• 제목/요약/키워드: conventional medicine

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두경부 재건을 위한 피판 선택에서 천공지피판의 역할 (Contribution of Perforator Flaps in the Flap Selection for Head and Neck Reconstruction)

  • 김정태
    • 대한두경부종양학회지
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    • 제35권1호
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    • pp.1-11
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    • 2019
  • In head and neck reconstruction, microsurgeons are faced with various demands, such as thin resurfacing, or three-dimensional reconstruction, and therefore, conventional flap as well as perforator flaps are all useful for the functional and aesthetic reconstruction successfully. Among perforator flaps, the pros and cons of anterolateral thigh perforator flap(ALTp) and thoracodorsal perforator flap(TAp) is compared and selected depending on the surgeon's preference, recipient site condition or patient status. Both flaps can be elevated in a chimeric pattern by combining different aspects of tissue components. Customized or tailored reconstruction as well as 3 dimensional reconstructions are all available with perforator flaps and it is useful in head and neck reconstruction. The most outstanding update in head and neck reconstruction is the perforator based island flap (PBIF) compared to conventional flaps. The conventional local flap has evolved on behalf of the perforator concept and its design becomes more flexible and freestyle with less limitations. Actually, random pattern flap is now a misnomer and most conventional local flaps turn into PBIFs. Finally we can say all conventional donor site becomes universal, depending on the surgeons' preference or idea. Moreover, there is no more "flap of choice" and postoperative results are quite variable by surgeons' ability. Operative procedures and plans are very flexible to freestyle flap. With all these advantages, surgeons should be armed with both conventional and perforator concepts for solving any defects or problems.

기관기내시경상 이상병변을 보이는 환자에게 있어 Thinprep검사법과 기존세포검사법의 효율성 및 유용성에 대한 비교 (Comparison of Thinprep (Liquid-Based Cytology) and Conventional Cytology : Abnormal Lesion on Bronchoscopy)

  • 이정호;양정경;정인범;이정의;설혜정;김윤미;김범경;최유진;나문준;손지웅
    • Tuberculosis and Respiratory Diseases
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    • 제61권6호
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    • pp.547-553
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    • 2006
  • 배 경: 액상 세포학 검사법(Liquid-based cytology)은 최근들어 각광을 받고있는 검사방법으로 여러 연구, 특히 산부인과적 영역에서 암진단에 높은 효율성을 보여주고 있다. 본 저자들은 기관지내시경상 이상병변을 보이는 환자에서 세척세포진, 솔질세포진, 액상 세포학 검사법인 Thinprep을 시행하여 진단율 및 효용성을 비교하여 보았다. 방법 및 대상: 본원에서 2005년 6월부터 9월까지 호흡기적 증상을 보여 내원한 환자 중 기관지내시경을 시행하여 병변이 발견된 30명의 환자에서 Thinprep과 기존세포검사를 시행하였다. 결 과: 이상병변을 보였던 30명의 환자 중 조직검사를 통해 암을 진단받은 환자는 24명이었으며 4명은 결핵, 각각 1명씩은 기관지확장증, 기관지-폐누공을 진단받았다. Thinprep에서 암인 24명의 환자 중 19명이, 기존세포검사에서 기관지솔질검사(brushing)을 통해 얻은 결과가 17명, 세척액(washing)은 12명에서 암세포나 비전형세포가 보였다. 두 방법 모두 암이 아닌 환자에서는 비전형세포는 보이지 않았다. 세척세포진검사는 민감도 50%, 특이도 100%, 양성예측도 100%, 음성예측도 33.3%, 솔질세포진검사는 민감도 70.8%, 특이도 100%, 양성예측도 100%, 음성예측도 46.2%, Thinprep에서는 민감도 79.2%, 특이도 100%, 양성예측도 100%, 음성예측도 54%를 보였다. 결 론: 액상 세포학 검사법인 Thinprep은 기존의 검사법보다 민감도, 음성예측도가 큰 검사로 폐암의 진단률을 높이는데 도움을 줄 수 있으며 앞으로 대단위의 연구가 필요할 것으로 생각된다.

관상동맥질환 치료를 위한 시롤리무스 방출 스텐트 ($CYPHER^{TM}$)의 경제성 분석 (Economic Value of the Sirolimus Eluting Stent($CYPHER^{TM}$) in Treating Acute Coronary Heart Disease)

  • 이후연;박은철;박기동;박지은;김영;이상수;강혜영
    • Journal of Preventive Medicine and Public Health
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    • 제36권4호
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    • pp.339-348
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    • 2003
  • Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

TRAIL in Combination with Subtoxic 5-FU Effectively Inhibit Cell Proliferation and Induce Apoptosis in Cholangiocarcinoma Cells

