대요근 근구차단술에 대한 임상경험

김천숙(Chun Sook Kim),차영덕(Young Deog Cha) 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1

N/A Psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and postoperative pain control. Nowadays this block is advocated for the man- agement of pain in the thighs, legs and lumbar area for various reasons. To relieve pain in the thigh and leg, 2l times of block were performed and observed clinically in the l7 patients at our hospital. The results were excellent for the relief of pain in metastatic cancer patients. And this block is satisfactory in the thigh pain but not in the leg pain. So we recommend psoas compartment block as a useful and simple method for the relief of pain in metastatic can- cer pain in the thigh.

측와위에서 시행한 하 장간막 신경총차단

김천숙(Chun Sook Kim),차영덕(Young Deog Cha) 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1

Inferior mesenteric plexus block(IMPB) is a useful nerve block for the relief of intracta- ble lower abdominal and pelvic pain caused by a lower abdominal visceral or a pelvic ma- lignancy. IMPB has been performed in the prone position. But there are many patients who can't lie in the prone position,because ascites is frequently noticed in cancer patients and they also frezuently received abdominal operations. We performed IMPB in the lateral position on two patients with lower abdominal pain. Case 1: A 77 year old female who had a right ovarian cancer with metastatic cancer of descending colon and rectum, experienced complete pain relief. Case 2: A 72 year old female who had a far advanced pancreatic cancer with intestinal obstruction due to carcinomatosis received right and left celiac plexus block and right and left IMPB.The patient was satisfied with the result of these pain blocks. Conclusion: IMAPB performed in the lateral position on two patients with lower abdomi- nal pain and their results were excellent for pain relief.

Effects of Cyclobuxine D on Carrageenin-induced Pleurisy and Croton Oil-induced Granuloma Pouch in Rats

이종화,박영현,조병헌,김유재,김종배,김정목,김천숙,차영덕,김영석,Lee, Jong-Hwoa,Park, Young-Hyun,Cho, Byung-Heon,Kim, Yu-Jae,Kim, Jong-Bae,Kim, Chung-Mok,Kim, Chun-Sook,Cha, Young-Deog,Kim, Young-Suk The Korean Society of Pharmacology 1987 대한약리학잡지 Vol.23 No.2

Steroidal alkaloid인 cyclobuxine D의 carrageenin으로 유발한 늑막염과 croton oil로 유발한 육아종양에 대한 영향을 관찰하고 그 작용을 aspirin, dexamethasone과 hydrocortisone의 작용과 비교하였다. Carrageenin으로 유발한 늑막염에서 혈장 삼출정도는 pontamine sky blue을 정맥으로 투여하여 20분 동안 늑막염 삼출물로 삼출되어 나오는 양으로 측정하였다. Cyclobuxine D는 용량적으로 삼출물의 양과 20분 동안 삼출되는 pontamine sky blue의 양을 감소시켰다. Cyclooxygenase 억제제인 aspirin과 phospholipase $A_2$를 억제하여 결과적으로 cyclooxygenase와 lipoxygenase의 생성물을 차단하는 dexamethasone은 현저하게 carrageenin으로 나타나는 염증현상을 억제하였다. Cyclobuxine D는 croton oil로 유발한 육아종양에서 종양 부위에 직접 투여하거나 근육내로 투여해도 pouch내 염증물 양과 pouch wall의 무게를 현저하게 억제하였다. Dexamethasone과 hydrocortisone은 육아종양의 형성을 현저히 억제하였으며 , dexamethasone은 근육내로 투여 하였을 때 육아종양 형성을 완전히 억제하였다. 이상의 결과에서 나타난 cyclobuxine D의 항염증 작용은 prostaglandins의 생성억제 또는 polymorphonuclear cell (PMN)의 유주 억제와 밀접한 관련이 있을 것으로 사려된다. Cyclobuxine D, a steroidal alkaloid, was extracted from Buxus microphylla var. koreana Nakai. The effects of cyclobuxine D on carrageenin-induced pleurisy and croton oil-induced granuloma pouch in rats was investigated and compared with those of aspirin, hydrocortisone ana dexamethasone. Intrapleural injection of 2% carrageenin caused the accumulation of exudate. The rate of plasma exudation, measured by the exuded dye amounts for 20 min in the pleural cavity after intravenous injection of pontamine sky blue, showed a peak at 5 hr. Cyclobuxine D (5, 20 and 50 mg/kg, i.p.) suppressed dose-dependently the accumulation of the pleural exudate and the exudation of dye. Among several methods used for screening and evaluation anti-inflammatory agents, granuloma pouch technic introduced by Hans Selye (Hans seyle, 1953) is considered as a simple and reliable method. An air pocket was produced in the subcutaneous tissue of the interscapular region by injection of 1 ml of 1% croton oil as irritant. Inflammatory exudate accumulated in the pouch during the succeding 14 days. Cyclobuxine D (5 and 20 mg/kg) decreased fluid volume in pouch and weight of pouch wall in granulomatous inflammation.

