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길현자,문도호,Gil, Hyeon-Ja,Mun, Do-Ho 한국호스피스협회 2007 호스피스 학술지 Vol.7 No.2
Purpose: Hepatocellular carcinoma is the 3rd leading cause of cancer death in Korea and its prognosis is very poor. We aimed to investigate the clinical characteristics of terminal patients with hepatocellular carcinoma on admission into a hospice unit, and to know if they had received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 62 patients with hepatocellular carcinoma who had admitted, received palliative care, and died in a hospice unit between January 2003 and December 2005. Results: The median age of patients was 56.5 years with 50 men(80.65%) and 12 women(19.35%) and gender ratio(male to female) was 417. Child-Pugh class A, B, and C were 6(9.68%), 22(35.38%), and 34(58.84%) respectively. We divided the patients into two groups and compared, the terminal HCC patients with class C as group I and those with class A & B as group 2. The median time from hospice referral to death was significantly short in group 1 with 15.5 days compared to group 2 with 53 days. Statistically more prevalent symptoms in group I were ascites, dyspnea, peripheral edema, and hepatic encephalopathy with abnormal laboratory findings (jaundice, hypoalbuminemia, or renal insufficiency). There, however, was no significant difference in complications and managements during admission between group 1 and 2. Conclusion: Most terminal HCC patients were often accompanied with chronic liver disease. The length of hospice and palliative care for above patients was not enough to attend them. Therefore, we suggest that proper education and information should be provided to physicians, patients, and their family members for effective hospice and palliative care.
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재발성 난소암 환자에서 복강내 온열관류요법 시행중 발생한 극심한 대사성 산증
유건희,문동언,길현자,김영철 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.4
Intraperitoneal hyperthermic perfusion(IPHP) was performed under combined epidural & general anesthesia in 57 year old female patient with recurrent ovarian cancer. She had past history of diabetes mellitus. Metabolic acidosis & hypokalemia were already developed before IPHP and aggravated during IPHP. NaHCO3 300mEq & KCl 40mEq were administered intravenously for three hours. In this case, we deduced that the causes of metabolic acidosis may be anaerobic glycolysis due to peripheral circulatory impairment from hypothermia, degradation of tumor cells by hyperthermia, and poor general condition with prolonged operation. The causes of hypokalemia were suspected to be continuous infusion of regular insulin, massive NaHCO3 administration, and diabetic ketoacidosis. Therefore, we recommend when performing IPHP in DM patient, precise preoperative evaluation and careful monitoring of arterial blood gas & electrolyte. (Korean J Anesthesiol 1997; 32: 673∼676)
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Buerger 병 환자의 통증 치료에서 경막외 Clonidine 투여의 임상적 고찰
유건희(Keon Hee Ryu),길현자(Hyeon Ja Kil),서재현(J 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2
N/A Buergers disease(Thromboangiitis Obliterans) is characterized by peripheral arterial occlu- sion of the extremities in young smokers, and leading to ischemia of the tissue and gangrene. Most of these patients suffered from severe pain. Therapy for Buergers disease not enable to undergo reconstructive arterial surgery has been discouraging while multiple modes of analge- sics have advanced. Eight subjects who had been operated due to Buergers disease or diagnosed with this disease were evaluated retrospectively. Continuous epidural block was done at L 2-3 or L3-4 inter- vertebral space and multiday continuous infusor was connected to epidural catheter. The con- tent of the infusor was clonidine-bupivacaine or clonidine-morphine-bupivacaine mixture. The minimum dose of clonidine was 75 μg/day and the maximum 450 μg/day. The results were as follows: 1) The analgesia produced by clonidine was superior to any other analgesics. 2) The incidence of the side effects produced by clonidine-bupivacaine mixture were less than that of clonidine-morphine-bupivacaine mixture. 3) Minimum dose of clonidine for the pain relief was required more than 225 μg per day. From the above results, we recommend that clonidine is an effective agent to provide pain relief for the patients with Buerger's disease.
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