Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medi-cal and non-medical. About 150 million people face financial catastrophe every year due to health care pay-ments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government in-itiatives consider the importance of mitigating the OOPE along with provision of cancer care.

Research Progress in Physiological Evaluation and Treatment of Visually Induced Motion Sickness in Virtual Reality / 中国医学科学院学报

Visually induced motion sickness(VIMS)is the major barrier to be broken in the development of virtual reality(VR)technology,which seriously affects the progress in the VR industry.Therefore,the detection and evaluation of VIMS has become a hot research topic nowadays.We review the progress in physiological assessment of VIMS in VR based on several physiological indicators,including electroencephalogram(EEG),postural sway,eye movements,heart rate variability,and skin electrical signals,and summarize the available therapies,aiming to provide an outlook on the future research directions of VIMS.

Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India

Objective To determine the outcomes in children with MIS-C receiving diferent immunomodulatory treatment. Methods In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case defnition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in diferent treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. Results The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case defnition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred ffty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19–25.0), p<0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n=45), and IVIG plus steroid (n=84) groups (p=0.515). Conclusion While no signifcant diference was observed in the frequency of occurrence of the primary outcome in diferent treatment groups, data from adequately powered RCTs are required for defnitive recommendations.

Supervivencia de pacientes con cáncer de pulmón de células no pequeñas en estadios avanzados. Matanzas / Survival of patients with non-small cells lung cancer in advanced stages. Matanzas

RESUMEN Introducción: el cáncer de pulmón de células no pequeñas en estadios avanzados tiene una alta incidencia y mortalidad. Los tratamientos que se emplean son la quimioterapia, la radioterapia, las terapias dirigidas y la inmunoterapia. Es preferible que los tratamientos se realicen en el marco de ensayos clínicos. Tiene una precaria supervivencia a los cinco años del diagnóstico. Objetivo: determinar la supervivencia global de los pacientes con cáncer de pulmón de células no pequeñas, en estadios avanzados. Materiales y métodos: estudio descriptivo, retrospectivo en pacientes con diagnóstico cito-histológico de cáncer de pulmón de células no pequeñas, en estadios avanzados. De un universo de 463 pacientes atendidos en el Servicio de Oncología Provincial de Matanzas, se conformó una muestra de 348. Período comprendido desde enero del 2013 a diciembre del 2016. Las variables estudiadas se tomaron de las historias clínicas y la base de datos nacional de fallecidos por cáncer de pulmón. Resultados: la mayoría de los pacientes se diagnosticaron en etapa IV (71,69 %), la modalidad de tratamiento más utilizada fue la quimioterapia (61,2 %). Los fármacos más empleados fueron las sales de platino en el78,73 %. La supervivencia global en la etapa IV fue de 1,23 % a cinco años. La modalidad de tratamiento de mayor supervivencia fue la inmunoterapia, con 3,33 % y la supervivencia global fue de 2 %. Conclusiones: predominó la etapa IV de la enfermedad. La quimioterapia a base de sales de platino como esquema de tratamiento de primera línea y la inmunoterapia como modalidad de tratamiento reportaron mayor supervivencia global, aunque esta fue precaria (AU).

ABSTRACT Introduction: non-small cell lung cancer in advanced stages shows a high incidence and mortality. The treatments used against it are chemotherapy, radiotherapy, directed therapies and immunotherapy. It is better to perform the treatments in the context of clinical trials. It has a precarious survival at the fifth year after diagnosis. Objective: to determine the global survival of patients with non-small cell lung cancer in advanced stages. Materials and methods: descriptive, retrospective study in patients with cyto-histological diagnosis of non-small lung cancer in advanced stages. A sample of 348 patients was formed from the universe of 463 patients who attended the Provincial Service of Oncology in the period from January 2013 to December 2016. The studied variables were taken from the clinical records and the national database of deceased due to lung cancer. Results: most of patients were diagnosed at the stage IV (71.69 %); the most used treatment modality was chemotherapy (61.2). The most used drugs were platinum salts in 78.73 %. The global survival at the IV stage was 1.23 at five years. The treatment modality of greater survival was immunotherapy, with 3.33 % and the global survival was 2 %. Conclusions: the disease's stage IV predominated. The platinum salts-based chemotherapy as the first line treatment scheme and immunotherapy as treatment modality provided higher global survival, although it was precarious (AU).

