• 제목/요약/키워드: Clinical morbidity

검색결과 822건 처리시간 0.025초

호스피스.완화의료에서의 사별 돌봄 (Bereavement Care in Hospice and Palliative Care)

  • 김창곤
    • Journal of Hospice and Palliative Care
    • /
    • 제10권3호
    • /
    • pp.120-127
    • /
    • 2007
  • Bereavement is the state of loss resulting from death. Grief is the emotional response associated with loss, intense and acute sorrow resulting from loss. Complicated grief represent a pathological outcome involving social, physical, emotional, cognitive, spiritual morbidity. The common psychiatric disorders associated complicated grief or abnormal grief responses include clinical depression, anxiety disorders, alcohol abuse or other substance abuse, and dependence, psychotic disorders, and post-traumatic stress disorder (PTSD). Grief tasks involve a series of stage or phases following an important loss that gradually permit adjustment and recovery. Three phases of grief involve phase 1 (walking the edges), phase 2 (entering the depths), and phase 3 (reconnecting the world). For intervention to be effective they need to be individually tailored to abnormal grief reaction or unresolved grief reaction. Clear understandings of complicated grief, abnormal responses, factors increasing risk after bereavement will often enable us to prevent psychiatric disorders in bereaved patients.

  • PDF

슬관절 주위 거대세포종의 치료 (Surgical treatment of Giant Cell Tumor in Knee Joint)

  • 배대경
    • 대한골관절종양학회지
    • /
    • 제1권1호
    • /
    • pp.1-6
    • /
    • 1995
  • Giant cell tumors are primary bone tumors originating from non-osteoblastic connective tissue. The sites of involvement were commonly distal femur, proximal tibia, proximal humerus, distal radius and others (including os calcis, ilium and sacrum). Giant cell tumor located around knee joint has been difficult to treat because of local recurrence following curettage with or without bone graft. Although primary resections reduce recurrence of the lesion, the joint function will be markedly impaired. Marginal excision was very often complicated by a loss of joint integrity since all the giant cell tumors occupy juxtaarticular positions. Techniques involving physical adjuncts(high speed burr and electric cauterization) have been used in the hope of decreasing the rate of local recurrence and avoiding the morbidity of primary resection. A meticulous clinical, radiological and histological evaluation is needed to choose the correct treatment, keeping in mind the possibility of recurrence after each treatment modality.

  • PDF

Propeller Perforator Flaps in Distal Lower Leg: Evolution and Clinical Applications

  • Georgescu, Alexandru V.
    • Archives of Plastic Surgery
    • /
    • 제39권2호
    • /
    • pp.94-105
    • /
    • 2012
  • Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot.

유방암에서 전초림프절 영상 (Sentinel Lymph Node Imaging in Breast Cancer)

  • 김병태
    • 대한핵의학회지
    • /
    • 제33권3호
    • /
    • pp.243-246
    • /
    • 1999
  • Currently, dissection of the axillary or regional lymph nodes is considered the standard staging procedure in breast cancer. However, accumulating evidence is becoming available that the sentinel node concept may provide the same or even better staging information. In the case of melanoma, it is proven that the histological characteristics of the sentinel node reflect the histological characteristics of the distal part of the lymphatic basin. Morbidity can be reduced significantly by the use of sentinel node dissection as several authors have reported successful introduction of this technique into clinical practice. But in breast cancer patients, there are signigicant differences in practice relating to the technology, such as radiopharmaceuticals, injection sites, volume of injectate, combination with vital blue dye, preoperative lymphoscintigraphy, etc. Valuable reports on these topics appeared in recent journals. This review is a summary of those reports for nuclear physicians interested in sentinel node detection by lymphoscintigraphy in breast cancer patients.

  • PDF

Cancer Control Programs in East Asia: Evidence From the International Literature

  • Moore, Malcolm A.
    • Journal of Preventive Medicine and Public Health
    • /
    • 제47권4호
    • /
    • pp.183-200
    • /
    • 2014
  • Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East.

흉강경검사의 임상적 고찰 (Clinical evaluation of thoracoscopy)

  • 김영호;조중구
    • Journal of Chest Surgery
    • /
    • 제17권3호
    • /
    • pp.522-530
    • /
    • 1984
  • During a 12-month period, 31 patients underwent diagnostic and therapeutic thoracoscopy for previously undiagnosed thoracic diseases. In all patient, the diagnosis had been unobtainable by the usual diagnostic modalities of thoracentesis, closed pleural biopsy, bronchoscopy, or mediastinoscopy. The patients ranged from 4 years to 84 years old. One procedure was performed for mediastinal mass, 8 for parenchymal lesions, 21 for pleural diseases, and 1 for diaphragmatic disease. A correct diagnosis was obtained by thoracoscopy in 31 procedures for a 90% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under intercostal nerve block and regional anesthesia, has proved to be a very attractive method of the diagnosis of thoracic disease.

