• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.4037-4040
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• 2015

Objective: To explore the clinical efficacy and toxic and side effects of recombinant human endostatin (rhendostatin/endostar) combined with chemotherapy in the treatment of advanced gastric cancer. Materials and Methods: A total of 70 patients with advanced gastrointestinal adenocarcioma confirmed by histopathology and/or cytological examination were divided into group A (37 patients) and group B (33 patients). Patients in group A were given intravenous drip of 15 mg endostar added into 500 mL normal saline, once every other day until the cessation of chemotherapy or patients' maximal tolerance to chemotherapy. Patients in group B received chemotherapy alone. Two groups selected the same chemotherapy regimens. FOLFIRI scheme: 90-min intravenous drip of $180mg/m^2$ irinotecan, intravenous drip of $200mg/m^2$ calcium folinate (CF) and $400mg/m^2$ 5-fluorouracil (5-Fu) on d1, and continuous intravenous pumping of 2 $400mg/m^2$ 5-Fu for 46 h. FOLFOX4 scheme: intravenous injection of $85mg/m^2$ oxaliplatin (L-OHP), $200mg/m^2$ calcium folinate (CF) and $400mg/m^2$ 5-FU on d1 for 2 h, and then continuous intravenous pumping of 2 $400mg/m^2$ 5-Fu for 46 h. XELOX scheme: oral administration of 1 $500mg/m^2$ xeloda (or tegafur 50~60 mg) in twice during d1~14 and intravenous drip of $135mg/m^2$ L-OHP on d1 for 2 h. The modified FOLFOX scheme: intravenous injection of $135mg/m^2$ L-OHP on d1 for 2 h, $200mg/m^2$ CF and 1.0 g tegafur during d1~5. Whereas, control Group B received chemotherapy regimens which were same as Group A, but no addition of endostar. Before chemotherapy, patients were given intravenous injection of 8 mg ondansetron, intramuscular injection of 10 mg metoclopramide and 20 mg diphenhydramine for prevention of vomiting, protection of liver and stomach as well as symptomatic supportive treatment. One cycle was 21 d, 4~6 cycles in total. The efficacy was evaluated every 2 cycles. Results: 32 patients in Group A could be evaluated, and the response rate (RR) and disease control rate (DCR) were 59.38% and 78.13%, respectively. 31 patients in Groups could be evaluated, and the RR and DCR were 32.26% and 54.84%, respectively. The differences between 2 groups were significant. The toxic effects include myelosuppression, gastrointestinal reaction, fatigue, cardiotoxicity and peripheral neurotoxicity. Conclusions: Preliminary observations show that endostar (once every other day) combined with chemotherapy is effective in the treatment of advanced gastrointestinal cancer, with low toxic effects, good tolerance, deserving further study.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.99-105
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• 2018

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

• Journal of Chest Surgery
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• 제30권11호
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• pp.1097-1104
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• 1997

객혈은 항상 환자들에게는 두려운 경험이고 담당 의사에게는 고심거리가 되고 있는데 이는 객혈 자체가 심각한 질환의 징후로 나타나는 경우가 많기 때문이다. 그러한 출혈이 있을 때에는 폐결핵이나 기관지확장 증 또는 폐암의 가능성을 즉시 생각해 보아야 하겠지만,오늘날 진보된 진단방법으로 인해 객혈환자의 감별 진단이 가능해 졌고 적절한 치료를 받을 수 있게 되었다. 본 연구는 1992년 3월부터 1997년 2월까지 6년간 서을 위생병원 흉부외과에서 객혈로 인해 응급 개흉술을 시행받은 75명의 환자를 대상으로 이루어 졌다. 환자의 연령은 19세부터 68세까지로 평균연령은 36.6세였고 가장 호발한 연령층은 30대 였다. 객혈유발의 가장 흔한 질환은 결착(44%)이었고, 병소부위를 가장 정확하게 진단할 수 있었던 검사는 객혈시의 기관지경 검사로 95%의 환자에서 병소부위를 밝힐 수 있었으며, 우중엽 및 하엽(17.3%)이 가장 흔한 병소 부위였다. 가장 많이 선택된 수술 방법은 폐엽절제술(50%)이었으며, 객혈의 재발(31.6%)이 가장 흔한 술후 합병증이었다. 수술후 환자의 예후는 82.6%에서 완전회복을 보였다. 저자들은 위의 결과를 통하여 객혈환자의 적절한 치료는 정확한 진단, 약물 보조치료와 더불어 외과적 치 료방법으로 완료됨을 알 수 있었다.

