중환자에서 APACHE III score와 사망율과의 관계

김준식 ( Jun Sig Kim ),이영주 ( Young Joo Lee ),조준필 ( Joon Pil Cho ) 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

To evaluate the relationship between APACHE III score and mortality in critically ill adult ICU patient, we studied the 548 patients who were admitted to the ICU from June 1, 1994 to January 31, 1995. We did not include patients with burn injuries, patients aged less than 15 years, or chest pain patients, in order to rule out myocardial infarction and unsatisfactory data files. There were 120 multiple trauma patients, 68 sepsis patients, 62 hemorrhagic shock patients, 20 multiple organ failure patients, and 120 patients with, among other conditions, drug int,oxication, diabetic ketoacidosis, renal failure, hepatic encephalopathy, and cerebral hemorrhage or infarction. The APACHE III scores of survivors and non-survivors were analyzed with Chi-square test and compared. The number of nonsurvivors was 168 patients, and the overall mortality rate was 30.7%. There was a positive correlation between a high APACHE III score and mortality : all patients with more than 90 points expired. The average points of the survivors was 34.52+-15.48 and of nonsurvivors was 77.74+-31. 37. The difference between each group is significant statistically. The average APACHE III points was 47.8. The APACHE III score is a good prognostic tool to predict the mortality rate in ICU adult patients, and can be used for selection of patients and for ICU admission/discharge. It can also be used to compare the efficacy of intensive care in different hospitals.

노인환자에서 전정신경염으로 오진된 후하소뇌동맥경색 1예

김준식(Jun-Sig Kim),한승백(Seung-Baik Han),신동운(Dong-Wun Shin),김훈(Hoon Kim),김강호(Kang-Ho Kim),백광제(Kwang-Je Baek) 대한임상노인의학회 2004 대한임상노인의학회지 Vol.5 No.2

노인 환자들이 가장 많이 호소하는 증상 중의 하나가 어지럼증, 이명, 청력손실 등이다. 저자들은 전정신경염으로 오진되었던 후하소뇌동맥경색 1예를 경험하여 보고하는 바이다. 67세 남자 환자가 어지럼증, 구토, 두통을 주소로 응급센터에 내원하여 신경학적인 검사로 뇌컴퓨터 단층촬영, 삼차원위상대조혈관 뇌전산화단층촬영(3D phase contrast angiography brain computed tomogram)을 시행하였으나 특이 사항은 발견되지 않았다. 그러나 환자는 증상이 심하여 전정신경염 진단하여 입원하였다. 입원 2일째에 환자는 기면상태로 의식변화가 발생하여 뇌자기공명영상 촬영을 시행하였는데 후하소뇌동맥경색이 발견되었다. 따라서 뇌압상승에 대한 치료를 하였으나 증가된 뇌압은 잘 조절이 되지 않았다. 입원 4일째 수두증이 발생하여 응급 뇌실외배액술(extraventriccular drainage)을 시행하였다. 적극적인 치료 후 환자의 의식은 명료해졌다. 저자들은 어지럼증을 호소하는 노인 환자에서 어지럼증의 원인이 확실하지 않을 경우에는 뇌컴퓨터 단층촬영이나 뇌자기공명영상 촬영을 하거나, 필요하면 두 가지 검사방법을 함께 시행하는 것이 중요할 것으로 생각된다. The elderly patients complaint most common frequently of dizziness, tinnitus, and hearing loss. We report a cerebellar infarction of posterior inferior cerebellar artery (PICA) that is misdiagnose as a vestibular neuritis. The 67 year-old patient complaints the vertigo, vomiting, and headache. The neuro-imaging study were performed. The non-contrast brain computed Tomogram (CT) and 3D phase contrast angiography brain computed tomogram (3D angio-CT) revealed that there was no specific findings. So He was admitted and the impression was vastibumar neuritis. The second hospital day, his menta status was changed, so Magnetic Resonance Image (MRI) was performed and the finding was cerebellar infarction of posterior inferior cerebellar arterty (PICA). After that, the increased intracranial pressure (ICP) was treated with mannitol. But increased ICP was not controled well. And the hydrocephalus was developed, so the extraventricular drainage was performed. After intensive treatment, his mental status become nearly alert. From this case, we think that the most important thing is the early correct differential diagnosis between psripheral and central origined vertigo. The final correct diagnosis was established with CT and/or MRI.

