• Title/Summary/Keyword: Conservative Treatment

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Clinical Analysis of the Chest Trauma (흉부 손상의 임상적 고찰)

  • 이재덕;이계선
    • Journal of Chest Surgery
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    • v.29 no.1
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    • pp.79-85
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    • 1996
  • A clinical evaluation was performed on 305 cases of chest trauma experienced at the department of the Thoracic and Cardiovascular Surgery, Dae Jeon Eul Ji Hospital, during the period from March 1991 to November 1994. Age distribution was from 4 to 85 years, the mosts common age groups were 4-th, 5th and 6th decades. The ratio of male to female was 229:76(3:1), the ratio showed male predominance, the most common cause of trauma was traffic accidents in nonpenetrating trauma and stab wounds in penetrating trauma. Hemothorax, pneumothorax, and hemopneumothorax were observed in 159 cases (52.1 %) of total cases, Rib fracture was observed in 236 cases (77.4%) of total cases, location distribution was right : left : Both (102 : 142 : 45), with left predominant, rib fracture commonly involved from the 3th to 8th rib. Lag period from accident to admission was 155 cases (50.8%) under 6hr The principles of therapy for early complications of chest trauma were rapid r expansion of the lungs by thoracentesis 5 cases(1.6%) and closed thoracostomy 1-42 cases(46.6%), but open thoracotomy had to be done on 17 cases (5.6%) because of massive bleeding 13 cases or ruptured diaphragm, foreign body. Conservative nonoperative treatment was 140 cases (45.9%). Overall mortality rate was Bcases (2.6%) and common causes of the death were respiratory insufficiency and shock.

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Prognosis and Surgical Treatment of the Urethra Embedding Leiomyosarcoma in a Dog (개에서 요도를 포매한 평활근육종의 수술적 처치 및 예후)

  • Kim, Ji-Hyun;Lee, Jun-Am;Kim, Ill-Hwa;Jang, Dong-Woo;Kang, Hyun-Gu
    • Journal of Veterinary Clinics
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    • v.31 no.4
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    • pp.307-312
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    • 2014
  • A 16-year-old female Shih-Tzu, weighing 5 kg, presented with clinical symptoms of abdominal distension and urinary and fecal incontinence. Abdominal palpation detected a large mass. According to the radiographic findings, the bladder had been moved to the umbilicus by the mass and a large abdominal mass was confirmed in the lower abdominal area. Ultrasonography indentified a large heterogeneous mass with heterogeneous parenchyma and a focal anechoic area in the lower abdominal area. The complete blood count abnormalities suggested thrombocytosis and mild neutrophilia, and the serum chemistry indicated an elevated alkaline phosphatase value. During laparotomy, a firm mass that measured $10.5{\times}9.6cm$ was found between the uterine cervix and urinary bladder. The urethra was embedded in the mass. A diagnosis of leiomyosarcoma was established based on histopathology and histochemistry. One week after surgery, urinary retention symptoms that did not appear to be related to mechanical obstruction presented suddenly, but they did not respond to several drug treatments, thus long-term conservative therapy was adopted. The urinary symptoms disappeared on day 27 and the patient started to void large quantities of urine in a smooth and frequent manner. This case report describes the serial changes in the patient's status and the response after surgical remove of the urethra embedding leiomyosarcoma.

COMPOUND ODONTOMA WITH CONGENITAL MISSING OF THE PERMANENT TEETH: CASE REPORTS (영구치의 선천적 결손을 동반한 복합 치아종)

  • Kim, Ha-Na;Kim, Jae-Gon;Baik, Byeong-Ju;Han, Ji-Hye;Yang, Yeon-Mi
    • Journal of the korean academy of Pediatric Dentistry
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    • v.34 no.4
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    • pp.679-684
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    • 2007
  • Odontoma is the most common benign odontogenic tumors, and have been defined as mixed odontogenic tumor composed of epithelial and mesenchymal cells. Odontoma is believed to be hamartomatous rather than neoplastic in nature. The classification by WHO divides odontoma into 2 groups such as complex odontoma and compound odontoma. Compound odontoma comprises dental tissues, resembling the morphology of a tooth and has predilection for the anterior maxilla. In contrast, complex odontoma has unorganized mass, not resembling the normal tooth and has predilection for the posterior mandible. Odontoma is almost asymptomatic, so it is usually found on routine radiographic examination. Common presenting symptom is impacted or unerupted permanent teeth and retained primary teeth, but coexistent odontoma and congenital missing of permanent teeth is a very rare condition. The recommended treatment for an odontoma is conservative surgical excision, with care taken to remove the surrounding soft tissue. This report presents 2 patients with compound odontoma of the mandible who have congenital missing of the permanent teeth.

