• The Korean Journal of Pain
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• 제8권1호
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• pp.159-163
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• 1995

Accidental high epidural block is a rare but serious complication. It can result from many factors, which include the volume and concentration of drug, posture, puncture site, age, pregnancy or intra-abdominal mass, and patients' height and weight. We had a case of accidental high epidural block recently. This is a case report which was confirmed by an epiduragram. A healthy 50-year-old woman with a huge uterine myoma was scheduled for a total abdominal hysterectomy under continous epidural analgesia. Epidural catheterization was carried out smoothly. However, an unexpected hypotension was noticed after an epidural injection of 2% lidocaine 25 ml. Thereafter, the patient was intubated and her respiration was controlled during the operation. Using the 5mg of ephedrine, her blood pressure and pulse were well maintained. The scheduled operation was carried out for one hour uneventfully, but after the operation, she felt paresthesia on her hands in the recovery room. To differentiate between the high epidural and the subdural blocks. We injected 5 ml of a water soluble Niopam 300 through the catheter postoperatively. It was observed on the epiduragram that the catheter was placed in the epidural space. It was suggested that the high epidural block was induced from the widespread diffusion through the narrowed epidural space due to the engorgement of the epidural venous plexus by the patient's huge uterine myoma.

• The Korean Journal of Pain
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• 제20권1호
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• pp.50-53
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• 2007

Background: Continuous epidural catheterization is a popular and effective procedure for postoperative analgesia. However, continuous epidural catheterization has associated complications such as venous puncture, dural puncture, subarachnoid cannulation, suboptimal catheter placement, and paresthesia because the tip of the epidural catheter touches thenerves of the dura in the epidural space. In this study, we compared the incidence of paresthesia in two different lengths of epidural catheter insertion. Methods: One hundred women undergoing gynecologic or orthopedic surgery were enrolled in this prospective, double-blinded, randomized study. All patients were randomly divided into two groups based on the insertion length of the epidural catheter 2 cm (group A) or 4 cm (group B). A Tuohy needle was inserted in the lumbarspinal region with a bevel directed cephalad by use of the median approach, and then the epidural space was confirmed by the loss of resistance technique with air. While the practitioner inserted an epidural catheter into the epidural space, a blind observer checked for paresthesia or withdrawal movement. Results: In 97 included patients, 30.6% of the patients in group A (n = 49) had paresthesia, versus 31.3% in group B (n = 48). Withdrawal movements were represented in 2% and 6% of the patients in group A and group B, respectively. There was no difference in the incidence of paresthesia and withdrawal movement between the two groups. Conclusions: There is no clear relationship for the incidence of catheter-related paresthesia according to the catheter length inserted into the epidural space for epidural analgesia.

• 대한통합의학회지
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• 제9권4호
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• pp.85-89
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• 2021

Background : Klippel-Trenaunay-Weber syndrome (KTS) is a rare congenital medical condition characterized by complex vascular malformation. KTS consists of a classic triad of capillary malformation (hemangioma), venous malformations and bone or soft tissue hypertrophy causing limb asymmetry. The aim of this report is to describe management for gait disturbance and foot pain in a Patient with KTS using custom-made total contact insole. Case presentation : A 32-year-old man with KTS presented with a 3-year history of gait disturbance on hard surface due to right first toe pain and Achilles tendon tightness. The patient had soft tissue hypertrophy, varicose veins and port-wine stains over the right lower limb associated with KTS. True leg length discrepancy was 2 cm. We prescribed custom-made total contact insole to protect his deformed foot and correct leg length discrepancy. The insole of right side included wedge shaped heel lift and the insole of left side included full length lift to add extra support on unaffected side. Also, we provided compression stocking and physiotherapy including manual lymphatic drainage for lymphedema and stretching exercise for tightness in right lower extremity. At 3 years follow-up, postural alignment including pelvic obliquity was improved using a custom-made total contact insole. The degree of scoliosis and foot pain were also reduced. Conclusion : An individualized and multidisciplinary approach is essential regarding the complexity of comorbidities in patients with KTS. For patients with KTS, orthotic management should be considered to prevent and correct deformities related to KTS. Active orthotic management, compression stocking and physiotherapy can enhance the quality of life and function in patients.