• 대한한방소아과학회지
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• 제31권1호
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• pp.52-62
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• 2017

Objectives The purpose of this study is to review pre-existing clinical practice guidelines for autism spectrum disorders, and refer those in developing a new practice guideline. Methods A total of 9 existing clinical practice guidelines for autism spectrum disorder developed from 2010 to 2016 were searched by Google scholar and Pubmed, and were reviewed those literatures in three parts: general, diagnosis & evaluation, and intervention. Results There were no consistency in the recommendation methods of 9 clinical care guidelines (such as the method of rating and recommendation intensity for diagnosis, evaluation, and treatment). However, in the diagnosis and evaluation section, frequently used evaluation and diagnostic tools are mentioned in most clinical practice guidelines, and the types of pharmacologic and non-pharmacological treatments that are mainly recommended in treatment are equally mentioned in most clinical practice guidelines could confirm. Conclusions 1. Some guideline recommendations are graded according to each criterion. Recommendations presented in various databases were based on systematic reviews or other literatures. The most utilized database were PsycINFO, CINAHL, Cochrane. 2. DSM-5 and ICD-10 were the most common used diagnostic criteria, and DSM-IV was used as a diagnostic standard in the guideline published before 2013. The tools used for diagnosis and evaluation were also varied. However, most recommended ones were ADI-R, ADOS-G, and DISCO. 3. Treatment was largely divided into pharmacological intervention and non-pharmacological intervention. In some guideline, the interventions were divided into pediatric and adult. Most of the pharmacological interventions were not recommended due to lack of evidence, but in cases in which specific symptoms were aimed, they recommended to seek professional help. 4. In addition to interventions, each guideline referred to supportive interventions that may be helpful in the daily life of patients with ASD, which may need to be addressed in future clinical guidelines.

• 정신신체의학
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• 제31권2호
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• pp.50-62
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• 2023

연구목적 유방암, 대장암, 폐암, 갑상선암 환자의 미충족 수요를 확인하고 관련 요인을 파악하고자 하였다. 방법 학술 검색을 통해 2010년 이후 출간된 암 환자 미충족 수요에 대한 논문을 선정하여 검토하였다. 결과 측정 도구는 암 생존자의 미충족 수요, 지지적 간호요구조사 설문이 주로 사용되었으며, 폐암 환자의 미충족 수요가 상대적으로 높았다. 유방암 환자는 의료시스템 및 정보, 갑상선암 환자는 사후관리와 심리문제, 대장암 환자는 심리, 종합적 암 치료, 폐암 환자는 신체 및 일상생활관리에서 미충족 수요가 높았다. 연령, 경과시간, 불안, 우울 및 디스트레스, 삶의 질은 미충족 수요와 관련이 있었다. 결론 각 환자군의 미충족 요구를 고려한다면 더욱 효과적인 치료 및 지원 프로그램 개발에 도움이 될 것이다.

