• Title/Summary/Keyword: 사망의 주요 원인

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Effects of Single Fetal Death on Mother and Live Co-twin in Twin Pregnancy (쌍태 임신에서 일측 태아의 자궁내 사망이 산모와 생존아에 미치는 영향)

  • Kim, So Youn;Chung, Hae Yul;Back, Hee Jo;Choi, Ic Sun;Cho, Chang Yee;Choi, Young Youn
    • Clinical and Experimental Pediatrics
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    • v.45 no.12
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    • pp.1512-1518
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    • 2002
  • Purpose : Twins have a higher mortality and morbidity than singletons. Co-twin with one fetal death is particularly at risk. We investigated the neonatal outcome of live co-twins when one fetus had died after the 20th gestational week, and associated risk factors. Methods : A retrospective study was performed in fifteen cases of twin pregnancy with single intrauterine fetal deaths after the 20th gestational week during the period from January 1996 to December 2000 at Chonnam University Hospital. Results : Gestational age was $33.7{\pm}3.2weeks$, birth weight was $1,992{\pm}592g$. Interval between one fetal death being detected and the delivery of a live co-twin was $32.4{\pm}29.5days$. There were 11 cases(73.3%) of premature babies less than 37 gestational weeks. Main causes of preterm delivery were preterm labor and premature rupture of membranes. Hematologic findings suggesting disseminated intravascular coagulopathy(DIC) were not found in all mothers before delivery, and was not associated with DIC and encephalomalacia of the live co-twin. Perinatal outcome of fifteen live co-twins was as follows : six were normal(40%), three were DIC(20.0%), three were encephalomalacia(20.0%), one suffered intrauterine growth retardation, there was one case of twin to twin transfusion syndrome, and one of congenital heart disease(atrial septal defect with pulmonary stenosis). The occurrence of DIC and encephalomalacia in live co-twins was not related to placental chorionicity, birth weight, gestational week, and the interval between the detection one fetal death and the delivery of a live co-twin. Conclusion : We could not find any maternal hematologic problems in twin pregnancies complicated by one fetal death. Twenty percent of live co-twins showed DIC and encephalomalacia. However, its associated risk factors were not found. We need to investigate more closely the cases of live co-twins with one intrauterine fetal death.

End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience (심폐소생술 금지 동의 후 사망한 환자의 현황과 연명의료 실태 조사: 단일 의료기관 경험)

  • Yoon, Sang Eun;Nam, Eun Mi;Lee, Soon Nam
    • Journal of Hospice and Palliative Care
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    • v.21 no.2
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    • pp.51-57
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    • 2018
  • Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.

영양상태와 면역능력

  • 김화영
    • Proceedings of the Korean Nutrition Society Conference
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    • 1992.05a
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    • pp.10-15
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    • 1992
  • 일반적으로 영양상태가 불량한 사람들은 저항력이 저하되어 질병에 잘 걸리고 사망율이 높으며 영양상태가 양호한 사람은 병균에 대한 저항력이 강하다는 것은 오래전 부터 알려져 온 사실이다. 그러므로 영양상태는 면역체계에 영향을 미치리라고 생각하게 되었고, 이를 뒷받침 할만한 많은 임상적, 역학적 연구들이 있다. 영양-면역-감염의 상호관계는 매우 복잡하고 여기에 관계되는 변인들은 아주 다양하다. 영양불량인 사람들은 대체로 가난하고 무지하며 위생시설도 나쁜 지역에 살고 있는 사람들이며, 이들에게 질병에 대한 감염은 항상 수반되는 문제이다. 즉, 영양불량, 면역능력 저하, 감염은 서로 영향 받으며 가난과 무지는 이러한 상태의 기본적인 원인이 된다고 하겠다. 영양불량인 사람들은 질병에 걸리기 쉽고, 또한 질병에 걸리면 영양상태를 더욱 악화시키는 악순환이 계속된다. 이제까지의 영양과 면역과의 연구에서는 단백질-열량 부족이 주로 연구되어 왔으나 그외의 특정한 영양소의 과부족이 면역능력에 미치는 영향도 연구되고 있다. 이러한 영양소로는 Fe, Zn, Cu Se 등을 포함한 무기질과, 비타민 A, C, E, 와 B 비타민들이 연구되고 있고, 또한 특정한 아미노산이나 지방산등도 관심을 모으고 있다. 여기에서는 단백질-열량 부족이 (PEM) 면역기능에 미치는 영향을 검토해봄으로써 영양과 면역과의 관계를 규명하기 위한 연구의 범위를 살펴보고자 한다. 또한 만성퇴행성 질병의 원인으로 생각되는 영양과잉과 면역과의 관계도 검토 하고자 한다.

