• Journal of Dental Anesthesia and Pain Medicine
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• 제17권3호
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• pp.235-240
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• 2017

Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.

• Journal of Chest Surgery
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• 제3권2호
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• pp.139-142
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• 1970

A Case of thoraco-abdominal aortic aneurysm involving from the lower descending- thoracic aorta to bifurcation of abdominal aorta into both common iliac artery is presented in special view-point of its surgical technic and postoperative complication. Operative technic is the most popular method of Dr. De Bakey's shunt of Dacron which is bridging thoracic aorta to terminal abdominal aorta primarily as temporary shunt but after anastomosing the individual hranch of left Renal, Celiac, Sup. meseateric and right Renal artery to corresponding part of the Dacron tube, the Dacroa graft is fixed as permanent graft in stead of excised thoraco-abdominal aorta. The patient died of acute renal failure and increasing evidence of CNS damage due to respiratory acidosis on 6th postoperative day hut this report will he a good experience in respect of further progress of aortic surgery in Korea.

• 대한임상독성학회지
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• 제2권1호
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• pp.7-11
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• 2004

Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.

• Parasites, Hosts and Diseases
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• 제51권5호
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• pp.551-555
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• 2013

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.

• Pediatric Infection and Vaccine
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• 제25권2호
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• pp.101-106
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• 2018

6세 남아가 인플루엔자 A 바이러스 감염 이후 급성 호흡부전 상태에서 내원하였다. 기관 삽관 이후 인공 호흡 및 산화 질소공급에도 호흡성 산증 및 저산소증의 호전이 없어 내원 9시간 이후 체외막 산소 공급을 이용하여 호흡 보조를 시행하였다. 내원 12시간 이후 기관지경을 이용하여 우측 중간 기관지부터 상엽 구멍을 막고 있는 단단한 점액 마개를 제거하였다. 이후 환자는 신경계와 호흡기계 후유증 없이 퇴원하였다. 저자들은 플라스틱 기관지염으로 인한 급성 호흡 부전 상태의 환자에서 신속한 체외막 산소 공급 및 기관지경술의 처치를 시행함으로써 후유증 없이 치료한 사례를 보고한다.

• Journal of Yeungnam Medical Science
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• 제31권2호
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• pp.89-93
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• 2014

Background: This study was conducted to investigate the epidemiological features, clinical courses, and diagnoses of neonates who are transferred to neonatal intensive care unit of Yeungnam University Hospital due to tachypnea soon after birth. Methods: Based on medical records, we performed a retrospective study of neonatal intensive care unit admissions due to tachypnea from January 2010 to December 2013. Results: A total of 311 neonates were included in this study. The patient characteristics showed male predominance at 2.65:1. Among the 311 neonates with tachypnea, 127 (40.8%) neonates needed oxygen supply, and 54 (17.4%) neonates needed assisted mechanical ventilation. Transient tachypnea of the newborns (TTN) (158, 50.8%) showed the highest incidence, followed by pneumonia (63, 20.3%), extrapulmonary infection (37, 11.9%), respiratory distress syndrome (21, 6.8%), air leak (16, 5.1%), meconium aspiration syndrome (12, 3.9%), congenital heart disease (5, 1.6%), metabolic acidosis (3, 1%), primary pulmonary hypertension of newborns (2, 0.6%) and anemia (2, 0.6%). Conclusion: Although the neonates with tachypnea showed no other respiratory distress symptom, clinicians should be aware of the possibility of other pulmonary diseases as well as TTN and their extra-pulmonary causes. If tachypnea does not improve within a few hours, the clinician should consider further evaluation and management as soon as possible.

