불화수소 음독 후 발생한 심금염 1례

김선휴,김 현,지호진,장용수,오성범,이강현,황성오,Kim Sun Hyu,Kim Hyun,Ji Ho Jin,Jang Yong Soo,Oh Sung Bum,Lee Kang Hyun,Hwang Sung Oh 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

Hydrofluoric acid (HF), one of the strongest inorganic acids, is used mainly for industrial purpose. Hydrofluoric acid injuries has a potential for both systemic as well as severe local tissue destruction. One of the most serious consequences of severe exposure to HF by any route is marked lowering of serum calcium (hypocalcemia) and other metabolic changes, such as hypomagnesemia and which may result in a fatal outcome if not recognized and treated. promptly cardiotoxicity is not well known except arrhythmias, which are a primary cause of death. We report a case of myopericarditis by ingestion of hydrofluoric acid.

불화수소 음독 후 발생한 심근염 1례

김선휴 ( Sun Hyu Kim ),김현 ( Hyun Kim ),지호진 ( Ho Jin Ji ),장용수 ( Yong Soo Jang ),오성범 ( Sung Bum Oh ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ) 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

Hydrofluoric acid (HF), one of the strongest inorganic acids, is used mainly for industrial purpose. Hydrofluoric acid injuries has a potential for both systemic as well as severe local tissue destruction. One of the most serious consequences of severe exposure to HF by any route is marked lowering of serum calcium (hypocalcemia) and other metabolic changes, such as hypomagnesemia and which may result in a fatal outcome if not recognized and treated. promptly cardiotoxicity is not well known except arrhythmias, which are a primary cause of death. We report a case of myopericarditis by ingestion of hydrofluoric acid.

한약복용 후 발생한 칸타리딘 중독 1례

지호진,김현,김선휴,오성범,문중범,이강현,황성오,Ji Ho Jin,Kim Hyun,Kim Sun Hyu,Oh Sung Bum,Moon Joong Bum,Lee Kang Hyun,Hwang Sung Oh 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1

Blister beetles produce cantharidin, which is toxic to people and animals. Cantharidin has been believed to be an aphrodisiac and an abortifacient based on its tendency to cause marked irritation to the genitourinary system leading to priapism in men and pelvic congestion in women for many years. Cantharidin was used by oriental traditional medicine for more than 2000 years. Typical signs related to cantharidin ingestion are gastrointestinal tract and urinary tract irritation, endotoxemia, shock and myocardial dysfunction. Cantharidin is a severe irritant to epithelial linings (gastrointestinal tract, urinary tract, and skin) and develop systemic inflammatory response syndrome. We report a case of corrosive esophagogastritis and acute renal failure by ingestion of cantharidin.

응급실 기반 약물에 의한 아나필락시스 쇼크 환자의 임상적 특성

한상근,안력,김선휴,최승원,홍은석,Han, Sang-Guen,Ahn, Ryeok,Kim, Sun-Hyu,Choe, Seung-Won,Hong, Seung-Won 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: This study was conducted to investigate the characteristics of drug induced anaphylactis and anaphylactic shock in patients who were admitted to the emergency department Methods: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. Results: The mean age of the study subjects was $47.9P{\pm}14.2$ years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group ($51.5{\pm}15.1$ vs $42.5{\pm}10.6$, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. Conclusion: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.

외상후 복부 다발성 고형장기 손상

박형도 ( Hyung Do Park ),김선휴 ( Sun Hyu Kim ),이종화 ( Jong Hwa Lee ),홍정석 ( Jung Seok Hong ),홍은석 ( Eun Seog Hong ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma. Methods: From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements. Results: Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities: 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group. Conclusion: Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality. (J Korean Soc Traumatol 2009;22:193-8)

골반골 골절로 인한 동맥 파열로 동맥 색전술을 시행받은 환자에서의 생존 비교

김우연 ( Woo Youn Kim ),홍은석 ( Eun Seok Hong ),홍정석 ( Jung Seok Hong ),안력 ( Ryeok Ahn ),황재철 ( Jae Cheol Hwang ),김선휴 ( Sun Hyu Kim ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1

