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Management of Severe Trauma Patients in the Emergency Intensive Care Unit (응급중환자실에서의 중증외상환자 치료)

  • Kim, Ji-Ju;Suh, Gil-Joon;Jeong, Ki-Young;Kwon, Woon-Yong;Kim, Kyung-Su;Lee, Hui-Jai;Kim, Yeong-Cheol;Choi, Seok-Ho;Lee, Young-Ho;Lee, Kyung-Hag;Han, Kook-Nam;Jae, Hwan-Jun;Kim, Hyo-Cheol
    • Journal of Trauma and Injury
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    • v.24 no.2
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    • pp.98-104
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    • 2011
  • Purpose: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. Methods: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. Results: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were $36.97{\pm}17.73$ and $7.84{\pm}6.75$, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS ($p$ <0.001). Conclusion: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.

B-cell Lymphoma 2 rs17757541 C>G Polymorphism was Associated with an Increased Risk of Gastric Cardiac Adenocarcinoma in a Chinese Population

  • Li, Qiong;Yin, Jun;Wang, Xu;Wang, Li-Ming;Shi, Yi-Jun;Zheng, Liang;Tang, Wei-Feng;Ding, Guo-Wen;Liu, Chao;Liu, Rui-Ping;Gu, Hai-Yong;Sun, Jia-Ming;Chen, Suo-Cheng
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.7
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    • pp.4301-4306
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    • 2013
  • Aim: Apoptosis has been considered as a fundamental component in cancer pathogenesis, and related genetic factors might play an important role in gastric cardiac adenocarcinoma (GCA) genesis. Methods: We conducted a hospital based case.control study to evaluate the genetic effects of functional single nucleotide polymorphisms (SNPs): BCL2 rs17757541 C>G, BCL2 rs12454712 T>C, FAS rs2234767 G>A, FASL/FASLG rs763110 C>T, ERBB2 rs1136201 A>G and VEGFR2/KDR rs11941492 C>T on the development of GCA. A total of 243 GCA cases and 476 controls were recruited for the study and genotypes were determined using a custom-by-design 48-Plex SNPscan$^{TM}$ Kit. Results: The BCL2 rs17757541 C>G polymorphism was associated with increased risk of GCA. However, there was no significant associations with the other five SNPs. Stratified analyses indicated a significantly increased risk of GCA associated with the BCL2 rs17757541 C>G polymorphism among males, older patients and those with a history of smoking or drinking. Conclusion: These findings indicated that the functional polymorphism BCL2 rs17757541 C>G might contribute to GCA susceptibility. However, our results were limited by small sample size. Future larger studies are required to confirm our current findings.

Drainage Alone or Combined with Anti-tumor Therapy for Treatment of Obstructive Jaundice Caused by Recurrence and Metastasis after Primary Tumor Resection

  • Xu, Chuan;Huang, Xin-En;Wang, Shu-Xiang;Lv, Peng-Hua;Sun, Ling;Wang, Fu-An;Wang, Li-Fu
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.6
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    • pp.2681-2684
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    • 2014
  • Aim: To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. Materials and Methods: We collect 42 patients with obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August 2012, for which percutaneous transhepatic catheter drainage (pTCD)/percutaneous transhepatic biliary stenting (pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapy including intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoing drainage only. We assessed the two kinds of treatment with regard to patient prognosis. Results: Both treatments demonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The time to reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survival times were 185 and 128 days, the differences being significant. Conclusions: Interventional drainage in the treatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decrease bilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongs the survival time and period before reobstruction as compared to drainage only.

Lack of Prognostic Value of Human Epidermal Growth Factor- Like Receptor 2 Status in Inflammatory Breast Cancer (IBC): a Meta-analysis

  • Li, Xiu-Juan;Zha, Quan-Bin;Xu, Xin-Yu;Xia, Lei;Zhang, Zhe;Ren, Zhao-Jun;Tang, Jin-Hai
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.22
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    • pp.9615-9619
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    • 2014
  • Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer which is more likely to be her-2/neu amplified. While the her-2/neu status has been utilised to predict prognosis, the published data are inconsistent. The present meta-analysis was conducted to determine whether the her-2/neu status predicts outcomes. Papers were selected from the PubMed database based on defined inclusion and exclusion criteria. Parameters such as total patients, follow-up time and outcome statistics (i.e. overall survival (OS), relapse-free survival (RFS) were collected. The analysis included 6 studies with 2,838 IBC patients. The summary hazards ratio (HR) estimating the association of OS with HER-2-positive disease was 0.96 (95% confidence interval (95%CI: 0.85-1.10)), with similar findings for RFS (HR=0.81, 95%CI: 0.61-1.09). No obvious statistical heterogeneity was detected. This meta-analysis suggests that HER-2-positive status is not an independent adverse prognostic factor for survival among IBC patient cases.

Safety and Efficacy of Sequential Transcatheter Arterial Chemoembolization and Portal Vein Embolization prior to Major Hepatectomy for Patients with HCC

  • Xu, Chuan;Lv, Peng-Hua;Huang, Xin-En;Wang, Shu-Xiang;Sun, Ling;Wang, Fu-An;Wang, Li-Fu
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.703-706
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    • 2014
  • Objective: To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) before major hepatectomy for patients with hepatocellur carcinoma (HCC). Methods: In this retrospective case-control study, data were collected from patients who underwent sequential TACE and PVE prior to major hemihepactectomy. Liver volumes were measured by computed tomography volumetry before TACE, and preoperation to assess degree of future remnant liver (FRL) hypertrophy and to check whether intro- or extrohepatic metastasis existed. Liver function was monitored by biochemistry after TACE, prior to and after major hepatectomy. Results: Mean average FRL volume increased 32.3-71.4% (mean 55.4%) compared with preoperative FRL volume. After TACE, liver enzymes were elevated, but returned to normal in four weeks. During PVE and resection, no patient had intro- or extrohepatic metastasis. Conclusion: Sequential TACE and PVE is an effective method to improve resection opportunity, expand the scope of surgical resection, and greatly reduce postoperative intra- and extrahepatic metastasis.

