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대한외상학회> 대한외상학회지> 원저 : 외상으로 인한 상처의 치료에 있어서 선택적 항균제의 효과 및 적응증에 관한 연구

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원저 : 외상으로 인한 상처의 치료에 있어서 선택적 항균제의 효과 및 적응증에 관한 연구

Original Articles : Rational Use of Antimicrobial Agents in Traumatic Simple Wounds

김재은 ( Jae Eun Kim ) , 서주현 ( Joo Hyun Suh ) , 최윤희 ( Yoon Hee Choi ) , 배현아 ( Hyun A Bae ) , 정진희 ( Jin Hee Jung ) , 어은경 ( Eun Kyung Eo ) , 전영진 ( Young Jin Cheon ) , 정구영 ( Koo Young Jung )
  • : 대한외상학회
  • : 대한외상학회지 20권1호
  • : 연속간행물
  • : 2007년 06월
  • : 40-46(7pages)
피인용수 : 22건

(자료제공: 네이버학술정보)

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Purpose: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. Methods: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman`s University Mokdong Hospital. Structured data sheets were completed at the times of the patient`s visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. Results: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). Conclusion: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate. (J Korean Soc Traumatol 2007;20:40-46)

ECN

ECN-0102-2009-510-008682452


UCI

I410-ECN-0102-2009-510-008682452

간행물정보

  • : 의약학분야  > 외과학
  • : KCI 등재
  • : -
  • : 계간
  • : 1738-8767
  • : 2287-1683
  • : 학술지
  • : 연속간행물
  • : 1988-2018
  • : 913


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1원저 : 동종유래각질세포(Cultured Allogenic Keratinocytes, Kaloderm(R))를 이용한 부분층 피부 결손의 치료

저자 : 서상원 ( Sang Won Seo ) , 장충현 ( Choong Hyun Chang ) , 조민수 ( Min Su Cho ) , 홍윤기 ( Yoon Gi Hong ) , 전세학 ( Sae Wha Jeon )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 1-5 (5 pages)

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Purpose: Grafting with autograft skin remains the most effective method for treating skin defects. When insufficient donor sites are present or patients are afraid of the operation, a skin graft is impossible. Cultured allogenic keratinocytes speed wound healing by providing cover and by producing growth factors and extracellular matrix protein. We report an application of cultured allogenic keratinocytes (Kaloderm(R), Tegoscience, Seoul, Korea) in the treatment of an acute partial thickness skin defect. Methods: From March 2005 to January 2006, 20 patients with a partial thickness skin defect were treated with cultured allogenic keratinocytes. The wound was covered with a sheet of cultured allogenic keratinocytes and ointment with Bactigras(R) gauze. The wound was inspected every two or three days. We regarded completion of epithelialization as wound healing. Results: The mean period between time of injury and time of Kaloderm(R) application was 7.5 days. The time taken from application of Kaloderm(R) to complete closure of the wounds was 7.2 days. Conclusion: In view of the favorable outcome, cultured allogenic keratinocytes are safe and effective biologic dressing materials for use in the treatment of open wounds. (J Korean Soc Traumatol 2007;20:1-5)

2원저 : 국내 응급실에서의 골수강내 주입법 사용 현황

저자 : 최상천 ( Sang Cheon Choi ) , 박현수 ( Hyun Soo Park ) , 김재우 ( Jae Woo Kim )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 6-11 (6 pages)

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Purpose: Gaining vascular access is difficult and time-consuming in critically ill children, so nowdays, in many countries, intraosseous vascular access is frequently used for rapid vascular access in critically ill children. Its pharmacokinetics is close to that of the peripheral intravenous route, but its infusion flow rate is faster. The purpose of this study was to determine how widely the intraosseous infusion technique was being used in Korean emergency departments. Methods: We telephoned forty-two (42) randomly selected university-affiliated hospitals. We asked physicians if they use the intraosseous infusion technique. Responders were emergency and pediatric residents and emergency faculty. If they responded that they were not using the intraosseous infusion technique, we asked the reason. Also, we asked about their experiences with the intraosseous infusion technique. Results: Forty-two (42) hospitals were enrolled in this study. No hospital used the intraosseous infusion technique on a regular basis. However, 8 hospitals used the intraosseous infusion technique occasionally. None of the responders had experience with the intraosseous infusion technique. Conclusion: The intraosseous infusion technique is currently underrepresented at emergency departments in Korea. (J Korean Soc Traumatol 2007;20:6-11)

