• Title/Summary/Keyword: Systemic approach

Search Result 246, Processing Time 0.028 seconds

Technical and Clinical Considerations for Successful Management of Postoperative Bowel Perforation by Percutaneous Foley Catheter Placement (경피적 폴리 카테터 삽입을 이용하여 수술 후 장 누출을 성공적으로 관리하기 위한 기술적 및 임상적 요인들)

  • So young Cho;Jung Suk Oh;Hae Giu Lee;Byung Gil Choi
    • Journal of the Korean Society of Radiology
    • /
    • v.81 no.6
    • /
    • pp.1389-1396
    • /
    • 2020
  • Purpose The aim of this study was to analyze several technical and clinical factors associated with the successful management of postoperative leakage by percutaneous Foley catheter placement. Materials and Methods Thirty-two patients were included in this retrospective study. Postoperative gastrointestinal leakage was diagnosed by computed tomography (CT) and the patients underwent percutaneous Foley catheter placement into the leakage site through Jackson-Pratt tubes or imaging-guided methods. Clinical success was defined as successful Foley catheter removal without symptom recurrence within 1 week and the risk factors for clinical failure were analyzed. Results In all patients, percutaneous Foley catheter placement was successfully achieved without complications. Foley catheter was placed at a median of 10 days (range, 1-68) after the confirmation of leakage on CT. Clinical success was achieved in 26 of the 32 patients (81%). Systemic comorbidity (p < 0.001) and failed oral intake (p = 0.015) were the statistically significant risk factors for clinical failure. Conclusion Percutaneous Foley catheter placement can be considered an effective approach for the management of postoperative bowel leakage. The presence of systemic comorbidity and successful oral diet after Foley catheter placement are significant factors for successful clinical recovery.

Presurgical Nasoalverolar Molding in Fraternal Twins with Bilateral Cleft Lip and/or Palate: A Case Report (양측성 구순/구개열을 가진 이란성 쌍둥이를 대상으로 한 술전 비치조정형술: 증례보고)

  • Kim, Jinsun;Kim, Youngjin;Nam, Soonhyeun;Kim, Hyunjung
    • Journal of the korean academy of Pediatric Dentistry
    • /
    • v.41 no.1
    • /
    • pp.72-79
    • /
    • 2014
  • Cleft lip and palate(CLP) is one of the most common craniofacial deformities that requires systemic management involving a multidisciplinary team approach. Although there has been great improvement in the field of cleft surgery, surgical approach alone cannot resolve the various problems in treating cleft lip and palate. Hence the need for presurgical treatment was appreciated and especially, the concept of presurgical nasoalveolar molding was applied to treat unilateral and bilateral cleft lip and palate patients. Presurgical nasoalveolar molding(PNAM) of unilateral cleft mainly aims to recover nasal symmetry while the objectives of pre-surgical nasoalveolar molding in the bilateral cleft are to elongate the columella, to erect the tip of nose, and to reposition the forward displaced premaxillary region. This report covers the case of fraternal twins diagnosed with bilateral cleft. Retraction of the premaxillary region and nasoalveolar molding were conducted for 70 days until cheiloplasty, using elastic bands and nasoalveolar molding appliances. After cheiloplasty, there had been improvements in the length of columella and the position of forward-displaced premaxilla for both patients compared to their initial states. The esthetics was also satisfactory for both the surgery and the parents. In order to maximize the efficacy of the appliance, three components should be in balance; patients' adaptation to the appliance, parents' cooperation and proper selection and careful adjustment of the appliance by the dentist.

