• 대한치과마취과학회지
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• 제9권1호
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• pp.30-35
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• 2009

Intravenous midazolam has been frequently used for the relief of anxiety in dental treatment. This is likely the result of the sedative and anterograde amnestic properties of midazolam that are mediated through $\gamma$-Aminobutyric acid agonism. Unfortunately, Paradoxical reactions to midazolam include agitation, talkativeness, confusion, disinhibition, aggression,violent behavior, act of self-injury and need for restraints. These occur in less than 1% of all patients receiving midazolam, may occur at variable times after administration and are difficult to predict and diagnose. Two women with severe anxiety for dental treatment experienced paradoxical reactions associated with the use of intravenous midazolam. We are reviewed the management and prevention of paradoxical reactions and its different etiology.

• 대한한의학방제학회지
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• 제24권1호
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• pp.31-43
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• 2016

Objectives Based on related literature, cold and heat, deficiency and excess, true and false, and actually used formulas, paradoxical treatments presented in the 『Plain Questions of Inner Canon of Yellow Emperor』 including ‘treating pseudo-heat symptoms and real cold syndrome with cold herbs, treating pseudo-heat symptoms and real cold syndrome with cold herbs’ were analyzed.Methods Out of literature, paradoxical treatment related classics and papers were investigated and analyzed. Among diseases and syndromes, real cold syndrome with pseudo-heat symptoms, real heat syndrome with pseudo-cold symptoms, real deficiency syndrome with pseudo-excess symptoms, and real excess syndrome with pseudo-deficiency symptoms were reviewed. Among formulas, typical examples of the above mentioned paradoxical treatments were used as examples to analyze paradoxical treatments.Results Treating pseudo-heat symptoms and real cold syndrome with cold herbs is a method that uses herbs with cool and cold nature to treat real cold syndrome with pseudo-heat symptoms and Tongmaeksayeokgajeodamjeuptang is suitable for this method. Treating pseudo-cold symptoms and real heat syndrome with hot herbs is a method that uses herbs with warm and hot nature to treat real heat syndrome with pseudo-cold symptoms and Baekhogainsamtang is suitable for this method.Conclusions Based on the related literature, cold and heat, deficiency and excess, true and false, and actually used formulas examined as mentioned above, the paradoxical treatments presented in the 『Plain Questions of Inner Canon of Yellow Emperor』 are thought to be reasonable paradoxical treatments that fit the diseases and syndromes that actually appeared in our bodies.

• Tuberculosis and Respiratory Diseases
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• 제64권6호
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• pp.427-432
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• 2008

연구배경: 결핵환자에서 항결핵제 치료 중 초기에 병변의 호전 이후 방사선학적, 임상적으로 이전의 병변이 악화 되거나 새로운 병변이 발생하는 경우를 역설적 반응이라 정의한다. 결핵흉막염에서의 역설적 반응 발생과 이와 관련된 인자에 대해서 알려진 바는 많지 않다. 방 법: 2004년 1월부터 2006년 12월까지 결핵흉막염으로 진단받고 4개월 이상 항결핵제를 복용한 환자를 대상으로 하였다. 항결핵제 투약 전과 투약 후 흉부 방사선의 변화를 연속적으로 살펴보고 치료시작 2주 후에 이전의 병변의 악화나 새로운 병변이 생긴 경우를 역설적 반응이 발생한 것으로 판정하였다. 역설적 반응군이 발생하였던 환자군과 발생하지 않았던 환자군 간의 임상적인 특성과 흉수, 혈액 검사를 비교하였다. 결 과: 대상환자 77명 중 역설적 반응을 보인 환자는 16명(21%)이었다. 역설적 반응을 보인 시기는 항결핵제 사용 후 평균 38.6일이었으며, 병변의 크기가 줄어드는데 걸리는 시간은 평균 32.1일이었다. 역설적 반응은 젊은환자에서(30.5세 vs 39.0세), 그리고 흉수의 백혈구 중 림프구의 백분율이 높았던 경우에서(82.1% vs 69.6%) 많이 발생하였다. 결 론: 결핵흉막염의 항결핵제 치료 중에 발생하는 역설적 반응은 드물지 않았으며 환자의 연령과 흉수의 백혈구 중 림프구의 백분율이 역설적 반응의 발생빈도와 관련이 있었다.

• 대한기관식도과학회지
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• 제9권1호
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• pp.83-86
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• 2003

Background and Objectives : Paradoxical vocal cord movement is a series of paroxysmal adduction of the anterior two-thirds of the vocal cords during respiration or during phonation. The choking, stridor, and wheezing in this condition occur primarily on inhalation, rather than on exhalation. The two pathognomonic diagnostic criterias that need to be assessed during an acute presentation are laryngoscopy with direct visualization of paradoxical adduction of the vocal cords and pulmonary function testing. Materials and Methods : A retrospective review of 3 patients who were referred to otolaryngologist from pulmonology department, and were confirmed by typical laryngoscopic findings with paradoxical adduction of the vocal cords was conducted. Results The patients were misdiagnosed as exercised-induced asthma, and unresponsive to corticosteroid and bronchodilators. Improvement was achieved only by diagnosis with paradoxial vocal cord movement. Biofeed back therapy, voice therapy, treatment for reflux laryngitis improved symptoms. Conclusion The etiology of paradoxical vocal cord movement is unknown. It may be functional or emotional. The functional factors that were proposed are neurologic deficit and gastroesophageal reflux. Management methods of this condition consist of psychological counselling, voice therapy, and antireflux medication.

