• Title/Summary/Keyword: 전신적 질환자

Search Result 73, Processing Time 0.025 seconds

ESOPHAGEAL FOREIGN BODY REMOVAL WITH FIBEROPTIC ESOPHAGOSCOPY (식도이물의 굴곡형 내시경을 이용한 치료)

  • 박수헌
    • Korean Journal of Bronchoesophagology
    • /
    • v.2 no.2
    • /
    • pp.182-193
    • /
    • 1996
  • 식도내 이물은 종종 어린이나 식도질환을 가진 환자, 죄수들, 정신박약자 및 정신질환자등의 위험성이 높은 성인에서 흔히 발생한다. 그러나 대부분의 이물은 저절로 위장관을 통과하나 날카롭고 뾰족하며 긴 이물은 위장관의 천공이나 혈관과 누공형성 및 다른 합병증을 초래할 수도 있다. 이물의 섭취는 대개 환자나 다른 목격자에 의하여 복용한 병력으로 진단할 수 있다. 그러나 어린이나 정신박약자는 병력을 얻을 수 없기 때문에 우선 의심하는 것이 중요한 진단방법이 될 수밖에 없다. 연하곤란과 연하통은 식도이물의 통상적인 증상이다. 주변기도의 압박으로 인한 호흡기 증상은 어린이에 흔하며 종종 성인에서도 관찰된다. 식도내 이물을 제거하는데 많이 사용되는 방법은 굴곡형내시경을 사용하여 제거하는 것이다. 이방법은 성인이나 어린이에서 전신마취없이 기존의 진정제 투여방법으로 시술할 수 있다. 이물제거에 사용되는 파지겸자와 올가미는 내시경이물제거술을 가능하게 하였고 굴곡형내시경에 사용되는 overtube는 기존의 강직 형내시경의 장점을 얻을 수 있어 뽀족하거나 날카로운 이물을 제거하는데 사용하게 되었다. 이런 내시경적이물제거 원칙을 잘 지키고 적절한 준비가 된다면 합병증이 거의 없이 98% 정도의 이물을 제거할 수 있다. 내시경을 사용하지 않는 여러 가지 방법은 천공의 위험성이 높고 흡인성폐렴을 유발할 수 있기 때문에 사용하지 않는 것이 낫다. 수술적인 처치는 천공이 되었거나 다른 이물로 인한 합병증이 있는 경우에만 드물게 적용된다.

  • PDF

A Case Report: Limitation of Mouth Opening in Dermatomyositis (개구장애를 동반한 피부근염 환자 증례)

  • Kim, Hye-Kyung;Kim, Ki-Suk;Kim, Mee-Eun
    • Journal of Oral Medicine and Pain
    • /
    • v.35 no.2
    • /
    • pp.155-163
    • /
    • 2010
  • Dermatomyositis (DM) is an idiopathic inflammatory connective tissue disorder and a systemic autonomic immune disease which shows a progressive muscle weakness and characteristic rash. It is identified by a characteristic rash accompanying, or more often preceding muscle weakness. Pathognomonic skin lesions are a blue-purple discoloration on the upper eyelids with edema (heliotropic rash), a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron's papule). The myopathy represents inflammatory and degenerative changes primarily affecting proximal muscles. DM often involves GI tract and respiratory system with as risk of 15-25% internal malignancy. It's managed with sun protection since muscle weakness as well as a rash could be aggravated by sun exposure. Systemic corticosteroid is an initial therapy and other immunosuppressive agent has been used as alternatives. Facial muscles are unaffected and masticatory muscles are rarely affected in DM. We present trismus close to muscle contracture in a patient with DM. Therefore, it needs continuous mouth-opening exercise to prevent progressive muscle contracture and to ensure normal mouth opening.

