• Journal of Yeungnam Medical Science
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• 제33권1호
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• pp.33-36
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• 2016

Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권2호
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• pp.116-124
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• 2020

Objectives: Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods: A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results: The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient's sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion: Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.

• Journal of Medicine and Life Science
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• 제17권3호
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• pp.80-85
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• 2020

Urinary tract infections are among the most common infectious diseases and are the major causes of mortality and morbidity. These diseases result in many severe hospitalizations each year. Severe sepsis and septic shock are common and life-threatening medical conditions, and large cases are associated with urinary tract infection. The medical term "severe sepsis" is defined as sepsis complicated by hypotension, organ dysfunction, and tissue hypoperfusion, whereas "septic shock" is defined as sepsis complicated either by hypotension that is refractory to fluid resuscitation or by hyperlacteremia. A recent multicenter-study in Korea reported that the rate of in-hospital mortality associated with severe sepsis and septic shock was > 34%. Among the causative diseases, urogenital tract infection showed a high correlation. Moreover, it is very important that clinicians detect severe sepsis and septic shock early and treat them properly. The principles of initial treatment include provision of sufficient hemodynamic resuscitation and early administration of appropriate antibiotic therapy to mitigate uncontrolled infection. Initial resuscitation includes the use of vasopressors and intravenous fluids, and it is a key to achieve the target of initial resuscitation. Supportive care in the intensive care unit, such as glucose control, stress ulcer prophylaxis, blood transfusion, deep vein thrombosis prophylaxis, and renal replacement therapy, is also significant. We have summarized the key components in the treatment of severe sepsis and septic shock in patients with urinary tract infection. Urologists should be aware that appropriate early treatment is necessary to prevent fatal outcomes in these patients.

• 대한간호학회지
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• 제51권6호
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• pp.732-745
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• 2021

Purpose: This study aimed to assess combined effects of early oral feeding after Cesarean section (C/S) under regional anesthesia on bowel function, gastrointestinal complications and surgical recovery. Methods: A systematic literature search was conducted using KISS, RISS, PubMed, CINAHL, EMBASE, CENTRAL and Google Scholar to identify randomized clinical trials comparing early oral feeding (EOF) with delayed oral feeding (DOF) after C/S. Outcome variables were bowel function and gastrointestinal complications and surgical recovery. Effect size was calculated using weighted mean differences (WMDs) and relative risks (RRs), with 95% confidence intervals (CIs). Results: Seven studies involving 1,911 patients from 568 studies, 7 studies were included in meta-analysis. EOF was significantly associated with shorter time to recover bowel movement compared with DOF (WMD, - 2.50; CI, - 3.50~- 1.50). EOF was not associated with nausea (RR, 1.15; CI, 0.87~1.53) and vomiting (RR, 0.96; CI, 0.65~1.42), but lower incidence of abdominal distension (RR, 0.70; CI, 0.50~0.98). EOF was significantly associated with shorter time to discontinuation of intravenous fluids (WMD, - 8.88; 95% CI, - 16.65~- 1.11) and removal of urinary catheter (WMD, - 15.23; CI, - 25.62~- 4.85). Conclusion: This meta-analysis provides evidence that EOF after C/S under regional anesthesia not only accelerates return of bowel function and surgical recovery but also reduces gastrointestinal complications. These results suggest that EOF should be offered to women who have undergone C/S to improve the recovery experience and reduce overall medical costs.

• Clinical and Experimental Pediatrics
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• 제51권11호
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• pp.1236-1240
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• 2008

Smith-Lemli-Opitz 증후군은 콜레스테롤 합성 과정의 장애로 발생하는 상염색체 열성으로 유전되는 드문 질환으로 다양한 기형을 동반한다. 이는 DHCR7 유전자 변이로 인한 활성도 저하로 발생하는 질환으로 7DHC, 8DHC의 증가 및 체내 콜레스테롤의 감소에 따른 임상상을 특징으로 한다. 저자들은 국내에서 최초로 SLO 증후군을 유전자 분석을 통하여 진단하였기에 이를 문헌 고찰과 함께 보고하는 바이다.

