• Title/Summary/Keyword: Refractory

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Arthroscopic Treatment of Calcific Tendinitis of the Rotator Cuff (회전근 개 석회화 건염의 관절경적 치료)

  • Lee Kwang-Won;Ryu Chang-Soo;Kim Ha-Yong;Kim Byung-Sung;Choy Won-Sik
    • Journal of the Korean Arthroscopy Society
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    • v.5 no.1
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    • pp.27-31
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    • 2001
  • Purpose : The purpose of this study was to evaluate results of the arthroscopic treatment of calcific tendinitis of the shoulder resistant to conservative treatment. Materials and Methods : From March, 1996 to June, 1998, fourteen patients underwent shoulder arthroscopy to treat resistant calcific tendinitis of the rotator cuff despite conservative treatment for more than 6 months. Calcium deposits were localized to the supraspinatus tendon only in eleven patients, the supraspinatus and infraspinatus tendon in two patients, and to the supraspinatus and subscapularis tendon in one patient. Each shoulder was evaluated with UCLA shoulder rating scale and Constant-Murley score Results : The Constant-Murley pain score improved from average score 3.2 before surgery to average score 8.3 after surgery, and the UCLA functional average score improved from 4.5 preoperatively to 8.3 postoperatively. Preoperative ROM averaged $110^{\circ}$ of flexion, $45^{\circ}$ of external rotation, $90^{\circ}$ of abduction, and internal rotation with the thumb reaching to the spinous process of the third lumbar vertebra, but postoperative range of motion averages improved as follows: $170^{\circ}$ or flexion, $50^{\circ}$ of external rotation, $140^{\circ}$ abduction, and internal rotation with the spinous process of the twelveth thoracic vertebra. Overall 3 patients were rated excellentm 9 were good, 2 were fair. Conclusion : Shoulder arthroscopy is an effective treatment in patients with refractory calcific tendinitis.

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A case of adolescent Kawasaki disease with Epstein-Barr virus-associated infectious mononucleosis complicated by splenic infarction (전염성 단핵구증과 비경색증이 동반된 청소년 난치성 가와사끼병 1예)

  • Choi, Byeong Sam;Kwon, Bo Sang;Kim, Gi Beom;Jeon, Yoon Kyung;Cheon, Jung-Eun;Bae, Eun Jung;Noh, Chung Il;Choi, Jung Yun;Yun, Yong Soo
    • Clinical and Experimental Pediatrics
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    • v.52 no.9
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    • pp.1029-1034
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    • 2009
  • Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that affects children. There are few reports that describe the Epstein-Barr virus (EBV) as the possible infectious agent of KD. Here, we describe a case of KD in a 15-year-old boy complicated with giant coronary artery aneurysms, pericardial effusion, and splenic infarction. The clinical course of KD was refractory to intravenous gamma globulin and aspirin. Our patient also showed typical findings of concomitant EBV-associated infectious mononucleosis, such as hepatosplenomegaly and generalized lymphadenopathy, with EBV-positive atypical lymphoid hyperplasia. He improved dramatically after receiving intravenous methylprednisolone followed by oral prednisolone. Ultimately, the coronary artery aneurysms remained as the only sequelae. We report a rare case of adolescent KD with EBV-associated infectious mononucleosis and splenic infarction.

Treatment of Refractory Organics in Dyeing Wastewater by Using Cell Immobilized Pellets (고정화담체를 이용한 염색폐수의 난분해성 유기물질 처리)

  • Han, Duk-Gyu;Bae, Woo-Keun;Cho, Young-Jin;Won, Ho-Shik;Lee, Yong-Woo
    • Journal of Korean Society of Environmental Engineers
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    • v.27 no.9
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    • pp.917-922
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    • 2005
  • The wastewaters from textile and dyeing industries are difficult to treat due to its high pH, temperature, color intensity and non-biodegradable organic contents. This study investigated the removal of recalcitrant organics in a dyeing wastewater by using a packed bed reactor (PBR) that contained cell-immobilized pellets. The feed, obtained from an effluent of a biological treatment plant, had $SCOD_{Cr}$ of 330 mg/L and $SBOD_5$ of 20 mg/L on average. In immobilizing the cells to a Polyethylene Glycol(PEG) based medium, activated sludges from either a sewage treatment plant or an industrial wastewater treatment plant were used. When the empty bed contact time (EBCT) was above 8 hrs in the PBR, the $COD_{Cr}$ removal efficiency was over 50% and the $COD_{Mn}$ concentration was 72 mg/L or lower on average, which was substantially lower than the discharge standard of 90 mg/L. The results indicated that the optimum EBCT in the PBR was 8 hrs. The PBR with cell-immobilized pellets was effective as an advanced treatment process after an activated sludge process for treating dyeing wastewaters.

