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과호흡증후군 환자에서 이온화칼슘,마그네슘과 산-염기상태의 변화에 대한 고찰
윤천재,정순미,장문준,이한식 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.3
Background. Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation for this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt, But6 clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hyperventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. Method and Material, 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan. 1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank, sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. Results. 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mm/l, 106mm/l each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO₂ 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dl, 0.16mg/dl lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. Conclusion. We conclude that other than decrement of ionized calcium, decrement of ionized magnesium could be a factor for inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.
윤천재,김욱진,구홍두,김승호 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4
Shock is often the final pathway through which a variety of pathologic processes lead to cardiovascular failure and death. The purpose of this study is to determine the value of serum lactate as a predictor of outcome in shock patient. We investigated the correlation between serum lactate levels and mortality in 42 patients whose systolic BP were below 90mmHg on initial presentation. Serial arterial blood lactate level were measured on admission and every 4 hours for one day. 29 patients were survived. Initial BP was not different between survivors and nonsurvivors. Lactate levels were significantly higher in the nonsurviviors than survivors(p<0.05). But, there were no difference in lactate clearance between survivors and nonsurvivors(p>0.05). 24 hours survival rate was 42.9% in patients whose lactate levels were above 100mg/dl initially and statistically significant in comparison with patients whose lactate levels were below 100mg/dl(p<0.01). The latters' survival rate was 85.7%. Our data suggest that initial lactate level could be correlated with the prognosis of shock patient.
응급진료센터에서의 전산화단층촬영 : ANALYSIS ON APPLICATION OF HEALTH INSURANCE 의료보험 적용에 대한 분석
윤천재,정순미,장문준,김승호 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4
A CT scan has been covered by an insurance since January 1, 1996. As a complication, it resulted in auditting many cases. The insurance lists some guidelines(approval and disapproval). In our experiences, the guidelines were not net the exact usefulness of CT and may disturb the doctor's decision for patient disposition. This study was focused on verifying the irrationality of the current guidelines. We retrospectively reviewed the charts of consecutive 189 patients who underwent CT scans during this period. The results were as follows: 1) The total cases were 228. 2) Fifty three of 228 cases were auditted. 3) Thirty four of 52 cases were brain CT scans which were taken for sudden headache (including post-traumatic headache and vertigo). Ten of 52 cases were chest CT and 4 of 10 were taken to search blebs and bullae resulting in pneumothorax. These can be included not only in the approval guidelines but also in the disapproval guidelines. This result indicates that approval and disapproval guidelines are inappropiate in many ways. Newer criteria should be considered to solve this confusion.
윤신교,김미소,홍용상,김한상,김승태,김지훈,윤홍석,유창훈,안희경,김효송,이인희,김인호,박인근,정재호,천재경,김진원,윤지나,임선민,차용준,장세진,장대영,김태원,강진형,김지현 대한암학회 2022 Cancer Research and Treatment Vol.54 No.1
Next-generation sequencing (NGS) is becoming essential in the fields of precision oncology. With implementation of NGS in daily clinic, the needs for continued education, facilitated interpretation of NGS results and optimal treatment delivery based on NGS results have been addressed. Molecular tumor board (MTB) is multidisciplinary approach to keep pace with the growing knowledge of complex molecular alterations in patients with advanced solid cancer. Although guidelines for NGS use and MTB have been developed in western countries, there is limitation for reflection of Korea’s public health environment and daily clinical practice. These recommendations provide a critical guidance from NGS panel testing to final treatment decision based on MTB discussion.
오진호,윤천재,구홍두,이한식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.2
Background: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. Methods: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. Results: 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. Findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. Conclusion: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the posibility of rhabdomyolysis.
이경룡,윤천재,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1
Scorpion intoxication is not often encountered. Scorpion venom is complex and species-specific, those of the family Buthidae being most harmful to humans. The toxin consists of phospholipase, acetylinesterase, hyaluronidase, serotonin, and neurotoxins. A neurotoxins envenomation can produce severe systemic toxicity, especially in children. Symptoms include throat spasms, muscular fasciculations, abdominal clamps, seizures, increased or decreased blood pressure, oliguria, dysrhythmias, pulmonary edema, and respiratory collapse. We experienced a 60-year-old female patient who suffered abdominal clamp and both leg pain with multifocal PVC through to be caused by scorpion intoxication. She hypertension for several years, but no medications. During last six months she had suffered from facial palsy. So she had received herb medication with scorpion venom. After treatment for 3days she recovered well and discharged. We report this case with literature reviews.