• 농촌의학ㆍ지역보건
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• 제26권2호
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• pp.111-132
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• 2001

골다공증 환자들의 치료순응도와 그 관련요인을 알아보기 위하여 1999년 4월에서 6월 사이에 골다공증으로 진단된 고령지역의 3개 보건진료소와 보건소 관할지역에 거주하는 40세에서 69세 사이의 여성 140명을 대상으로 골밀도 검사 사업을 실시한지 약 1년 후인 2000년 4월에서 5월 사이에 약물치료순응도와 치료순응도 관련 이론적 모형 변수에 대한 설문조사를 실시하였다. 연구 대상자 중 규칙적 치료군은 12.1%, 간헐적 치료군은 53.6%, 미치료군은 34.3%였다. 단순분석 결과, 일반적 특성 중 연령이 높을수록, 본인이 인지하는 질병의 정도가 심하다고 생각할수록, 의사의 치료권유를 받은 경우에 치료순응률이 높았다(p<0.05). 환자역할수행요인 중 합병증(골절)의 가능성과 골다공증의 심각성이 치료 순응과 유의한 관련성이 있었다(p<0.05). 그리고 치료가 유익하다고 생각할수록, 치료의 장애도가 낮을수록 치료경험율이 높았다(p<0.01). 경로분석 결과 모형의 적합도는 양호하였다. 합병증(골절)의 가능성 인지에는 연령, 학력, 골다공증에 대한 매스컴 접촉/보건교육 경험, 치료에 대한 가족의 관심 등이 정(正)의 직접효과를 미쳤으며, 골다공증의 심각성 인지에는 연령, 학력, 의사의 치료권유, 치료에 대한 가족의 관심 등이 정(正)의 직접효과를 미쳤다. 치료의 유익성 인지에는 의사의 치료권유와 치료에 대한 가족의 관심이 정(正)의 직접효과를 미쳤으며, 치료의 장애도 인지에 대하여는 연령, 경제적 수준, 의사의 치료권유와 치료에 대한 가족의 관심이 부(負)의 직접효과를 미쳤다. 골다공증 치료순응도에는 골다공증의 심각성이 정(正)의 직접효과, 치료의 장애도가 부(負)의 직접효과를 미쳤다. 수정요인 중 본인이 인지한 질병의 정도는 치료순응도에 정(正)의 직접효과를 미쳤으며, 연령, 경제적 수준, 학력, 의사의 치료권유, 가족의 치료에 대한 관심 등은 환자역할 수행요인에 대한 영향을 통해 치료순응도에 정(正)의 간접효과를 미쳤다. 치료순응도에 총 효과 가장 큰 요인은 치료의 장애도였으며, 그 다음으로 본인이 인지하는 질병의 정도, 연령, 의사의 치료권유, 치료에 대한 가족의 관심, 골다공증의 심각성 순이었다. 치료의 장애도는 연령, 경제적 수준, 의사의 치료권유와 치료에 대한 가족의 관심의 영향을 받았다. 또한 낮은 연령일수록 치료순응도가 낮았다. 향후 골다공증 환자의 치료순응도를 향상시키기 위하여는 자신의 질병상태를 올바르게 인식하도록 하고, 의사의 치료 권유와 치료에 대한 가족의 관심 등 골다공증 치료에 지지적인 환경을 조성하여 심리적 및 현실적 장애를 감소시키는 것이 중요하리라 생각되며, 효율적이고 지속적인 환자관리체계의 개발이 필요하겠다.

• Clinical and Experimental Pediatrics
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• 제52권4호
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• pp.508-511
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• 2009

폐구균(Streptococcus pneumoniae)은 소아, 특히 어린 영아에서 심한 침습성 질병을 일으키는 중요한 원인균이다. 2003년부터 우리나라에서 접종하기 시작한 7가 폐구균백신(PCV7)은 소아에서 침습성 폐구균성 폐렴과 수막염을 예방하는 것으로 알려져 왔다. 그러나 최근 7가 폐구균백신을 접종한 이후부터 비7가 폐구균 혈청형(non-PCV7 serotype) 감염 발생률이 증가하고 있다. 14개월 된 여아가 내원 3일 전부터 열과 구토가 있었으나 증상 치료만 하고 있던 중 갑작스런 의식불명과 기면(lethargy)으로 응급실로 내원하였다. 입원 후 즉각적인 진단과 치료를 시행했음에도 불구하고 환자는 빠르게 혼수와 뇌사 상태로 진행하였다. 환자는 이전에 3회의 7가 폐구균백신을 접종하였으나 최종 진단은 비7가 폐구균 혈청형인 폐구균 19A 수막염이었고, 입원 20일째 사망하였다. 이는 한국에서 문헌상 보고된 적이 없는, 폐구균 19A 혈청형 수막염으로 사망한 첫번째 증례이므로 이에 보고하는 바이다.

