• Title/Summary/Keyword: Patient experience

Search Result 2,013, Processing Time 0.027 seconds

A Case of Diffuse Large B-cell Lymphoma transformed from Primary Thyroid MALT Lymphoma (갑상선 MALT 림프종으로부터 전환된 미만성 거대 B세포 림프종 1예)

  • Young Rok Jo;Youn Jin Cho;Ju Yeon Pyo;Hye Ran Lee
    • Korean Journal of Head & Neck Oncology
    • /
    • v.39 no.2
    • /
    • pp.13-17
    • /
    • 2023
  • Diffuse large B cell lymphoma (DLBCL) is main subtype of primary thyroid lymphoma and can be histologically transformed from a low-grade B-cell lymphoma. The characteristics and treatment guidelines of these particular DLBCL have not been fully established. The mainstay of treatment of primary thyroid DLBCL is multimodality treatment with chemotherapy and radiotherapy. Meanwhile, surgery can be considered only for diagnosis or alleviation of airway compressive symptoms. A 57-year-old female visited our outpatient clinic for recently enlarged long-held anterior neck mass. A thyroid mass compressing the airway and esophagus was identified on imaging, which was diagnosed as MALT lymphoma by excisional biopsy. After staging, the patient underwent total thyroidectomy with regional lymph node dissection for treatment of stage IIE MALT lymphoma and relieving airway compromise symptoms. The final diagnosis was DLBCL transformed from MALT Lymphoma, and chemotherapy was additionally performed. We report this rare experience with a review of literature.

Clinical Course of Suspected Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy: A 10-Year Experience of Rapid Progressive Right Ventricular Failure Syndrome in Advanced Cancer Patients

  • Minjung Bak;Minyeong Kim;Boram Lee;Eun Kyoung Kim;Taek Kyu Park;Jeong Hoon Yang;Duk-Kyung Kim;Sung-A Chang
    • Korean Circulation Journal
    • /
    • v.53 no.3
    • /
    • pp.170-184
    • /
    • 2023
  • Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions: Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient's prognosis.

Surgery for symptomatic hepatic hemangioma: Resection vs. enucleation, an experience over two decades

  • Nalini Kanta Ghosh;Rahul R;Ashish Singh;Somanath Malage;Supriya Sharma;Ashok Kumar;Rajneesh Kumar Singh;Anu Behari;Ashok Kumar;Rajan Saxena
    • Annals of Hepato-Biliary-Pancreatic Surgery
    • /
    • v.27 no.3
    • /
    • pp.258-263
    • /
    • 2023
  • Backgrounds/Aims: Hemangiomas are the most common benign liver lesions; however, they are usually asymptomatic and seldom require surgery. Enucleation and resection are the most commonly performed surgical procedures for symptomatic lesions. This study aims to compare the outcomes of these two surgical techniques. Methods: A retrospective analysis of symptomatic hepatic hemangiomas (HH) operated upon between 2000 and 2021. Patients were categorized into the enucleation and resection groups. Demographic profile, intraoperative bleeding, and morbidity (Clavien-Dindo Grade) were compared. Independent t-test and chi-square tests were used for continuous and categorical variables respectively. p-value of < 0.05 was considered significant. Results: Sixteen symptomatic HH patients aged 30 to 66 years underwent surgery (enucleation = 8, resection = 8) and majority were females (n = 10 [62.5%]). Fifteen patients presented with abdominal pain, and one patient had an interval increase in the size of the lesion from 9 to 12 cm. The size of hemangiomas varied from 6 to 23 cm. The median blood loss (enucleation: 350 vs. resection: 600 mL), operative time (enucleation: 5.8 vs. resection: 7.5 hours), and postoperative hospital stay (enucleation: 6.5 vs. resection: 11 days) were greater in the resection group (statistically insignificant). In the resection group, morbidity was significantly higher (62.6% vs. 12.5%, p = 0.05), including one mortality. All patients remained asymptomatic during the follow-up. Conclusions: Enucleation was simpler with less morbidity as compared to resection in our series. However, considering the small number of patients, further studies are needed with comparable groups to confirm the superiority of enucleation over resection.

