• Journal of Trauma and Injury
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• v.18 no.2
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• pp.175-178
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• 2005

Fat embolism syndrome is a collection of respiratory, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of clinical syndrome is low while the embolization of marrow fat appears to be an almost inevitable consequence of long bone fractures. The pathogenesis is a subject of conjecture and controversy. There are two theories which have gained acceptance(mechanical theory, biochemical theory). Onset of symptom is usually within 12 to 72 hours, but may manifest as early as 6 hours to as late as 10 days. The classic triad of fat embolism syndrome involves pulmonary changes, cerebral dysfunction and petechial rash. The cornerstone of treatment is preventing the stress response, hypovolemia and hypoxia and operative stabilization of fractures. Corticosteroid are the only drugs which have repeatedly shown a positive effect on the prevention and treatment of fat embolism syndrome. We report a case of post-traumatic fat embolism syndrome with severe cerebral involvement without respiratory distress. A 55 years old female had a traffic accident. She sustained pelvic bone fracture and both humerus fracture. Approximately 4 hours after the accident, mental status change developed without a focal neurologic deficits. She had no respiratory symptom and sign. Her brain MRI showed multiple cerebral fat embolism lesion. The patients received supportive treatment with corticosteroid, albumin. Her neurologic status stabilized over several days. After orthopedic surgery, she was discharged 62 days after admission.

• Journal of Korean Dental Science
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• v.4 no.1
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• pp.14-19
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• 2011

Purpose: The aim of our study was to evaluate natural recovery of neurologic injury after minor dental surgery based on subjective neurologic evaluation. Materials and Methods: From December 2005 through July 2009, 30 patients from Seoul National University Bundang Hospital were identified as having been treated with minor dental surgery. The patients were composed of 12 men and 18 women, with a mean age of 50.6 years. The median duration of this study was 62 weeks. Results: The patients were treated by implants (17 cases), tooth extractions (6 cases), bone grafts (4 cases), inferior alveolar nerve transpositions (2 cases) and periodontal surgery (1 case) prior to the occurrence of altered sensation. Areas of altered sensation after minor surgery included the lip (36.7%), chin (30.0%) and tooth (21.7%), and at final follow-up, there was no change of ranking. Altered sensations expressed by patients included numbness (33.3%), discomfort (22.9%), relieving sense (14.6%), tingling (14.6%) and itching (14.6%). There was no change of ranking of altered sensation at the last follow-up. Patients experienced the altered sensation always (47.8%), during tactile stimulation (26.1%), when chewing food (13.0%), and talking (13.0%). Mean visual analogue scale (VAS) was $3.43{\pm}2.84$ for pain and $6.64{\pm}2.72$ for paresthesia. VAS of pain was decreased significantly between the first visit and the end of follow-up, and paresthesia also showed a significant difference. Conclusion: Altered sensations may occur at any time after minor dental surgery, but we observed that natural recovery of altered sensation occurred as time went on.

• Korean Journal of Adult Nursing
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• v.26 no.4
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• pp.393-402
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• 2014

Purpose: The aim of this study was to describe the risk of dysphagia among older adults in senior centers and to find the relationships between the risk of dysphagia and dysphagia-specific quality of life. Methods: The participants were 260 community-dwelling older adults, aged 65 years in two senior centers. Data were collected by self-report questionnaires or face to face interviews. The instruments were the modified dysphagia risk assessment scale for elderly and dysphagia-specific quality of life questionnaire. The data were analyzed using t-test, $x^2$-test, logistic regression, and pearson's correlation. Results: 162 older adults (62.3%) were classified as having the risk of dysphagia. Severe dry mouth (OR=15.677, CI=2.986~82.297), neurologic disease (OR=10.125, CI=1.092~93.899), gastritis (OR=5.731, CI=1.482~22.173), denture discomfort (OR=2.969, CI=1.016~8.677), teeth discomfort (OR=2.61, CI=1.311~5.196) were the significant factors predicting the risk of dysphagia. There is a significant correlation between the risk of dysphagia and dysphagia-specific quality of life. Conclusion: Dysphagia could be a major health problem among community dwelling older adults. It can affect the dysphagia-specific quality of life. Older adults having severe dry mouth, neurologic disease, or gastritis should receive dysphagia risk assessment and proper management on a regular basis. An effective nursing intervention needs to be developed for the older adults with risk factors of dysphagia.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.99-104
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• 2016

Purpose: There are many patients visited to ED in an alcohol intoxicated state. For these patients, it is difficult to predict by only clinical examination whether he/she would have brain lesion. The purpose of this study is to research whether it is possible to predict brain lesion by only clinical examination findings, with comparing patients with/without actual brain lesions. Methods: A retrospective study was performed at a university hospital for the period 11 months with the medical records. As for the inclusion group, head trauma patients with objectively proved drunk, judging by their blood ethanol concentration, and performed the brain CT were selected. In terms of medical record, Glasgow coma scale (GCS), the presence of neurologic abnormalities, the presence of lesion on brain CT of the patients, were examined. From laboratory results, blood ethanol concentration, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and glucose concentration were identified. Results: For this study, there were total 80 patients of inclusion group. There was no statistically significant difference in terms of GCS score and neurological examination abnormalities, between the group with brain lesion and the group without brain lesion on brain CT. Conclusion: Alcohol intoxicated patient with head trauma visits the ED, it is not possible to distinguish or determine whether brain lesion exists or not by only clinical findings. In order to check the lesion existence, the image examination, therefore, should be considered and performed.

