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Comparison of Northgate SD-3 and Modulith SLX Lithotriptors: Treatment Results with 2,000 Renal and Ureteral Stones (Northgate SD-3와 Modulith SLX 쇄석기를 이용한 체외충격파쇄석술의 비교분석: 단일 신결석 및 요로결석 2,000례의 치료결과 분석)

  • Lee, Jun-Young;Jung, Hee-Chang;Moon, Ki-Hak;Cho, Chul-Kyu;Park, Tong-Choon
    • Yeungnam University Journal of Medicine
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    • v.16 no.1
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    • pp.85-93
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    • 1999
  • Some reports have shown a decreased effectiveness of extracorporeal shock wave lithotripsy(ESWL) with newer lithotriptors. We compared the treatment results of ESWL with a second generation Northgate SD-3 and a third generation Modulith SLX device. A total of 2,000 patients underwent ESWL treatments for single urinary calculus between September, 1988 and July, 1998. 1,241 patients were treated with Northgate SD-3 between September, 1988 and December, 1995. And 759 patients were treated with Modulith SLX between January, 1996 and July 1998. The treatment results were compared using chi-square test to determine statistical significance. The overall success rate, success rate according to the location and size, the mean number of sessions, complication rate and retreatment rate were calculated, according to lithotriptor. The overall success rate was 90.6% with Northgate SD-3 and 89.1% with Modulith SLX. With Northgate SD-3 and Modulith SLX, the success rate according to the location was 91.0%(579/636) and 88.1%(236/268) in kidney: 93.2%(517/555) and 89.9%(258/287) in upper ureter: 83.3%10/12) and 94.4%167/177) in middle and lower ureter: 47.4%(18/38) and 55. 6%(15/27) in staghorn stone, respectively. The success rate according to the size of stone with Northgate SD-3 and Modulith SLX for stones with the size under 10mm was 96.1%(612/637) and 93.1%(470/505); from 11mm to 20mm was 87.3%(421/482) and 86.4%(165/191); from 21mm to 30mm, 77.5%(62/80) and 67.5%(23/34): and for stones larger than 31mm was 69%(29/42) and 62.1%(18/29), respectively. Mean number of sessions for successful fragmentation was 1.21 and 1.69, respectively with Northgate SD-3 and Modulith SLX. Retreatment rate was 16.7% and 17.5%, respectively. The complications after treatment were severe pain(6.2% with Northgate SD-3 vs. 2.0% with Modulith SLX), steinstrasse(3.4% vs. 1.9%), fever(1.2% vs. 0.5%) and perirenal hematoma(0.2% vs. 0%) in order of frequency. There was no significant difference in the effectiveness of Northgate SD-3 and Modulith SLX. However, a statistically significant difference was observed between the two lithotriptors. We concluded that ESWL with Modulith SLX is more safe compared to Northgate SD-3.

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Angiographic Results of Radial Artery Grafts that are Used for Myocardial Revascularization (관상동맥 우회술 후 혈관조영술을 이용한 요골동맥의 개통률 분석)

