453 research outputs found
Clinical factors influencing the outcomes of inpatient rehabilitation in patients with complex regional pain syndrome
ํ์๋
ผ๋ฌธ(์์ฌ) -- ์์ธ๋ํ๊ต๋ํ์ : ์๊ณผ๋ํ ์ํ๊ณผ, 2022.2. ์์ฌ์.Introduction: Patients with complex regional pain syndrome (CRPS) suffer from chronic refractory pain and a reduced quality of life. Providing timely and proper rehabilitation treatments can alleviate the pain, improve the quality of life, and reduce the burden of medical expenses. This study investigated factors influencing the effectiveness of inpatient rehabilitation in CRPS patients and identifies indications for such treatment.
Methods: We retrospectively reviewed medical records from January 2017 to June 2020. Patients over 18 years of age who were diagnosed with CRPS according to the Budapest criteria and received inpatient rehabilitation during that period were included. The rehabilitation program included medication, interventions, and physiotherapy. The primary outcome of the present study was the pain intensity at discharge minus the pain intensity at admission according to a numeric rating scale (NRS). To analyze the effect of inpatient rehabilitation on pain improvement, the following factors were analyzed: demographic factors, duration of disease, using an intravenous opioid as a rescue medicine, having a spinal cord stimulator, receiving scrambler treatment, CRPS severity score, CRPS type, region affected by CRPS, three-phase bone scan (TPBS) result, electromyography result, thermography result, and NRS score at admission. The MannโWhitney test, simple linear regression test, and multiple regression analysis were performed to identify variables associated with pain improvement.
Results: A total of 51 patients (19 male and 32 female) were included. Patients without abnormalities in their TPBS had better pain relief than those with abnormalities (mean difference = 0.82, P = 0.041). However, patients without abnormalities in the thermography test had worse outcomes than those with abnormalities (mean difference = 1.89, P = 0.032). Patients who had pain intensity โฅ 5 at initial admission had better results from inpatient rehabilitation than those who had pain intensity < 5 (mean difference = 1.49, P = 0.001). A simple linear regression test also revealed that the initial pain intensity significantly influences the effect of inpatient rehabilitation therapy, with the effect increasing with the initial pain intensity (R2 = 0.263, ฮฒ = โ0.486, P < 0.001). In the multiple regression analysis, only the initial pain intensity showed statistically significant results (adjusted R2 = 0.256, ฮฒ = โ0.584, P = 0.002).
Conclusions: Our results suggest that some clinical factors can affect the pain relief effect of inpatient rehabilitation. Severe initial pain intensity, abnormalities in a thermography test, and a lack of abnormalities in a TPBS gave better outcomes from inpatient rehabilitation. We suggest that these are indicators for inpatient rehabilitation therapy for patients with CRPS.๋ณตํฉ๋ถ์ํต์ฆ์ฆํ๊ตฐ(CRPS)ํ์๋ ๋ง์ฑ ํต์ฆ๊ณผ ์ถ์ ์ง ์ ํ๋ก ๊ณ ํต ๋ฐ๋๋ค. ์ด ํ์๋ค์๊ฒ ์๊ธฐ ์ ์ ํ๊ณ ์ ํฉํ ์ฌํ ์น๋ฃ๋ฅผ ์ ๊ณตํ๋ฉด ํต์ฆ์ ์ํํ๊ณ ์ถ์ ์ง์ ํฅ์์ํค๋ฉฐ ์๋ฃ๋น ๋ถ๋ด์ ์ค์ผ ์ ์๋ค. ์ด ์ฐ๊ตฌ๋ CRPS ํ์์์ ์
์ํ์ ์ฌํ์ ํจ๊ณผ์ ์ํฅ์ ๋ฏธ์น๋ ์์ธ์ ์กฐ์ฌํ๊ณ ์
์ํ์ ์ฌํ์ ์ ์์ฆ์ ํ์ธํ๋ ๊ฒ์ ๋ชฉ์ ์ผ๋ก ํ๋ค.
