• Tuberculosis and Respiratory Diseases
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• v.49 no.6
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• pp.724-732
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• 2000

Background : In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known that inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous bood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. Methods : Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical out∞me, chest radiography and pulmonary function tests. Results : The mean duration of air leak was 18.4${\pm}$6.16 days before ABP (autologous blood and dextrose pleurodesis) and $5.2{\pm}1.68$ days after ABP. The mean severity of pain was $2.3{\pm}0.70$ for DP(doxycycline pleurodesis) and $1.7{\pm}0.59$ for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of $0.6{\pm}0.63$. The mean dyspnea scale was $1.7{\pm}0.46$ before pneumothrax and $2.0{\pm}0.59$ after ABDP (p>0.05). The mean $FEV_1$ was $1.47{\pm}1.01$ before pneumothorax and $1.44{\pm}1.00$ after ABDP (p>0.05). Except in 1 patient, 14 patients had no recurrent pneumothorax. Conclusion : Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.784-789
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• 2006

Purpose : $Henoch-Sch{\ddot{o}}nlein$ purpura(HSP) is a systemic vasculitis involving small vessels of skin, gastrointestinal(GI) tract and kidney. Digestive involvement of HSP can be serious with massive GI bleeding, perforation, and intussusception. However, some patients do not respond to conventional corticosteroid therapy. In this study, we investigated the efficacy of intravenous immunoglobulin (IVIG) for serious digestive manifestations not responding to steroid. Methods : From April 1999 to January 2005, 22 children diagnosed as HSP with severe GI symptoms were included. Initially, all patients were treated with intravenous methylprednisolone. IVIG 2 g/kg of body weight was infused in children refractory to steroid therapy. Clinical data were reviewed retrospectively. Results : Among 22 children, 12 children underwent IVIG therapy. The mean duration of corticosteroid therapy was $5.61{\pm}4.9$ days before IVIG therapy, and 11 of 12 patients experienced disappearance of GI manifestations after the initiation of IVIG infusion. In one patient, IVIG was ineffective in relieving abdominal pain, but melena subsided. Comparison of the duration of hospitalization between IVIG group and corticosteroid group revealed no significant difference($12.8{\pm}7.6$ days vs. $13.2{\pm}7.8$ days, P=0.777). But, the total duration of abdominal pain decreased in IVIG group although the difference between two groups was not significant($8.8{\pm}8.1$ days vs. $14.8{\pm}16.9$ days, P=0.306). Among 10 children treated with steroid only, 2 children were operated for bowel perforation and intussusception. In contrast, there was no perforation in 12 children who underwent IVIG therapy. Conclusion : IVIG could be the alternative therapy to corticosteroids in children with severe digestive manifestations of HSP.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.528-536
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• 2019

Purpose: This study examined the effects of a weekly teriparatide on the change in vertebral compression ratio, back pain, and vertebral fracture healing in osteoporosis patients with vertebral compression fractured induced by low energy trauma. Materials and Methods: From January 2016 to December 2017, 57 patients with severe osteoporotic vertebral fractures with a T score of -3.5 or less were included in this study. The changes in the vertebral compression ratio, visual analogue scale (VAS), Oswestry disability index (ODI) for at least 6 months were examined. The morphology of bone marrow edema and the presence of intervertebral cleft, osteocalcin, and N-terminal telopeptide (NTx) were also investigated. Results: The mean compression ratio was 20% in the experimental group (teripratide group) at 3 months, and 38% in the control group. A significant difference in the compression ratio of the vertebral body over time was observed (p<0.05; t-test). A comparison of the compression ratio of the vertebral body with the follow-up duration in each group showed no significant increase in the, compression (p=0.063) in the experimental group and a significant increase in the control group (p<0.05). The mean time to reach the plateau of the compression rate was one month in the experimental group and three months in the control group. The VAS score in the experimental and control group was 0.39 and 1.07 points, respectively. The ODI score in the experimental and control group was 33.72 and 39.52, respectively. At the last follow-up radiographs, there were no cases with an intervertebral cleft (0%) in the experimental group and 1 case (2.2%) in the control group. A significant difference in the osteocalcin level was observed between the injury and 6 months after the injury (p=0.003). In addition, there was no significant difference in the NTx level between the injury and 6 months after injury (p=0.960). Conclusion: In vertebral compression fractures patients with severe osteoporosis, a weekly teriparatide can promote the union of fractures, prevent further collapse of the vertebral body, and reduce the back pain faster.

