폐부종과 심정지가 발생한 페노바비탈 중독환자

오동렬,이운정,박규남,김세경,김영민,이환,유은영,최경호,정시경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential for abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. The onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-10g. We describe an 23-year-old woman with pulmonary edema, and cardiac arrest ingestion of 18grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and homoperfusion. We report a case with literature review.

뇌열환자에서 임상증상과 영상소견과의 관계 : Correlation of Clinical Outcome with Imaging Findings

박세혁,조용준,이규호,오세문 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

Schizencephaly is an infrequent congenital disorder of neuronal migration characterized by gray matter-lined clefts that extend through the entire cerebral hemisphere, from the ependymal lining of the lateral ventricle to the pial covering of the cortex. We have studied seven patients with schizencephaly rstrospectively to correlate clinical outcome with the type, size, and location of the clefts and to find associated brain anomalies. Three patients had bilateral clefts(one with two open lip clefts and the other two with a left open lip cleft and a right closed lip cleft), another two patients had left unilateral open lip clefts, and the rest two patients had right closed lip clefts. Clinically these patients presented motor dysfunction such as hemiparesis, seizures, and variable developmental delay. Patients with bilateral clefts, paticularly open lip type had worse motor and developmental impairment than those with unilateral clefts. Patient with unilateral medium open lip cleft had worse motor and intellectual impairment than those with unilateral closed lip clefts or small open lip cleft. All patients with f개ntal lobe involvement had motor dysfunction. Absence of septum pellucidum, gray matter heterotopia, polymicrogyria, and hypoplasia of optic nerves were also frequently found to be associated with schizencephaly. Three patients with skull changes such as enlargement of the hemicranium of erosion of the inner table of the skull were shunted but only one patient improved in the imaging study We conclude that the severity of patient's symptoms is related to the amount type and location of the involved brain.

장시간 불가피한 공복(fasting)후 인체의 내분비 변화 : 삼풍백화점 붕괴 사고후 구조된 3인의 증례 THREE CASES IN COLLAPSE OF SAMPOONG DEPARTMENT STORE

박규남,황주일,박조현,오동렬,이원재,오승택,김세경,김인철 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The interactions between nutrition and the endocrine system are more intimate and complex that previously thought. Nutrition modulates secretion and activity of many hormones, as part of the stress adaptation process. Fasting, in particular, produces a number of important changes in the endocrine system, with teleological purpose of helping the body tolerate the lack of food ingestion. These changes are therefore beneficial and protective, although at times they may not appear to be that way. The endocrine changes of fasting mediate the metabolic response. We must emphasize that these changes are completely reversible when appropriate nutrition is established. These changes are as followes: 1) decreased insulin and increased glucagon levels, 2) decreased thyroid effect, 3) decreased sympathetic activity, 4) hypothalamic hypogonadism, 5) decreased growth, 6) altered glucocorticoid secretion and metabolism, 7) impaired mineralocorticoid response, 8) decreased ADH secretion and effect. We experienced three cases of involuntary prolonged fasting after collapse of Sampoong department store. They were released from collapsed field after 11(case Ⅰ), 13(case Ⅱ), 17days(case Ⅲ) respectively. In each case, the endocrine changes of plasma levels were as followes: decrease of cortisol in case Ⅰ, increase of GH in case Ⅱ, decrease of free T3, T3, cortisol and increase of reverse T3, insulin in case Ⅲ. Each one did not show the same endocrine changes of plasma levels. But we think these changes of fasting are beneficial in metabolic response of human.

심폐소생술후 혼수상태의 환자에서 체성감각유발전위의 예후 예측인자로서의 유용도

최세민,오동렬,최승필,박규남,김세경 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The improved technique for cardiopulmonary resuscitation(CPR) has resulted in the survival of many patients who experienced cardiac arrest. However, mortality in resuscitated patients is high, and the survival rate without brain damage is very low. Various neurological examination models, neuro-imaging techniques, electrophysiological procedures, and biochemical tests have been studied with respect to the detection of cerebral damage and outcome, but an early, reliable prediction of individual outcomes is still uncertain. Methods: We studied twenty patients who had been in a coma for more than 24 hours after CPR, Somatosensory evoked potentials(SEP) were measured within the first three days after CPR. Results: Of the twenty patients, seven patients(35%) had a good outcome, and thirteen patients(65%) had a bad outcome. Of the eleven patients with loss of the cortical evoked potential's N2O peak, all had a bad outcome. Conclusion: SEPs are of great benefit in prognostic evaluation after CPR.

