• 대한영상의학회지
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• 제82권1호
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• pp.162-172
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• 2021

목적 요추 후궁절제술 시행 부위 후관절 활액낭에 대해 투시유도 하 경피적 낭종파열술 및 스테로이드 주입술을 시행 받은 환자에 관하여 후향적으로 시술의 성공률 및 임상적 효과를 분석하였다. 대상과 방법 투시유도 하 경피적 후관절 낭종파열술과 관절 내 스테로이드 주입술을 시행 받은 환자이면서, 시술 전 6개월 이내 촬영한 요추 자기공명영상 상 이전 후궁절제술 부위와 후 관절 활액낭종의 위치가 일치하는 것이 증명된 환자, 그리고 그 낭종의 위치가 신경학적 증상을 설명하는 것으로 판단되는 환자를 대상(14명)으로 하였으며 시술 후 낭종파열의 성공유무와 증상의 호전 정도를 조사하였다. 결과 시술이 반복될수록 낭종파열의 성공률은 감소하였지만(첫 시술에서는 62.5%, 그 이후의 시술에서는 0~33%), 80%의 환자가 시술 후 증상 호전을 보였다. 추적관찰 기간 내 낭종에 대한 수술률은 14.3%였다. 결론 요추 후궁절제술 시행 부위 후관절 활액낭에 대한 투시유도 하 경피적 낭종파열술 및 스테로이드 주입술은 효과적인 치료 방법으로서, 수술적 치료를 고려하기 전에 먼저 시도해 볼 수 있다.

• 대한한방내과학회지
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• 제44권6호
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• pp.1327-1336
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• 2023

This case report presents the effectiveness of Korean medicine in the treatment of occipital neuralgia. The patient with occipital neuralgia was treated with acupuncture. Acupuncture treatment was administered to the occipital nerve area, which is commonly used in occipital nerve blocks by western medicine doctors. The severity of the symptoms was assessed daily using the Numerical Rating Scale (NRS) score of pain. The patient received outpatient treatment a total of 7 times, and only received acupuncture treatment each time. According to the patient, his symptoms decreased by about 90% two days after acupuncture treatment, and the frequency and duration of the symptoms also decreased. Seven days after all acupuncture treatments, the severity of pain was reduced from NRS 6 to NRS 0. The findings of this case report suggest that treatment with Korean medicine can be an effective option for treating occipital neuralgia. Acupuncture can be a good treatment method for occipital neuralgia, along with western drug treatment and occipital nerve block.

• 대한한방내과학회지
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• 제45권2호
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• pp.219-233
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• 2024

A 69-year-old female diagnosed with idiopathic Parkinson's disease and treated with anti-Parkinsonian medications, including levodopa, for 7 years presented with complaints of wearing-off phenomenon and delayed onset of medication efficacy, resulting in postural instability and feeling of severe exhaustion. The patient underwent a 50-day course of treatment with Bonoesikpungjigyeong-tang formula. The effects of the treatment were evaluated by recording the average time to onset of medication efficacy, the average time to medication wearing-off, and discomfort due to wearing-off phenomenon. Postural instability was assessed using the Numeric Rating Scale (NRS). The patient's overall quality of life was assessed using the EQ-5D-3L. After 50 days of treatment, the average time to onset of medication efficacy decreased, and the average time to medication wearing-off increased. Discomfort due to wearing-off phenomenon and postural instability decreased. This case suggests that Bonoesikpungjigyeong-tang might be an alternative for improving discomfort caused by long-term levodopa intake.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.47-56
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• 2024