  • Sriraksa, Ruethairat;Limpaiboon, Temduang
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권16호
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    • pp.6991-6996
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    • 2015
  • In the past decade, the incidence and mortality rates of cholangiocarcinoma (CCA) have been increasing worldwide. The relatively low responsiveness of CCA to conventional chemotherapy leads to poor overall survival. Recently, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL or Apo2L) has emerged as the most promising anti-cancer therapeutic agent since it is able to selectively induce apoptosis of tumor cells but not normal cells. In this study, we aimed to investigate the therapeutic effect of TRAIL in CCA cell lines (M213, M214 and KKU100) compared with the immortal biliary cell line, MMNK1, either alone or in combination with a subtoxic dose of 5-fluorouracil (5-FU). We found that recombinant human TRAIL (rhTRAIL) was a potential agent which significantly inhibited cell proliferation and mediated caspase activities (caspases 8, 9 and 3/7) and apoptosis of CCA cells. The combined treatment of rhTRAIL and 5-FU effectively enhanced inhibition of CCA cell growth with a smaller effect on MMNK1. Our finding suggests TRAIL to be a novel anti-cancer therapeutic agent and advantage of its combination with a conventional chemotherapeutic drug for effective treatment of CCA.

편마비 환자의 발목관절 전략 운동이 균형 조절 능력에 미치는 영향 (The Effects of Ankle Strategy Exercise on Balance of Patients with Hemiplegia)

  • 박기현;김원복
    • 대한물리의학회지
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    • 제9권1호
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    • pp.75-82
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    • 2014
  • PURPOSE: PURPOSE: The purpose of this study was to analyze the effect and examine the feasibility of an intervention of ankle strategy exercise on balance of patients with hemiplegia. METHODS: The subject were randomly allocated to three groups: ankle strategy exercise (group A), balance exercise (group B) and control (group C). Group A was received the conventional physical therapy plus ankle strategy exercises for 20 minutes in one session. Group B was received the same conventional physical therapy plus balance exercises for 20 minutes in one session. Two active groups were performed in the session 3 times a week, for a total of 6 weeks. and Group C was only received the same conventional physical therapy. Balance test was assessed using center of pressure (COP) in the anteroposterior (A-P), mediolateral (M-L) direction, Berg balance scale (BBS) and Timed Up and Go Test (TUG). RESULTS: All groups showed improvements in balance parameters. In especial, the Group A was statistically significant differences in almost part evaluation items and showed more improvements in BBS and TUG parameters than Group B and Group C. and moving distance of M-L COP was more improvements than Group B. CONCLUSION: Ankle strategy exercises had more influence on balance than balance exercises and neurodevelopmental treatment.

Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas

  • Sohn, Seil;Chung, Chun Kee
    • Journal of Korean Neurosurgical Society
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    • 제54권5호
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    • pp.373-378
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    • 2013
  • Objective : We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. Methods : From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. Results : Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. Conclusion : Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.

Comparison between intracytoplasmic sperm injection and intracytoplasmic morphologically selected sperm injection in oligo-astheno-teratozoospermia patients

  • Kim, Hyung Jun;Yoon, Hye Jin;Jang, Jung Mi;Oh, Hwa Soon;Lee, Yong Jun;Lee, Won Don;Yoon, San Hyun;Lim, Jin Ho
    • Clinical and Experimental Reproductive Medicine
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    • 제41권1호
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    • pp.9-14
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    • 2014
  • Objective: The aim of this study was to evaluate the efficiency of the intracytoplasmic morphologically selected sperm injection (IMSI) technique compared with conventional ICSI and previous ICSI attempts in oligo-astheno-teratozoospermia (OAT) patients. Methods: The sperms were selected under high magnification ($6,600{\times}$) and used to induce fertilization in previous ICSI patients by IMSI. These results were compared with previous conventional ICSI cycles in patients with OAT infertility. Results: These results demonstrated no significant difference in the fertilization rate between IMSI and previous ICSI cycles (67.7% vs. 65.0%). However, the pregnancy and implantation rates with IMSI were significantly higher than those of the ICSI cycles (33.3% vs. 12.5% and 14.6% vs. 5.4%, respectively; p<0.05). The miscarriage rate among pregnant patients (18.2% vs. 37.5%) showed no statistically significant difference between groups. Conclusion: Compared to conventional ICSI, this study found that IMSI increased the IVF-ET success rates in patients with OAT.

