• Childhood Kidney Diseases
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• 제11권1호
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• pp.9-15
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• 2007

목적 : 부종은 신증후군 환아에서 대표적 특징중 하나로 발생 기전은 아직 완전하지는 않으나 대개 저혈량증과 과다혈량증 두 가지로 설명되고 있다. 적절한 부종의 치료를 위하여서는 환자의 혈량 상태를 평가하는 것은 매우 중요하나 임상적징후만으로는 적절한 평가가 어려운 경우가 있어 소변 칼륨/소변 칼륨+소변 나트륨 비를 측정하는 방법이 보다 유용한 방법으로 소개되어, 본 연구에서는 소아 신증후군 환아의 혈류량 평가에 이를 적용하여 그 효용성에 대한 연구를 시행하였다. 방법 : 1995년 1월부터 2005년 6월까지 영남대학교 의과대학 부속병원 소아과를 방문한 일차성신증후군 환아를 대상으로 전향적인 방법으로 소변 칼륨/소변 칼륨+소변 나트륨 비가 60% 이상인 경우를 저혈량증, 소변 칼륨/소변 칼륨+소변 나트륨 비가 60% 이하인 경우를 과다혈량증으로 분류하였다. 혈류량의 상태를 간접적으로 나타내는 심박동수 증가, 심비대, 흉막삼출 등의 임상적 징후와 혈액검사 및 요검사 등을 분석하였으며, 저혈량증인 경우는 알부민 및 이뇨제를 함께 사용하였으며 반면에 과다혈량증인 경우는 이뇨제만 투여하여 이뇨 효과 및 수분-전해질 이상 등의 부작용 동반 유무를 관찰하였다. 결과 :소변 칼륨/소변 칼륨+소변 나트륨 비에 따른 과다혈량증은 29례이고 저혈량증은 21례였다. 빈맥, 심비대, 흉막삼출 등의 임상적 징후와 FeNa를 제외한 혈액검사 및 소변검사에서 두 군의 차이는 없었다. FeNa와 소변 칼륨/소변 칼륨+소변 나트륨 비은 유의한 음의 상관관계를 보였으며 BUN과 소변 칼륨/소변 칼륨+소변 나트륨 비은 유의한 양의 상관관계를 보였다. 부종 치료후의 소변량은 두 군 모두 효과적으로 이뇨되었으며, 치료로 인한 수분-전해질 이상 등의 부작용은 없었다. 결론 : 신증후군의 부종에서 소변 칼륨/소변 칼륨+소변 나트륨 비로써 혈류량 평가하며 그에 따른 부종의 치료는 매우 유용하였으며, FeNa와 혈액요소질소도 혈류량의 의미있는 평가 지표로 사용될 수 있음을 보여주었다.

• Asian-Australasian Journal of Animal Sciences
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• 제29권2호
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• pp.159-169
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• 2016

The goats raised in the barn are usually fed on fresh grass. As dry forage can be stored for long periods in large amounts, dry forage feeding makes it possible to feed large numbers of goats in barns. This review explains the physiological factors involved in suppressing dry forage intake and the cause of drinking following dry forage feeding. Ruminants consume an enormous amount of dry forage in a short time. Eating rates of dry forage rapidly decreased in the first 40 min of feeding and subsequently declined gradually to low states in the remaining time of the feeding period. Saliva in large-type goats is secreted in large volume during the first hour after the commencement of dry forage feeding. It was elucidated that the marked suppression of dry forage intake during the first hour was caused by a feeding-induced hypovolemia and the loss of $NaHCO_3$ due to excessive salivation during the initial stages of dry forage feeding. On the other hand, it was indicated that the marked decrease in feed intake observed in the second hour of the 2 h feeding period was related to ruminal distension caused by the feed consumed and the copious amount of saliva secreted during dry forage feeding. In addition, results indicate that the marked decreases in dry forage intake after 40 min of feeding are caused by increases in plasma osmolality and subsequent thirst sensations produced by dry forage feeding. After 40 min of the 2 h dry forage feeding period, the feed salt content is absorbed into the rumen and plasma osmolality increases. The combined effects of ruminal distension and increased plasma osmolality accounted for 77.6% of the suppression of dry forage intake 40 min after the start of dry forage feeding. The results indicate that ruminal distension and increased plasma osmolality are the main physiological factors in suppression of dry forage intake in large-type goats. There was very little drinking behavior observed during the first hour of the 2 h feeding period most water consumption occurring in the second hour. The cause of this thirst sensation during the second hour of dry forage feeding period was not hypovolemia brought about by excessive salivation, but rather increases in plasma osmolality due to the ruminal absorption of salt from the consumed feed. This suggests the water intake following dry forage feeding is determined by the level of salt content in the feed.

