• Journal of Chest Surgery
• /
• v.33 no.2
• /
• pp.125-131
• /
• 2000

Background: Hyperinflation during lung ischemia has been known to improve pulmonary functions after reperfusion which may be exerted through a pulmonary vasodilation and avoidance of atelectasis by an increased surfactant release and been known whether the improvement of pulmonary function was the effect of hyperinflation itself or the oxygen content in inflation gas. Therefore we attempted to clarify the effect of hyperinflation with oxygen in pulmonary inflation gas during warm ischemia on pulmonary function after reperfusion to solve the problem of ischemia-reperfusion injury after lung transplantation. Material and Method: sixteen mongrel dogs were randomly divided into two groups: the left lung was inflated to 30-35 cm H2O with 100% oxygen in oxygen group and 100% nitrogen in nitrogen group. The inflated left lung was maintained with warm ischemia for 100 minutes. Arterial and mixed venous blood gas analysis and hemodynamics were measured before ischemia and 30, 60, 120, 180 and 240 minutes afer reperfusion. Lung biopsy was taken for the measurement of lung water content after the end of reperfusion. Result: In oxygen group arterial oxygen tension the difference of arterial and mixed venous oxygen tension and the difference of alveolar-arterial oxygen tension at 30-minute after reperfusion were not significantly different from those before ischemia and were stable during the 40hour reperfusion. However in nitrogen group these values were significantly deteriorated at 30-minute after reperfusion. there was no significant difference between two groups in hemodynamic data peak airway pressure and lung water content. Conclusion : The results indicated that the oxygenation one of the most important pulmonary functions was improved by pulmonary inflation with 100% oxygen during warm ischemia but the hemodynamics were not. Oxygen as a metabolic substrate during warm ischenia was believed to make the pulmonary tissues to maintain aerobic metabolism and to prevent ischemic damage of alveoli and pulmonary capillary.

• The Korean Journal of Air & Space Law and Policy
• /
• v.7
• /
• pp.101-134
• /
• 1995

Article 3 Paragraph 1 of the Warsaw Convention regulates the requirements of passenger tickets, Article 4 Paragraph 3, the requirements of baggage tickets, Article 8, the requirements of airway bills. In this article the writer has discussed the legal nature of the documents of air carriage, such as air waybills, passenger tickets and baggage checks. Further, the writer has also discussed several issues relating to the use of the documents of air carriage under the Warsaw Convention. Article 3 Paragraph 2, as well as Article 4 Paragraph 4 and 9 provides that the carrier shall not be entitled to avail himself of the provisions of the Convention which evade or limit his liability. In particular, the Montreal Agreement of 1966 provides that the notification on the carrier's liability in passenger ticket should be printed in more than 10 point type size with contrasting ink colors. However, another question is whether the carrier shall not be entitled to avail himself of the liability limit under the Convention in case the type size is below 10 points. The Convention does not specify the type size of certain parts in passenger tickets and only provides that the carrier shall not be entitled to avail himself of liability limit, when a carrier fails to deliver the ticket to passenger. However, since the delivery of passenger tickets is to provide an opportunity for passengers to recognize the liability limit under the Convention and to map out a subsequent measures, the carrier who fails to give this opportunity shall not be entitled to avail himself of the liability limit under the Convention. But some decisions argue that when the notice on the carrier's liability limit is presented in a fine print in a hardly noticeable place, the carrier shall not be entitled to avail himself under the Convention. Meanwhile, most decisions declare that regardless of the type size, the carrier is entitled to avail himself of liability limit of the provisions of the Convention. The reason is that neither the Warsaw Convention nor the Montreal Agreement stipulate that the carrier is deprived from the right to avail himself of liability limit of the provisions of the Convention when violating the notice requirement. In particular, the main objective of the Montreal Agreement is not on the notice of liability limit but on the increase of it. The latest decisons also maintain the same view. This issue seems to have beeen settled on the occasion of Elisa Chan, et al. vs. Korean Airlines Ltd. The U.S. Supreme Court held that the type size of passenger ticket can not be a target of controversy since it is not required by law, after a cautious interpretation of the Warsaw Convention and the Montreal Agreement highlighting the fact that no grounds for that are found both in the Warsaw Convention and the Montreal Agreement. Now the issue of type size can hardly become any grounds for the carrier not to exclude himself from the liability limit. In this regard, any challenge to raise issue on type size seems to be defeated. The same issue can be raised in both airway bills and baggage tickets. But this argument can be raised only to the tranportation where the original Convention is applied. This creates no problem under the Convention revised by the Hague Protocol, because the Hague Protocol does not require any information on weight, bulk, size, and number of cargo or baggage. The problem here is whether the carrier is entitled to avail himself of the liability limit of the provisions of the Convention when no information on number or weight of the consigned packages is available in accordance with Article 4 of the Convention. Currently the majority of decisions show positive stance on this. The carrier is entitled to avail himself of the liability limit of the provisions of the Convention when the requirement of information on number and weight of consigned packages is skipped, because these requirements are too technical and insubstancial. However some decisions declare just the opposite. They hold that the provisions of the Convention Article 4 is clear, and their meaning and effect should be imposed on it literally and that it is neither unjust nor too technical for a carrier to meet the minimum requirement prescribed in the Convention. Up to now, no decisions by the U.S. Supreme Court on this issue is available.