• The Korean Journal of Air & Space Law and Policy
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• v.20 no.1
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• pp.211-253
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• 2005

Recently, the Korean Supreme Court released two important decisions concerning damages for the pain and suffering from Aircraft noise. The local people who are living near the Air Force practice site at Maehyang-ri and the Kimpo International Airport brought lawsuits against the Korean government requesting damages for their financial loss from the severe noise and the damages for their pain and suffering. Plaintiffs alleged that they suffered physical malfunctions, extreme disturbances and the reduction of property values from the extreme noises which were daily repeated. District Court of Seoul Province did not allow plaintiffs all but the damages for pain and suffering. Plaintiffs could not prove the causation between their financial loss and the noise. The Supreme Court confirmed the lower court's decision. Article V of the National Compensation Act (analogous to the Federal Tort Claims Act of the USA) reads, "the government shall be liable for any loss caused by the defect on establishment or maintenance of public facilities." In the two cases, the major issue was whether the government's establishment or maintenance of Air Force practice site and the airport was defective because they caused serious noise to surrounding neighbors. Previously, the Supreme Court interpreted the clause "defect on establishment or maintenance of public facilities" as failure of duty to provide safety measures to the degree generally required to ordinary manager. However the Court at this time interpreted differently that the defect could be found if the facility caused to any person loss to the degree intolerable. In the two cases the Court confirmed the lower court's finding that noise level at the site was severe enough to be intolerable. This standard is based on the severity of the loss rather than the failure of duty. It became easier for plaintiffs to prove the cause of action under this interpretation. The consequence of the ruling of these two cases is 'rush to the courtroom' by the local people at similar situations. The ruling of these two cases was not appropriate both in theory and in consequence. The Korean tort system is basically based on the theory of negligence. Strict liability is exceptional only when there is special legislation. The Court created strict liability rule by interpreting the Art. V of the National Compensation Act. This is against the proper role of the court. The result of the cases is also dismal. The government was already sued by a number of local people for damages. Especially the Department of Defense which is operating many airports nationwide has financial hardship, which will cause downsizing military practice by the Air Force in the long run, This is no good to anyone. Tens of millions of dollars which might be used for compensation might be better used to prevent further noise problem surrounding airports.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.205-215
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• 2013

Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.147-153
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• 2018

Study Design: Retrospective case series. Objectives: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). Summary of Literature Review: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. Materials and Methods: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. Results: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the followup period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p<0.05). Complications were not reported in any cases. Conclusions: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.31-39
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• 2004

