호기밸브 오작동으로 발생한 극심한 과탄산혈증 1예 보고

하경호,김문철 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

Severe hypercarbia can develop for unidirectional valve malfunction and may go undetected during anesthesia. A 29-year-old male patient with history of bronchial asthma underwent tonsillectomy and septorhinoplasty due to chronic tonsillitis, depressed bulbous, and deviated septum of nose. Anesthesia was induced with thipental-vecuronium and maintained with enflurane-N2O-O2 in a semiclosed circle system. We experienced a case of severe hypercarbia from replacement with an incorrect expiratory valve.

편도절제술을 받는 소아에서 수술 후 오심 및 구토에 대한 Propofol과 Ondansetron의 예방적 효과

김영재,구봉근,이정한,이근무,정순호,최영균,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: To examine the prophylactic effect of ondansetron and propofol against postoperative nausea and vomiting(PONV) in children undergoing tonsill ectomy Methods and Materials: Sixty children(aged 3-11 years) who underwent tonsillectomy received antiemetics (ondansetron group; ondansetron 0.1mg/kg, propofol group; propofol 0.5mg/kg) or not (control group) at the end of surgery. Anesthesia was induced with ketamine(1mg/kgiv) and rocuronium(0.5mg/kg) and maintained by inhalation anesthesia with 2-3vol% sevoflurane in 50% N_(2)O/O_(2). Premedication was given as atropine 0.01mg/kg iv. Ketorolac(1mg/kg) was injected for postoperative analgesia immediate after induction. They were monitored the incidence of PONV at operation room, postanesthetic care unit(PACU) and admission room. Results: No significant differences were observed in the total incidence of PONV among the groups. But ondansetron and propofol group made a difference(p<0.05) in the incidence of PONV at operation room compared with control group. Conclusion: In children undergoing tonsillectomy, ondansetron(0.1mg/kg) and propofol(0.5mg/kg) may have a prophylactic effect against PONV at operation room.

상부 위장관 출혈로 발현된 십이지장 양성 기질 종양 1예

정명교,박은택,이원동,김재환,이상헌,김기훈,배경임,제인수,이상혁,설상영,정정명 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

Small bowel tumors comprise less than 5% of gastrointestinal neoplasm. Because of their rarity, a correct diagnosis is very difficult and often delayed. Gastrointestinal stromal tumors(GIST) are spindle cell tumors occuring mainly in adults with 5-year survivals of 50-56% and 10-year survivals of 35-43%. It is difficult that we concluded clinical manifestation of GIST. At the time of diagnosis, we already consider metastatic lesions as malignancy, which is suggested poor prognosis. Patients frequently complain vague intermittent abdominal pain. Occasionally they experience severe colicky pain because of tumor-induced partial intestinal obstruction. Factors playing a prominent role in predicting their biological behavior are tumor site, size, and degree of mitotic activity. Recently, we experienced one case of duodenal benign GIST in a 23-year-old woman who had epigastric pain and intermittent melena, so we report it with a review of the literature.

경막외 Lidocaine이 Bispectral Index로 측정한 적절한 마취깊이에 필요한 Desflurane 농도에 미치는 효과

최영균,신상우,이근무,정순호,김영재,신치만,박주열 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

Background: Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC) of inhalation anesthetics. The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index(BIS) Methods: After premedication with 0.02 mg/kg midazolam, 30 patients aged 20-75 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus does; 25 ㎕·kg-1·min-1). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients receive 1.5 mg/kg propofol and 1mg/kg rocuronium for tracheal intubation. After 10 min of equilibration period with 3% end-tidal desflurane concentration, BIS was measured at every 30 second. If BIS score was above 50, vaporizer dial was increased by 0.5 vol%. If BIS score was under 45, vaporizer dial was decreased by 0.5 vol%. When BIS score was maintained between 45-50 by 3minutes, we checked the end tidal desflurane concentration and defined as MACBIS50(Minimum alveolar concentration at BIS 50). MACBIS50, BIS score, and mean arterial pressure were recorded. Results: The MACBIS50 of desflurane (2.5 0.49%) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (3.1 0.59%) or with intravenous lidocaine (3.0 0.51%)(p<0.05). Conclusions: Epidural anesthesia reduced by 19% the desflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocain absorption, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.

관상동맥질환의 일차예방을 위한 아스피린의 사용

이성윤 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

Aspirin use probably reduces the risk of myocardial infarction in men over the age of 50 years. For individual patients, the decision to initiate aspirin therapy should be based on a careful assessment of absolute risk. The absolute risk of major coronary events should be calculated as the Framingham risk score. This can easily be done in the physician's office with the use of an on-line or downloaded version of the scoring system (for example, that available at http://www.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof ). A suggested algorithm for making decisions about the use of aspirin therapy on the basis of predictions of absolute risk is presented in Figure 2. Patients with an estimated risk of coronary events of 1.5 percent per year of higher are, barring contraindications, good candidates for aspirin therapy, whereas those with a risk of 0.6 percent per year or less are probably not. Among patients with an intermediate level of risk -that is, 0.7 to 1.4 percent per year- other factors should be considered, including the preferences of the patient; treatment should be considered more seriously if there is adequately treated hypertension with target-organ damage, diabetes mellitus, or poor physical fitness.

