외상 중환자에서 Systemic Inflammatory Response Syndrome(SIRS) 점수와 다른 예후예측 지표들과의 비교

이준호 ( Jun Ho Lee ),이순정 ( Sun Jung Lee ),조광원 ( Kwang Won Cho ),황성연 ( Seong Youn Hwang ),표창해 ( Chang Hae Pyo ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Background: Since the systemic inflammatory response syndrome (SIRS) was first introduced in 1992, it has been well-known as an significant indicator to predict the level of severity and outcomes in medical, surgical and trauma patients for the last ten years. There are several other indicators such as triage Revised Trauma Score (t-RTS), Triage Score (TS), Trauma and Injury Severity Score (TRISS), Acute Physiology and Chronic Health Evaluation (APACHE), and Simplified Acute Physiology Score (SAPS) to predict trauma patients` severity and outcomes, and the authors focused on comparing the SIRS with those five other indicators to predict severity and outcome of traumatic intensive care unit (ICU) patients. Material and Method: The retrospective medical records of four hundred forty one consecutive ICU trauma patients from the emergency center, Masan Samsung Hospital from March 2002 and February 2003 have been carefully examined, and among them, three hundred fifty six were included as the target of this research. The t-RTS, TS and TRISS were calculated based on the record from the emergency center and operating rooms while SIRS, APACHE Ⅱ and SAPS Ⅱ were measured by the data for the first twenty four hours after their ICU hospitalization. The predictability of SIRS and other indicators was evaluated by using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. Result: Using injury severity score 15 as the gold standard, the accuracy of SIRS was higher than t-RTS, yet it was not higher than the one of TS (p<0.01). And the areas under the ROC curves of the SIRS, TS and t-RTS were 0.645±0.073, 0.803±0.054 and 0.766±0.054, respectively (p<0.01 vs. SIRS). Using survival as the gold standard, the accuracy of SIRS was remarkably lower than the ones of TRISS, APACHE Ⅱ and SAPS Ⅱ(p<0.01 vs. SIRS). And the areas under the ROC curves of the SIRS, TRISS, APACHE Ⅱ and SAPS Ⅱ were 0.665±0.052, 0.925±0.023, 0.946±0.025, and 0.965±0.017, respectively(p<0.001 vs. SIRS). Conclusion: The authors concluded that even though SIRS was closely related to death rate and injury severity score, yet its predictability was lower than the ones of other indicators mentioned above.

응급의학 센터로 내원한 산업재해 환자의 임상적 고찰

표창해,배성만,김형수,양혁준,박철완,이근,고영관 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

Owing to the recent high frequency of large square of accident, occupational injury prevention and industrial safety have been emphasized. However, due to the industrial growth and the increase of the insured work places to which industrial workman's accident compensation insurance is applied, the number of occupational injury patients had never decreased. As this hospital is located close to the industrial complexes, among the patients of traumatic wounds who visit to the emergency department, the proportion of the patients from occupational injury is much greater. On this we have reviewed the 1,027 inpatients from occupational injury and 41 occupational injury deaths who had visited Emergency medical center in Chung Ang Gil Hospital from January 1st to December 31th, 1995. The results were as follows : 1) Sex ratio of male to female was 3.4:1. 2) The mean age of occupational injury patients was 37years old and the commonest age was 35years old. 3) The most predominant monthly distribution of occupational injury patients was september and the least was August. 4) The leading transport method was by car(69%). 5) The occupational distribution were manufacturing(44.4%), construction(19.8%) and transportation/communication/public utilities(15.0%). 6) The leading causes of occupational injury were machine-related injuries(32.8%), falls(19.3%) and motor-vehicle-related injuries(12.6%). 7) The mean ISS of occupational injury deaths was 41, the mean RTS was 5.4 and the mean Ps was 0.62. In the view of the results so far, precautionary measures against occupational injury and accidents at the work places must be taken even more strongly. And for emergency treatment on the scene and on the way to the hospital after accident, the training and the disposition of E.M.T are urgently required. And in the view of the fact that the 69% of the occupational injury patients were taken to the Emergency Medical Center by car, the disposition of ambulances and necessary medical equipment is urgently requested. Further more, in order to lower the occupational death rate, some necessary measures are requested to be taken hereafter.

흰쥐 눈물샘 및 침샘에서 산화질소합성효소 (Nitric Oxide Synthase)에 대한 면역조직화학적 연구

박경호,표창해,고정식,안의태 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.6

경증 두부 외상 후 발생한 저나트륨혈증 3례

이근,박철완,표창해,안석근,임용수,민순식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone)is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. When moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.

