응급센터 입원환자의 통증처치에 대한 응급의학적 고찰

도병수,김현정,정준영,도호석,이창현,이삼범 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study objective: To recognize importance of pain management in ED and properly manage the ED patients complaining pain by analyzing the intervals between arrival time in ED and pain medicine starting time, the types and the administered routes of pain medicine. Design: Retrospective review of ED charts Setting: University teaching hospital Participants: The patients had admitted in ED of Yeungnam University Hospital with a chief complaint of acute abdominal pain or pain due to bone fracture between June 1, 1995 and December 31, 1995. Results: The study group consisted 256 patients, 161 of them female. ED administrations of analgesics were 103 cases, 17 of them administered more than two times. The average time interval between arrival time and medication time was 169.02±120.25 minutes. Each types of perceived analgesics were antispasmodics 55 cases(53.40%), NSAID 26 cases(25.24%) and opioid 19 cases(18.45%). Every analgesics were administered through intramuscular routes, except only 3 cases. Violences of patients or relatives due to delayed pain control were occured 32 cases, 5 cases of them self-discharged and looked for other hospitals. Conclusion: Emergency physicians including interns and residents delayed management so long and ordered inappropriate administration routes and types of analgesics. So we thought proper protocols about pain management in ED were established.

2인과 3인의 기본 심페소생술 비교

정준영,이창현,김현정,도호석,이삼범,도병수 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

Study objectives: To compare the quality of CPR provided by medical students and pre-EMTs perfoming three-rescuer CPR with that achieved by same students trained to provide standard two-rescuer CPR and to find the most effective method of resuscitation and to educate this methods to students. Material and methods: From July 1 to September 30, 1996, we had trained 60 groups consisted of the medical students, students of EMS technology and pre-EMT. Each group practiced two-rescuer CPR and three-rescuer CPR for 120 minutes with Resusci? Anne and perfomed CPR for at least 3 minutes without feedback. To eliminate any visual cues of perfomance the mannequin's recorder was hidden. Each actions were recorded by Resusci? skillmeter and Laerdal printer. To compare the quality of two-rescuer CPR and three-rescuer CPR, we analyzed the data by SPSS with paired t-test. Results: Three-rescuer teams delivered a mean minute ventilation and a mean minute cardiac compression substantially greater than that produced by two-rescuer teams(11.30±1.85 vs 9.09±2.22, p<0.001; 99.22±12.42 vs 95.12±15.75, p<0.001). Three-rescuer teams produce the more correct actions in chest compression and ventilation(93.84±7.56% vs 83.49±16.94%, 90.90±9.33% vs 77.00±17.06%). Conclusion: Three-rescuers can produce better CPR than two rescuers when a bag-valve-mask devices is used and the technique is easily learned and readily retrained, so we think that repeated education and training of this CPR methods to students is needed.

파킨슨씨병 환자에 있어서 자가부신수질 이식술

정상섭,박상근,오성훈,김선호,윤도흠,박정수,양우익,최인준,안영수,김경환,박창일,김진수,이현철 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

Recent experimental studies and clinical cases have suggested that grafting tissue from the adrenal medulla into the brain may alleviate the symptoms of Parkinson's disease. Autologous adrenal medullary grafts into the striatum was performed stereotactically in two patients with Parkinson's disease. Both patients were bedridden preoperatively, but 4 months after the surgery both became ambulatory and one was even capable of returning to his job. Even though the number of cases was small⑵ and the follow-up period was short, this study shows that adrenal medullary transplantation into the striatum may have some beneficial effects in patient with Parkinson's disease. Further experimental and clinical trials are necessary to see whether this procedure will be a recommendable surgical treatment for patients suffering from Parkinson's disease.

