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Total Spinal Block and Cortical Epidural Block for Whiplash Syndrome and Reflex Sympathetic Dystrophy (Report of Four Cases) (전척수(全脊髓) 및 경막외차단(硬膜外遮斷)으로 편타성(鞭打性) 손상(損傷)의 통증치험(痛症治驗) (4례(例) 보고(報告)))

  • Park, Wook;Ok, See-Young;Song, Hoo-Bin
    • The Korean Journal of Pain
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    • v.1 no.1
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    • pp.106-119
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    • 1988
  • For the relief of pain in 3 cases of whiplash syndromes (case I, II and IV) and in one of reflex sympathetic dystrophy (case III), we have carried out six intentional. total spinal blocks (TSB) which attempted two times in case I, three in case II and one in carte III whoso various symptoms were chronically unresponsive to the usual conservative treatments, and a time of cervical epidural and right suprascapular nerve block in case W whose acute symptom lasted 4 drys following the cervical injury (see fables from 1 to 9). During the 753, we have observed clinically the sequential charges of respiration, lid and pupil reflexes, body motion and consciousness. And checked the blood pressure, pulse rate and arterial Pco2. The effectiveness of those blocks has been assessed by using the Visual Analog Scale which is designed to measure the patient$\acute{s}$ subjective intensity of pain and also we have found out the sequelae following those blocks. The methods of the blocks were as the following: 1. Under the N.P.O. for 8~10 hours, the preparations of immediate cardiopulmonary resuscitation and premedication with atropine 0.5mg at thirty minutes before the TSB, it was performed by injecting the mixture of 2% mepivacaine 10 or 15ml and normal saline 10 or 5ml through No. 23 G. spinal needle into the subarachnoid space of $C_7-T_1$ interspinous region with fully flexed neck on the lateral posture. Immediately after the injection of the local anesthetic in the lateral position, the patient$\acute{s}$ were hasten to change Trendelenburg$\acute{s}$ position in order to act the drugs cephalad and to make easy controlled respiration with oxygen. 2. The cervical epidural block was done by injecting the mixture of 0.5% bupivacaine 4ml, normal saline 4ml and triamcinolone 15mg through No. 18 G. Tuohy needle into the epidural space on the same region and posture as the above without premedication.7he suprascapular nerve block was done by injecting of 0.5% bupivacaine 3ml only into the right suprascapular fossa on the sitting posture. The results were as the following: 1. The cessation of respiration was seen within 5 minutes following the subarachnoidal injection of the above 20ml mixture in 2 to 3 minutes and then soon the consciousness began to disappear. The loss of Lid and pupil reflexes noted between 5 to 10 minutes and the size of the dilated pupils was equal between 5 to 20 minutes, but the pupil of the dependent side on tile lateral position was dilated 1 to 3 minutes earlier than that of the independent. The patients had r=ever responded to any stimulations during the TSB except their heart funtion. 2. The recovery of the TSB was as the following, firstly the ankle and lower limb of the independent side began to move slightly with in 34 to 75 minutes after the injection and then that of the dependent Secondly the neck and upper limb moved 6 to 15 minutes later than the lower limb. Thirdly the self respiration began to appear between 40 to 80 minutes from the block. The lid and pupil reacted to touch and light respectively between 40 to 80 minutes but the pupil of the independent side responded earlier than that of the depends. Lastly the consciousness recovered completely between 80 to 125 minutes from the block. 3. In the cardiopulmonary function during the TSB, the blood pressure were stable except the 210/130 tory at the and block of case I. There were bradycardias between 65 to 85 minutes in case I and II but no arrythmia on the EKG. The level of the arterial Pco2 was maintained to 43~45 torr during the TSB. 4. The effectiveness of the above blocks was no pain(0%) in case IV, and light (10~20%) in case I and II but no improvement in case III. 5. The right arm weakness has been complicated as to be Injected accidently the "COLD" local anesthetic at the End block of case I.

