• Pediatric Infection and Vaccine
• /
• v.21 no.1
• /
• pp.9-21
• /
• 2014

Purpose: To determine the clinical significance of voriconazole therapeutic drug monitoring (TDM) in the pediatric population. Methods: Twenty-eight patients with invasive fungal infections administered with voriconazole from July 2010 to June 2012 were investigated retrospectively. Fourteen received TDM, and 143 trough concentrations were analyzed. All 28 patients were assessed for adverse events and treatment response six weeks into treatment, and at the end. Results: Out of 143 samples, 53.1% were within therapeutic range (1.0-5.5 mg/L). Patients administered with the same loading (6 mg/kg/dose) and maintenance (4 mg/kg/dose) dosages prior to initial TDM showed highly variable drug levels. Adverse events occurred in 9 of 14 patients (64.3%) in both the TDM and non-TDM group. In the TDM group, voriconazole-related encephalopathy (n=2, 14.3%) and aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation (n=8, 57.1 %) occurred with serum levels in the toxic range (>5.5 mg/L), whereas blurred-vision (n=2, 14.3%) occurred within the therapeutic range (1.18 mg/L and 3.9 mg/L). The frequency of voriconazole discontinuation due to adverse events was lower in the TDM group (0.0% vs. 18.2%, P =0.481). Overall, 57.2% of the patients in the TDM group versus 14.3% in the non-TDM group showed clinical response after 6 weeks (P =0.055), whereas 21.4% in the TDM group versus 14.3% in the non-TDM group showed response at final outcome (P =0.664). In the TDM group, >67.0% of the serum levels were within therapeutic range for the first 6 weeks; however 45.5% were within therapeutic range for the entire duration. Conclusion: Routine TDM is recommended for optimizing the therapeutic effects of voriconazole.

• Journal of Veterinary Clinics
• /
• v.32 no.2
• /
• pp.148-153
• /
• 2015

This study was performed to compare two opioid drugs with isoflurane and to determine the difference between isoflurane/remifentanil anesthesia and isoflurane/fentanyl anesthesia in terms of the anesthetic effects in beagle dogs. Isoflurane was maintained at 0.5 MAC, and the opioid drug was administered as a constant rate infusion. The anesthesia was maintained for 2 hours, and isoflurane and opioid drugs were discontinued 2 hours later. After discontinuing the anesthetics, the extremity movement time, eye global positioning time, gag reflex time, head up time, sternal recumbency time, standing time, walking time and complete recovery times were recorded for each dog. Both of the studied anesthetic protocols were suitable in beagle dogs because the anesthetic status was well maintained until the end of the procedure, and rapid recovery times were demonstrated in this experiment. And this study shows that the isoflurane/remifentanil group was more reliable than the isoflurane/fentanyl group because the recovery time CV was lower. Therefore, isoflurane/remifentanil combination anesthesia could be a better choice than isoflurane/fentanyl anesthesia if the patient is severely ill and stable recovery time is needed.

• Clinical and Experimental Pediatrics
• /
• v.45 no.12
• /
• pp.1559-1570
• /
• 2002

Purpose : There has been no exact answer to the question of when to discontinue antiepileptic drugs(AEDs) in children with well-controlled epilepsy for a long period. This study is about the risk factors of relapse after withdrawal of AEDs in seizure(Sz)-free patients to show a guideline for discontinuation of AEDs. Methods : One hundred and sixty-nine children were diagnosed as epileptic at the Pediatric Dept. of Kyung-Hee Univ. between 1993 to 1998, in whom AEDs had been withdrawn after at least two years of Sz-free period. Univariate analysis using Kaplan-Meier survival analysis and multivariate analysis using Cox-proportional hazard model were performed for sixteen risk factors. Results : Forty-nine of the 169 patients(28.9%) had recurrence of Szs. The mean follow-up after withdrawal of AEDs was 4.1 years, mean treatment period was 4.1 years, and the mean Sz-free period was 3.3 years. Factors associated with an increased risk of relapse were young age at onset, symptomatic Sz, Sz type in West and Lennox-Gastaut syndrome, neurologic deficit, longer Sz-controlling period, shorter total treatment period, number of AEDs used(more than one drug), age at withdrawal of AEDs, and Sz-free period less than two years in univariate analysis using Kaplan-Meier mothod. From multivariate analysis, the factors indicating a significantly higher relapse risk were pre-treatment period after first Sz attack, Sz-controlling period, Sz-free period, number of AEDs used, neurologic abnormalities. Conclusion : For epileptic children who were Sz-free for more than two years, and were more than six-years-old, the discontinuation of AEDs should be considered positively, according to age of onset, Sz type, age at withdrawal of AEDs, total treatment period, Sz-controlling period, number of AEDs used, etiology, neurologic deficit, and the wishes of the patients and the their parents.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.31 no.1
• /
• pp.1-10
• /
• 2004

