• The Korean Journal of Nuclear Medicine
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• v.19 no.1
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• pp.67-72
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• 1985

The development of paradoxical interventricular septal motion is a common consequence of cardiopulmonary bypass operation. The reason for this postoperative abnormal septal motion is not clear. 41 patients were studied preoperatively and postoperatively with radionuclide blood pool scan to evaluate the frequency of development of paradoxical septal motion with right ventricular volume overload before surgery and the frequency of development of paradoxical septal motion after cardiac surgery with cardiopulmonary bypass, and to evaluate the change of EF related to the development of paradoxical septal motion after cardiac surgery. The results were as follows; 1) 7 of 41 patients with right ventricular volume overload(that is 17%) showed paradoxical septal motion before surgery. But 13 of 34 patients(that is 42%) had paradoxical septal motion after cardiac surgery with cardiopulmonary bypass. So open heart surgery with cardiopulmonary bypass related the development of paradoxical septal motion after surgery. 2) EF significantly decreased in patients who developed paradoxical septal motion after surgery, whereas the EF did not change in the patients who retained normal interventricular septal motion after surgery. So paradoxical septal motion usually reflected some diminution of left ventricular function, immediately after cardiac surgery.

• Clinical Endoscopy
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• v.55 no.2
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• pp.234-239
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• 2022

Background/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions. Methods: This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction. Results: A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups. Conclusions: Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

• Tuberculosis and Respiratory Diseases
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• v.51 no.3
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• pp.260-264
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• 2001

Background : Paradoxical intracranial tuberculoma is tuberculoma that developed or was enlarged during antituberculous therapy. The course of the disease or effective treatment are not well known. Method : Patients who developed intracranial tuberculoma or an enlarged tuberculoma during antituberculous therapy were investigated. Ten patients were enrolled. Result : Paradoxical intracranial tuberculoma was detected 67.9 days after antituberculous therapy. The symptoms worsened over a period of 102.3 days. Improvement was noted after 165.4 days. Four patients recovered on the brain image and 4 recovered clinically. The CSF findings showed that the paradoxical tuberculomas had developed or were aggravated, the CSF findings was aggravated. Conclusion : Paradoxical intracranial tuberculoma can develop without specific symptoms. Paradoxical intracranial tuberculoma may not be a paradoxical response and may be a natural course of intracranial tuberculosis or a natural response to antituberculous therapy.

• Herbal Formula Science
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• v.24 no.1
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• pp.31-43
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• 2016

Objectives Based on related literature, cold and heat, deficiency and excess, true and false, and actually used formulas, paradoxical treatments presented in the 『Plain Questions of Inner Canon of Yellow Emperor』 including ‘treating pseudo-heat symptoms and real cold syndrome with cold herbs, treating pseudo-heat symptoms and real cold syndrome with cold herbs’ were analyzed.Methods Out of literature, paradoxical treatment related classics and papers were investigated and analyzed. Among diseases and syndromes, real cold syndrome with pseudo-heat symptoms, real heat syndrome with pseudo-cold symptoms, real deficiency syndrome with pseudo-excess symptoms, and real excess syndrome with pseudo-deficiency symptoms were reviewed. Among formulas, typical examples of the above mentioned paradoxical treatments were used as examples to analyze paradoxical treatments.Results Treating pseudo-heat symptoms and real cold syndrome with cold herbs is a method that uses herbs with cool and cold nature to treat real cold syndrome with pseudo-heat symptoms and Tongmaeksayeokgajeodamjeuptang is suitable for this method. Treating pseudo-cold symptoms and real heat syndrome with hot herbs is a method that uses herbs with warm and hot nature to treat real heat syndrome with pseudo-cold symptoms and Baekhogainsamtang is suitable for this method.Conclusions Based on the related literature, cold and heat, deficiency and excess, true and false, and actually used formulas examined as mentioned above, the paradoxical treatments presented in the 『Plain Questions of Inner Canon of Yellow Emperor』 are thought to be reasonable paradoxical treatments that fit the diseases and syndromes that actually appeared in our bodies.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.83-86
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• 2003

Background and Objectives : Paradoxical vocal cord movement is a series of paroxysmal adduction of the anterior two-thirds of the vocal cords during respiration or during phonation. The choking, stridor, and wheezing in this condition occur primarily on inhalation, rather than on exhalation. The two pathognomonic diagnostic criterias that need to be assessed during an acute presentation are laryngoscopy with direct visualization of paradoxical adduction of the vocal cords and pulmonary function testing. Materials and Methods : A retrospective review of 3 patients who were referred to otolaryngologist from pulmonology department, and were confirmed by typical laryngoscopic findings with paradoxical adduction of the vocal cords was conducted. Results The patients were misdiagnosed as exercised-induced asthma, and unresponsive to corticosteroid and bronchodilators. Improvement was achieved only by diagnosis with paradoxial vocal cord movement. Biofeed back therapy, voice therapy, treatment for reflux laryngitis improved symptoms. Conclusion The etiology of paradoxical vocal cord movement is unknown. It may be functional or emotional. The functional factors that were proposed are neurologic deficit and gastroesophageal reflux. Management methods of this condition consist of psychological counselling, voice therapy, and antireflux medication.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.1
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• pp.30-35
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• 2009

