Always continue the climb. It is possible for you to do whatever you choose, if you first get to know who you are and are willing to work with a power that is greater than ourselves to do it. We are taught you must blame your father, your sisters, your brothers, the school, the teachers - but never blame yourself.
Learn from the past, set vivid, detailed goals for the future, and live in the only moment of time over which you have any control: now. Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence. If you can dream it, you can do it. Do it now, not tomorrow. Always continue the climb. It is possible for you to do whatever you choose, if you first get to know who you are and are willing to work with a power that is greater than ourselves to do it. We are taught you must blame your father, your sisters, your brothers, the school, the teachers - but never blame yourself
If you first get to know who you are and are willing to work with a power that is greater than ourselves to do it
Learn from the past, set vivid, detailed goals for the future, and live in the only moment of time over which you have any control: now. Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence. If you can dream it, you can do it. Do it now, not tomorrow. Always continue the climb. It is possible for you to do whatever you choose, if you first get to know who you are and are willing to work with a power that is greater than ourselves to do it. We are taught you must blame your father, your sisters, your brothers, the school, the teachers - but never blame yourself
Leoma Cozart
It is possible for you to do whatever you choose, if you first get to know who you are and are willing to work with a power that is greater than ourselves to do it. We are taught you must blame your father, your sisters, your brothers, the school, the teachers - but never blame yourself.
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에볼루션
Foley 카테터를 사용한 식도내 주화제거법의
후유증으로는 비출혈이 가장 많고, 카테터 삽입시의 불편감, 삽입부의 통증, 구토 등이 있을 수 있으나 이러한 것들은 대부분
시술후에는 없어지고, 시술전 국소마취제를 비강에 분무하거나 도포 한다면 환자가 느끼는 불편감은 문제가 되지 않는다고 하였다.8) 주화 견인시 카테터 팽창부의 근위부와 원위부는
이완되어 있으므로 주화가 식도 점막에 손상을 줄 가능성은 거의 없고, 만일 카테터 팽창부 아래로 주화가 미끄러진다 하더라도 주화가 식도에 손상을 줄
위험성은 없었다.10) 심각한 합병증으로는 후두경련, 식도열상, 식도출혈, 식도천공 등이
있으나 본 연구에서 관찰되지 않았으며, Campbell과 Condon등13)의 보고에 의해서도 Foley 카테터를 사용하여 예리하지 않은 식도 이물을 제거한 2500예
중 1예만이 심각한 저산소증을 경험했으나,
특별한 신경학적 손상없이 회복되었고, Schunk등6)은 fluoroscopy를 사용한 Foley 카테터 식도이물 제거술을 실시한 총 415예 중 9예의 비출혈과 구토, 4예의 호흡부전과 식도열상을
경험하였으나 이 경우는 개재시간이 확인 안되거나, 기존의 폐질환이 있었던 경우라고 보고하였다.
실패 요인으로는 팽창이 불충분하거나 팽창부가 카테터 주위로 대칭적으로
팽창되지 않았거나 팽창부가 주화밑에 제대로 위치하지 않거나 주화가 제1협착부 아래로 내려간 경우, 협조가 되지 않는 소아에서 카테터가 제대로 삽입되지 않았을 경우이다.12)15) 이 시술을 실시할 수 있는 주화이외의
이물로는 보석이 박히지 않은 반지, 바둑알, 토큰, 금속구슬,
둥근 금속 단추등에 적용 될 수 있고,12) 이러한 경우
본 연구에 포함되지는 않았지만 저자들은 8예에서 적용하여
모두 성공하였고 주화의 경우와 비교해서 시술시의
차이점은 없었다. 카테터를 삽입할 때 기도로 들어 가는
것을 방지하는 방법은 될 수 있는 한 카테터를 천천히 삽입해서 기침 등의
상부 호흡기 자극 증상과 호흡음을 자세히 살펴 보아야 하고,
실제로 시술을 해 보면 일단 식도에 카테터가 들어가면 식도의 연동운동에 따른 카테터를 삼키는 것을
잘 관찰할 수 있어 이러한 점으로 식도에 안전하게 들어 간 것을 확인할 수 있었다.
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