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Efficacy of Long-term Interferon-alpha Therapy in Adult Patients with Recurrent Respiratory Papillomatosis (성인의 재발성 호흡기계 유두종증 환자에서 장기간 인터페론 치료의 유효성)

  • Nam, Hae-Seong;Koh, Won-Jung;Suh, Gee Young;Chung, Man Pyo;Kwon, O Jung;Kim, Hojoong
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.5
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    • pp.390-395
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    • 2008
  • Background: Since the early 1980s, interferon-alpha ($IFN-{\alpha}$) has been used as adjuvant therapy in pediatric patients with recurrent respiratory papillomatosis (RRP). However, its efficacy in adults needs to be validated. Since 2002, Samsung Medical Center's guidelines have mandated regular injection of $IFN-{\alpha}$ in patients with RRP to prevent recurrence. To evaluate these guidelines, patient data were investigated. Methods: Five patients diagnosed as having RRP by bronchoscopy and histopathology were included. After initial bronchoscopic intervention, including laser cauterization, all patients received subcutaneous injection of 6 million units of $IFN-{\alpha}$ every 2 months. Further bronchoscopic intervention was carried out as needed. Patients were regularly evaluated using bronchoscopy or computed tomography. Results: The median age of the patients was 44 years (range 13~68), and the median duration of papillomatosis was 31 years (range 1~45). Three and two patients had juvenile-onset and adult-onset disease, respectively. Two patients had a history of tracheostomy at the time of diagnosis. The median duration of $IFN-{\alpha}$ therapy was 56 months (range 12~66). Two patients showed complete remission at 12 and 36 months after $IFN-{\alpha}$ injection, respectively. The other three patients showed partial remission, and the number of laser therapy sessions was significantly reduced.Conclusion: Intermittent $IFN-{\alpha}$ injection is effective in patients with long-standing RRP and can reduce the number of laser therapy sessions required in their treatment.

A Study on The Nursing Needs of Users and their Service Status at Short-Stay Centers for The Elderly (단기노인보호소 이용자의 간호요구도 및 서비스 실태연구)

  • Shin Kyoung Hi;Rhee Seon Ja
    • Journal of Korean Public Health Nursing
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    • v.16 no.2
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    • pp.354-377
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    • 2002
  • Aging population is a global trend and Korea is no exception. Due to the progress of the medical and scientific sectors, increase in the average lifetime incurred increase in the number of elderly people. Meanwhile, the family function of supporting the elderly has become a major issue in a society due to the changes in the society's structure and increased entry of the women into the workforce. As a means to substitute the protection of the elderly who are not protected at their respective homes and to replace the tending needs, weekly protection centers and short-stay centers for the elderly were established and operated in Seoul since 1992. However, structured and satisfactory services are not yet to be provided, thus this research intends to understand the current situation at the short-stay centers for the elderly, to identify users' characteristics and to conduct study on nursing need for the health reasons so that the results of the research can be utilized as basic data for the development of nursing care program. Towards this end, this research targeted 142 elderly people who were undergoing treatment at the 11 short-stay centers for the elderly out of total of 13 located in Seoul that were willing to cooperate. The research was conducted from April to May 2002, with the measurement tool developed by Rhee, Seon-ja (2001) to measure the level of nursing need. Then data was collected and analyzed using SPSS program. The results are as follows. The general characteristics of users of the short-stay centers for the elderly were: 123 females $(86.6\%)$, 19 males $(13.4\%)$ and 72 elderly were over the age of 80 $(50.7\%)$. Among these, 24$(16.9\%)$ were living by themselves. Among the illnesses that the subjects were inflicted with were: dementia $(54.2\%)$, stroke $(54.1\%)$ and high blood pressure $(50.7\%)$, in the respective order. Despite the fact that they were diagnosed with illnesses, $47.2\%$ responded that they do not undergo special treatment due to financial reasons. When the level of needs for nursing care among the elderly who use the short-stay centers is divided into informational. physical. and emotional need levels and scored between zero to two, the level of emotional need is the highest with 1.80, followed by physical (1.45) and informational (1.44) need levels. As for the realities of services at the centers and improvement areas, restriction on term was cited as the greatest inconvenience with $38.7\%$, followed by lack of budget (24 respondents, $16.9\%$). Wishful services were financial assistance $(46.5\%)$, medical and nursing services $(40.1\%)$, meal provision service $(8.5\%)$ and counseling service $(4.9\%)$, in the respective order. Based on the above mentioned results, the research identified the need to develop nursing program for the patients of dementia that can be applied onto the short-stay centers and the need to develop volunteer service, backed by societal support. Also, placement of specialized cadre of professionals is needed so that medical and nursing service functions can be provided in a complementary manner.

