우발성 고위경막외차단 경험 - 증례보고 -

박정구(Jung Goo Park),전재규(Jae Kyu Jeon) 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1

Accidental high epidural block is a rare but serious complication. It can result from many factors, which include the volume and concentration of drug, posture, puncture site, age, preg- nancy or intra-abdominal mass, and patients height and weight. We had a case of accidental high epidural block recently. This is a case report which was confirmed by an epiduragram. A healthy 50-year-old woman with a huge uterine myoma was scheduled for a total abdominal hysterectomy under continous epidural analgesia. Epidural catheterization was carried out smoothly. However, an unexpected hypotension was noticed after an epidural injection of 2% lidocaine 25 ml. Thereafter, the patient was intubated and her respiration was controlled during the opera- tion. Using the 5mg of ephedrine, her blood pressure and pulse were well maintained. The scheduled operation was carried out for one hour uneventfully, but after the operation, she felt paresthesia on her hands in the recovery room. To differentiate between the high epidural and the subdural blocks, we injected 5 ml of a water soluble Niopam 300 through the catheter postoperatively. It was observed on the epiduragram that the catheter was placed in the epidural space. It was suggested that the high epidural block was induced from the widespread diffusion through the narrowed epidural space due to the engorgement of the epidural venous plexus by the patient's huge uterine myo-ma.

MOSFET에서 Gate Oxide층의 교류 절연파괴 특성

박정구(Jung-Goo Park),송정우(Jung-Woo Song),고시현(Si-Hyoen Ko),조경순(Kyung-Soon Cho),신종열(Jong-Yeol Shin),이용우(Yong-Woo Lee),홍진웅(Jin-Woong Hong) 대한전기학회 1999 대한전기학회 학술대회 논문집 Vol.1999 No.11

두께 변화에 따른 Gate Oxide의 전기적 특성

박정구(Jung-Goo Park),홍능표(Nung-Pyo Hong),이용우(Yong-Woo Lee),김왕곤(Wang-Gon Kim),홍진웅(Jin-Woong Hong) 대한전기학회 1999 대한전기학회 학술대회 논문집 Vol.1999 No.7

경막외차단 유도중 발생한 전척추마취 - 증례보고 -

박정구(Jung Goo Park),전재규(Jae Kyu Jeon) 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1

Total spinal anesthesia is a well documented serious life threatening complication which results from an attempted spinal or epidural analgesia. We had an accidental total spinal anes- thesia associated with a cranial nerve paralysis and an eventual unconsciousness during epidu- ral analgesia. A 45-year-old female with an uterine myoma was scheduled for a total abdominal hysterectomy under the epidural analgesia. A lumbar tapping for the epidural analgesia was performed in a sitting position at a level between L 4, using a 18 gauge Tuohy needle. Using the Loss of Resistance technique to identify the epidural space, the first attempt failed; however, the second attempt with the same level and the technique was successful. The epidural space was identified erroneously. However, fluid was dripping very slowly through the needle, which we thought was the fluid from the normal saline which was injected from the outside to identify the space. Then 20 ml of 2% lidocaine was administered into the epidural space. Shortly after the spinal injection of lidocaine, many signs of total spinal anesthesia could be clearly observed, accompanied by the following progressing signs of intracrainal nerve paraly- sis: phrenic nerve, vagus nerve, glossopharyngeal nerve and trigeminal nerve in that order. Then female was intubated and her respiration was controlled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in the reverse order four hours from that time.

