• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.3639-3644
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• 2015

Oral, cervical and breast cancers, which are either preventable and/or amenable to early detection and treatment, are the leading causes of cancer-related morbidity and mortality in India. In this paper, we describe implementation science research priorities to catalyze the prevention and control of these cancers in India. Research priorities were organized using a framework based on the implementation science literature and the World Health Organization's definition of health systems. They addressed both community-level as well as health systems-level issues. Community-level or "pull" priorities included the need to identify effective strategies to raise public awareness and understanding of cancer prevention, monitor knowledge levels, and address fear and stigma. Health systems-level or "push" and "infrastructure" priorities included dissemination of evidence-based practices, testing of point-of-care technologies for screening and diagnosis, identification of appropriate service delivery and financing models, and assessment of strategies to enhance the health workforce. Given the extent of available evidence, it is critical that cancer prevention and treatment efforts in India are accelerated. Implementation science research can generate critical insights and evidence to inform this acceleration.

• 대한한방내과학회지
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• 제27권2호
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• pp.416-428
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• 2006

Objectives : Arterial stiffness and pulse pressure are related to cardiovascular and cerebrovascular survival and longevity. This study is aimed at examining the effects of Chungpyesagan-tang on arterial stiffness and Pulse pressure in acute stroke Patients. Methods: The subject of this study was acute strike Patients within 1 week after ictus, with Cardio-ankle vascular index(CAVI) higher than 9.0. They were divided into two groups: A treatment group (n=44) and a control group(n=46). For two weeks, Chungpyesagan-tang was given to the former, other herbal medicines to the latter. used for stroke patients for the control group for 2 weeks. At the end of first and second week, CAVI, pulse Pressure, National Institute of Health stroke scale(NIHSS), Modified Barthel Index(MBI) were measured. Serum lipid Profile, aspartate transaminase(AST), alanine transaminase(ALT). blood urea nitrogen(BUN), creatinine were also measured at the end of the study. Results : After 2 weeks, CAVI and Pulse Pressure in Chungpyesagan-tane group were significantly tower than those in the control group(P<0.05). NIHSS and MBI were improved in both groups. But there was no significant difference between the treatment group and the control group in terms of the NIHSS and MBI. Conclusions : We suggest Chungpyesagan-tanghas desirable effects on arterial stiffness and Pulse Pressure of acute stroke patients. It can improve morbidity and mortality of patients on the basis of influencing vascular stiffness and increased pulse pressure.

• Journal of Chest Surgery
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• 제33권8호
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• pp.662-668
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• 2000

Background: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. Material and Method: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs(43∼70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy(24) and CT scans(7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. Result: All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects(6), refusal(1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. Conclusion: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

• Radiation Oncology Journal
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• 제38권2호
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• pp.119-128
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• 2020

Purpose: Colorectal cancer is becoming an increasing concern in the middle-aged population of Iran. This study aimed to compare the preliminary results of short-course and long-course neoadjuvant chemoradiotherapy treatment for rectal cancer patients. Materials and Methods: In this clinical trial we recruited patients with rectal adenocarcinoma located from 5 cm to 15 cm above the anal verge. Patients in group I (short-course) received three-dimensional conformational radiotherapy with a dose of 25 Gy/5 fractions in 1 week plus concurrent XELOX regimen (capecitabine 625 mg/㎡ from day 1-5 twice daily and oxaliplatin 50 mg/㎡ on day 1 once daily). Patients in group II (long-course) received a total dose of 50-50.4 Gy/25-28 fractions for 5 to 5.5 weeks plus capecitabine 825 mg/㎡ twice daily. Both groups underwent consolidation chemotherapy followed by delayed surgery at least 8 weeks after radiotherapy completion. The pathological response was assessed with tumor regression grade. Results: In this preliminary report on complications and pathological response, 66 patients were randomized into two study groups. Mean duration of radiotherapy in the group II (long-course) was 5 ± 1 days (range, 5 to 8 days) and 38 ± 6 days (range, 30 to 58 days). The median follow-up was 18 months. Pathological complete response was achieved in 32.3% and 23.1% of patients in the shortcourse and long-course groups, respectively (p = 0.558). Overall, acute grade 3 or higher treatment-related toxicities occurred in 24.2% and 22.2% of patients in group I and II, respectively (p = 0.551). No acute grade 4 or 5 adverse events were observed in either group except one grade 4 hematologic toxicity that was seen in group II. Within one month of surgery, no significant difference was seen regarding grade ≥3 postoperative complications (p = 0.333). Conclusion: For patients with rectal cancer located at least 5 cm above the anal verge, short-course radiotherapy with concurrent and consolidation chemotherapy and delayed surgery is not different in terms of acute toxicity, postoperative morbidity, complete resection, and pathological response compared to long-course chemoradiotherapy.

