• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.1
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• pp.74-91
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• 2005

척추의 기본적인 생체 역학적 기능은 신체 부분간의 운동을 허용하고 척수와 신경근을 보호하는 것으로서 이러한 기능을 수행하기 위해서는 척추의 역학적 안정성이 필수적이다. 척추의 안정체계는 수동적 근 골격계, 능동적 근 골격계, 그리고 신경계의 세 가지 하부체계로 나누어지며 이들 하부체계는 각각 독립적으로 안정성에 관여하고 있다. 경추의 불안정성의 문제는 비정상적으로 증가된 추간관절의 운동에 의해 염증성의 신경을 압박 또는 신장하거나 또는 통증수용기가 많이 분포하는 인대, 관절낭, 섬유륜과 종판에 비정상적인 변형을 일으키는 것을 말한다. 안정성의 장애는 근육의 기능적 측면에서 국소적 안정체계와 포괄적 안정체계의 문제로 구분할 수 있다. 불안정한 경추 환자의 임상적 양상은 일반적으로 머리가 앞으로 나오고 전방 전위된 자세로 견갑대와 승모근 상부의 과활동성을 나타낸다. 또한 능동운동은 감소되지 않으나 수동운동에서 분절의 회전운동과 병진운동의 증가와 종말감의 변화가 있다. 경추의 불안정성을 관리하기 위한 실험적 연구로 전반적인 근육 훈련, 고유수용기 훈련, 그리고 도수치료의 세 가지 주된 접근법이 있고 실제적인 접근법으로는 고유수용성 재활프로그램, 칼텐본-에반스 접근법, 그리고, 슬링운동법 등이 있다. 각 방법들은 임상에서 나름대로의 이점이 있으며 환자의 상태에 따라 이들 방법을 단독으로 또는 병행해서 적용할 수 있을 것이다. 그러나 경추에서 이러한 방법들의 효과를 입증하는 증거는 부족하여 앞으로 이러한 방법에 대한 임상적 경험보다는 그 효과를 입증할 수 있는 연구가 필요하다고 본다.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.69-73
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• 2005

This report describes a case of spinal nerve root compression due to an acute inflammatory granuloma after lumbar surgery. A 39 year-old man with a history of increasing back pain with a 3-week duration was diagnosed with a herniated intervertebral disc (HIVD). The diagnosis of a HIVD was confirmed by magnetic resonance imaging (MRI) with indications for surgery. A discectomy and a partial laminectomy was performed and the symptoms were alleviated immediately after surgery for a five-day period. However, a slowly progressing pain was subsequently noted along a different dermatome. There was no pain relief despite the patient being given pharmacological treatments, combined with an epidural steroid injection. The follow up MRI images showed severe compression of the nerve roots by a epidural lesion. Another procedure was performed 17 days after the initial operation. The lesion responsible for the compression of the nerve roots was found to be an acute inflammatory granuloma. The pain was relieved after the second procedure and there were no other symptoms or neurological problems. This case is remarkable in that a granuloma formed relatively quickly and grew to such a size that it was able to severely compress the surrounding nerve roots.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.449-453
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• 2007

Trigeminal neuralgia is defined as "a sudden, usually unilateral, brief stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve" by the International Association for the Study of Pain(IASP). Trigeminal neuralgia is classified as an idiopathic trigeminal neuralgia with no apparent cause and a symptomatic trigeminal neuralgia which is caused by a structural lesion such as brain tumor. Over 80% of the tumors are meningioma, acoustic neuroma, and epidermoid tumors. Symptomatic trigeminal neuralgia can not be excluded even if old-aged patient does not have abnormal neurologic sign and symptom, and good response to pharmacotherapy. Therefore, initial examinations such as MRI or CT are essential to exclude symptomatic trigeminal neuralgia. When compared with CT, MRI, especially gadolinium enhanced MRI, has an increased sensitivity in the detection of intracranial lesions. The most effective medical treatment of trigeminal neuralgia is carbamazepine. The most common side effects of carbamazepine include drowsiness, dizziness, unsteadiness, nausea, anorexia. Hepatotoxicity, bone marrow depression are the most feared side effect of carbamazepine therapy but occurs rarely. It require periodic complete blood cell counts as well as hepatic and renal function tests. It has been recommended that complete blood cell counts is done every 2 weeks for the first 2months and then quaterly thereafter. Oxcarbazepine can be used if neutropenia occurs.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.10
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• pp.303-308
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• 2019

Non-traumatic acute myelopathy caused by cervical disc herniation is rare. To date, no case has been reported to be caused by extrusion cervical disc herniation, unrelated to patient posture during surgery. Here, we report the case of a 65-year-old male patient with cervical myelopathy who underwent subsequent arthroscopic rotator cuff surgery under general anesthesia; non-cervical spine surgery. Ed. Notes: I am unable to understand the insertion of the highlighted phrase. Please delete if not required, or revise the sentence appropriately. Patient showed acute postoperative tetraplegia in spite of optimal anesthetic management. He showed no limitation of neck movement at pre-operative airway evaluation, and had no history of trauma to the cervical spine. During surgery, there had been no overextension or twisting of the neck, including at the time of anesthetic induction by tracheal intubation. However, cervical disc herniation causing spinal canal cord compression was detected in the postoperative magnetic resonance imaging, which probably resulted in tetraplegia of the patient. Motor and sensory functions were recovered after 21 days of conservative treatment, including steroid pulse intravenous therapy without any surgical intervention. In this report, the disease is described after reviewing other reported cases; furthermore, we also discuss the pathophysiology of the disease. Based on our report, we propose that under general anesthesia, clinicians should pay attention to the possibility of pre-existing cervical disease, even in non-cervical spine surgeries of geriatric patients.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.159-166
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• 2009

