응급실에서 시행된 기관내 삽관의 현황

김병철,강보승,송형곤,이정훈,송근정,정연권 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. Methods : We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center form April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. Results : Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). Conclusion : At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.

경구면역을 통한 항원 특이적 IgA 항체 합성에 있어 Cholera Toxin과 Alginate-Microsphere의 효과

송민형,유진수,권명상,성승룡,김용희,권익찬,정서영,양재명,김평현 大韓免疫學會 1996 大韓免疫學會誌 Vol.18 No.3

Secretory (S-IgA) isotype antibody (Ab) is known to play an essential role in the primary defense against various infectious agents in mucosal tissue. However, it has been mostly unsuccessful in the induction of antigen (Ag)-specific IgA Ab response in this site by peroral vaccination. In the present study, we investigated the effect of cholera toxin (CI) as a mucosal adjuvant and alginates-microspheres as a carrier on BSA-specific IgA Ab response in gut-associated lymphoid tissue`(GALT). Peroral immunization of BSA plus CT conferred a great BSA-specific IgA response but IgG response on intestinal fluid (IF). In contrast, intraperitoneal immunization of BSA with Freund's adjuvant readily induced BSA-specific IgG response but IgA response in IF. Further, number of CT specific IgA-secreting cells was substantially increased in mesenteric lymph node when CT-encapsulated-VI alginates-microspheres was administered perorally. Taken together, these results indicate that peroral immunization of soluble antigen in combination of CT or microspheres significantly enhances antigen-specific IgA response in GALT.

심장수술 시 농축적혈구, 자가수혈기 혈액, 체외 순환기 혈액에서의 유리 혈색소 농도 비교

송장호,구승우,백종화,정용보,이정순,최인철 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: Intraoperative autotransfusion or residual blood in a cardiopulmonaty bypass (CPB) circuit has been used to reduce the need for an homologous blood transfutsion during cardiac surgery. However, it may contain some free hemoglobin released from damaged cells. The load of blood containing free hemoglobin may cause renal dysfunction. We measured the amount of free hemoglobin in backed blood, cell saver blood and CPB blood to evaluate what is the least hemolytic blood transfused in cardiac surgery. Methods: This study was performed in 20 patients undergoing cardiac surgery. In each patient, the banked blood, intraoperative salvaged blood with a cell saver and CPB residual blood were sampled at the end of the operation. The concentration of free hemoglobin, hemoglobin and platelet counts were measured in these blood samples and percent of hemolysis was calculated (%hemolysis = [free hemoglobin] / .free hemogloben + hemoglobin]) Results: In salvaged blood with a cell saver, CPB residual blood and banked blood, hemoglobin concentrations were 20.1 ± 2.7 g/dl, 8.0 ± 1.1 g/dl, and 22.2 ± 2.7 g/dl, respectively. Free hemoglobin concentrations were 336.6 ± 239.5 mg/dl, 49.2 ± 26.8 mg/dl, and 279.5 ± 167.5 mg/dl respectively. Platelet counts were 26.1 ± 22.2 × 10^3/mm^3, 116.8 ± 56.5 × 10^3/mm^3, and 94.9 ± 43.6 × 10^3/mm^3 respectively. % Hemolysis were 1.6 ± 1.1%, 0.6 ± 0.4%, and 1.2 ± 0.7% respectively. In the comparison between the salvaged blood with a cell saver and CPB residual blood, free hemoglobin concentration, % hemolysis, and platelet counts had positive correlations (r = 0.8, 0.7, and 0.6). Conclusions: In twenty cardiac surgeries, CPB residual blood had a lower free hemoglobin level than the other two blood groups. The platelet counts in CPB residual blood were higher than those in cell saver blood but did not differ from those in banked blood. Therefore, CPB residual blood was the least hemolytic blood among the three blood groups when a transfusion was performed in cardiac surgery. (Korean J Acesthesiol 2002; 43: 588~593)

