• Title/Summary/Keyword: patient dose

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Reducing pain and opioid consumption after body contouring of the breast by application of a perioperative nerve block: a systematic review

  • Asserson, Derek B.;Sahar, David E.
    • Archives of Plastic Surgery
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    • v.48 no.4
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    • pp.361-365
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    • 2021
  • Background Pain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery. Methods A search of the PubMed/MEDLINE database for articles including the terms "post-operative analgesia" OR "postoperative pain management" AND "in plastic surgery" OR "in cosmetic surgery" OR "in elective surgery" in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation. Results A total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1-10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001). Conclusions The opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with post-operative pain, but also lower the need for narcotics, especially in subpectoral augmentation.

Characterizing the Stimulation Intensity in Acupuncture Manipulation Techniques for Tonification and Sedation Therapy (침자 보사에서 자침 자극 강도의 특성)

  • Yoon, Da-Eun;Jang, Woochang;Ryu, Yeonhee;Lee, In-Seon;Chae, Younbyoung
    • Korean Journal of Acupuncture
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    • v.39 no.3
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    • pp.91-96
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    • 2022
  • Objectives : The purpose of this study was to characterize the stimulation intensity in acupuncture manipulation techniques for tonification and sedation therapy. Methods : To describe the level of stimulation used in acupuncture manipulation techniques for tonification and sedation therapy, we reviewed the acupuncture manipulation techniques described in classical medical textbooks. Results : Based on the patients' conditions and pattern identification, acupuncture manipulation strategies for tonification and sedation therapy were chosen. For example, the excess condition was treated with sedative therapy, and the deficiency condition was treated with tonification therapy. For tonification therapy, weak to modest stimulation was applied in acupuncture manipulation techniques, whereas intense stimulation was applied for sedative therapy. Even though the intensity of acupuncture stimulation was chosen based on the clinical examination, deqi sensation is a crucial component of acupuncture treatment, and during acupuncture practice, the practitioner should choose the right intensity of acupuncture stimulation based on deqi response in each patient. Conclusions : We concluded that the tonifying and sedative effects of acupuncture treatment are related to the stimulation intensity of acupuncture manipulation techniques. For individualized medicine, the right amount of acupuncture stimulation should be administered based on the patients' conditions and responses, such as deqi responses.

Role of Oxytocin in Post-traumatic Stress Disorder: A Systematic Review (외상 후 스트레스 장애에 대한 옥시토신의 역할: 체계적 문헌 고찰)

  • Oh, Jaeuk;Kim, Minsu;Chu, Sang Hui
    • Journal of Korean Biological Nursing Science
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    • v.24 no.1
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    • pp.1-16
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    • 2022
  • Purpose: Recently, oxytocin has been introduced experimentally as a pharmacological treatment for post-traumatic stress disorder (PTSD). This study attempted to investigate the possibility of oxytocin as a treatment option for patients with PTSD by examining its dose, interval, and effectiveness in patients with PTSD. Methods: A systematic review was done on articles published from 1967 to 2020 using the PubMed, PsycINFO, and Cochrane databases. Our inclusion criteria were 1) subjects 18 years of age or older diagnosed with PTSD or exposed to a traumatic event that met criterion A of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for PTSD, 2) oxytocin was administered at least once, 3) clinical trials, and 4) studies published in Korean or English. Two independent researchers reviewed 22 articles and recorded the contents. The risk of bias was evaluated to determine the quality of the reviewed article. Results: The parameters for evaluating the effectiveness of oxytocin were identified as socio-behavioral measures in 11 articles, neuronal imaging in 9, and biomarkers in 4. In 5 papers, oxytocin was administered multiple times. Socio-behavioral measures were improved in 3 out of 5 studies in which oxytocin was administered multiple times. In 2 studies in which prolonged exposure treatment and nasal oxytocin administration were combined for 10 weeks, patient symptoms were decreased compared to the control group. Conclusion: The possibility of oxytocin as an adjuvant treatment for PTSD psychotherapy was confirmed. Further studies are necessary to evaluate the long term effectiveness of administering oxytocin multiple times combined with psychotherapy.

