Propanil 중독으로 인한 메트헤모글로빈혈증 치료 중 발생한 반동성 메트헤모글로빈혈증 1례

선경훈,조수형,박용진 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6

Methemoglobinemia results from the oxidation of ferrous iron (Fe++) to ferric iron (Fe+++) within hemoglobin. It is caused by various etiologies, including the herbicide Propanil. Patients with low levels of methemoglobin (metHb) are asymptomatic but symptomatic patients and patients with high levels of metHb require treatment. Methylene blue is the first choice for the treatment of methemoblobinemia, but has some complications such as hemolytic anemia and rebound methemoglobinemia. We report the case of a 91-year-old woman who died of aniline herbicides poisoning. The level of metHb in her blood was initially 20.7% and her mental status was drowsy. She was intravenously treated with methylene blue within a therapeutic range for methemoglobinemia. After treatment with methylene blue, the level of metHb decreased but later increased above 20%. Methylene blue treatment was repeatedly attempted, but the patient suffered from hemolytic anemia and rebound methemoglobinemia. The patient finally died from renal failure and cardiopulmonary collapse. We must be careful because methemoglobinemia can occur even when treated pesticides such as propranil.

하악 무치악 부위의 임플란트 이식을 위한 전산화단층촬영 영상의 비교 평가

선경훈,정호걸,박혁,박창서,김기덕 대한구강악안면방사선학회 2009 Imaging Science in Dentistry Vol.39 No.1

Purpose : The purpose of this study was to evaluate the clinical usefulness of the recently developed multi-detector computed tomography and cone beam computed tomography in pre-operative implant evaluation, by comparing them with the single detector computed tomography, already confirmed for accuracy in this area. Materials and Methods : Five partially edentulous dry human mandibles, with 1×1 mm gutta percha cones, placed in 5 mm intervals posterior to the mental foramen on each side of the buccal part of the mandible, were used in this study. They were scanned as follows: 1) Single detector computed tomography: slice thickness 1 mm, 200 mA, 120 kV 2) Multi-detector computed tomography: slice thickness 0.75 mm, 250 mA, 120 kV 3) Cone beam computed tomography: 15 mAs, 120 kV Axial images acquired from three computed tomographies were transferred to personal computer, and then reformatted cross-sectional images were generated using V-Implant 2.0 (CyberMed Inc., Seoul, Korea) software. Among the cross-sectional images of the gutta percha cone, placed in the buccal body of the mandible, the most precise cross section was selected as the measuring point and the distance from the most superior border of the mandibular canal to the alveolar crest was measured and analyzed 10 times by a dentist. Results : There were no significant intraobserver differences in the distance from the most superior border of the mandibular canal to the alveolar crest (p>0.05). There were no significant differences among single detector computed tomography, multi-detector computed tomography and cone beam computed tomography in the distance from the most superior border of the mandibular canal to the alveolar crest (p>0.05). Conclusion : Multi-detector computed tomography and cone beam computed tomography are clinically useful in the evaluation of pre-operative site for mandibular dental implants, with consideration for radiation exposure dose and scanning time.

응급의학과 의사의 야간근무가 수면과 건강에 미치는 영향

선경훈,조수형,김성중,조남수,손재룡,김동환,김선표 대한응급의학회 2009 대한응급의학회지 Vol.20 No.1

Purpose: Emergency medical doctors face a working environment full of various types of stresses and often must work the night shift. This research is focused on the influences between night shift work, sleep, and physical and psychiatric health. Methods: The subjects of research in the Internet-based survey were 51 emergency medical doctors working in four university hospitals, regional emergency medical centers, and hospitals of emergency medicine located in Honam District, Gwangju, Korea. Results: Of the 51 respondents, 41.2% worked two night shifts per week and 45.1% worked three night shifts per week. Comparison of specialists and resident doctors did not reveal statistical differences between the quality of sleep and the prevalence of cardiovascular and psychiatric symptoms. However, there was a significantly higher prevalence of gastrointestinal diseases among resident doctors. Comparisons based on hospital size revealed significantly higher prevalence of gastrointestinal disease in university hospitals. The number of weekly night shifts did not significantly influence outcomes. Conclusion: Resident doctors and emergency medical doctors working in university hospitals may be more susceptible to gastrointestinal diseases. While no significant differences were evident concerning the prevalence of cardiovascular disease, the known similar mechanisms between gastrointestinal and cardiovascular disease indicates that continued exposure to stressful situations may prelude severe diseases such as cardiovascular disease.

