• Journal of Korean Neurosurgical Society
• /
• v.30 no.9
• /
• pp.1065-1071
• /
• 2001

Object : This study was conducted to evaluate whether short-term intravenous infusion of tranexamic acid (AMCA) was able to improve the management outcome by preventing rebleeding without increasing vasospasm and hydrocephalus associated with the long-term administration of this agent in the patients with aneurysmal subarachnoid hemorrhage(SAH) who were planned for the early surgery. Methods : During the period from June, 1996 to May, 1998, 137 patients admitted within 3 days of their SAH and planned for early surgical intervention were subject to study population. Of these, 60 patients who had been treated with AMCA were classified as AMCA treated group and 77 patients without AMCA treatment as AMCA untreated group. Initially, prognostic factors for rebleeding, vasospasm, hydrocephalus and outcome following SAH including age, sex, clinical grade, CT grade, site of ruptured aneurysms, admission day after SAH, surgery day after SAH, number of aneurysms and hypertension history, were analyzed and compared between AMCA treated group and untreated group. Secondly, the incidence of rebleeding, symptomatic vasospasm and hydrocephalus were compared between the two groups. Also, the management outcome of the patients was compared between the two groups. Results : There were no significant differences in prognostic factors between the two groups. The rebleeding rate was 0% in the AMCA treated group whereas the rate was 7.8% in the untreated group. This difference was statistically significant. The incidences of symptomatic vasospasm and hydrocephalus were found not to be significantly different between the two groups. Of the treated group, 31.7% of patients developed hydrocephalus compared to 32.5% of those at the untreated group. Fourteen(23.3%) patients in treated group developed symptomatic vasospasm and 6 of them(10%) suffered stroke whereas incidences of these in untreated group were 25.9% and 11.7%, respectively. The AMCA treated group showed more favorable outcome than that of untreated group. There was no case of death by rebleeding in the AMCA treated group while one of the main causes of death in the untreated group was rebleeding. Conclusion : Short-term high-dose AMCA administration is considered beneficial in improving outcome and diminishing the risk of rebleeding in the patients who suffer from an aneurysmal SAH prior to early surgical intervention.

• Journal of The Korean Society of Inherited Metabolic disease
• /
• v.18 no.3
• /
• pp.78-86
• /
• 2018

Purpose: We aimed to delineate clinical spectrum and short-term effects after enzyme replacement therapy (ERT) for 5 mucopolysaccharidosis type II (MPS II). Methods: Five patients were diagnosed with MPS II by clinical findings, enzyme activity, and genetic testing. Idursulfase was administered by intravenous infusion at a dose of 0.5 mg/kg every week. Observational chart analysis of patients, who underwent systematic investigations more than 12 months after initiation of ERT was done retrospectively. Results: Three patients were classified as having the attenuated type, and 2 patients were classified as having the severe type. The median age at the diagnosis was 9.6 years (range 3.4-26 years). Four different mutations in 5 Korean patients (4 families) with MPS II were identified, among which two were novel mutations (1 small insertion mutation: p.Thr409Hisfs*22, and 1 missense mutation: p.Gly134Glu). Two severe type sibling patients with the same mutation had different clinical manifestation. Urinary glycosaminoglycan excretion decreased within the twelve months of ERT (P=0.043). Liver and spleen volumes showed reductions that were maintained in all patients (P=0.043 and P=0.043, respectively). Improvements were also noted in left ventricular mass index (P=0.042), shoulder flexion (P=0.043), shoulder abduction (P=0.039), knee flexion (P=0.043), elbow flexion (P=0.042), and respiratory distress index (P=0.041). Conclusion: This study demonstrates that Korean patients with MPS II are clinically heterogeneous and indicates that idursulfase is relatively effective in several clinical parameters including heart size and respiratory distress index without infusion-related reactions in patients with MPS II.

