• Title/Summary/Keyword: 동시치료

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A Randomized, Double-Blind, Placebo-Controlled Trial of Early Ursodeoxycholic Acid Administration for Prevention of Total Parenteral Nutrition-Induced Hepatobiliary Complications (총정맥영양법의 간담도 합병증에 대한 Ursodeoxycholic Acid 조기투여의 이중맹검 위약대조군 연구)

  • Choe, Yon-Ho;Beck, Nam-Sun;Kim, Ji-Hee;Lee, Suk-Hyang;Park, Tae-Sung
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.5 no.2
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    • pp.174-180
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    • 2002
  • Purpose: Ursodeoxycholic acid (UDCA) is known to decrease hepatic injury by promoting the biliary secretion of retained toxic endogenous bile acids in hepatobiliary diseases complicated by total parenteral nutrition (TPN). However, most studies have focused on treatment for complications after TPN. We investigated the preventive role of early administration of UDCA in TPN-induced hepatobiliary complications by a randomized, double-blind, placebo-controlled trial. Methods: Between May 2000 and May 2002, thirteen patients, who were given TPN more than 10 days in the hospital, were assigned randomly to two groups. One was the case group (7 patients) who were given UDCA simultaneously with TPN regimen, and the other, the control group (6 patients) who were given placebo. Their age ranged from 1 day to 13 years. They were affected with diseases impossible for enteral nutrition, such as prematurity, cerebral palsy, chronic diarrhea, anorexia nervosa, pancreatitis, and cyclic vomiting. The duration of TPN ranged from 10 to 70 days. Hematologic parameters including liver function test were measured at regular intervals, and the duration, composition, administration rate, total calorie of TPN were recorded. The serum levels of total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were compared between groups after cessation of the study. Results: The autoregressive coefficient of the control group was 0.4419 (p=0.0651) in bilirubin, -0.0431 (p=0.7923) in AST, 0.2398 (p=0.2416) in ALT, and 0.2459 (p=0.1922) in alkaline phosphatase by mixed procedure model when the parameters were referred to the case group. Conclusion: The serum level of total bilirubin did not increase in comparison with that of the control group, but statistically insignificant, when both TPN and UDCA were administered simultaneously from the beginning.

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HW/SW Partitioning Techniques for Multi-Mode Multi-Task Embedded Applications (멀티모드 멀티태스크 임베디드 어플리케이션을 위한 HW/SW 분할 기법)

  • Kim, Young-Jun;Kim, Tae-Whan
    • Journal of KIISE:Computer Systems and Theory
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    • v.34 no.8
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    • pp.337-347
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    • 2007
  • An embedded system is called a multi-mode embedded system if it performs multiple applications by dynamically reconfiguring the system functionality. Further, the embedded system is called a multi-mode multi-task embedded system if it additionally supports multiple tasks to be executed in a mode. In this Paper, we address a HW/SW partitioning problem, that is, HW/SW partitioning of multi-mode multi-task embedded applications with timing constraints of tasks. The objective of the optimization problem is to find a minimal total system cost of allocation/mapping of processing resources to functional modules in tasks together with a schedule that satisfies the timing constraints. The key success of solving the problem is closely related to the degree of the amount of utilization of the potential parallelism among the executions of modules. However, due to an inherently excessively large search space of the parallelism, and to make the task of schedulabilty analysis easy, the prior HW/SW partitioning methods have not been able to fully exploit the potential parallel execution of modules. To overcome the limitation, we propose a set of comprehensive HW/SW partitioning techniques which solve the three subproblems of the partitioning problem simultaneously: (1) allocation of processing resources, (2) mapping the processing resources to the modules in tasks, and (3) determining an execution schedule of modules. Specifically, based on a precise measurement on the parallel execution and schedulability of modules, we develop a stepwise refinement partitioning technique for single-mode multi-task applications. The proposed techniques is then extended to solve the HW/SW partitioning problem of multi-mode multi-task applications. From experiments with a set of real-life applications, it is shown that the proposed techniques are able to reduce the implementation cost by 19.0% and 17.0% for single- and multi-mode multi-task applications over that by the conventional method, respectively.

