• The Journal of Internal Korean Medicine
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• v.21 no.5
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• pp.747-763
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• 2000

through a literal study upon Arrhythmia between east and west medicine, the results were as follows 1. Arrhythmia is not only irregular cardiac beat but disorder of cardiac impulse making and conduction disturbance. it means almost irregularity of interval between two beat 2. In the east medicine, arrhythmia is represented various category as palpitation, continuous palpitation, dizziness, consumption which give the first consideration by the accompanied symptoms. A separate way in a diagnostics it become a base of diagnosis of diseases and decision of prognosis by the examination of pulse 3. In the west medicine, Arrhythmia is classified as disorder of heart rate, rhythm, conduction disturbance or tachycardia, bradycardia and it is concomitant with fatigue, palpitation, dyspnoea, syncope, chest discomfort 4. The diagnostic study of pulse condition which represent arrhythmia was started from $\mathbb{<}$Nae-Kyung$\mathbb{>}$ and it was revealed as pulse condition of rapid pulse, slow pulse, swift pulse, running pulse, knotted pulse, intermittent pulse etc. Out of them running pulse, knotted pulse, intermittent pulse which obviously are concomitant with irregularity of interval are clinically meaningful in a conditions of disease and decision of prognosis. and the significance of these pulse condition are transformed through the changes of the times 5. According to cause of disease it is classified by Arrhythmia(running pulse, knotted pulse, intermittent pulse) due to heat, cold, phlegm, deficiency(or insufficiency) and There are three categories of etiological factor that is, endogenous, exogenous and non-exo-endogenous factor. the endogenous factor is insufficiency of the heart Ki, deficiency of both Ki and blood, intemal stagnation of phlegm and fluid, stagnation of seven emotions. the exogenous factor is caused by stagnation of Ki and blood by six exogenous pathogenic factor and the non-exo-endgenous factors are improper diet, overstrain, traumatic injury. A cause of arrhythmia in western medicine are a organic and pathological change of the heart itself and malfunction of the autonomic nervous system.

• The Korean Journal of Pharmacology
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• v.12 no.2 s.20
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• pp.33-41
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• 1976

Agkistrodon halys (Crotalidae) is the only species of poisonous snakes in Korea, and is divided into three subspecies; Agkistrodon bromhoffii brevicaudus, Agkistrodon calaginosus and Agkistrodon saxatilis. With the three venoms, the pharmacological actions on the cardiovascular system and intestine as well as some toxicological characteristics were studied. In addition, the precipitin test in an agar gel medium was employed for immunological comparison of the venoms and the sera of envenomed patients. The results obtained were as follows: Lyophilized venoms contained solids of $211{\sim}273mg/ml$, and LD50 to mice were 1.73 and 0.86 mg/kg in venoms of Agkistrodon bromhoffii brevicaudus obtained on July and October respectively, and 0.40 and 0.32 mg/kg in Agkistrodon calaginosus and the venoms of Agkistrodon saxatilis obtained on October was 2.29 mg/kg. Isoelectric focusing of lyophilized snake venoms showed 19 to 22 protein fractions and 2 to 3 isoamylase fractions. Acute irreversible hypotension was caused by the intravenous injection of large doses of venoms in rabbits and cats, but at the small doses, acute hypotension followed by slow recovery. Little changes of cardiac movements by the venom injection despite of marked hypotension were showed except bradycardia and arrhythmia prior the death. Also no changes on the isolated rabbit atria by the snake venoms were noted. The hypotensive effect of the snake venoms was prevented by the bilateral vagotomy or atropine pretreatment (1 mg/kg), but they did not affect when already the hypotension has undergone. In the isolated rabbit duodenum, small doses of venom increased the phasic movement, while large doses decreased after spastic contraction. With the injection of venoms in dog, strong contraction of gall-bladder was caused and it was not blocked by the pretreatment with phenoxybenzamine (10 mg/kg) or atropine (1.4 mg/kg). In the venoms of Agkistrodon bromhoffii brevicaudus and Agkistrodon calaginosus, at least 5 antigenic components were detected, and four of them were shared in common with each other. Polyvalent antivenin (Wyeth Lab. USA) had three common precipitating antibodies with the venom of Agkistrodon bromhoffii brevicaudus and Akistrodon calaginosus. In the serum of envenomed patients, no precipitating antibodies were seen to the venoms and little changes in serum protein, GOT and GPT were observed. In conclusion, the snake venoms obtained in Korea were highly toxic and caused chiefly the vascular collapse leading to death. This vascular collapse was resulted largely by cholinergic effects, and not cardiotoxin of venoms. In human, it is likely that precipitating antibodies to venom were not produced by an envenomed incidence to poisonous snakes.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1274-1278
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• 2003

