신종인플루엔자 폐렴환자에서 임상적 악화와 연관된 초기 전산화 단층촬영 소견

유승목 ( Seung Mok Ryoo ),김원영 ( Won Young Kim ),이충욱 ( Choong Wook Lee ),손창환 ( Chang Hwan Sohn ),서동우 ( Dong Woo Seo ),이윤선 ( Yoon Seon Lee ),이재호 ( Jae ho Lee ),오범진 ( Bum Jin Oh ),김원 ( Won Kim ),임경수 ( Kyoun 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.2

Background: The aim of the present study was to evaluate whether findings on initial chest computed tomography (CT) of influenza pneumonia can help predict clinical outcome. Methods: We reviewed all adult patients admitted to the Emergency Department (ED) with a confirmed diagnosis of novel influenza A H1N1 virus (2009 H1N1) pneumonia, who underwent chest CT upon admission between Aug 26, 2009 and Jan 31, 2010. Radiologic findings were characterized by type and pattern of opacities and zonal distribution. Clinical outcome measures were intensive care unit (ICU) admission, mechanical ventilation, and inhospital death. Results: Of 59 patients diagnosed with 2009 H1N1 pneumonia, 41 (69.5%) underwent chest CT on admission into ED. Nine (22%) of these patients developed adverse clinical outcomes requiring the following treatments: 9 (22.0%) ICU admissions, 5 (12.2%) mechanical ventilation, and 3 (7.3%) inhospital deaths. Counting the number of patients with more than 4 involved lobes, the sensitivity, specificity, positive predictive value, and negative predictive value for detection of adverse clinical outcome were 67%, 84%, 55% and 80%, respectively. Conclusion: Extensive involvement of both lungs (over 4 lobes) is related to ICU admission, mechanical ventilation, and inhospital death. Initial chest CT may help predict an adverse clinical outcome of patients with 2009 H1N1 influenza pneumonia.

두 가지 항부정맥 약제를 병용 투여하여 성공적으로 치료한 심실빈맥이 동반된 부자중독 1례 보고

유승목 ( Seung Mok Ryoo ),손창환 ( Chang Hwan Sohn ),오범진 ( Bum Jin Oh ),김원 ( Won Kim ),임경수 ( Kyoung Soo Lim ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2

Aconitine is an anti-inflammatory agent with therapeutic uses in oriental medicine as an analgesic and for treatment of stroke. Because of its sodium channel effect, aconitine can promote undesirable, wide complex tachyarrhythmia. If tachycardia develops during use of aconitine, class Ia and class III anti arrhythmic drugs can be utilized for treatment. However there are no single anti-arrhythmia agents which are uniformly effective. We report a case, characterized by wide complex tachyarrhythmia and severe hypotension, which was successfully treated by simultaneous injections of amiodarone and lidocaine. A 59-year-old woman exhibiting clinical signs of drowsiness as a result of ingesting 6 g of aconitine, was admitted to the emergency department. Initially, wide complex tachyarrhythmia (ventricular tachycardia and pulse rate of 180 beats/min) and severe hypotension (blood pressure of 53/26 mmHg) was observed. After simultaneous injection of amiodarone and lidocaine, the patient’s rhythm pattern changed to an accelerated junctional rhythm with ventricular premature complex. Two hours later, the patient’s heart pattern became a sinus rhythm. As demonstrated by this case, simultaneous injections of amiodarone and lidocaine can be useful in treating ventricular arrhythmia induced by aconitine.

복어 중독의 임상적 분석

현승환 ( Seung Hwan Hyun ),손창환 ( Chang Hwan Sohn ),유승목 ( Seung Mok Ryoo ),오범진 ( Bum Jin Oh ),임경수 ( Kyung Soo Lim ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2

Purpose: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. Methods: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients’electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. Results: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. Conclusion: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.

