• Title/Summary/Keyword: Clinical patterns

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Metastatic Colorectal Cancer Treatment and Survival: the Experience of Major Public Hospitals in South Australia Over Three Decades

  • Roder, David;Karapetis, Christos S;Wattchow, David;Moore, James;Singhal, Nimit;Joshi, Rohit;Keefe, Dorothy;Fusco, Kellie;Buranyi-Trevarton, Dianne;Sharplin, Greg;Price, Timothy J
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.5923-5931
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    • 2015
  • Background: Registry data from four major public hospitals indicate trends over three decades from 1980 to 2010 in treatment and survival from colorectal cancer with distant metastases at diagnosis (TNM stage IV). Materials and Methods: Kaplan-Meier product-limit estimates and Cox proportional hazards models for investigating disease-specific survival and multiple logistic regression analyses for indicating first-round treatment trends. Results: Two-year survivals increased from 10% for 1980-84 to 35% for 2005-10 diagnoses. Corresponding increases in five-year survivals were from 3% to 16%. Time-to-event risk of colorectal cancer death approximately halved (hazards ratio: 0.48 (0.40, 0.59) after adjusting for demographic factors, tumour differentiation, and primary sub-site. Survivals were not found to differ by place of residence, suggesting reasonable equity in service provision. About 74% of cases were treated surgically and this proportion increased over time. Proportions having systemic therapy and/or radiotherapy increased from 12% in 1980-84 to 61% for 2005-10. Radiotherapy was more common for rectal than colonic cases (39% vs 7% in 2005-10). Of the cases diagnosed in 2005-10 when less than 70 years of age, the percentage having radiotherapy and/or systemic therapy was 79% for colorectal, 74% for colon and 86% for rectum (&RS)) cancers. Corresponding proportions having: systemic therapies were 75%, 71% and 81% respectively; radiotherapy were 24%, 10% and 46% respectively; and surgery were 75%, 78% and 71% respectively. Based on survey data on uptake of offered therapies, it is likely that of these younger cases, 85% would have been offered systemic treatment and among rectum (&RS) cases, about 63% would have been offered radiotherapy. Conclusions: Pronounced increases in survivals from metastatic colorectal cancer have occurred, in keeping with improved systemic therapies and surgical interventions. Use of radiotherapy and/or systemic therapy has increased markedly and patterns of change accord with clinical guideline recommendations.

The Clinical Study on 120 Cases with Traffic Accident (교통사고 환자 120례에 대한 임상적 고찰)

  • Lee, Ji-Eun;Jung, Hyo-Keun;Ryu, Chung-Ryul;Cho, Myoung-Rae;Wi, Jun;Ryu, Mi-Seon;Kim, Ja-Young
    • Journal of Acupuncture Research
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    • v.25 no.6
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    • pp.135-143
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    • 2008
  • Objectives : The main purpose of this research is to make a survey of the effective way of the Oriental medical care and to enlarge the range of Oriental medical treatment about traffic accidental patients. Methods : In following research, we surveyed 120 patients of traffic accident who were hospitalized in Dong-Shin Oriental Medical Hospital from October, 1, 2007 to August, 20, 2008 according to medical chart. Results : 1. In distribution of gender and age, the rate of male was 35.8%, that of female was 64.2% and the majority of the patients were twenties and thirties. 2. In the traffic accident patterns, the most was car crash from behind(61.7%) and after traffic accident, 75 patients(62.5%) visited our hospital for oriental medical treatment in less than 5days. 3. 46 patients(38.3%) choose the oriental medical treatment for the primary care and after medical care, 36 patients(31.7%) visited our hospital due to dissatisfaction of current treatment and maintained pain. 4. Partial pain was the chief complaint and the most of painful parts was neck(76.7%), followed by low back(69.2%). 5. Though radiation test, the most was cervical spine sprain(76.7%), followed by straightening of lumbar spine(66.7%). 6. In the periods of admission, less than 7 days was the most(53.3%), followed by less than 14 days(35.9%). 7. The treatment was effective to 93 patient out of 106 who had been hospitalized for less than 14 days. Conclusions : This data suggested that the Oriental medical care could be more effective treatment about traffic accidental patients without surgical injury.

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Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

  • Kim, Joo-Pyung;Park, Bong-Jin;Choi, Seok-Keun;Rhee, Bong-Arm;Lim, Young-Jin
    • Journal of Korean Neurosurgical Society
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    • v.44 no.3
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    • pp.131-135
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    • 2008
  • Objective : Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses. Methods : Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004. the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features. the compression patterns of the vessels at the time of surgery and treatment outcomes. Results : There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%). and in 27 cases (34.2 %) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05). Conclusion : In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.

