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응급수술을 시행한 흉부 및 경부 외상환자에 대한 임상적 고찰
현성열 ( Sung Youl Hyun ),오상우 ( Sang Woo Oh ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),진욱 ( Wook Jin ),류일 ( Eell Ryoo ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Background: Recently, the number of patients with the thorax or neck trauma has increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Most of the thorax or neck injuries can be managed with conservative methods and simple surgical procedures, but an open thoracotomy or exploration will be necessary in emergent cases. Traumas to the thorax and the neck have an extremely poor prognosis when not diagnosed and treated early. Therefore, we analyzed the results of emergent operations in patients with thorax or neck trauma and their clinical courses. Methods: A clinical evaluation was performed on 56 patients treated with emergent operations for thorax or neck trauma from January 1997 to July 2003 according to their medical Results: There were 45 males and 11 females. The mean age was 36.1 years. The modes of injury were as follows: traffic accidents 14 cases, stab wounds 27 cases, industrial disasters 7 cases, and others 8 cases. The annual distribution of cases was as follows: 1997 year 9 cases, 1998 year 6 cases, 1999 year 7 cases, 2000 year 10 cases, 2001 10 cases, 2002 6 cases and 2003 8 cases. The injured organs were 13 cases of a ruptured diaphragm, 12 cases of a ruptured lung, 7 cases of a ruptured heart, 2 case of a ruptured aorta, 9 cases of a simple vessel ruptured and 4 cases of a ruptured esophagus and trachea. There were 9 (16%) overall deaths: 6 cases in deaths among the blunt-trauma cases and 3 deaths among the stab injury cases. Conclusion: Early diagnosis and surgical treatment is essential for thorax or neck trauma, to decrease the mortality and complications. Therefore, careful diagnostic procedure, appropriate preoperative management for hypovolemia, and early surgical treatment are essential. The setup an of emergency operation system should be considered as a reform measure.
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.
정태교 ( Tae Kyo Chung ),현성열 ( Sung Youl Hyun ),김진주 ( Jin Joo Kim ),류일 ( Eell Ryoo ),이근 ( Kun Lee ),조진성 ( Jin Seung Cho ),황성연 ( Sung Yun Hwang ),이석기 ( Suk Ki Lee ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2
Background: Blunt thoracic trauma in children has a high morbidity and mortality. In this study, we assessed the significance of the injury pattern, mechanism and initial status in emergency department on severity and prognosis in pediatric blunt thoracic trauma patients. Method: We retrospectively reviewed medical records and chest X-ray and CT images of 111 pediatric blunt thoracic trauma patients from October 2000 to June 2005. Data recorded age, gender, season, injury mechanism, injury pattern, associated injury, length of hospital stay and cause of death. Result: Of all 111 patients, 68 patients were injured by motor vehicle accidents, 30 were falls, 5 were motorcycle accidents, 3 were sports accidents and 5 were miscellaneous. In thoracic trauma, single injury of lung contusion were 35 patients and 32 patients had multiple thoracic injuries. Hospital stay in school age group were longer than preschool age group. The causes of death were brain injury in 9, respiratory distress in 4, and hypovolemic shock in 2 patients. Emergently transfused and mechanically ventilated patients had higher mortality rates than other patients. Patients required emergency operation and patients with multiple thoracic injuries had higher mortality rates. Conclusion: In this study, patients with combined injury, emergency transfusion, mechanical ventilation, emergency operation, multiple injuries in chest X-ray had higher mortality rates. Therefore in these pediatric blunt thoracic trauma patients, accurate initial diagnosis and proper management is required.
박신웅 ( Shin Woong Park ),현성열 ( Sung Youl Hyun ),김진주 ( Jin Joo Kim ),임용수 ( Yong Su Lim ),조진성 ( Jin Sung Cho ),양혁준 ( Hyuk Jun Yang ),박원빈 ( Won Bin Park ),우재혁 ( Jae Hyug Woo ),장재호 ( Jae Ho Jang ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included outof- hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.
