박동류 및 비박동류에 의한 체외순환의 비교

선경,백광제,김요한,임창영,김광택,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Kim, Yo-Han,Kim, Chang-Young,Kim, Kwang-Taek,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

[here are so many reports that pulsatile blood flow provides physiologic organ perfusions during cardiopulmonary bypass. So, we compared the recent 30 cases undergoing cardiac surgery by Cobe-Stckert pulsatile roller pump with another 30 cases by Polystan nonpulsatile roller pump. Pulsatile flow was applied during aortic-cross clamping period when synchronized to internal EKG simulator, and perfusion mode was changed to continuous nonpulsatile flow after declamping of aorta. Age, sex, weight, and disease entities were comparable and operative techniques were similar between two groups. 1. There were no differences in average ACC time, ECC time, and Operation time. 2. Postoperative artificial respiration time was 6hrs 30mins in nonpulsatile group and 4hrs 48mins in pulsatile group, and detubation time after ventilator weaning was 2hrs 44mins in nonpulsatile group and 1hrs 43mins in pulsatile group. 3. Average pulse pressure was 8mmHg in nonpulsatile group and 55mmHg in pulsatile group, and a mean arterial pressure was 66.0mmHg in nonpulsatile group and 60.7mmHg in pulsatile group. 4. Mean urine-output during ACC;ECC period was 9.717.3;9.913.2ml/kg/hr in nonpulsatile group and 14.215.0;15.817.5 in pulsatile group [p<0, 05], and thereafter progressive decrease of differences in urine output between two groups until POD 2, and lesser amounts of diuretics was needed in pulsatile group during same postoperative period. Serum BUN/Cr level showed no specific difference and urine concentration power was well preserved in both groups. 5. Plasma proteins and other Enzymes showed no differences between two groups, but serum GOT/GPT level was higher in nonpulsatile group till POD 2. 6. Serum Electrolytes showed no differences between two groups. 7. WBC, RBC, Platelet counts, Hgb and Hct were not different and Coagulogram was well preserved in both groups. 8. Plasma free Hgb level was 7.09mg% in pulsatile group compared with 3.48mg% in pulsatile group on POD 1 but was normalized on POD 2. Gross hemoglobinuria after ECC was noted in 6 cases [20%] of pulsatile group and 4 cases [13%] of nonpulsatile group. 9. In both groups, most patients were included in NYHA class III to IV [28 cases;93% in nonpulsatile group, 22 cases;73% in pulsatile group] preoperatively, and well improved to class I to 11[22 cases; 73% in nonpulsatile group, 30 cases; 100% in pulsatile group] postoperatively. There were 7 operative mortalities in nonpulsatile group only, which were 5 cases of TOF with hepatic failure, 1 case of multiple VSDs with low out-put syndrome, and 1 case of mitral valvular heart disease with cardiomyopathy. We concluded that the new, commercially available Cobe-Stckert pulsatile roller pump device was safe, simple, and reliable.

유기인계-피레스로이드계 혼합제제 농약에 의한 중독

홍대영,백광제,이경룡,권운용,박준석,어은경,오범진,이미진,이성우,서주현,노형근,김준식,Hong, Dae-Young,Baek, Kwang-Je,Lee, Kyeong-Ryong,Kwon, Woon-Yong,Park, Joon-Seok,Eo, Eun-Kyung,Oh, Bum-Jin,Lee, Mi-Jin,Lee, Sung-Woo,Suh, Joo-Hyun,Roh, 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Purpose: Owing to organophosphate-pyrethroid mixtures are widely used, suicidal or unintentional poisoning is common. But there have been relatively few reports of poisoning. The purpose of this study is to evaluate the difference of the severity and toxicity between organophosphate-pyrethroid mixtures poisoning and single organophosphate poisoning. Methods: From August 2005 to July 2006, 65 patients presented with organophosphate-pyrethroid mixtures poisoning to emergency medical center. Date were gathered by report form it was drawn up. Results: 65 patients were enrolled in 28 hospitals and their mean age was $56.5{\pm}16.2$ years old. The most common cause of poisoning was suicide, in 52 cases(80%). Chlorpyrifos-cypermethrin, malathion-esfenvalerate were the most frequent chemicals involved, and the mean ingestion amount was 135.4ml. The most common symptom of the patients was nausea/vomiting, in 16 patients. The average GCS score was 13. The mean ICU stay was $4.4{\pm}5.2$ days, and mortality was 3.1%. Conclusion: The severity and toxicity of organophosphate-pyrethroid mixture poisoning were lower than that of single organophosphate poisoning.