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Primary Pulmonary Artery Sarcoma A Case Report -A Case Report- (원발성 폐동맥 육종)

  • 김성완;구본원
    • Journal of Chest Surgery
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    • v.30 no.10
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    • pp.1036-1039
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    • 1997
  • Primary pulmonary artery sarcoma is a rare tumor and commonly misdiagnosed as pulmonary embolism. The prognosis of these tumors is very poor. The Median length of survival without surgical resection is approximately 1.5 months, but surgical resection has lengthened survival time to approximately 1 year. We encountered a case of primary pulmonary artery sarcoma, with a 55 year-old woman whose symptoms were exertional dysp ea, right chest pain, and hemoptysis. A preoperative chest CT scan revealed mass lesion mimicking pulmonary embolism. Pulmonary angioplasty and right Pneumonectomy were Performed on partial cardiopulmonary bypass. Postoperatively the mass was confirmed as undifferenciated sarcoma histopathologically. The symptoms were somewhat improved, but the patient died of unknown causes about 3 months after surgery.

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Neuropathological Mechanisms of Perinatal Brain Injury (주산기 뇌손상의 신경병리적 기전)

  • Song Ju-Young;Kim Jin-Sang
    • The Journal of Korean Physical Therapy
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    • v.15 no.4
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    • pp.199-207
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    • 2003
  • This review describes the neurophathological mechanisms that are implicated in perinatal brain injury. Perinatal brain injury is the most important cause of morbidity and mortality to infants, often leading to spastic motor deficits, mental retardation, seizures, and learning impairments. The immature brain injury is usually caused by cerebral hypoxia-ischemia, hemorrhage, or infection. The important form of perinatal brain injury is the hypoxic-ischemic injury and the cerebral hemorrhage. The pathology of hypoxic-ischemic injury include delayed energy failure by mitochondrial dysfunction, neuronal excitotoxicity and vulnerability of white matter in developing brain. The immature brain has the fragile vascular bed of germinal matrix and can not effectively centralize their circulation. Therefore, the cerebral hemorrhage process is considered to be involved in the periventricular leukomalacia.

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Significance of Ligation of Patent Ductus Arteriosus in Premature Infant (미숙아 동맥관 개존증에서 동맥관 결찰술의 의의)

  • 조성래;이충석;백용운
    • Journal of Chest Surgery
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    • v.34 no.1
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    • pp.35-40
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    • 2001
  • 배경: 혈역학적으로 문제가 되며 인도메타신 치료가 불가능한 미숙아 동맥관 개존증에서 동맥관 결찰술은 비교적 안전하고 효과적인 치료법으로 알려져 있다. 대상 및 방법: 1995년 1월부터 2000년 5월까지 동맥관 개존증을 가진 50명의 미숙아를 대상으로 인도메타신 치료와 동맥관 결찰술의 치료성적을 검토하였다. 결과: 50례의 미숙아 동맥관 개존증 중 28례에서 혈역학적으로 문제가 되어 치료가 요구되었고 그 중 5례에서는 인도메타신 치료를, 나머지 23례는 인도메타신 치료의 금기가 되어 동맥관 결찰술을 시행하였다. 제태기간과 출생시 체중은 치료를 시행하지 않았던 군(32.1$\pm$2.1주, 1731$\pm$450.9g)과 인도메타신 치료군(32.0$\pm$2.1주, 1830$\pm$165.5g)보다 동맥관 결찰술군(29.6$\pm$2.1주, 1435$\pm$431.0g)이 가장 짧았다(p<0.05). 치료를 시행한 28례에서 치료시 나이(8.6$\pm$5.5일, 7,3$\pm$4.4일)는 인도메타신 치료군과 동맥관 결찰술군 간에 차이가 없었으나, 체중(1670$\pm$43.6g, 1211$\pm$22.4g)은 동맥관 결찰술군에서 의의있게 적었다(p<0.05). 치료후 생존율은 100%와 73.9%로 인도메타신 치료군에서 높았고 술후 사망은 23.7$\pm$22.4일(6-68일)째 발생하였으며 사망원인은 패혈증 5례, 뇌실질내 출혈과 기관지폐이형성증이 각각 2례, 패혈증 쇼크와 기흉이 각각 1례로 수술과는 직접적인 관련이 없었다. 결론: 미숙아 동맥관 개존증에서 조기에 동맥관 결찰술을 시행하는 것은 비교적 안전하고 효과적이며, 특히 인도메타신 치료를 시행할 수 없는 경우와 초저체중의 미숙아에서도 안전하게 적용 될 수 있을 것으로 사료된다.

