• Clinical Endoscopy
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• 제56권5호
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• pp.594-603
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• 2023

Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA- groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA- group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA-) groups were 84.0% and 72.0%, respectively. The PA- group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0-10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA- group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Conclusions: Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

• 대한족부족관절학회지
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• 제28권1호
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• pp.15-20
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• 2024

Purpose: Achilles tendon rupture is a frequently encountered ankle pathology associated with a substantial burden of intense pain and functional deficits. Chronic Achilles tendon ruptures with considerable defects pose intricate repair challenges that are often marred by complications such as re-rupture and persistent pain. Various treatment methods, including allograft transplantation, have been proposed, but the literature on this technique is limited. In this study, we propose a surgical approach utilizing allotendon transplantation and a calcaneal tunneling technique and provide clinical evaluation details. Materials and Methods: Fifteen patients with chronic Achilles tendon ruptures treated with allotendon between 2020 and 2022 were included in the study. Patients were evaluated at 1, 3, and 6 months postoperatively using Visual Analog Scale (VAS) scores and Achilles Tendon Total Rupture Scores (ATRSs). Complications were assessed postoperatively. Results: The average VAS score was 7 before surgery, 7.3 immediately after surgery, and 4.3 at 1 month, 2.5 at 3 months, and 1.3 at 6 months after surgery. Because the sample was limited to 15 individuals and distributions were non-normal, the analysis was conducted using the non-parametric Wilcoxon's signed-rank test, and statistical significance was accepted for p-values<0.05. Results showed a significant improvement in ATRS and VAS scores versus preoperative and immediate postoperative values. VAS scores showed a decreasing trend after surgery, whereas average ATRS scores increased from 14 before surgery, 33.8 at 1 month, 82.7 at 3 months, and 93.9 at 6 months. Conclusion: This study suggests that allograft transplantation using the described calcaneal tunnel technique provides an effective treatment for chronic Achilles tendon ruptures. However, extensive research and long-term clinical trials are required to validate and better understand the technique's efficacy.

• The Korean journal of internal medicine
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• 제39권1호
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• pp.86-94
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• 2024

Background/Aims: A catheter is inserted through the nasal cavity during high-resolution esophageal manometry (HRM), which may cause adverse events such as pain or epistaxis. Despite these possible safety considerations, studies on this subject are very limited. We aimed to investigate the usefulness of nasal cavity evaluation before HRM to reduce the risk of adverse events and test failure. Methods: Patients who underwent HRM after consultation with the ear-nose-throat department for nasal evaluation were retrospectively enrolled between December 2021 and May 2022. The included patients had a previous history of sinonasal disease or surgery or had subjective nasal discomfort. All patients answered the Sino-Nasal Outcome Test (SNOT-22) questionnaire, and subjective nasal discomfort was scored using a visual analog scale. Nasal endoscopy and acoustic rhinometry were performed for disease evaluation and volumetric assessment. Results: The analysis included 22 patients with a mean age of 58.9 years. The mean SNOT-22 score was 24.2, and 16 patients (72.7%) complained of subjective nasal obstruction. The HRM catheter was successfully inserted in 20 patients (90.9%), without any significant adverse events. The objective measurement outcomes of acoustic rhinometry and sinus endoscopy did not always correspond to subjective symptoms. Narrowed nasal airways unresponsive to decongestants were observed in two patients with failed catheter insertion. Conclusions: To reduce the risk of adverse events and test failure during HRM, a site-specific questionnaire to evaluate nasal obstruction might be helpful. When nasal obstruction is suspected, objective nasal cavity evaluation could be recommended for the safe and successful performance of HRM.