Analysis of clinicopathological characteristics and survival of 1 915 oral cavity squamous cell carcinoma patients: 24-year experience from a single institution / 口腔疾病防治

Objective @#To investigate the clinicopathological features and survival rate of oral squamous cell carcinoma patients in China.@*Methods@#The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of 1 915 OCSCC patients who received initial treatment at the Sun Yat-sen University Cancer Center from 1990 to 2013 were collected and analyzed. The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of OCSCC patients treated during the successive decades of 1990-1999, 2000-2009, and 2010-2013 were analyzed retrospectively to show the trends over time.@*Results @#The average age of all OCSCC patients who received initial treatment at this cancer center from 1990 to 2013 was 54.8 years (SD, 12.6 years). The sex ratio was approximately 2:1. The oral tongue was the site most prone for OCSCC, accounting for 63.6% of all cases. The proportions of early-stage (Ⅰ-Ⅱ) and advanced-stage (Ⅲ-Ⅳ) cases were approximate. Regarding the treatment modality, surgery-based treatment accounted for 80.4%. Survival analysis showed that the 5-year DSS rate of all cases was 57%. Survival decreased with age. The survival of females, nonsmokers, and nondrinkers was higher than that of males, smokers, and drinkers. The 5-year DSS rates of patients with squamous cell carcinoma of the lips, oral tongue, and other sites of the oral cavity were 81%, 63%, and 42%, respectively. The 5-year DSS rates of patients who received surgery-based treatment and nonsurgical treatment were 66% and 19%, respectively. The analysis of trends over time showed that in the period of 1990-1999 and 2010-2013, the age and sex ratio were relatively stable. The proportion of patients with squamous cell carcinoma of the lips and oral tongue gradually decreased, while the proportion of those with squamous cell carcinoma of the other sites of the oral cavity gradually increased. The proportion of surgery-based treatment increased from 77.7% to 91.3%. The 5-year DSS rate gradually increased from 53% in 1990-1999 to 64% in 2010-2013. The 5-year DSS rate of female patients increased significantly from 55% to 78%. However, the 5-year DSS rate of male patients was relatively stable. The 5-year DSS rate of patients who received surgery-based treatment gradually increased from 62% to 69%. @*Conclusion@#The 5-year DSS rate has steadily improved for OCSCC patients at this cancer center from 1990-2013, especially in female patients. The 5-year DSS rate of patients with squamous cell carcinoma of the oral tongue has reached the rate in developed countries worldwide. The proportion and survival rate of patients who received surgery-based treatment gradually increased. The survival rate of patients with squamous cell carcinoma of the other sites of the oral cavity was significantly lower than that of patients with squamous cell carcinoma of the lips and oral tongue, suggesting that more effort should be put into the treatment of patients with squamous cell carcinoma of the other sites of the oral cavity to improve the survival rate in the future.

Current status and advances in clinical diagnosis and treatment of mucosal melanoma of the head and neck / 中华放射肿瘤学杂志

Mucosal melanoma of the head and neck (MMHN) is a rare malignancy.The sinonasal cavity and oral cavity are the most common primary sites.MMHN is a very aggressive malignant tumor,with the 5-year overall survival (OS) rate less than 30％.Currently,the optimal treatment modality remains unclear.In the najority of available retrospective studies,postoperative radiotherapy improves the local control of MMHN,but without significant effect on OS.This article aims to improve our understanding of the clinical features,diagnosis,staging,treatment modalities,and outcomes of this malignancy.

