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The Prognostic Value of Oligo-Recurrence Following Esophagectomy for Esophageal Cancer

  • Minsang Kang;Woojung Kim;Chang Hyun Kang;Kwon Joong Na;Samina Park;Hyun Joo Lee;In Kyu Park;Young Tae Kim
    • Journal of Chest Surgery
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    • v.56 no.6
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    • pp.403-411
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    • 2023
  • Background: The concept of oligo-recurrence has not been generally applied in esophageal cancer. This study aimed to determine the prognostic significance of the number of recurrences in esophageal cancer. Methods: Patients with squamous cell carcinoma who underwent curative esophagectomy with R0 or R1 resection and who experienced a confirmed recurrence were included. The study included 321 eligible participants from March 2001 to December 2019. The relationship between the number of recurrences and post-recurrence survival was investigated. Results: The mean age was 63.8±8.1 years, and the majority of the participants (97.5%) were men. The median time to recurrence was 10.7 months, and the median survival time after recurrence was 8.8 months. Multiple recurrences with simultaneous local, regional, and distant locations were common (38%). In terms of the number of recurrences, single recurrences were the most common (38.3%) and had the best post-recurrence survival rate (median, 17.1 months; p<0.001). Patients with 2 or 3 recurrences showed equivalent survival to each other and longer survival than those with 4 or more (median, 9.4 months; p<0.001). In the multivariable analysis, the significant predictors of post-recurrence survival were body mass index, minimally invasive esophagectomy, N stage, R0 resection, post-recurrence treatment, and the number of recurrences (p<0.05). Conclusion: After esophagectomy, the number of recurrences was the most significant risk factor influencing post-recurrence survival in patients with esophageal cancer. In esophageal cancer, oligo-recurrence can be defined as a recurrence with three or fewer metastases. More intensive treatment might be recommended if oligo-recurrence occurs.

Prevalence and Treatment Pattern of Korean Patients with Facial Palsy (안면신경마비 환자의 최근 5년간 연도별 진료경향 분석)

  • Hong, Kwon-Eui
    • Journal of Acupuncture Research
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    • v.27 no.3
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    • pp.137-146
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    • 2010
  • Objectives : While there are many studies about treatments of facial palsy, no study has been performed on general population of Korea, especially concerning about comparison between western medicine and oriental medicine. This study aimed to investigate magnitude of health visits and treatment patterns for Korean patients with facial palsy through the computerized database of Health Insurance Review and Assessment Service(HIRAS). Methods : According to the HIRAS database over 5 years' period from 2004 to 2008, the medical records of patients with facial palsy as a main diagnosis were extracted. Inclusion criteria of facial palsy are Bell's palsy(G510), Geniculate ganglionitis(G511), Melkersson's syndrome(G512), Other disorders of facial nerve(G518), Disorder of facial nerve, unspecified(G519) in western medicine. And Paralytic face(G016), Deviated eye and mouth(J01), The other facial palsy(J013) were included in oriental medicine. We compared the claim number of western medical care with that of oriental medicine treatment by year and month. Results : The total claim number of facial palsy was increasing on both western medicine and oriental medicine from 2004 to 2008. In western medicine, the claim number of Bell's palsy(G510) is the most. In oriental medicine the inpatients claim number of Deviated eye and mouth(J01) is the most, while outpatients claim number of the other facial palsy(J013) is the most. Conclusions : Medical database of HIRAS provided comprehensive and vast information on epidemiologic characteristics and treatment, which can be more reliable data to expect medical demand for facial palsy in condition that accurate diagnosis and standardized treatment is delivered in clinical settings.

