슬관절내 견열골절의 자기공명영상 소견과 동반된 관절내 손상: 십자인대 파열을 중심으로

홍훈표,진욱,류경남,Hong, Hun-Pyo,Jin, Uk,Ryu, Gyeong-Nam 대한영상의학회 2003 대한영상의학회지 Vol.48 No.4

목적: 슬관절의 전방 및 후방십자인대의 견열골절 손상이 있을 때 십자인대 자체의 파열 유무를 MRI소견과 수술소견을 통해서 알아보고자 하였다. 대상과 방법 : 1997년 3월부터 2002년 5월까지 전방 혹은 후방십자인대의 견열골절 손상으로진단되었던 19예의 환자 중에서 수술을 시행한 10예를 대상으로 하였다. 남녀비는 8 :2 였고, 연령분포는 10세에서 51세사이로 평균 27. 7세 였다. 십자인대의 경골 부착부위에 견열골절이 있었던 10예에서 MRI상 전방 혹은 후방십자인대의 파열 유무를 분석하였고, 수술소견과 비교 하였다. 또한 동반된 슬관절내 다른 부위의 손상 여부를 알아보았고, 환자의 수술방법 및 추적 검사상에서의 수술결과를 알아보았다. 결과: 전방십자인대의 견열골절 손상이 있었던 7예 중 인대의 부분파열이 5예, 완전파열이 1예로 진단되었고, MRI소견과 수술소견이 일치하였다. 후방십자인대의 견열골절 손상이 있었던 3예 모두가 MRI상에서 인대의 부분파열로 진단되었고, 수술소견도 일치하였다. 6예에서 슬관절내 동반된 다른 구조물의 손상이 없었고, 내측반월상연골 파열, 외측반월상연골 파열, 후방십자인대 및 내측측부인대 파열, 오금인대 파열이 각각 1예씩 동반되어 있었다. 결론: 전방 및 후방십자인대의 견열골절이 있었던 대부분의 예에서 십자인대의 부분파열 및 완전파열을 동반하였다. 수술이나 관절경 상에서 간과할 수 있는 인대자체의 손상을 MRI상에서 진단해 내는 것이 전방 및 후방십자인대의 견열골절 영상분석에 도움을 줄 것으로 생각된다. Purpose: To determine the presence of cruciate ligament tears following avulsion injuries involving the ACL and PCL, and to correlate the findings with those of surgery. Materials and Methods: Between March 1997 and May 2002, avulsion injury involving the ACL or PCL was diagnosed in 19 patients. Ten of these [8 males and 2 females aged 10-51 (avergae, 27.7) years] were included in this study. We assessed the presence of cruciate ligament tears at MR imaging, correlating the findings with those of surgery. Associated intra-articular injuries, treatment methods and follow-up results were also evaluated. Results: Among Seven patients with ACL avulsion injury, this was assessed at MR imaging as complete tear (n=1), partial tear (n=5), or intact (n=1), while all MR images of PCL avulsion injury (n=3) showed that this was partial tear. All imaging findings corresponded with the surgical findings. In four patients there was associated knee injury involving, respectively, tears of the medial meniscus, lateral meniscus, PCL and MCL, and popliteal ligament. Conclusion: Our findings showed that with one exception, patients with avulsion injury of the ACL or PCL had suffered either a partial or complete tear. MR imaging may be useful in the diagnosis of tears of the cruciate ligament which have not been noticed at surgery or arthroscopy in avulsion injuries involving the ACL and PCL

Acetic Acid를 이용한 신낭종의 경화 치료법

홍훈표 대한영상의학회 1998 대한영상의학회지 Vol.39 No.4

자발성 흉추 경막외 혈종 1례

강남규,홍훈표,김명천,고영관 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.3

Spontaneous spinal epidural hematoma (SSEH) is a rare entity that has been reported to occur in different age groups, from pediatric to elderly patients. The etiology and the pathogenesis remain unclear. By definition, SSEH excludes that due to obvious trauma, anticoagulant therapy, coagulopathy, vascular malformation, and tumors. The presenting symptoms vary, but the usual earliest presentation is a sudden stabbing pain associated with a nerve-root type of irradiation. A variable degree of sensorimotor deficit then rapidly develops. An urgent computed tomography (CT) myelography and magnetic resonance imaging (MRI) can be performed to diagnose the hematoma. For patients with incomplete sensorimotor deficit, favorable outcomes are thought to correlate highly with surgery (decompressive laminectomy) within 48 hours. This critical time is sharply reduced to 12 hours for patients with complete sensorimotor deficit.