• 대한치과마취과학회지
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• 제14권1호
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• pp.63-71
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• 2014

Extension of advanced odontogenic infection from deep neck fascial spaces into the mediastinum is heralded by chest pain, dyspnea, fever, and radiographic demonstration of mediastinal widening. The critical care should be done in a team approach by multiple medical and dental departments, such as, oral & maxillofacial surgery, otolaryngology, anesthesiology, chest surgery, and infection medicine. Especially, fluid & drug therapy, adequate incision & drainage and systemic supportive psychosedation care are important. But, acute hyperventilation can be produced by several distinct causes: severe anxiety, respiratory alkalosis, increased blood catecholamine levels, and a decrease in the level of the ionized calcium in the blood. The orofacial fears about acute pain, trismus, dysphagia, swelling and oral surgical treatment lead to the severe anxiety and increased blood catecholamine level by stress. Therefore, the most dental patient should be cared gently as the stress reduction protocol. In spite of the care, hyperventilation was occurred during psychosedation and local anesthesia for incision and drainage of the masticatory fascial space abscess with deep neck infection & mediastinitis. We suggest that the dental patient with advanced odontogenic infection must be attention for the manifestation of hyperventilation, especially in the medically compromised conditions.

• 대한장애인치과학회지
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• 제9권2호
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• pp.111-117
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• 2013

Some odontogenic infections erode into fascial spaces directly and spread toward lymphatic tissues and blood streams. The principal maxillary primary spaces are the canine, buccal, and infratemporal space, the next secondary spaces are the masseteric, temporal and pharygeal space. As a result of the infection, trismus and orocutaneous fistula may be occurred. Trismus is owing to conditions not associated with temporomandibular joint itself and may be of myogenic, neurogenic, or psychogenic nature. Muscular trismus is due to infection adjacent to the elevator muscles of the jaw. The four principles of treatment of infection are as follows: (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including rest, nutrition and physiotherapy. Jaw physiotherapy is necessary to increase the amount of mouth opening and regain normal muscle tone. If proper care of odontogenic infection could be attained, the orocutaneous fistula will heal and close spontaneously by wound contraction mechanism of natural homeostatic response. This is a case report of the care of trismus and orocutaneous fistula due to fascial space abscess by advanced odontogenic infection in a physically disabled patient.

• 대한장애인치과학회지
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• 제9권1호
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• pp.30-35
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• 2013

The four principles of treatment of odontogenic infection are as follows : (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including proper rest and nutrition. A separate incision is required to establish drainage, especially in the case of extensive fascial space infections. There are four principle causes for active bleeding in the immediate incision & drainage phase; (1) vascular wall alteration (infection, scurvy, chemicals), (2) disorder of platelet function, (3) thrombocytopenic purpuras, (4) disorders of coagulation (liver disease, anticoagulation drug). If the hemorrhage from incision & drainage site is aggressive, the site must be packed with proper wet gauze and wound closure & drainage dressing are applied. The specific causes of bleeding may be associated with hypoxia, changes in the pH of blood & chemical changes affecting vascular contractility and blood clotting. This is a case report of bleeding control by the circumferential suture & drainage on active bleeding incision & drainage site of temporal space abscess due to advanced odontogenic infection in a multiple medically compromised disabled patient.