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Growth of the Tilapia, Oreochromis niloticus, in the Closed Aquaculture System (폐쇄식 사육 장치내에서 틸라피아(Oreochromis niloticus)의 성장)

  • KIM In-Bae;SON Maeng-Hyun;MIN Byung-Suk
    • Journal of Aquaculture
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    • v.4 no.1
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    • pp.1-12
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    • 1991
  • A series of rearing experiments were conducted to determine the growth rates and feed conversion efficiencies of tilapia in accordance with body size or age in nearly total closed system glass aquariums ($270\;\ell$ each in water volume) and concrete tanks ($4000\;\ell$) from April 10 to October 16, 1987. The fish used for the experiments was a Japanese strain of Oreochromis niloticus, and the size of the fish ranged from 7 g to more than 1,000 g in body weight. The starting stocking rates for each experimental lot were 10 to 20 kg in the glass aquarium ($3.7{\%}$ to $7.4{\%}$ of water volume) and 200 kg in the concrete tank ($5{\%}$ of water volume). A single experimental rearing term was 14 days with slight variations on occasions. Water temperature was designed to be kept at $26^{\circ}C$ but slight fluctuations were inevitable. Dissolved oxygen level was designed to be maintained at around $3\;mg/\ell$, but it also showed some variations. The ammonia level in the glass aquarium section once reached up to $18\;mg/\ell$, but generally remained at around $4\;mg/\ell$, and in the concrete tank section it was maintained at around $1\;mg/ell$. The feed was composed of mainly soybean meal with a small amount of fish meal as the protein source, and the crude protein content was about $32{\%}$. Mean daily growth rate was $3.5{\%}$ of body weight with 0.9 in food conversion ratio in the glass aquarium when the mean weight of fish was around 10 g with gradually reduced performances as the fish grew bigger. When the mean weight was 800 g, mean daily growth rate was $0.5{\%}$ with about 1.5 in food coversion for fish in the glass aquarium, and $0.8{\%}$ and 1.6 for fish in the concrete tank, respectively. According to the mean growth rate obtained from this experiment, it was calculated that the fish reared in the concrete tank require 223 days from 50 g to reach 1,000 g which is the ideal size for market in Korea, at the conditions provided as above, and 302 days from 10 g fingerlings to 800 g fish in the glass aquarium conditions of the closed recirculating water system.

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Decreased Attention in Narcolepsy Patients is not Related with Excessive Daytime Sleepiness (기면병 환자의 주의집중 저하와 주간졸음증 간의 상관관계 부재)

  • Kim, Seog-Ju;Lyoo, In-Kyoon;Lee, Yu-Jin;Lee, Ju-Young;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.12 no.2
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    • pp.122-132
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    • 2005
  • Objectives: The objective of this study is to assess cognitive functions and their relationship with sleep symptoms in young narcoleptic patients. Methods: Eighteen young narcolepsy patients and 18 normal controls (age: 17-35 years old) were recruited. All narcolepsy patients had HLA $DQB_1$ *0602 allele and cataplexy. Several important areas of cognition were assessed by a battery of neuropsychological tests consisting of 13 tests: executive functions (e.g. cognitive set shifting, inhibition, and selective attention) through Wisconsin card sorting test, Trail Making A/B, Stroop test, Ruff test, Digit Symbol, Controlled Oral Word Association and Boston Naming Test; alertness and sustained attention through paced auditory serial addition test; verbal/nonverbal short-term memory and working memory through Digit Span and Spatial Span; visuospatial memory through Rey-Osterrieth complex figure test; verbal learning and memory through California verbal learning test; and fine motor activity through grooved pegboard test. Sleep symptoms in narcolepsy patients were assessed with Epworth sleepiness scale, Ullanlinna narcolepsy scale, multiple sleep latency test, and nocturnal polysomnography. Relationship between cognitive functions and sleep symptoms in narcolepsy patients was also explored. Results: Compared with normal controls, narcolepsy patients showed poor performance in paced auditory serial addition (2.0 s and 2.4 s), digit symbol tests, and spatial span (forward)(t=3.86, p<0.01; t=-2.47, p=0.02; t=-3.95, p<0.01; t=-2.22, p=0.03, respectively). There were no significant between-group differences in other neuropsychological tests. In addition, results of neuropsychological test in narcolepsy patients were not correlated with Epworth sleepiness scale score, Ullanlinna narcolepsy scale score and sleep variables in multiple sleep latency test or nocturnal polysomnography. Conclusion: The current findings suggest that young narcolepsy patients have impaired attention. In addition, impairment of attention in narcolepsy might not be solely due to sleep symptoms such as excessive daytime sleepiness.