Effect of Pilocarpine Mouthwash on Xerostomia (구강건조증에 대한 필로카핀 구강양치액의 효과)

  • Kim, Ji-Hyun;Park, Ju-Hyun;Kwon, Jeong-Seung;Ahn, Hyung-Joon
    • Journal of Oral Medicine and Pain
    • /
    • v.36 no.1
    • /
    • pp.21-24
    • /
    • 2011
  • Xerostomia is subjective feeling of dry mouth, a symptom that may or may not be accompanied by hyposalivation, an objective decrease in salivary flow. There are many causes induced xerostomia like drugs, salivary gland diseases, radiation therapy to the head and neck region, Sjogren syndrome, emotional stress etc. Insufficient salivary flow creates complications with oral candidiasis, dental caries, periodontitis, halitosis, dysgeusia. So finally, these complications lead to an overall decline in quality of life. Managements of xerostomia are eliminating or alterating the etiologic factors, relieving symptoms, preventing or correcting the consequences of salivary dysfunction, treating underlying disease and stimulating salivation. One of the salivation stimulation agents studied to treat xerostomia was the pilocarpine muscarinic agonist. Pilocarpine is one of salivation stimulants, a parasympathomimetic drug and non-selective muscarinic receptor agonist. Systemic pilocarpine has been used to stimulate salivary secretion. But systemic administration of pilocarpine has limitations such as increased risk of side effects and contraindications. Side effects of systemic pilocarpine administration are sweating, urinary and gastrointestinal disturbance, risk of cardiovascular and pulmonary disorders. This drug must be used carefully by patients with controlled asthma, chronic bronchitis, pulmonary or cardiac disease. Patient with acute asthma, narrow angle glaucoma, iritis should not use pilocarpine. Like this, systemic pilocarpine has many limitations. So, many investigators also have looked at the effectiveness of topical pilocarpine. Here we present patients with xerostomia which was relieved by pilocarpine mouthwash.

Nocardia Brain Abscess Mimicking a Metastatic Brain Tumor: A Severe CNS Infection Requiring Aggressive Management (전이성 뇌암으로 오인된 노카디아 뇌농양: 적극적 치료를 요하는 심각한 중추신경계 감염병)

  • Lee, Aleum;Kim, Hee Kyung
    • Investigative Magnetic Resonance Imaging
    • /
    • v.17 no.1
    • /
    • pp.50-54
    • /
    • 2013
  • Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.

Evaluation of Taste in the Patients with Recurrent Aphthous Ulceration by Electrogustometer (전기미각측정기를 이용한 재발성 아프타성 궤양 환자의 미각평가)

  • Jun, Jin-Yong;Ahn, Yong-Woo;Ko, Myung-Yun
    • Journal of Oral Medicine and Pain
    • /
    • v.32 no.1
    • /
    • pp.1-8
    • /
    • 2007
  • The purpose of this study was to investigate whether there were any changes in taste sensitivity with recurrent aphthous ulceration. Nintyseven subjects(25 males and 72 females) were included for the study and they were categorized into 2 groups(recurrent aphthous ulceration 27 persons, control 70 persons), recurrent aphthous ulceration group was investigated in the department of Oral Medicine, College of Dentistry, Pusan National University from April, 2005 to August, 2006 and control group was investigated in the clinic at Incheon city from June, 2006 to August, 2006. The electrical taste thresholds were measured using an electrogustometer of the 4 different sites(tongue tip, tongue lateral, circumvallate papilla and soft palate) in oral cavity. The results were as follows ; 1. The electrical taste threshold showed significant lower in the RAU group. 2. The electrical taste threshold showed significant lower in female group, and showed significant lower except soft palate in male group of the RAU group. 3. The electrical taste threshold showed a tendency to increase in all site of the multiple RAU group, but there were no significant differences. 4. The electrical taste threshold showed a tendency to increase in tongue lateral of the acute RAU group, and showed a tendency to increase in tongue tip, circumvallate papilla, soft palate of the chronic RAU group. 5. After treatment, electrical taste threshold was significant increase than initial visit in the RAU group. 6. After treatment, NAS showed a tendency to decrease in the RAU group.

