• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.2
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• pp.98-102
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• 2013

Aplastic anemia (AA) is a blood dyscrasia characterized by hypocelluar bone marrow and peripheral blood pancytopenia. Symptomatology depends on the severity of pancytopenia. Patients with AA are susceptible to infection because of agranulocytosis. Hemorrhage caused by thrombocytopenia can be fetal to these patients. Therefore dental procedure potentially can cause serious complications and should be applied with caution. A 6-year-old boy with moderate aplastic anemia was referred to treat dental caries. General dental procedure including resin filling, preformed crown, pulpectomy and extraction was performed under sedation. Combination of modalities such as platelet transfusion, oral hygiene instruction, and dental prophylaxis was also implemented. In this report, the dental and medical management of a patient with AA was presented. Interdisciplinary care should be administered to patients with AA.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.10
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• pp.4169-4173
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• 2014

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determine the diagnostic value of EBUS-TBNA in patients with suspected lymphoma. Materials and Methods: Sixty-eight patients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study. EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negative predictive value and diagnostic accuracy of EBUS-TBNA were calculated. Results: Sixty-four patients were diagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures. Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) had tuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma (follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the 15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. Conclusions: EBUS-TBNA can be employed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.37-42
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• 1995

The intermittent injection of analgesics is a inadquate method for postoperative pain control. Recently a non-electroic, disposable and portable infusor (Boxter Two Day $Infusor^R$) has been developed which can deliver analgesics with 2 ml/h speed continuousely. The present study examined the effects of three methods of pain management on recovery in 306 patients undergoing elective surgery in Wonkwang University Hospital. Group 1 (n=106) received i.m. $Valentac^R$ on a PRN basis. Group 2 (n=100), initial 2 mg of bolus morphine was followed by 48 mg of continuous infusion. Group 3 (n=100), initial 2 mg of morphine followed by morphine 18 mg-ketorolac 120 mg. We evaluated an analgesic efficacy with NRS (numerical rating scale) at 12, 24, 36, 48, 60 and 72 hours after the operation. The side effects (nausea, vomiting, pruritus, sedation and respiratory depression) were evaluated. In group 1, we asked major concern before operation and efficacy of pain control with pain severity (no pain, mild pain, moderate pain, sever pain). The results were as follows: 1) Major concern before operation is pain (40%). 2) 53% of patients suffered pain in group 1. 3) Morphine and morphine-ketorolac infusion groups were superior to the i. m. ($Valentac^R$) group with respect to postoperative analgesia. 4) In group 3 (morphine-ketorolac), there was no pruritus and mild nausea and vomiting.

• Journal of the korean academy of Pediatric Dentistry
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• v.49 no.3
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• pp.348-356
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• 2022

Supernumerary teeth develop from excessive proliferation and development of the dental lamina. Supernumerary teeth can cause several problems, including ectopic eruption, delayed eruption, root resorption of adjacent teeth, and diastema. Supernumerary teeth in infancy are rare and have rarely been reported. Case of a 2-day-old infant with 3 supernumerary teeth is presented here and the patient was followed up for 21 months. The erupted supernumerary tooth in the primary dentition was extracted under moderate sedation at the age of 14 months. Microcomputed tomography analysis of the extracted tooth confirmed microscopic root malformation. After extraction, the midline diastema was reduced and oral hygiene improved. Early diagnosis and prompt treatment can prevent complications of supernumerary teeth.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.1
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• pp.46-50
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• 2013

Developmental disorders are a group of psychiatric conditions originating in childhood that involve serious impairments in different areas. These disorders comprise language disorders, learning disorders, motor disorders and autism spectrum disorders. Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties. The anterograde amnesia property of midazolam is useful for premedication before surgery to inhibit unpleasant memories. This article presents a case report including caries treatment of a 8-year-old male patient with developmental disorders using oral midazolam premedication as an alternative method of behavior management prior to general anesthesia.

• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.214-233
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• 2016

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.5 no.1
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• pp.23-26
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• 2009

Mental retardation is defined by the American Psychiatric Association as" subnormal general intellectual functioning which originates during the developmental period and is associated with impairment of either learning and social adjustment or maturation, or both." A patient with mild to moderate mental retardation can be managed adequately using restraints and medications. However, in case of severe or profound mental disability, dental treatment cannot be accomplished even with the use of behavior modification, physical restraints and sedation techniques. When treatment in the dental office has much difficulty, hospitalization for dental treatment under general anesthesia can and should be considered. This case presents the treatment of a patient with mental retardation who was referred to our department for comprehensive dental care. Dental examination revealed widespread dental caries and a severe anterior open bite with crowding problems. Under general anesthesia, generalized caries treatment was performed by our department, and the anterior dental esthetics was achieved in collaboration with the department of prosthodontic dentistry.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.22-28
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• 2008

Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was $174{\pm}56$ min and staying time at PACU was $88{\pm}39$ min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.239-250
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• 2005

Objective : The purpose of this study was obtaining data on the efficacy and safety of risperidone in child and adolescent psychiatric patients. Method : Thirty one children and adolescents (males n=18, females n=13, age ranged from 5.4 to 17.3 years) treated with risperidone were selected among child and adolescent psychiatric inpatients of Seoul National University Hospital from January, 2001 to June, 2002, and charts for them were reviewed retrospectively. Results : The primary psychiatric disorders treated with risperidone were schizophrenia and other psychosis, bipolar I disorder with psychotic features, Tourette's disorder, autism spectrum disorders, mixed receptive and expressive language disorder, attention deficit-hyperactivity disorder, conduct disorder and obsessive-compulsive disorder. twelve of these had comorbid mental retardation. Primary target symptoms of risperidone were psychotic symptoms (n=13 or $41.9\%$), behavioral symptoms (n=10 or $32.3\%$) including aggression, impulsivity, hyperactivity, stereotypy nonresponsive to other psychiatric treatments, and chronic and severe tics (n=8, $25.8\%$). The efficacy of risperidone was measured by clinical global improvement (CGI) for target symptoms, $67.7\%$ of subjects showed moderate or marked improvements and its therapeutic effect appeared to be maintained during at least 7.5 months. Mean daily dosage of risperidone was $0.05{\pm}0.01mg/kg$, the group with psychotic symptoms had significantly higher mean daily dosage (0.07mg/kg) compared with other two groups (0.04mg/kg) with behavioral symptoms or tics. A variety of adverse events were reported in this study : weight gain (n=23) most commonly reported, extrapyramidal symptoms (n=15), autonomic symptoms (n=6), sedation (n=5) and symptoms related to hyperprolactinemia (n=2) etc. Although there was no drug change related to the adverse events of risperidone, and $90\%$ of subjects at their last visits were maintained on it, thus its tolerability appeared good. Conclusions Results suggest that risperidone may be relatively safe and effective drug in managing a wide variety of child and adolescent psychopathologies such as psychotic symptoms, behavioral symptoms including aggression, impulsivity, hyperactivity and stereotypy nonresponsive to other psychiatric treatments, and chronic and severe tics. Controlled and long-term studies of efficacy and safety of risperidone treatment for children and adolescents are recommended in the future.