• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.118-124
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• 2017

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.

• 사상체질의학회지
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• 제14권2호
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• pp.160-168
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• 2002

Spinal cord infarction in vascular impairment of spinal cord is rare in the world. and besides, because spinal cord has small cross-sectional area and almost all tract of sensory system and motor system pass away, spinal cord disease is one of the terrible diseases, that leaves usually permanent and severe neurological sequela. The case is about a patient who is 57 years old woman. Both of her legs were suddenly paralyzed and her case was diagnosed as spinal cord infarction in medical center. In our hospital, we focussed on her basic physiological condition-defecation, urination, dormitio, diet, etc. In the case of this patient, power and sense of both legs with physiolocal condition improved remarkably through Sasang Constitutional Medicine with rehabilitative therapy.

• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.143-150
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• 2021

Spinal dysraphism often causes neurological impairment from direct involvement of lesions or from cord tethering. The conus medullaris and lumbosacral roots are most vulnerable. Surgical intervention such as untethering surgery is indicated to minimize or prevent further neurological deficits. Because untethering surgery itself imposes risk of neural injury, intraoperative neurophysiological monitoring (IONM) is indicated to help surgeons to be guided during surgery and to improve functional outcome. Monitoring of electromyography (EMG), motor evoked potential, and bulbocavernosus reflex (BCR) is essential modalities in IONM for untethering. Sensory evoked potential can be also employed to further interpretation. In specific, free-running EMG and triggered EMG is of most utility to identify lumbosacral roots within the field of surgery and filum terminale or non-functioning cord can be also confirmed by absence of responses at higher intensity of stimulation. The sacral nervous system should be vigilantly monitored as pathophysiology of tethered cord syndrome affects the sacral function most and earliest. BCR monitoring can be readily applicable for sacral monitoring and has been shown to be useful for prediction of postoperative sacral dysfunction. Further research is guaranteed because current IONM methodology in spinal dysraphism is still deficient of quantitative and objective evaluation and fails to directly measure the sacral autonomic nervous system.

• Journal of Audiology & Otology
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• 제24권1호
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• pp.40-47
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• 2020

Because the psychophysical symptoms of hearing loss and dementia in the elderly are very similar, untrained healthcare professionals in dementia facilities can easily overlook a severity of hearing loss in their patients. The present study identifies their knowledge, attitudes, and practices (KAP) on hearing loss using a survey whether they may help hearing problem of the patients with dementia. A total of 29 health-care professionals responded to the KAP survey. Also, 2 family members participated. The results showed that most of the nurses and caregivers in elderly medical welfare facilities who worked with dementia patients did not have knowledge of their hearing loss. Even the facility managers did not know how to conduct hearing tests for their patients although they did recognize that some of their patients had a hearing loss. Eventually, actual practice was not possible at this moment by the professionals. However, our respondents did have a positive attitude toward screening for hearing loss and help their patients with dementia wear hearing aids if a clinical guideline was provided. We suggest to develop clear and precise clinical guidelines of the hearing screening test for the dementia patients due to the interrelationship between dementia and hearing loss. When these guidelines apply to elderly residents in a medical welfare facility, early diagnosis and treatment of their sensory loss will help alleviate their dementia as well.

• 대한청각학회지
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• 제24권1호
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• pp.40-47
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• 2020

Because the psychophysical symptoms of hearing loss and dementia in the elderly are very similar, untrained healthcare professionals in dementia facilities can easily overlook a severity of hearing loss in their patients. The present study identifies their knowledge, attitudes, and practices (KAP) on hearing loss using a survey whether they may help hearing problem of the patients with dementia. A total of 29 health-care professionals responded to the KAP survey. Also, 2 family members participated. The results showed that most of the nurses and caregivers in elderly medical welfare facilities who worked with dementia patients did not have knowledge of their hearing loss. Even the facility managers did not know how to conduct hearing tests for their patients although they did recognize that some of their patients had a hearing loss. Eventually, actual practice was not possible at this moment by the professionals. However, our respondents did have a positive attitude toward screening for hearing loss and help their patients with dementia wear hearing aids if a clinical guideline was provided. We suggest to develop clear and precise clinical guidelines of the hearing screening test for the dementia patients due to the interrelationship between dementia and hearing loss. When these guidelines apply to elderly residents in a medical welfare facility, early diagnosis and treatment of their sensory loss will help alleviate their dementia as well.

