경피요골동맥삽관후 발생한 수지괴사 2예

송선옥,이경숙,김흥대 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.5

Percutaneous radial artery cannulation is a very useful method of invasive monitoring in critically ill patients. Although the method is generally safe and simple, it can infrequently lead to tissue necrosis. Recently we experienced this complication in two patients. The first patient was a 52-year-old male who received a craniotomy for removal of a subdural hematoma. Right radial artery cannulation was carried out after a modified Allen's test appeared to be positive. After removal of the cannula on the 9th hour after operation because it was obstructed, his right hand was cool and cyanotic. Despite stellate ganglion block and other supportive therapy, the ischemic changes increasingly worsened. On the 10th day after removal of the cannula, the necrotic change was extended in all fingers of the right hand and he underwent disarticulation of the right wrist. The second patient was a 63-year-old female who received a craniotomy for clipping of a cerebral aneurysm. Left radial artery cannulation was performed without a modified Allen's test. On the 2nd hour after operation, the cannula was removed because the left hand was cyanotic. On Doppler examination, the radial and ulnar arteries were not identified with blood flow. On angiographic finding, the radial artery was occluded almost totally and the ulnar artery was not visualized below the antecubital fossa. After the left stellate ganglion block, thrombectomy and anticoagulant therapy, the ischemia in the left hand was transiently improved, but then became more aggravated and eventually the level of tissue necrosis advanced to the left elbow, therefore amputation above the left elbow joint was performed. Presumptive causes of these tissue necroses were peripheral embolization in the first patient, and inadequate collateral circuation of the ulnar arterial malformation in the second case.

Formalin 통증바응으로 평가한 Naloxone 의 말초성 제통효과

송선옥,권성현,박대팔 대한정맥마취학회 1999 정맥마취 Vol.3 No.3

서론: Naloxone이 마약제 길항제로 쓰여 왔으나 통증에 미치는 영향은 명확하지 않다. 최근 마약제 말초성 제통효과의 기전을 규명하는데 naloxone에 의한 제통의 길항이 이용되는데 상반된 결과가 보고되고 있다. 본 연구에서는 국소 통증에 대한 naloxone의 말초 효과를 규명하고자 하였다. 방법: 흰쥐 40마리를 대조군(생리식염수 0.1 ㎖ 침윤)과 M침윤군(0.1 ㎎/0.1 ㎖의 morphine 침윤), MN침윤군 (morphine 0.1 ㎎과 naloxone 10 ㎍을 0.1 ㎖로 혼합 침윤), N침윤군(10 ㎍의 naloxone 침윤) 등 세 개의 실험군으로 분류하여 전신마취 하에서 우측 발바닥에 각 약제를 침윤하고 5분후 동일 부위에 formalin 0.1㎖을 침윤한 후 나타나는 통증반응(flinch)을 1시간동안 5분 간격으로 1분간씩 관찰하였다. 결과: Formalin 주사후 나타난 flinch수로 평가한 통증반응은 M침윤군, MN침윤군 및 N침윤군 모두 생리식염수를 침윤한 대조군보다 flinch수가 적었으며(P<0.05) 실험군 간의차이는 유의하지 않앗다. 아울어 flinch 총수를 제1기와 2기 반응으로 분류하여 비교한 결과, 제1기 반응에서 M침윤군과 MN침윤군은 대조군에 비해 flinch 총수가 유의하게 적었으나, N침윤군은 대조군과 차이가 유의하지 않았고 M침윤군 및 MN침윤군과도 유의한 차이가 없었다. 제 2기 반응에서는 세군 모두 대조군보다 flinch 총수가 적었고(P<0.05) 실험군 간의 차이는 없었다. 결론: 본 연구에서 흰쥐 formalin 통증 반응으로 관찰한 결과, naloxone이 단독 침윤시 formalin 통증반응을 감소시키고 morphine과 혼합하여 침윤한 경우에도 morphine의 제통효과를 길항하지 않으므로 naloxone이 말초성 제통효과를 나타낸다고 사료된다. Background: It is well known that naloxone, an opioid antagonist, reduces opioid-related side effects and may reverses analgesic effects of opioid. However, there are some reports that locally applied naloxone reverse or potentiates the analgesic effect of opioid. This study was performed to evaluate peripheral analgesic effects of naloxone in rat formalin test. Methods: Forty rats were divided into four groups; control (saline injected), M group (morphine 0.1 ㎎/0.1 ml), MN group (0.1 ㎎ of motphine and 10 ㎍ naloxone mixed in 0.1 ml) and N group (10 ㎍ of naloxone). Under halothane anesthesia, all rats were injected via subcutaneous infiltration with an agent according to their allocated group in the distal plantar area of the right hind paw. Five minutes later, followed by the injection of 0.1 ml of 5% formalin in the same site. All animals were observed for the number of flinches during phase 1 (2~3, 5~6 min) and phase 2 (1 min from 10 to 61 min) after the formalin injection. Results: The number of mean flinches were significantly less in M, MN and N groups than in control (P<0.05), and there were no differences between three experimental groups. In MN group, naloxone did not increase flinches compared to M group in phase 1 and phase 2 of rat formalin test. Naloxone infiltration in N group reduced pain behavior in phase 2 compared to control. Conclusions: This study suggests that naloxone has its own peripheral analgesic effect and does not reverse peripheral analgesic effect of opioid in rat formalin test.

Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System

송선옥,정창희,송영득,박철영,권혁상,차봉수,박중열,이기업,고경수,이병완 대한당뇨병학회 2014 Diabetes and Metabolism Journal Vol.38 No.5

Background: The National Health Insurance Service (NHIS) recently signed an agreement to provide limited open access to thedatabases within the Korean Diabetes Association for the benefit of Korean subjects with diabetes. Here, we present the history,structure, contents, and way to use data procurement in the Korean National Health Insurance (NHI) system for the benefit ofKorean researchers. Methods: The NHIS in Korea is a single-payer program and is mandatory for all residents in Korea. The three main healthcareprograms of the NHI, Medical Aid, and long-term care insurance (LTCI) provide 100% coverage for the Korean population. TheNHIS in Korea has adopted a fee-for-service system to pay health providers. Researchers can obtain health information from thefour databases of the insured that contain data on health insurance claims, health check-ups and LTCI. Results: Metabolic disease as chronic disease is increasing with aging society. NHIS data is based on mandatory, serial populationdata, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondaryprevention of disease after data mining. Conclusion: The NHIS database represents the entire Korean population and can be used as a population-based database. Theintegrated information technology of the NHIS database makes it a world-leading population-based epidemiology and diseaseresearch platform.

The Risk of Bladder Cancer in Korean Diabetic Subjects Treated with Pioglitazone

송선옥,김광준,이병완,강은석,차봉수,이현철 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.5

Background: There is growing concern regarding the increased incidence of bladder cancer in diabetic patients using pioglitazone. This study aimed to investigate the association between bladder cancer and the use of pioglitazone in Korean diabetics. Methods: This retrospective, matched case-control study included a case group (n=329) of diabetic patients with bladder cancer who presented at the Severance Hospital from November 2005 to June 2011. The control group consisted of patients without bladder cancer (1:2 ratio matching for sex and age, n=658) who were listed on the Severance Hospital diabetes registry. Results: The percentage of subjects who had ever used pioglitazone was significantly lower in the case group than in the control group (6.4% vs. 15.0%, P<0.001). Multivariate conditional logistic analysis revealed that independent factors affecting bladder cancer were smoking (odds ratio [OR], 11.64; 95% confidence interval [CI], 6.56 to 20.66; P<0.001), coexisting cancer (OR, 6.11; 95% CI, 2.25 to 16.63; P<0.001), and hemoglobin levels (OR, 0.78; 95% CI, 0.69 to 0.88; P<0.001). The OR of the history of pioglitazone use was 2.09 and was not significantly different between the two groups (95% CI, 0.26 to 16.81; P=0.488). Conclusion: A relationship between pioglitazone use and incidence of bladder cancer was not observed in Korean diabetic patients. This suggests that the risk for bladder cancer in Korean diabetic subjects treated with pioglitazone might be different from that of Caucasian populations. Large-scale, well-designed and multi-center studies are needed to further evaluate this relationship.

