급성 출혈 환자에서 N-Butyl Cyanoacrylate를 이용한 경도관 동맥색전술의 유용성

제환준 ( Hwan Jun Jae ),김상윤 ( Sang Youn Kim ),이의중 ( Eui Jung Lee ),이활 ( Whal Lee ),서길준 ( Gil Joon Suh ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Background: N-Butyl Cyanoacrylate (NBCA) is a liquid embolic material that can be useful for transcatheter arterial embolization (TAE) of acute bleeding especially in patients with coagulopathy, because it does not depend on coagulation for its therapeutic effect. The aims of this study were to evaluate the clinical efficacy and safety of TAE with NBCA in acute bleeding patients. Methods: Between August 2003 and September 2004, TAE using NBCA for acute bleeding was performed in 23 patients (16 men, 7 women; mean age, 56.5years). The causes of bleeding were gastric ulcer (n=5), postoperative bleeding (n=4), post-biopsy bleeding (n=3), postpartum bleeding (n=3), duodenal ulcer (n=2), angiodysplasia (n=2), gastric lymphoma (n=1), iatrogenic injury (n=1), CMV gastritis (n=1), stab injury of the liver (n=1). TAE was performed using 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure-related complication and clinical outcomes were evaluated. Results: The angiographic and clinical success rate was 100% and 91.3% (21/23), respectively. There was no serious ischemic complication. Recurrent bleeding occurred in 2 patients (8.7%) and they were managed with successful second TAE (n=1) and endoscopic treatment (n=1). Nine patients (39.1%) had coagulopathy at the time of TAE and clinical success rate in this group of patients was 88.9% (8/9). Conclusions: TAE with NBCA is highly effective and safe treatment modality for acute bleeding patients, especially when the patient has a coagulopathy.

학교 손상과 관련된 병원 전단계 응급 의료 실태 및 위해 환경 요인

송경준 ( Kyoung Jun Song ),정성구 ( Sung Goo Jeong ),곽영호 ( Young Ho Kwak ),서길준 ( Gil Joon Suh ),권운용 ( Woon Yong Kwon ),신상도 ( Sang Do Shin ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Purpose: This study was designed to evaluate the risk factors of injury and pre-hospital emergency service system in school. Methods: A designed questionnaire was made up by nurse-teachers. We described the frequency and the distribution by types of school, gaining method of information about emergency care, education programs and concerns about injury prevention, transportation methods, and number of injured victim. After all school were divided with two groups such as high and low injury group based on median points of injury count, the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of each risk factor were measured using the multivariate logistic regression analysis. Results: 246 female nurse-teachers were responded. Of them, 143 worked at primary school, 50 at middle school, 29 at high school, and 18 at special school, respectively. Injury was the second common cause visiting to nursing room. 43.67% of victims were directly transported by nurse-teacher. Degree of attention about injury prevention was relatively high (63.0%) but education program was not sufficient (83.0%). There were no oxygen devices, ventilatory devices, airway maintenance devices, electrocardiography equipments, and critical drugs except immobilization devices, stretchers, oral antibiotics, and fluids in most schools. Mean number of victim visiting to nursing room due to injury was 2.6 per a day per 1,000 students. Adjusting for related factors, ``disordered shopping and parking area to near school`` (adjusted OR 1.840; 95% CI 1.077~3.143), ``risky window without safety equipment`` (adjusted OR 1.786; 95% CI 1.019~3.131), and ``when number of involved indoor condition was increased by one`` (adjusted OR 1.255 95% CI 1.004~1.568) were significant risk factors on high injury incidence. Conclusion: Injury was one of the most common health problems in school but there was no equipped for emergency care. ``Disordered street near to school`` and ``risky indoor conditions`` were significant risk factors on school injury.

위암의 수술전 병기에서 내시경초음파 및 전산화단층촬영의 비교

강장영(Jang Young Kang),서길준(Gil Joon Suh),이성규(Sung Gyu Lee),변종훈(Jong Hun Byun),정윤형(Youn Hyoung Joung),유윤정(Youn Jun Yoo) 대한외과학회 1994 Annals of Surgical Treatment and Research Vol.47 No.3

지역응급의료센터에서 손상구역 운용이 응급실 과밀화 지표에 미치는 영향

강진욱 ( Jin Wook Kang ),신상도 ( Sang Do Shin ),서길준 ( Gil Joon Suh ),유은영 ( Eun Young You ),송경준 ( Kyoung Jun Song ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purposes: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, burns, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. Methods: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients` data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. Results: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). Conclusion: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it`s impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable. (J Korean Soc Traumatol 2007;20:77-82)

장폐쇄증 환자에서 수술적 치료를 필요로 하는 요인분석

송경준,천성빈,신중호,이중의,서길준,윤여규 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: There is a continuing debate about whether small bowel obstruction (SBO) is best managed operatively or nonoperatively. There is also no definite criteria for physician to decide to operate patient with SBO. This retrospective study was designed to determine the factors influencing the treatment modality of SBO. Methods: A clinical analysis was applied to 95 patients with SBO who were admitted to the emergency department of Seoul National University Hospital from January, 2000 to December, 2001. The patients were divided into the operative and non-operative treatment groups according to the treatment modality. We compared parameters such as age, sex, the etiology of SBO, the history of previous SBO, the history of previous operation due to SBO, time period from onset of symptoms to admission, and symptoms and signs between two groups. Results: Among 95 cases, the operative management was performed in 21 cases and the non-operative treatment in 74 cases. There was no significant difference in the distribution of age and sex between two groups. The most common etiology of SBO was adhesion due to previous operation. In the operative treatment group, 12 (57.1%) cases had the history of previous operation because of SBO, which showed a significant difference compared to the nonoperative treatment group (p<0.001). The major symptoms and signs were abdominal pain, vomiting, abdominal tenderness, hyperperistalsis, leukocytosis, tachycardia, rebound tenderness and fever. Of these symptoms and signs, rebound tenderness was only more common in the operative group than in the non-operative group (p<0.001). Conclusion: At the time of admission to the emergency department, the rebound tenderness in patients with SBO is an important factor to consider the early operative intervention.