Mucosal Melanoma of the Sinonasal Tract: Retrospective Analysis of 38 Patients of a Single Institution / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal melanoma comprises 1.3% of all malignant melanomas and mainly occurs at the oropharynx and the sinonasal cavity in the head and neck area. Five year survival rate is about 10-46%. We aimed to investigate the clinical features and treatment outcomes of 38 patients with sinonasal malignant melanoma (SNMM). SUBJECTS AND METHOD: A retrospective review of medical records was carried out on 38 patients who were diagnosed as SNMM between August 1995 and December 2012. Clinical features were evaluated and tumors were staged according to the TNM staging system. The Kaplan-Meier method was used to assess survival in the cohort. RESULTS: The 38 patients consisted of 18 males and 20 females, ranging in age from 36 to 91 years, with a median age of 59 years at diagnosis. Common symptoms were nasal obstruction and epistaxis, and mean symptom duration to diagnosis was 2.0 months. The main treatment modalities were surgery only (n=18) or surgery plus adjuvant radiotherapy (n=9). Distant metastases were detected in 15 patients (39.5%) at 8 months after initial therapy. Overall 5-year survival rate was 45.6%. There was no significant difference in survival rate between patients who underwent surgery only and those who had surgery with postoperative radiation (p=0.359). CONCLUSION: Sinonasal mucosal melanoma is a highly recurrent tumor (80% recurrence rate) with poor prognosis (5-year survival rate; 46%). As radiation treatment and/or chemotherapy are not so effective for the recurrent tumor, early detection and surgical resection are mandatory at present. New treatment modality should be developed to improve the survival rate.

Trend analysis of prosthodontic treatment modality between 2005 and 2008 in Seoul National University Dental Hospital

PURPOSE: The aim of this article is to analyze the preference for treatment modality of dentists. MATERIAL AND METHODS: Data of 20,038 patients was involved. Data analysis were done by distribution according to the various kinds of prosthesis, including complete denture, removable partial denture, fixed partial denture, implant-supported dental prosthesis as well as distribution according to the professional titles of the dentists finishing the treatment, including resident and professors. RESULTS: The number of cases of dental prosthesis increased year by year. 61.06% of the patients accepted fixed partial denture restoration. The number of patients who accepted implant supported restoration is also increasing year by year. The number of complete denture, implant-supported dental prosthesis finished by professors was larger than that done by residents, while it was contrary for removable partial denture, fixed partial denture, and the difference was statistically significant (P<.05). CONCLUSION: Professors and residents have some difference in the categorization of prosthesis finished. Fixed partial denture and implant-supported dental prosthesis are preferred.

Time Trend of Survival and Treatment Modalities of Endometrial Cancer in Korea (1990-2005) / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the overall survival and the change in treatment modalities in patients with uterine endometrial cancer in Korea. METHODS: From January 1990 to March 2005, medical records of 740 patients with endometrial cancer in nine hospitals were reviewed. The overall survival was determined supported by the death statistics of Korea National Statistical Office. RESULTS: The mean age of patients was 51.5 years (range: 21-82 years). The mean gravidity and parity were 3.3 and 2.1 (range: 0-18, 0-9), respectively. The most common stage, grade and histological type at diagnosis were FIGO stage I, grade 1 and endometrioid adenocarcinoma (76.5%, 56.4% and 87.2%), respectively. The main treatment modalities was surgery on stage I (59.8%), surgery-adjuvant radiotherapy on stage II (55.1%), surgery-adjuvant radiotherapy or surgery-adjuvant chemoradiation on stage III (38.3%) and surgery-adjuvant chemotherapy on stage IV (55.6%). The preferred treatment modality was surgery only on grade 1 (69.0%) and surgery-adjuvant radiotherapy on grade 2-3 (43.4% and 53.2%). Surgery had been the most common method of therapy before 1998 but its prevalence gradually decreased. As a result, surgery-adjuvant radiotherapy and surgery-adjuvant chemotherapy were most widely performed in 2004-2005 and surgery-adjuvant chemoradiation also increased more than a twofold. The overall 5 years survival rate (5YSR) for all 740 patients was 81.3%. The overall 5YSR of stage I was 89.0%. The overall 5YSR of grade 1, grade 2, grade 3 were 96.0%, 92.0%, 80.0%. Before 1998, the survival rate was 77.0%. Since then it increased to 83-88% and in 2000-2001 it increased to 88.0%, and it was the highest survival rate. CONCLUSION: The survival rate of endometrial cancer has been improving for the past 15 years and the method of treatment is also being changed currently. In order to improve the survival rate of endometrial cancer, a close investigation including genetic and environmental factors of the pathophysiology of endometrial cancer along with the epidemiology of risk factors, should be carried out.

