• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권6호
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• pp.461-472
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• 2022

Purpose: Golimumab (GLM) is an anti-tumor necrosis factor (TNF)-α antibody preparation known to be less immunogenic than infliximab (IFX) or adalimumab. Few reports on GLM in pediatric patients with ulcerative colitis (UC) are available. This study aimed to review the long-term durability and safety of GLM in a pediatric center. Methods: The medical records of 17 pediatric patients (eight boys and nine girls) who received GLM at the National Center for Child Health and Development were retrospectively reviewed. Results: The median age at GLM initiation was 13.9 (interquartile range 12.0-16.3) years. Fourteen patients had pancolitis, and 11 had severe disease (pediatric ulcerative colitis activity index ≥65). Ten patients were biologic-naive, and 50% achieved corticosteroid-free remission at week 54. Two patients discontinued prior anti-TNF-α agents because of adverse events during remission. Both showed responses to GLM without unfavorable events through week 54. However, the efficacy of GLM in patients who showed primary nonresponse or loss of response to IFX was limited. Four of the five patients showed non-response at week 54. Patients with severe disease had significantly lower corticosteroid-free remission rate at week 54 than those without severe disease. No severe adverse events were observed during the study period. Conclusion: GLM appears to be safe and useful for pediatric patients with UC. Patients with mild to moderate disease who responded to but had some adverse events with prior biologics may be good candidates for GLM. Its safety and low immunogenicity profile serve as favorable options for selected children with UC.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.28-35
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• 2022

Background: Given the complications involved in corticosteroid (CS) injections, subacromial platelet-rich plasma (PRP) injections may provide a valid alternative to CS in the treatment of rotator cuff (RC) tendinopathy. Methods: We retrospectively reviewed a total of 98 patients affected by RC tendinopathy who were treated with either subacromial injection of PRP or CS. The PRP group received three injections of autologous PRP at 2 weeks interval, and the CS group received one injection of CS. The Western Ontario Rotator Cuff Index (WORC) was the primary outcome measure, while the secondary outcome measures were the visual analog scale (VAS), range of motion (ROM), and need for cuff repair surgery, which were analyzed at intervals of 6, 12, and 18 months. Results: A total of 75 patients were included in the analysis (PRP, n=35; CS, n=40). The mean follow-up for PRP was 21.1±8.7 months and for CS was 33.6±16.3 months (p<0.001). Both groups showed improvement in WORC, VAS, and ROM. No significant differences were detected between the two groups in any of the primary (WORC) or secondary outcomes over 6, 12, and 18 months (all p>0.05). No adverse events were detected. Conclusions: Both treatments improved patient symptoms, but neither resulted in a significantly better outcome in this series of patients. PRP can be a safe and feasible alternative to CS, even at long-term follow-up, to reduce local and systemic effects involved with CS injections.

• Clinics in Shoulder and Elbow
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• 제26권1호
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• pp.49-54
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• 2023

Background: Lateral epicondylitis is an increasingly debilitating condition in working population. Evidence for conservative treatment modalities has been inconclusive. Percutaneous pie crusting of the common extensor origin at the lateral epicondyle at the time of local corticosteroid injection (CSI) has been proposed sparsely. The objective of this study was to analyze if concomitant CSI and pie-crusting of the common extensor origin provides better outcome than CSI alone in lateral epicondylitis. Methods: This case-control study on 236 patients was conducted at a single center between January 1, 2020, and May 31, 2022. Patients were divided into two groups (n=118 each) based on their preference. Group A underwent CSI alone and group B underwent pie crusting along with CSI. The clinical and functional outcomes of all patients were evaluated at 2, 4, 6, and 12-week post-procedure using the visual analog scale (VAS) and Nirschl score. The mean time for return to daily activities was also compared. Results: Both groups showed significant improvement in post-procedure outcome at successive follow-ups on intragroup longitudinal analysis (VAS: F=558.384 vs. F=1,529.618, Nirschl: F=791.468 vs. F=1,284.951). On intergroup analysis, VAS of group B was superior to that of group A; however, it was statistically significant (P<0.05) only from the 6-week follow-up onwards. Nirschl score of group B was significantly better throughout the period of follow-up (P<0.05). Group B returned to daily activities faster than Group A (6.2±0.44 weeks vs. 7.18±0.76 weeks). Conclusions: Concomitant pie crusting with CSI is recommended for lateral epicondylitis as it provides significantly better results than CSI alone.

• Clinics in Shoulder and Elbow
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• 제26권1호
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• pp.64-70
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• 2023

Background: This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). Methods: In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. Results: A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P<0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P<0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. Conclusions: Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI. Level of evidence: III.

