• Title/Summary/Keyword: Patient transport

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Effect of Corticosteroids on Renal Excretion of Lithium (Lithium 이온의 배설에 미치는 Corticosteroid의 영향)

  • Oh, Shin-Yul;Ha, Jeoung-Hee;Lee, Kwang-Youn;Kim, Won-Joon
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.229-235
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    • 1986
  • Lithium salts are being used increasingly to treat patient with affective disorders, especially acute mania, or bipolar manic-depressive illness. For therapeutic effect the lithium content must be maintained at or above a particular level. Lithium poisoning due to overdosage may be seen occasionally, and its course is determined primarily by the rate of renal lithium elimination. A search is therefore indicated for procedures that could raise the lithium clearance. In a number of reports renal lithium excretion has been studied in relation to the excretion of water, sodium, potassium and hydrogen, but effects of sodium or water on the lithium excretion has not yet been clarified. Hence the present study was undertaken to investigate the effects of corticosteroid on the excretion of lithium ion. The female rat(Sprague-Dowley), weighing from 200 to 300g, was injected with 50mg/kg of lithium chloride intraperitoneally, and then injected with graded dosage of fludrocortisone and dexamethasone in each group. During the injected rats were incubated in metabolic cage, 24 hour urine of rats were collected. At 24 hours after injection, the rats were sacrificed with guillotin, the blood were collected. And then the concentratios of $Na^+$, $K^+$, $Li^+$ of collected urine and serum were checked by Flame photometer. The results are summarized as follows; 1. Fludrocortisone decreased the serum concentration of lithium and increased the urinary excretion of lithium. 2. In the group treated with low dose of dexamethasone(0.1mg/kg), the serum concentration of lithium was decreased and high dose of dexamethasone (1mg/kg) increased the urinary excretion of lithium. 3. Fludrocortisone increased the urinary $[Na^+]/[K^+]$ in serum and decreased $[Na^+]/[K^+]$ in urine, but opposite effects were occurred in dexamethasone. By above results, it may be concluded that corticosteroid increased the urinary excretion of lithium and decreased the serum concentration of lithium, but it seems to be there is no relationship between these effects of corticosteroid and of the renal $Na^+$ or $K^+$ transport.

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Application of Critical Pathway in Trauma Patients (외상 환자 관리에서 Critical Pathway의 적용)

  • Shim, Hongjin;Jang, Ji Yong;Lee, Jae Gil;Kim, Seonghwan;Kim, Min Joung;Park, You Seok;Park, Inchel;Kim, Seung Ho
    • Journal of Trauma and Injury
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    • v.25 no.4
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    • pp.159-165
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    • 2012
  • Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.

KCCH Medical Cyclotron Operation for Neutron Therapy and Isotope Production (1989) - A Technical Report - (중성자 치료와 동위원소 생산을 위한 KCCH 의학용 싸이클로트론의 운영 (1989))

  • Kim, Byung-Mun;Kim, Young-Sear;Bak, Joo-Shik;Lee, Jong-Du;Yoo, Seong-Yul;Koh, Kyung-Hwan
    • Journal of Radiation Protection and Research
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    • v.15 no.2
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    • pp.113-122
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    • 1990
  • After four years of planning, equipment acquisition, facility construction and beam testing, the KCCH cyclotron facility was put into operation in November1986. Now the KCCH cyclotron(MC-50) has been used for four years in neutron therapy and radioisotope production. Up to December 1989, 179(1852 sessions) patient have undergone neutron therapy. Radioisotope production for nuclear medicine use was started from March 1989 after extensive work to overcome target transport, target melting, beam diagnostic and chemical processing problems. This status report introduces the cyclotron facility, and the experiences of neutron therapy and isotope production with the MC-50 cyclotron. Besides, the operation results and the general troubles of the MC-50 during 1989 are summarized. Total operation time was 1252.5 hours. Four hundred hours were used for neutron therapy of 599 treatment sessions and 832.5 hours for radioisotope production. Total amount of produced raioisotope was 1695 mCi(Ga-67 : 1478mCi, Tl-201 : 107 mCi, I-123 : 25mCi, In-111 : 85mCi). Twenty hours were used for scheduled beam testing. In 1989, 882% of the planned operation were performed on schedule and this rats is improved remarkably compared to 71.0% in 1988.

