• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.784-789
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• 2006

목 적 : HSP는 피부, 관절, 위장관, 신장을 포함한 전신의 소혈관을 침범하는 혈관염이다. HSP의 위장관 증상은 때로 다량의 위장관 출혈, 장천공, 장중첩 등의 위중한 형태로 나타날 수 있는데, 이 중 일부 환자는 corticosteroid 치료에도 불구하고 증상이 호전되지 않는 경우가 있다. 저자들은 심한 위장관 증세를 보이면서 스테로이드에 반응하지 않는 HSP 환아에서 IVIG 치료의 효과를 알아보고자 하였다. 방 법 : 1999년 4월부터 2005년 1월까지 심각한 위장관 증상으로 입원한 22명의 HSP 환아들의 의무기록을 조사하였다. 이들 모두에서 처음엔 methylprednisolone(2 mg/kg)을 정맥 투여하였으며, 스테로이드 치료에 반응이 없는 환아들을 대상으로 하여 IVIG(2 g/kg)을 투여하였다. 결 과 : 대량의 위장관 출혈과 복통 등이 동반된 심한 위장관 증상을 나타낸 22명의 환아(연령 : 2.3-15세, 성별 M : F=12 : 10)중에 12명이 스테로이드 치료에도 불구하고 증상이 호전되지 않아 고용량 IVIG 치료를 받았다. IVIG 투여 전, methylprednisolone 정맥주사의 평균 투여기간은 $5.6{\pm}4.9$일이었으며 12명 중 11명에서 IVIG 투여 후 1시간에서 5일 사이에 위장관 증상이 호전되었다. 나머지 1명은 IVIG 투여 후에도 복통이 있었으나, 혈변은 소실되었다. IVIG을 투여받은 환아들과 corticosteroid만을 투여받은 환아들간에 입원기간의 차이는 없었다($12.8{\pm}7.6$일 vs. $13.2{\pm}7.8$일, P=0.777). 복통이 지속되었던 총기간은 IVIG 투여군이 짧았으나 통계적으로는 유의하지 않았다($8.8{\pm}8.1$일 vs. $14.8{\pm}16.9$일, P=0.306). Methylprednisolone 정맥주사만을 단독으로 치료받은 10명 중 2명(20%)은 장천공으로 수술을 받았으나, IVIG 투여군 12명에서는 장천공이 전혀 발생하지 않았다. 결 론 : 심한 위장관 침범이 있는 HSP 환아의 복부증상이 기존의 스테로이드 치료에도 불구하고 호전되지 않을 때에는 고용량 정맥 면역글로불린 투여를 고려해 볼 수 있을 것이다.

• Clinical and Experimental Pediatrics
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• 제49권9호
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• pp.987-990
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• 2006

정맥내 면역글로블린은 급성 가와사끼병의 치료에 효과적이나 약 10-20%의 환자에서 치료 실패가 보고되고 있다. 이러한 경우 면역글로블린의 재투여 또는 스테로이드나 다른 약제의 사용 등 다양한 치료방법이 시도되고 있으나 아직 이에 대한 확립된 치료 가이드라인은 없다. $TNF-{\alpha}$는 가와사끼병의 급성기, 특히 관상동맥류를 가진 환자에서 혈중농도가 크게 증가한다. 저자들은 2번의 면역글로블린 투여와 3번의 pulse methylprednisolone 치료에 반응이 없던 10개월 된 난치성 가와사끼병 환아에게 항 $TNF-{\alpha}$인 infliximab (5 mg/kg, 1회)을 투여하여 임상 호전과 더불어 항염증지표가 정상이 되고 관상동맥류 진행이 억제됨을 경험하였다.

• 대한임상독성학회지
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• 제14권2호
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• pp.151-154
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• 2016

Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.

• Clinical and Experimental Pediatrics
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• 제61권11호
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• pp.348-354
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• 2018

Purpose: The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis. Methods: Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients' medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined. Results: Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, $76.5kU_A/L$; milk IgE, $20.5kU_A/L$; peanut IgE, $30kU_A/L$; eosinophil count, $5,810/{\mu}L$; eosinophil cationic protein, $93.45{\mu}g/L$; and platelet count, $666.5{\times}10^3/{\mu}L$. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients. Conclusion: Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.

