경막외마취 확산의 비교 관찰

김영석,김완식,황영희,김흥대,김교상,장경덕 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.1

The segmental spread of epidural analgesia was measured in seventeen surgical patients aged between 17 and 52 years, and in fourteen patients between 60 and 77 years. The upper level in the young was 6.29(±1.56) thoracic vertebra level, but in the elderly was 4(±0.65) thoracic vertebra level at 20 minutes after epidural injection of 1.5% lidocaine 20㎖. A given volume of solution spreads to 0.9, 1.07, 1.54, 2.29 segments greater upper extent at 5, 10, 15, 20 minutes after epidural injection and 0.57, 1.07 segments greater lower extent at 5, 10 minutes in the elder than young. So with increasing age relatively small amounts of solution are required, to produce the same extent of anesthesia in the yonung.

Castleman 씨 병에 동반된 신유전분증

김연수,한진석,이정상,김병국,이중건,정윤철,이진학,최영진,안규리,김성권,이현순 대한내과학회 1994 대한내과학회지 Vol.46 No.2

Castlemam's disease is an asymptomatic and benign lymph node hyperplasia which is frequently manifested as mediastinal mass in over 70% of cases. Amyloidosis is rarely associated with Castleman's disease. Recently we experienced a patient with nephrotic syndrome due to renal amyloidosis who had been previously diagnosed as Castleman's disease of retroperitoneal lymph node enlargement. A 47-year old woman was admitted because of generalized edema and chest tightness. Five months ago she diagnosed as Castlman's disease-plasma cell type, of retroperitoneal lymph node enlargement. The patient was followed up through outpatient department without any specific medication. Physical examination showed pale conjunctivae, palpable mass on epigastric area and pretibial pitting edema. The hemoglobin, leukocyte count and erythrocyte sedimentation rate were 96 g/L, 5.9×109/L and 127 mm/hour, respectively. The blood urea nitogen was 3.6 mmol/L and creatinine was 88 umol/L. The urinalysis showed 3 positive for albumin. Twentyfour hour urine contained 16.6 grams of protein. A computerized tomographic (CT) scan of the abdomen disclosed multiple lymph node enlargement at mesentery. Percutaneous needle biopsy of kidney showed massive infiltration of pale pinkish amorphous material in the glomerular tuft forming large nodules. Ultrastructural examination exhibited heavy deposition of amyloid fibrils in the mesangium and perpendicular to glomerular basement membrane. Polarizing microscopy with Congo-red stain revealed prominent yellow green birefringence in glomeruli, tubules and interstitium.

운동후 측복통과 함께 발생한 급성 신부전 1 예

김종순,박영주,조종태,이정임,신민호,구천희,박태용,한승수,강진화 대한내과학회 1996 대한내과학회지 Vol.50 No.6

We report a case of acute renal failure with severe loin pain and patchy renal vasoconstriction after exercise. An immediate postcontrast computed tomogram of this case shows multiple patchy areas of poor contrast enhancement in the cortex of the both kidneys. A 24-hours delayed scan without further injection of contrast dye shows multiple wedge-shaped contrast enhancement in the coincident areas of poor enhancement in the immediate scan. The 2 and 5 days delayed scans show that wedge-shaped contrast enhancement becomes disappeared gradually to the renal cortex, and the 8 days delayed scan shows complete disappearance of contrast enhancement. The renal scintigrams with technetium-99m-methylene diphosphonate and dimercaptosuccinic acid show diffuse increased uptakes and multiple patchy photon deficient areas in the both kidneys respectively. The follow-up renal scintigrams show nearly normal findings, This patient had an uneventful hospital course and recovered completely without dialysis.