• Journal of Hospice and Palliative Care
• /
• v.1 no.1
• /
• pp.47-55
• /
• 1998

Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

• Journal of Yeungnam Medical Science
• /
• v.22 no.1
• /
• pp.52-61
• /
• 2005

Background: Guillain-Barre syndrome is defined as a recognizable clinical entity that is characterized by rapidly evolving symmetric limb weakness, the loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions. This study evaluated the clinical and electrophysiological findings retrospectively. Materials and Methods: Forty-five patients with Guillain-Barre syndrome, who were admitted to the Yeungnam University Hospital for six years from Jan. 1994 to Dec. 1999 were investigated. The correlation between the clinical manifestation and the electrophysiological study was evaluated. Results: The male to female ratio was 1.8:1 and there was a peak seasonal incidence in the winter. A preceding illness was noted in 66.7 % of cases, and an upper respiratory tract infection was the most common one. The most common clinical manifestations were a loss of tendon reflex and ascending muscle weakness and paralysis. The cerebrospinal fluid examinations revealed, albuminocytologic dissociation in 33 cases (73.3 %). Intravenous immunoglobulin therapy was performed in 29 cases (64.4 %). The sequential electrophysiological abnormalities were most marked at 2 to 4 weeks after onset. At that time the most significant change was a decrease in the compound muscle action potential amplitude. These 45 patients with Guillain-Barre syndrome were subclassified using the clinical and electrophysiological data. Conclusion: The result in this study, concured with other research on the clinical and electrophysiological data of Guillain-Barre syndrome. However, an extensive and dynamic investigation is necessary to determine the reason for the peak seasonal incidence in winter.

• Journal of Hospice and Palliative Care
• /
• v.13 no.1
• /
• pp.24-31
• /
• 2010

Purpose: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. Methods: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. Results: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). Conclusion: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.

• Tuberculosis and Respiratory Diseases
• /
• v.58 no.3
• /
• pp.257-266
• /
• 2005

Background : The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. Patients and Methods : From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. Results : The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>0.05). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce phalosporin had been infused. Conclusion : Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

• Journal of Hospice and Palliative Care
• /
• v.11 no.3
• /
• pp.136-139
• /
• 2008

Purpose: Epidural morphine infusion has been used to control pain in cancer patients whose cancer pain can not be controlled high dose intravenous morphine injection. To study the effectiveness and side effects of epidural morphine for the treatment of cancer pain in terminal patients at Hospice Ward, we evaluated the change in morphine equivalent daily dose for effectiveness and complications of epidural morphine infusion. Methods: We retrospectively analyzed 24 terminal cancer patients who were treated with continuous epidural morphine between 2001 and 2004 at Hospice Ward of St. Vincent's Hospital. Results: The median of baseline morphine equivalent daily dose was 615 mg, whereas the median dose of initial epidural morphine was 16 mg. The median of morphine daily equivalent daily dose dropped from 615 mg to 274 mg in one week after epidural morphine infusion therapy (P-value=0.000). The median survival from the time of the first catheter insertion was 35 days. In 6 patients, the catheter was removed due to complications, however the catheter was reinserted in 3 patients. Conclusion: Cancer pain management by epidural morphine infusion is very effective method with low rate of severe complication.

• Radiation Oncology Journal
• /
• v.24 no.4
• /
• pp.248-254
• /
• 2006

$\underline{Purpose}$: To evaluate acute toxicities in cervix cancer patients receiving intensity modulated whole pelvic radiation therapy (IM-WPRT). $\underline{Materials\;and\;Methods}$: Between August 2004 and April 2006, 17 patients who underwent IM-WPRT were analysed. An intravenous contrast agent was used for radiotherapy planning computed tomography (CT). The central clinical target volume (CTV) included the primary tumor, uterus, vagina, and parametrium. The nodal CTV was defined as the lymph nodes larger than 1 cm seen on CT and the contrased-enhanced pelvic vessels. The planning target volume (PTV) was the 1-cm expanded volume around the central CTV, except for a 5-mm expansion from the posterior vagina, and the nodal PTV was defined as the nodal CTV plus a 1.5 cm margin. IM-WPRT was prescribed to deliver a dose of 50 Gy to more than 95% of the PTV. Acute toxicity was assessed with common toxicity criteria up to 60 days after radiotherapy. $\underline{Results}$: Grade 1 nausea developed in 10 (58.9%) patients, and grade 1 and 2 diarrhea developed in 11 (64.7%) and 1 (5.9%) patients, respectively. No grade 3 or higher gastrointestinal toxicity was seen. Leukopenia, anemia, and thrombocytopenia occurred in 15 (88.2%). 7 (41.2%), and 2 (11.8%) patients, respectively, as hematologic toxicities. Grade 3 leukopenia developed in 2 patients who were treated with concurrent chemoradiotherapy. $\underline{Conclusion}$: IM-WPRT can be a useful treatment for cervix cancer patients with decreased severe acute toxicities and a resultant improved compliance to whole pelvic irradiation.

