• Title/Summary/Keyword: Surgery first approach

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The Effect of Singing Therapy on Classical Singers with Voice Problems (음성장애가 있는 성악인에 대한 성악치료의 효과)

  • 문영일;홍현정;신혜정;박애경;정성민
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.11 no.1
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    • pp.32-38
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    • 2000
  • Background and Objectives : Voice therapy has been used as a viable adjuvant to surgery and pharmacological therapy fir the management of voice disorders. The singing voice features a special brand of emotion, intensity, and energy so successful therapeutical approach requires the doctor is able to involve himself into the physical and psychic condition and artistic usage of the voice. The purpose of this study was to evaluate the effect and utility of singing therapy as an initial treatment for classically trained singers with voice disorders. Material and method : Twenty-one male and fifty-five female classic singers with voice disorders were treated with singing therapy. At first, abdominal breathing, resonant phonation, and relaxation method was trained, then after accessing each patient's singing abilities, treatment methods for each specific problems was applied. The results were compared according to age, sex, treatment duration, part, laryngeal pathology, patient subjective evaluation, perceptual evaluation of voice, and maximal phonation time. Results : Patients subjective evaluation, perceptual evaluation, pathologic findings of larynx, maximal phonation time showed superior results after singing therapy. Conclusion : Singing therapy changes the mode of respiration and phonation and enhances the vocal function and improves the laryngeal pathology, The result of this study indicate that singing therapy is an effective treatment method that laryngologists can use for classical singers with voice disorders.

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Percutaneous Transcatheter Closure of Congenital Ventricular Septal Defects

  • Jinyoung Song
    • Korean Circulation Journal
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    • v.53 no.3
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    • pp.134-150
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    • 2023
  • Ventricular septal defects (VSDs) are the most common kind of congenital heart disease and, if indicated, surgical closure has been accepted as a gold-standard treatment. However, as less-invasive methods are preferred, percutaneous device closure has been developed. After the first VSD closure was performed percutaneously by Lock in 1988, both techniques and devices have developed consistently. A perventricular approach for closure of muscular VSD in small patients and the closure of perimembranous VSD using off-label devices are key remarkable developments. Even though the Amplatzer membranous VSD occluder (Abbott) could not be approved for use due to the high complete atrioventricular conduction block rate, other new devices have shown good results for closure of perimembranous VSDs. However, the transcatheter technique is slightly complicated to perform, and concerns about conduction problems after VSD closure with devices remain. There have been a few reports demonstrating successful closure of subarterial-type VSDs with Amplatzer devices, but long-term issues involving aortic valve damage have not been explored yet. In conclusion, transcatheter VSD closure should be accepted as being as effective and safe as surgery but should only be performed by experienced persons and in specialized institutes because the procedure is complex and requires different techniques. To avoid serious complications, identifying appropriate patient candidates for device closure before the procedure is very important.

A 32-year-old man with plexiform schwannoma of the thyroid gland: a case report

  • Il Rae Park;Min Chong Kim;Seung Min Chung;Si Youn Song
    • Journal of Yeungnam Medical Science
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    • v.41 no.4
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    • pp.312-317
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    • 2024
  • Plexiform schwannomas representing a rare subset, comprise 5% of all schwannomas. However, their occurrence in the thyroid gland is exceptionally rare. A 32-year-old male presented with an incidentally discovered, asymptomatic thyroid mass. Imaging revealed an approximately 5 cm heterogeneous solid mass on the right thyroid lobe extending to the upper mediastinum and directly invading the upper trachea. Under the suspicion of thyroid malignancy, the patient underwent right thyroidectomy. Histological examination confirmed a plexiform schwannoma with S100-positive spindle cells. Currently, the patient is undergoing outpatient follow-up, with no reported complications. To our knowledge, this is the first documented case of plexiform schwannoma of the thyroid gland within the English literature. This case highlights the diverse and unpredictable clinical manifestations of thyroid masses, emphasizing the importance of a multidisciplinary approach for diagnosing and managing rare entities, such as thyroid gland schwannomas.