A Study on the Postoperative Stability of Hard Tissue in Orthognathic Surgery Patients Depending on the Difference of Occlusal Plane (악교정 수술시 교합평면의 차이에 따른 술후 경조직의 안정성에 관한 연구)

  • Hwang, Chung-Ju;Lim, Seon-A;Moon, Jeong-Lyon
    • The korean journal of orthodontics
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    • v.29 no.2 s.73
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    • pp.239-249
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    • 1999
  • In orthognathic surgery to obtain proper functional and esthetic form after skeletal discrepancy treatment, precise diagnosis and treatment plan are essential. Especially in two jaw surgeries that have serious upper and lower jaw problems, maxilla and mandible are arranged in three dimensions. Based on the maxillary rearrangement, mandibular sagittal and transverse positions are determined, and thus new occlusal plane is established. The object of this study is to evaluate the stability of the indiviual ideal occlusal plane based on the architectural and structural craniofacial analysis of Delaires. The subjects of this study were 48 patients who underwent two jaw surgeries, and they were equally divided into two groups, A and B. A group was operated with ideal occlusal plane and B group was not. Two groups were compared at the preoperative, immediate postoperative (average 4.3days), and long-term postoperative (average 1.3years) lateral cephalometric radiographs. The following results were obtained: 1. ANS was lower than that of PNS for both A and B after the surgery. That is, maxilla and mandible are rotated in posterior and superior direction. 2. Significances were found between $T_2$ and $T_3$ for both A and B are HRP-Me at vortical measurements, articular angle(p<0.01), gonial angle(p<0.01), and Mn. plane angle(p<0.05) at angular measurement. Mn. plane angle is increased at HRP-Me is decreased for both A and B. 3. There is no significance in skeletal stability aster the surgery between group A and B. 4. Horizontal movements of B and Pog by surgery have statistically significant inverse correlations with horizontal relapse of B and Pog, and vertical relapse of PNS, as well as Mn. Plane angle, and gonial angle after the surgery.

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Usefulness of Three-phasic Bone Scan in Young Male Patients Suspected of Post-traumatic Reflex Sympathetic Dystrophy Syndrome (외상후 교감신경 이영양증이 의심되는 젊은 남자 환자들에서 삼상 골스캔의 유용성)

  • Lee, Won-Woo;Kim, Tae-Uk;Kim, Tae-Hoon;Jung, Cheoul-Yun;Moon, Jin-Ho
    • The Korean Journal of Nuclear Medicine
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    • v.35 no.1
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    • pp.52-60
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    • 2001
  • Purpose: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. Materials and Methods: Patients with narrow range of age (21-25. mean $22.8{\pm}1.3$, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed $21.2{\pm}7.3wks$ after trauma. Results: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight hearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). Conclusion: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.

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Middle and Long Term Results of 34 Cases of Emergency Coronary Artery Bypass Graft Surgery (응급 관상동맥 우회술 34예의 중장기 성적)

  • 손정환;김응중;지현근;신윤철;김건일;최광민;이원진;이원용
    • Journal of Chest Surgery
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    • v.36 no.10
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    • pp.741-747
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    • 2003
  • Background: Coronary artery bypass graf t (CABG) has been settled as most safe surgery among the open heart surgeries. However, in patients with cardiogenic shock, the emergency CABG has higher mortality than elective CABG. We analyzed thirty four patients who underwent emergency CABG and report the middle and long-term results. Material and Method: From June 1994 to December 2001, 34 patients who underwent emergency CABG at Kang-dong Sacred Heart Hospital were include in this study. On the basis of hospital databases and Out Patient Department (OPD) follow up data, preoperative diagnosis, risk factor, coronary artery anatomy, operation technique, postoperative mortality, complication, recurrence of symptom, and mid and long term mortality were analyzed retrospectively. Result: Indications for emergency CABG were 29 cardiogenic shocks (85.3%), 4 intractable chest pains (11.8%), and 1 polymorphic ventricular tachycardia (2.9%). Preoperative angiographic diagnoses were triple vessel disease in 16 (47.1%) and left main disease in 8 (23.5%) patients. We used saphenous vein grafts in 81 and left internal thoracic artery grafts in 14 anastomosis. The mean number of grafts per patients was 2.8$\pm$0.8. The mean aortic cross clamp time was 91.9$\pm$34.6 minutes and the mean cardiopulmonary bypass time was 262.7$\pm$198.3 minutes. Early mortality was 50% and the most common cause of early mortality was low cardiac output in 7 (20.6%) patients. The mean follow-up period was 30.9$\pm$35.7 months. There were no recurrences of symptom and late mortality. Conclusion: In the case of emergency operation, aggressive and proper management with drugs and IABP should be done for preoperative hemodynamic stability and early surgical intervention is the most important factor for patient salvage.

