• Title/Summary/Keyword: 악화환자

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A Clinical Study of Soeumin Doksamkwankaeijungtang (독삼관계이중탕(獨參官桂理中湯)의 소음인(小陰人) 인후통(咽喉痛) 치험례(治驗例))

  • Huh, Manhn-hoi;Song, Il-byung
    • Journal of Sasang Constitutional Medicine
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    • v.12 no.1
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    • pp.240-259
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    • 2000
  • 1. Background and Purpose I intented to be helpful to understand the consitutional symptoms of soar throat and the application of the prescription through a clinical study of Soeumin Doksamkwankaeijungtang. 2. Methods I studied 16 patients(1 man and 15 women) treated by Doksamkwankaeijungtang in Chewon Oriental Clinic. And then I investigated the characteristics of patients treated by Doksamkwankaeijungtang, remedial values and side effects. 3. Results Doksamkwankaeijungtang was used in the age groups between twenties and sixties. There were 28 kinds of chief complaints including soar throat, tonsilitis, allergic rheum, bitter taste, dry throat, dry cough, stomatitis, lower abdominal pains, climacteric syndrome, etc. The distributions of remedial values were completely recovered (56.25%), much improved (18.75%), slightly improved(6.25%), no improved(12.5%), aggravated(6.25%), side effects(18.75%). There was one aggravated patient. Using the prescription, I prescribed it without any changing and addition according to the symptoms of soar throat. The remedial value of Doksamkwankaeijungtang was effective and not influenced by the dosage of Ginseng. The onset of action was very quick by the changes of dosage without the relation of age. Side effects were upward tendency of blood presser, headache, chest pain, etc. 4. Conclusion Doksamkwankaeijungtang was specifically effective in soar throat of Soeumin.

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Changes in Bronchoscopic Findings during Treatment-Course in Active Endobronchial Tuberculosis (활동성 기관지결핵에서 치료경과에 따른 기관지경소견의 변화)

  • Chung, Hee-Soon;Lee, Jae-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.25-34
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    • 1995
  • Background: Endobronchial tuberculosis is classified into 7 subtypes as fibrostenotic type, edematous-hyperemic type, actively caseating type, tumorous type, ulcerative type, granular type and nonspecific bronchitic type by bronchoscopic features, and we make a prospective study to follow up how bronchoscopic findings change during treatment-course in each subtype of active endobronchial tuberculosis. Methods: We planned to do follow-up bronchoscopic examination every month until there was no significant change in endobronchial lesion, then every 3 months and at the end of the treatment in each patient with biopsy proven endobronchial tuberculosis from May, 1990 to August, 1993. Results: 1) This study included 66 cases, but bronchoscopic follow-up was completed as scheduled in 47 cases. 2) In actively caseating and edematous-hyperemic type, bronchostenosis occurred within 2 or 3 months of treatment in about 2/3 of total cases. 3) In fibrostenotic type, bronchostenosis did not improve in spite of the treatment. 4) In tumorous type, the changes in bronchoscopic findings were unpredictable because new lesions occured on other sites even 4 or 6 months after treatment in 2 cases and the size of initial mass increased 6 months after treatment in 1 case (among 7 cases). 5) Granular and nonspecific bronchitic type improved without significant sequelae within 2 or 3 months of treatment. Conclusion: It may be necessary to follow up the patient with bronchoscopy repeatedly 2 or 3 months after starting treatment in active endobronchial tuberculosis, and it is better to perform bronchoscopic examination at 6 months of treatment, especially in patients with tumorous type because there is possibility that new endobronchial lesion occurs. Aggressive therapeutic modalities such as stent-insertion, laser therapy or electrocautery should be considered to prevent bronchostenosis in cases with granulation tissue, fibrostenotic and tumorous types of endobronchial tuberculosis.

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The Correlation between the Radiological Changes and the Level of Transforming Growth Factor-β1 in Patients with Pulmonary Tuberculosis (폐결핵의 영상학적 진행과 Transforming Growth Factor-β1 농도와의 관련성)

