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In clinic, a drug administers to patients by the ad-mixed injection or the coincidental administration of intravenous and intramuscular injection. Thin drug toxicity or effect may be changed by the interaction. We thought that the coincidental administration of aminoglysoside antibiotics and Na-alginate preparation effected for renal function and renal tissue. So nave experimented on the renal damage in rabbits. which the coincidental adminstration of antibiotics and Na-alginate was been done. by microscopic finding blood urea nitrogen levels and creatinine levels. The results were as follows, 1) In intramuscular injection, nephrotoxicity of Amikacin was less than kanamycin. 2) As the coincidental administration of antibiotics (kanamycin or Amikacin) and Na-alginate preparation was been done, acute renal failure was significantly produced. 3) Characteristic morphological finding of this acute renal failure were identified by necrosis of proximal convoluted tubular cells and in early stage the appearance of PAS positive. 4) In this results, the produced material by interaction of Amikacin and Na-alginate preparation increased the nephrotoxicity as same as kanamycin.
A 70-year-old woman with an infectious thrombus in her left internal jugular vein (IJV) underwent carotid endarterectomy for stenosis and a highly movable plaque in her right carotid artery. She had been treated with antibiotics for four weeks before surgery due to Lemierre syndrome, a rare septic thrombophlebitis in the IJV secondary to an oropharyngeal infection. The right IJV was in a two-fold dilated state due to compensation for a thrombotic left IJV. Accordingly, superficial cervical plexus block was performed under ultrasound guidance to ensure safety and accuracy. During surgery, the alertness was maintained and the patient did not complain of pain in the absence of additional analgesics. No block-related complications were encountered. The authors report for the first time their regional anesthetic experiences in a patient with Lemierre syndrome.
We report on a case of difficult endotracheal intubation in a patient with marked tracheal deviation at an angle of 90 degrees combined with stenosis due to kyphoscoliosis with vertebral body fusion. After induction of general anesthesia, a proper laryngeal view was easily obtained using a videolaryngoscope. But a tracheal tube could not be advanced more than 3 cm beyond the vocal cords due to resistance, despite various attempts, including the use of small size tubes, full rotation of the tube tip, and fiberoptic bronchoscopy. Ultimately, the airway was successfully secured by placing a tube tip above the area of resistance and by additionally packing saline-soaked gauzes around the tracheal inlet to minimize gas leakage and to fasten the tube in the trachea.
Vascular injuries in lumbar disc surgery are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important to be aware of the perioperative implications of this rare occurrence to lower mortality risk. A 20-yr-old man with a right L4-5 lumbar disc protrusion was operated on routinely under a surgical microscope. A bloody surgical field was noted temporarily during a discectomy along with a decreased blood pressure. After fluid resuscitation with an ephedrine injection, the bleeding soon stopped spontaneously and his vital signs were stabilized. Fifty hours after the operation, the patient showed signs of hypovolemic hypotension with abdominal distension. The right femoral artery pulsation was absent on palpation. An enhanced CT angiography revealed a retroperitoneal hematoma and obstruction of the left common iliac artery. An urgent laparotomy was done to repair the injured vessel by excision and interposition of a graft. The patient had an uneventful recovery.The subacute course of deterioration might have been due to intermittent blood leakage from the lacerated common iliac artery, which was sealed spontaneously. It is very important to pay close attention to post-surgical clinical manifestations to avoid a potentially fatal outcome in lumbar disc surgery.
Background: Resuscitation following bupivacaine-induced cardiovascular collapse is difficult and often refractory to conventional treatment. This study was performed to assess the effect of insulin on bupivacaine-induced cardiovascular collapse in pentobarbital-anesthetized rabbits. Methods: Bupivacaine was administered at 0.75 mg/kg/min until the heart rate decreased to 65 beats/min. A bolus of regular insulin (2 U/kg) was administered intravenously at the bupivacaine infusion endpoint (BIE) in the insulin group (n = 8), and 2 mL of 0.9% NaCl was administered to the control group (n = 8). Results: All animals in the insulin group survived and four animals died in the control group. Arrythymia was rare 10minutes after the BIE in the insulin group. Conclusions: Bupivacaine-induced cardiovascular collapse can be effectively reversed with an insulin injection,probably through facilitation of cardiac conduction and contraction.
Background: The intravenous administration of indigo carmine has been reported to produce transiently increased blood pressure in patients. The goal of this in vitro study was to examine the effect of indigo carmine on phenylephrine-induced contractions in an isolated rat aorta and to determine the associated cellular mechanism with particular focus on the endothelium-derived vasodilators. Methods: The concentration-response curves for phenylephrine were generated in the presence or absence of indigo carmine. Phenylephrine concentration-response curves were generated for the endothelium-intact rings pretreated independently with a nitric oxide synthase inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME), a cyclooxygenase inhibitor, indomethacin, and a low-molecular-weight superoxide anion scavenger, tiron, in the presence or absence of indigo carmine. The fluorescence of oxidized dichlorofluorescein was measured in rat aortic vascular smooth muscle cells cultured in the control, indigo carmine alone and tiron plus indigo carmine. Results: Indigo carmine (10^-5 M) increased the phenylephrine-induced maximum contraction in the endotheliumintact rings with or without indomethacin, whereas indigo carmine produced a slight leftward shift in the phenylephrine concentration-response curves in the endothelium-denuded rings and L-NAME-pretreated endothelium-intact rings. In the endothelium-intact rings pretreated with tiron (10^-2 M), indigo carmine did not alter phenylephrine concentration-response curves significantly. Indigo carmine (10^-5 M) increased the fluorescence of oxidized dichlorofluorescein in the vascular smooth muscle cells, whereas tiron abolished the indigo carmineinduced increase in oxidized dichlorofluorescein fluorescence. Conclusions: Indigo carmine increases the phenylephrine-induced contraction mainly through an endotheliumdependent mechanism involving the inactivation of nitric oxide caused by the increased production of reactive oxygen species.
