소아에서 외상성 질식 증후군에 대한 임상적 고찰

박승현,최승필,나병호,황주일,나석주,전해명,김세경 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Traumatic asphyxia has often been described as a rare clinical syndrome characterized by cervicofacial cyanosis and edema, multiple petechiae, and subconjunctival hemorrhage after a severe crush injury of the thorax or upper part of the abdomen. The pathogenesis of traumatic asphyxia is that after compression of the chest or upper abdomen, intrathoracic pressure increased suddenly. Blood is forced out of the right atrium through the valveless innominate and jugular veins into the head and neck. This sudden increased thoracic pressure in small venules and capillaries causes rapid dilation and minute hemorrhages producing the petechiae often seen. Treatment is supportive and should be focused on the associated injuries. The prognosis for traumatic asphyxia is very good despite the alarming initial physical appearance. If the patient survives the initial insult, the prognosis is excellent. Neurologic sequale may be permernant. We experienced five case of the traumatic asphyxia, and its clinical and pathophysiologic features are discussed. Increased awareness of this syndrome by emergency physicians will result in better reporting ad understanding of its clinical implications.

영상분석장치를 이용한 미세흔적의 형태비교 및 특성분석에 관한 연구(Ⅲ) : 총기 발사흔 중 강선흔의 형태 비교

박성우,이정필,김동환,임세혁,김영만 內務部 國立科學搜査硏究所 2001 國立 科學 搜査 硏究所 年報 Vol.33 No.-

브레이징 온도 변화에 따른 ZrO2와 Ti-6Al-4V의 접합 특성

기세호,박상윤,허영구,정재필,김원중 大韓齒科補綴學會 2012 대한치과보철학회지 Vol.50 No.3

Purpose: In this study, brazing characteristics of ZrO2 and Ti-6Al-4V brazed joints with increasing temperature were investigated. Materials and methods: The sample size of the ZrO2 was 3 mm × 3 mm × 3 mm (thickness), and Ti-6Al-4V was 10 mm (diameter) × 5 mm (thickness). The filler metal consisted of Ag-Cu-Sn-Ti was prepared in powder form. The brazing sample was heated in a vacuum furnace under 5 × 10-6 torr atmosphere, while the brazing temperature was changed from 700 to 800℃ for 30 min. Results: The experimental results shows that brazed joint of ZrO2 and Ti-6Al-4V occurred at 700 - 800℃. Brazed joint consisted of Ag-rich matrix and Cu-rich phase. A Cu-Ti intermetallic compounds and a Ti-Sn-Cu-Ag alloy were produced along the Ti-6Al-4V bonded interface. Thickness of the reacted layer along the Ti-6Al-4V bonded interface was increased with brazing temperature. Defect ratios of ZrO2 and Ti-6Al-4V bonded interfaces decreased with brazing temperature. Conclusion: Thickness and defect ratio of brazed joints were decreased with increasing temperature. Zirconia was not wetting with filler metal, because the reaction between ZrO2 and Ti did not occur enough. 연구 목적: 온도 변화에 따른 ZrO2와 Ti-6Al-4V의 접합 특성에 대해 알아보기 위하여 새로운 브레이징 합금을 제조하고, 브레이징 온도가 접합 특성에 미치는 영향에 대하여 조사하고자 하였다. 연구 재료 및 방법: 본 연구에서 사용된 시편으로는 실험용 ZrO2 모재(ZirBlank-PS, Acucera, Inc., Gyeonggi-do, Korea)는 소결 전의 블록형태(65 mm × 36 mm × 12 mm (t))이며, 이를 잘라 사포(#2400)로 표면연마 후 소결하였다. 소결된 ZrO2 시편의 크기는 3 mm × 3 mm × 3 mm (t) 이다. Ti-6Al-4V 모재(Ti 6Al 4V ELI CG Bar, TMS, Washington, USA)는 직경 10 mm × 5 mm (t)를 사용하였다. 소결된 ZrO2와 Ti-6Al-4V의 접합을 위하여 브레이징 합금을 제조하였다. 시편을 3군으로 나누어A군은 700℃에서, B군은 750℃에서, C군은 800℃에서 각각 브레이징 하였다. 브레이징 부의 두께와 결함율의 측정은 각 군당 하나의 시편으로 각 시편 당 5회씩 반복 측정하여 평균값을 취하였다. 결과: 브레이징 합금을 사용하여 진공 브레이징을 수행한 결과 ZrO2 와 Ti-6Al-4V 는 700℃ - 800℃에서 양호한 접합을 보였다. 브레이징 후 브레이징 온도 변화에 따른 브레이징 부의 두께 및 결함율의 변화는SEM을 사용하여 측정하였다. 브레이징 온도가 700℃에서 800℃로 증가함에 따라 CuTi 금속간 화합물 층 및 Ti-Sn-Cu-Ag계 화합물 층의 두께는 각각 4.5 ㎛에서 10.3 ㎛로, 3.1 ㎛에서 5.0 ㎛로 증가되었다. 또한 브레이징 온도가 700℃에서 800℃로 증가함에 따라 브레이징 접합계면의 결함율은 ZrO2 및 Ti-6Al-4V 계면에서 각각25%에서 16.3%, 5%에서 1.5%로 감소되었다. 결론: 브레이징 온도가 700℃에서 800℃로 증가됨에 따라, 브레이징 접합계면의 결함율은 ZrO2 및 Ti-6Al-4V 계면에서 모두 감소되었다. 이는 결함부에서 ZrO2와 활성원소인 Ti과의 반응이 충분히 일어나지 않아서 브레이징 합금이 ZrO2에 웨팅되지 않은 것이 원인이라고 사료된다.

