• Title/Summary/Keyword: treatment follow-up

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The Analysis and Treatment of Rotator Cuff Tear After Shoulder Dislocation in Middle-Aged and Elderly Patients (중·장년층에서 견관절 탈구 후에 발생한 회전근 개 파열에 대한 분석과 치료)

  • Ji, Jong-Hun;Park, Sang-Eun;Kim, Young-Yul;Shin, Eun-Su;Park, Bo-Youn;Jeong, Jae-Jung
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.20-26
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    • 2010
  • Purpose: To evaluate clinical features and surgical results for rotator cuff tear secondary to shoulder dislocation in middle-aged and elderly patients. Materials and Methods: We reviewed 19 patients over 50 years of age who had rotator cuff tears combined with shoulder dislocation between October 2004 and October 2008. There were 7 males and 12 females with a mean age 64.7 years (range, 50 to 78 years). The average follow-up duration was 22 months (range, 8 to 56 months). We investigated the number of dislocations, the size of the cuff tear, the presence of Bankart lesions and the time interval from dislocation to surgery. We also investigated the ASES score, UCLA score, SST score, and shoulder range of motion before and after surgery. We analyzed clinical outcomes and contributing factors. Results: ASES scores improved from 30.2 preoperatively to 72.3 postoperatively; UCLA scores improved from 12.9 to 26.5; SST scores improved from 2.4 to 7.3. Range of motion improved significantly: forward flexion, abduction, external rotation and internal rotation were, respectively, $110.8({\pm}39.3)^{\circ}$, $107.7({\pm}40)^{\circ}$, $22.5({\pm}17.6)^{\circ}$ and L5 level preoperatively; postoperatively they were $153.6({\pm}20.6)^{\circ}$, $152.1({\pm}20.8)^{\circ}$, $36.4({\pm}22.7)^{\circ}$ and L1 level. Age, the presence of Bankart lesions and the number of dislocations were not correlated with clinical outcomes. But the size of the cuff tear was correlated with clinical results. Also, the duration from dislocation to surgery was correlated with postoperative UCLA and SST scores (p=0.039, p=0.038). Conclusion: For shoulder dislocation, it is important to achieve early diagnoses of rotator cuff tears in middle-aged and elderly patients. If these injuries are both present, early rotator cuff repair should be performed for better clinical results.

Outcomes and Management of Fetal Infants with Birth Weight Below 500 g at a Tertiary Center (출생체중 500 g 미만의 태아영아 치료성적 및 치료의 실제)

  • Chang, Yun Sil;Kim, Yu Jin;Koo, Soo Hyun;Lee, Jang Hoon;Hwang, Jong Hee;Choi, Chang Won;Shim, Jae Won;Kim, Sung Shin;Ko, Sun Young;Lee, Eun Kyung;Park, Won Soon
    • Clinical and Experimental Pediatrics
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    • v.48 no.9
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    • pp.939-945
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    • 2005
  • Purpose : The purpose of this study was to report outcome of fetal infants with birth weight below 500 g known as lower limit of viability and to evaluate treatment characteristics and short-term morbidity of their survivors. Methods : We retrospectively analyzed the medical records of all fetal infants with birth weight below 500 g who were delivered at Samsung Medical Center(SMC), or transferred to neonatal intensive care unit(NICU) of SMC within 24 hrs after birth between 1994 and 2004. Data for all interventions and morbidity outcome were analyzed for infants who were admitted to the NICU and were compared between NICU survivors and deaths. Results : Among 53 infants with birth weights of 400 to 499 g who were born in SMC during the study period, 8(15.1%) infants were admitted to the NICU and one was transferred to NICU from other hospital. Overall, 4(44%) of 9 survived and were discharged from the NICU. The smallest infant who survived weighed 439 grams. The least gestational age was $23^{+3}$ among the survivors. Compared with NICU deaths, NICU survivors had larger gestational age($24^{+2}{\pm}1^{+3}$ vs. $25^{+4}{\pm}2^{+3}$) and birth weight($424{\pm}17$ vs. $453{\pm}19$)(P<0.05). Median survival duration of NICU deaths was 15 days. None of NICU survivors had severe IVH, but 3(75%) had laser therapy for retinopathy of prematurity and bronchopulmonary dysplasia, respectively. Conclusion : Fetal infants with birth weight below 500 g known as lower limit of viability survived successfully. Study for their long-term follow-up will be needed to define our limit of viability and indication for their active resuscitation.