Oocyte Donation in Infertility Treatment / 대한산부인과학회지

Recent advances in assisted reproductive technology have been able to overcome the nearly all problems associated with traditional infertility factor. IVF and ET using donated oocyte has brought new hope to many couples who otherwise would remain childless, so oocyte donation can be the alternative treatment modality for specific fatal infertility patients. The high success rate of this procedure has led to its wide application in women with ovarian failure or dysfunction, at various ages and for various etiologies. Oocyte donation is also offered to patients who repeatedly fail to conceive with standard IVF. But there are many conflicting issues in this procedure such as moral, ethical, medical, legal problems. We review the technical aspects related with oocyte donation in infertility treatment and ethico-legal issue.

Survival Analysis according to Treatment Modality in Pancreatic Cancer Patients / 대한소화기학회지

BACKGROUND/AIMS: Pancreatic cancer is the 5th leading cause of cancer death in Korea and its incidence is increasing. At present, surgical resection offers the best chance of cure. However, most of pancreatic cancers are already unresectable at initial diagnosis. Thus, the majority of patients depend on chemotherapy, radiotherapy, or supportive care. We investigated the effect of treatment modalities on the survival in pancreatic cancer. METHODS: Between September 1994 and May 2003, one hundred and fifty four patients with pancreatic cancer were treated by surgery, radiotherapy, chemotherapy or conservative management. The clinical datas were analyzed retrospectively for survival according to stage and treatment modality. RESULTS: Overall median survival time was 5.7 months and 1 year survival rate was 18.3%. In patients with stage I to III disease, the median survival time was 13.9 months in surgery group, 10.2 months in radiation group, and 6.1 months in supportive care group (p<0.01). Survival rate according to treatment modality was significantly different among groups. In patients with stage IV disease, the median survival time was 6.1 months in radiation therapy group, 7.1 months in chemotherapy group, and 2.7 months in supportive care group. Overall survival was significantly higher in treatment groups than in supportive care group (p<0.01), but there was no difference in survival between chemotherapy group and radiotherapy group. CONCLUSIONS: In patients with stage I to III pancreatic cancer, surgery can improve median survival. In patients with stage IV, either chemotherapy or radiotherapy can prolong survival compared to supportive care. These results suggest that more active treatment of pancreatic cancer even in advanced stage will be needed to prolong the survival.

Comparison of Hospital stay and Cost-effectiveness between Treatment Modalities in Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the hospital stay and cost-effectiveness between treatment modalities in ectopic pregnancy for proper management. METHODS: In this study, the authors studied 121 cases retrospectively who had been admitted and treated at Department of Obstetrics and Gynecology, Konyang University Hospital from February 1, 2000 to August 31, 2003. We analyzed clinical features, treatment modality, hospital stay and cost-effectiveness between each groups. One-way ANOVA test was used and p<0.05 was regarded as statistically significant. RESULTS: There was no difference in clinical features between treatment modalites. Of total 121 cases, operative procedures were done in 105 cases (explo-laparotomy in 58, laparoscopy in 43, dilatation and curettage in 4) and medical treatment in 16 cases (Multiple dose methotrexate protocol in 11, Single dose methotrexate protocol in 5). Average of length of hospital stay was 5.3 +/- 0.2 days in explo-laparotomy, 3.8 +/- 0.2 days in laparoscopy, 2.8 +/- 1.4 days in dilatation and curettage, 6.5 +/- 0.5 days in multiple dose methotrexate protocol, 2.4 +/- 0.4 days in single dose methotrexate protocol. According to treatment modality, there was significant difference in total cost and cost sharing. Total cost in explo-laparotomy (875,324 +/- 25,977 Won) was more expensive than that of laparoscopy (734,375 +/- 35,179 Won). But, cost sharing in explo-laparotomy (156,543 +/- 9,583 Won) was less expensive than laparoscopy (319,493 +/- 26,255 Won). Total cost and cost sharing in multiple dose methotrexate protocol (323,231 +/- 33,972 Won, 184,465 +/- 17,344 Won) was more expensive than that of Single methotrexate protocol (192,495 +/- 31,180 Won, 68,793 +/- 13,422 Won). CONCLUSION: Based on these results, it is very important that we should have an interest in ectopic pregnancy for early detection and proper management. Consequently, Achievement of precise decision and successful methotrexate treatment can be possible to decrease hospital stay and cost-effectiveness.

