• Title/Summary/Keyword: Emergency operation

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Clinical Survey of Cesarean Section (제왕절개술에 대한 임상적 고찰)

  • Kim, Jae-Wung;Lee, Young-Gi;Kim, Jong-Wook;Lee, Tae-Hyung;Park, Wan-Seok;Lee, Sung-Ho;Chung, Wun-Yong
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.249-260
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    • 1986
  • Recent reports have noted the increase of and questioned the justification for cesarean section rate in the past decade. This study was carried out retrospectively based on the clinical charts of 510 patients who had been performed cesarean section among 3,357 deliveries at Yeungnam University Hospital from May, 9, 1983 through Nov., 30, 1986. The results were as follows : 1. Overall incidence of cesarean section was 15.7% of total deliveries. Of these, 10.9% were by primary cesarean section and 4.7% by repeat operation. There has been a gradual increase in the cesarean section rate. 2. In the distribution of age, the 26-30 aged group was the most prevalent(60.2%). 3. The most common indications for cesarean section were previous cesarean section(30.2%), CPD (26.9%), Malpresentation(22.7%), and fetal distress(3.5%). In primipara, CPD was the most frequent and in multipara malpresentation. 4. A great proportion(31.6%) was done at 40th gestational week. 5. In the weight distribution of infants, the group of 3,000-3,499gm was the most prevalent(39.8%), premature baby was 9.1%, and giant baby was 5.6%. 6. In the type of operation, lower segment transverse cesarean section was the most(97.5%). 7. In the combined surgery, sterilization was the most prevalent and the next was ovarian cystectomy, hysterectomy, and myomectomy in order. 8. In the type of the anesthesia, general anesthesia was 83.5%. 9. Maternal morbidity was 14.7%. Among the causes of this morbidity, wound infection was the most and the next was urinary tract infection, fever of unknown origin, and atonic bleeding in order. 10. It was found that 18.4% was maternal morbidity in the patients below 10gm Hb. In this group, maternal morbidity was markedly increased as the level of Hb was decreased. 11. Maternal morbidity was increased as the duration of ruptured membrane was prolonged. In the group of over 24 hours after rupture of membrane, it was markedly increased(44.4%). 12. Maternal morbidity was increased as the duration of labor was prolonged. In the group of over 12 hours after the onset of labor, it was 24.6%. 13. Maternal morbity of lower segment transverse cesarean section was the least(14.1%). 14. Maternal morbidity of emergency cesarean section was about two times as much as elective cesarean section.

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Clinical Experience of the Surgical Treatment of Cardiac Tumor (심장 종양의 수술적인 치료의 임상적 고찰)

  • Bang, Jung-Hee;Woo, Jong-Soo;Choi, Pill-Jo;Cho, Gwang-Jo;Kim, Si-Ho;Park, Kwon-Jae
    • Journal of Chest Surgery
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    • v.43 no.4
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    • pp.375-380
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    • 2010
  • Background: Primary cardiac tumors are extremely rare. The most common type are benign myxomas, and these are almost completely curable with early surgery. Malignant tumors, however, such as sarcomas, are difficult to remove surgically, and their prognosis is known to be poor. In this study, data on patients who had undergone surgical treatment of cardiac tumor in the authors' hospital were collected and analyzed. Material and Method: The subjects included 28 patients who had undergone surgical treatment of cardiac tumor from August 1993 to December 2008. Their medical records were reviewed and retrospectively analyzed. Result: The patients were aged from 20 to 76 years (mean age: $54.2{\pm}15.6$), and 11 were male (39%) and 17 female (61%). Fifteen of them (54%) underwent emergency surgery to improve heart failure symptoms. The most common preoperative symptom was dyspnea (15 cases, 54%). Preoperative echocardiography was performed on all the patients. The average size of the tumor as measured during the operation was $7.0{\pm}6.9cm$ (the average length of the long axis was 2∼40 cm), and the sites of tumor attachment were the interatrial septum (18 cases, 64%), the left atrium (9 cases, 32%), the mitral valve annulus (2 cases, 7%), and the left ventricle (2 cases, 7%). The operation was performed with an incision through both atria in all the patients, and a complete excision was made in 25 cases (89%). According to the biopsy results, there were 4 cases of sarcoma (14%), 1 case of lipoma (4%), and 23 cases of myxoma (82%). The three cases in which the tumors were not completely excised were sarcomas. No operative deaths occurred after the operations. Outpatient follow-up was possible for 24 cases (86%), with a mean follow-up period of $46.8{\pm}42.7$ months. Late death occurred in 3 of the 24 patients; each of these patients had sarcomas. Of these patients, the first had undergone two repeat surgeries, the second had metastatic sites removed, and the last had only chemotherapy. The average recurrence time was $12.7{\pm}10.8$ months, and the average metastasis time was $20.5{\pm}16.8$ months. Conclusion: Most cardiac tumors are benign myxomas. In principle, they should be surgically treated because they can create risks such as embolism, and can be radically treated when surgically removed. In most cases, however, malignant sarcomas are already considerably advanced with severe infiltration into the neighboring tissues at the time of diagnosis. The surgical removal of malignant sarcomas is known to be difficult because of the advanced stage and degree of infiltration. We suggest that excision of the removable portion of the tumor sites to alleviate symptoms such as heart failure can improve quality of life.