응급의료센터의 단기입원치료실 활용경험

최승필,박승현,정시경,박규남,김영민,김세경,이운정,이환 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. The SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admitted in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED during the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%) 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3±16years 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture of hand 6 cases(6.5%), and others 19 cases(20.6). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admitted to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65±9.6 to 7.52±5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admitted patients waiting in the ED.

흰쥐에서 심정지후 뇌의 허혈-재관류 손상과 Tumor Necrosis Factor-α의 상관관계

최승필,박규남,박승현,박상현,정시경,김세경 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : Tumor necrosis factor-α(TNF-α) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-α was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. Methods : Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and clamping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-α, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. Results : 1. TNF-α level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min-and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1±1.2% vs 1.2±0.9%, p<0.05). Conclusions : The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-α level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-α level during the early reperfusion period(<2h) is related to delayed neuronal damage.

심폐소생술후 혼수상태의 환자에서 체성감각유발전위의 예후 예측인자로서의 유용도

최세민,오동렬,최승필,박규남,김세경 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The improved technique for cardiopulmonary resuscitation(CPR) has resulted in the survival of many patients who experienced cardiac arrest. However, mortality in resuscitated patients is high, and the survival rate without brain damage is very low. Various neurological examination models, neuro-imaging techniques, electrophysiological procedures, and biochemical tests have been studied with respect to the detection of cerebral damage and outcome, but an early, reliable prediction of individual outcomes is still uncertain. Methods: We studied twenty patients who had been in a coma for more than 24 hours after CPR, Somatosensory evoked potentials(SEP) were measured within the first three days after CPR. Results: Of the twenty patients, seven patients(35%) had a good outcome, and thirteen patients(65%) had a bad outcome. Of the eleven patients with loss of the cortical evoked potential's N2O peak, all had a bad outcome. Conclusion: SEPs are of great benefit in prognostic evaluation after CPR.

