단기간의 심근허혈이 심근보호에 미치는 영향 -적출 쥐 심장의 연구-

전영진,이인성,김연수,최영호,김광택,김형묵,김학제,이건,Cheon, Young-Jin,Lee, In-Sung,Kim, Yeon-Soo,Choi, Young-Ho,Kim, Kwang-Taik,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

짧은 기간의 허혈은 뒤에 오는 장시간의 허혈 및 재관류시에 심근의 손상방지에 효과가 있는 것으로 보고되고 있으나 그 기전에 대해서는 논란이 많다. 본 연구에서는 심근에 단기간의 허혈조건을 부여한 후 심근보호액을 이용하여 심정지를 유도하였고 다시 재관류하였을 때 심근 기능의 회복에 미치는 영향을 연구하기 위해 적출 쥐 심장모델을 이용하여 2 시간의 저장기를 이용하여 재관류시의 기능을 비교하였다. 10 마리의 실험군에서는 심근보호액을 이용한 심정지전에 1 분간의 전체 허혈기를 가지고 5 분간의 재관류를 3 번 반복하는 방법으로 허혈조건부여를 하였으며 대조군에서는 위와 같은 조건부여 없이 2 시간의 심근보호액을 이용한 심정지 및 저장기를 가졌다. 2 시간의 저장기를 $0^{\circ}C$의 심근보호액에서 가진 후 재관류를 하여 두 군간의 회복시의 기능을 비교하였다. 재관류 20 분후의 회복기 기능의 비교에서 허혈 조건부여를 한 실험군에서 대조군에 비하여 좌심실 발생압 및 좌 심실압 순간 변화율에서 우수한 회복율을 보였다. 심정지전의 수치를 100으로 본 경우의 재관류시의 좌심실 발생압의 회복율에서 허혈 조건부여를 준 실험군에서는 93.20$\pm$15.7%의 회복율을 보인 반면 대조군에서는 67.3$\pm$15.6%의 회복율을 보여 차이가 있었다. 좌심실압 순간 변화율의 회복율에서 대조군은 54.7$\pm$18.2%의 회복율을 보인 반면 실험군에서는 78.1$\pm$15.1% 의 회복율을 보였다. 심박동수 및 관동맥 관류량에서는 양 군에서 통계적으로 유의한 차이를 발견하지 못하였으며 같은 압력으로 관류한 심근보호액의 관류량에서도 유의한 차이를 보이지 않았다. 이상의 결과 허혈 조건부여는 적출 쥐 심장에서 심근보호액을 이용한 심정지 및 2 시간의 저장 후 재관류시의 심근 기능 회복에 재관류시 심근기능 회복에 도움이 된다고 생각되며 이는 심근보호액의 관류량 및 관류저항과는 다른 기전에 의한 것으로 생각된다. Ischemic preconditioning is known to have protective effect on myocardial function at prolonged ischemic insult but the mechanism of the effect is not clearly known. The effect of the preconditioning on the global ischemia using cardioplegic solution is not well known. To evaluate the effect of global myocardial preconditioning on the functional recovery after cardioplegic arrest and two hours of hypothermic storage, we used the isolated rat heart and two hours cardioplegic arrest time at $0^{\circ}C$. In the experimental group(n=10), after baseline functional data was obtained, ischemic preconditioning was induced with 1 min of global normothermic ischemia for three times before the arrest period. In the control group(n=10), hearts underwent no ischemic precondi- tioning. After 2 hrs of cardioplegic arrest and storage in the $0^{\circ}C$ cardioplegic solution reperfusion was done and hemodynamic data were collected at post-reperfusion 20 min. Heart with ischemic preconditioning showed improved functional recovery at post reperfusion 20 min in peak developed pressure and dP/dT. In percent change of the peak pressure, preconditioning group showed 93.20$\pm$15.7% recovery rate compared to baseline data, and control group showed 67.3$\pm$15.6% recovery rate. In percent change of the dP/dT, control group showed 54.7$\pm$18.2% recovery rate and preconditioning group showed 78.1$\pm$15.1% recovery rate. Percent changes in heart rate and coronary flow showed no significant difference between two groups and there was no significant differences in amount of cardioplegic delivery between groups. Our data suggest ischemic preconditioning may have protective effect on recovery state after cardioplegic arrest and 2 hr ischemic storage of isolated rat heart and its mechanism is not related to the amount of the cardioplegic delivery amount.

