• Journal of Chest Surgery
• /
• 제30권7호
• /
• pp.677-685
• /
• 1997

혈전탄성검사(혈전탄성검사, thomboelastography)는 혈전 생성 전 과정에 대한 신속한 정보를 제공해 주는 유용한 측정 방법 중의 하나이며, 많은 수술 과정에서 발생하는 혈액응고 장애의 진단을 용이하게 함으로써 적절한 치료를 가능케 한다. 최근, 단백질분해효소 억제제인 아프로티닌에 의해 심폐바이패스 후의 혈액응고 장애에 의한 출혈 문제가 많이 해결되었지만,그 지혈 작용 기전은 아직 정확히 알려져 있지 않다. 이 연구 는 개심술을 시행 받은 환자들에서 아프로티닌이 심폐바이패스에 의한 혈액응고 체계 변화에 미치는 효과를 혈전탄성검사로 분석하기위하여 시행하였다 20세 이상 성인 개심슬 환자 40명을 2개의 군으로 나누어 시행하였다. 대조군(남 10명, 여8명, 평균연령 53.4세)은 심폐기 충전액에 아프로티닌을 투여하지 않았고, 아프로티닌군(남 14명, 여 8명, 평균연령 50.8세) 은 심폐기 충전액에 아프로티닌 2백만 KIU(kallikrein inhibition unit)를 투여하였다. 이 들을 대상으로, 심폐바 이패스 전, 후( 프로타민에 의한 헤파린 효과 중화 30분 후)에 혈전탄성검사와, 활성응고시간, 프로트롬빈시 간, 활성부분트롬보플라스틴시간, 혈소 \ulcorner수, 섬유소원과 섬유소용해물질 농도 등 일반적인 혈액응고 검사들 을 시행하였다. 일반적인 혈액응고 검사상에서는, 두 군간에는 섬유소용해물질이 대조군에서 심폐바이패스 후 아프로티닌 군 보다 의미 있게 증가한 것(p<0.05)을 제외하고는 차이가 발견되지 않았다. 혈전탄성검사에서는 혈전형성 시간(K)과 $알파각(\alpha^{\circ})이$ 두 군 모두에서 심폐바이패스 후에 각각 증가 및 감소하였으나(p<0.05), 섬유소용해 지수(LYS60)는 차이가 없었다. 아프로티닌군에서는, 반응시간(R)은 심폐바이패스 후에 감소하였으나(p<0.09) 혈전강도최대치(h4A)는 변화가 없었다. 반면 대조군에서는, 반응시간은 변화가 없었으나 혈전강도최대치는 의미 있게 감소하였다(p<0.05). . 이상의 결과로부터, 심폐바이패스 시 혈액응고 체계의 주된 변화는 혈소판 기능 저하에 의한 혈전 강도의 저하이고, 과도한 섬유소용해의 증가는 일어나지 않으며, 아프로티닌은 심폐바이패스 후의 혈액응고 체계에 서 초기에는 항혈액응고 작용을 갖지만, 심폐바이패스에 의한 혈소판 기능의 저하를 억제하여, 일단.혈전이 형성되기 시작하면 혈전강도를 심폐바이패스 전 상태로 유지하는 효과를 갖는다고 \ulcorner각된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제36권4호
• /
• pp.303-308
• /
• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.