TOAST Distribution of Ischemic Stroke Patients Admitted to Oriental Hospitals (한방 의료기관에 입원한 허혈성 뇌졸중 환자의 아형 분포)

  • Lee, Jung-Sup;Ko, Mi-Mi;Lee, Ju-Ah;Kang, Byoung-Kab;Cha, Min-Ho;Oh, Dal-Seok;Bang, Ok-Sun
    • The Journal of Korean Medicine
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    • v.31 no.5
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    • pp.82-89
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    • 2010
  • Objectives: The aim of this study was to determine distribution patterns of TOAST subtypes of ischemic stroke patients admitted to oriental hospitals and to get a better understanding of present conditions in oriental medicine by comparing with the Korea stroke registry (KSR), the largest and representative data. Methods: Clinical data were collected from acute ischemic stoke patients. MRI studies including vascular images were performed in all cases. TOAST criteria were used to determine subtypes of ischemic stroke patients. According to the duration from disease onset to hospital admission time, patients were assigned to 3 groups (Group I0 to 3 d, Group II4 to 7 d, Group III8 to 28 d) and the distribution of TOAST subtypes were compared among these three groups. Results: We collected 514 sets of clinical data from 10 oriental hospitals between May 2007 and September 2009. Small vessel occlusion (SVO) subtype was the most common (57.62%), followed by large artery atherosclerosis (LAA, 29.98%). Compared with TOAST distribution of KSR, the proportion of ischemic stroke patients with SVO subtype was higher than that of KSR. On the other hand the proportion of patients with stroke of undetermined etiology (SUE) was lower. Distributions of SVO, LAA and cardioembolism (CE) in group were I 66.4%, 23.8% and 8.9%, respectively; those in group IIIwere 51.03%, 34.71% and 11.57%, respectively. Conclusions: In oriental hospitals, the proportion of ischemic stroke patients diagnosed as SVO type was higher than that of KSR. At early stage (from onset to 2 d) proportion of SVO was very high, however after 7 days from onset it decreased with concomitant increases in proportions of LAA and CE. These phenomena may be due to the facts that 1) at early stage emergency treatments are limited in oriental hospitals, 2) after early stage many patients prefer oriental treatments, including rehabilitation.

Clinical Analysis of 2,048 Musculoskeletal Patients Who Visited the Traffic Accident Clinic of a Korean Medicine Hospital (교통사고로 한방병원에 내원한 근골격계 환자 2,048명에 대한 임상적 분석)

  • Do, Ho-Jeong;Shin, Ye-Sle;Kim, Chang-Eun;Song, Hyun-Seop;Shin, Jae-Kwon;Gang, Byeong-Gu;Koh, Won-Il;Jeon, Se-Hwan;Cho, Yong-Kyu;Kim, Eun-Soo
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.11 no.1
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    • pp.11-23
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    • 2016
  • Objectives : The purpose of this study was to investigate the characteristics and visiting patterns of traffic accident outpatients Methods : In this study, we reviewed the medical charts of 2,048 traffic accident patients who visited Jaseng Hospital of Korean Medicine from January 1st, 2012 to December 31st, 2012. Results : In the distribution of gender and of age patients, the male percentage was 52.3% and the majority of patients were in their thirties(47.2%). In the distribution of the patient's initial visit, most patients visited our clinic from Monday to Wednesday. By monthly distribution, the more patients visited the clinic at the latter half of the year. In the duration of treatment, 1,389 patients(67.8%) finished treatment within four weeks. The most frequently cited sites of pain were neck(82.0%), followed closely by low back(74.0%). In the access route, 746 patients(36.4%) visited our traffic accident clinic as a first choice for primary treatment. We referred patients for radiologic examination in 159 patients(7.9%), of which the exams were mainly lumbar spine MRIs(3.6%) and cervical spine MRIs(2.8%). The most frequent diagnosis were herniated nucleus pulposus. Conclusions : This study shows that most of the patients who visited the traffic accident clinic of a Korean Medical Hospital presented neck and low back pain, and the majority showed improvement without surgical treatment. Following the increasing minor injury rate caused by traffic accidents, we expect the role of Korean Medicine Hospital to become more prominent.

