• Journal of Yeungnam Medical Science
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• 제34권1호
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• pp.37-42
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• 2017

Background: A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects. Methods: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured. Results: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl). Conclusion: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.

• The Korean Journal of Pain
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• 제26권3호
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• pp.277-285
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• 2013

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6337-6342
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• 2012

Background: Clinical trials on cancer subjects have one of the highest dropout rates. Barriers to recruitment range from patient-related, through institutional-related to staff-related factors. This paper highlights the low response rate and the recruitment barriers faced in our Qigong exercises trial. Materials and Method: The Qigong trial is a three-arm trial with a priori power size of 114 patients for 80% power. The University Malaya Medical Centre database showed a total of 1,933 patients from 2006-2010 and 751 patients met our inclusion criteria. These patients were approached via telephone interview. 131 out of 197 patients attended the trial and the final response rate was 48% (n=95/197). Results: Multiple barriers were identified, and were regrouped as patient-related, clinician-related and/or institutional related. A major consistent barrier was logistic difficulty related to transportation and car parking at the Medical Centre. Conclusions: All clinical trials must pay considerable attention to the recruitment process and it should even be piloted to identify potential barriers and facilitators to reduce attrition rate in trials.

• 여성건강간호학회지
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• 제11권4호
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• pp.307-315
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• 2005

Purpose: A descriptive study was conducted to identify the change patterns on the level of perceived distress during the early postoperative period with regard to state anxiety in patients using patient controlled analgesia. Method: One hundred women who underwent elective hysterectomy procedures or other gynecologic surgeries completed a series of questionnaires measuring state anxiety, and subjective distress assessed by visual analog scales at 8, 24, & 48 hours postoperatively. Data were analyzed with frequencies, percentages, means, ANOVA, Repeated Measures ANCOVA, and Scheff'e post test utilizing SPSS WIN 11.0. Result: There was a gradual decrease in levels of total distress and pain over the three points in time after surgery regardless the levels of state anxiety. However, women with higher levels of anxiety their pain curve rose at 48 hours post-op. In addition, over the first two points in time, women in the higher anxiety group showed higher levels of distress than those in the lower anxiety group, but no such group differences were observed in the levels of pain, revealing higher pain levels only at 8 hours post-op in both groups. Conclusion: Irrespective of effective pain management modality, most postoperatively experienced distress in gynecological patients was derived from anxiety and pain. These findings have implications for pain management, especially in patients with emotionally charged surgeries like hysterectomy.

• 기본간호학회지
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• 제14권1호
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• pp.18-28
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• 2007

Purpose: This study was to identify knowledge, attitude, use and state of the Patient Controlled Analgesics (PCA) in postoperative patients. Method: The research design was a descriptive research. From December 7, 2005 to January 6, 2006, 102 postoperative patients in a university hospital at Daegu were participated in the study Results: Analgesics with PCA were mainly morphine complex 73.5% and Demerol complex 26.5%. Previous experience of using PCA was only 28.4%, and the main sources of information were other post-op patients and families(43.1%). The most common reason of choice was a recommendation from other post-op patients and families(46.1%). The most common side effects of PCA were nausea and vomiting(20.6%). About 57% of the patients were satisfied with PCA, and pain scores decreased with PCA. Mean score for knowledge about PCA was 2.55 out of a possible 6, and for attitude related to pain medication. 2.31 out of possible 5. Conclusion: To increase the score on knowledge of PCA, a structured preoperative PCA education program should be developed by nursing staff.

• 대한피부과학회지
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• 제56권9호
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• pp.548-551
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• 2018

Biologics are the most advanced treatment for psoriasis. Ustekinumab, one of the biologics for psoriasis, is a human monoclonal antibody that binds to the p40 subunit of interleukin-12 and interleukin-23. A 41-year-old woman with a 17-year history of plaque psoriasis and psoriatic arthritis presented with worsening lesions. The patient had previously been treated with a number of topical and systemic medications and narrow band ultraviolet B. However, none of the treatments consistently controlled her disease. Thus, treatment with ustekinumab 45 mg via subcutaneous injection was initiated. Approximately 7 days after the first treatment, she experienced a flare with generalized pustules in her whole body. The condition was controlled with systemic steroid treatment. The patient was subsequently treated with adalimumab, and improvement in her plaque and pustular lesions was noted. Herein, we report a case of psoriasis that flared up after ustekinumab therapy, which was accompanied by a morphological change from plaque to pustular lesions.

