitial emphysema (PIE) primarily occurs in preterm infants suffering from respiratory distress syndrome (RDS) and kept under mechanical ventilator care. Therefore, this study aimed to examine various risk factors for PIE, to identify conditions that can decrease the possibility of PIE development. Methods : PIE classification was conducted for 183 patients diagnosed to have RDS and receiving mechanical ventilator care with pulmonary surfactant between March 2000 and February 2007. The characteristics of each patient were analyzed through retrospective examination of their medical histories. Results : Among 183 patients, 17 had PIE; all factors, including birth weight, gestational age, RDS grade III or above, chorioamnionitis, and premature rupture of membranes, were statistically significant (P<0.05). The period of mechanical ventilator use was statistically significant, but the peak mean airway pressure and peak partial pressure of inspired oxygen were not. PIE mainly occurred on the right side or both sides rather than the left side and mostly developed within 72 h. The PIE group showed higher mortality rate than the control group, and the major cause of mortality was pneumothorax. Conclusion : Risk factors for PIE in infants suffering from RDS and kept under mechanical ventilator care include low gestational age, low birth weight, chorioamnionitis, and premature rupture of membranes. If any risk factors are noted, the infant must be observed closely for at least 72 h after birth.

• Journal of the Korean Society of Radiology
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• v.84 no.6
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• pp.1339-1349
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• 2023

Purpose To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. Materials and Methods This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan-Meier method. Results Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. Conclusion IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms.

• Korean Journal of Psychosomatic Medicine
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• v.24 no.1
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• pp.74-82
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• 2016

Objectives : Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. Methods : One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. Results : Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. Conclusions : Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.11
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• pp.5238-5246
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• 2012

This study was done to identify the evaluation of CPSCS for neurocritical patients and provide effective nursing interventions for these patients. Data were collected from medical records of 203 neurocritical patients over 18 years of age who were admitted to the ICU of C University Hospital during the period from January 2008 to May 2009 and from October 2011 to December 2011. Collected data were analyzed through t-test, ANOVA test, Person's correlation analysis, trend analysis, stepwise multiple regression. The average CPSCS score was $112.09{\pm}18.91$ and there was a significant trendency for higher severity to lead to higher CPSCS's scores(survival: J-T:9.795, die: J-T:5.415, p=<.001). The scores of the respective areas follows measurement of vital sign($3.74{\pm}2.15$), monitoring($28.97{\pm}4.31$), activity daily living ($34.99{\pm}3.66$), feeding($.19{\pm}.98$), intravenous infusion ($18.20{\pm}8.27$), treatment/procedure ($16.93{\pm}4.90$), respiratory therapy($8.61{\pm}7.07$). By means of stepwise multiple regression analysis, the intravenous therapy & medication, respiratory therapy, activities of daily living, and monitoring area that contains the model showed a significant (F=2073.963, p<.001), and they explained 98.1% of CPSCS. These findings provide information that is relevant in designing interventions to enhance CPSCS among neurocritical patients in hospital.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.836-846
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• 2002

Purpose : With the development of neonatal intensive care and the increased use of systemic antibiotics, candida sepsis has become one of the most important causes of neonatal morbidity and mortality. The purpose of this study was to investigate the prevalence rate and its associated risk factors. Methods : We retrospectively reviewed medical records of 28 cases with candida sepsis who were admitted in the neonatal intensive care unit(NICU) of Chonnam University Hospital from July 1995 to June 2001. Twenty-nine patients without candida sepsis were enrolled for the control group to verify the risk factors. Results : The overall incidence of candida sepsis was 0.61% for all NICU admissions and 3.68% for all very low birth weight infants with the gradual increase of the annual prevalance rate over time. The endotracheal intubation, percutaneous central vein catheter(PCVC), umbilical vein catheter, total parenteral nutrition, intralipid and dopamine were more applied than the control group (P<0.01 for all). The durations of mechanical ventilator care, central catheter appliance, nothing per os, and admission were also significantly longer than the control group(P<0.01 for all). Ampicillin/ sulbactam, ceftazidime, amikacin, netilmicin, teicoplanin and imipenem/cilastatin were significantly more used than the control group(P<0.05). The durations of ampicillin/sulbactam, ceftazidime, netilmicin and imipenem/cilastatin administration were also proved to be significant as the risk factors(P<0.01). Conclusion : The average annual prevalence rate of candida sepsis in NICU for six years was 0.61% with gradual increasing tendency over time. The elimination of the above risk factors is important in decreasing neonatal morbidity and mortality associated with candida sepsis.