  • Cho, Yongseon;Lee, Yang Deok;Cho, Wook;Na, Dong Jib;Han, Min Soo
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.3
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    • pp.297-303
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    • 2006
  • Background : Pulmonary tuberculosis is frequently accompanied with complications such as bronchiectasis, cavities, fibrosis and a deterioration of the lung function. However, there is little information available on the pathogenesis of these complications in pulmonary tuberculosis. Among the many factors involving in tissue remodeling, transforming growth factor-${\beta}1$ ($TGF-{\beta}1$) is a potent stimulus of the extracellular matrix fomation and a mediator of potential relevance for airway wall remodeling. Therefore, this study examined the relationship between the radiological changes and the $TGF-{\beta}1$ level in patients with pulmonary tuberculosis. Methods : Serum and bronchoalveolar lavage fluid (BALF) were collected from total of 35 patients before treating them for active pulmonary tuberculosis, and the $TGF-{\beta}1$ levels were measured using an enzyme-linked immunosorbent assay (ELISA). The BALF levels were recalculated as the epithelial lining fluid (ELF) levels using the albumin method. pulmonary function test (PFT) and high resolution computed tomography (HRCT) were performed before and after treatment. Results : There was a strong correlation between the serum $TGF-{\beta}1$ level and the presence of cavities (r=0.404, p=0.006), even though the BAL $TGF-{\beta}1$ level showed a weak correlation with complications. In addition, there was no correlation between the $TGF-{\beta}1$ levels before treatment and the changes in the PFT and HRCT during treatment. Conclusion : There is a correlation between the serum $TGF-{\beta}1$ level and cavity formation in pulmonary tuberculosis before treatment. However, further study will be needed to confirm this.

The Evaluation of External Radiation Exposure dose rate for Radium-223 Dichloride (Radium-223 Dichloride의 외부 방사선량의 평가)

  • Cho, Seong Wook;Yoon, Seok Hwan;Seung, Jong Min;Kim, Tae Yub;Im, Jeong Jin;Kim, Jin Eui
    • The Korean Journal of Nuclear Medicine Technology
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    • v.20 no.1
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    • pp.28-31
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    • 2016
  • Purpose $^{223}Ra-Dichloride$ is used for the medicine of castration-resistant prostate cancer (CRPC) and which emits ${\alpha}-ray$ of 28 Mev that is used for therapy. However $^{223}Ra-Dichloride$ emits ${\beta}-ray$ of 3.6% and ${\gamma}-ray$ of 1.1%(80,156,270 keV) aside from ${\alpha}-ray$ in decay. Therefore we would like to evaluate external radiation expose dose rate of ${\gamma}-ray$ of $^{223}Ra-Dichloride$. Materials and Methods We calculated external radiation expose dose rate using ${\gamma}-constant$ of $^{223}Ra-Dichloride$, $^{99m}Tc$ based on Health physics(2012). $^{223}Ra-Dichloride$ of 3.5 MBq and $^{99m}Tc-MDP$ of 740 MBq were applied. external radiation expose dose rate 15 times from 1m by survey meter. Results ${\gamma}-contant$ of $^{223}Ra$, $^{99m}Tc-MDP$ from 1m distance based on Health physics(2012) is 0.0469, 0.0215. calculated value of external radiation expose dose rate was $16{\mu}Sy$, $34{\mu}Sy$ which activity is $^{223}Ra-Dichloride$ of 3.5 MBq and $^{99m}Tc-MDP$ of 740 MBq from 1 m and measured mean value of 1 m was $0.7{\mu}Sy/h$, $18{\mu}Sy/h$. Conclusion ${\gamma}-constant$ of $^{223}Ra$ is higher than $^{99m}Tc$ based on Health physics(2012). however calculated maximum external radiation expose dose rate of $^{223}Ra-Dichloride$ is lower than $^{99m}Tc$ due to actually used quantity of activity of $^{223}Ra-Dichloride$ is small. measured value of $^{223}Ra-Dichloride$ is also lower than $^{99m}Tc-MDP$. Therefore external radiation expose dose rate of ${\gamma}-ray$ of $^{223}Ra-Dichloride$ is very low.

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Impact of Hemodialysis on Left Ventricular Performance: A Doppler Echocardiographic Study (혈액투석 유지요법 환자에서 투석 전후의 좌심실 Doppler 심초음파를 이용한 기능지표의 변화)

