No abstract available.
Acute Kidney Injury* ; Child* ; Humans

No abstract available.
Hypoglycemia*

BACKGROUND: Although blood is very important therapeutic agent in bleeding patients, it may transmit disease, cause an adverse reaction in the recipients, raise the cost of patient care. Since the misuse and inappropriate use of blood is common, we are to review the transfusion practice in our hospital and to reduce unnecessary blood transfusion. METHODS: During a 10-month period from June 1994 through March 1995, 347 patients received blood transfusion during the operation. Among them, we reviewed retrospectively the charts of 211 patients available. We analyzed the transfusion pattern of 47 patients whose postoperative hematocrit exceeded 32 percent to determine the magnitude and cause of unnecessary blood transfusion. RESULTS: The patients of postoperative hematocrit over 32 percent were 119 patients out of 211 patients(56.4%). The main cause of overtransfusion was no reevaluation of the patients hematocrit after the prior unit was given. CONCLUSIONS: Guidelines for transfusing patients must be constructed based on acceptable intraoperative hematocrits. Unnecessary transfusion can be decreased when the transfusion done according to the guidelines, insisting on each reevaluation of the hematocrit prior to the administration of unit of blood.
Blood Transfusion ; Hematocrit ; Hemorrhage ; Humans ; Patient Care ; Retrospective Studies

BACKGROUND: Rocuronium(ORG 9426) is a new steroid nondepolarizing neuromuscular blocking drug with fast onset and intermittent duration of action. Its effects on vital signs are controversial. We studied onset, clinical duration, recovery index of rocuronium and its effects on blood pressures and heart rates. METHODS: We selected thirty healthy children who would receive inguinal herniorrhaphy and allocated them to 2 groups(control and rocuronium group). Without premedication or with oral medication of PocralTM (20 mg/kg), they administrated propofol(2.5 mg/kg) intravenous for loss of consciousness and we maintained anesthetic states with 20 mg/kg/hr of propofol. After 2 minutes, we checked BP(SBP/ DBP/MBP) and HR at every minutes and checked TOF, T1 height compare to control, T4 to T1 at every twenty seconds. We injected intravenously rocuronium(0.8 mg/kg, 2ED95) to rocuronium group and nothing to control group. We determined intubation time(from injection to 90% depression of maximal block), onset time(to maximal depression or T1=0), clinical duration(to T1=25%) and recovery index(from T1=25% to T1=75%). RESULTS: In children, intubation time was 93.8sec, onset time was 146.2sec, clinical duration was 34.6min, recovery index was 15.4min. SBP, DBP, MBP and HR were not changed independent of injection of rocuronium. CONCLUSION: Rocuronium is a muscle relaxant with rapid onset and intermittent clinical duration in children. It does not affect BP and HR.
Anesthesia* ; Anesthetics ; Blood Pressure* ; Child* ; Depression ; Heart Rate* ; Heart* ; Herniorrhaphy ; Humans ; Intubation ; Neuromuscular Blockade ; Premedication ; Propofol* ; Unconsciousness ; Vital Signs

BACKGROUND: The clinical characteristics of seizures in adults with localization-related epilepsy have been clearly described and classified. But few researches and data are available in childhood intractable epilepsy. METHODS: We analyzed 334 videotaped seizures from 41 pediatric patients who underwent epilepsy surgery at Dong San Medical Center between 1993 and 1997. Twenty- one of 41 patients had temporal lobe epilepsy, and the remaining 20 patients had extratemporal lobe epilepsy. We divided the patient sample into two groups : (a) those with total cases, (b) those with good outcome (seizure-free or more than 90% reduction of seizures after surgery). We compared temporal lobe epilepsy (TLE) with extratemporal lobe epilepsy (ETE) by clinical symptoms and initial ictal symptoms. In addition, we analyzed the lateralizing value of ictal dystonia, head turning, head deviation and automatism. RESULTS: The aura and head deviation of TLE and the motor arrest, head deviation and dystonic posture of ETE were observed more frequently in total group (P<0.05). In contrast, the vocalization and secondary generalization of TLE and the motor arrest, dystonic posture and dysarthria of ETE were observed more frequently in good outcome group (P<0.05). In cases of the initial ictal symptoms, the aura and hand automatism of TLE and the motor arrest and dystonic posture of ETE were observed more frequently in both groups (P<0.05). Of the ictal motor phenomena, ipsilateral hand automatism and contralateral dystonic posture were useful in lateralizing the seizure focus (P<0.05). CONCLUSION: The clinical ictal manifestations in children are very helpful to localize or lateralize the epileptic focus, like in adults case. Because of the lack of younger age group in our study, however, we suggest more rigorous studies based on more comprehensive data.
Adult ; Automatism ; Child ; Dysarthria ; Dystonia ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Generalization (Psychology) ; Hand ; Head ; Humans ; Posture ; Seizures* ; Temporal Lobe*

