• Title/Summary/Keyword: treatment failure

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Surgical Strategies for Achilles Tendinopathy (아킬레스 건병증의 수술 전략)

  • Park, Hyun-Woo
    • Journal of Korean Foot and Ankle Society
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    • v.25 no.2
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    • pp.95-99
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    • 2021
  • The surgical treatment of Achilles tendinopathy can be considered after the failure of conservative treatment, and the surgical methods may be divided into two groups; treatments for insertional and non-insertional tendinopathy. In the case of insertional tendinopathy, debridement including tendon and calcification of the diseased lesion, reattachment of the tendon, and calcaneal ostectomy of the Haglund lesion are the primary treatments. If reattachment is not possible, reconstruction should be performed by other methods such as tendon transfer. As a result of surgery for insertional tendinopathy, there is an improvement in the pain and function after surgery, but there are some patients whose pain does not completely disappear. Some residual pain may persist; therefore, the overall success rate of the surgery can be expected to be 80% to 90%. For the patients of non-insertional tendinopathy, conservative treatment through eccentric exercise is the primary treatment, and most of them have reported good results. In case of failure after various conservative treatments, debridement of the diseased lesion and repair of the remaining tendon would be the primary surgical treatments. If the remaining tendon is not sufficient, reconstruction such as tendon transfer should be considered.

Long Term Outcomes and Prognostic Factors of N0 Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

  • Sun, Jian-Da;Chen, Chuang-Zhen;Chen, Jian-Zhou;Li, Dong-Sheng;Chen, Zhi-Jian;Zhou, Ming-Zhen;Li, De-Rui
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.5
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    • pp.2101-2107
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    • 2012
  • Treatment responses of $N_0$ stage nasopharyngeal carcinoma were firstly analyzed comprehensively to evaluate long term outcomes of patients and identify prognostic factors. A total of 610 patients with $N_0$ NPC, undergoing definitive radiotherapy to their primary lesion and prophylactic radiation to upper neck, were reviewed retrospectively. Concomitant chemotherapy was administrated to 65 out of the 610. Survival rates of the patients were calculated using the Kaplan-Meier method and compared by log-rank test. Prognostic factors were identified by the Cox regression model. The study revealed the 5-year and 10-year overall, disease-free, disease-specific, local failure-free, regional failure-free, locoregional failure-free and distant metastasis-free survival rates to be 78.7% and 66.8%, 68.8% and 55.8%, 79.9% and 70.4%, 81.2% and 72.5%, 95.8% and 91.8%, 78.3% and 68.5%, 88.5% and 85.5%, respectively. There were 192 patients experiencing failure (31.5%) after radiotherapy or chemoradiotherapy. Of these, local recurrence, regional relapse and distant metastases as the first event of failure occurred in 100 (100/610, 16.4%), 15(15/610, 2.5%) and 52 (52/610, 8.5%), respectively. Multivariate analysis showed that T stage was the only independent prognostic factor for patients with $N_0$ NPC (P=0.000). Late T stage (P=0.000), male (P=0.039) and anemia (P=0.007) were independently unfavorable factors predicting disease-free survival. After treatment, satisfactory outcome wasgenerally achieved in patients with $N_0$ NPC. Local recurrence represented the predominant mode of treatment failure, while T stage was the only independent prognostic factor for overall survival. Late T stage, male gender, and anemia independently predicted lower possibility of the disease-free survival.

Cardioprotective Potential of Gracilaria Verrucosa Extract in Myocardial Infarction-Induced Heart Failure Model (심근 경색 유발 심부전 모델에서 강리 추출물의 심장 보호 가능성)

  • Youn Jae Jang;Hye Yoom Kim;Jung Joo Yoon;Byung Hyuk Han;Je Kuk Yu;Nam Geun Cho;Ho Sub Lee;Dae Gill Kang
    • Herbal Formula Science
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    • v.31 no.3
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    • pp.157-169
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    • 2023
  • Gracilaria Verrucosa (GV), a seaweed used in traditional Korean medicine, was studied for its effects on MI-induced heart failure in rats. MI is caused by a blocked coronary artery, leading to severe cardiac dysfunction. The study used a rat model to assess cardiac changes over time and evaluate the impact of GV on heart failure. Ischemia was induced through LAD ligation surgery, and the extent of ischemic area was measured as a prognostic factor. GV extract administration significantly improved cardiac morphology and reduced cardiac weight compared to the MI group. GV treatment also improved cardiac function, as evidenced by positive effects on chamber dilation during MI-induced heart failure. Parameters such as ejection fraction (EF) and fractional shortening (FS) were measured. The MI group showed decreased EF and FS compared to the sham group, while these parameters improved in the GV group. GV treatment also reduced levels of LDH, CPK, and CK-MB in the serum, indicating reduced myocardial damage. Histological analysis revealed that GV treatment attenuated cardiac hypertrophy and fibrosis, with reduced collagen deposition in the myocardium. Immunohistochemistry analysis showed suppressed expression of TGF-β1 and collagen 1, involved in fibrosis. In conclusion, GV showed potential in improving cardiac function in a rat model of MI-induced heart failure. It alleviated myocardial damage, attenuated cardiac hypertrophy and fibrosis, and suppressed fibrotic markers. Further studies are needed to explore its clinical efficacy and underlying mechanisms in cardiac diseases beyond animal models.

