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신경통성 근위축성(Neuralgic Amyotrophy) 환자의 치료 경험 : 증례 보고 A case report
한경림,박성용,예상희,김부성,김찬 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6
Neuralgic amyotrophy is an uncommon disorder characterized by acute onset of severe shoulder and upper arm pain followed by marked upper arm weakness. It is easily confused with other neck and upper extremity abnormalities, such as cervical spondylosis and cervical radiculopathy. The diagnosis is based on history, clinical findings, electromyography and excluding other disease. Early diagnosis and adequate treatment is important to avoid unnecessary tests and surgery, and prevent complications, especially adhesive capsulitis of the shoulder. 20-year old female patient presented with a history of server pain involing left shoulder and upper extremity. 1 month after onset of pain suddenly, she noted weakness of left shoulder muscles, especially abduction and flexion. At first visit in our clinic, she felt persistant pain for 4 months in the left shoulder, upper extremity and mild pain in the left lower extremity. She diagnosed with neuralgic amyotrophy with complex regional pain syndrome. Her pain managed with epidural block, sympathetic ganglion block, brachial plexus block, stellate ganglion block, intravenous regional block, intravenous local anesthetic infusion, oral analgesics, and exercise therapy. 5 months after the onset of pain, weakness of her shoulder muscles were fully recovered and 9 weaks after caring in our clinic, she had tolerable pain in her extremities and discharged. (Korean J Anesthesoil 2002; 43: 804~809)
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한경림,채윤정,박형배,김찬,남시권 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.1
We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air.
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Atropine 의 전투여가 Propofol-Fentanyl 마취 유도시 혈압 및 심박수에 미치는 영향
한경림,이귀용 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1
Background: Induction of anesthesia with propofol is associated with decrease in blood pressure, but changes of heart rates are minimal. However the combination of two centrally acting vagotonic agents, propofol and fentanyl, decreased heart rates on induction, with concomitant decreases in arterial pressure. Thus we evaluated the effect of atropine on these hemodynamic changes. Methods: Patients were randomly allocated to three group. Group 1 was given no atropine premedication. In group 2, premedication with 0.01 mg/kg of atropine was administered intramusculary about one hour before anesthetic induction. In group 3, pretreatment with 0.01 mg/kg of atropine was administered intravenously about 4 minutes before anesthetic induction. Anesthesia was induced with 1 ㎍/kg of fentanyl, 2-2.5 mg/kg of propofol and 0.1 mg/kg of vecuronium and maintained with nitrous oxide, oxygen and enflurane. Heart rate and blood pressure were measured 1, 5 min before induction and 1, 2, 3, 5, 7, 9 min after induction. Results: eart rates are increased significantly(P$lt;0.001) during the 3 minutes before induction in patients given atropine intravenously and remained significantly higher(P$lt;0.05) during early maintenance of anesthesia than in patients receiving no premedication of atropine. The systolic and diastolic blood pressure weren't changed significantly between the three groups. Conclusions: Pretreatment of atropine intravenously before induction of anesthesia with propofol and fentanyl attenuates the decreasing the heart rates but does not affect the blood pressure before intubation.
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영가철과 독립영양미생물을 이용한 과염소산염의 환원제거에 대한 타당성 연구
한경림,이경환,유수영,안영희 동아대학교 환경문제연구소 2008 硏究報告 Vol.30 No.1
과염소산염은 지표수와 지하수 그리고 토양의 주요 오염물이다. 본 연구에서는 과염소산염을 처리하기위한 기존 기법들의 한계를 극복하기위해 독립영양미생물과 영가철을 이용하여 과염소산염을 환원시켜 제거하기위한 타당성을 조사하였다. 영가철과 소화슬러지를 공급하여 batch 실험한 결과 16,023.7 ug/L의 과염소산염의 농도가 236 h 후에 481.37 ug/L로 감소하여 97%의 제거율을 나타내었다. 영가철과 소화슬러지에 의한 과염소산염 제거에서는 소화 슬러지 내의 독립영양미생물이 영가철이 부식되어 발생하는 H2를 과염소산염을 환원하는데 전자 공여체로 사용할 수 있다. 그래서 전자공여체로 사용될 H2를 따로 공급할 필요가 없기 때문에 본 기법은 기존의 처리기법에 비해 저렴하고 H2사용에 의한 폭발의 위험이 없어 안전하다는 장점이 있다. 이 연구는 영가철과 독립영양미생물이 과염소산염의 환원에 효과가 있음을 입증하였다
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한경림(Kyung Ream Han),곽노길(No Kll Kwak),김수미( 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
A 72-year-old female patient was presented complaining of unbearable abdominal pain in the upper left quadrant at our hospital. Two weeks earlier she had developed a vesicular eruption on the right C3 dermatome and 1 week earlier she had experienced a vesicular eruption on the left Tl 1 dermatome. Her medical history was unremarkable. She had suffered from severe abdominal pain in the upper left quadrant for 10 days and the mild pain in the right shoulder region for 20 days. The pain in the upper left quadrant had increased and was unresponsive to drugs prescribed by the local clinic. And we performed Tll root block with 0.5% lidocaine 5 ml and dexametasone 5 mg, and thoracic epidural blockade on 1st hospital day under diagnosis of herpes zoster infection. Her VAS were improved from 10 to 2 on 2nd hospital day. We performed thoracic epidural blockade with 0.5% lidocaine 6 ml. Her VAS were changed from 2 to 7 and so then we performed the thoracic epidural blockade with 0.5% lidocaine 5 ml and triamcinolone 40 mg on 3rd hospital day. On 4th hospital day, her VAS were from 7 to l. After 4 month of our managements she was tolerable without any medications.
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