• 대한정형외과 초음파학회지
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• 제7권1호
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• pp.33-38
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• 2014

목적: 신경성형술로 치료한 추간판 탈출증 환자들 중 호전되지 않은 환자들을 대상으로 초음파 유도하 내측 분지 차단술을 시행하여 치료적으로 유용한가를 분석하고자 하였다. 대상 및 방법: 2011년 11월에서 2013년 2월까지 추간판 탈출증으로 신경성형술을 받은 만성 요통 환자 559명 중 시술후에도 요통 혹은 하지 연관통 증상을 보여, 초음파 유도하 내측 분지 차단술을 시행받고 1개월 추시가 가능하였던 88명과 이 중 6개월 추시가 가능하였던 39명의 환자들을 대상으로 하였다. 한 명의 의사가 모든 증례를 시술하였으며 방사선 피폭의 위험을 없애고자 방사선 투시 하가 아닌, 초음파 유도하에 23 G, 10 cm 주사 바늘을 삽입하고 약제를 주사하였다. 내측 분지를 목표로 하기 위하여 횡축 영상에서 상 관절 돌기와 횡 돌기의 교차점에 바늘이 놓이도록 하였다. 시술 후 각 시점에서 Visual Analog Scale (VAS) score와 Oswestry Disability Index (ODI)를 측정하여 시술 전과 통증의 정도와 기능의 변화를 비교 분석하였다. 의미 있는 통증 및 기능의 호전 기준은 VAS 50% 이상의 감소, ODI 40% 이상의 감소를 기준으로 하였다. 결과: 시술 전 VAS는 평균 $7.35{\pm}1.68$점, ODI는 평균 $32.82{\pm}8.77$점이었다. 이에 대하여 시술 후 1개월에 VAS는 평균 $3.36{\pm}2.98$점, ODI는 평균 $15.14{\pm}14.01$점으로 의미있게 감소하였으며(p<0.05) 시술후 6개월에는 VAS는 평균 $3.05{\pm}2.27$점, ODI는 평균 $12.97{\pm}8.82$점으로 의미있게 감소하였다(p<0.05). 1개월 군에서는 통증이 64.49%에서 의미있게 감소하였으며 59.81%에서 기능이 유의하게 향상되었다. 3개월 군에서는 통증이 64.10%에서 의미있게 호전되었고 61.54%에서 의미있게 기능이 향상되었다. 결론: 초음파 유도하 내측 분지 차단술은 추간판 질환으로 인해 이차적으로 발생한 후방 관절의 문제에 대한 치료로서 효과적이라고 생각한다.

• 근관절건강학회지
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• 제5권1호
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• pp.39-56
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• 1998

