Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향

최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-

Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.

니켈-크롬 합금에 폭로된 치과기공사들에서 자매염색분체 교환 빈도

신민정,성재혁,김웅철,이세훈 가톨릭대학산업의학센타 산업의학연구소 2002 韓國의 産業醫學 Vol.41 No.2

Nonprecious metal alloys were used in dental laboratories, may contain nickel, chromium, cobalt, molybdenum, beryllium, and small amounts gallium, ruthenium, or aluminum. Nonprecious metal alloys tend to rapid increase in use due to the economical merit. Despite the widespread use of Nickel-Chromium alloys, claims for safety of these alloys have not yet been accepted universally. This study was performed to investigate cytogenetic toxicity of Nickel-Chromium alloy in human cultured lymphocytes by sister chromatid exchange(SCE) which is a sensitive indicator of carcinogen and mutagen. Total subjects was divided into the two groups, including 34 Nickel-Chromium alloy exposed dental technicians and 24 control group members. 1. The frequencies of SCE were high in older than 40 years, but these was no statistical significance in two groups. 2. The effect of smoking on SCE values as higher than non-smokers in two groups, but there was no statistical significance. 3. The work duration also affected SCE frequencies, but these values didn't show any statistical difference between two groups. 4. The significant difference of SCE frequencies was found between Nickel-Chromium alloy exposed group and control group. 5. The SCE frequencies of current smoking exposed group was the highest and that of non-smoking control group was the lowest. The present study has shown that occupational exposure to Nickel-Chromium alloy is associated with an increase in SCE frequency.

Vecuronium에 의한 기관내 삽관시 안압 및 심맥관계에 미치는 영향

신용섭,이정은,최세진 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.1

The effects of muscle relaxants(vecuronium, pancuronium, d-tubocurarine, and succinylcholine) for endotracheal intubation on intraocular pressure, blood pressure, heart rate, and arrhythmia were studied in 60 patients undergoing general anesthesia, The patients were divided into 4 groups : vecuronium group (0. 1 mg/kg), pancuronium group (0.08 mg/kg), d-tubocurarine group(0.4 mg/kg), and succinylcholine group(1 mg/kg) according to be administrated. Before induction of anesthesia, initial measurement of intraocular pressure (control value) was taken with Schiotz tonometer after instilling of a 0. 5% pontocaine on conjunctival sac. Subsequent measurement were undertaken as soon as the lid reflex was lost after thiopental sodium injection and then at 75-100% depression of first twitch height of train-of-four after intravenous administration of muscle relaxants. It was measured at 1, 3, 5, 10 minutes after endotracheal intubation too. Blood pressure (systolic and diastolic), heart rate, and ECG abnormalities were observed in all cases. The results were as follows; 1. After thiopental sodium injection, intraocular pressure(IOP) decreased than the control value. 2. At 70-100% depression of first twitch height, IOP decreaeed significantly in vecuronium, pancuronium and d-tubocurarine group, but increased significantly in succinylcholine group than the control value. 3. After 1 minute of endotracheal intubation, IOP increased in all groups. There was no stastistical significance in vecuronium group compared with the control value. 4. After 3 minutes of endotracheal intubation, IOP decreased in all groups. 5. The changes of systolic and diastolic blood pressure and heart rate in vecuronium group were the smallest value among all groups. 6. There was no arrythmia in vecurouium group.

뇌종양 환자의 제왕절개술을 위한 전신마취 : 증례 보고 A case report

이헌근,전세현,손주태,신일우,정영균 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

A 28-year-old primigravida at 33 weeks gestation was referred to our hospital because of aggravation of seizures which occurred intermittently for the past 2 years. A brain magnetic resonance imaging scan taken at 33 weeks gestation showed a large brain tumor (7 × 5 × 4 cm) in the left high frontal lobe. She had a cesarean section under general anesthesia at 38 weeks and 1 day gestation. General anesthesia was induced with thiopental 250 mg, succinyleholine 75 mg and lidocaine 60 mg after a vecuronium 0.8 mg intravenous injection. The hyperventilation and mannitol used to reduce increased intracranial pressure (ICP) in this patient may be harmful and detrimental to the fetus before delivery. Achieving both ICP control and fetal well being at the same time during a cesarean section can be challenging to anesthesiologists. We report the anesthetic management of a cesarean section in a patient with a large brain tumor. (Korean J Anesthesiol 2002; 43: 515~519)