사료의 pH 및 단백질 수준이 자돈의 성장 및 영양소 소화율에 미치는 영향

김지훈,한인규,김진동,조원탁,현충남,이지훈 한국영양사료학회 1999 韓國營養飼料學會誌 Vol.23 No.4

자돈사료내 pH와 단백질 수준의 효과를 알아보기 위하여 2개의 시험을 수행하였다. 시험 1에서는 pH 수준이 자돈의 성장과 영양소 소화율에 미치는 영향을 총 150두의 자돈(L×D×LW ; 8.82㎏ BW 30 ± 2일령)을 이용하여 1) pH 4.7, 2) pH 5.2, 3) pH 5.7 (basal diet), 4) pH 6.2, 5) pH 6.7의 다섯처리를 두었고, 시험 2에서는 pH와 단백질 수준의 효과를 알아보기 위하여 150두의 자돈을 (L×D×LW ; 5.46㎏ BW) 2×3 요인법으로 배치하였다. (조단백질 = 21.5, 24.5%, 사료 pH = 4.5, 5.5, 6.5). 또한 소화율의 측정을 위하여 시험 1에는 25두, 시험 2에는 24두의 자돈에 T-cannular를 설치하였다. 시험 1에서 pH는 자돈의 성장에 아무런 영향이 없는 것으로 나타났다. 낮은 pH사료를 급이한 구에서 사료효율이 약간 좋은 경향이 있었으나, 유의적인 차이는 발견되지 않았다. 회장 및 분소화율도 처리에 의한 효과가 발견되지 않았다. 시험 2에서는 낮은 pH 사료를 급이한 구에서 성장 및 사료효율이 개선되는 경향이 있었다 (P = 0.16). 사료효율은 단백질 수준에 의한 영향이 있었으며 (P<0.05), pH와 단백질 수준간의 상호작용이나 다른 효과는 발견되지 않았다. 회장 소화율도 단백질 수준에 의한 영향은 있었으나, pH의 효과는 methionine의 소화율에만 영향이 있는 것으로 나타났다. 전체적으로 소화율은 pH에 의한 일정한 경향이 발견되지 않았다. 본 시험의 결과는 사료의 pH 조절효과는 자돈의 나이나 사료의 종류에 따라 영향을 받는다는 것을 암시하며, 일반적으로 통용되고 있는 자돈사료는 특별한 산성화 처리가 필요하지 않은 것으로 나타났다. Two experiments were conducted to investigate the effect of diet pH and protein levels on the growth performance and nutrients digestibility in young piglets. In Exp. 1, a total of 150 piglets (Landrace × Duroc × Large White ; 8.82㎏ B W, 30 ± 2 days of age) were allotted into 5 treatments. Treatments were 1) pH 4.7, 2) pH 5.2, 3) pH 5.7 (basal diet), 4) pH 6.2 and 5) pH 6.7. In Exp. 2, the effect of dietary protein and diet pH levels on the growth performance and nutrient digestibility was examined with 150 crossbreds Landrace × Duroc × Large White ; 5.46㎏ BW) piglets in 2 × 3 factorial arrangement. (21.5 and 24.5% CP and diet pH (4.5, 5.5 and 6.5)). Each treatment has 5 replications, 5 heads per replicate. For the digestibility determination, 25 pigs for Exp 1. and 24 pigs for Exp. 2. were fitted with simple T-cannula and individually fed the experimental diet. In Exp. 1, no significant difference was found in any of the criteria measured. Pigs fed low pH diets showed slightly better feed efficiency, but the difference was not significant. Both ileal and fecal nutrient digestibility were not different. A small difference was found in major amino acids digestibility, but there was no constant trend detected. In Exp. 2, pigs fed low pH diet showed a trend (P = 0.16) to grow faster than those fed high pH diet. Feed efficiency was affected by protein level (P<0.05). No other main effect was detected. Protein level affected the ileal digestibility of energy, dry matter, crude fat, methionine and threonine. The effect of pH was found only in methionine digestibility. No other main effect was found in ileal digestibility. It appeared that age of pigs and type of diet could greatly influence the effect of diet pH manipulation. Acidification of commercially available diets might have minimal effect when diet contained high portion of high quality feed ingredients.

늑막조직생검으로 진단한 Pleural Paragonimiasis 1 예

김기영,이승환,박진현,이재갑,용석중,신계철,홍욱균,김향인,진춘조 대한내과학회 1991 대한내과학회지 Vol.40 No.5

We report a 28-year old female patient with pleural paragonimiasis who did not have the usual diagnostic triad for this parasitic disease. She did not have chronic hemoptysis, there were no pulmonary infiltrations, and stool, sputum and pleural fluid examinations did not yield paragonimus ova. The diagnosis was made on the basis of ova found in the pleural biopsy. Paragonimus pleural effusion was resolved with frequent thoracentesis and oral praziquantel therapy.

