• Journal of Trauma and Injury
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• 제25권4호
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• pp.247-253
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• 2012

Purpose: Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival. Methods: This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test. Results: Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not. Conclusion: The ISS was a prognostic factor for trauma patients with massive bleeding.

• Childhood Kidney Diseases
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• 제12권1호
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• pp.99-104
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• 2008

현미경적 다발성 동맥염은 폐출혈과 급속 진행성 사구체심염을 특징으로 하는 전신성 혈관염의 일종으로 소아에서는 매우 드문 질환이다. 저자들은 폐출혈과 급성 신부전을 동반한 7세 여아에서 신장조직검사와 p-ANCA 검사로 현미경적 다발성 동백염으로 진단 후 5년 뒤 2차 신장조직검사와 경구 ACE inhibitor, angiotensin II receptor blocker와 저용량의 cyclophosphamide를 투여 받은 환아를 7년간 추적관찰하였다. 발병당시에는 BUN 117 mg/dL, Cr 2.3 mg/dL이었으나, 퇴원시 BUN 20.8 mg/dL, Cr 1.6 mg/dL이었고, 최근 검사에서는 BUN 51.7 mg/dL, Cr 3.2 mg/dL으로 만성 신병증 소견을 보이고 있으며, 외래 추적 관찰 지속 중에 있다. 이에 문헌 고찰과 함께 증례 보고하는 바이다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.170-174
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• 2010

Purpose: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. Methods: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. Results: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. Conclusion: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.170-177
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• 2014

Purpose: The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center. Methods: The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013. Results: The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of ${\geq}16$. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital. Conclusion: A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.

• Tuberculosis and Respiratory Diseases
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• 제70권1호
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• pp.28-35
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• 2011

Background: The aim of the study was to describe the characteristics, treatments, and outcomes of critically ill patients with pandemic Influenza A/H1N1 2009 at a major medical center in Korea. Methods: This retrospective observational study examined critically ill adult patients with pandemic Influenza A/H1N1 2009, who were admitted to the AMC between August and December 2009. Results: 27 patients with confirmed pandemic Influenza A/H1N1 2009 were admitted to the intensive care unit (ICU) at the Asan Medical Center (AMC). The median age (IQR) was 59 years (41~67), and 66.7% of the patients were older than 51 years. A total of 81.5% of the patients had 2 or more co-morbidities. The median time (IQR) from symptom onset to presentation was 2 days (1~4), and the median time from presentation to ICU admission was 0 days (0~1.5). All patients received oseltamivir (300 mg/day) and 13 patients received triple combination therapy (oseltamivir, amantadine, ribavirin). Twelve patients required mechanical ventilation on the first day of ICU admission. A total of 6 patients (22.2%) died within 28 days of admission. The patients who died had significantly higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores at presentation. There were no significant differences in age, co-morbidities, or antiviral regimens between survivors and non-survivors. Conclusion: Critical illness related to pandemic Influenza A/H1N1 2009 was common in elderly patients with chronic co-morbidities. All patients were given high-dose oseltamivir or triple combination antiviral therapy. Nonetheless, patients with critical illnesses associated with pandemic Influenza A/H1N1 2009 had a death rate of 22.2%.

• 한국임상약학회지
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• 제12권1호
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• pp.29-38
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• 2002

Hypertension is an important public health problem because it increases the risk of stroke, angina, myocardial infarction, heart failure, and end-stage renal disease. If it is not actively treated, morbidity and mortality increase with hypertension-induced complications and quality of life decreases. This study was to evaluate the use of antihypertensive drugs and blood pressure changes and to compare algorithms chosen (or the 1st and 2nd line therapy of hypertension based on the JNC VI recommendations. The medical charts of 222 patients with essential hypertension at St. Vincent's Hospital in Suwon from January 1997 to January 2000 were reviewed retrospectively. Data collection and analysis included baseline BP underlying diseases and complications, administered antihypertensives, BP changes, changes of antihypertensive regimen, and adverse effects with treatments. As results, the higher BP the patients had, the more frequent they had target organ damages and clinical cardiovascular diseases. Mean duration to reduce blood pressure less than 140/90 mmHg was 8 weeks in $85.3\%$ of the patients. The rate of control in BP was $82.4\%$ at 6 months. The major antihypertensive drugs prescribed were calcium channel blockers $(61.8\%)$ , ACE inhibitors $(19.1\%),\;\beta-blockers\;(13.7\%)$ and diuretics $(5.3\%)$ as the 1st-line monotherapy. The methods of treatment used as the 1st-line therapy were monotherapy$(59\%)$ and combination therapy $(41\%)$. Blood pressure change was significantly greater for combination therapy than monotherapy$(-26.2\pm21.4\;vs.\;-18.56\pm16.7$ mmHg for systolic blood pressure; P<0.003, $-16.9\pm13.2\;vs.\;-9.2\pm12.8$ mmHg for diastolic blood pressure; p<0.001). When blood pressure was not completely controlled with the first antihypertensive selected, the 2nd line therapy had 4 options: addition of 2nd agent from different class; $66.2\%$, substitution with another drug, $21.9\%$ increase dose $11.9\%$ continue first regimen $27.9\%$ Calcium channel blockers were the most frequently prescribed agents. This was not comparable to the JNC VI guideline which recommended diuretics and $\beta-blockers$ for the 1st-line therapy. Most of patients achieved the goal BP and maintained it until 6 months, but the remaining patients should be controlled more tightly to improve their BP with combination of life style modification, patient education, and pharmacotherapy.