The Role of PK/PD Modeling and Simulation in Model-based New Drug Development (모델 기반학적 신약개발에서 약동/약력학 모델링 및 시뮬레이션의 역할)

  • Yun, Hwi-Yeol;Baek, In-Hwan;Seo, Jeong-Won;Bae, Kyung-Jin;Lee, Mann-Hyung;Kang, Won-Ku;Kwon, Kwang-Il
    • Korean Journal of Clinical Pharmacy
    • /
    • v.18 no.2
    • /
    • pp.84-96
    • /
    • 2008
  • In the recent, pharmacokinetic (PK)/pharmacodynamic (PD) modeling has appeared as a critical path tools in new drug development to optimize drug efficacy and safety. PK/PD modeling is the mathematical approaches of the relationships between PK and PD. This approach in new drug development can be estimated inaccessible PK and PD parameters, evaluated competing hypothesis, and predicted the response under new conditions. Additionally, PK/PD modeling provides the information about systemic conditions for understanding the pharmacology and biology. These advantages of PK/PD model development are to provide the early decision-making information in new drug development process, and to improve the prediction power for the success of clinical trials. The purpose of this review article is to summarize the PK/PD modeling process, and to provide the theoretical and practical information about widely used PK/PD models. This review also provides model schemes and the differential equations for the development of PK/PD model.

  • PDF

Hyperventilation due to Incision & Drainage under Inadequate Psychosedation & Local Anesthesia in Advanced Odontogenic Infectious Lesion (진행성 치성 감염병소에서 부적절한 진정요법과 국소마취 시행하 절개 배농술에 따른 과환기증)

  • Oh, Ji-Hyeon;Son, Jeong-Seog;Yoo, Jae-Ha;Kim, Jong-Bae
    • Journal of The Korean Dental Society of Anesthesiology
    • /
    • v.14 no.1
    • /
    • pp.63-71
    • /
    • 2014
  • Extension of advanced odontogenic infection from deep neck fascial spaces into the mediastinum is heralded by chest pain, dyspnea, fever, and radiographic demonstration of mediastinal widening. The critical care should be done in a team approach by multiple medical and dental departments, such as, oral & maxillofacial surgery, otolaryngology, anesthesiology, chest surgery, and infection medicine. Especially, fluid & drug therapy, adequate incision & drainage and systemic supportive psychosedation care are important. But, acute hyperventilation can be produced by several distinct causes: severe anxiety, respiratory alkalosis, increased blood catecholamine levels, and a decrease in the level of the ionized calcium in the blood. The orofacial fears about acute pain, trismus, dysphagia, swelling and oral surgical treatment lead to the severe anxiety and increased blood catecholamine level by stress. Therefore, the most dental patient should be cared gently as the stress reduction protocol. In spite of the care, hyperventilation was occurred during psychosedation and local anesthesia for incision and drainage of the masticatory fascial space abscess with deep neck infection & mediastinitis. We suggest that the dental patient with advanced odontogenic infection must be attention for the manifestation of hyperventilation, especially in the medically compromised conditions.

Weekly Cisplatin-Based Concurrent Chemoradiotherapy for Treatment of Locally Advanced Head and Neck Cancer: a Single Institution Study

  • Ghosh, Saptarshi;Rao, Pamidimukkala Brahmananda;Kumar, P Ravindra;Manam, Surendra
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.16 no.16
    • /
    • pp.7309-7313
    • /
    • 2015
  • Background: The organ preservation approach of choice for the treatment of locally advanced head and neck cancers is concurrent chemoradiation with three weekly high doses of cisplatin. Although this is an efficacious treatment policy, it has high acute systemic and mucosal toxicities, which lead to frequent treatment breaks and increased overall treatment time. Hence, the current study was undertaken to evaluate the efficacy of concurrent chemoradiation using 40 mg/m2 weekly cisplatin. Materials and Methods: This is a single institutional retrospective study including the data of 266 locally advanced head and neck cancer patients who were treated with concurrent chemoradiation using 40 mg/m2 weekly cisplatin from January 2012 to January 2014. A p-value of < 0.05 was taken to be significant statistically for all purposes in the study. Results: The mean age of the study patients was 48.8 years. Some 36.1% of the patients had oral cavity primary tumors. The mean overall treatment time was 57.2 days. With a mean follow up of 15.2 months for all study patients and 17.5 months for survivors, 3 year local control, locoregional control and disease free survival were seen in 62.8%, 42.8% and 42.1% of the study patients. Primary tumor site, nodal stage of disease, AJCC stage of the disease and number of cycles of weekly cisplatin demonstrated statistically significant correlations with 3 year local control, locoregional control and disease free survival. Conclusions: Concurrent chemoradiotherapy with moderate dose weekly cisplatin is an efficacious treatment regime for locally advanced head and neck cancers with tolerable toxicity which can be used in developing countries with limited resources.

