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      • KCI등재

        Successful laparoscopic surgery of accessory cavitated uterine mass in young women with severe dysmenorrhea

        ( Joon Cheol Park ),( Dong Ja Kim ) 영남대학교 의과대학 2021 Yeungnam University Journal of Medicine Vol.38 No.3

        Accessory cavitated uterine mass (ACUM) is a rare and unique condition seen in young women. We report cases of ACUMs in two patients, a 14-year-old girl and a 25-year-old woman, both with complaints of severe dysmenorrhea that had started at menarche and had progressively worsened since. A large cystic lesion was localized in the anterolateral wall of the myometrium separate from the endometrium, which was difficult to distinguish from congenital uterine anomalies. Laparoscopic excision of the ACUMs was successful and completely resolved the dysmenorrhea. Early investigation of severe dysmenorrhea in young women can provide appropriate management and relieve symptoms.

      • KCI등재
      • Diazepam 전투여와 Lidocaine 투여용량이 혈중농도 및 심혈역학적 변화에 미치는 영황

        이경숙,김세연,박대팔,김진모,정정길 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.2

        Lidocaine if frequently administered as a component of an anesthetic: for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the stimulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and increased pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was associated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and increased PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather increased than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when an infusion of large dose of lidocaine is given to dogs anesthetized with halothane and nitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impaired autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.

      • KCI등재

        Significance of albumin to globulin ratio as a predictor of febrile urinary tract infection after ureteroscopic lithotripsy

        ( Seung Yun Yi ),( Dong Jin Park ),( Kyungchan Min ),( Jae-wook Chung ),( Yun-sok Ha ),( Bum Soo Kim ),( Hyun Tae Kim ),( Tae-hwan Kim ),( Eun Sang Yoo ) 영남대학교 의과대학 2021 Yeungnam University Journal of Medicine Vol.38 No.3

        Background: We aimed to analyze the effectiveness of albumin to globulin ratio (AGR) in predicting postoperative febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URS) and retrograde intrarenal surgery (RIRS). Methods: From January 2013 to May 2018, 332 patients underwent URS and RIRS. The rate of postoperative fUTI and risk factors for postoperative fUTI were analyzed using logistic regression. Patients were divided into postoperative fUTI and non-postoperative fUTI (non-fUTI) groups. AGR with other demographic and perioperative data were compared between the two groups to predict the development of fUTI after URS. Results: Of the 332 patients, postoperative fUTI occurred in 41 (12.3%). Preoperative pyuria, microscopic hematuria, diabetes mellitus, hypoalbuminemia, and hyperglobulinemia were more prevalent in the fUTI group. Patients in the fUTI group had larger stone size, lower preoperative AGR, longer operation time, and longer preoperative antibiotic coverage period. In a multivariable logistic analysis, preoperative pyuria, AGR, and stone size were independently correlated with postoperative fUTI (p<0.001, p=0.008, and p=0.041, respectively). Receiver operating curve analysis showed that the cutoff value of AGR that could predict a high risk of fUTI after URS was 1.437 (sensitivity, 77.3%; specificity, 76.9%), while the cutoff value of stone size was 8.5 mm (sensitivity, 55.3%; specificity, 44.7%). Conclusion: This study demonstrated that preoperative pyuria, AGR, and stone size can serve as prognostic factors for predicting fUTI after URS.

      • 신경베체트병의 자기공명영상소견

        장한원,변우목,조길호,황미수 영남대학교 의과대학 1998 Yeungnam University Journal of Medicine Vol.15 No.2

        MR findings in nine patients(three female, six male) with neuroBehcet's disease were retrospectively analyzed. NeuroBehcet's disease was diagnosed on the basis of typical clinical symptoms. Involved site, pattern, signal intensity, and contrast enhancement pattern on MRI were evaluated. In addition, follow up MR imaging was performed in four patients. The midbrain(7/9), internal capsule(7/9), pons(6/9), thalamus(6/9), basal ganglia(5/9), middle cerebella peduncle(4/9), medulla oblongata(2/9), and subcortical white matter(2/9) are involved on MRI. The size of lesions were 1cm to 3cm and their margin was ill-defined and patchy. Inhomogeneous high signal intensity on the T2-weighted images and low signal intensity on T1-weighted images was seen respectvely. In four of nine cases, there was focal enhancement. On follow up MR imaging, improvement or recurrance of the lesions was found. Also in two cases of follow up cases there was artophy in brainstem and/or middle cerebellar peduncles. In conclusion, MR imaging with systemic clinical symptoms is useful for diagnosing neuro-Behcet's disease.