An Open-Label Trial of the 5% Lidocaine Patches for the Treatment of Chronic Pain (다양한 만성 통증 질환에서 5% 리도카인 패치의 유용성 연구)

  • Moon, Jee Youn;Choi, Jong Bum;Lee, Pyung Bok;Son, He Min;Nam, Francis Sanhgun;Kim, Young Chul;Lee, Sang Chul;Lee, Sang Jin
    • The Korean Journal of Pain
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    • v.22 no.3
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    • pp.216-223
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    • 2009
  • Background: There have been limited reports on the effectiveness of 5% lidocaine patches (L5Ps) for treating a few types of chronic pain. We utilized L5Ps for chronic pain patients with various diagnoses and who had incompletely responded to their current treatment regimen. This study aimed at describing the results of a retrospective review of an open-label L5P trial to assess L5Ps' effectiveness and safety for treating various chronic pain patients. Methods: The chronic pain patients with pain lasting longer than 6-month duration were offered a 2-week L5P treatment trial. The patients were maintained on their other analgesic regimens. The treatment effect was measured according to the change from the baseline visual analog scale (VAS) to the week 2 VAS. After a 2-week trial, the patients were asked if they perceived pain improvement with L5Ps by using a four-item Pain Relief Scale (1 = a lot of relief, 2 = slight relief, 3 = no change, 4 = worse pain). Results: In the combined patient population (n = 177), 2-week treatment with the L5Ps significantly improved the week 2 VAS (P = 0.000). Significant improvement in the VAS was reported by the chronic pain patients with postherpetic neuralgia, intercostal neuralgia, degenerative osteoarthritis at knee joint, and other maladies. A higher proportion of the chronic pain patients reported improving their pain by the L5Ps. Seven patients experienced mild or moderate patch-related adverse events. Conclusions: The L5P provided clinically meaningful pain relief in some refractory chronic pain patients without any severe adverse events.

Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea

  • Kim, Eun Kyoung;Shin, Ji Yeon;Castaneda, Anyela Marcela;Lee, Seung Jae;Yoon, Hyun Kyu;Kim, Yong Chul;Moon, Jee Youn
    • The Korean Journal of Pain
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    • v.30 no.4
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    • pp.272-280
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    • 2017
  • Background: The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. Methods: We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016. Pain severity, changes in the morphine equivalent daily dosage (MEDD), any adverse events, and patients' satisfaction were determined. We calculated the financial break-even point of ITMP implantation via investigating the patient's actual medical costs and insurance information. Results: During the studied period, 23 patients received ITMP implantation, and 20 patients were included in our study. Scores on an 11-point numeric rating scale (NRS) for pain were significantly reduced compared to the baseline value (P < 0.001). The MEDD before ITMP implantation was 0.59 [IQR: 0.55-0.82]. The total MEDD increased steadily to 0.77 [IQR: 0.53-1.08] at 1 year, which was 126% of the baseline (P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying. The financial break-even point was 28 months for ITMP treatment after the NHI reimbursement policy. Conclusions: ITMP provided effective chronic pain management with improved satisfaction and reasonable financial break-even point of 28 months with 50% financial coverage by NHI program.

Characteristics of distribution and decomposition of organic matters in stream water and sewage effluent (하천수와 하수처리장 방류수의 유기물 분포 및 분해 특성)

  • Seo, Hee-Jeong;Kang, Yeoung-Ju;Min, Kyoung-Woo;Lee, Kyoung-Seog;Seo, Gwang-Yeob;Kim, Seung-Ho;Paik, Kye-Jin;Kim, Seong-Jun
    • Analytical Science and Technology
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    • v.23 no.1
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    • pp.36-44
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    • 2010
  • This study was performed to investigate the distribution and decomposition characteristics of organic matter in stream water and sewage effluent located in Gwangju. Average of dissolved organic carbon (DOC) to total organic carbon (TOC) ratio was approximately 73.9% in the Youngsan river system. The concentration of refractory dossolved carbon (RDOC) was 3.7 mg/L corresponding to 80.9% of the DOC. The ratio of recalcitrant organic carbon was relatively higher than that of biodegradable organic carbon in stream. Oxidation efficiencies in the stream were 45.0% for BOD, 63.0% for $COD_{Mn}$ and 106.5% for CODcr. In case of sewage effluent was 33.6%, 65.7% and 136.1% respectively. Mean decomposition rate ($K_d$) of Youngsan river mainstream, its tributary sites and sewage effluent were about $0.042\;day^{-1}$, $0.043\;day^{-1}$ and $0.028\;day^{-1}$, respectively and the difference was not significant between the mainstream and its tributary sites (t-test, p>0.05). $K_d$ of the sewage effluent was lower than that of stream water.

