• Pediatric Infection and Vaccine
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• 제24권3호
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• pp.146-151
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• 2017

목적: 본 연구에서는 소아 폐렴 환자에서 재입원의 분석을 통하여 이에 영향을 미치는 위험인자를 알아보고자 하였다. 방법: 2007년 1월부터 2016년 8월까지 전주예수병원 소아청소년과에 폐렴으로 입원한 소아를 대상으로, 퇴원 후 30일 이내에 폐렴으로 재입원한 환자(재입원군)와 초회 입원한 환자(초입원군)로 나누어 의무기록을 검토하여 후향적으로 분석하였다. 결과: 158명 중 연구군(재입원군)은 82명, 대조군(초입원군)은 76명이었다. 연령, 분절형 호중구 및 림프구 백분율, 12개월 내 입원 횟수, 동반 질환(천식 등 호흡기 질환), 우상 폐야의 병변이 재입원의 위험인자로 분석되었다. 그러나 회귀분석상 연령과 동반 질환만 의미 있는 차이를 보였고, 재입원율은 연령이 낮고 동반 질환이 있을 때 높았다. 결론: 소아 폐렴의 재입원 위험인자로 환자의 어린 연령과 동반 질환이 유의하였다. 소아 환자가 폐렴으로 입원했을 때 연령이 낮고 동반 질환이 있다면 더 정확한 검사와 치료, 퇴원 시기 결정, 외래 추적 관찰 등에 신중을 기하여 향후 재입원율을 줄이기 위한 종합적 접근이 필요하다.

• 대한교통학회지
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• 제24권2호
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• pp.113-124
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• 2006

교통안전시설 중 중앙분리대는 정면충돌 사고 예방에 효과가 있다고 인식되어 4차로 이상 국도를 대상으로 설치가 이루어지고 있다. 중앙분리대 설치효과분석에 관한 연구는 국내 외에서 지속적으로 이루어지고 있는데. 주로 해당구간의 전체적인 사고감소효과를 제시하고 있다. 즉, 지점에서 사고유형별 또는 심각도별로 사고발생형태가 어떻게 변화되는지에 대한 연구가 미미한 실정이다. 국외에서는 주로 중앙분리대 설치유형에 따른 사고감소효과를 산정하고 있으며, 국내에서는 일부 사고유형별 감소효과를 산정한 사례가 있기는 하나 시설물 설치전 후 각 1년만의 사고자료만을 이용함으로써 도출된 값의 통계적 신뢰성을 확보하지 못하고 있다. 이에 본 연구에서는 중앙분리대 설치에 따른 사고유형별 사고심각도별 사고전환효과를 추정하고자 한다 이를 위하여 중앙분리대가 설치된 국토 깊차로 108.6km에 대하여 사업전 후 총 7년간의 교통사고자료, 안전시설물 설치이력과 도로선형요소에 대한 조사와 자료수집이 이루어졌다 다음으로 경험적베이즈(Empirical Bayes)기법을 이용한 모형구축과 사고유형 심각도의 사고전환효과를 추정하였다. 연구결과는 향후 중앙분리대 관련 정책집행과 시설기준제시에 활용될 수 있을 것으로 기대된다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.89-95
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• 2010

Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was $44.6{\pm}18.9$ years. One hundred four (104, 71.2%) were men, and the injury severity score was $14.0{\pm}10.38$. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

• Journal of Chest Surgery
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• 제8권1호
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• pp.37-44
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• 1975

Authors have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975. Of the seven patients studied, automobile accidents led to the injuries in 4 cases, two patients were injured in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest. The numbers of the fractured ribs accounted for 6 to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position [the ratio was 6:1].. All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as having associated head injuries when they were admitted in comatose or semicomatose state. When a major degree of instability of the thoracic cage exists, adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction. All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracic hemorrhage. As to the fixation of the flail segments, authors employed two techniques; one was towel clip traction of the flail segments and the other was intramedullary insertion of Kirschner`s wire in to the double fractured rib fragments for the fixation of the flail segments [Kirschner`s wire fixation]. Because` of an different results in the course of treatment between two techniques, data from patients with towel clip traction was compared with those from patients with thoracotomy and Kirschner`s wire fixation of the flail segments. Of the three patients with towel clip traction, two patients required bronchoscopic toilet due to lung atelectasis which developed because of inadequate motion of thoracic cage and poor expectoration. This was in contrast to the four patients with thoracotomy and Kirschner`s wire fixation, who didn`t these complication because of adequate motion of the thoracic cage and subsequent good expectoration.

