급성신부전을 동반한 알콜성 횡문근융해증 2례

김영민,오동렬,이원재,김형국,황두영,이환,최경호,정시경,김세경,김영옥 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Rhabdomyolysis is a biochemical and clinical syndrome caused by lysis of skeletal muscle cell and release of muscle cell contents into the circulation. In addition to traumatic cause, various nontraumatic causes have been reported. Rhabdomyolysis has frequently been associated with seamy aspects of life and society: alcoholic abuse, drug addiction, sadistic drill exercise, war events and attempted suicide. The abuse of alcohol causes many hazards in many organs. One of these is acute alcoholic myopathy that may present as a fulminent syndrome of muscle pain and tenderness associated with rhabdomyolysis and acute renal failure. Because the prognosis of adequately treated rhabdomyolysis is excellent, early recognition and prompt management are essential in emergency situation. We experienced two typical cases of alcohol-induced rhabdomyolysis with acute renal failure and report these cases with literature review.

응급센터에서 기관내 삽관을 시행하지 않은 호흡곤란 환자의 동맥혈 이산화탄소분압과 호기말 이산화탄소분압의 연관성분석

김형국,박승현,오동렬,박규남,이원재,황두영,최승필,이운정,정시경,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The end-tidal carbon dioxide tension(ETCO₂) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. The purpose of this study is to determine the correlation between ETCO₂and arterial carbon dioxide tension(PaO₂) in nonintubated patients with respiratory distress in emergency department(ED). Methods: A prospective non-blind study was performed in ED of our university hospitals. Participants included all nonintubated adult patients with respiratory distress requiring arterial blood gas analysis. ETCO₂was measured with a capnography monitor during tidal volume breathing. ETCO₂were recoreded at the time of arterial blood gas sampling. The correlation between ETCO₂and PaCO₂was analyzed in all patients and in subgroups by simple linear regression. Results: Sixty patients were enrolled. In all patients, ETCO₂was 5.72mmHg lower than PaCO₂and correlated well with PaCO₂(r²=0.716). ETCO₂correlated best with PaCO₂in patients who were either acidotic or non-smoking. Conclusion: ETCO₂correlate well with PaCO₂in nonintubated patients with respiratory distress in ED. ETCO₂may be sufficient to reflect PaCO₂in selected patients and obviate the need for repeat arterial blood gas determination.

저혈량성 쇼크를 동반한 자발성 복직근초 혈종

박상현,오동렬,김형국,김세경,박승현 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. Methods: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He' s criteria. Results: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless case. Conclusion: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.

응급의료센터에서 신경색의 조기진단

최경호,오동렬,이원재,박규남,박승현,황두영,김형국,정시경,김영민,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

To evaluate appropriate diagnostic studies for renal infartion in emergency medical center, we analysed 33 patients of renal infarction treated in this hospital for last 8 years. Eleven patients, 4 trauma associated and 7 aortic disease associated patients were excluded. They are 11 males and 11 females with a mean age of 51 years. Fourteen came to the emergency medical center and seven came to the outpatient department, in the other one patient renal infarction was developed during hospitalization with other disease. On their past history they had hypertension in 9, valvular heart disease in 5, and diabetic mellitus in 4 patients. Abdominal or flank pain was noted in 17 of 22(77%). The other symptoms were vomiting, nausea, fever and so on. On microscopic examination of initial urine in hospital, 5 patients showed more than 10 red blood cells by high power field examination. The mean lactic dehydrogenase level was 1,239 I.U/L(normal range 218-472 I.U/L), while the mean aspartate aminotransferase and mean alanine aminotransferase were 51 I.U/L(normal range 13-36 I.U/L) and 44 I.U/L(normal range 5-33 I.U/L). Abdominal ultrasonography showed positive findings in 5 of 16(31%), of which 3 were confirmed by Doppler ultrasonography. In 18, computed tomography was done and all those showed positive findings of renal infarction(100%). In conclusion, it is important that identify the elevated lactic dehdrogenase level in case of any suspicion about renal infarction and confirm by computed tomography.

