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증례 : 소화기 ; 간문맥혈전을 동반한 간암의 화학색전술 후 장기생존 1예
박관식 ( Kwan Sik Park ),서은희 ( Eun Hee Seo ),이현석 ( Hyun Seok Lee ),최소영 ( So Young Choi ),조창민 ( Chang Min Cho ),탁원영 ( Won Young Tak ),권영오 ( Young Oh Kweon ) 대한내과학회 2009 대한내과학회지 Vol.76 No.2
본 저자들은 주간문맥 혈전이 동반된 간세포암종에서 경동맥화학색전술을 시행하여 재발이나 간부전 소견없이 장기간 생존한 예를 보았기에 문헌고찰과 함께 보고하는 바이며, 간문맥 혈전이 동반된 경우라도 간기능이 잘 보존되어 있고 문맥주위 측부혈관이 잘 발달되어 있으면 경동맥화학색전술을 통해 예후를 향상시킬 수 있음을 보여주는 예라고 하겠다. Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea and the prognosis of patients with HCC is generally poor. Most patients with HCC have unresectable disease at presentation and only a small proportion of patients diagnosed early receive curative treatment. Transarterial chemoembolization (TACE) is a widely used palliative treatment for advanced HCC and its prognostic benefit has been proven in several studies. TACE is contraindicated for patients with portal vein tumor thrombosis (PVT) because it carries a potential risk of acute hepatic failure. Recently, however, a few studies have provided evidence of a survival benefit after TACE in patients with PVT if they have good hepatic reserve and collateral circulation around the portal trunk. We experienced a case of HCC with PVT, with long-term survival and no evidence of recurrence or hepatic failure after TACE, and present this case with a review of the relevant literature. (Korean J Med 76:215-219, 2009)
임상연구 : Isoflurane 흡입마취 동안 아산화질소가 뇌 엔트로피에 미치는 영향
박관식 ( Kwan Sik Park ),박종국 ( Jong Cook Park ),문봉기 ( Bong Ki Moon ),이숙영 ( Sook Young Lee ),김진수 ( Jin Su Kim ),노현주 ( Hyun Ju No ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Background: The bispectral index has limitations in describing the exact depth of anesthesia during nitrous oxide inhalation. This study examined the effect of nitrous oxide on the cerebral entropy measured using an entropy module (M-ENTROPY Module S/5(R), Datex-Ohmeda division, Instrumentarium Corporation, Helsinki, Finland) during the stable anesthetic period with isoflurane inhalation. Methods: Sixty ASA 1 or 2 adult patients were randomly allocated to three groups. During the stable maintenance period after the skin incision, the baseline entropy values (response entropy, RE; state entropy, SE) were recorded at 2.5 minutes intervals over a 20 minute period on a single frontal channel at 0.9% end-tidal isoflurane. After this, medical air was used continuously (group C) or replaced with nitrous oxide at 40% (group L) or 60% (group H) with continuous hemodynamic and entropy values monitoring. Each of the variables was recorded and analyzed at 2.5 minutes intervals over a 20 minute period. Results: Average values (mean ± SD) of the RE and SE during experimental period were lower in group H (29.2 ± 12.3 and 28.5 ± 11.7, respectively) than group L (33.9 ± 7.3 and 33.0 ± 7.3, respectively) and the averaged values were lower in group L than in group C (46.6 ± 14.8 and 45.5 ± 14.2, respectively). The percent reduction was larger in group H (42.1 ± 14.2 and 38.7 ± 16.5, respectively) than in group L (25.3 ± 15.1 and 24.4 ± 14.9, respectively) and the percent reduction was larger in group L than in group C (P < 0.01). Conclusions: Added nitrous oxide during the anesthetic maintenance period with isoflurane decreases the level of cerebral entropy. (Korean J Anesthesiol 2007; 52: 543~9)
슬관절 전치환술을 받는 환자에서 진정 동안 발생한 기도 폐쇄가 수축기 혈압과 중심정맥압에 미치는 영향
