당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

철강업체와 용접봉 제조업체에 근무하는 생산직 근로자의 직업성 요통 유병률과 관련 요인

임현술,김수근,김덕수,김두희,이종민,김양호 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.1

A cross-sectional study was conducted for detecting the risk factors and to propose an effective control program for occupational low back pain. The subjects were 1,665 male production workers employed at a steel factory and a welding material manufacturing factory. The data were collected by a self-reported questionnaire and a medical examination with a rehabilitation specialist for ten days in September, 1997. The contents of the questionnaire were as follows: general characteristics, physical characteristics, employment status, type of work, working environment and the experience of low back pain. The number of cases with symptoms of occupational low back pain were 321, so the point prevalence was 19.3 persons/100 persons. The number of cases with a history of occupational low back pain for one year were 554, so the one year period prevalence was 33.3 persons/100 persons. The point and one year period prevalences of occupational low back pain showed no significant differences in age, marital status, educational level and body mass index. The point and one year period prevalences of occupational low back pain showed no significant differences in alcohol drinking, smoking, stretching exercise and regular exercise. The point and one year period prevalences of occupational low back pain were significantly higher in the unsatisfied group that the satisfied group (p<0.01). However, no significant differences were found among tenures and shift work. The point and one year period prevalences of occupational low back pain were significantly higher in the lifting of heavy materials group than the nonlifting group(p<0.01). However, no significant differences were found among posture of the waist and the working posture. Through the multivariate logistic regression, significantly associated factors with occupational low back pain were found to be dissatisfaction with job (point prevalence: OR=1.78, 95% CI: 1.21-2.61: one year prevalence : OR=1.76, 95% CI: 1.26-2.47), lifting of heavy materials(point prevalence OR=1.94 95% CI : 1.44-2.61; one year prevalence: OR=2.17, 95% CI : 1.70-2.77) and tenure (point prevalence : OR=1.03, 95% CI : 1.01-1.06; one year prevalence : OR=1.02, 95% CI : 1.00-1.05).

목재가 선적된 선창에서 발생한 산소결핍에 의한 질식사

김동훈,김기권,장태정,김정란,이구,김수근,임현술 大韓法醫學會 2001 대한법의학회지 Vol.25 No.1

Oxygen deficiency has been frequent in a clouted space. Wood consumes oxygen and discharges carbon dioxide Instead of photosynthesis in closed space without light, so do some microorganisms on the surface. We experienced a case that a healthy Insect-proofer fell down and died of asphyxia on stair-board at 7 m below the hatch of the cargo-hold shipping wood Analysis of gases in cargo-hold revealed O2; 12.3%, CO; 105 ppm, CH4; 2.7%, and H2S; 1.9% at 1 m below the hatch, and then O2; 6.1%, CO; 220 ppm, CH4; 2.9%, and H2S, 2.3 ppm at 2.5 m below the hatch. Autopsy findings were unremarkable. We justiced the cause of death asphyxia due to oxygen deficiency. As seen in this case, the serious oxygen deficiency was accounted for oxygen consumption by wood and microorganisms.

안과종합검진의 유용성

임수현(Soo Hyun Lim),김국영(Kook Young Kim),정재근(Jae Keun Chung)한재욱(Jae Wook Han),김응수(Ungsoo Samuel Kim) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.2

Purpose: To investigate the efficacy and detection rate of disease in the customized eye examination program. Methods: We reviewed the medical charts of 122 patients who have conducted the customized eye examination program from January 2018 to January 2019 in Kim’s Eye Hospital retrospectively. The customized eye examination program consisted of visual acuity test, intraocular pressure measurement, color vision test, slit-lamp examination, visual field tests, fundus photography, spectral domain optical coherence tomography (Cirrus HD-OCT, Zeiss), Optical Quality Analysis System (OQAS, Visiometrics, Terrassa, Spain), and dry eye test (LipiView II TearScience, Morrisville, NC, USA). The rate of newly diagnosed diseases and vision-threatening disorders including glaucoma and retinal disorders were calculated. Results: A total of 122 patients (46 males and 76 females, mean age; 47.8 ± 14.0 years old, from 22 to 85 years) were included. Nine patients (14 eyes) had a poor vision of less than 0.8. Newly detected diseases were found in 17 patients (13.9%), and among them, 10 glaucoma (8.2%) and retinal disorders (5.7%) were included. When it comes to glaucoma, 7 patients were diagnosed with definite glaucoma with visual field loss, and 3 patients had preperimetric glaucoma. Retinal disorders were composed of 5 epiretinal membranes, 1 diabetic retinopathy, and 1 central serous chorioretinopathy. Conclusions: Various diseases were identified by the customized eye examination program, and vision-threatening diseases such as glaucoma and retinal disorders were found. Therefore, a regular eye examination is needed to detect the serious ocular diseases in the early stage.

