• Journal of Korean Neurosurgical Society
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• 제29권2호
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• pp.240-248
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• 2000

Objective : Spontaneous intracranial hypotension is a rarely reported syndrome of spontaneous postural headache associated with low CSF pressure and has rarely been demonstrated radiographically or surgically. But recently, it is being recognized with increasing frequency. The purpose of this study was to characterize clinical and imaging features, etiologic factors, and outcome in the spontaneous intracranial hypotension. Patients and Methods : We reviewed our experience with documented cases of spontaneous intracranial hypotension in 5 consecutive patients with orthostatic headaches from April 1998 to April 1999. Results : The mean age was 41 years(from 35 to 49 years). All patients had postural headaches, which were completely alleviated by recumbency position. Nausea, neck pain, horizontal diplopia, photophobia, and blurred vision were noted in some of the patients. Brain MRI showed diffuse pachymeningeal gadolinium enhancement, subdural collections of fluid, and descent of the brain. The opening pressure from lumbar puncture was $4cmH_2O$ or less in three of five patients whereas the opening pressure was within normal range in two patients. All patients underwent radioisotope cisternography and computerized tomographic myelography. On radioisotope cisternography, CSF leakage was suspected at the level of cervical area(1 patient), upper thoracic area(2 patients), mid-thoracic area(1 patient). Computed tomography myelography revealed extraarachnoid accumulation of contrast media(compatible finding with CSF leakage) at the level of cervical or thoracic area. In all patients, the symptoms resolved in response to supportive measures or epidural blood patch(1 patient). Conclusion : Spontaneous spinal CSF leakage is increasingly recognized as a cause of spinal postural headache. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine and can be demonstrated by variable diagnostic method. The condition is usually self-limiting and its prognosis is typically good.

• Journal of Chest Surgery
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• 제39권6호
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• pp.475-478
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• 2006

배경: 동시에 발생한 양측성 자발성 기흉은 아주 드문 질환으로 일측성 기흉과는 달리 긴장성 기흉을 초래하지 않고도 심한 호흡곤란, 청색증, 흉통으로 사망에 이르게 할 수 있어 즉각적인 조치를 필요로 한다. 대상 및 방법: 한전의료재단 한일병원 흥부외과에서는 1994년 3월부터 2004년 2월까지 10년간 총 802명 자발성 기흉 환자 중 14명(1.7%)의 동시에 발생한 양측성 자발성 기흉을 발견하여 치험하였다. 결과: 총 14명 중 2명을 제외한 환자가 남자로 85.7%를 차지하였으며, 환자의 나이는 0세(1일)부터 79세로 넓은 연령층(평균 32.0세)을 보였다. 11명의 환자가 초발성 자발성 기흉이었으며 1명은 좌측 자발성 혈기흉을 동반하였고, 2명은 농기흉을 동반하였다. 신생아를 제외한 환자에 있어 흡연률은 13명 중 6명으로 42.8%였다. 결핵을 앓거나 앓았던 환자는 모두 5명(35.7%)이었으며 이 중 2명을 제외하고 현증 활동성 결핵이었다. 14명 중 3명이 사망하였는데 신생아는 메코니움 흉인성 폐렴으로 당일 사망하였으며, 2명은 급성 호흡곤란증후군과 폐렴으로 사망하였다. 동시에 발생한 양측성 자발성 기흉 환자를 비강을 통한 산소 흡인요법, 폐쇄성 흉강삽관술, 개흉술, 흉강경수술과 화학적 흉막유착술을 시행하여 해결하였다. 결론: 동시에 발생한 양측성 자발성 기흉은 총 802명의 자발성 기흉 환자 중 14명(1.7%)에게서 발생하였다. 증상을 완화시키기 위해 즉각적인 폐쇄성 흉강삽관술이 필요하며 자발성 기흉의 재발률을 낮추기 위해 폐쇄성 흉강삽관술 단독보다는 조기에 개흉술 또는 흉강경수술이 필요할 것이라 생각한다.

