• 대한두개안면성형외과학회지
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• 제20권1호
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• pp.71-74
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• 2019

Schwannoma is a benign tumor rarely found in the head and neck and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumor originating from the Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients may present with symptoms of facial palsy, but the most common presenting symptom is an asymptomatic swelling. Diagnosis is usually difficult before surgical removal and histopathological examination. We report a rare case of intraparotid facial nerve schwannoma in a 57-year-old female who had sustained a mass of the right preauricular area for 3 years. She reported no pain or facial muscle weakness. Enhanced computed tomography findings revealed the impression of pleomorphic adenoma. However, intraoperative gross findings were not characteristic of pleomorphic adenoma, and a frozen biopsy was performed resulting in the impression of a nerve sheath tumor. We performed an extracapsular surgical excision without parotidectomy. Permanent histopathology and immunohistochemistry reports diagnosed the mass as schwannoma. There were no complications including facial palsy after surgery. No recurrence was found at 6 months after surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권3호
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• pp.161-174
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• 2022

Foreign body aspiration can produce a medical emergency. Obstruction of the airways can be life-threatening, and complications may develop in less-severe cases if it is left untreated. Although it is more prevalent in children by approximately three times, adults can still experience it, and it is more frequently related to healthcare in adults. Objects used in dental treatment are usually placed in the oral cavity and can be ingested or inhaled by accident. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. However, few reports have been published on dentistry-related foreign body aspiration. This paper discusses the disease course, management, and clinical outcomes of foreign body aspiration, especially those associated with dentistry. The patient must be examined for respiratory distress. If the patient is unstable, urgent airway management and the maneuvers for removal should be performed. Radiographs and computed tomography can help identify and locate the object. The treatment of choice is often bronchoscopy, and both flexible and rigid endoscopes can be used depending on the situation. Preventive measures need to be implemented to avoid inhalation accidents given the potential consequences. Though the incidence is rare, healthcare levels need to be enhanced to avert morbidity and mortality. Radiological evaluation and bronchoscopy are vital for management.

• Imaging Science in Dentistry
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• 제52권4호
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• pp.435-440
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• 2022

Mucormycosis is a rare, invasive fungal infection that progresses aggressively and requires prompt surgery and appropriate treatment. The number of cases of mucormycosis in coronavirus disease 2019 (COVID-19) patients has recently increased, and patients with uncontrolled diabetes mellitus are particularly at an elevated risk of infection. This report presents a case of mucormycosis-related osteomyelitis of the maxilla in a 37-year-old man with diabetes mellitus. The patient complained of severe and persistent pain in the right maxilla, accompanied by increased tooth mobility and headache. On contrast-enhanced computed tomographic images, gas-forming osteomyelitis of the right maxilla was observed. Destruction of the maxilla and palatine bone then proceeded aggressively. Sequestrectomy was performed on the right maxilla, and the histopathological diagnosis was mucormycosis. Further investigation after the first operation revealed the patient's history of COVID-19 infection.

• Archives of Plastic Surgery
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• 제50권4호
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• pp.398-408
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• 2023

Background Carpal tunnel syndrome can be treated with corticosteroid injections (CIs) and surgery. In this systematic review, the influence of previous CI on different postoperative outcomes after carpal tunnel release is evaluated. Methods A systematic literature search using several databases was performed to include studies that examined patients diagnosed with carpal tunnel syndrome who received preoperative or intraoperative CIs. Results Of 2,459 articles, 9 were eligible for inclusion. Four papers reported outcomes of preoperative and four outcomes of intraoperative CIs. One study evaluated patients who received both intraoperative and preoperative corticosteroids. Conclusion Intraoperative CIs are associated with reduced postoperative pain after carpal tunnel release and support earlier recovery of the hand function that can be objectified in a faster median nerve conduction speed recovery and lower Boston Carpal Tunnel Questionnaire (BCTQ) scores. Using preoperative CIs did not lead to enhanced recovery after carpal tunnel release, and both preoperative and intraoperative CIs might be predisposing factors for infections.

• 대한정형도수물리치료학회지
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• 제28권1호
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• pp.53-60
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• 2022

Background: The aim of the study is to examine whether mediating or moderating effects of stress between teachers' work environment and work-related musculoskeletal disorders. Methods: Two hundred nine participants took part in the study and completed the surveys including work environment, stress and work-related musculoskeletal disorders questionnaires. Hayes's PROCESS macro was used to test the research models for mediating and moderating effects of stress between work environment with teachers and work-related musculoskeletal disorders. Indirect effect was tested using bootstrapped confidence intervals. Results: The result confirmed that Stress served as a indirect mediator between work environment and work-related musculoskeletal disorders, whereas there was no significant the moderating effect. Conclusion: Stress mediates the relationship between work environment and work-related musculoskeletal disorders. Therefore, it is crucial that teachers' work environment that increases stress should be enhanced to reduce work-related musculoskeletal disorders.

• 대한영상의학회지
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• 제81권5호
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• pp.1227-1233
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• 2020

윤활막육종은 주로 사지, 특히 무릎 근처에 발생하는 악성 연부조직 종양으로, 가슴벽에 발생한 경우는 매우 드물다. 저자들은 26세 여성에서 앞가슴벽에 발생한 윤활막육종의 증례를 CT 및 MRI 소견을 중심으로 보고하고자 한다. CT에서 흉막하에 위치한, 경계가 좋으며 석회화를 동반한 작은 종괴로 관찰되어, 처음에는 양성 종양으로 생각하였다. 하지만 갑자기 심한 통증과 함께 종괴의 출혈과 혈흉이 동반되어 악성의 가능성을 고려하였다. MRI에서는 다엽성 종괴 내부에 액체액체층이 보였고, 이는 윤활막육종의 특징적인 영상 소견이다.

