Purpose: To evaluate the feasibility of proton magnetic resonance spectroscopy () using a 1.5T magnetic resonance (MR) imager for quantification of the contents of model solutions. Materials and Methods: We prepared model solutions of dextrose+water and dextrose+water+ethanol at dextrose concentrations of 0.01% to 50% and 0.01% to 20%, respectively. Using these solutions and a 1.5T MR imager together with a high-resolution nuclear magnetic resonance (NMR) spectroscope, we calculated the ratios of dextrose to water peak, (dextrose+ethanol) to water peak, and (dextrose+ethanol) to ethanol peak, as seen on MR and NMR spectra, analysing the relationships between dextrose concentration and the ratios of peaks, and between the ratios of the peaks seen on MR spectra and those seen on NMR spectra. Results: Changes in the ratios between dextrose concentration and dextrose to water peak, (dextrose+ethanol) to water peak and (dextrose+ethanol) to ethanol peak, as seen on MR spectra, were statistically significant, and there was good linear regression. There was also close correlation between the ratios of the observed on MR and NMR spectra. The results depict the quantification of dextrose concentration according to the ratios of spectral peaks obtained by proton MRS at 1.5T. Conclusion: Using proton MRS at 1.5T, and on the basis of the ratios of spectcal peaks, it was possible to quantify the concentration of dextrose in model solutions of dextrose+water and dextrose+water+ethanol. The results of this study suggest that for quantifying the contents of biofluids, the use of low-tesla is feasible.
Purpose: Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up.Methods: This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid- to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre- and post-CRT, and at 12 months postoperatively.Results: Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P<0.001).Conclusion: The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment.
e14563 Background: Neoadjuvant chemoradiotherapy for rectal cancer results in prevention of local recurrence and may achieve sphincter conserving surgery. Association between pathologic response evaluated after radical tumor resection and patient prognosis was well established. The object of this study was to assess the association between the degree of tumor necrosis after chemoradiotherapy and oncologic outcomes. Methods: In all, 225 patients with locally advanced rectal cancer (stage II and III by endorectal ultrasonography, CT and MRI) had 50.4 Gy over 5.5 weeks, plus 5-fluorouracil and leucovorin and surgery was performed at 7 to 10 weeks after completion of all therapies. Pathologic tissue necrosis after chemoradiotherapy was reviewed and scored as follows: Grade 0, no response; Grade 1, necrosis or disappearance of tumor cells less than 2/3; Grade 2, necrosis or disappearance of tumor cells more than 2/3; and Grade 3, no viable cells (ypCR). Correlation analysis was performed using Pearson’s Chi square or Fisher’s exact test, as appropriate. Recurrence-free survival and overall survival were calculated using the Kaplan-Meier method. Results: This study included cStage II (101 patients) and cStage III (124 patients) rectal cancer patients, and down stage rate was 57.3% and pCR was 16.9%. The pathologic tumor response ( pStage 0 v I v II v III) was associated with 5-year RFS (97.4 % v 81.5% v 76.6% v 50.0%; p<0.001). The tumor necrosis (Grade 0 & 1 v 2 v 3) was associated with 5-year RFS (64.4% v 76.8 v 97.4%; p=.002). Conclusions: The tumor necrosis to neoadjuvant chemoradiotherapy is a surrogate marker for recurrence and oncologic outcomes in rectal cancer patients treated with 5 flurouracil and leucovorin neo-adjuvant chemoradiotherapy.
Korean children have their own unique lifestyle based on their living environment and culture. This study aimed to develop a questionnaire to evaluate the quality of life in Korean children with allergic rhinitis.After a preliminary survey, an initial questionnaire was developed. Questions were modified to be easily understood by young children aged 6 to 7 years. The modified questionnaire was tested on children aged 6 to 12 years old. Item scores, defined as the proportion of children whose answer score was 1 point or higher was multiplied by the average answer score of each question, were used to identify questions that have practical application to the quality of life in Korean children with allergic rhinitis. Differences in answer scores between children with allergic rhinitis and those who were healthy were assessed by a Wilcoxon rank-sum test. The relationship between nasal index scores and quality of life scores was determined by a Spearman rank order test.An initial questionnaire was composed of 21 items. We identified 19 questions with item scores above 0.5 in children with allergic rhinitis, many of which were related to nasal symptoms and 10 questions that were different between the allergic rhinitis group and the control group. The final questionnaire included the 10 questions that had both high item scores and a significant difference in the answer scores between the two groups.The developed questionnaire is essential and practical for assessing discomfort related to the symptoms felt by Korean children with allergic rhinitis.
Abstract Treatment of 1,3-disubstituted thioureas with superoxide radical anion (O2·−) at 20 °C in dimethyl sulfoxide resulted in the formation of 1,3-disubstituted ureas in excellent yields. The desulfurization appears to proceed by the formation of peroxy-sulfur intermediates such as peroxy-sulfenate, -sulfinate and/or -sulfonate.
