• Journal of The Korean Society of Clinical Toxicology
• /
• v.6 no.1
• /
• pp.37-41
• /
• 2008

Methemoglobinemia can be caused by dapsone toxicity. We report a case dapsone induced methemoglobinemia unresponsive to methylene blue successfully treated by exchange transfusion. A 52-year-old male ingested a handful of dapsone. He presented with severe peripheral cyanosis in lips and fingertips and his methemoglobin level was found to be 21.9%. After admission, methylene blue (1%) at 1 mg/kg was injected each time peripheral cyanosis and rising serum methemoglobin occurred. Despite methylene blue therapy, the patient‘s methemoglobin level continued to fluctuate. Five days after the injections of methylene blue, many Heinz bodies were visualized in the peripheral blood, suggestive of hemolytic anemia occurrence. By hospital day 6, serum methemoglobine levels were elevated and not measurable (> 50%) and the patient was constantly in a semi-comatose mental state. An exchange transfusion carried out by utilizing 6 units of packed red blood cells and 4 units of fresh frozen plasma was performed. The patient's methemoglobin levels were subsequently kept up below 20% and his peripheral cyanosis receded. Physicians should recognize the important role of exchange transfusion in refractory dapsoneinduced methemoglobinemia.

• Clinical and Experimental Pediatrics
• /
• v.58 no.12
• /
• pp.505-508
• /
• 2015

It is uncommon for pediatric patients with rhabdomyosarcoma to present with clinical and/or laboratory features of disseminated intravascular coagulation (DIC). We report a case of metastatic alveolar rhabdomyosarcoma with severe bleeding because of DIC in a 13-year-old boy. He experienced persistent oozing at the site of a previous operation, gross hematuria, and massive epistaxis. Two weeks after initiating combination chemotherapy consisting of vincristine, doxorubicin, and cyclophosphamide, the patients' laboratory indications of DIC began to resolve. During this period, the patient received massive blood transfusion of a total of 311 units (26 units of red blood cells, 26 units of fresh frozen plasma, 74 units of platelet concentrates, 17 units of single donor platelets, and 168 units of cryoprecipitate), antithrombin-III and a synthetic protease inhibitor. Despite chemotherapy and radiation therapy, he died 1 year later because of disease progression. In children with metastatic rhabdomyosarcoma and massive DIC, prompt chemotherapy and aggressive supportive care is important to decrease malignancy-triggered procoagulant activities.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.2 no.2 s.3
• /
• pp.114-117
• /
• 2002

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

• Journal of Chest Surgery
• /
• v.26 no.2
• /
• pp.108-114
• /
• 1993

The risks of homologous blood transfusion are well documented and recently increased with the emergence of acquired immunodeficiency syndrome. This is a report concerning 29 consecutive adult with no blood conservation patients (Group I) who had an elective cardiac operations. A similar group of 29 patients operated on 1992 but with blood conservation (Group II). In I of Group I patients and 15 of Group II patients, no homologous blood products were required. Group II patients used significantly less fresh frozen plasma (2.05${\pm}$0.68 unit versus 6.52${\pm}$0.72 unit, p<0.05) and the homologous blood transfusion (0.42${\pm}$0.9 unit versus 3.64${\pm}$0.17 unit, p<0.05) than Group I patients. Group II patients had also significantly less postoperative bleeding (338${\pm}$39.9 ml versus 585${\pm}$93.0 ml, p<0.05) than Group I patients. Group II patients recieved 460${\pm}$62.6 ml of mediastinal shed blood in acquired group. In conclusion, a simple and inexpensive blood conservation program, mainly combining autologous blood removal before bypass, retransfusion of the volume remaining in the oxygenator, and consistent autotransfusion of mediastinal shed blood has enabled us to avoid infusion of homologous blood in 15/29 patients of Group II patients. No side effects or complicatinos could be related to the blood conservation program.

