• The Korean Journal of Pain
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• v.2 no.2
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• pp.155-166
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• 1989

Bonica defined, that reflex sympathetic dystrophy (RSD) may develop pain, vasomotor abnoramalities, delayed functional recovery, and dystrophic changes on an affected area without major neurologic injury following trauma, surgery or one of several diseased states. This 45 year old male patient had been crushed on his left shoulder by a heavily laden rear car, during his job street cleaning about 10 years ago (1978). At first the pain was localizea only to the site of injury, but with time, it spreaded from the shoulder to the elbow and hand, with swelling. X-ray studies in the local clinic, showed no bone abnormalities of the affected site. During about 10 years following the injury, the had recieved several types of treatments such as nonsteroidal analgesics, steroid injections into the glenoidal cavity (10 times), physical therapy, some oriental herb medicines, and acupuncture over a period of 1~3 months annually. His shoulder pain and it's joint dysfunction persisted with recurrent paroxysmal aggrevation because of being mismanaged or neglected for a sufficiently long period these fore permiting progression of the sympathetic imbalance. On July 14 1988 when he visited our clinic. He complained of burning, aching and had a hyperpathic response or hyperesthesia in touch from the shoulder girdle to the elbow and the hand. Also the skin of the affected area was pale, cold, and there was much sweating of the axilla and palm, but no edema. The shoulder girdle was unable to move due to joint pain with marked weakness. We confirmed skin temperatures $5^{\circ}C$ lower than those of the unaffected axilla, elbow and palm of his hand, and his nails were slightly ridged with lateral arching and some were brittle. On X-ray findings of both the shoulder AP & lateral view, the left humerus and joint area showed diffuse post-traumatic osteoporosis and fibrous ankylozing with an osteoarthritis-like appearance. For evaluating the RSD and it's relief of pain, the left cervical sympathetic ganglion was blocked by injecting 0.5% bupivacaine 5 ml with normal saline 5 ml (=SGB). After 15 minutes following the SGB, the clinical efficacy of the block by the patients subjective score of pain intensity (=PSSPI), showed a 50% reduction of his shoulder and arm pain, which was burning in quality, and a hyperpathic response against palpation by the examiner. The skin temperatures of the axilla and palm rose to $4{\sim}5^{\circ}C$ more than those before the SGB. He felt that his left face and upper extremity became warmer than before the SGB, and that he had reduced sweating on his axilla and his palm. Horner's sign was also observed on his face and eyes. But his deep shoulder joint pain was not improved. For the control of the remaining shoulder joint pain, after 45 minutes following the SGB, a somatic sensory block was performed by injecting 0.5% bupivacaine 6 ml mixed with salmon calcitonin, $Tridol^{(R)}$, $Polydyn^{(R)}$ and triamcinolone into the fossa of the acromioclavicular joint region. The clinical effect of the somatic block showed an 80% releif of the deep joint pain by the PSSPI of the joint motion. Both blocks, as the above mentioned, were repeated a total of 28 times respectively, during 6 months, except the steroid was used just 3 times from the start. For maintaining the relieved pain level whilst using both blocks, we prescribed a low dose of clonazepam, prazocin, $Etravil^{(R)}$, codeine, etodolac micronized and antacids over 6 months. The result of the treatments were as follows; 1) The burning, aching and hyperpathic condition which accompanied with vaosmotor and pseudomotor dysfunction, disappeared gradually to almost nothing, within 3 weeks from the starting of the blocks every other day. 2) The joint disability of the affected area was improved little by little within 6 months. 3) The post-traumatic osteoporosis, fibrous ankylosis and marginal sclerosis with a narrowed joint, showed not much improvement on the X-ray findings (on April 25, 1989) 10 months later in the follow-up. 4) Now he has returned to his job as a street cleaner.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.555-561
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• 2011