The habit of finger sucking is a reflex occurring in the oral stage, due to nutritive and psychological desire. The habit of finger sucking is considered to be normal till 3 years of age. Dento-skeletal effect on maxillo-mandibular complex including occlusion is naturally correction, when habit stopped before 3 years. If finger sucking continues till $3{\sim}4$ years, Finger sucking leads to severe malocclusion and remarkable discrepancy maxillo-mandibular complex, which is difficult in expectation of natural correction. It is necessary to positive treatment. Treatment of malocclusion, as related to finger sucking is classified two methods. (psychological approach and orthodontic appliance) To stop a habit and to correct severe skeletal discrepancy and malocclusion, $fr\ddot{a}nkel$ appliance is very effective device. This study is to report two cases of treatment of malocclusion, as related to finger sucking. 2 years 10 months old girl with severe overjet, maxillo-mandibular skeletal discrepancy and severe convex facial profile was treated with a FR-II appliance. Finger sucking habit stopped immediately After 16 months, severe overjet, maxillo-mandibular skeletal discrepancy and severe convex facial profile was corrected. 4 years 2 months old girl with midline deviation, mandibular right shift, collateral posterior crossbite and facial asymmetry was treated with a FR-III appliance. Finger sucking habit stopped immediately. After 10 month, Midline deviation, mandibular right shift, collateral posterior crossbite and facial asymmetry were corrected. FR-appliance is a recommendable appliance for a habit breaker and correction of skeletal discrepancy.

• Clinical and Experimental Pediatrics
• /
• v.52 no.5
• /
• pp.538-543
• /
• 2009

Purpose : To report the clinical experience with amitriptyline for managing children with cyclic vomiting syndrome (CVS). Methods : Totally, eleven children (eight males) were diagnosed with CVS. Of these, medical records were reviewed for eight children treated with amitriptyline; three children were not treated because one was not followed up and two were kept under observation to study the natural course without medication, because the frequency of vomiting had recently decreased to less than one episode per year. The eight amitriptyline-treated children were divided into three groups by the therapeutic response: (1) complete remission (CR), with no recurrence of symptoms after treatment; 2) partial remission (PR), in which the frequency of symptoms decreased by almost 50% after treatment; and (3) no response. Results : For the eight amitriptyline-treated children, the mean age of symptom onset was 4.7 (0.3-7) yr and mean age at diagnosis was 8.9 (6.0-11.3) yr. The mean number of vomiting episodes was 8.8 (2-25) per year, and the duration of vomiting in each episode ranged from 3 hours to 5 days. CR was achieved in five (62.5%) of the eight amitriptyline-treated children (0.2-0.8 mg/kg/day orally, at night) and PR was achieved in three children (37.5%). Two children relapsed on discontinuation of amitriptyline by their parents decision but showed improvement on remedication. No adverse effects were noted throughout the study period. Conclusion : Amitriptyline can be used in long-term prophylaxis for the management of children with CVS aged over 6 yr. However, a large-scale study is needed to ascertain its effects.

