• Title/Summary/Keyword: Discharge method

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Video-assisted Talc Poudrage for the Treatment of Malignant Pleural Effusion: Analysis of Effects and Benefits (악성 늑막 삼출증에서의 비디오 흉강경하 탈크 분무의 효과 및 장점 분석)

  • Song, In-Hag;Chang, Won-Ho;Choi, Chang-Woo;Son, Jin-Sung;Kim, Dong-Hyun;Baek, Kang-Seok;Youm, Wook;Kim, Hyun-Jo
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.492-498
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    • 2007
  • Background: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. Material and Method: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). Result: The durations of chest tube placement after the procedure were $7.0{\pm}4.0$ days (group A) and $6.7{\pm}3.6$ days (group B). The hospital stays were $24.3{\pm}9.4$ days (group A) and $30.7{\pm}21.5$ days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group $A=8.5{\pm}2.2$ months, group B $8.0{\pm}7.4$ months). The collapsed portions of lung were better expanded in group A than in group B (p-value=0.011). Conclusion: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.

Studies on Spat Production of the Sun and Moon Scallop, Amusium japonicum japonicum (GMELIN) (해가라비, Amusium japonicum japonicum (GMELIN) 종묘생산에 관한 연구)

  • Son, Pal-won;Ha, Dong-soo;Rho, Sum;Chang, Dae-soo;Lee, Chang-hoon;Kim, Dae-Kweon
    • Journal of Aquaculture
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    • v.11 no.3
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    • pp.371-380
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    • 1998
  • This study has been conducted to develop the techniques for spat production of the sun and moon scallop from January 1995 to December 1996. With the adult scallops collected from the Sogwipo area, spawning induction and larvae rearing were attempted several times and monthly changes of GSI were also monitored during the experimental period. The results obtained wre as follows. 1. GSI started to increase from June and showed the maximum value of 22.17 and 14.98 in female and male respectively in November, and then gradually decreased from December. 2. Spawning induction by heating method turned out to the most efficient way showing the responding rate of 64.8~91.5%. The responding temperature was $21.4~26.4{\circ}C$ which was $3.1~8.5{\circ}C$ increased from the rearing temperature of $16.3~18.3{\circ}C$. An average number of eggs spawned was $9.2{\times}10^5$ 3. the average size of eggs after fertilization was about $72{\mu}m$ in diameter. The first polar body discharge, blastula formation, and trochopore larvae appearance occurred 30 mininutes, 18 hours, and 22 hours after fertilization respectively. 4. Settling rates in various collectors were similar one another, whereas pouring larvae in the mesh was the most efficient way for larval setting. 5. The spates grew to be 1mm in their shell length for the first 50 days after fertilization and 9.6mm in 135days. 6. Correlation between shell length (SL) of the spat and the number of days (X) after spat settlement could be expressed as $SL=257.75e ^{0.0272x}$(r=0.9100).

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Laparoscopic Assisted Total Gastrectomy (LATG) with Extracorporeal Anastomosis and using Circular Stapler for Middle or Upper Early Gastric Carcinoma: Reviews of Single Surgeon's Experience of 48 Consecutive Patients (원형 자동문합기를 이용한 체외문합을 시행한 복강경 보조 위전절제술: 한 술자에 의한 연속적인 48명 환자의 수술성적분석)

  • Cheong, Oh;Kim, Byung-Sik;Yook, Jeong-Hwan;Oh, Sung-Tae;Lim, Jeong-Taek;Kim, Kab-Jung;Choi, Ji-Eun;Park, Gun-Chun
    • Journal of Gastric Cancer
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    • v.8 no.1
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    • pp.27-34
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    • 2008
  • Purpose: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performing LATG for the gastric cancer located in the upper or middle portion of the stomach. Materials and Methods: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. Results: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago-jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was $212{\pm}67$ minutes. The mean total number of retrieved lymph nodes was $28.9{\pm}10.54$ (range: $12{\sim}64$) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the 8MI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.

