• 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.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.1
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• pp.9-15
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• 2008

Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1076-1080
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• 1998

Background: Spontaneous hemopneumothorax, occurring in 1% to 12% of patients with spontaneous pneumothorax, is a rare disorder that can potentially lead to life-threatening complications. Materials and methods: We have experienced 15 cases (2.28%) with spontaneous hemopneumothorax among 659 episodes of spontaneous pneumothorax for eight years, from 1990 to 1997, at our hospital. We studied our previously treated patients by retrospective case studies to determine the nature of optimal management. Results: There were 14 male and 1 female patients whose mean age was 27.5 years, ranging from 19 to 58. The sides with disorder were as following: right in 10 cases and left in 5, unilaterally. The amount of initial bleeding ranged from 400 to 1,500 mL and 8 patients received a homologous blood transfusion. Patients exhibited symptoms of chest pain, dyspnea, chest discomfort, and hypovolemic shock. We concluded that causes of this disease in our patients were a torn pleural adhesion (14 cases) and a rupture of vascularized bullae (1 case with an underlying intrinsic lung disease, tuberculosis). All patients underwent closed thoracostomy and had good results except for 3. One patient underwent thoracotomy within 3 days from the onset because of continuous active hemorrhage. Decortication was required in one case because of a reactive fluid collection in the pleural space, which led to impaired lung expansion. Another patient underwent thoracotomy due to a ipsilateral recurrent pneumothorax without blood collection. Conclusions: The goals of treatment include hemostasis and reexpansion of the collapsed lung. Thus, if patients arrive early at hospital, closed thoracostomy and transfusion are thought to be sufficient treatments, although early surgical repair has been considered recently.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.1042-1046
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• 2001

The incidence of paraplegia following drain of cerebrospinal fluid(CSF) by lumbar puncure below a spinal block is rare, and most of them occurred in spinal tumor. We report a case of acute paraplegia following lumbar puncture for computed tomography myelography(CTM) in a 42-year-old man who sustained a cervical disc herniation. Four hours after lumbar puncture for CTM, sudden paraplegia was developed. After emergent anterior cervical discectomy and fusion with cervical plating, the patient recovered completely. To the authors' knowledge, this is the first case of spinal shock complicating lumbar puncture for routine myelography in a patient with cervical disc herniation. The prompt recognition of this unusual complication of lumbar puncture may lead to good clinical outcome. Instead of CTM requiring lumbar puncture, MRI should be considered as the initial diagnostic procedure in a patient of cervical disc herniation associated with myelopathy. We discuss the possible mechanisms of acute paraplegia following lumbar puncture with literature review.

• Journal of Trauma and Injury
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• v.29 no.3
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• pp.93-97
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• 2016

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of ${\bigcirc}{\bigcirc}$ trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.

• Journal of Microbiology and Biotechnology
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• v.24 no.8
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• pp.1133-1142
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• 2014

Interleukin-32 (IL-32) is a cytokine and inducer of various proinflammatory cytokines such as $TNF{\alpha}$, IL-$1{\beta}$, and IL-6 as well as chemokines. There are five splicing variants (${\alpha}$, ${\beta}$, ${\gamma}$, ${\delta}$, and ${\varepsilon}$) and IL-$32{\gamma}$ is the most active isoform. We generated human IL-$32{\gamma}$ transgenic (IL-$32{\gamma}$ TG) mice to express high level of IL-$32{\gamma}$ in various tissues, including immune cells. The pathology of sepsis is based on the systemic inflammatory response that is characterized by upregulating inflammatory cytokines in whole body, particularly in response to gram-negative bacteria. We investigated the role of IL-$32{\gamma}$ in a mouse model of experimental sepsis by using lipopolysaccharides (LPS). We found that IL-$32{\gamma}TG$ mice resisted LPS-induced lethal endotoxemia. IL-$32{\gamma}$ reduced systemic cytokines release after LPS administration but not the local immune response. IL-$32{\gamma}TG$ increased neutrophil influx into the initial foci of the primary injected site, and prolonged local cytokines and chemokines production. These results suggest that neutrophil recruitment in IL-$32{\gamma}TG$ occurred as a result of the local induction of chemokines but not the systemic inflammatory cytokine circulation. Together, our results suggest that IL-$32{\gamma}$ enhances an innate immune response against local infection but inhibits the spread of immune responses, leading to systemic immune disorder.

• Proceedings of the KSR Conference
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• 2010.06a
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• pp.139-150
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• 2010

Recently, full-scale research about a passenger tube train system is being progressed as a next-generation transportation system in Korea in light of global green technology. The Korea Railroad Research Institute (KRRI) has commenced official research on the construction of a tube train system. In this paper, we studied various parameters of the tube train system such as the internal tube pressure, blockage ratio, and operating speed through computational analysis with a symmetric and elongated vehicle. This study was about the aerodynamic characteristics of a tube train that operated under standard atmospheric pressure (open field system, viz., ground) and in various internal tube environments (varying internal tube pressure, blockage ratio, and operating speed) with the same shape and operating speed. Under these conditions, the internal tube pressure was calculated when the energy efficiency had the same value as that of the open field train depending on various combinations of the operating speed and blockage ratio (the P-D relation). In addition, the dependence of the relation between the internal tube pressure and the blockage ratio (the P-${\beta}$ relation) was shown. Besides, the dependence of the relation between the total drag and the operating speed depending on various combinations of the blockage ratio and internal tube pressure (the D-V relation) was shown. Also, we compared the total (aerodynamic) drag of a train in the open field with the total drag of a train inside a tube. Then, we calculated the limit speed of the tube train, i.e., the maximum speed, for various internal tube pressures (the V-P relation) and the critical speed that leads to shock waves under various blockage ratios, which is related to the efficiency of the tube train (the critical V-${\beta}$ relation). Those results provide guidelines for the initial design and construction of a tube train system.

