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We experienced a case of congenital hiatal hernia in a 3 months old female infant. She was born as the first normal baby at hospital. There were no perinatal problems. But she had been suffered from frequent URI's and regurgitations. And she was admitted under the impression of pneumonia. The diagnosis was made by the diagnostic chest X-ray for pneumonia and confirmed by barrium meal study. The correstive surgery was performed, and all of those problems were disappeared.
Atypical facial pain is loosely used term to describe some chronic facial pain when the symptoms do not exactly and entirely fit one diagnostic criteria. In many cases of pain disorders, sympathetic system is involved, such as in conditions which symptoms mimic post-herpetic neuralgia or complex regional pain syndrome. We report a case of a patient with atypical facial pain following the reduction of temporomanidbular joint dislocation. The atypical pain which was resistant to analgesic medication was successfully managed with stellate ganglion block. Therefore we suggest that stellate ganglion block can be an effective treatment method for controlling atypical facial pain.
Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.
목적 : 폐 수술을 위한 전신마취시 일측폐환기는 저산소혈증 및 기도압 증가를 유발시킬 수 있다. 본 연구는 일측폐환기시 동맥혈 산소분압 및 기도압에 대한 propofol과 enflurane의 효과를 비교 평가 하고자 한다. 대상 및 방법 : 측와위, 일측폐환기로 수술 예정된 환자 30명을 임의로 propofol군 및 enflurane군으로 나누었다. 심박수, 평균동맥압, 산소포화도를 측정후 thiopental로 마취유도 후 enflurane(2Vol%)-O_2(2.5㎖/min)-N_2O(1.5㎖/min)로 마취유지하였다. Enflurane 군은 일측폐환기 시에도 이를 유지하였으며, propofol 군은 일측폐환기 35분후 enflurane 흡입을 중지하고 propofol을 정주하였다. 일측폐환기 후 5분 간격으로 75분간 심박수, 평균동맥압, 최대흡기압, 휴지기압, 평균호흡기압을 측정하였고, 일측폐환기 시작전, 환기후 35분, 65분 후 동맥혈 가스분석을 시행하였다. 자료의 통계분석은 t-test, paired t-test 및 repeated measures of ANOVA를 이용하여 p값이 0.05이하일 때 유의한 것으로 판별하였다. 결과 : Propofol 군에서 일측폐환기 65분후 측정한 동맥혈 산소분압의 변화율이 35분후 측정치에 비하여 유의한 증가를 보였다. 최대흡기압과 평균기도압은 propofol 정주 20분후(일측폐환기 55분 후)에 일측폐환기 35분 후 측정치에 비하여 유의하게 감소하였다. 결론 : 이상의 실험으로 일측폐환기를 이용한 전신마취시 propofol은 동맥혈 산소화를 개선시키고 기도압을 감소시키며 부하용량의 점진적 주사시 급격한 혈역학적 변화를 나타내지 않는다고 하겠다. Hypoxemia and high airway pressure would be occured during one lung ventilation(OLV). The aim of the present study was to evaluate the effect of enflurane and propofol on oxygenation and airway pressure during OLV. 30 patients undergoing thoracic surgery were assigned randomly to two goups. After heart rate(HR), mean arterial pressure(MAP) and oxygen saturation(SpO_2) were checked, anesthesia was induced with thiopental sodium and was maintained with enflurane(2 vol%)-O_2-(2.5 ℓ/min)-N_2O(1.5 ℓ/min). Enflurane group was maintained with enflurane during OLV and propofol group was maintained with propofol from 35 min after OLV. After OLV, for 75 min at interval of 5 min, HR, MAP, peak inspiratory pressure (PIP), pause pressure(PP) and mean airway pressure(PM) were checked and aterial blood gas analysis was done before OLV, at 35min, 65min after OLV. The results were as follows In propofol-group after OLV, PaO_2 at 65min was increased significantly compared to PaO_2 at 35min and PIP and PM at 65 min were improved compared to PIP and PM at 35 min. In conclusion, these results suggest propofol may improve oxygenation and reduce airway pressure OLV.
This Study aims to analyze and clarify the tectonic characteristics of Columns in Mies van der Rohe's german works. In chronological order, it includes his early traditional houses, avant guardian projects and glorious buildings such as Barcelona pavilion. By analyzing his works in this time, the following conclusions could be made. Mies van der Rohe sought a tectonic constructivity that was novel in its relation to structure and ornament, one that confronted with the era of mass production. Based on the three elements of classic base, rational column, and romantic skin, the connection between base and upper structure reinterprets classical tradition and spacial sensitivity, while that between column and skin displays a modern unification of structure and ornament through mass-produced elements. Above all, the inverted relation between structure and skin reflects Mies's efforts to meet the demands of various conditions and programs and modern aesthetics, a connection that was well explained by the concept of poetical tectonics. And finally, in the process of his trying of various experimental study in germany, We can find germinated seeds of USA works.