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THE CHARACTERISTICS OF CHILD AND ADOLESCENT INPATIENTS WITH SEVERE OBSESSIVE-COMPULSIVE DISORDER (심각한 소아 ${\cdot}$ 청소년 강박장애로 입원한 환아들의 특징)

  • Hwang, Jun-Won;You, So-Young;Chang, Jun-Hwan;Shin, Min-Sup;Cho, Soo-Churl;Hong, Kang-E;Kim, Boong-Nyun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.15 no.2
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    • pp.143-151
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    • 2004
  • Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.

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Improved Electrochemical Performance and Minimized Residual Li on LiNi0.6Co0.2Mn0.2O2 Active Material Using KCl (KCl을 사용한 LiNi0.6Co0.2Mn0.2O2계 양극활물질의 잔류리튬 저감 및 전기화학특성 개선)

  • Yoo, Gi-Won;Shin, Mi-Ra;Shin, Tae-Myung;Hong, Tae-Whan;Kim, Hong-kyeong
    • Journal of the Korean Electrochemical Society
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    • v.20 no.1
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    • pp.7-12
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    • 2017
  • Using a precursor of $LiNi_{0.6}Co_{0.2}Mn_{0.2}O_2$ as a starting material, a surface-modified cathode material was obtained by coating with KCl, where the added KCl reduces residual Li compounds such as $Li_2CO_3$ and LiOH, on the surface. The resulting electrochemical properties were investigated. The amounts of $Li_2CO_3$ and LiOH decreased from 8,464 ppm to 1,639 ppm and from 8,088 ppm to 6,287 ppm, respectively, with 1 wt% KCl added $LiNi_{0.6}Co_{0.2}Mn_{0.2}O_2$ that had been calcined at $800^{\circ}C$. X-ray diffraction results revealed that 1 wt% of KCl added $LiNi_{0.6}Co_{0.2}Mn_{0.2}O_2$ did not affect the parent structure but enhanced the development of hexagonal crystallites. Additionally, the charge transfer resistance ($R_{ct}$) decreased dramatically from $225{\Omega}$ to $99{\Omega}$, and the discharge capacity increased to 182.73mAh/g. Using atomic force microscopy, we observed that the surface area decreased by half because of the exothermic heat released by the Li residues. The reduced surface area protects the cathode material from reacting with the electrolyte and hinders the development of a solid electrolyte interphase (SEI) film on the surface of the oxide particles. Finally, we found that the introduction of KCl into $LiNi_{0.6}Co_{0.2}Mn_{0.2}O_2$ is a very effective method of enhancing the electrochemical properties of this active material by reducing the residual Li. To the best of our knowledge, this report is the first to demonstrate this phenomenon.

Three Cases of Menopausal Hot Flush and Sweating Treated by Ascending Kidney Water and Descending Heart Fire (AKDH) Pharmacopuncture Treatment (약침을 이용한 수화조절법으로 호전된 갱년기 상열감 및 발한과다 환자 치험 3례)

  • Jo, Na-Young;Roh, Jeong-Du
    • The Journal of Korean Obstetrics and Gynecology
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    • v.28 no.2
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    • pp.193-203
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    • 2015
  • Objectives : The purpose of this study is to evaluate the clinical effects of ascending kidney water and descending heart fire pharmacopuncture treatment for hot flush and sweating. Methods : Ascending kidney water and descending heart fire pharmacopuncture is achieved by injecting pharmacopuncture on a specific acupoint to change from the state of water-fire disharmony to harmonious state. Hwangryunhaedok-tang (黃連解毒湯) pharmacopuncture is injected on both side Gyeonjeong (GB 21 ), Pungji (GB 20 ). Total 0.4 cc was injected by 0.1 cc each point. BUM (Bear’s gall bladder, ox bezoar and musk) pharmacopuncture is injected on both side Jeonjung (CV 17 ), Jungwan (CV 12 ), Gihae (CV 6 ). Total 0.15 cc was injected by 0.05 cc each point. Treatment was done daily. The method of evaluation are Hot Flush Score (HFS), VAS and sweating areas. Results : In case 1, after treatment hot flush score was reduced from 24 to 4 points. VAS scale was reduced from 7 to 2. It took about two weeks for the symptoms to decrease by half. Associated symptoms almost did not stay at discharge. In case 2, after treatment hot flush score was reduced from 28 to 2 points. VAS scale was reduced from 10 to 3. And emotional symptoms were reduced about 70%. In case 3, after treatment hot flush score was reduced from 8 to 1 points. VAS scale was reduced from 6 to 1. And headache and chest discomfort symptoms have disappeared. Conclusions : Ascending kidney water and descending heart fire pharmacopuncture treatment is effective for improve ascending kidney water and descending heart fire energy. Therefore, it will be used to alleviate hot flush and sweating.

