약물중독 후 흡인성 폐렴의 발생에 미치는 인자에 대한 고찰

김동희,오주석,경연영,최세민,오영민,최경호,박규남,Kim, Dong-Hee,Oh, Joo-Suk,Kyoung, Yeon-Young,Choi, Se-Min,Oh, Young-Min,Choi, Kyoung-Ho,Park, Kyu-Nam 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: It is known that aspiration pneumonitis is associated with high mortality and morbidity following overdose. However, until now, few domestic studies on this subject have been conducted. The main aim of this study is to investigate the risk factors associated with aspiration pneumonitis in intubated patients following overdose. Methods: Among 654 adult overdosed patients who visited our institution from Jan. 2006 to June 2008, we enrolled 70 intubated patients within 24 hours after their overdose, and we reviewed the medical records to collect the data. This data was processed by univariate analysis, followed by multiple logistic regression analysis. P values <0.05 were deemed statistically significant. Results: In our study, a high incidence of pneumonitis was seen in the patients with an older age, a lower GCS and a high poisoning severity score or a high comorbidity score (p<0.05). Compared with the non-pneumonitis group, the pneumonitis group had a higher incidence of intubation (6% vs 61.8%, respectively, p<0.05). The main cause of intubation was a decreased mentality (68.6%). Older age, a high comorbidity score, irrigation without airway protection, relative hypoxemia and hyperkalemia were the risk factors of aspiration pneumonitis in the intubated overdosed patients (p<0.05). Among these factors, age, a high potassium level and airway protection might be significant predictors of aspiration penumonitis (p<0.05). Conclusion: Older age, a high potassium level and irrigation without proper airway protection may be the significant factors that can predict aspiration pneumonitis in patients who are intubated within 24 hours after overdose, although the further investigations on this are needed.

안정된 복부 둔상 환자에서 복강경하 비장 절제술

조항주 ( Hang Joo Cho ),경연영 ( Yeon Young Kyoung ),오주석 ( Ju Suk Oh ),오영민 ( Young Min Oh ),최세민 ( Se Min Choe ),최경호 ( Kyoung Ho Choi ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Splenic rupture is a frequent surgical emergency in blunt abdominal trauma patients. There are several treatment options, including conservative treatment, a partial splenectomy, splenorrhaphy, and a splenectomy for splenic injury. Although reports on the safety and the efficacy of an elective laparoscopic splenectomy are abundant in the literature, a laparoscopic splenectomy for a ruptured spleen has only been reported in a few cases. We report a case of a laparoscopic splenectomy in the patient with Grade III traumatic splenic injury. To our knowledge, this is the first report in which a laparoscopic splenectomy was performed in Korea for the treatment of a traumatic splenic injury. (J Korean Soc Traumatol 2010;23:192-195)

독사 교상 후 초기 증상 지연재평가의 임상적 중요성

김대희,최세민,오영민,오주석,경연영,최경호,Kim, Dae-Hee,Choe, Se-Min,Oh, Young-Min,Oh, Joo-Suk,Kyong, Yeon-Young,Choi, Kyoung-Ho 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. Methods: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. Results: The 32 patients had an average age of $54.0{\pm}14.5$ years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. Conclusion: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.

도금 용액 가열원 대체 시 에너지 절약 비용에 대한 경제성 분석 -시화공단내 집단도금업체 사례 분석

오승준 ( Seung Joon Oh ),노주석 ( Joo Suk Noh ) 대한설비관리학회 2015 대한설비관리학회지 Vol.20 No.1

In plating factories from the Sihwa industrial complex, the electrical energy is used for heating the plating solution due to simplicity and convenience. However, other thermal energy instead of electrical energy has been used in plating process in order to increase the energy efficiency and to decrease the risk of accidents. In this study, we perform an economic analysis of the change in heating the plating solution. When LNG and electricity are replaced by steam, we study the cost savings and the cash flow analysis. Finally, we analyse the economics of the use of steam through the discounted payback method.

