응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

우리 나라 재해 의료의 문제점 : 수원시 재해 대응 훈련의 평가를 통하여 본 ANALYSIS OF EMERGENCY RESPONSE EXERCISE IN THE MOCK DISASTER IN SUWON

곽동진,정윤석,진재우,조준필,김 철,김행재,배택환,김준식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Natural or man-made disasters are serious enough to paralyse the functions of the nation or regional distinct and affect the property and lives of numerous citizens. The first two hours after occurrence of the disaster are critical for determining death or permanent disabilities of the casualties. The current Disaster Medical Service(DMS) System in our country adopts mainly civil defense model which focuses the cause of the accident, compensation of the victims, or reconstruction. So in the initial phase of disaster, the appropriate rescue and emergency treatment is not provided effectively. In order to assess and reorganize the current status of DMS System in Korea, the Department of Emergency Medicine, Ajou University School of Medicine, planned and conducted an emergency response exercise in Suwon city on April 28, 1995. The exercise, which took place near the Kyunggido Culture and Art Center, coordinated the efforts of the Suwon Fire Department and other related agencies. As well as providing training on emergency response, the exercise was valuable for identifying areas of weakness which will be address in the future.

낙상으로 인한 좌심실 파열 후 생존한 환자 1례

배택환,김행재,정윤석,김준식,조준필,이철주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Blunt or nonpenetrating chest injuries are common after motor vehicle accidents or falls. Blunt injury to the heart ranges from contusion to rupture. Cardiac rupture, however, is un-common and associated with a very high mortality rate ; left ventricular rupture due to falling is even more rare. We experienced a case of left ventricular rupture of the heart caused by a fall, which the patient survived. A 63-year-old man fell off a ladder and presented with hypotension from left hemothorax and pericardial tamponade. The hemothorax was relieved via an emergency closed thoracostomy but dyspnea and hypotension continued. And so, echocardio-graphy was done and pericardial tamponade was detected. Emergency left thoracotomy was done to repair the rupture site. We believe that patients with cardiac rupture who reach the hospital alive can often be saved by prompt diagnosis and immediate surgical treatment.

겸상적혈구 혈증에 의한 동통성 발작 1례

김효철,배택환,정윤석,김현수,조준필,김준식,곽연식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The sickle cell disease are a group of hemoglobin disorders characterized by red cells that undergo sickle shape transformation when they are deoxygenated. Sickle cell disease is transmit-ted as an autosomal recessive trait. This unusual property, due to the polymerization of sickle hemoglobin results in anemia and vasoocclusive complication. 1) The most clinically significant of these disease are sickle cell anemia, sickle cell hemoglobin C disease, and sickle cell beta thalassemia. Symptoms of pallor, fever, abdominal and joint pain, enlargement of the liver and spleen, swelling of hands and feet first appear near the latter part of the first year of life. Intravascular sickling affects all organs. For clinical and therapeutic purposes, exacerbations may be classified as vasoocclusive or pain, aplastic, hemolytic or sequestration crisis. we experienced a 22 year old female patient who suffered severe multiple joint pain and back pain thought to be caused by vasoocclussive phenomena.

흉부외상 없이 발생한 흉부대동맥 절단증의 조기 진단 : 2례 보고 Two Cases Report

한승백,전영진,백광제,김준식,김정택,김광호,선경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Aortic transection or interruption is a rare condition which developed after an acute deceleration injury. Its occurrence depends on the location and direction of the force applied and is usually from motor vehicle accident or falling down. The exact incidence of aortic transection in trauma is not known but, when develops, only about 10-15% of the victims can survive and be transported to the hospital. Even in the survivors, majority of them will be fatal within a few days if a prompt diagnosis and surgical treatments are not made. Aggressive diagnostic work-up is recommended for the patients with high suspicious index, which would salvage the victims with this fatal condition. We report the experience of two cases of aortic transection or interruption following motor vehicle accidents.

이전 함수를 이용한 직접 확산 통신 방식의 초기동기

전정식(Jung Sig Jun),한영열(Young Yearl Han) 한국통신학회 1992 한국통신학회 학술대회논문집 Vol.1992 No.7

조산 예측을 위한 IGFBP-1 (Insulin-like Growth Factor-binding Protein-1)의 유용성에 대한 연구

최준식 ( Choe Jun Sig ),양재혁 ( Yang Jae Hyeog ),류현미 ( Ryu Hyun Mee ),김문영 ( Kim Mun Yeong ),한정렬 ( Han Jeong Lyeol ),안현경 ( Ahn Hyun Kyung ),신중식 ( Sin Jung Sig ),김주오 ( Kim Ju O ),문명진 ( Moon Myoung Jin ),정진훈 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.7

