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Descending Necrotizing Mediastinitis Secondary to Peritonsillar Abscess -A Case Report- (편도주위농양에 합병된 하행 괴사성 종격동염 -치험 1례-)

  • 최필조;이용훈;우종수;이기남;손춘희;박헌수;이인규
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.686-689
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    • 1999
  • Descending necrotizing mediastinitis(DNM) is a rare complication of the oropharyngeal and cervical infection. Descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. A 39-year-old man complained of odynophagia, neck swelling, and disturbance of swallowing with dyspnea. CT scans of the neck suggested a peritonsillar abscess and retropharyngeal and peripharyngeal abscess. He underwent cervical drainage. He remained febrile and complained of severe both pain in both shoulders. On postoperative day 5, a follow-up CT scan confirmed a mediastinal abscess. Reexploration of the neck and right thoracotomy for debridement and drainage of the mediastinal abscess were performed.. A large amount of pus was drained from the anterior and posterior mediastinum and its necrotic tissue was debrided. The patient's condition and radiologic findings gradually improved. Cultures of the drain fluid revealed Klebsiella pneumoniae. He was discharged on the 85th hospital day. In our experience, both transcervical drainage and aggressive mediastinal exploration via thoracotomy can lead to an improvement in the survival of the patient with descending necrotizing mediastinitis. CT scanning is useful for early diagnosis of mediastinitis and for follow up.

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Two Cases of Acute Glufosinate Ammonium Intoxication with Disparate Outcomes (급성 글루포시네이트 중독 후 서로 다른 예후를 보인 2례: 증례보고)

  • Han, Hong Joon;Jeong, Ju Ho
    • Journal of agricultural medicine and community health
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    • v.43 no.2
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    • pp.108-113
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    • 2018
  • 목적 글루포시네이트암모늄은 비선택성 제초제로 1984년 일본에서 개발되었으며, 급성 중독시에는 위장관계 증상뿐만 아니라 의식변화, 경련, 호흡부전 및 기억소실 등과 같은 다양한 임상증상을 보이는 것으로 알려져 있다. 한국에는 1994년 소개된 이후로 널리 사용되고 있으며, 사용량의 증가와함께 음독환자가 점점 증가하여 사회적 문제가 되고 있다. 저자들은 최근 글로포시네이트 중독 환자에서 초기치료 후 지연성 악화를 보였던 2례를 문헌고찰과 함께 보고하고자 한다. 방법 및 결과 첫 번째 증례는 62세의 남자환자로 음주상태에서 글루포시네이트암모늄 음독 후 의식 저하 상태로 발견되어 응급실로 이송되었다. 응급 위세척을 시행 후 보존적 치료 및 집중모니터링을 유지하였고, 의식수준은 6시간 후에 거의 명료한 상태로 호전되었다. 지연성 악화의 가능성에 대해설명하고 지속적인 경과관찰 및 치료를 위해 집중치료실 입원이 필요함에 대해 설명하였으나, 환자와 보호자는 타상급병원으로의 전원을 원하였다. 환자는 이송 중에 발생한 심폐정지로 심폐소생술을 시행하였으나, 회복되지 못하고 사망하였다. 두 번째 증례는 54세의 남자 환자로 글루포시네이트암모늄 음독 후 발생한 의식 변화로 응급실로 이송되었다. 내원시 의식은 혼미한 상태였으며 앞의 증례와 같이 응급 위세척을 시행하였다. 본 환자는 초기치료 후 본원 집중치료실에서 지속적인 혈액 및 생화학적 검사를 시행하였으며, 집중모니터링 및 치료를 유지하였다. 입원 2일째 혈액검사 소견은 호전 중이었으나, 경련이 발생하였으며 의식은 혼미한 상태가 지속되었다. 신경과 협진하여 뇌파검사를 시행 후 항경련제를 증량한 후로 경련은 발생하지 않았다. 입원 7일째에는 의식 수준은 거의 명료한 상태까지 호전되었다. 입원 13일째 혈액 및 생화학검사에서 약간의 혈색소 감소 외에는 정상소견을 보였으며, 뚜렷한 신경학적 합병증 없이 퇴원하였다. 결론 급성 글루포시네이트중독 환자는 매우 다양한 임상증상을 보이며 초기치료 후에 상태가 안정적이더라도 지연성으로 임상적 또는 신경학적 악화가 발생할 가능성이 있으므로 치료에 유의하여야 한다.