A Clinical Analysis on the Restoration of Sinus Rhythm Following Mitral Valve Surgery (승모판 수술 후 동율동 회복에 관한 임상분석)

  • 백완기;심상석;김현태;조상록;진성훈
    • Journal of Chest Surgery
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    • v.32 no.4
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    • pp.347-352
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    • 1999
  • Background: The atrial fibrillation in patients with mitral valvular heart disease is frequently converted to sinus rhythm after the mitral valve surgery. This sinus restoration implies an important meaning in that it not only helps postoperative convalescence in patients with unstable hemodynamics but also reduces the rate of postoperative thromboembolism. Material and Method: We retrospectively analyzed 184 patients who received mitral valve surgery from June 1986 to December 1996 to investigate the trend of rhythm change following mitral valve surgery and thus to clarify the predisposing factors of postoperative sinus rhythm conversion and its maintenance. Result: The sinus rhythm was restored after the operation in 54 out of 139 patients with atrial fibrillation preoperatively(38.8%). However, the atrial fibrillation recurred in 41 patients at the time of discharge showing a recurrence rate of 75.9 percent. The mean duration of sinus rhythm in patients with eventual atrial fibrillation recurrence was 8.2${\pm}$5.9 days. Only 15 patients were in sinus rhythm at the time of late follow-up with the mean follow-up period of 84.4${\pm}$34.7 months. While the age, duration of symptoms, duration of atrial fibrillation, left atral size, and pulmonary artery pressure were thought to be the predisposing factors for sinus conversion after the operation, only the duration of atrial fibrillation and ejection fraction were considered risk factors for the recurrence of the atrial fibrillation following sinus conversion. Conclusion: This study suggests that the early operation is mandatory for the satisfactory result regarding postoperative rhythm. Moreover, additional operative measure in adjunct to the intervention of mitral valve should be considered for the maintenance of restored sinus rhythm as reflected by high postoperative recurrence rate of atrial fibrillation.

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Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava

  • Lee, Sub;Kim, Han-Woong;Kang, Hyoung-Seok;Bae, Chi-Hoon;Jheon, Sang-Hoon;Kwon, Oh-Choon;Ahn, Wook-Su
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.672-679
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    • 2001
  • Background: Surgical correction of partial anomalous pulmonary venous connection to the superior vena cava has been associated with postoperative venous obstruction and sinus node dysfunction. In this paper we describe our current approach and its short-term results. Material and Method: Between April 1999 and January 2000, 5 consecutive patients, ranging from 2 months to 66 years old, underwent corrective operation for partial anomalous pulmonary venous connection to the superior vena cava at Sejong General Hospital and Daegu Catholic University Medical Center. Surgical correction involved diversion of the pulmonary venous drainage to the left atrium using a right atrial flap(2 patients) or prosthetic patch(3 patients) with division of the superior vena cava superior to the restore site of the pulmonary veins and reimplantation on the right atrial appendage to restore systemic venous drainage. Result: All patients were discharged between postoperative day 9 and 15 without complications. One Russian boy returned to his country, therefore, he was lost to follow-up after discharge. Remaining 4 patients were asymptomatic and in normal regular sinus rhythm at a mean follow-up of 17.75$\pm$4.27 months. Follow-up echocardiographic study (range, 12 to 24 months) revealed no incidence of narrowing of the venous pathways or of residual shunt. Conclusion: Our current approach is relatively simple and reproducible in achieving unobstructive pulmonay venous and SVC pathways. By avoiding incision across the cavoatrial junction, surgical injury to the sinus node and its artery may be minimized. The presented surgical technique can be safely and effectively applied to the selected patients.