응급실로 내원한 장중첩증의증 환아의 진단방법에 대한 임상적 고찰

원형섭,박정배,표창해,김형수,박철완,이근 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The purpose of this study is to evaluate the appropriate diagnostic methods for the patients with suspected intussusception. Intrssusception is a state that a portion of alimentary tract is telescoped into a segment just caudad to it, and has a characteristic symptoms of cyclic irritability, vomiting, bloody stools and palpable mass, It is the most common cause of acute or acquired intestinal obstruction in infants and children, and needs early diagnosis and immediate treatment. Authors reviewed retrospectively medical records of 411 infants & children with suspected intussusception from January 1, 1992 to December 31, 1994 and report the results with literature reviews. The results were as followings; 1) 263 cases were definite intussusception(DI) out of 411 suspected intussusception(SI). 2) The male to female ratio was 2.3 : 1 in SI and 2.8 : 1 in DI. 3) The distribution of age revealed that 85% of SI and 84% of DI were under 24 months old, and the most common age was 8 months in SI and 10 months in DI. 4) There were upper respiratory infection in 84 cases(2)%), gastroenteritis in 32 cases(8%) and bronchiolitis in 8 cases(2%) as preceding diseases. 5) The simple X-ray showed gaseous bowel distension in 212 cases(52%). 6) The most common symptoms and signs were cyclic irritability and abdominal pain(94%), bloody stools(72%), palpable abdominal mass(47%), in order. 7) Of 411 patients, 252 cases(61%) were diagnosed and treated by air enema(228 cases) and/or exploration(24 cases). Among 296 cases(72%) who showed bloody stools in digital rectal examination and glycerin enema, 245 cases(83%) were confirmed as intussusception through air enema and/or operative intervention, and that corresponds to 93% of DI. 8) Intestinal perforation as complication occurred in 3 of 393 cases who underwent air and barium enema, but all of them recovered without any sequelae after operation. Conclusively, it is thought that air enema preceded by digital rectal examination and glycerin enema is safe and useful method in diagnosis and treatment of infants and children with SI.

패혈증 백서 모델에서 비타민-C의 효과

이중의,신상도,표창해,서길준,정성은,윤여규 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-α and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. Methods : Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-α level in the blood and malondialdehyde(MDA)level, catalase activity and nitric oxide synthase(NOS)activity in the liver and the lung tissues were performed. Results : Serum TNF-α level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-α level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. Conclusion : high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.

소아 두부외상의 임상적 고찰

양혁준,박철완,표창해,박정배,이근 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Head injuries are a major cause of emergency department visits among the pediatric age group, frequently require extensive treatment and often result in disability or death. It has been reported that accidents cause more than half of all children death. And despite the early diagnosis and proper treatment head injury is the most common cause of death in children aged 1 to 15 years, accounting for 15% of death in this age group. In addition, the studies about pathophysiology of craniocerebral trauma indicate that the symptomatology and threshold for neurophysiologic dysfunction are different in children and adults. This report examined the nature of head injury, clinical course and the outcome of pediatric cases ranged from birth to 15 years at the Department of Emergency Medicine, Chung Ag Gil Hospital for 1993(N=900). The age incidence was greatest in 6∼10years(44.1%) and the spring was the most common season in which the head trauma occured. Traffic accident(47.0%) and fall (36.9%) were common as a cause of head injury. The distribution of Glasgow coma scales(GCS) was : 10.0% of children GCS 3∼8, 11.1% GCS 9∼12, and 78.9% GCS 13∼15. Concussion was diagnosed in 60.2% and skull fracture without intracranial abnormality in 14.8%. The frequency of mass lesion with or without skull fracture was 21.2% and diffuse brain injury was 3.8%. In clinical course 38.4% experienced loss of consciousness, 54.3% vomiting and 6.3% early post-traumatic convulsion but late epilepsy was not developed at all during the 6 months' follow-up period. Of 224 cases of intracranial abnormality, lucid interval was observed in 15.2%. Among 299 cases that showed a kind of skull fracture, associated intracranial lesion was detected in 55.2%. Besides of head trauma, 33.8% had associated injury and of which sprain was the most common type. As a whole neurosurgical interventions were required in 163 cases(18.1%) and in detail 18.7% of skull fracture, 72.6% of mass lesion. According to the GCS, 6.9% of GCS 13∼15 needed surgery, 55.0% of GCS 9∼12 and 65.6% of GCS 3∼8. In the outcome, the higher scored cases on the GCS were better than the lower scored ones. The overall mortality rate was 2.4% with the highest rate at GCS range of 3∼8, subdural hematoma among the mass lesion and aged from birth to 5 years.

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.

성폭력 실태와 법의학적 문제에 대한 고찰

양혁준,안석근,임용수,표창해,김형수,최유덕,이근 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

Female sexual assault victims who received medical care at Chung Ang Gil Hospital from 1993 to 1995 were evaluated. Data were obtained from the emergency department records and gynecologic clinic ; 25 patients were evaluated. The mean age was 18.5 ; the ages ranged from 3 to 37 years old. Twenty patients(80%) were unmarried and more than half were examined within five hours of assault. The vast majority of injuries were minor, including abrasions, contusions, and minor lacerations. Fourteen patients(56%) were acquainted with the assailant. Sexual assault was violent with 64% of all cases involving the use of a knife or blunt objects as a weapon. The optimal management of the sexual assault victim involves a multidisciplinary effort on the part of all legal, medical, and support personnel who interface with the emergency department. Taking a history and conducting a general physical examination are performed methodically and the gathering of evidence proceeds simultaneously with the physical examination. Treatment entails attention to physical injuries, potential venereal diseases and pregnancy and psychiatric intervention.