전수면박탈이 정상인의 생리기능과 인지기능에 미치는 영향

정종현,송후림,신윤경,한진희,이성필,홍승철 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

Objectives : Purpose of this study was to investigate physiological and neurocognitive effects of total sleep deprivation by using laboratory blood tests and the computerized neurocognitive function test in healthy subjects. Methods : Sixteen healthy volunteers participated in this study. Subjects were recommended to remain awake for 48 hour sunder continuous surveillance. Lab tests of cortisol, Prolactin, thyroid hormone, growth hormone, and immunoglobulin (IgG, IgA, IgM, IgD, IgE), CBC, BC and the Vienna test were performed before and after 48 hours of total sleep deprivation. Results : Concentration of T3 and T4 significantly increased after deprivation. In the reaction test, distribution reaction time significantly increased, and correct reaction significantly decreased. In the vigilance test, amount of correct reaction Signifi-cantly decreased, and the mean value of correct reaction time was significantly delayed. Level of fasting blood sugar, total protein, albumin, alkaline phosphatase and potassium significantly increased, respectively, except for the level of total bilirubin which was decreased. After total sleep deprivation, WBC counts significantly increased. Regarding immunoglobulin level, IgG,IgA and Ag M concentrations appeared to decrease, but the results were not statistically significant. Conclusion : The effect of total sleep deprivation on physiological function was significant in the level of thyroid hormone. Although statistically not significant, the results of growth hormone and the immune system showed a trend in relations to the effect oftotal sleep deprivation. Results of blood chemistry suggest that sleep dephvation may influence metabolism Of hepato-biliary system. Cognitive impairment was also seen in reactive and vigilant functions after total sleep deprivation.

위전절제시 단순공장간치술의 임상적 의의

노승무,배진선,정현용,이병석,조준식,신경숙,송규상,이태용 충남대학교 암공동연구소 2003 암공동연구소 업적집 Vol.3 No.

Purpose: The aim of this study was to evaluate the short-term outcome of a jejunal interposition, by comparing it with a conventional Roux-en-Y gastrojejunostomy, after a total gastrectomy. Materials and Methods: For 28 patients (20 men and 8 women) with a gastric adenocarcinoma, who underwent an isoperistaltic simple jejunal interposition, weight, hemoglobin, hematocrit, serum protein and albumin, and cholesterol levels were checked before the operation and at 1 year and 2 years after the surgery. Also, endoscopy was performed to confirm reflux esophagitis. In this study, the data were collected between January 1993 and July 1999 at Chungnam National University Hospital, and the results were compared with those of the Roux-en-Y procedure. Results: The body weights at 1 year and 2 years after the surgery had returned to 86.0% and 87.6% of the recent original body weight in the jejunal interposition (Jl) group and to 90.8%, 87.0%, respectively in the Roux-en-Y (RY) group. The levels of hemoglobin (g/dl) were 13.3, 12.5, and 11.9 in the Jl group, and 13.8, 12.6, and 12.1 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum protein (g/dl) levels were 7.1, 7.2, and 7.5 in the Jl group and 7.1, 7.0, and 7.2 in the RY gropu at the time of the operation and at 1 year and 2 years after the surgery, respectively. The serum albumin (g/dl) levels were 4.2, 4.1, and 4.2 in the Jl group and 4.2, 4.2, and 4.2 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum cholesterol (mg/dl) levels were 186.5, 174, and 164 in the Jl group and 213.7, 171.1, and 141.0 in the RY group at the time of the operation and at 1 year and 2 years after the surgery, respectively. The endoscopic finding showed that reflux esophagitis occurred in 7.1% of the patients in the Jl group and in 3.5% in the RY group. Conclusion: We think that from the view point of quality of life, a jejunal interposition, as well as a Roux-en-Y procedure, is a useful reconstruction methods for a total gastrectomy. (J Korean Gastric Cancer Assoc 2001;1:210-214)

