Background : Antibiotic therapy has proven an effective method of treatment on the majority of patients with pyogenic lung abscess and infected bulla. When medical therapy has failed, pulmonary resection is the current generally recommended therapy. But nowdays complications of percutaneous tube drainage has decreased with the use of small catheter. So we evaluated the effect of percutaneous tube drainage as an alternative therapy to the pyogenic lung abscess and infected bulla refractory to medical therapy in preference ot the pulmonary resection. Method : Nine cases of the lung abscess and three cases of infected bulla which has large cavity size over 6cm, and has underlying diseases such as lung cancer, diabetes mellitus, refractory to over 1 week of antibiotics, were performed percutaneous tube drainage with All Purpose Drainage catheter(Medi-tech, Watertown, USA) under fluoroscopy. Results : All the cases except one case which complicated empyema was improved clinically. Fever was down within 4days of percutaneous tube drainage(mean : 1.9days). Mean duration of tube drainage was 9.9days. Conclusion : Percutaneous tube drainage is an effective and relatively safe procedure in the management of lung abscesses that do not response to medical therapy. We speculate this procedure should be considered as an alternative therapy for the lung abscess refractory to medical therapy in preference to the surgery. The safety and effectiveness of this procedure in infected bulla should be evaluated with an additional study.
Objective: The visually impaired have limited access to health care services and related information, and thus, they can have serious hurdles against properly taking medications. Despite that it is important to improve self-care ability of the visually impaired for correct medication use, there have been few studies investigating their needs for health care services in Korea, particularly focusing on proper medication usage. This study is to explore safety-related issues regarding mediation usage among the visually impaired based on in-depth interview. We particularly focus on any obstacles for safe use of medicines including experience on medication-related adverse effects in order to provide preliminary evidence for policy measures to improve proper medication use among the visually impaired. Methods: Study sample was visually impaired individuals who resided in Seoul area and were registered in the National Association of Visually Impaired. The association helped the process of recruiting the study participants. In-depth interview for each study participants was conducted. Each interview was recorded and later converted into a written script to extract core contents for the analysis. Results: The study participants comprised of three women (42.9%) and four men (57.1%). One was in his 20's, and there were four participants in 30's and two in 40's. Fully impaired participants were majority (5 out of 7). Limitation to physical access to health care providers and health information were the key factors to hamper safe medication utilization among the study participants. Difficulty reading medication information and may take the wrong medication or incorrect doses of medication, resulting in serious consequences, including overdose or inadequate treatment of health problems. Visually impaired patients report increased anxiety related to medication management and must rely on others to obtain necessary drug information. Pharmacists have a unique opportunity to pursue accurate medication adherence in this special population. This article reviews literature illustrating how severe medication mismanagement can occur in the visually impaired elderly and presents resources and solutions for pharmacists to take a larger role in adherence management in this population. Conclusion: The visually impaired had difficulties reading medication information and identifying medicines, and took incorrect doses of medications. Public support for safe medication use and medication management among the visually impaired is necessary.
Aim: To investigate the efficacy and safety of lobaplatin-transcatheter arterial chemoembolization (TACE) combined with radioactive $^{125}I$ seed implantation in treatment of primary hepatocellular carcinoma (HCC). Methods: 75 patients with primary HCC were enrolled in the study, among them 43 receiving lobaplatin-TACE (TACE group) and 32 lobaplatin-TACE combined with $^{125}I$ seed implantation (TACE+$^{125}I$ group). After treatment, the local remission rates and postoperative complications of two groups were compared using the Pearson Chi-square test. Overall survival in the two groups was calculated using Kaplan-Meier survival curves and the differences were tested using Log-rank test. Results: There were 7 cases of complete response (CR), 13 of partial response (PR), 6 of stable disease (SD) and 17 of progressive disease (PD) in the TACE group, with 13 cases of CR, 9 of PR, 5 of SD and 5 of PD in the TACE+$^{125}I$ group. The disease control rates of TACE and TACE+$^{125}I$ group were 60.5% (26/43) and 84.4% (27/32), respectively, with a significant difference between them (P < 0.05). The survival rates at 6, 12 and 18 months in the TACE group were 100.0%, 81.8% and 50.0%, respectively, and those in TACE+$^{125}I$ group were 100.0%, 93.8% and 65.6%. The mean survival times in the TACE and TACE+$^{125}I$ groups were 19.5 and 22.9 months, respectively. There was a significant difference in the overall survival rate between two groups (P < 0.05). No serious complications were encountered in either group. Conclusion: Lobaplatin-TACE combined with $^{125}I$ seed implantation is favorable and safe for treatment of primary HCC.
