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Clinical outcomes of stereotactic body radiotherapy for spinal metastases from hepatocellular carcinoma

  • Lee, Eonju;Kim, Tae Gyu;Park, Hee Chul;Yu, Jeong Il;Lim, Do Hoon;Nam, Heerim;Lee, Hyebin;Lee, Joon Hyeok
    • Radiation Oncology Journal
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    • v.33 no.3
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    • pp.217-225
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    • 2015
  • Purpose: To investigate the outcomes of patients with spinal metastases from hepatocellular carcinoma (HCC), who were treated by stereotactic body radiotherapy (SBRT). Materials and Methods: This retrospective study evaluated 23 patients who underwent SBRT from October 2008 to August 2012 for 36 spinal metastases from HCC. SBRT consisted of approximately 2 fractionation schedules, which were 18 to 40 Gy in 1 to 4 fractions for group A lesions (n = 15) and 50 Gy in 10 fractions for group B lesions (n = 21). Results: The median follow-up period was 7 months (range, 2 to 16 months). Seven patients developed grade 1 or 2 gastrointestinal toxicity, and one developed grade 2 leucopenia. Compression fractures occurred in association with 25% of the lesions, with a median time to fracture of 2 months. Pain relief occurred in 92.3% and 68.4% of group A and B lesions, respectively. Radiologic response (complete and partial response) occurred in 80.0% and 61.9% of group A and B lesions, respectively. The estimated 1-year spinal-tumor progression-free survival rate was 78.5%. The median overall survival period and 1-year overall survival rate were 9 months (range, 2 to 16 months) and 25.7%, respectively. Conclusion: SBRT for spinal metastases from HCC is well tolerated and effective at providing pain relief and radiologic response. Because compression fractures develop at a high rate following SBRT for spinal metastases from primary HCC, careful follow up of the patient is required.

An Interview Survey for Grasping Clinical Actual State of Bloodletting Therapeutics in Korea (국내 자락(사혈)요법 임상 실태 파악을 위한 면접조사)

  • Han, Chang-Hyun;Kim, Seon-Woong;Shin, Mi-Suk;Choi, Sun-Mi
    • Journal of Acupuncture Research
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    • v.24 no.3
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    • pp.9-18
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    • 2007
  • Objectives: Bloodletting therapeutics is one of the most popular oriental medical treatments in Korea. In this study, we operate the Interview Survey for grasping clinical actual state bloodletting therapeutics in Korea. Methods : Survey questions were developed based on consensus of acupuncture professors. The list of the Korean medical doctors with experiences more than 10 years is provided by the Association of the Korean Oriental Medicine. The interviews were conducted to 39 members of the Korean medical doctors who answered to used bloodletting therapeutics over 30 percentage a day at previous telephone survey. Interview survey with them were conducted by the well-trained interviewers of College of Korean Medicine student from 29th May 2006 to 3rd June 2006. Results : Korean medical doctors prefer to use the bloodletting cupping treatment(89.5%) on the bloodletting therapeutics. Musculo-skeletal disorder was as frequent as 89.5% of treatment disease. The most common treatment area was back(57.9%), extremity(l5.8%), pain area(l0.5%). The most common instrument for treating was disposable lancet(57.9%), three-edged needle(26.3%). Most Korean medical doctors(60.5%) took up the position that bring symptom relief following good treatment area. 'Recover quickly from illness'(50%) was one of bloodletting good points but 'Sever pain'(34.2%) was a weak points. Conclusion : This survey provides unique insight into the perception of the Korean medical doctors at bloodletting therapeutics. Most doctors experienced symptom relief, received positive benefits from the treatment. Future research needs to provide more in-depth insight into doctor views of the experience.

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Surgical Observations of Diseases of the Aorta (대동맥질환에 대한 외과적 고찰)

  • Rho, Joon Ryang
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.251-264
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    • 1976
  • Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

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Clinical Analysis of Acute Radiculopathy after Osteoporotic Lumbar Compression Fracture

  • Kim, Do Eon;Kim, Hyeun Sung;Kim, Seok Won;Kim, Hyun Sook
    • Journal of Korean Neurosurgical Society
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    • v.57 no.1
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    • pp.32-35
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    • 2015
  • Objective : The purpose of this study was to analyze the relationship between fracture pattern and the development of acute radiculopathy after osteoporotic lumbar compression fracture. Methods : This study included 59 patients who underwent bone cement augmentation for osteoporotic compression fracture below the L2 level, which can lead to radiculopathic radiating pain. The patients were divided into two groups according to the presence of radiculopathy (group A : back pain only; group B : back pain with newly developed radiating pain). We categorized compression fractures into three types by the position of the fracture line. The incidence of newly developed radiculopathy was examined retrospectively for each compression fracture type. Results : The overall incidence of newly developed leg pain (group B) was 25%, and the frequency increased with descending spinal levels (L2 : 0%, L3 : 22%, L4 : 43%, and L5 : 63%). The back pain-only group (group A) had mostly superior-type fractures. On the other hand, the back pain with radiculopathy group (group B) had mostly inferior-type fractures. Most patients in group B showed significant relief of leg pain as well as back pain after bone cement augmentation. Conclusion : The incidence of a newly developed, radiating pain after osteoporotic compression fractures increased gradually from the L3 to L5 levels. Most of these fractures were of the inferior type, and the bone cement augmentation procedures seemed to be sufficient for relief of both back and radiating pain.