• 기본간호학회지
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• 제13권3호
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• pp.382-389
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• 2006

Purpose: The purpose of this study was to explore the effects of Patient Controlled Analgesia (PCA) on the postoperative patient's pain management and recovery of bowel movement with gastrointestinal cancer Method: The participants were 249 patients diagnosed with gastrointestinal disease and scheduled for elective surgery, who were recruited to either the postoperative patient-controlled analgesia group or epidural analgesia group. Participants aged 20 and above were recruited from P, K, D, and I university hospitals in B city. Pain visual analogue scale, and recovery of bowel movement according to PCA-related characteristics were measured using structured questionnaires from April 2005 through December 2005. Descriptive statistics t-test and F-test were used to analyze the data. SPSS WIN 10.0 program was used. Results: Mean score for pain was 62.31. Scores for pain on the visual analogue scale were significantly lower in the epidural-PCA than in the intravenous PCA, and also significantly lower in the absence of side effect of PCA than in the presence of side effect. Recovery time for bowel movement was significantly faster in the absence of side effect of PCA than in the presence of side effect. Conclusion: Based on the findings, there is a significant difference in pain and no difference in first passage of flatus according to PCA infusion route in patients who are post-operative for gastrointestinal cancer.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.141-146
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• 2015

Background: An understanding of the features of postoperative pain is essential for optimal analgesic dosing strategies. Using a visual analogue scale (VAS) score and patient controlled analgesia (PCA) infusion pattern analysis, an anesthesiologist can estimate when and how severely patients suffer from pain. Several reports have been published about circadian changes in the pain threshold. Postoperative pain was analyzed retrospectively in 250 patients who underwent orthognathic surgery. Methods: A total of 250 patients were allocated into two groups according to the time of recovery from anesthesia. Patients in the early group (group E) recovered from anesthesia before 06:00 p.m. Patients in the late group (group L) recovered from anesthesia after 06:00 p.m. All patients received intravenous patient controlled analgesia (IV PCA) at the end of the operation. The VAS score of pain intensity was measured. Self-administration of bolus analgesic from the IV PCA device was also analyzed according to actual time and elapsed time. Results: VAS scores showed no difference between the two groups except 36 hours after recovery from anesthesia. On POD1, there were two peaks for self-administration of bolus analgesics in group L and one peak in the morning for group E. Two peaks each in the morning and in the afternoon were shown in both groups on POD2. Conclusions: Diurnal variance in pain should be considered for effective dosing strategies.

• The Korean Journal of Physiology
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• 제28권2호
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• pp.225-231
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• 1994

The present study was undertaken to investigate the role of endogenous nitric oxide in renin release under different physiological conditions. In the first series of experiments, renin release was either inhibited by acute volume-expansion (VE) or stimulated by clipping one renal artery in the rat. VE was induced by intravenous infusion of saline (0.9% NaCl) up to 5% of the body weight over 45 min under thiopental (50 mg/kg, IP) anesthesia. VE caused a decrease of plasma renin concentration (PRC). With $N^G-nitro-L-arginine$ methyl ester $(L-NAME,\;5\;{\mu}g/kg\;per\;min)$ superadded to VE, PRC decreased further. The magnitude of increase in plasma atrial natriuretic peptide levels following VE was not affected by the L-NAME. In two-kidney, one clip rats, L-NAME-supplementation resulted in a decrease, and L-arginine-supplementation an increase of PRC. Plasma atrial natriuretic peptide levels were significantly lower in the L-arginine group than in the control. Blood pressure did not differ among the L-NAME, L-arginine, and control groups. In another series of experiments, the renin response to a blockade of NO synthesis was examined using in vitro preparations from isolated renal cortex. L-NAME significantly increased basal renin release, although it was without effect on the isoproterenol-stimulated release. These findings suggest that endogenous nitric oxide significantly contributes to the renin release. Since many factors may affect the renin release in vivo, an interaction between NO and renin under various pathophysiological states is to be further defined.

