소아환자의 Midazolam의 정맥투여 용량에 따른 진정 효과에 관한 비교연구

김은영,김종수,유승훈 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.3

소아환자는 치과치료시 다양한 방법의 진정요법이 요구된다. 정맥내 투여방법은 약효의 발현이 빠르고, 진정의 심도 및 시간을 술자의 의도대로 조절할 수 있다는 장점이 있다. Midazolam은 현재 의과 및 치과영역에서 성인의 진정요법에 가장 널리 쓰이며, 심혈관계와 호흡계에 대한 영항이 적은 진정 약제이다. 그러나 midazolam을 이용한 정맥내 진정요법의 소아치과에서의 사용에 대한 연구와 보고는 적은 편으로, 이에 본 연구에서는 소아환자에서의 midazolam을 이용한 정맥내 투여시 효과적이고 안전한 초기 투여용량에 관한 연구를 하고자 한다. 진정요법으로 2회 이상의 구치부 치료가 필요한 건강하고 비협조적인 행동을 보이는 16명의 환자를 대상으로 하였으며 평균연령은 54.7±10.7개월, 평균 몸무게는 18.1±3.0kg이었다. 술전 투약으로 0.3mg/kg, 최대 5mg의 midazolam을 근육내 투여 후 30~50%의 N₂O-O₂를 병용투여한다. 이중 맹검법에 의해 모든 환자는 두 번의 내원 중 임의로 한번은 0.1mg/kg(Ⅰ군)을, 다른 한번은 0.2mg/kg(Ⅱ군)의 초기 용량의 midazolam을 정맥내 투여하여 치료하였고, 추가투여시에는 초기용량의 1/2을 투여하였다. 치료시 환자의 생징후를 측정하였고, 행동양상은 Ohio State University Behavioral Rating Scale과 Automated Counting System을 사용하여 평가하였다. 술자는 Houpt가 제시한 기준을 응용하여 임상적 치료의 성공과 실패를 평가하였다. 몸무게에 대한 총 투여용량은 Ⅰ군에서 0.16mg/kg, 2군에서 0.24mg/kg이었다. 생징의 경우 두 군 모두 정상범위 내에서 안정된 상태를 보였고, 통계적으로 유의한 차이를 보이지 않았다(p>0.05), 행동양상평가에서 Ⅱ군에서 바람직한 행동양상(Quiet)의 비율이 높았고, 임상적 성공률은 Ⅱ군에서 높았으나, 두 군간 통계학적 유의차는 보이지 않았다(p>0.05). 작용 발현시간은 Ⅱ군에서 회복시간은 Ⅰ군에서 빨랐고, 약물 투여 횟수는 Ⅰ군에서 많았으나, 두 군간 통계학적으로 유의한 차이를 보이지 않았다(p>0.05). Intravenous sedation have many advantages of rapid onset and recovery, ability of control sedation levels and duration through titration. Midazolam is most commonly used intravenous medication for sedation in pediatrics, endoscopy, oncologic procedures and so on. But in dentistry, midazolam intravenous sedation is usually for adult, and there are few reports for children. Todays, children who need sedation become more and older, intravenous sedation technique is going a matter of concern in pediatric dentistry. The purpose of this paper is to evaluate the efficacy of sedation and clinical success for different initial dosage of midazolam in intravenous sedation for pediatric dental patients. 16 healthy children (male 10, female 6), mean age 54.7±10.7 months, who needed at least two separate treatment visits requiring local anesthesia were chosen for this study. Every children were taken 0.3mg/kg, maximum 5mg of midazolam by intramuscular route, and then 30~50% N₂O-O₂ for 10 minutes was given. On every visits, one of the following 2 different initial dosage was given by intravenous route : (1) Group Ⅰ : 0.1mg/kg Midazolam (2) Group Ⅱ : 0.2mg/kg Midazolam. Additional dosage was half of the first dose. Physiologic parameters (oxygen saturation, heart rate, respiratory rate, end-tidal carbon dioxide pressure) was recorded by ten procedure steps. Behavior was videotaped and rated using Ohio State University Behavioral Rating Scale and Automated Counting System by one investigator, blind to administered dosage. After the treatment, operator evaluated the clinical success. Physiologic parameters were stable and within normal range during treatment in both groups. The analyzed sedative effect, in behavioral evaluation, ratio of favorable Quiet was higher in group Ⅱ, and clinical success rate of group Ⅱ was better than group Ⅰ. Induction time was rapid in group Ⅱ, and recovery time was rapid in group Ⅰ. And there was no statistically difference between two groups in every results.

