• 대한약침학회지
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• 제25권2호
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• pp.114-120
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• 2022

Objectives: Antivenom serums have been used extensively for over a century and are the only effective treatment option for snake bites and other dangerous animal envenomations. In therapeutic serum centers, a wide range of antivenoms is made from animal serum, mainly equine and sheep, that are immunized with single or multiple venoms. This work aimed to use caprylic acid (CA) to purify therapeutic snake antivenom. Methods: Plasma was obtained from equine immunized with a mixture of venoms. Immunized plasma was obtained by precipitation of different concentrations (2-5%) of CA. This methodology was compared to that based on ammonium sulfate (AS) precipitation. Sediment plasma proteins were purified by ion-exchange chromatography. Protein assay, SDSPAGE, and agar gel diffusion were performed. Results: The total protein precipitation with AS was higher than precipitation with CA, but the best results were obtained when CA was added to the plasma until a final CA concentration of 5% was reached. Chromatography and electrophoresis indicated a stronger band for the 5% CA, and the gel diffusion assay showed antigen-antibody interaction in the purified serum. Conclusion: The use of CA compared to the routine method for purifying hyperimmune serums is a practical and cost-effective method for preparing and producing therapeutic serums. It constitutes a potentially valuable technology for alleviating the critical shortage of antivenom in Iran.

• Childhood Kidney Diseases
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• 제21권2호
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• pp.81-88
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• 2017

Purpose: The American Society for Apheresis provides clinical guidelines for therapeutic apheresis in adults, but there are no guidelines for children. This study aimed to analyze the effect of therapeutic plasma exchange (TPE) in pediatric patients with various kidney diseases in Korea. Methods: We retrospectively reviewed the data of 16 children (up to 18 years of age) who were admitted to Severance Children's Hospital with refractory kidney disease. All patients received TPE between 1994 and 2016. Clinical and laboratory characteristics such as age, weight, sex, change in blood urea nitrogen (BUN), and creatinine level before and after TPE, and complications after TPE were analyzed. Results: The mean age and weight of the 16 patients at the time of TPE was $11.3{\pm}4.0$ years and $34.6{\pm}17.5$ kg, respectively. The BUN level was 35.4 mg/dL before TPE and significantly decreased to 21.5 mg/dL (P=0.025) at 1 week and 20.5 mg/dL (P= 0.01) at 1 month after TPE. The creatinine level significantly decreased from 1.20 mg/dL before TPE to 0.90 mg/dL (P=0.02) at 1 week after TPE. Four complications (hypovolemia, anemia, hypocalcemia, and thrombocytopenia) were reported, but were not fatal. Conclusion: Our findings suggest that TPE is an effective therapeutic modality in children with refractory kidney disease and can be indicated for the treatment of various kidney diseases.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권6호
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• pp.481-488
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• 2022

Purpose: Liver transplantation (LT) is the only curative treatment for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). In high-volume therapeutic plasma exchange (HV-TPE), extracorporeal liver support filters accumulate toxins and improve the coagulation factor by replacing them. In this study, we aimed to evaluate the effectiveness of HV-TPE in pediatric patients with ALF and ACLF. Methods: We reviewed the records of children waiting for LT at Severance Hospital who underwent HV-TPE between 2017 and 2021. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), total and direct bilirubin (TB and DB), gamma-glutamyl transferase (GGT), ammonia, and coagulation parameter-international normalized ratio (INR) were all measured before and after HV-TPE to analyze the liver function. The statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Co., Armonk, NY, USA). Results: Nine patients underwent HV-TPE with standard medical therapy while waiting for LT. One had neonatal hemochromatosis, four had biliary atresia, and the other four had ALF of unknown etiology. Significant decreases in AST, ALT, TB, DB, GGT, and INR were noted after performing HV-TPE (930.38-331.75 IU/L, 282.62-63.00 IU/L, 11.75-5.59 mg/dL, 8.10-3.66 mg/dL, 205.62-51.75 IU/L, and 3.57-1.50, respectively, p<0.05). All patients underwent LT, and two expired due to acute complications. Conclusion: HV-TPE could remove accumulated toxins and improve coagulation. Therefore, we conclude that HV-TPE can be regarded as a representative bridging therapy before LT.

