• Childhood Kidney Diseases
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• v.19 no.2
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• pp.143-147
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• 2015

Purpose: Burkholderia cepacia is an aerobic, glucose-non-fermenting, gram-negative bacillus that mainly affects immunocompromised and hospitalized patients. Burkholderia cepacia has high levels of resistance to many antimicrobial agents, and therapeutic options are limited. The authors sought to analyze the incidence, clinical manifestation, risk factors, antimicrobial sensitivity and outcomes of B. cepacia urinary tract infection (UTI) in pediatric patients. Methods: Pediatric patients with urine culture-proven B. cepacia UTI between January 2000 and December 2014 at Samsung Medical Center, a tertiary referral hospital in Seoul, Republic of Korea, were included in a retrospective analysis of medical records. Results: Over 14 years, 14 patients (male-to-female ratio of 1:1) were diagnosed with B. cepacia UTI. Of 14 patients with UTI, 11 patients were admitted to the intensive care unit, and a bladder catheter was present in 9 patients when urine culture was positive for B. cepacia. Patients had multiple predisposing factors for UTI, including double-J catheter insertion (14.2%), vesico-ureteral reflux (28.6%), congenital heart disease (28.6%), or malignancy (21.4%). Burkholderia cepacia isolates were sensitive to piperacillin-tazobactam and sulfamethoxazole-trimethoprim, and resistant to amikacin and colistin. Treatment with parenteral or oral antimicrobial agents including piperacillin-tazobactam, ceftazidime, meropenem, and sulfamethoxazole-trimethoprim resulted in complete recovery from UTI. Conclusion: Burkholderia cepacia may be a causative pathogen for nosocomial UTI in pediatric patients with predisposing factors, and appropriate selection of antimicrobial therapy is necessary because of high levels of resistance to empirical therapy, including aminoglycosides.

• The Journal of Korean Medicine
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• v.35 no.1
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• pp.1-9
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• 2014

Objectives: This study was to propose a standardized method of retention enema by extracting elements associated with published experimental methods of retention enema. Methods: 1) Literature search (1) Data sources: Retrieval was made, using 'Enema' or 'Retention Enema' as search words in Medline, Cochrane library, KISS, RISS, and KDSL DB. (2) Study selection: Two authors excluded irrelevant papers and chose qualified abstracts from the rest of the papers. The chosen studies were reviewed fully by the authors so that they could screen the significant papers based on the exclusion criteria. (3) Data extraction: Data on the total number of subjects, the target disease, the animal species, the type, quality, length, and diameter of catheter, the insertion length of catheter, the sample, the sample volume, the process of retention enema and the number of retention enemas performed were extracted from the selected studies. 2) Performing preliminary experiments about the elements associated with experimental methods of retention enema. Results & Conclusions: The standardized experimental method is as follows: animal: 280-320g SD rat 1) inserting a rectal tube of 8 Fr that measures 8 cm into the animal's anus, 2) injecting herbal medicines at the volume of 6ml and 3) holding them for 10 minutes.

• Journal of the Korean Institute of Telematics and Electronics
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• v.27 no.3
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• pp.54-62
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• 1990

The thermodiluton is a standard method to measure cardiac output in clinical medicine. However it has many disadvantages such as expensive instrument and measurement, limited number of measurement, pain, safety problem, and side-effect due to insertion of catheter into heart. Electrical Impedance Cardiography has no such disadvantages and that it can continuously monitor stroke volume, contractility of cardiac muscle, and systolic time interval (STI) as well as cardiac output. While this impedance technique has been widely used and vigorously studied adroad, it is not introduced yet in Korea. Thus an Impedance Cardiograph has been developed in order to introduce this new technique. Its accuracy also has been verified by simultaneous measurement of cardiac output with the thermodilution technique. Finally changes of cardiac function during exercise were also measured.