ํ์์ ์๋ฌด๊ธฐ๋ก์ 2017๋
1์๋ถํฐ 2020๋
6์๊น์ง ํํฅ์ ์ผ๋ก ๋ถ์ํ์๋ค. ๋ถ๋คํ์คํธ ๊ธฐ์ค์ ๋ฐ๋ผ CRPS๋ก ์ง๋จ๋์ด ํด๋น ๊ธฐ๊ฐ ๋์ ์
์ ์ฌํ์น๋ฃ๋ฅผ ๋ฐ์ 18์ธ ์ด์์ ํ์๋ฅผ ๋ณธ ์ฐ๊ตฌ์ ๋์์ผ๋ก ํ์๋ค. ์
์์ฌํ์น๋ฃ๋ก๋ ์ฝ๋ฌผ ์น๋ฃ, ํต์ฆ์ ๋ํ ์ค์ฌ ์์ ๋ฐ ๋ฌผ๋ฆฌ ์น๋ฃ๊ฐ ํฌํจ๋์๋ค. ์ฃผ์ ๊ฒฐ๊ณผ๋ ์ซ์ ๋ฑ๊ธ ์ฒ๋(NRS)๋ก ํ๊ธฐ๋ ํต์ฆ ์ ์์ ์
์์์ ๊ณผ ๋น๊ตํ์ฌ ํด์ ์์ ์์์ ํธ์ ์ ๋์ด๋ค. ํด์ ์ ํต์ฆ ๊ฐ๋ ๊ฐ์์ ์
์ ์ ํต์ฆ ๊ฐ๋ ๊ฐ์ ๋บ ๊ฐ์ด๋ค. ์
์์ฌํ์ด ํต์ฆ ๊ฐ์ ์ ๋ฏธ์น๋ ์ํฅ์ ๋ถ์ํ๊ธฐ ์ํด ์ธ๊ตฌํต๊ณํ์ ์์ธ, ์ ๋ณ ๊ธฐ๊ฐ, ์ ๋งฅ ์ํธ๊ณ ์ฝ๋ฌผ ์ฌ์ฉ ์ฌ๋ถ, ์ฒ์ ์๊ทน๊ธฐ ๋ณด์ ์ฌ๋ถ, ์คํฌ๋จ๋ธ๋ฌ ์น๋ฃ๋ฅผ ๋ฐ์๋์ง ์ฌ๋ถ, CRPS ์ค์ฆ๋ ์ ์, CRPS ์ ํ, CRPS ์ดํ ๋ถ์, 3์ ๊ณจ์ค์บ ๊ฒ์ฌ ๊ฒฐ๊ณผ, ๊ทผ์ ๋ ๊ฒฐ๊ณผ, ์ดํ์ ๊ฒ์ฌ ๊ฒฐ๊ณผ ๋ฐ ์
์ ์์ ์์์ NRS ์ ์๋ฅผ ์์ธ์ผ๋ก ๋ถ์ํ์๋ค. ํต๊ณ๋ฐฉ๋ฒ์ผ๋ก๋ Mann-Whitney ํ
์คํธ์ ๋จ์ ์ ํ ํ๊ท ๋ถ์ ๋ฐ ๋ค์ค ํ๊ท ๋ถ์์ ํ์๋ค.
์ด 51๋ช
(๋จ 19/์ฌ 32)์ ํ์๊ฐ ํฌํจ๋์๋ค. 3์ ๊ณจ์ค์บ ๊ฒ์ฌ ๊ฒ์ฌ์์ ์ด์์ด ์๋ ํ์๋ ๊ฒ์ฌ์์ ์ด์์ด ์๋ ํ์๋ณด๋ค ํต์ฆ ์ํ ์ ๋๊ฐ ๋ ์ข์๋ค. (ํ๊ท ์ฐจ์ด: 0.82; P=0.041) ๊ทธ๋ฌ๋ ์ดํ์ ๊ฒ์ฌ์์ ์ด์์ด ์๋ ํ์๋ ๊ฒ์ฌ์์ ์ด์์ด ์๋ ํ์๋ณด๋ค ์น๋ฃ์ ๋ํ ๋ฐ์์ด ๋ ์ ์ข์๋ค. (ํ๊ท ์ฐจ: 1.89; P=0.032) ์ด๊ธฐ ์
์ ์ ํต์ฆ ๊ฐ๋๊ฐ 5์ ์ด์์ด์๋ ํ์๋ ์
์ ๋น์ ํต์ฆ ๊ฐ๋๊ฐ 5 ๋ฏธ๋ง์ด์๋ ํ์๋ณด๋ค ์
์ ์ฌํ์ ๊ฒฐ๊ณผ๊ฐ ๋ ์ข์๋ค. (ํ๊ท ์ฐจ์ด: 1.49; P=0.001) ๋จ์์ ํํ๊ท๊ฒ์ฌ์์๋ ์ด๊ธฐ ํต์ฆ ๊ฐ๋๊ฐ ์
์ํ์ ์ฌํ์น๋ฃ์ ํจ๊ณผ์ ์ ์ํ ์ํฅ์ ๋ฏธ์น๋ ๊ฒ์ผ๋ก ๋ํ๋ฌ์ผ๋ฉฐ, ์ด๊ธฐ ํต์ฆ ๊ฐ๋๊ฐ ๋์์๋ก ์
์ํ์ ์ฌํ์น๋ฃ์ ํจ๊ณผ๊ฐ ๋์ ๊ฒ์ผ๋ก ๋ํ๋ฌ๋ค. (R2=0.263, ฮฒ= -0.486; P<0.001) ๋ค์คํ๊ท๋ถ์์์๋ ์ด๊ธฐ ํต์ฆ ๊ฐ๋๋ง ํต๊ณ์ ์ผ๋ก ์ ์ํ ๊ฒฐ๊ณผ๋ฅผ ๋ณด์๋ค. (adjusted R2=0.256, ฮฒ= -0.584, P=0.002)
์ด๋ฒ ์ฐ๊ตฌ ๊ฒฐ๊ณผ๋ ์ผ๋ถ ์์ ์์ธ์ด ์
์ ํ์ ์ฌํ์ ํต์ฆ ์ํ ํจ๊ณผ์ ์ํฅ์ ๋ฏธ์น ์ ์์์ ์์ฌํ๋ค. ์ฌํ ์ด๊ธฐ ํต์ฆ ๊ฐ๋, ์ดํ์ ๊ฒ์ฌ์์ ์ด์์ด ์๋ ๊ฒฝ์ฐ, 3์ ๊ณจ์ค์บ ๊ฒ์ฌ์์ ์ด์์ด ์๋ ๊ฒฝ์ฐ ์
์ ์ฌํ์์ ๋ ๋์ ๊ฒฐ๊ณผ๋ฅผ ๋ณด์๋ค. ์ด๋ฌํ ๊ฒฐ๊ณผ๋ก๋ถํฐ CRPS ํ์์ ์
์ํ์ ์ฌํ์น๋ฃ ์ ์์ฆ์ ์ ์ํ ์ ์์ ๊ฒ์ด๋ค.์ 1 ์ฅ Introduction 1
์ 2 ์ฅ Materials and Methods 3
์ 1 ์ Study design and participants 3
์ 2 ์ Assessment and evaluation 3
์ 3 ์ Inpatient management program for CRPS 4
์ 4 ์ Outcome measures 6
์ 5 ์ Statistical analysis 7
์ 3 ์ฅ Results 9
์ 1 ์ Participantโs demographics and clinical variables 9
์ 2 ์ Primary outcome 10
์ 3 ์ Secondary outcome 10
์ 4 ์ฅ Discussion 12
Reference 16
๊ตญ๋ฌธ ์ด๋ก 20
ํ ๋ชฉ์ฐจ
[ํ 1] 22
[ํ 2] 25
[ํ 3] 27
๊ทธ๋ฆผ ๋ชฉ์ฐจ
[๊ทธ๋ฆผ 1] 28
[๊ทธ๋ฆผ 2] 29
[๊ทธ๋ฆผ 3] 30
[๊ทธ๋ฆผ 4] 32์
Comparision of Effectiveness between the ThinPrepยฎ and the Cytospin Preparations of the Repeated Urine Cytology
Once diagnosed as "cell paucity"or "atypia" by the cytospin (CS) preparation, this CS preparation does not secure a precise diagnosis by repeated testing alone. Although the ThinPrep (TP) preparation is acknowledged to show increased cellularity, performing the screening tests for the cases that have enough cellularity, according to CS, raises issues for the cost-effectiveness. To obtain a more precise diagnosis through increasing the cellularity by performing TP, we selected the cases that were diagnosed as "cell paucity" or "atypia" by CS, but they required a more precise diagnosis, and the samples were processed via both CS and TP to compare the results. 11 patients diagnosed as "cell paucity" and 22 patients diagnosed as "atypia" by CS participated in this study. When the detection rate of atypical cells in both preparations with repeated urine cytology was compared, the overall detection rate of TP (16cases, 48.5%) was superior than that of CS (11cases, 33.3%), with statistical significance. The cellularity of both preparations was compared on repeated urine cytology; the general cellularity of TP (29cases, 87.9%) was higher than that of CS (20cases, 60.6%), but there was no statistical significance. Particularly, we repeated the TP for the 1 case that was diagnosed as "atypia" and we performed polyoma virus immunohistochemical staining, which confirmed polyoma virus. In conclusion, we can avoid obtaining negative diagnosis from cases with uncertain "atypia" or "cell paucity" by performing repeated TP testing.ope