불완전 전뇌 허혈후 소생의 백서 모델을 이용한 재관류 뇌혈류량과 허혈성 뇌조직 손상도와의 관계

서정필,송근정,황태식,정연권,신백효,김승호 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Experimental data indicate that low-flow reperfusion following prolonged cardiocirculatory arrest may aggravate early cerebral microcirculatory reperfusion disorders. We investigated the influence of cerebral reperfusion flow change to the ischemic histopathologic damage of brain tissue after incomplete forebrain ischemia in rats. Materials and method: Anesthetized Sprague-Dawley rats were undergone ligation of both internal carotid artery by microvascular clamp for 10 minutes. After release of the clamp, reperfusion was started with several different flow levels (0, 10, 20, 30, 50, and 100%) of internal carotid artery comparing to pre-clamping phase using flowmeter. After 15minutes of reperfusion, rat brains were prepared by perfusion-fixation with 3% formaldehyde. Under light microscopic examination of Hematoxylin-Eosin stained tissue slide, histopathologic damage was examined at cortex, putamen, and hippocampus regions. Categorical hisotopathologic damage scores were derived in each regions by manual counts of ischemic neurons. Result: The histopathologic damage scores were 0, 10.2±0.5, 7.6±1.5, 5.9±1.4, 5.0±2.8, 3.5±0.7, and 1.0±0.0 in control, 0, 10,20, 30, 50, and 100% reperfusion groups, respectively(p<0.05). Conclusion: Our results showed significant increment of brain histopathologic damage scores along with decreasing amount of cerebral reperfusion flow after incomplete forebrain ischemia. We believe restoration of reperfusion flow to pre-ischemic level would be a critical component in attenuation of brain ischemic damage.

제2형 당뇨병 환자에게 적용한 표준진료지침이 혈당, 당화혈색소, 당뇨지식 및 재원일수에 미치는 효과

김희승,윤건호,유양숙,오정아,송민선,신미옥,김경희,송복례 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.1

