Purpose: Now the CT scanner and PACS program proved to be an excellent instrument for detection and localization of most facial foreign bodies above certain minimum levels of detectability. The severity of injury in penetrating trauma on the face is often underestimated in physical examination. Wood, with its porous consistency and organic nature, provides a good medium for microbial agents. This is a report of our recent experience with wooden foreign bodies in the parotid gland imaged with CT. Methods: A 9-year-old boy was referred for evaluation of possible retained foreign body within his face. One day earlier, he had fallen, face down approximately 1 miter onto ground. He had subsequently undergone an exploration of his right parotido-masseteric area at an outside hospital with repair of a right facial laceration. Enhanced 2 mm axial and coronal CT scans were obtained through the face. Axial and coronal CT images were obtained with a General Electric(Milwaukee, Wis) 9800 CT scanner at 130 kV, 90 mA, with a 2 mm section thickness. Results: We finally decided the linear "gas" attenuation was a foreign body because of its linear configuration, which did not conform to that of an anatomic structure, and on the basis of articles that described a wood foreign body in the orbit as having the appearance of air. We found that wood was hypoattenuating($-464{\pm}27HU$). Conclusion: We recommend this type of software program for CT scanning for any patient with an injury on the face in which a foreign body is suspected.
Purpose: This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury. Methods: We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test. Results: Among the 357 patients, 78 patients had cervical spine injuries. The average age was $43.9{\pm}15.2$ yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively. Conclusion: New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%.
The proper management of the pediatric facial bone fracture is critical in the facial bone development. This study characterizes the surgically treated patient population suffering from facial bone fractures by the use of current data from a large series consisting of 201 cases. The data was gathered through a retrospective chart review of patients surgically treated for facial bone fractures at the department of plastic and reconstructive surgery, Sanggye Paik hospital, Inje university medical center, collected over 10-years period from January, 1993 to December, 2002. Data regarding patient demographics(age, sex), seasonal distribution, location of fractures, and the causes of injury with admission periods, were collected. In total, there were 201cases of pediatric facial bone fractures. Male patients outnumbered female patients by a 5.48: 1 ratio and were found to engage in a wider range of behaviors that resulted in facial bone fractures. Physical violence was the leading cause of pediatric facial bone fractures(27.9%), followed by sports-related mechanisms (22.9%) and falling down(17.9%). The most prevalent age group was 11-15 years-old(71.1%) and there was a 14.3% prevalence in March. Among the location of fractures, the nasal bone was the most prevalent, accounting for 82.3% of injuries, followed by the orbit(9.95%), and the mandible fractures(7.5%). Most patients(59.7%) were treated within 6-9 days after trauma and the mean hospitalization period was 8-11 days. We should follow up the surgically treated patients, and they will be further evaluated about postoperative sequele and effect on the facial bone development. These studies demonstrate differences in the demographics and clinical presentation that, if applied to patients, will enable a more accurate diagnosis and proper management.
Fibrosis of skeletal muscle following acupuncture is an iatrogenic disorder. The present case illustrates a patient with a unilateral fibrotic formation on a thumb muscle after acupuncture injection therapy with red sage. The patient in the present case was a counter-terrorism police officer with right-handedness; he noted a palpable nodule three months after injection therapy at his left first dorsal interosseous in which the acupuncture point LI4 (He Gu) is located. He also found a reduction in the strength of his left pinch grip that noticeably affected his left handgun marksmanship. However, being ambidextrous in single-hand pistol shooting is an essential requirement for counter-terrorism police officers. Based on the patient's medical history and claims, no underlying disease or trauma was found to be associated with his current complaint. During physical examination, a fibrotic formation in his left first dorsal interosseous muscle was visualized by using diagnostic ultrasound; also, as confirmed with dynamometry, the strength of his left pinch grip was significantly lower than that of the right counterpart. Because acupuncture injection therapy has three components, antiseptic practices, the mechanical action of syringe insertion, and the pharmacological effect of the sterile herb extract, any one of the components may have contributed to the present adverse event. The first dorsal interosseous muscle is small in dimension and rather vascular; thus, it is not an ideal site for intramuscular injection. When a clinician needs to treat a patient by performing acupuncture at the LI4 acupoint and injecting a herbal extract simultaneously, the clinician should only mechanically stimulate the LI4 acupoint while injecting the herbal medicine into the LI14 (Bi Noe) acupoint on the same meridian, the LI14 acupoint being located in the distal portion of the deltoid muscle and being fairly close to the universally agreed upon site on the upper arm for safe administration of an injection.
Ji, Na-Ni;Song, Joong-Hyun;Hwang, Tae-Sung;Lee, Hee-Chun;Yu, Do-Hyeon;Kang, Byeong-Teck;Jung, Dong-In
한국임상수의학회지
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제35권3호
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pp.103-106
/
2018
A 12-year-old castrated male Shih Tzu presented with suspected hearing loss. The patient had no history of head trauma or exposure to ototoxic drugs. The results of neurologic and physical examinations were normal. An otoscopic examination showed that both the tympanic membranes and the external ear canals had a normal appearance. However, the results of brainstem auditory evoked response tests confirmed sensorineural deafness in the right ear and indicated conduction disturbances and brainstem abnormalities in the left ear. Magnetic resonance imaging was performed to confirm the causes of the conduction disturbances and brainstem abnormalities. Inflammatory changes in the left middle ear were highly suspected to be responsible for the findings in the left ear. The results of these examinations confirmed complete hearing loss in the right ear and indicated otitis media in the left ear, which could have been the cause of the conduction disturbances.
