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급성 허혈성 뇌줄중에 대한 동맥내 혈전 용해술 후 발생한 혈복증 1 예
정성구(Sung Koo Jung),김명천(Myung Chun Kim),고영관(Young Gwan Ko) 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2
Although thrombolytic therapy is one of the most effective therapeutic option for acute ischemic stroke, hemorrhagic complication still remains major concern about its application. A patient with hemoperitoneum, who previously underwent thrombolytic therapy (intraarterial urokinase infusion, IAUK) for acute ischemic stroke was treated successfully with emergency transarterial embolization for rupture of hepatocellular carcinoma. We present a rare case of rupture of hepatocellular carcinoma after intraarterial urokinase infusion for acute ischemic stroke with brief review of the literature.
패혈증과 피부 감염증 의중으로 오진된 스티븐스 존슨 증후군 1 예
정성구(Sung Koo Jung),김명천(Myung Chun Kim),고영관(Young Gwan Ko) 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4
Stevens - Johnson syndrome (SJS) is a rare, life-threatening, drug-induced cutaneous reaction which presents dramatic, unforgettable manifestations. While the characteristic features of the disease are well known universally, many physicians have not seen a case of SJS which may result in delay in recognition and treatment. We report a rare case of SJS, which was initially misiagnosed as sepsis with skin infection and atypical pneumonia on emergency department presentation, and we give a brief review of the literature
중환자실 재원환자의 정맥영양 지원과 영양집중지원팀 활동에 관한 비교분석 연구
도윤정 ( Yoon Jung Do ),조미란 ( Mi Ran Cho ),김명천 ( Myung Chun Kim ),김정태 ( Jung Tae Kim ),이숙향 ( Suk Hyang Lee ) 한국정맥경장영양학회 2010 한국정맥경장영양학회지 Vol.3 No.1
Purpose: The purpose of this study is to compare the NST (Nutrition Support Team) group with the non-NST group on the basis of nutritional guidelines and to examine how the NST`s intervention influences clinically important end points of critically ill patients. Methods: Between January 2009 and December 2009,161 patients in the ICU (Intensive Care Unit) and who were provided PN (Parenteral Nutrition) were included. SAS (Statistical Analysis System) was used for the analysis. Results: In this study, 161 patients were administered PN for 7.3±6.7 days and 8.7% of the patients were provided support by NST. The number of PN prescriptions was 235 and among them, only 7.2% were conducted according to the recommendations of the NST. Both of the groups (the NST and non-NST groups) had a marked malnutrition level of 1 when admitted to the ICU. During the hospitalization, the malnutrition level was increased (NST: P=0.03,non-NST: P<0.01). The NST group was provided macronutrients more often than the non-NST group under the guidelines. Supplement of micronutrients (vitamins) was significantly different between the two groups (82.4% vs.32.6%, respectively). There was no statistical difference in the administration of amino acid by dialysis between the dialysis and non-dialysis patients. Hyperglycemia was the most common complication related to PN for both of the groups. Also, hepatic dysfunction occurred in the NST group more often than that in the non-NST group (35.7% vs. 12.3%, respectively, P=0.03). Sepsis was associated with hepatic dysfunction and among the 5 patients with hepatic dysfunction in the NST group, 3 patients were sepsis. Conclusion: Regardless of NST consultation, most patients were provided PN under the guideline, but the administration of amino acids to the dialysis patients and the administration of micronutrients were inappropriate in the non-NST group. Therefore, it is necessary to make efforts for providing proper nutritional support to patients through more systematic NST activities and advertisement.(KJPEN 2010;3(1):54-60)
경추보조기를 착용 후 후굴곡 하였을 때 나타나는 미끄러짐 현상
최한성 ( Han Sung Choi ),고영관 ( Young Gwan Ko ),김명천 ( Myung Chun Kim ),홍훈표 ( Hoon Pyo Hong ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: In many study reports, the cervical collar is effective in restricting 60 to 70 percent of cervical motion in 4 directions; flexion, extension, lateral bending, and rotation. But we discovered the phenomenon of sliding in the extensive motion of cervical vertebrae during the investigation about the effectiveness of cervical collars. Thus, the purpose of this study was to find out whether the cervical collars are effective in restricting the extensive motion of the cervical spine Methods: Fifteen volunteers, young men (23~32 years), with clinically and radiographically normal cervical spines were studied. The