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국소 신경학적 장애가 동반되지 않은 급성 뇌중풍 환자에서S-100B 단백의 유용성
박맹렬,안지윤,오범진,김원,임경수 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.1
Purpose: There is a distinct probability of severe complications with stroke unless patients are administered proper treatment at the optimal time. S-100B protein has been reported to be elevated in brain injuries. The current study investigates the efficacy of serum S-100B protein administration during the diagnostic process for patients who have had an acute stroke. Methods: We prospectively recruited the patients with nonspecific neurological symptoms. Non-specific neurological symptoms were defined as no focal neurological deficits or stroke suspected symptoms with NIHSS score zero. We grouped the patients according to the presence of a brain lesion (positive vs negative group) by computed tomography or magnetic resonance imaging. Using serum S-100B protein together with CT/MRI imaging at the time of diagnosis, the cutoff value, sensitivities, and specificities were calculated in making a diagnosis of acute stroke. Results: Thirty one patients were enrolled. The level of serum S-100B protein was higher in positive group (median 0.201, interquartile range 0.134-0.469) than in negative group (0.085, 0.060-0.106, p=0.001). In diagnosing acute stroke, the sensitivity was 90.9% at a cutoff value for serum S-100B protein of 0.10 μg/L . At the cutoff level of serum S- 100B protein and the specificity was 75.0%. Conclusion: The current results suggest that serum S- 100B protein may be a useful serologic marker for detecting acute stroke that is suspected with non-specific neurological abnormalities. Further studies are necessary to use the marker as a screening method for acute strokes.
항암화학요법을 받은 고형암 환자들의 중증 의료관련폐렴의 임상상
박맹렬,박소영,고원중,정만표,김호중,권오정,서지영,안진석,안명주,임호영,전경만 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.3
Background: There are only inadequate studies on the characteristics of severe pneumonia in the patients who have solid cancer and who are treated with cytotoxic chemotherapy and also on the usefulness of the various severity index scores. Methods: We retrospectively reviewed 31 patients who were treated with cytotoxic chemotherapy because of solid cancer and who were admitted to the medical ICU at Samsung Medical Center from April 2007 to August 2008. Results: The median age of the 31 patients was 64 years old (34-79). The types of solid cancer were lung cancer (19, 61.3%), gastroesophageal cancer (4, 12.9%), breast cancer (2, 6.5%), liver cancer (1, 3.2%), ovarian cancer (1, 3.2%) and other types of cancer (4, 12.9%). The hospital mortality rate was 64.5%. We were able to determine the pathogen of 19 (61.3%) patients; S. pneumoniae (6), S. aureus (3), Candida species (3), P. aeruginosa (2), K. pneumoniae (1), Pneumocystis jiroveci (1) and others (3). There were no statistically differences of the laboratory data and severity index scores (PSI, CURB-65, APACHE II, SOFA, SAPS 3) between the survivors and non-survivors, except the P/F ratio. Conclusions: The hospital mortality rate of severe pneumonia in patients who had solid cancer and who received cytotoxic chemotherapy was high. The major pathogen was S. pneumoniae. The severity indexes for general pneumonia were not useful to these patients.