말뚝버섯속의 국내 미기록종(Phallus hadriani) 보고

조종원 ( Jong Won Jo ),심정교 ( Joungkyo Sim ),심주석 ( Joo Suk Sim ),곽영남 ( Young-nam Kwag ),김형소 ( Hyung So Kim ),박상영 ( Sang Young Park ),한상국 ( Sang-kuk Han ),한재구 ( Jae-gu Han ),오승환 ( Seung Hwan Oh ),김창선 ( Cha 한국균학회 2020 韓國菌學會誌 Vol.48 No.3

As part of the mushroom surveys in the unexplored areas of Korea in 2019 and 2020, a phalloid fungus was found in a saline sand beach. The specimen was mainly characterized by its reticulate pileus and violet volva with well-developed rhizomorphs. Based on ribosomal DNA internal transcribed spacer (ITS) sequencing and morphological characteristics, the specimen was identified as Phallus hadriani. Additionally, a morphological comparison of closely related species was performed. This study describes for the first time the presence of P. hadriani in Korea.

항우울제 중독환자의 심장독성에 관한 연구

박정택 ( Jung Taek Park ),최세민 ( Se Min Choi ),오영민 ( Young Min Oh ),오주석 ( Joo Suk Oh ),경연영 ( Yeon Young Kyoung ),조항주 ( Hang Joo Cho ),최경호 ( Kyoung Ho Choi ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2

Purpose: Although cardiac toxicity is a key parameter of significant toxicity, in antidepressant intoxication, there are few studies on the cardiac toxicity of serotonin reuptake inhibitor and the intoxication with the new generation of antidepressants. The aim of this study is to investigate the relative cardiac toxicity of serotonin reuptake inhibitor and intoxication with the new generation of antidepressants as compared with that of tricyclic antidepressant intoxication. Methods: We retrospectively reviewed the medical records of 109 antidepressant intoxicated patients who visited the Emergency Department from January, 2005 to December, 2009 to collect and analyze the demographic and clinical data. Sixteen patients were excluded. The enrolled seventy eight patients were classified into three groups: the tricyclic antidepressant group (TCA) (n=32), the selective serotonin reuptake inhibitor subgroup (SSRI) (n=28) and the new generation antidepressant subgroup (NGA) (n=18). Results: The demographic and clinical data of the SSRI and NGA groups were not significantly different from that of the TCA group. The QRS duration of the SSRI subgroup (86.4±12.0 msec) and the NGA subgroup (91.8±11.9 msec) was not significantly different from that of the TCA group (90.0±13.5msec) (p=0.598). The QTc interval of the SSRI group (444.5±33.5msec) and the NGA group (434.9±35.9) (p=0.260) were not significantly different from that of the TCA group (431.2±44.1msec) (p=0.287). Conclusion: Intoxication with SSRI and the new generation antidepressants seemed to show significant cardiac toxicity, like what is seen in tricyclic antidepressant intoxication. Clinicians must pay attention to SSRI and new generation antidepressant intoxication.

햄스터에서 유발된 amiodarone에 의한 폐섬유화 모델에서 vitamin E와 N-acetylcysteine의 효과

오주석,최경호,김세경,왕영필,나석주 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: Amiodarone (AD) is a potent and effective antidysrhythmic drug, but some literature reports that it' s long-term use is associated with the development of potentially life-threatening amiodarone-induced pulmonary toxicity (AIPT). Until now, oxygen free radical theory has been the most probable hypothesis for the development of AIPT. We investigated the protective effect of two potent antioxidants, N-acetylcysteine(NAC) and vitamin E, against AIPT. Methods: Twenty-six (26) Hamsters were divided into a sham-operation group(n=2) and the following 4 groups: AD-induced effects without antioxidants (group 1, n=6), with NAC (group 2, n=6), with vitamin E (group 3, n=6), and with both NAC and vitamin E (group 4, n=6). Vitamin E (100 mg/kg) was injected intramuscularly into the hind leg once a day. At day 21, amiodarone (1.83 umol) was administered by transoral intratracheal instillation. NAC (300 mg/kg) was injected intraperitoneally just after amiodarone instillation. At day 28, amiodarone and NAC were administered again. Twenty-one (21) days after instillation of the second dose of amiodarone, the hamsters were sacrificed, and the lung fibrosis index and the hydroxyproline content were assessed. Results: In the NAC-treated group (group 2), there was no significant decrease in either the lung fibrosis index, as determined by microscopic evaluation, or the lung hydroxyproline content (p>0.05). But there were significant decreases in the fibrosis index and the lung hydroxyproline content in the vitamin E-treated groups (group 3 and 4)(p<0.05). Conclusion: Although vitamin E and NAC are both potent antioxidants, we found that AD-induced lung fibrosis was significantly decreased by only vitamin E and that there was no synergistic effect between vitamin E and NAC. It is possible that AIPT is developed by some other mechanisms rather than oxygen free radical injury. Vitamin E may have some other path for decreasing lung fibrosis. Further studies are warranted.

