• Journal of Yeungnam Medical Science
• /
• v.30 no.2
• /
• pp.152-155
• /
• 2013

Orbital metastasis from hepatocellular carcinoma is very rare, with only 14 biopsy-proven cases from hepa tocellular carcinoma cases reported in English literature and three cases reported in Korea. Common symptoms of orbital metastasis are proptosis, visual loss, ocular pain and oculomotor dysfunction. For its precise diagnosis, we can perform fine needle aspiration biopsy, orbit CT or MRI, and ultrasonography. Radiotherapy is the mainstay in the treatment of orbital metastasis. In addition, chemotherapy, hormonal therapy and surgical intervention can play a role in the treatment of orbital metastasis according to the primary cancer and symptoms. However, the prognosis of orbital metastasis is poor. We report herein a rare case of a patient with orbital metastasis from hepatocellular carcinoma, which was treated with various modalities that included resection, and who had good clinical and radiological responses to radiation therapy and sorafenib (Nexavar, Bayer HealthCare).

• Korean Journal of Psychosomatic Medicine
• /
• v.10 no.1
• /
• pp.55-60
• /
• 2002

Central pontine myelinolysis(CPM) and Extrapontine myelinolysis(EPM) are uncommon neurologic disorders associated with osmotic inequality between the extracellular fluid compartment and intracellular fluid compartment in the brain. Myelinolysis can occur in hyponatremia and after rapid correction of hyponatremia. It may be caused by various metabolic disturbances such as chronic alcoholism, malnourishment, cancer, chronic renal failure and organ transplantation. The authors reported a 43-year-old male patient who have received a kidney transplantation because of chronic renal failure due to diabetic nephropathy. The patient manifested psychotic symptoms such as delusion, loosened association, hallucination, inappropriate affect and aggressiveness as a sequele of CPM and EPM. He also showed neurocognitive impairment such as disorientation, memory impairment, decresed intelligence and aphasia. These manifestations are rare in CPM and EPM. We discuss the clinical features, diagnosis, course and management of the patient which may be clinically significant in the neuropsychiatric aspect especially at the consultation-liaison field.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.10 no.1
• /
• pp.33-36
• /
• 2012

Opioids are the one of the most commonly used drugs to control cancer pain all over the world. But, we should not overlook the potential risk of opioid intoxication because they have well-known detrimental side effects. The opioid intoxication can be diagnosed thorough various clinical manifestations. The altered mental status, respiratory depression, and miosis is very representative clinical features although these symptoms don't always appear together. Unfortunately the opioid-toxidrome can be varied. A 42 years old man came to our emergency room after taking about 900 mg morphine sulfate per oral. He was nearly alert and his respiration was normal. Even though his symptoms didn't deteriorated clinically, serial arterial blood gas analysis showed increase in PaCO2. So we decided to use intravenous naloxone. Soon, he was fully awaked and his pupils size was increased. After a continuous infusion of intravenous naloxone for 2 hours, PaCO2 decreased to normal range and his pupil size also returned to normal after 12 hours. Though the levels of serum amylase and lipase increased slightly, his pancreas was normal according to the abdominal computed tomography. He had nausea, vomit, and whole body itching after naloxone continuous infusion, but conservatively treated. We stopped the continuos infusion after 1 day because his laboratory results and physical examinations showed normal. As this case shows, it is very important to prescribe naloxone initially. If you suspect opioid intoxication, we recommend the initial use of naloxone even though a patient has atypical clinical features. In addition, we suggest intranasal administration of naloxone as safe and effective alternative and it's necessary to consider nalmefene that has a longer duration for opioid intoxication.

• Journal of Korean Critical Care Nursing
• /
• v.9 no.1
• /
• pp.66-76
• /
• 2016

Purpose: This study was conducted to examine the relationship between lateral position change and sternal complications after cardiac surgery through median sternotomy. Methods: This study was a retrospective descriptive case-control study, involving 241 patients who underwent cardiac surgery through median sternotomy. Data from October 2011 to September 2014 were collected. Results: Sternal complications (i.e. dehiscence, sternal instability, mediastinitis) developed in 33 patients (13.7%). Primary symptoms of complications were discharge and erythema, and the mean time difference from surgery to appearance of symptoms was 15 days (range, 1-138 days). The factors associated with sternal complications were cancer comorbidity (${\chi}^2=5.22$, p=.039), internal mammary artery procedure (${\chi}^2=4.16$, p=.041), and duration of extra-corporeal membrane oxygenation (p=.033). Position change was not related to incidence of sternal complications (${\chi}^2=0.14$, p=.704). Pressure ulcers appeared in 63 patients (26.1%). Mean time difference from surgery until occurrence of ulcers was 6.7 hours (range, 0-323.0 hours), but position change was started from 132.4 hours (range, 27.1-503.2 hours) after intensive care unit admission. Conclusions: These results provide baseline data to create a standard position change and activity protocol for patients after median sternotomy. Furthermore, the study could help clinical practitioners establish evidence-based nursing practices.

