변비증

송화식,박길수 中央醫學社 1971 中央醫學 Vol.21 No.6

양형 및 행형에서의 형벌목적

송화식 한국형사정책학회 1999 刑事政策 Vol.11 No.-

가을철 발열을 주소로 내원한 환자의 임상 분석

이종안,김갑득,송화식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Tsutsugamushi disease, Leptospirosis, and Hemorrhagic fever with renal syndrome(HFRS) are an acute febrile illness of autumn-winter type which are characterized by fever, headache, myalgia in acute stage. We reported the clinical and laboratory characteristics of 49 cases under investigation for febrile illness in rural communities of Korea in order to differentiate the diagnosis among Tsutsugamushi disease, Leptospirosis, and HFRS. Methods : This study was done retrospectively by investigation of patient's age, occupation, symptom, laboratory findings and chest X-ray findings of Tsutsugamushi disease, Leptospirosis, and HFRS. All patients was seen in our hospital between September and November in 1997 and 1998 consecutive year. Results : The most characteristic symptoms and signs of Tsutsugamushi disease were eschar(90.1%), and skin rash(70%). The epidemiological and laboratory characteristics of Tsutsugamushi disease were age 40 or more, farmer(90.1%), s-GOT(serum glutamic oxaloacetic transaminase) and s-GPT(serum glutamic pyruvic transaminase) elevation. The most characteristic symtoms and signs of Leptospirosis were sputum and cough(75%). The epidemiological and laboratory characteristics of Leptospirosis were all farmers(100%), hyperbilirubinemia(1.67mg/dl). The most characteristic symptoms and signs of HFRS were gastrointestinal disturbance(100%), flank pain(66.7%). The epidemiological and laboratory characteristics of HFRS were leukocytosis, thrombocytopenia, azotemia, proteinuria(91.6%), and hematuria(83.3%). Conclusion : As the clinical feature, presence of eschar and skin rash were suggestive of Tsutsugamushi disease. As the clinical feature, presence of cough and sputum and laboratory finding such as elevation of bilirubin level were suggestive of Leptospirosis. As the clinical feature, presence of gastrointestinal disturbance, flank pain and laboratory findings of thrombocytopenia, and renal dysfunction were suggestive of HFRS.

의식명료한 경한 두부외상에서 CT촬영의 필요성에 대한 연구 : Is CT always Necessary?

송화식,김갑득 단국대학교 1998 論文集 Vol.33 No.-

We studied retrospectively 721 alert patients with mild head injury who visited to Emegency Medical Center of Dankuk University Hospital during a 18 months period to determined the clinical value of routine initial computerized tomography(CT) of the head and the follow-up CT scanning in alert patients with mild head injury. Variables reviewed were age of patients, symptoms of head trauma(brief loss of consciousness(LOC), amnesia, nausea and vomiting, headache), skull fracture on skull radiology, intracranial lesions, delayedintracranial lesion and operation. All 721 patients underwent CT of the head on the basis of history of symptoms and signs of head injury. Of these 721 patients, 159(22.1%) had skull fracture and 146(20.2%) with intracranial lesions, and 44(6.4%) required neurosurgical operation. Conclussively routine initial CT scanning in patients with linear or basal skull fracture, older than 60 years old or symptoms of head injury has clinical value and is warranted. Also follow-up CT scanning in necessary in patients with linear or basal skull fracture, symptoms of head injury or abnormal findings in initial CT scan.

응급실로 전원된 환자의 진료의뢰서 충실도 및 주 호소증상에 관한 연구

김광환,송화식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

We studied the contents of referral sheets of the patients transferred to DMC Emergency Center from Jan 1, 1999 to Jan 31, 1999. The study for the completion and chief complaints in the referral sheets shows the followings. 1. Examining the referral sheets status of disease, name and age record of 5 major items grade 0.92, the highest point, examining item and laboratorial record grade 0.72, dignosis record grades 0.38, and patients condition and diagnosis opinion record grade 0.10. 2. Name and age item had high completion score in referral sheets from local clinic and hospital for secondary referral level. For address item, however, local clinic scored 0.63 and hospital for secondary referral level scored 0.28, which showed statistically significant difference(P<0.001). 3. In the aspect of severity, name and age record leveled 0.94 to the non emergency patent, 0.92 to the emergency patient, 0.91 urgent patient, showed and no statistic significant difference 4. The major 10 symptoms of the complaints were these the pain of abdomen and pelvis(25.2%), somnolence and stupor, coma(13.6%), headache(10.9%), and open wound of head(4.0%), ranked 10th common symptom level;

중증뇌손상 환자의 초기 CT소견

김갑득,박준석,송화식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The authors have analyzed 60 patients with severe head injury who defined as post-traumatic coma for 24 hours with Clasgow Coma Scale(GCS) score of 8 or less and admitted to emergency room of Dankook university hospital from January to June 1995 to evaluate the factors affecting GCS and autcome with initial CT findings. The results are summerized as follows; 1. The status with low GCS score was observed from ① intracranial mass, especially acute subdural hematoma(SDH) ② midline shift≥3mm ③ completely compressed mesencephalic cistern 2. The mortality was high in intracranial mass, especially in acute SDH 3. The mortality for patients with miline shift≥3mm was high regardless of a mass lesion, but there was no statistical significance. As the mesencephalic cistern was partially compressed, the midline shift≥3mm did not affect the mortalith. The outcome was good in the group of midline shift≥3mm with GCS 6-8. 4. If the mesencephalic cistern were compressed, especially in complete compression, the outcome was much more likely to be poor than cistern was normal. 5. The poor outcome was obtained from the patients with low GCS score and compression, the outcome was much more likely to be poor than cistern was normal. 6. The poor outcome was obtained from the patients with low GCS score and compressed mesencephalic cistern in initial CT findings.

