• Title/Summary/Keyword: 임상적 접근

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Accuracy and Clinical Outcomes of Ultrasound-guided Glenohumeral joint Injection: Acromioclavicular Approach in Patients with Adhesive Capsulitis (초음파를 이용한 견관절 관절강내 주사의 정확성과 임상적 결과: 유착성 관절낭염 환자의 견봉 쇄골 접근법)

  • Lhee, Sang-Hoon;Hwang, Seok-Min
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.5 no.1
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    • pp.9-14
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    • 2012
  • Purpose: The purpose of the study was to evaluate the accuracy and clinical outcome of ultrasound-guided glenohumeral joint steroid injection on adhesive capsulitis. Materials and Methods: Patients who were diagnosed as adhesive capsulitis by MRI and physical examination and did not improve their symptom with physical therapy and NSAIDS treatment more than 6 months were included in the study. Patients who showed any other shoulder pathology or history if trauma were excluded from the study. 33 patients including 15 males and 18 females were enrolled in the study, the average age being 55.1 (age 42~72). Cocktail of steroid, lidocaine, saline and contrast medium injected inside shoulder glenohumeral joint using novel approach (which we called acromioclavicular approach) under ultrasound guidance. Clinical outcome was measured through passive range of motion and VAS scoring system. Results: Based on radiographic findings, cases were classified according to the leakage of contrast medium; perfect confinement of contrast-medium inside the capsule, partial leakage of the medium and contrast-medium found at outside the joint. Total 25 cases (76%) out of 33 cases showed perfect confinement of contrast-medium inside the glenohumeral joint. Partial leakage was observed in 6 cases (18%), and contrast medium was observed outside of the glenohumeral joint in 2 cases (6%). Perfect-confinement group showed $111^{\circ}$($80{\sim}140^{\circ}$) of forward flexion and $48^{\circ}$($0{\sim}90^{\circ}$) of external rotation before injection, and improved to $134^{\circ}$($90{\sim}150^{\circ}$) of forward flexion and $70^{\circ}$($30{\sim}90^{\circ}$) of external rotation after injection (p<0.01). Partial leakage showed $120^{\circ}$($90{\sim}150^{\circ}$) of forward flexion and $70^{\circ}$($10{\sim}90^{\circ}$) of external rotation before injection, and improved to $139^{\circ}$($135{\sim}140^{\circ}$) of forward flexion and $78^{\circ}$($50{\sim}90^{\circ}$) of external rotation after injection (p<0.01). VAS score improved from 7.1 (score 3~9) to 2.6 (score 0~5) (p<0.01) in perfect confinement group, from 7.5 (score 7~9) to 3.3 (score 2~4) (p<0.01) in partial leakage group. Two group showed no significant difference. Conclusion: Accuracy of Acromioclavicular approach was 94% which is better than any other methods published so far. Partial leakage of the injection material did not show inferior result compared to perfect injection.

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Estimating the Likelihood of Malignancy in Solitary Pulmonary Nodules by Bayesian Approach (Bayes식 접근법에 의한 고립성 폐결절의 악성도 예측)

  • Shin, Kyeong-Cheol;Chung, Jin-Hong;Lee, Kwan-Ho;Kim, Chang-Ho;Park, Jae-Yong;Jung, Tae-Hoon;Han, Sung-Beom;Jeon, Young-Jun
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.4
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    • pp.498-506
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    • 1999
  • Background : The causes of solitary pulmonary nodule are many, but the main concern is whether the nodule is benign or malignant. Because a solitary pulmonary nodule is the initial manifestation of the majority of lung cancer, accurate clinical and radiologic interpretation is important. Bayes' theorem is a simple method of combining clinical and radiologic findings to estimate the probability that a nodule in an individual patients is malignant. We estimated the probability of malignancy of solitary pulmonary nodules with a specific combination of features by Bayesian approach. Method : One hundred and eighty patients with solitary pulmonary nodules were identified from multi-center analysis. The hospital records of these patients were reviewed and patient age, smoking history, original radiologic findings, and diagnosis of the solitary pulmonary nodules were recorded. The diagnosis of solitary pulmonary nodule was established pathologically in all patients. We used to Bayes' theorem to devise a simple scheme for estimating the likelihood that a solitary pulmonary nodule is malignant based on radiological and clinical characteristics. Results : In patients characteristics, the probability of malignancy increases with advancing age, peaking in patients older than 66 year of age(LR : 3.64), and higher in patients with smoking history more than 46 pack years(LR : 8.38). In radiological features, the likelihood ratios were increased with increasing size of the nodule and nodule with lobulated or spiculated margin. Conclusion : In conclusion, the likelihood ratios of malignancy may improve the accuracy of the probability of malignancy, and can be a guide of management of solitary pulmonary nodule.