Clinical characteristics and prognostic factors for survival in hemophagocytic lymphohistiocytosis (혈구탐식성 림프조직구증의 임상적 특징과 생존에 미치는 예후인자)

  • Kim, Khi Joo;Kim, Ki Hwan;Lee, Taek Jin;Chun, Jin-Kyong;Lyu, Chuhl Joo;Kim, Dong Soo
    • Clinical and Experimental Pediatrics
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    • v.51 no.3
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    • pp.299-306
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    • 2008
  • Purpose : Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal disorder characterized by fever, splenomegaly, pancytopenia, and hemophagocytosis in the bone marrow and other tissues. In this study, we investigated the clinical manifestations and prognostic factors in patients with HLH. Methods : We retrospectively analyzed the data from 29 patients who were diagnosed whit HLH in the Severance Children's Hospital from Jan. 1996 to Feb. 2007. Results : The median age at diagnosis was 3.8 years (range 0.1-12.2). The ratio of male to female patients was 1.1:1. The 5-year overall survival rate was 55.2% with a median follow-up duration of 32 months. In a multivariate analysis, the duration of fever before admission (survival vs. non-survival, 6.5 days vs. 14 days, P=0.010), the interval from the day of fever onset to the day of initiation of etoposide (survival vs. non-survival, 10 days vs. 35 days, P=0.002) and the presence of neurologic symptoms (survival vs. non-survival, 1 case vs. 7 cases, P=0.010) were independent, poor prognostic factors of HLH. EBV infection, gender, and the level of serum ferritin had no relations to the poor prognosis of the disease. Conclusion : This study showed that the presence of neurologic symptoms and a longer duration of fever were related to a poor prognosis. Therefore, if a patient develops neurologic symptoms and the duration of fever is prolonged, a prompt diagnostic approach and aggressive treatment for HLH are necessary.

The Effect of Invisible Cue on Change Detection Performance: using Continuous Flash Suppression (시각적으로 자각되지 않는 단서자극이 변화 탐지 수행에 미치는 효과: 연속 플래시 억제를 사용하여)

  • Park, Hyeonggyu;Byoun, Shinchul;Kwak, Ho-Wan
    • Korean Journal of Cognitive Science
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    • v.27 no.1
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    • pp.1-25
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    • 2016
  • The present study investigated the effect size of attention and consciousness on change detection. We confirmed the effect size of consciousness by comparing the condition which combined attention and consciousness and the condition of attention without consciousness. Then, we confirmed the effect size of attention by comparing the condition of attention without consciousness and the control condition which excluded attention and consciousness. For this purpose, change detection task and continuous flash suppression (CFS) were used. CFS renders a highly visible image invisible. In CFS, one eye is presented with a static stimulus, while the other eye is presented with a series of rapidly changing stimuli, such as mondrian patterns. The result is that the static stimulus becomes suppressed from conscious awareness by the stimuli presented in the other eye. We used a customized device with smartphone and google cardboard instead of stereoscope to trigger CFS. In Experiment 1-1, we reenacted some study to validate our experimental setup. Our experimental setup produced the duration of stimulus suppression that were similar to those of preceding research. In Experiment 1-2, we reenacted a study for attention without consciousness using an customized device. The results showed that attention without consciousness more strongly work as a cue. We think that it is reasonable to use CFS treatment employing smartphone and google cardboard for a follow-up study. In Experiment 2, when performing the change detection task, we measured the effect size of consciousness and attention by manipulating the consciousness level of cue. We used the method in which everything but the variable of interest kept being fixed. That way, the difference this independent variable makes to the action of the entire system can be isolated. We found that there was significant difference of correct response rate on change detection performance among different consciousness level of cue. In this study, we investigated that not only the role of attention and consciousness were different also we were able to estimated the effect size.