• 한국산업보건학회지
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• 제24권3호
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• pp.345-352
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• 2014

Objectives: This study is aimed to describe the current situation about urinary biomarker N-methylformamide(NMF) for workers exposed to N,N-dimethylformamide(DMF) according to industrial classification. Materials: Special health examination records of the workers who had undergone urinary biological monitoring in 2013 were collected. The numbers and percentage of workers, whose urinary NMF values were above the limit of detection(LOD) and above the biological exposure index(BEI) were calculated. Health relatedness with DMF as judged by their doctors was also described. All description was classified according to the $9^{th}$ Korean Standard Industrial Classification(KSIC). Results: It appeared that most workers exposed to DMF belong to manufacturing section(80.7%). The geometric mean(GM) values of urinary NMF were 6.25 mg/L, 3.54, and 3.86 for the manufacturing section, professional, scientific and technical activities section, and for the construction section respectively. In detail, it seemed that division of textiles(except apparel) (GM 7.51 mg/L), division of leather, luggage and footwear(11.59 mg/L), and division of rubber and plastic products(6.89 mg/L) were highly exposed to DMF with a high percentage of workers with urinary NMF values above BEI. This was probably due to the effect of skin absorption that the division of leather, luggage and footwear showed the highest urine NMF GM. Conclusions: It seemed that workers in manufacture industries such as textile, leather, luggage, footwear, rubber and plastic products were highly exposed to DMF. So, efforts should be focused on those industries in order to effectively diminish worker's exposure. Further studies to compare DMF air-monitoring with bio-monitoring according to industrial classification should be considered.

• 한국산업보건학회지
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• 제27권4호
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• pp.313-323
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• 2017

Objectives: This study aimed to assess exposure to black carbon(BC) among forklift operators and to identify environmental and occupational factors influencing their BC exposure. Methods: We studied a total of 23 forklift operators from six workplaces manufacturing paper boxes. A daily BC exposure assessment was conducted during working hours from January to April 2017. A micro-aethalometer was used to monitor daily BC exposure, and information on work activities was also obtained through a time-activity diary(TAD) and interviews. BC exposure records were classified into four categories influencing BC exposure level: working environment, workplace, forklift operation, and job characteristics. Analysis of variance(ANOVA) was used to compare average BC exposure levels among the four categories and the relationships between potential factors and BC exposure were analyzed using a multiple linear regression model. Results: The operators' daily exposure was $12.9{\mu}g/m^3$(N=9,148, $GM=7.5{\mu}g/m^3$) with a range: $0.001-811.4{\mu}g/m^3$. The operators were exposed to significantly higher levels when they operate a forklift in a room ${\leq}20,000m^3$($AM=12.3{\mu}g/m^3$), in indoor workplaces($AM=16.3{\mu}g/m^3$), when they operate a forklift manufactured before 2006 ($AM=13.2{\mu}g/m^3$), a forklift with a loading limit of four-tons($AM=27.1{\mu}g/m^3$), with a roll and bale type clamp($AM=17.1{\mu}g/m^3$), and with no particulate filter($AM=15.7{\mu}g/m^3$). Conclusions: Occupational factors including temperature, smoking, season, daytime, room volume($m^3$), location of operating, and manufacturing era and model of forklift influenced the BC exposure of forklift operators. The results of this study can be used to minimize the BC exposure of forklift operators.

