• Journal of Chest Surgery
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• 제29권3호
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• pp.303-310
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• 1996

1994년 12월부터 1995년 4월까지 서울대학교병원 소아흉부외과에서 개심술을 시행받는 95명의 환아 들을 무작위로 아프로티닌을 쓴 환아군(n=47)과 쓰지않은 환아군(n=48)으로 분류하여 아프로티닌의 효과에 대하여 연구하였다. 아프로티닌은 50,000K/U/kg를 인공심폐기의 충전용액에 단일 투여하였다. 술전, 마취후 5분, 심폐기 관류 5분후, 심폐기 관류 35분후, 재관류 5분후, 재관류 3시간후 및 24시간후에 혈액을 채 취하여 헤모글로빈, 헤마토크릿, BUW, creatinine, 섬유소원, 전해질 농도, 활성 응고시간, 프 로트롬빈 시간, 제3항 트롬빈 등을 측정하였다. 또한 술후 24시간 동안 흥관을 통한 배액 양, 수혈 혈액의 양을 체중으로 나누어 비교하였다. 두 환자군간에 술후 24시간 동안 수혈한 충전 적혈구 양을 제외한 다른 모든 검사에서 통계 학적 의의는 없었으나 아프로티닌의 부작용은 발견되지 않았고 출혈로 인한 재수술도 없었다.

• 한국양식학회지
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• 제17권1호
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• pp.46-50
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• 2004

In the present study, attempts were made to cryopreserve sea urchin, Anthocidaris crassispina sperm in liquid nitrogen, to evaluate the effects of various cryoprotectants and freezing rates on motility, survival rate and fertilization rate of the post-thawing sperm, and the ultrastructural changes of sperm after cryopreservation were observed. The highest values of sperm motility (motility index: 3.3$\pm$0.37) and survival rate (72$\pm$3.5%) were obtained with 15% dimethyl sulfoxide (DMSO), and these values were significantly higher than those of sperm preserved with glycerol. Comparisons of motilities and survival rates between treatments of difference freezing rates showed that there was no difference between procedures (a) 5$0^{\circ}C$/min to -8$0^{\circ}C$ (motility index: 3.3$\pm$0.31 ; survival late 70$\pm$2.7%) and (b) 3$0^{\circ}C$/min to -8$0^{\circ}C$ (motility index: 3.1$\pm$0.29; survival rate 69$\pm$3.7%), while the results of (c) 1$0^{\circ}C$/min to -8$0^{\circ}C$ were significantly lower than the others (motility index: 2.2$\pm$0.33 ; survival rate 42$\pm$4.6%). There was no significant difference in fertilization rate between fresh sperm and sperm preserved with 15% DMSO as cryoprotectant and freezing rate (3$0^{\circ}C$/min to -8$0^{\circ}C$). Some ultrastructural changes of sperm, such as the detachment of plasma membrane, the destruction of mitochondria, and the flagellum rolling up head, were observed after cryopreservation. Morphological normality of the sperm in 15% DMSO frozen at the ratio of 5$0^{\circ}C$/min to -8$0^{\circ}C$ was better than the others.

• Clinical and Experimental Pediatrics
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• 제58권3호
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• pp.112-115
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• 2015

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.299-304
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• 2021

