• Journal of Korean Neurosurgical Society
• /
• 제42권5호
• /
• pp.377-381
• /
• 2007

Objective : High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low- and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. Methods : Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecular weight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PIT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. Results : A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. Conclusion : Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.

• Tuberculosis and Respiratory Diseases
• /
• 제57권6호
• /
• pp.573-578
• /
• 2004

저자들은 폐색전증과 파종성혈관내응고를 동반한 특발성 과호산구 증후군 1례를 경험하였다. 환자는 스테로이드 투여로 빠른 호전이 없어 시클로스포린을 추가하여 호전되었다.

• Journal of Microbiology and Biotechnology
• /
• 제31권2호
• /
• pp.327-337
• /
• 2021

Fibrinolytic enzymes with a direct mechanism of action and safer properties are currently requested for thrombolytic therapy. This paper reports on a new enzyme capable of degrading blood clots directly without impairing blood coagulation. This enzyme is also non-cytotoxic and constitutes an alternative to other thrombolytic enzymes known to cause undesired side effects. Twenty-four Bacillus isolates were screened for production of fibrinolytic enzymes using a fibrin agar plate. Based on produced activity, isolate S127e was selected and identified as B. subtilis using the 16S rDNA gene sequence. This strain is of biotechnological interest for producing high fibrinolytic yield and consequently has potential in the industrial field. The purified fibrinolytic enzyme has a molecular mass of 27.3 kDa, a predicted pI of 6.6, and a maximal affinity for Ala-Ala-Pro-Phe. This enzyme was almost completely inhibited by chymostatin with optimal activity at 48℃ and pH 7. Specific subtilisin features were found in the gene sequence, indicating that this enzyme belongs to the BPN group of the S8 subtilisin family and was assigned as AprE127. This subtilisin increased thromboplastin time by 3.7% (37.6 to 39 s) and prothrombin time by 3.2% (12.6 to 13 s), both within normal ranges. In a whole blood euglobulin assay, this enzyme did not impair coagulation but reduced lysis time significantly. Moreover, in an in vitro assay, AprE127 completely dissolved a thrombus of about 1 cc within 50 min and, in vivo, reduced a thrombus prompted in a rat tail by 11.4% in 24 h compared to non-treated animals.

• 대한한방종양학회지
• /
• 제9권1호
• /
• pp.53-63
• /
• 2003

This study was analyzed the effects of blood-activating and stasis-eliminating herbs on anti-tumor and hematogenic metastasis. The metastasis and recurrence of tumor was the basis of yudok(yudu) on remained tumor cell and stagnation of blood, thermotoxo, phlegm, asthenia of healthy enerngy, stagnation of vital energy. Malignant tumor is caused by carcinogen and go through the progress of initiation, promotion, progression, it is closely related with Eohyul$(y{\grave{u}}xi {\breve{e}})$. Symptoms of blood stasis disease are purplish tongue, mass, fixed stabbing pain, ecchymosis of nail, hypodermic petechia, dermal thesaurismosis, melena, ecchymoma, disturbance of circulation. Effects on the therapy of activating blood circulation and congestion are anti-tumor, anti-coagulation, anti-hemolysis, anti-solution, anti-inflammation, anti-infection, control of blood circulations, control of connective tissue metabolism and control of immunity. They can directly kill the cancer cells entering the blood circulation, inhibit the formation of tumor embody and reduce the blood hyperviscosity. It is suggested that these herbs can be used to prevent and treat blood metastasis of cancer under the guidance of syndrome differentiation.

• 한국정밀공학회:학술대회논문집
• /
• 한국정밀공학회 2006년도 춘계학술대회 논문집
• /
• pp.513-514
• /
• 2006

Recently intradiscal electrothermal therapy is introduced, which is a new and minimally invasive technique fer the treatment of discogenic low back pain. This procedure involves the percutaneous threading of a flexible catheter into the disc under fluoroscopic guidance. The catheter, composed of thermal resistive coil, heats the posterior annulus of the disc, causing contraction of collagen fibers and destruction of afferent nociceptors. This study tries to investigate the effects of the important factors of this procedure such as heat source temperature and heat applying time on the temperature distribution within the intervertebral disc. This study utilized both computer simulation and the experiment for the verification of finite element analysis. FE analysis was carried out with ANSYS v7.0 (ANSYS Inc, USA) using 10,980 number of brick element and 12,551 number of node. The functional spinal units of 5 month old swine were used for the experiment and the temperature was monitored using 10 channel temperature measurement device MV200. Through this study, it was able to analyze the temperature range of inner intervertebral disc by two mechanisms which are known to alleviate pain clinically. The results showed that when the heat source temperature was kept up 80 degree for 1,020 seconds, the temperature of inner annulus reached at 45 degree up to the distance of 15.6mm from heat source, which explains coagulation of inner annulus by heat. When the same heat source was used, the temperature of inner nucleus reached at 60 degree up to the distance of 9mm from heat source, which explains contraction of inner nucleus by heat.

