약물 중독 시 위 세척에 의한 산 - 염기 평형 및 전해질의 변화

윤형란(Hyung Ran Yun),손동현(Dong Hyun Sohn),이창범(Chang Bum Lee),이재웅(Jae Woong Lee),양석철(Suck Chul Yang),한동수(Dong Soo Han),손주현(Ju Hyun Sohn),김순길(Soon Kil Kim),김호중(Ho Jung Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives: There is little information on the imbalance of electrolyte and acid-base metabolism associated with gastric lavage in acute drug intoxication patients. This study was aimed to analyze the acid-base and electrolyte abnormalities associated with gastric lavage in acute drug intoxication patients. Methods: We studied 24 acute drug intoxication patients who had performed gastric lavage with 10 liters of 0.9% NaC1. Electrolyte parameters and arterial blood gas analysis were carried out before and after gastric lavage. Results: After gastric lavage, acidosis was reduced in general. But there was no significant change in pH (7.34±0.02 vs. 7.38±0.15, p=NS). In acid-base balance, the mixed form of metabolic acidosis and respiratory acidosis was reduced from 7 to 2 cases, and the simple form of respiratory acidosis was reduced from 3 to 1 case. In contrast, normal form was increased from 5 to 7 cases and the simple form of metabolic acidosis was increased from 2 to 6 cases. In electrolyte parameters, serum sodium was reduced significantly (145±1.0 mEq/L vs. 141±0.8 mEq/L, p<0.01), but there was no case of significant hyponatremia (<135mEq/L). Bicarbonate level (20±1.1 mEq/L vs. 22±0.9 mEq/L, p< 0.05) and anion gap (19±1.6 mB vs. 13±1.3 mEq/L, p< 0.01) showed significant change. But, blood levels of potassium (3.6±0.1 mEq/L vs. 3.8±0.1 mEq/L, p=NS), chloride (106±0.6 mEq/L vs. 106±0.6 mEq/L, p=NS) and F'aCO2 (36±1.mmHg vs. 37±1.5 mmHg, p=NS) were no significant change before and after gastric lavage. Conclusions: Gastric lavage with 10 liters of 0.9% NaC1 in acute drug intoxication patients did not show clinically significant changes in electrolytes and acid-base balance.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

전기손상으로 인한 심장질환자의 회복 1례

장문준,황태식,최성욱,김인병,손대곤,조광현,이한식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

An unconscious 20 year old male carried into the emergency department after an electric shock injury 20 minutes earlier. Cardiopulmonary resuscitation was undertaken when asystole appeared on the electrocardiograph monitor. A 12-lead electrocardiograph was taken when in that myocardial infarction was found after performing cardiopulmonary resuscitation on an electrical injury patient. We present out case's electrocardiographs with echocardio-graphic findings and radionuclide imaging studies.

고고학 유적 답사 보고

손보기,최복규,한창균,장호수,성현경,손기언 단국대학교 한몽학술조사연구협회 1992 한·몽공동학술조사 Vol.- No.1

응급환자에서의 쇼크계수의 의의

장문준,황태식,손대곤,이한식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

For the emergency patients in need of immediate resuscitation, cardiac catherization along with intensive cardiac monitoring is necessary to evaluate the cardiovascular stability. But this method requires machinery, technique and time which limits its use in emergency situations. In 1961, Allgower and Buri first discribed shock index, heart rate divide by systolic blood pressure, as easy to calculate and easy to use in acute settings given the simple measurements of the heart rate and the blood pressure. It has been said in circulatory failure patients shock index is inversely related to left ventricular stroke work. Because shock index is an indicator for resuscitation and also a prognostic indicator it could be applied in triaging an emerency patients. Therefore we studied the significance and the possible triage application of shock index in emergency patients. In the period of 6 months from May 1 to October 31, 1994. Among total 15,782 patients, who visited Yonsei University-affliated Yong Dong Emergency Department, 2425 patients were included in the study. There were 201 admissions to the intensive care unit and 2105 patients to general beds and 199 selected patient from discharged. Retrospective chart review for pulse rate, systolic blood pressure, diastolic pressure and shock index was done. Statistical analysis was performed using t'-test, p value of less than 0.05 was designated significant. Average shock index for ICU patients were 0.96 ±0.50, general ward admittees were 0.67 ±0.18, and discharged were 0.65 ±0.16. There were significant statistical difference in shock indices between ICU and general ward patients, and ICU and discharged patients. Shock index is helpful in identifing patients with potential for admission to the ICU in emergency situations. Therefore we conclude that the shock index should be recognized as a triage tool.

한국에서 유행한 Cholera균에 대한 Antibiotics sensitivity에 관한 연구

손준용,유재근,김영한,민창홍 國立保健硏究院 1970 국립보건연구원보 Vol.7 No.-

융모성림프구를 보이는 비장변연부 림프종 1예

진한영,손창학,주영돈,박정하,이재익,조영완,이원식 인제대학교 2006 仁濟醫學 Vol.27 No.-

Splenic marginal zone lymphoma is very rare B-cell lymphoma, characterized by an indolent clinical course. Clinical features are moderate-to severe splenomegaly, absolute lymphocytosis, and bone marrow intrasinusoidal infiltration of lymphocyte. We report the case of a 37-year-old male with SMZL. He complained of LUQ pain, who had a massive splenomegaly and moderate lymphocytosis in peripheral blood. Immunophenotyping findings and morphologic findings were consistent with SMZL. He underwent splenectomy and received chemotherapy with cyclophosphamide for eight months. Now, one year later after surgery he has a nearly normal blood count with no treatment.