The proximity of thoracic aortic aneurysm to the left subclavian artery (LSA) has made the coverage of LSA during thoracic endovascular aortic repair (TEVAR) be essential. Despite controversy concerning the safety of LSA coverage and the indications for LSA revascularizations, the cerebral hemodynamic change after LSA coverage has not been demonstrated. We prospectively examined two patients who would undergo TEVAR with LSA coverage by using 2D cine phase contrast MR imaging. After LSA coverage, the left subclavian steal was properly compensated by the increased flow volumes of both carotid arteries and right vertebral artery, which is the major collateral supply. The total brain supply after TEVAR did not lessen, which showed good correlation with uneventful clinical outcome. Therefore, 2D phase contrast MR imaging can be recommended as a useful technique to evaluate the hemodynamic change of the LSA coverage during TEVAR and to triage the candidate for LSA revascularization.
Goetze, Stefan;Schroder, Jens;Gerlach, Stephan;Hollosi, Danilo;Appell, Jens-E.;Wallhoff, Frank
Journal of Computing Science and Engineering
/
v.6
no.1
/
pp.40-50
/
2012
Increase in the number of older people due to demographic changes poses great challenges to the social healthcare systems both in the Western and as well as in the Eastern countries. Support for older people by formal care givers leads to enormous temporal and personal efforts. Therefore, one of the most important goals is to increase the efficiency and effectiveness of today's care. This can be achieved by the use of assistive technologies. These technologies are able to increase the safety of patients or to reduce the time needed for tasks that do not relate to direct interaction between the care giver and the patient. Motivated by this goal, this contribution focuses on applications of acoustic technologies to support users and care givers in ambient assisted living (AAL) scenarios. Acoustic sensors are small, unobtrusive and can be added to already existing care or living environments easily. The information gathered by the acoustic sensors can be analyzed to calculate the position of the user by localization and the context by detection and classification of acoustic events in the captured acoustic signal. By doing this, possibly dangerous situations like falls, screams or an increased amount of coughs can be detected and appropriate actions can be initialized by an intelligent autonomous system for the acoustic monitoring of older persons. The proposed system is able to reduce the false alarm rate compared to other existing and commercially available approaches that basically rely only on the acoustic level. This is due to the fact that it explicitly distinguishes between the various acoustic events and provides information on the type of emergency that has taken place. Furthermore, the position of the acoustic event can be determined as contextual information by the system that uses only the acoustic signal. By this, the position of the user is known even if she or he does not wear a localization device such as a radio-frequency identification (RFID) tag.
Tapeworms of the genus Spirometra are pseudophyllidean cestodes endemic in Korea. At present, it is unclear which Spirometra species are responsible for causing human infections, and little information is available on the epidemiological profiles of Spirometra species infecting humans in Korea. Between 1979 and 2009, a total of 50 spargana from human patients and 2 adult specimens obtained from experimentally infected carnivorous animals were analyzed according to genetic and taxonomic criteria and classified as Spirometra erinaceieuropaei or Spirometra decipiens depending on the morphology. Morphologically, S. erinaceieuropaei and S. decipiens are different in that the spirally coiled uterus in S. erinaceieuropaei has 5-7 complete coils, while in S. decipiens it has only 4.5 coils. In addition, there is a 9.3% (146/1,566) sequence different between S. erinaceieuropaei and S. decipiens in the cox1 gene. Partial cox1 sequences (390 bp) from 35 Korean isolates showed 99.4% (388/390) similarity with the reference sequence of S. erinaceieuropaei from Korea (G1724; GenBank KJ599680) and an additional 15 Korean isolates revealed 99.2% (387/390) similarity with the reference sequences of S. decipiens from Korea (G1657; GenBank KJ599679). Based on morphologic and molecular databases, the estimated population ratio of S. erinaceieuropaei to S. decipiens was 35: 15. Our results indicate that both S. erinaceieuropaei and S. decipiens found in Korea infect humans, with S. erinaceieuropaei being 2 times more prevalent than S. decipiens. This study is the first to report human sparganosis caused by S. decipiens in humans in Korea.
The present study was done to determine the efficacy and safety of varicose vein removal using a minimally invasive, powered vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compared this to a retrospective group of conventional phlebectomy operations. There were 133 limbs in 104 patients(72 women, 32 men) treated with the use of the vein extractor aided by transcutaneous illumination. The hydrodissection was performed with Trivex™ Irrigated illuminator(Smith & Nephe $w^{ R}$) system using normal saline after the 2~3mm sized skin incision. Varicose clusters were extracted by the use of TriveTM esector(Smith & Nephe $w^{ R}$) system under transillumination. After the varisoce vein extraction, the operation area was compressed with surgical pad for bleeding control. The complication rate was 3.84% The mean number of incisions was 3.24 and mean operative time per limb was 65.9 minutes. The mean hospitalization was 1.86 days. The varicose vein extraction using transilluminated powered phlebectomy(TIPP) is a safe, efficacious and cosmetically satisfactory method. The procedure decreases the operating time and the number of incisions required to remove varicose clusters. Further evaluation and long term follow up will be necessary to determine the recurrence rate and long termcomplications.to determine the recurrence rate and long termcomplications.