A Study on Survey of Improvement of Non Face to Face Education focused on Professor of Disaster Management Field in COVID-19 (코로나19 상황에서 재난분야 교수자를 대상으로 한 비대면 교육의 개선에 관한 조사연구)

  • Park, Jin Chan;Beck, Min Ho
    • Journal of the Society of Disaster Information
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    • v.17 no.3
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    • pp.640-654
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    • 2021
  • Purpose: Normal education operation was difficult in the national disaster situation of Coronavirus Infection-19. Non-face-to-face education can be an alternative to face to face education, but it is not easy to provide the same level of education. In this study, the professor of disaster management field will identify problems that can occur in the overall operation and progress of non-face-to-face education and seek ways to improve non-face-to-face education. Method: Non-face-to-face real-time education was largely categorized into pre-class, in-class, post-class, and evaluation, and case studies were conducted through the professor's case studies. Result&Conclusion: The results of the survey are as follows: First, pre-class, it was worth considering providing a non-face-to-face educational place for professors, and the need for prior education on non-face-to-face educational equipment and systems was required. In addition, it seems necessary to make sure that education is operated smoothly by giving enough notice on classes and to make efforts to develop non-face-to-face education programs for practical class. Second, communication between professor and learner, and among learners can be an important factor in non-face-to-face mid classes. To this end, it is necessary to actively utilize debate-type classes to lead learners to participate in education and enhance the educational effect through constant interaction. Third, non-face-to-face post classes, policies on the protection of privacy due to video records should be prepared to protect the privacy of professors in advance, and copyright infringement on educational materials should also be considered. In addition, it is necessary to devise various methods for fair and objective evaluation. According to the results of the interview, in the contents, which are components of non-face-to-face education, non-face-to-face education requires detailed plans on the number of students, contents, and curriculum suitable for non-face-to-face education from the design of the education. In the system, it is necessary to give the professor enough time to fully learn and familiarize with the function of the program through pre-education on the program before the professor gives non-face-to-face classes, and to operate the helpdesk, which can thoroughly check the pre-examination before non-face-to-face education and quickly resolve the problem in case of a problem.

A SURVEY OF INTRAFAMILIAL CHILD SEXUAL ABUSE BY PHYSICIANS' REPORTS (의사들의 보고에 의한 근친간 아동성학대 연구)