Paraquat중독에서 Vitamin C의 항산화성 효과에 관한 연구

김성혜,정중식,권운용,이중의,서길준,정성은,윤여규 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Paraquat is widely used herbicide. But if it is ingested by accident or by suicidal attempt it causes severe toxicity. And in emergency room, it is a big problem that there is no effective treatment modality for paraquat intoxication. It is reported that the mechanism of toxicity is by oxygen free radical. And Vitamin C is known as potent antioxidant. This study was designed to evaluate the antioxidant effect of Vitamin C to lipid peroxidaton in paraquat intoxication. Methods : 24 rats were divided to 6 groups after paraquat injection(20mg/kg), and each group has 4 rats. In 2 control groups we only observed until 6hours and 24hours. And Vitamin C of 10 mg per kilogram body weight on the low dose group and 100 mg per kilogram body weight on the high dose group were injected simultaneously. And in 6hours group, after 6hours of paraquat and vitamin C injection biochemical levels of malondialdehyde, superoxide dismutase and catalase were measured in liver and lung. And in 24 hours group after 24 hours the same measures were done. The stasistical methods used were ANNOVA and Mann-Whitney test and P-value was 0.05. Results : Malondialdehyde level of high dose Vitamin C group was significantly low compared to that of the control groups in liver tissues after 24hours(p<0.05). And in lung tissues both low dose and high dose vitamin C groups show significantly low level of malondialdehyde level after 24hours(p<0.05). On the superoxide dismutase activity, only high dose Vitamin C group shows significantly high level in 24hours both in liver and lung tissues. And the catalase activity is significantly elevated in high dose Vitamin C group after 24hours both in liver and lung tissues.(p<0.05) Conclusion : High dose Vitamin C suppresses lipid peroxidation, increases catalase activity and superoxide dismutase activity in paraquat intoxiation. It is thought to by antioxidant effect of vitamin C but it's effect is observed only in 24hours after intoxication.

백서의 화상모델에서 Vitamin C의 항산화 효과

신상도,김성혜,표창해,이중의,서길준,정성은,윤여규 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Inflammatory mediators, including oxidants, play a important role in the systemic response to burn injury and cause a sepsis and subsequent multiple organ failure by lipid peroxidation of cell. It has been known that vitamin C has potent antioxidant effect and inhibits the lipid peroxidation. This study was designed to evaluate the inhibitory effect of vitamin C about lipid peroxidation in the early stage of burn injury Methods : 15 rats with second degree burn on 30-35% of body surface were divided into three groups. Only normal saline was injected into intraperitonial space on the control group, and vitamin C of 50 mg/kg of body weight was added on the low dose group (LDG), and vitamin C of 500 mg/kg of body weight on the high dose group (HDG). After 24 hours of burn damage, biochemical levels of malondialdehyde (MDA), superoxide dismutase (SOD) and catalase were measured in lung and liver tissue. The statistical methods used were Kruskal-Wallis test and Mann-Whitney test. Results : MDA levels of LDG and HDG were significantly low compared to that of the control group (p<0.01). On the catalase activity, there was no significant difference when comparing the control group with LDG (p=0.015), but significant difference with HDG (p<0.01). There was no significant differences between three groups on the activities of SOD (p>0.01), except comparing the control group with HDG in lung tissue (p<0.01). Conclusion : Vitamin C therapy in the early stage of burn decreased the level of MDA and increased the catalase activity. It means that vitamin C inhibits the lipid peroxidation and has antioxidant effect. But vitamin C revealed the only partial effect on the SOD activity.

소아응급실에 내원한 정맥류 출혈 환자에 대한 고찰

김성혜,신상도,표창해,이중의,서길준,정성은,윤여규 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Varix bleeding in children is infrequent but it is potentially fatal. It has characteristics different from adult age varix bleeding. But there was littleclinical data about it. The purposes of this study is to detect its characteristics of varix bleeding in pediatric patients, and to help an emergency physician make a decision about the management. Methods : We reviewed medical records of 32 patients who visit Seoul National University Hospital Pediatric Emergency Center from Jan. 1, 1995 to Dec. 31, 1996. Results : 1) The peak age was between 1 and 5 years of age, and the ration of males to females was 1:1. 2) As a underlying cause, intrahepatic disease were more common than extrahepaticdiseases(87.1%:12.9%). 3) 10 patients(31.3%) had URI symptoms as a precipitating factor. 4) Varix bleeding has a circardian rhythm, and occured more often during the night. 5) In Child Classification for the gepatic reserve fuction, Child C was the most common(75%). 6) Endoscopic examinations were performed in 14 patients(43.8%). 7) According to shock classification. the ration of conservative to vasopressin treatmentin class Ⅰ and class Ⅱ were 13(40.6%)/10(31.3%) and 6(18.8%0/3(9.4%), respectively. 8) Fever was the most common complication (43.8%), adn the mortality rate was 3.1%. Conclusion : We suggest that the only conservative management can show a good result for pediatric varix bleeding compared to other treatment modalities.