Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation

No abstract available.
Gastric Emptying*

Acute autonomic and sensory neuropathy (AASN) is very rare immune mediated neuropathy characterized by prominent dysautonomia and sensory involvement without motor weakness. Most of AASN patients have a rapid onset reaching its worst within four weeks like Guillain-Barré syndrome. The treatment response is variable. Recently, we experienced a patient diagnosed as AASN with progressive autonomic and sensory symptoms more than 1 year, and showed good response in immunotherapy.

Ten healthy adult female patients scheduled for elective abdominal hysterectomy were evaluated for their rates and degrees of absorption following subarachnoid administration of 150 mg of 5% lidocaine in 5% dextrose solution. The mean blood concentrations of lidocaine measured at 5, 15, 30, 60 and 90 minutes after subarachnoid administration were 0.34+/-0.23, 0.78+/-0.27, 1.10+/-0.26, 1.24+/-0.24 and 1.07+/-0.19 mcg/ ml, respectively. The mean values of Cmax and Tmax obtained from these measurements were 1.30+/- 0.21 mcg/ml and 57+/-17 minutes, respectively. These results revealed that in comparison with other regional administration, absorption of lidocaine follwing subarachnoid injection is slower.
Absorption ; Adult ; Anesthesia, Spinal ; Female ; Glucose ; Humans ; Hysterectomy ; Lidocaine*

PURPOSE: To evaluate the effects of dexamethasone(D) on blood pressure(BP) in infants with bronchopulmonary dysplasia(BPD). METHODS: We retrospectively reviewed 10 infants with BPD(mean birth weight: 1,383+/-17 gm, mean gestational age: 29.0+/-1.7 weeks) treated with D at Wonkwang University Hospital from January 1994 to June 1998. D was started at 0.5 mg/kg/day intravenously for first week, followed by 0.3 and 0.1 mg/kg/day for second and third week, respectively. Changes in BP during pre-D, 1st wk(D1), 2ndwk(D2), 3rd wk(D3), and post-D periods were compared using Turkey Kramer multiple comparison test. RESULTS: Mean systolic pressure(sBP) significantly increased in Dl, D2, D3 compared to pre-D(63+1.3, P<0.01; 66+1.7, P<0.001; 683.4, P<0.001 vs 591.9 mmHg, respectively) but significantly decreased in post-D compared to D3(64+/-2.4 mmHg, P<0.05). Mean diastolic pressure(dBP) significantly increased in D2 and D3 compared to pre-D(42+/-1.1, P<0.001; 43+/-2.6, P<0.001, vs 382.1 mmHg, respectively). Mean dBP deed slightly in post-D(41+/-4.1 mrnHg, P>0.05). The sBP and dBP significantly increased from day 2 after initiation of D and were highest on day 17 and 17-18 of 3rd week, respectively. The number of hypertensive infants who were considered for antihypertensive medications were 2(20%) for sBP >or= 80-90 mmHg, 3(30%) for dBP >or= 50 mmHg and 1(10%) for dBP> or =60 mmHg. These infants, however, remained asymptomatic. CONCLUSION: Significant elevation of BP was observed during dexamethasone therapy for infants with BPD especially after 2nd day. However, BP elevation was transient, not requiring antihypertensive medications.
Birth Weight ; Blood Pressure* ; Bronchopulmonary Dysplasia* ; Dexamethasone* ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Retrospective Studies ; Turkey

BACKGROUND: Coal workers' pneumoconiosis is a fibrotic lung disease resulting from chronic inhalation of coal dust. The precise mechanism of lung fibrosis in coal workers' pneumoconiosis is uncertain. However, a relationship between the stimulation of fibroblast proliferation and collagen production by mediators released from inflammatory and resident lung cells is thought to be a major factor. The transforming growth factor-β(TGF-β), a multifunctional cytokine and growth factor, plays a key role in the scarring and fibrotic processes due to its ability to induce extracellular matrix proteins and modulate the growth and immune function of many cell types. To determine the involvement of TGF-βin the development of lung fibrosis in coal workers' pneumoconiosis, the TGF-β1 level in plasma was measured in patients with coal workers' pneumoconiosis. METHODS: Plasma was collected from 40 patients with coal workers' pneumoconiosis (20 with simple coal workers' pneumoconiosis and 20 with complicated coal workers' pneumoconiosis) and from 10 normal controls. The ELISA method was used to measure the plasma TGF-β1 concentration. RESULTS: Compared to the control group (0.63±0.18 ng/mL), there was no significant difference in the plasma TGF-β1 level in patients with simple coal workers' pneumoconiosis (0.64±0.17 ng/mL) (p>.05). However, in patients with complicated coal workers' pneumoconiosis the plasma TGF-β1 level (0.79±0.18 ng/mL) was significantly higher than in patients with simple coal workers' pneumoconiosis and control group (p<0.05). CONCLUSION: The data suggests that TGF-β1 has some influence in the development of lung fibrosis in coal workers' pneumoconiosis.
Cicatrix ; Coal* ; Collagen ; Dust ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix Proteins ; Fibroblasts ; Fibrosis ; Humans ; Inhalation ; Lung ; Lung Diseases ; Plasma* ; Pneumoconiosis* ; Pulmonary Fibrosis

