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응급의학과 전공의가 시행한 흉관 삽입술의 합병증에 대한 고찰
조대윤 ( Dai Yun Cho ),손동섭 ( Dong Suep Sohn ),전영진 ( Young Jin Cheon ),홍기훈 ( Ki Hun Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2
Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons. (J Korean Soc Traumatol 2012;25:37-43)
Hyun Jung Lee(이현정),Hyang Sun Ahn(안향선),Bum Jun Park(박범준),Dai Yun Cho(조대윤),Yoon Hee Chung(정윤희),Daejin Kim(김대진),Sung Su Kim(김성수),Kyung Yong Kim(김경용),Won Bok Lee(이원복) 대한체질인류학회 2008 해부·생물인류학 (Anat Biol Anthropol) Vol.21 No.4
본 연구에서는 흰쥐 중추신경계에서 insulin-like growth factor binding protein 7 (IGFBP7)의 분포를 규명하고자 면역조직화학적 연구를 시행하였다. 실험에는 4~6개월 된 성숙 흰쥐가 사용되었고 IGFBP7에 대한 항체를 이용하여 면역조직염색을 실시하였다. 연구결과, IGFBP7 면역염색성은 대뇌 겉질, 해마, 뇌줄기, 소뇌 및 척수에서 관찰이 되었다. 대뇌 겉질에서는 겉질의 Ⅱ-Ⅵ층에서, 해마에서는 CAI-3 부위의 피라미드 세포들에서 IGFBP7에 대해 강한 면역염색성을 나타내는 신경세포들이 관찰되었다. 시각로위핵, 뇌실곁핵, 중간뇌수도관주위회색질 및 눈돌림신경핵에서도 강한 면역염색성을 나타내는 신경세포들이 발견되었다. 소뇌에서는 조롱박세포와 소뇌핵 신경세포에서, 뇌줄기에서는 위안뜰핵, 달팽이핵, 삼차신경 운동핵, 마름체핵 및 얼굴신경핵에서 IGFBP7 면역염색성을 나타내는 신경세포들이 관찰되었다. 척수에서는 주로 앞뿔에 위치하는 운동신경세포에서 강한 면역염색성을 나타냈다. 본 연구에서 밝혀진 IGFBP7의 중추신경계 분포는 앞으로의 구조적, 기능적 연구에 유용한 자료가 될 것이라 사료된다. In the present study, we performed immunohistochemical studies to investigate the detailed distribution of insulin-like growth factor binding protein 7(IGFBP7) in the central nervous system of adult rats. Twelve adult (4~6 month old) Sprague-Dawley rats were examined in this study. Immunohistochemistry using specific antibodies against IGFBP7 was performed in accordance with the free-floating method. In the present study, IGFBP7 immunoreactivity was observed in the cerebral cortex, hippocampus, brainstem, cerebellum and spinal cord. In the cerebral cortex, heavily stained neurons were seen in layers Ⅱ-Ⅵ. In the hippocampus, pyramidal cells in CAI-3 region were strongly immunoreactive for IGFBP7. Strong immunoreactive neurons were also found in the supraoptic nucleus, paraventricular nucleus, periaqueductal gray and oculomotor nucleus. In the cerebellum, IGFBP7 immunoreactivity was prominent in the Purkinje cells and cerebellar output neurons. IGFBP7-immunoreactive neurons were prominent in the superior vestibular nucleus, cochlear nucleus. trigeminal motor nucleus, nucleus of the trapezoid, and facial nucleus. IGFBP7-immunoreactive neurons were also observed mainly in the anterior horn of the spinal cord. The first demonstration of IGFBP7 localization in the whole brain may provide useful data for the future investigations on the structural and functional properties of IGFBP7.
3차 의료기관 응급의료센터에서 시행된 병원내 심정지 환자의 심폐소생술 결과 분석
어은경,장혜영,전영진,정구영,손동섭,조대윤,양기민 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3
Purpose: The "In-hospital Utstein Style" is an internationally recommended grideline for reporting outcome data from in hospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation(CPR) in a tertiary emergency department and to provide basic data for a unified report guidelines for resuscitation in Korea. Methods: A clinical analysis of 249 cases of in-hospital CPR performed in a tertiary emergency department from August 1995 to December 2001 was conducted. The evaluation was made using Utstein reporting guidelines. Results: During the period, 232 patients received 249 resuscitations. The immediate precipitating causes of cardiac arrest were cardiogenic in 61 cases (24.5%), traumatic in 58 cases (23.3%), respiratory in 41 cases (16.5%), and metabolic in 28 cases (11.3%), Initial EKG rhythms were bradyarrhythmia in 115 cases (46.2%), pulseless electrical activity in 69 cases (27.7%), ventricular fibrillation/tachycardia (VF/VT) in 36 cases (14.5%), and asystole in 26 cases (10.4%). The spontaneous circulation was returned in 153 of the 249 resuscitations (61.5%). In 59 of the 249 resuscitations(23.7%), spontaneous circulation was maintained for more than 24 hours. Sixteen of the 232 patients (6.9%), were discharged alive. The VF/VT group of initial EKG rhythm had a better outcome in comparison with non VF/VT group. The prognosis for respiratory arrest was better(78% probability of survival) than it was for other causes of arrest. Patients suffering from traumatic arrest showed the worst outcomes (9% probability of survival). Conclusion: Although the "In-hospital Utstein Style" is very subjective as a report determining the outcome of resuscitation, it has many complementary factors. However, even with the "Utstein Style", new guidelines compatible with the actual circumstances of our emergency department must be developed.