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Efficacy and safety of electrolytes-free polyethylene glycol (PEG) 4000 for disimpaction in children with chronic functional constipation (소아 만성 기능성변비 치료에서 전해질이 함유되지 않은 polyethylene glycol (PEG) 4000의 분변박힘 제거효과 및 안전성)

  • Lee, Jeong Hee;Lee, Ran;Bae, Sun Hwan
    • Clinical and Experimental Pediatrics
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    • v.51 no.4
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    • pp.391-395
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    • 2008
  • Purpose : This study was performed evaluate optimal dose for disimpaction, efficacy and safety of PEG 4000 in children with chronic functional constipation. Methods : Eighty six children with chronic functional constipation were enrolled in this prospective study at Konkuk university hospital March, 2003 through August, 2006. Success in disimpaction with PEG 4000 was defined as meeting at least two out of three criteria; resolution of chief complaint, getting easiness of defecation with respect to frequency of bowel movement and hardness of stool based on defecation diary, and decrease in fecal impaction on simple abdominal X-ray test. Adverse effects of PEG 4000 were monitored clinically and biochemically. Results : Eighty three out of 86 children completed the study, and success rate of disimpaction was 99% (82/83). The mean dose of PEG 4000 for disimpaction was $0.93{\pm}0.28g/kg/day$ (0.4-2.0 g/kg/day, Max.: 30 g/day). Frequency of bowel movement increased ($5.02{\pm}2.71/wk$ vs. $11.25{\pm}5.43/wk$) in most children (79/83). Fecal impaction on simple abdominal X-ray test improved with statistical significance in 25 children (P=0.0007). Because of adverse effect of PEG 4000, 3 children did not complete the study; urticaria, severe diarrhea, diarrhea and abdominal pain. One 6-year-old girl who completed the study complained tingling sensation in the hand and foot without laboratory abnormality (4/86, 4.7%). Laboratory test revealed hyperosmolality without clinical symptom in 1 child, and eosinophilia in 6 children. Conclusion : The average safe and effective dose of PEG 4000 for disimpaction was $0.93{\pm}0.28g/kg/day$ (0.4-2.0 g/kg/day, Max : 30 g/day) in children with chronic functional constipation.

A CLINICAL STUDY OF THE TYPE OF DISEASE AND SYMPTOM ACCORDING TO SASANG CONSTITUTION CLASSIFICATION (체질진단분류(體質診斷分類)에 따른 질병(疾病) 및 증상유형(症狀類型)에 관한 임상적(臨床的) 연구(硏究) II (문진표를 중심으로))

  • Kim, Young-woo;Kim, jing-weon
    • Journal of Sasang Constitutional Medicine
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    • v.11 no.1
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    • pp.119-135
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    • 1999
  • The object of this study is 196 patients who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center during 33 months from January 1996,3 to June 1998,11. We proceeded the judgment of Sasang Constitution by 'Questionnaire of Sasang Constitution Classification(I)' and 'Questionnaire of Sasang Constitution Classification II(QSCCII)'. The following conclusion were made in comparison with Sasang Constitution and Questionnaire about disease and style of symptoms. 1. The subject of "increase of the weight of a body(gain weight), sweatier, the body swelled out, a lame pain, more like fat food, more like salty food", has significant differences in sasang constitution classification. The frequency of Taeeum group is more than that of Soeum group and Soyang group. 2. The subject of "the complextion is bas, uncomfortable feeling in the throat, insomnia, loss of appetite, apt to be fatigued easily, gastralgia what is not connected with food, diarrhea, headache, menorrhalgia, less like fat food, more like fresh food", has significant differences in sasang constitution classification. The frequency of Soeum group is more than that of Taeeum group and Soyang group. 3. It has not significant differences, but the frequency of Soyang group is more than that of Taeeum group and Soeum group in the subject of "the cough in the disease of the respiratory organs, hypomotility of the joint in the disease of the musculo-skeletal systems, menoxenia like menorrhagia and menostaxia and itching sensation of genitals in the disease of the gynecological organs, itching or boil in the dermatological disease", and fewer in the cardio-vascular disease, urinary disease and hematic disease. The frequency of Soeum group is more than that of Taeeum group and Soyang group in the subject of "the general disease of the digestive organs, uncomfortable feeling or pain of the throat in the disease of the respiratory organs, the general hematic disease, numbness or pain of the musculo-skeletal disease, psychical disease in the psychoneurotical disease, menorrhalgia, a lump of the breasts, leukorrhea in the gynecological disease, eruption or urticaria in the dermatological disease, the general visual and auditory disease". The frequency of Taeeum group is more than that of Soyang group and Soeum group in the subject of "a hoarseness in the disease of the respiratory organs, A lame pain of the musculo-skeletal disease, neurotical disease in the psychoneurotical disease, eruption or urticaria in the dermatological disease", and fewer in the the gynecological disease.

