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Investigation of relationship between inhalation injury assessment and prognosis in burn patients
Hyeong Tae Yang,Haejun Yim,Young Suk Cho,Dohern Kim,Jun Hur,Wook Chun,Jong Hyun Kim,So Young Jung,ByungChun Kim,Jae Jung Lee 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.1
Purpose: Inhalation injury is one of the most severe morbidity and mortality factors in burn patients. The purpose of this study is to analyze the impact of inhalation injury to the prognosis of burn patients and to investigate the relationship between the inhalation injury assessment and the prognosis of patients. Methods: Bronchoscopy was performed in 170 patients who had the suspicion of inhalation injury and the patients were reviewed retrospectively from January 2008 to December 2009. Mortality was compared between the factors of brochoscopic findings, age, total body surface area (TBSA) burned, carboxyhemoglobin (COHb) level, PaO2/FiO2 (P/F) ratio. Results: Of 170 patients, 28 patients had no inhalation bronchoscopic finding. 109 patients had mild inhalation, 31 patients had moderate inhalation, only 2 patients had severe inhalation findings. The patients of moderate and severe inhalation findings had higher mortality (48.5%) than mild inhalation patients (31.1%). The larger total burnsurface area in inhalation patients, the greater the mortality. When compared to total admitted burn patients during the same period, inhalation patients showed higher mortality in the patients between 10 to 40% total burn surface area. Inhalation patients whose P/F ratio was below 300 showed higher mortality than above 300. But inhalation patients whose COHb level was below 1.5 had no difference in mortality with patients above 1.5. The COHb level and P/F ratio was the statistically different factors between inhalation patients and non-inhalation group in the mortality. Conclusion: Bronchoscopic findings, age, TBSA burned, P/F ratio were related with mortality in inhalation patients. When the international standardization of bronchoscopic classification developed, it can be possible to assess the inhalation patients more objectively and that will lead to the advancement in inhalation treatment and research.
화상 환자에서 신속 순차 시각 제시를 이용한 주의깜빡임에 관한 예비연구
김대희,전보라,서정훈,조용석,임해준,허준,김도헌,전욱,김종현,정명훈,최인근,이병철,Kim, Dae Hee,Jun, Bora,Seo, Cheong Hoon,Cho, Yongsuk,Yim, Haejun,Hur, Jun,Kim, Dohern,Chun, Wook,Kim, Jonghyun,Jung, Myung Hun,Choi, Ihngeun,Lee, Boung Ch 대한생물정신의학회 2010 생물정신의학 Vol.17 No.2
Objectives : Trauma patients have attentional bias which enforces traumatic memories and causes cognitive errors. Understanding of such selective attention may explain many aspects of the posttraumatic stress disorder(PTSD) symptoms. Methods : We used the rapid serial visual presentation(RSVP) method to verify attentional blink in burn patients with PTSD. International affective picture system(IAPS) was used as stimuli and distracters. In the 'neutral test', patients have been presented series of pictures with human face picture as target stimuli. Each picture had 100ms interval. However the distance between target facial pictures was randomized and recognition of second facial picture accuracy was measured. In the 'stress test', the first target was stress picture which arouses patient emotions instead of the facial picture. Neutral and Stress tests were done with seven PTSD patients and 20 controls. In '85ms test' the interval was reduced to 85ms. The accuracy of recognition of second target facial picture was rated in all three tests. Eighty-five ms study was done with eighteen PTSD patients. Results : Attentional blinks were observed in 100-400ms of RSVP. PTSD patients showed increased recognition rate in the 'stress test' compared with the 'neutral test'. When presentation interval was decreased to 85 ms, PTSD patient showed decrease of attentional blink effect when target facial picture interval was 170ms. Conclusion : We found attentional blink effect could be affected by stress stimulus in burn patients. And attentional blink may be affected by stimulus interval and the character of stimulus. There may be some other specific mechanism related with selective attention in attentional blink especially with facial picture processing.
A Clinical Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Haejun Yim,Jin Mo Park,Yong Suk Cho,Dohern Kim,Jun Hur,Wook Chun,Jong Hyun Kim,Dong Kook Seo 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.3
Purpose: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), potentially life-threatening skin diseases with organ failures caused by drugs, require specialized intensive care. However, SJS and TEN have usually been managed in general wards and intensive care units by most doctors. This study describes the efficacy of treatment in the burn intensive care unit (BICU) compared to previous general treatments. Methods: To investigate the clinical features, outcomes and benefits of 11 patients with SJS and TEN treated in our burn intensive care unit. Data on 11 patients who were treated between January 2004 and December 2008 were collected via a retrospective chart review. Also, the data were reviewed with previous literatures on SJS and TEN treatments. Results: Patients were classified with overlap SJS/TEN (n=4, 36.36%) or TEN (n=7, 63.64%). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common causative agents. Hepatitis was the most common organ involvement in both overlap SJS/TEN (n=1, 9.1%) and TEN (n=4, 36.36%). Renal dysfunction (n=4, 36.36%) and respiratory disorders (n=3, 27.27%) were seen in some cases. Mean time of total reepithelization was 9 days and mean hospital day was 14.66 days. Two patients with TEN died from sepsis with multi-organ failure, and the mortality rate was 18.18%. Conclusion: Adequate treatment of SJS and TEN in the BICU supports efficacy with a low mortality rate, short healing time, short hospitalization and fewer complications.