두개골 골절의임상적 의의

송화식,김갑득,오성환,강명희 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.2

Background: A skull fracture is an indication of the severity of the head trauma and the physician should be alert to the potential for intracranial injuty , such as intracrnial lesioos and clinical management of patients with head injury. Methods: We evaluated 251 tients with nondepressed closed or basal skull fractures who was admitted to the Einergency Medical Center of Dankuk University Hospital from July 1996 to December 1997 tetroapectively and used x2-test statistical significance. Result: The overall incidence of skull fractures in head injury was 26,1%. Of wbom 78.5% have linear slnill fracture and 21.5% have basal skull frature, Of patients with skull fractures, 63.7% have associated, intracrainal 1esions and 19.5% with delayed intracrmial hematomas. Higher percentage of patients with linear skull fratures have iatracranial lesions, especially epidural bematoma, compered with patients with basal sku11 fratures. Similarly intracrania] lesions are highly associated in Older than 60 years old and multiple and long skull fractures. Epidural hematoma is almost found to be coup injuries whereas with subdural hematoma, contrecoup iajuriea in high percentage(22.4%). Delayed intracrainal hematomas are found in 63.7% of patients with skull fracture, and in 24.3% of patiens without skull fracture. They are also highly developed in patients with multiple or long skull fracture. Conclusion: The presence of a skull fracture is the important predictor of intracranial hematoma and influences mamagment of patient. We recommend the routine skull x-ray studies in all head injured patients. If skull fracture is detedcted, the patients then should undergo initial CT scanning and follow-up CT scanning.

복부외상 환자에 관한 임상적 고찰

현석천,박준석,김갑득,송화식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

This report is a retrospective clinical study of 60 patients with abdominal trauma admitted and treated at the department of emergency medicine of DanKuk University hospital during the period from January 1995 to December 1995. we obtained following results. 1) The sex distribution was 45 males(75%) and 15(25%) females with significant predominence in male(3:1), and the age distribution revealed high incidence in second to fourth decades(50%). 2) The cases of the abdominal trauma were traffic accident(80%) in most common, violence, fall down in order frequency. All were blunt trauma. 3) The clinical manifestations and physical examination were abdominal pain(92%), abdominal tenderness, rigidity, decreased bowel sound, rebound tenderness in order frequency. 4) The shock status on admission(below 80 mmHg in systolic) were 10 cases with high mortality(30%). 5) The hematocrit changes in serial check after admission were 36 cases(60%). 6) The diagnostic methods were abdominal paracentesis, simple X-ray, abdominal sonography, abdominal CT, and DPL(Diagnostic Peritoneal Lavage). The abdominal paracentesis showed positive 36 cases(63%) among 48 cases. Abdominal paracentesis was one of the valuable diagnostic method in abdominal trauma. The Abdominal CT was the best diagnostic method in solitary organ injury, but the diagnostic rate was very low(25%) in small bowel injury. 7) The injured intraabdominal organs were small bowel(41%), liver(30%), spleen(20%), and kidney(17%). 8) The commonly associated extraabdominal injury were chest trauma(30%), upper and lower extremity injuries(20%), head trauma(15%). 9) The overall mortality rate was 5%, in abdominal trauma with multiple injury.

복부둔상에서 사망에 영향을 주는 인자

김갑득,송화식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

To evaluate the risk factors affecting mortality in blunt abdominal injury we prospectively analysed 149 abdominal traumatic patients, who were performed laparotomy in 84 cases and conservative management in 65 cases, from January 1st. 1995 to September 30th. 1996. The liver was most frequently injured intraabdominal organ(46.3%), followed by spleen(32.9%), kideny(23.5%), small intestine(16.1%) and mesentery(13.4%). Mortality rate was 19.5%. The cause of death was hemorrhagic shock and its complications in 11 cases, craniocerebral injuries in 7 cases, pulmonary complications in 6 cases, and septic shock in 5 cases. The presence of hypotension(less than 90mmHg), head trauma(above 3 in severity code of abbreviated injury scale(AIS)) and chest trauma(hemothorax and/or pneumothorax) was associated with a high mortality rate(88.9%), but the mortality rate for the patients neither hypotension nor head and chest trauma was very low(1.8%). The mortality in the blunt abdominal injuries was highly influenced by hypotension, head injury and multiple intraabdominal injuries(p<0.05). Of the above influencing risk factors, the associated head injury was the most powerful determinant in the prognosis in the patients of blunt abdominal injuries.

두부 외상 환자의 고혈당과 예후와의 상관관계

현석천,이종안,박준석,박상문,김갑득,장인성,김승열,송화식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Severe head injury is associated with a stress response that includes hyperglycemia, which has been shown to worse outcome during cerebral ischemia. To better define the relationship between head injury and hyperglycemia, admission glucose level were analyzed in 150 head injured patients from January 1995 to December 1995. Our retrospective study demonstrated a higher glucose level in patients with low Glasgow Coma Scale(GCS) score, especially at 3-5 GCS score, compared to those with high GCS scores. Also a higher glucose level was noted in patients with vegetative state and dead than in those with good recovery and moderate disability. Hyperglycemia(serum glucose level≥200mg%) was associated with decreased level of consciousness and a poor outcome. We conclude that admission hyperglycemia is a significant indicator of severity of injury(p<0.001), but not significant predictor outcome from head injury. After controlling for the influence of the GCS score, glucose levels do not have an independent effect on outcome.