한국인 3차원 인체형상모델을 이용한 고리뼈의 성별판별 검증

홍종근(Chong-Kun Hong),정재광(Jae-Kwang Chung),이우영(U-Young Lee),김덕수(Duk-Soo Kim),박대균(Dae-Kyoon Park),박경호(Kyung-Ho Park) 대한체질인류학회 2014 해부·생물인류학 (Anat Biol Anthropol) Vol.27 No.4

사망 당시의 정보를 알고 있는 마른뼈들을 통계학적으로 분석한 연구가 있다면 마른뼈를 법의인류학적으로 분석하여 개인식별항목(biological profile)을 추정하는 것이 가능하다. 한국인의 경우 개인식별항목을 추정하는 데 필요한 뼈표본이 거의 없기 때문에 개인식별항목을 추정하기 위한 통계학적 자료가 부족하다. 그러므로 뼈대에 붙어 있는 물렁조직을 모두 제거하여 뼈표본을 제작하는 방법의 대안으로 방사선으로 촬영된 진단영상을 활용하여 뼈대를 3차원으로 재구성하는 연구가 제안되고 있다. 이 연구는 해부용 시신을 컴퓨터단층촬영(computed tomography)하여 구축한 3차원 인체형상모델에서 뼈대 정보를 재구성하여 계측하였고, 통계학적 분석을 통해 성별을 추정하는 데 도움이 되는지를 조사하였다. 가톨릭대학교 가톨릭응용해부연구소에서 관리하고 있는 디지털 코리언(Digital Korean) 데이터베이스에서 고리뼈 (atlas) 100개 (남성 51개, 여성 49개)를 계측하였다. 3차원 컴퓨터 프로그램인 미믹스 (Mimics, Simulation module, Version 13.0, Materialise NV, Belgium)를 이용하여 계측항목들을 계측하였고, IBM® SPSS® (version 20.0, Armonk, New York)를 이용하여 통계학적 분석을 하였다. 계측 결과를 실제 마른뼈의 연구에서 얻은 판별함수를 적용하였을 때 정확도가 떨어졌기 때문에 새롭게 판별함수를 구하였고, 19개 계측항목들 중에서 고리뼈너비(Width of Atlas)가 성별을 추정하는 데 가장 유용한 계측 항목이었다. 본 연구 결과 고리뼈너비가 76.7mm보다 큰 값일 경우 남성으로 판별할 수 있었다. 뼈표본이 부족한 현실에서 한국인 뼈대의 체질인류학적 특징을 연구하는 것은 한계가 있다. 그러므로 방사선 진단영상에서 3차원으로 재구성한 뼈대를 활용하여 형태학적 특징을 규명하려고 시도된 이번 연구의 결과는 디지털 코리언 데이터베이스를 활용하여 체질인류학적 연구를 할 수 있는 가능성을 보여주었다고 생각되고 현장에서도 계측값을 통해 성별을 추정하는 데 도움이 될 것으로 판단된다. Estimation of biological profile for skeletal remains by forensic anthropological examination would be possible based on physical anthropological studies which were statistically analyzed. However, physical anthropological studies for Korean population are not enough to establish biological profile for Korean because there is lack of documented osteological specimens in Korea. Recent study suggested that physical anthropological examination could be possible on the three dimensional data which were reconstructed from computed tomography, instead of preparing skeletal specimen by defleshing bone. One of the aim of this study is to evaluate Digital Korean database which were composed of computed tomographic images of 100 cadavers. The other is to perform statistical analysis on morphometrics for segmented atlas whether the results could be helpful to estimate sex in Korean. We measured 100 segmentation atlases (male 51, female 49) from the Digital Korean database which were under the control of Catholic Institute for Applied Anatomy, The Catholic University of Korea. Measurements of segmented atlas were carried out by using Mimics software (Simulation module, Version 13.0, Materialise NV, Belgium), and values of measurement were performed statistical analysis by IBM® SPSS® (version 20.0, Armonk, New York). Among 19 measurements, the width of atlas showed most crucial element for estimating sex, which was consistent with the result using dried bones of atlas and hit ratio of discriminant functions was 88.0%. 76.7 was the cut-off score of discriminant functions. This results showed that morphometrics for segmented atlas could be helpful in estimating sex using the Digital Korean database. In the future, we expect that the other researchers could more actively use the Digital Korean database as a good specimen for physical and forensic anthropological study.

