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Immediate Breast and Chest Wall Reconstruction for Advanced Breast Cancer (진행성 유방암에서 즉시 유방 및 흉벽 재건술)

  • Yang, Jung-Dug;Kim, Hak-Tae;Chung, Ho-Yun;Cho, Byung-Chae;Choi, Kang-Young;Lee, Jung-Hun;Lee, Jeong-Woo;Park, Ho-Yong;Jung, Jin-Hyang;Chae, Yee-Soo
    • Archives of Plastic Surgery
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    • v.38 no.5
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    • pp.627-635
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    • 2011
  • Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap (4 cases), extended LD flap with STSG (3 cases), thoracoabdominal flap (4 cases) and thoracoepigastric flap (3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients' oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

Mathematical Modeling of the Novel Influenza A (H1N1) Virus and Evaluation of the Epidemic Response Strategies in the Republic of Korea (수학적 모델을 이용한 신종인플루엔자 환자 예측 및 대응 전략 평가)

  • Suh, Min-A;Lee, Jee-Hyun;Chi, Hye-Jin;Kim, Young-Keun;Kang, Dae-Yong;Hur, Nam-Wook;Ha, Kyung-Hwa;Lee, Dong-Han;Kim, Chang-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.43 no.2
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    • pp.109-116
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    • 2010
  • Objectives: The pandemic of novel influenza A (H1N1) virus has required decision-makers to act in the face of the substantial uncertainties. In this study, we evaluated the potential impact of the pandemic response strategies in the Republic of Korea using a mathematical model. Methods: We developed a deterministic model of a pandemic (H1N1) 2009 in a structured population using the demographic data from the Korean population and the epidemiological feature of the pandemic (H1N1) 2009. To estimate the parameter values for the deterministic model, we used the available data from the previous studies on pandemic influenza. The pandemic response strategies of the Republic of Korea for novel influenza A (H1N1) virus such as school closure, mass vaccination (70% of population in 30 days), and a policy for anti-viral drug (treatment or prophylaxis) were applied to the deterministic model. Results: The effect of two-week school closure on the attack rate was low regardless of the timing of the intervention. The earlier vaccination showed the effect of greater delays in reaching the peak of outbreaks. When it was no vaccination, vaccination at initiation of outbreak, vaccination 90 days after the initiation of outbreak and vaccination at the epidemic peak point, the total number of clinical cases for 400 days were 20.8 million, 4.4 million, 4.7 million and 12.6 million, respectively. The pandemic response strategies of the Republic of Korea delayed the peak of outbreaks (about 40 days) and decreased the number of cumulative clinical cases (8 million). Conclusions: Rapid vaccination was the most important factor to control the spread of pandemic influenza, and the response strategies of the Republic of Korea were shown to delay the spread of pandemic influenza in this deterministic model.

Effectiveness of Public Credit Guarantee System and Its Coexistence with Market-based Finance Schemes (공적보증의 효과성과 시장기반 금융제도와의 공존)

  • Noh, Yong-Hwan;Hong, Jaekeun
    • The Journal of Small Business Innovation
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    • v.19 no.3
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    • pp.1-16
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    • 2016
  • Korean government had used public 'credit guarantee schemes' (CGS) as a counter-cyclical measure. However, it is still controversial about the effectiveness of policy financing on the SMEs. Criticism on policy financing involves the argument that supporting enterprises hampers competition and innovation of SMEs by increasing their dependence on the government and delays the exit of marginal firms. In this paper, we investigate how to effectively build up the rationale of running public CGSs. At the same time, we propose the ways to coexist of public credit guarantee and market-based private finance system for SMEs. First, CGS, as a counter-cyclical function, must coexist with the private financial system by compensating the market failure caused by pro-cyclical behavior of the private financial market. Second, CGS has the comparative advantages, compared to both the interest rate policy of the central bank and fiscal policy of the government. The credit guarantee is the symptomatic treatment that could revitalize the economy shortly by providing liquidity. Also, knowing that CGS is provided based on the leverage ratio defined by outstanding guarantee divided by capital fund, public 'credit guarantee' (CG) has an advantage that is free from the risk of government deficit. Third, the reason for existence of the CGS should be founded in supporting services for SMEs, available only in a public sector that is difficult to expect from private banks. In this regard, it is desirable to strengthen the publicness of credit guarantee over the support for start-ups, growing companies, the improvement of productivity, increase of exports, a long-term investment in facilities, the employment-creating businesses, and innovative enterprises.

