• Journal of Oral Medicine and Pain
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• v.20 no.1
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• pp.39-52
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• 1995

Burning mouth syndrome is characterized by a burning sensation in oral cavity without clinical signs. There has b een no established theories about the diagnosis and treatment. The purpose of this article is to examine the clinical feature of BMS patients of Korean and to present a treatment protocol that can be helpful in clinical applications. The subjects chosen for the study were 52 patients who had visited Department of Oral Diagnosis at Yonsei University Dental Hospital and were diagnosed as BMS. We did questionnaires and precise oral exam, laboratory exam, grouping of our patients, individual treatment for the groups and classification of responses to the treatment. The following results were obtained: 1. Chief complaints were throbbing (71.2%), pricking, stinging, tingling (30.8%), burning(25a%). The tongue is the most frequently affected site (82.7%), followed by full mouth, gingiva, palate, buccal mucosa, lips, throat, labial mucosa and floor of mouth. 2. The average age of onset was 48.1 year and the male to female ratio was 1 to 3. The average duration of symptom was 11.69 months for male and 23.07 months for female. 3. 32.7% of patients had appealed continuous pain, which was the most cases. Aggravating factors were peppery food, salty food, hot food, fatigue, tension conversation, sour food, cold food and toothpaste. Reducing factors were cold food, diet, going to sleep and smoking. 4. Associated symptoms were dry mouth, other life problem, altered taste perception, bad taste, throat pain, tingle and difficulty in swallowing. 5. Most of patients had appealed that there was not associated event on onset of symptom, and the order of prevalence is as fallow; dental treatment, stress, denture wearing, an attack of a systemic disease. 92.3% of patient appealed that there was no psychological withering and 7.7% of patients appealed positively. 6. There were eight males and four females that had jobs. 7. There was no family history in 100% of patients in questions about presence of family history. 8. 96.2% of patients appealed that there was no oral habits. 13.5% of patients had dryness of oral mucosa in oral exam. A significant relation to dental prosthesis was not observable, but incidence of diseases due to stress appeared high in BMS which had the clinical characteristics as above. A group having low serum iron was 63.5% and in this group period of potential iron deficiency appeared high in incidence just before move to anemia. A group represented positive response was 38.5% in fungus study for Candida albicans. Since we can expect high treatment response by prescription of iron-contained drug and antifungal drug in these patients, diagnosing patients' condition of BMS can be achieved in more various aspects through study for serum iron and Candida albicans. Furthermore, it is expected that treatment protocol can be made.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.197-202
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• 2008

Purpose: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. Materials and Methods: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than $75^{\circ}$ and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). Results: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and $82^{\circ}$ to postoperative 2.3 and $57^{\circ}$, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. Conclusion: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.

• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.1
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• pp.37-46
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• 2016

Purpose: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). Methods: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using ${\chi}^2$-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. Results: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). Conclusion: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.257-262
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• 2011

Purpose: In neurofibromatosis patients, complete surgical excision of the mass is almost impossible and surgical treatment usually consists of multiple serial excisions that only result in a debulking effect. Remnant tumor mass has a gravitational effect on facial soft tissues that leads to sagging of skin and soft tissue, and eventually, facial disfigurement and asymmetry. The purpose of our surgical method is to perform soft tissue lifting with longer lasting effect with less surgical risk of damaging facial nerve and vessels. With external fixation using K-wire or surgical screw, the procedure only called for a short incision length and had additional adhesive properties that enabled anchoring of soft tissue in a lifted position for a longer postoperative period. Methods: A total of 5 neurofibromatosis patients (NF-1) visited our clinic for mass reduction and face lifting. The age of patients ranged from 13 to 42 (mean 28.8 years), and most patients had a long history of multiple excisions in the past. Face lifting was performed in 2 different areas, the periorbital area in 3 patients, and the midface in 2 patients. The materials used in fixation of retaining ligament were K-wire (n=3) and titanium screw (n=2). Results: Follow up period was from 5 month to 3 years and 1 month (mean=2 years and 1 month). All patients conveyed satisfaction with the results and no major complications were reported. The lifting effect lasted for as long as 3 years, and there were no complaints of relapse of soft tissue depression or sagging within the operated area. 1 patient (M/13) needed secondary k-wire insertion and additional mass excision in 1 year and 10 months postoperatively due to tumor growth. In two patients with K-wire fixation, mild dimpling and tenderness were observed in the follow up period, but in about 2 months postoperatively, dimpling was relieved and there was no need for removal of fixating material. Conclusion: Surgical lifting in neurofibromatosis patients can be challenging, for mass excision cannot be done completely and gravitational effect by residual mass can be persistent. External fixation of the retaining ligament in patients with neurofibromatosis can give satisfactory results-for incision length is relatively shorter, and the lifting effect can last longer compared to other various face lifting techniques.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.186-189
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• 1998

