• Title/Summary/Keyword: treatment failure

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A Case of Continuous Positive Airway Pressure Therapy in a Patient with Central Sleep Apnea and Heart Failure (중추성 수면 무호흡이 동반된 심부전 환자에서 지속적 상기도 양압술 적용 1례)

  • An, Jee Young;Kim, Shin Bum;Kang, Hyeon Hui
    • Sleep Medicine and Psychophysiology
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    • v.24 no.2
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    • pp.118-123
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    • 2017
  • Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.

A Case Report of Improvement of Glomerular Filtration Rate and Anemia in Chronic Renal Failure through Herbal Medication (만성신부전 환자에게 한약투여 후 사구체여과율 및 빈혈 호전 1례)

  • Kim, Dong-Hyun;Bae, Eun-Joo;Park, Seong-Uk;Yoon, Seong-Woo;Ko, Chang-Nam;Rheu, Kyoung-Hwan
    • The Journal of Internal Korean Medicine
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    • v.26 no.2
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    • pp.498-505
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    • 2005
  • Renal failure means irreversible damage and depression of renal function, represented by glomerular filtration rate(GFR). A renal failure patient with uremia and anemia is presented. Anemia, in this patient, appeared before uremia did. A 55 year-old male patient was treated for renal failure with Weilingtang. Improvement was observed in, not only GFR, blood urea nitrogen(BUN), and creatinine, but also in such symptoms as difficulty in urine excretion, dyspepsia and abdominal swelling. But anemia appeared during treatment, so a mixture of Dangguibuxuetang(當歸補血湯) and Xiongguitang(芎歸湯) was prescribed. After this treatment, improvement in hemoglobin, and hematocrit was observed.

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Two Case Report of Spontaneous Pregnancy Treated with Gamiseogagjihwang-tang after Repeated Failure in In Vitro Fertilization or Intrauterine Insemination Treatment (보조생식술 실패 후 서각지황탕가미(犀角地黃湯加味) 복용치료를 통해 자연임신에 성공한 난임 환자 치험 2례)

  • Koh, Ji-Eun;Lyou, Myung-Sook
    • The Journal of Korean Obstetrics and Gynecology
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    • v.28 no.1
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    • pp.128-137
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    • 2015
  • Objectives: Spontaneous pregnancy is a rare event after repeated failure of in vitro fertilization (IVF) or Intrauterine insemination (IUI) treatment. So this paper is to report the natural pregnancy of Gamiseogagjihwang-tang treatments on two infertile patients who were repeatedly failed in IVF or IUI. Methods: One patient was a 35-year-old patient diagnosed with the adenomyosis and contralateral tubal obstruction, treated with 90 cc Gamiseogagjihwang-tang two times per day for 6 weeks after second failure of IVF. The other patient was a 34-year-old patient undergone induced abortion by three times, treated with 90 cc Gamiseogagjihwang-tang two times per day for 4 weeks after second failure of IUI. Results: Through taking Gamiseogagjihwang-tang without assisted reproduction techniques, two cases got pregnant naturally. Conclusions: These cases suggest that Gamiseogagjihwang-tang is effective in treating infertile female after failure in IVF or IUI and inducing spontaneous pregnancy. Therefore, there needs to be more trial on infertile patients treated with Seogagjihwang-tang.

An improved model of compaction grouting considering three-dimensional shearing failure and its engineering application

  • Li, Liang;Xiang, Zhou-Chen;Zou, Jin-Feng;Wang, Feng
    • Geomechanics and Engineering
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    • v.19 no.3
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    • pp.217-227
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    • 2019
  • This study focuses on an improved prediction model to determine the limiting grouting pressure of compaction grouting considering the ground surface upheaval, which is caused by the three-dimensional conical shearing failure. The 2D-dimensional failure curve in Zou and Xia (2016) was improved to a three-dimensional conical shearing failure for compaction grouting through coordinate rotation. The process of compaction grouting was considered as the cavity expansion in infinite Mohr-Coulomb (M-C) soil mass. The prediction model of limiting grouting pressure of compaction grouting was proposed with limit equilibrium principle, which was validated by comparing the results in El-Kelesh et al. (2001) and numerical method. Furthermore, using the proposed prediction model, the vertical and horizontal grouting tube techniques were adopted to deal with the subgrade settlement in Shao-huai highway at Hunan Provence of China. The engineering applicability and effectiveness of the proposed model were verified by the field test. The research on the prediction model for the limiting grouting pressure of compaction grouting provides practical example to the rapid treatment technology of subgrade settlement.

Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma

  • Seol, Ki Ho;Lee, Jeong Eun
    • Radiation Oncology Journal
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    • v.34 no.1
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    • pp.10-17
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    • 2016
  • Purpose: To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC). Materials and Methods: Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4-72 Gy (39.6-45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed. Results: The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively. Conclusion: No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.

