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        중증 외상에서 critical administration threshold와 대량수혈의 사망예측 비교

        조재완 ( Jae Wan Cho ),서강석 ( Kang Suk Seo ),이미진 ( Mi Jin Lee ),박정배 ( Jung Bae Park ),김종근 ( Jong Kun Kim ),류현욱 ( Hyun Wook Ryoo ),안재윤 ( Jae Yun Ahn ),문성배 ( Sungbae Moon ),이동언 ( Dong Eun Lee ),김윤정 ( Yun Je 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.4

        Objective: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. Methods: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. Results: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Fortytwo (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040-18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376-8.979). Conclusion: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.

      • 뇌하수체 종양 제거술 시행 후 뒤늦게 발생한 횡문근 융해증과 동반된 중추성 열

        장제혁,최규남,김일환,노은지,김윤정,유충헌,고정해,박봉수,김태균,권민정,이순희,박정현 인제대학교 2008 仁濟醫學 Vol.29 No.-

        Body temperature is controlled by thermoregulatory center of the hypothalamus. We report a case of 24 years old man with central fever. He was subjected to a partial excision of pituitary tumor compressing optic chiasm four years ago. He has received hormonal therapy for panhypothyroidism after removal of pituitary tumor. And He received gamma knife operation for partially contrast-enhancing masses in suprasellar and both hypothalamic areas that is probably postoperatively remnant or recurrent tumor of pituitary adenoma. One year after gamma knife operation, he presented with a febrile syndrome of unknown origin including rhabdomyolysis. All usual investigations proved negative. We diagnosed him as central fever with rhabdomyolysis. He received medical ICU care with cooling bed, ice pack. And his symptom improved. Postoperative hyperthermia may result following resection of the pituitary tumor. When central fever is suspected taking note of past history, a quick recognition of course of fever can help reduce the using of unnecessary antibiotics and hospital stay.

      • SCOPUSKCI등재

        위내시경으로 진단된 유전분증 3예

        김진홍,김상돈,김윤정,이한민,엄철,지석배,이광재,조성원,임현이 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.3

        Since amyloidosis is usually diagnosed later in the disease process, a high index of suspicion is therefore necessary for earlier diagnosis. Confirmative diagnosis rests on a biopsy of the involved organ. Gastrointestinal amyloidosis causes a variety of symptoms including intestinal obstruction, ulcers, malabsorption, hemorrhaging, protein loss, diarrhea, anorexia, nausea, vomiting, and dysphagia. We confirmed amyloid deposits in the stomach in three patients with epigastric pain through a biopsy of erosive gastritis documented on a gastrofiberscopy. One patient with primary amyloidosis which had invaded his kidney, stomach, and heart, expired, although aggressive treatment with a pacemaker insertion, peritoneal dialysis, and ventilator care was performed. Another patient with multiple myeloma died on the 38th day, after having started systemic chemotherapy. The other patient with secondary amyloidosis due to rheumatoid arthritis, is currently receiving colchicine at our out patient clinic.

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