Effect of a Single Tetanus Toxoid in Korean Adults with Low Tetanus Antibody Titers

Purpose: The determination of tetanus prophylaxis according to patients’ memories of past immunization is inaccurate. However, by using the Tetanos Quick StickⓇ test, it is possible to select Korean adults with low tetanus antibody titers and to perform tetanus prophylaxis in the emergency department. In 1996, Ha reported that tetanus toxoid injection into healthy Korean adults revealed significant differences between the tetanus antibody titers at the beginning and the tetanus antibody titers after 1 week. Our purpose is to determine the effect of a single tetanus toxoid in Korean adults with low tetanus antibody titers. Methods: Blood samples were taken from 44 volunteers for a period of 6 weeks. All samples were analyzed using the Tetanus IgG ELISA (enzyme-linked immunosorbent assay) method. Results: The results for tetanus antibody titers at the beginning and after 1 week, 2 weeks, 4 weeks, and 6 weeks were 0.04+/-0.05 IU/mL, 1.22+/-3.63 IU/mL, 4.99+/-7.3 6 IU/mL, 8.36+/-11.10 IU/mL and 6.59+/-9.21 IU/mL respectively. There was a statistically significant defference between the tetanus antibody titers at the beginning and the tetanus antibody titers after 2 weeks. There was no statistically significant defference between the tetanus antibody titers after 2 weeks and 6 weeks. After 4 weeks, all subjects’ tetanus antibody titers were at the protective level. Conclusion: A single tetanus toxoid injection is effective in Korean adults with low tetanus antibody titers.ope

Effect of a single tetanus toxoid in Korean adults with low tetanus antibody titers

의과학/박사[한글] 파상풍은 치사율 및 합병증이 높은 질환이나 파상풍 톡소이드 접종을 통해 예방 가능한 질환이다. 2004년도부터 국내에도 파상풍 톡소이드가 시판되기 시작함에 따라 예방접종이 가능하게 되었다. 기존의 파상풍 예방처치 지침은 상처의 상태와 파상풍 톡소이드 접종력에 따라 통해 파상풍 예방처치를 시행할 것을 권고하고 있다. 그러나 많은 연구자들이 백신 접종을 환자의 기억에 따라 시행하는 것은 부정확하다고 보고하고 있다. 이러한 문제점을 극복할 수 있는 방안으로 2004년 윤 등은 최근에 개발된 Tetanos Quick Stick？ 키트를 이용하면 항체 역가가 낮은 성인만을 선별해 파상풍 예방 처치를 할 수 있다고 보고한 바 있다. 그러나 항체 역가가 낮은 한국 성인에게 파상풍 톡소이드를 1회 접종할 경우 어느 정도 효과가 있는지는 밝혀져 있지 않다. 따라서 본 연구는 파상풍 항체 역가가 떨어져 있는 성인만을 선별하여 파상풍 톡소이드 1회 접종의 효과를 알아보고자 하였다.총 44명에게 파상풍 톡소이드를 접종하고 파상풍 항체의 상승 양상을 분석하였다. 2주 후부터 통계적으로 유의하게 파상풍 항체가 상승했으며, 4주 째 44명 모두 안전한 방어 항체 역가에 도달하였다. 44명중 65세 이상인 8명만을 다시 분석한 결과에서도 파상풍 항체의 유의한 변화가 있었다.결론적으로 파상풍 항체 역가가 낮은 한국 성인에서도 파상풍 톡소이드의 1회 접종은 유효한 것으로 판단된다. [영문]Tetanus is a serious health concern in many countries. It is well known that, although this disease has a high mortality rate, it can be easily prevented with appropriate prophylaxis. The determination of tetanus prophylaxis according to patients'memories of past immunization is inaccurate. However by using the Tetanos Quick Stick？ test, it would be possible to select Korean adults with low tetanus antibody titers and perform tetanus prophylaxis in the emergency department.In 1996, Ha reported that tetanus toxoid injection into healthy Korean adults revealed significant differences between the tetanus antibody titers at the beginning and the tetanus antibody titers after 1 week. Our purpose is to find out the effect of a single tetanus toxoid in Korean adults with low tetanus antibody titers.Blood samples were taken from 44 volunteers for a period of 6 weeks. All samples were analyzed with Tetanus IgG ELISA (enzyme-linked immunosorbent assay) method. The results of tetanus antibody titers at the beginning, after 1 week, 2 weeks, 4 weeks and 6 weeks were 0.04±0.05 IU/mL, 1.22±3.63 IU/mL, 4.99±7.36 IU/mL, 8.36±11.10 IU/mL and 6.59±9.21 IU/mL respectively. There was a statistical significance between the tetanus antibody titers at the beginning and the tetanus antibody titers after 2 weeks. There was no statistical significance between the tetanus antibody titers after 2 weeks and 6 weeks. After 4 weeks, all subjects' tetanus antibody titers came to the protective level. In conclusion, a single tetanus toxoid injection is effective in Korean adults with low tetanus antibody titers.ope

Web-based Distributed Lean Construction Information System;Development of System Prototype