Lower High-Density Lipoprotein Cholesterol Concentration Is Independently Associated with Greater Future Accumulation of Intra-Abdominal Fat

송선옥,황유철,류한욱,Steven E. Kahn,Donna L. Leonetti,Wilfred Y. Fujimoto,Edward J. Boyko 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.4

Background: Both intra-abdominal fat (IAF) and high-density lipoprotein cholesterol (HDL-C) are known to be associated withcardiometabolic health. We evaluated whether the accumulation of computed tomography (CT)-measured IAF over 5 years was related to baseline HDL-C concentration in a prospective cohort study. Methods: All participants were Japanese-Americans between the ages of 34 and 74 years. Plasma HDL-C concentration and CTmeasurements of IAF, abdominal subcutaneous fat (SCF), and thigh SCF cross-sectional areas were assessed at baseline and at5-year follow-up visits. Results: A total of 397 subjects without diabetes were included. The mean±standard deviation HDL-C concentration was 51.6±13.0mg/dL in men and 66.0±17.0 mg/dL in women, and the IAF was 91.9±48.4 cm2 in men and 63.1±39.5 cm2 in women. The baselineplasma concentration of HDL-C was inversely associated with the change in IAF over 5 years using multivariable regression analysiswith adjustment for age, sex, family history of diabetes, weight change over 5 years, and baseline measurements of body mass index,IAF, abdominal SCF, abdominal circumference, thigh SCF, and homeostatic model assessment for insulin resistance. Conclusion: These results demonstrate that HDL-C concentration significantly predicts future accumulation of IAF over 5 years independent of age, sex, insulin sensitivity, and body composition in Japanese-American men and women without diabetes.

Intra-Abdominal Fat and High Density Lipoprotein Cholesterol Are Associated in a Non-Linear Pattern in Japanese-Americans

송선옥,황유철,Steven E. Kahn,Donna L. Leonetti,Wilfred Y. Fujimoto,Edward J. Boyko 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.2

Background: We describe the association between high density lipoprotein cholesterol (HDL-C) concentration and computed tomography (CT)-measured fat depots. Methods: We examined the cross-sectional associations between HDL-C concentration and intra-abdominal (IAF), abdominal subcutaneous (SCF), and thigh fat (TF) areas in 641 Japanese-American men and women. IAF, SCF, and TF were measured by CT at the level of the umbilicus and mid-thigh. The associations between fat area measurements and HDL-C were examined using multivariate linear regression analysis adjusting for age, sex, diabetes family history, homeostasis model assessment of insulin resistance (HOMA-IR), and body mass index (BMI). Non-linearity was assessed using fractional polynomials. Results: Mean±standard deviation of HDL-C concentration and IAF in men and women were 1.30±0.34 mg/dL, 105±55.3 cm2, and 1.67±0.43 mg/dL, 74.4±46.6 cm2 and differed significantly by gender for both comparisons (P<0.001). In univariate analysis, HDL-C concentration was significantly associated with CT-measured fat depots. In multivariate analysis, IAF was significantly and non-linearly associated with HDL-C concentration adjusted for age, sex, BMI, HOMA-IR, SCF, and TF (IAF: β=–0.1012, P <0.001; IAF2: β=0.0008, P<0.001). SCF was also negatively and linearly associated with HDL-C (β=–0.4919, P=0.001). Conclusion: HDL-C does not linearly decline with increasing IAF in Japanese-Americans. A more complex pattern better fits this association.

