• 대한후두음성언어의학회지
• /
• 제11권2호
• /
• pp.161-166
• /
• 2000

Background and Objectives : Vocal fold hemorrhage occur by blood accumulation in Reinke's space by vocal trauma. It is mostly asymptomatic, but in some cases it may cause severe dysphonia. It is often seen in patients who use their voice professionally. However, recent changes of life style affected the phonation in general population. We studied to know what are the causes and what are the major factors to affect the vocal fold hemorrhages. Materials and Methods : 19 subjects were evaluated by using of questionaire and laryngoscopic examinations. We evaluated the factors to lead the change in voice directly, underlying causes, occupations and laryngeal findings. Results : The direct causes of the vocal fold hemorrhages were clearing throat, talking, coughing and singing. Reflux laryngitis and upper respiratory infection were the underlying diseases. Vocal fold hemorrhages were developed during the menstruation in 5 patients. Accompanying functional voice disorders were seen in 13 patients, such as, vocal fold nodule, nodule with varix, vocal polyp, Reinke's edema. Patients with reflux laryngitis had the habits of clearing throat as the direct cause of the vocal fold hemorrhages and had hyperkinetic functional voice disorders. Voice abuse was the direct cause of the vocal fold hemorrhages in patients who was in the period of the menstruation. The most common site of the hemorrhage was at the membranous portion of the vocal folds. Conclusions : Authors thought the forceful laryngeal activity was the cause of the vocal fold hemorrhages. And reflux laryngitis and menstruation was the risk factors of the vocal fold hemorrhages.

• 한국컴퓨터정보학회논문지
• /
• 제25권12호
• /
• pp.227-233
• /
• 2020

본 연구는 성문위기도기 인후두 튜브(Supraglottic Airway Laryngopharyngeal Tube, SALT)와 직접 후두경을 이용하여 어려운 자세에서 기관내삽관의 신속성과 자신감, 용이성 등을 비교하여 전문기도관리 시행 능력을 향상 시키는데 있다. 연구대상은 J도 소방서에서 근무하고 있는 1급 응급구조사 30명을 대상으로 무작위 교차방법(Randomized crossover design)으로 디자인한 실험연구로 자료 분석은 SPSS 20.0 Version을 사용하였다. 어려운 자세에서 SALT를 이용한 기관내삽관은 직접 후두경을 이용한 기관내삽관 보다 신속성에서 유의한 차이를 보였으며(p<.001), 자신감과 용이성에서도 유의한 차이를 나타냈다(p<.001). 직접 후두경을 사용한 기관내삽관이 어려운 환경이나 외상환자의 경우 SALT를 이용한다면 안전하고 신속한 삽관을 할 수 있을 것이다. 또한 전문기도관리의 효율성 향상을 위해서 국내 현장에 SALT의 도입이 필요 할 것으로 사료된다.

• 대한불안의학회지
• /
• 제12권2호
• /
• pp.69-78
• /
• 2016

Objective : Disaster causes psychological distress to a large number of people in a short period of time, by both direct and indirect exposure to traumatic events embedded in various realms of disaster experience. Optimal, well-planned treatment interventions should follow from the early acute period to recovery phase, extending up to several months later. In this context, there is an increasing need for systemic review to gain comprehensive insights for disaster interventions. These need to be added to public policy, and for the prevention and treatment of disaster-related psychopathology. Here, we review the published studies on psychological interventions for disaster-related posttraumatic stress disorder. Methods : Specific psychological interventions regarded as effective treatments for have been selected for this review, such as CBT (Cognitive-Behavior Therapy), Exposure Therapy, EMDR (Eye Movement Desensitization & Reprocessing), SIT (Stress Inoculation Therapy) and Psychoeducation. In addition, natural disasters, industrial disasters, and accidents involving aircraft and ships were also categorized as disasters, along with war and combat trauma. Results : Cognitive behavior therapy and exposure therapy had the strongest research support for effectiveness, and could be considered as the first-choice treatment for disaster-related PTSD. The second line of treatment is EMDR, although this treatment modality has the advantage of reaching certain treatment improvements in fewer sessions. However, the effects of SIT and psychoeducation to the survivors of disasters, remains unclear at this point. Additionally, we propose the possibilities of using virtual reality component and imagery rescripting as modified forms of traditional cognitive behavior therapy and exposure therapy. Conclusion : Cognitive behavior therapy and exposure therapy, deemed effective treatments for various trauma, are considered to be effective for survivors from disasters. However, the efficacy of other interventions has not yet been examined methodologically in well-designed studies, such as randomized controlled trials. In particular, future empirical studies are needed, since it is difficult to conclude that psychological interventions have similar effects on different types of disasters.