• Advances in pediatric surgery
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• 제16권2호
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• pp.117-125
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• 2010

Unreduced small bowel intussusception requires operative treatment although the rate of spontaneous reduction is 60 to 70 %. The aim of this study is to compare clinical characteristics and outcome between spontaneous reduction and operation group and to analyze factors related to decisions to treat small bowel intussusceptions. The records of 25 patients with small bowel intussusceptions treated in Seoul National University Children's Hospital from January 1999 to August 2009 were reviewed respectively. Spontaneous reduction group (n=12, 48 %) had signs and symptoms of vomiting, abdominal pain, currant jelly stool, abdominal distension, fever, increased CRP but no rebound tenderness. One of them had been diagnosed with Henoch-Schonlein purpura and no one displayed pathologic leading point by image study. Operation group (n=13, 52 %) consisted of patients who had primary surgery. Their signs and symptoms were similar to spontaneous reduction group. Seven of them had underlying diseases such as Crohn' disease, ALL, Lymphoma, Peutz-Jeghers syndrome (n=3), post-transplanted state of liver and 2 of them displayed Peutz-Jeghers polyp and Meckel's diverticulum as pathologic leading point by preoperative ultrasonography. Mean relieve interval (interval between onset of symptoms and reduction/operation) was 1.78 days in spontaneous reduction group and 2.25 days in operation group (p=0.341). Seven of operation group had manual reduction and 6 out of 7 received segmental resection of the small bowel. No one of them underwent manual reduction and all of them underwent segmental resection were found to have pathologic leading points [Peutz-Jeghers polyp (n=3), Meckel's diverticulum (n=2), lymphoma (n=1)] during operation. In conclusion, 48% of small bowel intussusceptions resolved spontaneously. Patients' symptoms and relieve intervals were not related to the operative decisions. We therefore recommend significant factors for determining treatment plan such as change of clinical symptoms, underlying disease or pathologic leading point by imaging.

• Journal of Chest Surgery
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• 제38권5호
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• pp.371-376
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• 2005

배경: 저자는 원발성 자연 공기가슴증 환자에서 고식적인 비디오흉강경하 쐐기절제술이 흉강경을 이용한 변형된 소절개술식보다 우수한가를 결정할 목적으로 후향적으로 연구를 하였다. 대상 및 방법: 원발성 자연 공기가슴증을 보인 $14\~35$세 사이의 160명의 환자를 대상으로 하였다. 환자는 수술기법과 수술 접근법에 의해서 고식적인 흉강경하 쐐기절제술군(A군: 80예)과 흉강경을 이용한 변형된 소절개술식을 이용한 군(B군: 80예)으로 분류하였다. 모든 환자에서 술 후 늑막강 첨부의 찰과상과 탈크 도포를 수행하였다. 이 연구는 수술시간, 수술 후 사용한 진통제의 사용일수, 수술 첫날 공기누출이 없는 수, 흉관 삽관일과 병원 입원일, 그리고 술 후 합병증, 추적기간 동안의 만성 흉통과 일상생활로 복귀할 때까지의 기간 그리고 또한 추적기간 동안에 수술동측에서의 재발을 평가하였다. 결과: 양 군사이에서 연구한 평가요소 중 어느 것에서도 의의 있는 차이는 없었다. 결론: 고식적인 비디오 흉강경하 쐐기절제술과 흉강경을 이용한 변형된 소절개술식은 원발성 자연 공기가슴증 환자의 수술적 치료에 있어서 유사한 결과를 야기하였다. 합병증의 발생률도 낮고, 통각도 장기 추적동안에 받아들일 만 하였다. 따라서 흉강경을 이용한 변형된 소절개술식 또한 가치 있는 대체수술 기법으로 보인다.

• Journal of Chest Surgery
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• 제23권5호
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• pp.1035-1039
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• 1990

All 10 cases of spontaneous rupture of esophagus had violent vomiting as precursor. 9 patients were male, 1 case was female. Chief complaints were chest pain and dyspnea. Chest P \ulcornerA and esophagogram were mainly used as confirm diagnostic tool. Perforation sites of all cases were at distal esophagus near the G-E junction. 6 cases were received primary repair within 24 hrs, other cases were managed with surgical drainage after exclusion and diversion of esophagus. Empyema was the most frequent complication. Other complications were sepsis, pneumonia, leaking etc. Overall mortality rate was about 70.0%.