외상성 간손상과 비장손상시 CT분류의 의의

정준영,이창현,김현정,도호석,이삼범,도병수 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

The Organ Injury Scaling Committee of the American Association for the Surgery of Trauma recently published a consensus classification of hepatic and splenic injuries. The hepatic and splenic injury scales, based on parenchymal laceration and intrahepatic hematoma, include grade 1 to 6 and grade 1 to 5 respectively, representing the least to most severe injury. Forty-eight patients with hepatic and splenic injury were evaluate by abdominal CT from January 1995 to May 1996 and we compared abdominal CT grading with operative grading. Four CT grades did not correlate with operative finding. CT grading showed a sensitivity of 80%, specificity 80% in regard to operative grading. We conclude that 1) CT is an accurate technique to determine the extent of hepatic and splenic injury. 2) CT grading of hepatic and splenic trauma has a high correlation with operative grading.

급성흉통으로 내원한 환자에서 심근경색증을 조기 발견하기 위한 TROP-T?Rapid Assay의 유용성

정준영,이창현,김현정,도호석,이삼범,도병수 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study Objectives : In the past, measurement of cardiac enzymes(i.e. CK and/or CK-MB, GOT, LDH)and myoglobin, cardiac specific serum troponin-T were widely used for the diagnosis of acute myocardial infarction, but it need a long time and have low specificity. Thus new diagnostic modality, TROP-T?? Rapid Assay, is very easy and rapid qualitative methods, is needed for the early detection of acute myocardial infarction. Methods : Total CK, GOT, LDH, myoglobin and serum troponin-T activities were measured in patients presenting with acute chest pain at the emergency department and at the same time TROP-T? Rapid Assay was done. Final diagnosis and diagnostic usefulness was evaluated. Results : Overall diagnotic sensitivity and specificity of initial results were as follows; TROP-T? Rapid Assay, 77.3, 100.0; myoglobin, 63.6, 70.4; CK, 95.5, 96.3; GOT, 86.4, 96.3; LDH, 90.9, 92.6; serum troponin-T, 86.4, 96.3, respectively. Conclusion : The TROP-T?? Rapid Assay is simple method and has a short time and nearly same sensitivity and specificity compared to other cardiac enzymes. Thus this is considered useful method in the early detection of acute myocardial infarction at emergency department.

HMG-CoA 환원효소 억제제에 의한 ICAM-1 유전자의 발현조절

김현진,정효균,홍우정,김군순,조영석,김도희,채수흥,구본정,송민호,노흥규,김영건 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

Background : ICAM-1 act as one of major adhesion molecules in the atherosclerotic lesion. ICAM-1 expression is mainly regulated at the level of transcription and depend on IFN-γ signal transduction pathway in which the STAT1 transcrption factor is a critical intermediate. IFN-γreceptor not only initiates tyrosine 701 phosphorylation of STAT1 by Jak1 and Jak2, but also phosphorylates serine 727 through the activation of Raf-1/MAP kinases. HMG-CoA reductase inhibitors have anti-atherosclertic effects, beyond normalization of hypercholesterolemia, by directly acting on endothelial cells, macrophages and vascular smooth muscle cells. HMG-CoA reductase inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibition posttranslational farnesylation and geranyl-geranylation processing of small GTP-binding preoteins and inhibition of normal signaling activities. Method : We made several 5'-deletion constructs of rat ICAM-1 promoter and analyzed the promoter activities by measuring the luciferase activity after transfection into ECV304 cells and smooth muscle cells. We checked the level of total and phosphorylated STAT1 protein by immunoblot analysis using specific antibodies. Results : Lovastatin inhibits IFN-γ-induced ICAM-1 gene expression in the ECV304cell. The cells pretreated with PD98059, MEKK inhibitor showed significantly low ICAM-1 RNA induction with IFN-γ stimulatio. IFN-γ induced phosphorylation of tyrosine 701 was not significantly changed by the pretreatment of lovastatin. But lovastatin suppresses IFN-γ-induced phosphorylation of ERK1/ERK2 which are responsible for the seine 727 phosphorylation in STAT1. Conclusion : We showed that HMG-CoA reductase inhibitors, lovastatin, suppresses IFN-γ mediated ICAM-1 gene expression through the inhibition of transcription. HMG-CoA reductase inhibitor suppresses IFN-γ-induced phosphorylation of serine 727 in STAT1 through the modulation of MAP kinases.