Liquid-Based Cytology of the Cerebrospinal Fluid in a Case of Cryptococcal Meningitis
Cryptococcus neoformans is the most common microorganism found in cerebrospinal fluid (CSF) cytology and causes life-threatening infections in immunocompromised hosts. Although its cytomorphologic features in conventional smear cytology have been well described, those in liquid-based cytology have rarely been. A 73-year-old woman with diffuse large B-cell lymphoma presented with mental confusion and a spiking fever. To rule out infectious conditions, CSF examination was performed. A cytology slide that was prepared using the ThinPrep method showed numerous spherical yeast-form organisms with diameters of 4-11 mum and thick capsules. Occasional asymmetrical, narrow-based budding but no true hyphae or pseudohyphae were observed. Gomori methenamine silver staining was positive. Cryptococcosis was confirmed in blood and CSF through the cryptococcal antigen test and culture. Liquid-based cytology allows for a clean background and additional slides for ancillary testing, facilitating the detection of microorganisms in CSF specimens, particularly when the number of organisms is small.ope
Angioleiomyoma in the Orbital Apex: A Case Report
A 56-year woman presented eyeball pain and blurred vision. MRI revealed a small well-delineated solid tumor in the apex of right orbit with optic nerve compression. Intraoperatively, the tumor was found very fibrous, hypervascular and adhesive to surrounding structures. The tumor was completely removed with the combination of endoscopic and microscopic technique. Patient experienced transient oculomotor nerve palsy, which completely recovered 3 months after surgery. Herein we report a rare case of angioleiomyoma in the orbital apex.ope
Surgical Management and Long-Term Outcome of Bronchial Carcinoids
Background: Bronchial carcinoids account for approximately 2% of all pulmonary tumor and consist of typical carcinoids and atypical carcinoids. An atypical carcinoid is considered to be an intermediate form of tumor between a low-grade malignant typical carcinoid and a high-grade malignant small cell lung carcinoma. There is still controversy with regard to the extent of resection and the value of systemic adjuvant therapy in atypical carcinoids. We performed a retrospective review of our experiences at Severance Hospital. Material and Method: Between 1990 and 2000, 15 patients with bronchial carcinoids were operated, and 5 of these had atypical carcinoids. Histologic diagnosis was established on the criteria of WHO/IASLC(1999). Result: There were 3 pneumonectomies, 11 lobectomies, and 1 segmentectomy. In typical carcinoids, one patient had regional lymph node metastasis, and 3 patients in atypical carcinoids had mediastinal lymph node metastases. Distant metastases developed in one patient of typical carcinoid, but developed in 4 patients of atypical carcinoids(p=0.0017). The 5-year survival rate in patients with atypical carcinoids was 20%, versus the 100% 5-year survival rate observed in patients with typical carcinoids(p=0.0039). Conclusion: In atypical carcinoids, because of many lymph node metastases on diagnosis and a low long-term survival rate, lobectomy constitutes a mininal procedure. Adjuvant systemic therapy is recommended for patients with lymph node and distant metastasis.ope
