No abstract available.
Analgesia, Obstetrical*

No abstract available.
Hydronephrosis* ; Turner Syndrome*

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome.
Adult ; Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol ; Female ; Fever ; Humans ; Hypersensitivity ; Isoniazid ; Kanamycin ; Leukocytosis ; Levofloxacin ; Patch Tests ; Prednisolone ; Pyrazinamide ; Rifampin ; Tuberculosis

In this paper, some parts of Fig. 1 and dose information of methylprednisolone on page 113 were misprinted.

Steroids are widely used for the treatment of a variety of diseases, including autoimmune and allergic diseases. Immediate hypersensitivity reactions can occur within 1 hour after administration of steroids and are regarded as IgE-mediated hypersensitivity presenting as urticaria, angioedema, bronchospasm, and anaphylaxis. Steroid hypersensitivity is rare, but can be life-threatening. Therefore, it is important to find implicated drugs and to choose safe alternative agents. A 44-year-old female was diagnosed with steroid hypersensitivity after intralesional steroid injection. She underwent a skin prick test and an intradermal test for methylprednisolone, triamcinolone, hydrocortisone, and dexamethasone. The results were positive to triamcinolone and methylprednisolone. The patient was educated to avoid culprit agents in order to prevent recurrence. Herein, we report a rare case of steroid hypersensitivity that showed positive reactions to triamcinolone and methylprednisolone. A review of the literature for steroid hypersensitivity is also provided.
Adult ; Anaphylaxis ; Angioedema ; Bronchial Spasm ; Dexamethasone ; Drug Hypersensitivity ; Female ; Humans ; Hydrocortisone ; Hypersensitivity ; Hypersensitivity, Immediate* ; Intradermal Tests ; Methylprednisolone ; Recurrence ; Skin ; Skin Tests ; Steroids* ; Triamcinolone ; Urticaria

Slowly growing intracranial tumors, especially located in the supratentorial compartment, permit major volume-spacial compensation. Patient with large supratentorial tumor may not even present any specific symptoms or signs related to the elevated intracranial pressure. We experienced a patient who showed delayed emergence from general anesthesia for total knee replacement without any pharmacologic or metabolic causes. Computerized tomogram scan and magnetic resonance image revealed an unnoticed large supratentorial tumor considered as a cause of delayed emergence. After removal of intracranial tumor, the patient regained consciousness and discharged from the hospital in a relatively good health.
Anesthesia, General* ; Arthroplasty, Replacement, Knee ; Brain ; Compensation and Redress ; Consciousness ; Humans ; Intracranial Hypertension ; Supratentorial Neoplasms

BACKGROUND: Preemptive treatment with ketamine, a noncompetitive NMDA antagonist, may prevent establishment of postoperative hypersensitivity by blocking the sensory input that induces the central sensitization. The aim of this study was to determine if continuous preemptive administration of intravenous (IV) ketamine decreases postoperative pain. METHODS: Sixty healthy informed patients scheduled for elective abdominal hysterectomy were randomly divided into two groups of equal size and studied in a double-blind manner. Before surgical incision, patients were given 1 mg/kg of ketamine or equal volume of saline followed by IV infusion of 0.01 mg/kg/min, which was discontinued at peritoneal closure. IV morphine patient-controlled analgesia (PCA) was started in all patients at peritoneal closure. Visual analogue scale (VAS) pain scores and total morphine consumption were recorded at 1, 3, 6, 9, 12, 24, 36, and 48 hours postoperatively. RESULTS: VAS pain scores at rest were significantly less in the ketamine group than in the saline group at 1, 3, 24, 36, and 48 hr postoperatively. VAS at moving status were less in the ketamine group at 1, 3, 12, 24, 36, 48 hr postoperatively. Patients in the ketamine group had significantly lower morphine consumption throughout the study period, about 20-50% reduction in postoperative total morphine was observed. Only ketamine group experienced severe headache (10 cases), while there were no intergroup differences in other side effects such as pruritus, bad dream, and backache. CONCLUSION: These results suggest that preemptive continuous IV ketamine decreases postoperative pain intensity and IV morphine requirement, and its action lasts longer than the normal expected duration of action of ketamine.
Analgesia, Patient-Controlled ; Back Pain ; Central Nervous System Sensitization ; Dreams ; Headache ; Humans ; Hypersensitivity ; Hysterectomy ; Ketamine* ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Pruritus