Syncope in children and adolescents have a common occurrence according for up to 15% before adulthood. Micturition syncope, a kind of situational syncope, can be considered a form of reflex syncope. It can typically occur in healthy young men after rising from bed in the early morning who experience sudden loss of consciousness during or immediately after urination. The mechanism of micturition syncope is not completely understood, but it has been suggested that vasovagal reflex mediated bradycardia and peripheral vasodilation and decreased venous return due to Valsalva effect and standing position lead to the decrease in cerebral blood flow resulting in syncope. The causes of syncope are variable. So complete history taking, physical examination, electrocardiography, exercise stress test, echocardiography, head-up tilt table test, electroencephalography(EEG), brain magnetic resonance image and urodynamic study should be required for the diagnosis of micturition syncope. There were several reports about micturition syncope. However, literature of micturition syncope at the pediatric age has rarely been reported in Korea so far. Therefore, we report a case of a 9-year-old boy with micturition syncope with typical EEG findings of high amplitude delta wave and flattening during syncope.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.713-718
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• 1997

Fracture of the sternum has been considered as a serious injury and also associated with major complications such as myocardial, major thoracic vascular, and spinal injury. Retrospective datas from blunt trauma victims admitted to our hospital were analyzed to determine significance of sternal fractures and possible associated injures. 101 sternal fractures by blunt trauma were admitted from january, 1986 to december, 1995. Frequency was about 3.51 olo of the nonpenetrating chest trauma. The ratio of male to female was 1.82 versus 1. Most common cause in the stemal fracture was high decelerating injury(73 cases). Most common fracture site was sternal body(75 cases). Average days of adm ssion were 26 days. Abnormal ECG findings were sinus bradycardia(Teases), complete or incomplete RBBB(6 cases), sinus tachycardia(4 cases), specific S-T change(3 cases), 1st degree A-V block(2 cases), LVH(1 case), PVC(1 case), and Low voltage(1 case). CPK-MB was increased about 32.Lolo of sternal fractures. Except of expired 2 patients, patients were treated with conservative treatment(94 cases) and open reductions & steel wire fixations(5 cases). Complication after operation was wound infection(1 case). Causes of death were 1 hypovolemia and 1 acute respiratory distress syndrome. In conclusion, although sternal fracture is less frequent, and mostly treats with conservative treatment, it shoed be carefully observed because of critical associated injuries.

• Neonatal Medicine
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• v.17 no.2
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• pp.207-216
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• 2010