• Tuberculosis and Respiratory Diseases
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• 제73권1호
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• pp.38-47
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• 2012

Background: The prevalence rate of pulmonary tuberculosis (PTB) is steadily decreasing in South Korea. However, PTB is a disease with relatively high mortality and morbidity rates throughout Korea. Although there are many studies and statistics about the risk factors of PTB mortality in many countries, there are only a limited number of domestic papers on this topic. The aim of this study is to determine predictive factors for mortality among in-hospital patients associated with PTB. Methods: From December 2006 to January 2011, we reviewed medical records of 2,122 adult patients diagnosed with tuberculosis at a single tertiary hospital in a suburban area. In this study period, 960 patients were diagnosed with PTB by positive Acid fast bacilli smear and/or mycobacterial culture of the respiratory specimen. We compared the groups of patients deceased and patients discharged alive with PTB. The number of dead patients was 82 (47 males, 35 females). Results: Mortality was significantly associated with increased values of white blood cells (WBC), blood urine nitrogen (BUN), creatinine, C-reactive protein (CRP), numbers of involved lung field, and length of hospitalization. Also, it was associated with the decreased values of hemoglobin, lymphocyte, sodium, albumin, and cholesterol. Furthermore, admission through the emergency department, initial intensive care unit admission, and drug resistant PTB affected mortality in PTB patients. Independent predictors associated with PTB mortality are BUN, initial intensive care unit care, and admission during treatment of tuberculosis. Conclusion: In our study, mortality of pulmonary tuberculosis was related with parameters associated with nutritional status, disease severity at the time of admission, and drug resistance.

• Journal of Yeungnam Medical Science
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• 제38권2호
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• pp.136-141
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• 2021

Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients' preoperative estimated glomerular filtration rate (eGFR) was 66.66 ±34.02 mL/min/1.73 m² in the AKI group and 78.07±21.23 mL/min/1.73 m² in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

• 대한정형외과학회지
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• 제54권6호
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• pp.574-578
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• 2019

급성 견관절 탈구에 동반된 골성 반카르트 병변은 골편과 상완인대의 정확한 해부학적 정복과 안정된 고정이 치료에 필수적이며, 이의 실패는 견관절 재발성 불안정성과 외상 후 관절염을 유발할 수 있다. 반카르트 병변에 큰 뼈 조각 또는 분쇄된 골절 파편이 있는 경우, 관절경 수술 시 제한된 시야와 조작의 어려움으로 큰 골편을 골절 부위에 정확하고 견고하게 고정하는 것이 어렵다. 개방형 시술 시는 골편에 도달하고 고정하기 위하여 광범위한 연부 조직 유리 및 절제가 필요하여 이는 신경과 혈관 합병증, 견갑하건의 약화 및 견관절 강직 등, 외과적 접근법과 관련된 병적 상태를 유발할 수 있다. 저자들은 관절경적 수술이 용이하지 않은 크기의 관절와 골절이 동반한 견관절 전방 탈구 환자에서 골절면에 봉합나사 고정 후 골 터널을 만든 골편에 봉합사를 통과한 후 골편 및 상완인대를 함께 매듭 하여, 해부학적 위치로 안정된 정복을 얻는 수술방법을 보고하고자 한다.

• Tuberculosis and Respiratory Diseases
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• 제47권1호
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• pp.77-89
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• 1999

연구 배경: 고위험군의 악성 질환의 치료로 최근에 시도되고 있는 고용량 항암화학요법은 기존의 치료보다 치료 반응율이 높고 생존의 향상을 기대할수 있는 방법이다. 그러나 치료와 관련된 부작용도 있어 이환율 및 사망률도 높다. 말초 조혈모세포이식을 이용한 고용량 항암화학요법 후에 발생하는 특발성 폐렴 증후군은 감염성 원인을 배제한다면 약제에 의한 폐독성으로 유발되었을 가능성이 가장 높다. 저자들은 약제 독성으로 유발되었을 것으로 추정되는 폐렴 증후군에 대하여 알아보고자 하였다. 방법: 1995년 5월부터 1997년 12월까지 아주대학교병원에서 말초 조혈모세포이식을 이용한 고용량 항암화학 요법을 시행받은 환자들을 대상으로 하였다. 이들 중 특발성 폐렴 증후군이 발생한 5례에서 경기관지폐생검을 시행하고 그 임상 양상과 치료 결과를 후향적으로 분석하였다. 결과: 전체 대상 환자는 97례이었으며 이들중 5례(5.1%)에서 특발성 폐렴 증후군이 발생하였다. 5례의 환자의 연령은 평균 $41{\pm}13$세, 남녀비는 3:2였으며 유방암 3례, 악성 림프종 2례이었다. 사용된 항암제는 CBP regimen 3례, BEAC regimen 1례, BEAM regimen 1례이었으며, 사용된 용량은 BCNU 300-400 mg/$m^2$, cyclophosphsmide 6,000 mg/$m^2$이었다. 다섯 례 모두에서 고용량 항암화학요법 전에 방사선 치료를 받았다. 고용량 항암화학요법을 시행한지 평균 14주 후 (4-26주)에 기침, 호흡곤란, 발열 등을 동반한 폐침윤이 발생하였다. 흉부 방사선 검사 소견상 3례에서는 양측성, 2례에서는 우하엽에 국한된 미만성의 폐침윤을 보였다. 경기관지폐생검 결과 폐포 손상과 격막의 비후, 비정상적인 제 II 형 폐세포의 증식이 관찰되었고 악성 세포의 침윤이나 감염성 질환 등의 소견은 없었다. 모든 환자에서 스테로이드를 투여하였으나 2례에서는 급성 호흡부전증으로 진행하여 사망하였다. 3례에서는 폐병변이 소실되고 중상도 호전되었으나 1례는 확장성 심근병으로 사망하였고 2례는 호전되어 폐병변이 없는 상태에서 외래 관찰 중이다. 결론: 말초 조혈모세포이식을 이용한 고용량 항암화학요법은 치료 효과가 기존의 항암치료보다 높지만 BCNU를 포함하는 복합 화학요법을 사용하는 경우 약제에 폐손상이 발생할 가능성이 있어 적절한 환자의 선정과 폐손상을 최소화할 수 있도록 유의하여야 한다.

