• Title/Summary/Keyword: 치료결정

Search Result 1,365, Processing Time 0.03 seconds

Changes of Mitral Regurgitation after Aortic Valve Replacement, according to the Aortic Valve Pathology (대동맥 판막 치환술 후 대동맥 판막 병변에 따른 승모판막 폐쇄부전의 변화)

  • Kim, Si-Wook;Lee, Young-Tak;Jun, Tae-Gook;Sung, Ki-Ick;Kim, Wook-Sung;Yang, Ji-Hyuk;Choi, Jin-Ho;Park, Pyo-Won
    • Journal of Chest Surgery
    • /
    • v.40 no.10
    • /
    • pp.667-673
    • /
    • 2007
  • Background: Patients with severe aortic valve disease frequently display mitral valve regurgitation (MR). In such patients, the clinical course of MR after isolated aortic valve replacement (AVR) may be important for determining the treatment strategies. After isolated AVR, the change of the concomitant moderate degree or less of MR according to the type of aortic valve disease is not known well. The aim of this study was to analyze the post-operative changes of MR after performing AVR in those patients with severe AS (Group S) and those with severe AR (Group R). Material and Method: We retrospectively evaluated 43 patients with severe aortic disease and a moderate degree or less of mitral valve regurgitation, and these patients underwent isolated aortic valve replacement from January 1996 to June 2005. The patients were divided into two groups: the aortic valve stenosis group (n = 29) and the aortic valve regurgitation group (n = 14). The patients underwent transthoracic echocardiography preoperatively and at 7 days, $6{\sim}10$ months and more than 18 months (mean follow-up duration: 38 months) postoperatively. Result: The mean age was 60.9 years (Group S: 62 years, Group R: 52.5 years) and 60% (Group S=55%, Group R=71%) of the patients were male. The preoperative MR was mild in 29 (67.5%), mild to moderate in 11 (25.5%), and moderate in 3 (6.9%) patients. In the Group S patients, MR improved in 16 (55%) patients at the immediate postoperative days and in 17 (59%) patients at more than 18 months postoperatively. On the other hand, all the Group R patients exhibited earlier improvement. The decrease of LA size had a similar pattern to the MR change, but there were no significant differences in the change of the ejection fraction of the two groups. Conclusion: In the patients with severe aortic valve disease and concomitant low grade MR, the MR after AVR improved earlier and more effectively in the patients with AR than in those patients with AS.

Malignant Bowel Obstruction in Terminal Cancer Patients (말기암 환자의 악성 장 폐색)

  • Moon, Do-Ho;Choe, Wha-Sook
    • Journal of Hospice and Palliative Care
    • /
    • v.7 no.2
    • /
    • pp.214-220
    • /
    • 2004
  • Purpose: As for the malignant bowel obstruction of terminal cancer patient, a prognosis is relatively bad. Physicians consider palliative procedures or surgery for the quality of life, but sometimes it is hard to decide. After diagnosis of a malignant bowel obstruction in terminal cancer patients, we investigated the clinical characteristics, the prognostic factors and the survival of patients with palliative procedures or surgery. Methods: we retrospectively reviewed the medical records in 40 malignant bowel obstruction patients who had been diagnosed as terminal cancer from May in 2002 to May in 2004. Results: There were 21 males (53%) and 19 females (47%), and median age of patients was $64.1{\pm}1.58$ years. The most common cause of malignant bowel obstruction was colorectal cancer (18 patients, 45%), followed by stomach cancer (11, 28%), pancreatic cancer (4, 10%), others (7, 19%). Metastases were carcinomatosis peritonei (14 patients, 35%), liver (13, 33%). During a bowel obstruction, symptoms were vomiting (15 patients, 38%), abdominal pain (10, 25%), constipation (6, 15%), abdominal distension (5, 13%). Performance status (ECOG) was 2 score (16 patients, 40%), 3 score (20, 50%), 4 score (4, 10%). Palliative procedure group were 30 patients, the others 10. Median survival in palliative procedure group was 142 days, that of no palliation group 30. Median survival time of palliative procedure group from palliative procedures or surgery were significantly higher than that of no palliation group from diagnosis of malignant bowel obstruction. Prognostic factors of palliative procedure group were PS, site of obstruction and primary cancer. Median survival in PS 2, lower GI obstruction and colorectal cancer was higher than PS 3, upper GI obstruction and others, respectively. Conclusion: we recommend aggressively palliative procedures or surgery in malignant bowel obstruction patients diagnosed with terminal cancer if palliative procedures or surgery could be performed effectively.