Malignant mesenchymoma is a very rare tumor presented during the embryonic and infant period and malignant mesenchymoma in the adult is extremely rare. Tumor is composed of two or more unrelated mesenchymal derivatives apart from fibrous tissue. These tumors are thought to be originated from embryonic mesenchyme capable of differentiating into any type of connective tissue. A 61 years old man with complaints of cough and copious sputum of onset of two months was admitted after initial examinations, showing a very huge mass over the right upper lobe. Right pneumonectomy with partial rib resection of 3rd, 4th, and 5th ribs was performed due to the initial diagnostic impression of squamous cell carcinoma by the fine needle aspiration biopsy. The operative field presented a mass locating across the interlobal fissure with severe adhesions to the chest wall. Postoperatively, the patient received 5,000 rads of radiotherapy and presently, 6 months later, has shown no signs of recurrence.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.298-302
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• 2008

We experienced a case of tuberculosis presented simultaneously with pseudoaneurysm of the aorta and ARDS. A 63-year-old man was admitted with complaints of fever and right upper quadrant abdominal pain for a week. Chest X-ray on admission showed a normal finding. Sub-diaphragmatic abscess on abdomen CT scan was suspected and serosanguinous fluid was aspirated from the abscess pocket. On day 2, he was getting more dyspneic and chest X-ray revealed extensive bilateral infiltration. Aspirated fluid revealed AFB. Later, follow-up abdomen CT scan revealed a leakage of dye from the aneurysmal sac of the descending aorta which was previously diagnosed as sub-diaphragmatic abscess. An aortic stent was placed, covering the opening into the aneurysm. The sputum also showed positive AFB. The patient was successfully weaned from the ventilator, and discharged with anti-tuberculous medication on day 42. Follow-up abdomen CT scan 6 months later showed that the aneurymal sac was completely disappeared.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.30-34
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• 2003

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiographic with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, heompericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.109-114
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• 2013

Chemical burn on the oral mucosa is caused by contact with various chemical products and manifests with localized mucositis, keratotic white lesions, bleeding, and painful tissue surface due to the coagulation of the tissue. Policresulen ($Albothyl^{(R)}$) is a topical antiseptic, commonly used over-the-counter drug for vaginitis, thrush and stomatitis. This drug is highly acidic with pH 0.6, and can act as a strong corrosive agent to oral mucosa. When inadvertently used in oral cavity, it may cause chemical burns of oral mucosa, resulting necrosis and bleeding surface resembling to erythema multifome. A 56 years old female patient presented with the chief complaints of painful ulcerations on the tongue, the upper and lower lips. On intraoral examination, an erythromatous, erosive or ulcerative surface covered with inflammatory exudates or bleeding crust is observed on the anterior half of the tongue and the upper and lower lips. She has occasionally applied the policresulen solution topically on the tongue to relieve pain from recurrent focal glossitis for about 10 years. In this time she applied it broadly and repeatedly to the tongue, the upper and lower lips for the purpose of pain relief by herself without instruction by physician or dentist. After cessation of policresulen application, the oral mucosa was rapidly recovered with use of topical steroids. In 2 weeks the lesions subsided completely. In summary, inadvertent use of $Albothyl^{(R)}$ on oral mucosa may result in chemical burn, causing mucosal erosion, ulceration and inflammation. It can be recovered by topical use of corticosteroid for 2 weeks after cessation of using $Albothyl^{(R)}$.