3원저 : 복부외상환자의 예후에 영향을 미치는 인자들에 대한 분석

저자 : 김희준 ( Hee Joon Kim ) , 김형수 ( Hyung Soo Kim ) , 서경원 ( Kyung Won Seo ) , 주재균 ( Jae Kyun Ju ) , 류성엽 ( Seong Yeop Ryu ) , 김정철 ( Jeong Cheol Kim ) , 김형록 ( Hyung Rok Kim ) , 박영규 ( Young Kyu Park ) , 김동의 ( Dong Yi Kim ) , 김영진 ( Young Jin Kim ) , 김신곤 ( Shin Kon K

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 12-18 (7 pages)

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Purpose: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. Methods: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. Results: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (<60 mmHg in systolic) were related to high mortality (85.7%). In laboratory findings, decreased hemoglobin (<8 g/dL), and platelet count (<50,000/mm3), and increased creatinine level (>1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. Conclusion: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient`s status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality. (J Korean Soc Traumatol 2007;20:12-18)

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Purpose: Trauma surgery is not an official medical specialty in the Republic of Korea (South Korea). Thus, a trauma victim transported to an emergency room (ER) is resuscitated and surveyed by an intern, a resident, or an emergency physician (EP) at first. Currently an operative management is decreasing because of multiple factors. Nevertheless, trauma surgery is the key for some patients. Does the EP`s treatment in the ER delay the surgeon`s emergency operation? Methods: A retrospective study was performed for trauma victims who underwent trauma surgery from March 2004 to February 2005 in a local emergency center of Daegu-city. We reviewed the medical records and analyzed the trauma victim`s age, sex, cause of injury, method of transport, time from the trauma to the operation, EP`s treatment, surgical department, mortality, and injury severity score (ISS). Results: Of the 223 trauma victims included in this study, males were predominant (83.4%). The mean age was 37.98 years of age. The main Causes of trauma were trauma NOS (not otherwise specified) and motor vehicle accidents (MVA). The main methods of transport was privately owned automobile. The mean time from trauma to operation was 617.46 min. The mean ISS was 7.67. Trauma surgery with the EP`s treatment group included 40 trauma victims with higher ISS, and the time from trauma to operation was shorter than it was for the 183 trauma victims not in that group. Conclusion: The EP`s treatment of high-ISS multiple-injury trauma victims can shorten the time from trauma to trauma surgery and will help the surgical department treatment. In the trauma care system of the Republic of Korea, and increased role should be encouraged for emergency physician. (J Korean Soc Traumatol 2007;20:19-25)

5원저 : 혈역학적으로 불안정한 골반골 골절 환자에서 골반골 골절 소견과 혈관조영술 소견의 비교

저자 : 이권일 ( Kwon Il Lee ) , 이강현 ( Kang Hyun Lee ) , 강성찬 ( Sung Chan Kang ) , 박승민 ( Sung Min Park ) , 장용수 ( Yong Su Jang ) , 신태용 ( Tae Yong Shin ) , 황성오 ( Sung Oh Hwang ) , 김현 ( Hyun Kim )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 26-32 (7 pages)

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Purpose: Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings. Methods: We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile`s classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings. Results: In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: ±20.1). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery. Conclusion: The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings. (J Korean Soc Traumatol 2007;20:26-32)

6원저 : 스키와 스노보드 사고에서 척추손상의 특징

저자 : 차용성 ( Yong Sung Cha ) , 이강현 ( Kang Hyun Lee ) , 김선휴 ( Sun Hyu Kim ) , 장용수 ( Yong Su Jang ) , 김현 ( Hyun Kim ) , 신태용 ( Tae Yong Shin ) , 황성오 ( Sung Oh Hwang )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 33-39 (7 pages)

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Purpose: Few studies have been done for spinal injuries after skiing and snowboarding accidents. Assuming that the riding patterns of skiing and snowboarding were different, we analyzed the differences between the mechanisms, diagnoses and levels of spinal injuries caused by them. The purpose of this study was to gain a better understanding of spinal hazards associated with skiing and snowboarding in order to educate skiers and snowboarders. Methods: We conducted a prospective study of 96 patients who had sustained spinal injuries as a result of skiing and snowboarding accidents from January 2003 to March 2006. We used a questionnaire, radiological studies, history taking, and physical examinations. We analyzed the mechanism of injury, the level of spinal injury, the severity of spinal injury, and the Abbreviated Injury Scale scores (AIS score). We used the t-test and the chi-square test. Results: The skiing and the snowboarding injury group included in 96 patients. The skiing injury group included 30 patients (31.2%), and the snowboarding injury group included the remaining 66 patients (69.8%). The primary mechanism of injury in skiing was collisions and in snowboarding was slip downs (p=0.508). The primary level of spinal injury in skiing and snowboarding was at the L-spine level (p=0.547). The most common athlete ability of the injured person was at the intermediate level (p=0.954). The injured were most commonly at the beginner or the intermediate level (p=0.302). The primary diagnosis of spinal injury in skiing and snowboarding was back spain (p=0.686). The AIS scores did not differed between the two groups (p=0.986). Conclusion: The most common spinal injury after skiing and snowboarding accidents was back sprain. There was no difference in the severity of spinal injury between skiing and snowboarding accidents. (J Korean Soc Traumatol 2007;20:33-39)