Spontaneous Femoral Artery Pseudoaneurysm Rupture in Systemic Lupus Erythematosus Patient

선경훈,유태호,정상인,김서진,김선표 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.4

Femoral artery pseudoaneurysm, a very uncommon disease,is usually reported trauma, iatrogenic vascular intervention,and nail fixation in the treatment of fracture. Thefemoral artery is a major vessel for blood supply to thelower extremities. If the femoral artery is injured, the patientwill experience cardiovascular collapse and hypovolemicshock due to massive hemorrhage. We report on the caseof a 49-year-old male patient who had been diagnosed withsystemic lupus erythematosus (SLE), who was admitted toour hospital with progressive swelling of the right thigh withoutany trauma history. A computed tomographic scan witharterial enhancement showed a large pseudoaneurysm ofthe right femoral artery, which was then treated successfullywith great saphenous vein graft surgery.

제초제 중독으로 유발된 메트헤모글로빈혈증 환자에서 고용량 비타민 C 치료 1례

선경훈 ( Kyung Hoon Sun ),김준규 ( Jun Kew Kim ),류창연 ( Chang Yeon Ryu ),김서진 ( Seo Jin Kim ),조현규 ( Hyeon Kyu Jo ),유태호 ( Tae Ho Yoo ),박용진 ( Yong Jin Park ),김선표 ( Sun Pyo Kim ) 대한임상독성학회 2017 대한임상독성학회지 Vol.15 No.2

Methemoglobinemia is a condition in which the iron portion of hemoglobin, which binds to oxygen, is oxidized to produce methemoglobin, which increases blood concentration. There are many causes of methemoglobinemia, the most common being food, drugs, and chemicals. A 75-year-old male patient who had taken an herbicide did not notice any nonspecific symptoms. However, after 4 hours, his methemoglobin levels increased to 17.1%, while after 7 hours it increased to 26.5%, at which time intravenous administration of methylene blue 1 mg/kg (an antidote) was started. After a total of five doses of methylene blue at 1 mg/kg due to reactive methemoglobinemia for about 36 hours, the methemoglobin levels increased to 23.7%. Because no more methylene blue could be administered, 10 g of ascorbic acid (vitamin C) was administered intravenously. After 82 hours, ascorbic acid 10 g was administered six times for repeated reactive methemoglobinemia. No additional reactive methemoglobinemia was observed. The ventilator and endotracheal tube were successfully removed on day 5 after admission.

민방위 교육에서 강의식 심폐소생술 교육의 효과와 그에 영향을 미치는 요인 분석

선경훈 · 조수형 · 김선표 조선대학교 의학연구원 2009 The Medical Journal of Chosun University Vol.34 No.3

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Acute pyelonephritis and myositis after carboxytherapy

KyungHoon Sun(선경훈),JunHo Heo(허준호),Yong Hwang(황용) 한국산학기술학회 2018 한국산학기술학회논문지 Vol.19 No.8

카르복시테라피(Carboxytherapy)는 메조테라피(mesotherapy)와 방법, 치료 조건 및 결과 면에서 매우 유사하다. 그러나 중요한 차이점은 카르복시테라피는 이산화탄소 가스를 피부 바로 아래의 피하층으로 주입하는 반면 메조테라피는 비타민, 미네랄, 그리고 약물의 혼합물을 주입한다는 것이다. 메조테라피의 합병증으로 혈종, 파누스육아종, 봉와직염, 농양 등 이전에 많은 사례들이 보고되었으나, 카르복시테라피는 피하 및 얕은층에 이산화탄소를 주입하고, 이산화탄소는 주입 1주일 안에 흡수되기 때문에 부작용이 거의 보고 되지 않았다. 3일전과 2주전에 한의원에서 카르복시테라피를 받은 29세 여자 환자가 고열, 근육통, 심한 요통 및 엉덩이 부위부터 아래쪽 흉벽까지 피하 기종을 주소로 응급실에 내원하였다. 진단 및 치료를 위해 컴퓨터 단층 촬영을 시행하였으며, 즉시 영상의학과에 판단을 의뢰하였다. 바늘에 의한 손상으로 인한 급성 복막염을 배제할 수 없어 즉각적인 광범위항생제를 투여하였으며, 판독 결과 근육염과 바늘 손상으로 인한 신우신염이 확진되었다. 신우 신염의 경우 적절한 치료가 이루어지지 않으면 패혈증까지 진행할 수 있어 치명적인 결과를 초래 할 수 있다. 따라서 만일 바늘에 찔리거나 침을 맞은 후에 환자가 늑골척추부위나 허리에 통증이 있는 경우 응급의학과 의사는 진단 및 치료를 위해 신속한 초기 평가가 필요하다. Carboxytherapy is very similar to mesotherapy in terms of methods, conditions it treats, and outcomes. An important difference consider, however, is that carboxytherapy administers carbon dioxide gas into the subcutaneous layer, just underneath the skin, whereas mesotherapy administers a cocktail of vitamins, minerals, and drugs and into the mesoderm of the skin. There have been many previous case reports of complications of mesotherapy such as hematoma, granulomatous panniculitis, cellulitis, and abscesses. However, complications of carboxytherapy have rarely been reported because the carbon dioxide gas is absorbed within a week and is infused into the subcutaneous and superficial layers. A 27-year-old woman who had twice undergone carboxytherapy to reduce abdominal fat (3 days and 2 weeks ago) at an oriental medical clinic visited the emergency department due to high fever, myalgia, severe back pain, and subcutaneous emphysema from the buttocks to the lower chest wall area. A computed tomography (CT) scan was performed for diagnosis and treatment. We immediately started broad spectrum antibiotics and consulted with the department of radiology, which could not rule out acute peritonitis due to needle injury. A radiologist confirmed abdominal myositis and needle puncture induced acute pyelonephritis. Pyelonephritis can even lead to septicemia, which can have fatal consequences. Therefore, if the patient has costovertebral or back pain after undergoing needle puncture or acupuncture therapy, the emergency physcians need careful initial evaluation for diagnosis and treatment.