Weekly Topotecan for Recurrent Small Cell Lung Cancer - a Retrospective Anatolian Medical Oncology Group Study

  • Altinbas, Mustafa;Kalender, Mehmet Emin;Oven, Basak;Sevinc, Alper;Karaca, Halit;Kaplan, M. Ali;Alici, Suleyman;Arpaci, Erkan;Yildiz, Ramazan;Uncu, Dogan;Camci, Celalettin;Gumus, Mahmut
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.6
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    • pp.2909-2912
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    • 2012
  • Aim: To evaluate efficacy and tolerability of topotecan treatment for recurrent small cell lung carcinoma. Patients and Methods: A total of 62 patients were evaluated retrospectively. Statistical analysis was performed using GraphPad Instat (version 3.05). Results: DFifty five of patients (89%) were male and 7 (11%) were female. Median age was $56.7{\pm}9.3$ (34-75). Forty eight of patients (80%) were extensive stage (ES) at the time of diagnosis. Fifty of the patients (80.6 Medical Oncology Clinic) were given median 5.36 cycles of cisplatin-etoposide (2-8 cycles). Time to recurrence was $15.6{\pm}6.13$ weeks in patients with limited stage (LS) and $6.3{\pm}3.82$ weeks in extensive stage (ES) (p<0.0001). Overall survival was $14.0{\pm}6.08$ months in ES and $17.9{\pm}6.88$ months in LS. The difference between two groups was statistically meaningful (p=0.0447). The overall survival of the patients was $14.8{\pm}6.43$ months (4.5-40 months). In terms of survival, there was no difference between males and females (p=0.1171). In 17 (27%) patients who were refractory to topotecan or in whom progression occurred other chemotherapies were used. Conclusion: Small cell lung cancer is chemosensitive, but recurrences occur in short time. Other chemotherapy regimens are used in progression. Topotecan is one of them. Patients who were young and in whom recurrences occur late had given better response to topotecan. Because of the retrospective nature of the study, we couldn't reach the records exactly and consequently, rate and duration of response couldn't be calculated. In recurrent SCLC topotecan is one of the treatment choices. But both hematological and non hematological side effects should be taken into consideration.

Ultrasound Targeted Microbubble Destruction for Novel Dual Targeting of HSP72 and HSC70 in Prostate Cancer

  • Wang, Hang-Hui;Song, Yi-Xin;Bai, Min;Jin, Li-Fang;Gu, Ji-Ying;Su, Yi-Jin;Liu, Long;Jia, Chao;Du, Lian-Fang
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.3
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    • pp.1285-1290
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    • 2014
  • The aim was to determine whether ultrasound targeted microbubble destruction (UTMD) promotes dual targeting of HSP72 and HSC70 for therapy of castration-resistant prostate cancer (CRPC), to improve the specific and efficient delivery of siRNA, to induce tumor cell specific apoptosis, and to find new therapeutic targets specific of CRPC.VCaP cells were transfected with siRNA oligonucleotides. HSP70, HSP90 and cleaved caspase-3 expression were determined by real-time quantitative polymerase chain reaction and Western blotting. Apoptosis and transfection efficiency were assessed by flow cytometry. Cell viability assays were used to evaluate safety. We found HSP72, HSC70 and HSP90 expression to be absent or weak in normal prostate epithelial cells (RWPE-1), but uniformly strong in prostate cancerous cells (VCaP). UTMD combined with dual targeting of HSP72 and HSC70 siRNA improve the efficiency of transfection, cell uptake of siRNA, downregulation of HSP70 and HSP90 expression in VCaP cells at the mRNA and protein level, and induction of extensive tumor-specific apoptosis. Cell counting kit-8 assays showed decreased cellular viability in the HSP72/HSC70-siRNA silenced group. These results suggest that the combination of UTMD with dual targeting HSP70 therapy for PCa may be most efficacious, providng a novel, reliable, non-invasive, safe targeted approach to improve the specific and efficient delivery of siRNA, and achieve maximal effects.

Assessment and Treatment of Depression in the Medically III (신체질환 환자들에서 우울증의 평가 및 치료)

  • Koh, Kyung-Bong
    • Korean Journal of Psychosomatic Medicine
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    • v.9 no.2
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    • pp.111-132
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    • 2001
  • Depression in the medically ill is a common clinical problem that primary physicians and psychiatric consultants encounter. Treatment of such patients begins with a careful evaluation of the patient's medical and psychiatric conditions. The assessment of depression in the medical patients requires a multidimensional approach. Psychological instruments are also used as a method of assessment in these patients. First of all, what the therapists have to do is to find and remove organic causes. Psychosoical treatment includes dealing with the patient's resistance and despondency relevant to physical diseases. For biological treatment, it is important to select appropriate antidepressants. Therapists should be familiar with the side effects of the antidepressants as well as the patient's primary depressive symptoms, pharmacokinetics and pharmacodynamics of the available agents. In addition, special attention should be paid to the potential for drug-illness and drug-drug interactions. Tricyclic antidepressants can be still effectively used for patients with pain disorder, although a variety of new antidepressants such as selective serotonin reuptake inhibitors (SSRI), bupropion and venlafaxine could have more benefits in depression of the medically ill. However, electroconvulsive therapy can be recommended for refractory cases of depression in patients with medical illness.

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Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

  • Kim, Hyun Jung;Ahn, Hyeong Sik;Lee, Jae Young;Choi, Seong Soo;Cheong, Yu Seon;Kwon, Koo;Yoon, Syn Hae;Leem, Jeong Gill
    • The Korean Journal of Pain
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    • v.30 no.1
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    • pp.3-17
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    • 2017
  • Background: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.