• Clinical and Experimental Pediatrics
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• 제60권7호
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• pp.232-236
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• 2017

Pulmonary alveolar proteinosis (PAP) is a rare disease in children characterized by intra-alveolar accumulation of surfactant proteins, which severely reduces gaseous exchange. Whole lung lavage (WLL) is the preferred technique for the treatment of severe PAP. Herein, we present a pediatric case of PAP treated with WLL. An 11-year-old boy was admitted with the chief complaint of a dry cough lasting 6 months. He developed symptoms of dyspnea on exertion and had difficulty in climbing stairs. He was ultimately diagnosed with PAP through video-assisted thoracoscopic lung biopsy. As first-line of treatment for PAP, he underwent therapeutic WLL for each of his lungs on separate days. After a brief recovery, his symptoms gradually worsened; therefore, he underwent a second WLL. This is the first pediatric case of PAP relapse despite successful WLL in Korea.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.757-766
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• 2020

Objective : Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA. Methods : Patients treated for SEA in the authors' department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre- and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as "early", when performed within 12 hours after admission and "late" when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention. Results : One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy. Conclusion : Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권1호
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• pp.55-60
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• 1997

Langerhans Cell Histiocytosis(Idiopathic Histiocytosis, Histiocytosis-X) is most often found in children and young adults, and cell proliferation with specific phenotype shows ultrastructural and immunohistochemical similarities with Langerhans Cells that normally exist in epithelium and mucosa. This disease occurs as single or multiple lesions in skull, ribs, vertebrae, mandible and long bones, and when it involves mandible, clinical sign and symptoms such as bone swelling and pain are noticed. When it involves alveolar bone, severe tooth mobility as well as gigival inflammation, proliferation, and ulceration are commonly found, and so it is not easy to differentiate it from general inflammatory diseases. Any local lesion at the tooth apex on the x-ray view needs to be differentiated from inflammatory disease, and multiple lesions from multiple ostoeoma and chronic multifocal osteomyelitis. This case is LCH in 51-year-old male patient ; this is a rare case, for the patient belongs to an age group with very low incidence rate of the disease. although three-timed biopsy tests and longterm observation at two university hospitals, it was misdiagnosed as multifocal osteomyelitis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권1호
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• pp.1-13
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• 1997

Preoperative and postoperative TMJ symptoms were observed in mandibular prognathism of 30 patients operated on by Le Fort I osteotomy and intraoral vertical ramus osteotomy. The alterations of TMJ symptoms were investigated and the relationship between changes of TMJ symptoms and some cephalometric values including occlusal plane angle, mandibular plane angle, posteior ramal height and a degree of deviation of mandibular incisor midline to facial midline were observed. The results are as follows. The incidence of patient with TMJ symptoms before orthognathic surgery was 40% and after orthognathic surgery was 20%. The most frequetly encountered symptoms in orthognathic TMJ dysfunction patients were TMJ pain and/or clicking. After surgery 66% of the preoperative symptomatic patients reported improvement TMJ symptoms. On the orther hand 2 patient (6%) of the preoperative asymptomatic patients developed TMJ symptoms after surgery. Preoperatively, 60% of the facial asymmetric patients with mandibular prognathism had TMJ symptomas. The more severe facial asymmetry was, the higher incidence of TMJ symptoms was. The alteration of occlusal plane angle and mandibular plane angle seems to be one of the contributing factors which make to change TMJ symptoms in orthognathic patients. But its amount seems to be low significance. Increase or decrease of posterior ramal height have influence on the change of TMJ symptoms.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권2호
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• pp.113-118
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• 2008

Temporomandibular joint disorder (TMD) can induce severe pain but, its pathogenic mechanisms remain poorly understood. In this study, we analyzed proteomes of human synovial fluid in the superior joint space in the patients with TMD, which is obtained during the treatment arthrocentesis. We've got this result that one of the spots was consistently down-regulated in synovial fluid of patients with TMD from analysis of protein pattern. Its molecular weight was estimated to be 33 kDa. Synoviolin was identified in our proteomics analysis of LC/MS/MS. This protein was recently reported as one of the proteins that might affect rheumatoid arthritis (RA). Synoviolin that might be associated with RA was detected in synovial fluid of patients with TMD. We can conclude that synoviolin might be involved not only in the pathogenesis of RA but also in TMD. In result, synoviolin might be involved in the pathogenesis of TMD and can be candidates as new therapeutic targets of TMD or early detection biomarkers.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.358-364
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• 2007

Purpose: A life-threatening hemorrhage resulting from a severe facial fracture is rare, but it needs a prompt and aggressive treatment. Especially, a massive oronasal bleeding combined with midfacial fracture which may result from the rupture of the internal maxillary artery. With the recent advances in the radiologic intervention, its use has increased for managing these life threatening case. We reviewed its usefulness with our experiences and literatures. Methods: A retrospective review was performed to determine the usefulness of the transcatheter arterial embolization in patients with panfacial trauma. If the vital signs were unstable, cardiopulmonary resuscitation was performed. Oronasal bleeding was controlled with nasal packing and electrocautery. All injured regions were studied by radiologic study including CT. Even after primary management, if the oronasal bleeding was persistent, radiologic intervention was performed 10 patients were treated with transcatheter arterial embolization and the bleeding focus controlled by embolization with polyvinyl alcohol and gelfoam. Results: After the intervention, the vital signs became stable and there were no complications from embolization in the follow-up for 6 months. Also patients could recover through appropriate operations. Conclusion: Transcatheter arterial embolization for maxillofacial injury has many advantages for both, the doctor and the patient. First, less pain is induced than a compression device or an operation, which is another way to treat oronasal bleeding. Second, it does not need general anesthesia. And through a single procedure not only we can know the accurate bleeding point, but we can also bleeding by embolization.