A 49-year-old man was referred to our department with profuse serous fluid discharge from a Penrose drain after undergoing internal fixation with metal screws for multiple pelvic bone fractures. A definite ureteral penetration was identified that was orientated from the lateral to the medial aspect of the right distal ureter. The patient was surgically treated with excision of the 2-cm injured ureteral segment, end-to-end ureteroureterostomy, and double J ureteral stent placement. To our knowledge, a penetrating ureteral injury caused by bone drilling has not been reported previously in the published literature. This case shows that surgeons who do pelvic surgery, including orthopedic surgeons, should be familiar with the anatomical relationship of the ureter and its potential injuries.
국가의 국민에 대한 보건의무를 규정한 헌법 제36조 제3항의 규정과 국민건강 보험법을 근거로 설립된 국민건강보험공단은 한정된 재원으로 국민의 보건향상에 기여하고 있다. 그러나 현실적으로 모든 의료서비스에 소요되는 비용을 공단에서 부담할 수 없는바, 국민건강보험법은 요양급여에 대하여는 공단과 환자가 각 부담하도록 하되, 업무 및 일상에 지장이 없는 의료행위에 대하여는 비급여로 구별하여 이 부분에 한하여 환자와 의료기관 사이의 합의에 따라 의료행위를 할 수 있는 사적자치(私的自治) 영역으로 두고 그 진료비에 대하여는 환자에게 전액 부담하도록 하고 있다. 위와 같이 공단이 모든 의료비를 보장하는 것이 아니라 진료비 중 일부만 보장하고, 나머지 진료비는 환자들이 부담해야 하기 때문에 환자들은 개인적으로 보험사와 진료비를 보장하는 보험계약을 체결하여 자신의 부담을 민영 보험사에게 맡기고 있다. 현재 우리나라 국민의 3분의 2 가량이 가입하고 있는 실손보험은 국민보건 향상이라는 역할에 비추어 볼 때 강제보험은 아니지만 매우 중요한 보험임에는 틀림이 없다. 한편, 정부에서는 건강보험의 보장범위를 확대하는 정책을 실시함으로 건강보험에서 비급 여가 줄어들어들게 되자 의료기관은 실손보험 가입자를 상대로 과잉 과다진료를 하고 있다.이렇게 과잉 과다진료, 임의비급여 진료를 제공함으로 수익을 창출하고자 하는 의료계의 이해관계와 이러한 과잉 과다진료 및 임의비급여 진료를 적극적으로 이용하고자 하는 환자들의 이해관계가 맞아 떨어져 실손보험의 지급률이 매우 가파르게 오르는 등 심각한 상황에 직면 하고 있다. 일부 의료기관과 환자 등 사회 구성원간 조금씩 자행되는 도덕적 해이가 결국 보험자 뿐 아니라 결국은 다른 선량한 보험가입자와 전체 국민에게 큰 부담으로 돌아가게 되는 것이다. 이러한 문제점을 바탕으로 본고에서는 실손의료보험자가 환자인 피보험자에게 보험금으로 지급한 임의비급여 진료비를 의료기관으로부터 직접 환수하는 방안에 대한 법적 구성을 어떻게 할 것인지가 문제된다. 먼저, 보험자가 직접 의료기관을 상대로 불법행위를 원인으로 손해배상청구를 할 수 있는지 여부를 살펴본다. 대상판결의 상고심에서는 의료기관의 행위와 보험자의 손해 사이에 인과관계가 없다는 이유로 불법행위책임을 부정하였다. 그러나 실손보험의 가입자 수가 다수 이고, 의료기관에서 실손보험 청구를 위해 필요한 각종 서류를 발급해 주는 등 진료를 받은 환자가 실손의료비를 청구하리라는 사정을 충분히 인지할 수 있는 점 등에 비춰볼 때 인과 관계를 부정할 수 없을 것이다. 이러한 점에서 대상판결의 상고심 결론에는 동의하기 어렵다. 다음으로, 채권자대위권을 근거로 보험자가 직접 환자인 피보험자의 권리를 대위하여 행사하는 방안을 적극 검토해 볼 필요가 있다. 이에 대하여 채권자대위권의 태동적 한계를 언급하면서 강제집행을 위한 보조수단으로서 채무자의 책임재산으로 충분히 변제 자력을 없는 경우에만 활용할 수 있도록 제한적으로 해석하는 입장이 있다. 그러나 우리 대법원 판결 및일본 최고재판소 판결은 채권자대위권의 독자적인 기능을 인정하여 일정한 경우에는 채무자의 변제자력, 책임재산 유무와 관련 없이 인정할 수 있다고 판단하고 있다. 이러한 판단은 채권자의 채권이 특정물 채권인지, 금전채권인지 여부에 따라 달라질 것은 아니라고 본다. 본고의 대상판결에서도 보험자에서 환자인 피보험자를 거쳐 의료기관에 지급된 금전이 결국 보험자로 다시 반환되어야 하는 상황이라면 이해관계가 없거나 때로는 의료기관의 임의비급여 행위에 가담하여 보험자에게 손해를 가한 피보험자(환자)를 거치지 않고 채권자인 보험자 에게 바로 반환할 수 있는지가 쟁점이 되었다. 결론적으로 대상판결은 보험자에게 민법에 규정된 채권자대위권 행사를 인정함으로써 향후 유사사안에 대해 방향성을 제시한 의미있는 판결이라 할 것이다.
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