Single Median Maxillary Central Incisor(SMMCI) 환아의 증례보고

신윤경,김영재,김정욱,장기택,이상훈,한세현,김종철 大韓小兒齒科學會 2007 大韓小兒齒科學會誌 Vol.34 No.4

Anatomic abnormalities of teeth development include the presence of a single maxillary central incisor at midline instead of two central incisors. The incidence of cases with a single maxillary central incisor is approximately 1 in every 50,000 live births. single median maxillary central incisor(SMMCI) may be a integral manifestation of anyone of a number of syndromes. It has been reported an association with several midline disorders which have varied in severity. A SMMCI has also been reported as an isolated finding. But in some cases, it has been considered as an incomplete expression of autosomal dominant holoprosencephaly. So any patient who appears for treatment with a SMMCI should be referred for a detailed medical examination to exclude other associated systemic abnormalities and for mutation analysis to facilitate correct diagnosis and the provision of appropriate genetic counseling. Early orthodontic treatment is needed to minimalize emotional trauma of child. This case report was about three patients with a SMMCI as isolated finding. The purpose of these case reports was to present cases of single maxillary central incisor not associated with other disorders. Single Median Maxillary Central Incisor(SMMCI)는 상악 중절치 형성부전으로 하나의 상악 중절치가 정중앙에 위치하는 치아 발달의 해부학적 이상을 의미한다. 50,000명 중에 1명 꼴로 발생할 정도로 아주 드물며 각종 증후군 및 정중선 이형성을 보이는 발달장애와 연관되어 나타나는 것으로 보고되고 있다. SMMCI는 다른 이상과 연계되지 않고 독립적으로 나타날 수도 있으나 상염색체 우성유전인 전전뇌증(holoprosencephaly)의 경미한 발현일 가능성이 있으므로 유전자 상담이 필요하다. 또 특징적인 안모 및 구강 상태를 보이므로 환아의 바람직한 신체적,정서적 발달을 위해 조기에 교정적 접근이 필요하다. 본 증례는 다른 이상 소견을 보이지 않는 세 명의 SMMCI 환아의 증례를 보고하는 바 이다.

간호사에서 항암제 취급양상과 건강증상

신혜숙,이세훈 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To evaluate the subjective symptoms among nurses handling anticancer drugs, we investigated symptom prevalence in 487 nurses exposed to anticancer drugs and 242 control nurses, who are working at 14 university hospitals in Korea by self-administered questionnaire. Safety regulations for handling anticancer drugs in these hospitals as well as the level of knowledge on safety rules of them among nurses were also evaluated. The results were as follows: 1. Only 1.5% of nurses used the biological safety cabinet always, 32.7% could not use it during evening time and on holidays, and 65.8% could not use at all since lack of it. When nurses prepared anticancer drugs, they were gloves(49.7%), gown(7.2%), goggle(1.6%), and mask(11.5%). And 46.1% of them answered that they ate and drank in the anticancer drugs preparation room. 2. The level of knowledge on safety rules of anticancer drugs were generally low in both exposed(12.7/17 items) and control(12.7/17 items) group. The questions which nurses answered wrong exceeded fifty percent were : the possibility of exposing to anticancer drugs when they correct their make-ups; and when they handled body fluids of cancer patients. Only 20.3% of the nurses were acknowledged with the hours for the cancer patients' body fluids being considered to be contaminated after receiving chemotherapy. 3. The prevalence of allergic disease was higher in exposed group than in control group. Among 43 symptoms of total, the prevalence of 10 symptoms (nausea, skin rash, itching, chronic throat irritation, tachycardia, alopecia, skin hyper pigmentation, loss of libido, leukopenia, thrombocytopenia) were higher in exposed group than in control group. 4. The prevalence of ten symptoms which showed higher prevalence in exposed group was significantly correlated with eating and drinking in the preparation room for anticancer drugs, the degree of skin contact with anticancer drugs, and the amount of anticancer handling them, and BMI. It was shown that eating and drinking in anticancer drug preparation room, and the amount of handling them, significantly affected the prevalence of 10 symptoms among nurses exposed after stepwise multiple regression analysis. The results of this study suggest that nurses handling anticancer drugs have potential risk of exposure to anticancer drugs, and the preventive measures for the protection of nurses' health be needed by education, and improvement of their working environment.

