• 대한한의학회지
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• 제43권2호
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• pp.110-116
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• 2022

Objectve: To inform a clinical usefulness of Nangan-geon (暖肝煎) decoction to treat a refractory abdominal pain especially in eldery. Methods: This case report presents an 85-year old male patient who had been suffered with a refractory abdominal pain without any abnormality in laboratory test and radiological examination for 5-years. The clinical outcome was observed by numerical rating scale (NRS) of self-reporting method. Results: Based on his previous multiple normal examination results from Western hospitals and clinical features including thin body (19.6 BMI), nocturnal pain around lower abdomen and cold-sensitivity, author diagnosed him as "deficiency and cold of liver-Qi (肝氣虛寒)" similar to intestinal spasm. After prescription with Nangan-geon (暖肝煎) for one month, all symptoms became improved notably (NRS 5), and almost completely recovered as a level of normal condition in 3 months (NRS 1). Conclusion: This study would show the potential of traditional Korean medicine (TKM) therapies for a refractory functional abdominal pain, and especially efficacy of Nangan-geon against cold-pattern of nonspecific abdominal pain in elderly patients.

• Clinical Endoscopy
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• 제51권6호
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• pp.570-575
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• 2018

Background/Aims: Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. Methods: This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. Results: Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (${\pm}$standard deviation) age of $50.9{\pm}15.9$ years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. Conclusions: Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.

• The Korean Journal of Pain
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• 제11권2호
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• pp.317-320
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• 1998

Since Reiestad and Str$\ddot{o}$mskag reported interpleural installation of local anesthetic solutions as a technique for the management of postoperative pain in the patients undergoing cholecystectomy, renal surgery and breast surgery, many physician applied this technique for upper abdominal pain from various reasons such as technically simple, effective pain relief, less respiratory depression. So we tried interpleural analgesia in two patients who suffered from severe upper abdominal pain. One had upper abdominal pain due to chronic pancreatitis and the other had right upper abdominal pain after PTBD (percutaneous transhepatic bile drainage) for biliary cirrhosis and systemic jaundice. Both were injected 10 ml of 1% lidocaine and infused continuously with 1% lidocaine (2 ml/hr) using 2-Day Baxter$^{(R)}$ infusor. After bolus injection of lidocaine, pain scores (VAS 0~100) were recorded below 25mm and had not exceed that level during continuous infusion. After removing the catheters, two patients were all satisfied with this therapy. Our experiences with this technique showed that continuous infusion of local anesthetics through an interpleural catheter is effective in the control of refractory upper abdominal pain without any complication.

• Childhood Kidney Diseases
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• 제1권2호
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• pp.176-178
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• 1997

Henoch-Scholein purpura is a systemic vasculitis of small blood vessels. It is characterized by nonthrombocytopenic purpura, abdominal pain, arthralgia and renal involvement. In Henoch-Scholein purpura, severe abdominal pain may be relived by steroid, but occasionally unresponsive to steroid and conventional analgesics therapy. We tried IV-gamma globulin for severe abdominal pain, unresponsive to steroid, analgesics, and antispasmodics therapy in HSP, and experienced dramatic symptomatic improvement. So we report three cases of IVIG therapy against severe abdominal pain in HSP with a brief review of literatures

• Clinical Endoscopy
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• 제51권6호
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• pp.508-509
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• 2018

• 대한한방내과학회지
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• 제34권4호
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• pp.466-477
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• 2013

Objectives : To report and demonstrate the effect of decreasing ascites volume by SB intraperitoneal injection to a refractory ascites patient with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis. Methods : Two cycles of intraperitoneal and intravenous SB injection were conducted. Each injection cycle was made up of 4 days. Nine vials of SB were injected to the patient every day. To compare the volume of ascites between pret- and post-treatment, follow-up computed tomography was done on June 3, 2013. To observe other therapeutic effects of SB injection, laboratory tests were conducted periodically. Results : On the follow-up computed tomography images, the amount of ascites and pleural effusion had decreased compared to the April 30, 2013 computed tomography images. The levels of aspartate transaminase, alanine aminotransferase and lactate dehydrogenase decreased significantly from May 9, to May 30, 2013. The amount of oral intake increased constantly during hospitalization. The patient's symptoms such as abdominal distension, abdominal pain and dyspnea were improving until discharge. Conclusions : Even if thiese results cannot be applied to every synchronous colorectal cancer liver metastasis patient, we demonstrated that SB intraperitoneal injection has ascites-decreasing effect to refractory ascites patients with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권3호
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• pp.214-220
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• 2016