• Asian-Australasian Journal of Animal Sciences
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• 제16권8호
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• pp.1118-1125
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• 2003

Research was carried out to clarify whether a suppression of dry forage intake during the early stages of feeding in ruminants is caused by feeding induced hypovolemia which is produced by the accelerated secretion of parotid saliva. Goats with a parotid fistula were fed roughly crushed alfalfa hay cubes, commercial ground concentrate feed and $NaHCO_3$ twice daily (10:00-12:00, 16:00-18:00). The animals were free access to drinking water all day prior to, during and after experiments. The animals were intraruminally infused every day prior to the morning feeding period with parotid saliva collected from the parotid fistula over a 24 h period. The present experiment consisted of two treatments, non-infusion (RNI) and intraruminal infusion of parotid saliva (RSF). In the RSF treatment, 4-5 kg of parotid saliva (280-290 mOsm/l) collected over a 24 h period was intraruminally infused 1 h prior to the commencement of the morning feeding. During feeding, eating and parotid saliva secretion rates were measured. Blood samples were also periodically collected from the jugular vein. During and after 2 h feeding, water intakes were measured, respectively. These measurements were used to define thirst levels. It is thought that rumen fill in the RSF treatment was higher than the RNI treatment. Plasma osmolality in the RSF treatment increased in the first half of the 2 h feeding period due to the intraruminal infusion of parotid saliva. Therefore, parotid saliva secretion rates in the RSF treatment were lower than the RNI treatment for 30 min period from 30 to 60 min after the commencement of feeding. On the other hand, plasma total protein concentration and hematocrit in the RSF treatment decreased by 3.2 and 3.3% prior to the commencement of feeding due to the intraruminal infusion of parotid saliva. In the first half of the 2 h feeding period, plasma total protein concentration and hematocrit in the RSF treatment showed a tendency to decrease compared to the RNI treatment. Thirst level in the RSF treatment during feeding was approximately 31.3% less than the RNI treatment. Upon the completion of the 2 h feeding period, cumulative feed intake in the RSF treatment was significantly larger (19.7%) than the RNI treatment. The results suggest that a suppression of dry forage intake during the early stages of feeding in goats is partly caused by feeding induced hypovolemia, which is produced by the accelerated secretion of parotid saliva.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.175-178
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• 2005

Fat embolism syndrome is a collection of respiratory, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of clinical syndrome is low while the embolization of marrow fat appears to be an almost inevitable consequence of long bone fractures. The pathogenesis is a subject of conjecture and controversy. There are two theories which have gained acceptance(mechanical theory, biochemical theory). Onset of symptom is usually within 12 to 72 hours, but may manifest as early as 6 hours to as late as 10 days. The classic triad of fat embolism syndrome involves pulmonary changes, cerebral dysfunction and petechial rash. The cornerstone of treatment is preventing the stress response, hypovolemia and hypoxia and operative stabilization of fractures. Corticosteroid are the only drugs which have repeatedly shown a positive effect on the prevention and treatment of fat embolism syndrome. We report a case of post-traumatic fat embolism syndrome with severe cerebral involvement without respiratory distress. A 55 years old female had a traffic accident. She sustained pelvic bone fracture and both humerus fracture. Approximately 4 hours after the accident, mental status change developed without a focal neurologic deficits. She had no respiratory symptom and sign. Her brain MRI showed multiple cerebral fat embolism lesion. The patients received supportive treatment with corticosteroid, albumin. Her neurologic status stabilized over several days. After orthopedic surgery, she was discharged 62 days after admission.

• Childhood Kidney Diseases
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• 제21권2호
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• pp.81-88
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• 2017

Purpose: The American Society for Apheresis provides clinical guidelines for therapeutic apheresis in adults, but there are no guidelines for children. This study aimed to analyze the effect of therapeutic plasma exchange (TPE) in pediatric patients with various kidney diseases in Korea. Methods: We retrospectively reviewed the data of 16 children (up to 18 years of age) who were admitted to Severance Children's Hospital with refractory kidney disease. All patients received TPE between 1994 and 2016. Clinical and laboratory characteristics such as age, weight, sex, change in blood urea nitrogen (BUN), and creatinine level before and after TPE, and complications after TPE were analyzed. Results: The mean age and weight of the 16 patients at the time of TPE was $11.3{\pm}4.0$ years and $34.6{\pm}17.5$ kg, respectively. The BUN level was 35.4 mg/dL before TPE and significantly decreased to 21.5 mg/dL (P=0.025) at 1 week and 20.5 mg/dL (P= 0.01) at 1 month after TPE. The creatinine level significantly decreased from 1.20 mg/dL before TPE to 0.90 mg/dL (P=0.02) at 1 week after TPE. Four complications (hypovolemia, anemia, hypocalcemia, and thrombocytopenia) were reported, but were not fatal. Conclusion: Our findings suggest that TPE is an effective therapeutic modality in children with refractory kidney disease and can be indicated for the treatment of various kidney diseases.

