• Journal of Digestive Cancer Research
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• 제11권3호
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• pp.125-129
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• 2023

Appropriate sedation and analgesia are crucial for successful endoscopic procedures, patient safety, and satisfaction. Endoscopic resection for upper gastrointestinal tumors requires a deep sedation level because the procedure is lengthy and induces moderate to severe pain. Continuous patient consciousness assessment and vigilant vital signs monitoring are required for deep sedation. General anesthesia may unintentionally occur even during deep sedation for endoscopic tumor resection, which may cause unexpected complications, especially in high-risk patients. Previous studies have revealed that general anesthesia increases the en bloc resection rate and decreases the procedure time. Complications, such as perforation, aspiration pneumonia, and cardiopulmonary instability, including hypoxemia, hypotension, and arrhythmia, occurred more frequently in patients with sedation compared to those with general anesthesia. Therefore, general anesthesia demonstrated potential benefits in endoscopic treatment results and patient safety. General anesthesia should be considered a useful alternative for sedation in patients undergoing endoscopic gastrointestinal tumor resection. However, more high-quality prospective studies are required to determine the safety and effectiveness of general anesthesia in endoscopic upper gastrointestinal tumor resection because most studies comparing general anesthesia and sedation in these procedures have been retrospectively conducted and the results were inconsistent.

• Radiation Oncology Journal
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• 제29권2호
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• pp.121-126
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• 2011

담도암 환자의 방사선치료 기간 중, 총담도에 삽입된 스텐트가 환자 복부의 우측부터 좌측까지 매우 넓은 범위로 움직인 경우를 발견하였다. 환자는 80세 노령의 여자로 흉추가 심한 척추 후만증을 보였고 흉추와 요추 몇 부위들에 압박골절이 있어서 키가 작았고 복부장기들이 아래로 내려와 있었다. 환자는 쇠약하고 야윈 상태였는데 방사선치료 기간 중 매주 컴퓨터단층촬영을 시행하여 비교한 결과 몸의 좌우방향으로 4 cm 이상의 스텐트의 위치 이동을 보였다. 따라서 흉추 후만증이 있으며서 몸이 매우 야윈 담도암 환자의 경우 방사선치료 범위 설정 시에 치료 기간 중 담도나 스텐트가 크게 움직일 가능성을 고려해야 할 것이다.

• Journal of Gastric Cancer
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• 제16권2호
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• pp.115-119
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• 2016

We report the case of a patient with gastric adenocarcinoma with multiple liver metastases. This patient showed complete remission for more than 68 months after S-1/cisplatin combination chemotherapy and radical total gastrectomy. The patient, a 63-year-old man, presented with dyspepsia and difficulty in swallowing. Endoscopic findings showed a huge ulcero-infiltrative mass at the lesser curvature of the mid-body, extending to the distal esophagus. Biopsy revealed a poorly differentiated tubular adenocarcinoma. An abdominal computed tomography scan demonstrated multiple hepatic metastases. S-1/cisplatin combination chemotherapy was initiated, and following completion of six cycles of chemotherapy, the gastric masses and hepatic metastatic lesions had disappeared on abdominal computed tomography. Radical total gastrectomy and D2 lymphadenectomy combined with splenectomy were performed. The patient underwent three cycles of S-1/cisplatin combination chemotherapy followed by tegafur-uracil therapy for 1 year. He remained in complete remission for more than 68 months after surgery.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.18-21
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• 2023

The combination of oxycodone and naloxone is useful for cancer pain management. Naloxone, as a pure opioid antagonist, cannot be used simultaneously with opioids. However, owing to its low bioavailability, it can be used in an oral composite formulation. We present the case of a 55-year-old man with gastric cancer who experienced severe opioid withdrawal syndrome (OWS) triggered by oxycodone/naloxone that was successfully managed with dexmedetomidine. He had been in a stable condition on intravenous morphine to alleviate cancer pain. Intravenous morphine was switched to oral oxycodone/naloxone for discharge from the hospital. The patient suddenly developed restlessness, heartburn, and violent behavior 30 minutes after taking oxycodone/naloxone. We attempted sedation with midazolam and propofol, but paradoxical agitation and desaturation occurred. Next, we tried dexmedetomidine and the patient showed a decreased heart rate and reduced agitation. The patient was eventually stabilized by increasing the dose of dexmedetomidine. This report informs clinicians of the possibility of OWS when switching from opioids to oxycodone/naloxone, which can be overcome with the appropriate use of sedatives and dexmedetomidine depending on the patient's condition.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.547-552
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• 2013