The Two Cases Report of Bee Venom Injection on Patient with Low Back Pain Maintaining after Heating-Conduction Acupuncture Therapy (전열침 시술에 호전되지 않는 요통환자에 대한 봉독약침 치료 증례보고 2례)

  • Yeon, Chang-Ho;Park, Hyun-Gun;Yi, Woon-Sup;Kim, Jong-Yeon;Chung, Seok-Hee
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.7 no.2
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    • pp.75-81
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    • 2012
  • Objectives : According to previous reports, heating-conduction acupuncture treatment is very effective for sprain and strain of ligament. But there was no report about pain aggravation by heating-conduction acupuncture and relief from bee venom injection. In this article, we report two cases of pain aggravation by heating-conduction acupuncture treatment and relief from bee venom injection. Methods : We used heating-conduction acupuncture treatment on possible sprain of sacroiliac ligament diagnosed by physical examination. Outcomes were measured by Visual Analogue Scale(VAS), Range of Motion(ROM) and Belt test, Goldthwait test. Results : The patient has shown an aggravation on pain and ROM. And after we use subcutaneous bee venom injection, pain has relieved and ROM improved. Belt test, Goldthwait test also changed from positive to negative. Conclusions : In this report, we assured the effect of Bee venom injection. Further well-designed, controlled studies and more cases are needed to differentiate the indication of heating-conduction acupuncture and bee venom injection.

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Enhancing Performance of Multicast over Push-to-Talk over Cellular (PoC 멀티캐스트 성능향상 방안)

  • Kim, Ki-Il
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.17 no.7
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    • pp.1602-1608
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    • 2013
  • PoC (Push-to-Talk over Cellular) provides one-to-one as well as one-to-many communications with VoIP technology based on SIP over cellular networks. According to above property, PoC is considered as perscrptive technology for public protection for disaster relief networks. For this networks, group communication is the essential function. However, since current standardization process takes into general scenarios account without any consideration for mentioned networks, it have some problems in the point of adaptability. To solve above problem, in this paper, we propose how to reduce the overhead on the PoC server to reduce the transmission delay. Simulation results are shown to evaluate the improved performance.

Implantation of an Intrathecal Drug Administration System -A report of two cases- (척수강 내 약물 주입기의 이식 -증례보고-)

  • Lee, Sang Jin;Nam, Sang Kun;Kim, Jang Hyun;Kim, Hyun Joo;Lee, Sang Chul;Kim, Yong Chul
    • The Korean Journal of Pain
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    • v.22 no.1
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    • pp.68-73
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    • 2009
  • Opioids profoundly inhibit evoked discharges of spinal nociceptive neurons, thereby inhibiting the transmission of pain. Intrathecal administration of opioids using implantable continuous infusion systems is an effective method of pain relief when other treatments have failed, as well as for patients with adequate analgesia on high dose therapy that produces unacceptable side effects. We report two cases of intrathecal pump implantation performed in patients suffering from intractable chronic pain. A test dose of 3 mg morphine was injected into the epidural space. No side effects were noted and patients experienced considerable pain relief. Implantation was performed one day after the test. The initial intrathecal morphine delivery dose was half of the equivalent dose of daily oral intake opioids and the infusion rate was increased gradually under close observation for opioid side effects. Two days post-implantation, both patients were discharged without any complications.

Pain Control for Hydrofluoric Acid Chemical Burn Using EMLA® creams (EMLA® 연고를 이용한 불산 화학 화상의 통증 조절)

  • Choi, Hwan Jun;Song, Jin Woo;Choi, Chang Yong
    • Archives of Plastic Surgery
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    • v.36 no.1
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    • pp.113-117
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    • 2009
  • Purpose: Although Hydrofluoric acid(HF) is not a strong acid when compared to other hydrogen halides, it is a feared corrosive and is particularly dangerous at higher concentrations. HF burns are characterized by symptoms, often delayed and localized with diluted HF solutions, to include erythema, edema and severe pain. Pain, a well known symptom following exposure to calcium binding. And, EMLA$^{(R)}$ cream is a topical formulation based upon the eutectic mixture of lidocaine and prilocaine and is used in clinical settings to provide pain relief undergoing superficial surgical procedures. The aim of this study is to evaluate effects of EMLA$^{(R)}$ cream, pain - control dressing on the treatment for HF injury wound. Methods: From June 2007 to June 2008, this study was carried out with 10 patients who had HF partial thickness burns. We were applied topically EMLA$^{(R)}$ cream to injured wound with vaseline gauze and 10% calcium gluconate wet gauze dressings. As a principle, in the emergency treatment, partial or complete removal of the bullae along with copious washing with normal saline was done, depending on the degree of HF invasion of the distal digital extremities. The effect of dressing was investigated by visual analogue pain scale. Results: We therefore reviewed 10 cases of HF - induced pain and pain relief treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae and EMLA$^{(R)}$ related complications. Conclusion: Proper initial treatment of HF burns are important, if not promptly recognized and properly treated, for produce serious injury. Topical EMLA$^{(R)}$ cream remain a powerful, new advancement for minimizing HF - related pain during dressing procedures. When used appropriately, topical EMLA$^{(R)}$ cream can provide a safe and effective alternative to other forms of HF - pain control treatment.

