지속적인 오심을 주소로 내원한 임신 16주 산모에서 발생한 중심성 뇌교 수초용해증 1례

김선표,김성중,조남수 대한응급의학회 2007 대한응급의학회지 Vol.18 No.2

Central pontine myelinolysis (CPM) is a demyelinating disease of the pons often associated as well with the demyelination of extrapontine areas of the central nervous system. Although the etiology and pathogenesis are unclear, CPM is usually associated with states such as too rapid correction of hyponatremia, alcohol intoxication, malnutrition, liver disease, burn, cancer, addison’s disease, dehydrated disease, and electrolyte imbalance. Clinical presentations are nonspecific but are typically characterized by confused mentation, bulbar or pseudobulbar palsy (dysarthria, dysphagia, tetraplegia), rock-in syndrome, and common symptoms such as lethargy and dysarthria. Brain magnetic resonance imaging(MRI) in CPM results in diffuse high signal intensity in the pons on T2-weighted images, and shows slightly decreased signal intensity and no enhancement in the central pons on T1-weighted images. We described a case of a 30-year-old woman presenting with continuous nausea and vomiting in the 16th week of pregnancy. In order to achieve early diagnosis of CPM, We recommend that emergency physicians should consider CPM during differential diagnosis. Prompt diagnosis and management of associated complications are essential for favorable clinical outcomes in CPM.

독사 교상 환자에게 아나필락시스성 쇼크와 횡문근 융해증 치료 후 발생한 저나트륨혈증

김선표,윤대흥,김성중,조수형,조남수 대한응급의학회 2007 대한응급의학회지 Vol.18 No.3

Hyponatremia is a condition of body fluid and electrolyte imbalance frequently encountered in clinical practice. However, treatment with small amounts of furosemide has in rare instances been reported to be associated with hyponatremia. We report a case of a 50-years-old woman who developed symptomatic hyponatremia after treatment for anaphylaxis and rhabdomyolysis resulting from snake bite. The woman was presented with hypotension and hypersensitivity induced by administration of antivenom after a snake bite. She was treated by fluid therapy and administration of epinephrine. One day after hospitalization, she complained of abdominal pain, and her myoglobin level and creatine phosphokinase concentration had increased. She was treated with hydration and urine alkalization. Renal failure and compartment syndrome were not complications of the clinical course. However, pleural effusion and ascites developed following fluid therapy. A small amount of furosemide was administered for treatment, and one day after administration, hyponatremia was found to have developed. The possibility of prescribing a small amout furosemide should be considered for patients who are treated with fluid therapy and require administration of antivenom for anaphylaxis and rhabdomyolysis resulting from snake bite.

Oxycodone을 과용한 환자에게서 발생한 급성 독성 뇌병증 1례

김선표,이동현,윤대흥,김성중,조수형,조남수,김병철,조수형 대한응급의학회 2008 대한응급의학회지 Vol.19 No.5

Acute encephalopathies can be defined as an acute central nervous system (CNS) insult, due to an underlying pathology. The clinical symptoms almost always include an acute state of confusion and cognitive impairment. Toxic encephalopathies can occur acutely or chronically depending on the toxic drugs and other substances as well as the individual metabolism of the drug. The organs acutely affected include the heart, lung and kidneys. However, the brain, spinal cord and sympathetic nerves can be affected chronically. If the toxic substance passes through the bloodbrain barrier into the hypothalamus and the posterior pituitary gland, the result can be diabetes insipidus. If the substance affects the anterior pituitary gland, the result can include hormone dysfunction, impaired immune function and altered cognition or personality. We report a patient that developed acute toxic encephalopathy after the prescribed dose of oxycodone was exceeded.

응급의료센터에서 조기에 예측된 신동맥류 파열을 동반한 결절성 다발성동맥염 1례

김선표,선경훈,조수형,조남수,변주남 대한응급의학회 2007 대한응급의학회지 Vol.18 No.4

Polyarteritis nodosa (PAN) is a necrotizing angitis that predominantly affects small-and medium-sized arteries in which microaneurysm or occlusion of the visceral arteries can be seen by arteriography. Patients with PAN may have non-specific symptoms at the beginning of their illness, but progression can be sudden and result in severe, even life threatening, complications. These include central nervous system hemorrhages, gastrointestinal hemorrhages or perforation, acute appendicitis, liver infarcts, acute renal failure, renal perirenal hematomas, and cardiac failure. A diagnosis of PAN should be considered when multiple small-sized aneurysms are detected by angiography, even if a biopsy is negative. Involvement of gastrointestinal and renal arteries is frequent in polyarteritis nodosa. The most common complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. Another rare but potentially life-threatening complication is perirenal hematoma caused by spontaneous rupture of renal aneurysm. Because of this possibility, rapid evaluation of these patients is necessary to make early diagnosis and treatment possible. We describe an extremely rare case of polyarteritis nodosa with development of spontaneous perirenal hematoma due to rupture of renal aneurysm, which was evaluated with immediate angiography and treated by coil embolization.

