• Title/Summary/Keyword: Advanced airway

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Surgery of Advanced Esophageal Cancer after Chemotherapy (선행화학요법을 시행한 식도암 환자의 외과적 고찰)

  • 임수빈;이종목
    • Journal of Chest Surgery
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    • v.29 no.5
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    • pp.536-541
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    • 1996
  • Between June 1988 and June 1994, twenty five patients with locAlly advanced esophageal carcinoma received preoperative chemotherapy (Cisplatln, 5-Fluorouracil with or without Etoposide) and followed by resection. All patients had clinical evidence of airway involvement or distant Iymphnode involve- ment (M 1 Iymphnode) on bronchoscopy or computed tomographic scans. The major response rate to chemotherapy decided by the postoperative stage was 48% (12125). The resection rate was 92% (23/25) with overall complete resection rate of 72% (18125). Two patients had exploratory laparotomy (thorn- cotomy) only. Thirteen patients had esophagogastrostomy with a combined abdominl and Rt. thoracic approach (Ivor Lewis operation), slx pAtients had transhiatal esophagectomy, four patients had esophagogastrostomy with a combined Rt. thoracotonly & abdominal, cervical approach. There were three postoperative deaths (12%). Follow-up duration was between 3.3 months to 65 months. Median survival ime of resected patients except hospital death was 14.8 months. Actuarial survival at 12, 24 months was 72.9%, 26.2%. Signifi- cant better survival was associated with responder group (postoperative stage less than lIB) (P=0.029). These results demonstrate that 1) Preoperative Cisplatin based combined chemotherapy Produce high response rate, 2) High complete resection rate with acceptable mortality rate occur after preoperative chemotherapy, 3) Better surviL dl can be anticipated if complete resection performed after major re- sponse to preoperative chemotherapy.

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Intravenous Target Controlled Infusion Sedation for Patients with Amyotrophic Lateral Sclerosis: Case Report (근위축성 측삭경화증 환자(ALS)의 치과 진료 시 목표농도 주입법을 이용한 정주 진정 마취: 증례 보고)

  • Doh, Re-Mee;Kim, Seung-Oh
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.3
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    • pp.177-181
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    • 2012
  • Amyotrophic lateral sclerosis (ALS) is one of the major neurodegenerative diseases that involves degeneration at all levels of the motor system- from the cortex to the anterior horn of the spinal cord. Patients with ALS often have difficulty of ambulation for dental treatment though they have poor oral hygiene state. General anesthesia may cause respiratory problem due to its high sensitivity to muscle relaxant and weakened upper airway. In this case report, 38-year-old female patient with ALS required many dental treatments. Conscious sedation with intravenous target controlled infusion method was successfully employed and patient was discharged without any complications.

Systematic Review of Effects of Nasal Continuous Positive Airway Pressure on Apnea of Preterm Infants (미숙아 무호흡을 위한 비강 지속적 양압환기법 효과에 대한 체계적 고찰)

  • Kim, Eun-Joo
    • Child Health Nursing Research
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    • v.20 no.3
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    • pp.225-235
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    • 2014
  • Purpose: The purpose of this study was to analysis the effects of nasal Continuous Postive Airway Pressure (nCPAP) for preterm infants using systematic review and meta-analysis. Methods: Thirteen peer-reviewed journals including preterm infants and apnea and nCPAP published between 1973 and 2013 were included. Effect size and statistics of homogeneity were done using STATA 10.0. Results: The design for 9 studies was Randomized Control Trial. In most of studies the pressure of nCPAP was set to 4-6 cm$H_2O$. The effect size of 5 studies for the effect on apnea rate using nCPAP compared to nasal Intermittent Positive Pressure Ventilator (nIPPV) showed that the Standardized Mean Difference (SMD) was -0.11 and was not significantly different (Z=0.41, p=.680). But the difference in nCPAP for nasal Synchronizes Intermittent Positive Pressure Ventilator (nSIPPV) (subgroup) was significant (SMD=-.44). The effect size of 7 studies on effect for ventilator weaning of using nCPAP compared to nIPPV showed the Risk Ratio (RR) as 1.60 and was not significantly different (Z=1.12, p=.268). But the difference between nCPAP and nSIPPV (subgroup) was significant (RR=3.94). Conclusion: The results indicate a need for an advanced care system and suggest continuous studies of apnea in preterm infants.