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Active Prosthetic Valve Endocarditis: The Clinical Profile, Laboratory Findings and Mid-term Surgical Results (활동성 인공판막 심내막염: 임상 양상, 검사 소견 및 중기 수술 성적)

  • Kim, Hwan-Wook;Joo, Seok;Kim, Hee-Jung;Choo, Suk-Jung;Song, Hyun;Lee, Jae-Won;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.447-455
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    • 2009
  • Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean$\pm$SD, 42.1$\pm$36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

Analysis of Patients with Mandibular Nerve Damage after Root Canal Therapy (근관치료 후 발생한 하악신경 손상 환자에 대한 분석)

  • Lee, Ji-Soo;Song, Ji-Hee;Kim, Young-Gun;Kim, Seong-Taek
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.3
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    • pp.327-336
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    • 2011
  • Reported causes of mandibular nerve injury in relation to neuropathic pain in dentistry include extraction, dental implant surgery, oral and maxillofacial surgery, periodontal treatment, and root-canal therapy. This study analyzed the characteristics of pharmacologic management of neuropathy after root-canal therapy. 32 patients who complain of abnormal sensation or pain after root-canal therapy and were referred to Department of Oral Medicine and the Temporomandibular Joint and Orofacial Pain Clinic at the Dental Hospital of Yonsei University, Seoul, Korea from 2004 to 2011 enrolled in this analysis and improvement of symptom was evaluated after pharmacologic management. Thirty-two patients who had hypoesthesia or dysesthesia at the initial visit were analyzed(9 men, 23 women; mean age: 44 years). The causes of neuropathy were local anesthesia(46.9%), chemical trauma from the sealant in root-canal(25%), endodontic surgery(15.6%), and unknown causes(12.5%). Medications such as steroids, anticonvulsants, antidepressants, and analgesics were took for improvement of symptoms and titrated for a variety of period from 1 week to 11 months. It was found that neuropathy of the inferior alveolar nerve and the lingual nerve was in 25 and 7 patients. The improvement of neurosensory disturbance and no improvement after pharmacotherapy was in 21(66%) and 11(34%) patients respectively. The hypoesthesia and dysesthesia was improved 67% and 65% respectively. These results suggest that symptomatic improvement by pharmacologic management can be possible in patients with neuropathy after root-canal therapy. But improvement of symptoms was influenced by the causes and degree of nerve injury, the periods of pharmacotherapy, and the choice of treatment methods. So, further investigation is needed by quantitative measurement of more variables in more individuals.

Improved Acroparesthesia During Enzyme Replacement Therapy in a Patient Lately Diagnosed with Fabry Disease (진단이 지연된 Fabry 병 환자에서 효소대체요법을 통한 사지 말단 동통의 호전을 보인 1례)

  • Yang, Aram;Kim, Jinsup;Cho, Sung Yoon;Jin, Dong-Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.17 no.3
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    • pp.92-95
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    • 2017
  • Fabry disease (FD) is an X-linked lysosomal storage disorder caused by an ${\alpha}$-galactosidase A (GLA, MIM 300644) enzyme deficiency due to pathogenic variants in the ${\alpha}$-galactosidase A gene (GLA). The disease leads to accumulation of globotriaosylceramide (Gb3) and related glycophospholipids affecting nearly all major organ systems, with the primary sites damaged by Gb3 including renal glomeruli, myocardium, neurons of the dorsal ganglion and autonomic nervous system, and vascular endothelial and smooth muscle. Progressive deposition in these organ systems present with various clinical manifestations including acroparesthesia, renal failure and heart failure. Here, we report a Chinese male diagnosed with Fabry disease in his late $4^{th}$ decades showing improvement of acroparesthesia during enzyme replacement therapy (ERT). A 48-year-old Chinese man who presented with chronic recurrent severe burning pain in his fingers and toes since the age of 10, with worse involvement of the former visited to our clinic for further evaluation. His medical history included a transient ischemic attack aged 40 and diagnosed with stage 4-5 chronic kidney disease aged 47. In the family history, the patient's brother was found to be have Fabry disease 1 month before his visit. Except for his brother, all other members of the family are healthy. Based on his medical history and family history, he was strongly suspicious for Fabry disease. He was found to have a galactose-alpha-1,3-galactose level 4.96 (Reference range, 42.5-67.9) suggestive of Fabry disease. The followed sequencing of GLA coding region in our patient revealed hemizyosity for the mutation c.988C>T (Q330X) in Exon 7. Since ERT start, he showed significant improvement in his symptoms of burning sensation of fingers and toes. On the contrary, due to deteriorating kidney function even with ERT, he is considered for kidney transplantation. Despite of diagnostic delay until late 4th decades, ERT showed a potential improvement of acroparesthesia in our patient. However, late start of ERT can lead to poor outcome in multiorgan function. Therefore, early diagnosis with high index of suspicion followed by continuous ERT with regular monitoring have an impact on quality of life in Fabry disease.

