Paraquat 중독 환자의 임상적 고찰

전경홍,강명수,Jun, Kyung-Hong,Kang, Myung-Soo 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.1

Purpose: Paraquat, a globally used herbicide, is highly toxic to human beings. Hence, we reviewed some cases of paraquat poisoning in Korea. Methods: We analyzed the clinical and laboratory findings of 50 patients poisoned with paraquat retrospectively. The patients were admitted to the department of internal medicine in the Eumseong KeumWang hospital from January 2008 to December 2008. Results: Among 50 cases of paraquat poisoning, 28 cases were male. Twenty-four cases (48%) were over 60 years old. Fourty-nine patients ingested paraquat on purpose as suicidal attempts, while 1 patient underwent accidental ingestion. Seven patients swallowed less than one mouthful of paraquat, of which 4 patients survived. Eleven patients swallowed two mouthfuls of paraquat, of which 8 patients survived. Thirty-two patients swallowed over three mouthfuls of paraquat and they all died. Thirty-one patients with leukocytosis died. Twenty-one patients with metabolic acidosis died. Increased levels of blood amylase and glucose were related to high mortality, and increased level of blood creatinine was related to severe mortality. Hemoperfusions were accomplished in 27 patients of paraquat poisoning, of which 12 patients survived. Conclusion: Paraquat is a highly toxic herbicide. When patients arrive at the hospital, laboratory findings, urine paraquat concentrations, arrival time, and the amount of paraquat consumed must be considered for treatment plan.

증례 : 신장 ; 항산화제 및 혈액관류 병합요법으로 생존한 Paraquat 중독 치험 3예

전경홍 ( Kyung Hong Jun ),강명수 ( Myung Soo Kang ),최원석 ( Won Seok Choi ),김향 ( Hyang Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

Paraquat 치료에서 가장 중요한 것은 급성 신부전이 일어나기 전에 위장 정화 및 항산화제와 혈액관류치료를 적극적으로 하여 혈중 paraquat의 농도를 낮추는 것이다. 적극적인 항산화제의 주입으로 산소라디칼에 의한 신장의 손상을 막고, 또한 신장은 paraquat의 최대의 배설구이므로 수액과 이뇨제 등을 통하여 paraquat의 배설을 촉진시키는 것이 paraquat 치료에 중심이 될 것으로 사료된다. 본 저자들은 내원 당시 비교적 높은 paraquat 혈중농도를 보인 환자들에 대하여 치료 프로토콜을 통한 혈액관류를 통한 빠른 체외 배설과 다양한 항산화제를 적극 투여하여 폐손상을 동반하지 않고 성공적으로 치료된 임상 3예를 보고 하는 바이다. 향후 paraquat 중독 환자의 치료에 도움을 줄 수 있는 치료 프로토콜이 더욱 연구 개발되어야 할 것으로 사료된다. Paraquat is a very potent herbicide and has produced many fatalities through indiscriminate use and suicide. Death is usually caused by pulmonary fibrosis with the ingestion of more than one mouthful of 20% paraquat. We experienced three cases of paraquat poisoning treated without pulmonary injury. Patients swallowed one to two mouthfuls of 20% commercial paraquat. Hemoperfusion was performed within a few hours after ingestion, and then combination therapy with several antioxidants, steroid, and diuretics was performed. The patients recovered completely without pulmonary injury. (Korean J Med 77:S1268-S1273, 2009)

느타리버섯 재배 농민에서 발생하는 호흡기 증상

임현술,배근량,김두희,전경홍,Lim, Hyun-Sul,Bae, Geun-Ryang,Kim, Doo-Hie,Jun, Kyung-Hong 한국농촌의학지역보건학회 1998 농촌의학·지역보건 Vol.23 No.2

It has been reported that among mushroom farmers, respiratory diseases such as hypersensitivity pneumonitis can be developed by inhalation of mushroom (Pleurotus ostreatus) spores. For the evaluation of respiratory symptoms among mushroom farmers, a questionnaire was made. The Questionnaire included general characteristics, past occupational histories, durations of the mushroom cultivation and characteristics of the symptoms. Following the questionnaire we interviewed the 72 mushroom farmers (12 males, 10 females) from Kyungbuk Province. We also examined white blood counts, erythrocyte sedimentation rates, eosinophil counts and total IgE counts for the 5 farmers. The results obtained are as follows. 1. The mean age among the 22 mushroom farmers was 46.9 years, and the mean duration of cultivation was 7.5 years. 2. Among the 22 mushroom farmers. 18 farmers (81.8 %) suffered from respiratory symptoms at work. The main symptom was coughing (100.0%), followed by chilling sensation (50.0 %), sputum (38.9 %) and sore throat (27.8 %). 3. Coughing and other associated symptoms occurred during work and disappeared after work or several days later when the exposure had been stopped. 4. Total IgE counts were elevated in all farmers examined the test. With above results, the respiratory symptoms that developed among mushroom farmers were typical patterns of hypersensitivity pneumonitis. Epidemiological studies and preventive measures for mushroom farmers should be established.

