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Clinical Characteristics of Aspergilloma (국균종의 임상적 고찰)

  • Kim, Ki-Up;Gil, Hyo-Wook;Lee, Suk-Ho;Kim, Do-Jin;Na, Moon-Jun;Uh, Soo-Taek;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.1
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    • pp.46-53
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    • 2002
  • Background: Pulmonary aspergilloma is relatively common in korea. It arises from the colonization and proliferation of Aspergillus in preexisting lung parenchymal cavities, in particular tuberculosis. The most common symptom in this disorder is hemoptysis, which mayor may not be massive and life threatening. A routine chest radiography and computed tomography (CT) are the most important diagnostic procedures. A surgical resection of the aspergilloma has recently been recommended, because of the relatively low incidence of postoperative complications than in the past. A more concentrated sample of patients with aspergilloma, who either underwent a thoracotomy or tested positive for aspergillus antibodies, were reviewed. Method : The medical records of twenty-two patients with aspergilloma, who had a proven thoracotomy (9 cases), or who tested positive for the diagnostic procedure and/or aspergillus antibodies (13 cases) from January 1995 to December 2000, were reviewed retrospectively. Results : The most common underlying lung disease was a current or old healed tuberculosis, and 3 patients had cultures of mycobacterium other than tuberculosis (MOTT). The mean time until the aspergilloma was detected 5.91 years in the healed tuberculosis cases. The others cases involved a lung abscess, bronchiectasis and without lung disease. The extrapulmonary disease was alcoholism and diabetes. Hemoptysis was most common in 72.7%. A computed tomography (CT) is useful for diagnosis. The right upper lobe, especially the posterior segment, is the most common location. Bronchial artery embolization is ineffective for a long term follow-up. A lobectomy is most common in a thoracotomy, and intra-operative and post-operative complications are rare. During follow-up, the mortality rate, not from the aspergilloma but from respiratory failure, was 13.6%. Conclusion : Aspergilloma is a common cavitary lung disease, It mainly arises from tuberculosis, either current or healed, but extra-pulmonary disease including alcoholism or diabetes are other possible risk factors. Their most common problem in aspergilloma is hemoptysis. Surgery has a low risk of post-operative complications and is recommended in relatively preserved lung function or healthy patients. Medical maneuvers including embolization, and the local insertion of certain materials needs to be studied more closely.

MacIntyre's Critique of Modern Moral Pluralism (매킨타이어의 현대 도덕 다원주의 비판)

  • Kim, Young-kee
    • Journal of Korean Philosophical Society
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    • v.137
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    • pp.57-79
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    • 2016
  • The purpose of this paper is to explain MacIntyre's critique of moral pluralism of modern society and reveal the limits of his critique of liberalism. It is a distinctive feature of the social and cultural order that we inhabit that disagreements over central moral issues are peculiarly unsettleable. Debates concerned with the value of human life such as those over abortion and euthanasia, or about distributive justice and property rights, or about war and peace degenerate into confrontations of assertion and counter-assertion because the protagonists of rival positions invoke incommensurable forms of moral assertion against each other. We usually call this situation 'modern moral pluralism' and concede as the natural outcome of the activities of human reason under free institution. But in After Virtue, MacIntyre vigorously criticizes modern moral pluralism. The main cause he took which brought about this state of affairs was the failure of 'the Enlightenment project'. According to MacIntyre, the Enlightenment project which has dominated philosophy for the past three hundred years promised a conception of rationality independent of historical and social context, and independent of any specific understanding of man's nature or purpose. But not only has that promise in fact been unfulfilled, the project is itself fundamentally flawed and the promise could never be fulfilled. In consequence, modern moral and political thought are in a state of disarray from which they can be rescued only if we revert to an Aristotelian paradigm, with its essential commitment, and construct an account of practical reason premised on that commitment. But one of the deepest difficulties with the argument of After Virtue is that the very extent of its critique of the modern world seems to cast doubt on the possibility of any realistic revival under the conditions of modernity of the Aristotelianism which MacIntyre advocates. Especially when we consider we are not only the characters found in our narratives but also we ourselves are the author of our own narratives. Moral pluralism is not seen as disaster but rather as the natural outcome of the activities of human reason under enduring free institutions.

