응급센터에서의 박리성 대동맥류에 대한 임상적 고찰

우건화,김원율,김홍용 대한응급학회 1998 대한응급의학회지 Vol.9 No.2

Dissecting aortic aneurysm is an emergency condition which requires prompt diagnosis and management. From January 1992 to December 1996, 54 patients were admitted to our department. Patients were categorized according to the Stanford classification of aortic dissection and investigation of the clinical records utilized the retrospective method. Male constituted the majority, accounting for 38(70.4%) of the total number of patients, whereas females accounted for 16(29.6%). Mean age was 52.1±2.2 years old (range: 25∼82). Clinical findings included chest pain in 46 cases(85.2%), renal failure in 11(20.4%), aortic insufficiency in 10(18.5%) and stroke in 9(16.7%). Predisposing factors were hypertension in 48 cases(88.9%), Marfan's syndrome in 5(9.3%) and diabetes mellitus in 1(1.8%). 21 patients(type A:12, type B:9) underwent surgical treatment. There were three(2 in type A and 1 in type B) deaths in the surgical treatment group and nine(5 in type A and 4 in type B) deaths in the medical treatment group. These results reflect our current policy in the management of dissecting aortic aneurysm.

흉부외상 환자에서 응급 전산화 단층촬영의 효용성에 관한 분석

우건화,김원율,김경환,김홍용,이기재 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background. Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 years of age. Computed tomography(CT) is an effective technique in the initial emergent evaluation of the abdomen and head following blunt trauma. Most chest injuries are not seen on conventional chest radiography, or may be underestimated. But routine use of CT in the initial emergent evaluation of chest trauma is controversial. CT, however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the efficacy of emergent CT in patients with blunt trauma on the chest. Methods. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram(CXR) was carried out on 121 patients with blunt trauma on the chest. The interval between CXR and CT was less than 1 hour. Results. Among 121 patients, 42 patients had normal initial chest roentgenogram in whom 19 patients showed normal CT findings, Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (49.3% and 45.1% respectively), whereas 65.7%(44/67) of patients had thoracostomy only by CXR. Conclusion. Although sometimes abused in patients with chest trauma, CT of the thorax is an effective method of detecting thoracic injuries and provides accurate information regarding their pattern and extent in the initial emergent diagnosis.

응급센터에서 검상하 심낭루조성술을 이용한 급성 외상성 심장압전에 대한 처치

김홍용,우건화 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.2

The development of cardiac tamponade is an acute, life-threatening emergency. Once the diagnosis has been established, an immediate decompression by a safe and effective method is required. We experienced two consecutive successful outcome for the treatment of traumatic cardiac tamponade with drainage using the subxiphoid pericardiostomy in emergency department. The causes of cardiac tamponade were blunt chest trauma due to car accident and falling. The patients were treated with emergency drainage by the subxiphoid pericardiostomy without procedure-related complications. We believe that subxiphoid pericardiostomy is a safe and effective method for the management of traumatic cerdiac tamponade in emergency department. The ability to perform this technique safely using local anesthesia and the capacity to obtain a direct visualization make this technique superior to both needle pericardiocentesis and pericardiectomy in the acutely ill patient.

둔상에 의한 흉골골절 104 례의 임상적 평가

오상준,김홍용,우건화 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.1

Background: Sternal fracture, once thought of as an uncommon phenomenon, has occurred with increasing frequency, paralleling the incidence of motor vehicle accidents. The tremendous force necessary to cause sternal fracture and this bone's prominent position overlying major intrathoracic and mediastinal structures, have important implications in the assessment and the treatment of patients. Methods: Data on blunt trauma victims admitted to our hospital were retrospectively analyzed to determine the significance of sternal fractures and possible associated injuries. One hundred four patients with sternal fractures due to blunt trauma were admitted from January 1990 to December 1999. Result: The frequency was about 4.2% of nonpenetrating chest traumas. The ratio of males to females was 2.1: 1. The most common cause of sternal fractures was TA (80 cases). The most common fracture site was the sternal body (83 cases). Abnormal ECG findings were sinus bradycardia (8 cases), sinus tachycardia (6 cases), complete or incomplete RBBB (3 cases), specific S-T change (3 cases), 1st degree A-V block (1 case), LVH (1 case), PVC (1 case), atrial fibrillation (1 case), and Low voltage (1 case). CK-MB was increased in about 14.4% of the sternal fractures. Patients were treated with conservative treatment (100 cases) and open reductions & steel-wire fixations (4 cases). The complications after treatment were atelectasis (4 cases), empyema (2 cases), ARDS (1 case). One patient died at the emergency center. The causes of death were lung contusion and ARDS. Conclusion: Although sternal fractures do not occur frequently, and are mostly treated with conservative treatment, they should be carefully observed because of critical associated injuries.