선천성 낭포성 선종양기형 -1례 보고-

선경,백광제,이철세,채성수,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Lee, Chol-Sei,Chae, Sung-Soo,Kim, Hark-Jei,Kim, Hyung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)

흉선종을 동반한 적혈구 무형성증 1례 보

선경,이철세,백광제,김요한,김학제,김형묵,Sun, Kyung,Lee, Chol-Sae,Baek, Kwang-Je,Kim, Yo-Han,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

Pure Red-Cell Aplasia [P.R.C.A.] is rare disease characterized by absence of erythroid precursors in the bone marrow, normocytic normochromic anemia with profound reticulocytopenia in the peripheral blood, and relatively or completely spared granulopoiesis and thrombopoiesis. The association rates of P.R.C.A. with Thymoma is approximately 50%, but only 5-10% of all patients with a Thymoma have a P.R.C.A.. P.R.C.A. is thought to be a variety of autoimmune disease, and humoral inhibitor, i.e. IgG, has been demonstrated experimentally. Its treatments such as thymectomy, immunosuppressants, steroid, androgenic hormone, and splenectomy have been tried but the result is not satisfactory and the prognosis is poor. We experienced a case of P.R.C.A. with Thymoma treated with thymectomy and postoperative steroid therapy, and which showed good postoperative recovery clinically and hematologically.

위축성 심낭염 [Constrictive Pericarditis]을 동반한 양측성 섬유흉 [Fibrothorax] 치험 1

선경,김요한,백광제,이철세,김학제,김형묵,Sun, Kyung,Kim, Yo-Han,Baek, Kwang-Je,Lee, Chol-Sae,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

Fibrothorax is the end stage of chronic pathologic processes of pleura such as hemothorax, empyema, or tuberculous effusion. The pleural space become adherent and obliterated, and the lung parenchyma is covered by a thick, fibrous, unexpandable "peel", so the lung function is diminished markedly with impaired ventilation and oxygenation. Constrictive pericarditis is often accompanied fibrothorax, also cardiac and hemodynamic function is deteriorated. Surgical relief of these fibrous peels causes remarkable improvement in pulmonary function, cardiac and hemodynamic function, and subjective symptoms. We experienced a case of bilateral fibrothorax combined with constrictive pericarditis which occured 3 years after bilateral tuberculous effusion. Decortication and percardiectomy were done at the same time through bilateral submammary thoracotomy with sternal transection. Comparing postoperative Peripheral venous pressure, Circulation time, Pulmonary function test, Arterial blood gas analysis, Subjective symptoms with preoperative conditions showed noticeable improvement.provement.

정상 기도와 선상 도수 고정법(Manual in-Line stabilization)을 이용한 경추손상이 의심되는 환자에서 기관내삽관시 매킨토시 후두경과 Disposcope endoscope(R)의 유용성 비교: 마네킹을 이용한 시뮬레이션 연구

손성호 ( Sung Ho Son ),백광제 ( Kwang Je Baek ),최필조 ( Pil Cho Choi ),박상오 ( Sang O Park ) 대한응급의학회 2011 대한응급의학회지 Vol.22 No.6

Purpose: We conducted a comparative evaluation in the ease of endotracheal intubation when using the Macintosh laryngoscope (ML) versus the new Disposcope endoscope(R) (DE) (Disposcope Taiwan, Hsinchuang city, Taiwan), a video-laryngoscope, during simulated normal airway and manual in-line stabilization of suspected cervical spine injury patients. Methods: Forty-three medical interns participating in an endotracheal intubation training program used both the DE and the ML as part of their lessons. In each of the two simulated patient scenarios, endotracheal intubation was performed using each endoscope, in random order. The rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, results of a modified Cormack & Lehane classification (CL grade), and a measure of dental injury were all recorded and analyzed. Results: In the normal airway scenario, there was no difference in the rate of successful completion of intubation (both 100%) between the two endoscopes. Time to complete endotracheal intubation using the DE was shorter than that with the ML (10.7 versus 12.6 sec; p=0 010). In the trauma scenario, despite similar success rates (95.3% in ML versus 100% in DE), the time required to complete endotracheal intubation using the DE was shorter than that with the ML (17.6 versus 24.1 sec; p=0.010). Rate of dental injury using the DE was significantly less than that observed with the ML (0.0% versus 30.2%; p<0.0001). In both scenarios, the DE provided higher achievement of CL grade 1 (93% versus 67.4% in normal airway; p=0.006 and 55.8% versus 0% in trauma airway; p<0.0001). Conclusion: Compared to the ML, the DE provided a better view of the glottis, provided decreased dental trauma, and offered faster completion time for endotracheal intubation.

메스암페타민 검사 양성 환자에 대한 임상적 고찰: 단일기관 연구

옥영빈,김진용,이경룡,홍대영,백광제,박상오,김종원,김신영,Ok, Young Bin,Kim, Jin Yong,Lee, Kyeong Ryong,Hong, Dae Young,Baek, Kwang Je,Park, Sang O,Kim, Jong Won,Kim, Sin Young 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.1

Purpose: Methamphetamine is an ongoing illegal drug problem worldwide, and its use in South Korea has spread over the last few years. In this study, a clinical review of patients who visited emergency medical centers with positive methamphetamine tests was conducted. Methods: Patients underwent methamphetamine screening based on physician suspicion over a period of 13 years. Their patient characteristics, clinical features, and drug administration properties were described. Results: A total of 297 patients were included, with 19 positive methamphetamine results. Patient age ranged from 21 to 84, with a mean of 37.52. Additionally, 13 were male and 6 were female. The mean BP, PR, RR were 131/82 mmHg, 94/min, 20/min. Saturation levels were all over 95%. Five patients had a psychiatric history. Patient showed varied symptoms ranging from mental changes to chest discomfort. In addition, seven showed abnormal electrocardiography findings and one showed elevated cardiac enzyme levels. Other laboratory results revealed no significantly abnormal results. Six patients also suffered from related trauma. The majority of patients consumed the methamphetamine orally, with unknown motivation at unknown locations. Most were transported by 119 and six patients co-ingested other drugs. Conclusion: Patients who showed positive results to a methamphetamine screening test in Korea visited the emergency medical center mostly by 119 and were unaware of or reluctant to reveal the fact that they had ingested methamphetamine. Emergency physicians should be more aware of the possibility that a patient may have consumed methamphetamine.