불법·비보고·비규제(IUU) 어업 근절을 위한 FAO의 국제행동계획과 국내적 이행방안

김선표,홍성걸,오순택 한국해양수산개발원 2001 해양정책연구 Vol.16 No.2

國際海洋法裁判所와 遠洋漁業紛爭의 司法的 解決

金宣杓 韓國海洋水産開發院 2000 (월간) 해양수산 Vol.- No.194

Coordinate Regulation of Vibrio vulnificus Heme Receptor HupA Expression by Cyclic AMP-receptor Protein and Ferric Uptake Regulator

김선표,이강욱,김춘미,신성희 대한미생물학회 2012 Journal of Bacteriology and Virology Vol.42 No.4

Vibrio vulnificus causes rapid progressing fulminant infections in susceptible individuals, especially those with elevated serum iron levels. This ferrophilic bacterium can directly acquire iron from heme-containing proteins, such as, hemoglobin,via its heme receptor protein HupA. This study was undertaken to determine the roles of cyclic AMP-receptor protein (Crp) as an activator and of ferric uptake regulator (Fur) as a repressor in regulating hupA expression at various iron and glucose concentrations. Under severely iron-deficient conditions, hupA expression in the absence of Crp was induced albeit at low levels and repressed by the addition of iron. In contrast, hupA expression in the presence of Crp was increased by the addition of iron. Under moderately iron-deficient and iron-sufficient conditions, iron addition repressed hupA expression in the presence of Fur, but not in the absence of Fur. Glucose addition repressed hupA expression in the presence of Fur but not in the absence of Fur. Furthermore, a mutation in cyaA encoding adenylate cyclase required for cAMP synthesis repressed hupA expression, and this repression was prevented by the exogenous addition of cAMP. These results indicate that hupA expression is under the coordinate control of cAMP or Crp, which responds to glucose availability, and of Fur, which responds to iron availability, and that Crp is not essential for the constitutional expression of hupA, but is required for the optimal expression of hupA, whereas Fur is essential for the prevention of hupA over-expression.

농약중독 환자에서 내원 초기에 실시된 혈액학적 검사와 예후와의 상관관계

김선표,김성중,조수형,조남수 朝鮮大學校 附設 醫學硏究所 2009 The Medical Journal of Chosun University Vol.33 No.S

Background: To determine the prognostic values of the hematologic parameters checked initial in pesticide poisoning patients, we evaluated and compared the relationship between hematologic parameters and clinical pathologic factors of pesticide poisoning patients. Materials and Methods: The initial hematologic parameters were measured from stored plasma samples, EDTA contained samples, citrated blood samples and urine samples. Patients were grouped according to result of treatment. The severe intoxicated group were expired patients, hopeless discharged patients and admitted in intensive care unit over 7 days. The mild intoxicated group had no indication of severe intoxicated group. But paraquat intoxicated patients, chronic disease's patients and terminal malignant patients were excluded in our study. The measured laboratory tests were done at visiting ER. The statistical significance of initial hematologic parameters were compared between the two group. Results: During the study period, 437 patients visited in ER for pesticide poisoning. 392 patients had indication of mild intoxicated group, but 45 patients had indication of severe intoxicated group. In complete blood count, white blood cell and platelet count had statistical importance (p<0.05). And also ammonia level had a significance (p<0.05). ALT, AST, creatinine and amylase level had significance in initial chemistry test, too (p<0.05). In other test, PT and aPTT had statistical importance, but INR, coagulation activity and urinary analysis had no importance in our study. Conclusion: Until now, the prognostic factors of pesticide poisoning patients were based on the clinical presentation. In our study, several initial laboratory test of pesticide poisoning patients had a statistical significance in patients' prognosis. So, initial hematologic parameters were useful in decision that of prognosis on pesticide poisoning patients.

응급실 심정지 환자의 심폐소생술시 순환 회복률에 관한연구

김선표,조남수,조수형 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.3

Background and Objectives: There has been an increase in the number of cardiac arrests due to increase in both cardiovascular diseases and the average age of the population. This study was designed to improve the result of CPR(cardiopulmonary resuscitation) by comparing and studying the outcomes of cardiac arrest. Materials and Method: We reviewed the charts of 283 patients whom CPR was performed of CPR performed in emergency department of Chosun University Hospital during the period from April 2001 to March 2004. Results: During the period, CPR were performed to 283 cardiac arrest patients. Initial ECG(Electrocardiogram) rhythm showed VF/VT(ventricular fibrillation/ventricular tachycardia) in 34 (12%) patients, PEA(pulseless electrical activity) in 99 (35%) patients and asystole in 150 (53%) patients. The precipitating causes of cardiac arrest were cardiogenic origin 20 (15.9%), non cardiogenic 164 (58%) and traumatic 55 (26.1%). 109 (38%) patients recovered the ROSC (restoration of spontaneous circulation) at least once and 7 (2.5%) patients discharged alive. Conclusion: The survival rate of patients with cardiac arrest has not changed much compared to the past. Positive predictive factor for ROSC is VF/VT as initial ECG rhythm. Negative predictive factor for ROSC is traumatic etiology.

에디펜포스와 이프로벤포스 유기인 살균제 중독 치료경험 4례

김선표,조수형,선경훈,추대혁 대한응급의학회 2012 대한응급의학회지 Vol.23 No.1

Organophosphate fungicides include edifenphos, iprobenfos and tolclofos-methyl. Edifenphos inhibits cell wall synthesis by reduction in chitin synthase activity and inhibits the action of acetylcholinesterase. Thus, exposure to this chemical results in excessive salivation, lacrimation, urination,defecation, gastrointestinal motility and emesis symptoms,just like other organophosphate insecticides. Although edifenphos is an organophosphate fungicide, it is the only agricultural chemical which inhibits the action of pralidoxime and atropine, an activity which in turn, inhibits treatment. Thus, we have to treat these cases as soon as possible with atropine and pralidoxime, using the same approach as used for exposure to other organophosphate insecticides. In this report we evaluate the results of treatment of 4 patients who were intoxicated by fungicides (3cases with edifenphos and 1 case with iprobenfos).