리더십 유형이 임파워먼트에 미치는 영향에 관한 연구

김준식 ( Kim Jun Sig ),조성제 ( Jo Seong Je ) 한국인적자원관리학회 2004 인적자원관리연구 Vol.8 No.-

중증 치핵에 대한 환상절제술

김준식(Jun Sig Kim),손승국(Seong Kook Sohn),민진식(Jin Sik Min) 대한외과학회 1989 Annals of Surgical Treatment and Research Vol.36 No.5

당뇨병 환자에서 신병증 진행정도에 따른 말초신경 전도에 관한 연구

김준식 ( Kim Jun Sig ),안재형 ( An Jae Hyeong ),이태원 ( Lee Tae Won ),임천규 ( Im Cheon Gyu ),김명재 ( Kim Myeong Jae ),박원도 ( Park Won Do ) 대한내과학회 1993 대한내과학회지 Vol.44 No.1

Background : Peripheral neuropathy is one of the important complication of patient with diabetes mellitus and chronic renal failure. But its pathogenesis and frequency has not been clearly verified. Methods : We measured amplitudes and conduction velocities of diabetes, proteinuria and renal insufficiency on the peripheral neuropathy in patients with diabetic nephropathy. Results : 1) The amplitude (5.8±1.3uV) and conduction velocity (22.1±4.1 m/sec) of sural nerve in DM group were significantly decreased compared with those (16.6±7.5uV, 48.7±5.1m/sec) in normal control group (each other P<0.05, P<0.01). 2) T도 amplitude (2.1±0.6uV) and conduction velocity (34.7±4.2m/sec) of peroneal nerve in DM group were significantly decreased compared with those (5.1±2.0uV, 52.2±6.2m/sec) in normal control group (each other P<0.05). 3) The amplitude (3.8±2.1 uV) of sural nerve in renal insufficiency group tended to be decreased compared with those in mormal renal function group (5.2±2.5 uV) and DM without nephropathy group (8.3±3.2 uV). 4) The amplitude of peroneal nerve in renal insufficiency group (1.1±0.2 uV) and normal renal function group (2.2±0.5 uV) were significantly decreased compared with that in normal control group (5.1±2.0 uV) (P<0.05), but not in DM without nephropathy (3.0±1.6 uV). 5) The conduction velocity of sural nerve in renal insufficiency group (12.1±6.3 m/sec) and normal renal function group (12.8±4.9 m/sec) were significantly decreased compared with those of normal control group (48.7±5.1 m/sec) (P<0.05) and DM without nephropathy group (41.3±6.6 m/sec) (P<0.05). 6) The conduction velocity of peroneal nerve in renal insufficiency group (29.1±3.9 m/sec) and normal renal function group (31.5±4.3 m/sec) were significantly decreased compared with that of normal control group (52.6±6.2 m/sec) (P<0.05), but not in DM without nephropathy (42.9±5.1 m/sec). 7) There was a significant correlation between HbA_1 C and nerve conduction velocity in patients with diabetic nephropathy. Conclusion : These data suggest that the peripheral neuropathy, diagnosed by amplitude and nerve conduction velocity, may occur more frequently in patients with diabetic nephropathy than normal controls and diabetes mellitus without nephropathy, whether renal insufficiency was or not.

급성골수성백혈병의 항원수용체유전자 재배열 양상

김정희 ( Kim Jeong Hui ),김준식 ( Kim Jun Sig ),어완규 ( Eo Wan Gyu ),김영일 ( Kim Yeong Il ),김선희 ( Kim Seon Hui ),김시영 ( Kim Si Yeong ),윤휘중 ( Yun Hwi Jung ),조경삼 ( Jo Gyeong Sam ) 대한내과학회 1993 대한내과학회지 Vol.44 No.4

