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췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염
이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-
Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.
경막외 신경차단 시술 중 우발적으로 발생한 저산소성 뇌손상
정순호,김세용,김영환,이근무,김영재,최영균,박진우,신치만,박주열 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2
Epidural nerve block is an effective method for postoperative pain control, anesthesia for operation and a diagnosis and treatment in the pain clinic. Epidural nerve block is the most widely practiced procedure, but epidural nerve block can cause serious complications. We report a case of an accidental hypoxic brain injury following several epidural nerve blocks for chronic pain control. The patient had been suffering form lower back pain. About 5 minutes after epdiural nerve block the patient became unresponsive and apneic, had cyanotic face, radial pulse was not felt. We performed resuscitations and about 3 days of ICU care later, the patient showed self respiration, but semicomatous mentality. MRI revealed that the patient has a hypoxic brain injury. We diagnosed the patient as vegetable state.
정희경,김두희,최병순,임현술,신용철,황보근 東國大學校醫學硏究所 1997 東國醫學 Vol.4 No.-
크롬은 산업에서 널리 사용되고 있으나 접촉성 피부염, 점막 자극, 비중격 천공, 천식, 폐암 등 건강에 영향을 미칠 수 있는데 크롬 및 그 화합물의 원자가, 수용성, 농도, 산성도, 폭로기간 및 경로에 따라 독성이 다르다. 약 5개월간 크롬에 폭로된 2명의 근로자에서 비중격 천공이 발생하여 35명 근로자의 작업조건과 건강상태를 조사하였다(페인트 분무 판넬부서 14명, 서스부서 16명, 기타 부서 5명). 공기 중 총크롬의 농도는 0.103-0.318 mg/m³이었고, 6가 크롬농도는 자동분무 중에 0.001-0.060 mg/m³, 수동분무 중에 0.029-0.226 mg/m³이었다. 모든 근로자에서 소변의 크롬농도는 50㎍/L를 넘지 않았으나, 혈액의 크롬농도는 3명에서 3㎍/dL를 초과하였다. 서스부서보다 판넬부서 근로자에서 비강의 미란이나 가피가 더 많이 발견되었다(교차비 7.0). 부서별로는 소변이나 혈액의 크롬농도가 차이가 없었고 비강소견에 따라서도 소변의 크롬농도가 차이가 없었으나, 혈액의 크롬농도는 비강의 미란이나 가피가 있는 경우 유의하게 높았다. 비중격 천공이 발생한 2명의 근로자에서 크롬에 의해 발생할 수 있는 폐나 비갑개, 간 및 신장의 이상소견과 천식은 발견되지 않앗다. 본 사업장에서 크롬에 의한 건강장애를 예방하기 위해서는 수동분무를 자동분무로 바꾸고 분무한 페인트가 완전히 건조한 후 다음 작업을 하여야 한다. 또한 크롬 미스트가 흡입되지 않도록 적절한 호흡기 보호구를 철저히 착용하여야 한다. After discovery, chromium has been widely used in industry. Health hazards of chromium and its compounds are contact dermatitis(allergic and irritant), mucosal irritation, nasal septal perforation, asthma, and lung cancer. Their toxicity depends on valency, solubility, concentration, PH, exposure duration and route. Nasal septal perforation was developed in two workers exposed to chromium for about 5 months, so we surveyed the working condition and health status of 35 workers(14 workers in paint spraying panel line, 16 in sus line and 5 in other line). Air concentration was as follows: total chromium 0.103-0.318 mg/m³, Cr(VI) 0.001-0.060 mg/m³in automatic spraying and 0.029-0.226 mg/m³in manual spraying. Urine chromium concentration was not over 50 ㎍/L in all workers, but blood chromium concentration was over 3 ㎍/dL in 5 workers. Erosion or crust of nasal cavity was detected more frequently in panel line workers than sus line workers(odds ratio=7.0). But blood or urine concentration of chromium was not different according to the job. Urine concentration of chromium was not different irrespective of nasal cavity finding, but blood concentration was high in the workers with erosion or crust of nasal cavity. Two workers with nasal septal perforation did not have any other diseases which can be developed by chromium exposure. To prevent health hazards of chromium in this factory, manual spraying process has to be changed to automatic process, the next process done after paint was absolutely dried, and respiratory protector should be weared to prevent inhalation of chromium mist effectively.
