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Erythrocyte Sodium Transport in Dialyzed Uremic Patients
Koo, Wan Suh,Choi, Euy Jin,Yoon, Young-Suk,Chang, Yoon Sik,Kim, Suk Young,Bang, Byung Kee CATHOLIC MEDICAL CENTER 1988 Bulletin of the Clinical Research Institute Vol.16/17 No.1
To investigate the status of the Na^+ concentration and ionic fluxes in red cells of human subjects with dialyzed chronic uremia, the authors measured the Na^(+)_K^+ pump activity as well as Na^(+)-K^+ cotransport (CoT), Na^(+)-Li^+ countertransport (CTT) and Na^+ passive permeability in erythrocytes from 37 normal subjects and 23 chronic uremic patiens receiving maintenance hemodialysis. The mean intracellular Na^+ concentration [Na^+]i value in the pre-dialytic group was significantly lower than that in control subjects (p < .0001), but tended to recover to the normal value of [Na^+]i in the pest-dialytic group. The mean intracellular K^+ concentration value in the postdialytic group was significantly higher than that of the control group (p < .001), but not significantly different from that of the pre-dialytic group. It was found that the Na^(+)-K^+ pump activity of erythrocytes in the pre-and post-dialytic groups markedly decreased over that of the normal control group with statistical significance (p < .0001, respectively). The Na^(+)-K^+ pump activity in the post-dialytic group, however, tended to recover, but not significantly. The rate constant for ouabain-sensitive Na^+ efflux in the post-dialytic group was significantly decreased over that of the normal controls (p < .05). The authors observed a significant decrease of the Na^(+) CoT value (p < .001 respectively) and .ate constant for Na^(+) CoT (p < .05, respectively) in the patients with pre-and post-dialytic uremia vs. that of normal subjects. Also, the authors observed a marked decrease of the Na^(+)-Li^+ CTT value in the patients in the pre-and post-dialytic groups than that of the control subjects (p < .05, respectively). Passive Na^+ permeability in the patients with predialytic uremia was decreased markedly compared to the normal subjects (p < 10^-5), but its value in the post-dialytic group tended to recover to the normal value. In conclusion, our studies demonstrate that another possible mechanism of inhibition of the Na^(+)-K^+ pump in pre-dialytic uremia might then be a secondary adaptive response of the cell to maintain normal intracellular ion concentration and transmembrane ion gradients in the face of the reduced [Na^+]i due to decreased passive Na^+ permeability .
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압전방식을 이용한 담낭결석의 체외충격파 쇄석술에 관한 실험적 연구
서경석,도영수,한준구,최병인,박용현,한만청,윤용범,최대섭,김주완,신용문,한기석 대한소화기학회 1992 대한소화기학회지 Vol.24 No.1
Extracorporeal, Shock Wave Lithotripsy (ESWL) was performed in 87 gallstones from 47 patients with the piezoelectric lithotriptor to evaluate the fragmentation rate and average number of shock waves according to the characteristics of gallstones. Sixty seven gallstones were classified as cholesterol stones (pure: 7, mixed: 42, and combination: 18), 15 stones as pigment stones (calcium bilirubinate: 7, and black pigment: 8), and five stones as rare stones on the basis of external morphology and internal structure of cut surface of stones. Size of gallstones was ranged from 5 to 30 ㎜ (mean: 13.0±4.6 ㎜). Sonography arid plain radiography of each gallstone was performed to evaluate the characteristics of stones. Sonographic findings of gallstones were classified into two types; type Ⅰ: surface echo with variable internal echo of gallstones and clean posterior acoustic shadow, type Ⅱ: echo of whole gallstones with posterior acoustic shadow. Sixty-six (95.7%) of 69 stones with sonographic type Ⅰ were cholesterol stones and 15 (83.3%) of 18 stones with sonographic type Ⅱ were pigment stones (p$lt;0.01). On plain radiographs, 35 stones were radiolucent and 52 stones had calcifications with variable laatterns. All 87 gallstones were fragmented by the piezoelectric lithotriptor. Average number of shock waves for complete fragmentation of stones less than 2 ㎝ and stones mare than 2 ㎝ wad 1052.5 and 7454. 2, respectively(p$lt;0.01). Average number of shock waves for fragmentation of sonographic type Ⅰ and Ⅱ was 1845.3 and 147.4 respectively (p$lt;0.01). Average number of shock waves for fragmentation of noncalcifed stones and calcified stones were 1901.8 and 1219.5, respectively (p:0.260). However, fragmentation of stones with diffuse calcification was easier than those of other types of calcification (p$lt; 0.05). On the basis of our results, the most important variables determining the degree of fragmentation of gallstones using piezoelectric lithotriptor were not their chemical composition (p:0.093) or sonographic type (p:0.098) but their size (p$lt;0.001) and calcification pattern (p:0.023).