• Clinical and Experimental Pediatrics
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• 제53권8호
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• pp.805-808
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• 2010

Although sodium nitroprusside (SNP) is often used in pediatric intensive care units, cyanide toxicity can occur after SNP treatment. To treat SNP-induced cyanide poisoning, antidotes such as amyl nitrite, sodium nitrite, sodium thiosulfate, and hydroxycobalamin should be administered immediately after diagnosis. Here, we report the first case of a very young infant whose SNP-induced cyanide poisoning was successfully treated by exchange transfusion. The success of this alternative method may be related to the fact that exchange transfusion not only removes the cyanide from the blood but also activates detoxification systems by supplying sulfur-rich plasma. Moreover, exchange transfusion replaces cyanide-contaminated erythrocytes with fresh erythrocytes, thereby improving the blood's oxygen carrying capacity more rapidly than antidote therapy. Therefore, we believe that exchange transfusion might be an effective therapeutic modality for critical cases of cyanide poisoning.

• Childhood Kidney Diseases
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• 제9권1호
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• pp.38-45
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• 2005

목 적 : 본 연구에서는 소아의 다양한 질환에서 시행한 치료적 혈장 교환술 9례의 치료 경과를 분석하고자 하였다. 방 법 : 원심 분리 기기를 이용한 COBE Spectra 기기를 이용하여 치료적 혈장 교환술을 시행하였으며 시행한 증례별로 원인 질환, 시행 횟수, 시행 방법, 치료 경과, 예후 등을 병록 기록지를 통하여 후향적으로 분석하였다. 결 과 : 대상 환아 9명의 연령 분포는 2세에서 16세로 평균 연령은 9.8세였으며 성비는 남아 5명, 여아 4명이었다. 치료적 혈장 교환술을 시행하게된 원인 질환은 용혈성 요독 증후군 2례, 루프스 신염 1례, 급속 진행성 신염 2례, 국소성 분절성 사구체 경화증 1례, 폐출혈로 발현한 전신성 혈관염 1례, 폐출혈을 동반한 원인 미상의 급성 신부전 1례, 신이식후 급성 거부 반응 1례였다. 혈장 교환 시행 횟수는 3회에서 13회로 평균6.9$\pm$3.0회를 시행하였으며 용혈성 요독 증후군, 루프스 신염, 폐출혈로 발현한 ANCA 양성 전신성 혈관염, 원인 미상의 폐출혈 동반 신부전에서는 호전을 보였으며 급속 진행성 신염과 치료 저항성 국소성 분절성 사구체 경화증, 신이식후 급성 거부 반응에는 효과가 없었다 시행 전후에 가장 흔한 부작용은 저 칼슘혈증이었으나 심각한 증상을 동반한 경우는 드물었으며 그 밖의 부작용도 경미하여 비교적 안전하게 치료적 혈장 교환술을 시행할 수 있었다. 결 론 : 본 연구에서는 대상 환아가 적은 제한점이 있어 치료 효과를 일반화하기 어려우나 향후 소아의 다양한 질환에서 혈장 교환술이 치료방법으로 선택되어질 수 있을 것으로 보인다.균 15개월의 간격을 두고 시행한 실험실 검사간에 유의한 차이는 없었으며, 추적기간 중 신부전으로 진행되거나 고혈압 등의 합병증을 보인 경우는 한 례도 없었다. 결 론 : 사구체 기저막 비박화는 소아의 무증상성 혈뇨의 가장 주된 원인으로, 특히 학생집단뇨검사 시행 이후 그 진단이 현저히 증가되었다. 가족력상 진행성 신질환이 있는 경우나 사구체 기저막에 국소적인 중복이 있는 경우는 알포트증후군의 확진이 필요하며, 지속적인 추적관찰이 필요하다고 생각된다.%, 골다공증은 11%로 상당수에서 골상태가 비정상임을 알 수 있었다. 본 연구에서는 스테로이드 사용기간 및 축적용량이 골상내의 변화에 특별한 영향을 미치지 않는 것으로 나타났다. 동일 환자들의 골상태의 변화관찰과 신질환 관련 골감소의 요인을 밝혀내기 위한 추가적인 연구가 필요할 것으로 사료된다. 정확한 진단 및 동반된 질환을 감별하기 위한 노력이 필요하다.심되나 X-ray VCUG로 발견되지 않은 경우에는 RI VCUG를 꼭 시행하는 것이 방광요관역류의 정확한 진단을 하는데 도움이 된다..25% sodium 식이 enalapril군에서 사구체여과율이 증가됨을 관찰할 수 있었다. 4) 신절제술후 남아 있는 신조직무게를 비교하여 보면 24주째 0.25% sodium 식이군, 0.25% sodium 식이 enalapril군, 0.25% sodium 식이 nicardipine군에서 16주째 0.49% sodium 식이군, 0.49% sodium 식이 enalapril군, 0.49% sodium 식이 nicardipine 군보다 의의있게 신조직무게가 증가됨을 관찰할 수 없었다. 5) 0.25%