      • 경추 물림 금속판을 이용한 경추 전방추체간 유합술

        박주태,안길영,이영태,안면환 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.1

        포항 성모병원 정형외과에서 실시한 경추 전방유합술 및 A-O금속판 고정술을 병행하여 치료하고 13개월이상(평균 20개월) 추시가 가능하였던 경추 추간판 탈출증 환자 11례 및 외상환자 3례를 대상으로 관찰하여 다음과 같은 결과를 얻었다. 1. 경추 추간판 탈출 환자 11례 중 상지 방사통을 호소한 경우가 8례이었으며 감각 둔화 및 근력약화를 호소한 환자가 3례이었다. 2. 외상의 기전으로는 굴곡 회전손상 3례이었다. 3. 고정범위는 1개 분절고정이 12례, 두 개 분절고정이 2례이었으며 술후 분절수에 관계없이 필라델피아 보조기를 이용해 조기 보행을(평균 2일)시작하였으며 이러한 조기 보행으로 인한 불편함의 호소는 없었다. 4. 골유합은 이종골을 사용한 1례에서의 불유합을 보였으나, 동종골을 사용한 13례에서는 전례 모두 유합(평균 12주)을 보임으로 이종골 보다는 동종골의 이식에서 높은 유합율을 보였다. 5. 추간판 탈출환자 전례에서 증상의 호전이 있었으며 불완전 마비가 있었던 외상환자 3례에서도 술후 추시 기간중 Frankel분류상 B에서 C등급으로 호전되었다. 6. 술후 합병증은 금속판 파열 1례 및 일시적인 사성 2례를 제외한 환부 혈종이나 나사못 파열등의 다른 합병증은 관찰되지 않았다. 이상의 결과를 종합해 보면 전방 도달법에 의한 전방유합술 및 물림나사와 금속판을 이용해 시술한 경추 추간판 탈출증 및 외상 환자에 있어서 수술적 치료가 안전하고 압박된 신경에 대한 감압, 충분한 안정성 확보로 인한 외고정 기간의 단축 및 신속한 골유합을 기대할 수 있는 방법이며 기존의 금속판과 달리 후방 피절골을 관통하지 않기 때문에 척수의 손상을 피할수 있으며 수술중 방사선 피폭량도 줄일수 있어 권장할 만한 방법으로 사료된다. Objectives: Anterior approach to achieve arthrodesis of the cervical spine has become a widely accepted and often-used approach since its earliest reports by Bailey, Smith and Robinson and Cloward. However, anterior interbody fusion in the presence of the posterior instability may be complicated by the bone graft dislodgement, kypkotic defomity or nonunion. As an attemp to prevent this undesirable complication, additional methods such as skeletal traction, halo appratus or even prosterior fusion has been utilized. Therefore, The cervical spine locking plate(CSLP) with the anterior intervertebral body bone grafiting provide immediate cervical stabilization and widely successful in achiveing fusion. Material and methods: This study analysed 14 patients who underwent a single anterior procedure and application of CSLP for the treatment of the cervical spinal disorder. Eleven patients were disc herniations and three patients were traumatic lesion. The average age of the patient was 47 years and the mean follow up periods was 20 months ranging from 13 to 27 months. Results: Ambulation was started 2nd day after the operation with the aid of the Philadelpia orthoses. Bone union was observed 13 cases on average 12 weeks after operation. The one case was nonunion with plate breakage without clinical symptom. Conclusion: Anterior with CSLP are thought to be a saft and valuable method for treating cervical spine disorder.

