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김시환,모지훈,황찬호,김인상,이철희,이재서,민양기 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.4
Background and Objectives:Isolated lesions of the sphenoid sinus are a rare disease entity that occurs after a wide use ofantibiotics. This lesion may have severe complications such as cranial nerve palsies due to its deep location in the skull. The useof endoscopic surgery for the sphenoid sinus has become popular for its several advantages. We report our experiences of 56case-isolated sphenoid lesions with a review of articles. Subjects and Method:Fifty-six patients with isolated sphenoidlesions who were treated at Seoul National University Hospital from January 1985 through December 2003 were analyzed.Patients who have lesions confined to the sphenoid sinus on radiologic images (CT or MRI) were included. A retrospectivechart review was performed with respect to the patients symptom, pathology and surgical outcome. Results:Thirty-nine of 56cases were inflammatory lesions, 8 neoplastic lesions, and 9 fibrous dysplasias. Headache was the most common symptom(66%), followed by nasal symptoms such as nasal obstruction and postnasal drip. Ophthalmologic symptoms were observed in14 cases. Endoscopic transnasal sphenoidotomy was perforemd in 33 of 39 cases of inflammatory diseases. Symptoms werecompletely improved in 32 cases after the operation and ophthalmologic symptoms were nearly all improved in all cases.Conclusion:The wide use of CT and MRI has increased the detection of isolated lesions of the sphenoid sinus. Complicationslike cranial nerve palsies were uncommon unlike from the reports that came out in the country. Primary physicians must rule outisolated lesions of the sphenoid to account for intractable headaches.
Mechanisms Underlying the Inhibitory Effect of GS 283 in Various Smooth Muscles
김시환,이영수,정원석,장기철,Kim, Si-Hwan,Lee, Young-Soo,Chong, Won-Seog,Chang, Ki-Churl The Korean Society of Pharmacology 1994 대한약리학잡지 Vol.30 No.1
Tetrahydroisoquinoline유도체인 GS 283의 약리학적 특성을 흰쥐 흉부대동맥, 기니픽 결장띠 및 토끼 장간막 동맥 및 흰쥐 뇌를 사용하여 조사하였다. 혈관 평활근에서 GS283은 고 $K^+$에 의한 수축을 농도 의존적으로 억제하여 $Ca^{2+}$ 길항작용을 보였다. 또한 ${alpha}_1$- 수용체 자극에 의한 수축도 억제하였다. GS 283의 혈관이완 작용은 propranolol영향을 받지 않으므로 ${\beta}$-수용체 자극작용에 의한 것이 아니었다. 세포내 칼슘이온과 근장력 변화를 동시에 측정하였을 때 GS 283의 억제효과는 조직내 형광의 증가를 수반했다. 이 증가는 fura 2형광에 의한것이 아니라 내인성 pyridine nucleotide에 의한 것이며 이는 GS 283이 미토콘드리아 기능을 억제하는 효과가 있음을 시사했다. 흰쥐 뇌의 cAMP와 cGMP 의존성 phosphodiesterase에 대한 GS 283의 $K_i$,값은 2.5와 6.7mM이었다. 이상의 결과에서 GS 283의 약리 작용은 $Ca^{2+}$ 길항작용, ${\alpha}_1$- 수용체억제 작용 및 cyclic nucleotide 의존성 phosphodiesterase 억제 등 다양한 작용이 있으며 평활근 수축 억제에 대한 GS283 작용에는 $Ca^{2+}$ 길항이 가장 중요한 요인이 될 것으로 생각된다. Pharmacological characterization of GS 283, a tetrahydroisoquinoline derivative has been elucidated using rat thoracic aorta, guinea pig tenea coli and rabbit mesentery artery in vitro. GS 283 showed calcium antagonistic action in vascular smooth muscle, since high $K^+-induced$ contraction was concentration dependently inhibited. GS 283 also inhibited the contraction induced by ${\alpha}_1$ receptor activation. Vasodilating action of GS 283 was not modified by the propranolol, indicating that GS 283 has no ${\beta}$ receptor stimulatory action. Simultaneous measurement of intracellular calcium change and muscle tension indicated that the inhibitory effect of GS 283 was accompanied by the increase in tissue fluorescence. This increment was not due to fura 2 fluorescence but to endogenous pyridine nucleotide, suggesting that GS 283 has an effect to inhibit mitochondrial function. GS 283 had an inhibitory action on cyclic AMP and GMP-dependent phosphodiesterases from rat brain with Ki values of 2.5 and 6.7 mM. From these findings we concluded that GS 283 has multiple action such as the inhibition of cyclic nucleotide-dependent phosphodiesterases, blocking of calcium channel as well as inhibition of mitochondrial function which are responsible for vasodilatation.
김시환,이재서 대한수면연구학회 2007 Journal of sleep medicine Vol.4 No.1
Uvulopalatopharyngoplasty (UPPP) remains the most commonly performed surgical procedure as treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Although curative for many patients, the procedure has an extremely high over-all failure rate, causing many questions on its validity. A meta-analysis revealed a success rate of UPPP as low as 40%. The reason for this low success rate might be due to the variable obstruction sites of the upper airway, causing OSAHS. Furthermore, the results of UPPP has been reported to decrease with time. Difficult localization of the upper airway obstruction sites accounts for the low success rate of UPPP. Proper selection of UPPP candidates based on Friedman Staging System, recently introduced, has reported an improved success rate as high as 80%. Furthermore, the concept of multilevel surgery for tongue base and nasal cavity in addition to UPPP enables better surgical outcomes. In conclusion, with its advantages of easy applicability and less invasiveness, better surgical outcome of UPPP might be anticipated with multilevel surgery including the tongue base and the nasal cavity in selected patients