The Utility of Picosecond Nd:YAG Laser for Tattoo Removal

  • Park, Kyong Chan;Park, Eun Soo;Nam, Seung Min;Shin, Jin Su
    • Medical Lasers
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    • v.10 no.1
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    • pp.31-36
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    • 2021
  • Background and Objectives Several predicted optimal parameters for laser treatment have been suggested, making the settings subject to variation. Thus, picosecond lasers may require more data and studies to optimize the laser parameters, increase the efficacy of each session, and minimize the total number of sessions. This study evaluated the results of picosecond laser tattoo removal in variable locations, focusing on the aesthetic outcome, number of procedures, and adverse effects. Materials and Methods Nine patients who underwent picosecond laser treatment from February 2014 to July 2020 were enrolled. Before the procedures, the required number of sessions was estimated using the Kirby-Desai scale. At the end of the treatment, the patients assessed their satisfaction. The patient and two plastic surgeons assessed the clearance of the tattoo. Results The mean of the clearance was 86.6% in both the patient and investigators assessment. The patients reported satisfaction for an average score of 5.1 ± 0.78 for the aesthetic outcome, 4.5 ± 0.78 for pain, 4.1 ± 0.92 for the number of procedures, and 4.7 ± 0.97 for adverse effects. The average number of actual procedures was 6.7 ± 1.20. The average Kirby-Desai score was 7.1 ± 1.45. Their correlation coefficient was 0.803, which is considered a strong positive correlation. Conclusion Picosecond lasers have a remarkable ability to degrade smaller tattoo pigments through a photoacoustic effect. Moreover, a picosecond laser treatment for tattoo removal can be a safe and effective method. Picosecond lasers are a promising technology with the potential to optimize the treatment of tattoos.

The Effects of Rival Hospitals on the Number of Patients in a Tertiary Hospital (공간분석기법을 이용한 경쟁병원이 병원내원 환자 수에 미치는 영향 분석)

  • Lee, Kwang-Soo;Choi, Young-Jin
    • Journal of the Korean Operations Research and Management Science Society
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    • v.37 no.4
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    • pp.211-223
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    • 2012
  • This study purposed to evaluate the influences of rival hospitals on the number of patients who visited the a study territory hospital. Spatial analysis technique was used to measure the impact of rival hospitals in study region. Selected hospitals were all medical school affiliated hospitals which were located in Daejeon metropolitan city and Chungchungnamdo. Patient data was collected from the claims data of the study hospital, and the number of inpatient and outpatients who visited the study hospital between January and June in 2008 were calculated on the smallest administrative district, Eup, Myeon, and Dong, in study region. To control the differences of regional characteristics among Eup, Myeon, Dong, socio-economic variables (total population, number of people aged over 65, number of basic livelihood security recipients, distance from the study hospital to the centroid point of each Eup, Myeon, Dong, number of business, and number of employees) were included in analysis model. These variables were collected from the annual year book of city as well as county located in study region. Cluster analysis classified the study region into three groups by using the difference of between th actual number of inpatient/outpatient and the predicted number of inpatient/outpatient in Eup, Myeon, and Dong. Most areas around the rivalry hospitals were categorized into same group. Multiple regression analysis indicated that areas around rivalry hospitals had statistically significantly negative relationship with the number of inpatients and outpatients who visited the study hospital. As the buffer size was increased from 5Km to 10Km, the standardized regression coefficients were decreased. These study results confirmed that rivalry hospitals in region had negative impacts on the performance of hospitals. It suggests that hospitals will require not only to select their location to minimize the effects of rivalry hospitals, but also to establish their strategy to cope with the rivalry's threats in their region.

Analysis of the Characteristics of Patients Admitted to Korean Medicine Ophthalmology, Otolaryngology and Dermatology Department -From March, 2018 to February, 2023, Korean Medicine Hospital of Daejeon University- (한방안이비인후피부과로 입원한 환자들의 특성 분석 -2018년 3월부터 2023년 2월까지 대전대학교 대전한방병원에서-)

