임상증례중심 성인 전문적 심장구조술 교육과정에 대한 고찰

유은영,박승현,박규남,최세민,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: To describe the first experience of case-based advanced cardiac life support(ACLS) course in Korea. Methods: We have given case-based ACLS course to 13 nurses(6 emergency nurses, 4 coronary care unit nurses, 3 professors) and 17 physicians(4 emergency physicians, 12 emergency residents, 1 intern). We performed the case-based ACLS course according to 1992 American Heart Association guidelines and recommendations for advanced cardiac life support by american ACLS instructors(1 pulmonologist, 4 critical care nurses). We performed final theoretical written test and 2 times written survey (immediate and 100th day after the course) about the course. Results: On final written test, all practitioners answered at least 70% of the questions correctly. There was no significant difference between nurses and physicians(86.2±3.6 of physicians and 82.5±6.8 of nurses, p=0.06). 90% of participants considered that case-based advanced cardiac life support was acceptable. 100th day after the course, 93% of participants answered that ACLS course have been helpful on his/her job and also want retraining of ACLS course. 70% of participants considered that ideal ACLS training committee in Korea is the Korean Society of Emergency Medicine. Conclusion: Case-based ACLS course is a useful educational method for physicians and nurses in Korea. In the future, we should organize Korean resuscitation committee and then make guidelines for ACLS, and then continuously educate physicians and nurses.

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.

접착제에 따른 유동성 복합 레진 수복물의 미세누출 양상에 관한 연구

박지은,김종수,유승훈 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

본 연구는 5급 와동에서 유동성 복합 레진 수복 시 수종의 상아질 접착제에 따른 미세 누출 양상을 비교하고, resin tag 및 혼성층의 형상을 전자 현미경으로 관찰하고 비교 분석하였다. 행동 조절에 어려움이 많은 소아 환자의 접착 수복에서 술식의 간편화 및 시간 단축이 장점으로 부각되고 있는 Aln-in-one 상아질 접착제의 임상 적용 가능성을 평가하고 다음과 같은 결론을 얻었다. 1. 법랑질 변연에서는 II군(AQ Bond Plus)이 가장 높은 미세누출을 보였고 III군(AdheSE^(ⓡ) One), I군(Adper™ Single Bond2) 순으로 감소하였으며, II군은 I군, III군과 통계학적 유의차를 보였고(p<0.05). I군과 III군 사이에는 유의차가 없었다. 2. 상아질 변연에서는 II군, I군, III군의 순으로 미세누출이 증가하였고, 각각 통계학적 유의차를 보였다(p<0.05). 3. I군과 III군에서는 법랑질 변연이 상아질 변연보다 유의하게 낮은 미세누출을 보였으나(p<0.05), II군에서는 통계학적 유의차를 보이지 않았다(p>0.05). 4. 주사전자현미경 소견에서 II군과 III군은 resin tag의 형성이 매우 미약하고 불규칙한 양상을 보인 반면 I군에서는 비교적 긴밀하고 균일한 resin tag가 관찰되었다. 이상의 결과를 종합해보면, AQ Bond Plus와 AdheSE^(ⓡ) One은 처리 과정의 단순화로 인한 시간 절약의 장점을 가지고 있으나 Adper™ Single Bond 2에 비해 상대적으로 높은 미세누출과 약한 결합력을 보인 본 실험의 결과를 미루어 볼 때, 임상적용 시 술식과 case에 따른 선택적 사용이 추천되는 바이다. This study was performed to evaluate the quality of newly offered dentin bonding system (AdheSE^(ⓡ) One) by comparing the degree of microleakage measured with those of several conventional adhesive materials (AQ Bond Plus and Adper™ Single Bond 2). The quality of hybrid layer and resin tags was analyzed by observing restoration/tooth interface under SEM. All-in-one system is in the limelight for having advantage of reducing chair time of children with difficult behavior pattern. Therefore the possibility of clinical application of All-in-one system was evaluated. The results obtained are as follows; 1. At the enamel margin, group II (AQ Bond Plus) showed the highest value of microleakage, and the other groups showed decreased value in order of group III (AdheSE^(ⓡ) One) and I (Adper™ Single Bond 2). There was statistically significant difference between group II and the others(p<0.05), and no statistical difference was found between group I and III. 2. At the dentin margin, microleakage value was increased in order of group II,I,III and significant difference between all groups(p<0.05). 3. In group I and III, microleakage value measured at the enamel margin was significantly lower than that seen at the dentin margin (p<0.05), and there was no statistical difference in group II. 4. Resin tags observed under SEM were very weak and tangled in group I and III while the strong and thick tags were observed in group I. In conclusion, careful case selection and accurate clinical application is recommended in using AQ Bond Plus and AdheSE^(ⓡ) One, giving consideration of the results showing its higher microleakage and weaker strength than Adper™ Single Bond 2.