Approach-avoidance, Stress Response, and Body Temperature of Dogs Following Removal of the Mamillary Bodies (유두체를 떼어버린 개의 접근-회피반응, 스트레스에 대한 반응 및 체온 변동)

  • Kim, Chul;Park, Rho-Soon
    • The Korean Journal of Physiology
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    • v.2 no.1
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    • pp.1-8
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    • 1968
  • As a continuation of a series of work on the physiology of the mamillary bodies, 3 experiments were carried out using 8 pointer dogs subjected surgical removal of this hypothalamic structure by subtemporal approach. In the first experiment, animals were tested per- and postoperatively in approach-avoidance situation. Food served as incentive, electric shock to the tongue as punishment, and response latency of postpunishment trial as an index of fear. The second experiment dealt with per- and postoperative tests in stress situation. A high frequency sound (12,000 cycle, 100 db sound for 1 hour) was regarded as a stressor, and decrease in blood eosinophil cell count as an index of response th the stress. Pre- and postoperative measurement of rectal temperature was carried out in the third experiment, using a clinical thermometer with decimal centigrade scale. The results obtained were as follows: 1. Tests in approach-avoidance situation showed no indication of increased or decreased fear response following removal of the mamillary bodies. 2. Postoperative stress response was as marked as that of preoperative period, but the recovery from the stress was significantly retarded after surgery. 3. The body temperature dropped slightly, but significantly following damage to the mamillary bodies.

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Changes of the Preoperative and Postoperative Nutritional Statuses in Patients with Gastric Cancer and Assessment of the Nutritional Factors That Are Correlated with Short-Term Postoperative Complications (위암 환자에서 수술 전후의 영양지표의 변화와 수술 후 단기간 합병증과의 연관성)

  • Oh, Cheong-Ah;Kim, Dae-Hoon;Oh, Seung-Jong;Choi, Min-Gew;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung;Bae, Jae-Moon
    • Journal of Gastric Cancer
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    • v.10 no.1
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    • pp.5-12
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    • 2010
  • Purpose: The aim of this study was to evaluate the preoperative and postoperative nutritional statuses of patients with gastric cancer and to investigate the nutritional factors that are correlated with perioperative complications. Materials and Methods: From January 2008 to Jun 2008, 669 patients who underwent curative gastrectomy were enrolled in a retrospective study. To evaluate the changes of their nutritional status preoperatively and postoperatively, we measured the total lymphocyte count, the serum albumin, the body weight change and the BMI. The nutritional factors correlated with short-term postoperative complications were analyzed. Results: The total lymphocyte count and serum albumin decreased from the first preoperative day to the $5^{th}$ day after operation, but they tended to increase and approach the normal range 6 months after operation. The only factor correlated with the short-term postoperative complications (defined as the ones that occurred for 30 days) was the serum albumin checked on the $5^{th}$ day after operation. Conclusion: Low serum albumin on the $5^{th}$ day after operation was correlated with postoperative short-term complications. Serum albumin can be the preoperative statistical parameter that can predict the occurrence of postoperative complications.

Detection of PIK3CA Gene Mutations with HRM Analysis and Association with IGFBP-5 Expression Levels in Breast Cancer

  • Dirican, Ebubekir;Kaya, Zehra;Gullu, Gokce;Peker, Irem;Ozmen, Tolga;Gulluoglu, Bahadir M.;Kaya, Handan;Ozer, Ayse;Akkiprik, Mustafa
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.21
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    • pp.9327-9333
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    • 2014
  • Breast cancer is the second most common cancer and second leading cause of cancer deaths in women. Phosphatidylinositol-3-kinase (PI3K)/AKT pathway mutations are associated with cancer and phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene mutations have been observed in 25-45% of breast cancer samples. Insulin growth factor binding protein-5 (IGFBP-5) can show different effects on apoptosis, cell motility and survival in breast cancer. We here aimed to determine the association between PIK3CA gene mutations and IGFBP-5 expressions for the first time in breast cancer patients. Frozen tumor samples from 101 Turkish breast cancer patients were analyzed with high resolution melting (HRM) for PIK3CA mutations (exon 9 and exon 20) and 37 HRM positive tumor samples were analyzed by DNA sequencing, mutations being found in 31. PIK3CA exon 9 mutations (Q546R, E542Q, E545K, E542K and E545D) were found in 10 tumor samples, exon 20 mutations (H1047L, H1047R, T1025T and G1049R) in 21, where only 1 tumor sample had two exon 20 mutations (T1025T and H1047R). Moreover, we detected one sample with both exon 9 (E542Q) and exon 20 (H1047R) mutations. 35% of the tumor samples with high IGFBP-5 mRNA expression and 29.4% of the tumor samples with low IGFBP-5 mRNA expression had PIK3CA mutations (p=0.9924). This is the first study of PIK3CA mutation screening results in Turkish breast cancer population using HRM analysis. This approach appears to be a very effective and reliable screening method for the PIK3CA exon 9 and 20 mutation detection. Further analysis with a greater number of samples is needed to clarify association between PIK3CA gene mutations and IGFBP-5 mRNA expression, and also clinical outcome in breast cancer patients.

