찰과상 & 괴사, 성형수술 · 재건수술 · 손발가락접합수술 2. 침샘에 든 히루딘 (hirudin) 은 항응고물질 (anticoagulants) 인 헤파린 (heparin) 과 함께 피가 응 고하여 혈관을 틀어막는 혈전증의 예방 및 치료에 써오고 있다 히루딘 헤파린 1.

Presentation on theme: "찰과상 & 괴사, 성형수술 · 재건수술 · 손발가락접합수술 2. 침샘에 든 히루딘 (hirudin) 은 항응고물질 (anticoagulants) 인 헤파린 (heparin) 과 함께 피가 응 고하여 혈관을 틀어막는 혈전증의 예방 및 치료에 써오고 있다 히루딘 헤파린 1."— Presentation transcript:

1 찰과상 & 괴사, 성형수술 · 재건수술 · 손발가락접합수술 2. 침샘에 든 히루딘 (hirudin) 은 항응고물질 (anticoagulants) 인 헤파린 (heparin) 과 함께 피가 응 고하여 혈관을 틀어막는 혈전증의 예방 및 치료에 써오고 있다 히루딘 헤파린 1. 침샘 -- 응고를 막는 항응고효소 (anticlotting enzyme) 와 마취 제 (anesthetic), 피를 많이 흐르게 혈관확장물질 (vasodilator)

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5 Hook worm( 십이지장충 ) Ancylostoma duodenale (old world hookworm) Necator americanus (new world hookworm)

6 BC 1600 Egypt ; Papyrus 1838 Dubini ; Italian patient (duodenum) 1879 Grassi ; ova from anemia’s patient 1880 peroncito ; free-living 1 st stage larva 1896 Looss ; PH lab in Alexandria ; filariform experimental infection in Korea : 듀비니구충과 아메리카 구충이 유행하고 있음. 한국 < 베트남

7 World wide ; tropics, subtropics A. duodenale ; S. Europe, Africa, Indonesia, China, Japan, Korea 40-50% 1970 N. americnus ; Latin America, M,N, America, Japan, China, Korea

8 (30’C) Egg -----------1 st stage rb larva ---------2 nd stage rb larva -- (24~48 hrs) (0.25~0.3 mm) (3 days) 3 rd stage filariform larva ------ protective covering (15 weeks) (0.6~0.7 mm) Host : f. larva – superficial venuole or lymphatics – rt. Heart – lung – trechea – glottis – esophagus – small intestine (5 weeks) Or oral ingestions – stomach – small intestine Within 1 yr, 70 % of spontaneous removal A.d : 5 years suvival, N.a : 3 ~ 4 yrs. Daily output : 9,000 ova Reservoir : chimpanges Pathogenicity : Ad : Na = 5 : 1

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11 A.d. m; 8 ~ 10 mm X 0.4 mm, teeth f; 10 ~ 13 mm X 0.6 mm N.a. m; 7 ~ 10 mm X 0.3 mm, plate f; 9 ~ 13 mm X 0.6 mm copulatory bursa & copulatory spicule egg ; 60 um X 40 um A.d. 60 um X 36 um N.a. 4 cell stage, unfertilized egg ( 森下 1955)

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18 100X 450X

19 Filarial form larva :

20 Skin lesion : secondary bacterial inf. ground itch. Oral infection : wakana disease Lung passage : peumonitis Intestine : blood sucking(0.2 ~ 0.6 ml/worm/day= 0.67 ml), microcytic, hypochromic anemia - anticoagulant secretions. No. of worms & species : 1) hookworm carrier – 25 worms 이하 (10 ~ 25%) 2) light infection – 26 ~ 100 worms 3) moderate inf. – 100 ~ 500 worms 4) heavy inf. - 500 이상 (10~25%) E.P.G. M – 2,000 (20 ~30 worms) F - 1,000(10 ~ 15 worms)

21 Contineous - Resistance of the pt’s : adult > children well nourished > poor n. male > female Reinfection : primary inf. < reinfection (resistance)

22 1. Hookworm carrier : asymptomatic, ova in stool on anemianess, abdominal pain 2. light infection : abd. Pain, light dyspnea, heart burn, geopgagia, fever, 3. severe form : G-I truble, polyphagia, nausia, diarrhea, joint pain, edema, anemia, pet belly etc. Wakana disease( 菜毒症 ) : vegetable, oral ingestion 1) glottis itching 2) nausea & vomiting 3) spasmodic coaughing 3 ~ 6 days, 채독증의 증세 지속 ova in stool – 20 ~ 50 day after inf.

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27 Most common & world wide distribution Baerman (1919) : 토양의 유충 감염도 영향 Envirinmental factor : temp, humidity, hygroscopic nature of soil, sandy soil, Insecta – contageous inf. Mamarian intestine : free passage or demage Human factor : worm burden – hygine 과 연관됨. vegetable & fruits – white > negro sensitive adult < children male < female

28 1. genral treatment ; iron deficiency – protein diet vit – A supply whole blood transfusion 2. Chemotherapy ; carbon tetrachlororate thymol tetrachloroethylene bepenium salts

29 1. personal hygiene ; 2. mass control – life cycle 의 blockage ; host – media – pt’s 의 단절

30 Ova in stool Cultivation T. orientalis & A.d & N.a 구별과 진단 실험책 p. 128-1

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