흡입화상이 동반된 중증화상환자에서 사망률 예측의 조기 인자로서 혈중젖산과 염기부족에 대한 연구
조용석(Yong Suk Cho),양형태(Hyeong Tae Yang),임해준(Haejun Yim),김도헌(Dohern Kim),허준(Jun Hur),김종현(Jong Hyun Kim),전욱(Wook Chun) 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.2
Purpose: The aim of this study was to elucidate whether plasma lactate (PL) and base deficit (BD) are useful early parameters to predict the prognosis of burn patients with inhalation injury. In addition, one of the main objectives was to evaluate if PL and its change, BD and its change due to fluid resuscitation, adds additional information. Methods: A retrospective review was performed on 151 patients admitted to our burn intensive care unit who were suspected to have inhalation burn injury, and then were confirmed by fibreoptic bronchoscopy between 1 Jan 2008 and 31 Dec 2008. All patients received proper fluid and electrolyte resuscitation, pain management, nutritional support, wound care and surgical debridement of dead tissue by burn surgeon. Results: Initial PL, PL1 (24 hours later) and initial BD show statistical differences between survivors group and non-survivors group. A better chance of survival occurs when resuscitation results in normal PL values within 24 h. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival. Conclusion: Measuring PL, BD and their changes may help to identify burn patients either for adequacy of treatment, or selection of other therapeutic options. Therefore titration of burn resuscitation to normalize PL and BD levels may be a reasonable method to improve burn mortality.
Necrotizing Fasciitis Following a Small Burn
Yong Suk Cho,Hyeong Tae Yang,Haejun Yim,Jin Mo Park,Dohern Kim,Jun Hur,Jong Hyun Kim,Wook Chun 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.1
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that manifests with a rapid course of inflammation and necrosis of the skin, subcutaneous fat, and fascia. NF commonly follows trauma to the skin, such as a laceration, scratch or insect bite. NF is a surgical emergency and requires both a high index of suspicion for diagnosis and prompt operative intervention. Early aggressive surgical intervention is important for improving survival rates. Mortality and morbidity can be decreased with early diagnosis, adequate and urgent surgical debridement, intensive supportive care, and wound resurfacing. Recently, we experienced a case of NF secondary to a third-degree contact burn on the dorsum of the right foot (1% body area). We report our therapeutic experience in this case, with a review of the literature.
조용석(Yong Suk Cho),임해준(Haejun Yim),김도헌(Dohern Kim),허준(Jun Hur),전욱(Wook Chun),김종현(Jong Hyun Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.6
Central diabetes insipidus (DI) is caused by failure of ADH release from the posterior pituitary gland. Common causes of central DI in critically ill patients include traumatic brain injury, anoxic encephalopathy, meningitis, primary or metastatic brain tumor and brain death. Inhalation burn injury with thermal injury can cause profound brain damage according to the degree of gas inhalation. This results in pituitary failure with diabetes insipidus (DI) and secondary adrenal insufficiency. We recently experienced 3 cases of central diabetes insipidus with inhalation burn injury, aggravated polyuria and abnormal serum or urine osmolarity. Severe burn injury is not easy to treat in and of itself, moreover, if central diabetes insipidus is combined it is difficult to manage appropriately. Therefore, if we suspected central diabetes insipidus, early aggressive control would lower mortality and morbidity. We report therapeutic experience in these cases with a review of the literature.
Serial Changes of Heat Shock Protein 70 and Interleukin-8 in Burn Blister Fluid
( Kicheol Yoo ),( Kang Yeol Suh ),( Gi Hun Choi ),( In-suk Kwak ),( Dong Kook Seo ),( Dohern Kym ),( Hyeon Yoon ),( Yong Se Cho ),( Hye One Kim ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.2
Background: It has been reported that heat shock protein 70 (HSP70) and interleukin-8 (IL-8) play an important role in cells during the wound healing process. However, there has been no report on the effect of HSP70 and IL-8 on the blisters of burn patients. Objective: This study aimed to evaluate the serial quantitative changes of HSP70 and IL-8 in burn blisters. Methods: Twenty-five burn patients were included, for a total of 36 cases: twenty cases on the first day, six cases on the sec-ond, five cases on the third, three cases on the fourth, and two cases on the fifth. A correlation analysis was performed to de-termine the relationship between the concentration of HSP70 and IL-8 and the length of the treatment period. Results: The HSP70 concentration was the highest on the first day, after which it decreased down to near zero. Most HSP70 was generated during the first 12 hours after the burn accident. There was no correlation between the concen-tration of HSP70 on the first day and the length of the treat-ment period. No measurable concentration of IL-8 was de-tected before 5 hours, but the concentration started to in-crease after 11 hours. The peak value was measured on the fourth day. Conclusion: While HSP70 increased in the first few hours and decreased afterwards, IL-8 was produced after 11 hours and increased afterward in burn blister fluid. These findings provide new evidence on serial changes of in-flammatory mediators in burn blister fluid. (Ann Dermatol 29(2) 194∼199, 2017)