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소아 삼출성 중이염이 약물 치료에 영향을 미치는 인자에 관한 연구
김영기,정현수,함태영 인제대학교 1994 仁濟醫學 Vol.15 No.2
삼출성 중이염의 예후와 관련된 인자를 알아보기 위하여 외래를 방문한 51명의 환자를 대상으로 난치성과 관련이 있는 요인을 조사해 본 결과, 과거의 중이수술 유무, 동반된 부비동염 등이 약물 치료에 대한 반응의 중요한 예후인자라고 생각되었다. It has been clarified that multiple factors are implicated in the otitis media with effusion which is common in children. This prospective study was performed to evaluate the factors related to the prognosis of the otitis media with effusion. History, physical examination, impedance audiometry, and radiologic examination were taken. Oral antibiotics (Augmentin or cefixime) were given to all patients orally for 3 months. Myringotomy and V -tube insertion was done in the patients who had no response after 3 months of medication. The factors implicated in the prognosis of otitis media with effusion were analysed. The significant risk factors were present inthose wish previous myringotomy or V-tube insertion, presence of mucopurulent rhinorrhea and total hazziness on PNS X-rays, but not to adenoid vegetaton, eardrum retraction, age, sex, bilaterality and presence of recurrence. Therefore, the presence of previous middle ear surgery and concomitant sinusitis were important prognostic factors in treatment of the otitis media with effusion medically.
Case Report : Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs` syndrome
( Tae Soo Hahm ),( Ji Sun Ham ),( Ji Yeong Kang ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.58 No.2
Pseudo-Meigs` syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs` syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs` syndrome. (Korean J Anesthesiol 2010; 58: 202-206)
갑상선기능항진증과 동반된 원발성 부갑상선기능항진증 1 예
박태준,정운태,김홍주,김홍용,고경수,이영수,이병두,함희용,전수영,윤진일,조혜제,황성보 대한내과학회 1994 대한내과학회지 Vol.46 No.3
Hypercalcemia secondary to hyperthyroidism is common, but hypercalcemia due to concomitant hyperthyroidism and hyperparathyroidism after medical treatment of hyperthyroidism is relatively uncommon. We experienced a patient who presented with primary hyperthyroidism [triiodothyronine 5.9 nmol/L (1.2~3.4), total thyroxine 276.7 nmol/L (64.4~180.2), and TSH 0.7 mU/L (2.0~8.0)] and hypercalcemia [3.6 mmol/L (2.1~2.6)]. In spite of the treatment of hyperthyroidism, hypercalcemia persisted and hypercalcemic crisis developed. The radioimmunoassay for parathyroid hormone showed high values [2.49, 3.93, 3.48 μg/L, (C-terminal 0~0.5)]. We performed subtotal thyroidectomy and parathyroid exploration, and confirmed right inferior parathyroid adenoma as the cause of persistent hypercalcemia. The patient is healthy without any medication after operation. While there are no clinical features which can make the differentiation easy between two groups: one with hyperthyroidism with secondary hypercalcemia and one with concomitant hyperthyroidism and hyperparathyroidism, in patients with hyperthyroidism and possible hyperparathyroidism, serum parathyroid hormone levels should be measured and surgical therapy should be considered.
임상연구 : 마취 중 H1-수용체 길항제 투여에 의한 혈역학적 변화에 대한 고찰
함태수 ( Tae Soo Hahm ),김정수 ( Chung Soo Kim ),구명신 ( Myong Shin Koo ),신병섭 ( Byung Seop Shin ),황희윤 ( Hee Youn Hwang ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Antihistamine agents are one of the most common drugs used during perioperative periods. As histamine can cause various hemodynamic reactions, administration of antihistamine can also result in unexpected responses. Therefore, we investigated what kind of hemodynamic changes might occur after the administration of antihistamine. Methods: We prospectively performed this study on 12 patients who underwent lung surgery. After induction of anesthesia, Swan-Ganz catheter was introduced and continuous arterial blood pressure was checked via radial arterial catheterization. Initial hemodynamic parameters were checked. Based on these parameters, we calculated systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). After administration of chlorpheniramine maleate 8 mg, hemodynamic parameters were checked and calculated at 2, 4, 6, 8, 10, 12, and 15 minute. Then, we made comparisons of these values with initial values. It is commonly recommended to maintain hemodynamic values within 20% of baseline for safe use of a drug. Results: SVR and PVR failed to show statistically significant changes. Heart rates were increased only at 2 minute after administration of chlorpheniramine maleate. Blood pressures were increased but returned to basal level within 4 minutes. Cardiac output showed statistically significant increase until 8 minutes. However, the changes of hemodynamic values were maintained within 20% of basal levels. Conclusions: Chlorpheniramine maleate is observed to cause statistically significant hemodynamic change after intravenous administration during anesthesia. But the changes were within 20% of basal levels, and we can safely use chlorpheniramine maleate 8 mg IV in the view of hemodynamic changes. (Korean J Anesthesiol 2006; 51: 395~9)
전정맥 전신마취下 복강경 수술환자의 부위별 심부체온의 변화 평가