미니스크류 식립 시 상악동의 골두께에 대한 고려

김도현,이진우,차경석,정동화 대한치과교정학회 2009 대한치과교정학회지 Vol.39 No.6

본 연구는 전산화 단층촬영 영상으로 상악동의 형태를 파악하여 교정용 미니스크류를 안전하게 식립할 수 있는 위치를 찾고자 시행되었다. 남자 20명, 여자 20명의 3차원 전산화 단층촬영 사진을 촬영한 후 3차원 영상프로그램을 이용하여 상악동의 형태를 계측하여 통계 분석하였으며 다음과 같은 결과를 얻었다. 상악동저에서 백악법랑경계까지의 골두께는 제1대구치와 제2대구치 사이에서 유의하게 얇았고, 제1소구치와 제2소구치 사이에서 유의하게 두꺼웠다. 상악동저에서 협측 상악골 외연까지의 두께는 제1대구치와 제2대구치에서 유의하게 두꺼웠으며, 제1소구치와 제2소구치 사이에서 유의하게 얇았다. 이상의 결과를 바탕으로 안전하게 미니스크류를 식립하여 교정치료의 영역을 넓힐 수 있을 것이다. Objective: Miniscrews are widely used in orthodontic treatment for the purpose of anchorage control. Maximum anchorage can be acquired by the use of miniscrews. Maxillary miniscrew has many clinical advantage for orthodontic treatment. Maxillary sinus, tooth root can be an obstacle for maxillary miniscrew installation. The purpose of this study was to find the safest area and direction of miniscrew insertion in consideration of the maxillary sinus. Methods: The maxillary sinus area of 40 patients (20 male, 20 female) was measured using 3D computed tomography and 3D reconstruction program. Results: The maxillary sinus floor was located most inferiorly between the 1st molar and 2nd molar and located most superiorly between the 1st premolar and 2nd premolar. Buccal bone thickness from the maxillary sinus is significantly thicker between the 1st molar and 2nd molar and significantly thinner between the 1st premolar and 2nd premolar. The area between the 1st premolar and 2nd premolar has a significantly longer vertical distance from CEJ to sinus in consideration of buccal bone thickness. Conclusions: Considering maxillary bone thickness, the posterior area has advantages over the anterior area for installing miniscrews safely and preventing perforation.