Programmed Follow-up and Quality Control of Treatment Techniques Enhance Chronic Thromboembolic Pulmonary Hypertension Management: Lessons From a Multidisciplinary Team

  • Taek Kyu Park;Sung-A Chang;Jeong Hoon Yang;Woochan Kwon;Min Yeong Kim;Young Seok Cho;Hye Yun Park;Dong Seop Jeong;Hojoong Kim;Duk kyung Kim
    • Korean Circulation Journal
    • /
    • v.54 no.7
    • /
    • pp.409-421
    • /
    • 2024
  • Background and Objectives: The recent developments in chronic thromboembolic pulmonary hypertension (CTEPH) are emphasizing the multidisciplinary team. We report on the changes in clinical practice following the development of a multidisciplinary team, based on our 7 years of experience. Methods: Multidisciplinary team was established in 2015 offering both balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) with technical upgrades by internal and external expertise. For operable cases, PEA was recommended as the primary treatment modality, followed by pulmonary angiography and right heart catheterization after 6 months to evaluate treatment effect and identify patients requiring further BPA. For patients with inoperable anatomy or high surgical risk, BPA was recommended as the initial treatment modality. Patient data and clinical outcomes were closely monitored. Results: The number of CTEPH treatments rapidly increased and postoperative survival improved after team development. Before the team, 38 patients were treated by PEA for 18 years; however, 125 patients were treated by PEA or BPA after the team for 7 years. The number of PEA performed was 64 and that of BPA 342 sessions. World Health Organization functional class I or II was achieved in 93% of patients. The patients treated with PEA was younger, male dominant, higher pulmonary artery pressure, and smaller cardiac index, than BPA-only patients. In-hospital death after PEA was only 1 case and none after BPA. Conclusions: The balanced development of BPA and PEA through a multidisciplinary team approach proved synergistic in increasing the number of actively treated CTEPH patients and improving clinical outcomes.

Short-term Clinical Experience on Interferon gamma-1b Therapy for Idiopathic Pulmonary Fibrosis (특발성 폐섬유화증에서 Interferon gamma-1b 치료의 단기 임상경험)

  • Hwang, Jung Hye;Chung, Man Pyo;Kang, Eun Hae;Kim, Kyung Chan;Lee, Byoung-Hoon;Koh, Won-Jung;Suh, Gee Young;Kim, Hojoong;Lee, Kyung Soo;Han, Joungho;Kwon, O Jung
    • Tuberculosis and Respiratory Diseases
    • /
    • v.56 no.6
    • /
    • pp.619-627
    • /
    • 2004
  • Background : Corticosteroids in combination with cytotoxic drugs are the mainstays of therapy for idiopathic pulmonary fibrosis (IPF). However, there has been no regimen showing any survival benefit. The aim of this study was to describe a short-term clinical experience on interferon gamma-1b (IFN-${\gamma}1b$) therapy for IPF, as an antifibrotic agent. Methods : Medical records of 27 patients who were treated with IFN-${\gamma}1b$ (2 million IU, 3 times a week, subcutaneous injection) were retrospectively reviewed. Treatment response was assessed using ATS/ERS criteria in 17 patients who received IFN-${\gamma}1b$ for more than 6 months. In addition, we compared the efficacy of IFN-${\gamma}1b$ therapy with that of cyclophosphamide${\pm}$prednisolone therapy (n=26). Results : The median age of IFN-${\gamma}$ treated group (M:F=19:8) was 59 years (44-74 years). Compared to the patients who showed a stable response at 6 months (n=12), the deteriorated group (n=5) had worse baseline lung function (FVC, $55.4{\pm}11.3%$ vs. $70.7{\pm}10.9%$, p=0.019; DLco, $50.3{\pm}7.3%$ vs. $76.9{\pm}19.6%$, p=0.014). Lower baseline $PaO_2$ on room air breathing was observed in the deteriorated group ($68.6{\pm}7.8mmHg$ vs. $91.4{\pm}6.6mmHg$ p=0.001). Subcutaneous IFN-${\gamma}1b$ did not show better efficacy than prednisolone. Five patients discontinued IFN-${\gamma}$ because of severe side effects. ARDS developed in one patient, who eventually died. Conclusion : The administration of IFN-${\gamma}1b$ is not desirable for patients diagnosed with IPF with poor lung function. Long-term and large-scaled clinical studies are needed for its efficacy in IPF.