건설생산성의 혁신적 향상을 지향하는 린건설(Lean Construction) 구현을 위해 가장 시급히 개선되어야 할 사항은 건설생산 프로세스의 개선과 건설정보의 신뢰성 향상으로 정의될 수 있다. 본 연구에서는 건설생산 프로세스 중 설계/시공단계에서의 개선사항을 설계관리, 자재조달관리, 공정관리 측면에서 도출하고, 각 단계에서 도출된 개선사항을 웹기반 정보시스템으로 실현하여 건설산업 종사자들에게 필요한 정보와 지식을 제공하고자 웹 기반 분산형 건설정보 시스템을 개발하고자 한다. 이를 위해 건설생산 프로세스 각 단계에서의 주요 문제점을 파악하여 개선모델 및 요소기술을 제시하고, 모델의 구현을 위한 시스템 프로토타입을 개발하였다. 설계/자재조달/공정 관리지원 시스템은 웹 기반의 지식관리 시스템을 중심으로의 통합을 추진할 예정이다. To reform and improve the productivity of construction industry, 1) it should be encouraged to improve the construction production process and 2) it is required to enhance reliability of construction information based on the systematic thinking process. To promote the information reliability created during construction production process, Lean Construction Research Center(LRC2) is developing a supporting system to improve design/material supply/schedule management, functioning to efficiently manage the information created at construction production processes and developing a web based construction information system that provides result management/decision making support/knowledge based information services.본 연구는 건설교통부가 출연하고 한국건설교통기술평가원에서 위탁 시행한 2005년도 건설기술혁신사업(과제번호: 05 기반구축D05-01)의 지원으로 이루어졌음

The Effect of Witness` Behavior on the Collapse to ED time Interval in out-of-hospital Cardiac Arrest

Purpose: The collapse-to-advanced life support (ALS) time interval is the most important factor for the survival of and the prognosis for patients suffering from out-of-hospital cardiac arrest. A witness is the key person who decides first response, the mode of transportation, and the activation of the emergency medical service (EMS). Accordingly, the time interval to ED arrival and ALS is mostly influenced by the witness factor. We analyzed the influence of the witness factor and examined how to reduce the collapse-to-ED time interval for cases of out-of-hospital cardiac arrest. Methods: We retrospectively reviewed 174 out-of-hospital cardiac arrest cases that occurred during a 1-year period. Then, we compared the time to call the EMS and the time to the ED arrival according to the witness’ type, the first response, the first place called and the mode of transportation to the ED. Results: The median time to call the EMS and time to ED arrival were 5 (0~30) and 55 (28~120) minutes, respectively. There was a statistically significant correlation between the time to call the EMS and the time to ED arrival. Family/Cohabitant comprised most (80.5%) of the witness and they had a statistically significant delay in the time to call the EMS and the time to ED arrival than other groups. The time to ED arrival was significantly longer for the group who contacted relatives as the first response than it was for other groups who called the EMS or directly transported the victim to the hospital. Among the first places called, the time to call the EMS and the time to ED arrival were significantly shorter for the witness group who called 119 first. As for the mode of transportation, the private ambulance group showed a significant delay in time to ED arrival compared to the 119 ambulance group and other groups. The victims who underwent CPR in the ED had significantly shorter times to call the EMS and to ED arrival than the other victims. Conclusion: The collapse-to-ED time interval was influenced mainly by the witness. The type of witness, the first response, and the first place called were significant factors that influenced the time to call the EMS and time to ED arrival. To improve the survival rate and the prognosis for out-of-hospital cardiac arrest victims, we need more education for people who might be witnesses of such an event.ope

Pneumomediastinum Secondary to an Open Mandible Fracture

Pneumomediastinum can result from fractures involving paranasal sinuses, orbits, mandibles, other facial bones. This is a case report of an 25-year-old man who fell from a third floor. He suffered injuries to the maxillofacial region. Initial examination revealed a mandibular complex fracture and tooth loss, but the man developed neck swelling, dyspnea, and dysphagia over the next 3 days. Repeat examination revealed marked pneumomediastinum and subcutaneous emphysema.ope

An Imperforate Hymen with Lower Abdominal Pain and Acute Urinary Retention -A case report-

A 13-year-old girl was transferred from a private clinic to our emergency department due to lower abdominal pain and acute urinary retention. Radiologic evaluation showed an imperforate hymen with hematocolpometra. In the emergency department, an imperforate hymen is a rare cause of acute urinary retention. Usually, the diagnosis of a congenital inperforate hymen can be made by inspection of the perineum; however, in many cases, an extensive radiologic evaluation must be performed because of misdiagnosis. The emergency physician should consider an imperforate hymen in girls with lower abdominal pain and urinary retention.ope

