정상혈압 폐색전증에서 위험도 평가도구로서의 D-dimer의 역할

윤재철 ( Jae Chol Yoon ),김원영 ( Won Young Kim ),최상식 ( Sang Sik Choi ),정상구 ( Sang Ku Jung ),손창환 ( Chang Hwan Sohn ),김원 ( Won Kim ),임경수 ( Kyoung Soo Lim ),정태오 ( Tae O Jeong ),진영호 ( Young Ho Jin ),이재백 ( Jae 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.2

Background: D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE. Methods: A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile. Results: In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94 [IQR: 4.03∼18.17] μg/mL) was higher than in patients with a benign course (5.29 [IQR: 2.60∼11.52] μg/mL, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <2.76 μg/mL) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%. Conclusion: Patients with D-dimer levels below 2.76 μg/mL have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.

급성 유기인계 중독과 관련된 초기 심전도 변화

이환중,윤재철,정태오,진영호,이재백,Lee, Hwan-Jung,Yoon, Jae-Chol,Jeong, Tae-O,Jin, Young-Ho,Lee, Jae-Baek 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: Various electrocardiogram (ECG) changes can occur in patients with acute organophosphate poisoning (OPP) and may be associated with the clinical severity of poisoning. The present study aimed to evaluate the extent and frequency of ECG changes and cardiac manifestations, and their association with acute OPP clinical severity. Methods: Seventy-two adult patients admitted to our emergency department with a diagnosis of acute OPP were studied retrospectively. ECG changes and cardiac manifestations at admission were evaluated. ECG changes between respiratory failure (RF) group and no respiratory failure (no RF) groups were compared. Results: Prolongation of QTc interval (n=40, 55.6%) was the most common ECG change, followed by sinus tachycardia (n=36, 50.0%). ST-T wave changes such as ST segment elevation or depression and T wave change (inversion or non-specific change) were evident in 16 patients (22.2%). Prolongation of QTc interval was significantly higher in the RF group compared with the no RF group (p=0.03), but was not an independent predictor for RF in acute OPP (OR; 4.00, 95% CI; 0.70-23.12, p=0.12). Conclusion: While patients with acute OPP can display ECG changes that include prolongation of QTc interval, sinus tachycardia, and ST-T wave changes at admission, these changes are not predictors of respiratory failure.

소방헬기를 이용하여 직접 내원한 외상환자의 분석: 3차 의료기관으로의 이송의 적절성 평가

송송원 ( Song Won Song ),윤재철 ( Jae Chol Yoon ),이부수 ( Boo Soo Lee ),김우주 ( Woo Joo Kim ),안지윤 ( Ji Yoon Ahn ),오범진 ( Bum Jin Oh ),임경수 ( Kyung Su Lim ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Purpose: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. Methods: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS≤15, and mCTAS≥3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. Results: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS≤15 group 30 cases (62.5%) and mCTAS≥3 group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). Conclusion: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter. (J Korean Soc Traumatol 2006;19:159-163)

물레고동 섭취 후 발생한 테트라민 중독 2례

김소은 ( So Eun Kim ),이재백 ( Jae Baek Lee ),진영호 ( Young Ho Jin ),윤재철 ( Jae Chol Yoon ),조시온 ( Si On Jo ),이정문 ( Jeong Moon Lee ),정태오 ( Tae Oh Jeong ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.1

Some carnivorous gastropods have heat stable tetramine toxins in their salivary glands. This toxin is an autonomic ganglionic blocking agent that enables them to catch the prey easily by paralyzing their targets. Acute tetramine toxin poisoning in humans from eating whelks has been well described based on numerous cases, but is rare in Korea. Symptoms of tetramine poisoning include eyeball pain, blurred vision, headache, dizziness, muscular twitching, tingling of hands and feet, weakness, paralysis and sometimes collapse. Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting can also occur. However, intoxication is self-limiting and patients will usually recover in about 24 hours. Herein, we report 2 cases of tetramine poisoning after ingestion of Buccinum striatissinum as meat and soup.

급성 엔도설판 중독의 임상적 고찰

김소은 ( So Eun Kim ),김수익 ( Su Ik Kim ),이재백 ( Jae Baek Lee ),진영호 ( Young Ho Jin ),정태오 ( Tae Oh Jeong ),조시온 ( Si On Jo ),윤재철 ( Jae Chol Yoon ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. Methods: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. Results: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. Conclusion: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.

