• Title/Summary/Keyword: Patient-controlled

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Gemcitabine Plus Nedaplatin as Salvage Therapy is a Favorable Option for Patients with Progressive Metastatic Urothelial Carcinoma After Two Lines of Chemotherapy

  • Matsumoto, Kazumasa;Mochizuki, Kohei;Hirayama, Takahiro;Ikeda, Masaomi;Nishi, Morihiro;Tabata, Ken-ichi;Okazaki, Miyoko;Fujita, Tetsuo;Taoka, Yoshinori;Iwamura, Masatsugu
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.6
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    • pp.2483-2487
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    • 2015
  • This study was conducted to evaluate the effectiveness of a combination of gemcitabine and nedaplatin therapy among patients with metastatic urothelial carcinoma previously treated with two lines of chemotherapy. Between February 2009 and August 2013, 30 patients were treated with gemcitabine and paclitaxel as a second-line chemotherapy. All had received a first-line chemotherapy consisting of methotrexate, vinblastine, doxorubicin and cisplatin. Ten patients who had measurable histologically proven advanced or metastatic urothelial carcinoma of the urinary bladder and upper urinary tract received gemcitabine $1,000mg/m^2$ on days 1, 8 and 15 and nedaplatin $70mg/m^2$ on day 2 as a third-line chemotherapy. Tumors were assessed by imaging every two cycles. The median number of treatment cycles was 3.5. One patient had partial response and three had stable disease. The disease-control rate was 40%, the median overall survival was 8.8 months and the median progression-free survival was 5.0 months. The median overall survival times for the first-line and second-line therapies were 29.1 and 13.9 months, respectively. Among disease-controlled patients (n=4), median overall survival was 14.2 months. Myelosuppression was the most common toxicity. There were no therapy-related deaths. Gemcitabine and nedaplatin chemotherapy is a favorable third-line chemotherapeutic option for patients with metastatic urothelial carcinoma. Given the safety and benefit profile seen in this study, further prospective trials are warranted given the implications of our results with regard to strategic chemotherapy for patients with advanced or metastatic urothelial carcinoma.

A Study on the Environmental Radiation Dose Measurement in the Nuclear Medicine Department (핵의학과에서 환경방사선량 측정에 대한 연구)

  • Kang, Bo-Sun;Lim, Chang-Seon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.11 no.6
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    • pp.2118-2123
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    • 2010
  • Korean individual occupational exposure control is focused on the retrospective service to the over-exposed person by the reading of personal dosimeter. Since the radiophamaceuticals using in the nuclear medicine department are uncontained radiation sources, the potential exposure at working environment is very high. Moreover, a patient remains radioactive for hours or even days after the administration of a radiopharmaceutical for diagnosis or treatment. Thus, the proper working environmental exposure control must be established and executed to protect not only the affiliated employees, but also guardians accompanying patients and temporarily visiting public from the exposure by the patients. Japanese radiation protection law regulates working environmental radiation exposure by regularly measuring and filing the environmental dose for years. This study was aimed at measuring working environmental radiation dose in the nuclear medicine department of an university hospital located in Daejeon, Korea. We measured the accumulation radiation dose in air at 8 locations in the nuclear medicine department by using the same method as in Japan with glass dosimeters. The highest dose rate, 0.23 mSv per month, was measured at the waiting room, and the second one is at reception desk. Even though the doses were lower than the Korean constraint dose rate (0.3 mSv/week) at the boundary of the radiation controlled area, it was over the dose limit of public (1 mSv/y) and environment (0.25 mSv/y). Conclusionally, it was found that the new or additional procedure was necessary to less the exposure dose to the receptionist and guardians by the environmental radiation dose in the nuclear medicine department.

Post-Traumatic Cerebral Infarction : Outcome after Decompressive Hemicraniectomy for the Treatment of Traumatic Brain Injury

