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급성 췌장염의 예후 평가를 위한 복부 전산화 단층 촬영과 C-Reactive Protein의 유용성
유연호,박정수,박성수,박정규,정성필,김승환,유인술 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.3
P u r p o s e: An early prediction of the prognosis is essential for proper management of acute pancreatitis. The Ranson criteria, a classic prognostic marker, are known not to provide relevant information, especially in an acute setting. The purpose of this study was to evaluate the usefulness of creactive protein (CRP) and CT scan as prognostic indicators in patients of acute pancreatitis. M e t h o d s: Patients who were diagnosed with acute pancreatitis from January 2002 to December 2003 were enrolled in this study. The patients underwent abdominal CT scans, and their CT findings were classified as normal, pancreatic enlargement, peripancreatic fat infiltration, single peripancreatic fluid collection, and two or more fluid collections or retroperitoneal air. The CRP results were classified as < 0.3 mg/dL, 0.3-15 mg/dL, and > 15 mg/dL. The outcome was evaluated by using the mortality and the number of organ failures. R e s u l t s: Among the 188 enrolled patients, 6 were died. The CRP level and the CT severity index were significantly lower in the survival group. The number of organ failures was significantly higher when two or more fluid collections were found in the CT and when the CRP level was higher than 15 mg/dL. The most useful indicator to predict death was the CT-CRP determined by using a ROC curve analys i s . C o n c l u s i o n: This study suggests that CT-CRP may be used as a prognostic indicator of acute pancreatitis in the emergency department.
유연호,김희덕,김현,최상천,김기운 대한의사협회 2014 대한의사협회지 Vol.57 No.7
Hyperbaric oxygen therapy (HBOT) is approved in the United States for 14 accepted indications, which are approvedby the HBOT committee of the Undersea and Hyperbaric Medical Society and by the Food and Drug Administration. These indications are also used worldwide. HBOT is a mode of medical treatment in which the patient is situated inan enclosed pressure chamber and breathes 100% oxygen at a pressure greater than 1 atmosphere absolute (ATA),with the usual therapeutic pressure set at greater than 1.4 ATA. In South Korea, an expanded knowledge base andformalized education in HBOT do not exist, and numerous HBOT devices are old and nearing the cessation of operation,although HBOT has undergone refinement, with an increased understanding of mechanisms of action and clinicalapplications. Furthermore, there is no specific board certification of HBO competence for emergency, critical care, andsurgical physicians and technicians in South Korea. We summarize the existing literature on the uses of HBO with theaim of enhancing the understanding of this therapeutic technique.
충수염 의심 환자에서 Alvarado 점수를 이용한 복부 전산화 단층 촬영의 적응증
유연호,박정수,박성수,박정규,김승환,정성필,유인술 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1
P u r p o s e: Although several diagnostic techniques have been introduced to evaluate appendicitis, no guidelines exists to determine which patients would benefit from these techniques. For that reason, we designed this study to use the Alvarado score to find the subgroup of patients that require CT scans. M e t h o d s: We evaluated the medical records of patients who presented with non-traumatic right lower abdominal pain from Mar to Sep 2003. According to the initial Alvarado score, the patients were divided in a high score group and a low score group. The differences in the diagnostic accuracy were compared for each group according to the CT scan when the reference Alvarado score (AS) was changed. R e s u l t s: Among two hundred patients, 106 underwent a CT scan. Of those 200 patients, 42 were in the high score group, and 158 were in the low score group, when the cutoff AS was 7. The diagnostic accuracy did not differ in the high score group according to the CT scan. However, a significant difference existed in the low score group and in the high score group (97% vs 80%). The difference in the diagnostic accuracy was greatest at a cutoff AS of 5. C o n c l u s i o n: This study suggests that a CT scan should be recommended for patients with right lower quadrant abdominal pain when the Alvarado score is less than or equal to 5.
유연호,박성수,박정규,박정수,정성필 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3
The occurrence of acute ischemic stroke in childhood is rare. The etilogy of childhood ischemic stroke is different from that of an adult, and coagulation abnormalities are suspected to be related. Protein S is a vitamin-K-dependent plasma protein that inhibits the coagulation system by serving as a cofactor for activated protein C, and the clinical manifestations of its deficiency are virtually identical to those of protein C deficiency. We reported the case of a child who presented with right side weakness and who was diagnosed as having a cerebral infarction associated with protein S deficiency as the cause of stroke.
부식제 이외의 음독 환자에서 상부 위장관의 내시경 소견
유연호,박정규,이장영,민진홍,정성필,김승환,유인술,김종선 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.6
P u r p o s e: There have been few studies of the direct effect of a drug overdose on the gastrointestinal (GI) mucosa. This study evaluated the frequency of GI mucosal injury and the necessity for esophagogastroduodenoscopy (EGD) in patients with non-caustic drug ingestion (DI). M e t h o d s: Patients who presented to the emergency department with non-caustic DI from January 2001 to December 2003 were enrolled in this study. EGD was performed on the patients after acute toxicologic management. Those who did not consent to EGD were excluded. The EGD findings were analyzed according to the non-caustic drug that had been ingested. R e s u l t s: Among the 37 patients, 24 (65%) had significant endoscopic lesions. Endoscopic findings were gastric erosion (n=17), ulcers (n=5), esophageal erosion (n=1), and a gastric hemorrhage (n=1). Pesticides, rodenticides, salicylates, and high dose doxylamine (>5 g) were associated with drug-induced gastropathy. C o n c l u s i o n: This study suggests that GI mucosal injury has been underestimated in DI patients and that a treatment for gastromucosal protection should be performed when the non-caustic ingested drug is a pesticides, a rodenticides, a salicylates or high-dose doxylamine.
유연호,정상민,조용철,유승,이진웅,김승환,유인술 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.5
Purpose: We evaluated the safety of bolus infusion through intraosseous access using the EZ-IO in adults in terms of extraosseous flow. Methods: We conducted a prospective study of adults (over age 18) in whom intraosseous access through the tibia was performed by emergency physicians or residents from June 2010 to June 2011. We used ultrasonography to confirm extraosseous flow during infusion of 80 mL normal saline with a 4 mL/s flow rate through intraosseous access,immediately after confirmation of intraosseous needle insertion using conventional methods. Finally, we recorded any complications that occurred immediately in the area of intraosseous access. Results: Of 30 patients enrolled in the study, 22(73.3%)were male and eight (26.7%) were female. The mean age of study participants was 62.78±15.68 years; mean cortical thickness of participants’ tibias was 0.27±0.03 cm. The mean time required for performance of the intraosseous access procedure was 16.00±4.65 s; success rate on the first attempt, 100.0%. No immediate complications, including swelling or extraosseous flow at the area of intraosseous access, were observed. Conclusion: In this study, bolus infusion though intraosseous access using the EZ-IO in adults in emergency departments was a safe option in terms of extraosseous flow.