황산구리 중독에서 대안 해독제로의 succimer 사용 1례

한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ),조영모 ( Young Mo Cho ),왕일재 ( Il Jae Wang ),배병관 ( Byung Kwan Bae ),염석란 ( Seok Ran Yeom ),박순창 ( Soon Chang Park ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.1

Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

골반골절 환자의 골절위치와 출혈량간의 상관관계 분석을 통한 대량수혈 필요에 대한 간단한 예측도구 개발: 골반골 출혈 지수

이상식 ( Sang Sik Lee ),배병관 ( Byung Kwan Bae ),한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jeong ),염석란 ( Seok Ran Yeom ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system. Methods: We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS). Results: From among the 102 patients, 97 patients (M:F=68:29, mean age=46.7±16.6 years) were enrolled for analysis. The average ISS of the patients was 16.2±7.9, and the average amount of packed RBC transfusion for 24 hr was 3.9±4.6 units. The regression equation resulting from the multiple linear regression analysis was ``packed RBC units=1.40×(sacrum fracture)+1.72×(pubis fracture)+1.67×(ilium fracture)+0.36`` and was found to be suitable (p=0.005). We simplified the regression equation to ``Pelvic Bleeding Score=sacrum+pubis +ilium``. Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%. Conclusion: We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management. (J Trauma Inj 2012;25:139-144)

중증외상환자에서 알코올 섭취에 따른 중증도와 예후에 대한 연구

정호형 ( Ho Hyung Jung ),한상균 ( Sang Kyoon Han ),이성화 ( Sung Wha Lee ),박성욱 ( Sung Wook Park ),박순창 ( Soon Chang Park ),염석란 ( Seok Ran Yeom ),민문기 ( Moon Gi Min ),김용인 ( Yong In Kim ),류지호 ( Ji Ho Ryu ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

Purpose: Alcohol ingestion is a significant risk factor for injuries. However, the influence of high blood alcohol concentration about the severe traumatic injury is controversial. The aim of study was to analyze the injury severity, prognosis in severe traumatic patients according to alcohol ingestion. Methods: This study was performed retrospectively with severe traumatic patients (Injury Severity Score≥16) who visited the emergency department at Pusan National University Hospital from January 2013 to December 2013. Results: In total 98 severe traumatic patients, blood alcohol concentration (BAC) positive group (BAC>30 mg/dl) is 42 (42.90%) patients and BAC negative group (BAC≤30 mg/dl) is 56 (57.10% )patients. Head and neck injury is significantly high in BAC positive group (35 patients, 83.3%) compared to BAC negative group (33 patients, 58.9%). Comparison of injury severity, outcome and mortality is not significantly different between two groups. Conclusion: In severe traumatic patients, head and neck injury occurred high in BAC positive group. Alcohol ingestion did not influence injury severity, outcome in severe traumatic patients. However, effort to decreasing injury related to alcohol ingestion and prospective multi-center study is needed. [ J Trauma Inj 2014; 27: 108-14 ]

조영제 부작용환자의 적절한 병원내 관찰시간에 대한 고찰

황순민 ( Sun Min Hwang ),이성화 ( Sung Hwa Lee ),염석란 ( Seok Ran Yeom ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jeong ),김용인 ( Yong In Kim ),한상균 ( Sang Kyoon Han ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.1

Purpose: The purpose of this study was to determine the optimal length of time to observe patients with contrast media anaphylaxis in the Emergency Department. Methods: This study included the patients of all age groups who presented with anaphylaxis due to contrast media to the ED of Pusan National University Hospital from January 2006 to August 2009. The medical records were retrospectively reviewed. We analyzed the 100 patients who met the inclusion criteria. Their median age was 55 (46-62), and 38 out of the 100 patients (38%) were male. Results: The most common symptom of patients was urticaria. Corticosteroid and H1 antihistamine were given to most of the patients in the ED. All were discharged after observation in the ED and none were admitted to the ward. The average time from injection of the contrast media to the onset of symptom was 31 minutes (24-39) and the average time to symptom recovery was 127 minutes (89-188). The mean observation time in the ED was 93 minutes (59-153). Biphasic reactions were reported in only one case (1/100, 1%). Conclusion: These results suggest that patients who present with an anaphylactic reaction after radiologic studies that use intravenous contrast media can be safely discharged early from the ED because the symptom recovery time is not long and a biphasic reaction is rare.