복강경 담낭절제술시 기복증 유도전 복강내 Lidocaine 점적주입이 술 후 통증과 술 중 혈압 변화에 미치는 영향

송선옥,박소영,김흥대,윤성수,이선영,김세연,박대팔,서일숙,지대림,이덕희,손욱진 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: This study was performed to evaluate the effects of pre-emptive subdiaphragmatic instillation of lidocaine before pneumoperitoneum on postoperative pain following a laparoscopic cholecystectomy (LC) and also to evaluate it's effect on the changes of blood pressure during an operation. Methods: Thirty-three relatively healthy patients for an LC were allocated into the two groups. after the induction of general anesthesia with sodium thiopental, vecuronium, nitrous oxide and enflurane (1-2 vol%), 0.2% lidocaine 200 ml was subdiaphragmatically instilled 10 min before pneumoperitoneum in the lidocaine group (n = 15), and normal saline in the control group (n = 18). The changes of the systolic and mean arterial pressure (SAP and MAP), postoperative pain score, and the number of analgesics used during the postoperative 24 h were compared between two groups. Results: The pain scores at postoperative 1, 3, 6, 12, 18 and 24 h and the number of analgesics used were significantly low in the lidocaine group compared to the control group (P < 0.01). The elevations of SAP and MAP during pneumoperitoneum were significantly attenuated in the lidocaine group (P < 0.01). Conclusions: This data suggests that subdiaphragmatic instillation of lidocaine before pneumoperitoneum is effective in the control of postoperative pain following an LC and also effective to attenuate the elevation of blood pressure during pneumoperitoneum. However, further study is needed to evaluate the safety of these meghods before recommendation of reutine use. (Korean J Anesthesiol 2002; 43: 625~632)

대상포진 통증관리시 Lidocaine의 정맥내주입 및 피내주사에 병용된 경막외 스테로이드 주입은 이점이 있는다?

송선옥,윤종석,이덕희 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: An epidural blockade has been considered a standard therapy for the management of pain in acute herpes zoster. However, it has many complications. Recently, we experienced good analgesia with a combination therapy including intravenous lidocaine infusion and intradermal injection of a local anesthetic and steroid in acute herpes zoster. Therefore, this study was performed to evaluate the necessity of an epidural steroid injection, added in a combination therapy, on the pain control of acute herpes zoster. Methods: This retrospective study was based on the analysis of data of medical records. Forty-three patients suffering severe acute herpes zoster pain, were randomly divided into two groups. Intravenous indocaine infusion (5 mg/kg) and an intradermal injection of lidocaine and a steroid into the wound were used twice a week in the Lidocaine group ( n = 23), and in the Epidural group (n = 20), and epidural block with 0.5% lidocaine 6-8 ml with triamcinolone 30 mg was added once a week in addition to the above. We compared the efficacy of pain control using a pain relief scale (PRS) at 4 weeks after the initial visit to the pain clinic. Results: Both groups were similarly managed in pain control. There were no statistical differences comparing the PRS between the two groups. Conclusions: Our results suggest that an epidural steroid injection, added in a combination therapy such as an intravenous lidocaine infusion and an intradermal injection of a local anesthetic and steroid, has no more advantages for the management of pain in acute herpes zoster. A further prospective study is recommended to compare the efficacy of pain control and the incidence of postherpetic neuralgia in a large number of acute herpes zoster patients. (Korean J Anesthesiol 2002; 43: 594~599)

한국인에서 관상동맥질환과 골다공증성 척추 골절과의 상관관계

송선옥,박경원,유승훈,고원준,강병수,김태호,김형진,조윤형,조덕규,김세화 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.1

Background: The association of osteoporotic vertebral fracture or osteoporosis with coronary artery disease (CAD) was investigated in Korean men and women. Methods: Four hundred consecutive postmenopausal women and men aged 50 years and older, undergoing coronary angiography,were enrolled for the evaluation of established or suspected coronary artery disease. CAD was diagnosed if there was narrowing of > 50% diameter in one or more major coronary artery. Morphometric vertebral fracture was assessed using lateral thoracic and lumbar spine radiographs. Bone mineral density was performed using dual-energy x-ray absorptiometry. Results: Of the 400 subjects in the study (mean age of 61.9 ± 11.6 years), 256 patients had CAD. Vertebral fracture was observed in 94 (23.5%) patients. There was no difference in vertebral fracture according to the presence or absence of CAD. In logistic regression analysis, vertebral fracture was not significantly associated with CAD after adjustment for multiple risk factors. Although women had lower BMD at any given site than men, BMD was not associated with the presence or absence of CAD among 191 patients. Conclusion: Our study demonstrated that osteoporotic vertebral fracture or osteoporosis was not associated with coronary artery disease in Korean men and women

지주막하강내 Morphine수입후 발생한 호흡 정지 1예 보고

송선옥 中央醫學社 1984 中央醫學 Vol.46 No.3