신생아 고 17α-Hydroxyprogesterone치의 추이

박은영,조진형,이수진,양승,김광남,신재훈,오필수 대한소아내분비학회 2003 Annals of Pediatirc Endocrinology & Metabolism Vol.8 No.2

Distraction divice를 이용한 수지연장술 치험례

김수신,주훈성,김우경,정전은 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2

The goal of reconstructive hand surgery is to maintain the normal mobile and sensory function of the hand while aesthetically be acceptable. In cases of congenital or post-traumatic shortening and loss of the digit, it is very important to achieve sufficient length of the digit with regard to functional and aesthetic aspect. The initial application of the distaction bone lengthening technique to the upper extremity reconstruction was performed by Matev(1967) for the correction of post-traumatic thumb deformities with first metacarpal lengthening. Matev and others have subsequently applied this method to congenital hand malformations and dislocations. The advantages of this method are; first, there is minimal bone resorption to the interpositional bone graft due to “bipolar nutrition”. second, normal sensibility is maintained. third, minimal sacrifice of other tissues as a donor. The authors used the Matev distraction divice to lengthen digits in 2 cases of post-traumatic shortening due to bone resorption and secondary scar contracture. By this method, we were able to maintain sufficient length of the digit so that the results were functionally and aesthetically accertable.

Enterococcus faecium 19-46-4에 의한 Cholic Acid의 생산

정은영,김명수,이철훈,김병홍 한국산업미생물학회 1996 한국미생물·생명공학회지 Vol.24 No.5

항균활성을 갖는 혐기성 미생물에 대한 탐색연구에서 항균활성이 강한 Enterococcus faecium 19-46-4를 선발하여 혐기적 배양으로 이 균주가 생산하는 항생물질의 분리, 정제 및 이화학적 특성 및 구조분석을 행하였다. 40ℓ 균배양액으로부터 iso-butanol extraction, C-18 liguid column chromatography, HPLC등을 통해 약 100mg의 항균물질을 분리정제하여 KIST 194로 명명하였고, KIST 194를 UV, IR, ^1H-NMR, ^13C-NMR, EI-MS와 LC-MS 등의 기기분석을 한 결과 cholic acid (3α, 7α, 12α-trihydroxy-5β-cholan 24-oic acid)로 동정하였다. A facultative anaerobe Enterococcus faecium 19-46-4 was used to study the production of an antimicrobial substance in anaerobic conditions. Major part of the antibiotic activity was found in the culture filtrate of the bacterium. The active compound was extracted by an equal volume of iso-butanol and concentrated in vacuo (at 50℃) before purification by C-18 liguid column chromatography and HPLC. A chromatographically pure compound was obtained by two passages of HPLC columns, The compound appeared as a pale-yellow powder. The yield was about 2.5 mg l^-1 culture filtrate. The compound was named as KIST 194. KIST 194 were identified as cholic acid (3α, 7α, 12α-trihydroxy-5β-cholan 24-oic acid) based on its physico-chemical properties determined by UV, IR, ^1H-NMR, ^13C-NMR, EI-MS and LC-MS.

멕시코와 네팔도입 고추 유전자원의 두 가지 점무늬병에 대한 저항성

조은형,김정훈,전수경,이지선,김병수 慶北大學校 農業科學技術硏究所 2005 慶北大農學誌 Vol.23 No.-

Pepper genetic resources consisting of introductions from Mexico and Nepal and susceptible and resistant controls were tested for resistance to gray leaf spot and to bacterial spot by serially inoculating the two disease pathogens, Stemphylium spp. first and Xanthomonas campestris pv. vesicatoria next, with application of fungicide after evaluation of resistance to gray leaf spot first. KC866, KC872, KC902, KC905 were resistant to gray leaf spot in addition to known resistance sources, KC43, KC47, KC220, KC319, KC320, KC380. KC897 was on the top of the resistance sources list, even better than KC177(163192), and was followed by KC889, KC896, KC898, all of which were introductions from Nepal.

