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성윤업(Yun Up Sung),김상훈(Sang Hoon Kim),강윤정(Yun Jung Kang),신종욱(Jong Wook Shin),임성용(Seong Yong Lim),고형기(Hyoung Gee Koh),박인원(In Won Park),최병휘(Byung Whi Choi),허성호(Sung Ho Hue) 대한내과학회 1995 대한내과학회지 Vol.49 No.4
N/A Background: The cervical injuries may impose a fatal result or permanent neurologic damage with multiple severe complications. Moreover most early deaths following acute cervical injury are due to pulmonary complications in spite of recent improvements in respiratory management. Objectives: With a comprehensive evaluation of pulmonary complications, the cervical injured patients with pulmonary dysfunction have a proper opportunity to be treated. Therefore it is important to know the incidence and the sorts of pulmonary complications in patients with cervical cord injury and to assess the important factors affecting on the development of pulmonary complications after cervical cord injury. Methods: The authors reviwed 84 patients who had visited Chung-Ang University Hospital due to cervical injury from 1988 to 1933. And the clinical data were analyzed according to the etiology of injury, injury level, presence or absence of pulmonary complications, neurologic status of the patients, associated trauma and multiple cervical fractures. Results: 1) The pulmonary complications occurred in 25 (28.6%) of the 84 patients with cervical injury. 2) The most common pulmonary complication was pneumonia (59.4%). Atielectasis and acute respiratory failure occurred in 5 patients respectively (15.6%). 3) Without complete neurolgic deficit, the development of pulmonary complications was primarily not dependent on the level of cervical cord injury. 4) The inportant factors affecting on the development of pulmonary complications were as follows Age over 50 years, initial neurologic status above grade C on Frankel classification, previous pulmonary diseases, associated trauma or head trauma and multiple cervical fractures. 5) There was significant difference in the patient distribution between the survivors (31.2%) and the non-survivors (62.5%) among the patients with pulmonary complications whose initial neurologic status was grade A. 6) The most common cause of death was pneumonia Conclusion: In patients with cervical cord injury the incidenc rate of pulmonary complication would be increased in patients with poor neurologic status, old age, previos underlying pulmonary diseases, associated trauma and multiple cervical fractures. Therefore in these patients, especially with pneumonia, intensive respiratory management is required.
원저 : 만성 폐쇄성 폐질환에서 급성 호흡부전 발생시 Simplifed Acute Physiology Score에 따른 단기예후의 평가
이상표 ( Sang Pyo Lee ),성윤업 ( Yun Up Sung ),김상훈 ( Sang Hoon Kim ),김봉식 ( Bong Sik Kim ),김영준 ( Young Jun Kim ),박인원 ( In Won Park ),최병휘 ( Byung Whui Choi ),허성호 ( Sung Ho Hue ) 대한결핵 및 호흡기학회 1993 Tuberculosis and Respiratory Diseases Vol.40 No.5
악성 , 결핵성 및 비특이성 흉막염 환자의 임상적 특성
김봉식(Bong Sik Kim),김상훈(Sang Hoon Kim),성윤업(Yun Up Sung),이상표(Sang Pyo Lee),박인원(In Won Park),최병휘(Byung Whui Choi),허성호(Sung Ho Hue),서승천(Seung Chun Seo) 대한내과학회 1995 대한내과학회지 Vol.48 No.1
N/A Objectives: The role of pleural biopsy in the evaluation of unexplained exudative pleural effusion has been well established. Although repeat pleural biopsy will increase the diagnostic yield in patients ultimately proven to have malignant or tuberculous pleuritis, it will increase the expense and morbidity of patients with nonspecific pleuritis. The identification of patients who should undergo additional diagnostic procedures is a difficult but important clinical problem. The purpose of this study was to determine if patients with nonspecific pleuritis could be distinguished from those with malignant or tuberculous pleuritis by clinical criteria. Methods: The medical records and chest roentgenograms of 93 patients who had pleural tapping and pleural biopsy performed during the five-year period from January 1986 to December 1990 at the department of Internal Medicine, Chung-ang University Hospital were reviewed. Results: The five clinical criteria, ie, fever, weight loss, pleurtitic chest pain, above moderate amount of pleural effusion, lymphocytosis of greater than 90 percent in pleural fluid, were observed significantly more often in the patients who were diagnosed to have either malignant or tuberculous pleuritis. The positive predictive value of the criteria, ie, the probability of the patient having tuberculous or malignant pleural disease, was 89 percent when one criterion was present and increased to 95 percent if two criteria were present. Conclusions: Based on our observations, we recommend the following diagnostic approach to the evaluation of an unexplained exudative pleural effusion. If the initial pleural biopsy reveals nonspecific pleuritis only in a patient without any of the above five criteria, further pleural biopsies are not needed, and the patient is followed up clinically. When two or more criteria are present, an aggressive diagnostic approach including repeat pleural biopsy is recommended.