• Clinical Endoscopy
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• 제55권2호
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• pp.234-239
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• 2022

Background/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions. Methods: This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction. Results: A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups. Conclusions: Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

• 대한치과마취과학회지
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• 제9권2호
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• pp.104-107
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• 2009

Midazolam, one of the most common benzodiazepine derivatives, is widely used in intravenous sedation for dental treatment without severe complications. However, paradoxical reactions to midazolam, including patient's unanticipated restlessness, agitation, hostility, and rage, have been frequently reported since the introduction of benzodiazepine. During outpatient intravenous sedation using midazolam for dental treatment, we experienced a paradoxical reaction to midazolam in a 28-year-old female patient. With a thorough review of the literature, the management of this complication and its various etiologies were discussed.

• Tuberculosis and Respiratory Diseases
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• 제75권5호
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• pp.218-221
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• 2013

This report describes a rare case of a patient with splenic tuberculosis (TB) who developed spontaneous splenic rupture after 10 weeks of antituberculous chemotherapy. The patient responded well to the antituberculous regimen prior to the spontaneous splenic rupture. We considered a paradoxical reaction as a cause of the splenic rupture. The patient underwent splenectomy and continuously received initial antituberculous drugs without change. To the best of our knowledge, this is the first report of spontaneous splenic rupture as a paradoxical reaction to antituberculous chemotherapy in an immunocompetent host with splenic TB.

• Clinical Pain
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• 제18권2호
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• pp.102-106
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• 2019

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.307-310
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• 2015

We report a case of a paradoxical response of a tuberculoma in the brain mimicking a brain tumor. A 76-year-old woman presented with a 2 week history of headache, dysarthia, and orthopnea. Brain magnetic resonance images (MRI) revealed two rim-enhancing lesions on the pons and occipital lobe, and chest computed tomography showed randomly distributed miliary nodules. The tentative diagnosis was tuberculosis (TB) of the brain and lung. She complained of right hemiparesis and worsening general weakness after taking the anti-TB medication. On the monthly follow-up images, the enhanced lesions were enlarged with increased perfusion and choline/creatinine ratio, suggesting a high grade glioma. A surgical resection was completed to diagnose the occipital lesion, and the tuberculoma was pathologically confirmed by a positive TB-polymerase chain reaction. The anti-TB medication was continued for 13 months. A follow-up MRI showed decreased size of the brain lesions associated with perilesional edema, and the clinical symptoms had improved. Brain tuberculoma could be aggravated mimicking brain malignancy during administration of anti-TB medication. This paradoxical response can be effectively managed by continuing the anti-TB drugs.

• Pediatric Infection and Vaccine
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• 제31권1호
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• pp.130-135
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• 2024

인체면역결핍바이러스 감염자의 페포자충폐렴 치료에 있어 보조적 스테로이드 치료의 효용성은 잘 알려진데 반해, 비인체면역결핍바이러스 면역저하자에서의 페포자충폐렴 치료에 있어서의 보조적 스테로이드 치료의 효용성은 논란의 여지가 있다. 본 연구자들은 비인체면역결핍바이러스 면역저하자인 중증복합면역결핍증 영아에서 이환된 중증페포자충폐렴를 치료하던 중 면역재구성염증증후군 유사현상을 관찰하였으며, 보조적 스테로이드 치료에 잘 반응하였기에 이를 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제78권2호
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• pp.47-55
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• 2015

Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment.

• 대중서사연구
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• 제25권1호
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• pp.349-392
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• 2019

한일국교정상화를 전후하여 '일본이 또 다시 한반도로 온다'라는 막연한 불안과 공포의 정조가 조성되었으며, 그에 대한 반작용으로 '왜색' 비판담론이 강력하게 대두되었다. 다만 기존의 '왜색' 비판담론이 미처 처분하지 못한 식민지 잔재에 대한 민족적 반감을 표명하는 것이었다면, 1960년대 비판담론은 대중문화 속에서 새롭게 생성되고 있던 '왜색'에 신경을 곤두세우고 있었으며 그것을 한국에 대한 '일본의 변함없는 악의'가 징후적으로 드러나는 현상으로서 파악하고자 했던 것이다. 이처럼 국교정상화를 전후하여 대두된 '왜색' 비판담론은 기존 비판담론과는 질적인 차이를 지녔다. 이 새로운 '왜색' 비판의 논리는 "국경을 넘는 문화적 현대성의 매개", 즉 냉전체제하 지정학적 질서 속에서 유동하고 연쇄되었던 서구(미국)발 탈민족적·탈국가적 '대중문화'와 그것의 소비주체로서 성장한 '대중'에 대한 경계와 검열의 의지를 동반하고 있었던 것이다. 따라서 1960년대 한국에서 '대중적인 것=왜색적인 것=소비적인 것'의 위상학은 그 사회 내부에 존재했던 "도덕적 요구의 역설"을 드러내 보인다. 이는 일본이라는 타자와의 직접적 접촉을 회피하도록 하면서도 동시에 그것에 한없이 이끌리며 가까이 다가가도록 만드는 분열적 순환구조를 고착화하는 계기가 된다. 그것은 자타를 엄밀하게 가르는 도덕적 절단을 통해 대상을 저편으로 밀어내면서도 한편으로는 그 대상에 매료되어 다시 이편으로 끌어들이는 반복강박을 내포하는 것이다. 이 글은 그것이 구조화된 궤적을 더듬어보고 그에서 반복되어 나타난 불협화음의 의의를 정치미학적 차원에서 해명하고자 당대에 발생된 상이한 소리들에 귀를 기울여 볼 작정이다. 그것은 곧 한국사회의 내적 통제원리를 구축하려는 권력이 강력하게 발동하면 할수록, 혹은 그 권력이 지닌 억압적이고도 폭력적인 이면을 감추기 위해서라도 되풀이하여 끌어들어야만 했던 '일본(적인 것)'이라는 대타성, 즉 완전히 자신의 일부로 받아들일 수도 없고 소멸시켜 버릴 수도 없는 역설에 대한 고찰이 될 것이다.