• Journal of Chest Surgery
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• v.31 no.12
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• pp.1147-1158
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• 1998

Background: Portable cardiopulmonary bypass(CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation(CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. Material and Method: By using adult mongrel dogs, open-chest CPR(OCPR group, n=4) and portable-CPB CPR(CPB group, n=4) were compared with respects to restoration of spontaneous circulation(ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest(VF-CA) of arrest(VF-CA) of 4 minutes followed by basic life support(BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support(ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means±SD percent change from baseline. Result: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group(90±19 vs. 71±32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group(105±24 vs. 146±6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group(p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group(survival time 31±36 hours) and 2 in CPB group(228±153 hours, p=ns). The remainders in both groups showed prolonged survival. Conclusion: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.

• Korean Security Journal
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• no.1
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• pp.351-370
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• 1997

This study concerns possible measures to prevent separatists' terrorist acts against overseas Korean businessmen. Of late, many Korean enterprises are helping a number of foreign countries develop their economy, by building factories and manning regional offices in those countries. But recent development of terrorism especially against Korean businessmen is alarming. This report discusses the need for Korean enterprises heading overseas to prepare themselves with awareness of terrorism and possible protective measures against it, besides their routine pursuance of profits; and for the government and prospective enterprises to refrain from investing in those countries having active separatist movements. If an investment has become inevitable, a careful survey of the region in conflict should be conducted and self-protective measures should be put in place through security information exchange, emergency coordination and training of personnel, etc. This study will first review the past terrorist incidents involving employees of overseas Korean enterprises, and then will focuss on seeking effective measures on the basis of the reported incidents. In carrying out the study, related literature from both home and abroad have been used along with the preliminary materials reported and known on the Internet from recent incidents. 1. The separatist movements of minority groups Lately, minority separatist groups are increasingly resorting to terrorism to draw international attention with the political aim of gaining extended self rule or independence. 2. The state of terrorism against overseas Korean enterprises and Koreans Korean enterprises are now operating businesses, and having their own personnel stationed, in 85 countries including those in South East Asia and Middle East regions. In Sri Lanka, where a Korean enterprise recently became a target of terrorist bombing, there are 75 business firms from Korea and some 700 Korean employees are stationed as of August 1996. A total of 19 different terrorist incidents have taken place against Koreans abroad since 1990. 3. Terrorism preventive measures Terrorism preventive measures are discussed in two ways: measures by the government and by the enterprises. ${\blacktriangleleft}$ Measures by the government - Possible measures at governmental level can include collection and dissemination of terrorist activity information. Emphasis should be given to the information on North Korean activities in particular. ${\blacktriangleleft}$ Measures by individual enterprises - Organizational security plan must be established by individual enterprises and there should also be an increase of security budget. A reason for reluctant effort toward positive security plan is the perception that the security budget is not immediately linked to an increment of profit gain. Ensuring safety for overseas personnel is a fundamental obligation of an enterprise. Consultation and information exchange on security plan, and an emergency support system at a threat to security must be sought after and implemented. 4. Conclusion Today's terrorism varies widely depending on reasons and causes, and its means has become increasingly informationalized and scientific as well while its method is becoming more clandestine and violent. Terrorist organizations are increasingly aiming at enterprises for acquisition of budgets needed for their activities. Korean enterprises have extended their business realm to foreign countries since 1970, exposing themselves to terrorism. Enterprises and their employees, therefore, should establish their own security measures on the one hand while the government must provide general measures, on the other, for the protection of the life and property of Korean residents abroad from terrorist attacks. In this regard, set-up of a counter terrorist organization that coordinates the efforts of government authorities in various levels in planning and executing counter terrorist measures is desired. Since 1965, when the hostile North Korea began to step up its terrorist activities against South Koreans, there have been 7 different occasions of assassination attempt on South Korean presidents and some 500 cases of various kidnappings and attempted kidnappings. North Korea, nervous over the continued economic growth and social stabilization of South Korea, is now concentrating its efforts in the destruction and deterioration of the national power of South Korea for its earlier realization of reunification by force. The possibility of North Korean terrorism can be divided into external terrorist acts and internal terrorist acts depending on the nationality of the terrorists it uses. The external terrorist acts include those committed directly by North Korean agents in South Korea and abroad and those committed by dissident Koreans, hired Korean residents, or international professionals or independent international terrorists bought or instigated by North Korea. To protect the life and property of Korean enterprises and their employees abroad from the threat of terrorism, the government's administrative support and the organizational efforts of enterprises should necessarily be directed toward the planning of proper security measures and training of employees. Also, proper actions should be taken against possible terrorist acts toward Korean business employees abroad as long as there are ongoing hostilities from minority groups against their governments.

• 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.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.20-24
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• 2010

Background: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. Material and Method: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was $20{\pm}6%$ according to transthoracic echocardiography. Result: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of $107{\pm}70$ hours of running. The mean EF after discharge was $56{\pm}7%$ without dilated cardiomyopathy. Conclusion: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

• Tuberculosis and Respiratory Diseases
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• v.63 no.3
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• pp.289-293
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• 2007

Lymphangioleiomyomatosis (LAM) is a rare disease that affects females of reproductive age. It is characterized by the abnormal proliferation of smooth muscle cells in the lung and along the axial lymphatics. We report a case of lymphangioleiomyomatosis presenting as a lung mass. The patient visited the emergency room because of dyspnea upon exertion. The chest X-ray showed a lung mass in the right lower lung field and a pneumothorax in the left lung. Chest computed tomography revealed a $5{\times}3cm$ sized mass in the right lower lobe and multiple thin-walled small cysts scattered in both lungs. Transbronchial biopsy of the lung mass was performed. The biopsy specimen showed atypical smooth muscle cell proliferation and cystic dilatation of the terminal bronchioles, which confirmed the diagnosis of lymphangioleiomyomatosis. To the best of our knowledge, this is the first case of lymphangioleiomyomatosis presenting as a lung mass.