Construction of the Genomic Expression Library of Bacillus anthracis for the Immunomic Analysis (면역체 분석을 위한 탄저균 유전자 발현 라이브러리의 구축)

  • Park, Moon-Kyoo;Jung, Kyoung-Hwa;Kim, Yeon-Hee;Rhie, Gi-Eun;Chai, Young-Gyu;Yoon, Jang-W.
    • Korean Journal of Microbiology
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    • v.46 no.1
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    • pp.21-26
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    • 2010
  • As the causative agent of Anthrax, Bacillus anthracis causes an acute fatal disease in herbivores such as cattle, sheep, and horses as well as humans. The therapeutics and prevention of anthrax currently available are based on antibiotics and the live attenuated vaccine strains, which may be problematic due to the emergency of antibiotic resistant strains or residual virulence in those vaccine strains. Therefore, it has been required to develop novel therapeutics and vaccines which are safer and applicable to humans. Recently, the development of the multivalent vaccine targeting both spores and vegetative cells of B. anthracis along with anthrax toxin has been reported. In our attempts to screen potential candidates for those multivalent vaccines, the whole genomic expression library of B. anthracis was constructed in this study. To the end, the partial digests of the genomic DNA from B. anthracis (ATCC 14578) with Sau3AI were ligated with the inducible pET30abc expression vectors, resulting in approximately $1{\times}10^5$ clones in E. coli BL21(DE3). The redundancy test by DNA nucleotide sequencing was performed for the randomly selected 111 clones and found 56 (50.5%) B. anthracis genes, 17 (15.3%) vector sequences, and 38 (34.2%) unknown genes with no sequence homology by BLAST. An inducible expression of the recombinant proteins was confirmed by Western blot. Interestingly, some clones could react with the antiserum against B. anthracis. These results imply that the whole genomic library constructed in this study can be applied for analyzing the immunomes of B. anthracis.

Surgical Treatment of Arrhythmias Associated with Congenital Heart Disease (선천성 심장 기형에 동반된 부정맥에 대한 수술적 치료)

  • Hwang, Ui-Dong;Im, Yu-Mi;Park, Jeong-Jin;Seo, Dong-Man;Lee, Jae-Won;Yun, Tae-Jin
    • Journal of Chest Surgery
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    • v.40 no.12
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    • pp.811-816
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    • 2007
  • Background: We analyzed our experience of arrhythmia surgery in patients with congenital heart disease. Material and Method: A retrospective review was performed on 43 consecutive patients with congenital heart disease, who underwent arrhythmia surgery between June 1998 and June 2006. Result: The median age at surgery was 52 years ($4{\sim}75$ years). The most frequent cardiac anomaly was an atrial septal defect (23/43, 53.5%). The types of arrhythmias were atrial flutter-fibrillation, intermittent non-sustainable ventricular tachycardia and others in 37, 2 and 4, respectively. Arrhythmia surgery consisted of a bi-atrial maze operation in 18 patients (modified cox maze III procedure in 5 patients, and a right side maze plus pulmonary vein cryo-isolation in 13), right side maze operation in 18 patients, cavo-tricuspid isthmus cryoablation for benign atrial flutter in 4 patients, right ventricular endocardial cryoablation in 2 patients and extranodal cryoablation for atrioventricular node re-entry tachycardia in 1 patient. The median follow-up was 23.8 months ($1{\sim}95.2$ months). There was no early mortality, and one late non-cardiac related death. The overall rates of restored sinus rhythm before discharge and $3{\sim}6$ months after surgery were 79% and 81%, respectively (bi-atrial maze group: 72% and 83%, right-side maze group: 77%, 77%). Conclusion: Arrhythmias associated with congenital heart disease can be safely treated surgically with an excellent intermediate-term outcome.

