• Journal of Yeungnam Medical Science
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• 제40권3호
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• pp.276-282
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• 2023

Background: Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited. Methods: We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO. Results: We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis. Conclusion: Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

• Journal of Digestive Cancer Research
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• 제3권2호
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• pp.89-94
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• 2015

The role of adjuvant chemotherapy in patients with stage II colon cancer remains a controversial issue. Adjuvant chemotherapy aims to eliminate any micrometastatic disease that may have been missed, at the time of surgery. Although one prospective study showed a small but statistically significant benefit with respect to the overall survival for those who received adjuvant chemotherapy, multiple pooled data did not demonstrate any benefit of this therapy in patients with stage II colon cancer. Current national and international guidelines for the adjuvant treatment of stage II colon dose not advise routine implementation of adjuvant chemotherapy, but rather recommend selective use of this therapy for patients with high risk of recurrence. High risk features for recurrence include T4 disease, poorly differentiated histology, presence of lymphovascular invasion, presence of perineural invasion, inadequate retrieval of lymph nodes, bowel obstruction, localized perforation, or positive margins. More recently, prediction tools using gene expression cancer profiles are proposed to identify patients who are most likely to have recurrence and therefore may benefit from postoperative chemotherapy in stage II colon cancer. These novel methods together with conventional prognosticators, will allow us to implement more optimized personalizing adjuvant therapy in these patients.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.16-22
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• 2017

A specialist in the medical field is probably one of the most time-consuming professions to train for before one is considered an expert. Inclusive of medical school, it can take as long as 20 or more years of structured training before one graduates as a new specialist in a particular surgical subspecialty or medical field. A fellowship is often the last official phase in this professional marathon, typically defined as a 1 to 2-year full-on clinical subspecialty experience. One would expect this important "finishing school" to be well researched and written about, however, as compared to other professionals and fields, there is scanty literature on how one can get into a good fellowship program. This is a perspective piece on the intricacies of securing a position in a good fellowship program, drawn from the collective experience of the authors, their colleagues and friends. There are several ways to achieve this and many processes one will encounter. A variety of factors one will need to consider, decide and works towards in this effort of optimizing of their chances of success in getting into their fellowship program of choice. The thought processes, suggestions and solutions at each phase may be helpful. In conclusion, obtaining a choice fellowship position is as much an art as a science, and maybe some luck. Many factors, some more obvious and objective, some softer and more subtle, can all influence the outcome in one way or another.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.37-43
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• 2017

Laparoscopic cholecystectomy is of one the most common general surgical operations performed today. Concomitant choledocholithiasis occurs in roughly 10-20% of patients with symptomatic gallstones. Laparoscopic bile duct exploration (LBDE) offers a single-stage minimally-invasive solution to the management of choledocholithiasis. LBDE may be performed either via the transcystic route or via laparoscopic choledochotomy. A number of strategies to improve success are available to the surgeon to help in the problem of complicated choledocholithiasis, these range from simple maneuvers to the use of laser or mechanical lithotriptors. With the advances in laparoscopic surgery, it is also possible to handle complex surgical conditions such as Mirizzi syndrome or recurrent pyogenic cholangitis laparoscopically, even though these have yet to be accepted as standard of care. Following laparoscopic choledochotomy, options for closure include: primary closure, closure over a T-tube, and closure over an endobiliary stent. T-tube placement has been associated with increased operating time and hospital length of stay compared to primary closure, with no significant differences in morbidity. Based on the available literature, LBDE appears comparable to ERCP with regards to procedural efficacy and morbidity. LBDE remains relevant to the general surgeon and is best viewed as being complementary to endoscopic therapy in the management of choledocholithiasis.