  • Kang, Dong-Oh;Lee, Du-Ha;Kim, Hyun-Seo;Kim, Hyun-Su;Kim, Sung-Rok;Park, Jong-Seon
    • Journal of Yeungnam Medical Science
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    • v.16 no.2
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    • pp.309-317
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    • 1999
  • Background: Left ventricular diastolic filling is an important determinant for maintenance of cardiac output during hemodialysis. Few investigators have studied the influence of hemodialysis on diastolic function. To evaluate the change of left ventricular systolic and diastolic function. we performed M-mode and Doppler echocardiographic studies before and after hemodialysis. Methods: The study population consisted of 30 patients(15 patients were male, mean age $45{\pm}10$ years) with CRF on maintenance hemodialysis. They have normal left ventricular systolic function(Fractional shortening>30%) and no evidence of valvular heart disease or regional wall motion abnormalities. The ejection fraction (EF) was measured using M-mode echocardiography and Doppler indices such as peak E velocity, peak A velocity, isovolumetric relaxation time(IVRT), deceleration time(DT). and left ventricular ejection time(LVET) obtained from Doppler echocardiography. The index of myocardial performance (IMP) was calculated from each of the Doppler velocity indices. Results: The weight reduction after hemodialysis was $2.1{\pm}1.0kg$(p<0.0001), After hemodialysis, there was some decrease in blood pressure(p<0.05), but no significant change in heart rate, EF and fractional shortening, mean VCF, peak A velocity, and DT. And significant reduction in peak E velocity, E/A ratio(p<0.0001. p<0.001), and significant increase in IVRT and IMP(p<0.05, p<0.0001) were noted. Conclusion: In conclusion, preload reduction is the main mechanism that accounts for changes in Doppler diastolic indices after hemodialysis. And an increased IMP suggests that diastolic function may be aggravated after hemodialysis, and that implies impaired left ventricular filling and disturbed left ventricular compliance.

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Outcome of LINAC Radiosurgery for a Cavernous Angioma (해면상혈관종에 대한 선형가속기를 이용한 고선량 정위 방사선수술의 임상경험)

  • Hong Semie;Chie Eui Kyu;Park Suk Won;Kim Il Han;Ha Sung Hwan;Park Charn Il
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.107-111
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    • 2003
  • Purpose: To establish the role of stereoactic radiosurgery using a linear accelerator for the treatment of patients with cavernous angloma. Materials and Methods: Between February 1995 and May 1997, 11 patients with cavernous angioma were treated with stereotactic radiosurgery using a linear accelerator. Diagnoses were based on the magnetic resonance imaging in 8 patients, and the histological in 3. The vascular lesions were located on the brainstem (5 cases), cerebellum (2 cases) thalamus (1 case) and cerebrum (3 cases). The clinical presentation at onset included previous intracerebral hemorrhages (9 cases) and seizures (2 cases). All patients were treated with a a linac-based radiosurgery. The median dose of radiation delivered was 16 Gy ranging from 14 to 24 Gy, which was typically proscribed to the 80$\%$ isodose surface (range 50 $\~$ 80$\%$), corresponding to the periphery of the lesion with a single isocenter. Ten patients were followed-up. Results: The median follow-up was 49 months ranging from 8 to 73 months, during which time two patients developed an intracerebral hemorrhage, 1 at 8 months, with the other at 64 months post radiosurgery. One patient developed neurological deficit after radiosurgery, and two developed an edema on the T2 weighted images of the MRI surrounding the radiosurgical target. Conclusion: The use of stereotactic radiosurgery in the treatment of a cavernous angioma may be effective in the prevention of rebleedlng, and can be safely delivered. However, a longer follow-up period will be required.

The Role of T1-201 Brain SPECT in the Differentiating Recurrent Tumor from Radiation Necrosis (뇌종양의 재발과 방사선 괴사의 감별을 위한 탈륨 SPECT의 역할)

  • Won, Kyoung-Sook;Ryu, Jin-Sook;Moon, Dae-Hyuk;Yang, Seoung-Oh;Lee, Hee-Kyung;Lee, Jung-Kyo;Kwun, Byung-Duk
    • The Korean Journal of Nuclear Medicine
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    • v.30 no.4
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    • pp.476-483
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    • 1996
  • Following radiation therapy for brain tumors, patients often have clinical deterioration due to either radiation necrosis or recurrent tumor progression in the treatment field. The distinction between these entities is important but difficult clinically or even with CT or MRI. T1-201 has been known to accumulate in various tumors and be useful to grade, predict prognosis or detect recurrence of glioma. The aim of this study was to evaluate the usefulness of T1-201 SPECT in the differentiation of recurrent tumor from radiation necrosis. Of 67 patients who did T1-201 brain SPECT imaging with clinically suspected recurrent tumor or radiation necrosis, 20 patients underwent histopathological examination and constituted the study population. T1-201 uptake indices on T1-201 brain SPECT imaging rrere calculated and correlated with histopathological diagnosis. Of 20 patients, 15 were histopathologically confirmed as recurrent original tumor or malignant transformation of benign tumor and 5 were diagnosed as radiation necrosis. On T1-201 SPECT, 18 of 20 had T1-201 index above 2.5 which was regarded as positive indicator for the presence of tumor. Seventeen cases showed concordance, which consisted of 15 true positive and 2 true negative. Discordant 3 cases were all false positive. There was no case of false negative. The sensitivity, specificity, positive and negative predictive value of T1-201 SPECT were 100%, 40%, 83% and 100%. In conclusion, T1-201 brain SPECT is a sensitive diagnostic test in the detection of recurrent tumor following radiation therapy and is useful in the differentiation of recurrent tumor from radiation necrosis. Relatively low specificity should be evaluated further in larger number of patients in consideration of sampling error and referral bias for pathologic examination.