7원저 : 외상으로 인한 상처의 치료에 있어서 선택적 항균제의 효과 및 적응증에 관한 연구

저자 : 김재은 ( Jae Eun Kim ) , 서주현 ( Joo Hyun Suh ) , 최윤희 ( Yoon Hee Choi ) , 배현아 ( Hyun A Bae ) , 정진희 ( Jin Hee Jung ) , 어은경 ( Eun Kyung Eo ) , 전영진 ( Young Jin Cheon ) , 정구영 ( Koo Young Jung )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 40-46 (7 pages)

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Purpose: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. Methods: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman`s University Mokdong Hospital. Structured data sheets were completed at the times of the patient`s visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. Results: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). Conclusion: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate. (J Korean Soc Traumatol 2007;20:40-46)

8증례 : 자동차의 사이드미러가 흉강에 박힌 채로 내원한 흉부관통상 - 2례 보고 -

저자 : 김수성 ( Soo Sung Kim )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 47-51 (5 pages)

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Penetrating chest trauma caused by the components of one`s own car is rare in motor vehicle accidents. We experienced two cases of penetrating chest injury caused by the sideview mirror of the patient`s vehicle. One was a 25-year-old man. The sideview mirror penetrated the left chest, went through the diaphragm, and ruptured the spleen. He was in shock upon arrival at the emergency room. An emergency thoracotomy and laparotomy were done. The ruptured spleen was resected, the lung and the diaphragm were debrided and repaired, and the chest wall was reconstructed. The other patient was a 57-year-old male, who was transported to our emergency room with the sideview mirror of his truck stuck into his right chest wall as the result of an accident. He also had a right Bennet`s fracture and an open fracture of the right tibia. Air had been sucked into the right pleural cavity through the wound. Multiple rib fractures and lung lacerations had also occurred. Removal of the sideview mirror, repair of the lacerated lung, and reconstruction of chest wall were done immediately. Both patients recovered without complication and were discharged. (J Korean Soc Traumatol 2007;20:47-51)

9증례 : 화상 후 두피에 생긴 편평 상피세포 종양에 대한 증례 보고 - 증례보고 -

저자 : 김강산 ( Kang San Kim ) , 황형식 ( Hyung Sik Hwang ) , 권흠대 ( Heum Dai Kwon ) , 문승명 ( Seung Myung Moon ) , 오석준 ( Suk Jun Oh ) , 최선길 ( Sun Kil Choi )

발행기관 : 대한외상학회 간행물 : 대한외상학회지 20권 1호 발행 연도 : 2007 페이지 : pp. 52-56 (5 pages)

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Marjolin`s ulcer is a rare and often-aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We experienced two cases after burns. Case I involved a forty eight year-old man who had suffered from a flame burn at the parietal scalp area, where had been initially described three years earlier as a full-thickness wound including the pericranium. The man consulted us for a persistent ulcerative and infected wound on the burned lesion during the last 24 months, which turned out on the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) to be the squamous cell carcinoma with involving the skull and the dura mater. Although the posterior auricular lymph node was enlarged on the ipsilateral side, recent positron emission tomography (PET) CT did not show any metastatic lesion. It was impossible for us to resect the intracranial involvement of the tumor radically, and the postoperative PET CT still showed a focal fluorodeoxyglucose (FDG) uptake around the wall of the superior sagittal sinus. We think that an aggressive combined approach is essential for treatment in early stages for a high success rate, before the intracranial structures are involved because there is no consensus on the treatment for advanced disease, and the results are generally poor. Case 1 also did not involve a radical resection because of the intracranial invasion to the wall of superior sagittal sinus and the possibility of damage to the major cortical veins. He received adjuvant radiotherapy and must be followed periodically. Case 2 involved an eighty six year-old women who suffered from a painful scalp ulcer lesion after flame burns three years earlier. Unlike case 1, neither tumor infiltration into the dura nor lymph node enlargement was observed on the contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) CT. We did a radical resection of the tumor, including the involved bone, and a cranioplasty with bone cement. (J Korean Soc Traumatol 2007;20:52-56)

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