외상성 뇌출혈 환자에서 수술 적응증 예측인자로서 초음파를 이용한 양안 시신경초 직경 차이의 유용성

박찬중,선경훈,조수형,김성중 대한응급의학회 2017 대한응급의학회지 Vol.28 No.3

Purpose: An increase in optic nerve sheath diameter (ONSD) has been associated with elevated intracranial pressure due to brain lesions, such as hemorrhage, infarction, and tumor. The aim of this study was to evaluate whether the difference of both ONSDs can predict surgical treatment in patients with traumatic brain hemorrhage. Methods: A prospective analysis of the data acquired between September 2016 and November 2016 was performed. We included 155 patients with traumatic brain hemorrhage undergoing computed tomography in the emergency room. We performed an ultrasonography to measure ONSDs for all included patients. The primary outcome of this study was operation indication in patients with traumatic brain hemorrhage. Results: The average age was 63.4±17.0 years (male 60.3±17.3, female 69.8±14.4). There were 61 (39.35%) patients with an indication for operation and 94 (60.65%) patients with an indication for no operation. Indications for operation showed a strong association with the difference of both ONSDs in patients with subdural hemorrhage (p<0.001), no association between them in patients with epidural and intracerebral hemorrhage. In patients with subdural hemorrhage, the area under the curve was 0.988 (0.653-0.998), and the cut-off value for the difference of ONSDs with respect to determining the indications for operation was 0.295 mm f maximizing the sum of the sensitivity (96.9%) and specificity (90.7%) using the receiver operating curve. Conclusion: A difference of both ONSDs above 0.295 mm was useful in predicting the indications for operation in patients with traumatic subdural hemorrhage, but not in patients with epidural and intracerebral hemorrhage.

The Effect of Glehnia Littoralis on Alpha-amanitin Induced Hepatotoxicity in a Murine Model

류창연,선경훈,홍란,박용진 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.2

Purpose: Glehnia littoralis has been reported to have several pharmacological properties but no in vivo reports describing the protective effects of this plant onα-amanitin-induced hepatotoxicity have been published.α-Amanitin is a peptide found in several mushroom species that accounts for the majority of severe mushroom poisonings leading to severe hepatonecrosis. In our previous in vitro study, we found thatα-amanitin induced oxidative stress, which may contribute to its severe hepatotoxicity. The aim of this study was to investigate whether Glehnia littoralis acetate extract (GLEA) has protective antioxidant effects onα-amanitin-induced hepatotoxicity in a murine model. Methods: Swiss mice (n=40 in all groups) were divided into four groups (n=10/group). Three hours after givingα- amanitin (0.6 mg/kg, i.p.) to the mice, they were administered silibinin (50 mg/kg/d, i.p.) or Glehnia littoralis ethyl acetate extract (100 mg/kg/d, oral) therapies once a day for 3 days. After 72 hours of treatment, each subject was killed, cardiac blood was aspirated for hepatic aminotransferase measurement, and liver specimens were harvested to evaluate the extent of hepatonecrosis. The degree of hepatonecrosis was assessed by a pathologist blinded to the treatment group and divided into 4 categories according to the grade of hepatonecrosis. Results: GLEA significantly improved the beneficial functional parameters inα-amanitin-induced hepatotoxicity. In the histopathological evaluation, the toxicity that was generated with α-amanitin was significantly reduced by GLEA, showing a possible hepatoprotective effect. Conclusion: In this murine model, Glehnia littoralis was effective in limiting hepatic injury afterα-amanitin poisoning. Increases of aminotransferases and degrees of hepatonecrosis were attenuated by this antidotal therapy.

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.