• Journal of Chest Surgery
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• 제39권10호
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• pp.782-785
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• 2006

복부 대동맥류의 수술에 있어서 만성 폐쇄성 폐질환은 수술 사망에 유의한 영향을 미치는 위험 인자로 알려져 있다. 따라서 수술 후 호흡기 합병증을 줄이기 위해서는 강제적 기계 호흡을 줄이고 가능한 환자의 자발 호흡을 유지하는 것이 수술 결과를 향상시킬 수 있다. 본 증례에서는 복부 통증을 주소로 내원한 77세의 남자 환자로 수술 전 검사에서 약 9 cm크기의 복부 대동맥류가 발견되었으나, 심한 만성 폐쇄성 폐질환이 동반되어 수술 후 사망률이 높을 것으로 예상된 경우에서 경막외 마취등을 통해 환자의 자발 호흡을 유지한 상태로 복부 대동맥류 절제 및 인조혈관 삽입술을 시행하여 좋은 결과를 얻을 수 있었다.

• Journal of Chest Surgery
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• 제30권4호
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• pp.462-466
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• 1997

원발성으로 종격동에서 발생한 융모막암종은 드문 질환으로 젊은 남자에서 주로 발견되었으며, 기침, 흉통, 여성형 유방 등의 증상을 보이는 것으로 알려졌다. 33세 여자로 약 3개월 전부터 가벼운 기침으로 시작하였으나 심한 호흡곤란과흉통증 등 증상이 급격히 악화되어 내원하였다. 방사선학적 검사상 후종격에서 직경 13cm크기의 종양이 발견되었고, 혈중 $\beta$-HCG가 20만 mIU 이상 증가하였으며, 적출된 종양은 $\beta$-HCG에 대한 면역조직화학적 검사상 양성반응을 보였다. 융모막암종 절제술을 받고 EMA-CO투여 받은후 약 7개월만에 뇌에 전이된 종양 때문에 뇌출혈을 일으켜 다시 뇌종양 적출술을 받았다. 환자는 그 후 약 7개월동안 두통외의 증상은 없었고 흉부단순촬영상 종격종양의 재발소견도 없었다.

• Journal of Chest Surgery
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• 제37권11호
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• pp.946-950
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• 2004

혈관주위세포종은 모세혈관을 둘러싼 주위세포(pericyte)에서 발생하는 종양이다. 비록 혈관이 많이 분포한 장기이나 폐에서 발생은 매우 희귀하다고 알려진 악성 종양이다. 63세 여자 환자는 약 8년간 기침, 객담과 간헐적인 가슴통증을 호소하였으며 최근 3개월 간 점진적으로 악화되는 호흡곤란 및 기좌호흡상태로 본원 흉부외과에 입원하였다. 침 폐조직 생검에서 폐혈관주위세포종으로 확인되었으며 흉부 X-선 소견, 흉부 전산화단층촬영에서 진행된 폐종괴로 확인되어 항암약물치료가 예정되었다. 그러나, 흉곽의 대부분을 차지한 종양이 파열되고 흉관삽관술로 혈흉이 제거되지 않아 응급 개흉수술을 하여 응고된 혈괴제거 및 종양을 포함한 좌전폐절제수술을 시행하였다. 수술 후 경과가 양호하여 술 후 7일째 퇴원하였다. 병리조직 검사상 악성 침습성 폐혈관주위세포종으로 확인되었고, 현재 방사선 치료 후 항암약물치료 중이다.

• 대한수의학회지
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• 제46권4호
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• pp.381-385
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• 2006

Discospondylitis is an infection of intervertebral discs, associated end plates, and adjacent vertebral bodies causing destruction and proliferation. A 10-year-old intact female Rhodesian Ridgeback dog was referred to the Veterinary Medical Teaching Hospital, Seoul National University with paraparesis and severe pain at T13-L1 region for one week duration. The treatment with PDS for one week by referring veterinarian showed no clinical improvement. At time of presentation, clinical signs of the patient included depression, vaginal discharge, and fever. In T-L spine radiography, osteolytic change was found between caudal endplate of T13 and cranial endplate of L1. The affected vertebral bodies were shortened and intervertebral disc space was widened. In abdominal radiography, a dilated soft tissue opacity tubular structure was found in mid-caudal abdomen. The abdominal ultrasonography revealed the uterus dilated with echogenic fluid. The CT findings showed concentric lysis of T13-L1 endplates. The dog was diagnosed as diskospondylitis at T13-L1 and pyometra. Urine and blood were cultured, and Staphylococcus (S.) intermedius was identified. The patient had surgical treatment for pyometra but died for septicemia.