Background: Detection of the immunoglobulin (Ig) and the T cell receptor (TcR) gene rearrangements are useful markers for determining lineage and clonality in lymphoid malignancy. Antigen receptor gene rearrangements have also found in some patients with acute myeloid leukemia (AML). The significance of these rearrangements remains unclear. Methods: Ig heavy chain (IgH) gene and TcR beta chain(TcRβ) gene rearrangements were examined in leukemic cells from 25 patients with AML by Southern blot analysis. DNA was extracted from bone marrow aspirates. Three different enzymes (EcoRⅠ, BamHⅠ, HindⅢ) and two different probes(J_(H), Cβ) were used. Results: 1) TcRβ gene rearrangements were demonstrated in 2 of 25 cases(8%). But IgH gene rearrangement was not detected at all. 2) Antigen receptor gene rearrangement pattern of three cases with B cell antigen, CD19(+) and two cases with T cell antigen, CD2(+) were germline. Immunophenotyping was not performed in two cases with TcRβ gene rearrangement. 3) Of the patients with TcRβ gene rearrangement, one is alive in complete remission state after chemotherapy, and the other patient died before therapy. Conclusion: TcRβ gene rearrangement was demonstrated in some patients with AML. Antigen receptor gene rearrangment did not correlate with specific immunophenotype and prognosis. The clinical implication of antigen receptor gene rearrangement study need further study.

응급의료센터에서 기관 내관의 위치 확인 시 초음파의 유용성

김형근 ( Hyung Geun Kim ),김강호 ( Kang Ho Kim ),김준식 ( Jun Sig Kim ),한승백 ( Seung Baik Han ),이의철 ( Eui Cheol Lee ),이경희 ( Kyung Hee Lee ),이경미 ( Kyoung Mi Lee ),김지혜 ( Ji Hye Kim ) 대한응급의학회 2007 대한응급의학회지 Vol.18 No.3

Purpose: The goal of this study was to determine the suitability of ultrasonography for detecting endotracheal tube placement in the emergency department. Methods: Emergency physicians examined patients immediately following intubation or after intubated patients were transferred. A linear ultrasound transducer was placed transversely on the cricothyroid membrane and suprasternal notch in order to check for the comet head and tail sign and double ring sign, and a sagittal view of the neck was also obtained in order to look for the bold parallel lines sign. Subsequently, simple thoracic sonography and color doppler sonography were used to check for the lung sliding sign. The examiner evaluated whether the tube was placed in trachea, the esophagus, or the right main bronchus. The accuracy of ultrasonography was calculated, and the required time for ultrasonography was checked. Results: One hundred ten patients were enrolled in the study. The endotracheal tube was placed in the trachea in 107 patients, in the esophagus in 2 patients, and in the right main bronchus in 1 patient. The sensitivity and specificity of ultrasonography were 100%. The bold parallel lines sign and lung sliding sign proved to be good indicators of endotracheal tube placement. The average required time for ultrasonography was 28.6±5.8 seconds. It was difficult to determine tube placement by thoracic ultrasonography in patients with pneumothorax, hemothorax, pleural effusion, or empyema. Conclusion: Ultrasonography is well suited for confirming endotracheal tube placement in the emergency department.

MIMO-OFDM 시스템에서 효율적인 채널 추정 방식

전형구,김준식,Jeon, Hyoung-Goo,Kim, Jun-Sig 한국정보통신학회 2015 한국정보통신학회논문지 Vol.19 No.10

본 논문에서는 4 × 4 multiple input multiple output-orthogonal frequency division multiplexing (MIMO-OFDM) 시스템에서 사용 가능한 Walsh 부호화된 시간영역 훈련신호를 설계하고 채널 추정 방법을 제안하였다. 제안된 방법은 다중 경로 지연신호에 의하여 발생되는 훈련 신호간 상호간섭를 고려하면서 채널 응답 추정 공식을 closed-form으로 유도하였다. 컴퓨터 모의 실험결과 제안된 방법은 기존의 방법<xref>[9</xref>,<xref>14]</xref>에 비하여 성능이 우수하고 직교 훈련신호 설계시 대역폭을 증가시키지 않으며 4 × 4 MIMO-OFDM 시스템에서 널(null) 부반송파 존재하여도 채널 추정이 수행될 수 있음을 보였다. In this paper, the Walsh coded orthogonal training signals for 4 × 4 multiple input multiple output-orthogonal frequency division multiplexing (MIMO-OFDM) systems are designed and the channel estimation equations are derived as a closed form, taking account of the inter training signal interference problems caused by the multi-path delayed signals. The performances of the proposed channel estimation method are analyzed and compared with the conventional methods<xref>[9</xref>,<xref>14]</xref> by using computer simulation. The simulation results show that the proposed methods has better performances, compared with the conventional methods<xref>[9</xref>,<xref>14]</xref>. As a result, the proposed method can be used for MIMO-OFDM systems with null sub-carriers.