Purpose: Although acute nonspecific mesenteric lymphadenitis (ANML) is probably common cause of abdominal pain in children, which can be severe enough to be an abdominal emergency, the clinical features of mesenteric lymphadenitis are not clear. Also, a differential diagnosis with acute appendicitis (APPE) is indispensable to avoid serious complications. The clinical features of ANML were determined, and the risk factors for differential diagnosis with APPE were analyzed. Methods: Between November 2000 and May 2001, data from 26 patients (aged 1 to 11 years) with ANML and 21 patients (aged 2 to 13 years) with APPE were reviewed. ANML was defined as a cluster of five or more lymph nodes measuring 10 mm or greater in their longitudinal diameter in the right lower quadrant (RLQ) without an identifiable specific inflammatory process on the ultrasonographic examination. There were risk factors on patient's history, physical examination, and laboratory examination; the location of abdominal pain, abdominal rigidity, rebound tenderness, fever, nocturnal pain, the vomiting intensity, the diarrhea intensity, the symptom duration, and the peripheral blood leukocytes count. Results: Of the 26 ANML patients and 21 APPE patients, abdominal pain was noted on periumbilical (76.9% vs 14.2%), on RLQ (11.5% vs 71.4%), with abdomen rigidity (7.6% vs 80.9%), with rebound tenderness (0.0% vs 76.1%)(p<0.05), in the lower abdomen (11.5% vs 14.2%), and at night (80.8% vs 100.0%) (p>0.05). The clinical symptoms were vomiting (38.4% vs 90.4%), the vomiting intensity ($1.5{\pm}0.7$ [1~3]/day vs $4.5{\pm}2.9$ [1~10]/day), diarrhea (65.3% vs 28.5%) (p<0.05), and fever (61.5% vs 76.2%)(p>0.05). The period to the subsidence of abdominal pain in the ANMA patients was $2.5{\pm}0.5$ (2~3) days. The laboratory data showed a significant difference in the peripheral blood leukocytes count ($8,403{\pm}1,737[5,900{\sim}12,300]/mm^3\;vs\;15,471{\pm}3,749[5,400{\sim}20,800]/mm^3$)(p<0.05). Discriminant analysis between ANML and APPE showed that the independent discriminant factors were a vomiting intensity and the peripheral blood leukocytes count and the discriminant power was 95.7%. Conclusion: The clinical characteristics of ANML were abrupt onset of periumbilical pain without rigidity or rebound tenderness, a mild vomiting intensity, normal peripheral leukocytes count, and relatively short clinical course. If the abdominal pain persist for more than 3 days, and/or the vomiting intensity is more than 3 times/day, and/or the peripheral leukocytes count is over $13,500/mm^3$, abdominal ultrasonography is recommended to rule out APPE.

• Journal of Korean Academy of Nursing
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• v.25 no.1
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• pp.5-16
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• 1995

The effects of the mouth care using cool sterile normal saline on oral stomatitis were investigated in 59 patients on chemotherapy. The subjects were divided into two groups, one was experimental group(N=31) in which the subjects were provided mouth care 4 times a day (after meals, before bedtime)with cool normal saline, the other was the control group(N=28), The Oral Assessment Guide(OAG) which it includes eight items(voice, swallowing, lips, tongue, salivation, oral mucous membrane, gingiva & teeth) was used to assess oral status six times(once in the Prechernotherapy Period, and on the third, 5th, 7th, 10th & 14th day postchemotherapy). The means of the total scores at each time were analyzed by repeated ANOVA The results are as follows : 1. The incidence of stomatitis was higher in the control group than in experimental group. The incidence of third grade stomatitis characterized by bleeding, sore, infection & severe pain was 3.3% in the experimental group, and while 21.4% in the control group(p=0.01). 2. The number of stomatitis sites which were occurred in the experimental group were significantly lower than in the control group(p=0.046). 3. The grade of stomatitis(mean of total score) for patients in the control group was significantly higher than for patients in the experimental group (p=0.005). 4. In the control group, voice change increased in the period between the seventh and tenth day after chemotherapy (p=0.04). 5. In the control group, swallowing difficulty was mest severe in the period between seventh and tenth day(p=0.05), and decreased by the fourteenth day(p=0.01). 6. Changes in the lips gradually increased after chemotherapy in the control group(p=0.0025), while they were significantly lower in the experimental group(p=0.0002). 7. The increment of tongue changes started on the third day after chemotherapy reached a peak on the tenth day and decreased by the fourteenth day in both groups(p=0.0016). 8. Driness of the mouth reached a peak on the seventh day after chemotherapy in the control group (p=0.05). 9. The degree of oral mucositis was significantly higher in the control group than in the experimental group(p=0.02) . In the control group, the mucosal change started three days after chemotherapy and reached a peak on the tenth day(p=0.03). 10. Changes in the gingia were significantly higher in the control group(p=0.03). In control group, the degree of gingivitis reached a peak on the tenth day. In conclusion, meuth care with normal saline four times a day could reduce the incidence and grade of stomatitis. Stomatitis was shown to begin on the third day after chemetherapy, reach a peak on the tenth day and be reduced by fourteenth day.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.18
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• pp.7653-7664
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• 2014

