• 제목/요약/키워드: severe pain

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임신 중 대량객혈로 발현된 원발성 폐고혈압 1예 (A Case of Primary Pulmonary Hypertension in Pregnancy Presented as Massive Hemoptysis)

  • 김명숙;김형두;김석찬;권순석;김영균;김관형;문화식;송정섭;박성학
    • Tuberculosis and Respiratory Diseases
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    • 제57권1호
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    • pp.66-71
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    • 2004
  • 저자들은 임신중기에 대량객혈로 내원하여 안정, 산소공급, 폐혈관확장제, 치료적 유산 그리고 항응고제 사용 등으로 치료하였으나 결국 우심부전으로 사망한 원발성 폐고혈압 환자 1예를 경험하였다. 본 증례는 폐관류 및 환기스캔, 폐혈관조영술 등의 검사와 사망후 부검은 시행하지 못하였으나 현재까지의 검사결과에 의거 시 임신 중 대량객혈로 발현된 일차성 폐고혈압으로 사료되어, 이에 문헌고찰과 함께 보고하는 바이다.

굴곡성기관지경으로 진단된 기관지결핵에 대한 고찰 (Flexible Bronchoscopic Observation on Endobronchial Tuberculosis)

  • 최재성;이영현
    • Journal of Yeungnam Medical Science
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    • 제2권1호
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    • pp.161-166
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    • 1985
  • 기관지결핵은 폐결핵 환자의 상당수에서 관찰되며, 폐침윤이 없는 경우에도 기관지폐쇄로 인한 무기폐, 임파선 종대로 인한 종괴의 형성으로 타폐질환과 감별을 요하게 된다. 저자들은 1983년 5월부터 1985년 7월까지 영남대학병원에서 굴곡성 기관지경을 사용하여 기관지결핵으로 진단하였던 25예를 대상으로 그 임상상을 관찰 조사 하였기에 보고하고자 한다. 1) 25명의 기관지결핵 환자 모두 항결핵제 투약을 받았으며, 이중 호흡곤란이 심하거나 주 기도내에 광범위한 육아종 병변이 있었던 6명에서는, corticosteroid의 투여로 호전을 보였다. 2) 기관지결핵의 진단에 굴곡성 기관지경을 통한 조식검사나 항산균의 도말 및 배양검사가 필수적이다.

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퇴행성 슬관절염에 대한 핵의학적 고찰 (The nuclear medicinal study on degenerative arthritis of knee joint using traditional acupuncture)

  • 김영규;박소영;고강훈;윤민영;진경선;장병선;오희홍;김성철;황우준;송호천;안수기
    • Journal of Acupuncture Research
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    • 제19권1호
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    • pp.127-134
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    • 2002
  • Background and Purpose : Now, a lot of people are suffering from arthritis of knee joint. Western and oriental medicine, all of them are trying various methods to cure this disease, but generally the grade or level of repairing has been decided by the subjective estimation of the patients and doctors. So, we suggest the new standard for estimating the level of repair in this disease using nuclear medicine. Objective : To evalute the difference of the blood pool and delayed images in the correlation with clinical symptoms in patients with arthritis of knee joint by using acupuncture. Methods : Eight patients with arthritis of knee joint included in this study. Using Thermograph (D.I.T.I) and Radionuclide, we obtained the results. In Bone scan Tc-99m MDP, and MIBI scan was obtained at 1 minute and 3 hour after injection of 1,110 MBq Tc-99m MDP and MIBI. The analysis was carried out hurted area of joint. The Joint-to-background(J/B) ratios were obtained exclusively in the joints regions. Clinical symptoms were evaluated as pain and swelling graded from 0(no) to 5(severe) in the same joints, respectively. Results : J/B ratios on the delayed scans were higher than those on blood pool images. There was significant correlation between clinical symptoms and J/B on blood pool image in the joints =0.03). Conclusion : The results demonstrate that blood pool images of Tc-99m MDP scintigraphy correlates with clinical symptoms more than delayed images in patients with arthritis Joint.