뇌동맥류환자에서의 나선식 CT를 이용한 3D CT 혈관조영술의 이용 및 가치

박세혁,이규호,오세문 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

We evaluate the detection of cerebral aneurysms with 3-dimensional(3D) computed tomographic angiography(CTA) and compare the results with those of magnetic resonance angiography(MRA) and conventional cerebral angiography(CCA). Ten patients with 12 cerebral aneurysms were studied with spiral CT in conjunction with CCA and MRA. All aneurysms(3-20㎜ in diameter) were seen in CTA, MRA and CCA except 1 aneurysm(3㎜ in diameter) in MRA. CIA demonstrated neck, shape, direction of the aneurysm, and adjacent vascular and bony structures well. Of 12 aneurysms. 4 were seen equally with CCA and MRA. 4 were seen better with CCA owing to flow-related or motion artifact in MRA, and 4 were seen better with MRA. CTA was considered to be superior to CCA and MRA in demonstrating calcification and thrombosis in the aneurysm. 3D CTA with spiral CT is a rapid noninvasive method of visualizing the cerebral aneurysms and is comparable with MRA in demonstrating the aneurysms. We think 3D CTA can be a screening tool for use in the patients with suspected cerebral aneurysms and will be of a value in surgical planning for patients with complex cerebral aneurysms, in demonstrating the anatomy of the aneurysms and surrounding structures.

두개골조기봉합증환자에서 3차원단층촬영영상의 이용

박세혁,윤대영,이규호,오세문 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7

Technical advances in computer image analysis have made possible three-dimensional(3D) surface reformations of anatomic structures from contiguous axial CT slices We have recently utilized this 3D CT reconstruction with spiral CT scanner in S consecutive patients with primary or secondary craniosynostosis to assess the pres-ence and extent of synostosis. associated calvarial deformity and to facilitate surgical planning of ths craniectomy sits High resolution 3- mm contiguous CT sections were obtained and 3D shaded-surface reconstruction image gen-erated after reformation at f- mm interval In each case 9D CT demonstrated the exact extent of synostosis. and in 3 cases it was confirmed by surgical inspection 3D CT lmages facilitated surgical planning by precisely localizing the proper sits for craniectomy Three-dimensional CT with shaded-surface display may be a us㉣ful adjunct to im-aging and surgical planning in the patients with craniosynostosis. as well as a useful follow-up imaging study during observation or after surgery

Effect of Long -term Treatment with the Adventious Root Cultured Mountain Ginseng (CBN-3) on Functions of Central Nervous System in Healthy Human Volunteers

LEE SE0UL,YU KEE WON,KEUM KYUNG SOO,KIM NARI,PAEK KEE-YEUP,JUNG KYUY0NG,CHOI BONG KYU,OH GYUNG JAE4 대한약학회 2006 大韓藥學會 總會 및 學術大會 Vol.2006 No.1

허혈성 장질환의 조기진단을 위한 혈청 락테이트(lactate)의 유용성

이미진,오동렬,박규남,김세경,양진홍,박상현 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: Intestinal ischemia remains a devastating event despite improvements in clinical recognition and in diagnostic and therapeutic modalities. The ischemic bowel diseases encompass a wide clinical spectrum from mild, reversible disease to severe, irreversible injury. The clinical picture is characterized initially by poorly localized visceral pain. Thus, it is difficult to diagnose this ischemia at an early stage. This study investigated whether an increased serum lactate level is a recognized danger signal marker for intestinal ischemia in patients who present at the emergency department because of abdominal complaints. Methods: Patients who came to our emergency department with abdominal pain and the risk factors of intestinal ischemia between Apr. 1999 and Nov. 1999 were included in this study. The data analysis included age, sex, final diagnosis, pathogenesis of bowel ischemia, and serum lactate level. Results: The serum lactate level in the intestinal ischemia group was 28.54±22.51 mg/dl; in non-ischemia group, it was 15.49±22.52 mg/dl. This difference between the two groups was significant(p<0.05). An increased serum lactate level had a sensitivity of 88.2% and specificity of 59.2%, a positive likelihood ratio of 4.92, and a negative likelihood ratio of 0.47 as a marker of bowel ischemia. These results do not represent a very meaningful revision of bowel ischemlc provability, but may make a small contribution to management of the disease, depending upon their magnitude and the clinical context in which they are applied. Conclusion: In patients with abdominal complaints, an increased serum lactate level is usually a useful aid as a diagnostic marker of bowel ischemia.

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.

풍화에 따른 퇴적암의 강도 변화

배우석,이봉직,오세욱,이종규 한국산업안전학회 2003 한국안전학회지 Vol.18 No.1

The failure of rock slopes were influenced by weathering, which causes change in the shear strength. The weathering is also directly related to slaking and swelling characteristics. In the paper, the core of diameter 10㎝ was obtained by digging on rock slope of Kong-ju in Korea and the EDX (Energy Dispersive X-ray spectrometer) analysis was carried out to verified element of chief rock-forming minerals. Uniaxial compression tests, slaking tests, and point load test are performed to study engineering characteristics of conglomerate and red shale. As a results of slaking test, slaking index of conglomerate indicate range of 85.11-99.58 and shale indicate 58.37-99.23.Therefore, it is recognized that the resistance of shale to weathering decreases in shallow depth and it greatly influences the strength of rock. The result of uniaxial compression test and point load test show that the strength of sedimentary such as conglomerate and red shale has an influence on both weathering and saturation.