터널근접시공에 의한 기초판으로 연결된 군말뚝의 거동에 지반보강이 미치는 영향에 대한 연구

전영진(Jeon, Young Jin),이규설(Lee, Gyu Seol),이준호(Lee, Jun Ho),이철주(Lee, Cheol Ju) 대한토목학회 2021 대한토목학회 학술대회 Vol.2021 No.10

흉부외상 없이 발생한 흉부대동맥 절단증의 조기 진단 : 2례 보고 Two Cases Report

한승백,전영진,백광제,김준식,김정택,김광호,선경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Aortic transection or interruption is a rare condition which developed after an acute deceleration injury. Its occurrence depends on the location and direction of the force applied and is usually from motor vehicle accident or falling down. The exact incidence of aortic transection in trauma is not known but, when develops, only about 10-15% of the victims can survive and be transported to the hospital. Even in the survivors, majority of them will be fatal within a few days if a prompt diagnosis and surgical treatments are not made. Aggressive diagnostic work-up is recommended for the patients with high suspicious index, which would salvage the victims with this fatal condition. We report the experience of two cases of aortic transection or interruption following motor vehicle accidents.

허혈 조건부여가 심근기능의 회복에 미치는 영향 : 적출 심장모델을 이용한 실험연구 Isolated heart experimental study

백광제,김준식,한승백,전영진,이인성 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Brief episode of coronary artery occlusion(i.e.,ischemic preconditioning) makes the heart more resistant to injury from a subsequent ischemic insult. Although a great deal of effort has been made in studying ischemic preconditioning, the underlying mechanism of ischemic preconditioning and its effect on hypothermic insult has not been elucidated. This study was performed to see whether ischemic preconditioning protects against the depression of cardiac contractility induced by hypothermic cardioplegic arrest/reperfusion. And recently, adenosine was known to have some correlation with the mechanism of preconditioning. If so, does this effect remain after the blockade of adenosine receptor by 8-phenyl theophyline? Method: Twenty-four Sprague-Dawley rat weighed 250-350g were used and divided into three groups. Rat hearts were removed rapidly, and each isolated heart paced with a rate of 180/min was perfused by modified Krebs-Hensleit buffer(KHB) solution on a Langendorff apparatus for an hour. After obtaining baseline data including left ventricular pressure(LVP), dp/dt, and coronary flow, cardiac arrest was induced by perfusion of 0℃ crystalloid cardioplegic(St Thomas) solution. After that, all hearts were stored in the same St Thomas solution at same temperature for 2 hours. In group Ⅰ(control group), the heart was reperfused by KHB solution. In group Ⅱ(preconditioning group), the heart was subjected to two 2-minute episode of global ischemia followed by 5 minute reperfusion with KHB solution(preconditioning) before cardiac arrest. In group Ⅲ(phenyl theophylline group), the heart was subjected to preconditioning procedure and 8-phenyl theophylline at 10μM in concentration was added to KHB solution at time of reperfusion. Observing parameter was obtained in each group at 10, 20, 40 and 60 minutes after starting reperfusion and compared statistically by use of one way ANOVA test(STASTICA, release 4.5). p-value less than 0.05 was considered significant. Results: Although depressed LVP, dp/dt, and coronary flow were seen in all groups during the reperfusion period, the preconditioned group showed more effective recovery of LVP than that of the control group, especially at 10, 20 and 40 minutes(p<.05). We failed to demonstrate the difference between the phenyl theophylline group and the control group(p=NS). Conclusion: These results suggest that ischemic preconditioning has protective effect on recovery state of hypothemic cardioplegic arrest/reperfusion. Its protective effect was limited during early reperfusion stage and was blocked by adenosine blocker.

