복부 둔상 및 유강장기 손상에 있어서 초기 나선형 복부전산화 단층촬영의 진단적 가치

조영덕 ( Young Duck Cho ),홍윤식 ( Yun Sik Hong ),이성우 ( Sung Woo Lee ),최성혁 ( Sung Hyuk Choi ),윤영훈 ( Young Hoon Yoon ),임성익 ( Sung Ik Lim ),장익진 ( Ik Jin Jang ),백승원 ( Seung Won Baek ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1

Purpose: This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients. Methods: This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients` demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed. Results: Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group. Conclusion: Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.

SIP 기반의 VoIP 서비스 환경에서 스팸 방지를 위한 인증 기법

장유정,문형권,최재덕,원유재,조영덕,정수환,Jang, Yu-Jung,Moon, Hyung-Kwon,Choi, Jae-Duck,Won, Yoo-Jae,Cho, Young-Duk,Jung, Sou-Hwan 한국통신학회 2007 韓國通信學會論文誌 Vol.32 No.8b

This paper proposes a message authentication scheme to resist potential spam threats in SIP-based VoIP services. Our scheme applies the extended HTTP digest authentication mechanism between the inbound proxy and the UAS to verify that a service request is coming through the valid inbound proxy. The proposed scheme is simple and requires minimal modification the current SIP standards, and effective to filter invalid peer-to-peer spam calls. In this paper, an experimental spam attack using modified open source was tested on a commercial VoIP networks to exploit the possibility of spam attacks in real environment. 본 논문에서는 SIP 기반의 VoIP상에서 스팸 위협에 대해 분석하고 이를 차단하기 위해 UAS에서 inbound proxy 서버를 인증할 수 있는 발신자 인증 기법을 제안하였다. 제안된 기법은 UAS로 들어오는 메시지가 inbound proxy를 통해 전송됐는지 여부를 검증하기 위해 inbound proxy 서버와 UAS 간 사전에 공유하고 있는 패스워드를 기반으로 HTTP Digest 인증을 적용하였다. 이는 SIP 표준의 큰 수정 없이 쉽게 적용이 가능하고 peer-to-peer로 발생되는 스팸을 효과적으로 차단할 수 있다. 본 논문에서는 상용 망에서 peer-to-peer로 스팸을 발송해보고 제안된 기법을 이용해 스팸이 차단되는 것을 검증하기 위해 오픈 소스를 이용해 구현해 보았다.

Salmonella enteritidis에 의한 농흉

김철현 ( Chul Hyun Kim ),조영덕 ( Young Duck Cho ),우준희 ( Jun Hee Woo ),김용훈 ( Yong Hoon Kim ),정연태 ( Yeon Tae Chung ),박춘식 ( Choon Sik Park ) 대한결핵 및 호흡기학회 1990 Tuberculosis and Respiratory Diseases Vol.37 No.1

교통사고로 수상한 임산부의 특성

김덕환 ( Duk Hwan Kim ),조영덕 ( Young Duck Cho ),김정윤 ( Jung Youn Kim ),윤영훈 ( Young Hoon Yoon ),이성우 ( Sung Woo Lee ),문성우 ( Sung Woo Moon ),최성혁 ( Sung Hyuk Choi ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: Trauma is one of the major causes of maternal and fetal mortality, and the most common cause of maternal trauma is a traffic accident. In Korea, data about traffic accidents in pregnant women are not widely collected and classified so far. Hence, we studied and analyzed the characteristics of injured pregnant women by the traffic accidents. Methods: From January 2002 to August 2011, pregnant women who were in traffic accidents visiting Emergency Department were studied. Pregnancy out come and the degree of the damage were determined through the retrospective analysis of the medical records. Results: The pregnant women who visited after traffic accidents were total 204 patients. Among them, 176 patients had no complication related to the traffic accidents, 28 patients had complications. The incidence of the complications in the 3rd trimester pregnants was statistically significant higher than that in the other trimesters. The analysis based on the mechanism shows more complications in the pedestrian injury. In the survey by the type of the vehicles, the complications from the trauma associated with a car had lower incidence. The patients arrived at the emergency center by walking had greater numbers than who arrived by an ambulance in the groups occurred the complications. The patients suffered complications who complained pain in trunk especially in abdomen and pelvis than in extremities and complained vaginal discharge, and those showed a statistically significant greater incidence. Conclusion: When pregnant women were injured by the traffic accidents, the factors related to the poor pregnant prognosis were trimester of pregnancy, means of visiting the emergency center, trauma mechanism, and complaining symptoms. Therefore, these factors may be used as a prognostic tool to predict an incidence of complications, length of hospital stay and rate of complications and can be used to plan for treatments. (J Trauma Inj 2012;25:132-138)