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Cytotoxic Effects of Prevotella nigrescens on Cultured Cells (Prevotella nigrescens가 배양된 세포에 미치는 영향)

  • Han, Jin-Soon;Kim, Eun-Sook;Lee, Su-Jong;You, Yong-Ouk;Han, Kyung-Soo;Im, Mi-Kyung
    • Restorative Dentistry and Endodontics
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    • v.27 no.2
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    • pp.183-195
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    • 2002
  • 흑색 색소를 형성하는 그람음성 혐기성 세균은 급성 임상 증상을 가진 환자의 근관에서 자주 발견되는 세균으로서 세균 및 세균의 성분과 산물이 치근단 병소의 생성과 밀접하게 연관된 것으로 알려져 있다. 본 연구는 흑색 색소를 형성하는 그람음성 혐기성 세균 중 가장 발현율이 높은 Prevotella nigrescens가 배양된 세포에 미치는 세포 독성을 연구하고자 하였다. 두 가지 세포주 및 사람의 치은섬유모세포를 일차배양하여 사용하였으며, 세포주에 따른 독성 발현에 차이가 있는지를 비교하였다. P. nigrescens ATCC 33563 표준 균주 및 임상 균주로는 환자의 감염된 근관으로부터 165 rRNA primer를 사용한 중합효소 연쇄반응으로 P. nigrescens 6 균주를 동정하여 사용하였다. 세균배양액, 세균의 초음파 추출단백질 및 lipopolysaccharide (LPS)를 MC3T3-El 조골세포, NIH3T3 섬유모세포 및 치은섬유모세포에 첨가한 후 MTT분석법으로 세포의 활성을 측정하였으며, 세포의 형태학적 변화를 도립현미경으로 관찰하였다. 세균배양액을 100$\mu\textrm{l}$ 첨가한 경우는 세가지 세포주 모두에서 통계적으로 유의하게 세포의 활성을 억제하였다. 세균의 초음파 추출단백질 12.5$\mu\textrm{g}$/ml 와 25$\mu\textrm{g}$/ml 는 NIH3T3세포에 통계적으로 유의한 세포독성을 보였다. 세 가지 세포주에 대한 LPS의 세포 독성 효과는 첨가된 LPS의 농도 및 균주에 따라 다양하게 나타났다. 심하게 손상된 세포는 세포의 단일층이 수축되고 세포가 응집되었으며 세포가 배양용기의 바닥에서 떨어지는 양상이 도립 현미경하에서 관찰되었다. 본 연구의 결과 P. nigrescens가 숙주 반응을 조절하여 치수 및 치근단 병소의 유발 및 악화에 기여하는 세균으로 작용할 수 있음을 시사한다. 조직과 함께 제거하고 포르말린에서 48시간 고정시킨 후 파라핀에 포매한 다음에 micro-tome을 사용하여 6$\mu\textrm{m}$로 serial section을 시행하였다. 정중선 부위의 시편에 Hematoxylin-Eosin staining을 시행한 후 Olsson, Orstavik 그리고 Mjor 등의 방법에 따라 조직학적 변화를 관찰한 후 slight(1), moderate(2), severe inflammation(3)의 단계로 분류하였다. 얻어진 결과를 통계처리 프로그램인 Jandel사의 Sigmastat을 이용하여 Kruskal Wallis Test로 통계처리를 하였다. 결과 : (Table omitted) 결론 : 1) Pulp Canal Sealer를 제외한 모든 군에서 시간이 지남에 따라 유의성 있게 염증이 감소되는 양상을 보였다(p<0.05). 2) Pulp Canal Sealer는 1주, 2주, 12주에서 강한 염증반응을 보였다. 3) AH 26과 AH Plus에서는 1주, 2주에서 강한 염증반응을 보였으나 12주에서는 염증반응이 감소하였다. 4) 새로 개발된 봉함제 Adseal-1,2는 1주, 2주에서는 가장 약한 염증반응을 보이나 4주, 12주 후에는 AH Plus와 비슷한 수준의 염증 반응을 보였다. 5) Pulp Canal Sealer를 제외한 모든 군에서 인정할 만한 생체친화성을 보였다. 6) Adseal-2가 Adseal-1에 비하여 전반적으로 낮은 염증반응을 보였다. 7) 각 군간 결과의 차이에 통계적 유의성은 없었다(p>0.05).mmunity. Then, a hierarchical language is to defeat its own purpose.중 행정부가 북한에 대해 실시한 포용정책이 어떠한 성과를 거두고 어떠한 문제점을 간과하고 있는가에 대해 논의하고, 대북 정책의 새로운 지평을 논의하는 것을 목적으로 하고 있다. 1) 포용 정책은 세계의