Complex regional pain syndrome (CRPS) is a chronically painful and disabling disorder. However, no data are available even on the epidemiology of CRPS in Korea. This study was undertaken to retrospectively assess the epidemiologic characteristics of CRPS in 150 consecutive patients at a tertiary chronic pain center from March 2002 to February 2006. Information was obtained regarding patients’ demographics, nature of injury, and treatment modalities. Seventy-one percent of patients had CRPS type I. The mean 11-point verbal numerical rating scale score at initial examinations and at the time of study were 8.0 and 5.7, respectively. Thirty-two percent of patients showed no change or increase in pain intensity during follow-up at our pain center. The mean duration of CRPS symptoms prior to our pain center evaluation and prior to the time of study were 27 months and 50 months, respectively. These patients had seen on average 5 different physicians before being referred to our center. This study shows that the majority of CRPS patients were referred to our center after more than 2 yr of symptoms. The clinical implication of such delayed transfer and strategies to avoid this problem are discussed.
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본 연구는 순발력과 근력 향상에 비중을 둔 복합 트레이닝과 지구력과 근력 향상에 비중을 둔 복합 트레이닝이 단거리 스피드 스케이팅 경기력에 어떠한 영향을 미치는지 검토하였다. 본 연구의 대상은 고등학교 남성 단거리 스피드 스케이팅 선수이며, 집단은 지구력과 근력 중심의 복합 트레이닝을 실시하는 그룹(the group gave more focus on endurance and strength training; ESG, n=7), 순발력과 근력 중심의 복합 트레이닝을 실시하는 그룹(the group gave more focus on power and strength training; PSG, n=7)으로 구성하였다. 연구 대상자는 복합 트레이닝에 따른 경기 기록의 차이를 알아보기 위해 각 시즌 중 경기 기록을 측정하였다. 모든 연구 대상자는 500m, 1,000m 경기를 출전하였고, 시즌 중 공통적으로 출전한 3경기의 평균 기록과 3경기 중 최고기록을 측정하였다. 본 연구의 결과에서 500m, 1,000m의 평균기록과 최고기록은 두 그룹 모두 기록단축에 경향을 보였지만, 전반적으로 PSG가 높은 기록단축이 나타났다. 그리고 500m, 1,000m의 출발구간인 100m, 200m 평균기록과 최고기록은 두 그룹 모두 기록단축의 경향을 보였지만, ESG가 높은 기록단축이 나타났다. 따라서 본 연구에서는 파워와 근력 향상에 비중을 둔 트레이닝 방법이 지구력과 근력 향상에 비중을 둔 트레이닝 방법보다 500m, 1000m 기록 단축뿐만 아니라 500m, 1000m 출발구간기록인 100m, 200m 기록 단축도 더 효과적일 수 있다는 가능성을 제시 할 수 있었다. This study was to know the effects of short speed skating’s athletic performance by a group more focuses on endurance and strength training and a group more focuses on power and strength training. The subject was high school player and the group was consisted of a group more focuses on endurance and strength training group (ESG, n=7) and a group more focuses on power and strength training group (PSG, n=7). The subject measured competition records in each season to know the differences of records by complex training. The subjects entered a 500m and 1000m competition and then measured average record of 3 games and the best record of 3 games in the season. In the result of this study, both groups showed aspect of improvement in average and the best record of 500m and 1000m, meanwhile PSG showed more improvement in times. Both groups showed improvement in average and the best record of 100m, 200m, which is starting phase records of 500m, 1000m, meanwhile ESG showed more improvement in times. In conclusion, this study could suggest more focuses on power and strength training method (PSG) more than more focuses on endurance and strength training method (ESG) improved both 500m, 1000m records and also starting phase records of 500m, 1000m (100m, 200m records).
Salmonella spondylitis is a rare illness, and it generally occurs in patients who have already had sickle cell anemia,and it is even rarer in patients who are without sickle cell anemia. A 61-year-old male patient was hospitalized for the evaluation of his renal function and then treatment was started for his back pain. His back pain had developed about 2 months previously without any specific trauma. Only a bulging disc was detected on the initial lumbar MRI. Regarding his fever, it was diagnosed as possible atypical pneumonia, scrub typhus, etc., and multiple antibiotic therapy was administered. At the time of transfer, the leucocytes and hs-CRP were normal and the ESR was elevated. A diagnostic epidural block was performed for his back pain, but his symptoms were not improved. Lumbar MRI was performed again and it showed findings of infective spondylitis. Salmonella D was identified on the abscess culture and so he was diagnosed as suffering from Salmonella spondylitis. After antibiotic treatment, his back pain was improved and the patient was able to walk.