화학적 요부 교감신경절 차단에서 한 분절 차단과 두 분절 차단의 비교

김종일,이규종,이상곤,민병우,반종석,문철준 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4

Chemical Lumbar Sympathetic Block: Comparison of One- Versus Two-needle Techniques Chul-Jun Mun, M.D., Kyu-Jong Lee, M.D., Sang-Gon Lee, M.D., Jong-Il Kim, M.D.^* Jong-Suk Ban, M.D., and Byung-Woo Min, M.D. Department of Anesthesiology, Fatima Hospital, Daegu, Korea ^*Kim Jong Il Pain Clinic, Daegu, Korea Background: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. Methods: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and thired lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. Results: The duration of anhidrosis was 12.2 ?? 2.6 months (mean ?? SD) in the single-needle group versus 13.6 ?? 3.6 months (mean << SD) in the two-needle group. Conclusions: As these results were not significantly different from those obtained in patients having considered to be effective for a neurolytic ;i,bar sympathectomy. (korean J Anesthesiol 2001; 41: 439~443)

Comparison of Hanwoo with Holstein of OPU derived Embryo and Offspring Production

Jong‐In Jin,Byung‐Hyun Choi,Seong‐Su Kim,Hyun‐Tae Jo,Il‐Keun Kong 한국동물생명공학회(구 한국동물번식학회) 2011 발생공학 국제심포지엄 및 학술대회 Vol.2011 No.1

The objective of this study was to evaluate the comparison of production efficiency of oocytes and OPU (ovum pick‐up) derived embryos of Hanwoo with Holstein. The OPU session of each species (6 cows) was carried out from the Hanwoo (106 sessions) and Holstein (114 sessions) at intervals of 3 4 days (2 times per week) for 3 months. Cumulus‐oocyte‐complexes (COCs) retrieved were classified into 4 grades by the status of oocyte cytoplasm and cumulus cells. The COCs collected were matured in vitro in TCM‐199 supplemented with 10% FBS, 10 mg/ml FSH and 1 mg/ml estradiol‐ 17β in 5% CO2 and over 99% humidity for 24 h. After 24 h co‐incubation with post‐thaw sperm, the presumed zygotes were cultured in CR1aa medium with 4 mg/ml BSA for 3 days and then changed CR1aa medium with 10% of FBS for another 3 4 days. The Mean number of aspirated follicles and collected oocytes were not significantly different between Hanwoo and Holstein spacies (10.4±0.42 vs. 11.4±0.41 and 7.5±0.38 vs. 6.1±0.37 per session). But the collection rate of oocytes from aspirated follicles were significantly higher in Hanwoo (72.8%) than that in Holstein (53.6%) (p< 0.05). Furthermore, the average number of good quality oocytes (Grade I and II) was 5.9±0.28 and 4.1±0.27 (Mean±SD), and the cleavage rate and the development rate to blastocysts was significantly (p<0.05) higher in Hanwoo (40.0%) than Holstein (21.6%). The OPU derived embryos of Hanwoo were transferred 83 times into 52 recipients and then 42 calves were produced from 44 pregnancy recipients. In conclusion, the efficiency of OPU derived embryo was significantly different between Hanwoo and Holstein species. In vitro culture system for OPU derived embryo production should be optimized for industrialization and the improvement of livestock.

Ropivacaine 을 이용한 경막의 마취시 Clonidine 병용의 효과

김종일,조영훈,이상곤,민병우,이지향,반종석 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4

Effects of Clonidine Added to Ropivacaine in Epidural Anesthesia Young-Hoon Cho, M.D., Ji-Hyang Lee, M.D., Sang-Gon Lee, M.D., Jong-Il Kim, M.D.^*, Jong-Suk Ban, M.D., and Byung-Woo Min, M.D. Department of Anesthesiology, Daegu Fatima Hospital, Daegu, Korea ^*Kim Jong Il Pain clinic, Daegu, Korea Background: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural ane-sthesia. Methods: Thirty-two healthy patients undergoing a hip or lower limb surgery were diveded into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 ㎍ was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. Results: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was sig-nificantly lower thatn that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. Conclusions: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. (Korean J Anesthesiol 2001; 41: 428~433)