Objectives : Amnesia is theloss or impairment of memory, caused by physical injury, disease, drugs, or emotional trauma. Recently, the average life span is increasing, while at the same time, the incidence of dementia-like diseases in conjunction with amnesia are also increasing. Therefore learning and memory are very important issues in modern society. Ancient Korean physicians used several herbs to treat dementia and these herbal effects were described in Korean herbal books. Among them are some reports on several cognitive-enhancing herbs which have since been shown to improve dementia in recent pharmacological studies, such as Panax ginseng; however, the facilitatory effects of many Korean cognitive-enhancing herbs on learning and memory are limited. Learning and memory are essential requirements for every living organism in order to cope with environmental demands; cholinergic systems are known to be involved in learning and memory. Methods : In this study, the effects of Acori graminei rhizoma (AGR, 石菖蒲) on learning and memory were investigated by Morris water maze, eight-arm radial maze, and the effects on the central cholinergic system of rats injected with scopolamine. Results : In the water maze, the experimental animals were trained to find a platform in a fixed position for 6 days and then received a 60 sec probe trial in which the platform was removed from the pool on the 7th day. In the eight-arm radial maze, the animals were tested four times per day for 6 days. Scopolamine impaired performance of the maze tests and reduced activity of acetylcholinesterase (AchE) in the hippocampus, which is a marker for the central cholinergic system. There were significant reversals from the scopolamine-induced deficits on learning and memory in these tests, through daily administrations of AGR (100 mg/kg, p.o.) over 14 consecutive days. These treatments also reduced the loss of cholinergic activity in the hippocampus induced by scopolamine. Conclusions : These results demonstrated that AGR ameliorated learning and memory deficits by affecting the central acetylcholine system.
Objects : This study is to be applied effectively to the acupuncture treatment for VDT syndrome. Methods : I referred to occidental and oriental medical records. Results and Conclusion : VDT syndrom is the concept focalizing work environment and labor load, and named all that symptoms according to excessive VDT works. The disorders of VDT syndrome is divided into 2 groups with muscaloskeletal disorders and non-musculoskeletal disorders, and non-musculoskeletal disorders is secondly divided into 3 groups with visual disorders, stress disorders and others. The risk factor of VDT syndrome is divided 4 groups with repetitive acts, consistent works, uncomfortable work postures, unprofitable light environments, jobs needs for excessive power and mental or physical fatigues. In oriental medicine area, I apply VDT syndrome to Kyunbitong(jianbeitong, 肩臂痛) to base on similarities of the risk factors and disorders between VDT syndrome and Kyunbitong(jianbeitong, 肩臂痛), that is painful illness on shoulders, arms, hands and fingers. And, Kyunbitong(jianbeitong, 肩臂痛) is divided 3 groups into Susamuhm(shousanyin, 手三陰), Susamyang(shousanyang, 手三陽) and Joktaeyang(zutaiyang, 足太陽) on the ground of meridian. Disorders related to Kyunbitong(jianbeitong, 肩臂痛) is grounded on kyungmaek(Jingmai, 經脈) disorder called sidongbyung(shidongbing, 是動病) and sosaengbyung(suoshengbing, 所生病) and Kyungkeun(Jingjin,經筋) disorder related to Kyunbitong(jianbeitong, 肩臂痛). As a result of this study, there is many similarities between VDT syndrome and Kyunbitong (jianbeitong, 肩臂痛). On acupuncture treatment, VDT syndrome can be applied to Kyunbitong(jianbeitong, 肩臂痛)'s on the basis of meridians, because of similarities of risk factors and disorders between VDT syndrome and Kyunbitong(jienbeitong, 肩臂痛).
Choi, Jun Ho;Kim, Kwang Seog;Shin, Jun Ho;Hwang, Jae Ha;Lee, Sam Yong
대한두개안면성형외과학회지
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제17권2호
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pp.68-76
/
2016
Background: In scalp allotransplantation, the scalp from a brain-dead donor, including hair, is transferred to a recipient with scalp defects. Opinions differ on the appropriateness of scalp allotransplantation. In order to maintain graft function and cosmetic outcomes, scalp transplantation recipients would need to receive lifelong immunosuppression treatments. The risks of this immunosuppression have to be balanced against the fact that receiving a scalp allotransplant does not extend lifespan or restore a physical function. Therefore, the present study aimed to investigate risk acceptance and expectations regarding scalp allotransplantation in different populations. Methods: A questionnaire survey study was conducted. A total of 300 subjects participated; survey was conducted amongst the general public (n=100), kidney transplantation recipients (n=50), a group of patient who required scalp reconstruction due to tumor or trauma (n=50), and physicians (n=100). The survey was modified by using the Korean version of the Louisville instrument for transplantation questionnaire. Results: Risk acceptance and expectations for scalp transplantation varied widely across the groups. Kidney transplantation recipients revealed the highest risk acceptance and expectations, whereas the physicians were most resistant to the risks of scalp transplantation. Conclusion: Our study demonstrates that, in specific groups, scalp allotransplantation and the need for immunosuppression carries an acceptable risk despite the lack of lifeextending benefits. Our results suggest that scalp allotransplantation can be an acceptable alternative to existing scalp reconstruction surgeries in patients with pre-existing need for immunosuppression.
Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist. (Korean J Pain 2007; 20: 60-65)
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