Compatibility Study of Excipients for Pravastatin Tablet (Pravastatin 정제 연구를 위한 첨가제와의 적합성 연구)

  • Kim, Kang Min
    • Journal of Life Science
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    • v.28 no.4
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    • pp.472-477
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    • 2018
  • Pravastatin sodium is a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor used in the treatment of hypercholesterolemia by reducing cholesterol biosynthesis. Pharmaceutical excipients of commonly used including water, diluents, stabilizers, disintegrants, lubricants and colorants, and were identified for compatibility. All tests were performed by means of physical mixture of pravastatin and the excipients, which were placed in a press-through-pack (PTP) and incubated under accelerated conditions ($40^{\circ}C$ and 75% relative humidity) for 3 months. The blends of pravastatin with all excipients developed white, off white, and light brown powders, which showed no changes upon visual analysis. Accelerated conditions changed the degradation profile of pravastatin calcium in the HPLC system when mixed with different excipients. Although most excipients can have minor effects on pravastatin stability, the major degradation product from pravastatin was lactone. Low-level interaction (assay and impurity) was induced by all excipients except for microcrystalline cellulose and croscarmellose sodium. These excipients increased lactone impurity in 3 months by as much as 0.22% and 0.18% respectively. The total mixture slightly increased the lactone impurity (by 0.43% in 3 months) of pravastatin. There was no change in the assays of all excipients. These results will be helpful in studying tablet size reductions for convenience of use.

A Design of Protocol Based on Smartcard for Financial Information to Protect in E-payment System (온라인 소액결제 시스템에서 금융정보 보호를 위한 스마트카드 기반의 프로토콜 설계)

  • Lee, Kwang-Hyoung;Park, Jeong-Hyo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.11
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    • pp.5872-5878
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    • 2013
  • This study provides two channel structure and two factor authentication. First, a purchasing request by Internet and then user certification and a settlement approval process by mobile communication. Second, it support that proposal protocol utilize a partial factor value of stored in users smartcard, smart phone and password of certificate. Third, storage stability is improved because certificate store in smartcard. Finally, proposal protocol satisfy confidentiality, integrity, authentication, and non- repudiation on required E-commerce guideline. In comparative analysis, Efficiency of the proposal protocol with the existing system was not significantly different. But, In terms of safety for a variety of threats to prove more secure than the existing system was confirmed.

Efficacy of Intra-Aortic Balloon Pump in Postcardiotomy Cardiogenic Shock (개심술 후 인공 심폐기 이탈 시 동맥내 풍선 펌프 사용의 유용성)

  • 장지원;민선경;원태희;안재호
    • Journal of Chest Surgery
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    • v.35 no.6
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    • pp.449-453
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    • 2002
  • Intra-aortic balloon pump (IABP) is well known for its hemodynamic benefit but still has its own complications. Proper use of IABP is the best way to obtain maximum benefit with low complication rate. Material and Method: Twenty one(men 10, female 11) patients were included in this study among the 100 consecutive adult cardiac surgery patients in our hospital. Eighteen(85.7%) were ischemic heart disease patients. They all received IABP therapy due to postcardiotomy cardiogenic shock according to the well-known indications. Their preoperative conditions, intraoperative factors including hemodynamics, postoperative conditions and IABP-related complications were analyzed. Result: Nineteen patients(90.5%) were successfully weaned from IABP. There were 2 patients of operative death and the mortality rate was 9.5%. Duration of IABP use was 40.7$\pm$24.3 hours. There were 2 cases(9.5 %) of IABP-related vascular complications that required surgical intervention. Conclusion: We concluded that IABP could be used effectively and safely for postcardiotomy cardiogenic shock patients with low complication rate.