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Development of K-bioassay for the Efficient Potassium Fertilization of Citrus Tree ($K(^{86}Rb)-bioassay$를 이용한 감귤나무의 가리영양진단법 개발)

  • U, Zang-Kual;Han, Hae-Ryong;Moon, Duk-Young;Kim, Chang-Myung;Lim, Han-Cheol;Moon, Do-Kyung;Song, Sung-Jun
    • Applied Biological Chemistry
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    • v.37 no.3
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    • pp.182-188
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    • 1994
  • Similar to the $^{42}K$ uptake, $^{86}Rb$ uptake by the roots of Hordeum distichum grown in the hydroponic culture was negatively correlated with the concentration of K supplied previously, showing that $^{86}Rb$ can be used for the K-bioassay. $^{86}Rb$ having longer half life (18.86 day) than $^{42}K$ (12.36 hr) allowed the use of larger number of root samples. $^{86}Rb$ uptake of 3 years old Citrus unshiu Marc. grown in water culture decreased drastically with the increase of K concentration of the culture solution, thus demonstrating that the nutrition status of K for citrus trees can be diagnosed by K-bioassay using $^{86}Rb$ tracer. $^{86}Rb$ uptake by the excised roots of Hordeum distichum grown in the pot with different K fertilizations was well correlated with the exchangeable K in soil. The amount of exchangeable K in soil for the optimal plant growth can be determined by its relationship. $^{42}K$ and $^{86}Rb-uptake$ by the Hordeum distichum roots were markedly inhibited by $5{\times}10^{-3}\; M$ KCN in the bioassay solution, indicating that uptake is energy-dependent. There was no significant relationship between K content in citrus leaves and K concentration in the water-culture medium. It is concluded that K-bioassay is a potentially useful tool for determining of K requirement in citrus trees.

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Reverse Total Shoulder Arthroplasty in Patients with Severe Rotator Cuff-Deficient Shoulder - A Minimum Three-Year Follow-up Study - (심한 회전근 개 부전을 동반한 환자에 대한 역형 견관절 전치환술 - 최소 3년 추시 결과 -)

  • Kim, Myung-Sun;Yeo, Je-Hyoung
    • Clinics in Shoulder and Elbow
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    • v.16 no.2
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    • pp.73-83
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    • 2013
  • Purpose: The goal of this study is to evaluate the minimum three-year follow-up results of reverse total shoulder arthroplasty (RTSA) for glenohumeral (GH) arthritic and pseudoparalytic patients with severe rotator cuff deficiency. Materials and Methods: We evaluated 13 patients (three males and 10 females) who underwent RTSA from July 2007 to July 2010. The average follow-up duration was 54.2 months (range, 37~74 months). Clinical results were evaluated using the Visual Analog Scale (VAS) for pain, active Range of Motion (ROM): active forward flexion (aFF); active external rotation at the side (aERs); active internal rotation to the back (aIRb), American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and intraoperative and postoperative complications. Results: VAS score improved from 7.5(6~10) points to 1.5(0~4), and ROM of active forward elevation improved from $42.7(10{\sim}100)^{\circ}$ to $129.1(110{\sim}180)^{\circ}$. In addition, ASES score improved from preoperative 32.9 (11.7~46.7) points to 80.2(58.3~95.0) postoperatively, and KSS score improved from 36.8(24~47) points to 78.4 (61~92). Twelve out of 13 cases showed various degrees of scapular notching at the last follow-up. There was one case of intraoperative anterior glenoid fracture and two cases of temporary nerve injury. Revision surgery was performed in two cases for treatment of delayed postoperative deep infection. Conclusion: According to minimum three-year follow-up results, RTSA may be an effective treatment option for glenohumeral (GH) arthritic and pseudoparalytic patients. However, considering the possibility of complications related to delayed deep infection or surgeon's technique, RTSA should be judiciously and carefully indicated by expert surgeons.