• Tuberculosis and Respiratory Diseases
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• 제51권3호
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• pp.260-264
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• 2001

연구배경 : 역설적 두개강내 결핵종이란 항결핵 치료 중 발생하거나 커지는 결핵종을 말한다. 그러나 이 병의 자연경과나 치료법등은 잘 알려져 있지 않다. 연구방법 : 항결핵 치료 후 두개강내 결핵종이 발견되었거나 결핵종이 커진 10명의 환자를 대상으로 후향적 연구를 시행하였다. 결 과 : 역설적 두개강내 결핵종은 항결핵제 치료 시작 후 평균 67.9일 후 발견 되었다. 결핵종은 발견 후 평균 102.3간의 악화소견을 보였으며 165.4일후 호전되는 양상을 보였다. 뇌 척수액 소견은 결핵종 발견당시 악화되었다가 결핵종이 호전되면서 같이 호전 되었다. 결 론 : 역설적 두개강내 결핵종은 특별한 증상 없이도 발생할 수 있다. 이 결핵종은 독립된 하나의 질병 혹은 반응이 아니라 두개강내 결핵종 혹은 결핵에서 치료에 대한 자연경과 이던지 치료에 약간 반응이 떨어지는 경우일 것일 수 있다.

• 대한한방내과학회지
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• 제37권5호
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• pp.733-740
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• 2016

Objective: To evaluate the effects of integrative treatment with conventional and Korean medicine on cerebral infarction due to presumed paradoxical embolism through a patent foramen ovale. Methods: We applied acupuncture, herbal medication, western medication, and physical therapy routinely every day and applied fluid therapy provided as needed. The NIHSS, K-MBI, MRS, MMT, and MMSE-K score were determined to assess any improvement in symptoms. Results: Scores appeared to be improved for the NIHSS (9 to 5), K-MBI (94 to 100), MRS (2 to 1), MMT (2+, 4 to 4, 4), MMSE-K (24 to 26). No side effects were observed during the treatment. Conclusions: This study demonstrates that integrative treatment with conventional and Korean medicine may be an effective option for treating cerebral infarction due to a presumed paradoxical embolism through a patent foramen ovale.

• 대한치과마취과학회지
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• 제9권2호
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• pp.104-107
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• 2009

Midazolam, one of the most common benzodiazepine derivatives, is widely used in intravenous sedation for dental treatment without severe complications. However, paradoxical reactions to midazolam, including patient's unanticipated restlessness, agitation, hostility, and rage, have been frequently reported since the introduction of benzodiazepine. During outpatient intravenous sedation using midazolam for dental treatment, we experienced a paradoxical reaction to midazolam in a 28-year-old female patient. With a thorough review of the literature, the management of this complication and its various etiologies were discussed.

• Journal of Korean Neurosurgical Society
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• 제51권2호
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• pp.102-104
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• 2012

Although decompressive craniectomy is an effective treatment for various situations of increased intracranial pressure, it may be accompanied by several complications. Paradoxical herniation is known as a rare complication of lumbar puncture in patients with decompressive craniectomy. A 38-year-old man underwent decompressive craniectomy for severe brain swelling. He remained neurologically stable for five weeks, but then showed mental deterioration right after a lumbar puncture which was performed to rule out meningitis. A brain computed tomographic scan revealed a marked midline shift. The patient responded to the Trendelenburg position and intravenous fluids, and he achieved full neurologic recovery after successive cranioplasty. The authors discuss the possible mechanism of this rare case with a review of the literature.

• Advances in pediatric surgery
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• 제19권2호
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• pp.150-155
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• 2013

Tuberculous Iliopsoas muscle abscess is a rare manifestation in patient with extrapulmonary tuberculosis and hardly observed in developed country. Paradoxical response to anti-tuberculous medication could make difficult therapeutic decision to clinicians. The authors report a case of tuberculous iliopsoas muscle abscess with multiple intraabdominal and thoracic abscesses in 9 year-old-boy who presented paradoxical response to anti-tuberculous treatment.

• Clinical and Experimental Pediatrics
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• 제52권6호
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• pp.717-720
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• 2009

결핵 환자들에서 역설적반응이란 항결핵제 치료 중 초기에 병변의 호전 이후 방사선학적, 임상적으로 이전의 병변이 악화되거나 새로운 병변이 발생하는 경우로 정의될 수 있다. 전세계적으로 지금까지 다양한 종류의 역설적 반응이 보고되어 왔다. 그러나 국내 소아에서의 보고는 거의 드물다. 이에 저자들은 17세 남아에서 결핵성 흉막삼출로 진단되어 결핵약물에 좋은 반응을 보여 적절한 치료 후 흉수가 호전된 후에, 첫 치료 3주 후에 새로이 발생한 폐병변이 기존의 항결핵제를 계속하면서 결국에는 호전된 케이스를 경험하였기에 보고하는 바이다.