• Clinical and Experimental Pediatrics
• /
• 제53권9호
• /
• pp.830-833
• /
• 2010

Crohn's disease is characterized by chronic inflammation involving any portion of the gastrointestinal tract. Treating Crohn's disease is a major challenge for clinicians, as no curative therapy currently exists. Pediatric Crohn's disease is characterized by frequent relapses, a wide extent of disease, a high prevalence of extraintestinal manifestations, and a severe clinical course. The classic therapeutic approach is known as the 'step-up' strategy, and follows a progressive course of treatment intensification as disease severity increases. Although this approach is usually effective for symptom control, many patients become either resistant to or dependent on corticosteroids. The efficacy of infliximab suggests that, rather than a progressive course of treatment, early intense induction may reduce complications associated with conventional treatment and improve quality of life. Intensive early therapy with infliximab is known as the 'top-down' strategy. Such therapy offers the potential for altering the natural history of Crohn's disease, and is changing treatment paradigms. However, the relatively new concept of an early aggressive or 'top-down' treatment approach is not yet widely accepted, especially in pediatric patients. The results of our current study demonstrate that early and intensive treatment of pediatric Crohn's disease patients with infliximab, at initial diagnosis, was more effective for maintaining remission and reducing flares.

• 근관절건강학회지
• /
• 제4권2호
• /
• pp.177-196
• /
• 1997

This study was undertaken to explore the antecedent factors and process of the treatment-seeking behaviors of medical and alternative treatments in patients with arthritis using methodological triangulation. The data were collected from 995 arthritic patients who were registered either in a center of rheumatology for medical treatment or residents of community having no treatment to classify different treatment patterns. Sixteen patients with various types of treatment only, alternative treatment only, and no treatment were selected among the total samples to identify the antecedent factors through in-depth interview. The quantitative data were analyzed by percentile, t-test, chi-square test and discrimant analysis using SAS PC program, while the qualitative data were analyzed by means of grounded theory methodology. Treatment-seeking behaviors of patients change from the early stage to the sick-role stage. At the early stage, initial characteristics of pain and acculturation of medical professionalism affect the choice of treatment patterns. The acculturation of medical professionalism is affected by health care accessibility, level of education, duration of sickness and lay referral system. At the sick-role stage, lay referral system and acculturation of medical professionalism affect the choice of treatment patterns. The acculturation of medical professionalism is affected by characteristics of symtoms, perceived treatment effects, perceived causes of diseases and socio-economic status as well as health care accessibility, level of education and lay referral system. In conclusion, different factors as well as common factors are influencing the treatment-seeking behaviors depending on the disease and treatment stages. More detailed further studies are required to explore the value system or medical acculturation of patients which is one of the most important factors in decision-making about treatment modalities.

• Journal of Gastric Cancer
• /
• 제18권4호
• /
• pp.400-408
• /
• 2018

Purpose: This study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection. Materials and Methods: We retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017. Results: Forty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed. Conclusions: In patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.

• Journal of Chest Surgery
• /
• 제50권3호
• /
• pp.177-183
• /
• 2017

Background: To improve postoperative outcomes associated with interstitial pneumonia (IP) in patients with lung cancer, the management of the postoperative acute exacerbation of IP (PAEIP) was investigated. Methods: Patients with primary lung cancer were considered to be at risk for PAEIP (possible PAEIP) based on a preoperative evaluation. The early phase of this study was from January 2001 to December 2008, and the late phase was from January 2009 to December 2014. In the early phase, chest computed tomography (CT) was performed for patients for whom PAEIP was suspected based on their symptoms, whereas in the late phase, chest CT was routinely performed within a few days postoperatively. The numbers of possible PAEIP cases, actual PAEIP cases, and deaths within 90 days due to PAEIP were compared between both phases. Results: In the early and late phases, surgery was performed in 712 and 617 patients, 31 and 72 possible PAEIP cases were observed, nine and 12 actual PAEIP cases occurred, and the mean interval from the detection of PAEIP to starting treatment was $7.3{\pm}2.3$ and $5.0{\pm}1.8$ days, respectively. Five patients died in the early phase, and one patient died in the late phase. Significantly fewer PAEIP-related deaths were observed in the late phase (p<0.05). Conclusion: Identifying patients at risk for PAEIP by routine postoperative CT examinations led to the early diagnosis and treatment of PAEIP, resulting in the reduction of PAEIP-related mortality.

• 대한후두음성언어의학회지
• /
• 제19권1호
• /
• pp.7-10
• /
• 2008

The early glottic cancers are traditionally treated by radiotherapy or endoscopic surgery. The excellent effectiveness of both treatment modalities for local control, larynx preservation, and disease specific death is similar. Therefore, functional voice outcome after treatment is one of the most important factors in the choice of treatment for early glottic cancer. To assess the functional outcomes and compare the voice quality in patients with early glottic cancer treated with curative intent with radiotherapy or laser cordectomy, we performed literature review. Most studies showed that the voice quality after radiation therapy is slightly better than that after laser cordectomy. Subanalysis according to types of laser cordectomy, however, indicates that voice quality depends on type of laser cordectomy. Especially, type I or type II laser cordectomy might be superior to other types of laser cordectomy and radiation therapy. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer including professional voice users.