• Journal of Oral Medicine and Pain
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• 제31권1호
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• pp.59-67
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• 2006

발치 등 치과치료 후에 발생한 하악신경의 감각이상(이감각증)으로 인해 발음문제를 호소하는 환자들이 있지만, 감각신경의 이상과 운동구어능력 사이의 직접적인 관련성에 대해서는 논란이 존재한다. 본 연구의 목적은 편측 하악 신경의 마취로 인한 일시적인 감각손상이 운동구어능력에 미치는 영향을 평가하여 감각이상과 운동구어능력과의 관련성을 밝히고자 하였다. 본 연구는 단국대학교 치과대학에 재학중인 학생들 중 표준어를 구사하는 건강한 지원자 10명 (남:녀=7:3)을 대상으로 통법에 따라 우측 하치조신경, 설신경, 장협신경의 마취를 시행하였다. 주관적인 평가를 위해 대상자들은 마취전, 마취 후 30초, 30분, 60분, 90분, 120분, 150분, 180분에 마취 심도와 주관적으로 느끼는 발음불편감의 정도를 VAS로 기록하게 하였고, 운동 구어능력을 객관적으로 평가하기 위해 선택된 문장과 단어를 각각의 경과시간 마다 피검자에게 읽도록 하여 녹음하고 채취된 녹음샘플을 Computerized Speech $Lab^{(R)}$, Model 4500을 사용하여 발화속도, 교호운동력, 억양, 음성진전, 발음을 평가하였다. 실험 결과, 마취에 의한 주관적인 발음불편감 정도는 마취 후 60분에서 최고조에 이르고 이후 점점 감소하는데, 이는 주관적 마취 심도의 증감과 상당한 상관관계가 있었다. 주관적 마취 심도와 마취에 대한 발음불편감 정도에 따르는 다중선형회귀 분석결과, 연속발화기본 주파수에서만 통계학적으로 유의한 차이를 보였고 발화속도, 교호운동력, 음성진전 등 나머지 항목에서는 통계학적으로 유의한 차이를 보이지 않았다. 또한, 마취 전후 발음상의 변화도 관찰되지 않았다. 즉, 편측 하악 전달마취는 마취의 증감에 따라 주관적인 발음불편은 변화하지만, 객관적 항목에서 운동구어능력에는 뚜렷한 영향을 미친다고 볼 수는 없었다. 그러므로 편측 하악의 감각손상이 운동구어능력에 뚜렷한 영향을 미친다고 볼 수는 없는 것으로 사료된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권6호
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• pp.464-469
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• 2011

Introduction: As dental implant surgery is becoming increasingly popular, it has become one of the causes for the hypesthesia of the inferior alveolar nerve, along with other surgical procedures, such as a third molar extraction. In addition, it tends to cause legal problems between the operator and patient. Therefore, there must be a proper method that is reliable, objective and economical to assess the nerve impairment. For this reason, an attempt was made to use an Electric Pulp Tester to assess inferior alveolar nerve block anesthesia. Materials and Methods: Thirty patients were tested. Electric pulp testing of the lower jaw skin was performed at the three different times, before anesthesia, at the onset of sensory changes and after 15 minutes waiting from the onset, and on the 10 points of the chin, which produced 10 sections on the skin area. Results: Twenty seven patients (90%) could feel the electric stimulus on the chin at all 10 points before local anesthesia and the scores represent the statistical differences between the right and left points except R4 and L4. After anesthesia, the difference between the right and left points (L3-R3, L4-R4, L5-R5) increased significantly with time but two points (L2, R2) showed no significant difference. The scores on the left chin (L3, L4, L5) increased, whereas the other points (R1-R5, L1, L2) showed no significant differences. Conclusion: This study highlights the potential clinical use of an electric pulp tester for an assessment of inferior alveolar nerve impairment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.380-385
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• 2010