Effects of Cyclobuxine D on the Biosynthesis of Prostaglandins in Vitro, Prostaglandins Production and Leukocyte Migration in Vivo

이종화,박영현,조병헌,김유재,김종배,김정목,김천숙,차영덕,김영석,Lee, Jong-Hwoa,Park, Young-Hyun,Cho, Byung-Heon,Kim, Yu-Jae,Kim, Jong-Bae,Kim, Chung-Mok,Kim, Chun-Sook,Cha, Young-Deog,Kim, Young-Suk The Korean Society of Pharmacology 1987 대한약리학잡지 Vol.23 No.1

Cyclobuxine D was extracted from Buxus microphylla var. koreana Nakai. The effects of cyclobuxine D on the biosynthesis of prostaglandins from arachidonic acid in guinea pig lung, prostaglandin production and leukocyte migration in carrageenin-induced inflammation was investigated. These effects of cyclobuxine D were compared with those of aspirin and dexamethasone. Cyclobuxine D does not inhibit significantly cyclooxygenase in guinea pig lung but reduces prostaglandin concentration and leukocyte migration in inflammatory exudates. These effects of cyclobuxine D differ from that of aspirin which inhibits biosynthesis of prostaglandin in vitro and has a relative small effect on leukocyte migration. Dexamethasone, which does not inhibit cyclooxygenase in vitro, has an effect similar to that of cyclobuxine D on leukocyte migration and prostaglandin production in inflammatory exudates. 본 실험실에서는 회양목(Buxus microphylla var. koreana Nakai)으로 부터 steroid성 alkaloid인 cyclobuxine D를 분리하였고, 그의 여러 약리작용을 검색하고 있다. 본 연구에서는 cyclobuxine D의 guinea pig lung homogenate에서 prostaglandins의 합성에 미치는 영향과 carrageenin으로 유도한 염증에서 prostaglandin의 합성과 백혈구 유주에 대한 영향을 관찰하였다. Cyclobuxine D (up to 100ug/ml)는 guinea pig lung homogenate에 의한 prostaglandins 합성에 대해서는 현저한 영향이 없었으나, 20mg/kg에서 carrageenin으로 유도된 염증에서 prostaglandin의 합성과 백혈구 유주에 대해 현저한 억제작용을 나타낸다. Aspirin은 vivo와 vitro에서 prostaglandin의 합성을 억제하나, 염증 삼출물에서 백혈구 유주에 대해서는 영향이 거의 없다. Dexamethasone은 vitro에서 외인성 arachidcnic acid를 기질로 가했을때는 prostaglandin 합성에 대해 영향이 없었고 carrageenin으로 유도된 염증에서 prostaglandin의 합성과 백혈구 유주를 억제하였다. 이상의 결과로 cyclobuxine D의 항염증작용은 phospholipase $A_2$ activity를 저해하여 항염증 작용을 나타내는 것으로 사료되는 corticosteroid와 유사한 것으로 추정된다.

Effects of Cyclobuxine D on Drug-Induced Contractions of the Isolated Rat Uterine Muscle and Potassium-Activated Calcium Channels in an Intestinal Smooth Muscle

권준택,이종화,박영현,조병현,최규홍,김유재,김종배,김정목,김천숙,차영덕,김영석,Kwon, Jun-Tack,Lee, Jong-Hwoa,Park, Young-Hyun,Cho, Byung-Heon,Choi, Kyu-Hong,Kim, Yu-Jae,Kim, Jong-Bae,Kim, Chung-Mok,Kim, Chun-Sook,Cha, Young-Deog,Kim, Y The Korean Society of Pharmacology 1988 대한약리학잡지 Vol.24 No.1