  • Jong-Chan Baek;Yoon-Young Choi;Jung-Ah Byun;Seo-Hee Kim;Hyun-A Jung
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.36 no.4
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    • pp.1-18
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    • 2023
  • Objectives : This study retrospectively analyzed the medical records of patients admitted to Korean medicine ophthalmology, otolaryngology and dermatology department of Daejeon Korean medicine hospital from March 2018 to February 2023 to analyze the characteristics of patients receiving inpatient treatment. Methods : We retrospectively analyzed inpatients who admitted to ophthalmology & otolaryngology & dermatology clinic of Daejeon Korean medicine hospital from March 1st, 2018 to February 28th, 2023, according to gender, age, year, season, detailed subdivision. The statistical analysis performed using IBM SPSS 29.0 for Windows. Results : 1. Examining the gender distribution of the patient group, there were 367 female patients, accounting for 71.7% of the total patients, and 145 male patients, accounting for 28.3% of the total patients. 2. When analyzing inpatients by subdivision, otology accounted for more than half of the total number of inpatients, and the combined number of otology and dermatology accounted for more than 80% of the total. 3. As a result of analyzing inpatients by frequent disease, Sudden hearing loss was a significantly higher number of patients, accounting for 22.7% of all inpatients. Conclusions : It was found that the proportion of patients with otologic diseases was very prominent. It is thought that further research is needed to see if the trend of increasing demand for otologic diseases continues.

The Monthly Statistics of Medicare Dental Patients in ratio of Total Number of Patients treated by the Dental Department in the National Medical Center(A Report Problems with Special Reference to Medical Insurance Charge) (국립의료원 치과에 래원한 환자중 의료보험환자가 전체가 외래환자에 차지하는 비율의 월별 통계 및 그에 따르는 문제점(의로보험수가를 중심으로))

  • Choi, Koo-Young
    • The Journal of the Korean dental association
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    • v.17 no.11 s.126
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    • pp.845-847
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    • 1979
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A Study on the Analysis of Factors for the Increase of Oriental Medicine Expenditure in the Automobile Insurance (자동차보험 한방진료비 증가요인 분석)

  • Lee, ChangSoo;Lee, Hyeon Ju;Chae, JungMi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.1
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    • pp.121-130
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    • 2019
  • Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014~2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

An Analysis of the Practices of Dental Hygienists in Offering Oral Health Education -In Case of Adult Patients Visiting Dental Clinics- (치과위생사의 구강보건지도 실천분석 -진료실내의 성인환자를 중심으로-)

  • Lee, Sung-Sook;Cho, Myung-Sook;Kim, Seol-Ag
    • Journal of the Korean Society of School Health
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    • v.12 no.1
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    • pp.131-141
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    • 1999
  • The purpose of this study was to serve as a basis for the planning of oral health education and the development of an oral health-promotion program for patients who visited dental clinics by examining how much dental hygienists offered oral health education to adult patients at dental clinics. A parent group was selected, being made up of 1,600 dental hygienists who registered with the Dental Hygienist Association and worked in Seoul. The questionnaire survey was carried out and an ${\chi}^2-test$ was made using the data collected from 218 subjects to determine how their practice of oral health education was different according to certain general characteristics(the sort of organization for which they worked, age, the term of their service, and the mean number of patients per day). As a result, the following findings were obtained: 1. Thees general characteristics made the following differences to the content of oral health, education: The sort of organization for which the subjects worked made a significant difference in the following tooth brushing instruction (p<0.05), the effect of oral prophylaxis or education about aftereffects (p<0.05), the regular examination of prosthesis (p<0.05), smoking-prohibition education (p<0.05), and the prevention poor-quality fillings (p<0.01). The mean number of patients per day made significant differences to the regular examination of prosthesis (p<0.05) and the prevention poor-quality fillings (p<0.01). But no significant disparity was generated by age or the term of service. 2. The general characteristics made the following differences to education about nutrition and diet counseling: The sort of organization for which the subjects worked had a significant effect just on the importance of a balanced menu (p<0.05). Age made significant differences in advice for vitamin, mineral, protein or other nutrients (p<0.01), and the importance of balanced menu (p<0.001). The term of service made significant differences in the importance of balanced menu (p<0.01), and advice for nutrients including vitamin, mineral or protein (p<0.01). 3. The general characteristics made the following differences to the recommendation and use of oral hygiene aids: The sort of oragnization for which they worked made significant differences only to a gingival massager and water pick (p<0.05). No significant difference was produced by age, the term of service or the mean number of patients per day. 4. The use of educational media for oral health was different according to the general characteristics: The use of pamphlets or booklets significantly varied depending on the organization for which they worked and with the mean number of patients per day (p<0.05). The use of slides or slide projectors was significantly affected by age (p<0.05). But no significant disparity was yielded by the term of service. 5. The general characteristics made the following difference as to whether a continued oral management system was carried out or not: The sort of organization for which they worked had very a significant effect on this result (p<0.001), and no significant disparity was made by age, the term of service or the mean number of patients per day. 6. The place where oral health education was giver differed according to the following general characteristics: The sort of organization for which they worked made very a significant difference as to the use of an examination room's dental unit chair or waiting room (p<0.01), and to the use of an oral health education room or reception counter (p<0.001). The term of service had a significant effect on the use of a counseling room (p<0.01). And the mean number of patients per day made significant differences in the use of a dental unit chair or reception counter (p<0.05), and to the use of an oral health education room or waiting room (p<0.01).

