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

• 대한임상독성학회지
• /
• 제19권1호
• /
• pp.8-16
• /
• 2021

Purpose: This study was conducted to analyze the social factors influencing the 'authenticity of suicidal ideation' based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion: The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

• Journal of Korean Neurosurgical Society
• /
• 제65권2호
• /
• pp.269-275
• /
• 2022

Objective : The coronavirus disease 2019 (COVID-19) pandemic is affecting the characteristics of patients with head injuries. This study aimed to evaluate the effect of the COVID-19 pandemic on patients with head injuries at a regional emergency medical center in South Korea. Methods : From April 2019 to November 2020, 350 patients with head injuries were admitted to our hospital. The study period was divided into the pre-COVID-19 (n=169) and COVID-19 (n=181) eras (10 months each). Patients with severe head injuries requiring surgery (n=74) were categorized into those who underwent surgery (n=41) and those who refused surgery (n=33). Results : Head injuries in pediatric patients (<3 years) were more frequent in the COVID-19 era than in the pre-COVID-19 era (8.8% vs. 3.6%, p=0.048). More patients refused surgery in the COVID-19 era than in the pre-COVID-19 era (57.9% vs. 30.6%, p=0.021). Refusal of surgery was associated with old age (67.7±14.5 vs. 52.4±19.1, p<0.001), marital status (married, 84.8% vs. 61.0%, p=0.037), unemployment (42.4% vs. 68.3%, p=0.034), COVID-19 era (66.7% vs. 39.0%, p=0.021), and lower Glasgow coma scale scores (6.12±3.08 vs. 10.6±3.80, p<0.001). Multivariable logistic regression analysis revealed that refusal of surgery was independently associated with old age (adjusted odds ratio [OR], 1.084; 95% confidence interval [CI], 1.030-1.140; p=0.002), COVID-19 era (adjusted OR, 6.869; 95% CI, 1.624-29.054; p=0.009), and lower Glasgow coma scale scores (adjusted OR, 0.694; 95% CI, 0.568-0.848; p<0.001). Conclusion : We observed an increased prevalence of head injuries in pediatric patients (<3 years) during the COVID-19 pandemic. Additionally, among patients with severe head injuries requiring surgery, more patients refused to undergo surgery during the COVID-19 pandemic.

• Journal of Korean Neurosurgical Society
• /
• 제66권6호
• /
• pp.672-680
• /
• 2023

Objective : We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage. Methods : This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed. Results : The mean age of the patients was 40±17 years (range, 17-68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow coma scale was 11.5±3.9 (range, 4-15), 46.3% presented with headache and 53.7% had stupor/coma. Four patients (26.6%) had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 patients (73.3%), the fistula was located in the tentorium and was the most common localization. Three patients (20%) had transverse and sigmoid sinus localizations, while one patient (6.7%) had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen sessions (88.8%) were performed with the transarterial (TA) route, one session (5.5%) with the transvenous (TV) route, and one session (5.5%) with the TA+TV route. Surgery was performed in two patients (14.2%). One patient (7.1%) passed away. While there were nine patients (64.2%) with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms. Conclusion : In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.

• 한국통신학회논문지
• /
• 제18권7호
• /
• pp.1044-1049
• /
• 1993

이 논문에서는 광대역 CDMA방식이 이동통신 시스템의 성능을 떨어뜨리는 다경로 페이딩현상의 영향을 근본적으로 줄일 수 있다는 것을 보였다. 광대역 CDMA 시스템은 높은 chip rate(약 10Mbps 이상)를 갖는 PN코드를 사용하여 신호를 대역확산하고, 수신단에서 신호를 복조할 때에 이와 똑같은 코드로 자기상관관계를 얻어 수신신호를 역확산한다. 이것은 수신단에서 확산코드를 동기화할 때 처음으로 도달하는 신호에 비해 한 칩 간격이상의 지연시간을 가지고 수신되는 다경로 신호는 상관관계가 없으므로 제거할 수 있어서 다경로파에 의한 페이딩현상의 영향을 원천적으로 줄일 수 있다는 것이다. 여기서 사용되는 광대역 페이딩 채널은 UHF대역에서 실측데이타와 비슷하게 모델한 채널모델을 참고하여 적절한 선형필터라고 가정하고, 신호의 송·수신을 컴퓨터 모의실험으로 행하였다. 그리고 성능확인을 위하여 협대역 시스템과 광대역 시스템에서의 수신신호에 대한 눈패턴을 도식적으로 비교·검토하었다.