Prognostic impact of high p16/cyclin D1 index in breast cancer
Proteins p16 and cyclin D1 (CCND1) are known to tightly regulate the G1/S transition during the cell cycle, but their role in breast cancer development and progression is not clear. We investigated 224 cases of breast cancer from the Kangbuk Samsung Medical Center between 2000-2005. Expression levels of p16 and CCND1 were assessed by tissue microarray-based immunohistochemistry. A p16/CCND1 index was divided into low- and high-expression groups using receiver operating characteristic curves. The p16/CCND1 index was significantly different across molecular subtypes and a high p16/CCND1 index was statistically correlated with survival rates. This p16/CCND1 index may be an indicator of poor patient outcome and thus, represents a potential therapeutic target.ope
The Effects of Anti-inflammatory Drugs on Histologic Findings of the Experimental Prolotherapy Model
Objective: To investigate the effects of nonsteroidal anti- inflammatory drugs (NSAIDs) and acetaminophen on histologic changes of the Achilles tendon in an experimental prolotherapy model.
Method: The right Achilles tendon of 60 rats was injected with 20% dextrose on experimental day 1, 7, and day 14, whereas the left was not injected and used as control. Rats were divided into 3 subgroups: NSAIDs medication group (10 mg/kg/day), acetaminophen medication group (100 mg/ kg/day) and no medication group. Medications were given for 3 consecutive days after each injection. Rats were sacrificed at 3 and 6 weeks after first injection. The transverse diameter of gross specimen, the number of fibroblasts on light microscope, and the distribution of collagen fibril on electron microscope were assessed.
Results: The transverse diameter and the count of fibroblasts of all groups increased significantly in the injected tendon compared to the non-injected tendon. However, there were no differences among all groups significantly (p๏ผ0.05). On electron micrograph, fibril diameters of injected tendon consisted of mainly smaller sizes with the intermediate sizes.
Conclusion: Prolotherapy enhances fibroblastic stimulation and elaboration of extracellular matrix. Short term use of NSAIDs may not have any adverse effects on tissue proliferation after prolotherapy.ope
Pathological Classification of Focal Cortical Dysplasia (FCD) : Personal Comments for Well Understanding FCD Classification
In 2011, the International League against Epilepsy (ILAE) proposed a first international consensus of the classification of focal cortical dysplasia (FCD). This FCD classification had been widely used in worldwide. In this review paper, the authors would like to give helpful comments for better understanding of the current FCD classification. Especially, the basic concepts of FCD type I, such as "radial", "tangential" and "microcolumn" will be discussed with figures. In addition, the limitations, genetic progress and prospect of FCD will be suggested.ope
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