• Pediatric Infection and Vaccine
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• 제29권2호
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• pp.96-104
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• 2022

Chronic recurrent multifocal osteomyelitis (CRMO)는 소아에서 호발하는 비감염성 염증성 골질환으로 염증성장질환, 건선, 베게너 육아종, SAPHO 증후군 등의 다른 자가 면역 질환이 병발하기도 한다. 13세 중앙아시아 인종의 남자환자가 18개월 동안 반복되는 하지 관절 통증과 연조직 염증 증상을 주소로 내원하여 CRMO로 진단 하 비스테로이드성소염제 치료를 시작하였다. 5개월 간 약물 복용하였으나 근골격계 증상 악화, 새롭게 발생한 위장관 증상에 대해 CRMO에 크론병이 병발한 것으로 진단되었으며, 이에 대해 infliximab을 투여하였다. 본 증례에서는 크론병이 병발한 CRMO 환자에서 비스테로이드성 소염제 치료에 실패한 후 infliximab을 이용하여 효과적으로 치료된 증례를 보고하는 바이다.

• 대한소아치과학회지
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• 제49권3호
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• pp.329-339
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• 2022

이 연구의 목적은 혼합치열기의 골격성 I, II, Ⅲ급 부정교합의 구개용적, 폭경, 장경, 고경을 비교하는 것이다. 이 연구는 단국대학교 치과대학병원 소아치과에 내원하여 교정을 목적으로 인상채득한 진단모형 1400개 중 30개를 선별하여 분석하였다. 모형은 Hellman's dental age ⅢA의 골격성 I, II, Ⅲ급 부정교합으로 구성되었다. 3차원 스캐너로 모형을 스캔한 후 여러 구개 수치들을 측정하였다. SPSS에서 Kruskal-Wallis test를 이용하여 비교 분석하였고, Mann-Whitney test로 사후검정하였다. 혼합치열기의 II급 부정교합에서 I급, Ⅲ급 부정교합에 비해 구개폭경이 유의하게 작았고, 구개장경이 유의하게 길었다. 혼합치열기의 Ⅲ급 부정교합에서 구개고경이 유의하게 가장 컸으며, 그 다음으로는 II급, I급 순이었다. 구개용적은 Ⅲ급, II급, I급 순으로 컸으나, 통계적으로 유의할 만한 차이는 보이지 않았다. 각 교합 양식에 따른 구개 형태의 차이를 이해하는 것은 임상적으로 매우 중요하다. 이 번 연구를 바탕으로 구개의 형태와 골격 패턴과의 관계에 대해 이해하였고, 이는 교정 치료 계획, 부정교합 조기 진단 및 구개 형태의 통합 메커니즘을 이해하는 데에 유용한 정보를 제공한다.

• Journal of Korean Neurosurgical Society
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• 제65권5호
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• pp.719-729
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• 2022

Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

• 임상간호연구
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• 제29권1호
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• pp.24-41
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• 2023

Purpose: This study aimed to update the previously published nursing practice guideline for prevention of venous thromboembolism (VTE). Methods: The guideline was updated according to the manuals developed by National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), and a Handbook for Clinical Practice Guideline Developer Version 10. Results: The updated nursing practice guideline for prevention of VTE was consisted of 16 domains, 46 subdomains, and 216 recommendations. The recommendations in each domain were: 4 general issues, 8 assessment of risk and bleeding factors, 5 interventions for prevention of VTE, 18 mechanical interventions, 36 pharmacological interventions, 36 VTE prevention starategies for medical patients, 25 for cancer patients, 13 for pregnancy, 8 for surgical patients, 7 for thoractic and cardiac surgery, 16 for orthopedic surgery, 10 for cranial and spinal surgery, 5 for vascular surgery, 13 for other surgery, 3 educations and information, and 2 documentation and report. For these recommendations, the level of evidence was 32.1% for level I, 51.8% for level II, and 16.1% for level III according to the infectious diseases society of America (IDSA) rating system. A total of 112 new recommendations were developed and 49 previous recommendations were deleted. Conclusion: The updated nursing practice guideline for prevention of VTE is expected to serve as an evidence-based practice guideline for prevention of VTE in South Korea. It is recommended that this guideline will disseminate to clinical nursing settings nationwide to improve the effectiveness of prevention of VTE practice.