아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

뇌실외 배액술 시행과 관련된 뇌실염 : 원인균주와 경험적 치료약제의 적절성

도병훈,김신우,오종택,손종원,하상우,이응갑,장현하,이종명,김능수 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 본 연구는 뇌실외 배액술을 시행한 신경외과 환자들에서 뇌실염 발생 빈도, 원인균주와 감수성 추이 및 경험적 치료로 사용되는 항생제인 ceftazidime과 vancomycin의 적절성 여부에 대하여 조사하였다. 재료 및 방법 : 2000년 12월부터 2003년 10월까지 EVD를 시행한 경북대학교병원 신경외과 입원환자 340명 중 뇌실염이 발생한 39명을 대상으로 후향적으로 조사하였다. 결과 : 340명 중 39예 (11.5%)에서 뇌실염이 발생하였고 이들 가운데 4명이 뇌실염과 연관하여 사망하였다(10.3%). EVD 시행일로부터 뇌실염 발생까지는 평균 8.4일이었다. 원인균은 33예(87.1%)에서 확인되었으며 Aci-netobacter (19예, 45%), methicillin-resistant coagulase negative Staphylococcus (9예, 22%), methicillin-resistant Staphylococcus aureus (9예, 22%) 등의 순이었다. 가장 많이 동정된 Acinetobacter 19예 중에서 8예(42.1%)가 ceftriaxone에 내성을 보였으며 현재 경험적으로 널리 사용되는 ceftazidime에 대해서는 11예중 3예(27%)가 내성을 보였다. 결론 : 최근 EVD 시행과 관련된 뇌실염 뇌실염 최근 그람음성 non-fermenter 특히 Acinetobacter에 의한 경우가 증가하고 있으며, 이들 그람음성 non-fermenter는 현재까지 경험적으로 사용되는 ceftazidime에 점차 내성을 보이고 있다. 경험적 치료제에 대한 성공률을 높이기 위해서는 각 병원별 내실염의 원인균주의 감수성에 대한 검사가 필요하겠다. Purpose : To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. Materials and Methods : Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. Results : Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows : Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. Conclusion : These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

추이적 행렬을 이용한 패트리 넷의 교착 상태 확인 분석

이종봉,김병규,김종욱,이종근 國立 昌原大學校 產業技術硏究院 2004 産技硏論文集 Vol.18 No.-

본 연구에서는 패트리 넷에서의 교착 상태 확인을 추이적 행렬을 이용하여 분석하는 기법을 제안한다. 교착 상태란 패트리 넷에서 마킹이 더 이상 진행되지 못하고 서로 점화 가능 상태를 기다리는 상태로 자원 공유의 문제에서 많이 발생 가능하다. 따라서, 모든 플레이스와 트랜지션과의 관계를 나타내는 추이적 행렬을 이용하여 간단하게 확인분석이 용이한 기법을 제안한다.

하지 수술을 위한 경막외 마취시 Ropivacaine 과 Bupivacaine 의 비교

이상곤,민병우,반종석,문철준 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4

Comparison of Epidural Ropivacaine and Bupivacaine in Patients Undergoing Lower Extremity Surgery Chul-Jun Mun, M.D., Sang-Gon Lee, M.D., Jong-Suk Ban, M.D. and Byung-Woo Min, M.D. Department of Anesthesiology, Fatima Hospital, Daegu, Korea Background: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A ran-domized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. Methods: Forty-nine patients (ASA Ⅰ-Ⅱ) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupiva-caine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. Results: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean ?? SD) was 18.9 ?? 7.0 minutes and 187.5 ?? 34.6 minutes respectively for ropivacaine, and was 15.2 ?? 8.8 minutes and 187.8 ?? 40.0 minutes respectively for bupivacaine. Maximum block height (mean ?? SD) was T6.5 ?? 2.0 for ropivacaine and T6.4 ?? 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12.20 for bupivacaine. Conclusions: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine. (Korean J Anesthesiol 2001; 41: 434~438)

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

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김형종,김진환,임현준 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.2

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