• 제목/요약/키워드: A case report

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자폐 환자의 자해로 인한 구강 내 손상 : 증례 보고 (SELF-INJURIOUS BEHAVIOR IN A PATIENT WITH AUTISM : A CASE REPORT)

  • 지은혜;이효설;최형준;김성오;최병재;손흥규;이제호
    • 대한장애인치과학회지
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    • 제8권1호
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    • pp.10-14
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    • 2012
  • 자폐증 및 정신 지체가 있는 환자의 입술 깨물기 증상을 mouthguard를 사용하여 성공적으로 조절하였다. 치과적으로 접근 가능한 구강 내 자해 증상의 치료는 가철성 혹은 고정성 장치를 이용하거나 관련 치아의 발치, 악교정 수술 등을 시도할 수 있으며 각 환자에 맞는 적절한 치료법을 선택하는 것이 중요하다. 자해 행동이 일시적으로 개선되었다 해도 재발의 가능성이 높으므로 장기적인 관리와 소아정신과와의 협진 하에 정신심리학적 환경 개선 및 약물 치료가 병행되어야 할 것이다.

상하악에 동시 다발성 골신장술을 이용한 반안면왜소증의 치험례 (Simultaneous Maxillo-Mandibular Distraction Osteogenesis in Hemifacial Microsomia: a Case Report)

  • 김일규;박종원;이언화;양정은;장재원;편영훈;주상현;왕 붕
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제32권5호
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    • pp.447-453
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    • 2010
  • The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.

흉강경하 흉부교감신경절제술을 이용한 안면다한증 치료 -증례보고- (Thoracoscopic Sympathectomy for a Patient with Facial Hyperhidrosis -A case report-)

  • 문동언;박병철;김병찬;김성년
    • The Korean Journal of Pain
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    • 제9권2호
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    • pp.399-402
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    • 1996
  • Endoscopic transthoracic sympathectomy (ETS) has recently become estabilished as a successful treatment for severe palmar and axillary hyperhidrosis. Descriptions have been published of neurolytic, operative and alternative endoscopic procedures involving thermocoagulation, laser coagulation, or or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. All methods have advantage and disadvantages. A 19-year-old male who suffered from severe hyperhidrosis on face, palms and axillary areas, has been initially treated with stellate ganglion block in other pain clinic. He was transfered to our pain clinic for endoscopic thoracic sympathectomy. The patient was intubated left side 34 Fr. double lumen tube and positioned left semi-lateral position for right sympathectomy. Right side pneumothorax was created by clamping the ipsilateral side of the double lumen tube and aspiration of air. 11-mm trocar was introduced through incision at the third intercostal space in anterior axillary line, and then additional two 11-mm and 5-mm trocar was introduced through second and fifth intercostal space in mid axillary line. The lung was gently retracted and the parietal pleura over the heads of the appropriate ribs excised using 5-mm sharp insulated coagulating microprocesss. The T4, T3, and T2 ganglions, as well as accompanying rami communicantes, and other branchs arising from upper thoracic nerves to the brachial plexus and surrounding tissues were carefully dissected, coagulated. During sympathectomy, skin temperature of middle was continuously monitored. Elevation of palmar skin temperature intraoperatively indicated an adequate sympathectomy with a definite therapeutic effect. A No. 28 Fr. thoracotomy tube was introduced through a troca under video guidance, placed under water seal after the lung was reinflated. the controlateral side was performed same procedure. After bilateral sympathectomy, chest tubes were removed, and then, he was discharged 2 days after operation with great satisfaction. The ETS provides a well-tolerated, cost-effective alternative to thoracic sympathectomy for primary hyperhidrosis and sympathetic mediated neuropathic pain disorder. And T2 ganglion is considered the key ganglion for the treatment of primary hyperhidrosis. The low incidence of compensatory sweating may by explained by the limited extent of the sympathectomy.