흉부 외상에서 폐좌상(Pulmonary contusion)과 외상성 폐낭종 (Traumatic Lung cyst)을 동반한 환자의 임상경과 및 예후 예측 인자
김용환 ( Yong Hwan Kim ),현성열 ( Sung Youl Hyun ),김진주 ( Jin Joo Kim ),김정권 ( Chung Kwon Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이미진 ( Mi Jin Lee ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.2
Purpose: A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs. Methods: We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst. Results: The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was 37.70±19.78 years with 36.6% of the patients being under 30 years forage. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score. Conclusion: The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs. (J Korean Soc Traumatol 2008;21:100-107)
Methylene Blue를 이용한 경부 관통상에 의한 식도손상 진단 1예
주정민 ( Jung Min Ju ),현성열 ( Sung Youl Hyun ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),이근 ( Gun Lee ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Penetrating injury of the cervical esophagus cannot be easily identified by physical examination due to its deep anatomical location, so many patients with penetrating neck injuries should be undergone esophagography or esophagoscopy for the evaluation of potential esophageal injuries. However, these diagnostic procedures are invasive, time-consuming, expensive, and, most importantly limited by availability of resources (diagnostic equipment and manpower). We experienced a patient with a penetrating esophageal injury who was promptly diagnosed by using methylene blue. A 32-year-old male visited the emergency room complaining of dyspnea and bleeding after a penetrating neck injury.Thrty (30) minutes after the patient had swallowed the methylene blue solution, we found leakage of blue-colored fluid through the stab wound. He underwent emergent surgical repair without further investigations for esophageal injury.
경미한 외상을 받은 소아,청소년 환자의 지연 진단에 대한 고찰
최지안 ( Jee Ahn Choi ),박원빈 ( Won Bin Park ),김진주 ( Jin Joo Kim ),조진성 ( Jin Sung Jo ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),현성열 ( Sung Youl Hyun ),정호성 ( Ho Seong Jeong ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2
Purpose: To analyze delayed diagnosis, we collected date on pediatric and adolescent patients who had been admitted to the Emergency Department with injuries due to minor trauma. Methods: We retrospectively analyzed the age distribution, trauma mechanism, time interval for each affected body region at delayed diagnosis, hospital stay, and outcome for 161 pediatric and adolescent patients who had been admitted to the Emergent Department of Gachon University Gil Hospital from January 2006 to September 2008. Results: The incidence of delayed diagnosis in pediatric and adolescent trauma was 11.8% in our retrospective review of 161 pediatric and adolescent patients. Lengths of hospitalization were longer in patients with delayed diagnosis (p<0.05). Patients with delayed diagnosis were more often transferred to other hospitals than patients with non-delayed diagnosis (p<0.05). The time intervals for each different affected body regions at delayed diagnosis were significantly different, but the hospital stays were not. There were no statistical significance to age on affected body region. Conclusion: From this study, we found that admission result and hospital stay were statistically significant differences between the delayed-diagnosis patient group and the non-delayed-diagnosis patient group. Finally, we must follow up pediatric and adolescent patients with minor trauma, closely considering missed injuries. (J Korean Soc Traumatol 2009;22:212-7)
선종효 ( Jong Hyo Sun ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Sung Jo ),현성열 ( Sung Youl Hyun ),정호성 ( Ho Sung Jeong ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),김정호 ( Jeong Ho 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2
Purpose: Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation. Methods: We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors. Results: Representative values were compared between survivors and non-survivors: RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes. Conclusion: The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage. (J Korean Soc Traumatol 2009;22:248-53)
소아 두부외상 환자에서의 반복적인 두부 CT 검사의 유용성
조호준 ( Ho Jun Jo ),임용수 ( Yong Su Lim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Seong Cho ),현성열 ( Sung Youl Hyun ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
Purpose: Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. Methods: We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. Results: A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. Conclusion: Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children. [ J Trauma Inj 2015; 28: 149-157 ]