OBJECTIVES: This study identifies associated factors of ischemic heart disease (IHD) among post-menopausal Korean women at the biomedical (age, family history of hypertension, dyslipidemia, type 2 diabetes mellitus, or cerebro-cardiovascular disease, body mass index, and metabolic syndrome), biosocial (socioeconomic status and educational level), and psychosocial levels (stress, depression, smoking, binge alcohol consumption, and physical activity). METHODS: This study used a cross-sectional design with secondary data analysis of the 2013–2016 Korean National Health and Nutrition Examination Survey. Data from 3,636 women were analyzed by logistic regression analysis using a complex sample procedure. RESULTS: Of the biomedical factors, older age [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.87–4.80, p < 0.001], family history (OR: 2.29, 95% CI: 1.44–3.65, p = 0.001), and metabolic syndrome (OR: 1.93, 95% CI: 1.27–2.95, p = 0.002) were associated with IHD in post-menopausal women. Of the psychosocial factors, depression (OR: 2.56, 95% CI: 1.66–3.96, p < 0.001) and smoking (OR: 1.92, CI: 1.04–3.55, p = 0.038) were associated with IHD in post-menopausal women. CONCLUSION: These findings suggest that healthcare providers need to consider the contributing adverse effects of older age, family history, metabolic syndrome, depression and smoking when evaluating risk factors for IHD in post-menopausal women.
Alcohol Drinking ; Body Mass Index ; Coronary Artery Disease ; Depression ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Female ; Health Personnel ; Humans ; Hypertension ; Logistic Models ; Myocardial Ischemia ; Nutrition Surveys ; Postmenopause ; Psychology ; Risk Factors ; Smoke ; Smoking ; Statistics as Topic

Purpose: This study aimed to identify factors-both infant-related and maternal-associated with pressure to eat as a feeding practice among mothers with infants. Methods: This study used a cross-sectional design and included 163 mothers of infants aged 2~12 months. Of the 180 self-reported questionnaires that were distributed, 163 (91%) were included in the data analysis. Multiple regression analysis was used to identify the factors associated with pressure to eat as a feeding practice among the mothers. Results: Infant’s temperament (β=-.17, p=.035), mother’s body mass index (β=-.16, p=.048), and concern about the infant being underweight (β=.30, p=.001) were associated with pressure to eat as a feeding practice among mothers. The explanatory power of these variables in the predictive model was 19.2%. Conclusion Educational programs should be developed for improving mother’s awareness of cues from infants with difficult temperament. In addition, educational interventions regarding the correct evaluation of infant’s weight are needed to relieve mother’s concern about their infant’s being underweight. These interventions might be helpful to reduce the prevalence of pressure to eat as a feeding practice among mothers with infants.

Purpose: This study aims to explore mothers’ experiences of anger while raising a child in South Korea based on a qualitative descriptive approach. Methods: A total of ten mothers of children aged 1-3 years participated in the study. In-depth individual interviews were conducted from August to September 2019 to collect data, which were then subjected to thematic analysis. Results: A total of 4 main themes and 10 subthemes were identified. The 4 themes were “individual and environmental factors that influence anger,” “a vicious cycle of anger expression and guilt,” “being a little bit more mature as a mother,” and “need for anger management.” This study described various causes, ways of expressing, and effects of anger, as well as the mother’s coping strategies. These experiences were viewed as milestones along the journey to becoming a real parent and helped mothers develop empathy for other children and mothers. The participants expressed support for expanding the social support system for child-rearing and providing psychological programs for mothers. Conclusion Mothers of children aged 1-3 years experienced anger owing to various factors, but adapted by developing coping skills. This study recommends family-based support interventions to help mothers manage their emotions and parenting roles.

OBJECTIVES: The purpose of this study was to make empirical evidence for a community based case management program for the first episode of psychosis. METHODS: We provided a case management program for first episode psychosis patients and assessed their symptoms, function, insight, and satisfaction using Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), Scale to assess Unawareness of Mental Disorder (SUMD), Global Assessment of Functioning Scales (GAF), and Quality of Life scales (QOL) at baseline and after the program. We also evaluated the treatment maintenance rate and the changes of their developmental task achievement. RESULTS: Significant improvement was observed in all sub-domains of PANSS and significant changes were also observed in the areas of symptoms and function of HoNOS. Significant improvement was observed in awareness of mental illness itself and its outcomes. The treatment maintenance rate was 87.5%, including three patients who stopped their medication with the doctor's order. The rate of participation in meaningful social activities, such as school or job showed an increase, from 25% at baseline to 81% after the program. CONCLUSION: Results of this study demonstrate the possibility of community programs for prevention of relapse, improvement of symptoms and function, and facilitation of return to meaningful social activities of first episode psychosis patients.
Case Management ; Humans ; Mental Disorders ; Psychotic Disorders ; Quality of Life ; Recurrence ; Weights and Measures