Ionic mechanism of afterdepolarization in hippocampal dentate granule cells 해마 치상회절 과립세포에서 후저분극 현상의 이온기전

Thesis (master`s)--서울대학교 대학원 :의학과 생리학전공,2002.Maste

Arterial blood lactate concentrations as a prognostic predictor in critically ill patients : in comparision with APAC

의학과/석사[한글] 중환자들에서 종종 락트산 대사 이상을 볼 수 있는데 이는 대개 조직의 저산소증 및 저관류압에 기인한다. 다발성 장기부전, 패혈증, 패혈성 쇼크 등의 환자에서는 산소 운반이 정상이라고 해도 대사량의 증가에 따라 산소 결핍으로 혐기성 대사가 이루어져 혈증 락트산 농도가 증가한다. 이런 환자들은 사망률이 높고 다발성 장기 부전으로 진행할 위험이 크다. 본 연구에서는 중환자실에 입실한 환자의 동맥 혈증 락트산 농도를 측정하고 APACHE Ⅱ(acute physiology and chronic health evaluation Ⅱ) 점수를 산출하여 동맥 혈증 락트산 농도와 사망률과의 상관관계, APACHE Ⅱ 점수와의 상관관계를 평가하고자 하였다. 연세대학교 부속 연세 의료원 제 1 및 제 2 중환자실에 입실하였던 성인(만 16세 이상) 환자 중 패혈증 환자 및 외상환자(수술 후 입실한 경우 포함) 29명을 대상으로 하였다. 중환자실 입실 24시간 이내, 퇴실 직전 동맥 혈증 락트산 농도와 APACHE Ⅱ 점수를 산출하였다. 환자를 생존 환자군과 비생존 환자군(사망환자, 가망없어 퇴원한 환자 포함)으로 나누어 APACHE Ⅱ 점수와 동맥 혈중 락트산 농도를 비교하였다. 중환자실 입실 24시간 이내 동맥 혈중 락트산 농도는 생존군(23.7±12.9mg/dl)에 비해 비생존군(48.5±27.0mg/dl)에서 높았으며 APACHE Ⅱ 점수를 보면 생존군(6.7±3.1)보다 비생존군(18.5±5.9)이 높았다. 퇴실 직전 동맥 혈중 락트산 농도는 생존군(14.9±7.1mg/dl)보다 비생존군(143.2±54.0mg/dl)이 높았고, APACHE Ⅱ 점수도 생존군(4.7±2.2)보다 비생존군(28.2±6.0)에서 의의 있게 높았다. 동맥 혈중 락트산 농도와 APACHE Ⅱ 점수가 높을수록 사망률이 증가하였다. 입실 24시간 이내 측정값 보다 퇴실 직전 측정한 동맥 혈중 락트산 농도가 �Ａ릴봇【��높았으나 통계적인 유의성은 없었으며 생존군에서는 의의 있게 감소하였다. 또한 입실시 측정한 동맥 혈중 락트산 농도가 40mg/dl 이상일 때 사망 률이 급격하게 증가하였다. 결론적으로, 동맥 혈중 락트산 농도는 중환자의 사망률 예측 및 치료 효과 판정의 지표로 이용할 수 있을 것으로 생각된다. [영문] Disordered lactate metabolism is frequently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ gaiure. The present study was designed to evaluate the prognostic value of the bolld loctate determination in comparison with the APACHE Ⅱ score in 29 patients who had been admitted to intensive care units. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE Ⅱ scores were colleced on the first and last day of ICU stay. These data were compared between survivor and non-survivor groups. There were statistical differences in blood lactate concentration and APACHE Ⅱ scores between the survivors and non-survivors. On the day of admission, blood lactate concentrations and APACHE Ⅱ scores of non-survivors were 48.5±27.0 mg/dl and 18.5±5.9, while those of survivors were 23.7±12.9 mg/dl and 6.7±3.1. On the day of dischange, arterial blood lactate concentrations and APACHE Ⅱ scores of non-survivors were 143.2±54.0 mg/dl and 28.2±6.0, while those of survivors were 14.9±7.1 mg/dl and 4.7±2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concentration and APACHE Ⅱ score. Furthermore, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients who presented with an initial arterial blood lactate concentration higher than 40 mg/dl. Therefore, it may be concluded that arterial blood lactate concerntration can serve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients.restrictio

토끼 관상동맥과 폐동맥에서 endothelin-1이 ATP-의존성 칼륨채널과 내향성 정류 갈륨채녈을 억제하는 기전에 대한 연구

Thesis(doctor`s)--서울대학교 대학원 :의학과 생리학전공, 2005.Docto

북서태평양 표면수온과 해양-대기 열교환량의 경년 및 수십년 주기의 변동성

Thesis (doctoral)--서울대학교 대학원 :해양학과,2002Docto

Sciatica from Retroperitoneal Lymphoma

Back pain with sciatica is a common clinical syndrome that may be the expression of an uncommon pathological process. We describe a case of retroperitoneal lymphoma mimicking herniated lumbar disc. 62 year old male patient with a clinical picture of sciatica as a first manifestation of retroperitoneal lymphoma. His pain was not response to conventional therapy, and progressively worsened. We reevaluated him and found huge retroperitoneal lymphoma in his pelvic cavity. So we discuss how to identify the few who had extra attention. It is important to rule out occult pathology in patient with an atypical presentation. In assessing a patient with a low back pain, accurate evaluation require a logical , step by step method.ope

Effect of epidural saline washout on regression of sensory and motor block after epidural anaesthesia with 2% lidocaine and fentanyl in elderly patients.

