• Title/Summary/Keyword: 부위마취

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Usefulness of Mouth Guard when the Endotracheal Intubation Is Indicated for Treacher Collins Syndrome Patient (Treacher Collins 증후군 환아의 기관 삽관 시 마우스가드의 활용)

  • Choi, Haein;Choi, Byungjai;Choi, Hyungjun;Song, Jeseon;Lee, Jaeho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.41 no.1
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    • pp.40-46
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    • 2014
  • Treacher Collins syndrome (TCS) is autosomal dominant disorder that occurs approximately 1 in 25,000 to 50,000 live births. The main signs of syndrome are hypoplasia of facial bone and microtia. One in third of them is associated with cleft palate and often shows dental hypoplasia. TCS patients need several number of surgery with general anesthesia throughout their life time for recovery of function and esthetic. Endotracheal intubation of TCS patient is very difficult due to microstomia, retrognathia, choanal stenosis, and decreased oropharyngeal airway. Therefore, general anesthesia of adolescent TCS patient with immature incisor roots has high risk of causing dental trauma. This case is regarding TCS patient who was referred to the Department of Pediatric Dentistry, Yonsei University for avulsed upper left central incisor during endotracheal intubation. The purpose of this report is to emphasize the usefulness of mouth guard to prevent dental trauma when endotracheal intubation is needed for TCS patient.

Effect of L-Ascorbic Acid Contents in Tissue on Collagen Synthesis in Guinea Pigs (Guinea pig의 조직중 L-Ascorbic acid함량이 콜라겐 생합성에 미치는 영향)

  • Yu, Rina;Kurata, Tadao;Arakawa, Nobuhiko
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.21 no.3
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    • pp.241-246
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    • 1992
  • To clarify the requirement of L-ascorbic acid (AsA) in collagen synthesis, the incorporation of 1-$^{14}$ C-proline into the tissues of guinea pigs and the specific radioactivity ratio (proline/hydroxyproline) in collagen were investigated. Male guinea pigs maintained on the AsA-deficient diet were divided into three groups ; group A (AsA-deficient animals) : group B (control animals) supplemented with 5mg AsA/day ; group C (high dose animals) with 300mg AsA/day, and orally supplemented with or with-out AsA for 14 days. Collagen synthesis was estimated by measuring the incorporation of labeled pro-line into collagen in lung and dorsal skin, and the hydroxyproline contents in lung and skin. The AsA contents in the tissues were determined by high-peforrnance liquid chromatography (HPLC), and serum alkaline phosphatase activity was also measured. The serum alkaline phosphatase activity of AsA deficient group was very low as compared with those of AsA supplemented group. Incorporation of labelled proline into collagen and its specific radioactivity ratio in collagen increased with increasing levels of AsA in the tissues. There was a significantly positive relationship between the levels of AsA and hydroxyproline in the tissues.

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MANAGEMENT OF THE IMPACTED TOOTH ASSOCIATED WITH DENTIGEROUS CYST IN AUTISTIC YOUNG PATIENTS (자폐증 환자에서 함치성 낭종과 연관된 매복치의 처치)

  • Kim, Ki-Rim;Song, Je-Seon;Choi, Byung-Jai;Kim, Seung-Hye;Lee, Jae-Ho
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.7 no.1
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    • pp.25-28
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    • 2011
  • Autism is a developmental, neuropsychiatric disorder that begins in early childhood. A patient with autism seen in the dental office frequently may have many complications. Therefore, it may be needed to consider modified or alternative therapy for dental care of autistic patients. This is the case of a 16-year old boy who have autism. He came to the department of the pediatric dentistry, Yonsei University Dental Hospital, for evaluation and treatment of dentigerous cyst associated with impacted teeth(#33,34,35). Under daily hospitalization and general anesthesia, the cyst was enucleated with surgical extraction of #34 and autotransplantation of #33,35. And during the periodic dental followup, apexification of #33,35 was performed for periapical lesion and root maturity. At 2 year 6 months follow- up, now, bony healing was completed and there are some complications like external resorption of #33 and space loss of #34 area. Generally, the marsupialization has been widely recommended for treatment of dentigerous cyst. However, in this case, there is a little possibility of spontaneous eruption after marsupialization considering of patient's age, location and angulation of the impacted tooth, root maturity. And there is necessity to choose the treatment that has low recurrence risk and needs short-term follow-up for autism. Above all, poor oral hygiene and lack of cooperation for decompression treatment is a matter of primary consideration. Consequently, enucleation of the cyst was chosen for the final treatment plan in this case. It is important to consider the conditions that affect the eruption of a dentigerous cyst-associated tooth to predict the successful eruption and special health care needs of the patient when the treatment plan is settled.