족관절 및 족부외상환자에서 Ottawa Ankle Rule의 유용성에 관한 연구

김준식,전영진,한승백,신동운,김아진 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.2

Background: This study was conducted to evaluate the efficacy of the Ottawa ankle rule in ankle and/or mid-foot injured patients. Methods : From June 1998 to May 1999, we used the Ottawa ankle rule to analyze prospectively the patients who suffered ankle and/or mid-foot injury. The exclusion criteria were less than 18 years old, open fractures, multiple organ injuries, unstable vital signs, and pregnant women. Also we evaluated the patients according to the British Columbia Council on Clinical Results: The total number of patients was 153. A total of 198 radiographs (ankle: 152; foot : 46) were taken in these153 patients. There were 33 ankle fractures and 9 mid-foot fractures. Only 21.7% of the ankle films showed fractures and 19.6% of the foot films showed fractures. therefore, the sensitivity and the specificity of the Ottawa ankle rule were 87.9% and 4.2% for ankle fractures and 77.8% and 13.6% for midfoot fractures. In our study, 4 ankle fractures and 2 mid-foot fractures were missed clinically. Conclusion: The Ottawa ankle rule is an effective diagnostic method for ankle and/or mid-foot injury patients. Application of the Ottawa ankle rule reduces the waiting time in the emergency department, avoids inappropriate X-Ray exposure, improves theaccuracy of the clinical exmination, and reduces medical costs due to unnecessary X-Rays of the ankle and/or mid-foot.

외상후 발생한 중뇌동맥분지파열과 장골요동맥파열로 인한 대량출혈시 응급색전술의 역할

조영국,박현선,백광제,김준식,전영진 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.2

We experienced a case of the ruptured internal maxillary and iliolumbar artery due to falling down. The patient was suffered from massive epistaxis and oral bleeding due to basal skull fracture, subarachnoid hemorrhage, multiple rib fracture, pneumothorax, left femur open fracture, left radius open fracture and dislocation, left ulnar fracture, and pelvic bone fracture. And the hemodynamic status was unstable. After fluid resuscitation, the internal maxillary and internal iliac arteriography was undergone due to uncontrollable nasal and oral bleeding and retroperitoneal hematoma. And the bleeding site was identified then the embolization of internal maxillary and iliolumbar artery were performed. The bleeding was controlled successfully.

응급실에 내원한 추락사고 환자의 임상고찰

백광제,김준식,전영진,한승백,신동운,김아진 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.2

$quot;Background : The object of this retrospective study was to evaluate the clinical patterns of the patients who were injured in free-fall accidents and to analyze the correlation between clinical symptoms and ultimate outcome of the treatment. Another purpose of the study was to establish guidelines of management for emergency departments. Methods : We performed a retrospective analysis of 334 free fall patients who were treated ay our emergency department during the 2-year period from January 1997 to December 1998. Age, sex, cause, previous history, height, injury severity scores, and clinical outcomes, including hospital mortality, are all the data collected from the medical records. Results : Among the 334 patients, 265 (79.3%) were male and 171 (51.2%) were work-related accidents. Only 7 had psychological problems, and 13 falls were from heights of more than 10 meters. Extremity injury, including fractures, were the most common injuries, accounting for 145 (43.4%), followed by spinal injuries and cranial injuries, accounting for 79 (23.7%) and 77 (23.7%) each. Ankle fractures, including talo-calcaneal fractures, were the most common injuries among the extremity injuries, accounting for 38. Correlation analysis with the Spearman coefficient revealed that mental status (r=0.646) at the emergency department was more corre-lated with mortality than hypotension(r=0.346). Conclusion : Among 334 free fall victims, extremity injuries were the most common injuries. Mental status at arrival was more correlated with hospital mortality than hypotension.$quot;

급성 폐손상의 기계환기 치료에서 일회호흡량 변화가 미치는 영향 : 실험 연구

백광제,김준식,선경,전영진,한승백 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.1

Background: Although the low tidal volume(TV) technique has been applied in the manage- ment of mechanical ventilation for patients with Acute Respiratory Distress Syndrome(ARDS) recently, there still remain controversies with regards to its effectiveness and hazard. Method: The study was designed to evaluate the effects of the amount of TV on hemody- namics, arterial blood gases, and airway pressures in an acute lung injury model by using six mongrel dogs. Each animal was paralyzed and intubated with applying mechanical ventilation at TV of 10mUkg, respiration rate of 20/min, FiO₂of 0.4, and Positive End Expiratory Pressure (PEEP) of 5cmH₂O. The lung injury was induced by injection of oleic acid dissolved in 99% ethanol(0.08ml/kg) into the pulmonary artery through a Swan-Ganz catheter. Parameters were observed with changes of TV to low(7ml/kg) and high(14ml/kg) accordingly, and the differ- ences between groups were compared statistically. Result: There were significant differences in airway pressure(16.5 ±2 vs. 23.3 ±3.4cmH₂O) and PaCO₂(54 ±12 vs. 42.8 ±9mmHg) between low and high TV(p$lt;0.01) while the differences in PaO₂(100.9 ±17 vs. 121.2 ±16mmHg) and mean Blood Pressure(BP)(96.0 ±12 vs. 106 ±19mmHg) were negligible(p=NS). Conclusion : Above results suggest that low TV keeps airway pressure low and does not deteriorate hemodynamics and oxygenation in the presence of hypezcapnia. We carefully sug- gest a low TV technique in the management of the patients with ARDS.

근거리에서 공포탄에 의한 두부손상

박현선,백광제,김준식,전영진,한승백,신동운,김아진 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.2

Blank cartridge guns are generally regarded as being harmless and are not considered to be firearms in most countries. We experienced a case of brain injury causedby an accidental blank cartridge shot at close range. The patient suffered from open compound comminuted skull fracture at th frontal area, including the orbital roof. The initial blood pressure was uncheckable, and the patient showed Cheyne-Stokes respiration. The mental status was a coma state. Bleeding was noticed continuously at the open frontal area wound, and bleeding rhinorrhea and otorrhea were noticed. After fluid resuscitation, the vital signs were stabilized, and brain computerized tomogram (CT) scan was performed. It revealed open compound comminuted skull fracture at the frontal area with intracranial hemorrhage (ICH), subdural hemorrhage (SDH), and subarachnoid hemorrhage (SAH). After resuscitation, an open craniectomy and removal of the ICH were performed. However, the patient died 6days after the operation due to severe lethal brain swelling.

자연 혈기흉의 임상고찰

이용주,안성태,이준희,한승태,백광제,김준식,선경,전영진 대한외상학회 1997 大韓外傷學會誌 Vol.10 No.2

Backgrounds: Spontaneous hemopneumothorax is an uncommon condition of which incidence has been reported to he I to 12% of spontaneous pneumothorax. We retrospectively analysed the cases of spontantaneous hemopneumothorax to determine the nature of clinical features and to establish the prompt diagnosis and successful management. Methods: From January 1994 to March 1997, 278 cases of spontaneous pneumothorax treated at our institution were reviewed retrospectively. Results: Spontaneous hemopneumothorax developed in 8 (2.9 %) out of 278 patients. All were male, and age rangecl from 24 to 66 years. Bloody effusion was aspirated in all of them by diagnostic tapping which was done in any spontaneous pneumothorax with pleural effusion on initial chest x-ray. The initial amount of bleeding ranged from 90-3000ml through the tuhe drainage. Two patients underwent operation. One with symploms of shock was explored by thoracolomy on the day ot presentation, and the other by video-assisted thoracotomy on the 3rd day ot hospitalization. Both cases showed bleeding points located on the parietal pleura of the torn adhesion. Hospital courses of all 8 patients were uneventful. Conclusion: Early diagnosis, prevention of cardiopulmonary collapse, and aggressive rnanagement are recommended for spontaneous hemopneumothorax.

외상성 가사 : 3 Case Report 3례 보고

김정택,백광제,선 경,김광호,전영진,이용주,이성우,김준식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Traumatic asphyxia is a clinical symptom complex characterized by craniofacial cyanosis, subconjunctival hemorrhage, and head and neck vascular engorgement due to sudden compressive injury on the thoracic cage. It is occasionally combined with mental deterioration, lung contusion, and edema. It is considered due to increased intrathoracic pressure in state of closed epiglottis. Recently, we had experienced three cases of traumatic asphyxia of which clinical courses were somewhat different. The first case developed by a compression between a elevator and the ground while the victim did not realized the accident happening, and the patient showed nonspecific facial edema and ecchymosis but mental deterioration and ultimate respiratory failure. The second case by a compression between cars, while the impending accident was noticed by the victim, showed full-blown asphyxia without mental or respiratory symptoms. The last case by forceful coughing and vomiting showed facial edema and ecchymosis without any other symptoms. Hospital course of all cases were uneventful. We believe that "fear response" or "closure of the epiglottis" might be an important mechanism on developing symptom of traumatic asphyxia.