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The effects of Moxibustion Therapy on Chronic Low Back Pain, Daily Living Disability and Sleep Pattern in Elderly Women (뜸요법이 여성노인의 만성요통, 일상생활기능장애 및 수면양상에 미치는 효과)

  • Kim, Hye-Jeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.7
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    • pp.301-310
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    • 2016
  • This is a nonequivalent control group non-synchronized experiment research to verify the effect of moxibustion therapy on efficient management of daily living disabilities and sleep patterns in elderly women with chronic low back pain. Total 12 sessions of moxibustion therapy were applied to elderly women(30 subjects in an experimental group and 30 subjects in a control group) in G City once a week for 12 weeks from March 15th to May $31^{st}$ 2015. Then the follow-up study was conducted 2 weeks after the post survey. For moxibustion, was applied to Shen-shu, Ashi point, Ta chang shu, Yang kuan and Yosu. 5 sheets of moxibustion were applied to 7 acupuncture points of Mugeukboyang moxibustion; Zu san li & Chu chi, Chung wan, Chung chi & Shui tao, Fei shu, Kao hung and Tien shu, Wijung respectively and experimental treatment was conducted. For assessing the degree of back pain, Visual Analog Scale(VAS) developed by Scott & Huskisson(1979) was used and for measuring the degree of daily living disability, Oswestry Disability Index, which was developed by Fairbank et al(1980) and translated and revised by Yim, Hyeon-sul et al.(1998), was used. For measuring sleep patterns, the sleep pattern measurement tool developed by Oh, Jin-su, Song, Mi-soon and Kim, Sin-mi(1998) was used. For data analysis, SPSS/WIN 18.0 was employed and Chi-square test, t-test and repeated measures ANOVA were performed. There were significant differences in pain score(F=2510.32, p<.001), daily living disability score(F=1937.82, p<.001) and sleep pattern score((F=15.54, p<.001) of elderly women that were provided with moxibustion therapy, compared to the control group. Therefore, it was found that moxibustion therapy made a positive contribution to reduction in pain and daily living disabilities and improvement in sleep quality. Based on this study finding, there is a need to apply moxibustion therapy to elderly people with chronic low back pain as a nursing intervention in future.

Dorsal Mini-thoracotomy for PDA Closure in Premature Neonates (후방 소개흉술을 통한 미숙아 동맥관 개존증의 수술요법)

  • Lee, Hyang-Lim;Choi, Chang-Hyu;Son, Dong-Woo;Shim, So-Yeon;Park, Kook-Yang;Park, Chul-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.434-440
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    • 2009
  • Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

Active Prosthetic Valve Endocarditis: The Clinical Profile, Laboratory Findings and Mid-term Surgical Results (활동성 인공판막 심내막염: 임상 양상, 검사 소견 및 중기 수술 성적)

  • Kim, Hwan-Wook;Joo, Seok;Kim, Hee-Jung;Choo, Suk-Jung;Song, Hyun;Lee, Jae-Won;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.447-455
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    • 2009
  • Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean$\pm$SD, 42.1$\pm$36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

Treatment Outcome of Postoperative Radiotherapy in Extrahepatic Bile Duct Cancer (간외담관암의 수술 후 방사선치료 성적)