Purpose: The aim of this study was to identify the effects of neonatal developmental intervention program (NDT) in promoting motor development and growth and to determine the usefulness of Hammersmith Neonatal Neurological Examination (HNNE) and Neonatal Behavioral Assessment Scale (NBAS) in premature infants. Methods: We performed NDT on selected premature infants (PI, n=42) and compared them with the full term control group (FC, n=20). NDT protocol and development assessment (HNNE, NBAS) were manipulated by the physical therapist in the neonatal intensive care unit. The data of this study were collected prospectively. Results: The PI with GA <34 weeks (VPI) subgroup showed a more use of mechanical ventilator and surfactant, severe bronchopulmonary dysplasia and intraventricular hemorrhage, and patent ductus arteriosus treated surgically than the PI with GA $\geq$34 weeks but less than 37 weeks (LPI) subgroup. The average scores improved significantly in the PI group between the 1st, 2nd, and 3rd assessment by repeated measure (P=0.000). Also, the PI group showed significantly higher total scores and average score at 40 weeks postmenstrual age, P=0.000, respectively than in the FC group. The LPI subgroup showed more weight gain and change in the head circumference between the 1st and 3rd assessment by repeated measure, respectively, P<0.05. The PI group showed no apnea, bradycardia and late sepsis associated with intervention and assessment. Conclusion: The NDT might be a safe and useful intervention to promote motor and growth outcomes in premature infants. Also, the HNNE and NBAS might be safe and useful tools for assessing neurodevelopment in premature infants.

• Neonatal Medicine
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• v.18 no.1
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• pp.130-136
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• 2011

Purpose: Chloral hydrate is a common drug frequently used for procedural sedation. But data on chloral hydrate use in the newborns are limited. This study examined the frequency of adverse effects of chloral hydrate and factors related to the adverse effects. We also examined if there were additional adverse effects when an additional sedative was used. Methods: The medical records of 104 patients admitted to neonatal intensive care unit of Seoul St. Mary's Hospital from March 2010 to February 2011 who used chloral hydrate for procedural sedation were retrospectively reviewed. Results: Adverse effects after administration of chloral hydrate were noted in 41.3% of the 104 patients. The adverse events included oxygen desaturation (18.8%), increase in apneic episodes (17.5%), increase in bradycardia (10%), and feeding intolerance (3.8%). Using oxygen at the time of chloral hydrate administration was independently associated with adverse effects (odds ratio [OR], 10.911: 95% confidence interval [CI], 2.082-57.178) and with the necessity for an additional sedative after administration of chloral hydrate (OR, 4.151: 95% CI, 1.455-11.840). Using one additional sedative agent after chloral hydrate showed no difference in adverse effects except feeding intolerance. Conclusion: Patients dependent on oxygen at the time of chloral hydrate administration may were found to be at higher risk for adverse effect of chloral hydrate and for an additional sedative. When an additional sedative is needed, it could be used with monitoring feeding intolerance after chloral hydrate administration.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.20-27
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• 1988

Continuous cervical epidural anesthesia with two different concentrations of bupivacaine had been performed in 43 cases for surgery of upper extremity and cervical spine. After the initial dose of 0.33% bupivacaine 15ml to Group I(n=22) and 0.5% bupivacaine 15ml to Group II(n=21) was injected respectively, we observed the circulatory and pulmonary functions to be changed, and evaluated the duration of those analgesic action. The number of spinal segment to be affected and the complications were checked. Statistical significance of changes after the initial dose in both groups was determined by student's t-test. All values are impresed as mean$\pm$1S.D.. The results were as follows: 1) Circulatory functions; Systolic B.P. and Pulse rate were decreased by 10~15torr and 5~6 beats per minute respectively between 10~30 minutes following the initial dose, which were statistically significant in both groups. 2) Pulmonary functions; The diminution of minute volume showed to 20% and a rise of $PaCO_2$ level to 5~6 torr respectively between 30~60 minutes following the initial dose, which were statistically significant in both groups. There were no significant changes in self respiration and respiratory rate in both groups. 3) The duration of analgesic action was $72.3{\pm}25.7$(min) in Group I and $83.5{\pm}28.5$(min) in Group II which was not statistically significant between two groups, and the number of affected spinal segment at ore hour following the Anesthusia was $8.7{\pm}2.0$ in Group I and $10.5{\pm}2.4$ in Group II which was statistically significant between two groups. 4) Complications; a. Hypotension(below 80torr in systolic pressure) was appeared in 5% of all patients. b. Bradycardia(below 60 beats per minutes) was appeared in 25% of all patients. c. Inadvertent dural puncture was developed in only one patient, In conclusion, the 0.33% bupivacaine as well as 0.5% bupivacaine were enough for those analgesic effect in the above mentioned surgery even though the duration of analgesic action was about 10 minutes shorter in Group I than that of Group II. The cardiopulmonary function was clinically rather stable in Group I than that of Group II. Therefore we thought 0.33% bupivacaine was satisfactory for the clinical practicality in the cervical epidural anesthesia.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• The Korean Journal of Physiology
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• v.30 no.1
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• pp.105-116
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• 1996