위장관 ; 이물질 섭취에 의한 식도 천공의 발생률과 임상 양상

김지은 ( Ji Eun Kim ),유승목 ( Seung Mok Ryoo ),김윤정 ( Youn Jung Kim ),이종승 ( Jong Seung Lee ),안신 ( Shin Ahn ),서동우 ( Dong Woo Seo ),손창환 ( Chang Hwan Sohn ),류정민 ( Jeong Min Ryu ),김원영 ( Won Young Kim ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.5

목적: 식도 천공은 드물지만 치명적인 질환이다. 하지만 이물질 섭취에 의해 발생한 식도 천공의 발생률과 임상 양상에 대한 연구는 국내에서는 미비한 상태이다. 이 연구는 식도 내이물질로 응급의료센터에 내원하였던 성인 환자들을 대상으로 식도 천공의 발생률과 임상 양상, 치료 결과를 알아보기 위한 것이다. 대상 및 방법: 2000년 1월부터 2008년 7월까지 단일 응급의 료센터에 이물질을 섭취하여 내원한 1,009명의 환자 중에서 식도 이물이 확인된 196명의 환자를 대상으로 연구를 시행하였고, 그 중에서 식도 천공이 발생한 18명의 전자의료기록을 후향적으로 분석하였다. 결과: 식도 이물의 발생률은 19.4% (196/1,009)였고, 식도 천공의 발생률은 1.8% (18/1,009)였다. 식도 천공이 발생한 환자들에서 가장 흔한 이물질은 생선가시(72.2%)였고, 천공이 발생한 환자의 66.7%에서 흉통을 호소하였다. 식도 천공이 발생한 환자 18명 중 8명이 중환자실에서 입원 치료를 받았으나, 사망한 환자는 없었다. 결론: 이물질 섭취에 의한 식도 천공의 발생률은 1.8%로 높지 않았으나, 식도 내 이물질이 있을 때 식도 천공의 발생률은 9.2%까지 상승하였다. 흉통은 식도 이물이 있는 환자에서 식도 천공을 시사하는 불길한 징후일 수 있다. 그러나 적절한 수술적 처치 혹은 보존적 처치를 받은 경우 대부분 좋은 임상 경과를 보였다. Background/Aims: Esophageal perforation is a rare but often a life-threatening condition. However, the incidence and clinical features of esophageal perforation caused by ingested foreign body are unknown. This study investigated the incidence of esophageal perforation caused by ingested foreign body and evaluated the clinical features and outcome of patients with esophageal perforation. Methods: Among a total of 196 adult patients with confirmed esophageal foreign body and complained of at least one of the related symptoms at the emergency department between January 2000 and July 2008, 18 patients with esophageal perforation due to esophageal foreign body ingestion were included in the study. Data were collected by retrospectively reviewing the electric medical records. Results: The incidence of esophageal foreign body and esophageal perforation in adults was 19.4% (196/1,009) and 1.8% (18/1,009), respectively. Chest pain was the most common symptom and fishbone was the most common foreign body causing esophageal perforation. Mediastinitis or mediastinal abscess occurred in 13 patients (13/18, 72.2%). About half (8/18) of the patients were admitted to the intensive care unit but there was no in-hospital mortality. Conclusions: The incidence of esophageal perforation in patients with foreign body ingestion was low but it increased up to 9.2% in patients with esophageal foreign body. However, prognosis was favorable with timely proper treatment. Chest pain can be an ominous sign indicating the presence of esophageal perforation in patients with esophageal foreign body. (Korean J Gastroenterol 2015;66:255-260)

최근 국내 일산화탄소 중독의 역학적 특징: 일개 응급의료센터의 후향적 코호트 연구

최병호 ( Byung Ho Choi ),전진 ( Jin Jeon ),유승목 ( Seung Mok Ryoo ),서동우 ( Dong Woo Seo ),김원영 ( Won Young Kim ),오범진 ( Bum Jin Oh ),임경수 ( Kyoung Soo Lim ),손창환 ( Chang Hwan Sohn ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.2