  • PDF

CONSIDERATIONS OF ANESTHETIC METHOD OF DEEP IMPACTED MESIODENS (심부 매복 정중 과잉치 수술 시 마취방법 선택)

  • Min, Soo-Young;Song, Je-Seon;Lee, Jae-Ho;Choi, Hyung-Jun;Son, Heung-Kyu;Kim, Seong-Oh
    • Journal of the korean academy of Pediatric Dentistry
    • /
    • v.39 no.1
    • /
    • pp.90-96
    • /
    • 2012
  • Supernumerary tooth occurs most frequently at premaxilla area. Followed by mandibular premolar area, mandibular fourth molar area, maxillary paramolar area. Mesiodens are mainly impacted in the palatal area and surgical approach is made at palatal side. The time of surgery remains controversial. In case of inverted or horizontal impacted supernumerary tooth, intraosseous tooth movement and vertical growth of premaxilla makes surgical extraction more difficult. And also the more quantity of removed bone is, the higher degree of difficulty is. Inverted mesiodens of these cases were impacted superior to apex level of adjacent permanent incisor. Although CT examination revealed exact location of impacted tooth, surgical procedure including ostectomy may take a long time more than expected. So, before surgical extraction, it's need to be considered several factors such as necessity of CT taking, degree of difficulty, direction of surgical approach, necessity of general anesthesia etc.

Comparison of Size Criteria in Mediastinal Lymph Node Involvement of Adenocarcinoma of Lungs (폐 선암의 종격동 림프절 전이에 있어서 림프절 크기 기준의 비교)

  • Gu, Ki-Seon;Kuk, Hiang;Koh, Hyeck-Jae;Yang, Sei-Hun;Jeong, Eun-Taik
    • Tuberculosis and Respiratory Diseases
    • /
    • v.46 no.4
    • /
    • pp.542-547
    • /
    • 1999
  • Background: Decision in mediastinal lymph node involvement of lung cancer by CT scan is very important and valuable for the treatment planning and prognosis prediction. In general, long diameter of mediastinal lymph node more than 15mm is used as criterion of lung cancer involvement. Adenocarci-noma has a tendency of early distant metastasis and micrometastasis, so adenocarcinoma may involve lymph node earlier and cannot be detected before lymph nodes are enlarged enough. The authors tried to determine the difference between two size criteria(15mm, 10mm) in adenocarcinoma for the detection of cancer involvement. Methods: Numbers of sample are 60 cases(male 46, female 14, median age: 61.5 years). According to pathology, squamous cancer 41, large cell cancer 2, adenocarcinoma 17. According to TNM stage, I 23, III 24, IIIA 13. Results : Mean long diameter of lymph node involvement is 16.0($\pm8.0$) mm in non-adenocarcinoma group, and that of adenocarcinoma group is 12.0($\pm3.2$) mm(p<0.05). If long diameter of lymph node larger than 15mm as involvement criterion is applied, sensitivity, specificity, positive predictive index, negative predictive index, accuracy of nonadenocarcinoma group are 54%, 100%, 100%, 83%, 86%, and those of adenocarcinoma group are 43%, 90%, 75%, 69%, 71%. If long diameter of lymph node larger than 10mm as involvement criterion is applied, sensitivity, specificity, positive predictive index. negative predictive index. accuracy of nonadenocarcinoma group are 65%, 77%, 61%, 92%, 79%, and those of adenocarcinoma group are 100%, 80%, 78%, 100%, 88%. Conclusion: Long diameter of lymph node larger than 10mm is more valuable criterion as lymph node involvement in adenocarcinoma of lungs.