한강변 응급센터에 내원한 익수환자에 대한 임상적 고찰

양진홍,박규남,최승필,김영민,김세경 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Background: There are approximately 2,400 drowning deaths reported every year in Korea, but there are few good reports about submerged patients visiting the emergency room, so this study was designed to investigate the clinical characteristics and outcomes of submerged patients treated at an emergency medical center near the Han river. Methods: A retrospective review of 123 cases of submerged patients admitted to our emergency medical center over a 5 year period from 1996 to 2000 was conducted. Results: Among the 123 submerged patients, there were 66 males and 57 females, and their mean age was 33.18. The common cause of submersions was a suicide attempt, followed by lack of attention, unknown etiology, and water sports such as swimming. Most of the patients were transported to ER by 119 ambulance. In-hospital CPR was performed on 27(22%) cases. At initial ECG rhythm of these cases, asystole was noted if 25 patients; VF and pulseless electrical activity, respectively, were noted in two others. Prehospital CPR had been performed on all in-hospital CPR cases except 2. Prolonged ROSC after succesful CPR was noted in 13 cases, The mean duration of CPR was 26 minutes. Five patients survived after CPR. Their neurologic outcomes were assessed on CPC(cerebral performance category). Three patients were categorized in CPC1, the other two patients were categorized in CPC3 and CPC4. Conclusion: Submerged patient's visits to emergency medical center near the Han river were most frequent in summer for suicide purposes. Drowned patients were more hypothermic than other cardiac arrest cases, and resulted in better outcome even with prolonged arrest time, if they were given appropriate prehospital CPR and aggreissive in-hospital resuscitation.

응급센터에서 기관내 삽관을 시행하지 않은 호흡곤란 환자의 동맥혈 이산화탄소분압과 호기말 이산화탄소분압의 연관성분석

김형국,박승현,오동렬,박규남,이원재,황두영,최승필,이운정,정시경,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The end-tidal carbon dioxide tension(ETCO₂) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. The purpose of this study is to determine the correlation between ETCO₂and arterial carbon dioxide tension(PaO₂) in nonintubated patients with respiratory distress in emergency department(ED). Methods: A prospective non-blind study was performed in ED of our university hospitals. Participants included all nonintubated adult patients with respiratory distress requiring arterial blood gas analysis. ETCO₂was measured with a capnography monitor during tidal volume breathing. ETCO₂were recoreded at the time of arterial blood gas sampling. The correlation between ETCO₂and PaCO₂was analyzed in all patients and in subgroups by simple linear regression. Results: Sixty patients were enrolled. In all patients, ETCO₂was 5.72mmHg lower than PaCO₂and correlated well with PaCO₂(r²=0.716). ETCO₂correlated best with PaCO₂in patients who were either acidotic or non-smoking. Conclusion: ETCO₂correlate well with PaCO₂in nonintubated patients with respiratory distress in ED. ETCO₂may be sufficient to reflect PaCO₂in selected patients and obviate the need for repeat arterial blood gas determination.

심장내로 연장된 정맥내 평활근종증 1예 : 심장내 평활근종증 intracardiac leiomyomatosis-case report and literature review

정재헌,민필기,박소영,변영섭,홍그루,임세중,심원흠 대한내과학회 2003 대한내과학회지 Vol.65 No.2

정맥내 평활근종증은 병리학적으로는 양성 질환이나 진행 양상은 악성으로 모든 종양의 적출술이 시행되어야 하며, 자궁적출술시 병리학적으로 정맥내 평활근종증을 진단받은 경우 정기적인 검사를 통해 종양의 재발이나 하대정맥과 심장내로의 연장을 확인하여야 한다. 우측 심장내 종양이 발견된 경우는 점액종을 포함한 원발성 심내 종양 외에도 다른 원인 질환을 확인하여야 하며, 반드시 정맥내 평활근종증을 감별진단하여야 한다. Intravenous leiomyomatosis is a rare benign vascular tumor defined as the extension into venous channels of a histologically benign smooth muscle tumor arising either from a uterus or from the walls of uterine vessels, and about 10% spread to the heart. The treatment of choice is complete resection of the tumor. Hormonal therapy should be considered in cases of unresectable residual tumor. A 46-year-old woman was admitted for abdominal discomfort and pain. She was found to have intravenous leiomyomatosis of the uterus with extension into inferior vena cava and right atrium. The patient underwent surgery employing simultaneous sternotomy and laparotomy. Radical excision was achieved using cardiopulmonary bypass. We herein describe a patient in whom complete removal of intravenous leiomyomatosis with cardiac extension was successfully performed.

Involvement of a MAPK Pathway in the Control of Cortical Granule Reaction and Mitosis during Bovine Fertilization

Jin Cheol Tae,Eun Young Kim,Kilsoo Jeon,Keum Sil Lee,Chang Hyun Lee,Yeon Ok Kim,Nam Hyung Kim,Se Pil1 Park 한국동물생명공학회(구 한국동물번식학회) 2007 Reproductive & developmental biology Vol.31 No.2