• 한국양식학회지
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• 제19권1호
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• pp.33-39
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• 2006

Anticoagulant activities of a fermented edible brown alga, Laminaria ochotensis was investigated. L. ochotensis was fermented with 15% sugar (w/v) at $25^{\circ}C$ for 10 weeks. Anticoagulant activity was measured from the supernatant of algal mixture at biweekly intervals up to $10^{th}$ week by activated partial thromboplastin (APTT), prothrombin time (PT) and thrombin time (TT) assay using citrated human plasma. Sample having high APTT activity $(6^{th}\;week)$ was filtered, ethanol precipitated and freeze-dried. The polysaccharide compound having anticoagulant activity was purified by DEAE ion exchange chromatography followed by Sepharose-4B gel filtration chromatography. Anticoagulant activity, polysaccharide concentration, and heparin like activity were determined for the collected fractions by APTT, $phenol-H_2SO_4$, and glycosaminoglycan assay, respectively. The anticoagulant activity assay showed that the activity was increased up to $6^{th}$ week, and decreased thereafter. The concentration of our purified compound was $31.0{\mu}g/ml$ and showed higher APTT activity than commercial heparin. At the same concentration of $31.0{\mu}g/ml$, the heparin showed 186.5 sec activity while our purified compound showed an activity of 386 sec. Single spot on agarose gel electrophoresis showed that the compound was purified and polyacrylamide gel electrophoresis (PAGE) results revealed that the molecular mass of the purified polysaccharide compound was between 60 and 500 kDa. Therapeutic interest of the algal polysaccharide as an anticoagulant has recently been in highlighted. This purified anticoagulant compound from fermented L. ochotensis can be used as a model for anticoagulant agent or could be developed as an anticoagulant agent. This study can be extended to identify the structure and chemical composition of the purified polysaccharide, and to establish a relationship between structure and the function of the identified anticoagulant compounds.

• 대한한방내과학회지
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• 제44권6호
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• pp.1279-1293
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• 2023

A 67-year-old female patient diagnosed with acute transverse myelitis visited our hospital in February 2023. Consultation papers indicated that she was diagnosed with acute transverse myelitis and that she complained of quadriparesis and numbness in both hands and feet. However, her spine magnetic resonance imaging (MRI) did not clearly indicate that she suffered from acute transverse myelitis. She was then sent to a high-level hospital and diagnosed with Guillain-Barre Syndrome through electromyography, cerebrospinal fluid test, and spine MRI. On March 2023, she visited our hospital again, still complaining about weakness in both hands and inability to walk. She was treated with Korean medicine, including acupuncture, electroacupuncture, pharmacopuncture, and herbal medicine such as Yanggyeoksanhwatang and Sipimijihwang-tanggami. After three months, she was discharged on cane walking. The manual muscle test (MMT) grade of her upper limbs increased from 3-/3-/3-/3- (shoulder/elbow/wrist/fingers) to 4/4/4/3+, and the MMT grade of her lower limbs increased from 2/2/2/2 (pelvis/knee/ankle/feet) to 4/4/4-/4-. Her numbness in both feet disappeared, and her numbness in both hands decreased from a numeric rating scale of 7 to 2. No adverse events were reported during treatment. This case implies the therapeutic potential of Korean medicine for Guillain-Barre Syndrome, especially for those who had delayed diagnosis and missed the opportunity to get plasma exchange.