  • PDF

Utility of FDG-PET in Solitary Pulmonary Nodules and the Relationship Between Standardized Uptake Values of PET and Serum Glucose (폐 결절에서 FDG-PET의 유용성과 표준섭취계수와 혈당농도의 상관관계)

  • Kim, Kyu Sik;Lim, Sung Chul;Ko, Young Chun;Park, Kyung Ha;Ju, Jin Young;Jo, Kae Jung;Kim, Soo Ok;Oh, In Jae;Kim, Yu Il;Kim, Young Chul;Kim, Sung Min;Song, Ho Chun;Bom, Hee Seung;Park, Kyung Ok
    • Tuberculosis and Respiratory Diseases
    • /
    • v.55 no.6
    • /
    • pp.589-596
    • /
    • 2003
  • Background : The solitary pulmonary nodule(SPN) presents a diagnostic dilemma to the physician and the patients in the our nation with high incidence of tuberculoma. We could not exclude whether the SPN was benign or malignant by the change of the size at chest radiograph and findings of chest CT. Recently, positron emission tomography(PET) have been tried as the differential diagnostic method of SPN. We evaluated the efficacy of PET for differentiating malignant from benign SPN and the relationship between standardized uptake values(SUV) of PET and serum glucose. Method : Between January 2001 and July 2002, sixty-one patients with pulmonary nodule were examined by the chest CT and PET. The SPN has been finally diagnosed by the transthorasic needle aspiration and biopsy, bronchoscopic biopsy, and open lung biopsy. Results : Forty eight patients had a malignant nodule(23 squamous cell lung carcinoma, 16 adenocarcinoma, 9 small cell lung cancer) and thirteen patients had a benign nodule(3 tuberculoma, 9 inflammatory granuloma, 1 cryptococcosis). The mean size of malignant and benign nodule was 40.6 mm and 20.0 mm, respectively. All malignant nodules showed a marked increase in 18 fluorodeoxyglucose (FDG) uptake. Mean SUV of malignant was $9.52{\pm}5.20$ and benign nodule was $1.61{\pm}3.60$. There were false positive cases with an increase in 18-FDG uptake (2 tuberculoma, 1 inflammatory granuloma). The SUV of malignant nodule in diabetes patients has no difference in non diabetes patients($9.10{\pm}4.51$ vs $9.65{\pm}5.46$). The sensitivity and specificity of the PET scan for SPN were 100%, 77%, respectively. The positive and negative predictive values were 94% and 100%. Conclusion : PET scanning showed highly accurate result in differentiating the malignant and benign SPN. There were no significant differences between the SUV and serum glucose in the patients with lung cancer.

Comparison of mandibular anterior alveolar bone thickness in different facial skeletal types (성인에서의 수평적, 수직적 안면 골격 형태에 따른 하악 전치부 치조골 두께의 비교)

  • Kim, Yoon-Soo;Cha, Jung-Yul;Yu, Hyung-Seog;Hwang, Chung-Ju
    • The korean journal of orthodontics
    • /
    • v.40 no.5
    • /
    • pp.314-324
    • /
    • 2010
  • Objective: The purpose of this study was to determine differences of mandibular anterior alveolar bone thickness and symphysial cross sectional area in 9 different horizontal and vertical facial types. Methods: By using the initial cephalometric radiographs of 270 adult patients (male 135, female 135), the authors measured the buccolingual thickness of anterior alveolar bone on the basis of the root axis and symphysial cross sectional distance. Results: The high angle group showed significantly thinner buccolingual alveolar bone width except for the CEJ area and lingual alveolar bone width ($p$ < 0.05). The low angle group and Class I, II average group showed similar or significantly thicker alveolar bone width than the Class I average group ($p$ < 0.05). The Class III average group showed significantly thinner buccolingual and lingual alveolar bone width than Class I and II average groups ($p$ < 0.05). The Class III high angle group showed minimal alveolar bone width in all facial skeletal types. No significant difference was found in the symphysial cross sectional area of the different vertical facial skeletal types ($p$ > 0.05). Conclusions: The results of this study found that Class III high angle patients have thinner mandibular anterior alveolar bone thickness; therefore, more attention will be needed to determine the incisor position during orthodontic treatment for this group of patients.

