• Childhood Kidney Diseases
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• 제24권1호
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• pp.53-57
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• 2020

Streptococcus agalactiae or group B streptococcus (GBS) is associated with infections in neonates and pregnant women. Herein, we describe a rare case of GBS renal abscess with peritonitis and pleural effusion in a 17-year-old girl with type 1 diabetes mellitus. The girl was admitted due to fever and right flank pain. Laboratory findings included leukocytosis and increased C-reactive protein level and erythrocyte sedimentation rate. Her serum glucose level was 484 mg/dL. Urinalysis showed no pyuria. Renal sonography revealed parenchymal swelling in the right kidney. The patient was administered intravenous cefotaxime. Urine and blood cultures were negative. Fever seemed to improve, but the following day, she complained of abdominal pain and fever. Antibiotic was switched to imipenem, and abdominal and pelvic CT revealed a ruptured right renal abscess, peritonitis, and bilateral pleural effusion with atelectasis. Pigtail catheter drainage of the abscess was performed. Culture from the abscess was positive for GBS, and fever subsided 2 days after the drainage. She was discharged with oral cefixime. The clinical course of urinary tract infections (UTIs) can be atypical in patients with diabetes, and GBS can be a cause of UTIs. Prompt diagnosis and management are necessary to prevent complications in patients showing atypical courses.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권4호
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• pp.400-406
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• 2019

We report a 12-month-old female infant who had a history of neonatal sepsis with liver micro-abscesses that resolved with intravenous antibiotics during neonatal period. During her neonatal admission period, no umbilical vein catheter was inserted. Also, she did not undergo any abdominal surgeries or had a postnatal history of necrotizing enterocolitis. However, the child developed upper gastrointestinal bleeding in form of hematemesis and melena secondary to esophageal varices at the age of 12 months with an extra-hepatic portal vein obstruction with cavernous transformation and portal hypertension subsequently. The child underwent a successful endoscopic injection sclerotherapy. She is now 20-month-old and has portal hypertension but otherwise asymptomatic. We are proposing the possibility of a delayed-onset portal hypertension as a complication of liver abscess and neonatal sepsis.

• 대한치과마취과학회지
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• 제12권1호
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• pp.45-50
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• 2012

The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

• Journal of Pharmaceutical Investigation
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• 제41권1호
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• pp.31-36
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• 2011

$5HT_{2C}$ receptor among fourteen 5-HT subtypes plays important roles in several disorders such as depression, anxiety, epilepsy, schizophrenia and sleep disorders. The purpose of the study is to investigate pharmacokinetic parameters and bioavailability of a newly synthesized selective agonist of $5-HT_{2C}$ receptor, KOPC-20010 (KP10) in rats after intravenous and oral administration for the development of therapeutic anti-obesity agents. KP10 was administered orally (40 mg/kg) or intravenously (20 mg/kg), blood was collected via a catheter, and analyzed by GC/MSD. The calibration curve of KP10 in plasma and urine showed high linearity ($r^2$ >0.999). The retention times of KP10 in plasma and urine were 8.7 and 9.7 min, respectively. After oral administration of 40 mg/kg, pharmacokinetic parameters were calculated as follows; $C_{max}$ value was $1242.9{\pm}1195.5$ ng/mL at $1.1{\pm}0.6$ hr ($T_{max}$). $AUC_{0->24hr}$ and $AUC_{0>{\infty}}$ were $8034.2{\pm}960.7$ and $10464.1{\pm}681.5\;ng{\cdot}hr/mL$, respectively. The terminal half-life was $21.9{\pm}7.6$ hr. $AUC_{0->24hr}$ and $AUC_{0>{\infty}}$ were $4292.4{\pm}523.0$ and $6111.2{\pm}756.2\;ng{\cdot}hr/mL$, respectively, after 20 mg/kg of intravenous administration. The terminal half-life after intravenous administration was $25.1{\pm}9.4$ hr. Bioavailability of KP10 was determined to 86%. The excretion amount into the urine within 48 hr was approximately 4.7 to 6.7% of the dose administered. These data may be beneficial to the anti-obesity drug development of KP10.

