황화수소가스에 노출된 후 혼수로 내원한 환자 2례

류현호,이병국,정경운,허탁,민용일,Ryu, Hyun-Ho,Lee, Byeong-Guk,Jeung, Kyung-Woon,Heo, Tag,Min, Yong-Il 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.1

Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.

전위를 동반한 갑상연골 골절의 자연 치유 치험 1례

류현호 ( Hyun Ho Ryu ),이병국 ( Byung Kook Lee ),정경운 ( Kyung Woon Jeung ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.1

A thyroid cartilage fracture is a rare entity and can be overlooked easily. Such cases are difficult to diagnose, and assessment and treatment guidelines are difficult to determine. CT of the neck region may be useful when acute airway intervention is not required or when more information regarding the neck`s anatomy is required for management decisions. We describe a case of a thyroid cartilage fracture with displacement. In the emergency department (ED), neck CT and fiberoptic nasopharyngoscopy were used to assess the status of the patient`s (a male) vocal chords immediately. He remained unable to phonate continuously. After an immediate assessment, we decided to use steroid and conservative therapy. The patient had a good recovery and was without symptoms one month after injury. There is no question that early surgical repair of neck injuries affords the best results for airway and voice patency in most cases however, we suspect that surgical repair is not needed in all cases. Early recognition and an accurate therapy plan for a thyroid fracture with displacement are essential. Therefore, the emergency physician`s immediate and careful decision based on endoscopy and neck CT is important for the patient`s long-term recovery. (J Korean Soc Traumatol 2010;23:53-55)

골반경하 자궁 근종절제술 93 예의 임상적 고찰

이승열 ( Seung Yol Lee ),류현호 ( Hyun Ho Ryu ),이춘보 ( Chun Bo Lee ),주은현 ( Eun Hyun Joo ),김성경 ( Seong Kyung Kim ),송치훈 ( Chi Hun Song ),윤광섭 ( Kwang Seop Youn ),이상녕 ( Sang Nyeong Lee ),이장용 ( Jang Yong Lee ),나재 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.6

목적 : 골반경하 자궁근종절제술을 시행한 93명의 환자를 대상으로 시행한 수술방법을 간략히 소개하고 임상경과 및 술후 합병증 여부를 분석하여 골반경하 근종적출술의 임상적 안정성 및 유용성에 대해 알아보고자 하였다. 연구 방법 : 2001년 5월부터 2002년 12월까지 20개월간 여수 전남병원 산부인과에서 골반경하 자궁 근종절제술을 시행한 환자 93명의 외래차트와 입원기록지를 가지고 이들의 나이, 출산력, 증상, 근종의 개수, 크기, 무게, 수술시간, 입원기간, 혈색소 감소량, 술후 합병증 등에 대해 후향적 고찰을 하였고 Microsoft Excel로 분석하였다. 결과 : 평균 연령은 42.68 (±5.37)세 였고 평균 출산력은 2.02 (±0.96)회였다. 근종의 개수는 평균 1.70 (±1.27)개였으며 평균 무게는 71.7 (±56.4) gm이었으며 위치는 점막하 근종이 가장 많았고 수술의 적응증이 되는 증상은 과다출혈이 가장 많았다. 평균 수술시간은 101.0 (±30.0)분이었고 술후 평균 혈색소 감소량은 1.40 (±0.81) g/dL이었다. 평균 입원기간은 3.90 (±1.19)일이었다. 술중 합병증으로 투관침 부위 출혈이 2예 있었고, 피하기종이 2예 있었고, 2예에서 개복술로 전환하였다. 술후 합병증은 없었다. 결론 : 본원에서 골반경하 자궁 근종절제술의 적응증을 확대하여 가임기 뿐만 아니라 거의 모든 연령층에 적용하여 심각한 합병증 없이 많은 환자를 수술하였다. 골반경하 자궁 근종절제술을 위한 적절한 시설과 술자의 숙련된 술기가 중요하다 사료되며 앞으로 다양한 기술개발과 훈련으로 근종치료에 있어서 골반경하 자궁근종절제술이 보다 대중화되고 효과적인 수술이 될 것을 기대하는 바이다. Objective : The study was undertaken to evaluate clinical safety and usefulness of laparoscopic myomectomy with analyzing clinical course and postoperative complications of 93 patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital and to introduce operative methods executed in this hospital. Methods : Total number of patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital from May 2001 to December 2002 was 93. With ward chart and admission recordings, Age, parity, symtom, size of myoma, number of myoma, location operation time and hemoglobin change were recorded. Data were analyzed with Microsoft Excel. Results : The mean age of patients was 42.68 (±6.05) years. The mean parity was 2.02 (±0.96). The mean number of myoma was 1.70 (±1.27). The mean weight of myoma was 71.7 (±56.4) gm. The most common symtom was hypermenorrhea. The location of myoma was submucosal, intramural, subserosal in large order. The mean operation time was 101.1 (±30.2) minutes. The mean hemoglobin change after operation was 1.40 (±0.81) g/dL. Mean hospital stay was 3.90 (±1.20) days. The operative complication was trocar site bleeding (2 cases), surgical emphysema (2 cases). In cases, Laparoscopic procedure was converted to laparotomic method. Conclusion : Indication of operation was extended in almost all age (including reproductive age) and 93 Laparoscopic myomectomy was done safely and effectively without severe complications. However, to obtain more safety and usefulness of laparoscopic myomectomy, adequate laparoscopic instrument and expertized operative technic should be demanded. In near future, laparoscopic myomectomy will be more popular and effective by variable technical development and ordered discipline.