• Investigative Magnetic Resonance Imaging
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• 제26권1호
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• pp.20-31
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• 2022

Purpose: To assess conventional MRI features associated with residual soft-tissue sarcomas following unplanned excision (UPE), and to compare the diagnostic performance of conventional MRI only with that of MRI including diffusion-weighted imaging (DWI) for residual tumors after UPE. Materials and Methods: We included 103 consecutive patients who had received UPE of a soft-tissue sarcoma with wide excision of the tumor bed between December 2013 and December 2019 and who also underwent conventional MRI and DWI in this retrospective study. The presence of focal enhancement, soft-tissue edema, fascial enhancement, fluid collections, and hematoma on MRI including DWI was reviewed by two musculoskeletal radiologists. We used classification and regression tree (CART) analysis to identify the most significant MRI features. We compared the diagnostic performances of conventional MRI and added DWI using the McNemar test. Results: Residual tumors were present in 69 (66.9%) of 103 patients, whereas no tumors were found in 34 (33.1%) patients. CART showed focal enhancement to be the most significant predictor of residual tumors and correctly predicted residual tumors in 81.6% (84/103) and 78.6% (81/103) of patients for Reader 1 and Reader 2, respectively. Compared with conventional MRI only, the addition of DWI for Reader 1 improved specificity (32.8% vs. 56%, 33.3% vs. 63.0%, P < 0.05), decreased sensitivity (96.8% vs. 84.1%, 98.7% vs. 76.7%, P < 0.05), without a difference in diagnostic accuracy (76.7% vs. 74.8%, 72.9% vs. 71.4%) in total and in subgroups. For Reader 2, diagnostic performance was not significantly different between the sets of MRI (P > 0.05). Conclusion: After UPE of a soft-tissue sarcoma, the presence or absence of a focal enhancement was the most significant MRI finding predicting residual tumors. MRI provided good diagnostic accuracy for detecting residual tumors, and the addition of DWI to conventional MRI may increase specificity.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.441-446
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• 2023

Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.

• Pediatric Infection and Vaccine
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• 제30권3호
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• pp.152-158
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• 2023

황색 포도알균은 흔한 피부 및 연조직 감염의 원인이며, panton-valentine leukocidin (PVL) toxin 생산 황색 포도알균은 전 세계적으로 발견되고 있으며 심각한 감염을 일으키는 것으로 알려져 있다. 그러나, PVL 양성 황색 포도알균으로 인한 신생아 감염은 매우 드물다. 저자들은 생후 7일 신생아에서 발견된 PVL 양성 황색 포도알균 감염으로 인한 심한 피부, 연조직 감염 사례를 보고하고자 한다. 환자는 당일 발생한 발열, 2일 전 시작된 둔부 열감, 부종, 압통으로 응급실로 내원하였다. 내원 당일, 발열, 빈맥, 전신 컨디션 저하, 둔부의 열감과 압통 진행이 확인되었다. 초음파 및 자기공명영상검사에서 피부 및 연조직, 일부 근육을 침범한 괴사성 근막염이 확인되었다. 둔부 병변에서 배농한 검체에서 PVL 양성 메티실린내성 황색포도알균 (MRSA)이 배양되었고, 균혈증은 없었다. 환자는 한달 간의 정맥 항생제 투여와 외과적 배액 수술 후 회복되었다. 퇴원 한달 후, 환자는 외이도염으로 재입원, 피부에서 동일한 MRSA가 확인되었다. 병변은 정맥 항생제 투여 및 소독만으로 호전되었다. 환자는 0.5% 클로르헥시딘 목욕을 통해 탈집락화(decolonization)를 시행하였고, 회복 후 재감염은 없었다. 본 사례는 PVL 생산 황색 포도알균 감염에 대해 적극적인 배액 수술 및 항생제 치료가 필수적이며, 재발 및 지역사회 확산을 방지하기 위해 추가적인 탈집락화가 필요함을 시사한다.