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Pulmonary Hypertension Secondary to Bronchopulmonary Dysplasia in Very Low Birth Weight Infants (<1,500 g) (기관지 폐 이형성증을 가진 극소 저체중 출생아에서 폐고혈압증)

  • Yoo, Hye-Soo;Kim, Myo-Jing;Kang, Ji-Man;Lee, Cha-Gon;Kim, Jin-Kyu;Ahn, So-Yoon;Kim, Eun-Sun;Huh, June;Chang, Yun-Sil;Kang, I-Seok;Park, Won-Soon;Lee, Heung-Jae
    • Neonatal Medicine
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    • v.18 no.1
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    • pp.96-103
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    • 2011
  • Purpose: Although infants with bronchopulmonary dysplasia (BPD) are at risk of developing secondary pulmonary hypertension (PH), which is associated with significant morbidity and mortality, little has been reported about the incidence, clinical course and prognosis of PH secondary to BPD in premature infants. This study was done to investigate the incidence, risk factors, clinical course, and the ultimate prognosis of PH developed secondary to BPD in very low birth weight infants (<1,500 g). Methods: Medical records of very low birth weight infant (VLBWI) admitted to Samsung Medical Center NICU from January 2000 to July 2007 were reviewed retrospectively. BPD was defined by Jobe's classification. The diagnosis of pulmonary hypertension was established as velocity of tricuspid valve regurgitation (TR) ${\geq}$3 m/s and a flattening of the intraventricular septum by conducting Doppler echocardiography. Results: The incidence of pulmonary hypertension was 6% in VLBWI with BPD and it developed in moderate to severe BPD. The diagnosis of pulmonary hypertension was made on postnatal 133 days (range 40-224 days) and the risk factors related to developing pulmonary hypertension were severe BPD, small for gestational age and outborn infants. The mortality rate was 57% and especially higher in severe BPD (70%). The time to recovery spent 3 months (range 1-10 months) in survived patients. Conclusion: Based on the results of this research, pulmonary hypertension secondary to BPD in VLBWI related to severity of BPD and had a poor prognosis. We expect that regular long-term echocardiography may be helpful in treating reversible in VLBWI with moderate to severe BPD.

Diagnosis and Monitoring of Chronic Myeloid Leukemia: Chiang Mai University Experience

  • Tantiworawit, Adisak;Kongjarern, Supanat;Rattarittamrong, Ekarat;Lekawanvijit, Suree;Bumroongkit, Kanokkan;Boonma, Nonglak;Rattanathammethee, Thanawat;Hantrakool, Sasinee;Chai-Adisaksopha, Chatree;Norasetthada, Lalita
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.2159-2164
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    • 2016
  • Background: A diagnosis of chronic myeloid leukemia (CML) is made on discovery of the presence of a Philadelphia (Ph) chromosome. The success of the treatment of this form of leukemia with tyrosine kinase inhibitor (TKI) is monitored by reduction of the Ph chromosome. Objective: To compare the role of conventional cytogenetic (CC) methods with a real time quantitative polymerase chain reaction (RQ-PCR) and fluorescence in situ hybridization (FISH) for diagnosis and treatment monitoring of CML patients. The secondary outcome was to analyze the treatment responses to TKI in CML patients. Materials and Methods: This was a retrospective study of CML patients who attended the Hematology clinic at Chiang Mai University Hospital from 2005-2010. Medical records were reviewed for demographic data, risk score, treatment response and the results of CC methods, FISH and RQ-PCR. Results: One hundred and twenty three cases were included in the study, 57.7% of whom were male with a mean age of 46.9 years. Most of the patients registered as intermediate to high risk on the Sokal score. At diagnosis, 121 patients were tested using the CC method and 118 (95.9%) were identified as positive. Five patients failed to be diagnosed by CC methods but were positive for BCR-ABL1 using the FISH method. Imatinib was the first-line treatment used in 120 patients (97.6%). In most patients (108 out of 122, 88.5%), a complete cytogenetic response (CCyR) was achieved after TKI therapy and in 86 patients (70.5%) CCyR was achieved long term by the CC method. Five out of the 35 analyzed patients in which CCyR was achieved by the CC method had a positive FISH result. Out of the 76 patients in which CCyR was achieved, RQ-PCR classified patients to only CCyR in 17 patients (22.4%) with a deeper major molecular response (MMR) in 4 patients (5.3%) and complete molecular response (CMR) in 55 patients (72.4%). In the case of initial therapy, CCyR was achieved in 95 patients (79.1%) who received imatinib and in both patients who received dasatinib (100%). For the second line treatment, nilotinib were used in 30 patients and in 19 of them (63.3%) CCyR was achieved. In half of the 6 patients (50%) who received dasatinib as second line or third line treatment CCyR was also achieved. Conclusions: CML patients had a good response to TKI treatment. FISH could be useful for diagnosis in cases where CC analysis failed to detect the Ph chromosome. RQ-PCR was helpful in detecting any residual disease and determining the depth of the treatment response at levels greater than the CC methods.