The Analysis of Risk Factors of Pulmonary Tuberculosis Patients Failed in Retreatment (재치료실패 폐결핵 환자의 위험인자 분석)

  • Kim, Hyoung-Soo;Lee, Won-Jin;Kong, Seok-Jun;Shon, Mal-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.684-690
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    • 2000
  • Background : The most common cause of treatment failure of pulmonary tuberculosis is early stoppage of treatment or irregular medication. The most important aspect of a retreatment is regular medication provided over a long period. Inadequate treatment may cause drug resistance and prolong the duration of chemotherapy. This study analyzed the risk factors of pulmonary tuberculosis patients, who failed in retreatment, and to use the results as basic data in the management of intractable tuberculosis patients with improving the rate of retreatment success. Methods : We performed a retroactive study of 62 pulmonary tuberculosis patients in retreatment at National Mokpo Tuberculosis Hospital from Jan. 1994 to Dec. 1995. The patients were separated into two groups: group I was retreatment failure and group II was retreatrnent success. For the analysis of risk factors in retreatment failure, we compared the difference between the two groups and tested the confidence limit about results of the results by independent t-test, ${\chi}^2$ test and Fisher's exact test. Results : The treatment failure rate of retreatment patients was 13(21%), and treatment success 49(79%). No significant difference (p>0.05)in age, sex, number of treatment, irregular rate of treatment, extent of the disease & cavitary lesion on the chest X-ray, number of resistance drugs, number of used drugs to medication, number of sensitive bactericidal drugs to medication, rate of sensitive drugs to medication and resisiance to INH & RFP had not significant difference. was found. However, the number of treatment was $2.4{\pm}0.8$ in group I and $1.6{\pm}0.9$ in group II, and had showing a significant difference(p<0.05) between the two groups. Conclusion : The risk factor of retreatment failure was more irregular previous treatment the irregularity of the previous treatment. For reducing the retreatment failure of pulmonary tuberculosis, greater efforts are needed more need to be done to prevent failure of first treatment.

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A Pilot Randomized Trial of As-Needed Budesonide-Formoterol for Stepping Down Controller Treatment in Moderate Asthma with Complete Remission

  • Nakwan, Narongwit;Ruklerd, Thidarat;Taptawee, Pattarawadee
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.3
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    • pp.227-236
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    • 2022
  • Background: The use of low-dose inhaled corticosteroid-formoterol as reliever monotherapy has recently been recommended in the asthma treatment guidelines. However, the efficacy of this treatment strategy has not yet been determined during the stepping-down period in moderate asthma. This study aimed to evaluate the feasibility of reducing treatment to as-needed budesonide-formoterol (BFM) in moderate asthma with complete remission. Methods: We randomly assigned 31 patients (8 males and 23 females with a mean age of 57.2 years) with complete remission of asthma by inhaled BFM (160/4.5 ㎍) twice daily to receive BFM (160/4.5 ㎍) as needed (16 patients), or budesonide (BUD) (200 ㎍) twice daily (15 patients). The study was an open-label study done for 48 weeks, with the primary outcome as the cumulative percentages of patients with treatment failure (asthma exacerbation or loss of asthma control or lack of satisfaction after using medications) in the two groups. Results: Six patients (42%) using as-needed BFM had treatment failure, as compared with three patients (21.4%) using BUD maintenance (hazards ratio for as-needed BFM, 1.77; 95% confidential interval, 0.44-7.12; p=0.41). The changes in forced expiratory volume in 1 second were -211.3 mL with as-needed BFM versus -97.8 mL with BUD maintenance (difference, 113.5 mL; p=0.75) and the change in fractional exhaled nitric oxide was significantly higher in both groups, at 8.68 parts per billion (ppb) in the as-needed BFM group and 2.5 ppb. in the BUD maintenance group (difference, 6.18 ppb; p=0.049). Conclusion: Compared with BUD maintenance, there were no significant differences in treatment failure rate in patients who received as-needed BFM during the stepping down period in moderate asthma. However, they showed reduced lung function and relapsed airway inflammation. The results are limited by imprecision, and further large RCTs are needed.

Risk Factors for the Treatment Failure of Antibiotic-Loaded Cement Spacer Insertion in Diabetic Foot Infection (당뇨병성 족부 감염에서 항생제 혼합 시멘트 충전물 사용의 치료 실패 위험 인자 분석)