Assessment of the 4-week repeated dose oral toxicity test of Smilax sieboldii extract in ICR mice (ICR 마우스에서 청가시덩굴 추출물의 4주간 반복 투여 독성시험)

  • Jung A Lee;Min-Hee Hwang;Young-Rak Cho;Eun-Kyung Ahn
    • Journal of Applied Biological Chemistry
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    • v.65 no.4
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    • pp.397-403
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    • 2022
  • Smilax sieboldii is one of the Smilax species. A number of Smilax plants have long been used in traditional medicine in the tropics and subtropics worldwide. Repeated dose oral toxicity test is an essential experiment for toxicity evaluation before efficacy evaluation. The purpose of this study is to evaluate toxicity and the no-observed adverse effect level (NOAEL) using oral administration of Smilax sieboldii extract (SSE) in male and female ICR mice for 4 weeks. SSE was orally administered daily for 4 weeks at a dose of 500, 1000, and 2000 mg/kg/day (MPK). There were no significant differences in mortalities, clinical signs, body weight changes, food intake, hematological analysis, serum clinical chemistry test and relative organ weights in all animals administrated with SSE. The results obtained in this study suggest that SSE did not show any toxic effect in ICR mice and the NOAEL of SSE was regarded as over 2000 MPK.

Analysis of Major Issues in the Serious Accidents Punishment Act (SAPA) (중대재해처벌법의 주요쟁점 해소 방안)

  • Cho Choonhwan
    • Journal of the Korea Institute of Construction Safety
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    • v.5 no.1
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    • pp.17-24
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    • 2023
  • The purpose of this study is to clearly recognize critical issues and to suggest relevant solutions for the issues since too many deaths and injuries due to industrial accidents has been going on for a long time, also the deaths of workers is a problem that affects not only one person's death but also many people connected with it and society as a whole. And the need for a strict Serious Accidents Punishment Act is sympathetic. However, the current Severe Accident Punishment Act is not welcomed by both labor and management due to its ambiguity, and it is suggested that the punishment and legislative content of the management manager who violated the duty to ensure safety and health is abstract and the level of punishment is excessive. In addition, due to the ambiguous part of the management manager's interpretation and serious industrial accidents, most companies appoint large law firms to receive legal interpretation and advice, so only law firms are getting full, and the cost that companies invest to protect the CEO is actually a safety accident. It is suggested that the current enforcement ordinance, which has ambiguity, needs to be revised because it must be entered into as a preventive cost.

Cloud-Based Reservation and Notification System for Efficient Testing of Infectious Diseases (효율적인 감염병 검사 예약을 위해 클라우드에 기반한 예약 및 알림 시스템)

  • Je-Seong Hwangbo;Ho-Yoon Kim;Seung-Soo Shin
    • Journal of Industrial Convergence
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    • v.21 no.1
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    • pp.67-76
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    • 2023
  • COVID-19, which occurred in 2019, has a strong contagious power, has serious symptoms of infection and after-effects, and death in severe cases depending on the underlying disease and symptoms. As COVID-19 is highly contagious, in Korea, screening clinics have been set up across the country to determine whether or not to be positive for COVID-19 and isolate the infected to prevent the spread of COVID-19. However, there are cases where COVID-19 test applicants flock to screening clinics and cannot receive tests due to longer waiting times, and there is a risk that secondary infections may occur in the atmosphere. In this study, the reservation and notification system can be applied from the existing screening care system to solve spatial constraints, reducing waiting time with screening appointments, and solving population bottlenecks to screening clinics. Taking the COVID-19 pandemic as an experience, we propose a system that can present directions in future pandemic situations. To process real-time data, we use Google's Firebase to use Realtime Database in the cloud environment. Because a real-time database is used, users can check the status of screening clinics in real time through the app, make reservations, and receive notifications about test reservations.

