• Clinical and Experimental Pediatrics
• /
• 제52권7호
• /
• pp.798-803
• /
• 2009

목 적 : 실신은 소아와 청소년들에게 흔히 발생되는 증상으로 혈관 미주신경성 실신이 가장 흔한 형태다. 이 연구의 목적은 원인불명의 실신 및 그와 유사한 증상으로 내원한 소아청소년기 환자들에게 기립 경사 검사(head-up tilt test, HUT)의 반응과 진단적 가치를 검토해 보고자 하였다. 방 법 : 2003년 5월부터 2008년 3월까지 전북대학교병원에 실신 및 실신 전 증상을 주소로 HUT를 하고 임상적으로 혈관 미주신경성 실신이 의심되는 160명(남 82명, 여 78명, 7-20세)을 대상으로 임상 양상 및 HUT 결과와 그 반응에 대해 의무기록을 통하여 후향적 조사를 시행하였다. HUT는 70도 경사에서 45분간 시행하였으며 일부는 isoproterenol 0.5-1.0 ug/min 주사를 이용하였으며 이 환아들을 소아군(7-12세, 39명, $10.59{\pm}1.60$세), 청소년군(13-20세, 121명, $15.93{\pm}2.28$세)으로 분류하여 두 군 간의 HUT 양성률과 그 반응유형을 비교해 보았다. 결 과 : 대상 환아 160명 중에서 양성반응인 환아는 92명(57.5%)이었고, 남녀 비는 차이가 없었다. 양성 반응은 혼합형이 70례로 제일 흔한 반응이었고, 혈관억제형이 12례, 무수축을 동반하지 않은 심장억제형이 6례, 무수축을 동반한 심장억제형이 4례이었다. 실신의 원인을 규명하는데 HUT를 비롯하여 혈액흉부 방사선 촬영, 심전도와 24시간 holter 검사 및 운동부하검사, 뇌파 검사, 뇌 단층촬영과 뇌 자기공명검사, 심초음파 검사 등이 시행되었다. 또한 연령대에 따른 HUT의 양성 반응률 비교는 소아군 43.6% (17/39), 청소년군 62% (75/121)이었고, 혼합형 반응이 소아 군에서 15명(38.4%)에서 청소년군 55명(45.0%)으로 청소년군이 더 높은 양성률을 보였으나 두 그룹간의 통계학적으로 의미 있는 차이는 없었다. 결 론 : HUT는 혈관 미주신경성 실신이 의심되는 병력과 진찰 소견이 정상인 소아에서 여러 다른 검사 방법에 우선하여 시행함으로써 실신의 원인을 규명하는데 유용하다.

