• Title, Summary, Keyword: treatment delays

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The Effectiveness of Mapping Biopsy in Patients with Extramammary Paget's Disease

  • Kim, Byung Jun;Park, Shin Ki;Chang, Hak
    • Archives of Plastic Surgery
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    • v.41 no.6
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    • pp.753-758
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    • 2014
  • Background Extramammary Paget's disease (EMPD) is an intraepithelial carcinoma usually occurring on the skin or mucosa of the perineum. Clinically, it resembles eczema or dermatitis, and misdiagnosis and treatment delays are common. The treatment of choice for EMPD is a wide excision with adequate margins. Wide excision with intraoperative frozen biopsy and Mohs micrographic surgery are common methods; however, these are associated with a high recurrence rate and long operation time, respectively. Methods Between January 2010 and June 2013, 21 patients diagnosed with EMPD underwent mapping biopsy. Biopsy specimens were collected from at least 10 areas, 2 cm from the tumor margin. When the specimens were positive for malignancy, additional mapping biopsy was performed around the biopsy site of the positive result, and continued until no cancer cells were found. Based on the results, excision margins and reconstruction plans were established preoperatively. Results The patients (18 male, 3 female) had a mean age of 66.5 years (range, 50-82 years). Almost all cases involved in the perineal area, except one case of axillary involvement. Permanent biopsy revealed one case (4.8%) of positive cancer cells on the resection margin, in which additional mapping biopsy and re-operation was performed. At the latest follow-up (mean, 27.4 months; range, 12-53 months), recurrence had not occurred. Conclusions Preoperative mapping biopsy enables accurate resection margins and a preoperative reconstructing plan. Additionally, it reduces the operation time and risk of recurrence. Accordingly, it represents an effective alternative to Mohs micrographic surgery and wide excision with intraoperative frozen biopsy.

Replacing Actinomycin-D with Carboplatin for Newly Diagnosed Rhabdomyosarcoma

  • Sezgin, Gulay;Acipayam, Can;Bayram, Ibrahim;Ozkan, Ayse;Kupeli, Serhan;Tanyeli, Atila
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.8
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    • pp.3351-3354
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    • 2015
  • Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the pediatric age group. All patients with RMS regardless of their initial stage or group receive combination chemotherapy as 'standard therapy' consisting of vincristine, actinomycin-D and cyclophosphamide. Actinomycin-D was not readily available in Turkey at one time. Carboplatin was used instead in order to prevent delays in treatment. The aim of this report is to present the results of patients with rhabdomyosarcoma receiving carboplatin or actinomycin-D therapy. Materials and Methods: Twenty four patients with rhabdomyosarcoma treated between December 2000 and June 2011 were included in this retrospective study. The patients were treated according to International Rhabdomyosarcoma Study Group guidelines. Eleven patients were treated with actinomycin-D and 13 with carboplatin ($250mg/m^2/dose$ for 2 days). The two groups were then compared in terms of 2- and 5-year overall survival (OS) and hematological and non-hematological toxicities. Results: Age, sex, stage and the mean duration of follow-up were similar in both groups (p>0.05). Two- and five-year OS levels were 68.2% in the carboplatin group and 78.0% and 40.0%, respectively, in the actinomycin-D group. There was no statistical difference in the number of febrile episodes (p=0.86) and no other hematological and non-hematological adverse effects were recorded in both groups. Conclusions: The findings show that carboplatin can be used as an alternative drug in the primary treatment of rhabdomyosarcoma in the event that actinomycin-D is unavailable or not tolerated.

Comparative Analysis of the Efficacy and Safety of Oxaliplatin Plus 5-Fluorouracil/Leucovorin (Modified FOLFOX6) with Advanced Gastric Cancer Patients having a Good or Poor Performance Status

