• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.20 no.3
• /
• pp.417-422
• /
• 2019

Hemodynamically unstable pelvic fractures show a remarkably high mortality rate of 40% to 60%. However, their standard of care remains controversial. We report here a case of a 78-year-old woman who was admitted to the Emergency Department with pelvic pain following a fall. Based on pelvic radiography, she was diagnosed with an unstable pelvic fracture. Her blood pressure was 60/40 mmHg, and owing to her unstable vital signs, emergency angiography was performed without computed tomography (CT). Both internal iliac arteries were embolized without sub-branch selection for prompt control of pelvic bleeding. Following embolization, her vital signs were stabilized. Subsequent CT revealed free intra-abdominal air, suggesting bowel perforation had occurred and necessitating emergency laparotomy. An approximately 1 cm-sized free perforation of the small intestine was identified intraoperatively, and primary closure was performed. A retroperitoneal hematoma identified intraoperatively was not explored further because it was a non-expanding and non-pulsatile mass. The patient was admitted to the Intensive Care Unit and transferred to the general ward on postoperative day 3. In this case, the hemodynamically stable pelvic fracture with bowel perforation was successfully and safely treated by prompt angioembolization without conducting CT.

• Korean Journal of Family Social Work
• /
• no.55
• /
• pp.59-90
• /
• 2017

The purpose of this study is to identify the overall effect of Family Hope Partner Project conducted by the Korean Association for Children with Leukemia and Cancer (KACLC) for pediatric cancer patients and their families and provide empirical basic data for the support of them. For this purpose, this study applied a qualitative research methodology as follows; 6 parents and 5 children who used the service for more than one year through the Family Hope Partner Project participated in the interviews. The interviews were conducted from June to July 2016, and the collected data were analyzed through the processes of qualitative analysis. The results of this study are as follows. Pediatric cancer patients and their families who were previously confronted with problems such as a 'barrier of severe pain' and 'swirling anxiety and exhaustion' experienced multi-dimensional effects, thanks to the intervention of 'a genuine master serving as a stepping stone toward their recovery and growth', who were linked to the pediatric cancer patients through Family Hope Partner Project. In other words, they experienced positive effects such as 'support for overall rehabilitation of pediatric patients', 'improvement of family relations', 'relief of needs for social relations', and 'liberation from pressure'. The results of this study were meaningful, in that it substantially corroborated the multidimensional effects of the Family Hope Partner Project, and presented the development direction of the Family Hope Partner Project, which was the first of its kind at home and abroad initiated by the Korean Association for Children with Leukemia and Cancer (KACLC) for pediatric cancer patients and their families.

• Asian Spine Journal
• /
• v.12 no.6
• /
• pp.1060-1068
• /
• 2018

Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

• Pediatric Infection and Vaccine
• /
• v.28 no.3
• /
• pp.173-180
• /
• 2021

After initial reports of multisystem inflammatory syndrome in children (MIS-C) in April 2020 in Europe, this disease has been known to occur in children with recent history of coronavirus disease 2019 (COVID-19) and most cases have been reported in Europe and the Unites States of America. We report a case of a 14-year-old girl who was diagnosed with MIS-C with acute myocarditis and successfully treated with intravenous immunoglobulin (IVIG), methylprednisolone, and anakinra. At initial presentation, she had persistent high fever, generalized rash, generalized swelling, abdominal pain, and low blood pressure. She showed a remarkably elevated level of inflammation and cardiac enzyme markers and had a previous history of COVID-19 5 weeks before the initial presentation. After extensive work up, other infectious and non-infectious causes were excluded. She was diagnosed with MIS-C and initially treated with IVIG and high-dose methylprednisolone; however, despite treatment, her heart function deteriorated and coronary artery dilatation progressed. Therefore, anakinra, an interleukin-1 receptor antagonist, was administered on hospital day 6, after which her cardiac function exhibited improvement. She was discharged on hospital day 19 without any symptoms, and follow-up echocardiography after 1 month revealed fully recovered heart function with normal coronary arteries.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.23 no.1
• /
• pp.19-28
• /
• 2023