데페록사민 전처치가 토끼 심근경색 크기의 감소에 미치는 효과

양관모,오동렬,박승현,박규남,이원재,김형국,황두영,최승필,채장성 대한응급의학회 1998 대한응급의학회지 Vol.9 No.4

Background: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. Purpose: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. Methods: Eleven rabbits were divided into two groups : control group (n=5) and deferoxamine pretreatment group (n=6). The left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with methylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after triphenyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. Results: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery(P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group(P<0.05). The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.

토끼 심폐소생술 모델에서 하행대동맥의 지속적인 폐쇄가 뇌허혈에 미치는 영향

김형국,채장성,오동렬,최승필,김세경,홍태용 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: A recent report introduce a new option for cardiopulmonary resuscitation by using of a continuous descending aortic balloon occlusion. The aim of the present study was to evaluate the effect of balloon occlusion of the descending aorta during cardiopulmonary resuscitation on brain ischemia. Methods: Twelve rabbits were enrolled in this study. A 4 French Swan-Ganz catheter was advanced through the right femoral artery into the descending aorta Ventricular fibrillation was induced with an AC current delivered through an electrode catheter advanced into the right ventricle. After 3 minutes of untreated ventricular fibrillation, the rabbits were randomized in two groups: (1) chest compression without balloon occlusion (control group) and (2) chest compression with balloon occlusion of the descending aorta (experimental group). The balloon was inflated for 3 minutes during resuscitation. Defibrillation was attempted at 3 minutes after start of chest compression. At 24 hours after return of spontaneous circulation, brain tissues were fixed in 4% paraformaldehyude and stained with hematoxylin eosin. Then, the ischemic cells in the hippocampal CA1 area were counted. Results: There was significant difference in ischemic neuronal cells between the two groups (control group: 41.8 ±10.9%, experimental group: 16.8 ±6.8%, p<0.05). In the experimental group, carotid blood flow was better than it was in the control group during chest compression (control group:2.4±1.0mL/min, experimental group: 7.6 ±1.9mL/min, p<0.05). Conclusion: These results suggests that balloon occlusion of the descending aorta during resuscitation decreases brain ischemia in rabbits during cardiac arrest.

흰쥐에서 심정지후 대뇌 No-reflow현상에 대한 Pentoxifylline의 효과

김세경,최경호,이원재,김형국,오동렬,채장성,최태환 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. Successful resuscitation of the brain requires unimpaired blood recirculation. However, unfortunately there are several factors against the successful recirculation. No-reflow phenomenon, characterized by a lack of reperfusion after cerebral ischemia, is the most important pathogenic factor during the early period of spontaneous circulation(ROSC). This study addresses question that pentoxifylline(PTX) aneliorates no-reflow phenomenon after cardiac arrest. Methods. Fourteen rats were divided three group ; Sham group(n=2), 12 minutes cardiac arrest group without PTX(group Ⅰ, n=6), and 12 minutes cardiac arrest group pretreated with PTX(group Ⅱ, n=6). Group Ⅱ were premedicated by intravascular injection of 5mg/kg PTX into the external jugular vein before 5 minutes of the arrest-induction. We induced cardiac arrest with endotracheal clamping and muscle relaxant. And then, resuscitation was initiated. Arterial blood samples were drawn at the femoral artery before 5 minutes of arrest-induction and at the 5 minutes after restoration of ROSC. Reperfusion of brain was visualized by injection of 0.3g/㎏ of 15% FITC-albumin at 5 minutes after restoration of ROSC, and the animals were decapitated 2 minutes later. The left hemisphere was fixed with 4% formalin, and coronal sections of 200um thickness at three different standard levels of the rat brain were investigated with fluorescene microscopy. Density of microvasular filling were identified and calculated. Results. Our observation demonstrated that 1. There were no significant differences of blood pressures, heart rates, and results of blood gas analysis between group Ⅰ and Ⅱ during the prearrest steady state. 2. There were no significant differences of blood pressures, heart rates, and results of blood gas analysis between group Ⅰ and Ⅱ at 5 minutes after ROSC. 3. Group Ⅱ premedicated with PTX, showed significant increased capillary refilling(0.310±0.035) than group Ⅰ without PTX(0.181±0.040). Conclusions. The results showed that during the prearrest steady state, premedication of PTX ameliorated the no-reflow phenomenon in the rat model of the asphyxial arrest. Further experimental studies are required to focus on the effects of postarrest infused PTX, the neurologic outcome, and the clinical applications.

