국산 Lidocaine 알칼리화를 위한 Bicarbonate 혼합시 침전유발 최소량에 대한 고찰

이선호,김현수,곽인숙,안원식,최관호,김광민,손민제 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.5

Background : When local anesthetics for regional anesthesia is used, usually small amounts of bicar-bonate are added for rapid onset. This addition gives the mixed solution a more alkaline pH. The following result is an increased unionized form of the local anesthetic and rapid penetration of the drug into tiissue. Unfortunately, no data about adequate mixing volumes of domestic lidocaine and bicarbonate is available. Methods : We examined six mixing pairs of two kinds of 2% lidocaines and three kinds of 8.4% bicarbonates for minimum volumes of bicarbonate to cause a precipitation of 2% 20 ml lidocaine. Results : The mean volumes of bicarbonate to cause precipitation were 1.54 ml for Kwang-Myung lidocaine with Kwang-Myung bicarbonate, 2.90 ml for Kwang-Myung lidocaine with Dae-Won bicarbonate, 2.73 ml for Kwang-Myung lidocaine with Je-Il bicarbonate, 0.97 ml for Je-Il lidocaine with Kwang-Myung bicarbonate, 1.26ml for Je-Il lidocaine with Dae-Won bicarbonate and 1.39 ml for Je-Il lidocaine with Je-Il bicarbonate. Conclusions : We conclude that the Kwang-Myung lidocaine and the Je-Il lidocaine could cause precipitation when mixing with a smaller bicarbonate volume than foreign textbook recommended. (Korean J Anesthesiol 2000; 39: 726-729)

입원한 입시 스트레스 증후군 환자의임상양상에 관한 정신의학적 연구

신광철,진태원,이영식,이재우,이재광,이길홍 중앙대부설한국의과학연구소 1991 한국의과학 Vol.23 No.3

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.

고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

인간 재조합 인터루긴-32 면역조절작용에 대한 유세포 분석

이광수,김영관,채정일,심정현,김은미,강형식,김수현,윤도영,명평근 충남대학교 생물공학연구소 2006 생물공학연구지 Vol.12 No.-

Xenotransplantation of porcine organs has the potential to overcome the severe shortage of human tissues and organ available for human transplantation. however, it remains various hurdles for clinical xenotransplantation. In pig and mouse xenotransplantation, porcine xenograft evoke a strong cellular rejection response in immunocompetent host and grafts are destroyed within a week. This cellular immune response could involved both T cells and NK cells. A number of groups have shown that human NK cells can recognize and damage porcine endothelial cells. In addition, human T cells can respond to porcine endothelial cells through both direct and indirect mechanisms. Cellular rejection of porcine tissues requires T cells, particularly CD4^(+) cells. A new cytokine recombinant human interleukin-32α,β(IL-32α,β) has a role innate and acquired immune system. In order to investigate the role of recombinant mouse IL-18 and recombinant human IL-32α,β in xenograft rejection, we transplanted the PK(15) cells to C57BL/6 mice with or without intraperitoneal injection of recombinant mouse IL-18 or recombinant human IL-32 α,β. It was analyzed the population of NK cell, T cell and B cell in the C57BL/6 mice transplanted with PK(15) cells and recombinant mouse IL-18 or recombinant human IL-32α,β by flow cytometry analysis. As a result, lymph node and thymus of PK15/IL18, PK15/IL32α and PK15/IL32β injected group were increased to T cell activation population than normal injected groups. CD8^(+) T cells were decreased in lymph node of PK15/IL18, PK15/IL32α and PK15/IL32β injected groups. CD4^(+) T cells were increased in lymph node cell of PK15/IL32α and PK15/IL32β injected group and also, B cell population were increased in lymph node cell and spleen of PK15/IL18, PK15/IL32α and PK15/IL32β injected group. Therefore, we suggest that recombinant mouse IL-18 and recombinant human IL-32α,β suppress xenograft rejection in cellular xenotransplantation.