• 대한한의학회지
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• 제40권1호
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• pp.124-152
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• 2019

Objectives: This study aimed to ascertain what should be considered in the "Guideline for Clinical Trials with Herbal Medicinal Products for Colorectal Cancer" by analyzing the existing guidelines and clinical trials. Methods: The development committee searched guidelines for herbal medicinal products for colorectal cancer that have already been developed. Then, clinical trials for colorectal cancer using herbal medicine were searched. The searched trials were analyzed in terms of inclusion and exclusion of participants, intervention, comparator, outcomes and trial design. Then, we compared the results of our analysis with the regulations and guidelines of the Ministry of Food and Drug Safety in order to identify the issues we will have to consider when making the "Guideline for Clinical Trials with Herbal Medicinal Products for Colorectal Cancer". Several guidelines for anti-tumor agents and clinical trials with herbal medicinal products were searched on the national institution homepage. In addition, 12 articles were searched using a combination of the following search terms: 'colorectal neoplasms', 'herbal medicine', 'Medicine, Korean traditional', 'Medicine, Chinese Traditional', 'medicine, East Asian medicine', 'medicine, Kampo', etc. Results: The characteristics of participants were various, such as people with medical histories of surgeries or recurrent cancers or who complained of chemotherapy-induced side effects. The types of interventions were also various and included decoctions, powders, intravenous fluids, intraperitoneal injections and gargles. Comparators used included placebos and conventional treatments. The outcome measurements used in the studies were quality of life, symptom score, tumor response, and survival duration, etc. Safety was evaluated by recording adverse events. Conclusions: Findings were made by reviewing existing guidelines and comparing them with clinical trials for colorectal cancer and herbal medicinal products. These results will be utilized in the development of the "Guideline for Clinical Trials with Herbal Medicinal Products for Colorectal Cancer".

• 한국정보전자통신기술학회논문지
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• 제16권6호
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• pp.441-447
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• 2023

정맥 주입요법은 의료기관에서 대상자의 점액 내로 약물, 수액, 혈액 및 영양분을 환자에게 제공하는 표준적인 간호 절차로, 주로 간호사가 담당하여 실행하고 관리하고 있다. 또한 혈관 속으로 약물을 직접 투여하는 주사법으로서 응급상황 시 신속한 효과를 보기 위해 실시하며, 빠르고 정확한 효과를 기대할 수 있다. 교육 훈련을 통한 숙련된 간호사들도 종종 실수를 하여 환자들에게 불편함을 유발할 수 있을 뿐만 아니라 환자의 안전을 위협하는 다양한 문제를 발생시킬 수 있다. 이러한 실수로 인한 고충을 줄이기 위해 다양한 연구들이 진행되고 있다. 본 논문은 영상 검출 기기를 통해 3명의 피검자의 손등 정맥 영상을 획득하였고 수집한 영상을 영상처리를 통해 선명한 정맥 영상을 제공하기 위한 알고리즘을 도출하기 위한 연구이다. 획득한 정맥 영상의 선명화를 위해 기존 알고리즘인 Histogram Equalization, CLAHE, Unsharp Masking을 선별하고 이를 조합했다. 개별 알고리즘과 알고리즘 조합을 영상에 적용하여 도출한 영상을 비교하기 위해 히스토그램 그래프를 사용하였다. 분포된 픽셀의 최솟값과 최댓값의 차이를 구하고 평균을 내는 방법으로 히스토그램 그래프를 확인했다. 본 논문에서 제시한 알고리즘 조합이 209.1로 개별 알고리즘 평균값인 138.7, 132.3, 126.2보다 높게 나왔으며 실제 영상에서도 가시성이 좋은 것을 확인했다.

