• Journal of Yeungnam Medical Science
• /
• v.32 no.2
• /
• pp.138-142
• /
• 2015

L-thyroxine (LT4) withdrawal prior to radioactive iodine (RAI) ablation therapy is a commonly used method for successful treatment of patients with papillary thyroid cancer (PTC). However, a prolonged period of hypothyroidism induced by LT4 withdrawal is sometimes associated with impaired quality of life and cardiopulmonary dysfunction in PTC patients. Furthermore, LT4 withdrawal may have a trophic effect on residual cancer by means of increased thyrotropin. We report on 2 cases of metastatic PTC patients with malignant pleural effusion (MPE) whose disease showed rapid worsening after LT4 withdrawal and RAI therapy. The first case is a 65-year-old woman who had PTC with multiple distant metastases and MPE. During LT4 withdrawal for RAI therapy, MPE showed rapid worsening, and the patient required repetitive therapeutic thoracentesis. The second case is a 49-year-old woman with PTC who underwent 3 additional operations for cancer recurrence in the neck lymph nodes and 6 times of RAI treatments. While preparing for the $7^{th}$ RAI treatment by withdrawing LT4, she developed MPE which became progressively aggravated after RAI therapy. Both patients experienced increased pleural effusion during the LT4 withdrawal period and a rise in the thyroglobulin level was observed after RAI therapy. MPE was not controlled with therapeutic thoracentesis and pleurodesis. Eventually, both patients died of rapid disease progression after RAI therapy. In summary, LT4 withdrawal may have an adverse effect on metastatic PTC patients, particularly those with MPE.

• The Journal of Internal Korean Medicine
• /
• v.22 no.3
• /
• pp.495-501
• /
• 2001

Alcohol withdrawal syndrome includes two or more of the following symptoms: autonomic hyperactivity, increased hand tremor, insomnia, nausea or vomiting, hallucinations of illusions, psychomotor agitation, anxiety, grand mal seizures. Symptoms are usually relieved by administering brain depressant. In oriental medicine, Ju sang correspond to alcohol withdrawal syndrome. Galhwahaesung-tang has been used for the treatment of Ju sang. The authors treated 2 cases of alcohol withdrawal syndome with Galhwahaesung-tang and symptoms are markedly improved. So, We report these case with a brief review of related literatures.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.6 no.1
• /
• pp.45-48
• /
• 2008

A 57-year-old man was transferred to our emergency department with decreased mental status after organophosphate intoxication. He had a four year history of benzodiazepine and hypnotic medication use for chronic insomnia and a depressive mood disorder. He had no previous history of seizures, diabetes mellitus, and hypertension. By hospital day 5, the patient was noted to be awake and to have repetitive jerking movements involving the left upper extremity, and appeared apathetic, depressed and less responsive to external stimuli. A benzodiazepine withdrawal syndrome was subsequently apparent when he developed several generalized tonic clonic seizures and status epilepticus. Using a continuous midazolam intravenous infusion, we successfully controlled the refractory seizure without complications. We present a rare case of status epilepticus from a benzodiazepine withdrawal that developed during the treatment for organophosphate intoxication.

• Journal of Trauma and Injury
• /
• v.21 no.2
• /
• pp.115-119
• /
• 2008

Purpose: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. Methods: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. Results: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (P<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (P<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (P<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (P<0.783), or in the duration of sedative use (P<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. Conclusion: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with post-operative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.

• Korean Journal of Biological Psychiatry
• /
• v.3 no.1
• /
• pp.51-56
• /
• 1996

The effects of 3 week treatment with haloperidol(2mg/kg/day, i.p.) on dopamine(DA) D2 receptor and DA metabolism in rat striata were studied at various time points after withdrawal from the drug treatment. Striatal DA D2 receptors were characterized with the radioligand 0.5nM [$^3H$]Spiperone. Dopamine(DA), homovanillic acid(HVA), 3,4-dihydroxyphenyl acetic acid(DOPAC) in rat striatum were measured with the high performance liquid chromatography. Drug withdrawal for 1 week induced significant increase in the number of D2 receptor in striatum after withdrawal for 1 week(p<0.05), and then this change was restored to control level during the withdrawal time of 2 and 4 weeks. There was no difference in striatal concentrations of DA and its metabolites among the groups. In conclusion, one-week withdrawal from chronic haloperidol treatment induced DA D2 receptor supersensitivity in the striatum, and that was normalized rapidly. Though this adaptive change in DA receptors, it may not affect the metabolism of DA in striatum.

