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급성 췌장염 이후 발생한 후복막강 농양에 속발된 위와 대장 누공의 1예
정혜원(Chung Hye Won),이용찬(Lee Yong Chan),이준규(Lee Joon Kyu),백용한(Pack Yong Han),박인서(Park In Suh),문영명(Moon Young Myoung),김명진(Kim Myeong Jin) 대한내과학회 2000 대한내과학회지 Vol.58 No.6
N/A According to several reports, the incidence of pancreatic and peripancreatic abscess after acute pancreatitits is quoted at about 5 percentage and this rare complication may cause fistulas with multiple intra-abdominal organs. Mortality rates are nearly 100 per cent, mostly due to sepsis and hemorrhage in the abscence of surgical intervention and even with surgical drainage and celiotomy, death rate of 30 to 50 percentage are noted due to recurrence. The pathogenesisi of these fistulas may be multifactorial ; activated pancreatic enzyme and the products of secondary infection penetrating visceral wall directly, and vascular thrombosis and shock causing ischemic necrosis of the gastrointestinal wall. The gastrointestinal fistulas after acute necrotizing pancreatitis have been reported rarely in Korea. The authors experienced a sixty three year old male patient case of gastric and colonic fistulas in communication with retroperitoneal pancreatic abscess after acute pancreatitis. The patient received broad-spectrum antibiotics and percutaneous catheter drainage without surgical intervention. After treatment, he recovered well complete. Conservative care with drainage procedure may be a suitable alternative for managing the gastrointestinal fistulas with the pancreatic and peripancreatic abscess after acute nectrotizing pancreatitis.(Korean J Med 58:675-680, 2000)
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요추 경막외 마취에서 카테테르 삽입 방향과 지각차단범위
한종인,김종학,이춘희,이귀용,김치효,정락경,백은주 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.2
Background : Endoscopic urologic surgery including transurethral resection of prostate(TURP) requires adequate sacral analgesia for insertion of resectoscope. But epidurally administered local anesthetic does not produce anesthetic effects uniformly. Failure to completely block S1 during epidural anesthesia because of the large size of nerve root has been noted. The purpose of this study to compare the relation between catheter direction and sensory anesthesia. Methods : Thirty patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L3-4 using a standard 18 gauge Tuohy needle. In group A(n=15), the Tuohy needle with bevel pointed in a cephalad direction during catheter insertion. In group B(n=15), it pointed caudally. And the catheter was introduced 3 cm into the epidural space. After test dose, 2% lidocaine 5 cc, 0.5% bupivacaine 5 cc and 2% lidocaine 3 cc were administered with fractionate dose through it. The extent of the sensory anesthesia to loss of cold sensation and pin prick test was measured every 5minute for 30 minutes. Results : Analgesia spread to loss of cold sensation and pin prick test was no significant statistical difference between the two groups. In 15 minutes after injection of surgical dose, complete blockade in L5, S1 dermatome was present in both groups. Conclusion : Our results conclude that epidural catheter direction is not significantly influence the epidural anesthetic spread including sacral area in continuous lumbar epidural anesthesia in elderly patients. (Korean J Anesthesiol 1997; 33: 291∼296)
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