• Tuberculosis and Respiratory Diseases
• /
• 제60권6호
• /
• pp.625-630
• /
• 2006

배 경: COPD 환자에서 흡연은 폐혈관에 직접 작용하여 혈관 수축, 확장 및 혈관세포 증식을 조절하는 매개물질을 분비하여 혈관의 부적절한 개형 및 생리 현상을 초래하여 폐성고혈압을 유발한다. COPD 환자에서는 종종 급성 및 만성 폐혈전증이 일어나고 혈장내 응고전구물질 및 섬유소용해계의 표지자들이 증가되어 있다. 그러나 COPD 환자에서 혈액 응고계 및 섬유소용해계가 우심실 기능 장애에 어떤 기여를 하는지는 잘 알려져 있지 않다. 본 연구에서는 진행된 COPD 환자에서 multidetector CT scan (MDCT)을 이용하여 측정한 우심실 기능에 따른 혈액내 응고계 및 섬유소용해 계의 변화를 알아보고자 하였다. 방 법: GOLD 지침에 따라 COPD로 진단한 26명에서 심장 MDCT scan을 이용하여 우심실 박출계수를 구하였다. 혈액내 thrombin antithrombin (TAT) 및 plasminogen activator inhibitor (PAI)-1은 enzyme linked immunoassay 방법으로 측정하였다. 결 과: COPD 환자의 혈중 TAT는 $10.5{\pm}19.8{\mu}g/L$으로 정상인의 혈중 TAT $3.4{\pm}2.5{\mu}g/L$보다 의미 있게 증가되었으나 (p<0.01) COPD 환자의 혈중 PAI-1는 $29.6{\pm}20.7ng/mL$으로 정상인의 혈중 PAI-1 $25.9{\pm}17.9ng/mL$와 비교하여 의미 있는 변화가 없었다. COPD 환자에서 혈중 TAT는 MDCT scan으로 측정한 우심실 박출계수와 의미 있는 역 상관관계를 보였으나 (r=-0.645, p<0.01) 혈중 PAI-1은 우심실 박출계수와 상관관계를 보이지 않았다 (r=0.022, p=0.92). 결 론: COPD 환자에서 혈중내 응고계는 활성화되어 있으며 혈중 TAT는 우심실 기능 장애의 의미있는 표지자로 사료된다.

• 대한장애인치과학회지
• /
• 제8권1호
• /
• pp.15-21
• /
• 2012

Extraction of all nonrestorable teeth prior to bone marrow transplantation is the major dental management of the patient being prepared for the transplantation. But, there are four principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (3) Thrombocytopenic purpuras (4) Disorders of coagulation (liver disease, anticoagulation drug-heparin, coumarin, aspirin, plavix) If the hemorrhage from postextraction wound is unusually aggressive, the socket must be packed with local hemostatic agent and wound closure & pressure dressing are applied. But, in dental alveoli, local hemostatic agent (gelfoam, surgcel etc) may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding and infection control by suture, pressure packing and iodoform gauze drainage on infected active bleeding extraction socket under sedation and local anesthesia in a 57-years-old multiple disabled patient with anticoagulation drug.

• Childhood Kidney Diseases
• /
• 제19권1호
• /
• pp.48-52
• /
• 2015

Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) is one of the causes of atypical hemolytic uremic syndrome, and increasingly reported. They are more severe and leave more long-term sequelae than more prevalent, typical hemolytic uremic syndrome. But it is not so easy to diagnose SpHUS for several reasons (below), and there was no diagnostic criteria of consensus. A 18 month-old-girl with sudden onset of oliguria and generalized edema was admitted through the emergency room. She had pneumonia with pleural effusion and laboratory findings of HUS, DIC, and positive direct Coombs' test. As DIC or SpHUS was suspected, we started to treat her with broad spectrum antibiotics, transfusion of washed RBC and replacement of antithrombin III. On the $3^{rd}$ day, due to severe hyperkalemia and metabolic acidosis, continuous renal replacement therapy (CRRT) was started. She showed gradual improvement in 4 days on CRRT and discharged in 16 days of hospital care. At the follow up to one year, she has maintained normal renal function without proteinuria and hypertension. We report this case with review of articles including recently suggested diagnostic criteria of SpHUS.

• 대한치과마취과학회지
• /
• 제2권2호
• /
• pp.114-117
• /
• 2002

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

• 한국입자에어로졸학회지
• /
• 제5권2호
• /
• pp.83-90
• /
• 2009

This paper describes a condensation-evaporation method (CEM) to produce size-controlled spherical silver nanoparticles by perturbing coagulation and coalescence processes in the gas phase. Polydisperse silver nanoparticles generated by the CEM were first introduced into a differential mobility analyzer (DMA) to select a group of silver nanoparticles with same electrical mobility, which also enables to make a group of nanoparticles with elongated structures and same projected area. These silver nanoparticles selected by the DMA were then in-situ sintered at ${\sim}600^{\circ}C$, and then they were observed to turn into spherical shaped nanoparticles by the rapid coalescence process. With the assistance of modified converging-typed quartz reactor, we can also produce the 10 times higher number concentration of silver nanoparticles compared with a general quartz reactor with uniform diameter. Finally, the spherical silver nanoparticles with 30 nm were electrostatically deposited on the surface of silicon substrate with the coverage rate of ~4%/hr. This useful preparation method of size-controlled monodisperse silver nanoparticles developed in this work can be applied to the various studies for characterizing the physical, chemical, optical, and biological properties of nanoparticles as a function of their size.