• Journal of Distribution Science
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• v.13 no.8
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• pp.61-71
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• 2015

Purpose - Before the year 2000, the housing prices in Korea were increasing every decade. After 2000, for the first time, Korea experienced a decrease in housing prices, and the repetitive cycle of price fluctuation started. Such a "boom and bust cycle" is a worldwide phenomenon. The current study proposes a mathematical model to explain price fluctuation cycles based on the theory of consumer psychology. Specifically, the model incorporates the effects of buyer expectations of future prices on actual price changes. Based on the model, this study investigates various independent variables affecting the amplitude of price fluctuations in housing markets. Research design, data, and methodology - The study provides theoretical analyses based on a mathematical model. The proposed model uses the following assumptions of the pricing mechanism in housing markets. First, the price of a house at a certain time is affected not only by its current price but also by its expected future price. Second, house investors or buyers cannot predict the exact future price but make a subjective prediction based on observed price changes up to the present. Third, the price is determined by demand changes made in previous time periods. The current study tries to explain the boom-bust cycle in housing markets with a mathematical model and several numerical examples. The model illustrates the effects of consumer price elasticity, consumer sensitivity to price changes, and the sensitivity of prices to demand changes on price fluctuation. Results - The analytical results imply that even without external effects, the boom-bust cycle can occur endogenously due to buyer psychological factors. The model supports the expectation of future price direction as the most important variable causing price fluctuation in housing market. Consumer tendency for making choices based on both the current and expected future price causes repetitive boom-bust cycles in housing markets. Such consumers who respond more sensitively to price changes are shown to make the market more volatile. Consumer price elasticity is shown to be irrelevant to price fluctuations. Conclusions - The mechanism of price fluctuation in the proposed model can be summarized as follows. If a certain external shock causes an initial price increase, consumers perceive it as an ongoing increasing price trend. If the demand increases due to the higher expected price, the price goes up further. However, too high a price cannot be sustained for long, thus the increasing price trend ceases at some point. Once the market loses the momentum of a price increase, the price starts to drop. A price decrease signals a further decrease in a future price, thus the demand decreases further. When the price is perceived as low enough, the direction of the price change is reversed again. Policy makers should be cognizant that the current increase in housing prices due to increased liquidity can pose a serious threat of a sudden price decrease in housing markets.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.139-144
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• 2012

Purpose: Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system. Methods: We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS). Results: From among the 102 patients, 97 patients (M:F=68:29, mean $age=46.7{\pm}16.6years$) were enrolled for analysis. The average ISS of the patients was $16.2{\pm}7.9$, and the average amount of packed RBC transfusion for 24 hr was $3.9{\pm}4.6units$. The regression equation resulting from the multiple linear regression analysis was 'packed RBC units=1.40${\times}$(sacrum fracture)+1.72${\times}$(pubis fracture)+1.67${\times}$(ilium fracture)+0.36' and was found to be suitable (p=0.005). We simplified the regression equation to 'Pelvic Bleeding Score=sacrum+pubis+ilium.' Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%. Conclusion: We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management.

• Korean Journal of Microbiology
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• v.44 no.2
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• pp.122-129
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• 2008

The purpose of this work was to investigate the synergically bactericidal effects and cellular responses of green tea polyphenols (TPPs) and nalidixic acid (NA) on nalidixic acid-resistant (NAR) Salmonella typhimurium. The bactericidal activities of $>3,500{\mu}g/ml$ TPPs and $<256{\mu}g/ml$ NA were investigated for S. typhimurium of which initial cell number was approximately adjusted to 107 cell/ml. Complete elimination of NAS-S. typhimurium was achieved within 6 hr of incubation at the concentrations of $3,500{\mu}g/ml$ TPP or $256{\mu}g/ml$ NA, whereas only partial bactericidal effect was achieved under the same conditions. However, the combinations of $3,000{\mu}g/ml$ TPPs and $32{\mu}g/ml$ NA against NAS-S. typhimurium and $3,500{\mu}g/ml$ TPPs and $64{\mu}g/ml$ nalidixic acid against NAR-S. typhimurium showed complete removal within 5 hr of incubation. The stress shock proteins (SSPs) were induced at different concentrations of TPP o rNA used as stressors against cell culture of S. typhimurium. The proteins were identified as 70-kDa DnaK and 60-kDa GroEL by SDS-PAGE and Western blot. SSPs induced by the stressors were found to increase in proportion to the TPPs or NA. Scanning electron microscopy analyses revealed the presence of perforations and irregular rod shape with wrinkled surfaces for cells treated with TPPs or NA.