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Traumatic Cerebrospinal Fluid Leak: Diagnosis and Management
오지웅,김소현,황금 대한신경손상학회 2017 Korean Journal of Neurotrauma Vol.13 No.2
Cerebrospinal fluid (CSF) leaks are one of the common complications after traumatic brain injuries (TBI). The risks ofCSF leaks can be detrimental to the outcomes of the patients. Early diagnosis and proper management is imperative for itis strongly associated with a better long-term prognosis of the patients. Diagnostic tools for CSF leaks are still under debate. Nevertheless, many reports of successful treatments for CSF leaks have been published with introduction of variousrepair techniques for leakage sites even though it is surgically challenging. Hereby, we review about the pathophysiology,manifestations as well as the update of the clinical diagnosis and current management of CSF leaks.
응급실에서 관류전산화단층촬영을 이용한 두부 외상 환자의 초기 평가: 증례보고
오지웅,황금,김헌주 대한응급의학회 2012 대한응급의학회지 Vol.23 No.3
Acute subdural hematoma (SDH) is a neurological trauma that can lead to death or life-long disability of the patient. It is usually diagnosed by examination of the patient’s brain computed tomography (CT) images. While macroscopic change in the posttraumatic brain can be identified using this mode of diagnosis, visualization of abnormal change in cerebral blood flow and the resulting brain damage following a head injury is often difficult. The two patients studied in this case report were similar in terms of thickness and volume of subdural hematoma and severity of midline shift. However,their perfusion parameters were markedly different and so were their outcomes. According to findings of our study, with its perfusion parameters, CT brain perfusion imaging is a practical tool for use in initial evaluation of patients with traumatic brain injury and for prediction of the clinical prognosis. Subsequently, we may use the information for help in planning of treatment and in preparation for post-operative complication based on the severity of brain damage.
오지웅,리원연,장지영,Pilyoung Jung,Sohyun Kim,Jongyeon Kim,Jinsu Pyen,황금,Sungmin Cho 대한중환자의학회 2015 Acute and Critical Care Vol.30 No.4
The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
기관내관 흡인 방법에 따른 반정량적 객담배양검사 결과의 양상 비교
오지웅,황금,정현호,박종택 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.2
Background: The endotracheal suction was one of the critical requirements for severe neurosurgical patients in the prevention of the airway-obstruction, pneumonia, atelectasis, and so on. There were two types of suction methods, closed and open. In the literature, many reported the comparison of the two methods with variable factors, yet, it was still controversial. In this study, we compared the two types of endotracheal suction methods based on the pattern of the sputum cultivation, which was not discussed in the previous studies. Methods: In 2010, 85 patients who had intubation tube for more than 10 days were evaluated in this study. A total of 55 patients were managed with an open suction method, while the other 30 patients were managed with a closed suction method. All patients’ sputum culture was reported semi-quantitatively, and had been classified into 3 different groups, according to the culture pattern. The control group was defined in which the bacterial count was not increased, whereas the non-control group was those with bacterial count increased. We investigated patients’ age, gender, disease-type, suction techniques and the pattern of sputum cultivation. Results: The non-control group was 45.45% in the open suction group, while it was 16.67% in the closed suction group. On the other hand, more control group was observed in the closed suction group (36.67%), than in the open suction group (25.45%) (p < 0.05). There was no statistically significant difference in the analysis based on the pattern of sputum cultivation, age, gender, and disease-type. Conclusions: We suggest that the closed suction methods were more effective in the management of endotracheal tube, according to the pattern of sputum culture.
An algorithm for the detection of the cylinderical contact shape
오지웅,박상철 대한산업공학회 2013 대한산업공학회 추계학술대회논문집 Vol.2013 No.11
본 논문은 assembly geometric model로부터 자동적으로 실린더 형태의 접촉면을 탐색하는 알고리즘을 제안한다. assembly geometric model이란 강건한 부품들끼리 조립된 모델로써, 부품들 간에 관절을 형성하고 있지만 논리적 움직임을 위한 구조는 갖춰지지 않은 모델을 말한다. Kinetic model은 추상적인 개념으로써 눈에 보이지는 않지만 관절의 움직임을 가능하게 해주는 논리적 모델을 말한다. Virtual Factory(VF)에서 사용되는 대부분의 assembly geometric model은 2개의 대표적인 관절(revolute joint, prismatic joint)로 이루어져 있기 때문에 본 논문은 이 두 가지 관절에 대해서만 고려한다. 이 두 가지 관절은 중심 축을 기준으로 회전운동과 직선운동으로 나뉘어진다. 관절은 두 개의 부품이 서로 접촉하여 생성하게 되는데 대부분의 관절은 실린더 형태의 접촉면을 이룬다. 각 부품 별 접촉면을 탐색하기 위해서 GPU를 이용한 parallel computing 기법을 사용했으며, 무분별하게 탐색된 접촉면들 중에서 실린더 형태의 접촉면을 구분하기 위해서 gauss map을 이용한다. 본 논문에서는 자동차 조립 라인의 6축 로봇을 이용했고, 핵심 기술인 gauss map을 이용하여 실린더 형상의 접촉면과 중심축을 생성하는 알고리즘에 대해서 설명한다.
Retrieval of Unintended Migrated Detached Coil - Case Report -
오지웅,김종연,홍순기,허철,변진수,황금,조성민,유도성 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3
Owing to the rapid development of intervention techniques and devices,endovascular coil embolization of cerebral arteries has become standardized. It is particularly preferred when a patient presents with an unruptured intracranialaneurysm of the posterior communicating artery (PcomA). However, the risk of thrombogenic complications of the coil migrationmay also result in a large cerebral infarction. When coil migration occurs during embolization, a procedure for removalof the embolic coil should be performed immediately. We experienced aclinically rare case of migration of a framing coil to the distal middle cerebralartery aneurysm during endovascular embolization of an unrupturedPcomA aneurysm. The migrated coil was barely retrieved using snaretechniques.