Delirium in the Final Weeks of Terminally Ill Cancer Patients / 가정의학회지

BACKGROUNDS: In terminally ill cancer patients, delirium must be considered to be important clinically and for the quality of life. We reviewed cases of delirium in hospitalized cancer patients with the aim to recognize and treat delirium. METHODS: We reviewed retrospectively the medical records of patients admitted with terminal cancer from April 2003 to April 2004 in the department of family medicine, National Health Insurance Corporation Ilsan Hospital. A total of 71 patients were evaluated with age, sex, oncological diagnosis, metastases, morphine (oral morphine equivalents/day, OME) use and amount, sedatives use, duration from delirium to death, and laboratory fi ndings. Analysis was conducted to fi nd the characteristics of delirium patients and to quantify the relationship between delirium and predicting factors. RESULTS: Among 71 cases, those patients who developed delirium were 41 (57.7%). Among them, gastric cancer was the most common diagnosis with 10 patients (24.4%), followed by colon and lung cancers (9: 22%, 5: 12.2%). The patients receiving sedatives or morphines were 24 (58.5%) and 28 (68.3%), respectively. The mean amount of morphine was 168.6 +/- 125.5 mg OME/day. Hyperbilirubinemia (4.2 +/- 9.2 mg/dL) and hyponatremia (132.5 +/- 4.5 mM/L) were found. Not only bone metastasis and the use of morphine or sedatives but serum Na were significant (P = 0.047; P < 0.001; P = 0.069; P = 0.029). By logistic regression analyses, the occurrence of delirium was increased with decreased serum Na (odds ratio [95% CI] 0.798 [0.649-0.981]) and increased use of sedatives (5.955 [1.080-32.835]). CONCLUSION: In terminally ill cancer patients, the risk factors of delirium were bone metastasis, the use of morphine or sedatives, and serum Na level. Among these, the use of sedatives and serum Na level were independent risk factors.

Clinical Study of Patients with Fever and Fever of Unknown Origin

BACKGROUND: Family physicians in their on primary practice frequently encounters patients with fever, welch is one of the common symptoms. Fever is an important symptom and can occur in mild disease, common cold, influenza, acute pharyngotonsillitis or can originate from a particular severe disease, such as bacterial endocarditis, malignant lymphoma and SLE, which need more aggressive management. Therefore, we studied patients who were admitted with short-term fever or long-term fever to find out their causes of febrile disease and to compare the differences with previous other studies. METHODS: 601 patients with fever above 37.2 degree centigrade or those who were transferred from other hospitals due to long-term fever were enrolled from Jan. 1991 to Jun. 1997. Patients' medical records reviewed and were classified according to disease, sex, age. Standardization of Petersdorf's rule for F.U.O. was used. RESULTS: 601 patients were randomly selected among which 301 were males and 300 females. Males were 147 and females 147 young adult patients as compared to 154 males and 153 females were elderly patients. According to disease category, the number of infections, connective tissue diseases, neoplastic diseases and other diseases were 442(73.5%), 14(2.3%), 87(14.5%) and 21(3.5%), respectively. The number of diseases of undetermined case was 37(6.2%). The most frequent disease was pneumonia with 103(31.1%). UTI and tuberculosis were the 2nd and 3rd most common diseases. The total number of F.U.O. patients was 82(13.6%). According to the disease categories there were 29(35.4%) in infections, 2(2.4%) in connective tissue diseases, 12(14.6%) in neoplasms, 2(2.4%) in others and 37(45.2%) in unknown origin. The most common disease was tuberculosis. Infection and tuberculosis were common disease category and disease in the classification of sex and age of F.U.O.. CONCLUSIONS: In the clinical study of febrile patients admitted from Jan. 1991 to Jun.1997 through medical record review, the disease category in the order of frequency was infection, neoplasm, collective tissue disease and the distribution of F.U.0. was same result. In comparison with other study, the order of connective tissue disease and neoplasm was different in other hospital study but same result was taken In comparison with Petersdorf's study.

What Plasma Ionized Calcium Concentration Increased by Intravenous Injection with 3% Calcium Chloride and 10 % Calcium Gluconate Is Affected on Cardiovascular System? / 대한마취과학회지

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows;, 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p<0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p<0.05).

What Plasma Ionized Calcium Concentration Increased by Intravenous Injection with 3% Calcium Chloride and 10 % Calcium Gluconate Is Affected on Cardiovascular System? / 대한마취과학회지

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows;, 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p<0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p<0.05).