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SK텔레콤의 차세대 마케팅 시스템 개발사례 연구 (A Case Study on SK Telecom's Next Generation Marketing System Development)

  • 이상구;장시영;양정연
    • 한국정보과학회논문지:컴퓨팅의 실제 및 레터
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    • 제14권2호
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    • pp.158-170
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    • 2008
  • 무한 경쟁체제인 시장에서 변화하는 요구들을 수용하기 위한 해결책으로, SK 텔레콤은 향후 10년간 증가할 대용량의 데이타 및 트랜잭션을 처리하고, 다양한 마케팅활동 지원이 가능한 새로운 마케팅 시스템을 구축하였다. 이 시스템은 기존의 메인프레임 기반의 COIS시스템을 유닉스기반의 클라이언트 -서버 구조로 변경한 것이며, 웹브라우저 기반 인터페이스를 제공한다. NGM(Next Generation Marketing) 이라고 명명된 이 프로젝트는 그 규모가 전례가 없이 매우 컸다. 그러나 관리 및 기술적 문제들로 인하여 프로젝트는 위험을 맞게 되었다. 기존의 거대 벤더들이 제공하는 소프트웨어 솔루션에 기반한 어플리케이션 프레임워크가 새로운 시스템의 다양하고 방대한 요구조건을 충분히 소화시키지 못했기 때문이다. 결국 2005년 3월 SK텔레콤은 NGM 프로젝트를 보류하였다. 2005년 5월 종합적인 기획 수정을 통해 프로젝트는 2단계에 착수되었다. 새로운 시스템의 복잡도에 대응하기 위해 더 이상 단일 솔루션을 택하지 않기로 결정하여, 새로운 시스템은 커스팀 빌트의 형태가 되었다. 본 논문에서는 성공적인 NGM 프로젝트 수행을 위해 고려된 3가지 기술적 요소 - 미들웨어 및 어플리케이션 프레임워크, 데이타베이스 아키텍처, 튜닝 및 시스템 퍼포먼스 - 에 대하여 다루고 있다. NGM 구축에 있어서 적용된 이 프로세스 및 접근방법은 텔레커뮤니케이션 사업분야에서의 가장 성공적인 실제 적용사례로 볼 수 있다. 완성된 NGM 시스템은 2006년 10월 9일 성공적으로 가동되었고, "U.Key 시스템"으로 명명되었다. 이 새로운 시스템은 가까운 미래에 혁신적이고, 효과적이며 고객지향적인 어플리케이션 둥을 제공할 수 있을 것으로 기대된다.

Glutaric Aciduria Type I 1례 (A Case of Glutaric Aciduria Type I with Macrocephaly)

  • 신우종;문여옥;윤혜란;동은실;안영민
    • Clinical and Experimental Pediatrics
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    • 제46권3호
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    • pp.295-301
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    • 2003
  • 출생 이후 머리둘레가 커지는 1개월 남아에게서 뇌초음파 검사상 지주막하 공간이 확장되어 있고 백질의 음영이 증가 되어 있었고 뇌 MRI 소견은 실비우스열의 확장과 양측 대뇌, 소뇌 피질과 백질이 T1 강조 영상에서 저신호 강도와 T2 강조영상에서 고신호 강도를 보였으며 경피생검으로 얻은 섬유아세포 배양에서 glutaryl-CoA 탈수소효소의 활성도가 전혀 없어 GA1을 확진하게 되었다. 대두증이 있는 신생아나 영아에서 전측두엽 위축의 신경방사선학적 징후가 있으면 우선적으로 GA1을 의심해 보아야 한다. 이후 특수분유인 Glutatex 분유의 수유와 카르니틴, 리보플라빈 보충요법을 시행하여 대사성 위기나 급성 뇌증의 위기 없이 양호한 발달을 하고 있는 환아를 경험하였기에 보고하는 바이다.