Background: Fearful and anxious patients who find dental treatment intolerable without sedative and analgesic support may benefit from moderate sedation. Target controlled infusion (TCI) pumps are superior to bolus injection in maintaining low plasma and effect-site concentration variability, resulting in stable, steady-state drug concentrations. We evaluated the safety and efficacy of moderate sedation with remifentanil and propofol using TCI pumps in non-hospital dental settings. Methods: A prospective chart review was conducted on 101 patients sedated with propofol and remifentanil using TCI pumps. The charts were completed at two oral surgeons and one general dentist's office over 6 months. Hypoxia, hypotension, bradycardia, and over-sedation were considered adverse events and were collected using Tracking and Reporting Outcomes of Procedural Sedation (TROOPS). Furthermore, patient recovery time, sedation length, drug dose, and patient satisfaction questionnaires were used to measure sedation effectiveness. Results: Of the 101 reviewed sedation charts, 54 were of men, and 47 were of women. The mean age of the patients was 40.5 ±18.7 years, and their mean BMI was 25.6 ± 4.4. The patients did not experience hypoxia, bradycardia, and hypotension during the 4694 min of sedation. The average minimum Mean Arterial Pressure (MAP) and heartbeats were 75.1 mmHg and 60.4 bpm, respectively. 98% of patients agreed that the sedation technique met their needs in reducing their anxiety, and 99% agreed that they were satisfied with the sedation 24 hours later. The average sedation time was 46.9 ± 55.6 min, and the average recovery time was 12.4 ± 4.4 min. Remifentanil and propofol had mean initial effect-site concentration doses of 0.96 µ/.ml and 1.0 ng/ml respectively. The overall total amount of drug administered was significantly higher in longer sedation procedures compared to shorter ones, while the infusion rate decreased as the procedural stimulus decreased. Conclusion: According to the results of this study, no patients experienced adverse events during sedation, and all patients were kept at a moderate sedation level for a wide range of sedation times and differing procedures. The results showed that TCI pumps are safe and effective for administering propofol and remifentanil for moderate sedation in dentistry.

• Journal of Industrial Convergence
• /
• v.21 no.7
• /
• pp.51-63
• /
• 2023

This study aimed to verify the effects of a 4-week program of ankle-strengthening exercise and toe-taping walk exercise on the basic lower body strength and walking to examine the benefits of the two exercises. The subjects involved 30 women in their 20s enrolled in university A. The subjects were equally divided into three groups - ankle-strengthening exercise group, toe-taping walk exercise group, and control group. The subjects were instructed to massage and do ankle-strengthening exercises using a towel, massage ball, and CRT, for 60 minutes, 3 times a week. They also taped their hallux valgus using a kinesiology tape and walked for 20 minutes with white tape applied. To sum up, the 4-week ankle-strengthening exercise and toe-taping walk exercise were identified to have a partial statistical significance on the basic lower body strength (muscular strength, power, and balance) and walking (length of gait line, plantar pressure, and COP) of women in their 20s. Therefore, the study confirmed the effects of ankle-strengthening exercises and toe-taping walk exercise on the lower body exercise function, and it is considered that further studies should be conducted on more various effects of the exercises by subdividing them into different pain locations and orthomechanic findings.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.24 no.1
• /
• pp.19-35
• /
• 2024

Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 ㎍/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 ㎍/kg, 1-minute), and group 3 (high dose group, 0.2 ㎍/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO₂, respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times. In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion: PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