Atypical hemolytic uremic syndrome (aHUS) is a rare, progressive, life-threatening condition of thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and renal impairment. The mechanisms underlying aHUS remain unclear. Herein, we present the first case in the literature of aHUS after a traumatic injury. A 55-year-old male visited the emergency department after a traumatic injury caused by a tree limb. Abdominal computed tomography revealed a rectal wall defect with significant air density in the perirectal space and preperitoneum, implying rectal perforation. Due to the absence of intraperitoneal intestinal perforation, we performed diverting sigmoid loop colostomy. An additional intermittent simple repair was performed due to perianal and anal injuries. One day postoperatively, his urine output abruptly decreased and serum creatinine level increased. His platelet level decreased, and a spiking fever occurred after 2 days. The patient was diagnosed with acute renal failure secondary to aHUS and was treated with fresh frozen plasma replacement. Continuous renal replacement therapy (CRRT) was also started for oliguria and uremic symptoms. The patient received CRRT for 3 days and intermittent hemodialysis thereafter. After hemodialysis and subsequent supportive treatment, his urine output and renal function improved. The hemolytic anemia and thrombocytopenia also gradually improved. Dialysis was terminated on day 22 of admission and the patient was discharged after recovery. This case suggests that that a traumatic event can trigger aHUS, which should be considered in patients who have thrombocytopenia and acute renal failure with microangiopathic hemolytic anemia. Early diagnosis and appropriate management are critical for favorable outcomes.

• 대한소아치과학회지
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• 제37권2호
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• pp.207-212
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• 2010

단백 C 결핍증은 항응고인자인 단백 C의 결핍으로 혈전 색전증의 위험성이 높다. 선천성 단백 C 결핍증 중 동형접합성 단백 C 결핍증은 단백 C의 활성도가 측정되지 않을 정도로 낮고 1/25만~50만의 발생 빈도를 가지는 희귀한 질환이다. 동형접합성 단백 C 결핍증의 주요 증상은 자반성 및 괴사성 피부 병변, 반상출혈, 실명, 중추신경계의 혈전증 등이다. 본 증례는 동형접합성 단백 C 결핍증인 만 4세 여아로 치아의 전반적인 우식을 주소로 내원하였다. 본 환아는 와파린 복용 중이었고 치과치료시 합병증의 예방을 위해 소아청소년과에 협진 의뢰하였다. 와파린 복용 중단 시 혈전으로 인한 심각한 합병증이 예상되어 와파린을 적절하게 (INR 3~5) 복용하되 치과 치료 중 과다 출혈 시 신선냉동혈장으로 조절할 것을 권고받았다. 이 환아는 실명을 동반한 중증 장애 아이로 행동조절이 어려웠고 과다 출혈시 신속한 처치가 가능하도록 하기 위해 전신마취 하에 치과치료를 시행하였다. 저자는 치아의 전반적인 우식을 주소로 내원한 만 4세 단백 C 결핍 환아에 대하여 전신마취 하 치과치료를 시행하였으며 다소의 지견을 얻었기에 보고하는 바이다.

• 대한장애인치과학회지
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• 제4권2호
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• pp.73-76
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• 2008

만 1세의 남아가 입에서 피가 계속 난다는 주소로 본과에 내원하였으며 지혈을 위해 봉합술을 시행하였다. 수일 후 다시 출혈 양상이 관찰되어 혈액종양과 협진 의뢰 및 임상 병리검사를 시행하여 경증의 혈우병 A 로 진단하였고 FFP를 투여하여 최종 지혈을 얻었다. 경증의 혈우병은 치과 외상을 통해 처음 발견되는 경우가 종종 있기 때문에 출혈이 지속되거나 수일 후 재발되는 경우에는 혈액 관련 전문가에게 의뢰하고 병리 검사를 시행하는 것이 바람직하다.

• Journal of Trauma and Injury
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• 제33권2호
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• pp.74-80
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• 2020

