Oblique interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain - A case report -

변경조,최은지,최윤미,장은정,김혜진,김경훈 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.4

Epidural steroid injection (ESI), which is commonly used for treatment of low back pain with lumbosacral radicular pain, can be performed via transforaminal, interlaminar, or caudal routes. The transforaminal route is generally regarded as more effective than the interlaminar route due to its high level of drug delivery to the ventral epidural space. However, in some postoperative patients, use of the transforaminal route may be difficult. Thus, there is an urgent need for technology that can offer more effective drug delivery to the ventral epidural space with fewer complications. In this context, we describe a case about our new method where patient has undergone oblique interlaminar lumbar epidural steroid injection (OIL-ESI) instead of transforaminal ESI. We treated a patient with OIL-ESI instead of transforaminal ESI. Patient was symptomatic improved at postoperative visits. Based on our findings, OIL-ESI may be a suitable alternative to transforaminal ESI.

시뮬레이션을 응용한 심폐소생술 훈련의 반복이 피교육자의 교육에 대한 만족도에 미치는 영향

변경조,이현정,김해규,송봉재,김재연,염석란 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.2

Background: Simulation-based training is becoming more widespread in clinical education because of the increased technology of patient simulators in conjunction with their increased use by many medical centers. Simulation-based training enhances the learning,clinical skills and judgment of the trainees. However, the effect of repetition of simulation-based training has not yet been evaluated. The purpose of this presentation will be to examine whether the number of experiences could have an influence on the interest of the trainee. Methods: Simulation-based training was designed as an introductory course for new interns and residents. The training course was divided into three sessions: Airway management training, cardiac massage training and advance cardiac life support mega code training. All the trainees were divided into the new interns and residents group. The two group’s performances during conducting the three sessions were monitored by video equipment. All the trainees were debriefed and given a post intervention survey to assess their satisfaction with the simulation-based training. Results: A total of 110 trainees completed the survey. On a four point scale, the students rated their stimulation of interest, the usefulness of the knowledge that they learned and if they enjoyed the simulation. There were no significant differences in the effectiveness of the three sessions of simulation-based training among the groups. Conclusions: Simulation is a powerful tool to get trainees excited about applying the skills they learned in the classroom. Most trainees in both groups agreed that the exercises were a great experience helpful and exciting. We postulate that the repetition of simulation-based training will not decrease the effectiveness of the training. (Anesth Pain Med 2011; 6: 195∼201)

Piriformis Syndrome in Knee Osteoarthritis Patients after Wearing Rocker Bottom Shoes

변경조,김경훈 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.2

Background:Rocker bottom shoes (RBS) are popular among patients with different foot, leg, or back problems in Korea. Patients with knee osteoarthritis concurrent weakness in the quadriceps femoris muscle, who wear these shoes, are often assumed to develop piriformis syndrome (PS). This study was performed to improve the understanding about the effect of wearing such shoes on duration of the syndrome in knee osteoarthritis. Methods:We randomly assigned 150 patients with PS, who had used RBS daily for at least 6 months, to 2 groups, the S (stopped wearing) and K (kept wearing) groups. Both the groups were subdivided into the O and N groups, comprising patients with and without knee osteoarthritis, respectively. The effects of the treatment, including piriformis muscle injections and a home exercise program, were compared between the 2 groups by using a flexion-adduction-internal rotation (FAIR) test, a numeric rating scale (NRS), and the revised Oswestry disability index (ODI) during the 12-week follow-up. Results:The positive FAIR test ratios, mean NRS scores, and revised ODIs were higher in the KO group than the SN group from 4−12 weeks after treatment. Conclusions:RBS may extend duration of the PS in osteoarthritis patients.