Permanent Preservation and Use of Historical Archives : Preservation Issues Digitization of Historical Collection (역사기록물(Archives)의 항구적인 보존화 이용 : 보존전략과 디지털정보화)

  • Lee, Sang-min
    • The Korean Journal of Archival Studies
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    • no.1
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    • pp.23-76
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    • 2000
  • In this paper, I examined what have been researched and determined about preservation strategy and selection of preservation media in the western archival community. Archivists have primarily been concerned with 'preservation' and 'use' of archival materials worth of being preserved permanently. In the new information era, preservation and use of archival materials were faced with new challenge. Life expectancy of paper records was shortened due to acidification and brittleness of the modem papers. Also emergence of information technology affects the traditional way of preservation and use of archival materials. User expectations are becoming so high technology-oriented and so complicated as to make archivists act like information managers using computer technology rather than traditional archival handicraft. Preservation strategy plays an important role in archival management as well as information management. For a cost-effective management of archives and archival institutions, preservation strategy is a must. The preservation strategy encompasses all aspects of archival preservation process and practices, from selection of archives, appraisal, inventorying, arrangement, description, conservation, microfilming or digitization, archival buildings, and access service. Those archival functions should be considered in their relations to each other to ensure proper preservation of archival materials. In the integrated preservation strategy, 'preservation' and 'use' should be combined and fulfilled without sacrificing the other. Preservation strategy planning is essential to determine the policies of archives to preserve their holdings safe and provide people with a maximum access in most effective ways. Preservation microfilming is to ensure permanent preservation of information held in important archival materials. To do this, a detailed standardization has been developed to guarantee the permanence of microfilm as well as its product quality. Silver gelatin film can last up to 500 years in the optimum storage environment and the most viable option for permanent preservation media. ISO and ANIS developed such standards for the quality of microfilms and microfilming technology. Preservation microfilming guidelines was also developed to ensure effective archival management and picture quality of microfilms. It is essential to assess the need of preservation microfilming. Limit in resources always put a restraint on preservation management. Appraisal (and selection) of what to be preserved was the most important part of preservation microfilming. In addition, microfilms with standard quality can be scanned to produce quality digital images for instant use through internet. As information technology develops, archivists began to utilize information technology to make preservation easier and more economical, and to promote use of archival materials through computer communication network. Digitization was introduced to provide easy and universal access to unique archives, and its large capacity of preserving archival data seems very promising. However, digitization, i.e., transferring images of records to electronic codes, still, needs to be standardized. Digitized data are electronic records, and st present electronic records are very unstable and not to be preserved permanently. Digital media including optical disks materials have not been proved as reliable media for permanent preservation. Due to their chemical coating and physical character using light, they are not stable and can be preserved at best 100 years in the optimum storage environment. Most CD-R can last only 20 years. Furthermore, obsolescence of hardware and software makes hard to reproduce digital images made from earlier versions. Even if when reformatting is possible, the cost of refreshing or upgrading of digital images is very expensive and the very process has to be done at least every five to ten years. No standard for this obsolescence of hardware and software has come into being yet. In short, digital permanence is not a fact, but remains to be uncertain possibility. Archivists must consider in their preservation planning both risk of introducing new technology and promising possibility of new technology at the same time. In planning digitization of historical materials, archivists should incorporate planning for maintaining digitized images and reformatting them in the coming generations of new applications. Without the comprehensive planning, future use of the expensive digital images will become unavailable. And that is a loss of information, and a final failure of both 'preservation' and 'use' of archival materials. As peter Adelstein said, it is wise to be conservative when considerations of conservations are involved.

A Study on the Development of Assessment Index for Catastrophic Incident Warning Sign at Refinery and Pertrochemical Plants (정유 및 석유화학플랜트 중대사고 전조신호 평가지표 개발에 관한 연구)

  • Yun, Yong Jin;Park, Dal Jae
    • Korean Chemical Engineering Research
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    • v.57 no.5
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    • pp.637-651
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    • 2019
  • In the event of a major accident such as an explosion in a refinery or a petrochemical plant, it has caused a serious loss of life and property and has had a great impact on the insurance market. In the case of catastrophic incidents occurring in process industries such as refinery and petrochemical plants, only the proximate causes of loss have been drawn and studied from inspectors or claims adjustors responsible for claims of property insurers, incident cause investigators, and national forensic service workers. However, it has not been done well for conducting root cause analysis (RCA) and identifying the factors that contributed to the failure and establishing preventive measures before leading to chemical plant's catastrophic incidents. In this study, the criteria of warning signs on CCPS catastrophic incident waning sign self-assessment tool which was derived through the RCA method and the contribution factor analysis method using the swiss cheese model principle has been reviewed first. Secondly, in order to determine the major incident warning signs in an actual chemical plant, 614 recommendations which have been issued during last the 17 years by loss control engineers of global reinsurers were analyzed. Finally, in order to facilitate the assessment index for catastrophic incident warning signs, the criteria for the catastrophic incident warning sign index at chemical plants were grouped by type and classified into upper category and lower category. Then, a catastrophic incident warning sign index for a chemical plant was developed using the weighted values of each category derived by applying the analytic hierarchy process (pairwise comparison method) through a questionnaire answered by relevant experts of the chemical plant. It is expected that the final 'assessment index for catastrophic incident warning signs' can be utilized by the refinery and petrochemical plant's internal as well as external auditors to assess vulnerability levels related to incident warning signs, and identify the elements of incident warning signs that need to be tracked and managed to prevent the occurrence of serious incidents in the future.