흉부 둔상에 의해 발생한 내흉동맥 손상의 카테터경유 혈관색전술 치료 경험

최석진 ( Seok Jin Choi ),정태오 ( Tae Oh Jeong ),이재백 ( Jae Baek Lee ),윤재철 ( Jae Chol Yoon ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

The aorta is the most common major thoracic artery injured by blunt chest trauma. Injuries to major aortic arch branch arteries can also occur but are much less common than aortic injuries in the setting of blunt trauma. Although internal mammary artery (IMA) injury is uncommon and rarely diagnosed in cases of blunt chest trauma, it is one of the important sources of bleeding in chest trauma. IMA bleeding can cause ongoing blood loss and may lead to serious conditions such as extensive hemothorax, anterior mediastinal hematoma or its catastrophic complication, cardiac tamponade. However such arotic and branch artery injuries are not easily detected by plain radiograph, and are detected indirectly because of associated mediastinal hematoma. Herein, we report a case of IMA injury caused by blunt chest trauma secondary to pedestrian traffic accident. The injured patient was successfully treated by transcatheter arterial embolization (TAE). (J Trauma Inj 2012;25:296-299)

건강한 젊은 성인에서 액상 물질 한 모금 삼킴량의 측정

김수익 ( Su Ik Kim ),강지훈 ( Ji Hun Kang ),이동익 ( Dong Ik Lee ),조정열 ( Jeong Ryul Jo ),김형준 ( Hyung Jun Kim ),이재백 ( Jae Baek Lee ),진영호 ( Young Ho Jin ),정태오 ( Tae Oh Jeong ),윤재철 ( Jae Chol Yoon ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2

Purpose: The aim of this study is to estimate one mouthful volume in a single swallow and average volume per swallow (AVS) in multiple swallows in the situation of toxic liquid poisoning. Methods: Thirty five men and 35 women were included in this study. Each subject was asked to drink one swallow and three consecutive swallows from bottle containing water and a bottle containing saline separately. We calculated one mouthful volume in a single swallow and AVS in three swallows. One mouthful volume and AVS were compared according to sex and content, respectively. One mouthful volume of water and saline was then compared with AVS of each. Results: Sixty seven adults(34 men; 26.9±3.2 years, 33 women; 25.6±2.4 years) completed the study. Men had larger one mouthful volume of water(49.1±19.9 ml vs 39.7±10.2 ml, p=0.02) and saline(20.7±10.9 ml vs 14.0±4.6 ml, p=0.004) and AVS of water(28.5±11.9 ml vs 21.5±5.9 ml, p=0.004) and saline(11.9±6.3 ml vs 7.9±2.0 ml, p=0.001) than women. One mouthful volume and AVS of saline swallow were lower than those of water swallow. AVS of three consecutive swallows was lower than one mouthful volume in water and saline swallow. Conclusion: We suggest that one mouthful volume in a single swallow is 21 ml in men and 14 ml in women and AVS in multiple swallows is 12 ml in men and 8 ml in women. AVS in multiple swallows is two-threefold lower than reference values(20~30 ml) commonly used in poisoning study.

특발성 자발성 신장 파열 1예

윤재철,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Primary aldosteronism is a syndrome characterized by hypertension, hypokalemia, suppressed plasma renin activity, and elevated serum aldosterone levels. Conn first described it 1955 in association with adrenal cortical adenoma(Conn's syndrome). Today, it can be divided into at least six distinctive sub-groups. The diagnosis of primary aldosteronism is usually suspected when the patient presents with poorly controlled hypertension with hypokalemia. The main issues in the evaluation of primary aldosteronism are to differentiate an adenoma from hyperplasia and to localize the adenoma. Basic hormonal studies and computed tomographic(CT) scanning can be used effectively for that differentiation. An adenoma is one of a few potentially curable forms of hypertension, and it is best treated by removing the adrenal tumor. We experienced a case of a typical adrenal adenoma. The patient was a 37-year-old male who had experienced in both his legs over a period of several days a weakness due to hypokalemia. He was diagnosed using basic hormonal studies and adrenal CT scanning. After, he received laparoscopic adrenalectomy and was discharged with improved condition.