일개 응급센터에서 급속가압수액주입기의 사용경험

홍종근 ( Chong Kun Hong ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1

Purpose: Hypovolemia is not uncommon among trauma patients in the emergency department (ED). Successful resuscitation of a hypovolemic patient often requires rapid intravenous administration of massive amounts of fluid. A rapid fluid infuser is used in the ED for this purpose, there have been no studies of their clinical uses and effectiveness. We studied clinical experience with a rapid fluid infuser at an urban university hospital in Seoul, Korea. Methods: We reviewed the medical records of 38 patients admitted to the ED with a history of application of a rapid fluid infuser from January 2004 to July 2005. Adult trauma patients older than 15 years of age were included in this study. Clinical data on the patients and the volume of fluid used to achieve a stable blood pressure were extracted from their medical records. Results: The total number of adult trauma patients with a history of application of a rapid fluid infuser from January 2004 to July 2005 in the ED was 16. The mean systolic blood pressure for deciding to apply the rapid fluid infuser was 74.9±12.7 mmHg. The mean time and volume used to achieve a stable blood pressure were 40.4 min and 2947.3±1339.2 ml, respectively. In all patients, the amount of fluid infused before using the rapid fluid infuser was between 500 ml and 10,000 ml, compared to 1,000 ml and 6,200 ml with the rapid fluid infuser. The mean amount of fluid per min. via the rapid fluid infuser was 85.5 ml. Vital signs were stabilized in 11 patients, 6 of the 11 were discharged alive. Conclusion: The mean amount of fluid delivered per min. via the rapid fluid infuser was much less than expected; thus, there should be clinical guidelines on volume resuscitation with a rapid fluid infuser in the ED. In the future, prospective, multicenter, clinical-data collection is needed for a more sophisticated study. (K Korean Soc Traumatol 2006;19:41-46)

혈역학적으로 안정된 복부둔상환자에서 FAST의 유용성 평가

하상현 ( Sang Hyun Ha ),홍종근 ( Chong Kun Hong ),이준호 ( Jun Ho Lee ),황성연 ( Seong Youn Hwang ),최성희 ( Seong Hee Choi ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.3

Purpose: Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard. Methods: The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department.Results: There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively. Conclusion: Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients. (J Korean Soc Traumatol 2012;25:67-71)

성인둔상환자에서 평균동맥압과 위해사건발생의 관련성: 단면 조사 연구

차승용 ( Seung Yong Cha ),김용환 ( Yong Hwan Kim ),홍종근 ( Chong Kun Hong ),이준호 ( Jun Ho Lee ),조광원 ( Kwang Won Cho ),황성연 ( Seong Youn Hwang ),이경렬 ( Kyoung Yul Lee ),이영환 ( Young Hwan Lee ),최성희 ( Seong Hee Choi 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.2

Purpose: Non-invasive blood pressure measurement is widely used as a pre-hospital triage tool for blunt trauma patients. However, scant data exits for using the mean arterial pressure (MAP), compared to the systolic blood pressure, as a guiding index. The aim of this study was to determine the association between adverse outcomes and mean arterial pressure (MAP) and to exhibit the therapeutic range of the MAP in adult blunt trauma patients. Methods: The electronic medical records for all trauma patients in a single hospital from January 2010 to September 2012 were retrospectively reviewed. Patients below 17 years of age, patients with penetrating injuries, and patients with serious head trauma (injuries containing any skull fractures or any intracranial hemorrhages) were excluded. Adverse outcomes were defined as one of the following: death in the Emergency Department (ED), admission via operating theater, admission to the intensive care unit, transfer to another hospital for emergency surgery, or discharge as hopeless. Results: There were 14,537 patients who met entry criteria. Adverse outcomes occurred for MAPs in range from 90 to 120 mmHg. Adverse outcomes were found, after adjusting for confounding variables, to occur increasingly as the MAP declined below 90 mmHg or rose above 120 mmHg. Conclusion: Not only lower but also higher mean arterial pressure is associated with increased adverse outcomes in adult blunt trauma patients. Thus, patients with a MAP above 120 mmHg should be considered as a special group requiring higher medical attention, just as those with a MAP below 90 mmHg are.

외상 환자에서 초음파 유도 내경정맥 도관 삽입 시카테터 바늘과 피부 사이의 적정 각도

전현민 ( Hyun Min Jeon ),정성민 ( Sung Min Jung ),정루비 ( Ru Bi Jung ),전진 ( Jin Jeon ),홍종근 ( Chong Kun Hong ),신태용 ( Tae Yong Shin ),하영록 ( Young Rock Ha ),김영식 ( Young Sik Kim ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients. Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV`s anterior-posterior (AP) vessel wall on the longitudinal scan`s midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV`s internal center on screen`s midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5≤ middle CVP ≤10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles. Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68±0.30, 1.06±0.31, and 1.23±0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups` mean optimal angles (28.1±6.1, 30.1±4.5, and 28.0±5.0 degree respectively). Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV`s diameter is altered in proportion to the CVP.