패혈증 백서 모델에서 비타민-C의 효과

이중의,신상도,표창해,서길준,정성은,윤여규 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-α and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. Methods : Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-α level in the blood and malondialdehyde(MDA)level, catalase activity and nitric oxide synthase(NOS)activity in the liver and the lung tissues were performed. Results : Serum TNF-α level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-α level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. Conclusion : high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.

강산 및 강알칼리 음독에서 냉각 용액을 사용한 희석 요법과 중화 요법의 가능성

이중의,송형곤,김동훈,권운용,곽영호,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: There is no effective treatment modality for caustic agent ingestion. Dilution and neutralization are prohibited because of the risk of secondary thermal injury. This experiment is designed to evaluate the amount of dilution and neutralization heat and to gauge the applicability of dilution and neutralization therapy using cold solutions to suppress the peak temperature. Methods: This is an in-vitro chemical experiment. HCl, CH3COOH, NaOH, and NH4OH are selected as representatives of strong and weak acids and strong and weak alkali, respectively. 20℃, 11.6M, 5.8M, and 2.9M solutions of each acid and alkali are made and mixed using a magnetic stirrer at a room air temperature of 28℃. The peak temperature, the duration above 40℃, and the heat amount are measured or calculated. Results: When a 11.6M HCl or NaOH solution is diluted with same amount of water, 32 or 18cal. per mL of HCl or NaOH is produced, respectively. HCl produces a significant peak temperature, but NaOH does not. The lower the concentration, the lower the amount of heat production. 11.6M CH3COOH and NH4OH solutions don't produce dilution heat.11.6M and 5.8M solutions of all acids and alkali produce destructive neutralization heat. However, 2.9M solutions produce neutralization heat which might be controllable. When a 11.6M HCl or NaOH solution is neutralized with a -10℃ 2.9 M NaOH or HCl solution, respectively, the peak temperature produced is below 40℃ and seems to add little thermal damage to viable tissue. Conclusion: Dilution and neutralization with a cold solution in cases of strong acid or alkali ingestion is a promising method to avoid thermal injury.

차량의 방송 수신 전파 환경 분석에 관한 연구

김의태,김성철,이중근,양승완,전인학 漢陽大學校 工學技術硏究所 2001 工學技術論文集 Vol.10 No.-

본 논문에서는 이동 중인 차량의 수신 성능에 영향을 주는 전파 환경 측정을 위한 측정 셋업을 구성하고, 측정 결과 분석을 통한 수신 이상 현상의 원인을 밝혔다. 이를 위해 필요한 측정 파라메터의 정량적 설정과 측정 및 분석 방법을 제시하였다. In this paper we constitute the measurement setup of electromagnetic environment which has an effect on the radio receiver of vehicles an analyzed causes. This paper proposes various measurement and analysis methods for uncovering noise mechanism of vehicle receiver system.

발열이 있는 호중구 감소증 환자에서의 위험도 예측인자

정중식,권운용,김규석,임용수,이중의,서길준,윤여규 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. Methods: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. Results: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17,2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr < 75㎖/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). Conclusion: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-prediction factors in febrile neutropenia at the time of visiting the emergency department.

사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.

파라콰트 중독에서의 항산화치료

권운용,조유환,송형곤,김명천,이중의,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Paraquat causes severe tissue toxicity when ingested, but has no effective treatment modality. We have shown that high dose vitamin C has effective antioxidant activities against the paraquat intoxication in a previous animal experiment. This study was designed to evaluate the effect of antioxidant therapy with high dose vitamin C and vitamin E in human cases of paraquat intoxication. Methods: From August 1999 to August 2001, 19 paraquat intoxication patients who visited the emergency department of the Seoul National University Hospital and the Kyounghee University Hospital were enrolled to this study. They were devided into two groups, a control group(9 patients) and a study group(10 patients). The control group received only conservative managements including gastro-intestinal decontaminati-on. The study group received conservative managements plus the antioxidant therapy which was composed of vitamin C 24 gm/day intravenously and 20 gm/day orally, and vitamin E 1.6 gm/day orally. Results: In the study group, 5 of 10 patients(50%) survived, but all patients of the control group died(p=0.003). There were no significant differences in age, sex, and usage of gastric lavage and activated charcoal between the two groups. Difference in ingested amount of paraquat between the two groups could not be analyzed due to the inexact and subjective measuring methods based on patients' histories. Conclusion: Antioxidant therapy with high dose vitamin C and vitamin E is effective in vival rate in paraquat intoxicated patients.

119구급대를 통한 서울지역 외상환자 진료체계에 대한 통계분석

서길준,이승한,조익준,권운용,송형곤,이중의,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Backgroud: Despite continous efforts to improve the prehospital trauma care system in Korea, the preventable death rate has been reported to be high. The purpose of this study was to evaluate the prehospital trauma care system in Seoul by analyzing 119 rescue databases. Methods: The 119 rescue data bases of 22,275 trauma patients, who were transported to the secondary and tertiary hospital in Seoul by Seoul 119 rescue services from January 1, 2000 to December 31, 2000, were analyzed. Results: The response time(mean 3.7 min.) showed no time, weekly, and regional variations. However, the transport time from field to hospital showed was high in the morning rush hour(7:00 to 10:00 am), and was gradually decreased and the lowest between 10:00 pm and 7:00 am. There was also a regional variation in the transport time, which was short in the central area and long in the peripheral area of Seoul. Prehospital cares were given to the 10,999 trauma patients(49.4%). Of the 464 unresponsive patients(2%), only 236 patients were identified in transported hospitals. The outcomes of these unresponsive patients were DOA(54%), survival(19%), death in ER(14%), transfer to other hospitals(8%), and death after admission(5%) in order. Conclusion: We suggest that this study may be helpful to the establishment and improvement of the prehospital trauma care system as well as the determination of the adequate numbers and locations of trauma center in Seoul.

