• Clinical Endoscopy
• /
• v.55 no.2
• /
• pp.234-239
• /
• 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.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.9 no.2
• /
• pp.104-107
• /
• 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
• /
• v.75 no.5
• /
• pp.218-221
• /
• 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
• /
• v.18 no.2
• /
• pp.102-106
• /
• 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
• /
• v.57 no.4
• /
• pp.307-310
• /
• 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
• /
• v.31 no.1
• /
• pp.130-135
• /
• 2024

The effectiveness of corticosteroids in preventing immune reconstitution inflammatory syndrome in non-human immunodeficiency viruses Pneumocystis carinii pneumonia (PCP) patients, such as severe combined immunodeficiency (SCID) patients, is controversial. We experienced a paradoxical reaction during severe PCP treatment in a SCID infant, which responded well to adjuvant corticosteroids.

• Tuberculosis and Respiratory Diseases
• /
• v.78 no.2
• /
• pp.47-55
• /
• 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.

• Journal of Popular Narrative
• /
• v.25 no.1
• /
• pp.349-392
• /
• 2019

In the 1960s of Korea, the normalization of diplomatic relations between Korea and Japan led to a sense of a vigorous anxiety and fear that "Japan will once again come to the Korean peninsula". As a reaction to this, the discourse on the criticism of 'Japanese Style' strongly emerged. If the prior discourse of criticism was to express the national antipathy toward the colonial remnants that had not yet been disposed of, the critical discourse of the 1960s was the wariness of the newly created 'Japanese Style' in popular culture, and to grasp it as a symptomatic phenomenon that 'evil-minded Japan' was revealed. Thus, this new logic of criticism of the 'Japanese Style' had a qualitative difference from the existing ones. It was accompanied by a willingness to inspect and censor the 'masses' that grew up as consumers of transnational 'mass culture' that flowed and chained in the geopolitical order under the Cold War system. Therefore, the topology of 'popular things=Japanese things=consuming things' reveals the paradox of moral demands that existed within Korean society in the 1960s. This was to solidify the divisive circulation structure that caused them to avoid direct contact with the other called 'Japan', but at the same time, get as close to it as ever. It is a repetitive obsession that pushes the other to another side through the moral segregation that strictly draws a line of demarcation between oneself and the other, but on the other hand is attracted to the object and pulls it back to its side. This paper intends to listen to the different voices that have arisen in the repetitive obsession to understand the significance of the dissonance that has been repeated in the contemporary era. This will be an examination of the paradoxical object of Japan that has been repeatedly asked to build the internal control principle of Korean society, or to hide the oppressive and violent side of the power, and that can neither be accepted nor destroyed completely as part of oneself.