  • Choi, Young-Min;Cho, Heung-Lae
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.27-34
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    • 2003
  • Purpose : To evaluate the efficacy of radiotherapy, and the factors affecting survival in patients of extrahepatic bile duct cancer, by analyzing the results of postoperative radiotherapy Materials and Methods : Between October 1991 and July 2001, 21 patients with extrahepatic bile duct cancer, who received radiotherapy after a radical resection, were retrospectively reviewed. The patients' ages ranged from 39 to 75 years, with a median of 61 years, and a male to female ratio of 16 to 5. The numbers of patients with proximal and distal bile duct cancer were 14 and 7, respectively. From the postoperative pathological examination, 19 of the patients were found to have microscopic residues, and 7 to be lymph node positive. Patients with AJCC stages I, II and III were 10, 10 and 1, respectively. The total radiation dose administered was 4,500$\~$6,300 cGy, with a median dose of 5,040 cGy. The follow up period was 20$\~$81 months, with a median of 57.5 months. Results : The overall and disease free survival rates at 3 and 5 years were 41.0 and 29.3$\%$, and 41.6 and 29.7$\%$, respectively. The influences of age, sex, tumor location, differentiation, microscopic residue, neural invasion, 7 and N stage, the stage itself, the dose of radiation and chemotherapy, on survival were evaluated. The T stage and the stage itself were found to be significant from a univariate analysis (p<0.05), but the degree of significance was limited by the small number of patients. A recurrence occurred in 12 patients (57.1$\%$), 5 in locoregional sites, 4 in distant sites and 3 in a combination of locoregional and distant sites, and the sites of distant metastasis were the liver, 6, and the bone, 1 Grade 2 or 3 acute leucopenias occurred in 2 patients and grade 2 chronic peptic ulcers occurred in 4, who were all recovered by conservative management. Conclusion : Postoperative radiotherapy is feasigbls in extrah데atic bile duct cancer, with tolerable toxicity, but prospective studies, with a large patient enrollment, are needed for the evaluation of the effects of postoperative radiotherapy and the related prognostic factors.

Prediction of Late Rectal Complication Following High-dose-rate Intracavitary Brachytherapy in Cancer of the Uterine Cervix (자궁경부암 환자의 고선량률 강내치료 시행 시 직장합병증의 예측)

  • Lee, Jeung-Eun;Huh, Seung-Jae;Park, Won;Lim, Do-Hoon;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.21 no.4
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    • pp.276-282
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    • 2003
  • Purpose: Although high-dose-rate intracavitary radiotherapy (HDR ICR) has been used in the treatment of cervical cancer, the potential for increased risk of late complication, most commonly in the rectum, is a major concern. We have previously reported on 136 patients treated with HDR brachytherapy between 1995 and 1999. The purpose of this study is to upgrade the previous data and confirm the correlation between late rectal complication and rectal dose in cervix cancer patients treated with HDR ICR. Materials and Methods: A retrospective analysis was peformed for 222 patients with cevix cancer who were treated for curative intent with external beam radiotherapy (EBRT) and HDR ICR from July 1995 to December 2001. The median dose of EBRT was 50.4 (30.6$\~$56.4) Gy with a daily fraction size 1.8 Gy. A total of six fractions of HDR ICR were given twice weekly with fraction size of 4 (3$\~$5.5) Gy to A point by Iridium-192 source. The rectal dose was calculated at the rectal reference point using the barium contrast criteria. in vivo measurement of the rectal dose was peformed with thermoluminescent dosimeter (TLD) during HDR ICR. The median follow-up period was 39 months, ranging from 6 to 90 months. Results: Twenty-one patients (9.5$\%$) experienced late rectal bleeding, from 3 to 44 months (median, 13 months) after the completion of RT. The calculated rectal doses were not different between the patients with rectal bleeding and those without, but the measured rectal doses were higher in the complicated patients. The differences of the measured ICR rectal fractional dose, ICR total rectal dose, and total rectal biologically equivalent dose (BED) were statistically significant. When the measured ICR total rectal dose was beyond 16 Gy, when the ratio of the measured rectal dose to A point dose was beyond 70$\%$, or when the measured rectal BED was over 110 Gy$_{3}$, a high possibility of late rectal complication was found. Conclusion: Late rectal complication was closely correlated with measured rectal dose by in vivo dosimetry using TLD during HDR ICR. If data from in vivo dosimetry shows any possibility of rectal bleeding, efforts should be made to reduce the rectal dose.

