심한 과탄소혈증을 동반한 만성저환기증후군 환자의 마취 경험 : 증례 보고 A case report

한승묵,곽현정,이명애 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Alveolar hypoventilation exists by definition when arterial PaCO_2 increases above the normal range of 37 to 42 mmHg, but in clinically important hypoventilation syndromes PaCO_2 is generally in the range of 50 to 80 mmHg. The management of chronic hypoventilation must be individualized to the patient's particular disorder, circumstances and need. This is a case report anesthetic management of a 63-year-old woman with central alveolar hypoventilation (CAH) secondary to cerebral infarction. For hip surgery epidural anesthesia with 0.5% bupivacaine was performed and doxapram was applied to maintain respiratory drive. The anesthetic experience with a brief review of literature is reported. (Korean J Anesthesiol 2002; 43: 678~683)

복수를 동반한 호산구성 위장염 1례

한승묵,신원승,김민수,김정희,김성종,정재진,이동욱,이동욱,곽동협 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.3

호산구성 위자염은 툭발성으로 위장관 벽의 호산구 침윤과 말초 혈액내 호산구증다증을 동반하고 다양한 위장관 증상을 나타내는 질환으로 복수가 동반된 경우는 매우 드문 것으로 알려져 있다. 이에 저자들은 최근에 말초 혈액에 호산구증다증과 장점막의 호산구 침윤뿐만 아니라 소산구성 복수가 동반되고 스테로이드 요법으로 잘 치료된 호산구성 위장염 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Eosinophilic gastroenteritis is an uncommon disease of uncertain etiology characterized by eosinophilia in the peripheral blood and eosinophilic infiltrates in the bowel wall. Clinical features vary depending on which layers or regions of the gastrointestinal tract are mainly affected. Mucosal involvement causes malabsorption. protein-losing enteropathy and diarrhea. Infiltration of the muscle layer manifests gastric outlet or small bowel obstruction. Serosal involvement causes an exudative ascites rich in eosinophils. Eosinophilic gastroenteritis with ascites is a rare from of eosinophilic gastroenteritis. In this paper, we present a case of eosinophilic gastroenteritis with ascites demonstrating eosinophilia in the peripheral blood and eosinophilic infiltrates in the mucosal wall. The patient was successfully treated with steroid therapy. In addition to this case report, the several literatures on eosinophilic gastroentritis are reviewed.

증례보고 : Charcot-Marie-Tooth씨병 환자에서 Propofol과 Rocuronium을 이용한 마취경험

곽현정 ( Hyun Jeong Kwak ),한승묵 ( Seung Muk Han ),김달용 ( Dal Yong Kim ),곽호성 ( Ho Sung Kwak ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.5

만성 폐동맥고혈압 환자에서의 Phenylephrine 의 약물 효과

오영준,이종화,곽영란,곽현정,한승묵 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.1

Background : Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. Methods : Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP ≥ 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. Results : Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. Conclusions : Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seeded to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiac output was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine. (Korean J Anesthesiol 2002; 42: 64~70)

반코마이신 정주투여후 발생한 위막성 대장염 1례

이동욱,권순대,박진용,한승묵,황준영,이인규,박근용,류성열,김미정,신동우,김성종,여준기 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.3

저자들은 당뇨병성 신부전환자의 족부궤양 치료로 투여한 반코마이신 정주로 인한 위막성 대장염 1례를 경험하였기에 보고하는 바이다. 특히 신부전이 있는 경우에 반코마이신 정주 요법은 C.difficile에 의한 위막성 대장염을 일으킬 수 있는 빈도가 증가되므로 정확한 약물의 용량결정과 추후 혈중 약물 농도의 측정이 반드시 필요하며 상기 환자에서 설사 및 복통이 발생시 위막성 대장염의 발생을 고려하여야 겠다. Diarrhea is a common complication of antibiotics usage. The diarrhea ascribed to antibiotics usually consist of loose or watery stools, sometimes containing mucus but rarely gross evident blood. Almost every antibiotics has been implicated. Although the pathogenesis of antibiotics-associated diarrhea is not confirmed, recent studies have shown that a toxin of Clostridium difficile is implicated as a cause of it. Diagnosis is made by detecting toxin in the stool or by positive stool culture for C. difficile. Treatment is either directed at binding the toxin with anion exchange resins such as cholestyramine in mile case, or at eradicating the C. difficile organism with oral vancomycin, metronidazole for more severe cases. We have recently experienced one patient who developed diarrhea, abdomminal pain after having received prolonged vancomycin injection. Sigmoidoscopic finding revealed typical cream-colored plaque lesions (pseudomembrane) on a red friable edematous mucosa. Light microscopic finding of the rectal mucosa showed a volcano-like appearance. The symptom improved after treatment with oral vancomycin and metronidazole. So, we report one case of pseudomembranous colitis secondary to the use of parenteral vancomycin.