Rendering the brain ischemic would evoke the cerebral ischemic reflex which is characterized by an arterial pressor response, apnea and bradycardia. Since the rostral ventrolateral medulla (RVLM) is known to play a key role in the maintenance of normal cardiopulmonary activity, during the cerebral ischemic reflex some cardiac related cells should be excited and respiration related cells inhibited. In this context, the responses of RVLM neurons to systemie and focal hypoxia were analyzed in the present study. Twenty-five adult cats of either sex were anesthetized with ${\alpha}-chloralose$ and the single neuronal activities were identified from RVLM area. For the induction of focal hypoxia in the recording site, sodium cyanide was applied iontophoretically and for systemic hypoxia the animal was ventilated with nitrogen gas for a twenty-second period. Cellular activities were analyzed in terms of their discharge pattern and responses to the hypoxia by using post-stimulus time and single-pass time histograms. Of eighteen cardiac related cells recorded from the RVLM area, twelve cells were excited by iontophoresed sodium cyanide and of twenty-five respiration related cells, fourteen cells were excited by iontophoresed sodium cyanide. Remaining cells were either inhibited or unaffected. Eight of fifteen cells tested with iontophoresed sodium lactate were excited and remaining seven cells were inhibited. Systemic hypoxia induced by nitrogen gas inhalation elevated the arterial blood pressure, but excited, inhibited or unaffected the single neuronal activities. Some cells showed initial excitation followed by inhibition during the systemic hypoxia. Bilateral vagotomy resulted in a decrease of arterial pressor response to the systemic hypoxia, and a slight decrease in the rhythmicity related to cardiac and/or respiratory rhythms. The single neuronal responses to either systemic or focal hypoxia were not affected qualitatively by vagotomy. From the above results, it was concluded that the majority of the cardiac- and respiration- related neurons in the rostral ventrolateral medulla be excited by hypoxia, not through the mediation of peripheral chemoreceptors, and along with the remaining inhibited cells, all these cells be involved in the mediation of cerebral ischemic reflex.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.39-42
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• 2005

Background: Besides its general anesthetic effect, ketamine interacts with sodium channels in a local anesthetic-like fashion, including the sharing of binding sites with those commonly used by clinical local anesthetics. This study evaluated the dose related effects of ketamine during epidural anesthesia with 0.5% ropivacaine. Methods: Sixty ASA physical status I II patients, scheduled for minor elective surgery under epidural anesthesia using 0.5% ropivacaine, were randomly divided into three groups (n = 20 each). The patients initially received either 0.5% ropivacaine (group 1), ketamine (0.1 mg/kg) in addition to the epidural 0.5% ropivacaine (group 2) or ketamine (0.2 mg/kg) in addition to the epidural 0.5% ropivacaine (group 3). The regression of sensory block was assessed by transcutaneous electric stimulation (TES), equivalent to a surgical incision. Motor block was assessed using the Modified Bromage's scale. Episodes of bradycardia, hypotension and sedation were also recorded. Results: There were no significant differences among the three groups in the maximal levels of sensory block or the times taken for these levels to be reached. The mean times for the block to regress to two and four segments below the maximal level were significantly prolonged by epidural ketamine. Conclusions: Epidural ketamine prolongs the duration of ropivacaine epidural anesthesia. These results suggest that ketamine has local anesthetic-like actions.