This study was an quasi-experimental study, done to identify factors Influencing the reduction of symptoms in patients with fibromyalgia. The primary purpose of the study was to develop a Self-Help Program suitable for patients with fibromyalgia in Korea. The secondary purpose was to identify the effects of a Self-Help Program which included stretching exercise. This study was carried out between Feb. 24 and July 8, 1997 and patients in the study Included out patient diagnosed with fibromyalgia based on the criteria developed by the American College of Rheumatology(1990) and H, University which is a tertiary patient care clinic for Rheumatism. The experimental group included 38 patients who were residents of Seoul or Kyungi province, and a control group of 38 patients who were residents of other areas. The control patients were matched to the experimental group patients and they were selected considering the number of tender points on the Fibromyalgia Impact Questionnaire score and a score of self-efficacy. The experimental group participated in a Self-Help Program based on the American Arthritis Foundation(1995) guidelines. The program participants participated in a small group which consisted of 12-15 members attending the program once a week, for 6 weeks with each program lasted two to two and a half hours. The stretching exercise was carried out in each patient's home every day following the video tape exercise provided by the researcher, and the researcher provided encouragement and concern to the patients by calling them once a week. The number times the exercise was performed was divided by the number of participants to calculate the percentage of performance and determine the amount of exercise. Self-efficacy was measured by the Self-Efficacy Scale developed by Lorig et al. (1989) for arthritis patients. The degree of pain was converted to scores based on the Visual Analog Scale, the number of tender points was converted to scores based on the criteria of the ACR(1990) and of Yunus. Depression was measured by CES-D and physical disability, sleep disturbance, fatigue, and anxiety of patients with fibromyalgia were measured by the Fibromyalgia Impact Questionnaire. The level of the exercise performance was converted to scores using the number of times the exercise was performed following the video tape prepared by Association of Rheumatology Health Professionals. Data were analyzed by SPSS windows and the results ire described below. 1. The experimental group which participated in the Self-Help Program showed higher efficacy scores than the control group when both groups were analyzed for depression and the number of tender points as common variables(F=9.146, p=.003). 2. The experimental group which participated in the Self-Help Program showed lower scores than the control group, for pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety. These symptoms of fibromyalgia can all be seen to have subsided(F=9.483, p=.003 : F=32.680, p=.001 ; F=11.104, p=.001, F=5.344 : p=.024, F=7.630 : P=.007, F=15.6512, p=.003 : F= 7.5412, p=.008). 3. In the experimental group, the self-efficacy score for the first three weeks showed a positive correlation with the exercise-performance score for four to six weeks (r=.387, p=.043). 4. In the experimental group, the relationship between the level of exercise-performance and the reduction of symptoms showed a significant correlation only to physical disability(r= -.500, p=.001). 5. In the experimental group, the relationship between the self-efficacy score and pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety score showed inverse correlations and thus, a reduction of symptoms occured when the self-efficacy score increased(r=-.325, p=.004 ; r= -.253, p=.027, r=-.452, p=.001 : r=-.434, p=.001 ; r=-.316, p=.005 ; r=-.460, p=.001 ; r=-.397, p=.014). Therefore, self-efficacy improved following the Self-Help Program including the stretching exercise. It was also found that physical symptoms (pain, number of tender points, level physical disability) and psychological symptoms (depression, fatigue, sleep disturbance, anxiety) were reduced. Moreover, It was found that the higher the self-efficacy, the the higher the degree of achievement of goals set for the stretching exercises. In addition, the level of exercise-performance influenced the level of physical disability, one of the symptoms of fibromyalgia. Accordingly, the conclusions from this study are that exercise-performance and the reduction of symptoms is achieved through promotion of self-efficacy. Therefore, it is proposed that are the Self-Help Program including stretching exercises is an appropriate nursing intervention for the reduction of symptoms of fibromyalgia.

• 대한관절경학회지
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• 제13권1호
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• pp.28-33
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• 2009

목적: 동종 반월상 연골 이식술의 결과를 내측과 외측 및 동반손상 유무에 따라 비교하고자 하였다. 대상 및 방법: 1999년 12월부터 2007년 6월까지 동종 반월상 연골 이식술을 시행하고 1년이상 추시가 가능했던 52례를 대상으로 하였다. 내측 이식군은 19례, 외측 이식군은 33례였고, 단독 손상군은 18례 동반 손상군은 34례였다. 평균나이는 34.2세(18세~51세) 평균 추시기간은 42.2개월(12개월~90개월)이었다. 임상적 결과의 판정을 위하여 슬관절 운동범위, VAS 점수, IKDC 주관적 평가 점수, Lysholm 점수, Tegner 점수, 환자 만족도 및 이차 관절경 또는 추시 MRI를 시행하였다. 결과: 수술 후 평균 관절운동 범위는 130.3도 였다. VAS 점수는 수술 전 5.96점에서 3.05점으로, IKDC 주관적 평가 점수 46.5점에서 64.52점으로(p<0.001), Lysholm 점수는 61.94점에서 79.58점으로(p=0.0019) Tegner점수는 수술 전 2.97에서 3.62점으로 향상되었으며 수술의 만족도는 '매우만족', '대체로 만족'이라고 대답한경우가 61.5% 였다. 수술 후임상적 점수의 향상이 있었지만 내측과 외측 이식술 군간 그리고 단독 손상군과 동반 손상군 간의 통계적 유의한 차이는 없었다. 이차 관절경을 시행한 18례중 10례에서 이식된 동종 반월상 연골의 변연부의 치유 소견이 관찰되었고 6례에서 부분파열이 2례에서는 복합 파열이 관찰되었다. 추시 MRI 촬영이 가능하였던 16례에서 아탈구는 12례에서 관찰되었다. 결론: 반월상 연골 이식술 후 내측과 외측 이식군 간의 임상적 결과는 차이가 없었으며 동반된 연골 손상이나 불안정성에 대한 치료를 병행한 경우 동반손상의 유무는 결과에 영향을 미치지 않았다.

