• Advances in pediatric surgery
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• 제14권1호
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• pp.67-74
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• 2008

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.

• The Korean Journal of Pain
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• 제20권2호
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• pp.169-173
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• 2007

Background: Although the use of intravenous patient controlled analgesia (IVPCA) has been compared to the use of patient conrolled epidural analgesia (PCEA), there is no optimal administration route of alfentanil for the treatment of postoperative pain. This randomized double-blind study compared the efficacy of the use of IVPCA and PCEA for postoperative pain and the side effects after a total abdominal hysterectomy (TAH). Methods: Sixty patients undergoing a TAH were randomly assigned to receive either IVPCA (Group I) or PCEA (Group E) for the infusion of alfentanil for postoperative pain control. In both groups, a loading dose of $750{\mu}g$ alfentanil was administered. All patients received the same continuous infusion rate (0.3 mg/h), bolus dose (0.15 mg), and lockout time (15 min). The incidence of side effects, the VAS (visual analog scale) of pain, blood pressure, and heart rate were checked for 20 hours after the loading dose injection. Results: The VAS of pain was not significantly different between the two groups of patients. The onset of the analgesic effect was significantly more rapid in the Group I patients than in the Group E patients. There was no difference in side effects for either group. Conclusions: When considering multiple factors such as the onset of analgesia, technical difficulties or infection after the procedure, IVPCA using alfentanil is more useful than PCEA for postoperative pain control after a TAH.

• Journal of Yeungnam Medical Science
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• 제9권1호
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• pp.121-129
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• 1992

STZ투여 전후 2주씩 4주간의 규칙적인 운동 부하가 당뇨흰쥐의 골격근 당섭취와 당내성에 미치는 영향을 알아보기 위하여 Sprague-Dawley종 수컷 흰쥐를 사용하여 soleus근의 당섭취를 시험관에서 $^3H$-3-O-methyl-glucose의 섭취로 추적하였으며 정맥으로 당을 부하 (0.5g/kg BW)하여 당내성을 평가한 본 실험의 결과를 요약하면 다음과 같다. STZ의 투여로 대조군에 비하여 공복시 혈당과 유리지방산이 증가하고 인슐린 농도, soleus근의 당섭취, 인슐린에 대한 예민도와 반응도, 및 근 glycogen농도는 감소하였으며 내당능이 저하하였다. STZ 투여 흰쥐에서 4주간의 규칙적인 운동으로 인한 변화로 안정군에 비하여 공복시 혈당이 감소하고 soleus근의 당섭취와 인슐린에 대한 반응도 및 근glycogen 의 농도가 증가하였으며 유리지방산의 농도가 감소하는 경향을 보였다. 그러나 인슐린 농도는 차이가 없었으며 당내성은 개선되지 않았다. 위의 결과로 보아 4주간의 운동은 STZ 투여후 당뇨 흰쥐 발생율에는 영향을 미치지 못하였으나 골격근의 인슐린 반응도는 향상시켰으며 공복시 혈당도 감소시키는 효과를 나타내었다. 그러나 저하된 내당능은 골격근의 인슐린 반응도가 향상되었음에도 불구하고 개선되지않은 것으로 사료된다.

• 한국임상약학회지
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• 제22권3호
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• pp.251-259
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• 2012