Purpose: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique Materials and Methods: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O'Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. Results: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was $3^{\circ}$(range: $0^{\circ}\sim25^{\circ}$), the mean flexion was $137^{\circ}$(range: $130^{\circ}\sim140^{\circ}$), the mean pronation was $69^{\circ}$(range: $45^{\circ}\sim90^{\circ}$) and the mean supination was $78^{\circ}$(range: $45^{\circ}\sim90^{\circ}$). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. Conclusion: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.

• Journal of Veterinary Clinics
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• v.27 no.5
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• pp.588-592
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• 2010

A 15-year-old neutered male Yorkshire terrier was presented with a gait disorder of the pelvic limbs. For differential diagnosis of neural disease, magnetic resonance imaging (MRI) and computed tomography (CT) scan were performed. CT showed bone defect in the 4th lumbar vertebra and adjacent soft tissue mass. MRI revealed a mass in left side of the 4th lumbar vertebra. The mass was uniformly enhanced on contrast-enhanced T1-weighted imaging (T1W1). Excision of the mass alleviated back pain. Vertebral osteosarcoma was identified by the histopathological examination. Therefore, CT and MRI were helpful to diagnose vertebral osteosarcoma in the dog and to plan surgical excision of the mass.

• Journal of Veterinary Clinics
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• v.31 no.3
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• pp.237-240
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• 2014

A 12-year-old, intact, female Alaskan malamute presented with severe spinal pain and hind limb lameness. On radiographs, a round, demarcated lytic lesion was identified in the central fifth lumbar vertebra. On magnetic resonance imaging (MRI), the lesion involving the spinal cord appeared hypointense on T1 weighted, hyperintense on T2 weighted, heterogeneously enhanced on post-contrast T1 weighted, and hypointense on GE images. A focal, small, ill-defined, lytic lesion was also observed radiographically in the sixth lumbar vertebra, it appeared as a focal hyperintense lesion on T1 weighted, T2 weighted, and GE images and showed focal enhancement on post-contrast T1 weighted images. She was euthanized owing to extreme pain and severe and progressive clinical signs; a plasmacytoma was histopthologically diagnosed. This report presents an unusual type of spinal tumor, plasmacytoma. MRI is a useful modality to evaluate the anatomic location and extension of spinal lesions.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.3
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• pp.171-176
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• 2021

Pneumomediastinum is a very rare and potentially catastrophic complication of dental procedures. Its common causes are tooth extraction, endodontic treatment, and subgingival curettage using handpieces and high-pressure air/water syringes. We present a case of massive pneumomediastinum with subcutaneous emphysema in a 61-year-old female who underwent bone grafting into the maxilla for pretreatment of dental implantation using a syringe. The patient suffered from abrupt severe odynophagia and loss of consciousness. The patient transferred to emergency department and images work-up revealed a pneumomediastinum and subcutaneous emphysema on the entire face and neck. We performed conservative treatments including prophylactic antibiotics, oxygen inhalation, and fasting meals, and then discharge after 7 days uneventfully. The patient's syncope might be resulting from hypotension and pain shock induced by pneumomediastinum with a sudden chest compression. The pneumomediastinum could be resulting from concurrent perforation and massive air infiltration into the maxillary sinus during bone grafting. We suggest that pneumomediastinum needs prompt diagnosis and management because of the risk of airway obstruction when a patient present syncope in the dental room.

• Journal of the Korean Society of Radiology
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• v.85 no.3
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• pp.654-660
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• 2024

Primary malignant fibrous histiocytoma (MFH) is a malignant tumor of mesenchymal origin that rarely occurs in the urinary tract, particularly in the urinary bladder. Unlike urothelial carcinoma, which accounts for most bladder cancers, it occurs in the submucosal portion of the bladder wall and consists of the lamina propria, muscularis propria, and adventitia. It is presumed to originate from poorly differentiated pluripotent mesenchymal cells in which fibroblasts and histiocytes are partially differentiated. Radiologically, it is known as the "non-papillary tumor" and is commonly diagnosed as a large mass without necrosis, which shows invasion beyond the muscularis propia. Although the prognosis of this rare malignancy depends on pathological parameters, it generally has a poor prognosis with high local tumor recurrence. Here, we present a case of primary MFH in the urinary bladder with clinical symptoms of lower abdominal pain without gross hematuria that recurred rapidly and showed an aggressive disease course.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.279-281
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• 2009

A 38-year old man was admitted to our hospital due to a $5{\times}6cm$ sized pulsating mass in the right neck. He suffered from intermittent neck pain and hoarseness for two months due to the rapidly growing mass. The radiological examinations revealed an aneurysm of the right common carotid artery near the bifurcation, and it was compressing the internal and external carotid arteries. Endarterectomy of the right internal carotid artery, aneurysmectomy of the right common carotid artery and graft interposition were done, while the cerebral circulation was maintained by an internal shunt. Intraoperative injury to the nerve tissue around the aneurysm was avoided. He was discharged on the postoperative 7th day without any complications.