  • Hong, Kang-E;Kang, Byung-Goo;Kwack, Young-Sook
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.2
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    • pp.138-147
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    • 1998
  • Authors surveyed intrafamilial child sexual abuse in the children under 15years old in clinical. We sent the semi-structured child sexual abuse questionnaires to 7055 board certified pediatrics, obstetrics and gynecology, family medicine and emergency medicine. Total respondents were 1205. The results from these respondents were as follows. 1) The numbers of respondents who have had the experience of treating victims of intrafamilial child sexual abuses were 157(13.0% of total respondents). 2) Among the perpetrators, 58(36.9%) were siblings and 32(20.4%) 26(16.6%) were step-fathers, and respectively. The most common age bracket was 10s(39.5%), and the next was 40s and 50s (33.7%) Almost all(98.7%) of the perpetrators were male. 3) The mean age of victims was $12.1{\pm}3.3$ years old, and all of the victims were female, and the number of victims who had previous mental or physical handicaps and behavior problems were 5(3.2%) and 8(5.1%) respectively. 4) The ways by which intrafamilial child sexual abuses were found were abnormal behaviors 45(28.7%), victim's own report 40(25.5%), pregnancy 18(11.5%), pain complaint 13(8.3%), other person's report 13(8.3%), and detection during examination 12(7.6%). 5) Time lags between intrafamilial child sexual abuses and hospital visits were after 1 month 97(61.8%), from 1 day to 1 week 29(18.5%), within 1 day 21(13.4%), and from 1 week to 1 month 10(6.4%). 6) Physical complications were perineal wound 93(59.2%), hymen rupture 90(57.3%), pregnancy 68(43.3%), wound of other part of body 11(7.0%), and sexually transmitted disease 4(4.5%). 7) Treatment for victims were discharge 92(58.6%), admission, operation or transfer to a bigger hospital 25(15.9%), psychiatry consult 19(12.1%), report to police(10.9%) and social work consult 3(1.9%). These results suggest that considerable numbers of physicians have had the experience of treating victims of intrafamilial child sexual abuses, and intrafamilial child sexual abuses are the major medical as well as social issue in children in Korea.

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Estimation of Uranium Particle Concentration in the Korean Peninsula Caused by North Korea's Uranium Enrichment Facility (북한 우라늄 농축시설로 인한 한반도에서의 공기중 우라늄 입자 농도 예측)

  • Kwak, Sung-Woo;Kang, Han-Byeol;Shin, Jung-Ki;Lee, Junghyun
    • Journal of Radiation Protection and Research
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    • v.39 no.3
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    • pp.127-133
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    • 2014
  • North Korea's uranium enrichment facility is a matter of international concern. It is of particular alarming to South Korea with regard to the security and safety of the country. This situation requires continuous monitoring of the DPRK and emergency preparedness on the part of the ROK. To assess the detectability of an undeclared uranium enrichment plant in North Korea, uranium concentrations in the air at both a short and a long distance from the enrichment facility were estimated. $UF_6$ source terms were determined by using existing information on North Korean facility and data from the operation experience of enrichment plants from other countries. Using the calculated source terms, two atmospheric dispersion models (Gaussian Plume Model and HYSPLIT models) and meteorological data were used to estimate the uranium particle concentrations from the Yongbyon enrichment facility. A maximum uranium concentration and its location are dependent upon the meteorological conditions and the height of the UF6 release point. This study showed that the maximum uranium concentration around the enrichment facility was about $1.0{\times}10^{-7}g{\cdot}m^{-3}$. The location of the maximum concentration was within about 0.4 km of the facility. It has been assumed that the uranium sample of about a few micrograms (${\mu}g$) could be obtained; and that few micrograms of uranium can be easily measured with current measurement instruments. On the contrary, a uranium concentration at a distance of more than 100 kilometers from the enrichment facility was estimated to be about $1.0{\times}10^{-13}{\sim}1.0{\times}10^{-15}g{\cdot}m^{-3}$, which is less than back-ground level. Therefore, based on the results of our paper, an air sample taken within the vicinity of the Yongbyon enrichment facility could be used to determine as to whether or not North Korea is carrying out an undeclared nuclear program. However, the air samples taken at a longer distance of a few hundred kilometers would prove difficult in detecting a clandestine nuclear activities.

A Study Security Measures for Protection of VIP in the G20 Summit (G20 정상회의 시 주(主)행사장에서의 VIP 안전대책 방안에 관한 연구)