• Advances in pediatric surgery
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• 제11권2호
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• pp.150-156
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• 2005

Failure of the urachus to regress completely results in anomalies that may be classified as patent urachus, urachal sinus, urachal cyst and bladder diverticula. The presenting symptoms of children with urachal anomalies are variable and uniform guidelines for diagnosis and treatment are lacking. The purpose of this study was to analyze our experience and develop conclusions regarding the presentation, diagnosis and treatment of urachal anomalies. We retrospectively analyzed the records of 32 patients who were admitted for urachal anomalies from March 1995 to February 2005. The age distribution of these patients at presentation ranged from 1 day to 14 years old (median age 1 month). There were 20 boys and 12 girls. The 32 cases comprised 13 cases of urachal sinus (40.6 %), 10 urachal cyst (31.3 %), and 9 patent urchus (28.1 %). In 30 patients ultrasonography was used for diagnosis and 2 patients with patent urachus were explored without using a diagnostic method. Twenty-three patients were confirmed by ultrasonography alone and 7 patients were examined using additional modalities, namely, computed tomography for 2 patients with an urachal cyst, magnetic resonance imaging for 1 patient with an urachal cyst, and fistulography for 3 patients with an urachal sinus. The presenting symptoms were umbilical discharge (14 patients), umbilical granuloma (8), abdominal pain and fever (3), fever (3), abdominal pain (2), and a low abdominal mass (2). Excision was performed in 29 patients, and 3 patients were conservatively managed. Urachal anomalies in children most frequently presented in neonates, and the most common complaint was umbilical discharge with infection. Urachal anomalies can be diagnosed by a physical examination and an appropriate radiographic test. Ultrasound was the most useful diagnostic method. Complete surgical excision of an urachal anomaly is recommended to avoid recurrence, and the rare development of carcinoma.

• Clinical and Experimental Reproductive Medicine
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• 제43권2호
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• pp.133-138
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• 2016

Objective: To determine the incidence of embryo retention (ER) in the transfer catheter following embryo transfer (ET) in blastocyst transfer and investigate whether retransferring retained embryos has an impact on reproductive outcomes in patients undergoing in vitro fertilization-ET. Methods: We retrospectively analyzed the records of 1,131 blastocyst transfers, which comprised 223 single blastocyst transfer (SBT) and 908 double blastocyst transfer (DBT) cycles. Each SBT and DBT group was classified depending on whether ET was performed without retained embryos in the catheter during the first attempt (without-ER group) or whether any retained embryos were found following ET (ER group) for the purpose of comparing reproductive outcomes in a homogenous population. Results: The overall incidence of finding retained embryos was 2.8% (32/1,131). There were no retained embryos in SBT cycles. In DBT cycles, implantation rates (30.0% vs. 26.6%), positive ${\beta}-hCG$ rates (57.2% vs. 56.2%), clinical pregnancy rates (45.3% vs. 46.9%), and live birth rates (38.9% vs. 43.8%) were not significantly different between the without-ER and ER groups. There were no significant differences in the mean birth weight (g) $2,928.4{\pm}631.8$ vs. $2,948.7{\pm}497.8$ and the mean gestational age at birth ($269.3{\pm}17.2days$ vs. $264.2{\pm}25.7days$). A total of nine cases of congenital birth defects were found in this study population. Eight were observed in the without-ER group and one in the ER group. Conclusion: Our results suggest that retransfer of retained embryos does not have any adverse impact on reproductive outcomes in blastocyst transfer cycles. Furthermore, our results support finding that SBT might be advantageous for decreasing the incidence of retained embryos in catheters.

• 사상체질의학회지
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• 제20권2호
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• pp.30-42
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• 2008