코일과 클립을 선택적으로 적용해서 성공적으로 치료했던 다발성뇌동맥류 1례 : A case report

이덕구,김범태,황선철,임수빈,이세영,신원한 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

The author report a case of multiple cerebral aneurysm successfully treated with an appropricate selection of surgical clipping and coil embolization. A 64 years old female patient was admitted with stuporous consciousness. Initial 3D CT angiography showed diffuse subrarachnoid hemorrhage on the basal cisterns, saccular aneurysms on the terminal basilar artery and right middle cerebral artery(MCA). Converntional angiography confirmed the ruptured aneurysm was basilar one. Coil embolization was perfromed on the basilar aneurysm with 6 Guglielmi detachable coils(GDC) on the 3 days after ictus. Sugical clipping was done on the unruptured right MCA aneurysm on 10 days after ictus without any morbidity. Each treatment modalities can be appropriate indicated for the coiling or clipping aneurysms.

Stem cell과 Myeloperoxidase가 스티렌, 하이드로퀴논 및 트리클로로에틸렌에 의한 림프구의 자매염색분체 교환과 소핵체 유도에 미치는 영향

이경재,김형아,신민정,성재혁,박정일,한훈,이세훈 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.3

목적 : 스티렌, 하이드필퀴논 및 트리클로로에틸렌 (TCE)이 사람의 stem cell과 human myeloperoxidase (MPO)에 의해 대사성 활성화되는 지를 규명하고자 스티렌, 하이드로퀴논 및 TCE에 사람의 stem cell 또는 MPO 효소의 첨가가 이들 화학물질에 의한 자매염색분체교환(SCE)과 소핵체 (MN) 빈도에 미치는 영향을 관찰하였다. 방법 : 건강한 남자의 전혈에서 림프루를 분리하여 72시간동안 이중배양하되 배양개시 24시간만에 0.05mM 하이드로퀴논, 1.50 mM 스티렌, 혹은 1.50mM TCE를 전체용량이 30 ㎕가 되도록 아세톤에 희석하여 배양액에 주입하였고 대조군은 아세톤으로 처리하였다. 화학물질 처리 후 즉시 1.3×106 및 2.6×106 cells/ml 농도의 제대혈액으로부터 나온 stem cell 세포액의 상층액이나 1.0 및 2.0 unit의 human myeloperoxidase를 H2O2와 함께 첨가하였다. SCE분석을 위한 배양액에는 배양종료 2.5시간 전에 colchicine을 가한 후 수확하여 Giemsa염색을 하여 metaphase 세포에서 SCE빈도를 분석하였다. MN분석을 위한 배양액에는 배양개시 44시간만에 cytochalasin-B를 가하였고 acridine orange 염색 후 이핵체에서 MN수를 분석하였다. 결과 : 1. stem cell이나 MPO 자체는 SCE나 MN의 빈도에 영향을 미치지 않았다. 2. stem cell이나 MPO는 스티렌에 의해 유도되는 SCE의 빈도를 용량-반응관계로 유의하게 증가시켰고, MN빈도의 경우 step cell이나 MPO에 의해 증가되는 경향이 있었으나 2.0 unit MPO를 첨가한 경우에만 첨가하지 않은 경우에 비하여 유의하게 증가하였다. 3. 하이드로퀴논은 stem cell이나 MPO가 없는 상태에서도 대조군에 비하여 SCE빈도가 대조군에 비하여 높았다. stem cell이나 MPO는 하이드로퀴논에 의한 SCE 빈도를 용량 반응관계로 유의하게 증가시켰지만, MN의 경우에는 증가시키는 경향만 있을 뿐 유의한 차이는 아니었다. 4. TCE자체는 SCE나 MN빈도를 증가시키지 않았다. stem cell은 1.3 ×106 및 2.6 × 106 cells/ml 농도 모두에서 SCE빈도를 유의하게 증가시켰고 MPO는 2.0 unit농도에서만 유의하게 증가시켰다. stem cell이나 MPO모두 TCE에 의한 MN빈도를 증가시키는 경향이 있었으나 유의한 차이는 아니었다. 