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경희의학 update

The Journal of Kyung Hee University

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수록정보
수록범위 : 1권1호(1985)~36권1호(2021) |수록논문 수 : 1,161
경희의학
36권1호(2021년 07월) 수록논문
최근 권호 논문
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1악교정 수술의 현재와 미래

저자 : 오주영 ( Joo-young Ohe ) , 심규조 ( Kyu-jo Shim )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 1-6 (6 pages)

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The orthognathic surgical procedures are performed for the correction of abnormalities of the facial skeleton that are present from the birth or arise during growth or acquired secondarily during lifetime. We would prefer to summarize some commonly used techniques to correct the dentofacial deformities. Even we have described all these techniques at their popular time with our orthodontist colleagues; skeletal anchor systems, some basic interdental osteotomies, or complex mechanics that are applying orthopedic corrective forces are currently being used by the orthodontists rather than surgeons. Le Fort I osteotomy in maxilla and Bilateral sagittal split ramus osteotomies (BSSRO) in mandible are commonly used techniques to solve the deformity problems of the facial skeleton; therefore, the scope of this paper is going to be including my personal experience and some technical details with Le Fort I and SSRO.

2Expression of Apoptosis- and Autophagy-Related Genes in Passaged Normal Human Dermal Fibroblasts

저자 : Young Il Kim , Ye-jin Lee , Hye-jin Ahn , Ki-heon Jeong , Min Kyung Shin

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 7-14 (8 pages)

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Purpose: Apoptosis, autophagy, and replication senescence play important roles in cellular responses. This study was performed to investigate the expression of apoptosis- and autophagy-related genes with increasing passage number in normal human dermal fibroblasts.
Methods: The levels of mRNA were examined by real-time polymerase chain reaction and expression levels of proteins were measured by western blotting analysis.
Results: Among the cell cycle-related genes, the levels of cyclin D1, p16, and p21 mRNA were increased at passage number 10 compared to passage number 5, while all were decreased at passage number 15. The level of p27 mRNA was reduced with increasing number of passages. Among apoptosis-related genes, the levels of Bcl-2, Bax, caspase-3, and p53 protein were enhanced with increasing number of passages. The levels of PARP protein were decreased. Among autophagy-related genes, the levels of LC3 II, mTOR p62, Atg5, and AMPK protein were significantly enhanced with increasing number of passages, while levels of Akt protein were slightly enhanced and levels of Beclin 1 protein were reduced at passage number 15.
Conclusion: Our data suggested that aging normal fibroblasts undergo G1 arrest due to increased cell cycle gene expression during cellular senescence, with enhanced apoptosis and autophagy occurring in association with increasing passage number.

3장시간 진행된 뇌혈관수술에서 발생한 주술기 압박 손상

저자 : 김미현 ( Mihyeon Kim ) , 최정현 ( Jeong-hyun Choi )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 15-20 (6 pages)

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Incidence of intraoperative pressure injury is higher than incidence of pressure ulcer in patients who don't have surgery. Efforts should be made to reduce the incidence of pressure injury as the number of prolonged operations increases and various surgical positions are applied.
In this report, intraoperative pressure blister formation occurred to a 49-year old man who had 30 hours long neurovascular surgery. The causes of pressure induced blister in this case are expected to prolonged surgery time, low Hb concentration, park bench position, low albumin concentration below 3.0g/dL and hypertension. It is necessary to judge whether or not the patients are vulnerable to pressure injury and to perform early correction of risk factors before surgery. If the risk of pressure injury is high, more active prevention, for example, padding and protection tools such as gel pad or air mattress should be used.

4마취 관리 중 수액가온장치에 의해 발생한 심전도 허상

저자 : 김연진 ( Yeonjin Kim ) , 강희용 ( Hee Yong Kang ) , 박성욱 ( Sung Wook Park )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 21-26 (6 pages)

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Continuous monitoring of the patient's electrocardiogram during surgery is an important part of anesthesia management. It is one of the essential qualities of anesthesia providers to analyze the electrocardiogram accurately and to take appropriate measures if there is an abnormality. In this article, we investigated the cases of artifacts of ECG caused by fluid warming device. In addition, we studied various factors that affect electrocardiogram, its mechanism, and the solution method. The purpose of this article is to find out how to distinguish between actual arrhythmia and artifacts such as pseudoarrhythmia.

5하인두암과 기관지암이 동시에 발생한 환자의 수술 중 기도 및 환기 관리

저자 : 김재원 ( Jaewon Kim ) , 최정현 ( Jeong-hyun Choi )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 27-32 (6 pages)

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The special ventilation strategy, careful planning and management is required for the patient who scheduled for general anesthesia with an anatomical abnormality in the airway in preoperative evaluation and anesthesia management If there is anatomical deformation of the upper airway due to a tumor, the patient's imaging test results should be sufficiently analyzed and a plan for airway management should be established. In addition, if one lung ventilation is required to secure an appropriate surgical field and ensure ventilation of the patient, it is necessary to determine which lung should be ventilated, and especially if the tumor is in the main bronchus, more detailed strategy is needed. In this case, a malignant tumor occurred in the pyriform sinus of the hypopharynx and the right bronchus at the same time, and surgery was performed on both sites at the same time. Difficulty in airway management was expected before surgery, and careful planning was required. The patient was unable to access the airway through the mouth due to an upper airway tumor, and unilateral pulmonary ventilation for right bronchus and lobectomy would be required at the same time. The patient underwent tracheotomy under moderate sedation. After performing upper airway tumor removal surgery under general anesthesia, a double-tube bronchial tube was inserted through a tracheostomy, and right lobectomy and bronchectomy were performed under one lung ventilation. This is a case report of clinical experience of successfully implementing general anesthesia management for patients who required complex airway management along with literature review.

