급성 신손상과 동반된 metformin 관련 중증 유산산증 1예

전해리 ( Hae Ri Chon ),김민정 ( Min Jung Kim ),김동현 ( Dong Hyun Kim ),구남호 ( Nam Ho Koo ),장세헌 ( Sae Heun Jang ),천미주 ( Mi Ju Chon ),정시정 ( Shi Jung Chung ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2

Metformin is the first line therapy for the treatment of type 2 diabetes mellitus. Metformin associated lactic acidosis is rare, but potentially life-threatening adverse effect. It may occur as a result of drug overdose, kidney injury or hepatic disease. We report a case of a 49-years-old man presented with general weakness, severe diarrhea and vomiting for several days. Arterial blood gas analysis showed severe metabolic acidosis and lactate level of 17.4 mmol/L. Serum creatinine level was 9.3 mg/dL. His current medications included metformin 3700 mg daily. We diagnosed him as metformin- induced lactic acidosis precipitated by acute kidney injury and drug overdose. We treated him with intravenous bicarbonate and hemodialysis with bicarbonate-rich dialysate and his renal function and acidosis were fully recovered.

Association of Toll-like receptor 2 polymorphisms with National Institute of Health Stroke Scale scores of ischemic stroke patients.

Park, Hae Jeong,Kim, Su Kang,Yun, Dong Hwan,Kim, Dong Hwan,Chon, Jinmann,Kim, Jong Woo,Chung, Joo-Ho Birkhäuser Boston 2012 Journal of molecular neuroscience Vol.46 No.3

<P>Toll-like receptor 2 (TLR2) has been shown to have an important role in the postischemic inflammatory response and to contribute to ischemic brain damage. In this study, we investigated whether coding region single nucleotide polymorphisms (SNPs) of the TLR2 gene were associated with ischemic stroke (IS) and with clinical phenotypes in IS patients. We genotyped two SNPs (rs3804099 [Asn199Asn] and rs3804100 [Ser450Ser]) using direct sequencing in 202 IS patients and 291 control subjects. No SNPs of the TLR2 gene were found to be associated with IS. However, in analysis of clinical phenotypes, we found that rs3804099 was associated with the National Institute of Health Stroke Scale (NIHSS) scores of IS patients in codominant (TC vs. TT, p?=?0.0005; CC vs. TT, p?=?0.0007) and dominant models (TC/CC vs. TT, p?=?0.0001). Also, rs3804100 revealed significant association in codominant (TC vs. TT, p?=?0.0002; CC vs. TT, p?=?0.008) and dominant models (TC/CC vs. TT, p?<?0.0001). In allele frequency analysis, we also found that the C alleles of rs3804099 and rs3804100 were associated with higher NIHSS scores (p?=?0.0003 in rs3804099; p?=?0.0001 in rs3804100). Our results suggest that TLR2 may be related to severe IS.</P>

전신마취중 심부정맥의 발생빈도

김교상,이동호,김혜순,이청,김경헌,전세웅,서정국,유희구,염종훈,전종헌,승익상 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.2

The incidence of cardiac arrhythmias during anesthesia in a total 5,845 surgical patients who were admitted to Hanyang university hospital from Janury 1 to December 31, 1988 was investigated using on-line continuous EKG monitoring. The results were as follows: 1) Among study patients, 111 patients (1.9%) had pre-existing cardiac arrhythmias before anesthesia and showed significantly higher incidence of arrhythmias (49.5%) than that of patients without pre-existisng arrhythmias before anesthesia (2.9%). 2) Among arrhythmias found during anesthesia, most types of arrhythmias were ventricular premature contractions (77.4% in the patients with pre-existing cardiac arrhythmias and 43.6% in the patients without pre-existing cardiac arrhythmias) except sinus bradycardia and tachycardia. 3) Although the incidence of arrhythmias during the induction of anesthesia was similar to that during anesthesia maintenance, it was somewhat greater on the basis of incidence per unit time. 4) The incidence of arrhythmias was increased with age. 5) The incidence of arrhythmias when anesthesia was induced with halothane (3.7%) was greater than that when anesthesia was induced with enflurane (2.1%). 6) Most of the arrhythmias were controlled with sufficient ventilation and oxygen supply, adjusting concentration of inhaled anesthetics or changing anesthetics, and occasionally, intravenous admininstration of 1% lidocaine (1.0-1.5 mg/kg). Considering the above results, it may be an appropriate conclusion that the continuous on-line EKG monitoring during the induction and maintenance of anesthesia is a noninvasive and simple method for detecting early signs of cardiac arrhythmias and hemodynamic changes during anesthesia, and consequently, improving the overall efficiency of patient care. Therefore, we are impressed with an idea that the continuous EKG monitoring should be mandatory for all surgical patients to be anesthetized.