• 대한영상의학회지
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• 제82권6호
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• pp.1613-1618
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• 2021

중추신경계의 원발성 림프종은 비호지킨림프종의 드문 형태이다. 그중에서도 말총의 원발성 T세포 림프종은 극히 드물다. 이 증례 보고는 4개월 전부터 시작된 허리통증과 하지방사통을 주소로 내원한 56세 여성의 증례에 대한 것이다. 요추 MRI에서 10 cm 크기의 길다란 다결절의 경막 내 병변이 4번 요추에서부터 2번 미추까지 있었으며 T1 강조영상에서는 등신호강도이고 T2 강조영상에서는 비균질적인 등신호강도와 고신호강도, 가돌리늄 조영증강 T1 강조영상에서는 비균질적인 강한 조영증강을 보였다. 말총 종괴에 대한 수술적 경막 내 생검을 시행하였고 면역조직화학염색과 T-cell receptor gamma 유전자 재배열 분석을 통한 진단은 말총의 말초 T세포 림프종이었다.

• 대한영상의학회지
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• 제85권1호
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• pp.171-183
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• 2024

목적 본 연구의 목적은 수술 전 MRI의 다양한 간접 소견 중 어떤 소견이 외과적 치료가 필요한 견갑하건 파열을 예측하는 데 가장 주요한 것인지 조사하는 것이다. 대상과 방법 총 86명의 환자를 대상으로 수술 전 MRI 영상을 후향적으로 분석하였다. 견갑하건 파열의 직접평가, 이두박근 장두의 병리, 상완골두의 후방위, 상완골 회전, 견갑하근의 지방변성과 위축을 평가하였다. En-face 보기에서 부리돌기의 끝과 관절오목의 기저를 연결한 base-to-tip line (이하 BTL)을 이용한 육안 등급 및 두께 측정을 통해서 위축을 평가하였다. 결과 관절경 시술에서 31명(36%)의 환자가 Lafosse type III 또는 IV의 견갑하건 파열을 보여, 재건수술을 받았다. 이두박근 장두의 병리(p = 0.002), 상완골두의 후방위(p = 0.012), 견갑하근의 지방 변성(p < 0.001), BTL 등급(p = 0.003)은 견갑하건 파열과 유의한 상관관계가 있었다. 다변량 분석에서 상완골두의 후방위(p = 0.011, odds ratio [이하 OR] = 5.14)와 견갑하근의 지방변성(p = 0.046, OR = 2.81)은 견갑하건 파열의 독립적인 예측인자였다. 결론 상완골두의 후방위와 지방변성은 견갑하건 파열 진단에 도움이 될 수 있다. 이러한 결과를 판독하는 것은 최적의 수술 전략을 계획하는 데 기여할 수 있다.

• Korean Journal of Radiology
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• 제22권3호
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• pp.384-394
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• 2021

Objective: To quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and combined calcaneofibular ligament (CFL) injuries using MRI T2 mapping. Materials and Methods: This study was performed according to regulations of the Committee for Human Research at our institution, and written informed consent was obtained from all participants. Forty CLAI patients (26 with isolated ATFL injuries and 14 with combined ATFL and CFL injuries) and 25 healthy subjects were recruited for this study. All participants underwent MRI scans with T2 mapping. Patients were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system. The subtalar and midtarsal joints were segmented into 14 cartilage subregions. The T2 value of each subregion was measured from T2 mapping images. Data were analyzed with ANOVA, the Student's t test, and Pearson's correlation coefficient. Results: T2 values of most subregions of the subtalar joint and the calcaneal facet of the calcaneocuboid joint in CLAI patients with combined CFL injuries were higher than those in healthy controls (all p < 0.05). However, there were no significant differences in T2 values in subtalar and midtarsal joints between patients with isolated ATFL injuries and healthy controls (all p > 0.05). Moreover, T2 values of the medial talar subregions of the posterior subtalar joint in patients with combined CFL injuries showed negative correlations with the AOFAS scores (r = -0.687, p = 0.007; r = -0.609, p = 0.021, respectively). Conclusion: CLAI with combined CFL injuries can lead to cartilage degeneration in subtalar and calcaneocuboid joints, while an isolated ATFL injury might not have a significant impact on the cartilage in these joints.