• BMB Reports
• /
• 제41권2호
• /
• pp.102-107
• /
• 2008

Extracellular proteases play an important role in a wide range of host physiological events, such as food digestion, extracellular matrix degradation, coagulation and immunity. Among the large extracellular protease family, serine proteases that contain a "paper clip"-like domain and are therefore referred to as CLIP-domain serine protease (clip-SP), have been found to be involved in unique biological processes, such as immunity and development. Despite the increasing amount of biochemical information available regarding the structure and function of clip-SPs, their in vivo physiological significance is not well known due to a lack of genetic studies. Recently, Drosophila has been shown to be a powerful genetic model system for the dissection of biological functions of the clip-SPs at the organism level. Here, the current knowledge regarding Drosophila clip-SPs has been summarized and future research directions to evaluate the role that clip-SPs play in Drosophila immunity are discussed.

• 상하수도학회지
• /
• 제24권5호
• /
• pp.485-493
• /
• 2010

Chemical coagulation destabilizes colloidal particles so that particles grow to larger flocs. Solid particles are then removed by solid-liquid separation after typical precipitation. Rapid precipitation enhances the separation by reducing the precipitation time with larger and denser particles. Conventionally, polyelectolyte compounds (polymers) function as a flocculant aid by introducing a interparticle binding, which increases the particle size and density. And more recent ballasted flocculation adds a ballasting agent (microsand) to form denser particles with its high-density(sp gr=2.65). The current research was to evaluate the manner in which ballasted flocs are formed under different injection timings of microsand and to recognize the effects on floc formation. $FeCl_3$ as a coagulant, anionic polymer for a flocculation aid and microsand were used for the floc formation. Floc size (diameter) was widely ranged with the highest mean value when microsand was injected between $FeCl_3$ and polymer. Mean floc density was larger when the floc formed smaller. Settling velocity increased with larger floc size, whilst not significantly affected by the timing of microsand injection. The additional slow mixing on floc formation increased floc size to some extent.

• 대한한의학회지
• /
• 제16권1호통권29호
• /
• pp.96-117
• /
• 1995

1. The Pung(風) is the necessary power for growth and maintenance of life. 2. The characteristics of the Pung(風) is the Yang evil, the features for opening and excretion, mobility and rapid change. That is the major cause of all diseases, and its mobility is the main character. 3. Jung Pung(中風) is the same concept of apoplexy in Western medicine. 4. Jung Pung(中風) is classified on the basis of pathology, anatomy, and histology in Western Medicine, but In Oriental Medicine that is classified on the basis of symptom and severity of disease. 5. In Western Medicine, Jung Pung(中風) was regarded as the local cause of disease, but in Oriental Medicine regarded as the physiological changes caused by the weakness of the whole body. 6. In the emergency care, the method of GaeKeum is compared to Levin tubing, the method of to the use of urokinase for the promotion of cerebrovascular circulatio, and the method of To(吐法) to suction for the elimination of Dam(痰), the method of Hun(熏法) to the use of solution for the improvement of circulation. 7. With the comparison of the cause and diagnosis, the hemorrhagic disease and infarction were regarded as the major agents in Western Medicine and the symptom appeared in the patient was the standard of diagnosis and therapy in Oriental Medicine. 8. In the Western therapy of cerebral hemorrhage, the method of coagulation and hemostasis was used for the elimination of hematoma and cerebral edema, but in Oriental Medicine, the method of YanghaelGiHael(凉血止血) was used for descending the PungHwa(風火) and hemostasis. 9. In the period of recovering injury, the physical therapy was underlined for the recovering of partial function in Western Medicine, the method of accupuncture and drug therapy was adapted for the normal function of the whole body.