• 제목/요약/키워드: Fluid Management

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Long-Term Management of a Refractory Corticosteroid Responsive Tremor Syndrome

  • Kim, Soomin;Kim, Yoonji;Kim, Ji-Hee;Kim, Hyeon-Jin;Lee, Ji-Hye;Geum, Migyeong;Kim, Ha-Jung
    • Journal of Veterinary Clinics
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    • v.38 no.3
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    • pp.143-146
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    • 2021
  • A 2-year-old intact female Maltese dog was presented with generalized involuntary tremors and nystagmus without regular direction. The dog was conscious the whole time while it was trembling. Its involuntary tremors were alleviated at rest or during sleep. Magnetic resonance imaging (MRI) revealed asymmetric hydrocephalus and caudal occipital malformation. In cerebrospinal fluid (CSF) analysis, a trace of protein was found and total nucleated cell count (TNCC) was slightly increased. However, infectious pathogens were not found. In complete blood count, there was a mild leukocytosis. After the patient received anticonvulsants (midazolam, phenobarbital, KBr), diuretics (furosemide) with an anti-inflammatory drug (prednisolone, 0.5 mg/kg PO bid), and a proton-pump inhibitor (omeprazole), it showed no improvement. The patient was tentatively diagnosed with corticosteroid responsive tremor syndrome. So the anticonvulsants and diuretics were discontinued and the dose of prednisolone was increased to an immunosuppressive dose (1 mg/kg PO bid). After administering the immunosuppressive dose of prednisolone, the patient did not show nystagmus. Its tremors were much alleviated. However, they did not disappear. Five weeks later, the patient showed gradual improvement but still was trembling when moving around. Nine weeks later, its tremors were similar to before. So diazepam (0.3 mg/kg PO sid) was added to the treatment. After that, its tremors were alleviated more. Prednisolone and diazepam were maintained for about five months, with tapering of the dose of prednisolone (until 0.5 mg/kg PO sid). About 7 months later after the treatment was started, the dog was trembling rarely except when it was excited. Therefore, diazepam was discontinued. This case describes a refractory white dog shaker syndrome successfully managed with long-term administration of a steroid and diazepam.

A Study on Tinnitus and Deafness Based on the Donguibogam (『동의보감(東醫寶鑑)』을 중심으로 한 이명(耳鳴), 이농(耳聾)에 대한 고찰)

  • Park, Chae yeon;Ahn, Jinhee;Baik, You-sang;Jeong, Chang-hyun;Jang, Woochang
    • Journal of Korean Medical classics
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    • v.35 no.1
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    • pp.117-136
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    • 2022
  • Objectives : The objective of this paper is to examine the pathology and treatment methods of tinnitus and deafness. Methods : Contents on the ears, pathology and treatment methods of tinnitus and deafness in the Donguibogam were examined. Results & Conclusions : Findings indicate that Kidney jing deficiency and problems of qi metabolism of the Kidney are at the root of tinnitus and deafness pathology. In treatment, once the primary symptoms are managed, the root, which is Kidney deficiency, needs to be improved, together with life style management. In the case of Heart-Kidney disconnection, the Heart must be collected while nurturing jing; in the case of yin deficiency and flaring, ministerial fire must be managed while tonifying jing and blood. If the cause lies in the Lungs and Kidney, they must be tonified, while in cases due to problematic water fluid metabolism, phlegm-fire or exterior pathogens, the Kidney needs to be dealt with even after treating the aforementioned causes.

