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Yim, Haejun,Woo, Heungjeong,Song, Wonkeun,Park, Min-Jeong,Kim, Hyun Soo,Lee, Kyu Man,Hur, Jun,Park, Man-Seung Institute for Clinical Science] 2011 Annals of clinical and laboratory science Vol.41 No.1
<P>This study evaluated the activity of tigecycline combined with imipenem, amikacin, and ciprofloxacin against clinical isolates of multidrug-resistant Klebsiella pneumoniae and Escherichia coli co-producing extended-spectrum 관-lactamases and acquired AmpC 관-lactamases. Broth microdilution tests were performed for cefotaxime, ceftazidime, cefepime, imipenem, amikacin, ciprofloxacin, and tigecycline. Time-kill synergy studies were tested for tigecycline plus imipenem, tigecycline plus amikacin, and tigecycline plus ciprofloxacin. Imipenem (MIC(90) = 1 관g/ml for both K. pneumoniae and E. coli) and tigecycline (MIC(90) = 2 관g/ml for K. pneumoniae and 1 관g/ml for E. coli) were the most potent agents. Combination studies with tigecycline plus imipenem resulted in synergy against 18 K. pneumoniae and 3 E. coli isolates; tigecycline plus amikacin yielded synergy against 8 K. pneumoniae and 3 E. coli isolates; tigecycline plus ciprofloxacin yielded synergy against 7 K. pneumoniae and 2 E. coli isolates. No antagonism was observed with any combination. In the present study, imipenem, amikacin, and ciprofloxacin led to indifferent and some synergistic effects in combination with tigecycline, and none of them demonstrated antagonistic effects.</P>
A Clinical Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Haejun Yim,Jin Mo Park,Yong Suk Cho,Dohern Kim,Jun Hur,Wook Chun,Jong Hyun Kim,Dong Kook Seo 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.3
Purpose: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), potentially life-threatening skin diseases with organ failures caused by drugs, require specialized intensive care. However, SJS and TEN have usually been managed in general wards and intensive care units by most doctors. This study describes the efficacy of treatment in the burn intensive care unit (BICU) compared to previous general treatments. Methods: To investigate the clinical features, outcomes and benefits of 11 patients with SJS and TEN treated in our burn intensive care unit. Data on 11 patients who were treated between January 2004 and December 2008 were collected via a retrospective chart review. Also, the data were reviewed with previous literatures on SJS and TEN treatments. Results: Patients were classified with overlap SJS/TEN (n=4, 36.36%) or TEN (n=7, 63.64%). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common causative agents. Hepatitis was the most common organ involvement in both overlap SJS/TEN (n=1, 9.1%) and TEN (n=4, 36.36%). Renal dysfunction (n=4, 36.36%) and respiratory disorders (n=3, 27.27%) were seen in some cases. Mean time of total reepithelization was 9 days and mean hospital day was 14.66 days. Two patients with TEN died from sepsis with multi-organ failure, and the mortality rate was 18.18%. Conclusion: Adequate treatment of SJS and TEN in the BICU supports efficacy with a low mortality rate, short healing time, short hospitalization and fewer complications.
2-2 ; Clinical Significance of Serum Transthyretin Level in Massively Burn Patients
( Hyeong Tae Yang ),( Haejun Yim ),( Young Suk Cho ),( Do Hern Kim ),( Jun Hur ),( Wook Chun ),( Jong Hyun Kim ) 한국정맥경장영양학회 2012 한국정맥경장영양학회 학술대회집 Vol.2012 No.-
Purpose: The purpose of this study is to analyze the correlation of serum transthyretin level with nutritional support and investigate the clinical significance of serum TTR level through comparing with other markers that reflect the clinical severity in massively burned patient. Materials and Methods: From September of 2010 to March of 2012, total of 158 patients who admitted with burn wound greater than 20% of total body surface area were reviewed retrospectively. Serum transthyretin, C-reactive protein, base excess, lactic acid and NST index (calculated by division of real caloric intake with estimated caloric need) was analyzed each week until 5 weeks from admission with correlation analysis and logistic regression. Results: In every week, there was a significant difference in serum transthyretin, base excess and lactic acid level between survivors and non-survivors on each week. However, CRP and NST index did not have significant differences between survivors and non-survivors in any week. TTR was only significantly correlated with base excess positively (c=0.344, p<0.01) and lactic acid negatively(c=.0.244, p<0.01) in total patient. But TTR had no correlation with CRP and NST index. In multivariate regression analysis, TBSA burned, TTR, base excess and lactic acid had an independent association with mortality. But CRP and NST index were not independently associated with mortality. Conclusion: Serum transthyretin level is associated with clinical severity rather than nutritional status in massively burn patients.