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Research on ANIOS Disinfection Efficiency to Prevent Infection in Radiography Room (방사선촬영실 감염 방지를 위한 에니오설프의 소독효율 연구)

  • Jung, Woo-Chan;Ahn, Ki-Song;Yang, Eun-Ju;Kim, Young-Jae
    • Journal of the Korean Society of Radiology
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    • v.15 no.1
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    • pp.55-61
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    • 2021
  • In this study, microbes were collected before and after disinfection using ANIOS(ANIOSURF Premium NPC) and compared the areas where the radiological technologist and the patient frequently contacted the chest X-ray. From September 1st to September 7th, 2020. in P Hospital in Deagu, 4 region were collected in a 10×10 size using a sterile cotton swab of the transport medium, and before and after disinfection results were obtained through the colorimetric method. As a result, n the X-ray tube handle Proteus mirabilis, Staphylococcus epidermidis, Bacillus spp., Candida spp., and in the Chin region Proteus mirabilis, Enterococcu faecium, Pseudomonas aeruginosa, NTM, and in the Chest region Proteus mirabilis, Enterococcu faecium, Pseudomonas aeruginosa, and in the Palm region NTM, Candida spp. were detected, and 103 CFU(Colony Forming Unit) or more were measured. After disinfection, only X-ray tube handle was detect Bacillus spp. and more than 102 CFU was measured. Microorganisms found prior to disinfection can cause opportunistic infections, Experimental results showed that Aniosulf(0.25%) is more economical and disinfectant than ethanol(70-90%) and isopropyl alcohol(70-90%). However, further research is needed on the detection of Bacillus spp. resultingly this research is useful basic data of infection control in Radiography room and prevention secondary infections.

Characterization of a Mucolipidosis Type II Mouse Model and Therapeutic Implication of Lysosomal Enzyme Enriched Fraction Derived from Placenta (뮤코지방증 2형 마우스 모델의 특징과 태반에서 추출한 리소좀 효소 투여의 결과)

  • Cho, Sung Yoon;Kim, Ki-Yong;Kim, Su Jin;Sohn, Young Bae;Maeng, Se Hyun;Kim, Chi Hwa;Ko, Ah-Ra;Song, Junghan;Yeau, Sung-Hee;Kim, Kyung-Hyo;Jin, Dong-Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.12 no.1
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    • pp.5-13
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    • 2012
  • I-cell disease (mucolipidosis type II; MIM 252500) and pseudo-Hurler polydystrophy (mucolipidosis type III; MIM 252600) are disorders caused by abnormal lysosomal transport in cells. The presence of numerous inclusion bodies in the cytoplasm of fibroblasts, a lack of mucopolysacchariduria, increased lysosomal enzyme activity in serum, and decreased GlcNAc-phosphotransferase activity are hallmark. Here, we attempted to investigate phenotypical and biochemical characteristics of the knockoutmouse of GlcNAc-phosphotransferase ${\alpha}/{\beta}$ subunits; in addition, we also attempted to determine whether the lysosome enriched fraction derived from placenta can be beneficial to phenotype and biochemistry of the knockout mouse.We found that the knockout mouse failed to thrive and had low bone density, as is the case in human. In addition, skin fibroblasts from the animal had the same biochemical characteristics, including increased lysosomal enzyme activity in the culture media, in contrast to the relatively low enzyme activity within the cells. Intravenous injection of the lysosome rich fraction derived from placenta into the tail vein of the animal resulted in a gain of weight, while saline injected animals didn't.In conclusion, our study demonstrated the phenotypical and biochemical similarities of the knockout mouse to a mucolipidosis type II patient and showed the therapeutic potential of the lysosome enriched fraction. We admit that a larger scale animal study will be needed; however, the disease model and the therapeutic potential of the lysosome enriched fraction will highlight the hope for a novel treatment approach to mucopolipidosis type II, for which no therapeutic modality is available.

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The Effects of Hypercapnia and High Flow on Cerebral Metabolism During Cardiopulmonary Bypass (심폐바이패스 시 고탄산분압과 고관류법이 뇌대사에 미치는 영향)