Clinical research on the skin saftey of the human derived lactic acid culture (인체 유산균 배양액의 피부 안전성 임상 연구)

  • Min, Kyung-Nam
    • Journal of Industrial Convergence
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    • v.20 no.7
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    • pp.123-129
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    • 2022
  • It was to establish the usage possibility as cosmetic material by testing stimulation of Leuconostoc mesenteroides which were cultured from human scalp's dead skin cell by patching it to the skin in the form of solubilized essence. Cultured L. mesenteroides diluted to 1% concentration and essence which contains it were patched to 31 and 32 participants' back each for 24 hours and established the stimulus figures by the specialists in 30 minutes, 24 hours, and 48 hours after they were taken off. They are both revealed as non-stimuli due to the result of 0.011 and 0 points each and therefore they are safe when used as skin products. Considering the results of this test and the other previous studies which reported the L. mesenteroides as anti-allergic, antioxidant, and anti-inflammatory, L. mesenteroides is usable for cosmetics and worth further research.

A simple and novel equation to estimate the degree of bleeding in haemorrhagic shock: mathematical derivation and preliminary in vivo validation

  • Chon, Sung-Bin;Lee, Min Ji;Oh, Won Sup;Park, Ye Jin;Kwon, Joon-Myoung;Kim, Kyuseok
    • The Korean Journal of Physiology and Pharmacology
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    • v.26 no.3
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    • pp.195-205
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    • 2022
  • Determining blood loss [100% - RBV (%)] is challenging in the management of haemorrhagic shock. We derived an equation estimating RBV (%) via serial haematocrits (Hct1, Hct2) by fixing infused crystalloid fluid volume (N) as [0.015 × body weight (g)]. Then, we validated it in vivo. Mathematically, the following estimation equation was derived: RBV (%) = 24k / [(Hct1 / Hct2) -1]. For validation, non-ongoing haemorrhagic shock was induced in Sprague-Dawley rats by withdrawing 20.0%-60.0% of their total blood volume (TBV) in 5.0% intervals (n = 9). Hct1 was checked after 10 min and normal saline N cc was infused over 10 min. Hct2 was checked five minutes later. We applied a linear equation to explain RBV (%) with 1 / [(Hct1 / Hct2) -1]. Seven rats losing 30.0%-60.0% of their TBV suffered shock persistently. For them, RBV (%) was updated as 5.67 / [(Hct1 / Hct2) -1] + 32.8 (95% confidence interval [CI] of the slope: 3.14-8.21, p = 0.002, R2 = 0.87). On a Bland-Altman plot, the difference between the estimated and actual RBV was 0.00 ± 4.03%; the 95% CIs of the limits of agreements were included within the pre-determined criterion of validation (< 20%). For rats suffering from persistent, non-ongoing haemorrhagic shock, we derived and validated a simple equation estimating RBV (%). This enables the calculation of blood loss via information on serial haematocrits under a fixed N. Clinical validation is required before utilisation for emergency care of haemorrhagic shock.

Evaluation of SPACE Code Prediction Capability for CEDM Nozzle Break Experiment with Safety Injection Failure (안전주입 실패를 동반한 제어봉구동장치 관통부 파단 사고 실험 기반 국내 안전해석코드 SPACE 예측 능력 평가)

  • Nam, Kyung Ho
    • Journal of the Korean Society of Safety
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    • v.37 no.5
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    • pp.80-88
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    • 2022
  • The Korean nuclear industry had developed the SPACE (Safety and Performance Analysis Code for nuclear power plants) code, which adopts a two-fluid, three-field model that is comprised of gas, continuous liquid and droplet fields and has the capability to simulate three-dimensional models. According to the revised law by the Nuclear Safety and Security Commission (NSSC) in Korea, the multiple failure accidents that must be considered for the accident management plan of a nuclear power plant was determined based on the lessons learned from the Fukushima accident. Generally, to improve the reliability of the calculation results of a safety analysis code, verification is required for the separate and integral effect experiments. Therefore, the goal of this work is to verify the calculation capability of the SPACE code for multiple failure accidents. For this purpose, an experiment was conducted to simulate a Control Element Drive Mechanism (CEDM) break with a safety injection failure using the ATLAS test facility, which is operated by Korea Atomic Energy Research Institute (KAERI). This experiment focused on the comparison between the experiment results and code calculation results to verify the performance of the SPACE code. The results of the overall system transient response using the SPACE code showed similar trends with the experimental results for parameters such as the system pressure, mass flow rate, and collapsed water level in component. In conclusion, it can be concluded that the SPACE code has sufficient capability to simulate a CEDM break with a safety injection failure accident.