The Legal Interest of Doctor's Duty to Inform and the Compensation to Damages for Non-pecuniary Loss (의료행위에서 설명의무의 보호법익과 설명의무 위반에 따른 위자료 배상)

  • Yi, Jaekyeong
    • The Korean Society of Law and Medicine
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    • v.21 no.2
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    • pp.37-73
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    • 2020
  • Medical practice with medical adaptability is not illegal. Consent to medical practice is also not intended to exclude causes of Illegality. The patient's consent to medical practice is the exercise of the right to self-determination, and the patient's right to self-determination is take shape through the doctor's information. If a doctor violates his duty to inform, failure to inform or lack of inform constitutes an act of illegality of omission in itself. As a result, the legal interest of self-determination is violated. The patient has the right to know and make decisions on his or her own, even when it is not connected to the benefit of life and body as the subject of the body. If that infringed and lost, the non-property damage shall be recognized and the immaterial damage must be compensated. On the other hand, the violation of the duty of information does not belong to deny the compensation for physical damage. Which the legal interest violated by violation of the obligation to inform is the self-determination, and loss of opportunity of choice is recognized as ordinary damage. However, if the opportunity of choice was lost because of the infringement of the right to self-determination and the patient could not choice the better way, that dose not occur plainly bad results, under the prove of these causal relationship, that bad results could be compensated. But the unexpectable damage could not be compensated, because the physical damage is considered as the special damage due to the violation of the right of the self-determination.

A Development of Facility Web Program for Small and Medium-Sized PSM Workplaces (중·소규모 공정안전관리 사업장의 웹 전산시스템 개발)

  • Kim, Young Suk;Park, Dal Jae
    • Korean Chemical Engineering Research
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    • v.60 no.3
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    • pp.334-346
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    • 2022
  • There is a lack of knowledge and information on the understanding and application of the Process Safety Management (PSM) system, recognized as a major cause of industrial accidents in small-and medium-sized workplaces. Hence, it is necessary to prepare a protocol to secure the practical and continuous levels of implementation for PSM and eliminate human errors through tracking management. However, insufficient research has been conducted on this. Therefore, this study investigated and analyzed the various violations in the administrative measures, based on the regulations announced by the Ministry of Employment and Labor, in approximately 200 small-and medium-sized PSM workplaces with fewer than 300 employees across in korea. This study intended to contribute to the prevention of major industrial accidents by developing a facility maintenance web program that removed human errors in small-and medium-sized workplaces. The major results are summarized as follows. First, It accessed the web via a QR code on a smart device to check the equipment's specification search function, cause of failure, and photos for the convenience of accessing the program, which made it possible to make requests for the it inspection and maintenance in real time. Second, it linked the identification of the targets to be changed, risk assessment, worker training, and pre-operation inspection with the program, which allowed the administrator to track all the procedures from start to finish. Third, it made it possible to predict the life of the equipment and verify its reliability based on the data accumulated through the registration of the pictures for improvements, repairs, time required, cost, etc. after the work was completed. It is suggested that these research results will be helpful in the practical and systematic operation of small-and medium-sized PSM workplaces. In addition, it can be utilized in a useful manner for the development and dissemination of a facility maintenance web program when establishing future smart factories in small-and medium-sized PSM workplaces under the direction of the government.