• 대한유전성대사질환학회지
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• 제16권2호
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• pp.102-108
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• 2016

멜라스 증후군은 사립체 질환 중의 하나로서, 증상발현 시기 및 임상 양상이 매우 다양하여 의심하지 않으면 진단이 늦어지는 경우가 있을 수 있다. 연구자들은 임상경과를 달리하는 두 증례를 경험하였기에 보고하는 바이다. 증례 1에서는 두통과 시야 흐림, 경련 등이, 증례 2에서는 성장장애, 난청, 시야 흐림, 경련 등이 초기 증상으로 나타났으며, 증례 1은 현재도 일상 생활이 가능한 정상적인 활동도를 보이는 반면에, 증례 2의 경우에는 심각한 뇌손상을 받은 후에 진단되어 예후가 불량하였다. 멜라스 증후군의 치료는 대증적으로 이루어지게 되며, 약물적인 치료 중 코엔자임 Q10, L-아르지닌 등을 사용하였을 때 성공적인 결과를 얻을 수 있다. 질환의 초기에는 비특이적인 경우가 많음으로 관심과 의심을 통하여 멜라스 증후군을 조기 진단하는 것이 매우 중요하다고 할 수 있으며, 조기 진단과 적절한 교육 및 지지적인 치료를 통해 임상경과를 좋게 만들 수 있도록 노력하는 것이 예후에 중요하다고 할 수 있겠다.

• The Korean Journal of Physiology
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• 제24권1호
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• pp.123-129
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• 1990

A comparative study of acid-base balance has been made between acidemia-induced hyperkalemia and hyperkalemia-induced acidemia. A group of rabbits was infused 0.1 N hydrochloric acid solution and metabolic acidosis was induced. Another group was administered 20 mM potassium chloride solution and hyperkalemia was induced. The third group was infused 0.1 N hydrochloric acid and 20 mM potassium chloride solution, simultaneously. Acid-base data and plasma potassium ion concentration were monitored every thirty minutes in these three groups of rabbits. Following results were obtained: 1 ) Along with the infusion of hydrochloric acid, acute metabolic acidosis was induced in the rabbits. Plasma bicarbonate ion concentration decreased primarily in this group. As a respiratory compensation, there was a tendency of reduction of arterial $Pco_{2}$. The alteration of data became larger along with the amount of administration and the time elapsed. However, hyperkalemia was not so severe compared with the second group. 2) In potassium chloride infused group, plasma potassium ion concentration increased along with the time elapsed and the amount of infusion. And the alteration of acid-base data was parrallel to the level of potassium ion concentration, above all depression of pH was prominent. 3) Above data suggest that when acute metabolic acidosis was induced, exchange of intracellular potassium ion with extracellular hydrogen ion seems significant for the regulation of extracellular acid-base balance. And when hyperkalemia was induced with the infusion of potassium chloride solution, the exchange of intracellular hydrogen ion with extracellular potassium ion also seems significant for the regulation of extracellular potassium balance. 4) In the group of rabbits infused hydrochloric acid and potassium simultaneously, disturbances of acid-base balance and potassium balance were much more severe than two other groups. In these mixed disturbances, the process of compensatory mechanism might be inhibited and one disturbance might aggregate each other. 5) Through above data it has been postulated that in acid-base disturbance potassium balance can be sacrificed as a compensatory mechanism, and vice versa in disturbance of potassium balance. And our data also suggest that hydrogen ion and potassium ion are compensatory pair, one another.

• 대한유전성대사질환학회지
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• 제16권1호
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• pp.47-51
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• 2016

