• Tuberculosis and Respiratory Diseases
• /
• 제48권2호
• /
• pp.246-259
• /
• 2000

연구배경: 패혈증에 의해 발병하는 ARDS의 기전은 아직까지 명확히 알려져 있지 않다. 특히 패혈증시 폐 혈관내피세포 및 제 1, 2형 폐포세포의 손상이 호중구의 respiratory burst에 따른 oxidative stress에 의한 것인지는 아직도 논란의 대상이다. 또한 이때 oxidative stress의 직접적인 원인인 산소기 생성기전도 명확하지가 않다. 본 연구에서는 패혈증에 의한 ARDS 발병기전을 $PLA_2$의 작용과 호중구의 산소기 생성을 연관시켜 알아보고자 하였다. 방 법: Sprague-Dawley종 흰쥐에서 diethylmaleate(DEM)를 이용하여 glutathione을 고갈시킨 뒤 내독소를 기도 내로 분무하여 급성 폐손상을 유발하였다. 이때 oxidative stress를 평가할 수 있는 방법들, 즉 단백누출지수, 폐세척액 내 단백함량, 폐장 내 myelo-peroxidase(MPO)의 활동도 malondialdehyde(MDA)의 측정 및 GGT의 활성도를 측정하고 동시에 oxidative stress에 관여하는 $PLA_2$의 역할을 확인하기 위하여 비특이적 $PLA_2$ 억제제인 mepacrine(50mg/kg)을 복강 내 투여한 후 폐장 내 $PLA_2$의 활성도를 측정하였다. 또한 미세구조적 변화 및 세포화학적인 방법을 통해 조직 내 산소기의 생성을 확인, 비교하여 산소기 형성에 관여하는 $PLA_2$의 역할을 규명하였다. 결 과: Diethylmaleate에 의해 폐장 내 glutathione을 고갈시킨 뒤 내독소를 투여한 흰쥐에서, 내독소는 폐장 내 현저한 조직의 손상을 유발하였고, 동시에 oxidative stress의 증가를 관찰하였다. 즉 lipid peroxidation의 증가 및 GGT 활성도의 증가를 관찰하였다. 이러한 변화들은 폐장 내 호중구 침윤의 증가 및 $PLA_2$ 활성도와 관계가 있음을 확인하였고, 미세구조적 및 세포화학적인 방법으로 조직 내의 산소기 형성의 증가도 관찰하였다. 이러한 변화들이 비특이적 $PLA_2$ 억제제인 mepacrine의 작용에 의해 감소하는 것으로 미루어 보아 $PLA_2$가 내독소에 의한 oxidative stress에 관여한다고 생각되었다. 결 론: 내독소에 의해 유발되는 급성 폐손상에서 조직손상의 원인은 호중구의 respiratory burst에 따른 oxidative stress임을 확인하였고 이때 oxidative stress에 $PLA_2$의 활성화에 따라 생성되는 지질분자가 그 원인으로 사료되었다.