Development of Detachable IORT Table for Colorectal Cancer (장착-탈거 및 경사각 조절이 가능한 대장직장암의 수술 중 방사선 치료대의 개발)

  • Kim, Myung-Se;Lee, Joon-Ha
    • Radiation Oncology Journal
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    • v.12 no.1
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    • pp.117-121
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    • 1994
  • In spite of remarkable improvement of surgical skills and anesthesia, local failure still occurred in 36-45$ \% $ of locally advanced colorectal cancer after curative resection with or without pre-or post-operative irradiation. Intraoperative radiation therapy(IORT) is the ideal modality which resectable lesions are removed surgically 3nd the remaining cancer nests are sterilized by irradiation during a surgical procedure. Therefore, the excellent local control without the damage of the adjacent normal tissues can be achieved. In IORT, judicious set up of the treatment cone on the treatment surface of the patient is required for accurate and homogenous dose distribution within treatment field, especially on the slopping surface of sacrum and pelvic sidewall which are the common sites of the local recurrence in rectal cancer. For this purpose, adequate co-ordination of gantry rotation and table tilting are essential. Adjusting gantry rotation is not difficult but tilting of the table is impossible inconventional treatment couch. Department of Therapeutic Radiology in Yeungnam University Medical Center developed the IORT table for colorectal cancer which is easy to set up and detach on the Linac treatment couch within 5 minutes. The range of tilting with head-up and head-down is about 30 degree which is efficient and easy-to-use, not only for IORT but also for colorectal surgery. So far, authors performed IORT with newly developed treatment table in 2 patients with rectal cancer and we found that this newly developed table could contribute in improving the dose distribution of IORT and surgical procedure for colorectal cancer.

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EFFECTS OF ELECTROACUPUNCTURE AND NALOXONE ON MOUTH OPENING REFLEX (전기침과 Naloxone이 개구반사에 미치는 영향)

  • Park, Min-Gap;Seo, Young-Ah;Song, Hyung-Geun;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.25 no.2
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    • pp.467-475
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    • 1998
  • 악안면 영역에 동통이 가하여지면 회피반사의 일종인 개구반사가 유발되며, 개구반사의 크기는 뇌간의 중추에 전달된 동통의 크기에 비례한다. 따라서 동통의 정도를 악이복근의 근전도를 이용하여 정량화 할 수 있고 동통의 지표로 이용할 수 있다. 본 실험은 악안면동통에 의하여 유발된 개구반사의 크기가 침점(족삼리) 전기자극으로 감소되는지와 이러한 전기침의 효과가 나타나는데 opioid 물질이 관여하는지에 대하여 연구하고자 하였다. 8주 이상, 150g이상의 Sprague-Dawley계 쥐 34 마리를 암수 구별없이 이용하여 실험하였다. 복강 내 Urethane용액(1.5g/kg)을 주입 전신마취하고 악이복근을 노출시켜 근전도 기록을 위한 한쌍의 선전극을 삽입하였다. 동통유발을 위하여 구강내 하악 이공주변에 0.1mm의 선전극을 한쌍 삽입하고 전기자극기에 연결하였다. 유해자극 조건은 duration $100{\mu}sec$, interval 5sec의 pulse로 정하고 자극의 크기는 개구반사를 일으키는 역치의 2배 크기로 하며 매 측정시마다 동일 자극을 10회식 가하여 평균하였다. 침점의 전기자극을 위하여 침점의 하나인 족삼리(Zusanli)에 표면전극(넓이 $0.4cm^2$ 정도)을 부착하고 자극부위가 약한 근수축을 일으키는 강도인 $100{\mu}sec$, 5V, 2Hz의 자극을 20분간 가하였다. 악이복근의 근전도는 교류증폭기 (Dam80, WPI, USA) 에서 1000배 증폭하여 유해자극이 가해진 순간 oscilloscope 에서 관찰하여 그 크기를 측정하였다. 침점의 전기자극으로 나타나는 진통효과가 opioid의 분비와 관련있는지 알아보기 위하여 opioid 의 길항제인 naloxone(0.2mg/kg)을 복강 내로 투여하였다. 실험군을 4군(group I - IV)으로 분류하였고 각 군에서 근전도를 측정한 단계는 다음과 같다. group I : control 침점에 전기자극 20 분간 가한후(EA), 20분후(EA20) group II : control 침점에 전기자극 20분간 가한후(EA), naloxone 투여 20분후(NX) group III : control naloxone 투여 5분후 침점에 전기자극 20분 가한후(NxEA20) group IV : control naloxone 투여 20분후(NX20) 구강내에 가해진 유해자극에 의하여 발생하는 악이복근 근전도는 족삼리 침점의 전기자극으로 그 크기가 감소하였고 이러한 침점자극의 효과는 naloxone의 투여로 인하여 억제되었다. 이와 같은 결과는 침점자극으로 진통작용이 나타나는데에 opioid 물질이 관여하고 있음을 시사한다.

