성폭력 피해자에 관한 최신의 역학적 분석

원형섭,윤연정,서동엽 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Purpose: It is important for the physician and a rape counselor to understand epidemiology studies of the incidence, prevalence, spread, prevention, and control of sexual assault in a local community or a specific group of individuals. We did this study in order to find an effective treatment for the sexual assault victims and to establish a data base on them. Methods: We prospectively evaluated sexually assaulted patients who visited the Medical Supportive Center for Women at the Nabonal Police Hospital from Oct. 11, 2001, to Oct. 10, 2002. The data were obtained from the records of the ER (emergency room) and OB & GY (obstetric & gynecologic) clinic; a total of 169 patients were evaluated. Results: The mean age was 20.1 years old. The age distribution of sexual assault victims was divided into four: 14 cases under 7 years of age (8.3%), 26 cases between ages 7 and 13 years (15%), 43 cases between ages 14 and 19 years (26.3%), and 86 cases over 20 years of age (52.6%). Of the patients, 157 (92.9%) were unmarried and 117 (69.20/.) were examined within 1 hour after visiting the hospital. The physical injuries were 15 vaginal injuries (26.9%), 34 ruptures of the hymen (16.9%), 1 sexually transmitted disease (0.6%), 57 abnormal sensations of the genital organ (28.3%), and 55 minor injuries including abrasions, contusions, and lacerations (27.3%). The psychological injuries were 105 phobias (21.4%), 92 anxieties (18.8%), 68 angers (13.9), 51 guilts (10.4%), and the like. Eighty-eight patents (52.1%) were acquainted with the assailant. Conclusion: Optimal management of sexual assault victims should involve continuous epidemiologic analysis and the estalishment of an assault-victim data base.

약물과 사회범죄

원형섭,임금숙,원사덕,서동엽 한국병원약사회 2002 병원약사회지 Vol.19 No.4

Because data rape drugs have disinhibiting sedative and amnesiac properties, they are being used to make sexual assault victims helpless. The drugs are usually administered to the victim in an alcoholic drink at a bar club, party, social event and so on. The drugs MDMA, Ketamine, GHB, GBL, Rohypnol, LSD, PCP, and methamphetamine are included in these categories, but it is possible for them to be used frequently in conjunction with alcohol or other drugs. Police departments often say that after ingestion of these drugs, some women have reported waking up in frat houses with no clothes on, finding themselves in unfamiliar surroundings with unfamiliar people, or having actually been sexually assaulted while under the influence of the drug. We only hope that this study may be helpful in establishing a care system for sexual assault victims and in determining of the etiology of sexual assault.

성폭력 증거채취 프로그램의 개략

원형섭,윤연정,서동엽 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Cases of sexual assault are often difficult to investigate and prosecute. The collection of evidence is a crutial factor when determining if such a case will go forward. Evidence contained in a rape kit plays a significant role in whether or not a crime of sexual assault can be prosecuted. It is important not only that the evidence be collected properly but also that the kit itself provide for the proper collection of evidence and materials. Because most hospital emergency departments throughout the country use their own kits, or none at all, there is a vast inconsistency in evidence collection. Different kits collect different amounts of evidence. For this reason, we established a kit committee to evaluate the contents of victim evidence collection kits. We propose that most hospital emergency departments and some clinics across the country be provided with rape kits to be used during forensic medical examinations of sexual assault victims and that those kits should be supplied the Sexual Assault Evience Collection (SAEC) Program, commonly referred to as the Rape Kit Program.