박관식 ( Kwan Sik Park ),김대희 ( Dae Hee Kim ),문봉기 ( Bong Ki Moon ),박용덕 ( Yong Duck Park ),채윤정 ( Yun Jeong Chae ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Background: Severe respiratory variations of systolic arterial and central venous pressure (CVP) may increase the risk of embolic event in orthopedic patient. As airway obstruction during sedation can cause this respiratory variation, we evaluated the degree of variations of systolic blood (SBP) and CVP during airway obstruction period. Methods: Fifteen females who had obstructed airway during total knee replacement (TKR) were included for the study. After regional anesthesia were established, SBP and CVP variations were analyzed according to the three periods; baseline, obstruction, and airway, respectively. Calculated CVP variables were similar to SBP variables as below: ΔSBP=Exp(max) (maximal value at expiration)-Insp(nadir) (minimal value at inspiration), %ΔSBP=(ΔSBP/Exp(max))×100. The frequencies of pulsus paradoxus (PP) and negative inspiratory CVP (NIC) were also measured. Results: At obstruction period, ΔSBP was 21.7 mmHg and 93.3% of patient had PP. Also, ΔCVP was 19.3 mmHg and 100% of patient showed NIC. %ΔCVP (140%) was larger than %ΔSBP (16%). And ΔCVP was inversely correlated with baseline and obstruction SBP and %ΔCVP was also inversely correlated with baseline CVP at obstruction period. Conclusions: During airway obstruction in sedated TKR patients, variations of CVP are larger than those of SBP. So we have to monitor CVP continuously as well as SBP so as not to increase the possible risk of respiratory of variation. (Korean J Anesthesiol 2009; 57: 38~43)
박관식 ( Kwan-sik Park ),이미영 ( Mi-young Lee ),김종호 ( Chong-ho Kim ) 대한임상검사과학회 2010 대한임상검사과학회지(KJCLS) Vol.42 No.1
It has been well known that organic industrial solvents such as toluene, xylene and styrene are environmental health hazards causing occupational diseases to workers. The detection of biological metabolites of toluene, xylene and styrene in blood, urine, breast milk, saliva, and hair of workers exposed to these organic industrial solvents is a useful tool for assessing the amount of organic industrial solvents. Therefor, the external analytical quality assurance program is extremely important work for increasing reliability of the data analyzed in the special health examination laboratory. We evaluated the results of analysis by Korean analytical quality assurance program from the second half 2007 to the first half 2009. The number of participants for analytical quality assurance program for both mandatory item and one of optional items, hippuric acid and methylhippuric acid were 116-122, 116-122 and 105-115 laboratories, respectively. The proficient rate of the special health examination laboratories analyzed both mandatory item and optional item, hippuric acid and methylhippuric acid were 92-98%, 92-98% and 96-98%, respectively. We can conclude from our data that the analytical quality assurance program is a essential tool for improvement of reliability on the data analyzed in the special health examination laboratories.
증례보고 : Hemocoagulase에 의한 것으로 추정되는 아나필락시스: 혈중 비만세포 Tryptase 증가에 의한 확인 -증례보고-
이숙영 ( Sook Young Lee ),박관식 ( Kwan Sik Park ),조외경 ( Oi Gyeong Cho ),김의석 ( Yeui Seok Kim ),정원호 ( Won Ho Jeong ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Multiple agents can cause anaphylaxis in a perioperative setting. Identifying the agent responsible is essential for avoiding future adverse reactions as well as to attenuate the progression of anaphylaxis. Being able to distinguish an anaphylactic reaction from an anaphylactoid reaction would help clarify the therapeutic and medicolegal issues. Anaphylaxis generally occurs after reexposure to a specific antigen and requires the release of proinflammatory mediators from mast cells and basophils. An increased concentration of mast cell tryptase is a highly sensitive indicator of anaphylactic reactions during anesthesia. Botropase(R) is a procoagulant hemocoagulase purified from venom of Bothrops jararaca, a Brazilian viper and in wide use in patients with high risk of bleeding. We report a case of suspected anaphylaxis to Botropase(R) in a 67 years old female patient undergoing segmental resection of the liver with elevated concentration of serum mast cell tryptase. (Korean J Anesthesiol 2006; 51: 105~8)