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Woo Hyung Lee,Hyun Kyung Do, Joong Hoon Lee,Bo Ram Kim,Jee Hyun Noh,Soo Hyun Choi,Sun Gun Chung,Shi-Uk Lee,최지은,Seihee Kim,Min Jee Kim,Jae-Young Lim 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.2
Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear.Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments.Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups.Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.
Acute Myocardial Infarction Occurred in Multivessel Disease Including Chronic Total Occlusion
Jee Seon Kim,Tae Hoon Yim,Byung Chul Kim,Hyun Sik Ju,Ja Joong Gu,Tae Jin Kim 이화여자대학교 의과학연구소 2015 EMJ (Ewha medical journal) Vol.38 No.3
Simultaneous multi-vessel acute myocardial infarction is rare and has poor prognosis. We report a 70-year-old Korean man with an anteroseptal wall ST-elevation myocardial infarction presenting as ventricular tachycardia, sudden cardiac arrest and cardiogenic shock. After successful cardiopulmonary resuscitation, a coronary angiogram revealed three-vessel coronary disease; simultaneous total occlusions of the proximal left anterior descending artery (LAD) and the proximal left circumflex artery (LCX), and chronic total occlusion of the proximal right coronary artery. Primary percutaneous coronary intervention (PCI) of the LAD and LCX was successful and an intra-aortic balloon pump was inserted. Despite the timely and successful PCI result, he died on the 58th day in the hospital due to pneumonia with multiple organ failure.
( Jee Hee Park ),( Joong-won Park ),( Bo Hyun Kim ),( Ju Hee Lee ),( Young Hwan Koh ),( Chang-min Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Sorafenib has been the only approved systemic agent for advanced hepatocellular carcinoma (HCC) for the past decade and multiple new drugs were recently approved. Out of these, nivolumab, a programmed cell death protein-1 inhibitor, is the first immune checkpoint inhibitor approved for the second-line therapy for advanced HCC. The aim of this study is to describe our experience with nivolumab in patients who have progressed on or been intolerant of prior sorafenib. Methods: Thirty consecutive patients with advanced HCC receiving nivolumab were enrolled between October 2017 and March 2018. Enrolled patients were given nivolumab 3mg/ kg intravenously every 2 weeks. Assessment of response was based on the Immune-Modified Response Evaluation Criteria In Solid Tumors (iRECIST) and RECIEST version 1.1 every 8 weeks. Results: The median age of patients was 65.5 years (range, 46-81 years) and the predominant etiology was hepatitis B (64%). Most patients had preserved liver function (Child-Pugh class A, 93%) and good performance status (ECOG score of 0 or 1, 100%). Portal vein invasion and extrahepatic spread was present in 54% and 67%, respectively. Sorafenib was given all patients as a first-line treatment. Before nivolumab treatment, 6 patients received 2 systemic agents and another 6 patients received 3 or more. As of the cutoff date of April 5 2018, the median duration of nivolumab treatment was 61 days. Eleven out of 30 patients (36.7%) are on treatment, while 19 patients stopped treatment because of disease progression (n=9, 30%), serious toxicity (n=7, 23.3%), treatment refusal (n=2) and follow up loss (n=1). Of 22 patients available for evaluating tumor response, 2 showed partial response (PR; 9.2%); 8 stable response (SD; 36.3%); 4 immune unconfirmed progression (iUPD; 18.2%) and 8 immune confirmed progression (iCPD; 36.3%). One of the four iUPDs was identified as iCPD and discontinued treatment, while three patients are still on treatment awaiting the next evaluation. Median overall survival (OS) was not reached because of short follow up duration (83 days). Mean OS was 117.7 days (95% confidence interval [CI]; 105.4-129.9) and median progression free survival (PFS) was 97 days (95% CI; 72.9-121.1). Survival rate and PFS rate at 3 months were 90.2% and 64.9%, respectively. Most common adverse reactions included abdominal discomfort (20%), general weakness (13%), constipation (13%), ascites (13%), skin eruption or pruritus (13%), anorexia (10%), nausea (10%), myalgia (7%), diarrhea (7%), peripheral edema (7%), fatigue (3%), dyspnea (3%). Treatment-emergent grade 3 adverse events (n=7) included hepatotoxicity, azotemia, hematochezia, anorexia, hyperbilirubinemia, and hypercalcemia, which necessitated treatment cessation. Conclusions: In real life practice of a single center, nivolumab as a second- or a third-fourth-line therapy appears to have meaningful efficacy and acceptable tolerability in patients with far-advanced HCC. Further follow-up studies are warranted.