• 대한인간공학회지
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• 제13권1호
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• pp.15-25
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• 1994

Based on Fatal Accident Reporting System (FARS) data, safety belt effect- tiveness in preventing fatalities is investigated for the following five types of crashes: frontal, left, rear, right, and rollover. Passenger cars containing two occupants, a driver and a right front passenger, are included in this analysis. For each crash type, these cars containing the two occupants are classified into four categories according to the safety belt usage categories for the two front seat occupants, namely, both belted, both unbelted, and either one was belted but not both. Relative risks of driver and right front passenger fatalities are compared among these four cases. For each crash type, two independent estimates of safety belt effectiveness are obtained for drivers and for right front passengers. The weighted average of the two estimates is calculated for drivers and for right front passengers for the five crash types. Using FARS data starting 1978 throught 1983, safety belts are more effective in rollover accidents than in frontal collisions. In rollover accidents, safety belt effectiveness estimate for drivers is $68%{\pm} 6% $ and that for right front passengers is $71%{\pm}6% $ , in which the error limits indicate one standard error. Sfety belt effectiveness estimates for drivers and right front passengers involved in frontal collisions are $41%{\pm} 9% $ and $37%{\pm} 10% $ , respectively. For left and right sided collisions and for both drivers and right-front-passengers, none of the four estimates are significantly different from 0%, statistically : however, when left and right sided collisions are combined with far sided occupants(drivers involved in right sided collisions and right front passengers involved in left sided collisions) safety belt effectiveness is significant, $38%{\pm} 12% $ . For rear collisions, the estimate for drivers shows statistically significant positive effect, $60%{\pm}23% $ . while for right-front-passengers the estimate is not significantly different from 0%. These results show that a safety belt is an effective restraint system not only in frontal crashes but also in a variety of crashes.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권4호
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• pp.381-387
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• 2005

Malignant hyperthermia is a catastrophic, hypermetabolic syndrome that arises in susceptible individuals when they are exposed to certain inhalational anesthetics or muscle relaxants. It is characterized by hyperthermia, tachycardia, acidosis, and muscle rigidity. It has been noted that the majority of cases of malignant hyperthermia are fatal unless early diagnosis and treatment are performed. We experienced a 24 year old male Malignant hyperthermia presented for orthognathic surgery under $O_2-N_2O$-sevoflurane anesthesia without succinylcholine. Two half hours after induction, tachycardia developed and was followed by unstable blood pressure and hyperpyrexia. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient was treated by the intravenous administration of dantrolene sodium. The diagnosis of an acute malignant hyperthermia reaction by clinical criteria can be difficult because of the nonspecific nature and variable incidence of many of the clinical signs and laboratory findings. So the malignant hyperthermia clinical grading scale is recommended for use as an aid to the objective definition of this disease. This clinical grading system provides a new and comprehensive clinical case definition for the malignant hyperthermia syndrome. We recently encountered a case of delayed malignant hyperthermia during sevoflurane anesthesia that was successfully treated by the intravenous administration of dantrolene sodium. In conclusion, exposure to sevoflurane should be avoided in patients thought to be susceprible to malignant hyperthermia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권1호
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• pp.31-34
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• 2015

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

• Journal of Yeungnam Medical Science
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• 제33권2호
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• pp.166-169
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• 2016

Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and self-expanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.

• Journal of Oral Medicine and Pain
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• 제36권2호
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• pp.117-121
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• 2011

파상풍은 손상부위에 Costridium tetani 감염으로 발생하는 근육의 경련성 마비와 근육의 통증, 및 자율신경계증상을 동반하는 치명적인 신경학적인 질환이다. C. tetani는 오염된 상처에서 산소부족 상태에서 임상적 파상풍으로 발생하며, 상처의 크기보다는 혈액과 산소의 공급장애에 의해 발행한다. 파상풍은 전신형, 국소형, 두개형 신생아형으로 분류되며 잠복기는 보통 7일이다. 파상풍의 전형적인 임상 증상은 근육의 지속적인 경련과 경직이며, 안면근 경련으로 인해 경련미소나 등쪽의 경련 지속으로 인해 활모양강직이 나타난다. 파상풍 환자의 75%가 안면부 근육에 증상 즉, 개구제한을 보여 초기에 치과로 내원 할 가능성이 높다 본 증례에서는 손상후에 개구제한을 주소로 본과로 내원한 환자가 파상풍으로 진단됨에 따라 이 환자의 증례를 살펴 파상풍으로 인한 개구 제한에 대해 고찰하고자 한다.

• Tuberculosis and Respiratory Diseases
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• 제65권1호
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• pp.57-60
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• 2008

공기 색전증은 임상 각 과에서 시행하는 많은 시술을 통하여 흔히 발생할 수 있고 대량의 공기 색전은 치명적일수도 있으므로 어떠한 시술을 시행하던지 공기 색전증의 발생 가능성에 대해서 인식하고 있는 것이 중요하다고 하겠다. 저자들은 수액 주입 속도를 늘리기 위하여 수액병에 주사기를 이용하여 공기를 주입한 후 발생한 빈호흡을 주소로 내원한 환자에서 흉부 컴퓨터 단층촬영상 폐부종을 동반한 왼팔머리정맥내에 공기음영을 발견하여 의인성 공기 색전증을 진단한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Neonatal Medicine
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• 제25권3호
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• pp.102-108
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• 2018