Simultaneous Multiple Transmit Focusing Method with Orthogonal Chirp Signal for Ultrasound Imaging System (초음파 영상 장치에서 직교 쳐프 신호를 이용한 동시 다중 송신집속 기법)

  • 정영관;송태경
    • Journal of Biomedical Engineering Research
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    • v.23 no.1
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    • pp.49-60
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    • 2002
  • Receive dynamic focusing with an array transducer can provide near optimum resolution only in the vicinity of transmit focal depth. A customary method to increase the depth of field is to combine several beams with different focal depths, with an accompanying decrease in the frame rate. In this Paper. we Present a simultaneous multiple transmit focusing method in which chirp signals focused at different depths are transmitted at the same time. These chirp signals are mutually orthogonal in a sense that the autocorrelation function of each signal has a narrow mainlobe width and low sidelobe levels. and the crossorelation function of any Pair of the signals has values smaller than the sidelobe levels of each autocorrelation function. This means that each chirp signal can be separated from the combined received signals and compressed into a short pulse. which is then individually focused on a separate receive beamformer. Next. the individually focused beams are combined to form a frame of image. Theoretically, any two chirp signals defined over two nonoverlapped frequency bands are mutually orthogonal In the present work. however, a tractional overlap of adjacent frequency bands is permitted to design more chirp signals within a given transducer bandwidth. The elevation of the rosscorrelation values due to the frequency overlap could be reduced by alternating the direction of frequency sweep of the adjacent chirp signals We also observe that the Proposed method provides better images when the low frequency chirp is focused at a near Point and the high frequency chirp at a far point along the depth. better lateral resolution is obtained at the far field with reasonable SNR due to the SNR gain in Pulse compression Imaging .

Prediction of Prognosis to Concurrent Chemo-Radiotherapy by Standardized Uptake Value of $2-[18^F]$ Fluovo-2-Deoxy-D-Glucose for Nasopharyngeal Carcinomas (비인강암 환자의 예후에서 $2-[18^F]$ Fluoro-2-Deoxy-D-Glucose PET 영상에서 계산되는 Standardized Uptake Value의 의의)

  • Lee Sang-wook;Im Ki Chun;Nam Soon Yuhl;Kim Jae Seung;Choi Eun Kyung;Ahn Seung Do;Shin Seong Soo;Ryu Jin Sook;Kim Sang Yoon;Lee Bong-Jae;Choi Seung-Ho;Kim Sung-Bae;Moon Dae Hyuk
    • Radiation Oncology Journal
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    • v.23 no.1
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    • pp.9-16
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    • 2005
  • Purpose : To prospectively evaluate the use of positron emission tomography with the glucose analog fluoro-deoxyglucose (FDG-PET) to deoxyglucose (FDG-PET) to predict disease-free survival (DFS) after concurrent chemo-radiotherapy (CCRT) in patients with non-disseminated nasopharyngeal carcinoma (NPC). Materials and Methods : We studied 41 patients with non-disseminated NPC scheduled to undergo platinum-based CCRT were eligible for this study. Patients were studied by FDG-PET prior to the CCRT. FDG uptake of tumors were measured with the maximal standardized uptake value (SUV). Results : Complete response rate was $100\%$. In ten patients who presented with any component of treatment failure, the median $SUV_{max}$ was 8.55 (range: $2.49\~14.81$) in any component of failure and the median $SUV_{max}$ was 5.48 (range: $2.31\~26.07$) In the remaining patients without any such failure. Patients having tumors with high FDG uptake had a significantly lower 3-year DFS ($51\%\;{\nu}91\%$, p=0.0070) compared with patients having low uptake tumors. Conclusion : FDG uptake, as measured by the SUV, has potential value in predicting DFS in NPC treated by CCRT, High FDG uptake may be a useful parameter for Identifying patients requiring more aggressive treatment approaches.