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Studies on Involvement of Central GABAergic Mechanism and Central ${\alpha}_{2}-Adrenoceptors$ in Pressor Responses to Raised Intracranial Pressure (두개내압상승에 의한 혈압상승작용과 중추 GABA계 및 중추 ${\alpha}_{2}$-아드레날린 수용체와의 관계)

  • Kim, Yung-Sik
    • The Korean Journal of Pharmacology
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    • v.29 no.1
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    • pp.23-32
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    • 1993
  • Recent studies have shown that a GABAergic mechanism in the brain modulates arterial blood pressure (BP) through alterations of sympathetic activity in the brain. The purpose of the present study was to determine if this modulation is involved in the pressor response to raised intracranial pressure (ICP). The pressor response to raised ICP was abolished by pretreatment of anesthetized rabbits with intracerebroventricular (icv) muscimol (a GABA agonist) as well as with icv clonidine $(an\;{\alpha}_2-agonist)$. Raising ICP in the hypertensive state after icv yohimbine $(an\;{\alpha}_2-antagonist)$ did not cause an additional increase in the BP, whereas raising ICP in the hypertensive state following icv bicuculline (a GABA antagonist) produced a further increase. Bicuculline produced an increase of the BP which had been lowered by muscimol or by clonidine, whereas it failed to increase the hypertensive state induced by either previous yohimbine or raised ICP. Yohimbine reversed the BP which had been made low by clonidine but was incapable of raising the hypotensive state after muscimol. Yohimbine failed to increase the heightened BP due to raised ICP, whereas bicuculline-induced pressor state was further elevated by yohimbine. Muscimol, besides the bicuculline-antagonizing property, inhibited the pressor response to yohimbine, suggesting participation of a GABAergic mechanism in the pressor action of yohimbine. From these results it was inferred that there were three ways in which BP could be increased via raised ICP: inactivation of the inhibitory sympathetic activity through (1) ${\alpha}_{2}-adrenoceptors$, (2) bicuculline-sensitive GABA receptors, (3) yohimbine-sensitive, clonidine-acting GABAergic sites.

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A Canine Model of Tracheal Stenosis Using Nd-YAG Laser (Nd-YAG laser를 이용한 기관협착 동물모델의 개발)

  • Kim, Jhin-Gook;Suh, Gee-Young;Chung, Man-Pyo;Kwon, O-Jung;Suh, Soo-Won;Kim, Ho-Joong
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.1
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    • pp.54-61
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    • 2002
  • Background: Tracheal stenosis is an urgent but uncommon disease. Therefore, primary care clinicians have limited clinical experience. Animal models of a tracheal stenosis can be used conveniently for the learning, teaching, and developing new diagnostic and therapeutic modalities for tracheal stenosis. Recently, a canine model of a tracheal stenosis was developed using a Nd-YAG laser. To describe the methods and results of developed animal model, we performed this study. Methods : Six Mongrel dogs were generally anesthetized and the anterior 180 degree of tracheal cartilage of the animal was photo-coagulated using a Nd-YAG laser. The animals were bronchoscopically evaluated every week for 4 weeks and a pathologic evaluation was also made. Results : Two weeks after the laser coagulation, the trachea began to stenose and the stenosis progressed through 4 weeks. All animals suffered from shortness of breath, wheezing, and weight loss in the 3 weeks after the laser treatment, and two died of respiratory failure just before the fourth week. The gross pathologic findings showed the loss of cartilage and a dense fibrosis, which resulted in a fibrous stricture of the trachea. Microscopy also showed that the fibrous granulation tissue replaced destroyed cartilage. Conclusion : The canine model can assist in the understanding and development of new diagnostic and therapeutic modalities for tracheal stenosis.

