• Journal of Trauma and Injury
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• 제22권2호
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• pp.206-211
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• 2009

Purpose: Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries. Methods: A retrospective investigation of patients'electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT. Results: Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type. Conclusion: This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.77-86
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• 2009

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.157-162
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• 2013

Purpose: Abdominal trauma rarely causes injuries involving duodenum. But, it is associated with higher rate of the complication and mortality than other abdominal injuries. There are many options for the management of duodenal injuries. Herein we are to review our experiences and find out the risk factors related to the morbidity and the mortality in traumatic duodenal injuries. Methods: The medical records of total 25 patients who managed by surgical managements and survive more than 48 hours were conducted from January 2006 to December 2012. The clinical characteristics, treatments, and outcomes are reviewed. Results: Among 25 patients, most of them (n=17, 68.0%) were managed by the pyloric exclusion and the gastrojejunostomy. The $3^{rd}$ portion is the most injured site (n=15, 60.0%), and the majority exhibited grade 2 severity (n=14, 56.0%). Most of patients had blunt abdominal traumas (n=23, 92.0%) so that many of them (n=14, 56.0%) had other combined abdominal injuries. The mean ISS is $11.5{\pm}6.2$. The surgery related mortality rate was 28.0%. There was no statistical significance between each factors and the mortality except leakage (p=0.012). But, we could find some trends about traumatic duodenal injuries in this study. The mortality rates of them who older than 55 years were higher than others. And, all 3 patients who delayed the operation more than 24 hours after the trauma had some complications or died. Also, the patients who had the $2^{nd}$ portion injury, grade 3 injury, or combined abdominal injury were less survived. Conclusion: Duodenal injury is related to high rate of morbidity(47.8%) and mortality(28.0%). Age, portion of injury, OIS grade, ISS>15, combined intra-abdominal operation, and trauma to operation time over 24 hrs have some trend with attribution to mortality. Especially leakage of duodenal injury is related to mortality.

• Pediatric Infection and Vaccine
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• 제13권2호
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• pp.124-129
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• 2006

목 적 : 1996년부터 2005년까지 단일기관에서 발생한 세균성 수막염의 주요 원인균의 연령별 분포를 조사하였다. 방 법 : 1996년 1월부터 2005년 12월까지 세브란스병원 소아과에 입원하여 세균성 수막염이나 신생아 수막염으로 진단받은 환아들 중 뇌척수액 배양검사 및 라텍스응집반응검사에서 원인균이 확인된 증례들의 의무기록을 후향적으로 조사하였다. 결 과 : 원인균이 확인된 46례 중 신생아 수막염은 미숙아 4례를 포함하여 27례였고 신생아기 이후의 세균성 수막염은 19례였다. 신생아 수막염 환아 중 원인균이 혈액배양검사에서도 동정된 경우는 모두 15례(55.6%)였다. 신생아 수막염의 가장 흔한 원인균은 B군 연쇄상 구균이었다(44.4%). 또한 B군 연쇄상 구균에 의한 수막염의 75.0%가 지발형 감염이었다. 신생아기 이후의 세균성 수막염 환아들의 84.2%가 5세 미만에서 발생하여, 이들의 연령 중앙값은 23개월이었다. 신생아기 이후의 세균성 수막염의 원인균으로는 폐구균 8례(42.1%), 인플루엔자균 8례, 수막구균 3례 등이 있었으며, 이 중 인플루엔자균는 2001년 이후 최근 5년간 검출되지 않았다. 결 론 : 신생아 수막염의 가장 흔한 원인균은 B군 연쇄상 구균이고 신생아기 이후에는 폐구균과 인플루엔자균이 세균성 수막염의 가장 흔한 원인균이었다. 이 중 단백결합 백신의 도입으로 인플루엔자균에 의한 세균성 수막염은 감소되는 경향을 보였다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.57-62
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• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Journal of Chest Surgery
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• 제39권11호
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• pp.822-827
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• 2006

배경: 폐 이식 수술은 호흡부전을 동반한 말기 폐질환 환자에서 유용한 치료방법 중의 하나로 본원에서는 1996년 국내에서 처음으로 일측 폐 이식 수술을 성공한 이래로 현재까지 재 이식 2예를 포함한 총 13예의 폐 이식 수술을 시행하였다. 저자 등은 그동안 환자들의 수술성적 및 합병증, 생존율 등을 분석하고자 하였다. 대상 및 방법: 1996년 7월부터 2005년 7월까지 영동세브란스병원 흉부외과에서 폐 이식을 시행받은 13예, 11명의 환자(2명은 재 이식환자)를 대상으로 후향적으로 임상기록지를 분석하였다. 결과: 남녀비는 9:4, 평균연령은 $45.2{\pm}10.7$세(범위 $25{\sim}59$세)였으며, 폐기종 및 만성폐쇄성 폐질환이 5예로 가장 많았고, 동맥관 개존증으로 인한 아이젠맹거 증후군 2예, 폐섬유증, 폐고혈압, 림프관 평활근종증, 기관지확장증이 각 1예였다. 조기 합병증으로는 출혈, 이식 폐 부전, 감염이며 후기 합병증으로는 감염 및 이식 후 림프증식증이었다. 조기사망 3예를 제외한 평균생존기간은 16.5개월($2{\sim}60$개월)이었다. 재 이식 2예는 이식 폐의 기능 부전에 의하여 각각 첫 이식 후에 2주, 13개월째 시행 받았다. 결론: 폐 이식 수술 후 장기성적을 향상시키기 위해서는 수술술기의 향상뿐만 아니라 수술 후 집중적인 환자관리를 통하여 합병증을 조기에 발견하고 필요한 내과적, 외과적 처치를 즉시 시행하는 것이 예후에 좋은 영향을 미칠 것으로 생각된다.