Clinical Characteristics of Neonatal Status Epilepticus (신생아 간질 중첩증의 임상 특성)

  • Jung, Kyeong Hun;Kim, Yun Hee;Kwon, Young Se;Jun, Yong Hoon;Kim, Soon Ki;Son, Byong Kwan
    • Clinical and Experimental Pediatrics
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    • v.48 no.12
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    • pp.1342-1347
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    • 2005
  • Purpose : Among perinatal risk factors, neonatal seizures are one of the strongest independent discriminators of adverse outcome, representing high risks of mortality and neurologic morbidity. This study was undertaken to evaluate the neurologic outcome of neonatal status epilepticus according to underlying etiology, seizure pattern, onset time, and duration. Methods : We reviewed retrospectively 36 neonates(19 males, 17 females) with status epilepticus who were admitted to the neonatal intensive care unit, Inha Hospital between July, 1988 and June, 2003. They were evaluated with neurologic examination, laboratory data, EEG findings, and neuroimaging studies etc. Results : The mean gestational period of the patients was $37.0{\pm}3.6$ weeks and birth weight was $2.70{\pm}0.82$ kilogram. Fifty two point eight percent of the neonates were male and 66.7 percent were born at term. The most common cause of neonatal status epilepticus was hypoxic-ischemic encephalopathy. In preterm babies, intracranial hemorrhages showed an especially high frequency(P=0.034). Gestational age and birth weight did not show a correlation with neurologic complications. The incidence of neurological sequelae were significantly related to prolonged seizures lasting more than 1 hour(P=0.002). Neonates with seizures within the first 72 hours tended to be more frequent among those who developed adverse outcomes(P=0.016). Generalized tonic seizures had the worst prognosis, whereas those children who had subtle seizures had better outcomes than any other type(P<0.05). Generalized tonic seizures were primarily represented on EEG by abnormal background, whereas subtle seizure showed a significantly more normal EEG than any other seizures(P<0.05). Conclusion : Our results indicate that neonatal status epilepticus with early onsets, prolonged durations. And generalized tonic types can predict an increased risk for neurologic sequelae. So, those seizures must be perceived as medical emergencies and treated aggressively with antiepileptic drugs.

Total Parenteral Nutrition-associated Cholestasis in Premature Infants (미숙아에서의 전비경구적 영양 관련 담즙울체)

  • Park, Kyung Pil;Kim, Se Young;Kim, Heng Mi
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.17-23
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    • 2003
  • Purpose : Cholestasis is a major complication in prolonged use of TPN, especially in the neonatal period, but there are few long-term reviews examining the clinical course in premature infants. Thus, in this study, we reviewed premature infants with TPN-associated cholestasis(TPNAC) to determine the incidence, clinical courses and possible risk factors. Methods : Retrospective review of 66 premature infants less than 2,000 gm of birth weight and on TPN for more than two weeks was performed. Cholestasis was defined as a serum direct bilirubin level greater than 2.0 mg/dL. The clinical course of cholestasis was described, and perinatal risk factors were evaluated. Results : TPNAC developed in 21 out of 66 infants(31.8%). The onset was $41.7{\pm}17.4days$ after receiving TPN, and the mean duration was $33.6{\pm}23.4days$. The incidence of TPNAC was significantly correlated with birth weight, and gestational age, and duration of TPN. But, possible etiologic factors, such as incidence of perinatal asphyxia or infection, showed no remarkable differences between infants with TPNAC and those without TPNAC(control). The enteral intake in the third postnatal week was significantly smaller in infants with TPNAC than in the control infants(P=0.033). Conclusion : The enteral intake in the third postnatal week was smaller in the infants with TPNAC than in the control infants. Thus, the incidence of TPNAC may be reduced by increasing the amount of oral intake during TPN in high risk infants.