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Short-term clinical outcome of intentionally replanted posterior molars (의도적 재식술을 시행한 대구치의 단기간의 임상 평가)

  • Choi, Yong-Hoon
    • Restorative Dentistry and Endodontics
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    • v.36 no.1
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    • pp.12-18
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    • 2011
  • Objectives: This retrospective study evaluated the therapeutic effects of the intentional replantation (IR) procedure performed on the maxillary and mandibular molars of 35 patients. Materials and Methods: For the subjects, IR was performed due to difficulties in anatomically accessing the lesions and/or close proximity to the thick cortical bone, inferior alveolar nerve, or maxillary sinus, which rendered the ordinary periradicular surgery impossible. The patients'progress was followed for a year and up to 2 years and 4 months. The success of the procedure was evaluated in terms of clinical and radiographic success (%). Results: The results revealed the following: (a) 1 case (3%) of failed tooth extraction during IR; (b) 2 cases (6%) of extraction due to periodontal diseases and inflammatory root resorption; (c) 3 cases (9%) of normally functioning teeth in the oral cavity with minor mobility and apical root resorption, and; (d) 29 cases (82%) of normally functioning teeth without obvious problems. Conclusions: IR was confirmed to be a reliably repeatable, predictable treatment option for those who cannot receive conventional periradicular surgery because of anatomic limitations or patient factors.

Proton therapy: Literature review of clinical effectiveness as an advanced convergent cancer therapy (양성자 치료: 융복합 첨단 암 치료로서의 임상적 유효성에 대한 문헌 고찰)

  • Park, Hyojung
    • Journal of the Korea Convergence Society
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    • v.9 no.10
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    • pp.191-198
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    • 2018
  • This study was conducted to evaluate the clinical effectiveness of proton therapy as an advanced convergent cancer therapy. Clinical data of proton therapy were analyzed. As proton enters patient's body, it releases low dose of energy and shows an increasing energy deposition as it reaches certain point unlike x-ray. It may therefore reduce the radiation dose to the normal tissues in front and beyond the lesion and minimize the radiation damage. Proton therapy is expected to improve clinical outcomes and reduce treatment related toxicities. It is used in various cancers. Further studies are necessary.

Complicated AC Joint Cyst with Aseptic Fistula Secondary to Simple Excision - A Case Report and Review of Literature - (단순절제술 이후 견봉쇄골 낭종에 합병된 무균성 누공 - 증례보고 및 문헌고찰 -)

  • Shon, Min Soo;Baek, Duck In;Lee, Kyung Hag
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.2
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    • pp.120-126
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    • 2014
  • Acromioclavicular (AC) joint cyst is an uncommon presentation around the shoulder joint that is usually associated with chronic rotator cuff pathology and degenerative AC joint arthritis. Understanding the underlying pathophysiology of the shoulder joint is essential for appropriate interpretation of the AC joint cyst, assistance in determining the therapeutic strategy, and prevention of complications after treatment. We present a case of AC joint cyst with an aseptic fistula which was complicated by simple excision for recurred AC joint cyst after multiple aspirations. This case revealed a massive rotator cuff tear involving supraspinatus, infraspinatus, and subscapularis tendon on ultrasonography. We also reviewed the clinical approach and treatment options to be considered for its pathogenesis in the literature.

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Radiological Diagnosis and Surgical Stabilization of the Atlantoaxial Subluxation in a dog (개의 환축추 아탁구의 방사선진단 및 외과적 고정)

  • 김남수
    • Journal of Veterinary Clinics
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    • v.14 no.1
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    • pp.126-130
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    • 1997
  • 10개월경의 그리폰 벤딘 수컷 강아지가 8개월경부터 점점 운동 실조 및 마비증상을 나타내어 머독대학 동물병원에 내원 하였다. 내원 했을 때 주변에 매우 민감한 반응과 경계를 늦추지 않았지만 호흡과 심박수 및 체온은 정상이었다. 일반 방사선 사진 및 척수조영사진(myelography)을 촬영하여 확인한 결과 환축추의 불안정에 따른 척수의 복측 압박을 확인할 수 있었다. 외과적 고정은 복측 접근을 통하여 2개의 키르크너 강선(Kirschner wire)과 자가골이식을 실시하였으며 8주동안 외부 고정을 하였다. 수술 후 5개월 동안 지켜본 결과 증상은 꾸준히 좋아졌으며 환축추 관절으 관절고정술(arthrodesis)은 완벽한 고정을 유지하고 있었다.

