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3세 소아에서 토혈을 주소로 내원한 위식도 탈출증 1례
조진성,류일,이근,김재광,Cho, Jin-Seong,Ryoo, Eell,Lee, Gun,Kim, Jae-Kwang 대한소아소화기영양학회 2003 Pediatric gastroenterology, hepatology & nutrition Vol.6 No.2
저자들은 반복적인 구토와 복통이 발생한 후 토혈을 주소로 내원한 3세 된 남아에서 상부소화관 내시경으로 진단된 위식도 탈출증 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Prolapse gastropathy is not uncommon in adult, but is not reported yet in previously healthy children. A 3-year-old child came to our emergency room after a 1-day history of emesis episodes with coffee-ground hematemesis. During the endoscopic procedure, and the process of retching and vomiting was observed and a tense knuckle of gastric mucosa was seen to be forcefully and repeated prolapsed into the distal esophageal mucosa, and mucosal hematoma was found in the gastric fundus. Upper gastrointestinal study revealed no abnormality and 24 hour pH monitoring revealed no pathologic gastroesophageal reflux. Retching is thought to cause the forceful prolapse and induce subsequent trauma of gastric mucosa. This case illustrates that the episodes of vigorous retching and resultant gastric mucosa are now considered to be the cause of the hematemesis and epigastric pain in children.
두부외상 후 동반 발생한 경동맥해면정맥동루와 내경동맥박리증 1례
조진성 ( Jin Seong Cho ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),유찬종 ( Chan Jong Yoo ),진욱 ( Wook Jin ),이재관 ( Jae Gwan Lee ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
A carotid-cavernous fistula (CCF) is a pathologic arteriovenous communication between the carotid artery and the cavernous sinus, and the incidence of CCF as a result of craniofacial trauma is less than 0.2%. Traumatic internal carotid artery dissection (TICAD) is a rare phenomenon, occurring in 0.02 to 0.67% of cervical blunt trauma cases. We report a rare case of CCF associated with ICAD after craniofacial trauma injury, which is very rare. A 23-year-old woman presented with left ptosis on 21 days after a car crash accident. She had suffered from headaches, diplopia, tinnitus, and dizziness. Brain MRI revealed no mass or aneurysmal sac or intracranial hemorrhage, but cerebral angiography showed CCF with ICAD. She was treated with a ICAD percutaneous transarterial stent and endovascular embolization, 1 months after cerebral angiography. clinicians treating patients with craniofacial injuries should have a complete understanding of these patients` entity, because urgent intervention may improve outcome.
Methylene Blue를 이용한 경부 관통상에 의한 식도손상 진단 1예
주정민 ( Jung Min Ju ),현성열 ( Sung Youl Hyun ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),이근 ( Gun Lee ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Penetrating injury of the cervical esophagus cannot be easily identified by physical examination due to its deep anatomical location, so many patients with penetrating neck injuries should be undergone esophagography or esophagoscopy for the evaluation of potential esophageal injuries. However, these diagnostic procedures are invasive, time-consuming, expensive, and, most importantly limited by availability of resources (diagnostic equipment and manpower). We experienced a patient with a penetrating esophageal injury who was promptly diagnosed by using methylene blue. A 32-year-old male visited the emergency room complaining of dyspnea and bleeding after a penetrating neck injury.Thrty (30) minutes after the patient had swallowed the methylene blue solution, we found leakage of blue-colored fluid through the stab wound. He underwent emergent surgical repair without further investigations for esophageal injury.