In vitro and In vivo Activities Studies of Chois Mastic Using Self-microemulsifying Drug Delivery System (SMEDDS) against Helicobactor pylori (자가미세유화시스템을 이용한 매스틱의 헬리코박터파일로리 대한 In vitro 및 In vivo 활성 연구)

  • Kim, Su-Ji;Jeong, Sang-Young;Gil, Young-Sig;Shin, Byung-Cheol;Hwang, Sung-Joo;Cho, Sun-Hang
    • YAKHAK HOEJI
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    • v.55 no.1
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    • pp.1-10
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    • 2011
  • Mastic is a bleed resin formed in pistacia lentiscus tree extract form the anacatdiaceae family. Mastic is used as a food ingredient in the Mediteraanean resin, and has been used by local inhabitants as a traditional medicine for relief of upper abdominal discomfort, dyspepsiaand peptic ulcer. Clinically, mastic has been effective in the treatment of benign gastric and duodenal, ulcers, giving symptomatic relief and endoscopically proven healing. In this study, to enhance activiteies of poorly water soluble Mastic with oils, surfactants and cosurfactants and then the mixure was microemulsified in aqueous media under condition of gentle agitation and digestive motility that would be encountered in the gastrointestinal tract. Formulation development and screening were based on phase diagrams and characteristics of resultant microemulsion. For optimum mastic formulation, microemulsions with various ratio (w/w%) of mastics, oils, surfactants and cosurfactants were prepared and their solubility was evaluated by monitoring particles size in their buffer through visual asessment and electrophoretic light scattering spectrophotomerter (ELS). In vitro activity of self microemulsified mastic (SME mastic) was determined by minimum ingibition concentration (MIC) test against a panel of Helicobacter pylori (H. pylori) clinical strains. Additionally, in vivo activity of SME masitc was investigated us mouse infected by CH275 of H. pylori. The mean diameter of SME mastic was less then 100 nm in water and SME mastic was showed similar antiboisis effect compared to tometronidazole, clarithromycin and omeproazole. Consequently, SME mastic would be effective system to exterminate H. pylori. If mastic were dose with combined treatment, mastic might augur well for effect of H. pylori eradication as good remedy.

Analgesia of Electroacupuncture and Radio-Frequency Warm Needling in Acupoint Combination on Ankle Sprain in Rats (발목염좌에 배혈에 따른 전침과 고주파온침의 진통효과)

  • Yang, Seung-Bum;Kim, Min-Su;Kim, Jae-Hyo
    • Korean Journal of Acupuncture
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    • v.35 no.1
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    • pp.27-35
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    • 2018
  • Objectives : The purpose of this study was to investigate the analgesic effect of electroacupuncture(EA) and radio-frequency warm needling(RFWN) stimulation in acupoint combination on ankle sprained pain in rats. Methods : The lateral ligaments of the Sprague-Dawley rats ankle were injured surgically resulting in sprain, of which was divided into EA, RFWN treatment groups and control group without treatment. The level of pain was measured through foot weight bearing force ratio followed by calculating pain relief. To stimulate proximal or distal area in ankle sprain, combination of proximal acupoints(GB34-GB39) and distal acupoints(GB39-GB42) from sprain area were applied, respectively, to either EA or RFWN stimulation. In addition, naltrexone or phentolamine was injected intraperitoneally before the stimulation to observe the pathway of analgesic effects. Results : In the proximal combination of GB34-GB39, EA and RFWN significantly increased pain relief compared to the control group (p<0.05). However, in distal combination with GB39-GB42, both EA and RFWN stimulation did not relieve pain due to ankle sprains. In the combination of GB34-GB39, the analgesia of EA was inhibited by blockade of the ${\alpha}$-adrenoceptor receptor. The analgesia of RFWN was inhibited by blockade of the ${\alpha}$-adrenoceptor receptor as well as ${\mu}$-opioid receptor. Conclusions : We observed that the proximal combination was effective in relieving pain when the treatment by acupoint combination was applied to the ankle sprain pain. Also, it was confirmed that this analgesia was also related to the pathways of ${\mu}$-opioid receptors and/or ${\alpha}$-adrenoceptors.