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COMPARISON OF FRACTURE STRENGTH AND PATTERN OF ENDODONTICALLY TREATED TEETH RESTORED WITH FIBER POSTS AND METAL CAST POST (섬유강화 포스트와 금속주조 포스트의 파절강도 밋 파절양상의 비교)

  • Kim Mee-Kyung;Kim Seok-Gyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.42 no.5
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    • pp.535-543
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    • 2004
  • Purpose: The purpose of this study is to compare the effect of two fiber post systems and one metal cast post system on the fracture strength and fracture pattern of crowned, endodontically treated teeth with 2 mm-height of the reamining tooth structure. Materials and methods: A total of 36 recently extracted sound human mandibular premolars were selected Each tooth structure of the crown portion except 2mm-height of the one above the cementoenamel junction was removed. After being endodontically treated, they were randomly distributed into 3 groups: group 1, restored with quarts fiber post(D.T. Light-Post), group 2, with glass fiber post(FRC Postec), and group 3, metal cast post and core. All teeth were fully covered with nonprecious metal crowns. Each specimen was embedded in an acrylic resin block and then secured in a universal load-testing machine. A compressive load was applied at a 130 degree angle to the long axis of the tooth until fractured, at a crosshead speed 20mm/min. The highest fracture loads were measured and recorded as the fracture strength of each specimen. Fracture areas were measured on the mid-buccal and mid-lingual point from the crown margins. One-way analysis of variance and Turkey test were used to determine the statistic significance of the different fracture loads and areas among the groups (p<0.05). Results: The mean fracture loads were $1391{\pm}$425N(group 1), $1458{\pm}476N$(group 2) and $1301{\pm}319N$(group 3). The fracture loads among the three groups had no statistically signifiant difference (p>.05). The mean fracture area of the fiber post was closer to the crown margin than that of the metal cast post and core(p<.05). The metal cast post showed unrestorable and catastrophic fracture patterns. Conclusion: Within the limitations of this study, fracture loads with any statistically significant difference were not recorded for endodontically treated teeth restored with two fiber posts and the metal cast post. But teeth restored with the fiber posts typically showed the fracture pattern close to the crown margin, which was almost restorable.

Future Medical Screening: A Challenge to the Insurance Industry (보험업계(保險業界)의 과제(課題))

  • Yoon, Byong-Hak;Kraus, H.K.
    • The Journal of the Korean life insurance medical association
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    • v.12
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    • pp.50-55
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    • 1993
  • After a short historical resume, screening is discussed on the basis of the current philosophy of Life insurance compaines in leading countries. This is followed by considerations with regard to the future in areas of major bearing on Life insurance screening which have emerged as important within the last decade. HIV-antibody testing is dealt with from the screening point of view followed by aspects regarding the applicability of tumour marker use in Life insurance medicine. Last but not least genetic testing will be addressed, taking into account prospects for the future, as well as the resulting responsibility in medical and underwriting terms. The major considerations and suggested guidelines can be summarized as follows: 1) Screening in Life insurance is a prerequisite for underwriting and is a well-functioning selection instrument. 2) Screening technologies are medically well defined and have to follow general clinical rules, also in the future. 3) Screening parameters should follow the patterns of diseases according to age and risk groups. 4) Screening parameters for prognostic use are legitimate as long as they are considered in conjuction with clinical medical observations and rules. 5) Screening technologies of a sensitive nature require very special rules for handling in the sense of "consequential ethies". 6) Screening parameters like HIV-antibody testing require ongoing scientific feedback in their new testing dimensions. 7) Screening in the form of genetic testing is as yet not used in Life insurance; its potential future role in Life insurfance medicine must, however, be discussed responsibly and in time. 8) Screening enables the insurance industry to rule out possible antiselection and provide for equal knowledge on the part of the insurance applicant and the insurer about impairements which shorten life expectancy. 9) Screening, informed consent, counselling and confidentiality must go hand in hand both now and to an even greater extent in the future.

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Study on the Relationship between Korean Standard of Pattern Identification (II) and Pattern Identification of Cold-Heat and Deficiency-Excess (한국형 중풍 변증 표준안 - II와 한열허실 변증지표의 연관성 연구)

