Do Clinical Manifestations Influence the Efficiency of Computed Tomography and Ultrasonography in Diagnosing Acute Appendicitis?

천성빈,조준휘,오원섭,이승준,전용환,박찬우,문중범 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.4

Purpose: Radiological readings of possible or suspicious appendicitis are often unhelpful for clinicians, and normal readings may be misleading if the patient has appendicitis. We conducted a retrospective study to determine whether the efficiency of computed tomography (CT) or ultrasonography (USG) in diagnosing acute appendicitis is altered by clinical manifestations. Methods: Data were collected from all the pathologicallyproven acute appendicitis patients who underwent CT or USG and subsequently had appendectomy between January 2009 and March 2010 at Kangwon National University Hospital. We classified radiological findings of “compatible with” and “probable” appendicitis as “highly efficient”and “possible” or “suspicious” appendicitis and “normal appendix” as “less efficient.” The following clinical manifestations were included: duration of the chief complaint prior to performing CT or USG, right lower quadrant pain, pain migration, body temperature, abdominal tenderness,rebound tenderness, muscle guarding, wall rigidity,white blood cell count, percentage of polymorphonuclear cells, and C-reactive protein level. Results: A total of 202 patients underwent appendectomies after imaging studies (37.2±20.3-years-of-age; male-tofemale ratio, 1.08). Of these, 154(76.2%) received CT, 44(21.8%) received USG, and four (2.0%) received magnetic resonance imaging. Radiological findings were highly efficient in 155 cases (76.7%) but less efficient in 47 cases (23.3%). Multiple logistic regression analysis demonstrated that the absence of pain migration was related to less efficient results (adjusted odds ratio, 3.26; 95% confidence interval, 1.16-9.12). Conclusion: The ‘efficient’ sensitivity of CT or USG in diagnosing acute appendicitis is low in the absence of a history of pain migration.

A simple and novel equation to estimate the degree of bleeding in haemorrhagic shock: mathematical derivation and preliminary in vivo validation

천성빈,Min Ji Lee,오원섭,박예진,권중명,김규석 대한약리학회 2022 The Korean Journal of Physiology & Pharmacology Vol.26 No.3

Determining blood loss [100% – RBV (%)] is challenging in the management of haemorrhagic shock. We derived an equation estimating RBV (%) via serial haematocrits (Hct1, Hct2) by fixing infused crystalloid fluid volume (N) as [0.015 × body weight (g)]. Then, we validated it in vivo. Mathematically, the following estimation equation was derived: RBV (%) = 24k / [(Hct1 / Hct2) – 1]. For validation, nonongoing haemorrhagic shock was induced in Sprague–Dawley rats by withdrawing 20.0%–60.0% of their total blood volume (TBV) in 5.0% intervals (n = 9). Hct1 was checked after 10 min and normal saline N cc was infused over 10 min. Hct2 was checked five minutes later. We applied a linear equation to explain RBV (%) with 1 / [(Hct1 / Hct2) – 1]. Seven rats losing 30.0%–60.0% of their TBV suffered shock persistently. For them, RBV (%) was updated as 5.67 / [(Hct1 / Hct2) – 1] + 32.8 (95% confidence interval [CI] of the slope: 3.14–8.21, p = 0.002, R2 = 0.87). On a Bland-Altman plot, the difference between the estimated and actual RBV was 0.00 ± 4.03%; the 95% CIs of the limits of agreements were included within the pre-determined criterion of validation (< 20%). For rats suffering from persistent, non-ongoing haemorrhagic shock, we derived and validated a simple equation estimating RBV (%). This enables the calculation of blood loss via information on serial haematocrits under a fixed N. Clinical validation is required before utilisation for emergency care of haemorrhagic shock.

침투성 동맥경화성 궤양: 종격동 확장증에서 주의할 또 다른 감별진단

천성빈,조준휘,박찬우,이길수 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.5

A widened mediastinum is not always caused by aortic dissection,which is the default diagnosis among emergency physicians. Other acute aortic syndromes should be included in differential diagnosis, such as penetrating atherosclerotic ulcer (PAU), intraluminal hematoma, aneurismal leak, and traumatic transection. When an ulcerative lesion is found in the atherosclerotic aorta, especially the descending aorta of an elderly, PAU should be considered as the possible cause of widened mediastinum. We present a case of PAU, the diagnosis of which was delayed without the knowledge of PAU even though thoracic computed tomography showed widened mediastinum and suspious pericardial effusion.

Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography

천성빈,오원섭,조준휘,김삼수,이승준 대한의학회 2011 Journal of Korean medical science Vol.26 No.11

Cardiothoracic ratio (CTR), the ratio of cardiac diameter (CD) to thoracic diameter (TD), is a useful screening method to detect cardiomegaly, but is reliable only on posteroanterior chest radiography (chest PA). We performed this cross-sectional 3-phase study to establish reliable CTR from anteroposterior chest radiography (chest AP). First, CD_Chest PA/CD_Chest AP ratios were determined at different radiation distances by manipulating chest computed tomography to simulate chest PA and AP. CD_Chest PA was inferred from multiplying CD_Chest AP by this ratio. Incorporating this CD and substituting the most recent TD_Chest PA, we calculated the ‘corrected’ CTR and compared it with the conventional one in patients who took both the chest radiographies. Finally, its validity was investigated among the critically ill patients who performed portable chest AP. CD_Chest PA/CD_Chest AP ratio was {0.00099 × (radiation distance [cm])} + 0.79 (n = 61, r = 1.00, P < 0.001). The corrected CTR was highly correlated with the conventional one (n = 34, difference: 0.00016 ± 0.029; r = 0.92,P < 0.001). It was higher in congestive than non-congestive patients (0.53 ± 0.085;n = 38 vs 0.49 ± 0.061; n = 46, P = 0.006). Its sensitivity and specificity was 61% and 54%. In summary, reliable CTR can be calculated from chest AP with an available previous chest PA. This might help physicians detect congestive cardiomegaly for patients undergoing portable chest AP.

Search for Structural Cardiac Abnormalities Following Sudden Cardiac Arrest Using Post-mortem Echocardiography in the Emergency Department: A Preliminary Study

천성빈,신상도,조영석,정환석,최준혁,조규종,한갑수,조태환,이성우,박용주,나상훈 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.1

Purpose: Sudden cardiac arrest (SCA) accounts for approximately 15% of all-cause mortality in the US and 50% of all cardiovascular mortalities in developed countries; 10% of cases have an underlying structural cardiac abnormality. An echocardiography has widely been used to evaluate cardiac abnormality, but it needs to be performed by emergency physicians available in the emergency department immediately after death, rather than by cardiologists. We aimed to determine whether post-mortem echocardiography (PME) performed in the emergency department may reveal such abnormalities. Methods: We evaluated the reliability and validity of PME performed by emergency physicians in the emergency department. Measurement by a cardiologist was used as reference. Results: Two emergency physicians performed PME on 3 out of the 4 included patients who died after unsuccessful cardiopulmonary resuscitation. PME was started within 10 minutes of death, and it took 10 minutes to complete. Parasternal views in either supine or left decubitus position were most helpful. The adequacy of the image was rated good to fair, and that of measurements was acceptable to borderline. Regarding the chamber size and left ventricular wall thickness, intraclass correlation coefficients for reliability and validity were 0.97 (n=15) and 0.95 (n=35), respectively (p<0.001). Evaluation of presence/absence of left ventricular wall thinning, valve calcification, and pericardial effusion was incomplete (3/7-5/7), precluding further analysis. Conclusion: Emergency physicians could perform reliable and valid PME to assess the chamber size and left ventricular wall thickness. A large prospective study with collaboration between emergency physicians and cardiologists would reveal the feasibility and usefulness of PME in diagnosing structural causes of sudden cardiac arrest.

Mathematical Explanation for the Wide and Deviated Range of Optimal Hematocrit

천성빈,조준휘,이승준,오원섭 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.1

Hematocrit is an important determinant of oxygen delivery. Of particular interest, its target level is very wide for different kinds of shock: from 30% for hemorrhagic or septic shock to 56% for secondary polycythemia. This range is not only wide but also deviated to the higher level from the optimal value of 40%. In this letter, the authors determine the mathematical basis of the wide and deviated range of hematocrit starting from the Hagen-Poisseuille equation.