  • Hacibekiroglu, Ilhan;Kodaz, Hilmi;Erdogan, Bulent;Turkmen, Esma;Esenkaya, Asim;Uzunoglu, Sernaz;Cicin, Irfan
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.6
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    • pp.2355-2359
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    • 2015
  • Background: Combination chemotherapy of 5 fluorouracil (5-FU) and leucovorin (LV) with oxaliplatin, mainly FOLFOX regimens, has shown considerable antitumor activity and a tolerable toxicity profile in gastric cancer. The goal of this study was to retrospectively compare the efficacy and toxicity of modified FOLFOX-6 (mFOLFOX6) regimen in advanced gastric cancer (AGC) patients with good and poor performance status (PS). Materials and Methods: AGC patients receiving the mFOLFOX6 regimen including oxaliplatin $85mg/m^2$, bolus of 5-FU $400mg/m^2$ and LV $400mg/m^2$ on the first day, followed by $2400mg/m^2$ of 5- FU as a continious infusion over 46 hour for first-line treatment were eligible for the study. Results: A total 58 patients with a median age of 59.5 (32-81) were included. The median follow up of the study was 9.2 months. Thirty patients (51.7%) with an ECOG PS 0-1 were assigned to the good PS arm, while 28 patients (48.3%) with ECOG PS 2 were in the poor PS arm. Overall response rates were 36.6 and 28.8%, respectively (p=0.91). Median PFS was 6.7 and 6.3 months in good PS and poor PS arms (p=0.50) and median OS was 9.6 and 10.4 months (p=0.55). As compared with good PS arm, poor PS arm was associated with more grade 3-4 neutropenia and anemia. Dose reduction and dose delays were also significantly higher. Conclusions: In this study, mFOLFOX6 was similarly effective in both arms. Although hematologic toxicity was significantly higher in patients with poor PS, it remained manageable. Our results suggest that this regimen may be an effective treatment option for AGC patients with poor PS.

Fragile X Syndrome and it's Association with Autism (약체X염색체 증후군과 자폐증과의 연관)

  • Yang, Moon-Bong
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.3 no.1
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    • pp.147-157
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    • 1992
  • The fragile X syndrome, which is considered to be synonymous with the Martin-Bell syndrome, is a relatively common form of X-linked mental retardation. The syndrome seems to occure in many different ethnic groups and its prevalence among mentally retarded males has been estimated to be in the order of 2 to 6%. The karyotypic hallmark of the syndrome is made up with a pronounced constriction near each tip of the long arm of the X chromosome(fragile site), shown in vitro only under conditions in which thymidylate production is blocked(lowered folate levels). Special culture media are needed to demonstrate this constriction site. Major clinical features associated with the syndrome include macroorchidism, large or prominent ears, significant emotional and behavioral dysfunctions such as hyperactivity, self-injury, lack of eye contact and social interaction, schizophrenia, autism, etc., and speech and language dysfunctions ranging from nonverbal to verbal speech with moderate to severe expressive language delays. Some have minor clinical features in common such as an increase in birth weight high forehead, prognathism, increased head circumference in infancy and childhood which did not persist into adult life. The recent research findings have shown that the fragile X syndrome is associated with infantile autism. Many patients with the fragile X syndrome fulfill the diagnostic criteria for infantile autism. Therefore it is recommendable that any patient with developmental delays and autism or autistic manifestations should have a chromosomal analysis, including fragile X examination. In the present review, historical aspects, incidence, and clinical features are presented. Recent anecdotal reports of the association with autism and the clinical improvement following high dose folic acid treatment will be discussed.

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A Study on the Improvement of Delay Compensation System in Defense Industry R&D (방위산업 R&D 지체상금 제도 개선방안 연구)

  • Kim, Sun-Young
    • Industry Promotion Research
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    • v.5 no.3
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    • pp.37-44
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    • 2020
  • Currently, the delayed compensation system, which does not reflect the R&D characteristics of the defense industry, is being applied, causing problems such as worsening management of defense companies and delayed power generation. The purpose of this study is to contribute to the development of the defense industry and the efficient promotion of combat capability by studying the improvement plan of the delayed compensation system reflecting the R&D characteristics of the defense industry. The research analyzed the defense industry R&D characteristics, national R&D, delayed compensation rate, reduction and exemption procedures and existing studies. Further, the Delphi technique was applied based on the status of the delayed compensation and the analysis of the cause of delay. It has been studied that it is not appropriate to apply the 'manufacturing and purchasing' standard of commercial products to defense industry R&D where the latest technology is applied and the success is unclear. Four measures were drawn to prevent delays, including the selection of excellent technology companies, and three measures to reduce delay compensation and apply differentials for rational treatment in case of delays. Just as the defense industry R&D is carried out under the Defense Acquisition Program Act due to the nature of the R&D industry, the defense industry will develop if the delayed compensation system is improved to reflect the R&D characteristics of the defense industry, and it will contribute to the acquisition of an efficient and economic weapons system.

