• Clinical and Experimental Pediatrics
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• 제50권12호
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• pp.1225-1230
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• 2007

목 적 : 만성 빈혈로 대량 수혈을 받아야 하는 환아들에서는 조직과 장기에 철이 축적될 수 있다. 이러한 환아들에서 효과적인 철킬레이트 치료의 목적은 충분한 양의 철을 제거하여 체내에서 철로 인한 장기 손상이 나타나지 않도록 하는데 있다. 본 연구는 후향적으로 대량 수혈을 받은 환아들에서 정맥 투여한 deferoxamine의 효과를 알아보고자 하였다. 방 법 : 2005년 3월부터 2007년 1월까지 15명의 대량 수혈을 받았던 환아들을 대상으로 하였으며 이들 중 수혈 의존성 환아들은 한 달에 1단위 이상의 농축 적혈구 수혈을 최근 6개월 이상 계속 받고 있는 환아들로 정의하였다. 7일 동안 deferoxamine을 10-30 mg/kg/day로 24시간 지속 정맥주입하였으며 투여 전, 후 그리고 3개월 후의 혈청 철, 총철결합능, ferritin을 수혈 의존성 환아들과 수혈 비의존성 환아들로 나누어 비교하였다. 결 과 : 6명의 남아와 9명의 여아가 있었으며 이들의 나이는 5.6-21.3(중앙값 8.3)세였고 수혈 의존성 환아들은 7명, 수혈 비의존성 환아들은 8명이었다. 수혈 의존성 환아들의 ferritin은 deferoxamine 투여 전과 후, 3개월 후에 의미 있는 차이를 보이지 않았으나 수혈 비의존성 환아들에서는 투여 전과 비교 시 투여 3개월 후에는 의미 있는 감소를 보였다(P=0.046). Deferoxamine 정맥주입과 연관된 이상 반응은 경미하였으며 1-2일 내에 소실되었다. 결 론 : 7일 동안 정맥주입하는 deferoxamine은 수혈 비의존성 환아들에서 단기간의 효과적인 치료로 사용될 수 있을 것으로 생각되지만 수혈 의존성 환아들의 경우에는 철의 축적을 막기 위해 유지 요법이 필요할 것으로 생각된다.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.1-12
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• 2020

Purpose: Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent. Methods: Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Results: Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80-90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100-110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient's initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C). Conclusions: This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

• Journal of Trauma and Injury
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• 제34권1호
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• pp.44-49
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• 2021

Purpose: The aim of this study was to elucidate the prognosis, and other clinical features, such as time to surgery and the amount of transfusion, of small bowel injury (SBI) accompanied by liver injury (LI). Methods: We investigated 221 patients with SBI who visited an emergency center from October 2000 to March 2019. We excluded patients with injuries that directly led to mortality, and the remaining 149 patients were divided into the SBI alone (SBI-A) group and the SBI accompanied by LI (SBI-LI) group. Data were collected for preoperative and surgical outcome variables, and the treatment results were compared between groups. Results: The SBI-LI group had a higher mortality rate than the SBI-A group (22.4% vs. 14.3%), but this difference was not statistically significant (p=0.061). There were no significant differences between the SBI-A and SBI-LI groups, except for the amount of red blood cell (RBC) transfusion (SBI-A: 3.53±0.1 vs. SBI-LI: 8.38±0.7 packs, p=0.035) and the length of intensive care unit (ICU) stay (SBI-A: 6.7±0.2 vs. SBI-LI: 11.1±0.5 days, p=0.047). Conclusions: The SBI-LI group required more RBC transfusions and longer ICU stays than the SBI-A group. SBI accompanied by LI may show higher mortality than SBI alone; however, since the difference was not statistically significant in the present study, larger-scale follow-up research is needed.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.329-336
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• 2023

Purpose: In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality. Methods: Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18-64 years), group B (65-79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death. Results: The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death. Conclusions: For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.

• 대한정형외과학회지
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• 제56권2호
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• pp.142-149
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• 2021