가토에서 Pancuronium 과 Verapamil 에 의한 근이완과 심혈관반응

김교상,이동호,김동환,김혜순,이청,전세웅,서정국,유희구,김성종,승익상,김경헌,염종훈 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.3

Pancuronium is one of the most available nondepolarizing muscle relaxant. It is primarily eliminat-ed unchanged by the kidney, although a small fraction is metabolized by the liver. On the other hand, calcium channel blocking agents are a chemically heterogeneous group of drugs that inhibit the ionic current carried through the calcium slow channel in cardiac and vascular smooth muscle. This action is the basis of their usefulness in the treatment of cardiovascular disorders. Although the role of calcium in skeletal muscle differs from that in cardiac and vascular smooth muscle, various recent studies have shown that verapamil is able to inhibit neuromuscular function in skeletal muscle preparations. However, it is not well known, yet. Increasing number of patients who are taking calcium channel blockers were reported recently. The present study was undertaken to determine if verapamil could potentiate the effects on pancuronium and how does it affect the cardiovacular response. The results were as follows; 1. Verapamil (1.41 mg) significantly enhanced the recovery index of pancuronium as 226.7 sec compared with control recovery index as 162.5 sec (p$lt;0.025). But tetanic stimulation (50Hz, 5 sec) was sustained in the both group. 2. Hypotensive effect was appeared when 1.41 mg of verapamil was given and it was taken 7.7 min. 3. Signs of cardiovascular response was decreasing the blood pressure especially diastolic first then heart rate was decreased.

돌발성난청 환자에 대한 성상신경절 차단술의 치료효과

이호기,양해동,김문석,한재욱,전경명,김희남 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.3

저체온 가토에서 Vecuronium 의 그이완과 Neostigmine 의 효과

김교상,이동호,김혜순,전세웅,서정국,유희구,김경헌,승익상 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.4

Anesthesiologists may have close relationship with muscle relaxants in clinioal practice. Fortunately, few of the new muscle relaxants were discovered and used in clinic recently. And also hypothermia reduced the effectiveness and prolonged duration of non-depolarizing block, has been challenged, and it is now generally accepted that hypothermia prolongs the duration of non-depolarizing neuromuscular block. But exactly how much block may prolonged is not mentioned so there may exist controversial result from animal to animal. We have studied newly introduced vecuronium effects during hypothermic rabbits. The results were as follows ; 1. Spontaneous recovery index by vecuronium 7.05 mg/kg in normothermic rabbit was 216.4 sec(3.6 min). 2. Spontaneous recovery index by vecuronium 0.05 mg/kg in hypothermic (32℃) rabbit was markedly prolonged as 441.3 sec(7.35 min) . 3. Recovery index by the neostigmine 40 ug/kg reversal in hypothermic(32℃) rabbit was 120.1 sec(2.0min). Authors concluded that vecuronium effects hypothermic rabbits were markedly prolonged and promptly reversed.

가토에서 정주공기량에 따른 심전도 및 혈액가스변화

김교상,이동호,김혜순,이청,김경헌,전세웅,서정국,유희구,염종훈,전종헌,승익상 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.2

After the hemodynamic comparison of venous air volume in 32 rabbits, the following conclusions were derived. 1) The precordial doppler ultrasonography was most sensitive and end titdal CO₂ pressure was statistically decreased at 0.1 ml/kg of air. 2) The mean arterial pressure was suddenly decreased at 1 minute after injection of more than 0.25 ml/kg of air, and was furether reduced according to the time. 3) The arterial PCO₂ was continuously increased and statistically different from 0.25 ml/kg of air, and the arterial PO₂ was suddenly decreased to about 1/3 of the control data. 4) The pulse rate was statistically decreased at more than 0.5 ml/kg of air and shown peaked p wave, arrhythmias, ST depression and premature ventricular contraction on the EKG. There 4 dead rabbits at 1.0 ml/kg of air, so we could conclucle that the fatal dose of rabbits was more decreased than that of the dogs in venous air embolism.