The Significance of Sentinel Node Biopsy in Malignant Melanoma and Squamous Cell Carcinoma of Lower Extremities (하지에 발생한 악성흑색종 및 편평상피세포암에서 소속 림프절 생검의 의미)

  • Kim, Jae-Do;Lee, Gun-Woo;Kwon, Young-Ho;Chung, So-Hak
    • The Journal of the Korean bone and joint tumor society
    • /
    • v.16 no.2
    • /
    • pp.69-73
    • /
    • 2010
  • Purpose: Sentinel lymph node (SLNB) is the first confronted lymph node from primary lesion of tumor through lymphatic drainage, which is important for determining early metastasis and setting guidelines for treatment. We reported significant of sentinel lymph node biopsy in malignant melanoma (MM) and squamous cell carcinoma (SCC) of lower extremities. Materials and Methods: Twenty-five cases of surgically treatment and being possible for follow up more than 1 year among the patients who were diagnosed as MM and SCC in this institution from Sep. 2005 to Jan. 2009, and 10 cases of them were performed SLNB. Average age was 64 years old, and 15 cases of male and 10 cases of female were in this group. Results: 3 years overall survival rate was 100% and 3 years disease-free survival rate was 76%. Metastasis occurred in total 6 patients, 4 cases of inguinal lymph nodes, 1 case of soft tissue around knee, 1 case of left achilles tendon. In 15 cases of not performing SLNB, overall survival rate was 93.3% and disease-free survival rate was 73.3%. In 10 cases of performing SLNB, overall survival rate was 100% and disease-free survival rate was 90%. And only 1 case showed positive finding in the biopsy, and none of the 10 cases showed metastasis in follow-up. Conclusion: SLNB leads simpler and less complications compared to prior elective lymph node dissection, and shows high degree of accuracy. Throughout the SLNB, setting guidelines for treatment by accurate staging is thought to be helpful for increasing the survival rate in the patient with MM and SCC.

The Comparison of Methods Processing Cells Recovered by Bronchoalveloar Lavage (기관지폐포세척액에서 세포수 측정을 위한 처리방법의 비교)

  • Park, Jae-Seuk;Kim, Jae-Yeal;Lee, Gwi-Lae;Yoo, Chul-Gyu;Han, Sung-Koo;Shim, Young-Soo;Kim, Young-Whan
    • Tuberculosis and Respiratory Diseases
    • /
    • v.45 no.1
    • /
    • pp.176-183
    • /
    • 1998
  • Background: The total and differential cell count of bronchoalveolar lavage(BAL) fluid are useful assessing activity, prognosis and response to therapy in diffuse interstitial lung disease. But controversy exist as to the appropriate method in processing BAL fluid. Therefore we investigated the effect of gauze filtration, centrifugation and different storage time of BAL fluid on the total and differential cell count. Methods: We obtained BAL fluid from 6 persons with no active lung lesion and divided pooled BAL fluid into several siliconized glass tubes and filtered through 0, 1, 2, 4 folds of cotton guaze(pore size: 1mm), and compared total cell count using hemocytometer after trypan blue staining and differential cell count after Wright-Giemsa staining of cytocentrifuged preparations. And we also counted total and differential cell count after centrifugation(400g for 30 min) and various storage time(2hr, 24hr, and 48hr). Results: There was no difference in total and differential cell count according to folds of gauze filtraion. But without gauze filtration, mucus threads that hampered total and differential cell count were found in 2 cases (33%). Centrifugation resulted in loss of total cell count($24{\pm}18%$) without change in differential cell count. There was no change in total cell count after 2hr storage but significant cell loss was found after 24hr storage time(24hr : $28{\pm}21%$, 48hr : $41{\pm}24%$). However there was no change in differential cell count with 48hr storage time. Conclusion: Total and differential cell count of BAL fluid may be best performed after cotton gauze filtration without centrifugation and within 2 hours.