• The Korean Journal of Physiology and Pharmacology
• /
• v.4 no.4
• /
• pp.291-299
• /
• 2000

Morphine or butorphanol was continuously infused into cerebroventricle (i.c.v.) with the rate of $26\;nmol/{\mu}l/h$ for 3 days, and the withdrawal from opioid was rendered 7 hrs after the stopping of infusion. The expression of physical dependence produced by these opioids was evaluated by measuring the naloxone-precipitated withdrawal signs. The withdrawal signs produced in animals dependent on butorphanol (kappa opioid receptor agonist) were similar to those of morphine (mu opioid receptor agonist). Besides the behavioral modifications, opioid withdrawal affected G protein expression in the central nervous system. The G-protein ${\alpha}-subunit$ has been implicated in opioid tolerance and withdrawal. The effects of continuous infusion of morphine or butorphanol on the modulation of G protein ${\alpha}-subunit$ mRNA were investigated by using in situ hybridization study. In situ hybridization showed that the levels of $G\;{\alpha}s$ and $G\;{\alpha}i$ were changed during opioid withdrawal. Specifically, the level of $G\;{\alpha}s$ mRNA was decreased in the cortex and cerebellar granule layer during the morphine and butorphanol withdrawal. The level of $G\;{\alpha}i$ mRNA was decreased in the dentate gyrus and cerebellar granule layer during the morphine withdrawal. However, the level of $G\;{\alpha}i$ mRNA was significantly elevated during the butorphanol withdrawal. These results suggest that region-specific changes of G protein ${\alpha}-subunit$ mRNA were involved in the withdrawal from morphine and butorphanol.

• Journal of Oriental Neuropsychiatry
• /
• v.17 no.3
• /
• pp.107-116
• /
• 2006

Delirium Tremens is the most terrible and dramatic syndrome in Alcohol Withdrawal Syndrome. Delirium Tremens is one of acute psychiatric symptoms and happens that a chronic drinker is suddenly off drinking for any reasons. In Oriental medicine, Alcohol Withdrawal Syndrome is comprised in a category of Jusang(酒傷). In this case, we described a 53-year old man who diagnosed as Delirium tremens. He suffered mental derangement and headache, and his condition was improved through oriental medical treatment.

• Annals of Clinical Neurophysiology
• /
• v.7 no.2
• /
• pp.107-109
• /
• 2005

Neuroleptic malignant syndrome is a serious complication of levodopa withdrawal in patients with Parkinson's disease. We report a patient with advanced parkinsonism who developed neuroleptic malignant syndrome in setting of withdrawal of levodopa intake.

• Journal of Oriental Neuropsychiatry
• /
• v.16 no.2
• /
• pp.135-148
• /
• 2005

Objective : The purpose of this study is to take around the oriental medical treatment about substance related disorder in china. Method : We review the studies which are published by six different journal in China since 1992 to 2002 involved in substance related disorders. Result 1. The kinds of substance which is the subject of each study. It suggest that the narcotics-withdrawal patients in china take kinds of opium many more than phillopon or barbiturate, cocain etc. especially the heroine takes the most portion in the kinds of opium. 2. The type of chinese medicine demonstration which is about the addiction and withdrawal. There are many symptoms in the each period of withdrawal, According to the each period demonstration, the herbal formula must be different. 3. The formula used in treatment and the substance which is used in common Codonopsis radix is widely used, and pinellia ternata, aractylodes japonica, citrus nobilis, vegetable worms, angelica gigas, zizyphus jujuba, panax ginseng, astragalus membranaceus etc are also used in treatment. 4. The methods of acupunture treatment Hapkok(LI-4), Naegwan(PC6), and Sanyinjiao(SP6) are the widely used acu-points. in addition to these acupoints, there are waegwan(TE5) choksamli(ST36) hanggan(LR2)etc. Conclusion : We expect that this review about substance related disorders in TCM help the clinical study of substance related disorders in Korean medicine.

• Journal of Trauma and Injury
• /
• v.36 no.3
• /
• pp.249-252
• /
• 2023

Neuroleptic malignant syndrome (NMS) is a rare but fatal condition, with a high mortality rate. NMS is characterized by altered mental status, fever, myoclonus, autonomic dysfunctions, and elevated creatinine phosphokinase. The clinical manifestations may be confused with alcohol-related symptoms, trauma, sepsis, postoperative agitation, or malignant hyperthermia. A 69-year-old male patient with alcohol withdrawal was admitted to the operating theatre to rule out septic shock due to mesenteric injury after multiple trauma. He was suspected NMS with abrupt increase body temperature to 41.7℃ after haloperidol administration. Active cooling and rapid fluid infusion was done during anesthesia. Delayed diagnosis and treatment of NMS lead to catastrophic result. Therefore, if the patient's past medical history is unknown or clinical symptoms develop that are suggestive of NMS, early treatment must be considered.