흰꽃독말풀 열매 달인 물 복용 후 발생한 의식 변화 환자 1례

유제성,남연우,이진희,정성필,김승호,박인철,You Je-Sung,Nam Yeoun-Woo,Lee Jin-Hee,Chung Sung-Pil,Kim Seung-Ho,Park In-Cheol 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Datura stramonium is a wild growing plant, consumption of which can result in severe toxicity. It contains a variety alkaloids include atropine, hyoscamine, and scopolamine that can all cause anticholonergic poisoning. It has been use of herb medicine in Korea. Side effects from ingesting Datura stramonium include dry mouth, blurred vision, photophobia, and may be followed by hyperthermia, confusion, agitation, hallucination, and aggressive behavior. In severe toxicity, it can cause seizure, coma, life-threatening arrhythmia, and death. We experienced one patient who developed stupor mentality caused by Datura stramonium. Severe presentation, especially mental change of Datura stramonium should draw attention. Poisoning associated with Datura stramonium can be prevented through educational public health program.

Clinical Features of Fitz-Hugh-Curtis Syndrome in the Emergency Department

유제성,박인철,김민정,정현수,정용은,정성필,김승호,이한식 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.4

Purpose: Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. Materials and Methods: We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. Results: During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. Conclusion: FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.

Imaging Findings of Liposuction with an Emphasis on Postsurgical Complications

유제성,정용은,백송이,정성필,김명진 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.6

Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.

삼일열 원충(Plasmodium vivax) 감염에 의한 부정맥 및 심막 삼출액 발생 1예

유제성,이진희,정성필,구홍두,박인철 대한감염학회 2006 Infection and Chemotherapy Vol.38 No.6

Plasmodium vivax is a typically seen infectious disease in Korea. The incidence of Plasmodium vivax malaria has been increasing in recent year despite of worldwide attempts at control. Fever, anemia, thrombocytopenia, and splenomegaly are the most common manifestations seen in Korean patient with P. vivax. Cardiac involvement is thought to be a very rare complication of malaria infection. Cardiac complication seems to be limited to acute infection with Plasmodium falcifarum. However we have experienced cardiac complication such as pericardial effusion, and complete AV block by Plasmodium vivax. Physicians should consider cardiac involvement in patient who present hypotension, fever and arrhythmia in malaria endemic area. 말라리아에 감염되었을 경우, 고열 외에 뇌형 말라리아, 급성신부전, 급성 폐부종, 저혈당, 세균성 감염 등의 합병증을 유발하는 것으로 알려져 있다. 드물지만, 외국에서는 열대열 원충에 의해 부정맥이나 심막 삼출액 등과 같은 심장 질환이 발생한 보고도 있다. 하지만 본 예와 같이 삼일열 원충에 의해서도 서맥, 2도, 3도 방실결절 차단의 부정맥과 심막 삼출액 발생할 수도 있다. 말라리아가 빈발하는 지역에서 이런 증상의 환자를 발견하는 경우, 반드시 말라리아 감염을 의심하고, 적절한 진단 및 치료가 이루어지도록 해야 할 것이다. 저자들은 삼일열 원충에 의해 부정맥 및 심막 삼출액이 발생한 환자 1예를 경험하였기에 보고하였다.

아스피린 중독에 의한 심전도 변화 2례

유제성,박종우,최영환,조영순,조광현,박준석,정성필,이한식,You Je-Sung,Park Jong-Woo,Choi Young-Hwan,Cho Young-Soon,Cho Kwang-Hyun,Park Jun-Seok,Chung Sung-Pil,Lee Hahn-Shick 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial infarction. We report 2 cases of young women with aspirin overdose who exhibited ischemic changes on their ECGs a few hours after the ingestion with spontaneous recovery in a few days. First case, a 29 year old woman, presented to the emergency department 6 hours after ingesting 250 tablets of aspirin (325 mg/T). On examination, the temperature was $36.3^{\circ}C$: blood pressure, 105/72mmHg; Pulse, 111/min and respiratory rate, 24/min. Second case, a 27 year old woman, an hour after ingesting 60 tablets (325mg/T). On examination, the temperature was $36.0^{\circ}C$: blood pressure, 102/72 mmHg; pulse, 89/min and respiratory rate, 25/min. In both cases, ECG after 6 hours of ingestion had sinus tachycardia and developed T wave inversion on the anterior leads in the following ECGs. Their initial serum salicylate levels after 6 hours of ingestion were 71.2 mg/dL and 28.4 mg/dL respectively. These salicylate levels were resolving when these ECGs were observed. The ECG changes resolved in the following days and they were discharged without any further symptoms. Further studies are needed, but for the time being, when dealing with salicylate overdose, transient cardiac depression should be kept in mind to avoid adverse ischemic cardiac events.