• 한국해양학회지:바다
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• 제5권2호
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• pp.157-168
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• 2000

우리나라 동해안에 서식하는 새치성게(Strongylocentrotus intermedius)는 둥근성게과(Strongylocentrotidae)에 속하는 냉수성 해양 무척추동물이다. 둥근성게과에는 현재 9종의 성게가 속해 있으나, 아직 종간의 분류 기준, 계통 분류학적 유연관계, 진화과정 등이 잘 밝혀져 있지 않다. 본 연구는 유전자 염기서열이라는 분자형질을 이용하여 새치성게의 종 분류기준을 확립하고 이 종의 계통진화 및 분화 시기를 파악하고자 수행되었다. 이를 위하여 변화율이 빠르고 모계로만 유전되는 특성을 가진 미토콘드리아의 한 유전자인 cytochrome c oxidase subunit I(COI)을 분석하였다. 새치성게의 생식소에서 DNA를 추출하고 중합효소연쇄반응으로 COI 유전자 단편을 선택적으로 증폭하였으며, 클로닝과 시퀀싱 과정을 거쳐 COI 유전자의 단편 1077개 염기쌍 순서(염기서열)를 확정하였다. 이 염기서열과 유전자 데이터베이스(GenBank)에 들어있는 다른 성게 및 해삼, 불가사리의 유전자를 비교하고 그 분자 계통수를 작성함으로써 새치성게의 진화과정을 분석하였다. COI 유전자 계통수는 새치성게가 태평양 동쪽 연안에 서식하는 S. purpuratus와 계통적으로 자매군(sister species)의 관계에 있음을 보였다. 두 종의 분화 시기는 계통수 상 분지의 길이와 화석연대를 고려하여 산출했을 때 지구 온도의 변동이 심했던 약 890만년 전으로 추정되었다. 태평양의 동안과 서안으로 분리된 두 종의 현재 분포와 종분화 시기의 지구 환경조건은 두 종간의 분화가 환경변화에 따른 개체군의 지리적 분리(vicariance)에 의한 것임을 시사해 준다. 한편, 새치성게의 COI 유전자염기서열은 이 종을 대표하는 분자형질로서 둥근성게과의 성게들을 서로 구분할 수 있는 종분류의 기준이 될 것이다.

• Journal of Chest Surgery
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• 제53권2호
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• pp.64-72
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• 2020

Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.

• 대한지역사회영양학회지
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• 제13권1호
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• pp.111-124
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• 2008

This study was conducted to develop a computerized food frequency questionnaire (FFQ) for assessing nutritional status of women of child-bearing age. Computerized food frequency questionnaire (FFQ) that reflect intakes of energy, carbohydrate, fat and protein was developed for women of child-bearing age. This FFQ is composed of 61 foods or food groups containing 192 dish items. To estimate of energy intake easily, we have developed a computer program that can be viewed on a computer screen in an actual size of dish items. Nutrient intakes of the last three months by the FFQ was validated with comparing the result of a 3-day diet record through 92 college students aged from 20 to 30. The level of energy, carbohydrate and sodium of estimating by the FFQ method was significantly higher than the level of a 3-day diet records method (p < 0.01). Pearson's correlation coefficients between the two methods were 0.50 for carbohydrate (p < 0.01), 0.55 for energy (p < 0.01) and 0.56 for protein (p < 0.01). Spearman's correlation coefficients were 0.53 for carbohydrate (p < 0.01), 0.55 for energy (p < 0.01) and 0.52 for protein (p < 0.01). The percent of subject in the lowest quartile in a 3-day diet record belonged to the first and second lowest quartile in food frequency questionnaire is 78.2% in energy, 91.3% in carbohydrate, 78.2% in protein, 69.5% in fat. Also, the percent of subject in the highest quartile in a 3-day diet record belong to the first and second highest quartile in food frequency questionnaire is 78.3% in energy, 73.9% in carbohydrate, 82.6% in protein, and 73.9% in fat. On the whole, the result of this study seemed to be in good agreement with other studies. Therefore, the FFQ developed by this study is considered to be a reliable tool to assess nutrients and food intakes for women of child-bearing age.

• 한국해안·해양공학회논문집
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• 제26권2호
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• pp.65-71
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• 2014

최근 우리나라에는 거의 매년 대형 태풍이 내습하였으며 이로 인해 직 간접적으로 많은 피해가 발생하였다. 그러나 태풍의 내습 시 태풍의 외해 진입경로에서 파랑 및 바람자료를 확보한 사례는 매우 드물며 이로 인해 태풍파 모델링의 보정 및 검증자료 확보에 어려움을 겪고 있는 실정이다. 본 논문은 기상청과 한국해양과학기술원에서 2004~2006년에 내습한 태풍 송다, 나비, 산산으로 인한 폭풍파들을 관측한 기록들을 종합하여 제공함으로써 태풍파 수치모델링 관련 연구자들에게 도움이 되도록 하였다. 태풍 나비와 산산의 진행경로가 대한해협보다 동쪽이었음에도 불구하고 거제도 동쪽에 위치한 남형제도에서 유의파고 8.3 m가 관측되었으며, 특히 영일만방파제 전면 1.4 km 지점에서는 두 태풍 모두 기록적인 유의파고 12.2 m가 관측되었다. 한편, 거제도의 해양기상부이와 남형제도의 파향 파고계로 취득된 자료들의 비교 결과 최대파고는 유사하였으나 유의파고는 상당한 차이를 나타냈다.