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무치악 환자에서 기성 조립식 bar를 이용한 임플란트 피개의치 증례 (Implant-retained overdentures with pre-fabricated bar attachment system in edentulous patients)

  • 소나영;홍영기;하승룡
    • 대한치과보철학회지
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    • 제54권1호
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    • pp.41-48
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    • 2016
  • 치아 상실에 이어 심각한 치조골 소실을 보이는 무치악 환자들은 전통적인 방식의 총의치를 사용하는데 어려움이 많다. 이러한 문제를 보완할 수 있도록 임플란트를 이용한 피개의치가 사용되고 있다. SFI-bar$^{(R)}$는 진료실에서 직접 조정이 가능한 기성품으로 복잡한 기공과정을 필요로 하는 기존의 바 시스템보다 간결하여 시간과 비용을 절감할 수 있다. 첫 번째 증례는 55세 남자 환자로 기존 하악 임플란트-지지 피개의치가 파절되었다는 주소로 내원하였고 내구성이 있으며 통증이 없는 의치를 원하였다. 파절된 Locator$^{(R)}$ 어태치먼트를 제거 후 바를 이용한 피개의치로 치료하였다. 두 번째 증례는 파킨슨병을 앓고 있는 77세 여자 환자로 하악 치조골이 심각하게 흡수되어 의치가 자주 탈락한다는 주소로 내원하였고 통증이 없고 유지력이 있는 의치를 원하였다. 하악 전치부에 두개의 임플란트를 식립한 후 임플란트에 연결된 어댑터에 바를 연결하였다. 그 후 바에 맞는 여성부를 새로운 의치에 장착하여 치료하였다. 2년의 추적 관찰 결과 상기 환자 모두 심미적, 기능적으로 만족할만한 결과를 보였으므로 증례를 보고하고자 한다.

골관절염 환자에서의 건강관련 삶의 질 도구(EQ-5D)의 타당도 검증 (A Validation Study of EQ-5D in the Patients with Osteoarthritis)

  • 임난영;이인옥;이은남;이경숙;조경숙;이선자;강현숙;김금순;김종임;박원숙;이윤경;전미영
    • 근관절건강학회지
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    • 제17권2호
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    • pp.203-211
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    • 2010
  • Purpose: We aimed to test the validity of the EQ-5D (Euro-Quality of Life-5 Dimension), a brief and simple instrument, in measuring health related quality of life in the patients with osteoarthritis. Methods: 183 participants attending the education programs for osteoarthritis patients at the Health Centers located in Seoul and Gyunggi province area during the periods of June to December in 2009 were interviewed with the EQ-5D and KWOMAC (Korean version of Western Ontario and McMaster Scale). The data were analysed with Spearman correlation coefficents and t-test by using of SPSS/WIN 12.0 version. Results: There was a negative correlation between knee pain, stiffness and difficulty in usual activity of sub category items of KWOMAC and EQ-5Dindex, while there was no correlation between these categories and EQ-VAS. Moreover, as a result of comparing the score of physical function measured by KWOMAC according to the severity degree of the EQ-5Dindex, the group of advanced stage having moderate and severe symptoms reported significantly higher scores of physical function than those of groups having no health problems. Conclusion: The EQ-5D is an acceptable and valid instrument for measuring health-related quality of life in patients with osteoarthritis.

후기 황체기 불쾌기분 장애의 평가 방법 및 진단에 관한 예비 연구 - 정신과 외래환자를 대상으로 - (A Preliminary Study on Method for Evaluation and Diagnosis of Late Luteal Phase Dysphoric Disorder in Women - Focusing on Psychiatric Outpatients -)