Purpose: This study was conducted to investigate whether rapid and efficient administration of blood products was achieved and whether clinical outcomes were improved by applying a massive transfusion protocol (MTP). Methods: From January 2016 to September 2019, the medical records of trauma patients who received at least 10 units of packed red blood cells (PRBC) at Pusan National University Hospital (level I trauma center) were retrospectively reviewed. The patients treated from January 2016 to January 2018 were designated as the non-MTP group, and those treated from February 2018 to September 2019 were designated as the MTP group. Results: During the study period, 370 patients received massive transfusions. The non-MTP and MTP groups comprised 84 and 55 patients, respectively. No significant between-group differences were found in the units of PRBC (23.2 vs. 25.3, respectively; p=0.46), fresh frozen plasma (FFP) (21.1 vs. 24.4, respectively; p=0.40), and platelets (PLT) (15.4 vs. 17.0, respectively; p=0.54) administered in the first 24 hours. No statistically significant differences between the non-MTP and MTP groups were found in the FFP-to-PRBC ratio (0.9 vs. 0.94, respectively; p=0.44) and or the PLT-to-PRBC ratio (0.72 vs. 0.72, respectively; p=0.21). However, the total number of cryoprecipitate units was significantly higher in the MTP group than in the non-MTP group (7.4 vs. 15.3 units, respectively; p=0.003) and the ratio of cryoprecipitate to PRBC in the MTP group was significantly higher than in the non-MTP group (0.31 vs. 0.62, respectively; p=0.021). The time to transfusion was significantly reduced after MTP implementation (41.0 vs. 14.9 minutes, respectively; p=0.003). Conclusions: Although no significant differences were found in the clinical outcomes of patients who had undergone severe trauma, rapid and balanced transfusion was achieved after implementing the MTP.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.512-515
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• 2009

Purpose: Neurofibromatosis(NF) is an autosomal - dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop - shaped ligation before removal of the giant NF in both buttocks. And then we could successfully reduce the amount of hemorrhage during the operation. Methods: A 46 - year - old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about $30{\times}20cm$ in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop - shaped suture ligation(weaving the thread up and down in a loop - shaped pattern, leaving a space of 2 cm between each loop) with a straight needle and prolene 2 - 0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged - shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop - shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. Results: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscense did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow - up, the functional and cosmetic result was excellent. Conclusion: A continuous loop - shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.

• 대한수혈학회지
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• 제29권3호
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• pp.253-261
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• 2018

배경: 대량수혈은 혈액은행의 상당한 집중을 요하게 된다. 이 연구의 목적은 아주대병원의 대량 수혈에 사용된 혈액제제와 외상센터에서 응급환자들을 위하여 직접 사용되었던 O형 Rh 양성농축적혈구를(이하 O형 혈액) 분석하고자 하였다. 방법: 대량수혈은 24시간 이내 10 단위 이상의 적혈구제제를 수혈 받은 것으로 정의하였다. 수혈을 포함한 진료 기록은 병원정보시스템에서 추출하여 검토하였다. 병원정보시스템을 통하여 2016년 3월부터 2017년 11월까지 출고된 총 적혈구제제, 신선동결혈장, 혈소판제제(성분채집혈소판 혹은 농축혈소판)에 대한 정보를 검토하였다. 한 단위의 성분채집혈소판은 6 단위의 농축혈소판과 동일한 것으로 간주하였다. 결과: 345건의 대량수혈이 발생하였으며, 적혈구제제 11.7% (6233/53268), 신선동결혈장 24.3% (4717/19376), 그리고 혈소판제제 4.8% (4473/94166)가 대량수혈에 사용되었다(P<0.001). 대량수혈과 비대량수혈에 사용된 적혈구제제의 혈액형은 각각 A형 28.0%와 34.1%, B형 27.1%와 26.0%, O형 37.3%와 29.7% 그리고 AB형 7.5%와 10.2%였다(P<0.001). 적혈구제제:신선동결혈장:혈소판제제의 비율은 대량수혈은 1:0.76:0.72인 반면, 비대량수혈은 1:0.31:1.91을 나타내었다. 응급 O형 혈액은 461 단위가 대량수혈 환자의 36.2% (125/34)에서 사용되었으며, 한 환자당 사용된 응급 O형 혈액은 1~18단위까지 다양하였다. 결론: O형 적혈구는 대량수혈시 많이 이용되므로 대량수혈시 응급 O형 혈액의 남용을 최소화하기 위한 의료진들의 지속적인 교육이 필요하다. 신선동결혈장도 대량수혈시 자주 사용되므로 대량수혈시 즉시 가용할 수 있는 혈장 해동에 대한 수기를 갖추는 것이 중요할 것으로 여겨진다.