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Evaluation of Anti-thrombosis Activities of Different Parts of Cannabis sativa L. (대마 부위별 추출물의 항혈전 활성)

  • Kang, Deok-Gyeong;Kim, Young-Min;Sohn, Ho-Yong
    • Journal of Life Science
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    • v.31 no.6
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    • pp.581-586
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    • 2021
  • The high fatality of COVID-19 (Corona Virus Disease 2019) is closely related to acute pneumonia and severe blood clot formation in brain, heart, kidney and lung. The use of low-molecular weight heparins has been shown to reduce the risk of thrombosis and reduce fatality rates among COVID-19 patients. In this study, we investigated the antithrombotic activity of different parts of C. sativa extracts to determine its potential in preventing blood clots in patients with thromboprophylaxis. The extracts of leaf, stem, root, immature flower and seed of C. sativa showed strong inhibitory activities on blood clot formation. In particular, the flower extract showed the strongest inhibitions against blood coagulation factors and thrombin. Strong hemolysis activities were observed in flower extract and seed extract, suggested that removal of the hemolysis active compounds in th extracts is necessary. This is a first report of anti-thrombosis activities of different parts of C. sativa extracts, and our results suggest that C. sativa extract has potential has a valuable bioresource for high-value products.

Short-term Results of Endobronchial Brachytherapy for Malignant Airway Obstructions (악성 기도 폐쇄에 대한 기관내 근접 조사 방사선치료의 단기 임상 경험)

  • Ahn Yong Chan;Lim Do Hoon;Choi Dong Rak;Kim Moon Kyung;Kim Dae Yong;Huh Seung Jae;Kim Ho Joong;Chung Man Pyo;Kwon O Jung;Rhee Chong Heon
    • Radiation Oncology Journal
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    • v.14 no.4
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    • pp.299-306
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    • 1996
  • Purpose : Respiratory symptoms related with malignant airway disease have been the main causes of lowered qualify of life and also sometimes may be life-threatening if not properly managed. The authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. Materials and Methdos : Twenty-five Patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center Twenty-one ($84\%$) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty Patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patient were planned and total of 70 procedures were completed. Results : Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were $88\%$(22/25). $96\%$(22/23), $100\%$ (15/15), and $100\%$(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG performance scores were improved in $56\%$ of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range: $1\~17$ months), while that of ten survivors was 9 months (range $5\~19$ months). There were five patients with controlled intrathoracic disease, who have survived over one rear. All deaths were associated with uncontrolled local and/or distant disease. Four Patients died of massive fatal hemoptysis, three of who received emergency endobronchial laser evaporation therapy before the start of endobronchial brachytherapy. Conclusion : Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.

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Classification of Premature Atrial Contraction using Feature of ECG Signal based on Error Back-Propagation (오류 역전파 기반 ECG 특징을 이용한 심방조기수축(PAC) 분류)

  • Jeon, EunKwang;Nam, Yunyoung;Lee, Hwa-Min
    • Proceedings of the Korea Information Processing Society Conference
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    • 2017.04a
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    • pp.669-672
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    • 2017
  • 최근 한국인의 주요 사망원인 중 하나로 부정맥이 부각되고 있다. 심방조기수축(PAC:Premature Atrial Contraction)은 심방이 동방결절의 명령이 있기 전에 수축해 버리는 것이다. 심방조기수축은 일시적으로 유발하였다 사라지곤 할 수 있기 때문에 심한 증상이 없다면 생명에 위협을 가하진 않지만 반대의 경우에는 위험할 수 있다. 따라서 비정상적인 심장 박동이 발생하면 이를 검출하여 조기에 부정맥을 진단할 수 있는 방법이 필요하다. 이를 위해 대상의 ECG 신호로부터 QRS패턴에 해당하는 특징들을 추출하였고 특징들을 이용하여 심방조기수축 파형을 분류한다. 오류 역전파 기반으로 특징들을 훈련하며 가중치와 바이어스값을 구한뒤 이를 이용하여 정상파형과 심방조기수축 파형을 분류한다.

Measurement of Environmental Tobacco Smoke in Office Environments (사무실 환경에서의 간접흡연 노출량 측정)

  • 백성옥;박상곤;황승만;정진욱;김미현;박지혜
    • Proceedings of the Korea Air Pollution Research Association Conference
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    • 2000.11a
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    • pp.43-44
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    • 2000
  • 흡연 당사자의 직접흡연이 이와 관련한 발병률과 사망률의 주요 원인이 되어 왔다는 것은 여러 연구조사자료에 보고되어 왔다. 그러나 최근 들어 담배연기에 대한 비흡연자의 비자의적인 노출 즉, 환경담배연기(Environmental Tobacco Smoke, 이하 ETS)로 인한 보건학적 위해성에 대한 논란이 제기되면서 간접흡연은 새로운 사회문제로 대두되고 있다(Surgeon General, 1986). 1986년에 미국 National Research Council은 미국 내에서 연간 3000명에 달하는 폐암의 발생이 ETS에 대한 노출에서 기인한다고 발표한 바 있으며(NRC, 1986), 이를 근거로 1990년대 초에 미국 EPA와 NIOSH에서는 세계최초로 ETS를 인체발암성물질로 규정한 바 있다(NIOSH, 1991; USEPA, 1992). (중략)

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