• 한국의료질향상학회지
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• 제10권1호
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• pp.28-41
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• 2003

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.468-471
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• 2009

Objective : The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. Methods : All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. Results : Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%). remained stable in 8 (33.4%). and worsened in 2 (8.3%). Conclusion : The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.134-141
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• 2010

Purpose: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. Methods: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. Results: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. Conclusion: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.207-210
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• 2001

Objective : The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. Material and Method : A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. Results : In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. Conclusion : It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.

• Journal of Chest Surgery
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• 제32권5호
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• pp.448-455
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• 1999

배경: 비디오흉강경수술은 최근 기기의 급속한 발달로 인해 많은 흉부 질환에 적용되고 있으며, 자연기흉에 대한 적절한 치료법으로 제시되고 있지만 개흉술에 비해 높은 재발율이 문제점으로 거론되고 있으며, 수술후 재발에 대한 장기 추적관찰이 미흡한 실정이다. 대상 및 방법: 고대 안암병원 흉부외과에서는 비디오흉강경이 도입된 1992년 3월부터 1997년 3월까지 288명의 자연기흉 환자에 대해서 292례의 비디오흉강경수술을 시행하였다. 수술후 추적 관찰한 결과와 재발에 관여하는 인자를 전향적으로 분석하였다. 개흉술로의 전환례 8례는 제외하였다. 결과: 남자 249명(88.9%), 여자 31명(11.1%)이었으며, 나이는 평균 28.1 12.2세(15~69세)였다. 원발성 자연기흉이 237명(83.5%), 이차성 자연기흉이 47명(16.5%)였으며 이차성 자연기흉 중에서는 결핵성이 27명(57.5%)으로 가장 많았다. 수술 적응증으로는 동측 재발성 기흉이 123명(43.9%)과 지속적 공기누출 53명(18.9%)으로 대부분을 차지하였으며, 그외 흉부촬영상 폐기포가 존재한 경우 40명(14.3%), 긴장성 기흉 30명(10.7%), 반대측 기흉 21명(7.5%), 양측성 기흉 3명(1.1%), 합병증이 동반된 경우 2명(0.7%), 그리고 환자나 보호자가 원한 경우가 8명(2.9%)이였다. 흉강경수술시 폐기포가 관찰된 경우 247례(87%)였다. 244례(85.9%)에서 폐기포절제술이 시행되었다. 평균 수술시간은 52.8 23.1분(20~165분)이었다. 술후 합병증으로 5일 이상 공기누출이 16례이었으며, 이중 4례에서 재수술이 필요하였으며 전례에서 폐기포가 다시 발견되었다(100%, 4/4). 출혈이 5례 있었으며 이중 3례에서 재수술이 필요하였다. 그외 무기폐 2례, 농흉 5례, 창상감염 1례가 병발되었으며 술후 사망례는 없었다. 평균 흉관거치기간은 5.0 4.5일(2~37일), 평균 입원일은 8.2 5.5\ulcorner(3~43일)이었다. 평균 22.3 18.4개월(1~65개월)의 추적 관찰기간 동안 12례가 누락됐으며(4.2%), 24례(8.5%,)가 재발하였다. 이중 7명의 경우 재수술이 필요하였으며 6례에서 폐기포가 재발견되었다(85.7%, 6/7). 12개의 요인(나이, 성별, 기흉의 위치, 기흉의 정도, 원인질환 유무, 수술 적응증, 폐기포의 수, 폐기포의 크기, 폐기포의 위치, 폐기포절제 유무, 흉막유착술 방법, 술후 지속성 공기누출 유무)가 재발에 관여하는 지에 대해 분석하였다. 원인질환 유무, 흉막유착술 방법과 술후 지속성 공기누출 유무가 재발에 관여하는 위험요인으로 나타났다. 이차성인 경우가 원발성인 경우보다 재발율이 높았고[17.0%(8/47) : 6.8% (16/237), p=0.038], 술후 지속적 공기누출이 있었던 경우 재발율이 높았으며[37.5%(6/16) : 6.7%(18/268), p=0.001], 기계적 흉막유착술이 흉막절제술보다 재발율이 높았다[11.4%(19/167) : 4.3%(5/117), p=0.034]. 폐기포절제술을 시행한 경우가 하지않은 경우보다 재발율이 낮았으나 통계학적 의의는 없었다[10.0%(4/40) : 8.2%(20/244), p>0.05]. 결론: 비디오흉강경술에서 재발을 낮추기 위해 수술시 폐야 전체를 관찰하여 존재하는 폐기포를 놓치지 않는 것이 중요하며, 폐기포를 확인하지 못한 경우와 이차성 자연기흉에 대해서는 흉막유착술에 더 세심한 주의가 필요하다는 것을 확인하였다. 비디오흉강경수술은 통증이 적고, 입원기간이 짧고, 사회로의 복귀가 빠르며, 고위험군에 적용할 수 있고, 무엇보다도 미용상의 이점이 크다는 면에서 자연기흉에 대해 유용한 치료방법임에는 틀림이 없으나 개흉술에 비해 재발율이 높고 비용이 비싸다는 문제가 제기되고 있는 만큼 더 세심한 주의와 장기 추적관찰이 필요하리라 사료된다.