• Journal of Korean Biological Nursing Science
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• 제6권2호
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• pp.57-68
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• 2004

The contrast medium is very commonly used in more than 90% of computed tomography(CT) scans. It is difficult to predict the occurrence of adverse reactions and the degree of adverse reactions are diverse from mild urticaria, itching, nausea, vomiting to even cardiopulmonary arrest. The purpose of this study was to evaluate the symptoms, occurrence rate and risk factors of the adverse reactions in patients after contrast injection during CT examinations. Two hundreds sixty-five patients showed symptoms of adverse reactions out of 71,117 adult patients who received intravenous contrast administration during CT scans from January 2003 to December 2003 at a general hospital. Data was collected by reviewing adverse reaction records and electronic medical record. The results of this study were as follows; 1. Adverse reactions occurred in 265 out of a total of 71,117 patients(0.37%). Clinical symptoms of adverse reactions were most commonly dermatologic problems such as urticaria(69.81%) and itching(63.02%), followed by dyspnea(14.34%), dizziness(11.70%), nausea(6.79%), and vomiting(7.17%). 2. Anaphylactoid reactions occurred in 47 out of a total of 265 patients, and their pattern of symptoms were most commonly related to cardiovascular system(90.91%), followed by respiratory system(82.22%), gastrointestinal system(51.72%), and dermatologic system(16.51%). Eleven patients were transferred to emergency room for further treatment and two patients needed cardiopulmonary resuscitation. 3. The adverse reactions were significantly more common in women than in men(0.46% vs.0.32%, p=.003) and in type D contrast medium than the others(p<.001). The occurrence rate of adverse reactions was not significantly different according to the age and infusion speed of the contrast medium.

• Asian-Australasian Journal of Animal Sciences
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• 제20권10호
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• pp.1503-1509
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• 2007

Endothelin-1 (ET-1) is an important factor in regulation of cardiovascular tone in humans and mammals, but the biological function of ET-1 in the avian vascular system has not been determined. The purpose of this study was to characterize the role of endogenous ET-1 in the vascular system of poultry by investigating the effect of endothelin A receptor ($ET_AR$) antagonist BQ123 on the femoral artery pressure (FAP) and the pulmonary artery pressure (PAP) in broiler chickens. First, we found that plasma and lung homogenate ET-1 levels were both increased with age over the seven weeks life cyccle of broiler chickens. Second, 60 min after intravenous injection, BQ123 ($0.4{\mu}g\;kg^{-1}$ and $2.0{\mu}g\;kg^{-1}$, respectively) induced a significant reduction in FAP and PAP (p<0.05). Third, chronic infusion of BQ123 ($2.0{\mu}g\;kg^{-1}$ each time, two times a day) into abdominal cavities led to significant decrease in systolic pressure of the femoral (p<0.05) and pulmonary arteries (p<0.01) in broiler chickens at 7 and 14 days after treatment. Taken together, the $ET_AR$ antagonist BQ123 lead to a significant reduction of FAP and PAP, which suggests that endogenous ET-1 may be involved in the maintenance and regulation of systemic and pulmonary pressure in broiler chickens.

• The Korean Journal of Pain
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• 제11권1호
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• pp.47-53
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• 1998

Background: Epidural coadministration of opioids and local anesthetics has provided excellent analgesia during postoperative period. However, it is usually associated with the occurance of many side effects which were induced by epidural morphine. Low dose of intravenous naloxone has been known to reduce morphine-induced side effects without reversing analgesia, but the effect of epidural naloxone has not been defined in human study. Therefore we evaluated side effects and analgesia when naloxone was administered via epidural route. Methods: Eighty patients having epiduro-general anesthesia for hysterectomy were randomly assigned to one of four study groups. As a mean of postoperative pain control, all received 2 mg of epidural morphine bolusly at 1 hr before the end of surgery and continuous epidural infusion was started by Two-day Infusor containing morphine 4 mg in 0.125% bupivacaine 100 ml with either none of naloxone(Group 1, n=20), 2 ug/kg/day of naloxone(Group 2, n=20), 3 ug/kg/day of naloxone(Group 3, n=20) or 4 ug/kg/day of naloxone(Group 4, n=20). Study endpoints included visual analog scales(VAS) for pain, severity of nausea, itching, somnolence and respiratory depression. They were assessed at 2, 4, 8, 16, 32, and 48 hr postoperatively. Results: VAS for pain showed significant difference in Group 4 compared with Group 1 at all of the evaluation time. Itching score decreased significantly in Group 3 and 4 after 8 hr postoperatively and nausea score decreased significantly in Group 3 after 4 hr postoperatively. Alertness score decreased significantly in Group 3 and 4 especially in early postoperative period. Conclusion: This study suggests that epidural naloxone reduce morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect of epidural morphine.