Treatment of Callosal Arteriovenous Malformations

OBJECTIVE: To establish management strategy and to improve outcome of callosal arteriovenous malformations(AVMs), forty-six consecutive cases hospitalized from 1984 to 2001 are analyzed. METHODS: Clinical and radiologic files were reviewed. Average follow-up period was 20.3 months in microsurgery group, and 28.2 months in radiosurgery group. RESULTS: The resection rate of microsurgery was considered total in 12 patients(85.7% ), subtotal 2(14.3%). The final clinical outcome of microsurgery was good in 13 patients(92.8%), fair in 1(7.2%). One patient with splenial lesion had postoperative disconnection syndrome. Initial insults and hemodynamic complications were the major cause of an unfavorable outcome. In radiosurgery the complete regression of nidus was considered in 16 patients(51.6%), partial shrinkage in 13(41.9%), and no response in 2(6.5%). The clinical outcome of radiosurgery was good in 26 patients(83.9%), fair in 3(9.75%), and poor in 2(6.5%). Rebleeding during the latency period(3 patients), radiation necrosis(1 patients) and initial insults(1 patients) were the major cause of postradiosurgery morbidity. Rebleeding during the latency period occurred in 3 patients(9.7%). Two lesions were in the splenium, and one lesion in the body of corpus callosum. All lesions were larger than 3cm in diameter. Two of them occurred during the second year, and the rest one during the third year of latency period. CONCLUSION: Microsurgery, which eliminates the risk of bleeding immediately, is referred for callosal AVMs. Radiosurgery is another effective treatment modality for splenial lesions with large bridging veins that interfere with microsurgical approach, and combined endovascular treatment would be strongly recommended for the splenial lesions larger than 3cm in diameter that has higher risk of hemorrhage during the latency period.

Changing Trends in the Treatment of Erectile Dysfunction in the Era of Oral Sildenafil / 대한남성과학회지

PURPOSE: Intracavernous injection (ICI) was once the cornerstone of treatment for erectile dysfunction (ED). This study was designed to investigate how the treatment of ED has changed since introduction of oral sildenafil. MATERIALS AND METHODS: In a total of 574 new ED (mean duration 2.9 years) patients with a mean age of 52.6 11.8 years, associated diseases, the cause and duration of ED, and the treatment used initially and after 6 months were investigated. RESULTS: The ED was psychogenic in 40.7% of the men. The most common cause of organic ED was vascular (18.1%) followed by diabetes (15.9%). The associated diseases were hypertension (19.9%), diabetes mellitus (16.5%), trauma and surgery (5.5%), endocrinologic (4.7%), coronary artery (1.6%), and hypercholesterolemia (1.1%). The initial treatment modality was an oral sildenafil in 68.7%, ICI in 11.3%, testosterone replacement in 2.7%, implantation of penile prostheses in 0.8%, and wait and see in 16.5%. Six months later, excluding the patients lost to follow-up, 73.4% of the patients were using oral sildenafil and 20.5% were using ICI. CONCLUSIONS: Oral sildenafil has largely replaced intracavernous injection for the initial treatment of erectile dysfunction.

Artificial liver support and liver transplantation for the treatment of severe hepatitis / 中国普通外科杂志

Objective To sum up the experience of application of artificial liver support system (ALSS) combined with liver transplantation(LT) in the treatment of end stage severe hepatitis.Methods Clinical data of 23 patients with end stage severe hepatitis receiving ALSS treatment prior to liver transplantation among 223 patients who underwent LT consecutively between April 1993 and December 2003 were analyzed retrospectively. Twenty three patients with end stage severe hepatitis received 58 courses of ALSS prior to liver transplantation. The 6 month survival rate was compared to those in non ALSS non LT group and non LT group.Results ALSS treatment facilitated improvement of liver function, endotoximia, and the tolerance to LT, thus provided a bridge time for attaining the donor liver. The total serum bilirubin level at LT was significantly lower than that before the first run of ALSS ( P