Background: Among the various pain-related diseases that can be encountered at the clinic, there is a neuropathic pain that is difficult to treat. Numerous methods have been proposed to treat neuropathic pain, such as taking medication, nerve block with lidocaine, or neurolysis with alcohol or phenol. Recently, a method of perineural injection using dextrose instead of lidocaine was proposed. This study was designed to compare the effects of perineural injection therapy (PIT) with buffered 5% dextrose or 0.5% lidocaine on neuropathic pain. Methods: The data were collected from the database of pain clinic from August 1st, 2019 to December 31st, 2022 without any personal information. The inclusion criteria were patients diagnosed with postherpetic neuralgia (PHN), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), or peripheral neuropathy (PN), and patients who had undergone PIT with buffered 5% dextrose (Dextrose group) or 0.5% lidocaine (Lidocaine group) for pain control. The data of patients, namely sex, age, and pain score (numerical rating scale, NRS) were collected before PIT. The data of NRS, side effects, and satisfaction grade (excellent, good, fair, or poor) were collected one week after each of the four PIT, and two weeks after the last PIT. Results: Overall, 112 subjects were enrolled. The Dextrose group included 89 and Lidocaine group included 23 patients. Because the number of patients in the Lidocaine group was too small to allow statistical analysis, the trend in Lidocaine group was just observed in each disease. There were no significant side effects except for a few bruise cases on the site of injection in all groups. The NRS in most Dextrose groups except CRPS were reduced significantly; however, the Lidocaine group showed a trend of pain reduction only in PHN. The Dextrose group except CRPS showed increased satisfaction two weeks after the final PIT. Conclusion: From the results, it is suggested that PIT with buffered 5% dextrose may have a good effect for neuropathic pain without any side effect except for patients with CRPS. This may offer a window into a new tool that practitioners can employ in their quest to help patients with neuropathic pain.

• 품질경영학회지
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• 제51권4호
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• pp.531-550
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• 2023

Purpose: The unique nature of life-and-death healthcare services sets them apart from other service industries. While many studies exist on the relationship between healthcare services and customer satisfaction, most of them focus on mildly ill patients, ignoring the differences between critically ill and non-seriously ill patients. This study discusses the actual quality of healthcare services for patients who are facing life-threatening illnesses and are on life support, as well as their right to protection and dignity. Methods: The survey conducted to 149 patients with the four major illnesses: cancer, heart disease, brain disease and rare and incurable disease, those who have experiences with senior general hospitals. Results: The basic statistics of this study are adequate to represent the four major critical illnesses, and the reliability and validity of this study's hypotheses, which were measured by multiple items, were analyzed, and the internal consistency was judged to be high. In addition, it was found that the convergent validity was good and the discriminant validity was also secured. When examining the goodness of fit of the hypotheses, the SRMR, which is the standardized root mean square of residuals that measures the difference between the covariance matrix of the data variables and the theoretical covariance matrix structure of the model, met the optimal criteria. Conclusion: The academic implications of this study are differentiated from other studies by moving away from evaluating the quality of healthcare services for mildly ill patients and focusing on the rights and dignity of patients with life-threatening illnesses in four senior general hospitals. In terms of academic implications, this study enriches the depth of related studies by demonstrating the right to protection and dignity as a factor of patient-centeredness based on physical environment quality, interaction quality, and outcome quality, which are presented as sub-factors of healthcare quality. We found that the three quality factors classified by Brady and Cronin (2001) are optimized for healthcare quality assessment and management, and that the results of patients' interaction quality assessment can be used to provide a comprehensive quality rating for hospitals. Health and human rights are inextricably linked, so assessing the degree to which rights and dignity are protected can be a superior and more comprehensive measurement tool than traditional health level measures for healthcare organizations. Practical implications: Improving the quality of the physical environment and the quality of outcomes is an important challenge for hospital managers who attract patients with life and death conditions, but given the scale and economics of time, money, and human inputs, improving the quality of interactions and defining them as performance indicators in hospital quality management is an efficient way to create maximum value in the short term.