소아 두부외상 환자에서의 반복적인 두부 CT 검사의 유용성
조호준 ( Ho Jun Jo ),임용수 ( Yong Su Lim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Seong Cho ),현성열 ( Sung Youl Hyun ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
Purpose: Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. Methods: We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. Results: A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. Conclusion: Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children. [ J Trauma Inj 2015; 28: 149-157 ]
응급수술을 시행한 흉부 및 경부 외상환자에 대한 임상적 고찰
현성열 ( Sung Youl Hyun ),오상우 ( Sang Woo Oh ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),진욱 ( Wook Jin ),류일 ( Eell Ryoo ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Background: Recently, the number of patients with the thorax or neck trauma has increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Most of the thorax or neck injuries can be managed with conservative methods and simple surgical procedures, but an open thoracotomy or exploration will be necessary in emergent cases. Traumas to the thorax and the neck have an extremely poor prognosis when not diagnosed and treated early. Therefore, we analyzed the results of emergent operations in patients with thorax or neck trauma and their clinical courses. Methods: A clinical evaluation was performed on 56 patients treated with emergent operations for thorax or neck trauma from January 1997 to July 2003 according to their medical Results: There were 45 males and 11 females. The mean age was 36.1 years. The modes of injury were as follows: traffic accidents 14 cases, stab wounds 27 cases, industrial disasters 7 cases, and others 8 cases. The annual distribution of cases was as follows: 1997 year 9 cases, 1998 year 6 cases, 1999 year 7 cases, 2000 year 10 cases, 2001 10 cases, 2002 6 cases and 2003 8 cases. The injured organs were 13 cases of a ruptured diaphragm, 12 cases of a ruptured lung, 7 cases of a ruptured heart, 2 case of a ruptured aorta, 9 cases of a simple vessel ruptured and 4 cases of a ruptured esophagus and trachea. There were 9 (16%) overall deaths: 6 cases in deaths among the blunt-trauma cases and 3 deaths among the stab injury cases. Conclusion: Early diagnosis and surgical treatment is essential for thorax or neck trauma, to decrease the mortality and complications. Therefore, careful diagnostic procedure, appropriate preoperative management for hypovolemia, and early surgical treatment are essential. The setup an of emergency operation system should be considered as a reform measure.
주정민 ( Jung Min Ju ),김용인 ( Young In Kim ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),양혁순 ( Hyuk Sun Yang ),이근 ( Gun Lee ),현성열 ( Sung Youl Hyun ),황성언 ( Seong Youn Hwang ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Blunt chest trauma can lead to cardiac complications ranging from simple arrythmias to myocardial rupture. Injury to coronary arteries with subsequent myocardial infarction after blunt chest trauma is rare, but carries a significant risk of morbidity and mortality. Therefore, rapid diagnosis and prompt treatment are reguired. Most coronary artery occlusions after trauma are caused by disruption of pre-existing atherosclerotic palque, so acoronary artery occlusion is unusual complication in a young man. We report the case of a previously healthy young man who developed acute myocardial infarction following blunt chest trauma.
소아 중증 외상환자의 병원 전 요인에 따른 중증 손상의 예측과 손상의 예방
우재혁 ( Jae Hyug Woo ),양혁준 ( Hyuk Jun Yang ),임용수 ( Yong Su Lim ),조진성 ( Jin Seong Cho ),김진주 ( Jin Joo Kim ),박원빈 ( Won Bin Park ),장재호 ( Jae Ho Jang ),이근 ( Gun Lee ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3
Purpose: Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors. Methods: Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS≥7). The general characteristics and the pre-hospital factors were compared between the two groups. Results: Six hundred seventy-three children were enrolled, their mean age was 8.03 (±4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000). Conclusion: The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established. [ J Trauma Inj 2014;27:43-49 ]
김용인 ( Yong In Kim ),노기철 ( Ki Cheul Noh ),강영준 ( Young Joon Kang ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),진욱 ( Wook Jin ),황성연 ( Seong Youn Hwang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results: The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age≥40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mechanisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.
일개 대학병원에서 경험한 소아의 경증 두부 외상에서 Brain CT 측정 및 효용성
김하경 ( Ha Kyung Kim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Seong Cho ),장재호 ( Jae Ho Jang ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3
Purpose: In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients. Methods: The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule. Results: A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion. Conclusion: There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT. [ J Trauma Inj 2014;27:63-70 ]