• 대한간호학회지
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• 제29권4호
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• pp.929-939
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• 1999

The purpose of this study was to identify knowledge of universal precautions and its performance in practice. The research was conducted from November 2 to 30, 1998. A total 515 student nurses ; 249 from a baccalaureate nursing college and 266 from second and third year of a 3-year community nursing college were surveyed. The results are as following : 1. The average score for universal precautions knowledge was 270.41$\pm$19.43/300(range 150-300). The results showed that 99.2% of students avoid injury from used needles, 98.6% answered that they always wash their hands if they had contact with the patient's blood and they always dispose of used needles in special collectors (97.7%) for needles. But, 39.2% responsed that they dispose of used needles after recapping them. 2. The average score for universal precautions knowledge of the senior students in the 4-year college was the highest (277.65$\pm$13.99). 3. The average score for the performance of universal precautions knowledge was 53.18 $\pm$5.91(range 14-70). The items : ‘I cautiously avoid injury from the used needles’(4.92$\pm$0.33), ‘I always wash my hands if there has been contact with the patient's blood’(4.91$\pm$0.34), and ‘I always disposed of used needles in the appropriate collector’(4.89$\pm$0.42) showed the highest performance. However ‘I always dispose of used needles after recapping them’(2.19$\pm$1.39) and ‘I always use protection goggles when in danger of contamination’(2.19$\pm$1.20) showed low performance level. 4. The highest average score for universal precautions performance was shown among the second year students in 3-year nursing college (54.19$\pm$6.92) between the groups. It showed that the level of the universal precautions performance was higher for those who had education on university precautions prior to performance of the universal precautions than for those without any prior education. 5. The percentage of students who reported the experience of direct contact with patients' blood and/or body fluids was 42.30%. The experience of direct contact with blood and/or body fluids of the educational group was significantly higher than those were not educated. 6. The most frequent cause of the direct contact was ‘needle pricking and/or skin cut’(63.04%). The most frequent substance with which the students contact was ‘blood’(59.85%). The majority of the sample had answered that the mode of contamination was ‘unknown’(63.54%). The majority of the sample answered that strategies used after contamination included ‘washing with soap’(33.61%). Reviewing the chart of patients or asking other health professionals(28.85%). 7. The number of students who had the experience of a needle stick and/or skin cut was 145(28.16%). The clinical practice places where the incidents occurred were mainly in the internal medicine unit (45.07%) and the surgical unit (31.92%) followed by the intensive care unit and the emergency unit in order. The experience of a needle stick and/or skin cut happened during on intra-muscular injection 47.34% and intravenous injection 21.81%. The causes of the needle stick and/or skin cut were ‘putting the needle cap back on 77(35.81%)’. The number of students who took an appropriate post management blood test and/or vaccination was 27(18.62%). 8. The Pearson Correlation Coefficient between the knowledge of universal precautions and performance of universal precautions in practice showed a positive correlation.

• Childhood Kidney Diseases
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• 제16권2호
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• pp.89-94
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• 2012