Anterior Cranial Base Reconstruction in Complex Craniomaxillofacial Trauma: An Algorithmic Approach and Single-Surgeon's Experience

  • Shakir, Sameer;Card, Elizabeth B.;Kimia, Rotem;Greives, Matthew R.;Nguyen, Phuong D.
    • Archives of Plastic Surgery
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    • v.49 no.2
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    • pp.174-183
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    • 2022
  • Management of traumatic skull base fractures and associated complications pose a unique reconstructive challenge. The goals of skull base reconstruction include structural support for the brain and orbit, separation of the central nervous system from the aerodigestive tract, volume to decrease dead space, and restoration of the three-dimensional appearance of the face and cranium with bone and soft tissues. An open bicoronal approach is the most commonly used technique for craniofacial disassembly of the bifrontal region, with evacuation of intracranial hemorrhage and dural repair performed prior to reconstruction. Depending on the defect size and underlying patient and operative factors, reconstruction may involve bony reconstruction using autografts, allografts, or prosthetics in addition to soft tissue reconstruction using vascularized local or distant tissues. The vast majority of traumatic anterior cranial fossa (ACF) injuries resulting in smaller defects of the cranial base itself can be successfully reconstructed using local pedicled pericranial or galeal flaps. Compared with historical nonvascularized ACF reconstructive options, vascularized reconstruction using pericranial and/or galeal flaps has decreased the rate of cerebrospinal fluid (CSF) leak from 25 to 6.5%. We review the existing literature on this uncommon entity and present our case series of n = 6 patients undergoing traumatic reconstruction of the ACF at an urban Level 1 trauma center from 2016 to 2018. There were no postoperative CSF leaks, mucoceles, episodes of meningitis, or deaths during the study follow-up period. In conclusion, use of pericranial, galeal, and free flaps, as indicated, can provide reliable and durable reconstruction of a wide variety of injuries.

An Analysis of the Impact of Building Wind by Field Observation in Haeundae LCT Area, South Korea: Typhoon Omais in 2021

  • Byeonggug Kang;Jongyeong Kim;Yongju Kwon;Joowon Choi;Youngsu Jang;Soonchul Kwon
    • Journal of Ocean Engineering and Technology
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    • v.36 no.6
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    • pp.380-389
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    • 2022
  • In the Haeundae area of Busan, South Korea, damage has continued to occur recently from building wind from caused by dense skyscrapers. Five wind observation stations were installed near LCT residential towers in Haeundae to analyze the effect of building winds during typhoon Omais. The impact of building wind was analyzed through relative and absolute evaluations. At an intersection located southeast of LCT (L-2), the strongest wind speed was measured during the monitoring. The maximum average wind speed for one minute was observed to be 38.93 m/s, which is about three times stronger than at an ocean observation buoy (12.7 m/s) at the same time. It is expected that 3 to 4 times stronger wind can be induced under certain conditions compared to the surrounding areas due to the building wind effect. In a Beaufort wind scale analysis, the wind speed at an ocean observatory was mostly distributed at Beaufort number 4, and the maximum was 8. At L-2, more than 50% of the wind speed exceeded Beaufort number 4, and numbers up to 12 were observed. However, since actual measurement has a limitation in analyzing the entire range, cross-validation with computational fluid dynamics simulation data is required to understand the characteristics of building winds.

