• Journal of Chest Surgery
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• 제32권3호
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• pp.270-275
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• 1999

배경: 저자들은 흉부 손상환자에서 심손상이 예상되는 경우 심전도, 혈중내 CK, CK-MB분획 변화를 선별하여 이상이 있는 경우 이면성 심초음파검사를 실시하여 이상유무로 심타박상 및 심좌상으로 분류하여 임상적 고찰을 해보기로 하였다. 대상 및 방법: 1997년 1월부터 1998년 3월까지 15개월간 심손상이 의심되어 본교실에 입원치료한 24명을 대상으로 병력, 내원당시 심전도 및 혈중내 CK, CK-MB 분획을 연속적 선별검사를 실시하여 이상이 있는 경우 심초음파검사를 하였다. 결과: 연령분포는 20∼40대가 58.3%로 가장 많았으며, 남여비는 3 : 1 이었다. 원인은 교통사고가 15례(62.5%)로 가장 많았다. 동반손상의 경우 다발성 늑골골절, 흉골골절 순이었다. 심전도 검사상 심타박상의 경우 정상이 가장 많았으며, 심좌상에서는 ST-T변화가 가장 많았다. CK-MB분획은 심좌상에서 높았으며, 내원 당일은 통계학적 유의성은 없었으나 내원 1, 2, 3일에는 통계학적 유의성이 있었다. 재원기간은 심타박상에서 평균 9.22일이었고, 심좌상에서 26.18일이었다(p=0.0075). 합병증은 급성폐부전이 7례로 가장 많았으며, 이중 5례에서는 인공호흡기 치료를 하였으며 사망한 경우는 없었다. 결론: 저자들은 흉부손상환자에서 심손상이 의심되는 경우 심전도, CK, CK-MB분획을 연속 선별검사하여 이상이 있는 경우 심초음파를 실시하여 심좌상의 유무를 진단하는 것이 좋을 것으로 사료된다.

• Journal of Chest Surgery
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• 제34권12호
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• pp.937-943
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• 2001

배경 : 본 연구의 목적은 흉골골절에서 심혈관계 동반 손상의 예측인자를 알아내고 응급 심장 초음파검사의 적응증을 제시하고자 하였다. 대상 및 방법 : 1994년 3월부터 5년간 이화여자대학교 부속 목동병원 응급실을 통해 입원한 흉골골절로 입원한 40명의 환자들을 대상으로 후향적 분석을 시행하였다. 예측인자로서는 1) 안전띠 착용의 유무, 2) 동반 손상의 유무, 3) 심혈관계 질환의 병력 유무, 4) 내원시 환자의 RTS(Revised Trauma Score) 4가지를 대상으로 분석하였다. 또한 심혈관계 손상의 동반 유무를 파악하기 위하여 일반적으로 사용하는 심전도와 흉부 단순 촬영 및 심근 효소의 분획을 조사하였으며, 그 결과에서, 흉골골절에서 응급 심장 초음파 검사의 적응증을 추론하였다. 결과 : 흉골골절에서 심혈관계 손상의 동반 유무를 나타내는데 통계적으로 의미가 있다고 나온 인자로는 심혈관계 과거 병력이 있는 경우와 입원시 RTS의 이상을 들 수 있다. 응급 심장 초음파검사의 시행은 예측인자들과 심전도와 흉부 단순 촬영 및 심근 효소의 분획 같은 일반적으로 사용하는 검사 결과에 따라 시행하였다. 흉골골절 환자에서 응급 심장 초음파검사의 적응으로 1) 의미 있는 예측 인자의 변화가 없더라도 두 개 이상의 검사에서 이상소견을 보이던가, 2) 예측인자의 의미있는 변화가 하나 이상 나오는 경우를 들 수 있다. 결론 : 흉골골절 환자에서 심혈관계의 과거 병력과 초기활력 징후가 심혈관 동반 손상 유무를 중요하게 나타날 수 있으며, 필요한 경우, 응급 심장 초음파 검사를 시행하여 조기에 확진을 내리는 것이 중요하다고 생각한다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권1호
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• pp.55-66
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• 2019

Background: Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. Methods: Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl $700{\mu}g$ was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. Results: Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were $4.4{\pm}2.0$ and $3.7{\pm}1.9$ in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was $10.7{\pm}13.7$ and $8.6{\pm}8.5$, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. Conclusion: Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.