다양한 신경학적 이상을 나타낸 glufosinate ammonium(바스타$^{(R)}$) 급성 경구 중독 1례

백진휘,김준식,이현규,박현주,하충건,노형근,Paik Jin Hui,Kim Jun Sig,Yi Hyeon Gyu,Park Hyun Joo,Ha Choong-Kun,Roh Hyung-Keun 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

BASTA is an herbicide which contains glufosinate ammonium as a main component with an anionic surfactant, polyoxyethylene alkylether sulfate, and nonselectively inhibits glutamine synthetase. It became a wildly used herbicide in Korea and its intoxication is now increasing. A 42-year old woman ingested about 300ml of BASTA in a suicide attempt. She showed unconsciousness and respiratory distress in the beginning, and later developed multiple generalized convulsions, low blood pressure, fever and diabetes insipidus. Although she became alert 12 days after the ingestion, she showed retrograde amnesia for a period of about recent 10 years. A neuropsychological test on day 22 revealed frontal lobe dysfunction, visual memory disturbance and slight decrease in visuospatial function. All these neurological abnormalities that might occur due to glufosinate ammonium were almost improved in the follow-up test performed a month later.

폐폴리스티렌의 열분해 및 연소반응특성

김사중 ( Kim Sa Jung ),이찬기 ( Lee Chan Gi ),송평섭 ( Song Pyeong Seob ),윤종성 ( Yun Jong Seong ),강용 ( Kang Yong ),김준식 ( Kim Jun Sig ),최명재 ( Choe Myeong Jae ) 한국공업화학회 2003 공업화학 Vol.14 No.5

폐폴리스티렌 및 범용 폴리스티렌을 각각 시료로 하여 TGA (thermogravimetric analysis)를 이용하여 열분해와 연소 반응을 수행하여 폐폴리스티렌과 범용 폴리스티렌의 열분해 및 연소반응 특성을 검토하였다. TGA의 승온속도는 10 K/min, 20 K/min, 30 K/min, 40 K/min 및 50 K/min로 변화 시켰으며, 질소와 산소 분위기에서 가열온도는 323 K~1073 K 범위에서 수행하였다. 반응 특성 검토에서 중요한 요소인 반응차수 및 활성화 에너지들은 Kissinger, Freeman-Carroll, Chatterjee-Conrad, Friedman 및 Coats-Redfern 방법을 사용하여 해석하였고, 각각의 방법에 따른 열분해와 연소반응의 활성화에너지 값을 구하여 비교, 해석하였다. 연구에 사용된 해석 방법과 실험조건에 따라 결과값에 차이가 있음을 알 수 있었으며, 연소 분위기의 겉보기 활성화에너지 값은 140~225 kJ/mol으로 열분해 분위기의 155~260 kJ/mol 값보다 작게 나타났다. Thermal characteristics and kinetic parameters of polystyrene waste and polystyrene were determined by means of thermogravimetry (TGA) at non-isothermal heating conditions(10 K/min, 20 Wmi, 30 K/min, 40 Wmin and 50 K/min) both for pyrolysis and combustion processes. Activation energies and reaction orders of the samples were determined by different methods such as Kissinger, Freeman-Carroll, Chattejee-Conrad, Friedman and Coats-Redfem methods. These methods were compared in terms of their accuracy and the ease of interpretation of the kinetics of thermal decomposition. It was found that the apparent activation energies of the thermal processes were different with variation of analytical methods and experimental conditions. The apparent activation energy of combustion at the atmosphere of 80∼130 KJ/mol was lower than that of pyrolysis at the atmosphere of 90∼150 KJ/mol.