Iodinated contrast media (ICM) can cause not only immediate onset hypersensitivity but also delayed onset hypersensitivity. While the most common form of delayed onset hypersensitivity reaction to ICM is exanthematous eruption, fixed drug eruption (FDE) can occur rarely related to ICM. A 70-year-old male with liver cirrhosis and hepatocellular carcinoma repeatedly experienced erythematous patches on his right forearm and hand 6 hours after exposure to iopromide for computed tomography scan. ICM induced FDE was diagnosed clinically. Intradermal test with 6 kinds of ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, and iodixanol) was performed and showed the weakest positive reaction to iohexol compared to the others in 48 hours. After changing iopromide to iohexol based on these results, FDE did not recur. We report here a case of iopromide induced FDE which was successfully prevented by changing ICM to iohexol based on intradermal test results.
Aged ; Carcinoma, Hepatocellular ; Contrast Media ; Drug Eruptions* ; Forearm ; Hand ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Intradermal Tests ; Iohexol ; Iopamidol ; Liver Cirrhosis ; Male

BACKGROUND: Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication. METHODS: A total of 35 women with type 2 diabetes (body mass index, 26.6+/-2.8 kg/m2; age, 56.4+/-1.9 years; duration of diabetes, 4.7+/-4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (K(ITT)), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program. RESULTS: The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA. CONCLUSION: Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.
Abdominal Fat ; Atherosclerosis ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Energy Intake ; Energy Metabolism* ; Exercise* ; Female ; Humans ; Insulin ; Insulin Resistance* ; Intra-Abdominal Fat ; Metabolic Equivalent ; Motor Activity* ; Subcutaneous Fat ; Vascular Stiffness*

PURPOSE: Food intake of COPD patients decreases because of appetite loss, depression, and breathing problems while eating, which increase the likelihood of patients becoming malnourished. This study investigated the nutrient intake and dietary quality of people with and without COPD in Korea. METHODS: There were 2,160 adults aged 50 and over who participated in the 5~6th Korea National Health and Nutrition Examination Survey. The subjects were divided into the COPD group and non-COPD group according to the rate of forced expiratory volume at 1 second (FEV1) against forced vital capacity (FVC). Consumption of food and nutrients were calculated based on the nutrition examination survey. Statistical analyses were conducted using SPSS 19.0. RESULTS: Among individuals in their 50s, intake of vitamin B1 in the COPD group was significantly less than the NCOPD group, while intake of sodium in the COPD group was significantly greater than the NCOPD group. Among individuals in their 60s, the energy intake of the COPD group was significantly less than that of the NCOPD group. The COPD group showed significantly less intake of vitamin B1 and vitamin C, but greater intake of sodium than the NCOPD group. In the group aged 70 and over, The COPD group had significantly less intake of vitamin B1 than the NCOPD group and showed lower nutrient adequacy ratio values in protein, vitamin B1, vitamin B2, and iron than the NCOPD group. CONCLUSION: The COPD group consumed less energy and certain nutrients, and their dietary quality was poor compared to the NCOPD group. Thus, more detailed research is required to understand the concrete relationship between COPD and malnutrition.
Adult* ; Appetite ; Ascorbic Acid ; Depression ; Eating ; Energy Intake ; Forced Expiratory Volume ; Humans ; Iron ; Korea* ; Malnutrition ; Nutrition Surveys* ; Nutritional Status ; Pulmonary Disease, Chronic Obstructive* ; Respiration ; Riboflavin ; Sodium ; Thiamine ; Vital Capacity