國家間의 協商考

윤영무 건국대학교 1978 樂圓誌 Vol.13 No.1

바람이 전해주는 이야기- 장남으로 살아가기

윤영무 우리신학연구소 2004 갈라진 시대의 기쁜소식 Vol.- No.640

간견병증 환자에서 체내 나트륨 대사변화와 그 기전에 대한 연구

채현기,윤영무,이오영,한동수,손주현,윤병철,김호중,함준수,박경남 大韓消化器病學會 1994 大韓消化器病學會誌 Vol.26 No.4

중심정맥압 측정 카테테르 위치이상 3 예 보고

이상귀,윤영무 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

중심정맥압은 혈액량, 정맥tone, 우심장의 기능을 나타내는 지표러서, 중심정맥압을 측정하기 위해서는 상지의 말초혈관, 내외경정맥, 쇄골하정맥 등을 통해서 카테테르 중심정맥내로 삽입하여야 한다. 그러나 카테테르 삽입조각 또는 카테테르 자체에 의해서 감염, 신경 또는 주위조직 손상, 혈종, 혈전성 정맥염, 공기 색전증, 카테테르 색전증, 수흉 등의 각종 합병중이 발생할 수 있다. 따라서 이런 합병증을 예방하기 위한 각종 카테테르 거치 방법이 소개되어 있기는 하나, 아직까지 이러한 합병증을 완전히 없앨 수 있는 방법 및 카테테르 재료는 소개되어 있지 않다. 저자들은 개심슬시 중심정맥압을 관찰하기 위해서 우쇄골하정맥, 우내경정맥을 통해 각각 삽입한 카테테르의 위치이상 3예를 경험하엿는데, 제1예에서는 우내경정맥에 삽입한 카테테르가 우내경정맥내에서 2회 회전한후 우내경정맥동을 향해 카테테르 끝이 제 4 경추 부위에 위치하고 있었으며, 제 2예에서는 우내경정맥에 삽입한 카테테르가 제 3늑간 부위에서 우내경정맥쪽으로 역행하여 제 1흉추부위에 위치하고 있었고, 제 3예에서는 우쇄골하정맥으로 삽입한 카테테르가 우내경정맥으로 삽입되어 카테테르끝이 제 5경추부위에 위치하였다.

통증치료를 위한 신경차단 중 발생한 드문 합병증 3예

김갑동,최현규,윤영무,최훈,Kim, Gab-Dong,Choe, Hyun-Kyu,Yun, Young-Moo,Choe, Huhn 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.2

통증치료의 분야에서 뿐 만 아니라 환자를 진단하고 치료하는 의학의 전반에 걸쳐 예기치 못한 합병증의 발생은 어쩌면 피할 수 없는 것인지도 모른다. 따라서 환자를 진료하는 의사는 합병증의 발생에 대한 잠재적 가능성을 언제고 염두에 두어야하고, 일단 합병증이 발생하였더라도 임기응변으로 적절히 대처할 수 있는 지식과 기술을 폭넓게 갖추고 있어야 한다고 생각된다. 저자들은 통증치료목적으로 지주막하 alcohol차단, 경천추차단, 경막외 catheter 거치중 폐기종, 약물의 이상확산, catheter 절단을 각각 경험하였으므로 이에 관하여 고찰하였다. Anesthesiologists are usually responsible for the major works in pain clinics and are often called for many sophisticated nerve blocks in the management of acute or chronic intractable pain. It is, therefore, not uncommon for the anesthesiologists to meet some unexpected and unusual complications during his or her performance. We experienced a case of a pneumothorax following a thoracic intrathecal alcohol block. There was an unusual and yet unexplainable cephalad spread of alcohol following an injection through the 4th sacral foramen, and a shearing off of the catheter by a Tuohy epidural needle following the epidural catheterization. All these three cases are herein presented.

전신마취로부터 회복시 동맥혈 산소포화도에 관한 연구

이선숙,이상귀,윤영무 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.1

To investigate the incidence of hypoxemia which was defined as arterial blood oxygen saturation (SaO₂) of 90% or less following general endotracheal anesthesia, 112 adult patients were randomly allocated to one of 8 groups aceording to oxygen administration or not. SaO₂ was continually measured during postanesthetic period using a pulse oximeter (Nellcor, N-100 C, USA). The incidence of hypoxemia was lower in oxygen administration groups (5%) than in no administration groups (14%) in the recovery room. The mean discharge time of oxygen administration groups in the recovery room (37.9 min) was significantly shorter than that of no administration groups (45.6 min) (P=0.003). There were two cases of hypoxemia during transfer of patients from the operating room to the recovery room. The incidence of hypoxemia in oxygen administration groups (9%) was lower than no oxygen administration groups (71%) during 5 minutes after endotracheal extubation. It was coneluded that the incidence of hypoxemia can be reduced by administrating oxygen during postanesthetic period. Therefore, it is recommended that oxygen should be administered to all postoperative patients for prevention of hypoxemia following general endotracheal anesthesia.

리튬에 의한 신성 요붕증에서 Amiloride 의 치료 1 예

김호중,안유헌,손장원,김명곤,윤영무,이상,채현기,김상목 대한내과학회 1996 대한내과학회지 Vol.50 No.4

In the treatment of affective disorders with lithium, nephrogenic diabetes insipidus is a common side effect, Lithium induces a vasopressin-resistant defect in urinary concentration of kidney. We described a 50 years old woman on chronic lithium intake for her manic-depressive disorder with polyuria due to nephrogenic diabetes insipidus and acute mental change with dehydration, but she was treated by hydration and amiloride effectively. This case reminded us that the amiloride could be used as a good therapeutic agent for the lithium induced nephrogenic diabetes insipidus.