Buxus microphylla var. koreana Nakai에 존재 하는 steroidal alkaloid인 cyclobuxine D는 흰쥐에 있어 심박동수 감소 작용, 적출 개구리 심장에서 수축력 감소작용, 토끼 적출 장관에서 acetylcholine과 $Ba^{++}$.에 유발되는 수축에 대한 억제작용 등을 나타낸다고 보고되었다. 본 연구에서는 흰쥐 적출 자궁에서 acetylcholine, oxytocin과 $Ba^{++}$에서 의해 나타나는 수축 작용에 대한 cyclobuxine D의 영향을 관찰하였으며, 또 흰쥐 적출장관에서 칼륨에 의해 활성화되는 칼슘채널에 대한 cyclobuxine D의 작용을 관찰하였다. Cyclobuxine D는 흰쥐 적출 자궁에서 acetylcholine, oxytocin과 $Ba^{++}$에 의해 증가되는 peak tension과 duration을 용량적으로 현저히 억제하였다. Cyclobuxine D는 oxytocin보다 acetylcholine에 의해 나타나는 수축작용에 대해 강하게 작용했다. 흰쥐 적출 장관(ileum)을 Ca을 고갈시킨 Tyrode's 용액에 $40{\sim}50$분 담그고 $Na^+$ 대신 $K^+$로 대체시킨 용액에 10분간 담근 후 1.8 mM $CaCl_2$를 가했을 때 이중적인 근육수축작용이 나타난다(Phasic and tonic increase in tension). Cyclobuxine D $(6.2{\times}10^{-5}\;M)$은 이 두 components를 유의하게 억제하였으며 tonic component가 최대치에 도달했을 때 cyclobuxine D $(3.1{\times}10^{-4}\;M)$을 가하면 근육은 긴장도를 빨리 상실했다. 이 결과는 적출 장관에 있어 칼륨에 의해 활성화되는 칼슘 채널이 cyclobuxine D에 의해 차단되고 있음을 나타낸다. 이상의 결과에서 cyclobuxine D의 흰쥐 적출 자궁에 대한 수축 억제 작용은 voltage-dependent calcium channel 차단에 밀접한 관련이 있는 것으로 사려된다. Cyclobuxine D, extracted from Buxus microphylla var. koreana Nakai, is a steroidal alkaloid. Many pharmacological effects of cyclobuxine D were examined in our Lab. Cyclobuxine D showed a significant bradycardic effect in the rat heart and an inhibitory action on acetylcholine and $Ba^{++}-induced$ contraction of the longitudinal muscle isolated from the rabbit jejunum. In this study, we investigated the effect of cyclobuxine D on the contractile response-elicited by acetylcholine, oxytocin and $Ba^{++}$ in rat uterine. In order to analyse the inhibitory action of cyclobuxine D on the smooth muscle, we examined the inhibitory action of cyclobuxine D against the contractile response of the high potassium-depolarized rat ileum to calcium. Concentration-dependent decrease in the peak tension and duration of the acetylcholine, oxytocin and $Ba^{++}-induced$ contraction in the isolated rat uterus was observed when cyclobuxine D was added to the organ bath. The isolated longitudinal muscle from the rat ileum was immersed calcium-depleted potassium-depolarizing solution. Ten minutes after, 1.8 mM $CaCl_2$ was added to muscle bath and elicited a biphasic increase in muscle tension. Cyclobuxine D $(6.2{\times}10^{-5}\;M)$ produced an appreciable inhibition of both components of the mechanical response. In addition, $3.1{\times}10^{-4}\;M$ cyclobuxine D, introduced at a point when the tonic response had reached its maximum level, caused the muscle to exhibit a rapid lose of tension. Based on these experimental results, we propose the possibility that the inhibitory action of cyclobuxine D on the acetylcholine, oxytocin and $Ba^{++}-induced$ contraction in the isolated rat uterus may be due to blocking potassium-activated calcium channels, voltage-sensitive calcium channels.

Cyclobuxine D의 prostaglandin 합성과 백혈구 유주에 미치는 영향

이종화(Jong-Hwoa Lee),박영현(Young-Hyun Park),조병헌(Byung-Heon Cho),김유재(Yu-Jae Kim),김종배(Jong-Bae Kim),김정목(Chung-Mok Kim),김천숙(Chun-Sook Kim),차영덕(Young-Deog Cha),김영석(Young-Suk Kim) 대한약리학회 1987 대한약리학잡지 Vol.23 No.1

