Corticosteroids are widely used in the treatment of various diseases because of its potent antiinflammatory effect. According to recent knowledge, bronchial asthma is also chronic inflammatory disease. Therefore antiinflammtory agent such as cromoyln sodium and corticosteroid is highly recommended for treament of chronic bronchial asthma. Especially hydrocortisone succinate (Solu-Cortef) is commonly used for treament to acute asthmatic attack via intravenous injection due to have rapid therapeutic onset and short duration. Since Sunaga et al. reported acute asthma attack after hydrocortisone injection in 1973, several cases of bronchospam with or without angioedema and urticaria after intravenous injection of hydrocortisone have been reported. We experienced a case of severe bronchospasm and acute respiratory failure after intraveous injection of hydrocortisone succinate in 64 year-old female asthmatic patient who visited to emergency room for acute asthmatic attack. About 5 minites after Solu-Cortef injection, a severe bronchospasm with arterial hypoxemia was developed. In order to confirm the suspected relationship between the offending drug(Solu-Cortef) and acute bronchospasm, we examed intravenous and inhalation provocation test by hydrocortisone succinate and methylprednisolone(control). After administration of hydrocortisone succinate via intravenous and inhalation route, severe asthmatic attack occurred. But administration of intravenous methylprednisolone and orall triamcinolone and saline were not provoke bronchospasm. Skin test using hydrocortisone sodium succinate was also positive. Administration of hydrocortisone is very serious to asthmatic patient with hydrocortisone hypersensitivity. Therefore, the clinician must be have history taking about previous adverse reaction of steroid before its clinical use. And methylprednisone may be useful and safe drug to the treatment of acute asthmatic patient with hydrocortisone hypersensitivity.
The currently existing "Bonchojeonghwa (本草精華)" is a manuscript without the preface and the epilogue, composed of 2 books in 2 volumes. This book is a quintessence of knowledge on science of medicinal ingredients (medicinal phytology I herbal science) as well as an trial of new development in Chosun medical science. I.e. this book includes surprising change representing medical science in Chosun dynasty as a single publication on science of medicinal ingredients. It holds a value essential to clinician as a specialized book in medicinal ingredients, and Includes richer content on medicinal ingredients than any other books published before. In addition, it is away from boring list-up of superfluous knowledge as seen in "Bonchokangmok(本草綱目)" published in China, and well summarizes essential knowledge which can be used within a range of medicines available in Korea. This book has an outstanding structure that can be even used in today's textbook on science of medicinal ingredients, as it has clear theory, system and classification. Because it handles essential learning points prior to prescription to disease, it is possible to configure new prescription and adjustment of medicinal materials. Moreover, this book can play a good role for linguistic study at the time of publication, because it describes many drugs in Hangul in many parts of the book. "Bonchojeonghwa" includes a variety of animals, plants and mineral resources in Korea, like "Bonchokangmok" which was recently listed in UNESCO. As such, it has a significance in natural history as well as pharmacy in Korean Medicine. It has various academic relationships all in biologic & abiologic aspects. It has importance in sharing future biological resources, building up international potential, setting up the standard for biologic species under IMF system, and becoming a base for resource diplomacy. We should not only see it as a book on medicinal ingredients in terms of Oriental Medicine, but also make an prudent approach to it in terms of study strengthening Korea's national competitiveness. After bibliographical reviewing on the features & characteristics of the only existing copy of "Bonchojeonghwa" housed in Kyujanggak(奎章閣) of Seoul National University, the followings are noted. First, "Bonchojeonghwa" is a specialized book on medicinal ingredients voluntarily made by private hands to distribute knowledge on drugs in the desolate situation after Imjinoeran (Japanese Invasion in 1592), without waiting for governmental help. Second, it raised accessibility and practicality by new editing. Third, it classified 990 different kinds of drugs into plant, animal, and mineral at large, and dassified more in detail into 15 'Bu' and 48 'Ryu' at 258 pages. Fourth, the publication of this book is estimated to be around 1625~1633, at the time of Injo's reign in 17th century. Fifth, it contains the existing & up-to-date knowledge at the time of publication, and it is possible to see the supply-demand situation by Hangul descriptions in 149 places in the book. By the fact that there are many linguistic evidences of 17th century, explains well when the book was published.