  • Lee, Sun-Ki;Lee, Choong-Soo
    • Korean Security Journal
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    • no.24
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    • pp.91-123
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    • 2010
  • The threat factors available for occurrence given G20 Summit Meeting are expected leader terrorism, hostage terrorism, bomb terrorism, public facilities terrorism, and aircraft terrorism. As for the threat groups, which are expected in Korea, the North Korea, Islam extremist group, and the group such as NGO organization of being opposed to international meeting are regarded as having possibility of causing hazard. Thus, the purpose of this study is to suggest VIP Security-measure plans in the main site in preparation for G20 Summit Meeting. Accordingly, each country in the world is adopting 'the principle of Triple Ring' in common. Thus, it elicited a coping plan by 1st line(inner ring) 2nd line(middle ring) 3rd line(outer ring) based on this principle, and proposed even an opinion together that will need to be reflected in light of policy for the VIP security measures. In conclusion, as for the VIP Security-measure plans in the main site in preparation for G20 Summit Meeting, In the inner ring(safety sector), first, an intercepting measure needs to be devised for a spot of getting into and out of vehicles given the Straight Street. Second, the Walking Formation needs to be reinforced boldly in the exposed area. In the middle ring(security sector), first, the control plan needs to be devised by considering particularity of the main site. Second, there is necessity for adopting the efficient security badge operation plan that is included RFID function within security badge. In the outer ring(aid protective sector), first, there is necessity of preparing for several VIP terrorisms, of collecting information and intelligence, and of reinforcing the information collection system against terrorism under the cooperation with the overseas information agency. Second, the urgent measure training in time of emergency needs to be carried out toward security agent event manpower. Third, to maintain the certain pace in VIP motorcade, the efficient traffic control system needs to be operated. Finally, as for what will need to be reflected in light of policy for VIP security measures, first, there is necessity for allowing VIP residence to be efficiently dispersed to be distributed and controlled. Second, there is necessity for allowing impure element to misjudge or attack to be failed by utilizing diverse deception operations. Third, according to the reorganization in North Korea's Organization of the South Directed Operations, the powerful 'military-support measure' needs to be driven from this G20 Summit Meeting. For this, the necessity was proposed for further reinforcing the front back defense posture under the supervision of the Ministry of National Defense and for positively coping even with detecting and removing poison in preparation for CBR (chemical, biological, and radio-logical) terrorism.

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Early Results of Coronary Artery Bypass Graft with Purely Bilateral Internal Thoracic Arteries Using Y-anastomosis in Multiple Coronary Artery Disease Patients: Coronary Angiographic Analysis (다중혈관 관상동맥 환자에서 Y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적: 관상동맥 조영술 분석)

  • 성기익;이영탁;박계현;전태국;박표원;한일용;장윤희
    • Journal of Chest Surgery
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    • v.36 no.3
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    • pp.142-149
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    • 2003
  • To know the feasibility of the coronary artery bypass graft (CABG) for multivessel coronary artery disease with purely bilateral internal thoracic arteries (ITAs), we analyzed the short-term clinical results and the coronary angiography of the patients. Material and Method: From March 2001 to June 2002, four hundred and five patients underwent CABG. Purely bilateral ITAs were used in 159 patients (39.3%). We analyzed these patients retrospectively The mean age of these patients was $61.2{\pm}8.5$ (range: 30 ~80) years and there were 123 male patients. The preoperative risk factors were as follows: diabetes in 54 patients (34.0%), history of acute myocardiac infarction within 4 weeks in 29 (18.2%), and emergency operation in 6 (3.8%). Off-pump CABG was carried out in 128 patients (80.5%). Associated procedures were mitral valvuloplasty (5), aortic valve replacement (3), Dor procedure (1), and so on. Result: The mean number of distal anastomoses was $3.1{\pm}0.9$ (range: 2~6), the mean duration of hospital stay was $8.4{\pm}4.5$ days. There was one (0.6%) operative death. Except for one early death, no other patients suffered from low cardiac output. The other postoperative complications were occurred as follows: reoperation due to bleeding in 3 patients, perioperative myocardiac infarction in 1, transient cardiac arrest in 2, transient cognitive dysfunction in 7, and transient ischemic attack in 1, and deep sternal wound infection in 1 patient. Recently, early postoperative angiography was performed in 19 patients who had triple vessel disease. The total number of distal anastomosis was 78 (mean $4.1{\pm}0.8$/patient). All distal anastomosis sites were patent, but competition flow was observed at the bypass sites where the native coronary artery stenosis was not significant. Conclusion: The CABG with purely bilateral ITAs for triple vessel disease was performed safely. The early patency rate was relatively good in small number of patients. However the long-term patency rate and the functional study to evaluate the sites where competition flow was observed should be followed.