• 한국지형공간정보학회:학술대회논문집
• /
• 2002.03a
• /
• pp.106-112
• /
• 2002

최근 급속한 도시의 팽창 및 신도시 건설과 산업의 발전으로 가스시설은 꾸준히 확대되고 있는 실정이다. 그리고 94년 아현동 도시가스사고와 95년 대구 도시가스사고 이후로 도시 가스 시설물의 대한 안전 대책 및 시설물 관리에 대한 국민들의 관심이 증대되었다. 이러한 흐름에 따라 가스회사들은 GIS 기술을 도입하여 기존에 수작업으로 관리되고 있는 가스시설 정보체계를 전산화하여 항상 최신의 현황을 유지하고, 사고 발생시 신속한 대처 방안 및 피해예측을 위한 시스템을 개발하기 위하여 많은 연구를 진행하고 있는 실정이다. 본 연구의 목적은 안전이 중요시되는 가스시설물에 대하여 가스사고 발생시 신속한 대처 및 처리방안을 제시할 수 있는 GIS 기반의 가스사고 관리시스템을 개발하는데 있다. GIS의 가스사고 관리시스템에서는 사고 발생시에 시설물 관리자가 사고 지점을 선택하여 우선적으로 공급을 중단해야 할 관로를 제시하고 사고지점을 검색하여 차단해야 할 밸브에 대한 정보를 신속히 제공하여 대응 방안을 제시 할 수 있도록 하였다. 아울러 가스공급이 중단되는 지역에 대한 정보를 추출하여 피해범위를 산정하여 효율적인 사고 관리를 지원하도록 구성되었으며, 이와 함께 잔존가스량을 구하여 사고후의 대처방안을 마련할 수 있는 기능을 제공하도록 하였다. 향후 연구과제로는 원격으로 가스 시설물을 감시하고 제어할 수 있는 원격감시/제어시스템(SCADA System)과 연계를 통하여 가스사고 후에 신속한 피해예측 및 피해를 최소화 할 수 있는 방안제시 및 GPS를 활용하여 신속한 사고처리를 할 수 있는 활용 방안을 연구하여 체계적이고 종합적인 가스사고의 관리가 필요하다고 사료된다. 또한, 사고 후의 긴급 대처방안 뿐만 아니라 잔존가스량을 이용하여 수용가에 가스의 신속한 재공급을 위한 정보의 제공까지 한 단계 발전된 시스템의 개발이 추진되어야 한다.남산지역에 대해 정사영상과 10m간격의 DEM을 제작하였으며 1:1000 수치지도를 통해 제작된 DEM과 비교한 결과 총 43990개 격자점의 표고 차이는 평균 5.98m였다.여재 높이 100 cm에서 원수를 하향류 및 상향류로 주입하면서 하향류 20, 40, 80, 100 cm, 상향류 20, 40, 60, 80, 100 cm에서 시료를 채취하여 분석한 결과 모두 원수가 주입되는 부근 여재 높이 20 cm에서 가장 많이 제거되었다. 상향류 보다 하향류로 원수를 주입했을 때 제거효율이 높았다. $Fe^{+++}$을 $Fe^{++}$로 환원하는 $O^{-}_{2}{\cdot}$의 작용을 대신할 수 있음을 증명하며 이와같은 ascorbate 의존적인 $OH{\cdot}$ 의 생성은 ascorbate가 조직손상에 관여할 가능성을 시사하였다.었다. 정확한 예측치를 얻기 위하여 불균질 조직이 조사야에 포함되는 경우 보정이 요구되며, 골반의 경우 골 조직의 보정이 중요한 요인임을 알 수 있었다. 이를 위하여 불균질 조직에 대한 정확한 정보가 요구되며, 이는 CT 영상을 이용하는 것이 크게 도움이 되리라 생각된다.전시 슬러지층과 상등액의 온도차를 측정하여 대사열량의 발생량을 측정하고 슬러지의 활성을 측정할 수 있는 방법을 개발하였다.enin과 Rhaponticin의 작용(作用)에 의(依)한 것이며, 이는 한의학(韓醫學) 방제(方劑) 원리(原理)인 군신좌사(君臣佐使) 이론(理論)에서 군약(君藥)이 주증(主症)에 주(主)로 작용(作用)하는 약물(藥物)이라는 것을 밝혀주는 것이라고 사료(思料)된다.일전 $13.447\;{\mu}g/hr/g$, 섭취 7일중 $8.123\;{\mu}g/hr/g$, 절식 14일후 $10.612