FET형 CO₂센서의 제조 및 감응특성

이은숙,이영철,정지영,윤종훈,김창수,손병기,이흥락 경북대학교 센서기술연구소 1995 센서技術學術大會論文集 Vol.6 No.1

A FET type micro CO_(2) sensor based on a Severinghaus type arrangement has been prepared and its response characteristics were examined. The sensor was fabricated by formation of hydrogel layer containing bicarbonate/chloride ions on the PH-ISFET and the Ag/AgCl reference electrode prepared by the thermal evaporation and chemical chloridation methods. And then gas-permeable membrane was dip-coated on the hydrogel layer of the sensor. Gas-permeable membranes were fabricated with silicon rubber and polyurethane dissolved in toluene and THF, respectively. The CO_(2) sensor with the silicon rubber membrane showed better sensitivity and lower detection limit than the CO_(2) sensor with the polyurethane membrane for dissolved CO_(2). The sensor with silicon rubber membrane at optimal conditions showed a good response: linear range of 1.60X10^(-4) ~ 4.40X10^(-2) M CO_(2), sensitivity of 57.30 mV/decade, and detection limit of 7.50x10^(-4) M.

경구진정 실패 후 피부 도포마취제를 사용한 정주진정으로의 전환 치료

이은희,김승오,김종수,유승훈 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.2

Chloral hydrate와 hydroxizine을 이용한 경구진정법은 적용대상의 나이와 체중에 따라 제한을 받는다. 일반적으로 경구 진정법은 36개월 미만, 체중 15 kg 미만의 환아에서 가장 좋은 진정 효과를 보인다. 그러나 36개월 이상 또는 15 kg 이상의 환아에 대해서는 경구진정법이 적절한 진정 효과를 얻는데 한계를 가지며, 얕은진정으로 인해 시술 중 잦은 움직임을 보여 쉽게 진정에 실패하게 된다. 진정 실패 시 고려 할 수 있는 대안은 추가적인 약제 투여로 인한 재진정의 유도나, 좀 더 깊은진정법으로의 전환이 있다 그러나 갚은진정법으로의 전환은 환아의 움직임과 동통의 감소를 위해 흡입마취재 및 마취기계가 요구되어 외래 진료실에서는 쉽게 선택되지 못한다. EMLA cream(Eutectic Mixture of Local Anesthesia)은 피부의 도포마취를 위해 널리 사용되고 있는 약제로 본 증례에서는 이를 이용하여 자극 없이 정주진정 경로를 확보하여 경구진정에서 정주진정으로의 전환에 성공하였다. 만 46개월, 체중 15 kg 남아가 다발성 우식을 주소로 단국대학교 치과대학 병원 소아치과에 내원하였다. 일반적인 행동조절 하에 치료 권유하였으나 보호자의 요구에 의해 경구진정 시도하였으며, 경구진정 실패를 고려하여 복용 전 EMLA cream을 사전 도포하였다. 경구 복용 90분 경과 뒤에도 진정효과를 얻지 못하여 보호자의 동의하에 아산화질소를 이용하여 얕은진정 유도 후, EMLA cream 도포 부위에 정맥로를 확보하였다. 총 시술 시간 2시간 30분으로 특별한 부작용 없이 성공적으로 시술을 완료하였다. The use of chloral hydrate and hydroxyzine for oral sedation is most effective in children aged less than 36 months and weighing less than 15 kg. Children who do not belong to this category may show frequent movements due to shallow sedation level, and it can lead to sedation failures. One of the solutions to such sedation failure is conversion to deeper sedation. But, it is not so much of an option, since inhalation anesthetics and devices are required. In this case, conversion from oral sedation to intravenous sedation was successfully achieved without causing injection pain while searching for an intravenous route, by using EMLA cream (Eutectic Mixture of Local Anesthesia). A patient aged 46 months and weighing 15 kg visited the Pediatric Department of Dankook University Dental Hospital. Treatment under TSD(Tell Show Do) was offered, but due to the parent's request, oral sedative measures were taken. Considering prompt converting from oral sedation to iv sedation in case the oral sedation fails, EMLA cream was apllied preemptively. Adequate sedation level could not be achieved after 90 minutes of oral administration, therefore, under the parent s consent, intravenous route was prepared after conscious sedation by N₂O-O₂. During treatment, ETCO₂, SPO₂and heart rate was monitored every 5 minutes. The patient showed stable vital signs and did not show any movements. The whole procedure took two and a half hours in total, and the treatment was completed without any adverse effects.

