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A Clinical Evaluation of Splanchnic Nerve Block (내장신경차단에 관한 임상적 연구)

  • Kim, Soo-Yeoun;Oh, Hung-Kun;Yoon, Duek-Mi;Shin, Yang-Sik;Lee, Youn-Woo;Kim, Jong-Rae
    • The Korean Journal of Pain
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    • v.1 no.1
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    • pp.34-46
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    • 1988
  • Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

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A Study on the Relationship Between Online Community Characteristics and Loyalty : Focused on Mediating Roles of Self-Congruency, Consumer Experience, and Consumer to Consumer Interactivity (온라인 커뮤니티 특성과 충성도 간의 관계에 대한 연구: 자아일치성, 소비자 체험, 상호작용성의 매개적 역할을 중심으로)

  • Kim, Moon-Tae;Ock, Jung-Won
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.4
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    • pp.157-194
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    • 2008
  • The popularity of communities on the internet has captured the attention of marketing scholars and practitioners. By adapting to the culture of the internet, however, and providing consumer with the ability to interact with one another in addition to the company, businesses can build new and deeper relationships with customers. The economic potential of online communities has been discussed with much hope in the many popular papers. In contrast to this enthusiastic prognostications, empirical and practical evidence regarding the economic potential of the online community has shown a little different conclusion. To date, even communities with high levels of membership and vibrant social arenas have failed to build financial viability. In this perspective, this study investigates the role of various kinds of influencing factors to online community loyalty and basically suggests the framework that explains the process of building purchase loyalty. Even though the importance of building loyalty in an online environment has been emphasized from the marketing theorists and practitioners, there is no sufficient research conclusion about what is the process of building purchase loyalty and the most powerful factors that influence to it. In this study, the process of building purchase loyalty is divided into three levels; characteristics of community site such as content superiority, site vividness, navigation easiness, and customerization, the mediating variables such as self congruency, consumer experience, and consumer to consumer interactivity, and finally various factors about online community loyalty such as visit loyalty, affect, trust, and purchase loyalty are those things. And the findings of this research are as follows. First, consumer-to-consumer interactivity is an important factor to online community purchase loyalty and other loyalty factors. This means, in order to interact with other people more actively, many participants in online community have the willingness to buy some kinds of products such as music, content, avatar, and etc. From this perspective, marketers of online community have to create some online environments in order that consumers can easily interact with other consumers and make some site environments in order that consumer can feel experience in this site is interesting and self congruency is higher than at other community sites. It has been argued that giving consumers a good experience is vital in cyber space, and websites create an active (rather than passive) customer by their nature. Some researchers have tried to pin down the positive experience, with limited success and less empirical support. Web sites can provide a cognitively stimulating experience for the user. We define the online community experience as playfulness based on the past studies. Playfulness is created by the excitement generated through a website's content and measured using three descriptors Marketers can promote using and visiting online communities, which deliver a superior web experience, to influence their customers' attitudes and actions, encouraging high involvement with those communities. Specially, we suggest that transcendent customer experiences(TCEs) which have aspects of flow and/or peak experience, can generate lasting shifts in beliefs and attitudes including subjective self-transformation and facilitate strong consumer's ties to a online community. And we find that website success is closely related to positive website experiences: consumers will spend more time on the site, interacting with other users. As we can see figure 2, visit loyalty and consumer affect toward the online community site didn't directly influence to purchase loyalty. This implies that there may be a little different situations here in online community site compared to online shopping mall studies that shows close relations between revisit intention and purchase intention. There are so many alternative sites on web, consumers do not want to spend money to buy content and etc. In this sense, marketers of community websites must know consumers' affect toward online community site is not a last goal and important factor to influnece consumers' purchase. Third, building good content environment can be a really important marketing tool to create a competitive advantage in cyberspace. For example, Cyworld, Korea's number one community site shows distinctive superiority in the consumer evaluations of content characteristics such as content superiority, site vividness, and customerization. Particularly, comsumer evaluation about customerization was remarkably higher than the other sites. In this point, we can conclude that providing comsumers with good, unique and highly customized content will be urgent and important task directly and indirectly impacting to self congruency, consumer experience, c-to-c interactivity, and various loyalty factors of online community. By creating enjoyable, useful, and unique online community environments, online community portals such as Daum, Naver, and Cyworld are able to build customer loyalty to a degree that many of today's online marketer can only dream of these loyalty, in turn, generates strong economic returns. Another way to build good online community site is to provide consumers with an interactive, fun, experience-oriented or experiential Web site. Elements that can make a dot.com's Web site experiential include graphics, 3-D images, animation, video and audio capabilities. In addition, chat rooms and real-time customer service applications (which link site visitors directly to other visitors, or with company support personnel, respectively) are also being used to make web sites more interactive. Researchers note that online communities are increasingly incorporating such applications in their Web sites, in order to make consumers' online shopping experience more similar to that of an offline store. That is, if consumers are able to experience sensory stimulation (e.g. via 3-D images and audio sound), interact with other consumers (e.g., via chat rooms), and interact with sales or support people (e.g. via a real-time chat interface or e-mail), then they are likely to have a more positive dot.com experience, and develop a more positive image toward the online company itself). Analysts caution, however, that, while high quality graphics, animation and the like may create a fun experience for consumers, when heavily used, they can slow site navigation, resulting in frustrated consumers, who may never return to a site. Consequently, some analysts suggest that, at least with current technology, the rule-of-thumb is that less is more. That is, while graphics etc. can draw consumers to a site, they should be kept to a minimum, so as not to impact negatively on consumers' overall site experience.