온려, 심통방

원형섭,Won, Hyeong-Seop 대한한약협회 1998 大韓漢藥 Vol.2 No.-

응급실로 내원한 장중첩증의증 환아의 진단방법에 대한 임상적 고찰

원형섭,박정배,표창해,김형수,박철완,이근 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The purpose of this study is to evaluate the appropriate diagnostic methods for the patients with suspected intussusception. Intrssusception is a state that a portion of alimentary tract is telescoped into a segment just caudad to it, and has a characteristic symptoms of cyclic irritability, vomiting, bloody stools and palpable mass, It is the most common cause of acute or acquired intestinal obstruction in infants and children, and needs early diagnosis and immediate treatment. Authors reviewed retrospectively medical records of 411 infants & children with suspected intussusception from January 1, 1992 to December 31, 1994 and report the results with literature reviews. The results were as followings; 1) 263 cases were definite intussusception(DI) out of 411 suspected intussusception(SI). 2) The male to female ratio was 2.3 : 1 in SI and 2.8 : 1 in DI. 3) The distribution of age revealed that 85% of SI and 84% of DI were under 24 months old, and the most common age was 8 months in SI and 10 months in DI. 4) There were upper respiratory infection in 84 cases(2)%), gastroenteritis in 32 cases(8%) and bronchiolitis in 8 cases(2%) as preceding diseases. 5) The simple X-ray showed gaseous bowel distension in 212 cases(52%). 6) The most common symptoms and signs were cyclic irritability and abdominal pain(94%), bloody stools(72%), palpable abdominal mass(47%), in order. 7) Of 411 patients, 252 cases(61%) were diagnosed and treated by air enema(228 cases) and/or exploration(24 cases). Among 296 cases(72%) who showed bloody stools in digital rectal examination and glycerin enema, 245 cases(83%) were confirmed as intussusception through air enema and/or operative intervention, and that corresponds to 93% of DI. 8) Intestinal perforation as complication occurred in 3 of 393 cases who underwent air and barium enema, but all of them recovered without any sequelae after operation. Conclusively, it is thought that air enema preceded by digital rectal examination and glycerin enema is safe and useful method in diagnosis and treatment of infants and children with SI.

흉골 골절의 의의에 관한 임상적 연구

원형섭,황성연,박정배,이준형,박철완,이근 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

It has been known that sternal fracture increases the risk of potentially life-threatening injuries, such as myocardial, pulmonary, and thoracic vascular injuries, and it has 25% to 45% of mortality, primarily resulting from these underlying injuries. The authors reviewed retrospectively the medical records and radiographic findings of the patients who admitted with sternal fracture at Chung Ang Gil Hospital from 1 June 1994 to 31 December 1995 to evaluate the significance and clinical course of sternal fracture. The results were followings: 1. The male to female ratio was 3:2 and the mean age was 43.1 and 45.4 years old in male and female, respectively. 2. Motor vehicle occupant accident was the most common cause of sternal fracture. 3. Of 33 cases, there was no death, but common associated injuries which were rib fracture, hemothorax, lung contusion, vertebral fracture, penumothorax, long bone fracture, myocardial contusion, flail chest, facial chest, facial bone fracture, and pericardial effusion, in order. 4. The clinical course of sternal fracture was determined primarily by associated injuries except for communited sternal fracture. 5. The patients with isolated sternal fracture, who had an otherwise normal chest x-ray, normal electrocardiogram, no other significant associated injuries and are hemodynamically stable, had a benign clinical course.

사지의 주요 동맥손상의 처치: 23증례에 대한 분석

원형섭,김상은,배성만,박철완,이 근,조상훈,김상일,우병완 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Extremity vascular trauma is common in most emergency centers, and controversy remains about the optimal management of arterial injuries. Retrospectively we reviewed the records of 23 patients who had upper or lower extremity arterial trauma from July 1994 to December 1995. The purpose of this study was to evaluate our department`s management policy to major arterial injuries. The leading cause of major arterial injuries was penetrating trauma. We found that there were clinical findings such as absence of or decreased strength of pulsation(82.6%), cool ischemic extremity(69.6%), large expanding hematoma(43.5%), major bleeding(17.4%) and bruit or thill(8.7%). We gave the priority to management of life-threatening injuries and applied the pressure dressing to wounds as early as possible. There were 18 men(78.3%) and 5 women(21.7%); the mean age was 35(range 20-56 years old) years. There were 12 arterial injuries(52.2%) in the upper extremity and 11 arterial injuries(47.8%) in the lower exteremity. The most commonly injured artery was the brachial artery in the upper(34.8%) and the femoral artery in the lower(30.4%) extremity. The etiology included knife stabbing in 10 patients(43.5%), motor vehicle accidents in 6(26.1%), industrial accidents in 4(17.4%), falls in 2(8.7%) and a farm equipment accident in 1 patient(4.3%). The associated injuries were muscle injuries(78.3%), fracture(56.5%), nerve injuries(52.2%), vein injuries(43.5%), shock(17.4%) and dislocation(13.0%). All patients with arterial injuries were given a preoperative prophylactic antibiotic and TIG(tetanus immunoglobulin). We used Doppler technique as a means of detecting the blood flow. Fourteen patients(60.9%) underwent preoperative arteriography in the radiology department. We performed surgical exploration as soon as major arterial injuries were suspected. The most common methods of treating major arterial injuries were interposition vein graft(69.6%) and end to end anastomosis(21.7%). Systemic or locally infused heparin was used for all vascular repairs. In many of our patients(56.5%), fasciotomy was performed before the vascular repair, as a part of the exploration of the distal arteries. There were 2 amputations(8.7%) but no death. The reason for secondary amputation were wound infection in one and failure to achieve sufficient arterial flow to the involved extremity with resulting gangrene in the other. As the time factor is vitally important in the management of arterial injuries, we advocate prompt and early surgical treatment within 6 hours of the trauma. In conclusion, we believe that the crucial factorsin successful management of major arterial injuries of the extremities are early diagnosis, prompt treatment, complete debridement, fasciotomy when indicated, and simultaneous treatment of concomitant injuries.