정신병환자 가족의 걱정에 관한 조사

이정식,오동열,김광일 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.3

Opinions about the family burden of psychotic in-patient were collected from 207 caretakers of psychotic in-patient admitted to the Seoul National Mental Hospital from December 1989 to February 1990 through individual informal interview. Each respondent was asked to varbalize initially all the worries concerning the patients. and their care and then to choose two serious worries among them. Form these opinions, the authors tried to identify the family burden of psychotic in-patient and the relevance between family burden and demographic variables. and to discuss the issues arising from this investigation. The results were as follows : 1) The caretaker's worries could be classified into six areas. “The future and outcome” of the patient was the most frequent worrying area. being 64.3%. The worry about “Family was 45.4% ; Care and support”.42.5% : “Mental health support”. 14.5% ; “Shame and stigma”. 12.6% ; “Neighborhood”. 4.8%. 2) The parents worried much more about “The future and outcome” of the patient whereas the spouse and the siblings worried more about “Family” and the offsprings worried about “Neighborhood”. especially. The caretakers who inhabit in the metropolis worried more about “Care and support” and worried especially about “care and responsibility” among the “Care and supports” area while the caretakers in the other areas worried more about “Neighborhood ” and worried especially about “financial burden” among the“Care and support” area. The caretakers of the famale patient worried more about “everyday life of patients” among “The future and outcome area”. The higher the education level of the caretakers. the more they worried about “future of patient” among “The future and outcome” area and “influence on offspring” among the “Family” area. Male caretakers worried more about “drug” while female caretakers worried more about “policy and institution” among the “Mental health supports area”. There were three problems regarding family's burden of psychotic in-patient : Caretaker's loading in all areas : Caretaker's devastated emotion by the long-standing burden ; A lack of helpers.

신부전이 동반된 당뇨병 환자에서 발생된 침습성 모균증 : 수술과 Liposomal amphotericin B 및 GM-CSF 병합 요법에 의한 성공적인 치험 1예

이원영,오기원,임국희,장재혁,이동건,최정현,강무일,신완식,차봉연,이광우,손호영,강성구 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.4

저자들은 신부전이 동반된 당뇨병 환자에서 발생된 부비동형 모균증에 대하여 수술과 함께 liposomal amphotericin B 및 GM-CSF의 복합치료를 하여 성공적으로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Mucormycosis (zygomycosis) primarily affects diabetic or immunocompromised patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are needed for cure, but it has the risk of causing significant renal toxicity. The recent development of liposomal amphotericin B allows antifungal therapy to be administered with potentially improved efficacy and reduced nephrotoxicity. We have experienced a case of paranasal mucormycosis successfully treated with surgery, liposomal amphotericin B and GM-CSF. A 59-year-old male suffering from diabetes mellitus for 6 years was admitted with pain at left maxillary area. He was diagnosed as mucormycosis after cytologic exam on the necrotic nasal mucosa, which showed typical hyphae. He have had diabetic nephropathy with macroproteinuria and had rapidly rising serum creatinine levels with the amphotericin B treatment: creatinine levels reverted to basal level with the use of liposomal amphotericin B. Despite surgical excision and continued antifungal therapy, his infection was not effectively controlled. Therefore, GM-CSF was administered additionally to improve phagocytic activity of leukocytes. He was finally cured after receiving a combination of aggressive surgery, liposomal amphotericin B and GM-CSF. To our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with liposomal amphotericin B in Korea.

중범위 이상 회전근 개 파열 환자의 관절경적 봉합술 : 견봉성형술의 역할 The Role of Acromioplasty

이광원,김갑중,이항호,김병성,김하용,최원식 대한견.주관절학회 2003 大韓肩.주關節學會誌 Vol.6 No.2

초등학교 수준별 교육과정 운영 방안에 관한 연구

이성영,김광명,신준식 춘천교육대학교 초등교육연구소 2001 敎育硏究 Vol.18 No.-

댐퍼붙이 거위목바이트를 使用하는 切削系의 動的 安定性에 關한 硏究

李炯植,鄭準基,盧光春 연세대학교 산업기술연구소 1982 논문집 Vol.14 No.2

The effect of the damped goose-neck tool upon the dynamic stability of machine tool was investigated. The dynamic stability of machine tool is directly related to the chatter in the metal cutting process. By the test of the dynamic characteristics for the damped goose-neck tool, theoretical approach of dynamic stability of machine tool is identified. It's results are compared with the results of actual cutting test. And the dynamic stability of machine tool is improved by the higher elasticity and the increase of damping coefficient for the damped goose-neck tool.