• Clinical and Experimental Pediatrics
• /
• v.45 no.4
• /
• pp.505-511
• /
• 2002

Purpose : Mean platelet volume(MPV) and platelet distribution width(PDW) are useful parameters in evaluating disorders of platelets. In cases with idiopathic thrombocytopenic purpura(ITP), they change as platelet count increases. In this study, we compared the values of MPV and PDW in ITP patients at diagnosis with those of normal children. We also studied whether the early changes in MPV may predict the clinical course. Methods : From December 1995 to May 2001, 71 patients with ITP were admitted to Ajou University Hospital. They were treated with IVIg 400 mg/kg for five days and MPV, PDW, platelet count were analysed. Normal control group(n=38) was compared. The study group was divided into acute and chronic forms, and also divided into group A, good early responders whose platelets increased more than $100,000/{\mu}L$ within 5 days and group B who did not. Results : Mean value of MPV at diagnosis in ITP patients was lower than the normal control group(P<0.05). In group A, MPV was abruptly increased on the first day after IVIg and then started to decrease. But in group B, MPV was steadily increased until the fourth day after IVIg. In the normal control group, there were inverse correlations between platelet count and MPV(r=-0.415, P<0.05), but in ITP patients, there were positive relationships between platelet count and MPV(r=0.646, P<0.05) at diagnosis. Conclusions : MPV at diagnosis of ITP was lower than the normal control. MPV and PDW could not predict the course of ITP patients, but MPV could distinguish good early responders. More research is needed to find out the reasons of decreased MPV at diagnosis of ITP.

• Journal of the Korean Society of Food Science and Nutrition
• /
• v.41 no.12
• /
• pp.1716-1726
• /
• 2012

This study was undertaken to evaluate the antihyperglycemic, antilipid peroxidative, and antioxidant effects of the ethanol extracts of Artemisia iwayomogi (Ai) in streptozotocin (STZ)-induced diabetic rats. Diabetes was induced in Sprague-Dawley rats with a single intravenous injection (45 mg/kg b.w.) of STZ. The diabetic rats were then randomized to the diabetic and Ai extract therapy groups which were treated with Ai extract at doses of 1, 2, and 3 g/kg b.w./day, respectively, for 14 days. Oral administration of Ai (2 g/kg b.w.) significantly decreased their intake of food. Dosage of 2 g/kg of the extract significantly decreased blood glucose levels in the glucose level in diabetic rats after 4 day, there was no significant difference observed at 1 and 3 g/kg. A dose of 2 or 3 g/kg of the Ai extract significantly reduced plasma glucose levels in STZ-induced hyperglycemic rats at 7 days. The hypoglycemic effect of Ai at a dose of 2 g/kg was significantly more effective than that of STZ-control. The effect was more pronounced in 2 g/kg than 1 g and 3 g/kg. A significant reduction in triglycerides (TG) and free fatty acids (FFA), and a significant increase in liver glycogen were observed in treated diabetic rats at doses of 2 g/kg after 14 days of treatment. Administration of Ai extracts to diabetic rats showed a significant decrease in liver malondialdehyde (MDA) levels. The activity of superoxide dismutase (SOD) was significantly increased in the 3 g extract-supplemented groups. The activities of glutathione peroxidase (GSH-px) and catalase (CAT) were significantly increased in the 1 g and 3 g extract-supplemented groups. Ai extract significantly increased glutathione-S transferase (GST) activity in a dose-dependent manner compared with treatment in STZ-control rats. Our result supports the fact that the administration of Ai extract is able to reduce hyperglycemia and hyperlipidemia risk, and also reduce the oxidative stress in diabetic rats.