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중증 외상 환자의 골반골절에서 경피적 혈관 색전술과 Young과 Burgess 분류의 상관관계
차용한 ( Yong Han Cha ),설영훈 ( Young Hoon Sul ),김하용 ( Ha Yong Kim ),최원식 ( Won Sik Choy ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn’t an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies. [ J Trauma Inj 2015; 28: 144-148 ]
설영훈(Young-Hoon Sul),송인상(In-Sang Song) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
Purpose: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment. Methods: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured. Results: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean gallbladder wall thickness between the groups was statistically significant. Conclusion: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis
설영훈 ( Young Hoon Sul ),문재영 ( Jae Young Moon ),이경하 ( Kyung Ha Lee ),이상일 ( Sang Il Lee ),전광식 ( Kwang Sik Cheon ),이준완 ( Jun Wan Lee ),송인상 ( In Sang Song ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.2
Traumatic diaphragmatic rupture is quite uncommon and rarely lethal injury. However, delayed presentation between the injury and the diagnosis can cause a life-threatening condition with various complications such as intestinal hernia, obstruction, strangulation, respiratory distress. Here, we present a case of delayed presentation of traumatic diaphragmatic rupture in a 51-year-old man, and then discuss about the clinical implication of delayed presentation of diaphragmatic rupture with a review.
설영훈(Young-Hoon Sul),신형섭(Hyoung-Seob Shin),이경하(Kyung-Ha Lee),전광식(Kwang-Sik Chun),송인상(In-Sang Song) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.3
Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. We report a case of pancreaticopleural fistula that was presented with right-sided hemothorax. A 49-year-old male with a history of chronic alcoholism was presented with a month of dyspnea. A chest radiography showed a right-sided massive pleural effusion with old-blood-colored fluids and amylase levels of 1,020 IU/L. On the chest computerized tomography (CT), there was pleural effusion and a well-defined tract from the posterior mediastinum to the pseudocyst in the tail of the pancreas. Even with conservative treatment with closed thoracostomy, octreotide and gabexate mesilate, he developed hemothorax. Abdominal CT revealed an increase of the hemorrhagic pancreatic pseudocyst. Distal pancreatectomy with splenectomy and external drainage of the pancreaticopleural fistula on the posterior mediasternum were performed. The patient had an uneventful course and was discharged on the 27th postoperative day. Management of pancreaticopleural fistula is multimodal included medication, endoscopic stenting and surgery. Surgery in pancreaticopleural fistula might be beneficial in selective cases.
외상성 췌장 경부 절단에서 시행된 Binding 췌위장문합술 1례
설영훈 ( Young Hoon Sul ),이상일 ( Sang Il Lee ),전광식 ( Kwang Sik Cheon ),송인상 ( In Sang Song ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.1
Pancreatic injury following blunt abdominal trauma is rare, but it has high morbidity and mortality. Various treatments have been attempted, but none has yet been clearly established. The pancreatic neck transection is usually managed by using a distal pancreatectomy with or without a splenectomy. However, pancreatic insufficiency and the risk of post-splenectomy infection remain significant problems. To avoid these problems in patients with a pancreatic neck transection, one may use a pancreaticoenteric anastomosis as a treatment option, but a pancreatic fistula from the pancreaticoenteric anastomosis remains a significant cause of morbidity and mortality. Recently, several reports proposed the binding pancreaticogastrostomy to minimize the possibility of a postoperative pancreatic fistula developing after pancreatic surgery. Thus, we report a case of a traumatic pancreatic neck transection successfully treated with a binding pancreaticogastrostomy.
설영훈 ( Young Hoon Sul ),전광식 ( Kwang Sik Cheon ),장창은 ( Chang Eun Jang ),이경하 ( Kyung Ha Lee ),이상일 ( Sang Il Lee ),송인상 ( In Sang Song ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1
The isolated duodenal injury following blunt abdominal trauma is extremely rare. Because, duodenal injury is usually presented with other intra-abdominal organs injuries such as hepatic injury, pancreatic injury due to the anatomical position. So, We report a case of isolated duodenal injury following blunt abdominal trauma, and the discuss about the related article. [ J Trauma Inj 2015; 28: 47-50 ]
설영훈 ( Young Hoon Sul ),이문행 ( Moon Haeng Lee ),이상일 ( Sang Il Lee ),전광식 ( Kwang Sik Cheon ),송인상 ( In Sang Song ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.3
Bladder rupture following blunt trauma is rare, and no neobladder rupture following blunt trauma has yet been reported. We present a case of neobladder rupture following blunt trauma. The patient was a 65-year-old male patient who had been treated for bladder cancer via a radical cystectomy with an orthotopic ileal neobladder four years prior to this admission, and who was admitted to our emergency department due to multiple trauma after a 1.5 m fall. Primary repair was performed for the neobladder rupture. (J Korean Soc Traumatol 2012;25:101-104)
예진봉 ( Jin Bong Ye ),설영훈 ( Young Hoon Sul ),문윤수 ( Yun Su Mun ),고승제 ( Seung Je Go ),권오상 ( Oh Sang Kwon ),구관우 ( Gwan Woo Ku ),이민구 ( Min Koo Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
Neck trauma is a relatively uncommon but can be a life-threatening injury. Several guidelines for neck trauma is established to recommend a proper management such as no clamping of bleeding vessels, no probing of wounds, Trendelenberg position for preventing venous air embolism. Here, we present a regretful case of 49-year-old man with neck trauma presenting undesired bleeding after probing of wound, and then discuss about treatment guildeline for neck trauma with a review. [ J Trauma Inj 2015; 28: 198-201 ]
예진봉 ( Jin Bong Ye ),설영훈 ( Young Hoon Sul ),고승제 ( Seung Je Go ),권오상 ( Oh Sang Kwon ),김중석 ( Joong Suck Kim ),박상순 ( Sang Soon Park ),구관우 ( Gwan Woo Ku ),이민구 ( Min Koo Lee ),김영철 ( Yeong Cheol Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
The primary and secondary survey was designed to identify all of a patient’s injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment. Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed. [ J Trauma Inj 2015; 28: 211-214 ]