• Pediatric Infection and Vaccine
• /
• v.16 no.2
• /
• pp.205-209
• /
• 2009

Staphylococcal toxic shock syndrome (TSS) is a severe systemic illness caused by toxins produced by Staphylococcus aureus. We report a case of staphylococcal TSS in a 16 month-old boy who presented with high fever, vomiting, skin rash, and shock after a burn injury. He was managed with intravenous vancomycin, fresh frozen plasma, and intravenous immunoglobulin. Methicillin-resistant S. aureus (MRSA) was isolated from the burn wound site and anterior nostril of the patient. In addition, the MRSA isolate was genetically characterized.

• Clinical and Experimental Pediatrics
• /
• v.57 no.4
• /
• pp.202-205
• /
• 2014

Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS), a very rare disease that is caused by the presence of antifactor II antibodies, is usually counterbalanced by the prothrombotic effect of lupus anticoagulant (LAC). Patients with LAHPS are treated using fresh frozen plasma, steroids, immunosuppressive agents, and immunoglobulins for managing the disease and controlling hemorrhages. Notably, steroids are the important treatment for treating hypoprothrombinemia and controlling the bleeding. However, some patients suffer from severe, life-threatening hemorrhages, when factor II levels remain very low in spite of treatment with steroids. Here, we report a case of LAHPS in a 15-year-old girl who experienced pulmonary hemorrhage with rapid progression. She was referred to our hospital owing to easy bruising and prolonged bleeding. She was diagnosed with LAHPS that presented with pancytopenia, positive antinuclear antibody, proloned prothrombin time, activated partial thromboplastin time, positive LAC antibody, and factor II deficiency. Her treatment included massive blood transfusion, high-dose methylprednisolone, vitamin K, and immunoglobulin. However, she died due to uncontrolled pulmonary hemorrhage.

• Childhood Kidney Diseases
• /
• v.10 no.2
• /
• pp.109-118
• /
• 2006

Purpose : HUS usually occurs in children after infection with shiga toxin-producing microorganism(D＋HUS). In contrast, non-postdiarrheal(D-) HUS occurs at any age and has a high rate of relapse and a poor prognosis. The clinical presentation of D-HUS is similar to that of thrombotic thrombocytopenic purpura(TTP). Recently severe deficiencies of ADAMTS13 were reported not only in TTP and D- HUS but also in D+ HUS during their acute phase. The purpose of the study is to evaluate the plasma ADAMTS13 activity in D＋ and D-HUS. Methods : Nineteen children with HUS(D＋ HUS 12 and D- HUS 7) were enrolled. The assays of plasma ADAMTS13 activity were performed during the acute stage in the D＋ HUS and at various stages of relapsing courses in the D- HUS patients by multimer assay, based on electrophoresis. Results : The median plasma activity of ADAMTS13 in D＋ HUS and D- HUS were 80.9%(37.8-132.4%) and 53.9%(1.0-94.1%), respectively, which were not statistically significantly different from control(86.4%, 34.2-112.3%)(P>0.05). One boy with D- HUS had severe deficiency of ADAMTS13(1.0%). His platelet count was normalized temporarily by fresh frozen plasma infusion. Conclusion : We have demonstrated that there is no significant difference of the plasma ADAMTS13 activity between D＋ HUS, D- HUS and control. We detected severe deficiency of ADAMTS13 in one boy who presented with relapsing episodes of D- HUS. ADAMTS13 deficiency should be considered in the subgroup of D- HUS especially with early onset and recurrent courses. Plasma therapy can be beneficial in this subgroup.

