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      • SCOPUSSCIEKCI등재

        원발성 뇌실질내 혈종의 임상적 분석

        김갑득,김흥식,김영철,조맹기,황도윤 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.1

        We experienced 150 caese of spontaneous intracerebral hematoma which were confirmed by CT scan in Gang Nam Sacred Heart Hospital from November 1980 to October 1982. The analysis is based on 110 patients with primary intracerbral hematoma on whom operation was performed in 44 cases and conservative treatment was done in 66 cases. The CT scan of brain allows the clinical diagnosis of intracerebra1 hematoma, and size, location, extension, ventricular penetration and evolution of hemorrhage are accurately portrayed. The results of the treatment were affected by conscious level, location and volume of hematome, ventricular penetration and blood pressure; The operative treatment was better than conservative management in followings: 1. semicomatose and drowsy mental state, 2. subcortical hemorrhage, 3. more than 20 cc in volume, 4. progressively deteriorating neurological function and consciousness. We have obtained the best results in operating cases between 4th and 7th day after the stroke.

      • KCI등재

        급성 설사환자에서 대변 배양검사 시행 및 항생제 사용의 결정

        김갑득,김진철,송화식 대한응급의학회 2001 大韓應急醫學會誌 Vol.12 No.1

        Background: Most episodes of acute diarrhea are self-limiting. Most patients require neither a stool culture nor antibiotic therapy. This study was designed to investigate the predictors of a stool-culture positivity and indicators for antibiotic therapy in acute infectious diarrheal patients. Methods: Medical records of 139 adult cases were retrospectively reviewed during the 12 months between January 1999 and December 1999, We used the Chisquare-test to analyze the data for statistical significance. Results: Fecal leukocytes were examined in 104 cases; 30 tested positive (28.8%). Eighty-five stool cultures were taken, and 24 yielded enteric pathogens, such as Salmonella, Shigella, V. Cholera and V. Parahaemolyticus. Cultures from patients treated between August and October, with fever above 37.6℃, or with symptoms of abdominal pain had higher yields(44.2% vs 11.9%, p=0.001, correlation coefficient=0.359; 36.8% vs 10.7%, p=0.012, correlation coefficient=0.273;, 38.1% vs 18.6%, p=0.046, correlation coefficient=0.216 ; respectively) and when combined with fecal leukocytes had a sensitivity of 100% and a specificity of 90.1-95.1%. Conclusion: The primary variables (season, fever, and abdominal pain) were excellent predictors of stool culture positivity and indicators for antibiotic therapy, especially when combined with fecal leukocytes

      • KCI등재

        응급실에서 급성 심장허혈에 대한 Cardiac STATus™의 진단적 가치

        김갑득,박귀웅,송화식 대한응급의학회 2002 大韓應急醫學會誌 Vol.13 No.2

        Purpose: The purpose of this study was to investigate the usefulness of a qualitative bedside test for detection of cardiac troponin Ⅰ(Cardiac STATus^TM) in evaluating patients with acute chest pain in emergency settings. Meterial and methods: In 147 patients who had chest pain without ST-segment elevation on their electrocardiograms, we evaluated the sensitivity and the specificity of the new, rapid, bedside troponin I assay for acute myocardial infarction (AMI) and acute cardiac ischemia (ACI). Patients whose samples were taken at least 4 hours after the onset of pain were selected. Results: Cardiac STATus^TM was positive in 28 patients (19.0%). Among 31 patients with AMI, Cardiac troponin I was positive in 19 (61.3%) patients. Among 95 patients with ACI, Cardiac STATus^TM was positive in 24 patients (25.3%). The results were false positive in 12/31 patients (38.7%) for AMI and in 71/119 patients (59.7%) for ACI. The negative predictive value of the Cardiac STATus^TM was 90.5% for AMI and 65.0% for ACI. During the 30 days of follow-up, there were 4 deaths and 12 cases of non-fatal AMI. Cardiac troponin I proved to be independent predictor of cardiac events. Conclusion: In contrast to its excellent specificity(0.92), the sensitivity (0.61) of the Cardiac STATus^TM assay was poor. Thus, we conclude that this test is not highly sensitive for early detection of myocardial-cell injury. Negative test results were associated with low risk, but did not allow safe discharge of patients, with chest pain from the emergency setting. Positive results of Cardiac STATus^TM were associated with unfavorable outcomes.

      • 교통사고 사망환자의 통계적 고찰

        김갑득,홍성엽 대한응급의학회 2002 大韓應急醫學會誌 Vol.13 No.1

        Purpose: Comparing the results of traffic accident deaths between ours and a previous study, we assessed the improvement in the emergency medical service system and the traumatic care system. Methods: Three hundred twenty-one traumatic accident deaths occurring in Chunan and the nearby region between 1999 and 2000 were reviewed; data were obtained from paramedic trip reports, medical records, and radiological findings. Results: One hundred fifty-eight (49%) deaths occurred in the prehospital setting. The remaining 163 (51%) patients were transported to the hospital. Of these, 89 (55%) died in the first 48 hours (acute), 26 (16%) within three to seven days (early) and 48 (29%) after seven days (late). Central nervous system injuries were the most frequent cause of death (57%), followed by exsanguination (25%) and organ failure (8%). Two distinct peaks of time were found on analysis : 50% of the patients died within the first 60 minutes, and 9% of the patients died at three to seven days after injury. The overall preventable death rate was 24%. Conclusion: Access to the prehospital emergency medical system was improved, and there was greater proportion of late deaths due to brain injury. We found the distribution to be a bimodal distribution.

      • 한탄바이러스와 서울바이러스 재조합 뉴클레오캡시드 단백생산과 효소면역측정법에의 이용

        김갑득,김익상 단국대학교 2000 論文集 Vol.35 No.-

        In the typical cases of hemorrhagic fever with renal syndrome(HFRS), sudden onset of high fever. hemorrhage and renal symptoms could be observed. Although HFRS could be diagnosed by clinical observations in typical cases, serological tests are widely used for thr diagnosis, because it is difficult to diagnose HFRS patients with atypical symptoms or in the early stage of the disease. The indirect immunofluorescent anyibody assays(IFA) are most widely used in for the diagnosis of HFRS. But, there is increasing need to develop more convenient diagnostic methods, because the IFA has several shortcomings, such as handling of dangerous viruses, objectiveness in the interpretation of IFA results and inadequacy in testing large number of samples. In this study, genes encoding nucleocapsid protein of Hantaan vius(37∼1308bp) and Seoul virus(43∼1314bp) were cloned and expressed in E. coli by using pIH821. The applicability of the recombinant antigens for the diagnosis of HFRS were analyzed by enzyme-linked immunosorbent assays(ELISA) with 60 HFRS patients' sera and 48 normal control sera. The assays were used to detect IgM and IgG antibodies. The sensitivity and the specificity of recombinant Hantaan virus recombinant nucleocapsid IgM-ELISA were 93.3% and 95.8%, respectively. And those of the recombinant Hantaan virus recombinant nucleocapsid IgG-ELISA were 91.7% and 95.8%. The sensitivity and the specificity of recombinant Seoul virus nucleocapsid IgG-ELISA were 98.3% and 93.8%. From these results, it can be concluded that the recombinant nucleocapsid proteins produced in this study would be valuable in the development of safe and convenient diagnostic methods for HFRS.

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