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A Study on the Relationship between the Experience of Sanhujori, the Traditional Postpartal Care in Korea and Present Health Status of Chronic Arthritis Female Patient (만성관절염 여성 환자의 산후조리 경험과 건강상태와의 관계)

  • Yoo, Eun-Kwang;Lee, Sun-Hyae;Kim, Myoung-Hee
    • Women's Health Nursing
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    • v.4 no.2
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    • pp.217-230
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    • 1998
  • The purpose of this descriptive correlational study was to define the relationship between the experience of Sanhuujori, Korean traditional non-professional postpartal care after delivery and abortion and present health status of chronic arthritis female patient who visited to outpatient clinic of rheumatic internal medicine at a hospital located in Seoul, Korea. A convenience sample of 64 women who orally agreed to be a participant and data were collected form October 1996 to May, 1997 for sis months by way of interview with semistructured questionnaire. The data were analyzed by the SPSS pc program using t-test, ANOVA and Scheffe test as a post hoc and Pearson Correlation Coefficient. The results of the study were as follows ; Mean age of participants was 53.2 years and mean number of children was 3.1. Mean frequency of abortion was 2.1 times per woman. Seventy four percentage of respondents did not have Sanhujori after abortion. The mean period of Sanhujori after delivery was 17.7, 15.2, 13.8 days from the first child to third child and shorter than that of general woman such as 20.0, 19.0, 17.3 days in the previous study. On the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori wrongly' was the highest rank in each child where as general woman 'did Sanhujori well' at the first child, 'moderate' at the second and third child and 'did Sanhujori wrongly' at the 4th and fifth child. The health status implies both subjective health status women perceived and the rate of complaints of physical symptom distress women are experiencing presently. The respondents of 82.5% perceived them as unhealthy or sick and 68.9% of women complained more than two symptoms. Mean number of physical symptom distress women complained was 2.33. The main sites of physical symptom distress were upper & lower extremities 69.1% including knee and hand, whole body 19.1%, neck 3.7%, waist & shoulders 2.7% respectively. The characteristics of the symptoms were mostly pain 60%, swelling 19.8%, rigidity & deformity 7.9% respectively, sensation of heat 6.8% and weakness 1.7%. Women perceived the etiology of the chronic arthritis as stress 25.8%, 'did Sanhujori wrongly' & overwork 23.4% respectively, genetic 12.9%, malnutrition, 4.8%, and aging process 3.2%. There were significant positive correlation between subjective health status and the period of Sanhujori after delivery of the second child(r=-0.22) and negative correlation with the number of child at the level of 5% of significance statistically(r=0.27). There were significant negative correlation between the rate of complaints of physical symptom distress and the subjective evaluation whether she did Sanhujori well or not at the level of 5% of significance statistically(r=-0.23). And the rate of complaints of physical symptom distress in the group of women who experienced abortion was significantly higher than that of women who did not experience it at the level of 5% significance statistically(t=2.00) In conclusion, this finding reconfirmed the possible relationship between health status of chronic arthritis female patient and the experience of Sanhujori after delivery & abortion. It provides a challenge to the professional care givers to research further on the effects of Sanhujori on the health status, health recovery after abortion or delivery from the various aspects through the crosssectional and longitudinal research for the refinement of the reality of not only as cultural phenomenon but as conceptual model for the appropriateness of intervention and quality of care for desirable health outcomes.