Digital radiography has been replacing rapidly the analog radiography for diagnosis of pneumoconiosis. The purpose of this study is to compare quality control of digital radiography (DR) and analog radiography (AR) for chest radiography in medical institution for pneumoconiosis (MIP) For the first time, we visited MIP to evaluate the chest radiography which is used for patients with pneumoconiosis, including equipment, technical parameters and reading environment. There were 33 institutions. DR and AR were installed in 24 and 9 institutions, respectively. Between DR and AR, we compared the radiological technique (RT), image quality (IQ) and reading environment (RE) to use the guideline published by Occupational Safety and Health Research Institute (OSHRI). The image quality was rated by two experienced chest radiologists for pneumoconiosis with certified from OSHRI. The chest radiography equipment was not significantly difference between AR and DR, but there were significantly difference in tube voltage and grid ratio used for chest radiography except to tube current, exposure time. Statistically, DR is significantly higher in RT(70.3 vs. 43.8, p = 0.009), RE(77.7 vs. 33.3, p = 0.004) than AR, but it's not significantly difference in IQ (65.6 vs. 52.8, p = 0.050). AR and DR in RT were passed 33.3%, 75.0% respectively (p = 0.044) and 44.4%, 79.2% (p = 0.090) in IQ and 44.4%, 91.7% (p = 0.009) in RE. In MIP, DR needs to replace AR in diagnosis of pneumoconiosis.
Since Gamma Knife(R) radiosurgery(GKRS) is based on a single-fraction high dose treatment strategy, independent verification for the results of Leksell GammaPlan(R) (LGP) is an important procedure in assuring patient safety and minimizing the risk of treatment errors. Several verification methods have been developed and reported previously. Thus these methods were tested statistically and tried on Leksell Gamma Knife(LGK) target treatments through the embodiment of the previously proposed algorithms(PPA). The purpose of this study was to apply and evaluate the accuracy of verification methods for LGK target treatments using PPA. In the study 10 patients with intracranial lesion treated by GKRS were included. We compared the data from PPA and LGP in terms of maximum dose, arbitrary point dose, and treatment time at the isocenter locations. All data were analyzed by Paired t-test, which is statistical method used to compare two different measurement techniques. No statistical significance in maximal dose at 10 cases was observed between PPA and LGP. Differences in average maximal dose ranged from -0.53 Gy to 3.71 Gy. The arbitrary point dose calculated by PPA and LGP was not statistically significant too. But we found out the statistical difference with p=0.021 between TMR and LGP for treatment time at the isocenter locations. PPA can be incorporated as part of a routine quality assurance(QA) procedure to minimize the chance of a wrong overdose. Statistical analyses demonstrated that PPA was in excellent agreement with LGP when considering the maximal dose and the arbitrary point dose for the best plan of GKRS. Due to the easy applicability we hope PPA can be widely used.
Murine encephalomyocarditis virus (EMCV) has been used as a surrogate for hepatitis A virus (HAV) for the validation of virus removal and/or inactivation during the manufacturing process of biopharmaceuticals. Recently international regulation for the validation of HAV safety has been reinforced because of the reported cases of HAV transmission to hemophiliac patients who had received ntihemophilic factors prepared from human plasma. The purpose of the present study was to compare the resistance of HAV and EMCV to various viral inactivation processes and then to standardize the HAV validation method. HAV was more resistant than EMCV to pasteurization (60oC heat treatment for 10 hr), low pH incubation (pH 3.9 at 25oC for 14 days), 0.1 M NaOH treatment, and lyophilization. EMCV was completely inactivated to undetectable levels within 2 hr of pasteurization, however, HAV was completely inactivated to undetectable levels after 5 hr treatment. EMCV was completely inactivated to undetectable levels within 15 min of 0.1 M NaOH treatment, however, residual infectivity of HAV still remained even after 120 min of treatment. The log reduction factors achieved during low pH incubation were 1.63 for HAV and 3.84 for EMCV. Also the log reduction factors achieved during a lyophilization process of antihemophilic factor VIII were 1.21 for HAV and 4.57 for EMCV. These results indicate that HAV rather than EMCV should be used for the virus validation study and the validation results obtained using EMCV should be precisely reviewed.
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