임상연구 : Nitroglycerin과 Nicardipine을 이용한 유도 저혈압 마취 시 국소조직 혈류량의 변화

변경조 ( Gyeong Jo Byeon ),이현정 ( Hyeon Jeong Lee ),김해규 ( Hae Kyu Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: Nicardipine or nitroglycerin has been used to induce controlled hypotension in healthy patients undergoing orthopedic surgery. Despite the fact that controlled hypotension reduces the amount of blood loss during surgery, the changes in the regional blood flow (RBF) are unclear. This study compared the effects of nicardipine and nitroglycerin on the RBF using a laser Doppler flowmeter. Methods: Twenty adult patients, ASA physical status I or II, who were scheduled for hip or spine surgery under general anesthesia, were randomly divided into two groups. After inducing general anesthesia, Group N (n = 10) was infused with nitroglycerin to induce hypotension, and group P (n = 10) was infused with nicardipine. The RBF was measured at the upper arm (1 cm lateral from the acromion of the scapula and deltoid region) and the second fingernail of the same side during the prehypotensive and hypotensive states. Results: There was no significant difference in the estimated level of blood loss and urine output between the groups. The reduction in the mean arterial pressure was faster in group P than in group N. There was no difference in the time for the mean arterial pressure to return to the baseline after the stopping drug infusion. Although the change in the RBF during the hypotensive period was significantly higher in group N than in group P, there was a similar estimated level of blood loss. Conclusions: Nicardipine is better than nitroglycerin in maintaining the regional blood flow in the peripheral tissue during controlled hypotension and induces controlled hypotension more rapidly. (Korean J Anesthesiol 2006; 50: 519~24)

간이식 수술 중 발견된 심각한 간문맥 폐고혈압 환자의 치료 : Perioperative treatment for severe portopulmonary hypertension in a patient undergoing liver transplantation

변경조 ; 이현정 ; 김희영 ; 이현수 ; 신상욱 ; 백승완 부산대학교 병원 암연구소 2014 부산대병원학술지 Vol.- No.37

에토미데이트로 마취 유도한 환자에서 심폐우회술 이탈 후 발생한 불응성 저혈압 : A case report : Refractory hypotension after weaning from the cardiopulonary bypass in the patient induced by etomidate

김희영 ; 백승훈 ; 변경조 ; 윤석현 부산대학교 병원 암연구소 2014 부산대병원학술지 Vol.- No.36

원예치료가 지역아동센터 아동의 자아존중감에 미치는 영향

변경란(Kyoung-Ran Byun):노수은(Soo-Eun Noh),조원근(Weon-Keun Cho) 인간식물환경학회 2015 인간식물환경학회 학술대회 Vol.2015 No.춘계

소비 공간의 개인적 의미와 지리교육적 함의

변경아 ( Kyung Ah Byun ),조철기 ( Chul Ki Cho ) 경북대학교 중등교육연구소 2014 중등교육연구 Vol.62 No.2

이 연구는 청소년들이 소비 공간에 부여하는 개인적 의미를 파악하고, 이것이 지리교육에 주는 함의를 고찰한 것이다. 연구 결과는 다음과 같다. 첫째, 청소년이 선호하는 소비 공간은 성별에 따라 상이하다. 둘째, 청소년들은 개인이 선호하는 소비 공간에 대해 하나의 장소감이 아니라 여러 요인(시간, 동행하는 사람, 마주치는 사람 등)에 따라 복합적 장소감을 가지는 것으로 나타난다. 셋째, 학생들은 백화점, 쇼핑센터와 같은 특정 건물 내에 구획된 소비 공간에 따라 포섭과 배제를 경험하는 것으로 나타났다. 넷째, 청소년들은 평소에는 집과 학교 근처의 소비 공간을, 휴일에는 교통이 편리한 복합적인 소비 공간을 선호하면서, 쇼핑 및 오락 공간을 일차적으로, 외식 공간은 부가적인 것으로 고려하는 경향이 있다. 이러한 연구 성과는 어른들의 지리로 가득 차 있는 지리교육과정 및 지리교과서에 대안적 접근을 제공할 수 있다. 장소인식의 차이를 학생들 개인의 관점에서 조명하도록 함으로써, 어른들의 지리가 아닌 젊은이 지리를 학교 현장으로 끌어 올 수 있는 계기를 부여할 수 있다. 인간주의 지리교육에서 강조하는 개인지리뿐만 아니라, 개인의 장소 경험이 다양한 요인(연령, 성, 인종, 계층, 민족 등)에 의해 포섭되거나 배제되는지를 보여주는 포스트모던적 관점을 지리수업으로 끌어올 수 있는 계기를 제공할 수 있다. This study is to examine what young people feels in their space of consumption and its implication to geography education. Findings are as follow. First, young people select differently a preference of space of consumption according to their gender. Second, young people perceive differently the space of consumption preferred by the personal according to different factors(time, people who are with and meet etc) and have a complex sense of place. Third, young people experience inclusion or exclusion according to spaces of consumption divided within specific building like department and shopping center. Fourth, young people prefer space of consumption near their home and school on weeks, but complex space of consumption in downtown on weekend. And they focus on more shopping and entertainment than food space when they select space of consumption. The findings can give alternative approaches to the geography curriculum and textbooks that is full of adult`s geography. By focusing on young people`s different perception of a place, we can bring young people`s geography instead of adult`s geography to school geography. It became opportunity to bring postmodern views that show inclusion and exclusion in terms of personal experiences of a place, as well as personal geographies of humanistic geography education to geography lessons.

