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사각근간 차단을 이용한 어깨 관절경수술에서 좌위에 따른 Bezold - Jarish 반사
이두익(Doo Ik Lee),원시권(Shi Gwen Won),김동우(Don 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: We have noted a high incidence of vasovagal episodes associated with use of interscalene block(ISR) for shoulder arthroscopy in the sitting position. The purpose of this retrospective study is to alert the possibility of potentially dangerous vasovagal events, describe the characteristics of this problem, and propose therapeutic devices. Methods: Results 62 patients who underwent shoulder arthroscopy in the sitting position with ISB were retrospectively analyzed. Group 1, 10 patients experienced vasovagal events characterized by sudden hypotension and bradycardia. Remaining 52 patients, Group 2, did not experience these symptoms. All patient charts were reviewed for age, sex, side of surgery, premedication, preoperative fluid and intraoperative medications. Perioperative hemodynamic changes were also compared between the two groups. Results: Vasovagal events experienced in 16% of patients(10/62) and occurred 39+ 18 min after sitting position and 22+18 min after start of operation. Number of patients who receiving anticholinergics for premedication were significantly lower in Group 1 than Group 2(2/10 vs. 28/52, p<0.05). Conclusions: Bezold-Jarish reflex is a potential mechanism for sudden hypotension and bradycardia which can occur during shoulder arthroscopy in sitting position. Therefore anticholinergic pretreatment and meticulous monitoring during operation are recommended to prevent B-J reflex
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다기관 기능부전을 초래한 치명적인 삼일열 말라리아 증례
박상원,김동우,박주원,이순일,신영학,김의종,오명돈,최강원 대한감염학회 2005 감염과 화학요법 Vol.37 No.2
삼일열 말라리아는 국내에서 재유행하고 있는 감염질환으로, 일반적으로 양성의 임상경과를 거친다. 저자들은 특이한 질병력이 없이 건강하였던 젊은 성인이 국내에서 삼일열 말라리아에 걸린 후 다기관기능부전과 폐출혈으로 사망한 증례를 경험하였다. 환자의 중증 임상경과를 설명할 만한 특이한 인자가 발견되지 않았다. Vivax malaria is a re-emerging infectious disease in Korea with cumulating 19,416 cases as of December 2003 since 1993. Vivax malaria is generally a benign disease with few severe complications. Even in the worldwide literature, there are only small number of case reports on severe complications. We experienced a fatal vivax malaria in a previously healthy young adult with severe multi-organ failure and fatal massive pulmonary hemorrhage. The patient presented with abdominal pain and shock. There were splenic hemorrhage, disseminated intravascular coagulation, oliguric acute renal failure requiring dialysis, and pulmonary hemorrhage leading the patient finally to death. The initial parasitemia was 2,046/μL. Thin smear and PCR revealed only Plasmodium Vivax. There was no explainable cause of death except for the only serological suggestion of Mycoplasma pneumoniae infection without correlating clinical evidence. This is a first case of fatal vivax malaria in Korea since its re-emergence in 1993. Further case monitoring is needed to define whether this is a index case or an isolated one.
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