Die Korrelation zwischen der DG und GB-Theorie (의존문법과 생성문법 간의 상호관계)

  • Rhie Jum-Chool
    • Koreanishche Zeitschrift fur Deutsche Sprachwissenschaft
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    • v.5
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    • pp.143-166
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    • 2002
  • Das Ziel dieses Aufsatzes liegt darin, auf Grund der Theorien von einigen Grammatikern die Korrelation zwischen der Dependenzgrammatik (=DG) und GB­Theorie(=GB) zu beschreiben. Nach Eroms(2000) sind VPn in eine engere Phrase, die die $Erg\"{a}nzungen$ in obliquen Kasus bindet, und eine $\"{a}u{\ss}ere$, die Subjektsvalenz abbindet, zu trennen. Dem INFL-Phrasenkopf der GB entspricht das Finitheitsmorphem in der DG. In der $herk\"{o}mmlichen$ DG steht das Verb an der Spitze des Satzes, aber Eroms(2000) stellt S an die Satzspitze. Die S(mit S., S?, S!) sind $n\"{a}mlich$ oberstes Element des Satzes, von dem alle anderen $W\"{o}rter\;abh\"{a}ngig$ sind. Die Konjunktionen regieren ihren Satz, bzw. der Satz wird durch sie gesteuert. Damit ist die Analogie zur X-bar-Syntax $vollst\"{a}ndig$. Nach Vater(l996) lasst sich die Struktur der deutschen VP systernatisch nach dem X-bar-Schema darstellen, wobei die Zuordnung der Objekte mehrere $M\"{o}glichkeiten\;zul\"{a}sst$. X-bar-Regeln allein $k\"{o}nnen$ nicht die Vielfalt $m\"{o}glicher$ VP-Strukturen erzeugen. Hier greifen V-bar-Regeln und Valenz ineinander. Vater(l996) $schl\"{a}gt$ vor, den von $\'{A}gel(1993)$ vorgeschlagenen Unterschied zwischen Valenzpotenz und Valenzrealisierung zu $ber\"{u}cksichtigen$, um die verschiedenen syntaktischen und morphologischen Realisierungen zwischen verschiedenen Sprachen in den Griff zu bekommen. $\'{A}gel(1993, 2000)$ nimmt in Anlehnung an $L\'{a}szlo(l988)$ zwei Realisierungsebenen der Valenz, die Mikroebene(=die der morphologischen Aktanten) und die Makroebene(=die der syntaktischen Aktanten) an. Der $Tr\"{a}ger$ auf Mikroebene ist der Mikroaktant, also der Teil des Verbflexivs, der $Tr\"{a}ger$ auf Makroebene ist der Makroaktant, also das syntaktische Subjekt. Die Begriffe 'Mikroebene' und 'Makroebene' werden sowohl statisch und als auch dynamisch interpretiert. Auf Grund dieser Begriffe versucht $\'{A}gel(1993, 2000)$, nach Parallelen der Valenzrealisierung in S und NP zu suchen. Aber die Untersuchung der $Valenzrealisierungsverh\"{a}ltnisse$ in der NP wird zu einem scheinbaren typologischen Gegensatz zwischen S und NP $f\"{u}hren$. Um diesen Gegensatz $aufzul\"{o}sen$, wird das Konzept 'finites Substantiv' $eingef\"{u}hrt$, das analog zum Konzept 'finites Verb' ist. Dabei wird die sog. starke Adjektivflexion in einen Teil der Substantivflexion uminterpretiert. Die GB-Theorie definiert sich als eine Theorie der sog. mentalen Grammatik, des $Sprachverm\"{o}gens$. Da als der Gegenstand der DG die sog. objektive Grammatik angesehen werden kann, scheint der grundlegende Unterschied zwischen den $Gegenst\"{a}nden$ beider Theorien in der Opposition 'intem(=mental vs. extern (=objektiv)' zu liegen. Da die GB eine 'naturwissenschaftlicher' organisierte Theorie ist als die empirische Richtung der DG, ware eine Vergleichsgrundlage in der Tat nicht einfach zu etablieren. Obwohl die beiden Theorien von $v\"{o}llig$ anderen Voraussetzungen und Zielsetzungen ausgehen, gibt es zwischen der DG und der GB $\"{U}berlappungen$ und zunehmende $Ann\"{a}herungen$. Generell ist es notwendig, dass Teileinsichten aus einer Theorie in eine andere Theorie $\"{u}bernommen$ werden. In diesem Aufsatz konnten wir durch die Untersuchung der Korrelation von beiden Theorien partielle Konvergenzen erkennen. Nach Engel(l994) gibt es keine Grammatik 'an sich', sie wird von Grammatikern gemacht. Grammatiken sind Menschenwerk und Linguistenwerk. Wir sind auf der Suche nach 'einer besseren Grammatik.'