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A Performance Evaluation Framework for e-Clinical Data Management (임상시험 전자자료 관리를 위한 평가 프레임웍)

  • Lee, Hyun-Ju
    • Journal of Internet Computing and Services
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    • v.13 no.1
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    • pp.45-55
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    • 2012
  • Electronic data management is getting important to reduce overall cost and run-time of clinical data management with the enhancement of data quality. It also critically needs to meet regulated guidelines for the overall quality and safety of electronic clinical trials. The purpose of this paper is to develop the performance evaluation framework in electronic clinical data management. Four key metrics in the area of infrastructure, intellectual preparation, study implementation and study completion covering major aspects of clinical trial processes are proposed. The performance measures evaluate the extent of regulation compliance, data quality, cost and efficiency of electronic data management process. They also provide measurement indicators for each evaluation items. Based on the key metrics, the performance evaluation framework is developed in three major areas involved in clinical data management - clinical site, monitoring and data coordinating center. As of the initial attempt how to evaluate the extent of electronic data management in clinical trials by Delphi survey, further empirical studies are planned and recommended.

A Study on the Development of Academic Classification System for Biomedical Laboratory Science (임상병리검사학의 학문분류체계 개발을 위한 연구)

  • Koo, Bon-Kyeong
    • Korean Journal of Clinical Laboratory Science
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    • v.49 no.4
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    • pp.477-488
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    • 2017
  • This study presents a discussion on the biomedical laboratory science (formally clinical laboratory science or medical laboratory science) with the identity of biomedical laboratory science, as well as the academic classification system for systematic approach. The field of biomedical laboratory science is not registered in the academic research area classification system of the National Research Foundation of Korea. Since the inception of the first department of biomedical laboratory science in 1963, about 52 departments were since established. Despite the scientific identity, biomedical laboratory science have not been acknowledged professionally in most institutions. Observing the academic research area classification, the physical therapy, occupational therapy, and dental hygiene science are systematically classified and approved the identities by the authorities. This study is freshly academic area classification system of the biomedical laboratory science. The contents of this study are summarized as follows. The medical laboratory technologist's discipline is considered within the medical and science category, clinical pathology in class, and biomedical laboratory science in division. Sections of biomedical laboratory science include hematology, transfusionology, immunology, biochemistry, microbiology, parasitology, science, molecular biology, histology, cytology, cardiopulmonary physiology, and neurophysiology.

TREATMENT OF CHILD AND ADOLESCENT DEPRESSIVE DISORDERS (소아 ${\cdot}$ 청소년 우울장애의 치료)

  • Kim, Ja-Sung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.5 no.1
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    • pp.36-40
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    • 1994
  • Child and adolescent depressive disorders are complex clinical problems. Although our knowledge of the epidemiology, clinical manifestation and etiology of child and adolescent depressive disorder has grown enormously, less has been established concerning effective managements for this disorder Some articles suggest that children and adolescents may require significant modification of adult treatment. This article reviews the range of available therapies for the condition add provides a systematic approach for the clinician. And guidelines f3r management of depression have been described. In conclusion, approaches to the treatment of this disorder must be comprehensive and broad-based to be successful. And practitioners should be encouraged to become skilled iii as many treatment as possible, because the needs of individual children and adolescents with depressive disorder and their families can vary greatly.

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Development of Clinical Trial Guidelines for Using Korean Herbal Medicine in Treatment of Common Cold (감기 치료를 위한 한약제제 임상시험 가이드라인 개발)

  • Jiwon Park;Kwan-Il Kim
    • Journal of Society of Preventive Korean Medicine
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    • v.28 no.1
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    • pp.131-157
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    • 2024
  • 목적 : 본 연구는 감기에 대한 한약제제 임상시험을 수행하고 평가하는 데 보편적인 원칙을 제공하는 가이드라인 개발과정 및 내용을 소개하여 가이드라인 활용성 및 접근성을 높이고자 한다. 방법 : 임상시험 가이드라인 개발을 위해 총 9인으로 이루어진 위원회를 구성하고, 전반적인 절차를 수립하였다. 먼저, 가이드라인 집필위원회에서 관련된 국내외 가이드라인을 고찰하고, 감기에 대한 최신 임상시험 논문을 분석하여 초안을 완성하였다. 이후 대한한방내과학회 소속 전문가 자문위원회 검토 및 8인의 전문가로 구성된 협의회 자문을 통해 최종 가이드라인을 도출하였다. 결과 : 본 가이드라인은 (1) 일반적 사항 (2) 유효성 평가 기준 (3) 유효성 평가 방법 (4) 시험 대상자 선정 (5) 임상시험 설계 (6) 안전성 평가 (7) 감기 치료에서의 병용요법 (8) 한의학적 고려 사항의 8가지 범주로 나뉘어진다. 최종 개발된 가이드라인은 한의약임상시험센터 협의회와 대한한방내과학회의 인증을 득하였다. 결론 : 본 가이드라인은 감기 치료를 위한 임상시험을 수행하고 평가하는 데 유용하게 사용될 것이며, 이를 통해 신뢰할 수 있는 결과를 이끌어내고 정확한 해석을 용이하게 할 수 있을 것이라 기대된다. 또한 추후 해당 가이드라인 개정 및 관련된 호흡기질환 가이드라인 개발 과정에 도움을 줄 수 있을 것으로 사료된다.