Mechanical Antiallodynic Effect of Intrathecal Nefopam in a Rat Neuropathic Pain Model

김경훈,변경조,김희영,백승훈,신상욱,구성태 대한의학회 2015 Journal of Korean medical science Vol.30 No.8

Nefopam has a pharmacologic profile distinct from that of opioids or other antiinflammatory drugs. Several recent studies demonstrate that nefopam has a mechanism of action similar to those of anti-depressants and anticonvulsants for treating neuropathic pain. The present study investigates the mechanical antiallodynic effect of nefopam using immunohistochemical study and western blot analysis in a rat neuropathic pain model. Twenty-eight male Sprague-Dawley rats were subjected to left fifth lumbar (L5) spinal nerve ligation and intrathecal catheter implantation, procedures which were not performed on the 7 male Sprague-Dawley rats in the sham surgery group (group S). Nefopam, either 10 or 100 μg/kg (group N10 or N100, respectively), and normal saline (group C) were intrathecally administered into the catheter every day for 14 days. The mechanical allodynic threshold of intrathecal nefopam was measured using a dynamic plantar aesthesiometer. Immunohistochemistry targeting cluster of differentiation molecule 11b (CD11b) and glial fibrillary acidic protein (GFAP) was performed on the harvested spinal cord at the level of L5. Extracellular signal-regulated kinase 1/2 (ERK 1/2) and cyclic adenosine monophosphate response element binding protein (CREB) were measured using western blot analysis. The N10 and N100 groups showed improved mechanical allodynic threshold, reduced CD11b and GFAP expression, and attenuated ERK 1/2 and CREB in the affected L5 spinal cord. In conclusion, intrathecal nefopam reduced mechanical allodynia in a rat neuropathic pain model. Its mechanical antiallodynic effect is associated with inhibition of glial activation and suppression of the transcription factors’ mitogen-activated protein kinases in the spinal cord.

기관내 삽관시 혈역학적 변화에 대한 Nicardipine의 효과

김해규,변경조 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21

Background: Laryngoscopy and tracheal intubation often provoke an undesirable increase in blood pressure and heart rate. Nicardipine-induced reduction in blood pressure was greater with inhalational anesthetics than nicardipine alone. This study was designed to determine the optimal dose of nicardipine for acceptable hemodynamic change during inhalation with sevof1urane. Methods: Forty ASA physical status I patients were randomly allocated into three groups, control, NIC15, and NIC30. After intravenous thiopental 5 mg/kg, vecuronium 0.13 mg/kg 15 ㎍/kg (NIC15) or 30 ㎍/kg (NIC30) of nicardipine or same amount of normal saline (Control) was given intravenously followed by mask ventilation of three minutes with sevoflurane, nitrous oxide and oxygen. Tracheal intubation under direct laryngoscopy was performed after then. Heart rate, blood pressure, and cardiac output were measured at the period of baseline, preintubation, immediately after intubation until time of peak value. Results: After tracheal intubation, the increase of systolic blood pressure was suppressed significantly by NIC30 and NICl5 group compared with the control group. The increase of heart rate after tracheal intubation was least in the NIC15 group. The cardiac output was significantly increased only in NIC15 group. Conclusions: These results suggest that both 15 and 30 ㎍/kg of nicardipine are the appropriate dose of nicardipine during induction with sevoflurane for attenuation of pressor responses to laryngoscopy and intubation in healthy patients.