• Journal of Veterinary Clinics
• /
• v.20 no.1
• /
• pp.33-41
• /
• 2003

The cardiopulmonary and anesthetic effects of tiletamine/zolazepam(TZ, 10 mg/kg IV), xylazine-tiletamine /zolazepam(XTZ, X: 1.1 mg/kg IM, TZ: 10 mg/kg IV) and medetomid-ine-tiletamine/zolazepam(MTZ, M: 30$\mu\textrm{g}$/kg IM, TZ: 10 mg/kg IV) were evaluated to 15 healthy mongrel dogs (4.16$\pm$0.65 kg). These dogs were randomly assigned to the three treatment groups(Control, XTZ, MTZ) with 5 dogs in each group. All experimental animals were premedicated with atropine(0.03 mg/kg, IM). Xylazine or medetomidine were administered to dogs in XTZ group and MTZ group 10 minutes after atropine injection. TZ was administered 20 minutes after atropine injection in all groups. The loss of pain response at pedal reflex and ear pinching tests in XTZ and MTZ groups were much longer compared with those of Control group(P < 0.01). All dogs in this study showed head rocking and hypersalivation during recovery time. Body temperature decreased progressively during experimental period in all groups, but it was not significant. After TZ injection, heart beat rate significantly increased 10 and 20 minutes in Control group, and 20 and 40 minutes in XTZ group(P < 0.05). Respiratory rate significantly decreased 0,10,20 and 40 minutes after 72 injection in XTZ and MTZ groups. In Control group, systolic arterial pressure (SAP) 20 minutes. diastolic arterial pressure(DAP) 10 minutes and mean arterial pressures (MAP) 10 and 20 minutes after 72 injection significantly decreased(P < 0.05). In XTZ group, SAP, DAP and MAP significantly decreased 20 and 40 minutes after 72 injection(P < 0.05). Thus, it was considered that XTZ and MTZ were useful in a canine surgical treatment that requires long anesthetic duration and deep analgesia.

• Journal of Chest Surgery
• /
• v.41 no.5
• /
• pp.610-618
• /
• 2008

Background: There are various treatment modalities for atherosclerotic arterial obstructive disease at the lower limbs, for example, conservative physical therapy, medication, operation etc. Yet it has been established that an arterial bypass operation is the most effective treatment. The aim of this study is to evaluate the effect of arterial bypass operation within our experience and to determine the indicators of treatment. Material and Method: Ninety six patients received arterial bypass operation for atherosclerotic arterial obstructive disease from June 2002 to April 2006. We evaluated the feasibility of arterial bypass operation based on the improvement of symptoms and the ankle-brachial index (ABI) and the surgical outcomes, as based on the complications, the amputation rates and the patency rates. We also assessed the possible risk factors such as gender, age, a smoking history, co-morbidities, the anastomotic sites, the graft size and the graft type. We retrospectively reviewed the medical records of the patients. The total mean follow-up period was $29.4{\pm}13.1$ months. Result: The mean age was $65.95{\pm}9.61$ and there were 88 male patients. The most common clinical manifestation was ischemic resting pain in the lower extremities. The underlying combined diseases were hypertension (61%), diabetes (43%), cardiac problems (35%) and smoking (91.7%). The most frequent site of arterial obstruction was the superficial femoral artery (44 cases, 40%). A femoropopliteal artery bypass operation with a Polytetrafluoroethylene(PTFE) synthetic graft was done in 44 cases (40%) and the great saphenous vein graft was used in 11 cases. The postoperative ABI increased significantly from $0.30{\pm}0.11$ preoperatively to $0.63{\pm}0.11$ (p<0.001) postoperatively. In 8 cases, amputations above the ankle level were necessary. The graft patency rates were 86.4% and 68.0% after 1 and 3 years, respectively. There were 29 cases (30.21%) of patency failure; the male gender, smokers and hypertension were significantly more frequent in the failure group. Of these, hypertension was the most powerful risk factor (p=0.042). Conclusion: The arterial bypass operation is an effective treatment modality for controlling the symptoms such as pain and claudication, and for preventing major amputations for the patients with atherosclerotic arterial obstructive disease. This study suggests quitting smoking, strict blood pressure control, selection of an appropriate graft, regular outpatient follow up and proper medication would offer higher patency rates and more favorable outcomes.