  • PDF

A Needs Analysis Oral Health Education Contents for Teachers and Parents Using Borich Priority Formula and The Locus for Focus Model (Borich 요구도와 The Locus for Focus Model을 활용한 교사와 학부모의 구강보건교육 내용 우선순위 요구분석)

  • Kim, Ji-Su;Kang, Yu-Min;Lee, Su-Young
    • Journal of dental hygiene science
    • /
    • v.18 no.4
    • /
    • pp.252-264
    • /
    • 2018
  • The purpose of this study was to analyze the priorities of oral health education contents for preschool children by targeting teachers and parents using the Borich priority formula and The Locus for Focus Model. The survey was conducted in 212 teachers and 215 parents from December 26, 2017 to January 21, 2018. The priorities of oral health education contents were based on a 3-step analysis method, including the paired sample t-test, Borich priority formula, and The Locus for Focus Model. As a result of this study, the number of items about oral health education for preschool children that were prioritized by teachers was 7, while that by parents was 9. The top priorities that teachers and parents had in common were the following 5 items; "The progression of dental caries," "Symptoms of dental caries," "How to prevent dental caries," "Eruption sequence of permanent teeth," and "Method for emergency management of avulsed teeth." The teachers' priorities of the oral health education contents were the same between teachers and parents; "Eruption sequence of deciduous teeth" and "The function of the permanent teeth" were added. The parents' priorities of the oral health education contents were the same between teachers and parents; "The effect of fluoride application," "The number of permanent teeth," "How to prevent malocclusion," and "The appropriate timing of malocclusion treatment" were added. Based on the results of this study, when developing oral health education programs for teachers and parents, oral health education for teachers should include 7 items and oral health education for parents should include 9 items.

Enhanced Production of Oleanolic Acid by the Elicitation in Oldenlandia diffusa Suspension Cell Cultures (백화사설초의 현탁세포배양에서 Elicitation에 의한 Oleanolic acid 생산성 증대)

  • Lee Yong-Il;Kim Dong-Il
    • KSBB Journal
    • /
    • v.19 no.6 s.89
    • /
    • pp.471-477
    • /
    • 2004
  • Oldenlandia diffusa is a Chinese medicinal herb with antitumor activity capable of suppressing the growth of some cancer cell lines. Oleanolic acid and ursolic acid are triterpenoid compounds that exist in Oldenlandia diffusa. Recently, these have been noted for anti-inflammatory, anti-cancer, and hepato-protective effects. Application of both plant growth regulators, 2,4-D and kinetin, was found to be essential for the initiation of callus and suspension cells. Leaf blades of Oldenlandia diffusa was transformed into callus on Schenk and Hildebrandt medium supplemented with 0.5 mg/L 2,4-D and 0.1 mg/L kinetin, while optimum initiation condition for suspension cells of Oldenlandia diffusa was determined to be 0.75 mg/L 2,4-D and 0.1 mg/L kinetin. Chromatographic separation of oleanolic acid from its derivatives was achieved using Rexchrom S5-100-ODS column. Analytical conditions for oleanolic acid were determined as follows: flow rate at 1.0 mL/min, UV length at 200 nm and mobile phase of $80\%$ acetonitrile and $20\%$ water. Production of secondary metabolites was found to be increased by the treatment with elicitors or signal transducers. The maximum production of oleanolic acid was 99.6 mg/L in cultures with 0.5 mM salicylic acid. It is 1.74 times higher than that of control.