A Study on Park Gye-hyeong -Focusing on the Change of Romantic writing (박계형론 -낭만적 글쓰기의 변주를 중심으로)

  • Jin, Sun-Young
    • Journal of Popular Narrative
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    • v.25 no.2
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    • pp.247-275
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    • 2019
  • We hope that more diverse interests will arise in the novels by Park Gye-hyeong By looking at writers and works in time, we identified the key element of Park Gye-hyeong's novels as 'romantic'. Romantic nature of this time is lyrical, sentimental, spiritual, unrealistic and idealistic. Based on a romantic understanding of the world, the core sanction of the novel is love, focusing on feelings of sadness, and on the aspects of joy, separation, and pain that arise from loving relationships rather than the aspects of joy. Based on the feelings of grief, the novels end with failure, death and betrayal, thus embodying tragic romanticism. Before her marriage, Park Gye-hyeong's novels were love stories that revealed her longing for beautiful love based on sensibility. The idyllic world and longing for nature reveal a romantic world-view. Ultimately, it is a fictional worldview that the author seeks to despair and long for, and to find the sincerity and morality of love in an environment that does not. Park Gye-hyeong, who became a housewife, expressed that she wanted to write a piece that can give readers a sense of nostalgia by embodying "romance at a high level," not "sentimental." In subsequent works, physical relationships are treated as failures of love and spiritual relationships as the fruit of love, revealing the lofty spirituality, idealistic longing and religious nature of love. Park Gye-hyeong confessed her shame about her previous work when she published a new one after more than two decades of writing. And after more than two decades of reflection, her new novel had a new theme of "recovering destroyed humanity." However, the search for "humanity" in the two novels released after the write-off tends to be somewhat hasty at the end of the novel. The question of human nature, sin and forgiveness, is the next best thing to save as a way of life, rather than as a result of the intense inner agony and behavior of the characters within the narrative, and this also shows a sudden shift in religiousness at the end of the novel. Therefore, the romantic meaning of the superficial is superficial.

Estimation of Structural Deterioration of Sewer using Markov Chain Model (마르코프 연쇄 모델을 이용한 하수관로의 구조적 노후도 추정)

  • Kang, Byong Jun;Yoo, Soon Yu;Zhang, Chuanli;Park, Kyoo Hong
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.43 no.4
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    • pp.421-431
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    • 2023
  • Sewer deterioration models can offer important information on prediction of future condition of the asset to decision makers in their implementing sewer pipe networks management program. In this study, Markov chain model was used to estimate sewer deterioration trend based on the historical structural condition assessment data obtained by CCTV inspection. The data used in this study were limited to Hume pipe with diameter of 450 mm and 600 mm in three sub-catchment areas in city A, which were collected by CCTV inspection projects performed in 1998-1999 and 2010-2011. As a result, it was found that sewers in sub-catchment area EM have deteriorated faster than those in other two sub-catchments. Various main defects were to generate in 29% of 450 mm sewers and 38% of 600 mm in 35 years after the installation, while serious failure in 62% of 450 mm sewers and 74% of 600 mm in 100 years after the installation in sub-catchment area EM. In sub-catchment area SN, main defects were to generate in 26% of 450 mm sewers and 35% of 600 mm in 35 years after the installation, while in sub-catchment area HK main defects were to generate in 27% of 450 mm sewers and 37% of 600 mm in 35 years after the installation. Larger sewer pipes of 600 mm were found to deteriorate faster than smaller sewer pipes of 450 mm by about 12 years. Assuming that the percentage of main defects generation could be set as 40% to estimate the life expectancy of the sewers, it was estimated as 60 years in sub-catchment area SN, 42 years in sub-catchment area EM, 59 years in sub-catchment area HK for 450 mm sewer pipes, respectively. For 600 mm sewer pipes, on the other hand, it was estimated as 43 years, 34 years, 39 years in sub-catchment areas SN, EM, and HK, respectively.

The Role of Tumor Necrosis Factor-$\alpha$ and Interleukin-$1{\beta}$ as Predictable Markers for Development of Adult Respiratory Distress Syndrome in Septic Syndrome (패혈증 증후군환자에서 성인성 호흡곤란 증후군 발생의 예측 지표서의 혈중 Tumor Necrosis Factor-$\alpha$와 Interleukin-$1{\beta}$에 관한 연구)