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Survival Analysis of Patients with Gastric Cancer Undergoing Surgery at the Iran Cancer Institute: A Method Based on Multi-State Models

  • Zare, Ali;Mahmoodi, Mahmood;Mohammad, Kazem;Zeraati, Hojjat;Hosseini, Mostafa;Naieni, Kourosh Holakouie
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6369-6373
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    • 2013
  • Background: Gastric cancer is one of the most common causes of cancer deaths all over the world and the most important reason for its high rate of death is its belated diagnosis at advanced stages of the disease. Events occur in patients which are regarded not only as themselves factors affecting patients' survival but also which can be affected by other factors. This study was designed and implemented aiming to identify these events and to investigate factors affecting their occurrence. Materials and Methods: Data from 330 patients with gastric cancer undergoing surgery at the Iran Cancer Institute from 1995-1999 were analyzed. The survival time of these patients was determined after surgery and the effects of various factors including demographic, diagnostic and clinical as well as medical, and post-surgical varuiables on the occurrence of death hazard without relapse, hazard of relapse, and death hazard with a relapse were assessed. Results: The median survival time for these patients was 16.3 months and the 5-year survival rate was 21.6%. Based on the results of multi-state model, age and distant metastases affected relapse whereas disease stage, type and extent of surgery, lymph nodes metastases, and number of renewed treatments affected death hazard without relapse. Moreover, age, type and extent of surgery, number of renewed treatments, and liver metastases were identified as factors affecting death hazard in patients with relapse. Conclusions: Most cancer studies pay heed to factors which have effect on death occurrence, but some events occur which should be taken into consideration to better describe the natural process of the disease and provide researchers with more accurate data.

End-stage Renal Disease and Risk of Active Tuberculosis: a Nationwide Population-Based Cohort Study

  • Min, Jinsoo;Kwon, Soon Kil;Jeong, Hye Won;Han, Joung-Ho;Kim, Yeonkook Joseph;Kang, Minseok;Kang, Gilwon
    • Journal of Korean Medical Science
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    • v.33 no.53
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    • pp.341.1-341.11
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    • 2018
  • Background: The converging epidemics of tuberculosis (TB) and end-stage renal disease (ESRD) have generated a significant public health burden, however, previous studies have been limited to a small number of patients. This nationwide cohort study aimed to assess the rate of developing active TB among patients receiving dialysis for ESRD. Methods: The Korean national health insurance database was used to identify patients receiving dialysis for new-onset ESRD during 2004-2013, who were propensity score matched to an equivalent number of non-dialysis subjects from the general population. The incidences of active TB in the ESRD and control cohorts were calculated for 2004-2013, and multivariable Cox proportional hazards model was used to evaluate the ESRD-related risk of active TB. Results: During 2004-2013, 59,584 patients received dialysis for newly diagnosed ESRD. In the dialysis and control cohorts, 457 (0.8%) and 125 (0.2%) cases of active TB were detected, respectively. Patients with ESRD were associated with a significantly higher risk of active TB compared to the controls (incidence rate ratio, 4.80). The ESRD cohort had an independently elevated risk of active TB (adjusted hazard ratio, 4.39; 95% confidence interval, 3.60-5.37). Conclusion: We found that patients receiving dialysis for ESRD had an elevated risk of active TB. These results highlight the need for detailed and well-organised guidelines for active TB screening among patients with ESRD.