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THE ERUPTION GUIDANCE OF AN IMPACTED TOOTH ASSOCIATED WITH A COMPLEX ODONTOMA : CASE REPORT (복잡 치아종으로 인한 매복치아의 교정적 견인)

  • Pack, Jung-Ah;Yang, Kyu-Ho;Choi, Nam-Ki;Kim, Seon-Mi
    • Journal of the korean academy of Pediatric Dentistry
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    • v.34 no.4
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    • pp.651-657
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    • 2007
  • Odontomas are the common type of odontogenic tumors and generally are asymptomatic and frequently lead to impaction or delayed eruption of permanent teeth. They are composed of enamel, dentin, cementum and pulp tissue and are divided into compound and complex according to the morphology of the hard tissues. Compound odontomas consist of varying numbers of small toothlike structure and have a predilection for the maxillary anterior regions. Complex odontomas consist of an unorganized mass of odontogenic tissues and comprise approximately 25 percent of all odontomas and have a predilection for the mandibular posterior regions. The etiology of odontomas is uncertain but hypothesized to involve local trauma, infection and genetic factors. Treatment of odontoma is conservative surgical removal and are little probability of recurrence. These two cases were about the patients with delayed eruption of mandibular first molar and mandibular lateral incisor. We surgically removed odontoma, exposed impacted tooth and guided impacted tooth into normal position by orthodontic traction. At the completion of traction, the mandibular first molar and mandibular lateral incisor was positioned fairly within the arch and complications such as root resorption were not observed.

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The Clinical Evaluation of Anomalous Bronchi Arising From The Trachea and Main Bronchi (기관 및 주기관지에서 발생한 기관지기형의 임상적 고찰)

  • Kim, Jun Chul;Kim, Yeon Jae;Kang, Byung Jun;Youn, Young Deuk;Lee, Se Young;Kwon, Young Lan;Lee, Soo Ok;Jeong, Chi Yeong;Lee, Byung Ki
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.664-669
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    • 2005
  • Objectives : To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. Methods : 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. Results : Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. Conclusion : Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.

Three Cases of Mitochondrial Disorders in the Neonatal Period (신생아기에 진단된 미토콘드리아 질환 3례)

  • Kim, Yoon-Hee;Lee, Young-Mock;Namgung, Ran;Kim, Jeong-Eun;Lee, Soon-Min;Park, Kook-In;Kim, Se-Hoon;Lee, Jin-Sung
    • Neonatal Medicine
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    • v.17 no.2
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    • pp.254-261
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    • 2010
  • Little is known about neonatal mitochondrial disease, though mitochondrial metabolic disorders may often present in the neonatal period because of the high energy requirement of neonate. In newborn period, common presentations are not specific and the disease course may be rapid and fatal. In this study, we report three cases of neonatal mitochondrial disease. The first case was strongly suspected because of sudden seizure and mental change with severe lactic acidosis, and multiorgan failure. Plasma lactate/pyruvate (L/P) ratio was increased to 55.6 with marked lactic aciduria and increased plasma alanin up to 2,237 nmol/mL. In the second patient, a peritoneal dialysis was performed for acute adrenal and renal failure, but metabolic acidosis persisted. Plasma L/P ratio was increased to 23.9, and MRC I (mitochondrial respiratory chain defect) was diagnosed through the enzymatic analysis of the muscles. The third case showed repetitive episode of lactic acidosis during the first two months of life, hypotonia, failure to thrive and feeding difficulties. We found markedly increased cerebrospinal fluid L/P ratio up to 57 though plasma L/P ratio(19.4) was borderline with increased plasma lactate. The lactate peak was prominent in brain magnetic resonance spectroscopy (MRS). MRC II was confirmed through muscle biopsy. Plasma lactate level and lactate peak of brain MRS were normalized after conservative treatment.

