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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.
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)