Objective: This study aimed to develop and validate the Korean version of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in outpatients at a psychiatric clinic and assess its diagnostic accuracy. Methods: A total of 207 patients completed SSD-12. For the diagnostic accuracy of SSD-12, the somatic symptom disorder (SSD) section of the structured clinical interview for DSM-5 disorders-research version (SCID-5-RV) was used. The SSD-12 construct and concurrent validity were assessed by examining the correlations with Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), PHQ-15, 5-level EQ-5D version (EQ-5D-5L), and World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Results: The SSD-12 had excellent internal consistency (Cronbach α=0.90). Confirmatory factor analysis revealed good fit indices for a general factor model (comparative fit index [CFI]=0.92, Tucker-Lewis index [TLI]=0.88, root mean square error of approximation [RMSEA]=0.10; 95% confidence interval [CI], 0.08–0.11) and a three-factor model (CFI=0.94, TLI=0.91, RMSEA=0.08; 95% CI, 0.07–0.10). The total SSD-12 score was significantly correlated with anxiety (GAD-7: r=0.53, p<0.001), depression (PHQ-9: r=0.52, p<0.001), physical symptom burden (PHQ-15: r=0.36, p<0.001), and quality of life (EQ-5D-5L: r=-0.40, p<0.001; WHOQOL-BREF: r=-0.51, p<0.001). SSD-12 demonstrated good accuracy (area under the curve=0.75, standard error=0.04; 95% CI, 0.68–0.82) with an optimal cut-off of 29. Conclusion The Korean SSD-12 demonstrates reliability and validity for diagnosing SSD in clinical setting.

Background: The purpose of this longitudinal prospective cohort study was to investigate the role of chronotype in the incidence of chemotherapy-induced peripheral neuropathy (CIPN) among women with breast cancer. Methods: We recruited women with breast cancer awaiting adjuvant chemotherapy, including four cycles of docetaxel. Participants reported peripheral neuropathy symptoms of numbness/ tingling at the baseline, and at 4weeks after completion of chemotherapy. Candidate psychiatric factors associated with CIPN were assessed at the baseline, using the Composite Scale of Morningness, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale. To examine the association between chronotype and CIPN, we built logistic regression models, adjusting for demographic, clinical, and other psychiatric variables. Results: Among 48 participants, 29 participants developed CIPN. The morning chronotype was inversely associated with CIPN (odds ratio, 0.06; confidence interval, 0.01–0.74; P = 0.028) after adjusting for age, BMI, education, type of operation, alcohol use, smoking, sleep quality, depression, and anxiety. Conclusion Our results suggest that the morning chronotype is a protective factor against the development of CIPN in patients with breast cancer who were treated with docetaxel.

Objective: Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS. Methods: This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle. Results: PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA. Conclusion The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.

Background/Aims: We examined the efficacy and safety of tegoprazan as a part of first-line triple therapy for Helicobacter pylori eradication. Methods: A randomized, double-blind, controlled, multicenter study was performed to evaluate whether tegoprazan (50 mg)-based triple therapy (TPZ) was noninferior to lansoprazole (30 mg)-based triple therapy (LPZ) (with amoxicillin 1 g and clarithromycin 500 mg; all administered twice daily for 7 days) for treating H. pylori. The primary endpoint was the H. pylori eradication rate. Subgroup analyses were performed according to the cytochrome P450 (CYP) 2C19 genotype, the minimum inhibitory concentration (MIC) of amoxicillin and clarithromycin, and underlying gastric diseases. Results: In total, 350 H. pylori-positive patients were randomly allocated to the TPZ or LPZ group. The H. pylori eradication rates in the TPZ and LPZ groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.009 and p=0.013), respectively. Subgroup analyses according to MICs or CYP2C19 did not show remarkable differences in eradication rate. Both first-line triple therapies were well-tolerated with no notable differences. Conclusions TPZ is as effective as proton pump inhibitor-based triple therapy and is as safe as first-line H. pylori eradication therapy but does not overcome the clarithromycin resistance of H. pylori in Korea