응급센터를 내원한 대퇴골 골절 환자에서 골밀도와 생화학적 표지자들의 의의

이경미 ( Kyoung Mi Lee ),한승백 ( Seung Baik Han ),김준식 ( Jun Sig Kim ),백광제 ( Kwang Je Baek ),홍성빈 ( Seong Bin Hong ),문경호 ( Kyoung Ho Moon ),강준순 ( Joon Soon Kang ),윤승환 ( Seong Hwan Yoon ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Backgound: The most frequent fracture seen at the emergency department (ED) in the elderly is a femur fracture whereas they do not know the degree of osteoporosis. We analyzed the degree of osteoporosis in patients with femur fractures and compared patients with only femur fractures (FX) to patients with femur and vertebral fractures (VX) by examining the clinical features, the bone mineral density (BMD), and biochemical markers. Methods: From January 2004 to December 2004, we enrolled prospectively 30 femur fracture patients who visited the ED. The bone mineral densities of the lumbar spine and the femur were examined. Total calcium, phosphate, alkaline phosphatase, osteocalcin, and serum C-terminal telopeptide (s-CTx) were measured. The patients with femur fractures were divided into two subgroups according to the presence of vertebral fracture. Results: All BMDs of the FX group showed osteoporosis. The s-CTx levels were higher than normal. The patients in the FX with VX were older than those in the FX only group, and had lower BMDs. There were no significant differences in markers between the subgroups, but the incidence of trochanteric fractures was higher in FX with VX group than in the FX only group. Conclusion: Femur fractures in the elderly were associated with osteoporosis. In our study, despite a considerable difference in BMD between patients with femur fractures and those with femur fractures combined with vertebral fractures, there was no difference in biochemical markers on bone formation nor in the those of bone resorption. We will further investigate the biochemical markers and BMD in the population of osteoporotic fractures. So those indicators should be helpful for planning treatment and for prevention of FX in the elderly.

흉부외상없이 발생한 흉부대동맥 절단중의 조기진단 2례 보고

한승백(Seung Baik Han),전영진(Young Jin Cheon),백광제(Kwang Je Baek),김준식(Jun Sig Kim),김정택(Jung Taek Kim),김광호(Kwang Ho Kim),선경(Kyoung Sun) 대한응급의학회 1998 대한응급의학회지 Vol.9 No.4

Aortic transection or interruption is a rare condition which developed after an acute deceleration injury Its occurrence depends on the location and direction of the force applied and is usually fiom motor vehide accident or falling down The exact incidence of aortic transection in trauma is not known but, when, only about 10-15 % of the victims can survive and be transported to the hospital Even in the survivors, majority of them will be fatal within a few days if a prompt diagnosis and surgical treatments are not made. Aggressive diagnostic work-up is recommended for the patients with high suspicious index, which would salvage the victims with this fatal condition We report the experience of two cases of aortic transection or interruptian following motor vehide acddents.

의수 자살 기도후 알파 혼수를 보이다 생존한 1례

안성태 ( Sung Tae Ahn ),이용주 ( Yong Joo Lee ),백광제 ( Kwang Je Baek ),김준식 ( Jun Sik Kim ),이일근 ( Il Keun Lee ),하충건 ( Choong Kun Ha ) 대한응급의학회 1997 대한응급의학회지 Vol.8 No.1

A case of survivor who showed alpha coma after an attempted suicide by hanging was reported. A 44 years old women was admitted to the hospital because of respiratory arrest following a hanging attempt on July 3, 1996. She was found pendant completely. On admission she was comatose and the pupils were not reactive to light. The systolic pressure was 100 mmHg, and diastolic pressure was 80mmHg and she had no self respiration and immediately an endotracheal intubation was instituted. After three hours from the onset, the weak spontaneous respiration was restored and the pupils reacted briskly to light. On the 1st day the brain computed tomography (CT) revealed no abnormal findings. An electroencephalogram (EEG) showed widespread alpha activity without occipital dominance a moderate amount of regular, 8 approximately 10 Hz, 10 approximately 30 microvolt potentials. This alpha rhythm had persisted until 24 hours from the onset. At 36 hours later she was still comatose, presenting flaccid quadriplegia with no responses to stimulations. On the 2nd hospital day she was drowsy and on the 3rd day she had become conscious. She showed gradual progress towards complete nerologic recovery. This is the first presentation of a survivor from alpha coma caused by anoxic encephalopathy following a hanging attempt in Korea.