• Journal of Digestive Cancer Research
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• 제6권1호
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• pp.16-24
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• 2018

위암은 최근에 균일한 성격의 단일 질환이 아니라, 매우 이질적인 질환으로 인식되고 있다. 수술이 불가능한 진행성 또는 전이성 위암의 경우 일반적으로 완치가 불가능하며 항암치료를 하지 않는 경우 중앙 생존기간이 3-6개월 정도로 알려져 있다. 따라서 항암치료를 하는 경우가 최선의 지지 치료에 비하여 삶의 질이나 생명연장의 측면에서 우월함을 이미 여러 연구를 통해서 확인되고 있다. 지난 기간 동안 다양한 항암치료가 진행성 위암의 치료에 적용되었고, 최근에 여러 표적 치료와 면역치료가 도입되고 있으나, 여전히 다른 암종에 비하여 진행성 위암환자에서는 현저한 생명연장은 아직 저조하고 답보 상태에 있다. 그러나 향후 위암의 분자생물학적인 특성이 자세히 알려지면서 이러한 어려움들은 극복될 것으로 기대된다.

• Child Health Nursing Research
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• 제30권2호
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• pp.118-128
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• 2024

Purpose: This study aimed to examine the health concerns of parents regarding their premature infants and to identify changes in these concerns during perinatal period and after discharge. Methods: This was a retrospective study performed at a single tertiary center that enrolled 119 premature infants who were discharged from the neonatal intensive care unit (NICU) and visited the outpatient pediatrics department between December 2018 and October 2021. Data on the concerns of 176 parents regarding enrolled premature infants' health from before birth to 1 week after NICU discharge were obtained from outpatient records. The t test and with the chi-squared test were used to analyze the data for this study. Results: The consistently greatest focus of parents' health concerns was the respiratory system. The second focus of parents' health concerns before discharge was the central nervous system. However, during the first week after NICU discharge, the gastrointestinal system was the second-most frequent focus of parents' health concerns among parents of infants without diseases related to prematurity and infants with older gestational ages. Conclusion: The results of this study offer insights into the health concerns among parents of premature infants. Parental health concerns about premature infants vary over time, from before birth to post-discharge, necessitating supportive interventions to enhance parental understanding of their child's health status.

• Journal of Digestive Cancer Research
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• 제12권1호
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• pp.23-30
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• 2024

Borderline resectable pancreatic cancer, an intermediate stage between a completely resectable state and an unresectable state, requires a multidisciplinary treatment approach. This study aimed to elucidate the main characteristics and recent research trends regarding borderline resectable pancreatic cancer to gain further insights into them. Data from published papers about borderline resectable pancreatic cancer were collected from Web of Science (2014-2023) for the analysis. This study included 355 papers; data on major countries, publishing organizations, and keywords were collected and analyzed. Furthermore, R studio and VOSviewer were used for the qualitative and quantitative analyses of keywords. Publication of papers on borderline resectable pancreatic cancer was observed to be increasing annually by 12.8%, with the United States and Japan being the main publishing countries. In 2014, keywords related to surgery and chemotherapy were dominant; however, a shift toward more integrative approaches, such as neoadjuvant therapy, was observed over time. This study demonstrates rapidly evolving trends and paradigm changes in the research and management of borderline resectable pancreatic cancer. Thus, the results of this study are expected to contribute to establishing future research strategies and improving patient treatment outcomes.

• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4437-4441
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• 2014

SMAD7 has been identified as a functional candidate gene for colorectal cancer (CRC). SMAD7 protein is a known antagonist of the transforming growth factor beta ($TGF-{\beta}$) signaling pathway which is involved in tumorigenesis. Polymorphisms in SMAD7 may thus alter cancer risk. The aim of this study was to investigate the influence of a SMAD7 gene polymorphism (rs2337107) on risk of CRC and clinicopathological features in an Iranian population. In total, 210 subjects including 105 patients with colorectal cancer and 105 healthy controls were recruited in our study. All samples were genotyped by TaqMan assay via an ABI 7500 Real Time PCR System (Applied Biosystems) with DNA from peripheral blood. The polymorphism was statistically analyzed to investigate the relationship with the risk of colorectal cancer and clinicopathological properties. Logistic regression analysis revealed that there was no significant association between rs2337107and the risk of colorectal cancer. In addition, no significant association between genotypes and clinicopathological features was observed (p value>0.05). Although there was not any association between genotypes and disorder, CT was the most common genotype in this population. This genotype prevalence was also higher in the patients with well grade (54.9%) and colon (72.0%) tumors. Our results provide the first evidence that this polymorphism is not a potential contributor to the risk of colorectal cancer and clinicopathological features in an Iranian population, and suggests the need of a large-scale case-control study to validate our results.