Laparoscopic surgery is a well-established alternative to open surgery across disciplines. However, in veterinary medicine, laparoscopic surgery in dogs was rarely reported because of small abdominal size for multiple ports insertion. The concept of single-incision laparoscopic surgery (SILS) is to perform the entire laparoscopic operation through a single incision rather than conventional multiple small skin incisions. Indirect evidence of potential benefits of SILS, decreases operative morbidity related to reduction in port size, already exists. Therefore, this study was performed to evaluate the safety and feasibility of the modified form of SILS using flexible endoscope in Cholecystectomy before clinical adoption. A 2 cm single periumbilical incision was performed, and flexible endoscope was introduced into the abdominal cavity. A laparoscopic grasper was inserted into the abdominal cavity for the traction of gall bladder. Cystic duct and artery were ligated by 5 mm Hem-o-lok$^{(R)}$. Then, gall bladder was dissected and resected from the liver with 5 mm Autonomy Laparo-Angle Maryland dissector and endoscopic needle knife. Resected gall bladder was wrapped by using specimen pouch and was retrieved through abdominal incision from the cavity. All three gall bladders were successfully removed. Hematological changes were not observed during examination periods. No leakage sign was identified at necropsy. The flexible endoscope, as distinct from conventional rigid laparoscope, allows the visualization from various angles and the wide range of motion, result in less crowding.

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.533-538
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• 2006

Purpose : The headache, one of the symptoms of meningitis, is related to abrupt elevation of intracranial pressure(ICP) or stimulation of intracranial nociceptive structure. However, in cases of mild elevation of ICP or normal findings of cerebrospinal fluid(CSF) analysis, patients sometimes complain of headaches. Therefore, other pathways may contribute to the occurrence of headaches in aseptic meningitis or meningismus. We intend to investigate the role of substance P(SP) and calcitonin gene-related peptide(CGRP) in aseptic meningitis or meningismus. Methods : We measured leukocyte count, the concentration of protein and glucose in CSF and ICP of patients with meningeal irritation sign. We also measured SP and CGRP levels by using immunoassay. We analyzed the relationship between the presence of headache and the value of SP and CGRP. Results : The concentrations of CGRP($18.8{\pm}10.5ng/mL$) in CSF and ICP($14.8{\pm}4.5cmH_2O$) in aseptic meningitis group were significantly higher than in those($14.1{\pm}7.4ng/mL$ and $12.0{\pm}5.1cmH_2O$, respectively) of the meningismus group(P<0.05). There was no significant difference in the SP levels between the two groups. In the aseptic meningitis group, the concentrations of SP and CGRP were significantly higher in the normal ICP group than in the elevated ICP group(P<0.05). Conclusion : Headaches in children with aseptic meningitis or meningismus is considered to be related to the elevation of the CSF levels of SP and CGRP.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.314-322
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• 2010

Purpose : Through a clinical and retrospective analysis of pediatric patients who visited the Regional Emergency Medical Center of Masan Samsung Hospital from January 2007 to December 2008, we characterized pediatric and adolescent emergency patients to improve emergency care in future. Methods : We reviewed the medical records of 14,065 pediatric patients below 19 years of age. Results : The male to female ratio was 1.5:1, and the most common age group was less than 3 years (49.6%). The peak month was May (10.0%), the peak day of the week was Sunday (24.7%), and the peak time of day was 20:00-0:59 (8.5%). There was no difference in the number of visits per day based on weather (sunny, rain [below 10 mm per day], snow, and fog) or daily temperature difference; however, visits increased on sandy, dusty days and decreased on rainy days with more than 10 mm of rain per day. Based on the international classification of disease (ICD)-10 system, the most common disease code was code R (symptoms, sign, and abnormal clinical laboratory finding) (31.5%), and the most common symptom was fever (13.1%). Final outcomes were discharged (73.8%), admitted (25.7%), transferred (0.4%), and expired (0.1%). In adolescent patients aged 15-9 years, the most common disease code was Injury & Poisoning (code S&T, 36.9%); the most common symptom was abdominal pain (9.6%). Conclusion : Pediatric patients visiting the emergency center were most likely to be male and under 3 years of age and to visit between 20:00 and 21:00 on Sundays and in May, and the most common symptom was fever. Differences between adolescents and pediatric patients showed that adolescents had a higher visiting rate with abdominal pain and a larger temperature difference.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.329-337
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• 1997