  • 강도균;최석철;윤영철;최국렬;정신현;황윤호;조광현
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.472-482
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    • 2003
  • Recent studies have demonstrated that cerebral desaturation during rewarming period of CPB was associated with postoperative neurologic dysfunction. The prevention of cerebral desaturation during CPB may reduce the incidences of neurologic and neuropsychological complications. The present study was prospectively undertaken to compare the clinical effects between two strategies (hypercapnic CPB and high flow CPB) to prevent cerebral desaturation for establishing a proper CPB technique. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized into either hypercapnic (Pa$CO_2$ 45~50mmHg, n=18) or high flow group (flow rate 2.75 L/ $m^2$/min and Pa$CO_2$ 35~40mmHg, n=18) during rewarming period of CPB. In each patient, middle cerebral artery blood flow velocity ( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), modified cerebral metabolic rate for oxygen (MCMR $O_2$), cerebral oxygen transport rate ( $T_{E}$ $O_2$), incidence of cerebral desaturation (internal jugular bulb blood oxygen saturation $\leq$ 50%), increased rate of S-100 $\beta$ concentration, and arterial and internal jugular bulb blood gas were measured during the five phases of the operation; Pre-CPB, CPB-10 min (steady-state CPB, nasopharyngeal temperature 29~3$0^{\circ}C$), Rewarm-1 (rewarming phase, nasopharyngeal temperature 33$^{\circ}C$), Rewarm-2 (nasopharyngeal temperature 37$^{\circ}C$), and CPB-off. Incidence of postoperative delirium and duration were assessed in all patients. All variables were compared between the two groups. Result: $V_{MCA}$ (157.88$\pm$10.87 vs 120.00$\pm$6.18%, p=0.006), internal jugular bulb $O_2$ saturation (68.01$\pm$2.75 vs 61.28$\pm$2.87%, p=0.03) and $O_2$ tension (41.01$\pm$2.25 vs 32.02$\pm$ 1,67 mmHg, p=0.03), and $T_{E}$ $O_2$(110.84$\pm$7.41 vs 81.15$\pm$8.11%, p=0.003) at rewarming periods were higher in the hypercapnic group than in the high flow group. C(a-v) $O_2$ (4.0$\pm$0.30 vs 4.84$\pm$0.38 mg/dL, p=0.04), COE (0.36$\pm$0.03 vs 0.42$\pm$0.03, p=0.04), increased rate of S- 100$\beta$ (391.67$\pm$23.40 vs 940.0$\pm$17.02%, p=0.003), and incidence of cerebral desaturation (2 vs 4 patients, p=0.04) at rewarming periods, and duration of postoperative delirium (18 vs 34 hr, p=0.02) were low in the hypercapnic group compared to the high flow group. Conclusion: These results indicate that hypercapnic CPB may provide relatively diminished cerebral injury and beneficial effects for cerebral metabolism relatively compared to high flow CPB.low CPB.

The Clinical Effects of Normocapnia and Hypercapnia on Cerebral Oxygen Metabolism in Cardiopulmonary Bypass (체외순환 시 뇌대사에 대한 정상 탄산분압과 고 탄산분압의 임상적 영향에 관한 비교연구)

  • 김성룡;최석철;최국렬;박상섭;최강주;윤영철;전희재;이양행;황윤호
    • Journal of Chest Surgery
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    • v.35 no.10
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    • pp.712-723
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    • 2002
  • Substantial alterations in cerebral blood flow(CBF) are known to occur during cardiopulmonary bypass(CPB). Many investigators have speculated that these changes may be responsible for both minor and major cerebral damages after CPB. More recently, these changes in CBF have been observed to be intimately related to the arterial carbon dioxide tension(Pa$CO_2$) maintained during CPB. The present study was prospectively designed to investigate the clinical effects of normocapnic and hypercapnic CPB on the cerebral oxygen metabolism in cardiac surgery Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to either normocapnic group (Pa$CO_2$35~40 mmHg, n=18) or hypercapnic group(Pa$CO_2$, 45~55 mmHg, n=18) with moderately hypothermic nonpulsatile CPB(nasopharyngeal temperature of 29~3$0^{\circ}C$). In each patient, middle cerebral artery blood flow velocity( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), cerebral oxygen extraction(COE), cerebral metabolic rate for oxygen(CMR $O_2$), cerebral oxygen transport( $T_{E}$ $O_2$), $T_{E}$ $O_2$/CMR $O_2$ ratio, cerebral desaturation(internal jugular bulb blood oxygen saturation $\leq$ 50%), and arterial and jugular bulb blood gas were evaluated throughout the operation. Postoperative neuropsychologic complications were assessed in all patients. All variables were compared between the two groups. Result: VMCA(169.13 $\pm$ 8.32 vs 153.11 $\pm$8.98%), TE $O_2$(1,911.17$\pm$250.14 vs 1,757.40$\pm$249.56), $T_{E}$ $O_2$,/CMR $O_2$ ratio(287.38$\pm$28.051 vs 246.77$\pm$25.84), $O_2$ tension in internal jugular bulb (41.66$\pm$9.19 vs 31.50$\pm$6.09 mmHg), and $O_2$saturation in internal jugular bulb(68.97$\pm$10.96 vs 58.12$\pm$12.11%) during CPB were significantly lower in normocapnic group(p=0.03), whereas hypercapnic group had lower C(a-v) $O_2$(3.9$\pm$0.3 vs 4.9$\pm$0.3 mL/dL), COE(0.3$\pm$0.03 vs 0.4$\pm$0.03), CMR $O_2$(5.8 $\pm$0.5 vs 6.8$\pm$0.6), and arterial blood pH(7.36$\pm$0.09 vs 7.46$\pm$0.07, p=0.04) during CPB. Hypercapnic group had lower incidence of cerebral desaturation than normocapnic group(3 vs 9 patients, p=0.03). Duration of the neuropsychologic complication(delirium) were shorter in hypercapnic group than in normocapnic group(36 vs 60 hrs, p=0.009). Conclusion: These findings suggest that hypercapnic CPB may have salutary effects on the cerebral oxygen metabolism and postoperative neurologic outcomes in cardiac surgery.surgery.