황화수소가스에 노출된 후 혼수로 내원한 환자 2례

류현호,이병국,정경운,허탁,민용일,Ryu, Hyun-Ho,Lee, Byeong-Guk,Jeung, Kyung-Woon,Heo, Tag,Min, Yong-Il 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.1

Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.

Localization of Cyclooxygenase Isozymes in Skin Wound Healing in Mouse

고준혁(Jun Hyuk Koh),조백현(Bek Hyun Cho),허탁(Tag Heo),배미옥(Mi Ok Bae),이송은(Song Eun Lee),안규윤(Kyu Youn Ahn),배춘상(Choon Sang Bae),김백윤(Baik Yoon Kim),박성식(Sung Sik Park),남광일(Kwang Il Nam) 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.2

Cyclooxygenase (COX)-1 and -2 expressions in the incisional wound healing of mouse skin were determined by immunohistochemistry and Western blot analysis. By Western blotting, compared to normal skin, COX-2 activity was increased at days 1, 4, 8, and 12 and was maximal at 4 day after incisional wound of mouse skin whereas COX-1 was barely detectable. In normal skin, COX-1 immunostaining was observed among the basal cells of epidermis whereas COX-2 immunostaining was detected in the more differentiated, suprabasal keratinocytes. At 1~4 days after wound, COX-2 staining was particularly prominent in the inflammatory cells, and at day 8, many macrophage-like cells were stained positively. COX-2 immunoreactive fibroblast, macrophage-like cells, and newly formed vascular endothelial cells were increased in number at 12 days after incision. These data suggest that COX-2 is constitutively expressed, just as is COX-1, in epidermis and is associated with keratinocyte differentiation. In addition, these findings support the well-established role for COX-2, the prostaglandins that they generate, as mediators of inflammatory response. 생쥐 피부상처 치유과정에서 cyclooxygenase(COX)-1과 COX-2의 분포 및 역할을 Western blot 분석과 면역조직화학 염 색을 통하여 알아보고자 하였다. Western blotting 실험에서 COX-2 단백질은 정상 피부에 비해 손상 후 1일부터 증가하여 4일째 최고치를 나타내며 12일 까지 증가한 반면에, COX-1은 검출이 되지 않을 정도의 적은 단백량을 나타내었다. 면역조직화학 염색에서 COX-1은 정상 및 손상 피부의 표피 바닥층과 털주머니의 윗부위에서 드물게 양성 반응을 나 타내었다. COX-2는 정상 및 손상군 표피에서 바닥층 위의 각질세포와 털주머니의 윗부위 및 진피유두에서 양성이었다. 손상 후 1일과 4일째 진피의 염증세포에서 COX-2에 강한 양성 반응을 나타냈고, 8일째는 큰포식세포에서, 12일째는 큰포 식세포, 섬유모세포와 신생혈관 내피세포에서 양성 반응을 보였다. 이상의 결과로서, COX-2가 COX-1과 마찬가지로 표피에 상재하는 구성요소로서 각질세포의 분화를 조절할 것임을 암 시하였고, 진피에서는 염증과 같은 자극에 대한 반응을 매개함을 확인할 수 있었다.

천연가스 직접 열분해 방법에 의한 수소제조의 전과정평가

박희일 ( Park Hui Il ),김익 ( Kim Ig ),이병권 ( Lee Byeong Gwon ),허정림 ( Heo Jeong Lim ),허탁 ( Heo Tag ) 한국공업화학회 2003 공업화학 Vol.14 No.6

수소는 에너지 효율성과 다양한 산업 분야에서의 활용성이 매우 높고 특히, 사용 중에 환경영향이 거의 없기 때문에 미래의 청정한 대체에너지로서 주목을 받고 있는 에너지원이다. 그러나 수소의 제조공정에서는 상당한 양의 대기배출물이 발생할 가능성이 있기 때문에 에너지를 포함한 제품의 환경영향은 전과정 즉, 원료채취, 제조, 유통, 사용, 재활용 및 폐기를 고혀하여 평가되어야 한다. 본 연구에서는 천연가스 직접 열분해에 의한 수소제조방법의 전과정에 걸친 온실가스 배출량과 그에 따른 지구온난화에 대한 환경영향을 정량화하고 주요 개선 사항을 규명하기 위하여 전과정평가를 수행하였다. 천연가스 직접 열분해를 이용하여 수소 1 kg을 제조하는데 전과정에 걸쳐 1.570 kg의 CO₂가 배출되었으며 전체 온실가스로 인한 GWP는 1.584 kg CO₂-eq./kg H₂이었다. 또한, 수소의 제조공정 내에서 사용되는 전기에너지 대신 내부적으로 생산되는 수소를 에너지로 사용할 때 상당한 CO₂ 감축효과를 기대할 수 있는 것으로 나타났다. Hydrogen has emerged as a promising energy source because of its high efficiency and applicability in various industrial sectors. In addition, hydrogen has been considered as one of the most environmentally friendly energy sources since there is almost no air emission during its usage. However, it is expected that a considerable amount of air will be emitted from the hydrogen production process. Thus, the environmental impact of a product, including energy, has to be evaluated by considering its entire life cycle, throughout raw materials extraction, manufacturing, distribution, use and recycle and disposal. Life Cycle Assessment on hydrogen production by direct thermal cracking of natural gas was carried out in order to examine the net emission of greenhouse gases as well as other environmental impacts. The CO_(2) emission per 1 kg of hydrogen production via direct thermal cracking of natural gas was 1.570 kg. It was shown that the amount of CO_(2) emission could be remarkably reduced by using the internally produced hydrogen instead of electricity for the hydrogen production process.