한 · 미 통상 관계의 성격과 전망 - 한 · 미FTA를 중심으로 -

정하용 한국외교협회 2018 외교 Vol.127 No.0

2018년 타결된 한 · 미FTA 재협상은 1980년대 이후 지속되어 온 미국의 일방주의적 통상 정책이 여전히 한 · 미 통상 관계를 규정하고 있다는 점을 잘 보여준 협상이다. 한 · 미FTA 재협상은 경제적 동인보다는 미국의 국내정치적 요구에 기인한 정치적 고려를 강하게 반영한 것으로 한 · 미FTA는 미국의 국내정치적 상황에 따라서 조정되거나 극단적으로는 폐기의 위협에 놓일 수도 있음을 시사하고 있다. 이러한 불확실성에도 불구하고 여전히 한 · 미FTA는 양국 간 갈등이 아닌 협력을 강화시킬 수 있는 기제로 발전될 수 있는 가능성을 내포하고 있고, 이는 통상의 상호 보완 구조를 통하여 강화될 수 있다. 한 · 미FTA로 대표되는 한 · 미통상관계가 양국 간의 협력을 강화시켜 줄 수 있는 제도로 작동하기 위해서는 한국의 입장에서는 통상 마찰에 대비한 기회 비용을 최소화하기 위한 교역 구조의 변화 노력이 반드시 이루어져야 한다. 통상 관계에서 발생하는 단절의 기회비용이 비대칭적으로 높은 구조에서는 한 · 미FTA는 경제 논리와는 무관한 정치적 관계에 의해 언제든지 재규정될 수 있는 취약한 협정이 될 수 있기 때문이다.

외상 환자에 대한 바늘감압술에서 흉벽 두께와 바늘 길이의 관계

김지완 ( Jee Wan Kim ),정진우 ( Jin Woo Jeong ),조석주 ( Suck Ju Cho ),염석란 ( Seok Ran Yeom ),한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: A tension pneumothorax is a fatal condition that requires immediate intervention. Although a definitive treatment for a tension pneumothorax is a tube thoracostomy, needle decompression can provide temporary relief, that is lifesaving. The traditional procedure for needle decompression involves inserting a needle or catheter at the second intercostal space, the midclavicular line. Recent evidence suggests that the commonly used catheters do not have sufficiently penetrate the chest wall. There are also claims that a lateral approach to needle decompression is easier and safer than the traditional anterior approach. The purpose of this study is to evaluate the optimal approach for needle decompression for the Korean population by measuring chest wall thicknesses at the points used for both the anterior and the lateral approaches. Methods: The chest wall thickness (CWT) of trauma victims who visited the Emergency Center of Pusan National University Hospital was measured by computed tomography (CT) images. The CWT was measured at the points used for the anterior and the lateral methods and was compared with the length of commonly used catheters, which is 45 mm. Results: The mean CWT at the second intercostal space, the midclavicular line, was shorter than the CWT at the 5th intercostal space, the anterior axillary line. However, the percentage of patients whose CWT was greater than 45 mm was larger when measured anteriorly (8.2%) that when measure laterally (5.7%). Female patients and those older than 60 were more likely to have an anterior CWT greater than 45 mm (28.2% for females and 15.5% for those older than 60). Conclusion: The percentage of trauma victims in Korea whose CWT is greater than 45 mm is lower than the values previously reported by other countries. However, females and older patients tend to have thicker chest walls, so the lateral approach would be suggested when performing needle decompression for such patients with suspected tension pneumothoraces. (J Korean Soc Traumatol 2010;23:63-67)

어떤 다발성 외상환자가 중환자실에 오래 있게 되는가?: Injury severity score와 손상부위 수의 비교

조무진 ( Mu Jin Jo ),이성화 ( Seong Hwa Lee ),조석주 ( Seok Ju Cho ),염석란 ( Seok Ran Yeom ),한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ),이대섭 ( Dae Seop Lee ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.2

Purpose: Injury severity score (ISS), a widely used scoring system, is used to define the severity of trauma in multiple-trauma patients. Nevertheless, ISS cut-off value for predicting the outcome of multiple-trauma patients has not been confirmed. Thus, this study was performed to determine the more useful method for predicting the outcome for multiple-trauma patients: the ISS or the number of anatomical Abbreviated injury scale (AIS) injury regions. Methods: for 195 consecutive patients who a regional emergency medical center, we analyzed the ISS and the number of anatomical AIS injury region. The patients were divided into four groups based on the ISS and the number of anatomical AIS regions. We compared intensive-care-unit (ICU) admission days and hospitalization days and ICU stay ratio (ICU admission days/hospitalization days) between the four groups. Results: In the groups with an ISS more than 17, the results were not significantly different statistically the group with 2 anatomical AIS injury regions and more than 3 anatomical AIS injury regions. Also, in the group with an ISS of 17 or less, the results were the same as those for patients with an ISS more than 17 (p>0.05). Among the patients with 2 anatomical AIS injury regions, patients with an ISS more than 17 patients had more ICU admission days and a higher ICU stay ratio than patients with an ISS 17 or less. Also, Among the patients with 3 anatomical AIS injury regions, the results were the same as those for patients with 2 anatomical AIS injury regions. Conclusion: Patients with high ISS, regardless of the number of anatomical AIS injury regions had significantly longer ICU stays and higher ICU admission ratio. Thus, the ISS may be a better method than the number of anatomical AIS injury regions for predicting the outcomes for multiple-trauma patients.