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Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet

  • Lim, Sang Youn;Sohn, Sung Birm;Lee, Jung Min;Lee, Ji Ae;Chung, Sangmi;Kim, Junga;Choi, Juwhan;Kim, Sehwa;Yoo, Ah Young;Roh, Jong Ah;Park, Haein;Kim, Won Shik;Sim, Jae Kyeom;Shim, Jae Jeong;Min, Kyung Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.79 no.1
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    • pp.37-41
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    • 2016
  • Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.

Hospital Arrival Rate within Golden Time and Factors Influencing Prehospital Delays among Patients with Acute Myocardial Infarction (급성심근경색 환자의 증상 발현 후 골든타임내 응급의료센터 도착율 및 지연에 관련된 요인)

  • Ahn, Hye Mi;Kim, Hyeongsu;Lee, Kun Sei;Lee, Jung Hyun;Jeong, Hyo Seon;Chang, Soung Hoon;Lee, Kyeong Ryong;Kim, Sung Hea;Shin, Eun Young
    • Journal of Korean Academy of Nursing
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    • v.46 no.6
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    • pp.804-812
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    • 2016
  • Purpose: This research was done to identify the hospital arrival rate and factors related to prehospital delay in arriving at an emergency medical center within the golden time after symptom onset in patients with acute myocardial infarction (AMI). Methods: Data used in the research was from the National Emergency Department Information System of the National Emergency Medical Center which reported that in 2014, 9,611 patients went to emergency medical centers for acute myocardial infarction. Prehospital time is the time from onset to arrival at an emergency medical center and is analyzed by subdividing arrival and delay based on golden time of 2 hour. Results: After onset of acute myocardial infarction, arrival rate to emergency medical centers within the golden time was 44.0%(4,233), and factors related to prehospital delay were gender, age, region of residence, symptoms, path to hospital visit, and method of transportation. Conclusion: Results of this study show that in 2014 more than half of AMI patients arrive at emergency medical centers after the golden time for proper treatment of AMI. In order to reduce prehospital delay, new policy that reflects factors influencing prehospital delay should be developed. Especially, public campaigns and education to provide information on AMI initial symptoms and to enhance utilizing EMS to get to the emergency medical center directly should be implemented for patients and/or caregivers.

Radiation-induced Apoptosis is Differentially Modulated by PTK Inhibitors in K562 Cells (K562 백혈병 세포주에서 방사선에 의해 유도되는 Apoptosis에 미치는 PTK Inhibitors의 영향)

  • Lee Hyung Sik;Moon Chang Woo;Hur Won Joo;Jeong Su Jin;Jeong Min Ho;Lee Jeong Hyeon;Lim Young kin;Park Heon Joo
    • Radiation Oncology Journal
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    • v.18 no.1
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    • pp.51-58
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    • 2000
  • Purpose :The effect of PTK inhibitors (herbimycin A and genistein) on the induction of radiation-induced apoptosis in Ph-positive KS62 leukemia cell line was investigated. Materials and Methods :K562 cells in exponential growth phase were irradiated with a linear accelerator at room temperature. For 6 MV X-ray irradiation and drug treatment, cultures were initiated at 2×106 cells/mL. The cells were irradiated with 10 Gy. Stock solutions of herbimycin A and genistein were prepared in dimethyl sulphoxide (DMSO). After incubation at 37$^{\circ}C$ for 0$\~$48 h, the extent of apoptosis was determined using agarose gel electrophoresis and TUNEL assay. The progression of cells through the cell cycle after irradiation and drug treatment was also determined with flow cytometry. Western blot analysis was used to monitor bel-2, bel-X$_{L}$ and bax protein levels. Results :Treatment with 10 Gy X-irradiation did not result in the induction of apoptosis. The HMA alone (500 nM) also failed to induce apoptosis. By contrast, incubation of K562 cells with HMA after irradiation resulted in a substantial induction of nuclear condensation and fragmentation by agarose gel electro-phoresis and TUNEL assay. Genistein failed to enhance the ability of X-irradiation to induce DNA fragmentation. Enhancement of apoptosis by HMA was not attributable to downregulation of the bel-2 or bel-X$_{L}$ anti-apoptotic proteins. When the cells were irradiated and maintained with HMA, the percentage of cells in G2/M phase decreased to 30$\~$40$\%$ at 48 h. On the other hand, cells exposed to 10 Gy X-irradiation alone or maintained with genistein did not show marked cell cycle redistribution. Conclusion : We have shown that nanomolar concentrations of the PTK inhibitor HMA synergize with X-irradiation in inducing the apoptosis in Ph (+) K562 leukemia cell line. While, genistein, a PTK inhibitor which is not selective for p210$^{bcr/abl}$ failed to enhance the radiation induced apoptosis in KS62 cells. It is unlikely that the ability of HMA to enhance apoptosis in K562 cells is attributable to bel-2 family. It is plausible that the relationship between cell cycle delays and cell death is essential for drug development based on molecular targeting designed to modify radiation-induced apoptosis.