가성 장폐쇄로 발현한 부신경절종 1 예

김용태,이기업,박건춘,송영기,이문호,유은실,이준호,진태선 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Phenochromocytoma is a catecholamine-secreting tumor, most of which grow at the adrenal gland. About 109p Of pheochromocytomas are detected at the extra-adrenal chromaffine tissues and are called paraganglioma. The main symptoms of pheochromacytoma include hypertension, headache, palpitation, and sweating. Gastrointestinal symptoms such as abdominal pain, constipation, and vomiting are found in 20∼40% of patients with pheochromocytoma, but these are usually overlooked because of the severe, prominant cardiovascular symptoms. Intestinal pseudo-obstruction without hypertension in pheochromocytoma is very rarely found. It is caused by the decreased motility of the intestine and the over-contraction of the intestinal sphincter, which are caused by the unbalanced activation of α-and β-adrenal receptors. It can be hypothesized that catecholamine receptors in the cardiovascular system are down-regulated or desensitized, but those in the intestine remain intact. We report herein a case of pheochromocytoma in which intestinal pseudo-obstruction was the main presenting clinical manifestation. Symptoms of intestinal pseudo-obstruction were completely relieved by administration of phenoxybenzamine, an α-receptor blocker, and excisional surgery.

크롬 피콜린산 또는 카르니틴이 첨가된 사료급여가 비육돈의 성장 및 도체특성에 미치는 영향

김지훈,한인규,김대성,배극환,양종석,손현수,현영 한국영양사료학회 1999 韓國營養飼料學會誌 Vol.23 No.5

본 시험은 여러 가지 광물질과 혼합된 크롬 피콜린산이나 카르니틴을 첨가한 사료의 급여가 비육돈의 성장 및 도체특성에 미치는 영향을 조사하기 위하여 실시되었다. 평균체중 60.69±1.11 kg인 삼원교잡종 (Yorkshire×Landrace×Duroc) 비육돈 암수 180마리를 대조구, CFC{CrP + Fe₂O₃ + CaCO₃}, CFZC{CrP + Fe₂O₃ + ZnO + CaCO₃}, CZC-1 {CrP (1/300) + ZnO(9/300) + CaCO₃(290/300)}, CZC-2(CrP(1/300) + ZnO(14/300) + CaCO₃ (285/300)} 그리고 카르니틴구 등 6처리구에 성별로 배치하였다. 크롬 피콜린산이나 카르니틴에 의한 성장개선은 발견되지 않았다. 수퇘지에 있어서는 CFZC 처리구가 CZC-2 처리구보다 유의적으로 사료효율이 좋았다 (p<0.05). 도체특성에 있어서도 전체적으로 처리구간의 유의적인 차이는 발견되지 않았으나, 수퇘지에서는 CFZC 처리구가 대조구에 비해 등지방두께가 않았고 (p<0.05), 가장 좋은 도체등급은 CZC-2 처리구에서 나타났다. A study was conducted to investigate the effect of feeding diets containing chromium picolinate (CrP) or carnitine on growth and carcass characteristics in finishing pigs. A total of 180 cross bred pigs (Yorkshire x Landrace x Duroc; initial body weight of 60.7±1.1 kg) were assigned to 6 treatments : Control, CFC{CrP + Fe₂O₃ + CaCO₃}, CFZC{CrP + Fe₂O₃ + ZnO + CaCO₃}, CZC-1 {CrP (1/300) + ZnO(9/300) + CaCO₃(290/300)}, CZC-2(CrP(1/300) + ZnO(14/300) + CaCO₃ (285/300)} and camitine. No significant improvement was found in average daily gain (ADG), average daily feed intake (ADFI), and feed/gain ratio (F/G) by feeding diets containing chromium picolinate. The feed efficiency of male pigs fed with CFZC was better than pigs fed CZC-2 diet during the entire period (p<0.05). No differences were found in carcass characteristics between treatments expect that backfat thickness was reduced in male pigs fed the CFZC diet compared to the control (p<0.05). The best carcass grade was found in pigs fed CZC-2 the diet.

경막외마취 확산의 비교관찰 제 1 보 Bupivacaine-Lidocaine

김영석,김완식,김인규,김흥대,안기량,김교상 대한마취과학회 1980 Korean Journal of Anesthesiology Vol.13 No.1