Treatment of Ethylene Glycol Poisoning Patient Presented with Mental Change (의식저하로 내원한 에틸렌 글리콜 중독 환자 1례)

  • Min Jin Hong;Lee Jang Young;Min Moon Gi;Chung Sung Pil;Kim Seung Whan;Yoo In Sool
    • Journal of The Korean Society of Clinical Toxicology
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    • v.2 no.2
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    • pp.129-132
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    • 2004
  • Ethylene glycol poisoning can cause profound morbidity and is almost universally fatal if untreated. Central nervous system depression, pulmonary edema, and acute oligulic renal failure with crystalluria are among the most commonly encountered complication of ingestion. Ingestion of ethylene glycol may be an important contributor in patients with metabolic acidosis and subsequent renal failure. The diagnosis of ethylene glycol poisoning is based on nonspecific clinical symptoms and signs and indirect and direct laboratory measurement of ethylene glycol. As a result, diagnosis and treatment sometimes can be delayed. We describe 52-year-old man who visited to emergency department with mental change of unknown origin. The patient has high anion gap metabolic acidosis and renal failure due to ingestion of antifreeze that contained ethylene glycol. We used hemodialysis for elimination technique. The patient was discharged with minimal complication.

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Result of Surgical Treatment for Infective Endocarditis (심내막염의 수술적 치료 성적에 관한 보고)

  • Kim, S.H.;Ahn, H.;Kim, C.W.
    • Journal of Chest Surgery
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    • v.23 no.2
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    • pp.370-376
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    • 1990
  • From April, 1981, through March, 1989, 30 patients had received valve replacements and 1 patient had received foreign body removal for infective endocarditis at Seoul National University Hospital. There were 22 male and 9 female patients, ranged in age from 22 to 59 [mean 34.9] years. Twenty-three had native valve endocarditis, 7 had prosthetic valve endocarditis and 1 had infected transvenous permanent pacemaker electrode in right heart. Twenty-four required operation during active phase of disease and 7 during inactive phase. The infecting organism was Streptococcus in 10 patients, Staphylococcus in 5 patients, both Staphylococcus and Streptococcus in 1 patient, E. coli in 2 patients, and Candida in 1 patient. Indications for Surgery were congestive heart failure in 20, systemic emboli in 5, combination of both in 3, congestive heart failure with uncontrolled sepsis in 2, and complete heart block in 1 patient. Hospital mortality was 9.7% [3/31], and all were the patients who received emergency operation. There were 2 late mortality [7.7 %] due to acute myocardial infarction and recurrent endocarditis. This report suggests that the surgical treatment can be achieved with acceptable low mortality and morbidity in medically intractable congestive heart failure, emboli and sepsis.

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Study on Corrosion Characteristics and Stress Corrosion Cracking of the Weldment for HT-60 Steel in Synthetic Seawater

  • Na, Eui-Gyun;Koh, Seung-Ki;Oh, Seok-Hyung
    • Journal of Mechanical Science and Technology
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    • v.14 no.2
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    • pp.152-158
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    • 2000
  • The contents of this paper include the evaluation of corrosion characteristics and the behaviour of stress corrosion cracking (SCC) for the weldment and post weld heat treatment (PWHT) specimen and parent of HT -60 steel using a slow strain rate test (SSRT) in synthetic seawater. Corrosion characteristics were obtained from the polarization curves by potentiostat, and SCC phenomena were evaluated through the parameters such as reduction of area and time to failure by comparing the experimental results in corrosive environment with those obtained in air. Corrosion rate of the weldment was the fastest, followed by parent and PWHT specimen. SCC phenomena between the weldment of HT-60 steel and synthetic seawater were shown. Besides, SCC was dependent upon the pulling speed greatly. Maximum severity of SCC was obtained at a speed of $10^{-6}mm/min$, whereas SCC could not be seen almost at $10^{-4}mm/min$. The resistance to SCC for PWHT specimen was improved considerably compared that of the weldment at $10^{-6}mm/min$. In case of SCC failure, it was verified from SEM examination that brittle mode and lots of pits could be seen at the fractured region near the surface of the specimen.