간 부분절제술 후 간 조직 재생과정에서의 성장호르몬의 효과

이중의(Joong-Eui Rhee),서길준(Gil-Joon Suh),김영덕(Young-Deok Kim),정성은(Sung-Eun Jung),윤여규(Yeo-Kyu Youn) 대한외과학회 1999 Annals of Surgical Treatment and Research Vol.57 No.5

백서의 패혈증 증후군 모델에서 고용량 비타민-C 투여의 효과에 관한 실험적 연구

이중의,정연권,정성은 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

1. Background : In sepsis syndrome, peroxidation reaction of polyunsaturated cell-membrane lipids by reactive oxygen free radicals is known as the main mechanism of cell injury. Recent explosive rush of studies on the biologic functions of NO has made it clear that NO is essential to the vessel function and microcirculation and increased production of NO in sepsis has important pathophysiologic actions. 2. Purpose : This study is designed to evaluate the therapeutic effects of vitamin-C, a famous antioxidant, on the liver tissue protection in severe intraperitoneal infection. 3. Methods : Female rats of Sprague- Dawley as experiment animal were divided into a control group(group-A) and two experimental groups of a peritonitis group (group-B) and a peritonitis-and-vitamin-C group(group-C). Peritonitis had been induced by cecal ligation and perforation under ketamine anesthesia. Vitamin-C (600 mg/kg) was injected intramuscularly. As a index of peroxidation reaction, malondialdehyde (MDA)level and catalase activity of the liver tissue were examined. And NOS activity in liver tissue was measured. In blood, the concentration of TNF- α was measured with ELISA method. 4. Results : On microscopic examination. liver tissue of group-B showed lymphocyte and neutrophil infiltration. fatty degeneration of hepatocyte, and destruction of liver lobular structure. In group-C, there were lesser lymphocyte and neutrophil infiltration and lesser structural injury in the liver tissue in comparison with in group-B. MDA levels of liver tissue were remarkably increased in group-B. Catalase activity of group-B was used up in very early phase of peritonitis. In comparison with group-B, group-C had significantly lower MDA levels and significantly higher catalase activity. Plasma TNF- α levels of group-B were markedly increased compared with group-A. Group-C showed markedly suppressed plasma TNF-α levels, compared to group-B. NOS activity in liver tissue of group-B was significantly increased. Vitamin-C suppressed increment of NOS activity. 5. Conclusion : Cell injury by reactive oxygen free radicals was thought to play a key role in sepsis. High dosage of vitamin-C had therapeutic cell-protective effect against lipid peroxidation, suppressive action on the TNF- α production, and inhibitory effect on NOS activation. The therapeutic effect of vitamin-C in sepsis was supposed to be mediated mainly by their antioxidant function. But the exact interaction between peroxidation reaction and NO or TNF- α could not elucidated clearly. Further well-designed experiment is necessary.

복부외상 환자의 진단법 : 진단적 복강 세척술 , 초음파 , 전산화 단층촬영 그리고 진단적 복강경술

이중의 대한외상학회 1996 大韓外傷學會誌 Vol.9 No.2

To determine the roles of diagnostic peritoneal lavage (DPL), ultrasonography (US), computed tomography (CT) and diagnostic laparoscopy (DL) in the evaluation of abdominal trauma, the author reviewed and compared the data of recently published 26 reports about the diagnostic values of the diagnostic tools. Comparative analysis of sensitivity, specificity, positive predictive value, accuracy, indications & contraindications, advantages & disadvantages, non-therapeutic laparotomy rate of the diagnostic tools was performed. DPL has been the golden standard of abdominal trauma diagnosis, but DPL is too sensitive with very high non-therapeutic laparotomy rate. In detecting hollow viscus injury, DPL is superior to all others. Many users of US belive that US can serve bestly as a first-line of diagnostic adjunct in detecting free peritoneal and thoracic fluid in truncal blunt trauma. But US has some false negative rate in the diagnosis of solid organ injury itself, and frequently misses bowel and mesenteric injury. CT gains more popularity than DPL in blunt abdominal trauma recently. It is very sensitive and specific, but due to the requirement of coorperation from the patient, long performance time, and transportation to the CT room, it is not suitable as a first-line of diagnosis in blunt abdominal trauma. CT also has a limited diagnostic value in detecting bowel and mesenteric injury. DL, can be used on 3 purposes in abdominal trauma firstly, as a first-line of diagnostic tool, secondly, as a second-line of diagnostic tool, and finally, as a therapeutic tool. The first-line diagnosis should not miss a severe injury that requires prompt surgical treatment. And the second line of diagnosis should be able to differentiate a patient who belongs to the non-operative therapy from others accurately. Conclusively, in blunt abdominal trauma, US and DL are suitable as a first- and a second-line tool, respectively, In penetrating abdominal trauma, DPL and DL are suitable as a first- and a second-line diagnostic tool. Further prospective studies about this issue are expected.