Introduction: The iliac crest has been the accepted place to obtain bone for reconstruction in oral and maxillofacial surgery. The iliac crest has many advantages because of its accessibility, large amount of cancellous bone, relative ease of bone harvest, possibility of two team approach and ability to close the wound primarily. This study evaluated retrospectively the morbidity of bone harvesting from the anterior iliac crest to provide a logical guide for recognizing the complications and morbidities of an iliac crest bone graft. Materials and Methods: Fifty healthy patients (mean age of 35.5 years; range 7 to 59) underwent iliac crest bone harvesting for a maxillofacial reconstruction from January 2007 to September 2009 at the Department of Oral and Maxillofacial Surgery in Kyungpook National University Hospital. Age, sex, size and kind of grafted bone, duration of pain on donor site, duration of gait disturbance, sensory deficit, scar, contour defect were measured in each patients by retrospective research. Results: The mean duration of pain is 6.7 days, and mean duration of gait disturbance is 7.2 days. Most patients were free from gait disturbances and pain within 2 weeks and there was no correlation between the size of the harvesting block bone and the duration of gait disturbance or pain. However, this study showed that the duration of pain is associated with gait disturbance. In addition, most patients had no complaints regarding their surgical scar and contour defect, and only one patient had permanent impairment of the sensory function. Moreover, an iliac bone graft did not extend the length of hospitalization. Conclusion: This study suggests that split thickness bone harvesting from the inner table of the anterior iliac crest is a well accepted procedure with relatively low morbidity.

• 한국임상약학회지
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• 제22권4호
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• pp.356-366
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• 2012

Background: Chemotherapy-induced peripheral neuropathy (CIPN) involving sensory and motor nerve damage or dysfunction is a common and serious clinical problem that affects many patients receiving cancer treatment. This condition may pose challenges for the clinician to diagnose and manage, particularly in patients with coexisting conditions or disorders that involve the peripheral nervous system. Many chemotherapeutic agents used today are associated with the development of serious and dose-limiting CIPN that can adversely affect the administration of planned therapy and can impair quality of life by interference with the patients' activities of daily living. The most important clinical objective in the evaluation of patients with CIPN is to determine their level of functional impairment involving activities of daily living. These findings are used to make medical decisions to continue, modify, delay, or stop treatment. The most commonly reported drugs to cause CIPN include taxanes, platinum agents, vinca alkaloids, thalidomide, and bortezomib. We aimed to determine PN incidence during cisplatin, carboplatin and oxaliplatin administration. Methods: We collected data from 125 patients who received at least one cycle of cisplatin, carboplatin or oxaliplatin. They completed a self-reported questionnaire and items related to their disease and peripheral neuropathy. The investigators filled in part of items about disease and treatment. Patient Neurotoxicity Qeustionnaire developed by Bionumerik company were applied for PN assessment. Results: The incidences of sensory neurotoxicities of cisplatin, carboplatin and oxaliplatin were respectively 23%, 56% and 50%. The incidences of motor neurotoxicities of cisplatin, carboplatin and oxaliplatin were respectively 18%, 42% and 19%. The incidences of severe neurotoxicities of cisplatin, carboplatin and oxaliplatin were respectively 13%, 28% and 14%. The incidences of PN were associated with cumulative dose but not age, gender and concurrent illness. 19.2% of the patients (24/125) were prescribed with gabapentin, nortriptyline or gabapentin plus nortriptyline to reduce these peripheral symptoms and 75% of the patients answered the drug were effective. Conclusion: Incidence of PN after cisplatin or oxaliplatin administration is cumulative dose-related. Physician-based assessments under-reported the incidence and severity of CIPN. To overcome this limitation, diagnostic tools specifically designed to assess peripheral neuropathy severity associated with chemotherapy must be developed.

• 디지털콘텐츠학회 논문지
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• 제19권4호
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• pp.615-620
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• 2018

당뇨병성 다발성 신경병증 환자들을 진단하는 전류지각 역치 시험과 진동 감각 지각 역치의 임상학적 유용성에 대한 평가는 당뇨병성 다발성 신경병증에 대한 진단방법 중의 하나이다. 현재까지 당뇨병성 다발성 신경병증 환자들에 대해 몇 가지 방법들이 사용되어 왔는데, 예를 들면, 하지 신경병증 장애 시험, 신경전도 시험, 냉각감지 역치 시험, 열-고통 역치 시험 등을 들 수 있다. 그러나, 이들 대부분의 시험은 고가이거나 시험하는데 많은 시간을 필요로 한다. 본 논문에서는 진동 감지 능력을 평가하는 새로운 기구가 소개되고, 이를 위해 환자의 말초 신경을 자극하는 보이스 코일 모터(voice coil motor)와 전류 증폭기를 제작하였다. 또한, 당뇨병성 다발성 신경병증 환자들의 정량적 진동 감지 수준을 측정하기 위하여 진동 감지 역치 시험을 센싱하고 구동하는 소프트웨어가 개발되었다.