• Journal of Hospice and Palliative Care
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• 제13권1호
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• pp.24-31
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• 2010

목적: 암환자에게 있어 중심 정맥관 삽입은 항암치료나 수혈, 비경구 영양공급 목적으로 흔히 시행된다. 중심정맥관 삽입으로 인해 발생하는 합병증으로는 감염, 혈전, 물리적 합병증이 있는데, 이 연구는 합병증의 빈도와 관련 인자들을 규명하기 위해 계획되었다. 방법: 2001년 3월부터 2006년 8월까지 중심 정맥관을 삽입한 고형암과 혈액암 환자를 대상으로 경과기록 분석을 통한 후향적 연구를 시행하였다. 감염, 혈전, 물리적 합병증 각각의 빈도를 조사하였고, 감염과 혈전의 발생에 영향을 미치는 여러 인자들과 그 연관성을 분석하기 위해 교차 분석을 사용하였다. 또한, 삽입관 수명에 영향을 미치는 인자들을 알기 위해 단변량 분석에는 log-rank test를 이용한 Kaplan-Meier 방법과 다변량 분석에는 Cox regression analysis 를 사용하였다. 결과: 310명의 암환자들에게 310개의 중심 정맥관 삽입이 시술되었고, 남자 157명, 여자 153명이었고, 혈액암 환자가 132명, 고형암 환자 178명이었으며, 평균 연령은 52세였다(range: 15~82). 60예(19%)의 환자에서 합병증이 나타났으며, 혈전을 가진 환자에서 감염이 더 빈번하게 일어났고(P=0.003), 암이나 삽입관의 종류, 수혈 및 비경구 영양 시행 여부와 합병증 발생과는 큰 연관성이 없었다. 삽입관의 평균수명은 99일(range: 2~1,330)이었는데 삽입관의 수명은 터널식 삽입관(P=0.000)을 가진 경우에, 그리고 중심정맥관을 통해 수혈을 하지 않은 경우(P=0.030) 더 연장되었다. 결론: 중심 정맥관 삽입의 주요 합병증은 혈전과 감염이었다. 터널식 정맥관은 장기적인 사용에 효과적인 방법이며, 특히 중심정맥관을 통해 수혈을 받지 않는 경우에 그러하다. 중심 정맥관 장기 사용을 위해 혈전과 감염의 예방 및 치료에 대한 연구가 더욱 이루어져야할 것으로 여겨진다.

• Journal of Hospice and Palliative Care
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• 제17권3호
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• pp.179-184
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• 2014

목적: 이 연구는 임종기 암환자들에서 말초삽입중심 정맥카테터(peripherally inserted central catheters, PICC)의 안정성 및 효과에 대해 확인하고자 한다. 방법: 2013년 한 해 동안 한전병원에 호스피스 완화의료를 목적으로 입원한 환자들 중, 말초삽입중심정맥카테터를 시행 받은 환자들을 대상으로 후향적으로 의무 기록 관찰하였다. 모든 말초삽입중심정맥카테터는 중재적 방사선의사에 의해 삽입되었다. 결과: 언급한 기간 동안 30명의 임종기 환자에서 말초 삽입중심정맥카테터가 시행되었고, 그들 중 1명의 환자에서 2회의 삽입이 이뤄져, 전체적으로 31회의 말초삽입중심정맥카테터 삽입 횟수와 571일의 거치기간(PICC days)이 분석되었다. 말초삽입중심정맥카테터 거치기간(PICC days)의 중앙값은 14.0일(범위, 1~90일)이었다. 25예는 계획된 시기(퇴원, 전원, 사망 등)까지 유지하였으나, 6예에서는 여러 이유로 계획된 시기보다 조기에 PICC를 제거하였다(PICC 조기 제거율, 19%; 10.5/1000 PICC days). 따라서, 카테터 유지 성공 비율(catheter maintenance success rate)은 81%였다. PICC 조기 제거 6예 중, 섬망 등에 의한 스스로 제거한 경우가 4예였고(13%; 7.0/1000 PICC days), 카테터 관련 혈액 감염 및 혈전증이 각각 1예씩 있었다(3%; 1.8/1000 PICC days). 조기 PICC 제거를 포함한 총 합병증 발생은 8예에서 있었다(26%; 14.1/1000 PICC days). 합병증 발생까지 기간은 중앙값 7일이었다(기간, 2~14일). 말초삽입중심정맥카테터 관련 합병증에 의한 사망은 없었다. 결론: 좋지 않은 전신 상태, 작은 시술 합병증에도 취약함, 제한된 여명등과 같은 임종기 암환자의 특징을 고려할 때, PICC는 임종기 환자에서 안전한 혈관 접근 방법이 될 수 있다.