Prevalence and genotypes of pestivirus in Korean goats
Yang, Dong-Kun,Kweon, Chang-Hee,Kim, Byoung-Han,Choi, Cheong-Up,Kang, Mun-Il,Hyun, Bang-Hun,Hwang, In-Jin,Lee, Cheong-San,Cho, Kyoung-Oh The Korean Society of Veterinary Science 2008 大韓獸醫學會誌 Vol.48 No.1
In total, 1,142 serum samples were collected from 223 goat flocks rising in five different regions of Korea. These samples were screened for the presence of border disease virus (BDV) antibodies using an enzyme linked immunosorbent assay. Of the 1,142 samples, we found 47 bovine viral diarrhea virus (BVDV) positive cases (4.1%). These positive serum samples were also examined further by using the virus neutralization test against BDV. In addition, samples were tested for both BVDV and classical swine fever virus (CSFV). All of the samples that were seropositive for BDV also demonstrated positive antibody titers against BVDV and CSFV. Due to their common antigenicity, we also determined further the prevalence and carried out virus neutralization test against three pestiviruses: 314 of the goat samples were screened using reverse transcription polymerase chain reaction with primer pairs specific to common pestivirus genome regions. Overall, 1.6% (5/314) of the samples tested was positive for pestivirus. Based on the nucleotide sequence data and the phylogenetic analysis, three isolates were characterized as BVDV type 1 and two isolates as BVDV type 2. However, none of the isolates could be classified as BDV. These results indicate that BVDV-1 and BVDV-2 are the pestivirus strains circulating among Korean goat populations.
박영수,최창환,안상훈,송건훈,전재윤,한광협,문영명,박영년,정준원,이관식,이현웅,손주혁,정재연 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.4
Background / Aims : The relationship between HBV infection and nephropathy has been reported with some differences according to the investigators and regions studied. Liver biopsis were not performed in most of the reports. In this study both liver and kidney biopsis were performed. The histologic correlation was analyzed between chronic B viral hepatitis and nephropathy. Methods : From January 1985 ro june and hebaturia. Also, a new histopathologic calssification of chronic hepatitis was applied in the assessment of liver disease. Results : Light microscopy of kidneys showed IgA nephropathy in 7 cases(27%) ; minimal change nephrotic syndrome(MCNS) in 1 case (3.8%); and membranous glomerulonephritis(MGN) in 9 cases(34.6%), membranoproliferative glomerulonephritis (MPGN) in 9 cases (34.6%). Among the cases with a higher hepatitis activity index and fibrosis score, the frequency of MGN and MPGN was higher. The hepatitis activity index of cases with MGN was significantly higher than IgA nephropathy and MPGN (p=0.011, p=0.039). The fibrosis score of cases with MGN and MPGN was significantly higher than IgA nephropathy (p=0.011, p=0.003). The positivity of HBeAg was highest in cases with MGN.Serum C3 level was low in all cases but the serum C4 level was within normal range. Immunofluorescence studies showed granular deposition of Ig G and C3 in the capillary loops in MGN. Conclusion : The frequency of MGN and MPGN was higher when the liver disease was more severe. It was suggested that HBeAg, IgG AND C3 might ci\ontribute to the pathogenesis of MGN in HBsAg positive patients.
임상연구 : 목표 농도 조절 주입에서 예측 제지방체중과 실측 제지방체중의 차와 Propofol 혈중농도의 상관관계
최석환 ( Suk Whan Choi ),임세훈 ( Se Hun Lim ),이상은 ( Sang Eun Lee ),김영환 ( Young Hwan Kim ),이정한 ( Jeong Han Lee ),이근무 ( Kun Moo Lee ),정순호 ( Soon Ho Cheong ),최영균 ( Young Kyun Choe ),김영재 ( Young Jae Kim ),신치만 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Background: We evaluated the correlation between the difference of estimated lean body mass (LBM(E)) with actual lean body mass (LBM(A)) and actual blood concentration of propofol, hemodynamic variables and Bispectral index (BIS) during target controlled infusion (TCI) of propofol in Korean female patients who would take total intravenous anesthesia (TIVA) using propofol-remifentanil combination. Methods: Eighty Korean women participated in this trial. Demographic data were collected and LBM(A) was measured using body mass analyzer. Target concentration of propofol was set at 6 μg/ml during induction and 3μg/ml during maintenance. Hemodynamic variables and BIS were measured at 60 minutes after anesthetic induction. Peripheral blood sample was collected from a large forearm vein on the contralateral side of infusion for measurement of whole blood concentration of propofol at 60 minutes after anesthetic induction. Delta lean body mass (ΔLBM) was obtained by subtracting LBM(A) from LBM(E). Correlation analyses were done between ΔLBM and plasma propofol concentration, blood pressure, and BIS, respectively. Results: Blood concentrations of propofol were 1.9-6.9μg/ml. Mean plasma concentration of propofol was higher than target concentration. ΔLBM had a positive correlation with actual plasma propofol concentration. ΔLBM was not correlated with hemodynamic variables and BIS. Conclusions: TCI of propofol resulted in large variation in measured plasma concentration. We thought ΔLBM was one of interpatient variation factors of propofol plasma concentration during TCI. We found that TCI of propofol using Schnider model would result in higher blood concentration than target concentration in Korean women. (Korean J Anesthesiol 2008; 55: 666~9)