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The Effects of Sensory Integration Intervention Combined With Auditory Perception Training on Sensory Processing, Visual Perception and Attention of Children With Developmental Delay: Single-Subject Design (청지각 훈련과 병행한 감각통합치료가 발달지연 아동의 감각처리, 시 지각 발달, 주의집중에 미치는 영향: 개별실험연구)

  • Park, Mi-Young;Lim, Young-Myung;Kim, Hee
    • The Journal of Korean Academy of Sensory Integration
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    • v.15 no.2
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    • pp.66-79
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    • 2017
  • Objective : The purpose of this study is investigate the effects of sensory integration combined with auditory treatment on the sensory processing, visual perception and attention ability of children with developmental delay. Methods : A combined treatment of auditory training and sensory integration therapy was implemented to 3 children aged 4 to 7 and diagnosed with developmental delay during 9 weeks period from December 2016 to January 2017. ABA' design which is one of single subject research designs was used in this study. Baseline A had 4 sessions, intervention B had 15 sessions, and baseline A' had 4 sessions, so 23 sessions were applied in total. During the baseline A and A 'periods, visual perception ability was measured by K-DTVP-2 (Korea Developmental Test Visual Perception-2) and sensory processing ability was evaluated by sensory profile. The maintenance time of attention was measured with the absence of intervention for the baseline period, and for the intervention period, it was measured at 10 minutes break time which was provided after the intervention. The children's attention time during a fine motor task provided were measured using video recorder with the interval recording method, and the interval for the evaluation was 30 seconds. Results : No statistically significant difference were found in the visual perception function and sensory processing scores before and after treatment. Attention of participant A enhanced significantly while that of participant B and C did not improve significantly. Conclusion : It is hard to conclude that sensory integration therapy combined with auditory perception training has positive effects on visual perception function and attention of children with developmental delays. However, there were significant increase in attention and improvements in behavior related to sensory processing for some cases in this study. In further study, longer intervention periods and valid measurement need to be applied in order to get better results. And it is proposed that more studies need to be done to enhance evidence of auditory perception training as a mean to facilitate attention and to prepare learning.

Effects of Seed Coating and Molding on Seed Germination and Seedling Growth of Rehabilitating Plants in Forest Road Slopes (임도 비탈면 녹화식물의 종자피복 및 복토처리가 발아와 생장에 미치는 영향)