Rational Diagnosis and Management of Sjogren's Syndrome (쉐그렌 증후군의 합리적 진단 및 관리)

  • Tae, Il-Ho;Kwon, Jeong-Seung;Jeon, Young-Mi;Choi, Jong-Hoon;Shim, Woo-Hyun;Ahn, Hyung-Joon
    • Journal of Oral Medicine and Pain
    • /
    • v.32 no.4
    • /
    • pp.397-402
    • /
    • 2007
  • Sjogren's syndrome is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands. Primary SS presents alone as xerostomia, keratoconjunctivitis sicca and patotid gland enlargement, secondary SS occurs in connection with other autoimmune disorder such as rheumatitoid arthritis, systemic lupus erythematosus, or progressive systemic sclerosis. Among many other systemic complication, lymphoma is considered seriously. Patient with SS had a 44 times higher relative risk of lymphoma, and clinically identifiable lymphoma occurs in approximately 5% of patients with SS. So, patients with SS should be closely monitored. In dental office, diagnosis of SS is important in view of high risk of lymphoma. When a dentist diagnose and manage dry mouth, he or she should consider possibility of SS all the times and have knowledge of diagnostic criteria of SS.

Study on Detection of Oral Bacteria in the Saliva and Risk Factors of Adults (성인의 타액 내 구강세균 검출과 위험요인에 관한 연구)

  • Hong, Min-Hee
    • Journal of the Korea Academia-Industrial cooperation Society
    • /
    • v.15 no.9
    • /
    • pp.5675-5682
    • /
    • 2014
  • As oral diseases are developed by mixed infections, not by any single element, an accurate analysis of the causative microorganisms related to dental caries and periodontal diseases is required. In this study, saliva was collected from selected adults to determine if the bacteria that are well known as the causative microorganisms of dental caries and periodontal diseases would be detected in their saliva. In addition, this study examined whether there would be any differences among adults according to age, smoking, drinking and presence or absence of diseases in the distribution of oral bacteria to determine the risk factors for oral bacteria. The study subjects were 120 adults ranging in age from 20 to 65 years. The experiment data was collected from March 15, to May 2014. The gDNA was collected from the saliva, and the distribution of bacteria for oral diseases was investigated by PCR. The findings of the study were as follows. S. mutans was detected from 72 adults, and P. intermedia was detected from 88 adults. Both bacteria were detected from 54 adults, and no oral bacteria was detected in 14 adults. An analysis of the risk factors of oral bacteria showed that smokers had a 2.8-fold higher risk of S. mutans than nonsmokers, and the former had a 3.5-fold higher risk of P. intermedia than the latter. Drinkers had a 3.3-fold higher risk of S. mutans than nondrinkers. Patients who suffered from systemic diseases had a 4.1-fold higher risk of P. intermedia than those with no diseases. Therefore, smoking, drinking and systemic diseases are factors that increase the likelihood of oral bacteria detection. More periodontal disease bacteria were detected from older adults, and more oral bacteria were found in adults who were in their 20s, as dental caries and periodontal diseases were more common in this age group. The adults in which oral bacteria were detected are more likely to have dental caries or periodontal diseases, and they should try to keep their mouth cavity clean and make regular visits to a dental clinic to prevent possible oral diseases.

Cardiopulmonary bypass -induced Gene expressions of proinflammatory cytokines and chemokines (체외순환에서 전염증성 사이토카인 및 케모카인 유전자 발현 특성에 대한 연구)