The Prognostic Value of Fibroblastic Foci Quantity in Patients with Usual Interstitial Pneumonia (UIP 환자에서 측정된 Fibroblastic Foci량이 예후에 미치는 영향)

  • Park, Sung-Woo;Lee, Young-Mok;Lee, June-Hyeuk;Kim, Ki-Up;Kim, Do-Jin;Uh, Soo-Taek;Kim, Yong-Hoon;Park, Choon-Sik;Kim, Hyun-Jo;Youm, Wook
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.6
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    • pp.540-549
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    • 2001
  • Background : Usual interstitial pneumonia (UIP) is a progressive fibrous lung disease with occasional fatal outcomes. However, the extent and rate of progression varies markedly from one patient to another. As a result, it is difficult to determine the time of the initial treatment and assess the disease activity and course. Fibroblast foci (FF) is well known to synthesize collagen actively by their myofibroblasts component. However, the prognostic value of the FF have not been evaluated in patients with VIP. Therefore this study was undertaken to determine how the number of fibroblastic foci can reflect the disease activity and progression. Methods: Twenty patients with UIP(M : F=13 : 7), who were diagnosed by a surgical lung biopsy. The number of fibroblastic foci was analyzed in terms of its correlation with the clinical manifostations, pulmonary function test, arterial blood gas analysis, and a bronchoalveolar lavage(BAL). Results : The number of fibroblastic foci did not correlate with the various lung function tests and the other clinical parameters. Interestingly, the percentage of neutrophils in the bronchoalveolar lavage fluid did correlate with the quantity of the normalized Vv of FF(r=0.60, p<0.05). The patients were divided into 2 groups, group I and II, arbitrarily, according to the value of the normalized Vv. The clinical parameters and the PIT results were not different between the two groups. In particular, the survival rate between the two groups according to the Kaplan-Meier analysis were not different. Conclusion : A large number of FF does not imply a bad prognosis in patients with UIP.

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Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations (영양집중지원팀 자문 의뢰 및 순응 여부에 따른 중환자실 환자의 영양상태 비교)

  • Sohn, Yunjin;Hyun, Taisun
    • Korean Journal of Community Nutrition
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    • v.27 no.2
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    • pp.121-131
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    • 2022
  • Objectives: This study aimed to examine the effectiveness of the intervention of the nutrition support team (NST) on the nutritional status of critically ill patients. Methods: The medical records of 176 adult patients who were admitted to the intensive care unit and received enteral or parenteral nutrition for more than 7 days were retrospectively analyzed. The patients were classified into the NST and non-NST groups according to whether they were referred to the NST or not. The NST group was further classified into the compliance and non-compliance groups depending on their compliance with the NST recommendations. Results: The NST referral rate was 56.8%, and the rate of compliance with the NST recommendations was 47.0%. Significantly higher energy and protein were provided to the NST and the compliance groups than to the non-NST and the non-compliance groups. The proportion of patients who reached the target calories after the initiation of enteral nutrition was significantly higher in the NST and the compliance groups than in the non-NST and the non-compliance groups. The serum albumin and hemoglobin levels significantly decreased in every group, but the changes were significantly lower in the compliance group. The nutritional status at discharge from the intensive care unit compared to the status at admission was significantly worse in the NST, non-NST, and non-compliance groups. However, the status was maintained in the compliance group. The length of stay in the intensive care unit was significantly shorter in the compliance group. Conclusions: Compliance with the NST recommendations was found to provide more calories and protein and prevent the deterioration of the nutritional status of critically ill patients. Therefore, effective communication between medical staff and the NST from the early stages of admission to the intensive care unit is needed to improve referrals to the NST and compliance with the recommendations.