Recovery of Delayed Graft Function after Calcineurin Inhibitor Sparing Regimen in a Renal Transplant Patient with Calcineurin Inhibitor Toxicity: A Case Report

  • Kang, Seok Hui;Yun, Woo Sung;Cho, Kyu Hyang;Do, Jun Young;Yoon, Kyung Woo;Park, Jong Won
    • Korean Journal of Transplantation
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    • v.28 no.3
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    • pp.165-168
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    • 2014
  • The recipient candidate was a 51-year-old male with end-stage renal disease owing to diabetes mellitus. The initial immunosuppressive regimen included basiliximab for induction and tacrolimus, mycophenolate mofetil, and steroids. Urine output was 413 mL/day on the operative day and 100 mL/day on the postoperative day (POD) 1. There was no definite stenosis of the ureter or vessels. He had anuria on POD 2~4 and he had undergone hemodialysis. His serum creatinine level did not decrease. Therefore, a graft biopsy was performed on POD 4. The pathologic finding was consistent with acute calcineurin inhibitor (CNI) toxicity. There was no evidence of rejection or acute tubular necrosis. Anuria continued on POD 6; therefore, we started sirolimus instead of a CNI based regimen. Graft function was gradually recovered 1 day after reduction of CNI dose and hemodialysis was stopped. The serum creatinine level was normalized on POD 10. He was discharged on POD 21.

A Study on Image Change according to Grid Ratio in Digital Radiography (디지털 방사선에서 격자 비에 따른 영상변화에 관한 연구)

  • Sung-Hun Jeong
    • Journal of radiological science and technology
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    • v.46 no.2
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    • pp.89-97
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    • 2023
  • With the introduction of the D.R system, the grid with high removal rate of scattered radiation is selected and used without considering the grid performance evaluation. Despite the high removal rate of scattered radiation belonging to high grid ratio, it is also possible to see the cut-off phenomenon in which the primary ray involved in the formation of image could be removed as well. Thus, the purpose of this study is to provide the basic data for researches on the usefulness of using the grid by presenting the appropriate grid ratio in the D.R system through the measurement of image in grid such as non-grid, 6:1, 8:1, 10:1, 12:1. The equipments used for this study were radiation generator with grid in 12:1, 10:1, 8:1, 6:1, indirect-type detector, and acryl phantom. As the study for image evaluation, this study measured the SNR, PSNR, MSE, and Entropy. In the results of this study, the PSNR was the highest in 6:1 and the lowest in 8:1. The SNR was high in 6:1 and 8:1, and the lowest in 12:1. In case of Entropy, it was high in 8:1 and 10:1, and the lowest in 12:1. Therefore, when the grid is used, it would be more proper to choose the grid in 8:1 or 10:1 with less loss in information content of primary ray rather than the high grid ratio showing the increased patient exposure dose.

Study on Methods to Improve Image Quality of Abdominal CT Images (복부 CT 영상의 화질 개선 방법에 대한 연구)

  • Seok-Yoon Choi
    • Journal of the Korean Society of Radiology
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    • v.17 no.5
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    • pp.717-723
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    • 2023
  • Liver disease is highly associated with death, and other abdominal diseases are also important causes affecting a person's lifespan, and a CT scan is essential when treating abdominal diseases. High radiation exposure is essential to create images that are good for reading, but managing the patient's radiation exposure is also essential. In this study, a post-processing wavelet algorithm was proposed to improve the image quality of abdominal CT images. Wavelets have the disadvantage of having to set a threshold value depending on the type of input image. Therefore, we experimentally proposed the threshold value of the wavelet and evaluated whether the image quality was effective. As a result of the experiment, the optimal threshold value for abdominal CT images was calculated to be 50. In the case of image 1, noise was improved by 49% and in the case of image 2, by 29%, and the contrast also increased. if the results of this study are applied for post-processing after abdominal CT, image quality can be improved and it will be helpful in disease diagnosis.

Characteristics Analysis of SiPM for Detection of High Sensitivity of Portable Detectors (휴대용 검출기의 방사선 고감도 검출을 위한 SiPM 특성 분석)

  • Byung-Wuk Kang;Sun-Kook Yoo
    • Journal of the Korean Society of Radiology
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    • v.17 no.6
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    • pp.897-902
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    • 2023
  • The purpose of this paper is to analyze the characteristics of Silicon Photomultiplier (SiPM) for the realization of high-sensitivity radiation detection in portable detectors. Portable X-ray detectors offer the advantage of quickly accessing the patient's location and obtaining real-time images, allowing physicians to perform rapid diagnoses. However, this mobility comes with challenges in achieving accurate radiation detection. In existing detectors, SiPM is used for a simple purpose of detecting X-ray triggers. To verify the feasibility of high-sensitivity X-ray detection through SiPM, seven types of SiPM sensors were compared and selected, and their characteristics were analyzed. The SiPM used in the final test demonstrated the ability to distinguish signals at the ultra-low radiation level of 10 nGy, and it was observed that the slope of the signal rise curve varies with the X-ray tube voltage. Utilizing the characteristics of SiPM, which exhibits changes in signal level and duration with X-ray dose, it appears possible to achieve high-sensitivity measurements for X-ray detection.