• Clinical Pain
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• 제16권1호
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• pp.20-25
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• 2017

Objective: To find that the patients who conducted home self-exercise in conjunction with intra-articular corticosteroid injection will have better improvement in subacromial subdeltoid (SASD) bursitis symptoms than those who received only an injection. Method: A prospective, nonrandomized, comparison study was conducted in outpatient rehabilitation clinic in a tertiary university hospital. Patients diagnosed with SASD bursitis with physical examination and ultrasound evaluation were included and received ultrasound guided injection (UGI). Patients were divided into two groups according to the compliance of self-exercise: UGI-exercise group and UGI only group. Visual analog scale (VAS) was checked before, at 3 weeks, 3 months, and 6 months after the UGI. A patient's global impression of change (PGIC) survey was made at 3 months after the UGI. Results: A total of 82 patients with SASD bursitis were included. At 3 weeks after the injection, the mean VAS for the UGI-exercise group was 2.6 ± 1.7 and for UGI only group was 1.9 ± 1.3 (p=0.030). At 3 months after the injection, the mean VAS for the UGI-exercise group was 4.0 ± 1.3 and for UGI only group was 5.4 ± 1.4 (p<0.001). Conclusion: We concluded that home-based self-exercise of the shoulder provides an additional benefit for pain alleviation possibly with prolonging the effect of injection in SASD bursitis.

• Clinical Pain
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• 제18권2호
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• pp.76-81
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• 2019

Objective: To examine (1) the degree of reduction of passive range of motion (PROM) on the affected side compared to that on the unaffected side and (2) the degree of increase in PROM following intra-articular corticosteroid injection (IACI) in patients with frozen shoulder. Method: The medical records of 120 patients with frozen shoulder were retrospectively reviewed. PROM of the unaffected and affected shoulder (flexion, extension, abduction, internal rotation, external rotation) was compared, and changes in PROM of the affected shoulder after a single IACI (triamcinolone 20 mg) were evaluated after 12 weeks. Results: At the time of diagnosis, PROM of the affected shoulder was most limited in external rotation, followed by internal rotation, abduction, extension, and flexion, compared to that of the unaffected shoulder. Compared to before IACI, PROM of external rotation demonstrated the greatest increase compared to all the other movements after IACI. Conclusion: Limitation in PROM of the frozen shoulder at the time of diagnosis was greatest for external rotation. Moreover, external rotation experienced the greatest improvement after IACI. Our findings should help to further clarify the clinical characteristics of frozen shoulder, aid in its diagnosis, and allow the prediction of the effects of IACI.

• 한국임상수의학회지
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• 제41권1호
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• pp.49-53
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• 2024

A two-year-old, spayed female, 22.5 kg Pungsan was referred with chronic crusts and erosion on the nose. A referring veterinarian prescribed an anti-inflammatory dose (0.5-1 mg/kg/day) of oral glucocorticoids for 5 months, but skin lesions showed no meaningful improvement. A dermatological evaluation revealed a crust, depigmentation, erosion, and erythematous lesion over the nasal planum with a loss of the normal cobblestone texture. Also, firm and multifocal plaques over the thigh, groin, axilla, and dorsum were detected. A cytology examination on the nose, thigh, groin, axilla, and dorsum revealed moderate neutrophilic inflammation and bacterial infection. Abdominal radiography and ultrasonography revealed subcutaneous calcified materials along the thigh, groin, axilla, and dorsum. Calcinosis cutis was suspected because of the adverse effect of previous prolonged corticosteroid therapy. A histopathology examination of the nose lesion revealed moderate to severe degenerative or apoptotic changes of the basal layer and lymphoplasmacytic interface dermatitis. Facial discoid lupus erythematosus (FDLE) was diagnosed based on the history and the clinical, cytological, and histopathological results. Minocycline (7 mg/kg PO q 12 h) and niacinamide (500 mg/dog PO q 12 h) were prescribed as initial treatment. Glucocorticoids were not administered due to the presence of calcinosis cutis induced by previous corticosteroid treatment. After 6 weeks of treatment, the clinical signs on the nose were mildly improved. At this time, topical 1% pimecrolimus cream (twice daily) was initiated, while minocycline and niacinamide were continued at the same dose. The nasal planum markedly improved after 6 weeks of additional treatment, hence minocycline and niacinamide were prescribed for an additional 2 weeks and stopped, and the patient was continued solely on topical pimecrolimus. The dog's skin lesion has been maintained in clinical remission with topical 1% pimecrolimus twice daily for more than 5 months.

