골반 골절 위치와 방광, 요도, 하부 위장관계 손상의 관련성

김창호 ( Chang Ho Kim ),박정배 ( Jung Bae Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),서준석 ( Jun Seok Seo ),정제명 ( Jae Myung Chung ),제동욱 ( Dong Wook Je ),성애진 ( Ae Jin Sung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher`s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts. (J Korean Soc Traumatol 2007;20:90-95)

유기인계 농약 중독환자에서 기계환기 필요성에 대한 예측인자 분석

박동찬 ( Dong Chan Park ),박정배 ( Jung Bae Park ),김윤정 ( Yun Jeong Kim ),신수정 ( Soo Jeong Shin ),문유호 ( You Ho Mun ),박신률 ( Sin Ryul Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),정제명 ( Jae Myung Chung ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2

Purpose: The purpose of this study is to investigate the factors that predict using mechanical ventilation for patients with organophosphate intoxication. Methods: We retrospectively reviewed the medical records of 111 patients with acute organophosphate intoxication and who were treated in our emergency center from January 2000 to December 2008. We compared the toxicologic characteristics, the laboratory findings and the APACHE II scores between the Mechanical Ventilation group (MV group) and the non-Mechanical Ventilation group (the non MV group). Results: Sixty three patients were in the MV group and 48 patients were in the non MV group. In the MV group, the patients had an older age (p<0.001), a larger amount of ingestion (p<0.001), a lower initial serum cholinesterase level (p=0.003), a higher APACHE II score (p<0.001) and they ingested a more toxic agent (p=0.001). There were no significant differences in gender, the type of visit and the arrival time between the MV group and the non MV group. Conclusion: We suggest that the patient’s age, the amount of organophosphate ingestion, the toxicity of the agent, the initial serum cholinesterase level and the APACHE II score are important factors to determine if mechanical ventilation will be applied for patients with organophosphate intoxication.

두부 외상 환자의 중증도 평가 시 단순운동점수의 유용성

이상경 ( Sang Kyong Lee ),류현욱 ( Hyun Wook Ryoo ),박정배 ( Jung Bae Park ),서강석 ( Kang Suk Seo ),정제명 ( Jae Myung Chung ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.2

Purpose: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. Methods: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)≥4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). Results: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS≥4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS≥4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. Conclusion: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations. (J Korean Soc Traumatol 2008;21:71-77)

흉부 외상 환자에서 늑막 천자를 위해 바늘 도관의 길이에 대한 연구

강성원 ( Sung Won Kang ),류현욱 ( Hyun Wook Ryoo ),박정배 ( Jung Bae Park ),서강석 ( Kang Suk Seo ),정제명 ( Jae Myung Chung ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma. Methods: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. Results: As the left and the right mean CWTs were 3.4±1.0 cm and 3.4±1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT >5 cm. Conclusion: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed. (J Korean Soc Traumatol 2009;22:1-4)

흉부 외상 환자에서 일반흉부촬영과 비교한 흉부단층촬영의 진단적 유용성

최규일 ( Kyu Ill Choi ),서강석 ( Kang Suk Seo ),류현욱 ( Hyun Wook Ryoo ),박정배 ( Jung Bae Park ),정제명 ( Jae Myung Chung ),안재윤 ( Jae Yoon Ahn ),강성원 ( Seong Won Kang ),이재혁 ( Jae Hyuck Yi ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT. Methods: This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients` characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present. Results: Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn`t be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR. Conclusion: CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn`t be found on CXR to be verified, which helped us to could accurately evaluate patients. (J Korean Soc Traumatol 2009;22:142-7)

경북의대 의학과 학사편입 시행 경험

이유철(Yoo Chul Lee),여상희(Sang Hee Yeo),이원기(Won Kee Lee),강덕식(Duk Sik Kang),강이철(Echeol Kang),곽연식(Yun Sik Kwak),김보완(Bo Wan Kim),이종명(Jong Myung Lee),장봉현(Bong Hyun Chang),정제명(Jae Myung Chung),조희중(Hee Jung Cho 한국의학교육학회 2003 Korean journal of medical education Vol.15 No.1

Purpose: Kyungpook National University School of Medicine initiated a pilot project to admit small number of qualified students who received BS degree or above in the field of sciences in 1996. This study was conducted to evaluate effectiveness of the pilot project. Methods: Students academic grades, outcome of their opinion surveys on adaptability to the school life, difficulties and problems from the classes of 1996 to 2001 were analyzed. Results: A total of 57 students were admitted to this program over the past 7-year period, 54.8% of them from natural science major and 36.8% from engineering. Students admitted with BS degree were performing above average in the class by % rank. There was no significant difference in academic performance between the natural science and the engineering major. Of 20 graduated, only one took career in basic medical science (physiology). The students thought undergraduate education was helpful in maturing personal characters than in knowledge or skill attainment. Conclusion: The achievement of medical students admitted after baccalaureate level was comparable to that of students with two years of premedical education.