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Deviations of Implant Position between Pre- and Post-operation in Computer-guided Template-based Implant Placement (Computer-guided template를 이용한 임플란트 식립에서 술 전과 술 후 사이의 임플란트 위치에 따른 변위량 검사)

  • Kim, Won;Kim, Seung-Mi;Kim, Hyo-Jung;Song, Eun-Young;Lee, Si-Ho;Oh, Nam-Sik
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.2
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    • pp.175-184
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    • 2011
  • With a development of implant restoration technique, there are increasing use of computer-guided system for edentulous patients. It was carried out simulated operation based on CT information about patient's bone quantity, quality and anatomical landmark. However, there are some difference between the programmed implant and post-operative implant about it's position. If the deviation was severe, it could happen a failure of 'passive fit' and not suited for path of implant restoration. The aim of this presentation is to evaluate about a degree of deviations between programmed implant and post-operative implant. Five patients treated by 'NobelGuide' system (Nobel Biocare AB, G$\ddot{o}$teborg, Sweden) in Department of Prosthodontics, Inha University were included in this study. The patients were performed CT radiograph taking and intra-oral impression taking at pre-operation. Based on CT images and study model, surgical stent was produced by NobelBiocareTM. To fabricated a pre-operative study model, after connected lab analog to surgical template, accomplished a pre-operative model using type 4 dental stone. At final impression, a post-operative study model was fabricated in the conventional procedures. Each study model was performed CT radiograph taking. Based on CT images, each implant was simulated in three dimensional position using $Procera^{(R)}$ software (Procera Software Clinical Design Premium, version 1.5; Nobel Biocare AB). In 3D simulated model, length and angulation between each implant of both pre- and post-operative implants were measured and recorded about linear and angular deviation between pre-and post-operative implants. A total of 24 implants were included in this study and 58 inter-implant sites between each implant were measured about linear and angular deviations. In the linear deviation a mean deviation of 0.41 mm (range 0~1.7 mm) was reported. In the angular deviation, a mean deviation was $1.99^{\circ}$ (range $0^{\circ}{\sim}6.7^{\circ}$). It appears that the both linear and angular mean deviation value were well acceptable to application of computer-guided implant system.

Radiographic Changes of the Medial Epicondyle in Little League Baseball Player (청소년기 야구선수의 주관절 내상과의 방사선학적 변화)

  • Choi Chang-Hyuk;Eum Dong-Hwan
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.1
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    • pp.43-48
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    • 2002
  • Purpose : We evaluated radiographic changes and clinical manifestations of the elbow joint to identify the effects of the throwing between dominant and non-dominant arms. Materials and Methods : A hundred and five little leaguer’s baseball player in 5 elementary school and 2 middle school were evaluated for clinical symptoms and radiographic changes about elbow joint. Mean age was 12 years old and average periods of exercise were 32 months. Elbow functions were evaluated using ASES standardized assessment form and radiographic changes of medial epicondyle were examinated for enlargement, separation of the apophyses, fragmentation and irregularity. Results : Thirty seven players (35$\%$) were complained pain with throwing and the average score was 4.8 using visual analog scale. There were no significant differences in range of motion except flexion angle, valgus angle, and strength between dominant arm and non-dominant arm. Valgus laxity was more prominent in dominant arm. Ulnohumeral tenderness, radiocapitellar tenderness and medial flexor origin tenderness were in 18, 6, and 17 cases respectively in dominant arm. Medial epicondyle was enlarged in dominant arm with 13.0 by 6.3 mm compared to non-dominant arm with 11.7 by 6.1 mm. Apophyseal separation was 0.8 mm in dominant arm and 0.5 mm in non-dominant arm. Fragmentation and irregularity were 14 (13$\%$) and 25 (24$\%$) cases respectively in dominant arm. Conclusion : In little league baseball player, it needs usage of ball and bat with appropriate weight, and careful conditioning programs through throwing exercise in order to avoid elbow injuries.