• Clinical and Experimental Pediatrics
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• v.58 no.11
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• pp.454-458
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• 2015

Compartment syndrome is a rare but devastating condition that can result in permanent neuromuscular or soft tissue injuries. Extravasation injuries, among the iatrogenic causes of compartment syndrome, occur under a wide variety of circumstances in the inpatient setting. Total parenteral nutrition via a peripheral route is an effective alternative for the management of critically ill children who do not obtain adequate nutrition via the oral route. However, there is an inherent risk of extravasation, which can cause compartment syndrome, especially when detected at a later stage. Herein, we report a rare case of compartment syndrome and skin necrosis due to extravasation, requiring emergency fasciotomy and skin graft in a 7-month-old boy who was treated with peripheral parenteral nutrition via a pressurized infusion pump. Although we cannot estimate the exact time at which extravasation occurred, the extent and degree of the wound suggest that the ischemic insult was prolonged, lasting for several hours. Pediatric clinicians and medical teams should carefully examine the site of insertion of the intravenous catheter, especially in patients receiving parenteral nutrition via a peripheral intravenous catheter with a pressurized infusion pump.

• The Korean Journal of Pain
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• v.32 no.3
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• pp.206-214
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• 2019

Background: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB ($33.0{\mu}g$; interquartile range [IQR], $27.0-69.5{\mu}g$) than in the control group ($92.8{\mu}g$; IQR, $40.0-155.0{\mu}g$) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). Conclusions: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

• Journal of Yeungnam Medical Science
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• v.16 no.2
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• pp.347-356
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• 1999

Background: Exit site/tunnel infection causes considerable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. Materials and Methods: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI. we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms (purulent discharge, abscess lesion around exit site). we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. Results: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt. mon and 1 per 2l.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. aureus(MRSA) (13 cases, 24%). Seven patients(5: MRSA. 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, P<0.01). Conclusions: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

• The Korean Journal of Pain
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• v.29 no.1
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• pp.23-28
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• 2016

Background: Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode ($Interstim^{(R)}$, Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. Methods: We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. Results: Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. Conclusions: The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.

• The Journal of Internal Korean Medicine
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• v.33 no.2
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• pp.172-179
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• 2012

Objectives : This study was designed to quantify the characteristics, main diagnosis and complications in the intensive care unit (ICU) at an Oriental Medical Hospital. Methods : The medical records of 44 patients admitted to the ICU at Kyunghee Oriental Medical Hospital between January 1, 2011 and December 31, 2011 were reviewed. Basic characteristics of patients, admission channel, main diagnosis, east-western medical therapy, mortality, and complications were investigated retrospectively based on medical notes. Results : 1. The total number of patients was 44. Males were 63.6%, females 36.3%. Average admission days was 15.9. 2. The most frequent age group is eighties, 38.6%. 3. The most frequent disease is cerebrovascular disease, 61.3%. 4. The medical therapy done after admission to ICU was intubation. Central vein insertion was performed next, followed by Foley's catheter insertion, ventilator, tracheostomy, nasogastric intubation, and thoracentesis in order. The proportion of Oriental medical treatment provided to the patients of ICU was as follows: herbal medication only 6.8%; herbal medication plus acupuncture 31.8%; herbal medication, acupuncture electro-acupuncture, plus subcutaneous acupuncture 2.3%; and none 27.3%. 5. The number of cases of complications occurred since ICU admission was 18. The most frequently observed complication was infection, including 6 cases of pneumonia and 4 cases of urinary tract infection. Conclusions : We suggest that ICUs of Oriental medical hospitals need to be managed effectively to treat diseases including cerebrovascular disease and prevent complications.

• Journal of Chest Surgery
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• v.47 no.1
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• pp.26-31
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• 2014

Background: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. Methods: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. Results: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). Conclusion: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.6
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• pp.636-640
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• 2018

Objective: Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization. Methods: This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group. Results: Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement. Conclusion: The guidewire J-tip direction does not influence the rate of misplacement.