• Journal of Trauma and Injury
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• 제25권4호
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• pp.159-165
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• 2012

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.

• Journal of Chest Surgery
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• 제48권3호
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• pp.180-186
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• 2015

Background: Extracorporeal membrane oxygenation (ECMO) has recently attracted interest as a treatment for severe acute respiratory distress syndrome (ARDS). However, the outcomes of this procedure in post-surgical settings have not yet been characterized. In this study, we evaluated the outcomes of ECMO in patients with severe postoperative ARDS. Methods: From January 2007 to December 2012, a total of 69 patients (aged $58.3{\pm}11.5$ years, 23 females) who underwent venovenous ECMO to treat severe postoperative ARDS were reviewed. Of these patients, 22 (31.9%) had undergone cardiothoracic surgery, 32 (46.4%) had undergone liver transplantation, and 15 (21.7%) had undergone other procedures. Results: Thirty-four patients (49.3%) were successfully weaned from ECMO, while the other 35 patients (50.7%) died on ECMO support. Among the 34 patients who were successfully weaned from ECMO, 21 patients (30.4%) eventually died before discharge from the hospital, resulting in 13 hospital survivors (18.8%). Multivariable analysis showed that the duration of pre-ECMO ventilation was a significant independent predictor of death (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.29 to 3.90; p=0.004), whereas the concomitant use of continuous venovenous hemodialysis (CVVHD) was associated with improved survival (OR, 0.55; 95% CI, 0.31 to 0.97; p=0.038). Conclusion: Although the overall survival rate of patients treated with ECMO for postoperative ARDS was unfavorable, ECMO offered an invaluable opportunity for survival to patients who would not have been expected to survive using conventional therapy. CVVHD may be beneficial in improving the outcomes of such patients, whereas a prolonged duration of pre-ECMO ventilator support was associated with poor survival.

• 공업화학
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• 제19권4호
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• pp.407-412
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• 2008

니들 코크스의 활성화 방법으로서 기존의 방법과는 다른 $HNO_3$와 $NaClO_3$ 혼합용액에서의 산처리와 $300^{\circ}C$ 열처리 방법을 이용하였다. 산처리 코크스와 열분해 코크스의 미세구조는 XRD, FESEM, element analysis, BET, Raman spectroscopy를 이용하였으며, 전기이중층 거동은 충방전 분석을 행하였다. 니들 코크스는 산처리 시간에 따라 산소의 중량 %의 증가와 함께 (001) 구조로 상변화가 일어나고, $300^{\circ}C$ 열처리에서 흑연구조인 (002) 구조로 환원한다. 이들 산처리-상분해 과정에서 층간에 유기된 층간 구조결함은 first 충전에서 전계 활성화에 의해 pore를 생성하고 second 충전에서는 전기이중층 용량을 발생시킨다. 24 h 산처리-$300^{\circ}C$ 열처리한 열분해 코크스의 2.5 V까지의 2 전극 기준에서 구한 활물질 중량 당 용량과 전극 부피 당 용량는 각각 33 F/g과 30 F/mL를 나타내었다.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.441-447
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• 2012

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

• 한국수자원학회논문집
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• 제43권3호
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• pp.295-308
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• 2010

본 논문에서는 기후변화가 수자원의 이수측면에서 어떠한 영향을 미치는지에 대하여 검토하고자 한강유역에 대한 물수지 변화를 분석하였다. 이를 위하여, 우선 RegCM3 RCM ($27{\times}27\;km$)의 A2 기후변화 시나리오를 이용하여 모의된 70년의 일강우량을 강우유출모형인 SLURP 모형의 입력자료로 활용하여 70년의 일유출량을 모의하였다. 다음으로 수자원평가계획모형인 K-WEAP 모형을 이용하여 한강유역의 월별 물수지 분석을 실시하였다. 하지만, 미래의 물수요와 기후변화에 의한 유출량을 예측하는 데는 많은 불확실성을 내포하기 때문에 3개의 물수요와 50개의 유출 시나리오를 가정하여 검토하였다. 여기에서, 3개의 물수요 시나리오는 예상되는 물수요에 따라 저수요, 기준수요, 고수요로 구분되며, 50개의 유출 시나리오는 70년 기간 동안 50 set씩 모의된 유출량계열을 의미한다. 따라서 3개의 기후변화 시나리오와 50개의 유출량 시나리오를 조합하여 150 Set의 입력자료를 구성하고 K-WEAP 모형을 이용하여 분석하였다. 검토 결과 미래에 한강유역의 물부족량은 장기적으로 증가하는 것으로 예상되었다. 그리고 한강유역의 소유역별 물부족량을 검토한 결과 특정 소유역에서 물부족이 가중되고 장기적으로 한강유역 전체로 물부족이 예상되는 소유역이 증가함을 확인할 수 있었다.