• Journal of Yeungnam Medical Science
• /
• 제15권1호
• /
• pp.97-113
• /
• 1998

교감신경계는 광범위한 각종 기능의 항상성 조절에 결정적인 역할을 하고 있으며, 저산소증, 출혈, 통증 등에 따른 스트레스 반응에 의해 자극되어 심박출량의 증가 및 조직으로 산소공급 향상을 위한 혈류 조절 반응이 나타나게 되나 주어진 환경에 따라 반응 정도는 다양하게 보고되고 있다. 고농도의 $N_2O$로 인해 발생된 저산소혈증 상태에서 혈역학적 변화가 저산소혈증을 발견하는 지표로서 유용한 지를 관찰하기 위해 본 실험에서는 마취후 기계적 환기를 시행한 한국산 잡견에서 고농도의 $N_2O$를 이용하여 흡입산소농도를 점진적으로 감소시킬 때 발생된 저산소혈증이 혈중 catecholarnine의 분비와 혈액 가스 및 혈역학적 변화를 비교 관찰하였다. Halothane으로 흡입 마취하여 기계적 환기를 시행한 뒤 10 마리의 한국산 잡견에서 21%, 15%, 10%, 5%의 산소를 5분씩 공급하여 혈역학상의 변화와 조직의 산소이용 상태 및 혈중 catecholamine치를 관찰하여 다음과 같은 결과를 얻었다. 조절호흡의 결과, 실험견은 등탄산성 저산소혈증이 초래되었으며 흡입산소농도의 감소 정도에 따라 동맥혈 및 혼합정맥혈의 산소분압 및 포화도가 감소되었고, 산소섭취율이 증가함에 따라 동정맥혈 산소함량의 차이는 증가하였으며 동시에 심박출량이 증가하는 대상성 반응을 보였다. 중심 정맥압은 10%와 5%의 흡입산소농도에서 측정치가 유의하게 증가되었고, 평균 폐동맥압은 10%와 5%의 흡입산소농도에서 각각 55% 및 82% 증가되었으며 폐혈관저항도 각각 76%, 95%로 유의하게 증가되었으나 전신혈관저항의 변화는 유의성이 없었다. 실험견에서 혈중 norepinephrine, epinephrine 및 dopamine의 대조치는 각각 $141.4{\pm}94.4$ pg/ml, $172.6{\pm}130.1$ pg/ml, $151.1{\pm}282$ pg/ml이었다. 15% 산소 흡입 시 norepinephrine, epinephrine 및 dopamine치는 모두 유의한 증가를 나타내기 시작하였고 dopamine은 10% 흡입산소농도에서 가장 많이 증가하였으나 5% 흡입산소농도에서는 오히려 감소되었고 60%의 흡입산소로 재산소화하는 동안 대조치 수준으로 회복되었다. 이에 비해 norepinephrine은 15%의 흡입 산소농도에서 74% 증가한 후 저산소혈증이 심화될수록 더욱 증가하는 양상이 계속되었다. Epinephrine은 대조치에 비해 15% 산소 흡입시 29% 증가하였으나 10% 및 5% 흡입산소농도에서 각각 382%, 350% 증가되었다. 60%의 흡입산소로 재산소화하였을 때는 norepinephrine과 epinephrine치는 감소되었으나 대조치보다는 여전히 증가되어 있었다. 이상의 결과로 볼때 마취후 고농도의 $N_2O$에 의한 저산소 가스 흡입은 혈중 catecholamine의 농도를 증가시키나 심혈관계 및 교감 신경계의 반응을 매우 둔화시키는 것으로 생각된다. 따라서 임상 마취에서 환자에게 고농도의 $N_2O$를 흡입시켜 저산소혈증이 초래되는 경우 혈압 및 맥박수의 변화는 저산소혈증을 발견하는 지표로 유용하지 않은 것으로 사료된다.

• 생물정신의학
• /
• 제24권3호
• /
• pp.110-128
• /
• 2017

Electroconvulsive therapy (ECT) has been recognized effective as primary or secondary treatments for major psychiatric disorders including depression and schizophrenia, as well as psychiatric emergency such as suicide, food refusal and catatonia, and so on. Medicines used in anesthetic induction for ECT, cause various reactions in autonomous, hemodynamic, and neuromuscular systems. The anesthetics also affect the duration, threshold, and intensity of seizures evoked with electric stimuli, and thus modify the seizure quality in ECT. Individual characteristics of age, sex, weight, comorbid physical disorders, and medications should also be considered for optimal clinical response after ECT. When preparing for anesthesia, adequate anesthetic agents and muscle relaxants, and rapid recovery should be carefully considered. We conducted a case-series study to address practical issues that are frequently encountered during ECT anesthesia with reviews of updated journals in order to provide practical helps to clinicians who are preparing ECT for their patients.

• BMB Reports
• /
• 제48권3호
• /
• pp.131-138
• /
• 2015

Cardiac hypertrophy is a form of global remodeling, although the initial step seems to be an adaptation to increased hemodynamic demands. The characteristics of cardiac hypertrophy include the functional reactivation of the arrested fetal gene program, where histone deacetylases (HDACs) are closely linked in the development of the process. To date, mammalian HDACs are divided into four classes: I, II, III, and IV. By structural similarities, class II HDACs are then subdivided into IIa and IIb. Among class I and II HDACs, HDAC2, 4, 5, and 9 have been reported to be involved in hypertrophic responses; HDAC4, 5, and 9 are negative regulators, whereas HDAC2 is a pro-hypertrophic mediator. The molecular function and regulation of class IIa HDACs depend largely on the phosphorylation-mediated cytosolic redistribution, whereas those of HDAC2 take place primarily in the nucleus. In response to stresses, posttranslational modification (PTM) processes, dynamic modifications after the translation of proteins, are involved in the regulation of the activities of those hypertrophy-related HDACs. In this article, we briefly review 1) the activation of HDAC2 in the development of cardiac hypertrophy and 2) the PTM of HDAC2 and its implications in the regulation of HDAC2 activity.