Investigation of relationship between inhalation injury assessment and prognosis in burn patients
Hyeong Tae Yang,Haejun Yim,Young Suk Cho,Dohern Kim,Jun Hur,Wook Chun,Jong Hyun Kim,So Young Jung,ByungChun Kim,Jae Jung Lee 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.1
Purpose: Inhalation injury is one of the most severe morbidity and mortality factors in burn patients. The purpose of this study is to analyze the impact of inhalation injury to the prognosis of burn patients and to investigate the relationship between the inhalation injury assessment and the prognosis of patients. Methods: Bronchoscopy was performed in 170 patients who had the suspicion of inhalation injury and the patients were reviewed retrospectively from January 2008 to December 2009. Mortality was compared between the factors of brochoscopic findings, age, total body surface area (TBSA) burned, carboxyhemoglobin (COHb) level, PaO2/FiO2 (P/F) ratio. Results: Of 170 patients, 28 patients had no inhalation bronchoscopic finding. 109 patients had mild inhalation, 31 patients had moderate inhalation, only 2 patients had severe inhalation findings. The patients of moderate and severe inhalation findings had higher mortality (48.5%) than mild inhalation patients (31.1%). The larger total burnsurface area in inhalation patients, the greater the mortality. When compared to total admitted burn patients during the same period, inhalation patients showed higher mortality in the patients between 10 to 40% total burn surface area. Inhalation patients whose P/F ratio was below 300 showed higher mortality than above 300. But inhalation patients whose COHb level was below 1.5 had no difference in mortality with patients above 1.5. The COHb level and P/F ratio was the statistically different factors between inhalation patients and non-inhalation group in the mortality. Conclusion: Bronchoscopic findings, age, TBSA burned, P/F ratio were related with mortality in inhalation patients. When the international standardization of bronchoscopic classification developed, it can be possible to assess the inhalation patients more objectively and that will lead to the advancement in inhalation treatment and research.
Evaluation of diagnostic biomarkers for acute kidney injury in major burn patients
Dohern Kym,Yong-Suk Cho,Jaechul Yoon,Haejun Yim,Hyeong-Tae Yang 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.88 No.5
Purpose: Acute kidney injury (AKI) in major burn patients is a common complication with high morbidity and mortality. The mainstream treatment is early diagnosis and rapid termination and prevention of the underlying insult. Therefore, it’s essential to identify early biomarkers predicting AKI. Methods: A total of 85 patients who were admitted to the burn intensive care unit from June 2012 to July 2013 were included in this prospective cohort study. Ten biomarkers (blood urea nitrogen, serum creatinine, urine creatinine, cystatin C, cystatin C glomerular filtration rate, AST, lacate dehydrogenase [LD], creatine kinase, lactic acid, and myoglobin) were obtained at time of admission and evaluated as diagnostic biomarkers to predicting AKI and early AKI. Results: Out of 85 patients, 35 patients were dead and overall mortality was 41.2%. The mean age was 49.4 years and mean percentage of total body surface area was 53.2%. Area under the curve (AUC) of receiver operating characteristic curve of biomarkers on predicting AKI were 0.746, 0.718, and 0.717 in LD, lactic acid, and serum creatinine, respectively. AUC of cystatin C predicting AKI was much lower at 0.555. AUC of biomarkers on predicting early AKI were 0.833, 0.816, 0.790, and 0.759 in LD, serum creatinine, AST, and serum myoglobin. Conclusion: LD, lactic acid and serum creatinine were acceptable as diagnostic biomarkers of AKI and LD, serum creatinine, AST, and serum myoglobin were reasonable as diagnostic biomarkers of early AKI. However, cystatin C was an unfavorable biomarker in major burn patients.
조용석(Yong Suk Cho),임해준(Haejun Yim),김도헌(Dohern Kim),허준(Jun Hur),전욱(Wook Chun),김종현(Jong Hyun Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.6
Central diabetes insipidus (DI) is caused by failure of ADH release from the posterior pituitary gland. Common causes of central DI in critically ill patients include traumatic brain injury, anoxic encephalopathy, meningitis, primary or metastatic brain tumor and brain death. Inhalation burn injury with thermal injury can cause profound brain damage according to the degree of gas inhalation. This results in pituitary failure with diabetes insipidus (DI) and secondary adrenal insufficiency. We recently experienced 3 cases of central diabetes insipidus with inhalation burn injury, aggravated polyuria and abnormal serum or urine osmolarity. Severe burn injury is not easy to treat in and of itself, moreover, if central diabetes insipidus is combined it is difficult to manage appropriately. Therefore, if we suspected central diabetes insipidus, early aggressive control would lower mortality and morbidity. We report therapeutic experience in these cases with a review of the literature.
Necrotizing Fasciitis Following a Small Burn
Yong Suk Cho,Hyeong Tae Yang,Haejun Yim,Jin Mo Park,Dohern Kim,Jun Hur,Jong Hyun Kim,Wook Chun 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.1
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that manifests with a rapid course of inflammation and necrosis of the skin, subcutaneous fat, and fascia. NF commonly follows trauma to the skin, such as a laceration, scratch or insect bite. NF is a surgical emergency and requires both a high index of suspicion for diagnosis and prompt operative intervention. Early aggressive surgical intervention is important for improving survival rates. Mortality and morbidity can be decreased with early diagnosis, adequate and urgent surgical debridement, intensive supportive care, and wound resurfacing. Recently, we experienced a case of NF secondary to a third-degree contact burn on the dorsum of the right foot (1% body area). We report our therapeutic experience in this case, with a review of the literature.