• Journal of Yeungnam Medical Science
• /
• v.1 no.1
• /
• pp.171-178
• /
• 1984

Many reports have been made concerning underlying and associated conditions causing pseudomembranous colitis and it has been documented that occurrence of pseudomembranous colitis is related with antibiotics administration. Recent study showed that Clostridium difficile produced enterotoxin by colonization in intestinal wall and leading into pseudomembranous colitis. Diagnosis is based on positive culture of Clostridium difficile, positive test of Clostridium difficile toxin and specific histological findings after observation of whitish plaque on colonoscopic or sigmoidoscopic examination. Authors have experienced one case of pseudomembranous colitis developing after long term ampicillin administration in a case with colon cancer associated with diarrhea and diagnosis was confirmed by typical pseudomembrane on biopsy following classical whitish plaque observation on sigmoidoscopic examination. Symptoms have been ameliorated by discontinuation of antibiotics and administration of metronidazole in four days and disappearance of whitish plaque on repeated sigmoidoscopic examination and improvement of clinical symptoms after 9 days of medication.

• Toxicological Research
• /
• v.22 no.1
• /
• pp.55-59
• /
• 2006

The purpose of this study was to investigate the toxicity of hematoporphyrin-coated magnetic ferrofluid (HP-MF) through intravenous administration in Sprague-Dawley rats. Each group was treated with either saline, or the HP-MF at 0.5, 1, 1.5, 2 and 4 ml/kg body weight (b.w.) for the observation of survival rate, clinical symptoms, laboratory values and histopathological findings. In this study, HP-MF was evaluated for the survival rates, symptoms, laboratory values and histopathological examination after treatments. The result revealed that the animals in the group of HP-MF at 2 and 4 ml/kg b.w. showed some lethality. In serum biochemistry, the levels of AST, ALT and ALP were increased in the MF and HP-MF treated groups. However, histopathological examination for the suspected organs showed no evidence of hepatotoxicity and nephrotoxicity of typical iron poisoning. Though the toxicity of HP-MF was higher than that of HP, long retention of hematoporphyrin via HP-MF provides additional benefit over conventional hematoporphyrin. HP-MF could be utilized as a potential photodynamic agent in cancer therapy. It is suggested to develop an efficient external magnetic device to attract hematoporphyrin in the target site, thereby enabling to administering a small amount of HP-MF.

• Korean Journal of Acupuncture
• /
• v.37 no.3
• /
• pp.159-171
• /
• 2020

Objectives : This study aimed to understand the characteristics of the cases covered in the case studies on traditional Korean medicine (TKM) and furthermore, to provide basic information that can lead the discussion on 'what cases are worth reporting' in future case reports. Methods : Case reports on TKM were searched using the OASIS. The searched researches were analyzed according to the type of case, including information on disease/symptoms and intervention. Results : A total of 940 researches were searched. The most frequently reported type of case study was the report on the effectiveness of intervention. Case reports, which were only two cases in the 1970s, increased rapidly in the 2000s, and in particular, 314 cases within the last five years accounted for about 33% of the total literature. As for the number of studies by disease, the cases dealing with musculoskeletal diseases such as spine, shoulder and knee joint disorders were the most prevalent. Besides, there were many case reports related to cardiovascular, gynecological, cancer, psychiatric, and dermatological diseases. In a total of 51.9% of the included case reports, a combination of two or more Korean medical treatments such as acupuncture and herbal medicine was used at once, and western treatment was used with Korean medical treatment in 28.2% of the studies. The types of Korean medical treatments were varied, such as acupuncture, moxibustion, pharmacopuncture, electroacupuncture, Chuna, acupotomy, herbal medicine, external preparation, and psychotherapy. The main purpose of the publication of the included case reports was analyzed as a report of TKM treatment for rare diseases, or the application of TKM treatment to diseases or symptoms that are "uncommon in TKM treatment" even if it is not a rare disease. Conclusions : Case reports have the strength of generating new scientific hypotheses by detecting the basic needs and novelty of medicine. The current case studies of TKM do not seem to be sufficient to highlight these strengths. It is necessary to discuss which cases are reported as cases of patients worth publishing, and based on this, it is necessary to activate case studies of TKM by utilizing diagnostic tools and science technology.

