• 대한응급의학회지
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• 제29권5호
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• pp.509-518
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• 2018

Objective: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. Methods: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH <7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. Results: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. Conclusion: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권2호
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• pp.143-148
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• 1997

Cancer therapy for the head and neck malignoncy by surgery, radiotherapy, or combined modalities may cause substantial aesthetic and functional problems for the patient. The placement of osseointegrated implants into irradiated bone should only be performed when the predictability of achieving and maintaining osseointegration is high and the risk of developing of osteoradionecrosis is low. There are many benefits that irradiated patients may gain from the use of implants. A successful implant-retained prosthesis is dependent upon the implants attaining osseointegraton and then sustaining it during functional loads. The use of implants in irradiated patients requires high implant success rates that are acceptable to warrant their use. We report a case and review the literatures about implants in irradiated bone. In that case, the patient were undergone tumor resection and inner-table mandiblectomy due to squamous cell carcinoma of lower posterior gingiva. But 5 year later, the tumor were recurred, we resected the tumor and applied the radiation therapy. After then, we installed four IMZ implants after hyperbaric oxygenation, and made prosthesis using those implants. Until now they don't have any complications.

• Journal of Preventive Medicine and Public Health
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• 제15권1호
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• pp.145-151
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• 1982

산모(産母)와 태아(胎兒)에서의 CO 배출양상(排出樣相)의 차이(差異)가 hemoglobin의 CO와의 결합력(結合力)의 차이(差異)에서 기인(起因)된 것인지의 여부(與否)를 산소분압(酸素分壓)에 따른 HbCO의 해리양상(解離樣相)으로써 규명(糾明)하고 이를 토대(土臺)로 임신부(姙娠婦) 및 영아가 CO에 중독(中毒)되었을 때의 적절(適切)한 산소치료방식(酸素治療方式)을 모색(模索)하고자 본(本) 실험(實驗)을 실시(實施)하여 다음과 같은 성적(成績)을 얻었다. 1. 성인혈(成人血)과 태아혈(胎兒血)의 total hemoglobin량(量)은 각각(各各) $16.1{\pm}0.50gm%,\;15.7{\pm}0.32gm%$였으며 fetal hemoglobin 비율(比率)은 각각(各各) $1.2{\pm}0.15%,\;72.7{\pm}3.01%$ 였다. 2. 성인혈(成人血)과 태아혈(胎兒血)을 100% HbCO로 포화(飽和)시킨 뒤 일반대기(一般大氣), 100% $O_2$, 3기압산소(氣壓酸素)에 30분간(分間) 폭로(曝露)시킨 직후(直後)의 혈중(血中) HbCO 포화도(飽和度)는 성인혈(成人血)에서 각각(各各) 96.7%, 70.9% 및 52.8%였으며 태아혈(胎兒血)에서 각각(各各) 98.5%, 76.1% 및 62.2%로 감소(減少)하여 3기압산소(氣壓酸素)에서 가장 현저(顯著)한 감소(減少)를 보여 HbCO의 해리(解離)는 산소분압(酸素分壓)에 비례(比例)함이 확인(確認)되었으며 또 전(全) 실험군(實驗群)에서 성인혈(成人血)보다 태아혈(胎兒血)의 HbCO 해리(解離)가 늦은 양상(樣相)을 보였다. 3. 실험군(實驗群)에 대(對)한 각(各) 산소분압별(酸素分壓別) 폭로(曝露)가 끝난 후(後) $36.5^{\circ}C$의 일반대기하(一般大氣下)에서 시간경과(時間經過)에 따른 성인혈(成人血)과 태아혈중(胎兒血中) HbCO의 해리양상(解離樣相)은 거의 비슷하게 완만(緩慢)하였다. 4. 이상(以上)의 소견(所見)으로 미루어 볼 때 임신부(姙娠婦)의 CO 중독(中毒)은 산모(産母)보다 태아(胎兒)에서 더 큰 위해(危害)를 초래(招來)할 가능성(可能性)이 크며 또 HbF의 구성점유율(構成占有率)이 높은 6개월(個月) 이하(以下)의 영아에서도 그 위해도(危害度)가 클 것으로 간주(看做)된다. 따라서 임신부(姙娠婦) 또는 생후(生後) 6개월(個月) 이하(以下)의 영아가 CO 중독(中毒)되었을 때는 고압산소요법(高壓酸素療法)이 효과적(效果的)인 치료법(治療法)으로 보이며 그 치료시간(治療時間)을 성인환자(成人患者)에 있어서의 그것보다 좀 더 길게하는 것이 CO 중독(中毒)에 의한 위해(危害)를 감소(減少)시켜 줄 것으로 기대(期待) 된다.