• 대한약리학회지
• /
• 제12권1호
• /
• pp.31-44
• /
• 1976

It has been reported that many of the effects of digitalis glycosides could be mediated partly through the central nervous system. In this study the effects of ouabain given directly into the lateral ventricle of the brain on the renal function of the rabbit were investigated. Intraventricular ouabain elicited antidiuresis in doses ranging from 0.1 to $3\;{\mu}g$, exhibiting a rough dose-response relationship, and decreased the renal plasma flow, glomerular filtration rate and urinary excretion of sodium and potassium, concomitant with the decrease of urine flow. These decreases in urine flow, excretory rate of electrolytes significantly correlated with the decrease in renal plasma flow or glomerular filtration rate, suggesting that the antidiuresis might have been induced by the hemodynamic changes. Intravenous ouabain in a dose of $1\;{\mu}g$ did not affect the renal function. Systemic blood pressure as well as cardiac activity was not affected by the intraventricular ouabain. Effects of the intraventricular ouabain on renal function were abolished by the intravenous phentolamine-pretreatment but not affected by intraventricular phentolamine-pretreatment. Neither vasopressin infusion nor hydration did affect the renal effects of intraventricular ouabain. From these observations, it is suggested that the antidiuresis of intraventricular ouabain is induced by the increased sympathetic influence to the kidney.

• Journal of Chest Surgery
• /
• 제24권10호
• /
• pp.973-978
• /
• 1991

From January, 1982, to December, 1990, 15 patients underwent pericardiectomy for chronic constrictive pericarditis on Department Of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University. There were 9 male and 6 female patients [male to female ratio was 1.5: 1] ranging from 15 years to 63 years old [mean age 35.0]. All patients underwent pericardiectomy through a median sternotomy, partial cardiopulmonary bypass was performed on two patients. There were 3 postoperative death [20%]. Six cases [40%] were tuberculous origin 5 cases [34%] were Idiopathic [nonspecific chronic inflammatory change was considered to idiopathic], 2 cases [13%] were malignant origin, 2 cases [13Yo] were pyogenic origin. Dyspnea on exertion was evident in all patients and abdominal distention, general weakness, palpitation, peripheral edema were found. Eleven patients showed low voltage of QRS wave, 7 patients showed diffuse ST-T wave change, 2 patients showed atrial fibrillation on EKG. There were 6 patient showed pericardial thickening, 5 patients showed evidence of restriction, 5 patients showed pericardial effusion, 4 patients showed low cardiac output on preoperative echocardiogram. Hemodynamic response to pericardiectomy were observed; preoperative CVP 26.8 cmH2O declined to 15.0 cmH2O. Preoperative NYHA Functional class showed class II - 1, class III - 10, class IV - 4, postoperative NYHA functional class showed class I - 7, class II - 4, class Ill - l.

• 대한신경집중치료학회지
• /
• 제11권2호
• /
• pp.71-80
• /
• 2018

Nutritional assessment and support are often overlooked in the critically ill due to other urgent priorities. Unlike oxygenation, organ dysfunction, infection, or consciousness, there is no consensus of indicators. Making it difficult to evaluate the effectiveness of an intervention. Nevertheless, appropriate nutritional support in the critically ill has been associated with less morbidity and lower mortality. But, nutritional support has been considered an adjunct, for body weight maintenance and to help patients during the inflammatory phase of illness. Thus, it has been assigned a lower priority, compared to mechanical ventilation or hemodynamic stability. Recent findings have shown that nutritional support may prevent cellular injury due to oxidative stress and help strengthen the immune response. Large-scale randomized trials and clinical guidelines have shown a shift from nutritional support to nutritional therapy, with an emphasis on the importance of protein, minerals, vitamins, and trace elements. Nutrition is also important in neurocritically ill patients. Since there are few studies or recommendations with regard to the neurocritical population, the general recommendations for nutritional support should be applied.