• Journal of Oral Medicine and Pain
• /
• v.34 no.2
• /
• pp.207-216
• /
• 2009

Trigeminal neuralgia is defined "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve". The initial treatment of choice for trigeminal neuralgia is medical therapy. In patients with medically intractable pain or intolerable medication side effects, invasive therapeutic approaches are often necessary. Based on the amount of evidence and estimated efficacy, carbamazepine is the drug of choice in the management of trigeminal neuralgia. In case of insufficient or no response to carbamazepine, second-line drugs can be added. In this study, the author tried to review and analyzed the cases of 90 patients whom had visited for treatment of trigeminal neuralgia at the Department of Oral Medicine, Kyungpook National University Hospital from 2003 to 2008. The results were as follows: 1. Trigeminal neuralgia was significantly more common with advancing age, and nearly twice as common in women than men (ratio of 2.1:1) 2. The maxillary branch of the trigeminal nerve involved most often (51.1%), and the right side of the face is affected more commonly than the left (ratio of 2.9:1). 3. 85(94.4%) patients had experiences visiting medical or dental specialties before being referred to the Department of Oral Medicine. 4. 40(44.4%) patients with trigeminal neuralgia had systemic diseases. 5. Treatment with carbamazepine monotherapy was satisfactory initially in 69(76.7%) the patients, and the mean daily dose of carbamazepine was 402.9mg. On the other hand, 16(17.8%) patients expressed effectiveness after combination therapy of carbamazepine and other drugs. 6. Of the 69 patients who had a good initial response to carbamazepine monotherapy, 18 patients became resistant, so that combination therapy of carbamazepine and other drugs were necessary. 7. 54(60%) patients developed side effects such as dizziness, drowsiness, nausea, vomiting, blood dyscrasias, skin rash and constipation, and 11 of the patients decided to stop tmedicaion due to side effects.

• Clinical and Experimental Pediatrics
• /
• v.53 no.4
• /
• pp.585-591
• /
• 2010

Purpose : Graves' disease is the most common cause of hyperthyroidism in children and adolescents. In this study, we investigated the natural course and the prognostic factors of Graves' disease in Korean children and adolescents. Methods : One-hundred thirteen (88 girls and 25 boys) patients were included in this study. A retrospective analysis was made of all patients who were diagnosed with Graves' disease. The following parameters were recorded and analyzed: patient's sex, age at diagnosis, duration of disease, laboratory findings, symptoms and signs, and family history of autoimmune thyroid disease. Results : All patients were initially treated with antithyroid drugs, either methimazole (93.8%) or propylthiouracil (6.2%). Antithyroid drugs had been discontinued in 75 (66.4%) of 113 patients. Of these 75 patients, 23 (20.4%) relapsed after $25.5{\pm}33.7$ months. Thirteen (11.5%) of 23 patients, who experienced the first relapse, showed a second remission. However, 2 (1.8%) of 13 patients relapsed again. Euthyroid state could not be achieved by antithyroid drugs in 1 patient, and radioactive iodine therapy was performed. The older the patient at diagnosis, the greater the likelihood of remission ($P$=0.034). Conclusion : Age at diagnosis seems to be a prognostic factor in Korean children and adolescents with Graves' disease, and should be taken into account in treatment plan determination.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.17 no.9
• /
• pp.387-393
• /
• 2016

The aim of this study is to analyze the effectiveness of QEEG-based neurofeedback clinical tests on patients diagnosed with anxiety disorder. Researchers tested six patients with anxiety disorder using 32-channel QEEG(Quantitative electroencephalograpy) and neurofeedback training equipment. The study measured anxiety levels of patients using QEEG and BAI physiological psychology tests. Test results found hyperactive beta waves present in all six patients' temporal lobe. The intensity of the wave of the right hemisphere temporal lobe T4(M=31.07) was the higher than that of the left hemisphere temporal lobe 3(M=29.11). Following Neurofeedback training, the beta wave of the right hemisphere lobe was reduced significantly in all patients. The average anxiety level decreased from 23.57 to 12.14 after the neurofeedback training. In addition, among the two patients who were taking medication, one patient reduced his dosage while the other patient discontinued taking medication. This result implies that the QEEG neurofeedback training technique can be effectively applied to patients with anxiety disorder.

• Korean Journal of Psychosomatic Medicine
• /
• v.23 no.1
• /
• pp.66-69
• /
• 2015

In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.