Fruit Quality of 1-Methylcyclopropene Treated 'Formosa' Plum on the Shelf Life at Ambient Temperature (1-Methylcyclopropene이 'Formosa' 자두의 품질과 유통기간 연장)

  • Jung, Jae-Hoon;Kim, Young-Chil;Jung, Seok-Kyu
    • Horticultural Science & Technology
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    • v.28 no.3
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    • pp.429-433
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    • 2010
  • The effects of 1-methylcyclopropene (1-MCP) for controlling ripening processes such as weight loss, fruit softening, soluble solids content (SSC), titratable acidity (TA), and fruit skin color were investigated and also the possibility that 1-MCP can inhibit the development of brown rot was explored in 'Formosa' plum ($Prunus$ $domestica$ L.). Fruit were treated with $1{\mu}L{\cdot}L^{-1}$ 1-MCP on the day of harvest and one day after harvest for 16 h at ambient temperature ($20^{\circ}C$), followed by 14 days of shelf life. 1-MCP treatment delayed fruit softening, weight loss and changes in skin color and TA during the shelf life period, but did not affect SSC. These 1-MCP effects were similar with and without delayed treatment. 1-MCP treatment inhibited the development of brown rot caused by $Monilinia$ $laxa$ during storage. Our data shows that treatment delays of ${\geq}1$ day before 1-MCP application had no negative effect of fruit softening, fruit skin color, and TA at ambient temperature ($20^{\circ}C$). Overall, these results indicate that 1-MCP can be used to maintain the quality of non-refrigerated plums.

Pituitary Adenylate Cyclase-activating Polypeptide (PACAP) Treatment during Pre-maturation Increases the Maturation of Porcine Oocytes Derived from Small Follicles

  • Park, Kyu-Mi;So, Kyoung-Ha;Hyun, Sang-Hwan
    • Journal of Embryo Transfer
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    • v.33 no.1
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    • pp.1-11
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    • 2018
  • Cellular cyclic adenosine-3' 5'-monophosphate (cAMP) modulator is known as meiotic inhibitor and can delays spontaneous maturation in IVM experiment. Among many cAMP modulators, the role of Pituitary adenylate cyclase activating polypeptide (PACAP) on IVM isn't known. The purpose of this study is to improve the maturation of oocytes derived from follicles ${\leq}3mm$ in diameter through PACAP as meiotic inhibitor during pre-in vitro maturation (pre-IVM). First, we checked PACAP and its receptors in cumulus cells and, to establish the optimal phase and concentration of PACAP for pre-IVM, we conducted chromatin configuration assessments. As a result, the rate of GV (Germinal Vesicle) according to duration of pre-IVM was significantly decreased 12 h and 18 h after IVM (87.1 and 84.1%, respectively) compared to 0 h (99.4%). When COC was cultured for 18 h, the GV rate in the $1{\mu}M$ of PACAP treatment group (82.1%) was significantly higher than any other PACAP treatment groups (60.5, 64.1, 74.4 and 69.9 %, respectively). So, we divided into four groups as follows; MF (the conventional IVM group, obtained from follicle from 3 to 6 mm in diameter), SF (the conventional IVM group, obtained from follicle ${\leq}3mm$ in diameter), Pre-SF(-)PACAP (IVM group including 18 h pre-IVM without $1{\mu}M$ of PACAP, obtained from follicle ${\leq}3mm$ in diameter) and Pre-SF(+)PACAP (IVM group including 18 h pre-IVM with $1{\mu}M$ of PACAP, obtained from follicle ${\leq}3mm$ in diameter). To examine the effect of PACAP during pre-IVM, we investigated analysis of nuclear maturation, intracellular glutathione (GSH) and reactive oxygen species (ROS) levels. In cumulus cells, PACAP receptors, ADCYAP1R1 and VIPR1 were detected but were not detected in oocytes. After IVM, the Pre-SF(+)PACAP had the highest Metaphase II rate (91.7%) among all groups (P<0.05). The GSH levels in the MF and Pre-SF(+)PACAP were significantly higher than in the other groups (P<0.05) and ROS levels was no significant difference among all groups. In conclusion, these results indicated that even though the oocytes were derived from SF, pre-IVM application of PACAP improved meiotic and cytoplasmic maturation by regulating intracellular oxidative stress.