  • Ham, Hyung-Yong;Lee, Jung-Kil;Jang, Jae-Won;Seo, Bo-Ra;Kim, Jae-Hyoo;Choi, Jeong-Wook
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.370-376
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    • 2011
  • Objective : Posttraumatic cerebral infarction (PTCI), an infarction in well-defined arterial distributions after head trauma, is a known complication in patients with severe head trauma. The primary aims of this study were to evaluate the clinical and radiographic characteristics of PTCI, and to assess the effect on outcome of decompressive hemicraniectomy (DHC) in patients with PTCI. Methods : We present a retrospective analysis of 20 patients with PTCI who were treated between January 2003 and August 2005. Twelve patients among them showed malignant PTCI, which is defined as PTCI including the territory of Middle Cerebral Artery (MCA). Medical records and radiologic imaging studies of patients were reviewed. Results : Infarction of posterior cerebral artery distribution was the most common site of PTCI. Fourteen patients underwent DHC an average of 16 hours after trauma. The overall mortality rate was 75%. Glasgow outcome scale (GOS) of survivors showed that one patient was remained in a persistent vegetative state, two patients were severely disabled and only two patients were moderately disabled at the time of discharge. Despite aggressive treatments, all patients with malignant PTCI had died. Malignant PTCI was the indicator of poor clinical outcome. Furthermore, Glasgow coma scale (GCS) at the admission was the most valuable prognostic factor. Significant correlation was observed between a GCS less than 5 on admission and high mortality (p<0.05). Conclusion : In patients who developed non-malignant PTCI and GCS higher than 5 after head injury, early DHC and duroplasty should be considered, before occurrence of irreversible ischemic brain damage. High mortality rate was observed in patients with malignant PTCI or PTCI with a GCS of 3-5 at the admission. A large prospective randomized controlled study will be required to justify for aggressive treatments including DHC and medical treatment in these patients.

Randomized Controlled Trial : Effect of Master Dong's Acupuncture in Chronic Shoulder Pain Patients (만성 견비통에 대한 동씨침 치료의 무작위 대조군의 임상 연구)

  • Kim, Chan-Young;Kwon, Na-Hyoun;Shin, Ye-Ji;Nam, Dong-Woo;Kim, Kun-Hyung;Kim, Jong-In;Choi, Do-Young;Lee, Yun-Ho;Lee, Jae-Dong
    • Journal of Acupuncture Research
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    • v.24 no.6
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    • pp.89-96
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    • 2007
  • Objectives : To observe the effect of acupuncture treatment in chronic shoulder pain patients. Methods : 36 voluntary patients were randomly assigned to an acupuncture treatment group(E Group, n=18) and a control group(C Group, n=18). The E Group patients received acupuncture treatment on $LI_{15}$, $TE_{14}$, $GB_{21}$ and Master Dong's acupuncture points, Shin-gwan and Gyun-joong, twice a week for four weeks. The C Group patients received no treatment. All patients in both groups were instructed to practise self exercise in their daily lives. Evaluations were made at baseline and after four weeks of study. The Constant Shoulder Assessment(CSA), Shoulder Pain and Disability Index(SPADI) and the patient's subjective pain was measured by Visual Analogue Scale(VAS). The obtained data was analyzed. Results : The E Group showed significant(p<0.05) improvement in CSA, SPADI and VAS after four weeks of treatment. The C Group showed significant(p<0.05) improvement in CSA, but the change of SPADI and VAS was insignificant(p>0.05). CSA and SPADI of E Group significantly(p<0.05) improved compared to the C Group, but the difference of VAS change in the two groups was insignificant(p>0.05). Conclusions : Four weeks of acupuncture treatment significantly improved CSA, SPADI and VAS. The improvement of CSA and SPADI was significant(p<0.05) compared to untreated patients.

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Outcomes of IVF-ET in Infertile Patients with Failed Microsurgical Reversal of Tubal Sterilization (미세수술적 난관복원술 후 임신에 실패한 환자에서의 체외수정시술 결과)