• The korean journal of orthodontics
• /
• v.26 no.2 s.55
• /
• pp.125-139
• /
• 1996

The author obtained some useful information for the class III treatment from long term observation on the growing patients with class III malocclusion. 8 patients were selected for this study and presentation. From these observation so far my conclusions might be as follows: First in the early correction of the anterior crossbite, considerable forward growth changes were observed in the maxilla Second, as for the growth modification of jaws by orthopedic treatment only limited effects were recognized from the long-term observation Thrid, at early age of patients with anterior crossbite, any data couldn't make me predict the stability after treatment on the long-term basis. Fortunately, however, genial angle showed a marginal possibility of it prediction. Fourth, at an advanced age/ retraction orthopedic force on the mandible and the rapid change in the mandibular position may cause some trouble in the T.M.joint. Finally, the followings are recommendable. As for the anterior crossbite, correct it early as possible, and use orthopedic force under the age of ten. Do not enter the phase II treatment directly. Just wait and observe until the growth were almost completed, focusiong on some important factors such as airway problem, tongue position, and third molar development. Of course, these factors may have some effects on the mandibular growth. for the female, at the age of around 14 years old and the male, around 17 years old, make a final decision whether the patients will continue to be treated orthodontically or surgically Thereby, (I think) the relapse and retreatment problem after treatemnt we have observed so far might be minimized. Furthermore, the active treatment time may be also reduced.

• The Korean Journal of Emergency Medical Services
• /
• v.13 no.1
• /
• pp.87-96
• /
• 2009

Purpose : To grasp the mental burden for legal responsibility that rescue members have in the performance of job. Method : Questionnaire was presented to rescue members serving in 2 direct control safety centers of fire station located in Seoul, Daejon, Incheon, Kwangju, Busan, Daegu and Ulsan. Results : 1. Questioned whether they have mental burden for legal responsibility while performing job on the site, the rescue members responded : very burdensome in 38.0%, burdensome in 56.0%, moderate in 4.5%, not burdensome in 1.0%, no burden at all in 0.5%. 2. Questioned on the first aid treat for which they have the most mental burden, the rescue members responded : intubation into trachea laryngeal mask airway(LMA) in 40.4%, automatic external defibrillator in 16.3%, securing vein providing sap(medicine) in 10.8%, basic cardiopulmonary resuscitation in 7.2%, eliminating foreign matters inserted into body in 5.4%, stanching external bleeding and treating injury in 5.4%, fixing extremities and spine by using splint in 1.8%, measuring the symptom of vitality in 1.2%, providing oxygen in 0.0%. 3. Questioned whether experiencing legal problem or firm petition(complaint) raised by patient while serving as rescue members, they responded : experiencing a complaint in 41.6%, experiencing no complaint in 58.4%. Asked to indicate the stress level in the scale of which they suffered when lawsuit or firm petition was raised, 0(weak)-10(strong), they answered 8.8 in average. 4. Questioned whether 119 rescue members put the legal responsibility in case that they cause damage to patients intentionally in performing, they responded to the inquiry 3.66 in average(of 5.00). It represented meaningful differences (F=2.874, p=.024) whether they had license or not. 5. In future, legal action will raise against the rescue member by 99% because of people's rights improvement(63.1%), high expectations for the rescue system(29.5%), non-licensed rescue members(5.1%). Conclusion : It was found that the rescue members had severe mental burden for advanced life support which was investigated to have low enforcement rate in the preceding research, for instance, intubation into trachea securing vein management by using automatic external defibrillator. To improve the qualitative level of rescue service in the fire fighting, it may be required to construct the environment that eliminates the mental burden of rescue members for legal responsibility.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.44 no.2
• /
• pp.243-255
• /
• 2017

Cardiopulmonary resuscitation (CPR) is an emergency treatment that stimulates blood circulation and breathing when the function of the heart stops or stops breathing. CPR can be divided by basic life support (BLS) and advanced life support (ALS). BLS involves the use of chest compression to force the blood flow to the main organs, rescue breathing to improve the breathing to the respiratory failure patient and the use automated external defibrillator (AED). The categories of advanced life support include advanced cardiovascular life support (ACLS) for adult and pediatric advanced life support (PALS) for children. In the treatment of dental care for children, which is extremely difficult to deal with, and for a variety of reasons, the use of sedation is considered to treat the children who are unlikely to cooperate with dentistry. This is why there is an increasing possibility of an emergency situation involving cardiac arrest. PALS includes the BLS, and it presents a systematic algorithm to treat respiratory failure, shock and cardiogenic cardiac arrest. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is necessary to be able to immediately implement professional skills in emergency situations.