Antinociceptive Effect of Memantine and Morphine on Vincristine-induced Peripheral Neuropathy in Rats

  • Park, Byoung-Yoon;Park, Sang-Hee;Kim, Woong-Mo;Yoon, Myung-Ha;Lee, Hyung-Gon
    • The Korean Journal of Pain
    • /
    • v.23 no.3
    • /
    • pp.179-185
    • /
    • 2010
  • Background: Vincristine-induced peripheral neuropathy is a major dose limiting side effect and thus effective therapeutic strategy is required. In this study, we investigated the antinociceptive effect of memantine and morphine on a vincristine-induced peripheral neuropathy model in rats. Methods: Male Sprague-Dawley rats weighing 220-240 g were used in all experiments. Rats subsequently received daily intraperitoneal injections of either vincristine sulfate (0.1 ml/kg/day) or saline (0.1 ml/kg/day) over 12 days, immediately following behavioral testing. For assessment of mechanical allodynia, mechanical stimuli using von Frey filament was applied to the paw to measure withdrawal threshold. The effects of N-methyl-D-aspartate receptors antagonist (memantine; 2.5, 5, 10 mg/kg intraperitoneal), opioid agonist (morphine; 2.5, 5, 10 mg/kg intraperitoneal) and vehicle (saline) on vicristine-induced neuropathy were evaluated. Results: Mechanical allodynia developed over the course of ten daily injections of vincristine relative to groups receiving saline at the same time. Morphine abolished the reduction in paw withdrawal threshold compared to vehicle and produced dose-responsiveness. Only the highest dose of memantine (10 mg/kg) was able to increase paw withdrawal threshold compared to vehicle. Conclusions: Systemic morphine and memantine have an antinociceptive effect on the vincristine-induced peripheral neuropathy model in rats. These results suggest morphine and memantine may be an alternative approach for the treatment of vincristine-induced peripheral neuropathic pain.

Fire-Flame Detection using Fuzzy Finite Automata (퍼지 유한상태 오토마타를 이용한 화재 불꽃 감지)

  • Ham, Sun-Jae;Ko, Byoung-Chul
    • Journal of KIISE:Software and Applications
    • /
    • v.37 no.9
    • /
    • pp.712-721
    • /
    • 2010
  • This paper proposes a new fire-flame detection method using probabilistic membership function of visual features and Fuzzy Finite Automata (FFA). First, moving regions are detected by analyzing the background subtraction and candidate flame regions then identified by applying flame color models. Since flame regions generally have continuous and an irregular pattern continuously, membership functions of variance of intensity, wavelet energy and motion orientation are generated and applied to FFA. Since FFA combines the capabilities of automata with fuzzy logic, it not only provides a systemic approach to handle uncertainty in computational systems, but also can handle continuous spaces. The proposed algorithm is successfully applied to various fire videos and shows a better detection performance when compared with other methods.