Causative Pathogens and Therapeutic Assessment of Cefprozil in Acute Otitis Media (급성 중이염의 원인 병원균과 Cefprozil 치료의 임상적 평가)

  • Kang, Jin-Han;Kim, Jong Hyun;Park, Yong-Soo;Choi, Young-Chul;Noh, Heil;Yang, Hoon Shik;Kim, Kyu Sung;Moon, Yeon Sook;Hong, Young Jin
    • Clinical and Experimental Pediatrics
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    • v.46 no.5
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    • pp.459-466
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    • 2003
  • Purpose : AOM is the most common bacterial URI in children. The bacteriology and antibiotic Tx of AOM in children has been studied in many countries. But, there is few study of causative pathogens and antibiotic Tx of AOM in our country. In this aspect, we performed prospective clinical study to confirm the causative pathogens and assess the clinical responses of cefprozil in AOM patients. Methods : Thirty three AOM patients enrolled in this study. Tympanocentesis for isolation of causative pathogens were performed before Tx of cefprozil. The study patients received cefprozil with dose of 15 mg/kg/bid.po/day for 10-12 days, and initially assessed the clinical response at 4-5 days after receiving cefprozil and finally at the end visit. In vitro susceptibility tests of cefprozil to isolated pathogens were done by disc diffusion method, and in vitro susceptibility tests of cefaclor and cefixime to isolated pathogens were simultaneously performed. Results : Bacterial pathogens[S. pneumoniae(10), H. influenzae(5), S. aureus(2), M. catarrhalis(1) and Group A stretococcus(1)] were isolated from 19 patients. Clinically, all patients had history of abrupt high fever except one. Tympanic perforation was dominant in pathogens isolated cases, and otalgia was significantly developed in non-pathogens isolated cases. The ages of pathogens isolated cases were usually below 2 years. Eighty four point nine percent of the patients including two cases with isolation of intermediate resistant S. pneumoniae were clinically improved. Antimicrobial in vitro activity to S. pneumoniae of cefprozil were superior than that of cefacor and cefixime. Conclusion : We confirm that bacteria has the causative role in about 60% cases, and S. pneumoniae is the most common pathogen. Clinically, there were some differences in symptoms, signs and ages between pathogens isolated and non-pathogens isolated cases. The clinical responses of cefprozil in our patients revealed similar outcomes to other countries. And we reconfirm that cefprozil may be clinically effective in cases of AOM due to intermediate resistant S. pneumoniae.

Acceptability of Low Intensity Anticoagulation Therapy after Mechanical Heart Valve Replacement (기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구)

  • Kim, Jong-Woo;Rhie, Sang-Ho;Kim, Young-Chun;Yang, Jun-Ho;Jang, In-Seok;Choi, Jun-Young
    • Journal of Chest Surgery
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    • v.42 no.2
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    • pp.193-200
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    • 2009
  • Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy.

Second look arthroscopic findings after microfracture surgery in osteoarthritic knee (퇴행성 슬관절염에서 미세천공술 후 이차 관절경 소견)

  • Bae, Dae Kyung;Kim, Jin Moon;Lee, Jeong Heui;Park, Yong Koo
    • Journal of the Korean Arthroscopy Society
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    • v.3 no.2
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    • pp.85-90
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    • 1999
  • Purpose : The purpose of this study is to evaluate the clinical and histological results of the osteoarthritic patients who had second look arthroscopy after microfracture surgery. Materials and Methods : From Oct. 1997 to Dec. 1998, 46 patients, 48 knees were treated by microfracture technique. In the 22 patients, 24 knees, 'second-look' arthroscopies and biopsies were performed at 6 months following microfracture. Three patients were men and 19 patients were women. Average age of the patients were 58 years (range, 40-75 years). The average follow up period was 12 months(7-20 months). We analysed clinical results according to the nine-point scale. Also we observed type II collagen formation with immunohistochemical staining. Results : Clinical results were excellent in 83% and good in 17%. Among the 24 knees, more than 80% areas of chondral defect were covered with regenerated cartilage in 21 knees. Histologically, the regenerated tissue appears to be a hybrid of hyaline cartilage and fibrocartilage. Regenerated cartilage contains variable amount of type II collagen with immunohistochemical staining. Conclusion : Most of the patients had significant improvement clinically. 'Second-look' showed that the chondral defect areas were covered with newly grown grayish white tissue. Microfracture in the full thickness chondral defect provides and enriched environment for cartilaginous tissue regeneration.

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