의식이 명료한 경증 두부 외상환자에서 뇌 전산화단층촬영의 의의

허탁,김성근,민용일 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

A standardized approch to serious head injury employing immediate CT scanning and aggressive medical and surgical therapy has improved outcomes in cases of intracranial lesions. Unfortunately, there is less agreement on how patients with mild head injury should be handled when first seen in an emergency department setting. The ideal policy in mild head injury would be diagnosis or rule-out intracranial lesions as quickly as possible. We reviewed the records of 126 mild head injury patients admitted during 6-month period to the Chonnam University Hospital to identify a group of mild head injury patients having lesions on brain CT scanning and to investigate the risk factors affecting abnormal lesions on brain CT scanning. All patients had alert mental status without neurological deficit and signs of skull fracture. Routine brain CT scans were obtained on all patients. Fifteen patients(12%) had 17 lesions on brain CT scans. Three patients needed surgery for their intracranial lesions. The initial Glasgow Coma Scale(GCS) was 15 in 107 patients and 14 in 19 patients. The incidence of abnormal brain CT lesions for each GCS was 9% in 15 and 26% in 14. The common symptoms of patients who had abnormal brain CT lesions were headache in 7(47%) cases, loss of consciousness in 7(47%) cases, amnesia in 4(27%) cases, dizziness in 4(27%) cases, vomiting in 3(20%) cases, and lethargy in 3(20%) cases. These data suggest that early brain CT scanning is necessary in alert patients who have GCS in 14, headache, loss of consciousness, amnesia, dizziness, vomiting, or lethargy following mild head injury.

복부 둔사에 의한 장 천공 의심시 진단적 복강세척술의 새로운 양성기준의 의의

민용일,허탁,소정일 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classic criteria to aid in the diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. Methods. The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) ≥ 500/㎣ and newly developed supplementary criteria positive when RBC ≥ 100,000/㎣, the positive-negative borderline was adjusted to WBC ≥ RBC/150, and when RBC < 100,000/㎣, to WBC ≥500/㎣. And analyzed the diference of sensitivity, specificity, and accuracy each other. Results. Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patiens regardless of DPL time 11 false-positive. Conclusions. The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients

의식이 명료한 두통환자의 응급실내 평가와 입원 적응증

류진호,허탁,민용일 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : Headache is a common symptom. It has not proved useful methods that the physician evaluated the alert patient who had headache. It needs the presence of predictors of intracranial pathology(ICP) which serves as influential factors in the indication evaluation and hospitalization of patients. Methods : So, in order to identify such factors, patient records were retrospectively analyzed. 168 patients with the chief complaint of headache presented to the Emergency Department of Chonnam University Hospital during the period from January 1,1995 to December 31, 1997. All were in an alert mental state and had no evidence of trauma and intoxication. Results : 14 cases(8.3%) revealed ICP. 41 cases(24.4%) revealed systemic disease. The remainder of cases were divided among unclassified headaches(61 cases, 36.3%), tension headaches(30 cases, 17.9%), and migraine(22 cases, 13.1%). Comparison of ICP-positive and ICP-negative cases revealed that IGP-positive patients could be categorized by the following findings: (1) presence of focal sign through neurological examination, (2) age greater than 55 years, (3) presence of associated symptoms, (4) acute headache. These four manifestations were proven to be statistically significant as predictors of ICP. Conclusion : Although the positive predictive value of the above criteria is not perfect for the prediction of ICP, they are worthy of clinical consideration in alert patients presenting with headache.

흰쥐 전정신경핵의 전압의존성 포타슘전류에 미치는 산화질소의 영향

정한성,이고욱,김재하,허탁,문종영,박종성 全南大醫大 2000 전남의대학술지 Vol.36 No.2

소화관내 이물에 대한 고찰

윤한덕,류진호,박주경,허탁,조석주,김성근,민용일 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngopharyngoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.

초오 중독 환자에서 심혈관계의 변화에 대한 고찰

문정미,이병국,전병조,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: The roots of Aconitum plants (e.g.,A carmichaelii, A napellus) have been believed to possess anti-inflammatory, analgesic, and cardiotonic effects and have been used in traditional Chinese medicine mainly for the treatment of musculoskeletal disorders. Because of low safety margin, it is not uncommon to visit emergency departments to have variable amounts of highly toxic diterpene alkaloids (e.g., aconitine) contained in their systems. Typical manifestations of aconitine posioning are neurological, cardiovascular, and gastrointestinal problems. The known cardiovascular manifestations are several types of arrhythmia and hypotension. The author experienced a cases of transient ventricular ischemic change in an EKG and elevation in cardiac enzymes. This study aimed to evaluate cardiac ischemia associated with aconitine poisonining. Methods: The author analyzed 13 patients with aconitine poisoning, who visited the Emergency Department of Chonnam National University Hospital from 1995 to 2001. Variables included in data analysis were age, sex, clinical features, cardiac enzyme levels, and EKG changes. Results: Aconitine had been taken for a variety of medical problems, including arthralgia, neuralgia, and some gastrointestinal complaints. All patients suffered from neurological (tingling of the mouth and skin, followed by numbness and weakness in the extremities), cardiovascular (palpitation, dizzness), and gastrointestinal (nausea, vomiting) manifestations. Most patients had a variety of cardiac rhythm disturbances. Two patients exhibited transient cardiac ischemia, including cardiac enzyme elevation and ischemic changes on their an EKGs. Conclusion: Two patients (15.4%) among 13 patients showed transient cardiac ischemia, including cardiac enzyme elevation and ischemic changes on their EKGs. It is important to observe the possibility of myocardial toxicity of aconitum and to evaluate the mechanism of cardiac toxicity through clinical and experimental study.

저혈당증과 동반된 고정 증후군 1례

문정미,전병조,이병국,염경인,허탁,민용일,서정진 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65∼75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.