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Clinical Analysis of Video Assisted Thoracic Surgery for the Treatment of Thoracic Empyema (비디오 흉강경을 이용한 농흉수술의 임상분석)

  • Oh, Sang-Gi;Song, Sang-Yun;Yun, Chi-Hyeong;Na, Kook-Ju;Kong, Kang-Eun;Park, Song-Ran;Kim, Sang-Hyung
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.139-143
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    • 2010
  • Background: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. Material and Method: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. Result: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was $90{\pm}38.5\;min$. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chesttube insertion was $11.9{\pm}5.8$ (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. Conclusion: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.

Results of Arthroscopic-assisted Minimally Invasive Removal of a Lateral Periarticular Plate used for the Treatment of AO Type-C Distal Femoral Fractures (AO C-형 원위 대퇴골 골절의 치료로 삽입된 관외측 금속판의 절경 보조하 최소 침습적 제거의 결과)

  • Kim, Young-Mo;Lee, June-Kyu;Yang, Jae-Hoon;Kim, Bo-Kun;Lee, Won-Gu
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.1
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    • pp.46-52
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    • 2009
  • Purpose: To evaluate the usefulness of minimally invasive arthroscopy-assisted plate removal of a laterally inserted periarticular distal femur plate used for the treatment of AO type-C distal femur fractures. Materials and Methods: From October 2002 to November 2005, we evaluated 17 patients whose plates were removed through minimally invasive arthroscopy-assisted plate-removal technique and 15 patients who got their plates removed through conventional method without using arthroscopy, 32 patients in total. All these patients included in this study initially underwent open reduction and internal fixation of the distal femoral fractures with a lateral plate, and complained of continued pain over the lateral femoral condyle after the fracture fixation. The average age was 42.6 (ranges: 20~66) and initial fracture types included 16 cases of C1, 11 cases of C2, and 5 cases of C3 following AO/ASIF classification guidelines. Measured outcomes included: associated intra-articular pathologies, time needed to return to activities of daily living, patients' overall satisfaction, complications following the removal of hardware, and pain before and 6 months after the operation. Results: The distal-most end of the plate was placed in the knee joint in all cases and damage of the lateral articular capsule was found in 23 cases. Continuous wound discharge after surgery was found in one case who underwent arthroscopy-assisted plate removal, and it was treated by irrigation and re-suture. Average time needed to return to activities of daily living was 7 days in arthroscopy assisted group and 7.6 days in conventionally removed group. Fourteen patients (82.4%) who underwent arthroscopyassisted plate-removal reported above 'fair' satisfaction and the Visual analog scale pain score decreased from 4.9 to 1.9, six months after the plate removal. Thirteen patients(86.7%) who underwent conventional plate removal reported above 'fair' satisfaction and the Visual analog scale pain score decreased from 5.2 to 2.5, six months after the operation. Conclusion: Through minimally invasive arthroscopic-assisted plate removal, intrarticular pathology of the knee joint was able to be simultaneously identified and treated at the time of hardware removal. Damage of lateral capsule of the knee joint caused by the inserted plate for the treatment of type C distal femoral fracture was very frequently found and following the plate removal, patients experienced an improvement in pain score. We therefore recommend routine lateral distal femoral plate removal if the bony union is attained in such cases as type C distal femoral fractures whose distal most end of the plates are located in the joint.

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