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The Clinical Considerations of Serous Otitis Media and Ventilation Tube (삼출성중이염과 중이내 통기관 유치술의 임상적 고찰)

  • 김영명;박인용;장태영;심형보
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1982.05a
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    • pp.14.2-15
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    • 1982
  • Serous otitis media (SOM) is one of the most common otologic diseases which was first discribed by Politzer in 1869. Currentely, among many methods introduced to treat SOM, ventilation tube insertion is considered to be the most popular and standard method being used. However due to complication of it, there remains many disputable various problems. In order to review the clinical aspect of SOM and search for the effects and safety of ventilation tube, we studied 97 SOM patients, who had performed V-tube from Jan. 1981 to Feb. 1982 at ENT dept. of Severance Hospital. Analizing the clinical symptoms, age distribution, associated disease, otoscopic findings of ear drum, degree of hearing loss, hearing gain after insertion of V-tube and complications, following results were obtained. 1) As a subjective symptom, among 29 cases all patients had hearing loss, 19 cases (65.6%) had tinnitus, 12 cases (44.4%) had autophony and 10 cases (34.5%) of the patients had sensation of ear fullness. 2) In age distribution, 6 to 10 year old group was most numerous up to 42 cases (43.3%) and 20 years and over was 23 cases (23.5%) 3) In adult group SOM tend to be involved unilaterally whereas young child group had tendency involving bilaterally. 4) 49 cases (50.05%) were associated with tonsillitis and adenoid vegetation, 15 cases (15.5%) were associated with sinusitis, 4 cases (4.1%) had nasal allergy. 5) In preoperative otoscopic findings, 62 ears (47.7%) had retraction, 37 ears (23.6%) had bulging, 34 ears (21.7%) had color change, and 29 ears (19.7%) had no significant findings. 6) In characteristics of middle ear fluid, child group was tend to have mucinous content (84.2%) while adult group had serous content (62.5%). 7) Average preoperative air-bone gap of pure tone was 25.3 dB. 8) 24 ears (72.7%) had over 10 dB of postoperative hearing gain and average hearing gain was 17.2 dB. 9) There were 44 ears (28.1%) of complications. Among them 37 ears (23.6%) had infection, 3 ears had atelectasis, 2 ears had granulation tissue, 2 ears had permanent perforations. 10) Among 37 ears suffered from post-op. infection, 19 ears (51.4%) had initial infection just after insertion of ventilation tube, 18 ears (48.6%) were infected during the course of post-ventilation tube. Of 37 infected ears, 26 ears (70.3%) responded to conservative care, while 11 ears (29.7%) was cured after removal of ventilation tube.

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Review of 2019 Major Medical Decisions (2019년 주요 의료판결 분석)

  • Yoo, Hyun Jung;Park, Noh Min;Jeong, Hye Seung;Lee, Dong Pil;Lee, Jung Sun;Park, Tae Shin
    • The Korean Society of Law and Medicine
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    • v.21 no.1
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    • pp.107-152
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    • 2020
  • During the main ruling in 2019, a number of rulings that were of interest or meaningful were handed down, such as just because the complication of medical practice has occurred, there is no presumption of negligence, a case involving a fall accident in which a lot of culpability has recently been made. the death of a well-known singer that caused a sensation, a case about damages caused by MERS in 2015, which is more meaningful in connection with damages caused by COVID-19, an infectious disease that has recently hit the world, including Korea. In preaching the principles of the law, just because there has been a complication caused by medical practice, there is no presumption of negligence, 'The scope of the complication without presumption of negligence' was determined differently by the court, the court was not able to specify the criteria. Specific circumstances were presented to limit the responsibility of the medical institution while acknowledging the malpractice of the medical institution in relation to the fall accident. In relation to the scope of damages, judgment was made on issues related to the calculation of lost profits of medical malpractice; criteria for determining celebrities' daily income, criteria for determining daily income in case of receiving survivor's pension due to medical accident, an incident in which the daily income is denied if the labor capacity is already lost at the time of a medical accident. But, it seems that judgments should be made based on clearer and more reasonable standards. Related to Medical Advertise, specific logic of judgment was presented as to whether it was interpreted as being in accordance with the specific prohibition listed in Article 27 paragraph 3 of the Medical Law, which is the criterion for violation of the Medical Law, or if it constitutes a significant harm to the order of the medical market. In response to the prohibition of operating the multiple medical institutions, the Constitutional Court decided that it was constitutional because it did not violate the regulations on excessive funding, and rationally limited the scope of the prohibited 'redundant operation'. The Supreme Court ruled for the first time that even a medical institution established and operated in violation of the Medical Service Act did not make it impossible to receive all medical care benefits implemented by a medical institution under the National Health Insurance Act. Significant rulings were finalized that recognized the existence of specific protection obligations for the people of the country in the management of infectious diseases.

