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최동주,김영환,심영수,김건열,한용철,유빈,송재훈,한성구 대한내과학회 1987 대한내과학회지 Vol.32 No.4
Sleep apnea syndrome is characterized by loud snoring, excessive daytime somnolence and multiple attack of apnea during sleep which can cause sudden nocturnal death, cor pulmonale, hypertension, personality change and morning headache. We report a typical case of obstructive sleep apnea syndrome in a 30 year old Korean woman. She was very obese and complained loud snoring, daytime hypersomnolence. Nocturnal sleep study showed repetitive attack of apnea and fall of arterial oxygen tension and saturation. Bilateral severe tonsilar hypertrophy was thought to be the mechanism of obstruction.
심재철(Jae Chol Shim),김동원(Dong Won Kim),전웅석( 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1
Block of superior hypogastric plexus has been advocated as a useful technique in the palliation of various of pelvic pain syndromes. This technique has been performed under fluroscopic or CT guidance using bilateral placement of needles. We performed a modification of transdiscal approach with the patient in oblique position permitting successful superior hypogastric plexus block using a single needle placed under fluoroscopic guidance. Our experience suggest transdiscal approach performed in oblique position allows easier, safer, and more accurate needle placement for superior hypogastric plexus block.
방정중접근법에 의한 경막외 천자시 피부로부터 경막외강까지의 거리의 예측인자
심재철(Jae Chol Shim),이명의(Myoung Eui Lee),김동 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
N/A Background: Although the paramedian approach for epidural blockade is useful in some clinical situation, the parameters which are correlated with the distance from skin to the epidural space has not been established. Methods: We studied in 145 patients having elective continuous epidural blocks for relief of postoperative pain. All blocks were performed using paramedian approach with Tuohy needle in the lumbar (group l, n=100) and thoracic (group 2, n=45) area. We measured the distance from skin to the epidural space, body weight, height, and the angle between the shaft of the needle and the skin. Data were analyzed by linear regression. The relation- ships between parameters identified by the F-test with a P value of less than 0.05 were considered statistically significant. Results: The mean distance from skin to the lumbar epidural space was 4.4±0.7cm. Sig- nificant correlation between the body weight and the depth of lumbar epidural space 4 value .0.492) was noted with regression equation of depth(cm)=2.293±0.034 x body weight (kg). Also the significant correlation between the ponderal index (PI) and the depth of lumbar epidural space (y value: 0.539) was noted with regression equation of depth(cm)=1. 703±0.07 x PI, The mean distance from skin to the thoracic epidural space was 5.2±0.7cm which did not correlated with other anatomic measurements. Conclusions: We found that PI and body weight are the suitable predictors of the depth of the lumbar epidural space, but not the thoracic epidural space.
하지 방산통에 대한 Pulsed Radiofrequency Thermocoagulation : 단기적 추적결과
심재철(Jae Chol Shim),조희영(Hee Young Cho),김동원(Dong Won Kim),승익상(Ik Sang Seung) 대한통증학회 2002 The Korean Journal of Pain Vol.15 No.1
N/A Background: Application of pulsed radiofrequency (RF) current to the dorsal root ganglion has been reported produce short term relief of spinal pain without causing thermal ablation in failed back surgery patients. The present study was undertaken to investigate the influence of pulsed RF thermocoagulation of dorsal root ganglion for chronic segmental pain radiating to the legs. Methods: It was an open, prospective, pilot study of the effect of pulsed RF adjacent to the dorsal root ganglion in patients with radiating lower extremity pain. Following diagnostic segmental block, a maximum of 2 dorsal root ganglia were treated. Out of 23 patients, 6 were lost to follow up, and pulsed RF was applied to the remaining 17. The short term effect of pulsed RF treatment (20 msec RF pulse delivered at a rate of 2Hz for 240 sex to produce of original pain. Five cases were successful out of 19 cases at a mean follow up period of 44.8 < 18.6 days. Transient motor weakness was observed (duration 7 days) in one case. We also found transient pain relief in patients whose pain relief was not successful (duration; 3-35 days) Conclusions: Treatment with pulsed, but not continuous, RF was associated with improvement of radiating pain in patients with or without spinal surgery. The electromagnetic field may be instrumental in producing the clinical effect of the RF lesion adjacent to the dorsal root ganglion. If a meticulous technique of pulsed RF and patient selection criteria for pulsed RF were prepared, pulsed RF would be a useful treatment modality for pain clinicians who are treating radiating pain of lower extremities.
심재철(Jae Chol Shim),김동원(Dong Won Kim) 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
Bertolloti syndrome is the association between low back pain (LBP) and the presence of a lumbosacral transitional vertebrae. A transitional vertebrae is composed of one or both transverse process connecting with the sacrum or ilium and the presence of a vestigial intervertebral disc space caudal to the transitional vertebrae. We experienced a case of low back pain with intermittent radiating pain in patient with complete lumbosacral sacralization. Long term relief of low back pain was maintained with intra and/or periarticular infiltration of local anesthetics and steroid. The relief of LBP suggests a correlation between LBP and lumbosacral sacralization
방사선 사위상 관찰하의 측와위에서 행한 요부 후근 신경절 고주파 열응고술
심재철,김동원 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.1
Intractable pain of malignant origin is sometimes limited to one to three dermatomes. 4 consecutive patients with intractable chronic pain in the lumbosacral region were treated with a radiofrequency lesion of dorsal root ganglion. Their pain intensity was severe, not controlled with opioid analgesics. Following diagnostic root block, the patients underwent a percutaneous lesion of 1 to 2 dorsal ganglia of the affected painful dermatomes. The patients were positioned in the lateral decubitus position. Under the radiographic oblique view observation, the precise localization of the needle tip was done. In case of difficult localization of needle tip, 2 needle technique was performed. On assessment one patients had good results, which persisted for 2 months. Two patients had fair relief needing only reduced doses of moderate analgesics and one patient had poor reduction of pain. Hypesthesia which lasted for 2-4 weeks was found in all patients. Motor deficit developed in 1 patients.