  • Yie, Kil-Soo;Oh, Sam-Sae;Kim, Jae-Hyun;Shinn, Sung-Ho;Kim, Soo-Cheol;Seo, Hong-Joo;Na, Chan-Young
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.40 no.8
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    • pp.546-551
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    • 2007
  • Background: The radial artery is gaining widespread acceptance as complementary arterial conduits for surgical myocardial revascularization, but there have been limited reports about its angiographic patency compared with that of internal thoracic artery or saphenous vein. We tried to evaluate angiographic patency of radial artery graft and to compare that of radial artery and other gratis with retrospective manner. Material and Method: From January 2001 to Jure 2006, totally 132 patients (male 92, female 40) who underwent coronary artery bypass graft using radial artery were re-admitted to our hospital for follow up angiographic examination. Mean age was 58.2+8.87 and mean follow up duration was 32 month ($2{\sim}110$ month). Off pump and on pump bypass surgery were performed 74 and 58 patients respectively. Along with radial artery, left internal thoracic arteries were used in 57 cases, concomitant left internal thoracic artery and saphenous veins were used in 47 cases and bilateral internal thoracic arteries were used in 20 cases. Result: Totally 412 distal anastomosis were performed and 376 anastomosis remained patent (91.2%). Left internal thoracic artery showed the most excellent patency in all of the conduits (98.5%). Radial artery graft patency was 90.8% (169/186). There was no statistical difference of the patency by conduit between on-pump and off-pump group. But radial artery showed more higher patency rate (98/110, 89%) in the severe stenotic lesion that preoperatively revealed more than 90% stenosis than in the lesser severe (<90%) stenotic lesion (60/76, 78%)(p < 0.005). Radial artery conduit represented the worst result when it was grafted in the right coronary system. But when it was positioned in the left heart especially diagonal or obtuse marginal area, patency was comparable with left internal thoracic artery. Conclusion: Radial artery graft showed good midterm patency when it was used in the severe stenotic lesion more than 90% and left coronary system. But great notice should be taken when it is grafted in the right coronary system or less severe stenotic lesion.

Complementary and Alternative Medical Therapies in Children and Adolescent with Chronic Disease : Utilizations and Patterns (만성 질환을 가진 소아, 청소년에게 시행되는 보완대체요법의 실태 연구)

  • Kim, Young Bin;Song, Jun Ho;Jang, Myoung Wan;Yoo, Hwang Jae;Kim, Cheol Hong;Lee, Hyun Hee
    • Clinical and Experimental Pediatrics
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    • v.48 no.9
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    • pp.929-934
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    • 2005
  • Purpose : This study describes how often complementary and alternative medical(CAM) therapies, what patterns of CAM therapies utilization, what types of CAM therapies and why CAM therapies are used in children and adolescent with chronic disease. Methods : We interviewed and filled out questionnaires with parents of patients suffering from asthma, atopic dermatitis, congenital myopathy, epilepsy and so on from Mar 2004 to Aug 2004. Results : Two hundred fifty two parents answered questionnaires; 160 cases(63.5 percent) had used CAM therapies. Utilization of CAM therapies according to each chronic disease was as follows : congenital myopathy(100 percent), atopic dermatitis(91.1 percent), asthma(72.5 percent), chronic diarrhea (50.0 percent), epilepsy(17.1 percent) etc. Types of CAM therapy were as follows : dietary supplement (31.1 percent), herb medicine(23.4 percent), massage(14.2 percent), acupuncture(4.6 percent) etc. Sixty four(40.0 percent) case underwent more than two types of CAM therapies simultaneously. One hundred thirty three(83.1 percent) case were asked through non-medical prescription. Ninety nine(61.9 percent) case were recognized positive effect of CAM therapies. Parents' and childrens' ages were influential factors in CAM therapies utilization : the older the parents and the younger the children, the higher the utilization. Conclusion : Although patients receive treatment with western medicine, many of them not only undergo CAM therapies, especially more than two types, but also recognize the positive effects of CAM therapies. As a result, we suggest that it is easy to use of CAM therapies, and the positive effects of CAM therapies are prominent, domestically. Therefore, medical approach and study about the effectiveness and side effects of CAM therapies is necessary to avoid the imprudent use of such therapies.

Epidural Morphine for Pain Control in Patients with Terminal Cancer in Hospice Ward (호스피스 병동의 암환자에서 경막외 모르핀 주입을 이용한 통증 조절)