Polymorphisms of TAS1R3 and GNAT3 Genes Are Associated with Patients with Taste Disorder (미각장애와 TAS1R3 및 GNAT3 유전자의 다형성과의 연관성)

  • Bae, Jae-Woong;Kim, Un-Kyung;Kwon, Tae-Jun;Choi, Su-Jin;Ye, Mi-Kyung
    • Journal of Life Science
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    • v.21 no.3
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    • pp.412-416
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    • 2011
  • Taste sensation plays a crucial role in selecting and ingesting foods with different qualities which convey information about their nutrient content and/or safety. Sweetness is one of the five modalities in humans and serves as an energy resource for metabolism. There are reports on allelic polymorphisms which influence perception of sweetness in mice and humans. Since the influence of genetic factors on taste disorder has not been studied, we investigated the association of genetic polymorphisms in TAS1R3 and guanine nucleotide binding protein, alpha transducing 3 (GNAT3) genes and taste disorder. A total of 150 individuals composed of 50 patients with taste disorder and 100 healthy controls were recruited for the study and PCR-mediated directing sequencing method was used to genotype for two different single nucleotide polymorphisms (SNPs) - rs307355 (T>C) and rs35744813 (T>C) in the TAS1R3 gene, and rs7792845 (T>C) and rs1524600 (C>T) in the the GNAT3 gene. The allele and genotype frequencies of rs307355 and rs35744813 in the TAS1R3 gene showed a significant association between patients with taste disorder (p=0.022 and p=0.013 in both of SNPs, respectively). In addition, the frequency of T-T haplotype in the TAS1R3 gene was higher in taste disorder cases than in the controls (OR, 1.93: 95%. CI, 1.09-3.39, p=0.022). In the GNAT3, the genotype frequency of rs7792845 in the patients was also different from the controls (p=0.048), but allele frequency was not significantly associated in either group. Our result provides the frequencies of SNPs and haplotypes of the TAS1R3 and GNAT3 genes for the fundamental information of nutrigenetics in perception of the taste of sweetness in the Korean population. Also, the study suggests that the allelic polymorphisms of TAS1R3 and GNAT3 genes may be useful as a molecular marker for evaluating patients with taste disorder. Further studies with large samples are required to clarify our observation.

Clinical Effects of Prothinoamide, Cycloserine, Para-Aminosalicylic Acid, Ofloxasine in Retreatment of Pulmonary Tuberculosis (폐결핵 재치료 환자에서 Prothionamide, Cycloserine, Paraminosalicylic acid, Ofloxasine을 이용한 경구 4제 요법의 임상 효과)

  • Hong, Jae-Rak;Yoo, Min-Kyu;Jeong, Jae-Man;Kim, Young-Jun;Son, Mal-Hyeon
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.5
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    • pp.693-700
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    • 1996
  • Background : Antituberculous therapy is set a short-term therpy used isoniazid(INH), rifampin(RFP), ethambutol(EMB), pyrazinamide(PZA) from 1970s' and treatment rate has been very improved. But drug interruption or irregular medication due to side effects and resistance of drug are serious problem to retreatment cases, specially. Ofloxasine(OFX), developed from Quinolone at 1980's is effective not only other respiratory infectious disease but also pulmonary tube rculosis. And this is useful drug instead of injection agents for retreatment patients who have side effects to other drugs, lived far distance from medical clinics. So, we will evaluate theffectiveness as four oral drugs involving OFX. Method : A retrospective study was made through the regular follow up of smear positive cases,who treated by four drug, namely, prothionamide (PTA) cycloserine(CS), OFX, paraminosalicylic acid(pAS). Results: 1) Out of 66case with positive sputum AFB smear, 42(64%)cases achieved the negative conversion. 2) Considering the negative conversion in all group, 34 case (52%) of sputum conversion occured within first 6 months, on the extent of diease was minimal, moderate, far advanced pulmonary tuberculosis, sputum AFB smear negative response to treatment was 100%, 78%, 46% respectively. 3) The roentgenological improvement occured in 38(58%), extent of diease was minimal, moderately, far advanced pulmonary tuberculosis, Roentgenological improvement to retreatment was 75%, 64%, 46%. 4) When the drnation of patients illness was less than 1 year, 1 to 3 years, 3 10 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 100%, 88%, 80%, 52 %. 5) On side effects, major problems are gastrointestinal troubles, mild liver function abnormality, psychotic problemes, and skin problem(urticaria, itching sensation). Conclusion : The duration & extents of patients illness was shorter & minimal, sputum AFB smear negative response rate was better. Radiologic response is better as shorter duration and minimal extent of diease. But, as diease is longer duration & far advanced, sputum negative conversion & Roentgenological improvement is poor and limited. The adverse reaction was mainly observed gastrointestinal troubles(indigestion, abdominal pain, nausea, vomiting, diarrhea) and are well controled by symptomatic management in most patients, as regard to tolerance to the secondary drugs.

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