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A Study on the Visions of Zechariah in the Old Testament from a Perspective of Analytical Psychology (구약성서 '스가랴'서의 환상에 대한 분석심리학적 연구)

  • Sang Ick Han
    • Sim-seong Yeon-gu
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    • v.29 no.1
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    • pp.1-45
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    • 2014
  • Mystic experience such as seeing an vision could be explained as experiencing elusive and mysterious unique existence in religious way. In depth psychology, which is based on unconsciousness like analytical psychology, this could be explained as a something that gives a meaning of life and purpose through discovering health and healing. The importance of primodial experience in depth psychology is that it can possibly discover the base of present acts. In Christian theology, symbolic mystery and truth of religious experience that appear in Christian tradition have interest on human situation. These two fields' approach methods are different, but both show common interest on unique experience which can be said properly as raw experience. Various visions appear in many parts of the Bible. Among many visions, the book of Zechariah, one of the 12 Prophets, describes rich and diverse 8 visions through chapter 1 to chapter 8. However, due to the Genre of revelation, it lacks historicity, and because of vagueness and symbolic meanings, its visions are hard to understand and interpret. Theologically, visions of Zechariah show communality of Israelites by reconstructing kingdom of Judah and church in a way of historical circumstances. Though, these visions could deliver the meaning of an ethnical aspect as reporting continuous conversation between the God and humans. Furthermore, it could mean a personal aspect of the Prophet Zechariah as reaching for a opportunity of new change. Moreover, those who read these visions could try to interpret the meanings of various images which represent meeting mysterious existences. Therefore, the Author would concentrate on the fact that 8 visions in the book of Zechariah, which has not been received much attention to neither Christians nor non-believers, develop in chiastic structure (stylistic contrast), so that tries to interpret the first, second, seventh, and the eighth visions in analytic psychology way. In visions of Zechariah, excepting the 4th vision which probably was inserted later, rest of 7 visions each shows the stage of the hours of darkness. 1st to 3rd visions represent evening, 5th vision represents deep in the night, and 6th to 8th visions represent dawn to morning. Moreover, since structure of visions arranged in chiastic way, horse appears in 1st and 8th vision, measuring rope and measure tools are used as main motif in 2nd and 7th vision. However, same motifs could have different symbolic meanings and roles as visions are formed in different situations and conditions. In the first vision, angels who ride horses look around the world and report it is calm and peaceful. Concerning the political situation back in the day, the world being calm and peaceful in the beginning of evening means that it is not ready to change to a whole new world. Psychologically, if there is no readiness to adopt new world, it means being hopeless. It is sending you a message to get out of those kinds of situation. Moreover, appearance of four angels who rode red, brown, and white horses to a myrtus tree in the valley means that it is time for individuation and it is right and good timing for changing. In second vision, you will be able to see that Israelites had long years being caught in the shadows by foreign country, and long years succumbed by the strength of four horns, which shows the progress of renewing strength and being oneness with oneself from overwhelmed situation by paternity. In seventh vision, meaning of two women bringing the godness of the sky, who were locked up in a rice basket, back to the temple in Babylon is going towards in a level of Self-actualization by separating one's ego captured excessively by matherhood and putting back to a place where it was before. In eighth vision, chariots pulled by horses are scattered far and wide, and horses which went to north had rest in the land of North. After horses and chariots are seen between two mountains of bronze with the image of Self and anima/animus. These images can be explained as the changing progress are almost completed and the God and human, in other words Self and ego are being united and is now time for rest. All of 8 visions contains the conversation between angel and Zechariah who willing to know the meaning of visions. Zechariah asks the angel actively about the meaning of visions because of his wish for Israelites to return home and rebuild church. Conversation among the God, Zechariah, who asks questions until he knows everything, an Angel, who gives answer to given questions, is conversation between ego and anima/animus. Eventually, it is a conversation between Self and ego.