• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.2
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• pp.178-182
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• 2006

Pulmonary edema is a well known phenomenon in medicine, physical findings indicative of this condition include frothy pink sputum, dispnea, and chest X-ray may present cephalization of vessels, perihilar edema, or diffused increase of density. It is one of the most serious, life threatening situation and should be diagnosed and managed instantly. Early diagnosis and intensive treatment are mandatory in order to effectively resolve the situation. The most common etiology for this pathology is cardiogenic, such as left ventricular failure and valvular disease. The one following is noncardiogenic, such as transfusion, infectious pneumonia, inhaled toxins, shock lung in association with trauma. Other forms of pulmonary edema which have not been clearly explained result from pulmonary embolism, drug overdose, after anesthesia, epinephrine overdose, exposure to high altitude, neurogenic, etc. We experienced two cases of pulmonary edema during two jaw surgeries(Le Fort I Osteotomy & BSSRO). These patients were young and physically healthy individuals on preoperative evaluation. Thus we report and discuss the etiology, diagnosis, prognosis, and treatment with journals review.

• Journal of Korean Academy of Nursing
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• v.28 no.4
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• pp.970-979
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• 1998

Cancer has been considered a life-threatening disease and coping patterns could have a strong impact the physical and psychological health of patients and their family. The purpose of this study was to identify the change of coping patterns according to the phases of illness in the patients with cancer and their family caregivers and to compare the coping patterns of patients with those of their caregivers. The phases of illness consisted of 1st(initial) stage, 2nd(metastatic or recurred) stage and 3rd (terminal) stage based on literature. The coping methods were measured using the modified Ways of Coping Questionnaire by Lazarus & Folkman(1984). Seventy-nine patients(35 in stage 1, 31 in stage 2, and 13 in stage 3) and ninety-two caregivers (38 in stage 1, 30 in stage 2 and 24) agreed to participate from two general hospitals in Seoul and Choongnam. No significant changes were found in the coping patterns according to the phases of illness in both groups. Patients in stage 2 and caregivers in stages 2 and 3 problem-focused coping methods were significantly used more than emotion-focused coping methods. Patients in stage 1 significantly used two coping strategies that were cognitive reconstruction and emotion expression more than caregivers. Patients in stage 2 significantly used emotion-focused coping methods including minimizing threat, blame, and emotion expression excepting wishful thinking more than caregivers. We need more research to identify the relationship between the coping methods and their efficiencies through longterm observation and attempt to develope the nursing interventions that could have an improvement on positive coping methods and provide guidance on the problems the patients experience.

• Tuberculosis and Respiratory Diseases
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• v.75 no.6
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• pp.260-263
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• 2013

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

• Research in Community and Public Health Nursing
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• v.30 no.4
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• pp.581-587
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• 2019

Purpose: Abdominal pain is the most common symptom of patients visiting the emergency department (ED). Abdominal pain is caused by a variety of causes, so it is difficult for a triage nurse to determine the urgency of a patient, but it is still a must. The purpose of this study was to identify the related factors to the urgent diseases of patients with abdominal pain visiting ED. Methods: This study was a retrospective descriptive study. The study setting was an ED in a tertiary hospital in Korea. Data were collected from September 1, 2017 to October 15, 2017. During the study period, of a total of 6,181 patients visiting the ED, 731 complained of abdominal pain. Patients with obvious cause of pain and patients who could not express detailed symptoms were excluded. The 573 patients were included in the final analysis. We collected demographics, clinical characteristics, and final diagnosis. We divided final diagnoses into urgent diseases which were more likely to be life-threatening without treatment and non-urgent diseases. We identified the related factors to the urgent diseases of patients with abdominal pain using the logistic regression. Results: 173 (30.2%) patients had urgent diseases. Age (OR=1.02, 95% CI=1.00~1.03), referral from other clinics (OR=2.92, 95% CI=1.86~4.60), ambulance utilization (OR=2.00, 95% CI=1.27~3.15), diarrhea (OR=0.44, 95% CI=0.25~0.76), and tachycardia (OR=2.27, 95% CI=1.44~3.58) were related to urgent diseases. Conclusion: Triage nurse should take into account the patient's age, mode of visiting, and route of visiting ED; and check the symptom of tachycardia or diarrhea.

• Clinical and Experimental Pediatrics
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• v.58 no.6
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• pp.199-205
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• 2015

Severe aplastic anemia (SAA) is a life-threatening disorder for which allogeneic hematopoietic stem cell transplantation (HSCT) is the current available curative treatment. HSCT from matched sibling donors (MSDs) is the preferred therapy for children with acquired SAA. For patients who lack MSDs, immunosuppressive therapy (IST) is widely accepted as a first-line treatment before considering HCT from an unrelated donor (URD). Given the recent progress in HSCT using URDs for childhood SAA, well-matched URDs became a realistic alternative for pediatric patients who have no suitable related donors and who are refractory to IST. However, it is quite challenging to treat patients with refractory SAA who lack suitable related or URDs. Even though haploidentical HSCT from genetically mismatched family members seemed to be an attractive procedure with the amazing benefit of readily available donors for most patients, early attempts were disappointing because of refractory graft-versus-host disease (GVHD) and excessively high transplant-related mortality. Recent advances with effective ex vivo depletion of T cells or unmanipulated in vivo regulation of T cells, better supportive care, and optimal conditioning regimens have significantly improved the outcome of haploidentical transplant. Besides considerable progress in the treatment of malignant diseases, recent emerging evidences for haploidentical HSCT in SAA has provided additional therapeutic options for patients with refractory diseases. Further improvements to decrease the rates of graft failure, GVHD, and infectious complications will facilitate the emergence of haploidentical HSCT as a front-line therapy for treating acquired SAA in children and adolescents who have no suitably matched donors.

