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임신에 의해 악화된 원발성 하지불안증후군(restless leg syndrome)의 치료
김시선 ( Shi Sun Kim ),안치옥 ( Chi Ok Ann ),조은규 ( Eun Kyu Cho ),심현진 ( Hyun Jin Shim ),김윤숙 ( Yun Sook Kim ),배동한 ( Dong Han Bae ),양광익 ( Kwang Ik Yang ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.10
Restless leg syndrome (RLS) is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs, occurring during periods of rest, evening and night. These symptoms can be improved by movement. There are two different phenotypes of RLS. One early-onset form starts before 36 years old. It has mostly a familial history, severe symptoms, and highly genetically determined. And it is a highly dependent to iron level of the brain. The other delayed-onset form starts after 36 years old, mostly secondary, without familial history, with a rapid evolution in two or three years. And it is associated with frequent low ferritin level of serum. Pathophysiology of RLS remains incompletely understood. However, advanced studies suggest that RLS may be generated by dopamine dysfunction locally within the central nervous system. Dopaminergic agonists are the treatment of choice, if the symptoms are severe. And iron therapy improves RLS symptoms in iron deprived patients. Early detection during pregnancy is needed because RLS gives an important impact on sleep efficiency and quality of life. Recently we have experienced a case of primary RLS patient diagnosed at 24+3 weeks, treated by dopaminergic agonist ropinirole and iron. We describe this case with a brief review of the literature.
우리나라 응급의학과 수련병원 내의 초음파 사용 현황 및 실태, 전공의 교육과정에 대한 조사
안치원,김창선,강보승 대한응급의학회 2013 대한응급의학회 학술대회초록집 Vol.2013 No.2
Purpose: This study is aimed to investigate the availability and use of emergency physician-performed ultrasound in the emergency department (ED) and the status of ultrasound education in ED residency training programs of the teaching hospital in Korea. Methods: We e-mailed the link of web-based survey, that consist of multiple-choice and rating scale - 20 questions, to all 81 residency training directors of the teaching hospital in Korea in September 2013. Results: The response rate was 60.5% (49/81). Of respondents, all had their own ultrasound machine in the ED. 77.5% of respondents reported that the ultrasound for adult patients was usually performed every day, whereas only 25.7% performed the pediatric ultrasound every day, moreover, 48.6% performed the pediatric ultrasound less than once a week. 76.9% of respondents had education programs for adult ultrasonography in residency training, but only 18.4% had the programs for pediatric ultrasonography. The faculty most commonly participated in instructing ultrasonography to ED residents were emergency physicians (76.3%). 89.5% of respondents reported that they had an image review/feedback process by the faculties. The training directors agreed that the emergency physician-performed ultrasonography could shorten ED stays (71.1%), improve the quality of care (86.8%) and patients`satisfaction (73.7%). Conclusion: The distribution rate of ultrasound machine in the ED of teaching hospitals in Korea was very high and many training directors agreed with the value of emergency physician-performed ultrasonography. Nevertheless, the availability of pediatric ultrasonogrpahy was still low, which is probably due to the insufficiency of the education program.
산전 초음파로 진단된 태반 기저층의 광범위 경색에 의한 태아사망
안치옥 ( Chi Ok Ahn ),김시선 ( Shi Sun Kim ),조은규 ( Eun Kyu Cho ),심현진 ( Hyun Jin Shim ),김윤숙 ( Yun Sook Kim ),배동한 ( Dong Han Bae ),양승하 ( Seoung Ha Yang ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.1
Placental infarction is a localized area of ischemic villous necrosis, resulting from interruption in maternal blood supply. These have been associated with postterm pregnancies, maternal hypertension, and anticardiolipin antibodies. Most are due to thrombotic occlusion of an uteroplacental artery. But, infarction in the basal layer of the placenta is very rare and characterized histologically by massive deposition of fibrin. The etiology remains uncertain. However, it has clearly associated with significant perinatal morbidity and mortality including stillbirth, preterm birth, and intrauterine growth restriction. This condition has been diagnosed by prenatal ultrasonography with hyperechoic areas along the maternal side, but extending through much of the placental tissue. Recently we have experienced a case of extensive infarction in the basal layer of the placenta diagnosed by prenatal ultrasonography at 17 weeks, resulted in stillbirth. We describe this case with a brief review of the literature.