• 대한영상의학회지
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• 제84권4호
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• pp.958-963
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• 2023

복막의 모래종암종은 장액성 암종의 드문 한 형태로서 많은 양의 모래종 형성과 인접한 주변 장기로의 침범을 특징으로 하고 있다. 이전 자궁절제술의 과거력이 있는 55세 여자 환자가 심한 복부 통증을 주소로 응급실로 내원하였고 시행한 조영증강 CT에서 복강내 석회화 종괴를 발견하였다. 양쪽 난소는 정상적으로 관찰되었으며 환자의 이전 수술력으로 인하여 이소성 골화로 생각되었다. 진단을 위해 시행한 내시경적 그물막절제를 통하여 최종적으로 일차성 복막 모래종암종으로 진단되었고 부피감량수술을 연속적으로 시행하였다. 복막의 모래종암종은 비록 드물지만 복강내 석회성 종괴 혹은 석회성 결절을 동반한 환자에게서 감별 진단에 포함되어야 할 것이다.

• Journal of Chest Surgery
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• 제55권2호
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• pp.118-125
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• 2022

Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1-3, 4-6, and 7-9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1-3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4-6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7-9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7-9 months post-ERATS (p=0.06). Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.

• Radiation Oncology Journal
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• 제29권2호
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• pp.63-70
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• 2011

목 적: 간세포암에 의한 뼈전이 환자의 방사선 조사선량에 따른 통증 감소 정도 및 전이성 병소의 영상학적 치료반응을 분석하고 고선량 방사선치료가 도움이 될 수 있는지 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2010년 6월까지 병리 혹은 임상적으로 간세포암에 의한 뼈전이로 진단받고 증상 완화 목적의 방사선치료를 받은 103명에서 뼈전이 병소 2237개 부위를 대상으로 연구하였다. 조사받은 생물학적 유효선량이 39 $Gy_{10}$이하인 경우 저선량군, 39 $Gy_{10}$를 초과하는 경우 고선량군으로 대상환자를 구분하였다. 통증 감소 정도는 숫자통증등급(numeric rating scale)을 이용하였고 통증이 감소한 경우, 통증 정도에 변화가 없는 경우, 통증이 증가한 경우로 나누었다. 영상학적 반응은 modified Response Evaluation Criteria In Solid Tumors (RECIST) 기준을 이용하였으며 환자의 생존율에 영향을 미치는 인자를 분석하였다. 결 과: 중앙추적 관찰기간은 6개월이었다(범위, 0~46개월). 저선량군에서는 67개 병소(66.3%) 부위에서, 고선량군 에서는 44개 병소(89.8%) 부위에서 영상학적 반응이 있었다 저선량군과 고선량군 사이에 영상학적 치료 반응 정도는 유의하게 차이를 보였다(p=0.02). 저선량군과 고선량군은 각각 65%와 75%의 통증 감소를 보였으나 통계적으로 유의한 차이는 없었다(p=0.24). 저선량군과 고선량군 사이에 급성 및 만성 치료 독성은 통계적으로 유의한 차이가 없었다(p>0.05). 뼈전이 진단 시부터 사망까지 생존기간은 0~46개월(중앙값, 11개월) 범위였고 1년 생존율은 41.6%였다. 잔존 간 기능(Child-Pugh 점수)이 생존율에 유의한 영향을 미치는 인자였고 Child-Pugh 점수에 따른 중앙생존기간은 A 14개월, 8와 C는 2개월로 나타났다. 결 론: 간세포암에 의한 뼈전이는 고선량군에서 영상학적 반응 정도가 더 높았다. 잔존 간 기능이 좋은 환자에게 고선량의 방사선치료 시 높은 치료 반응을 얻음으로써 삶의 질의 향상에 도움을 줄 수 있음을 알 수 있었다.

• 한국임상수의학회지
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• 제31권3호
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• pp.237-240
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• 2014

12살령의 암컷 알라스칸 말라뮤트가 후지 파행과 통증으로 내원하였다. 방사선 검사에서 요추 5번 추체 내 방사선 투과성 병변이 확인되었다. MR 영상에서 요추 5번 추체에서 T1 저신호, T2 고신호, GE 저신호 및 조영 후 T1 영상에서 이질적인 조영 증가 병변이 확인되었고, 병변은 척수까지 침입하여 척수 실질을 심하게 압박하고 있었다. 요추 6번 추체 내에서도 국소적인 방사선 투과성 병변이 확인되었으며, MR 영상에서 T1, T2 및 GE 고신호 및 조영 후 국소적인 조영 증가 병변이 관찰되었다. 심한 통증으로 안락사 후, 생검을 통해 형질세포종이 진단되었다. 척수 질환 환자에서 종양은 반드시 고려되어야 하며 영상 검사가 병변의 위치와 범위를 평가하는데 도움이 된다. 이 증례는 개 척추에서 발생한 고립성 형질세포종의 영상에 대한 유용한 정보를 제공할 것이라 생각한다.