Clinical Analysis of Epistaxis : Result of the Recent 10 Years / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis is a common occurrence and most of us have at least one episode in a life time. These episodes are usually minor events and resolved spontaneously, although those who need help can be admitted. It is important to know about etiologic factors of each case of epistaxis, sex and age distribution of patients, bleeding site, seasonal incidence and methods of management. MATERIAL AND METHOD: We performed a retrospective study of epidemiology, etiology and control methods and their effectiveness in patients of epistaxis who visited Korea Veterans Hospital out-patient department in otolaryngology and emergency room from January, 1990 to December, 1999. RESULTS: It was more prevalent in male and commonly occured in the left nasal cavity. Incidence of epistaxis was the greatest in the month of May and the least in August. Among the age groups of patients, it was most prevalent among the fifties followed by the twenties. The most common cause was idiopathic, with the local causes being more attributable. It was found to easily occurr in the convex side with septal deformity. Kiesselbach's area was the most common bleeding site, although when compared with previous reports, the incidence rate has been decreasing. Recurrent bleeding was more common in posterior epistaxis. Most cases were adequately managed with anterior nasal packing (65.4%), but in the minority, posterior nasal packing and blood transfusion were needed. CONCLUSION: Incidence of bleeding have increased and the most frequent bleeding sites have become more variable, because of the increasing rate of air pollution, cerebrovascular accidents and heart diseases. Epistaxis easily occurred when the atmospheric changes were severe. Further prospective studies are mandatory to clarify the correlation between epistaxis and multifactorial causes.

Clinical Outcome and Prognostic Factors of Biopsy-proven Diffuse Proliferative Lupus Nephritis / 대한신장학회잡지

Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group

The Treatment of Croup with Nebulized Budesonide and Intramuscular Dexamethasone

PURPOSE: Steroids have anti-inflammatory effects which reduces inflammation and edema of the tissue. Thus, corticosteroids have been used for treatment of croup. The aim this study is to compare and assess the effects of intramuscularly injected dexamethasone and nebulized budesonide in treatment of moderate or severe croup. METHODS: Between July 1995 to June 1996, we have assessed 44 inpatients with croup syndrome, of which 20 patients have been treated by intramuscularly injected dexamethasone and 24 patients by nebulized budesonide. We measured the croup symptom scores and arterial oxygen saturation at initial, at 4 hours, 12 hours and 24 hours after treatment. RESULTS: The sex ratio and mean age of patients were 2.3:1 and 18.7 +/- 9.1 months in budesonide treatment group and 3:1 and 22.3 +/- 13.1 months in dexamethasone treatment group, respectively. There was no significant difference (P>0.05) among the two groups. In budesonide treatment group, the symptom scores were 7.5 +/- 4.5 at initial and 4.5 +/- 1.3 at 4 hours after treatment. These were statistically significant (P<0.005). In the dexamethansone treatment group, the symptom scores were 7.6 +/- 1.2 at initial and 5.1 +/- 1.2 at 4 hours after treatment. They were statistically significant (P<0.005). Arterial oxygen saturations were significantly different (P<0.005) between initial and 4 hours after treatment in both groups. There were no side effects in the budesonide treatment group. CONCLUSION: Nebulized budesonide has the same effects with intramuscularly injected dexamethasone in treatment of croup whether the severity is moderate or extreme. Therefore it should provide an effective means of treatment for moderate or severe croup patients without systemic side effects.

Efficacy of Computed Tomography for Diagnosis and Treatment of the Deep Neck Infection / 대한이비인후과학회지

BACKGROUND: Deep neck infection is an inflammatory disease process within the deep cervical fascia of the head and neck. Although the frequency has declined dramatically with development of antibiotics, the morbidity is still high because the diagnosis is delayed in the course of the disease. OBJECTIVES: To determine the diagnostic value of neck computed tomography (CT) and treatment modality according to the disease severity. MATERIALS AND METHODS: Forty-three patients with deep neck infection admitted and treated from January 1992 to December 1996 were analysed retrospectively. CT was checked at the initial state and checked again at the seven to ten days later for evaluation of treatment. RESULTS: CT was valuable for early diagnosis when this disease was suspected and follow-up evaluation of treatment results. Hospital days were longer in patients with underlying disease. The size of abscess and the involved regions of cellulitis were used guides for the decision of treatment modality. In cases of cellulitis and small abscess less than 3cm, intravenous antibiotic therapy and CT-guided aspiration was efficient. Combined therapy with intervention and antibiotics was needed in patients with abscesses larger than 3cm and progressive disease. CONCLUSION: CT was an excellent diagnostic method and valuable for the evaluation of treatment. Treatment modality was decided according to the size of abscess and the presence of underlying disease.