제초제 중독으로 유발된 메트헤모글로빈혈증 환자에서 메틸렌블루 사용 후 발생한 용혈성 빈혈 1례

김선표,김동환,선경훈,윤대흥,김성중,조수형,조남수,Kim, Sun-Pyo,Kim, Dong-Hwan,Sun, Kyung-Hoon,Yoon, Dae-Heung,Kim, Seong-Jung,Cho, Soo-Hyeong,Cho, Nam-Soo 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

Methylene blue is the first choice for treating methemoglobinemia, any increase in normal methemoglobin levels. Methemoglobin is an abnormal hemoglobin in which the iron has been oxidized to the ferric(+3) state, making it incapable of oxygen transport. Methemoglobinemia most commonly results from exposure to oxidizing chemicals, but may also arise form genetic, dietary, or even idiopathic etiologies. Patients with low methemoglobin levels are asymptomatic, but high methemoglobin levels can lead to headaches or even death. Methylene blue, the first-line treatment for methemoglobinemia, can also produce hemolytic anemia. Jaundice or dark urine during methylene blue treatment may indicate hemolytic anemia. A 47-year-old female patient with a history of depressive mood disorder developed significant methemoglobinemia after ingesting a Propanil overdose. Twenty-two hours after ingestion, methemoglobin levels in the blood were 73.2%. She was treated with intravenous methylene blue in the therapeutic range (1 mg/kg every 4 h for 3days). The 2nd day after methylene blue use, methemoglobin levels in the blood were 33%, and the 5th day decreased to 10% with better general condition. The patient had hyperbilirubinemia after hemolytic anemia, but she recovered completely.

국제상사중재절차 문제에 있어 당사자자치의 원칙- UNCITRAL 모델법과 스코틀랜드의 법을 중심으로 -

김선표 한국중재학회 1996 중재연구 Vol.6 No.-

Coordinate Regulation of Vibrio vulnificus Heme Receptor HupA Expression by Cyclic AMP-receptor Protein and Ferric Uptake Regulator

김선표,이강욱,김춘미,신성희 대한미생물학회 2012 Journal of Bacteriology and Virology Vol.42 No.4

Vibrio vulnificus causes rapid progressing fulminant infections in susceptible individuals, especially those with elevated serum iron levels. This ferrophilic bacterium can directly acquire iron from heme-containing proteins, such as, hemoglobin,via its heme receptor protein HupA. This study was undertaken to determine the roles of cyclic AMP-receptor protein (Crp) as an activator and of ferric uptake regulator (Fur) as a repressor in regulating hupA expression at various iron and glucose concentrations. Under severely iron-deficient conditions, hupA expression in the absence of Crp was induced albeit at low levels and repressed by the addition of iron. In contrast, hupA expression in the presence of Crp was increased by the addition of iron. Under moderately iron-deficient and iron-sufficient conditions, iron addition repressed hupA expression in the presence of Fur, but not in the absence of Fur. Glucose addition repressed hupA expression in the presence of Fur but not in the absence of Fur. Furthermore, a mutation in cyaA encoding adenylate cyclase required for cAMP synthesis repressed hupA expression, and this repression was prevented by the exogenous addition of cAMP. These results indicate that hupA expression is under the coordinate control of cAMP or Crp, which responds to glucose availability, and of Fur, which responds to iron availability, and that Crp is not essential for the constitutional expression of hupA, but is required for the optimal expression of hupA, whereas Fur is essential for the prevention of hupA over-expression.

비스테로이드 소염제 사용 후 나타난 독성 표피 괴사 융해증 1례

김선표,김성중,최연규,조수형,조남수 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.2

A patient who was transferred to our Emergency Medical Center from a local clinic with a dermatologic disorder of unknown origin presented to us with TEN with a 40% skin slough. The patient was a 53-year-old women with complaints of erythematous rash and blisters on her trunk and both proximal extremities. She had taken NSAIDS, 1300 mg per oral, every 8 h for 5 days. Five days after administration of NSAIDS began, the doctors at the local clinic noted that a rash with blisters had begun on her back and progressed to her extremities. After 4 days of that progression she came to us. On physical examination, she had asymptomatic multiple clear filled bullae and erosion with brown- to black-colored hyperpigmentation on her trunk and proximal extremities involving 40% of the body surface. She was admitted to a private room to prevent secondary infections, and her management included fluid replacement, third-generation cephalosporin and corticosteroid administration, and intensive wound care. Fifteen days after admission, no further treatment was required, and only a small scar and a mild dispigmentation lesion could be seen. Emergency department physicians should think about TEN if the patient has extensive exfolating skin lesions. Treatment of patients with suspected TEN must be directed at minimizing fluid and electrolyte loss and preventing secondary infection, and an effort should be made to identify the suspicious drug and to educate patient to avoid the drug.

