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Purpose: In the Korean armed forces, vaccination against tetanus is done when personnel join the military service, but we do not know how many military personnel are vaccinated and how many soldiers have protection against tetanus. We performed a qualitative analysis of the tetanus antibody in Korean military personnel by using the TQS (Tetanus Quick Stick) Methods: This study used a prospective collection method for military personnel visiting to the emergency department of a tertiary armed forces hospital from July 2005 to January 2007. We performed an analysis by using the TQS and asked whether the personnel had been inoculated during military service. Results: The number of enrolled military personnel was 474. Among them, 412 had been vaccinated against tetanus after entering the military service. The positive rate of TQS was 91.3% (373 patients) after vaccination for tetanus. Conclusion: Many military personnel were inoculated with tetanus toxoid during military service and have protective antibodies for tetanus. According as TQS should be used for military personnel who visit the emergency department of an armed forces hospital. Also, anti-tetanus immunoglobulin should not normally be used a positive TQS for tetanus prophylaxis. (J Korean Soc Traumatol 2007;20:65-71)
김진주 ( Jin Joo Kim ), 신종환 ( Jong Hwan Shin ), 임용수 ( Yong Su Lim ), 김정권 ( Chung Kwon Kim ), 김재광 ( Jae Kwang Kim ), 현성열 ( Sung Youl Hyun ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 최영철 ( Young Cheol Choi ) 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.5
Purpose: Relative adrenal insufficiency is common in intensive care unit patients. Basal cortisol and the cortisol response following the injection of synthetic corticotropin were prospectively evaluated in postresuscitation patients after cardiac arrest. Methods: This is a prospective cohort study of relative adrenal insufficiency of patients with return of spontaneous circulation (>24 hours) after cardiac arrest who were admitted to the intensive care unit over three-year period from January 2005 to December 2007. Relative adrenal insufficiency was measured the next day after return of spontaneous circulation following cardiac arrest. Results: Seventy-five patients were included over three years. Relative adrenal insufficiency developed in 41 patients. In patients with relative adrenal insufficiency, SOFA (sequential organ failure assessment) and lactate were elevated (p=0.03, 0.048), mortality was higher (p=0.014) and basal cortisol concentrations were significantly increased (p=0.001). In patients with therapeutic hypothermia, there were no significant differences with or without relative adrenal insufficiency (p=0.847). The factors associated with mortality, as assessed by multiple logistic regression were relative adrenal insufficiency, therapeutic hypothermia and the time from arrest to the start of cardiopulmonary resuscitation. Conclusion: Both basal cortisol and the cortisol response after the injection of synthetic corticotropine must be considered in predicting patients outcome. For patients with relative adrenal insufficiency, some specific treatments such as cortisol can be considered. More prospective multicenter study is needed.
Purpose: A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs. Methods: We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst. Results: The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was 37.70±19.78 years with 36.6% of the patients being under 30 years forage. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score. Conclusion: The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs. (J Korean Soc Traumatol 2008;21:100-107)
정건영 ( Geon Yeong Jeong ), 임용수 ( Yong Su Lim ), 김진주 ( Jin Joo Kim ), 김재광 ( Jae Kwang Kim ), 김정권 ( Chung Kwon Kim ), 양혁준 ( Hyuk Jun Yang ), 이형석 ( Hyung Seok Lee ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.1
Purpose: We wanted to investigate the serial changes of the serum interleukin-6 (IL-6) and interleukin-10 (IL-10) concentrations, according to the neurological outcome, in patients who received therapeutic hypothermia after successful cardiopulmonary resuscitation. We also wanted to evaluate the usefulness of serum IL-6 and IL-10 as biochemical markers to predict the neurological outcome. Methods: We prospectively evaluated 23 patients who received therapeutic hypothermia after successful cardiopulmonary resuscitation. Blood samples were taken at 0, 4, 12, 24 and 48 hours after the return of spontaneous circulation. We compared the IL-6 and IL-10 levels between the good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome (NO) groups. Results: The serum IL-6 level at 0 hr was significantly higher in the good NO group than that in the poor NO group. The periods of time that showed the greatest pattern of change between the good and poor NO groups were 4-12 hr for the IL-6 level and 0-4 hr for the IL-10 level. On the analysis of the ROC curve, the cut-off value for delta IL-10 (0-4 hr) was -5.4 pg/ml (AUC=0.827, sensitivity 80.0%, specificity 93.3%, p=0.032) and the cut-off value for delta IL-6 (4-12 hr) was 62.8 ng/ml (AUC=0.527, sensitivity 80.0%, specificity 34.0%, p=0.861, respectively). Conclusion: Our study suggests that the early delta IL-10 can be used as a neurological prognostic marker for patients who are undergoing therapeutic hypothermia after successful cardiopulmonary resuscitation.
Lysozyme activities were measured in sera and cerebrospinal fluid (CSF) of 8 patients with tuberculous meningitis and 12 patients with non-tuberculous meningitis to differentiate tuberculous meningitis from non-tuberculous meningitis patients admitted to Chonbuk National University Hospital from March 1986 to August 1987. Sera and CSF were analysed for their lysozyme activities by the Freehool method in the Worthington Enzyme Manual. The results obtained were as follows: 1) Serum and CSF lysozyme activities in the control group were 66.8±10.3㎍/min/ml and 0.7±0.9㎍/min/ ml respectively. 2) Serum lysozyme activities in patients with tuberculous meningitis and viral meningitis were 114.46±16.5 ㎍/min/ml and 79.9±18.5 ㎍/min/ml respectively. 3) CSF lysozyme activities in patients with tuberculous meningitis and viral meningitis were 132.5 ㎍/min/ ml and 35.8±12.2 ㎍/min/ml respectively and there was a significant difference between the two groups (p$lt;0.001). 4) Serum lysozyme activities in patients with pulmonary tuberculosis with meningitis and pulmonary tuberculosis without meningitis were 114.76±16.5 ㎍/min/ml and 133.38±55.3 ㎍/min/ml respectively. There was no significant difference between the two groups (p$lt;0.05). CSF lysozyme activities in patients with tuberculous meningitis and tuberculosis without meningitis were 131.5±58.5㎍/min/ml and 3.29±5.8 ㎍/min/ml respectively and this was statistically significant (p$lt;0.001). 5) Lysozyme activities in patients with tuberculous meningitis treated with glucocorticoid returned to the control level in CSF, but not in serum. The above results suggest that determination of CSF lysozyme activities is useful in differential diagnosis between tuberculous meningitis and non-tuberculous meningitis, except for pyogenic meningitis, and is useful in monitoring the clinical course of tuberculous meningitis.