      • 거대아에 대한 임상적 연구

        박완석,이태형,이승호,정원영,이강원,김종욱 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

        1983년 5월 9일부터 1986년 10월 27일까지 약 3년 6개월간 영남대학교 의과대학 부속병원 산부인과에서 체중 4,000gm 이상의 거대아를 분만한 산모의 병상기록을 중심으로 거대아 임신에 관계되는 요인과 출산에 따르는 문제점을 조사 분석한 결과 다음과 같은 성적을 얻었다. 1. 거대아의 빈도는 체중 4,000gm 이상이 2.8%, 4,500gm 이상이 0.16%이었다. 2. 거대아의 성비는 남아가 65.9%로 전체 신생아의 남아비 53.5%보다 유의성있게 높았다.(P<0.05). 3. 임신기간에 따른 거대아 분만 빈도는 임신기간이 길수록 증가하였으며, 임신 42주와 43주이상에 출생한 신생아의 분포도 거대아군이 각가 33.3%와16.6%로 전체 산모에서의 분포 14.2%와 6.2%에 비해 유의성 있게 높았다.(P<0.01) 4. 산모의 출산회수에 따른 거대아 분만 빈도는 출산회수가 많을수록 증가하였으며, 초산부(2.35%)와 경산부 (3.74%)의 비교에서도 경산부의 거대아 분만빈도가 유의성있게 높았다.(P<0.01) 5. 산모의 연령에 따른 거대아 분만빈도는 24세이하, 25~29세, 30세이상에서 각각 2.4%,3.0%,2.5%로 차이가 없었다. 6. 거대아의 제왕절개 분만 빈도 30.8%와 흡인 및 감자분만 빈도 31.9%는 기간중의 전체적인 빈도 15.7%와 21.7%에 비해 유의성있게 높았다(P<0.01과 P<0.05). 7. 거대아의 임신 및 출산에 따르는 모성 합병증으로는 산전 빈혈(24.2%), 산후 출혈(11.0%), 산도 손상(10.0%),분만 제2기의 지연(7.7%)등이 있었으며 모성사망 및 자궁파열의 예는 없었다. 8. 태아 및 신생아 합병증으로는 태아가사 10예(11.0%), 견갑난산 2예, 자궁내 태아사망과 천미골 기형종 각각1예가 있었다. Obstetric problems concerning macrosomia were evaluated by retrospective review of 91 pregancies that resulted in the delivery of an infant weighing 4,000gm or more at the Yeungnam University Hospital during 3 1/2 years from Jun. 1983 to Oct. 1986. The results Obtained were as follows. 1. Macrosomic infants weighing 4,000gm or more occured in 2.8% of the deliveries. 2. 65.9% of macrosomic infants and 53.5% of total infants were male. The ratio of male was stastically higher in the macrosomic infants than in the total infants(P<0.05) 3. The incidence of macrosomia was highter with increasing qestational age, and deiveries at 42 weeks or more gestation were more common in the macrosomic infants than in the total infants(P<0.01). 4. The incidence of macrosomia was highter with increasing parity, and stastically higher in the multipara than in the primipara(P<0.01). 5. There was no difference in the incidence of macrosomia between the mothers aged 24 or less and that of 30 or more. 6. The cesarean section rate of macrosomia(30.8%) was stastically higher than that of the total infants(15.7%)(P<0.01) 7. With the pregnacy and delivery of macrosomic infants, 22 antepartum anemia(24.2%), 10 post-partum hemorrhage(11.0%), 9 birth canal injury(10.0%), 7 prolonged second stage of labor (7.7%), 4 breech presentation, and 3 pregancy induced hypetensionn occured in the mothers, and 10 asphysia(or Apgar score 6 or less), 2 shoulder dystocia, 1 intrauterine fetal death, and 1 sarococcygeal teratoma occured in the infants.

      • 원위 속목동맥과 중간대뇌동맥에 발생한 섬유근육형성이상

        김주현,이준 영남대학교 의과대학 2009 Yeungnam University Journal of Medicine Vol.26 No.1

        Fibromuscular dysplasia is an uncommon condition of idiopathic, non-inflammatory and non-atherosclerotic disease of the musculature of arterial walls. The disease is rare, but it commonly affects young and middle aged women. Isolated intracranial cerebral fibromuscular dysplasia is extremely rare because cerebral fibromuscular dysplasia usually affects extracranial vessels. A 26-year-o1d woman was admitted with right hemiplegia and global aphasia. Brain MRI and MRA demonstrated acute left middle cerebral artery territory infarction with a multifocal stenosis and dilatation of the left middle cerebra artery and left internal carotid. The characteristic conventional cerebral angiographic findings demonstrated a typical string-of-beads appearance in the left distal internal carotid artery and proximal portion of the left middle cerebral artery, which suggested a medial type fibromuscular dysplasia. We report a case of isolated intracranial fibromuscular dysplasia with left middle cerebral artery territory infarction. Fibromuscular dysplasia should be considered as a stroke risk factors in children and young adults, especially in patients with no known cardiovascular risk factors.

      • 염증성 장질환의 최신지견

        장병익 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

        Inflammatory bowel disease(IBD) which is well known as Crohn's disease and ulcerative colitis is a chronic disorder that repeats improvement and exacerbation. The possible causes of the disease are environmental factors, genetic factors and immune deficiency resulted from bacterial infection. Recently, IL-23 is proved to be a main cytokine which has a central role in Crohn's disease. The diagnosis of IBD is made by clinical manifestation, serologic test,endoscopic finding and histologic finding. The mainstay of remission and maintenance therapy of ulcerative colitis is 5-aminosalicylate(5-ASA). Steroid can be used in severe or refractory case and nowadays, budesonide shows a good effect with minimal side effects. In cases of steroid dependent, we can use the immunomodulators such as azathioprine, cyclosporin and 6-thioguanine. The cytokine associated with inflammation of IBD has been emphasized and the treatment which targets the cytokine such as tumor necrosis factor is tried. Infliximab and adalimumab block tumor necrosis factors-a and they are proved the efficacy by many clinical trial. Leukocytapheresis(LCAP) is tried in ulcerative colitis since 1980 in Japan. When we treat IBD patients, we need to consider all the things such as safety, side effects and economy of the patients. We expect that the development of new biologic agent which is more cost effective and more effect with more convinience.

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