Psychiatric Follow-up after ED Discharge in Cases of Intentional Poisoning

Purpose: Many patients who intentionally poison themselves are reported to have underlying mental problems and to repeat the attempted suicidal poisoning. As a first step to prevent this regretful complication, we looked into the present status of psychiatric follow-up of the patients who intentionally poisoned themselves. Methods: Using a chart review and telephone contact, we analyzed the psychiatric follow-up rate, the underlying psychiatric illness, the number of suicidal attempts, and the reasons for no follow-up for adult patients who intentionally poisoned themselves and who visited the Emergency Department of Severance Hospital from Mar. 2003 to Feb. 2004 with chart review, telephone contact. Results: Forty-nine of 119 suicide patients (41.2%) chose poisoning as a means of suicide. The results of emergency treatment of those 119 patients were 4 deaths during treatment, 36 admissions (15 psychiatry, 21 others), and 79 discharges including 5 transfers. The most common underlying psychiatric problem based on 103 initial psychiatric interviews was depressive disorder in 52(50.5%) patients. Not counting the 19 deaths and psychiatry admissions, 26 patients received psychiatric follow-up during admission or after discharge, and the remaining 74 patients were subjected to telephone surveys. In the telephone surveys, only 53 patients were contacted; 25 patients declined to answer the questions and out of the 28 patients who answered them, 5 patients had received psychiatric follow-up at other hospitals. The most common reason given by the other 23 patients for no follow-up was that it was not necessary (39.1%, 9/23). The overall follow-up rate was 39.2% (31/79). Of the 48 patients who answered the question on repeated suicide attempts, 3 patients had repeatedly attempted suicide. Conclusion: To prevent further suicide attempts and resultant deaths in cases of patients who intentionally poisoned themselves, we urgently need an integrated psychiatric follow- up care program that is activated through a collaborative effort before discharge from the emergency department.ope

Utility of Tetanos Quick Stick？ Test for Selective Tetanus Prophylaxis

Purpose: Tetanus is still one kind of major health problem in many countries, so tetanus prophylaxis is very important. However medical interview and wound description are not always enough to determine the tetanus prophylaxis. Thus, we assessed the utility of Tetanos Quick Sticky test for selective tetanus prophylaxis in the emergency department. Methods: From September 17, 2003,to October 4, 2003, 180 patients were studied for 14 days. Tetanos Quick Stick 8 and EUSA (enzyme-linked mmunosorbent assay) were performed with 180 samples from 180 patients. Results: The Tetanos Quick Sticks had a sensitivity of 79,6%a, a specificity of 99.2%, a positive predictive value of 97.7 %, a negative predictive value of 91.9%, and an accuracy of 93.3%. Conclusion: The results of our study revealed that the Tetanos Quick Sticks test is useful for selective tetanus prophylaxis in the emergency department.ope

Construction Process based Schedule Risk Management System

건설공사의 성공적인 수행을 위한 다양한 건설관리기법들 중 리스크관리기법은 프로젝트 규모의 대형화, 신공법 적용 등에 의한 불확실한 요인의 증가에 의해 그 중요성이 부각되고 있다. 따라서 본 연구에서는 현장실무자들의 공정리스크 관리 업무를 지원하기 위해 공종별 공사프로세스 중심의 공정리스크 확인방법과 현장별 특성이 반영된 공정리스크 중요도 지수를 개발하였으며, 향후 타 현장에서의 적용을 고려한 공정 리스크 중요도 보정방법을 제안하였다. 또한 공정리스크 요인별 대응방안을 현장에서 공사일정에 따라 검색하고, 공정정보와 연계된 공정리스크 관리 업무의 출력기능을 갖춘 공정 리스크 관리지원 시스템 프로토타입을 개발하였다. 공정리스크 관리지원 시스템은 건설현장 실무자들이 공정리스크 관리업무를 수행하는 데 필요한 지식을 제공하여, 의사결정지연에 따른 공기 지연을 방지할 수 있을 것으로 기대된다. In order to achieve the best performance of a project, uncertainties involved in the building construction process need to be identified in the planning phase of the project. Risk management plays a significant role in construction to minimize risk occurred due to uncertainties of a project. Although the importance of the risk management has been known to the construction industry, a more effective system should be developed to meet the demands of the industry. The purpose of this study is to develop the effective risk management system for scheduling the construction processes. The study provides a tool that can optimize the management system which would assist managers to identify schedule risks in the planning phase of the project.본 연구는 건설교통부가 출연하고 한국건설교통기술평가원에서 위탁시행한 건설기술혁신사업(05기반구축D05-01)연구의 지원을 받아 수행한 결과의 일부임

A Case of Streptococcal Toxic Shock Syndrome with Myonecrosis due toGroup A β-hemolytic Streptococcus

Streptococcal toxic shock syndrome with myonecrosis is a rapidly progressive process that kills 80% of patients in 72-96 h. Various bullae, hypotension, fever, and evidence of organ failure are late clinical manifestations. The symptoms and signs of myonecrosis can be nonspecific and misleading, not clearly revealing the involvement of deep skeletal muscle. Thus, the challenge to clinicians is to make an early diagnosis and to intervene with aggressive fluid replacement, emergent surgical debridement, and general supportive measures. We describe an presentation of myonecrosis of the lower extremities secondary to group A beta-hemolytic streptococcus infection in a 21-years-old woman. In addition, the patient had no history or evidence of trauma to the affected area.ope