응급실 기반 약물에 의한 아나필락시스 쇼크 환자의 임상적 특성

한상근,안력,김선휴,최승원,홍은석,Han, Sang-Guen,Ahn, Ryeok,Kim, Sun-Hyu,Choe, Seung-Won,Hong, Seung-Won 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: This study was conducted to investigate the characteristics of drug induced anaphylactis and anaphylactic shock in patients who were admitted to the emergency department Methods: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. Results: The mean age of the study subjects was $47.9P{\pm}14.2$ years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group ($51.5{\pm}15.1$ vs $42.5{\pm}10.6$, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. Conclusion: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.

불안정성 골반골 골절 손상에서 동반 복부 고형장기 손상의 임상적 특성

이상원 ( Sang Won Lee ),김선휴 ( Sun Hyu Kim ),홍은석 ( Eun Seog Hong ),안력 ( Ryeok Ahn ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.1

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intraabdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types Ⅱ and Ⅲ, antero-posterior compression types Ⅱ and Ⅲ, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale(AIS), injury severity score(ISS), amount of transfusion, admission to the intensive care unit(ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries. (J Korean Soc Traumatol 2012;25:1-6)

둔상 후 복부 전산화단층촬영에서 조영제 유출로 동맥색전술을 시행받은 환자의 복강내와 후복막강/골반강내 출혈 비교

윤지영 ( Ji Young Yoon ),김선휴 ( Sun Hyu Kim ),안력 ( Ryeok Ahn ),황재철 ( Jae Cheol Hwang ),홍은석 ( Eun Seog Hong ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. Methods: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. Results: The mean age of the study subjects was 40.2±2.6 years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. Conclusion: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group. (J Korean Soc Traumatol 2009;22:199-205)

골반골 골절로 인한 동맥 파열로 동맥 색전술을 시행받은 환자에서의 생존 비교

김우연 ( Woo Youn Kim ),홍은석 ( Eun Seok Hong ),홍정석 ( Jung Seok Hong ),안력 ( Ryeok Ahn ),황재철 ( Jae Cheol Hwang ),김선휴 ( Sun Hyu Kim ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1

Purpose: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. Methods: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. Results: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (±0.20) vs 7.30 (±0.08), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group (24.1±12.5 vs 14.4±6.8, p=0.046). Conclusion: No differences in initial blood pressure and trauma scores existed between survivors and non-survivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

복부 고형장기 손상을 동반한 안정 골반골 골절의 특성

박상준 ( Sang June Park ),김선휴 ( Sun Hyu Kim ),이종화 ( Jong Hwa Lee ),안력 ( Ryeok Ahn ),홍은석 ( Eun Seog Hong ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young`s classification is defined as a lateral compression type Ⅰ and antero-posterior compression type Ⅰ. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries. (J Korean Soc Traumatol 2010;23:57-62)

6미터 이하 저고도 추락 환자의 안전성 여부

서영우 ( Young Woo Seo ),홍정석 ( Jung Seok Hong ),김우연 ( Woo Yun Kim ),안력 ( Ryeok Ahn ),홍은석 ( Eun Seok Hong ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1

Purpose: The committee on trauma of the american college of surgeons, in its manual resources for optimal care of the injured patients involved in falls from less than 20 feet need not be taken to trauma centers. Because triage criteria dictate less urgency for low-level falls, this classification scheme has demerits for early detection and treatment of serious problems in the emergency room. Methods: A prospective analysis was conducted of 182 patients treated for fall-related trauma from June 2003 to March 2004. Falls were classified as group A (<3 m), group B (≥3 m, <6 m), and group C (≥6 m). Collected data included the patient`s age, gender, site and height of fall, surface fallen upon, body area of first impact, body regions of injuries, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS). Results: The 182 patients were classified as group A (105) 57.7%, group B (61) 33.5%, and group C (16) 8.8%. There was a weak positive correlation between the height of fall and the patients` ISS in the three groups (p<0.001). There were significant differences in GCS (p=0.017), RTS (p=0.034), and ISS (p=0.007) between group A and B. In cases that the head was the initial impact area of the body, the GCS (p<0.001) and the RTS (p=0.002) were lower, but the ISS (p<0.001) was higher than it was for other type of injuries. Hard surfaces as an impact surface type, had an influence on the GCS (p<0.001) and the ISS (p=0.025). Conclusion: To simply categorize patients who fall over 6 meters as severely injured patients doesn`t have much meaning, and though patients may have fallen less than 6 meters, they should be categorized by using the dynamics (impact surface type, initial body - impact area) of their fall. (K Korean Soc Traumatol 2006;19:54-58)

원발성 중추신경계 혈관염 1례 : A Case Presentation

안지윤,김원,윤재철,김원영,안력,박윤경,임경수 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Primary angiitis of the central nervous system (PACNS) is a rare idiopathic disorder with recurrent vasculitis restricted to the central nervous system (CNS) and involves small-sized (and at time medium-sized) blood vessels. The typical clinical manifestations include multifocal strokes or encephalopathy, often associated with severe headaches. There are very few pediatric cases with PACNS reported in the literature. The diagnosis of PACNS is mainly based on its clinical features, demonstration of angiitis on angiography or biopsy, and exclusion of secondary causes of angiitis. A high index of suspicion is necessary for the diagnosis. Though the prognosis is generally poor, use of steroids and immunosuppressive therapy has been useful in achieving successful remission in many patients. We report the case of a patient with PACNS presenting recurrent headaches for 5 days.

양 하지의 근력저하를 주소로 응급실로 내원한 원발성 알도스테로증 1예

안력,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

A primary central nervous system lymphoma(PCNSL) is defined as a lymphoma limited to the cranial-spinal axis without systemic involvement. PCNSLs were formerly very rare, only 0.5∼ 1.2% of all intracranial neoplasms, and were usually associated with acquired immuno-deficiency syndrome(AIDS) and other immune-compromised states. Recently, there has been a clear rise in the incidence of this disease among normal individuals. We describe a 77-year-old female with hyponatremia who presented with a confused mental state. Computed tomography(CT) of the brain demonstrated a suprasellar mass with enhancement. We evaluated the basic hormonal studies and the magnetic resonance imaging(MRI). A ventricular biopsy was done, and the result was a diffuse, large, B-cell-type malignant lymphoma. She presented panhypopituitarism and partial central diabetes insipidus. She received chemotheraphy and was discharged in an improved condition. We report a case of panhypopituitarism due to PCNSL and give a review of the literature.