The aim of this study was to explore the reliability and validity of the Korean version of the Recovery Assessment Scale in psychiatric patients. The original RAS was translated into Korean and the content was verified through back-translation procedures. This study included 142 patients who had chronic mental illness and were aged 18 or older. The subjects were assessed by using RAS-K, the 12-item Dispositional Hope Scale(DHS), the 28-item Mental Health Recovery Measure(MHRM), the 32-item Behavior and Symptom Identification Scale (BASIS-32). In the reliability test, Crobach's a coefficient and test-retest reliabilities were 0.92 and 0.79, respectively, indicating that the RAS-K has good internal consistency. In the analysis of the concurrent validity of the RAS-K, there were significant correlations between the RAS-K and DHS(r=.675, p<0.01), and between the RAS-K and MHRM(r=.816, p<0.01), but lower correlations with symptoms and clinician-related measures of psychiatric functioning. Factor analysis resulted in a five factor solution accounting for 62.476% of the common variance. Our study indicates that the RAS-K is an appropriate instrument to assess recovery in Korean psychiatric patients.
Purpose : This study was performed to determine the rate of neonatal symptomatic spontaneous pneumothorax, and the corresponding clinical characteristics, co-morbidities, and outcomes. Methods : The demographic characteristics, clinical symptoms and signs, associated abnormalities, methods of treatment, and outcomes were investigated in 22 neonates with symptomatic spontaneous pneumothorax in the neonatal intensive care unit (NICU) of Chonnam University Hospital between March 2003 and February 2008. Results : The rate of spontaneous pneumothorax was 0.55%. Among the 22 neonates, the number of outborns was 15 (68.2%) and the number of males was 12 (54.5%). The main symptoms and signs were chest retraction, tachypnea, and cyanosis. The pneumothoraces were more frequent on the right side (59.1%) and all cases were diagnosed within 3 days of life. Four cases (18.2%) had urologic abnormalities and 7 cases (31.8%) had cranial abnormalities by ultrasonography. The treatments included oxygen (81.8%) and oxygen with chest tube drainage (18.2%). All of the infants survived and the overall outcomes were favorable. Conclusion : When respiratory symptoms and signs are develop abruptly in otherwise healthy newborns, the clinician should suspect a spontaneous pneumothorax and check a chest x-ray as soon as possible. Although the outcome of neonatal symptomatic spontaneous pneumothorax is favorable, renal and cranial ultrasonography are needed because of the higher possibility of urologic abnormalities and germinal matrix/intraventricular hemorrhage than in newborns without a pneumothorax.
Objective : The end-stage renal disease patients who shared fear of death, functional impairment due to hemodialysis are vulnerable to depression, anxiety and other mental problems. It is possible that their psychiatric characteristics and related autonomic nervous functions have some differences depending on their age. We purpose to find the differences of psychiatric characteristics and related autonomic nervous functions between adult and elderly hemodialysis patients. Methods : Our subjects are end-stage renal disease hemodialysis patients composed of 39 adults (<65 years) and 24 seniors (${\geq}65$ years). Outcome measures included the 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale and Mini-International Neuropsychiatric Interview by clinician. And subjects fulfilled self-report scale, The Positive thinking scale and The Snaith-Hamilton Pleasure Scale. The autonomic nervous functions are measured by heart rate variability. Results : There are no significant differences in demographic factors between two groups. The 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale, The Snaith-Hamilton Pleasure Scale and autonomic nervous functions are also not different. But only positive thinking scale is higher in adult hemodialysis group than the elderly (F=5.395, p=0.024). Conclusion : This study compared depression, anxiety and autonomic nervous functions between adult and senior hemodialysis patients. There are no significant differences in psychiatric characteristics and autonomic nervous functions between two groups except positive thinking traits. Senior patients endured their chronic disease similar to adult patients did in spite of their old age. This result suggests that elderly's higher positive thinking traits affect their endurances about the negative situations.
Purpose: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. Methods: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS ${\geq}$ 5. Results: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. Conclusion: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.
Journal of the korean academy of Pediatric Dentistry
/
v.36
no.4
/
pp.591-596
/
2009
In the case of the impacted teeth, the clinician has to consider development of tooth, site of impaction, eruption path, and cooperation of patient. Treatment options for the management of impacted teeth are separated into four categories: observation, intervention, orthodontic or surgical relocation and extraction. Autotransplantation may be defined as the transplantation of embedded, impacted or erupted teeth, from one site to another in the same individual into extraction site or surgically prepared sockets. Autotransplantation ensures preservation of natural tooth, induction of alveolar bone growth and root development, offers one of the fastest and most economically feasible means in the replacement of young patients' missing teeth. This case presents a malpositioned impacted mandibular premolar of an 11-year-old girl. It was thought that orthodontic traction was difficult because of its unfavorable impacted position. Therefore the tooth was treated by autotransplantation, we can observe good healing pattern during 12 months.