한국에서 분리된 콕사키 바이러스 B3 cDNA의 클로닝 및 전체 염기서열 분석

정윤석(Yoon Suk Jung),김기순(Gee Sun Kim),박정구(Jung Goo Park),이윤성(Yoon Sung Lee),신수연(Soo Yeon Shin),천두성(Doo Sung Chun),지영미(Young Mi Jee),김문보(Mun Bo Kim),나병국(Byung Gook Na),윤재득(Jae Deuk Yoon),이광호(Gwang Ho Lee 대한바이러스학회 2000 Journal of Bacteriology and Virology Vol.30 No.1

We have determined and analyzed the full-length cDNA sequence of a coxsackievirus B3 (CVB3) Korean isolate (CVB3-Korea/97) which has been known as a general human pathogen. The whole genome contains 7,400 nucleotides and has a single large open reading frame with 6,555 nucleotides that encodes a potential polyprotein precursor of 2,185 amino acids. The genome also contains a 5 non-coding region (NCR) of 741 bases and a 3' NCR of 104 bases followed by poly(A) tail. Sequence homologies of nucleotides and deduced amino acids between the CVB3-Korea/97 strain and the prototype (Nancy strain) were 81.7% and 91.5%, respectively. The genes encoding the functional proteins including viral protease and RNA dependent RNA polymerase showed higher homology than those encoding the structural proteins. We have further analyzed the sequences of 5' NCR, VP1 and VP2 of CVB3-Korea/97, which are known as cardiovirulent determining factors at the nucleotide and amino acid levels. Although the CVB 3-Korea/97 strain was isolated from an aseptic meningitis patient without cardiomyopathy, its 234th nucleotide and 165th amino acid were uracil and Asn as same as those of other cardiovirulent strains one. However, the 155th amino acid of VP1, which closely associated with cardiovirulence, was replaced with Arg by single nucleotide substitution from A2916 to T2916. Moreover, additional amino acid substitutions were observed in the flanking region of Asp155. Taken together, amino acid(s) substitution in VP1 may play a critical role in determining cardiovirulence of the CVB3- Korea/97 strain rather than individual nucleotide replacements in the 5' NCR and/or an amino acid substitution in VP2.

원주지역 설사 환자에서 분리한 Small Round Structured Viruses ( SRSV ) 염기서열 분석

지영미(Young Mi Jee),김기순(Gee Sun Kim),천두성(Doo Sung Chun),박정구(Jung Goo Park),강영화(Young Hwa Kang),정윤석(Yoon Suk Jung),고운영(Woon Young Ko),신영학(Young Hak Shin),윤재득(Jae Deuk Yoon) 대한바이러스학회 1999 Journal of Bacteriology and Virology Vol.29 No.4

Small round structured viruses (SRSV) are the major ethological agents which can cause outbreaks of non-bacterial gastroenteritis or food poisoning both in children and adults. The classification of family Caliciviridae to which SRSV belong, is based on the genome encoding three open reading frames. The rotavirus is another major pathogen which causes diarrhea in young children. We examined stool specimens obtained from diarrheal patients in Wonju from which bacterial pathogens were not found. To detect causative viruses from stool specimens of patients, reverse transcription (RT)-polymerase chain reaction (PCR) or nested PCR using rotavirus or SRSV specific primers was performed. In this study, RT-nested PCR procedure which can amplify a 330 bp fragment derived from RNA dependent RNA polymerase (RDRP) region within ORF1 was applied for the detection of SRSV. For the detection of rotaviruses, a 877 bp fragment from the VP4 region of rotavirus genome was amplified. As a result, rotavirus was not detected while SRSV sequences were detected from one out of five specimens. The nucleotide and amino acid sequences of the Wonju isolate were compared with other 6 Korean isolates which have been isolated and sequenced in our laboratory. Sequence analysis revealed that the Wonju isolate was rather distinct from other Korean isolates: the Wonju isolate was closer to genogroup I of SRSV while other 6 Korean isolates belonged to genogroup II.

Esmolol 정주후 발생한 기관지 경련

박정희,김애라,김진모,박정구 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Esmolol is rapid ultrashort-acting, cardioselective g-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patients color was retumed to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.

