응급의료기관 간 단계별 역할 및 기능 정립

윤한덕 건강보험심사평가원 심사평가연구소 2015 HIRA 정책동향 Vol.9 No.4

시설, 장비, 인력수급체계 개선방안

윤한덕,Yun, Han-Deok 대한병원협회 2004 대한병원협회지 Vol.33 No.6

권역외상센터의 추진배경 및 경과

윤한덕 대한의사협회 2016 대한의사협회지 Vol.59 No.12

In a modern medical delivery system, it is very difficult to provide adequate, timely, and equitable medical care for severely injured patients. Trauma is a leading cause of deaths under the age of 40 and a source of expensive socioeconomic losses in Korea. Korean government has been making a major effort to establish a trauma system since 2000, but inadequacies of the current trauma system still result in many preventable deaths from accidental injuries. The designation and support program for regional trauma centers is the first step in a national plan for trauma system development. At present, there are 9 regional trauma centers and 7 candidates for trauma centers. Regional trauma centers must play a key role in a regionally inclusive trauma system that integrates emergency medical services systems and healthcare delivery systems to deliver optimal medical care for injured patients.

자발성 뇌지주막하출혈 환자에서 극초기 재출혈에 영향을 미치는 위험인자에 관한 분석

허 탁,민용일,윤한덕 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 254 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years of more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.

혈복이 의심되는 복부둔상 환자에서 응급 초음파 검사의 의의

윤한덕,박주경,류진호,허 탁,조석주,김성근,민용일 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

The reliability of emergency ultrasonographic(US) detection of hemoperitoneum and solid organ injury in blunt abdominal trauma was evaluated retrospectively. From October 1, 1995 to August 31, 1996, 90 patients were included in the study. Ultrasonographic findings showed a sensitivity, specificity, and accuracy of 97.6%, 97.9%, and respectively, in detecting intraabdominal fluid collection. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. In our department, US has replaced diagnostic peritoneal lavage(DPL) and computed tomography(CT) as the screening study of first choice.

소화관내 이물에 대한 고찰

윤한덕,류진호,박주경,허탁,조석주,김성근,민용일 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngopharyngoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.

2년간 응급실에 내원한 비외상성 병원전 심정지 환자에 대한 임상적 분석 : 광주ㆍ전남 지역을 중심으로

윤한덕,박주경,민용일 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Background : Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. Methods : After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan, 1,1994 to Dec, 31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories, t-test or chi-square analysis was used. Results : 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35±27 vs 37±24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. Conclusion : We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).

증독관리체계

황정연,윤한덕,노형근,황만식,유일제 대한임상독성학회 2003 대한임상독성학회지 Vol.1 No.1

생쥐 췌 장내 Inducible Nitric Oxide Synthase (iNOS)의 발현에 관한 면역조직화학적연구

안규윤,윤한덕,민용일 대한해부학회 1997 Anatomy & Cell Biology Vol.30 No.3

흰쥐에서 새로운 Na+/HCO3--Cotransporter 변이형의 동정

안규윤,윤한덕,조혜정,정희영,남광일,배춘상,김백윤,박성식 대한해부학회 2005 Anatomy & Cell Biology Vol.38 No.2

The potassium depletion has remarkable and opposite effect on kidney and body growth and has affected the expression of the several ion transporters. Previously, Ahn et al. have reported that HK alpha 1 and 2 subunit gene were upregulated in the hypokalemic rat kidney. To clone the unreported genes expressed in potassium deficiency, differential display PCR-based cloning strategy was used in normal and potassium-depleted rat kidney and a novel gene was isolated. Sequence analysis with blast search program identified a cDNA clone encoding an isoform of kidney sodium bicarbonate cotransporter-1. The tissue and cellular expression pattern of this gene were investigated with Northern analyses and in situ hybridization histochemistry (ISH) in normal and hypokalemic rats. This novel transcript was highly expressed in kidney and brain and at lower levels in distal colon, urinary bladder, and heart but not in salivary gland, stomach, liver, and lung in normal rat. In potassium-depleted rat, this transcript was upregulated in kidney, brain, and distal colon. By ISH, cellular distribution of this gene was highly expressed in S3 segment of proximal tubule, distal convoluted tubule, and cortical collecting duct of kidney and lower third of intestinal glands of distal colon but at lower levels in cortical and medullary thick ascending limb and medullary collecting duct of kidney and middle third of intestinal glands of distal colon. From these results, this candidate gene may play an important role in HCO3- transport by these organs during potassium depletion. 칼륨 결핍은 신장과 신체 성장에 서로 반대되는 결과를 초래하고 이온수송에 관여하는 효소들의 발현에 영향을 미친다고 한다. 본 연구는 흰쥐 Na+/HCO3- cotransporter-1 (NBC-1)의 새로운 변이형을 찾았고 이 유전자의 신장 및 원위결장에서의 발현 및 분포를 알아보고자 하였다. mRNA 수준에서 특이하게 발현되는 유전자를 탐색하는데 유용하게 쓰이는 DD-PCR(Differential Display-Polymerase Chain Reaction) 방법을 이용하여 새로운 유전자를 찾고 이 유전자의 신장 및 원위결장에서의 발현 및 분포는 Northern 분석과 in situ hybridization 조직화학 방법을 이용하였다. 이 유전자는 약 7.6 Kb 크기로 흰쥐 NBC-1과는 매우 유사하였다. 5′-UTR에서 55개의 b.p를 가지고 있고 ORF (open reading frame)는 3,105개 b.p, 즉 1,035개의 아미노산, 3′-UTR에서는 4173개의 b.p를 가지고 있었다. ORF에서는 NBC-1과 비교하여 1967번째와 2213번째에서 T가 C로, 2242번째에서 A가 G로, 2275번째에서 C가 G로 4개의 nucleotide가 전환되었으며 아미노산에서도 해당부위 즉, 656번째 Phe은 Ser으로, 738번째 Leu은 Pro으로, 748번째 Thr은 Ala으로 그리고 759번째 Pro은 Ala으로 전환되었다. Northern 분석소견에서 뇌와 신장에서 아주 강한 signal을 관찰할 수 있었고 그 다음으로 원위결장, 방광 및 심장 순으로 미약하게 관찰되었으나 위, 간, 폐 및 침샘에서는 발현되지 않았다. 뇌, 신장 및 원위결장에서 칼륨제한 식이 3일 후에 상당히 발현이 증가 되었으며 그 이후에는 일정한 수준을 유지하고 있었다. 정상식이 in situ hybridization 조직화학 소견에서 신장 토리쪽세관의 S3 부위, 먼쪽곱슬세관 및 겉질집합관에서는 강한 hybridization signal을 관찰할 수 있었고 속질집합관, 겉질 및 속질오름부분에서는 중등도의 signal을 관찰할 수 있었다. 원위결장에서는 하 1/3의 장선에서 강한 hybridization을, 중 1/3의 장선에서는 중등도의 signal을 관찰할 수 있었다. 그러나 표면상피세포나 상 1/3의 장선에서는 hybridization signal을 관찰할 수 없었다. 이상의 결과로 본 연구에서 clone된 유전자는 새로운 NBC-1 변이형라는 것이고 신장 토리쪽세관의 S3 부위, 먼쪽곱슬세관, 집합관, 겉질 및 속질오름부분, 원위결장의 장선 그리고 뇌에서 HCO3- 수송에 중요한 역할을 할것으로 생각되었다.