연구배경 : 당뇨병 환자의 평균 재원기간을 단축시키고, 제한된 입원기간 내에서 질적인 면과 비용효과성을 고려한 총체적인 건강관리체계의 필요성이 요구됨으로써 생겨난 것이 당뇨병 표준진료지침(Critical Pathway: CP)이다. 현재 개발된 당뇨병 CP를 통한 진료가 환자의 당뇨병에 관한 지식을 개선시키고 이에 따라 장기적으로 당뇨병 환자의 혈당조절이 개선되었다는 과학적인 검증은 당뇨병 CP를 여러 병원에 정착시키기이전에 반드시 선행되어야 할 과제이다. 이에 본 연구는 2000년 3월부터 1년간 강남성모병원에 입원하는 당뇨병 환자를 대상으로 현재 개발된 1주일 CP를 적용한 실험군의 혈당, 당뇨병 관련 지식 및 재원일수가 대조군에 비하여 차이가 있는지를 조사하였다. 방법 : 1주일 CP를 적용한 실험군은 내과병동에 입원한 당뇨병 환자 89명이었고, 대조군은 기타병동에 입원한 당뇨병 환자 22명이었으며 CP를 적용하지 않았다. CP를 적용하기 전인 입원시에 실험군과 대조군의 공복혈당, 식후 2시간혈당, 당화혈색소 및 당뇨관련 지식을 측정하였고, 퇴원 시에 실험군과 대조군에게 공복혈당과 당뇨관련 지식을 재측정하고 재원일수를 파악하였다. 그리고 두 군에게 퇴원 3개월 후의 공복혈당, 식후 2시간 혈당 및 당화혈색소를 조사하였다. 결과 : 1) 실험군의 공복혈당은 입원 시 238.7: 1) 실험군의 공복혈당은 입원 시 238.7mg/dL에서 퇴원 시 139.4mg/dL로 감소하는 경향이었으나 퇴원 3개월 후에는 150.6mg/dL로 약간상승하는 경향을 보였다. 대조군은 입원 시 251.5mg/dL에서 퇴원 시 136.2mg/dL로 감소하는 경향이었으나, 퇴원 3개월 후에는 219.3mg/dL로 현저히 증가하는 경향이었다. 2) 실험군의 입원 시 식후 2시간 혈당은 312.5mg/dL에서 퇴원 3개월 후 248.5mg/dL로 감소하는 경향이었다. 대조군도 입원 시 식후 2시간 혈당이 300.1mg/dL에서 퇴원 3개월 후 262.5mg/dL로 감소하는 경향이었으나 실험군보다 감소의 폭이 적은 경향이었다. 3) 실험군과 대조군의 입원 시 당화혈색소는 각각 10.3%와 9.7%로 유의한 차이가 없었으나,퇴원 3개월 후 실험군은 7.5%로 대조군의 9.1% 보다 유의하게 감소하였다. 4) 실험군의 입원 시 당뇨지식 점수는 실험군이 12.1점 대조군은 12.0점으로 유의한 차이가 없었으나 퇴원 시는 실험군이 15.5점으로 대조군의 14.6점 보다 높은 경향이었다. 5) 재원일수는 실험군이 8.4일로 대조군의11.0일 보다 유의하게 적었다. 결론 : 따라서 당뇨병 환자를 위한 CP는 재원일수의 감소뿐만 아니라 환자의 자가관리에 대한 체계적인 교육과 개선의 기회를 가짐으로써 장기적인 혈당 조절의 향상을 도모할 수 있는 효과적인 방법이라고 생각한다. Background: The aim of this study was to examine the effects of the critical pathway for the admitted patients with type 2 dia betes me llitus on glycemic control, the knowledge on the disease, and the length of hospital stay. Methods: 89 diabetic in-patients were applied with the 1 week critical pathwa which was consisted of intensive education program for self-management of diabetes me llitus such as glucose monitoring, excercise prescription, diet control, self-a djustment of the drugs and so on. The results were compared with 22 diabetic inpatients who were treated with conventional way. We assessed the effects of critical pathway on the degree of glycemic control, the knowledge on the disease, and the length of hospital stay. Results: Although fasting and postprandial 2 hours blood g lucose levels did not showed sta tistically significantd ifference between critical pathway group and conventional group on discharge , HbA1c was significantly decreased in critical pathwa group compared with the conventional group (7.5±1.8% vs 9.1±2.6%) on 3 months after discharge . Knowledge on the disease tended to increase in critical pathway group compared with the conventional group on discharge. The Length of hospital stay was significantly decreased in critical pathway group compared with the conventional group (8.4±2.8day vs 11.0±3.9da ) Conclusion: These results showed that critical pathway for the patients with diabetes mellitus might be a usefulway for improving the long term glycemic control through motivation, enhancing the knowledge on the disase as well as reducing the length of hospital stay.