• Tuberculosis and Respiratory Diseases
• /
• 제55권3호
• /
• pp.287-296
• /
• 2003

연구배경 : 익수 사고로 인한 사망은 유아기 및 청소년기에 흔히 발생하며, 전 세계적으로 사고사의 원인 중 세번째로 흔한 사인이다. 익수 환자에 대한 국내보고는 극히 드물며, 몇몇 보고가 있었으나 그 대상이 주로 소아였었고 성인에 대한 그 원인과 예후들에 대한 임상적 자료가 드물기에 성인을 대상으로 익수 손상 환자에 대한 임상적 특성을 알아보고자 하였다. 방 법 : 1990년 7월부터 2003년 3월까지 경북대학교병원 응급실로 내원한 15세 이상의 성인 익수 손상 환자 31명을 대상으로 익수 사고 및 손상 환자의 특성, 흉부방사선소견, 임상 경과 및 결과, 그리고 예후에 대한 예측 인자에 대해 의무기록지를 통해 후향적으로 조사하였다. 결 과 : 성인의 익수 손상은 20세 전후와 65세 이상의 연령에서 각각 10예 (32.3%), 7예 (22.6%)로 가장 호발하였다. 사고의 원인으로는 수영 미숙 12예 (38.7%)에 이어 음주가 10예 (32.3%)로 두번째로 많았으며, 익수 장소로는 강이 9예 (29%), 공중목욕탕이 7예 (22.6%) 순이었다. 단순흉부사진상 익수 손상에 의한 폐부종은 약 90%에서 하부쪽에 우세하게 양측성의 중심성 분포를 보였으며 10%에서는 상부에만 분포하였다. 치료 경과중 폐렴과 급성호흡곤란증후군의 호흡기 합병증이 각각 10예 (32.3%), 5예 (16.1%)로 가장 많이 발생하였으며, 17예 (54.8%)에서는 특별한 합병증이 없었다. 현장에서 소생술이 시행된 환자의 87.5%에서 회복된 것을 포함하여 25예 (80.6%)에서 신경학적인 손상 없이 회복되었고, 2예 (6.5%)에서 심각한 신경학적 손상을 남겼으며, 4예 (12.9%)는 사망하였다. 예측인자에 대한 기초 변수의 비교에서 나이, 동맥혈 가스의 산소화 지수, 그리고 의식 상태가 예후에 대한 뚜렷한 차이를 보였다. 결 론 : 65세 이상의 연령, 음주 등의 이차적인 원인과 공중목욕탕에서의 발생이 성인 익수 손상에서 상대적으로 중요하였으며, 현장에서 즉각적인 소생술 시행과 함께 적절한 호흡보조 치료로 80%이상에서 후유증 없이 회복된 결과는 성인 익수 손상 환자에서도 적극적인 심폐소생술이 시도되어야 할 것을 시사한다.

• Journal of Chest Surgery
• /
• 제24권11호
• /
• pp.1115-1124
• /
• 1991

Recently the thoracic injuries have been markedly increasing due to the vast increase of traffic accident, industrial disaster, and incidental accident as well as the frequent use of the murderous weapons including gun or rifle. Because the thoracic injuries could involve the heart, lung, and great vessels, and would influence the lives, prompt diagnosis and adequate treatment are essential. Most of thoracic injuries can be managed with the conservative treatment and simple surgical procedure such as closed thoracostomy, but certain cases require open thoracotomy to preserve lives and to return to their normal environment. The authors have analysed the result of 53 cases of open thoracotomy after thoracic injuries mainly according to the patient`s chart review. The mean age was 33.4 years old and male to female ratio was about 5: l. Injury mechanisms that elicited thoracic trauma indicated for open thoracotomy were penetrating[47%] and non-penetrating[53%] injuries. The Most common type of the thoracic lesion was hemothorax with or without pneumothorax and diaphragm rupture was the second. 58\ulcornero of thoracic injuries were accompanied by abdominal injuries and 47% by bone fractures. 34 patients were operated within 24 hours after injury and their average elapsed time was 13.6 hour. The remained patients were operated after 24 hours and their average elapsed time was 7.8 days. 71 cases of operative procedures containing some overlappings were performed: diaphragm repair[28], bleeding control[12], pulmonary and cardiac repair[4 cases] Postoperative complication rate was 32.1% and operative mortality rate was 9.4%[5/53].

• Journal of Chest Surgery
• /
• 제35권7호
• /
• pp.560-563
• /
• 2002

심흉부 수술 후에 발생하는 횡격막 신경 손상으로 인한 편측 횡격막 마비는 드물지 않게 발생하는 질환으로 증상 없이 방사선학적 비정상 소견만을 보이는 것에서 심한 폐기능 장애와, 심지어는 폐기능이 저하되어 있는 환자에서는 사망을 초래하기도 하는 질환이다. 이러한 증상이 발현된 편측 횡격막 마비시, 마비된 편측 횡격막의 주름성형술이 가장 효과적인 치료방법으로 알려져 있다. 본원에서는 천식의 병력이 있는 38세의 남자 환자의 전종격동에 발생한 종양 절제시 발생한 우측 횡격막 신경 손상에 대해 비복 신경을 이용한 횡격막 신경 재건술을 시행하여 술후 10개월째 시행한 단순 흉부 방사선 검사상 좋은 결과를 얻었기에 간략한 문헌 고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.204-207
• /
• 2014