Thrombotic Microangiopathy Score as a New Predictor of Neurologic Outcomes in Patients after Out-of-Hospital Cardiac Arrest

유제성,이혜선,전소영,이종욱,정현수,정성필,공태영 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.5

Purpose: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial asit can be automatically and accurately measured. This study aimed to investigate whether serial TMA scores until 48 h post admissionare associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospitalcardiac arrest (OHCA). Materials and Methods: We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed TMAscores at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurological outcome at dischargeand 30-day mortality. Results: Increased TMA scores at all measured time points were independent predictors of poor neurological outcomes and 30-day mortality, with TMA score at time-12 showing the strongest correlation [odds ratio (OR), 3.008; 95% confidence interval (CI),1.707–5.300; p<0.001 and hazard ratio (HR), 1.517; 95% CI, 1.196–1.925; p<0.001]. Specifically, a TMA score ≥2 at time-12 was closelyassociated with an increased predictability of poor neurological outcomes (OR, 6.302; 95% CI, 2.841–13.976; p<0.001) and 30-daymortality (HR, 2.656; 95% CI, 1.675–4.211; p<0.001). Conclusion: Increased TMA scores predicted neurological outcomes and 30-day mortality in patients undergoing TTM afterOHCA. In addition to the benefit of being serially measured using an automated hematology analyzer, TMA score may be a helpfultool for rapid risk stratification and identification of the need for intensive care in patients with return of spontaneous circulationafter OHCA.

삼일엽 원충(Plasmodium vivax)감염에 의한 부정맥 및 심막 삼출액 발생 1예

유제성,이진희,정성필,구홍두,박인철 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

말라리아에 감염되었을 경우, 고열 외에 뇌형 말라리아, 급성신부전, 급성 폐부종, 저혈당, 세균성 감염 등의 합병증을 유발하는 것으로 알려져 있다. 드물지만, 외국에서는 열대열 원충에 의해 부정맥이나 심막 삼출액 등과 같은 심장 질환이 발생한 보고도 있다. 하지만 본 예와 같이 삼일열 원충에 의해서도 서맥, 2도, 3도 방실결절 차단의 부정맥과 심막 삼출액 발생할 수도 있다. 말라리아가 빈발하는 지역에서 이런 증상의 환자를 발견하는 경우, 반드시 말라리아 감염을 의심하고, 적절한 진단 및 치료가 이루어지도록 해야 할 것이다. 저자들은 삼일열 원충에 의해 부정맥 및 심막 삼출액이 발생한 환자 1예를 경험하였기에 보고하였다. Plasmodium vivax is a typically seen infectious disease in Korea. The incidence of Plasmodium vivax malaria has been increasing in recent year despite of worldwide attempts at control. Fever, anemia, thrombocytopenia, and splenomegaly are the most common manifestations seen in Korean patient with P. vivax. Cardiac involvement is thought to be a very rare complication of malaria infection. Cardiac complication seems to be limited to acute infection with Plasmodium falcifarum. However we have experienced cardiac complication such as pericardial effusion, and complete AV block by Plasmodium vivax. Physicians should consider cardiac involvement in patient who present hypotension, fever and arrhythmia in malaria endemic area.

소아 열상 처치에서 적절한 용량의ketamine과 midazolam 병용 근육주사의 진정효과

유제성,조영순,최영환,김승환,이한식,이진희 대한소아청소년과학회 2006 Clinical and Experimental Pediatrics (CEP) Vol.49 No.7