결론 : 저자들은 스티렌, 하이드로퀴논, 및 트리클로로에틸렌에 의해 유도되는 자매염색분체교환과 소핵체의 빈도가 사람의 stem cell이나 myeloperoxidase에 의해 증가됨을 발견하였으며, 이러한 결과는 myeloperoxidase가 이들 물질의 대사성활성화에 관여함을 암시하고, 또한 아마도 이 물질들의 골수독성과 관련이 있는 것이라고 제시된다. Objectives : The objective of this study was to identify the possible role of stem cell and myeloperoxidase (MPO) in the metabolic activation of styrene, hydroquinone and trichloroethylene, by investigating the effects of stem cell from umbilical cord blood and MPO on the frequency of sister chromatid exchange (SCE) and micronuclei (MN) induction in cultured human peripheral lymphocytes exposed to hese chemicals. Methods : Islated lymphocytes from whole blood were cultured for 72 hours. The cells were treated with 1.50 mM styrene, 50 μM hydroquinone and 1.50 mM trichloroethylene dissolved with acetone (30㎕ in total volume) at 24 hours after the beginning of culture. Control group was treated with acetone only. Immediately after adding these chemicals, 1.3×106 cells/ml and 2.6×106 cells/ml stem cell/ml stained with Giemsa's solution, and acridine orange for sister chromatid exchange, and for micronucleus analysis, respectively. Results : The results were as follows: 1) Myeloperoxidase and stem cell did not significantly affect the frequencies of SCE or MN in the control group. 2) The frequency of SCE or MN with exposure to styrene did not different from control in the absence of stem cell or MPO. Sister chromatid exchange induced by styrene was significantly increased by adding stem cell or MPO in dose-dependent relationship. The frequency of MN induced by styrene significantly increased in the presence of 2.0 unit MPO. 3) The frequency of SCE was significantly increased with exposure to hydroquinone than acetone treated control in the absence of stem cell or MPO. Sister chromatid exchange induction by hydroquinone significantly increased dose-dependently in the presence of stem cell or MPO. There was a tnendency of increase of the MN frequency induced by hydroquinone in the presence of stem cell or MPO, but not significant. 4) It was found that trichloroethylene itself did not increase SCE or MN frequency. Frequency of SCE induced by trichloroethylene was significantly increased with adding stem cell (low and high) and 2.0 unit MPO. Even though them cell or MPO increased the frequency of MN of lymphocyte exposed to trichloroethylene, the difference was not significant. Conclusions : Authors found that the frequencies of both sister chromatid exchange and micronucleus induced by styrene, hydroquinone, and trichloroethylene were increased significantly with the treatment of stem cell or myeloperoxidase. It was suggested that myeloperoxidase may therefore play an important role in the metabolic activation of styrene, hydroquinone, and trichloroethylene and myeloperoxidase probably be involved in the myelotoxicity of these chemicals.