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김완식,김교상,박동호,전세웅,유희구,김인규,승익상,서정국,원중영 대한마취과학회 1986 Korean Journal of Anesthesiology Vol.19 No.5
The supine hypotensive syndrome occurs when the parturients near term in supine, enlarged uterus compresses the inferior vena cava and partially obstructs the lower aorta and venous return to the heart and arterial blood flow to the pelvic organs and lower extremities are decreased. Major supine hypotensive syndrome was defined as a fall greater than 30% or a value less than 80 mmHg in systolic blood pressure. Many studies in Western countries have reported that up to 50% of parturients near term develop signs of shock including fainting, nausea, vomiting, loss of consciousness or sudden death when they assume supine position. The hazards of obstructing the aorta by the gravid uterus in pregnancy are well documented. Compression of the aorta is not associated with maternal symptoms byt does cause arterial hypotension in the lower extremities and uterine arteries, so it can cause fetal distress and asphyxia. Most parturients are able to compensate for mild to moderate supine hypotensive syndrome by increase in collateral circulation via azygos venous system and vertebral venous system and peripheral resistance or heart rate. But the anesthesiologists must recognize the importance of the supine hypotensive syndrome and the potential hazard of anesthesia in augmenting its effects. We have investigated the incidence of supine hypotensive syndrome in 171 parturients were Cesarean sectioned. we have investigated the correlating factors such as fetal body weight and parturient's physical status, body weight and age among the 36 cases of decreased blood pressure in supine position and also we have investigated the relationship between blood pressure changes and parturient's associated diseases. We have measured the arterial blood pressure indirectly by the Riva-Rocci method when they are lying on the operating table in supine and compared it with arterial blood pressure in their comfortable position in ward. The results are as follows: 1) Among the 171 parturenits, the incidence of decreased arterial blood pressure in supine position was 21%(36cases). However the incidence of increased arterial blood pressure in supine position was 79%(135 cases). No case of severe blood pressure changes defined as a fall greater han 30% was noticed byt there was one case with less than 80mmHg in systolic blood pressure which would be a rate of 0.6%. 2) The relationship between decreased blood pressure in supine posction and fetal body weight and parturient's physical status, body weight and age was not statistically significant(P>0.05). 3) The relationship between decreased blood pressure in supine position and parturient's associated diseases especially preeclampsia or eclampsia was statistically significant(P<0.05).
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Diazepam, Lorazepam 및 MeDeridine 의 진정효과에 관한 비교연구
김완식,김교상,박동호,이홍식,전세웅,서정국,유희구,김인규,승익상 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.2
Among the elective Surgeries performed at Hanyang University Hospital from March to July 1986, 150 cases were studied. Each 50 cases were given diazepam, lorazepam and meperidine as prefnedicants. In the diazepam and lorageparm group, each 25 cases were given by intramuscvlary and intravenously. 40 minutes after injection, scoring the degree of sedation was performed. Scoring the degree of sedation was adopted by $quot;Simple Scoring System$quot; (Nisbet and Norria, 1963). The results were as follows : 1) Comparison of diazepam, lorazepam and meperidine intramusclar administration, sign-ificantly lower souring wan defined in meperidine. (p$lt;0.05 7r riait analysis) 2) Comparison of scoring in intramuscular and intravenous administration of diagepam and lorazepam, no significance were defined in both groups. (p$gt;0.05 by ridit analrsis in both groups) 3) Environmental factors (sex, grade of education, religion and sits of operation) were not influenced on scoring significantly. (p$gt;0.05 by Chi-square test)
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김완식,박동호,심재철,서정국,정창우,황영희,김유재,강귀빈,유희구 대한마취과학회 1984 Korean Journal of Anesthesiology Vol.17 No.2
Recent studies in western countries have reported that the mechanism of pain are concorded with gate control opiate receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, serotonin, histamine and prostaglandin E. Otherwise the mechanism of the stimulation producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. Nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and celiac plexus or pituitary gland block with phenol or alcohol has unevenful complication. From January 1980 to december 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervention and neuropolytics. The results are as follows; 1) There are two kinds of treated patients; One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the higest number of patients in the 3rd decade (21%) and in the 4th decade (24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed transient improvement and there were 3 cause of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.
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김완식,박동호,심재철,황영희,차영덕,유희구,서병태,장경덕,서정국,김유재 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.2
In contrast to younger patients, old peoples frequently manifest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteri-osclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgein and the anesthesiologist must see that their clincial decisions are tied to a physiologic understanding dased on exact quantification of the specific hemodynamic, respira-tory, renal, and metabolic factors which may play a decisice role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department od anenthesiology, Hanyang University, Col-lege were analyzed clinically according to age, sex, department, phsical status, anesthetic technique and agent, anesthesia time, length of admission, laboratoty studise (chest X-ray, EKGm arterial blood gas), and postoprative complications (mortality and causes og death) the results are as follows: 1) Out of 25.857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases(47.6%) were from general surgery; 81 cases (15.7%), orthopedic surgry; 78 cases(15.1%), urology; and 67cases(12.9%), neurosugery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases(35.0%) class 3, 28 cases(5.4%) class 4, and 6 cases(1.2%) class 5, Emerg-ency cases were 137 cases(26.5%) and 380 cases(73.5%) eere elevtive. 4) Concernign premedication-150 cases(29.0%) were premedicated with atropine sulfate plus Valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia(82.2%) and 92 cases of regional anesthesia(17.8%). The major anesthetic was halothene, 362 cases(70.0%). The rechnic in 419 cases(81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1 hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3 hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases(45.9%) were within nomal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases(12.9%) had pulmonary tuberculosis, and 38 cases(5.1%) had senile lung fibrosis. The EKG, which ws done on 85% of the patients, ravealed that 193 cases(44.0%) were within narmal limits, 61 cases(13.9%) showed left ventricual hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preiperative arteral blood gas studies of 56 cases the results were almost all within narmal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The differnce of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rateed ot physical status was statistically significanct.(p<0.005). 9) As the cause of death-1 cases(36.7%) had transtentorial herniation, 2 cases(6.7%) sepsis, 2 cases(6.7%) hypobolemiam, and 1 cases(3.3%) had pulmonary edema.
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