Earthquake Monitoring : Future Strategy (지진관측 : 미래 발전 전략)

  • Chi, Heon-Cheol;Park, Jung-Ho;Kim, Geun-Young;Shin, Jin-Soo;Shin, In-Cheul;Lim, In-Seub;Jeong, Byung-Sun;Sheen, Dong-Hoon
    • Geophysics and Geophysical Exploration
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    • v.13 no.3
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    • pp.268-276
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    • 2010
  • Earthquake Hazard Mitigation Law was activated into force on March 2009. By the law, the obligation to monitor the effect of earthquake on the facilities was extended to many organizations such as gas company and local governments. Based on the estimation of National Emergency Management Agency (NEMA), the number of free-surface acceleration stations would be expanded to more than 400. The advent of internet protocol and the more simplified operation have allowed the quick and easy installation of seismic stations. In addition, the dynamic range of seismic instruments has been continuously improved enough to evaluate damage intensity and to alert alarm directly for earthquake hazard mitigation. For direct visualization of damage intensity and area, Real Time Intensity COlor Mapping (RTICOM) is explained in detail. RTICOM would be used to retrieve the essential information for damage evaluation, Peak Ground Acceleration (PGA). Destructive earthquake damage is usually due to surface waves which just follow S wave. The peak amplitude of surface wave would be pre-estimated from the amplitude and frequency content of first arrival P wave. Earthquake Early Warning (EEW) system is conventionally defined to estimate local magnitude from P wave. The status of EEW is reviewed and the application of EEW to Odesan earthquake is exampled with ShakeMap in order to make clear its appearance. In the sense of rapidity, the earthquake announcement of Korea Meteorological Agency (KMA) might be dramatically improved by the adaption of EEW. In order to realize hazard mitigation, EEW should be applied to the local crucial facilities such as nuclear power plants and fragile semi-conduct plant. The distributed EEW is introduced with the application example of Uljin earthquake. Not only Nation-wide but also locally distributed EEW applications, all relevant information is needed to be shared in real time. The plan of extension of Korea Integrated Seismic System (KISS) is briefly explained in order to future cooperation of data sharing and utilization.

Consideration of Shoulder Joint's Image with the Changed Tube Angle of the Shoulder Oblique Projection in Supine Position (Supine 자세에서 Shoulder oblique촬영시 Tube angle 변화에 따른 Shoulder joint에 대한 고찰)

  • Seo, Jae-Hyun;Choi, Nam-Gil
    • Journal of radiological science and technology
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    • v.31 no.2
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    • pp.109-114
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    • 2008
  • There is a standard shoulder oblique method (Grashey method) available to view the shoulder joint. This method projects AP view of the shoulder joint so that the Humerus head's subuxation or joint degeneration can be easily visualized. However, in this view, the patients, with supine or sitting or erect position, have to keep their body obliquely. Whereas, the patients who are not well or operated, usually feel very uncomfortable to keep their body in this position and hence, we need other persons' help and much efforts will be needed to get the good quality shoulder joint view. Therefore, we thought of examining a method which shows the joint well by angling the tube to Medio-Lateral direction and without keeping the patients' one side upward in supine position. For this study, total 15 subjects with no history of neurological or psychiatric illness, were recruited for examinations. They consisted of 9 males and 6 females. Statistic group analysis was performed with ANOVA test. Scores of the evaluation of the experts were $1.10{\pm}0.54$ at $25^{\circ}$, $2.50{\pm}0.50$ at 30^{\circ}$, $2.85{\pm}0.36$ at $35^{\circ}$ and $2.33{\pm}0.47$ at $40^{\circ}$, respectively, and they were significant(p<0.05, Table 1). Joint space of the Humerus head and Scapula were well distinguished at $35^{\circ}$, $30^{\circ}$ and $40^{\circ}$ with the almost same score. However, the degree of distortion at $40^{\circ}$ was more severe than that at $30^{\circ}$. Ultimately, $30-35^{\circ}$ views were shown to yield good quality shoulder oblique images. In conclusion, this method may be very useful for the patients who are uncomfortable and for the emergency patients. In order to get similar or comparable view, the same X-tube angle is recommended to be used before and after the operation. Therefore, we hope that this new angled method seems to be efficient.

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Management of Vascular Injuries to the Extremities after Trauma (외상 후 사지 혈관손상의 치료)

  • Kim, Han Yong;Park, Jae Hong;Kim, Myoung Young;Hwang, Sang Won
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.46-52
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    • 2009
  • Background: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. Material and Method: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. Result: There were 38 men and 5 women patients with a mean age of $42.0{\pm}16.8$ years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was $319.0{\pm}482.2$ minutes (range: 27~2,400 minutes). The average time from admission to discharge was $53.1{\pm}56.0$ days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively. Conclusion: Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.