목적: 일차 슬관절 전치환술을 받은 환자들에게서 트라넥삼산의 효능을 확인하고, 트라넥삼산의 정맥 내 사용 방법과 관절 내 투여 군을 비교하여 어떤 방법이 혈액 손실 감소 효과가 더 있는지 알아보고자 하였다. 대상 및 방법: 이 연구는 광주보훈병원에서 2017년 3월부터 2019년 2월까지 일차 슬관절 전치환술을 받은 환자들에 대한 후향적 연구이다. 단측 일차 슬관절 전치환술을 시행 받은 총 210명의 환자가 연구에 포함되었다. 트라넥삼산 사용 방법에 따라 각각 70명의 환자들에 대해 3개의 그룹으로 나누었다(Group I: 정맥 내 투여 군, Group II: 관절 내 투여 군, Group III: 트라넥삼산을 사용하지 않은 군). 그룹 간 수술 후 총 실혈량, 헤모글로빈 감소치, 수혈 단위를 비교하였다. 결과: 총 실혈량은 관절 내 투여 군(1,136±339 ml) 및 트라넥삼산을 사용하지 않은 군(1,366±866 ml)보다 정맥 내 사용 군(987±449 ml)에서 더 낮았다(p=0.004). 수술 후 헤모글로빈의 손실 또한 정맥 내 사용 군(1.8 g/dl)에서 관절 내 투여 군(2.9 g/dl)이나 투여하지 않은 군(3.5 g/dl)보다 현저히 낮았다(p<0.01). 수혈 빈도는 트라넥삼산을 사용하지 않은 그룹(5.7%)에서 더 높았으며 정맥 내 사용 시 1.4%를 보이고, 관절 내 투여한 군에서 수혈을 받은 환자는 없었다. 혈전색전증의 발생 빈도는 그룹 간 통계적으로 유의하지 않았다. 결론: 일차 슬관절 전치환술 시행 시 트라넥삼산을 사용한 환자 군에서 사용한지 않은 군에 비해 총 실혈량을 유의하게 감소시켰고, 관절 내 투여보다는 정맥 내로 투여하는 것이 더 효과적이었다. 정맥 내 투여로 인한 합병증은 관절 내 투여 및 트라넥삼산을 사용하지 않은 군과 비교해 유의한 차이는 없었다.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.315-324
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• 2023

Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords "free tissue transfer," "free flap," or "microsurgery" and "sickle cell" on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

• 대한치과마취과학회지
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• 제2권2호
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• pp.114-117
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• 2002

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

• Clinical and Experimental Pediatrics
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• 제54권9호
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• pp.368-372
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• 2011

Necrotizing enterocolitis (NEC) is one of the most critical morbidities in preterm infants. The incidence of NEC is 7% in very-low-birthweight infants, and its mortality is 15 to 30%. Infants who survive NEC have various complications, such as nosocomial infection, malnutrition, growth failure, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental delays. The most important etiology in the pathogenesis of NEC is structural and immunological intestinal immaturity. In preterm infants with immature gastrointestinal tracts, development of NEC may be associated with a variety of factors, such as colonization with pathogenic bacteria, secondary ischemia, genetic polymorphisms conferring NEC susceptibility, anemia with red blood cell transfusion, and sensitization to cow milk proteins. To date, a variety of preventive strategies has been accepted or attempted in clinical practice with regard to the pathogenesis of NEC. These strategies include the use of breast feeding, various feeding strategies, probiotics, prebiotics, glutamine and arginine, and lactoferrin. There is substantial evidence for the efficacy of breast feeding and the use of probiotics in infants with birth weights above 1,000 g, and these strategies are commonly used in clinical practice. Other preventive strategies, however, require further research to establish their effect on NEC.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권2호
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• pp.134-137
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• 2017

Gastric hemangioma in the neonatal period is a very rare cause of upper gastrointestinal bleeding. We present a case of hemangioma limited to the gastric cavity in a 10-day-old infant. A huge, erythematous mass with bleeding was observed on the lesser curvature side of the upper part of the stomach. Surgical resection was ruled out because the location of the lesion was too close to the gastroesophageal junction. Medical treatment with intravenous $H_2$ blockers, octreotide, packed red blood cell infusions, local epinephrine injection at the lesion site, application of hemoclip, and gel-form embolization of the left gastric artery did not significantly alter the transfusion requirement. Hemostasis was achieved with endoscopic argon plasma coagulation (APC). After two sessions of APC, complete removal of the lesion was achieved. APC was a simple, safe and effective tool for hemostasis and the ablation of gastric hemangioma without significant complications.

• 대한한의학회지
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• 제37권2호
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• pp.104-109
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• 2016

Objectives: A 74-year-old male patient with unresectable advanced gastric cancer (clinical initial stage T3N+, Borrmann type III) admitted due to gastric bleeding at tumor site. On first admission day, hemoglobin level was 5.7g/dl and performance status was grade 3 according to Eastern Cooperative Oncology Group Performance Status(ECOG-PS). After performing red blood cell transfusion as an emergency treatment, hemoglobin level was increased up to 9.5g/dl. However, bleeding of oozing site was continued. For hemostasis, decoction of notoginseng radix (30g/day) was administered since day 7 after admission. The dose was elevated to 40g/day after hemoglobin level was decreased to 6.5g/dl on day 11. Since then, melena was stopped and hemoglobin level was maintained over 9.1g/dl. This case shows the hemostasis effect of decoction of notoginseng radix on gastric bleeding in unresectable advanced gastric cancer.