active cervical motion angles in flexion and extension were measured in each subject and were compared with the motion angles permitted in each of the two cervical orthoses (Philadelphia collar, Stifneck collar). We compared the restricting ability of cervical orthoses in the non-sliding state with the sliding state, especially during extension. One sample t-test, and paired t-test were used in the calculation of the statistics and the significant difference was indicated when p< 0.05. Results: With the pressure forced inferoposteriorly from the apex of the skull while extended, we created the sliding and compared the previously established method of measurement and the non-sliding state. The results showed significant difference among the three. The results, which the use of the previous method without considering the sliding was compared with the new method in consideration of the sliding, differed significantly. This phenomenon diminished the effect of restricting the cervical motion of the cervical orthoses by 50%. Conclusion: With the pressure forced inferoposteriorly given to a person wearing cervical orthoses, we could observe the occurrence of the phenomenon that occiput was slid along the rear slope face of cervical orthoses and that reduced the restricting effect of cervical extensive motion around 10%. Therefore, it must be considered that cervical orthoses need to be improved to reduce the motion for the direction.
황현철 ( Hyun Chul Hwang ),홍훈표 ( Hoon Pyo Hong ),김동필 ( Dong Pil Kim ),김명천 ( Myung Chun Kim ),고영관 ( Young Gwan Ko ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Purpose: This study was performed to review our experience with geriatric pelvic fracture patients in our emergency center. Methods: Pelvic bone fracture patients who visited the emergency center of Kyung Hee University Hospital and Dongsuwon General Hospital from March 2001 to July 2003 were analyzed using a retrospective medical records review. Variables included in the data analysis were demographics, injury pattern, transfusion needs, and outcome of pelvic fractures in older versus younger patients. Results: We cared for 93 patients with pelvic fractures during the study period. The mean age was 38 years, 56% were men, and the mean Injury Severity Score (ISS) was 19. Overall mortality was 13%. Seventy-five percent were younger than 55 years, and 25% were older than 55 years. Severe pelvic fractures were more common in older patients. The initial systolic blood pressure was lower and the heart rate higher in older patients, although the ISS was not different between the two age groups. Older patients were 2.2 times as likely to undergo transfusion and those undergoing transfusion, required more blood. Lateral compression (LC) fractures occurred 2.7 times more frequently in older patients than anteroposterior (AP) compression fractures. Conclusion: In older patients, pelvic fractures are more likely to produce severe complications and sequelae. Fracture patterns differ in older patients, with LC fractures occurring more frequently and commonly causing significant blood loss. The outcome for older patients with pelvic fractures is significantly worse than it is for younger patients, particularly for higher injury severity. Recognition of these differences should help clinicians to identify patients at high risk for bleeding and death early and to refine diagnostic and resuscitation strategies.
천일영 ( Yil Young Chen ),홍훈표 ( Hoon Pyo Hong ),김명천 ( Myung Chun Kim ),고영관 ( Young Gwan Ko ),김동필 ( Dong Pil Kim ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Portal venous gas is a severe and life-threatening sign since it is associated with an overall mortality rate ranging from 75% to more than 90% in instances due to noniatrogenic causes, but its mechanism is still not fully understood. However, after blunt abdominal trauma, portal venous gas is found even if only rarely. Because of developments and improvements in diagnostic procedures, especially computed tomography and ultrasonography, portal venous gas and intestinal pnuematosis can detected, and treated early, and a recent study reported mortality rates as low as 29%. Therefore, in the emergency department, the emergency physician must pay attention to portal venous gas in patients with blunt abdominal trauma. Delay in diagnosis and treatment may lead to intra-abdominal catastrophe, sepsis, and increased mortality. We report a case of portal venous gas and intestinal pnematosis after blunt abdominal trauma.