중증 다발성 늑골골절에 대한 조기 수술적 늑골고정술

황정주 ( Jung Joo Hwang ),김영진 ( Young Jin Kim ),류한영 ( Han Young Ryu ),조현민 ( Hyun Min Cho ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients` demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures. (J Korean Soc Traumatol 2011;24:12-17)

기도협착을 유발한 흉선낭종

황정주,양홍석,백효채,홍순원,이두연,Hwang, Jung-Joo,Yang, Hong-Seok,Paik, Hyo-Chae,Hong, Soon-Won,Lee, Doo-Yun 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.2

Thymic cysts are uncommon tumors which usually occur in the neck and mediastinum. It is known to arise from embryonic remnants of the thymopharyngeal duct or from inflammation of thymic tissues. Patients with thymic cyst are often asymptomatic and identified after surgical removal and histologic examination. We experienced a 73 year-old man with recently developed dyspnea. During the examination, chest CT showed a $5\times6cm$ sized cystic mass causing deviation of the trachea. It was located in between the right thyroid gland and anterior mediastinum. It also caused tracheal narrowing noted by bronchoscopy. Right anterior cervical incision and removal of the mass was performed and a histological diagnosis of thymic cyst was confirmed. The patient was discharged without complication.

식도 파열의 수술적 치료

황정주,정은규,이두연,백효채,Hwang Jung Joo,Joung Eun Kyu,Lee Doo Yun,Paik Hyo Chae 대한기관식도과학회 2005 大韓氣管食道科學會誌 Vol.11 No.1

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.

기도협착을 유발한 흉선낭종

황정주,양홍석,백효채,홍순원,이두연,Hwang, Jung-Joo,Yang, Hong-Seok,Paik, Hyo-Chae,Hong, Soon-Won,Lee, Doo-Yun 대한기관식도과학회 2005 大韓氣管食道科學會誌 Vol.11 No.1

Thymic cysts are uncommon tumors which usually occur in the neck and mediastinum. It is known to arise from embryonic remnants of the thymopharyngeal duct or from infammation of thymic tissues. Patients with thymic cyst are often asymptomatic and identified after surgical removal and histologic examination. We experienced a 73 year-old man with recently developed dyspnea. During the examination, chest CT showed a $5{\times}6cm$ sized cystic mass causing deviation of the trachea. It was located in between the right thyroid gland and anterior mediastinum. It also caused tracheal narrowing noted by bronchoscopy. Right anterior cervical incision and removal of the mass was performed and a histological diagnosis of thymic cyst was confirmed. The patient was discharged without complication.

3단형 과학로켓용 과학탑재체 개발

황승현(Seung-Hyun Hwang),김준(Jhoon Kim),이수진(Soo-jin Lee),전영두(Young-Doo Chun),박정주(Jung-Joo Park) 한국항공우주학회 2003 韓國航空宇宙學會誌 Vol.31 No.2

한국인의 골반과 비구 골절에서 정맥 혈전색전증의 발병률

이상기,이재원,황정주,Lee, Sang Ki,Lee, Jae Won,Hwang, Jung Joo 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: There are no detailed reports on the incidence of venous thromboembolism (VTE) in pelvic and acetabular fractures in the Asian population. The purpose of this study was to investigate the incidence of VTE in pelvic and acetabular fractures in the Korean population. Methods: The cases of 67 Korean patients with pelvic and acetabular fractures treated at our hospital from January 2009 to February 2012 were analyzed retrospectively. Until May 2010, VTE screening was performed by contrast-enhanced computed tomography (CT) or ultrasonography (US) when the D-dimer value did not decline predictably, still exceeded $20{\mu}g/ml$ at 5 days after trauma and surgery, or increased to greater than $20{\mu}g/ml$ after a period of decline. After May 2010, contrast-enhanced CT and US were performed routinely irrespective of the D-dimer value. Physical prophylaxis was performed on all patients. The effects of the presence of a pelvic and/or acetabular fracture, and the effects of fracture type, accompanying injuries, and screening strategies on the incidences of VTE were investigated. Results: Overall, 26 patients(38.8%) were diagnosed with VTE and PTE in 14(20.9%). All were asymptomatic. Significantly higher incidences of VTE and PTE were observed in trauma patients with pelvic and acetabular fractures than in trauma patients without pelvic and acetabula fractures treated during the same period. No significant differences were observed in the incidences of VTE and PTE between patients with pelvic fractures, and patients with acetabular fractures or between patients with and without accompanying injuries. Compared with the previous screening strategy, the detection rates for VTE and PTE were higher for the newer screening strategy; however, the difference did not reach statistical significance. Conclusion: In the Korean population, we should be vigilant for a high incidence of VTE, especially PTE, in patients with pelvic and acetabular fractures.

인삼 단백질분획에 대한 폴리아크릴아마이드 전기영동

김춘미(Choon Mi Kim),황정주(Jung Joo Hwang) 大韓藥學會 1986 약학회지 Vol.30 No.6

Korean ginseng was purified to obtain radioprotective protein fractions by buffer extraction, ammonium sulfate fractionation, CM-cellulose column chromatography, heat inactivation and Sephadex G-75 column chromatography. The final three fractions, GI, GII and GIII were subjected to Disc-polyacrylamide gel electrophoresis (PAGE) and SDS-PAGE. The molecular weights (M.W.) of native and denatured proteins were estimated by using regression line equations obtained from the mobilities of standard proteins. As the results, in Disc-PAGE, the GI fraction showed two protein bands with M.W. of above 213,000 and 55,000, GII showed one band with M.W. of 44,000 and GIII, also one band with M.W. of 19,000. In SDS-PAGE, GI fraction gave four subunit bands with M.W. of above 114,000, 27,000, 24,000 and 19,000, GII gave two bands with M.W. of 46,000 and 22,000 and GIII, one band of 19,000.