Comparison of crown designs of different dental occupational groups, using CAD-CAM (CAD-CAM을 이용하여 디자인한 금관의 치과 직업군에 따른 형태 비교)

  • Kim, TaeHyeon;Kim, Jong-Eun;Lee, Ah-Reum;Park, Young-Bum
    • The Journal of Korean Academy of Prosthodontics
    • /
    • v.54 no.3
    • /
    • pp.234-238
    • /
    • 2016
  • Purpose: Increasing use of computer aided design-computer aided manufacturing (CAD-CAM) system and number of design software made design of restoration easy and quick. Outcome of restoration has been dependent on dental technician's wax up proficiency, dentists can design restoration for themselves now. This study aims to investigate the outcome of restoration designs, according to handling skill of CAD-CAM design tool. Materials and methods: A patient's mandibular right 1st molar was prepared. After taking impression, stone model was made, scanned the stone model with 3 shape intra-oral scanner, stereolithography (STL) file was extracted. With 3shape dental designer, one dental technician with more than 5 years work experience (designer 0) and three dental technicians with less than 2years work experience (designer 1, 2, 3-group DT) and 4 1st year residents (designer 4, 5, 6, 7-group RT) designed gold crown on the same STL file. Designed crown's MD (mesio-distal) and BL (bucco-lingual) diameter, height of crown, inter-cuspal distance, number of occlusal contact points were compared. Statistical analysis was carried out, test of normality within each group, using independent t-test. Number of contact points were compared, using Wilcoxon signed-rank test. Results: There was no significant difference between group DT and group RT. Number of contact points also resulted in no significant difference. Conclusion: The outcome of each designed crowns showed no statistical differences, in values which can be expressed as numbers. Subjective factors were different. With increasing proficiency in handling designing software, fabrication of restorations according to each designer's occlusal concept can be made easy.

The Ross Procedure in Pediatric Patients: 10 Years Experience at the Asan Medical Center (소아 환자에서 Ross 수술 성적 보고: 아산병원 10년 경험)

  • Kim, Hee-Jung;Seo, Dong-Man;Yun, Tae-Jin;Park, Jeong-Jun;Park, In-Sook;Kim, Young-Hwue;Ko, Jae-Kon
    • Journal of Chest Surgery
    • /
    • v.42 no.3
    • /
    • pp.305-310
    • /
    • 2009
  • Background: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. Material and Method: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: $0.5\sim14.0$). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8$\sim$138.2 months). We reviewed the echocardiographic data with focusing on the, auto-graft dysfunction and reoperation. Result: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from $1.6{\pm}1.7/0.9{\pm}1.7$ at preoperation to $1.8{\pm}1.6$(p=0.64)/$2.2{\pm}0.9$ (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency. Conclusion: Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Vet reoperation due to allograft dysfunction was a major concern.

A Study of the Improvement of Clinical and Practical Trainings in the Education of Radiologic Technologists (방사선사(放射線士) 교육(敎育)의 임상실습(臨床實習) 개선(改善)에 관(關)한 연구(硏究))