• 한국축산시설환경학회지
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• 제1권1호
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• pp.9-19
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• 1995

This study was carried out to investigate the effect of sawdust bedding barn on manure handing, management labour and physiological aspect of dairy cows, and then to establish the criteria on the optimum utilization method of sawdust bedding barn. 46 tie stall barns and 49 sawdust bedding barns were surveyed to cmopare the milk productivity between two different barns, and also 5 tie stall barns, 15 sawdust bedding barns and 1 rice hull bedding barn were selected to study the utilization situation of sawdust barn in Kyung-Ki province area. The major results obtained were as follows; 1. The roof material of sawdust barn were consisted of 66% vinyl house, 23% PVC light and 11% slate and galvanum coated tin. Most of the floor structure was earth ground with the rate of the approximately 82%. 2. The average occupied area of sawdust bed per cow was 15.2 $m^2$, depth that 30 cm and the utilization period was 12 months. 3. Milk Yield was significantly higher at sawdust barn than at tie stall barn(P<0.01). Bacterial and somatic cell count in raw milk were less at the sawdust barn than in tie stall barn. However, there was not significance difference between two barns. 4. The labour hour needed to cow management in the sawdust barn was approximately 48% of that of tie stall barn. 5. The temperature and moisture content measured in sawdust bed were closely affected by seasonal ambient temperature. The skin and hair of cow were much cleaner at the PVC light roofed sawdust barn than any other roof materials. 6. The additives used for improving of fermentation did not show any effect on temperature and moisture content in sawdust bed. When the ambient temperature was $30.4^{\circ}C$, the surface temperature of measured 1 cm above the sawdust bed was $12.2^{\circ}C$ lower and the temperature of 100 cm above the sawdust bed was $2.4^{\circ}C lower under shading net facility than that of vinyl roofed one.7. The hoof length of miking cow was 7.95 cm in tie stall and 9.19 cm in sawdust barn with high significance (P<0.01). And disease occurence such as mastitis and foot-rot tended to decrease in the sawdust barn. 8. The number of total bacteria and coliform bacteria were less in the sawdust bed compared with earth ground resting area. And a parasite strongyloides papillosus was detected but without any infected cow. 9. The nitrate($NO_3N$) content in non-roofed earth ground resting area and earth ground under the sawdust bed was likely to pollute the ground water. 10. In economic point of view, rice hull bedding barn was the cheapest among different systems. And in the sawdust bedding barn PVC light + slate roofed barn was most desirable, and vinyl roofed one the least.

• 대한약리학회지
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• 제11권1호
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• pp.33-38
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• 1975

말정혈관확장제(末精血管擴張劑)인 Ethaverine의 임상효과(임상(臨床效果)는 말초동맥질환(末梢動脈疾患)을 갖인 29명(名)의 당뇨질환자(糖尿疾患者)를 대상으로 이중맹검(二重盲檢) 비교차(非交叉) 방법(方法)에 의(依)하여 연구검토(硏究檢討)하였다. 임상적(臨床的)인 개선(改善)은 간헐성파행증(間歇性跛行症)의 발생빈도(發生頻度)를 포함하는 환노(患老)들의 병역(病歷)으로부터 평가(評價)하였다. Ethaverine을 사주(四週) 치료후(治療後)는 임상증상(臨床症狀)을 개선(改善)하는데 있어 위약(僞藥)에 비(比)하여 효과가 없었다. 어째든 간에 Ethaverine은 위약(僞藥)보다는 혈관확장제(血管擴張劑)로서 효력이 있었다. Ethaverine에 의(依)하여 유발(誘發)되는 혈관확장제(血管擴張劑)의 성질(性質)은 alcohol의 그것과 유사하였다. 말초혈관확장제(末梢血管擴張劑)를 연구(硏究)하는 새로운 임상적(臨床的) 방법(方法)을 제시(提示)하였다. 하지(下肢)의 말초혈관(末梢血管) 동맥질환(動脈疾患)의 임상증상(臨床症狀)은 촉맥강도(觸脈强度)의 감소냉감(減少冷感) 및 피부(皮膚)의 변색(變色)등을 들 수 있다. 간헐성파행증(間歇性跛行症)도 수반하는 수가 있다. 혈관조직(血管組織)에 있어서의 병변(病變)이 이같은 증상(症狀)에 선행(先行)하여 일어나며 위중(危重)한 혈관부전(血管不全)의 입증(立證)은 혈관확장제료법(血管擴張劑療法) 또는 외과적(外科的) 처치(處置)를 택하는데 있어서의 결정적(決定的)인 요인(要因)이 된다. 만성 말초동맥질환(末梢動脈疾患)이 있는 술후환자(術後患者)들도 차후혈관확장제(次後血管擴張劑)의 치료(治療)를 받아야한다. 임상보고((臨床報告)에 의(依)하면 말초혈관확장제(末梢血管擴張劑)는 폐새성(閉塞性) 혈관질환(血管疾患)에 대(對)해서 보다는 혈관경련성(血管痙攣性) 말초혈관장해(末梢血管障害)에 대해서 보다 유효하며 비교적 큰 혈관상(血管床)보다는 작은 모세혈관상(毛細血管床) 일때의 혈관(血管)이 가장 잘 감응(感應)한다고 한다. 최근(最近)에 이르러 말초혈관확장제(末梢血管擴張劑)의 임상(臨床)효과는 수많은 임상연구가(臨床硏究家)들 및 임상의(臨床醫)들의 연구대상(硏究對象)이 되고있다. 본연구(本硏究)에서 연구자(硏究者)들은 혈관경련성말초동맥질환(血管痙攣性末梢動脈疾患)을 갖인 환자(患者)들에 대(對)한 말초혈관확장제(末梢血管擴張劑)로써의 Ethaverine HCl의 임상(臨床)효과를 재평가(再評價)하였다. Ethaverine은 각종임상시험결과(各種臨床試驗結果)에 의(依)하면 항경련제(抗痙攣劑)로서는 papaverine 보다도 2배(倍) 내지 4배(倍)정도 그 약효가 강력(强力)하다고 한다.