• 국제물리치료학회지
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• 제3권1호
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• pp.345-355
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• 2012

This study purposed to examine the effect of low power laser on pain response and axonal regeneration. In order to prepare peripheral nerve injury models, we crushed the sciatic nerve of Sprague-Dawley rats and treated them with low power laser for 21 days. The rats were divided into 4 groups: normal group(n=10); control group(n=10) without any treatment after the induction of sciatic nerve crush injury; experimental group I(n=10) treated with low power laser(0.21$mJ/mm^2$) after the induction of sciatic nerve crush injury; and experimental group II(n=10) treated with low power laser(5.25$mJ/mm^2$) after the induction of sciatic nerve crush injury. We measured spontaneous pain behavior(paw withdrawal latency test) and mechanical allodynia(von Frey filament test) for evaluating pain behavioral response, and measured the sciatic function index for evaluating the functional recovery of peripheral nerve before the induction of sciatic nerve crush injury and on day 1, 7, 14 and 21 after the induction. After the experiment was completed, changes in the H & E stain and toluidine blue stain were examined histopathologically, and changes in MAG(myelin associated glycoprotein) and c-fos were examined immunohistologically. According to the results of this study, when low power laser was applied to rat models with sciatic nerve crush injury for 21 days and the results were examined through pain behavior evaluation and neurobehavioral, histopathological and immunohistological analyses, low power laser was found to affect pain response and axonal regeneration in both experimental group I and experimental group II. Moreover, the effect on pain response and axonal regeneration was more positive in experimental group I to which output 0.21$mJ/mm^2$ was applied than in experimental group II to which 5.25$mJ/mm^2$ was applied.

• 대한족부족관절학회지
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• 제13권2호
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• pp.236-239
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• 2009

Heel abscesses present as heel pain that progressively worsens, with associated tenderness and fullness a the heel pad. To our knowledge, there are fews reports in the literature describing a spontaneous heel pad abscess. A 48-years old woman presented spontaneously with pain, erythema, edema and increased warmth to this right foot. She has no underlying disease and steroid injection history. A radiologic examination was suggestive of an abscess. Follow incision and drainage, cultures that were taken during the surgical procedure did not produce any organism. The patient was discharged home and recovered from the abscess without recurrence or further surgical intervention.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.109-113
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• 2011

Objective : Peripheral neuropathy is characterized by hyperalgesia, spontaneous burning pain, and allodynia. The purpose of this study was to investigate the effect of rolipram, a phosphodiesterase-4-specific inhibitor, in a segmental spinal nerve ligation model in rats. Methods : Both the L5 and L6 spinal nerves of the left side of the rats were ligated. Phosphodiesterase-4 inhibitor (rolipram) and saline (vehicle) were administered intraperitoneally. We measured mechanical allodynia using von Frey filaments and a nerve conduction study. Results : The mechanical allodynia, which began to manifest on the first day, peaked within 2 days. Multiple intraperitoneal injections of rolipram ameliorated the mechanical allodynia. Furthermore, an intraperitoneal administration of rolipram improved the development of pain behavior and nerve conduction velocity. Conclusion : This study suggests that the phosphodiesterase-4 inhibitor, rolipram, alleviates mechanical allodynia induced by segmental spinal nerve ligation in rats. This finding may have clinical implications.

• Journal of Korean Neurosurgical Society
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• 제44권6호
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• pp.385-388
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• 2008

We herein describe the case of a focal spontaneous spinal epidural abscess who was initially diagnosed to have a free fragment of a lumbar disc. A 71-year-old woman presented with history of low back and right leg pain. Magnetic resonance imaging suggested a peripherally enhancing free fragment extending down from S1 nerve root axilla. Preoperative laboratory investigation showed elevation of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels. She was taken for surgery and a fluctuating mass at the axilla of S1 nerve was found. When the mass was probed with a dissector, a dark yellow, thick pus drained out. Pus cultures were negative. Patients who present with extreme low back plus leg pain and increased leucocyte count, ESR and CRP levels should raise the suspicion of an infection of a vertebral body or spinal epidural space.

• Journal of Oral Medicine and Pain
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• 제20권1호
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• pp.7-18
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• 1995

The Purpose of this article is to describe the biochemical properties and biological functions of several salivary proteins that possess the unusual properties of inhibiting spontaneous and secondary precipitation of calcium phosphate. This function is very important since human salivary secretion is supersaturated with respect to calcium phosphate. Biological function of statherin, proline rich protein (PRP) and histidine rich protein (HRP) is to inhibit precipitation of calcium phosphate in salivary glands, in the oral fluids, and onto tooth surfaces. The resulting supersaturated state of the salivary secretions contributes a protective and reparative environment which is important for the integrity of the tooth. Beneficial consequences of salivary supersaturation with respect to calcium phosphate are selectively expressed in the oral cavity- that is, protection is provided for the dental enamel-while undesirable consequences, for example, precipitation of calcium phosphates in the salivary glands and onto the teeth do not occur. Purification and structural characteristics of these proteins as well as clinical significance of functions of each protein will be discussed.