• Tunnel and Underground Space
• /
• v.22 no.3
• /
• pp.163-172
• /
• 2012

As more diesel engines have been employed in underground limestone mines with large cross section, underground space environment is worsened by diesel exhausts and heat flow. This paper aims for the ultimate goal to optimize the work place environment through assuring the optimal required ventilation rate based on the analysis of the airflow, diesel exhaust gas concentrations and the effects of mechanization and deepening working face on temperature and humidity. Due to the insufficient capacity of the main exhaust fan and poor airway management, stagnant airflows were observed at various locations, while the flow direction was reversed instantly with passing diesel equipment and the flow reversal was also made by the seasonal variation of the outside surface weather. During the loading operation, CO concentration measurements were found to be frequently higher than the threshold limit of 50 ppm, and most of the $NO_2$ measurements during drilling and loading operations shows even more serious levels surpassing the permissible limit of 3 ppm. The actual ventilation quantity was considerably less than the required quantity estimated by the mine health and safety law, and this shortage problem was less serious in colder winter showing more effectiveness of the natural ventilation.

• Journal of Chest Surgery
• /
• v.38 no.9 s.254
• /
• pp.622-626
• /
• 2005

Background: Non-invasive interventional therapy has been performed for main bronchial obstruction by endobronchial tuberculosis because of the risk of main bronchial reconstruction regardless of the pulmonary function. But, effects of the inteeventional therapy are attacked by arguments. This study was aimed at interpreting the risk and effectiveness of bronchoplasty for benign bronchial stenosis over the last ten years in our hospital by reviewing the results based on clinical progression. Material and Method: We retrospectively reviewed the clinical records and out-patient medical records including 2f consecutive patients who underwent main bronchial reconstruction for obstruction by endobronchial tuberculosis. All of them had past medical history of anti-tuberculosis medication. They were preoperatively evaluated by bronchoscopy and chest computed tomography. Result: There were no incidences of postoperative mortality and signifcant morbidity. There were 2 cases of retained secretions but these problems were resolved by therapeutic bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. Conclusion: Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.36 no.4
• /
• pp.303-308
• /
• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.

• Journal of Yeungnam Medical Science
• /
• v.24 no.2
• /
• pp.148-153
• /
• 2007

Background : Computer- and web-based simulation methods help students develop problem solving and decision making skills. In addition, they provide reality based learning to the student clinical experience with immediate medical feedback as well as repetitive training, on-site reviews and case closure. Materials and Methods : Seventy-five third-year medical students participated in a two-week simulation program. The students selected four modules from eight modules as follows: airway and breathing 1, cardiac arrest 1, cardiac arrhythmia 1, and chest pain 1, and then selected the first case within each of the modules. After 2 weeks, a pass score was obtained and the data analyzed. The average pass score of over 70% was considered a passing grade for each module. If the student did not pass each module, there was no score (i.e., pass score was zero). In addition, when at least one of the four modules was zero, the student was not included in this study. Results : Seventy-five students participated in the simulation program. Nineteen students were excluded based on their performance. The final number of students studied was 56 students (74.7%). The average scores for each module 1 to 4 were 86.7%, 85.3%, 84.0%, and 84.0%, and the average obtained pass score was 88.6 for the four modules in all 56 students. Conclusion : Medical simulation enabled students to experience realistic patient situations as part of medical learning. However, it has not been incorporated into traditional educational methodology. Here we describe the introduction and the development of various simulation modules and technologies for medical education.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.5 no.1
• /
• pp.12-17
• /
• 2009

Background : To do dental treatments successfully for dentally disabled patients who are unable to cooperate to procedures needs deep sedation (DS) or general anesthesia (GA). But there are some difficulties in selecting DS because of some disadvantages such as airway problem etc. But, if we select appropriate cases, DS would be better than GA. Methods : We reviewed total 238 cases of patients who had received dental treatments under GA or DS at the clinic for the disabled in Seoul National University Dental Hospital from November 2007 to February 2009. To compare anesthesia condition between DS and GA, we reviewed preanesthesia evaluation sheet, anesthesia or sedation records and PACU sheets retrospectively. Results : The number of DS cases was 25 (11%) and that of GA was 218 (89%). To maintain DS, intravenous propofol was infused with syringe pump (100%), and sevoflurane (134 cases) or propofol (13 cases) were used for sedation induction. Mean total treatment time for DS was 36 min and 2 hour 25 min for GA. The recovery time at PACU was 44 min for DS and 80 min for GA. There were no severe complications in DS, but 18 cases showed nausea and vomiting in GA. Conclusion : Deep sedation for disabled dental patients should be selected for effective behavioral control in conjunction with general anesthesia, considering duration and pain-evoking potentials of dental treatment and type and severity of patients' disabilities altogether.