응급실에 내원한 골반골절 환자의 사망률 및 예후와 관련된 요인에 관한 연구

윤순영 ( Soon Young Yun ),배현아 ( Hyun A Bae ),이혜진 ( Hye Jin Lee ),전영진 ( Young Jin Cheon ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: The object of this retrospective study was to evaluate the clinical characteristics of the patients with pelvic fracture due to blunt trauma. We analyzed the correlation between clinical symptoms, classification of pelvic fracture, trauma score and mortality. And we aimed to establish the guideline of management in emergency departments. Methods: We performed a retrospective analysis of 133 patients with pelvic fracture during 10-year period (from January 1994 to December 2003) who were presented in our emergency department. We collected data from the medical records and made a database for analysis of following: age, sex, mechanism of injury, vital sign at admission, abbreviated injury scores (AIS), injury severity scores (ISS), anatomical grading of the fracture, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid. The data were stratified into patients less than 55 years of age (young group) and 55 years or older (old group). The data were also stratified according to fracture grading and trauma scores. Results: Grade 4 fracture was the most frequent pattern(n=37, 27.8%), followed by grade 3. According to stratification by age, mortality of older age group was higher than younger group (p<0.001). But there was no significant difference between the two groups in length of hospital stay, initial systolic blood pressure, heart rate and fluid and blood product requirements. According to stratification by fracture grading system, severely fractured group (grade 4, n=37) showed higher mortality than mild group (grade 1, 2 and 3). Stratification by AIS showed significant difference in the hospital mortality and length of hospital stay, initial systolic blood pressure, requirement of fluid between the severely injured group (AIS≥3 in any part of head, thorax, abdomen) and mild injured group. Conclusion: The mortality of pelvic fracture is associated with age, AIS and mental status at arrival.

응급실을 통하여 입원한 체간부 관통상 환자에 관한 임상적인 고찰

윤순영 ( Soon Young Yun ),전영진 ( Young Jin Cheon ),원태희 ( Tae Hee Won ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.1

Background: This study was undertaken to evaluate the clinical pattern of the patients with penetrating torso injury. We retrospectively analyzed the clinical symptoms, mechanism of injury, injury type including injured organ, and ultimate outcome of treatment. Our purpose of the study was to establish guideline of management in penetrating torso injury. Methods: This study consists of an analysis of a consecutive series of 94 patients with penetrating injury of trunk treated at one general hospital during 7year period (from January 1995 to April 2003) who was admitted through in our emergency department. All data were collected from the medical records and entered in a database for analysis on the following: age, sex, mechanism of injury, vital sign at admission, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid and blood product. Results: Among 94 patients, there were 68 men and 26 women, with ages ranging from 19 to 82 years (average 38.2 years). The most frequent mechanism of injury was violence by others including rob (n=54, 57.4%) followed by suicidal attempt (n=24, 25.5%) and accidental injury (n=16, 17.0%). No injury was inflicted from gun. In 37 patients, systolic blood pressure at admission was under 90mmHg. The time interval from injury to admission, and from admission to operation was 57.8minutes and 4hour 12minutes each. Laparotomy was required in 70 patients, thoracotomy in 5 patients, and 3 patients required thoracotomy and laparotomy. Among 94 patients, an average of 1.7 organs were injured. The small bowel and colon were the organs most commonly wounded followed by liver, mesentery, pleura. Of the 94 patients, 6 died for an overall mortality rate of 6.4%, and two of them were not related with hemorrhage. The average length of hospital stay was 18.1 days, and 40 patients required ICU care. Conclusion: Of the 94 patients who were admitted from penetrating torso injury, no patient was injured from firearm. Overall mortality rate was 6.4%. In our hospital, firearm injury was relative rare

전자선 직접묘사에 의한 Deep Submicron NMOSFET 제작 및 특성

이진호,김천수,이형섭,전영진,김대용,Lee, Jin-Ho,Kim, Cheon-Soo,Lee, Heyung-Sub,Jeon, Young-Jin,Kim, Dae-Yong 한국전자통신연구원 1992 전자통신 Vol.14 No.1

전자선 직접묘사 (E-beam direct writing lithography) 방법을 이용하여 $0.2\mum$ 과 $0.3\mum$ 의 게이트길이를 가지는 NMOS 트랜지스터를 제작하였다. 게이트만 전자선 직접묘사 방법으로 정의하고 나머지는 optical stepper를 이용하는 Mix & Match 방식을 사용하였다. 게이트산화막의 두께는 최소 6nm까지 성장시켰으며, 트랜지스터구조로서는 lightly-doped drain(LDD) 구조를 채택하였다. 짧은 채널효과 및 punch through를 줄이기 위한 방안으로 채널에 깊이 붕소이온을 주입하는 방법과 well을 고농도로 도핑하는 방법 및 소스와 드레인에 $p^-$halo를 이온주입하는 enhanced lightly-doped drain(ELDD) 방법을 적용하였으며, 제작후 성능을 각각 비교하였다. 제작된 $0.2\mum$의 게이트길이를 가지는 소자에서는 문턱전압과 subthreshold기울기는 각각 0.69V 및 88mV/dec. 이었으며, Vds=3.3V에서 측정한 포화 transconductance와 포화 드레인전류는 각각 200mS/mm, 0.6mA/$\mum$이었다. $0.3\mum$소자에서는 문턱전압과 subthreshold 기울기는 각각 0.72V 및 82mV/dec. 이었으며, Vds=3.3V에서 측정한 포화 transconductance는 184mS/mm이었다. 이러한 결과는 전원전압이 3.3V일 때 실제 ULSI에 적용가능함을 알 수 있다.