• 한방안이비인후피부과학회지
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• 제14권2호
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• pp.194-197
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• 2001

Progressive pigmented purpuric dermatosis(Schamberg's disease, purpura simplex) is an uncommon eruption characterized by petechiae and patches of brownish pigmentation, particularly on the lower extremities. Lesions remain for months or years and present only a cosmetic problem. there is no hematologic disease, venous insufficiency, or associated internal disease. The most characteristic feature is orange brown, pinhead-sized "cayenne pepper" spots. It is hard to find similar disease in Oriental Medicine, however it could be though related with 瘀血. We observed and treated a 25 old female with progressive pigmented purpuric dermatosis on her lower extremities, without pain and itching sign. About 1 year after our treatment, herb-medication. acupuncture treatment, negative therapy and applied aroma oil in order to remove the 瘀血(a kind of congestion) & inner heat and promote the circulation of her blood, the area of pigmented purpuric dermatosis was decreased remarkably and the colour was lighter. She is been treated continuously now and satisfied with the efficacy of treatment.

• 혜화의학회지
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• 제10권1호
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• pp.157-166
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• 2001

Oryoungsan which first recorded in Sanghanron, the clinical medical book consists of treating acute febrile disease according to its change, is one of the frequently used oriental medicines. these days, it has been prescribed in symptoms accompanied by edema mostly. therefore it is easy to consider it as a type of diuretics. In Sanghanron it was originally used in the symptoms of perspiration, decreased urine volume, thirsty, flatulence. these symptoms indicate loss of body fluid and the prescription which orders "taking warm water sufficiently" supports this. On this background, it is supposed that Oryoungsan treats dehydration after providing water and electrolytes. To consider that herbal medicines consisted of Oryoungsan make electrolytes go out of the body, The healing mechanism of dehydration doesn't meet this. Because Oryoungsan was used in condition of fever or in similar condition, it is more resonable to understand that restoration of increasing blood flow to the subcutaneous venous plexus regulating body temperature in febrile condition into body circulation, resulting into maintaining main blood volume and into treating decreased urine volume and thirsty is Oryoungsan's function in the dehydration or febrile condition. That is, symptoms are decreased or disappeared through restoring unbalance of internal body fluid. The other target is pain controls, especially chronic headache, facial pain and trigeminal neuralgia. it is suggested that the function of pain control of Oryoungsan is related to 5-HT(5-hydroxytrypamine), nerve transmitter in the endogenous analgesic system. Moreover it is also suggested that Oryoungsan is relate to 5-HT, considering the fact that gastroparesis, a symptom of cyclic vomiting syndrome treated with 5-HT1D receptor agonist is similar to the 'bi', symptoms appeared in the Oryoungsan-related disease.

• Journal of Chest Surgery
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• 제43권6호
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• pp.764-768
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• 2010

상지의 정맥 시스템에 발생하는 정맥류는 아직까지 정확한 병인이 규명되지 않은 매우 드문 양상의 질환이다. 일반적으로 정맥확장증은 방추형 혹은 주머니 모양의 정맥 확장을 의미하여, 독립적으로 상완에 발생한 정맥확장증은 통증이 없는 미용적 문제나 통증, 움직임의 제한, 인접 장기의 압박 소견, 출혈, 혈전 및 소모성 응고병증 등을 야기할 수 있다. 이에 저자들은 상완에 발생한 정맥확장증을 간략한 문헌 보고와 함께 상기 질환을 보고하는 바이다.

• 한국산학기술학회논문지
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• 제10권9호
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• pp.2451-2459
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• 2009