Personnel's Perception toward Conducting an Autopsy in General Hospital (대학병원 직원들의 부검에 대한 인식도)

  • Lee, Ho-Beom;Kwak, Jyung-Sik
    • Journal of forensic and investigative science
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    • v.2 no.2
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    • pp.30-49
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    • 2007
  • An autopsy is a postmortem assessment or examination of a body to determine cause of death or manner of death. The author had surveyed Personnel's perception toward conducting an autopsy in general hospital with autopsy at YeungNam University Medical Center, Daegu, Korea from April, to May, 2007. The total number of 286 personnel consisted of 121 men(42.3%), 165 women(57.7%). There were 57 doctors(19.9%), 71 nurses(24.8%), 83 medical technicians (29.0%), 58 office workers(20.3%), and 17 others(5.9%). 61.4% of doctors had an experience of education for autopsy more than 2 times, but nurses(1.4%), medical technicians(15.7%), office workers(1.7%), and others(5.9%) had little experience. Response of conducting an autopsy for sudden death of respondent or respondent's family member was 59.6% of doctors, 22.5% of nurses, 39.8% of medical technicians, 41.4% of office workers, and 35.3% of others. Response of conducting an autopsy for sudden death of respondent's companion was 66.7% of doctors, 33.8% of nurses, 39.8% of medical technicians, 43.1% of office workers, and 17.6% of others. Response of conducting an autopsy for sudden death of patients in general hospital was 50.9% of doctors, 8.5% of nurses, 19.3% of medical technicians, 24.1% of office workers, and 17.6% of others. Survey about a proper institution for autopsy showed 73.7% of doctors for department of forensic medicine in medical school, and 62.0% of nurses, 59.0% of medical technicians, 46.6% of office workers, and 58.8% of others for National Institute of Scientific Investigation. Most of the respondents agreed with the forensic pathologist as the director of autopsy:98.2% of doctors, 94.4% of nurses, 96.4% of medical technicians, 89.7% of office workers, and 88.2% of others. Survey for necessity for autopsy showed responsiveness of doctors, 23.9% of nurses, 47.0% of medical technicians, 34.5% of office workers, and 23.5% of others. Survey for donation of him- or herself after death to the medical school or institution for the death investigation revealed responsiveness of 22.8% of doctors, 11.3% of nurses, 24.1% of medical technicians, 22.4% of office workers, and 23.5% of others. The result of the survey questionnaire showed more negative awareness for autopsy in nurses, medical technicians, office workers, others and than doctors. To improve the negative awareness for autopsy and settle proper postmortem inspection system, education of professional manpower for forensic medicine and inaction of law which is adequate for the actual circumstance of Korea should be considered.

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Results of Segmental Resection and Reconstruction of the Trachea for Obstructive Tracheal Lesions (기관 폐쇄 병변에서 시행된 기관 절제 및 재건술에 대한 결과)

  • 김명천;박주철;조규석;유세영;김범식
    • Journal of Chest Surgery
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    • v.31 no.8
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    • pp.792-798
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    • 1998
  • Background: There are various tracheal diseseas which cause the obstruction of the trachea: postintubation tracheal stenosis, tracheal cancer, thyroid cancer, endotracheal tuberculosis, et al. Recently surgical resection and reconstruction of the trachea has been adopted as the safe method for tracheal lesions. Materials and methods: We report our experience and results of resection and reconstruction for various obstructive tracheal lesions in 38cases from 1985 to 1996. Length of resection of the trachea was up to 6 cm. Twenty lesions were approached by cervical collar incision, 12 lesions by cervicosternal incision and 4cases needed transthoracic approach. Surgical procedures consisted of resection and tracheotracheal anastomosis in 32 cases, resection and laryngotracheal anastomosis in 6cases and in addition laryngeal release was necessary to release anastomotic tension in 3cases. Results: The complications were 4 minor wound infections, 2 mild suture line granulomas, 1 vocal cord palsy, 2 pneumonias and 1 systemic candidiasis. Two patients who had poor consciousness and pnemonia and one who developed systemic candidiasis were expired after operation. Conclusion: We suggests resection and reconstruction of trachea is optimal procedure for up to 6cm long tracheal lesions. However, for the patients with poor consciousness or poor general conditions would be the conservative treatment preferred to the tracheal reconstruction because of high serious complications and mortalities.

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