6중심 정맥관 삽입 후 혈관 내에 남은 유도 철사의 중재적 시술을 통한 제거

저자 : 황성욱 ( Sung Wook Hwang ) , 박성욱 ( Sung Wook Park )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 33-37 (5 pages)

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Indications for central venous catheter (CVC) placement are continually expanding. In the United States, approximately 5 million CVCs are used to patients every year during the perioperative period. Central venous catheterization is a technique widely used in lots of department of hospital and intensive care units. The Seldinger technique, originally used to cannulate vessels for radiographic procedures and generally considered safe, is frequently used for central venous〔annulation. However, CVC placement also comes with many risks, many of which are iatrogenic complications. Guide wire-related complications are rare but potentially serious. This article describes an event that guide wire is left behind during CVC insertion. The management that can be taken to prevent such complications are explained in detail, and if they occur, recommended steps to fix the errors.

7Seizure with Subdural Hemorrhage in an Infant with Unrecognized Hemophilia A: Case Report of Mimicking Febrile Convulsion

저자 : Yoon Zi Kim , Hoi Soo Yoon , Eun Hye Lee

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 38-42 (5 pages)

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Seizure is the most common neurologic emergency in children, especially higher occurrence among infants and toddlers. Because the potential etiology of seizure in children is various, an accurate diagnosis is challenging. Even more, seizure which is associated with post-traumatic brain injuries is not common. We present one patient with hemophilia A, who presented with prolonged focal seizure and subdural hemorrhage. This patient had no family history of hemophilia but showed prolonged active partial thromboplastin time and severely low level of factor VIII (1%). This case highlights the management of prolonged focal seizure and the importance of performing neuroimaging and identifying underlying disease among children with seizure.

8정맥-정맥 체외막산소공급 보조 하에 시행한 갑상선전절제수술의 마취 1례

저자 : 장용석 ( Yong-seok Jang ) , 강종만 ( Jong-man Kang )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 43-47 (5 pages)

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W-ECMO is used as a supporting device in patients with lung failure or difficulty in securing the airway. In this case study, general anesthesia with W-ECMO for a patient whose ventilation is not possible due to tracheal obstruction is discussed. W-ECMO can cause complications such as bleeding, thromboembolism, neurological injury, catheter related complications, and heparin-induced thrombocytopenia. During anesthesia, patients should be monitored for hypoxemia and hypercapnia, appropriate levels should be maintained through monitoring for blood tests and coagulation tests, and the risk versus benefit of thrombus and bleeding should be considered.

9기흉을 동반한 쇄골 골절 환지에게 사각근간 차단법과 얕은 목 신경얼기 차단법을 시행한 마취 증례

저자 : 조용현 ( Yong Hyun Cho ) , 신광일 ( Kwang Il Shin ) , 신옥영 ( Ock Young Shin ) , 김선희 ( Sun Hee Kim ) , 장원 ( Won Jang ) , 이현석 ( Hyun Seok Lee ) , 고현철 ( Hyun Cheol Ko )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 48-50 (3 pages)

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Regional anesthesia is used as an alternative to general anesthesia, and among them, brachial plexus block is widely used in orthopedic upper extremity surgery. The anesthesiologist must make a good decision about which type of nerve block to perform depending on the surgical site. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity This case is a superficial cervical plexus block and interscalene block performed on a patient who was unable to perform general anesthesia using nitrous oxide due to pneumothorax.
The patient was discharged after recovery without side effects such as worsening of pneumothorax after surgery.

10요추 2번 선택적 신경근 차단 후 발생한 고환 통증과 쳐짐

저자 : 조용현 ( Yong Hyun Cho ) , 신광일 ( Kwang Ii Shin ) , 신옥영 ( Ok Young Shin ) , 김선희 ( Sun Hee Kim ) , 장원 ( Won Jang ) , 이현석 ( Hyun Seok Lee ) , 고현철 ( Hyun Chul Go ) , 고우형 ( Woo Hyung Go ) , 권재현 ( Jae Hyun Kwon )

발행기관 : 경희대학교 경희의료원 간행물 : 경희의학 36권 1호 발행 연도 : 2021 페이지 : pp. 51-54 (4 pages)

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The L2 spinal nerve root block is an effective procedure for pain reduction in patients with discogenic low back pain, but relatively few cases have been published that address complication of testicular pain and ptosis associated with this intervention.
We experienced a patient testicular pain and ptosis after L2 spinal nerve root block, and the patient was recovered after 2 weeks without any serious side effect
In this report, the ways on how to deal with testicular pain and ptosis are discussed including brief review of the relevant literature.

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