  • 이상규;조숙행;곽동일
    • 정신신체의학
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    • 제3권2호
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    • pp.115-125
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    • 1995
  • Reports about the prevalence of premenstrual symptoms state that occurs in 20 to 100% of most reproductive-age women. There is a close association between premenstrual syndrome and affective disorders as well as same some other psychiatric disorders. Late luteal phase dysphoric disorder (LLPDD) is a premenstrual condition defined in DSM-III-R by severe mood changes and other symptoms that repeatedly occur only in the luteal phase of the menstrual cycle. However, DSM-III-R does not specify how to compute the change from the follicular to the luteal phase or how to determine when the amount of change is great enough to warrant the diagnosis nor how to determine occupational or social functional impairment. This study was conducted to evaluate the nature, severity and magnitude of premenstrual syndrome in women with current psychiatric disorders by using prospective Daily Rating Form(DRF), and to measure symptom changes according to three scoring methods for diagnosing LLPDD. Our study obtains the data about premenstrual changes estimated by DRF from 22 women with psychiatric disorders who had met criteria for major depressive syndrome on the Premenstrual Assessment Form (PAF). The data was scored by each three methods and was determined to meet criteria A for LLPDD. The results are as follows: 1) the subjects, when scored according to the percent change method, effect size method and absolute severity method, met the DSM-III-R criteria A for LLPDD in 36.4% (8 subjects), 14% (3 subjects) and 4.5% (1 subject) of the cases respectively. 2) The items of irritability, anger and impatience were occurred most frequently on the DRF, when it was scored according to the three scoring methods. And the item of breast pain was next frequent according to the effect size method and the percent change method but according to the absolute severity method. 3) The PAF item of impaired social functioning was reported by 16 (73%) of the subjects. 4) 4 (18%) of the subjects met criteria A for LLPDD and reported impaired social functioning. The prevalency of LLPDD according to each method varied. The percent change method yielded the greatest (36.4%), and the absolute seventy method yielded the laest (4.5%), The effect size method yielded an intermediate frequency (14%). Therefore, for maximizing the diagnostic accuracy of LLPDD, a diagnostic procedure including a measure of change (e.q., effect size method, percent change method) as well as confirmed diagnosis by DRF, will be needed. Also, an accurate tool to evaluate impaired social functioning will be required.

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시각적 피로도에 영향을 미치는 시청거리와 깊이방향의 운동속도 (The effect of viewing distance and the speed of motion-in-depth on visual fatigue)

  • 감기택;이형철;이승현
    • 감성과학
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    • 제12권2호
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    • pp.169-180
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    • 2009
  • 본 연구에서는 입체 영상이 가지는 특성과 시청환경의 특성에 따라 입체 영상을 시청할 때 발생할 수 있는 시각적 피로도를 체계적으로 살펴보기 위해 깊이방향의 운동속도와 응시거리 각각을 입체 영상과 시청환경의 대표적인 특성으로 삼고 각 요인에 의해 발생되는 시각적 피로도를 측정하였다. 시각적 피로도는 눈통증 요인, 시각적 스트레스, 어지러움 요인, 신체 통증 요인, 상흐림 요인으로 구성된 피로도 측정도구를 이용하여 주관적인 시각적 피로도를 측정하였다. 실험 1에서는 깊이 방향의 운동속도를 변화시킨 자극을 40분간 제시하면서 10분, 20분, 40분에 시각적 피로도를 측정하였다. 측정결과 전체 피로도 점수는 시청시간이 증가함에 따라 높아졌지만 운동 속도에 따른 차이를 보이지 않았다. 다섯 개의 하위척도들 중 어지러움 하위척도 점수에 서만 운동 속도가 증가할수록 증가하는 것으로 나타났다. 실험 2에서는 동일한 입체 영상을 응시거리만 변화시켜가면서 시각적 피로도를 측정하였다. 전체 피로도 점수는 시청시간이 증가함에 따라 높아졌지만 응시거리에 따른 차이는 발견되지 않았다. 다섯 개의 하위 척도들 중 상흐림 하위척도 점수에서만 응시거리가 멀어질수록 감소하는 것으로 나타났다. 이러한 결과는 입체 영상의 특성이나 시청환경에 따라 시각피로도가 변화될 수 있음을 보여주며, 시각피로도를 발생시키는 요인에 따라 각기 다른 종류의 시각피로도가 발생할 수 있음을 보여준다.