Surgical Management and Long-Term Results of Rathke's Cleft Cyst

  • Seung-Ho, Seo;Kihwan, Hwang;So Young, Ji;Jung Ho, Han;Chae-Yong, Kim
    • Journal of Korean Neurosurgical Society
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    • v.66 no.1
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    • pp.82-89
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    • 2023
  • Objective : Rathke's cleft cysts (RCCs) are nonneoplastic cysts. Most of them are asymptomatic and stable; when symptomatic, RCCs are surgically fenestrated and drained. However, the outcomes remain unclear. The authors evaluated the outcomes of RCC decompression. Methods : Between 2004 and 2019, 32 RCCs were decompressed in a single tertiary institution. The clinical characteristics, intraoperative findings, postoperative complications, and endocrinological and surgical outcomes were retrospectively reviewed. Patients who underwent sequential imaging at least twice and at least 12 months after surgery were included in the analysis. Results : Patients' mean age was 40.8±14.9 years, and 62.5% were women. The mean follow-up duration was 62.3±48.6 months. In 21 patients (65.6%), no residual cysts were identified on postoperative magnetic resonance imaging. Of the 18 patients with preoperative visual field defects, 17 (94.4%) experienced postoperative visual improvement. Postoperative complications included endocrinological deterioration in 11 patients (34.4%), permanent diabetes insipidus in 11 (34.4%), infection in four (12.5%), intrasellar hemorrhage in three (9.4%), and cerebrospinal fluid leak in two (6.3%). Follow-up images revealed cyst recurrence in nine patients (28.1%), an average of 20.4 months after surgery; in three patients, the cysts were symptomatic, and resection was repeated. Multivariable analysis revealed that postoperative endocrinological deterioration was the only independent factor associated with cyst recurrence (p=0.028; hazard ratio, 6.800). Conclusion : Our findings showed that although only cyst fenestration for decompression was performed to preserve pituitary function, more pituitary dysfunction occurred than expected. Besides, the postoperative hormonal deterioration itself acted as a risk factor for cyst recurrence. In conclusion, surgery for RCC should be more careful.

Successful Management of Post-Traumatic Hydrocephalus and Pseudomeningocele Following Traumatic Brain Injury in a Cat

  • Hyoung-Won Seo;Jeong-Min Lee;Hae-Boem Lee;Yoon-Ho Roh;Tae-Sung Hwang;Kun-Ho Song;Joong-Hyun Song
    • Journal of Veterinary Clinics
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    • v.40 no.1
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    • pp.56-61
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    • 2023
  • A 5-month-old female domestic short-haired cat presented with a history of seizure episodes for two months following an animal bite injury to the head. There were no remarkable findings on physical and neurological examination or blood analysis. Computed tomography revealed a fracture of the left parietal bone with an inward displacement of the bone fragment while magnetic resonance imaging revealed an enlarged temporal horn of the left lateral ventricle and a pseudomeningocele compressing the adjacent cerebral parenchyma. Subsequently, cerebrospinal fluid analysis results were normal. The patient was diagnosed with traumatic brain injury (TBI), with subsequent post-traumatic hydrocephalus (PTH) and pseudomeningocele. Despite treatment with phenobarbital and levetiracetam, seizures were not sufficiently controlled. Craniectomy for bone fragment removal and duraplasty were performed after a week. The patient then returned to normal condition with no further seizure activity. On repeated MRI two months after discharge, the hydrocephalus of the lateral ventricle and pseudomeningocele were enlarged; however, the patient maintained a good clinical status without any neurological signs. To the best of our knowledge, PTH and intracranial pseudomeningoceles have not yet been reported in cats. PTH and pseudomeningocele are among the complications of TBI and may not have any significant relevance with the clinical signs in this case. Thus, to broaden our knowledge about PTH and pseudomeningocele in cats, we describe serial changes in the clinical findings of this cat over the treatment period.

Surgical Strategy for Skull Base Chordomas : Transnasal Midline Approach or Transcranial Lateral Approach

  • Wang, Benlin;Li, Qi;Sun, Yang;Tong, Xiaoguang
    • Journal of Korean Neurosurgical Society
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    • v.65 no.3
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    • pp.457-468
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    • 2022
  • Objective : The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. Methods : We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. Results : Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. Conclusion : The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.