The Decision-Making Journey of Malaysian Women with Early Breast Cancer: A Qualitative Study

  • Abdullah, Adina;Abdullah, Khatijah Lim;Yip, Cheng Har;Teo, Soo-Hwang;Taib, Nur Aishah;Ng, Chirk Jenn
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7143-7147
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    • 2013
  • Background: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision making experiences of women with early breast cancer. Materials and Methods: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach. Results: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves. Conclusions: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.

Effect of Presurgical Nasoalveolar Molding in Unilateral Cleft Lip and Palate Infants (편측성 구순구개열 신생아에 대한 술전비치조정형장치의 효과)

  • Kim, Jin-Sun;Kim, Young-Jin;Nam, Soon-Hyeun;Kim, Hyun-Jung
    • Journal of the korean academy of Pediatric Dentistry
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    • v.40 no.3
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    • pp.209-215
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    • 2013
  • Cleft lip and palate, the most common craniofacial anomalies, are severe congenital defects that have an incidence of 0.28 to 3.74 per 1000 live births. Although there has been great improvement in the field of cleft surgery, surgical approach cannot be the single solution to resolve the various problems encountered in patients with cleft lip and palate. The concept of presurgical infant orthopedics (PSIO) for gradual closure of the cleft gap and simplified surgical performance was first introduced by McNeil in 1950. Recently, there are many attempts not only to approximate the alveolar segments but also to reshape the nasal cartilage. Three infants with unilateral cleft lip and palate were referred from the department of Plastic Surgery for presurgical nasoalveolar molding (PNAM). Maxillary appliances using resin with orthodontic wire were fabricated. Then these appliance was applied until patients underwent lip surgery. In all cases, the patients could wear the appliance all day since they were able to eat even with the appliance on, This resulted in significant improvements in the nasal symmetry were found. Our appliance, namely K-NAM, extends the wearing time within the limited period and as a result it is expected to maximize the treatment effects. Used properly, this appliance would play a major role in enhancing nasal symmetry with satisfactory results.

Conservative Treatment of Impingement Syndrome and Rotator Cuff Tear (충돌 증후군 및 회전근 개 파열의 보존적 치료)

  • Jung, Hong Jun;Jeon, In-Ho;Chun, Jae Myeung
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.1
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    • pp.79-86
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    • 2012
  • The conservative treatment for impingement and rotator cuff tear includes rest, nonsteroidal anti-inflammatory drugs (NSAIDs), local steroid injection and physiotherapy depending on the purpose to relieve the pain and inflammation, in addition, stretching exercise to recover flexibility and strengthening exercise to recover the function could be used. When these conservative treatments are divided into multiple steps, the first one contains pain relief, modification of daily activity and stretching exercise. Second step includes strengthening exercise of the anterior/posterior cuff and peri-scapular muscles and eventually. The third step includes training program to return to job, housework and hobby activities and maintain. Thus, the key of these step wise approach for the treatment of impingement and rotator cuff tear is exercise program. Understanding of various exercise program and apply to the patients properly is most important for the conservative treatment of impingement and cuff tear.

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Three-year Analysis of Patients and Treatment Experiences in the Regional Trauma Center of Gachon University Gil Hospital between 2011 and 2013 (가천대학교 길병원 권역외상센터 3개년 내원 환자 및 치료 경험 분석(2011~2013))

  • Yoon, Yong-Cheol;Lee, Jung-Nam;Chung, Min;Jeon, Yang Bin;Park, Jae Jeong;Yu, Byung Chul;Lee, Gil Jae;Cho, Hyun Jin;Ma, Dae Sung;Lee, Min A;Choi, Jung Ju;Son, Seong
    • Journal of Trauma and Injury
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    • v.27 no.4
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    • pp.170-177
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    • 2014
  • Purpose: The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center. Methods: The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013. Results: The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of ${\geq}16$. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital. Conclusion: A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.