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Metastatic Cancer Detection during Evaluation of Flank Pain in Painclinic Patients
김영미 ( Young Mi Kim ),김선욱 ( Seon Wook Kim ),한철식 ( Cheol Sig Han ),정미화 ( Mi Hwa Chung ),최영룡 ( Young Ryong Choi ),강화자 ( Wha Ja Kang ),최은미 ( Eun Mi Choi ) 경희대학교 경희의료원 2011 慶熙醫學 Vol.27 No.1
54세 남자 환자와 82세 여자 환자가 대증적 치료에도 호전되지 않는 옆구리 통증을 주소로 본원 통증 클리닉을 방문하였다. 과거력과 이학적 검사, 혈액 검사와 흉부 X선 검사상 척추 주위의 전이암이 의심되어 정밀 검사가 진행되었고 조직 검사와 컴퓨터 단층 촬영, 자기 공명 영상 검사에서 각각 폐암과 난소암이 진단되었다. 옆구리 통증을 유발하는 원인중 하나인 척추내 또는 척추 주위 종양은 혈액성 전이에 의한 전이암이 대부분이다. 원발암을 진단 받기 전에 통증 클리닉을 방문한 환자에서 옆구리 통증을 단순한 양성 통증으로 오인하는 경우 원발암의 진단과 치료가 늦어지게 되어 예후에 영향을 미치게 된다. 저자들은 원발암을 진단 받기전 옆구리 통증을 주소로 본원 통증 클리닉을 방문한 환자에서 검사 도중 척추 주위 전이암을 발견한 경험을 하였기에 문헌과 함께 보고하고자 한다.
증례보고 : 지혈대 감압 후 라텍스 아나필락시스를 보인 환자의 마취 관리 -증례보고-
이진영 ( Jin Young Lee ),이현철 ( Hyun Chul Lee ),박윤정 ( Youn Jung Park ),정미화 ( Mi Hwa Jung ),최영룡 ( Young Ryong Choi ),원임수 ( Rim Soo Won ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Latex is the second most common cause of anaphylaxis during anesthesia. The increasing number of reports of latex-induced anaphylaxis are a major concern for anesthesiologists. We encountered a 56-year-old male patient who developed severe anaphylactic shock whilst under anesthesia when the tourniquet was deflated during elbow arthrolysis. A subsequent allergy workup revealed an IgE mediated hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients under anesthesia. (Korean J Anesthesiol 2006; 50: 466~8)
거대 자궁 근종의 복식 전 자궁 절제술 후 발생한 폐색전증
이립 ( Rippy Lee ),정미화 ( Young Ryong Choi ),최영룡 ( Mi Hwa Chung ),최은미 ( Eun Mi Choi ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2011 慶熙醫學 Vol.27 No.1
We report a case of pulmonary embolism on 2nd postoperative day of total abdominal hysterectomy under general anesthesia. Patient was transfused preoperatively because of severe anemia, but she did not undergo any diagnostic test for pulmonary embolism and prophylactic trial because there was no symptom and sign that can predict pulmonary embolism. On the morning of 2nd postoperative day, with first ambulation, patient showed abrupt symptom and sign such as dyspnea, tachypnea, drowsy mental status, hypotension and hypoxemia. Under suspecting pulmonary embolism, patient was sent to intensive care unit and cardiopulmonary resuscitation was done. After 2 hours from first symptom and sign patient died. Pulmonary embolism was diagnosed on autopsy and the cause of death was cardiac arrest by pulmonary embolism.
곽인숙 ( In Suk Kwak ),정성원 ( Sung Won Jung ),이진영 ( Jin Young Lee ),정미화 ( Mi Hwa Jung ),최영룡 ( Young Ryong Choi ),원임수 ( Rim Soo Won ),한태형 ( Tae Hyung Han ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Major burns can alter the pharmacokinetics of the commonly used drugs during the perioperative period. This study was carried out to define the pharmacokinetics of propofol in the burned patients during the subacute hyperdynamic phase of the injury. Methods: Twenty adults, aged 43.7 ± 2.3 years, with total body surface area burn of 44.0 ± 22.2%, were examined at 14.1 ± 2 days after the injury (mean ± SD). Age and sex gender matched unburned patients were used as controls. Propofol 2 mg/kg was given intravenously over 10 seconds as a single bolus in both groups. Blood samples (n = 20) were collectedat predetermined intervals. A noncompartmental approach was used for the pharmacokinetic analyses of the propofol concentrations, which were determined by HPLC. The cardiac index was measured by esophageal echocardiography. Results: The burns patients had a significantly higher cardiac index (CI). The clearance (CI) and total volume of distribution (Vd) of propofol were higher in the burns patients, compared with the controls, yielding a smaller area under the curve. The total half-life (t1/2) was similar in both groups. Conclusions: There is a large increase in Vd and CI in the burns patients compared to with the controls. The increased Cl in the burns patients is most likely to be related to the increased CI. Therefore, the initial bolus dose and maintenance infusion may have to be increased in the burns patients, provided the pharmacodynamic sensitivity is unaltered. (Korean J Anesthesiol 2006; 51: 285~91)
임상연구 : 중화상 환자에서 Mivacurium의 신경근 약역학