• 대한정형외과 초음파학회지
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• 제3권1호
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• pp.21-25
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• 2010

목적: 회전근 개 봉합 수술 후 증상이 지속되는 환자에서 초음파를 활용한 증식 주사술의 유용성에 대해서 분석하였다. 대상 및 방법: 2008년 1~12월까지 회전근 개 손상 중 극상근 파열을 보인 환자에서 수술을 시행하고, 4주 후 평가에서 동통이 지속된 환자 중 초음파를 이용한 증식 요법을 시행한 90명을 대상으로 하였다. 평균연령은 55.2세였다. 시술 전 후 통증에 대한 시각 점수 척도(Visual analog scale, VAS)와 관절 운동 범위 및 시술 시 발생하는 문제점 및 합병증을 비교 분석하였다. 결과: 통증에 대한 시각 척도 검사(VAS)는 시술 전, 시술 후 4주에서 각각 $6.3{\pm}1.25$, $2.5{\pm}2.304$로 감소하여 의미 있는 통증의 감소를 보였고(P<0.001), 관절 운동 범위 (Forward flexion)는 $106{\pm}21.64$도, $143{\pm}26.63$도 증가하여 의미 있는 운동 범위의 호전을 보였다(P<0.001). 시술 4주 후 재 평가된 통증 및 관절 운동 범위는 74예(82%)에서 호전을, 13예(14%)에서는 2~5일 사이의 단기간의 호전을 보였으며 3예(4%)에서는 증식 치료 후 증상의 변화가 없었다. 결론: 회전근 개 파열의 환자에서 시행한 증식 주사 요법은 이론적으로 치유의 가능성을 증대시킬 수 있으며 실제 환자의 증상을 완화함으로써 재활의 효과를 높일 수 있는 방법의 하나로 생각된다.

• 대한약침학회지
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• 제4권2호
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• pp.95-103
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• 2001

Background : Central poststroke pain(CPSP) can occur as a result of lesion or dysfunction of the brain from stroke and may cause many difficulty in the social activities and daily life. In this study, we evaluate the clinical effectiveness of east-west medical management for CPSP through VAS(visual analogue scale), infrared themography, MBI(Moderfied Barthel Index) and Rankin scale. Methods : We treated thirty patients with oriental medical treatment method and western & oriental medical treatment method. Each group has fifteen patients of the CPSP. We evaluated their pain(characterizes tingling and burning sensation, aching, hyperalgesia, and allodynia) through VAS(visual analog scale) pain score, the skin temperature of pain site by infrared thermography and assessed their mobility & rehabilitation ability through MBI(Moderfied Barthel Index), Rankin scale before and after pain treatment. Results : The skin temperature of pain site was lower than non-pain site. The difference of skin temperature improved from $0.65{\pm}0.45^{\circ}C$ to $0.39{\pm}0.25^{\circ}C$ after oriental medical treatment and $0.68{\pm}0.54^{\circ}C$ to $0.27{\pm}0.24^{\circ}C$ after western & oriental medical treatment VAS scores improved from $7.9{\pm}1.4$ to $4.7{\pm}1.6$ after oriental medical treatment and $8.1{\pm}1.3$ to $4.6{\pm}1.2$ after western & oriental medical treatment. MBI scores improved from $61.40{\pm}13.58$ to $85.00{\pm}13.85$ after oriental medical treatment and $52.26{\pm}13.52$ to $77.13{\pm}12.04$ after western & oriental medical treatment. And Rankin scale scores improved from $3.33{\pm}0.72$ to $2.46{\pm}0.74$ after oriental medical treatment and $3.60{\pm}0.82$ to $2.66{\pm}0.81$ after western & oriental medical treatment Conclusion : The difference of skin temperature and Rankin scale scores more significantly improved after western & oriental medical treatment than oriental medical treatment. According to the results, we thought east-west medical management is very useful treatment for CPSP and rehabilitation of the patients with stroke.