Research on Ways to Attract Foreign Patients Based on Analysis of Foreign Patients Who Visited Hospital of Korean Medicine (한방병원에 내원한 외국인 환자 분석을 통한 외국인 환자 유치 방안 연구)

  • Jun, Jae Yun;Nam, Ji Hwan;Lee, Min Jung;Kim, Kie Won;Lim, Su Jin;Lee, Chong Whan;Lee, Seul Ji
    • Journal of Acupuncture Research
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    • v.30 no.4
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    • pp.107-114
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    • 2013
  • Objectives : The purpose of this study is to analyze actual status of foreign patients who visited hospital of Korean medicine and suggest developmental direction of korean medical tourism. Methods : This study includes 675 foreign patients who visited spine-specialized hospital of Korean medicine from January 1, 2012 to December 31, 2012. Based on computerized medical records, patients' age, gender, country, date of initial and last visit, chief complaint, treatment period and species of treatment were collected. These data were used for analyzation of actual condition of medical tourism at hospital of Korean medicine. Results : A total of 675 foreign patients visited spine-specialized hospital of Korean medicine. 395 patients(59 %) were female and the forties was the most common by ages. Patients from Japan were the most common followed by Russia and United States of America. Patients visited hospital 5.1 times during 27.4 days in average. There were 526 cases of spinal pain and only 52 cases were non-musculoskeletal disease. The most frequently performed treatment was general acupuncture treatment while moxibustion and bee venom acupuncture were remarkably infrequently treated. Conclusions : The result of this study suggests potential possibility of development of Korean medical tourism focused on disease cure as well as current trend of beauty and Korean medical experience at the Korean medical tourism field.

Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient Treated with Methotrexate

  • Park, Jin Sun;Jung, Eul Sik;Choi, Woosuk;Park, Soo Yong;Rim, Min Young;Yu, Inku;Park, Hyeonsu;Lee, Sang Min;Park, Jeong-Woong;Jeong, Sung Hwan;Lee, Sang Pyo;Park, Sanghui
    • Tuberculosis and Respiratory Diseases
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    • v.75 no.1
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    • pp.28-31
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    • 2013
  • Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.

Chuna Therapy and Myofascial Release Technique for the Pain Relief and Cobb's Angle Improvement in Patients with Adolescent Idiopathic Scoliosis : Case Report (추나요법과 근막이완요법의 연소성 특발성 측만증 환자 3례에 대한 증례 보고)

  • Jo, Hee-Guen;Lee, Sang-Young;Han, Sae-Hyuk;Shin, Jun Hyuk;Park, Su-Gon;Kim, Min-Sung;Hwang, Choon-Ho;Park, Jin-Woo;Sung, In-Hyung;Jung, Pil-Sun;Sul, Jae-Uk;Kim, Dae-Hun;Choi, Eun-Sill
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.8 no.2
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    • pp.87-95
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    • 2013
  • Objectives: This report of three cases illustrates the potential effect of chuna therapy and myofascial release technique on back pain and curve regression in the at-risk, skeletally immature patient with adolescent idiopathic scoliosis. Methods: The correction program for scoliosis takes 3 month per case. Chuna Therapy and MRT were given once a week and other oriental medicine care was given twice a week to care the complications of scoliosis. The Cobb's angle(by X-ray, Full spine view) and Visual analogue scale(VAS) were evaluated before and after the treatments. Results: After the program, both of Cobb's angle and VAS decreased. Conclusion: Though it is a case report, we found Chuna Therapy and MRT might have valid effect on adolescent idiopathic scoliosis patients. Further rigorous case series and controlled trials are warranted.

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Successful Schooling Rate and Satisfaction of the Inpatient Hospital School Participants among the Child and Adolescent Psychiatric Inpatients in the Closed Ward (정신건강의학과 안정병동 내 병원학교교실 참여자의 학교복귀율과 만족도)

  • Lee, Mi-Kyeong;Bhang, Soo-Young;Ahn, Joon-Ho;Park, Jang-Ho;Choi, Hyun-Kyoung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.24 no.3
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    • pp.141-150
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    • 2013
  • Objectives : The objective of this report is to identify the utilization of hospital school service during hospitalization among patients in their childhood and adolescence with psychiatric disorders. Methods : We retrospectively reviewed the medical record of child and adolescent psychiatric who were hospitalized during March 2009 through October 2012. We compared the one-year successful schooling and outpatient follow up rate between users and nonusers of the inpatient hospital school service. The hospital schooling experiences of the users were investigated upon follow-up visits to the outpatient clinic. Results : Sixty-three students received hospital school service during hospitalization among total 122 child and adolescent inpatients. Hospital school participants showed a significantly higher school reentry rate (61.9%) than non-participants (40.7%). However, there was no difference on follow up rate between the two groups. More than 60% of the 22 interviewed participants expressed an above-average level of satisfaction about hospital school service. Conclusion : Many patients with mental illness experience difficulty in receiving school education during treatment. That induces deterioration in disease, academic failure, poor social skills, low self-esteem, economic difficulties, and future job opportunities. The results of this study emphasize the importance of hospital school service and offer useful guidance for hospital school operation.