외상환자 중증도 분류에 있어 병원전단계와 병원단계의 RTS (Revised trauma score) 비교

이승엽 ( Seung Yeop Lee ),전영진 ( Young Jin Cheon ),한철 ( Chul Han ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources. Methods: We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records. Results: There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS. Conclusion: Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients. [ J Trauma Inj 2015; 28: 177-181 ]

Zolpidem 중독의 임상적 특징에 대한 연구

서주현,노형근,어은경,전영진,정구영,Suh, Joo-Hyun,Roh, Hyung-Keun,Eo, Eun-Kyung,Cheon, Young-Jin,Jung, Koo-Young 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

Purpose: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. Methods: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. Results: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: $0.2{\sim}7.4\;mg/L$). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. Conclusion: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.

응급의학과 전공의가 시행한 흉관 삽입술의 합병증에 대한 고찰

조대윤 ( Dai Yun Cho ),손동섭 ( Dong Suep Sohn ),전영진 ( Young Jin Cheon ),홍기훈 ( Ki Hun Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons. (J Korean Soc Traumatol 2012;25:37-43)

유기인계 농약 중독 환자에서 고용량 Pralidoxime이 치료 결과에 미치는 효과

이경민 ( Kyung Min Lee ),최윤희 ( Yoon Hee Choi ),전영진 ( Young Jin Cheon ),이덕희 ( Duk Hee Lee ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2

Purpose: The optimal dose of oximes for use in the treatment of organophosphorus pesticide poisoning has not been conclusively established. In this retrospective study, we assessed the effectiveness of the use of high-dose pralidoxime infusion in treating organophosphorus pesticide poisoning. Methods: From January 1998 to December 2009, 71 patients visited the hospital Emergency Department (ED) as a result of organophosphate pesticide intoxication. All of these patients received an initial bolus of 2 g of pralidoxime as the first step of treatment. Patients who then received continuous infusion of pralidoxime at a dose of 500 mg/hr were entered into study group 1 (low dose), and those treated by continuous infusion of pralidoxime at a dose of 1000 mg/hr were entered into study group 2 (high-dose). Plasma cholinesterase activities for each patient were evaluated at ED arrival and re-evaluated 24 hours after pralidoxime infusion. The effectiveness of the two treatment modalities was gauged by comparing the required duration of mechanical ventilation, time spent in the intensive care unit (ICU) and total time spent in the hospital. Results: The mean duration of mechanical ventilation was 9.98±6.47 days for group 1 and 4.39±6.44 days for group 2. The respective mean duration of time spent in ICU and the total number of days in the hospital were 16.38 ±18.84 days and 21.87±20.16 days for group 1, and 7.83±9.99 days and 11.71±13.53 days for group 2. Highdose pralidoxime treatment was associated with shorter required durations for mechanical ventilation, ICU and hospital stay. In addition, plasma cholinesterase reactivation rates were higher for those patients receiving high-dose pralidoxime treatment. Conclusion: The results suggest that high-dose pralidoxime treatment has greater efficacy for patients suffering from organophosphorus pesticide poisoning.

외상으로 인한 상처의 치료에 있어서 선택적 항균제의 효과 및 적응증에 관한 연구

김재은 ( Jae Eun Kim ),서주현 ( Joo Hyun Suh ),최윤희 ( Yoon Hee Choi ),배현아 ( Hyun A Bae ),정진희 ( Jin Hee Jung ),어은경 ( Eun Kyung Eo ),전영진 ( Young Jin Cheon ),정구영 ( Koo Young Jung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1

Purpose: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. Methods: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman`s University Mokdong Hospital. Structured data sheets were completed at the times of the patient`s visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. Results: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). Conclusion: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate. (J Korean Soc Traumatol 2007;20:40-46)

Gerbil 전뇌허혈-재관류 모델에서 L-Arginine과 7-Nitroindazole이 뇌손상에 미치는 영향

전영진,김성은,김용재,구혜수 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: This study was performed to determine whether L-Arginine would improve or worsen the neurologic outcome after ischemic brain injury and whether 7-Nitroindazole (7-NI, inhibitors of neuronal nitric oxide (NO) synthase inhibitor) would improve or worsen. Methods: Five (5) groups (N=11 to 14) of anesthetized gerbils were subjected to 10 min of global cerebral ischemia by means of a bilateral carotid artery occlusion. One group (N=11) was the control group. In a second group (N=12), the animals were pretreated with intraperitoneal L-Arginine(300 mg/kg) one hour before ischemic insult. In a third group (N=12), pretreatment with L-Arginine was performed in the same manner and intraperitoneal 7-NI were given at the time of reperfusion and 2 hours after reperfusion. The animals of a fourth group (N=12) were treated with 7-NI in the same manner without any pretreatment with L-Arginine. The animals in the last group (N=14) underwent sham operations. Results: Compared with control group, concomittent treatment with L-Arginine and 7-Ni showed no significant improvement in the neurological cell survival rate. Also, group pretreated with L-Arginine only showed a similar outcome. The group treated with 7-Ni at the time of reperfusion and 2 hours after reperfusion showed a significant improvement in the neurological cell survival rate compared with the control group and the other two experimental groups (p<0.05). Conclusion: In the ischemia-reperfusion injury of global ischemia in gerbils, NO from endothelial NO synthase has no important role in the neurological outcome.