비외상성 양측 견관절 탈구를 동반한 과운동성 증후군 1례

이승호,김영민,오주석,최승필,박규남,김세경 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Hypermobility syndrome (HMS) was first described as a disease entity by Kirk et al. in 1967. It presents hypermobility of a joint without hereditary connective tissue disorders such as Marfan syndrome (MFS), Ehlers-Danlos syndrome (EDS), or osteogenesis imperfecta (OI). Arthralgia is a common symptom, and dislocation may occur with minimal trauma or even spontaneously. This symptom is often ignored or recognized as non-specific chronic pain because the diagnostic criteria for HMS varies among reserchers and because HSM has no typical radiologic and laboratory findings. We report a case of hypermobility syndrome, which was accompanied by spontaneous dislocation of both shoulders, along a review of appropriate literature on the subject.

병원외 심정지 후 혼수환자에 대한 소생후 경도 저체온 치료 : 임상 적용을 위한 예비 시험 A preliminary clinical feasibility trial

김영민,박규남,최승필,오주석,김세경 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: No proven neuroprotective treatment exists for ischemic brain damage after cardiac arrest (CA). Although several animal studies have shown that mild to moderate hypothermia markedly mitigates ischemic brain damage after CA, the clinical safety and efficacy of mild hypothermia remain unproven. We conducted this preliminary study to evaluate the clinical feasibility and safety of mild resuscitative hypothermia (RH) for comatose patients of out-of-hospital CA. Methods: We performed prospectively a preliminary, non-randomized, uncontrolled, clinical feasibility trial over four years in a university-based hospital. Consecutive patients admitted or transferred to the emergency medical center after out-of-hospital CA who met inclusion and exclusion criteria were enrolled. Hypothermia was induced as soon as possible after return of spontaneous circulation (ROSC) by using external surface cooling methods and cold saline gastric lavage at the target temperature (34℃) and was maintained for 24 hours by using external surface cooling methods, which was followed by passive rewarming. Results: Twelve patients were enrolled. Mean arrest time was 20±12 minutes (range 2 to 40); the mean advanced cardiac life support (ACLS) time was 12±8 minutes (range 4 to 27) and the mean time from start of ACLS to initiation of RH was 129±113 minutes (range 40 to 420). Achieving the target temperature took 160±79 minutes (range 80 to 330) and the mean rewarming time was 605±190 minutes (range 360 to 960). One patient developed transient atrial fibrillation and premature ventricular complex during the induction period. Hypotension developed in six patients during hypothermia, pneumonia associated with induced hypothermia developed in four patients. Other complications, such as myoclonus (n=4), increased serum amylase (n=7), increased serum creatinine (n=2), and potassium abnormalities (n=2), also occurred. These complications occurred more frequently in patients with poor cardiac function after ROSC. No serious complications, such as ventricular fibrillation, bleeding, or sepsis, occurred. Conclusion: Mild RH after CA appears clinically feasible. However, induction with surface external cooling methods is slow, and maintenance of mild hypothermia was difficult. Future efforts to shorten the induction time and to develop more effective maintenance methods and more cautious applications to patients with poor cardiac function after ROSC are needed. Furthermore, well-designed, prospective, randomized, and controlled, multi-center efficacy trials are needed to evaluate the effect of mild RH.