  • Lee, Jang-Eun;Hur, Ki-Hoon;Kang, Yoo-Jin;Jeon, Yon-Soo;Lee, Ok-Kyung;Shim, Byoung-Yong;Kim, Hoon-Kyo
    • The Korean Journal of Hospice and Palliative Care
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    • v.11 no.3
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    • pp.136-139
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    • 2008
  • Purpose: Epidural morphine infusion has been used to control pain in cancer patients whose cancer pain can not be controlled high dose intravenous morphine injection. To study the effectiveness and side effects of epidural morphine for the treatment of cancer pain in terminal patients at Hospice Ward, we evaluated the change in morphine equivalent daily dose for effectiveness and complications of epidural morphine infusion. Methods: We retrospectively analyzed 24 terminal cancer patients who were treated with continuous epidural morphine between 2001 and 2004 at Hospice Ward of St. Vincent's Hospital. Results: The median of baseline morphine equivalent daily dose was 615 mg, whereas the median dose of initial epidural morphine was 16 mg. The median of morphine daily equivalent daily dose dropped from 615 mg to 274 mg in one week after epidural morphine infusion therapy (P-value=0.000). The median survival from the time of the first catheter insertion was 35 days. In 6 patients, the catheter was removed due to complications, however the catheter was reinserted in 3 patients. Conclusion: Cancer pain management by epidural morphine infusion is very effective method with low rate of severe complication.

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Usefulness of the Salivagram for the Diagnosis of Brain Lesions in Patients with Aspiration Pneumonia (뇌병변 환자에서 흡인성 폐렴 진단을 위한 Salivagram의 유용성)

  • Oh, Shin Hyun;Choi, Yung Sook;Ro, Dong Wook;Nam-Koong, Hyuk;Kim, Jae Sam;Leee, Chang Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.1
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    • pp.48-52
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    • 2013
  • Purpose: Bed, living a long time is required in adult patients with brain lesions such as stroke, traumatic brain injury, and Parkinson's disease, causing pneumonia and respiratory diseases may be due to aspiration of food or saliva. In patients with recurrent pneumonia or pulmonary symptoms, there is a need to determine the possibility of pulmonary aspiration due to aspiration of saliva. Materials and Methods: Saliva due to aspiration pneumonia diagnosis in patients with brain lesions request for inspection to the Department of Nuclear Medicine, 10 patients (male 6, female 4) were included in this study. Patients were fasted before the test, $^{99m}Tc_{O4}$ 185 MBq (5 mCi) of less than 1 mL of solution was administered in the oral cavity. Administration and 20 minutes of dynamic imaging acquisition, and immediately after that the static images were acquired. Delayed scan after 2-4 hours if necessary. Results: Positivity rate of all 10 patients was 60%. In 4 patients showed positive reactions after the administration of oral cavity in a 20-minute dynamic imaging were able to confirm whether the aspiration. In the remaining 2 patients, four hours of additional delay tests were able to confirm whether the aspiration. Conclusion: Does not require changes in patient posture compared to the other checks that can be diagnosed with aspiration pneumonia. A simple test and takes less time. Therefore be useful in providing information for the diagnosis and treatment modality.

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The Effects of Autologous Blood Pleurodesis in the Pneumothorax with Persistent Air Leak (지속성 기흉에서 자가혈액을 이용한 흉막유착술의 효과)

  • Yoon, Su-Mi;Shin, Sung-Joon;Kim, Young-Chan;Shon, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Chung, Won-Sang;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.724-732
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    • 2000
  • Background : In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known that inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous bood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. Methods : Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical out∞me, chest radiography and pulmonary function tests. Results : The mean duration of air leak was 18.4${\pm}$6.16 days before ABP (autologous blood and dextrose pleurodesis) and $5.2{\pm}1.68$ days after ABP. The mean severity of pain was $2.3{\pm}0.70$ for DP(doxycycline pleurodesis) and $1.7{\pm}0.59$ for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of $0.6{\pm}0.63$. The mean dyspnea scale was $1.7{\pm}0.46$ before pneumothrax and $2.0{\pm}0.59$ after ABDP (p>0.05). The mean $FEV_1$ was $1.47{\pm}1.01$ before pneumothorax and $1.44{\pm}1.00$ after ABDP (p>0.05). Except in 1 patient, 14 patients had no recurrent pneumothorax. Conclusion : Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.

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