Background: Colorectal ranked first among cancers reported in males and ranked second amongst females in Jordan, accounting for 12.7% and 10.5% of cancers in males and females, respectively. Colorectal cancer patients can suffer several consequences after treatment that include pain and fatigue, constipation, stoma complications, sexual problems, appearance and body-image concerns as well as psychological dysfunction. There is no published quantitative data on the health-related quality of life and psychological wellbeing of Jordanian colorectal cancer survivors. Method: This project was a cross-sectional study of colorectal cancer survivors diagnosed in 2009 and 2010. Assessment was performed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the colorectal cancer specific module (EORTC QLQ-CR 29) and the Hospital Anxiety and Depression Scale (HADS). Data on potential predictors of scores were also collected. Results: A total of 241 subjects completed the study with mean age of $56.7{\pm}13.6$. Males represented 52.3% of study participants. A majority of participants reported good to high overall health; the mean Global health score was $79.74{\pm}23.31$ with only 6.64% of study participants scoring less than 33.3%. The striking result in this study was that none of the study participants participated in a psychosocial support group; only 4 of them (1.7%) were even offered such support. The mean scores for HADS, depression score, and anxiety score were $8.25{\pm}9$, $4.35{\pm}4.9$ and $3.9{\pm}4.6$, respectively. However, 77.1% of study participants were within the normal category for the depression score and 81.7% were within this category for anxiety score; 5.4% of participants had severe anxiety and 5.4% of them had severe depression. Discussion: Patients with colorectal cancer in Jordan have a good quality of life and psychological wellbeing scores when compared with patients from western countries. None of the colorectal cancer patients managed at the Ministry of Health received any formal counselling, or participated in psychological or social support programmes. This highlights the urgent need for a psychosocial support programme, psychological screening and consultations for patients diagnosed with colorectal cancer at the Ministry of Health Hospitals.

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.1
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• pp.24-29
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• 2010

Purpose: Neonicotinoid insecticides are widely used as they have been proven by experimental studies to have low toxicity to mammals, including humans. As the use of neonicotioids increases, the number of patients with neonicotinoid poisoning has also increased. We conducted a study to investigate the clinical manifestations of neonicotinid poisoning. Methods: We retrospectively analyzed the patients who ingested neonicotinids and who visited the emergency department located in Korea from March 2002 to February 2010. We reviewed the patients' age, gender, the amount of exposure, the elapsed time to presentation, the treatment and the outcome. According to the poisoning severity score, we divided the patients with a Poisoning severity score (PSS) of 0 or 1 into the mild/moderate toxicity group and the patients with a PSS of 2 or 3 into the severe/fatal toxicity group. Results: A total of 24 patients were analyzed. The most common clinical manifestations of neonicotinoid insecticide toxicity were gastrointestinal symptoms (66.7%) such as nausea, vomiting and abdominal pain and the others are respiratory symptoms (16.7%), cardiovascular symptoms (12.5%), metabolic imbalance (12.5%), renal dysfunction (8.3%), CNS symptoms (8.3%), and asymptomatic (29.2%). Twenty patients (83.3%) showed mild/moderate toxicity and 4 patients (16.7%) showed fatal conditions such as shock and mutiorgan failure. The mortality rate was 4.2%. In these fatal cases, the patients developed respiratory failure, hypotension, altered mentality and renal failure at the acute stage and they deteriorated to a more serious condition. This severe toxicity was caused by decreased renal excretion of neonicotinid metabolite, and this was improved after hemodialysis. Conclusion: Most patients with neonicotinoid poisoning and who showed mild toxicity usually improved after symptomatic treatment. However, some patients showed significant toxicity with respiratory failure and renal function deterioration, and intensive care needed, including mechanical ventilation and hemodialysis.