Protective effect of ginsenoside Rb1 against tacrolimus-induced apoptosis in renal proximal tubular LLC-PK1 cells

Lee, Dahae,Lee, Dong-Soo,Jung, Kiwon,Hwang, Gwi Seo,Lee, Hye Lim,Yamabe, Noriko,Lee, Hae-Jeong,Eom, Dae-Woon,Kim, Ki Hyun,Kang, Ki Sung The Korean Society of Ginseng 2018 Journal of Ginseng Research Vol.42 No.1

Background: The aim of the present study was to evaluate the potential protective effects of six ginsenosides (Rb1, Rb2, Rc, Rd, Rg1, and Rg3) isolated from Panax ginseng against tacrolimus (FK506)-induced apoptosis in renal proximal tubular LLC-PK1 cells. Methods: LLC-PK1 cells were treated with FK506 and ginsenosides, and cell viability was measured. Protein expressions of mitogen-activated protein kinases, caspase-3, and kidney injury molecule-1 (KIM-1) were evaluated by Western blotting analyses. The number of apoptotic cells was measured using an image-based cytometric assay. Results: Reduction in cell viability by $60{\mu}M$ FK506 was ameliorated significantly by cotreatment with ginsenosides Rg1 and Rb1. The phosphorylation of p38, extracellular signal-regulated kinases, and KIM-1, and cleavage of caspase-3, increased markedly in LLC-PK1 cells treated with FK506 and significantly decreased after cotreatment with ginsenoside Rb1. The number of apoptotic cells decreased by 6.0% after cotreatment with ginsenoside Rb1 ($10{\mu}M$ and $50{\mu}M$). Conclusion: The antiapoptotic effects of ginsenoside Rb1 on FK506-induced apoptosis were mediated by the inhibition of mitogen-activated protein kinases and caspase activation.

Progastrin-releasing peptide as a diagnostic and therapeutic biomarker of small cell lung cancer

오형주,( Ha Young Park ),( Tae Ok Kim1 ),( Chul Kyu Park ),( Hong Jun Shin ),( Hee Jung Ban ),( In Jae Oh ),( Yong Soo Kwon ),( Yu Il Kim ),( Sung Chul Lim ),( Young Chul Kim ),( Soo Hyun Kim ),( Myung G 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Background: Progastrin-releasing peptide (proGRP) is a recently identified biomarker of small cell lung cancer (SCLC). We aimed this study for evaluating the usefulness of automated proGRP measurement for diagnosis and treatment monitoring in patients with SCLC. Methods: From January 2011 to December 2013, plasma samples were prospectively collected from 452 [213 non-small cell lung cancer (NSCLC), 104 SCLC, 135 other diseases] patients visited for tissue diagnosis and tested by two-step automated immunoassay using the ARCHITECT proGRP assay kit (Abbott Diagnostics, USA). The cutoff level of proGRP was set at 63 pg/mL. Results: The mean proGRP was higher in SCLC (1823.0 ± 2684.0 pg/mL) than in NSCLC (61.0 ± 341.7 pg/mL) and other diseases (51.5 ± 222.6 pg/mL, p<0.001). The sensitivity of proGRP was 85.7% (90/105) in SCLC and 11.8% (25/212) in NSCLC. The specificity was 90.2%, positive predictive value was 72.5%, and negative predictive value was 95.4% in SCLC. The mean proGRP was higher in extensive disease (2158.1 ± 2980.6 pg/mL) than in limited disease (901.4 ± 1216.0 pg/mL, p=0.033). Among the 39 patients with SCLC could be followed, the mean proGRP levels of 23 responders were significantly decreased after chemotherapy (from 1651.5 ± 1386.4 pg/mL to 290.0 ± 524.8 pg/mL, p<0.001), whereas those of the 16 non-responders were not. (from 572.5 ± 790.3 pg/mL to 494.4 ± 610.9 pg/mL, p=0.583). Conclusion: Plasma proGRP could be a useful biomarker of SCLC for diagnosis and treatment monitoring. And the initial level may represent the tumor extent of SCLC.