Estimating the Cost Savings Due to the Effect of Kremezin in Delaying the Initiation of Dialysis Treatments among Patients with Chronic Renal Failure (크레메진의 투석도입 지연효과에 따른 진행성 신부전증환자의 비용감소분 추계)

  • Cho, Woo-Hyun;Lee, Sun-Mi;Kim, Hyung-Jong;Lee, Ho-Yong;Woo, Tae-Wook;Kang, Hye-Young
    • Journal of Preventive Medicine and Public Health
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    • v.39 no.2
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    • pp.149-158
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    • 2006
  • Objectives : We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. Methods : We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. Results : The present value of cumulative cost savings per patient with CRF from the societal perspective would be $18,555,000{\sim}29,410,000$ Won or $72,104,000{\sim}112,523,000$ Won if Kremezin delays the initiation of dialysis by 1 or 4 years. Conclusions : The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.

A case of imipramine induced toxicity with Brugada electrocardiographic pattern in a toddler (Brugada 심전도 양상을 포함한 이미프라민에 의한 독성 부작용 1예)

  • Choi, Woo-Yeon;Park, Soo-Min;Han, Ui-Jeong;Kim, Young-Nam;Cho, Young-Kuk;Ma, Jae-Sook
    • Clinical and Experimental Pediatrics
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    • v.51 no.11
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    • pp.1232-1235
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    • 2008
  • Imipramine, a tricyclic antidepressant (TCA), is used for the treatment of non-polar depression and nocturnal enuresis in children in whom an organic pathology has been excluded, anxiety disorders, and neuropathic pain. Clinical toxicity following the treatment of TCAs, including imipramine, is well known. The anticholinergic effects initially present include a dry mouth, ileus, dilated pupils, urinary retention, and mild sinus tachycardia. The central nervous system toxicity includes delirium, agitation, restlessness, hallucinations, convulsions, and CNS depression or coma. However, the most life-threatening toxicity remains the development of cardiac dysrhythmias. Conduction delays such as QRS and corrected QT prolongation, wide QRS complex tachycardia, and the Brugada electrocardiographic pattern have been reported. Sodium bicarbonate decreases QRS widening and suppresses dysrhythmias by providing excess sodium to reverse the TCA-induced sodium-channel blockade and possibly by binding directly to the myocardium. There are no pediatric case reports on imipramine or other TCA associated toxicity in Korea. Here, we describe a patient who presented with convulsions, tachycardia with a wide QRS complex, a Brugada electrocardiographic pattern, and anuresis associated with an accidental overdose of imipramine and the outcome of treatment with sodium bicarbonate.

Relationship between emergency department crowding and initial management, mortality of severe trauma patients (응급실 과밀화와 중증외상환자의 초기 처치 및 사망률과의 연관성)

  • Park, Chang Won;Ahn, Jae Yun;Seo, Kang Suk;Park, Jung Bae;Lee, Mi Jin;Kim, Jong Kun;Ryoo, Hyun Wook;Kim, Yun Jeong;Lee, Dong Eun;Moon, Sungbae;Choe, Jae Young
    • Journal of The Korean Society of Emergency Medicine
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    • v.29 no.6
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    • pp.624-635
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    • 2018
  • Objective: This study examined whether emergency department (ED) crowding influences the timing of the initial assessment and treatment in severe trauma patients, as well as their mortality rates. Methods: This retrospective, observational study was conducted between January 2015 and October 2016, and included adult severe trauma patients who presented to the ED. The emergency department occupancy rate (EDOR) was used to measure ED crowding. The patients were divided into four groups using the EDOR quartile. The timeliness of the initial assessment and treatment in the four groups as well as the mortality rates were compared. Results: This study investigated 307 patients. The timing of the first computed tomography (CT) and laboratory test order, CT and laboratory test result acquisition, first transfusion, and patient transfer from the ED to the operating room were similar in the four groups. Multivariable logistic regression analysis did not show a significant difference in mortality between the groups. Conclusion: ED crowding was not associated with delays in the initial assessment and treatment of severe trauma patients, or in their mortality rates.