  • Kim, Seok-Hyun;Hong, Joon-Seok;Ku, Seung-Yup;Suh, Chang-Suk;Choi, Young-Min;Kim, Jung-Gu;Moon, Shin-Yong;Lee, Jin-Yong
    • Clinical and Experimental Reproductive Medicine
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    • v.28 no.4
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    • pp.307-315
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    • 2001
  • Objective: To evaluate the clinical outcomes and influencing factors of in vitro fertilization and embryo transfer (IVF-ET) in patients with failed pregnancy after microsurgical reversal of tubal sterilization. Materials and Methods : From January, 1997 to December, 2000, IVF-ET was performed in two groups; the study TR (tubal reanastomosis) group consisted of 147 cycles in 66 patients with failed microsurgical reversal of tubal sterilization, and the control group of 115 cycles in 67 patients with bilateral tubal occlusion (BTO). The two groups were evaluated and compared for clinical characteristics, clinical pregnancy rates, and factors influencing the outcomes of IVF-ET. Results: Compared with the control BTO group, age and the previous parity were significantly higher ($36.3{\pm}2.7$ vs. $33.6{\pm}2.0$ years, p<0.05; $1.6{\pm}0.7$ vs. $0.2{\pm}0.4$, p<0.05), and the clinical pregnancy rate per cycle was significantly lower (23.8% (35/147) vs. 29.3% (34/115), p<0.05) in the TR group. Difference in the clinical pregnancy rates was age-related, since there was no significant difference between the two groups, except for the previous parity ($1.6{\pm}0.7$ vs. $0.1{\pm}0.3$, p<0.05), when the patients aged 37 years or older were excluded. No difference was found in terms of the following: the proportion of controlled ovarian hyperstimulation (COH) cycles with GnRH agonist ultrashort protocol, the duration of COH, the dosage of gonadotropins used, and the numbers of oocytes retrieved and of embryos transferred, irrespective of age correction. Conclusions: The outcomes of IVF-ET following the failed microsurgical reversal of tubal sterilization depend upon patient age. The previous fertility of patients does not seem to be a factor of better IVF-ET prognosis.

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A Study on the Length of Stay In Hospital Before and After Operation (수술전.후 재원일수에 관한 조사연구)

  • Kim Mi-Young;Park Kyung-Sook;Kim Kyung-Hee
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.4 no.2
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    • pp.245-265
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    • 1997
  • The purpose of this study was to promote the effectiveness in managing disease or injury, by examining the length of stay in hospital according to characteristics concerned before and after operation, and by serving as a basis for reducing that length. As a result of investigating the length of stay in hospital according to inpatient's personal characteristics, clinical features and other characteristics concerned, the following characteristics appeared significant. The characteristics that showed a significant difference about the length of stay in hospital before and after operation were the age and the fact whether one was married or not among inpatient's personal characteristics. The significant ones among clinical features were the route to be taken to hospital, the form of insurance, the experience of re-hospitalization, whether another disease coexisted, the experiment of changing department, whether a diagnosis was determined by consultation, whether an intensive care unit was used, whether re-operation was performed, the total number of case of the experience of re-hospitalization, inpatient who were again sent to hospital under the same diagnosis was not included in the investigation, which was pointed out as a limit in this study. The significant ones among other characteristics concerned were the date and season when the patients were taken to hospital and the doctor in attendance. The doctor in attendance appeared to give a significant impact on the length of stay in hospital before operation, but no significant difference was noted in the mean among the doctors in attendance. And those characteristics were not found regularly among the selected departments. As stated above, one way to reduce the length of stay In hospital was to diminish the length of stay in hospital before operation. The term of hospitalization before operation shall be reduced by grasping the factors that affected that length before operation and by conducting examination as many as possible in the out-patient department. Also, the efforts should be put on that length after operation. The management of hospital seemed to be successfully carried out if those factors affected that length were effectively controlled.

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Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes

  • Moon, Jei-Won;Kim, Chung-Hoon;Kim, Jun-Bum;Kim, Sung-Hoon;Chae, Hee-Dong;Kang, Byung-Moon
    • Clinical and Experimental Reproductive Medicine
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    • v.42 no.4
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    • pp.163-168
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    • 2015
  • Objective: To investigate the impact of fibroids on the blood flow of the uterine and subendometrial arteries and in vitro fertilization (IVF) outcomes. Methods: In this study, we analyzed 86 IVF/intracytoplasmic sperm injection (ICSI) cycles in which a gonadotropin-releasing hormone antagonist protocol was used for controlled ovarian stimulation between January 2008 and March 2009. The subjects comprised 86 infertile women with (fibroid group, n=43) or without (control group, n=43) uterine fibroids. Results: Patient characteristics were similar between the fibroid and control groups. The IVF/ICSI outcomes in patients with fibroids were similar to those of patients in the control group. The resistance index (RI) and pulsatile index (PI) of the uterine and subendometrial arteries on the day of embryo transfer were also comparable between the two groups. IVF outcomes and uterine hemodynamics in patients with multiple (${\geq}2$) fibroids were similar to those of patients with a single fibroid. However, clinical pregnancy and implantation rates were significantly lower in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). The RI and PI of the subendometrial artery were significantly higher on the day of embryo transfer in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). Conclusion: Fibroids which distorting the uterine cavity might impair the subendometrial artery blood flow clinical pregnancy rate and embryo implantation rate in infertile patients undergoing IVF. Otherwise, IVF outcomes were not influenced by the presence of uterine fibroids.