  • Yu, Jae-Hyeon;Jo, Eun-Kyeong;Park, Jeong-Kyu;Kang, Shin-Kwang;Na, Myung-Hoon;Lim, Seung-Pyung;Lee, Young
    • Journal of Chest Surgery
    • /
    • v.35 no.2
    • /
    • pp.118-126
    • /
    • 2002
  • 배경: 체외순환에 의해 생성되는 염증매개체는 소아 환자에서 술 후 다기관 기능부전과 연관이 있다. 본 연구에서는 선천성 신장질환 소아환자에서 체외순환에 의한 전염증성 사이토카인과 케모카인의 유전자 발현 특성에 대해 알아보고자 하였다. 대상 및 방법: 개심술을 시행한 18명의 소아 환자의 요골 동맥에서 마취유도 후(기준치), 체외순환(0시간), 체외순환 2시간 후 24시간 후, 48시간 후에 혈액을 채취하였다. 모든 환자에서 인터루킨-1알파, 인터루킨-1베타 인터루킨-6, 인터루킨-8, 종양괴사자인자-알파, 인터루킨-15,인터페론 감마의 mRNA의 유전자 발현 정도를 반정량적으로 역전사 중합효소 연쇄반응으로 측정하였다. 6명의 환자에서 인터루킨-6단백치는효소결합면역흡착검사로 측정하였다. 결과: 전신적인 인터루킨-6 mRNA와 비슷한 양상을 보였으나 최고치는 인터루킨-6보다 낮은 값을 보였다. 인터루킨-1알파와 인터루킨-1베타의 mRNA의 발현은 체외순환 2시간 후에 최고치를 나타내었고 체외순환 2시간 후에 최고치를 나타내었고 체외순환 48시간 후에 감소하였다. 종양괴사자인자-알파는 체외 순환 24시간 후에 최고치를 나타내었고 체외순환 48시간 후에 감소하였다. 인터루킨-15 mRNA 발현은 체외순환 전후와 비교하여 유의한 변화가 없었다. 인터페론-감마는 시간이 지남에 따라 감소하였다. 결론: 선천성 심장질환으로 개심술을 시행한 소아환자의 혈청 내 인터루킨-6, 인터루킨-8, 인터루킨-1알파, 인터루킨-베타, 종양괴사자인자-알파의 유전자 발현은 체외 순환 전후로 유의한 변화를 보였다. 인터루킨-15는 유의한 변화가 없었고 인터페론-감마는 반대 양상의 변화를 보였다. 체외순환 후 전염증성 사이토카인과 케모카인의 높은 혈중 농도는 술 후 조직 손상과 연관되리라 생각한다.

Factors Associated with Self-Assessment of Halitosis in Adult (일부 성인에서 자가 구취 인식도와의 관련요인 분석)

  • Han, Ji-Seon;Hong, Ju-Hee;Choi, Jun-Seon
    • The Journal of the Korea Contents Association
    • /
    • v.11 no.12
    • /
    • pp.347-356
    • /
    • 2011
  • The aim of this study was to determine the prevalence of self-assessment halitosis and to offer the basic information that establishes a strategy of effective health promotion and to enhance the quality of life. This study performed a questionnaire survey. The questionnaire was filled out by the 362 adults, who lived in Incheon Metropolitan City from May to July, 2010. The data were analyzed using a Chi-square test in the SPSS version 12.0 program. The prevalence rate of self-assessment halitosis was 24.3%. Hypertension, diabetes, medication and inadequate oral hygiene practice were significantly associated with self-assessment halitosis. Other factors of self-assessment halitosis were older age and occupation. As a result, dental professionals have to investigate a systemic disease history thoroughly. And they have to educate regular checkup of oral health and to perform a continuous feedback. The self-assessment halitosis has a negative influence on mental health and social life, so dental professionals must take into consideration about the halitosis.

Assessment on Quality of Life: Based on Oral Health Conditions (구강건강상태에 따른 삶의 질 평가)

  • Kim, Ji-Hwa;Kang, Sun-Hee;Jeong, Mi-Ae
    • Journal of the Korea Academia-Industrial cooperation Society
    • /
    • v.11 no.12
    • /
    • pp.4873-4880
    • /
    • 2010
  • This study adopted two instruments, i.e. Oral Health Impact Profile-14 (OHIP-14: index of patient's subjective oral health impact) and Todai Health Index (THI: index of patient's subjective systemic health) The Purpose of this study was to determine potential effects of oral health upon systemic health and quality of life (QOL) and provide required basic reference data for developing oral diseases prevention program and public oral health improvement As a result, it may contribute to improving health and quality of life in local community. Analysis on OHIP for subjective oral health conditions revealed that there were significant differences among all categories of self-aware oral health conditions on statistic basis and good oral health group showed significantly higher total OHIP points (4.33) than any other group. Analysis on THI for subjective oral health conditions showed that there were significant differences among all categories of self-aware oral health conditions on statistical basis and very good oral health group got higher total THI points (3.83) than any other group. Analysis on QOL for subjective oral health conditions suggested that there were significant differences among all categories of self-aware oral health conditions but social category and good oral health group got highest total QOL points (3.39) of all groups.