• Clinical and Experimental Pediatrics
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• v.59 no.2
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• pp.100-103
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• 2016

Patients with hemolytic-uremic syndrome (HUS) can rapidly develop profound anemia as the disease progresses, as a consequence of red blood cell (RBC) hemolysis and inadequate erythropoietin synthesis. Therefore, RBC transfusion should be considered in HUS patients with severe anemia to avoid cardiac or pulmonary complications. Most patients who are Jehovah's Witnesses refuse blood transfusion, even in the face of life-threatening medical conditions due to their religious convictions. These patients require management alternatives to blood transfusions. Erythropoietin is a glycopeptide that enhances endogenous erythropoiesis in the bone marrow. With the availability of recombinant human erythropoietin (rHuEPO), several authors have reported its successful use in patients refusing blood transfusion. However, the optimal dose and duration of treatment with rHuEPO are not established. We report a case of a 2-year-old boy with diarrhea-associated HUS whose family members are Jehovah's Witnesses. He had severe anemia with acute kidney injury. His lowest hemoglobin level was 3.6 g/dL, but his parents refused treatment with packed RBC transfusion due to their religious beliefs. Therefore, we treated him with high-dose rHuEPO (300 IU/kg/day) as well as folic acid, vitamin B12, and intravenous iron. The hemoglobin level increased steadily to 7.4 g/dL after 10 days of treatment and his renal function improved without any complications. To our knowledge, this is the first case of successful rHuEPO treatment in a Jehovah's Witness child with severe anemia due to HUS.

• Journal of Yeungnam Medical Science
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• v.29 no.2
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• pp.121-124
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• 2012

Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.

• Archives of Craniofacial Surgery
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• v.13 no.2
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• pp.147-150
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• 2012

Purpose: Varicella-zoster virus (VZV) infection is a common childhood disease. However, old and immune compromised patients are also at risk. Necrotizing fasciitis is a life threatening infection of the subcutaneous tissues, rapidly extending along the fascial planes. It is associated with a significant mortality rate, reported between 20% and 50%, and is therefore regarded as a surgical emergency. The authors treated a patient, who developed skin necrosis of her nose and left hemifacial area, following VZV infection. There are few literatures concerning this case; therefore, we present a rare case with review of literature. Methods: A 39-year-old woman had shown a localized, painful, multiple bullae and eschar formation in her nose and left hemifacial area for several days. Her skin lesion had rapidly worsened in size and morphology. Results: We diagnosed her as a necrotizing fasciitis, following herpes zoster, and then we performed a debridement of necrotic tissue and took a full thickness skin graft on her nose and left hemifacial area. Now, she was followed up with acceptable aesthetic result after 6 months. Conclusion: Secondary bacterial skin infection following VZV, can cause a result in a higher risk of complications. Among the complication, a necrotizing fasciitis of the head and neck is uncommon, and involvement of the nose is even more rare. Through this uncommon case report, we intend to emphasize the fact that early diagnosis of necrotizing fasciitis is very important, since it frequently necessitates surgical treatment which improves morbidity and leads to good recovery.

• Journal of Yeungnam Medical Science
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• v.21 no.1
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• pp.101-107
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• 2004

Diffuse alveolar hemorrhage is a rare but serious and frequently life-threatening complication of a variety of conditions. The first goal in the management of patients with diffuse alveolar hemorrhage is to achieve or preserve stability of the respiratory status. Subsequently, the differential diagnosis is aimed at the identification of a remediable cause of the alveolar hemorrhage. The most common causes of diffuse alveolar hemorrhage with glomerulonephritis are microscopic polyangiitis and Wegener's granulomatosis, followed by Goodpasture syndrome and systemic lupus erythematosus. Microscopic polyangiitis (MPA) is a distinct systemic small vessle vasculitis affecting small sized vessels with few or no immune deposits and with no granulomatosus inflammation. The disease may involve multiple organs such as kidney, lung, skin, joint, muscle, gastrointestinal tract, eye, and nervous system. MPA is strongly associated with antineutrophil cytoplasmic autoantibody (ANCA) that is a useful serological diagnostic marker for the most common form of necrotizing vasculitis. Our report concerns a case of microscopic polyangiitis with diffuse alveolar hemorrhage in a 54-year-old man. He was admitted to our hospital due to dyspnea upon exertion and recurrent hemoptysis. Laboratory findings showed hematuria, proteinuria and deterioration of renal function. In the chest CT scan, diffuse ground glass appearance was seen in both lower lungs. A lung biopsy revealed small vessel vasculitis with intraalveolar hemorrhage and showed a positive reaction to against perinuclear ANCA. The patient was treated with prednisolone and cyclophosphamide. Chest infiltration decreased and hemoptysis and hypoxia improved. He is still being followed up in our hospital with a low dose of prednisolone.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.892-895
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• 2008

H-type tracheoesophageal fistula (TEF) is extremely rare in infants and children, and clinical manifestations of this condition are diverse based on its severity. Some cases of congenital TEF diagnosed in adulthood have been reported, which indicate the difficulty of early diagnosis of this disease. Gastroesophageal reflux (GER) may induce chronic aspiration, pulmonary aspiration, apparent life-threatening events, and failure to thrive. We report a 5-month-old boy whose recurrent pneumonia and wheezing did not improve under usual treatment and led to acute respiratory distress syndrome. He was found to have severe GER on the second-trial of the esophagogram and was eventually revealed to have congenital H-type TEF upon repeated evaluation.