정미화 ( Mi Hwa Chung ),정진경 ( Jin Kyung Jung ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),최영룡 ( Young Ryong Choi ),원임수 ( Rim Soo Won ),한태형 ( Tae Hyung Han ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Burned patients sometimes require rapid onset of neuromuscular paralysis to secure the airway in full stomach patients or to treat laryngospasm. Because of poor lung function and hypermetabolic state, they desaturate quite rapidly. Burned patients are usually resistant to the effects of nondepolarizing relaxants. Mivacurium can be potentially a good alternative for rapid onset of paralysis, since it is metabolized by plasma cholinesterase, an enzyme often decreased in subject with major burns. This prospective study was conducted to define the neuromuscular pharmacodynamic profile of a single bolus dose of mivacurium in adult patients with major burns. Methods: Adults (M/F = 22/8), aged 44.0 ± 10.2 years, with total body surface area (TBSA) burn of 35.0 ± 12.5% were studied at 39.8 ± 28.9 post burn days. Age and sex matched 30 non-burned patients served as controls. Anesthesia was consisted of propofol and fentanyl infusion with nitrous oxide and oxygen. Mivacurium 0.2 mg/kg was administered as a bolus. Using TOF Watch, neuromuscular block was monitored with T1 response after the initial tetanic stimulation to recruit all muscle fibers. Onset time was defined as the interval from the beginning of drug administration to maximal twitch suppression. Intubation was attempted at 1 minute after the drug administration to simulate the rapid sequence induction with recording of either failure or success of intubation. By allowing spontaneous recovery without reversal drug, recovery profiles of neuromuscular paralysis were also measured. Results: Patients demographics were similar in both groups except for the burn. Onset times and all recovery profiles were significantly prolonged in the burned versus non-burned groups. Attempts at intubation at 1 minute after the drug administration were successful with difficulty in approximately 70% of patients in both groups. Conclusions: Mivacurium 0.2 mg/kg demonstrated the conflicting dual responses in the burned patients. The prolonged onset time suggests resistance to neuromuscular effects. The prolonged recovery suggests increased sensitivity. This can be partially explained by the acetylcholine receptor proliferation and decreased level of plasma pseudocholinesterase. In view of the prolonged onset time of almost two minutes for maximal paralysis, mivacurium does not appear to be a good drug for rapid onset of paralysis in burns. (Korean J Anesthesiol 2006; 51: 541~6)
척추경막외 병용마취 합병증으로 오인된 종말끈에서 기원한 부신경절종
전주현 ( Joo Hyun Jun ),이미현 ( Mi Hyun Lee ),최은미 ( Eun Mi Choi ),김은미 ( Eun Mi Kim ),최영룡 ( Young Ryong Choi ),이영섭 ( Young Sub Lee ),이효근 ( Hyo Keun Lee ),정미화 ( Mi Hwa Chung ),박성욱 ( Sung Wook Park ) 경희대학교 경희의료원 2015 慶熙醫學 Vol.30 No.1
Paragangliomas are neuroendocrine tumors that occur throughout the body, particularly the head and neck. But paragangliomas of the central nervous system are uncommon and usually arise from cauda equina, spinal nerve root and filum terminale. Spinal paragangliomas clinically present with pain and neurologic deficits. Because of these nonspecific symptoms, it is difficult to distinguish spinal paraganglioma from epidural hematomas. Magnetic resonance imaging (MRI) is currently the best modality demonstrating details of spinal paragangliomas, although it could not confirm the spinal paraganglioma. We report a case of paraganglioma occurred from filum terminale; A patient, who was presented neurologic symptom after cesarean section via combined spinal-epidural anesthesia, had suffered from mild back pain.
실험연구 : 전자회로기판 히터를 이용한 고열효율 휴대용 수액 혈액 가온기의 유속에 따른 가온능력 및 안정성 평가
정성원 ( Sung Won Jung ),한태형 ( Tae Hyung Han ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),정미화 ( Mi Hwa Jung ),원임수 ( Rim Soo Won ),최영룡 ( Young Ryong Choi ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Currently available warming devices are often heavy and cumbersome, requiring development of more portable, user friendly, high efficiency fluid and blood warmer. The intravenous fluid heating capabilities of a new, heat-plate print circuit board (PCB) based warmer at various low flow rates were tested. Methods: Model Joyother BM-1® was investigated for normal saline (0.9% NaCl) and colloid at various infusion rates (60-6000 ml/hr). Final temperatures were measured by electronic thermometer after passing through the warmer. Effective warming was defined as a fluid temperature ≥ 32℃. Ambient temperature was maintained at 22-25℃. Degree of heating capability and temperature decrease were compared and correlated between different flow rates. Results: The device warmed the room temperature crystalloid and colloid efficiently. Its warming capability was continuously improved as the flow rates increased in all tested flow rates, reaching maximum 41℃. After the warming, the temperature decrease showed high negative correlation with the flow rates. The extent of cooling was less in colloid. No overheating was noted at sudden brake. Conclusions: Joyother BM-1® heated crystalloid and colloid sufficiently and safely enough for clinical application (exit temperature ≥ 35℃) at various flow rates. The warming capacity and the length of the intravenous tube infusion system determined the efficiency of the warmer. Further study is warranted for the efficiency of warming for the blood and its element changes. (Korean J Anesthesiol 2006; 51: 598~605)