증례보고 : 호산구증가 환자에게 발생한 간문맥,비장정맥 및 상장간막정맥 혈전증과 소장괴사 1례

천일영,홍훈표,김명천,고영관,도인구,양문호 대한응급의학회 2003 大韓應急醫學會誌 Vol.14 No.5

둔상에 의해 발생한 요관 송산 1례

황현철,홍훈표,김명천,고영관 대한응급의학회 2003 大韓應急醫學會誌 Vol.14 No.4

독사 교상 후에 생긴 뇌경색 1례

이형민,홍훈표,김동필,김명천,고영관 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.5

There are only three species of poisonous snakes in Korea. Deaths from poisonous snakebites are rare in Korea, but the World Health Organization estimates that as many as 30,000 to 40,000 death occur following venomous snakebites. The most important factor for determining a prognosis for a victim of a venomous snakebite is the grade of envenomation, because the grade of envenomation is highly correlated with severe complications such as disseminated intravascular coagulopathy, a bleeding tendency, acute renal failure, pulmonary edema, and sepsis. Also, bleeding complications with the central nervous system are well known to occur following a snakebite. However, non hemorrhagic manifestations, such as ischemic stroke, are extremely rare. We report the case of 72-year-old male who suffered a cerebral infarction following a snakebite. We also present a review of the literature of possible mechanisms for the cerebral infarction.

기복증과 종격동기종이 동시에 동반된 기종성 신우신염 1례

박상혁,홍훈표,김명천,고영관 대한응급의학회 2005 대한응급의학회지 Vol.16 No.3

응급실을 통해 입원한 패혈증 혹은 패혈성 쇼크 환자에서 생존에 영향을 미치는 인자

변재민,홍훈표,최한성,고영관,조한진 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.4

Purpose: We sought to determine the impact of the factors that affect the mortality of critically ill patients with sepsis or septic shock. Methods: We performed a retrospective cohort study of adult patients admitted with sepsis or septic shock from April 1, 2006, to December 31, 2007, at a single, urban academic emergency department (ED). The primary outcome was patients’ death. Predictor variables were the EDLOS, the time from registration to order for antibiotics administration, number of hospital days, initial systolic blood pressure, systolic blood pressure after hydration, heart rate, respiration rate, body temperature, serum white blood cell count, and serum lactic acid level. Cox’s proportional hazard model was used to elucidate the relationship of predictor variables to patients’ death. Data were analyzed with SPSS version 12.0. Results: The overall mortality rate was 56.2%. Average length of stay was 204.5±90.6 minutes in the survival group and 166.6±81.8 minutes in the death group (p=0.041). The mortality was not shown to be significantly different between patients spending less than 4 hours and patients spending over 4 hours. The relative risk (RR) for patients’ death was significantly higher in patients with hypotension persisting despite adequate fluid resuscitation. Conclusion: EDLOS did not affect mortality for the patients admitted with sepsis or septic shock. The patients’ prognoses were mainly related to the systolic blood pressure after hydration.

응급의료기관에서의 의료소송: 판례 중심의 의료법학적 고찰

서창원,홍훈표,고영관,이종석,권오영,최한성,김신철,김동필 대한응급의학회 2009 대한응급의학회지 Vol.20 No.6

Purpose: To investigate which factors are associated with the causes and results of medical malpractice claims on emergency medical facilities. The study analyzed the alteration of judicial precedents between before and after 1995 when the court ruled that the burden of proof was to be placed upon the accused as well as the plaintiff. Methods: We collect 213 medical malpractice claims covering from 1953 to 2008, using a database of closed claims maintained by the Supreme Court of Korea. Of the 213 claims, 31 involved emergency medical facilities. The cases were divided into 4 groups according to the physician’s specialty and the causes and results of the claims were compared among each group. The causes and results were also compared between before and after 1995. Results: In the medical department, the physicians were mainly accused in connection with mis- or delayed diagnosis. In the surgical and emergency departments, the plaintiff denounced the physician generally for neglect of duty in the emergency medical service system. The tendency of the court’s ruling related to the distribution of the burden of proof has been changed after 1995 and the rate of physician legal victory in the judicial precedents has declined since then. Conclusion: Medical malpractice claims on emergency medical facilities were mostly related to misdiagnosis or emergency medical service system. Due to the change in the court’s ruling regarding the distribution of the burden of proof, emergency physicians with medical malpractice claims need to change their attitude with regards to the activeness in the claims.

두정후두엽으로 돌출된 경막동정맥루 1례

이형민,홍훈표,김명천,고영관 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.4

Arteriovenous fistulas are vascular abnormalities consisting of fistulous connections of arteries and veins without normal intervening capillary beds. Arteriovenous fistulas (AVFs) located within the dura mater make up about 15% of all intracranial vascular malformations. Frequent sites of involvement include the transverse and the sigmoid sinuses, followed by the cavernous sinus, anterior cranial base, and tentorium. The natural history of dural AVFs (DAVFs) is highly variable. Some patients have no symptoms or benign symptoms for many years. Clinical symptoms are a complex function of multiple factors, such as location, mode of venous drainage, and magnitude of flow, as well as host angiologic factors. Reversal of flow and venous hypertension in the leptomeningeal draining veins account for the majority of neurological manifestations. The most common nonhemorrhagic symptoms include pulsatile tinnitus and headache. Other manifestations include a global or a focal neurological deficit that may be a seizure, papilledema, hydrocephalus, dementia, cranial nerve palsies, and cervical myelopathy. Angoigraphy is the gold standard of diagnosis. CT or MRI is often normal. We report a case of occipitoparietal protrusion of DAVFs in a 43-year-old man that presented initially as a pulsatile mass in his occiput.