  • Kim, So-Yeon;Lee, Jung-Sup;Oh, Dal-Seok;Kang, Byoung-Kab;Ko, Mi-Mi;Kim, Jeong-Cheol;Kwon, Se-Hyug;Bang, Ok-Sun
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.24 no.1
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    • pp.15-21
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    • 2010
  • Previously standardization study for identifying 5 types of pattern identification of stroke patients has been performed and the Korean standard of pattern identification (II) was developed. In the present study we investigated the interactions between total indices designated by the Korean standard of pattern identification(KSPI II) and indices for PI of Cold-Heat and Deficiency-Excess. Indicators for Cold-Heat and Deficiency-Excess are isolated from 58 indices through the survey of oriental medicine doctors and their relationship with KSPI-II indices was analyzed by corresponding analysis method using data of 1581 stroke patients. Means and standard deviations indicated that 2 Cold indices, 14 Heat indices, 12 Deficiency indices, and 5 Excess indices were included for Cold-Heat and Deficiency-Excess pattern identification. The results of corresponding analysis shows the relationship of 57 indices and 4 types of pattern identification (excluding 1 index and 1 pattern among 58 indices and 5 patterns) using the cross-tabulation which was obtained from the clinical data. Most of Cold and Heat index were divided to dimension 1(inertia 51.9%) obtained from the result of corresponding analysis. Deficiency and Excess index were partially associated with dimension 2(inertia 31.7%). These data suggest that pattern identification of Cold-Heat plays an role in the standardization of pattern identification in stroke, although further studies are required by various trials such as analysis of surveys and clinical data.

Clonal Dissemination of Multidrug Resistant Acinetobacter baumannii Isolates Harboring blaOXA-23 at One University Hospital in Daejeon, Korea (대전지역 소재 대학병원에 blaOXA-23 유전자를 가지고 있는 다제내성 Acinetobacter baumannii의 확산)

  • Sung, Ji Youn
    • Korean Journal of Clinical Laboratory Science
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    • v.48 no.2
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    • pp.94-101
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    • 2016
  • Acinetobacter species isolates are important opportunistic pathogens and commonly implicated in nosocomial infections. The therapeutic options for treatment of the bacterial infections are limited because the bacteria isolates are usually multidrug resistant (MDR). In the current study, we investigated various carbapenemase genes in 68 Acinetobacter species isolates. Antimicrobial susceptibilities were tested using the disk diffusion method. Screening of carbapenemase genes was performed via multiplex PCR. In addition, PCR and DNA sequencing were used to identify the carbapenemase genes. Repetitive extragenic palindromic-PCR (REP-PCR) was also performed to assess the clonality of isolates. In our study, A. baumannii isolates were highly resistant to all agents tested while all non-A. baumannii isolates were susceptible to all agents tested, with the exception of aztreonam and cefotaxime. All 51 A. baumannii isolates contained the $bla_{OXA-51}$ gene and 37 (72.5%) isolates also harbored the $bla_{OXA-23}$ gene. In addition, 39 MDR A. baumannii isolates were identified in our study and 37 isolates contained the $bla_{OXA-23}$ gene. The 37 MDR strains harboring $bla_{OXA-23}$ showed type I (n=22) or type II (n=15) banding patterns on their REP-PCR profiles. Our results suggest clonal relation and horizontal spreading of MDR A. baumannii isolates containing the $bla_{OXA-23}$ gene at the hospital located in Daejeon. Continuous investigation of antimicrobial resistant determinants and monitoring emergence and dissemination of MDR isolates is required to prevent and control infection and colonization of MDR A. baumannii isolates.

Seasonal Patterns of Ticks in Pocheon and Cheolwon, Republic of Korea (경기도 포천, 강원도 철원지역에서 진드기의 계절적 발생 유형)

  • Shin, Yong Chil;Lee, In Yong;Seo, Jang Hoon
    • Korean Journal of Clinical Laboratory Science
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    • v.47 no.3
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    • pp.147-152
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    • 2015
  • The seasonal pattern of larvae, nymph and adult life stages for three tick species were studied for April-October, 2014. Haemaphysalis longicornis (610), Haemaphysalis flava (296) and Ixodes nipponensis (15) were collected from Pocheon by the dragging and flagging method. H.longicornis (254), H.flava (345) and I.nipponensis (15) were collected from Cheolwon in the same way. H.longicornis adults peaked in June while nymphs were more frequently collected from April through June. In contrast, H.longicornis larvae were collected only in September and October. H.flava adults were collected in April, September, and October while nymphs were collected from April through October. The nymphs peaked in April in Pocheon while May was the peak in Cheolwon. Larvae of H.longicornis and H.flava were collected only in September and October. I.nipponensis adults and nymphs were more frequently collected in April, while the larvae were not collected during that period. Collecting ticks by the dragging and flagging method provides estimates of population densities for life stages of the selected species and the associated disease risk. These results can be used to predict seasonal population densities of ticks and the prevalence of tick-borne pathogens.