• Physical Therapy Rehabilitation Science
• /
• 제13권2호
• /
• pp.213-222
• /
• 2024

Objective: Stroke is a leading cause of disability worldwide, often leaving survivors with significant cognitive and motor impairments. Dual-task (DT), which involves performing cognitive and motor tasks simultaneously, can influence brain activation patterns and functional recovery in stroke patients. Design: A systematic review Methods: Following PRISMA guidelines, databases including MEDLINE, CINAHL, Embase, and Web of Science were searched for studies assessing cortical activation via functional near-infrared spectroscopy (fNIRS) during DT performance in stroke patients. Studies were selected based on predefined eligibility criteria, focusing on changes in hemodynamic responses and their correlation with task performance. Results: Eight studies met the inclusion criteria. Findings indicate that DT leads to increased activation in the prefrontal cortex (PFC), premotor cortex (PMC), and posterior parietal cortex (PPC), suggesting an integrated cortical response to managing concurrent cognitive and motor demands. However, increased activation did not consistently translate to improved functional outcomes, highlighting the complex relationship between brain activation and rehabilitation success. Conclusions: DT interventions may enhance cortical activation and neuroplasticity in post-stroke patients, but the relationship between increased brain activity and functional recovery remains complex and requires further investigation. Tailored DT programs that consider individual neurophysiological and functional capacities are recommended to optimize rehabilitation outcomes.

• The Korean Journal of Pain
• /
• 제6권2호
• /
• pp.231-236
• /
• 1993

Clonidine, a centrally-acting antihypertensive agent known to reduce central sympathetic outflow and modulate presynaptic transmitter's release, has shown to suppress central noradrenergic hyperactivity induced by immobilization stress in animals, by decreasing the MAC of halothane and the dose of narcotics required to prevent reflex cardiovascular response to noxious stimuli, and to have potent analgesic properties in humans. These characteristics suggest that clonidine might be a useful adjunct to the anesthetic management of patients with preexisting hypertension. Accordingly, we determined the clinical efficacy and safety on analgesia, sedation and hemodynamic stability in the perioperative period. Thirty patients(ASA physical status II-III) with a history of arterial hypertension, scheduled for elective orthopedic surgery were randomly assigned to two groups. We applied CPA-clonidine patch($6.9\;mg/cm^2$, 0.2 mg delivered daily) or placebo patch to each groups, 48 hours prior to induction of anesthesia. Antihypertensive medication was continued until the morning of the scheduled surgery. All patients received premedication of atropine and lorazepam, and induced anesthesia with thiopental and succinylcholine, and maintained with enflurane and 50% nitrous oxide, while sustaining the BP and pulse rate at acceptable range. For the relief of pain postoperatively, diclofenac and fentanyl were administered intramuscularly on demand. The results were as follows: 1) The change of hemodynamic responses in clonidine group was less compared to the placebo group. 2) Intraoperative anesthetic requirement for enflurane in clonidine group were significantly lower than placebo group. 3) Postoperative analgetic requirement in clonidine group were significantly lower than placebo group. In clonidine group, 5 cases out of 15 cases were required no analgetics, and the incidence of administration of additional fentanyl was decreased to 5 cases, comparing with 10 cases in placebo group.

• 센서학회지
• /
• 제22권1호
• /
• pp.38-43
• /
• 2013

In this study, the artery's compliance model and the pulsation waveform model was proposed to estimate blood pressure without applying HPF (High Pass Filter) on signal measured by the oscillometric method. The method proposed in the study considered two ways of estimating blood pressure. The first method of estimating blood pressure is by comparing and analyzing changes in pulsation waveform's dicrotic notch region during each cardiac period. The second method is by comparing and analyzing morphological changes in the pulsation waveform during each cardiac period, which occur in response to the change in pressure applied on the cuff. To implement these methods, we proposed the compliance model and the pulsation waveform model of the artery based on hemodynamic theory, and then conducted various simulations. The artery model presented in this study only took artery's compliance into account. Then, a pulsation waveform model was suggested, which uses characteristic changes in the pulsation waveform to estimate blood pressure. In addition, characteristic changes were observed in arterial volume by applying artery's pulsation waveform to the compliance model. The pulsation waveform model was suggested to estimate blood pressure using characteristic changes of the pulsation waveform in the arteries. This model was composed of the sum of sine waves and a Fourier's series in combination form up to 10th harmonics components of the sinusoidal waveform. Then characteristic of arterial volume change was observed by inputting pulsation waveform into the compliance model. The characteristic changes were also observed in the pulsation waveform by mapping the arterial volume change in accordance with applied cuff's pressure change to the pulsation waveform's change according to applied pressure changes by cuff. The systolic and diastolic blood pressures were estimated by applying positional change of pulsation waveform's dicrotic notch region.