• 한국전문물리치료학회지
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• 제26권2호
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• pp.34-48
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• 2019

Background: Fall-related injuries in older adults are a major health problem, and the risks and mechanisms of these injuries should be affected by race, culture, living environment, and/or economic status. Objects: Research articles have been systematically reviewed to understand fall-related injuries in older adults in South Korea. Methods: 128 published research papers have been found through the Korea Citation Index and the Korean Studies Information Service System, and reviewed in various perspectives, including incidents, fall death rates, medical costs, causes, injury sites and types, locations where falls occurred, prevention strategies, scholarly fields interested in fall injuries, and the role of physical therapy. Results: Fall-related injuries were found to be more common in women than in men, and the number of incidents increased with age, with the highest rate found in individuals over 85 years old. Risk of fall injury was associated with education level, comorbidities, and fear of falling. Common places where falls occurred included the bathroom, living room, stairs, and hallway. Common types of injury included bruises, fractures, and sprains in the lower extremities. Intervention strategies included exercise programs, education, and protective clothing. Scholarly fields interested in fall-related injuries in older adults included medicine, nursing, physical therapy, occupational therapy, physical education, pharmacology, oriental medicine, biomedical engineering, design, clothing, and textiles. Physical therapy intervention using proprioceptive neuromuscular facilitation has been used to improve one's balance. Conclusion: Any movement during the activities of daily living can lead to a fall. Physical therapists are highly educated to analyze human movements and should be involved in more research and practices to solve fall-related injuries in older adults.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• 제60권8호
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• pp.390-395
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• 2017

Background and Objectives With increasing frequency of car accidents, patients of dizziness caused by car accidents are also increasing. Various types of dizziness or vertigo can occur from car accidents depending on different injury mechanisms. Since accurate diagnosis is important for providing proper treatments, we evaluated clinical characteristics related to vestibular function of patients with dizziness caused car accidents. Subjects and Method In this retrospective case review study that runs from January 2011 to March 2013, a total of 82 patients with dizziness following car accident were enrolled consecutively. We analyzed the final diagnosis of dizziness according to different mechanisms of injury during car accident through clinical record review. Patients who developed dizziness within one month of car accident were included, excluding those who had temporal bone fracture and previous history of dizziness. Results Of the different types observed, 36.6% was head injury, 24.4% whiplash injury, 3.7% complex injury, 2.4% others and the rest was unknown. In the final diagnosis, the different types included 36.6% benign paroxysmal positional vertigo (BPPV), 23.2% unclassifiable dizziness, 18.3% cervical vertigo, 7.3% labyrinthine concussion, 3.7% BPPV with labyrinthine concussion and the rest was others. Of the different types of dizziness symptoms, 58.5% was headache, 45.1% was audiologic symptoms, and others included earfullness, tinnitus and hearing disturbance. Tinitogram and pure tone audiogram results show that 2.9% (27 people) of patients have tinnitus and 7.3% (6 people) have hearing disturbance. Conclusion An accurate diagnosis and timely management would be very important in forming a proper approach for post traumatic vertigo patients.

• 대한두개안면성형외과학회지
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• 제23권4호
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• pp.171-177
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• 2022

Background: The treatment of zygoma complex fractures is of crucial importance in the field of plastic surgery. However, surgical methods to correct zygoma complex fractures, including the number of fixation sites, differ among operators. Although several studies have compared two-point and three-point fixation, no comparative research has yet been conducted on one-point versus two-point fixation using computed tomography scans of surgical results. Therefore, the present study aimed to address this gap in the literature by comparing surgical results between one-point and two-point fixation procedures. Methods: In this study, we randomly selected patients to undergo surgery using one of two surgical methods. We analyzed patients with unilateral zygoma complex fractures unaccompanied by other fractures according to whether they underwent one-point fixation of the zygomaticomaxillary buttress or two-point fixation of the zygomaticomaxillary buttress and the zygomaticofrontal suture. We then made measurements at three points-the zygomaticofrontal suture, inferior orbital wall, and malar height-using 3-month postoperative computed tomography images and performed statistical analyses to compare the results of the two methods. Results: All three measurements (zygomaticofrontal suture, inferior orbital wall, and malar height) showed significant differences (p< 0.05) between one-point and two-point fixation. Highly significant differences were found for the zygomaticofrontal suture and malar height parameters. The difference in the inferior wall measurements was less meaningful, even though it also reached statistical significance. Conclusion: Using three parameters in a statistical analysis of imaging findings, this study demonstrated significant differences in treatment outcomes according to the number of fixations. The results indicate that bone alignment and continuity can be achieved to a greater extent by two-point fixation instead of one-point fixation.