• 대한약리학회지
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• 제31권2호
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• pp.251-259
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• 1995

Pharmacokinetics and pharmacodynamics of metoprolol, a selective beta-l blocker, were examined for 360 minutes after intravenous bolus administration of metoprolol to 6 dogs. Plasma concentration and excreted amount in the urine metoprolol were measured by liquid chromatography with fluorescence detection. PR interval and heart rate were measured by ECG monitoring. Blood pressure was monitored through intraarterial catheter in femoral artery and cardiac output by thermodilution method using Swan-Ganz catheter. To analyze the effect site concentration-response relationship, plasma concentration and pharmacological effects were simultaneously fitted to a two pharmacokinetic compartment linked to pharmacodynamic model with NONLIN program. Results are as follows. 1) The plasma concentration of metoprolol after intrvenous injection decreased biexponentially. The terminal half-life estimated was $1.33{\pm}0.40$ hours and the volume of distribution at steady state (Vdss) and the total body clearance were $1.04{\pm}0.4\;L/kg,\;6.55{\pm}2.21\;L/hr$, respectively. The central compartment volume of distribution and peripheral compartment volume of distribution were $0.35{\pm}0.14L/kg\;and\;0.69{\pm}0.34L/kg$. The renal clearance and intercompartment clearance were $0.53{\pm}0.25\;L/min\;and\;0.35{\pm}0.19\;L/min$. 2) Simulated biophase concentration-response curve shows hyperbolic relationship and the estimated concentration-effect relationship was best explained by Emax model when the prolongation of PR interval and the reduction of the heart rate were used as pharmacodynamic parameters. Emax and EC50 were estimated to be $26.3{\pm}4.7\;msec\;and\;88.8{\pm}82.3\;g/ml$ for PR interval, and $48.7{\pm}18.8\;beats/min\;and\;113.5{\pm}78.7\;ng/ml$ for heart rate, respectively. 3) The changes of cardiac output-effect site concentration relationship was best fitted by a linear model and the slope of the relationship was $0.005{\pm}0.003$. Diastolic blood pressure-effect site concentration relationship was also explained by the linear model and the slope of the relationship was $0.038{\pm}0.034$.

• 지역사회간호학회지
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• 제18권1호
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• pp.165-176
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• 2007

Purpose: The purpose of this study was to investigate the needs of home care nursing services in relation to the patients in hospital. Method: Subjects were 129 patients who admitted hospital and were selected through convenience sampling. Data were collected using the Home Health Care Need Assessment Questionnaire constructed by the Korea Health Industry Development Institute. Data were analyzed using SAS 8.12 program by applying percentage. Results: 1. According to the diagnosis of the subjects, the majority had cancer (25.0%), followed by musculoskeletal disease (15,6%), neuro/cerebral vascular disease (14.1%), digestive (10.9%) and respiratory disease (10.9%). 2. With regard to fundamental nursing service, subjects wanted to receive home care services for the following reasons: Problem identification and diagnosis (77.5%), vital sign check (49.6%); and intake and output measure (20.9%). 3. With regard to clinical laboratory tests, 62.8% wanted to receive blood tests, and followed by urine tests 26.4%, and wound drainage 26.4%. 4. With regard to medication and treatment service, 40.3% of the subjects wanted to receive intravenous fluid therapy, 26.4% intravenous antibiotics, and 26.4% the monitoring of fluid therapy. 5. With regard to therapeutic nursing service, 33.3% wanted to receive wound care, 26.4% ROM exercise, and 27.9% foley catheter change and care. 6. With regard to educational needs, 42.6% wanted education on infection monitoring, 41.4% on medication, and 34.9% on diet. 7. With regard to counseling needs, 65.9% wanted to receive telephone counseling about patient condition, 52.7% counseling about re-admission and 51.9% direct counseling about patient condition. In the group of injury and toxicity, and cardiovascular/circulatory diseases, 100% wanted telephone and direct counseling about the patient condition. Conclusion: Therefore, in order to improve the quality of hospital based home health care services, various factors that affect to the need of home health care should be analyzed and specified nursing care should be looked into.