A Randomized Trial Comparing the Effect of Unani Formulation with Metronidazole in Bacterial Vaginosis

  • Nazia Usmoni;Mariyam Roqaiya;Mohd Aqil Quadri;Arshiya Sultana;Taseen Banu;Sumbul Alam
    • CELLMED
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    • v.13 no.14
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    • pp.18.1-18.13
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    • 2023
  • Background and objectives: Bacterial vaginosis (BV) is recognized as the most prevalent type of vaginal infection, impacting approximately 19-24% of women in their reproductive years. The recurrence rate of BV is significant, negatively impacting the well-being of affected women. This study aimed to compare the therapeutic effects of a polyherbal Unani formulation and metronidazole in treating bacterial vaginosis. Methodology: In this prospective patient blinded standard controlled trial, a total of 40 individuals with a clinical diagnosis of bacterial vaginosis were randomly assigned to receive either an active control treatment (n = 20) or a test drug (n = 20). In the test drug combination of Acacia catechu, Azadirachta indica and Quercus infectoria in tablet (1g) form in the dose of 2 tablets orally twice daily with water was administered for 3 weeks. In the active control standard drug, metronidazole 400 mg tablet, orally twice daily was given for one week. The primary outcome measure was clinical cure; H. negative Amsel's criteria and a reduction in subjective symptoms, while the secondary outcome measure was an improvement in SF-36 quality of life (QOL). Results and conclusion: Both the experimental treatment and the metronidazole demonstrated a significant clinical cure for bacterial vaginosis as well as an increase in health-related quality of life. Based on these findings, it appears that the test medication is a potent Unani formulation for the treatment of bacterial vaginosis. A well conducted trial with a bigger sample size is required to corroborate these findings.

Dermatofibrosarcoma Protuberans on the Occipital Scalp Showed Uncommon Presentation: A Case Report (비전형적 임상양상을 보이는 후두부의 융기성 피부 섬유 육종에 대한 증례보고)

  • Jiwon Jeong;Chul Hoon Chung;SeongJin Cho
    • Korean Journal of Head & Neck Oncology
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    • v.40 no.1
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    • pp.49-53
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    • 2024
  • Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma, with an incidence of about 0.8% to 5% per million people per year, accounting for 1% of soft tissue sarcomas. In its early stage, DFSP is typically found as a violet or pinkish macule or patch, and it can develop into a palpable mass with ulceration or bleeding. The standard treatment for DFSP is wide local excision of the tumor with a 2- to 3-cm negative margin, and radiation therapy or chemotherapy can be conducted with surgical treatment. A 35-year-old man had a palpable mass on the left side of his occipital scalp without color change, ulceration, or bleeding, which typically are present in malignancy. A magnetic resonance imaging (MRI) scan showed a 3-cm homogenous enhanced mass without adhesion between the scalp and the mass. Unexpectedly, a biopsy revealed the round mass to be DFSP. A wide excision and rotation of the scalp flap were performed. The patient recovered without any complications and received adjuvant radiotherapy at a dose of 60 Gray (Gy) for six weeks. There was no recurrence through six months of follow-up. Here we report this unique case of DFSP with atypical presentation.

Effectiveness and Safety of Pharmacopuncture Therapy for Chronic Low Back Pain: A Study Protocol for a Pragmatic Randomized Controlled Trial

  • Youn Young Choi;Hwa Yeon Ryu;Jae Hui Kang;Hyun Lee
    • Journal of Acupuncture Research
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    • v.41 no.2
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    • pp.107-114
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    • 2024
  • Background: Low back pain (LBP) is a common musculoskeletal disorder worldwide, with a lifetime prevalence of up to 80%. Among nonsurgical treatments for chronic LBP, Korean medicine treatments are highly preferred, and pharmacopuncture therapy combining acupuncture and herbal medicine is widely used. However, no evidence-based study has focused on the use of various types of pharmacopuncture. Methods: The pragmatic randomized controlled clinical trial will include 44 participants; recruitment will start in July 2023. All participants will receive integrated Korean medicine treatment including acupuncture, cupping, and infrared therapy, and the intervention group will also receive pharmacopuncture. After 16 treatment sessions, twice a week for 8 weeks, follow-up assessments will be performed at week 9. As a pragmatic randomized controlled clinical protocol, the type, dose, and acupoints of acupuncture and pharmacopuncture are not determined in advance but are selected and recorded according to the clinical judgment of the Korean medicine doctor. Results: The primary outcome will be measured using a visual analog scale score, and the secondary outcomes include the Oswestry disability index, patient global impression of change, no worse than mild pain, and range of motion. Safety will be assessed by examining participants' self-reported adverse events and vital signs and conducting blood tests before and after the test. Conclusion: This study aims to provide clinical evidence of the effectiveness and safety of pharmacopuncture for chronic LBP.