• 자원환경지질
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• 제55권1호
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• pp.1-17
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• 2022

암반의 역학적 및 열적 특성은 고준위방사성폐기물(high-level radioactive waste; HLW) 심지층 처분시스템 내 방사성 물질의 격리 및 이동 지연 능력과 관련된 성능에 영향을 미칠 수 있다. 이 연구는 HLW 처분시설 부지의 암반역학적 및 열적 특성과 관련된 부지설명모델에 필수적인 항목을 고찰하고 스웨덴과 핀란드의 선행 부지설명모델 사례를 통한 기술적 배경을 논의하였다. 스웨덴 SKB (Swedish Nuclear and Fuel Management Company)와 핀란드 Posiva는 암반역학적 및 열적 특성 조사·평가에 필수적인 항목을 제시하고 부지의 안전성 분석과 처분시설의 건설을 위한 암반역학 부지설명모델을 도출하였다. 암반역학 부지설명모델은 처분시설 부지 내 응력 분포와 더불어 신선암, 절리, 절리성 암반에 대한 강도 및 변형특성과 대규모 변형대의 기하학적 구조, 소규모 불연속면의 연결망 구조 및 암석의 열적 특성에 대한 조사·평가 결과를 포함한다. 또한, 암반역학 부지설명모델은 입력변수에 대한 민감도 분석결과와 입력변수의 불확실성에 대한 평가 결과를 제시하여야 한다.

• Clinics in Shoulder and Elbow
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• 제26권4호
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• pp.357-365
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• 2023

Background: The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). Methods: A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. Results: Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. Conclusions: Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidence: III.

• 시큐리티연구
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• 제2호
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• pp.259-289
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• 1999

The Security Industry has dynamic working conditions. So this study intends to find the advisable direction for the reduction of accidents. To achieve the aim, the investigation of documents and the examinations of actual proofs have been done to figure the theoretical background and to see the basic knowledge of security industry. The questionnaire was composed of two question sheets to search real data and actual proofs, with making targets of pure security organization and personnel. The one consists of 9 questions to find the scale and extent of security organizations and the population and character of security personnel, and the other 25 questions in 3 major areas to analyze the causes, the frequency rates, the factors, and the condition of accidents. The period of survey was July 15th to October 15th in 1997 by mail/telephone/interview. The questionnaires were efficiently returned from 102 different organizations including the public security groups of Seoul Metropolitan Police Bureau and so on, with the information of 8,222 persons having worked for Korean Security Industry in 1996. So being based on the reality, some meaningful facts were found, and were compared with the national statistics of the Government. This study is made up of 5 chapters : in the 1st chapter the motivation, the object, the method, the direction and the limitation of the approach were presented ,in the 2nd chapter the theoretical background were inferred ; in the 3rd chapter the collected data of accidents in Korean Security Industry were analyzed and explained on the base of the questionnaires , in the 4th chapter the advisable facts connected with preventing accidents were mentioned ; in the last the conclusion were stated. With the replies of 102 different organizations including the information of 8,222 persons in 1996, the main facts found or analyzed through this study are as follows. Firstly, accident is an unpredictable and occasional event. It occurs to man and/or thing, but the frequency rate of accidents in Korean Government and other Institutes has been calculated and evaluated only in the point of the accident related with man. Secondly, the factors of accidents are firstly relevant to the way preventing accidents in Security Industry in Korea. However the frequency rate is academically calculated and evaluated by at once man(population) and hour(time). But the Government has done the rate only by man(population). This can be improper and inaccurate rates. Thirdly, the confused concept of security is used in Korean Government, academic society, corporation and so on. Therefore the detailed formation of the concept is needed for the development of Security Industry in Korea. Fourthly, security organizations can be classified into 'public security(public law enforcement)' and 'private security' according to its identification, and furthermore 'private security' can be divided into 'facilities-guard service', 'body-guard service', and 'patrol service' according to its major role. Fifthly, in the viewpoint of the number of both organization and population,'facilities-guard service' is centered in Korean 'private security'. According to the analyzed results of the questionnaires in this study, the frequency rate of accidents of Korean Security Industry is 0.43(%) totally in 1996 : 'facilities-guard service' 0.54(%), 'body-guard service' 0.12(%), and 'patrol service' 0.21(%) in 'private security', and 'public security' 0.20(%). With regard to the accident frequency rate of organization and population, 'facilities-guard service' is the highest. The accident frequency rate of population in 'facilities-guard service' organization ranges dispersively from 0.20(%) to 11.11(%). Sixthly, the accidented rate of workers having serviced for under one year is 57.6(%). This can mean that the main factor of accidents in Korean Security Industry is the lack of role-understanding and training/education. And another factor can be found on the time of accident occurrence. Many accidents have been occurred on the relaxed points like as just after lunch and morning rush-hour. Lastly, the major advisable facts related to preventing accidents are as follows : The workers who are over fifty years old in 'facilities-guard service' organization need to be educated for preventing accidents ; It is desirable that the training and education to prevent accidents should be practiced in the time of pre-service ; As the style of accidents and the age of the accidented are not same according to major service area('public security' and 'private security' : 'facilities-guard service', 'body-guard service', and 'patrol service'), the plans to prevent accidents must be different and various. However fracture and bruise are general accidents in Korean Security Industry ; Workers must care about traffic accident and violent fall ; It seems that the grouped working with other two persons will reduce accident occurrence possibility rather than individually single working.