Development of Multichannel On-line Thermometry System (다 채널 직결 온도측정 시스템의 설계 및 제작)

  • Shin, Sei-One;Shin, Hyun-Jin;Kim, Myung-Se;Kim, Sung-Kyu
    • Journal of Yeungnam Medical Science
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    • v.16 no.2
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    • pp.193-199
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    • 1999
  • Background: Measurement of body temperature is an important parameter in patient management in many clinical conditions. Failure to reach minimal acceptable body temperature standards has been associated with physiological derangements and has necessitated the application of additional therapy. The authors developed a new, simple, accurate thermometry system, which could be used to undertake precise temperature measurement for various clinical conditions. Materials and Methods: A new thermometry system using a specially designed temperature detecting and display system was developed. This system contains a temperature detecting sensor(LM 35CZ), which enables multiple serial checking of heat, data collection and processing computer, and 3-dimensional display system. It provides real time volumetric visualization of temperature distribution of a defined volume and stores and prints the data. Results: With this system, temperature can be measured at multiple interesting sites simultaneously, demonstrated as a 3-dimensional temperature distribution and stored. In well-controlled, systematic experiments a significant correlation has been observed between standard temperature and temperature using this system at various measuring points. Conclusion: This thermometry system is a real-time measurement system, which can demonstrate 3-dimensional heat distribution in experimental phantom and human body and can be used for diagnosing abnormal clinical conditions. In addition, this system reduces the nursing staff work load, providing them more time for long term care to patients.

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Anti-Obesity Effect of Panax Ginseng in Animal Models: Study Protocol for a Systematic Review and Meta-Analysis (동물실험에서 인삼의 항비만 효과: 체계적 고찰과 메타분석을 위한 연구 프로토콜)

  • Cho, Jae-Heung;Kim, Koh-Woon;Park, Hye-Sung;Yoon, Ye-Ji;Song, Mi-Yeon
    • Journal of Korean Medicine for Obesity Research
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    • v.17 no.1
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    • pp.37-45
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    • 2017
  • Recently the global epidemic problem of obesity has stimulated intense interest in the study of physiological mechanisms using animal models as a way to gain crucial data required for translation to human studies. Panax ginseng has been reported to have anti-obesity or antidiabetic effects in many animal studies; however, there have been few studies investigating human obesity. Herein, we will assess and examine the evidence supporting the anti-obesity effect of Panax ginseng in animal models with respect to anthropometric and metabolic outcomes. We will include controlled, comparative studies assessing the effect of Panax ginseng in preclinical studies of obesity. Panax ginseng will be administered during or following the induction of experimental obesity. The primary outcome measure will be anthropometric assessment and the secondary outcome measures will include adipose tissue weight, total amount of food consumed and metabolic parameters. We will search MEDLINE, Embase, PubMed, Web of Science, and Scopus without language, publication date, or other restrictions. Ethical approval will not be necessary as the data collected in this study will not be individual patient data, consequently there will be no concerns about violations of privacy. After finishing the whole procedure, the results will be disseminated by publication in a peer-reviewed journal or presented at a relevant conference. This protocol has been registered on the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) website (http://www.camarades.info).

Full-mouth rehabilitation with pressed ceramic technique using provisional restorations (Pressed ceramic technique을 이용하여 제작되는 완전 도재관 완전 구강 회복 증례)

  • Roh, Hyun-Sik;Woo, Yi-Hyung;Pae, Ahran
    • The Journal of Korean Academy of Prosthodontics
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    • v.51 no.1
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    • pp.47-51
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    • 2013
  • With the introduction of dental implants, restoration of missing teeth with conventional fixed or removable partial dentures is being replaced with implants. Especially, with young patients, not only longevity but also esthetic factors need to be considered. Implant restorations provide long-term success functionally but, esthetic complications such as, marginal exposure due to gingival recession, loss of the papilla and dark color of metal abutments may occur. Recently, zirconia restorations with CAD/CAM technology provide functional, biocompatible and esthetic restorations possible. All-ceramic restorations using the pressed ceramic technique show better fracture toughness values than those of the conventional porcelain veneering technique. Pressed ceramic technique creates the veneer design in wax and the lost wax technique is used to create the restoration. The final contour of the restoration may be controlled during wax-up. A 22-year old female patient was restored with dental implants and zirconia restorations using the pressed ceramic technique presenting short-term but optimistic prognosis.