2급 와동 수복 시 한국 치과 의사들의 복합레진 사용 실태 연구

신동호,박세은,양인석,장주혜,이인복,조병훈,손호현 대한치과보존학회 2009 Restorative Dentistry & Endodontics Vol.34 No.2

본 연구는 2008년 1월 현재 한국 치과의사들의 복합레진 사용 실태에 관한 설문 조사로서, 2급 와동을 수복하는 증례에서 치과의사의 면허 년도, 교육 배경 및 진료환경 등에 따라 수복재료의 선택, 복합레진의 사용여부 및 사용방법, 문제점 등을 비교하였다. 한국 치과의사들을 대상으로 2급 와동 수복에 관한 17 문항의 설문지를 제작하였다. 이 설문지는 시술자 정보 2급 와동의 수복으로 크게 2부분으로 나누어진다. 이 설문지는 대한치과의사협회를 통해 12.193 명의 치과의사들에게 E-메일로 발송되었다. 이 중 2.612개의 메일이 수신 확인되었고 840 개의 설문지가 작성되어 회신되었다. 수신 확인된 메일 수에 대한 회신된 메일 수의 비율 (회신율)은 32.2%이었고, 이 자료는 SPSS프로그램에서 카이제곱 분석을 이용하여 교차 분석하였다. 답변자의 비율은 면허년도를 기준으로 1998 ~ 2007년에 면허를 취득한 그룹 (한국 전체 치과의사의 33 3%, 추정 년령 26-35세)이 60.3%로 1997년 이전에 면허 취득한 그룹 (한국 전체 치과의사의 66.7%.추정 년령 36세 이상)의 39.7%보다 높은 것으로 나타났다. 또한 이들이 근무하는 병원은 개인의원 (77%)이 가장 많았고 남자 치과의사(79%)가 많았다. 복합레진 수복에 대한 지식은 학생 때 수업이나 학회, 세미나를 통하여 (83.4%) 얻은 것으로 나타났다. 2급 와동 수복 시 재료 선호도를 살펴보면 금인레이가 65.7%를 차지하고 있고 복합레진 직접 수복은 12.1%로 낮게 나타났다. 2급 와동의 복합레진 직접 수복 시 시술 방법에 있어서는 러버댐을 사용하지 않거나 잘 사용하지 않는 그룹의 비율(74.4%)이 더 많았고. 격벽법으로는 mylar strip (53.4%)이나 metal matrix (33.8%), Palodent svstem (6.5%)를 사용하였다. 충전은 적층법 (99.6%)을 사용하는 것으로 나타났으며, 시술 시 인접면 형성을 가장 어려워하였다.(57.2%). 2-step 접착시스템 (76%)이 3-step 접착시스템 (16%)보다 많이 사용되고 있었다. 사용하는 레진 제품으로는 Z250(20%)이 가장 많이 사용되고 있었다. The purpose of this study was to assess the current materials, methods and difficulties according to the year of licence and educational background of Korean dentists in Class Ⅱ direct composite resin restorations. Total 17 questions were included in the questionnaire. Questions were broadly divided into two parts first, operator's information and second the materials and methods used in Class Ⅱ posterior composite restoration. The questionnaire was sent to dentists enrolled in Korean Dental Association via e-mail. Total 12,193 e-mails were distributed to dentists. 2,612 e-mails were opened and 840 mails (32.2%) were received from respondents. The data was statically analyzed by chi-square test using SPSS(v 120.1 SPSS Inc. Chicago. IL USA). Male dentists among respondents was 79% 60.3% of the respondents acquired their licences recently (1998-2007) and 77% practiced in private offices 83.4% have acquired their knowledge through school lectures conferences and seminars. For the Class Ⅱ restorations gold inlays were preferred by 65.7% of respondents while direct composite resin restorations were used by 12.1% amalgam users were only 4.4% of respondents. For the restorative technique 74.4% of respondents didn't use rubber dam as needed. For the matrix. mylar strip (53.4%), metal matrix (33.8%) and Palodent system (6.5%) were used 99.6% of respondents restored the Class Ⅱ cavity by incremental layering. Obtaining of the tight interproximal contact was considered as the most difficult procedure (57.2%) followed by field isolation (21%). Among various bonding systems, 22. 6% of respondents preferred SE Bond and 20.2% used Single Bond. Z-250 was used most frequently among a variety of composite resins.

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.