• Journal of Korean Academy of Nursing
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• v.25 no.2
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• pp.362-371
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• 1995

There is no national system to manage, evaluate, and analyse the information about accidents, even though it is necessary for accident prevention policies and health promotion of the general public. The existing studies are, also limited as they focus only on particular group(for example : inpatients, emergency room patients) or on particular geographic areas. Thus the results of the studies cannot be ap-plied to the general public. In order to overcome these limitations, this research focuses on data collection and analysis from accident information for the general population. By providing the analysis on types and causes af accidents, this research aims to produce the basic data necessary for accident prevention policy development. The specific aims of this research are to : 1. Analyse the actual occurrences and characteristics of accidents. 2. Suggest for the accident prevention policies and safety education. Accident report form three major newspaper printed in Korea between January 1, 1989 and December 31, 1993 were collected, and the cause, place, time, and personal injury related to the accidents were classified and then analyzed by de-scriptive statistics. The results of this research conclude : 1. The number of accidents reported by the three newspapers were 2155. 2. The highest proportion of accidents were as follows ; occurred during the June-August(31.2%), Sunday(24.8%), and 5 p.m. (7.6%) of the day. 3. The highest proportion of the accident occurred in Seoul(33. l％), Kyunggi province(14.5%), Kangwon province (7.8％), and Kyungnam prov-ince(6.7%) were next highest. 4. The main causes include car accidents(32.4%), drowning(10.9%), falls(8.8%), explosion(7.1%), and poisoning(5.8%). 5. Slightly more than half of injuries(50.5%) and about two fifths of deaths(40.3%) were caused by car accidents. Therefore, the most serious type of accidents were car accidents. 6. The number of males in accidents were almost three times higher than that of females(males 72.3%, females : 27.7%). 7. The age group from 10 to 19 years old represents the highest proportion(21%) of accidents. 8. The number of the accidents in Korea, based on the information collected from the newspapers, is estimated to be 14, 367 per year. The number of in-juries is estimated to be 88, 480 persons, and the number of deaths 29, 007 respectively. It is said that ninety percent of accidents can be prevented. Several accidents prevention policies are suggested here. 1. Safety education should be done more actively throughtout life, with special emphasis on safety education for children. 2. Safety measures for children(halmets for cycling, children car seats, seats belts, and so on) should be emphasized. 3. An injury surveillance system should be initiated. The initiation of injury reporting system in each factory and school could contribute considerably to the reduction of accidents.

• The Journal of Korean Academy of Prosthodontics
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• v.54 no.3
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• pp.298-305
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• 2016

The maxillary anteriors play an important role in esthetics. Therefore after extraction, it is crucial to preserve the hard tissue and soft tissue in order to promote esthetics of restoration. There are several challenges when restoring the maxillary anteriors via implant. Some of the challenges are be maintaining consistency with neighboring teeth in terms of shade, form, and texture : as well as having harmonious emergency with the gingival margin. In this case, a traumatized patient with crown-root fracture of the maxillary central and lateral incisors is presented. The cracked teeth were extracted, and implants were inserted with bone grafts to compensate the volume of damaged area of the maxillary anterior. Cantilever implant prosthetics were planned while precise adjustments to the gingival area were made using customized impression coping to perform the esthetic restorations. The final outcome of the treatment was satisfying in both esthetic and utilitarian perspective.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.139-145
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• 2016

Purpose: The major pelvic trauma results in high mortality with associated fatal other injuries. During early stage of resuscitation, multidisciplinary approach is essential to improve the survival and outcomes. This study aims to report the effect and positive outcome of the trauma team approach on the management of hemodynamically unstable pelvic bone fracture. Methods: This retrospective review included all patients with hemodynamically unstable pelvic bone fracture admitted between March 2007 and December 2015. Patients were divided into group A, which comprised those admitted before the trauma team approach was started, and group B, which comprised those admitted after the approach was started. The advanced trauma life support protocol was followed for all patient. The comparisons between the two groups were based on medical records. Study variables included demographics, initial vital sign, injury severity score, fracture type, and injury mechanism. We analyzed the outcomes in each group with respect to the time interval for doctors' arrival, total length of stay in the emergency department (ED), time interval for computed tomography evaluation, 24-hour mortality, time interval for definitive fixation, and definitive fixation in the time-window of opportunity. Results: Fifty-three patients met the inclusion criteria. No statistically significant differences in demographic data existed between the two groups. The time interval for doctors' arrival (min, $63.09{\pm}50.48$ vs $21.48{\pm}17.75$; p=0.038) and total length of stay in the ED (min, $269.33{\pm}105.96$ vs $115.49{\pm}56.24$; p=0.023) were significantly improved. The 24-hour mortality was not significantly different between the two groups.(%, 14.3 vs 12.0; p=1.000) However, the time interval for definitive fixation and definitive fixation in the time-window of opportunity showed better results. Conclusion: The trauma team approach has positive effects, which include initial resuscitation through multidisciplinary approach and shortening the time interval to definitive fixation, on the management of hemodynamically unstable pelvic bone fracture.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.