EXPERIMENTAL RECONSTRUCTION OF LARYNX WITH STERNOMASTOID MYOPERIOSTEAL FLAP (흉유돌근골막 피판을 이용한 후두 재건)

  • 조재식;안병현;김선태;이종원
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1991.06a
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    • pp.28-28
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    • 1991
  • 후두암의 수직절제 수술후의 후두 재건 목적은 기관절개를 통하지 않고 후두를 통한 호흡이 가능하도록 하면서 연하시 기도흡인을 피하기 위한 sphincter 능력의 보존, 그리고 발성이 가능하도록 성대진동 mechanism을 재건하는데 있다. 오늘날 수많은 후두학자들에 의해서 고안 개발된 다양한 재건 방법이 있다. 연자는 광범위한 후두절제에 따른 큰 결손을 메우기 위해 bulky하면서도 점막 상피의 재생이 용이한 재건 피판으로 흉유돌근골막 피판을 이용하여 후두 결손부를 재건하여 보았다. 방법은 성견 3마리를 대상으로하여 thiopental sodium 정맥주사로 전신마취를 시행한 후 설골에서부터 흉골상까지 경부 정중앙의 피부를 절개하고 후두를 노출시켜 후두 수직절제술을 시행하였다. 흉유돌근과 흉골에 부착된 골막을 박리하여 흥유돌근골막 피판을 제작한 후 골막이 후두강 안쪽으로 되도록하여 골막연과 후두점막을 봉합하였다. 그리고 3, 5, 9개월에 후두적출술을 시행하여 병리조직학적 및 수술후 경과를 관찰하였다. 3실험견 모두 기관절개술 없이 후두를 통한 호흡이 가능하였고 흡입성 폐렴이나 피하기종등의 합병증없이 창상이 치유되었으며 발성도 양호하였다. 이식된 골막위로 신생혈관의 출현과 함께 점막재생이 잘되 있었다. 단지 봉합사 주위에 소량의 육아종이 관찰되었다. 조직학적으로는 섬유조직위로 편평상피가 재생되었으며 성문하부에서는 일부 섬모가 있는 호흡기 점막도 관찰되고 골막하부에 신생골 형성은 관찰할 수 없었다. 골막 피판은 그 유연성 때문에 결손부위의 점막연에 맞춰도 tension이 없고 공기 누출이 되지 않게 봉합이 가능할 뿐 아니라 점막이 재생할 수 있는 frame-work의 역할을 하는 것으로 사료되었다. 이상과 같은 사실로 미루어 흉유돌근 자체가 견실하고 골막에 혈류공급이 잘되어 창상치유에 좋을 뿐 아니라 큰 후두결손부의 재건이 가능하리라고 사료되었다.로서 몇가지 앞으로의 치료지침에 도움이 되는 결과를 얻었기에 보고하는 바이다. 1) 성별 분포는 남자 16(39 %), 여자 25 (61%)이었으며 1 : 1.5의 빈도를 보였다. 2) 연령 분포는 20대와 30대에서 남녀 모두 25명으로 대부분을 차지하였다. 3) 부식제의 종류는 빙초산이 26명 (63.4 %)으로 대부분을 차지하였고 염산 7 (17.1 %) Lye 3 (0.7 %) 의 순이었다. 4) 음독후 12시간내에 식도경술을 받은 환자가 3명(0.7 %) 12-24시간에 받은 환자가 17명(41.5 %), 24 - 48시간에 받은 환자가 11명(26. 8%)으로 48시간 내에 시행받은 환자가 전체의 75.6%를 차지하였다. 5) 식도경 검사상 나타난 식도화상은 Grade I 11명 (26.8%) G.ade II 18(43.9%) Grade III 7명(17.1%) 이었으며 Grade II 인 경우가 18명(43.9%)로 가장 많았으며 Grade I 11명(26.8 %), Grade III 7명 (17.1 %) Normal 5명 (12.2 %) 순이었다. 6) 조기 식도경 검사에서 41명중 oral cavity burn이 없었던 경우가 15명(36. 1 %) 이었으며, oral cavity burn이 있었던 26명중 5명(19 .2 %)에서 Esophageal burn이 없었다 특히 Esophageal burn의 Grade II, III 25명 중 9명(29.6 %)에서 oral cavity burn이 없었다. 7) 식도 부식중 환자의 치료 원칙으로 Grade I, II, III에서 항생제 및 보존적 치료를 하였으며 Grade I에선 oral feeding을 시켰고 Steroid는 경우에 따라 투여하였으며 Grade III에선 원칙적으로 사용치 않았다. 식도조영술은 Grade I II III에서 3주 후에 모두 시행하였다. 8) 3주 후 식도조영술을 실