장내의 탄수화물과 지방 흡수 억제를 통한 체지방 및 비만 개선 효과에 관한 연구

정은희,윤승원,이홍석,윤유식,유경미,황인경 한국조리과학회 2003 한국식품조리과학회지 Vol.19 No.1

In a previous study, a dietary supplement was developed in our lab using natural herbal extracts against digest enzyme activity in GI tract for weight control. This natural herbal extracts could regulate absorption of glucose and lipid by the inhibition of digest enzyme activity. In this study, we screened the natural herbs that inhibit glucoamylase activity and developed an water extract of cinnamon. The cinnamon extract delayed and decreased the increment of carbohydrate degradation through the inhibition of glucoamylase activity in vitro. Fifty volunteers were subjected to the intake of the herbal extracts by taking twice a day for 60 days. As a result, the treated subjects lost 3kg of body weight and 3.5kg of body fat mass after the treatment. Furthermore, the body mass index and waist size were significantly decreased during the experimental period. Above results suggested that the administration of the dietary additives composed of cinnamon and natural herbal extract improves the obesity by the decrement of body weight and body fat mass.

부착성 동물세포의 Scale-up을 위한 방법의 개발

김승모,송상호,최명락,유은정,임현수 여수대학교 1997 論文集 Vol.11 No.2

This study was a protocol of serial propagation for anchorage-dependent animal cell. Vero. by the optimization of trypsin and EDTA concentration in T-25 flask. Commen enzymetic treatment in PBS solution has been modified for a high degree of cell datachment from T-25 flask and for transfer of a maximum number of viable cells from one culture to the next during the scale up process. Culture of Vero cells were washed with Dulbecco's modified Eagle's medium(DMEM) and then exposed to DMEM containing trypsin(0.025%) and EDTA(0.16%). Up to 90% of cells detached from bottom of flask and the viability of cells was greater than 93%. The protocol using the developed method was successfully applied to the next 10 times scale up process. Consequently, the developed method changed multiple steps of processes to one step, so it promised th easy scale-up and low cost demand of animal cell culture.

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

안내염과 대장암이 동반된 재발성 간농양

전승정,김태헌,류민선,오다연,송명은,이신아,류재인,김혜인,문일환,유권 이화여자대학교 의과학연구소 2011 EMJ (Ewha medical journal) Vol.34 No.2

The causes of pyogenic liver abscess has been known as biliary tract disease or intrabadominal infection but the large proportions of the patients has no apparent underlying disorders. Recently colonic mucosal lesions were reported in patients with cryptogenic liver abscess and it has been suggested that colonic mucosal break may play a role in developing liver abscess in otherwise healthy patients. We experienced a patient of severe recurrent liver abscess complicated with endophthalmitis only 3 months after successful treatment of initial cryptogenic liver abscess and a polypoid colon cancer was discovered by chance. It seems prudent to proceed colonoscopic examination in patients with cryptogenic liver abscess especially when it is recurrent.

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.

성장과 운동수행능력 향상에 도움을 주는 식이조성물의 개발

윤승원,정은희,양동식,이홍석,윤유식 대한지역사회영양학회 2003 대한지역사회영양학회지 Vol.8 No.3

We developed a dietary supplement using natural herbs and nutrients for the growth and exercise performance improvement. It called JR-22 supplement containing distilled extracts of natural herbs to remove bitterness and the addition of Vitamin B1, B6, Ca and xylitol. We investigated on the effect of JR-22 supplementation on the maximal exercise performance, IGF-1 (insulin like growth factor-1) concentration and antioxidant activity in SD rat model. In result, JR-22 supplement group was better than control group about 10% in exercise performance test and increased about 63% of IGF-1 concentration in blood. In addition, the oxidative damage induced by exercise was reduced by JR- 22 supplementation. Therefore, we suggested that JR-22 supplementation enhanced effectively exercise performance and IGF-1 concentration and reduced to oxidative stress in muscles. Also, we analysed biochemical factors in blood for the safety of JR-22 supplement. We known that there is no change of blood lactic acid, ammonia, inorganic phosphorous ion and creatine kinase activity.

경막 내 colistimethate 투여로 치료한 다제 내성 cinetobacter baumannii 뇌실염

홍유아,유진홍,김진진,모은영,안건희,정희경,김진석,이현정,정미향,윤승배 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.