복어 섭취 후 발생한 급성 테트로도톡신 중독 환자의 임상적 특징과 예후 인자 분석

조용수 ( Yong Soo Jo ),전병조 ( Byeong Jo Chun ),문정미 ( Jeong Mi Moon ),류현호 ( Hyun Ho Ryu ),정용훈 ( Yong Hun Jung ),이성민 ( Sung Min Lee ),송경환 ( Kyung Hwan Song ),류진호 ( Jin Ho Ryu ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

Purpose: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. Methods: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. Results: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), PaCO2<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and PaCO2<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). Conclusion: Overall, dizziness, time interval between onset of symptoms and ingestion, DBP and PaCO2<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and PaCO2<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.

간경화증 환자에서 경도 외상 후 발생한 지연 비장 파열

정경운 ( Kyung Woon Jeung ),이병국 ( Byung Kook Lee ),류현호 ( Hyun Ho Ryu ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma. (J Korean Soc Traumatol 2011;24:52-55)

Nalidixic acid 내성 장티푸스균에 대한 항생제 시간-살균 연구

김동민,윤나라,정종훈,류현호 대한감염학회 2008 감염과 화학요법 Vol.40 No.4

Background : We recently encountered a case of typhoid fever in a patient who visited us after travelling India. The patient received ciprofloxacin therapy, but developed typhoid pneumonia and typhoid hepatitis, and nalidixic acid resistance Salmonella Typhi (NARST) was identified. The aim of this study was to assess the in vitro efficacy of several antimicrobial combinations, which are commonly used in clinical practice. Materials and Methods : Time-kill studies were performed for a clinical NARST strain to evaluate synergy. Synergy was defined as a ≥2 log_10 decrease (l00-fold drop) in CFU per mL at 24 hours by a drug combination compared to the most active constituent. Results : The combination regimen of cefotaxime plus ciprofloxacin significantly reduced the bacterial counts (>3 log CFU) at 3/4 MIC and at 24 hours compared to the ciprofloxacin or cefotaxime alone and showed synergistic effect against a NARST strain. Conclusions : In conclusion, our time-kill studies showed that ciprofloxacin plus cefotaxime was the best in vitro combination against a NARST. This combination may improve efficacy compared to fluoroquinolone alone in typhoid fever patient with NARST. Time kill studies with more NARST strains and clinical studies are required to test the relevance of our findings