1. Objectives This paper was tried to find out the clinical use of Gwanjung-tang by comparing patients' chief complain and natural symptom. 2. Methods The study was researched as clinically with medical records of 88 patients who visited a certain oriental medicine clinic which is in Seoul during January, 2000 and June, 2006. 3. Results 1) The male patient who was treated with Gwanjung-tang(寬中湯) is rare. The rate of patients who visited clinic in her forties is 27.3%, in fifties is 18.2%, in thirties is 15.9%, in sixties is 12.5%, in twenties is 10.3%. 2) Chief complain which made patients to visit clinic is a chest pain(19.3%), back pain and shoulder pain (15.9%), edema (12.5%), headache (9.1%), irregular menstruation (8.0%), dyspepsia (8.0%), fatigue (8.0%), insomnia (5.6%), menopausal disorder (4.5%), lumbago (4.5%), abnormal condition of stools (2.3%), and abnormal condition of urine (2.3%). 3) Natural symptom is classified into appetite, digestion, stools, urine, sweat, and sleep. The rate of patients who complained abnormal condition of digestion is 71.6%, of sleep is 59%, of stools is 52.3%, of urine is 47.7%, if sweat is 34.1%, and of appetite is 30.7%. 4) The rate of patients who is treated with Gwanjung-tang between thirty and forty packs is 43.2%, twenty packs is 39.7%, between fifty and sixty packs is 5.7%, between seventy and eighty packs is 2.3%, and between ninety and hundred packs is 3.4%. 5) The rate of patients who is treated with Gwanjung-tang during 15 days is 45.5%, between 16 and 30 days is 26.2%, between 31 and 60 days 7.9%, between 61 and 90 days 3.4%, between 91 and 120 days is 4.5%, and more than 120 days is 12.5%. 6) There are not many cases that chief complain was abnormal condition of digestion (8.0%), sleep (5.6%) stools (2.3%), and urine (2.3%). But the rate of patients who complained discomfort of digestion(71.6%), sleep(59%) stools (52.3%), and urine (47.7%) is significantly high. 7) According to "Sasang Sin Pyeon", Gwanjung-tang was used in To-sa-gwak-ran (吐瀉藿亂), Hae-su (咳嗽), Jeok-chui (積聚), Pyo-han -bu-jong (表寒浮腫), Chang-man (脹滿), Chil-gi (七氣), Dam-um (痰飮), Dam-goe (痰塊), Seom-jwa-yo-tong (閃挫腰痛), Bi-tong (臂痛) of Soeumin, and it is corresponds with clinical cases for various components. 4. Conclusions Gwanjung-tang is a medicine of reconciliation, and it makes Stomach to be warm and take down Yin Qi. The most important effect of Gwanjung-tang is Sun-qi(順氣). So it is considerable that Gyejibanhasenggang-tang (少陰人 桂枝半夏生薑湯), Hyangsayangwi-tang (少陰人 香砂養胃湯), and Gwakhyangjunggi-san (少陰人 藿香正氣散) is also effective to symptoms above, because these are medicines of reconciliatio.

• 디지털융복합연구
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• 제15권1호
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• pp.267-275
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• 2017

본 연구는 심혈관 질환자의 발목-상완 지수(ankle-brachial index, ABI)에 따른 심혈관 질환 중증도를 분석하여 ABI의 임상적 유용성을 확인하기 위함이다. 연구 대상자는 일개 종합병원의 ABI를 측정한 심장내과 환자 441명 이었으며, 전자 의무 기록을 통해 ABI와 심혈관 질환 중증도를 나타내는 vessel disease 및 Gensini score를 조사하였다. 수집된 자료는 SPSS 21.0을 이용하여 분석하였다. ABI 0.90 이하인 비정상군과 0.90 초과인 정상군으로 나누어 비교하였을 때, vessel disease 분포 비율의 차이가 있었다($x^2=4.731$, p=.030). ABI 두 군과 Gensini score에 대한 비교분석에서 비정상군 $39.1{\pm}32.7$점, 정상군 $27.4{\pm}27.4$점으로 유의한 차이가 있었다(t=2.351, p=.019). 본 연구의 결과에서 ABI 비정상군이 중증도 높은 심혈관 질환자들의 분포가 많았으며, 평균 Gensini score도 높은 것을 확인할 수 있었다. 따라서 ABI를 시행하는 것은 비침습적인 방법으로 중증도 높은 심혈관 질환자를 예측하는데 도움이 되어 허혈성 심장 질환의 조기 발견에 유용하게 활용 가능할 것으로 기대된다.