• 기본간호학회지
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• 제5권2호
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• pp.207-224
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• 1998

The purposes of this study were to identify nurse's recognition and performance and to represent the factors of hindrance in the IV therapy management. The subjects were 420 nurses who worked at five general hospitals in Pusan. Tha data were collected using a questionnaire and the period of data collection was from January 1 to January 31, 1998. The instrument for this study was made by author oneself on the basis of guidelines Simmons et al', CDC' Stanley' and Kurdi' guideline, Cllinical Nurse's Association' that consist of 68 items for 5 fields ; pre-injection, just before-injection, needle-injection, during injection, post-injection field. Cron-bach Alpha coefficient of recognition and performance in the IV therapy management was .93 and .87. The datas were analized by a SPSS program using frequency, percent, paired t-test, t-test and oneway ANOVA. The results obtained were as follows : 1. The mean score of recognition in IV therapy management was significantly higher than that of performance(t=5.86, P<.001). 2. The items of lower than mean score of each fields in performance were the identification of drugs, hands washing, patient teaching about medication, disinfectional methods of the injection site and the rubber stopper in bottle, the use of disposable gloves, mask and eye goggles at the chemotherapy preparation, use of tape and armboard, changing the IV tubing, labeling the dressing over the injection site, observation and recordings of patient's condition after medication and confirmation of the needle length at the needle removal. 3. The factors of hindrance in IV therapy were 'having no time', 'insufficiency of goods', 'unknowing of methods', 'no disadvantage', and 'factors of doctor's doing'. The most important factor was 'have no time', especially item of hands washing. The other factors of hindrance showed high frequency in the following items ; 'insufficiency of goods' in the use of disposable gloves, mask and eye goggles at the chemotherapy preparation, 'unknowing of methods' in the certification of drugs compatibility, 'no disadvantage' in the labeling the dressing over the injection site, and 'factors of doctor's doing' in the changing the subclavian catheter dressing and checking the glucose level during the TPN infusion. In conclusion, there is necessity of educational program which can improve the nurse's knowledge of drugs, disinfection methods, comfort of patient and recordings in IV therapy management and alternative plan which are political and financial aids such as setting up the sink, giving of paper towels and necessary goods in the IV therapy for reducing the factors of hindrance for IV therapy management.

• 대한영상의학회지
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• 제79권6호
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• pp.323-331
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• 2018

목적: 간종양의 경피적 고주파 열치료(radiofrequency ablation, 이하 RFA) 도중 및 종료 후 발생하는 통증을 관리하는데 있어 흉부방척추블록(thoracic paravertebral block, 이하 TPVB)의 효용성을 평가하고자 하였다. 대상과 방법: TPVB를 시행하지 않은 그룹(4명; 4개 종양, 4회 RFA)과 시행한 그룹(5명; 7개 종양, 7회 RFA)으로 나누었다. 초음파 유도하 TPVB는 7번 흉추에서 시행하였다. 시술 전 우측 방척추 공간에 0.375% ropivacaine을 15 mL 주입하였다. 시술 중 환자가 통증을 호소하며 진통제를 요구하거나 구두통증척도(verbal numerical rating scale) 4점 이상의 통증을 호소하면 fentanyl $25{\mu}g$ (최대 $100{\mu}g$), pethidine 25 mg, midazolam 0.05 mg/kg (최대 5 mg)을 순차적으로 정맥 주입하였다. 결과: RFA 전, 도중, 후 사용된 진통제의 총 정맥 주입 모르핀 등가(total intravenous morphine equivalence)는 TPVB를 시행하지 않은 그룹에서는 129.1 mg이었고, 시행한 그룹에서는 0.0 mg이었다. 결론: 초음파 유도하 TPVB는 간종양의 RFA 도중 및 후에 발생하는 통증을 감소시키는데 효과적이고 안전한 방법일 수 있겠으며 마약성 진통제의 사용량을 줄이는데 도움이 될 것이다.