박맹렬 ( Maeng Real Park ),이재호 ( Jae Ho Lee ),안지윤 ( Ji Yoon Ahn ),오범진 ( Bum Jin Oh ),김원 ( Won Kim ),임경수 ( Kyoung Soo Lim ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2
Tension viscerothorax (gastrothorax) is rare life-threatening disease which is caused by air trapped in viscera. A distended viscera in the hemi-thorax shifts the mediastinal structures and causes extra-cardiac obstructive shock. A defective diaphragm is caused by abdominal trauma or a congenital anomaly. Traumatic diaphragmatic injury can be missed until herniation develops several years after blunt trauma. In our case, a 10-year old boy developed hemodynamic compromise in the emergency department. Three years earlier, he had suffered blunt abdominal trauma during a pedestrian traffic accident, but there was no evidence of diaphragmatic injury at that time. He was successfully resuscitated by gastric decompression and an emergent thoracic operation. The operation finding revealed a traumatic diaphragmatic injury. Tension viscerothorax is a rare, but catastrophic, condition, so we suggest that addition of tension viscerothorax to the Advanced Trauma and Life Support (ATLS) guidelines may be helpful. (J Korean Soc Traumatol 2006;19:201-205)
성문위기도기를 적용한 장시간의 심폐소생술 후 발생한 위식도접합부 파열에 의한 기복증
왕일재,염석란,박맹렬,이성화,박순창,김형빈 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.3
Gastric rupture after cardiopulmonary resuscitation (CPR) is a rare complication. In most cases, it is associated with bystander-provided CPR, bag-mask ventilation, and difficult airway management. To the best of our knowledge, there has been only one previous case report in the literature regarding gastric rupture after CPR via supraglottic airway. We present a case of a gastroesophageal junction rupture secondary to CPR with supraglottic airway. Healthcare providers should consider that gastric rupture can be a complication from performing CPR.
김용인,한상균,박성욱,민문기,박맹렬 대한응급의학회 2013 대한응급의학회지 Vol.24 No.2
Lemierre syndrome is a rare syndrome caused by an acute pharyngitis with secondary septic thrombophlebitis of the internal jugular vein and metastatic infections. Although mortality from Lemierre syndrome is low, it remains a potentially lifethreatening disease that requires careful consideration, as its early diagnosis and treatment is essential to prevent metastatic infection. We report a case of a 19-year-old woman who presented with a sore throat and right upper quadrant pain. Abdominal and pelvic computerized tomography (CT)showed acalculous cholecystitis with hepatosplenomegaly. The chest CT showed septic emboli in both lung fields and the neck CT revealed thrombosis in the left internal jugular vein. The patient was treated with antibiotics. After nine days, the chest CT showed a further increase in the size of the septic embolism and the patient was treated with anticoagulants. After 23 days, the size of septic emboli in the lung significantly decreased and the patient was discharged.
응급의료 정보센터에서 시행된 119 구급대원에 대한 직접의료지도
박성욱,조석주,김용인,박맹렬,민문기,이성화,황순민 대한응급의학회 2011 대한응급의학회지 Vol.22 No.1
Purpose: This study was performed to evaluate the appropriateness of medical direction for the prehospital emergency treatment of 119 rescue services in an emergency information center. Methods: A total of 4,028 cases requested by 119 rescue services from January 1, 2008 to December 31, 2009 were reviewed retrospectively. Medical direction for requests of 119 rescue services constituted five categories. The appropriateness of medical direction for prehospital emergency treatment of 119 rescue services was evaluated according to area and specialty. Results: The majority of the 119 rescue service requests concerned resource information (72.4%). Medical direction for prehospital treatment comprised a small proportion of the requests (13.2%). The total appropriatenss of medical direction for prehospital treatment was 56.4% and was higher in emergency physician than non-emergency physician. The appropriatenss difference between two areas was not determined. Conclusion: The requests for prehospital emergency treatment of 119 rescue services was low. The appropriatenss of medical direction for emergency treatment was low and higher appropriatenss was observed in emergency physician.
Extension of a Scapular Fracture into the Glenoid Cavity after Low-voltage Electric Shock
김형빈,한상균,박성욱,이성화,박순창,조영모,염석란,김용인,민문기,박맹렬,류지호 대한응급의학회 2017 대한응급의학회지 Vol.28 No.1
We, herein, present a patient with no history of trauma who developed shoulder pain after undergoing low-voltage electric shock. According to the computed tomography, there was a multi-segmental fracture that extended into the glenoid cavity of the left scapula. A good outcome was obtained after open reduction and internal fixation. Emergency physicians should be aware of the possibility of scapular fracture extending into the glenoid cavity, especially in patients with shoulder pain after electrical injury.