폐쇄식 흉관삽관술을 시행할 때 에토미데이트와 펜타닐의 병용투여에 의한 진정효과 비교

김선표,김성국,김성중,조수형,조남수 대한응급의학회 2004 대한응급의학회지 Vol.15 No.6

P u r p o s e: As a sedative hypnotic agent, etomidate has a little side effect like respiratory depression and has an excellent pharmacokinetics and hemodynamics. The objective of this study is comparison of etomidate effect in the two groups, only lidocaine injection group and combinational administration group, during closed thoracostomy in the emergency department. M e t h o d s: The patients with respiratory problems, which needed a closed thoracostomy, from March 1, 2003 to February 29, 2004 were enrolled in this prospective study. Thus, we were enrolled 68 patients. etomidate were used for 34 patients and only lidocaine local injection was used for 34 patients. Patients of combinational administration were randomized to receive intravenous boluses of etomidate (0.2 mg/kg) prior to fentanyl (1.0 ug/kg) during PSA (procedural sedation anesthesia). We recorded pre-administration and interval of 5 minute, 10 minute, 15 minute and transcutaneous oxygen saturation, heart rate, respiratory rate, blood pressure, degree of sedation, satisfaction of sedation, and side effects after administration. R e s u l t s: Of all combinational administration group, significant hemodynamic, as hypotension or bradycardia etc. and respiratory depression, as apnea or tachypnea etc. were absent. With comparison of two groups, significant clinical problems and statistics were not different and degree of sedation was fast and impaired conscious was effective in the combinational administration group. C o n c l u s i o n: We conclude combinational administration with etomidate and fentanyl during procedural sedation is safty and excellent effectiveness. Therefore we recommened the use of etomidate for emergency procedural sedation in emergency department.

응급의료센터에서 조기에 예측된 신동맥류 파열을 동반한 결절성 다발성동맥염 1례

김선표,선경훈,조수형,조남수,변주남 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.4

Polyarteritis nodosa (PAN) is a necrotizing angitis that predominantly affects small-and medium-sized arteries in which microaneurysm or occlusion of the visceral arteries can be seen by arteriography. Patients with PAN may have non-specific symptoms at the beginning of their illness, but progression can be sudden and result in severe, even life threatening, complications. These include central nervous system hemorrhages, gastrointestinal hemorrhages or perforation, acute appendicitis, liver infarcts, acute renal failure, renal perirenal hematomas, and cardiac failure. A diagnosis of PAN should be considered when multiple small-sized aneurysms are detected by angiography, even if a biopsy is negative. Involvement of gastrointestinal and renal arteries is frequent in polyarteritis nodosa. The most common complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. Another rare but potentially life-threatening complication is perirenal hematoma caused by spontaneous rupture of renal aneurysm. Because of this possibility, rapid evaluation of these patients is necessary to make early diagnosis and treatment possible. We describe an extremely rare case of polyarteritis nodosa with development of spontaneous perirenal hematoma due to rupture of renal aneurysm, which was evaluated with immediate angiography and treated by coil embolization.

國際海洋法裁判所와 遠洋漁業紛爭의 司法的 解決

金宣杓 韓國海洋水産開發院 2000 (월간) 해양수산 Vol.- No.194

불법·비보고·비규제(IUU) 어업 근절을 위한 FAO의 국제행동계획과 국내적 이행방안

김선표,홍성걸,오순택 한국해양수산개발원 2001 해양정책연구 Vol.16 No.2

에디펜포스와 이프로벤포스 유기인 살균제 중독 치료경험 4례

김선표,조수형,선경훈,추대혁 대한응급의학회 2012 대한응급의학회지 Vol.23 No.1

Organophosphate fungicides include edifenphos, iprobenfos and tolclofos-methyl. Edifenphos inhibits cell wall synthesis by reduction in chitin synthase activity and inhibits the action of acetylcholinesterase. Thus, exposure to this chemical results in excessive salivation, lacrimation, urination,defecation, gastrointestinal motility and emesis symptoms,just like other organophosphate insecticides. Although edifenphos is an organophosphate fungicide, it is the only agricultural chemical which inhibits the action of pralidoxime and atropine, an activity which in turn, inhibits treatment. Thus, we have to treat these cases as soon as possible with atropine and pralidoxime, using the same approach as used for exposure to other organophosphate insecticides. In this report we evaluate the results of treatment of 4 patients who were intoxicated by fungicides (3cases with edifenphos and 1 case with iprobenfos).

Top of the Basilar Syndrome after 2nd Cervical Spine Fracture

김선표,선경훈,김성중,김태훈 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.2

Top of the basilar (TOB) syndrome occurs with occlusion of the rostral portion of the basilar artery that supplies blood to the midbrain, thalamus, and temporal and occipital lobes. Symptoms associated with TOB include decreased alertness, abnormal eye movement, dysarthria, and disorders of cerebellar function. A 47-year-old man was transferred to our hospital to manage C2 vertebral fracture sustained in a traffic accident. He was alert on arrival; however, he lapsed into semicoma. He was diagnosed with TOB. Thrombolytic agents could not be administered due to a contraindication in cervical spine fracture. Brain magnetic resonance imaging showed acute infarction of the pons, cerebellum, and posterior cerebral artery territory. This rare case demonstrates that C2 vertebral fracture can result in TOB.