Background : Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. Methods : The subjects were 34 patients(M : F = 20 : 14, mean age = $61{\pm}17yre$) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group 1(decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. Results : Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26%(9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.6%(4/14) of group 2 and 44%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p > 0.01). In three cases of group 3 whose respiratory indices could be measured until 48 hr after extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. Conclusions : Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubation may increase in the patients who have increased WOB immediately after extubation.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.134-140
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• 2005

Purpose: We evaluated the effectiveness of temporary using the extendible external fixator (EF) for lengthening of soft tissue that contracture caused by tumor prosthesis removal in the treatment of complications after limb salvage surgery like deep infection and loosening. Materials and Methods: Five patients six cases were included who underwent extendible EF (Dyna-extor(r)). EF was applied after insertion of half pin to the proximal and distal bone of defect area. EF lengthening started at third day of post-operation, above 2-3 mm per day in the range of no neurological sign. Results: The treatment area was three in femur and two in tibia. Mean age when the time of EF apply was 22.2 years old (range 15-29), but its primary limb salvage operation had done in 13.4 years old (range 9-19), therefore mean times of interval between initial tumor prosthesis reconstruction and temporary EF apply was 8.8 years (range 3-14). One patient had EF for 150 days with 7.2 cm lengthening. Others 5 cases of 4 patients had EF for mean 37 days (range 25-50) and mean soft tissue lengthening was 5.8 cm. Three patients underwent re-insertion of tumor prosthesis and two patients underwent knee fusion as final operation and showed no evidence of infection through mean 22 months follow up period. Conclusion: Temporary using of extendible EF is an effective method for correction of leg shortening which occurred by soft tissue contracture in the complications of limb salvage operation or their treatment process, and it could be provide easily application of tumor prosthesis and knee fusion as final operation.

• Journal of Korean Society of Transportation
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• v.20 no.5
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• pp.33-43
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• 2002

Travel choice behavior is affected by real-time traffic information. Recently, in urban area, real-time traffic information is provided by several instruments such as transportation broadcasting, internet PC network and variable message sign, etc. Furthermore, it has been increasing for urban travelers to use real-time traffic information provided by several instruments. The purpose of this study is to analyze the effects of advanced traveler information on urban worker's travel choice behavior. Among several Advanced Traveler Information System(ATIS) employed in urban area. This study focuses on examining the effects of transportation broadcasting on urban worker's travel choice behavior. This study attempts to examine traveler's mode change behavior in the pre-trip stage and traveler's route change behavior in the on-route stage. For this study, the survey data collected from Daegu City in 2000 is used. For empirical analysis, several nested logit models are estimated, and among them, the best models are reported in this paper. Furthermore, based on the empirical models estimated for this research, important findings and their policy implications are discussed.

• Journal of Astronomy and Space Sciences
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• v.22 no.2
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• pp.147-174
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• 2005