Ulcerative colitis (UC) is characterized by a life-long chronic course with remissions and exacerbations. Use of biological therapies may reduce or delay the surgical procedures in patients with UC. The aim of this study was to determine the impact of infliximab (IFX) use on the rate of remission, surgical interventions, and the effect on quality of life in patients with moderate to severe UC. Literature was searched for studies that investigated the efficacy of IFX on the rate of remission, colectomy and quality of life (QoL) between January 1990 and June 2012 at MEDLINE, January 1988 and June 2012 at EMbase and others. Eleven trials were included in the meta-analysis; divided into placebo controlled 8 trials and intravenous corticosteroid controlled group 3 trials. In comparison to placebo control groups, patients who received IFX had an odds ratio (OR) of 3.712 (95% CI: 2.714, 5.079) for the short-term clinical remission, and 3.053 (95% CI: 2.044, 4.559) for the rate of long-term remission. In colectomy rate and quality of life (QoL), odds ratio were 0.566(95% CI: 0.387, 0.827) and 0.658 (0.505, 0.811) respectively. Any adverse reactions including infections, infusion reaction, rash and arthralgia were equivalent in both groups. Compared with intravenous corticosteroid controlled group, patients who received IFX had lower remission rate with short-term odds ratio 0.227 (95% CI: 0.033, 1.556) and long-term odds ratio 1.054 (95% CI: 0.317, 3.502) respectively. However, statistical significance was not showed with both two analyses. The higher adverse drug reaction (ADR) rates were occurred in the corticosteroid controlled groups. 73.3% of patients treated corticosteroid reported Cushing-like syndrome with moon face. In conclusion, IFX does increase remission rate and decrease the rate of colectomy in patients with UC without elevating any adverse reactions significantly. IFX also improves QoL in moderate to severe UC patients. It would not exceed the efficacy of intravenous corticosteroid, whereas intravenous corticosteroid also reported high rate of adverse reactions.

• 대한약리학회지
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• 제10권2호
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• pp.63-74
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• 1974

This study was carried out to observe the direct effect of hydrocortisone on renal function by infusing it into a renal artery. Hydrocortisone (5mg/kg) or saline (0.5 ml/kg) was infused directly into the left renal artery of the rabbit, the right kidney was left intact to serve as a control for general action of acetazolamide (10 mg/kg) or aminophylline (10 mg/kg), which was administered intravenously 30 minutes after the direct infusion of pretreated drugs (hydrocortisone or saline). The changes of urine volume, pH, urinary excretion rates of $Na^+,\;K^+\;and\;Cl^-$, and the clearances of inulin and PAH were measured at an interval of 10 minutes for half an hour after the direct infusion of hydrocortisone or saline, and for one hour after intravenous administration of acetazolamide or aminophylline. The results of the experiment were as follows: 1. Significant changes in urine volume and urinary electrolytes (excreted rates of $Na^+,\;K^+\;and\;Cl^-$) were observed in the hydrocortisone-infused group 10 minutes after the administration of acetazolamide, compared with the saline-infused group. Especially, the effect was more potent on the infused (left) side than on the contralateral (right) side. 2. Significant changes in urine volume and urinary electrolytes were also observed in all the aminophylline-treated groups, but no remarkable difference was noticed between the hydrocortisone-infused group and the saline-infused group, nor between the left and right sides. 3. No signicant changes in the clearances of inulin and PAH were in the infused (left) side of all the experimental groups, as compared with the contralateral (right) side. From the above results, it is obvious that hydrocortisone infused into a renal artery exerts diuretic action when administered in combination with acetazolamide, and the mechanism of action rests not on its hemodynamic change for renal blood flow, but on the potentiation of carbonic anhydrase inhibiting action. However, the exact mode of action remains yet to be clarified.

• Pediatric Infection and Vaccine
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• 제21권3호
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• pp.225-230
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• 2014

최근 가와사키병에서 tumor necrosis factor-alpha(TNF-alpha) blocker인 infliximab 단일 정주 요법이 불응성 가와사키병 환자들에게 유용한 치료제로 여겨지고 있다. 장기적인 TNF-alpha blocker 사용이 기회감염의 위험을 증가시킬 수 있지만, 가와사키병 환자들에게 infliximab 사용이 심각한 부작용을 초래하지 않으며 안전하게 사용된 증례들이 보고된 바 있다. 불응성 가와사키병을 앓고 있는 5개월 된 영아에서 infliximab (5 mg/kg) 단일 정주 요법을 사용하였고 가와사키 증상이 호전되었으나 infliximab 치료 후 Acinetobacter lwoffii에 의한 패혈증이 발생하였다. 그래서 저자들은 불응성 가와사키병을 앓은 영아에서 infliximab 치료 후 발생한 패혈증의 첫 사례를 보고하며 infliximab 치료 선택에 있어 기회 감염의 위험성에 대해 고려할 것을 당부하는 바이다.