EEG Feature Engineering for Machine Learning-Based CPAP Titration Optimization in Obstructive Sleep Apnea

  • Juhyeong Kang;Yeojin Kim;Jiseon Yang;Seungwon Chung;Sungeun Hwang;Uran Oh;Hyang Woon Lee
    • International journal of advanced smart convergence
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    • v.12 no.3
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    • pp.89-103
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    • 2023
  • Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders that can lead to serious consequences, including hypertension and/or cardiovascular diseases, if not treated promptly. Continuous positive airway pressure (CPAP) is widely recognized as the most effective treatment for OSA, which needs the proper titration of airway pressure to achieve the most effective treatment results. However, the process of CPAP titration can be time-consuming and cumbersome. There is a growing importance in predicting personalized CPAP pressure before CPAP treatment. The primary objective of this study was to optimize the CPAP titration process for obstructive sleep apnea patients through EEG feature engineering with machine learning techniques. We aimed to identify and utilize the most critical EEG features to forecast key OSA predictive indicators, ultimately facilitating more precise and personalized CPAP treatment strategies. Here, we analyzed 126 OSA patients' PSG datasets before and after the CPAP treatment. We extracted 29 EEG features to predict the features that have high importance on the OSA prediction index which are AHI and SpO2 by applying the Shapley Additive exPlanation (SHAP) method. Through extracted EEG features, we confirmed the six EEG features that had high importance in predicting AHI and SpO2 using XGBoost, Support Vector Machine regression, and Random Forest Regression. By utilizing the predictive capabilities of EEG-derived features for AHI and SpO2, we can better understand and evaluate the condition of patients undergoing CPAP treatment. The ability to predict these key indicators accurately provides more immediate insight into the patient's sleep quality and potential disturbances. This not only ensures the efficiency of the diagnostic process but also provides more tailored and effective treatment approach. Consequently, the integration of EEG analysis into the sleep study protocol has the potential to revolutionize sleep diagnostics, offering a time-saving, and ultimately more effective evaluation for patients with sleep-related disorders.

Cardiopulmonary Resuscitation and Pediatric Advanced Life Support for Pediatric Dentist (소아치과의사를 위한 심폐소생술과 소아고급생명구조술)

  • Kim, Jongbin
    • Journal of the korean academy of Pediatric Dentistry
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    • v.44 no.2
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    • pp.243-255
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    • 2017
  • Cardiopulmonary resuscitation (CPR) is an emergency treatment that stimulates blood circulation and breathing when the function of the heart stops or stops breathing. CPR can be divided by basic life support (BLS) and advanced life support (ALS). BLS involves the use of chest compression to force the blood flow to the main organs, rescue breathing to improve the breathing to the respiratory failure patient and the use automated external defibrillator (AED). The categories of advanced life support include advanced cardiovascular life support (ACLS) for adult and pediatric advanced life support (PALS) for children. In the treatment of dental care for children, which is extremely difficult to deal with, and for a variety of reasons, the use of sedation is considered to treat the children who are unlikely to cooperate with dentistry. This is why there is an increasing possibility of an emergency situation involving cardiac arrest. PALS includes the BLS, and it presents a systematic algorithm to treat respiratory failure, shock and cardiogenic cardiac arrest. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is necessary to be able to immediately implement professional skills in emergency situations.

Anti-Immunomodulating Activities in Mycelial Filtrates and Culture Broth of Cordyceps ochraceostromat (동충하초의 균사 및 배양액에 의한 면역 활성 비교)

  • Heo, Jin-Chul;Nam, Sung-Hee;Lee, Kwang-Gil;Yeo, Joo-Hong;Yoon, Chul-Sik;Park, Chul-Hong;Nam, So-Hyun;Son, Min-Sik;Chung, Shin-Kyo;Lee, Sang-Han
    • Food Science and Preservation
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    • v.16 no.2
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    • pp.253-258
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    • 2009
  • This study investigated the effects of mycelium and culture supernatant of Cordyceps ochraceostromat(Co) on air way hyper-responsiveness, pulmonary immune cell infiltration, and Th2 cytokine expression in animal models of atopy and asthma. After ConA(+/-) activation of mouse primary spleen cells, decreased IL-4 and IL-13 cytokine production were seen in the presence of Co mycelium extracts and culture supernatant. The asthma model involved mice sensitized to ovalbumin by i.p. injection treatment; Co mycelium extract was also injected. The atopy model was the dinitrofenylbenzene-treated mouse ear. Ear thicken ing induced by DNFB was decreased by Co mycelium extract, and the extract also inhibited lung cell infiltration in ovalbumin-induced asthmatic mice. The results thus indicated that the Co mycelial extract reduced the undesirable immune responses seen in asthma and atopy.

Use of Defibrillator(AED) on Prehospital Cardiac Arrests (심정지 환자 이송 시 구급대원의 자동제세동기 사용현황)

  • Koh, Bong-Yeun;Choi, Yong-Chul;Lee, Jae-Youl
    • The Korean Journal of Emergency Medical Services
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    • v.10 no.2
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    • pp.53-62
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    • 2006
  • Purpose: There has been an increase in the number of prehospital cardiac arrests due to the increasing number of cardiovascular diseases and the increase in the average age of the population. We performed this study to identify the proper resuscitation technique and AED to be used to increase the survival rate in prehospital cardiac arrests. Methods: This studied 159 victims with prehospital cardiac arrests(VF or VT rhythm) by EMT's Reports from January to August, 2005. Results: 108 of 159 victims(67.9%) were shocked by AED. Eighty of 159 victims(50.9%) were recorded with AED shock in prehospital cardiac arrests. A number of shocks is averaged 2.19; 46.2% of one-shock and 86.1% of 1-3 shock. EMS first-tier response interval from time of dispatch to scene arrival was 5.88 minutes, from scene arrival to scene start was 7.36 minutes, from scene start to hospital admission was 9.91 minutes and from scene arrival to AED shock was 6.84 minutes. EMT provided advanced care to prehospital cardiac arrests: 97.5% in CPR, 10.1% in advanced airway management, 67.9% in AED shock. Conclusion: With the increase in cardiovascular disease and old age, the number of prehospital cardiac arrests has risen gradually. However, there were lack of CPR by bystander, defibrillation and advanced cardiac life support(ACLS) in prehospital stage. To improve the adequacy of basic life support and to increase the performance of ACLS, especially AED, we must create challenges to develop new protocols in prehospital care.