To understand the physical processes that control the high-latitude lower thermospheric dynamics, we quantify the forces that are mainly responsible for maintaining the high-latitude lower thermospheric wind system with the aid of the National Center for Atmospheric Research Thermosphere-Ionosphere Electrodynamics General Circulation Model (NCAR-TIEGCM). Momentum forcing is statistically analyzed in magnetic coordinates, and its behavior with respect to the magnitude and orientation of the interplanetary magnetic field (IMF) is further examined. By subtracting the values with zero IMF from those with non-zero IMF, we obtained the difference winds and forces in the high-latitude 1ower thermosphere(<180 km). They show a simple structure over the polar cap and auroral regions for positive($B_y$ > 0.8|$\overline{B}_z$ |) or negative($B_y$ < -0.8|$\overline{B}_z$|) IMF-$\overline{B}_y$ conditions, with maximum values appearing around -80$^{\circ}$ magnetic latitude. Difference winds and difference forces for negative and positive $\overline{B}_y$ have an opposite sign and similar strength each other. For positive($B_z$ > 0.3125|$\overline{B}_y$|) or negative($B_z$ < -0.3125|$\overline{B}_y$|) IMF-$\overline{B}_z$ conditions the difference winds and difference forces are noted to subauroral latitudes. Difference winds and difference forces for negative $\overline{B}_z$ have an opposite sign to positive $\overline{B}_z$ condition. Those for negative $\overline{B}_z$ are stronger than those for positive indicating that negative $\overline{B}_z$ has a stronger effect on the winds and momentum forces than does positive $\overline{B}_z$ At higher altitudes(>125 km) the primary forces that determine the variations of tile neutral winds are the pressure gradient, Coriolis and rotational Pedersen ion drag forces; however, at various locations and times significant contributions can be made by the horizontal advection force. On the other hand, at lower altitudes(108-125 km) the pressure gradient, Coriolis and non-rotational Hall ion drag forces determine the variations of the neutral winds. At lower altitudes(<108 km) it tends to generate a geostrophic motion with the balance between the pressure gradient and Coriolis forces. The northward component of IMF By-dependent average momentum forces act more significantly on the neutral motion except for the ion drag. At lower altitudes(108-425 km) for negative IMF-$\overline{B}_y$ condition the ion drag force tends to generate a warm clockwise circulation with downward vertical motion associated with the adiabatic compress heating in the polar cap region. For positive IMF-$\overline{B}_y$ condition it tends to generate a cold anticlockwise circulation with upward vertical motion associated with the adiabatic expansion cooling in the polar cap region. For negative IMF-$\overline{B}_z$ the ion drag force tends to generate a cold anticlockwise circulation with upward vertical motion in the dawn sector. For positive IMF-$\overline{B}_z$ it tends to generate a warm clockwise circulation with downward vertical motion in the dawn sector.

• Journal of Korean Academy of Nursing Administration
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• v.2 no.1
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• pp.35-56
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• 1996

Nowerdays, the increase of traffic accidents and old age population make the Femoral Neck Fracture(FNF) patients increase. By the improvement of education and standard of living the patients demand better medical service than before. This study is designed to give practical help for the FNF patients by observing their hospital life and establish practical nursing strategies for the FNF patients. For these purposes the Ethnographic Participant Observation was adopted. By this study is focused on the hospital life patient's view. For this end, the field study adopted orthopedic ward in the C University Hospital with 400 beds in Seoul. The object patients of the study were twelve patients. The patients experienced five stages : Embarrassment, Conflict, Stability, Independent, and Extension Stage. The findings and prepared nursing strategies are stated as follows. First, in the Embarrassment Stage they suffered embarrassment, anxiety, pain, they could not do ordinary things. The patients who accidental fractures had anxiety from unfamiliar tests and from hospitalization itself. They lamented that they could not ordinary things, and do nothing but obeying the hospital, and endure the pain. They recognized the changed environment and resigned themselves to life in the ward. In this stage, full openness by the nurses is needed. Second, the attribute of the Conflict Stage were conflict, fear, curiosity, belief, reflection. When they sign the consentment form, they experience conflicts about the possibility of complication, fear of recovery from anesthesia, curiosity about the operation procedure, post - operation state, reflection on their past life, and promise to care for their family members after discharge and keep their religious life faithfully. And they accepted the operation depending on God, believing in modern medicine, and the surgeon. Asking for their changed informations, they expected positive results from the operation. In this stage, an empathic attitude by the nurses is needed. Third, the attribute of the Stability Stage were relief, gratitude, difficulty with excretion, and pain. When they awoke from anesthesia, they felt relief because of a the end of the operation, but they experienced extreme pain, difficulty of excretion in bed. They accepted the changed environment and expected recovery. In this stage, support by the nurses is needed. Fourth, the attributes of the Independence Stage were freedom, exercise, nurturing, anxiety, and discomfort. When they ambulated and exercised, they experienced freedom. They showed exhibited weakness of the digestive organs and discomfort hospital's space, structure, and facilities, the delay of medical certificate issue the lack of prompt response by the medical agents. They ate nurturious food and felt anxiety on the end of hospital life and returning to their ordinary life. They showed the independence of overcoming their environment by increasing exercise and expected their discharges. In this stage, respect by the nurses is needed for the patients to, overcome their environment and prepare for their independence. Fifth, the attributes of the Extension Stage were pessimism, isolation, dissatisfaction, and pain. Accompanied injury and old age made their ward life extend to over seven weeks. They exhibited weariness, melancholy, skeptisis, general pessimistic feeling, and desperation caused by their isolated life. They experienced the digestive discomfort caused by the prolonged medication and psycological pain caused by long-time hospitalization. As a, result, their dissatisfaction on the human, physical, and systematic environments had been increased. They acquired critical power and sought for something to do spending their time. They expected vaguely about the returning of their ordinary life. In this stage, counseling is needed by the nurse to overcome positively their psychological, social, and physical problems. The process of the FNF patient's ward life starts from the dependent state, when they are hospitalized, and gradually progresses to self-fulfillment in order to keep independent life. As a result, the FNF patients showed "Response in Challenge" or "Adaptation in Conflict" through their experiences of social, physical, and psychological difficulties.