• 대한장애인치과학회지
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• 제4권1호
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• pp.21-25
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• 2008

A 33-years-old female pateint with cerebral palsy showing spastic quardriplegia and severe mental retardation was scheduled for dental implant restorations. Before implant surgery we had to take implant CT. But, because of her involuntary motion and communication difficulty, sedation was needed in order to take CT. After 8 hour NPO, propofol infusion sedation with TCI (target controlled infusion) system was administered. The propofol blood concentration of the patient was maintained 2-3 ${\mu}$/ml to keep deep sedation to prevent uncontolled movement. During sedation, we monitored ECG, pulse oximetry, blood pressure, capnometry for patient safety. Oxygen was administered via nasal prong for preventing hypoxemia and to keep airway during sedation some bands were applied to lift mandible. Total duration was 20 minutes for taking CT, and she was discharged from hospital after 30 minute rest without complication.

• Clinical and Experimental Pediatrics
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• 제48권11호
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• pp.1256-1256
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• 2005

심실중격결손을 동반하지 않은 폐동맥 폐쇄(pulmonary atresia with intact ventricular septum)는 전체 선천적 심장병의 1%를 차지하는 드문 질환으로 형태학적 특성에 따라 다양한 치료적 접근이 필요하다. 이에 저자들은 정상 크기발달의 우심실을 가진 심실중격결손을 동반하지 않은 폐동맥 폐쇄가 있는 신생아에서 풍선판막성형술 후 지속적인 저산소증을 보여 동맥관 스텐트를 이용하여 거의 정상적인 심장구조와 기능으로 호전된 1례를 경험하였기에 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.377-381
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• 2007

Objective : High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low- and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. Methods : Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecular weight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PIT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. Results : A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. Conclusion : Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.

• 대한수의학회지
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• 제43권4호
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• pp.597-606
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• 2003

Although the antidepressant effects of imipramine (IMI) have been well known in several studies, the effects on cardiovascular system, particularly the vasorelaxant effects, have not known clearly. We hypothesis that IMI-induced vasorelaxation involves NO (nitrie oxide), activation of guanylate cyclase (GC) and $Ca^{2+}$ channel. The possible roles of the endothelium and $Ca^{2+}$ in IMI-induced responses were investigated using isolated rings of rat thoracic aorta and anesthesized rats. In KCl-precontracted rings. IMI produces endothelium-dependent and endothelium-independent relaxations in intact (+E) as well as endothelium-denuded (-E) rat aorta in a concentration-dependent manner. In phenylephrine (PE)-precontracted rings, the IMI-induced relaxation was significantly greater in +E rings. The IMI-induced relaxations were suppressed by nitric oxide synthase (NOS) inhibitors, N(G)-nitro-L-arginine (L-NNA), N(omega)-nitro-L-arginine methyl ester (L-NAME) and aminoguanidine, a non-selective GC inhibitor, methylene blue, $Na^+$ channel blockers, lidocaine and procaine, or $Ca^{2+}$ channel blockers, nifedipine and verapamil, in PE-precontracted +E rings, but not in PE-precontracted -E rings. These relaxations were also suppressed by lidocaine or procaine in -E aortic rings. However, IMI-induced relaxations were not inhibited by a PLC inhibitor 2-nitro-4-carboxyphenyl-n,n-diphenylcarbamate (NCDC), an inositol monophosphatase inhibitor, lithium, indomethacin and dexamethasone in +E and -E rings. In vivo, infusion of IMI elicited significant decrease in arterial blood pressure. After intravenous injection of saponin, NOS inhibitors. MB and nifedipine, infusion of IMI inhibited the IMI-lowered blood pressure markedly. These findings suggest that the endothelium-dependent relaxation induced by IMI is mediated by activation of NO/cGMP signaling cascade or inhibition of $Ca^{2+}$ entry through voltage-gated channel, and this mechanism may contribute to the hypotensive effects of IMI in rats.