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (${\times}2$) and via a nasoduodenal tube (${\times}4$) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.485-488
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• 2010

Purpose: Paragonimiasis is infectious disease occurred by Paragonimus Westermani, which invades into human body as a final host. Habitual eating the freshwater crab or crawfish unboiled is one of the reason of infection. Paragonimiasis raged in 1970s in Korea, Japan, China and other Asian countries but the incidence decreased rapidly. Once people eat infected second host, parasite penetrates the duodenal wall and migrates to the lung. During this migration period, the parasite can migrate to other organ, such as brain, spinal cord, liver and subcutaneous tissue, but the cases are rarely reported. The objective of our study is to present our experience of the ectopic migration of parasite to the subcutaneous tissue of the abdomen, which was easily treated with excision and Praziquantel medication. Methods: A 59-year-old woman who likes eating unboiled freshwater crab was diagnosed as Paragonimiasis 15 months ago. Her symptoms were fever and cough, and she was treated with Praziquantel medication. 3 months after discharge, she visited our hospital with left pleuritic chest pain, cough with fever, and palpable mass formation on left lower quadrant of the abdomen. Wedge resection of the left lung and Praziquantel medication was maintained for a week. Nevertheless, fever persisted after the treatment. The patient received total excision of the abdominal soft tissue mass, and the fever was relieved. Results: Pathologic findings of the mass showed multiple cyst and abscess formation with crystal structure which is suspicious parts of the parasite or calcified egg shells. Uncontrolled fever was relieved after the operation, and there was no evidence of recurrent Paragonimiasis and ectopic migration for 1 year follow up period. Conclusion: Ectopic migration of Paragonimus is rare, but multiple organ can be involved. Patient with Paragominiasis who was refractory in fever control after Praziquantel medication or surgical evaluation of the lung should be considered as ectopic migration of the Paragonimiasis.

• 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.

• 정신신체의학
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• 제14권1호
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• pp.62-66
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• 2006

서론: 치료저항성 환자 치료 시 선택될 수 있는 여러 약물들의 병용 투여에 의해 예측할 수 없는 심각한 부작용을 야기하는 약물 상호작용이 일어날 수 있다. 저자들은 만성 정신분열병 환자에서 클로자핀(clozapine)과 부스피론(buspirone)을 병용 투여한 후 상부위장관 출혈이 의심되는 사례가 있어 보고하고자 한다. 증례: 망상형 정신분열병으로 진단받은 69세 여자 환자로 입원 당시 혈색소가 약간 감소된 것을 제외하고는 신체검사와 검사실 검사 상 다른 특이 소견은 없었다. 불안 증상이 심하여 부스피론 15mg을 올란자핀(olnazapine) 30mg과 같이 투여하였다. 하지만, 병력상 약물에 반응이 좋지 않고 본원 입원 치료에서 치료 반응이 없어 올란자핀을 클로자핀으로 교체하였다 인원 11주째, 클로자핀으로 교체한 지 4주가 지난 후, 환자는 클로자핀 300mg과 부스피론 60mg을 복용하고 있었다. 이 시점에서 약 4일 동안 간헐적으로 복통, 발한, 저혈압, 구토, 발열과 함께 토혈, 흑색변 소견 보였지만, 위내시경과 위장조영촬영에서 상복부위장관 출혈 소견은 발견되지 않았다. 모든 약물을 중단한 후, 상부위장관 출혈 의심 증상은 사라졌다. 이후 클로자핀만 단독으로 투여한 후, 정신병적 증상 호전을 보였고 상부위장관 출혈 소견도 재발하지 않았다. 고찰: 상부위장관 출혈은 클로자핀과 부스피론 각각의 약리학적 작용 및 부작용의 측면에서는 예상할 수 없었던 부작용이었으나, 정신분열병 치료를 위해 투여하고 있던 클로자핀에 추가적으로 항불안 효과가 있는 부스피론을 복합 투여하는 동안 발생하였으며 부스피론을 중단한 이후에는 동일한 부작용이 재발하지 않았다. 따라서, 저자들은 상부위장관 출혈 부작용의 발생 원인을 클로자핀과 부스피론 두 약물의 상호작용에 의한 것으로 보고 참고 문헌에 기초하여 몇 가지 가능한 기전들에 대해 고찰해 보았다. 두 약물의 상호작용에 대한 명백한 기전은 아직 밝혀지지 않았으나 상부위장관 출혈은 잠재적으로 생명에 치명적인 부작용이므로 클로자핀과 부스피론의 병용 투여 시 특별한 주의를 요한다.