위전절제시 단순공장간치술의 임상적 의의

노승무,배진선,정현용,이병석,조준식,신경숙,송규상,이태용 충남대학교 암연구소 2003 암연구소 업적집 Vol.3 No.-

Purpose: The aim of this study was to evaluate the short-term outcome of a jejunal interposition, by comparing it with a conventional Roux-en-Y gastrojejunostomy, after a total gastrectomy. Materials and Methods: For 28 patients (20 men and 8 women) with a gastric adenocarcinoma, who underwent an isoperistaltic simple jejunal interposition, weight, hemoglobin, hematocrit, serum protein and albumin, and cholesterol levels were checked before the operation and at 1 year and 2 years after the surgery. Also, endoscopy was performed to confirm reflux esophagitis. In this study, the data were collected between January 1993 and July 1999 at Chungnam National University Hospital, and the results were compared with those of the Roux-en-Y procedure. Results: The body weights at 1 year and 2 years after the surgery had returned to 86.0% and 87.6% of the recent original body weight in the jejunal interposition (Jl) group and to 90.8%, 87.0%, respectively in the Roux-en-Y (RY) group. The levels of hemoglobin (g/dl) were 13.3, 12.5, and 11.9 in the Jl group, and 13.8, 12.6, and 12.1 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum protein (g/dl) levels were 7.1, 7.2, and 7.5 in the Jl group and 7.1, 7.0, and 7.2 in the RY gropu at the time of the operation and at 1 year and 2 years after the surgery, respectively. The serum albumin (g/dl) levels were 4.2, 4.1, and 4.2 in the Jl group and 4.2, 4.2, and 4.2 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum cholesterol (mg/dl) levels were 186.5, 174, and 164 in the Jl group and 213.7, 171.1, and 141.0 in the RY group at the time of the operation and at 1 year and 2 years after the surgery, respectively. The endoscopic finding showed that reflux esophagitis occurred in 7.1% of the patients in the Jl group and in 3.5% in the RY group. Conclusion: We think that from the view point of quality of life, a jejunal interposition, as well as a Roux-en-Y procedure, is a useful reconstruction methods for a total gastrectomy. (J Korean Gastric Cancer Assoc 2001;1:210-214)

흰쥐 삼차신경 척수감각핵 미측소핵 세포의 흥분성 시냅스 전도에 대한 nociceptin의 효과

김승록,최정희,송원정,천상우 원광대학교 치의학연구소 2003 圓光齒醫學 Vol.12 No.1

The caudal subnucleus of the spinal trigeminal nucleus (medullary dorsal horn; MDH) is implicated in the processing of nociceptive information in the orofacial region. In the present study, whole cell patch clamp recordings were carried out on MDH neurons in brainstem slice of neonatal rats to investigate the characteristics of spontaneous excitatory postsynaptic currents (sEPSCs) and the roles of nociceptin/orphanin FQ on excitatory synaptic transmission. In the presence of strychnine (1 μM) and bicuculline (20 μM), spontaneous inward currents at -70 mV were observed. The baseline frequency, amplitude and decay time constant of sEPSCs were 2.0 ± 0.5 Hz, 23.0 ± 1.8 pA, 3.8 ± 0.2 ms, respectively. sEPSCs were mediated by non-NMDA and NMDA receptors. The specific AMPA receptor antagonist GYKI-52466 (50 μM) completely blocked the non- NMDA mediated sEPSCs, indicating that they are mediated by an AMPA-preferring receptor. Perfusion of the opioid orphan receptor (ORL_1) adonist nociceptin (3 μM) reduced the frequency of sEPSCs and miniature EPSCs (mEPSCs). The effects of nociceptin were blocked by the selective ORL_1 receptor antagonist [Nphe'] nociceptin(1-13)NH_2 (3 μM) and were not affected by the non-specific opioid receptor antagonist naloxone (10 μM). To investigate the specificity of this synaptic inhibition, we selectively activated the nociceptive C fibers with capsaicin, which induced a strong increase in the frequency of sEPSCs. In the presence of nociceptin, the response to capsaicin was diminished. In conclusion, these results suggest that nociceptin inhibits excitatory synaptic transmission in the MDH by acting on presynaptic ORL_1 receptors.

부착성 동물세포의 Scale-up을 위한 방법의 개발

김승모,송상호,최명락,유은정,임현수 여수대학교 1997 論文集 Vol.11 No.2

This study was a protocol of serial propagation for anchorage-dependent animal cell. Vero. by the optimization of trypsin and EDTA concentration in T-25 flask. Commen enzymetic treatment in PBS solution has been modified for a high degree of cell datachment from T-25 flask and for transfer of a maximum number of viable cells from one culture to the next during the scale up process. Culture of Vero cells were washed with Dulbecco's modified Eagle's medium(DMEM) and then exposed to DMEM containing trypsin(0.025%) and EDTA(0.16%). Up to 90% of cells detached from bottom of flask and the viability of cells was greater than 93%. The protocol using the developed method was successfully applied to the next 10 times scale up process. Consequently, the developed method changed multiple steps of processes to one step, so it promised th easy scale-up and low cost demand of animal cell culture.