• Journal of Pharmacopuncture
• /
• v.5 no.1 s.8
• /
• pp.113-133
• /
• 2002

Objective: To investigate effects of Cervi Cornu on Adjuvant Athritis in rats, the edema inhibit rate, the anaJgesic effects, the number of WBC, RA facter, Platelet, the quantity of CRP, total protein, albumin and globuline in the blood serum were measured in the arthritis part. Results: The results obtained as fonows ; 1. After arthritis of Sprague dawley(SD) rats was induced by injecting Freund's complete adjuvant for 2 weeks, any treatment was not for Control group, acupunctured for Treat Ⅰ group. normal saJine was ora] administrated for the Treat Ⅱ group, Cervi Cornu Ex. was oral administrated for Treat Ⅲ, and Cervi Cornu Herbal-acupullcture was injected for Trea Ⅳ group during 2 weeks every other day. Selected point was on pressure pain point in both groups. And then the edema inhibit rate were checked. The edema inhibit rate was $46.03\%$ in Treat I group, $43.24\%$ Treat IV group, $37.44\%$ in Treat III. there was significance in the edema inhibit rate between Control group and Treat group, in order of Treat Ⅰ, Ⅳ, Ⅲ.(p<0.05) 2. The analgesic effects was $7.58{\pm}1.80$(${\times}10$gm) in Control group. $11.00{\pm}1.10$(${\times}10$gm) in Treat Ⅰ group. $99.92{\pm}1.28$(${\times}10$gm) in Treat Ⅲ group and $14.67{\pm}1.03$(${\times}10$gm) in Treat Ⅳ group. There was significance in the analgesic effects between Control group and Treat group(p<0.05) 3. The number of WBC was $14.72{\pm}1.48$(${\times}10^3$㎕) in control Group, $10.26{\pm}1.13$(${\times}10^3$㎕) in Treat Ⅰ group, $11.00{\pm}1.13$(${\times}103$㎕) in Treat Ⅱ Group and $9.63{\pm}1.75$(${\times}10^3$㎕) in Treat Ⅳ group. There was significance in the number of WBC between Control group and Treat group(p<0.05) 4. The content of total protein in the blood serum were $6.13{\pm}0.05$g/dl in control group, $5.73{\pm}0.14$g/dl in Treat I group, $5.88{\pm}0.13$g/dl in Treat Ⅲ group and $5.90{\pm}0.13$g/dl in Treat IV group. There was significance in The content of total protein in the blood serum between Control group and Treat group(p<0.05) 5. The contests of albumin in the blood serum were $2.32{\pm}0.12$g/dl in the Control group, $2.35{\pm}0.05$g/dl in Treat Ⅰ group, $2.35{\pm}0.05$g/dl in Treat Ⅱ group, $2.30{\pm}0.06$g/dl in Treat Ⅲ group, $2.42{\pm}0.08$g/dl in Treat IV group. There was no significance in The content of albumin in the blood serum between Control group and Treat group(p<0.05) 6. The contests of globulin in the blood semm were $3.68{\pm}0.08$g/dl in the Control group, $3.43{\pm}0.12$g/dl in Treat Ⅰ group, $3.55{\pm}0.10$g/dl in Treat IV group. There was significance in The content of globulin in the blood serum between Control group and Treat group(p<0.05) 7. The numbers of RA factor were $3.47{\pm}0.54$IU/ml in Control group and $2.38{\pm}0.50$IU/ml in Treat Ⅱ group. There was significance inThe numbers of RA factor between Control group and Treat group(p<0.05) 8. The numbers of platelet were $1126.33{\pm}1126.33{\pm}85.93{times}10^3$/㎕ in Control group, $1043.33{\pm}80.80{times}10^3$/㎕ in Treat Ⅰ group, $1116.82{\pm}77.93{times}10^3$/㎕ in Treat Ⅱ group, $1164.17{\pm}94.02{times}10^3$/㎕l in Treat Ⅲ group, $1076.67{\pm}54.84{times}10^3$/㎕ in Treat Ⅳ group. There was no significance in The numbers of platelet between Control group and Treat group(p<0.05) 9. The quantity of CRP were $0.05{\pm}0.01$mg/ml in Control group, $0.05{\pm}0.01$mg/ml in Treat Ⅰ group, $0.06{\pm}0.01$mg/ml in Treat Ⅱ group, $0.05{\pm}0.00$mg/ml in Treat Ⅲ group, $0.05{\pm}0.00$mg/ml in Treat Ⅳ group. There was no significance in The quantity of CRP between Control group and Treat group(p<0.05) Concluslon : From these results, it is shown Cervi Comu Herbal-acupuncture more efffective thaJJ Cervi Cornu Ex. on Adjuvant Arthritis in rats.