Surgical outcome of severe pulmonary arterial hypertension secondary to left-to-right shunt lesions (심한 폐동맥 고혈압을 동반한 좌우 단락 질환 환자의 수술 후 경과)

  • Lee, Cha Gon;Jeong, Su-In;Huh, June;Kang, I-Seok;Lee, Heung Jae;Yang, Ji-Hyuk;Jun, Tae Gook
    • Clinical and Experimental Pediatrics
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    • v.53 no.2
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    • pp.195-202
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    • 2010
  • Purpose : Despite recent advances in pulmonary hypertension management and surgery, appropriate guidelines remain to be developed for operability in congenital heart disease with pulmonary artery hypertension (PAH). Our aim was to evaluate clinical outcomes of patients with severe PAH who underwent surgical closure of left-to-right shunt lesions (LRSL) on the basis of pulmonary reactivity. Methods : We retrospectively reviewed 21 patients who underwent surgical closure of LRSL with severe PAH (${\geq}8$ Wood unit) from January 1995 to April 2009. The median age at operation was 26 years. Atrial septal defect, ventricular septal defect (VSD), VSD and patent ductus arteriosus (PDA), and PDA was present in 11, 4, 4, and 2 patients, respectively. Results : Operability was based on vasoreactivity of PAH. Of the 21 patients, 5 showed response to pulmonary vasodilator therapy and 8 showed vasoreactivity after balloon occlusion of defects. The remaining 8 patients were considered operable because of significant left-to-right shunt (Qp/Qs ${\geq}1.5$). Five patients underwent total closure of defects and 16 were left with small residual shunts. The median follow-up duration was 32 months. There was no significant postoperative mortality or morbidity. Systolic pulmonary artery pressure (PAP) decreased in all but 2 patients. All patients except 1 showed improvement of New York Heart Association functional class. Conclusion : Closure of LRSL in patients with severe PAH on the basis of pulmonary vasoreactivity seems reasonable. PAP and clinical symptoms improved in most patients. Further research is needed for the evaluation of long-term results.

Short Term Effects of Sodium Intakes on Serum Lipids and Glucose in Adult Women (단기간의 나트륨 섭취수준이 정상 성인 여성의 혈청 지질과 혈당에 미치는 영향)

  • 이영근;승정자;최미경;이윤신
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.31 no.6
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    • pp.1035-1042
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    • 2002
  • This study was conducted to investigate the effect of sodium intake on serum lipids and glucose. 20 young adult women were fed the diets containing 290.5 mEq (high-Na diet) and 51.3 mEq (low-Na diets) Na for 6 days, respectively. Serum lipids, glucose, and other parameters after high-Na diet and low-Na diet were compared. The results would be summarized as follows. The mean age, body weight, height, and blood pressure of the subjects were 22.9$\pm$2.5 years,54.7+6.6 kg, 160.0$\pm$4.8 cm, 110.3$\pm$7.7/67.5$\pm$19.7 mmHg, respectively. Body weight, BMI, and diastolic blood pressure were significantly higher at the end of high-Na diet than of low-Na diet (p<0.001 p<0.001, p<0.05). However, there were not significantly different in height and systolic blood pressure between high- and low-Na diet. Serum cholesterol, LDL-cholesterol, and HDL-cholesterol were not significantly different with Na intakes. Serum triglyceride was significantly higher at the end of high-Na diet than of low- Na diet (p<0.05) Serum apo A-I was significantly decreased in low-Na diet, while apo B was increased (p<0.001, p<0.001). Thrombin time and prothrombin time, blood aggregation time were significantly faster following low-Na diet (p<0.001, p<0.05). There was not significantly different in serum glucose between high- and low-Na diet. However, serum insulin was significantly higher following low-Na diet (p<0.01). It is concluded that diastolic blood pressure, serum triglyceride, serum apo A-I, blood aggregation time were decreased in low-Na diet, while serum apo B and serum insulin were increased. These results suggest that Na-restricted diet affects not only blood Pressure but other biochemical parameters in blood. Therefore, for the patients who need restricted Na diet, it would be suggested that various biochemical changes should be carefully considered along with dietary Na manipulation.