  • Lee, Man-Koo;Kang, Se-Sik;Yoon, Han-Sik;Huh, Joon
    • Journal of radiological science and technology
    • /
    • v.6 no.1
    • /
    • pp.117-129
    • /
    • 1983
  • This study, in order to improve clinical and practical trainings in the education of radiologic technologists, applies to 76 medical institutions of 91 ones which are used as the hospitals of clinical and practical training in 9 existing junior colleges except 3 new ones of 12 ones throughout all over the country from November 1, in 1982 to April 30, in 1983. And the purpose of this study is to research the percent conditions of basic practical trainings and clinical ones enforced in each college, and the percent conditions, equipments, contents, and opinions in clinical and practical trainings enforced in each hospital. The results are summarized as follows; 1. In the case of junior colleges in the whole country the curriculum of basic practical trainings averages 336.66 hours and the limits are between 120 and 510 hours. The actual hours in practice average 140 hours and the limits are between 60 and 240 hours, which correspond to 41.58% of the curriculum of basic practical trainings. 2. There were three junior colleges among nine that had a reserved hospital for clinical and practical trainings(only 33.33%). 3. The period of the practice was almost vacation in 4 junior colleges. The practice was conducted only for students to want the practice(44.45%), junior colleges that all students in them conducted the practice was 2 junior colleges and presented 22.22%. 4. In the field of students engaging in the practice, each field of radiation therapy and nuclear medicine presented 16.5%, 20.3% and almost students didin't have experience for the practice. 5. In medical institutions the educational institutions for intern showed 67.11%. Hospital with radiologist showed 26.32%. Radiotechnologist who had experience below 5 years presented 60.17%. 6. In the equipment for radiation diagnosis, each hospital had no difference. The number of hospitals passessing diagnostic equipments above 125 KVP was 56.26%. But radiation therapy equipment and nuclear medicine equipment had extremely low rate. 7. In the diagnosis of patient in the practice hospital, conventional radiography-to Skull, Chest, Abdomen, Skeleton, Urogenital system-reached the criterion. But special radiography was comparatively low. There appeared low rate, 32.89% in the field of nuclear medicine, 15.79% in the field of radiation therapy. 8. Students who carried out the practice were 1-89 students, days in practice were 1-30 days. There were differences in that point among among hospitals. Junior colleges conducting the practice were 2 colleges per hospital. Scope of the object were 1-8 junior colleges. 9. The practice conducted for the request of the colleges presented 72.37%, in addition, The prctices were conducted for growth of the younger generation and the same coperation with the colleges establishment of sisterhood with the colleges, relationship with students. 10. The practice conducted without the establishment of plan presented 59.21% The need for guiding book to the practice and evaluating was recognized over 90%. 11. In the relation between the practice with achievement of credit. There were big differences in opinion between hospitals-Group and the colleges-Group; hospital-Group had opinion that must follow achievement of credit with the practice. The colleges-Group had opinion that must conduct the practice after achieving credit. 12. After conducting the practice, in the practice leaders satisfaction degree dissatisfactory opinion presented the most rate 80.26%. Very much satisfactory opinion, as one hospital, presentd only 1.32%. 13. Both hospitals-Group and the colleges-Group had an opinion that the practice leader must have actual experiences, lectures and achievement, an opinion that actual experiences is over 5 years. 14. In the guide of human relation, cooperation, responsibility, courtesy to patients. Both hospitals-Group and the colleges-Group had an opinion that the guide must be involved in the period of the practice and must be instructed.

  • PDF

Serum Levels of IL-$1\beta$, IL-2 and IL-6 in Functional Gastrointestinal Disorders in Relation to Depression and Stressful Life Events (기능성 위장관 장애에서 혈청 IL-$1\beta$, IL-2, IL-6의 변화 : 우울증 및 스트레스와의 상관성)

  • Park, Si-Sung;Lee, Sang-Shin;Park, Moo-In;Koo, Ja-Young;Park, Je-Min;Kim, Myung-Jung
    • Korean Journal of Psychosomatic Medicine
    • /
    • v.10 no.2
    • /
    • pp.130-141
    • /
    • 2002
  • Objectives : Stress induces alteration of gastrointestinal function in which interleukin (IL) and hypothalamo-pituitary-axis are involved. Depression again is associated with functional gastrointestinal disorders (FGID) and interleukins. The author attempted to look into the role of interleukins in the FGID also the association of depression and stress in this context. Methods : Entered were 20 patients with FGID, diagnosed by Rome IT criteria and 20 healthy controls. Depression was measured by Hamilton Rating Scale for Depression (HAM-D), and stress of the last one year by Schedule of Recent Experience (SRE). Serum levels of IL-$1\beta$, IL-2, IL-6 were measured by Enzyme-linked Immunosorbent Assay and serum cortisol by Fluorescence Polarization Immunoassay. The results were as follows : Results: 1) Serum levels of IL-$1\beta$, IL-2 were significantly lower in the patients with FGID than those in the controls, but level of IL-6 did not differ between two groups. 2) The patient group showed significantly higher level of serum cortisol as well as higher degrees of depression and stress. 3) Positive correlation was noted between depression and serum cortisol, and between depression and IL-2. A trend of negative correlation was seen between depression IL-$1\beta$. Positive correlation was noted between SRE and IL-6 and IL-6 and serum cortisol. Conclusions : It was concluded that FGID might be related to depression and stress. Changes of the interleukins might be involved with elevated cortisol level.

  • PDF

Long-term Results after 1,144 CarboMedics Mechanical Valve Implantation (CarboMedics 기계판막을 이용한 1,144예 판막치환술의 장기 성적)

  • Kang, Chang-Hyun;Kim, Kyung-Hwan;Kim, Ki-Boong;Ahn, Hyuk
    • Journal of Chest Surgery
    • /
    • v.37 no.7
    • /
    • pp.559-569
    • /
    • 2004
  • The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.