목적: 소아 입원 환자에서 유지용액을 기존의 저장성 수액 대신 등장성 수액으로 대체해야 된다는 주장이 제기되어왔다. 소아에서의 폐렴과 중추신경계 감염은 항이뇨 호르몬의 분비 자극으로 인해 저나트륨혈증이 흔히 발생할 수 있는 임상적인 상황으로 알려져 있다. 이에 저자들은 소아에서 폐렴과 중추신경계 감염질환에서 저나트륨혈증의 발생률을 확인하고 유지용액 선택의 중요성과 관련 인자들에 대해 조사하고자 본 연구를 시행하게 되었다. 방법: 부산대학교 어린이병원에 2008년 11월부터 2011년 8월까지 폐렴과 중추신경계 감염질환진단하에 입원하여 유지용액을 투여받고 혈장 나트륨 농도가 측정된 1992명의 환아를 대상으로 하였다. 저나트륨혈증은 혈장 나트륨 농도가 135 mEq/L 미만일 때로 정의하였다. 검사결과를 포함한 임상적 자료는 후향적으로 분석되었다. 결과: 연구기간 동안 1,992명 중 218명의 환아가 급성 저나트륨혈증으로 확인되었다. 따라서 총 발생률은 10.9%였다. 저나트륨혈증의 발생률은 뇌염에서 가장 높았고 세균성 뇌수막염, 바이러스성 뇌수막염, 세균성 폐렴, mycoplasma성 폐렴, 바이러스성 폐렴 순으로 발생률의 차이를 나타내었다. 세균성 폐렴에서의 발생률은 바이러스성 폐렴의 발생률에 비해 의미있게 높은 결과를 보였다. 또한 뇌염에서의 발생률은 바이러스성 뇌수막염의 발생률에 비해 의미있게 높은 결과를 보였다. 평균발생연령은 저나트륨혈증 환아군이 정상나트륨혈증 환아군에 비해 의미있게 높았다. 저나트륨혈증의 발생률은 D5 0.18% NS 투여군이 D5 1/2NS 투여군에 비해 의미있게 높았다. 입원기간 중 저나트륨혈증이 발생한 82명의 환아 중 78명이 SIADH의 진단에 필요한 모든 검사를 시행하였고, 이중 20.5%에서 진단되었다. 결론: 저나트륨혈증의 발생률은 폐렴과 중추신경계 감염질환에서 높게 나타나며 저장성 수액의 투여는 입원 후에 발생하는 저나트륨혈증의 중요한 원인이다. 따라서 저자들은 폐렴과 중추신경계 질환이 있는 환아에서 유지용액으로 D5 0.18% NS 보다 D5 1/2NS의 투여를 권장하는 바이다.

• Radiation Oncology Journal
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• 제24권1호
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• pp.1-10
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• 2006

목적: 비인강암 환자를 대상으로 시행한 동시차등조사가속치료(simultaneous modulated accelerated radiation therapy, SMART)를 이용한 세기조절방사선치료(Intensity modulated radiation therapy, IMRT)의 예비적 임상결과를 보고하고자 하였다. 대상 및 방법: 2001년 9월부터 2003년 12월까지 서울아산병원에서 근치적 목적의 동시차등조사가속치료를 시행 받은 20명의 비전이성 비인강암 환자를 대상으로 전향적 분석을 시행하였다. IMRT는 "step and shoot" SMART를 사용하여 시행되었으며, 각각 육안적종양체적(gross tumor volume, GTV)에 72 Gy (2.4 Gy/day), 비인강과 전이성 림프절부위(metastatic nodal station) 등을 포함하는 임상표적체적 1 (Clinical target volume 1, CTV1)에 60 Gy (2.0Gy/day), 그리고 임상적으로 전이가 없는 경부 부위림프절을 포함하는 임상표적체적 2 (clinical target volume 2, CTV2)에 46 Gy (2 Gy/day)를 조사하였다. 18명의 환자는 주당 1회의 isplatin 화학요법을 시행받았다. 결과: 연구대상에 포함된 환자의 추적관찰 기간의 중앙값은 27개월이었다. 19명의 환자는 치료 중단 없이 계획된 치료를 성공적으로 수행하였으나, 1명은 고도의 인두염과 영양불량으로 2주간 치료가 중단되었다. 치료 기간 중급성 독성은 RTOG 3도의 점막염과 인두염이 각각 5명(25%)과 9명(45%)에서 관찰되었다. 7명(35%)은 10% 이상의 체중 감소를 보였으며 11명(55%)은 정맥수액요법 혹은 경관영양요법을 필요로 하였다. 만성 독성에서 3급 이상의 구강건조증은 관찰되지 않았다 치료 반응은 모든 환자에서 완전관해를 보였고, 원격전이와 국소재발이 각각 2명과 1명에서 관찰되었다. 결론: SMART를 사용한 IMRT를 도입하여 임상적으로나 선량측정상 이하선의 기능 보존이 가능하였으며, 또한 생물학적으로 더욱 효과적일 것으로 생각되었다 향후 정확한 종양억제 효과와 만기 독성을 알기 위해서는 추가적인 연구대상과 추적관찰이 필요하다고 생각한다.