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Effects of Dysphagia Treatment Applied to Infants with Pierre Robin Syndrome - Single Subject Research Design

  • Kim, Mikyung;Kim, Deokju
    • International Journal of Advanced Culture Technology
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    • v.8 no.1
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    • pp.1-12
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    • 2020
  • Pierre Robin syndrome is characterized by micrognathia, glossoptosis, and cleft palate. Infants with Pierre Robin syndrome causes feeding difficulty, upper airway obstruction, and other symptoms. This study aims to examine the effects of applying dysphagia treatment to infants with Pierre Robin syndrome. The study participant was an infant who was born four weeks premature and referred for dysphagia treatment approximately 100 days after birth. At the initial assessment, the infant showed oral sensory sensitivity, a high level of facial and masticatory muscle tension, and a low stability of the chin and cheeks with almost no normal "sucking-swallowing-breathing" pattern. We set the baseline period and intervention period using the AB design. During the baseline period, non-nutritive sucking training using a rubber nipple was conducted without implementing an oral stimulation intervention. During the intervention period, non-nutritive sucking training and an oral stimulation intervention were performed. After the intervention period, the infant's daily oral intake and oral intake per time significantly increased compared to that during the baseline period. We observed that the oral intake time of the infant decreased during the intervention period compared to that in the baseline period, which indicated an improvement in control over the chin, tongue, and lip movements, a change in muscular tension, and stabilization of the "sucking-swallowing-breathing" pattern. We provided dysphagia treatment before breastfeeding, it was positive effects such as normal development of the infant, transition from tube feeding to bottle feeding, and enhancement of overall oral motor function.

Management Principles of Bilateral Vocal Fold Immobility (양측성 성대 마비의 치료 원칙)

  • Kim, Tae-Wook;Son, Young-Ik
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.20 no.2
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    • pp.118-125
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    • 2009
  • Bilateral vocal fold immobility (BVFI) is a challenging condition which may result from diverse etiologies including vocal fold paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar. Most patients present with dyspnea and stridor, but sometimes with a breathy dysphonia. Careful history taking, laryngoscopic evaluation under general anesthesia or awaken status, laryngeal EMG, and imaging studies with CT and/or MRI are helpful for providing a precise diagnosis and planning appropriate managements. In children, congenital neurological disorder is one of the most common etiologies, and spontaneous recovery has been reported in more than 50% of cases. Therefore, observation for more than 6 months while securing the upper airway with tracheostomy if needed is a generally accepted rule before deciding any destructive procedure to be undertaken. In children with advanced posterior glottic stenosis, laryngotracheal reconstruction with rib cartilage graft should be considered. In contrast to children, BVFI most commonly occurs as sequalae of surgical complication in adults. Diverse static or dynamic procedures can be applied; posterior cordotomy, vocal fold lateralization, endoscopic or open arytenoidectomy, arytenoid abduction, and reinnervation, electrical laryngeal pacing, which need to be carefully selected according to each patient's needs and pathophysiology of BVFI.

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Comparison of Notation Items for Chemical Occupational Exposure Limits (화학물질에 대한 직업적 노출기준의 표기 항목 비교)

  • Phee, Young Gyu;Kim, Seung Won;Ha, Kwonchul
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.30 no.2
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    • pp.226-235
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    • 2020
  • Objectives: This study was to investigate the signs and notations of skin absorption, carcinogenicity, germ cell mutagenicity, and reproductive toxicity in the occupational exposure limits of Korea and of other advanced countries. Methods: Information on occupational exposure limits in Korea, the USA, the UK, Germany, and Japan was investigated through the Internet, and items marked as carcinogenicity and skin absorption were compared by country. Results: Legal occupational exposure limits have been greatly simplified. However, in the case of HSE WEL, skin absorption, carcinogenicity classification, sensitization, and in the case of DFG MAK, skin absorption, carcinogenicity, pregnancy risk group, germ cell mutagenicity, airway and skin sensitization, photo contact sensitization, and vapor pressure were provided. Conclusions: It is desirable to indicate the carcinogenicity and skin absorption within permissible limits, and to include information on critical effects in chemical substance exposure limits to uphold the right to know of industrial hygienists and workers in Korea. It is also necessary to clarify the precautions, limitations and protections for skin absorption.