파라캇 중독 환자에서 파라캇 혈중농도와 조기 예후 예측인자

최원석 ( Won Suk Choi ),김자현 ( Ja Hyun Kim ),이현아 ( Hyun A Lee ),전경홍 ( Kyung Hong Jun ),강명수 ( Myung Soo Kang ),김향 ( Hyang Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

목적: 파라캇은 전 세계적으로 널리 사용되는 맹독성 제초제로 이에 중독될 경우 급성 신부전 급성 폐부전 및 폐 섬유화를야기 시키는 치명적인 약물이다. 본 연구는 급성 파라캇 중독 환자에서 내원 초기 응급실에서 측정 가능한 검사항목들과 파라캇 혈중 농도와의 상관관계를 알아보고 이를 통해 초기 검사항목이 예후예측에 이용될 수 있는 가능성을 보고자 하였다. 방법: 파라캇 노출 후 24시간 이내 응급실에 내원한 환자 83명을 대상으로 내원 당시 소변 dithionite검사와 혈중 파라캇 농도를 확인하였으며 초기 검사지표로 백혈구 수 및 소변pH와 혈중 AST, ALT, BUN, Creatinine, Glucose, Amy-lase, Ph, PaO2, PaCO2, HCO3, Base excess, Na, K, Cl등을 분석하였다. 생존군과 사망군으로 나누어 소변 dithionite 검사와 혈중 파라캇 농도 SIPP를 비교하였으며, 혈중 파라캇 농도에 따라 4그룹으로 분류하여 각 그룹간 초기 검사지표를 비교 분석하였다. 결과: 평균 파라캇 혈중농도는 생존군에서 1.32±1.72 μg/mL 사망군에서 사망군에서 88.44±81.56μg/mL로 사망군에서 유의하게 높았다. 파라캇 혈중 농도 증가에 따라 4군으로 분류하여 각 그룹의 초기 검사지표를 비교한 결과 WBC, glucose, Cr, pH, HCO3 BE항목에서 파라캇 혈중농도가 낮은 그룹과 높은 그룹사이에 통계적으로 유의한 차이를 보였고 나이와 음독 후 내원 시간에 대한 보정 후에도 WBC, HCO3 BE 항목에서 혈중농도 변화에 따른 증감관계를 보였다. 결론: 파라캇 혈중 농도와 SIPP는 사망군에서 유의하게 높았다. 초기 검사지표 중 파라캇 혈중농도 변화에 따른 유의한 증감관계를 보인 WBC, glucose, Cr, pH, HCO3 BE등은 생존가능성을 예측하는 조기 인자로 볼 수 있겠다. 특히 나이와 시간에 대한 보정 후에도 유의한 상관관계를 보인 WBC, HCO3, BE 항목은 혈중 농도를 대신해 예후 예측에 이용될 수 있을 것으로 생각된다. Purpose: Paraquat is a lethal herbicide and induces acute renal failure, hepatic dysfunction, and progressive respiratory failure. The aims of this study are to investigate the correlation between plasma paraquat concentrations and initial laboratory data at Emergency Medical Center and to investigate whether initial laboratory data is useful for predicting outcomes of paraquat-poisoned patients. Methods: A retrospective analysis by chart review was done on 83 patients who ingested paraquat and who had presented to Emergency center of within 24 hours. Plasma paraquat concentrations, urine dithionite test and initial laboratory parameters including white blood cell count, urine pH, and AST, ALT, BUN, Creatinine, Amylase, Glucose, pH, PaCO2, PaO2, HCO3. Base Excess, Na, K, Cl were obtained at the time of Emergency Center visit. We compared urine dithionite test, plasma paraquat concentrations and Severity Index of Paraquat Pisoning (SSPI) of the survival group to those of the dead group. The patients were divided into four subgroups based on the level of plasma paraquat concentration, their initial laboratory data was compared and analyzed. Results: The mean plasma paraquat concentration in the mortality group was higher than that in the survival group (88.44±81.56 vs. 1.32±1.72 g/mL). Among the initial laboratory data of four subgroups, μ WBC, Glucose, Cr, pH, HCO3, Bass excess were significantly different between the group of low level of plasma paraquat concentration and higher group. ANCOVA analysis revealed that WBC, HCO3, Bass excess correlated with the level of plasma paraquat concentration significantly. Conclusion: The plasma paraquat concentration and SIPP were higher in the mortality group significantly. Initial laboratory data including WBC, Glucose, Cr, pH, HCO3, Bass excess were proven to be significant prognostic factors. Especially WBC, HCO3, Bass excess can be used to predict the outcome of paraquat poisoning.