프로피온산혈증은 상염색체 열성유전에 의해 발생하는 질환으로, 혈중에 암모니아, 독성 물질 등이 축적되어 경한 증상에서부터 사망에까지 이르는 질환이다. 유병률은 50,000-100,000명당 1명이다. PCCA 또는 PCCB 유전자의 돌연변이로 발생하며, 이것을 규명하는 것이 가장 확실한 진단 방법이다. 두 유형에 따른 임상경과 차이는 뚜렷하게 밝혀져 있지 않다. 발병 시기에 따라 신생아기형과 후기형으로 나눌 수 있다. 증상 발현의 원인은 이화작용을 강화시키는 감염, 스트레스, 변비, 단백질의 과도한 섭취 등이며, 운동실조, 이상행동, 식욕부진, 주기적 구토, 성장장애, 신경발달이상 등의 광범위한 임상 경과를 보인다. 정확한 진단과 조속한 초기 치료가 환자의 생존율 및 신경 발달 장애 여부에 중요한 요소이다. 본 증례는 고암모니아혈증 및 대사산증이 심하지 않았으나 조기에 대사성 질환을 염두에 두고 PCCA와 PCCB 유전자의 돌연변이를 분석하여 프로피온산혈증을 진단하고 적극적인 금식 및 수액 치료와 진단을 통해 신체 발달 및 운동 및 치명적인 신경학적 장애 없이 성장한 고무적인 사례로 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제3권2호
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• pp.73-90
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• 1970

Clinical perfusion data on 16 cases of cardiopulmonary bypass using Sigmamotor pump and RyggKyvsgaard Oxygenator which performed at Seoul National University Hospital during the period of Aug. 1968 to Aug. 1970 was analized. AIl cases were hemodiluted and the perfusion was carried out under the normothermic condition. The age of the patients ranged between 6 and 43 years. The b:dy weight varied between 18.3 and 54.0 kg and the body surface area between 0.78 and 1. 59$M^2$. The priming solution was consiste:I with fresh ACD blood. Hartmann solution and Mannitol. The average amount of priming was approximately 2242 ml. The average hemodilution rate was 17%. The flow rate ranged from 1.7L to 3.5L/Min/$M^2$ and averaged 2.4L/Min/$M^2$ or 78mI/Min/kg. The duration of perfusion varied from 22 to 110 min with average of 56.9 minutes. Some hemodynamic responses were observed. The arterial pressure dropped immediately after the initiation of partial perfusion and was more marked after the total perfusion foIlowed by gradual increase to the safety level. The central venous pressure reflected the reduced blood volume especially in the cases of prolonged perfusion which lasted over 60 min. In most of the cases, red blood cell count decreased and white blood ceIl count increased after the perfusion. Hemoglobin level was decreased, averaging of 12.5mg%, Hct 3.3% and platelets count of 18% postoperatively. Plasma hemoglobin increased mildly, from pre-perfusion average value of 4. 06mg% to postperfusion value of 22.5mg%. Serum potassium was 4.4mEq/L pre-operatively and was decreased to 3.7mEq/L postoperatively. Five cases showed definite hypopotassemia immediately after the operation. Sodium and chloride decreased mildly. These electrolyte changes are thought to be related with hemodilution. diuretics and reduced blood volume during and after the perfusion. Arterial blood pH value revealed minimal to moderate elevation from preperfusion average value of 7.376 to 7.461 during perfusion and then 7.365 after perfusion. The pC02 and hicarbonate showed minimal to moderately lowered values. The total CO2 was decreased. Buffer base decreased during perfusion (Av. 42.6mEq/L) and further decreased after the perfusion (Av. 40.8mEq/L). These arterial blood acid base changes suggested that the metabolic acidosis was accompanied by respiratory alkalosis during and immediately after the perfusion. Authors belived that the acidosis could more effectively be corrected with the more additional dose of bicarbonate than we used by this study. The chest tune drainage during the first 24 hours following operation was 1158 ml in average. One case (Case No. 15) showd definite bleeding tendency and it was believed that the cause might be due to the defect of heparin and protamine titration. The average urinary out put during 24 hours post-perfusion was 1291ml. One case (Case No. ]) showed definite post perfusion oliguria. As conclusion hemodilution using fresh ACD blood. Hartmann and Mannitol solution added with Bivon and high flow rate unler normothermia. was thought to amelioratc the severity of mctabolic acidosis during and after perfusion with relatively satisfactory effect on the diuresis and bleeding tendency.