2.9% 과산화수소를 함유한 부착형 미백제의 임상적 효능과 안정성에 관한 연구

박은숙,성소래,홍성태,김지은,이소영,황수연,이신재,진보형,손호현,조병훈 大韓齒科保存學會 2006 Restorative Dentistry & Endodontics Vol.31 No.4

2.9%의 과산화수소를 함유한 시험용 부착형 미백제(Medison dental whitening strip, Samsung medical Co.,Anyang,Korea)를 실험군 피험자 23명, 시험용 미백제에서 과산화수소를 제외한 동일한 제재를 대조약으로 대조군 피험자 24명에게 매일 1시간 30분씩, 2주간 적용하여 임상적 효능과 안전성을 평가하였다. 미백 효과는 Shade Vision, Chroma Mete 및 Vitapan classical shade guide를 이용하여 색변화를 측정하여 다음과 같은 결론을 얻었다. 1. 실험군에서의 전체 치아의 색변화량(ΔE^(*))은 세 가지 측정법에서 모두 대조군에 비해 통계적으로 유의한 차이를 보였고 (p < 0.05). 쉽게 인지할 수 있는 정도였다. 2. 색변화는 색좌표 상에서 명도의 증가와 녹색조 및 청색조로의 변화에 의해 얻어졌다. 3. 치아별로는 어두운 견치의 색변화량이 가장 컸고, 측절치, 중절치 순으로 감소하였다. 4. 47명의 피험자 중 5명이 경도의 과민증을 경험하였으나 곧 완화되었다, 치은염증지수와 전기치수검사 결과 시험 전후에 차이가 없어 안전성을 확인하였다. This study evaluated the effectiveness and safety of an experimental bleaching strip (Medison dental whitening strip, Samsung medical Co., Anyang, Korea) containing 2.9% hydrogen peroxide. Twenty-three volunteers used the bleaching strips for one and a half hour daily for 2 weeks. As control group, the same strips in which hydrogen peroxide was not included were used by 24 volunteers with the same protocol. The shade chang (ΔE^(*), color differnce) of twelve anterior teeth was measured using Shade Vision (X-Rite Inc., S. W. Grandville, MI, USA), Chroma Meter (Minota Co., Ltd. Osaka, Japan) and Vitapan classical shade guide (Vita Zahnfabrik, Germany). The shade change of overall teeth in the experimental group was significantly greater than that in the control group (p < 0.05) and was easily perceivable. The change resulted from the increase of lightness (CIE L^(*) value) and the decrease of redness (CIE a^(*) value) and yellowness (CIE b^(*) value). The shade change of individual tooth was greatest in canine, can smallest in central incisor. The safety of the bleaching strip was also confirmed. 〔J Kor Acad Cons Dent 31(4):269-281, 2006〕

복망-척수 이전술을 이용한 비외상성 경추 및 흉추 협착성 척수병증의 치료 경험

김영수,조용은,지훈상 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.2

Stenotic myelopathy due to ossification of posterior longitudinal ligament or degenerative spondylosis compresses the spinal cord and produces pain, motor weakness, sensory change. spasticity by several factors such as direct compression, vascular factor, mechanical factors. Chronic compression of spinal cord causes a ischemic change of spinal cord and cord atrophy. In this condition, only decompression of cord with wide decompressive laminectomy or expansive laminoplasty initially can expect mild improvement of clinical conditions of cord compression, but it cannot improve the irreversible ischemic change or atrophy of cord Omentum in peritoneal cavity has good blood supply and has lipid angiogenic factors proven by experimental study. Using these characteristics omentum transposition to spinal cord in chronic spinal cord injured patients have been tried. Authors tried the omentum-spinal transposition after wide decompressive laminectomy in three cases of severe nontraumatic spinal stenotic myelopathy and experienced the marked clinical improvement in one case of them. Operative thechniques were introduced and literatures were reviewed.

미꾸리과 어류 남방종개 Iksookimia hugowolfeldi (Cobitidae)의 핵형

김익수,최은경,양현,고명훈 한국어류학회 2003 韓國魚類學會誌 Vol.15 No.2

영산강의 상류인 전라남도 장성군 북하면 신계리에서 2003년 2월 3월에 채집된 남방종개 Iksookimia hugowolfeldi 암컷 14마리와 수컷 9마리의 신장 조직에서 염색체를 조사하였다. 2n 염색체수는 50개이었는데 핵형은 meta-submetacentrics이 24개이고, subtelo-telocentrics가 26개였으며 FN은 74개이었다. 염색체에서 배수체나 암수간의 성적이형은 보이지 않았다. Chromosome analysis of the southern spined loach, Iksookimia hugowolfeldi was investigated in 23 individuals collected at Bukha-myon, Jangseong-gun, Jeollanam-do Provice, Korea an upper stream of the Yongsan River, in February, 2003. The diploid modal number of the specimens examined was 50, and the karyotype was composed of 24 metacentrics-submetacentrics and 26 subtelocentrics-telocentrics. Polyploidy and sex dimorphism were not observed in the present species.