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구강과 인후두의 악성종양 치료시 발생한 누공의 진단과 치료 (Diagnosis and Treatment of Pharyngocutaneous Fistula After Treatment of Oral Cavity and Pharyngolaryngeal Cancer)

  • 홍현준;송승용;이원재;유대현;나동균
    • Archives of Plastic Surgery
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    • 제36권5호
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    • pp.611-616
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    • 2009
  • Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

천연물 항암제제 임상시험 평가지표 개발연구 (Study on Development of Assessment Guideline and Endpoints for Clinical Trial with Antitumor Natural Products)

  • 남궁미애;장유성;정승기;김진성;윤성우;장기영;유화승;정면우;이성호;김성훈
    • 동의생리병리학회지
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    • 제20권6호
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    • pp.1678-1727
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    • 2006
  • This study was perfromed to develop the assessment guideline and endpoints for clinical trial with anticancer herbal medicine. The botanical products used to humans for long time may be applied to phase 3 clinical trial after submitting the evidences for safety and efficacy of them or completion of basic requirement of phase 1 and phase 2 for safety confirmation and dose determination. Syndrome improvement was chiefly evaluated by Zubrod and karnofsky(%) methods. We suggest the general clinical trial assessment with botanical products, by following assessment points, that is, tumor size for 50 points, survival fate for 10 points, major syndromes for 40 points. It is recommendable that the each symptom of Qi deficiency syndrome, blood deficiency syndrome and Qi stagnation syndrome was allocated by assessment points, Similarly, the each symptom was given the assessment points according to the severity of symptom, for example, slight for 3 points, moderate for 2 points and severe for 1 point in hepatocelluar carcinoma and lung cancer. Then, the efficacy of botanical products was evaluated by the difference between pre-treatment and post-treatment. Asking the neoplastic patients of questionnaire on physical, emotional, cognitive, social and role subjects availability, three more syndromes (Fatigue, Pain and Nausea/Vomit), quality of life(QOL) will be evaluated by GLM statistics. In addition, in case of lung cancer, 13 questions will be asked by the EORTC QLQ-C13 forms. As the assessment of endpoints for efficacy to reduce side effects induced by chemotherapy and radiotherapy, the data of image scanning and hemato-urinalysis can be usefully applied on immune response, weight loss, indigestion, hemopoietic damage and injury of liver and kidney, while the changes of syndromes of side effect can be evaluated by differentiation methods of Qi and blood and five viscera. However, it is still necessary to determine the ratio between scientific analytical method and Oriental differentiation method as well as confirm the Oriental assessment endpoints by clinical trial. In addition, we suggest the continuous development of assessment endpoints on other carcinomas except of hepatocelluar carcinoma and lung cancer in future.

용혈성 요독 증후군에서 발생한 췌장염 2례 (Two Cases of Pancreatitis in Children with Hemolytic Uremic Syndrome)

  • 박지민;김기성;남영미;김은수;안선영;신재일;이재승
    • Childhood Kidney Diseases
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    • 제7권2호
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    • pp.211-216
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    • 2003
  • 장출혈성 대장균에 의한 식중독의 대규모 집단발생이 2003년 5월부터 9월까지 국내에서 발생하였다. 오염된 학교 급식을 통해 감염된 환자들은 주로 서울과 경기도에서 발생하였다. 이 식중독의 결과로, 2003년 한 해, 총 36명의 환자들이 용혈성 요독 증후군으로 진단되었고, 그 중 5명의 환자가 본원을 방문하였다. 올해 대규모 집단 발생 이전에 저자들은 지난 14년간 본원에서 총23명의 용혈성 요독 증후군 환자들을 보고하였는데, 이들은 모두 췌장 효소의 상승이 없었다. 지난 14년간의 보고와는 달리, 올해의 용혈성 요독 증후군 환자들은 심한 복통과 2명에서 현저한 췌장 효소의 상승을 보였다. 저자들은 2003년에 유행하였던 용혈성 요독 증후군 환자 중에서 췌장염을 일시적으로 동반하였던 2례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

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