유리섬유에 의한 피부질환 및 임상적 진단

임현술,김정란,정해관,김수근 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.2

This study was conducted to evaluate the health hazards and to develop diagnostic methods of glass fiber workers. We examined 40 male glass fiber workers(exposure group) and 57 male non-glass fiber workers (reference group) with a questionnaire, physical examination, chest x-ray and pathological examination in Mar, 1997. Also we examined 65 male glass fiber workers(exposure group) and 42 male non-glass fiber workers(reference group)with the same methods also we did some energy-dispersive x-ray analyses with a scanning electron microscopic examination in Sep, 1997. Most of the clinical symptoms were significantly more frequent among the exposure group than the reference group. Coughing(32.5%), itching of the nose(30.0%), irritation of eyes(27.5%), irritation of the nose(25.0%) and sputum(22.5%) were the major symptoms among the exposure group in Mar, 1997. Only itching of the nose was significantly more frequent in Sep, 1997. No cases of pneumoconiosis were observed among the groups and there were no differences in chest abnormalities between the exposure group with the reference group on both examinations. The prevalence of dermatosis among the exposure group was 20.0% (8cases) and the cumulative prevalence was 72.5%(29 cases) in Mar, 1997. The prevalence of dermatosis among the exposure group was 23.1% (15 cases)and the cumulative prevalence was 58.5%(38 cases) in Sep, 1997. Onset of dermatosis among the exposure group was most frequent within one month after handling. The frequent sites of skin lesions were the hands and arms on both examinations. Glass fiber induced skin lesions can be diagnosed by the scotch tape method or KOH mount and then can be examined under the light, polarizing and phase-contrast microcopies. Glass fibers can be identified by some energy-dispersive x-ray analyses with a scanning electron microscopic examination.