• 보험의학회지
• /
• 제17권
• /
• pp.3-8
• /
• 1998

• Journal of Korean Neurosurgical Society
• /
• 제55권3호
• /
• pp.125-130
• /
• 2014

Objective : This study was conducted to elucidate neuroprotective effect of carnosine in early stage of stroke. Methods : Early stage of rodent stroke model and neuroblastoma chemical hypoxia model was established by middle cerebral artery occlusion and antimycin A. Neuroprotective effect of carnosine was investigated with 100, 250, and 500 mg of carnosine treatment. And antioxidant expression was analyzed by enzyme linked immunosorbent assay (ELISA) and western blot in brain and blood. Results : Intraperitoneal injection of 500 mg carnosine induced significant decrease of infarct volume and expansion of penumbra (p<0.05). The expression of superoxide dismutase (SOD) showed significant increase than in saline group in blood and brain (p<0.05). In the analysis of chemical hypoxia, carnosine induced increase of neuronal cell viability and decrease of reactive oxygen species (ROS) production. Conclusion : Carnosine has neuroprotective property which was related to antioxidant capacity in early stage of stroke. And, the oxidative stress should be considered one of major factor in early ischemic stroke.

• Neonatal Medicine
• /
• 제16권2호
• /
• pp.101-109
• /
• 2009

Pulmonary surfactant (PS) therapy in premature infants has a remarkable impact on improving survival and outcomes in neonatal respiratory distress syndrome (RDS). Early PS therapy involves instillation of PS upon delivery of very premature infants or if there is evidence of RDS, such as an increased requirement of oxygen 2 hours after birth, especially in infants <30 weeks gestation. Early PS treatment in very premature infants results in a significant reduction in the severity of RDS, mortality, and incidence of pneumothorax, pulmonary interstitial emphysema, and bronchopulmonary dysplasia in comparison with late PS treatment. According to European and American consensus guidelines on the management of neonatal RDS, early PS instillation should be considered for infants <30 weeks gestation, infants with a birth weight <1,250 g, or if the mother has not received antepartum corticosteroids. We suggest that the Korean health insurance policy on RDS be modified so that PS can be used for better clinical outcomes of very premature infants.

• Journal of Gastric Cancer
• /
• 제10권2호
• /
• pp.49-54
• /
• 2010

Endoscopic resection is now accepted as curative treatment modalities for early gastric cancer without lymph node metastasis. However, based on large-scaled data about the risk of lymph node metastasis in early gastric cancer and as a result of the technical development of endoscopic devices, it was suggested that the criteria for endoscopic resection should be extended. According to the treatment guidelines for gastric cancer in Japan, the extended indications include the following: differentiated-type mucosal cancer without ulceration and greater than 2 cm in diameter, differentiated-type mucosal cancer with ulceration and up to 3 cm in diameter, undifferentiated-type mucosal cancer without ulceration and up to 2 cm in diameter, and, in the absence of lymphovascular invasion, a tumor not deeper than submucosal level 1 (less than $500\;{\mu}m$). In this review, we discuss the evidence of the application of expanded endoscopic indication based on analysis of biologic behavior and data of endoscopic resection.

• 한국의사학회지
• /
• 제25권2호
• /
• pp.1-10
• /
• 2012

The late Goryeo and Early Joseon period marks the development of Hyang-yak medicine in medical history in Korea. There have been not a few outcomes in organizing Hyang-yak medicine through the hitherto research works, but there has hardly any attempt to view the medicine in the late Goryeo and Early Joseon period from a different standpoint besides Hyang-yak. This writer, in the middle of doing research on 'Book for Alimentotherapy' named "Sikuisikgam", came to know that not a few parts of this book were quoted in a large volume of "Biebaekyobang" in the late Goryeo, "Hyangyakjipseongbang" which compiled the early Joseon Hyangyak medicine, "Uibangyuchi" which wrapped up the medical knowledge in East Asia before the early Ming Dynasty, and "Sikryochangyo" which was a representative book for alimentotherapy in the early period of Joseon Dynasty. The reason that the representative medical books written in the period of Late Goryeo and Early Joseon thought much of the knowledge contained in "Sikuisikgam" is that they showed a great concern for prevention and treatment of diseases through alimentotherapy. When we say that Hyangyak medicine, which has provided the Late Goryeo and Early Joseon medicine, bases its standard on 'Regionality' and 'Properties of Medicinal ingredients', then alimentotherapy puts its focus on a 'Remedial method' itself. As for food, they might have given priority to the food that was easy to get nearby, so there is no way for alimentotherapy but to have the realm which is overlapped with Hyangyak medicine in some measure, That's the very reason why alimentotherapy has remained inseparate from Hyangyak medicine. Through 'Alimentotherapy' and Late Goryeo and Early Joseon medical books, this writer thinks that it might be possible for us to take a view of the Late Goryeo and Early Joseon not only from the perspective of Hyangyak medicine but also from a new perspective of so-called alimentotherapy.