Epidural anesthesia is widely practiced for lower abdominal operation and delivery in many hospital and its complication in minimal compared with spinal anesthesia. Lidocaine has been used extensively for epidural anesthesia with very satisfactory results. It has a very rapid onset of action, producing complete analgesia and has a reasonable duration of action(about 1-1½hr). A concentration of 1. 5% lidocaine causes effective sensory and autonomic blockade but it is unlikely to produce motor paralysis. More recently, bupivacaine(0.5%) has tended to supplement lidocaine as the drug of choice of epidural anesthesia. Firstly, the duration of action is longer. Secondly, it has better affinity for the tissue so that less will be absorbed into the circulation, thus reducing the risk of a toxic reaction. Thirdly, when used with a continuous technique, there is much chance of tachyphylaxis. Using a standardized anesthesia technic, we compared level of sensory anesthesia with a 0. 5% bupivacaine and 1. 5% lidocaine uder elective and emergency surgery. When equal volume of local anesthetic solution were injected(20 ml of 0.5% bupivacaine and l. 5% lidocaine) there were no statistically significant differences in sensory level in bupivacaine and lidocaine, but the duration of anesthesia in bupivacaine from 2 to 3 times longer than lidocaine.

보행마취(步行麻醉)

김영석,김완식,황호성,이진근,유희구,김흥대 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.2

An imaginative innovation to shorten hospital stays as a means to reduce patient charges, is out-patient surgery. This procedure also minimized the inconvenience and disruption of the family unit, reduced the opportunities for cross-infection, and freed hospifal beds for the more serriously ill patienta Since the concept of out-patient surgical service was organized, managed, and performed in the Hanyang Medieal Center, we had experience of 132 ambulatory anesthetics during the last two years (from Jan. 1974. to Dec. 1975 ). The results are summarized as follower 1. Preanesthetic examination should be routinely cheeked with Hb., Hct., urinalysis and chest x-ray. 2. Premedication should be administered preanesthetically, atropine sulfate intravenously. 3. ASA class 1 patients should be rhnsen fnr short (less than 1 hour) procedures. 4. Anesthesia is induced with Epontol+S.C.C. and maintained with Halothane+N2O+O2. 5. We suggest that ambulatory anesthesia should be more carefully planned, organized, and managed.

가토에서 CCNU 로 유발된 골수 저형성증의 혈액학적 소견과 골수스캔의 변화에 관한 연구

김승택,이명철,최두혁,고창순,김병국,이문호,박선양,최성재,김노경,최영희 대한내과학회 1986 대한내과학회지 Vol.30 No.1

To understand systematically the hematological changes including the bone marrow changes in chemotherapeutic agent-induced bone marrow hypoplasia and to define the relationship between hematological and bone marrow scan findings and prognosis of the hypoplasia, CCNU (lomustine) was given orally to 44 rabbits to induce hypoplasia of the bone marrow. And serial changes of peripheral blood and bone marrow findings and (111)In Cl(3)((111)In scan)/(99m)Tc tin colloid bone marrow scan((99m)Tc scan) were checked before and after induction of hypoplasia. With assessment of 28 evaluable rabbits, the following results were obtained: 1) Significant hypoplasia of the bone marrow developed around day 4 of CCNU administration and recovered around day 14(cellularity 51,4±13.5% and 24. 5±14.97o before and after CCNU respectively, p<005). Megakaryocyte count was significantly depressed from 95.67,26% to 36.7$gt;31.82%(P$lt;0.005). M: E ratio was decreased from 162±1.19 to 0, 0.5$lt;0. 43(p±0.005). Shift to left(475), maturation a(40%), naked nucleus and degenerated cells(20%), increase of lymphocytes(47%), monocytes and reticulum cells were also found. 2) The uptake ratio of the 99(m)Tc tin colloid bone marrow scan was markedly increased in contrast to the depression of the bone marrow(4.4±2.12 and 14.1±7.06 before and 4 days after CCNU, respectively, p40. 005). Tc scan uptake ratio was inversely related to the cellularity(r=-0.442, p$lt;0.05) and megakaryocyte number of the bone marrow(r= 0.89, p< 0.01) and peripheral blood granulocyte (r = 0. 54. Pg0.01) and platelet count(r=0.40, p$lt;0.05). There was not significant correlation between (111)In scan uptake ratio and hematologic parameters. 3) The amplitude of the change of the (99m)Tc scan uptake ratio was significantly related to the prognosis of the rabbits with experimentally induced hypoplasia of the bone marrow(dead 5.1±2,67, survivors 2,5±0.96, P<0.01). The change of the (111)In scan uptake ratio was not related to the prognosis of these rabbits. In experimentally induced rrow hypoplasia, morphologic changes in addition to the numerical changes of the bone marrow elements were observed. And serial (99)Tc scan of the bone marrow appears to be helpful assessing the severity and predicting the outcome of bone marrow hypoplasia.