흉부둔상후 발생한 급성 심근경색증 1예

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.

기관 삽관후 발생한 기관 협착 -치험 1례-

현성열 ( Sung Youl Hyun ),강영준 ( Young Joon Kang ),김진주 ( Jin Joo Kim ),김용인 ( Yong In Kim ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Joon Yang ),서태석 ( Tae Suk Seo ),박희권 ( Hee Kwon Park ),이석기 ( 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Tracheal intubation is the most common cause of Tracheal stenosis. The treatment of trachea stenosis vary according to site or size of tracheal stenosis. Thirty six age old man was transferred our hospital for evaluation of dyspnea. Subglottic stenosis was shown on bronchoscopy & chest computerized tomography(CT) scan of neck. Balloon dilatation was performed and then patient breathed at ease. Tracheal resection and end-to-end anastomosis was applied to repetitive tracheal stenosis. Balloon dilatation before surgical management makes better respiratory difficulty. We report succesful application of surgical management after balloon dilatation in repetitive tracheal stenosis patient. We will suggest that the balloon dilatation improve symptoms before tracheal resection and end-to-end anastomosis or stent, if sugery or stent insertion are not applicable due to poor status of patient.

경추부 손상에서 자기 공명 영상법의 진단적 유용성

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.

표준화 환자를 이용한 가천의대 임상수행평가의 운영 경험

박귀화(Gwi Hwa Park),오재환(Jae Hwan Oh),박연호(Yeon Ho Park),임영희(Young Hee Lim),이선녀(Sun Neo Lee),박찬용(Chan Yong Park),김선숙(Sun Suk Kim),임용수(Yong Su Lim),이영돈(Young Don Lee),김용일(Yong Il Kim) 한국의학교육학회 2005 Korean journal of medical education Vol.17 No.2

Purpose: This study aims to abstract the differences of scores between the clinical instructors and standardized patients (SPs) in a clinical performance examination (CPX) using SPs and to correlate the concordance between the evaluation scores and the school records. Methods: The CPX was administered in 2003 to a total of thirty-six fifth year medical students at Gachon Medical School. The examination consisted of four cases, and four stations were duplicated, each requiring a total of 7.5 minutes per station. Evaluation of the student s performances was conducted by both clinical instructors and SPs using a formatted checklist. Results were analysed by t-test, agreement rates, and Pearson correlation. Result: The mean scores given out by the clinical instructors and the SPs for the newly developed case were significantly different, while those scores for pre-existing cases were not in the old cases. The correlation coefficients between these two evaluation groups were relatively high. And agreements between the two evaluation groups were 0.37~0.72. The mean scores among clinical instructors were not significantly different, but the correlation coefficients and agreement rates were relatively high. The correlation between the evaluation scores and school records did not correlate significantly. Conclusion: It is concluded that the CPX is a useful tool to measure the students essential competences in areas of knowledge, skills and attitude during the subinternship stage. In conducting a successful CPX, it is crucial to reconsider the recycling of cases and the selection and training of SPs aside from the development of an objective checklist.

Phalloides Syndrome의 임상적 고찰

김규석,임영운,정중식,신상도,표창해,이중의,서길준,정성은,윤여규,박정배,서강석,유은영,임용수 대한응급의학회 2000 대한응급의학회지 Vol.11 No.2

Background: To review the important features and treatment modalities of phalloides syndrome. Method: We perfomed a retrospective analysis of 16 patients with phalloides syndrome who visited the Emergency Center of Seoul National University Hospital, Uijongbu St. Mary's Hospital, Gachon Medical College Hospital, and Kyungpook National University Hospital from July 1st to August 31st, 1998. Mann-Whitney U test was used for statistical analysis(p<0.05). Results: 9 were male and 7 were female. The mean age was 54 years(men 46 years, women 65 years). Fourteen cases(88%) occurred in Kyungpook area. All cases of phalloides syndrome resulted from mistaking toxic mushrooms for edible mushrooms. The doses of ingestion of mushroom were not available because the patient could not remember the exact amounts. The identification of mushrooms in 4 cases was confirmed by mycologist, 6 cases by mushroom photoatlas, and remained 6 cases were not confirmed. The initial symptoms of mushroom poisoning were abdominal pain, nausea, and watery diarrhea. The time intervals from the ingestion of mushroom to the onset of symptom were from 6 to 13 hours(mean 11.3±2.68 hours). The laboratory data showed the increased GOT and GPT, prolonged prothrombin time, elevated serum creatinine level, and decreased platelet count. The initial management of phalloides mushroom poisoning was done conservatively, but the early specific treatments such as gastrointestinal decontamination, administration of activated charcoal, IV penicillin or silymarin were not perfomed in all cases. The mortality rate was 18.8%. There were significant differences in total bilirubin, prothrombin time, platelet count, and serum creatinine between survival and non-survival group(p<0.05) Conclusion: It is important to know the morphological differences between edible and toxic mushroom for prevention of phalloides syndrome. If the patient with acute gastroenteritis has a history of mushroom ingestion, the emergency physician should suspect phalloides syndrome and start early proper treatment. For the identification of mushroom it is desirable to contact a mycologist.

성폭력 실태와 법의학적 문제에 대한 고찰

양혁준,안석근,임용수,표창해,김형수,최유덕,이근 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

Female sexual assault victims who received medical care at Chung Ang Gil Hospital from 1993 to 1995 were evaluated. Data were obtained from the emergency department records and gynecologic clinic ; 25 patients were evaluated. The mean age was 18.5 ; the ages ranged from 3 to 37 years old. Twenty patients(80%) were unmarried and more than half were examined within five hours of assault. The vast majority of injuries were minor, including abrasions, contusions, and minor lacerations. Fourteen patients(56%) were acquainted with the assailant. Sexual assault was violent with 64% of all cases involving the use of a knife or blunt objects as a weapon. The optimal management of the sexual assault victim involves a multidisciplinary effort on the part of all legal, medical, and support personnel who interface with the emergency department. Taking a history and conducting a general physical examination are performed methodically and the gathering of evidence proceeds simultaneously with the physical examination. Treatment entails attention to physical injuries, potential venereal diseases and pregnancy and psychiatric intervention.