Gracilis Muscle Transplantation in Neglected Brachial Plexus Palsy (진구성 상완 신경총 마비에 대한 유리박근이식술)

  • Chung, Duke-Whan;Han, Chung-Soo;Ok, Jae-Chul;Cho, Chang-Hyun
    • Archives of Reconstructive Microsurgery
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    • v.6 no.1
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    • pp.73-79
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    • 1997
  • Complete denervation after severe brachial plexus injury make significant muscle atrophy with loss of proper function. It is much helpful to reconstruct the essential function of the elbow flexion movement in patient with total loss of elbow flexion motion after brachial plexus lesion which was not recovered with nerve surgery or long term conservative treatment from onset. In whole arm type brachial plexus injury, if there were no response to neurotization or neglected from injury, the volume of the denervated muscle is significantely reduced month by month. About 18 months most of the muscle fibers change to fibrous tissues and markedly atrophied irreversibly, further waiting is no more meaningful from that period. Authors performed 14 cases of functioning gracilis muscle transfer from 1981 to 1995 with microneurovascular technique, neuromusculocutaneous free flaps were performed for reconstruction of lost elbow flexion function. Average follow-up period was 5 years and 6 months. We used couple of intercostal nerves as a recipient nerve which were anastomosed to muscular nerve from obturator nerve in all cases. Recipient vessels were three deep brachial artery and eleven brachial artery which were anastomosed to medial femoral circumflex artery with end to end or end to side fashion. Average resting length of the transplanted gracilis were 24 cm. We can get average 54 degree flexion range of elbow with fair muscle power from flail elbow. There were one case of muscle necrosis with lately developed thrombosis of microvascular anastomosed site which comes from insufficient recipient arterial condition, 3 cases of partial marginal necrosis of distal skin of the transplanted part which were not significant problem with spontaneously solved with time goes by gracilis muscle has constant neurovascular pattern with relatively easy harvesting donor with minimal donor morbidity. Especially it has similar length and shape with biceps brachii muscle of upper arm and longer nerve pedicle which can neurorrhaphy with intercostal nerve without nerve graft if sufficient mobilization of the nerves from both sides of gracilis and intercostal region. Authors can propose gracilis muscle transplantation with intercostal nerves neurotization is helpful method with minimal donor morbidity for neglected brachial plexus palsy patients.

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Common Docking Domain Mutation E322K of the ERK2 Gene is Infrequent in Oral Squamous Cell Carcinomas

  • Valiathan, Gopalakrishnan Mohan;Thenumgal, Siji Jacob;Jayaraman, Bhaskar;Palaniyandi, Arunmozhi;Ramkumar, Hemalatha;Jayakumar, Keerthivasan;Bhaskaran, Sajeev;Ramanathan, Arvind
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.12
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    • pp.6155-6157
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    • 2012
  • Background: Mutations in the MAPK (Mitogen Activated Protein Kinase) signaling pathway - EGFR/Ras/RAF/MEK have been associated with the development of several carcinomas. ERK2, a downstream target of the MAPK pathway and a founding member of the MAPK family is activated by cellular signals emanating at the cell membrane. Activated ERK2 translocates into the nucleus to transactivate genes that promote cell proliferation. MKP - a dual specific phosphatase - interacts with activated ERK2 via the common docking (CD) domain of the later to inactivate (dephosphorylate) and effectively terminate further cell proliferation. A constitutively active form of ERK2 carrying a single point mutation - E322K in its CD domain, was earlier reported by our laboratory. In the present study, we investigated the prevalence of this CD domain E322K mutation in 88 well differentiated OSCC tissue samples. Materials and Method: Genomic DNA specimens isolated from 88 oral squamous cell carcinoma tissue samples were amplified with primers flanking the CD domain of the ERK2 gene. Subsequently, PCR amplicons were gel purified and subjected to direct sequencing to screen for mutations. Results: Direct sequencing of eighty eight OSCC samples identified an E322K CD domain mutation in only one (1.1%) OSCC sample. Conclusions: Our result indicates that mutation in the CD domain of ERK2 is rare in OSCC patients, which suggests the role of genetic alterations in other mitogenic genes in the development of carcinoma in the rest of the patients. Nevertheless, the finding is clinically significant, as the relatively rare prevalence of the E322K mutation in OSCC suggests that ERK2, being a common end point signal in the multi-hierarchical mitogen activated signaling pathway may be explored as a viable drug target in the treatment of OSCC.