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Ultrasound Imaging for Position of the Sciatic Nerve Division in Korean Female (한국 여성에서 좌골 신경 분지 위치에 대한 초음파 영상)

  • Nam, Il Hyun;Yeo, Eui Dong;Yu, Ji Soo;Lee, Jun Ho;Lee, Young Koo
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.28-32
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    • 2014
  • Purpose: We aim to determine sciatic nerve bifurcation location and depth at the level of the popliteal fossa in Korean female. Materials and Methods: Thirty three subjects were enrolled in Korean female. M-turbo ultrasound system (SonoSite, bothell, WA, USA)with 38 mm high frequency linear array transducer, 13-6 MHz probe was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin to nerve distance were assessed via ultrasound. Analyses were performed with SAS version 9.3 using multiple linear regression. Results: Thirty three subjects were enrolled. Distance from the popliteal crease to the sciatic nerve was 4.5-7.5 (mean 5.7 cm), and the depth of the sciatic nerve from the skin was 1.8-3.2 (mean 2.4 cm). Multiple linear regression for the usefulness of the model has a p value of 0.036, shows between weight and depth. Conclusion: We show that variability exists for sciatic nerve bifurcation location in Korean female, The success rate is creased if consider the relations between weight and depth when performs sciatic nerve block in Korean female. In our study, a sciatic nerve block is recommend that performed 7.5 cm proximal to the crease in the popliteal fossa.

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Assessment of Systemic Arterial Thromboembolism with Multi-Slice Spiral CT in a Dog (개에서 다중나선형 CT촬영에 의한 동맥혈전색전증의 평가)

  • Shin, Seung-Ho;Lee, Ki-Chang
    • Journal of Veterinary Clinics
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    • v.24 no.2
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    • pp.208-213
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    • 2007
  • A 15 kg 6-year-old intact male Jindo dog with a history of a respiratory distress, hindlimb paralysis with necrosed skin of dorsal digit for three weeks was referred to Animal Medical Center, Chonbuk National University. Heartworm infection was identified by kit examination. In plain thoracic radiographs, dilated pulmonary arteries reverse D sign and focal interstitial pattern was compatible with heartworm infection and possible pulmonary thromboembolism. Abdominal radiographs showed poor serosal detail indicating fluid accumulation within peritoneal cavity. No evidence of musculoskeletal abnormalities was found. Ultrasonography presented focal wedge-shaped hyperechogenecity on the both poles of left kidney, weak or absent pulse on the distal to the external iliac artery as well as ascites and irregular liver margin. Multi-organ failure was strongly supposed by blood profile including leukocytosis, anemia, hemoglobinuria bililubinemia, hypoalbuminemia, imbalance of electrolytes, and increased hepatic and renal function values. Interestingly, the glucose level is remarkably lower in pelvic limb compared to thoracic limb. Suspected pulmonary thromboembolism, renal infarction and femoral arterial embolization causing hindlimb paralysis and dermatic necrosis were confirmed by 3D reconstructed CT imaging. Prior to taking a consideration of euthanasia, interventional radiology was experimentally attempted but failed due to not recovered from general anesthesia. Early and accurate diagnosis of thromboembolism is valuable and 3D reconstructed CT images might be very useful to show the correct way to treat effectively.