Perianal abscess and fistula caused by actinomycosis

Guh Jung SEO,Rul Bin KIM,Hyung-Suk CHO 대한외과학회 2019 대한외과학회 학술대회 초록집 Vol.2019 No.10

무통성 대동맥 박리와 합병된 급성 뇌경색 환자에서 r-tPA를 투여한 1례

이승호,오동렬,김형국,오영민,이미진,김세경 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Acute aortic dissection is a catastrophic, often life threatening event that usually presents as a sudden, severe, exquisitely painful, ripping sensation in the chest or back. Painless dissection occurs in approximately 5% of the patients, and the diagnosis may often be delayed. It can be associated with neurologic sequelae, such as ischemic stroke, spinal cord ischemia, ischemic peripheral neuropathy, in as many as one-third of the patients. As an initial manifestation, neurologic deficit is seen in about 20% of patients. The diagnosis of ischemic stroke in patients who present within a 3-hour time window is generally made on clinical grounds before administration of thrombolytic therapy. The etiology of the stroke is not definitely determined until well after the patient has received recombinant tissae plasminogen activator. It is likely that poor outcomes will occur in ischemic stroke resulting from aortic dissection if r-tPA is administered intravenously. Therefore, it is important to clinically recognize this possibility. We report the case of a patient who presented with symptoms consistent with acute ischemic stroke and was given r-tPA. Further investigation demonstrated an aortic dissection as the cause of her stroke.

운동종목 특성에 따른 Force-Velocity Curve와 근지구력 발현 형태의 차이에 관한 연구

선우섭,전정우,김형돈,최영렬 경희대학교 사회체육연구소 1995 體育科學論叢 Vol.- No.8

The purpose of this study was to compare the anthropometric parameters, anaerobic power, isometric peak torque, and isokinetic muscle performance of the college male taekwondo players, female taekwondo players, and female soccer players. Sargent jump was estimated for the anaerobic power. Maximal voluntary force in knee extension was measured before and after a muscle endurance test (MET) by using a Cybex 350 isokinetic dynamometer isometrically at 90˚and con-centrically at the angular velocity of 30˚, 120˚, and 270˚·S-¹, The MET conists of 30 maximal concentric muscle actions at the angular velocity of 270˚·S-¹. The significant group differences were observed in %fat(p<.05) and the male taekwondo players demonstrated the highest mean values. A significant difference (p<.05) was observed in sargent jump between male taekwondo players and female players. The male taekwondo players showed the highest mean value, followed by female soccer and female taekwondo players. In isometric and isokinetic muscular strength test the male taekwondo players showed a significant difference(p<.05) from the female athletes before MET and no differences were found between female taekwondo and soccer players. The similar results in isometric and isokinetic muscular strength were observed after MET except that no significant differences exist between male taekwondo and female soccer players. These results indicates that the correlation exists between sargent jump and knee extension forces. Male taekwondo players showed a significant differences from the female players in total work of MET(p<.01). However, no significant difference were observed between the subjects in knee extension endurance ratio and flexion endurance ratio and recovery ratio. The female taekwondo players showed statistically higher values compared to female soccer and male taekwondo players(p<.05) in recovery ratio of MET. Therefore, it is assumed that there exist gender differences in the muscular endurance, and further research is needed on this issue.