Objective : Evidence from recent studies supports the role of genetic factors in the development of Posttraumatic Stress Disorder (PTSD). The primary aim of this study is to investigate the association between the dopamine D2 receptor (DRD2) TaqI A polymorphism and PTSD. The second aim is to examine the association between the DRD2 TaqI A polymorphism and clinical symptoms in patients with PTSD. Methods : We recruited 189 Vietnam veterans for participation in this study, among whom 99 were PTSD patients and 90 were control subjects. The presence of the DRD2 TaqI A polymorphism was determined by polymerase chain reaction (PCR). Several standardized research scales were used in the clinical assessment of PTSD, including the Combat Exposure Scale (CES), Clinician Administered PTSD Scale (CAPS), Beck Depression Inventory (BDI), and Clinical Global Impression (CGI). Results : There was no significant difference in the distribution of the DRD2 genotype, frequency and prevalence of the A1 allele, or the frequency of heterozygotes between the patients with PTSD and the controls. In the PTSD group, the patients with the A1 allele (A1A1, A1A2) scored higher on the CAPS-total (p=0.044), CAPS-avoidance symptoms (p=0.016) and BDI (p=0.024) than those without the A1 allele (A2A2). Conclusion : We could not find an association between the dopamine D2 receptor (DRD2) TaqI A polymorphism and PTSD. However, the A1 allele of DRD2 seemsto influence avoidance symptoms in patients with PTSD.
Recently attention has been focused on the effects of early intervention, or its lack, on both normal and preterm infants. Particularly numerous studies suggest that premature infants are not necessarily understimulated but instead are subjected to inappropriate stimulation. Developmental support and sensory stimulation have become clinical opportunities in which nursing practice can impact on the neurobehavioral outcome of premature infants. Developmental care has been widely accepted and implemented in neonatal intensive care units across the country. Increasingly, attention and concern in caring for low-birth-weight infants and premature infants has led clinicians in the field to explore the effects of a complex of interventions designed to create and maintain a developmentally supportive environment; to provide age-appropriate sensory input; and to protect the infant from inappropriate, excessive and stressful stimulation. The components of developmental care include modifications of the macro-environment to reduce NICU light and sound levels, care clustering, nonnutritive sucking, and containment strategies, such as flexed positioning or swaddling. Sensory stimulation of the premature infants is presented to standardize the modification of a developmental intervention based on physiologic and behavioral cues. The most appropriate type of stimuli are those that are sensitive to infant cues. Evaluation of infant physiological and behavioral responds to specific intervention stimuli may help to identify more appropriate interventions based on infants' cues. A critical question confronting the clinician is that of determining when the evidence supporting a change in practice is sufficient to justify making that change. There are acknowledged limitations in the current studies. Many of the studies examined had small sample sizes; used nonprobability sampling; and used a phase lag design, which introduces the possibility of threats to internal validity and limits the generalizability of the results. Although many issues regarding the effects of developmental interventions remain unresolved, the available research base documents significant benefits of developmental care for LBW infants in consistent outcomes, without significant adverse effects. Particularly, although the individual studies vary somewhat in the definition of specific outcomes measured, instrumentation used, time and method of data collection, and preparaion of the care providers, in all studies, infants receiving the full protocol of individualized developmentally supportive care had improvements in some aspect of four areas of infant functioning: level of respiratory or oxygen support, the establishment of oral feeding; length of hospital stay, and infant behavioral regulation. In summary, based on the available literature, individualized developmental intervention should be incorporated into standard practice in neonatal intensive care. And this implementation needs to be coupled with ongoing research to evaluate the impact of an individualized developmental care programs on the short- and long-tenn health outcomes of LBW infants.
Contrast extravasation in hyperacute intracerebral hemorrhage (ICH) indicative of active bleeding is a predictor of possible enlargement of hematoma, providing clinician with valid management decisions. We report unusual MR imaging features of contrast extravasation in hyperacute ICH in three patients: Case 1 with hypertension revealed dual foci of contrast extravasation, one in right basal ganglia and the other in left lateral ventricle, suggesting simultaneous bleeding of the two foci. Case 2 with presumed diagnosis of vasculitis showed relatively large area of contrast extravasation mimicking enhancing tumor or vascular lesion. Case 3 with hypertension showed the findings of active bleeding which was likely to occur during the time of MR imaging acquisition.
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