소아 대퇴골 간부 골절에 대한 조기 고수상 석고 고정술

이한용,유기원,정진영,손문익,김창기,강용구 대한골절학회 2003 대한골절학회지 Vol.16 No.1

목 적 : 소아 대퇴골 간부 골절의 여러 가지 치료 방법 중 조기 고수상 석고 고정술의 유용성을 알아보고자 시행하였다. 대상 및 방법 : 대퇴골 간부 골절로 1997년 1월부터 2000년 12월까지 보존적 방법으로 치료를 시행받았던 10세 미만의 소아 중 심각한 동반 손상이 없고, 추시 기간이 최소 12개월이었던 환아를 대상으로 하였다. 총 27명, 27예 이었으며, 조기 고수상 석고 고정군(조기군)이 12예, 견인 후 고수상 석고 고정군(견인군)이 15예 이었다. 두 군에 대하여 각각 수상 시 연령, 성별, 수상 기전 등의 기본 자료를 분석하였으며, 재원 기간, 견인 및 고수상 석고 고정 기간, 재원 기간 동안의 방사선 촬영횟수, 고수상 석고 고정 직후와 최종 추시 소견에서의 각 변형 및 하지 부동 등의 임상적 및 방사선학적 자료와 입원 기간 중의 총 진료비를 비교 분석하였다. 결 과 : 평균 연력은 조기군은 4.2세, 견인군은 5.3세 이었으며, 전체 연구 대상 중 남아가 24예로 88%를 차자하였고, 수상 기전은 교통사고가 20예(71%)로 가장 많았다. 재원 기간은 조기군이 평균 7.8일 이었으며, 견인군은 25.8일로 나타나 유의한 차이를 보였다. 수상 일로부터 석고 제거가지의 기간 즉 침상 안정기간은 각각 44.2일과 65.1일 이었다. 재원 기간 중 방사선 촬영 횟수는 조기군은 수상 직후 및 고정 후 각각 1회의 방사선 촬영을 하였으며, 견인군은 견인 및 정복의 정도를 파악하기 위하여 평균 6.9회의 방사선 검사를 시행하였다. 두 군 모두 최종 추시 때의 관절 운동 각도는 정상 범위에 속하였고, 고수상 석고 고정 직후와 최종 추시 소견 상 각 변형은 허용 범위 내에 있었으며, 하지 부동이 각 군에서 3예 씩 발생하였다. 총 입원 진료비는 견인군이 재원 기간의 증가로 인하여 약 2.4배의 비용이 더 필요하였다. 결 론 : 소아 대퇴골 간부 골절에 대한 조기 고수상 석고 고정술은 견인 후 고수상 석고 고정술과 비교하여 임상적 및 방사선학적 결과에서 유의한 차이가 없었으며, 재원 기간의 단축과 고정 기간의 감소를 통한 의료비 절감 및 환자 순응도를 높일 수 있었고, 방사선 촬영 횟수 감소로 소아 생식기에 대한 위험을 줄일 수 있었으므로 유용한 치료 방법이라고 판단되었다. Purpose : To evaluate an efficacy of immediate closed reduction and hip spica casting in pediatric patients with femoral shaft fractures. Materials and Methods : 27 cases of 27 pediatric patients who had seen treated conservatively for the femoral shaft fractures under 10 years of age were retrospectively reviewed. The cases with serious associated injuries were excluded. The hospital stay, duration of traction and hip spica cast, frequencies of plain radiographs, clinical and radiological outcomes at the final follow-up, and financial aspects were evaluated comparatively between the groups of immediate hip spica casting(12 cases) and traction-casting(15 cases). Results : The patients treated with immediate hip spica casting had a mean hospital stay of 7.8 days, compared with a mean of 25.8 days for those treated with traction and casting. The mean duration of immobilization were 44.2 days in the group of immediate hip spica casting, and 65.1 days in the group of traction and casting. The radiologic examinations were performed 2 times and 6.9 times respectively. The clinical and radiological outcomes at the final follow-up were good in both groups. Insignificant leg length discrepancies were seen in 3 cases each group. The total charges of traction and casting was 2.4 times higher than that of immediate hip spica casting. Conclusion : The immediate hip spica casting seems to be an effective method of treatment in femoral shaft fractures without serious associated injuries under 10 years of age because there are several advantages such as satisfactory result, shortened hospitalization and immobilization, reduction of total charges, and lowered the risk of radiologic exposures.

갑상선 유두암이 병발된 가족성 대장 용종증 1예

백종현,소창배,이은영,이지숙,신은경,박은호,서정아,양재홍,송준영,박선자,박요한,최영식 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome, typically characterized by multiple colorectal adenomas and increased incidence of colorectal carcinomas if it is not treated. Moreover, a variety of extracolonic manifestation are seen. The prevalence of thyroid tumors developing in patients with FAP is about 1∼2%. Generally, papillary thyroid cancer indicates low mortality but ,however, as people get older, the cancer becomes more aggressive. So, the operation is required. Recently we experienced a case of FAP, presenting with papillary thyroid carcinoma, and reported with a brief review of literatures.

만성 승모판 패쇄부전증 환자에서의 안지오텐신 전환효소 억제제의 장기 투여 효과

김대희,이명묵,이해영,조현재,박승정,서재빈,서정원,양한모,윤창환,조상호,이준희,김용진,김명아,손대원,오병희,박영배 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2