목적 : 조기 자궁 진통은 제태 기간 37주 이전에 자궁 수축이 일어나는 것을 의미하며, 조산의 대부분의 원인이다. 본 연구의 목적은 조기 양막 파수가 없는 산모에서 자궁 경부의 IGFBP-1 (phosphorylated isoform)을 측정하여, phIGFBP-1의 수치 증가와 조산과의 연관성을 보고자 하였다. 연구 방법 : 환자는 2002년 4월부터 2002년 12월까지 삼성제일병원 산부인과에서 조기 자궁 진통으로 진단 받은 57명의 산모를 대상으로 하였으며, 대조군은 환자군과 제태 기간이 유사한 무증상의 산모 30명을 대상으로 하였다. 소독된 경 (speculum)을 사용하여 자궁 경부 염증에 대한 검사 및 dacron swab을 이용하여 phIGFBP-1의 정성 및 정량 분석을 하였다. 이때 nitrazine test를 사용하여 조기 양막 파수가 있는 경우를 제외하였다. phIGFBP-1의 정성 분석은 Medix Biochemica사의 rapid strip test를 사용하였다. 결과 : 조산은 환자군에서 7예가 있었으며, 대조군에서는 한예도 발생하지 않았다 (p=0.037) (Table 2). phIGFBP-1의 정성 분석상 양성이 30예, 음성이 39예이었다. 평균 phIGFBP-1 농도가 양성인 군이 63.5±81.2 g/L, 음성인 군이 1.2±3.7 g/L로 양성인 군이 통계적으로 의미 있게 높았다 (P<0.0001) (Fig. 1). 그러나 이 두 군간의 조산의 발생 빈도는 통계적인 차이를 보이지 않았다 (Table 3). phIGFBP-1의 정량 분석은 양성군에서 83.8±86.5 g/L, 음성군에서 2.1±5.0 g/L로 양성군에서 통계적으로 유의하게 phIGFBP-1의 높은 농도를 보였다 (Table 4). 본 연구 결과에 의하면 phIGFBP-1 검사 kit의 민감도 18.5%, 특이도 59.6%, 위양성률 40.3%, 위음성율 28.6%, 양성예측치 16.7%, 음성예측치 94.9%의 결론을 얻을 수 있었다. 결론 : phIGFBP-1 kit는 검사 결과 산정까지도 단시간에 이루어지며, 검사 방법 및 판독 또한 용이하여 향후 조산 예측의 한 도구로 도움을 줄 수 있으리라 생각된다. 비록 민감도와 특이도가 낮으나 본 연구에서 보인 phIGFBP-1의 높은 음성예측치는 조기 자궁 수축이 있는 산모에 대한 과잉 치료를 예방에 기여할 수 있고, 잠재적인 자궁 수축 억제제의 부작용 또한 낮출 수 있으리라 기대된다. 앞으로 많은 수의 연구가 축적되면 좀 더 낳은 결과가 나오리라 생각된다. Objective : This study is performed to assess whether detection of phosphorylated insulin like growth factor binding protein-1 (phIGFBP-1) in cervical secretions by a bed side test could be used to prediction preterm delivery in patient with regular uterine contraction. Methods : In our prospective study, 42 women between 20.2 and 36.4 weeks gestation with regular, persistent contraction (2-3/min for 30 min). and 27 women between 22.0 and 37.0 weeks of gestation without symptoms of preterm labor were assessed for presence of cervical phIGFBP-1. Dacron swabs were applied to the cervix and assayed in 5min by using immunochromatography, actim partus test (Medix Biochemica). Results : Of the 42 patients with regular uterine contractions, 22 had a positive actim partus test and 20 had a negative test. Among the 22 patients with positive test, 5 delivered preterm and other 17 patients delivered term (<37 weeks). Among the the 20 women with a negative test, 2 delivered preterm (NS). The mean concentration of phIGFBP-1 in 22 positive patients is 83.8±86.5 ㎍/L and that in 20 negative patients is 2.1±5.0 ㎍/L (P<0.0001) (Table 4). Sensitivity, specificity, false positive, false negative, positive predictive, and negative predictive values were 18.5, 59.6, 40.3, 28.6, 16.7, and 94.9%, respectively. Conclusion : The absence of cervical phIGFBP-1 is seems to be a valuable test in excluding preterm delivery in patients who have regular uterine contractions. The high negative predictive value in this study may enable physicians to prevent over treatment of patients with uterine contractions. Therefore, many unwanted side-effects and complications of potentially hazardous tocolytic therapy can be prevented.

Relationship between Fruit Cracking and Water Absorption in Sweet Cherry Cultivars

Jung Hyun Kwon,Ji Hae Jun,Seong Sig Hong 한국원예학회 2008 한국원예학회 기타간행물 Vol.- No.-

Multivariate Analysis of Peach [Prunus persica (L.) Batsch.] Germplasm Collection

Jung Hyun Kwon,Ji Hae Jun,Eun Young Nam,Kyeong Ho Chung,Sung Sig Hong,Ik Koo Yoon,Seok Kyu Yun 한국원예학회 2015 한국원예학회 학술발표요지 Vol.2015 No.5

전신성 홍반성 낭창 환자에 동반된 골수 섬유화증 1 예

정재혁,김양식,서영배,이순,김호규,최성대,원영준,배효근 대한내과학회 1998 대한내과학회지 Vol.55 No.1

Myelofibrosis is characterized by excessive deposition of collagen, laminin and fibronectin within the bone marrow stroma. These change can be due to primary myeloproliferative disorders, a variety of malignant process, endocrine disturbances, or inflammatory disease. Clinical and laboratory finding are suggest in the immune process with myelofibrosis. It has been rarely reported that myelofibrosis coexisting with SLE. This is a case report of systemic lupus erythematosus coexisting with bone marrow fibrosis in a 44 years old female patient presenting with menorrhagia, syncope and palpitation. We report the case with relevant literature review. Treatment with corticosteroid in a patient with SLE and myelofibrosis remit to the clinical and hematologic abnormalities.