• 대한간호학회지
• /
• 제34권7호
• /
• pp.1255-1264
• /
• 2004

Purpose: The purpose of this study was to determine the effect of a 3-week somatosensory stimulation program on the integrity of the somatosensory pathway of patients with brain damage. Method: The sample consisted of two groups of patients with brain damage matched by Glasgow Coma Scale (GCS) scores and age:8 patients with a mean age of 56.75 years who were treated with somatosensory stimulation, and 8 patients with a mean age of 58.88 years, who were not treated with sensory intervention program. A repeated measures matched-control group design was used to assess functional recovery of the brain. The instrument used in this study was SSEP (somatosensory evoked potentials), a neurophysiological parameter, for the integrity of the somatosensory pathway. Results: The hypothesis that patients with brain damage who were treated with the somatosensory stimulation program will show higher SSEP wave form scores than the non-treatment group was supported (3rd week.: U=13.000, p=.014). Additional repeated measures analysis showed that there were no significant differences in recovery trends between the groups (F=1.945, p=.159). Conclusion: This study demonstrates that a somatosensory stimulation program is effective in promoting recovery of the integrity of the somatosensory pathway of patients with brain damage.

• Clinical and Experimental Pediatrics
• /
• 제60권9호
• /
• pp.302-306
• /
• 2017

Purpose: This study aimed to investigate whether serum neuron-specific enolase (NSE) was expressed in acute encephalitis syndrome (AES) that causes neuronal damage in children. Methods: This prospective observational study was conducted in the pediatric neurology ward of Soetomo Hospital. Cases of AES with ages ranging from 1 month to 12 years were included. Cases that were categorized as simple and complex febrile seizures constituted the non-AES group. Blood was collected for the measurement of NSE within 24 hours of hemodynamic stabilization. The median NSE values of both groups were compared by using the Mann-Whitney U test. All statistical analyses were performed with SPSS version 12 for Windows. Results: In the study period, 30 patients were enrolled. Glasgow Coma Scale mostly decreased in the AES group by about 40% in the level ${\leq}8$. All patients in the AES group suffered from status epilepticus and 46.67% of them had body temperature >$40^{\circ}C$. Most of the cases in the AES group had longer duration of stay in the hospital. The median serum NSE level in the AES group was 157.86 ng/mL, and this value was significantly higher than that of the non-AES group (10.96 ng/mL; P<0.05). Conclusion: AES cases showed higher levels of serum NSE. These results indicate that serum NSE is a good indicator of neuronal brain injury.

• 대한임상독성학회지
• /
• 제14권2호
• /
• pp.71-77
• /
• 2016

Purpose: No studies have been conducted to investigate the acute toxicity of aryloxyphenoxypropionate herbicides in humans following ingestion. Therefore, this study was conducted to investigate the clinical characteristics of aryloxyphenoxypropionate herbicide poisoning and provide guidance for physicians treating patients who have ingested these types of herbicides. Methods: A retrospective observational case series was conducted using ten patients with history of aryloxyphenoxy propionate herbicide. Data were collected for clinical manifestation, management and final outcome. Results: The most common symptoms were gastrointestinal irritation and an altered mental state (Glasgow Coma Scale<15). An elevated lactate level was a common laboratory abnormality, and prolonged QTc interval was commonly observed. These clinical features normalized within one day of supportive treatment. Conclusion: The acute toxicity of aryloxyphenoxypropionate herbicides in humans is manageable with supportive treatment. However, physicians should take into account depressed consciousness, the possibility of arrhythmia, and an elevated lactate level when planning their treatment strategy.

• 천문학회지
• /
• 제37권5호
• /
• pp.455-460
• /
• 2004

There have been many speculations about the presence of cosmic ray protons (CRps) in galaxy clusters over the past two decades. However, no direct evidence such as the characteristic $\gamma$-ray signature of decaying pions has been found so far. These pions would be a direct tracer of hadronic CRp interactions with the ambient thermal gas also yielding observable synchrotron and inverse Compton emission by additionally produced secondary electrons. The obvious question concerns the type of galaxy clusters most likely to yield a signal: Particularly suited sites should be cluster cooling cores due to their high gas and magnetic energy densities. We studied a nearby sample of clusters evincing cooling cores in order to place stringent limits on the cluster CRp population by using non-detections of EGRET. In this context, we examined the possibility of a hadronic origin of Coma-sized radio halos as well as radio mini-halos. Especially for mini-halos, strong clues are provided by the very plausible small amount of required CRp energy density and a matching radio profile. Introducing the hadronic minimum energy criterion, we show that the energetically favored CRp energy density is constrained to $2\%{\pm}1\%$ of the thermal energy density in Perseus. We also studied the CRp population within the cooling core region of Virgo using the TeV $\gamma$-ray detection of M 87 by HEGRA. Both the expected radial $\gamma$-ray profile and the required amount of CRp support this hadronic scenario.

• 한국광학회지
• /
• 제13권4호
• /
• pp.275-282
• /
• 2002

2매 접합렌즈와 단렌즈로 구성된 2군 렌즈계의 구면수차, 코마, 종색수차 보정을 위한 3차수차 전개식을 얇은렌즈 근사를 이용하여 해석적으로 유도하였다. 유도된 3차수차 전개식은 telephoto렌즈계의 설계에 적용되었다. 초기설계에서 광학유리 조합은crown-flint-crown조합과 flint-crown-flint 조합에 관하여 조사하였다. Crown-flint-crown조합의 경우 2가지 형태의 achromatic aplanat 존재하였다. Flint-crown-flint조합의 경우에서도 2종류의 해가 존재하였으나, 해의 형태가 유용하지 못하였다.