파상풍 환자의 치료1례

김동필,원형섭,김명천,안효용,고영관 대한응급의학회 1998 대한응급의학회지 Vol.9 No.2

Tetanus is a rare in the developed countries, including Korea as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thigh at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.

혼수환자 193예의 임상적 고찰

정호성,원형섭,박철완,이근 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

We performed a clinical analysis of 193 cases of comatose patients who visited to the emergency department of Chung Ang Gil Hospital from January 1993 to December 1993. The results were summarized as follows : 1. The incidence of comatose patients was 0.4%(193 cases of total 49061 patients). 2. There were 70 cases of traumatic coma(36.2%) and 123 cases of nontraumatic coma(63.7%) 3. The male to female ratio was 1 : 0.9, traumatic comatose patients were mainly male(26.4%) and nontraumatic comatose patients mainly female(38.3%) 4. The highest incidence of traumatic comatose patients was among third decade patients(9.8%) and for nontraumatic comatose patients the highest incidence was among eighth decade patients(13.5%). 5. The month which was visited most frequently by comatose patients was August(14%) and both January and December were next with(12.4%). The nontraumatic comatose patients had seasonal variations but the traumatic comatose patients had no concern with seasonal variation. 6. The cause of nontraumatic coma was mainly diffuse and metabolic brain dysfunction and it's incidence was 36.8%(71 cases of total 193 patients). 7. 16 traumatic coma patients(32.7%) had arterial hypoxia and 90 nontraumatic coma patients(44.4%) had arterial hypoxia. So, It is important for prehospital care to prevent irriversible change of brain function. 8. In long-term outcome, 24 cases of the nontraumatic patients(19.5%) were good-outcome out of a total 123 and 10 cases of the traumatic comatose patients(14.3%) were good-outcome out of a total of 70. We conclude that nontraumatic metabolic brain dysfunction is more common than other causes and the prognosis of much better. We must have interest in these cases. Prehospital care and rapid management in E.D. must be initiated to prevent irreversible neurological change.

사지의 급성동맥 색전증에 대한 응급동맥 색전제거술

박철완,원형섭,박정배,이근,조상훈,표창해,김상일 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Acute arterial occlusion of the extremities is often a surgical emergency and is due mostly to arterial embolus. It has infrequently been reported in the emergency department. Cardiac embolism is most commonly the result of atrial fibrillation secondary to valvular heart disease followed by ischemic heart disease. The emergency arterial embolectomy by Fogarty balloon catheter works well when the cause of occlusion is cardiac embolus obstructing normal vessels in a patient with valvular heart disease. Recently we met some patients with acute critical ischemia of the extremities due to arterial emboli in our emergency department. On physical examination, they all had symptoms of 5"P"s(pain, pallor, pulselessness, paresthesia, paralysis). After emergency arterial embolect omy, immediate improvement was observed in all patients. They were discharged within 1 week. We report our experiences with the review of literatures.