내독소를 투여한 백서의 패혈증 모델에서 glutamine 및 N-Acetylcysteine 투여가 간내 항산화에 미치는 효과

천성빈 ( Song Bin Chon ),김지수 ( Jee Soo Kim ),이창현 ( Chang Hyun Lee ),정성은 ( Sung Eun Jung ),윤여규 ( Yeo Kyu Youn ),서길준 ( Gil Joon Suh ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Background: Glutathione (GSH) has been known to be an important intracellular antioxidant. The aim of this study was to investigate the effects of the glutamine and N-acetylcysteine (NAC) on lipid peroxidation and antioxidant effect in sepsis model. Methods: All female Sprague-Dawley rats were given an intraperitoneal diethylmaleate (DEM) injection before treatment, and divided into four groups: control group (DEM only), lipopolysaccharide (LPS) treated group (DLPS), LPS with glutamine treated group (DLPG) and LPS with both glutamine and NAC treated group (DLPGC). Animals were killed at 6 and 24 hours after treatment. The histology and the counts of the infiltrative neutrophils, and the levels of malondialdehyde (MDA) and GSH in the liver were measured. Results: While the liver histology in the both DLPG and DLPGC groups showed mild neutrophil infiltration, vacuolization of hepatocytes, and the sinusoidal dilation compared to those of the DLPS group, there was no significant change of the neutrophil counts between the treatment groups. Both the DLPG and DLPGC groups showed decreases in liver MDA level compared to the DLPS group. Although both the DLPG and DLPGC groups demonstrated significant increases in the liver GSH level compared to the DLPS group, there was no significant change between the DLPG and DLPGC groups. Conclusion: This study showed that the administration of the glutamine and NAC in sepsis model revealed an inhibition of the lipid peroxidation and an antioxidant effect through the increase of GSH in the liver.

권역 응급의료센터에 내원한 비외상성 객혈 환자에서 기관지 동맥 색전술의 장기 생존 효과

천성빈 ( Song Bin Chon ),정성구 ( Sung Koo Jung ),곽영호 ( Young Ho Kwak ),서길준 ( Gil Joon Suh ),유은영 ( Eun Young You ),신상도 ( Sang Do Shin ) 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.2

장폐쇄증 환자에서 수술적 치료를 필요로 하는 요인분석

송경준,천성빈,신중호,이중의,서길준,윤여규 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: There is a continuing debate about whether small bowel obstruction (SBO) is best managed operatively or nonoperatively. There is also no definite criteria for physician to decide to operate patient with SBO. This retrospective study was designed to determine the factors influencing the treatment modality of SBO. Methods: A clinical analysis was applied to 95 patients with SBO who were admitted to the emergency department of Seoul National University Hospital from January, 2000 to December, 2001. The patients were divided into the operative and non-operative treatment groups according to the treatment modality. We compared parameters such as age, sex, the etiology of SBO, the history of previous SBO, the history of previous operation due to SBO, time period from onset of symptoms to admission, and symptoms and signs between two groups. Results: Among 95 cases, the operative management was performed in 21 cases and the non-operative treatment in 74 cases. There was no significant difference in the distribution of age and sex between two groups. The most common etiology of SBO was adhesion due to previous operation. In the operative treatment group, 12 (57.1%) cases had the history of previous operation because of SBO, which showed a significant difference compared to the nonoperative treatment group (p<0.001). The major symptoms and signs were abdominal pain, vomiting, abdominal tenderness, hyperperistalsis, leukocytosis, tachycardia, rebound tenderness and fever. Of these symptoms and signs, rebound tenderness was only more common in the operative group than in the non-operative group (p<0.001). Conclusion: At the time of admission to the emergency department, the rebound tenderness in patients with SBO is an important factor to consider the early operative intervention.

Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography

김신우,천성빈,오원섭,조선호 대한응급의학회 2019 Clinical and Experimental Emergency Medicine Vol.6 No.4

Objective There is a traditional assumption that to maximize stroke volume, the point beneath which the left ventricle (LV) is at its maximum diameter (P_max.LV) should be compressed. Thus, we aimed to derive and validate rules to estimate P_max.LV using anteroposterior chest radiography (chest_AP), which is performed for critically ill patients urgently needing determination of their personalized P_max.LV. Methods A retrospective, cross-sectional study was performed with non-cardiac arrest adults who underwent chest_AP within 1 hour of computed tomography (derivation:validation=3:2). On chest_AP, we defined cardiac diameter (CD), distance from right cardiac border to midline (RB), and cardiac height (CH) from the carina to the uppermost point of left hemi-diaphragm. Setting point zero (0, 0) at the midpoint of the xiphisternal joint and designating leftward and upward directions as positive on x- and y-axes, we located P_max.LV (x_max.LV, y_max.LV). The coefficients of the following mathematically inferred rules were sought: x_max.LV=α0*CD-RB; y_max.LV=β0*CH+γ0 (α0: mean of [x_max.LV+RB]/CD; β0, γ0: representative coefficient and constant of linear regression model, respectively). Results Among 360 cases (52.0±18.3 years, 102 females), we derived: x_max.LV=0.643*CD-RB and y_max.LV=55-0.390*CH. This estimated P_max.LV (19±11 mm) was as close as the averaged P_max.LV (19±11 mm, P=0.13) and closer than the three equidistant points representing the current guidelines (67±13, 56±10, and 77±17 mm; all P<0.001) to the reference identified on computed tomography. Thus, our findings were validated. Conclusion Personalized P_max.LV can be estimated using chest_AP. Further studies with actual cardiac arrest victims are needed to verify the safety and effectiveness of the rule.