To investigate patient, cancer and treatment characteristics in females with breast cancer from more remote areas of Australia, to better understand reasons for their poorer outcomes, bi-variable and multivariable analyses were undertaken using the National Breast Cancer Audit database of the Society of Breast Surgeons of Australia and New Zealand. Results indicated that patients from more remote areas were more likely to be of lower socio-economic status and be treated in earlier diagnostic epochs and at inner regional and remote rather than major city centres. They were also more likely to be treated by low case load surgeons, although this finding was only of marginal statistical significance in multivariable analysis (p=0.074). Patients from more remote areas were less likely than those from major cities to be treated by breast conserving surgery, as opposed to mastectomy, and less likely to have adjuvant radiotherapy when having breast conserving surgery. They had a higher rate of adjuvant chemotherapy. Further monitoring will be important to determine whether breast conserving surgery and adjuvant radiotherapy utilization increase in rural patients following the introduction of regional cancer centres recently funded to improve service access in these areas.

• 한국병원경영학회지
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• 제26권4호
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• pp.59-66
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• 2021

Purposes: This study aimed to identify relevant factors that determine cancer surgery at a medium-sized general hospital where patients are diagnosed with cancer. Methodology: The study subjects were 1,530 patients diagnosed with cancer between November 2013 and October 2019 at a 400-bed general hospital located in the metropolitan area. Multiple logistic regression analysis was performed to identify the patient characteristics, cancer types, and characteristics of treatment experience of the study subjects, in addition to the determinants of cancer surgery in the hospital. Findings: Among 1,530 cases diagnosed with cancer, 353 cases (23.1%) were operated at the hospital where the cancer diagnosis was made. As determinants of surgery after a fist-time diagnosis at a general hospital, the likelihood of having surgery at the hospital, for colorectal cancer patients compared to stomach cancer patients (Odds Ratio=2.38), bladder and kidney cancer patients (Odds Ratio=1.79). According to the results of an additional survey conducted, it was found that important determinants of decisions on a hospital to receive cancer surgery were the kindness of the staff including doctors and nurses, and the trust in the medical skills and technique of the doctor. Practical Implication: The management of general hospitals should take note of the fact that it is important to establish proactive strategies for hospital management including strengthening the rapport between patients and medical institutions based on the kindness of medical staff (doctors and nurses) and staff, in addition to promoting cancer adequacy evaluation results and introducing one-stop systems.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8135-8142
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• 2014

Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.

• 대한상한금궤의학회지
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• 제4권1호
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• pp.37-47
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• 2012

Objective : This study is intended to demonstrate the effect of FulingXingrenGancao-Tang on worsened dyspnea after medical treatment for thymic cancer. Method : We diagnosed this case as XiongbiXintongDuanqi(胸痺心痛短氣病) in Jinguiyaolue and treated this patient with FulingXingrenGancao-Tang. Results : By using ZhishiXiebaiGuizhi-Tang, LingGuiWeiGan-Tang, Fuling XingrenGancao-Tang, the patient's symptoms were significantly decreased. Conclusion : This study shows that FulingXingrenGancao-Tang is effective on dyspnea after medical treatment of thymic cancer. However further clinical studies are needed.

• 대한간호학회지
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• 제29권5호
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• pp.1113-1122
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• 1999

The author investigated pain experiences of 90 cancer patients and the adequacy of pain treatment they have received during their stay at a large medical center in T city between October 1994 and August 1995. Pain was assessed by the Shortened BPQ and results are summarized as follows: As for ratings of “worst pain” during the 24 hour period, 70% of the patients reported they had “severe” pain. As for ratings on “pain now,” 43% of the cancer patients reported “moderate to severe” pain. Over 46% of the patients reported a pain relief score of 0(not at all) or 1(somewhat) even after receiving pain medication. Adequacy of analgesic treatment was evaluated by comparing the patient's reported level of pain and the analgesic use, namely, the pain management index(PMI). The PMI indicated that 58% of the patients were undertreated for the pain control. In review of nurse's notes. systematic pain assessment was scarcely recorded, although pain documentation appeared in 70% of the notes; and the contents were mostly simple description. In conclusion, the results of patient's pain ratings, the PMI and poor pain documentation in the nurse's notes implied poor pain assessment and management.