• Journal of Yeungnam Medical Science
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• 제28권1호
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• pp.54-59
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• 2011

Leptospirosis is a spirochetal infectious disease caused by $Leptospira$ $interrogans$, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of $Leptospira$. Renal disorders caused by $Leptospira$ infection vary from an abnonnality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.167-171
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• 2009

Purpose: It is important to begin a transfusion safely and appropriately as soon as possible in a hemorrhagic shock patient. A group $O^+$ unmatched pack red blood cell (universal $O^+$) transfusion may satisfy that requirement. We report our experiences with universal $O^+$ to compare its usefulness for hemorrhagic shock patients with that of a matched pack red blood cell transfusion in the emergency department (ED). Methods: This is a retrospective study. Patients who had systolic blood pressure of less than 90 mmHg or a pulse rate of more than 120 beats per minute in the ED were included, and their medical records were reviewed. The collected data were demographic data, vital signs, blood test results, time to transfusion, the amount of transfusion, complications, and diagnoses. We calculated the emergency transfusion score (ETS) based on the patients' medical records. Results: Two hundred thirty-five patients were included. Forty-eight patients (36 trauma and 12 non-trauma patients) were transfused with a universal $O^+$. These patients had less time to transfusion compared with the cross-matched transfusion groups (35${\pm}$42 versus $170{\pm}187$ minutes, p<0.001). There were no differences in complications between groups (p=0.076). Of the patients who were transfused with universal $O^+$, 94.4% got more than 3 ETS. Conclusion: The universal $O^+$ transfusion, compared with matched pack red blood cell transfusion, should be a useful treatment for ED hemorrhagic shock patient due to its having a shorter time to transfusion without an increase in complications.

• The Korean Journal of Physiology
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• 제11권1호
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• pp.21-26
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• 1977

Many cases have been reported that a post spinal headache can be relieved immediately by an epidural injection of saline; and autologous blood also has recently been used successfully instead of saline. The changes of the cerebrospinal fluid pressure in 40 cases were observed in the present study in support of the concept; that a continuous leakage in association with hypovolemia and hypotension of the cerebrospinal fluid is the primary cause of a post spinal headache. Subarachnoid pressure increased immediately with saline injection into the lumber epidural space. A spinal needle was inserted into the subarachnoid space at the level of $L2{\sim}3$ and opening pressure of the cerebrospinal fluid was read. An epidural Tuohy needle was insertad at the$L3{\sim}4$ and 25m1 of saline was injected into the epidural space and the cerebrospinal fluid pressure was read in the sitting position. $\underline{Sitting\;Position:}$ Mean pressure after injection $555{\pm}(110.9)mm\;H_2O$, Pressure rise rise (%) 51.3%, Mean opening pressure $366{\pm}(52.2)mm\;H_{2}O$, $\underline{Lateral\;position:}$ Mean pressure after injection $308{\pm}(70.8)mm\;H_{2}O$, Pressure(%) 86.7%, Mean opening pressure $165{\pm}(42.6)mm\;H_{2}O$. These pressure changes responded almost simultaneously as saline was injected. This pressure rise of 51.3% in the sitting position and 86.7% in the lateral position are clinically very significant. Therefore, it is most possible that the immediate relieve of post, spinal headache by injection of fluid into the epidural space is simultaneous with the increase of the cerebrospinal fluid pressure.

• Tuberculosis and Respiratory Diseases
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• 제50권5호
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• pp.636-640
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• 2001

저자들은 불임환자에서 성선자극호르몬을 투여하고 발생한 난소과자극증후군에서 심한 임상경과를 보이는 양측성 삼출성 늑막을 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권1호
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• pp.65-68
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• 1999

Multiple facial trauma patient should be carefully treated because of severe bleeding on extraoral and intraoral wound, possibilty of airway obstruction and hypovolemic shock. Hypovolemic shock may be divided to hemorrhagic shock and non-hemorrhagic shock. Also hemorrhagic shock is divided to mild, moderate and severe shock according to the degree of blood volume depletion. Mild shock occurs in blood loss of less than 20% of blood volume and moderate shock does in blood loss of 20-40% of blood volume. And Severe shock occurs in blood loss of more than 40% of blood volume. The goal of emergency care of trauma patient is that respiration and perfusion should be recovered to satisfactory level and that normal vital sign is maintained. We reported the case of multiple facial trauma patient with severe bleeding and hopovolemic shock and metabolic acidosis who was treated with adequate supply of fluid transfusion, intubation, tracheostomy and emergency operation.