• Journal of Korean Neurosurgical Society
• /
• 제41권2호
• /
• pp.77-81
• /
• 2007

Objective : In a variety of thoracolumbar diseases, corpectomy followed by interbody bone graft and anterior instrumentation has allowed direct neural decompression and reconstruction of the weight-bearing column by short segments fusion. In this study, we compared spinal stability of the two different anterior thoracolumbar instruments : Z-plate and Kaneda device representing plate and two-rods type, respectively. Methods : A retrospective review was performed for all the patients with thoracolumbar diseases or traumas treated with anterior corpectomy, autologous iliac bone graft, and fixation with instruments from 1996 to 2000. For the anterior instrumentation, Z-plate or Kaneda device was used for 24 [M:F=5:9, average age=37] and 12 [M:F=9:3, average age=41] patients, respectively. The plain AP and lateral flexion-extension films were taken immediately after surgery and at each follow-up. The sagittal and coronal Cobb's angles at the operation segments were used to observe the change of initial fixation status. The surgical time length and bleeding amount of the two groups were compared. Intra-operative and post-operative instrument associated complications were evaluated. Student t-test was used for statistical analysis and p-value less than 0.05 was considered to be significant. Results : Mean follow-up durations for Z-plate and Kaneda device were 24 and 21 months, respectively. The fusion rate was 91% for Z-plate and 100% for Kaneda device. Two cases of Z-plate group showed instrumentation failure during the follow up period, in which additional surgery was necessary. The mean differences of sagittal Cobb's angles among the AP images immediate after surgery and at follow-up were 7 and 2 degrees for Z-plate and Kaneda device, respectively [p<0.05]. The mean differences of coronal Cobb's angles were 5 and 2 degrees for Z-plate and Kaneda device, respectively [p<0.05]. No Intra-operative complication has occurred in both groups. There was no difference in surgery time and bleeding amount between two groups. Conclusion : We think that Kaneda device [rod type] is stronger than Z-plate [plate type] to keep the spinal stability after anterior thoracolumbar surgery.

• Journal of Korean Neurosurgical Society
• /
• 제52권3호
• /
• pp.267-269
• /
• 2012

Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries.

• Archives of Plastic Surgery
• /
• 제47권2호
• /
• pp.187-193
• /
• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

• 감성과학
• /
• 제7권2호
• /
• pp.179-186
• /
• 2004

중추신경계는 일단 손상이 되면 손상된 세포의 재생, 손상된 수초의 회복, 신경계의 정상적인 연결 등의 제한성 때문에 그 회복이 매우 힘들다. 이러한 중추신경계의 중요한 손상으로는 다발성 경화증, 뇌졸중, 척수손상, 외상, 축삭의 탈수초화 등이 있다. 이전 연구들은 많은 발생빈도를 보이고 있는 척수손상에서 실질적인 척수의 기능적인 회복을 위해 손상된 척수신경의 재생과 축삭의 재수초화가 중요한 요인이라고 전하고 있다. 최근에는 이러한 척수손상에 대한 치료적 접근으로서 세포이식 기술이 하나의 해결책을 열어주고 있다. 따라서 본 논문에서는 척수손상의 특성을 살펴보고, 척수손상에 의한 기능장애에 대해 세포이식이 기능의 회복을 증진시킬 수 있다는 증거를 논의하고자 한다.

• Clinics in Shoulder and Elbow
• /
• 제25권3호
• /
• pp.224-229
• /
• 2022

Background: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. Methods: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. Results: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. Conclusions: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

• 대한두개안면성형외과학회지
• /
• 제24권1호
• /
• pp.24-27
• /
• 2023

Background: Osteomas are benign, slow-growing bone tumors that can be classified as central, peripheral, or extraskeletal. Central osteomas arise from the endosteum, peripheral osteomas from the periosteum, and extraskeletal osteomas within the muscle. Frontal peripheral osteomas are mainly encountered in plastic surgery. In this study, we retrospectively analyzed the clinical data of patients with frontal peripheral osteomas. Methods: We retrospectively reviewed the medical records of patients who visited our hospital with frontal peripheral osteomas between January 2014 and June 2022. We analyzed the following variables: age, sex, tumor type (sessile or pedunculated), single or multiple, size, history of head trauma, operation, and recurrence. Results: A total of 39 patients and 41 osteomas were analyzed, of which 29 osteomas (71%) were sessile and 12 osteomas (29%) were pedunculated. The size of the osteomas ranged from 4 to 30 mm, with an average size of 10 mm. The age of patients ranged from 4 to 78 years with a mean age of 52 years. There were seven men (18%) and 32 women (82%), and the man-to-woman ratio was 1:4.6. Two patients (5%) had multiple masses, with two osteomas in each, while only two patients (5%) had a history of head trauma. Twenty-nine patients (74%) underwent ostectomy by a direct approach, and none of the patients experienced recurrence. Conclusion: The epidemiologic data of our study will help plastic surgeons encounter frontal peripheral osteomas in the field to provide proper management for their patients.

• 대한족부족관절학회지
• /
• 제7권2호
• /
• pp.208-217
• /
• 2003

Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.