십이지장 선암을 동반한 Peutz-Jeghers 증후군 1 예

김정희,김은영,이동욱,정재진,이원석,한승묵,곽동협 대한내과학회 1998 대한내과학회지 Vol.55 No.2

The Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and mucocutaneous melanin pigmentation. Although these polyps are believed to have little potential for malignancy, and the disease was believed to have a relatively benign course, it recently has been recognized that patients with this syndrome are at increased risk for the development of cancer at gastrointestinal and nongastrointestind sites. A 33-year-old male patient was admitted because of vomiting and abdominal pain for 3 months duration. A diagnosis of Peutz Jeghers syndrome was made 3 years ago by multiple hamartomatous polyps confined to the colon and mucocutaneous pigmentation. A barium study showed abrupt string like luminal narrowing at the 4th portion of the duodenum. On laparotomy, there was an annular constricting mass involving the serosa of duodenum with multiple metastasis to liver, so a segmental resection of small bowel followed by chemotherapy was performed. The histologic finding was adenocarcinoma.

신 호산성 과랍세포종 1예

이태원,김우식,김경환,홍성표,양문호,김명재,임천규,장종억,한승묵 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.4

Renal oncocytoma, a benign tumor composed of eosinophilic cells which show abundant mitochondria on electron microscopy,($quot;oncocytes$quot;) is a well-documented entity. Before the 1976 review by Klein and Valensi, few cases of renal oncocytoma were reported in the world biomedical literature, witb Zippel recognizing the first case in 1942. Increased awareness and improved diagnostic modalities have led to well over 600 cases of renal oncocytoma currently described in other country. In Korea renal oncocytoma has been reported since 1986. We report herein a case of renal oncocytoma that was found incidentally by aMominal ultrasonogram and treated by the radical nephrectomy.

폐암의 위전이 1예

김양식,정재혁,김호규,원영준,최성대,서영배,배효근,조창호,한승묵 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.6

Blood-borne metastatic involvement of the gastric mucosa as a result of cancer is a rare occurrence. The tumors which were most commonly reported to metastasize to the stomach include melanoma, breast carcinoma, and lung carcinoma. Some reports document that large cell carcinoma and squamous cell carcinoma of the lungs have a higher pre- dilection for gastrointestinal tract metastases. Upper gastrointestinal endoscopic findings of metastatic lesions may vary but often produce a characteristic single or multiple bulls eye or target lesion. Therefore, whenever single or multiple target lesions are seen in the stomach on upper gastrointestinal endoscopy or barium study, the examination should include careful radiographic evaluation of the chest. Moreover, when the patient is known to have lung cancer, metastatic disease should be suspected. With a correct diagnosis and proper treatment, relief of symptoms and prolongation of life can sometimes be achieved, A case in reported involving squamous cell lung cancer with stomach metastasis in a 73 year-old woman. The patient was diagnosed by bronchoscopy, upper gastrointestinal endoscopy, chest CT, and abdominal CT. The chest and abdominal CT revealed a poorly marginated, lobulated, and 4 x 3 cm sized mass lesion in the right lower lobe causing obstruction of right lower lobe bronchus with invasion to the left atrium. right inferior pulmonary vein, and superior vena cava. Mediastimal lymph node enlargement and liver metastasis was also detected. Upper gastrointestinal endoscopy showed two $quot;bulls eye$quot; lesions with different sizes and two nodules without tip ulceration.