• Journal of Acupuncture Research
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• 제28권1호
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• pp.65-75
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• 2011

Objectives : The purpose of this study was to evaluate the clinical effect of indirect moxibustion treatment for HIVD patients. Methods : From March 2010 to December 2010, 32 HIVD patients who admitted to Semyung oriental medical hospital were divided into two groups. Group I was treated by indirect moxibustion and general acupuncture, group II by general acupuncture. We evaluated the treatment effect of each group with the visual analog scale(VAS) and Oswestry disability index(ODI) by dividing three period(from admission day to third day after admission, from third day to sixth day after admission and from sixth day to ninth day after admission). Results : 1. Group I was more effective than group II in VAS score reducing rate at sixth day after admission and ninth day after admission but there was no statistical significance between two groups at third day after admission 2. Group I was more effective than group II in VAS improvement rate from third day to sixth day after admission but there was no statistical significance between two groups from admission day to third day after admission and sixth day to ninth day after admission. 3. Group I was more effective than group II in ODI score reducing rate at sixth day after admission and ninth day after admission but there was no statistical significance between two groups at third day after admission. 4. In ODI improvement rate group I was higher than group II, but there was no statistical significance. Conclusions : Through this research, Indirect moxibustion treatment is considered to be effective reducing pain for HIVD(Herniated intervertebral disc) patients.

• Journal of Microbiology and Biotechnology
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• 제16권11호
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• pp.1699-1705
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• 2006

Recent studies have suggested that oral bacteriotherapy with probiotics might be useful for preventing and managing childhood atopic dermatitis (AD). The purpose of this investigation was to evaluate the efficacy and safety of oral treatment with probiotics for adolescent and adult AD patients as well as for childhood AD patients. Sixty-four patients with mild to moderate AD were recruited for treatment with a mixture of four probiotic strains (Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus casei, and Biftdobacterium lactis) twice daily for 8 weeks. The degree of pruritus was determined by a 10-point visual analog scale every other week, and the patients' global assessments of their clinical responses (i.e., better, unchanged, or worse) was done at the end of intervention. The clinical severity of the eczema was evaluated by eczema area and severity index (EASI) score every other week. As laboratory markers, total immunoglobulin E (IgE), eosinophil cationic protein (ECP) in the serum, and cytokine production [interleukin-4 (IL-4), interleukin-10 (IL-10), and $interferon-{\gamma}\;(IFN-{\gamma})$ by the peripheral blood mononuclear cells (PBMCs) were measured at the beginning and at the end of intervention. Of the 64 enrolled AD patients, only 50 patients finally completed the 8-week study. After 8-week treatment with probiotics, the EASI score was significantly improved (p<0.0001), 50% of the patients experienced improvement of their eczema, and significant improvement of the pruritus was also observed (p=0.0002). The effect was more pronounced for the patients with very high IgE levels (>1,000 ku/l) or for the patients with moderate disease severity. There was no significant difference in the therapeutic effects between the childhood AD and adolescent and adult AD patients. There were no significant changes of cytokines, as well as the total IgE and ECP levels, in the patients' serum. Treatment with the mixture of four probiotic strains was generally well tolerated. Our results suggest that the treatment with the mixture of four probiotic strains is beneficial for the management of the adolescent and adult AD patients, as well as for the childhood AD patients.