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Treatment for acute renal failure occurred by ingestion of grape skins in a dog (개에서 포도껍질 섭취 후 발생한 급성신부전 치료 증례)

  • Oh, Hyun-Wook;Jun, Hyung-Kyou;Choi, Ho-Jung;Lee, Young-Won;Song, Kun-Ho
    • Korean Journal of Veterinary Research
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    • v.48 no.2
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    • pp.215-218
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    • 2008
  • A 2-year-old, female, Maltese dog (3.2 kg of body weight) was referred to the Veterinary Medical Teaching Hospital, Chungnam National University with vomiting, anorexia and depression. Twelve hours prior to the onset of clinical signs, the dog ingested some grape skins (about 60 g). Physical examination at the time of presentation showed peripheral edema and mucous pallor. Blood and blood chemical analysis revealed anemia and moderate azotemia with elevated blood urea nitrogen (107.2 mg/dl), creatinine (6.3 mg/dl) and hyperphosphatemia (11.3 mg/dl). Echogenicity of renal cortex were observred by ultrasonography. The dog was diagnosed as acute renal failure occurred by grape skin toxicosis. The dog was treated with supportive care such as fluid therapy, diuretics (furosemide) and phosphorus binder (almagate). A normal condition of blood and blood chemical findings and clinical signs was observed at five days after treatment, and prognosis is good to date.

A Case Report of Chronic Renal Failure(stage4) on Stroke Patient through Integrative Medicine Therapy. (만성 신부전 환자의 중풍치료에 대한 한·양방 협진효과 증례보고)

  • Hwang, Yunkyeong;Lee, Boram;Kim, Wonill
    • Herbal Formula Science
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    • v.24 no.3
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    • pp.233-242
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    • 2016
  • Objective : Chronic renal failure(CRF) is defined as a permanent reduction in glomerular filtration rate(GFR), resulting in Structural and functional abnormalities. The purpose of this thesis is to report the improvement of a CRF stage4 on stroke patient through integrative medicine therapy.Methods : We treated the patient with herbal medication(Sibjeondaebo-tang gagambang), acupuncture and moxibustion as well as Western medication. We measured the Creatinine, BUN, eGFR in the serum and observed clinical symptoms During 4monthsResult : After treatment, the level of BUN and Creatinine was decreased and eGFR was increased. And the symptoms of CRF(edema, anorexia, general weakness) were improved.Conclusion : This study suggests that Integrative Medicine Therapy is effective in the treatment of CRF symptoms. In the future, for the effective management of CRF, It is considered necessary to build a systematic integrative medicine therapy.

Critical Care Paper Review 2012

  • Sohn, Jang Won
    • Tuberculosis and Respiratory Diseases
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    • v.73 no.1
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    • pp.1-10
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    • 2012
  • Care of patients with sepsis has improved over the last decade. However, in the recent two years, there was no significant progress in the development of a new drug for critically ill patients. In January 2011, it was announced that the worldwide phase 3 randomized trial of a novel anti-Toll-like receptor-4 compound, eritoran tetrasodium, had failed to demonstrate an improvement in the mortality of patients with severe sepsis. In October 2011, Xigris (drotrecogin alfa, a recombinant activated protein C) was withdrawn from the market following the failure of its worldwide trial that had attempted to demonstrate improved outcome. These announcements were disappointing. The recent failure of 2 promising drugs to further reduce mortality suggests that new approaches are needed. A study was published showing that sepsis can be associated to a state of immunosuppression and loss of immune function in human. However, the timing, incidence, and nature of the immunosuppression remain poorly characterized, especially in humans. This emphasizes the need for a better understanding of sepsis as well as new therapeutic strategies. Many clinical experiences of the extracorporeal membrane oxygenator (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) patients, which is caused by the H1N1 influenza A virus, were reported. The use of ECMO in severe respiratory failure, particularly in the treatment of adult ARDS, is occurring more commonly.

A case of acute skin failure misdiagnosed as a pressure ulcer, leading to a legal dispute

  • Kim, Jung Hwan;Shin, Hea Kyeong;Jung, Gyu Yong;Lee, Dong Lark
    • Archives of Plastic Surgery
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    • v.46 no.1
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    • pp.75-78
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    • 2019
  • It is difficult to differentiate acute skin failure (ASF) from pressure ulcer (PU). ASF is defined as unavoidable injury resulting from hypoperfusion caused by severe dysfunction of another organ system. We describe a case of ASF mistaken as PU that resulted in a legal dispute. A 74-year-old male patient was admitted to our intensive care unit with sepsis due to bacterial pneumonia. Despite the use of air cushions and regular position changes, skin ulcerations occurred over his occiput, back, buttock, elbow, and ankle. After improvement in his general condition, he was transferred to the department of plastic and reconstructive surgery. Debridement was performed immediately, followed by conservative treatment (including a vacuum-assisted closure device) for 6 weeks. The buttock and occiput wounds were treated surgically. Despite complete healing, his caregivers sued the hospital for failing to prevent PU formation. ASF is a pressure-related injury resulting from hemodynamic instability due to organ system failure. Unlike PU, ASF may occur despite the implementation of all appropriate preventive measures. Furthermore, misdiagnosis of ASF as PU can lead to litigation. Therefore, it is critical for the proper diagnosis to be made quickly, and for physicians to explain that ASF occurs despite proper preventative treatment.