  • Lee, Byung-Tae;Park, Chong-Min
    • Korean Journal of Environment and Ecology
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    • v.20 no.4
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    • pp.436-447
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    • 2006
  • Recently, there is increasing demand on enhancing the efficiency of hydro-seed spraying in afforestation for damaged or degraded land including forest road slopes. In this study, we focus on how seed coating and molding may affect seed germination and seedling growth. Plant species used in the study are Lespedeza cyrtobotrya, Indigofera pseudotinctoria, Arudineila hirta, Poa pratensis, and Lolium perenne. The results of seed germination and seedling growth with and without seed coating and molding are analyzed as follows: 1. For all the species and in both seeding with molding covered with soil and seeding without molding in which seeds were over sown, the increment of germination ratio by seed coating method is greater than by non·coating one. Seed coating increases average germination ratios observed in seeding with molding and without molding by 11.2% and 21.4%, respectively. Germination force may decrease from 0.8 to 3.7 days depending on the plant species and the treatments. The $LD_{50}$ decreased by $0.8{\sim}2.6$ days. However, seed coating delays the start of germination by approximate 1 day for all of the observed plants. 2. Seed coating may have the effect of accelerating the growth of stem and leaf and root. The experimental result shows that seed coating leads to 21.7% and 34.8% increment of average stem and leaf growth by seeding with molding and without molding, respectively. In terms of root growth, seeding with molding results in 22.0% increment while seeding without molding produces 26.2% increased root growth. 3: Compared to seeding without molding, germination starts on an average of 1.3 days later in seeding coated seeds with molding. However. the germination ratio is increased by 5%, and germination force and $LD_{50}$ are observed to shorten by 1.0 day and 1.4 days, respectively. Meanwhile, whether seeds are coated or not may be more related with germination and seedling growth in seeding without molding than with those in seeding with molding. 4. In this study, coating materials are examined to look at which ones are better in each treatment. Coating with Vermiculite+Talcum is the most effective in germination and seedling growth for overall plants. Seed coating using Bentonite, Calcium Carbonate, and Calcium Hydroxide shows better results than non-coating does. 5. When seeds are coated, the greatest enhancement of seed germinations was observed in Indigofera pseudotinctoria and, in the case of seedling growth, Lespedeza cyrtobotrya has the most increasing observation value among the 5 examined species. These results may indicate that woody plant seeds, having greater sizes of seeds than ones of grass seeds, may have greater relation with seed coating than grass plant seeds may have. 6. Therefore, if seeds cannot be molded up after hydro-seeding on forest road slopes, it is recommended that seeds for restoration be pre-coated with Vermiculite+Talcum and then be sowed, in order to quickly stabilize the damaged slope and achieve successful afforestation.

A Cause Analysis of Missed Fractures in an Emergency Medical Center (응급센터에 내원한 외상환자에서 간과된 골절의 요인 분석)

  • Park, Deuk-Hyun;Lee, Sung-Sil;Kim, Dong-Un;Cho, Hyun-Young;Lee, Young-Geun;Kim, Jun-Su;Jun, Jin;Kim, Young-Sik;Ha, Young-Rock;Sin, Tae-Yong
    • Journal of Trauma and Injury
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    • v.22 no.1
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    • pp.37-43
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    • 2009
  • Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had three-site fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was $50.12{\pm}18.54$ years in the diagnosis group and $57.38{\pm}16.88$ years in the missed fracture group. For the diagnosis group, the mean ISS was $9.03{\pm}8.26$, but in the missed fracture group it was $17.53{\pm}9.69$. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high (ISS$ ISS{\geq}16$) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

The Efficacy of Speech and Language Therapy for Children with Speech and Language Delays according to the Eiologies (말 언어 지연을 보인 소아에서 원인에 따른 말 언어 치료의 효과)

  • Kim, June Bum;Suh, Jin-Soon;Kim, Young-Hoon;Chung, Seung-Yun;Lee, In-Goo;Whang, Kyung-Tai;Lee, Byung-Churl
    • Clinical and Experimental Pediatrics
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    • v.48 no.9
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    • pp.924-928
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    • 2005
  • Purpose : Treatment efficacy for children with speech and language delay has been the subject of considerable debate in recent years. We evaluated the clinical features of children with delayed speech and language and their prognoses according to their etiologies after 6 months of speech and language therapy. Methods : From January, 2000 to March, 2004, we retrospectively reviewed 56 children with speech and language delay who were administered speech and language therapy for 6 months in Uijongbu St. Mary's Hospital. Results : Of 56 cases, the proportion of developmental language disorder was 66.1 percent, structural malformation 19.6 percent, mental retardation 12.5 percent, hearing defect 1.8 percent. The ratio of male to female was 4.6 : 1 and the most frequent age group was over 47 months. The mean age of first spontaneous words with useful meaning was 15.9 months. The mean gestational age of the subjects was 39.8 weeks. The proportion of full-term infants was 96.4 percent and of premature infants was 3.6 percent. As for the birth order, the proportion of the first baby was 51.8 percent, the one of second babies it was 42.9 percent, and percent of third babies it was 7.1 percent. After 6 months of language intervention, 32.4 percent of patients with developmental language disorder showed normal linguistic development. All the patients with mental retardation showed sustained language and speech delay. As for the patients with structural malformations, five out of 11 patients showed normal linguistic development. Conclusion : The relatively advanced old age of majority of participants in this study suggests the necessity of screening test for language delay in this local community.