함태수(Hahm Tae Soo),김원호(Kim Won Ho),김남초(Kim, Nam Cho),유제복(Yoo, Je Bog) 기본간호학회 2015 기본간호학회지 Vol.22 No.4
The trend of body temperature change during laparoscopic surgery and the most adequate site for monitoring temperature measurements have not been investigated thoroughly. In this study body temperature change during laparoscopic surgery was measured and measurements of the tympanic, esophageal, and nasopharyngeal core temperatures in surgical patients with total intravenous anesthesia were compared. Methods: From February to October 2013, 28 laparoscopic surgical patients were recruited from a tertiary hospital in Seoul. The patients’ core temperature was measured 12 times at ten minute intervals from ten minutes after the beginning of endotracheal intubation. Results: Repeated measure of core temperatures indicated a significant difference according to body part (p=.033), time of measure (p<.001) and the reciprocal interaction between body part and time of measure (p<.027). The core temperatures were highest at tympany location, lowest at nasopharynx. The amount of temperature change was least for the esophagus (36.10~36.33℃), followed by nasopharynx and tympany. Conclusion: The esophageal core temperature showed the highest stability followed by nasopharyngeal and tympanic temperature. Therefore, close observations are required between 10~20minutes after the beginning of the operation.
김태영,박준용,박경남,한동수,이용욱,최호순,함준수,전용철,윤병철,은창수,문광호,최태열 대한소화기학회 1998 대한소화기학회지 Vol.32 No.3
Background/Aims: The detection of Helicobacter pylori (H. pylori) hoth before and after treatment is very important, but conventional methods to detect H. pylori are less specific. The aim of this study was to evaluate the efficiency of polymerase chain reaction (PCR) assay as a diagnostic method of H. pylori infection. Methods: One hundred ninety three patients were included in the study. Their biopsy specimens obtained from gastric antrum and body were submitted to PCR assay, rapid urease test (CLO test), culture, and histological examination. Results: Fifty eight percent (111 out of 193 patients) of the patients had H. pylori infection. The diagnostic sensitivity/specificity of PCR assay, rapid urease test, histological examination, and culture were 98.2%/95.1%, 95.5%/74,4%, 86.5%/98.8%, and 73.9%/100%, respectively. The positive predictive value/negative predictive value of PCR assay, rapid urease test, histological examination, and culture were 96.5%/97,5%, 83.5%/92.4%, 99%/84.4%, and 100%/73.9%, respectively. The highest sensitivity was achieved in the PCR assay, while the highest specificity was obtained in culture. Conclusions: PCR assay was proved to be the most sensitive test with high specificity for the detection of H. pylori.
실험연구 : 잡견에서 Bupivacaine의 주입에 의한 심장 독성 발생 시 시행한 심폐소생술에서 인슐린 부가 효과의 연구
함태수 ( Tae Soo Hahm ),신병섭 ( Byung Seop Shin ),김정수 ( Chung Su Kim ),이상민 ( Sang Min Lee ),여진석 ( Jin Seok Yeo ),황희윤 ( Hee Youn Hwang ),이국현 ( Kook Hyun Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. Methods: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. Results: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). Conclusions: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine-induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity. (Korean J Anesthesiol 2006; 50: 579~84)
함태수 ( Tae Soo Hahm ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Electrical stimulation of acupoint (EA), a form of electrotherapy, involves passing an electrical current via pairs of acupuncture needles attached to a device that generates an electrical pulse. This electrical generator is used to control and adjust the stimulus parameters. EA is quite similar to traditional acupuncture in that the same points are stimulated. However, EA stimulates a larger area than a specific point. In addition, greater control of stimulus parameters is possible with EA, which results in its being reproducible and objective. EA has been used to treat in various conditions, including musculoskeletal disorders and as a form of anesthesia. Additionally, EA reportedly relieve pain and inflammation, and reduce nausea and vomiting. Although the mechanism by which EA functions has not yet fully elucidated, some of its action on the endogenous opioids system through multiple neuronal pathways has been indentified. It has also been shown that the released neurotransmitters are dependent on stimulation frequencies, although there is considerably overlap. Although EA is increasingly used to treat various clinical conditions, there are insufficient scientific evidences available regarding its efficacy. There is no established optimal protocol of EA treatment (optimal parameter, frequency of treatment, duration of a treatment session). Moreover, the exact mechanism by which EA treats underlying conditions. Therefore, for EA to be recognized as an established mode of treatment, further studies are warranted to assess its scientific and systematic efficacy and to clarify the mechanism underlying its effects. (Korean J Anesthesiol 2009; 57: 3~7)