신장 ; Paraquat 중독 환자에서 혈액관류의 유용성

최원석 ( Won Seok Choi ),정은행 ( Eun Haeng Jung ),박은혜 ( Eun Hye Park ),서정연 ( Jung Yeon Seo ),전경홍 ( Kyung Hong Jun ),강명수 ( Myung Soo Kang ),김향 ( Hyang Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3

목적: Paraquat는 급성신부전 및 간부전과 함께 간질성 폐렴 또는 진행성 폐 섬유화증을 일으켜 폐부전으로 사망하게 하는 맹독성 제초제이다. 본 연구의 목적은 paraquat 중독 환자에서 혈액관류의 치료 효과 및 유용성에 대하여 연구하고자 하였다. 방법: 2009년 1월부터 2010년 1월까지 paraquat 중독 환자는 총 58명으로 이 중 27명이 혈액관류 치료를 시행 받았다. 혈액관류 치료 받은 환자를 대상으로 동맥혈 가스 분석 등의 혈액검사와 소변 dithionite 검사, 혈중 paraquat 농도를 비교 분석하여 혈액관류의 시작 시간과 종결시점 및 혈액관류의 효과 등에 대하여 조사하였다. 결과: 혈액관류를 받은 27명 중 생존군은 13명, 사망군은 14명이었다. 사망군에서 생존군에 비하여 음독량이 많았으며, 음독량이 4모금(80 mL) 이상인 경우는 혈액관류 치료에도 불구하고 24시간 이내에 사망하는 것으로 나타났다. 생존군에서 혈액관류 후 혈중농도는 Proudfoot 생존곡선 하방으로 감소하였으나 사망군에서는 혈액관류 치료에도 불구하고 Proudfoot 생존곡선 하방으로 혈중농도가 감소하지 않았다. 결론: Paraquat 음독환자의 혈액관류치료는 가급적 빠른 시간 내에 시행하는 것이 좋으며, 혈액관류의 대상은 대사성 산혈증이 없으며, 급성신부전이 동반되어 있지 않는 환자군에서 시행되어야 할 것으로 사료된다. 향후 대단위의 연구가 필요할 것으로 사료된다. Background/Aims: Paraquat is a potentially lethal herbicide that induces acute renal failure, hepatic dysfunction, and progressive respiratory failure. This study examined the usefulness of hemoperfusion in paraquat poisoning. Methods: We reviewed the medical records of 27 patients who underwent hemoperfusion after paraquat poisoning at Eumseong Keumwang Hospital from January 2009 to January 2010. Results: All 27 paraquat-poisoning patients underwent hemoperfusion therapy within 6 hours of ingestion, and 13 patients survived. Patients who had ingested more than four mouthfuls died with 24 hours despite hemoperfusion. The mean arrival time at the emergency room and the plasma paraquat concentration in the survivors was 3.08 hours and 1.30 μg/mL, respectively; after hemoperfusion, the mean elapsed time was 8.92 hours and the plasma paraquat level was 0.14 μg/mL. The mean arrival time at the emergency room and plasma paraquat concentration in the non-survivors was 2.93 hours and 50.52 μg/mL, respectively; after hemoperfusion, the mean elapsed time was 9.36 hours, and the plasma paraquat level was 40.52 μg/mL. Conclusions: Urgent hemoperfusion therapy is essential for complete recovery from paraquat poisoning in patients who do not have metabolic acidosis or renal failure. However, hemoperfusion is not effective in those who ingested large amount of paraquat or have a urine dithionite of 4+, metabolic acidosis, or acute renal failure. (Korean J Med 2011;80:308-316)

속립성 결핵환자에서 간문 임파선염에 의해 발생한 식도 정맥류 출혈 치험

이상종(Sang Jong Lee),김명숙(Myung Sook Kim),전우규(Woo Kyu Jeon),임시영(Si Young Lym),박창영(Chang Young Park),김병익(Byung Ik Kim),김기택(Ki Taek Kim),전경홍(Kyung Hong Jun),박해원(Hae Won Park),유종현(Jong Hyun You),정을순(El Soon 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