• Journal of Oral Medicine and Pain
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• 제44권3호
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• pp.77-82
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• 2019

Purpose: With the popularity of implant therapy, clinicians need to know about treating the dental implant in patients with gingival involvement of oral lichen planus (OLP). The aim of this study is to evaluate the survival and success rates of dental implant and propose of clinical guidelines for implant treatment in OLP patient with gingival involvement. Methods: A literature search was performed in PubMed/Medline, and Cochrane database. Papers in English language published between 1990 and 2019 were evaluated. The focused questions were following; 1) Dose gingival OLP affect the survival and success rates of dental implants? 2) The management of OLP patients with gingival involvement receiving dental implant. Results: There was no study about the evaluation of dental implant only in gingival OLP patient. Five studies evaluating dental implants in OLP patients were included in this review. Implant survival rate was 100.0% in well-controlled OLP patients in all included studies. The use of topical/systemic corticosteroid in OLP patients was performed before and/or after implant placement in all included studies. Conclusions: The implant survival and success rates in well-controlled OLP patients did not different from that of non-OLP healthy subjects. The gingival OLP is associated with higher rate of peri-implant mucositis. Adequate management of gingival OLP lesions before and after implant insertion is required to reduce inflammation and associated bone loss.

• Journal of Digestive Cancer Research
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• 제4권1호
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• pp.39-42
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• 2016

A 67-year-old male was admitted due to abdominal pain. Abdominal CT scan performed in a local clinic showed about 2 cm sized pancreatic tail mass with extensive liver and multiple regional lymph node metastasis. Histology of liver biopsy revealed poorly differentiated adenocarcinoma. He underwent chemotherapy with gemcitabine and erlotinib for 5 cycles followed by 8 cycles of second line chemotherapy with 5-fluorouracil and cisplatin. At 12 months after diagnosis, follow-up abdominal CT scan revealed marked reduction of tumor mass in the liver and pancreas with small residual tumor. After one month of last chemotherapy, he complained radiating pain along left leg. Blood chemistry revealed isolated elevation of alkaline phosphatase (ALP) and multiple bone metastasis were demonstrated in bone scan. Palliative radiation therapy to pelvic bone was performed for the relief of bone pain. The prognosis of advanced pancreatic cancer is extremely poor. We report late occurrence of multiple bone metastasis in a patient with well controlled advanced pancreatic cancer with chemotherapy.

• 한국건강관리협회지
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• 제4권1호
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• pp.39-48
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• 2006

Background : Diabetes mellitus is chronic condition which needs patients' understanding of disease status and effort for disease control. We investigated whether the patients' estimation for blood glucose control was reliable or not comparing with their HbA1C value, Method: Among people who visited one health promotion center in Seoul from 1995 to 2003,those who answered as having diabetes mellitus on self reported questionnaire were identified. Subsequent question was whether his or her diabetes was well controlled or not. We compared these replies with their HbA1C values. When their HbA1C values were below7% with answering not well controlled, we analyzed if there was any variable which can predict the discrepancy. And the same analyze we did for the opposite situation. Result: A total of 1193 patients were eligible. Those who answered as well controlled formed32.9% of the group with HbA1C values above 7%. In the cases with well controlled though significantly associated with this discrepancy, Conclusion: Considerable proportion of diabetic patients' estimation for diabetic control status was not matched with glycemic control guideline. For successful management of diabetes mellitus, more efforts for patient education and communication skills are essential.

• The Korean Journal of Pain
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• 제20권2호
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• pp.169-173
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• 2007

Background: Although the use of intravenous patient controlled analgesia (IVPCA) has been compared to the use of patient conrolled epidural analgesia (PCEA), there is no optimal administration route of alfentanil for the treatment of postoperative pain. This randomized double-blind study compared the efficacy of the use of IVPCA and PCEA for postoperative pain and the side effects after a total abdominal hysterectomy (TAH). Methods: Sixty patients undergoing a TAH were randomly assigned to receive either IVPCA (Group I) or PCEA (Group E) for the infusion of alfentanil for postoperative pain control. In both groups, a loading dose of $750{\mu}g$ alfentanil was administered. All patients received the same continuous infusion rate (0.3 mg/h), bolus dose (0.15 mg), and lockout time (15 min). The incidence of side effects, the VAS (visual analog scale) of pain, blood pressure, and heart rate were checked for 20 hours after the loading dose injection. Results: The VAS of pain was not significantly different between the two groups of patients. The onset of the analgesic effect was significantly more rapid in the Group I patients than in the Group E patients. There was no difference in side effects for either group. Conclusions: When considering multiple factors such as the onset of analgesia, technical difficulties or infection after the procedure, IVPCA using alfentanil is more useful than PCEA for postoperative pain control after a TAH.