• 대한핵의학회지
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• 제25권2호
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• pp.192-199
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• 1991

Peripheral arterial disease, because of it's significant and prolonged morbidity and related mortality is a major medical and surgical problem. Contrast angiogram remains the essential standard for the anatomic demonstration of disease. It does not, however, provide data suitable for quantification or any evaluation of the microcirculation. For these reasons, radionuclide studies are playing an increasingly important role by not only confirming the diagnosis and offering objective data on the physiologic significance of anatomic lesions, but by offering prognosis of healing and prediction of therapeutic results. In addition, radionuclide procedures offer means to safely and repeatedly monitor response to therapy and long term follow up. The object of this study was to evaluate the clinical availability of $^{201}T1$ perfusion scan in patients with peripheral arterial diseases. We performed $^{201}T1$ perfusion scans in patients with five Buerger' s disease (10 legs), six DM gangrenes (12 legs) and classified three perfusion pattern groups. Finally we compared treatment modalities among each groups and compaired T1-201 perfusion scan findings with angiographic findings in six patients with Buerger's disease. The results were as follows: 1) Seven legs showed increased perfusion in stress image and normal or increased perfusion in resting image (type 1). Six legs showed decreased perfusion in stress image and improved in resting image (type II). Of total 13 legs, only 1 leg needed to amputation. 2) Three legs showed decreased perfusion in stress and resting image (type III), and subsequently all cases were received surgical amputation. 3) In six Buerger's disease patients, there were disagreements in two patients (2 legs) between $^{201}T1$ scan and angiography, in which angiograms were normal but $^{201}T1$ scans showed 'type II' perfusion patterns.

• Journal of Chest Surgery
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• 제30권7호
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• pp.693-700
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• 1997

싣낭삼출액에 대한 검상하 심낭배액술의 임상적 효용성을 알아보기 위하여 1986년 1월부터 1995년 12월까지 10년간 서울대학교병원 흉부외과에서 검상하 심낭배액술을 시행 받았던 총 80명의 환자를 대상으로 임상 기록을 분석하였다. 남녀 구성은 남자 39명, 여자 41명이었으며, 연령은 20세에서 80세까지 분포하였고 평균 50$\pm$15세였다. 수술 전 모든 환자에서 심초음파 검사를 시행하여 심방삼출을 확인하였다. 50명(62.5%)의 환 자는 전신마취 하에 수술을 시행하였고 30명(37.5%)의 환자는 국소마취 하에서 수술을 시행하였다. 악성종양 에 의한 심낭삼출액은 33례(41.3%)였으며 이들 중 결과 확인이 가능했던 31례의 심낭액 세포검사와 29례의 심낭조직 생검 결과 각각 14례(45%)와 7례(24%)에서 양성이었다. 결핵성 심낭삼출액은 27례(33.8%)였으며 이 들 중 12례(44.4%)에서 확진이 가능했는데, 배양검사에서 결핵균이 자란 경우는 1례 뿐이었고, 조직생검에서 건락괴사를 동반한 만성 육아종성 염증소견이 확인된 경우는 12례였다. 수술사망은 14례(17.5%)였으며 모두 악성 심낭삼출 환자였다. 수술사망 환자 중 수술수기와 직접 연관되어 사망한 경우는 없 駭\ulcorner 수술사망 14례를 제외한 나머지 66명의 환자들에 대한 추적관찰 기간은 9일에서 5년까지로, 평균 452일이었다. 추적기간 중 심낭삼출의 재발로 다시금 심낭배액술이 필요했던 경우는 모두 6례(7.5%)였으며 그중 1례는 재수술 직후 갑작스런 심정지로 사망하였다. 만성 압박성 심낭염으로 이행되었던 경우는 4례(5%)였으며 이들 중 2명은 심낭절제술을 시행 받았다. 결론적으로 검상하 심낭배액술은 비교적 간편하고 안전하게 시행할 수 있으며, 심낭배액술시 시행하는 심낭액 세포검사와 조직생검을 통해 원인 진단에도 도움을 줄 수 있다고 생각된다.