목 적 : 소아의 통증을 수반하는 술기의 시술시에 진통, 진정을 위해 ketamine을 사용하는데, midazolam을 병용 투여 할 필요가 있는가에 대한 논의가 활발하게 진행되고 있다. ketamine의 근육주사의 적정용량은 국내에서 연구된 바가 없으며 저자들은 이전 연구에서 ketamine 3 mg/kg가 부족하다는 결론을 얻어 용량을 4 mg/kg로 증량하여 KMA(ketamine+midazolam+atropine)와 KA(ketamine+atropine)의 진정 및 부작용 발생 여부의 차이를 알아보고자 하였다. 방 법 : 2005년 1월부터 2005년 7월까지 열상처치 시 진정이 필요한 생후 3개월에서 7세까지의 60명의 소아를 대상으로 KMA군(IM ketamine 4 mg/kg+atropine 0.01 mg/kg+intramuscular midazolam 0.05 mg/kg) 혹은 KA 군(without midazolam)을 무작위로 선택하여 anxiety/tolerance scores, 합병증, 진정정도, 진정유도시간, 진정회복시간, 총 진정시간, 시술자의 만족도를 기록하였다.결 과 : 두 군간에 성비, 체중, 연령, 상처 부위에는 통계학적으로 유의한 차이가 없었으며anxiety/tolerance score, 진정유도시간, 진정회복시간, 총 진정시간에는 두 군간에 통계적으로 유의한 차이가 없었다. 효과적 진정을 보인 경우가 KA군은 66.7 %, KMA군은 90.9%로 KMA군이 진정에 보다 효과적이었으며(P=0.02), 시술자의 만족도는 KA군은 55.6%, KMA군은 90.9%로 만족, 매우 만족 이상으로 유의한 차이를 보였다. 의미 있는 부작용의 발생은 KA군은 37.0%, KMA군은 0.0%였다. Purpose : We reported previously that intramuscular ketamine with adjunctive midazolam is more effective than ketamine alone in pediatric procedural sedation, but with limited satisfactory sedation by suboptimal ketamine dose. The optimal dose of intramuscular ketamine in children has never been studied in Korea. In this study, we investigated the effectiveness and adverse events of ketamine 4mg/kg with adjunctive midazolam in pediatric laceration repair. Methods : From Jan. 2005 to July 2005, we enrolled 60 children, aged 3 months-7 years, who needed laceration repair under sedation. After verbal consent from parents, patients were randomly assigned to KMA group(IM ketamine 4 mg/kg+atropine 0.01 mg/kg+intramuscular midazolam 0.05 mg/kg) or KA group(without midazolam). We compared both groups with the induction time, recovery time, total sedation time, efficacy of sedation, adverse effects, and the satisfaction score of treating physicians. Results : Potentially confounding variables, age, weight, injury site and anxiety score, were similar between groups. The induction time, recovery time and total sedation time were not different statistically. In KMA group, 90.9 percent of patients showed satisfactory sedation compared to 66.7 percent of KA group(P=0.02) and the occurrence rate of significant adverse effect was 0.0 percent and 37.0 percent respectively. Conclusion : We found adjunctive midazolam with ketamine doses of 4 mg/kg IM produced more effective, satisfactory sedation and less adverse effect than without midazolam in pediatric laceration repair. The emergence phenomenon(agitation during recovery) only occurred in 9 KA group patients. In spite of adverse effect, all patients recovered, were discharged and there were no reported delayed events.

Evaluating the Utility of Rapid Point-of-Care Potassium Testing for the Early Identification of Hyperkalemia in Patients with Chronic Kidney Disease in the Emergency Department

유제성,정성필,박유석,정현수,이혜선,주영선,박종우,이신호,이한식 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: Severe hyperkalemia leads to significant morbidity and mortality if it is not immediately recognized and treated. The concentration of potassium (K+) in the serum increases along with deteriorating renal function. The use of point-of-care K+ (POC-K+) in chronic kidney disease (CKD) could reduce the time for an accurate diagnosis and treatment, saving lives. We hypothesized that POC-K+ would accuratelyreport K+ serum level without significant differences compared to reference testing, regardless of the renal function of the patient. Materials and Methods: The retrospective study was performed between January 2008 and September 2011 at an urban hospital in Seoul. The screening program using POC was conducted as a critical pathway for rapid evaluation and treatment of hyperkalemia since 2008. When a patient with CKD had at least one warning symptom or sign of hyperkalemia,both POC-K+ and routine laboratory tests were simultaneously ordered. The reliability of the two assays for serum-creatinine was assessed by intra-class correlationcoefficient (ICC) analysis using absolute agreement of two-way mixed model. Results: High levels of reliability were found between POC and the laboratory reference tests for K+ (ICC=0.913, 95% CI 0.903--0.922) and between two tests for K+ according to changes in the serum-creatinine levels in CKD patients. Conclusion:The results of POC-K+ correlate well with values obtained from reference laboratorytests and coincide with changes in serum-creatinine of patients with CKD.

Optimal Seat and Footrest Positions of Manual Standing Wheelchair

유제성,손종상,조민,최은경,안순재,김신기,김영호 한국정밀공학회 2017 International Journal of Precision Engineering and Vol.18 No.6

A standing wheelchair is highly recommended to an individual suffering from secondary complications due to long-term sitting in a standard wheelchair. However, the newly-designed standing wheelchair has hand rims separate from the wheels, likely affecting the biomechanical characteristics and the efficiency of propulsion. The objectives of this dissertation were aimed to propose a method to determine the optimal riding position by evaluating energy expenditure during manual standing wheelchair propulsion. Ten elderly male subjects were asked to propel the hand rims with nine different seat (while sitting) and footrest (while standing) positions. During the experiments, kinematic and kinetic data were simultaneously obtained using a 3D motion capture system and a brake-type wheelchair dynamometer, respectively. Upper-limb joint torques and total propulsion energy were determined using a planar link-segment model with the optimization technique based on minimal joint torque criteria. Shorter subjects had the lowest total propulsion energy expenditure in the downward-forward and middle-forward positions, while closest to the hand rims. However, taller subjects had the lowest total propulsion energy expenditure in the downward-center and middle-center positions, while a little further from the hand rims. We believe that these methods and results will be helpful in assessing the adequacy of the riding position of various types of wheelchair.