• Tuberculosis and Respiratory Diseases
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• 제63권6호
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• pp.486-490
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• 2007

연구배경: 객혈에 대해 안정, 진해제, 및 항생제 등의 보존적 치료를 요하는 환자에서 단기간의 겉질스테로이드 사용이 미치는 영향을 알아보고자 하였다. 방 법: 2005년 2월부터 2006년 8월까지 객혈을 주소로 응급실을 내원한 환자 중 폐암, 활동성 폐결핵 및 폐렴이 의심되는 환자는 제외하고, 그 중 보존적인 치료를 필요로 하는 환자만을 대상으로 하였다. 이들을 무작위로 겉질스테로이드 투여군(37명)과 대조군(41명)으로 나누어 객혈의 평균 중지 시점, 평균 재원기간 및 합병증에 대하여 전향적으로 조사하였다. 결 과: 비활동성 폐결핵 단독 혹은 그에 합병된 질환을 가진 환자가 가장 많았고(51%), 다음으로 기관지확장증 및 기관지염이 각각 15%였으며, 겉질스테로이드 투여군 과 대조군 사이에 환자의 특성과 원인질환의 분포에 따른 차이는 없었다. 겉질스테로이드 투여군이 대조군에 비해 평균 객혈의 평균 중지 시점($4.0{\pm}2.7$일 vs. $6.1{\pm}4.8$일)과 재원기간($5.8{\pm}3.4$일 vs. $7.9{\pm}4.8$일)이 유의하게 짧았다 (각각 p=0.022, p=0.036). 그리고 겉질스테로이드 사용과 관련된 병원성 폐렴이나 위장관 출혈 등 심각한 합병증의 발생은 없었다. 결 론: 기관지염, 기관지확장증, 비활동성 폐결핵 및 그에 합병된 질환에 의한 객혈의 보존적 치료에서 단기간의 겉질스테로이드 사용은 안전하게 객혈 증상과 재원기간을 단축시킬 수 있는 것으로 사료된다.

• Pediatric Infection and Vaccine
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• 제31권1호
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• pp.37-45
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• 2024

목적: 본 연구는 마크로라이드 불응성 마이코플라즈마 폐렴(macrolide-unresponsive Mycoplasma pneumoniae pneumonia, MUMP)의 임상 양상 및 관련 인자와 2차 치료제로서 doxycycline (DXC), tosufloxacin (TFX) 및 corticosteroid (CST) 사용 후 해열되는 데까지 걸리는 시간의 차이를 평가하고자 하였다. 방법: 2018년 7월부터 2020년 2월까지 노원을지대학교병원에 발열 및 호흡기 증상과 함께 흉부 엑스선 상 폐렴 소견이 있어 입원하여 마이코플라즈마 폐렴으로 진단받은 18세 이하의 환자들의 의무기록을 후향적으로 분석하였다. M. pneumoniae의 23S 리보솜 RNA (23S rRNA) 유전자의 점 돌연변이 유무로 마크로라이드 내성을 확인하였다. MUMP는 마크로라이드계 항생제 치료 개시 후 72시간 이상 발열(≥38.0℃)이 지속된 경우로 임상적으로 정의하였다. MUMP의 경우, CST를 추가한 군과 이차 항생제인 DXC 또는 TFX로 변경한 군으로 구분하였다. 결과: 총 157명의 마이코플라즈마 폐렴 환자 중 MUMP 군은 83명(52.9%)이었으며, C-반응단백(C-reactive protein, CRP)의 상승(3.2±3.0 vs. 2.4±2.2 mg/dL, P=0.047), 흉부 X-선상 대엽/분절성 폐렴, 흉수(56.6% vs. 27.0%, P<0.001; 6.0% vs. 0.0%, P=0.032) 그리고 23S rRNA 유전자의 점 돌연변이(96.4% vs. 64.6%, P<0.001) 가 MUMP와 유의한 연관성을 보였다. MUMP 군 83명 중 30명(36.1%)은 DXC로, 38명(45.8%)은 TFX로 항생제를 변경하였고 15명(18.1%)은 CST를 추가하였다. 2차 치료로 변경 이후 발열 호전까지 걸린 평균 시간을 각 군별로 비교하였을 때 CST 군이 DXC, TFX 군보다 발열 호전까지의 시간이 유의하게 짧았고(10.3±12.7 vs. 19.4±17.2 시간, P=0.043; 10.3±12.7 vs. 25.0±20.1 시간, P=0.003), DXC 군과 TFX 군 사이에는 유의한 차이를 보이지 않았다(19.4±17.2 vs. 25.0±20.1 시간, P=0.262). 결론: CRP의 높은 상승과 흉부 X-선 상 대엽/분절성 폐렴 및 흉막 삼출, 그리고 23S rRNA A2063G 점 돌연변이가 마크로라이드 불응성과 유의한 연관이 있었다. CST 환자군에서 DXC나 TFX 환자군에 비하여 더 빠른 발열 호전을 보였다. 향후 MUMP에 대한 최적의 2차 치료제를 결정하기 위해 더 큰 규모의 전향적 연구가 필요하다.