• KDI Journal of Economic Policy
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• v.31 no.1
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• pp.239-276
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• 2009

The paper investigates the possible relationship between earnings prediction by security analysts and special ownership ties that link security companies those analysts belong to and firms under analysis. "Security analysts" are known best for their role as information producers in stock markets where imperfect information is prevalent and transaction costs are high. In such a market, changes in the fundamental value of a company are not spontaneously reflected in the stock price, and the security analysts actively produce and distribute the relevant information crucial for the price mechanism to operate efficiently. Therefore, securing the fairness and accuracy of information they provide is very important for efficiencyof resource allocation as well as protection of investors who are excluded from the special relationship. Evidence of systematic distortion of information by the special tie naturally calls for regulatory intervention, if found. However, one cannot presuppose the existence of distorted information based on the common ownership between the appraiser and the appraisee. Reputation effect is especially cherished by security firms and among analysts as indispensable intangible asset in the industry, and the incentive to maintain good reputation by providing accurate earnings prediction may overweigh the incentive to offer favorable rating or stock recommendation for the firms that are affiliated by common ownership. This study shares the theme of existing literature concerning the effect of conflict of interests on the accuracy of analyst's predictions. This study, however, focuses on the potential conflict of interest situation that may originate from the Korea-specific ownership structure of large conglomerates. Utilizing an extensive database of analysts' reports provided by WiseFn(R) in Korea, we perform empirical analysis of potential relationship between earnings prediction and common ownership. We first analyzed the prediction bias index which tells how optimistic or friendly the analyst's prediction is compared to the realized earnings. It is shown that there exists no statistically significant relationship between the prediction bias and common ownership. This is a rather surprising result since it is observed that the frequency of positive prediction bias is higher with such ownership tie. Next, we analyzed the prediction accuracy index which shows how accurate the analyst's prediction is compared to the realized earnings regardless of its sign. It is also concluded that there is no significant association between the accuracy ofearnings prediction and special relationship. We interpret the results implying that market discipline based on reputation effect is working in Korean stock market in the sense that security companies do not seem to be influenced by an incentive to offer distorted information on affiliated firms. While many of the existing studies confirm the relationship between the ability of the analystand the accuracy of the analyst's prediction, these factors cannot be controlled in the above analysis due to the lack of relevant data. As an indirect way to examine the possibility that such relationship might have distorted the result, we perform an additional but identical analysis based on a sub-sample consisting only of reports by best analysts. The result also confirms the earlier conclusion that the common ownership structure does not affect the accuracy and bias of earnings prediction by the analyst.