가토에서 Atracurium 의 용량에 따른 근이완 효과

김교상,이동호,김혜순,이청,전세웅,서정국,유희구,전종헌,황재현,승익상,김경헌 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.2

Atracurium, one of the newly developed nondepolarizing muscle relaxants, is remarkable due to the intermediate duration of action from the other previously known nondepolarizing agents and the broad safety margin in patients with renal or liver disease. There have been many reports suggesting that the pharmacologic effects of the nondepolarizing muscle relaxants are influenced by dosage. In this study, we attempted to identify the specific mechanism of muscle relaxation of atracurium. Particular attention was paid to the actually delivered atracurium dose and to the degree of muscle relaxation in rabbits. The results were as follows; 1) In the atracurium 0.4 mg/kg group, the onset of action was shortened and in the atracurium 0.6 mg/kg group, it was shortened more significantly. 2) The duration of action was increased with the increase of dose: the mean duration was 895 seconds in the atracurium 0.1 mg/kg group, 1,113.7 seconds in the 0.2 mg/kg group, and 1,199.3 second is in the 0.4 mg/kg group. It was prolonged to 1,730 seconds in the atracurium 0.6mg/kg group. 3) The spontaneous recovery index showed no differences in the atracurium 0.1 mg/kg group, 0.2 mg/kg group and 0.4 mg/kg group (196.7 sec., 195.0 sec, 202.7 sec. each). But in the atracurium 0.6 mg/ kg group, it was markedly prolonged to 334 seconds. In conclusion, atracurium, like other nondepolarizing agents, produces a dose related duration of action in muscle relaxation.

다음증을 동반한 정신분열증 환자에서 항콜린성 약물 복용 중 발생한 만성 신부전 1례

전일영 ( Il Young Chon ),오동준 ( Dong Joon Oh ),최승진 ( Seung Jin Choi ),김지영 ( Ji Young Kim ),안계련 ( Ke Ryun Ahn ),이원준 ( Won Joon Lee ),이지연 ( Ji Yeon Lee ),백혜리 ( Hae Ri Baek ),이은지 ( Eun Ji Lee ),한상원 ( Sang Wo 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

Anticholinergic drugs block muscarinic receptors at the detrusor muscle of the bladder. It can cause urinary retention by contracting the bladder neck. Cases of hydronephrosis, bladder dilatation as a result of polydipsia while taking anticholinergic drugs have been reported, but very few cases of chronic renal failure can be found. We report a case of a polydipsic schizophrenic patient who, after taking anticholinergic drugs as antipsychotic drugs to treat his schizophrenia for a long time, presented with chronic renal failure due to functional obstructive uropathy in the absence of demonstrable anatomic causes of obstruction.

외상후 스트레스 장애 이외의 정신 장애에 대한 EMDR 전후의 치료 반응 및 증상 변화

이해원,김대호,배활립,최준호,오동훈,박용천,Lee, Hae-Won,Kim, Dae-Ho,Bae, Hwal-Lip,Choi, Joon-Ho,Oh, Dong-Hoon,Park, Yong-Chon 대한불안의학회 2008 대한불안의학회지 Vol.4 No.1

Objective : Eye movement desensitization and reprocessing (EMDR) has been established as an effective treatment for patients with posttraumatic stress disorder (PTSD). However, the literature is unclear as to whether EMDR is effective in the treatment of other psychiatric disorders. The purpose of this study was to evaluate the potential use of EMDR in the treatment of psychiatric disorders other than PTSD by using a clinician's impression of patient response and a subjective symptom evaluation. Methods : Seventeen diagnostically heterogenous patients without PTSD underwent an average of 4.3 sessions of EMDR. Symptom severity was assessed by the Clinical Global Impression-Change Scale (CGIC), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Symptom Checklist-90- Revised (SCL-90-R) before and after EMDR. Those whose CGI-C scores were 'very much improved' and 'much improved' after EMDR were classified as 'responders.' The patients' before and after treatment scores of symptom severity and group differences were compared. Results : Twelve of the 17 participants (12/17, 71%) were classified as 'responders.' The patients' scores on all of the scales, with the exception of the trait anxiety scale and obsession-compulsion scale of the SCL- 90-R, significantly decreased after treatment. There was no difference in sociodemographic and clinical variables between the responders and non-responders. Conclusion : The results of our study suggest that EMDR can be a promising candidate for the treatment of patients with psychiatric disorders other than PTSD, and thus further controlled studies are needed to determine whether EMDR can be applied to various psychiatric populations.