의식이 명료한 다발성 외상환자에게 전신 전산화단층촬영이 반드시 필요한가?

문유호 ( You Ho Mun ),김윤정 ( Yun Jeong Kim ),신수정 ( Soo Jeong Shin,),박동찬 ( Dong Chan Park ),박신율 ( Sin Ryul Park ),류현욱 ( Hyun Wook Ryu ),서강석 ( Kang Suk Seo ),박정배 ( Jung Bae Park ),정제명 ( Jae Myung Chung ),배지 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients` mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients` evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was 44.6±18.9 years. One hundred four (104, 71.2%) were men, and the injury severity score was 14.0±10.38. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients. (J Korean Soc Traumatol 2010;23:89-95)

일개 의과대학 의학과 학생의 학습양식

여상희(Sang Hee Yeo),이경우(Kyung Woo Lee),장봉현(Bong Hyun Chang),강이철(Echeol Kang),강덕식(Duk Sik Kang),곽연식(Yun Sik Kwak),김보완(Bo Wan Kim),이유철(Yoo Chul Lee),이종명(Jong Myung Lee),조희중(Hee Jung Cho),정제명(Jae Myung Chu 한국의학교육학회 2006 Korean journal of medical education Vol.18 No.1

Purpose: The purpose of this study is to investigate the learning styles of students at Kyungpook National University (KNU) School of Medicine and to assess its implications on teaching-learning methods in medical school. Methods: 571 students in all years of medical school were invited to complete a questionnaire via online. For this study, Felder s Index of Learning Styles (ILS) was used, which included 49 items. Felder s ILS measures the learner s relative preference for each of the five dichotomous learning style dimensions. Results: 242 (42.3%) students completed the questionnaire. More than 80% preferred sensitive information and more than 60% preferentially took in visual information. Both males and females preferred sensing and visual learning materials. On average, The students at KNU school of Medicine were reflective, sensing, visual, global and inductive. Conclusion: From these results, we suggested some effective methods of teaching-learning based on the students preferences and some perspectives for future works.

응급실로 내원한 소아 장중첩증의 임상적 고찰

박삼식,강재구,왕순주,정제명 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

Intussusception is a condition of invagination of the proximal segment of bowel into the more distal receiving bowel. Intussusception is one of the common pediatric and surgical emergencies of infancy and childhood in Korea. Intussusception is the most common cause of acquired intestinal obstruction in infancy and childhood, and it needs emergency treatment. 1) On the age and sex distribution, the age under 15 month was the most common(70.6%), and the peak incidence was 3-12 months of age(60.1%). In sex distribution, male to female ratio was 1.25:1. 2) The seasonal distribution was summer(27.4%), spring, autumn and winter in order of frequency 3) As to the etiology of Intussusception treated by surgery, idiopathic was the most common(75%). 4) The cardinal symptoms and signs were vomiting (72.5%), bloody or bloody mucoid stool (57.5%), abdominal pain(49.7%), abdominal distention(20.9%), abdominal mass(19.6%) and others in order of frequency. 5) On the hematologic finding, 60.8% revealed leukocytosis above 10,000/mm3 6) As to the duration from the onset of the symptom to admission, 84.2% was within 24hours, 9.8% was from 24 hours to 48 hours, and 5% was over 48 hours. 7) The common anatomical types were ileocolic(73.2%), and ileocecal(17.0%). 8) The success rate of air reduction was 84.3%. 9) In the method of operation, manual reduction was performed in 91.7% and intestinal resection in 8.3% 10) The recurrence rate after air reduction was 12.4%, and after operative manual reduction was 8.3%

新손상정도계수에 의한 외상 환자의 분석과 적정진료의 평가

설동환,서강석,박정배,정제명,서준석,이정호,최승필 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Purpose: The Injury Severity Score (ISS) has limited predictive power and is difficult to calculate. We used the New Injury Severity Score (NISS) and compared it to the ISS. The purpose of this study was to give a prognosis and predict the mortality for trauma patients by using the ISS and the NISS and to compare Trauma and Injury Severity Score(TRISS) method using NISS with the TRISS method using ISS. Methods: A retrospective study of 100 trauma victims who visited the emergency room of Kyungpook National University Hospital from September 2000 to May 2001 was made using the ISS, the NISS, and the TRISS methods. Results: A comparison between survivors and nonsurvivors showed differences in the revised trauma score (RTS), ISS, NISS, and TRISS Ps-1 by using RTS and the ISS and TRISS Ps-2 by using RTS and NISS (p<0.01). We found that the NISS was more predictive of survival than the ISS. A receiver operating curve analysis and Hosmer Lemeshow statistics showed that both the NISS and the ISS provided a good fit throughout its entire range of prediction. Conclusion: By comparing the ISS with the NISS, we concluded that the NISS better separated survivors from nonsurvivors. The NISS predicted survival better and was easier to calculate than the ISS. The results of the TRISS method using NISS were satisfactory, and we expect to use this method in quality assessment with further study and modification.