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Usefulness of Ultrasonographic Examination in Diagnosis and Follow-up of the Frozen Shoulder (동결견의 진단과 치료 경과 판정에 대한 초음파 검사의 유용성)

  • Choi, Chang-Hyuk;Kim, Seok-Jun;Lee, Sang-Hwa;Kim, Hee-Soo;Shim, Jung-Hyun
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.1-6
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    • 2014
  • Purpose: In order to know the effectiveness of ultrasonographic examination in diagnosis and follow-up evaluation for the frozen shoulder, we compared those with contralateral side in initial and after steroid injection. Materials and Methods: For the 20 unilateral frozen shoulder from July 2012 to July 2013, ultrasonographic examination was tried using reference line 1 (CBT: distance from coracoid process to LHB tendon) and line 2 (CBG: distance from coracoid process to bicipital groove). We tried 1 time steroid injection and compared the improvement in gross motion and reference line with 2 month, 4 month, and 6 month's serial ultrasonographic examination. Results: The differences on CBT line between lesion side and normal side were -5.6 mm, -5.0 mm, and -4.3 mm in neutral (Neut), external rotation (ER) and internal rotation (IR), respectively. The differences on CBG line were -6.1 mm, -4.7 mm, and -5.0 mm respectively (p<0.05). The changes in the reference line after steroid injection were evaluated at 2 month (CBT: -4.8 mm, -3.5 mm, -2.6 mm / CBG: -4.7 mm, -4.0 mm, -3.6 mm), 4 month (CBT: -4.7 mm, -3.2 mm, -1.7 mm / CBG: -4.3 mm, -3.7 mm, -1.2 mm), and 6 month (CBT: -1.1 mm, -2.9 mm, -0.5 mm / CBG: -1.2 mm, -0.7 mm, -0.9 mm). The gross motion was improved at 4 month after injection, from elevation $108^{\circ}$, ER $32^{\circ}$, IR L5 in initial to $133^{\circ}$, $42^{\circ}$, L3 respectively (p<0.05). Pain improved from 7.5 in initial to 3.0 at 2 month on visual analog scale (VAS). Conclusion: The serial examination after steroid injection revealed that the delayed improvement on reference line (6 month) compared with pain (2 month) or gross motion (4 month). Dynamic ultrasonogram was useful in diagnosis and follow-up evaluation of frozen shoulder.

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The Effectiveness of Buprenorphine Transdermal Patch on Patients with Shoulder Pain: Short-Term Follow-up Study (견관절 통증을 동반한 동결견 환자에게서 Buprenorphine transdermal patch의 효과: 단기 추시 결과)

  • Hong, Jin Ho;Park, Yong Bok;Ryu, Ho Young;Jeon, Sang Jun;Park, Won Ha;Yoo, Jae Chul
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.7-12
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    • 2014
  • Purpose:The effectiveness of transdermal buprenorphine patch on the patients with frozen state of frozen shoulder was evaluated. Materials and Methods: Between March and September in 2013, 127 patients with pain and limited range of motion in shoulder joint over 6 months were included. Every patient was confirmed the diagnosis through MRI or ultrasonogram and each patient received intra-articular injection of steroid once. After 2~4 weeks, every patient was interviewed via telephone survey and finally 105 patients were included, 54 patients received only oral NSAIDs (NP group) while 51 patients received additional transdermal buprenorphine patch (BP group). Pain and functional visual analog scale (PVAS, FVAS), American Shoulder Elbow Society (ASES) score was checked. Results: Generally, every outcome variables showed improvements in both groups (p<0.001). PVAS score after treatment showed superior result in NP group but it was not significant (p=0.088). In ASES score, NP group had superior result than BP group and it had significant difference. Similarly in FVAS, NP group showed superior result but the data before treatment was significantly different (p=0.028) Conclusion: Transdermal buprenorphine patch didn't show superior treatment result in the patient with frozen state of frozen shoulder which was applied with oral NSAIDs after single intra-articular glenohumeral steroid injection in short-term follow-up.

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