통증이 거의 없는 새로운 모세혈액 채혈기법인 진공자동채혈법(vacuum assisted auto-lancing)의 정확도를 분석하고자 전형적인 대체부위인 전완(팔) 부위에서 채혈하여 측정한 혈당값을 표준 채혈부위인 정맥 및 손가락에서 채혈하여 측정한 혈당값과 비교, 분석하는 연구를 수행하였다. C대학교병원을 내원한 531명의 환자들을 대상으로 왼손 집게손가락 끝과 왼쪽 전완 부위에서 말초혈액의 혈당을 측정하였고, 곧바로 정맥 채혈하여 혈당을 측정하였다. 전완 부위 혈당 평균값이 손가락보다 정맥 혈당값에 더욱 가까웠으나 이들 간의 차이는 약 10 mg/dL 범위에 불과하여 임상적으로는 동일한 값들로 볼 수 있었다. 측정값들 간에 상관분석을 수행한 결과 손가락과 정맥 채혈의 혈당값 간의 상관계수는 0.94, 전완 부위와 정맥 혈당값 간의 상관계수는 0.92, 또한 전완 부위와 손가락 채혈 간의 상관계수는 0.94로 모두 매우 유의한 상관관계를 보였다(p<0.001). 따라서 대체부위인 전완 부위 혈당검사의 정확도가 실험적으로 입증되었다. 손가락 혈당검사는 상당한 채혈 통증이 수반되어 당뇨 환자들이 자가 검사를 기피하는 주요 원인이 되지만, 전완 부위에서 진공자동채혈하면 통증이 거의 없으므로 만성 당뇨환자들의 자가 질환관리를 위해 매우 유용하리라 기대된다.

• Journal of Chest Surgery
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• 제35권6호
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• pp.483-486
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• 2002

71세 남자 환자로 좌측 총장골 동맥의 완전 폐쇄를 동반한 복부 대동맥류로 수술하였다. 술 전, 좌측 대퇴 및 장골 정맥에 동반된 만성 심부정맥 혈전증은 진단하지 못 하였다. 동맥류 절제술 및 우측은 외측 장골동맥에, 좌측은 대퇴동맥에 문합한 Y-graft 치환술과 대퇴동맥간 우회술을 시행하였으나, 술 후 반복적인 부종과 통증이 발생하였고 점차 악화되어 결국 광범위한 정맥 혈전증으로 사망하였다. 본례는 만성 심부정맥 혈전증을 동반한 폐쇄성 대동맥 장골 동맥 질환에 있어 수술적 치료 및 합병증에 관한 보고이다.

• Journal of Digestive Cancer Research
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• 제1권2호
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• pp.108-110
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• 2013

전체 정맥혈색전증 환자의 20% 이상이 암과 관련이 있고, 암 환자에 있어 혈색전증은 두 번째 사망 원인으로 작용하고 있어 이에 대한 효과적인 예방과 치료가 사망률을 감소시킬 수 있는 것으로 알려져 있다. 혈색전증 진단에 있어 혈액검사로 D-dimer 측정 및 영상검사로 도플러 초음파, 전산화단층혈관 촬영술을 사용한다. 치료 약제로 경구 비타민 K 길항제가 사용되었으나, 최근에는 정기적인 모니터링이 필요하지 않은 약제들이 새롭게 사용되고 있다. 저자들은 진행성 위암환자에서 발생한 하지 심부정맥 혈전증 및 폐동맥 혈색전증에 있어 저분자량 헤파린을 투여하며, 호전된 사례를 문헌고찰과 함께 보고하는 바이다.

• 대한물리치료과학회지
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• 제4권3호
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• pp.475-489
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• 1997

Connective tissue massage(CTM, Bindegewebs massage) are developed and named by Mrs. Elizabeth Dicke, a German physical therapist. The CTM is used primarily for internal disorder such as myocarditis, coronary insufficiency, high blood pressure, functional stomach and intestinal disorders, inflamma-tion of the gallbladder, and hepatitis, arterial circulatory problems, venous disorders, headache, particularly trauma to the head, and some gynecologic disorder, etc. Which is performed with special stroking technique of the subcutaneous tissue of the trunk, extremities, and face. The mechanism of effectiveness of CTM is based on a viscerocutaneous reflex. The stroking stimulates the nerve end-ings of the autonomic nervous system. The impulses activated by stroking travel to the sympathetic trunk and the spinal cord and brain, which causes a change in reaction susceptibility. The most important for apply CTM is necessary to know the reflex zone (Head's zone, Mackenzie's zone and Dicke's connective tissue zone). Dicke's connective tissue zones are only found by the special dia-gnostic stroking. Because the connective tissue zones no discomfort when unmanipulated, and thus the patient is unaware of them. It is characterized by diagnostic stroking that causes a sharp pain in the tissue. As a general rule, all treatment are preceded by the basic stroke from the level of the coccyx to the first lumbar vertebra and each stroke is done three times. The right side is done first, then the left side.