• Asian-Australasian Journal of Animal Sciences
• /
• v.22 no.4
• /
• pp.507-515
• /
• 2009

A series of experiments were conducted to determine the suitable freezing and thawing temperatures for the freezing of boar semen in 5 ml maxi-straws. The ultrastructure, in vitro fertilization (IVF) and artificial insemination (AI) of frozen-thawed semen were also be evaluated. The 5 cm freezing height gave the best results not only in post-thaw motility rate (54.00%), but also in normal acrosome morphology rate (NAR) (80.23%). There was no significant difference in the post-thaw motility between different thawing temperatures and corresponding thawing times (p>0.05); the group of $52^{\circ}C$ and 25 s gave the highest motility rate (45.00%). As a whole, not only from the motility but also the NAR, thawing at $42^{\circ}C$ was better than the other two treatments. In the freezing packages, 5 ml maxi-straw gave a little lower mobility (40%), viability rate (49.58%), plasma membrane integrity rate (53.91%) and NAR (52.65%) than the 0.25 ml straw, but there was no significant difference between the two straw volumes (p>0.05). The IVF capacity of frozen-thawed semen in this experiment was similar to fresh semen. From ultrastructure observation, the main damage to boar spermatozoa after freezing was seen in the acrosome, such as swelling and formation of vesicles. After AI in recipient Shanghai White sows, frozen-thawed semen from 5 ml maxi-straws and pellets produced 72.2% and 80% conception rate and 7.8 and 8 litter sizes, respectively, and there was no significant difference between the 5 ml maxi-straw and the pellet (p>0.05).

• Journal of Yeungnam Medical Science
• /
• v.4 no.1
• /
• pp.145-149
• /
• 1987

The technique of radial artery cannulation and its complications are well documented, but serious complications are rare. This is a report of one case of amputation of wrist due to finger necrosis developed from the radial artery cannulation in patient who had craniectomy surgery. This 52-year-old 70kg male underwent subdural hematoma removal surgery. Right radial artery cannulation was carried out percutaneously using 22 gauge Teflon extracath needle after modified Allen's test appeared to be positive. It was intermittently flushed by heparinized solution. His arterial blood pressure was maintained 100/70 - 110/80mmHg and 5 units of banked whole blood and 1 unit of fresh frozen plasma were transfused during 8-hours operation. Cannula was removed on the 9th hour after operation because that was obstructed. On the 12th hour after removal of cannula, his right hand noted to be cool and cyanotic. So, warm towel and hot bag applied continuonsly on the right hand and the right stellate ganglion block was carried out everyday for 4 times. However, on the 10th day after removal of cannula, necrotic change of all fingers of the right hand became worse and skin of fingers were shrunken. Therefore, disarticulation of the right wrist carried out on the 71th day of his hospitalization.

• Asian-Australasian Journal of Animal Sciences
• /
• v.31 no.2
• /
• pp.270-277
• /
• 2018

Objective: The present experiment has tested the effect of dietary alfalfa flavonoids (AAF) supplementation on the productive performances, carcass characteristics, meat quality and lipid oxidation of growing rabbits. Methods: One hundred and sixty crossbred rabbits (42 days old) were divided into four groups of forty animals each and were fed either a control diet (AAF0) or an AAF0 diet supplemented with 400, 800, or 1,200 mg of AAF/kg per diet (AAF4, AAF8, and AAF12, respectively) from weaning to slaughtering (102 days old). Performance data were recorded over a period of 60 days. At the end of the trial, 12 rabbits were slaughtered per group, and the carcass characteristics were recorded. Moreover, the plasma, liver and dorsal muscles were sampled from 12 rabbits/group, and were analyzed for lipid oxidation. Results: No significant differences were recorded for the performance, carcass characteristics and meat quality traits except for lightness parameter that was lower in the control group. Dietary AAF supplementation significantly (p<0.01) affected the malondialdehyde (MDA) levels of the frozen meat in a dose-related manner, with the lowest value (0.24 mg MDA/kg fresh meat) recorded in the AAF12 group samples. Conclusion: These findings indicated that the dietary inclusion of AAF in rabbit diets improved muscle oxidation stability with no adverse effects on the growth performance of the animals even if a slight impact on meat lightness color parameter was recorded.