Purpose: The aim of this study was to describe the epidemiologic characteristics of adult patients with carbon monoxide poisoning who presented to the emergency department in recent years. Methods: This was a retrospective cohort study on adult consecutive patients with carbon monoxide (CO) poisoning who presented to the emergency department of a tertiary care university-affiliated hospital from January 1, 2008 to December 31, 2011. Results: A total of 91 patients were included in this study; there were 56(61.5%) unintentional and 35(38.5%) intentional poisonings. For the unintentional CO poisonings, the principal sources of exposure to CO were fire (39.3%), charcoal (17.9%), briquette charcoal (7.1%), wood burning boiler (7.1%), gas boiler (5.4%), automobile heater (3.6%), briquette boiler (3.6%), firewood (3.6%), and other items (12.5%). For the intentional CO poisonings, the sources were ignition charcoal (60.0%), briquette (31.4%), charcoal (5.7%) and butane gas (2.9%). For the unintentional CO poisonings, the places of poisoning were the home (58.9%), workplace (10.7%), public accommodation (8.9%), tent (8.9%), automobile (3.6%) and parking place (1.8%). For the intentional CO poisonings, the places of poisoning were the home (77.1%), public accommodation (11.4%) and automobile (11.4%). The proportion of intentional CO poisonings among total poisonings has increased significantly in recent years; 0.0% in 2008, 3.3% in 2009, 5.5% in 2010, and 29.7% in 2011. Conclusion: This study showed that in recent years in Korea, the source of CO has diversified broadly and intentional CO poisonings from burning ignition charcoal or briquettes has increased. Prevention efforts should consider these factors.

히말라야산 석청 복용 후 발생한 심장독성 환자들의 임상적 특성 분석

김성호 ( Sung Ho Kim ),서동우 ( Dong Woo Seo ),유승목 ( Seung Mok Ryoo ),김원영 ( Won Young Kim ),오범진 ( Bum Jin Oh ),임경수 ( Kyoung Soo Lim ),손창환 ( Chang Hwan Sohn ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2

Purpose: The aim of this study was to evaluate the clinical characteristics and outcome of patients who presented to the emergency department (ED) with cardiotoxicity caused by ingestion of Himalayan mad honey. Methods: Medical records of 12 patients who presented to the ED from January 1, 2005 to December 31, 2012 with cardiotoxicity caused by ingestion of Himalayan mad honey were retrospectively reviewed. Results: The mean age of patients was 54.5 years and 58.3% were men. The median amount of mad honey ingested was 30.0 cc, and the mean time from ingestion to onset of symptoms was 39.4 minutes. All patients had hypotension and bradycardia upon arrival in the ED. The initial electrocardiogram showed sinus bradycardia in seven patients, junctional bradycardia in four patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eight patients were treated with intravenous normal saline solution and atropine sulfate in a dose ranging from 0.5 to 2.0 mg. Blood pressure and pulse rate returned to normal limits within 24 hours in all patients. Conclusion: Our study showed that all patients with cardiotoxicity caused by ingestion of Himalayan mad honey had severe hypotension, bradycardia, and bradyarrythmias, including sinus bradycardia and junctional bradycardia and all patients responded well to conservative treatment, including intravenous normal saline solution and intravenous atropine sulfate.

독극물정보센터 구축사업의 일환으로 시행한 전국단위 응급해독제 비축 및 배송경험

박소영 ( So Young Park ),오범진 ( Bum Jin Oh ),손창환 ( Chang Hwan Sohn ),정루비 ( Ru Bi Jeong ),임경수 ( Kyoung Soo Lim ),김원 ( Won Kim ),유승목 ( Seung Mok Ryoo ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.1

Purpose: Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide stocking and delivery system for emergency antidotes in Korea. We report on a two-year experience of a nationwide stocking and delivery trial for emergency antidotes at emergency departments in Korea. Methods: An expert panel of clinical toxicologists reviewed and made a list of 15 stocked antidote. These antidotes were purchased or imported from other countries and delivered from 14 antidote stocking hospitals nationwide 24 hours per day, seven days per week. Results: From August 1, 2011 to April 30, 2013, 177 patients with acute poisoning, with a median age of 48.5 years, were administered emergency antidotes. The causes of poisoning were intentional in 52.0% and 88.0% were intentional as a suicide attempt. Regarding clinical severity, using the poisoning severity score, 40.7% of patients had severe to fatal poisoning and 39.0% had moderate poisoning according to clinical severity. The most frequent presenting symptom was neurologic deficit, such as altered mentality (62.7%). alerted mentality (62.7%). Emergency antidotes were administered as follows: methylene blue (49 cases), flumazenil (31), N-acetylcysteine (25), glucagon (17), 100% ethanol (15), cyanide antidote kit (12), anti-venin immunoglobulin (5), pyridoxine (4), hydroxocobalamine (2), and deferoxamine (1). The median time interval from antidote request to delivery at the patient’s bedside was 95 minutes (interquartile range 58.8-125.8). Conclusion: Findings of this study demonstrated the possibility of successful operation of the nationwide system of emergency antidotes stocking and delivery in Korea.