Purpose: Congenital diaphragmatic hernia (CDH) is rare but potentially fatal. The overall outcome is highly variable. This study aimed to identify a simple and dynamic parameter that helps predict the mortality of CDH patients in real time, without invasive tests. Methods: We conducted a retrospective chart review of 59 CDH cases. Maternal and fetal information included the gestational age at diagnosis, site of defect, presence of liver herniation, and lung-to-head ratio (LHR) at 20 to 29 weeks of gestational age. Information regarding postnatal treatment, including the number of days until surgery, the need for inhaled nitric oxide (iNO), the need for extracorporeal membrane oxygenation (ECMO), and survival, was collected. The highest respiratory severity score (RSS) within 24 hours after birth was also calculated. Results: Statistical analysis showed that a younger gestational age at the initial diagnosis (P<0.001), a lower LHR (P=0.001), and the presence of liver herniation (P=0.003) were prenatal risk factors for CDH mortality. The RSS and use of iNO and ECMO were significant factors affecting survival. In the multivariate analysis, the only remaining significant risk factor was the highest preoperative RSS within 24 hours after birth (P=0.002). The area under the receiver operating characteristic curve was 0.9375, with a sensitivity of 91.67% and specificity of 83.87% at the RSS cut-off value of 5.2. The positive and negative predictive values were 82.14% and 92.86%, respectively. Conclusion: Using the RSS as a prognostic predictor with simple calculations will help clinicians plan CDH management.

• Journal of Korean Neurosurgical Society
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• 제37권3호
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• pp.173-178
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• 2005

Objective: The goal of this study is to provide the clinical data of patients with brainstem cavernous hemangiomas after treatment with microsurgery or radiosurgery after conducting a retrospective analysis of 21 patients at one institution. Methods: Twenty one patients with brainstem cavernous hemangiomas were treated at the authors' institution between 1995 and 2004 and clinical analysis was performed by retrospective review of medical records and neuroimaging examinations. Thirteen patients underwent microsurgical resection and radiosurgery was performed as an initial treatment in 9 patients. Results: Radical excision was achieved in 12 among 13 patients and transitory neurological deterioration or new neurological deficit developed during the immediate postoperative period in 7 (54%). The final outcomes at 5 - 70 months after surgery were improved in 11 patients (85%) and worsened in 2 patients (15%) compared with the preoperative state. Radiosurgery was performed in 9 patients. During the follow up period from 5 to 70 months there was neurological improvement in 3 patients, no significant change in 3 and deterioration in 3 patients. Two patients developed rebleeding at 5 months, 60 months respectively after radiosurgery. Conclusion: Microsurgery for symptomatic cavernous hemangioma of brainstem can be performed with acceptable morbidity. Fatal complication is rare with careful selection of the optimal operative approach in well selected patients. Radiosurgery is an effective alternative for the lesions which are not accessible by surgical approach, however, there is still a possibility of rebleeding over a long period after radiosurgical treatment and microsurgery should be considered as a treatment with priority for the majority of cases.

• 한국정보과학회논문지:컴퓨팅의 실제 및 레터
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• 제13권5호
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• pp.300-310
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• 2007

SIP은 IP 전화 통신에서 통신 셋업을 위해 사용되는 주요 프로토콜 중 하나다. SIP을 통한 통신은 사용자 요구에 따라 다양한 상태가 필요하다. 본 논문은 기존의 SIP 프로토콜을 이용하여 전화연결 시 사용자의 요구에 따라 수시로 변하는 상태를 7가지로 정의하고, 객체 지향적인 시스템 설계에 따라 각 상태를 전이하는 이벤트를 두어 개발자 관점에서 SIP 프로토콜을 이용한 새로운 응용서비스를 개발하고자 할 때 객체지향적인 시스템 설계를 할 수 있다. 상용망에서 RFC 3261에서 제시하는 Call-Setup과정을 따라 인터넷 전화연결 시스템을 설계하면 예외처리 및 과다한 트래픽이 발생하여 시스템 오류를 불러올 수 있다. 이 경우에 시스템의 State를 보고 예상된 이벤트일 경우 정형화된 처리루틴으로 대처하고, 그렇지 않을 경우도 예외상황을 효율적으로 처리할 수 있다. 이벤트 처리루틴은 FSM으로 설계 및 구현하였다.

• 한국미생물·생명공학회지
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• 제45권2호
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• pp.93-100
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• 2017

인간노로바이러스는 바이러스성 식중독 원인의 대부분을 차지한다. 노로바이러스가 건강한 성인에 감염하면 설사 등의 병변을 몇 일간 일으키다 대부분 별다른 처치 없이도 치유되는 경우가 대부분이다. 그러나 면역기능이 약화된 환자에게 감염한 경우, 만성감염 내지 치명적 감염도 가능한 것으로 보고 되고 있다. 1968년에 처음 노로바이러스가 보고된 이후 세포 감염모델과 소동물감염 모델을 만들고자 하는 시도가 이어져 왔으나 대부분 실패하였다. 그러나 최근들어 세포감염 모델 개발에 있어 주목할 만한 기념비적인 연구들이 이루어졌다 것이 고무적이다 할 수 있다. 이번 총설에서는 새로 개발된 감염 모델들의 특징과 장단점을 살펴보고, 이를 더욱 개선할 수 있는 방향에 대하여 살펴보고자 한다.