Purpose: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. Methods: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. Results: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (±0.20) vs 7.30 (±0.08), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group (24.1±12.5 vs 14.4±6.8, p=0.046). Conclusion: No differences in initial blood pressure and trauma scores existed between survivors and non-survivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

불안정성 골반골 골절 손상에서 동반 복부 고형장기 손상의 임상적 특성

이상원 ( Sang Won Lee ),김선휴 ( Sun Hyu Kim ),홍은석 ( Eun Seog Hong ),안력 ( Ryeok Ahn ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.1

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intraabdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types Ⅱ and Ⅲ, antero-posterior compression types Ⅱ and Ⅲ, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale(AIS), injury severity score(ISS), amount of transfusion, admission to the intensive care unit(ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries. (J Korean Soc Traumatol 2012;25:1-6)

둔상 후 복부 전산화단층촬영에서 조영제 유출로 동맥색전술을 시행받은 환자의 복강내와 후복막강/골반강내 출혈 비교

윤지영 ( Ji Young Yoon ),김선휴 ( Sun Hyu Kim ),안력 ( Ryeok Ahn ),황재철 ( Jae Cheol Hwang ),홍은석 ( Eun Seog Hong ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. Methods: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. Results: The mean age of the study subjects was 40.2±2.6 years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. Conclusion: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group. (J Korean Soc Traumatol 2009;22:199-205)

복부 고형장기 손상을 동반한 안정 골반골 골절의 특성

박상준 ( Sang June Park ),김선휴 ( Sun Hyu Kim ),이종화 ( Jong Hwa Lee ),안력 ( Ryeok Ahn ),홍은석 ( Eun Seog Hong ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young`s classification is defined as a lateral compression type Ⅰ and antero-posterior compression type Ⅰ. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries. (J Korean Soc Traumatol 2010;23:57-62)

국내 남동 해안지역의 음식물 관련 아나필락시스의 임상 양상

서민후 ( Min Hoo Seo ),김선휴 ( Sun Hyu Kim ),홍정석 ( Jung Seok Hong ),김우연 ( Woo Youn Kim ),최승원 ( Seung Won Choe ) 대한천식알레르기학회 2010 천식 및 알레르기 Vol.30 No.2

Background: Food-induced anaphylaxis accounts for the most proportion of the anaphylaxis treated at the emergency department. In Korea, reports regarding food-induced anaphylaxis are very few. Objective: The purpose of this study is to evaluate the general characteristics and clinical features of food-induced anaphylaxis in the southeastern coasted area of Korea. Method: A retrospective study was conducted on the patients visiting the emergency department at Ulsan University Hospital between 2000 and 2009. We reviewed patients` medical records diagnosed with food-induced anaphylaxis and other related diseases. Result: We identified 66 patients with food-induced anaphylaxis. The mean age of the patients was 41.9 years (SD±13.8). The inciting agent included seafoods in 29 cases (43.9%), wheat in 5 cases (7.6%), pork meat in 5 cases (7.6%), buckwheat in 2 cases (3.0) and cowmilk in 2 case (3%). Mucocutaneous manifestations were the most common, followed by respiratory, cardiovascular, gastrointestinal and neurologic manifestations in decreasing order of frequency. There were 32 patients (48.5%) with moderate anaphylaxis and 51.5 patients (51.5%) with severe anaphylaxis. There were no significant correlations between severity and epidemiologic factors including age, sex, comorbid disease and smoking. Conclusion: We found that seafoods are major causative agents of food-induced anaphylaxis in the southeastern coastal area of Korea. Therapeutic fluid was more frequently required, and the time from arrival at the emergency department to discharge was longer in patients with severe anaphylaxis. (Korean J Asthma Allergy Clin Immunol 2010;30:110-115)