• Journal of Korean Academy of Nursing
• /
• v.49 no.5
• /
• pp.538-549
• /
• 2019

Purpose: This study aimed to explore and compare the knowledge structure of pain management nursing research, between Korea and other countries, applying a text network analysis. Methods: 321 Korean and 6,685 international study abstracts of pain management, published from 2004 to 2017, were collected. Keywords and meaningful morphemes from the abstracts were analyzed and refined, and their co-occurrence matrix was generated. Two networks of 140 and 424 keywords, respectively, of domestic and international studies were analyzed using NetMiner 4.3 software for degree centrality, closeness centrality, betweenness centrality, and eigenvector community analysis. Results: In both Korean and international studies, the most important, core-keywords were "pain," "patient," "pain management," "registered nurses," "care," "cancer," "need," "analgesia," "assessment," and "surgery." While some keywords like "education," "knowledge," and "patient-controlled analgesia" found to be important in Korean studies; "treatment," "hospice palliative care," and "children" were critical keywords in international studies. Three common sub-topic groups found in Korean and international studies were "pain and accompanying symptoms," "target groups of pain management," and "RNs' performance of pain management." It is only in recent years (2016~17), that keywords such as "performance," "attitude," "depression," and "sleep" have become more important in Korean studies than, while keywords such as "assessment," "intervention," "analgesia," and "chronic pain" have become important in international studies. Conclusion: It is suggested that Korean pain-management researchers should expand their concerns to children and adolescents, the elderly, patients with chronic pain, patients in diverse healthcare settings, and patients' use of opioid analgesia. Moreover, researchers need to approach pain-management with a quality of life perspective rather than a mere focus on individual symptoms.

• Clinical Psychopharmacology and Neuroscience
• /
• v.16 no.4
• /
• pp.376-382
• /
• 2018

We reviewed clinical studies investigating the pharmacological treatment of major depressive episodes (MDEs) with mixed features diagnosed according to the dimensional criteria (more than two or three [hypo]manic symptoms+principle depressive symptoms). We systematically reviewed published randomized controlled trials on the pharmacological treatment of MDEs with mixed features associated with mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). We searched the PubMed, Cochrane Library, and ClinicalTrials.gov databases through December 2017 with the following key word combinations linked with the word OR: (a) mixed or mixed state, mixed features, DMX, mixed depression; (b) depressive, major depressive, MDE, MDD, bipolar, bipolar depression; and (c) antidepressant, antipsychotic, mood stabilizer, anticonvulsant, treatment, medication, algorithm, guideline, pharmacological. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found few randomized trials on pharmacological treatments for MDEs with mixed features. Of the 36 articles assessed for eligibility, 11 investigated MDEs with mixed features in mood disorders: six assessed the efficacy of antipsychotic drugs (lurasidone and ziprasidone) in the acute phase of MDD with mixed features, although four of these were post hoc analyses based on large randomized controlled trials. Four studies compared antipsychotic drugs (olanzapine, lurasidone, and ziprasidone) with placebo, and one study assessed the efficacy of combination therapy (olanzapine+fluoxetine) in the acute phase of BD with mixed features. Pharmacological treatments for MDEs with mixed features have focused on antipsychotics, although evidence of their efficacy is lacking. Additional well-designed clinical trials are needed.

• Journal of Sasang Constitutional Medicine
• /
• v.30 no.4
• /
• pp.33-52
• /
• 2018

Objectives The purpose of this study was to analyze the clinical characteristics of patients with hyperhidrosis who visited a Korean medicine hospital, and provide information on treated hyperhidrosis, based on Sasang Constitutional medicine. Methods A retrospective review was made of the electronic medical record (EMR) charts for 157 Korean patients with hyperhidrosis (90 male, 67 female), who first visited hospital from January 1, 2013 to December 31, 2017. The following information was collected: sex, age, height, weight, body mass index (BMI) and clinical data (diagnosis, area of onset, duration of illness, aggravating factors, medication, healing process, et al). Results There were many patients with hyperhidrosis, in the other of So-Yang type (57.3%), Tae-Eum type (35.0%) and So-Eum type (7.6%). The proportion of male was higher than female. The most common area of hyperhidrosis was hands and feet (44.0%), followed by generalized whole body (27.4%) and head and face (25.5%). The cure rate of hyperhidrosis was 32.2%, and effectiveness rate of that was 72.7%. In individual patients, the better the usual health condition expressed by original symptoms, the higher the possibility of treatment success, with shortened duration of treatment and reduced total drug dose. The most frequent treatment modality in patients was that consistently improved, and this duration of treatment was statistically significantly shorter than that experienced worsening of excessive sweating during treatment period (p<0.001). Conclusions This study provides some original information on the Korean patients with hyperhidrosis, and suggests the suitability of Sasang Constitutional medicine as treatment methods for hyperhidrosis.