• Journal of Korean Clinical Nursing Research
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• v.19 no.1
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• pp.57-68
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• 2013

Purpose: In assessing patients' neurological status following a stroke it is very important to have a valid tool for early detection of neurological deterioration. NIHSS is considered the best tool to reflect neurological status in patients with ischemic stroke. An education program on use of NIHSS was planned for nurses caring for these patients and the effects of the program were evaluated. Methods: The NIHSS education program (NEP) which includes online and video lectures, and practical education was provided to the nurses from April to July, 2010. To examine the effect of NEP, nursing records of patients with ischemic stroke who were admitted to a stroke center were analyzed. Two groups, a historical control group (n=100) and the study group (n=115) were included. Results: Nursing records for neurologic symptoms for each patient increased (41.0% versus 100.0%, p<.001), and especially, visual disturbance, facial palsy. limb paralysis and ataxia, language disturbance, dysarthria, and neglect symptoms significantly increased (all p<.001). Nurse notification to the doctor of patients with neurological changes increased (21.0% versus 39.1%, p=.004), and nurses' neurological deterioration detection rates also increased (37.5% versus 84.6%, p=.009). Conclusion: NEP improved the quality of nursing records for neurological assessment and the detection rate of neurological deterioration.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.137-142
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• 2003

Purpose : This study was performed to determine the sensitivity of neonatal electroencephalography (EEG) in detecting underlying brain disease, to compare the sensitivity and specificity of EEG with those of brain ultrasonography and to determine the prognostic value of EEG for neonatal neurologic diseases. Methods : Eighty-seven newborn babies were subjected to a electroencephalographic examination for the evaluation of underlying neurological diseases and EEGs were recorded at least before three days of life. The findings of early ultrasonography performed within three days after birth were compared with those of magnetic resonance imaging(MRI) or ultrasonography after seven days of life. Results : The EEG results were more sensitive and specific than ultrasonography for the detection of neonatal brain damage. The EEG results showed 91.7% sensitivity for mild grade neurological sequelae and 100.0% sensitivity for moderate and severe-grade neurological sequelae in predicting the neurological outcome. However, early ultrasonography results showed 20.8% and 18.8% of sensitivity and specificity, respectively. Conclusion : EEG is a highly sensitive diagnostic tool for detecting neonatal brain disease and is valuable for predicting the long-term outcome of neurologic sequelae.

• Tuberculosis and Respiratory Diseases
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• v.63 no.4
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• pp.372-377
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• 2007

Tuberculous spondylitis is the most common manifestation of musculoskeletal tuberculosis (TB). The progression of the disease is usually slow and insidious. The main symptom, back pain, is not specific, which frequently results in a delayed diagnosis resulting in neurologic deficits and more advanced vertebral destruction. It is more difficult to diagnose the disease if the involved area is an uncommon sites, such as the upper thoracic, cervical or sacral region. It is important to make an early diagnosis and treatment to achieve a better treatment outcome. We reported a 29 year old female with upper thoracic TB spondylitis(T2-8) and pulmonary TB complaining of back pain that persisted for 5 months and fever. TB spondylitis was not suspected to be due to upper thoracic involvement despite her pulmonary tuberculosis. Chest CT for the evaluation of pulmonary TB found T5 destruction and the paravertebral abscess that was consistent with TB spondylitis. Her spine was examined by MRI, which made an early diagnosis before the neurologic deficit had developed. She was treated with surgical intervention due to the spinal instability and anti-TB medication for 1 year with excellent results.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.88-94
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• 2007

Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and December 2002, 201 patients who underwent lumbar fusion for degenerative conditions of lumbar spine were evaluated. We studied radiologic features, the method of operation, the length of fusion, age, sex, osteoporosis, and body mass index. Special attention was focused on, preoperative radiologic features of patients who required additional surgery were studied to detect risk factors for clinical deterioration. Results : Follow-up period ranged from 3 to 11 years. In our study, 61 [30%] patients developed adjacent segment degeneration, and 15 [7%] patients required additional surgery for neurologic deterioration. Age, the postoperative delay, facet volume, motion range, laminar inclination, facet tropism, and preexisting disc degeneration of adjacent segment considered as possible risk factors. Among these, laminar inclination and preexisting disc degeneration of adjacent segment were significantly correlated with clinical deterioration. Conclusion : The radiologic degeneration of adjacent segment after lumbar fusion can be predicted in terms of each preoperative radiologic factor, age and the postoperative delay. Laminar inclination and preexisting disc degeneration of adjacent segment have shown as strong risk factors for neurologic deterioration. Thus, careful consideration is warranted when these risk factors are present.

• Korean Journal of Biological Psychiatry
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• v.3 no.2
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• pp.162-169
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• 1996

An association study with korean schizophrenic patients(N=75) and normal controls(N=87) was performed to find the relationship between D6S274 polymorphism and schizophrenia using polymerase chain reaction. Nine different alleles of a dinucleotide polymorphism on D6S273 locus were observed in both group. When we compared the frequencies of alleles between schizophrenics and normal controls, there was no significant difference between two groups. To increase homogeneity of schizophrenic group, we divided schizophrenic group by clinical phenotypes such as DSM-IV diagnostic subtype, family history, negative and positive symptoms(PANSS), soft neurologic signs(NES-K). Then we compared the frequencies of alleles among subgroups of clinical phenotypes. there was only significant difference between two subgroups on soft neurologic signs(p<0.05). Although our findings fail to provide on evidence of association between schizophrenia and D6S274 locus, follow-up investigation of this locus may be needed in homogeneous subtypes of schizophrenia and schizophrenic pedigrees.

• Journal of Trauma and Injury
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• v.25 no.1
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• pp.7-16
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• 2012

Purpose: Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management. Methods: We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications. Results: The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection. Conclusion: We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure.