• Title/Summary/Keyword: Conservative Treatments

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Morphologic Changes of L5 Root at Coronal Source Images of MR Myelography in Cases of Foraminal or Extraforaminal Compression

  • Kim, Soo-Beom;Jang, Jee-Soo;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.46 no.1
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    • pp.11-15
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    • 2009
  • Objective: Two findings easily found at coronal source images of MR myelography (MRM) were evaluated : dorsal root ganglion (DRG) swelling and running course abnormality (RCA) of L5 exiting root at foramen or extraforamen. We tried to find the sensitivity of each finding when root was compressed. Methods: From 2004 July to 2006, one hundred and ten patients underwent one side paraspinal decompression for their L5 root foraminal or extraforaminal compression at L5-S1 level. All kinds of conservative treatments failed to improve leg symptom for several months. Before surgery, MRI, CT and MRM were done. Retrospective radiologic analysis for their preoperative MRM coronal source images was done to specify root compression sites and L5 root morphologic changes. Results: DRG swelling was found in 66 (60%) of 110 patients. DRG swelling has statistically valuable meaning in foraminal root compression (chi-square test, p<0.0001). Seventy-two (66%) in 110 patients showed abnormal alteration of running course. Abnormal running course has statistically valuable meaning in foraminal or extraforaminal root compression (chi-square test, p<0.0001). Conclusion: Three-dimensional MRM provides precise thin sliced coronal images which are most close to real operative views. DRG swelling and running course abnormality of L5 exiting root are two useful findings in diagnosing L5 root compression at L5-S1 foramen or extraforamen. MRM is thought to provide additional diagnostic accuracy expecially in L5-S1 foraminal and extraforaminal area.

Korean Medical Treatment for Improving Symptoms of Four Patients Diagnosed with Grade II Lumbar Spondylolisthesis

  • Park, Han Sol;Kim, Min Chul;Kim, Seh Young;Seo, Young Woo;Seo, Young Hoon;Lee, Sang Min;Lee, Seung Won;Kim, Ki Ok;Kim, Tae Hun
    • Journal of Acupuncture Research
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    • v.31 no.2
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    • pp.153-163
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    • 2014
  • Objectives : To investigate the clinical results of patients who were diagnosed with grade II spondylolithesis treated with Korean medicine of relaxative Chuna and Gangchuk herbal medicine. Methods : We reviewed medical records of four patients diagnosed with grade II spondylolisthesis. Each patient has taken intensive Korean medical admission treatment at Mokhuri Hospital. All patients received treatments of Gangchuk herbal medicine, relaxative Chuna and acupuncture during admission period. Before treatment and every after 7-day treatment the patient's pain and walking distance without pain were assessed. The zero minimum to ten maximum pain numeric rating scale(NRS) was used to determine the degree of pain. Results : Average admission duration was 23 days. All the patients' NRS decreased from median figure of 7.5[the minimum 7 to the highest 8] to median figure of 1[the minimum 0 to the highest 2]. Walking distance without pain increased from a median of 55 m[the minimum 20 m to the highest 100 m] to median of 165 m[the minimum 100 m to the highest 250 m]. Conclusions : Intensive conservative korean medical treatment was effective in reducing pain and functional improvement for grade II lumbar spondylosisthesis patients.

DENTAL MANAGEMENT OF A PATIENT WITH PRADER-WILLI SYNDROME : A CASE REPORT (Prader-Willi syndrome 환자의 치과 치료 : 증례보고)

  • Lee, Myeong-Yeon;Jung, Younwook;Kim, Seong-Oh;Choi, Hyung-Jun;Son, Heung-Kyu;Lee, Hyo-Seol
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.10 no.1
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    • pp.26-30
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    • 2014
  • Prader-Willi syndrome (PWS) is a rare neurodevelopmental disease caused by abnormality of chromosome 15q11-13. The estimated prevalence of PWS is 1/10,000-30,000. Most common features of this disease are feeding problems characterized by poor sucking habit related with neonatal or infantile hypotonia and obesity due to early childhood hyperphagia involved with lack of satiety. In the orodental findings, enamel hypoplasia, rampant caries, delayed eruption, poor oral hygiene, hypodontia, supernumerary teeth, increased tooth wear, decreased salivary flow and change in saliva composition were reported. This case report describes the dental treatment of 3-year-9-months-old male patient with PWS. Periodic check-ups and conservative treatments were followed, however, rapid dental caries progression caused by estimating hyposalivation was observed. Because of lack of patient cooperation, dental procedures were performed under general anesthesia.

A Retrospective Clinical Study of Survival Rate for a Single Implant in Posterior Teeth (구치부 단일 임플란트의 생존율에 대한 후향적 연구)

  • Han, Sung-Il;Lee, Jae-Hoon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.34 no.3
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    • pp.186-199
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    • 2012
  • Purpose: Single implants, of which screw loosening has been observed frequently, presents problems such as fixtures fractures, marginal bone loss, and inflammation of the soft tissue around the implant. However, the single implant is more conservative, cost effective, and predictable compared to the 3 unit bridge with respect to the long-term outcome. This study evaluated the survival rate as well as future methods aimed at increasing the survival rate in single implants in posterior teeth. Methods: Among the implants placed in the Dankook University Dental Hospital department of Oral & Maxillofacial surgery from January 2001 to June 2008, 599 implants placed in the maxillar and mandibular posterior were evaluated retrospectively. Survival rates were investigated according to implant location, cause of tooth loss, gender, age, general disease, fixture diameter and length, surface texture, implant type and shape, presence of bone graft, surgery stage, surgeons, bone quality and opposite teeth. Results: Out of 599 single implants in posterior teeth, 580 implants survived and the survival rate was 96.8%. The difference in survival rate was statistically significant according to the implant location. The survival rate was low (84.2%) in implants exhibiting a wide diameter (${\geq}5.1mm$) and the surface treated by the acid etching group demonstrated a significantly lower survival rate (91.1%). One stage surgical procedure, which implemented a relatively better bone quality survival rate (100%), was higher than the two stage surgical procedure (96.1%). The survival rate of type IV bone quality (75%) was significantly lower than the other bone quality. Conclusion: Single posterior teeth implant treatments should use an improved surface finishing fixture as well as careful and safe procedures when performing implant surgery in the maxilla premolar and molar regions since bone quality is poor.

A Clinical Case Report Treated by Megadose Pharmacoacupuncture and Korean Medical treatments for the three Patients with HIVD of L-Spine and one Patient with HIVD of C-Spine (대용량약침 및 한방치료를 적용한 요추 추간판 탈출증 환자 치험 3례, 경추 추간판 탈출증 환자 치험 1례)

  • Ju, Yeong-Guk;Kim, Tae-Ho;Lee, So-Jin;Ahn, Sang-Min;Sin, Su-Ji;Kwon, Ok-Jun;Kim, Joo-Won;Yoon, Moon-Sik
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.10 no.2
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    • pp.61-71
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    • 2015
  • Objective : To report cases of HIVD of C&L-Spine successfully treated with conservative Korean Traditional Medicine treatment with Megadose Pharmacoacupuncture. Methods : Four patients diagnosed with HIVD of C&L-Spine were treated with Megadose Pharmacopuncture, acupuncture and herbal medicine. Numeric Rating Scale(NRS), Neck Disablility Index(NDI) and Oswestry low back pain Disablility Index(ODI) scores were collected before and after treatment for comparison. Results : There was a significant decrease in NRS, NDI and ODI scores. The mean NRS score decresed from 9 to 2.25, NDI from 45 to 14 and ODI from 46.66 to 11.33. Conclusion : The result suggests Megadose Pharmacoacupuncture can be an effective treatment on patients with HIVD of C&L-Spine.

Treatment of Otitis Media in Cleft Palate (구개열 환자에 있어 중이염의 치료)

  • Pang, Kang-Mi;Ji, Young-Min;Kim, Seong-Min;Myoung, Hoon;Choi, Jin-Young;Lee, Jong-Ho;Choung, Pil-Hoon;Kim, Myung-Jin;Hwang, Soon-Jung
    • Korean Journal of Cleft Lip And Palate
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    • v.10 no.2
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    • pp.89-96
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    • 2007
  • Otitis media with effusion is known to be very common among children with cleft palate and is the common cause of acquired hearing loss in childhood. The purpose of the present study was to examine the anatomic variances, incidence and treatment of middle ear disease in children with cleft palate. In Korea, before 4-year-old age, the prevalence of otitis media was as high as 91.7%. Common treatments for otitis media were conservative or surgical treatment. The medical treatment options include the use of decongestants, antihistamines, antibiotics and mucolytics. Surgical treatment options include grommet insertion, myringotomy. Unlike the case for children without clefts, cleft patient has a higher incidence of recurrence, so surgical treatment between the age of 3 month and 6 month was recommended. The effect of palatoplasty on middle ear disease has remained controversial. Early and periodic evaluation on the symptomatic infection or significant of hearing loss was recommended.

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Stereotactic Lumbar Dorsal Root Ganglionotomy in the Management of Intractable Pain -A case report- (난치성 통증 환자의 치료를 위한 정위적 요부 후근신경절 절제술 -증례 보고-)

  • Shin, Keun-Man;Ahn, Cheol-Soo;Hong, Soon-Yong;Choi, Young-Ryong;Son, Ho-Kyun
    • The Korean Journal of Pain
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    • v.9 no.2
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    • pp.407-411
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    • 1996
  • Stereotactic radiofrequency dorsal root ganglionotomy can be very useful procedures for the treatment of pain emanating from the lumbar segmental nerves. This procedure is reserved for patients who have failed conservative interventional treatments and in whom open surgical intervention is not an option. The advantages of the radiofrequency lesion method are presented, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neural tissue. The afferent fibers in the ventral root which are spared by dorsal rhizotomy but nerve fibers with their cells in the ganglion from either dorsal or ventral root can be destructed with stereotactic radiofrequency ganglionotomy. This technique is performed using a 100 mm cannula with a 5 mm active tip. Repeated lateral fluoroscopic view should be taken to make sure that cannlua still resides within the superior, dorsal quadrant or the foramen. With the cannula in this position, electrostimulation is performed and good paresthesia on the leg should be noted with 0.3 and 0.5 volt at 50 Hz stimulation. At 2Hz stimulation distinct dissociation between motor and sensory should be shown. Percutaneous lumbar ganglionotomy have carried out under local anesthesia on inpatient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have been relieved of pain without serious complications.

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Chronic Compartment Syndrome and Stress Fracture (만성구획증후군 및 스트레스 골절)

  • Choi, Chang-Hyuk;Baek, Seung-Hoon;Jang, Il-Woong
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.9 no.1
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    • pp.16-21
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    • 2010
  • The prevalence of overuse syndrome in the lower extremity including chronic compartment syndrome and stress fracture is increasing with popularity of sports activities. Chronic compartment syndrome is defined as elevation of the interstitial pressure during exertional activities in a closed osseofascial compartment that results in microvascular compromise and operative procedures can be necessary if conservative treatments fail. Stress fracture can be classified as fatigue and insufficiency fracture; stress fracture occurs by repeated strain under abnormal conditions from the patient's activity whereas insufficiency fracture does by those from a process intrinsic to the bone. Most stress fractures occur in the lower extremity, most commonly in the tibial region. Fatigue fractures begin in athletes with the change in their training programs. The radiographic findings are usually diagnostic or at least strongly suggestive and MRI has proven to be a beneficial diagnostic tool for difficult diagnostic cases. Fatigue fractures are treated with a decrease in activity, but surgical procedure may be necessary in those in anterior cortex of the tibial diaphysis.

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Review of Acute Traumatic Closed Mallet Finger Injuries in Adults

  • Botero, Santiago Salazar;Diaz, Juan Jose Hidalgo;Benaida, Anissa;Collon, Sylvie;Facca, Sybille;Liverneaux, Philippe Andre
    • Archives of Plastic Surgery
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    • v.43 no.2
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    • pp.134-144
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    • 2016
  • In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

Clinical Outcomes of Percutaneous Lumbar Discectomy Using Dekompressor(R) (Dekompressor(R)를 이용한 요부의 경피적 추간판 감압술의 임상 결과)

  • Han, Sun Sook;Sim, Sung Eun;Kim, Yang Hyun;Lee, Eun Hyoung;Joh, Ju Yeon;Kim, Ji Young;Lee, Sang Chul
    • The Korean Journal of Pain
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    • v.18 no.2
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    • pp.187-191
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    • 2005
  • Background: Discogenic leg pain is a major cause of health problems, often due to herniation of the intervertebral disc, and has traditionally been treated conservatively or with an open surgical discectomy. Conventional open surgery has many complications, such as nerve root injury, discitis and a relatively high mortality rate; failure of conservative treatments is also common. Recently, the $Dekompressor^{(R)}$ Percutaneous Lumbar Discectomy probe was developed. Herein, we present the early results for a percutaneous lumbar discectomy in herniated lumbar disc disease. Methods: Eleven patients, including 8 men and 3 women, with ages ranging from 22 to 78 years, were enrolled in this study. Those patients with a previous history of back surgery were not excluded from the study. All patients were postoperatively evaluated for their clinical outcomes, such as visual analogue scale (VAS) for pain after 1 and 3 months, reduction in analgesics, functional improvement and overall satisfaction. Results: The percutaneous lumbar discectomy was completed in 11 patients (17 levels), with average reductions in pre-VAS of 61.3 and 60.2% at 1 and 3 months, respectively. Also, 72.7% of patients reported functional improvement, with 81.1% expressing overall satisfaction. There were no procedural related complications. Conclusions: We concluded that a percutaneous lumbar discectomy is a safe and effective treatment modality for a herniated lumbar disc.