Delayed Elimination After High-dose Methotrexate in Pediatric Patients with Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma

BACKGROUND: High doses of methotrexate (MTX) are often used in various chemotherapy protocols to treat acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) in children, but its delayed elimination increases the occurrence of adverse events, such as bone marrow suppression. The aim of this study was to investigate the elimination of MTX at 24 and 48 hours. METHODS: We retrospectively analyzed electronic medical records of ALL or NHL pediatric patients who received 5 g/m² MTX infusion over 24 hours (between June, 2012 and July, 2018) at the Yonsei University Health System, Korea. The delayed elimination of MTX concentrations was assessed with 100 or 150 µM MTX at 24 hours, and 2 or 5 µM at 48 hours. RESULTS: Among the 85 MTX cycles administered, 23 cycles were classified in delayed elimination group, and 62 cycles showed normal elimination. At 24 hours, the delayed elimination group with MTX concentration > 100 µM showed higher percentage than group with MTX concentration < 100 µM (45.8% vs. 19.7%, p = 0.015). However, no differences were observed at 150 µM MTX (p = 0.66). At 48 hours, the delayed elimination was higher than the normal elimination at both concentration baselines (p < 0.001 at 2 µM, p = 0.024 at 5 µM). CONCLUSIONS: MTX concentrations greater than 100 µM show high probability of delayed elimination at 24 hours. When MTX levels are above normal, leucovorin and hydration regimens should be continued to prevent delayed elimination.

Effects of Tracheal Suction and Method of Bronchodilator Inhalation on Vital Signs and Pulmonary Functions in Patients with Open Heart Surgery(OHS) / 기본간호학회지

OBJECTIVE: The purpose of this study was to identify the effects of tracheal suction and the effects of different methods of bronchodilator inhalation (Ultrasonic nebulizer, MDI puff, MDI puff with spacer) in VSD surgery patients. MATERIAL & METHOD: From June 2001 to March 2002, sixty consecutive patients were randomly assigned to a control group (n= 15), ultrasonic nebulizer group (n=15), metered dose inhalation (MDI) puff group (n=15) and MDI with spacer group (n=15). Vital signs (HR, BP, CVP), ABGA and pulmonary functions were measured before suction (baseline for suction), after suction, 15 minutes after suction (base of bronchodilator inhalation), 30 minutes after bronchodilator inhalation, and 2 hours after bronchodilator inhalation. Stastistical analysis was performed using SPSS software. Repeated measure ANOVA was used to examine the effects of tracheal suction. One way ANOVA with Bonferroni's correction and mutiple range test (the least significant difference test) were used to examine the effects of albuterol inhalation. RESULT: 1. Heart rate increased significantly immediately after suction (p<0.01) and recovered 15 minutes after suction. 2. PaO2 and PH decreased significantly immediately after suction (p<0.05) and PaO2 recovered 15 minutes after suction. PaCO2 increased immediately after suction and significantly 15 minutes after suction (p<0.01). But changes in vital signs and ABGA were within the normal range. 3. Tidal volume decreased significantly 15 minutes after suction (p<0.05) 4. Changes of HR and tidal volume were greater in the nebuizer group compared to the other groups (p<0.05) 30 minutes after bronchodilator inhalation and recovered 2 hours after bronchodilator inhalation. 5. Changes of airway deadspace was greater in the nebulizer group compared to the control group and MDI puff group 30 minutes after albuterol inhalation (p<0.05) and at 2 hours (p<0.01). CONCLUSION: Tracheal suction did not have significant effect on vital signs and pulmonary functions after OHS. Although the methods of bronchodilator inhalation did not showed any significant difference on pulmonary function, the nebulizer method increased PaO2 (20%) and tidal volume transiently. If the patient needs bronchodilator inhalation with bronchospasm after OHS, the nebulizer method is the best choice. More study on the effects of bronchodilator inhalation in bronchospasm group is needed.

Accuracy Comparison of Blood Pressure among the Direct Measurement Method and Two Automatic Indirect Measurement Methods in the Patients with Various Blood Pressure / 기본간호학회지

OBJECTIVE: The purpose of this study was to identify differences in measurement methods for blood pressure (Direct measurement, HP automatic indirect measurement, and SE 7000 Korean made indirect measurement), and to evaluate the clinical trial of the Korean made automatic indirect blood pressure measurement. MATERIAL & METHODS: From June, 1999 to February, 2000, fifty five consecutive patients were randomized into hypertension group (n=20), normotension group (n=20), and hypotension group (n=15). Measuring blood pressure by indirect methods (HP NIBP M 1008B and SE 7000 NIBP Korean made) was done simultaneously in the same arm with arterial line for direct blood pressure measurement (HP M1006A). The procedures were repeated ten times at intervals of 2 minutes. Statistical analysis was performed using SPSS (version 8.0 for windows) software package. Values were expressed as means and standard deviation and means were compared using t-test. Statistical significance was considered present with a p value less than 0.05. RESULTS: In the hypertension group and noromotension group, the disparity between HP direct measurement and indirect SE 7000 NIBP did not show any differences compared to the disparity between HP direct measurement and indirect HP NIBP. In the hypotension group, the disparity in the diastolic pressure between HP direct measurement and indirect SE 7000 NIBP was significantly different compared to the disparity between HP direct measurement and indirect HP NIBP (p<0.001), however, disparities in systolic pressure did not showed any differences. CONCLUSION: Direct blood pressure measurement (HP M1006A) can be replaced with indirect blood pressure measurements (HP NIBP M 1008B & SE 7000 NIBP) in normotension and hypertension patients. Korean made indirect measurement was found to be more accurate compared to HP indirect measurement in hypotension patients, but more study is needed.