제왕절개술시 수액이 제대혈의 혈당, 전해질 및 인슐린에 미치는 영향

김애라,박정구,전재규 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.5

It is well documented that rapid administration of solution containing dextrose results in marked hyperglycemia and osmotic diuresis. The maternal effect of hyperglycemia caused by rapid administration of dextrose solution may affect the fetus or the newborn baby as well. Therefore, there was a need to ascertain an appropriate IV solution for prehydration in cesarean section. The aim of this study was to determine an appropriate solution for cesarean section based on the results of the effects of matemal IV glucose solution on the newborn's glucose, electrolyte and insulin. 40 parturients scheduled for cesarem section were chosen at random. They were divided into two groups : one group received Hartmann's solution and the other group received 5% D/W. Patients' venous blood was drawn on the operating table prior to starting IV infusion for the measurement of blood sugar and electrolytes(Na, K, Cl) in various conditions of NPO. Then, intra-venous fluid was administered rapidly for prehydration about 20 ml/kg/hr(about 500 ml for 20 minutes) while anesthesia was induced and maintained with an endotracheal tube in place. The second blood samples were taken from matemal vein, umbilical vein and artery immediately after delivery for the measurement of glucose and electrolyte. At the same time insulin levels of umbilical veins were measured. The prehydrative glucose levels were 75.40±20.80 mg/dl in group 1 and 78.60±12.44 mg/dl in group 2. Both values were within normal range without significant hypoglycemia following the various times of NPO. Posthydration values of maternal glucose in group 2 with glucose infusion was 221.30±3.62 mg/dl. This was significantly higher than 72.20±7.11 mg/dl in group 1(p$lt;0.05). At the time of delivery, the values of umbilical venous and arterial blood glucose in group 2 were significantly higher than in group 1(p$lt;0.05). The values of insulin in umbilical venous blood in group 2 was 48.09±25.54 μU/ml. This was significantly higher than 6.06±2.06 μU/ml in group 1(p$lt;0.05). Hydration ther solutions did not affect the value of electrolyte either in the mother or newborn baby. However, the rapid administration of glucose solution increased the maternal and umbilical glucoses as well as umbilical insulin proportionally. As the result of this study, prehydration with the solution containing glucose for cesarean section increased maternal and fetal glucoses as well as fetal insulin levels. Therefore, prehydration with any solution containing glucose is not recommended to prevent maternal and fetal hyperglycemia, and can result in delayed newbom hypoglycemia. It was concluded that prehydration with balanced electrolyte solution without dextrose seems to be safer to babies as well as mothers.

Lidocaine/Meperidine 혼합용액을 이용한 제왕절개술을 위한 척추마취

김애라,박정구,전재규 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6

Recently several reports have described the usefullness of meperidine as a sole agent for spinal anesthesia. In this study, 50 mg meperidine mixed with l5-25 mg lidocaine(group 1, n= 11), 25 mg meperidine mixed with 40~50 mg lidocaine(group 2, n= l0) and 65~75 mg lidocaine only (group 3, n=9) were respectively injected into the subarachnoid space for elective cesarean section. The results were as follows: 1) Hypotension over 20% decrease in systolic blood pressure was found in 7 out of 11 cases in group 1,5 out of 10 cases in group 2 and S out of 9 cases in group 3. The dosage of ephedrine used for hypotension was not signifieantly different amoung the three groups. 2) The time from subarachnoid injection to Bromage scale 0 of group l was 77.3±20.7 minutes which was significantly shorter than 125.0+21.5 minutes of group 3(p$lt;0.05). 3) The duration from the administration of the drug until the development of severe pain postoperatively was checked as 483.6±157.9 minutes in group 1, 424.0±109.4 minutes in gro2 which were significantly longer than 55.5±25 minutes in group 3(p$lt;0.05). 4) Nausea/vomiting were occured 5/0 out of l1 cases in group 1, 4/1 out of 10 cases but none in group 3. 5) Complaints about pain during the operation occured in 5 out of 9 cases in group 3, but none in group 2 and 3. 6) The Apgar score and umbilical cord blood gas analyses were not significantly different amoung the three groups. The results of this study clear1y indicate that combining meperidine with hyperbaric spinal lidocaine for cesarean section is a safe and effective method of improving intraoperative pain relief. Furthermore, it provides adquate prolonged postoperative analgesia.