본 실험실에서는 회양목(Buxus microphylla var. koreana Nakai)으로 부터 steroid성 alkaloid인 cyclobuxine D를 분리하였고, 그의 여러 약리작용을 검색하고 있다. 본 연구에서는 cyclobuxine D의 guinea pig lung homogenate에서 prostaglandins의 합성에 미치는 영향과 carrageenin으로 유도한 염증에서 prostaglandin의 합성과 백혈구 유주에 대한 영향을 관찰하였다. Cyclobuxine D (up to 100ug/ml)는 guinea pig lung homogenate에 의한 prostaglandins 합성에 대해서는 현저한 영향이 없었으나, 20mg/kg에서 carrageenin으로 유도된 염증에서 prostaglandin의 합성과 백혈구 유주에 대해 현저한 억제작용을 나타낸다. Aspirin은 vivo와 vitro에서 prostaglandin의 합성을 억제하나, 염증 삼출물에서 백혈구 유주에 대해서는 영향이 거의 없다. Dexamethasone은 vitro에서 외인성 arachidcnic acid를 기질로 가했을때는 prostaglandin 합성에 대해 영향이 없었고 carrageenin으로 유도된 염증에서 prostaglandin의 합성과 백혈구 유주를 억제하였다. 이상의 결과로 cyclobuxine D의 항염증작용은 phospholipase A₂ activity를 저해하여 항염증 작용을 나타내는 것으로 사료되는 corticosteroid와 유사한 것으로 추정된다. Cyclobuxine D was extracted from Buxus microphylla var. koreana Nakai. The effects of cyclobuxine D on the biosynthesis of prostaglandins from arachidonic acid in guinea pig lung, prostaglandin production and leukocyte migration in carrageenin-induced inflammation was investigated. These effects of cyclobuxine D were compared with those of aspirin and dexamethasone. Cyclobuxine D does not inhibit significantly cyclooxygenase in guinea pig lung but reduces prostaglandin concentration and leukocyte migration in inflammatory exudates. These effects of cyclobuxine D differ from that of aspirin which inhibits biosynthesis of prostaglandin in vitro and has a relative small effect on leukocyte migration. Dexamethasone, which does not inhibit cyclooxygenase in vitro, has an effect similar to that of cyclobuxine D on leukocyte migration and prostaglandin production in inflammatory exudates.

Gabapentin 단독요법을 이용한 지속적 딸꾹질의 치료 경험

유시현 ( Sie Hyun You ),김천숙 ( Chun Sook Kim ),김병흠 ( Bung Heum Kim ),서환주 ( Hwan Joo Seo ),강규식 ( Kyu Sik Kang ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.2

수술중 감염방지를 위한 공조시스템의 개선방안에 대한 연구

주영철(Joo Youngcheol),김천숙(Kim Chun-Sook),권순정(Kwon Soonjung) 한국산학기술학회 2004 한국산학기술학회논문지 Vol.5 No.6

수술중 감염방지를 위해 수술실의 공조시스템의 개선방안에 대한 연구를 수행하였다. 대학병원들의 수술실과 공조 시스템을 조사하였다. 수술실 내부의 여러 부위에서 공기 샘플을 채취하여 세균을 배양함으로써 수술실내 세균의 분포를 측정하였다. 수술실 단면을 2차원 모델화 하여 공기의 유통을 전산유체해석하였다. 준공한지 오래된 병원의 수술실은 공조시스템이 정화된 신선한 공기를 수술이 진행되는 부위에 효과적으로 공급하지 못하는 것으로 판단되어졌다. 시설비의 큰 증가 없이 환자의 수술부위에 효율적으로 신선한 공기를 공급할 수 있는 시스템을 제안하였다. The air ventilation system of operation rooms has been studied for the prevention of cross infection during the operation. Operation rooms and air ventilation systems of three University hospitals are investigated. The distribution of microbe is measured by cultivating air samples in the operation room. A two-dimensional model for the cross-section of an operation room is developed. for the CFD analysis. The characteristics of air flow inoperation room are calculated by using a CFD program. The current air ventilation system of an old hospital does not deliver the clean air to the operation area efficiently. A new air ventilation method which improves air venting with little increase of the cost of equipment is suggested.

하악신경차단으로 도움받은 삼차신경통환자의 영양섭취 및 간기능회복

차영덕(Young Deog Cha),김천숙(Chun Sook Kim) 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1

It is well known that many patients with trigeminal neuralgia suffer from electric shock-like stabbing pains. The pain can be triggered by nonnoxious stimuli such as touching of the face, chewing, talking or swallowing. This 62 year old woman was urgently admitted to the internal medicine department due to abdominal distention and severe general weakness. She has suffered characteristic violent pain triggered by chewing and swallowing for little over 4 years. This resulted in poor oral feeding for prolonged period which left her severely debilitated. The large amount of ascites that developed 20 days before admission and extreme emaciation forced her to bed rest. She also suffered from Herpes Zoster. After medical treatment to improve liver function and severe pain was persisted, the patient was referred to our department for control of pain. We performed right mandibular block with 1% dibucaine 0.4 ml and the effect was excellent. After the pain had subsided, patient was able to take meals more comfortably and improved liver function returned.

유방절제술 후 광배근 근피판을 이용한 즉시 유방재건술 환자에서 경추 경막외 및 정맥내 자가통증조절의 효과 비교

강규식 ( Kyu Sik Kang ),김창원 ( Chang Won Kim ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),유시현 ( Sie Hyeon Yoo ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Won Chung ),김상호 ( Sang Ho Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6

Background: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. Methods: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n=30), 0.15% ropivacaine+fentanyl 4 μg/ml] or IV-PCA [Group IV-PCA (n=30) fentanyl 20 μg/kg+ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C) 7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. Results: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV-PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. Conclusions: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction. (Korean J Anesthesiol 2009; 56: 669~74)