• 대한통합의학회지
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• 제12권3호
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• pp.37-47
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• 2024

Purpose : Cancer survivors often suffer from postoperative sequelae. the diagnosing and provision of manual therapy using spiral taping significantly improves the quality of life of cancer patients. The aim of this case study is to investigate the immediate effects of spiral taping on pain, range of motion (ROM), chemotherapy-induced peripheral neuropathy (CIPN), and lymphedema following breast cancer surgery. Methods : The taping techniques were performed as follows by spiral taping. The measurements were taken before, in the middle, and after taping using a mobile phone camera, tape measure, and a numerical rating score (NRS). The evaluation employed a single-group pre-post design based on a primitive experimental design. Results : Out of four patients, all four exhibited Reverse circle flow energy (RCFE), Passive cervical right (Rt) rotation test, anterior-posterior movement pattern, nerve type (+), cold energy (CE), sangcho acupuncture point, blood clot, hwal point. Comparing before and after treatment, almost all values were reduced to zero after treatment in terms of pain complaints. The lack of range of motion (ROM) caused by the shortened tissue after surgery did not increase. The range of motion (ROM) lost due to pain returned to normal. The circumference of lymphedema did not show a tendency. The symptoms of CIPN improved. Conclusion : There was a significant change in joint range of motion, with pain decreasing, but there were structural limitations in the tissue due to total resection, and the chemotherapy-induced peripheral neuropathy scale. It was effectively treated surgical site pain, axillary membrane syndrome-induced pain, and unexplained pain. While there was a treatment effect for lymphedema in the evaluation of circumference values, there was no significant change in circumference. There was a significant effect on chemotherapy-induced peripheral neuropathy, particularly in treating numbness in the feet, which is a side effect of TC anticancer drugs. This case study found that spiral balance taping provides a rapid therapeutic effect for most side effects in patients who have undergone total breast cancer resection. However, the generalization is limited due to the small sample size, and further research is needed to determine the extent to which the effects of one treatment are maintained.

• 대한한방내과학회지
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• 제45권4호
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• pp.773-780
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• 2024

Objectives: The purpose of this study was to report the effectiveness of Korean medicine in the treatment of chronic migraine persisting for 30 years. This patient had been taking various painkillers (acetaminophen, nonsteroidal anti-inflammatory drugs, caffeine hydrate, etc.) every day for 30 years. Methods: The patient with chronic migraine was treated with acupuncture. Acupuncture treatment was performed on the gall bladder meridian (足少陽膽經) and bladder meridian (足太陽膀胱經) line passing through 24 of the 31 injection sites used for chronic migraine prevention treatment with botulinum toxin type A. The severity of the symptom was assessed by the daily Numerical Rating Scale (NRS) score of pain. Results: The patient received outpatient treatment 42 times and received only acupuncture treatment each time. The patient said that after 4 sessions of acupuncture treatment, the severity of pain was reduced from NRS 7 to NRS 5 and that the frequency and duration of the symptoms were lower. After 8 sessions of acupuncture treatment, the symptoms were reduced to NRS 3 and, after 14 days of treatment, to 0~1. Now she barely has any severe headaches. Conclusion: The findings of this study suggest that treatment with Korean medicine can be an effective option in treating chronic migraine. In addition, acupuncture can be a good treatment method for chronic migraine that cannot be fundamentally controlled by Western pain relievers.

• 대한한방내과학회지
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• 제45권4호
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• pp.615-634
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• 2024

Objectives: This study summarizes the current trends and results in clinical studies on herbal medicine treatments after thyroidectomy. Methods: Studies published between 2019 and 2024 were searched for on the China National Knowledge Infrastructure (CNKI), PubMed, and Research Information Sharing Service (RISS). The studies were analyzed according to year, study design, characteristics of the patients, and traditional Chinese medicine (TCM) intervention. A meta-analysis was conducted and classified according to the outcome measurements, such as the total effective rate (TER), thyroid stimulating hormone (TSH), free T4 (FT4), self-rating depression scale (SDS), CD3+, CD4+, and CD8+. CD8+. Results: A total of 18 randomized controlled trials (RCTs) and 5 non-randomized controlled trials were reviewed. The most common herbal prescriptions were decoctions made from Yangyin Sanjie (Yangeumsangyeol-tang), Yiqi Sanjie (Ikgisangyeol-tang), Yiqi Yangyin Sanjie (Ikgiyangeumsangyeol-tang), Yiqi Yangyin (Ikgiyangeum-tang), and Huiyan Zhuyu (Hoeyeomchugeo-tang). The most frequently used herbs were Prunellae Spica, Scrophulariae Radix, and Astragali Radix. The meta-analysis found that the group using both herbal and Western medicine was benefited more than the group using Western medicine alone (RR: 1.28, 95% CI: 1.20-1.37, P<0.00001). The experimental group had higher TSH, CD3+, and CD4+ levels, while FT4, SDS, and CD8++ were lower. However, due to high study heterogeneity, the results were not statistically significant. Conclusion: Complications after thyroidectomy include hypothyroidism, hypoparathyroidism, and psychological aftereffects. Herbal and conventional treatments showed potential in improving hormone levels, immune function, and depression, but statistical significance was limited due to study variability. These results should be interpreted cautiously given the risk of bias in the trials.