간경변증 환자에서 체내 나트륨 대사변화와 그 기전에 대한 연구

채현기(Hyun Kim Chae),윤영무(Young Moo Yun),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),김호중(Ho Joong Kim),함준수(Joon Soo Hahm),박경남(Kyung Nam Park),기춘석(Choon Suhk Kee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4

N/A This prospective study was performed to evaluate the concentration of the serum sodium and its pathogenesis in 16 patients of liver cirrhosis without ascites and 8 patients with ascites who were admitted to Hanyang University Hospital from November 1992 to January 1993. In order to evaluate the pathogenesis of the hyponatremia, we measured the level of serum sodium, serum albumin, serum creatinine, creatinine clearance, 24 hour urinary sodium excre- tion, plasma renin activity(PRA), aldosterone and sympathetic activity in cirrhotic patients without ascites(Group I, n=16) and with ascites(Group II, n=8). Serum Na level and ex cretion of Na in 24 hour urine were decreased significantly in patients with decompensated liver cirrhosis(liver cirrhosis with ascites)(P=0.006). And the frequency of patients with hyponatrernia was high in liver cirrhosis with ascites(Group I:13%, Group II: 50% ). The serum albumin and creatinine clearance were significantly decreased in liver cirrhosis with as- cites(P=0.000, P=0.012). The PRA and serum norepinephrine were also significantly in- creased in liver cirrhosis with ascites(P=0.000, P=0.018). During hospital 10 days, the serum sodium concentration was significantly more decreased(P = 0.04, 136 + 1.9mEq/1132+ 2.6mEq/ 1) with significant weight loss and decreased creatinine clearance in liver cirrhosis with asci- tes. The serum concentration of sodium showed positive correlation with serum albumin(R=O. 6, P=0.004) and negative correlation with PRA(R=0.7, P=0.001) in all patients with liver cirrhosis. These findings indicate that the hyponatremia in liver cirrhosis is associated with de- creased creatinine clearance and disturbance of frea water excretion due to hypoalbuminemia, decreased effective circulatory volume, increased PRA and increased sympathetic activity. (Korean J Gastroenterol 1994; 26: 662 668)

제왕절개술시 전신마취유도제로서 Thiopental Sodium 과 Ketamine 의 병용에 관한 연구

최훈,김현명,이상귀,강금이,윤영무 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.6

The incidence of C-sections has increased up to 15-20% and general anesthesia for C-sections isulually induced with thiopental or ketamine. Thiopental can produce significant fetal depression in doses higher than 4 mg/kg and ketamine can cause dysphoria. The purpose of this study was to evaluate the possibility of minimizing untoward effects of both drugs by conbination of the two. Sixty-four pregnant women who underwent general anesthesia and C-section received thiopental 5mg/kg (n=24); ketamine 1 mg/kg (n=19); or a combination of thipental 2.5mg/kg and ketamine 0.5mg/kg (n=21). The results were as follows: 1. At endotracheal intubation, mean arterial pressure, pulse rate, systolic blood pressure, and rate pressure product were increased from the values before anesthetic inducion but there was no statistical significance among groups(p>0.05). 2. The patient's movenment to the strong stimulus of skin incision and intraoperative awarencss were lower in the ketamine group and higher in the combined group. 3. The induction-delivery interval and uterine incision-delivery interval did not differ significantly among groups. 4. The incidence of 1 and 5 min Apgar scores below 7 was highest in the thiopental group and lowest in the ketamine group. 5. Postoperative recalling of intraoperative awareness occurred in two patinets only in the combined group. 6. PAR scores in the recovery room did not differ significantly among 3 groups. From the above results, the combination of thiopental and ketamine appeared to offer little advantage over thiopental or ketamine. ketamine (1mg/kg) was though to be appropriate for the induction of anesthesia for C-sections with respect to the incidence of intraoperative awareness, patient's movement to surgical stimuli, and neonatal Apagar scores.

Kappa-light Chain 다발성 골수종에 동반된 유전분증 및 제한성 심근증 1 예

김경수,김정호,김인순,김정현,임헌길,이정균,이방헌,홍은경,윤영무,채현기 대한내과학회 1994 대한내과학회지 Vol.47 No.3

Amyloid diseases constitute a group of conditions of diverse causes characterized by the accumulation of ultrastructually fibrillar material in various tissues in quantities sufficient to compromise vital organ function. The symptoms of the amyloidoses depend upon the amount and localization of the deposits. Myocardial involvement with amyloid is a common cause of secondary restrictive cardiomyopathies caused by a variety of conditions (amyloid, sarcoid, Gaucher disease, Hurler disease). Of the three major functional categories of the cardiomyopathies (dilated, hypertropic and restrictive), the restrictive are the least common in Western countries. The hallmark of the restrictive cardiomyopathies is abnormal diastolic function with excessively rigid ventricular walls. We had experienced one case of amyloidosis, especially involving heart who was admitted to Hangyang University Hospital due to dyspnea on exertion, abdominal distension and edema on both lower extremites. Echocardiogram showed markedly thickened septum and ventricular wall, as well as mitral valve thickening, and left atrial enlargement. Doppler echocardiogram showed markedly increased E wave, and in pulmonary venous flow by tranesophageal echocardiogram, D wave was prominent. In tissue sections of endocardium and rectum, with conventional staining technique, amyloid appears homogenous and eosinophilic. Amyloid showed apple-green birefrigence withCongo-red stain and under polarized light. On electron microscopy of endocardial biopsy, typical rigid, nonbranching fibrils (amyloid fibrils) are arranged randomly and are noted in the interstitium and around blood vessels, surrounding cardiac myocytes and capillaries. Kappa light chain multiple myeloma was diagnosed by bone marrow aspiration, biopsy and immunoelectrophoresis of serum and urine. He was treated with mephalan, prednisolone and diuretics.