The Effects of Price Salience on Consumer Perception and Purchase Intentions (개격현저대소비자감지화구매의도적영향(价格显著对消费者感知和购买意图的影响))

  • Martin-Consuegea, David;Millan, Angel;Diaz, Estrella;Ko, Eun-Ju
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.2
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    • pp.149-163
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    • 2010
  • Previous studies have shown that retail price promotion change consumers' purchase behavior and that retailers use price promotion more frequently. Keeping constant the benefits received by consumers, there are several ways for retailers to communicate a price promotion. For example, retailers can present a price reduction in absolute terms ($, ${\euro}$), percentage terms (%), or some combinations of these two methods (Della Bitta et al. 1981). Communicating a price promotion in different ways is similar to the framing of purchase decisions (Monroe 1990). Framing effects refers to the finding that subjects respond differently to different descriptions of the same decision question (Frisch 1993). Thus, the presentation of the promotion has an impact on consumer deal evaluation and hence retail sales. In fact, much research in marketing attests to the effects of price presentation on deal perception (Lichtenstein and Bearden 1989; Urbany et al. 1988; Yadav and Monroe 1993). In this sense, a number of marketing researches have argued that deal perceptions are also determined by the degree to which consumers are able to calculate the discounts and final purchase prices accurately (Estelami 2003a; Morwitz et al. 1998), which suggests that marketers may be able to enhance responses to discounts by improving calculation accuracy. Consequently, since calculation inaccuracies in the aggregate lead to the underestimation of discounts (Kim and Kramer 2006), consumers are more likely to appreciate a discounted offer following deeper processing of price information that enables them to evaluate a price discount more accurately. The purpose of this research is to examine the effect of different presentations of discount prices on consumer price perceptions. To be more precise, the purpose of this study is to investigate how different implementations of the same price promotion (semantic and visual salience) affect consumers' perceptions of the promotion and their purchase decisions. Specifically, the analysis will focus on the effect of price presentation on evaluation, purchase intentions and perception of savings. In order to verify the hypotheses proposed in the research, this paper will present an experimental analysis dealing with several discount presentations. In this sense, a2 (Numerical salience presentation: absolute and relative) x2 (Worded salience presentation: novel and traditional) x2 (Visual salience: red and blue) design was employed to investigate the effects of discount presentation on three dependent variables: evaluation, purchase intentions and perception of savings. Respondents were exposed to a hypothetical advertisement that they had to evaluate and were informed of the offer conditions. Once the sample finished evaluating the advertisement, they answered a questionnaire related to price salience and dependent dimensions. Then, manipulation checks were conducted to ensure that respondents remembered their treatment conditions. Next, a $2{\times}2{\times}2$ MANOVA and follow-up univariate tests were conducted to verify the research hypotheses suggested and to examine the effects of the individual factors (price salience) on evaluation, purchase intentions and perceived savings. The results of this research show that semantic and visual salience presentations have significant main effects and interactions on evaluation, purchase intentions and perception of savings. Significant numerical salience interactions affected evaluation and purchase intentions. Additionally, a significant worded salience main effect on perception of savings and interactions on evaluation and purchase intentions were found. Finally, visual salience interactions have significant effects on evaluation. The main findings of this research suggest practical implications that firms should consider when planning promotion-based discounts to attract consumer attention. Consequently, because price presentation has important effects on consumer perception, retailers should consider which effect is wanted in order to design an effective discount presentaion. Specifically, retailers should present discounts with a traditional style that facilitates final price calculation. It is thus important to investigate ways in which marketers can enhance the accuracy of consumers' mental arithmetic to improve responses to price discounts. This preliminary study on the effect of price presentation on consumer perception and purchase intentions opens the line of research for further research. The results obtained in this research may have been determined by a number of limiting conceptual and methodological factors. In this sense, the research deals with a variety of discount presentations as well as with their effects; however, the analysis could include additional salience dimensions and effects on consumers. Furthermore, a similar study could be carried out including a larger, more inclusive and heterogeneous sample of consumers. In addition, the experiment did not require sample individuals to actually buy the product, so it is advisable to compare the effects obtained in the research with real consumer behavior and perception.