爐보수 근로자의 혈중 Carboxyhemoglobin 농도와 신체증상

임현술,윤덕로,조수헌,김헌 大韓産業醫學會 1993 대한직업환경의학회지 Vol.5 No.1

제철소 爐보수 작업에 종사하는 근로자의 일산화탄소 폭로정도를 추정하고, 만성적인 저농도 일산화탄소 폭로가 근로자의 건강에 미치는 영향을 평가하고자 제철소 현장에서 일하는 로보수작업 생산직 근로자 808명을 폭로군으로, 제철소 밖에 있는 사무실에서 근무하는 근로자 162명을 대조군으로 하여 흡연, 작업조건, 신체증상 등을 묻는 설문조사를 시행하고 정맥혈을 채취하여 Co-oximeter(Instrumentation Laboratory사, Model482)를 이용하여 carboxyhemoglobin 농도를 측정하여 다음과 같은 결과를 얻었다. 1) 폭로군과 대조군의 혈중 COHb농도는 폭로군이 평균 3.21%, 대조군이 2.36%로 양군간에 통계적으로 유의한 차이를 보였다(p-value<0.0001 by T-test). 2) 흡연 습관에 따른 혈중 COHb농도는 흡연자군이 평균 3.88%, 비흡연자군이 0.90%로 양군 간에 통계적으로 유의한 차이가 있었으며(p-value<0.0001 by T-test) 폭로군과 대조군에서 모두 흡연자와 비흡연자간의 혈중 CPHb 농도는 유의한 차이를 보였다(p-value<0.001 by T-test). 3) 흡연자군의 혈중 COHb 농도는 폭로군과 대조군 사이에 유의한 차이가 있었으나 (p-value<0.05) 비흡연자군에서는 양군간에 유의한 차이를 발견할 수 없었다. 4) 폭로군이 대조군보다 통계적으로 유의할 정도로 더 높은 발현율을 보였던 증상은 없었다. 흡연자군에서는 비흡연자군에 비하여 '가래'의 발현율이 더 높게 나타났다(p-value<0.001 by χ²-test). 5) 혈중 COHb 농도는 작업종료후 채혈까지의 시간에 따라서는 유의한 변화양상을 보이지 않았던 반면 마지막 흡연후부터 채혈까지의 시간이 길어질수록 통계적으로 유의하게 감소하는 경향을 보였다. 이상의 결과로 미루어 제철소 로보수 작업 근로자의 일산화탄소 폭로수준은 임상적 증상을 유발할 만큼 높지 않으며 폭로군과 대조군의 혈중 COHb 농도가 통계적으로 유의한 차이를 보였던 것은 거의 대부분이 흡연습관의 차이에 기인하는 것으로 생각된다. 그러나 고위험군이나 흡연자의 경우에는 저농도 일산화탄소 폭로에 의해서 건강 장해가 유발될 가능성이 높으므로 저농도 일산화탄소에 폭로될 수 있는 작업장에서는 고위험군의 색출과 금연에 대한 교육이 필수적이다. To estimate carbon monoxide(CO) exposure levels and to evaluate health effects of chronic low level CO exposures of furnace-repairing workers, self-administrative questionnaire and venous carboxyhemoglobin(COHb) concentration measurements were performed on 808 furnace-repairing workers(exposed group) and 162 clerical workers(control group). Mean COHb level of furnace-repairing workers(3.21%) was significantly higher than that of clerical workers(2.35%)(p-value<0.0001 by T-test) and mean COHb level of smokers(mean:3.88%) was higher than that of nonsokers(mean:0.90%)(p-value<0.0001 by T-test). Smokers in exposed group showed statistically different COHb levels from those in control group but mean COHb level of nonsmokers in exposed group was not statistically different from that of control group. There was no CO-related symptoms, the positive response rates of which were higher in exposed group. 'Sputum' was the only symptom that showed higher positive rate in smokers. COHb levels did not linearly decrease with the time interval from workshift to blood sampling, while it did with time interval from last smoking to blood sampling. These results suggest that COHb level of furnace-repairing workers mainly depends on the smoking habit and may be related to their occupational CO exposures only to a small degree. Since low level CO exposure may be harmful to high risk patients and to smokers, furnace-repairing compaines require attention to detecting those high risk workers and educating hazardous effects of smoking.

저농도 복합유기용제 폭로 근로자의 주관적 자각증상에 관한 연구

김선민,조수헌,임현술,김헌 大韓産業醫學會 1993 대한직업환경의학회지 Vol.5 No.1

The subjective symptoms related to long-term exposure to a mixture of organic solvents were investigated in a comparison. Of the test results of 64 workers in the paint manufacturing industry with those of a reference group. The organic solvent concentration in the air of the paint manufacturing factory was significantly higher than wire manufacturing factory, but only one of them exceeded reference value. The mean concentration of hippuric acid in urine of the manual workers in the paint factory was significantly higher than that of the clerical workers, but not than that of the manual workers in wire factory. Of the paint manufacturing manual workers, seven persons exceeded reference value(1.0mg/l), but no one of the clerical workers and coil manufacturing manual workers. Of the subjective symptoms, 'nasal irritation', 'drunken feeling', 'heartburn' 'unusual smell' 'dizziness' and 'headache' during work, and 'heaviness in the head' 'headache' 'difficulty in hearing' 'ringing in ears' 'decrease in muscle power of the extremities' 'decreased libido', 'dizziness', 'muddle headedness', 'decrease in sense of smell', 'numbness on extrimities', 'abnormal sensation on extrimities', 'tremor in extrimities', 'poor appetite', 'dry mouth', 'general weekness' and 'fainting on sudden stand-up' in daily life were complained in higher proportion of the higher in paint manufactring workers.

심방조동과 특발성 심실빈맥 환자의 의식소실을 위해 사용한 Propofol 에 의한 정상 동성리듬으로의 전환

김태정,이춘수,이홍식,차영덕,정종권,임현경,이성근,한정욱,허이희 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2