Biomechanical Analysis of Different Thoracolumbar Orthosis Designs using Finite Element Method (유한요소 해석을 이용한 정형용 흉·요추 보조기의 형태에 따른 생체역학적 분석)

  • Kim, Y.H.;Jun, S.C.;Jung, D.Y.;Lee, S.J.
    • Journal of rehabilitation welfare engineering & assistive technology
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    • v.6 no.1
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    • pp.45-50
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    • 2012
  • Thoracolumbar orthosis has been used for the rehabilitation of the patients with senile kyphosis. Recently, a number of different thoracolumbar orthosis designs have been introduced but its biomechanical effectiveness still remain unknown. In this study, we compared the pressure distribution on the surface of the trunk and stresses on the orthosis in relation to changes in connecting frame designs (Type 1, one-connecting frame type; Type 2, two-connecting frame type; Type 3, all-in-one type) using finite element (FE) models under different motions of the trunk. The results showed that Type 3 distributed the pressure on the trunk most evenly followed by Type 2 and Type 1 and the difference between Type 1 and Type 2 was negligible. ROM was limited most effectively by Type 3 ($8.5{\sim}9.4^{\circ}$), followed by Type 2 ($11.3{\sim}13.9^{\circ}$) and Type 1 ($12.1{\sim}15.4^{\circ}$). The ratio between the peak von Mises stress and yield strength of each material remained less than 20% regardless of orthosis type indicating low likelihood of component failure. In conclusion, our study found that all-in-one type of orthosis was the most effective design for the conservative treatment of spinal deformity in terms of function and comfort.

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Recurred Thyroid Carcinoma (재발성 갑상선 암)

  • Park Kyue-Il;Yoon Jung-Han;JeGal Young-Jong
    • Korean Journal of Head & Neck Oncology
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    • v.8 no.2
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    • pp.72-81
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    • 1992
  • Thyroid cancer, the most common cancer of endocrine neoplasms, has tremendous variation in tumor biologic behavior. There is no consensus about treatment mode to prevent recurrences despite of recent advance in understanding characteristics of thyroid cancer. So, we have made a clinical analysis and follow-up study of recurred 27 cases among 189 cases treated under the diagnosis of thyroid carcinoma in the department of surgery, Chonnam University Hospital from February, 1982 to February, 1992 to clarify our experience about the characteristics of recurred thyroid cancer. The results were as follow: According to the pathological classification of recurred thyroid cancer, recurrence rate was 11.6% in papillary carcinoma, 15.6% in follicular carcinoma, 37.5% in medullary carcinoma, 66.7% in undifferentiated carcinoma, respectively, and the mean recurrence rate of thyroid cancer was 14.3%. The recurrence rate according to age was 28.6% in 8th decade and 17.9% in 4th decade. The recurrence rate according to sex was not singificant(15.6% in male: 14% in female). The mean period to relapse was 4 years 6 months in papillary carcinoma, 2 years 5 months in follicular carcinoma, 2 years 1 months in medullary carcinoma, 2 years 6 months in undifferentiated carcinoma. The recurrence rate according to previous operating methods, such as performing lymph node dissection or not, mode of thyridectomy, type of lymph node dissection was statisfically non-specific. Common recurrent sites of papillary and follicular carcinoma was cervical lymph node and remained thyroid tissue. Medullary and undifferentiated carcinoma was noted in multiregional or systemic involvement Reoperation was performed with complete resection of recurred or metastatic mass, such as radical neck dissection or mass extirpation from involved organs as possible. The postoperative complications were 2 cases of horseness, and 1 case with hematoma, transient hypocalcemia, wound infection, and pulmonary insufficency, respectively. 5-year survival rate was 85.5% in papillary carcinoma, 66.7% in follicular carcinoma. 50% in medullary carcinoma, and 50% in undifferentiated carcinoma. We concluded that recurrence in thyroid cancer give a reconsideration to previous conservative therapy and more extensive surgical procedures for thyroid cancer including lymphatic dissection are recommanded to prevent recurrences in selected cases if possible.

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