• 생물정신의학
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• 제7권1호
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• pp.85-98
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• 2000

1) 성기능장애 빈도는 정신분열병 환자군이 80%로 대조군 42%에 비해 유의하게 높았다(p<0.001). 성반응 주기에 따른 장애유형은 성적욕망장애 76%, 발기장애 75%, 발기유지장애 75%, 성적극치감의 질적감소 61%, 지루 50%, 사정시 정액량의 감소 44% 순서로 많았다. 성적극치감 횟수의 감소는 32%로 다른 장애유형에 비해 적었으며, 조루를 호소하는 경우도 15%나 되었다. 2) PRL 및 5-HT 측정치는 환자군에서 $28.5{\pm}20.6ng/ml$, $298.5{\pm}89.1ng/ml$으로서 대조군 $10{\pm}5.6ng/ml$, $169.2{\pm}37.8ng/ml$보다 유의하게 높았다(p<0.001). TST 측정치는 환자군이 $4.3{\pm}1.5ng/ml$, 대조군이 $4.5{\pm}1.2ng/ml$로 양군 모두 유의한 차이가 없었다. 3) 성기능장애를 증가시키는 변인은 결혼(미혼), 초발연령, 이병기간, 입원기간, 총약물투여기간 그리고 5-HT 측정치이었다. 특히 5-HT 비정상치군이 정상치군보다 성기능장애가 유의하게 높았다. 그러나 연령, 교육연한, 종교, 경제상태, PRL 및 TST 측정치, 항정신병약물용량, 약물역가, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K 점수와 성기능장애와는 무관하였다. 성기능장애는 정신분열병군에서 높았고, 성기능장애 유형별로는 성적욕망장애와 발기장애가 많았다. 미혼이거나, 초발연령이 높을수록, 질병에 이환된 기간이 길수록, 5-HT 농도가 높을수록 성기능장애가 증가하였다. 비록 혈중 5-HT 농도가 뇌 5-HT 활성을 어느정도 반영하는지는 알 수 없으나, 정신분열병 환자의 일차 병인인 과도한 5-HT 활성으로 인한 직접적인 성기능 억제효과 때문에 장애가 초래한다고 생각된다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제9권2호
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• pp.209-217
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• 1998