• Journal of Chest Surgery
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• 제47권3호
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• pp.255-261
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• 2014

Background: To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. Methods: We identified 103 patients (23 females; mean age, $64.1{\pm}12.3$ years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). Results: The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was $80.9%{\pm}4.3%$ and $71.7%{\pm}5.9%$, respectively. Reoperation-free survival at 5 and 10 years was $77.3%{\pm}4.8%$ and $70.2%{\pm}5.8%$. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). Conclusion: Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy.

• 한국임상수의학회지
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• 제24권2호
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• pp.208-213
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• 2007

호흡곤란과 후지마비 및 발등부위의 괴사를 나타낸 수컷 진돗개가 전북대학교 동물의료센터에 내원하였다. 초기 검사에서 심장 사상충 감염이 확인되었다. 흉부방사선 외측상에서 폐동맥의 확장과 후엽의 간질패턴, 그리고 복배상에서 주 폐동맥의 뚜렷한 확장등이 관찰되어 심장사상충증을 뒷받침하였고, 복부 외측상 및 복배상에서 복부세부음영 소실이 관찰되어 복수를 의심하였다. 초음파상에서 복수와 불규칙한 간변연 그리고 신장양극의 피질에서 쐐기모양의 국소적 고에코상을 관찰하였으며 복부대동맥에서 분지하여 주행하는 바깥장골동맥의 3상형 동맥파형이 분지부 근위에서 관찰되었으나 이 후 대퇴동맥의 파형은 확인되지 않았다. 혈액화학검사에서 백혈구증다증, 빈혈, 혈색소 뇨, 고빌리루빈혈증, 저 알부민혈증, 전해질불균형, 그리고 간장 및 신장효소치의 상승등이 관찰되어 광범위한 장기의 손상이 의심되었다. 특히 글루코스는 정상적인 전지와 마비를 보이는 후지에서 비교한 결과 후지의 글루코스 수치가 현저하게 낮았다. 전산화단층촬영술 후 3차원으로 재구성한 영상을 이용하여 후지 마비의 원인으로 여겨지는 후지 동맥의 혈전색전증과 폐동맥혈전색전증 및 신장경색 등을 확인하였다. 예후불량으로 판단되었으며 실험적 중재적 방사선술을 시도하였으나 마취에서 깨어나지 못했다. 3차원 재구성 CT 영상은 색전증의 빠르고 정확한 진단에 유용하며 효과적인 치료 계획을 수립하는데도 큰 도움이 된다고 판단된다.

• 한국임상수의학회지
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• 제28권5호
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• pp.473-478
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• 2011

이 연구는 개에서 isoflurane을 이용한 전신마취 하에 개복술시 아스코르빈산 (AA)의 항산화 효과를 평가하였다. 12마리의 개를 아스코르빈산 그룹 (AAG) 또는 sham 그룹 (SG)으로 무작위 배정하였다. AAG는 마취 10분 전 에 표준 아스코르빈산의 100 mg/animal 복용량을 정맥주사하였다. 혈장에 있는 코티졸, 포도당, total oxidant status (TOS), total antioxidant status (TAS)와 oxidative stress index (OSI)를 측정하였다. 코티졸 수치는 두 그룹에서 시간이 지남에 따라 유의성있게 증가하였다 (p < 0.05). 포도당 수치의 변화는 두 그룹 사이에 유의성이 없었다. TOS와 OSI는 SG에서 시간이 지남에 따라 유의성 있게 증가하였다 (p < 0.05). 그런데 AAG에서는 유의성있는 변화가 없었다. 그리고, AAG의 TOS와 OSI는 SG에서 보다 더 유의성 있게 낮았다 (p < 0.05). 그러나 TAS는 두 그룹 사이에 유 의성이 있는 변화가 없었다. 이런 결과는 AAG에서 TOS 감소가 항산화제에서 산화제로의 변환과 관련 있음을 예측 해 볼 수 있게 한다. OSI 감소는 손상부위에 발생한 활성산소 (ROS, 즉 산화 스트레스)의 감소가 혈액순환 이상, 기관 부전 및 염증의 수술 부작용을 줄일 수 있다는 것을 의미한다. 그러므로, AA는 개의 개복술에서 산화 스트레스로부터 수술환자를 보호하기 위하여 사용될 수 있다.

• 한국의료질향상학회지
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• 제27권2호
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• pp.18-29
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• 2021

Purpose: Patients with hematologic malignancy (HM) typically have a high mortality rate when their condition deteriorates. The chronic progressive course of the disease makes it difficult to assess the effect of intervention on acute events. We investigated the effectiveness of a rapid response team (RRT) on in-hospital mortality in patients with HM. Methods: We retrospectively analyzed the data of patients with HM who admitted to the medical intensive care unit between 2006 and 2015. Clinical outcomes before and after RRT implementation were evaluated. Results: A total of 228 patients in the pre-RRT period and 781 patients in the post-RRT period were included. The overall in-hospital mortality was 55.4%. Patients in the post-RRT period had improved survival; however, they required more vasopressor therapy, continuous renal replacement therapy, and extracorporeal membrane oxygenation. Multivariate analysis revealed that in-hospital mortality was associated with RRT activation (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.498-0.807; p < .001), neurological disease (HR, 2.007; 95% CI, 1.439-2.800; p < .001), sequential organ failure assessment score (HR, 1.085; 95% CI, 1.057-1.112; p < .001), need for continuous renal replacement therapy (HR, 1.608; 95% CI, 1.206-1.895; p< .001), mechanical ventilation (HR, 1.512; 95% CI, 1.206-1.895; p< .001), vasopressor (HR, 1.598; 95% CI, 1.105-2.311; p = .013), and extracorporeal membrane oxygenation (HR, 1.728; 95% CI, 1.105-2.311; p = .030). Conclusion: RRT activation may be associated with improved survival in patients with HM.