Non-occlusive mesenteric ischemia (NOMI) encompasses all forms of mesenteric ischemia with patent mesenteric arteries. NOMI is commonly caused by decreased cardiac output resulting in hypoperfusion of peripheral mesenteric arteries. We report a case of NOMI secondary to hemorrhagic shock and rhabdomyolysis due to trauma. A 42-year-old man presented to our trauma center following a pedestrian trauma. On arrival, he was drowsy and in a state of hemorrhagic shock. He was found to have multiple fractures, both lung contusion and urethral rupture. An initial physical examination and abdominal computed tomography (CT) scan revealed no evidence of intra-abdominal injury. High doses of catecholamine were administered for initial 3 days due to unstable vital sign. On day 25 of hospitalization, follow-up abdominal CT scan demonstrated that short segment of small bowel loop was dilated and bowel wall was not enhanced. During exploratory laparotomy, necrosis of the terminal ileum with intact mesentery was detected and ileocecectomy was performed. His postoperative course was uneventful and is under rehabilitation.

• 식품보건융합연구
• /
• 제5권4호
• /
• pp.25-28
• /
• 2019

Now a days problem in health has become common. So, instead of curing them, prevention through dietary supplements has proven to be useful. In the case of patients who have already developed the disease atleast relieving pain and suffer is a challenging thing. In this context L- arginine is doing better compared to other essential aminoacids up to some extent. Arginine was found to reduce the pain associated with pulmonary hypertension foun to be associated with sickle cell anaemia. It also reduces the reperfusion injury after ischemia, trauma and shock. Some of the drugs with L-arginine as component are under clinical trials and hope to be available in the market soon. Severe preeclampsia is characterised by headaches, blurred vision, and inability to have high photovision, nausea and vomiting. L-Arginine along with Vit C and E are given as medical food to the patients and decrease in condition symptoms is the project now under phase II clinical trial. However the role of arginine in ameolirating preeclampsia symptoms is uncertain except with that of hypertension. Arginine is used to treat pain in sickle cell anaemia, lung damage, reperfusion injury, Trauma and shock but should be excluded during sepsis.

• International Journal of Advanced Culture Technology
• /
• 제7권2호
• /
• pp.13-18
• /
• 2019

Comorbidity isthe simultaneous presence of two chronic diseases or conditions in a patient. As part of a larger research study, the aims of this study were to explore comorbid conditions in intensive care unit (ICU) patients and to compare the comorbidity across different demographic groups, and to determine what comorbid health problems coexisted in the patients with hospital-acquired pressure injury (HAPI). The average number of comorbid conditions was 6.4 with range from 0-20 in the ICU patients. African American patients had significantly more comorbid health problems than other race/ethnicity groups. Asian and Hispanic female patients showed higher comorbidity than male patients across age. The patients with HAPIs had significantly more comorbid health problems than the patients without HAPIs -- the average numbers were almost two-fold. We found comorbid health problems that existed with HAPI in ICU patients. 'Other diseases of lung' and 'Disorders of fluid, electrolyte, and acid-base balance' were most frequently coexisting health problems in the ICU patients with HAPI. Exploratory plots are helpful to discover patterns or hypotheses relevant to clinical management in critical care. Inclusion of patients' comorbid health problems to ICU HAPI risk assessment may be helpful. Identification of patients at a high risk for the development of HAPI and the early preventative interventions can help reduce length of stay as well as costly complications.