A Study on the Evaluation of 'Small Library' Design Applying Natural Environmental Characteristics - Focused on the Case Study - (자연환경 특성을 적용한 '작은도서관' 디자인 평가에 관한 연구 - 사례조사를 중심으로 -)

  • Hong, Min-Hee;Shim, Eun-ju
    • The Journal of Sustainable Design and Educational Environment Research
    • /
    • v.19 no.1
    • /
    • pp.3-12
    • /
    • 2020
  • Many libraries have recently become enlarged and industrialized. Spaces dedicated to natural environments and climates in libraries have been isolated, and spaces that take natural environments into consideration have only recently started to receive attention. People all around the world enjoy reading books in nature. Reading is interpreted as the same context as the desire to go somewhere higher. Contemporary people have discovered ways to enjoy reading books along with nature by establishing bookshelves in mountains, forests, or green fields. These people have created libraries that place nature as the protagonist. In spatial terms, natural environments mainly encompass scientific and systemic concepts and embrace a sentimental approach to the natural environments of local areas not previously considered. The purpose of this research study is to present the direction for spatial planning that harmonizes nature with space, and to propose the spatial planning of a "small library" by applying natural environmental characteristics.

Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection

  • Jung, Ki-Hyun;Ro, Seong-Su;Lee, Seong-Won;Jeon, Jae-Yoon;Park, Chang-Joo;Hwang, Kyung-Gyun
    • Maxillofacial Plastic and Reconstructive Surgery
    • /
    • v.41
    • /
    • pp.25.1-25.5
    • /
    • 2019
  • Background: Brain abscess is a life-threatening condition that occurs due to complications during a neurosurgical procedure, direct cranial trauma, or the presence of local or distal infection. Infection in the oral cavity can also be considered a source of brain abscess. Case presentation: A 45-year-old male patient was transported with brain abscess in the subcortical white matter. Navigation-guided abscess aspiration and drainage was performed in the right mid-frontal lobe, but the symptoms continued to worsen after the procedure. A panoramic radiograph showed alveolar bone resorption around the maxillary molars. The compromised maxillary molars were extracted under local anesthesia, and antibiotics were applied based on findings from bacterial culture. A brain MRI confirmed that the three brain abscesses in the frontal lobe were reduced in size, and the patient's symptoms began to improve after the extractions. Conclusion: This is a rare case report about multiple uncontrolled brain abscesses treated by removal of infection through the extraction of maxillary molars with odontogenic infection. Untreated odontogenic infection can also be considered a cause of brain abscess. Therefore, it is necessary to recognize the possibility that untreated odontogenic infection can lead to serious systemic inflammatory diseases such as brain abscess. Through a multidisciplinary approach to diagnosis and treatment, physicians should be encouraged to consider odontogenic infections as a potential cause of brain abscesses.

The Trend and Issues of the Gerontological Nursing Study in Korea (국내 노인간호연구 분석과 발전방향)

  • 이영란;김신미;박혜옥;박효미;조계화;노유자
    • Journal of Korean Academy of Nursing
    • /
    • v.28 no.3
    • /
    • pp.676-694
    • /
    • 1998
  • Issues related to the elderly have been recognized in Korea and nursing schalors have tried to study these issues. It is hard to say which the direction we, are going or have to go, since there has been little systemic effort to establish gerontological nursing field yet. Therefore, it is necessary to find out the trend and the guidelines of gerontolotical nursing studies for the future. Dissertation and published articles related to the elderly in the nursing field from 1991 to the Feburary of 1997 were are reviewed. Total 127 studies were analysed in terms of concept, design/methodology, and results, and the nature and issues of the gerontologic nursing studies in Korea were explored. The results are as follows : 1. There was no clear chronological definition of the elderly. 2. The most popular research design was an exploratory/descriptive study. 3. The major concepts studied were physical and mental health. 4. Among those studies using instruments which were developed and modified and/or translated by researchers, the reliability and validity were rarely reported. 5. Theory based studies were rare. We suggest the following issues for future studies : 1. The chronological and other criteria related to the defition of elderly is needed. 2. Physiopsychosocial characteristics of Korean elderly and their mangements in terms of intervention studies need to be conducted more systemically. 3. Social issues from the change of types and functions of family such as single elderly family need to be studied. 4. Participation in and collaborate with other disciplins are needed. 5. Development and test of instruments to measure phenomena or concepts is needed. 6. Macroscopic approach such as policy also needed. 7. Theory based studies are needed.

  • PDF