  • Park, Se-Jin;Song, Seungcheol
    • Journal of Korean Foot and Ankle Society
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    • v.23 no.2
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    • pp.58-66
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    • 2019
  • Purpose: To evaluate the efficacy of antibiotic-loaded cement spacers (ALCSs) for the treatment of diabetic foot infections with osteomyelitis as a salvage procedure and to analyze the risk factors of treatment failure. Materials and Methods: This study reviewed retrospectively 39 cases of diabetic foot infections with osteomyelitis who underwent surgical treatment from 2009 to 2017. The mean age and follow-up period were $62{\pm}13years$ and $19.2{\pm}23.3months$, respectively. Wounds were graded using the Wagner and Strauss classification. X-ray, magnetic resonance imaging (or bone scan) and deep tissue cultures were taken preoperatively to diagnose osteomyelitis. The ankle-brachial index, toe-brachial index (TBI), and current perception threshold were checked. Lower extremity angiography was performed and if necessary, percutaneous transluminal angioplasty was conducted preoperatively. As a surgical treatment, meticulous debridement, bone curettage, and ALCS placement were employed in all cases. Between six and eight weeks after surgery, ALCS removal and autogenous iliac bone graft were performed. The treatment was considered successful if the wounds had healed completely within three months without signs of infection and no additional amputation within six months. Results: The treatment success rate was 82.1% (n=32); 12.8% (n=5) required additional amputation and 5.1% (n=2) showed delayed wound healing. Bacterial growth was confirmed in 82.1% (n=32) with methicillin-resistant Staphylococcus aureus being the most commonly identified strain (23.1%, n=9). The lesions were divided anatomically into four groups; the largest number was the toes: (1) toes (41.0%, n=16), (2) metatarsals (35.9%, n=14), (3) midfoot (5.1%, n=2), and (4) hindfoot (17.9%, n=7). A significant difference in the Strauss wound score and TBI was observed between the treatment success group and failure group. Conclusion: The insertion of ALCSs can be a useful treatment option in diabetic foot infections with osteomyelitis. Low scores in the Strauss classification and low TBI are risk factors of treatment failure.

Treatment Results for Adenoid Cystic Carcinoma of the Major Salivary Gland (주타액선에서 발생한 선양낭세포암종의 방사선치료성적)

  • Lee Sang-Wook;Kim Gwi-Eon;Park Cheong-Soo;Choi Eun-Chang;Lee Kang-Kyoo;Park Won;Suh Chang-Ok
    • Korean Journal of Head & Neck Oncology
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    • v.18 no.2
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    • pp.197-202
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    • 2002
  • Purpose: This study was to investigate clinical feature of adenoid cystic carcinoma (ACC) in the major salivary gland. Materials and Methods: A retrospective analysis was undertaken for 23 patients with adenoid cystic carcinoma of the major salivary gland, who completed postoperative radiotherapy at the Yonsei Cancer Center, Yonsei University Hospital between May 1981 and December 1999. The male to female ratio was 1.1:1. Median age was 50. Follow up periods were 12-180 months with the median follow-up time of 59 months. Results: Parotid gland, submandibular gland and sublingual gland were 17, 5 and 1 respectively. Overall failure rate was 26%. Local failure was observed in two patients with parotid gland origin. Five cases showed distant failure. Overall and disease free survival rate were 68% and 72% respectively. Conclusion: Major pattern of failure was distant failure. Resection margin status had not prognostic significance. Postoperative radiation treatment is an effective to control in the adenoid cystic carcinoma of the major salivary gland.

A STUDY OF TENSILE BOND STRENGTH ACCORDING TO VARIED TREATMENT METHODS OF NONPRECIOUS METAL SURFACE AND RESIN CEMENTS (비귀금속합금 표면처리방법과 레진시멘트 종류가 접착인장강도에 미치는 영향에 관한 연구)

  • Yang, Tai-Jin;Lim, Ju-Hwan;Cho, In-Ho
    • The Journal of Korean Academy of Prosthodontics
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    • v.34 no.2
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    • pp.335-348
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    • 1996
  • Retention is one of the major factors deciding the success and longevity of resin bonded restorations. The purpose of this study was to find a better resin cement and metal surface treatment method that would enhance the bonding strength. The bonding surfaces of Verabond, one of Ni-Cr-Be alloys, were treated with sandblasting(Group 1), sandblasting and EZ-Oxisor(Group 2), sandblasting and silicoating(Group 3), and than thay were bonded with All-Bond C & B, Panavia 21, Superbond C & B. The specimens were thermocycled, and the tensile bond strength was measured using the unive-rsal testing machine. Also the mode of bond failure was observed. The results were as folows. 1. The Superbond C & B showed the highest bond strength among the three resin cements and decreased in the order of Panavia 21, All-Bond C & B. There was significant differe-nce among them(p<0.05). 2. Group 3 showed the highest bond strength among the three metal surface treatment methods, and there was significant difference compared with Group 1 and Group 2(p<0.05). But there was no significant difference between Group 1 and Group 2. 3. Observing the mode of bond failure, Superbond C & B and Panavia 21 showed mostly cohesive failure in all groups. All-Bond C & B showed all types of bond failure in Group 3, but Group 1 and Group 2 showed only adhesive failure. 4. According to the results of this study, the silicoating method and 4-META containing resin cement were considered to be more acceptable for resin bonded restoration.

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