• Journal of Trauma and Injury
• /
• 제35권4호
• /
• pp.232-239
• /
• 2022

Purpose: The recent increase in electric scooter (e-scooter) use has been accompanied by an increase in injuries from e-scooter-related accidents. Studies have reported that most such injuries are minor, and physicians may therefore underestimate the severity of such injuries. This study investigated the types and severity of injuries caused by isolated e-scooter accidents (i.e., those that did not involve colliding with other cars or falling from heights). Methods: This prospective observational study was conducted from May to December 2021 at Dankook University Hospital tertiary medical center. The demographic data of patients injured in isolated e-scooter-related accidents were collected. All injuries were categorized by body part. Results: Fifty eligible patients visited our emergency department during the study period. Of these, 76% were categorized as nonemergency, and 62% were discharged after initial evaluation and treatment at the emergency department. Another 10% were admitted to the intensive care unit (ICU) and 18% to the ward, with nine patients receiving at least one operation. The average hospital stays were 2.4 days in the ICU and 9 days in the ward. One death occurred due to traumatic brain injury (overall mortality rate, 2%). Multiple fractures of the left third through ninth ribs combined with lung laceration and fractures of T12 and L4 were noted. Conclusions: Various types and severities of injuries can occur in isolated e-scooter accidents. While most such injuries are minor, some will require ICU admission or surgery, and deaths can occur. Physicians should not underestimate the severity of such injuries.

• Environmental Analysis Health and Toxicology
• /
• 제31권
• /
• pp.19.1-19.7
• /
• 2016

A large portion of the Korean population has been exposed to toxic humidifier disinfectants (HDs), and considering that the majority of the victims are infants, the magnitude of the damage is expected to be considerably larger than what has currently been revealed. The current victims are voicing problems caused by various diseases, including but not limited to lung, upper respiratory tract, cardiovascular, kidney, musculoskeletal, eye, and skin diseases, etc. However, there has been difficulty in gaining validation for these health problems and identifying causal relationships due to lack of evidence proving that toxic HD is the specific causes of extrapulmonary diseases such as allergic rhinitis. Furthermore, the victims and bereaved families of the HD case have not received any support for psychological distress such as post-traumatic stress disorder, depression, feelings of injustice, and anger caused by the trauma. In addition, because the underlying mechanisms of the toxic materials within the HDs such as polyhexamethylene guanidine phosphate, poly(oxyalkylene guanidine) hydrochloride, chloromethylisothiazolinone /methylisothiazolinone have yet to be determined, the demand for information regarding the HD issue is growing. The victims of the HD cases require support that goes beyond financial aid for medical costs and living expenses. There is a desperate need for government-led integrated support centers that provide individualized support through health screenings; in other words, we need an integrated facility that provides the appropriate social support to allow the victims to recover their physical and mental health, so as to well prepare them to return to a normal life. The implementation of such a plan requires not only the close cooperation between those departments already directly involved such as the Ministry of Environment and the Ministry of Health and Welfare, but also active support on a national scale from pan-governmental consultative bodies.

• Tuberculosis and Respiratory Diseases
• /
• 제56권2호
• /
• pp.203-209
• /
• 2004

MTX는 골육종이나 진행된 비호치킨씨 임파종과 같은 종양성 질환 뿐아니라 건선이나 류마치스 관절염, 유육종증, 웨그너씨 육아종증등의 양성질환에서도 널리 쓰여지는 약물이다. MTX에 의한 폐독성은 약제를 투여받은 환자들 중 0.3-7.5%정도에서 나타나는 것으로 알려져 있다. 급성 또는 만성의 경과로 나타나는 MTX 폐렴의 예가 기술되어 있지만 전형적으로는 MTX를 투여한지 수개월내에 증상이 나타나는 아급성의 임상경과를 취하는 경우가 많다. 조직병리학적으로는 NSIP의 형태로 나타나는 경우가 가장 흔한 것으로 되어 있으나 BOOP나 DAD로 나타나는 경우도 드물게 보고되고 있으며 그 중 육아종의 형성을 보이는 예는 34.7% 정도로 알려져 있다. 우리나라에서는 NSIP나 DAD로 나타난 MTX 폐장염의 예가 보고되어있다. 저자들은 과민성 폐장염의 형태로 발현한 MTX에 의한 폐독성의 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.