석유계 드라이클리닝 용제 접촉에 의한 접촉피부염

김동훈 ( Dong Hoon Kim ),김정은 ( Jeong Eun Kim ),황의경 ( Eui Kyung Hwang ),정주양 ( Ju Yang Jung ),진현정 ( Hyeon Jeong Jin ),김주희 ( Joo Hee Kim ),예영민 ( Young Min Ye ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.4

Background: Petroleum-based solvents have been widely used for dry cleaning in Korea. Although there has been a few reports of irritant contact dermatitis induced by petroleum- based dry cleaning solvents, this is the first case of contact dermatitis with peripheral eosinophilia in Korea. Case History: A 53 year old man had suffered from itching sensation, erythema and bullae in both arms. The onset time was 1 hour after wearing a jacket which had been dry cleaned the day earlier. The skin lesions were localized to the area in contact with the jacket, and the Nikolsky sign was seen. The patient had no history of previous allergic diseases. Results: Serum total IgE levels, peripheral eosinophil counts, eosinophil cationic protein levels and liver function test results (aspartate and alanine transaminase) were elevated. Histopathological examination of the skin biopsy specimen showed epidermal necrosis with superficial perivenular lymphocytic and eosinophilic infiltration. He was negative for the patch test with maximum 1% of the solvent used at that laundry, which was composed of paraffin and naphten. Therefore, we thought that his skin lesion may be attributed to irritant reactions to this solvent. Conclusion: We report herein a case of contact dermatitis induced by a petroleum-based dry cleaning solvent. (Korean J Asthma Allergy Clin Immunol 2011;31:295-299)

중증외상환자에서 TRISS를 활용한 예방가능 중증외상사망률 지표: PARK Index

박찬용 ( Chan Yong Park ),유병철 ( Byung Chul Yu ),김호현 ( Ho Hyun Kim ),황정주 ( Jung Joo Hwang ),이정남 ( Jung Nam Lee ),조현민 ( Hyun Min Cho ),박한나 ( Han Na Park ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: To calculate Preventable Trauma Death Rate (PTDR), Trauma and Injury Severity Score (TRISS) is the most utilized evaluation index of the trauma centers in South Korea. However, this method may have greater variation due to the small number of the denominator in each trauma center. Therefore, we would like to develop new indicators that can be used easily on quality improvement activities by increasing the denominator. Methods: The medical records of 1005 major trauma (ISS >15) patients who visited 2 regional trauma center (A center and B center) in 2014 were analyzed retrospectively. PTDR and PARK Index (Preventable Major Trauma Death Rate, PMTDR) were calculated in 731 patients with inclusion criteria. We invented PARK Index to minimize the variation of preventability of trauma death. In PTDR the denominator is all number of deaths, and in PARK Index the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths from patients who have Ps larger than 0.25. Results: The size of denominator was 40 in A center, 49 in B center, and overall 89 in PTDR. The size of denominator was significantly increased, and 287 (7.2-fold) in A center, 422 (8.6-fold) in B center, and overall 709 (8.0-fold) in PARK Index. PARK Index was 12.9% in A center, 8.3% in B center, and overall 10.2%. Conclusion: PARK Index is calculated as a rate of mortality from all major trauma patients who have Ps larger than 0.25. PARK Index obtain an effect that denominator is increased 8.0-fold than PTDR. Therefore PARK Index is able to compensate for greater disadvantage of PTDR. PARK Index is expected to be helpful in implementing evaluation of mortality outcome and to be a new index that can be applied to a trauma center quality improvement activity. [ J Trauma Inj 2015; 28: 115-122 ]

외상성 기도 손상의 임상적 고찰

조현민 ( Hyun Min Cho ),김영진 ( Young Jin Kim ),류한영 ( Han Young Ryu ),황정주 ( Jung Joo Hwang ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Purpose: Traumatic airway injuries have high rates of mortality and morbidity. Thus, we evaluated the clinical results of trauma-related airway-injury patients. Methods: A clinical analysis was performed for patients with airway trauma who were admitted and treated at the Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital from Dec. 2002 to Dec. 2009. Results: Sixteen patients were admitted and treated. Fourteen patients were male, and the ages of the patients ranged from 16 to 75 years. Six cases were penetrating injuries, 4 were traffic-accident injuries. 3 were fall injuries, and. 3 were other blunt trauma injuries. Anato- mic injuries included 14 trachea cases (87.5%), 1 Rt. main bronchus (6.25%), and 1 Lt. main bronchus cases (6.25%). Diagnosis was made by using computed tomography and bronchoscopy. Five patients were treated with an explothoracotomy, and 7 underwent neck exploration with primary repair. Three patients simply needed conservative management, and 1 patient was treated with a closed thoracostomy. The post-operative mortality rate was 6.25 % (1 patient). Conclusion: Airway trauma is dangerous and should be treated as an emergency, so a high index of suspicion is essential for rapid diagnosis and successful surgical intervention in patients with airway injuries. (J Korean Soc Traumatol 2011;24:7-11)