• 대한의생명과학회지
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• 제2권2호
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• pp.133-151
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• 1996

심장수술후 흔히 발생하는 다양한 술후 합병증들은 체외순환으로 인한 체액성 및 세포성 면역계의 손상이 깊이 연루되어 일어나는 것으로 인식되어져 왔다. 특히, 술후 종종 경험하게되는 폐기능 부전은 보체계 활성화 및 염증반응에 따른 백혈구의 폐내 정체(pulmonary leukostasis)가 이와 같은 합병증의 주된 요인으로 알려져 있다. 일부 연구들은 체외순환 실시전 항 염증 약제인 부신피질 호르몬제를 투여함으로써 보체계 및 백혈구 활성화가 억제되어 술후 폐기능 부전의 발생을 예방시켜 주었다고 보고하고 있다. 이에 본 연구의 저자는 체외순환을 이용한 심장수술 동안과 술후, 백혈구의 숫적 변화 및 폐내 정체를 관찰하였다. 술후 시기에 있어 폐기능 평가의 한 지표로 동맥혈 산소분압을 측정하여 술전치와 비교하였고 흉부 X-선 필름을 통한 폐부종 징후와 발열유무, 그리고 그외 여러 변수들을 분석하였다. 또한 체외순환 실시전 투여한 부신피질 호르몬제(solu-Medrol; 30mg/kg)가 이러한 변수들에 어떤 영향을 미치며 과거의 연구에서 설명된 여러가지 예방적 효과가 과연 있는지를 함께 규명하였다. 연구는 무작위로 선정된 심장수술환자 50명을 대상으로 전향적 맹검법(blind fashion)으로 시행하였다 연구의 목적상 전체 환자를 placebo 군(n=25)과 steroid 군(n=25)으로 분류하였고 연구를 통해 다음과 같은 결과를 얻었다. 1. 체외순환은 말초혈액의 총백혈구수를 유의하게 변화시키는데 초기엔 그 수를 저하시켰고 시간이 경과할수록 점차 상승시켰으며 유의한 상승은 술후 7일까지 지속되었다(P<0.05). 이러한 총 백혈구의 숫적 변화는 호중구수의 절대적 변화에 기인한 것이었다. 2. 부분체외순환 동안 placebo 군은 백혈구의 폐내정체가 일어났으나, steroid 군은 예방되었다. 3. 양 군 모두에 있어 체외순환 동안 임파구수는 의미있게 변화되지 않고 체외순환 종료후부터 3일 동안 유의한 감소를 보였으나(p<0.05) 술후 7일엔 완전히 기준치로 회복되었다. 4. 단구수는 양 군 모두 체외순환 초기엔 큰 변화가 없다가 이후 점차 상승하여 술후 7일까지 유의한 증가가 지속되었다(P<0.05) .5. 술후 동맥혈 paO$_2$는 placebo 군은 술전치에 비해 감소되었으나(P=0.01) steroid 군은 유의한 감소가 없었다(P=0.90). 폐부종 발생환자는 placebo 군에 비해 steroid 군이 보다 의미있게 낮았고(P=0.001)술후 발열환자 역시 steroid 군이 placebo 군 보다 훨씬 낮았다(P=0.01). 그러나 기계호흡 보조시간과중환자실에서 머문 시간은 양 군 간에 유의한 차이가 없었다(P>0.05).이상의 연구결과를 통해 저자는 체외순환을 이용한 심장수술 동안 백혈구의 활성화로 인한 숫적변화와 폐내 정체를 관찰하였고 스테로이드의 사용이 보다 높은 호중구 수의 보존효과를 가져다 주었으며 백혈구의 폐내 정체를 예방해주고 술후의 일부 관류후 증후군을 경감시켜줌을 확인할 수 있었다. 그러나 술후 시기에 있어 양 군 모두 임파구의 숫적 감소가 3일간 지속됨으로 해서 임파구와 연관된 면역계의 손상이 여전히 우려되는바 이므로 향후 이 부분에 대한 예방적 수단과 스테로이드의 술후 면역학적 기능에 미치는 영향에 관한 연구 역시 더 필요할 것으로 사료된다.