  • Koh, Youn-Suck;Jang, Yun-Hae;Kim, Woo-Sung;Lee, Jae-Dam;Oh, Soon-Hwan;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.5
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    • pp.452-461
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    • 1994
  • Background: Tumor necrosis factor(TNF)-$\alpha$ and Interleukin(lL)-$1{\beta}$ are thought to play a major role in the pathogenesis of the septic syndrome, which is frequently associated with adult respiratory distress syndrome(ARDS). In spite of many reports for the role of TNF-$\alpha$ in the pathogenesis of ARDS, including human studies, it has been reported that TNF-$\alpha$ is not sensitive and specific marker for impending ARDS. But there is a possibility that the results were affected by the diversity of pathogenetic mechanisms leading to the ARDS because of various underlying disorders of the study group in the previous reports. The purpose of the present study was to evaluate the roles of TNF-$\alpha$ and IL-$1{\beta}$ as a predictable marker for development of ARDS in the patients with septic syndrome, in which the pathogenesis is believed to be mainly cytokine-mediated. Methods: Thirty-six patients of the septic syndrome hospitalized in the intensive care units of the Asan Medical Center were studied. Sixteens suffered from ARDS, whereas the remaining 20 were at the risk of developing ARDS(acute hypoxemic respiratory failure, AHRF). In all patients venous blood samples were collected in heparin-coated tubes at the time of enrollment, at 24 and 72 h thereafter. TNF-$\alpha$ and IL-$1{\beta}$ was measured by an enzyme-linked immunosorbent assay (ELISA). All data are expressed as median with interquartile range. Results: 1) Plama TNF-$\alpha$ levels: Plasma TNF-$\beta$ levels were less than 10pg/mL, which is lowest detection value of the kit used in this study within the range of the $mean{\pm}2SD$, in all of the normal controls, 8 of 16 subjects of ARDS and in 8 in 20 subjects of AHRF. Plasma TNF-$\alpha$ levels from patients with ARDS were 10.26pg/mL(median; <10-16.99pg/mL, interquartile range) and not different from those of patients at AHRF(10.82, <10-20.38pg/mL). There was also no significant difference between pre-ARDS(<10, <10-15.32pg/mL) and ARDS(<10, <10-10.22pg/mL). TNF-$\alpha$ levels were significantly greater in the patients with shock than the patients without shock(12.53pg/mL vs. <10pg/mL) (p<0.01). There was no statistical significance between survivors(<10, <10-12.92pg/mL) and nonsurvivors(11.80, <10-20.8pg/mL) (P=0.28) in the plasma TNF-$\alpha$ levels. 2) Plasma IL-$1{\beta}$ levels: Plasma IL-$1{\beta}$ levels were less than 0.3ng/mL, which is the lowest detection value of the kit used in this study, in one of each patients group. There was no significant difference in IL-$1{\beta}$ levels of the ARDS(2.22, 1.37-8.01ng/mL) and of the AHRF(2.13, 0.83-5.29ng/mL). There was also no significant difference between pre-ARDS(2.53, <0.3-8.34ngfmL) and ARDS(5.35, 0.66-11.51ng/mL), and between patients with septic shock and patients without shock (2.51, 1.28-8.34 vs 1.46, 0.15-2.13ng/mL). Plasma IL-$1{\beta}$ levels were significantly different between survivors(1.37, 0.4-2.36ng/mL) and nonsurvivors(2.84, 1.46-8.34ng/mL). Conclusion: Plasma TNF-$\alpha$ and IL-$1{\beta}$ level are not a predictable marker for development of ARDS. But TNF-$\alpha$ is a marker for shock in septic syndrome. These result could not exclude a possibility of pathophysiologic roles of TNF-$\alpha$ and IL-$1{\beta}$ in acute lung injury because these cytokine could be locally produced and exert its effects within the lungs.

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Initial Experience of the Emergency Bypass System ($EBS^{(R)}$) for the Patients with Cardiogenic Shock due to an Acute Myocardial Infarction (급성 심근경색으로 인한 심인성 쇼크 환자에 대한 경피적 순환 보조장치($EBS^{(R)}$) 적용의 초기경험)

  • Ryu, Kyoung-Min;Kim, Sam-Hyun;Seo, Pil-Won;Ryu, Jae-Wook;Kim, Seok-Kon;Kim, Young-Hwa;Park, Seong-Sik
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.329-334
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    • 2008
  • Background: Percutaneous cardiopulmonary support. (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial Infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. Material and Method: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system($EBS^{(R)}$, Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the $EBS^{(R)}$ circuit. The $EBS^{(R)}$ flow rate was maintained between $2.5{\sim}3.0L/min/m^2$ and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. Result: The mean age of patients was $61.1{\pm}14.2$ years (range, 39 to 77 years). Three patients were under control of the $EBS^{(R)}$ before percutaneous coronary intervention (PCI), three patients were under control of the $EBS^{(R)}$ during PCI, one patient was under control of the $EBS^{(R)}$ after PCI, and one patient was under control of the $EBS^{(R)}$ after coronary bypass surgery. The mean support time was $47.5{\pm}27.9$ hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the $EBS^{(R)}$ after $53.6{\pm}27.2$ hours. (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before $EBS^{(R)}$ support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at $16.8{\pm}3.1$ months (range, 12 to 20 months) of follow-up. Conclusion: The use of $EBS^{(R)}$ for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after $EBS^{(R)}$ treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the $EBS^{(R)}$ in the future.