• Journal of Hospice and Palliative Care
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• 제8권1호
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• pp.57-64
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• 2005

Cyclooxygenase-2 (COX-2) selective inhibitors were specifically developed to reduce the risks of gastrointestinal bleeding associated with other NSAID drugs. However, the APPROVe (Adenomatous Polyp Prevention on VIOXX) trials revealed that rofecoxib sometimes exerts prothrombotic effects. Meanwhile, cancer patients, who also carry a risk of thrombosis due to a variety of mechanisms, are often treated with COX-2 selective inhibitors, due to their relative gastrointestinal safety. This report concerns the case of a 46-year old woman with advanced cervical cancer, who had been treated with opioids and a COX-2 selective inhibitor (celecoxib) for 2 months, for the relief of pain associated with her cancer. The patient was admitted due to swelling of the left leg, which was also accompanied by pain. A computerized tomography scan revealed deep vein thrombosis occurring in multiple veins of both legs. After the administration of low-molecular weight heparin and oral warfarin, the patient's symptoms were relieved initially. However, her prothrombin time was found to be prolonged, necessitating the discontinuation of anticoagulation therapy. The patient's dyspnea worsened, ultimately resulting in her death. In conclusion, the administration of cox-2 selective inhibitors should be carefully considered in patients with a number of different risk factors, and assessed on a case-by-case basis.

• 대한간호학회지
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• 제28권3호
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• pp.705-717
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• 1998

Ostomates have suffered from many difficulties due to their physical, psychosocial handicaps and changes of life style to include ostoma management that influences their daily and quality of life. An appropriate nursing education for ostoma management is very important. Practical educational materials needs revision because those were developed by pharmaceutical companies and hospital institutions. The purpose of this study is to provide more practical and reasonable education materials for ostomates by doing analysis and survey of educational materials now being used. We surveyed 8 types of educational materials used in 23 university hospitals and medical centers in Seoul ; four of them were developed by department of nursing and the remainder by an Ostomy Company Data, collected from July 14, 1997 through July 31, 1997 were analyzed. The results are as follows ; 1. The analysis of education guide, on ostomate included 14 subcategories : introduction, structure and function of gastrointestinal tracts, definition of stoma, types of ostomy, definition of peristalsis, methods of defecation management, selection of instrument, resolution of problems and general situations following surgery, daily life, where to ask for help, explanations for terms, information about where to buy instrument, explanations for enterostomal therapist, a matter of consultation with doctor, etc. 2. Introduction contained specific contents on practical ostomate management that ostomates would experience through their lives. Ostomate education guides were developed 3 hospitals except one which missed this point. 3. Most ostomate education guides, except one hospital, helped ostomates to understand their physical structure changes with specific explanations on gastrointestinal tracts with figures. 4. Six institutions did not talk about the definition of peristalsis. 5. All institutions, except two, helped ostomates to understand types of ostomy with figures. 6. More detailed explanations on natural defecation are needed. The benefits and pitfalls of natural defecation should be more specified. 7 No psychosocial difficulties of ostomy management were addressed. 8. The efficiency of enema can be better understood through all explanations with figures. Some institutions did not mention items about definition, benefits, pitfalls of enema, sequency of enema, how to wash, cautions performing and enema, skin management, cleaning instrument after enema proper time to spend. 9. There were no detailed contents and what to do in case of not being able to do enema. 10. Only one educational material mentioned emotional aspects after the surgrey. 11. Most institutions explained subcategory of daily life but did not provide specific contents on the difficulties of physical, psychological, and sociocultural controls. 12. The subcategory of ureterostomy education guides included explanations on normal structure and function of urinary tracts, types of ureterostomy, how to manage skin, usage and types of instrument, commercial urostomy, how to manage instrument, daily life, introduced the general contents. However, more specific explanations were needed.