외상환자에 있어서 일차조사로서 경추부 전산화 단층 촬영의 예측인자

박경애 ( Guen E Pak ),한철 ( Chul Han ),조영덕 ( Young Duck Cho ),김정윤 ( Jung Youn Kim ),윤영훈 ( Young Hoon Yoon ),이성우 ( Sung Woo Lee ),문성우 ( Sung Woo Moon ),최성혁 ( Sung Hyuk Choi ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Purpose: Missing cervical pathology after injury may lead to disability and influence long-term survival. Controversies continue to evolve concerning the initial screening methods used to predict cervical spine injury. Through a retrospective chart review, we attempted to analyze and propose factors predictive of cervical trauma. Methods: Of all the patients who had visited the Emergency Department of Korea University, from January 2009 to December 2009, a retrospective review of the clinical records of the 217 patients who had undergone cervical spine computed tomography was done. We investigated whether we could predict the need for cervical spine computed tomography shortly after presentation in trauma patients by comparing the group with fractures and group without fractures and by finding risk factors showing significant differences between the two groups that might be used as guides in decision making. Results: Of the 217 subjects who underwent cervical spine computed tomography scans, 33 were identified with fractures of the cervical spine while 184 were not. The most common mechanisms of trauma, in order, for those with fractures were falls, followed by traffic accidents. We found that the injury severity score, multiple injuries, a high-energy injury mechanism, neurologic deficit, and pain and tenderness of the cervical spine showed statistically significant differences between the two groups. Conclusion: Fractures of the cervical spine that are not observed with simple radiography occur with a relatively high frequency in trauma patients. Consideration should be given to the risk factors for cervical spine fracture, and if pertinent, cervical spine computed tomography should be performed with speed for early diagnosis of cervical spine fractures. (J Korean Soc Traumatol 2011;24:18-24)

EEMR 튜브를 이용한 조기식도암의 근치적 절제 1예

조주영,이준성,김진오,김주호,이문성,황성규,심찬섭,봉형근,조영덕,김연수 대한소화기내시경학회 1995 Clinical Endoscopy Vol.15 No.4

Although esophageal cancer has been recognized as difficult to treat, its long-term survival statistics are significant lower than those of other gastrointestinal cancers, Postoperative 5-year survival of the early esophageal cancer which invasion is limited to the mucosa is close to 100%. So, early detection of esophageal cancer has been extremely significant. Progress in the endoscopic technique has enabled to make not only early detection but also curative endoscopic resection of the early esophageal cancers. The indication for curative endoscopic resection of esophageal cancer are as follows: mucosal cancer apart from gross invasion to the muscularis mucosae without nodal involvement and less than 2 cm * 2 cm in size of lesion. EEMR tube(endoscopic esophageal mucoaal resection tube), which was designed by Makuuchi in 1991, is widely used for resection of early esophageal cancers. We report a case of patient with early esophageal cancer, who was admitted due to complation of postprandial epigastric pain, diageosed by endoscopy, endoscopic ultra sonography and chest computerized tomography, and successfully resected by using EEMR tube.