• Journal of Chest Surgery
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• 제42권2호
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• pp.226-232
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• 2009

배경: 흉부 둔상은 전체 흉부 손상의 90%정도를 차지하며 외상과 관련된 사망률의 20%를 유발시킨다. 흉분 둔상에 의한 손상 후 이환율과 사망률의 주요 원인은 발견되지 못한 손상이 남아있기 때문이다. 그리하여 흉부전산화단층 촬영은 외상환자의 진단적 검사에서 매우 자주 사용되어져 왔다. 그러나 흉부 컴퓨터 촬영은 가격이 비싸고, 방사선 노출을 증가시킬 수 있다. 이번 연구를 통하여 흉부둔상 환자에서 흉부단순촬영과 비교하여 흉부전산화단층촬영을 통하여 얼마나 더 많은 정보를 얻을 수 있는지 조사해 보고 그리고 흉부 컴퓨터 촬영의 진단과 치료에 있어서의 역할을 알아보고자 한다. 대상 및 방법: 2006년 11월부터 2007년 7월까지 응급실로 내원한 환자 100명을 대상으로 하였다. 이 중 74명의 자동차 관련사고 환자와 26명의 낙상 사고 환자가 있었으며 흉부엑스선과 흉부전산화단층 촬영을 동시에 시행한 환자를 전체 응급실 환자 중에 선택하였다. 자료는 차트를 통하여 혈역학적 소견, 중재적 치료 여부, 손상의 중증도(RTS)와 종류를 조사하였으며, 초기 응급실 내원환자 중 흉부단순촬영과 흉부전산화단층촬영을 시행한 환자를 대상으로 발견되지 못한 병적 소견을 각각 질환별로 분석하였다. 결과: 100예의 환자 중 흉부엑스선 검사상 하나 이상의 병적소견을 보인 환자가 79예였으며 21예의 환자에서는 흉부엑스선 검사상 정상 소견을 보였으며, 이 21예의 환자 중 17예에서 흉부전산화단층촬영상 이상소견이 발견되었다. 흉부엑스선 검사상 발견하지 못한 소견으로는 기흉, 혈흉, 폐좌상, 흉골 골절 등이 있었으며 이러한 병적 소견의 진단은 흉부전산화단층촬영이 흉부엑스선 검사보다 통계적으로 유의하게 우수한 것으로 나타났다. 하지만 치료에 있어서는 흉부전산화촬영 시행 후 발견된 병변으로 흉관삽입술등의 치료를 시행한 환자는 31명에 불과했고 흉관삽입술, 개흉술 등의 흉부외과적인 치료 없이 집중관찰을 위하여 입원한 환자가 42명이었으며, 흉부엑스선촬영과 환자의 이학적 소견으로 진단되어 치료를 시행한 환자가 27명이었다. 결론: 흉부전산화단층촬영은 진단에 있어서 흉부엑스선 촬영보다 통계적으로 의미 있게 진단에 도움이 되는 것을 알 수 있었으나 발견되지 못한 병변이 증가할지라도 치료의 변화와 방법의 변화가 있는 경우는 매우 소수에 불과했다. 그리하여 응급실에서의 흉부전산화단층촬영의 오남용을 막기 위하여 선별적인 흉부전산화단층 촬영을 고려해야 할 것이다.