• 한국농공학회지
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• 제8권1호
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• pp.1088-1096
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• 1966

The following is a method of synthetic unitgraph derivation based on the routing of a time area diagram through channel storage, studied by Clark-Jonstone and Laurenson. Unithy drograph (or unitgraph) is the hydrograph that would result from unit rainfall\ulcorner excess occuring uniformly with respect to both time and area over a catchment in unit time. By thus standarzing rainfall characteristics and ignoring loss, the unitgraph represents only the effects of catchment characteristics on the time distribution of runoff from a catchment The situation abten arises where it is desirable to derive a unitgraph for the design of dams, large bridge, and flood mitigation works such as levees, floodways and other flood control structures, and are also used in flood forecasting, and the necessary hydrologie records are not available. In such cases, if time and funds permit, it may be desirable to install the necessary raingauges, pruviometers, and stream gaging stations, and collect the necessary data over a period of years. On the otherhand, this procedure may be found either uneconomic or impossible on the grounds of time required, and it then becomes necessary to synthesise a unitgraph from a knowledge of the physical charcteristics of the catchment. In the preparing the approach to the solution of the problem we must select a number of catchment characteristic(shape, stream pattern, surface slope, and stream slope, etc.), a number of parameters that will define the magnitude and shape of the unit graph (e.g. peak discharge, time to peak, and base length, etc.), evaluate the catch-ment characteristics and unitgraph parameters selected, for a number of catchments having adequate rainfall and stream data and obtain Correlations between the two classes of data, and assume the relationships derived in just above question apply to other, ungaged, Catchments in the same region and, knowing the physical characteritics of these catchments, substitute for them in the relation\ulcorner ships to determine the corresponding unitgraph parameters. This method described in this note, based on the routing of a time area diagram through channel storage, appears to provide a logical line of research and they allow a readier correlation of unitgraph parameters with catchment characteristics. The main disadvantage of this method appears to be the error in routing all elements of rainfall excess through the same amount of storage. evertheless, it should be noted that the synthetic unitgraph method is more accurate than the rational method since it takes account of the shape and tophography of the catchment, channel storage, and temporal variation of rainfall excess, all of which are neglected in rational method.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.611-616
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• 2009

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

• 한국정보통신학회논문지
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• 제11권12호
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• pp.2335-2342
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• 2007

최근에 레이저를 임상치료에 응용하는 사례가 증가하고 있다. 그러나 전기적 관점에서 레이저 자극이 경락에서 어떠한 전기적 반응을 유도할 수 있는지에 대한 연구가 미흡하고, 명확한 치료효과에 대한 임상보고가 발표되지 않고 있다. 본 논문에서는 레이저자극과 수기자극이 경락전위 형성에 미치는 영향을 비교 관찰하여 전기적 관점에서 침술과정 및 침술효과에 대한 객관적 근거를 제시하고자 하였다. 수양명대장경상의 삼간혈(LI3)을 각각 자극했을 경우, 삼간혈(LI3)과 합곡혈(LI4)에서의 전위변화를 측정하였다. 그 결과, 레이저 자극 시, 평균 피크전위는 $7.53{\pm}3.44{\mu}V$로 매우 낮게 나타났고, 자극전후 전위패턴에 차이가 없어서 레이저 자극에 대한 유효한 전기반응으로 간주하기 어렵다. 접지조건에 대한 수기자극에서는 평균피크전위가 $2.65{\pm}1.53mV$로 매우 높게 측정되었고, 개인별, 접지조건에 따라 전위크기와 패턴이 다양하게 나타나고 전위패턴은 주로 캐패시터의 충방전 전위와 매우 비슷하게 나타났다. 또한, 절연자침의 경우에서는 접지조건에 관계없이 평균 피크 전위가 $0.25{\pm}0.16mV$로 수기자극 전위에 비하여 매우 낮게 나타났으며, 이는 침자극에 대한 유효한 전기 반응으로 간주하기 어렵다. 따라서, 전기적 관점에서 침술과정과 침술효과는 시술자와 피시술자간의 생체이온전하의 이동에 의한 에너지 교감현상임을 확인하고, 수기자극은 경락의 전기반응을 유도하는 반면, 레이저 자극은 경락의 전기적 반응을 유도하기 어렵다는 것을 확인하였다.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.93-101
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• 2018

Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

• Korean Journal of Radiology
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• 제23권8호
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• pp.811-820
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• 2022

Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825-0.910) in the training cohort and 0.890 (0.844-0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion: The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.