• Journal of Medicine and Life Science
• /
• 제19권3호
• /
• pp.79-89
• /
• 2022

Whereas systolic blood pressure (SBP) continuously rises with age, diastolic blood pressure (DBP) gradually decreases after the age of 55 years. Therefore, hypertension in the elderly shows the pattern of isolated systolic hypertension. There is evidence on the benefits of controlling blood pressure (BP) in elderly patients with hypertension. The BP lowering effect has also been demonstrated in patients over 80 years of age with hypertension. The BP threshold for the initiation of antihypertensive drug treatment for older adults with hypertension is gradually decreasing. The antihypertensive treatment is recommended if, despite therapeutic lifestyle modifications, SBP ≥140 mmHg or DBP ≥90 mmHg in those aged 65-79 years old, and SBP ≥140-160 mmHg or DBP ≥90 mmHg in those aged ≥80 years old. Although there is no consensus on the target BP for older adults with hypertension, a target SBP of <130-140 mmHg and DBP of <80-90 mmHg are recommended. In older adults over 80 years of age with hypertension, the target SBP is <140-150 mmHg. When the dose of antihypertensive drugs is increased to reach the target SBP, DBP may decrease to less than 70 mmHg, but it should not be <60 mmHg. Thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers can be selected as the first-line drug for older adults with hypertension. Beta-blockers may be selected in case of compelling indications.

• Journal of Medicine and Life Science
• /
• 제20권1호
• /
• pp.48-52
• /
• 2023

High-grade serous carcinoma (HGSC) is the most common type of pelvic cancer among women. Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of HGSC. Herein, we report a rare occurrence of STIC in patients undergoing surgery for benign indications without a family history of ovarian cancer. A 77-year-old woman underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for uterine prolapse. Pathological examination revealed bilateral STIC without ovarian abnormalities, and no other abnormal findings were noted. Another patient, a 49-year-old woman, underwent laparoscopic total hysterectomy and bilateral salpingectomy for uterine fibroids. STIC lesions were observed in both fallopian tubes. Subsequently, a staging was performed. No additional lesions were found, and the patient was followedup through imaging and blood tests. As reports of STIC lesions are rare, data on their clinical outcomes and management strategies are limited. In this report, we present cases of incidental STIC in benign surgery and discuss its proper interpretation and management. Through the early detection of STIC lesions, patients with risk factors can be identified in advance, which will allow prevention and early detection of ovarian cancer. Opportunistic salpingectomy was also actively discussed in this regard.

• Childhood Kidney Diseases
• /
• 제28권1호
• /
• pp.8-15
• /
• 2024

With the rapid evolution of diagnostic tools, particularly next-generation sequencing, the identification of genetic diseases, predominantly those with pediatric-onset, has significantly advanced. However, this progress presents challenges that span from selecting appropriate tests to the final interpretation of results. This review examines various genetic testing methodologies, each with specific indications and characteristics, emphasizing the importance of selecting the appropriate genetic test in clinical practice, taking into account factors like detection range, cost, turnaround time, and specificity of the clinical diagnosis. Interpretation of variants has become more challenging, often requiring further validation and significant resource allocation. Laboratories primarily classify variants based on the American College of Medical Genetics and Genomics and the Association for Clinical Genomic Science guidelines, however, this process has limitations. This review underscores the critical role of clinicians in matching patient phenotypes with reported genes/variants and considering additional factors such as variable expressivity, disease pleiotropy, and incomplete penetrance. These considerations should be aligned with specific gene-disease characteristics and segregation results based on an extended pedigree. In conclusion, this review aims to enhance understanding of the complexities of clinical genetic testing, advocating for a multidisciplinary approach to ensure accurate diagnosis and effective management of rare genetic diseases.

• Clinics in Shoulder and Elbow
• /
• 제27권1호
• /
• pp.108-116
• /
• 2024

Reverse total shoulder arthroplasty (RTSA) is widely popular among shoulder surgeons and patients, and its prevalence has increased dramatically in recent years. With this increased use, the indicated pathologies associated with RTSA are more likely to be encountered, and challenging patient presentations are more likely to be seen. One prominent challenging presentation is RTSA patients with severe glenoid bone loss. Several techniques with varying degrees of invasiveness, including excessive reaming, alternate centerline, bone grafting, and patient-specific implants (PSIs), have been developed to treat patients with this presentation. PSI treatment uses a three-dimensional reconstruction of a computed tomography scan to design a prosthetic implant or component customized to the patient's glenoid morphology, allowing compensation for any significant bone loss. The novelty of this technology implies a paucity of available literature, and although many studies show that PSIs have good potential for solving challenging shoulder problems, some studies have reported questionable and equivocal outcomes. Additional research is needed to explore the indications, outcomes, techniques, and cost-efficiency of this technology to help establish its role in current treatment guidelines and strategies.

• 대한영상의학회지
• /
• 제84권6호
• /
• pp.1233-1243
• /
• 2023

경피적 초음파 유도생검은 진단 및 치료 계획을 정하기 위해 다양한 신체 병변에 대한 병리 확인에 유용한 시술이다. 하지만 깊은 골반 병변은 병리진단이 어려운데 장, 방광, 주요 혈관, 그리고 골반뼈로 인해 경피적 접근이 어렵고 위험하기 때문이다. 여성의 경우 질은 탄력적이고 골반의 내부 장기와 가깝다. 따라서 경질 초음파는 골반 병변에 대한 병리진단을 위해 효과적이고 안전한 길잡이 역할을 할 수 있다. 이 종설의 목적은 경질 초음파 유도생검의 적응증과 방법을 소개하고, 또한 보고된 진단 정확도 및 안정성을 기술하고자 한다.