Intravenous midazolam has been frequently used for the relief of anxiety in dental treatment. This is likely the result of the sedative and anterograde amnestic properties of midazolam that are mediated through $\gamma$-Aminobutyric acid agonism. Unfortunately, Paradoxical reactions to midazolam include agitation, talkativeness, confusion, disinhibition, aggression,violent behavior, act of self-injury and need for restraints. These occur in less than 1% of all patients receiving midazolam, may occur at variable times after administration and are difficult to predict and diagnose. Two women with severe anxiety for dental treatment experienced paradoxical reactions associated with the use of intravenous midazolam. We are reviewed the management and prevention of paradoxical reactions and its different etiology.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.435-439
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• 2021

While there is a high prevalence of patent foramen ovale in adults, paradoxical embolism via a patent foramen ovale is rare. Previous echocardiographic studies indicated that paradoxical embolism might only occur in patients with high-risk features of patent foramen ovale (i.e., large defect size, presence of a Eustachian valve, and high right atrial pressure). Here, we present a case of patent foramen ovale with high-risk CT features for paradoxical embolism.

• The Journal of Asian Finance, Economics and Business
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• v.8 no.5
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• pp.167-178
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• 2021

This study aims to identify the influence of paradoxical leadership on proactive work behavior mediated through psychological safety in the hotel industry. This study employs survey data of five-star deluxe hotels in South Korea using convenience sampling. The number of 270 cases was used for analysis and the hypotheses were analyzed with structural equation modeling and AMOS 20. Paradoxical leadership includes five sub-variables of self-centeredness with other-centeredness (SO) distance and closeness (DC), uniformly and individualization (UI), work requirements and flexibility (RF), and decision control and autonomy (CA). The results indicate that DC, UI, and CA positively influence psychological safety. Further, RF and CA make a positive impact on proactive work. Psychological safety fully mediates the effect of DC and UI on proactive work behavior and partially mediates the effect of CA on it. The findings of this study suggest that the impact of paradoxical leadership on proactive work behavior can be strengthened when this relationship is accompanied with psychological safety and other mediation variables for the relationship need to be further investigated. This study suggests how hotel managers enhance the level of proactive work behavior by training themselves to be paradoxical leaders and making psychologically safe environment.

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.244-253
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• 1990

Sixty-four patients with paradoxical ventricular wall motion noticed both in angiocardiography or 2-dimensional echocardiography were assessed by ECG gated blood pool scan (GBPS). Endless cine loop image, phase and amplitude images and paradox image obtained by visual inspection of each cardiac beat or Fourier transformation of acquired raw data were investigated to determine the incremental value of GBPS with these processing methods for identification of paradoxical ventricular wall motion. The results were as follows: 1) Paradoxical wall motions were observed on interventricular septum in 34 cases, left ventricular free wall in 26 and right ventricular wall in 24. Underlying heart diseases were ischemic (23 cases) valvular(9), congenital heart disease (12), cardiomyopathy (5). pericardial effusion(5), post cardiac surgery(3), col pulmonale (2), endocarditis(1) and right ventricular tumor(1). 2) Left ventricular ejection fractions of patients with paradoxical left ventricular wall motion were significantly lower than those with paradoxical septal motion(p<0.005). 3) The sensitivity of each processing methods for detecting paradoxical wall motion was 76.9% by phase analysis, 74.6% by endless cine loop mapping and 68.4% by paradox image manipultion respectively. Paradoxial motions visualized only in phase, paradox or both images were appeared as hypokinesia or akinesia in cine loop image. 4) All events could be identified by at least one of above three processing methods, however only 34 cases (48.4%) showed the paradoxical molies in all of the three images. By these findings, we concluded that simultaneous inspection of all above three processing methods-endless cine loop, phase analysis and paradox image-is necessary for accurate identification and assessment of paradoxical ventricular wall motion when performing GBPS.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.27-35
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• 2002

Background : The paradoxical response refers to an enlargement of old lesions or unexpected new ones during apparently adequate antituberculous therapy. This response has been reported in cases of intracranial tuberculoma, tuberculous lymphadenopathy, tuberculous pleurisy and pulmonary tuberculosis. However, there are few reports on its frequency and clinical characteristics. Materials and Methods : This study enrolled 205 patients who were treated with first line antituberculous agents for more than 6 months. We retrospectively studied 155 patients with pulmonary tuberculosis and 57 patients with pleural tuberculosis (7 patients had both) from July 1998 to March 2000. The patients were divided into the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical group were investigated. Statistical analysis was done with an independent sample T-test and Chi-squared test. Results : 29 of the 205 patients(14.1%) had paradoxical response. Among the 29 patients, there were 19 pulmonary tuberculosis, 8 tuberculous pleurisy(2 patients had both). Paradoxical response appeared 32 days (mean 35 days in pulmonary tuberculosis, mean 25 days in tuberculous pleurisy) after the beginning of chemotherapy. The duration to regress less than half of initial chest lesion was 114 days in pulmonary tuberculosis and 124 days in tuberculous pleurisy, respectively. Most common clinical manifestation of paradoxical response patients was coughing in both pulmonary tuberculosis and tuberculous pleurisy. Male sex, high blood WBC count and high level of pleural fluid LDH were related with paradoxical response. Conclusion : These findings suggest that presponse usually appears 1 month and disappears within 4 months after the beginning of anti-tuberculous chemotherapy. Paradoxical response was relatively correlated with male sex, high blood WBC count and high level of pleural fluid LDH.