다발성 외상환자에서 개흉술이 필요했던 환자에 대한 임상적 고찰

김경환,오상준,김홍용,우건화,김원율 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.1

Background: Recently, multiple trauma patients have been increasing markedly due to the vast increase of traffic accidents, industrial disasters, and incidental accidents as well as the fre- quent use of murderous weapons. Because thoracic injuries could involve the heart, lung, and great vessel and would influence lives, prompt diagnosis and adequate treatment are essential. Most of the thoracic injuries can be managed with a conservative method and simple surgical procedure such as closed thoracostomy, but in certain cases open thoracotomy is necessary. Materials and Methods: We analyzed the surgical result of 64 cases of open thoracotomy after multiple organ injury mainly according to the patients chart review. Results: The most common type of thoracic lesion was hemothorax with or without pneu- mothorax and diaphragm rupture was second. 38.9% of thoracic injuries was accompanied by abdominal injuries and 32.5% by bone fractures. The modes of operation were ligations of torn vessels for bleeding control(32.4%), repair of diaphragm(24.6%), and repair of lung lacera- tion(18.2%) in order of frequency. Additional procedures were splenectomy(14 cases), repair of liver laceration(6 cases) and hepatic lobectomy(3 cases). The postoperative complication rate was 26.6% and operative mortality rate was 6.1%. The causes of death were acute renal failure(2 cases), respiratory failure(1 case), and sepsis(1 case).

학령기 및 그 이후에서 대동맥교약증의 수술

오상준,변정욱,윤찬식,이선훈,구본일,우건화,박용원 인제대학교 1999 仁濟醫學 Vol.20 No.1S

학령기 및 그 이후에서 대동맥교약증의 수술은 영유아기 수술에서보다 잘 터지기 쉬운 부혈행로와 대동맥의 변성, 봉합부의 과도한 긴장시 대동맥조직 탄력성의 감소로 절제 및 단단문합술의 적용이 용이하지 않은 경우가 많고, 대동맥교약증의 다양한 해부학적 형태 때문에 다양한 술식이 필요할 수 있다. 따라서 그 해부학적 형태에 따른 이상적인 수술 방법을 알아보고자 하였다. 본 교실에서는 1989년 2월부터 1998년 6월까지 8세 이상에서 대동맥교약증으로 수술받은 11예를 대상으로 하였다. 남자가 7명, 여자가 4명이었고. 연령은 8세에서 25세까지로 평균 13세였다. 수술 방법은 절제 및 단단문합술(resection and end-to-end anastomosis)이 5예, 대동맥간 우회술(aorto-aortic bypass)이 3예, 인조 혈관 덮개포편술(prosthetic patch outlay graft)이 2예, 절제 및 인조혈관 간치술(resection and interposition of prosthesis for aorta)이 1예였다. 추적 기간은 평균 66.3개월(범위 3∼109개월)로 추적 기간 시행한 도플러 심초음파도 검사를 분석하였고 (순간 속도), 하지의 간헐적 파행의 유무 및 촉지 등도 아울러 분석하였다. 추적 기간 중 사망 및 재협착은 없었으며 술후 일시적인 고혈압이 2예, 일시적인 성애가 1예, 일시적인 혈색뇨가 1예였다. 이상의 결과로 다양한 해부학적 형태에 따른 위의 수술방법은 학령기 및 그 이후에서 대동맥교약증의 수술에 모두 유용한 것으로 사료된다. Background: Surgical correction of aortic coarctation presenting initially after late childhood requires various operative techniques, because resection and end-to-end anastomosis are difficult due to the presence of friable collaterals and decreased in elasticity of the aorta, and coarctation of aorta has the various pathologic anatomy. Modifications in surgical technique is based on the anatomical characteristics of the coarctation. Material and methods: Between Feb, 1989 and July, 1998, we operated on a total of 11 cases of coarctation of aorta in late childhood or older. There were seven male and four female patients aged from 8 to 25 years old(mean, 13 years). The surgical techniques are as follows: resection and end-to-end anastomosis in 5 cases, aorto-aortic bypass in 3, prosthetic patch onlay graft in 2, and resection and interposition of prosthesis in 1. Result: No postoperative deaths and recoarctation occurred. Conclusion : After 66.3 months of mean follow-up, we found no differences in the outcome on the basis of the type of repair. All four techniques are an effective and safe surgical procedures.

학령기 및 그 이후에서 대동맥교약증의 수술

오상준,변정욱,윤찬식,이선훈,구본일,우건화,박용원 인제대학교 1999 仁濟醫學 Vol.20 No.1