  • PDF

심장 점액종의 외과적 고찰임상 경험 및 장기 성적 (Approach in the Surgical Management of Cardiac Myxoma - Clinical Experience and Long-term Result -)

  • 김응수
    • Journal of Chest Surgery
    • /
    • 제21권3호
    • /
    • pp.518-525
    • /
    • 1988
  • Between 1977 and 1987, 8 patients underwent excision of cardiac myxomas at the Hanyang University Hospital. All had a left atrial myxoma. There were 4 female and 4 male patients ranging from 15 to 62 years of age. Preoperative findings consist of symptoms and signs of congestive heart failure except one. Diagnosis was confirmed by echocardiography[8 cases] and angiography[2 cases], preoperatively. A biatrial operative approach was utilized in all but 2, who were small sized. Complete excision of the tumor with a cuff of normal tissue[1 was atrial wall and 7 were atrial septum] was performed. all heart chambers were carefully explored for presence of multicentric myxomas or tumor debris. There were no operative deaths or intraoperative embolization. Follow-up has been 1/3 to 10 years. There has been 1 late death, due to recurrence and 1 patient had reoperation for mitral regurgitation due to dilatation of the annulus by a huge tumor mass. Surgical excision of the myxoma can be performed with low morbidity, and it provides excellent and sustained symptomatic relief. The recurrence rate is low, but long-term follow-up and serial echocardiography are advisable.

  • PDF

Pulmonary hypertension in infants with bronchopulmonary dysplasia

  • Kim, Gi-Beom
    • Clinical and Experimental Pediatrics
    • /
    • 제53권6호
    • /
    • pp.688-693
    • /
    • 2010
  • An increase in the number of preterm infants and a decrease in the gestational age at birth have resulted in an increase in the number of patients with significant bronchopulmonary dysplasia (BPD) and secondary pulmonary hypertension (PH). PH contributes significantly to the high morbidity and mortality in the BPD patients. Therefore, regular monitoring for PH by using echocardiography and B-type natriuretic peptide (BNP) or N-terminal-proBNP must be conducted in the BPD patients with greater than moderate degree to prevent PH and to ensure early treatment if PH is present. In the BPD patients with significant PH, multi-modality treatment, including treatment for correcting an underlying disease, oxygen supply, use of diverse selective pulmonary vasodilators (inhaled nitric oxide, inhaled prostacyclins, sildenafil, and endothelin-receptor antagonist) and other methods, is mandatory.

체외 수정후 발생한 병합임신 1예 (A Case Report of Heterotopic Pregnancy after IVF-ET)

  • 박철민;김성엽;손영수
    • Clinical and Experimental Reproductive Medicine
    • /
    • 제32권4호
    • /
    • pp.353-359
    • /
    • 2005
  • Heterotopic pregnancy is named when an extrauterine (ectopic) pregnancy coexists with an intrauterine pregnancy simultaneously by many causes such as PID (pelvic inflammatory disease), endometriosis, IUD (intrauterine device), previous pelvic surgery and others. This is very rare in general population, with a range of occurrence estimated between 1:7963 and 1:30000. But recently the incidence has increased as the uses of ARTs (assisted reproductive technologies) including ovulation induction, IVF-ET (in-vitro fertilization and embryo transfer) and GIFT (gamete intrafallopian transfer) increase. Because this has high maternal morbidity, mortality and fetal loss, early diagnosis and proper management is very important. We report a case of heterotopic pregnancy following IVF-ET with a brief review.

BRW Stereotaxic System을 이용한 뇌간신경교종의 정위수술적 생검술 (A BRW Stereotaxic Biopsy of Brain Stem Glioma)

  • 백승찬;최병연;문충배;지용철;조수호
    • Journal of Yeungnam Medical Science
    • /
    • 제3권1호
    • /
    • pp.343-349
    • /
    • 1986
  • 본 교실에서는 2례의 뇌간부위 병소에서 BRW system을 이용한 정위적 생검술을 시행하여 악성 신경교종 및 신경교 성상 세포종 Grade II로 확진된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

  • PDF