제2형 당뇨병 환자에서 우연히 발견된 기종성 방광염 1례

박보민,김윤정,이영태,노정현,권수경,김동준,고경수,이병두,임경호,이순희,박정현 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Emphysematous cystitis is an uncommon disease in which bacterias produce gas within the bladder wall and surrounding tissue. Patients with diabetes, neurogenic bladder and chronic urinary tract infection are predisposed to the disease. It is usually caused by E.coli and Klebsiella. Severity of illness ranges from an asymtomatic condition to life threatening cystitis. Succesful management depends on early diagnosis with correction of underlying causes, administration of appropriate antibiotics, establishment of adequate bladder drainage and surgical excision of involved tissue when required. We report a case of 52-year-old woman who did not compain of symtoms of cystitis but epigastric pain, nausea, and vomitting. Emphysematous cystitis was revealed on the abdominal X-ray series incidentally. CT scans of the pelvis showed mottled gas bubble within the bladder. After treatment, the symtoms subsided and plain abdominal film showed no evidence of gas shadow in the pelvic cavity.

발열로 인해 발현된 부루가다 증후군 1례

박혜연,김종훈,박경일,황철웅,김태년,남궁준,도준형,이원로,이성윤 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Brugada syndrome is characterized by right bundle branch block morphology and ST segment elevation in the right precordial leads and a propensity to develop ventricular arrhythmias. Mutations in a cardiac sodium channel gene have been linked to this syndrome, and the ionic mechanisms responsible for the electrocardiographic phenotype are temperature-dependent. This case report describes a patient in whom a typical Brugada ECG pattern developed during fever and returned normal ECG after fever was subsided.

뇌, 척추, 전립선 병변을 동반한 속립성 결핵 1예

김철홍,김경욱,박재홍,이민재,양윤식,김주인,설상영 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

국내에서 폐외결핵의 유병율은 잘 알려져있지 않지만, 아직도 뇌 결핵종, 결핵성 척추염 등의 보고는 드물지 않다. 저자들은 두통을 주소로 내원한 63세의 환자가 속립성 폐결핵, 뇌 결핵종, 결핵성 척추염, 전립선 결핵을 동시에 보여, 전립선 낭종의 흡입생검상 항산균도말검사 및 배양검사상 양성으로 결핵성으로 진단하고 치료하였기에 문헌고찰과 함께 보고하는 바이다. The prevalence of the extrapulmonary tuberculosis in Korea is not well-recognized, but the number of reports about brain tuberculoma and tuberoculous spondylitis is not small. The authors experienced a case of a 63-years-old man who had visited for a headache and was diagnosed as having miliary tuberculosis with brain tuberculoma, tuberculous spondylitis and prostatic tuberculosis at the same time. Tuberculous infection was confirmed by positive AFB stain & culture of aspirates of prostatic cystic fluid. We report this case with a brief review of the references.

전기경련요법에서 remifentanil이 혈역학에 미치는 효과

정순호,이상은,임세훈,이정한,이근무,최영균,김영재,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: Electroconvulsive therapy (ECT) is often associated with transient hypertension and tachycardia. Acute hemodynamic change may produce serious complications. Remifentanil is a potent ultra short acting opioid and has been found to reduce blood pressure and heart rate. The goal of this study was to evaluate effects of remifentanil on seizure duration, recovery parameters and hemodynamic changes during ECT. Methods: Ten ASA Ⅰ, Ⅱ patients enrolled in this prospective, randomized trial, each receiving more than four electroconvulsive therapy. Patients were randomized to receive placebo, group P (propofol 1mg/kg+0.9% normal saline 1ml, n=10), and propofol with remifentanil, group R (propofol 1mg/kg+remifentanil 1ug/Kg n=10). Supplemental dose of propofol was given as required to achieve loss of consciousness. We recorded hemodynamic parameters, seizure duration, and recovery parameters. Results: Seizure duration and recovery parameters were similar in group R and group P. Blood pressure and Hear rate after ECT were significantly lower in group R. Conclusions: Remifentanil(1ug/kg) attenuated the acute hemodynamic response to ECT under propofol anesthesia without adversely affecting the duration of seizure activity and recovery profile. Adjunctive use of remifentanil may be good alternative regimens for ECT.

Tsunami 스텐트를 이용한 경피적 관상동맥 중재술의 초기 및 6개월 관상동맥조영술 성적 : immediate and six-month angiographic results

이성윤 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

The Tsunami stent is balloon expandable, stainless steel, tubular coronary stent whose design is based on a number of radial, diamond shaped cells joined by double connector. The aim of this prospective observational study was to examine the procedural, in-hospital, and long term clinical and angiographic outcomes of patients undergoing Tsunami stent. Thirty-nine consecutive unselected patients were treated by means of the implantation of forty-one Tsunami stents in forty-one coronary lesions. Most of the patients (89.8%) had unstable angina or acute myocardial infarction. The baseline lesion morphology was complex in 75.5% of cases, and the mean lesion length was 15.2 3.8 mm. The procedural success rate was 100%. Mean percentage diameter of the stenosis decreased after the intervention from 75.2 12.2% to 4.8 4.6%. The in-hospital major adverse cardiac event rate was 2.5% including one cardiac death. During the six-month follow-up, there was one more cardiac death and four subjects (8.1%) underwent target vessel revascularization. The six-month event-free survival rate was 87.1%. The angiographic restenosis rate was 11.8%: a focal or limited pattern (class Ⅰor Ⅱ) was found in 25% of cases, whereas the remaining 75% had a proliferative morphology (class Ⅲ or Ⅳ). In conclusion, this study indicates the good clinical and angiographic performance of the Tsunami stent system in consecutive unselected patients.