Esophageal variceal hleeding is usually caused by portal hypertension associated with liver cirrhosis. However, it might be caused by lymphadenopathy of porta hepatis in noncirrhotic patient. A 19-year-old student was admitted to this hospital because of profuse hematemesis. He had been treated with anti-tuberculosis agents of miliary tuberculosis during past nine months period. On admission, gastroduodenal fiberscopy revealed esophageal variceal bleeding, Abdominal sono- graphy disclosed nothing remarkable except thickened gallbladder wall, but computed tomography showed low attenuated lymphadenopathy in porta hepatis. Further doppler sonography demonstrated lymphadenopathy of porta hepatis with fibrosis and obliteration of rnain portal vein with collateral circulations. Laparoscopic findings suggested tuberculous peritonitis without any evidence of cirrhosis of the liver. We report a very rare case of variceal bleeding caused by lymphadenopathy of porta hepatis during anti-tubereulous treatment. (Korean J Gastroenterol 1997; 29:122-128)

만성 간질환에서 Tissue Polypeptide Specific Antigen의 진단적 가치

김경수,박창영,이만호,최권,이상종,김병익,정을순,이승세,전경홍,유종현,심성춘,최윤상 대한소화기학회 1998 대한소화기학회지 Vol.30 No.5

간경변증 환자에서 신장 Doppler 초음파: Resistive Index의 예후적 가치

유종현,조용균,전경홍,이영래,박창영,김병익,김향,정을순,이상종 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.2

간경변증 환자에서 신장 Doppler 초음파 - Resistive Index의 예후적 가치

박창영,조용균,김향,이상종,정을순,이영래,김병익,전경홍,유종현 대한소화기학회 1998 대한소화기학회지 Vol.30 No.2

Background/Aims: Kidney dysfunction in cirrhosis is a well recognized complication that often appears to develop abruptly in previously nonazotemic patients. Intrarenal vasoconstriction is an early hallmark of this functional renal failure because e;evatecl serum creatinine is a late feature of the hepatorenal syndrorne. Resistive index(RI) is the most widely used for estimation of intrarenal arteriolar vascular resistance. We have applied renal dup]ex Doppler ultrasonography to identify this early renal vasoconstriction in nonazotemic patients with liver cirrhosis. Methods: We prospectively measured RI, kidney and liver function and plasma level of renin activity, aldosterone and antidiuretic hormone in 12 healthy subjects, 13 cirrhotic patients without ascites, 22 cirrhotic patients with ascites, 7 cirrhotic patients with ascites and renal falure. Tnen, patiens were followed for 6 months. The incidence of renal failure in each groups were recored and ccrrelated with RI, liver and renal function. Results: RI was significantly increased in patients with cirrhosis(0.68±0.06) compared with healthy subjects(0.39±0.04). In 42 cirrhotic patients, it was significantly increased in patients with ascites(0.69±0.05) compared with patients without ascites(0.64±0.05) and correlated significantly to creatinine clearance(Cr=-0.61, p$lt;0.05). RI was significantly increased in patients with intractable ascites(0.72±0.04) compared with diuretics responded ascites(0.68±0.05). Kidney dysfunction subsequently developed in six(37%) of 16., who had an clevated RI.(≥0.70) In contrast, only one(4%) of 26 patients with a normal RI had kidney dysfunction. Conclusions: Renal duplex Doppler ultrasonography can identify high risk group for subsequenl development of renal dysfunction and be useful for treatment of ascites in cirrhotic patients with nonazotemia by detecting renal vasoconstriction.

유암종에 대한 임상적 고찰

박창영,이상종,김병익,정을순,김기택,성기철,전경홍,황기은,장남수,편유장 대한소화기학회 1998 대한소화기학회지 Vol.30 No.2

Background/Aims: The term, carcinoid, is derived from $quot;Karznoid$quot; coined by Oherndorfer in 1907, which means carcinoma like lesion with no malignant potential. However, it is now generally accepted that these innocuous neoplasms potentially can produce widespread metastasis. Although the carcinoid tumor is relatieve]y rare, it continue to be of special clinical interest because of the endocrine potential, the malignant potential and the recent appearance of the composite carcinoma-carcinoid tumor. Methods: We reviewed the recorded clinical rnanifestations of twenty-two patients with carcinoid tumor, which had been treated from the Kang Book Samsung Hospital for 17 years frorn August 1979 to Septernher 1996. Results: The peak incidence was in the 5th decade occup- ying 9 cases(42%) and male predominence with a ratio of 2.1:1. The common site of the tumors was the rectum(8 cases) and appendix(5 cases). The incidence ot' carcinoid tumors according to the embryologic origin were foregut 6 cases(27%), midgut 7 cases(32%), hindgut 9 cases(41%). The hepatic metatasis was presented in 3 cases. There was no case with classic carcinoid syndrome. Thirty-two percent cases had carcinoma with carcinoid tumor, and nine percent cases had malignant carcinoid tumor. Conclusions: Comparing the age and tumor location, some difference was observed between 22 cases carcinoid tumor experienced at our hospital and those of foreign studies, but other difference was not observed.