• Clinical Endoscopy
• /
• 제57권3호
• /
• pp.342-349
• /
• 2024

Background/Aims: Nonagenarians will purportedly account for 10% of the United States population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group. Methods: The National Inpatient Sample database between 2016 and 2020 was used to compare the clinical outcomes of NVUGIB in nonagenarians and octogenarians and evaluate predictors of mortality and the use of esophagogastroduodenoscopy (EGD). Results: Nonagenarians had higher in-hospital mortality than that of octogenarians (4% vs. 3%, p<0.001). EGD utilization (30% vs. 48%, p<0.001) and blood transfusion (27% vs. 40%, p<0.001) was significantly lower in nonagenarians. Multivariate logistic regression analysis revealed that nonagenarians with NVUGIB had higher odds of mortality (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3-1.7) and lower odds of EGD utilization (OR, 0.86; 95% CI, 0.83-0.89) than those of octogenarians. Conclusions: Nonagenarians admitted with NVUGIB have a higher mortality risk than that of octogenarians. EGD is used significantly in managing NVUGIB among nonagenarians; however, its utilization is comparatively lower than in octogenarians. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.

• Clinical and Experimental Pediatrics
• /
• 제50권5호
• /
• pp.469-475
• /
• 2007

목 적 : 이차공 심방 중격 결손의 Amplatzer 기구를 이용한 경피적 폐쇄의 안정성, 효용성 및 임상 결과를 수술적 폐쇄법과 비교하기 위하여 본 연구를 시행하였다. 방 법 : 2000년 1월부터 2006년 6월까지 가천의과학대학교 길병원에서 이차공 심방 중격 결손으로 진단 받은 환자 115명을 대상으로 하였다. 그 중 70명에게 결손의 수술적 폐쇄술을 시행하였고, 45명의 환자에게 Amplatzer 기구를 이용한 경피적 폐쇄술을 시행하였다. 수술군과 시술군의 사망율, 합병증, 입원기간과 효용성을 조사하여 결과를 비교분석하였다. 결 과 : 전체 남녀 비는 1:2.4였다. 두 환자군에서 평균 연령과 결손크기는 유의한 차이가 없었다. 성공율은 시술군에서 97.8%, 수술군에서 100%였다. 전체 합병증은 수술군에서 시술군보다 많이 발생하였다(64.0 vs. 15.6%, P<0.05). 입원기간은 시술 군이 수술군보다 짧았다($4.2{\pm}1.2$ vs. $12.4{\pm}4.7days$, P<0.0001). 잔류단락은 시술군(8.9%)에서 수술군(4.3%)에 비해 더 많이 발생하였는데, 3개월후 추적 검사에서는 모두 소실되었다. 결 론 : 이차공 심방 중격 결손증의 Amplatzer 기구를 이용한 경피적 폐쇄는 수술을 대체할 수 있는 안전하고 효과적인 방법이다. 경험이 축적되고 기구가 발전하면서 경피적 폐쇄술의 적용 범위가 점차 확대되고 있다.

• Journal of Chest Surgery
• /
• 제49권4호
• /
• pp.250-257
• /
• 2016

Background: Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). Methods: We retrospectively reviewed 66 patients (36 male; mean age, $44.5{\pm}9.5years$) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results: Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1-3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were $81.5%{\pm}5.1%$ and $76.4%{\pm}5.4%$, respectively. Conclusion: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.

• Clinics in Shoulder and Elbow
• /
• 제17권2호
• /
• pp.68-76
• /
• 2014

Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from $96.9^{\circ}$ to $125.6^{\circ}$ (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

• 동의신경정신과학회지
• /
• 제20권3호
• /
• pp.15-33
• /
• 2009

Objectives : To study for classifying indications and procedure of historical changes, as a preliminary study, we collected and arranged prescriptions of headaches in medical documents after "Hwang-Je-Nae-Gyeong". Methods : 1. The researcher reviewed books, as a bibliography, recording to associate with a headaches in "UI-Bu-Jeon-Rok". 2. In reference books, we collected and arranged the herb medicines related to headaches in chapter of them. 3. In case of no chapter associated with headaches in books, we found prescriptions related to headaches and rearranged them. 4. Applied or added herb medicines were excluded, if the chief virtue was not primarily for headaches. 5. Prescriptions for signs to headaches related to dizziness were excluded. 6. Prescriptions for signs to associated with tremor were excluded. 7. We excluded prescriptions of headaches for dermatological disease. Results and conclusions : 1. Thirty seven documents were referred to the section of a headche in "UI-Bu-Jeon-Rok". 2. Prescriptions of "Sang-Han-Ron", which were related to headaches, were repeatedly quoted in chinese medical publications. 3. Nameless prescriptions of headaches were recorded from earlier books to later publications. 4. It started to record prescriptions of headaches separately from "Hawl-In-Seo" in 1107. 5. Described how to discriminate Naesang from Oegam, but prescriptions of headache were not listed in Dongwon Yi's "Nae-Oe-Sang-Byeon-Hok-Ron" which was published in 1247.