다낭신 환자의 요추 추간판탈출증에 대한 통합한방치료 1례 (A Case Report of Lumbar HIVD Treated with Korean Medicine on a Polycystic Kidney Patient)

  • 주아라;류광현;박미소;최요섭;추원정;채지원
    • 대한한방내과학회지
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    • 제41권2호
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    • pp.132-140
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    • 2020
  • Objectives: This research study aimed to determine the effect of Korean medicine treatments on a patient with lumbar disc herniation accompanying polycystic kidney disease. Methods: Acupuncture, herbal medicine, pharmacopuncture, spine decompression therapy, Motion Style Acupuncture Treatment (MSAT), and Chuna were preceded for treatment. We checked the patient's Oswestry Disability Index (ODI), numeric rating scale (NRS), and straight leg raise test (SLRT) on admission and discharge; we also used the NRS and SLRT to evaluate the patient's symptoms on every third day during the hospital stay. Because it is important to manage blood urea nitrogen (BUN), serum creatinine, and blood pressure during the early stage of polycystic kidney disease, BUN and serum creatinine levels were checked weekly while blood pressure was checked every morning. Results: Twelve days after admission, the NRS for lower back pain and right leg pain decreased from 7 to 3 and from 7 to 2, respectively. The ODI value also decreased from 56 to 20 while the SLRT value increased from 30/70 to 60/70. The BUN and serum creatinine levels and the blood pressure readings were all within normal range every time they were checked. Conclusions: The use of Korean medicine treatments resulted in improvements in NRS, ODI, and SLRT on a patient with a herniated lumbar disc herniated who had a past history of polycystic kidney disease; thus, the patient was able to maintaining kidney functioning. Herbal medicine, an alternative method of analgesic anti-inflammatory drugs that has been evaluated as relatively safe on liver and kidney function, could be suggested on a patient with a past history of polycystic kidney disease to maintain kidney function when renal function and blood pressure are monitored.

척추 손상 환자에서 고환 종물로 오인된 거대 요도 결석과 요도루 (Giant Urethral Stone Presenting as a Scrotal Mass and Urethral Fistula)

  • 박승철;이재환;최정우;황용
    • 한국산학기술학회논문지
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    • 제18권12호
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    • pp.208-212
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    • 2017
  • 요도 결석은 매우 드믄 질환으로 보고된 증례가 많지 않으며, 대부분 요도 협착이나 요도 게실이 있는 남성에게서 대게 발생한다. 이에 우리는 20년 전 자동차 사고로 인한 척수 손상 후 하반신 마비가 발생한 42세 남성에서 발견된 거대 요로 결석 증례를 보고하고자 한다. 낮 동안에 다원적 증상을 가지고 있고, 고환 밑으로 종물이 만져지며 혈뇨 및 배뇨시 발생하는 통증을 보이면서 최근에는 소변이 전혀 나오지 않는 증상으로 응급실에 내원하여 비뇨기과 협진이 의뢰되었다. 고환 종물의 성상을 확인하기 위해 복부와 골반 컴퓨터 단층 촬영(CT)이 시행되었다. 검사 결과 종양은 관찰되지 않았다. 하지만, 요도 결석이 확인되었다. 우선적으로 요도성형술을 시행하여 방광루를 제거하였으며, 이후 요로 결석은 제거되었다. 2주 후에 요도조형술을 시행하였고 특이사항이 없음을 확인 후 소변줄을 제거하였다. 현재는 배뇨에 대한 특별한 문제는 없는 상태이다. 거대 요도 결석은 때때로 종양과 감별이 필요하며, 크기와 위치에 따라 치료법이 달라질 수 있어 좀 더 면밀한 검사가 필요하다.

7-dehydrocholesterol reductase (DHCR7) 변이로 진단된 Smith-Lemli-Opitz 증후군 1예 (A case of Smith-Lemli-Opitz syndrome diagnosed by identification of mutations in the 7-dehydrocholesterol reductase (DHCR7) gene)

  • 박미림;고정민;전종근;김구환;유한욱
    • Clinical and Experimental Pediatrics
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    • 제51권11호
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    • pp.1236-1240
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    • 2008
  • Smith-Lemli-Opitz 증후군은 콜레스테롤 합성 과정의 장애로 발생하는 상염색체 열성으로 유전되는 드문 질환으로 다양한 기형을 동반한다. 이는 DHCR7 유전자 변이로 인한 활성도 저하로 발생하는 질환으로 7DHC, 8DHC의 증가 및 체내 콜레스테롤의 감소에 따른 임상상을 특징으로 한다. 저자들은 국내에서 최초로 SLO 증후군을 유전자 분석을 통하여 진단하였기에 이를 문헌 고찰과 함께 보고하는 바이다.