Seventy elderly males received lumbar epidural anaesthesia with 12 ml of 2% lidocaine containing fentanyl 50 mug. At the end of transurethral surgery, the washout group (n = 33) received an epidural bolus of 30 ml saline while the control group (n = 34) did not. Mean (SD) times to 1-grade (17.2 (11.9) vs 32.7 (11.3) min) and 2-grade regression (23.8 (12.2) vs 56.0 (23.9) min) of motor block, 3-dermatomal sensory regression (31.4 (11.6) vs 42.2 (14.4) min for cold and 30.8 (15.6) vs 40.6 (14.2) min for pinprick), and regression to S1 (57.7 (16.1) vs 76.2 (20.2) min for cold and 56.8 (17.3) vs 69.2 (16.2) min for pinprick) were significantly shorter in the washout group than the control group. There were no differences in postoperative pain scores and side effects between the two groups. We concluded that epidural washout facilitates regression of both motor and sensory block following epidural anaesthesia without reducing the postoperative analgesic benefit.ope

Pulmonary edema after da Vinci-assisted laparoscopic radical prostatectomy: a case report

A 63 year-old man developed sudden pulmonary edema after uneventful robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer despite normal preoperative laboratory findings and appropriate anesthetic management. The pulmonary edema was attributed to prolonged (4 hrs) pneumoperitoneum with concomitant high intraabdominal pressure (15-20 mmHg).ope

Aprepitant for antiemesis after laparoscopic gynaecological surgery : A randomised controlled trial

BACKGROUND: Ondansetron, a 5-HT3 receptor antagonist, and aprepitant, a neurokinin-1 receptor antagonist, block the emetic effect of serotonin and neurokinin, respectively. Aprepitant combined with ondansetron can be more effective for preventing emesis in patients at high risk of postoperative nausea and vomiting (PONV). OBJECTIVE: To investigate the prophylactic effect of combining aprepitant with ondansetron compared with ondansetron alone on PONV in patients with fentanyl-based patient-controlled analgesia (PCA) after laparoscopic gynaecological surgery. DESIGN: Single-centre, double-blinded randomised controlled trial. SETTING: A major university hospital in Seoul, Korea, between July 2012 and April 2013. PATIENTS: One hundred and twenty-five female patients (American Society of Anesthesiologists' physical status 1 or 2) with fentanyl-based intravenous PCA after gynaecological laparoscopy were recruited to the study, and 110 completed the protocol. INTERVENTIONS: Oral aprepitant 80 mg or placebo was given 1 h before anaesthesia. In all patients, ondansetron 4 mg was administered intravenously at the end of surgery and 12 mg was added to the PCA solution. MAIN OUTCOME MEASURES: The primary outcome measure was complete response (no PONV and no rescue antiemetics) up to 48 h postoperatively. RESULTS: There was no difference in the proportion of complete responses to 48 h between the groups (P = 0.05), but in the post-anaesthesia care unit and up to 24 h postoperatively, the proportion was significantly higher in the aprepitant and ondansetron group than in the ondansetron only group (76 vs. 50%, P = 0.004 and 38 vs. 16%, P = 0.011, respectively). In the aprepitant and ondansetron group, the time to first PONV was delayed (P = 0.014) and the incidence of nausea up to 24 h postoperatively was lower (P = 0.014). However, there were no differences in the incidences of retching or vomiting, the severity of nausea, use of rescue antiemetics or the incidence of side-effects. CONCLUSION: Aprepitant 80 mg orally with ondansetron is effective in suppressing early PONV up to 24 h postoperatively and delays the time to first PONV in patients with fentanyl-based intravenous PCA after gynaecological laparoscopy. However, the combination prophylaxis with aprepitant and ondansetron failed to reach the predefined primary study outcome when compared with ondansetron alone. TRIAL REGISTRATION: Clinicaltrial.gov identifier: NCT01897337.restrictio

Optimal effect-site concentration of remifentanil for preventing cough during emergence from sevoflurane-remifentanil anaesthesia.

This randomised, double-blinded, controlled trial was designed to identify the optimal dose of remifentanil for cough suppression without adverse effects during emergence from sevoflurane-remifentanil anaesthesia for thyroidectomy. One hundred and four patients were randomly assigned to maintain target effect-site concentrations of remifentanil at 0 (control group), 1.0 (remifentail 1 group), or 1.5 ng.ml(-1) (remifentanil 1.5 group) during emergence. The incidence of coughing was lower in the remifentanil 1.5 group (31%) than in the control group (74%) or remifentanil 1 group (63%) (p = 0.0004). In addition, the severity of coughing during extubation was lower in the remifentanil 1.5 group (median (IQR [range]) 0 (0-1 [0-1]) than in the control group (1 (0-2 [0-3])) and remifentanil 1 group (1 (0-2 [0-3])) (p = 0.004). Haemodynamic changes were reduced, but emergence time and stay in the post-anaesthesia care unit was prolonged in the remifentanil 1.5 group. Maintaining the remifentanil effect-site concentration at 1.5 ng.ml(-1) during emergence from sevoflurane-remifentanil anaesthesia reduces the incidence and severity of coughing without serious adverse events and may provide haemodynamic stability in patients undergoing thyroidectomy. However, awakening may be delayed.ope