Reconstruction of extended orbital floor fracture using an implantation method of gamma-shaped porous polyethylene

  • Hwang, Woosuk;Kim, Jin Woo
    • 대한두개안면성형외과학회지
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    • 제20권3호
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    • pp.164-169
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    • 2019
  • Background: The conventional surgical method for reconstructing orbital floor fractures involves restoration of orbital continuity by covering an onlay with a thin material under the periorbital region. However, in large orbital floor fractures, the implant after inserting is often dislocated, leading to malposition. This study aimed to propose a novel implanting method and compare it with existing methods. Methods: Among patients who underwent surgery for large orbital floor fractures, 24 who underwent the conventional onlay implanting method were compared with 21 who underwent the novel ${\gamma}$ implanting method that two implant sheets were stacked and bent to resemble the shape of the Greek alphabet ${\gamma}$. When inserting a ${\gamma}$-shaped implant, the posterior ledge of the orbital floor was placed between the two sheets and the bottom sheet was impacted onto the posterior wall of the maxilla to play a fixative role while the top sheet was placed above the residual orbital floor to support orbital contents. Wilcoxon signed-rank test and Mann-Whitney U test were used for data analyses. Results: Compared to the conventional onlay method, the gamma method resulted in better restoration of orbital contents, better improvement of enophthalmos, and fewer revision surgeries. Conclusion: Achieving good surgical outcomes for extended orbital floor fractures is known to be difficult. However, better surgical outcomes could be obtained by using the novel implantation method of impacting a ${\gamma}$-shaped porous polyethylene posteriorly.

Evaluation of the $HApS^{TM}$ Method for the Enumeration of Aerobic Microorganisms and Coliforms in Retailed Meat Samples in Korea

  • Keun-Seok Seo;Wonki Bae;So-Hyun Kim;Nam-Hoon Kwon;Ji-Yeun Kim
    • 한국식품위생안전성학회지
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    • 제16권3호
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    • pp.194-199
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    • 2001
  • 국내에서 시판중인 230점(돈육샘플80점, 계육샘플 80점, 우육샘플 70점)의 식육 샘플에 대하여 미생물 오염수준 측정시 표준방법으로 통용되는 AOAC (the Association of Official Analytical Chemists)의 standard total aerobic count method 및 coliform count method와 국내에서 개발된 HApS$^{TM}$ (Hazard Analysis process System) method를 비교하였다. 돈육, 계육, 우육을 샘플군으로 하여 총세균수 및 대장균수를 표준방법과 HApS$^{TM}$방법으로 각각 측정하여 그 두 방법간의 상관관계를 조사하였다. 선형회귀분석 및 t-검정법의 통계적 방법을 사용하여 각 샘플군에서의 두 방법간의 상관계수(r) 및 회귀직선식을 얻었고, 각 샘플군에서 두 방법에 의한 각각의 표본평균이 주어진 유의수준($\alpha$=0.05)에서 유의한 차이를 보이지 않았다. 즉, 본 실험에 사용된 샘플에 대하여 표준방법과 HApS$^{TM}$ 방법간의 유의한 차이를 발견하지 못하였다. 그러므로 표준방법에 비하여 실험시간 및 실험방법에서 신속성 및 간편성을 지니는 HApS$^{TM}$방법은 축산식품의 총세균 및 대장균군 오염도 측정시에 표준방법을 대신할 수 있는 유용한 방법이라고 할 수 있다.

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원발성 자연 공기가슴증 환자에서 고식적인 흉강경하 쐐기절제술과 흉강경을 이용한 변형된 소절개술식의 비교 (Comparison of Conventional Thoracoscopic Wedge Resection and Modified Transaxillary Minithoracotomy with Thoracoscopy for the Treatment of Primary Spontaneous Pneumothorax)

  • 이미경;류대웅;이삼윤;최종범;최순호
    • Journal of Chest Surgery
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    • 제38권5호
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    • pp.371-376
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    • 2005
  • 배경: 저자는 원발성 자연 공기가슴증 환자에서 고식적인 비디오흉강경하 쐐기절제술이 흉강경을 이용한 변형된 소절개술식보다 우수한가를 결정할 목적으로 후향적으로 연구를 하였다. 대상 및 방법: 원발성 자연 공기가슴증을 보인 $14\~35$세 사이의 160명의 환자를 대상으로 하였다. 환자는 수술기법과 수술 접근법에 의해서 고식적인 흉강경하 쐐기절제술군(A군: 80예)과 흉강경을 이용한 변형된 소절개술식을 이용한 군(B군: 80예)으로 분류하였다. 모든 환자에서 술 후 늑막강 첨부의 찰과상과 탈크 도포를 수행하였다. 이 연구는 수술시간, 수술 후 사용한 진통제의 사용일수, 수술 첫날 공기누출이 없는 수, 흉관 삽관일과 병원 입원일, 그리고 술 후 합병증, 추적기간 동안의 만성 흉통과 일상생활로 복귀할 때까지의 기간 그리고 또한 추적기간 동안에 수술동측에서의 재발을 평가하였다. 결과: 양 군사이에서 연구한 평가요소 중 어느 것에서도 의의 있는 차이는 없었다. 결론: 고식적인 비디오 흉강경하 쐐기절제술과 흉강경을 이용한 변형된 소절개술식은 원발성 자연 공기가슴증 환자의 수술적 치료에 있어서 유사한 결과를 야기하였다. 합병증의 발생률도 낮고, 통각도 장기 추적동안에 받아들일 만 하였다. 따라서 흉강경을 이용한 변형된 소절개술식 또한 가치 있는 대체수술 기법으로 보인다.