First Report of Myiasis Caused by Cochliomyia hominivorax (Diptera: Calliphoridae) in a Diabetic Foot Ulcer Patient in Argentina

  • Olea, Maria Sofia;Centeno, Nestor;Aybar, Cecilia Adriana Veggiani;Ortega, Eugenia Silvana;Galante, Guillermina Begona;Olea, Luis;Dantur Juri, Maria Julia
    • Parasites, Hosts and Diseases
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    • 제52권1호
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    • pp.89-92
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    • 2014
  • Myiasis is usually caused by flies of the Calliphoridae family, and Cochliomyia hominivorax is the etiological agent most frequently found in myiasis. The first case of myiasis in a diabetic foot of a 54-year-old male patient in Argentina is reported. The patient attended the hospital of the capital city of Tucum$\acute{a} $n Province for a consultation concerning an ulcer in his right foot, where the larval specimens were found. The identification of the immature larvae was based on their morphological characters, such as the cylindrical, segmented, white yellow-coloured body and tracheas with strong pigmentation. The larvae were removed, and the patient was treated with antibiotics. The larvae were reared until the adults were obtained. The adults were identified by the setose basal vein in the upper surface of the wing, denuded lower surface of the wing, short and reduced palps, and parafrontalia with black hairs outside the front row of setae. The main factor that favoured the development of myiasis is due to diabetes, which caused a loss of sensibility in the limb that resulted in late consultation. Moreover, the poor personal hygiene attracted the flies, and the foul-smelling discharge from the wound favoured the female's oviposition. There is a need to implement a program for prevention of myiasis, in which the population is made aware not only of the importance of good personal hygiene and home sanitation but also of the degree of implication of flies in the occurrence and development of this disease.

ESR 자동분석기를 이용한 내부정도관리방법 (The Internal Quality Control for TEST 1, the Automatic Analyzer of Erythrocyte Sedimentation Rate)

  • 조영국;심현설;송운흥;박규은
    • 대한임상검사과학회지
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    • 제36권2호
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    • pp.239-244
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    • 2004
  • Recently automatic equipment has been well popularized for the erythrocyte sedimentation rate, a widely used test, but no standard quality control has been established yet. Thus, we are going to report a case that established and applied a quality control method using the TEST 1 automatic analyzer. For internal quality control, we adopted the repeatability test through comparison with daily mean check, with a manual method using patients' specimens and with the results of a test on the previous day. In order to set the tolerance standard for each quality control method, we compared the results of 50 specimens that showed a wide range of ESR results and examined correlation and differences according to result. After setting the tolerance standard, we applied the standard at tertiary university hospitals for 120 days and investigated positive rates and re-examination rates. If the tolerance standard was exceeded, the cause was also identified. We selected a specimen of below 25 mm/hr (T1), one between 26-50 mm/hr (T2) and one of over 51 mm/hr (T3) at random. The correlation between the manual method and the automatic method was quite high (r=0.98), and it is found appropriate to set based on differences in result values below 25 mm/hr, the upper limit of the reference value, and based on differences in the percentage of result values above 25 mm/hr. Accordingly, we set the criteria for rejection above 10 mm/hr and above 20%. When the criteria were applied in the laboratory, 1.7% of specimens in the range of T1, 8.3% of those in the range of T2 and 7.5% of those in the range of T3 were rejected. Because all the rejected ones fell within the tolerance limit in re-examination calibration verification was not carried out. With the wide popularization of erythrocyte sedimentation rate analyzers that can carry out a lot of tests quickly using automatic methods, it is necessary to improve the reliability of test results by establishing internal quality control policies. We expect that an agreed standard quality control method may be established based on the method proposed in this study.

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