Lipomyces starkeyi KSM 22 Glucanhydrolase 함유 용액의 치은 섬유아세표에 대한 영향

윤현정,정현주,김옥수,김도만 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.3

A novel glucanhydrolase from a mutant of Lipomyces starkeyi KSM 22 has additional amylase activity besides mutanolytic activity and has been suggested as promising anti-plaque agent. It has been shown effective in hydrolysis of mutan, reduction of mutan formation by Streptococcus mutans and removal pre-formed sucrose-dependent adherent microbial film and has been strongly bound to hydroxyapatitie. These in vitro properties of Lipomyces starkeyi KSM 22 glucanllydrolase are desirable for its application as a dental plaque control agent. In human experimental gingivitis model and 6month clinical trial. mouthrinsing with Lipomyces starkeyi KSM 22 dextranase was comparable to 0.12% chlorhexidine mouthwash in inhibition of plaque accumulation and gingival inflammation and local side effect was negligible. This study was aimed to evaluate the cytotoxic effect of Lipomyces starkeyi KSM 22 glucanhydrolase on human gingival fibroblasts. Primary culture of human gingival fibroblasts at the 4th to 6th passages were used. Glucanhydrolase solution was made from lyophilized glucanhydrolase powder from a mutant of Lipomyces starkeyi KSM 22 solved in PBS and added to DMEM to the final concentration of 0.5, 1, and 2unit. Cells were exposed to glucanhydrolase solution or 0.1% chlorhexidine and the cells cultured in DMEM with 10% FBS and 1% antibiotics as control. After exposure, the morphological change, cell attachmcnt. and cell activity by MTT assay were evaluated in 0.5, 1.5, 3, 6, 24 hours after treatment. The cell proliferation and cell activity was also evaluated at 2 and 7days after Iminute exposure, twice a day. The cell morphology was similar between the Lipomyces starkeyi KSM 22 glucanllydrolase groups and control group during the incubation periods. while most fibroblasts remained as round cell regardless of incubation time in the chlorhexidine group. The numbers of the attached cells in the glucanhydrolase groups were comparable to that of control and significantly higher than the chlorhexidine group. The numbers of the proliferated cells in the glucanhydrolase groups at 7 days of incubation were comparable to the control group and higher than the chlorhexidine group. The cell activity in glucanhydrolase groups paralleled with the increased cell number by attachment and proliferation. According to these results, Lipomyces starkeyi KSM 22 glucanhydrolase has little harmful effect on attachment and proliferation of human gingival fibroblasts, in contrast to 0.1% chlorhexidine which was cytotoxic to human gingival fibroblasts. Therefore this glucanhydrolase preparation is considered as a safe and promising agent for new mouthwash formula in the near future.

소각재에 함유된 중금속성분의 농도 분석

박현서,정진도 공주대학교 자원재활용 신소재 연구센터 2002 센터사업 성과집 Vol.- No.1

The disposal of municipal solid waste is a serious problem in Korea and throughout the world General diposal methods-incineration or dumping in landfills-creat more problems than they could be solved. Incineration generates toxic ashes and gase, and landfills will soon reach capacity and do not gurarantee the safe containment of harmful substances. Recently the fly ash has been classified as hazardous waste and diposal is no longer allowed unless it is treated by new law, the bottom ash also has become a very controversial issue due to their harmfulness. Sampling and analysis of ash at the three MSW incinerators was performed to determine if beneficial use could be made of this material. According to the results of analysis with HELOS, Atomic Absorption Spectrophotometry, and ICP-MS, bottom ashes included only 8.8% of PM-10 and Fly ashes, on the other hand, included approximately 50% which represented a very dangerous level. Among 17 heavy metals, tested Pb was detected to the extent harmful to human body, while the rest were discovered relatively to be lower level compared to Po.

전단보강근량에 따른 초고강도 콘크리트를 사용한 고층형 내력벽의 이력거동

윤현도,연길환,정수영,윤석천,이창갑 忠南大學校 産業技術硏究所 1995 산업기술연구논문집 Vol.10 No.1

Three one fourth scale models using ultra high-strength concrete(f' =704 kg/㎠) are tested under the combined action of a constant axial and a horizontal load cyclically to failure. Such specimens are considered to represent the critical 3-story of low part in 60-story tall building of a structural wall system in area of high seismicity. The amount of vertical reinforcement and the level of applied axial stress are identical for the three wall tested. The cross-section of all walls is barbell shape. The aspect ratio(h /l ) of test specimen is 1.8. The primary objectives of this paper are to investigate the influence of the amount of horizontal reinforcement on the lateral resistance, failure mechanism, ductility and energy-dissipation capability of walls with ultra high-strength concrete. In contrast to what is widely believed, the horizontal web reinforcement does not appear to have a significant effect on shear capacity. Certainly, since the reduction of the web horizontal reinforcement to almost half the value specified by building codes doesn't affect the failure load, this effect in not accounted for by the truss analogy concept. The results obtained have helped to identify the causes of wall failure and have demonstrated that the concepts underlying current ACI Building Code provisions for the design of walls conflict with the observed structural behavior. It has been found that shear resistance is associated with triaxial compressive stress conditions that develop in the compressive zone of the section at the base of the wall.