• Journal of Digestive Cancer Research
• /
• 제2권1호
• /
• pp.1-4
• /
• 2014

Palliative care for cancer aims to relieve the discomfort and pain from the cancer itself and associated conditions. Gastrointestinal cancers originate from the tube like structure of gastrointestinal tract and cause complications such as obstruction, bleeding, adhesion, invasion, and perforation to adjacent organ. Recent advances in interventional endoscopy enables endoscopy physicians to do safe and effective care for gastrointestinal cancer patients. Endoscopic palliation includes stent, hemostasis, nutritional support and targeted drug delivery. Self expandable metallic stent is one of the most important modalities in gastrointestinal palliation. Through the endoscopy or over the wire pre-placed by endoscopy, stents restore the gastrointestinal luminal patency and relieve the obstructive condition. Endoscopic hemostasis is another important palliation in gastrointestinal cancer patients. Epinephrine injection, argon plasma coagulation and thermal cauterization are usual modalities for hemostasis. Histoacryl glue and fibrin glue are also available. Hemostatic nanopowder spray is newly reported effective in benign disease and is supposed to be effective also in cancer bleeding. Enteral feeding tubes including gastro- or jejunostomy and nosoduodenal tubes are placed by using endoscopic guidance. Enteral feeding tubes role as the route of easily absorbable or semi-digested nutrients and effectively maintain both patients calorie requirements and gut microenvironment. Photodynamic therapy is the one of the outstanding medical employments of photo-physics. Especially for superficial cancers in esophagus, photodynamic therapy is very useful in cancer removal and maintaining organ structure. In biliary neoplasm, photodynamic therapy is well known to be effective in cancer ablation and biliary ductal patency restoration. Targeted drug delivery is the lastest issue in palliative endoscopy. Debates and questions are still on the table. In this article, the role of endoscopic interventions in palliative care for the gastrointestinal tumors will be thoroughly reviewed.

• 생명과학회지
• /
• 제21권10호
• /
• pp.1422-1427
• /
• 2011

한방생약제의 항혈전 및 혈소판 응집 억제 효능을 탐색하기 위하여 하고초의 물 추출물로 혈전 용해능 활성과 혈액 응고시간 지연효과 즉 PT (prothrombin time), APTT (activated partial thromboplastin time)와 혈소판 응집억제 활성 등에 대해 항혈전 효능을 평가하였다. 혈전용해도를 측정하는 fibrin plate가 용해되어 형성된 투명환의 넓이를 측정하는 실험을 진행한 결과 혈전용해도가 농도의존적으로 효능을 나타내었다. 혈액 응고 cascade에 미치는 영향을 알아보기 위해 혈액 응고 시간 지연 및 단축 효과를 확인하고자 APTT와 PT에 미치는 영향을 조사한 결과 PT의 경우 10 mg/ml, 5 mg/ml의 경우에는 대조군보다 우수한 지연효과를 보였다. APTT의 경우에는 10 mg/ml, 5 mg/ml는 대조군과 비교하여 매우 탁월한 지연효과를 보이고, 2.5 mg/ml, 1.25 mg/ml에서도 높은 지연효과를 나타냈다. 혈소판의 응집에 따라 형성되는 두 전극 사이에 형성된 전기적 저항의 변화로 나타나는 실험을 시행한 결과 하고초의 ADP와 collagen에서 뛰어난 응집억제 활성을 보였다. 따라서 위의 항혈전 효능평가 실험결과를 볼 때 하고초를 향후에 혈전 질환의 치료제 개발에 효과적으로 이용될 수 있을 것으로 사료된다.

• Journal of Chest Surgery
• /
• 제37권3호
• /
• pp.245-251
• /
• 2004

심폐바이패스하 관상동맥우회술과 달리 심폐바이패스 없이 시행하는 관상동맥우회술의 경우 수술 후 혈액응고 기능이 항진되어 이식편의 혈전과 같은 문제가 발생되는 것이 우려된다. 비교연구를 통하여 심폐바이패스 없이 시행하는 관상동맥우회술 후 혈액응고기능이 항진되는지를 규명하고자 하였다. 2001년 11월부터 2002년 5월까지 관상동맥우회술을 시행받은 환자 중 심폐바이패스 없이 시행하는 관상동맥우회술을 시행받은 11명(I군, 연구군)과 같은 기간에 좌심실 심첨부와 중격의 무운동성으로 관상동맥우회술과 Dor 술식을 시행받은 11명의 환자들을(II군, 대조군)비교하였다. 술후 혈액응고기능이 항진되는지를 알아보기 위해 thromboelastography 검사를 수술 전, 술 후 1, 2, 3, 5일째 시행하여 r time, k time, $\alpha$ angle, MA값을 측정하였고 동시에 혈액응고기능검사, fibrinogen, D-dimer, protein S, protein C, antithrombin III, plasminogen, 혈소판 수 등을 시행하여 비교하였다. TEG검사의 각각의 변수값과 혈액응고기능검사 중 MA값, $\alpha$ angle, 혈소판수가 양 군 간 의미있는 차이를 보였다. MA값이 I군의 경우 술 후 3일과 5일째 140$\pm$72%와 153$\pm$98%로 증가하였으나 II군의 경우 87$\pm$27%와 78$\pm$28%로 감소하였다(p<0.05). $\alpha$ angle은 술후 3일째 I군이 122$\pm$92%로 증가하였고 II군이 69$\pm$23%로 감소하였다(p=0.09). 혈소판수는 술 후 3일째 I군이 63$\pm$55%였으며 II군이 33$\pm$13%였다(p<0.05). 심폐바이패스하 관상동맥우회술과 비교하여 심폐바이패스 없이 시행하는 관상동맥우회술의 경우 혈액응고기능이 항진되며 따라서 보다 적극적인 항응고치료의 필요성이 제기된다고 할 수 있다.

• 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.

• 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.