본 연구는 최근 증상이 악화된 뚜렛씨 증후군 환자에서 A군연구균(GABHS) 감염을 확인하기 위하여 antistreptolysin-O의 혈중 농도를 측정 하고 틱의 증상을 평가하여 항체의 혈중농도의 증가가 틱 증상 정도에 영향을 미치는지를 분석하여 악화 요인 중의 하나로 A군연구균(GABHS)의 감염을 검증하고자 하였다. 전체 대상군은 14명의 아동들로 특징은 다음과 같다. (1) 연령은 $6{\sim}15$세로 학동기와 청소년전기 아동으로 구성된다. (2) DSM-Ⅳ에 의해 1년이상 지속된 운동틱과 음성틱이 있는 뚜렛씨 증후군을 진단하였다. 단순틱 장애와 만성 운동 또는 만성 음성틱 장애는 배제하였다. (3) 정신병적인 상태나 경련이 있거나 기왕력이 있었던 경우 대상군에서 제외 하였다. 대상 아동들은 뚜렛씨 장애를 내원시에 처음 진단 받았거나 이전에 진단을 받고 약물 투여 중에 증상의 악화가 있었던 아동, 이전에 약물을 사용하였으나 호전 되어 약물 중단이후 최근 증상의 악화가 나타난 아동들었다. 예일 틱증상 평가척도(Yale Global Tic Severity Scale)를 사용하여 틱증상의 정도와 antistreptolysin-O 항체 수치(ASO titer)를 측정하였는데 항체수치가 상승한군(6명), 정상항체군(8명)의 두군으로 나누어 두군에서의 인구학적, 임상학적 특성, 틱증상의 정도, 공존장애율 등을 비교하였다. 항체수치가 상승한 군에서 정상항체군에 비해 남아의 비율이 더 높았으며 예일 틱증상 평가척도에서 장해도와 틱증상의 총점에서 더 높은 점수를 나타내 항체상승군에서 틱증상의 정도가 더욱 심함을 알 수 있었다. 통계적으로 유의하지는 않았지만 공존장애율도 항체상승군에서 더 높은 경향을 보이고 있었다. 이는 뚜렛씨 장애의 일부아형에서는 기존에 알려진 요인이외에도 증상의 발병과 악화에 A군연구균(GABHS)의 감염이 중요한 역할을 할 가능성이 있음을 시사해 준다고 할 수 있겠다.등 다른질환군이 동반된 군에서는 사회기술 평가 척도의 사회기술 항목에서 유의한 증가(p<.05)를 보였다. 그러나 각 집단간의 치료효과에 대해서는 세 집단사이에서 유의한 차이는 보이지 않았다. 위 결과로 보아 주의력결핍 과잉운동장애 아동에서 사회기술훈련 치료프로그램은 통계적으로 유의미할 만한 사회기술 향상은 보이지 않았다. 반면 품행장애가 동반된 군에서 공격적 행동의 감소를 가져오고 인지능력이 떨어진 군에서 사회기술 호전을 보이는 등 아동의 특성 및 동반증상에 따라 사회기술의 호전 및 증상의 변화에 도움이 됨을 확인할 수 있었다. 문제이며, 이것을 예방하고 치료하기 위해서는 우리 의사들의 적극적 관심이 필요하다고 생각하였다.)에서 자기파괴적인 행동이 있었으며 46명(29.3%)에서 충동성이 동반되었고 35명(22.3%)에서 유뇨증이 관찰되었다. 환자의 발병연령과 내원시 연령, 병의 이병 기간, 강박증상의 정도 사이에 통계적으로 유의한 양성의 상관관계가 있었고 과잉행동성과 음성의 상관관계가 있었다. 과잉행동성과 충동성, 강박성, 야뇨증, 자기파괴적 행동사이에 통계적으로 유의한 양성의 상관관계가 있었다. 환자의 강박증상의 정도와 과잉행동성, 수면장애, 자기파괴적 행동 사이에 통계적으로 유의한 양성의 상관관계가 있었다. 본 연구 결과 저자들은 외래에 내원한 뚜렛장애 환자의 임상적 특성이나 동반된 행동상 문제들이 이전 연구와 크게 상이하지 않음을 확인할 수 있었으며 발병연령이 어릴수록 과잉행동성이 심했으며 발병연령이 늦을수록 강박성이 심했다. 과잉행동성과 충동성, 강박성, 야뇨증, 자기파괴적 행동 등은 상호 높은 관련성이 있었다.}$과잉운동장애환아(過剩運動障碍患兒)에서의 충동성(衝動性)은 이 장애의 중심증상이 아니거나, 이들 약물투여에 의해 호전되지 않거나, 호전의 측정에 문제가 있을 수도 있겠다. 마지막으로 주의력결핍(注意力缺乏)${\cdot}$과잉운동장애(過剩運動障碍)에서 과잉행동(過剩行動)